Welcome to the OPL Center PTSD Blog

May the offerings here support your healing journey and move your life forward into hope and purpose.

Control is Critical

child“Make sure you got clean underwear”, she always said, “in case you get in an accident” & I always figured that’d be the least of my worries, but now I’m older & I see there’s a lot you can’t control & some you can control & clean underwear is one of the you can.

for the most part.”

 

Control is the need to feel power after having been powerless for so long.  Notice that there are already many parts of your life where you have real control. You can decide what you wear.  You can decide to brush your teeth.  You decide when to eat.  These all are part of the healthy control that you can exercise on your own behalf.

Overcoming your sense of helplessness is key to overcoming post-traumatic stress. Trauma leaves you feeling powerless and vulnerable. It’s important to remind yourself that you have strengths and coping skills that can get you through tough times – beginning with the strengths you used to survive your trauma.  Be sure to review your entire life as you mine for strengths.  Many strengths have been there for years, and some may be more recent.

If you have a trusted care-giver who is helping you on your healing journey, consult with this person about the bigger decisions.  At first, after a trauma, the “pause-and-plan” part of your brain (often called the executive function) is often upstaged by the protective fight or flight part.  Therefore, your caregiver might be better positioned to advise you on bigger choices for now.  Choices like selling your house/car, going to a safe house, choosing a therapist or a treatment program might not be wisely done on your own just for now.  There’s a cartoon in our PTSD Handbook that jokingly refers to this, created by John McPherson:

thinking

“Mr. Carlton here will handle your thinking until your brain has healed enough from your surgery to think for itself.”

 

Many times, I’ve welcomed a prospective client and their family member to come and see if the work at the On Purpose Living Center is a good fit for them, and I trust the caregiver’s opinion.

For now, enjoy and exercise the areas where you have healthy control of your life.  Connect with a trusted loved one to support your bigger decisions just for now. Gradually, as you heal, you will be able to engage more and more of the inherent strengths that you possess, and you life will be good again.

One step at a time, just for now, eat well, rest well, exercise gently.  You will heal in time.

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Frozen isn’t just a Movie

N92-440249Of the fight – flight – or freeze responses to an assault, it seems most difficult to reconcile the freeze response. “Why didn’t I run” “Why didn’t I fight harder” “I always thought I’d be stronger and more resistant to an attack”. The truth is, that you probably chose the wisest option, given your circumstances.

When we are hugely threatened, we first mobilize vast energies to protect and defend ourselves. Our entire nervous system engages to help us fight or run. But, and here’s the kicker, if those actions are ineffective, we freeze or collapse.

People who study wild animals call this response tonic immobility – what we often call “playing possum”. In truth, when an animal goes into the freeze state, it isn’t “playing” at all, it is using the last resort to buy time to escape. (See a video example here.)

Dr.Stephen Porges is a Professor in the Department of Psychiatry and the Director of the Brain-Body Center in the College of Medicine at the University of Illinois at Chicago. He has done extensive work on the neurological aspects of trauma responses. He explains that when we experience a threat and all strategies of “escape” appear exhausted, a sense of helplessness sets in and we revert or “fall back” on our oldest neural structures. Evolutionarily speaking, “immobilization” in the face of a life threat is the oldest strategy.  He explains, when people are scared to death, they are not “hyper-mobilized” so much as they are “immobilized.”

We experience this frozen state as helpless terror and panic. It is crippling and fixates on the experience of the trauma. This state of shutdown and paralysis is meant to be temporary.  Many humans remain stuck in a kind of limbo where their window of tolerance to feeling unsafe narrows, and their preferred trauma response, in this case freeze, becomes their default “setting” to a wide variety of situations.  Even actions that normally are pleasant, like having sex, can easily and unexpectedly become a moment of frigidity, revulsion or avoidance.  Survivors often remain wary, phobic of being seen, and experience many panic attacks.

An interesting study published in the Journal of Biopsychology in 2011 explored this tonic immobility in humans. Authors of this study measured biological responses to reading of each patient’s trauma story and found that there were restricted areas of body sway and were correlated with accelerated heart rate and diminished heart rate variability, implying that tonic immobility is preserved in humans as an involuntary defensive strategy.

Here’s the interesting part: they found that the same tonic immobility  seemed more evident in PTSD patients, suggesting that, in some patients, tonic immobility may be elicited during re-experiencing episodes in daily life.

