Long-term health effects of trauma. Inevitable: yes or no?
It has been known for a long time that victims of trauma, especially childhood trauma, are also more likely to experience a myriad of health issues. Now, a new study published by the American Heart Association found an enhanced incidence of cardiovascular disease among women who had experienced childhood abuse, especially repeated sexual molestation and rape. Children who experienced severe physical abuse were slightly less affected, but still significantly so. In this incidence the main culprit was identified as significant weight gain and obesity among women who had been sexually abused.
Sadly, therapists who work with severely abused and traumatized clients often see those clients have physical ailments such as autoimmune disease, gastrointestinal issues, cancer, asthma, cardiovascular disease, COPD, and on and on. We see it so often that it is almost expected before we first meet such a client that there will be health issues as well.
There is a wealth of published material one can find to help explain what happens physically to traumatized people for those who want to read up on the subject. For our purposes here, I am not going to go into depth or use scientific terms to explain the chemical and physiological changes that occur in response to trauma. The focus for this blog entry is simply to attempt to answer the question, “Is there anything you can do about it?”
I believe the short answer to that question is “yes.” To simplify it, think of it this way. If you walk around throughout the day in a state of hypervigilance, nerves on-edge, with muscle tension throughout the body, never able to relax or sit still, and a disturbance of appetite (either lacking or too much), then your body is under attack. At a minimum you will be affected by health issues such as high blood pressure, ulcers, and body aches and pain. Add to that sleep disturbances so you never get the rest you need for optimal physical and mental functioning, and you have a real recipe for medical problems.
Now imagine that you learn coping methods that reduce the constant muscle tension, allow you to relax, reduces hypervigilance, and returns your digestive system to a more normal functioning status. Increased quality and quantity of sleep would in turn improve mental and physical functioning and endurance. A body no longer under the constant attack of tension and stress would have a better functioning immune system that could better fight off diseases and slow down the problems associated with the aging process. So, if you know that you are in the high-risk group described above, take action. Find a way to achieve greater relaxation. Exercise, participate in Yoga classes, learn to meditate, or any number of other healthy activities. Find a good trauma therapist who can help you resolve the issues related to the trauma and abuse. You can take steps to reduce your risk of severe health issues linked to a history of childhood abuse, as well as other types of trauma and suffering.
Mark E. Hankla, MA, LIMHP
Saturday, November 19, 2011
Saturday, November 12, 2011
This Is SO Not About Football
Following the Penn State news has made it a tough week for lots of us—those who experienced childhood sexual abuse and those who strive to help them heal from the long-term harm caused by that abuse. It’s not just the sexual exploitation, damaging as that is, that harms a child. For many victims who develop post-trauma disorders, it is more than the anguish of being used, raped, humiliated by a perpetrator. The response and non-response of other adults can constitute a betrayal that leaves a decades-long impact.
As satisfying as it may be to hear that one perpetrator has been temporarily removed from the general public, there is no doubt that thousands of serial pedophiles have been allowed to continue abusing kids because they are “pillars of the community,” are well known, would be angry if someone complained. Penn State is one small example of what has happened, and continues to happen every day, when other adults witness, hear about, or suspect child sexual abuse. Otherwise responsible adults walk away, pretend that they did not see or hear, whisper to other adults, worry about the perpetrator’s reputation and their own. Rarely does the non-protective adult speak to that child at all, much less provide comfort or support.
Psychology calls it cognitive dissonance—the psychological disconnect between recognition of the perpetrator as a criminal and the accustomed image of protective parent, loving grandparent, dedicated member of the clergy, conscientious teacher, or devoted Scout leader. We know that those conflicting social images are what cause abused children to think “Everybody knows that he/she is a good person. It must be me. I must deserve this.”
So it’s a good thing that one perpetrator has been arrested and a few enabling adults has been removed from leadership positions. But what about all of the child victims that have not yet been identified, in Pennsylvania and Nebraska and elsewhere? The adults who were once those youngsters? The years of fear and pain that don’t end when a child grows up? It’s a good thing that Penn State took some action. It is not nearly enough.
