The following are sample questions that can be used to generate discussion about a traumatic event:
I. Fact Questions
- How did you first learn of the incident?
- Where were you when the incident occurred?
- What did you see?
- In what way were you involved in the incident?
- Who told you about the incident?
- What were you doing at the time of the incident?
II. Thought Questions
- What was your first thought when you learned, saw, heard, about the incident?
- What were you thinking when the incident was occurring?
- What did you say to yourself?
- What have you been thinking/saying to yourself since the incident happened?
- What thoughts keep coming back to you?
III. Reaction Questions
- What is the worst part of this incident for you?
- Which part of this would you most like to change?
- What about the incident makes this such a difficult situation to handle?
- What are you having the most difficulty handling?
- What is the strongest reaction that you are experiencing?
IV. Symptom Questions
- What, if any, physical symptoms have you experienced?
- Has anyone experienced sleep disturbance?
- Has anyone’s appetite been affected?
- What “out of the ordinary” physical symptoms are you experiencing?
- What is your body telling you about this incident?
V. Relationship Questions
- How has this incident affected the people closest to you?
- What have others said or done that upset you?
- What have others said or done that has been helpful to you?
- Has it been helpful to talk to others about what has happened?
- Do you have people that you can speak to about the incident?
VI. Recovery Questions
- What are you doing to manage the stress that you are feeling?
- What are you doing to cope with the incident?
- What are you doing that’s working for you?
- What are you doing that’s not working for you?
- If someone else were in your situation, what would you advise them to do?
- What are you going to do to take care of yourself?
- What things have you done in the past that helped get you through a stressful event/period?
- What things do you have planned in the next several days that will help you in dealing with this stressful situation?
Shock and Numbness
At first you may be in a state of shock and may feel numb and confused. You also may feel detached—as if you are watching a movie or having a bad dream that will not end. This numbness protects you from feeling the full impact of what has happened all at once.
You may feel overpowered by sorrow and grief. As shock begins to wear off, it is not unusual to feel intense grief and cry uncontrollably. While some parts of our society frown on emotional behavior, this emotional release is an important part of grieving for most people. It is unhealthy to hold back or “swallow” your painful feelings and can actually make the grieving process last longer. If you are uncomfortable with these feelings, you may want to seek help from a counselor or minister or other victims who understand what you are going through.
You may feel intense fear and startle easily, become extremely anxious when you leave your home or are alone, or experience waves of panic. Someone you love has been suddenly and violently killed while going about his or her daily life. You had no time to prepare psychologically for such an incident, so you may feel intense anxiety and horror. You may be afraid that the attacker will return and harm you or your loved ones again. Crime shatters normal feelings of security and trust and the sense of being able to control events. Once you have been harmed by crime, it is natural to be afraid and suspicious of others. These feelings will go away or lessen over time.
Victims who were injured in the traumatic disaster want to understand why the crime happened, and families wonder why they lost a loved one. Some people find it easier to accept what happened if they can blame themselves in some way. This is a normal way of trying to once again feel a sense of control over their lives. Victims often feel guilt and regret for things they did or did not say or do and that they should have protected a loved one better or have done something to prevent his or her death. Survivors spend a lot of time thinking, “If only I had . . . .” This guilt does not make sense because the circumstances that lead to terrorism usually cannot be controlled and are hard to predict. Get rid of imagined guilt. You did the best you could at the time. If you are convinced that you made mistakes or have real guilt, consider professional or spiritual counseling. You will need to find a way to forgive yourself. Feelings of guilt can be made worse by people who point out what they would have done differently in the same situation. People who say such things are usually trying to convince themselves that such a tragedy could never happen to them.
Anger and Resentment
It is natural for you to be angry and outraged at the tragedy, the person or persons who caused the tragedy, or someone you believe could have prevented the crime. If a suspect is arrested, you might direct your anger toward that person. You may become angry with other family members, friends, doctors, police, prosecutors, God, or even yourself and may resent well-meaning people who say hurtful things and do not understand what you—as a victim—are going through. Feelings of anger may be very intense, and the feelings may come and go. You also may daydream about revenge, which is normal and can be helpful in releasing rage and frustration.
Feelings of anger are a natural part of the recovery process. These feelings are not right or wrong; they are simply feelings. It is important to recognize the anger as real but to not use it as an excuse to abuse or hurt others. There are safe and healthy ways to express anger. Many people find that writing down their feelings, exercising, doing hard physical work, beating a pillow, or crying or screaming in privacy helps them release some of the anger. Ignoring feelings of anger and resentment may cause physical problems such as headaches, upset stomachs, and high blood pressure. Anger that goes on a long time may cover up other more painful feelings such as guilt, sadness, and depression.
Depression and Loneliness
Depression and loneliness are often a large part of trauma for victims. It may seem that these feelings will last forever. Trials are sometimes delayed for months and even years in our criminal justice system. Once the trial day comes, the trial and any media coverage means having to relive the events surrounding the traumatic disaster. Feelings of depression and loneliness are even stronger when a victim feels that no one understands. This is the reason a support group for victims is so important; support group members will truly understand such feelings. Victims of traumatic disaster may feel that it is too painful to keep living and may think of suicide. If these thoughts continue, you must find help. Danger signals to watch for include (1) thinking about suicide often, (2) being alone too much, (3) not being able to talk to other people about what you are feeling, (4) sudden changes in weight, (5) continued trouble sleeping, and (6) using too much alcohol or other drugs (including prescription drugs).
You may feel that you are different from everyone else and that others have abandoned you. Terrorism is an abnormal and unthinkable act, and people are horrified by it. Injury by terrorism carries with it a stigma for the victim that can leave him or her feeling abandoned and ashamed. Other people may care but still find it hard or uncomfortable to be around you. You are a reminder that terrorism can happen to anyone. They also cannot understand why you feel and act the way you do because they have not gone through it.
Physical Symptoms of Distress
It is common to have headaches, fatigue, nausea, sleeplessness, loss of sexual feelings, and weight gain or loss after a traumatic event. Also, you may feel uncoordinated, experience lower backaches and chills/sweats, twitch/shake, and grind your teeth.
Feelings of panic are common and can be hard to cope with. You may feel like you are going crazy. Often, this feeling happens because traumatic disasters like terrorism seem unreal and incomprehensible. Your feelings of grief may be so strong and overwhelming that they frighten you. It can help a great deal to talk with other victims who have had similar feelings and truly understand what these feelings are all about.
Inability To Resume Normal Activity
You may find that you are unable to function the way you did before the act of terrorism and to return to even the simplest activities. It may be hard to think and plan, life may seem flat and empty, and the things that used to be enjoyable may now seem meaningless. You may not be able to laugh, and when you finally do, you may feel guilty. Tears come often and without warning. Mood swings, irritability, dreams, and flashbacks about the crime are common. These feelings may come several months after the disaster. Your friends and coworkers may not understand the grief that comes with this type of crime and the length of time you will need to recover. They may simply think it is time for you to put the disaster behind you and get on with normal life. Trust your own feelings and travel the hard road to recovery at your own pace.
Some individuals will experience no immediate reaction. They may be energized by a stressful situation and not react until weeks or months later. This type of delayed reaction is not unusual and, if you begin to have some of the feelings previously discussed, you should consider talking with a professional counselor.Read Full Post | Make a Comment ( None so far )
As the years pass, you build up a collection of good and bad memories. Your brain has the ability to recall these memories at the drop of a hat – almost instantly. As an example, read the following questions and watch how fast your brain pulls the recollection: Name some songs by the Beatles. What was the last movie you saw? Where were you on 9/11? Where were you when the OJ verdict was announced? Who is the president of the United States? Who was your first kiss? As you can see, your brain instantly finds a memory when a question is asked.
There are several types of memory, each with different time courses that involve different parts of the brain. One kind of memory that is easy to recognize is that of short-term vs. long-term memory. Short-term memory is fast and takes no more than several minutes to recall. Short-term memory reflects your ability to recall specifics, the particulars of what went on. However, such memories fade quickly. Long-term memory extends beyond those several minutes, to hours, days and years in the past. Another kind of memory is called working memory, which is usually associated with short-term memory. Working memory is the ability to hold facts or details of events in the forefront of your thoughts.
All types of memory are interconnected and pathways in your brain. When you experience a very significant event, the brain records not only the details of the experience (where you were, when, who was there, what happened, etc.) but the emotions you experienced at the time as well. The entire memory of an emotional event (an assault, an automobile accident, a wedding, death of a loved one, a combat experience, etc.) is actually remembered by several systems and stored in separate areas of the brain. That is to say that memory is distributed throughout the brain. No single region of the brain has any one of these types of memory completely embedded in it. Instead, each type of memory involves several areas of the brain acting from different regions, where information is brought together, processed and then re-distributed to where your memories are permanently housed. This happens simultaneously, with all of the regions being activated and processing at the same time, so memories are recalled before you even have it concentrate.
Ever wonder why some memories can stay vivid for years while others fade with time? The answer is emotion. Your memory will only hold on to new information (working memory) gained from these events for about five days (this is your short-term memory). Memories that are not significant are usually forgotten or “dumped” and erased after this five-day waiting period (this is the time taken to transfer events from short to long term memory). The brain will learn or memorize all kinds of information with frequent repetition and constant use. However, if a memory containing only facts is not frequently used, the memory slowly fades away. You can store and create memory, as when memorizing spelling words or learning math. For example: 1) Can you calculate square root by hand? 2) Do you remember the names of all your high school teachers or classmates? In the second question, chances are you can remember those who also have emotional memories attached to them. What I mean is that when your emotions are activate, your brain automatically takes note. That is why you remember some events from the past with vivid detail, particularly the ones that were emotionally charged (like a favorite possession, an unjust punishment or first love). For example, I remember when I was able to tie my shoes for the first time. I can still recall how I ran to my mother and proudly showed her my accomplishment. It was an emotion-filled moment, but also provided useful information that I have carried on to this day, which is why it is still so vivid in my memory.
Humans are hardwired to remember things that threaten or are very rewarding to them. You have learned that what is threatening may be painful and what is rewarding may offer pleasure. These pleasures and pains trigger emotions that elevate the status of any would-be memory. This makes a lot of sense in evolutionary terms: emotional events would be biologically significant. Many survival lessons involve emotion, such as fear, anger or joy and your memory is enhanced by hormones that are released when you experience a strong emotion or stress. This explains why emotional arousal has such a powerful influence on how well you remember things.
