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Photo Credit Department of the Army
Last week, I had the honor of working with a courageous Iraq war combat veteran who sustained a traumatic brain injury (TBI) in the war and suffered severe flashbacks.
He asked if Rapid Resolution Therapy (RRT) would work for him, given the TBI. While I told him I was not sure how the TBI would impact things, I was sure we could clear the impact of the trauma. I reassured him that he’d already completed the hard part by surviving the war. He laughed and agreed that meeting with me could not be any worse than what he’d already experienced in combat.
When the soldier arrived at my office, he had a service dog with him, which led me to think he had a visual impairment. So, I offered to fill out the paperwork for him as he verbally gave me his answers. The soldier laughed and said,
“I can see just fine. My service dog accompanies me because my flashbacks have been so bad. When I have a flashback, my dog walks in a circle around me clearing the area to protect me and other people. Then, he licks my face and helps me wake up and come back to the present time and place.”
Wow. I was totally impressed with him and his dog, and it motivated me even more to free this guy up of those flashbacks. He told me he’d not been allowed to drive due to the flashbacks, and really wanted his freedom back. Here this guy dedicates his life to fighting for our freedom, and now this PTSD had imprisoned him. I was totally dedicated to this mission to fight for his freedom now.
We cleared his trauma in just under 2 hours. Though the TBI caused him to have some delay in his speech and thought process at times, he had a wonderful sense of humor and a keen intellect. His favorite part of RRT was the “goat and the snowflake” story (see this post for an explanation).
Upon hearing this story and playing the “pants” game to help him stay present, the soldier quickly realized that the horrific images were just images now, and the events were no longer in existence. We only had to discuss one event in detail, and he was able to apply the same concept to the other traumatic events he had experienced. I watched in amazement as he smiled and said, “Yes, there is no IED exploding. It no longer exists. My commanding officer is okay now and is not pinned under that truck. I am not getting shot at this moment. There are no piles of beheaded bodies that I have to clean up anymore. Those guys left their bodies and they are at peace now.”
Three days after our session, I gave him a follow-up call. He said, “I feel great. I have not had any flashbacks, even when my kids were screaming or I heard a loud noise. I have been driving again. I am able to imagine being on the beach watching the cranes when I feel stress and it immediately calms me. I am free again.”
I thanked this brave soldier for his service and we celebrated his return to freedom! You do not have to be imprisoned by trauma or your past. There is a way to return to freedom and reclaim your life.
Courtney Armstrong is a Licensed Professional Counselor as well as a Master Practitioner and Associate Trainer in Rapid Resolution Therapy. She has a private counseling practice in Chattanooga, TN where she specializes in treating trauma, anxiety, and grief. To contact Courtney, click here. To learn more about Rapid Resolution Therapy, click here.
photo courtesy of Cliff1066 via flickr
Recently, a client made this most insightful and delightful comment:
Courtney, you’ve really helped me overcome my childhood abuse. I’ve worked with a lot of therapists over the years and I now realize I didn’t want sympathy. I wanted a TROPHY- I mean a BIG Wimbledon-sized trophy and some applause. I’ve just wanted to hear someone say ‘Well done! That was a tough journey and you made it! That was quite an accomplishment, good for you.’
Her comment is something to which all therapists should pay attention. Most therapists were taught the way to help an adult heal from physical, sexual, or emotional abuse is to sanction the client’s status as a “victim-survivor.” Then the next steps in therapy might be to show a lot sympathy as you encourage the client to re-live the event over and over again to get “repressed feelings” out. After that, the therapist might urge the client to confront her abuser and do a lot of imagery and letter-writing to comfort her inner child. While all these approaches are certainly well-intentioned, I find they just keep people stuck.
