To Heal Trauma Work with the body, not just the mind!

What do you know about trauma? You probably know that when bad things happen some people get stuck there and some people don’t. You also probably know the symptoms like nightmares, feeling on edge, flashbacks, keeping others at a distance or not trusting, never being able to fully relax… we could write a book on the symptoms alone (and people have!).

I’m sure some of you have heard people say that those who get stuck are weak.

They are completely wrong.

What if I told you that we could do therapy for years, talk all day, and if we don’t address your BODY not much will happen for you?

Now that I have your attention, let me tell you why.

When something traumatic happens, the brain functions differently. Under normal circumstances, the brain encodes whatever it needs to encode, sends it down the pathway, it is processed, stored or disposed of, and life goes on, memories intact. This is a completely different process under stress.

Our bodies communicate consistently all day long with all kinds of electrical and chemical impulses. These impulses tell our brain and body what to do. “Process this, dump that, pay attention here, this doesn’t need your attention….” Under normal circumstances, the only messages are the ones that need attention- you are fully present, encoding the information, and it’s not a big deal. Under stress, all of this goes haywire.

Any time that we process information we form explicit memories and implicit memories. Explicit memories are the factual information, general knowledge, and autobiographical information. Implicit memories are the emotional responses and body sensations- this part doesn’t have to do with fact, but feeling. These two types of memories travel in different pathways in the brain and have to be integrated later to form one unified memory.

In a traumatic situation your “fight or flight” response gets triggered. Your body senses danger and sends out red alert signals in the form of hormones. Your bloodstream is swimming with chemical messengers that tell you to “GET OUT NOW!” The primary goal under these circumstances isn’t encoding the memory, but getting you to safety. This is the reason that so many trauma victims have gaps in memory: the attention was focused on getting the body to safety. The symptoms of Post Traumatic Stress, and often anxiety itself, are the same signals that the body sends when you are in danger: your heart beats fast and your breathing races to get oxygen to the muscles to run, your body shuts down extra impulses like hunger and needing to use the restroom, your palms sweat, adrenaline fuels your energy so that you can get out- sound familiar? These are normal responses to stress in the short term. The problem is when you get stuck.

When you get stuck, your Amygdala- the primary culprit in the fight or flight response- gets really really sensitive. If you’ve ever seen a deer in the wild, you’ve seen the Amygdala at work. This part of your brain screams GET OUT when It feels that you are in danger. Your brain stops processing and focuses all of its energy on getting you away from danger. The memory doesn’t get fully processed and is fragmented in the brain in chunks of implicit and explicit memories. This is why sometimes a smell, the way a person touches you, or even tone of voice can trigger a trauma victim.

Here’s the problem (and this is important): your body cannot tell the difference between physical and emotional danger. This is the reason that you have this fight or flight response to stimuli, whether it is emotional or physical. Your brain, the very primal part of your brain involved here, thinks that you are in physical danger, which is why you have the physical symptoms.

We need to address the physical in order to solve the problem. So the issue is twofold: we need to bring the body’s response down, calm down the hormonal messengers who are telling you that you are in danger and then we can work on the mental and emotional aspects. Otherwise, we are setting you up for failure.

So, the next time that you are struggling with healing from your trauma, remind yourself that your body is doing exactly what it is supposed to do. It is protecting you. You just need a little work on recalibrating the alarm system. 

A good professional counselor can explain this to you, help you understand, and walk you through helping your body understand that you are no longer in danger. Working together, we can process the trauma so that it is a part of your story and not something that needs avoiding. We just need to work with your body a little.

In the meantime, consider starting the work yourself. The term we use for being present In our bodies is “mindfulness.” You can always google that term and find several coping mechanisms that may work for you. There are also several ways that you can start to bring your body down. Diaphragmatic breathing techniques are wonderful for this because they signal to your body (and brain) that you’re not actually in danger. There are also several meditation apps on smartphones that help guide you through how to do this. Two favorites are “Calm” and “Stop, Breathe, Think.” It may take a moment to explore different techniques until you find one that works for you.

And if you’re not buying into this whole mind-body connection thing just yet, stay tuned. I’ll be addressing this soon in another blog!

Anxiety: The Perpetual Game of Mental Whac-A-Mole

Regardless of the type of anxiety you experience, you know it feels exhausting. This is for a couple of reasons. First, anxiety wears us out because it’s characterized by sympathetic nervous system arousal. This autonomic arousal, known as the “stress response” or the “fight or flight response,” is responsible for about 1,400 biochemical and psychophysiological changes in the body that make us feel tense, vigilant, nervous, and ready to act. While this can be helpful for short periods of time, such as when we swerve to avoid having a car accident, or when we can benefit from an extra boost of energy before an athletic competition, it can be unhelpful if we stay in this state too long or at the wrong time (such as when you’re trying to fall asleep at night). Unfortunately, it can be difficult to control when we feel anxious, and to what extent, and the result for some people is that they feel anxious or worried all the time.

Second, anxiety is exhausting because of how it impacts our thoughts. Anxiety tells us that there is always something that needs attention, or needs worried about, and it won’t let us relax until we’ve addressed all of those worrisome thoughts. But here’s the problem: It often feels as though you can never quite squash all of the thoughts you believe to be the cause of anxiety. This, too, contributes to a constant state of anxiety.

For people suffering from anxiety, worrisome thoughts seem to function like a never-ending game of Whac-A-Mole, the popular children’s arcade game where you hit plastic moles that keep popping up with a padded mallet. But unlike Whac-A-Mole, there is no end to the anxious thoughts that pop up. People suffering from this unending game of mental Whac-A-Mole can become very good at squashing each worry, one after another. However, while they become skilled at talking themselves out of believing each anxious thought, there is always another worry waiting to “pop up.” After a while squashing these anxious thoughts becomes exhausting, and ultimately it just doesn’t work.  

So what does work? To address mental Whac-A-Mole consider working on reducing the high stress response underlying the thoughts. While this may not be sufficient for stopping the Whac-A-Mole completely, it is often necessary, as it is frequently the case that underlying autonomic arousal fuels anxious thoughts. What happens is the nervous energy, which we can feel in our body, is picked up by our thoughts, which then try to make sense out of the anxiety. It does this by creating thoughts consistent with those anxious feelings. Thus, the problem is not always the anxious thoughts, rather, a big part of the problem can be the underlying arousal and anxious sensations. If you can tackle the stress response and the related physical and emotional reactions, it can be a major step toward managing anxious thoughts as well. Here are some techniques that can reduce a high stress response:

If your anxiety feels overwhelming or difficult to manage, consider seeking mental healthservices, as professional treatment for anxiety can be very effective for many people!

