Tag Archives: Posttraumatic stress disorder

The dreadful, breathless and uncomfortable Mr. Anxiety

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Have you been afraid of the dark?

You’re Not The Only One

Anxiety disorders refer to a high prevalence group of problems, which include excessive levels of fear and anxiety. Anxiety is a normal reaction to stress, threat, or danger and often serves us well. It enables us to deal with threatening situations by triggering the fight/flight response so that we can take evasive action. However, it is when this response is persistent, excessive and interferes with our functioning in daily life that it is referred to as an anxiety disorder; at this point a psychologist or counselling service may be required.

  • Excessive Worry/Generalised Anxiety: This is characterized by excessive anxiety and worry lasting 6 months or more. It is accompanied by central nervous problems including bodily tension, restlessness, irritability, fatigue, poor concentration and sleep disturbance. Worries usually relate to education, work, finances, safety, social issues and often minor issues such as being on time.
  • Social Phobia/Social Anxiety: Persistent fear of situations in which we are exposed to possible scrutiny of others, such as public speaking engagements, social gatherings or communication with the opposite sex. This form of anxiety elicits fear of intenseElettroshockfinalsolution_by_LucaRossato_flickr panic in such situations and avoidance of or escape from social environments
  • Panic Attacks: This form of anxiety can manifest in sudden, intense and unprovoked feelings of terror and dread often culminating in heart palpitations, dizziness, shortness of breath and an out of control or very frightening feeling. When we suffer this disorder we generally discover strong fears about when we might experience the next panic attack and often avoid places we feel we might have a panic attack or where escape may be difficult such as movie theatres, shopping malls or social gatherings.
  • Obsessions and compulsions which are characterized by persistent, uncontrollable and unwanted feeling, thoughts or images (obsessions) and/or routines or repeated behaviors(compulsions) in which individuals engage to try and prevent or rid themselves of anxiety provoked by the obsessions. Common themes through compulsions may include repeated actions such as; washing hands or cleaning the house excessively for fear of germs or checking something over repeatedly for
    PTSD

    PTSD

    errors. When we are caught in the cycle if obsession and ritual our lives are constrained and our time otherwise used for living is consumed.

  • Post Traumatic Stress: Witnessing or experiencing a traumatic event including severe physical or emotional trauma such as a natural disaster, serious accident or crime may expose us to the risk of post traumatic stress. Post Traumatic Stress can be characterized by thoughts, feelings and behaviour patterns that can become seriously affected by reminders of events, recurring nightmares and/or flashbacks, avoidance of trauma related stimuli and chronically elevated bodily arousal. These reactions mat arise weeks even years after the event.

Anxiety treatment at Sydney Emotional Fitness also covers specific phobias, a related disorder to Panic. Specific Phobias involve marked, persistent and intense fears about certain objects or situations. Specific phobias may include things such as enclosed spaces, encountering certain animals or flying in airplanes. Exposure to the feared situation or object usually elicits a panic attack leading to a tendency to avoid the feared object.

For all information regarding Anxiety TreatmentPsychologist CounsellingAnger CounsellingGrief CounsellingAnger ManagementRelationship CounsellingStress Management and Depression Treatment in Sydney, or any of our services that may assist you in leading a more rewarding life please call us on 1300 790 550.

Clinic for Dissociative studies

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About DID

Dissociative Identity Disorder

The international psychiatric criteria in the DSM IV specify that DID is:

  • The presence of two or more distinct identities or personality states (each with its own relatively enduring pattern of perceiving, relating to, and thinking about the environment and self).
  • At least two of these identity or personality states recurrently take control of the person’s behaviour.
  • Inability to recall important personal information that is too extensive to be explained by ordinary forgetfulness and not due to the direct effects of a substance (e.g. blackouts or chaotic behaviour during alcohol intoxication) or a general medical condition (e.g. complex partial seizures).

Professor Peter Fonagy and others have shown that the most common aetiology for DID is a disorganised attachment followed by abuse at the hands of a care-giver (McQueen, D; Kennedy, R; Itzin, C; Sinason, V; Maxted, F, 2009).

Whilst some people with DID have ‘alters’ that can communicate with each other, others can experience partial or total amnesia between personality states.  Particular events may trigger flashbacks or bring other personalities to the fore.  The results can have a devastating impact on an individual’s ability to maintain relationships and jobs and even to carry out everyday tasks.

ansikt

All those faces

International research has shown that long-term specialist therapy is the most effective treatment option, and that as with work with extreme post-traumatic stress, short-term interventions are unlikely to have a lasting effect if used in isolation.  For some patients, particularly those coming to treatment early, the prognosis can be good.  For others, particularly if they are still being exposed to trauma and abuse, treatment needs to be approached in a similar way to that for long-term conditions, with the aim of minimising further psychological damage, improving quailty of life and reducing risk.

