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  What Is...

Trauma

Post-Trauma Response

Post-Trauma Responses, including Post-Traumatic Stress Disorder (PTSD), may occur after exposure to a very stressful event.  Events that lead to PTSD and other related stress disorders tend to include those typified by serious injury, illness, or threat of death personally or to those who you know or have contact with.

A traumatic event is generally something that is terribly frightening that leaves you feeling hopeless, helpless and out-of-control of the unfolding events.

In the course of one’s lifetime approximately 60% of men and 50% of women directly experience at least one significant traumatic event. Women are more at risk of exposure to childhood sexual abuse or a sexual assault later in life; while men are more inclined to experience physical violence, war combat, natural disaster, accident or to witness another’s serious injury or death.

The good news is that although exposure to trauma is fairly common only 7-8% of the general population is diagnosed with PTSD over the course of their life-time.

Women tend to be more vulnerable to the development of PTSD (approximately 10%) while only 5% of men exposed to trauma will develop PTSD. In the U.S. approximately 5.2 million adults will meet the diagnostic criterion for PTSD in any given year. This number represents only a small percentage of individuals who have experienced a trauma over the course of the same year. So although diagnosis of PTSD is relatively small compared to exposure those suffering from the aftermath of trauma but still managing to cope is quite a large number and requires care in order to lead to an optimal outcome for the individual.

The most common post-trauma struggles result in the development of particular symptoms as a result of exposure to trauma in which one's personal health and well-being is threatened. The stressor is often identified as one that may lead to one's death or injury or that of a person close to the individual (i.e., friend, family or colleague).

There are six criteria that need to be met in part or whole in order to establish Post-Traumatic Stress Disorder (PTSD) as a diagno­sis. The PTSD diagnosis is based on the following cri­teria from the DSM:

A1: personal involvement in a life or death event that is a threat to personal safety or that of friends, associates, or family;

A2: the person responds to the stressor with horror, helplessness, or great fear;

B:   re­current, intrusive mental re-experiencing of the trauma;

C:   avoidance of trauma related cues and emo­tional numbing;

D:   hyperarousal;

E:   PTSD must be present for longer than 1 month; and

F:   the symptoms must be significant enough to impair functioning of life skills (APA, 2000).

Other possible diagnoses to consider might include: Acute Stress Disorder; Gen­eralized Anxiety Disorder; Major Depressive Disor­der; Panic Disorder; Adjustment Disorder, Dissocia­tive Disorders or Dysthymia.

The wording of the diagnostic criterion for PTSD in the DSM-IV-TR recognizes that the individual's response to a traumatic event is equal in importance as the ob­jective evaluation of the event itself and the degree to which it might be determined to be traumatic. By tak­ing into account individual responses, we are able to begin to make sense of why some individuals become debilitated after experiencing a seemingly innocuous event while others can spend long periods of time in the midst of heinous trauma without developing nega­tive effects.

To recap, key post-trauma symptoms include:

  • Feelings of horror, helplessness or fear
  • Recurrent, intrusive re-experiencing of the trau­matic event (i.e., nightmares, flashbacks, intrusive memory replay)
  • Avoidance of any trauma-related cues (i.e., places, people or activities associated with the trauma or resulting in reminders of the trauma)
  • Anxious arousal (i.e., increase in heart rate and breathing, nervousness, fearfulness, agitation, easily ignited startle response)
  • Impairment of life skills (i.e., ability to socialize, work, attend school or manage family responsibilities)

Related Post-Trauma Struggles

  • Guilty feelings like survivor guilt
  • Suicidal/homicidal thoughts or behaviors
  • Sense of disillusionment with others and authority
  • Sadness or depressed mood
  • Feeling overwhelmed
  • Assumptive losses (i.e., after being injured in on a vacation “I will never be able to enjoy myself away from home again – the world is not safe")
  • Re-enacting the trauma experience
  • Self-destructive or self-injurious behavior
  • Body sensations like headaches or stomaches when feeling emotionally upset
  • Relationships difficulties
  • Poor memory, concentration or forgetfulness
  • Feeling hopeless or helpless

In addition, there are two types of trauma that the traumatologist would benefit from differentiating at the beginning stage of treatment to assist in treatment planning.

  • Type I Trauma: An unexpected and discreet experi­ence that overwhelms the individual's ability to cope with the stress, fear, threat and/or horror of this event leading to PTSD (i.e., motor vehicle accident, natural disaster). It is possible that the trauma might be in the form of witnessing of an event (second­ary traumatic stress). Treatment outcome tends to be achieved more rapidly than in Type II trauma if ser­vices are offered within a reasonable time (months rather than years) after onset of post-trauma symp­toms.
  • Type II Trauma: Expected, but unavoidable, ongoing experience(s) that overwhelm the individual's ability to metabolize the event (i.e., childhood sexual abuse, combat trauma). This type of trauma is the origin of DESNOS (Disorders of Extreme Stress Not Other­wise Specified) and Dissociative Disorders.

Medication for Trauma

Finding the right medication for treating trauma and other mental health disorders can be trick business. In fact, although medication can make a big difference in managing symptoms for some people is not always the best solution. For more information, click here.

