When discussing Post-Traumatic Stress Disorder (PTSD) with clients in the aftermath of their traumatic experience, we have noticed a recurring experience. Many times, clients who meet criteria for the diagnosis of PTSD understand this to mean that they will always suffer from the effects of their trauma. All too often, we see a shadow sweep over our client’s faces as shame and fear rise in their bodies. We want to help clarify this particular diagnosis with a message of hope. PTSD is not a lifelong chronic condition, rather a description of how our bodies work to restore safety after trauma. Let’s talk about Post Traumatic Stress and how we can use this information to work toward healing.
Post-traumatic stress (PTS) is a natural response to experiencing or witnessing a traumatic event, impacting both mind and body. When confronted with trauma, the body's nervous system initiates a complex cascade of responses aimed at survival. Understanding the neurobiological impact of trauma can shed light on the symptoms individuals may experience, such as hypervigilance, flashbacks, and emotional dysregulation. Understanding PTS must involve the nervous system's role in trauma, which illuminates how our body reacts to perceived threats. Traumatic experiences can dysregulate the autonomic nervous system, leading to a state of hyperarousal or dissociation. This dysregulation can disrupt the body's ability to distinguish between real and perceived danger, resulting in ongoing feelings of fear and vulnerability. By learning about the nervous system processes at play, individuals can gain insight into their symptoms and recognize that they are not signs of weakness but rather adaptive responses to overwhelming circumstances. This knowledge can also inform treatment approaches, emphasizing interventions aimed at regulating the nervous system's stress response. Treatment for PTS often involves therapeutic modalities that target both the mind and body. Polyvagal theory helps to pay attention to nervous system signals and to use this information to create safety in the mind and body. Dialectical Behavior Therapy (DBT) helps individuals become skillful in mindfulness, emotional regulation, interpersonal skills and distress tolerance, while somatic experiencing focuses on releasing stored trauma from the body. Eye Movement Desensitization and Reprocessing (EMDR) and Brainspotting harness the brain's natural healing mechanisms to reprocess traumatic memories and alleviate distress. These approaches not only address psychological symptoms but also aim to restore balance to the nervous system. Despite the challenges posed by PTS, there is hope for recovery. With the right support and resources, individuals can learn to regulate their nervous system responses, reduce symptoms, establish safety and cultivate resilience. It's essential to approach treatment with compassion and patience, recognizing that healing is a gradual process that unfolds over time. In conclusion, understanding the neurobiological impact of trauma is crucial for navigating post-traumatic stress with compassion and efficacy. By integrating this knowledge into psychoeducation and treatment approaches, we can empower individuals to reclaim agency over their healing journey. Remember, recovery is possible, and there is hope for a brighter future beyond trauma's shadow. Next week’s blog post will be about Post Traumatic Growth.
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Introducing Radical Acceptance Radical Acceptance is a core skill in Dialectical Behavior Therapy (DBT). This skill falls into the category of Distress Tolerance skills. We reach for this skill when we are navigating something big and hard in our life that is outside of our control or influence. The idea behind Radical Acceptance is that we can work to improve our wellbeing even in the midst of the big and hard things. To appreciate what Radical Acceptance can offer us, we must first understand the difference between pain and suffering. Pain is an inevitable part of being human in our world. We will all experience pain at different times in our life. Suffering, however, is caused when we make choices that make painful circumstances harder for ourselves. Radical Acceptance seeks to accept pain and reduce suffering. When we reduce suffering, we grow in emotional resilience and wellbeing. Understanding Radical Acceptance Radical Acceptance is the act of fully acknowledging and embracing reality without judgment or resistance. In other words, Radical Acceptance is a choice to stop fighting against reality. Likely something is happening in our life that is hard and beyond our ability to change it, and we are left with the decision to accept (radically) or reject the reality of the situation. The radical part of Radical Acceptance speaks to the complete and total nature of our choice to accept reality. Radical Acceptance is not resignation or apathy, rather it is a conscious choice to yield to what is real. Radical Acceptance also does not require our stamp of approval on the difficult circumstances, instead a simple acknowledgement that it exists and that we will stop fighting against it. Suffering comes when we fight against painful events that we don’t have the power to change, and Radical Acceptance offers us a peaceful alternative. Cultivating Radical Acceptance DBT offers us some step-by-step guidance on how to execute the choice to Radically Accept painful circumstances.