Major research from the Albert Einstein College of Medicine (Foote, Smolin, Neft and Lipschitz, 2008) has shown that adults with dissociative disorders are at high risk of suicide or self-harm, as well as sectioning and other unplanned psychiatric admissions.  As a result of its clinical and theoretical understanding of this subject the risk of suicide or involuntary psychiatric admissions of clinic patients has been substantially reduced.

About trauma

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Traumatizing experiences shake the foundations of our beliefs about safety, and shatter our assumptions of trust.

Because they are so far outside what we would expect, these events provoke reactions that feel strange and “crazy”. Perhaps the most helpful thing I can say here is that even though these reactions are unusual and disturbing, they are typical and expectable. By and large, these are normal responses to abnormal events.

08d0ab8d1b1a5435a32a3e5134150cd2Trauma symptoms are probably adaptive, and originally evolved to help us recognize and avoid other dangerous situations quickly — before it was too late. Sometimes these symptoms resolve within a few days or weeks of a disturbing experience: Not everyone who experiences a traumatic event will develop PTSD. It is when many symptoms persist for weeks or months, or when they are extreme, that professional help may be indicated. On the other hand, if symptoms persist for several months without treatment, then avoidance can become the best available method to cope with the trauma — and this strategy interferes with seeking professional help. Postponing needed intervention for a year or more, and allowing avoidance defenses to develop, could make this work much more difficult.

We create meaning out of the context in which events occur. Consequently, there is always a strong subjective component in people’s responses to traumatic events. This can be seen most clearly in disasters, where a broad cross-section of the population is exposed to objectively the same traumatic experience. Some of the individual differences in susceptibility to PTSD following trauma probably stem from temperament, others from prior history and its effect on this subjectivity.

Traumatic experiences shake
the foundations of our beliefs
about safety, and shatter our
assumptions of trust

In the “purest” sense, trauma involves exposure to a life-threatening experience. This fits with its phylogenetic roots in life-or-death issues of survival, and with the involvement of older brain structures (e.g., reptilian or limbic system) in responses to stress and terror. Yet, many individuals exposed to violations by people or institutions they must depend on or trust also show PTSD-like symptoms — even if their abuse was not directly life-threatening. Although the mechanisms of this connection to traumatic symptoms are not well understood, it appears that betrayal by someone on whom you depend for survival (as a child on a parent) may produce consequences similar to those from more obviously life-threatening traumas. Examples include some physically or sexually abused children as well as Vietnam veterans, but monkeys also show a sense of fairness, so our sensitivity to betrayal may not be limited to humans. Experience of betrayal trauma may increase the likelihood of psychogenic amnesia, as compared to fear-based trauma. Forgetting may help maintain necessary attachments (e.g., during childhood), improving chances for survival; if so, this has far-reaching theoretical implications for psychological research. Of course, some traumas include elements of betrayal and fear; perhaps all involve feelings of helplessness.

 

About Trauma

Emotional and Psychological Trauma
Nice explanation of the causes, symptoms, effects, & treatments of psychological or emotional trauma — broader than PTSD.
Information on the Threat Response
Detailed and well-done article on responses to threat, by Eric Wolterstorff.
APA Topics: Trauma
American Psychological Association webpage offers information on emotional trauma.
Facts for Health: PTSD
“The intensity of experiencing a life-threatening trauma can take time to subside. For some, it simply never does…”

Inspiration: Movies about mental illnesses

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– submitted by Ruth Levine, MD, University of Texas Medical Branch, Galveston

Black Swan (2010), Darren Aranofsky

Brilliant psychological movie. Dissociation?

 