Sherry Cox
As satisfying as it may be to hear that one perpetrator has been temporarily removed from the general public, there is no doubt that thousands of serial pedophiles have been allowed to continue abusing kids because they are “pillars of the community,” are well known, would be angry if someone complained. Penn State is one small example of what has happened, and continues to happen every day, when other adults witness, hear about, or suspect child sexual abuse. Otherwise responsible adults walk away, pretend that they did not see or hear, whisper to other adults, worry about the perpetrator’s reputation and their own. Rarely does the non-protective adult speak to that child at all, much less provide comfort or support.
Psychology calls it cognitive dissonance—the psychological disconnect between recognition of the perpetrator as a criminal and the accustomed image of protective parent, loving grandparent, dedicated member of the clergy, conscientious teacher, or devoted Scout leader. We know that those conflicting social images are what cause abused children to think “Everybody knows that he/she is a good person. It must be me. I must deserve this.”
So it’s a good thing that one perpetrator has been arrested and a few enabling adults has been removed from leadership positions. But what about all of the child victims that have not yet been identified, in Pennsylvania and Nebraska and elsewhere? The adults who were once those youngsters? The years of fear and pain that don’t end when a child grows up? It’s a good thing that Penn State took some action. It is not nearly enough.
Sherry Cox
Monday, October 3, 2011
Emergency Relaxation
You want me to WHAT when I’m in crisis????!!!
That is often the type of response I get when I suggest, “Well, you need to relax.” But don’t worry. I’m not being as invalidating or insensitive as it may sound. I really do want my clients to relax at that point, precisely because they are feeling so overwhelmed, panicked, angry, or whatever it is that they are feeling. It is my response to how bad I believe it is for them, not my way of saying, “Oh come on!” “You need to get over this right now!”
It is at that point that I have found it beneficial to implement what I call an “emergency relaxation intervention.” And the emphasis is on the “emergency” part of the phrase. It should be the number one priority when in crisis to take care of yourself. Or to put it even more direct, it should be the only priority. It is necessarily a very simple procedure with very few steps.
This is how it goes: Inhale deeply and exhale slowly. While exhaling, visualize your body letting go of muscle tension EVERYWHERE, ALL AT ONCE. Imagine that you can see your whole body, as if watching an X-ray machine. Or some way of seeing yourself from the inside out, and every muscle in your body is relaxing at the same time. Visualize your body deflating (i.e., relaxing). Like letting all of the air out of a balloon. The balloon doesn’t progressively deflate, from one part to the next. It goes down all at once. So your body can also relax, all at once.
In doing so you are switching off one part of your central nervous system (i.e., sympathetic nervous system) and switching on another (i.e., parasympathetic nervous system). Very basic, primitive, and physical. Not a mental activity at all. Don’t think, act.
The conversation in the office when I do this may sound like this:
Client: I can’t stop thinking about this! I feeling like I’m going out of my mind! I feel like I’m out of control and I feel like doing something really bad…….
Therapist: I am so sorry. That sounds…
Client: I am soooo angry! I had a panic attack last night. I almost went to the hospital! I don’t think I can breathe…….(crying) They shouldn’t have…
Therapist: OK. We need to do something right now so you can regain a sense of control. I need you to focus on me and bring yourself back to this room.
Client: I can’t! It wasn’t right that….
Therapist: No. We’re not talking about that right now. Focus on me and we’re going to do an “emergency” relaxation.
Client: But you don’t know how much they hurt me….
Therapist: No. We are not going to focus on that. I’m sorry your hurting, but I’m more worried about how you are feeling physically right now. This is not good for you to be so upset.
Client: But they shouldn’t have…
Therapist: We are not going to talk about that right now. I am worried about you being in this state. It’s not good for you. You need to give yourself a break from all of the stress and the chemicals that are flooding your body right now.
Client: What do you want me to do?
At that point, I guide the client through the above procedure. I explain that I want them to be able to do it without thinking. No need for “steps.” You can not think your way out of the problem. Thinking about it more will not fix it. You have already thought about it, playing out scenarios of what actually happened, as well as what you would like to do, over and over and over.
So, it is not as crazy or paradoxical as it sounds to say “relax” while in the middle of the crisis of the moment. It is something you can do physically to reduce the effects of the stress you feel. It is as ok for you to do as it would be to put a tourniquet on a bleeding, life-threatening wound. You would not worry about how the wound got there or how unfair it was that you have it. The focus would be on how to stop the bleeding. The same goes for bringing yourself down from a panic attack or mental meltdown! “You need to relax right now ……….”
