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Post-traumatic Stress Disorder (PTSD)

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Can Art Therapy Help Heal the Pain of PTSD?

Mon, 08/07/2017 - 14:00

Art therapy has experienced tremendous growth over the past two decades, not only advancing treatment options but also advancing into different populations and treatment settings. In particular, art therapists have been working with a very special and unique population — the military.

For over 15 years, post-9/11 military service members and veterans have been coming home after serving sometimes multiple tours to Iraq and Afghanistan. Many have sustained physical and psychological combat injuries and require extensive care. While medical advancements have made it possible to survive catastrophic injuries, the reality for those who do survive is that they may require extensive physical, hands-on care for many years to come. In addition to physical impacts, post-traumatic stress disorder (PTSD) and traumatic brain injuries (TBIs) are prevalent in the Operation Iraqi Freedom, Operation Enduring Freedom, and Operation New Dawn veteran populations, which poses tremendous daily challenges for the veteran and his or her entire family.    

Stark cultures exist between the military and art therapy. The military — an institution and culture of rigid protocol, disciplined training, mission-focus; and art therapy — a profession based in creativity and the therapeutic relationship, within a fluid and flexible approach that offers myriad ways to openly express one’s feelings and thoughts. Yet many who serve in the military are finding art therapy to be their preferred method of treatment.

Why?  
It’s a simple answer to a not-so-simple and pervasive issue challenging many military members who return from war: trauma. These two contrasting worlds of military service and art therapy intersect because art therapy has the means to assist service members, veterans and their families in dealing with combat trauma.

The American Art Therapy Association explains Art therapy is an integrative mental health and human services profession that enriches the lives of individuals, families, and communities through active art-making, creative process, applied psychological theory, and human experience within a psychotherapeutic relationship (AATA, 2017).

In 2016, the Defense and Veterans Brain Injury Center reported that 352,619 US military service members worldwide have been diagnosed with TBI, with 82.3% cases classified as mild. Research points to the connection between PTSD and TBIs in military service members. In fact, recent studies link TBIs sustained during deployment to significant predictors of the service member developing symptoms of PTSD (Walker et. al., 2017).   

Combat veterans are seeking art therapy to assist with trauma resolution, integrate with their TBI treatment plan, and provide coping mechanisms for PTSD symptoms. These therapies have become an increasingly accepted form of complementary care for military veterans (Nanda, Gaydos, Hathron, & Watkins, 2010). Art therapy, facilitated by a professional art therapist, effectively supports personal and relational treatment goals as well as community concerns (AATA, 2017).

Over the past 20 years, the field of neuroscience has grown exponentially and has contributed to advancing art therapy to the forefront of trauma-focused treatment today.  Significant to the use of art therapy in trauma work is understanding the neurobiology of trauma, the biological study of the effects of trauma on the nervous system.  

Advances in medical technology, such as brain imaging, now allow physicians, therapists, and scientists to literally see and understand what art therapists have known all along: creating, such as art-making, can change neural pathways in the brain; and that potentially changes the way one thinks and feels.     

Art Therapy is a profession that facilitates psychic integration through the creative process and within the context of the therapeutic relationship. Conscious and unconscious mental activity, mind-body connectedness, the use of mental and visual imagery, bi-lateral stimulation, and communication between the limbic system and cerebral cortex functioning underscore and illuminate the healing benefits of art therapy — none of which could take place without the flexibility of neuronal processes, otherwise known as neuroplasticity (King, 2016).

Creative arts therapists know through creating — whether through art, music, poetry, or drama — that traumatic memory can be readily accessed in a way that is far less threatening than traditional verbal therapies. Traumatic memories are often stored in images and other sensations rather than in words or through verbalization, and many art therapists have observed how making art helps in releasing traumatic memories that were previously inaccessible.

