Using Your Strengths for PTSD Recovery

You. I'd like to welcome everybody to today's presentation of a strength based biopsychosocial approach to understanding post traumatic stress disorder. I'm your host, Dr. Donnelly Snipes. In this hour, we're going to highlight the functional nature of most behaviors and reactions, define PTSD and cptsd, examine the function and meaning of their symptoms, develop an understanding of why some people develop PTSD and others don't, and explore useful interventions for persons with ptsd. Now, the majority of this video is going to focus on understanding the symptoms. I have many other videos that talk about different treatment approaches. So the end part of it just provides a synopsis of a few tools that can be used. Remember that humans and animals experience reactions that prompt behavior, anger, fear, and forget about it. These are our stress responses. And when people feel angry, when something happens and people feel angry, they either fight or they fawn. And some people may think, well, isn't fawn fear? Well, you can argue that point. My definition is if the person is staying, they're not running away, they're not escaping, then it's anger. So they're either going to fight or they're going to do whatever they need to do to try to make the other person happy or make the threat go away. That's the fawn. Fear is when the person flees or freezes and then forget about it is when the person just kind of lays down and says, I give up. Reactions are responses designed to protect life and either achieve a reward or avoid punishment. And exploring behaviors and reactions from that somewhat unemotional standpoint can help us get curious and under explore things in terms of what is this behavior communicating, in what way is this behavior helping the organism survive or helping them achieve a reward or avoid punishment, or all of the above. So PTSD and complex ptsd. PTSD is exposure to an event or multiple events, and that produced a sense of extreme horror or trauma. And again, we're not going to go into specific diagnostic criteria today. We're just going to talk in general about the symptoms. People who experience PTSD may be in the military or they may be crime victims. They may be law enforcement. Law enforcement can fall into either category. The defining feature, or differentiating feature, if you will, in many cases for complex PTSD is that there were multiple events. It was a repeated exposure to a horrific or threatening event in which escape was difficult or impossible, causing a sense of helplessness. CPTSD is ongoing. It's not, you know, a couple of occurrences. It's something that happens with regularity. And for some reason, the person feels like they can't escape from it in law enforcement. And I put law enforcement under CPTSD because in order to escape from those traumas that they are exposed to on the regular, maybe not every day, but on the regular, that would mean they'd have to quit their job, which would mean they would lose their income, which would mean they couldn't support themselves. Maybe they don't have training for anybody el anything else. So it may seem like they're stuck. It may seem like they can't address the situation. The military, once you sign up, you can't just decide six months later, hey, hey, I'm not liking this very much. You're there. Once you're deployed, you're there. So there is no escape, if you will. And the same thing is true when you're in an environment where there is abuse of or neglect of self or other. And what do I mean by that? Obviously, abuse of. If somebody's abusing me or neglecting me, that could be traumatic for. Especially for children who can't get out of the situation, who are sitting there going, I can't survive on my own. I've got nowhere to go. Even if it's. I don't want to minimize that because actually more deaths occur from child neglect than do from abuse. But if it's neglect, emotional, physical neglect, the child is, you know, wondering where their next meal is coming from. That's traumatic. People, adults who are in domestically violent relationships or older adults who are infirmed and relying on caregivers so who are being abused or neglected, that can be traumatic. So that's abuse or neglect of the person. It can also be traumatic if you're in an environment which you don't feel like you can escape from, in which you're seeing someone else abused. Maybe the children aren't getting abused, but the caregiver is, or vice versa. Or maybe the children and the caregiver aren't getting abused, but the family dog is. That's traumatic, and that's communicating. What could happen to you is h. What's happening to this person or this animal could happen to you. So it's a loud communication of threat. Complex. PTSD is so complex because it happen. Happens for so long, it's so ongoing and becomes associated with so many different things, things. And it really alters the person's way of viewing the entire world and viewing themselves. So PTSD is exposure to a horrifying event in which there was a sense of helplessness with complex. There's Also a sense of an inability to escape. For each symptom that follows, we're going going to identify the function, what triggers that symptom or exacerbates it and how the person deals with it or mitigates that symptom and other they might be able to do. Re experiencing the traumatic event. This can be, this can happen for people with CPTSD or ptsd. Why? Well, this event happened and it was very dangerous, it was very threatening. So your brain says, hey, don't forget about this. You need to protect yourself from this sort of situation. So the brain doesn't kind of hones in on that and says, be aware for next time. Be on alert. Like if you're out hiking and