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Managing Post Traumatic Stress Disorder (PTSD) - Chat Transcript

The Pandora's Aquarium chat room welcomed Randi Nathenson, as a guest speaker on May 13, 2011. Randi is a clinical social worker based in the United States who works with clients with a trauma history. Her clinical interests are trauma, grief, and anxiety. She works with children, adolescents, and adults. She has also done advocacy work with rape crisis centers and domestic violence shelters, and particularly felt drawn to hospital advocacy work.

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Sasha: Welcome everyone to the Randi Nathenson guest speaker chat! We’re very excited that she has agreed to discuss PTSD with us today! Randi is a clinical social worker based in the United States who works with clients with a trauma history. Her clinical interests are trauma, grief, and anxiety. She works with children, adolescents, and adults. She has also done advocacy work with rape crisis centers and domestic violence shelters, and particularly felt drawn to hospital advocacy work. We’re so pleased that you’re here with us tonight, Randi!

RandiNathenson: I am very pleased and honored to be here.

Sasha: This chat will have two question and answer sessions. The first half will be questions you have submitted to me to ask Randi. Throughout the chat, feel free to ask questions you would like Randi to answer in the chat room. These questions are sent to a queue that is moderated. We will do our best during the second half of the chat to ask all of your questions!

Sasha: Let’s begin with our first question and answer session.

Sasha:I can't afford a therapist, can I treat PTSD myself?

RandiNathenson: Although there are ways in which you can help yourself PTSD is best treated by a professional. Maybe try to call a local rape crisis center, or therapists in your area who might offer services at a sliding scale rate. Without a therapist you could try a support group, books, sites like this one, or other ways of expression such as yoga, art, dance, etc.

Sasha: How can you be sure you have PTSD?

RandiNathenson: A mental health professional or doctor can confirm a diagnosis of PTSD.

Sasha: Does PTSD always revolve around a life threatening event? or Can the symptoms occur with a lesser event?

RandiNathenson: I think the answer depends on how you define the term "life threatening". My sense is that when the symptoms were written in the DSM, they were based mostly on combat trauma, car accidents, etc. But I view the term "life threatening'" in a more symbolic way. The event does not have to literally threaten your life in order to be life threatening. : You do not even have to feel your life was threatenened. Basically when trauma occurs, it overwhelms the psyche, and that is a threat to its existance. Any trauma can be "life threatening" I think it is also important not to define trauma as "less" or "more" or to compare trauma. Trauma is trauma and does not need to be qualified, or minimized. I believe this to be particularly true with sexual abuse. Where there is a tendency to minimize. But it is all traumatic regardless of the story. Any trauma can result in PTSD, and be considered "life threatening."

Sasha: I've heard conflicting accounts on whether or not PTSD can be "cured", in your opinion, is this something that can be cured or do we simply adjust to our symptoms?

RandiNathenson: You can heal from PTSD. I tend to shy away from words like "cured" or words that pathologize. PTSD is a normal response to a traumatic event. You can heal, you can move forward. It takes time and work, but it can happen.

Sasha: Are there ways to treat PTSD without medication?

RandiNathenson: Yes, you can treat PTSD without medication. Meds are not necessary, although at times needed and helpful. It depends on the individual.

Sasha: I have a terrible time trying to control my hypervigilance, do you have any tips?

RandiNathenson: What I find to be helpful with hypervigilance is self care and relaxation techniques. Try your best to relax. Take deep breaths, count them. :Tak to yourself, even outloud, in a gentle and soothing way, with compassion for yourself. Remind yourself that you are safe and okay. That you are responding to the past, and you are safe now. Try some physical activity, write, draw, exercise, dance, something to release the energy. The main thing is to be gentle with yourself. What is needed and deserved is loving kindness and compassion for you. breathing techniques can also be very useful.

Sasha: How do I soothe myself in public? I worry about what people will think of me.

