Breathe In, Breathe Out

So we know what trauma is from this post, and what the symptoms of PTSD can be from this post. But how do we manage them? With my two most commonly used words: Coping Skills. Coping skills can be used for grounding, calming and even simply distracting. Everyone will respond a little differently to different skills, so you have to play around with them and find what works best for you. For the sake of this post, I will list some of my more commonly suggested skills for you to try and why they work. If you want more options, contact me and I can give you more ideas.

1.) Deep/Belly Breathing. 

This is probably the most basic, yet most helpful tools you can have in your tool box. This kind of breathing is very intentional.

How to do it: Best practice is to breathe in through your nose and out through your mouth. Now, most of us, when we breathe normally, can see or feel our chest rising and falling. When you intentionally deep breathe, concentrate on breathing with your diaphragm instead of your chest. In the beginning, it might help to lay down on your back and rest one hand on your belly so you can feel it rise and fall. Image there is a balloon in your stomach and as you breathe in, you fill it up as much as you can and as you breathe out, you slowly let the air out and use your stomach muscles to push out every last ounce of air.  Make sure you practice pacing yourself; try counting to 4 on the in breath, hold for 4 and breathe out for 6 counts. You can play with the length of time, but be sure you aren't breathing too fast, that will have the opposite effect of calming. This kind of breathing might take some practice but keep at it and you'll get the hang of it!

How it helps: There is a nerve right behind your stomach called the Vagus Nerve.  This nerve is considered the link between the mind-body connection. By naturally stimulating it with diaphragmatic breaths, it activates the parasympathetic nervous system (the one that calms your body). It will slow your mind, your heart rate and blood pressure.  As someone is experiencing anxiety, every part of the body can be agitated and needs to be reminded to slow down a little. Belly breathing may not make the feelings or anxiety go away entirely, but it helps to take the edge off enough to make it manageable.

2.) Grounding/Mindfulness

There are a plethora of ways to practice mindfulness, so I'm going to stick to two of my favorites. If you are new to the practice of mindfulness, I'll give you a quick run down. Mindfulness is the practice of staying fully aware in the present moment without judgment. This includes awareness of our thoughts, feelings, bodily sensations and environment. If you are interested in learning more in depth, you can check out this website. There are also plenty of mindfulness/meditation apps that you can download to your phone. I haven't found one that I have loved, so I won't make a specific recommendation. Find what works for you and get going on it!

The first exercise I teach my clients is a full body scan.

How to do it: Begin by getting to a quiet place where you can get comfortable, whether it's laying down, or sitting comfortably in a chair. Just take a minute to relax and get used to the environment. Take a few deep belly breaths to begin with and try to focus on just your breathing. Once you get back to your normal breathing, just stay there for a moment and be very conscious of your breath going in and out. Notice the sounds in the room, any smells or other sensations. When you're ready, begin by bringing your attention to your toes and feet; notice any pressure or pain, notice where they rest on the floor. Maybe take a moment to tense the muscles in your feet and release. When you're ready, go ahead and move up to your ankles...then calves and shins...then knees....then thighs...etc etc.

You can make this body scan as simple or complex as you want and as time permits. If you have a lot of time and need it to take longer, you can work through smaller groups of muscles at a time. If you are in a hurry, you can make the groups as large as you like. Make it work for YOU individually. If you have a hard time leading yourself through this, you can always turn to youtube for a helpful video.

The second exercise is a little more conducive to a work or school environment when you need a quick skill to calm down and you can't be alone. I call it 5,4,3,2,1.

How to do it: Wherever you happen to be in the moment that you need some calming, look around you and find:

5 things you can see
4 things you can hear
3 things you can touch
2 things you can smell
1 thing you can taste.

This can be repeated as many times as you need to bring your anxiety down.

How these help: Both exercises are specifically designed to bring your attention back to the present moment, where you are safe. Bringing awareness to your body and/or your environment will help bring that heart rate down and settle your mind. Part of what it does is distract you from whatever past or future scenario you have in your head that's causing the anxiety. Any time you can bring your consciousness back to the present moment, you will find some calm and peace. Anxiety is always rooted in a past event or a future worry.

But here is the key to all mindfulness practice! It has to be done non-judgmentally. This means that when a thought or worry comes to your mind, you acknowledge it, DO NOT make a decision on if it's good or bad, and let it move on, as if it were a cloud in the sky, or a leaf floating down a stream. Let it go. In this moment of mindful practice, it does not matter. Your goal is to find the peace that is stored inside you. It's there, believe me. It may feel far away, but it's there. With some practice and effort, you'll find it inside you and you'll find some relief from the pain, confusion, shame, chaos or fear you may be feeling.

Let's get practicing!!

