Young adult in jeans and hoodie sits against station wall, hands covering face, knees up to chestHumans are complex creatures. We operate on many levels simultaneously, and not all of these levels are in our conscious awareness. Therein lies the potential for internal conflict, which can sometimes feel impossible to resolve. We may not even be clear on what is causing the internal conflict in the first place:

“Why do I get so angry?”

“Darn it, why can’t I sleep? I have to get up in four hours and I’m going to be exhausted!”

“Why can’t I stand up to her? I argue with her in my head all the time, yet when she’s actually there, I just can’t stick up for myself.”

“I know it’s dangerous to tailgate; why do I do it?”

“There I go, overreacting (or under-reacting) again!”

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These internal battles are difficult to fight. They can create a profound lack of trust in ourselves. Exasperated, we might shrug and say “it’s just my personality” or “it’s genetic; my father was just like that.” These statements create an air of inevitability, as though we’re just going to have to learn to live with this aspect of ourselves. I’ve noticed “genetics” is a favorite fallback for when we don’t understand the threat response cycle, or the formerly adaptive learning that now contributes to our self-created troubles.

Of course, every person is unique. We all have cultural, familial, genetic, and individual components of our characters and behaviors, as well as unique histories. In this article, we are looking at a major portion of the equation that is often overlooked: the underlying psychophysiological (mind-body) “engine” that drives these responses. If the cortex (our “thinking brain”) is the road map, then the autonomic nervous system is the engine. (Might I note few cars go to the mechanic for GPS problems!)

According to Dr. Stephen Porges, the human nervous system essentially has the following “gears” available to it:

All of these gears are responses to the environment and are designed to help ensure our survival.

Unlike a car’s gears, these human “gears” aren’t mutually exclusive. We can be primarily in social engagement, but feel the beginnings of the fight response begin to stir within us. Or we may be mostly frozen and immobile, but feel anxiety (flight) creeping up.

If we are in a safe and generally supportive environment, the healthy, well-balanced nervous system is in social engagement most of the time. In other words, it’s not wasting precious life energy by revving up into anxiety or anger when there is nothing actually threatening at the moment.

If something does start to go wrong in the social environment, a well-balanced nervous system will go to that social engagement option first: it tries to solve problems via discussion or negotiation, not jumping right into fight or flight. It uses exactly as much fight/flight/freeze as the situation warrants, and no more. All four responses are freely available, and our automatic perception of safety/threat, called neuroception, makes a snap judgment about which one to go to.

However, our previous learning comes into play. Our system goes to what has worked in the past, and it avoids what hasn’t worked. So if you grew up with a very angry parent, when you encounter stress as an adult, you might:

Your automatic, default response in any given situation depends on what your autonomic nervous system found most helpful in previous situations of high stress.

Implicit in this model is the fact the more we drop out of social engagement and into a threat response, the more our survival energy is running the show and the more our frontal cortex (reasoning, socialization) goes offline. This explains why, under stress, we can engage in behaviors we really disagree with later.

The freeze response is closely related to tonic immobility, a state in which the body becomes motionless (like a possum). It’s also related to dissociation (disconnecting from one or more aspects of our experience). When it becomes chronic, it is also closely related to depression.

Let’s take a moment to focus on the freeze response, which generally tends to be the least understood of all of our “gears.”

The freeze response is closely related to tonic immobility, a state in which the body becomes motionless (like a possum). It’s also related to dissociation (disconnecting from one or more aspects of our experience). When it becomes chronic, it is also closely related to depression. The freeze response comes up when the organism decides whatever is facing it is overwhelming, too much to cope with. Fight or flight won’t work. Therefore, it “decides” the best strategy is to hold still, be uninteresting, and see if the threat passes. Young children, who lack capacity for fighting or running away, are particularly prone to getting stuck in the freeze response.

In terms of self-regulation, the freeze response arises when the charge in the sympathetic nervous system climbs too high (fight/flight isn’t working!) and thus the parasympathetic activates at the same time, effectively buffering the high SNS charge. (For explanation of fight, flight, and freeze charges, please refer to my previous article.) People in freeze response look like they’re in a low-energy state, but it’s really a well-camouflaged high-energy state. It’s very costly to the body, especially when it sticks around longer than it needs to. And the nervous system can be slow to come out of this state.

None of these responses are a conscious choice. Many police officers, firefighters, and other first responders feel guilty when they freeze under stress, but it is neither their fault nor under their control. It’s been my consistent experience that these states can indeed be re-regulated, at least partially, so the autonomic nervous system adopts a healthier balance and more adaptive responses. This happens over time, with consistent work, and you have to be able to “speak reptile brain”—that is, know how to access and work with the unconscious part of the body-mind. I have generally not found it effective to work with these states via cognition alone, because cognition becomes unavailable under high-stress states. Somatically oriented psychotherapy, yoga, art therapy, and psychodrama are among the solutions many have found helpful when wrestling with the question of how to bridge the gaps within.

References:

  1. Arnsten, A.F., Raskind, M.A., Taylor, F.B., and Connor, D.F. (2014). The Effects of Stress Exposure on Prefrontal Cortex: Translating Basic Research into Successful Treatments for Posttraumatic Stress Disorder. Neurobiology of Stress, Vol. 1, January 2015, p. 89-99. Retrieved from http://www.sciencedirect.com/science/article/pii/S2352289514000101
  2. Porges, S. W. (2011). The Polyvagal Theory: Neurophysiological Foundations of Emotions, Attachment, Communication, and Self-Regulation. New York, NY: W.W. Norton and Company.

Rear view of person on leaf-strewn forest road stretching arms up to the sky Imagine being able to make significant progress in healing from posttraumatic stress in one therapy session. Several mental health practitioners using accelerated resolution therapy (ART) have told me of such stories.

ART is a relatively new brief therapy for treating a variety of behavioral health issues. Effective relief has been shown to be achieved even for combat veterans in only three to five sessions (Kip et al., 2013). It is now being used in a number of U.S. Army hospitals, such as Walter Reed and Fort Belvoir, and is expected to expand through the armed services rapidly. The Federal Substance Abuse and Mental Health Services Administration (SAMHSA) has recognized ART as an evidence-based treatment for depression and depressive symptoms, personal resilience and self-concept, and trauma and stressor-related conditions (PTSD) (Accelerated Resolution Therapy, 2015).

What Is ART?

ART is an eye-movement therapy. The person in therapy moves their eyes back and forth following the therapist’s hand, and the therapist gives specific directions before each set of eye movements. ART draws on a number of other established and evidence-based therapies, such as cognitive behavioral theory, gestalt, and eye movement desensitization and reprocessing (EMDR). However, it is unique in being a procedurally oriented therapy. Other therapies typically focus on the content of the person’s thoughts and emotions.

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Since ART is procedurally oriented, the person in therapy doesn’t have to talk about what happened. This makes the approach great when working with people who may have trouble talking about their emotions, as might some individuals in the military. It also may be easier on the therapist, who doesn’t have to experience secondary (vicarious) trauma as a result of hearing about terrible things.

ART Is Said to Work Quickly

Very rapid healing is a hallmark of accelerated resolution therapy. Many therapists trained in ART report people can heal from a single traumatic event—such as an auto accident, assault, or witnessing an atrocity—in as little as one session. Some therapists report healing phobias in one session as well.

One consideration when choosing a therapy is how likely the person is to complete the full course of treatment. The longer a therapy takes to complete, the less likely it is the person will complete it. Because it is such a brief treatment, more people may be likely to complete a course using ART.

I recently watched the developer of ART, Laney Rosenzweig, heal a woman from two phobias in less than an hour. These very rapid results may seem unbelievable to someone familiar only with other therapies. Most of the evidence-based therapies for treating posttraumatic stress expect to take between 12 and 20 sessions to be effective. ART, meanwhile, has been shown to be effective in only three to five sessions in scientific studies of both military and civilian populations (Kip et al., 2012; Kip et al., 2013; Kip et al., 2014).  It was even shown to be effective working with a population of homeless veterans (Kip et al., 2016). Some of them didn’t complete treatment because they found jobs or housing, but despite this, a study found a success rate of over 50%.