I learned through my training from Jon Connelly’s Rapid Resolution Therapy to take a different attitude. With RRT, we acknowledge the painful impression a traumatic event may have left on a person’s psyche. But, then we are interested in revising this impression by making less of a big deal about the event itself, and instead, make a big deal about the client’s fortitude and resilience in surviving the darn thing! We encourage them to view themselves as heroes, realizing that not only are they still valuable and whole, but they are also wiser, stronger, and more compassionate. This is a far more accurate view of the situation and far more therapeutic for clients. Using this view, clients walk out of my office literally standing taller and smiling.
This particular client who made the “trophy” comment said in the past she had been thinking the way to heal was to forgive herself, forgive her father, and hope that one day he would show her the love and respect she’d been craving. After our work together, she was able to realize her father was just limited emotionally and interpersonally and that it was not her fault. We compared her father to the wizard in the Wizard of Oz. She had finally pulled back the curtain to see he was not so big and powerful, but a frail old man who was trying to keep the facade going. She’d been waiting for him to give her a “medal,” like the wizard hands out to Dorothy and her friends at the end of the story. Now, the story ends with my client realizing the wizard is too weak and preoccupied to hand out medals, so she decides to pick up the bag of medals herself and hand them out as she sees fit.
Recently in the media, there has been so much focus on horror and destruction around our world. Seeing such images over and over again can make us feel helpless. But, aren’t you more uplifted, inspired, and motivated when you hear stories of how people are helping one another, creatively surviving, and coming up with innovative ways to get through these tragedies? Let’s change our focus to where we can be resilient and creative in the face of adversity. Let’s start a new movement. Please share your “hero” stories here!
Guest blogger: Mark Chidley, LMHC, CAP
This week’s post features excerpts from a wonderful article by my colleague Mark Chidley, LMHC, CAP. Thanks Mark!
Traumatic experiences may not always involve the imminent threat of death or dismemberment, nor even horror and helplessness. Trauma spreads out far beyond experiences of overt physical threat, violence, or even emotional horror or helplessness. What happened to the person may be more on the level of identity and meaning than what happened physically.
Indeed, in many cases the person was never actually touched, and yet for them their world shifted and neither their view of the world or themselves would ever be the same again.This is important because meanings affecting identity are often subtle and nuanced, not always what they would seem on face value. The temptation is always there to try to understand someone else in terms of how one would feel in a similar situation instead of how it was for them, thereby misreading the meaning and missing a chance for connection. Below are a few representative examples of such trauma arranged into categories I’ve noticed over time. There could doubtless be other categories added to this list.
Experiences of Humiliation
Many of us have heard clients tell of a moment of vulnerability or childhood incompetence and being humiliated in that moment . Wetting one’s pants in school, being the butt of jokes on the school bus, having a teacher single one out in a demeaning way, or being suddenly in the wrong viz. a viz. adult systems, as in church.
Experiences of Abandonment and Rejection
One lady remembered coming into her kitchen as a 9 year old. “I came home from school one day with a problem with my homework and told my step mom I needed her help. She was already overwhelmed with the other kids and my alcoholic dad. She just wheeled on me and said, ‘You need, you need, all’s you ever do is need. Well, I cant take care of you right now. Why dont you just leave me alone. Why don’t you just disappear!’” It was a phrase that had affected her for many years.
Experiences of Implied Violence
One doesn’t have to be hit or beat to be affected by violence. One woman was selected to be the observer as her alcoholic father would stage punching matches between her brothers. She was forced to look on as one brother would beat down the other to escape the greater threat of the father’s violence crashing down onany unwilling contestants. She exclaimed, “It was like the Roman Coliseum, and it took place on my living room rug every Friday night!”
Experiences of Demolished Values or Vulnerability
Many people have the innocence of their values or their childhood sensitivities taken from them in a way that is traumatic. Having lived near rural Midwestern farmlands, I remember more than one client tell of witnessing an animal’s untimely death or an adult family member’s cruelty. Seeing a family pet run over in the driveway, or seeing wildlife slaughtered out of a pickup truck window, for no good reason other than the shooter wanted to kill something, can have a profound effect on a child. And the effect can be anchored at various levels–the abruptness and unexpectedness of the act, the dying gasps of an animal as its eyes glaze over, the stark brutality and indifference demonstrated by an attachment figure, and the inference that small and defenseless life forms are dispensable. Children are vulnerable and that vulnerability can be demolished at any age.
