Survival versus Healing Modes in recovery from trauma

     After the traumatic event is over our struggle to survive just started. Now we have to do something about the memories, the images, and the feelings. Our psyche often suggests that there is only one option, which is to keep moving. We have a fear that if we stop, we will fall apart and cease to function all together. So, we employ our body, especially our nervous system,  and our mind  to focus on staying busy and engaged in our present life. Sounds like a great idea, right? However, we cannot really be fully present with our life until we process what happened and heal from it. We are caught between the rock and the hard place. BUT WE ARE SURVIVORS! So, we keep pushing memories, feelings, and later symptoms down and aside. We keep moving and striving. We work hard just to stay afloat.

     This set up may work for us for a while, but after a few months or a few years our minds and our

bodies get exhausted from working non-stop on keeping the horror out of our consciousness. We start getting fatigued, depressed, physically sick, anxious. At this point, dorsal branch of the parasympathetic nervous system gets activated. As a result, we may go into the chronic “freeze” state, which is often accompanied by dissociation and avoidance. Alternatively, we might employ some stronger tactics at that point, like alcohol and drugs or compulsive sex to help us handle our internal mess. All of those tactics might be good in the moment, but they only bring a temporary relief and are accompanied by serious consequences to our health, our relationships, and our lives as a whole. We keep hoping that if we wait long enough, our wounds will get healed by time. However, trauma does not have an expiration date. So, waiting alone is not going to help.

     Sooner or later we face the dilemma. We can’t keep going anymore, because we are exhausted and falling apart, but we are really afraid of letting go, because we are confident we will lose it forever. This is a point of reaching the limits of the survival mode, which has been helpful and is familiar to us. We need to let go of it and shift into the healing mode, but it is unknown and scary as hell. I will help us understand what healing mode is, how we can shift into it, and some of the drawbacks associated with switching into the healing mode.

    At the point when we are forced to turn survival mode off or when our bodies or minds already did it for us, we have a choice to make. Our choice is between falling into the abyss of depression, PTSD, another emotional disorder, getting sick physically OR shifting into the healing mode. We often feel like we DON’T have a choice. We just fall into the abyss. BUT WE DO. We can start working on shifting into the HEALING MODE at any point in the process. It can happen before we reach the limits of the SURVIVAL mode, right at that point, or even afterwards. It is NEVER too LATE J

     Here is how I understand the HEALING MODE.  We heal, when we give ourselves space and time to connect with our Divine core, which is connected with Universe, Higher Power, or God, or

some other Higher Source as you understand it. When we are in the HEALING MODE, we feel calm, connected, loved and loving, supported, expansive, and trusting. Our creativity and our senses are enhanced. Time often stops or slows down in our perception. Healing mode is also associated with the increased activity of the ventral branch of parasympathetic nervous system (as opposed to the dorsal branch, which is responsible for the freeze response in trauma) and decreased activity of sympathetic nervous system.

     According to Peter Levine, the author of Waking the Tiger, animals shift into the healing mode automatically and quickly after objective danger goes away. They do it through the process of discharge, when they shake and vocalize. For humans the shift is not automatic and often does not happen at all. But it does not mean that it could not happen. We can facilitate this process by integrating certain practices in our lives.

SHIFTING INTO THE HEALING MODE

     From the physiological perspective, we need to activate the ventral branch of the parasympathetic nervous system. At this point, science has a lot of data about the ways to trigger this response. 

     1.       Safety
First, this response is easier to trigger, when environment is assessed to be safe. So, two important things to do in the beginning of the process are as follows:

a.       Find an objectively safe place to be (i.e., your bedroom, a secluded natural spot, or any other physical place that is OBJECTIVELY safe).

b.      Once you are in a physically safe place, work on creating a SENSE of being safe by using safe place imagery, praying, meditating, or employing any other safety practice you are aware of.

2.       2. Physical practices

a.       Stretching muscles as in hatha yoga practices triggers ventral parasympathetic nervous system and relaxation response. Note please, that some yoga classes MAY

NOT be appropriate here (e.g., ashtanga yoga, brikham yoga or power yoga). Classes that may be helpful include but are not limited to subtle yoga, beginner yoga, restorative yoga, therapeutic yoga, or yin yoga. If you are using yoga at home go for the poses from the first and last phases of your typical yoga class. Some examples of those poses include cat-cow, child’s pose, legs up the wall, gentle twists, bridge, and shavasana.

b.      Any MILD exercise. I really mean it. Streneous aerobic exercise or running are NOT good choices here. Opt for a walk in nature, dancing, or swimming.

c.       Rhythmical movement is also good. Examples of it include mild vinyasa yoga, dancing, and walking.

