When Trauma Damages Our Relationshps

During the fall of 2008, the relationship I was in ended by drowning in trauma. Each of us was facing life-changing, traumatic circumstances of our own. Neither of us was able to really help the other, and lacking the skills to do otherwise we added damaging each other to the list of traumas we each were reeling from.

I wish we had been able to read "Reconsidering the Anger in Your Relationship," an article I just received in my email in box from Psych Central, last year.

If you and your partner are dealing with trauma right now or in the more recent past, or you may ever have to deal with trauma in the future, take a moment to read and bookmark the article now. Following these steps, even imperfectly, may save you from adding a failed relationship to whatever list of traumas you're experiencing.

Image courtesy Life is a wonder via flickr.

Today's PTSD News Roundup

This is what happens when I find too many things worthy of writing about.

First, in the "No Shit, Sherlock Department," comes news from a Dartmouth web site that faculty at Dartmouth Medical School have discovered that, when people have both PTSD and substance abuse issues, it's a good idea to treat both at the same time.

According to the article, "PTSD is traditionally not addressed until up to a year after addiction treatment..."

Ok, I know that "common sense" is not always correct, and I realize the importance of studying therapies to see what will be most effective rather than jumping in and trying things that make sense.

But, I can't help but wonder if clinicians have been listening to their patients. You know, when we tell them that we use substances to self-medicate the symptoms of our PTSD. For the life of me, I can't imagine that people seeking treatment for both PTSD and substance abuse disorders don't at least occasionally talk about the former.

Next up, we have a study which says that mental health patients, including people living with PTSD, may not be receiving the most beneficial treatments.

Science Daily reports on a study written up in Psychological Science in the Public Interest, a journal published by the Association for Psychological Science. According to that study, mental health clinicians haven't been trained in the most up to date and effective methods to treat their patients.

Money quote:

"For example, cognitive-behavioral therapy (CBT) has been shown to be the most effective treatment for PTSD and has the fewest side-effects, yet many psychologists do not use this method. Baker and colleagues cite one study in which only 30 percent of psychologists were trained to perform CBT for PTSD and only half of those psychologists elected to use it. That means that six of every seven sufferers were not getting the best care available from their clinicians. Furthermore, CBT shows both long-term and immediate benefits as a treatment for PTSD; whereas medications such as Paxil have shown 25 to 50 percent relapse rates."

The study's authors are urging reform of clinical psychology training programs and a new accreditation system to be sure that clinicians aren't trained in outdated treatment methods.

Amen to that.

Finally, a reminder to help our veterans. As reported in this blog last month, the VA is considering a change to regulations to make it easier for many servicememembers to receive PTSD treatment and other mental-health benefits related to the traumas they've faced in combat. The public comment period is over on October 23rd. Head on over to the comment site and, well, comment.

Image courtesy Paul Keleher via Flickr.

Note from the Management: Nothing Substantive Today

I get headaches about once every five years or so. Make that, "Headaches." One started last night, and even looking at the computer screen is mildly painful.

I'll be back at my post as soon as the knife is out of my cranium.

Until then, be well and take care of yourselves.

This Month's Knee-Jerk Reaction: Roman Polanski

Originally, this post was going to be titled "Bullshit Headline of the Day."

The headline in question, "Polanski's past suffering entitles him to sympathetic treatment," initially had me using language I won't repeat here.

I'm a survivor of abuse and violence. I also believe it is important to take responsibility for my triggers, my reactions, and the impact I have on others.

Polanski survived the Holocaust. He lost his wife and unborn child to one of the most horrific mass murders in US history. No one reading this post, and certainly not it's author, can begin to imagine the horror that has taken place in Roman Polanski's head and heart.

But when it comes to raping a 13-year-old-child, I don't give a damn what he suffered. I do care that he chose to act his pain out in a way that would permanently mark, and possibly scar, a child for life.

Then I read the article. Ah, humble pie.

"Do we measure such a horrific history against his later crime of sexual abuse? We cannot measure one against the other any more than we can juxtapose art as licence or abuse as excuse. Being abused can confuse the victim's moral boundaries. Polanski's offence is not nullified by his own immense suffering. Nor is his crime pardonable through his brilliant and sensitive art.