Anxiety and Anxiety Disorders Bipolar Disorder/Mania
Copycat (panic/agoraphobia) Mr. Jones
As good as it gets (OCD) Network
The touching tree (Childhood OCD) Seven Percent Solution
Fourth of July (PTSD) Captain Newman, MD
The Deer Hunter (PTSD) Sophieís Choice
Ordinary People (PTSD) Sheís So Lovely
Depression Psychosis
Ordinary People Shine
Faithful I Never Promised You a Rose Garden
The Seventh Veil Clean Shaven
The Shrike Through a Glass Darkly
Itís a Wonderful Life (Adjustment disorder) An Angel at my Table
The Wrong Man (Adjustment disorder) Personal
Dissociative Disorders Man Facing Southwest
The Three Faces of Eve Madness of King George (Psychosis due to Porphyria)
Sybil Conspiracy Theory
Delirium
The Singing Detective
Substance Abuse
The Long Weekend (etoh) The Days of Wine and Roses (etoh)
Barfly (etoh) Basketball Diaries (opiates)
Kids (hallucinogens, rave scenes, etc.) Loosing Isaiah (crack)
Reefer Madness Under the Volcano
Long Day’s Journey into Night Ironweed
The Man with the Golden Arm (heroin) A Hatful of Rain (heroin)
Synanon (drug treatment) The Boost (cocaine)
The 7 Percent Solution (cocaine induced mania) Iím Dancing as Fast as I can (substance induced organic mental disorder)
Eating Disorders
The Best Little Girl in the World (made for TV)-Anorexia Kateís Secret (made for TV)-Bulemia

Axis II Disorders

Personality Pathology
Cluster A Cluster B
Remains of the Day- Schizoid PD Borderline PD
Taxi Driver-Schizotypal PD Fatal Attraction
The Caine Mutiny- Paranoid PD Play Misty for Me
The Treasure of Sierra Madre -Paranoid PD Frances
After Hours
Cluster C Looking for Mr. Goodbar
Zelig-Avoidant PD
Sophieís Choice-Dependent PD Histrionic PD
The Odd Couple-OCPD Bullets over Broadway
Gone with the Wind
A Streetcare Named Desire
Antisocial PD
A Clockwork Orange
Narcissism Obsession
All that Jazz Taxi Driver
Stardust Memories Single White Female
Zelig The King of Comedy
Jerry Maguire Triumph of Will
Alfie
Shampoo Mental Retardation
American Gigolo Charly
Citizen Kane Best Boy
Lawrence of Arabia Bill
Patton Bill, On His Own

Miscellaneous Issues

Family Early Adult Issues
Ordinary People Awakenings
The Field The Graduate
Kramer vs Kramer Spanking the Monkey
Diary of a Mad Housewife
Betrayal Latency and Adolescent Issues
Whoís Afraid of Virginia Woolfe Stand by Me
The Stone Boy Smooth Talk
The Great Santini
Doctor/Patient Relationship Boundary Violations
The Doctor The Prince of Tides
Mr. Jones
Idealized “Dr. Marvelous” Psychotherapy
Spellbound Suddenly Last Summer
The Snake Pit Captain Newman, MD
The Three Faces of Eve Ordinary People
Good Will Hunting

Steve Hyler directs an APA course on this topic, and
would be a good person to check with.
For more details, you can call me (409) 747-1351. Hope to see you in Maine!

Ruth Levine
University of Texas Medical Branch


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How we remember, and how we forget

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How We Remember and How We Forget: Trauma, Denial, and Dissociation

I “forgot” a good part of my life.  I “forgot” the 3-6 months I spent in foster care, the events that led up to it, and the intense grief of being returned to a biological family I felt no connection to.  I “forgot” being trafficked for sex by my own father.  I “forgot” being placed in a freezer, tied to a wall in the dark in the garage like an animal, and forced to hang myself.

For a long time, I “forgot” about appointments, bills, and things I had done and said within the last 24 hours.  Sometimes, I still do.

I know a lot about forgetting.

Since then, I’ve been working at remembering.  I know a lot about that too.

A diagram of a neuron.

We remember information, experiences, and ideas because there are robust neural pathways between them.  If I am trying to remember a person’s name, I will most likely start with a piece of information that seems like it will lead me there: the face, trivia about the person, our last conversation.  If I am really intent on remembering, I will continue to dredge up these bits of associated memory until I am able to locate it.  So, the more connections we have between something we want to remember and other things and the more robust those pathways, the easier memory becomes.

Neural pathways become faster and more efficient with use.  When we stop using a particular pathway on a regular basis, it becomes less robust, slowing us down when we try to use it.  We may not “forget” information so much as lose the connections that allow us to find it.

I suspect that denial and dissociation both affect memory because of how they impact the neural pathways between parts of a memory.

Both the cortex and the limbic system are involved in memory formation. The amygdala, in particular, plays an important role in emotional memories.

In the case of dissociation, I speculate that the lack of robust neural pathways occurs at the time of the event.  Sensory impressions, thoughts, and emotional reactions are recorded, but with very little connection between them.  Whether this is because the brain functions that create order and connectivity are suppressed during traumatic events or because the parts of the brain involved in forming memories during life-or-death situations are different and don’t form connections as well, I’m not sure.

