http://ptsd.about.com/od/glossary/g/hypervigilance.htm

Trauma has occurred when symptoms have developed and have become visible. One type of trauma results from natural disasters such as earthquakes, tornados or hurricanes, forest fires, floods, volcanic eruptions, landslides, or tsunamis. These types of experiences are particularly insidious because they tend to traumatize large populations of people at once, and can result in epidemics of Survivor Guilt along with other PTSD symptoms.

Like many causes of trauma, natural disasters can be sudden and overwhelming. The most immediate and typical reaction to a calamity is shock, which at first manifests as numbness or denial. Quickly—or eventually—shock can give way to an overemotional state that often includes high levels of anxiety, guilt or depression.

If victims have lost their loved ones or their homes, they may feel helpless. This can be exacerbated if they have to live in shelters without support from relatives or friends for extended time periods. However, living with other survivors can be a time to reconnect, talk about the event with others, and help to reframe the event. Being able to help another survivor can reduce helplessness, and may start the healing process.

Natural disasters in particular can bring victims a feeling of being betrayed by “their god,” which can result in a loss of faith.  Making peace with “the divine” might be one step toward healing and gaining faith back.

It’s hard to predict when PTSD will set in with a survivor of a traumatic natural disaster. Some victims seem at first perfectly (or even abnormally) fine, only to be beset with symptoms later on.  Survivors are recommended to seek professional guidance if they find themselves unable to regain control of their lives or if they continue to suffer from PTSD symptoms for more than a month.

Victims do not need to have experienced a disaster firsthand in order to suffer from PTSD. As an example, an emigrant from Haiti living abroad at the time of the recent earthquake could be profoundly affected by the countless hours of television coverage of the disaster, especially if they still had family living in Haiti at the time of the event who they were unable to contact or gain information about.

It’s very important with natural disaster trauma that the victim give himself time to heal and pass through an appropriate mourning process. Only by processing the experience over a realistic period of time is healing possible.

Over the next few months, I’ll touch upon the most common types of trauma and the ones I see most frequently in my practice. You can also read a longer version of this article on Examiner, Psychology Today, and Womens Radio (published 3/3/10).

One unfortunate side effect of a calamity such as the recent earthquake in Haiti is a phenomenon known as Survivor Guilt. Obviously, Survivor Guilt affects those who are fortunate enough to survive a traumatic event such as a natural disaster.

The phenomenon of Survivor Guilt is especially insidious because those who are afflicted with it are under the impression that they have done something wrong, and that their own survival is somehow responsible for the death, injury or trauma of others.

Interestingly, The DSM-IV (The Diagnostic and Statistic Manual of Mental Disorders—the professionals’ guide to mental illness and diagnosis) lists Survivor Guilt as a symptom of Post Traumatic Stress Disorder, and not as a malady in its own right. Like other symptoms of PTSD, Survivor’s Guilt is a distorted reaction to a traumatizing experience.

What Survivor Guilt Looks Like

Survivor Guilt is defined by a pattern of symptoms such as anxiety, depression, social withdrawal, sleep disturbance, nightmares/flashbacks, and emotional lability (instability). As we know, PTSD can also manifest as physical symptoms, which is the body’s way of expressing pent up stress.

Proactive Reactions to Disaster

Those of us who live in earthquake-prone places such as the Bay Area find it easy to feel empathy for those who are suffering in Haiti. After all, it could easily be us. And we can derive lessons from this tragedy.

Dr. Peter Levine, a well-known trauma therapist, offers the following suggestions, which he calls “Emotional First Aid” for trauma. (You can read the expanded version of this list here. http://www.summerjoy.com/September112001/levinepeter.html)

Fortunately, many of these suggestions are inherently practical in the wake of a natural disaster—such as an earthquake—that affects an entire community and displaces people from their homes.

