Coping with trauma

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Having recently been involved with the Algerian crisis it was evident how the impact of the trauma reverberated across a wide spectrum internationally. Just as a pebble thrown into a pond casts ripples across the water where there was once stillness, so too, does a disaster such as this.

For many reading this, the event will have been something that happened to others. Yet, we all feel the pain visited on the relatives, the worry and the anguish felt so keenly by relatives as events unfold and they waited anxiously for news. Whether we were involved or not, we too awaited developments on the national news.

It is the suddenness and the enormity of an event such as this, that impacts so deeply on our psyche. One day we are going about our business, oblivious to events in this small part of North Africa, the next, an event of epic proportions is unfolding in our living-rooms. An event just like the pebble thrown in the pond which has ramifications for the whole of the region, further afield, the ripples impact on us and those we love.

It is the way an event such as this, a trauma, changes the way we see the world. Just as this is a crisis of global proportions, each of us at some time or other will have our own personal crisis to deal with.

It may be the illness and death of a close relative, a car accident, an assault or other traumatic event. Whatever it is, to us it has the capacity to take over our lives, change our outlook and perspective in a major way.

Our reactions to trauma are broadly the same whether it is a major life threatening event or sudden and unexpected loss of job or relationship breakdown. The way we are programmed at an evolutionary level dictates our response. Coping with a trauma is a “normal response to an abnormal set of circumstances”. This abnormal set of circumstances occurs when something happens that’s outside the “normal” range of our daily experience.

As far as I am concerned, a trauma reaction should not be regarded as an “illness”. I would go so far as to say that a trauma reaction is actually a sign of “wellness”. It is our body absorbing and processing an event of such magnitude, that it reacts the way it does to help us achieve this. Yes, you will find that trauma is categorised in the DSM*, the manual of psychiatric disorders. You will hear references to PTSD or Post Traumatic Stress Disorder, but essentially this “diagnosis” is a convenient way to categorise a set of circumstances. It is important to understand that the traumatised person is not “mad” or “crazy” but they are normal healthy individuals doing what normal healthy individuals do in a crisis.

There are a wide range of feelings that people experience when faced with a trauma or life crisis:

Helplessness – feeling out of control, powerless
Sadness- grief stricken
Anger- as a result of events, at whatever caused it or at the injustice of it all.
Guilt- over what you did or didn’t do, or perhaps for simply being alive

People are likely to experience physical reactions such as:

Headaches, tension and muscle pain
Restlessness
Loss of interest and enthusiasm
Excessive jumpiness
Loss of concentration
Poor memory
Numbness
Sleep difficulties
Poor appetite
Loss of libido

It is likely that many people experiencing a trauma reaction will find themselves reliving aspects of what they have encountered. Repeatedly mentally re-playing a scene is a very normal occurrence and is the way the mind processes and ultimately stores data. These memories are known as “intrusions” or intrusive memories.” They may be a very distressing, perhaps they will be experienced as an image or a thought, or perhaps present in the form of sensory impressions such as a smell or sound. Whatever form they take, such intrusions are normal and it will fade over time.

One type of intrusive memory that may be experienced is known as a “flashback.” These often take the form of powerful visual images and may be accompanied by sounds, smells and other sensory impressions. Flashbacks feel real, it is as if the event were happening again. Flashbacks are a particularly strong type of intrusion. They re often provoked by “triggers,” things that occur unconnected to the event, perhaps something somebody says, or perhaps triggered by something you have seen on the television. I was working with a man who had returned from Iraq and during our session a car backfired outside in the street. This was enough to trigger a particularly distressing flashback for my client who proceeded to dive for cover under the table. It took some time for him to cam down and be fully present back in the room again.

Another common reaction following any kind of traumatic event is to feel “hyped-up.” This is caused by high levels of the hormone adrenalin which our body produces to help us deal with threat. Sometimes people will feel panicky or on guard, watchful, vigilant. This is very normal after an event to continue to look out for danger.

At a behavioural level people’s reactions vary but many experience:

Avoidance, in particular wanting to stay away from the scene of the event
Loss of interest in things normally enjoyed
Withdrawal, wanting to isolate self and not mix with others
Increased levels of irritability, getting angry quickly
A tendency to overwork
Lack of drive or motivation to work
Lack of interest in meeting own needs
An increasing reliance on alcohol
Staying indoors and keeping to “safe”places

At an emotional level people may:

Become low in mood
Feels particularly sensitive, tearful and emotional
Find they lose confidence
Can no longer laugh as they did
Find things getting out of proportion
Be very sensitive to reminders of the incident
Avoid media coverage, finding it too upsetting

How can you help yourself?

