What doors do you want to open?
Write this down. Get clear. Think big.
Can’t close the doors? Let’s talk.
What doors do you want to open?
Write this down. Get clear. Think big.
Can’t close the doors? Let’s talk.
Nightmares are a terrifying symptom of PTSD. Sometimes the nightmares are direct representations of the abuse or trauma. Sometimes the nightmares are a jumble of pieces and parts of the traumatic event. Sometimes the nightmares represent the trauma only in its emotional tone. The nightmares often represent unprocessed emotional material from a traumatic event. The cure for nightmares is prolonged exposure therapy which cannot be done without a trained therapist. However, some management is possible to limit the after affect of the nightmare.
The following exercises are often helpful for people that have night-mares:
1. You can write about the nightmare in vivid detail as soon as you wake up. Keep a note book or laptop by your bed.
2. Have a list of five of the things that you do not like to do. You must be able to do them at night without disturbing the rest of your household. When you wake up start with the one that you like to do the least. After you complete it go back to bed. If you are not asleep in 10-15 minutes get back up and do the next thing on the list.
3. Read a boring book if you are able to concentrate.
These exercises may help in alleviating the distress of the nightmares. There are some medications that are helpful in suppressing nightmares, but individuals suffering with PTSD are vulnerable to abusing or becoming addicted to some of these medications to escape the awful feelings that accompany traumatic events. Therefore, I recommend skills, carefully managed and monitored medication use along with prolonged exposure treatment when you are ready.
These tips are provided to help you manage flashbacks and intrusive memories to make them more bearable. These exercises do not reduce or minimize the symptoms of trauma. To do that I recommend that you contact us to schedule an assessment to see if prolonged exposure therapy may help you to move beyond surviving to thriving.
1) Increase your awareness about what happens to you at a physical and physiological level before and during a flashback.
2) Develop an observing self that helps you identify what is happening to you from a non-judgmental and detached perspective. Think “Isn’t this interesting I am (observe and describe just the facts).” As if you are watching yourself on a TV or movie screen.
3) To minimize a flashback ‘ground’ yourself in the moment. Notice in specific detail what is around you. How would you explain to others the room or place you are at in such detail that they could paint a picture of it from the details you provide them.
4) Play word or number games such as crossword puzzles or Sudoku at levels that take minimal to moderate concentration. In other words do not try the most challenging puzzles at this time save those for when you are in a good place. Challenging enough to engage your mind, yet not so challenging you cannot do the exercise. Count backwards from 100. Do it in specific increments like five or seven if that is more helpful. 100, 99, 98; or 100,95,90; or 100, 93, 86. Say the alphabet backwards. List names or places that start with each letter of the alphabet. You can do a multitude of variations of this mind game.
5) Move feelings and thoughts from inside yourself to outside yourself by writing, talking, drawing, painting, or make a collage as a representation of what is going on internally for you.
6) Engage in moderate physical activity (as long as you are medically cleared to exercise) such as walking, planting flowers, cleaning, or bike riding.
7) Play with your favorite pet.
8) Change your space…go to a place that is safe for you.
9) Change physical sensations, take a cold shower or hold ice in your hand. Blast the air conditioning or go stand in the warm sun.
10) Avoid using behaviors that in the long run will become problematic for you or increase the likelihood that symptoms will increase more frequently in the future such as restricting or bingeing food, drinking alcohol or taking prescription medications beyond prescribed limits.
Remember that you will have to practice, and find the techniques that are the most helpful for you in managing symptoms. These techniques are not permanent solutions for more assistance in significantly reducing symptoms contact us.
A flashback is difficult to define and understand. In simplest terms it is the re-experiencing of a traumatic event in the present. Flashbacks can be full, abreactions or partial. A full flashback is typically not remember-ed by you. You leave the present and relive the event at both a psych-ological and physiological level. If you experience a full flashback you may lose significant amounts of time and be unable to account for that lost time. Others may not be able to arouse you out of this state. After the flashback you may feel like you are losing your mind. You may be afraid to tell others what is happening to you because you are afraid they will think that you are crazy.
A partial flashback is easier to identify. A partial flashback may consist of memories, thoughts, and feelings of a traumatic event typically with accompany feelings in your body. You will feel as if the trauma is happening again yet at some level you are aware of the present. You may feel as if you are living between the past and the present. You may feel the age you were when the traumatic event occurred. If you do not know what is happening to you, you may think you are crazy, especially if it seems to occur without an easily identifiable trigger in your present environment.
Flashbacks are extremely frightening for you and your family because most people do not know what is happening or how to manage these symptoms. Unfortunately many people turn to the use of behaviors that at least in the short run help to manage the symptoms but in long run are self-harming and become less effective over time. You may use drugs, alcohol, dieting, bingeing, purging, over eating, over working, over exercising, obsessions, compulsions, cutting, burning, gambling, sex, or relationships to manage flashbacks.