Recent developments in neuroscience have provided information about areas of the brain responsible for the verbal processing of traumatic events.  Brain imaging illustrates that for many, when recounting a traumatic event, the Broca’s area (language) of the brain shuts down, and at the same time, the amygdala becomes aroused (Tripp, 2007).  Right brain activation through art media and process allow for less reliance on the verbal languages area of the brain, which provides some substantiation for why nonverbal therapies like art therapy might be more effective when working with trauma (Klorer, 2005).

Art Therapy operates on multiple levels, addressing immediate symptoms and underlying conditions that cause symptoms to persist (Howie, 2016).  The American Art Therapy Association identified four major contributions of art therapy to the treatment of PTSD (AATA, 2012).    

1 – Reducing anxiety and mood disorders

2 – Reducing behaviors that interfere with emotional and cognitive functioning

3 – Externalizing, verbalizing, and resolving memories of traumatic events

4 – Reactivating positive emotions, self-worth, and self-esteem (American Art Therapy Association)

For many service members, being able to express memories, feelings and thoughts in a nonverbal way is a big relief. The artwork provides a safe way to depict and confront recurrent nightmares, flashbacks and traumatic memories. Art therapy practice encourages the healthy expression and integration of imprinted memories as they are brought to consciousness within the safety of the therapeutic relationship (Wadeson, 2010).  

Art therapy was introduced into military treatment facilities years ago because it is an effective treatment for service men and women who have experienced the trauma of war. Today, art therapy has become a more widely accepted treatment for those experiencing trauma from their military service. Many are learning that to overcome combat trauma, art therapy is a critical part of their treatment plan.

References:

American Art Therapy Association, Inc. (2013). Art therapy, posttraumatic stress disorder, and service members [Electronic Version]. Retrieved July 24, 2017 from www.arttherapy.org/upload/file/RMveteransPTSD.pdf.  

American Art Therapy Association, Inc. (2017). Definition of profession [Electronic Version]. Retrieved July 24, 2017 from https://www.arttherapy.org/upload/2017_DefinitionofProfession.pdf

Howie, P. (2016).  The Wiley Handbook of Art Therapy, First Edition. In D. Gussak & M. Rosal (Eds.),  Art therapy with Trauma (pp. 375-386). Oxford, UK: John Wiley & Sons.  

King, J. (2016). The Wiley Handbook of Art Therapy, First Edition. In D. Gussak & M. Rosal (Eds.), Art Therapy: A Brain-based Profession (pp. 77-89). Oxford, UK:  John Wiley & Sons.  

Klorer, P.G. (2005). Expressive therapy with severely maltreated children: Neuroscience contributions. Art Therapy: Journal of the American Art Therapy Association, 22 (4), 213-220.  

Nanda, U., Gaydos, H. L. B., Hathron, K., & Watkins, N. (2010). Art and posttraumatic stress: A review of the empirical literature on the therapeutic implications of artwork with war veterans with posttraumatic stress disorder. Environment and Behavior, 42(3), 376-390. dio:10.1177/0013916510361874

Tanielian, Terri, Rajeev Ramchand, Michael P. Fisher, Carra S. Sims, Racine S. Harris and Margaret C. Harrell. Military Caregivers: Cornerstones of Support for Our Nation’s Wounded, Ill, and Injured Veterans. Santa Monica, CA: RAND Corporation, 2013.

Tripp, T.  (2007). A short term therapy approach to processing trauma:  Art therapy and bilateral stimulation.  Art Therapy Journal of the American Art Therapy Association, 24 (4), 176-183.

van der Kolk, B. (2003). Post-traumatic stress disorder and the nature of trauma.  In M. Solomon & D. Siegel (Eds.), Healing trauma: Attachment—mind, body, brain (pp.168-196).  New York, NY:  W.W. Norton.  

Wadeson, H. (2010).  Art psychotherapy (2nd ed.). Hoboken, NJ:  John Wiley & Sons.

Walker, M.S., Kaimel, G. Gonzaga, A.M.L., Myers-Coffman, K.A., & DeGraba, T.J. (2017). Active-duty military service members’ visual representations of PTSD and TBI in masks, International Journal of Qualitative Studies on Health and Well-being, 12:1, 1267317.