Trauma, for the survivor, is never spelled with a small “t”. But if we are listening only for certain types of experiences or experiences of a certain magnitude, like war, rape, or a plane crash, we can miss what is real for the client.
As a Rapid Trauma Resolution therapist, I was also taught that part of what makes trauma “hang” in a timeless limbo is the mind’s tendency to make matters worse by taking an already negative event and attaching meanings of even greater negation or diminishment of personal worth. All of this can still be driving symptoms, warping beliefs about self and world, and troubling relationships. I am grateful for clients who have taught me what it’s like to be suddenly without connection when you need it most or suddenly exposed to the pathology in another when you weren’t prepared for it. I feel it is crucial to build a solid connection with clients early so that my attention is easily drawn to what still has to be cleared for that person to regain fullness of life and functioning. And so doing, I feel more satisfied in serving those whose trauma may have otherwise continued to affect them.
*Note- This post is highlights excerpts from Mark’s article. To read the full article on Mark’s blog, click here.
Todd Vance, photo courtesy of NBC San Diego
Martial arts classes may be a good therapy alternative for combat veterans looking to overcome PTSD. NBC San Diego recently featured an article and video clip about a mixed martial arts class led by Todd Vance that is helping veterans overcome PTSD and adjust to civilian life.
Click here to watch the the 2-minute video about this therapeutic class for veterans.
Obviously, such classes can empower survivors and help them overcome that sense of helplessness that so many feel in the aftermath of trauma. The physical actions and mental discipline learned in martial arts classes may also help survivors channel energy, reprogram responses, and discover skills to regulate emotions. The veterans in Todd Vance’s class also report the bonding and camaraderie with other trauma survivors in the class was healing.
Similarly, trauma expert Bessel van der Kolk has also observed that self-defense and martial arts classes can be good adjuncts to trauma therapy. However, caution should be used before embarking on any sort of martial arts or self-defense class. In one PTSD forum, several people commented that they had been “triggered” in self-defense classes, suffering flashbacks, anxiety, and helpless feelings during and after the class. So, if you want to try this approach, be sure the class is led by an instructor who is familiar with trauma. The instructor should know how to ease someone into increasing challenges and respond if they do experience PTSD symptoms. As a therapist, I would also want to do some trauma “clearing” using Rapid Resolution Therapy, EMDR, or similar methods prior to someone entering one of these classes, so they are less likely to be “triggered.”
Have you or anyone you know had any experience using martial arts to overcome trauma? Let me know your opinion about using this as an intervention or adjunct to trauma treatment!
Courtney Armstrong is a Licensed Professional Counselor as well as a Master Practitioner and Associate Trainer in Rapid Resolution Therapy. She has a private counseling practice in Chattanooga, TN where she specializes in treating trauma, anxiety, and grief. To contact Courtney, visit www.courtneyarmstronglpc.com.
Could we have the potential to “erase” the fear from a traumatic memory soon? Would this relieve PTSD, or cause more problems?
Last month, Science Express published research done by Dr. Richard Huganir and colleagues at Johns Hopkins University suggesting we may be able to manipulate fear-based memories. Laboratory rats were conditioned to fear a tone that was paired with an electric shock. The scientists found calcium permeable proteins, labeled AMPARS, formed in the amygdala for a day or two in the brains of the mice after the shock. The scientists administered a drug to some of the mice to keep their brain flooded with AMPARS longer than 48 hours. These mice retained fearful responses long after the shock, while the mice without the drug gradually appeared to forget the tone had been associated with a shock. The scientists believe this will lead them to develop drugs to manipulate AMPARS to reduce fear-conditioned responses.