Mark E. Hankla
That is often the type of response I get when I suggest, “Well, you need to relax.” But don’t worry. I’m not being as invalidating or insensitive as it may sound. I really do want my clients to relax at that point, precisely because they are feeling so overwhelmed, panicked, angry, or whatever it is that they are feeling. It is my response to how bad I believe it is for them, not my way of saying, “Oh come on!” “You need to get over this right now!”
It is at that point that I have found it beneficial to implement what I call an “emergency relaxation intervention.” And the emphasis is on the “emergency” part of the phrase. It should be the number one priority when in crisis to take care of yourself. Or to put it even more direct, it should be the only priority. It is necessarily a very simple procedure with very few steps.
This is how it goes: Inhale deeply and exhale slowly. While exhaling, visualize your body letting go of muscle tension EVERYWHERE, ALL AT ONCE. Imagine that you can see your whole body, as if watching an X-ray machine. Or some way of seeing yourself from the inside out, and every muscle in your body is relaxing at the same time. Visualize your body deflating (i.e., relaxing). Like letting all of the air out of a balloon. The balloon doesn’t progressively deflate, from one part to the next. It goes down all at once. So your body can also relax, all at once.
In doing so you are switching off one part of your central nervous system (i.e., sympathetic nervous system) and switching on another (i.e., parasympathetic nervous system). Very basic, primitive, and physical. Not a mental activity at all. Don’t think, act.
The conversation in the office when I do this may sound like this:
Client: I can’t stop thinking about this! I feeling like I’m going out of my mind! I feel like I’m out of control and I feel like doing something really bad…….
Therapist: I am so sorry. That sounds…
Client: I am soooo angry! I had a panic attack last night. I almost went to the hospital! I don’t think I can breathe…….(crying) They shouldn’t have…
Therapist: OK. We need to do something right now so you can regain a sense of control. I need you to focus on me and bring yourself back to this room.
Client: I can’t! It wasn’t right that….
Therapist: No. We’re not talking about that right now. Focus on me and we’re going to do an “emergency” relaxation.
Client: But you don’t know how much they hurt me….
Therapist: No. We are not going to focus on that. I’m sorry your hurting, but I’m more worried about how you are feeling physically right now. This is not good for you to be so upset.
Client: But they shouldn’t have…
Therapist: We are not going to talk about that right now. I am worried about you being in this state. It’s not good for you. You need to give yourself a break from all of the stress and the chemicals that are flooding your body right now.
Client: What do you want me to do?
At that point, I guide the client through the above procedure. I explain that I want them to be able to do it without thinking. No need for “steps.” You can not think your way out of the problem. Thinking about it more will not fix it. You have already thought about it, playing out scenarios of what actually happened, as well as what you would like to do, over and over and over.
So, it is not as crazy or paradoxical as it sounds to say “relax” while in the middle of the crisis of the moment. It is something you can do physically to reduce the effects of the stress you feel. It is as ok for you to do as it would be to put a tourniquet on a bleeding, life-threatening wound. You would not worry about how the wound got there or how unfair it was that you have it. The focus would be on how to stop the bleeding. The same goes for bringing yourself down from a panic attack or mental meltdown! “You need to relax right now ……….”
Mark E. Hankla
Monday, September 26, 2011
If Only I Could Get Some Sleep
“If Only I Could Get Some Sleep”
Trauma disorders and sleep problems tend to go together. For some individuals, the same over-active brain chemicals that keep them feeling “on alert” during the day keep them feeling as if they must be on the lookout for danger throughout the night as well. Nightmares and upsetting dreams—a common consequence of traumatic experience—can awaken some people from sleep and make others dread falling asleep in the first place.
Other causes of sleep problems include medical problems such as chronic pain and stomach or intestinal distress. Research has shown that individuals with trauma disorders are far more likely than the non-traumatized person to suffer from both.
Unwanted memories of past traumatic events, from which the activity of daily living can be a distraction, sometimes resurface as an individual settles down for the night. And worry—about present day stresses or fear that something dangerous will again happen in his life—commonly interferes with the quality of a trauma survivor’s sleep.
