Post-Traumatic Stress Disorder & the Value of Operating From a Trauma Response Perspective
National PTSD Awareness Day is a day dedicated to creating awareness regarding PTSD. It is acknowledged annually on the 27th of June. The US Senate officially designated this day in 2010. In 2014 the Senate designated the whole month of June as PTSD Awareness Month. PTSD is a disorder that will affect about 7-8 out of 100 people in their lifetime, the National Institute on Mental Health (NIMH) reports. PTSD stands for Post Traumatic Stress Disorder, which is a mental health condition that’s triggered by a terrifying event – either experiencing or witnessing it. The most common types of events leading to the development of PTSD include combat exposure, childhood physical abuse, sexual violence, physical assault, being threatened with a weapon or an accident.
It’s not uncommon for individuals who experience traumatic events to have a difficult time adjusting and coping, but with time and good self-care, they typically will get better. Common PTSD symptoms may include flashbacks, nightmares, severe anxiety – as well as uncontrollable thoughts about the event. If an individual experiences an increase in symptom severity or length or symptoms interfere with daily functioning, it’s likely they may have PTSD.
Furthermore, Post-traumatic stress disorder can have a profound impact on an individuals life including job, relationships, health and enjoyment of everyday activities. Research has found that PTSD may also increase an individuals risk of other mental health disorders such as: depression, anxiety, substance abuse, eating disorders and suicidal thoughts or actions.
In fact in a recent study, it was found that almost half of the individuals seeking substance abuse treatment also meet the criteria for post-traumatic stress disorder. Getting effective treatment for co-occurring substance abuse disorder and PTSD can be critical to reducing symptoms and improving overall functionality. An element of importance is providing an environment of trauma-informed or trauma responsive care. At Footprints to Recovery our programming, environment, language, and staff was and continues to be built to better care for patients who have experienced trauma. Below, Footprints to Recovery’s Clinical Director Frank Loriggio explains best practices for responding effectively to individuals who have experienced trauma.
Treat the resulting emotions, not the event.
A common mistake in treating trauma is a sole focus on the traumatic event. Two individuals can go through the same type of traumatic experience yet have different reactions to the experience. This speaks to the meaning that an individual gives to the traumatic event. Take some of the common reactions to traumatic events: “What’s wrong with me?”; “Why can’t I just get over it?”; “I’m damaged”; “It’s all my fault.”; “I’m no good.” Each question invokes some type of maladaptive meaning to the experience related to worthiness, responsibility, safety, and control. Focusing solely on the event can trigger the individual and lead to re-traumatization and emotional dysregulation, which only further drives feelings of shame. Helping the individual process the shame from these experiences is what begins the healing process and creates more adaptive or functional meanings: “I can do this”; “It’s not my fault”; “I am safe now”; “ I am enough.”
Start with safety and end with safety.
Healing from a traumatic event doesn’t take place until an individual connects with safety on several levels. They need to have an internal compass of safety, which means they need to feel confident that whatever “comes up” is manageable and that they can contain it when they need to. The fear that once they “open their trauma” they won’t be able to “close it” is a common concern. Clients need to have trust in the therapist, the group, the program, the external environment that these factors will help them manage their trauma symptoms and support them in seeking safety. Providing conditions, guidelines, validation, and attunement throughout the whole process is important. A patient will feel more confident in working on their trauma if they know that immediately after the session as well as that evening or days later that they can safely contain or ground themselves. Ending sessions with containment imagery, somatic engagement, progressive muscle relaxation, breathing strategies, and even yoga poses can provide this sense of safety and reach patients ways they can accomplish this for themselves.
Create and support emotional reparative experiences.
Part of the healing process is to help patients experience their trauma from a stance of safety, empowerment, and value. This can simply be an individual telling their story and receiving validation and empathy from others. It can also be someone who has been physically and emotionally beaten down who is able to assert themselves and set clear boundaries. You are always in your audience and you can be your biggest fan or greatest critic. Watching yourself overcome or do something you once weren’t able to do fosters growth.
Perspective and language matters.
The most common question I am asked is “how do I get over it.” This is a flawed question and stifles growth from the get-go. The problem is that trauma is not a wall to climb over or an object to jump over. Trauma is a typical response to an abnormal experience with the sole focus on surviving. If the individual is in my office they have survived the experience or experiences. Helping the patient to shift their perspective and also ask themselves better questions are important components of treatment. First, they need to develop awareness around their own resilience. “I survived.” This can be a powerful affirmation that can help an individual move out of the identity of a victim and into the identity of a survivor. Next is asking yourself “how do I get on WITH it?” This question encourages acceptance with a focus on the future. It fosters post-traumatic growth, a transformation where you reclaim what you have been through and channel it as fuel for growth. The language that you use with your patients can either perpetuate victimization or encourage healing and growth. It is the ability to tell your story through a different lens.
“The issues are in your tissues.”
I don’t know who said that but I love it! Trauma is in the body. If we were to look at the cells of an individual with trauma under a microscope we would see some cells with their fists up ready to fight, some lacing up their sneakers and getting ready to run, and some completely frozen. This speaks to the fight, flight, or freeze response, which becomes the overused faulty operating system individuals with trauma become accustomed to. Sometimes there is a total disconnection to the body and mind. Experiential and body focused strategies are effective at creating awareness in the body as well as processing the past trauma. EMDR, NET, Somatic Experiencing, psychodrama, yoga therapy, and massage therapy are just a few strategies that can help the somatic component of trauma.
All in all, operating from a trauma-informed and responsive perspective allows for the environment, programming, language, and staff to be better able to provide the best care to patients who have experienced trauma. It’s important to recognize that the person affected by trauma will take some time to heal. Unrealistic expectations of a quick recovery, pushing the trauma survivor beyond his or her readiness and capability and badgering, over-protectiveness, ignoring or dismissing very real symptoms won’t help. What will help includes support and encouragement during the healing process.