We can draw upon other DBT skills as tools to help us in this process. Mindfulness skills help us notice what is happening internally and externally and bring awareness to the present moment. Additionally, mindfulness skills call us to self-compassion and nonjudgmental observation of emotions. We may have an opportunity to reframe negative thoughts about our reality and notice growth opportunities or unexpected benefits. Some nourishing activities like journaling and spending time in nature can help promote acceptance. Often times, Radical Acceptance requires patience and practice, as most painful events will require us to choose acceptance over and over again. Disclaimer: Radical Acceptance is not an excuse for harmful or abusive dynamics, but it may be a starting point for being honest about the harm that exists. May this honesty open doors for healing and support. Written by Allison Harvey
Trauma survivors have gone through something that challenged every part of them, most significantly their sense of safety. Their needs are personal, unique to their personality and circumstances, and often quite delicate. Naming these needs creates space for trauma survivors to feel safe, work toward healing and maintain connection with loved ones. Physical Needs On a very basic level, trauma survivors have a need for safety and security. Through their traumatic incident(s), they learned to be on guard and watchful. Trauma survivors need a physical location where they can let their guard down and rest. Trauma survivors also need access to medical and psychological care—professionals to come alongside them and nurture their physical and emotional self back to health. Trauma survivors also need adequate nutrition and sleep. Tending to these basic needs helps to heal a nervous system that felt a strong lack of safety. Emotional Needs Those who have survived trauma(s) have a strong need for emotional understanding, empathy and validation. When they are ready to share about their story, they need to be received with compassion, support and validation that says “what you are feeling makes sense to me.” Trauma survivors can also be supported with emotional skills that help them navigate trauma triggers and a large emotional burden while they are healing. Social Needs Trauma healing happens within a safe, understanding and supportive relationship(s). Those who have survived trauma need their people to remain open to them. Trauma healing can be messy and indirect, so survivors need compassion and grace to learn to feel safe in relationships again. Survivors may need more accommodations so that they can stay regulated, and this may look like them setting boundaries or asking for certain changes. Connecting with others who are healing from trauma can be very beneficial as well. Psychological Needs Professionals who are supporting trauma survivors should be trauma-informed and have a path toward healing in mind. Psychological care should be gentle and paced by the survivor. Professionals should respect the trauma survivor’s wishes to tell their story or not, knowing that healing can happen either way. Trauma survivors benefit greatly from learning and practicing coping mechanisms and stress management techniques. All of these activities support the survivor to rebuild trust, regain resilience and personal strength. Practicing this DBT Skill can help us stay grounded and connected this holiday season! Mindfulness is a skill that, when practiced regularly, is a great tool to reduce stress, connect with our personal goals and create genuine connection with others. The holidays can be rich in memory, sentiment and relationship. They can also be full of family expectations, grief and reminders of trauma. These, and many more experiences, can overwhelm, cause us to disregard our own needs, and flood us with many different emotions. In order to enjoy the positive aspects of the holiday and skillfully navigate the challenges, try practicing mindfulness throughout your holiday season!
Mindfulness has three components:
Mindfulness as Stress-Reduction For many, the holiday season means a busy schedule and many more tasks and to-dos than normal. Practicing mindfulness in the midst of the whirlwind helps to produce moments of calm to catch our breath and remember our priorities. Mindfulness also helps us evaluate where our time and energy are going and make the most intentional decisions for ourselves in this season. Mindfulness as Social Support Paying attention to the present moment, without judgement can give us a lot of important information about what is happening in a room, or in a conversation. In the midst of a holiday gathering, take a moment to simply observe what is happening inside and outside of yourself. Allow yourself the gift of a few deeper breaths. Notice who is talking with who, and what those dynamics are like. Notice what is happening inside yourself as you connect with different people. Hold this information lightly and without judgement, and allow this information to guide your interactions. Mindfulness to support Intentional Decisions If you find yourself navigating a lot of spoken and/or unspoken expectations over the holidays, mindfulness skills can help you identify your needs and desires and to stay connected to them throughout the season. Spend some intentional moments noticing where you would like your time and energy to go this season, what would make it memorable and special for you and yours. Notice how other’s expectations are making you feel, especially if those expectations cause you to disregard your own needs and desires. Give yourself the gift of staying connected to yourself and your values, which becomes a much more congruent and grounded holiday experience. Have you lost a loved one and find yourself in a never-ending sea of grief? The process of mourning typically takes much longer than we anticipate. As a grief therapist, I know that grief can take a long time, often extending years after a significant loss. There is no protocol for how long grieving is meant to take. In fact, the grief process is wholly informed by the relationship itself. However, there may be some reasons that we may extend the grieving. If this is your experience, you may be encouraged to know that moving through grief emotions and adjustments may help you remember more from your time with your person.