All in all, it’s hard for many individuals who live with trauma disorders to get a good night’s sleep. These suggestions may help:
• Stay away from alcohol. Lots of people make the common mistake of using alcohol to turn off “on alert” feelings. While alcohol may help us fall asleep, it disrupts the sleep cycle, interfering with the length and quality of sleep as well as meddling with the internal clock that tells when to become sleepy the next night and the night after that. Alcohol causes more problems than it solves.
• Stay away from noise and light. Sleep in a bedroom with lights off or dimmed and the TV off. While lights and background noise may be initially reassuring, they interfere with being able to enter a deep, resentful sleep stage.
• Start early to prepare for bedtime. Try to get up every day at the same time, even when you are tired, to reset your biological clock for sleep time. Exercise early in the day rather than before bed. A soothing hot bath and cup of coffee may look good on TV commercials but exercise, heat and caffeine are all stimulants that will hinder becoming sleepy.
Sherry Cox
Trauma disorders and sleep problems tend to go together. For some individuals, the same over-active brain chemicals that keep them feeling “on alert” during the day keep them feeling as if they must be on the lookout for danger throughout the night as well. Nightmares and upsetting dreams—a common consequence of traumatic experience—can awaken some people from sleep and make others dread falling asleep in the first place.
Other causes of sleep problems include medical problems such as chronic pain and stomach or intestinal distress. Research has shown that individuals with trauma disorders are far more likely than the non-traumatized person to suffer from both.
Unwanted memories of past traumatic events, from which the activity of daily living can be a distraction, sometimes resurface as an individual settles down for the night. And worry—about present day stresses or fear that something dangerous will again happen in his life—commonly interferes with the quality of a trauma survivor’s sleep.
All in all, it’s hard for many individuals who live with trauma disorders to get a good night’s sleep. These suggestions may help:
• Stay away from alcohol. Lots of people make the common mistake of using alcohol to turn off “on alert” feelings. While alcohol may help us fall asleep, it disrupts the sleep cycle, interfering with the length and quality of sleep as well as meddling with the internal clock that tells when to become sleepy the next night and the night after that. Alcohol causes more problems than it solves.
• Stay away from noise and light. Sleep in a bedroom with lights off or dimmed and the TV off. While lights and background noise may be initially reassuring, they interfere with being able to enter a deep, resentful sleep stage.
• Start early to prepare for bedtime. Try to get up every day at the same time, even when you are tired, to reset your biological clock for sleep time. Exercise early in the day rather than before bed. A soothing hot bath and cup of coffee may look good on TV commercials but exercise, heat and caffeine are all stimulants that will hinder becoming sleepy.
Sherry Cox
Wednesday, September 21, 2011
A Definiton of Mindfulness
A Definition of Mindfulness
Mindfulness is awareness without judgment of what is, via direct and immediate experience. When you are mindful, you are fully alive to each moment of life as it is, not as you wish it would be, and can respond to it skillfully. Mindfulness is taught as a skill in Dialectical Behavior Therapy and other mindfulness-based therapy approaches.
How often in life are we doing one thing while thinking of another, whether thinking ahead to the next thing we need to do or ruminating on a problem of the past. It is in doing this that people often run on “auto-pilot,” missing their life in the present moment. How often do we miss out on the opportunity for true intimacy with another in being self-conscious rather than being able to be truly present with the person and enjoy their company. The goal in teaching mindfulness skills is to help a person to become mindful rather than mindless; to help one to control’s one mind rather than let their mind control them.
In learning to become fully aware of one’s present experience with acceptance, one can best meet each moment of their life by doing just what is needed. Each moment of one’s life becomes an opportunity to practice mindfulness skills and life becomes one’s practice. There is freedom in being able to face the reality and sometimes pain encountered in our life. In being truly mindful, one is able to experience life as it is, as well as one’s own self and emotions, and other people as they are, in the here and now.
Jaci Pekarek
Mindfulness is awareness without judgment of what is, via direct and immediate experience. When you are mindful, you are fully alive to each moment of life as it is, not as you wish it would be, and can respond to it skillfully. Mindfulness is taught as a skill in Dialectical Behavior Therapy and other mindfulness-based therapy approaches.
