Category Archives: ptsd

Brooks on journaling about emotions


Friend Jeff McMullen pointed out a recent David Brooks op ed in the New York Times. (Read it here). While I’m not sure I agree fully with his journaling/not journaling point he says something very important about the timing of writing one’s emotions after a traumatic event. He says,

When people examine themselves from too close, they often end up ruminating or oversimplifying. Rumination is like that middle-of-the-night thinking — when the rest of the world is hidden by darkness and the mind descends into a spiral of endless reaction to itself. People have repetitive thoughts, but don’t take action. Depressed ruminators end up making themselves more depressed.

Then later, this important distinction between immediate processing of emotions and later processing,

We are better self-perceivers if we can create distance and see the general contours of our emergent system selves — rather than trying to unpack constituent parts. This can be done in several ways.

First, you can distance yourself by time. A program called Critical Incident Stress Debriefing had victims of trauma write down their emotions right after the event. (The idea was they shouldn’t bottle up their feelings.) But people who did so suffered more post-traumatic stress and were more depressed in the ensuing weeks. Their intimate reflections impeded healing and froze the pain. But people who write about trauma later on can place a broader perspective on things. Their lives are improved by the exercise.

David points to some research that exists that suggest CISD is unhelpful for some participants. Some are made worse. Yet, narrating one’s trauma in the broader context of a life tend to see a reduction of symptoms. The difference seems to be whether the focus in on life or mostly on the trauma. Trauma in perspective is the goal. Just reviewing trauma may in fact strengthen the traumatic reaction rather than weaken it.

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Military trauma and traumatic brain injury: Challenges and Opportunities


Colleague and veteran Steve Smith has let me know about this web article regarding the state of PTSD/TBI injury among active duty military personnel. The essay points to some very startling numbers:

  • 59% report no improvement or worsened symptoms after undergoing treatment for PTSD and TBI
  • 30% dropped out before treatment was complete
  • A large portion of patients are on up to 10 meds at a time

The news item goes on to summarize presentations made a few days ago at the American Legion symposium on care for TBI and PTSD veterans. What makes this worth reading is that the actual slides from the presentations are provided in links at the end of the piece. I encourage you to go and read up. You can see what is being done using complementary treatments, the numbers of veterans with head injuries (interestingly, 80% are NOT received during combat) and/or PTSD, what services are available and what recommendations are made to DoD and the VA system to improve patient care.

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Does yoga decrease PTSD symptoms?


The lead article in the most recent issue of Journal of Traumatic Stress (27:2, 2014) presents a small randomized control trial pitting yoga interventions (12 sessions) against “assessment control” (i.e. assessment plus no treatment). The authors suggest this is the first randomized control trial for yoga interventions, something needed since there is significant anecdotal and quasi-research evidence that yoga reduces trauma symptoms. It is purported to work for several reasons: improved breath-control, improved mind-body awareness/mindfulness, and improved stress resiliency.

What did they find?

The answer to the title question: yes, but not more than controls. Some improvement is noted in the Yoga intervention group: reduction of re-experiencing symptoms and reduction of hyperarousal symptoms. However, the same reductions are also noted in the assessment control group. You might wonder why. The authors suggest that the control group found benefit in tracking their symptoms each week. Thus, self-monitoring may help improve well-being, especially if the person also is accepting and normalizing symptom expression of PTSD. Thus, both groups may have received the same intervention: self-awareness, self-monitoring, and self-acceptance.

Now, this trial was rather small, just 38 in total. With a larger study, researchers might find more power to their intervention. Why keep trying? Yoga is (a) low-cost, (b) not particularly taxing from an emotional standpoint (thus few drop-outs when compared to something like Prolonged Exposure), and (c) something that helps sufferers stay attuned to their body.

 

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Urban trauma or bad kids?


Psychiatrist Michael Lyles gives an excellent presentation on the nature of urban trauma at the 2014 ABS Community of Practice. He points out how much of what gets labeled as uncaring violence is better seen through the lens of urban trauma reactions. In addition, he discusses the response of the church. Not to be missed!

Michael Lyles – COP 2014 from American Bible Society on Vimeo.

After his presentation, Police chaplain and urban pastor Rev. Luis Centano gave this response regarding trauma in the city of Philadelphia.

Rev. Luis Centeno – COP 2014 from American Bible Society on Vimeo.

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Mapping urban domestic trauma


Our community of practice continues with a presentation by Michael Lyles, MD who presented on the problem of trauma in urban settings. [Watch his talk here] He pointed out how we often think about violence and the connection with trauma in international settings but fail to connect the two in American urban settings. We see angry young men and women who seem calloused and do not value life. Yet, often what is happening is that we have hypervigilant individuals who choose to manage their trauma reactions by being alert and on edge and ready to attack before being attacked. When you bring together poverty, violence and a traumatized population, you develop a chronically traumatized person, meeting most criteria for PTSD but never getting diagnosed.