1. Get together with family and friends for support.

2. Organize and meet in community/neighborhood groups.

3. Don’t be isolated.

4. Try to get the information about your loved ones ASAP… without getting hooked on traumatic images on the TV.

5. Refocus on your resources and support systems, and keep your mind occupied.

6. Stay active, volunteer, and help.

7. Encourage people and yourself not to tell their stories in a repetitive way which ultimately deepens the trauma.

Therapy for Survivor Guilt

Once Survivor Guilt has been diagnosed, therapy is of course the most appropriate form of action.

A therapist working with a traumatized victim of a natural disaster will help the patient to formulate alternative and more positive views on the situation and will also help the patient consciously recognize how their own trauma is affecting their behavior. It’s important for the afflicted person to understand that their own actions did not cause or exacerbate the situation, and that they in fact were a victim.

The next and most important step for conquering Survivor Guilt is to pass through an appropriate mourning process. Only then can the patient continue on with their life.

trust

“We’re never so vulnerable than when we trust someone—but paradoxically, if we cannot trust, neither can we find love or joy.” — Walter Anderson

Merriam Webster dictionary defines trust as the “assured reliance on the character, ability, strength, or truth of someone or something” and “one in which confidence is placed.”

But unfortunately, trust can be broken in many ways. We may have been betrayed, mistreated, lied to or hurt by someone such as a partner, family, friend or colleague.

Instead of developing mistrust only for the person who hurt us, we often begin to be suspicious of every person from that point on. Out of protection to avoid getting hurt again, we carry our unpleasant memories of that original person with us and displace the distrust onto other relationships. Sometimes it only takes one person to determine that nobody is in fact trustworthy due to past trauma. In the process, we often lose trust in ourselves—simply because our judgment of the person or circumstance was incorrect—and we then wonder how we can believe our own judgment. As a result, we might close our hearts, repress our emotions, and walk around numb or suspicious in relationships.

The problem is, we need to be able to trust in order allow ourselves to fall in love and to feel loved. Yes, we can live our life by carrying our hurt everywhere we go… but not without consequences. The consequences of not trusting (and therefore not feeling) may hurt others who were not responsible for our pain and may deprive us of feeling loved, and emotional wellness. This eventually leads to loneliness, depression, and relationship difficulties.

The first step to recovering our sense of trust is to learn to trust our own judgment and feelings again. The following is a somatic exercise to learn increase trust in yourself:

• Sit or lie down so that you are comfortable and are in a safe place.
• Now, how can you make it even more comfortable? Get a blanket, a pillow, whatever will make you feel relaxed and content.
• Once you are settled, ask yourself: “How do I know this is comfortable?” This might appear to be a silly question, and perhaps even confusing. However, it is an important one in increasing your skills of building trust.
• Continue to explore what sensation you feel that you recognize as comfort. For example, you might think, “I do not feel any pain,” “I breath easily,” or “I feel relaxed.”

You might be anticipating that this feeling won’t last, which is true. We can’t control or grasp to this pleasurable feeling. It’s only important that you are in the present moment right now, not drifting into thoughts of the future or the past. Thinking of the future can create anxiety; thinking of the past can create depression.

This is an awareness exercise so that you learn to trust what you are feeling right now. Remain aware of any sounds, the temperature, the light, and your physical sensations. Can you let yourself simply enjoy the moment?

You can practice this exercise for as long as you prefer and as time allows you. Just keep checking in with your level of comfort. What feelings indicate that you are comfortable? With time, you may start to trust your feelings again.

When you start to say to yourself; “I trust myself,” you begin to restore faith in your judgment of others and situations, and as a result, you open your heart to love, joy and feeling safe again.

Chronic pain is defined as prolonged physical pain that lasts for longer than the natural healing process should allow. This pain might stem from injuries, inflammation, or neuralgias and neuropathies (disorders of the nerves), but some people suffer in the absence of any of these conditions. Chronic pain can debilitate one’s ability to move with ease, may hinder their normal functioning, and the search for relief can lead to pain medication addictions, which compound the problem. Chronic pain is also often accompanied by feelings of hopelessness, depression and anxiety.