RandiNathenson: Take deep breaths, find something to hold onto, go outside and touch a tree, something that can connect you. Call a friend. If you need to just leave where you are. That is okay. In public also remember, most people are not paying that much attention, you might feel like a mess, but seem completely fine to the outside observer. Focus on caring for yourself first.

Sasha: My startle response is extremely high the more stressed I become but I can't always keep my life on an even keel, how can I learn to function more efficiently, so I'm not jumping out of my skin?

RandiNathenson: Again the most important thing is loving kindness and compassion for yourself. You do deserve it. Use self care techniques, and make it a habit to do so can help relieve stress. Do things that give you energy, make you happy, and relax you.

Sasha: Does it matter if PTSD goes untreated for many years?

RandiNathenson: The sooner PTSD is treated, the better and the easier it is to treat. One thing that I remind clients of is that you have been dealing with the trauma for a certain number of years, it is going to take that time plus more to heal from it. The longer one is struggling the harder it will be to work through, but it can be done.

Sasha: In some ways PTSD protects us by keeping us on alert, are there other ways you see that it helps protect us?

RandiNathenson: I am not sure that PTSD is really protective. What I am beginning to understand is that it creates a system of false defensive that can feel protective, but are more harmful to the self. Donald Kalsched writes about this in this book "the inner world of trauma". What therapy and other techniques can do is help learn ways to protect yourself that are based on compassion for the self, rather then on what might be harmful.

Sasha: Do PTSD symptoms only appear soon after the traumatic event or can they remain hidden and come out years after when the event is remembered again and the person starts to process it?

RandiNathenson: PTSD symptoms can appear days, weeks, months, or even years later. Sometimes symptoms are triggered, or other times may appear without any apparent reason. Sometimes their appearance may mean the individual is ready to work through the trauma.

Lyndsie: We're going to begin sumbitting to Randi the questions you've all submitted during this chat. Again, thank you so much for being here, Randi!

Lyndsie: Does PTSD delay healing?

RandiNathenson: That is a tough question. I suppose, yes, it does, since without PTSD it might be easier to heal, or there might be different obstacles. In many cases PTSD can be debilitating enough that school/work etc. are interrupted, which can make it more difficult to receive needed services. It is likely dependent on the individual, but I would say that any mental health diagnosis would make the healing process last longer.

Lyndsie: What happens if you don't feel you are progressing with the PTSD?

RandiNathenson: It might mean something needs to be changed. If you are seeing a therapist talk to them about it. If you arn't, maybe try to find one. It also is important though to look at how progress is defined. Healing is not a linear process, and you might be making all sorts of progress without being aware of it. If you do not have a therapist you could also try a different technique, read a book, try a new hobby, something to help with what you are experiencing.

Lyndsie: My primary abuse was over 60 years ago, however it continued with more trauma a few years after. My question is this: Why is it, even though the time frame is long ago, that I still get triggered by certain sounds, touches?

RandiNathenson: Trauma is not time bound. With triggers in particular, it is like you are experiencing the event as if it is happening in the moment. This is because of how trauma is experienced, in the brain. Once processed, it becomes more time bound, and you can heal from it. It is normal though to be triggered so many years later.

Lyndsie: Are there actual physological changes that occur in the brain to adapt to the traumatic environment?

RandiNathenson: Yes. There are several books, particularly recently on this. I do not know offhand all the chemicals or technical terms, but basically, there is a split in the brain when you experience trauma. The logical, rational side is "turned off" and the emotional side experiences the trauma. This creates a split in the brain, which is why trauma can be so difficult to process and work through. The sides have to be integrated. It has been shown that the brain of traumatized individuals are very different from those who have not been traumatized. But, the brain can heal, and this can change as well. Through therapy or other techniques new neuropathways are created, and the split can be integrated. Which is why EMDR has been showsn to be successful.

Lyndsie: Do you have to process all the memories to heal?

RandiNathenson: You do not have to process all of the memories to heal. Often, that is impossible. What you process is whatever memories you feel you need to process. You can heal without processing everything.

Lyndsie: What can you do to heal the brain that is affected by PTSD?