What is so important about this? Well, in daily living, especially during times of stress, your memory is very important. Your memory is active every second of your life. It can be controlled when you try and memorize something. Yet your memory is primarily unconscious, in that it works automatically beyond your control and awareness. But the key point is that it can change your mood within two minutes. Perhaps, you have injured your knee in an accident and whenever the memory is reactivated in your mind, the knee may begin to throb with pain and discomfort. The strength of the memory is associated with the intensity of the event. This can trigger your body to react as it did at the time of your experience. So whenever you see and or hear about an accident, or even watch one in a movie, your memory triggers painful tension in your knee.
Emotional memories re-create your original emotional response. A sight, a sound, or even a smell can bring back the joy, fear, love, or hate that you have associated with it. You may not remember all of your many trips to the grocery store or gas station. However, you will always remember times which have a good or bad value attached to them, such as the time a store was robbed when you were there, the time an old lady threatened you over a parking spot, or the time you spilled gasoline all over your clothes in one of those self-serve pumps. You don’t remember washing your car unless that spray wand just about gave you a skull fracture. In short, if a daily memory does not have a strong emotional value, it is faded out. The problem is that you can give an ordinary, harmless, experience greater emotional value then it really deserves.
When you get upset, scared, angry, or nervous without any identifiable cause it is a sign that your feelings are being “triggered” by the memory of a past situation. When people feel a strong emotion, the emotional brain (amygdala) remembers it, along with many other details connected with the event. Even things that are indirectly related to the event can trigger the old feeling without our even being aware that this is happening. The emotional brain (amygdala) takes in all kinds of impressions like sights, smells, tastes, and sounds and uses a “fast track circuit” to try to find a match with something that happened before. The mind is constantly looking for patterns, which are stronger and have better developed pathways in the brain. As an example, an adult who has had a bad first marriage may automatically trigger an emotional memory of jealousy any time his wife mentions, “I might be late”. The anxiety in that statement causes his brain to search for a memory and recalls a feeling of jealousy from his first marriage. If the husband dwells on this feeling, he will become insecure, jealous, and suspicious for no reason in the present.
This raises the important point that the brain doesn’t know if an experience is real or imagined! How can this be you may ask? Well, the brain creates memories based on information it is given, usually through your senses but sometimes through your thoughts. If you are in the same room with your sweetheart, it will give you that warm, romantic feeling. However, looking at their picture and thinking about them will do the same thing, even though they are not present. Even better, simply thinking about them will produce the same feelings (triggering the same emotional memory). The brain only reacts to the thought or sense, it doesn’t care how it receives that feeling or information, be it by physical presence, by reminders (pictures), or by “thought”.
When an emotional memory is triggered, you will say the same things, feel the same intensity of emotion, and behave the same way that you did at the time the memory was created. That is to say, you will respond to today as if it was a different time or place in your life. The emotional experiences you have endured resurface and are replayed when you perceive an event in the present as emotionally similar to something for your past. As a result you may become defensive and lash out with anger or withdrawn and avoid confrontation out of sadness or fear. Many of these reactions, however, are not appropriate for the current situation. These reactions are based on past relationships and emotional experiences, causing you erupt or melt down in the form of crying, yelling, panic or violence.
People that are shy and introverted tell therapists that when they enter a restaurant, people look at them, creating anxiety. It’s true, but it applies to everyone, not just those who are shy. When anything enters your visual field, you unconsciously begin scanning it. A person walking into a room is “scanned” by almost everyone else and that automatic scanning procedure takes about two seconds. The unconscious mind is looking for two things 1) to see if you have a memory or point of reference for comparison and 2) to protect you for any signs of danger. If the new individual is odd looking, carrying a weapon, or naked, the brain will start a full-scan and react accordingly (long stare, fright, or “Don’t I know you?). Individuals with physical features that are unusual lead to the common “double take” where you will first unconsciously scan for safety and reference, then look again consciously to examine and analyze. These references are designed to help you, as when remembering an old friend, the location of the store in a mall, or when remembering needed facts/details.
Let’s say you can’t stand the smell of fresh asphalt. This may be because you had a bad crash on your bike on fresh asphalt when you were younger. You may or may not even remember the crash, but your body does, and it links that smell with the crash. A dog bit one of my clients when he was young. The bite hurt, and my client was frightened. The event became stored in his emotional memory. As a teenager, the sight of a dog-even a gentle one-still triggered a feeling of fear and hesitation. When my client sees a dog now, his brain instantaneously compares the image of the dog with his past memories through the fast track circuit. The brain finds a match-with the memory of “dog” and getting bitten-and triggers a feeling of fear. This feeling then affects how his brain perceives the dog. He reacts with a fear of dogs without knowing why. The information about the dog goes to the brain through another pathway-the “slow track circuit.” If the different parts of your brains are working well together, the brain can then tell that everything is OK. It’s a friendly dog, and there is no reason to feel threatened. However, even if this happens, the initial reaction has already sent signals down my client’s nerves causing stress hormones to be released into his body.
Of course, such memories do not happen just with dogs. They happen with all of your past situations, including your relationships with other people-and places and situations that have left deep impressions on you. A person with a certain kind of walk or body type might cause you to feel fear because he reminds you of someone who once bullied you. The smell of a hot dog can make you nauseous because you came down with a stomach flu after eating one once. You may dislike people with red hair because of that one red-headed person who once picked on you. And the list goes on.
Your emotional response to a memory begins 90 to 120 seconds after a memory surfaces. For example, recall when you were told about the death of a loved one. The first two minutes of the conversation may have gone well, but then you become sad. If this memory remains in your attention, the feelings from the funeral and bereavement will surface today. Your mind then recalls other experiences of loss, unfairness, or guilt that is associated with what was felt at the time of your initial grief. In this way what was unconscious become conscious. You are now mindful of a memory, which was dormant and now has sprung to life. And the longer the memory is available in your awareness, the stronger the emotional component becomes, to the point that you may begin to cry. Famous actors and actresses have known this method for years. If they want to cry on stage, they can recall a painful memory from their personal life and within 90 seconds, tears are flowing.
When a memory comes to your awareness, it is as though you have placed a disc in a DVD player. The disc begins playing and you hear the same discussion or feel the same feelings over and over. Husbands and wives refer to this sometimes as “broken record” conversations. You may get the same lectures, the same anger, the same resentment, the same everything – it’s all on the disc. For example, a couple can be discussing whether they have enough money to purchase a new computer. The wife mentions using a particular credit card – that triggers a memory in her husband, hitting the play button on the “credit card” disc. At that point, the husband launches into a long story about credit cards, high interest, harassing letters, and so forth. When that memory is pulled up, a discussion about the computer becomes useless. While you may try to remain business-like and focus on a topic of discussion, you can’t help but think of the past.
You know when an emotional memory is trigged if the emotional reaction is far above what would be expected from the situation. If the listener has the general idea that the conversation doesn’t make sense, you’re probably listening to someone talk about emotions from the past. For example, a husband and wife meet an old boyfriend or girlfriend at the supermarket. Suddenly, there’s a gigantic reaction complete with jealousy, suspiciousness, and anger. Many recollections begin with, “We’ve talked about this before,” “When I was young…” and so on. References to the past are almost always related to an emotional memory. For example, teenagers have difficulty, understanding why a simple request for money leads into a long discussion of dad’s collecting pop bottles for money during his youth. The key is the phrase, “When I was your age…” This kind of memory error is known as persistence. Persistence is not the loss of memory, nor is it the distortion of memory. A person suffering from persistence is doomed to remember events that he or she would prefer to forget and are frequently making references to the past. Persistence is often seen in post-traumatic stress disorder. After a traumatic event, such a violent attack or a rape, people often re-experience their memories of the event. Trauma victims seem to lose control over the retrieval of their trauma-related memories, so that the memories are constantly being pulled into awareness by the slightest trigger. Persistence can occur in non-traumatic situations as well. Depressed individuals are often bothered by negative memories that intrude when they are not wanted.
One of the most common situations in which emotional memory is created is in physical or mental trauma. Many of us have experienced trauma in our life. Traumatic emotional memories can be created by physical assaults, combat experiences, crime, death of a loved one, viewing severe accidents, surgery, or brush-with-death experiences. In trauma, the brain not only memorizes everything about the event – including the emotions – but adds the surroundings as well. If you are assaulted in your home, suddenly your home is no longer comfortable due to the memories it produces. A severe automobile accident may prompt you to quit driving completely or develop panic attacks if you near the site of the accident. Traumatic emotional memories are perhaps the strongest memories and often create long-lasting complications or challenges if not properly handled.
Another common way that emotional memories create patterns is in the case of a panic attack. When you suffer a panic attack, hormones are released in the brain, which creates the muscle tension, rapid heartbeat, shortness of breath, and trembling associated with a panic attack. After an attack however, your brain remembers the feeling and the physical sensations. Months later, you may be in a crowded store or in an emotionally tense situation when the brain recognizes a physical sensation of tension, which it has seen before during the panic attack. At that point, the brain immediately triggers the “panic attack” memory. If you dwell on the memory of panic, you are quite likely to have another panic attack. Remember: With each emotion or experience, the brain is always searching to see if you have a memory on that topic.
Imagine being stressed-out for six months, almost at the breaking point. You decide to stop by the market to pick up some bread and milk. While in the store, you run into someone you dislike which immediately triggers a memory of how you were threatened and hurt by an argument with that person’s husband. That conflict reminds you of this morning’s argument with your spouse, which now dominates your concentration and your mood becomes worse. At this point, your brain, already overtaxed, kicks in with a panic attack. You feel your heartbeat race, your breathing becomes shallow and rapid, and you feel as though you are going to have a heart attack. You end up leaving your groceries and running out of the store. You now have compounded the threatening-memory of “this individual” and have created a new panic-memory with a label “market” on it. Therefore, the next time you drive by the market to stop for milk, your brain will pull the panic-memory. You’ll develop a feeling – “I can’t go in there!” This is exactly how people become agoraphobic, where they become fearful of leaving their home. You fear that the same negative outcomes that arose in the past will occur again. The link between the emotions and your memories is like the umbilical cord. You need to cut it so you can access the memory without the strength of your emotions
The effect of the experience of trauma over the life span lays the seeds for most chronic, poorly understood disease processes that defy explanation by our current concepts of health and disease. These chronic diseases make up the majority of symptoms for which patients present to doctor’s offices.
The Brain / Mind / Body Continuum
The brain, mind, and body exist on a continuum, wherein sensory input from the body shapes and changes the structure and function of the brain, which concurrently shapes and alters the body in all of its parts – particularly those that provided the sensory input to the brain. The brain and body are intimately inter-related rather than two distinct parts of the greater whole. These two parts of the continuum form a dynamically changing servo system, constantly and reciprocally adapting based on the influence of the other. The mind is a receptacle for perceptual experience, including body sensations or feelings, and the positive or negative emotions that are related to that information. The mind is based on brain activity and is the conscious manifestation of what we sense and feel based on the dynamic interaction of the brain / body.