One consideration when choosing a therapy is how likely the person is to complete the full course of treatment. The longer a therapy takes to complete, the less likely it is the person will complete it. Because ART is such a brief treatment, more people may be likely to complete a course using this approach to healing.

How Does ART Work?

Research is still pending, but eye movements used in ART are believed to have some link to the sort of eye movement seen in REM sleep, when the brain is believed to be processing the day’s events. We used to believe memories were fixed and that accessing one was like taking a book from a library, looking at it, and then putting it back. In fact, we have found accessing a memory makes it plastic; it can then be altered by the sort of techniques employed by ART. After four to six hours, the memory reconsolidates and the altered (new) memory is stored.

Who Can Benefit from ART?

ART has been used with a wide variety of people. Children as young as 4 have been treated with ART, and I recently utilized the approach to help a 16-year-old male with an IQ of 66. This method has been researched in both military and civilian populations, and similar effectiveness results have been obtained within both populations. (Kip et al., 2015).

Basically, three things are necessary for ART to be successful. The person receiving the treatment must be motivated to heal, capable of tracking the therapist’s hand with their eyes, and able to hold on to a thought.

How ART Differs from EMDR

Col. Charles Hoge, an Army psychiatrist who trained in both EMDR and ART, compared the two and noted 10 points of difference (Hoge, 2015). Some of the major ones are:

Why You May Not Have Heard of ART

If ART is so good, why haven’t you heard of it? There are two good reasons.

First, it’s new, having been introduced only in 2008 by its developer, Rosenzweig. Most other evidence-based treatments for posttraumatic stress have been around for over 25 years. Awareness is mostly spread by word of mouth, from one therapist to another, from one person in therapy to another. So far, fewer than 1,000 therapists have been trained in ART, and the vast majority of these therapists are located on the east coast of the U.S.

The second reason is sheer disbelief—based on the length of time it takes for other therapies to work, the ability to heal a person from one traumatic event in only a few sessions (or perhaps just one) simply seems unbelievable to many people, including therapists.

What’s Next for ART?

SAMHSA has identified ART as a “promising” therapy for disruptive behavior issues and antisocial behaviors; phobias, panic, and generalized anxiety; and sleep and wake conditions. These areas all need to be investigated via further research.

In addition, many therapists are reporting success in treating substance abuse and obsessive-compulsive issues with ART, but this type of treatment requires two sessions a week in the early stages.

References:

  1. Accelerated resolution therapy. (2015, May 22). Retrieved from http://nrepp.samhsa.gov/ProgramProfile.aspx?id=7
  2. Hoge, C.W. (2015). Accelerated resolution therapy (ART): Clinical considerations, cautions, and informed consent for military mental health clinicians. Walter Reed Army Institute of Research. Retrieved from http://acceleratedresolutiontherapy.com/wp-content/uploads/2016/08/ART-vs-EMDR_by-Hoge.pdf
  3. Kip, K.E., D’Aoust, R.F., Hernandez, D.F., Girling, S.A., Cuttino, B., Long, M.K., … Rosenzweig, L. (2016). Evaluation of brief treatment of symptoms of psychological trauma among veterans residing in a homeless shelter by use of Accelerated Resolution Therapy (ART). Nursing Outlook, 64:411-223.
  4. Kip, K.E., Elk, C. A., Sullivan, K. L., Kadel, R., Lengacher, C. A., Long, C. J., … Diamond, D. M. (2012). Brief treatment of symptoms of post-traumatic stress disorder (PTSD) by use of accelerated resolution therapy (ART®). Behavioral Sciences, 2(4), 115–134. doi:10.3390/bs2020115
  5. Kip, K.E., Hernandez, D.F., Shuman, A., Witt, A., Diamond, D.M., Davis, S.E., … Rosenzweig, J. (2015). Comparison of accelerated resolution therapy (ART) for treatment of symptoms of PTSD and sexual trauma between civilian and military adults. Military Medicine, 180:964-971. PMID: 26327548
  6. Kip, K.E., Shuman, A., Hernandez, D.F., Diamond, D.M., Rosenzweig, L. (2014). Case report and theoretical description of accelerated resolution therapy (ART) for military-related post-traumatic stress disorder. Military Medicine, 179(1): 31-7, 2014. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/24402982
  7. Kip, K.E., Rosenzweig, L., Hernandez, D.F., Shuman, A., Sullivan, K.L., Long, C.J., … Diamond, D.M. (2013). Randomized controlled trial of accelerated resolution therapy (ART) for symptoms of combat-related post-traumatic stress disorder (PTSD). Military Medicine, 178(12): 298-309. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/24306011

One blurred figure stands against wall of water on a glass window provides an interesting view of the world outside.The experience of trauma often shapes our beliefs of self, other, and world. In turn, those beliefs shape our relationships, pervade our families, spread to our communities, and stretch across societies. Our attachment styles and strategies, which can be categorized by individual beliefs about dependency and support in the wake of interpersonal trauma, often correspond to early relational traumas.

Attachment styles are most often associated with parenting or romantic relationships. They shape the ways we lie and/or cheat. They might define our sexual fantasies and influence our decision to pursue sex as a shared or solo practice. They help mold our political and religious views, boundaries in friendships, assessment of dangerous situations, physical health, epigenetics, over- or under-utilization of health and human services, and interactions with employers or any other authority figure or system.

They may further impact a wide range of interactions between self and other:

Trauma-molded beliefs may predict our ability to thrive or fail when life presents obstacles. In our culture, we can see these extreme echoes and reflections of trauma. They are in the vernacular, the language that defines and divides geographic regions: “Buck up. Emotion is weak. We don’t ask for directions.” These are all avoidant, counter-dependent messages, often assigned and attributed to males in our culture. These are also vestiges of the “rugged individualism” that shaped our country.

The constructed rules that dictate social interactions originated at some point from individual attachment styles that developed in direct response to relational trauma. These internal rules, formed during individual traumas, eventually externalize and spread outward, permeating cultures and influencing conflicts on a grander scale. Rules and beliefs related to anxious attachment—“Your partner is responsible for your emotions, is supposed to take care of you. Individual needs do not matter. It’s more important to belong, to share everything—”can also spread. There is no escaping trauma in this world, and trauma can interrupt even the most robust and healthy generational patterns.

With anxious attachment, there may be a tendency to blame the parents. While it’s true we do form attachment beliefs based on our relationships with our caregivers, in the greater scheme, the trauma-broken innocence was also true for them, for their parents, and for their parents’ parents.

There is no escaping trauma in this world, and trauma can interrupt even the most robust and healthy generational patterns. In the wake of trauma, we are forced to relearn ways of connecting with self and other. And the relearning can span generations—generations that are likely, in the meantime, to be interrupted again by other traumas.

Basic Trauma/Attachment Reactions

Our trauma reactions are hardwired into these vessels we inhabit. The theory of a “defense cascade,” supported by Porges’ polyvagal theory, suggests our trauma responses occur in a specific sequence: we move from our “social nervous system” to “fight or flight” and then to “freeze.”

The work of Peter Levine, developer of Somatic Experiencing®, supports another idea: longer-held, character-shaping postures that are often the response to ongoing or repeated trauma also occur in sequence. To escape from these postures, then, it may be necessary to traverse the sequence in reverse: from freeze, through fight or flight, and then back to social connection.

What follows is a framework of attachment styles that serves as both a defense “cascade” and a progression through beliefs of dependence or abandonment. Note that, while this is presented as a “simplified” model, humans are not simple. We each come with hardwired temperaments and a variety of motivation systems—though our survival and attachment systems often overrides these—and we internalize multiple caregivers. Few of us remain consistently in one attachment style across a range of situations.

Stage 1: Secure Attachment, Internalized Connection

In this stage, the trauma response is one of connection: “I am supported; I can depend on self and other.” The mind and body function in harmony, and desires are easy to identify and express. Individuals may be more discerning in their relationships and better able to move on when a relationship is not working. Posture is more likely to be relaxed and expressive or nonreactive, and a person may be able to bond more easily. The internalized connection may be more attuned: the internal parent is connected, curious, and welcoming, while the internal child is soothed and regulated.

