A Different Kind of “Time Out!”

When many people (especially young parents) hear the term “Time Out!” they often think of discipline for a child who is misbehaving.  The type of “Time Out!” we are talking about today, covered in Chapter 7 of the Recovery Guide, is a different application for a different purpose. 

Let’s consider both types of “Time Out!”  In dealing with a youngster’s misbehavior, the purpose is to remove any rewards in the child’s environment that are perpetuating the misbehavior.  Then, after the brief “Time Out!” period, the parent wants to intentionally reward the next desirable behavior that the child does.  With consistency, the child gets rewarded for good behaviors, and the rewards for misbehavior are removed. 

The “Time Out!” procedure for use with adults has two major differences.  First, it is self-administered.  It is a technique or strategy that you apply to your own behavior.  Second, the purpose is to remove oneself from a situation that has become too stressful or overwhelming, thus allowing the person to regain appropriate self-control. 

When done properly, the person prevents harmful behavior, manages their own anger, relaxes, regains proper control of their thoughts and actions, and reduces the chances of overreacting and of negative consequences.  The difficult part in all of this is to catch yourself and remember to use the technique in the midst of high anger or anxiety – before your behavior has “gone too far.” 

In Chapter 7, the specific steps for using the “Time Out!” procedure are detailed and explained.  While the idea is fairly simple, that does not make its application easy.  On the contrary, many people have explained that this can be quite difficult the first several times it is tried.  When used successfully, a person has given themselves permission to handle the upsetting situation in an alternative way that hopefully produces better outcomes. 

This week, give yourself permission to catch yourself and put the situation or task on hold if things are becoming too intense or overwhelming.  Once you have regained composure and self-control, go back to the situation and finish your task in a better way.  Any time you exercise better self-control, you should feel good about that success.  This type of success is a big deal.  Many have found that by using the “Time Out!” technique, it is possible to manage many situations without making yourself vulnerable or unsafe. 

I wish you success in mastering this powerful technique.

Learning How to Breath?

This post deals with Chapter 6 in A Mind Frozen in Time, which focuses on the therapeutic technique of Deep Breathing.  In the therapy setting, many people ask, “Why learn how to breath?  It happens automatically, doesn’t it?”  This is an honest question, and the answer is Yes and No.  Yes, the body will breath automatically.  However, when revved up due to high levels of stress, the body tends to exhibit very shallow breathing which increases the sensation of anxiety and body tension.

Why does this matter?  To get the full benefit of the way the lungs are designed, we need to breath deep into the belly or abdomen.  The lower lung areas are where the majority of blood vessels are for the exchange of oxygen.  When we have shallow breathing, the lungs are being utilized in an inefficient manner.  For coping with anxiety or stress, two things happen.  First, the act of focusing on your breathing helps divert your attention from the stressful situation.  This in itself can help reduce the sense of urgency about current stress.  Second, deep breathing gets the body to relax as an automatic process.

Many individuals when first introduced to this technique for coping with stress have expressed disbelief or skepticism at its usefulness.  Also, many have come back later and attested to the benefits and simplicity of the technique which can be used most anywhere in most any situation.  Chapter 6 outlines how the Deep Breathing technique works and the steps to follow when first learning it. 

At the beginning of PTSD recovery, many people are feeling overwhelmed many times every day.  The use of a simple but useful strategy for reducing anxiety and regaining control over your own physical and mental processes can bring a spark of hope that is much needed early on in this process.  Remember:  You must first control yourself before you will truly be able to control anything else.  Practice daily.

Why Coping Skills?

This post is concerned with the topic of Coping Skills as a core part of PTSD recovery.  Chapter 5 in the Recovery Guide is titled “Why Coping Skills?”  A coping skill is any thought, behavior, or specific skill that helps us deal with stress, daily hassles, symptoms, and painful emotions.  In the midst of a traumatic experience, a person’s coping skills become overwhelmed, and extreme behaviors that are more accurately termed “survival skills” are utilized.  After PTSD symptoms become dominant in the person’s life, coping with even routine daily stress is a major challenge.  At this point, many people use all-or-nothing strategies such as complete withdrawal and isolation, aggression and violence, depression (as self-protection), alcohol and drug abuse, and risky or extreme behaviors to reduce tension.