Threat and Trauma
A life-threatening experience, either ‘real’ or imagined, may also become a traumatic experience if it occurs in a state of helplessness. The field of psychology accepts the premise that such trauma affects the mind. Through imaging studies we now know that trauma affects the structure and physiology of the brain as well. If we accept the idea that the mind, brain and body exist on a continuum, then we must also consider the ways in which trauma affects the brain / body. Ideally, the brain / mind / body uses what it learns from a traumatic event to develop resiliency and fortify the individual against future similar occurrences. However, depending on the individual’s prior experience and the nature and outcome of the event, the trauma may actually lead to dysfunctional physiological change in both the brain and body. The dynamic interaction of the brain / body in turn sends cues to the mind affecting what it senses, feels and perceives. If the brain / body has been overly conditioned and sensitized to react to life threats, the mind will perceive threat in situations where none may exist. This hypersensitivity to threat amounts to what I call ‘the imprisonment of the mind’ – a state in which the mind is primed to perceive threat, is continually assaulted by and frozen in the past, and cannot conceive of a self that is free of physical and emotional pain.
Reality and Our Senses
Our concept of reality is tightly bound by the amount of meager information that our sensory organs are able to provide us at any given time. Other species possess organs of sensory perception that we totally lack. The entire function of the brain / mind / body continuum is altered by the nature and quality of the sensory information that the senses provide.
The brain is defined as a plastic, fluid, and ever-changing electrical / chemical / structural system that generates new synapses and neurons and discards old ones in response to sensory / emotional / experiential input. Life experience therefore changes the brain permanently in the way that it specifically reacts to subsequent similar experiences.
Conditioning and Unconscious Knowledge
Unconscious learned behavior in all species is primarily directed toward survival-based activities. This behavior is established primarily through the repeated chance association of successful forms of complex behavior with escape from a life-threatening situation or with access to a life-sustaining reward. The behavioral patterns which emerge from this learned association are called conditioning.
Like Pavlov’s experiments which showed how animal behavior is classically conditioned, these conditioned responses, which are based on cumulative life experiences, are the basic means by which species accumulate knowledge to enhance survival. Because this knowledge must be available at all times and at a moment’s notice — and must be independent from the complexity of conscious problem solving — it is basically unconscious knowledge. Such unconscious knowledge constitutes the primary source of learning and behavior, not only in animals but also in human beings. Although the brain’s reciprocal responses to sensory experience are central to its role, they may be corrupted by traumatic experiences which drastically alters its ability to be an effective participant in the goal of survival.
The Mind and Trauma
Trauma is a perceptual / somatic / emotional experience generated by a complex set of synapses, neurons, and neurochemical states and determined by genes, instinct, and experience, that is capable of developing and directing novel behavior.
Basically, the complex cognitive processes of the mind are unnecessary for survival in an immediately threatening situation and can even be a hindrance. However, after successful resolution of the life threat, the mind reflects, problem solves, and incorporates conscious information from the experience, both to avoid future exposure to a threat and to develop additional means of assuring safety. In addition to unconsciously incorporating survival-enhancing motor skills, the mind develops future self-protective and avoidant behaviors that also promote survival. This process of conscious skill acquisition, based on mind / body interaction, constitutes a continuum of mind and body.
Trauma and Learned Responses
Traumatic life experiences often contribute to learned habits of movement and posture that reflect the self-protective movement patterns associated with those threats. Many of these trauma-related movement patterns affect the way that we move, sit and stand. They may lead to patterns of movement and posture that are abnormal and they may inhibit our normal coordination and our learning of other desirable motor skills.
Self-protective movement and postural patterns of the experienced trauma are stored in the brain and the body’s survival memory. These learned dysfunctional patterns persist because they are, in a metaphorical sense, necessary for defense against future threats similar to those that elicited the defense in the first place.
If traumatic memories are implanted in the brain, internal cues (such as dreams, imagined scenarios, and memories) as well as sensory information from the external environment will evoke motor, autonomic, somatic, and visceral responses to a perceived threat. This process is almost entirely unconscious and occurs typically before any conscious recognition or awareness.
Using the term ‘psychological’ as opposed to ‘physical’ to explain a physical symptom or somatic feeling state or emotional event defies the obvious – that all perceptions, thoughts, symbols, or experiences have a physiological basis within the mind / body continuum.
The Fight / Flight / Freeze Response
All animals must have the capacity to learn from life-threatening experiences. All animals learn to survive through the functions of the areas of the brain that process information through a complex behavioral process that has been termed ‘ the fight / flight / freeze response’.
The brain pathways and behaviors in this response are common to all animals from reptiles to primates. But these instincts only form a template on which exposure to a series of life threats builds specific survival skills. Whether one fights or flees when exposed to a threat must be learned very quickly through such experiences. The information from these learning experiences must be stored in unconscious form in order to be of use in the survival game. It must be capable of triggering a predictable behavioral response learned through trial and error without thinking or planning. The process through which we learn these survival skills is called classical conditioning, a term coined by Pavlov (1926).
All threatening experiences, even those that are successfully resolved, will prompt unconscious responses related to cues from that experience. Persistence of the conditioned response to the conditioned stimulus is dependent on reinforcement. The internal or external repetition of the traumatic event (or events of a similar kind) will deliver such reinforcement.
The process of classical conditioning involves intrinsic or unconscious memory, part of which is ‘procedural memory’ (the part that we use to learn skills). Survival depends upon classical conditioning through procedural memory.
The capacity to initiate the fight / flight response is determined by the sympathetic nervous system – one of the two branches of the autonomic nervous system. The sympathetic nervous system is responsible for activating the cardiovascular and motor systems of the body and for making available the extra energy for the vigorous physical activity required to fight or flee.
The Freeze Response
Sometimes fight or flight options are no longer available. Under these circumstances a third survival option is available: the freeze response. The freeze response, common to all species, indeed may allow the animal to survive, but in mammals it sometimes comes at a terrible cost. Animals who survive the freeze response experience an unconscious ‘discharge’ of all of the energy and stored memories of the threat and failed escape through stereotyped body movements as the animal ‘awakens’. If they don’t experience this discharge, a host of adverse behavioral and health problems may follow. Classical conditioning in this context can fool the brain and lead to a host of inappropriate and ineffectual survival behaviors. When this happens we may say that ‘trauma’ has occurred.
When fight or flight are unsuccessful or not possible, a third instinctual and quite unconscious option will be exercised. The animal collapses and becomes immobile. This is the freeze response. If the freeze response is successful in preventing the animal from being killed, the animal will gradually emerge from immobility.
The freeze response is made possible through the functioning of the parasympathetic nervous system. When the parasympathetic response is very strong or extreme, the animal in freeze is in a precarious state of abnormally dysregulated and fluctuating autonomic nervous system activity.
One of the expressions of the freeze response in humans is the phenomenon of dissociation. Dissociation is reflective of a state of shock, stunning, trance, numbing of emotion and cognitive fogging. Dissociation is physiologically the same as the freeze.
The work of Peter Levine showed that PTSD patients experienced a dramatic clearing of many of their symptoms when they were allowed to complete the motor discharge of their freeze response through unique therapeutic behavioral techniques. In the absence of of this freeze discharge, the ‘energy’ of the intense arousal associated with the threat and attempted escape remains bound in the body and brain, leading to a host of abnormal symptoms that we attribute to PTSD. Levine also noted that repeated freeze events without discharge seemed to be cumulative, adding to a progressive worsening of post-traumatic symptoms and to the development of progressive helplessness in the face of threat.
Explicit / Declarative Memory
The type of memory that we use in the specific process of conscious, cognitive learning is called ‘explicit or declarative memory’ . Access and retention of conscious, declarative memory is in part a learned skill based to a degree on native intelligence; it is exquisitely sensitive to decay with distraction, emotional distress, impaired attention, and to the passage of time. When paired to an intense emotional event it may assume features of unconscious memory, including long-term accuracy and resistance to decay.
Declarative memory is notoriously unstable, is subject to prior preference or bias, and may change significantly with the passage of time. It is often distorted by subsequent life experiences and memories, including the abortive attempts to revisit and reprocess emotionally charged or painful events.
The area of the brain that processes declarative memory is called the hippocampus. This small brain center in the temporal lobes, represented on both sides of the brain, processes incoming information from the sense organs of the body.
Implicit / Nondeclarative / Procedural Memory
Survival skills acquired by life experience through the process of conditioning depend on specific memory mechanisms and structures in the brain. Much of this learned behavior is stored in our most primitive (or reptilian) brain: the mid-brain, cerebellum, and brainstem. Because these brain centers frequently operate separately from higher centers that control conscious thought and emotions, information stored and processed in these parts is intrinsically unconscious in nature.
Generally we refer to behavior generated by the reptilian brain as being reflexive in nature – occurring automatically without regards to planning or intent and without being based on input from the thinking brain. Only through repeated and varied exposures to to different forms of threat can the human / animal develop the conditioned responses necessary for survival in their particular world. And only by bypassing the conscious brain and its complex circuits can this system work effectively.
The type of memory that serves conditioned responses is called ‘implicit or non-declarative memory’. By definition, it is unconscious and is acquired without intent or effort. When implicit memory pertains to motor skills and to conditioned sensorimotor responses, it is called ‘procedural memory’. Procedural memory, in general, is also hardwired into the brain.
When procedural sensorimotor learning takes place in a situation experienced as a threat to life, that pattern of unconscious memory is rendered more permanent and resistant to decay. The unconscious sensations that the body experiences during a traumatic event are therefore permanently retained in procedural memory.
In unresolved traumatic stress, procedural memory turns inward, responding to internal cues of a threat that no longer exists – thus evoking inappropriate somatic and autonomic experiences and responses that pertain to cues unwittingly emerging from past memory rather than from present external experiences.
The varied symptoms of trauma, of which a small number are included under the diagnosis of PTSD, fall under the definition of conditioned responses. These symptoms are incredibly varied. They include abnormal memories (e.g. flashback images, intrusive conscious memories, recurring physical sensations, nightmares), abnormal arousal (e.g. panic, anxiety, startle), and numbing (e.g. confusion, isolation, avoidance, dissociation). Ther broad spectrum of expression of these symptoms reflect a dysfunction involving the brain and most of the regulatory systems of the body (i.e. autonomic, endocrine, and immune). They are based on a disruption of the usually modulated regulation of brain centers that govern arousal, emotional tone, memory, and perception.
The core of this problem is the fact that procedural and declarative memories for the traumatic event, and the conditioned sensory perceptions and reflex motor responses associated with those memories, continue to replicate failed efforts of successful fight or flight responses.