But I am sure that it happens because of how my own memories arise for me.  A major part of working through the trauma I’ve experienced has been simply finding things and putting them together–connecting pictures to words, declarative knowledge to sensory impresssions, physical responses to my knowledge of feeling states.  I “remember” nearly everything significant that has happened to me, but when I first began to work with them these memories stood in no particular order and in no relation to one another.

How the events were recorded in my mind in the first place has something to do with this.

Now, I know that the general wisdom is that we suppress trauma because we are trying to protect ourselves from the knowledge of what happened until we are in a position to deal with it.

I don’t entirely believe that.  I don’t think the memories are difficult to locate for the sole reason of emotional self-protection.  Partly, yes, but not entirely.

At the time of the event, we shut down certain types of awareness for two reasons that really come down to physical survival: one, we do this in order to suppress an awareness of physical pain so that our reactions to pain don’t interfere with doing what we need to do to survive.  Two,  we do this because conscious thought is the slow-track to action, and if we engage in it we could be killed before we’ve even come to a decision.  Much better to think like a lizard and just run away.

It is this state of suppressed conscious awareness that limits our ability to form connections between parts of a memory.  If a traumatic event is extremely intense, or if we have a lot of experience with being traumatized, touching on one aspect of the memory can re-start the process of suppressing conscious awareness, and our brains remain unable to form connections.

That is what PTSD looks like.  Elements of a memory are triggered, but instead of this access to the memory allowing us to form robust connections between parts of the memory, the connection is instead formed to whatever processes are involved in dissociation.  The more this happens, the better we get at dissociating as the pathways involved in dissociation get more and more robust.

But we may never figure out why red sweaters scare the bejesus out of us, or what happened after we put one on.  We may never link the scratchy feeling of the sweater with the color, or with the queasy feeling in our stomachs.  Not because we are avoiding that connection, but because we are busy doing something else.  We aren’t trying to protect our psyche.  We are trying to protect our bodies, and our brains don’t know that they can stop.

Denial, on the other hand, can lead to a kind of deliberate forgetting.  Every time the memory is accessed, we shift our attention away from it.  (For why, see Unsolicited, Bad Advice.)  The connections are there, but we train ourselves not to use them.  With time, the connections become tenuous, weak, frail.  They may break altogether.  The memory then becomes suppressed.  It is there, but we no longer know how to find it.

In dissociation, there may not be enough connections to the memory or between parts of a memory to start with.  In denial, we can intentionally remove them.

In the case of childhood trauma, the family can aid in this.  Children remember events partly because others in the family rehearse what happened with them later on.  Those pleasant sessions of “Remember when…?” reinforce and strengthen neural pathways between the details of events.  They also help children construct comprehensible narratives of what may be more fragmented impressions.

When traumatic experiences occur in the family, members often actively avoid doing this.  The message implicitly or explicitly stated may be that it would be better to talk (and think) about other things.  Without those rehearsals, children lose the connectivity between traumatic events and the rest of their lives and may have trouble accessing them as adults.  Or they may be able to access them, but assume the memories were simply bad dreams or the products of a fertile imagination.  The memories may not seem like memories because no one else seems to have them.

In cases of family abuse, both mechanisms involved in “forgetting” can work to “repress” a memory.  Elements of memory start out disconnected and isolated because of the functioning of the brain in the midst of trauma, and the connections that are there can become disused, slow, and inefficient because of denial within the family that means those pathways are deliberately avoided.

No wonder I feel like I’m giving my brain an extreme home make-over–cleaning, organizing, and re-designing.

Further reading:

The Brain Athlete. (2012)  Brain Plasticity Forms Who We Are.  Retrieved from: http://www.brainathlete.com/brain-plasticity-forms/

—-Neocortext and Not Hippocampus May Form Memories.  Retrieved from: http://www.brainathlete.com/neocortex-hippocampus-form-memories/

How to Forget Unwanted Memories.  (2012, October 20).  Medical News Today.  Retrieved from: http://www.medicalnewstoday.com/articles/251655.php

Plasticity and Neural Networks.  Canadian Institutes of Health Research.  Retrieved from: http://thebrain.mcgill.ca/flash/d/d_07/d_07_cl/d_07_cl_tra/d_07_cl_tra.html

Posttraumatic Stress Disorder Factsheet.  (2011, October 17).  National Institutes of Mental Health.  Retrieved from: http://www.nimh.nih.gov/health/publications/post-traumatic-stress-disorder-research-fact-sheet/index.shtml

Memory-training as treatment for depression and PTSD

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Earlier this year, I was updated on the latest new in the treatment of depression and PTSD. I use EMDR a lot, but this was an interesting addition to the therapeutic tools available. Empirical research show that people who remember specifics, like the color on your shoes when you were 8, or how an animal looked at the zoo, have happier life. For depression this “steals” meaning, if you can`t see earlies experiences, its also hard to imagine a future. When not depressed, most people will create emotional picture of what they dream of: Like how you will look in a wedding dress, the people who would come, and you might even dream up your husband to be. What would life be without memories connected to emotions?