3.       3. Rituals and routines
     Rituals and routines are very important in supporting shift into the healing mode. Our nervous system responds well to predictability and repetition, which are basic components of any ritual or routine. So, consider starting and ending your day the same way. For example, having coffee every morning while you journal or starting day with a prayer or a brief yoga practice or just a shower and breakfast are all good ways of calming your nervous system from get go. The content of the routine is LESS important than its repetition and predictability.
     The same goes for the end of the day. Here are some of the ideas of calming pre-sleep routines: (a) having a cup of chamomile tea w/1/2 tsp of honey while reading something calming; (2) taking a WARM shower or bath with aroma oils of lavender, chamomile, rosemary, ylang-ylang or sweet orange; (3) listen to calm music while working on a crossword or puzzle; (4) journal about your day or things that you are grateful for; use words or pictures or scribbles, use colors; (5) do deep breathing and guided imagery exercise.
     One pre-caution in regards to the bedtime routines. Many people love watching TV or surfing the net and believe that those are good calming practices. Even though it may feel calming to you in the moment, those activities do NOT calm our nervous system. You may fall asleep or doze off, because you are exhausted, but the quality of your sleep is not going to be great.

4.       4. Music and use of voice

a.       Listening to calming music, including but not limited to nature sounds, classical and new age music, tends to trigger the ventral parasympathetic response associated with HEALING mode.

b.      Vocalizing like in singing, screaming, or crying may be very helpful

c.       Playing musical instruments intuitively (not learned piece of music or professional performance) and letting yourself express your current state maybe very helpful.

5.       Connecting with the Divine
     Connecting with the Divine in your life may be very helpful. It does not mean going to church and practicing religion. You could use going to church if it works for you. For many people it does not do it. If you are one of these folks, try one of the following:

a.       Identify your own Higher Power and talk to it in your own voice and your own words. Different people have very different understanding and images of Higher Power. For some it may be the Universal Energy, for others – spirits of the deceased ancestors, yet for others it may be Nature or Community. It does not matter what it is, as long as the image speaks to and resonates with you.

b.      Spend time in Natural spots that you like and watch/admire natural beauty and wildlife

c.       Play with and take care of babies

d.      Play with pets

6.       Being in SELF from IFS perspective
     Being in SELF, as  Internal Family Systems Model defines it, is very healing for our psyches and bodies. There are different ways of getting into that state, which is associated with compassion, curiosity, calmness, clarity, confidence, creativity, courage, and connectedness.
         One way is to spend 10-15 min listening to your parts from the place of compassion. As each part feels acknowledged and understood, ask it to step back. When all activated parts step back, you are left with the Self. Now you can spend some time in that healing place of acceptance and serenity.
     Another way is to use one of the more traditional meditation approaches. Self-compassion meditation or mantra-based meditation with the use of one of the C-words may be very helpful in evoking that state. Of course, as with any other practices, repetition and consistency are the keys to reaching and enjoying the benefits of the HEALING Mode. 

7.       Intimate and safe connection with another person   
         When we look into the loving eyes of another and feel the warmth and tenderness of their touch and their openness to us and our experiences, we are in the healing space. Deliberately focusing on those moments and cherishing them may be very helpful. Whether it is a smile that came from the stranger or a hug from a co-worker or a brief exchange with a family member about your day, be present in that moment and cherish it. Collect those interpersonal moments as opposed to the moments of conflict, disconnect, or misunderstanding that are frequent guests in most of our interpersonal spaces. 

8.       Rest and Relaxation 
     Sleep and rest are very important components of healing. So, instead of freaking out when you slept for 8 or 10 hours, tell yourself that you let your body and mind restore and repair and increased the amount of goodness in the world. If you can let yourself lay around, read, nap with your pet, watch fire in the fireplace or stars in the night sky, DO IT!!! The healing nature of those activities cannot be overestimated.

     Instead of conclusion

      Working with trauma survivors, I am very aware of how difficult it is for many to shift into and be in the HEALING MODE. In the beginning you may be able to tolerate only brief moments of it and only one or two of the aforementioned practices. AND, IT”S OK! As you continue healing, your ability to tolerate the states of calm and relaxation will increase and with it will increase the effects of being in the healing mode. Be gentle and patient with yourself. Be compassionate towards you as you would be towards a baby, who is learning how to crawl. HAPPY SHIFTING!

Practice of gratitude as an antidote to depression and PTSD

     I have heard and read about gratitude and its positive impact on health for years before the first attempt to apply it to my situation. Every spiritual approach and religion out there teaches about importance and helpfulness of gratitude. In the past twenty years or so scientists have been catching up with the idea as well. For example, Robert Emmons, Ph.D. is a director of the lab at UC-Davis that has been studying gratitude and well-being for many years now. In one of the projects they asked people to keep daily journals. One group was asked to record things they are grateful for, another group was asked to write about difficulties and events causing negative feelings, and the third group was asked to write about any of their daily experiences. The study found that those who kept gratitude journals exercised more regularly, reported fewer physical symptoms, felt better about their lives as a whole, and were more optimistic about the upcoming week compared to those who recorded hassles or neutral life events (Emmons & McCullough, 2003). Other studies showed positive effects of gratitude on the functioning of immune system, mood, anxiety, recovery from trauma, relationships, and so forth. 