Psychophysiology of Trauma

The how's and why's of posttraumatic stress, subse­quent symptoms, and symptom resolution can be un­derstood in relation to the events that occur in the brain during and after a traumatic event. What follows is a brief (emphasis on brief) description of the se­quence of events during and after a trauma. It is helpful to recognize that your symptoms are part of the body and mind’s natural response to extreme events. For a more complete understanding of the neurological sequence involved with trauma, you are referred to Sapolsky, 1997; Scaer, 2006; van der Kolk, McFarlane & Weisaeth, 1996; Rothschild, 2000; and Johnson, 2003.

When a person experiences a traumatic event, the in­formation is registered in the brain along two pathways. The first and quickest path sends sensory information (i.e., scent, related objects, sounds, sights, etc) to the amygdala, where a fear response is triggered and the information is cataloged as important for sur­vival. From the amygdala, the information proceeds to other areas of the brain (e.g. the stria terminalis and the locus ceruleus) responsible for preparing the body for flight or fight and a subsystem of the Autonomic Nervous System (the sympathetic nervous system) is activated. The information is eventually stored in the hippocampus as a memory important for survival. Thereafter, anything that stimulates that sensory memory trace will also potentially stimulate the body to prepare for survival (fear/anxiety/arousal).  In other words, when an individual is exposed to related cues to the memory (i.e., scent, related objects, sounds, sights, etc) these sensory reminders re-ignite the associated strong feelings.  Interestingly enough, the memory of the traumatic event itself may or may not be recalled.  This can leave you feeling as if you were in danger but not necessarily knowing why.

This variability in memory can be understood by following the second pathway for information processing.  This second and much longer path for the information proceeds through the thalamus, which routes sensory information to appropriate parts of the neo-cortex to be analyzed. This information is processed through various areas in the neo-cortex where language is used to organize and generate responses (a declarative memory is formed), associations to other information are made, and meaning is created. It is, then, routed to and stored in the hippocampus. It is also the case that the neo-cortex contains inhibitory areas that are ca­pable of inhibiting or turning down the survival/fear response generated by the information passed through the amygdala. In other words, the neo-cortex can po­tentially change the meaning of the original memory trace and alter or modulate the survival response.

Under conditions of extreme stress, the brain pro­duces stress hormones such as cortisol that interfere with the consolidation of the information from the neo-cortex. This also interferes with the possible in­hibitory responses that would ameliorate the anxiety of the survival response. Memories that are formed under conditions of trauma often become fragmented. They remain out of context and are, thus, left unincor­porated and unassociated with other memories. The result is that whenever the memory trace is stimu­lated, the body reverts to survival mode, which is ex­perienced as anxiety. Since the traumatic memories are often unconsolidated, it is sometimes difficult for a survivor to make the link between earlier traumatic experi­ences and the current feeling of anxiety. You might then be­gin to perform behaviors to relieve the anxiety (i.e., not driving after you were in a transportation accident; not returning to work if that is the place where you were physically injured). If these behaviors work to relieve the anxiety (i.e. remove a noxious condition), they are negatively reinforced to occur again.  

These information storage pathways account for the development of many trauma related symptoms.  In the example of someone who was injured in an accident, a large number of sensory cues are recorded such as the smell of exhaust fumes, heavy traffic, and dim light.  This sensory information is recorded in such a manner that even without actually remembering the original accident, the person in the accident might find themselves becoming extremely anxious at the smell of exhaust fumes or being in heavy traffic at dusk.  Since a person might not necessarily make a connection to a previous accident when smelling exhaust fumes it might be difficult to make sense of feelings of anxiety in the current moment.  This is often a confusing task, especially if there isn’t anything particularly threatening at the time that you might be feeling upset about.  A person might just assume they are having an “anxiety attack” and attribute it to a physiological problem.  Or you might simply begin to perform behaviors to reduce feelings of anxiety such as self-medicating with drugs or alcohol or avoiding driving.

The initial neurological response of the brain is quite likely the mechanism by which the immediate learning of the traumatic response is accomplished. In one-trial learning the sensory stimuli are sent to the midbrain and recorded as a threat to survival. The brain attaches the emotions of fear and anxiety to these stimuli and prepares the body for flight, fight or freeze. Very little cognitive processing occurs at this stage, since the neo-cortex has been flooded with cortisol and other cortico-steroids, which interfere with memory consolidation.  The fact that memories are unconsolidated and un­connected results in the failure to normally resolve the fear/anxiety/arousal response. In other words, the brain has failed to unhook the sensory information from the fear/anxiety/arousal response.  Later behav­iors are operationally learned as a way to alleviate this fear/anxiety/arousal. 

Subsequent stimulation of this memory trace will potentially re­activate the survival routines until the neo-cortex has been allowed to process the information and inhibit the response.  Relaxation in the face of expo­sure facilitates access to neo-cortical functions (de­clarative memory, meaning generation and anxiety inhibition). Recent research suggests that this may be mediated by a decrease in cortisol under conditions of relaxation (Benson, 1997; Luecken,, Dausch, Gulla, Hong & Compas, 2004; Mason, Giller, Kosten & Harkness, 1988).  Strictly behavioral inter­ventions pair the memory trace with responses (relax­ation, self soothing) that are inconsistent with the sur­vival mode (fear/anxiety/arousal), expanding the re­sponse set.  Cognitive interventions specifically work to pair the memory trace with more fully processed (and hence more meaningful) information that has the ability to inhibit the survival response.