Autobiographical memory and emotional disorder

ImageTo remember other incidents in specific detail might protect from PTSD

Autobiographical memory refers to our recollection of events in our past. Disturbed patterns of autobiographical memory, particularly for emotional events, are a cardinal feature of affective disorders. These difficulties range from intrusive flashbacks of traumatic events such as war, accidents, or interpersonal violence, in sufferers of PTSD, to ruminations upon general negative autobiographical themes such as failure and worthlessness in depression.

Such patterns not only define the mental lives of patients but drive the onset and maintenance of their problems. Consequently, clinical interventions that can target and reverse these maladaptive memory processes have enormous potential. One of our key research goals is therefore to elucidate the nature of autobiographical recollection in depression and PTSD, and to use these insights to refine and develop novel memory-focused treatments. Below are a couple of examples from this work.

Memory Specificity Training (MEST)

What are we investigating?

Patients with depression and PTSD find it relatively difficult to bring to mind specific, detailed auotbiographical memories of discrete emotional past events. Researc has shown that access to such memories is important in everyday mental life for problem-solving, social communication, emotional processing of distressing experiences, and future planning. Unsurprisingly then, reduced access to specific autobiographical memories disrupts day-to-day cognitive fucntioning and therefore plays a significant role in maintaining depression and in the onset of PTSD (Williams et al., 2007).

What are we doing?

ImageTreatment of PTSD will evoke memories, but if you try to bury them, you also bury other things that might help you and make you stronger!

These research findings suggest an elegantly simple clinical treatment for depression and PTSD  – training patients to become more specific in their emotional autobiographical recollection. Memory Specificity Training (MEST) is a 4-session group clinical intervention with precisely this aim. Patients undergoing MEST simply practice retrieving emotional and neutral specific memories to a variety of cues, both in session and at home.

What have we found?

We have conducted two clinical treatment trials of MEST. One for individuals with depression (Neshat-Doost et al., 2012) and one for individuals with PTSD. We found that MEST was successful in both cases in markedly reducing pateints’ symptoms and that the level of symptom improvement was directly related to how good they had become at retrieving specific memories.

Why is this important?

These findings are important for a number of resons. Firstly, the underline the importance for mental health of how we recollect autobiograhical memories. Secondly, MESt is a very straightforward treatment that is easy to deliver, and thus suitable for less experienced therapists, and cost-effective due to its group format. It is also suitbale for a rnage of clinical settings; for example our clinical trial with patients with PTSD was carried out in a shelter for refugees in a war zone.

Here is a interesting profile from pinterest with personal information about PTSD:

Understanding PTSDby Michele JanesAbout Grounding Techniques ~ Grounding is about learning to stay present in your body in the here & now. Basically it consists of a set of skills/tools to help you manage dissociation & the overwhelming trauma-related emotions that lead to it. Processing done from a very dissociated state is not useful in trauma work. Neither is the goal to be so overwhelmed by feelings that you feel re-traumatized. Every one is different and there are a variety of grounding techniques to choose from.Recovering from mental illness often makes us feel exhausted. This blog explores five reasons why.If I could tell you one thing..."mental disorders are NOT adjectives". This always bothers me.. That's me. Definitely today... :sAlexithymiaStory of my life...That's the truthFight like hellYES. I am an introvertI Am Anxiety- Pretty powerful video. I haven't watched it yet but plan to as soon as possible..ashamedyeah, what ^^^^ saysPTSD.......Pretty much :):/peanutsMindfulness...Child maltreatment has been called the tobacco industry of mental health. Much the way smoking directly causes or triggers predispositions for physical disease, early abuse may contribute to virtually all types of mental illness.Psychological abuse is a subtle method used to destroy a child's sense of well being, to instill fear or terror, or prevent, undermine or destroy confidence. The use of psychological abuse, brutality or torture on a growing child is most damaging. It prevents the child from being who they were born to be, and limits or destroys their ability to function normally in life. It is the most damaging of child abuse, without leaving any physical scars. fears

See On Pinterest