    Despite all the overwhelming evidence that practicing gratitude may improve both physical and mental health, I never considered applying those findings to myself. When it was first suggested to me to write in a gratitude journal, I thought my therapist was full of shit. REALLY???? Gratitude journal? What the fuck do I have to be grateful for? Nightmares? Panic attacks? Constant problems with my physical health? Immigration issues? Inability to get out of bed, because I am so fatigued and depressed? Struggling with simple things like making meals for my family and cleaning my house? My anger took the best out of me at that point, and I did not follow up on this idea. Just a year later I found myself so depressed that I was willing to try anything. At that point, my therapist suggested gratitude journal again, and I agreed to give it a go.

    The idea was to write down 3-5 things I am grateful for on a daily basis.  My first entries in gratitude journal had 1 or 2 items. Most of them read something along the lines: “I am grateful that this day is over” or “I am thankful I can go to bed now”. I was NOT sarcastic. This is how I really felt. As months went by my entries became more comprehensive and included a number of different appreciations. I became capable of feeling grateful for good night’s sleep and for enough energy to wash dishes and for play time with my daughter. Few months later I graduated to being thankful­­ for my husband’s sense of humor, my daughter’s curious mind, my body’s ability to practice yoga, and for the safety of my neighborhood. What was happening to me? I believe that my ability to notice good things and blessings in life was developing. It has been exercised daily for a while. So, a year after I started this practice I was more capable of paying attention to and focusing on things that were right. And, I discovered through this practice that there was much more right than wrong with my life. I kind of knew it before, but I did not feel or experience it until I put time and effort into the gratitude journal.

     In addition to my sharpened ability to notice good things, I believe that the practice of gratitude led to improved mood, decreased anxiety, and increased sense of well-being. Since my first gratitude journal, I keep coming back to this practice over and over again. I start making entries on the daily basis, when I notice first signs of depression creeping in. Also, I actively use my journal through the holiday season to stay grounded in the hurricaines of commercialism and entitlement that I observe around me. Some entries in my journal are about big things, like my house or peace and safety of my community; others are about small things like playing with my cat or beautiful colors of fall leaves. Sometimes when I had a difficult day, I read through the journal entries in the evening and they remind me of the wider positive context of my life and help me escape the tunnel vision.

     I highly recommend this practice to anyone struggling with depression, anxiety, or PTSD. If you are willing to try, start with a clean notebook and a pen. Write down today’s date and underneath it describe 3-5 different things you are grateful for today. Then repeat the same thing tomorrow, the day after tomorrow, and daily for two weeks. In the end of the two weeks, read through your entries. Notice how they make you feel. Reflect on how this practice affected you (even in tiniest ways) in the past two weeks. If you noticed any positive effects at all, consider continuing with it.

     Helpful tips about gratitude journal:

1. You don’t have to write in it every day to get the benefits. Even writing in it once a week could be very helpful. HOWEVER, consistency and continuity are very important like with any practice. After all, you would not go to the GYM just once and expect that this visit will get you in good shape. Right?
2.  If you feel resistant towards this idea, ask yourself what concerns you. Maybe it seems cheesy to a part of you or maybe it feels like too much work. Maybe a part of you feels hopeless and not willing to try yet another approach only to find it did not help in the end. Acknowledge any and all concerns that you are hearing from different sides of you. Treat those questions and worries as very important. Ask what can help that side feel less worried. And then follow through with that. You may be surprised how easy internal resistances could be resolved once we listen with respect and show desire to work things out.
3.  Make the experience of writing in the journal pleasing for you. Use supplies that you like. Buy a notebook that appeals to you and that you want to use. Be creative with the journal if you feel like it. Doodling, drawing, writing in circles, create collages, using mixed media, or whatever else that appeals to the different sides of you will facilitate this process and make it more interesting.

If you would like to learn more about gratitude’s impact on well-being and different gratitude practices, check out the following resources:

·         http://greatergood.berkeley.edu/topic/gratitude

·         http://emmons.faculty.ucdavis.edu/

·         http://www.gratefulness.org/

Thank you for reading,

Irina Diyankova

When and where will it end?

     I am often asked by my clients whether they “will ever be normal again”. I hear over and over something along the lines of: “Will I ever be able to move on?” or “Will the time come when I am not affected by my past traumas?” or “When will I be healed?” In other words, most clients want to know when will IT be over? People often wish I would say that I have a magic wand that would completely heal them once I wave. They hope that I would at least tell them that they will be completely done after N number of sessions or months or if they work really hard.