The Neurophysiology of Threat and Trauma
The frontal and central areas of the right cerebral hemisphere are the regions in the brain which attend to the arousal response and to threatening information. The parts of the brain that function in an executive fashion (e.g. thinking, planning, communicating, using any type of rational thought) are, in general, not essential for the execution of emergency behavior.
Typically, the first level of information that warns us of an impending threat is accessed and received by the primary senses (smell, vision and hearing). Messages from these basic senses are routed to the locus ceruleus or blue center – a tiny cluster of cells in the brainstem. The locus ceruleus sends the message on the the amygdala (the ‘olive’) which is the center for memory of emotionally laden information. Because of its function as the storehouse and processor of emotionally charged experiences, the amygdala plays a crucial role in the mediation of the response to a perceived / conditioned threat experience. Therefore, any part of the brain receiving information which has been processed by the amygdala is likely to be influenced significantly by the emotional conditioning attached to the threat experience.
The amygdala then sends messages tot the hippocampus (the ‘sea horse’), as well as to other parts of the brain. The hippocampus forms a conscious structure for the threat-based message that includes its emotional / conditioned importance, and then sends it on to the orbitofrontal cortex, the master regulator of survival behavior (both conscious and unconscious). The orbitofrontal cortex then sends information to many parts of the brain which may then organize and initiate the necessary behavior patterns which can help the individual survive.
It also activates the body’s endocrine response through the hypothalamic / pituitary / adrenal (HPA) axis. The hypothalamus is a center deep in the middle and base of the brain. In addition to regulating many other complex functions (e.g. sleep and appetite), it also regulates the autonomic nervous system. In the case of a threat, the sympathetic nervous system (the energy-burning survival part) is activated. The pituitary gland (the master endocrine gland) is also activated and initiates the body’s endocrine response.
The pituitary gland, through the hormone adrenocorticotropic homone (ACTH) stimulates the adrenal glands to release cortisol, which puts a brake on norepinephrine – thus modulating the brain’s arousal response.In the event that the individual survives the immediate threat, cortisol also prepares the animal to manage ongoing stress through changes in its circulation, metabolism, and immune responses.
This complex interaction of nerve centers, glands, and chemicals is typical of the multiple interactive feedback systems by which the body is designed to not only survive a threatening event, but also to regulate itself and to promote stability of the entire organism.
Robert Scaer’s The Trauma Spectrum: Hidden Wounds and Human Resiliency Norton, 2005Read Full Post | Make a Comment ( None so far )
Insightful Transcript from NPR…
IRA FLATOW, host: This is SCIENCE FRIDAY. I’m Ira Flatow. This Sunday will mark the 10th anniversary of the 9/11 attacks. We all have a story about that day, what we were doing when we heard the news. We could all watch the events unfold on TV, seeing a plane hit, the towers falling, a live, televised terrorist attack on a scale that Americans have never before experienced.
Thousands were killed, of course, and millions were left to struggle with the psychological aftereffects. An army of counselors and mental health experts have tried for the past 10 years to not only soothe the mental anguish of the victims and their families, but to document, study and understand the long-term health effects that may linger with firefighters, police and the public.
By one count, more than 150 research papers have looked at the mental health of 9/11 survivors. And now 10 years later, what have counselors and researchers learned? What would they do differently? What have we learned about how people cope and how people did cope, and even grow after a traumatic incident?
What helps people get through it, and who continues to survive? That’s a lot to talk about, and we’ll be spending a great part of the hour talking about it. And if you’d like to be involved in the conversation, give us a call. Our number: 1-800-989-8255, 1-800-989-TALK. You can tweet us @scifri, @-S-C-I-F-R-I, or go to our website at sciencefriday.com and leave some comments.
Let me introduce my panel. Roxane Cohen Silver is a professor in Department of Psychology and Social Behavior at UC Irvine. She edited a special issue of the journal American Psychologist that looked at the 9/11 attacks, and she joins us from the studios of KUCI. Welcome to SCIENCE FRIDAY, Dr. Silver.
ROXANE COHEN SILVER: Thank you.
FLATOW: You’re welcome. Sandro Galea is a Gelman Professor and chair in the Department of Epidemiology at the Mailman School of Public Health at Columbia University in New York. Thank you for being with us today, Dr. Galea.
SANDRO GALEA: Thank you for having me.
FLATOW: Claire Cammarata is a licensed clinical social worker and a clinical director for the New York City Fire Department Counseling Services Unit. She’s also an adjunct lecturer at the NYU School of Social Work, and she’s here in our New York studios. Thank you for being with us.
CLAIRE CAMMARATA: Thanks for having me.
FLATOW: Patricia J. Watson is a senior educational consultant for the National Center for PTSD. She is also assistant director of terrorism and disaster programs at the National Center for Child Traumatic Stress, and assistant professor at Dartmouth Medical School. Welcome to SCIENCE FRIDAY, Dr. Watson.
PATRICIA J. WATSON: Thank you very much.
FLATOW: Let me – there’s so much to talk about. Let me talk about the immediate weekend that’s coming up. This weekend people are going to be living and reliving the 9/11 attack all over again. Dr. Silver, for people who’ve lived through it, experienced it or watched the videos over and over and over again the last 10 years, is this weekend and seeing all the stuff that’s going to be on the media, the act of reliving the event and feeling associated with it, is it going to help people cope, or is it going to make it worse for some people?
SILVER: I think that we can respectfully commemorate the day 10 years ago, the thousands of lives that were lost. We can appreciate the heroism of many people in the aftermath of 9/11, and I think we can do all of that respectfully this weekend.
I think that we can do that without reliving, without reactivating the feelings if we are not continuously exposed to the graphic images of that day. So I think that we can do – we can have a commemoration, and we can have a respectful memorial, and we don’t need to see the pictures again.
FLATOW: Are you suggesting we not look at them?
SILVER: I’m a researcher, and in my research, I would say that we see no psychological benefits from watching the graphic images. I personally will not be watching them.
FLATOW: If any of you want to jump in and add your comments, please feel free to do so. Dr. Watson, or Dr. Silver, let’s talk about some people retreated in the days immediately after 9/11. Some people were encouraged to talk about their feelings, to share what they went through as part of something called critical incident stress debriefing. Can you tell us what that is about?
WATSON: Yes. Critical incident stress debriefing was a model that was used primarily with first responders following traumatic incidents, and it involves usually a group setting, where people sit and talk about what happened, what they saw, what they felt, what their reactions were, what was hard for them. And then there’s a bit of sort of guidance about stress management.
And it was with all the best of intentions that this model was used after 9/11 and after other disasters. But some of the research literature and expert consensus suggested that it might not be the best model for a post-disaster or post-terrorism situation for many reasons, one of which is people – it’s such a chaotic environment, people have many basic needs that need to get met. They need to have resources, and oftentimes people needed downtime. They need to be focused on what needs to happen for them to get their feet back on the ground.
And we also know from some of the literature, looking at immediate reactions after traumatic stress, that when the heart rate goes up and when people have higher anxiety levels, it can actually lead to longer-term problems.
So the goal, in many ways, has been to move away from a model that imposes that people should talk to more of a model that’s very much tailored to the individual and to the circumstance. So that model has to fill the gap. One model is what’s called psychological first aid, which is very much tailored to what’s happening for the person, getting their needs met, providing them resources.
If they choose to talk and they want to talk, absolutely, the person should be supportive and listen, but not to impose that they should talk before they’re ready to talk.
FLATOW: Dr. Cammarata? You’re shaking your head about this.
CAMMARATA: Yeah. I agree with Dr. Watson. I think at the fire department, we’ve been very fortunate to have a very strong peer program, so that we were able to actually visit the members at their – at the site, at their firehouse and just check in with them, what it is that they needed at the time, rather than imposing any particular kind of treatment or intervention.
FLATOW: Mm-hmm. There are studies that I’m reading that have shown – and I think you’re one who can talk about this – that the onset of the disorder PTSD was very often delayed among firefighters and emergency responders because their work – their experience and their training allowed them to suppress the emotions, but something later on in their life could trigger it and bring it back.
CAMMARATA: Well, I think a big factor was working at the site until June of the following year, and I think that allowed the members to use more of an active style of coping. I think once the site was closed, they were somewhat robbed of that opportunity, and I think that caused a bit of a delay in some of the more formal traumatic stress symptoms.
FLATOW: How well were – and I’ll ask all of you – how well were mental health officials prepared to deal with an event like this? Dr. Silver, any – or Dr. Watson?
SILVER: I think Dr. Watson, perhaps, maybe.
WATSON: From what we saw after 9/11, providers were actually extraordinarily well-prepared in some ways, because they – this occurred in a community, particularly in the New York community, where you have a very strong resource base of providers. And because it was a large urban community, you had people who were trauma experts there who were willing to go out and do mass trainings, to teach the most updated techniques on how to treat traumatic stress and loss and traumatic grief.
And the national community responded with an outpouring of support and funding to bring people across the nation together to figure out, you know, how do we do the best to treat people. So we were extraordinarily lucky in that way.
And I think that there was funding released, as well, for research to take a look at what was helping people and what makes the most sense for people at different time phases after an event like this.
FLATOW: Mm-hmm. 1-800-989-8255 is our number if you’d like to be involved in the conversation. Dr. Galea, you were part of a study looking at PTSD rates across a number of studies. Who was more susceptible to getting PTSD, from your results?
GALEA: Well, we know from our findings and from those of many others that the people who are most exposed to a trauma are more likely to get PTSD. So if we did it in different groups, for example, within rescue workers, the rescue workers who got to the scene first or those who were there longest were more likely to get PTSD, compared to those who were there later or spent less time.
And we have – we did a study where we looked at survivors of the towers, and we found that those survivors of the towers who encountered more injured people, encountered more traumatic events on their way out were more likely to have PTSD.
And in the general population, the people who were living closer to the World Trade Center – who were south of Canal Street, for example – were more likely to have PTSD than those in the rest of Manhattan or in the rest of New York City.
FLATOW: Is it possible for people who don’t even live in New York or in Washington or in Pennsylvania to get PTSD from the repeated seeing of these videos over and over and over again?
GALEA: That’s actually a very interesting scientific question. It’s a matter of some controversy. The – there have been studies, some done by our group, some done by others, that suggest that those who are vulnerable – who are vulnerable because of something else – so, for example, somebody who has had PTSD in the past, or potentially people who have some sort of genetic vulnerability – may have PTSD triggered by watching specific images.
So I would consider the groups at risk of PTSD because of images to be a very particularly vulnerable group. There is a nice paper in today’s literature, actually, summarizing the findings on this. And I think the papers are consistent across about a dozen papers, showing that the group of individuals who have something else to make them vulnerable may develop symptoms of what we call PTSD simply through the watching of repeat images.