But his suffering, his life and his art send us a message. Violence and abuse create violence and abuse."

The rest of the article, by a Psychologist practicing in Melbourne, Australia, brings forward ideas that I believe as well: retribution does not bring healing. Revenge begets emptiness at best, but usually all it gives us is more revenge. Not all victims become perpetrators, but all too many perpetrators were once victims.

As trauma survivors, how do we balance the demands of personal responsibility against the damage done to us as former and/or current victims? How do we judge the actions of others who have also been victimized?

For example, I learned nothing of empathy until at least my 30's, and my "trauma mind" still regards issues like health care insurance reform as a very real battle of good vs. evil. I know how hard I continue to struggle to fit in to a society I don't always understand, and still frequently regard as a hostile place from which the next bad thing will attack at any moment.

How dare I condemn Roman Polanski, or third-world terrorists, or any other victim who perpetuates the cycle of violence because that is all they know?

At the same time, how do we as a society, and as individuals, walk the wide crack between sympathy for a damaged perpetrator and preventing the "creation" of more victims?

Like I said, "humble pie." Because while my knee-jerk reaction was viscerally satisfying (and gave me a wonderful opportunity to feel morally superior to another trauma survivor; one with money and fame, no less) the fact is that our society already reacts, over and over and over again, with both knees jerking rabidly.

And we all know how much good those reactions aren't doing any of us.

Swimming Through the Memories

Sorry for my delay in posting this week; it's amazing what having a close friend in the hospital with a heart attack does to one's schedule.

That said, Monday evening gave me a chance to face the memories from one of the more traumatic times in my life, because my friend was in the same, inner-city hospital that was my second home for eight weeks after my then-husband was in a 6 O'Clock newsworthy car accident years ago.

Despite the move in recent years to make hospitals -- well, more hospitable -- this place hasn't changed. The same greasy pizza place, the same old architecture of doom, and the same dismal, cramped, loud rooms and hallways sucked me in on Monday for a trip down Remembered Trauma Lane.

I'm happy, ecstatic in fact, to say that it was three hours before my PTSD reactions to the place made it necessary for me to leave.

I'm not so happy to have to say (in the spirit of complete honesty) that yesterday was filled with lots of staring at walls and a seeming inability to get my mind to track anything for any length of time.

But at this moment (the only one that counts) the song below is going through my head courtesy of a friend who posted it in her journal. And I remember all of the times I've been able to keep my head above water, if even just my nose, and remind myself that it's getting a little bit easier every day to keep swimming.

(Fair Warning: There's a few lines of political commentary in this with which you may or may not agree. But that's not what the song is about.)



Image courtesy Nunu Bear via Flickr.

Narrative Exposure Therapy and Child Victims of Violence

Narrative Exposure Therapy: Helping Child Victims of Violence

This could be interesting for trauma-care professionals and hold out hope for our wider society as well.

While searching for a topic for today's post, I came across this article which talks about how Narrative Exposure Therapy (NET) seems to be an effective short-term method for helping children who have been repeatedly traumatized.

The article focuses on the work of two psychologists who are helping children who have been repeatedly victimized by violence in places including some African and Asian countries. They claim that NET helps these children put the past in the past.


According to the article, NET is a very structured process:

"The first session starts with a shank of rope, some flowers and some stones. The child arrays the rope in a way he feels outlines the arc of his life, then places flowers along the rope when times were good, stones when times were bad.

And then the excavation begins. Nothing is left unexplored ... particularly within those experiences that cause the most trouble.

'We have them describe it fully, from an emotional and psychological context to a sensory context - what did it smell like? - everything,' [Psychologist Frank] Neuner said. 'What we need to be able to do, finally, is to retell this entire narrative, so that it's something that's occurring in the past.'

In up to eight sessions, the therapists pull and tug the child's story, assembling it in a manageable context and blocking its jarring intrusion into the present." ...