     Nobody wants to hear that his or her life was changed FOREVER by the traumatic events that happened to them and that the more events happened or the longer in duration and the higher in intensity they were, the more it affected their bodies and souls. No one is prepared for the idea that there is NO WAY BACK. You are NEVER going to be the same person, ever! It is very hard to swallow. Believe me I know, because I am both in your shoes and the shoes of the mental health professional.

     My conscious healing journey from the traumatic events of my past started in 2005. Even though I struggled with depression and suffered from anxiety for years before that, and I even sought help and benefited from psychotherapy and alternative treatments, it was NOT until I acknowledged to myself that I had been deeply affected and continue to be affected by the traumas of my past that I took the first steps on my path towards healing. I am still on this journey, and I will be for as long as needed if not forever.

 

    Today I look back at the nine years of hard personal work that included consistent psychotherapy, daily self-care practices, countless sessions of acupuncture, massage, energy healing, numerous meditation and healing retreats, and I experience both pride and shock. I wonder how I would have felt on that day in 2005, when I realized how wounded I was by the past and that I cannot continue running away from it, if I knew that nine years later I will still be healing? Would I have taken that first step or would I have decided to keep running away? Was it even a free choice at that point? Maybe I took that step because I reached my personal bottom of sickness and exhaustion? Even though I have all these questions, I know that today I feel HAPPY  taking that step in 2005. I am very glad that I kept taking one more step every day of those nine years. Some of these steps were backwards, others were accompanied by despair, some were taken in anger or rebelliousness, others were more like inch-long baby steps, AND it all is OK.

     There is ONLY one wish I have, when it comes to reflecting on what I could have done differently. I really regret wasting so much of my time, energy, and emotion on the question of whether I will ever be NORMAL. I thought about it, I talked about it, I cried about it, I raged about it, and then I realized IT DID NOT MATTER. What the fuck????  How did I not see it sooner? But that is OK too. I guess it is all a part of a journey.

     So, you might wonder where am I at in the end of my nine-year long healing journey and what do I have to show for it? Here are my thoughts.

• ·    MY JOURNEY IS NOT OVER and IT IS OK with me. I continue to work daily on supporting my traumatized brain and nervous system by meditating, journaling, and practicing yoga. I am religious about my sleep, eating, hydrating, and taking medications and supplements. Sometimes I need more support, when the stress level in my life increases. So, I sleep longer hours, practice reiki daily, do grounding multiple times a day, write in my gratitude journal, take long walks outside, etc. Sometimes I get cocky, because I have been feeling really good for a while. Very quickly my brain and nervous system put me in place by escalating migraines, increased irritability and anger, or intensifying depressive symptoms, and I am back on track. Again, I am focused on one day at a time and one step at a time.
• ·         I HAVE GATHERED A LOT OF “FRUITS” from my endless labor of recovery. I have much more empathy for myself and other people. I enjoy my life much more. I have learned so much about Myself, other people, my two cultures, and the world in general. I would not have done it if my PTSD has not continued to push me. An added benefit in my situation is that I have become such a better therapist as a result of all that personal work. I know how to deal with the flare-ups and can detect them much quicker than before.
• ·         I AM CHANGED FOREVER by what happened to me. Because so many different traumatic events happened over a stretch of twenty years, because some of them happened when I was a child, and because I have been running away from the past for a while, my mind and body are much more sensitive to the daily stressors and much deeper affected by them. I have many more needs than your average Jane or Joe. I need much more support and resources to keep going. I used to agonize over all of it: my “weak constitution”, my “neediness”, lack of normalcy in my life and so on. Here is what I believe today. I NEVER ASKED to be traumatized. WHAT HAPPENED to me was NOT FAIR, and I DID NOT have a choice. Therefore, it is not my fault I have so many needs. HOWEVER, it is MY RESPONSIBILITY to take care of myself and my needs as an adult. I am working hard and doing the best I can to minimize the impact of my condition on those around me. That is all I can really expect of myself.
• ·         THE JOURNEY HAS BEEN DIFFICULT and PAINFUL but LESS AND LESS so, as I kept moving forward. Today I am walking my path with acceptance and curiosity, and it is much nicer to me than in the past, when I was moving along it kicking and screaming and trying to run in the other direction.
• ·         I keep at it NOT because I have to anymore. I continue my journey, because I firmly believe that I DESERVE HEALING and so does everyone else and so does the world. So, every step that I take on my own healing journey makes our world a little brighter and a little more loving and a little more peaceful. I know that if everyone in this world were to do their

  

  own HEALING WORK, we will have no more war and no more violence and no more trauma to pass on to the future generations. I did not have a say in whether I will get to experience violence, HOWEVER, I have a say in whether I am going to perpetrate it and pass it on. And I have been saying “NO!” every day for the past 9 years. So, my HEALING WORK is NOT only my gift to myself, it is my gift to you and to the world.

