Ten Steps to Ease the Symptoms of PTSD

Familiar yet terrifying, disorienting and disruptive feelings associated with trauma can come on without warning. A word, sound, smell or image can trigger disturbing thoughts as well as emotions. This happens because the right side of the brain, which is faster and “comes on line” sooner than the left side, leaves us unable to think clearly about what is happening and we can be cast into a different time zone known as the past. Since we do not know whether or how to fight or flee, we end up freezing and are unable to move from this place in time. Frequently, we cannot reason our way out of such emotionally charged events, so other strategies are needed.

Here are Ten Steps, that in my years of work with trauma and PTSD, I have found helpful:

1. Identify the present date and the time down to the specific hour if you can.
   Keep your eyes open. There is no rush, so take your time. Look around at your surroundings and notice the shapes. Notice and count, for example, all the objects that you see which are square and all the items that are round.
   
2. With eyes open continue to slowly and gently look but this time notice the colors. Again see red or blue or green and count them, still remembering the date and time. Your attention is focused outward to both see your world and orient yourself.
   
3. If not seated, please do so. Sit erect and forward in your chair, so your back is not touching the back of the chair. Let your hands rest on your thighs. Your feet should be firmly on the floor with shoes off. Press your weight forward a bit so you can feel the floor beneath you as firm and solid.
   
4. Take a tennis or handball and with one foot firmly planted lift the other and roll the ball along your arch. Then do the same with your other foot. This might be a bit tender at first but feel your foot gently relax and give into the ball, as you remain present and aware of your surroundings.
   
5. Return both feet to the floor and still sitting erect, pay attention to your body checking for points of tension. If you feel any point of tension, just notice and comment: “My neck is tight,” “My legs are heavy.” Try not to judge or interpret, just notice.
   
6. Focus on your breathing with your lips slightly parted. Feel the air enter your body through your nostrils, traveling to your stomach and diaphragm and then back up and out. Become aware of the rhythm, be it rapid and shallow or slow and deeper. Slowly drop your gaze to about three feet in front of you and feel yourself breathe with no effort to control it.
   
7. Begin to count or name your breaths; for example, 1 on the inhalation and 2 on the exhalation or name them “in” and “out.” Just focus on the rhythm of your breathing, knowing your mind will wander but bringing it back each time you are distracted by simply saying, “thoughts.” Continue for five minutes to start if you can and build up to twenty minutes.
   
8. Attend again to your body to note any tension. If you still notice discomfort, assign a feeling phrase to the area: “My stomach feels nauseous and I am anxious.” Just notice the feeling and let the sensation linger to see what else you become aware of without interpreting or assigning meaning.
   
9. If the feeling and sensation fades or lessens some, say to yourself, “That was then, this is now,” and alternate light tapping on your thighs with your hands. You are “tapping in” the present experience, as such bi-lateral stimulation helps the brain integrate the experience.
   
10. If you are still uncomfortably anxious image yourself sitting in your favorite place: a place where you enjoy and have experienced calm and relaxation. Fill in as many details as you can, like the temperature, sounds, smells, textures, etc. If you wish and you have a special friend, relative or pet, for example, imagine them with you as you breathe and rest. In the present you can care for yourself.

Repeat these steps or if you so choose change them to fit your needs.

May a sense of peace be with you.

Richard Raubolt, Ph.D.
www.richardraubolt.com

Podcast 1: What's Wrong with Therapists & Counselors, or Why Are Dr. Laura and Dr. Phil Mistaken as Either?

My first podcast, entitled "What's Wrong with Therapists & Counselors, or Why Are Dr. Laura and Dr. Phil Mistaken as Either?"

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Book Review: The Heebie Jeebies

My Review of
Do You Ever Get The Heebie Jeebies?
by Jill Reiling (Falcon Books 2006)
Available at adventuresofgracie.com

It has been some fifteen years since I have seen young children in my psychotherapy/counseling practice. I have, however, continued to see the ravages of childhood abuse on the adults and young adults I meet with regularly. Quite often I hear a plaintive plea: "Where were the adults, an aunt, uncle, teacher, mother or father to protect or guide?" It is one of the saddest questions I have had to face and one for which I have had no satisfactory answer.

How do we protect our innocent, wide-eyed, curious children? How do we shield rather than scare our little ones? How do we keep them safe when they are out of our sight?

I have been on a search to find answers, tentative as they may be, to this question. Now with the help of my precocious, lively and dear sweet niece, Ella, I can offer at least one recommendation.

"Our recomnation, Tio" as Ella reminded ( "Tio" is family Spanish for Uncle): it's the" heebie jeebies".

Jill Reiling has written a marvelous, witty, playful children's book, Do You Ever Get The Heebie Jeebies?, that also contains a compassionate but serious message. This book, the winner of the Gradiva Award for outstanding psychoanalytic writing for children is smart, attractive, clever and simple in directing children to listen to their own feelings of uneasiness. Ella got the message immediately: "Oooh, I know the heebie jeebies. They freak me out. They make my tummy squishy so I look for mommy". Now nothing really bad has happened to Ella but she knows, or is beginning to know, what frightens her. She then asked, "Do you know about heebie jeebies, Tio?" Yes, I do Ella, sometimes more than I want to at times but this I kept to myself. What I did say was "Yes. Ella and I want you to be safe". "Me too, she answered," 'sides the pictures are cool". Indeed they are as illustrated by Alexander Juhasz.

