They are frightening, disturbing, inconvenient, and happen when you are supposed to be rejuvenating your body and brain: the nightmares that follow a traumatic experience.

Nightmares are quite common among people who have experienced a traumatic event. The aftereffects of a nightmare often follow them into the next day, which can affect their emotional well-being and ability to function. Nightmares can be quite scary and negatively impact the amount of restful sleep a person is getting. They can feel like one is re-experiencing the traumatic event, and the thought of going to sleep can become anxiety-provoking. The less sleep a person gets, the more difficult it is for the brain to process a traumatic event and file it away correctly. Sometimes the symptoms that are present due to trauma are the very barriers that get in the way of a person’s ability to heal.

The Function of Dreams

According to Hartmann (1996), one theory regarding the function of dreaming is that it allows the brain to make connections more efficiently and effectively than the conscious mind. In other words, it is the time when the brain reviews information that has been observed and then sorts and organizes it in a way that makes sense.

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Hartmann (1998) also states that dreaming is a way for the brain to work through trauma, and the dreams are often based on the main emotion the person experienced during the trauma or experiences when they recall the trauma. This is important to the healing process but, as discussed above, can be problematic when the person’s nightmares interfere with their sleep and their ability to function day-to-day. According to Leskin et al. (2002), people who had a diagnosis of posttraumatic stress had a significantly higher rate of sleep problems. They state that 96% of participants in their study who were diagnosed with PTSD experienced nightmares and 100% experienced insomnia.

So what can a person do to work through unwanted trauma nightmares?

1. Keep track of your dreams and nightmares and discuss them with your therapist. Dreams can contain information that is significant in therapy work. I often encourage people in therapy to write down the basic themes of their dreams and nightmares so we can investigate their significance to the trauma treatment work we are doing. I often find that the information gathered from dreams is directly related to the themes that are increasing or continuing the disturbance related to trauma (for example, a sense of helplessness).
2. Develop coping and self-soothing skills. Practice self-soothing and anxiety-reduction techniques before sleep and/or if you wake up from a nightmare. Continue self-soothing throughout the day as needed to deal with the aftereffects of a nightmare. Some of the tools people in therapy have found most useful include guided meditations, body scans, progressive muscle relaxation, and mindfulness exercises. Another tool that many find particularly useful is called “container.” Essentially, the person experiencing the disturbance creates a container (real or imagined) wherein they can keep the things that bother them most (thoughts about the event, flashbacks, or even the nightmares or other disturbing material) until a time when he or she able to sort through the material with his or her therapist. When the disturbing material comes up, the person can allow whatever it is to go into container until therapy, where we can decide what should be addressed. Some containers that are common are safes, boxes, vaults, and jars. The container should have a lid or door of some type. A person can imagine this container in the form of a picture in the mind and imagine the disturbing material going into the container. Alternately, the person can have a physical container and write down the disturbing material on a piece of paper and then place it in the container.
3. Don’t stay in bed if you can’t sleep. Often, when awakened from a nightmare, going back to sleep may be difficult. Also, the act of initially going to sleep may be anxiety-provoking for fear that the nightmares or other symptoms the person may be experiencing will return. If you are not able to go to sleep in a reasonable amount of time, get up and do something self-soothing. It may take time before sleep comes, but it is better to engage in self-soothing exercises than to get yourself worked up and more anxious because sleep won’t come.
4. Make changes to your sleep environment to avoid associating anxiety with the place you sleep. When a person has repeated nightmares, the sleep environment may become a trigger for anxiety and other trauma symptoms. Making changes to the sleep environment, such as moving furniture around, getting new bedding, or changing the decor, may be helpful in starting with a clean slate when it comes to sleep.
5. Remind yourself that your brain is trying to heal. Healing is not always a comfortable process and it takes time. As uncomfortable as nightmares are, your brain is giving you the information it needs you to work through. Nightmares can bring to light issues that you may have been unaware of during your awake time. Work with a therapist so you do not feel alone in this process. A therapist can normalize what you are going through and can help you to process your symptoms in a way that may make them less overwhelming.

References:

1. Hartmann, E. (1996). Outline for a theory on the nature and functions of dreaming. Dreaming, 6(2), pp 147-170.
2. Hartmann, E. (1998). Nightmare after trauma as a paradigm for all dreams: A new approach to the nature and functions of dreaming. Psychiatry: Interpersonal and Biological Processes, 61(3), pp223-238.
3. Leskin, G.A., Woodward, S.H., Young, H.E., and Sheikh, J.I. (2002). Effects of comorbid diagnoses on sleep disturbance in PTSD. Journal of Psychiatric Research, 36(6), pp 449-452.

“Go into your grief, for there your soul will grow.” —Carl Jung

Grieving is a powerful and personal journey. It is an inevitable part of living. Eventually we all grieve something or someone. If you’ve lost a child or parent, or a friend, lover, or spouse, you know that grief has the power to transform.

We usually live within the illusion that we are in control. That is, we live a certain way until something happens to shatter our perception. The resulting dissolution—or you might say dis-illusion—that follows is actually the beginning of a remarkable process of being healed. It marks the first stage in the grief journey.

Stages of Grief

In 1969, Elisabeth Kübler-Ross, a Swiss American psychiatrist, introduced the “five stages of grief.” Her work with people who had terminal cancer led her to define the five distinct phases a dying person goes through while coming to terms with their fate:

• Denial: Disbelief, shock, and numbness after hearing the “bad” news.
• Anger: When the numbness lifts, anger may be easier to feel than the intense pain associated with what is being lost. This free-flowing anger can be directed inward toward the self or outward toward doctors, nurses, friends, family, spiritual advisors, and/or God.
• Bargaining: For some, bargaining can be a reaction to the vulnerability that occurs when feeling the sorrow of loss. It can be an attempt to feel more in control of a situation where control just isn’t possible. It is characterized by an attempt to seek the impossible; to find a way out.
• Depression: The full impact of the unmasked impending loss of life finally hits, and feelings of sorrow, sadness, and depression follow.
• Acceptance: Coming to terms with what is happening and finding a way forward.

