RECOGNIZING THE COMPLEX TRAUMA OF PROLONGED VIOLENCE

RECOGNIZING THE COMPLEX TRAUMA OF PROLONGED VIOLENCE

Children inside U.S. Customs and Border Protection detention facility at the Rio Grande Valley Centralized Processing Center in Rio Grande City, Texas. CBP/via REUTERS 2018

Complex trauma (C-PTSD) is still, relatively, a new term. It was coined in the 1990’s by trauma expert Judith Herman to connote repeated, prolonged (protracted, chronic) trauma. Another name sometimes used to describe the cluster of symptoms referred to as Complex PTSD is Disorders of Extreme Stress Not Otherwise Specified (DESNOS).

In reality, C-PTSD is still actually just a proposed disorder: because 92% of individuals with Complex PTSD also meet diagnostic criteria for PTSD. Complex PTSD is not added as a separate diagnostic classification. 

I’m included in the group of many clinicians, however, who render it extraordinarily useful as a separate diagnosis. The current PTSD diagnosis often does not fully capture the severe psychological harm that occurs with prolonged, repeated trauma. While some symptoms may overlap, there are additional possible symptoms as well as possible conceptual differences.

Certainly, more precision in diagnosis leads to more precise treatment, and treatment for PTSD often fails with those experiencing C-PTSD. So, regardless of how one’s cluster of symptoms is labeled, it is crucial for a clinical to know the hallmarks of C-PTSD.

 Another trauma expert, Dr. Christine Courtois, wrote that complex trauma is “a type of trauma that occurs repeatedly and cumulatively, usually over a period of time and within specific relationships and contexts.” In her well-known article, Understanding Complex Trauma, Complex Reactions, and Treatment Approaches, Dr. Courtois continues to summarize the characteristics of complex traumatic events as:

  • Repetitive, prolonged, or cumulative.
  • Most often interpersonal, involving direct harm, exploitation and maltreatment including neglect/abandonment/antipathy by primary caregivers or other ostensibly responsible adults.
  • Often occur at developmentally vulnerable times in the victim’s life, especially in early childhood or adolescence, but can also occur later in life and in conditions of vulnerability associated with disability/disempowerment/dependency/age/infirmity, etc.

 

While there are many types of repeated trauma, it is most often experienced by children who are victims of long-term physical and/or sexual abuse. It also can include: experience in a concentration camp, POW situations, long-term domestic violence, prostitution/brothel situations, and organized child exploitation rings. In all of these circumstances, according to Dr. Herman, the trauma victim is generally held in a state of captivity, physically or emotionally, and in a situation in which there is no actual or perceived way to escape.

As I write this, I humbly and painfully think about how the current #BorderCrisis is a #MentalHealthCrisis, and how this will impact these children long-term. At the heart of C-PTSD is the idea of emotional neglect. When it comes to human beings making emotional attachments and proper development – we need more than just a bed to sleep in.

C-PTSD is not a psychological death sentence, so to speak, and there is treatment, but it needs to be recognized in general, and particularly with regards to what is going on at the border. People need to know that these children need help, and like any challenge, the earlier there’s intervention, the better.

People who experience chronic trauma often report symptoms that are additional to those seen in those diagnosed with PTSD. Dr. Herman initially identified this list of additional symptoms, which aren’t all included in the diagnosis of standard PTSD:

  1. Difficulty Regulating Emotions: May include persistent sadness, suicidal thoughts, explosive anger, or inhibited anger.
  2. Alterations in Consciousness:Includes forgetting traumatic events, reliving traumatic events, or having episodes in which one feels detached from one’s mental processes or body (dissociation).
  3. Alterations in Self-Perception:May include helplessness, shame, guilt, stigma, and a sense of being completely different from other human beings.
  4. Distorted Perceptions of the Perpetrator:Examples include attributing total power to the perpetrator, becoming preoccupied with the relationship to the perpetrator, or preoccupied with revenge.
  5. Difficulties with Relationships to Others:Examples include isolation, distrust, or a repeated search for a rescuer.
  6. Somatization and/or medical problems: Somatic reactions may relate directly to the type of abuse suffered (or any physical damage endured) and can involve all major body systems.
  7. Alteration in One’s System of Meanings:May include a loss of sustaining faith or a sense of hopelessness and despair.

 

Personal Clinical Note: Patients of mine who have experienced complex trauma, consistently describe feeling a lack of sense of self, very low self-esteem, extreme self-loathing, difficulty in interpersonal relationships, and an inability to discern between any real or potential threats to their minds and/or bodies. Often, and while this can happen in other diagnoses and from enduring a solitary trauma, it is more likely for someone who is chronically traumatized to engage in self-destructive and self-mutilating behaviors.

