Hello, quarantine. Today we’re going to talk about trauma and PTSD.
PTSD requires one thing out of criterion A (trauma):
which is currently defined as you being exposed to death, threatened death, actual or threatened serious injury, actual or threatened sexual violence in the following ways
- direct exposure
- witnessing the trauma
- learning that a relative or close friend was exposed to the trauma
- indirect exposure to aversive details of the trauma, usually in the course of professional duties
Now, while all the world is watching the response to COVID19 deaths and injuries, I’d argue that anyone following the news is getting some low level trauma exposure. Folks in the healthcare industry, you are witnessing trauma and being exposed to trauma on the daily.
But diagnostic criteria doesn’t stop there, we have plenty of other trauma criterion.
PTSD also requires
|1 of Criterion B (intrusive)||1 of Criterion C (avoidance)||2 of Criterion D (negative alterations)||Criterion E (alterations that began or worsened after trauma)|
|Unwanted upsetting memories||Avoiding trauma related thoughts or feelings||Inability to recall key features of trauma||Irritability or aggression|
|Nightmares||Avoiding trauma related external reminders||Overly negative thoughts and assumptions about oneself or the world||Risky or destructive behavior|
|Emotional distress after exposure to trauma triggers||Decreased interest in activities||Heightened startle reaction|
|Physical reactivity after exposure to trauma triggers||Feeling isolated||Difficulty concentrating|
|Difficulty in experiencing positive affect||Difficulty sleeping|
Plus, if we’re looking at PTSD specifically, those symptoms last for more than a month, create distress and functional impairment socially and/or at work, and are not due to medication, substance use, or other illness.
(Note that for kids under 6, this criteria changes a bit and can include things like extreme tantrums as a symptom.)
Why go into all this detail? Well friends, as you know we treat a ton of anxiety and ADHD. We also treat a ton of PTSD. While all of these conditions can have a lot of the same symptoms, trauma doesn’t always respond to the same therapies that anxiety and ADHD do, and realizing that something is different is critical for useful treatment.
Trauma induces a response called “Fight, Flight, or Freeze” which is your body’s automatic built in system to protect you from danger. Prior to emails and pandemics, the sort of thing this would have really helped with is running away from predators, fighting your way out of a landslide, or hiding until the generally very physical danger passed. Fighting responses now can look like crying for what seems like no reason, clenched fists and jaws, desire to stomp or smash things, anger/rage, nausea and burning stomach. Freezing responses can look like feeling stuck, cold, numb; having a sensation of stiffness or heaviness, holding your breath, sense of dread and heart pounding, being unable to look away from trauma and trauma triggers. Flight responses can look like restless legs, numb legs, shallow breathing, fidgeting, feeling trapped, running from one activity from the next, excessive exercise.
You might notice that these totally overlap with anxiety and depression symptoms. The main point of going over this right now is that we’re in a worldwide trauma exposure, and many folks may go on to develop the rest of the symptoms. Knowing that this pandemic is a trauma exposure that might lead to PTSD right now can help you get your brain to work on health coping skills as we go through this.
We have two main goals for trauma treatment: identifying triggers, and building resiliency.
Identifying triggers helps you find the edge where emotional and physical responses are starting, which can allow you to interrupt patterns that aren’t helping you now. Maybe it’s the news popping on to the radio. Maybe it’s seeing ads about face masks. Maybe it’s hearing from friends who are really struggling from the same trauma. Maybe it’s feeling helpless. Maybe it’s remembering your vacation plans that you can’t go on now.
Triggers can be internal (meaning that they are generated from inside of your brain) or external (coming from outside of your brain). When the symptoms start showing up, what are you feeling? What’s going on around you? How does your body feel? Figuring out exactly what happens right before you start falling into a fight/flight/freeze behavior is all a big homework project for you. The things that bother you are probably different than things that bother other people, though when everyone gets the same trauma you might experience some of the same triggers as well.
Once you know what triggers are, avoiding them as much as you can helps give your nervous system a break. It’s impossible to avoid every trigger, but you can do things like:
- Take a break from your phone
- Take a break from the news
- Limit your social media intake, and aggressively moderate any online content you come into contact with via keyword blocking, unfriending, and snoozing things that stress you out.
- Get rid of or put into storage things that only remind you of negative experiences. Does it spark joy? Here’s the one place where I will advocate for some Kon Mari instead of UFYH cleaning methods.
Once you know what your triggers are and have some strategies in place for avoiding them, then it’s all coping strategies for building resiliency. Resiliency is that quality that lets you recover quickly from difficulties, and there’s a million ways to build resiliency.
- Breathing training
Yoga, tai chi, box breathing, and anything else that helps you slow your breathing down into a deep belly breathing pattern gives your nervous system a physical reset by massaging your vagus nerve. There’s a whole polyvagal theory around this that covers digestive, cardiac, and neurological symptoms that helps explain some of the physical symptoms folks develop after trauma.
Note: If you’re asthmatic or coughing, keep in mind that this is not the coping skill you want during an asthma attack or bronchitis, so make sure you have additional skills.
- Cognitive behavioral therapy for PTSD (change the way you think about things) and cognitive behavioral processing (like EMDR or TRE) can be really helpful.
Many therapists are offering telehealth sessions.
- Exercise (it really is good for everything)
Just like always, we only care that you’re moving your body in a way that you enjoy. From advanced hula hooping to doing bicep curls with your cat, finding some way to move will help you use up that adrenaline that’s messing with your sleep. Here are some resources that might be helpful at the time of writing:
- SW Portland Martial Arts is posting a workout daily to their facebook page.
- Chris Hemsworth’s centr app is free for 6 weeks
- Peloton app is free for 90 days
- Fitnessblender.com has always been free.
- Meditation – especially with breath work.
This doesn’t have to be sitting on a pillow on a mountain top- there are plenty of apps for this, and moving meditation like yoga and tai chi as well. (I know I put yoga and tai chi on the list twice. I do have some bias)
- Repetitive motion
(knitting, whittling, crocheting, painting, building, gardening) helps keep your hands and brain busy enough that it’s more difficult to get stuck in the overwhelm. There are lots of wonderful tutorials on the internet, either via ye olde standard youtube.com or moderated platforms like skillshare. ADHD folks, I generally recommend that especially you find something to do with your hands as trauma can help you hyperfixate on only getting bad news. Maybe now is the time to pick up that one hobby you always thought about and might even have supplies for in the back closet.
- Community connection
(with social distancing standards and stay at home orders in mind) can help you build routines and anchor points to your day. Find the people that make you feel joyful and give you hope. Make a point of talking to family members, friends, neighbors. You can play charades over facetime, and the internet again allows us to have so much amazing connection with people all over the world without ever getting within 6 feet of them
The more positive coping skills that you have that you can use in more situations, the more capacity you will have to deal with unexpected triggers.
Finally- consider also having a safety plan made. For some, negative coping skills like addiction habits are going to be more difficult to avoid. If everything is scary and you need more help, figure out when your coping will need extra help and how you will get it.
We’re still here for you- contact 503-344-1345 to schedule.
(as always, sources:)