Many people who have suffered a trauma don’t recognize that several hours on the couch after a trigger may very well be their tonic immobility kicking in.  As with all trauma survival strategies, it may have saved your life, and it is no longer useful, and even intrusive on your present day life.

The way out is to gently help the body out of that frozen state into more mobility, even if the first step is to just wiggle a toe or a nose.  Working with a trauma therapist that is aware of the physiological aspect of traumatic stress will help you move forward into your future with ease and grace.  The brain has enormous ability to rewire, and will do so given a chance.  That’s where self calming is so critical to a healing journey.  To be able to slow one’s breathing, lower one’s heart rate and get your own pause-and-plan system working for you gives the ancient reptilian part of the brain to come out of default position and back to a last resort place.  You can heal, with gentleness, tenderness and kindness toward yourself and toward your body.

For more information on the physical aspects of this freeze response, check out Dr. Levine’s material at his Somatic Experiencing web site.

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Choose Fight or Flight

The best known responses to stress are  fight and flight.  There are many biological changes that occur when one is fearful, all of which pretty much take the thinking brain off-line.

“Although the word fear is hard to define, everyone knows how it feels to be afraid. The physiological response to fear is called the ‘fight or flight’ response, or the ‘acute stress response’, and was first described by the American physiologist Walter B. Cannon in the 1929. The response is caused by the actions of adrenaline, noradrenaline and the steroid cortisol, whose release is triggered by the sympathetic branch of the autonomic nervous system: heart rate increases and breathing speeds up; pupils dilate to let in more light, enabling one to see better; metabolism of fat and glucose in the liver increase to provide the energy that might be needed to escape; production and release of endorphins is stepped-up; and the brain’s decision-making centers become primed for action.”  

( quoted from “The Neurobiology of Fear” )

The decision-making areas that light up are focused on where to run, or the best next punch to deliver. This is not a time to figure out how to pay the bills, or change the tire – these are different areas of the brain that pretty much stay on the side-lines.  Many people contrast the fight-or-flight chemistry with the pause-and-plan chemistry which has that thinking brain fully operative.  Your healing journey can result in more pause-and-plan moments, really.

Fear can broadly be characterized into two types. Conditioned fear is the process by which any insignificant and otherwise harmless stimulus becomes, by association, a sign of danger. The association between an innocuous stimulus and a fear response can easily be learned. For trauma survivors, any stimulus/trigger that resembles any aspect of the trauma creates the fear chemistry (adrenaline and cortisol) and results in the person’s preferred response to fear. This includes colors, sounds, smells, shapes as well as environments, words, and situations that may or may not seem to be connected to your trauma.  You don’t have to figure out why a trigger sets off a fear response, you just need to be aware that it has.

We do have unconditioned fear which is not learned, but, rather, is ‘instinctive’, and can be regarded as an evolutionary gift – we sometimes fear what our ancestors feared. Most people find an unfounded fear of spiders, snakes, rodents, curious, and very real. We probably also fear tigers, grizzly bears, green-scum water – very good idea!

As the fight response becomes a life plan or schema, the person becomes fight vigilant.  This can. then, express as being angry, judgmental, mistrustful, self-destructive, controlling,needing to control, and also suicidal, when the fight is directed against the self.

When the flight response becomes a pattern, the person keeps themselves at a distance, and may suffer from a small social circle and rare authentic or long lasting relationships.  This person runs away from conflict, feels ambivalent and cannot commit, and may have addictive problems or eating disorders.

If you find yourself in either of these patterns, realize that the life-affirming reason you have chosen this pattern has more to do with your original vital strategy for surviving your trauma, and that choice has become habitual.  The more you are aware of what choices you made, and what choices you are making today, the more you build a bridge from yesterday’s wisdom into your own present day wise self, who can now make fully informed decisions for your safety and happiness.

The over-riding question to ask yourself is “who is showing up today?” My current, safe self, or my past trauma Self.  The more you can help yourself know who is standing in your shoes, the more choices you have about your life.

You can heal in your own time, in your own way, one step at a time.  What step are you willing to take today?

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Trauma induced “Multiple Personalities”

While most people have several “selves” they can identify such as my corporate self or my pouty self – trauma survivors have a full set of Selves that help them go on with their lives.  When a first trauma occurs, the personality splits into a “Going-on-with-life” self, and a “Traumatized” self.  After the first trauma, if it occurs when the person has both internal and external resources, 80% of people do recover in time.  The “Traumatized” self draws on those internal and external resources and takes steps in their own healing journey.