Think of what might happen to someone who has experienced an automobile accident.  The sensory stimuli are sent to the midbrain and recorded as a threat to survival.  The brain attaches the emotions of fear and anxiety to these stimuli and prepares the body for flight or fight.  As expected, little cognitive processing occurs at this stage, and the neo-cortex becomes flooded with cortisol and other cortico-steroids essentially inhibiting the ability to consolidate and fully store memories.  Future reminders of the memory will re-ignite the poorly stored memory trace of the event resulting in survival strategies being engaged.  Survival responses will continue to occur until neo-cortical processing of the traumatic memory has adequately allowed for re-storage of the memory while concurrently extinguishing the emotional distress associated with the memory.  An in vivo (on-site) behavioral intervention would teach relaxation techniques and then pair relaxation with the sensory stimulus.  In this example, the person would be relaxed and then perhaps be instructed to imagine driving on the highway or preparing to take a road trip until anxious feelings ignite.  At that point, the individual would be instructed to initiate relaxation exercises until the symptoms of anxiety begin to reduce.  This might require many exposures or sessions until the person no longer feels anxious when thinking of or engaging in the previously fearful memory or activity.  Cognitive interventions often require teaching relaxation techniques and re-experiencing the event.  Initial sessions, often involve discussions of memories peripheral to the actual trauma and subsequent beliefs about the event.  Eventually trauma reduction sessions would involve the direct memory of the event (again, under conditions of relaxation) and the ability to describe the event without anxiety.  Finally, cognitive restructuring would address distorted beliefs and behaviors previously learned and used to keep safe.

 

Offering post-trauma care that addresses the impact of the trauma on our brain functioning requires that the clinician assist the client to slow down the reactivity ignited when exposed to trauma reminders that set-off old emotions.  It is the gap between exposure to trauma reminders and reactivity that opens the door to change.  It is pausing in that gap with calm reflection that allows us to inform and reform our reactivity creating a new storage of the trauma memory associated with a more reflective and less reactive or emotionally strained response. Our goal in Trauma Practice is to find the route to retraining the brain along with the body, mind and emotion.

Post Traumatic Stress Disorder (PTSD)

Post Traumatic Stress Disorder PTSD

Post-traumatic stress disorder (PTSD) is an anxiety disorder that can develop following traumatic or life-threatening events such as war, the unexpected death of a loved one, rape, assault, a plane crash or a natural disaster.

The normal psychological response to such trauma is "shock" or acute stress. A person may be disoriented and unable to comprehend what is going on. It is very common to feel numb, experience nightmares, and have continuous thoughts about the traumatic event. But, as the mind begins to process the event, these symptoms gradually lift.

However, with post-traumatic stress disorder (PTSD) you remain in a state of mental shock and symptoms begin to worsen. Not every traumatized person develops PTSD, but it doesn’t always develop immediately following the trauma, either. For some, the symptoms develop several days or sometimes years later.

According to the National Institute of Mental Health, PTSD affects millions and can occur at any age, including childhood. In addition, women are more likely to develop PTSD than men, and there is some evidence that susceptibility to the disorder may be hereditary. Like many other mental health illnesses, PTSD is often accompanied by depression, substance abuse, or one or more of the other anxiety disorders.

Symptoms of Post-Traumatic Stress Disorder (PTSD)

Post-traumatic stress disorder (PTSD) symptoms can cause significant problems at home, work or other important areas of life.

For many, symptoms can be triggered by a loud noise, a particular image or a distinct smell that reminds them of the traumatic event; for others, symptoms may appear, seemingly, out of the blue.

Common symptoms of PTSD include:

  • Feelings of stress or fear when reminded of the trauma
     
  • Re-living the event in the form of a flashback
     
  • Nightmares of the event or other fears
     
  • Avoidance of situations that are associated with the trauma
     
  • Feeling detached or emotionally numb
     
  • Difficulty concentrating and being easily startled
     
  • Out-of-control anger or violence
     
  • Constantly on alert for danger (hypervigilance)
Anxiety Disorders

What is Anxiety?

Anxiety is a fairly common response to stressful events.  All of us experience stress in our daily lives and somethings that stress is the result of exposure to real and present danger.  When we becomes anxious our nervous system activates to help us respond to danger by becoming highly focused and enables us to react in a manner to fight, run or in some cases freeze in the face of danger.  These are adaptive coping skills that can mean the difference between life and death.

Unfortunately, some of us experience feelings of anxiety that last far beyond the threatening or stressful circumstances.  In these cases we may develop an Anxiety Disorder that leaves us feeling overwhelmed and stressed even when there is no danger or even noteworthy stressor.

When anxious feelings become overwhelming, intrusive, irrational and debilitating they can interfere with our ability to manage the demands of our life, work, education and relationships.  In these cases, we may meet the criterion for an Anxiety Disorder.  In order for this to be the case, the anxious feelings would need to impair our ability to manage our life and to be significant and long-standing (a minimum of 1 month or longer with significant symptoms).