However, many folks have voiced ethical concerns, worried this research suggests that scientists are attempting to erase memories. For example, Katie Farinholt, executive director of NAMI in Maryland and Paul Root Wolpe, director of the Center for Ethics at Emory University, opined that “erasing” an aspect of a memory could significantly alter a person’s personality and history. Yet Dr. Huganir clarified that blocking AMPAR’s just eliminates the strong emotions attached to a memory. The process won’t erase the memory entirely.
But, I suspect PTSD and developmental trauma disorders are more than a set of fear-conditioned memories. All sorts of learning takes place when we experience something terrifying or overwhelming. Say you were bitten by a chihuahua as a kid and had avoided them for years until you had this drug administered. Now you may no longer fear chihuahuas, but you still don’t trust your mother who let the darn thing bite you. Yet, now you don’t remember why you don’t trust your mother.
I don’t know if it would work that way, I’m just thinking we can’t control all the neural circuits that get activated around a traumatic memory. Apparently Dr. Huganir believes this too. He sees this research and any potential drug development as an adjunct to trauma therapy, not a replacement. After all, Dr. Huganir notes many behavior and trauma therapies are attempting to do the same thing he is doing. Manipulate memories. Decondition fear responses. Clear negative associations. What’s the difference?
I do appreciate Dr. Huganir’s work. He seems to be very level-headed about what he is doing and is not promising miracles. Honestly, the media seems to be jumping to more conclusions about the potential of this research than Huganir and his colleagues.
What are your thoughts? Do you think there are advantages to having drugs that can manipulate proteins involved in fear-based memories? What concerns you about it? As always, I would love to hear your thoughts!
The power of a stare...
Note: This post discusses a sexual trauma. Please read at your discretion.
One thing that causes a traumatic memory to haunt a person is a distorted meaning he/she attached to the disturbing event. Below is an example of a case in which we cleared the trauma by transforming a meaning the client had attached to the event.
*”Naomi” was a 39 year old divorced woman. She had started dating again, but was suddenly being troubled by flashbacks of a molestation she experienced as a child. Naomi explained that when she was 11 years old, she was spending the night at a friend’s house. She and her friend were watching a movie, and her friend’s father brought them some apple juice and snacks. Naomi remembered feeling “kind of funny” within half an hour of drinking her apple juice, and promptly fell asleep on the couch.
Sometime in the middle of the night, Naomi briefly awoke only to stare into the eyes of her friend’s father lying on top of her. At that time she wasn’t sure if she was dreaming or not. But, the next morning she was pretty sure something had happened because her clothes and legs were wet and sticky. She also had a terrible headache and suspected her apple juice had been drugged.
Initially, it appeared she was most haunted by the distorted belief that she should have done something to keep this from happening. So our first target was replacing this belief and clearing self-blame.
At our next appointment, Naomi said she was feeling less shame, but was still having anxiety and brief flashbacks. I noticed what she consistently referenced was her feelings of helplessness and the fear something more happened that she couldn’t recall. Naomi didn’t think intercourse occurred because she had no pain upon awakening, and was confirmed a virgin via medical exam in her late teens.
Suddenly, it occurred to me that perhaps when Naomi briefly woke up and stared into the eyes of the perpetrator, she spooked him. I suggested her stare may have in effect “stopped” him, & kept anything worse from happening that night.
Naomi’s face lit up as she exclaimed, “Yes, that’s possible! I was known as a tough girl in my neighborhood who used to beat up all the boys. So, this guy probably thought if I was waking up, then I’d start fighting and knock his teeth out!”
At our next session, she said, “I’ve been feeling really good!” She hadn’t had any flashbacks or nightmares at all, and reported that her relationship with her boyfriend had improved. What Naomi needed to believe was that she had responded effectively to the situation and that nothing more had happened.
It amazes me how quickly the negative effects of a trauma get cleared when you can pinpoint and transform distorted meanings. Please share your transformational stories and ideas through the comments box. I’d love to share them.