The other 20%, not so much.  When another trauma occurs, then that “Going-on-with-life” self get very busy working, taking care of others, and getting very involved socially.  It feels to this part of you, that busy-ness can outwit, outlast, and outplay any memories of trauma.  The “Traumatized” self, however, gets very skilled at survival strategies.  It continues to develop several selves, since even more parts of the self are needed to survive the dangerous conditions.  This is where the “Fight” self and the “Flight” self begins to get more refined and embeds deeper into one’s lifestyle.  Other strategies also come to the front.  These show up a “Freeze” self and a “Submit” self – especially when the trauma occurs at the hand of a powerful adversary where fight or flight are both impossible.  There is also an “Attach” self.  This is the one who concludes that survival depends on having a powerful caregiver is the best step forward.

In the next few days, you can find here more discussion about each of these selves, and how they may show up for you as an adult.

The most important message I want you to have is that being a versatile Self, with many survival strategies is a silver lining to your experiences – just so you know who is showing up today, and what that self is really worried about.  You can heal, with continued awareness to yourSelf.

To the healing of your many self, in your own time, and your own way.

(The concept of Structural Dissociation is from Van der Hart, et al in their 2006 publication of “The Hauted Self : Structural Dissociation and the Treatment of Chronic Traumatization”.)

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What is Trauma, anyway?

 

Traumatic experiences are:

  • Overwhelming;
  • Invoke intense negative effect on the victim emotionally and/or physically;
  • Involve some degree of loss of control and/or vulnerability.

Trauma and PTSD

The experience of trauma is subjective and depends on the age and resources of the victim.  So while a person surrounded by family, community, church support who has not suffered previous traumas may be able to navigate the aftermath of hurricane Katrina, the person next door who suffered trauma as a child, is not connected to community, may feel overwhelmed, victimized, and unable to recover their sense of control and strength without professional help.

Trauma can be multilayered.

Trauma often includes overt harm as in the case of physical or sexual abuses.  Especially in young children, it also can include a deep lack of attention and need fulfillment as in cases of neglect.  Clinically, we know that the damage to normal brain development is more severe in cases of neglect than direct physical or sexual abuse.  It is often confusing to the adult who was neglected as a child to find themselves suffering the symptoms of PTSD even though they don’t have a history of being assaulted physically or sexually.

Trauma impacts us on the interpersonal level when there is a betrayal of caregiving expectation as in Mom knew I was being hit, and didn’t intervene to help.  It is also traumatic to a child when the caregiver becomes unavailable to her through leaving the home, severe physical or mental illness, or death.  Whereas an adult mind can understand the reasons for abandonment, the child who rightfully has caregiving expectation of the parent, suffers, sometimes for decades.

There are specific brain development periods, such as ages 2-5, preadolescence, and adolescence when necessary links are being created.  When there is trauma in these age groups, those links develop less densely, and the victim’s ability to move from fight/flight survival mode, emotional regulation skills, and ability to pause and consider behavioral outcomes are seriously compromised.  Many developmental tasks suffer and the surviving adult is left playing the game of life with a short deck.

Complex Outcomes

Defining trauma

Because trauma is multilayered, the outcomes for surviving adults can be very complex and elusive to the survivor. It is understandable that nightmares and flashbacks are clearly a result of their trauma, but other difficulties in life have not been connected to their history.

Many survivors hold an expectation of harm from the world in general and from other people specifically.  So, even though you may be in a relationship with a wonderful man who is kind in every way, you keep the suspicion that he is cheating on you, and you think it is your intuition keeping you safe.  It’s more likely a strategy toward safety that you embraced at the time of your trauma (even if it was when you were two and couldn’t talk yet).  You know from your early environment that you shouldn’t trust others, even a caregiver who might strike you or leave you.  That strategy was your hero, and probably accounts for your being alive today.  However, it hinders your ability to create strong relationships.

Similarly, if the early response to assault was to submit, your adult sense of boundaries is distorted, and you may find yourself in repeated disrespectful or even abusive relationships, believing that this is just the way life is. You might hold an unconscious expectation of disrespect, and are attracted to partners that feel “comfortable” but ultimately are disrespectful and hurtful for you.

Newborns expect that they are the absolute center of their universe.  When that universe turns on them, they logically assume it is because they have done something wrong/bad to create the painful outcomes they suffer.  They try desperately to get Mom, who is comatose with severe mental illness, to see them, to care for them.  They conclude often that they are bad people, that Mom locks them out of her room because they are ugly, unlovable, stupid, (fill in the blank yourself…).  They then carry this theory about themselves into their adulthood and continue to find evidence that they are in fact ugly, unlovable, etc.  The journey in therapy is to recognize and describe those theories as what they really are – just theories and assumptions, and travel the road toward new theories.