 

Originally published at: https://www.psychologytoday.com/blog/workings-well-being/201703/anxiety-the-perpetual-game-mental-whac-mole

My Therapist Keeps Telling Me To Breathe…. Why?

If you’re like a lot of people who’ve been to therapy, you’ve probably heard your therapist tell you to breathe. The recommendation might have been in passing, or perhaps they even taught you some specific diaphragmatic breathing exercises to practice at home. Either way, you may have asked yourself why this seems to be a thing. Why emphasize something you’re already doing? I’m breathing right now, and I bet you are too. I breathed yesterday, and the day before that, and I’ll breathe every day from now until I die.

When I’ve brought up breathing to clients, I’ve seen the initial, “I’m paying you for this?” look more than once. But breathing the right way is really good for you and might just help you reduce some of the symptoms that brought you to therapy in the first place. Let me explain.

Take Home Point 1: Normal breathing and diaphragmatic breathing are NOT the same thing.

This is critical to understand. Diaphragmatic breathing is when you fill your whole diaphragm with air, breathing fully in, and fully out. This is different from what most of our breathing tends to look like day to day, which is usually “chest breathing.” Chest breathing is faster and much more shallow, and does not utilize our entire diaphragm. Chest breathing can be associated with a heightened stress response, increased toxins in the body, and less oxygen in the brain, and is usually not very healthy. However, it’s what we’re all used to, and to create more healthy breathing habits takes training.

Take Home Point 2: In order to reduce your anxiety you must breathe through the diaphragm. All other breathing is pointless (other than it keeps you alive).

The error a lot of people make when practicing breathing exercises is that they don’t actually breathe through the diaphragm. Maybe it’s because they don’t know how to, or perhaps they erroneously think they are (but actually aren’t). For most people, there seems to be a lack of understanding regarding how important this actually is, so I want to emphasize this. If you are not breathing through your diaphragm during a mindful breathing exercise, you’re wasting your time.

Take Home Point 3: Breathing through the diaphragm activates the vagus nerve; vagus nerve activation is what reduces your anxiety.

When you breathe through your diaphragm, something amazing happens: You activate your vagus nerve, which tells your brain to stop producing anxious feelings and start relaxing. Here’s a depiction of the vagus nerve – it’s the bright yellow band running from the brain to the organs.

 

So here’s what happens when you breathe through the diaphragm:

1.     You inhale fully, expanding your diaphragm.

2.     As your diaphragm fills with air, the diaphragmatic wall pushes downward, like a balloon that is filling up.

3.     When the diaphragmatic wall drops, it begins to squish your internal organs a liitle bit.

4.     Wrapped around your internal organs is the vagus nerve, so as the organs are getting slightly compressed, so is the vagus nerve.

5.     When the vagus nerve is pressed, such as when you breathe through your diaphragm, it activates!

6.     After activating, the vagus nerve sends a signal upward, through the spine to the brain, telling the brain to stop the stress response and activate the relaxation response.

7.     The brain can then reduce the stress response and everything associated with it (fast heart rate, that nervous jittery/buzzing sensation, foggy thinking) and replace it with the relaxation response!

This whole process takes about 45 seconds. That’s right – we can literally calm down and reclaim a sense of control over our emotions, thanks to how our bodies are naturally built, in less than a minute. Amazing, right? So, the next time you’re told to breathe, consider trying it, but make sure you’re breathing through the diaphragm!

If you aren’t sure whether what you’re doing is diaphragmatic breathing, and want to ensure you’re breathing optimally, click HERE to request my free mini-guide, “Diaphragmatic Breathing 101: Five Ways To Breathe Well.” It contains five breathing strategies that take the guesswork out of diaphragmatic breathing.

Here’s Your Brain on Trauma

Approximately 50% of the population will experience a traumatic event at some point in their lives. While reactions to trauma can vary widely, and not everyone will develop Post Traumatic Stress Disorder (PTSD), trauma can change the brain in some predictable ways that can be useful to be aware of if you are struggling to cope after trauma. With an increased awareness of what is going on in your brain, you can seek treatment to address your symptoms and learn skills that will actually rewire your brain for recovery! Additionally, knowing what’s going on can be immensely helpful because you may realize that you’re not crazy, irreversibly damaged, or a bad person. Instead, think of a traumatized brain as one that functions differently as a result of traumatic events. Just as your brain changed in response to your past experiences with the world, it can change in response to your future experiences as well. In other words, the brain is “plastic,” and you can change it!

Three brain areas to know:

Trauma can alter brain functioning in many ways, but three of the most important changes seem to occur in the following areas:

1.     The prefrontal cortex (PFC), called the “Thinking Center”

2.     The anterior cingulate cortex (ACC), called the “Emotion Regulation Center,” and

3.     The amygdala, called the “Fear Center”

A visual depiction of these three areas appears below.

 

As you can see, the Thinking Center (PFC) of the brain is located near the top of your head, behind your forehead. The Thinking Center is responsible for many abilities that we possess, including rational thought, problem-solving, personality, planning, empathy, and awareness of ourselves and others. When this area of the brain is strong we are able to think clearly, make good decisions, and be aware of ourselves and others.

The second region, the Emotion Regulation Center, is located next to the Thinking Center, but is deeper inside your brain. This area is responsible (in part) for regulating emotion, and (ideally) has a close working relationship with the Thinking Brain. When this region of the brain is strong, we are able to manage difficult thoughts and emotions without being totally overwhelmed by them. While we might want to send that snarky email back to a coworker, the Emotion Regulation Center reminds us that this is not a good idea, and helps us manage our emotions so that we don’t do things we regret!

The last area listed is the amygdala, which is a tiny brain structure deep inside our brain. This subcortical area, which is outside of conscious awareness or control, serves as the Fear Center of the brain. Specifically, its primary job is to receive all information – everything you see, hear, touch, smell, and taste – and answer one question: “Is this a threat?” The main purpose of the Fear Center is to detect danger and threat and, if present, produce fear in us. When this area is activated, we feel afraid, reactive, and vigilant.

So what’s going on in a traumatized brain?

Traumatized brains look different from non-traumatized brains in three predictable ways:

1.     The Thinking Center of the brain is underactivated,

2.     The Emotion Regulation Center of the brain is underactivated, and

3.     The Fear Center of the brain is overactivated.

Here’s what it looks like:

 

What this shows is that oftentimes, a traumatized brain is bottom-heavy, meaning that activation of lower, more primitive areas of the brain (called subcortical areas) are HIGH, including the Fear Center, while the higher areas of the brain (called cortical areas) are underactivated.