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Book Review: The Posttraumatic Growth Workbook

Wed, 07/26/2017 - 21:28

If you told most people that after a traumatic event, they could feel stronger, more open to new experiences, more appreciative of life, a deepened sense of spirituality and closer, more authentic relationships, they might tell you that it sounds unbelievable.

But according to the authors of The Posttraumatic Growth Workbook Richard Tedeschi and Brett Moore, what I am describing is indeed very real, and very relevant.

In the mind-nineties, Tedeschi and Lawrence Calhoun identified posttraumatic growth as “the positive psychological change that results from the attempt to find new meaning following a traumatic event.”

Since then, several others, such as Nassim Nicholas Taleb (Antifragile), Tim Harford, (Adapt), and Ryan Holiday (The Obstacle Is The Way) have written about the ways in which adversity, challenges, obstacles and trauma can make us stronger, more resourceful and more able to adapt in the face of challenges.

The Posttraumatic Workbook: Coming Through Trauma Stronger, Wiser, And More Resilient is designed to show us just how we can learn and use the powerful concepts of posttraumatic growth to our advantage.

Tedeschi and Moore begin by saying that struggling with life’s losses and tragedies can help humans develop in ways that would not have been possible without them. The concept of growth through adversity, they remind readers, is centuries old.

“From the ancient Greeks to today, tragedy has been a common theme in many great works of literature,” they write.

And the concept of posttraumatic growth is backed up with research. According to the authors, studies show that sixty percent of people who experience trauma also report posttraumatic growth. And posttraumatic growth doesn’t only exist in the absence of posttraumatic stress disorder (PTSD) either. In fact, it is many of the same challenges that create PTSD that also set the stage for posttraumatic growth. And while trauma can be debilitating, posttraumatic growth will not eliminate suffering.

According to the authors, psychological distress following trauma is not an abnormal reaction, but rather a normal reaction to an abnormal event. The symptoms of trauma can include anger, frustration, mood swings, racing thoughts, disorientation, impulsive behavior, fatigue and headaches. To help readers identify their symptoms, the authors present exercises such as describing the traumatic event in detail and labeling the emotional, physical, mental and behavioral symptoms. They also provide a comprehensive definition of PTSD complimented by several helpful exercises to identify the risk factors, maintenance factors and protective factors that influence it.

Of particular importance is the way trauma affects a person’s brain.

“Just as the city comes to a halt when its infrastructure is damaged, so it is with your brain in the aftermath of trauma: without it functioning the way it should, you come to a halt,” they write.

It is this halt, however, that incites the process of reflective thinking, which leads to a re-examination of the beliefs about the self, others, and the world – what is known as the assumptive world – and allows trauma survivors to constructively develop a new belief system in the aftermath of trauma. This new belief system – a rebuilding of the infrastructure – will make a person more resilient much as it would make a city more resilient to future disasters.

“Posttraumatic growth is the reconstruction of your belief system into a new system that did not even exist in any substantial form in the past,” write the authors.

While Tedeschi and Moore incorporate several helpful exercises to identify core beliefs and the ways in which they have been challenged, they also offer numerous exercises to identify the emotions that accompany a traumatic event, as well as specific exercises to take control of them. For example, in an exercise called imagery, they suggest finding a quiet place and creating a vision of a safe, comfortable and peaceful place as a way to temporarily leave the harsh reality that trauma often leaves in its wake. The authors also provide helpful exercises to become a neutral observer of some of the troublesome thoughts that can follow trauma. Readers are asked to evaluate and challenge the evidence for such thoughts, and eventually to create more realistic thoughts.

The work of facilitating and encouraging posttraumatic growth begins by first recognizing our strengths, such as those that we used to cope with the trauma, our family strengths, relationship strengths and positive coping mechanisms – and then building upon them. It’s important to note, however, that this work cannot take place without compassion and companionship. Of particular importance, write the authors, is an “expert companion.”