From the perspective of the person dealing with PTSD, it just seems natural to continue using the behaviors that helped them survive, because “they work(ed).”  A new difficulty arises in which short term solutions are used as long term strategies.  This approach to coping can get some immediate results and achieve immediate desired outcomes.  However, the long term fallout for the person’s life becomes eventually disastrous. 

As a result of these problems, many PTSD treatment approaches include the development of coping skills as a core element of the recovery process.  Basic skills include Deep Breathing to calm the body, taking a Time Out to reduce impulsive behavior and give some time to think things through, and also mental focus skills for thinking more clearly and making better decisions. 

As a person becomes more and more proficient in identifying stressful situations and applying the more healthy coping skills, the negative consequences of many symptoms begin to diminish.  A sense of healthy self-control returns and confidence increases.  Healthy appropriate coping skills are an essential part of good normal life, and must be rebuilt as part of PTSD recovery for lasting mental health.   This takes practice, practice, and more practice.  Persistence is your friend on this part of the journey.

Why PTSD is a Problem

This week we are considering Chapter 4 in the Recovery Guide.  Why is PTSD a problem?  I get this question quite often, and it’s not just skeptics or naysayers who bring this up.  Many people honestly want to know.  The line of thinking goes something like – “the person survived the trauma didn’t they?”  Their actions and skills somehow got them through the worst possible experiences.  This sounds like a very strong person.  How then could the results be something that would be a problem, much less be a group of symptoms that would be considered a mental disorder? 

The fact is that this is a very strong person.  The inner fortitude, resilience, and will to survive are incredibly strong in persons who survive traumas. 

However, there are 2 major reasons that the lasting results in PTSD are problematic.  First, the general rule that has to be met for something to be considered a mental disorder is that the symptoms must cause some kind of problem, reduced functioning, limitation, or difficulty in important areas of the person’s life. 

In PTSD, a person often experiences concentration and mental focus difficulties.  Confusion is common, and it can feel like you are being interrupted constantly by the intrusive thoughts coming from your own worst memories.  Emotions can feel overwhelming, resulting in outbursts of anger or a general “numbing” of most all feelings.  It is common to have trouble falling asleep or staying asleep.  Getting close to other people does not feel safe, so most relationships in the person’s life suffer.  Arguments, outbursts, and fights (physical or verbal) are common.  I’ll let you decide if this overall pattern meets the general rule about symptoms causing problems in important areas of the person’s life.

The second reason that the behaviors that result in PTSD can be problematic is that they are too extreme to be effective in most typical daily situations of civilian life.  Instead of swatting a fly with a fly swatter, the person uses a bazooka.  Instead of a slight change in your voice to make a point, there is yelling.  Instead of getting a little irritated with a minor inconvenience, there is full blown rage that produces physical fighting or breaking things (and sometimes people).  At the other extreme, there is complete isolation and withdrawal from situations that feel threatening or overwhelming.  As a result, the behaviors that result from PTSD do not match the reality of many normal daily situations, and are usually some version of “overkill.” 

Chapter 4 in the Recovery Guide concludes with an explanation of the expectable course of untreated PTSD.  The end result is depression, chaos, confusion, fear, and the ruin of the person’s life, with much damage done to those around them.  There is a summary of life before treatment, and also the positive side of the story when a person applies him- or herself to good treatment. 

There is hope.  People do reach high levels of healing and recovery.  A much better life can be lived.  I hope you find and achieve this for your own good and for the good of those you love.

Be Aware Up Front!

This week’s posting focuses on four key issues a person needs to know at the beginning of PTSD treatment.  These are elaborated in more detail in Chapter 3 of  The Recovery Guide.  The first issue is that despite all of the confusing and bewildering symptoms that can feel as if you are losing your mind, the fact is that PTSD is not the same as crazy.  Many people with PTSD question their own sanity, and that is expectable when no answers have been found to explain what can at times seem like you are losing control over your own memories and thoughts.  There are reasonable answers for what you are experiencing. 