** The name and identifying details in this story have been changed to protect privacy.
Courtney Armstrong is a Licensed Professional Counselor as well as a Master Practitioner and Associate Trainer in Rapid Resolution Therapy. She has a private counseling practice in Chattanooga, TN where she specializes in treating trauma, anxiety, and grief. To contact Courtney, visit www.courtneyarmstronglpc.com.
Nat'l Institute of Mental Health, NIH Medical Arts
Did you know that you don’t have to use EMDR or painful exposure techniques to clear the emotional charge of a traumatic memory? All that is required is keeping the client “emotionally present” as they are describing the details of the event.
This concept was introduced to me many years ago by Dr. Jon Connelly. Now, neuroscience discoveries, and trauma researchers like Bessel van der Kolk, MD and Dan Siegel, MD are coming to similar conclusions.
Why does this work? I believe it works because when we keep the client emotionally present, we are helping to prevent the amygdala from activating the fight/flight response. The amygdala is the little almond shaped structure in the mid-brain that is triggered if the deeper mind senses danger. (See the Amygdaloids video on this blog for more info about this.)
The problem is, when the amygdala and fight/flight response go into high gear, the brain inhibits the function of the hippocampus and parts of the pre-frontal cortex. The hippocampus and certain aspects of the pre-frontal cortex are responsible for integrating memory and tempering emotional responses. If these parts of the brain are “off-line,” then the memory stays seared into the deeper brain as a non-verbal, implicit, felt memory.
When a memory stays in this implicit form, associated sensory details like smells, times of year, sounds, and visual images can trigger the same feelings of terror as the original event. However, these triggers are often “unconscious” to the client.
One goal of any trauma therapy is to integrate the traumatic memory over into conscious, explicit memory. To do this, we have to keep the hippocampus and pre-frontal cortex open and on-line. If you have the client emotionally re-live the event, guess what? You inadvertently activate the fight/flight response right there in the session and cause the hippocampus and pre-frontal cortex to go offline again.
“Recollecting’s not forgetting, it’s vivid rehearsal of pain. It keeps fear in my thoughts. It reminds me of that day. It keeps fear in my brain.” The Amygdaloids, from their song Fearing.
For a client to recall a traumatic event without “vivid rehearsal of pain,” you have to use tools that keep them emotionally responding to the present situation. This seems to allow the deeper brain/amygdala to realize the event is over so that it no longer fires off the fight/flight response at the mere recollection of the event’s details.
This has huge implications for how we practice psychotherapy and I am actively staying on top of research related to this phenomena.
Courtney Armstrong is a Licensed Professional Counselor who specializes in treating trauma, anxiety, and grief. She has a private practice in Chattanooga, TN and trains mental health professionals in an approach called Rapid Resolution Therapy. To contact Courtney, visit www.courtneyarmstronglpc.com.
Short-term therapies like Rapid Resolution Therapy (RRT), EMDR, EFT, and somatic-experiencing all suggest we can resolve the negative impact of traumatic memories within a few therapy sessions. That has been super-exciting news.
However, for developmental trauma such as childhood abuse, many clients greatly benefit from additional training in managing stress and emotions. One of the first studies to actually illustrate this was just published by Cloitre, et al. in the American Journal of Psychiatry’s August 2010 edition.
Cloitre and colleagues took a group of women who were diagnosed with PTSD related to childhood abuse. The experimental group received training in emotional regulation and interpersonal skills for 8 weeks prior to receiving trauma focused cognitive-behavioral therapy.
The study also included two control groups. One control group received only supportive therapy prior to receiving CBT targeting the trauma, and did not get the emotional skills training. The other control group received emotional skills training, but did not receive specific trauma focused therapy during the subsequent 8 weeks of treatment.
The study found that 27% of the women who received both emotional skills training and trauma focused therapy had sustained remission of symptoms at the 6 month follow-up. This suggests that emotional skills training and specific trauma focused therapy together are needed for optimal treatment responses.