Vicarious Trauma

My first experience with vicarious trauma that I can recall, was September 11, 2001. I was in 4th grade and lived no where near New York City. There was a lot of trauma happening in the city, but there was also trauma all over the country. I remember as a 9 year old, watching the news and seeing the clips play over and over of the billowing clouds of smoke, the towers falling down on themselves, and the particularly horrifying clips of people jumping from the buildings. I remember feeling terrified and worried that something similar would happen where I lived. My sweet mother reassured me that we lived in a fairly insignificant part of America that would be very unlikely to be targeted, which helped ease my worry. However, anytime the news was on about the happenings in the city, I had to leave the room because it was too much for me to handle. I eventually was able to move past the intense and distressing feelings that resulted from that terrorist attack. I was more fortunate than others who dealt with, and probably still deal with, worse experiences from that day.

Also known as secondary trauma, vicarious trauma happens when we accumulate and carry the stories of trauma—including images, sounds, and resonant details—we have heard, which then come to inform our worldview.* And yes, it still qualifies as trauma, because remember, trauma is any distressing experience that alters your perspective of the world. 

Since 9/11, I have experienced other forms of vicarious trauma; hearing about my friends’ sexual assaults, reading a heart-wrenching news story of child abuse, and listening to the accounts of sexual abuse from my clients at work. With each experience of vicarious trauma, I had to take some time to process and reset my mind. Each event brought up difficult emotions, some easier to handle than others. And each one in their own way, brought up a distorted thought or perception about the world: “men can’t be trusted,” “the world is a terrible place,” or “there is no good left in the world.” Each thought brought panic and feelings of despair. I had to process through each experience and remind myself that one instance does not represent the human kind in its entirety. I reminded myself that there are still good people and good things in the world, I just had to keep looking for the good.

The point I’m trying to make is that each of us are likely to experience vicarious trauma. Whether you are a mental health counselor, teacher, parent, siblings or friend. You may have someone in your life share a traumatic experience with you, or you may read something disturbing in the news. The feelings that come from that are common, and you are not alone. You may experience feelings of fear, anger, sadness, anxiety, despair or panic. Be gentle with yourself and practice self-compassion, the way you would for a best friend. Allow yourself time to process and take care of yourself. If you are a mental health counselor, make sure you are engaging in self-care and setting healthy emotional boundaries. If you have a friend who is need of your help, make sure to take time for yourself and ask for help when you need it. Seek professional help if you find that your feelings are making it difficult to function like you normally do. 

I think we all have an innate sense to want to help and nurture others in difficult times, but be sure to take care of yourself first, so you have your whole self to give.  

*Definition found here

Trauma Symptoms in Children

Think about the last time you got hangry. Be honest, we all get this way. Maybe you got snippy with a family member or friend? When we get hungry we feel discomfort and we are more susceptible to being irritated and acting out. Most often we snap at those we care about and our hunger is manifested through our behavior. Sound familiar?

Now think of a child, whatever age you can identify with at the moment. Imagine this child has been abused in some form, or maybe abandoned by a biological parent (or both). This child has many underlying and difficult emotions including feeling rejected, hurt, guilt, shame, or insecurity to name a few. Now think of the children in your life. How many of them are able to clearly communicate that they are feeling rejected or ashamed? I imagine the number would be small.

Children don't typically turn to words to explain what they are feeling or experiencing. They communicate through their play and their behavior. Children who have a hard time regulating their emotions tend to act out and often are labeled as “difficult” children or my least favorite term “oppositional.” 

When a child has experienced trauma, particularly complex or long-term trauma, their brains don’t have the chance to develop correctly. During a traumatic event, the brain does not need the logic/reasoning frontal cortex area of the brain. It needs the fight/flight/freeze center, called the Amygdala. When a child experiences chronic trauma/abuse, that emotion center becomes more used than the other parts of the brain. Our brain is essentially a muscle, and just like a bicep or a hamstring, as we use the muscle it becomes stronger. For a child who rarely needs the logic center and constantly relies on the emotion/fear center, that part of the brain will be overdeveloped and the logic/reasoning will be underdeveloped.

This means we are left with children who are unable concentrate and manage impulses. These children are often written off with negative labels or diagnosed with ADHD or Oppositional Defiant Disorder and are heavily medicated. The problem with medication is that it only treats symptoms, it doesn’t fix the underlying issues. This is where a trauma-focused approach is helpful; understanding that there is much more going on than the behaviors. This is not to say that medication isn’t helpful, because it can be very effective for children who truly have ADHD or need the help to take the edge off of intense emotions enough for them to begin to learn other coping skills. If you are hoping that a medication will "fix" a child, then you will be disappointed over and over again. You have to get to the root of the problem; the emotions. 

If you see this kind of issue in your own children, take some time to explore feelings with them. Engage in play with them and let them lead, you will learn a lot about their worldview. When you notice your child is particularly ornery or acting out, give them a time-in rather than a time-out and use that time to talk with and teach them about emotions, especially the difficult emotions like sadness, anger, shame, insecurity, loneliness and grief. Help them learn that talking about their emotions is brave and helpful and not something to be afraid of.