Stage 2: Anxious Attachment, Internalized Abandonment

When threat is imminent, our bodies mobilize into action. We may become loud, often drawing attention intentionally. This anxious stage represents the duality of a screaming child being abandoned and an internalized parent who may be overwhelmed or fleeing from that child. As this relationship is projected onto the world, the feelings of abandonment may feel insatiable. Finding no internal support, the child reaches out to other people in desperation, sometimes chasing and clinging.

The trauma response here is one of fight. Flight is a non-option because it leads away from other, from life. A person who is in this stage may resort to expressive or reactive strategies in order to elicit a response, with an attitude of dependence: “I need you. You’re supposed to take care of me.” A person may experience chaotic or limited boundaries, easily merging with others and losing their sense of self. The body may overwhelm the mind, making it hard to separate the wants of the self from the wants of another.

Relationships may be characterized by hypo-discernment: A person may remain with a partner they no longer care for in order to avoid being alone. In abandoning or being unable to access the internal self, a person may become unable to connect to others in the present moment. Individuals in this stage may create “drama” to amplify their needs and test or sabotage friendships. In a relationship, they may feel abandoned easily and tend to seek romantic or sexual support outside the relationship when they perceive their partner as unavailable.

For healing to take place, a person typically must learn to be with self enough to feel the presence of other.

Stage 3: Avoidant Attachment, Internalized Oppression

We fall into freeze when the energy of fight or flight is spent and neither sequence has completed. Freeze also remains the default when both fight and flight are non-options, as is the case for many children. At an internal level, avoidant attachment develops in reaction to anxious attachment that evoked punishment. As this is a step beyond (or a layer atop) stage 2, the challenge lies first in gradually learning to trust other, then in dealing with the intense feelings of abandonment that lie hidden and compartmentalized beneath this secondary defense.

Individuals in this stage may be more likely to hide in order to minimize attention and potential judgment, and they may be less active in the pursuit of their goals. Counter-dependence means they often avoid asking for help, may avoid doctors when sick, and feel resentment when others act in dependent ways. In the long term, there may be a sense of being stuck—limited facial expression, decreased connection to body and emotion, immobility, lack of energy, risk aversion, and a preference to be alone and away from judgment. There is a knowing, in this state, that to be with others means to lose self, to give up agency or will. People in this stage may think, “If I seek support, I will be attacked. I should get small. Remain quiet. Avoid becoming a target. There is only self.”

In relationships, this freeze state often plays out in hesitation, fear, lack of engagement, minimal expression, low motivation, limited enthusiasm, and greater attunement to anger and controlling actions in others. Those using avoidant strategies tend to look for ways to get out of a relationship before commitment enters the picture. This is the partner who lives with one foot out the door, resists talking about the future, and struggles with dependence in both self and other. Active and impenetrable boundaries preserve self from threat of other, limiting intimacy and threatening relationships.

Relationships may be characterized by hyper-discernment: Individuals may spend years or decades choosing the “perfect” partner, and they may be more likely to leave a friend/partner/lover they truly love after spending years struggling with the relationship, realizing afterward they were simply dissociated from their fear of being alone.

People may be more likely to seek alone time, even lying about demands on them in order to justify the need for space. They are more likely to use unintentional gaslighting as a means of deflecting attention/punishment. While less likely to verbalize their needs, they may tend to blame others for not meeting those needs. Avoidant strategies can, without being directly antagonistic, assert dominance in passive-aggressive ways, such as withdrawal as punishment. Even breakups might be handled in indirect and often ineffective ways—investing months or years trying to get one’s partner to initiate a breakup, for example. With a goal of protecting freedom and agency, individuals may disengage and even dissociate to maintain self as separate from other.

With awareness and attention, meeting self can feel like coming home, and we can begin to elicit and receive from the world what we have needed all along.The avoidant stage represents a reaction to a reaction. The duality of the first stage is still present, but the internalized parent (or protector) has become oppressive instead of abandoning. “We cannot show this neediness to the world. It is weak. It brings social and physical threat.” Tools used in this stage include dissociation and compartmentalization, as individuals attempt to simply maintain baseline survival functions. Strategies in this stage attempt to separate from dependence and present as self-sufficient. Individuals may be unable to identify or verbalize physical sensations in the present.

Completing the Circuit

Presence occurs only in the completed circuit between self and other. This is more than a connection between two parties. Each side must be connected within in order to feel connected without, and vice versa. For the anxious side, this step means moving more toward self and mind. For the avoidant side, it means reaching toward other and landing in body. In attachment terms, if we cannot bear remaining present with the full experience of self and other simultaneously, connection may elude us, and trauma will persist.

We can look out into the world and see the undercurrent of attachment in every facet of existence—every choice, every reaction, every interaction. We rarely see the person before us. When we look into our partner’s eyes, we see the people behind us that laid the groundwork, the ones that defined our beliefs about the possibility of connection.
We meet ourselves in the same ways our caregivers met us, and in doing so, we continue to feel the same pain.
The outside world reflects our internal world. Through our own perceptions and projections, then, the world meets us the way we meet ourselves.

As we learn to meet ourselves with empathy and compassion, our experience of life can change. It may become a little softer, a little more manageable. With awareness and attention, meeting self can feel like coming home, and we can begin to elicit and receive from the world what we have needed all along.

References:

  1. Diamond, D., Blatt, S. J., & Lichtenberg, J. D. (2007). Attachment & Sexuality. New York, NY: Analytic Press.
  2. Levine, P. A. (1997). Waking the Tiger: Healing Trauma: The Innate Capacity to Transform Overwhelming Experiences. Berkeley, CA: North Atlantic Books.
  3. Noricks, J. S. (2011). Parts Psychology: A New Model of Therapy for the Treatment of Psychological Problems through Healing the Normal Multiple Personalities Within Us: Case Studies in the Psychotherapy of Mental Disorders. Los Angeles, CA: New University Press.
  4. Porges, S. W. (2011). The Polyvagal Theory: Neurophysiological Foundations of Emotions, Attachment, Communication, and Self-Regulation. New York, NY: W. W. Norton.
  5. Siegel, D. J. (2010). Mindsight: The New Science of Personal Transformation. New York: Bantam Books.
  6. Van der Kolk, B. (2014). The Body Keeps the Score. New York, NY: Viking.

Sepia-toned image capturing motion of child running up to parent and leaping into parent's armsThe adoption of a child is an event, fixed in time, with a beginning and an end. However, the impact of adoption is far-reaching and ever-changing—a process that continues throughout the lifespan of the adopted person and those connected.

It’s been my professional experience that many individuals who were adopted share similar symptoms, beliefs, and reactions in the present that stem from the separation trauma of parting from their biological mother at birth. Multiple placements, foster care, or time in an orphanage can exacerbate this trauma.

An infant or child separated from their birth mother will almost certainly experience some level of trauma, as they will perceive this event to be a dangerous situation. The sensations, sights, and sounds with which they were familiar are gone, and the mother is no longer available to soothe the child or help the child self-regulate. Because the only part of the brain fully developed at birth is the brain stem—this controls the sympathetic nervous system, which generates the “fight, flight, or freeze” response—babies are unable to use parasympathetic abilities, such as self-soothing. When this happens before the age of 3, it is encoded as implicit memory—like any event that takes place before the development of language. As noted trauma expert Bessel van der Kolk explains in his book The Body Keeps the Score, “We have learned that trauma is not just an event that took place sometime in the past; it is also the imprint left by that experience on the mind, brain, and body.”

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Eye movement desensitization and reprocessing (EMDR) is an integrative therapy originally developed by Francine Shapiro to alleviate distress associated with traumatic memories. When a traumatic event occurs or something happens that is perceived as traumatic, the associated memories may become stored in the brain and nervous system in a maladaptive way—frozen rather than processed. Current reactions are fueled by negative beliefs stemming from events that occurred in the past. People become stuck. In some cases, trauma that happened years ago continues to feel like it’s happening in the present.