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While many have applied these stages to the process of grieving the death of another person, it was not Kübler-Ross’ intention that they be used this way when she created the model. There are other models that are more specific to grieving the loss of a loved one that are used by grief counselors and therapists. While the stages described by these models differ somewhat, like Kübler-Ross’ model they all chronicle a journey-type process that leads to acceptance and the eventual ability to once again move forward.

Acknowledging Brokenness; Being Present

When the shock of sudden loss subsides, the numbness that initially accompanies that shock wears off as well. A pain-filled state ensues when the harsh reality of loss is realized. This early phase of grief is about brokenness. When we experience a loss, the bond that once attached us to the other—whether the other is a person, place, or thing—is severed. When the bond that ties is severed, we feel as though we have been broken. It is a painful and searing state; a state that can’t be rushed.

What a grieving person in this stage needs most is to feel that those they are closest to can accept the pain they are experiencing. Unfortunately, many people are uncomfortable with their thoughts and ideas about endings and death. The feelings that arise with grief are just too much for them. Their attempts, aimed at getting a grieving person to feel better and leave the sorrow behind, only serve to prolong the grief process.

A kind touch and a shared quiet moment that honors the feelings of a grief-stricken friend can be the best offering of condolence. A willingness to simply be present, to witness and accept the raw emotions of grief, is the first step in a transformative and healing process for both the bereaved and those who surround them.

Support Groups

The feelings that come with grief are powerful. Grieving takes time, and often the family and friends of a grief-stricken person are ready to move on long before the grieving one can or wants to. Support groups are a viable option for those who find themselves alone in their grief. Being able to share the experience with others on the same path may be a relief. Since the grieving process is different for everyone, a support group can accommodate these differences. Some studies suggest that men and women grieve differently, with women needing to speak about and share their intense feelings with others while men often deal with their own intense emotions by taking action. In a support group setting, all experiences can be heard, shared, and validated.

Widows and widowers in the gay community often have difficulty finding the support needed while experiencing the grief of bereavement. Even finding a support group can be difficult. Blogger Dan Cano writes poignantly about his experience after finally finding a support group where he could speak freely and be understood:

“I started my lesbian and gay bereavement group a few weeks ago, and every Thursday night we gather to tell our stories. We share of our history with our partners, lovers, husbands and wives. We share the trauma of losing the most central person in our lives. We tell of our difficult goodbyes, and of the daily anguish that we must now endure. We talk about being left behind, of feeling lost, of struggling with a new identity. We talk of people’s well intended, but missing the mark, words. We cry, we laugh, we listen.”

What We Learn from Grief

When we sit in stillness and accept the waves of grief that wash over, eventually there will come a time when the urge to move will stir. It will be quiet, unassuming, and almost imperceptible. From intense feelings over what has been lost there will arise a feeling of gratitude for what is remaining. When experiencing the loss of a loved one, an inevitable gratitude for life and living unfolds. The gift of grief is ultimately a strengthening of the ability to truly appreciate and value the process of being alive.

References:

1. Greenspan, Miriam. Healing Though the Dark Emotions: The Wisdom of Grief, Fear & Despair. Shambhala Publications Inc. Boston, Massachusetts, 2003.
2. Hanson, Rick, Ph.D. (2007). Grief Recovery: Implication of Neuroscience and Contemplative Wisdom. Retrieved from: http://www.wisebrain.org/KaraSlides.pdf on 21/06/2014.
3. Cano, Daniel (2009). Gay Grief. Retrieved from http://daninrealtime.blogspot.ca/2009/11/gay-grief.html on 22/06/2014.

When a friend or loved one has been impacted by a traumatic event, it can be distressing and confusing to stand with them and watch them try to deal with the effects of such an experience. It can also feel overwhelming to the person trying to help or support when they don’t feel as if they have the tools necessary to respond to the traumatized person.

If you are wondering what you can do to be supportive to a person dealing with a recent trauma, here are some places to start:

1. Listen. Telling our stories is powerful and healing for human beings. It helps us to make sense of what has happened, to consolidate our memories of the events, and to feel heard and supported. Doing what we sometimes call “active listening” can be really important to survivors of trauma. This means devoting your attention to the act of listening carefully—without judging, interrupting, or making self-referencing comments. Asking questions is, however, an important part of active listening, as it shows that you are interested in getting the details right.
2. Don’t judge. Try to assume a stance of curiosity about the person’s story. Judgments are a heavy burden that trauma survivors become all too familiar with. Don’t add to this burden. Often, the person is struggling with internal judgments about the trauma and their reaction to it. You can help by simply supporting the person without implying that they should (or shouldn’t) have done something differently, that they did the right thing or the wrong thing, or that there was anything about the event(s) that was good or bad. The words in italics are words to avoid when discussing with a survivor the event(s) they are dealing with and/or how the person is coping in the aftermath.
3. Don’t pathologize. It is normal for human beings to feel grief, pain, rage, despair, and/or fear after a traumatic incident. Often, people will work through this on their own after a period of time, come to understand the event(s) in a way that works for them, and resume their typical engagement in everyday life. Give them a few weeks—don’t label what they are going through or make it sound like an “illness” or “disability.” As therapists, we don’t view having this response itself as problematic; we start to see a problem only if, after a couple of months, these responses are still interfering with the person’s ability to engage in daily life. In that case, you may wish to speak with the person about finding some professional support, but do so in a nonjudgmental way that is open to and hears the person’s thoughts about this.
4. Take care of yourself. Being a support person for a person dealing with deep pain can in itself be distressing and overwhelming. Sometimes this can even result in what we call “secondary traumatization”—feeling the effects of the trauma yourself. Give yourself permission to do the little things that nurture you and bring joy as you provide support to a person in distress. Be mindfully aware of your own level of distress, energy, and need for support. Learn a little bit about normal trauma responses (such as avoidance, arousal, and intrusions) so that you can understand what is happening. If you feel it might be helpful, you might consider seeking professional support for your own needs and keep yourself grounded. Give yourself permission to feel distressed, frustrated, overwhelmed, or confused, and take care of your own needs about this so that you are able to continue to be supportive when you would like to without making the trauma-affected person the target of your own pain or frustration—this can be a difficult cycle that causes more pain for everyone.