And I think Dr. Silver made the point about the repeat images on the anniversary, and I think it’s a very good point. I think there is a possibility that those images will be associated with problems in people who are vulnerable, and it’s also likely that those images can trigger recurrence of PTSD among those who have already had it.
FLATOW: All right, we’re going to take a break and take some calls. Our number: 1-800-989-8255. You can also tweet us, @scifri, @-S-C-I-F-R-I. Talking withRoxane Cohen Silver, Sandro Galea, Claire Cammarata and Patricia J. Watson about the 9/11 psychological effects. You might want to share some experiences. We’d like to hear from you, but you know as always, we can’t take any – treat personal problems. So don’t, you know, try to narrow in too focused on what might be going on there, because it’s unethical for us to talk to you about that.
So – but we will talk about everything else. So stay with us. We’ll be right back after this break.
(SOUNDBITE OF MUSIC)
FLATOW: I’m Ira Flatow. This is SCIENCE FRIDAY, from NPR.
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FLATOW: You’re listening to SCIENCE FRIDAY. I’m Ira Flatow. We’re talking this hour about the mental health effects of 9/11 with my guests, Roxane Cohen Silver, Sandro Galea, Claire Cammarata and Patricia J. Watson. Our number: 1-800-989-8255. And Dr. Cammarata, can you give us some idea of – how did you know what to do working with the NY Fire Department when these calls first came in? You were still a social worker with the New York City Fire Department then.
CAMMARATA: At the time, yes.
FLATOW: At the time.
FLATOW: How did you know how to handle all that stuff?
CAMMARATA: Well, I mean, we were lucky that we had a preexisting counseling unit, a pre-existing peer team. Just a few months prior to 9/11, we had lost three firefighters. So we had just sort of went through a much smaller-scale disaster. So that helped tremendously.
But I don’t think a lot of us did know what to do right afterwards, and I think that was a blessing in disguise, because it caused us to sit back a little bit and see what people needed, rather than rushing in, assuming what people needed.
FLATOW: What makes a terrorist attack different from, let’s say, other natural disasters, like a tornado or a tsunami or other big disasters that affect, you know, hundreds or thousands of people. Dr. Silver?
SILVER: Yes. There are many unique aspects of terrorism. And particularly, you have a clear, malicious intent, somebody who seeks to do harm in general by elevating anxiety and fear in the population. So the goal of terrorism is inherently psychological.
That means that, in addition to any effort – any successful destruction of buildings or successful murdering of individuals as a result of the terrorist attack, the real goal is to scare people. And I think that makes it unique from other disasters.
However, terrorism, like natural disasters, are uncontrollable. They seem random. They’re often unpredictable. And so there are many features that these disasters share. But the fact that there is a malicious intent to do harm and to create fear and anxiety is what makes terrorism unique.
FLATOW: Mm-hmm. 1-800-989-8255. Teresa in Santa Rosa, California. Hi, Teresa.
TERESA: Hello. Thank you for taking my call. I was hoping to have the opportunity to talk about this time, which is very – it’s very kind of mixed blessing at this time of year. But I wanted to acknowledge the flight attendants and the pilots. It seems like oftentimes when you hear stories about 9/11, people refer to the firefighters and the policemen.
But I was a flight attendant at the time, and I had the, I guess, unfortunate opportunity to be flying over the World Trade Center. We were in a plane trying to land in Newark as the World Trade Center was coming down and exploding.
But more than that, I just wanted to have opportunity to bring some remembrance to the flight attendants and pilots that we lost on the planes during that time.
FLATOW: Well, thank you for calling. Is there any research, Dr. Galea, on the flight attendants, all flight attendants thinking that those were my brothers and sisters on those planes?
GALEA: I don’t know that there’s been any research specifically on flight attendants. There has been the research on workers who are involved indirectly in events like this. And we do know that workers who are exposed to sort of the horrors of terrorism or of disasters indirectly are themselves at risk of, let’s say, post-traumatic stress disorder or psychopathology. But I am not aware, maybe Dr. Silver is, of other…
SILVER: No, I’m not aware of any research specifically on that, either. It’s an excellent question, and I think it is – I appreciate your bringing that to our attention.
FLATOW: You know, what’s interesting is I’m reading through all the papers that all of you have written in. So many of your papers say there’s so much we still don’t know. I mean, there’s so much research in – and even in methodology of how to do the research that we still haven’t figured out yet or haven’t attempted to do yet.
GALEA: Well, the disasters in general – and terrorism in particular – pose particular challenges for research. It’s – these are events that happened completely unexpectedly. The research is – typically, it’s large operations, and they take years to prepare. And when they do happen, they disrupt the typical infrastructure. So mounting research projects becomes tremendously difficult.
So, as a result, there remains much to be done. I actually think that the science has progressed tremendously in the past 10 years, in large part due to some work, very good work that was done after September 11th. I think we know a lot more now than we did 10 years ago, but I think the papers are correct. There remain a lot of open questions.
SILVER: And also one needs funding, and it’s very challenging to get funding in the immediate aftermath to launch a study. Dr. Galea and I both launched studies in the early aftermath of 9/11, and we have spoken with a few others that have done so, as well. And we all talked about the incredible challenges of not only setting up a project, but getting it out into the field quickly so that you can do a methodologically sophisticated project, so that the conclusions that you draw are valid ones.
FLATOW: So have you been specifically turned down for your requests for funding?
GALEA: Well, getting – when one is in the business of applying for research funding, one is turned down routinely.
(SOUNDBITE OF LAUGHTER)
GALEA: But that’s – one does not take that personally. I think – but I think Dr. Silver’s point is valid. It’s – because these events are challenging to launch research projects, it – the problems compound. You are trying to launch something quickly. You’re trying to get funding quickly, and you really have no margin of error in getting the funding.
So it – the – it is – there’s no question that it is harder to launch research projects under conditions of post-disaster than they are normally.
FLATOW: 1-800-989-8255. Dr. Cammarata, let’s talk about the firefighters for a moment. And post-9/11, compared to other trauma survivors or the general population, how do the rates of PTSD rank among firefighters?
CAMMARATA: Well, in the general population, I believe there is an average about eight percent of post-traumatic stress disorder. But – and I think it was a study that was in 2006 that was on the retired and active members that were actively involved in the rescue and recovery rates downtown. They found 12 percent among those members to have symptoms of PTSD or to meet the criteria for the full disorder.
I think a lot depends on the population, though, within the fire department: those who were there at the time of the attacks, those who were there at the time of the collapse or the buildings or those who worked at the morgues. So there’s many different groups within the entire department.
FLATOW: Do you see new firefighters, who never claimed to have PTSD before, now coming in and saying I don’t know what’s going on, I think I have it?
CAMMARATA: I have personally never had that experience, but I have had clients that have not come in until recently. And in my opinion, I feel like they’ve just sort of muddled through somehow, and then have recently gone through a situation that just exacerbated the symptoms that they had, whether it be another incident at work, like a fatal fire, whether it be the threat of a hurricane or something like that.
FLATOW: Well, that’s what we were talking about before: Something new can trigger an old feeling or something that happened before. And then that’s why there’s a danger of watching the film – the video of it again this weekend.
CAMMARATA: I think a lot has to do with the threat of safety, of one’s personal safety. I think that really is a main factor.
FLATOW: 1-800-989-8255. Let’s go to Jane in Beaufort, South Carolina. Hi, there.
JANE: Hi there. It’s Beaufort, South Carolina. Thank you for having me.
FLATOW: Excuse me.
JANE: I’m a licensed, professional counselor, and I’m trained in EMCR, cognitive process, as well as prolonged exposure. And I was wondering if there’s any research, you know, comparing those types of – three different types of therapy with the victims, you know, with either acute stress disorder or post-traumatic stress disorder.
FLATOW: Dr. Watson?
WATSON: Yes, there has been research that has compared cognitive behavioral theory and cognitive processing therapy and exposure therapy and EMDR. And generally, taking into account a lot of methodological issues, they both – they all three show progress, that people recover and that the treatment is effective.
And what you hear is there are some studies that show that EMDR is a type of exposure treatment, and when you take away the bilateral movements across the midline, you still have the same effects. So there’s a question about whether it’s that much different. Other people say, yes, it is, and that it’s more well tolerated than some of the other types of cognitive behavioral intervention.
So the same thing with exposure and cognitive processing treatment – there are studies that show that exposure tends to be more effective for the fear-based types of elements, but that cognitive processing might be better for guilt and anger and shame and that type of thing. So you’ll see different results. But in general, the results are fairly good across all three of those types of treatments.
FLATOW: George in Santa Barbara, hi. Welcome to SCIENCE FRIDAY.
GEORGE: Thank you very much. My question has to do with the firefighters and their exposure about – and as you can hear in the background.
(SOUNDBITE OF LAUGHTER)
FLATOW: Right on cue.
GEORGE: (unintelligible) ambulance going by. The delayed effect of the firefighters going in there, like their suicide rate is much higher than it was – I was a firefighter for, like, 30 years. And guess what, you know, it may occur sometime later. One of my good friends from – I’m a Vietnam vet. And 25 years later, he’s driving on his vacation and had to pull over to the side of the road. He – and his wife says, what’s wrong, and he’s crying because he said, I couldn’t save my men. There’s some signs that come along with it, or is there something that you guys look at when it starts, like, five, 10 years later, five years later or down that line?
FLATOW: Good question. Thanks. We’ll see if we can get an answer for you.
GALEA: Well, there – I think that there is no question that – as I mentioned earlier, repeat trauma is associated with psychopathology. And we do see this, that particularly trained personnel will have earlier trauma then go on to have subsequent trauma, which then manifests as post-traumatic stress disorder. The – I – we have seen cases where five, 10 years down the road, people will develop symptoms of post-traumatic stress disorder due to something that’s quite trivial, in fact, at that time. But really what’s happening is the symptoms are manifesting now as a result of a serious trauma years previously. And I think the caller is describing really a good example of that in the context of a firefighter.
FLATOW: Can you give us a definition of PTSD?
GALEA: Well, post-traumatic stress disorder is a complex of symptoms and is essentially the same reaction that one has when you’re scared of something, only it persists for a very long period of time. So you have symptoms where you keep re-experiencing the event, you keep re-living it, you keep having nightmares, you keep having memories of it. You start avoiding what reminds you of the event, and you become what we call hyper-vigilant, which is you’re very jumpy. And if everybody thinks about what you feel like when you’re scared, it’s a pretty dramatic feeling. PTSD is that set of symptoms, but continuing on chronically for weeks and weeks and months and even years.
FLATOW: Hmm. I’m Ira Flatow. This is SCIENCE FRIDAY from NPR, talking about mental health effects of 9/11. Let’s see if we – a lot of people want to ask interesting questions. David in Boise, hi, welcome to SCIENCE FRIDAY.