RandiNathenson: EMDR has been shown to be effective, as well as yoga, body work, and sand tray work . I think that the biggest , factor in healing the brain can be the therapeutic relationship and the connection. It can help rewire parts of the brain. But it depends on the individual, what will work for them.

Lyndsie: How do I know for sure I am diagnosed with PTSD or other disorders? Does the therapist give me some sort of stamped form?

RandiNathenson: It depends on the therapist. Some will tell you your diagnosis, some won't. You can always ask them. My tendency is not to, I don't tend to think in terms of diagnosis and pathology. My sense is at times it can be limiting, or make a person feel something is wrong with them. But if a client were to need or want that, I would. I think it is important to remember that PTSD is a normal reaction to trauma, as are other disorders. Symptoms have reasons, and the idea is not to label as much as find the underlying reasons for the symptom.

Lyndsie: What is sandtray work?

RandiNathenson: Sand tray work is essentially a tray of sand, either wet or dry.There are several miniatures, people, animals, ojects that a client can choose to place in a tray.You process the image in the tray, tell a story, or some clients choose to simply play in the sand. What it can do is bring things from the unconscious into consciousness. It also allows play to occur which can be very healing.

Lyndsie: Have you found that PTSD complicates the process of picking with and staying with one therapist (consistently) for a lot of people?

RandiNathenson: I think it can. It is difficult to find a therapist that can fit the needs of the individual, and who someone feels comfortable with. It can also at times be difficult finding a therapist who has experience with PTSD, and with sexual abuse survivors. The therapeutic relationship is crucial in healing from sexual abuse, and building of that relationship takes time. It can be very difficult to trust and open up in therapy, and that presents challenges to the work.

Lyndsie: How do you deal with difficult people that quantify your PTSD against others and deminish you and your experience? Such as friends, family, etc?

RandiNathenson: That can be very difficult since so many do not understand the impact sexual abuse has. You can try to explain to them, or recommend books they might read, websites they might go to, in order to help them to understand. It is hard because it should not be the role of the survivor to educate others, but often it becomes that. I think self-care techniques are important in those cases to remind yourself that those who diminish and wish to minimize or quantify your experience are not right, and that you should be validated and supported. You deserve that.You can also choose to not associate with them, or to tell them you will not talk about your PTSD with them, if they cannot support you.

Lyndsie: If PTSD is a normal reaction to trauma then why doesn't everyone who's been through a traumatic experience develop it?

RandiNathenson: Everyone is different and everyone responds to trauma differently. There is not one way to heal, there is not one way to respond to trauma. PTSD is one of many normal reactions to trauma. I does not mean that if you do not develop it that you are not normal. And it does not mean that if you do not develop PTSD, that your trauma was less, or not "as bad" as someone who does develop PTSD.

Lyndsie: Have you heard of brainspotting? If yes, what do you think about it?

RandiNathenson: I have not heard enough about it to really comment on it. I think the brain, and learning ways to heal the brain, seems to be key in healing from trauma, and I am interested in learning more about it.

Lyndsie: Alright, I'm sorry that we couldn't get to everyone's questions! You all had some amazing, heart-felt questions to ask!

Lyndsie: We would like to thank Randi for joining us today and talking about this topic. The information you’ve provided is very much appreciated, Randi. Thank you for spending time with us!

RandiNathenson: The questions were all great! I was glad to be here and answer them, and sorry that I could not get to more.

Sasha: Thanks very much for coming Randi we really do appreaciate it

RandiNathenson: Thank you for having me.


For further reading on PTSD, suggested by Randi Nathenson:

The PTSD Workbook: Simple, Effective Techniques for Overcoming Traumatic Stress Symptoms by Mary Beth Williams

The Body Remembers Casebook: Unifying Methods and Models in the Treatment of Trauma and PTSD by Babette Rothschild

The inner world of Trauma-Donald Kalsched

I Can't Get over It: A Handbook for Trauma Survivors - Aphrodite Matsakis

Recovering From Rape - Linda Ledray

 

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