How often in life are we doing one thing while thinking of another, whether thinking ahead to the next thing we need to do or ruminating on a problem of the past. It is in doing this that people often run on “auto-pilot,” missing their life in the present moment. How often do we miss out on the opportunity for true intimacy with another in being self-conscious rather than being able to be truly present with the person and enjoy their company. The goal in teaching mindfulness skills is to help a person to become mindful rather than mindless; to help one to control’s one mind rather than let their mind control them.
In learning to become fully aware of one’s present experience with acceptance, one can best meet each moment of their life by doing just what is needed. Each moment of one’s life becomes an opportunity to practice mindfulness skills and life becomes one’s practice. There is freedom in being able to face the reality and sometimes pain encountered in our life. In being truly mindful, one is able to experience life as it is, as well as one’s own self and emotions, and other people as they are, in the here and now.
Jaci Pekarek
Monday, September 19, 2011
I Don't Know What To Say
“I Don’t Know What to Say”
The people closest to a traumatized individual—partners, family members, friends—often tell us that they don’t have any idea what to do or say in response to trauma disorder symptoms. It may help readers in that difficult position to begin with a review of common well-intentioned statements that are not helpful. These are some things that we encourage you not to say:
“That was in the past. You’re OK now.” It’s just not true. The traumatic event may be long over but the essence of a trauma disorder is that the effects of the event last far into the future. You would not tell someone with a broken leg that he is “OK now,” since the auto accident in which he was hurt happened in the past. Likewise, the damage done by exposure to psychological trauma takes a long time, and much work, to heal.
“You’ve got to let go of the past and get on with your life.” People with trauma disorders are not holding onto the past. The past is holding on to them—often with a suffocating grip. The traumatized individual usually wants desperately to get on with her life and is working as hard as she can to do just that.
“Try not to think about it.” Among the symptoms of trauma disorders are intense attempts to avoid any reminders of the traumatic event. While understandable, this tends to make trauma symptoms worse. It’s not thinking about the past that is the problem, it’s not being able to think about traumatic experiences in a full beginning-to-end way.
So…..when you want to help and don’t know what to say, replace giving advice with giving support. Saying “I’m sorry you are feeling rotten. Is there anything I can do to help?” can mean a lot.
Sherry Cox
The people closest to a traumatized individual—partners, family members, friends—often tell us that they don’t have any idea what to do or say in response to trauma disorder symptoms. It may help readers in that difficult position to begin with a review of common well-intentioned statements that are not helpful. These are some things that we encourage you not to say:
“That was in the past. You’re OK now.” It’s just not true. The traumatic event may be long over but the essence of a trauma disorder is that the effects of the event last far into the future. You would not tell someone with a broken leg that he is “OK now,” since the auto accident in which he was hurt happened in the past. Likewise, the damage done by exposure to psychological trauma takes a long time, and much work, to heal.
“You’ve got to let go of the past and get on with your life.” People with trauma disorders are not holding onto the past. The past is holding on to them—often with a suffocating grip. The traumatized individual usually wants desperately to get on with her life and is working as hard as she can to do just that.
“Try not to think about it.” Among the symptoms of trauma disorders are intense attempts to avoid any reminders of the traumatic event. While understandable, this tends to make trauma symptoms worse. It’s not thinking about the past that is the problem, it’s not being able to think about traumatic experiences in a full beginning-to-end way.
So…..when you want to help and don’t know what to say, replace giving advice with giving support. Saying “I’m sorry you are feeling rotten. Is there anything I can do to help?” can mean a lot.
Sherry Cox
Thursday, September 1, 2011
Judgmental Thinking
One of the most important principles of Dialectical Behavior Therapy (DBT) is adopting a nonjudgmental pattern of self-talk and thinking. My simplest definition of judgmental thinking is “being at war with what is.” Or perhaps even more to the point would be “being at war with WHY things are the way they are,” instead of focusing on how to make things better.
Rarely do I have a therapy session where “judgmental thinking” is not a significant factor in the level of suffering that I see in my clients. Over the past several weeks, I have noticed “anger” to be the main issue being reported by so many of my clients, seemingly eclipsing reports of depression, anxiety, and other common symptoms of psychological suffering.