One study mentioned a few statistics about violence prevalence. 55% of urban children have experienced sexual abuse (compare that to about 15% of US population); 39% have witnessed domestic violence. 27% experienced physical abuse.

To highlight the problem he pointed out a 2o12 Philly Magazine report on trauma in our city. Between 2001 and 2012, more than 18,000 people were shot. During that time some 3800 murders. He noted that suicide rates run about 20% and that number goes even higher when you include “academic suicide”–dropping out of life. In addition, he pointed to the connections between trauma and adrenal overload, hypertension, diabetes, and other physical illness. He also pointed to the scarring that takes place in the amygdala.

He noted a good book to consider: John Rich, MD (Drexel University) Wrong Place, Wrong Time: Trauma and Violence in Lives of Young Black Men.

He ended his presentation considering the role of “Chief Musician” as found in the Psalms. These are folks who listen to the story, don’t debate it, set it to words/music that are appropriate.

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Mapping Global Trauma


This week I am participating in the American Bible Society sponsored Community of Practice for trauma healing interventionists. The audience represents many organizations, Exile International, Wycliffe, SIL, the Seed Company, Food for the Hungry, as well as many bible societies. Attendees come from places such as Sri Lanka, Nigeria, South Sudan, CAR, Rwanda, Uganda plus several more.

Today, we heard from successes and challenges in several specific areas. Then, Dr. Matthew Stanford (Baylor) gave us an overview of trauma around the world. When we look at armed conflict, we see much on the continent of Africa. Natural disasters take even more of the globe. Trafficking, HIV and sexual violence cover the rest. While some 50% of the US population are exposed to traumatic events, only about 8% will meet criteria for PTSD during their lifetime. In other parts of the world, 90% are exposed to trauma and 40% will meet criteria for PTSD during their lifetime. One of the challenges missionary/humanitarian efforts face is learning about the symptoms and impact of trauma on populations. Too often people either neglect trauma or only focus on a few symptoms. We can try to work on one problem (domestic violence) but without addressing the deeper roots of trauma, it is likely not to be very effective.

After Matt, Rebecca Deng spoke of the experience of being a refugee (South Sudan) and coming to the US as a refugee. Some 42 million refugees worldwide. Some 25 million internally displaced (IDPs) on the continent of Africa. She told a bit of her story of loss and struggle even as she came to the US as an unaccompanied youth. She spoke this very important question

You can grow food, purify water, but who can clean the wounds of the heart?

We ended the morning session with a presentation from Bethany Haley of Exile International. Dr. Haley spoke about the impact of trauma on children. (Exile has work in the DRC and Uganda.) She reviewed the many sources of trauma (armed violence, sexual violence, trafficking, child labor, orphans, recruitment into armed gangs) and how it commonly impacts capacity to develop well and learn. We know that trauma changes brain structure and function. She pointed us to the work of Karyn Purvis at Texas Christian University who has done work on the effects of trauma on developing brains. In addition, she pointed us to Unicef materials available to teach about child trafficking around the world.

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Filed under Africa, Post-Traumatic Stress Disorder, Psychology, ptsd, suffering

Free Issue of Journal of Traumatic Stress


As a member of International Society of Traumatic Stress Studies (ISTSS), I am able to offer you a link to a free issue of their journal, Journal of Traumatic Stress.

Click this link for the February issue page with links to download individual articles.  Several essays relate to PTSD treatment for veterans, at least one essay re: child maltreatment in Uganda.

 

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Is PTSD an internal problem causing social problems? Or the other way around?


I am finally getting around to read Ethan Watters’ polemic Crazy Like Us: The Globalization of American Psyche (Free Press, 2010). In this book he details the way America has exported not only its pharmaceuticals but have redefined mental health and disease. As the promotional material on the front cover says, the book “[uncovers] America’s role in homogenizing how the world defines wellness and healing.”

As I read the book, I find he is overly negative and pessimistic, even as he right points out some major bumbling when bringing Western mental health ideas to the world. And yet, consider this…

In chapter two he examines the way Western mental health providers flooded (bad pun but appropriate picture) Sri Lanka after the Tsunami to treat all the PTSD that would most definitely come to light. They “educated” the country about the symptoms of PTSD and trained caregivers and counselors to provide counseling interventions. When certain symptoms weren’t presenting widely, some helpers assumed victims must be living in denial.