Navigating the aftermath of a traumatic event can be difficult for everyone affected—those directly involved in the event and those in the position of continuing to love and support people through their pain and grief. These tools are a place to start for those of you wondering how best to support a traumatized person. It is important to remember that being such a support person is a wonderful gift and a difficult place to be, and to give yourself the permission to struggle with it, to care for yourself and your needs during this time, and to seek your own support and care when you need it.

Most everyone has at least one traumatic memory embedded in their brains. One that still resonates for me was the time my mother left me alone when I was six years old to take the babysitter home. When I looked apprehensive, she told me not to worry. “I’ll be right back,” she said, smiling brightly, and drove off. As it got dark, I became more and more frightened that something had happened to her and she wasn’t coming back.

By the time she returned I was totally terrified. She found me standing outside wailing. She scolded me and took me inside. Years later, whenever my wife was late coming home I would become worried and anxious. My heart would begin to pound, and more than once when she was particularly late, I had a full-blown panic attack.

I know I’m not alone. Some have memories from a car accident, a rape, a natural disaster, a violent parent, a drunk husband, a hospital stay, an assault, the horrors of war. Experiences like these are more common than you might think, with an estimated 60% or more of Americans who have experienced at least one of these at some point in life. Not all of these memories cause people to experience trauma later in life, but they can cause problems for many, and for some they can be debilitating. People with posttraumatic stress (PTSD) can become hypersensitive, with nerves on a permanent state of high alert. Fear and anxiety recur without warning, and nightmares can ruin sleep.

Memories and Trauma

But now there are simple, yet effective, ways to actually erase the traumatic emotions that often accompany these memories so that they can finally be put to rest. Many people can do this work on their own. For more difficult traumatic memories, working with a therapist who specializes in healing trauma can be helpful.

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In his book Hardwiring Happiness: The New Brain Science of Contentment, Calm, and Confidence, neuropsychologist Rick Hanson says, “Your brain was wired in such a way when it evolved, it was primed to learn quickly from bad experiences but not so much from the good ones.” It’s why traumatic memories so often stick in our brains, while positive memories seem to slip away. “It’s an ancient survival mechanism that turned the brain into Velcro for the negative, but Teflon for the positive,” Hanson concludes.

Fortunately, new findings from the field of affective neuroscience can help people heal traumatic memories that can contribute to PTSD, depression, bipolar, and even Alzheimer’s. One of the things we are learning about memories is critically important: Though the brain is particularly good at recording bad memories, they are not permanently locked into the brain’s memory banks, as we once thought. Whenever we actively recall a memory, it transforms and becomes vulnerable to modification.

When we recall a memory it becomes a little unstable and for a window of perhaps two or three hours, it’s possible to modify it before it settles down again, or “reconsolidates,” in the brain. That’s why, paradoxically, recalling bad memories can help us heal from old wounds. Reliving traumatic moments again in a condition of safety can help a person disconnect the memory from the painful “alarm” mechanisms that are the source of so much discomfort.

In the book The Archeology of Mind: Neuroevolutionary Origins of Human Emotions, Jaak Panksepp and Lucy Biven say, “Emotional memories remain forever malleable, subject to influence by future events—through a phenomenon called reconsolidation.” This is the basis of various treatment approaches for healing trauma including prolonged exposure therapy, supportive psychotherapy, emotional freedom techniques (tapping), eye movement desensitization and reprocessing (EMDR), trauma-based cognitive behavior therapy, and MDMA-assisted psychotherapy.

How to HEAL

Based on the latest in neuroscience finds Rick Hanson offers a simple, yet effective, method for rewiring the brain from the negative emotions associated with trauma to the positive emotions associated with health and wellness. In his book, he describes a four step process using the acronym HEAL.

1. Have a positive experience.

Step 1 activates a positive mental state, and steps 2, 3, and 4 install it in your brain. In step 1 we notice a positive experience that’s already present in the foreground or background of your awareness. In the example I offered at the beginning, I tuned into an experience where I felt safe and supported, and brought to mind experiences of safety and security.

2. Enrich it.

Too often we spend minutes, and sometimes hours and days, ruminating over a negative experience, but we gloss over the positive. Here we take time to deepen the positive experience. I would open myself to the feelings of support I have in my life. I would picture and my wife and friends and the many supports I have, filling my inner conscious with at least 10 to 20 seconds of positive memory.

3. Absorb it.

Here we imagine ourselves drinking in the experience. I imagine all my cells being infused with the experience. I feel it sinking into me and becoming part of my brain and all the parts of my being.

4. Link positive and negative material.

Hanson describes this as an optional step. We don’t want to become overwhelmed by the negative, but to hold the negative in consciousness while it is infused with the positive. Hanson uses the image of a garden. We imagine the beauty of beautiful flowers we are planting. We become aware of the weeds and gently pull them out so there’s room for growth. He concludes by saying, “Whenever you want, let go of all negative material and rest only in the positive. Then, to continue uprooting the negative material, a few times over the next hour be aware of only neutral or positive things that may have been associated with the negative.

I bought back the memories of being left by my mother and some of the associated experiences of getting anxious whenever someone I cared about was late. Focusing on the negative while activating positive experiences can actually “erase” the fearful feelings from the past. I still remember my mother leaving me alone and being angry with me when she returned, but it doesn’t grab me and shake me up like it used to do and I’m much less anxious when my wife is late coming home.

I describe other techniques for healing old pain in my book, Stress Relief for Men: How to Use the Revolutionary Tools of Energy Healing to Live Well. I often use them along with the ones that Dr. Hanson teaches. In this engaging TED talk Dr. Hanson describes how we can rewire the brain for joy and happiness and heal from trauma. In another show he describes how our mind can change the brain from being Velcro for the negative and Teflon for the positive.

Even when traumatic memories don’t reach a level of discomfort associated with PTSD, they can still be destructive. Hanson notes that unresolved trauma “increases inflammation, weakens your immune system, and wears on your cardiovascular system. No one has to live with traumatic memories from the past. They can truly be healed now and forever.

We all have at least one memory that makes us cringe, but some bad memories are more than just sources of embarrassment or mild grief. Bad memories can plague the mind, serving as a ready source of nightmares, self-doubt, and sadness.

For some people who have experienced serious trauma such as military combat or rape, bad memories lead to posttraumatic stress. Researchers at the Beckman Institute at the University of Illinois hope to lessen the negative effects of bad memories, and their research suggests there’s a better way to move past bad memories.