As expert companions walk with us along the path of posttraumatic growth, helping us sort out what to believe and offering guidance where it is needed, they also help us recognize some of posttraumatic growth’s most profound gifts – gratitude, an openness to new experiences, a more authentic sense of purpose, deepened relationships and a strength we’ve never known. Ultimately, as we look back and venture forward, we may find that the path never taken is the path we should have been on all along.

Filled with exercises, tips, and helpful guidance, The Posttraumatic Growth Workbook is a gift for anyone coping with trauma, ultimately helping them see that not only can they make it through trauma, but they can be stronger for it. 

The Posttraumatic Growth Workbook: Coming Through Trauma Wiser, Stronger, And More Resilient

Richard G. Tedeschi, PhD and Bret A. Moore, PsyD, ABPP

New Harbinger Publications (2016)

Softcover, 166 Pages

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Postpartum Psychosis: Is It Real?

Fri, 07/21/2017 - 14:10

“I don’t remember too clearly,” says Sarah, 40, now divorced. “There was a rat. It was black and silky, the size of a cat, and it ran across the closet from one side to the other. I was terrified it would bite the baby if it had burrowed into the walls, so I pulled all the shoes out to the center of the closet, searching for it, or for the hole where it had to be hiding. It had to be there — I had seen it, and I could smell it: like damp and oily rags.”

She loses the thread of her broken memory, recounting her then husband’s confusion at her behavior, irritated, telling her to come back to bed, there wasn’t a rat, it was a dream, turn off the damn light. So she did, and though the baby woke several times that night, as he always did, she got up, and cared for him as she had done since the day she brought him home. A bright, blue-eyed boy, a lightning bolt of infant activity. When he grew sleepy the next morning, she laid him in his crib, and returned to bed, restless and unwell.

Through the monitor, she heard him scream. Agonizing, a sound of pain that took her back to the videos of babies born addicted to drugs and their haunting cries of withdrawals. She leapt from the bed, down the hall to the crib. He slept, peacefully, the little back rising and falling with easy breath. She stared at him, waiting for him to stir, but he slept on.

“It was strange,” she says, “But there were children playing outside. I thought maybe it had been one of them. I just went back to bed. Then it happened again. The same cry, the same peaceful child, sound asleep. Just a nightmare, I thought.”

“Then there was a third cry. Deeper and different. When I went to him, I was nervous. From the doorway, I could see the strange, grey lights, like blades, stabbing into sparkling air above his small body. He looked asleep, but the cry came from inside him, from deep in his belly, and the lights around him were greyish, and sinister. The cries turned to laughter, and indistinct voices like scraping metal on metal. I backed away. I didn’t know what to do.”

Frightened, confused, she called her mother.

“Later, she told me that she thought I had killed him, that I said, over and over, ‘He’s asleep, but he’s still screaming. Please help me.’ She was a thousand miles away. She called a local friend, who came to the apartment to see us. She must have been terrified of what she would find. But the baby was fine. I was a wreck.”

Sarah pauses in the telling, eyes wet, though it has been long enough that the infant in question is now preparing for college, no worse for the wear. I let her gather herself, and she smiles.

“She sent me to bed, and took the baby monitor. I don’t know how long I slept, but someone must have called my mother and reassured her.”

She stops talking and looks out the window. I wait, expecting to hear the end of the story.

“That’s it,” she says. “The next day it was as if nothing had happened.”

She shrugs.

“You’re thinking I should have gotten care, gone to the hospital, someone should have come to help me. But none of that happened. And no one talked about it again, ever. You’re right, of course. I needed help. But I wasn’t sure what had happened. I don’t really remember the next six months of his life. I must have done what was expected of me.”

“The thing is, if everyone around you acts as if nothing has happened, you wonder if it did, especially when your mind fails you in that way. I remember seeing and hearing vague sounds and voices, and thinking, ‘Is it real?’ I’d decide it didn’t matter, and go on about the day. If you’re doing what you should be doing, aren’t you alright?”

