WHAT’S NORMAL ABOUT PTSD?

The thing about PTSD is that it is a normal reaction to trauma. You can actually think of it as a normal reaction to an abnormal event.  So why do we call it a disorder?  .  Although we may be changed by what we’ve been through, we can and usually do get better over time.  While we may never be the same, for many people the symptoms lessen or disappear altogether.

PTSD treatment works. There are different options you can try to treat PTSD.  The thing is, if you don’t get into treatment, your PTSD may get worse.  It’s never too late to get into treatment; the sooner treatment starts, the sooner you can start to feel better!

There are a variety of treatments available for treating PTSD:

  • Talk Therapy involves discussing what you went through with a therapist.
  • With Prolonged Exposure Therapy, you’ll discuss your experience with a therapist who will ask you to review the situation multiple times. Reliving the experience helps reduce the intensity of the memory.
  • Cognitive Processing Therapy helps you change your thoughts about the event which helps change how you feel too.
  • Eye Movement Desensitization and Reprocessing involves having you think about the event while listening to a sound such as a beeping tone, or being exposed to a blinking light. For some reason, this helps your brain reprocess your feelings about the event.
  • Stress Inoculation Training teaches you the skills you need to handle stress.
  • Medications may be used to increase certain chemicals in your brain that help you manage stress.

PTSD is a normal reaction to an abnormally stressful situation.  It is treatable, and treatment can result in reduction or elimination of symptoms.

PTSD AND OLDER ADULTS

(Adapted from VA’s “PTSD: The National Center for PTSD”)

There has been little research done that looks at treatment for PTSD in older adults versus younger people. We do know that PTSD, like many other disorders, can affect older individuals differently than it affects younger adults.

When dealing with trauma-focused treatments, older adults may develop increased anxiety and confusion. As it may be more difficult for older adults to benefit from therapies when confusion is present, presenting materials in a variety of formats and focusing on one topic at a time may be helpful. It may also help to include caregivers in the treatment plan as they often play a critical role by reinforcing information presented in therapy sessions.

Medications used to treat older adults may take longer to work, including those drugs prescribed to treat PTSD. Side effects may be more pronounced in older adults too, so dosages may have to be adjusted over time.   And, because older adults are often taking medications for other disorders, physicians should monitor any confusion to determine whether it is related to drug interactions.

PTSD in older adults may need a bit of a different approach for treatment purposes than is required with younger adults. What limited evidence there is at this time does support that PTSD treatments are effective for older adults.

TRIGGER STACKING

As a dog trainer, I sometimes see things that can be applied to people as well as dogs. Last night I worked with a wonderful little beagle who gets so excited she can barely function.  When she’s worked up, she barks constantly and won’t stop.  It’s very frustrating to the owners, as you can imagine.

When the owners drove up, this dog was in the back of the car, and she was very excited over going for a ride. They took her out and she immediately spotted several other dogs and their owners.  That also excited her.  As there were many other dogs that had been on the grounds that day, she was able to scent them, and that further excited her.  And, finally, when we took her to the exercise pen to stretch her legs, she spotted a fat rabbit nibbling the grass on the far side of the fence.  She immediately went into hound behavior, baying at the rabbit and frantically looking for a way to get under the fence to get it.  She was so excited, it was impossible to calm her down.  She was a victim of trigger stacking.

Each one of those events made her excited and nervous. Added together, they created a situation where she became out of control.  Unfortunately, I did not recognize what was happening until after the fact, but at least I was able to identify what was really going on: she wasn’t a bad little dog, just one that observed everything going on around her and was stimulated by it.  Her response was undesirable: barking, non-stop, but she wasn’t “just misbehaving.”

I think trigger stacking happens to humans quite often, and we also may not recognize what’s happening. We’re driving and someone runs a stop sign in front of us.  It scares us and makes our hearts race.  Then we get home and the kids are running around the yard, screaming as they play.  We go inside and the dog bolts out the door and runs away.  Finally we sit down to relax a few minutes and the neighbor comes over banging on the door with a complaint.  That may be the point where we lose it.  They are little things, but they build on one another until you’re feeling frantic.  It’s a perfect time for your PTSD triggers to go off too.

So, how can we respond to trigger stacking to stop the process? Recognizing what’s happening is the first step.  When you start to feel that first racing of your heart, take a time out.  Slow down and let yourself process what’s happening.  Are you in danger now?  No.  Can you afford to pull over for a few minutes at the local park and let yourself calm down?  If you can, it may break the sequence before it goes further.  At each step, recognize that things may be out of control, but there is no actual danger at the moment.

Staying healthy means recognizing when we have multiple issues that are having a negative impact on us. Don’t let your triggers build up until you go over the edge and lose it entirely.  Stop, evaluate the danger you’re really in, and then go on knowing you are in control.

SLEEPLESS NIGHTS

All of us experience those nights when we can’t sleep. For those of us with PTSD, they may happen more often than is usual.  Last night I was up almost all night.  It’s my own fault.  I didn’t think ahead, and went out with a friend for supper.  I had a large diet Coke with my meal.  Normally, I drink caffeine-free, diet beverages, but this restaurant didn’t offer the caffeine-free variety, so, I took what I could get.  I paid for it too.