             As a result, today I am not worried about when and how and whether it is going to end. I hope that this account will help reduce your worry too. I wish you the best on your healing journey. I know you can walk the path and learn to enjoy it too, because I did, many of my clients did, and because there is a lot of support available for this kind of healing today.

 

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Befriending our parts

  In my work with clients I often use a therapy approach called Internal Family Systems (IFS) developed by Dr. Richard Schwartz. This approach postulates that human psyche consists of different parts organized around Self. Each part has its own function in the system. Some parts organize and plan our lives. Other parts respond to emergencies, yet other parts deal with difficult emotions and painful experiences. All of the parts also have a goal of protecting Self from ever being hurt. Self is a center and essence of our psyche. It is our life force, our connection to the Universe. In ideal situation, Self leads our psyche by making important decisions in consultation with our parts (you can read more about IFS here: http://www.selfleadership.org/about-internal-family-systems.html ). However, ideal is not real.

     For folks, who are trauma survivors, Self is often hidden deep inside and one (or several parts in turn) are in charge of behavior, decisions, relational styles, in other words, life.  You might be wondering why this is a problem? When a person gets stuck in one of their parts, they are cut off the resources and experiences contained in other parts and what is even more problematic, they are disconnected from Self, their life force. In these situations one may experience themselves as disconnected, numb, or on contrary completely flooded by certain feeling, such as anxiety or depression. Another example would be shifting back and force between being on top of things, very strict with yourself, busy with multiple responsibilities, not having time for fun and people for weeks or months (managerial part is in charge of life) and then shifting into depressed, almost frozen state, dropping all the responsibilities and staying in bed for days (firefighter part) or shifting from busy mode into being physically sick with multiple pains, fatigue, inflammation, or just infection or cold (firefighter part). When two parts get into opposition with each other, like the one described above, it is called polarization. It is like being on the seesaw, when one part of you cancels activity or decisions made by another part.

     Naturally, we get upset with and critical of ourselves for not being able to change our behavior, thoughts, or feelings. This state of frustration makes the patterns even more engrained. The more frustrated we get, the more stubborn our parts that carry out those unwanted behaviors become. So, is there anything we can do to improve our lives and behaviors? ABSOLUTELY!

     One possible step is scheduling an appointments with an IFS therapist (go here: http://www.selfleadership.org/find-an-ifs-therapist.html  to find an IFS-trained therapist in your area). A professional can help you understand your internal landscape and befriend your different parts, so that they start truly working FOR you and NOT against each other.

     Another step that can be combined with the first one is to get CURIOUS about your internal parts while working on being COMPASSIONATE towards and UNDERSTANDING of them. All of our parts, even most hideous ones, have our best interests in mind and want us to be safe and well. For example, a part that wants to kill you maybe motivated by a desire to soothe your pain and this is the only way it knows of dealing with severe and chronic pain. A part that constantly shames and blames you for every breath or lack thereof may be motivated by a fear of rejection and may want you to be accepted by others.  And again, this may be the only method it is familiar with, because this is how your mother (father, teacher, older sister…) treated you growing up. These parts may also be very young. Almost always they are isolated and alone and do not have support they need to carry out their jobs. Therefore by turning your LOVING ATTENTION towards them you are starting to build relationship of understanding and support with your parts. You might be surprised how much transformation can happen just from taking 5-10 minutes a day to listen to your parts from your caring core. You do not have to agree or disagree, to argue, or evaluate. Just listen and let the part know you understand what it is saying and that it has the right to feel the way it does. No more no less. If you are willing to give it a try, please use the practice described below on a daily basis for the next ten days and see what happens.

     LISTENING TO YOUR INTERNAL PARTS      

1.                Find a quiet safe place, where you can sit without being disturbed for 10-15 minutes. Bring alarm or stopwatch, a sheet of paper or a journal and a pen with you. Put your alarm to signal the end of your meditation (10-15 minutes out)

2.                Find comfortable seated position. Close your eyes and start focusing on your breathing. Just pay attention to how you breathe in and out without any judgment. Now focus on the internal observer, the one, who has been watching your breath. Give that observe qualities of COMPASSION, WISDOM, and CURIOSITY. Breathe those qualities in.

3.                From this compassionate and curious place, invite your internal part that would like to get some of your attention to step forward. You may have a visual image of that part or you may experience it as a sensation in your body, thought in your mind, or a feeling or all of the above. No matter how vague or defined the part is, focus your compassionate and curious attention on it. If you experience any negative feelings towards this part, such as anger, anxiety, impatience, frustration, sadness, etc., ask the part that carries the feeling to step aside for a few moments so that you can focus from the core of compassion and curiosity on the part that asked for attention.

4.                 Let the part that requested your attention know that you are compassionate and curious towards it and see what it would like to share with you. Our parts may share through sensations in our body, visual images, thoughts, or verbal messages (as an internal voice). No matter what mode this part chose, let it know that you hear the message and thank it for sharing. Again, you don’t need to agree or disagree with the part. Just listen and understand.