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EMDR therapy targets the unprocessed memory as well as the emotions, beliefs, and body sensations associated with it. Bilateral stimulation (generally eye movements, tapping, or tones) activates the brain’s information processing system, allowing the old memories to be digested or reprocessed and stored in an adaptive way—even if the person doesn’t have an autobiographical account of the memory. For many adoptees, the trauma happened before they developed the language to explain the events, so the memory is primarily somatic in nature and stored in the nervous system.

Many adoptees have issues related to attachment ruptures. An adopted child whose parent is a few minutes late to pick them up from school may dissolve into tears. The internalized belief or negative cognition that child develops may sound something like “It’s not safe to trust” or “People I love leave me.” An adult who was adopted may unknowingly recreate abandonment scenarios in relationships, unconsciously choosing partners who are not truly available and do leave, fulfilling the negative belief “I am not worth it” or “I am not lovable.”

Using bilateral stimulation, EMDR helps integrate the early memories, body sensations, emotions, and negative beliefs the person has. Over a series of sessions, symptoms are reduced, and beliefs associated with the memories or experience are shifted to a more positive and adaptive state.

In both examples, the reaction in the present is disproportionate to the situation. This is useful information that some feeling, experience, or memory from the past is being triggered. A much younger “self” is running the show. The fight, flight, or freeze response gets activated in these situations, and the prefrontal cortex, the part of the brain in charge of executive functioning and decision making, goes offline. The person may feel disregulated, scared, and confused.

So what does a typical EMDR session with an adopted person look like?

After gathering history and establishing rapport, the therapist and person in therapy work together to establish target memories and present triggers that are causing suffering and/or interfering with daily life. The “targets” are the starting points of the session and a point of reference to trace the memory back in time. Using bilateral stimulation, EMDR helps integrate the early memories, body sensations, emotions, and negative beliefs the person has. Over a series of sessions, symptoms are reduced, and beliefs associated with the memories or experience are shifted to a more positive and adaptive state.

Rather than the belief “I’m not lovable,” the person may be able to recognize and have a felt sense of worth despite what happened in the past. In my work with adopted individuals, I combine various EMDR protocols, guided imagery, mindfulness practices, and visualization to create calm states and nurturing figures in the present to help heal the wounds of the past.

EMDR is safe, effective, noninvasive, and powerful. It does not involve medication or hypnosis, and I’ve found it a wonderful adjunct to talk therapy in my work with people who were adopted. If you want or need support on your healing journey, find an EMDR therapist in your area.

Reference:

van der Kolk, B. (2014). The Body Keeps the Score: Brain, Mind, and Body in the Healing of Trauma. London, UK: Penguin Books.

Close-up shot of two people holding hands on top of a table, water glasses out of focus in backgroundAlthough trauma-informed therapy is gaining in popularity, one crucial component is often missing from the conversation—the importance of healing from a perceived lack of relational safety that often accompanies posttraumatic stress (PTSD).

If you have experienced a life-altering traumatic situation, you may understand all too well the more commonly discussed symptoms of PTSD:

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While you may experience some or all of these symptoms as a trauma survivor, they paint only a part of the picture. Taken together, these symptoms often have an unfortunate effect of causing a person experiencing PTSD to distrust themselves and the world around them; to isolate by numbing or avoiding discussing their thoughts or experiences with others; and to feel unsafe in their body due to the hyperarousal symptoms. Healing from PTSD requires connection to friends, family, and community, support from others who have experienced similar symptoms, and a strong therapeutic connection with a therapist who understands how to help heal trauma symptoms. These relationships help restore both a belief and a felt sense that the world can be safe. Yet, paradoxically, PTSD causes those very connections to feel dangerous and threatening rather than potentially healing.

The first step to healing from trauma is recognizing the ways in which symptoms may cause you to want to isolate from others, whether loved ones or support groups or a therapist. This recognition is important, as it will be necessary when pacifying any fear, anxiety, or panicked feelings you may experience while interacting with others. These feelings are natural and understandable in the context of understanding trauma can cause a lack of trust in the world and in others. This can be even truer if the trauma was a result of harm caused by others rather than a natural disaster or events not directly related to a human cause.

Once you have noticed and recognized these isolating behaviors as being an effect of having experienced a traumatic event, you have the choice to deliberately make decisions and take actions that could lead to connection and trust.

While post-trauma survival instincts may cause you to feel most comfortable trusting only yourself, to isolate from others, or to turn to coping behaviors such as drinking or working long hours, these behaviors may prevent you from reestablishing connection and trust in the world and yourself—vital for healing from the effects of trauma and living a satisfying life. The effects of isolation can be even greater if you are living with the symptoms of PTSD caused by traumatic occurrences in childhood, in which case you may never have had the chance to build or experience deep, loving relationships or trust in the world around you.

Once you have noticed and recognized these isolating behaviors as being an effect of having experienced a traumatic event, you have the choice to deliberately make decisions and take actions that could lead to connection and trust. This may feel frightening or difficult, and you may find yourself having thoughts about other people being unsafe, untrustworthy, or not worth the effort. It is important to take small steps that may be counterintuitive to what your survival-based instincts are telling you, and then stop to reassess to see if your perceptions were true or not.

Two of the best places to experience safety and healing within a relationship are in therapy with a safe and understanding therapist, and in therapeutic or support group settings with others who understand your experiences.

If you are living with symptoms of PTSD, it is possible to recover and feel better. With courage, patience, and the help of experienced professionals and caring peers, you can rediscover the strength within to live a satisfying and meaningful life.

Rear view of person with long hair in tank top standing in open doorway and looking outsideTrauma bonds occur in very toxic relationships, and tend to be strengthened by inconsistent positive reinforcement—or at least the hope of something better to come. Trauma bonds occur in extreme situations such as abusive relationships, hostage situations, and incestuous relationships, but also in any ongoing attached relationship in which there is a great deal of pain interspersed with times of calm (or maybe just less pain). I liken it to a heroin addiction—the trauma bond relationship promises much, gives fleeting feelings of utopia, and then it sucks away your very soul.

If you or someone you know has been in an abusive relationship, you have witnessed the strength of this type of relationship. Maybe you or someone you know is trying to get out, but seems incapable of leaving.

Well, there is hope. Here is some advice on how to break a trauma bond:

1. Make a commitment to live in reality

If you find yourself wanting to fantasize about what could be or what you hope will be, stop. Remind yourself that you have made a commitment to live in truth. Even if you don’t choose to leave the relationship immediately, in the meantime you can at least remind yourself that you will stop fantasizing about what is not happening.

Reach out to one of our therapists in Houston, TX, or find a city closer to you.

2. Live in real time.

That means stop holding on to what “could” or “will” happen tomorrow. Notice what is happening in the moment. Notice how trapped you feel. Notice how unloved you feel and how you have compromised your self-respect. self-worth and self-esteem for this relationship. Pay attention to your emotions. Stop hoping and waiting, and start noticing in real time what is happening and how it is affecting you and your well-being.

3. Live one decision at a time and one day at a time.

Sometimes people scare themselves with all-or-nothing thinking. Don’t tell yourself things like, “I have to never talk to the toxic person again or else”; this is akin to trying to lose weight by telling yourself you can never eat chocolate again. While it is true that your relationship is an unhealthy one, you don’t need to make every encounter a do-or-die situation. Don’t scare yourself.

4. Make decisions that only support your self-care and sense of self.

That is, do not make any decision that hurts you. This goes for emotional “relapses” as well. If you find yourself feeling weak, don’t mentally berate yourself, but rather talk to yourself in compassionate, understanding, and reflective ways. Rather talk to yourself in compassionate, understanding, and reflective ways. Remind yourself that you are a work in process and it is a part of the healing process. You will have highs and lows and that is okay. Do not make the uncaring decision to mentally beat yourself up. In every encounter you have with the object of your obsession, stop and think about each choice you make. Make choices that are only in your best interest.

