Archive for the ‘Veterans’ Category


Health Care Providers: How to Welcome and Respond to Trauma Disclosure

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TMIMy husband, a cardiologist, and I recently spoke to a group of physicians about how heart disease is caused by traumatic stress and also causes it. Afterwards, one family practice doc asked me, “I never know what to say when patients tell me their traumas.”

I realized that many doctors and therapists, for that matter, were trained in an era before abuse was acknowledged, before trauma and PTSD were common household words (in some places they still are not).

So I’ve compiled a short list of do’s and don’t’s when answering a client that discloses a disturbing history of trauma or a traumatic event.

Do:

~ Routinely administer a screening questionnaire for abuse in your intake forms. You can use the ACE questionnaire or website or come up with your own boxes to check off (e.g. history of physical abuse, sexual abuse, domestic violence, neglect, veteran etc.) Clients with a very high ACEs score will have more health problems as they age.

~ Answer with a sympathetic and simple affirming response such as:

“I’m sorry that happened to you.”
“ That is a terrible thing to have to go through.”
“You must really be suffering a lot (if the event is currently affecting the client).”

If your client’s disclosure is met with a stony or panicked silence they will leave feeling very guilty, damaged, enraged or all three. Abuse has a lot of shame associated with it. Please do not reinforce this by failing to respond appropriately.

~ Maintain eye contact with a soft gaze. Our clients often do not feel seen or like others really want to see them and their suffering. Eyes are “the windows of the soul” and the client really needs to see that you are with them in taking this great risk of disclosure. We know that people are present to us and with us when they look into our eyes.

~ Get yourself grounded in that moment. Take a deep breath and take a moment to really absorb what your client just said to you.

Some of us providers have our own trauma histories and the older we are the more likely that is. If we dissociate or ‘check out’ our client will definitely notice and probably assign the worst possible meaning to our behavior such as: “they don’t really care about me”; “they are just collecting their paycheck”; “they think I’m crazy”. Our traumatized clients already have those feelings, and they respond to any perceived confirmation of those thoughts with panic and/or rage. This panic/rage can be expressed outwardly in your office as difficult behavior or as self-harm when they go home.

~ Ask for more details – especially about how this is affecting the patient in their body right now. It is a universal truth that our clients will only tell us what we are ready to hear. They do not want to ‘injure’ us with sordid details and will often leave out important aspects of their traumas. Occasionally a client will disclose too much in a kind of verbal diarrhea manner; in those cases it is OK to gently contain the discussion and take the necessary action for that client to get help.

~ Assess for current safety and contact the correct agencies as a mandated reporter. You can never overreport elder abuse or child abuse. As a medical social work supervisor I am always surprised about how conflicted medical staff are about filing reports and how little the laws are understood and followed. The state is responsible for determining whether abuse is happening or not. Most medical providers are not trained to make those screening decisions. Hence the law that says you are a mandated reporter to file if abuse is suspected. And, yes, that means everyone on your team who has a contact with the patient. It is extremely common for abuse victims to divide up what they tell to different people. There is no way for agencies to file as a single entity. If a doctor, a nurse and a social worker talk to this person and get any kind of disclosure they ALL are legally obligated to file a report. Our clients almost never call disclosure hotlines themselves. Sometimes they don’t understand that what is happening is reportable. Child and adult lives depend on us doing our jobs. The states do a very good job of maintaining confidentiality about who said what.

~ Refer! to the appropriate provider. Have a list of trusted mental health providers in your office. Steer your client towards the Psychology Today referral website which is excellent and widely used by practitioners.

Do Not:

~ Panic. Forewarned is forearmed. Educate yourself about the types of abuse in your community and the populations you serve. If you are expecting to hear these types of disclosures (and why shouldn’t you?) your clients will have an easier time telling and you will have an easier time hearing. I have heard about some truly horrendous and damaging responses from both therapists and doctors who were not ready to hear an abuse disclosure. One damaging response can put off a patient’s healing for years or forever.

~ Promise to keep a dangerous secret. A lot of patients will ask us to keep what they tell us confidential before they want to disclose anything. Don’t paint yourself into a corner. When my patients ask me to keep their secrets, I always reply that it depends on what kind of secret they have and explain my role as a mandated reporter. That gives them more control on what they want to disclose.

~ Ignore a disclosure. Yes, I know you have less time to do more work than at any other time in your career. Working correctly with a disclosure does not have to take a great deal of time. Our patients are pretty savvy. They know we have busy schedules and lives, and they do too. The vast majority of people who disclose will not abuse the privilege. If they do, you can still be kind and containing at the same time. Or you can ask them to schedule a longer appointment soon for a full trauma assessment (something I hope to be coming soon to a medical and psychiatric clinic near you). Being busy is no excuse for being uncaring. It’s not business; it’s personal.