The Effects of Bad Memories

It’s easy to conceive of a bad memory as just a small annoyance, but some bad memories can be life-altering. Memory plays a role in everything from self-esteem to how we conduct our romantic relationships. The worst bad memories can even make it difficult to function. People with posttraumatic stress experience intrusive flashbacks, during which they relive the traumatic event. They may also experience trauma via nightmares, and stimuli such as smells and sounds that remind them of the memory can reignite feelings of fear and trauma. For the 7.7 million Americans who experience posttraumatic stress every year, bad memories are much more than just an annoyance.

Anastasia Pollock, LCMHC, a GoodTherapy.org trauma Topic Expert, emphasizes the role of memories in trauma, explaining, “In my own experience working with clients dealing with trauma, I have found it necessary to help them develop positive neural networks in order to counteract the negative networks created by trauma, by focusing on times in their lives when they felt safe, in control, or good about themselves.”

Getting Over Bad Memories

[fat_widget_trauma_ptsd_right]In their ongoing memory research, researchers have found that contemplating the emotion associated with a memory makes the memory more pronounced and less difficult to forget. But thinking about the context of the memory—the setting, weather, who was there—can help reduce the effects of bad memories. People have a tendency to dwell on negative emotions associated with bad memories, and this can contribute to the development of depression and posttraumatic stress. Focusing on the context of a memory makes it harder to ruminate on negative emotions.

Dr. Sunda Friedman TeBockhorst, a GoodTherapy.org trauma expert, says that getting “stuck” in a bad memory can lead to posttraumatic stress. “This development fits nicely with what we already know about how memories continue to cause distress well after an event. One of the primary working hypotheses about how trauma-related problems develop is that traumatic memories get ‘stuck’ in the emotional part of the brain and aren’t stored in other areas of the brain that can make sense of them. So, it stands to reason that having these two areas of the brain ‘talk’ to each other will defuse the negative charge of the memory and facilitate a more adaptive storage and retrieval process of that specific memory. By focusing on the specifics of an emotionally-laden memory, you can get these two areas of the brain to ‘talk’ to each other and ‘unstick’ the memory,” she says.

At this point, the research is preliminary and has only shown that focusing on context can reduce the short-term effects of negative memories. The researchers associated with the project hope to eventually find ways to mitigate the long-term effects of negative memories.

References:

1. Better way to deal with bad memories suggested. (2014, April 18). Retrieved from http://www.sciencedaily.com/releases/2014/04/140418141121.htm
2. Denkova, E., Dolcos, S., & Dolcos, F. (n.d.). Neural correlates of ‘distracting’ from emotion during autobiographical recollection. Social Cognitive and Affective Neuroscience, 9(4). doi: 10.1093/scan/nsu039
3. The numbers count: Mental disorders in America. (n.d.). Retrieved from http://www.nimh.nih.gov/health/publications/the-numbers-count-mental-disorders-in-america/index.shtml

Editor’s note: This story contains sensitive material and descriptions of childhood abuse and trauma that may be triggering to some readers.

My story focuses on two areas of trauma: childhood sexual abuse and the lasting effects of working in the field of law enforcement and rescue work. I am, for all intents and purposes, a normal adult—a college educated mother and grandmother. You wouldn’t know it to look at me, but I am a survivor of trauma for many decades.

In my family, I was known as the “spooky smart” child. As soon as I could talk, it became apparent that I had an intellect unlike other children my age. I seemed much older than my chronology would attest. It’s true that I did understand a lot; the saying about little pitchers having big ears was spot on. I could listen to those around me and because I was a little person; no one thought too much about what they said around me.

It didn’t take long for me to figure out that my father was emotionally distant—trying, but often failing not to repeat the abuse he received as a child. He never hit like his father before him, but the words were weapon enough against us. My mother was a black-out alcoholic who, for all of the good in her, spent her life slowly committing suicide by drinking herself to death. She would rather drink than face her demons and get help.

It began when I was about four years old. A family “relative,” the boyfriend of my great-grandmother, began sexually assaulting me and my sister, who was two years younger than I. When I learned he had touched my sister, I decided I needed to stop him.

I could not tell anyone about the abuse, as my dad was in the process of divorcing my mother. Any reports of any type could threaten his ability to maintain custody of us; something I understood, even at such a tender age. So instead of telling another adult, I made a deal.

I told him that he could do whatever he wanted to do, but only to me; he had to leave my sister alone from now on. I told him I would never tell, never yell—nothing. He could do anything to me as long as my sister was free of him. He accepted.

[fat_widget_trauma_ptsd_right]Over the course of the next 10 years he raped me repeatedly; always just outside my sister’s door so she could hear everything. I tried to stay as quiet as possible; even when he made me get on my knees and beg him to rape me. I cannot forget his greasy hair or the alcoholic sweat stink of his body and his breath on me while he used his adult-sized body against me.

As I grew up, around the age of 7 or so, I became involved in rescue work. My father was a cop on a specialized team sent to major accident scenes where someone must be extricated from the vehicle. He also assisted in other areas including search and rescue, looking for the lost, working in the local jail, and ordinary day-to-day beat cop duties.

Because he was a single parent, called out at all hours of the day or night, he sometimes had to scoop up my sister and me, taking us with him to the crime scenes. We stayed in his truck and I would try to occupy my sister so she didn’t look out the windshield at the crash. No child should see the death, grief, anger, and confusion we witnessed. Even though I thought of my dad as a hero for saving others, these are still scenes to which no child should be privy.

I too began learning these fields, taking an interest first in ambulance rescue work and later on to law enforcement. Since then, I have been involved in these areas. I worked with an ambulance crew at 11, becoming one of the youngest people ever to complete the EMT certification at 13. I would later become a police dispatcher, marry a man who became an officer, and have a son who decided to become Military Police officer in the Army.

My life has been spent helping others—being their protector, their advocate, a voice on the phone to help, to instruct them how to breathe life back into the lifeless body of their infant grandchild, trying to talk someone out of committing suicide or homicide. Sometimes I succeeded, but sometimes I failed. Needless to say, I have a somewhat overinflated sense of protecting others, often to my own detriment.