In English, what this means is that if you are traumatized, you may experience chronic stress, vigilance, fear, and irritation. You may also have a hard time feeling safe, calming down, and sleeping. These symptoms are the result of a hyperactive Fear Center.

At the same time, individuals who are traumatized may notice difficulties with concentration and attention, and often report they can’t think clearly. This, not surprisingly, is due to the Thinking Center being underactivated.

Finally, survivors of trauma will sometimes complain that they feel incapable of managing their emotions. For example, if someone spooks them, they may experience a rapid heart rate long after the joke is up, or may have a hard time “just letting go” of minor annoyances. Even when they want to calm down and feel better, they just can’t. This is in large part due to a weak Emotion Regulation Center.

What can you start doing now?

Changing the brain takes effort, repetition, and time. The best gift you can give yourself, if you’re serious about rewiring your brain for health, is psychotherapy. If you’re ready to start that journey, look for a psychologist who specializes in trauma and PTSD, and who uses evidence-based methods that change the brain by working with both the body and the mind.

Also, consider adding a body-based or mindfulness-based technique to your daily routine, in order to begin de-activating the Fear Center. This is a fantastic first step to healing, as when we are able to quiet the Fear Center, we are better able to work on strengthening and activating the Thinking Center and Emotion Regulation Center. Two Fear Center de-activating exercises include diaphragmatic breathing and autogenic training, and you can access free, guided practices of these techniques here. The recommendation is to practice these techniques, or similar ones, for short periods of time multiple times per day. Remember, practice makes progress!

Bringing Gaslighting to Light, Part IV

Once you understand and can recognize the warning signs and negative effects of gaslighting, you can easily disentangle yourself from it, right?

Not usually. While increased awareness is necessary to address gaslighting, it is not sufficient. It can take a large amount of effort to change the dynamics of gaslighting relationships, and it is very difficult to do this alone. Because of this, gaslightees commonly feel alone and helpless to change their situation. However, it is possible to free yourself from gaslighting to live a full, meaningful life with healthy relationships. While each person’s journey is different, there are three steps of recovery that can help you empower yourself and reclaim your life.

Step I: Get a Reality Check

There is an old saying in psychology: “What you monitor, you manage.” In order to change a gaslighting dynamic, you have to first know it is happening. But this awareness can be a huge challenge, as gaslightees have been trained over time to blame themselves and distrust their own judgment and experiences. In other words, these individuals may begin gaslighting themselves. This further obscures reality for the person, as they are not only used to being invalidated by others, but also by themselves.

Gaslightees often need a reality check, and one of the best ways to get one is to ask for a third party perspective. Remember, though, that one of the warning signs of gaslighting is that the gaslightee hides or lies about the gaslighter’s behavior. When this occurs it makes it impossible to get the needed reality check to see what is happening in the relationship. Thus, the first step to addressing gaslighting for many clients is to identify a safe and non-threatening third party, and to disclose information about the relationship to them.

This third party may be a friend or family member but if this is not possible, or you are not comfortable with this, consider seeing a psychologist. The benefit of seeing a psychologist in this situation is that they cannot, by law, share any personal information about you with others. Also, psychologists are extensively trained to help clients manage unhealthy relationships, as well as the negative outcomes of those relationships (such as anxiety, depression, or PTSD). It is frequently the case that when gaslightees have the opportunity to talk about their relationship with a neutral third party, they become better at recognizing instances of gaslighting. Moreover, once clients open up to a therapist about their experiences with gaslighting, it becomes more likely that they will seek out other supportive and healthy individuals with whom they can share their experiences.

Once an individual becomes skilled at identifying examples of gaslighting, they can begin to recognize the impact these events have on their health, emotions, thoughts, and behavior. A structured way to do this is to log every gaslighting occasion. Along with a description of the event or statement, clients note how they reacted to it when it took place, including how they felt, thoughts they experienced, and resulting behaviors. Examples of reactions may include, “I felt depressed,” “I cancelled the dinner with my friends,” “I told myself that I am worthless,” “I felt sick to my stomach,” etc.

When people are able to recognize not only when gaslighting takes place, but also the impact it has, they greatly increase self-awareness and begin to reconnect with themselves. Additionally, acknowledging the harmful effects of gaslighting can motivate individuals to want to take action against the gaslighting occurring in their lives.

Step II: Begin to Take Back Your Power

Once you are able to recognize gaslighting, it is time to explore your role in this dynamic and make some changes. Acknowledging your role does not mean you are to blame for the gaslighting, or that anyone ever deserves gaslighting. Rather, understanding your role implies that you possess power in the relationship, and that you may be able to shift your relationship dynamics. For most people, what happens is that they unwittingly become involved with someone prone to gaslighting (due to upbringing, values, socialization, etc.). When the gaslighting begins, the person does not recognize it, and unknowingly reacts to it in ways that reinforce it. For instance, they may try to defend themselves when called “crazy” or “too sensitive,” etc. The mission becomes to convince the gaslighter that their feelings are valid, with real emotions and experiences. These reactions to gaslighting are completely normal, as they are very similar to other interaction patterns in relationships in which one partner is challenged and feels a desire to defend a stance. However, in the context of gaslighting these reactions can actually reinforce the bad behavior, as it sends the gaslighter the message that it is okay to challenge one’s reality or try to force another person to stop feeling something. When you experience gaslighting and continue to engage with the gaslighter, your participation “fuels the fire.” So how do you stop reinforcing gaslighting?

First, define (in your own mind) the objective of serious conversations before you start them. You likely already know the topics or types of statements that will prompt the person to gaslight you, and you may find yourself avoiding these subjects for fear of being gaslighted. The next time you feel a need to bring up one of those topics, pause for a moment and set an intention for the conversation. What is the objective, or main goal, of this discussion? Objectives may include:

  • Validation of my feelings
  • Reassurance that I am valued
  • An understanding that a behavior is harmful to me and needs to stop
  • Agreement to take some sort of action

Every conversation has an objective, and it can be useful to clarify what your own objective is at the outset. With gaslighting, it often happens that the objective quickly shifts away from productive goals to control and manipulation. This is precisely what needs to be avoided. Defining your objective allows you to mentally revisit the objective as you engage in the conversation, to make sure the discussion has not been derailed.

Second, if you find that a discussion that began with the objective, “Come to an agreement regarding where we should live” has devolved into an argument with the objective, “Make me agree that I am too sensitive,” it is time to:

  1. Reassert the original objective (“I want us to focus on where we are going to live…”).
  2. Label the phenomenon (“This is gaslighting…”), and if that does not work...
  3. Disengage (“My feelings are not up for debate, so I am done with this conversation…”).