DAVID: Hi. Thank you. I have a question for your guests regarding the emergency dispatchers that handled all of the thousands of calls. I’m a paramedic and been a paramedic for about 32 years. I also train dispatchers. And we have statistics from 9/11 within, like, the first 18 minutes after the first attack, 50 dispatchers got, like, 30-some-thousand calls, excuse me, I’m sorry, 3,000 calls, and they had about 55,000 calls total in that one dispatch center. And I was wondering if any studies had been done about the dispatchers experiencing stress from that situation.
FLATOW: Good question. Sandro, any…
GALEA: I am not aware of any studies that have been done, but I think the caller’s point about dispatchers being overwhelmed is an essential point in our disaster preparedness. We just finished a full day meeting yesterday, bringing together scientists and policymakers around thinking of the next 10 years what should we do. And one of the big issues that emerges is our capacity to cope with future events and our limitations in the number of people who we have working in dispatch and how much pressure they’re under is, I think, a critical rate (unintelligible) not to mention, of course, something that puts tremendous pressure on these people who are on the front lines.
FLATOW: Mm-hmm. Dr. Watson, what do we know about how young people have responded to 9/11? We talked a lot in the days after 9/11 about how we should talk to kids about what was happening. Ten years later, do we know how they responded?
WATSON: Knowing about children and researching about children can be more challenging, in some ways, because of funding and also ethical and difficulties with intervention research. However, we do know that depending on the developmental age, cognitively children responds very differently depending on how old they are. For instance, the younger children very much take their cues from their parents. And we know that part of the work that the National Child Traumatic Stress Network has tried to do over the last 10 years has been to find ways to educate parents about what to do with children at the different age, developmental ages.
We know that developmental milestones sometimes get interrupted in a way that doesn’t necessarily happen with adults. So, for instance, right around this time of year, school is starting, things might have gotten put off. If there’s any kind of ritual that a child misses, it can be a sticking point for them and then every year that becomes a trigger for them. Children, younger children, we heard anecdotally, when they were watching the images on the TV – because the parents would have the news programs on, understandably so. But we heard that children were sometimes confused and thought that multiple planes were flying into buildings all over the country because they kept seeing it happen over and over again on the news.
And so what we’ve tried to do is educate parents that they need to monitor and restrict, you know, exposure to these types of things with kids or be able to talk with them. We’ve tried to have school-based interventions as well for teachers and schools that can access groups of children and just give them education about what this means and how to cope with it. There’s – usually with children there’s a multi-pronged approach that involves some schoolwork and some work with parents and that type of thing.
SILVER: I’d like to just comment on this a little bit. I was involved in writing a review of the dozens and dozens of studies that have been done in the aftermath of 9/11 on children. And as Dr. Watson says, these are challenging studies to do. But I would say that the good news is that in general, with the exception of those children who were directly affected by the attacks – that is, they lost a loved one or they were at a school that – in which they could see the attacks occur outside their school window – with the exception of these directly impacted children, in general most children were quite resilient in response. Over time the symptoms abated.
FLATOW: All right. We’re going to take a break, come back and talk lots more about the mental health effects of 9/11. Our number: 1-800-989-8255. You can tweet us, @scifri. Stay with us. We’ll be right back.
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FLATOW: You’re listening to SCIENCE FRIDAY. I’m Ira Flatow. We’re talking this hour about the mental health effects of 9/11 with Roxane Cohen Silver, Sandro Galea, Claire Cammarata, and Patricia J. Watson. Our number: 1-800-989-8255.
Dr. Cammarata, let’s talk about something that’s really interesting, and I had not heard about – post-traumatic growth. Is that good news?
CAMMARATA: It is. It is, but it oftentimes is confused or dismissive of the post-traumatic stress that can co-exist. So I think it’s important to note that assessing for or addressing post-traumatic growth is not minimizing the trauma of the experience, the sadness, the suffering, but it’s been a very interesting topic for me and one that I’m curious about and want to study further.
FLATOW: What is it?
CAMMARATA: Well, the idea is that after being exposed to a traumatic event, that an individual may have the opportunity to actually grow from the experience in different ways and areas of personal strength and their relationship with others and their spirituality.
FLATOW: Mm-hmm. They realize that they have given – been given a second chance, perhaps?
CAMMARATA: Mm-hmm. And that the trauma was grand enough to really shake up their world and give them an opportunity to possibly reorganize things, in a way.
FLATOW: Is there any percentage of people or any number you can give us about how – who is affected or who has experienced that?
CAMMARATA: Well, Tedeschi and Calhoun are really the ones who studied the concept of post-traumatic growth. One of the theories is that the trauma has to be seismic. It has to really impact the individual on a grand scale in order to have the potential for growth.
FLATOW: Are there types of personalities or coping strategies that make some individuals better able to survive and thrive after a trauma?
CAMMARATA: Mm-hmm. It’s definitely thought that people who have a more optimistic personality or higher self-esteem are more prone to post-traumatic growth. In my study, that showed those who used emotional support, humor, but also those who used denial and disengagement also had higher levels of post-traumatic growth. But again, they also had high levels of post-traumatic stress as well, so they run parallel.
FLATOW: Dr. Silver, you’ve studied this, have you not?
SILVER: Mm-hmm. We looked at whether or not people across the country were able to see any social benefits from the attacks. So we didn’t look merely at personal growth, but whether or not people saw that there were changes in society that they saw as positive. And in fact, we did find that many people were able to see something positive that happened after 9/11. As you may remember, there was an outgrowth – there was an outpouring of philanthropy. People gave charitable donations, gave blood, and there was a coming together. People saw benefits in the support of their communities and in the positive pro-social behaviors that they saw in their neighbors and friends.
FLATOW: Mm-hmm. Did you also find, as Dr. Cammarata talked about, that people who are more spiritual did cope better?
SILVER: We conducted some research showing – that did show that individuals who found religion as helpful in the aftermath of the attacks saw that as beneficial. And in fact they experienced more positive emotion over the years afterwards. Of course that doesn’t mean that we should impose that on others, but we did see that those individuals who were more religious, who reported being more spiritual, did find that to be helpful, and they did adjust better over time.
GALEA: Ira, I would jump in for a second and agree with Dr. Cammarata that sometimes in the discussion around post-traumatic growth, we have – it has been confused with thinking that post-traumatic growth is a balm against post-traumatic stress disorder. And that is not the case. Research shows clearly – I’m in agreement with what both Dr. Cammarata and Dr. Silver have said, that there are that there is evidence that there is a positive social good that emerges for some people from these events.
However, that does not mitigate the post-traumatic stress disorder that the bulk of people have. I think there are two different axes. I think some people do find meaning. I think these large-scale events do have a positive effect on some aspects of social bonding and on shifting social norms to the positive. But it doesn’t minimize the potential harm that does occur to a substantial minority of the population that merits attention.
SILVER: I completely agree with that point.
FLATOW: Mm-hmm. 1-800-989-8255. Dr. Galea, let me ask you about – do these mental health effects, are they related to possible physical effects?
GALEA: Yeah. It’s a terrific question. I think they are. The evidence suggests that they are. And increasingly, we are beginning to realize that. The – we are beginning to realize, increasingly, that the symptoms that I described, what we call, let’s say, post-traumatic stress disorder, are not symptoms in isolation. They reflect an underlying pathophysiologic mechanism likely, in some respects, mediated by immune function that also is associated with the development of other disorders, including autoimmune disorders, for example, and cardiovascular disorders.
So we know that mental disorders and physical disorders after trauma go together. And, increasingly, we are beginning to realize that these are not two separate streams of research. They are representing different manifestations of the same spectrum of pathophysiology. And this is an important realization for us, because it won’t direct us to finding the cause, and also, from a clinical point of view, I think helps us realize that when a patient presents – after a traumatic event, let’s say with PTSD – she may well be at a greater risk of physical disorder.
And, conversely, if a patient presents to an emergency department with reports of, let’s say, an asthma attack after a traumatic event, that kind of – that patient is at a substantially higher risk of PTSD.
FLATOW: Hmm. And possibly, could depression be involved here, too?
GALEA: Well, depression and PTSD after traumatic events frequently go together. In fact, it is a minority of PTSD patients, after these kinds of events, who do not also have some other psychopathology, with depression being most common, followed by use of substances, typically alcohol. So there are these complexes of what we call comorbidity, both with a number of mental disorders going together, as well as with mental disorders and physical disorders going together.
FLATOW: In the few moments I have left here, I want to ask – just throw out this question, and you’re all welcome to answer it, and that is: What about the future? What do we need to know more about? And what should we be studying?
GALEA: Well, I’ll tell you my two cents. I think we are – as we become more sophisticated in understanding the consequences of trauma, we are getting better at combining the impact of context of what happens outside us, the trauma and the biology that explains the symptoms that are happening. I think we are getting better, and we need to get better at understanding how trauma gets under the skin so we can understand the social processes and the biologic processes together. And I think that will lead us to a clearer sense of the nature of these disorders, of course, so that we may intervene and make them better.
SILVER: I think we need to do more research to identify what kinds of interventions might be most helpful for different aspects of the population. We heard, in some of the callers, people were highlighting that there have been workers that perhaps have been understudied relative to firefighters and recovery workers. We need to see how we might best treat individuals who encountered these kinds of traumas as part of their daily work activities, in addition to individuals who suffer direct loss and in addition to the more general population who may merely witness these kinds of events on the television screen.
CAMMARATA: I hope to see a continuation of studies in PTSD and the pathology that’s related to trauma, but at the same time, to not ignore the resilience of these survivors.
FLATOW: Mm-hmm. Well, I want to thank you all for taking time to join us today. Roxanne Cohen Silver of the UC Irvine, Sandro Galea of Columbia, Claire Cammarata of NYU School of Social Work, and Patricia Watson at Dartmouth Medical School, thank you for taking time to be with us today.
WATSON: Thank you.
CAMMARATA: Thank you.
SILVER: Thank you very much.Read Full Post | Make a Comment ( None so far )
The soldiers crowd around a large conference table, their maroon berets scattered on top. A digital clock on the wall shows the time in Afghanistan and Iraq. The unit’s flag, hung with battle streamers, rests at one end of the room.
Outside, not far away, stands the 16-foot bronze statue of World War II paratrooper “Iron Mike,” grim-faced with submachine gun in hand — the epitome of the rugged American soldier.
But the training here this morning has little to do with war.
A young soldier from Rhode Island is telling how his wife walked out on him when she was two months pregnant and he fell into depression and alcoholism.
A burly soldier with red hair admits that he has a bad temper, which leads to disputes with his spouse. There are murmurs of assent around the room, and other problems galore.