As an adult, I can now say I typically fell for men who would treat me abusively. I know now that I was searching for what I knew was familiar. Even if it’s wrong, familiar is comfortable. It wasn’t until just last year that I realized I needed help. In 2012, I began a relationship with a man I had known for a number of years before; we were friends and co-workers.

He is the first person to be in a relationship with me who was not abusive to me. I didn’t know how to handle it. The whole idea of a life with this man was at once both terrifying and desirable. I knew that while I’m okay overall, when I get angry about something I really overreact. I have thrown things in anger—never toward anyone, though; I have given up on relationships way too quickly, been too ready to believe I don’t deserve to be treated reasonably, all of the things which go hand in hand with abuse.

I couldn’t see any of that until I lived in a nonabusive household. Not being abused freaked me out. He and I discussed it many times and it was then that I decided to find a therapist and a therapy style which would work for me.

I contacted our employee assistance program. They gave a preliminary diagnosis of posttraumatic stress (PTSD) due to sexual and other abuse. They recommended eye movement desensitization and reprocessing (EMDR) therapy for me and gave me the name of a therapist. She did not work out at all. She was truly only worried about the money, not the people she treated. Her half-hearted attempts at helping me did worse than nothing —I was full of uncertainty, emotions, and questions to which she had no real answers.

So I decided to look around on my own. I did some searching and found a therapist who was specifically trained in first responder trauma, a type of trauma that affects those personnel who first respond to crime scenes. He also treated sexual abuse trauma.

Another nice addition was that he was familiar with the trauma of chronic pain and disease. I have rheumatoid arthritis and fibromyalgia, as well as issues related to the removal of my thyroid gland. I am in pain constantly and will be for the rest of my life. My health is overall sound and I have great doctors, but even that can’t compensate for the physical and emotional trauma these diseases offer. I contacted him about my situation and he agreed to let me interview him and vice versa as a potential patient. This invitation was to become the beginning of the rest of my life.

I have been in therapy for only a few months. In that time, I can say I have never felt better overall about myself, my health, and my place in this world. Yes, I am scared. I am scared of what will happen when I begin to feel things again, about traveling back in time to those places, about the idea of bringing up and reprocessing these memories—all of it.

Some days I feel like I can take over the world; other days I can cry at the drop of a hat. I am nervous about the type of person I will become over time and whether I am strong enough to live with it. I am nervous about trusting anyone with my mind and allowing them to help me change. It is a good struggle; I can feel it is worth it.

To anyone with trauma or involved in the treatment of it, I offer my story. My life was filled with visions of unimaginable horror. I have seen more death, destruction, and hate than anyone ever should. But I know I will survive and thrive in the future. To do that, I must deal with the demons of my past and decide that they will no longer direct that future. I have removed control from them. Now I’m practicing keeping that control.

With the help of my therapist and the support of my mate, I look with a cautious smile toward my future. If you are troubled, I hope you will soon be able to do the same. Your situation is unique, but that doesn’t mean you are alone.

Last month I wrote about avoidance, one component of trauma-related struggles for many people. Another one of the primary things therapists consider when exploring trauma-related problems is what we call “re-experiencing.” When the natural healing process after a traumatic experience does not go smoothly, one of the things that many people will find themselves struggling with is the fact the memories of the traumatic event won’t seem to settle in and fade into the background, instead remaining very charged and intruding frequently into day-to-day life—re-experiencing.

Re-experiencing happens in a few ways. Some people find that they have unavoidable nightmares related to the event. This can be so distressing that some people find they avoid going to sleep at all. Others find that thoughts about the event and its aftermath trespass unbidden in their minds during their waking hours; we call these “intrusive thoughts.” Some find that memories from the event pop up and that they cannot control when and how these memories occur, sometimes in response to specific environmental cues and sometimes seemingly at random.

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When these types of memories begin to plague a person, they can be quite distressing. This is because the way our brains form memories during a critical incident is physiologically different than the way they form the more pedestrian memories of our day-to-day lives. When the memories associated with a traumatic event are formed, they tend to be stored as sensory memories: we remember the sights, the smells, and the sounds the way we experienced them during the event. The part of our brains that stores these memories does not comprehend language and it does not read clocks—there is no sense of orderliness or reason about the memories, and there is no sense of relative distance in time. When the memories occur, our brains interpret it as an urgent sense of danger and distress in the present moment, and the sensory nature of the memories adds to the sense of urgency associated with them.

While our logical brains recognize that the memories don’t make sense and are not rational, they cannot communicate this to that part of the brain reacting to the sense of urgency created by the memories, since they do not comprehend the orderly, reasonable input of language created by our rational brain. This dilemma—understanding that there is no comprehensible or logical reason to feel distressed, yet feeling extremely distressed and trapped by the memories that won’t stop intruding—can itself be extremely distressing to the trauma survivor, who may feel like he or she is “going crazy” or “losing it” when the memories and distress they engender won’t abate.

If this overwhelming cycle of re-experiencing, distress, and confusion about what’s happening is causing difficulty for you or a loved one, it’s important to know this: you AREN’T crazy and you AREN’T losing it. You are experiencing a normal response to an abnormal event. However, if after a few weeks have passed the memories still intrude with urgency, it may be that your normal healing process has become stuck. In this case, speaking with an experienced therapist skilled in this area may be a good choice for you.

Moving forward from this place can feel overwhelming for some, but know that it most certainly is possible. It won’t always be easy, and confronting those memories requires courage. However, doing so in the safe and contained therapeutic environment can be very effective in helping the brain get the memories sorted out and “put away” in an adaptive and functional way so that they no longer intrude on and disrupt day-to-day functioning. It is worth the investment of time and energy it will take to move on to a place of healing and put the past where it belongs—in the past.

We know that certain functions of the body shut down when a person is faced with a threatening situation. This allows other parts to become more active. Larger sets of muscles receive more blood as heart rate increases, allowing for the well-documented “fight-or-flight” response. While the body tenses and readies to “respond,” some areas of the brain become less active. Hence, the ability to process emotional responses and store memories during a traumatic event can be impaired while pre-programmed survival mechanisms kick in.

Posttraumatic Stress

For some, this will lead to a condition known as PTSD (posttraumatic stress). The intense emotions associated with an unintegrated traumatic memory can impair normal functioning in daily life for those experiencing PTSD. Read more about this here.