Remember that a trauma reaction is a normal reaction.
Talk to others who were involved or may have had similar experiences
Talk to friends and family, tell them how you are feeling
Avoid excessive alcohol or use of drugs
Seek out a doctor, priest or local victim support
You may find it helpful to talk to a mental health professional such as a counsellor

Quite often traumatic events seem to make other life events and everyday matters seem trivial. Try not to feel frustrated with others or disregard things because they may seem mundane.

Be aware of the following:

Take care, accidents are more common particularly when distracted
Look after yourself, get plenty of rest and relaxation
Physical activity such as jogging, swimming can help burn off excess adrenalin
Many people feel alone and on their own after a trauma
Your confidence and self esteem may be affected
You may find yourself somewhat forgetful and absent minded

Remember

It is both understandable and normal to feel the way you do, it is what is known as a trauma reaction. Everything will return to normal over time.

Seek medical assistance if after a month:

You start noticing your symptoms getting worse
You are unable to experience positive emotions
You are unable to see a positive future
You find yourself with little interest or enthusiasm
You find yourself avoiding people or places associated with the trauma
You are experiencing ongoing poor sleep, nightmares and other stress related problems
Your relationship deteriorates and you lose closeness and intimacy
You find your alcohol intake increasing
Your ability to work is negatively affected
You continue to feel tired and worn out
Your mood worsens

If you find yourself experiencing the above feel free to contact – stevecliffordcbt@gmail.com

Until next time, Steve Clifford, Cognitive Behavioural Psychotherapist

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www.stevecliffordcbt.co.uk

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Thinking the unthinkable

Do you have disturbing thoughts that simply won’t go away?  Thoughts that upset you, yet you keep obsessing on them?  Such unwanted intrusive thoughts can be very distressing, particularly as they keep popping into the mind and seem to get stronger and stronger.

You may feel guilty and think that you are a terrible person, or perhaps fear that you may act upon them. Many people have such thoughts and are often persecuted, tormented, fearing their thoughts will never go away or that the only answer is prison, mental hospital or worse still…  People try to push them away or “neutralise” them, spending a lot of time trying to put them right, perhaps inserting another thought or carrying out some kind of ritual, such as counting to three, touching wood or repeating certain words or phrases in a vain attempt to banish them.

Often these thoughts are the worst possible kind imaginable.  For example, the mother with a young baby may have thoughts of harming her child, perhaps even seeing herself doing it.  Someone with high morals may have sordid thoughts, completely out of character.  Very often, the kind of thoughts experienced will be the exact opposite of the thought they would wish to have.  This is part of the problem.

Obsessive thoughts or fear of indulging in impulsive acts are very common.  Research has shown that as many as 90% of “normal” people will at some time have obsessional thoughts. The thoughts may be accompanied by strong urges. Common ones include shouting obscenities in a quiet place such as a church, library or the workplace during a meeting. Perhaps you have thoughts of jumping off a railway platform in front of a train or  pushing somebody onto the line, maybe you fear you will drive into oncoming traffic. Perhaps you worry that you may shake or strangle your baby, whatever your thoughts, they can be really upsetting.

The problem is that such thoughts keep returning because every time you think about them, however fleetingly, you give them negative importance in your mind.  In other words, you give them power by focusing on them, by not wanting them – it’s as simple as that.  Allow them to be there and they will go away.  One of the biggest problems with obsessional thoughts is that they seem so real.

Obsessive thoughts appear:

  • Unstoppable  – they just pop into your mind without any effort
  • Unhelpful – they lower your mood and make you unhappy
  • Unbelievable – you know they are not true, yet you keep repeating them
  • Implausible – you accept them as facts, although they are ridiculous

Such thoughts become habits, and habits can be broken.  Overcoming the problem can be achieved by following ten simple steps outlined below:

Try to accept your thoughts; they are just thoughts, however odd or out of character.   Don’t try to change your thoughts, just the way you respond to them.

Remember, a thought is just a thoughtit doesn’t mean anything – learn to relax with your thoughts.

Be compassionate to yourself; you are normal; everyone has odd, weird or unpalatable thoughts sometimes.  Having such thoughts does not mean you are a bad person.

Do not give your thoughts any importance.  They are not worth the energy invested in them.

Do not try to push thoughts out of your mind.  This is known as “thought suppression .  It will only make them return ten times stronger.