 Many C-PTSD researchers and clinicians report that using the same treatment paradigm as one would use for PTSD (see below), might not cut it, and might even prove problematic. In response to this, the recommended course of treatment involves the sequencing of healing tasks across several main stages of treatment. These stages include (1) pre-treatment assessment, (2) early stage of safety, education, stabilization, skill-building, and development of the treatment alliance, (3) middle stage of trauma processing and resolution, and (4) late stage of self and relational development and life choice.”

This is part 1 of a 4-part series of excerpts from the latest 2018 edition of Dr. Wolkin’s PTSD Packet

This is your Brain on Poetry

This is your Brain on Poetry

Poetry: Your new tool for a healthy self & brain

Did you know that Emily Dickinson can change your neurophysiology? Well, maybe not Dickinson herself, but certainly the poetry she wrote.
In 2013, researchers at the University of Exeter had subjects take functional MRI’s (i.e., a tool that allows the brain’s activity to be seen in real time) while they read from texts that they had never seen before, these included works of non-fiction, fiction, and poetry.
The results indicated two main things:

  1. The brain parts activated in response to reading the poetry were the same as those activated in response to hearing beloved music.
  2. The brain’s response to poetry mimicked the brain “at rest”. That is to say, the same way the brain looks when we feel introspective.

 

Since humans have an innate response to rhythm and sound, it seems to make sense that poetry and music would align in the brain. Poetry as an art form predates literacy, and poetry was first employed as a way to both remember and convey oral history. Poetry is not much different than music in this way as it is found in ancient hymns and chants that delineated cultural traditions.

In addition, it appears that poetry also serves as a haven for a reflective, contemplative, and daydreaming brain. Therefore, poetry might also prove beneficial to the brain on a cognitive level.

In a 2006 study, researchers observed how brains reacted to Shakespeare’s linguistic craftiness, including his pun-making and also a technique called ‘functional shifting’ during which Shakespeare uses a noun as a verb. When the grammar shifted, the brain “lit up” and responded in its attempt to make sense of the unusual use of the word. This type of stimulation is beneficial to long-term cognitive functioning. Learning, especially learning that is not passive, is neuroprotective.

In 2013, researchers had subjects read both original Shakespeare texts as well as versions that had been translated to be more easily understood by modern audiences. When reading the complex originals, researchers noticed a more intense reaction from the language centers of the brain (for most people, their left hemisphere) as subjects strove to make meaning of the text. Furthermore, during the same study, researchers noticed that when it came to reading Shakespeare’s original poetry, brain regions related to personal and autobiographical memory were activated (found grossly in the right hemisphere).

These findings point to poetry’s ability to foster both a personal connection to a poem, as well as create a sense of self-reflection. To take the latter even further, we can extrapolate that poetry triggers what is called a “reappraisal mechanism,” or the process of reflecting and sometimes rethinking our own experiences in the context of what we are reading.

As one of the authors of the study, Professor Davis, put it:

“Poetry is not just a matter of style. It is a matter of deep versions of experience that add the emotional and biographical to the cognitive.”

So, reading poetry, especially poetry that keeps us on our toes linguistically, is a portal into a space for our self-reflection and growth, as well as serving as a beneficial tool to keeping the brain vital.

At the very least…poetry is like music to our ears!

The TWO most counterproductive ways of finding happiness

The TWO most counterproductive ways of finding happiness

In honor of International Day of Happiness: Tuesday, March 20, 2018

Ever since brains have evolved enough to desire the abstract feeling of happiness, there’s been both a pursuit of that feeling, and the difficult task of defining exactly what it is. Happiness is known enough to those who feel it, but intangible enough to lack one concise, universal and objective definition.Scientists and psychologists have at least agreed upon its multifaceted and subjective nature, and have noted such words as “joy”, “fulfillment”, “well-being”, “contentment”, and “satisfaction” to be somewhat synonymous.
One thing is for certain though, its pursuit is widespread. So, how does one find this state of being? Well, there is an entire field of psychology devoted to this answer, and it’s called, aptly, Positive Psychology. Trying to “Find Happiness” is a common theme in the work that I do, and I have discovered that there are two very surprising ways to help.