This intense process enables the child victims to tranform non-declarative or "hot" memories into declarative or "cold" memories, thus giving them a sense of perspective.

"'The difference would be feeling, right now, that you are being raped, compared with the recollection that at some time in the past you were raped,' [Psychologist Claudia] Catani said. 'This second part is still very difficult, but when we place it in the past, we can start to put some distance there and keep it from intruding in the present.'"

Children and Trauma -- A More Widespread Problem Than You Think

The two psychologists were in Montana on Sept. 22 for a talk at the National Native Children's Trauma Center. The Director of the Center, Mariyln Bruguier-Zimmerman, brought up a very important issue when she likened the effects of violence on children in other countries with the effects of alcohol, poverty and neglect.

"'What we're talking about is trauma at the foundational level for all these children,' she said."

Bruguier-Zimmerman is right, and not just about Native American children. As a former traumatized child myself, I'm very aware of what can and often does happen when children who have been traumatized are not given the help they need.

I'm also aware that there are too many people who only think of obvious forms of violence when they think about trauma. But poverty, for example, can make a person (especially a child) feel every bit as helpless and victimized as rape does. In the case of someone who is raped society (mostly) has sympathy; victims of poverty are (mostly) told to pull themselves up by their bootstraps when they frequently don't have any boots, and thus are doubly victimized.

Narrative Exposure Therapy to Help Poor Communities?

According to this article, Narrative Exposure Therapy is even helpful when the treatment is facilitated by a trained lay therapist. This seemingly extremely low-cost modality may well help us reach both child and adult victims of poverty, neglect and violence who can't afford traditional treatments and/or who are too suspicious of professional agencies to seek them out.

In other words, we may well have the means to begin training people to help each other deal with the effects of our society's dismal record on fiscal equality.

Image courtesy Peter Mantello via Flickr.

New Help for Veterans with PTSD, substance abuse disorders

Proposed Rules Change Would Make it Easier for Vets to File for PTSD-Related Benefits

Here's a bit of overdue good news for our veterans who are living with PTSD and/or substance abuse disorders.

First, the Veterans Administration is looking to make it easier for some vets to qualify for PTSD-related benefits. Previously, many vets had to provide evidence of a traumatic event during their military service. (Because, while experiencing the event/s that caused your PTSD, the first thing were worried about was making sure you'd be able to prove it later.)

Under the proposed change, the veteran's lay testimony will be sufficient evidence, subject to review by a psychologist or psychiatrist to confirm that the event/s were sufficient to cause the vet's PTSD and were linked to the vet's military service.

Combat veterans and former prisoners of war are already allowed to qualify using a streamlined process, according to the report, so they will not be affected by the proposed change.

According to the report, "The proposed change is aimed in large part at the many troops in the current wars whose jobs do not involve combat with the enemy but nonetheless may experience traumatic events that lead to PTSD, such as combat support personnel and health care providers."

The VA is accepting comments about the proposed change through October 23rd. If you know a vet with PTSD, are a vet with PTSD, or care about our nation's duty to our veterans, please take a moment to hop over and comment now.

Be Careful! The comment site, www.regulations.gov, is one of the most difficult to navigate that I have ever seen!

New Non-Profit Organization Aims to Fund More Care for Vets with PTSD

Yesterday saw the announced launch of the Veterans Healing Initiative, a non-profit seeking to bridge the gaps between available VA-funded treatment for vets living with PTSD and/or substance-abuse disorders and the huge need generated by the current wars.

According to the VIA's mission statement,

At VHI we will:

• Raise funds for licensed existing treatment centers across the country that provide evidence-based, best practices, dual-diagnosis treatment for substance abuse and PTSD and have a dedicated veterans treatment track
• Fund growth of veteran-focused recovery programs, create capacity and uncover treatment models that can be replicated nationally
• Develop a consortium of treatment programs that will work with federal, state and local agencies to facilitate the growth of and ongoing research into comprehensive dual-diagnosis care for men and women veterans
• Work collaboratively with federal, state and local agencies, Veterans Drug Courts and other charitable organizations to promote and develop veteran recovery programs
• Expand the growing national dialogue about these disorders through public service ads, fundraising initiatives, conferences and on-line resources to create new programs for veterans and their families

The organization's founders and Board of Governors are an eclectic group of business, mental health, and media professionals. They have already recommended some programs -- though there is no indication on the organization's Web site that those programs have received VHI funding yet. And, of course, we'll want to keep track of their budget in terms of how much is being raised and how much ultimately ends up directly helping our vets.