Teaching emotional regulation skills seems especially relevant for people who have suffered multiple traumas. If they grew up in a chaotic environment, chances are they never had the opportunity to learn how to naturally regulate emotions. Instead they may have turned substances, self-injury, sex, shopping, or other compulsive behaviors to feel better. So, even after they’ve cleared a specific trauma, they may still benefit from guidance on how to self-nurture and cope with other life stressors.
Even people who haven’t been traumatized may need help understanding and managing emotional reactions. So, I always spend some sessions teaching people healthy ways of doing this. I adapt the skills training to my client’s personality and value system. Some of my clients respond well to meditation practice. More restless clients do better with yoga, tai chi, or some other physical activity. My Christian clients prefer contemplative prayer. My creative clients love learning ways to use humor, metaphor, music, and art to redirect emotions. My technical clients like biofeedback.
Although it can be challenging to implement new behaviors, I tell my clients that we now know the brain is capable of neuroplasticity at any age. Therefore, it is never too late to learn new skills. Yet, as with any new skill learning, it requires practice and repetition to build those new neural networks.
These are really exciting times for the field of trauma therapy as we get closer to identifying what interventions really work for people. I’d love to hear about any interventions you’ve found that have helped your clients. Please leave your comments and ideas!
Courtney Armstrong is a Licensed Professional Counselor who specializes in trauma therapy. She has a private practice in Chattanooga, TN and also trains mental health professionals in creative ways to treat trauma. To contact Courtney, visit her website at www.courtneyarmstronglpc.com
I am a big fan of neuroscientist and musician, Joseph LeDoux. His band, the Amygdaloids, just released a new album called Theory of My Mind. Their songs address common issues of mind and brain such as fear, memory, love, and loss.
Check out the video below of the song called “Fearing.” It’s haunting tone underscores words from an Emily Dickinson poem. Dr. LeDoux throws a little neuro-psych education about fear learning as well. Go to www.amygs.com to sign up for the Amygdaloids mailing list and help them move up the pop charts!
Omega Sunrise II by Irargerich via Flickr
**Cassie came to therapy plagued by memories of physical, emotional, and sexual abuse from her childhood. She was in a good marriage now, had a sweet daughter, and many friends. Yet, Cassie continued to feel unworthy of anyone’s love.
When she was younger, Cassie’s step-father was very violent and often threatened her and her brother with a gun. Her mother constantly told her that she was “fat, lazy, and stupid.” The only person that seemed to value Cassie was her grandfather. They’d go fishing every few weeks, and he’d call Cassie “his Sunshine.” She never told her grandfather what was going on at home for fear she’d lose his love and respect too.
As Cassie and I addressed the traumatic memories from her childhood, I shared a beautiful metaphor with her that I learned from Dr. Jon Connelly. Cassie later told me that this metaphor was instrumental in her recovery, and I want to share it with you too.
First, I asked Cassie to close her eyes and imagine being out on the lake with her grandfather, hearing him call her “Sunshine.” I asked her what she felt as she recalled this experience. Cassie said, “I feel warmth, peace, and love.”
I suggested that the experience of being with her grandfather drew her awareness to where she had warmth, peace, and love at her center. In fact, this light of warmth, peace, and love wasn’t just hers. It is her essence, who she really is deep inside, and it is with her all the time.
Cassie opened her eyes and tearfully smiled as she said, “I thought I was full of darkness. But now I realize you are right, I AM the Sunshine! My grandfather saw that in me. I am not those things my mom said about me. I am the Light and can chase old shadows away.” I teared up too as I watched her entire countenance change and she got up to give me a big hug.
Cassie is an avid gardener and now teaches troubled kids how to use gardening to heal and remember that they are the “Sunshine.”
**The name and identifying details have been changed in this story to protect privacy.
Courtney Armstrong is a Licensed Professional Counselor who specializes in trauma therapy. She has a private practice in Chattanooga, TN and also trains mental health professionals in creative ways to treat trauma. To contact Courtney, visit her website at www.courtneyarmstronglpc.com
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