Do not try to “neutralise” it with another thought or ritual, as this will keep you locked into the cycle, strengthening the thoughts by giving them some negative importance.

Just allow your thoughts to be there as you engage in everyday activities.  They will fade if you turn your attention to other things.

Remember, the more frightened you are, the more they will come to mind – fear feeds thoughts.

Stop asking for reassurance – reassurance will only last briefly and you will never gain confidence in believing that your obsessional thoughts will just fade away and that you will not act on them.

Remember  – if you don’t want to have them, you will.  Let the thoughts do whatever they want; they can’t harm you – they are just thoughts.

For more detailed information you may wish to contact a health professional.

Feel free to email me at:  stevecliffordcbt@gmail.com, or look for a therapist near you at www.babcp.com.

Until next time, Steve Clifford, Cognitive Behavioural Psychotherapist

www.stevecliffordcbt.co.uk

Image reference http://commons.wikimedia.org/wiki/File%3AAnother_stone_face%2C_Holy_Cross_church%2C_Chiseldon%2C_Swindon_-_geograph.org.uk_-_1119722.jpg

Are you feeling just so tired, yet you have only just returned to work?

Can you believe it?  You have returned to work after a well earned break, yet you feel so tired. It is almost as if you need another holiday!

This is such a common phenomenon. The Royal College of Psychiatrists: rcpsych.ac.uk have estimated that 1 in 5 people feel unusually tired a lot of the time and as many as 1 in 10 people suffer with chronic tiredness. So prevalent are problems with tiredness and fatigue that the acronym TATT (“tired all the time”) has been coined to describe this condition.  Women seem to be particularly affected.

In my psychotherapy practice I see so many people who complain of persistent tiredness, even though they may be sleeping well. For many of them, this problem has been going on for months. The first thing I do is consider their mental state. Could they be depressed? Are there any significant life events that may underpin or trigger tiredness, such as bereavement or relationship breakdown? Are they under particular stress or having work problems? I then ask if they feel unwell or have suffered a recent illness. Chronic fatigue syndrome (CFS) which is a particularly debilitating and often long term medical condition, often follows on from a viral illness. While fatigue is common often accompanying illness in general, CFS is comparatively rare. The next thing to consider, if a particular trigger is not readily apparent, is to refer them to their GP for a routine blood test to rule out an underlying medical condition.

The types of underlying medical conditions to consider are:

Thyroid problems. An underactive thyroid will lead to tiredness, muscle fatigue and aches as well as weight gain. It affects women more than men and is more prevalent with age.

Anaemia. While particularly common in women who have heavy periods and post-menopausal women, this should not be dismissed by men. NHS UK estimate that 1 in 20 men suffer with anaemia. Symptoms include lethargy, heavy muscles, rapid onset of tiredness.

Diabetes. A long term condition caused by excess sugar in the blood, will lead to increased tiredness, along with excessive thirst, frequent urination and weight loss.

Food intolerance. One type of food intolerance where tiredness is a common symptom is Coeliac disease. This is where the body cannot tolerate gluten, which is found in bread, cakes and most cereals. Affecting as many as 250.000 people in the UK, it is estimated** that up to 90% of sufferers do not know they have it. Other primary symptoms include diarrhoea, anaemia and weight loss.

Chronic Fatigue Syndrome. Also known as myalgic encephalomyelitis or ME is a very severe condition, where extreme tiredness often lasting six months or more is commonplace. It often comes about after a viral illness and is sometimes known as post-viral fatigue. While symptoms tend to differ between sufferers, sore throat, joint pain, muscle ache and head ache are common. I have seen many people with this condition, some of them so disabled that they are bed bound. Cognitive Behavioural Therapy (CBT) has been found to be particularly helpful and is something I would recommend. For a list practitioners near you, contact: babcp.com or contact us on steveclifford.co.uk.

Sleep Apnoea. Severe exhaustion during the day can indicate sleep apnoea, particularly where the sufferer is a bad snorer. What appears to happen is that the throat narrows or closes during sleep, which frequently interrupts breathing. AS a result blood oxygen levels drop and sleep is broken. Predominantly affecting middle aged men and compounded by alcohol and smoking. Assessment by a sleep and respiratory specialist is recommended.

Other conditions include:

Pregnancy. The first trimester (12 weeks) is marked by tiredness and often accompanying nausea, breast tenderness as well as absence of menstruation.

Obesity. Tiredness often results from exhaustion as the body has to work harder to carry round excess weight and undertake everyday activities. Shortness of breath and joint pain can also feature with extreme obesity.