When you first try this new way of interacting it may prompt the other person to gaslight even more, in the hopes of pulling you back into the conversation that they want to have. Expect to hear things such as, “You’re just like your mother!” or “See how childish you are?” These statements are designed to make you reengage and defend. But remember, the engagement fuels the gaslighting. No matter how difficult it is to distance in that moment, stand your ground. Identifying the gaslighting and disengaging from it are the main tools you possess that can shift this unhealthy dynamic, so refuse to continue the conversation until the objective can be mutually defined as something productive.

Step III: Get Out (If You Need To)

Not all gaslighting relationships need to end. It is sometimes the case that gaslighting is a learned behavior that, like other behaviors, can be reshaped and extinguished with some work. Some partners who gaslight will be horrified to learn about what they are doing and will genuinely want to stop. Others may be more resistant but ultimately willing to shift how they interact with others. Sometimes couple or family therapy can help restore relationships. However, if your attempts to stop gaslighting fail, and there seems to be no hope to change this dynamic, you may consider leaving the relationship altogether. If this sounds like you, there are some things you should expect.

First, expect that leaving will be difficult. While some people find is easy to walk away, that is not the norm with gaslighting relationships. In part, this is because individuals who have suffered long-term gaslighting tend to underestimate their own abilities and suffer from low self-esteem and self-efficacy. Also, gaslighting relationships can be intense and co-dependent, making disengagement extremely difficult.

Second, expect that you will try to leave several times before succeeding. Most relationships that contain abuse (whether physical or emotional) are exceptionally difficult to end, and it may take 5-10 attempts before a partner is able to truly break free. Thus, if you know you need to leave but feel bad that you keep going back, take heart. This is part of the process. Keep focused on your goal, recognize the barriers to leaving (emotional, financial, or otherwise), and seek support from friends, family, or a mental health professional.

Finally, expect that life will get better once you do break free. Believe this is not only possible, but probable. A common fear that long-term gaslightees express is that no one else will love them if they leave the relationship, or that they will not be able to make it without the other person. It is tempting to believe these frightening thoughts without examination, but it is important to recognize that these thoughts can imprison you and, if taken too seriously, can make it even more difficult to leave. When you have these kinds of self-limiting, “spam thoughts,” be very suspicious of their truthfulness, just as you are suspicious of spam emails (you know, the ones in all caps yelling at you to send money to a Nigerian king). You may not be able to prevent the “spam thoughts” from appearing, but you can make sure they do not dictate your actions!

This article was originally posted at Psychology Today on January 6, 2017.

Post-Election Stress Disorder in Women

“Post-Election Stress Disorder” (PESD) is not one of the mental illnesses listed in psychologists’ overly verbose diagnostic manual, the DSM-5, but it is a phenomenon that feels real nonetheless. Countless Americans are reporting feeling triggered, traumatized, on edge, anxious, sleepless, angry, hopeless, avoidant of connection, alone, and suddenly haunted by past traumas they believed they had buried. Of course, there is not just one type of American who has been experiencing these types of symptoms, and there is not just one reason for it. What is clear, however, is that there seems to be a sort of collective trauma (or at least stress) response occurring.

Over the past three days I have received more emails and calls from female clients suffering from PESD-like symptoms than I have in the prior three months combined. Moreover, I have read many complaints of these symptoms from female friends on social media. After a while they begin to look the same…

“I haven’t slept in two days…”

“I can’t stop sobbing…”

“I am having nightmares…”

“This reminds me of when I was sexually assaulted…”

“I thought I was over all of my past abuse but now it’s back…”

“I can’t sleep, can’t eat, can’t function…”

From what I am hearing and reading, many women are experiencing these symptoms (to varying degrees) and more right now. This is not to say that other groups are not also suffering, but as a trauma psychologist who works primarily with women, this is the demographic I see the most. So what are these symptoms all about?

Look at the Facts

First, let’s create some context with numbers, with a focus on women.

  • 10% of women suffer from PTSD (4% of men)
  • 31% of women suffer from an anxiety disorder (19% of men)
  • 12% of women suffer from depression (6% of men)
  • 4.8% of women suffer from an eating disorder (2% of men)
  • 25% of women will experience sexual assault in their lifetime
  • 33% of women report having experienced sexual harassment in the workplace
  • Approximately 100% of women report experiencing some type of sexual harassment in their lifetime (this finding is consistent across multiple studies)

Add to those numbers a small sampling of not-so-fun facts:

  • Women more often experience traumatic events likely to lead to the development of PTSD (such as sexual violence, assault, and abuse) than men
  • Rape within marriage was legal until the mid-1970s
  • A whopping 96% of sexually objectifying imagery is of women’s bodies
  • Only 20% of political offices are occupied by women
  • Only 4.4% of Fortune 500 CEOs are women

What does this mean? Women are more likely than men to suffer from mental illnesses such as anxiety and PTSD, and they are more likely to have been sexually assaulted. Also, the numbers show us that women have not historically enjoyed the same power and privilege as men. For some women, the result may be a subtle but constant sense of vulnerability and vigilance.

Additionally, recent research has introduced the world to epigenetics, which tells us something about how our experiences can impact gene expression. Through epigenetic research we are beginning to learn how the experience of trauma to be communicated to future generations. Though beyond the scope of this post, what you need to know about epigenetics is that when a traumatic event is experienced, it can lead to methyl binding, which may increase stress sensitivity in future generations. This, in turn, increases an individual’s vulnerability to developing disorders such as PTSD in response to traumatic events.

The Role of Intersectionality

Finally, research tells us that a person’s vulnerability to stress and trauma are linked to more than just gender. Other aspects of a woman’s identity such as race, ethnicity, sexual orientation, gender identity, and disability status may play a role. For instance, take a look at the following:

  • A (CIS, non-transgender, gender-conforming) White woman is 4.5 times more likely to be sexually assaulted than a man.
  • Native American women are three times more likely to be sexually assaulted than Caucasian women, substantially increasing their risk.
  • Women of color who are also transgender are four times more likely to be sexually assaulted than White transgender women. For more information, read this

What we see here is an example of intersectionality, which means that our various social identities and the systems of oppression in which we live influence one another, mingle, and “intersect.”

Why We Can’t Just Get Over It

While the outcome this election means different things to different people, it is no secret that many of the words, values, and behaviors Americans have heard and seen during this election have deeply affected many people, including women (with a magnified impact on people of color, immigrants, LGBTQQA communities, differently-abled individuals, the religiously diverse, etc.). Moreover, in the past 72 hours since the election we have heard of several instances of violence and harassment committed toward women and other marginalized groups across the country. Some of the instances have included the perpetrators invoking the name of the President-Elect.