you step on a poisonous snake and you get bit, that's traumatic. And when you're hiking in the future or when you see snakes in the future, your brain's going to go, oh, remember that thing that was really bad stuff? That's a survival mechanism. Re experiencing can come through intrusive, upsetting memories of the event. You remember what happened, flashbacks, acting or feeling like the event is happening again. And our brain will do that to us if we're reminded of can feel like that's happening again. Because all those sensory cues that were associated with that event, your brain may kind of turn on again, if you will. Nightmares, feelings of intense distress when reminded, and intense physical panic reactions to reminders. This is natural. When your body or your brain senses something that reminds them of a trauma, reminds them of something that was dangerous, then your brain triggers the stress response. And the stress response is going to dump a bunch of cortisol and norepinephrine and other stuff so you can fight, flee, fawn, freeze or forget about it. Generally, the person experiences intense panic and physical symptoms. That stress response amps up. It causes the heart rate to increase, it causes the palms to sweat, it causes breathing to increase to help the person prepare to fight or flee. So physical symptoms that we see difficulty falling or staying asleep. So let's think about this. If you've been in an environment or in a situation that was dangerous and now you're trying to fall asleep, when we're asleep, we are vulnerable depending on the person. Example, if you were in an environment where it was regularly unsafe because of abuse or neglect, especially abuse the person, you may have difficulty falling or staying asleep because you never know when that threat is going to appear. If, for example, you were the survivor of a tornado or a hurricane that was devastating to your area, you may be able to fall or stay asleep a lot of the time. But if it's raining outside or if it's forecast to rain outside, it may be more difficult. If the tragedy, the tornado happened while you were sleeping, it may be more difficult to fall or stay asleep even if rain's not forecast, because maybe you didn't know it was going to rain and then you woke up and your roof was gone. That's traumatic. That is extremely traumatic. The person may experience irritability or outbursts of anger. Recognizing when our stress response is triggered. We have that fight or flee. You are in survival mode. So you tend to be. People tend to be more reactive instead of contemplative about how they respond. They're already feeling stressed. And one more thing is just like, make it stop. Make it stop. Go away. Okay, we understand this. So if we can help people recognize you're having difficulty falling asleep because you don't feel safe. All right, we're going to talk in a little, little while about strategies to help you feel safe. What can you do? You have more irritability and outbursts of anger because your stress response is already primed. You're already, you know, stressed out under undercurrents of stress. So it doesn't take much to make you feel completely out of control. Hypervigilance, being on constant red alert. And I put this under physical symptoms because when somebody's hypervigilant, they're not relaxing, they're scanning, they're looking, they're listening. All of their senses are heightened, if you will, to prepare for and to be alert for any threat that may be happening. That's freaking exhausting. Now we understand why it happens. If you have been caught unawares before, if you have experienced a trauma before, then you're going to be more hyper vigilant even after, for example, a car accident. And maybe it wasn't a bad car accident, but it was a car accident. You may be more hypervigilant when you're driving. You're scanning, you're paying attention. For drivers that aren't paying attention themselves, you're paying attention for. To see if there are any animals that are going to run out in front of you. You're a little more hypervigilant after you start feeling safer driving. You have more experiences where nothing bad happens. You probably will become less hypervigilant. You'll become. You'll still be vigilant, but not hyperv. Vigilant and helping people again understand that's your brain's way of saying, oh, I ain't going to get caught with my pants down again. Okay. Feeling jumpy and easily, easily startled. That's different than hypervigilance. Hypervigilance is awareness, scanning, paying attention, feeling, jumping. And easily startled is having an extreme stress response when something happens. When the dogs bark, when somebody knocks at the door, when somebody drops something. This is your stress response, your HPA axis going, something happened. I don't know what it is. I feel out of control. Okay. Not everybody is as sensitive to being jump, jumpy and easily startled, but some people are. And it's important that people be able to communicate, recognize that's their, their stress response. It's a little hypersensitive right now. Okay. Be able to communicate to people what makes it worse. So people can be more sensitive to their needs. For example, not slamming doors, but also recognizing when that happens. And they, they, they jump, they startle. All right, I'm going to get grounded. I'm going to look around. I'm going to recognize who, where, and when I am, and I am going to just let that go instead of getting angry about it, instead of dwelling on is what it is. I still do that. Somebody will drop something that's, that's really loud, or the dogs will bark all of a sudden crazy for no apparent reason, and I will startle and I, you know, may say something about it. But then I've recognized