Underweight. Lack of muscle strength may lead to tiredness and exhaustion.

Vitamin or mineral deficiency. Important for a healthy lifestyle vitamins and minerals are essential for repair, metabolism and for skin, bone and muscle development. Signs of deficiency include tingling in fingers and toes, mental confusion, tiredness and minor illnesses.

While it is important to rule out medical conditions, tiredness caused by psychological factors is far more common. A recent survey by the Mental Health Foundation: mentalhealth.org.uk found that nearly a third of the population suffer with severe sleep deprivation. Job stress and money worries contribute significantly to emotional tiredness with many people funding Christmas on credit, yet feeling insecure about their jobs. Unhappiness at work (and often at home) is frequently pushed down and internalised, this requires a lot of effort and can lead to pervasive feelings of tiredness. As a body therapist as well as a talking therapist,  I see many people with headaches, back aches and tiredness, again caused by internalised stress. Over the long term this can lead to skin conditions, stomach ulcers and a myriad of other health complaints. It is not just negative states, however, that can lead to tiredness and exhaustion, but happy events such as weddings, moving house and childbirth. Anyone with a young child will no how exhausting it can be on a day to day basis. When combined with juggling childcare, work and running a household, no wonder tiredness is such a feature of our modern society.

How many men (and women for that matter) reading this, use alcohol on a daily basis to switch off and cope with the stress of work and daily life. Regular use can lead to depression and it also affects sleep, often leading to wakefulness in the middle of the night. Shift working and irregular working hours disrupt circadian rhythm, impacting on sleep and body functioning, leading to peaks and troughs of tiredness.

I have mentioned depression and this is something I should give more space to discuss. Many people experience depression and are not aware of it. Whilst depression is primarily seen as a psychological condition, many physical symptoms are prevalent. These include aches and pains, constipation, weight loss or weight gain and extreme tiredness. This tiredness is part of a global slowing down or retardation. Body functioning, in particular movement becomes slow, simultaneously brain function slows. This leads to poor concentration, slowed thinking, difficulty making decisions and loss of energy and enthusiasm.  Appetite often diminishes, activities normally enjoyed are neglected, everything seems too much; loss of libido and interest in sex, inability to do jobs around the house, deal with finances and even contacting friends goes by the way. Withdrawal goes hand in hand with the aforementioned symptoms, sometimes to the point where staying in bed, not washing or even dressing may be the ultimately result.

Chronic tiredness resulting from lack of sleep is something many people experience. This is treatable and again CBT can be very helpful. If you would like more information on CBT for insomnia see: insomnia-treatment.co.uk.

Here are ten simple tips to help you overcome tiredness.

1. Aim to keep a regular bedtime and rising time, try to establish a pre-bedtime routine gradually winding down ready for bed.

2. Pay attention to “sleep hygiene” which includes ensuring the temperatu re of your bedroom is on the cool side, make sure the bedroom is quiet and dark. Only use the bed for sleep (not work). Sex,is the only exception as it tends to induce sleep

3. Do not engage in exercise in the two hours before bed, also do not eat too close to bedtime and avoid using the computer as it can be too stimulating.

4. Try to put the day to bed, leaving work behind. Keep a diary and reflect on the day, making notes for anything you need to prepare for tomorrow.

5. Have a warm bath or shower in the two hours before bed. Have a milky drink and a light snack, listen to soothing music and dim the lights over the course of the evening in preparation for bed.

6. Try to reduce reliance on alcohol and/or caffeine in the evenings. You may find stopping both helps greatly.

7. If your mood has been low for a two week period, visit your GP and enquire as to whether you might be depressed.

8. Try to eat a balanced diet with regular meals and ensure that you have an adequate fluid intake. Poor nutrition, unbalanced blood sugar and dehydration can all cause tiredness.

9.  Lack of exercise can lead to tiredness. Make 2013 the year you become more physically active. Make sure you do so gradually allowing the body to adjust.

10. Seek specialist help to address relationship, work or money problems rather than putting them off. Remember, you are important and tiredness may just be your body shouting at you, trying to tell you to get things sorted out.

Until next time, Steve Clifford, Cognitive Behavioural Psychotherapist

www.stevecliffordcbt.co.uk

Image refhttp://commons.wikimedia.org/wiki/File%3ATired.jpg                                                                                                                                                                                                       Main reference: “Why am I tired all the time?” – Live Well – NHS Choices  www.nhs.uk