Mark Twain once said, “I am an old man and have known a great many troubles, but most of them never happened…” Twain is clearly referencing anxiety here, and we chuckle a bit at his statement because it highlights how silly worries can be. Sometimes.

But some tragedies have happened, and they have happened to an overwhelmingly high percentage of women. Not only that, but several Americans have been given the clear message that trauma will continue. This is what America needs to realize as we see so many of our citizens suffering in what appears to be intense or even extreme ways. The panic and desperation we see is not due to the bad things that have never happened, or would likely never happen. This collective fight-or-flight response is a reflection of all that has in fact happened, and reflects for many a legitimate fear of what might happen.

Why We Shouldn’t Just Get Over It

As women, the accumulation of our past traumas, and remnants of those our mothers and grandmothers suffered before us, remain with us and shape our perception of, and reaction to, danger. These reactions do not reflect weakness; rather, these memories and traces are gifts that have helped us to survive. The accumulated traumas that we carry, for better and for worse, may remain dormant most of the time if we are lucky, but our brains are wired to remember, and react strongly to, perceived threats that resemble the original trauma(s) in some way.

For many women, hearing about a powerful leader’s many sexual assault accusations will feel threatening and triggering, as it may remind them of their own traumas. The brain will recognize these stories of victimization as being similar to past experienced trauma, and the woman may feel triggered, on guard, and anxious. Similarly, listening to a tape recording of a powerful leader endorsing sexual violence will also likely be triggering. Witnessing the American public elect this leader to the highest position of political office in the United States, creating a scenario in which the daily lives of millions of women (and others) will undoubtedly be influenced, and in which many women will face daily reminders of their past victimizations and threats of future victimizations, will produce an even more intense trigger response. Remember what the statistics show: Millions of women have suffered sexual harassment and assault (100% and 25%, respectively). Thus, we should not be shocked as we witness a collective fight-or-flight reaction, we should expect it. Also, the stress response should not be viewed as irrational or maladaptive when the danger is not imaginary.

What You Can Do To Help Others

If it is not helpful to tell people to calm down, or that everything will be okay, what can we say and do to be helpful? Here are a few suggestions for those wanting to support fellow Americans who are suffering right now.

  1. Ask them what they need. Some people may know right away what is most helpful, and some won’t, but this is a good starting point. Asking this question communicates to the person that they are important to you, that they can be trusted to know what is best for themselves, and that you are willing to listen to them.
  2. Avoid playing “devil’s advocate. There is a time and a place to debate political issues in a cool, calm, and collected manner. If the other person is in a triggered state where they are feeling anxious and unsafe, now is not that time. When the brain is in fight-or-flight mode the rational, thinking areas of the brain dull as the body and subcortical areas of the brain rev up to prepare to the person to cope with danger.
  3. Help the person regulate their stress response. Instead of starting a deep conversation during a high anxiety state, consider ways that you can help the person manage their stress response. There are many techniques that can help with this, such as deep breathing, meditation, getting out in nature, yoga, eye contact, and physical contact (when appropriate and wanted by the other person). For more ideas about how to manage election-related stress, read this.
  4. Contribute to worthy organizations. Another way to help others is to donate time and/or money to organizations that work to preserve (or gain) the rights your loved one values. Knowing that there are organizations, movements, and other groups that are “in their corner” can help reduce a person’s stress and provide some peace of mind. Here are some organizations for your consideration. 
  5. Keep your privilege in check. While it is natural - and even loving - to want to understand what the other person is experiencing, be careful not to communicate to the other person that your support of them is contingent on your full understanding of the situation. Those of us who enjoy various types of privilege are accustomed to our opinions and viewpoints being very important and, well, privileged. This can make put us at risk of asserting our privilege in high stress situations where we demand explanations for others’ feelings, and in the process use privilege to override another person’s suffering. Also, keep in mind that belonging to a privileged group may make it impossible to fully “get” what others are feeling, as your experiences may be very different. It is okay if there are aspects of a person’s experience that do not resonate with you. Offering support is powerful regardless of whether you have had the same experiences in life!
  6. Remind the person they have options. You may have noticed that when you feel very stressed, the world seems to narrow. Problem solving becomes more difficult, concentration seems impossible, and creativity dulls. This means that the person experiencing PESD symptoms may benefit from others reminding them of their options. For example, while it would not be helpful to pressure or goad a person into a meditation practice, it might be helpful to simply suggest it, along with other stress management options. For instance, you might say to the person, “We could relax at home for a while, or do a breathing exercise, or walk the dog. What sounds best?” Remembering that options exist can be empowering, as it means that the person is not totally helpless and out of control.
  7. Hold space. To hold space means to create a safe and welcoming environment for someone you care about, so that they can feel free to come to you to express and process their pain. When we hold space for others we meet them where they are, listen to them attentively, and connect with them and their pain without an agenda to change them. For more information on how to hold space, read this article.

Finally, if you or other people in your life are experiencing severe post-election stress, consider asking for professional help from a psychologist. A list of professionals in your area can be found on Psychology Today.  

10 Signs of Gaslighting, Part III

My last post ("Bringing Gaslighting to Light, Part II") discussed why gaslighters gaslight, and the contextual factors that can lead to gaslighting. In this post, the focus shifts to the gaslightees.

Gaslighting is defined as a form of manipulation (on the mild end), emotional abuse, or even psychological warfare (on the extreme end) that results in the slow dismantling of a gaslightee’s self-trust. What makes someone vulnerable to experiencing gaslighting, and what are the warning signs of gaslighting?

Three main needs that set the stage for gaslighting. In no particular order, these include:

  • Our need to be liked.
  • Our need to be loved.
  • Our need to be understood.

These needs are part of being human, and are hardwired into most of us. The bright side of these needs is that they motivate us to form close and loving connections with other human beings, which is healthy. The dark side is that these needs, when combined with certain tendencies, make people vulnerable to gaslighting. Among these tendencies are: 

  • Self-doubting tendencies.
  • People-pleasing tendencies.
  • Conflict-avoidant tendencies.

Do any of these sound like you? If so, you may need to pay attention to the possible presence of gaslighting in your relationships. Gaslighting is more likely to occur when people enter into relationships that contain a substantial situational or relational power differential, such as when one person is especially vulnerable due to losing a job, or suffers “fear of abandonment” issues due to a previous loss or trauma. Keep in mind that it is not the need to be loved, liked, or understood that is the problem; it’s the combination of these needs with specific tendencies and habits that makes individuals susceptible to gaslighting.

Here are the 10 signs to watch for that might indicate you are being gaslighted:

  1. You feel pulled by the other person to constantly blame yourself when things go wrong in the relationship, while the other person assumes no responsibility.
     