Anxiety Disorder affect over 40 million people in North America every year. 

According to the National Institute of Mental Health, anxiety disorders affect 40 million Americans a year. If you are suffering from an anxious feelings that are not resolving in a reasonable period of time (1-3 months) then it is time to seek professional help to assess the problem in order to get the right treatment.

Anxiety Disorder, of which PTSD is one, can be treatment with counselling approaches and have been shown to respond well to proper treatment.  Getting the right help in a timely manner can allow you to live a fully productive and engaged life.  TraumaLine1 may have the right therapist for you.  Many of our Trauma Therapists are very skilled in dealing with a wide range of Anxiety Disorders as well as trauma related difficulties. 

Symptoms of Anxiety

Symptoms of Anxiety vary from person to person, but the common symptoms include extreme fear, physical feelings of stress (i.e., heart racing, shallow breathing, muscle tension) and dread of something terrible occurring.

Other symptoms may include:

  • Sensations of panic, fear, and nervousness
     
  • Intrusive, obsessive thoughts
     
  • Repeated thoughts or "flashbacks" of traumatic events
     
  • Disrupted sleep and nightmares
     
  • Repetitive behaviors such as checking door locks and washing hands
     
  • Sweating that is not due to heat
     
  • Feelings of tingling or numbness in hands and feet
     
  • Shallow and short breathing, hyperventilation
     
  • Rapid heart rate and/or chest pain
     
  • Irritability, agitation and difficulty remaining calm
     
  • Dizzy feelings and nausea
     
  • Mouth dryness
     

The major categories of Anxiety Disorders:

  • Generalized Anxiety Disorder (GAD)
    This involves a pattern of frequent anxious feelings or and worry over regular daily activities or life events. Sufferers can experience severe feelings of worry and tention even over minor concerns. GAD can leave a person with a sense of constant dread with no obvious or tangible issue at hand. It can undermine their ability to focus on day-to-day matters as they may use considerable energy anticipating disaster. Chronic anxious feelings can result in physical discomfort, fatigue and diminished health as stress takes it toll on the physical body as well.
     
  • Obsessive-Compulsive Disorder (OCD)
    Excessive, unwanted thoughts or obsessions accompanied by compulsive behaviors aimed at reducing anxiety typify OCD. Even when the sufferers recognize these thoughts and compulsions as irrational they are often unable to stop them from occurring or for performing anxiety reducing rituals. When thoughts about stepping on cracks, organizing our furniture or plates into precise patterns or turning off the oven become excessive it is time to seek out a professional evaluation to determine what the source is and how to manage these symptoms.
     
  • Panic Disorder
    A Panic Attack can leave the individual experiencing extreme physical symptoms such as chest pain, rapid heart rate, shortness of breath, severe sweating and the fear of dying. It is not unusual for an individual experiencing their first Panic Attack to seek physical care in an emergency department only to learn that there is no physical evidence of a heart attack or other cardiac event. Often sufferers fear that they will experience another event and begin to control their behaviors to avoid any stressful circumstances or events. Individuals can feel unable to engage in work, studies or any unique circumstances or people resulting in a very restricted life.  Panic is very responsive to appropriate treatment. Clinicians skilled in trauma therapy are often quite competent in addressing symptoms of panic disorder. The Therapists at TraumaLine1 may be ready to assist you in managing your symptoms of Panic.
     
  • Post-Traumatic Stress Disorder (PTSD)
    Occurs as a result of exposure to an event that leaves the individual feeling that they were at risk of serious injury, illness, or death (or the injury, illness or death of a loved one or known associate). After exposure to a life-threatening incident there is a period of adjustment in which the person may feel extreme feelings of stress but these feelings to not last long than one month. In these cases they may find that their symptoms fully resolve.  Unfortunately, this is not always the case and those who suffer with PTSD may experience an event that results in severe symptoms of anxiety over a long period of time.  For more information see the FAQ sections on Trauma.
     
  • Social Anxiety Disorder (SAD)
    Social Anxiety is a debilitating disorder that can result in extreme social discomfort, withdrawal and a sense of self-consciousness and self-judgement. Sufferers usually experience low self-esteem and an overwhelming feeling of discomfort in social settings. This makes work, education, social events and settings where others gather very overwhelming. Some people may avoid all social settings to minimize their discomfort. Seeking counseling services can make the difference between a extremely limited life and one that allows for greater comfort and engagement in meaningful activities as well as a greater sense of ease.
     
  • Specific Phobias
    Intense, irration fears of specific circumstances or objects (i.e., heights, planes, enclosed places, spiders, germs, etc.) is a warning sign of a Specific Phobia. It becomes a problem with fears that are so excessive that individuals go to great lengths to avoid the fear provoking object or circumstance. Receiving appropriate and timely care can mean the difference to sufferers as approaches for treatment are often well received.

Anxiety Treatment Approaches

Anxiety Disorders are an area of counseling care that are known to respond well to appropriate treatment. It is very possible to sufferers to lead engaged, healthy and enjoyable lives after treatment.

Treatment for Anxiety Disorders usually involve both counseling services and medication but it is possible to try one or the other and then modify or combine treatments where needed. Regardless, it is important to find the correct treatment for a particular type of disorder as not all approaches fit the problem. Ensure that your therapist is familiar with your disorder and has successfully treated this problem in the past.

