411 on TRAUMA – With Love from Dr. G
What is Trauma? Well, simply put it is a psychological injury in which we see changes in biology (physiology/anatomy), emotion (feelings), and cognition (thoughts). Following a traumatic experience, it is completely normal for our memories and their meaning to seem confused and disorganized. We may recall only “snapshots” of what occurred, and this is normal. During a life-threatening experience, the brain (specifically the Limbic System) invokes a Fight, Flight, Freeze reaction. A person’s visual range and focus narrows to ensure our survival, and because of our heightened level of anxiety and arousal, we zone in on only what our brain in that moment believes it needs to register in order to live. This is why some of you (and me too!) cannot remember things that other people right next to us can remember, even seemingly important (now), relevant, or horrific facts/events. Try not to worry about this or focus on what you can or cannot remember. At the end of the day, it is irrelevant. What is truly going to matter in your recovery is the way in which you INTEGRATE what you do remember with your current worldview and beliefs. And this is something we actually have control over and the power to change.
PTSD (Posttraumatic Stress Disorder) takes a little time to diagnose. As of today, none of us meet criteria for the diagnosis since it cannot be made prior to one month anyway (unless you had a preexisting diagnosis of course). Even then, I hesitate in my own practice to diagnose it so soon after a trauma, because is MOST cases, trauma symptoms subside and life goes back to normal within months. Just because you continue to experience trauma symptoms after a few months does not mean that you have PTSD. PTSD and trauma symptoms are treatable and in most cases, they go away (although our underlying biological and genetic predispositions may still exist).
NATURAL RECOVERY IS THE MOST COMMON OUTCOME! What this means is that MOST people recover, and rather quickly (i.e., quicker than we might expect). So be patient and compassionate with yourself and the people around you. This is a PROCESS. What we want to do here is help keep you all on the road to natural recovery. There are 2 main things that knock someone off that road and interferes with recovery from trauma:
• Avoidance behaviors
• Unhelpful thoughts
These two things “maintain” your trauma symptoms. The most important thing to be working on NOW, is the avoidance behaviors. Start with experience, and then we can work on thought-processing. I’ll explain rationale for that next week in our group!
Remember, it is completely normal to experience trauma symptoms following a traumatic experience. Common reactions to trauma may include any of the following examples:
Fear and Anxiety; Re-experiencing the trauma as flashbacks or nightmares; Hypervigilance (over-alertness; startling easily); Irritability and anger; Trouble concentrating; Avoidance of trauma reminders; Shame and guilt; Feelings of “going crazy” or being “out of control;” Loss of interest and depression; Emotional numbing; Lowered self-esteem
There is NO one particular symptom that increases a person’s chances of developing PTSD over time. Rather, it is an OVERALL level of symptoms (e.g., intensity of distress) that may predispose someone to developing a more chronic psychological disorder.
SO…RIGHT NOW: FOCUS ON ONE THING:
DO NOT AVOID
What do I mean? Well, do not avoid thinking about what happened. Do not avoid talking about what happened. Do not avoid feeling your feelings about what happened. Do not avoid the news. Do not avoid movies. Do not avoid going out to crowded places, concerts, parties, shopping malls, parking lots. Do not avoid the dark. Do not avoid noises or places where there are screaming people or children (Halloween is coming up, so an opportunity for a lot of exposure as luck would have it). Do not avoid anything that triggers a panic symptoms (more to come on that). Do not avoid by drinking excessively or using drugs to numb your anxiety or emotional pain. Do not start relying on safety objects, people, signals, animals, etc. (more to come on this as well). Do not avoid all of the above things by staying super busy and overscheduled. DO NOT AVOID.
In order to fight and kill this insidious beast, we need to face it. Sorry folks. There is NO shortcut. Now, do we have to do the 10/10 exposure (the most avoided dreadful activity) to start? No. If you need to, start small. If you feel too anxious to go to another country concert this weekend, maybe start by going to a smaller venue, or an evening show downtown.
What’s the problem with avoidance? Well, it feels GOOD! It’s a total relief, and that feeling is much better than the anxiety associated with going out and doing the feared thing, so following down that seductive path is highly reinforcing. Avoidance over time can begin to generalize (more to come about how PTSD develops) and eventually causes a lot of more serious problems.
What’s the point of exposure? Well, it allows for us to build tolerance, or to “habituate” (acclimate) to feared situations, people, places, activities, etc., that we have begun to fear (more to follow on this).
The BOTTOM LINE: We want to make life choices based on our VALUES, not our FEARS. If we allow fear to dictate our behaviors, then we will lose everything we hold dear to us in life over time.
Why is talking about the event important? It helps us reconsolidate our experience and put the pieces (“snapshots”) together into a story that makes sense. We are not trying to remove memories, even traumatic ones. We are simply trying to remove the unhelpful or unhealthy reactions we have to those memories.
You’ve all heard about Pavlov and his dogs? His research serves as a behavioral model for our understanding of how PTSD develops.
Begin to have difficulty discriminating between what is dangerous and what is really not dangerous. During an actual life-threatening experience, we want to be able to focus in on what is most salient to our survival. If we have generalized our fear through conditioned learning and now response to many different things around us in a fearful way, it takes focus away from what we need to focus on in a time of true danger. Engaging in exposure activities is a means of helping us develop greater discrimination between REAL and PERCEIVED threats. Overtime, generalizing fear has a snowball effect and a person may collect more and more “things” to avoid, leading to a smaller and smaller life.