This brief book should be in every elementary school library, church nursery and home with young children. It is a hard book to purchase although printed by Falcon Press. If you can' t get it let me know. I'll make sure you receive a copy even if I pay for it myself. It is that special. "Right on, Tio" says Ella.

Book Review: Let Them Eat Prozac

My Review Of
Let Them Eat Prozac: The Unhealthy Relationship Between the Pharmaceutical Industry and Depression
by David Healy, M.D. (New York University Press)

This is a far different book that I am including in my “Healing List.” It is scholarly, scientific and professional. It is also well written, accessible to general readers and most importantly packed with provocative questions and crucial information.

David Healy is a distinguished research and practicing psychiatrist and former head of the British Association for Psychopharmacology. He is an expert on treating depression and has run clinical trials for major anti-depressant drugs. While Healy doesn’t deny the effectiveness of these medications (SSRI’s) and has prescribed them to his patients, he vehemently challenges the simplistic “biobabble myth” that depression is only the result of a deficiency of the neurotransmitter serotonin in the brain. Instead he demonstrates that no causation has been found, that there is no known depression center in the brain, but that 95% of our serotonin is found elsewhere in the body. Most concerning to me is that he has also found that raising this one “selective” neurotransmitter decreases others (dopamine and adrenaline) that are natural “feel-good” chemicals.

When depression is viewed from the vantage point of this myth then feelings of sadness, grief, loss or even shyness are often misdiagnosed as disorders rather than the results of painful but natural experiences in life. In the parlance of marketing by pharmaceutical companies this is known as “condition branding” where a need is developed for medication disbursement. Who among us has not heard of Zoloft, Prozac or Paxil? Even if we have not taken any of them, we all “know” they are treatments of choice for depression. “Big Pharma” says so, Healy notes.

These are not benign medications and withdrawal symptoms can be severe and include dizziness, anxiety, nightmares, nausea and agitation. Now Healy is not opposed to the judicious use of these drugs and neither am I (see my newsletter on medication) so long as they are properly prescribed for treating severe, chronic depression and patients are warned of potential side effects.

This is a first hand well researched and balanced account of the development, marketing and use/misuse of one of our most popular types of medications.

Living with Chronic Pain

Living with chronic pain is draining, disturbing, frightening, debilitating and terribly disruptive. Sometimes the injury or ailment is visible like the results of a severe automobile accident or stroke. Frequently there is no apparent "cause" as the pain results from stenosis, immune disorders or fibromyalgia.

Seen or unseen symptoms are often deceiving. We can see symptoms but we can’t see pain. Oh, we can catch glimpses like a wince or more dramatically a sudden collapse. But we can’t see inside the body to measure, know or really appreciate what the pain feels like to someone else. Does it cut like a dull, rusty knife? Throb like the sounds of a beginning drum student? Does it come and go like some mysterious, sadistic phantom? Or is it like both all of these and none of them at the same time?

Frequently what we have to rely on are the descriptions by the patient/person. Words. Words express what is felt so individually and uniquely. These words can reveal or hide a great deal. They can be a cry for help, relief or for attention. They can exaggerate or minimize the pain or at different times under different circumstances they can do either or both.

With chronic pain all areas of a person’s life can be drastically affected: emotions, physical movement, thinking such as attention and concentration and activities. Sometimes even the capacity to love or believe in a future or in God are compromised or missing. Then there are the financial uncertainties about health care, savings or even the basic ability to earn an income.

What I have come to realize is that chronic pain can also create relationship problems with loved ones be they children, parents, friends or especially spouses/partners. Young children, for example, can miss out on normal activities when a parent is in pain and can’t participate. Children can also become protective and anxious leading them to curtail their lives by staying close to home to the point of not developing friendships or even attending or having problems learning in school.

Friends can express concern and make themselves available but usually only to a point. They move on with their lives and activities, often forgetting about a friend in pain. The person in pain is inadvertently dropped from the circle of friends who are vibrant and active. Life goes on.

Parents of adult children can feel guilty that their son or daughter has such pain and no amount of nurturing or guidance can make it go away. Some often wonder why their children and not themselves are stricken and as a result may become overly involved in an attempt to manage their own guilt and sense of failure.

The most difficult, confusing and disruptive problems, however, most often occur in marital/partner relationships. For the "healthy" one there is often an overwhelming feeling of helplessness, sadness and loss. The nature of the relationship can change as favored activities and plans have to be abandoned and worry about the future can set in with a vengeance: "What will we become?" Patience can run dry and spouses can say hurtful, angry words that deepen the anxiety and despair. Couples may need help in offering a "safety net of love" for each other.

There are very effective medications to relieve pain or at least some of it, there are non-traditional approaches such as acupuncture, yoga and massage that can also be wonderfully helpful and relaxing. To this list I would add psychotherapy where couples can talk honestly and openly about their individual feelings and experiences and where words can begin to heal the pain in the relationship if not the body.

Darkness, Lightness and the Unintegrating Mind

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Trauma, Psychosis and American Apocalyptic Christianity: Analysis in the Midst of Spiritual Warfare

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