  2. You frequently second-guess yourself and question whether your perceptions of a situation are accurate. Over time, you may even question your sanity.
     
  3. You conclude that you are “just too sensitive” and should “get over it” when something about the other person bothers or hurts you.
     
  4. You hide your partner’s behavior from friends and family (or lie about it), because you know something is wrong, but you are not sure what exactly it is.
     
  5. You begin to withdraw from close friends or family.
     
  6. You find it increasingly difficult to make decisions because you think you can't do anything right.
     
  7. You notice your self-esteem plummeting, and you start to feel depressed and self-critical. You may even feel worthless and undeserving of love.
     
  8. Your memory seems hazy and you have difficulty remembering what happened during conflicts with the other person.
     
  9. Conflicts with the other person are almost never productive. They usually result in the other person playing the victim, even if they have behaved irrationally or abusively.
     
  10. You notice that you sometimes gaslight yourself by invalidating and questioning your own reality and experiences.

If these warning signs feel familiar, you may want to ask yourself whether you are in a gaslighting relationship, and assess the impact of this on your life and health. Remember that relationships should enhance people’s lives and help them become better people through encouragement and support, not disempowerment and manipulation.

My next post will focus on how to cope with, manage, or—if needed—leave a toxic relationship. 

This article was originally published at Psychology Today on October October 24, 2016

 

Bringing Gaslighting to Light, Part II

As discussed in Part I, gaslighting is defined as “a sneaky, difficult-to-identify form of manipulation (and in severe cases, emotional abuse)” that results in the gaslightee questioning his or her own perception, experiences, and even reality. In severe cases, this psychological warfare can result in the victim becoming dependent on the gaslighter for his or her own sense of reality.

Gaslighters must be villains, setting out to destroy the lives of unwitting victims. Right?

Not necessarily. If you’re looking for scary predators lurking in the night, ready to jump out and gaslight you, you’ll miss the real danger. Many writings on gaslighting portray gaslighters as vicious and intentionally manipulative, but this isn’t always the case. People who gaslight aren’t always monsters, rather, they are friends, romantic partners, parents, and siblings. They are people with whom we laugh and fall in love, and their identity is more complex than “part-time gaslighter.” This is important to realize because when we vilify gaslighters, we tend to overlook the gaslighting behavior of those close to us and make excuses for it because we don’t want to see those we love as bad. As the old saying goes, “love blinds.” Also, when we believe that gaslighting reflects a sort of inherent badness within the individual, we miss the broader context of gaslighting and the ways societal norms and history encourage and perpetuate this phenomenon.

So if gaslighters aren’t gaslighting because they’re bad people, what underlies the behavior and why are they doing it? Here are the three main underlying destructive beliefs that can lead to gaslighting. Note that these beliefs are often not consciously held, but are deeply ingrained and subtly communicated through patriarchal values, the media, our legal system, politics, etc.

Destructive Belief 1: Overwriting another person’s reality is okay. Gaslighting occurs because the gaslighter, at some level, consciously or unconsciously, believes that it is both possible and acceptable to overwrite your experiences and replace them with his or her own. This seems outrageous to say, but the fact is that the erasure of certain people’s lived experiences is not new. We have a long history of erasing the histories and realities of a whole lot of people, including but not at all limited to…

We see erasure happening through cultural appropriationwhitewashing, media and movies, the enforcement of harmful stereotypes, and many other ways.  The overwriting of experience is so common that it’s hard to recognize most of the time! But given its pervasiveness, it’s not unreasonable for people in positions of power and/or privilege to have an unconscious (or conscious!) belief that it is both possible and okay to overwrite the realities of others. After all, history has shown that it is indeed possible, and common. In fact, it’s a really effective way to reinforce one’s own power and privilege by making sure only their perspectives and realities exist.

Destructive Belief 2: People can be controlled or possessed. According to Shea Emma Fett from Everyday Feminism, “The distinguishing feature between someone who gaslights and someone who doesn’t is an internalized paradigm of ownership.” Gaslighters often equate closeness and intimacy with control and possession. This can be seen through jealously and controlling behaviors, which are often misidentified as romantic gestures early in a relationship. Examples might include grabbing a romantic partner and kissing them to “shut them up” when they are angry, persistently pursuing a potential partner in a response to believing the partner is “just playing hard to get,” etc. While movie portrayals of such behaviors are intended to be romantic, they encourage a dynamic of invalidation, control, and ownership in real-life relationships. This dynamic often grows with time, and can lead to gaslighting and other forms of manipulation and even abuse that are designed to maintain control. 

Destructive Belief 3: Challenging me is unacceptable. We all find being challenged frustrating sometimes. Parents of toddlers often become exasperated due to constant questions and challenges presented by their children, and in response may blurt out, “Because I said so!” in irritation and exhaustion. Disengaging while being challenged isn’t ideal, but sometimes we just don’t have the resources to handle it well.

In gaslighting, however, the gaslighter doesn’t shy away from being challenged because they’re too tired or in a bad mood. Rather, the mere act of being challenged is intolerable and unacceptable to the gaslighter, who not only needs to be right, but also needs you to wholeheartedly believe that he/she is right. “Agreeing to disagree” is not an option; the only acceptable outcome is for you, the gaslightee, to unquestioningly align with the gaslighter. You must see the world exactly as the gaslighter does, because even the possibility of being challenged causes intolerable anxiety. Strong anxiety in response to being challenged may be linked to childhood abuse or other traumatic events, a lack of self-regulation or coping skills, or just plain arrogance. In any case, when challenged, the gaslighter works hard to undermine the gaslightee’s perceptions and to overwrite their reality. Over time this erasure of experience eliminates all possibility of being challenged by the gaslightee, as the gaslightee’s self-confidence and personal sense of reality diminish. Eventually, not surprisingly, the gaslightee begins to look to the gaslighter to define reality for them. The result is that the gaslighter may go through life unquestioned and unchallenged, while the gaslightee suffers a devastating loss of self.

These three destructive beliefs (one or more of them) are often at work when gaslighting occurs. Overwriting reality, a need to be in control, and an inability to tolerate being challenged can serve as attempts to maintain power or privilege, to avoid loss, or to preserve and elevate the gaslighter’s self-esteem. If you want to learn how to recognize the signs of gaslighting, revisit the blog soon for Part III of “Bringing Gaslighting to Light.”