It feels like an intense group-therapy session.
In a way, it is.
It’s also a radical shift in the Army’s approach to mental health, a switch from the just-suck-it-up tradition of the past and a change that was expected to get a grumpy reception from rank-and-file “Joes.”
But the new program, designed largely by outside psychologists, appears to have been embraced by soldiers.
The critics, it turns out, are other psychologists.
The Army, burdened by almost a decade of war and beset by increases in suicides, substance abuse and combat stress, embarked on the controversial $125 million project to instill psychological strength in soldiers the same way it teaches physical fitness.
The program, called Comprehensive Soldier Fitness, is designed to make soldiers more psychologically “resilient” amid the pressures of combat, repeated deployments, and family and financial crises.
The effort runs counter to many military traditions.
“It’s a big culture change,” said Col. Jeffery Short, a physician and the program’s medical director.
“For decades,” he said, the Army attitude was “everybody’s just going to be tough. . . . You’re going to sweat this out, and when you come out the other end, you’re going to be better for it.
“Now, to concentrate on how people are thinking, and how they’re feeling . . . that is an Army culture change,” he said.
Brig. Gen. Rhonda Cornum, who oversees the program, said: “The Army recognized that its historical way of dealing with psychological fitness was to wait until somebody showed evidence of not having psychological fitness and then trying to fix it.”
This is an effort to help soldiers before that happens.
The program includes a mandatory confidential online assessment tool so soldiers can gauge their emotional status around issues such as relationships, job satisfaction and life in general. They can take further optional online training to get help in areas where they would like to improve.
The Army also wants resilience to be taught face to face, classroom-style and is in the process of teaching “master resilience trainers,” who go back to their bases and conduct sessions in person.
There, the MRTs use slides, excerpts from TV shows and round-the-table discussions to talk about ways to stay optimistic, avoid prejudging others and forestall “catastrophic thinking,” or dwelling on worst-case scenarios.
During one recent session touching on prejudgment, MRTs here played the now-famous segment of the “Britain’s Got Talent” TV show in which the drab-looking phone salesman Paul Potts turns out to have a world-class opera voice.
So far, according to recent interviews here and at training sessions at the University of Pennsylvania, Comprehensive Soldier Fitness seems to be a hit.
“It’s a revolution for us younger-generation soldiers,” said Spec. Matthew Gregg, 27, a Fort Bragg truck driver from Leesville, La., who has twice been deployed to Iraq.
“It shows that the military does care,” he said during a break in a recent Fort Bragg session. “When you fill out surveys, they’re not just going in the trash. People are actually . . . listening to what soldiers are saying.”
The program’s most vocal critics have been outside the Army — other psychologists who contend that it won’t work and that it is not training at all but rather a vast, quasi-ethical research project.
“There’s little reason to believe that these techniques would have any efficacy at all,” said James C. Coyne, a psychology professor in the psychiatry department at the University of Pennsylvania School of Medicine. “It’s very difficult to do anything preventively before the fact.”
In cases of combat stress, he said, he fears that preventive techniques could disrupt a soldier’s natural coping process.
“Getting upset, saying, ‘I don’t like feeling this way, this is a horrible way to feel,’ can often be the first step in a very healthy, adaptive response,” he said.
“Targeted, secondary prevention is much wiser and has much more of an evidence base than primary prevention,” he said.
Another critic, Roy Eidelson, a board member of the Coalition for an Ethical Psychology, added: “This is the largest experiment ever undertaken — it involves a million soldiers.”
“The stakes are very high,” he said, “because we’re talking about war. We’re talking about life and death. And there’s a lot that wasn’t done to prepare for this experiment.”
Search for a strategy
The program was launched after the Army said it recognized some alarming trends.
Suicides among active-duty soldiers jumped from 138 in 2008 to 162 in 2009, according to the most recently available Army statistics.
Cases of spousal abuse and child abuse or neglect almost doubled between 2004 and 2009, from 913 to 1,625, the Army said. And referrals for alcohol and drug abuse rose from 15,000 in 1999 to 22,500 in 2009.
“It used to be that you just kind of joined the Army and lived your life . . . and there wasn’t anything very dangerous about it,” Cornum said.
“When I came in the Army, which was 1978, nobody was going anywhere and doing anything. Vietnam was over.”
Now, she said, almost everybody who joins is quickly deployed to a hot zone and faces redeployment over and over. “It’s a different Army, and nobody sees peace breaking out.”
The idea for the program was that of Gen. George W. Casey Jr., the recently retired Army chief of staff, who Cornum said was dismayed by the cases of suicide, post-traumatic stress disorder and family violence.
“We’ve got to have something besides the Whac-a-Mole theory,” Cornum quoted Casey as saying. “We need a strategy to teach people to do better and not just wait till they do badly.”
The Army’s vice chief of staff, Gen. Peter W. Chiarelli, said day-to-day pressures on the modern soldier are enormous.
“We are putting as much stress on a soldier in the first six years in the United States Army” as many 80-year-old civilians have experienced in an entire lifetime, he said.
In 2008, Cornum said, the Army asked the University of Pennsylvania to help design something to combat negative behaviors.
The Army had a similar program, called Battlemind, but it was aimed at soldiers being deployed and coming off deployments and had not been implemented effectively, said Lt. Col. Sharon McBride, a senior research psychologist with the soldier fitness program.
Penn’s Positive Psychology Center and its director, Martin E.P. Seligman, are proponents of the idea of positive psychology, where attention is focused on positive aspects of life.
Seligman and his colleagues had already designed resilience programs for middle schools, high schools and college to prevent anxiety and depression, and they found that it was not that hard to adjust the training for soldiers.
“A lot of the material was directly relevant,” Seligman said. “The struggles of a soldier are relational — families, getting along with others. A very small part of life is going into battle.”
“I was worried that people would say [it was] ‘girlie psychobabble,’ ” he said. Instead, about half the soldiers who rated the program “said it was the best course they ever had in the Army.”
In 2009, the university began teaching resilience to the first 150 of the more than 4,500 noncommissioned officers who have thus far become trainers.
“We teach a set of skills around building mental toughness,” said Karen Reivich, co-director of the Penn Resiliency Project, who helps lead training sessions at a hotel near the university’s campus in Philadelphia.
The teaching is “designed to enhance a person’s ability to handle stress, to perform well, to stay optimistic,” she said during a break in a recent session.
“It’s about making sure that the soldiers have the skill sets to be able to do what our army is asking of them,” she said.
Sgt. 1st Class Brian Diggs, 35, a drill sergeant who has twice been deployed to Iraq and took the Penn trainers course in March, said he found it “excellent.”
He said he believed it would be useful in dealing with recruits.
“The younger generation . . . coming in the military, some of them have, already, issues that they bring with them,” he said. “I think this is just a better tool for leaders to help these new recruits get past those individual barriers that they bring with them.”
In January, at the suggestion of Seligman, a special issue of American Psychologist, the flagship journal of the American Psychological Association, devoted 13 articles — by Cornum, Casey and others — to the Comprehensive Soldier Fitness program.
Norman B. Anderson, head of the association and the journal’s editor, said Seligman’s work is a hot topic, and so is the mental health of American military personnel.
But in March, a trio of psychologists — Eidelson, Marc Pilisuk and Stephen Soldz — wrote a blistering online essay accusing the journal of “cheerleading” and attacking the Army program as research, not training.
And as research, the program should involve the consent of its subjects, the soldiers, the authors stated. “Such research violates the Nuremberg Code developed during post-World War II trials of Nazi doctors,” the authors said.
In addition, Seligman’s resilience work in schools has been “only modestly and inconsistently effective,” the authors contended, producing only small reductions in mild depression.
The critics also charged that the resilience work done in schools is probably not applicable to soldiers who face combat.
Finally, the authors worried that the program might actually harm soldiers: “Might soldiers who have been trained to resiliently view combat as a growth opportunity be more likely to ignore or underestimate real dangers, thereby placing themselves, their comrades, or civilians at heightened risk of harm?”
“Given those ethical questions,” Eidelson said, “psychology . . . should be thinking really hard about whether this is a good idea.”
Seligman countered that “it’s not remotely” a research project. “It’s an Army-wide course. . . . It’s no more subject to consent than . . . when you’re told to run in sneakers rather than boots.”
Chiarelli, the vice chief of staff, said: “We do all kinds of mandatory things. . . . We make people pee in a bottle every month, too. We take mandatory physical fitness tests.”
At the same time, “they’re probably right in saying it’s an experiment,” he said. “Take an organization of 1.1 million people and try to institute a program like this, it probably is a little bit of an experiment. But that’s okay.”
Chiarelli said the debate is understandable.
“There are always going to be naysayers out there,” he said. “That doesn’t mean that we should wait until all the publishers publish all the articles.
“I think we have enough evidence on Comprehensive Soldier Fitness,” he said. “We know resiliency is key. And we know we can train people to be more resilient. To me, that’s all I need to know right now.”
Working through crises
At Fort Bragg one recent morning, sun streamed through an open door to a meeting room of the 264th Combat Sustainment Support Battalion.
Inside, the soldiers were among the first “lower enlisted” to be exposed to the notions of resilience by the newly minted teachers.
They had broken into small groups to analyze a personal crisis detailed by one person in each group.
The Rhode Island soldier’s group offered the story of his reaction to his pregnant wife’s departure for general discussion in the room.
“What was the activating event?” asked the moderator, Staff Sgt. Nathan Hayes, 27.
“Uh, finding out your wife was two months pregnant, and she leaves you,” a spokesman for the group replied.
“Sorry to hear that,” Hayes said.
He asked for the soldier’s reaction to his wife’s departure.
“He went into a drunken rage,” the spokesman related, “went into a downward spiral, got put into AA . . . got put on medicine, went through depression, didn’t want to work, didn’t want to do anything.”
Why did he turn to alcohol? Hayes asked.
“Just to forget everything,” the 24-year-old Rhode Island soldier, who had been sitting quietly, replied. “Just block it out.”
“So, ‘I can’t handle this on my own? I need alcohol?’ ” Hayes asked.
“Yeah, basically” the soldier said.
“So what’s the thinking trap there?” Hayes asked.
A “thinking trap,” a decades-old psychological concept, is one of the things the program wants soldiers to identify and avoid.
Reivich, of Penn, identified eight thinking traps in “The Resilience Factor,” a 2002 book she co-authored with Andrew Shatte. They include jumping to conclusions, overgeneralizing and “personalizing,” or always blaming oneself for setbacks.
“ ‘Alcohol’s the solution’ was the conclusion you jumped to,” Hayes told the young specialist.
After the session ended, the Rhode Island soldier, who has since reached an understanding with his wife, said he found the program valuable.