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Not everyone experiencing a traumatic event will go on to develop PTSD. However, for those that do, PTSD is treatable. Eventually, there can actually be benefits that result from a well-integrated traumatic event. This is called posttraumatic growth.

Posttraumatic Growth

Many people experience a meaningful improvement in their psychological outlook on life after a traumatic or life-altering event. For example, after a near-death experience, some report a renewed zest for living, an intense wonder at the beauty of the natural world that surrounds them, and a deeply felt sense of purpose not previously recognized.

In one study, Robert James Miller II and David Read Johnson noted an increased capacity for symbolic thinking in a group of 56 Vietnam War veterans who experienced PTSD. From the abstract: “Unexpectedly, subjects with PTSD in comparison to subjects without PTSD showed greater capacity for symbolic representation, and no difference in lexical capacity, raising new questions as to the mechanism by which trauma could increase the capacity for mental imagery.”

It’s possible that in order to avoid re-experiencing a traumatic event (because memories of the event have not been properly stored), some people unknowingly strengthen their ability to think symbolically as a coping mechanism. Since we know that symbolic thinking is a cornerstone of the creative process, can an unexpected benefit of trauma be an increase in creativity?

Surges in Creativity

There is compelling evidence that suggests surges in creativity could be linked to the experience of trauma. Dr. Marie Forgeard conducted an online study to investigate this idea. An online questionnaire was filled out by participants, whose answers were used to measure posttraumatic growth, rumination related to the event, and growth of creativity. Forgeard used two measures in the study: (1) scores on a measure of posttraumatic growth and depreciation and (2) scores on self-reported measures of creativity in the aftermath of adversity.

She found that “… adversity-induced distress predicted self-reported creative growth and breadth in a sample of online participants. Cognitive processing [intrusive/deliberative rumination] as well as domains of posttraumatic growth/depreciation—in particular, self-reported changes in interpersonal relationships and in the perception of new possibilities for one’s life—mediated the link between self-reported distress and creativity outcomes.”

It is important to note that intrusive rumination describes a process where the individual is primarily focused on the symptoms of the distress being experienced as opposed to solutions for these symptoms. On the other hand, deliberate rumination is a process by which an individual turns inward and engages in reflection along with contemplation about various problem-solving possibilities.

Creative Therapy and Deliberate Rumination

Given the links between trauma and creativity that are being uncovered, creative therapies such as art therapy or expressive writing, coupled with supported deliberate rumination practice, could be beneficial in the recovery process for individuals wishing to deal with the aftermath of traumatic, life-altering events and/or full-blown PTSD.

References:

1. Miller II, Robert James, and Johnson, David Read. Psychological Trauma: Theory, Research, Practice, and Policy. Vol. 4(1), Jan 2012, 112-116. doi: 10.1037/a0021580. Retrieved 3/21/14 from: http://psycnet.apa.org/journals/tra/4/1/112/
2. Thompson, Paula. The Traumatized Imagination: Creativity, Trauma, and the Neurobiology of the Resilient Spirit. Retrieved 3/21/14 from: http://www.healingresources.info/article_thomson1.htm
3. Forgeard, Marie J. C. Perceiving Benefits after Adversity: The Relationship Between Self-Reported Posttraumatic Growth and Creativity. Psychology of Aesthetics, Creativity, and the Arts. Vol. 7(3), Aug 2013, 245-264. doi: 10.1037/a0031223. Abstract retrieved on 3/21/14.

I recently had the honor and privilege of attending a workshop with renowned art therapists Cathy Malchiodi and Kate Webb in San Diego, CA, entitled Trauma-Informed Art Therapy and Positive Psychology. To say I was inspired, confirmed, validated, and energized by the experience is truly an understatement.

As a licensed clinical social worker, I often have drawn from the expressive arts as a means of helping my clients work through grief, loss, and trauma in psychotherapy. Art making, whether via collage, painting, drawing, sculpting, dancing, making music, and drama, has the potential to help individuals heal through very traumatic circumstances. The workshop focused on the evidence-based use of art making interventions and the intersection with neurobiology and somatic experiencing to help clients work through trying life challenges.

In my 20+ years of psychotherapy practice, I have called upon art intervention with the following populations: child witnesses of domestic violence, abuse survivors, hospice patients and their families, preschool children who witnessed L.A. riots, bereavement support groups, students struggling in academic settings, children of incarcerated parents, and mothers experiencing perinatal depression.

Art allowed clients to transcend their emotional pain, create a narrative through image of their trauma/loss, and subsequently “master” the trauma, thereby releasing the painful memory from its grip in the brain. Art continues to be transformative in my practice with clients and also in my own personal life.

[fat_widget_trauma_ptsd_right]As Malchiodi and Webb stated in their conference, we as humans all experience traumas across the lifespan. These incidents can be as “minor” as a traffic jam to as life-changing as the death of a family member. All traumas, no matter how seemingly big or small, are encoded in the brain’s amygdala where they are registered as potential alarm bells. The hippocampus then takes on the role of organizing these traumatic images, but struggles to encode them in such a way that makes sense to the cognitive (higher thinking/verbal) areas of the brain.

Art making taps into the lower-level (somatic/limbic) areas of the brain and also allows the client to release trauma in a somatic (physically manifested/preverbal) manner. Some individuals are rendered speechless in moments of trauma. As researchers have indicated, Broca’s Area in the brain has the potential to shut down verbalization of trauma, as an individual is in a hyper-alert state of fight or flight.

Art making accesses the somatic elements of the brain, enabling a client to express emotion which at times cannot be verbalized initially. Art making creates containment, safety, encouragement, validation, and an opportunity to narrate the traumatic experience in such a way that the trauma is then organized in the brain so that the individual’s somatic experiencing of the trauma is reduced.

Relaxation exercises coupled with art making bring about great relief for many clients. Playing music that matches a resting heartbeat has been proven to induce a state of calmness in many trauma survivors. Some clients are compelled to also engage in other forms of expression, such as drum playing and dancing. Discharging the trauma physically (exercise, music making, etc.) and through the use of creativity in art allows the client to move through the experience with a sense of self-compassion, mastery of the trauma, and a restored sense of trust in one’s surroundings.