~ Forget to take care of yourself. Know your community population. If you are in low income, high crime area, your entire population may be filled with trauma. Taking a trauma informed approach to your practice could be the best thing you ever do for you and can avoid needless complaints and confrontations. Get therapy if you need it (and who doesn’t?). Do your own sympathetic downregulating exercises: yoga, tai chi, meditation, exercise, breathwork. The less you care for yourself and your own suffering, the less you will want to help anyone else.

There, that wasn’t so hard was it?! If you need more in-depth assistance I offer trauma-informed consultations for health care professionals, and I travel!

Be well!




Flashbacks, PTSD and You

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Of all the PTSD symptoms, flashbacks are some of the worst. They interrupt our sleep and our waking hours without warning. They chew us up and spit us out leaving us spent, exhausted and retraumatized. Flashbacks can really hurt us as they activate our amygdala, the crisis response center in the brain, and throw our entire nervous system into high gear. In the worst cases, we can momentarily lose touch with reality and become totally engulfed in a full body replay of traumatic events. As we heal from PTSD, it becomes essential to get a grasp on flashbacks and slowly eliminate them.

What are flashbacks?

Flashbacks are an involuntary and intrusive experience of a memory. Flashbacks can involve any combination of the senses: visual, auditory, kinesthetic (or feeling state), taste and smell. I have found that many people with traumatic pasts enter flashbacks regularly without knowing they are having one. Movie type flashbacks are obvious; for example a soldier experiencing himself back on the battle field. But flashbacks can also be, for example, an overpowering feeling of helplessness and abandonment in the present that is not in proportion to a current event.

I have come to see flashbacks as part of the body/mind’s attempt to heal. Persistent flashbacks are like a telephone ringing, or someone knocking at your door. They are your unconscious mind demanding that traumatic events in your past be dealt with and healed. Like a persistent visitor, the knocking will only get louder and more in your face if you don’t answer the door.

How can I get rid of flashbacks?

There is only one way to really get rid of flashbacks for good, and that is to dive deep into your mind and heal your PTSD by dealing with the traumatic events that caused your injury. I realize that this is not the answer that many want to hear. It is a bit like saying the only way out of your burning house is to walk straight through the fire. In the meantime there are things you can do to lessen the severity of flashbacks and help those around you cope with them:

– Learn your triggers and inform those closest to you. The more you know what causes flashbacks, the more control you have over them. Keep a log or map them, either mentally or on paper.

– Develop a twice-daily practice of invoking the relaxation response and by that I mean something like yoga, tai chi, progressive relaxation or centering prayer. Not drugs, TV or other escapist types of activities. These techniques have been shown to improve recovery time from flashbacks and decrease their intensity and frequency.

– Strengthen your mind! Flashbacks are a time disorder. Your mind gets sucked back to the time and place of injury. Don’t let that happen! Learn to stay in the present moment through meditation and grounding exercises. That way, when a flashback hits you can stay present and not get swept away in the memory.

– Talk about it. Ever since Freud discovered the “talking cure” we have known there is something magical about telling others about our difficulties. The more we process verbally, the less grip these events and memories have over us. If your memories are too intense to share with loved ones find a good trauma therapist (see my blog on finding a good trauma therapist!).

– Do not blame your self. Shame and flashbacks go hand in hand, and are often a part of the trauma being re-experienced. Be gentle with yourself and realize that this is a process that will take time to resolve.

I’ve said it before and I’ll say it again. PTSD can be healed. That means you will reach a point where flashbacks are no longer a part of your life, at least not in such a pernicious form. We may always have unpleasant memories but when trauma is resolved, they no longer have the power to hurt us.

Blessings on your journey of healing.













INSOMNIA!

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Insomnia and PTSD go together like a mosquito bite and itching but with far worse results. Insomnia is not only a consequence of traumatic events but, left untreated, can result in such chronic medical conditions as mood disorders, chronic fatigue syndrome, and even fibromyalgia, a painful condition affecting joints and tissues throughout the body.

There are roughly 4 types of insomnia:

1) Early awakening
2) Inability to fall asleep
3) Repetitive waking throughout the sleep cycle (usually every 90 min)
4) Unsatisfactory sleep

There can be other physical or disease processes that interfere with sleep so the first step with insomnia is to get a medical exam to determine if there are any conditions, such as sleep apnea (poor breathing during sleep) that are resulting in awakening or unsatisfactory sleep (waking up tired).

With PTSD the two most common types of sleep disorder I’ve seen are the inability to fall asleep or waking approximately every 90 minutes. These are so common that if I have a patient walk in with those symptoms there is a high likelihood that they have suffered past traumatic events.