5. Start feeling your emotions.

Whenever you are away from the abusive person in your life and feel tempted to reach out to them for reassurance, stop. Consider writing your feelings down instead. Write whatever comes to you. For example, “I feel ____. I miss ____. I wish I could be with ____ right now, but I am going to sit and write my feelings down instead. I am going to teach myself how to feel my way through the obsession, rather than turning to ____.” This may help you to build inner strength. Learn to simply be with your emotions. You don’t need to run from them, hide from them, avoid them, or make them go away. Once you fully feel them, they may begin to subside. Remember: the only way out is through.

6. Learn to grieve.

Letting go of a toxic and unhealthy relationship and breaking a traumatic bond may be one of the hardest things you ever have to do. You cannot do it without honoring the reality you are losing something very valuable to you.

7. Understand the “hook.” Identify what, exactly, you are losing.

It may be a fantasy, a dream, an illusion. Perhaps your partner had convinced you into believing they were going to fulfill some deep, unmet need. Once you can identify what this need (or hook) is, you can get down to the business of grieving. Grieving means (figuratively) holding your hands open and letting it go. You say goodbye to the notion the need you have may never be met. At minimum, it will not be met by this relationship.

8. Write a list of bottom-line behaviors for yourself.

Possible examples: “(1) I will not sleep with someone who calls me names. (2) I will not argue with someone who has been drinking. (3) I will take care of my own finances. (4) I will not have conversations with anyone when I feel desperate (or defensive, or obsessive, etc.).” Whatever your areas of concern, determine what you need to do to change and make those your bottom-line behaviors.

9. Build your life.

Little by little, start dreaming about your future for yourself (and your children, if you have them); in other words, make dreams that don’t involve your traumatic partner. Maybe you want to go to school, start a hobby, go to church, or join a club. Start making life-affirming choices for yourself that take you away from the toxic interactions that have been destroying your peace of mind.

10. Build healthy connections.

The only way to really free yourself from unhealthy connections is to start investing in healthy ones. Develop other close, connected, and bonded relationships that are not centered on drama. Make these your “go-to” people. It is extremely difficult to heal without a support system. Notice the people in your life who show you loving concern, and care and hang around with them as often as you can. Reach out for professional help as needed.

 

Side view of wolf on snowy hill, ears perked, head high, looking off to right side of photoAs we begin, here is an invitation for you:

In your mind’s eye, create a mental picture of a wolf. The wolf is alone; perhaps he is a young male who’s just left his mother’s side, setting out for his first solo adventure. The sun is setting, and our wolf is atop a hill, standing, all four paws on the ground. His head is high, his eyes scanning the horizon. His ears are perked, swiveling to capture sounds from all around. His nose receives all sorts of information from the evening breeze, information that would be imperceptible to us, his human observers. Perhaps his tail is lifted ever so slightly as it curves gracefully behind him. He is fully alive, vibrant, and completely in the present moment.

Now imagine what it would feel like to be that wolf. Feel the pads of your four paws on the ground, the bones and sinews of your legs supporting your spare, muscular torso. Feel your spine elongate as you gently test the wind with your finely honed sniffer. Feel the strength and springiness in your shoulders, your haunches. Imagine you are ready to respond in a split-second to any tiny change in the environment, reacting from instinct before you can even think about it.

Feel the energy that arises in your body as you spend a moment with this experience. And congratulate yourself, because in doing this exercise, you are contacting your felt sense.

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The felt sense is a term coined by Eugene Gendlin to describe our innate sense of everything we know and experience in a wordless, non-cognitive way, from the interior of our bodies. The common term “gut instinct” is closely related, as is the scientific term interoception, the process of sensing inside the body. Dr. Gendlin founded a school of therapy he called focusing. Essentially, focusing involves paying attention to our felt sense, and learning how to work with what it has to say. As the focusing website says, “This sensation in your body is called a ‘felt sense.’ It lies behind your thoughts and feelings and is significant and full of meaning. It is a message from your body to you, and will speak to you when you listen.” As Dr. Peter Levine is fond of saying, its language is sensation.

Much of this non-cognitive, somatic information involves not only our body, but also our reptile brain. As I have noted in previous articles, we are interested in the body and the reptile brain because this is where most mental health symptoms “live.” The felt sense is the place where we can work with painful symptoms to get them to subside. Then, the energy these symptoms used to drain from us becomes available for more joy and more productive engagement with the world.

Although modern Western thought has been quite resistant to this idea, there are other valid ways of knowing things besides our thoughts. In some cultures, people regularly converse about this innate, biological, or instinctual source of knowledge. As owners of living, human bodies, our access to our intuitive felt sense is our birthright! It is where the experiences of pleasure, joy, and liveliness originate.

Our felt sense is incredibly useful when we cultivate a relationship with it. As the focusing website points out, “Your body knows more about situations than you are explicitly aware of. For example, your body picks up more about another person than you consciously know.” Although modern Western thought has been quite resistant to this idea, there are other valid ways of knowing things besides our thoughts. In some cultures, people regularly converse about this innate, biological, or instinctual source of knowledge. As owners of living, human bodies, our access to our intuitive felt sense is our birthright! It is where the experiences of pleasure, joy, and liveliness originate. Unfortunately, there is very little discussion or guidance about the felt sense in our culture.

So, then, how do we cultivate a better relationship with this “interior us”?

Well, some of us have to be careful about it. If we have a trauma history, whether or not we’re aware of it, the felt sense is (predominantly) where it lives. In my experience, this is why some people have a difficult time even accessing any of their interior sensations: They are dissociated (disconnected) from their inner selves as a protection from the traumatic residue.

Unfortunately, shutting down pain inherently involves shutting down at least some pleasure. On the other hand, some people experience emotional flooding, physical pain, or other distressing experiences when they turn their focus inward. Of course, this is not true for everyone. People’s experiences with their inner selves vary greatly, largely depending on their life histories. Many people already have a rewarding and lively relationship with their inner lives—and that is ultimately one of the primary goals of somatic psychotherapy.

For more information about focusing, please refer to the focusing website. For those who suspect or already know that contacting this aspect of themselves can be challenging, I would recommend working with an experienced guide, such as a somatic psychotherapist. The work of Dr. Levine uses the felt sense as one of several fundamental tools for trauma healing. Pursuing such therapeutic support can greatly help in reclaiming access to one’s birthright of joy and vibrant well-being.

References:

  1. Gendlin, E. (2016). What is Focusing? The International Focusing Institute. Retrieved from http://www.focusing.org/newcomers.htm#what
  2. Levine, P. (2010). In an Unspoken Voice: How the Body Releases Trauma and Restores Goodness. Berkeley, CA: North Atlantic Books.

standing in a field of flowers with mistIt took a long time before I finally decided to see a psychotherapist—and for reasons that are probably very common:

It took a long time before I was able to acknowledge that my childhood had an effect upon my adult life. Again, with nothing to measure against, how was I to know? I took for granted that my self-doubt, low self-esteem, anxiety, irritability, and desire to be on my own were simply who I was. I didn’t even realize I kept people at a distance and shared nothing of myself because I had been that way all my life. It was simply my personality. I was an introvert. So what?

But thankfully, I began to piece together that negative patterns in my life were emerging and repeating. I recognized the depression I felt had begun in high school, continued and got stronger in college, and then became a recurrent theme in adulthood. After several failed relationships, the depression continued and grew intolerable. I had no idea my own self-imposed barriers against people were actually making things worse.

[fat_widget_right]At 34, I knew something was wrong because I was drinking more, not less. I could see I had always pursued relationships that were destined to fail from the outset, and if they weren’t, I would sabotage them so they did. Through either cheating or losing interest in sex, we would simply drift apart and become friends. For me, the concept of intimacy was repellent.

I give myself credit for recognizing I was stuck, unhappy, and highly unlikely to improve on my own. I was concerned about costs, so I searched and managed to find a therapy organization with a sliding scale fee. I forced myself to the initial consultation meeting, and was caught off-guard when the therapist fairly quickly asked me about my childhood. What would that have to do with anything? I managed to tell her it wasn’t happy. I had snippets of foggy, bad memories.