Still, this seems like progress to me. Comments?

Image courtesy of Dom Cruse via flickr.

Insurance Law Changes May Affect Your Mental Health Treatment

The 2008 Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act will go into effect on January 1st of 2010, about five months from now.

This law mandates that health insurance companies cover physical and mental health treatment equally. That is, if the company already provides treatment for symptoms of psychiatric illnesses.

Obviously, this change in the law could be very good for those of us with health insurance who deal with trauma-related symptoms of mental illness.

For more detailed information on how the new law could affect your health insurance coverage, visit the American Psychological Association's help page on the issue.

Ecstasy For Agony?

Forgive the play on the original title; I couldn't help myself. All kidding aside, though, this piece in Mother Jones has some fascinating things to say about the uses of MDMA, also known as Ecstasy, as part of a particular course of psychological therapy for PTSD.

The article is informative on several counts, primarily in discussing studies into the use of MDMA in exposure-based therapies, where clients repeatedly confront their fears in a safe, controlled environment.

"The therapy requires patients to confront their anxieties, but researchers believe medication — including MDMA — can help by making the patient feel safer, more in control, more able to process emotions and less evasive or dispirited."

And did you know that MDMA was being studied as a therapy for psychiatric symptoms back in the 80's? I didn't, but I also wasn't surprised to read the history of our government's ban on the drug and how that ban slowed research for many years. Once again, we're reminded that according to US drug policy, "If it feels good, don't do it -- even if it's good for you."

Finally, the article provides a good overview of exposure therapy. According to the two Norwegian scientists interviewed by Mother Jones,

"There is a common misconception that psychotherapy is a really long process of vaguely defined 'talking' and that it probably isn't that effective anyway. Actually, exposure therapy (in particular "prolonged exposure therapy," as developed by Dr. Edna Foa at the University of Pennsylvania) is short-term, structured, based on scientific behavioral principles of conditioning and extinction, and validated by many controlled studies. For most patients, exposure therapy has clinically significant effects on anxiety after a few hours, and for PTSD, exposure therapy has demonstrated long-term positive results after 10 to 12 hourlong weekly therapy sessions."

If you have an interest in any of these subjects, take a moment and check out the full article.

Note from the Management: to April

For reasons I can't fathom, Blogger isn't allowing me to post replies to comments right now.

This note is to April who commented on the recent post regarding Psychiatric Service Dogs:

April, would you be willing to do a quick guest post about life with your service dog? Details about your partnership, how you adopted him, and your training protocals may well be helpful to others.

Yet Another New Beginning: DBT

Tomorrow I'm beginning a new chapter in my own healing journey.

After 15 years of tearing down and rebuilding my life, I'm at something of an impasse. I've become increasingly proficient at figuring out the why's of my reactions -- after the fact.

After the fact isn't good enough when "during the fact," so to speak, leads to difficulties being with other people, keeping jobs, and occasionally even having a civil discussion with my one living family member.

Which leads me to tomorrow. I'll be going to Wayne State University for a full battery of assessments prior to joining a Dialectical Behavioral Therapy (DBT) group. So far, my research (along with the positive advice of a Peer Support friend of mine who leads a DBT group) leads me to believe that this type of therapy will teach me how to respond rather than react to the many things which still seem to trigger me.

In other words, it's time for me to learn a new behavioral Standard Operating Procedure; one in which I'm in charge of what happens when I'm triggered.

This is going to be a six-month process after the group starts. I'll be posting updates on the process here periodically. Perhaps my experiences can help someone else decide whether DBT is for them, or at least provide some solid information from a first-person point of view.