She shakes her head, lets her gaze fall to her shoes.

“Years later, I described the incident to my doctor, after another bout of depression. Her eyes got wide. ‘That’s psychosis,’ she said. ‘You should have been hospitalized. Someone should have taken care of that boy for you.’ I’d never had that word attached to me, and I laughed. Of course I wasn’t crazy. ‘Crazy isn’t a great word. If you are seeing and hearing things that aren’t there, that’s psychosis,’ she said. ‘A sign that you really need help. Why didn’t they help you?’”

Sarah sighs and admits there wasn’t anyone to help her. Her family and friends were a thousand miles away, her husband had to work to keep them fed. And her face turns sad when she admits it might have been for the best. She still worries all these years later that someone might find out about what happened. Her career is such that a label of ‘psychosis’ would likely end it.

“The stigma attached to it is so powerful. An involuntary commitment would have marked me as unfit to do my job.”

While privacy laws protect medical records, licensing boards for several careers in most states ask questions regarding mental health treatment, and the consequences for reporting are unknown. The Americans with Disabilities Act should protect people who are under mental health care, but, it becomes a grey area when it comes to the public service sector. Whether a doctor, lawyer, nurse, or police officer is “fit” for duty after having been hospitalized for mental health issues remains a topic of debate, even years after the incident, and even if the incident was so clearly tied to a particular event.

“If something went wrong, even if it wasn’t my fault, something like that on my record might be enough to push a jury to blame me. It was years ago, but that might not matter. So I just don’t report it. I was never hospitalized. I’ve had colleagues through the years who refused to seek treatment for depression, even with mental health coverage, for that exact reason. Especially if the policy comes through their jobs. Sure, HIPPA protects people. Until it doesn’t.”

She smiles again, and says it feels good just to tell the story. She asks to see it when it’s finished, ostensibly out of curiosity, but also to make sure her identity is properly disguised. The stigma of mental illness weighs heavily on her, as it does on any society that prevents its public servants from seeking out the help they need to continue to serve. Sarah has received awards from her superiors for her hard work and dedication. She is an exemplary employee. Thousands like her are not seeking treatment because of stigma and miseducation, when they might serve their communities better with treatment, and offer a unique perspective on those members of the public who are themselves struggling with mental illness. That is the reality.

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Book Review: Mindfulness Skills for Trauma & PTSD

Wed, 07/12/2017 - 16:01

Post-traumatic stress disorder affects a wide range of individuals, from combat veterans and law enforcement to the survivors of sexual assault and childhood abuse. The disorder expresses itself in a variety of ways, including anxiety, depression, avoidance and anger. Just as no two people are completely alike, so it is with those dealing with post-traumatic stress disorder (PTSD). Reasonably, then, we should not expect a one-size-fits-all approach to work for dealing with the effects of PTSD. Talk-therapy is a popular approach, but in her book, Mindfulness Skills for Trauma and PTSD, Rachel Goldsmith Turow introduces another.

Although it looks something like a textbook, Mindfulness Skills for Trauma and PTSD specifically targets trauma survivors as its intended audience and should prove to be a rich resource for those survivors interested in mindfulness. Turow has written a comprehensive text for readers looking for understanding, exercises and a new approach to dealing with the symptoms of PTSD. This is not to say the book would replace any other work being done with the assistance of professionals, rather, it seems a worthy supplement to the recovery process for trauma survivors of all backgrounds. Likewise, there is plenty here to learn for those working or studying in the field, as well as the friends and family of individuals with PTSD.

Appropriately, Turow begins Mindfulness Skills for Trauma and PTSD with the basic concepts of mindfulness, trauma and PTSD. She defines mindfulness simply as “paying attention to our experiences in this moment in a caring and curious way,” and establishes the core tenets of practicing mindfulness, including: attention, present-moment awareness, the beginner’s mind, nonjudgment, nonstriving and patience. While contemporary discourse has become somewhat oversaturated with writings about and guides to mindfulness, Turow addresses it in a distinct way here by focusing on its unique benefits for trauma survivors.