“If I had this kind of training before, I probably would have still been with my wife,” he said. “It definitely does help.”Read Full Post | Make a Comment ( None so far )
A dog bit one of my clients when he was young. The bite hurt, and my client was frightened. The event became stored in his emotional memory. As a teenager, the sight of a dog—even a gentle one—still triggered a feeling of fear and hesitation. When my client sees a dog now, his brain instantaneously compares the image of the dog with his past memories through the fast track circuit. The brain finds a match—with the memory of “dog” and getting bitten—and triggers a feeling of fear. This feeling then affects how his brain perceives the dog. He reacts with a fear of dogs without knowing why. The information about the dog goes to the brain through another pathway—the “slow track circuit.” If the different parts of your brains are working well together, the brain can then tell that everything is OK. It’s a friendly dog, and there is no reason to feel threatened. However, even if this happens, the initial reaction has already sent signals down my client’s nerves causing stress hormones to be released into his body.
Of course, such memories do not happen just with dogs. They happen with all of your past situations, including your relationships with other people—and places and situations that have left deep impressions on you. A person with a certain kind of walk or body type might cause you to feel fear because he reminds you of someone who once bullied you. The smell of a hot dog can make you nauseous because you came down with a stomach flu after eating one once. You may dislike people with red hair because of that one red-headed person who once picked on you. And the list goes on.
Your memory will often see someone at a distance and offer a “best guess” as to their identity. As the person moves closer, the “best guess” offered by the brain may be true or false. Emotional memory works the same way, looking at a current situation or experience, your brain searches for memories and looks for patterns to offer a “best guess” by comparing today with a previous emotional situation. This is the reality of Post-Traumatic Stress Disorder (PTSD) and emotional trauma. This is why you may immediately recall a painfully traumatic memory when you hear a car backfire or feel as if you are being assaulted when someone jokingly grabs you from behind.Read Full Post | Make a Comment ( None so far )
David Sharpe finally hit bottom on the bedroom floor of his apartment in Yorktown, Va. That’s where he sat, legs folded, ready to finish the fight with the demons that had followed him back from the war zone: the sudden rages; the punched walls; the profanities tossed at anyone who tried to help.
There was little in the room but dirty Air Force uniforms, some empty Jaegermeister bottles and a crushing despair. He took a deep breath. Shut his eyes. Closed his lips a little tighter around the cool steel.
And then something licked his ear. He looked around and locked gazes with a pair of brown eyes.
Cheyenne cocked her head to one side.
“It was just one of those looks dogs give you,” Sharpe recalls. “It was like, ‘What are you doing? Who’s going to take care of me? Who else is going to let me sleep in this bed?’ ”
For a long minute, Sharpe stared into the puzzled face of his 6-month-old pit bull. And then slowly, reluctantly, he backed the barrel of the .45 out of his mouth.
“There’s no doubt about it,” he says now. “I owe her my life.”
This is a different kind of tale of K-9 Corps bravery, distinct from those exploits of grenades sniffed out and warnings barked. Cheyenne’s heroics were in her unconditional devotion. Sharpe, whose series of harrowing encounters as an Air Force security guard in the Middle East led to post-traumatic stress disorder, says that just by being there day after dark day, his dog rescued him from a soldier’s death as surely as if she had dragged him bloody from the battlefield.
A decade later, it’s a much more stout pit bull lolling on the floor of Sharpe’s much neater apartment in Arlington County. But Cheyenne still loves to nuzzle her buddy’s hand whenever she gets the chance. And he still loves to tell the story of how a torn-eared refugee from a shabby animal shelter saved his bacon.
“She was the force that pulled me back into society,” says Sharpe, 32, who was married last month and is now a program analyst in the Office of the Director of National Intelligence.
But it’s also a story of action: Sharpe is trying to give other scruffy pound dogs a chance to save other emotionally wounded warriors. Even as he continues his own recovery from acute depression and PTSD, Sharpe has launched P2V.org (Pets to Vets), a nonprofit group that seeks to link service members and first responders with shelter animals and help them with related expenses and training.
“I couldn’t talk to anybody — not my father, not the counselors — but I could talk to that dog, and she never judged me,” Sharpe says. “We don’t want to hear, ‘Wow, that must have been horrible.’ We just want to talk.”
Sharpe got the idea for P2V after seeing a documentary on the role highly trained service animals can play in a veteran’s recovery. But those elite creatures can take thousands of dollars to prepare and years to deliver. Sharpe saw a more straightforward match to be made between suffering soldiers and animals from the pound.
“Most of the vets I’ve spoken to don’t want dogs to do tricks. We just want companionship,” he says. “Eighteen vets commit suicide every day in this country, and one animal is put to sleep every eight seconds. They can help save each other.”
It costs P2V about $650 for each adoption, including veterinary care, supplies, health insurance and the training consultants the groups make available. So far, P2V has matched 47 animals to vets, many of them former patients at Walter Reed Army Medical Center.
Sharpe has hired his first paid employee and put together an advisory board that features some local heavy hitters, including former White House press secretary Dana Perino and Rep. James P. Moran (D-Va.). They have started volunteer teams in New York and San Diego and hope to expand further.
Jimmy Childers, a Marine sergeant whose left left was lost and right foot injured when a roadside bomb in Afghanistan detonated, was looking for a dog to relieve the dreary monotony of his therapy routine. When a service-dog organization told him that it would be at least 18 months before could he get an animal, he turned to Sharpe. Two weeks later, he was walking, with two canes, through the pens of the Washington Animal Rescue League in the District.
“Tidus isn’t going to be fetching my [prosthetic] leg for me or anything,” Childers says of the beagle that now lives with him and his wife, Brandi, in Gaithersburg. “He’s here to bring joy into my life, and he does that every day.”
He finds himself less prone to outbursts over, in particular, people who illegally park in spaces for the handicapped. “He really calms me down,” he says.
Retired Senior Airman Sharpe says his own descent into the shadowy storms of PTSD stemmed from multiple deployments at bases in Saudi Arabia and Pakistan. One afternoon in a sweltering guard shack, he found himself staring down the rifle barrel of the Saudi soldier manning the post with him. After an intense standoff, Sharpe managed to overpower the man, who turned out to be an al-Qaeda sympathizer.
In Pakistan, he says, he detected and helped subdue two suicide bombers trying to enter a base filled with U.S. military personnel, avoiding the blast only when one of the attackers dropped his detonator.
“They were loaded and ready to rock,” he says. “They were going to blow up the chow hall.”
It was rough duty. There were suicides in his unit, he says. Sharpe was cracking. But he refused any attempt at counseling. He was a mess by the time he got home from his first tour, drinking himself stupid and picking fights in bars. Anything could set him off: snow falling on his arm, a casual word from a stranger.
His visits to family on St. Simons, Ga., were disastrous. When his father, a soft-spoken retired Army Ranger, would try to talk to him, he’d answer with a string of profanities.
“A few months after he left, I found a bunch of holes he’d punched in the walls,” recalls David Sharpe Sr. “He’d moved some picture frames to cover them up.”
One summer day in 2002, a friend asked Sharpe to go with him to an animal shelter in Hampton Roads, where they were stationed. A batch of pit bull puppies had been rescued from a fighting ring.
“I thought, ‘Hell, yeah, I want a fighting dog,’ ” Sharpe said. “I’m a fighter myself.”
There were seven puppies. Only one of them didn’t swarm over Sharpe’s feet, begging for attention. He picked the aloof one, its ears and face already scabbed from an earlier scrap, and named her Cheyenne.
But at his apartment in Yorktown, the hard-drinking fighter started to cuddle his little dog. He started talking to her about things that had happened. She licked his face.
“I felt like a 10,000-pound weight had been lifted off my chest,” Sharpe says.
One night, he awoke from a nightmare and went to the kitchen for a drink. The refrigerator door banged him on the knee and he went nuts, whaling on it, nearly ripping it off the hinges. He heard a little bark.
He snapped “Shut up!” at the dog, but then he scooped her up and took her back to bed.
“She lay on my chest, and I just started sobbing,” he says. “It felt good. She licked my tears, and I had to start laughing.”
It was up and down, and the worst would come a few months later, a stretch of pain and feelings of survivor guilt that would lead him to that dark bedroom with that heavy pistol.
He got better, slowly. When he finally sought professional help, the diagnosis of acute PTSD was nearly instantaneous. He left the Air Force Security Forces in 2005 and began therapy.
“He’s like a different person now,” says his father. “All that stuff was taking over his life. That dog just listened to him for hours.”
In May, Sharpe married Jenny Fritcher, an Air Force staff sergeant stationed at Ramstein Air Base in Germany. She’s about to be discharged and will join her husband, and Cheyenne, in Arlington this fall.
On their afternoon walks along Clarendon Boulevard, Sharpe knows some people are wary of Cheyenne. They see a pit bull and steer clear. Just as some do with angry vets.
“We’re two of a kind,” Sharpe says. “We saved each other.”Read Full Post | Make a Comment ( None so far )
If a loved one has post-traumatic stress disorder (PTSD), it’s essential that you take care of yourself and get extra support. PTSD can take a heavy toll on the family if you let it. It can be hard to understand why your loved one won’t open up to you – why he is less affectionate and more volatile. The symptoms of PTSD can also result in job loss, substance abuse, and other stressful problems.
Letting your family member’s PTSD dominate your life while ignoring your own needs is a surefire recipe for burnout. In order to take care of your loved one, you first need to take care of yourself. It’s also helpful to learn all you can about post-traumatic stress disorder (PTSD). The more you know about the symptoms and treatment options, the better equipped you’ll be to help your loved one and keep things in perspective.
Helping a loved one with PTSD
- Be patient and understanding. Getting better takes time, even when a person is committed to treatment for PTSD. Be patient with the pace of recovery and offer a sympathetic ear. A person with PTSD may need to talk about the traumatic event over and over again. This is part of the healing process, so avoid the temptation to tell your loved one to stop rehashing the past and move on.
- Try to anticipate and prepare for PTSD triggers. Common triggers include anniversary dates; people or places associated with the trauma; and certain sights, sounds, or smells. If you are aware of what triggers may cause an upsetting reaction, you’ll be in a better position to offer your support and help your loved one calm down.
- Don’t take the symptoms of PTSD personally. Common symptoms of post-traumatic stress disorder (PTSD) include emotional numbness, anger, and withdrawal. If your loved one seems distant, irritable, or closed off, remember that this may not have anything to do with you or your relationship.
- Don’t pressure your loved one into talking. It is very difficult for people with PTSD to talk about their traumatic experiences. For some, it can even make things worse. Never try to force your loved one to open up. Let the person know, however, that you’re there when and if he or she wants to talk.
Some resources that may offer you some support are:Read Full Post | Make a Comment ( None so far )