Why?

The answer is simple. REM (rapid eye movement) sleep occurs approximately every 90 minutes. In this stage of sleep the brain processes memories and emotions. That is what the brain is hardwired to do and why people normally wake up feeling refreshed.

But if the memories are too scary and overwhelming or if the conscious mind is not ready to assimilate the information a person will shut down the REM process by popping prematurely out of sleep. Similarly with sleep inhibition or the inability to fall asleep, the mind is unconsciously resisting the process of assimilation or digestion of overwhelming experiences.

For these reasons, sleep can start to feel like a very overwhelming experience and can snowball into its own traumatic situation. Insomnia breeds its own special kind of anxiety. A secondary trauma develops: the fear of not being able to sleep.

What to do?

Here are three steps to getting back to a restful night even while healing from trauma:

1) Unwind the fear about falling asleep. If you are awake use your time productively. Do some yoga postures and relaxation exercises. Or read something that is “good for you” like history, medical information or a religious text. The mind wants to shut down out of boredom after a while, just like in school. Do not read Stephen King or the latest murder mystery! Tell yourself that you will not be awake forever and allow yourself to be awake if you need to be. You can always nap tomorrow. The more anxious you are about being anxious the less chance sleep will come.

2) Develop excellent sleep hygiene. Sleep in a dark room without computers, tv’s etc. Turn off bright lights at least 2 hours before bed (yes that includes all media screens). Abstain from caffeine and sugar for 6 hours before bed. Develop a routine. Etc.

3) Most important: Start addressing your traumas! Your unconscious mind wants you to heal and will keep throwing up traumatic dreams and memories until you get the point and deal with them. Seriously. The best cure for insomnia is curing your PTSD. Find a great counselor or program and get to work! 

The alternatives to not addressing insomnia are unbearable. Pills only work for so long. If you resolve the underlying issues be they physical or psychological you will be well on your road to healing and back to the land of Bedfordshire in no time.

Sweet dreams.







KBOO Interview on Recovery Zone

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I was fortunate to have Stephanie Potter of KBOO’s show Recovery Zone, in Portland, Oregon interview me yesterday about healing from stress and PTSD. The show is 30 minutes long and features three different callers with excellent questions. I had a blast doing it and am thankful for a chance to help people go deeper in their healing process. Click here, for a link to the downloadable interview.




TTK BREAKING NEWS

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Hi all. Today I am pleased to tell you that one month out, the Search Inside function has been activated for The Trauma Tool Kit: Healing PTSD From the Inside Out. Quest Publishing has been quite generous with their sharing so you can begin reading now! Click on the book cover to the right of this post to go to Amazon’s site for the book. My greatest desire is that this book help you overcome your traumatic stress and PTSD. Blessings, Sue




Horse Therapy for PTSD in the UK

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I am loving watching the spread of all kinds of healing therapies for PTSD here and around the world. I can personally vouch for the power of horses. Many a day I went in with raging PTSD symptoms to see my beloved horses only to come out fully grounded and even with what we call around here “barn bliss”. Winston Churchill famously said, “there is nothing so good for the inside of a man as the outside of a horse”. And I couldn’t agree more (except add women!).

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Mind fitness routines fight combat stress – Marine Corps News | News from Afghanistan & Iraq – Marine Corps Times

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Mind fitness routines fight combat stress – Marine Corps News | News from Afghanistan & Iraq – Marine Corps Times

Yes! This is exactly what I do in my psychotherapy practice. The first step to managing and overcoming PTSD is to strengthen the mind. The mind is like a horse, you can master it and have it go in the direction you want it to, or it can run away with you. Mindfulness, relaxation exercises, focusing, and meditation are invaluable skills that anyone can learn. And like any skill, it takes regular practice! 5-10 minutes a day is a good place to start.







The Promise of Complementary Therapies for PTSD

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I was happy to see that our cousins across the ocean are so open to working with traumatic stress in a variety of ways.  I had the pleasure of meeting with David Marteau, the head of substance abuse treatment for offenders in London, England.  He felt that the complementary therapies “showed real promise” for helping with traumatized people. 

Here at home the military is increasingly turning to alternative therapies for PTSD in their personnel.  The great thing about the American military is that they are intensely pragmatic and great at following protocol. Treatments that have been researched by the Pentagon and/or used to date include:  acupuncture, aromatherapy (yes, really), yoga, reiki massage, relaxation techniques, mindfulness.  The Ft. Bliss Restoration and Resilience Center has an integrative model that has treated dozens of officers with multidimensional holistic treatments.  They went from a 10 percent redeployment rate of officers with PTSD to a redeployment rate of over 60 percent for those who completed the program!  Complementary therapies work!




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