Over the next two months, I dared to open up to her. I told her about my mother, who had beaten me over the course of six years. It wasn’t my mother’s fault, I explained, because she’d experienced much worse: her father had committed suicide. After a particularly difficult session, I broke down for the first time. I told the therapist about a horrible beating and the announcement from my mother that she hated me.

But I was very fearful, and that would be my last session. I returned the next week and told the therapist I couldn’t afford to come anymore. My finances were too tight. She said I was always welcome to come back, and she was proud of the progress I had made.

While my first attempt at therapy ended prematurely because I was still unable to face painful, buried memories, it proved to me that something mattered about my childhood. I’d hidden it away for a reason. There was something inside me, because I’d never cried like that before.

It took about another 10 years before I dared to try therapy again. By then I’d become a poster child for dysfunction: anonymous hook-ups, juggling sex with multiple partners, heavy binge drinking on weekends, and depression. Thankfully—again—I recognized my patterns were not going to stop without outside help. I had proven myself powerless to make changes on my own.

Searching the internet, I found GoodTherapy.org. I liked I could explore psychological topics, and could find a large, supportive community.

Searching the internet, I found GoodTherapy.org. I liked I could explore psychological topics, and could find a large, supportive community. I located a doctor near my home with a specialty in childhood trauma. Though I had no idea what trauma meant, I thought back to my first experimentation with therapy, and surmised a childhood focus would probably be what I needed.

I was very nervous on the first meeting, but the therapist put me at ease. I felt an immediate rapport with him. When prompted, I told him about the “childhood” part. I showed him a scar just below my right eyebrow. My mother had thrown me and I’d caught my face on the corner of a wooden bookshelf. I wanted to be worthy of his time and was afraid he might find my case frivolous and refuse to see me. At the end of the session, I asked him if he thought we would be a good fit, and he said, “Very much so.”

About two years later I began a book, Grandson of a Ghost, as a therapeutic exercise. I still had difficulty comprehending that my childhood impacted my life, and the book helped me see—literally, in black and white—the ramifications. Here is an excerpt, taken from the moment when I was able to articulate how the abuse poisoned my sense of self:

For Scott, it was now clear that with no one to talk to, and with no frame of reference—in isolation—he grew up fearful of people and had a low self-image. The low self-esteem as a child made the world a scary place. It was terrifying before and after a beating. He was helpless and lacked any shred of control. Everything was potentially dangerous and threatening, laced with a fear of getting in trouble. Fear of making a mistake. Fear of others discovering he was actually something awful. The secret had to be hidden so that no one would find out. It would interfere with learning, because of the amount of mental energy required to keep the secret. He daydreamed constantly, lost in a fog. It made sense. He was ashamed, because he misbehaved and always made his mother cry. He didn’t deserve love, because he was the horrible dark seed somehow planted within the family and disrupting it.

Generational abuse—abuse passed down from parents to children—is a widespread problem, and it impacted my family after the suicide of my grandfather. It’s a difficult topic, and I hope my book can help people.

Three and a half years later, I am still with my therapist. My life has been transformed. The fog has lifted. I’ve learned not to overreact to threats, both real and imagined. I’ve learned to question and quickly parse an alarm. I’ve learned my abuse did have lasting repercussions. I’ve also learned that love means something. It matters. And before working with my therapist, I was closed to it. Now I see connection to others as the key that sets me free.

Scott Depalma is the author of the forthcoming book, Grandson of a Ghost. He grew up in Vermont and fled to New York City when he turned 21, unsure of anything except the need to run and disappear. Scott hopes his story helps others recognize that abuse has a lasting impact, but also that a new perspective (a rebirth) filled with joy and connection is possible at any age.

Person with long curly dark hair sits in grassy field with eyes closed, meditating peacefullyLife can be stressful for anyone, but for people dealing with the negative effects of trauma on top of everyday life, elevated stress levels can be much more common. One course of treatment for experiencing a more positive and peaceful life after trauma is eye movement desensitization and reprocessing (EMDR), a methodology originated by Francine Shapiro. It pairs specific protocols with bilateral stimulation—back-and-forth eye movements, alternating tones delivered through headphones, and/or alternating tactile stimulation such as vibrations delivered through hand-held pulsers. Part of the eight-phase EMDR protocol includes teaching the person in therapy a relaxation technique to recall when needed.

One of the most common relaxation techniques for EMDR is known as “safe place,” also referred to as “calm place.” This technique is part of the second phase of EMDR known as “preparation.” Prior to this phase, the person’s history is taken, assessments are performed to determine if EMDR is appropriate, and a treatment plan is prepared. This matters because before a counselor proceeds with EMDR, a person must be assessed for physical health, support system, and any tendency to dissociate. Therefore, it is imperative that all portions of EMDR protocols are performed only by a trained, qualified EMDR clinician.

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“Safe place” may be thought of as an emotional sanctuary where a person can internally go to recover stability when feeling stressed. Once the person has successfully learned to perform “safe place,” it is used in the reprocessing phase or to close a session. It is also useful in one’s everyday life between sessions when a person feels stress or a disturbance rising to a point they need to take out and use a coping tool from their internal toolbox.

‘Safe Place’ Protocol in EMDR

When “safe place” is taught to a person preparing for EMDR, the counselor will guide the person through the following steps shared by Shapiro (2001):

“Safe place” may be thought of as an emotional sanctuary where a person can internally go to recover stability when feeling stressed.

  1. The person is asked to picture an image of a place that generates feelings of calm and safety.
  2. The person is asked to focus on the physical sensations and emotions that are conjured while imagining the “safe place.”
  3. The counselor encourages a sense of security and may add soothing tones, such as ocean waves, to enhance the effect.
  4. While the person concentrates on the image, sensations, and emotions, sets of eye movements or other bilateral stimulation may be included to “install,” or strengthen, the “safe place.”
  5. The person is asked to think of a word to associate with the “safe place” and add this to the calm, safe image and sensations. Sets of bilateral stimulation are added.
  6. The person is asked to self-cue the image and feelings.
  7. The person is asked to think of a minor annoyance and its accompanying emotions. The counselor then guides the person through the exercise until the undesired emotions melt away.
  8. The person is asked to think of another disturbance and follow the exercise without the counselor’s assistance to ensure the person can perform the exercise unassisted.

The person should be instructed to practice “safe place” daily by retrieving the positive image, emotions, and sensations via the cue word. People can then use “safe place” to relax and reduce stress any time needed. Shapiro believes people preparing to be treated with EMDR can benefit not only the “safe place” visualization but also from listening to guided visualizations such as those included in Letting Go of Stress (Miller, 2014), as these may increase the the effectiveness of “safe place” as a means of self-control.

While “safe place” for EMDR should be taught by a qualified clinician, anyone can access guided meditation/visualization CDs and podcasts to help to manage stress, fall asleep at bedtime, and promote a positive self-image. These materials may be found for little or no cost through public libraries, iTunes, and online resources. Comments below sharing your favorite guided visualization/meditation resources are welcome.

References:

  1. Miller, E. (2014). Letting go of stress. San Anselmo, CA: Halpern Inner Peace Music.
  2. Shapiro, F. (2001). Eye movement desensitization and reprocessing: Basic principles, protocols, and procedures (2nd). New York, NY: The Guilford Press.

Dear GoodTherapy.org,

Three months ago, my husband returned from his second deployment to the Middle East. I was excited to see him and resume our life together, but he came back to me a changed man, and not for the better. He barely talks to me. He just sits there and watches television or goes out drinking or lays in bed all day. Every time I try to talk to him, he gets snippy and tells me to leave him alone. I can count the number of times we’ve had sex on one hand. He has made me cry numerous times and he acts like I’m not even in the room, let alone tries to comfort me or apologize.

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I have gathered from people I’ve talked to that he witnessed some horrific things while deployed, including bombings, shootings, and several deaths. He has told me he was shot at repeatedly. I don’t mean to downplay the effects that can have on a human being. I can’t imagine having been in that position. I don’t doubt that it would change me, too. I know he’s hurting terribly, and I want to help, but he won’t let me. He won’t let me in.