I'm at home, I'm safe, it's all good. And I can calm myself back down. I can use my distress tolerance and my down regulation, down regulation tools. Fatigue. If you can't sleep, you're irritable all the time. You're constantly scanning and you're constantly tense and prepared to spring into action. Yeah, you're going to be fraking exhausted. Makes sense. Totally makes sense. In order to address that fatigue, the person is going to have to get to a place where they can feel safe, where they can feel empowered. And the core of trauma, complex or otherwise, is feeling unsafe and disempowered. Somatic complaints. Some people are less emotional and they tend to use, to use an analogy, swallow their emotions. They may feel more pain because their muscles are tense so much. And you know how your muscles can get achy, things can get out of alignment, and you can feel more pain if you're not getting enough sleep. If your HPA axis, that stress response is overactive, it can lead to dysregulation of that system, which can lead to increased inflammation. Stress, no matter where it comes from, causes changes in our gut microbiome. So People may start experiencing gastrointestinal problems. Any of these can be traced back to potentially a trauma. Now you may be scratching your head going, well how do I know if they've got the flu or if they've got trauma? When did the symptoms start and how long have they been going on? If the trauma occurred six months ago and they just started developing stomach pain may be related, but maybe related to other stressors or something physical. If the somatic complaints started shortly after the trauma, you can be pretty certain that it's related. And in order to address those somatic complaints, it's important for the person to understand why do I have these, this pain? Why do I have these aches? Why do I have this, you know, GI upset? Well, let's look at how stress impacts the body. Let's look at how you feeling unsafe and powerless impacts the body. And why when we are stressed, our body says it's time to fight or flee, not rest and digest. You gotta choose. Which is why you're not supposed to go exercise shortly after eating because your body can't exercise and rest and digest at the same time. So your somatic complaints, like GI distress is going to be partly because that stress response is hyperactive. As that tones down, some of that other stuff may come back into alignment. Now that doesn't mean we're going to diagnose that. We can help people understand where it might be coming from. But obviously refer for a physical as always and then addictive behaviors, and I know they're behaviors, but where do you stick this addictive behaviors? Regardless of whether it's gambling or sex or alcohol or drugs or even adrenaline, they are often used to help the person numb the pain or feel some semblance of control over something. Interpersonal symptoms of trauma Persistent difficulties in sustaining relationships and in feeling close to others. Remember, when people have a mental health diagnosis, it's rare that somebody has every single symptom and people don't have to have all the same symptoms. If your trauma was interpersonal in nature, then yeah, you may have difficulties in sustaining relationships because other people are perceived as a threat. Threat. If you develop PTSD or CPTSD and the people around you don't get it and they're invalidating, then it may have, you may have difficulty feeling understood and accepted and supported, which leads to difficulties in sustaining those relationships. There may be a lack of interest in relationships and social engagement, especially if the trauma was interpersonal. Being around people means that there's a, an increased chance of threat. So you're Already exhausted. Why do you really want to subject yourself to that? What is the behavior saying? Why have you lost interest in relationships there? The people don't seem to understand you. You just don't have the energy to engage in them. What's going on? What is that behavior saying? Feelings of mistrust and betrayal. If you were traumatized, if you were threatened in some way by somebody else, then you can see where that might happen. If it was somebody that you knew and thought you trusted, you can see where that might be even more intensified. But feelings of mistrust and betrayal can also happen. If this event occurs, it's traumatic, say a hurricane, and other people either don't help or they take advantage of you. And we've seen that after hurricanes and tornadoes and other things, where is this fear of other people, inability to trust other people? Where's this coming from? What thoughts are contributing to your inability or the person's inability to trust others? Alternately, there may be occasional intense relationships, but the person has difficulty sustaining them. Some people who've been traumatized are desperately seeking another person that can help them feel safe. But because of the intensity of their trauma and generally the inability to communicate what's going on and what they need, it comes off as overpowering. If the original trauma was interpersonal, then you may see the vacillation between all good and all bad. I can trust you. I need you. You help me feel safe. The minute I start to sense something is off or troublesome, I hate you. And you know that. That is one of those key features that we associate with borderline personality. But I would encourage you to consider trauma, emotional symptoms, loss of interest in activities and life in general. If you're not getting good sleep, if you're stressed out all the time, if you're hypervigilant, if you, you know, all that stuff is going on, you don't have a lot of energy. Not to mention the fact that your