5.                When the part is done sharing and if there is still time left, invite next part to step forward. And then go through the process of listening to this new part from the compassionate and curious place again.

6.                When your alarm goes off, thank all of the parts that talked to you for sharing. Send appreciation to each and every part of your internal system and your system as a whole.
Now, take 5 minutes or so to record what you heard from different parts of you. 

     There is something very liberating in the practice of listening to the parts. For me personally, once I was able to identify that constant critical voice in my mind as a part of me AS OPPOSED to ALL of me, I very quickly learned to take those messages it with a grain of salt. I understood on a very deep level that those criticisms are just a perspective of a rather young wounded part and NOT true undeniable facts. I have seen many people that I work with benefit greatly from listening to their parts on the regular basis. If you decide to give it a try, please, comment on what your experience with it has been like or message me with questions and concerns.

 

Healing the body

     Throughout my work with the survivors of emotional traumas I have noticed that people, who have survived multiple traumatic events or whose PTSD was chronic, tended to experience multiple physical health problems. Some of the survivors experienced chronic pain that seemed to travel throughout the bodylodging into different parts at different times. Others had autoimmune conditions, such as fibromyalgia, Lupus, Multiple Sclerosis, or chronic fatigue. Yet others had type 2 diabetes or heart diseases. I have always wondered about the connections between emotional impact of trauma and physical symptoms.

     Recent research shed a lot of light into the impact of psychological trauma on the body.  For example, we now know that trauma may lead to the increase in chronic inflammation response (Gill ey al., 2009), which in turn may be connected to the dysregulation in the function of Hypothalamic-Pituitary-Adrenal Axis and excessive amounts of cortisol secreted by the adrenals for long periods of time, when a person experiences flashbacks or being triggered in any other way. Some studies suggest that the more traumas an individual has survived the more his/her physical health will be affected. In other words, multiple traumas have a cumulative effect on physical health. Moreover, the impact of trauma on physical health may be independent of PTSD symptomatology (Sledjeski et al., 2008).

     Connections between specific diseases and disorders and PTSD have been supported by multiple studies. Thus, McFarlane (2010) in the review of this topic discussed connections between post-traumatic stress and chronic fatigue, fibromyalgia, irritable bowel syndrome, hypertension, obesity, and coronary heart disease. Trief et al. (2006), as well as other researchers, connected PTSD to the risk of type 2 diabetes.

     I can continue going on and cite study after study, as well as case after case, showing connections between traumatized psyche and malfunctioning body. But I think I made the case already. SO, I would like to focus on the treatment implications. Given that body is deeply affected by prolonged exposure to traumatic stress, we need to include body in the treatment and healing process. I summarized a number of different suggestions based on my clinical experience and bits and pieces of information from the psychotherapy literature and different seminars I have attended on the topic.

1.      RESTORATION
Early in the process of healing it is important to focus on restoring your body’s immune function, level of energy, and general resilience. This phase may take long time. There is no magic to it. Here are the things that tend to heal your body on a very basic level:

a.       Sleep and rest are the most important gifts  you can give your body (and your mind too). Create a habit of giving yourself AT LEAST 8 hours to sleep at night. In the beginning, you may need more than 8 hours. Some people need 9 or 10 hours every night as they are letting their bodies heal. If you have sleeping issues, address them in your work with your therapist and/or your primary care physician. Your body NEEDS sleep in order to heal. In addition, give yourself 15 to 20 minutes during the day for a nap or just rest. When I was in the phase of actively healing my body and struggling with a lot of fatigue, I used to take 20-30 minutes every lunch break and lay down on my yoga mat on the floor in my office. During this time I dimmed down the lights, put an eye pillow scented with lavender on my eyes and practiced white light meditation. Sometimes I fell asleep, at other times, I did not. But I felt refreshed and a little bit more energized afterwards. Depending on your level of physical depletion, you may need two or more of such breaks during the day.

b.      Stay hydrated. Drink 8 or more glasses of purified drinking water a day. Coke, mountain dew, coffee, and juice DO NOT count. Drink as little of those as possible. If it is difficult for you to drink plain water, squeeze a piece of lemon or grapefruit into the water glass. You may also opt for herbal tea with a tiny (1/2 tea spoon) bit of honey, or make some fruit water or iced green or herbal tea.

c.       Nurture your body with fresh and healthy food. Proper nutrients are essential to healing. There are many books and articles available on the topic. In general, eat three meals a day. Include plenty of fresh vegetables and fruit in your diet. Also, eat foods that are good sources of protein, such as organic eggs, organic chicken, tofu, nuts and seeds. Consult a nutritionist if you have some special concerns or need to modify your diet due to allergies or specific illnesses.

d.      Supplement. Unfortunately, our food sources lack vitamins and microelements, which often results in the need to supplement our diet. Consult a holistic health practitioner, such as an oriental medicine practitioner, an integrative physician, or a chiropractor for help in creating supplementation program that is right for you.