After talking it over with my parents, I’ve decided to leave him, at least for now. I just can’t subject myself to the hurtful language and behavior anymore. He’s not treating me like a wife or even a friend, but rather like the enemy. And yes, for the record, I feel guilty about leaving, but should I? I feel like I’ve done everything I can do. Maybe you have other ideas. I hurt for him, for me, and for our marriage. —Not the Enemy

Submit Your Own Question to a Therapist

Dear NTE,

Thank you for writing. I read your question with a heavy heart, feeling sadness for your husband and for you. I would not blame yourself or consciously nurture guilt or shame. It sounds as though distancing yourself was a necessary last resort. I do not think your husband is fully conscious of what he is doing, nor do I think you are acting selfishly.

Not to downplay your suffering in the slightest, but your husband has been to hell and back. His feelings and behavior are not inconsistent with other veterans exposed to such horrific trauma. It may be posttraumatic stress (PTSD) or dissociative numbness or some/all of the above, but I do know that too many of our veterans are not receiving the treatment they need and ought to have, considering their selflessness and risk. Not long ago I read that PTSD is not a qualifying condition for receiving the Purple Heart, that only obvious physical injuries qualify. This, I think, indicates the stigma of shame and corresponding ignorance accompanying mental health issues, which only superficially appears to undermine stereotypes of “bravery” and so forth. As always, we tend to be afraid of what we can’t tangibly see or explicitly define, and psychology remains a curious mix of art and science (and philosophy, and literature …).

Yet what could be braver than facing one’s own inner “demons”? A veteran I once treated briefly for addiction said he found facing “the monster within” was more frightening than actual gunfights he’d seen on assignment. Your husband is in the awful predicament of needing to process indescribably hellacious experiences, within the right setting with a trained professional, of course. This could never be expected of a partner or loved one.

Acute trauma also, as indicated by your empathic, eloquent question, affects the families of those suffering, as the traumatized one’s behavior pushes others away. You, too, sound traumatized in being neglected, shut out, demeaned, and so forth—painful experiences for someone who, I surmise, longs to reconnect with a long-absent spouse.

It is interesting that some people, including some professionals, call patterns of psychological suffering “disorders.” But if you put it in context, both you and your husband are having a normal, human reaction to extreme circumstances which would be “disordering” to anyone. Being abused in childhood or traumatized in battle might, for instance, lead to addictive or depressive (or other) issues, though it’s worth asking whether it is the person or their traumatizing experiences that are disordered.

Your husband returned to “normal life” with profound suffering and perhaps shame, and reacts by “acting out” (I mean this non-pejoratively) what he is feeling, keeping you at a painful distance and emotionally wounding you in the process. Perhaps he feels too overwhelmed or ashamed to express his pain and corresponding inadequacy, and so he enacts his trauma on those closest to him as a way of unconsciously expressing what he feels inside but cannot express, hiding his vulnerability defensively, even hurtfully. Clearly, there is some kind of unbearable risk for him in allowing the kind of intimacy you so understandably want and miss.

Often trauma makes a person into a kind of wary rescue animal—strong but brutalized, rowling or hissing angrily over and over again at anyone who approaches, until they can, slowly and painstakingly, learn to trust again. It is hard, if not impossible, for us to do this without the proper support.

His own repressed or dissociated trauma feelings are, in other words, probably similar to what you are feeling: shame, a sense of feeling torn, abandoned, and abandoning (since he may also long to reconnect but is too terrified or wounded to do so, perhaps guilty or ashamed he left you behind or is doing so now in his withdrawal). In a bizarre way, he may feel he is protecting you from the chaos within; if he feels he is drowning in unexpressed pain and terror, he may not want to pull a beloved into the maelstrom. He may say, in other words, “You couldn’t handle it,” while you respond, “Try me.”

Often trauma makes a person into a kind of wary rescue animal—strong but brutalized, rowling or hissing angrily over and over again at anyone who approaches, until they can, slowly and painstakingly, learn to trust again. It is hard, if not impossible, for us to do this without the proper support.

Of course, what your husband may be missing or repressing is that the distancing itself is hurtful to you and the relationship, and ultimately self-sabotaging, since what he (likely) needs most of all is human connection, emotional safety, and deep validation of his suffering, in a way that confirms (and not undermines) his manhood. (He may unconsciously feel he is “the enemy” for being so “weak” and shamefully afraid, may feel shame or guilt that he could not protect or save those who died—again, a common reaction.)

At a certain point, however, we have to get in the lifeboat even if our loved one refuses to do so. It is an impossibly painful choice. This leads me to reiterate, again, that there is no “right” decision here for you. You can stay and risk drowning, or find safety yourself while anxious you have “left him behind.”

If only we could somehow culturally redefine “strength” to mean addressing and healing, rather than avoiding or numbing, our own psychic pain and isolation. If only, in such a masculinized culture like the police or military, emotional sensitivity is not equated with being “wimpy,” etc. It’s actually the “keep a stiff upper lip and carry on” mentality that is dangerous after the battle has ended.

Perhaps, then, you can role model for your husband the kind of strength I’m talking about. I cannot recommend enough the following: support, support, and more support. I strongly suggest you seek out the kind of education and emotional assistance your husband needs. Is there a “wives of veterans” group, in person or online, from which you can find sustenance, both practical and psychological? Can the local or online VA provide helpful info? I would bet what you are experiencing is also not uncommon. It is too early to abandon hope, and helping yourself is helping the relationship since you are 50% of the equation.

You might also seek out counseling, either individual or group, via a therapist with specific training and experiencing in this area. Trauma resulting from military service or firefights is not quite like any other, given the specifics of military culture, codes of honor and bravery, and so forth. You can look via GoodTherapy.org, if you like. But do find something, because this is agonizing, if not impossible, to handle on one’s own. Ending the pain of your guilt and isolation will make it easier to communicate with your husband, and I would urge you to not make a final decision until after you have found some peer or professional support.

I thank you again for writing. You, too, are doing your country a duty in attempting to help yourself and your husband address the wounds he carries inside.

Kind regards,

Darren

Two people sit on a fence overlooking a field. One person has an arm around the other person. Being close to someone who is suffering because of trauma can be a difficult, bewildering experience. Trauma symptoms may appear suddenly, sometimes surfacing many years after a traumatic event. Or symptoms may creep up gradually. You might notice your loved one seems “off”—not like their usual self. Or their emotions can flare up suddenly and intensely for little apparent reason, even to the person. Some trauma survivors seem unusually flat or numb. They may become needy or clingy. Or they may withdraw, refusing help entirely.

Although symptoms may differ, responses to trauma have a similar underlying cause: a nervous system stuck in threat. Understanding what happens inside a person experiencing posttraumatic stress (commonly referred to as PTSD) provides a pathway to compassion, clarity, and possible solutions. This article is not therapeutic advice, and the advice of a qualified psychotherapist should always be sought. Think of this article as a general guide for families who suspect that a loved one has been impacted by trauma.

Trauma and stress are not the same thing. Stress refers to the body’s response to threat—a physiological and biochemical cascade of bodily changes designed to ensure survival. Informally, “stress” can also refer to subjective experiences: how it feels to be experiencing the challenge in the environment and in the body’s responses.

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The difference between stress and trauma is one of degree. Not all stress is bad; we need some challenges to stimulate us and encourage our growth. Trauma (or traumatic stress), on the other hand, refers to an internal state of overwhelm. This is an important point, and it explains why something that is “no big deal” for one person can be extremely traumatizing for another.

Trauma comes from overwhelm—when environmental circumstances are perceived as bigger than the individual’s capacity to handle them. When overwhelm happens, the body automatically mobilizes a survival response to deal with the threat, just as it does during stress. However, when the threat is too big or lasts too long and there is no effective response, it becomes trauma. For example, a person being cruelly taunted may not fight back because if they do, they may get into legal trouble and make the threat even worse. Not fighting back may be the smart thing to do, but the overall result is the body’s automatic survival response is ineffective against the threat.