Children will learn what they observe in their families. The way we cope with our issues and feelings will set the tone for how they deal with their feelings. Remember, children may not have the same responsibilities that adults do, but they experience all the same feelings and are less-equipped to deal with them without help. Difficult behavior means an unmet need.

What is PTSD?

Have you heard the term before? PTSD? It is a mental health diagnosis that stands for Post Traumatic Stress Disorder. You’ve most likely heard of it in conjunction with war veterans or victims of violent crimes. But yes, as you probably know from reading the first post, PTSD can come from a variety of experiences.

First let’s just go over the basic symptoms of PTSD:

• Depression
• Irritability
• Loss of interest
• Numbing
• Decreased concentration
• Insomnia
• Emotional overwhelm
• Loss of a sense of the future
• Hopelessness
• Shame and feelings of worthlessness
• Little or no memories
• Nightmares
• Flashbacks
• Hypervigilance (increased alertness to danger)
• Mistrust
• Anxiety/Panic attacks
• Chronic pain/headaches
• Substance abuse
• Eating disorders
• Feeling unreal or out of body
• Self-destructive behavior
• Loss of sense of “who I am”

This list is not comprehensive, but you can clearly see how a survivor of trauma might really struggle to function “normally.” The trauma they’ve experienced has also changed their perspective of the world. We base our perception of the world on our experiences and most of us expect that we can get through our day safely and without much distress or worry. For a trauma survivor, their world has been shaken and they no longer feel safe and they don’t feel that they can expect good things to happen to them.

I have found that when my clients look over a list of common symptoms of PTSD, they immediately feel some relief that what they have experienced is normal. Almost every time, I can see the understanding and peace that comes across their faces when they are validated in their experience. Now, one person will not necessarily exhibit every single one of those symptoms, although that certainly can happen. It’s important to note that these are the symptoms generally found in teenagers and adults. Trauma shows up differently in children and that information will come in it’s own post.

This is the handout I give my teenage clients and ask them to circle the symptoms they have experienced:

Do any of those symptoms seem to be familiar? Do you see them in yourself or a loved one? If you do, please seek professional help. Everyone deserves to leave a full life and to have a healed heart. YOU deserve better than to live with those symptoms every day, and it’s possible to move past your trauma and live a better life.

Big T, Little T

Welcome! I want to start with a little background on the inspiration for the creation of this educational blog. I have now been doing clinical therapy for about a year and a half since graduating with my Masters of Social Work and have found such a love for understanding and treating trauma. I recently met with the caregivers of a young girl who experienced trauma for the first 5 years of her life. Her caregivers were concerned about her behaviors and were looking for help in knowing how to support her. As I helped them understand how early childhood trauma affects the brain and the basic perception of the world and the self, I realized that this “basic” information really isn’t so basic to most people. Now, being a therapist, I realize my bias when I say how important I think it is that people understand the effects of trauma, and especially childhood trauma.

The fact of the matter is this: EVERYONE will experience some form of trauma in their life, if they haven’t already. Now you may think I’m wrong because trauma only comes in the form of a sexual assault or seeing war. So let me set the record straight.

Trauma can come in many different forms ranging from something as severe as rape or surviving a natural disaster all the way to growing up in a home where your feelings were invalidated and there was always the fear of doing something “wrong.” If you google “what is trauma,” this is what you get: 

“A deeply distressing or disturbing experience.” This could be the loss of a loved one, witnessing a violent crime, made to feel small or embarrassed by a loved one, etc. I like to describe trauma as any situation that we find ourselves feeling helpless or “stuck” and leaves us with an altered perspective of the world.

We differentiate types of traumas by referring to them as a Big Trauma and a Little Trauma (Big Ts and Little Ts).  A Big T is what typically comes to mind when we hear the word “trauma” such as experiencing abuse, neglect, or sexual assault. A Little T is more along the lines of being bullied at school, emotional abuse, or a death of a loved one. A lot of Little T’s can certainly add up and become what is called complex trauma, and it can have the same effects as one Big T if they are left to fester. Whether or not you’ve experienced a Big T, I’m certain that you’ve experienced a variety of Little Ts. Everyone’s experiences are different and each one of those Ts you lived through has altered or affected your worldview and self-perception in some way.

If you still think you haven’t ever experienced a trauma, that’s okay! I hope you’ll read this blog anyway to educate yourself on what trauma means for all of the survivors in your life. I promise you have come across them already, whether you know it or not. 1 in 4 girls and 1 in 6 boys are sexually abused by the time they are 18. That statistic ALONE should tell you something about the people around you, and that’s only one kind of trauma.

So take this knowledge into consideration as you interact with others around you. Have some compassion for their idiosyncrasies and quirks, because you never know what they have had to do to survive.