At the heart of Mindfulness Skills for Trauma and PTSD, readers will find the common theme of self-compassion. Turow explores this somewhat nebulous concept in Chapter 4, subtitled, “The Kind Witness Within.” Trauma victims, she notes, often mistake self-compassion for self-indulgence, but of course it is nothing of the kind.

“Self-compassion also reflects truly listening to everything that is occurring within us, as well as the genuine wish that the suffering be reduced,” she writes.

Like others, Turow argues that self-compassion involves being a sort of friend to one’s self, someone who regrets our pain and genuinely wishes for our recovery. This central concept may be one of the most challenging in Mindfulness Skills for Trauma and PTSD, but is arguably also one of the most necessary.

Turow builds the text from there, establishing some foundational skills, such as anchoring in the present moment, focusing on breathing, acknowledging thoughts without fixating on them, mindful walking, emotional recognition and more. These serve as the basis for later practices.

In Chapters the later chapters, she focuses the scope of her discussion by exploring specific concerns of those dealing with PTSD, including intrusive thoughts and traumatic memories, anxiety, avoidance, self-criticism, depression, numbing, dissociation and how PTSD affects relationships. Consequently, after reading the first few introductory chapters, readers can easily skip ahead to learn about strategies for dealing with their particular symptoms.

Within each chapter, readers will find not only useful discussions of different expressions of PTSD, but also firsthand accounts, research highlights, and, perhaps most beneficial, a series of exercises that deal specifically with the chapter’s subject. For example, in Chapter 7, “Forge Ahead Gently: Mindfulness Practices for Avoidance,” Turow includes several practices including: noting avoidance behaviors, self-compassion for avoidance, mindfulness in graded exposure and others. These exercises include lists with bullet points and charts for easy reference and understanding. Indeed, Mindfulness Skills for Trauma and PTSD as a whole is incredibly accessible, and includes a comprehensive reference section and index for more academically-minded readers.

Moreover, Turow makes a compelling argument. PTSD manifests in a number of ways and addressing it successfully requires diverse approaches. In the final chapter, “Beyond Trauma and PTSD: Posttraumatic Growth and Resilience,” she discusses the ways in which recovery is often nonlinear and leads to significant changes within individuals. In particular, overcoming PTSD may impact our levels of awareness, of ourselves, of our surroundings and of our relationships. That this not need be a negative change is a vital message, for survivors and their loved ones alike.

With mindfulness, those dealing with PTSD can observe their own responses and how they might change over time. This in its own way is potentially empowering, a necessary aspect of the recovery process.

Mindfulness Skills for Trauma and PTSD: Practices for Recovery and Resilience
Rachel Goldsmith Turow
Norton
432 pages, softcover

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A Step Forward in Our Understanding of C-PTSD

Thu, 06/29/2017 - 14:00

The concept of Complex Post Traumatic Stress Disorder, known as C-PTSD for short, was first developed in the early 1990s. As with all scientific advances, not everyone realized its importance immediately and time was required to both refine and propagate the idea. The World Health Organization, for example, still does not recognize C-PSTD as a distinct health problem, though it may be included in the new list, scheduled for publication in 2018. The widespread slowness in recognizing C-PTSD is sometimes frustrating for those of us working in the field of psychology, trauma, and behavioral health. C-PTSD can produce severe depression, anxiety, and even psychotic episodes, which in turn can lead to serious physical symptoms. When healthcare practitioners are not aware that the problems they are dealing with are really results of C-PTSD, then treatment is much less likely to be effective.

The traumatologist, John Briere, was once quoted as saying, only half in jest, that “if Complex PTSD were ever given its due …. the DSM (The Diagnostic and Statistical Manual of Mental Disorders used by all mental health professionals) would shrink to the size of a thin pamphlet.” There is certainly very good evidence that C-PTSD is a much more prevalent problem than generally recognized. The C-PTSD advocacy organization, Out of the Storm, makes a strong case that there are hundreds of millions of undiagnosed cases worldwide. While the data we have is incomplete, what there is paints a picture in which, as they put it, “the numbers are staggering to contemplate”.