I talked before about developmental challenges that result from trauma at specific ages.  In addition to anger management and emotional regulation mentioned above, sufferers also may have difficulty problem-solving.  When they are frightened by something that reminds their body, their emotions, or their awareness of threat, the ability to rationally find solutions evades them, even in situations that don’t seem to merit that kind of fear.  This can include finding their classroom, finding their homework or locker, paying attention to the boss, presenting project results to a team, or any number of thinking tasks that students and adults perform daily.  I’ve had a client that wasn’t capable of grocery shopping at the beginning of healing.  Being in a place with bright lights, noise, strangers put her in an overwhelming place that made decisions about which brand, which cut of meat, which banana to get just couldn’t happen for her.

Finally, a common outcome of complex trauma is a reduction in the capacity to act.  That may look like being stuck in a difficult and unrewarding job, but unable to find the idea or vision of something better.  It can also be as intense as finding yourself in an abusive, even violent relationship, but unable and fearful of escaping.  For many survivors, the most difficult word in their vocabulary is “no”.  An old definition of stress was “when every fiber of your being is screaming NO to a request while your mouth is saying ‘YES’.”  Exerting power on your own behalf by saying no, this is what I want, or saying yes to what is really right for you is possible as you succeed on your healing journey.

 

 

These are difficult challenges, but you can heal in your own time and your own way.

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PTSD Healer Within

There are many PTSD symptoms the you might experience after your trauma.

  • Intrusive memories
  • Acting or feeling as if the event is recurring (even if it occurred decades ago).
  • Nightmares of the event.
  • Looking for ways to avoid these memories or triggers of those memories
  • Avoiding thought or feelings with substances
  • Avoiding activities or situations
  • Inability to recall aspects of the trauma
  • Diminished interest in activities that you used ot enjoy
  • Feeling detached
  • Sense of a foreshortened future
  • Difficulty falling or staying asleep
  • Irritability or outbursts of anger
  • Difficulty concentrating
  • Hyper vigilance
  • Exaggerated startle response
  • Limited social or occupational functioning
  • Survivor guilt
  • Feelings of hopelessness
  • Forgetfulness
  • Sadness
  • Feelings of being overwhelmed.

The truth is that most of the time, most people are resilient and these symptoms are short-lived, and the symptoms wane over time.  We really do not know why  20% of folks exposed to a specific trauma develop PTSD.  They just do.  Who does and who doesn’t is not a measure of anyone’s strength, goodness, karma, any more than someone born with blue eyes is stronger, nicer, better, or has better karma that those born with brown eyes.

What is important to understand is that at your core, you are healthy and any treatment you use is essentially a way of helping you to get in touch with your own innate health.  Whether you work with caregivers who love you, or professionals to are specifically trained to help you, they all are helping you find your innate health.

Healing is your journey back to your strong, safe, resourceful self. You can find your way back, many have, and so will you.  Trust.

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When Adaption Hurts

You are reading this today because you survived your trauma.  What that shows is that you have found strategies for adapting to the nightmares, the triggers, the fearful vigilance, the self-blaming and self-doubt.  Some typical adaptions include:

  1. Medications
  2. Food
  3. Spending
  4. Alcohol
  5. Sex
  6. Drugs
  7. Hiding
  8. Victim advocacy
  9. Anger
  10. Working, more working, extra working
  11. Connecting with pets
  12. Connecting to care givers

All of these strategies work for people in the short run.  However, some of the ways that people adapt are solutions that create an added burden to your life.

Hiding in your bed feels good, and is an important step toward your healing.  The first stage of healing, after all, is finding safety, and that bedroom may be the safest place you have.  However, six months in your bed is likely not going to help you heal further, and can even exacerbate your injury by preventing the brain from healing distorted links.  You know those links that act as triggers.  The smell of a rose, and your whole body is flooded with terror.  That kind of link in your brain will heal when there are more calm moments than panic ones.  Alone with your stories is more likely to create the opposite – more vigilance than calm. In your bed on your own can keep the trauma story alive in your mind and in your body, and that constant fight-or-flight state prevents you from healing.

Similarly, numbing substances like alcohol, drugs, food do help you to find peace for a little while.  However, in the words of a returning veteran, “Eventually there just wasn’t enough whiskey to stop the memories and the silent scream that rang in my head.”  All of us create our own healing journey, and every single adaption has a life affirming reason for becoming part of your day.  The wisdom is knowing when that adaption helps, and when it hurts.