1. The most productive way to find happiness is…to stop looking for it!

The more we become obsessed with feeling a certain way, the more we put pressure upon ourselves. In other words, we start “shoulding” all over ourselves, which has proven an unhelpful way to think, i.e. “I know I SHOULD be happy right now, but…”

People who engage in “should” statements are more likely to actually feel anxious or depressed, because if we think we “should” feel a certain way, we often set ourselves up for expectations that sometimes we can’t meet. Why can’t we meet the expectation of “I should be happy”? Well, for one, emotions are transient, and as humans we have the capacity to feel a gamut of emotions.

What if we could allow happiness to find us, organically, without chasing it down, gasping and out of breath?

 

This brings me to my second seemingly counterintuitive way to find happiness:

2. Don’t discredit any emotion!

Yes, that’s right. By allowing oneself to validate all emotions that are felt, even sadness, one is more likely to feel greater well-being overall. You see, emotions are our compass, part of our life force, and though some emotions are more uncomfortable than others, the old adage of “what we resist, persists” rears its ugly proverbial head!

Resisting discomfort sets us up for perpetual discomfort. This is why mindfulness meditation is such a useful mechanism. While a nice byproduct of mindfulness practice can be relaxation, it is actually a tool used to help people expose themselves to all of their feelings, and with as little judgment as possible, truly embrace them.

One can argue that emotions are neither intrinsically “good or bad”, and to think of them in such dichotomous terms is to do ourselves a disservice. Emotions just are. In fact, every emotion tells us something about our inner experience that might be informing our outer experience. Even Rumi, the Sufi poet, waxed poetic in his ‘The Guest House’ way back in the 13th century about how we should treat every emotion as a visitor, without looking to get rid of any of them, but rather to understand their message and purpose.

The Guest House

This being human is a guest house.
Every morning a new arrival.

A joy, a depression, a meanness,
some momentary awareness comes
as an unexpected visitor.

Welcome and entertain them all!
Even if they are a crowd of sorrows,
who violently sweep your house
empty of its furniture,
still, treat each guest honorably.
He may be clearing you out
for some new delight.

The dark thought, the shame, the malice.
meet them at the door laughing and invite them in.

Be grateful for whatever comes.
because each has been sent
as a guide from beyond.

— Jellaludin Rumi

What Rumi alluded to in his writing, was also recently confirmed by research that indicates that well-being is actually predicated on having a wider range of emotions! Yes, that’s correct, the more you can feel, in all of feeling’s iterations, the better off you are (read more: www.scientificamerican.com/article/negative-emotions-key-well-being/)

So c’mon let’s get happy!…and sad…and…

Mindful Coloring Challenge #ShareYourBrain

Mindful Coloring Challenge #ShareYourBrain

Live your best life: Mindfully control your brain’s reaction to stress

Did you know that the brain’s “stress center,” the amygdala, shrinks post mindfulness practice? In addition, the functional connections between the amygdala and the prefrontal cortex are weakened. This allows for less reactivity to life’s basic stresses, and paves the way for higher order brain functions to be strengthened (i.e. attention, concentration, etc.)

The impact that mindfulness exerts on our brain is borne from routine: a slow, steady, and consistent reckoning of our realities, and the ability to take a step back, become more aware, more accepting, less judgmental, and less reactive. Just as playing the piano over and over again over time strengthens and supports brain networks involved with playing music – mindfulness over time can make the brain, and thus, us, more efficient regulators, with a penchant for pausing to respond to external stimuli instead of mindlessly reacting.

The amazing thing about mindfulness is that you can apply it to any action you engage in on a daily basis; cooking, cleaning, walking to work, talking to a friend, driving – or even drawing or coloring!

Why coloring? Well, for one, we all need to embrace our inner child! As adults, we don’t do enough coloring, or any type of play for that matter. Did you know that play can help reduce stress? Also, believe it or not, coloring utilizes areas of the brain that enhance focus and concentration, and nurturing attention is one of the mechanisms by which mindfulness leads to well-being.

That is helpful, because when we are engaged “on purpose” in a particular task, by focusing on it instead of remaining on autopilot, then our negative and unhelpful thinking seems far away (i.e. isn’t on our minds!) Our minds literally can’t focus on both at the same time.

Yet, it should not be seen as just a distraction from really dealing with our “problems”. By engaging in this exercise, we can continue to deepen our ability to be mindful and train our mind to stay in the present moment rather than habitually straying into unhelpful thoughts about the past or future, to rather stay non-judgmentally present to our every sensation as it unfolds. In this way, we are better equipped to calmly approach our anxiety and parse out if it is a real or imagined stress.