To summarize the workshop I attended in a small article would not lend justice to all the incredible learning experienced. Suffice it to say my education of expressive arts is ongoing, and continues to be a driving force in the work I am honored to provide along the people who come to see me for therapy. Truly, belief that the client has the power of self-determination and the awareness and knowledge within to interpret their own art making is essential in nonjudgmentally supporting the client.

Ongoing training in the cutting edge juxtaposition of art and science in expressive arts and neurobiology is incredibly exciting and groundbreaking. Mindfulness and positive psychology also weave their way into the expressive arts as a form of healing which empowers clients to transcend trauma and loss and evolve to a place of healing and wellness.

The following is a list of titles I have found to be inspiring and helpful for psychotherapists wishing to learn more on the path of incorporating expressive arts in their work with clients:

1. Malchiodi, Cathy. (2002)The Soul’s Pallete: Drawing on Art’s Transformative Powers, Shambhala Publications
2. Malchiodi, Cathy. (2006)The Art Therapy Sourcebook, McGraw-Hill
3. Allen, Pat . (1995) Art is a Way of Knowing,Shambala Publications
4. McNiff, Shaun (2004). Art Heals: How Creativity Cures the Soul, Shambhala Publications
5. McNiff, Shaun (1992). Art as Medicine: Creating a Therapy of the Imagination, Shambhala Publications

Much of the United States has had a long, harsh, and cold winter. While it seemed like it would never end, some of us are starting to see the light of spring.

Winter can be a perfect representation of the darkness and despair that we feel from time to time. Whether it is grief associated with death, a trauma that we had to endure, or the end of a relationship, we all have had experiences of darkness and despair that feel never-ending.

But when you have lived long enough and seen enough winters, you know that the despair and darkness do not last forever. There comes a time when the pain recedes, is not all-consuming, and you have a desire to live life again.

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The process of re-emerging into life can be challenging. When you have been wearing the cloak of sadness, grief, or depression for so long, it can feel strange to walk through the world without it. You may even experience a cultural shock, in a sense. Coming back into the world can seem different and even strange.

Just as it takes time to deal with a difficult emotion, it takes time to adjust to its leaving you. It is a process of recognizing that the pain is no longer all-consuming. There are steps you can take to help you navigate this re-emergence:

Reconnect

Reach out to your support system. Many people retreat into isolation when they are struggling with depression or grief; it is necessary to reconnect with people and activities you previously enjoyed. Rather than let the shame or embarrassment of being out of touch stop you from reconnecting, speak to it. Call a friend and acknowledge that you were out of touch. Apologize and tell him or her why it’s been so long since you called. Let the person know that his or her friendship is important to you.

Review

As you reconnect with people and activities, you will need to take time to review what you came through. Think about the grief and sadness that you experienced. Consider how you dealt with it. Ask yourself:

• How did I get through the grief? What did I do?
• Who helped me through this rough time?
• What do I need now to continue my healing?

Reviewing the depression and grief can be scary; it might feel as if you will fall right back into the despair. But the contrary is true. Reviewing your sadness allows you to see your resiliency and how you survived. It also provides an opportunity to consider options you may try in the future when facing challenges.

Rest

Finally, it is time to rest. People often wonder, “What do I need to rest for? I was just in my bed/house for two months!” Grief and sadness are exhausting. Recuperating from them is a necessary part of the healing process. Allow your body to be active as you re-engage with the world, but also let your emotions rest, as they have been on a roller coaster of sadness, darkness, and re-emergence to light.

Taking the time to process and come out of the darkness is a foundational tool that you can use throughout your lifetime. When life is challenging, as it will be, you will not only survive it but come through in a way that is healing and compassionate toward yourself.

There are different kinds of trauma, but in general an experience can be considered traumatic when what is happening threatens to overwhelm those involved, making them feel helpless. Some types of traumatic experiences can have long-lasting and far-reaching consequences.

The body is programmed to work in a specific way when faced with a threat. The heart rate increases, and muscles are supplied with more blood in the event running becomes necessary. While this is happening, less important bodily functions temporarily shut down as the body readies itself for “fight or flight.”

Studies show that the areas of the brain involved with emotional responses, thinking processes, and memory storage become less active. This can lead to experiences not being processed or “integrated” by these various brain functions at the time the traumatic event is happening.

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Trauma and Emotional Response

Some people find that posttraumatic stress (PTSD) follows life-threatening events such as an earthquake, a tsunami, a sexual assault, or war-zone encounters. It can affect those who go through the event, individuals who witness it, and people who come later, such as first responders and those who just happen onto the scene.

As time passes, memories, thoughts, and feelings of the trauma can surface unexpectedly in a disconnected and confusing fashion, making it difficult for those who deal with severe forms of PTSD to get on with the challenges of daily life.

Scientists, doctors, psychologists, and counselors are still studying and learning about the effects and consequences of different types of trauma on the human psyche. Not all traumatic experiences will lead to identifiable PTSD, but it is generally understood that the effects of an unintegrated experience can be unexpected and often will occur without warning.

The way a person responds emotionally can be profoundly affected. An unintegrated traumatic experience can affect how an individual meets the world and his or her ability to be authentic.

Being Authentic

Being authentic means to act in a way that is consistent with, and in accordance with, one’s core beliefs. It isn’t hard to see that a person dealing with the disconnects associated with unprocessed trauma will inevitably come face to face with the fact his or her emotional responses don’t always reflect true beliefs and intentions.

The person may wish to express a loving feeling, for example, but the sheer emotional vulnerability of such an expression may result in withdrawal from the very people he or she holds near and dear. When repressed and left unexamined, the fragmented thoughts and feelings associated with traumatic events often find expression in behaviors that impede and distort authentic expression.

Seeking Treatment

After a traumatic experience, it is normal for the people involved to have mixed emotions—to feel angry, sad, and anxious. They may also feel disconnected from other people and their surroundings. This is to be expected, is normal, and may fade as time passes.

For some, though, these feelings don’t fade.

There are a variety of successful treatment options for people experiencing the effects of trauma, and there is no shame in opting for therapeutic interventions. There are identifiable biological reasons for post-trauma difficulties that have nothing to do with culturally rooted ideas of who is weak and who is strong.