One obstacle, then, to giving the best help to sufferers of C-PTSD is a lack of awareness. Another is that, as a relatively new diagnosis, much still remains to be discovered about the mechanism by which C-PTSD comes about. A promising new study1, however, may represent a major advance in our understanding of what C-PTSD is, which in turn would help us better identify and treat it.

C-PTSD and Childhood Trauma

C-PTSD differs from its better-known cousin PTSD mostly in that it is the result of a series of destabilizing incidents that happen over a period of time, even years. Each one on its own would not be sufficient to induce trauma, but their cumulative effect does. The typical case of C-PTSD involves an adult who, as a young person, was the victim of repetitive, chronic, and prolonged trauma involving harm and abandonment by a primary caregiver. Such mistreatment can include ‘passive’ slights, such as a parent withholding love or affection, or never giving praise.

It may seem intuitive that people react to such unhealthy relationships by developing the common symptoms of C-PTSD, such as, among others, shame, guilt, and an inability to regulate emotions or find enjoyment in life. This is because, unfortunately, we all know of too many examples where children of abusive parents go on to develop mental health problems. However, on reflection, this is not such an obvious result. Human beings have been forged by millions of years of evolution in order to survive, grow and procreate. Wouldn’t it make more sense for evolution to endow us with the ability to shrug off childhood traumas so that we can get on with having a successful life?

The new study suggests that C-PTSD is best understood as a learning process that has gone wrong. Part of the way we are designed for survival is that we are flexible enough to learn to thrive in very different environments. The skills you need to survive and succeed in the Savannah are very different from those you need in a modern city. During childhood, we go through a long process of learning how to avoid danger and how to deal with danger when it comes around. This is an essential part of adapting to our environment.

During this process of learning and adaptation, the relationship of the young person to his or her caregivers plays a central role. There are many dangers that a vulnerable child might face that they are unable to cope with alone. To navigate these kinds of danger and discover the appropriate way of responding, the child relies on caregivers, especially parents, for guidance and also protection. If the caregiver does not fulfill this role, or, worse, is perceived by the child as a source of danger then this process is interfered with. The child experiences dangers which he or she cannot adapt to and learns self-protective strategies that are actually deeply maladaptive in normal situations. In adult life, they are more likely to mistakenly interpret situations as dangerous and then respond in ways that are self-destructive. When a child grows up learning that the world around them is not safe, he or she takes this view of the world into adult life, with wide-ranging and damaging consequences.

Progress in Treating C-PTSD

The study suggests ways that treatment of C-PTSD can be improved. In particular, conceptualizing C-PTSD as a result of a learning process perverted through mistreatment indicates that successful treatment involves the therapist facilitating a new learning process by functioning “as a transitional attachment figure, using the therapy to generate the missing resilience-building processes of childhood.” Providing individualized treatment would mean looking closely at the ways in which the adaptive process of learning has been distorted. Some sufferers from C-PTSD will fail to process information, leaving them feeling helpless and unable to interpret the world around them. Others will err in the opposite direction and overinterpret details, which should be filtered out. To use an example given in the study, if they receive ill treatment at the hands of someone wearing a red jacket, then they will erroneously “focus on red jackets as signals of danger.”

Successful therapy is based on identifying the specific ways in which the way each individual processes information about potential and actual danger, in order to guide them to healthier thought patterns. In this way, the psychological profession can make a meaningful difference to the life of those suffering from this extremely serious, and still under-recognized condition.