When there is no way to fight back or run away, instead of deactivating, the mobilized survival response becomes “stuck” in the “on” position. It wants to complete and turn off, as it would if there had been a successful resolution of the threat, but it can’t. As a result, some bodily functions are stuck on “on.” For example, there may be lasting changes in blood pressure, heart rate, digestion, muscle tension, hormonal levels, and emotional reactivity.

Both stress and trauma involve the activation of the body’s threat response cycle. This survival response is hardwired into all vertebrate animals. Under threat, the unconscious brain and the body attempt to:

When stress happens, deactivation is possible. Traumatic overwhelm makes deactivation nearly impossible.

Threat responses are unconscious, hardwired, and involuntary. People cannot control these responses. When trauma has occurred, the person’s nervous system may still be involuntarily responding to prior circumstances more than to what’s actually happening.

Most importantly, threat responses are unconscious, hardwired, and involuntary. People cannot control these responses. When trauma has occurred, the person’s nervous system may still be involuntarily responding to prior circumstances more than to what’s actually happening. (This is what causes flashbacks or other re-experiencing of traumatic circumstances.) Posttraumatic stress responses are essentially the body’s survival alarms going off at the wrong time, because they have never been able to completely turn off.

Posttraumatic survival responses also occur much more quickly than conscious thought. In fact, intense activation of the threat response cycle shuts down the cortex, the area of the brain responsible for rational thought and verbal communication. This is why logical arguments don’t work when a person is in a posttraumatic stress response. They may be, literally, “too angry for words.” This also means that, for the most part, people with posttraumatic stress don’t intend to respond inappropriately to things going on in the environment around them and may feel very badly after the event is over, but at the moment, their automatic survival wiring is running the show.

Even when acute trauma triggers are not causing posttraumatic survival responses, a person whose nervous system is stuck in some phase of the threat response cycle is likely suffering. Eventually, they may start to numb out (dissociate) to protect against the ongoing awful feelings. Others become caught in cycles of addictive behaviors in order to try to manage the distress.

When a Loved One Is Experiencing Posttraumatic Stress

Loved ones who understand this can respond with compassion; however, this does not mean putting up with hurtful or dangerous behaviors. Some trauma survivors might even seem okay on the surface, but underneath, managing the unresolved trauma is using up some of their strength and energy. Unresolved trauma also tends to build up inside, making the person more emotionally and physically brittle over time. Eventually, symptoms may appear after a relatively mild stressor, such as a small fender bender.

The ultimate goal of treatment for posttraumatic stress is to foster deactivation of the nervous system and restoration of resilience (flexibility and the ability to “bounce back”). With this comes the ability to be fully present—instead of being partly stuck in the past—and to respond appropriately in the current moment. The neurological term for this resilience/responsiveness is self-regulation.

Here are several suggestions to keep in mind while supporting a loved one impacted by trauma:

To sum up, it can be incredibly distressing to be living in a nervous system that feels disobedient and unpredictable. However, as Dr. Peter Levine has said, humans were designed to withstand incredibly difficult conditions. With the help of a good practitioner, trauma survivors can access their underlying restorative ability of mind, body, and spirit, and continue on with their lives.

Note: I would like to acknowledge Phyllis Stein, PhD, SEP, for her editing contributions to this article.

References:

  1. Butler, E.A., & Randall, A.K. (2012). Emotional Coregulation in Close Relationships. Retrieved from http://emr.sagepub.com/content/5/2/202
  2. Center for Substance Abuse Treatment (U.S.). (2014). Treatment Improvement Protocol (TIP) Series, No. 57. Ch. 3. Retrieved from http://www.ncbi.nlm.nih.gov/books/NBK207191/
  3. Levine, P. (2010). In an Unspoken Voice: How the Body Releases Trauma and Restores Goodness. Berkeley, CA: North Atlantic Books.

Rear view of two women looking out over a lakeDespite some recent legal changes to protect the civil rights of LGBTQ+ people in some states, we continue to be the most common targets of hate crimes in the U.S. (Park and Mykhyalyshyn, 2016). No such crime has resonated in the public consciousness like the one that took place in the early hours of June 12, 2016 at a gay nightclub in Orlando, Florida, where 49 people were killed and 50 others injured by a lone gunman in “the deadliest attack on the LGBT community in U.S. history” (Ravitz, 2016).

The incident created a ripple effect of grief, fear, anger, and unity among those directly and indirectly affected by it. Through the bonds of shared trials and tribulations that come with being a marginalized group, the LGBTQ+ community provides vital safety and connection—a “family of choice,” if you will—for those who may not be accepted even within their families of origin. Because this connection is so deeply rooted, it only makes sense that the Orlando tragedy devastated and traumatized the whole of our community.

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Research has demonstrated that acts of terrorism erode “the sense of security and safety people usually feel” (Hamblen and Sloane, 2016). But what about people who weren’t accustomed to feeling safety and security in the first place? Even those of us in the LGBTQ+ community who have been able to legally marry our partners face conscious and unconscious threats and concerns on a daily basis: disclosing LGBTQ+ identity to coworkers/employers, choosing certain clothing options to avoid detection of our identity, researching how our community is treated in a given location before planning a trip, making split-second calculations as to whether it is safe to show even minimal forms of public affection. It is our complex set of collective experiences that places us at risk for having our previous experiences of aggression and microaggression triggered by an act of violence like the one in Orlando.

Guarding Against Secondary Trauma

Those of us in the helping professions have been trained to guard ourselves against vicarious trauma. This type of secondary trauma is the “emotional residue of exposure that counselors have from working with people as they are hearing their trauma stories and become witnesses to the pain, fear, and terror that trauma survivors have endured” (American Counseling Association, 2011). However, secondary trauma is a concern for anyone, not just mental health professionals. According to a 2015 study, individuals viewing traumatic events through various forms of media are susceptible to trauma-related symptoms despite having no direct connection or experience of the traumatic event (British Psychological Society, 2015).

So what can we do to cope in the aftermath of Orlando? First, it’s a good idea to check in with loved ones and ourselves and notice if there have been changes to daily routines (such as eating and sleeping) and functioning (concentration, racing thoughts or worries, increased startle responses, etc.). If there have been changes, the U.S. Department of Veterans Affairs (2015) recommends the following self-care approaches:

We can also borrow from the tips given to professional helpers to transform trauma into something positive. The Headington Institute, specializing in helping humanitarian workers cope with the traumas they witness, has several tips for achieving this transformation (Ashimoto, 2014):

As a therapist and a member of the LGBTQ+ community, I challenge my “family of choice” and our allies to transform this trauma, even as we mourn.

References:

  1. American Counseling Association. (2011). Fact Sheet #9: Vicarious Trauma. Retrieved from http://www.counseling.org/docs/trauma-disaster/fact-sheet-9—vicarious-pdf?sfvrsn=2
  2. Ashimoto, F. (2014, October, 6). Transforming vicarious trauma [Video file]. Retrieved from http://www.headington-institute.org/blog-home/433/transforming-vicarious-trauma
  3. British Psychological Society. (2015, May 6). Viewing violent news on social media can cause trauma. ScienceDaily. Retrieved from http://www.sciencedaily.com/releases/2015/05/150506164240.htm
  4. Hamblen, J., & Sloane, L. (2016, February, 23). Research findings on the traumatic stress effects of terrorism. Retrieved from http://www.ptsd.va.gov/professional/trauma/disaster-terrorism/research-findings-traumatic-stress-terrorism.asp
  5. Park, H., & Mykhyalyshyn, I. (2016, June, 16). G.B.T. people are more likely to be targets of hate crimes than any other group. Retrieved from http://www.nytimes.com/interactive/2016/06/16/us/hate-crimes-against-lgbt.html?_r=1
  6. Ravitz, J. (2016, June, 17). Before Orlando: the (former) deadliest LGBT attack in US history. Retrieved from http://www.cnn.com/2016/06/16/health/1973-new-orleans-gay-bar-arson-attack/
  7. U.S. Department of Veterans Affairs. (2015, August, 14). Coping with traumatic stress reactions. Retrieved from http://www.ptsd.va.gov/public/treatment/cope/coping-traumatic-stress.asp
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