It takes work on both the part of the therapist and the client to result in a good outcome. It is important to give the treatment some time to result in the type of outcome you are looking for. Nonetheless, if you find that the approach is not working after giving it a good effort, seek another care provider or new approaches with your current therapist.

Ensure that you receive an appropriate evaluation so that the therpy provided is the best fit for your symptoms.

 

Cognitive Behavioral Therapy

When dealing with an Anxiety Disorder the most well researched approaches rely on Cognitive-Behavioral Therapy and Exposure Therapy. Find service providers with skills in these areas.

Depression

What Is Depression?

Depression is a serious illness that impacts both the mind and body.  When people experience a major depression it can affect their emotions, thoughts and behaviors. Depression is more than just feeling sad which can be a normal response to life circumstances. It is a chronic and complex illness that may require both psychological and medical intervention over a long period of time.

A depressive disorder may result in feelings of hopelessness and helplessness, self-blame and extreme sadness or emotional despair. A Major Depressive Disorder goes beyond feelings of sadness and will result in difficulties or inability to manage regular activities of daily living. Suicidal thoughts or a desire to harm oneself may begin to intrude in ones thoughts.

Psychological counseling, medication and other treatments have been shown to be helpful in alleviating or managing symptoms for those suffering with depression. Learning about depression, the symptoms, and the impact on the individual can also be part of the solution as it gives you the chance to identify the problem, recognize the symptoms and find appropriate treatment.

Signs and Symptoms of Depression

Each person experiences depression in a unique manner. However, there are common symptoms that can be seen in most types of depression. These signs and symptoms include the following:

  • A certainty that nothing will ever improve and nothing you do will help.
  • Overbearing feeling of sadness that won't go away
  • Feelings of anxiety
  • A sense of worthlessness or low self-esteem
  • Low frustration tolerance, irritability, agitation or restlessness
  • Reduced enjoyment in previously pleaurable activities (i.e., getting together with friends, enjoying hobbies, etc.)
  • Feelings of exhaustion that you cannot shake regardless of how much sleep you get
  • Disrupted sleep (i.e. either difficulty falling asleep, staying asleep, awakening too early in the morning)
  • Poor memory or difficulty focusing, making decisions, or learning new material
  • Changes in appetite that result in weight gain or loss of over 10lbs
  • Suicidal thoughts or attempts or a desire to self-harm
  • Physical discomfort, aches and pains, headaches, or stomach discomfort not explained by other medical problems

Types of Depression

Although we may see depression as one disorder there are actually several different type of depressive disorders that manifest in a unique manner and result due to different causes. Becoming aware of the type of depression you are struggling with will help you find the treatment that has the best fit. Symptoms of depressed mood are frequently experienced by people who have been exposed to traumatic events. If you have symptoms of depression but are not recovering from the treatments being provided you might also want to ask your health care provider if you might require treatment for Post-Traumatic Stress.

The most common forms of depression are Major Depressive Disorder; Dysthymic Disorder and Bi-polar Disorder (aka Manic-Depression). They are share the common traits of significant and debilitating emotional distress that impairs ability to function in regular daily activities (i.e., work, socializing, studying, etc.).

  • Major Depressive Disorder is characterized a number of chronic and constant daily symptoms that impair the individual's ability to experience joy in life or to manage the demands of daily living. Many people who suffer from depression experience one episode and then never again while some experience recurring bouts of depressed mood.  The most common features are listed above in the Signs and Symptoms section of this FAQ.
     
  • Dysthymic Disorder sufferers experience a low-grade depression that is not as severe as Major Depression but lasts a long period of time (at least two years or more in duration). Those who struggle with dysthmia are often able to manage many of their regular daily activities, work, socializing, studying and other life demands. However they generally describe a sense of lack of enjoyment and a disconnection from any pleasureable feelings. They may feel that this is their normal way of experiencing life and that they do not recall feeling any other way.
     
  • Bi-polar Disorder is often characterized by cycling moods which range from Manic feelings to Depressed feelings. When an individual is in a manic phase they often describe it as high energy combined with irritability which generates increased levels of activty. They may feel compelled to act out their mood through compulsive spending, speaking loudly and rapidly, increased sexual activity and various types of risky behaviors. They may also experienced decreased need for sleep, lack of fear, racing thoughts, and an inflated sense of self. It is important to be aware that treating Bipolar Disorder with antidepressants can make the symptoms worse. Ensure that the prescribing practitioner is familiar with current medication for Bipolar Disorder if you have been given this diagnosis or believe that you may have Bipolar disorder.
     

Each of these types of depression require monitoring and may warrant hospitalization or intensive therapy or treatment. Nonetheless, depression is treatable through psychological therapy and when treated with the proper approach is is linked to good outcomes.

There are other less common types of depressive disorder that might be of concern. When meeting with your mental health care professional ensure that you are notified of any diagnoses that they make and request information about the specific type of depression that you have been diagnosed with.

Treating Depression

The good news is that there are many different succesful approaches to dealing with the symptoms of depression. Even individuals struggling with severe symptoms of depression can experience very good results with timely and appropriate treatment.