How to practice mindful coloring:

  1. Start with colored pencils, or crayons or any other drawing/coloring tool that feels right to you.
  2. Take a moment to notice the feeling of these instruments in your hand. Their weight, texture, the engineering that went into their creation…
  3. Then, listen to your gut, and start to color without too much thought about it. Don’t analyze your drawing, rather, just let what comes organically come. Try not to edit.
  4. If you want, you can print multiple pages so you can do this over and over again.
  5. See if you can focus also on the act of coloring itself as you are engaged in it. Here are some cues for you:
  • How does your hand move across the page? You might even want to spend some time following it.
  • How do the different strokes look? Notice the difference between using the sharp edge vs. the side of the pencil.
  • How do the different colors (if you are using multiple colors) add to the different parts of the image?
  • Notice, without judgment, as your drawing unfolds.

What does your unique brain look like?

In my ‘The Grand Conductor’ packet, we go through the biology of the brain, as well as the latest research on how to keep it in tip-top shape, but at the end of the day, it’s important to remember that we’re just brains studying brains. We’re limited in our understanding of the brain by the virtue of the very thing we’re using to study it!

In addition, just as every individual is unique, so is each brain different from the next, and, moreover, constantly changing as we age! So, let’s all open our minds (see what I did there?) and learn more about ours, and each other’s, unique brains.

Print out the brain image below and color it in however you please! Remember to try to practice staying mindful during the process. Let it reflect the latest brain science (learn more from the infographics at the bottom of this blog!) or let it reflect your own personal understanding of self. Whatever you decide – Let your mind soar! Keep in mind, it’s not about being an artist, in fact, no artistic skill is necessary. Just dive in and notice, again, without judgment, what the process is like for you. I’m going to do this as well, and share it on my social media pages, so stay tuned! 

 

 

When you are finished, please, #ShareYourBrain on social media and tag @BrainCurves!

 

BRAIN EVOLUTION, ANATOMY &  PHYSIOLOGY, AND WELLNESS INFOGRAPHICS 

Repost: 4 Lessons I’ve Learned From Chronic Migraine About Mindful Living

Repost: 4 Lessons I’ve Learned From Chronic Migraine About Mindful Living

This post originally appeared on The Mighty. The blog below has been updated since the original post.

I’ve had episodic migraines all my life. My doctor categorized them as “menstrual migraines” because a day or two before menstruation a bad headache would strike, sometimes with nausea, and mostly on one side of my head.

I’d take four Advil, put an ice pack on my neck, and be fine a few hours later. It seemed like a given, and I just went with it. Looking back, I found them routine, rather than debilitating.

That all changed a few years ago; here’s how I remember it:

In June 2017 I took a flight from New York City to the West Coast, and then two more flights within the same week. I experienced 110° F Las Vegas summer weather, jet lag, and overall exhaustion. I was still feeling stressed from the news the month prior that I might be experiencing perimenopausal hormonal changes (read: premature ovarian insufficiency). Then, on the fourth day of the trip, after sleeping for 16 hours straight, I woke up feeling an off-ness that grew into a slew of neurological symptoms that never went away.

This perfect storm of events, as my neurologist called it, must have set off a cascade inside my body that culminated in a migraine that has lasted for the past two years in varying degrees of intensity. I have had various in and out symptoms including light sensitivity, dizziness, nausea, blurriness, stabbing eye pain, gastric stasis, brain fog, and headaches.

Some might call it status migrainosus, which by definition is a migraine that lasts for more than 72 hours. Whatever we call it, my migraines clearly went from being episodic to a chronic and debilitating issue. The initial migraine technically broke two months later following a steroid taper, which gave me two days of relief. Since then, I have had on and off symptoms almost daily in varying degrees and intensities.

Despite the pain and discomfort, this time has been ripe with lessons in more mindful living. Going through this experience has been a game-changer in the level of care I provide to my own clients who experience migraine. I can relate on a level that immediately sets me a part from other health psychologists.

Here are some of the things that I’ve learned:

1. Awareness

Knowing and eliminating my triggers:

While migraine is often genetic, and there is no one agreed upon cause, there are triggers involved – which don’t cause an attack, but can set one off. Some are uncontrollable, like barometric pressure, and some can be managed through lifestyle changes. The latter requires meticulous self-calibration.

I’ve eliminated many dietary triggers, including alcohol, chocolate, anything with tyramine, anything with nitrates, and even some food high in histamines. The calibration continues, as even the amount of caffeine that I put in my body can put me at risk for symptoms. So, every morning I have just the right amount of espresso, no more, no less. This also applies to sleep. I need enough sleep to feel well, but too much sleep can actually tip the scales in the wrong direction. This awareness to detail has been a bit painstaking, and it sometimes feels like a roulette game. Yet, I’ve never been so aware of what my body needs in any given moment.