Many people are already familiar with the fact that emotional stress can lead to stomachaches, irritable bowel syndrome and headaches, but might not know that it can also cause other physical complaints and even chronic pain. One logical reason for this: studies have found that the more anxious and stressed people are, the more tense and constricted their muscles are, over time causing the muscles to become fatigued and inefficient. More subtly, one might develop psychosomatic symptoms or stress-related symptoms because of unresolved emotional issues. These are not new discoveries; researchers have studied the mind/body interrelationship for several decades because of the importance of this link.

Experts have noticed that experiencing a traumatic event can have an impact on the development of pain. In fact, approximately 15-30% of patients with chronic pain also have PTSD. Peter Levine, an expert on trauma, explains that trauma happens “when our ability to respond to a perceived threat is in some way overwhelming.” Most researchers disagree on a precise definition of trauma, but do agree that a typical trauma response might include physiological and psychological symptoms such as numbing, hyperarousal, hypervigilance, nightmares, flashbacks, helplessness, and avoidance behavior.

During a traumatic event, the nervous system goes into survival mode (the sympathetic nervous system) and sometimes has difficulty reverting back into its normal, relaxed mode again (the parasympathetic nervous system). If the nervous system stays in survival mode, stress hormones such as cortisol are constantly released, causing an increase in blood pressure and blood sugar, which can in turn reduce the immune system’s ability to heal. Physical symptoms start to manifest when the body is in constant distress.

If someone has experienced a trauma prior to their current injury or trauma, old memories can potentially be triggered, exacerbating the effects of the newer trauma. Dr. Bessel van der Kolk, a well-known trauma researcher, explains; “Research has shown that, under ordinary conditions, many traumatized people, including rape victims, battered women and abused children, have a fairly good psychosocial adjustment. However, they do not respond to stress the way other people do. Under pressure, they may feel (or act) as if they were traumatized all over again.”

Often, physical pain functions to warn a person that there is still emotional work to be done, and it can also be a sign of unresolved trauma in the nervous system. Even if one has grieved and processed the emotional impact of a trauma, the nervous system might still unwittingly be in survival mode.

Maggie Phillips, author of Reversing Chronic Pain, writes: “Whether or not trauma was connected to the event or condition that originated their pain, having a chronic pain condition is traumatizing in and of itself.”

Since trauma has been found to have a strong correlation to chronic pain, a combination of psychotherapy and physical therapy would be the most logical pain management option for stress and chronic pain relief. Maggie Phillips states that imagery is a more effective intervention than verbal therapy, because trauma tends to impair the language and the mind’s organizational capacities. Psychotherapy that uses imagery, addresses the nervous system, and facilitates cognitive behavioral therapy is recommended.

To tackle the physical aspect of chronic pain, Mindy Marantz, director of the Healthwell clinic in San Francisco, suggests focusing on alignment in the body, as well as posture that supports organized alignment. Additionally, she advises to address potential inflammation, and provides strategies to help calm the nervous system such as Craniosacral therapy or Feldenkrais Movement Re-education. “These both will help ‘stoke’ the lymphatic system, which in turn helps diminish the effects of fluids that pool as a result of injury. Lymphatic massage as well as compression wraps and education help bring this often overlooked pathway to recovery to patients’ attention.”

Beginning a daily program of walking can help to mobilize the muscles and is the best way to stimulate the lymph system to do its job and oxygenate injured muscles. The International Association for the Study of Pain concluded that acupuncture is also effective in long term chronic pain reductions related to musculoskeletal pain.

PTSD and chronic pain are often connected, and both must be addressed in order to help a person be fully functional again. Although one might not be aware of the lingering effect of the trauma, or believe that the traumatic event has been put behind them, the body could be clinging to unresolved issues. Relevant psychotherapy can help to resolve the physical problems.

What does psychological stress do to you physically?