This article was originally published at Psychology Today on May 5, 2016

Bringing Gaslighting to Light, Part I

“You’re crazy…”

“You're just being emotional…”

Sound familiar? If so, you may have experienced gaslighting, a sneaky, difficult-to-identify form of manipulation (and in severe cases, emotional abuse). The term “gaslighting” originated from Patrick Hamilton’s 1938 play, Gas Light, which tells the story of a husband who attempts to manipulate his wife into believing she has lost her mind. This is accomplished by secretly dimming gas lamps throughout the house and, when the wife comments on the dimmed lights, the husband tells her she is imagining things. This, along with other small manipulations of her environment that the husband refuses to substantiate, leads the wife to question whether she might in fact be crazy.

The plot of the play captures the essence of gaslighting, which is defined as a form of manipulation on the mild end and emotional abuse, or even psychological warfare on the extreme end that results in the slow dismantling of the gaslightee’s self-trust. In other words, gaslighting leads victims to question the soundness of their own judgment, their sense of self, their perception of reality, and the validity of their emotions. Repeated over time, gaslighting can result in the victim losing the ability to trust their own memory, experiences, and in some cases, their sanity.

How does this happen? Some forms of gaslighting include denying things that were said during an argument, challenging another person’s feelings (which should not be up for debate), telling another person how to think or feel, or twisting information in favor of the gaslighter. Some gaslighting statements include:

“It’s all in your head…”

“That never happened…”

“You’re too sensitive…”

“Are you on your period or something?”

“Your feelings are wrong…”

More severe forms of gaslighting may include denying physical or sexual abuse that has occurred, or other major negative events that have happened in the past.

Of course, not remembering things said in the heat of the moment during an argument isn’t gaslighting. That’s normal, as no one can remember all conversations verbatim. Gaslighting occurs when someone denies having said or done something hurtful and turns it on the other person, accusing them of simply “being too sensitive” or “crazy” in an attempt to replace or overwrite the person’s reality. In a sense, the gaslightee who is communicating the grievance is punished for bringing up the statements or behaviors of the gaslighter. Calling someone overly sensitive or crazy is very different from a non-gaslighting response that communicates, “I have no memory of that at all,” or “I didn’t mean it like that.” It’s not that the gaslighter simply doesn’t believe they said or did something, rather, there is a need to undermine and disorient the gaslightee, criticize them, and insist that they question their own credibility.

If you feel like you are being pulled to defend your sanity or your value as a person, or if you find that your self-esteem plummets when you try to air a grievance, ask yourself whether gaslighting might have occurred. For more information about why people gaslight, how to recognize the signs of gaslighting, and what to do to protect yourself from (or recover from the effects of) gaslighting, stay tuned for the next three blog posts of the series, “Bringing Gaslighting to Light.”

This article was originally posted on Psychology Today on March 31, 2016.

Suffer from Low Self-Esteem? Consider a Feminist Therapist

A very common reason clients begin psychotherapy is to improve low self-esteem. While low self-esteem isn’t in mental health providers’ diagnostic “bible” of mental disorders (called the DSM-5), self-esteem issues can wreak havoc in multiple domains of a person’s life and are connected to a variety of other conditions such as anxiety, depression, and posttraumatic stress disorder. And while men sometimes suffer from low self-esteem, this affliction disproportionately affects women.

So what do you do if you’re suffering from low self-esteem?

The short answer is to seek professional help, but keep in mind that not all therapists are alike, and there are many theoretical orientations from which mental health providers work. Here’s a somewhat more specific answer: Consider a feminist therapist.

What is a Feminist Therapy?

Feminist therapy is a bit difficult to define because it does not prescribe specific methods be used, and it does not have a single founder or champion. Rather, feminist therapy is based on a core set of feminist values and adheres to four main tenets. Specific methods and techniques, in turn, are derived from these feminist assumptions.

Core Values of Feminist Therapy

Feminist therapy is based on the following values (Rawlings & Carter, 1977):

  1. Pathology is conceptualized as social and external, as opposed to personal and internal. Thus, women’s low self-esteem is believed to be driven by past (and often current) oppression and repeated disempowering experiences.
  2. The assumption that pathology is externally-based does not exonerate the client from responsibility. While the cause of the pathology may be largely external, the solutions, and resulting individual and social change, begin from within.
  3. Rather than encouraging women to simply adjust to social conditions, usually by modifying themselves, the focus is on social and political change. This shift toward social change can be a difficult one, as women are frequently taught to accommodate others and to modify themselves.
  4. Other women are not the enemy, and neither are men. Rather, an oppressive, patriarchal system is assumed to be the catalyst for many of society’s problems, as well as for several mental health issues.
  5. Women should work to become psychologically and economically independent. This helps women to become more empowered and to avoid becoming trapped in coercive or abusive relationships.
  6. Relationships should be equal in personal power. The minimization of relationship power differentials reduces women’s chances of being mistreated, manipulated, or coerced.
  7. Rigid gender roles should be challenged and eliminated. Instead of blindly adopting traditional gender roles, women are encouraged to actively define their roles and to design their lives in a way that fits with their own personal values.

Core Tenets of Feminist Therapy

In addition to the values described above, feminist therapists tend to adhere to the following core tenets of feminist therapy (Worell & Remer, 2003):

  • Privileging women’s experiences: Historically, psychological theory and professional practice has centered on men’s lived experiences and realities, while women’s experiences have been largely marginalized. To privilege women’s experiences the feminist therapist considers both women’s and men’s experiences equally, and the commonality of women’s experiences is validated (Sturdivant, 1980).
  • Egalitarian relationships: The creation of a completely equal relationship between mental health providers and clients is not believed to be possible, however, in feminist therapy the inherent power differential is minimized and treatment planning is collaborative. Power differential reduction can be accomplished through the identification of therapist and client roles and responsibilities, therapist transparency regarding methods used and what they intend to accomplish, and the assumption that the client is the expert on themselves, while the therapist is the expert on psychotherapeutic approaches (Brown & Brodsky, 1992).
  • Personal is Political: During the self-reflective and consciousness-raising Women’s Movement groups of the 1960s, it was discovered that many women experienced similar problems and symptoms. These women had previously assumed their issues to be unique, but these groups revealed certain women’s issues to be common, and strongly influenced by the social and political context in which women live (Morgan, 1970).
  • Empowerment: Empowering women to actively make positive changes is a central tenet of feminist therapy because it helps to address the myriad of problems created as a result of women’s subjugation, limited power, and maltreatment (such as sexual harassment and sexual assault). The result of empowerment is that women become able to identify and use their own strengths, and to facilitate individual, social, and perhaps even political change.

Given all of this, how exactly can feminist therapy improve self-esteem?

Self-esteem is defined as “confidence in one’s own judgment, abilities, power, etc.”  Those who experience low self-esteem often have difficulty making decisions, excessively worry about what others think, doubt their abilities and potential for success, experience disempowerment, and/or often feel as though they are not as good as others. Feminist therapy can help with these issues in a variety of ways!