The second issue to understand up front is that the normal thoughts and actions that we use to deal with stresses everyday (i.e., called coping skills) got overwhelmed in the traumatic event.  As a result, the person thereafter becomes overwhelmed by small events or perceived dangers quickly and easily.  This is why many treatment approaches focus on rebuilding and strengthening a person’s coping skills.

The third issue is the fact that a person loses the ability to feel safe.  This is a product of both changes in brain functioning and also psychological factors.  It is normal for people to want to feel generally safe and secure in their environment on a regular basis.  When that is taken away, the natural reaction is to try and feel safe by anticipating danger and changing your behaviors to ensure your own safety and the safety of those you care about.  These behaviors might be labeled as “paranoid” by someone who is uninformed about what is really happening.

The fourth issue a person needs to be told about at the beginning of PTSD treatment is the tendency to feel worse before you start to feel better.  Some people quit treatment because there is the expectation that treatment will help them feel better immediately, but in the first several weeks (or months) the opposite seems to occur.  The reason for feeling worse initially, is that the absolute worst experiences of the person’s life are being brought to mind frequently in the treatment process, even if the details of the trauma are not being discussed specifically.  Remember that the person has been trying to keep these thoughts out of their awareness, and now here we are thinking about those very things quite often.  This is very much like opening up and cleaning an infected wound so that it can begin to heal correctly. 

Encouragement – It is very important to stick with the treatment process early on.  If you feel worse initially and quit (like many people do) then you have not given treatment an adequate chance to work.  Most people who stick with treatment and figure it out, build their coping skills, and resolve the emotional damage of the trauma find significant levels of healing. 

I put an explanation of these issues near the beginning of The Recovery Guide  in order to help individuals just starting treatment have a head start in understanding what is most likely happening to them early on.  By knowing up front how these four issues work, a person can better know why it seems so difficult in the beginning and hopefully take courage as they “tough it out” and stick with the process of recovery.  Thousands of other people have made it through this very painful part of the journey of healing.  I encourage you to persist in this investment in your own healing.  For those who have done so, I have seen huge benefits in their lives, and also in the lives of people close to them. 

Take heart – it does get better.

So, What’s it Like?

This week we look at the question “What’s it Like if You Have PTSD?”  which is the title of Chapter 2 in the Recovery Guide.  Let’s start with the basic logic and thinking process that occurs during and after psychological trauma.  In the midst of the life-threatening or horrifying event, you know that something terrible is happening, and the normal survival instincts kick in.  Logic says that it is obvious the event that is “messed up” and if I can just get out of this situation or back to “normal life” then things will return to normal.  However, after enough time, numerous overwhelming symptoms cause more and more problems at work, in your relationships, disrupting your sleep, and changing your previous typical patterns of thinking and acting.  Now, you think again, and the situation has changed, but things seem to be getting worse, not better.

When no answers are to be found, many people privately think, “Maybe I’m just crazy!”  Again, to the person experiencing these things, this is a logical conclusion because it would seem that everything else has been ruled out.  Many have described living with PTSD as total fear and confusion, a destroyed quality of life, frustration and regret, angry, tired, hopeless, and as a mental gloom that controls your life.  Thoughts of what happened in the trauma seem to always be forcing their way into your awareness at any given time, and you can’t seem to get any rest because everytime you sleep the nightmares of the traumas cause you to fight in your sleep and then wake up in a cold sweat feeling complete fear and panic. 

With untreated PTSD, it feels as if you are out of control, your life is ruined, there is danger everywhere, you can’t seem to feel safe or relax, you feel worthless, the symptoms seem to be inescapable, and all you see is danger, anger, and misery. 