Studies have shown that chronic pain might not only be caused by physical injury but also by stress and emotional issues. The more anxious and stressed you are, the more tense and constricted your muscles can become. As a result, they may fatigue and be inefficient over time. For that reason, just stretching or massaging your muscles may not accomplish the goal of being active without underlying muscle tension….treating the whole person is important.

Peter Levine explains: “The rain of pain is mainly in your brain.”

Many people are already familiar that emotional stress can lead to stomachaches, irritable bowel syndrome, and headaches but might not know that it can produce other physical complaints and chronic pain. However, these are not new discoveries; researchers have studied the mind body interrelationship for several decades because they saw the importance of this link.
One might also develop psychosomatic symptoms or stress-related symptoms because of unresolved emotional issues that they have not dealt with and which are causing physiological as well as mental health issues.

Unresolved memories might hinder the healing of physical injuries or medical procedures as well. Additionally, stress hormones such as cortisol increase your blood pressure and blood sugar which can reduce your immune system’s ability to heal. For example, one woman, who already felt emotionally stressed due to a break-up with her boyfriend, found that when she had a car accident she could not find relief from her pain until she dealt with her emotional loss as well.

Often, pain has the function of warning a person that there is still something to work on. It can point to a need for emotional healing.

When your body is in pain and you are not healing the way you should, there might be emotional issues, waiting to be resolved.

Therefore, a combination of psychotherapy and physical therapy might be the best pain management option to reduce stress and recover from your chronic pain when nothing has worked so far.

Please, read the following interview with Mindy Marantz:

Mindy Marantz is the director and clinician at the Healthwell Physical Therapy Group in San Francisco and is currently active in the National Pain Foundation.

Dr. Babbel:
Mindy, your clinic has been very successful addressing chronic pain when people thought there was no way out. What have you noticed that makes it easier or more difficult for people to recover?

Mindy Marantz:
First of all, when an individual picks up the phone to call for help, recovery has begun. Our initial job at Healthwell, as I see it, is to help guide the individual through the biomechanical mechanisms which help the body heal. This is relatively easy. We help focus on alignment and the postural attitudes that support organized alignment. This can very quickly reduce pain intensity.

We also address inflammation, and we immediately provide strategies to help calm the nervous system, like Craniosacral therapy or Feldenkrais Movement Re-education.

These both will also help “stoke” the lymphatic system, which in turn helps diminish the effects of fluids that pool as a result of injury. We use lymphatic massage as well as compression wraps and education to help bring this often overlooked pathway to recovery to our patients’ attention.

Beginning a daily program of walking and helping to mobilize the muscles is the best way to stimulate the lymphatics to do their job and oxygenate injured muscles!

Finally, we help our patients reflect on their lifestyle, and the things that contribute to their wellness, and those habits which will tend to slow their recovery.

Our care is about them, carving out a time frame to focus on their well-being and health. This is the realm where recovery occurs best. Optimally, a patient will be fortunate enough to find concomitant care by a somatic psychologist to help dissipate the deeper impact of trauma, which is why our clinic often works with Dr. Babbel.

Please e-mail or call Dr. Babbel at Susanne@bodyconversations for a FREE handout on “Specific Techniques and Resources to Help you Ease your Pain.” This handout was prepared in collaboration with Mindy Marantz.

If you have further questions for Mindy Marantz please visit her website www.healthwellpt.com

Find out if you might have acute stress symptoms and what to do about it.

Definition of acute stress disorder:

Acute Stress Disorder (ACD) describes a response to a life threatening or terrifying event occurring within one month of the stressor. If ACD is not addressed it might turn into Post Traumatic Stress Symptoms.

“Most Americans will be involved in a traffic accident at some point in their lives, and 25% of the population will be involved in accidents resulting in serious injuries. The National Comorbidity Survey of 1995 found that 9% of survivors of serious motor vehicle accidents developed ASD or PTSD.”