To overcome the effects of trauma, it is essential to meet what happened head-on. Doing this with the support of a knowledgeable therapist will help ensure that the traumatic event becomes a successfully integrated past experience and support the healthy expression of authenticity.

References:

1. Posttraumatic Stress Disorder (PTSD) and the Family. Retrieved 2/22/14 from: http://www.veterans.gc.ca/eng/mental-health/publications/ptsd-families#cn-tphp
2. Goldman, Brian M. (under the direction of Michael H. Kernis) (2004). Interrelated Roles of Dispositional Authenticity, Self-Processes and Global Role Functioning in Affecting Psychological Adjustment. Retrieved from: http://athenaeum.libs.uga.edu/bitstream/handle/10724/7885/goldman_brian_m_200412_phd.pdf?sequence=1
3. Treatment, Services and Support for PTSD. Retrieved 02/25/14 from: https://www.nami.org/Template.cfm?Section=posttraumatic_stress_disorder
4. Posttraumatic Stress Disorder (PTSD). Retrieved 02/25/14 from: http://www.helpguide.org/mental/post_traumatic_stress_disorder_symptoms_treatment.htm

When something traumatic happens, the result can be the development of a variety of symptoms that impair a person’s ability to function. These symptoms reverberate beyond the person who was traumatized. They can easily impact close friends and partners, as well. According to Cook et al. (2004), trauma survivors often report a decrease in relationship satisfaction, along with impaired expression of emotion, sexual activity, intimacy, communication, and adjustment. Cook et al. also state that “those with PTSD have higher separation and divorce rates than their non-PTSD counterparts” (2004).

Trauma can impact intimate relationships in a number of ways. Some of the most common I have observed in my own practice include (but are not limited to) the following:

• Avoidance of and decrease in emotional and physical intimacy
• Isolation
• Feelings of helplessness and hopelessness (in both partners)
• Feelings of frustration, anger, confusion, and sadness
• Increase in anxiety
• More frequent arguments and difficulty finding resolution to problems

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These problems can cause a relationship to end if left unaddressed. I have often had partners of people with trauma in my office. They feel completely frustrated and alone, not knowing how to make their partner feel better or what to do to save the relationship. People in therapy are also affected by the above issues, which can further aggravate their trauma symptoms by adding stress. The result is two people in a relationship who both want the same things: to heal and make the relationship healthy. But they have no idea how to accomplish either.

Below are some of the behaviors and practices I suggest to people in therapy and their partners as they work through trauma.

For Partners

Don’t try to fix or heal the trauma and the accompanying symptoms your partner is experiencing. Sometimes well-meaning partners will try to “make it all better” by doing things they think will help the person heal. The fact is healing from trauma takes time. The brain needs time to process traumatic information. The best thing a partner can do is be available to listen when the person who is experiencing the trauma symptoms needs to talk. Be supportive emotionally by offering statements such as, “That sounds like it is really difficult to deal with,” and, “I hear you saying this is really hard for you right now.” The power of just being present for another person is often underestimated.

Don’t take it personally. Your partner is working through something very difficult. Sometimes people who have been traumatized feel more distant emotionally. Sometimes they also don’t want to be close physically. This is not necessarily reflective of how the traumatized person feels about the relationship or about you. This is a common occurrence and part of the process.

Don’t make assumptions. Sometimes well-meaning partners assume a person who has recently been through something traumatic will not want to connect physically. There is often a fear that connecting physically will make the traumatic symptoms worse. In some cases this may be true, as sometimes trauma is sexual in nature, which means some healing will have to take place before physical intimacy can resume. However, it is important to communicate with your partner about what they want and how they would like to connect with you. This subject can feel like the “elephant in the room,” but it is so very important that it is acknowledged. If either partner feels rejected, damage to the relationship can occur. By discussing where each of you are and what your desires are, even if physical intimacy cannot occur, the damage to the relationship has been controlled, as each partner knows where the other stands so those assumptions can be tossed out with the trash.

Consider getting your own counseling. I wrote an article on secondary trauma that discusses the difficulties loved ones often experience after someone they love has been traumatized. Vicarious traumatization is very real and possible. You are offering support to someone working through trauma, so it is vital that your self-care is excellent and that you are getting the emotional support and guidance you will need through this challenging time. You will be much more effective at helping your loved one if you are in good mental shape.

Mills and Turnbull (2004) give good advice for partners of people who have experienced trauma. They use the acronym LOVER to make some important behaviors easier to remember. They suggest partners Listen, Observe, Verify, Empathize, Reassure, and offer practical help. Practical help might include helping to rebuild, fight back, console, prevent, or repair.

For the Traumatized Individual

Involve your partner and communicate regularly. I have found many traumatized people are hesitant to share what they are going through with their loved ones for fear of becoming a burden. The fact is, when you don’t communicate with your partner, they may feel confused and left out. Your partner may tend to become anxious and can sometimes do things to try to make you feel better. But these things may just end up distancing the two of you further. Let your partner know what you are going through. You don’t have to give gory details,. Just let them know, as much as possible, how you are feeling right now and communicate how they can help. If you need someone to just listen, tell them so. If you need guidance and support, your partner needs to know.

Attend your counseling sessions and communicate with your therapist about stressors such as relationship strain. It is important for your therapist to know all your stressors so they can provide the best, most comprehensive care. Additional stressors can stunt healing and lengthen the longevity of symptoms.

For Partners and Survivors

Remember there is hope! People initially get into a relationship because there are things that draw them to one another. When you are having relationship difficulty related to trauma, the problems that arise can sometimes distract you from what you love about your partner and why you want to work in the relationship. A relationship can survive trauma if both people are willing to put in the effort it takes to heal.

References:

1. Cook, J. M., Riggs, D. S., Thompson, R., Coyne, J. C., and Sheikh, J. I. (2004). Posttraumatic stress disorder and current relationship functioning among World War II ex-prisoners of war. Journal of Family Psychology, 18(1), pp. 36-45. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/14992608
2. Mills, B., and Turnbull, G. (2004). Broken hearts and mending bodies: The impact of trauma on intimacy. Sexual and Relationship Therapy, 19(3), pp. 265-289. Retrieved from http://www.recoveryonpurpose.com/upload/Broken%20Hearts%20and%20Mending%20Bodies%20The%20Impact%20of%20Trauma%20on%20Intimacy.pdf