In many cases these coping measures are effective, sometimes for years. It is not unusual for an individual to enter treatment in their late 30’s, 40’s, or 50’s. It seems at least in the early years of life an individual’s cop-ing mechanisms remain effective with minimal negative impact. You may have entered therapy for other reasons that concern the way you were managing the symptoms. You may have been using or abusing drugs or alcohol, acquired an eating disorder, or some other type of behavior that was negatively impacting your life. What you found was that as you started to recover or stop using your typical methods of coping the flashbacks increased. Relapse is a higher risk when trauma symptoms remain untreated.
What is prolonged exposure therapy? Prolonged exposure therapy is a research based time-limited treatment that successfully decreases posttraumatic stress disorder symptoms in 85% of the people that under- go the treatment by more than 70%. Prolonged exposure is a cognitive-behavioral technique used to reduce the symptoms of post- traumatic stress disorder through a process of desensitizing the client to specific traumatic events.
How can prolonged exposure therapy help posttraumatic stress dis- order? Prolonged exposure therapy decreases the client’s sensitivity to internal and external triggers of historical trauma through a process called imaginal exposure that allows the client’s physiological responses to be modified over time. By decreasing avoidance and experiencing safety during the exposure process the client’s internal processes adjust to the present safe context in which the exposure is being done. This difference allows the client to have fewer and less intense triggers in the environment after a series of imaginal exposures.
What is a typical session using prolonged exposure therapy like for a client? A typical session for a client in prolonged exposure therapy is tough, especially in the beginning. In each session the therapist will work to increase the intensity of the exposure, which often results in increased physiological symptoms during the exposure session. A session is 90 minutes long. It begins with a 15-20 minutes review of the client’s experience during the past week, especially the daily homework the client is to complete. The following 30-40 minutes are spent with the client doing the actual exposure process while the therapist monitors the client’s subjective units of distress, and physical signs of anxiety. The final 20-30 minutes are spent grounding the client in the present, discussing the client’s experience of this exposure and defining the homework for the week.
What last advice would you like to leave for someone who is coping with post traumatic stress disorder and is considering prolonged exposure therapy? Work with an experienced therapist that is trained specifically in prolonged exposure therapy. Have an evaluation by a psychiatrist to see if medication may assist in modulating your trauma symptoms. Medication may make doing the prolonged exposure work manageable and less frightening. Timing is important in the treatment of symptoms for trauma especially if you suffer with co-morbid mental health illnesses. Realize that your symptoms will get worse before they get better, therefore some behavioral issues must be contained in order for the exposure work to be effective. If you use drugs, alcohol, or have an eating disorders or other behaviors that you use to numb or block intense emotions they will decrease the effectiveness of treatment. Therefore, consider treatment for these specific behaviors before and during pro- longed exposure therapy. If you are currently living in abusive or traumatizing environments do not undergo prolonged exposure therapy until you are living in a safe environment.
“I must be bad or these things (abuse, trauma) would not have happened to me!” “Is there something wrong with me?” “It must be my fault!” “I must have done something wrong!” Perhaps you have thought or said these same things. As a therapist, I have often heard these thoughts voiced. I wish I could say that I have come up with a good answer to “Why me?” Yet, I remain mystified as to why some individuals suffer so immensely. Unfortunately, I do not know “why” bad things happened to you. I only know that the “why” from my experience does not matter in the long run. What does matters is what you decide to do about what happened to you. Most of the individuals I treat are decent, hard working people that have suffered terribly. They have come to me to help them reduce the symptoms that are getting in the way of them living their lives. They are seeking freedom from the symptoms of trauma. Eventually some are able to make meaning out of the pain they endured. Most have more energy after healing and are able to use this energy to thrive and build the lives they have wanted for themselves.
You may feel crazy but I assure you, you are NOT crazy. You are flooded with emotions, physical feelings that are a re-experiencing of the traumatic event(s). You have body symptoms, intrusive memories and flashbacks that are especially frightening when you have no idea why you are feeling like you do. On top of it your feelings do not fit with what is going on around you.
You could be at the grocery store and see a shirt like the one your father wore when he fondled you the first time at age 7. You feel as if you are 7 again and as if your father is inappropriately touching you again. Yet you know at some level that you are at the grocery to get milk and eggs, you really are 45 years old and that you are a physician with her own practice. Yet you move between the past and present struggling to understand what is going on. If you do not slip all the way into the past (full flashback) and disassociate (lose time) then you will probably be able to get out of the store and get yourself to a safe place. Until you understand what is occurring, and even when you do, it is a terrifying to have and fear it will continue to resurface.
The good news is that once you begin to identify these symptoms you can begin to use some techniques that will help you to ground yourself in the present. A couple simple things that you can tell yourself is “It is not happening now.” “I have already survived it.” “I am safe right now, right now I am safe.” “Nothing or no one is hurting me right now.” “I feel terrible but I am ok.” You may have to tell yourself this a 1000 times but the feelings will pass and you will eventually move from feeling shell shocked into a more ‘normal’ range of feeling for yourself.
If you would like to decrease or eliminate your PTSD symptoms please contact me. Research based treatment for PTSD is effective in 85% of the cases with a reduction in symptoms of more than 70%. You can do more than survive, you can thrive.