1. We hang on to grief as a way to stay close to our person Grief and mourning are an intense and all-consuming experience. When we are processing and feeling and adjusting on such an intense scale, our brain is much less available for it’s normal functions. It is common to feel brain fog while grieving. The griever may be tempted to stay in this phase of grief because it centers the person that they lost. The focus is on the relationship and the stories are about the person. The pain seems to point back to their person. The logic here is that staying in the pain of grief must be the only way to stay connected to the person who is now gone. There is a time for all grievers when the pain eases, the emotions have softened and the adjustments are starting to feel normal. It is important to acknowledge when the grief seems to be letting up. And the good news here is that when the griever is out of “survival mode,” they are able to access many more memories and stories from their time with their person. There is a sense of gaining more of them back as the grief softens. 2. We hang on to grief because we don’t know what comes next Another common experience for those grieving a significant loss is a fear and confusion about the future. Moving forward in life without your person seems impossible for so many reasons. As uncomfortable as the grief experience can be, it does become familiar terrain after a while. For some, the temptation is to stay in the grief because it is familiar instead of navigating the uncertainty of the future. Considering a new future is a creative task, and one that is unwelcome at first. Our imaginations fail to offer a vision of what our lives might offer us as we move forward. Even so, it is important to choose to allow yourself a new future. Moving toward the opportunities that open ahead of you does not mean that you leave your person in the past. In fact, your forward motion can be propelled by the strengths you have gained through your experiences with your person. We may be able to use their memory as a spring-board toward what comes next, imagining them as an encouraging and empowering voice nudging us forward. It is a lovely thing to learn to carry our person with us as we continue in life. Only the griever will know if they are hanging on to their grief unnecessarily. It is an internal milestone, marked by choice in the depths of a grief-stricken heart. If you find yourself wondering if it might be time to move forward and feeling stuck in your grief, please reach out for some support. Our team is available to help navigate all phases of this process! When we are grieving, we often ask ourselves, “when will I start to feel better?” Seasons of grief are intense and demanding in ways that we don’t experience otherwise. The emotional burden is great, our relationships may be strained as the result of our grief, and everything feels so far from normal. It is natural and normal to long for the end of these feelings. So, what does it look like to engage our grief in a way that leads to healing?
1. Learn to Tolerate and Accept the Difficult Emotions Grief requires us to befriend the most uncomfortable emotions. Grief emotions—shock, sadness, confusion, anger, longing, disorientation, despair—are all terribly uncomfortable to feel. And when our loss is significant, we end up feeling them for much longer than we ever expect. We increase our grief suffering when we fight against the grief emotions—ignoring, avoiding, overcompensating, engaging addiction—these all end up heightening our emotional experience. Additionally, when we don’t tend to our emotions, they may come out sideways in ways we don’t intend. We can help our grief process along by looking at each grief emotion that we find ourselves feeling and explore its source, its history, its message. In doing so, we are almost listening to the emotion, giving it time and space to breathe. For some, these grief emotions signal danger or threat. Take the time to disentangle these historical messages and learn to welcome each emotional character. In time each of the grief emotions will soften. 2. Notice and Name all of the Adjustments The other major focus of grief work is making many (sometimes hundreds!) of life adjustments. Without our person in our life, we may find ourselves needing to learn new skills, take on new tasks, fill new roles. Each one of these adjustments can take an enormous amount of emotional energy, during a time in life when energy is at a minimum. It is important to be aware of these adjustments, to bring them into focus by noticing and naming them. Even better, to be talking with an understanding person about them. Sometimes, we can slow the pace and take just one or two tasks or activities at a time. Other times, we just need to keep moving forward and taking care of business. Regardless, naming the many adjustments can be very helpful in processing grief and moving forward in healing. Notice for yourself how difficult these tasks feel. How are you navigating them today? Does your support system know you are working and healing in these ways? What can you request your people do for you as you engage grief healing? If you are in need of a skilled and sensitive grief therapist, please reach out to our team! We understand these tasks and are available to help create safety and opportunity for doing this work! Dialectical Behavior Therapy (DBT) offers a set of skills to help with many different emotional and relational difficulties. The four pillars of DBT are Mindfulness, Emotion Regulation, Interpersonal Effectiveness and Distress Tolerance. Each of these pillars offers a number of skills to practice in that area. I have selected three DBT skills that I believe can make a significant difference for those managing depression.
Depression is an experience that includes a slow-down or freeze response in the nervous system. People managing depression may feel numb, detached, hopeless and sad. These internal experiences may cause them to isolate from relationships, get stuck in their difficult emotions, struggle to complete normal activities. Often, those managing depression feel misunderstood by the people in their life, especially when they are encouraged to “think positively” and “just get over it.” In fact, people managing depression are often expending enormous effort to engage in their life in the most simple ways. The following set of DBT skills can be used together or individually to improve depression symptoms and help catalyze healing and forward movement. 1.Emotion Regulation Skill: Opposite Action When we are using Emotional Regulation skills, we are paying attention to whether or not our emotions fit the situation we are in. Opposite Action is a skill that we reach for when we have determined that our emotions DO NOT fit the facts of the situation. This is often the case with depression. Depression is like a lens that makes life look harder and sadder than it actually is. All emotions have an action urge, an instinctual action that the emotion makes us want to do. When our emotions DO NOT fit the situation, we benefit from acting opposite to the action urge. Here are some common emotions experienced in depression and suggestions for opposite action.