Something New Every Day: Psychiatric Service Dog Society

Sometimes I'm a bit slow.

For example, I've become used to seeing dogs at Peer Support trainings. However, I just assumed that any dogs wearing service vests most likely were helping their owners live with other disabilities.

Yesterday my ignorance on this count was remedied through the good auspices of the Psychiatric Service Dog Society, which I found while bouncing from article to article doing research for this blog.

Thinking about it, it would seem to be common sense that dogs could be a tremendous help to people living with symptoms of both PTSD and other psychiatric conditions, if only through their gift of unconditional love for their owners.

But it's more than that. Psychiatric Service dogs can be trained to help us wake up when we oversleep, for example, or remind us to take our meds. And what could be more soothing to those of us with social anxiety than the protecting, loving presence of our dog with us in a public place?

If there's even a chance that a Psychiatric Service Dog would be helpful to you or someone you know, or you're even just curious, check the site out. It is well-researched and full of information to quench your curiosity, help you make a decision about getting a service dog and/or help you get started.

There is valuable information for clinicians as well, including research into the therapeutic benefits of Psychiatric Service Dogs.

Note from the Management

Apologies for the lack of posting yesterday as I played catch-up from Labor Day. Sometimes it's Good to take time off!

Obesity as a "Shield" Against Childhood Trauma?

This report from the blog PsychCentral talks about something that, on the face of it, would seem to be common sense -- a link between childhood physical and/or sexual abuse and obesity.

In addition to the overeating that leads to obesity, the article also discusses possible links between early abuse and the development of other eating disorders.

While the whole article is fascinating, what I found most helpful for purposes of this blog is that the author discusses why traditional weight-loss tips may not be helpful to people who have become obese as a "shield" against either further trauma or against the feelings brought on by the trauma.

She then goes on to list 6 tips for healing from both the effects and the causes of trauma-induced obesity. As part of the list she includes these three links to articles on avoiding emotional eating, 3 Principles of Mindful Emotional Eating, and 10 Skill-Sets of Mindful Emotional Eating.

No one who has suffered the trauma of abuse deserves to have to deal with unwanted obesity or other eating disorders as well. If you see yourself in this article, I hope you'll find the offered tips and resources helpful. I do know that I plan on checking into them further.

Shield photo courtesy of Craftsman1 via Flickr.

PTSD Isn't Fiction, but Sometimes It's a Plot Point

Over at Science Fiction/Fantasy site Tor.com, SF reviewer and self-identified PTSD sufferer Arachne Jericho has put up two (so far) excellent articles about PTSD in fiction.

Part 1 includes a description of the ways that triggers manifest that I'd recommend excerpting and sending to anyone among your friends/family/acquaintances who need an explanation that is plain-spoken and accessible.

In addition, Part 1 talks about the ways that fiction authors "do" PTSD wrong; Part 2 showcases to instances where authors got it "mostly right" using examples from two of the most iconic works of TV and film in the Science Fiction/Fantasy universe.

Whether or not you're into the Science Fiction or Fantasy genres, my guess is that you'll be able to relate to Jericho's description of authors' usual approaches to PTSD: "What PTSD?" and "Set Piece PTSD," and perhaps see a bit of yourself in the characters she discusses in Part 2.

Jericho lists some resources at the end of Part 2, but I've not had a chance to check those out as of this posting.

I for one am looking forward to the rest of the series.

Neurogenesis and Trauma Recovery

The Discovery of Neurogenesis

Long ago and far away (or so it seems) it was a standard belief among researchers that, once our brains matured they stopped growing or changing. Brain cells neither died, nor were new cells made.

That belief was so well-known, in fact, that I remember my mother saying something about it when I was growing up.

The idea that our brains can't heal like the rest of our bodies do -- by generating new cells -- was frightening.

It was also dead wrong.

To seriously oversimplify the story (the rest of which you can read in this terrific article in a 2006 SEED magazine piece), roughly eleven years ago Princeton Professor Elizabeth Gould proved that, rather than being static, human adult brains are, "constantly giving birth" to new cells.

The implications for trauma recovery could be phenomenal.

