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Yes, there is an app for just about everything, including PTSD management. I downloaded “PTSD Coach” last night on my i-phone and have to say it is a handy little tool.
PTSD Coach contains all sorts of exercises someone can use to calm down and reorient themselves when they are triggered or feeling anxious. The exercises are all instantly accessible, easy to use, and even customizable with your own photos and songs. You can choose from a progressive muscle relaxation exercise, visual imagery, music you enjoy, the RID exercise- which helps you identify the anxiety trigger and get present- and many more.
In addition there are assessment tools, charts to monitor progress, education modules that explain causes and symptoms of PTSD as well as treatment options. Last there is a support module that links you to online resources or your own personal support contacts that you enter from your phone.
PTSD Coach was created by the VA’s National Center for PTSD and the DoD’s National Center for Telehealth and Technology.
The VA stresses that people who think they have PTSD should also seek professional help and only use the app as an adjunct to professional counseling and therapy. I agree. While this tool can be somewhat useful when someone is having a mild to moderate level of anxiety, these are somewhat lightweight tools that won’t work so well for someone experiencing severe flashbacks or anxiety.
Fortunately, there are therapy options such as Rapid Resolution Therapy that can clear these severe reactions. Now we just need to create a Rapid Resolution Therapy app and we’ll have all the bases covered!
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.
photo courtesy of oddsock via flickr
Need more incentive to meditate? A recent study headed by Sara Lazar and colleagues at Massachusetts General Hospital documented measurable changes in brain regions associated with memory, empathy, and stress after just 8 weeks of daily meditation practice.
More specifically, the MR images showed increased grey-matter density in the hippocampus, known to be important for learning and memory, and decreased grey-matter density in the amygdala, known for its role in fear conditioning and stress. This has strong implications for utilizing mindfulness meditation in treating trauma, as people with PTSD have been shown to have reduced volume of the hippocampus and larger volume in the amygdala area of their brains, making them more prone to anxiety and memory problems. Could a trauma survivor reverse this through regular practice of mindfulness meditation?
In this study, the participants demonstrated brain changes after only 8 weeks of attending a weekly mindfulness meditation class and practicing meditation at home for an average of 27 minutes a day. Lazar and others had published previous studies that demonstrated experienced meditators appeared to have thicker areas of the middle pre-frontal cortex, an area associated with empathy, emotional regulation, and attunement to others. Yet those studies could not prove that these differences were actually produced by meditation. In contrast, the participants in this study had no prior meditation practice and therefore the researchers were able to surmise the measurable structural brain changes were associated with daily practice of meditation. Moreover, this study included a control group that did not meditate and did not show any changes in the study’s pre and post tests.
In my opinion, this study provides further evidence that integrating mindfulness practices into treatment for anxiety, PTSD, and other trauma related problems is a good idea. Traditionally, research has indicated practicing meditation at least 20 minutes per day produces measurable benefits within 2-3 months. To give people even more incentive, I am offering a free 20 minute Mindful Relaxation audio download on my website, get it by clicking here.
To read the full article, refer to: Mindfulness practice leads to increases in regional brain gray matter density. Psychiatry Research: Neuroimaging, 2011; 191 (1): 36; authors: Britta K. Hölzel, James Carmody, Mark Vangel, Christina Congleton, Sita M. Yerramsetti, Tim Gard, Sara W. Lazar.
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!
photo courtesy of Eddie~S via Flickr
Another middle-aged client presented today with chronic anxiety related to bullying she experienced in elementary school. I am amazed at how frequently clients report some experience of bullying in their past that continues to affect them even 30 or 40 years later.
I almost wrote about this issue after the Rutgers student took his life in September. Unfortunately, bullying seems to have increased among teens aged 12-18, according to recent polls. Increases may be related to the ease of taunting one another in cyberspace where people can hide behind their LCD screens. More than half of 15-16 year olds say they have experienced cyberbullying. But, frankly, I am often astonished by the cruelty being exchanged on Facebook by adults my age and older.
Who becomes a bully? A recent study at DePaul University found that kids who felt they were being arbitrarily punished at home were more likely to become bullies. Ironically, studies suggest bullies are not suffering low self-esteem. Often the bullies turn out to be kids that have popularity, intelligence, and a drive for power and status. Similarly, the kids that get picked on are often not the “nerdy”, “fat”, or so-called “different” kids. As Rachel Simmons wrote in her book “Odd Girl Out,” the girls who got picked on were usually girls perceived as being smarter, prettier, or more athletic than the bully.
On the other hand, there does seem to be an increase in bullying toward homosexual young people. The incident with the Rutgers student really brought this to light. Fortunately, this incident also seemed to promote more public advocacy for this population. Dan Savage’s “It Gets Better” video campaign has received over a million hits, inspiring straight and gay people all over the world. Even the federal government has gotten involved by holding the first anti-bullying summit in August and setting funds aside for anti-bullying programs in schools.