Altering your own brain chemistry through addiction to alcohol, drugs, food, sex, or spending does create an island of peace, but it cannot provide the sustainable peace that you look for – and eventually it doesn’t work any more.  This is the point where adaption hurts.  If you notice that your use of any adaptive strategy isn’t working the way it used to, and you increase the use, it might be a good time to turn to a different strategy.  Talk with your counselor to see what stage of the healing process you’re in, and what alternate strategies might serve you now.

Some of them also work in the long run and integrate well into your post-trauma lifestyle.  These might include victim advocacy or connecting with pets and loved ones. It may include medications (while your brain heals from its own distortions caused by your trauma).  It may include working as in working toward a goal, rather than working to exhaustion in order to be able to sleep.  When you consider what adaption strategies you are using, can you imagine them part of your post-healed life?  If you think of working in victim advocacy for another 5 or 10 years, does that energize you?  If not, maybe it isn’t your best choice.  If so, move toward that role with tenderness for yourself, and with the support of someone who can notice if hearing more victim stories is OK for you in that moment.

Your being alive today is a testament to your ability to create adaptive strategies.  As you heal in your own time, consider those adaptive strategies, and choose the best ones for you today.

 

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Peace Within

In “Awakening to the Peace Within“, Rosa Bergola says,

oyster-shell

Despite all the chaos
around me, there is
a deep seated pearl
in my heart
which cannot
be moved.”

pearl

May you find your own deep seated pearl today and rest, there, right there in this moment.

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Wake Up Call

I-5Yesterday, as I was driving south on I-5, listening to the radio, a comedian recounted this:

“I checked into my hotel, and asked for a wake up call for the next morning.  At the agreed-upon time, the phone rang, and a voice said, “What are you doing with your life?”

All of us, whether we’ve suffered a severe trauma or not, can be with the question, “What am I doing?”  So often, the answer is – nothing much, just getting by, winning many games on my Kindle.  I know that there are times during the healing, when the very best we can do with our lives is to chill, sit, sleep, eat, and play games on our devices.  I also know that under the covers, my brain is rewiring, my body is healing, and my heart is mending.  I’ve learned that “nothing much” may be the greatest gift I can give myself, as long as I’m giving it with compassion and respect for my own healing journey.

The precious gift is to gracefully allow those times of living in the cocoon. It’s also a gift to notice the urge to break out, to take a walk, to try a new habit.  As you move on your healing journey, there are times when staying in your cocoon is your own most precious gift to yourself.  Trust, also those times when you’re ready to move forward into your new, healed, and precious life.

Those times will come, trust your process and know that you will heal in your own way.

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Insider’s View of Reality

A new study from the University of Missouri-Columbia notes that women do not receive adequate care after a traumatic event.

“More than half of the women participating in our study suffered from depression, PTSD or both illnesses,” said Mansoo Yu, an assistant professor of social work in the College of Human Environmental Sciences. “However, most of the survivors had not used mental health services in the past year, even though they reported having access to the services. Social stigmas, shame, privacy concerns, health care costs and lack of information may prevent survivors from getting the help they need.”

One of the reasons may be that each of us compares our insides to others’ outsides, and our picture of the human condition is completely distorted as a result.  That difference makes it believable that it is our birthright to be psychologically healthy, happy, and carefree – and that feeling good is a measure of a life well lived.  If you’ve had a trauma, you know that you don’t feel any of that, and you may look at others, knowing that one in four of the people you see have suffered a trauma, but they look just fine, so “I must be doing something wrong, and I’ll just try harder to get it together”.

The truth is that almost all people are in pain somewhere in their lives much of the time.  Almost all will struggle and suffer.  Your unique situation, with the neurological repatterning that takes place after a trauma simply means that it isn’t going to get better by itself.  It will more likely get worse.  If you are suffering from flashbacks, nightmares, difficulty concentrating, then your specific condition will benefit from PTSD treatments that are proven to help – EMDR, relaxation techniques, specific skill building to engage the parasympathetic nervous system.

You can get better, with help, and you will.  Comparing how you feel on the inside to how others look on the outside is like comparing apples and sand.  It just doesn’t compute.  As soon as you are able, take the courageous step of seeking out a support person and step on your own path to recovery.

You can do this – I believe in your deepest ability to heal, even if you can’t see that right now.

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