Symptoms:

Flashbacks of car accident several times a day
Difficulty sleeping/Nightmares
Problems concentrating
Anxiety and depression
Over emotional: easily irritated, sudden sadness,
Avoiding scene of accident, people, places, and conversations
Hyppervigilant-constantly over-reacting to traffic sounds with startle response
Feeling numb or frozen-inability to perform daily tasks
Daydreaming

Factors influencing development of symptoms:

Age
Former Trauma Experiences
Internal and External Resources:
Vulnerability, Support of Family and Friends

Treatments:

A combination of physical and psychological treatment such as physical therapy, acupuncture, message, chiropractic care, and psychotherapy is suggested.

trapped

Many people wonder, “Why don’t kidnapping victims like Jacee Dugard try to escape when they have the chance? Why do they bond with their perpetrator?” Research shows that these behavioral patterns are typically experienced by sexually assaulted people; abuse, domestic violence, and incest victims; cult members; and those who survive kidnapping and hostage situations.

We have to step away from what we think is logical and discover how trauma affects people’s physical and mental health.

Additionally, we need to consider that trauma has a greater impact on children than on adults because they are mentally, physically, and emotionally more vulnerable. The underlying cause of many survivors’ behaviors might be physiological and psychological trauma reactions such as escape paralysis, which is created by a combination of nervous system responses, conditioning, dependency, and a phenomenon called trauma bonding.

During a traumatic event, such as abuse, assault, or kidnapping, our logic is turned off and our nervous system automatically goes into a survival-mode (“fight, flight, freeze”) response. If we cannot run away or are unable to fight, we go into a freeze state, unable to move or act.

Peter Levine, a psycho-physiological trauma specialist, explains that this is a leftover state from our animal instinct in which animals pretend they are dead so the perpetrator will lose interest. Additionally, when physical and psychological pain becomes too much to tolerate, the mind distances itself from the experience by numbing the body and the psyche, which is called dissociation. Feelings, emotions, thoughts, and memories are shut off, causing one to lose touch with reality and feel detached or estranged from others. Unfortunately, we cannot override our nervous system by logic alone; it will likely remain stuck in the survival loop of freeze and dissociation unless the nervous system has been regulated and the psychological and physical wounds are healed.

Van der Kolk, a trauma researcher, says, “Trauma interferes with the ability to meet daily needs and perform the most basic task.”  Therefore, it will be difficult for anyone to perform basic undertakings or think of taking actions to escape or change a situation when one is faced with such traumatic experiences.

Part of feeling paralyzed and avoiding escape may also occur if the perpetrator instills emotional and physical conditioning in the victim, such as fear, threat, or pain. With enough repetition, the brain circuitry becomes conditioned to make certain associations, known as Hebbian learning (“cells that fire together wire together”), so that a person may feel too paralyzed to escape, avoid certain behavior, and distrust his/her own judgment. This condition has been known to continue internally in the victim even when the abusive situation is over.

When a victim is dependent for food, shelter, and human interaction, the victim’s escape paralyses might deepen even further. Often, a captor uses a formula to deprive his/her victim of what they need to function (such as safety, sleep, and food) and punishes them with threat, pain, and isolation to create dependency. However, as humans, we tend to stay away from isolation and strive to have human contact. When the caregiver is the perpetrator and the only person with whom to attach, the victim will depend on the bond for survival and become anxiously obedient. This emotional attachment lessens the fear of survival because, if the victim bonds, historical data show that she/he is less likely to be killed. Bonding with tormentors is also known as the Stockholm Syndrome, a term that describes victims who attach to their captors and develop loyalty towards them as a way to adapt to the exploitative person/situation.

There are many people who are unable to leave their tormentors as a result of escape paralysis. This behavior might be created by a combination of survival mechanisms including trauma responses, victims’ conditioning, dependency, and trauma bonding. The good news is that there is hope for survivors. It is not a quick process but, with resources such as support and understanding of family, friends, and community, as well as therapy that addresses the nervous system and the psyche, healing can happen.