Although seeking treatment can feel uncomfortable at first for some, it can result in re-engagement in life in all aspects and a sense of relief from extreme feelings of sadness and dispair. Treatment for depression generally involves counselling of some type in combination with medication or either medication or psychotherapy.

Give yourself the time to ensure that the treatment you are trying is working. Sometimes it requires an extended period of time before improvements are noticed. You may need to try different approaches or combinations of treatment before you find the best combination for you.

Psychological Counseling

The most commonly used approach for treating depression is Cognitive Bahavioral Therapy or CBT. This approaches assists the individual to challenge negatively held personal beliefs by reflecting on a more positive manner of thinking. It also utilizes processes exercises to help the individual recognize where they are getting stuck in their beliefs and how to come up with new solutions to old problems.

Substance Abuse

What is Substance Abuse?

Any form of Substance abuse can be defined as a regular pattern of use of substances for mood or physical altering purposes that has an overall negative or harmful outcome. In general, when referring to substance abuse we recognize that there is an addictive feature or the tendency to require more of a substance to get the same effects over time and a desire to continue to consume the drug despite negative consequences. The substance may be an illegal drug, or one that is overused or used illicitly (such as prescription medication which is used for purposes other than directed).

This is an important issue among individuals or communities who have face trauma as it is not unusual for the sufferer to turn to substances to self-soothe or distract themselves from the emotional discomfort they are experiencing. Although substances can be used within the normal boundaries of social activity (i.e., having a glass of wine with a meal) it becomes a problem when the individual begins to spend increasing time seeking the substance of choice and that the use of this substance is impairing their functioning in various areas of their lives.

Commonly used Drugs or Substances

There are substances such as Alcohol, Cigarettes, Coffee and even over the counter medication which when taken in large doses can lead to dependence, health and social problems. In addition, medication prescribed to be taken in moderate or required doses by one individual can be abused either by the individual, sold or given to others for whom it is not prescribed or purchased illegally and consumed illicitly.

Some of the most commonly used illegal or illicitly used drugs or substances include the following:

  • Cannabinoids:  Hashish, Marijuana
  • Depressants:  Barbituates, Benodiazepines, Rohypnol, GHB, Quaaludes
  • Dissociative Anesthestics:  Ketamine, PCP
  • Hallucinogens:  LSD, Mescaline, Psilocybin
  • Opiods and other Morphine Derivatives:  Codeine, Ecstacy, Methamphetamine, Nicotine
  • Other Substances:  Anabolic Steroids, Inhalants

Common signs and symptoms of Substance Abuse

  • You are using the substance of choice in dangerous situations or take risks while under the influence of the drug (i.e., driving while drunk, having unsafe sex or sharing needles with other drug users).
  • You are getting into legal trouble as a result of your substance use, such as stealing to support your habit, being arrested for your conduct while under the influence, or being charged with Driving Under the Influence (DUI).
  • You have been neglecting your responsibilities and failing to function normally at home, parenting, school, at work or socially
  • Your relationships are suffering as a result of your substance abuse and leading to fights, job loss, rejection by family and friends.

Common signs and symptoms of a Substance Addiction

  • When you need more of the drug to experience the same effects as you used to with a smaller dosage you have tolerance to the substance.
  • Withdrawal symptoms become a problem when you do not get more of the substance within a short period of time.  When experiencing withdrawal you might feel restlessness, insomnia, sweating, shaking, anxious feelings, depression, nausea, etc.
  • You no longer feel you have control over your substance usage and as a result use the substance more frequently than you planned even when you want to stop.  You have a feeling of powerlessness over your substance use.
  • Your life becomes focused on finding, thinking about, and recovering from your substance usage.
  • You no longer enjoy activities that were previously pleasurable such as sports, socializing with others, entertainment.  Instead you spend the majority of your time engaged in using the substance of your choice.
  • Even when you recognize that the substance is harming you and resulting in serious problems in your life you continue to use the substance.
Counselling Approaches

Trauma Counseling Approaches

There are many trauma counseling approaches and techniques available to address the symptoms of PTSD. Choosing which is the most appropriate might seem confusing.

When selecting a therapist to assist you, they will, hopefully, be trained in a number of approaches so that they can select the approach that is the best fit for you. That choice is will often dependent on your particular struggles. Presenting a clear and honest description of what you are experiencing will help the counselor treat you with interventions which are the best fit for your needs.

Although there are many types of approaches, many are derived from Cognitive Behavioral Therapy and Reciprocal Inhibition.

Cognitive Behavioral Therapy (CBT)

Cognitive Behavioral Therapy is probably the most used, intensively researched, and consistently effective treatments for the symptoms of posttraumatic stress currently used by clinicians that treat trauma survivors. CBT Trauma Therapy combines the aspects of Behavioral Therapy (BT) and Cognitive Therapy (CT) so it includes explicit, observable, as well as the implicit and internal behaviors.

One essential feature of CBT is addressing the distorted cognitions (thoughts) that are negatively impacting your life, limiting your activities, outlets and life pleasures. These include:

  1. Identifying distorted beliefs
  2. Identifying the root of the distortion (when did the belief first surface; what happened at that time?)
  3. Extinguish the old belief (often through various exposure and/or challenging exercises)
  4. Develop new more adaptive and intentional schemas or belief systems (i.e., I am doing my best)

Reciprocal Inhibition

Another essential element of CBT is Reciprocal Inhibition; a theoretical approach developed by Joseph Wolpe in 1958.