Since “judgmental thinking” is an expression of frustration leading to anger, I have spent significant time discussing being nonjudgmental versus judgmental, and the toxic effects of the latter. What I also came to realize as many of my clients talked about their anger at various people and/or situations, is that they were most angry with themselves, but not verbalizing it. When this is gently brought to their attention (that they were harshly judgmental with themselves), they have almost always experienced a gush or flood of emotions, often crying, and admitting that they were indeed afraid they were the cause of all of their problems.
The effects of this on me have been to remind me not only of the powerful effects of judgmental thinking on the mood and disposition of my clients, but also of the many forms that the thinking style can take. I also have come to view much of the anger being expressed in my sessions as misdirected self-anger. I would argue that self-anger is far more important and damaging (and therefore demanding attention first) than the anger expressed at others. I would like to know what others think about this link between judgmental thinking and self-anger.
Mark Hankla
Rarely do I have a therapy session where “judgmental thinking” is not a significant factor in the level of suffering that I see in my clients. Over the past several weeks, I have noticed “anger” to be the main issue being reported by so many of my clients, seemingly eclipsing reports of depression, anxiety, and other common symptoms of psychological suffering.
Since “judgmental thinking” is an expression of frustration leading to anger, I have spent significant time discussing being nonjudgmental versus judgmental, and the toxic effects of the latter. What I also came to realize as many of my clients talked about their anger at various people and/or situations, is that they were most angry with themselves, but not verbalizing it. When this is gently brought to their attention (that they were harshly judgmental with themselves), they have almost always experienced a gush or flood of emotions, often crying, and admitting that they were indeed afraid they were the cause of all of their problems.
The effects of this on me have been to remind me not only of the powerful effects of judgmental thinking on the mood and disposition of my clients, but also of the many forms that the thinking style can take. I also have come to view much of the anger being expressed in my sessions as misdirected self-anger. I would argue that self-anger is far more important and damaging (and therefore demanding attention first) than the anger expressed at others. I would like to know what others think about this link between judgmental thinking and self-anger.
Mark Hankla
Monday, August 29, 2011
Dialectical Behavior Therapy (DBT)
Dialectical behavior therapy (DBT)
Dialectical behavior therapy (DBT) was developed by psychologist, Marsha Linehan in the 1980s. Some of Dr. Linehan's research focused on suicidal behavior and why people engaged in self-destructive acts. She found that cognitive behavior therapy did not adequately address some of the problems that these people were experiencing. Through her research and study, Dr. Linehan developed a type of therapy that added mindfulness and other Zen based strategies to cognitive behavior therapy.
Her book, Cognitive-Behavioral Treatment of Borderline Personality Disorder, was published in 1993 and was accompanied by a skills training manual. DBT, as designed by Dr. Linehan, consisted of individual therapy, skills training and therapist consultation. Since its creation, DBT has been successfully used to treat a variety of disorders. Outcome research, indicates that DBT is one of the more successful forms of therapy and many psychotherapists have taken the time to learn and apply the therapy.
We welcome your comments, questions and ideas regarding therapy in general or DBT. I'll post more in the near future.
Bill Bonacker
Dialectical behavior therapy (DBT) was developed by psychologist, Marsha Linehan in the 1980s. Some of Dr. Linehan's research focused on suicidal behavior and why people engaged in self-destructive acts. She found that cognitive behavior therapy did not adequately address some of the problems that these people were experiencing. Through her research and study, Dr. Linehan developed a type of therapy that added mindfulness and other Zen based strategies to cognitive behavior therapy.
Her book, Cognitive-Behavioral Treatment of Borderline Personality Disorder, was published in 1993 and was accompanied by a skills training manual. DBT, as designed by Dr. Linehan, consisted of individual therapy, skills training and therapist consultation. Since its creation, DBT has been successfully used to treat a variety of disorders. Outcome research, indicates that DBT is one of the more successful forms of therapy and many psychotherapists have taken the time to learn and apply the therapy.
We welcome your comments, questions and ideas regarding therapy in general or DBT. I'll post more in the near future.
Bill Bonacker
Monday, August 22, 2011
We're Back in Operation!
Welcome to Psychotherapy Associate's Fall 2011 updated Living With Trauma Disorders blog. We're hoping that you find the contributions of our clinicians and colleagues of help. Your feedback is always appreciated.
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