Stress Disfigures the Mind. Neurogenesis Can Help Bring it Back.

Indulging in oversimplification once again, Gould's research shows that our brains are literally molded by our lives.

According to the article:

The structure of our brain, from the details of our dendrites to the density of our hippocampus, is incredibly influenced by our surroundings. Put a primate under stressful conditions, and its brain begins to starve. It stops creating new cells. The cells it already has retreat inwards. The mind is disfigured.

The social implications of this research are staggering. If boring environments, stressful noises, and the primate’s particular slot in the dominance hierarchy all shape the architecture of the brain—and Gould’s team has shown that they do—then the playing field isn’t level. Poverty and stress aren’t just an idea: they are an anatomy. Some brains never even have a chance.

Or, as Gould's post-doc student Chrisian Mirescu said, “When a brain is worried, it’s just thinking about survival. It isn’t interested in investing in new cells for the future.”

Sounds like a good description of trauma, doesn't it?

Rats With PTSD

During one long experiment, Gould and Mirescu deprived newborn rats of their mothers for set lengths of time.

You know the problems that trauma-survivors have in dealing with day-to-day stressors? Once grown, these rats had the same issues -- they never learned how to deal with stress because the stress of being deprived of their mothers flooded their brains with a class of steroids, glucocorticoids, that are toxic for the brain. Too much chronic stress and neurogenesis stops happening while the parts of our brain that we need for learning and memory begins to wither away.

3 Possible Ways to Promote Neurogenesis -- and thus Healing -- In Our Brains

1. Learn new things. When put in plain cages, the brains of Dr. Gould's marmosets (another primate she works with) experienced decreased neurogenis. When the same animals were transferred to an "enriched" enclosure with things like hidden food and a variety of toys, their brains, "...underwent radical renovations at the cellular level," in less than four weeks.
   
   Not that this proves anything, but when last winter I experienced major depression brought on by sudden extreme stressors, one of the things I gravitated to almost instinctively was re-learning how to play chess. Within a few weeks, my mind started feeling sharper overall and I stopped being stumped by decisions like which pair of underwear to choose in the morning.


2. If you've been prescribed anti-depressants, take them. There is evidence that anti-depressants actually work by promoting neurogenesis, according to the SEED article.


3. Exercise. Yes, you've heard this before. But according to this article in BioEd online, physical exercise promotes the generation of new neurons (neurogenesis).

Further Research?

I've chosen to focus on the sEED Magazine piece because, 1. it fascinates me; 2. it's easy for a layperson to understand; and 3. I'm excited about the possibilities this research could have for helping people heal from trauma. However, this article was written in 2006. Does anyone out there have something just as good (or better) but more recent?

Thanks in advance!

Image courtesy of Hljod.Huskona via flickr

Welcome

This blog is about trauma; specifically, recovery from trauma. You'll find my explanation and hopes for the blog on the sidebar, but it feels important to say a few things up front:

Guidelines

• For purposes of this blog, all traumas are equal. If you experienced something as traumatic, and you are working to recover from that trauma (or considering your options for doing so) you are welcome here. This blog is not a forum for comparing one person's trauma to another's or for sensationalizing what has happened to us.
• Trauma survivors, loved ones, and the professionals who work to help us are all welcome here. As the blog goes on I will be soliciting articles from professionals geared to furthering the conversation about effective treatments for trauma, and especially the things that we trauma survivors can do for ourselves.
• I am not (yet) a professional counselor. That means you, the reader, need to take what I say with a larger-than-usual grain of salt. I will do my best to link to and write about scientifically and socially valid treatments, but/and I welcome corrections, further explanations, and/or elaborations. My opinions, of course, are mine alone.
• As you may get from the above, comments are welcome. Comments that serve only or mostly to advertise your business, however, will be deleted, as will any comment that I as the editor deem to be abusive, exploitative, or in any other way out of line with the purpose of this blog. If you want to write about your practice or approach to healing trauma, ask me first.

Get it, got it, good?? Great! Thank you, future readers, for what I plan to be a thriving online community.