e.       Exercise. Every body NEEDS movement in order to heal and maintain health. Even if you are completely depleted or badly physically injured, you can do chair yoga (https://www.youtube.com/watch?v=Fkl88Nq3BiU ) or restorative yoga (https://www.youtube.com/watch?v=MZn6ZnT_mI8 ). If you can, choose something more active, such as walking, swimming, dancing, lifting weights or any other form of movement that appeals to you. Try a class, such as yoga, tai chi, cycling, Zumba, or anything else that appeals to you. Work on incorporating movement into your life, while accommodating for your current limitations and being gentle with yourself.

f.       Acknowledge and deal with your limitations.  This is very difficult for many trauma survivors that I have worked with. Often chronic trauma comes with either pushing self too hard and creating more physical and psychological damage or wallowing in disease and hardship and not dealing with limitations properly. The idea is to honestly acknowledge your limitations and special needs while finding a way to work with them. For example, if you need a lot of rest in order to function properly, working as a nurse with 12-24 hour shifts is not for you, but it does not mean that you have to stay home on disability. You maybe able to work part-time or volunteer.

2.      SPECIAL CARE
      In addition to the basic restoration regimen discussed above, make your body a special focus for a few months or years. The length of healing depends on how much damage has been done, more specifically how many traumas you survived, how long-stretched traumatic events were, and for how long you have been suffering with PTSD-related symptoms. Most trauma survivors that I encountered needed to do some additional things to help their bodies heal. Some examples of those are discussed below.

a.       Massage. Find an experienced massage therapist and try a couple of massage sessions. I would suggest just general massage focused on stress relief. If you like it, make massage a part of your life. Depending on your finances, get massage once a week or once a month, but do it regularly.

b.      Reiki is a special form of energy therapy. It involves a trained practitioner channeling healing energy through their hands into your body. If nothing else, a reiki session is often very restful and restorative. It can also help alleviate pain, reduce inflammation, and lower stress. There are multiple anecdotal accounts of reiki helping with all kinds of chronic health conditions. Again, try a couple of sessions. See how it feels to you. If it seems helpful, make it a part of your regular life.

c.       Aromatherapy is an approach that uses natural essential oils to heal different body problems or concerns. Multiple books have been written on the topic (for example, see this book http://www.amazon.com/Complete-Book-Essential-Oils-Aromatherapy-ebook/dp/B0090QVWA2/ref=sr_1_2?ie=UTF8&qid=1407364555&sr=8-2&keywords=aromatherapy or a quick guide http://www.amazon.com/Aromatherapy-Quickstudy-Health-Inc-BarCharts/dp/1572229551/ref=sr_1_7?ie=UTF8&qid=1407364555&sr=8-7&keywords=aromatherapy). Aromatherapy can be used in a self-help fashion or you can find a trained practitioner to work with you. I personally like adding 10-15 drops of lavender (for restful sleep and relaxation) or sweet orange (for mood improvement) or peppermint (for pain relief and to reduce inflammation) to a bath and soaking in it for 20 minutes.

d.      Mindfulness meditation is an approach to training your mind to focus on the object of your choice, such as breath. You can use a mindfulness tape, a book, or take a mindfulness class to learn how to meditate. See http://marc.ucla.edu/body.cfm?id=22
for a number of meditation instructions and tapes. According to multiple studies, regular meditation practice was connected improvement in multiple chronic conditions, such as fibromyalgia and other autoimmune conditions, hypertension, diabetes,  heart diseases, and asthma. It improves immune system function and sleep.  

3.      PROFESSIONAL MEDICAL HELP
     Having a primary care physician that knows you and wants to help is a must for a trauma survivor. If your physician is well-informed on the impact of psychological trauma on physical health, it is even better. At the minimum it should be a person, who is willing to listen to and address your concerns. Make sure that you are also current with your physicals and all age-appropriate tests, such as mammograms and colonoscopies. Follow your physician’s recommendations for the treatment and management of your chronic health concerns.

          It is very important for you to understand and remember that as a trauma survivor, your body has special challenges and needs. There is no shame in it. If your doctor is making you feel bad for seeing them too often or for not being able to determine what is contributing to your symptoms, CHANGE your doctor! In this country, there is no lack of primary care physicians. You have the right to heal and to be supported in your healing. It is NOT indulgence, it is a necessity.

4.      PSYCHOTHERAPY with BODY IN MIND
     If  you do not have a psychotherapist yet, please, find one. Dealing with chronic and complex trauma without a good therapist is an extremely challenging enterprise. When searching for a therapist and interviewing potential candidates, ask your therapist if they pay attention to the body in their work with trauma survivors. The idea of including a body in the therapy process is becoming more and more mainstream. A number of therapeutic approaches that include body have been developed for the treatment of trauma, such as Somatosensory psychotherapy, Internal Family Systems, EMDR, Somatic Experiencing and so forth. Even if your therapist has not been trained in any of those approaches, it is important that they pay attention to the bodily sensations during therapy and can help you find healthy ways to regulate your nervous system functioning.