neurotransmitters are going to be becoming imbalanced. You need to be able to get rest. You need to be able to set your circadian rhythms. You need to be able to eat a healthy diet and have your body actually absorb the nutrients to make the neurotransmitters that can help you feel and interested in activities and life in general. Dopamine, norepinephrine, serotonin, oxytocin, all of those things are important. And when you are stressed, it alters the balance not only of your neurotransmitters that I just talked about, but your hormones Estrogen, testosterone, thyroid hormones. So people might start feeling very flat and blah. Feeling detached from others or emotionally numb. Well, you may not feel much of anything. Sometimes trauma was causes people to detach from their own feelings because it was so overwhelming and so overpowering. They just put up a wall, they don't feel anything anymore. Other times it may be feeling detached from others because they, you feel like they don't get you, they don't understand what you've been through, they don't validate your perspective. And a lot of times even well meaning therapists and doctors and loved ones may inadvertently invalidate people by trying to tell them either it's not that bad or trying to take their trauma and take their pain away. It's theirs, let them have it. If they feel betrayed by people. Okay, when you're ready to work on that, when you're ready to look at it, I'm here to talk. But if you feel betrayed, far be it from me to tell you that you're wrong. People experience reality through the lens of their prior experiences and we need to recognize that. A sense of a limited future, especially if the trauma was painful or physically threatening. Persistent problems with affect regulation and dysregulation. This goes back to that dysregulation of the stress response, the HPA axis. When the HPA axis is on for too long, the receptors become resistant to the cortisol, they become glucocorticoid resistant, which means the person is, is not going to feel energized, excited, they're going to feel flat a lot of the time. But when they finally do experience a threat of some, some sort, it's going to be intense because the brain has to secrete a tsunami of stress hormones just to get the receptors to wake up and pay. So the person goes from flat to furious or flat to frantic. That's exhausting. People who've experienced trauma also deal with anger, shame, sadness, humiliation, guilt, and sometimes survivor guilt. How a person interprets and feels about a trauma is very individualized. So we need to ask them, do you feel angry about this? Do you feel shame or guilt? What is it that you're feeling? And let's talk about what's causing those feelings? What thoughts are you having that are triggering those emotional reactions? Cognitive symptoms, difficulty concentrating, you're not getting enough sleep, you're stressed out, you're hypervigilant, you're scanning all over the place looking for threats. You're. Yeah, you're not going to be concentrating on your PowerPoint. That's just not gonna happen. People who are in fight or flee are not engaging their prefrontal cortex. They're going to have a lot more ADHD type symptoms because that's not where their energy is. Recognizing that compassionately providing accommodations for that while the person is healing is important. Okay, you can't concentrate on a movie for an hour and a half. No problem. What can you concentrate on? You can't focus on reading a book for two hours. Okay, how much can you do if that's something you want to do? Helping people learn how to chunk stuff so they can get it done without taxing their concentration and making sure that they have prompts that are helping them remember things, writing things down, not trying to remember a grocery list, not trying to remember what they're supposed to do this week. Having pretty much everything scheduled into a planner or prompts. Dissociative symptoms are very common. And that's, you know, we all know the brain kind of checks out when the person starts to feel overly stressed out. And sometimes people will report that the dissociative symptoms are like they're a fly on the wall watching what's going on. Other people report the dissociative symptoms are like they just, they lose time. And that's the brain's protective mechanism. It says, oh, boy, this is just too overwhelming. Peace out, I'm gone. And that's somewhere between freeze and forget about it. I think in terms of a stress response, recognizing the protective function of the dissociative symptoms, helping people figure out, you know, what triggers dissociation for you and what can help you stay grounded in the moment. Sometimes narrating what's going on. Sometimes talking on the phone to somebody with, while they're doing something that's stressful, if they. I've shared with you before. A client I worked with used, had had horrible, horrible history of abuse and cooking. Being in the kitchen was very stressful because of some abuse she had experienced as a child. Playing with pots and pans, she made too much noise and it was bad. So when she would be in the kitchen, she would dissociate. And that's not good when you're cooking for her. Talking through things or talking to someone while she was doing it was helpful for keeping her in the moment. After trauma. People can have persistent beliefs about themselves as being diminished, defeated, or worthless, accompanied by a deep and pervasive feeling of shame, guilt, failure, rejection related to the stressor. I should have known better, I shouldn't have. A lot of times we try to, we rethink it. Number one, hindsight's always clearer than in the moment. In the moment, you're terrified, you're in fight or flee. You may not know what