Recognizing the subtle signs of a migraine before they escalate:

My interoceptive awareness has been heightened in a beneficial way. Some of the medications to abort migraine work best when you can catch the symptoms early. This has required me to be consciously aware of the subtle nuances in the way I feel at any given moment. Of course, at its extreme, this can become almost obsessive. But when it’s for the sake of one’s wellness, it feels calming to be able to know that I can help myself by being more attuned to my body.

For me, my heart starts to race, my vision tends to blur, and my shoulders and neck start to tighten. I’ve learned that by noticing these symptoms early, I can sometimes even skip the medication by immediately applying peppermint oil to my wrists and temples, ice on my forehead, and heat on my neck area.

2. Self-Compassion

Less “shoulding” all over myself:

I have a tendency to “should” all over myself to the tune of, “I should be writing my book right now, I should be creating my e-courses, and I should expand my practice to include group therapy, etc.” At times, however, the symptoms were so disabling that I couldn’t do much but lay in a dark room. In those moments, I worked hard on letting go of my “shoulds, ” such as, “How can I be laying here when I should be accomplishing this and that and the other thing?!”

Compassion for my body:

Chronic migraine forced me to take a break from physical exertion. With the lack of consistent cardio, coupled with the weight-gain side effects of certain medications, I saw the number on the scale go up. At first, I started to obsess over the weight that I “should” be at. Then, I started to have compassion for the strength of my body as it went through this process. Instead of focusing on pounds, I focused on wellness.
I am finally challenging many of the “shoulds” I’ve amassed, and as I do I notice the seeds of self-compassion budding within me.

3. Gratitude

Gratitude for moments of relief:

I’m certainly not going to imply that we have to struggle in some capacity to feel and express gratitude! Yet, the caliber of gratitude that I felt in the moments when I experienced even modicums of relief from my migraine symptoms, was something I’d never experienced in all my years of gratitude training. I found myself literally saying, “Thank you, thank you, thank you!” But when the pain returned, and I was at risk for falling into a darkness, “Why was that relief taken away from me!?” I challenged that thought, and reminded myself that if I had a moment of relief, I would have another – and that gave me hope.

Gratitude for the care I have been, and continue to be, shown:

I tend to be more of a nurturer, caregiver type — much better at giving than receiving — but because of the sometimes disabling nature of migraine, I literally had no choice but to allow myself to surrender to others’ giving.

Whether it was foot massages in the throes of a more severe attack, ice and heat around the clock as needed, mailing me different essential oils, including peppermint — which I’ve found has been crucial — showing up to the ER when the relentless pain called for a visit, calling or checking in daily, helping me strategize to find the best and highest caliber treatment team, and even just holding me during some of the more emotional moments when I’d cry from exhaustion, when the hope was too hard to hold, when I couldn’t see my future.

To see those I love show up in many different ways to bring me even just a little more relief filled me with gratitude — again, the kind I had never quite felt before.

4. Patience

Patience in finding the right treatment:

By nature, I tend towards the more impatient end of the spectrum. I like to take productive action and see immediate results — cause and effect, right? Well, sometimes, life just doesn’t work like this and I have had to maintain patience across many facets of my migraine experience.

Finding the right treatment team takes time. Not every doctor is going to be the right fit for your needs, and that’s OK. However, it can feel like a job finding the point person who will facilitate the appropriate treatment, the clinician who is the right fit. After a few months, thanks to a friend’s recommendation, I’ve finally found someone.

Often, treating migraine also calls for finding the right cocktail of medications. This takes a lot of time, too. Not only do you need to find the right combination that works for each unique individual, but it also takes at least one month before you’ve given each and every medication its “fair shot.” Plus, some come with egregious side effects, and you have to decide: do you wait it out and hope they subside as the medication takes effect – or do you stop it, and start over?

I’d like the healing to be more linear and more blatant, but it’s not. There’s a lot of waiting involved, and the waiting feels compounded because it happens sometimes in the context of great discomfort and pain. Baby steps is my new mantra, but none of this feels easy.

So, while it’s taken a solid treatment team, preventative meds, significant lifestyle and dietary changes, and incredible support, I have no doubt that these lessons are part of my healing process.

That’s the irony of all ironies. The lessons learned are like lifeboats in an unpredictable, roaring sea. Again, one doesn’t have to struggle to “see the light,” but if one is experiencing discomfort and pain, there’s more to see in that muck than meets the eye.