AS A CONCLUSION, your body needs help in healing just as much as your mind does. Focus on it, pay attention to it, love it, and it will pay you back with increased energy, reduced pain, and overall improved health.

Impact of trauma on ourselves and our lives

     When something unimaginable happens, something that should not happen in the context of normal human life as our culture portrays it, such as our parent or other authority abuses us, our child commits suicide, we are attacked at the workplace, we witness a terrorist attack and people dying, we participate in a war, OUR ABILITY TO FUNCTION GETS OVERWHELMED. In those moments as our minds, bodies, and spirits are focused on survival and making it through, our ability to take information in and process is impaired. As a result, we only remember bits and pieces of what happened and the memories are often not flexible – frozen images of horror instead of a coherent story.   

 

     After we physically make it through and the traumatic event is over, we are left with those images of horror and our worldview shattered in pieces. We are supposed to quickly put it together and move on, right? This is what everyone else is telling us. But can we really do it? Would any human in our place be capable of doing it? How do you unsee the face of the attacker or the gun to your head or the agony of someone dying in pain or your parent hitting or raping you or a motionless body of a friend who killed himself? How do you persuade yourself that in spite of what happened yesterday or two month or ten years ago, you are PERFECTLY safe now and it is not going to happen again? How do you go on living when your spirit feels broken, you don’t believe in God or good in this world anymore, and you feel deep despair and depression that weighs so much you cannot move?

     Here is the first fact about trauma: IT CHANGES a SURVIVOR on all levels of his or her being, including physical, mental, sprirtual, energetic, and social. A brief, few minutes-long attack leaves a person shaken to the core, with their adrenals on overdrive, limbic system of their brain hyperactive, neocortex of the brain shut down, belief that a world is generally a safe place gone forever, belief that they are a good person severely damaged, ability to trust others jeopardized, and belief in Higher Power and Important Purpose feeling like a joke. All of those are NORMAL reactions to the ABNORMAL SITUATION. Sometimes people believe that those who are less affected by trauma or not affected at all are stronger and somehow superior. I STRONGLY DISAGREE with that. It is normal to be deeply affected by the horror of abuse, mistreatment, and murder. This is what makes us human!

    

  Unfortunately, there is very little understanding of trauma and its impact on a survivor on a cultural level. So, when a deeply shaken survivor comes back to his/her family, workplace, community, very soon they start experiencing pressure to BE BACK TO NORMAL. People around them find it very difficult to understand why what happened is such a big deal and why they cannot just forget about it.  People just don’t want to relate, because in order to relate, you have to put yourself in the survivors shoes and experience horror through their eyes and to admit to yourself that you could very well be in their shoes right now and it is only by the draw of luck that you are NOT. How terrifying! Who would want to do that?

     From the lack of support and understanding comes the secondary traumatization. It stems from the inability of those around the person, significant others, authority figures, justice system, organizations, and whole communities to adequately and supportively respond to the survivor’s needs. Even worse, at times, a person him or herself maybe blamed for what happened to them, which isolates them even further and makes possibility of recovery even more slim. When a mother says to the daughter that was raped, “it is your fault, you should not have gone to that date” or a wife says to her husband, “What is wrong with you? Why cannot you just forget about that damn war and be here with us?”, the survivor’s guilt and shame increase exponentially and their already impaired ability to trust others becomes further damaged.

     There is a wide spread myth about trauma that time will heal that wound. Nothing can be further away from truth. Here is another fact about trauma: TRAUMA DOES NOT HAVE AN EXPIRATION DATE. In fact, if left untreated, it tends to get worse with the passage of time and accumulation of big and little stresses. It is not unusual for a person to dust themselves off after the traumatic event and to keep moving, only to find themselves struggling to function years later or completely falling apart after some significantly smaller event.

     In order to heal from trauma, which is possible by the way, a survivor has to recognize the impact it had on his or her life and to give the wounds attention they deserve. The longer the person waits to address those issues, the more complex the impact will be and the longer it will take to heal.

         Here is an exercise that you may find helpful in unpacking the impact of your specific traumas on your life.  Journal about the following question on a number  of occasions in the next few weeks. Make sure you: (a) do not spend more than 15 minutes on each journaling session; (b) take very good care of yourself before, during, and after the session; (c) stop right away if you are getting overwhelmed; (d) use relaxing/safe place for a few minutes after each session:

What are your thoughts about the impact trauma(s) had on you? Think about all of the following aspects: (1) your believes about yourself, other people, and  life in general; (2) your moods and emotions; (3) your body; (4) your relationships with higher power; (5) your relationships with other people. 

Please, share your thoughts and comments.