Watters describes how one researcher began looking to see how Sri Lankans described symptoms of poor responses to trauma–instead of using a pre-determined set of symptoms. This researcher concluded that Sri Lankans experience trauma quite differently.

1. Sri Lankan PTSD symptoms were primarily physical in nature.

2. Sri Lankans did not identify anxiety, numbing, fear symptoms but rather identified isolation and loss of social connection as key to PTSD symptoms.

The root problem in PTSD? 

So, is PTSD internal or external? Intrapsychic or social? Most Westerners think of psychopathology in terms of the individual. A sick individual will likely find their social lives eroding and less supportive. It appears Sri Lankans think of pathology in terms of social connection which when broken results in some of the physical symptoms. So, does trauma cause psychological damage which in turn harms social networks…or does trauma harm social networks which in turn causes distress?

Your answer to this question likely reveals whether you see the world as a community or a group of individuals.  Or, your answer reveals whether you focus on universal human experiences or constructed human experiences.

One semi-helpful answer

My answer? Our minds, bodies, spirits and social networks are not disconnected. While distinct entities, we are far more connected than disconnected. To paraphrase the bible, if the eye is sick, the whole body is sick. Psychopathology does not reside only in one location, even if we can see it’s impact in one specific location (e.g., cells not functioning). We would not assume that seeing the destruction after a tornado would be all that is needed to find the cause of that same tornado. Whatever interventions we devise, we will not find a one-size-fits-all solution. For some, we will intervene first in the interior of their lives (medications, private counseling). For others, we will start with social reconnection.

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Resilience in the face of trauma: Can it be learned?


The last plenary session at the ISTSS conference today covered the topic of resilience. I’ll give a few highlights of the Charney and Southwick presentation that might be of interest to you along with some of my own thoughts and questions.

The presentation centered on findings from their research regarding factors supporting resilience in POWs during the Vietnam war. Here are some of these factors that support overcoming and growing through traumatic experiences:

  • Optimism. Or, more pointedly, realistic optimism. Charney described it as trait optimism. This kind of optimism is not pollyanna but the combination of realistic assessment plus the faith/belief that one will persevere
  • Cognitive flexibility. The capacity to re-assess the traumatic events  and come to a different meaning. For example, instead of viewing torture as something that can’t be stopped, viewing it as something that makes the person stronger over time. KEY: the ability to reframe failures
  • A strong personal morality maintained.
  • Purpose in life. The researchers noted that those who attended more religious services were more likely to be resilient. They wondered if this was the result of the social support and identity or the sense of being created for a greater purpose. HOWEVER, they also noted that those more likely to believe that the trauma was a direct result of God’s punishment had much lower hope and resilience. 
  • Role models. Resilient individuals have a role models to encourage strength. The POWs often found each other to be a source of inner strength to bear up under torture. 
  • Ability to face fears; acceptance, yet 
  • Active coping responses. Responses such as minimizing memories of trauma, positive focus on personal strengths
  • Attending to physical well-being
  • A strong social network actively sought out. Inter 
  • Experiences of stress inoculation. Having minor to moderate stressors but with the capacity to cope (success with lower stressors)

Is resilience born or learned?

There is some evidence of genetic components. Personality traits seem to play a significant role. In addition, neurochemical processes play a strong role. Fear and reward circuitries in the brain play a significant role. One such neurochemical, Neuropeptide Y seems to be a naturally occurring anti anxiety neurotransmitter. Apparently, there are some promising studies underway using a nasal version of Neuropeptide Y to decrease anxiety in mice. 

However, there is some evidence that cognitive re-framing work in counseling helps improve resilience. In addition, physical activity, better sleep, improved social support, the practice of mindfulness, the presence of a caring adult and reflecting on positive self appraisal can improve resilience. 

So, if you are struggling to cope with recent or historic traumatic experiences, I strongly encourage you to consider not so much what you lost in the trauma but how God has given you power to survive despite the experiences. In addition, accepting the losses experienced during trauma is necessary even as you continue to take note of the gifts God has given you in spite of those losses. And when you can’t do that, get sleep, eat a high protein diet, and exercise. 

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The Mission of Trauma Recovery: Making the Church a Safe Place for Victims


A few months ago I asked readers to give me ideas about how the church could better serve victims of trauma experiencing PTSD and other
related symptoms. I did so as I was thinking about the presentation I would make to conference attendees in Potchefstroom, South Africa on October 18, 2013. So, I post these slides (in advance) for those who can’t join me there or who were there, but want a copy.

The Mission of Trauma Recovery South Africa

Conference link

 

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Filed under Abuse, Africa, christian counseling, Christianity, Christianity: Leaders and Leadership, Post-Traumatic Stress Disorder, ptsd