2.Interpersonal Effectiveness Skill: Making Requests Making Requests is a relationship skill that is very closely related to making boundaries. Requests highlight what we need from another person. While they can be vulnerable to make, they are also vital to communicating our needs with others. Loved ones are not mind-readers and need invitations and instructions to know how to care for those managing depression. People experiencing depression are almost always misunderstood by the people who care for them most. Unless they have experienced depression themselves, loved ones will likely minimize the depressed experience. From the outside, it may appear that it would only take a few simple steps to recover from depression. If only that were true. In order to stay connected with loved ones and to receive the care they absolutely need, those managing depression need to lean into this skill of making requests. They need to speak about how they are feeling and the effort they are expending to engage with their lives. They need to ask their loved ones to be patient with them, to use encouraging language, to offer comfort and presence rather than solutions. 3.Distress Tolerance Skill: Radical Acceptance We reach for distress tolerance skills when we are going through circumstances that are too big and/or too hard for us to change. Depression often comes on the tails of a big and hard life event, such as the loss of a loved one, a difficult transition, a painful event or unmovable circumstances. When there is truly nothing we can do to change our circumstances, we need to shift our focus toward acceptance. We are using radical acceptance skills when we work to create openness and willingness toward our difficult circumstances. Willingness is a powerful mindset shift and means that we will stop fighting against what is inevitable. Endlessly fighting against unfavorable circumstances is a recipe for suffering. Pain is inevitable in our lives, but suffering is a choice. We can still live meaningful lives in the midst of painful circumstances. When we give up the fight, we are more able to find acceptance. . . and peace. Social anxiety can be consuming and can really limit the life experiences one might be open to. Imagine having to overcome a wave of panic, accompanied with rapid heartbeat, muscle tension and even blurry vision when walking into certain social circumstances. This dizzying experience can feel disorienting and even dissociative. When this happens regularly, it is understandable that we might start to avoid situations that cause this response all together. When this becomes a pattern, we may experience a narrowing of life experiences, a decrease in self-esteem and a reduced willingness to try new things.
It is possible to learn skills that help us navigate social events with more ease. Feeling confident and calm in social situations allow us to be present with ourselves and with others in the room. We are more able to be genuine and operate within our natural personality, making higher quality connections. There is one skill that has been the most helpful for our clients who are unlearning social anxiety. It is the DBT Mindfulness skill OBSERVATION. To understand this skill the most, let’s take a quick look at Mindfulness. When we are practicing mindfulness, we are 1) noticing our internal/external environment,2) without judgement and 3) without minimizing or enhancing what we find there. It is simply a practice of noticing. Noticing what we are feeling in any given moment. Noticing what is happening around us. Noticing what might feel like a threat. Simply noticing. Mindfulness practices like this slow us down and bring us into the present moment. And when we break this mindful practice into even smaller skills, one of the most impactful skills is that of OBSERVATION. We are simply taking in information, through our senses, thought processes and relationships. To observe skillfully, we need to create enough distance from what we are encountering to fully take it in. And this observable distance can make a big difference for social anxiety. Let me explain a little more clearly. Imagine yourself preparing to go to a social event where you do not know anyone. You are expecting to walk into a room of people milling around and forming small conversation groups, and you are expected to go and have a good time. Practically speaking, this might be a business networking event, an awards ceremony, a college orientation day, etc. What I am encouraging you to try, is to enter the event as an OBSERVER first and foremost. Find a comfortable place in the room to sit or stand. Once you are there, take a few deep breaths that bring you into the present moment and allow the room to stop spinning. As you do this, you are creating an observable distance from which you can take in all that is happening in the room in that moment. Notice what is happening around you. Notice how many conversation groupings there are, how are the people in conversation feeling, are there other nervous people present, where are the food and beverages located, are there people who are also looking for someone to talk with? You are simply noticing what is happening in the room. And from this observation point, you might start to notice where you’d like to be in the room. You may prefer to stay right where you are at, you may notice a conversation you’d like to join, you may notice that you’d like to get a drink before doing anything else. Regardless of where you go from here, mindfully observing your surroundings has allowed you more choice to be genuine in your interactions. And with practice, you may just feel more open and confident in new social situations! |
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