However, experts on bullying behavior like Izzy Kalman believe anti-bullying programs are the wrong approach. Dr. Kalman states, “… Anti-bullying” policies that turn a school into a totalitarian police state in which it is a crime for kids to upset each other will intensify the bullying problem… What I am interested in is victims and victim behavior. When I teach you how not to be a victim, no one can bully you. You don’t have to wait for society to get rid of bullies for you to become happy.”
Perhaps we can use Izzy Kalman and Dan Savage’s example by using cyberspace to build up immunity to bullying and judgmental behaviors. One of the things I love about Dr. Connelly’s philosophy in RRT is that we promote the resilience of the client. That’s what I did with my client today. She said it never occurred to her to recognize the strength and creativity she demonstrated through the bullying incidents. Instead of focusing on old feelings of fear, she left the session voicing increased awareness of her fortitude.
What do you think is the best response toward bullying and cyberbullying behaviors? Support anti-bullying programs? Build up immunity to bullying? I think ideally it will have to be some combination of the two. Let me know your thoughts!
photo courtesy of Pseudo Victor via Flickr
Watching the rescue of the Chilean mine workers was such an emotional event for many. Now people are wondering if the miners will continue to be okay, or are they at risk for developing post-traumatic stress disorder?
Several experts around the world are weighing in on this issue, and they are actually quite optimistic the majority of the miners will return to their daily lives without any emotional fallout. Dr. George Bonanno, who was featured in my last post on grief, did an interview with Discovery news noting that most people recover from traumatic events without any PTSD symptoms. He says, “I believe we’re innately wired to handle these events.” In his long-term studies, Dr. Bonanno observed that most people are exposed to at least one traumatic event during their lifetime, yet only 30% of people actually develop PTSD.
What factors seem to keep people from developing PTSD after a traumatic event? The data is not fully clear on this, but it seems people who develop PTSD are those who feel incredibly unprepared and helpless during the traumatic event. People who develop PTSD also tend to lack social support during or after the trauma, leaving them feeling more isolated, helpless, and misunderstood.
Because the Chilean mine workers knew the risks of their profession, experts opine they may have felt more prepared to deal with this event than say, a group of visitors to the mine. In addition, the 33 miners engaged in active social support. Discovery news reported that the men sat in a circle every day and talked about their feelings. During the event, the miners also had some access to food, water, and contact with the outside world. After the event, they were welcomed with celebration, love, and support, providing further buffers from developing post-traumatic stress.
While the news is optimistic, the mine workers may still have some reactions as a result of the traumatic experience. For example, they may find they are not as eager to jump down into a mine. Or, they may notice feelings of apprehension when they experience certain smells, sounds, or other sensory associations from the event.
In my work with trauma survivors, I’ve noticed that many may not have the full blown diagnostic criteria for PTSD. However, they can still encounter feelings of dread, anxiety, and exaggerated responses upon encountering reminders of the traumatic event. The survival oriented part of our brain has a tendency to encode certain sensory data from the experience and tag it as a sign of something potentially dangerous. While the process is meant to alert and protect us from future trauma, it can interfere with our lives when this part of the mind confuses similar and same.
Overall, I think the Chilean mine workers will be okay and I applaud their courage.While I agree with Dr. Bonanno that we are wired for resilience, I’ve observed that sometimes our wires get crossed up! Fortunately, trauma treatments like Rapid Resolution Therapy can help you straighten them back out. So, even for those who develop PTSD, the news is still optimistic that you can recover and live a full life.
Photo Credit Department of the Army
Earlier this month, the United States Army posted an article on their website featuring Rapid Resolution Therapy as an alternative trauma therapy treatment for soldiers experiencing combat PTSD.
Click here to read the article on the Army’s website.
While the Army has not officially approved RRT as a treatment they offer, the article lets people know they can seek treatment from private therapists trained in RRT. The article features comments from Chicago therapist Dr. Laura Bokar, explaining how the treatment works. In addition the article reports testimonials from a client of Dr. Bokar’s, as well as a client of Florida RRT therapist, Dr. Jason Quintal.
In the article, Col. Elspeth Cameron Ritchie, medical director for the Army Medical Department’s Office of Strategic Communications notes the Army offers several support programs for soldiers experiencing PTSD, such as Battlemind, Post Deployment Health Reassessment, and specialized psychotherapy sessions.
However, the article reports “private treatment can offer individuals options currently not available through military medicine; and Rapid Resolution Therapy is one of those options.”
Special thanks to Jacqueline M. Hames for publishing this article and letting people know that PTSD is treatable and that there are are a myriad of treatment options now to help people end suffering.
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 her website at 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
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