References:

  1. Crittenden, P. M. & Heller, M. B. (2017). The Roots of Chronic Posttraumatic Stress Disorder. Chronic Stress, 1, 1-13. doi: 10.1177/2470547016682965
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Combat PTSD — One Veterans’ Journey to Control the Beast

Fri, 05/26/2017 - 14:00

I thought January 9, 1970 was the end of my involvement with the military and the Vietnam War. That was the day I was discharged from the US Navy after having completed three tours to Vietnam, two of which took me “in-country” with various Marine elements needing to document their activities with photographs. (I was a Navy Photographers Mate Second Class.) Now 45 years later, at times, I am thrust back there. PTSD, or PTSS as it was called then, takes me there instantly. I smell the smells, feel the sweat on the back of my neck and everything else — fear, high alert and paranoia flood over me. To me, PTSD isn’t what many people believe. From first hand, I know it is an insidious thing, a beast that once embedded is opportunistic and nearly impossible to kill completely. Weird things can awaken it, sounds, visuals and even moods, especially depression. It is hard to guard against and impossible to predict when it will raise its head. So what do you do? Here is what I did.

I spent many years visiting at Vet Centers in group counseling all across the nation as I traveled for work, sometimes weekly, sometimes monthly. It helped. My wife of nearly 40 years has probably been the best healing agent as she is a good detached listener when the beast is present. But recognizing what the beast we call PTSD is and its power over us or more precisely the power we allow it to have over us is a key. Another major key is to give it a path out. For many years I kept it all inside. I didn’t know I had buried it. Nobody knew I had any problems. As the saying goes, I just sucked it up. It was killing me.

One evening after a frightful bout with the trauma nearly breaking me, my wife suggested that I write it down. I did, slowly. Over the next ten plus years, when it raised its head, I wrote it down. Over time, writing it down made me begin to feel like I was in control. Then I read and read and re-read my journal countless times. Over time I found I could talk to others who were not in combat about my experiences and how I felt. Then I put the manuscript away — for nearly 20 years. Every five years or so I got it out and read parts of it. Sometimes I cried, sometimes for hours. You see in my journal it wasn’t just about me. Matter of fact, I could not write about what happened emotionally to me and my friends directly. Following the advice of a Vet Center counselor, I put my journey and other comrades’ experiences on the shoulders of fictitious people. I could only write it down that way. I could handle it obliquely — just not head on.

During the intervening years, with help from many people, I’ve had a great career; a very supportive family helped and I got educated along the way. My wife and I started a business that became a school that then turned into a respected university. So there are no complaints there. My wife suggests that the workaholic nature of mine is probably related to the PTSD. I don’t ever forget that the monster still hides in deep sacred parts of my mind. Sometimes when least expected it still raises its head. That’s okay. For now I know it for what it is — only part of my past and it has nothing to do with my future. If there is a positive consequence to this all it is that the beast causes me to remember the fallen Marines I worked with, to celebrate them again, ponder the good times and reaffirm my vow that they will never be forgotten. Semper fi

With that in mind, I reworked my therapy journal and it became a manuscript. It was published as fiction. The comments I’ve gotten from readers, many of which are family members of service members who served in Iraq and Afghanistan, thank me. I never would have dreamed it could help others understand how PTSD can happen to anyone and the importance of not ignoring it as something a vet can handle on his or her own. Even Mike Farrell of M*A*S*H fame saw its value and wrote a review. The book is too personal for me a make a judgment call as to its value to others. Interesting to me, I didn’t realize how getting it out there is really the final or at least a major step in my healing process.  Now I can talk about it without crying—most of the time. I reached my goal: most of the time, I’m NORMAL AGAIN. It was a long road.

The title of the book says it all: “By What Is Sure To Follow — a PTSD Odyssey”. I have been told my book may empower a vet’s family to take action. I will let them decide.

Before I put it away in 1990, I had several Vietnam vet survivors (Marines) read it. They violently cussed me out, saying “How dare you degrade Marines like that.” Back then you didn’t speak about PTSD. They saw it as an insult, a weakness that soldiers didn’t talk about — ever. You were supposed to JUST SUCK IT UP. Luckily today it is out in the open and there is support to manage the beast. Semper fi

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