First, feminist therapists can help clients to better balance responsibility and power in their lives, whether it be by reducing responsibility for things out of the client’s control (which leads to feelings of anxiety and helplessness) or increasing the power the client experiences by emphasizing natural strengths and encouraging assertiveness and positive action (whether it be individual, social, or political). Also, by focusing on clients’ strengths and helping them step out of their comfort zone to take small, manageable risks, clients can begin to experience small successes and moments of increased confidence. Through empowerment-building exercises such as these and others, clients can grow to fully enjoy the courage and strength they have always possessed, become more decisive and independent, and trust in their ability to handle difficulties that come their way. These shifts allow clients to become proactive instead of reactive, hopeful instead of hopeless, and empowered instead of disempowered. They can also bring the client’s own voice to the forefront of decision-making so that decisions are no longer fear-based, but value-based.

If you believe a feminist therapist might be helpful for your low self-esteem, one option is to peruse Psychology Today and contact a mental health provider who specializes in self-esteem issues. When first speaking with them, inquire about their “therapeutic orientation” (which is essentially the therapist’s beliefs about how mental health issues develop and how to best resolve them), and ask whether they utilize feminist principles in their work. Also, remember that the most important factors when choosing a therapist are whether you can really connect with and open up to them. Choose someone who is a good fit for YOU. In doing this, you’ll have taken the first step toward self-empowerment!

This article was originally posted on Psychology Today on March 16, 2016.

Recognizing the Signs of Post-Traumatic Stress

How do you know if you need help?

During the past year the United States has suffered several tragedies, including the Oklahoma tornados, the Boston Marathon bombing, the Sandy Hook School massacre, Hurricane Sandy, and the Aurora, Colorado shooting. With each passing year these events will be pushed further into our country’s collective past, but our sadness will never diminish. Although less than 20% of those exposed to traumatic events are expected to develop Post-Traumatic Stress Disorder (PTSD), a large percentage of victims will suffer from distressing post-trauma reactions that interfere with life.

The American Psychiatric Association’s Diagnostic and Statistical Manual-V2 classifies PTSD as a trauma- and stress-related disorder that includes four symptom clusters: intrusion symptoms, avoidance, negative alterations in cognitions and mood, and alterations in arousal and reactivity. While a mental health professional’s assessment is required for a diagnosis of PTSD, the first steps toward a diagnosis (and therefore treatment) are 1) an improved understanding of the signs of PTSD, 2) a self-evaluation of the post-trauma reactions negatively affecting you and those you love, and 3) a willingness to ask for help. After all, we cannot address problems we do not recognize!

Post-trauma reactions occur after exposure to traumatic events such as motor vehicle accidents, sexual assault, terrorist attacks, natural disasters, and many other tragedies. During these events individuals experience terror, and they often feel helpless to stop the event. In the weeks, months, and even years following a trauma, substantial changes in a person’s thoughts, emotions, and behaviors may occur. Because such changes can be warning signs of PTSD or other serious post-trauma reactions, it is crucial for trauma survivors to be aware of how the trauma has affected them. How do you know if you or someone you love might be suffering from post-traumatic stress? Eight of the most common cognitive and emotional indicators of PTSD include:

1. Sleep Difficulties: Problems may include falling asleep, staying asleep, or experiencing frequent nightmares.

2. Anger: The person may feel irritable, and may experience frequent anger outbursts that are difficult to control.

3. Numbness and Disconnection: Trauma victims may feel disconnected from others. They may also feel numb and have difficulty accessing the loving feelings they know they have for loved ones.

4. Depression: Depressed mood, hopelessness, and a loss of interest in previously enjoyed activities are common.

5. Chronic Anxiety: Individuals often report feeling on guard and hypervigilant, and they have difficulty relaxing and “unwinding.”

6. Reliving the Trauma: Highly distressing thoughts and memories of the event may repeat in the mind, despite the individual’s attempts to avoid or stop them.

7. Feeling Unsafe: The person may experience intense feelings of fear or impending doom even when no danger is present. They may also feel as though it is impossible to ever feel safe again.

8. Thoughts of Suicide: Suicidal thoughts may be active, with an intention and plan to commit suicide (“I will purchase a firearm to shoot myself”). Conversely, these thoughts may be passive (“Things would be better if I just weren’t around anymore”).

In addition, many trauma survivors exhibit significant behavioral changes after suffering a traumatic event. Such changes in behavior may become apparent in several domains of a person’s life, some of which include:

1. Relationships with Others: Increased conflict with others, withdrawal from relationships, and decreased trust and intimacy are common PTSD indicators.

2. Self-Esteem/Relationship with Self: Changes may also take place in an individual’s relationship with themself. Self-harm behaviors, thoughts of suicide, and reduced self-care and self-esteem can be signs of a serious post-trauma reaction.

3. Work Performance: Those suffering from PTSD often experience difficulty concentrating, sometimes due to thoughts about the trauma, or to lack of sleep. This in turn may compromise one’s ability to complete daily tasks or to perform well at work.

4. Lifestyle: After a trauma some individuals go to great lengths to avoid reminders of the event. For instance, they may isolate and give up hobbies or activities they used to enjoy. The purpose of this may be to feel safer and less vulnerable, and to reduce reminders of the trauma. For example, a combat veteran who was bombed in a crowd oversees may avoid concerts despite his love of music, in order to feel safe.

5. Coping: Ineffective coping strategies may be adopted after trauma. For instance, an individual may begin drinking alcohol or using drugs to cope with their symptoms. Often, these unhealthy ways of coping help the individual temporarily avoid reminders of the traumatic event.

In the first few weeks following a trauma, most people will experience at least a few post-trauma reactions and symptoms. However, if you experience these changes for more than one month, if they interfere with your daily life, or if you have thoughts of hurting yourself, it is important to seek professional help as soon as possible. The following websites offer assistance to those looking to connect with a mental health professional:

• Substance Abuse and Mental Health Services Administration, Disaster Distress Helpline: disasterdistress.samhsa.gov/

• Psychology Today: therapists.psychologytoday.com

• GoodTherapy.org: www.goodtherapy.org/

• NetworkTherapy.com: A Mental Health Network: www.networktherapy.com

References 

1. Kessler, R. C., Sonnega, A., Bromet, E., Hughes, M., & Nelson, C. B. (1995). Posttraumatic stress disorder in the National Comorbidity Survey. Archives of General Psychiatry, 52, 1048-1060.

2. American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington, DC: Author.

This article was originally published on Psychology Today on 7/04/2013.