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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!
Did you know there have been many recent advances in the effective treatment of traumatic grief that have not been featured in the mainstream literature?
Well, I’ve been working feverishly over the last six months to put these together in a book I’ve written called, Transforming Traumatic Grief: Six Steps to Move from Grief to Peace after the Sudden or Violent Death of a Loved One.
My motivation to write the book initially grew out of my excitement about the trauma and grief interventions I’d learned through Jon Connelly’s Rapid Resolution Therapy. Dr. Connelly helped me with my own traumatic grief several years ago and I’ve had phenomenal success using his approach with my clients over the last four years.
I grew even more excited as I began to research other methods for clearing grief and found they paralleled what I learned from Dr. Connelly. For instance, Columbia professor of psychiatry, Katherine Shear has developed an empirically validated model for treating complicated grief that was featured in the Journal of the American Medical Association (JAMA) that includes a protocol for reprocessing traumatic memories and having an imaginal conversation with the deceased. Similarly, Seattle psychiatrist, Ted Rynearson has a very effective model for helping families of homicide victims called Restorative Retelling that he’s been using for years.
In the book, I put together interventions that these successful models have in common along with other tools like mindfulness and community resources that help people heal. The book is written for both the bereaved as well as the people who help them such as therapists and clergy. In it you will find:
- Mindfulness and imagery scripts that promote healing
- Methods to stop nightmares and intrusive images/thoughts
- How to clear guilt/regrets and foster resilience from loss
- The value of connecting to “the living story” of the deceased and sensing them as a supportive presence in one’s life
- Ways to obtain social support through family, community, and online resources
Currently, you can get PDF and e-book versions of the book at Smashwords.com where I can offer you a 20% discount through 5/30/11. To get your discount, use the code: ST98L. I will also be donating 10% of the proceeds to the American Red Cross to help those negatively impacted by the tornadoes and storms in the southeast last week.
If you prefer paperback over digital, you will be able to get a print version of the book this June through Amazon.com and other online book retailers.
Over the next several weeks, I’ll continue sharing excerpts from the book here on the blog. We’ll be discussing big changes in the field of grief and trauma therapy as well as tools that promote peace and healing. Please join us in the discussion!
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.
I greatly appreciated Jon Stewart’s touching and honest commentary regarding the impact the Arizona shooting had on our country.
Although people are tempted to blame politicians, let’s not make this a political event. As Stewart says, “You can’t outsmart crazy. You don’t know what a troubled mind will get caught on,” and Jared Loughner clearly has a troubled mind.
Let’s keep this thing in perspective. Let’s put our energy into things that would be of benefit to those who were harmed by this tragedy, rather than waste energy churning anger and blame. Let’s focus on the acts of heroic kindness witnessed during this event that are a testament to the unity of the human spirit, rather than focus on things that divide people.
photo courtesy of nieve44 laluza flickr
How do you get through traumatic grief around the holidays, especially if a holiday marks the anniversary of a traumatic loss? Below are some ways that others have found to deal with their grief and ease the pain this time of year.
1. Alter your traditions– Sometimes it helps to do something different, even if it is just one thing, to shift the focus off the loss. I’ve known families who have decided to go away to the beach or some other place that has fewer associations with the loss. Others want to keep old traditions, but may just change them up slightly, signifying a fresh start.
2. Special tributes– One way to alter your tradition may actually be to include some sort of special tribute to your loved one during the holiday get togethers. You might light a special candle in honor of your loved one at the holiday table. Or, you may give people the opportunity to share special memories of your loved one verbally or in writing. You may just have a moment of silence to remember that person at some point in the day. A special tribute is not meant to highlight the loss, but rather to honor your loved one and affirm their presence with you through this holiday season.
3. Give yourself alone time– Grief can zap you of energy, so its important to plan some alone time time to rest. You do not have to attend every event, or endure the duration of each event. Find a balance between solitude and socializing.
4. Let others know its okay to talk about your loved one– Many people avoid mentioning the name or any memories of the deceased for fear it will be awkward or painful. But, most people enjoy hearing stories about their loved ones. Let people know, and reassure them if it is okay to openly talk about your loved one.
5. Attend special services or support groups in your community or online– More people are recognizing the value of having special services to honor those we’ve lost and support those who are grieving this time of year. On this blog, I’ve written about Blue Christmas services that many churches are now offering. If there is no such service in your community, perhaps you can get a small group of family members or friends to create one yourselves.
6. Remember it is just one day– The anticipation of a holiday or anniversary is often worse than the actual day itself. Remember this is just one day, one week, one season. You do not have to relive your loss or dive headlong into your grief on this day to prove how much you loved someone who has died. Instead use this time to acknowledge your gratitude for having known the person and find ways to affirm their presence with you throughout the season.
Take care and be well.
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.
Scan your brain for signs of PTSD
New technology is allowing us to better understand traumatic memory and flashback phenomena from a neuroscience perspective. In a recent study Minnesota researchers observed that patients with PTSD consistently show heightened activity on the right side of their brain, specifically in the temporal lobe area.
PTSD patients demonstrated this heightened activity performing a simple, objective task. None of the participants were asked to recall traumatic material during the study.
Previous studies have suggested the right hemisphere is involved in flashbacks. In the 1960’s Penfield found that applying electrical stimulation to the temporal lobe in the right hemisphere caused people to re-live and re-enact past experiences. Similarly, this study showed hyperactive communication between the right temporal cortex, parietal and/or parieto-occipital in the brains of patients with PTSD. Yet the heightened activity was there without any additional stimulation.
To measure brain activity, participants wore an MEG helmet while concentrating on a spot 65 centimeters in front of them for 60 seconds. The study included 80 people diagnosed with PTSD, 18 people reporting remission from PTSD, and 284 people without PTSD. Interestingly, the patients reporting remission of PTSD still had heightened activity in the right hemisphere, even though it was less intense than those reporting current PTSD.
The researchers believe this suggests PTSD is not just a disorder of an overactive neural fear circuit. Witnessing this heightened activity on the right side of the brain also supports theories that PTSD is a disorder of memory. In other words, the heightened activity suggests memories are still being represented as purely sensation based, and have not been fully integrated with contextual memory.
From a Rapid Resolution Therapy standpoint, this research may lend support to the concept of the traumatic event leaving an “impression.” We can think of the “impression” as the sensation aspects of the memory still held in the right hemisphere. Our goal with RRT is to integrate the data into the left hemisphere and give the memories some context. This is accomplished through the process of retelling the trauma story while staying emotionally present.
The research study cited in this post was conducted by the Minneapolis Veterans Affairs Medical Center and the University of Minnesota. The research was just published in the October issue of the Journal of Neuroengineering.
If you are a mental health professional and still have not viewed the RRT online class, you can still get access to it. Click here to send me your contact information and I will send you the link and the password for the class.
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.
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.
Trauma Therapy Alternatives 
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