This is where most people are when they finally show up for therapy.  Many people have said it was their last chance before suicide.  As bad as all of this sounds, it is true that thousands of people have reached high levels of recovery from exactly what you have read above.  Find a therapist with whom you feel comfortable and are willing to try and place some trust.  If money is a problem, call a local psychologist and ask for a referral to a reputable group that provides sliding scale fees.  Also, therapy training programs at a university or medical school often have low fees and provide therapy that is supervised closely by experienced licensed therapists.  If you are a veteran, call the VA or local Vet Center and ask about eligibility for services.

To finish this post, let’s look at the two major intentions that are prominent in A Mind Frozen in Time:  A PTSD Recovery Guide.  One of the first needs of the person described above is to cut through the confusion they are experiencing.  The Recovery Guide provides concise, clear, and direct answers for understanding what PTSD is and how it affects a person’s life.  With high-quality answers, the confusion begins to lift like a fog.  The second immediate and practical need is to get some skills for actually doing something about these symptoms and related problems.  Most of the chapters in the Recovery Guide are only 2 or 3 pages, and begin with an explanation of the issue, but finish with practical actions, techniques, or skills for practical use in daily life to address the issue.  What most people find is that the symptoms are understandable, and there are practical skills and actions you can take to begin getting better. 

Let’s be painfully honest.  Seeking treatment for a trauma-related problem is very scary.  Be encouraged.  We now have good answers and people do achieve high levels of healing.

I wish for you courage and strength.  Actually, you already have it within you because of the things you have survived.

The Start to PTSD Recovery

The focus thisValentine’s Day weekend on Relationships is a good theme to illustrate some of the behavior patterns common in PTSD.  One of the foundations of trauma is that a person loses the ability to feel safe.  As a result, any activity or situation that might risk the feeling of being vulnerable will be avoided like the plague.  For example, a close relationship (romantic or friendship) is viewed as dangerous when it feels that the other person “starts to get too close.”  Often, we “push the other person away” without realizing why.  After several months or years, many people conclude something like, “I guess I’m just no good at relationships” but don’t necessarily connect it to a collection of symptoms.   

In A Mind Frozen in Time, chapter 1 is titled:  PTSD?  How’d I Catch That? A very brief description of PTSD is followed by an explanation of symptoms.  It ends with six simple questions, the answers to which give clues as to whether a person might have PTSD. 

Trauma is an inherently confusing experience.  Therefore, it is critical to get answers and make sense of the bewildering symptoms.  How can we deal with something that we don’t understand?  Clear and concise answers can also help in getting past the denial, which is an outgrowth of the thinking associated with trauma survival.  If other people have commented that you have changed after an extremely stressful event in your life, consider getting the recovery guide for clear answers to how trauma can affect people.  Also, get a formal evaluation by a psychologist or psychiatrist who specializes in trauma-related disorders.

With current estimates of there being anywhere from 15 Million to 27 Million persons with PTSD in the U.S. at this time, having an understanding of this disorder and how to help (yourself or others) will become increasingly valuable.  Next time we will discuss “What’s it Like” when you have PTSD. 

I wish for you love, peace, and healing.

Hello world!

This blog is dedicated to every person who has ever struggled with Post-Traumatic Stress Disorder (PTSD).  The intent of the information that follows is to increase awareness of PTSD, show that PTSD is an understandable and treatable condition from which people achieve high levels of recovery, and to foster hope in the face of what seems to be a confusing emotionally painful experience.

I am a licensed clinical psychologist specializing in the treatment of PTSD. 

Each week I will post a brief description of some symptom or aspect of Post-Traumatic Stress, and also an excerpt or brief summary of a chapter from my recently published book:  A Mind Frozen in Time – A PTSD Recovery Guide. 

Whether you are suffering symptoms from surviving a natural disaster, combat experiences, domestic violence, rape, or an unexpected accident, there are things that can help.  Consider the possibility of being evaluated by a psychologist or other therapist who specializes in trauma recovery.  Consider the possibility of medication.  Then, the beginning of recovery starts with becoming informed about what you are dealing with.  How can we fix something that we don’t understand?  Whatever you do or don’t do in dealing with this condition will be your own choice.  Good options are now available.

I wish for you the best on your journey of recovery.