the best response is. But even if you're looking prior to the trauma and saying, well, I. I should have known better not to do these things, well, it happened and nobody's perfect, encouraging people to start examining those things and how, holding on to those beliefs that they. And punishing themselves, feeling guilty or shameful for making a mistake, how that's contributing to their quality of life now and what they can do to learn from it and prevent it in the future. Inability to remember important aspects of the trauma, or even unimportant aspects of the trauma can be frustrating for people and the brain when you're stressed. Interestingly, when the brain has a bunch of glutamate, which is your main excitatory neurotransmitter, it actually prevents the formation of memories. So the brain says, you know what? I really don't want to remember this. And some people may never remember certain aspects of the trauma. Increased negativity and pessimism. If you feel unsafe, you're probably not going to look around and see a world full of puppy dogs, kitty cats and roses, or whatever makes you happy. You're going to look around and you're going to see potential threats. You're going to see potential helplessness. And addressing some of those cognitive symptoms will help the person start to feel safer and more empowered. Environmental symptoms. Deliberate avoidance of reminders of the trauma. If you experienced a trauma when you were driving, then deliberately avoiding driving, I'm not getting in a car again, or I'm not getting in an airplane again, or, or whatever it is, okay, if, you know, sometimes you can't avoid reminders of the trauma. But if you are a survivor of a tornado, deliberately avoiding watching television shows about tornadoes probably is in your best interest. But recognizing that, and sometimes it's healthy, you can avoid watching a show about a tornado and it's not going to have significant impact on your life. If you were in a bank when it was held up and now you avoid going into banks and oh, by the way, a bank is kind of like a store. There's lots of people, I don't know lots of uncontrolled variables, then you start not wanting to go into any public places, okay, that's a problem. And helping the person develop tools to deal with that. Specific and generalized triggers. And I kind of alluded to that specific triggers are those that are associated with the trauma it was nighttime, it was a parking garage, you were held up, your purse was stolen, whatever. So there are very specific triggers. However, there can. These triggers can become generalized. Maybe you are in a parking lot at night and you start to feel anxious. Well, it's similar. It's night, there's a car involved. Now, parking lots, as well as parking structures are threatening to you. So you can see how these things can generalize. If they have some characteristics that are similar to the original trauma, then that trauma, those trauma reactions, those trauma feelings or perception of threat becomes associated with those similar situations. And very quickly, a person can have difficulty going anywhere without being reminded, Triggered. Reminded of their trauma. So Triage, Pinus and Nader did some work. I cited them in my dissertation. So this was in the late 90s, probably that they were doing the research that indicated there are certain things that make people more likely to develop post traumatic stress disorder after a trauma. Most people process it. Okay, thank you very much. And go through a process that we call traumatic growth. It doesn't become traumatic stress disorder, but for some people, they get stuck feeling helpless and disempowered and unsafe. So what may cause that? Well, if you're, if you are the victim, all right, you're going to be more likely to develop PTSD than if you observed somebody else who was a victim or if you're similar to the victim. And I see this a lot in law enforcement, where responders will go to a. A scene, maybe it's a child drowning, and they've got children, and they can, even though it's not their child in the pool, they can see, sort of their mind says it, this could be your kid, and it's more traumatic. It sticks with them harder than people who maybe didn't have kids. So similarity to the victim also makes people more prone to getting stuck. Proximity to your safe zones. These are places where, prior to the trauma, you felt safe. Your home, your. Your immediate neighborhood, your work, the immediate area around there. Hopefully. Generally, we feel safe in those areas. When I was in college, we had, sadly enough, a serial killer that plagued the city of Gainesville for a while. And up until that point, we didn't think twice about walking by ourselves at night, going jogging with our headphones on, whatever. And once that happened, that was our safe zone. We felt if we were on campus, even though it was a big campus, if we were on campus, we were safe. Well, that was incorrect thinking anyway. But it hit home when all of a sudden it became very objectively unsafe. So it's important to Recognize if it happens in somewhere where you did feel safe and now all of a sudden that's ripped away from you, that could make it more difficult to feel safe there. Again, not impossible. Difficult. Social support after the trauma 24, 48, 72. Support within the first 24 hours is most helpful and most effective because that trauma is fresh. It hasn't started to be processed and accommodated and whatever by your brain. It's right there. And support during this period can help people process stuff before they start locking it down. 48 hours is still good. Generally, the initial emotional reactions have subsided some, but there's a lot of confusion and disorientation. You can still process a