Reciprocal inhibition was used to explain and direct the treatment of anxiety and phobia symptoms and most recently post-traumatic stress. The theory of reciprocal inhibition holds that when exposure to an anxiety-provoking stimulus is paired with the relaxation response (i.e., the individual is able to keep the muscles in their body relaxed) and the individual is able to maintain this relaxation, then over time fear-provoking stimulus (such as reminders of a trauma) are eventually extinguished through consistent exposure while feeling safe and/or calm.

Reciprocal inhibition, the pairing of exposure and relaxation, is at the heart of all Behavior Therapy with symptoms of anxiety. Some Behavioral Therapies (e.g. in vivo exposure or flooding) begin with exposure and push their way through the anxiety, hopefully to a point where you can become relaxed in the face of exposure. However, these techniques have the potential of re-traumatizing some people especially when you are not able to fully maintain relaxation throughout the exposure exercise and as well if there is insufficient time to resolve or get used to the trauma memory. This would leave the trauma memory recovery work incomplete. It is not until relaxation occurs in the face of exposure to a trauma memory that symptoms subside. It is our opinion that relaxation is a necessary ingredient to symptom resolution and better learned before and experienced during exposure than experienced after the process of being overwhelmed by anxiety, panic or post-trauma response.

Thus, we identify reciprocal inhibition as a "necessary ingredient" in effective treatments of PTSD. Working with your trauma therapist, you will learn techniques to help approach and confront your traumatic history when you are ready. You will also learn techniques for developing and maintaining a relaxation response during the stabilization stage of your treatment as well as during the trauma memory processing portion of recovery. A skilled traumatologist will help you navigate this journey.

Three Phase Trauma Therapy (Tri-Phasic treatment)

Judith Herman is a psychiatrist in the Boston area who has written extensive about traumatic response and therapy. She recommended an approach to trauma recovery that includes three stages. The Traumatology Institute most recommends this approach, as seen in the book Trauma Practice: Tools for Stabilization & Recovery (Baranowsky, Gentry & Schultz, 2010, 2nd Ed.)

Using a comprehensive three phase approach, the client is:

  1. given a sense of emotional and physiological Stabilization prior to moving into
  2. Remembrance and Mourning, which we will now refer to as Trauma Memory Processing, and then
  3. Reconnection with communities and with meaningful activities and behaviors.

Phase 1: Safety and Stabilization

The central task of recovery is safety. People who have experienced trauma often feel betrayed both by what has happened to them as well as their own bodies. Their symptoms become the source of triggers that result in re-traumatization. This can leave the individual feeling both emotionally and physically out of control. Getting the right help to regain internal and external control is a primary focus of this phase. This is accomplished through careful diagnosis, education and skills development. The safety section of phase one, is focused on skills development to aid you to practice self-soothing and care skills to increase emotional and behavioral stabilization. In cases where you remain in an unsafe environment, plans to establish personal and practical safety remain the focus prior to delving into trauma memory processing work. The overriding goal is to make a gradual shift from danger that is unpredictable to a situation where you can rely on safety both in your environment and within yourself. Accomplishing this goal depends on the circumstances as well as your internal ability to cope with exposure to trauma memories and may take days, weeks, or months to achieve. In some cases, individuals may remain in the emotional safety and stabilization phase indefinitely while they work on establishing physical safety. Although we do encourage clients to work through their trauma memories this must be done in a respectful manner with the mutual consent of both client and therapist.

Phase 2: Trauma Memory Processing

In the second phase of recovery you will begin to work more deeply with exercises to work-through trauma history bringing unbearable memories to greater resolution. Because of the nature of traumatic memories, this process is rarely linear. Bits and pieces of the traumatic events emerge and can be processed. The objective is to create a space in which you can safely work through traumatic events and begin to make sense of the devastating experiences that have shaped your life. A good therapeutic relationship should provide you with a compassionate companion who will "bear witness" to your experiences, and help you to find the strength to heal. Using exercises that are designed for trauma memory processing.

There are many excellent Cognitive Behavioral Therapy techniques that fit well within this stage of trauma memory processing. In addition, there are newer approaches such as Eye Movement Desensitization and Reprocessing (EMDR), Time-Limited Trauma Therapy (TLTT), Layering, and Traumatic Incident Reduction (TIR) that have proven to be helpful in trauma memory processing.

Phase 3: Reconnection

The final stage of recovery involves redefining oneself in the context of meaningful relationships and engagement in life activities. Trauma survivors gain closure on their experiences when they are able to see the things that happened to them with the knowledge that these events do not determine who they are. Trauma survivors are liberated by the conviction that, regardless of what else happens to them, they always have themselves. Many survivors are also sustained by an abiding faith in a higher power that they believe delivered them from oppressive terror. In many instances survivors find a "mission" through which they can continue to heal and to grow. They may even end up helping others with similar histories of abuse and neglect. Successful resolution of the effects of trauma is a powerful testament to the indomitability of the human spirit. Once Phase 2 of Trauma Practice is completed, personality that has been shaped through trauma must then be given the opportunity for new growth experiences that offer the hope of a widening circle of connections and the exploration of a broader range of interests.