I was several hours into the sleeplessness when I realized what I’d done. I quickly got up out of bed and went out of the room to pursue quiet activities until I became sleepy.  After watching a bit of TV and playing some soft music, I returned to bed and fell asleep quickly.  Getting out of bed is one ploy for remedying the situation.  Doing something calming until you become sleepy is another.  Some of the other tips for overcoming sleepless nights include:

  • Keep your bedroom dark, quiet and cool
  • Get regular exercise, and make sure you don’t exercise late in the day
  • No caffeine within six hours of going to bed
  • Establish a routine so you go to bed at the same time every night
  • Avoid taking naps in the middle of the day

Sleepless nights can be frustrating and may leave you feeling like you’re among the living dead the next day. Try to avoid getting caught up in negative thoughts about how your sleepless night will affect you, as it only makes it worse.  Reframe those thoughts by realizing you’ve been here before and you’ve gotten through it successfully…and you will again.  Sweet dreams.

RECONNECTING TO REALITY

Sometimes, with PTSD, we tend to lose ourselves and disconnect from the reality around us. It can be difficult to stop when we find ourselves tumbling down the rabbit hole, but it can be done. One way is to focus in on actual sensations of touch, sound and sights. The PTSD on-line Coach offers suggestions for how to ground yourself and prevent disconnecting from reality.  Some of the simple grounding activities you can try are:

  • Place your feet flat on the floor. Focus all of your attention on your feet and feel the floor underneath them.
  • Walking. Walk slowly while focusing on what it feels like to take each step.
  • Examine an object. Pick up any small object and focus on it. Pay attention to the texture and feel of it.
  • Pet an animal. Use a cat or dog that is quiet and calm. Focus on the sensation of touch, the feel of the fur, the peacefulness of the animal.
  • Feel the earth. Stand with your feet shoulder-width apart. Close your eyes and imagine you’re putting roots down into the earth, making you strong and stable.
  • Ice cube. Hold an ice cube. Focus all your attention on the sensations- cold, wet, tingling.
  • Name what you see. Look around you and name the things you see. Start with large objects and then move on to smaller and smaller ones.
  • Focus on touch. Rub your hands together and clap them. Focus on the feeling, sound and experience.
  • Reorienting. Remind yourself where you are, what the date is, when you were born and what you did yesterday.
  • Call a friend. Discuss some activity you did together recently.
  • Past success. Remember what you did to successfully get past a previous painful experience.
  • Stamping your feet. Feel the force, hear the sounds.

As you can see, these are simple exercises that you can do most anywhere at any time. In all of them, you are focusing on something other than unwanted memories. They are easy to do and can be used successfully to keep yourself grounded and in the moment.

PTSD: GARBAGE IN/GARBAGE OUT

I’ve found, over the years, that it is beneficial for me to monitor what I’m watching on television or at the movies and limit programs that are billed as having a lot of violence in them.  I know the more violent the story, the more likely it is to negatively affect me and trigger my PTSD.  It’s just easier to stop and say, “It’s not worth it!”

Although many people enjoy action-packed dramas, knowing it’s a trigger means that it’s my responsibility to limit what I watch.  I’ve learned that seeing the movie often isn’t worth the trauma that comes after.  I tend to think of this as the “garbage in/garbage out” effect.  If I pour violent visual input into my brain, the output is going to be negative too.  It’s just not worth going through.

I think it’s easy in today’s society to just kind of let things happen, and use the television to anesthetize ourselves. We tend to get lazy in ensuring that what we’re taking in is worthwhile, or at least not toxic.  Television is a great escape, but it comes with a price: if you don’t monitor what you’re watching, you may well find your subjecting yourself to unnecessary content that simply inflames your PTSD.

Don’t allow yourself to become a victim of senseless violence.  Turn off the TV and find something more worthwhile to take in.  Garbage in/garbage out is controllable!

PTSD SUPPORT SYSTEMS

It may seem that it’s easier to keep to yourself when you have PTSD. Your fear prevents you from letting other people get close.  If you let them in, you have to accept that you may hurt them and that they may hurt you.

Living without a support system is like trying to live in a vacuum. We are social animals and we need that interaction with others in order to be healthy.  Unfortunately, when we isolate ourselves, it causes us to give up the very people that can help us heal.

You may say that you have people in your social environment and that it doesn’t help. But it’s not just living with others it’s having meaningful interaction with them too.  That includes talking to them about the things that are going through your head, sharing what’s in your heart, and letting them stand with you when things get tough.  That’s how we relearn trust.

When you are isolated, you let the demons inside your head do the talking and no one is there to challenge them. You chase those demons out by exposing them to the light through sharing them and challenging the things you tell yourself that let them maintain their hold over you.  This is why getting involved in a PTSD Support Group can be so helpful.  You team up with others who have shared in similar experiences and together you rewrite the lessons you learned.

We can’t live and flourish in a vacuum. We need other people in our lives, even when that means we have to trust them to not hurt us…or live with the knowledge that we’ll survive even if they do cause us pain.  Going it alone doesn’t work.  Sharing the burden of PTSD makes it bearable.