lot of stuff in the first 48 hours. If a person feels during this period that they are safe and empowered, it's may not be the time to actually talk through what happened. The important thing is helping the person start to feel safe and empowered again. If they're left out there flapping in the breeze for 72 hours before anybody is there to help them feel safe and empowered, they're at a much greater risk of developing post traumatic stress issues. History of mental health problems. If the person already had a history of anxiety or depression or addiction or something else, trauma is a huge trigger for relapse. It doesn't mean it will happen, but it means it could happen. And the number of stressors the person's experienced in the past six months, why six months? I don't know. I don't know if they pulled that out of the hat or if they found that it was six months was more important than 12 months. But remember, every time you experience a stressor, it drains you. And if you've had 12 stressors in the past six months, you're probably walking around going, I can't take one more thing. And then a trauma hits. That's system overload. If you've only had two or three stressors in the past six months and trauma hits, yeah, it is overwhelming, but it may not be complete. System overload. When you're talking to people assessing or screening, if you are not the victim, how are you similar to the victim? This helps us try to get a handle on whether they're at greater risk for developing post traumatic stress. How are people around you similar to the perpetrators? Again, looking for their inability to trust others and feel safe and empowered. What was or would have been helpful for other people to do after the trauma? If people ignored them, that's not helpful. If people were just constantly telling them, hey, it's okay, you'll be fine. That's invalidating too, you know, hear my reactions, hear my experience, validate where I'm coming from and help me figure out how to get my footing again because I just had the rug pulled. And who can you rely on to do those helpful things now? Now the helpful things are important that we and we'll talk about it in a minute. But you got to communicate that. What is it when you're in crisis? What is it when you're feeling unsafe and powerless that you need and want people to do? Do you want them to just sit there? Sometimes just having another person there is enough. Do you want to talk about your feelings or do you want to do anything but talk about your feelings? What is it that would be helpful to you? Because what's helpful for you may not be what's helpful for them. It doesn't matter. Helping them understand what's helpful for you, they can do that. Physical Interventions Sleep Sleep helps balance our neurochemicals. Lack of sleep triggers the stress response. Sleep helps reduce cortisol and HPA axis activity and has been associated with the ability to better control ruminations and intrusive thoughts, which are prominent for a lot of people with ptsd. In order to help people improve their sleep, help encourage them to develop a routine to let their body know when it's time to sleep. For example, when kids, they come home from school, they play, they eat dinner, they take a bath, you read them a story, they go to bed. That routine actually helps set their circadian rhythm. It's not just the light outside. Help them figure out ways to to release stress and tension. For some people it's journaling. For others it's jogging, woodworking, whatever it is that helps people kind of release some stress can be helpful. Medication is out there for some people and it can be something like over the counter like melatonin or something harder like Ambien, for example. That is a personal decision for the individual to make interpersonal interventions. Helping people find non judgmental people you know, think about in your life, who in your circle is non judgmental and if there is nobody, where can you find non judgmental people? And it can be trauma specific. People who have been in the military and experienced trauma through being in war or trauma through the military sometimes feel like they're better understood and less judged by people who've been through similar experiences. Their perception of feeling understood and accepted is what's important even if you haven't been through it and you are the most non judgmental person in the world. If they don't feel that way, if they don't expect it or perceive it, then saying, well, you can talk to me. Why don't you just talk to me? That's. That's invalidating. So we need to help them a place where, find a place where they feel accepted and understood, ideally finding Support that's available 24 7. That's one of the beauties of the Internet is people can find a chat room, if nothing else, pretty much any time of the day. But helping them find healthy message boards and chat rooms that they can access, helping them put either icons on their mobile device or bookmarks on their. On their browser so they can easily find it. Helping them find people that they perceive as empathetic, understanding, willing to take their perspective and able to handle it. A lot of people who've experienced trauma are reticent to share their experience and their feelings because they're afraid they're going to either scare or overwhelm the person they're telling. And that's true even for therapists. I've worked with a lot of people who have been very cautious, starting to tell me about their trauma, even though they wanted to tell me because they were like, I don't know if, if she can handle it. I'm like, bring it on. You know, if you're a therapist, reassuring people that you can handle what's going on, you're not going to be overwhelmed by whatever they