Treatment Approaches - Trauma Therapy Interventions

Below is a list of some trauma counselling approaches that might be useful for you in your recovery.

This list does not include all the different types of trauma therapy interventions that are available, but it does do a good job of outlining many approaches that have been found to be useful for trauma survivors.

  • Accelerated Experiential Dynamic Psychotherapy (AEDP)
     
  • Acceptance and Commitment Therapy (ACT)
     
  • Addictions Training
     
  • Attachment, Self-Regulation and Competency (ARC)
     
  • Cognitive Behavioral Therapy (CBT)
     
  • CBT Trauma Therapy
     
  • Contextual Therapy
     
  • Couples & Family Therapy
     
  • Crisis Management Training
     
  • Critical Incident Stress Debriefing/Management
     
  • Dialectical Behavior Therapy (DBT)
     
  • Experiential and Emotion Focused Therapy (EEFT)
     
  • Expressive and Art Therapy
     
  • Eye Movement Desensitization and Reprocessing (EMDR)
     
  • Hypnotherapy
     
  • Individual Therapy
     
  • Internal Family Systems Therapy (IFS)
     
  • Marital & Family Therapy
     
  • Motivational Interviewing
     
  • Mindfulness Based Stress Reduction Program/Meditation (MBSRP)
     
  • Movement Therapies
     
  • Narrative Therapy
     
  • Neurofeedback Therapy
     
  • Neuro-linguistic Reprogramming (NLP)
     
  • Psychoanalytic
     
  • Psychodynamic
     
  • Sensorimotor Psychotherapy
     
  • Somatic Experiencing (SE)
     
  • Suicide Prevention Training
     
  • Thought Field Therapy (TFT)
     
  • Time-Limited Trauma Therapy
     
  • Time-Limited Trauma Therapy (TLTT)
     
  • Trauma Resiliency Model (TRM)
     
  • Traumatic Incident Reduction (TIR)

     
Other questions

Licensing

In some countries, most notably the United States and Canada, individual practitioners are required by law to be licensed in order to provide professional therapeutic counseling services. Holding a license means that a practitioner has completed a level of training specified by the licensing board.

In the US/Canada, licensing is regulated at the state/provincial level, and it is illegal to offer services while physically within that state unless licensed by that state or province. If you are seeking face-to-face counselling in the United States or Canada, it is essential that you verify whether your practitioner is licensed — not because licensing provides any guarantee about the quality of the service you will receive (it does not) — but because a counsellor offering services in the US or Canada without a license is breaking the law. This would indicate either that the counsellor is unaware of the laws regulating their profession, or that they are deliberately undertaking criminal activity; neither alternative is acceptable!

In addition, if you work with a therapist who has behaved in an unethical manner you would have recourse to contact their professional licensing body. When working with a person who is not licensed you would not have this option.

Licensing guarantees that a practitioner has completed a particular level of training specified by the relevant licensing body. Remember, however, that anyone can state that theyclaim are licensed, so a simple statement that a practitioner is not enough to confirm this as fact. You would then need to check with the board that they have identified to confirm their status and ensure that they are in good standing and do not have any actions or pending investigations regarding their practice. More importantly, licensing is not a guarantee of service quality. 

Review Licensing Boards page for more information.

What is TI certified?

Traumatology InstituteTI Certified refers to those trauma professionals who have completed trauma training with the Traumatology Institute either in class or online.

They will be recognized as having completed programs on their profile by having a visible ribbon with TI Certified displayed.

Courses completed through TI will also be posted to the therapist’s profile page.

Those practitioners who have completed the full Traumatology Institute Curriculum training series will have a comprehensive methodology for working with trauma survivors. This training ensures a certain level of skill and understanding of the meaning of Trauma Informed care as well as a toolkit for assisting trauma survivors. Although there are many well-qualified trauma therapists, those with specialized and recognized training can offer care that is a good fit.

Whoever you end up seeing for your trauma psychotherapy, your comfort and emotional safety and stabilization are primary. Choose carefully and feel empowered to try a different therapist if you do not feel that you are making progress.

What is Verified Provider?

Verified Providers are those practitioners whose license, registration or status has been confirmed by a professional regulatory body.

This means that, according to the professional regulatory body (or licensing body), the member has no outstanding ethical or legal matters that they are aware of.

It also confirms that the individual has been trained to a certain standard of practice, and that they meet the requirements of their profession.

At TraumaLine1 we recommend that all professionals list their licensing and regulatory registrations so that service seekers can confirm their practice standing with those professional associations.

Visit the Licensing page for information about professional licensing and regulatory bodies for professional mental health practitioners.

Why do we alternate between U.S. and Canadian spellings?

TraumaLine1 services both Canada and the United States.

In the United States, counselor is spelled with 1 “l” and behavior is spelled with no “u”.

In Canada, counsellor is spelled with 2 “l’s” and behaviour is spelled with a “u”.

We alternate these spellings throughout our site to provide equal opportunity to Seekers and Providers in both countries. We are hoping to make is as easy as possible to find us when individuals search on all major search engines.