have to tell you can be really important. Same thing. If you're a parent and your child has been traumatized, surrounding yourself with people who are open to learning what you need to help you. And I already touched on that a lot. If somebody is trying to be supportive, but they're going to do it their way, they're going to fix it for you, or they're going to tell you that you need to talk about your feelings, they're telling you what they think you need. That's not helpful. Being surrounded by people who are willing to say, what is it that you need? And let me help you. That's what's going to be most helpful. And that will help the person feel more empowered and safer because they've got people listening to them. We need to encourage them to use these interpersonal relationships to help help them meet their health and safety. Safety needs, you know, getting groceries, eating healthfully, whatever, and handling the details. People who are in shock or traumatized can't remember squat. So helping them figure out what they need to do for prompts and writing things down, notes on the Refrigerator. If they've got like an Alexa or whatever that they can tell when to add stuff to a list. I don't have one of those. I don't know how it works. But some, some more techie people may have that. Keeping notes on their mobile device, setting prompts and appointments with reminders. All of those things are important. Not expecting themselves to remember something because then when they don't remember it, they're going to feel bad. And, and, you know. Emotional interventions, another mnemonic. You know, I love my mnemonics idea. Helping people develop emotional intelligence by identifying their emotions effectively and accurately in self and others. What is this person feeling? What am I feeling? Learning how to downregulate to get into their wise mind. Okay, I'm feeling angry, or it seems like this person's feeling angry, which is making me feel anxious. Let me downregulate so I can effectively process, explore the function of the feeling. If I feel angry or anxious, then that's my body saying, hey, there might be a threat. And what triggered that feeling? Why am I thinking there might be a threat right now? And then actively solve the problem. Help people learn about pieces of motivation, physical motivation. How is doing whatever this is going to help me feel physically better? Less pain, more energy. How is it going to improve my relationships? How is it going to help me feel happier or less stressed? How is it going to help me think more clearly and logically move toward my goals? How is. What can I put in my environment that can remind me to, to do these things and how is it in line with my values? Encourage people to create successes and be patient. Don't expect to go from PTSD to completely recovered in three weeks. That's not, that's not realistic. Don't expect to go from can't remember anything to don't need to write down anything in three weeks. Make sure people set small, achievable smart goals so they can have those successes. Successes help promote dopamine, promote a sense of competence and empowerment and safety. Sometimes people are not going to succeed even if they try. They may fail at something. So helping them be compassionately patient is also important. You may have intended to go looking for a job today and it was just, it was too overwhelming. Okay, you know that you didn't achieve your goal today, but let's look at why that happened. Being patient and compassionate with yourself and developing a strategy to address those things. Encourage people to do things that used to help them feel happy. Don't expect those things to make them feel over the moon. Happy anymore, but occasionally exposing themselves to things that used to make them smile, whether it's puppies or sunrises or babies giggling. I love watching babies giggling on the Internet. I don't know why. And help people process the dysphoria. Encourage them to talk to somebody, to start unpacking that unpleasant emotional baggage. In terms of trauma recovery, trauma is a grief process. You lost a sense of safety and a sense of personal power. You lost potentially a sense of control. You lost potentially hope and idealism. You thought the world was a wonderful place and you realized, oh, maybe not. There are a lot of sort of esoteric losses in addition to potentially tangible losses that happen for trauma. And it's important that people understand the breadth of their losses and process those in their own time. Just like any grief process, people need to do it in their own time. Remember the stages of grief or denial. Anger. It's a threat. This, whatever this was, it was taken away. It made you feel powerless. Okay, so you're going to get angry, bargaining, trying to figure out how to make it not have happened. Depression, accepting that it did happen, or recognizing that it did happen and sitting for a minute with your sense of powerlessness, okay, I can't change it, can't make it go away. And then acceptance. How are you going to integrate it into your next chapter? So the questions that you can ask people, what losses did you experience as a result of the trauma? Do it one by one. Don't have a whole laundry list here. One loss at a time. Sometimes it can be helpful for people to write their losses on index cards. And you just process one index card a day or a week. What about this loss makes you a feel angry or afraid or threatened? How can you deal with this anger or fear in a health helpful way? Remember, remind them that anger and fear protect them and ex have them explore what they still need to be protected from in this situation. Remind them that depression signals a sense of hopelessness or helplessness and recognition that what's done is done and they can't change it. Therefore, once they've sat with those feelings for a bit, they've developed a sense of the safety and power that's helped them move out of the threat zone. They've sat with that depression for a minute, accepted that the loss occurred. Then how do they move to full acceptance? How do they integrate it into the next chapter of their life? You know, what's the character arc? Cognitive desensitization can be very helpful. Some things that people logically know are threatening speak still evoke A startle response. So helping them acknowledge the event. Be kind to themselves. All right, somebody dropped something. I jumped. I got scared. Well, it was what it was. Recognize the value of the startle response in protecting yourself. Identify times when the startle response might be greater. If somebody dropped something in the library, that's probably going to be more startling than if somebody drops something in a restaurant for most people. And identify ways to mitigate the startle response. For example, if people making loud noises or something is startling, maybe sitting with your back to the wall so you can see what's going on, so you feel less vulnerable. Some beliefs about safety, happiness, or people or situations in general can be distorted by trauma. Encourage people to explore what happened, what the belief is. If the belief is based on facts or feelings. Feelings are not facts. How reliable the source of those facts are, whether the person is using any extreme words, whether they're considering the whole picture or just this little part or their part or, you know. In what ways does holding on to the belief protect them? In what ways does holding on to the belief impair their ability to achieve their rich and meaningful life? And how can they best use their energy to move forward? This is part of cognitive processing therapy, which can be very helpful with PTSD in terms of cognitive errors. Overgeneralization. Encourage people to find exceptions and change their language. Instead of always or never and or all or nothing. Sometimes a few. The control fallacy. Encourage them to examine the facts in context. If they think I could have controlled it, is that true? What are the facts in context? If this happened when you were a child, could you have controlled it? If it happened now, maybe you could, but. But as a six year old you couldn't. Or maybe the situation, no matter how old you were, was uncontrollable, or the belief that they can change it. If I would have only blah, then this wouldn't have happened. How do you know that? All or nothing Thinking. Encourage people to examine the facts, find exceptions, and again, change their language. Catastrophizing, expecting the worst possible scenario, or seeing the worst possible aspects. Encourage people to look at all the facts and then the probability. If you're catastrophizing that every time we have a thunderstorm there's going to be a tornado, that's catastrophic thinking. Or every time that there's a bad storm there's going to be a tornado and the house is going to be destroyed, what are the facts for and against that belief? And what is the probability that that's actually going to happen based on Those facts. Personalization means taking, taking it personally, it's my fault, or this had to do with me. Unhooking the behavior or the experience from the person can be helpful and encouraging them to look for alternate explanations. Why did this happen other than it's your fault or what are some alternate explanations? And then mind reading. I should have anticipated this person was going to do this. No, none of us can read minds. Is that. Can you give me examples of when anybody is successful 100% of the time at mind reading? Environmentally, encourage people to address triggers in their environment, like sounds, smells, and sights that may cause them to remember the trauma. Get rid of things that are excessively triggering and add sounds, smells, and sights that help them feel safe and empowered. Fun has a lot of great tools for reducing stress because we tend to be more stressed if we can't see around us, if we can't see someone who might sneak up on us. So it talks about adding mirrors and it talks about doing different things that may help reduce stress. From a practical standpoint, anchoring is also important so when you awaken, you can stay in or get in the present moment. Being able to easily turn lights on with a, you know, a tap thing, or having a safety item with you, like a light, a flashlight, or for a lot of people, a dog. A dog can help them actually feel grounded and feel safe and sometimes able, able to relax so they can get to sleep. In terms of creating safety, help people reflect on what they've done that helps them feel safe, what they can do to take back their safe zones, their home and their work, how they can protect themselves from trauma in general in the future, Encourage them to reflect on how the experience changed, how they view things, what's important to them, and how they're going to live their life now. Encourage them to brainstorm different ways to create safety at home, at night, in the car, at their office, and again, any of those safe zones is important. Trauma can occur from a single event or multiple ongoing stressors. Traumatic events can change people's beliefs about the world in a very extreme way. For some people, understanding the functions of symptoms can help them desensitize. So when they start to feel something, they're able to say, okay, this is just a feeling, and I'm actually not in danger right now. Can help them modify their beliefs and make positive mindful choices. Thank you everybody for being here today and I'll see you next week.