PTSD Awareness Post 2017 – Part II


June was PTSD Awareness Month
Adding to our awareness – Part II

© Madelyn Griffith-Haynie, CTP, CMC, ACT, MCC, SCAC
Updated Refliections Post
Self-Health Series
Part I HERE

“Emotions are very good at activating thoughts,
but thoughts are not very good at controlling emotions.

~  Joseph LeDoux

Since my Sleep Awareness post somehow jumped the queue and was posted at the same time as Part-1 of this article, I decided to wait a bit to give readers a shot at catching up.  Again, my apologies for seeming to inundate with info – it was not intentional.

This Part may seem long, but much of the first half is review — so those of you who read Part-1 will be able to skim through it quickly.

Identifying PTSD

PTSD can present in a variety of ways, with more than a few symptoms in common with depression, in addition to any or all of those characterizing other anxiety disorders.

As I explained in Part I, PTSD is now believed to be caused by a neuro-chemical alteration in the brain in response to exposure to trauma. It holds us prisoner, responding in the moment to threats from the past.

Unprocessed trauma continues to haunt us, eroding our sense of safety and security. As a result, it can keep us stuck in an amygdala-defensive emotional pattern that may induce a variety of symptoms over which we feel we have no control.

In fact, we cannot control them in the moment.  Current therapies are focused on helping us to change our subsequent response to them.

Exposure to trauma physically changes the structure of the brain, upsetting the neurochemical balance needed to respond appropriately, faster than we can over-ride cognitively.

It seems that repeated experience of traumatic events, especially when left to fester unprocessed, can prevent rebalancing, which prevents healing (meaning, allowing the past to remain in the past, confident that you have the strength to handle whatever life throws your way in the future).

In other words, our brains are designed to respond neuro-chemically when our safety is threatened, regardless of what we think about it logically or how we feel about it emotionally.

  • Some of us are able to process those perfectly normal and appropriate fearful responses and move forward.
  • Others of us, for a great many reasons science is still trying to understand, are not.
  • At this point in time, we move forward primarily with statistics.

Statistics explored in Part I

In the previous section of this article we also looked at the prevalence of PTSD compared to the total number of people who ever experienced trauma in their lives.  We took a look at the various risk factors for developing PTSD following exposure to trauma.

You saw that the risk was effectively double for women, and that significantly more women are exposed to trauma in their lives than their male friends and relatives – and that recovery times tended to be longer.

Approximately 50% – five out of every ten women – will experience a traumatic event at some point during their lifetime, according to the The National Center for PTSD, a division of the U.S. Department of Veterans Affairs.

One in ten of those women will develop PTSD as a result.

Inadequate understanding & treatment

Science is still looking for many of the pieces of the PTSD puzzle.

Even though a variety of therapies can help relieve PTSD symptoms, at the current time there is no “cure” – or prevention – nor is there an adequate explanation for how exposure to the same trauma can affect different individuals to different degrees of severity.

We also do not have definitive treatment protocols equally effective for everyone who experiences PTSD.

Brain-based research

Right now it looks like the difference between who recovers from trauma and who is more likely to develop PTSD may turn out to have a genetic component.

It may be also be linked to the size of specific areas of the brain, which could be a product of genetics or epigentics (how your internal and external environments change the expression of your genes).

Related Posts:
Making Friends with CHANGE
A Super Brief and Basic Explanation of Epigenetics for Total Beginners (off-site)

While controversial, the most recent research ties the development of PTSD to the size of an area of the brain called the hippocampus, which is primarily known for its role in the formation of non-disordered memories.

Greater size indicates a greater ability to recover from trauma.

A smaller hippocampus may increase the risk of developing PTSD as well as the severity of its symptoms, and/or lengthen the duration and recovery time.

Some studies suggest that repeated exposure to stress may actually damage the hippocampus, through the repeated release of the stress-hormone cortisol.

Related Posts:
Hippocampal volume and resilience in PTSD
Brain region size associated with response to PTSD treatment

So perhaps PTSD is hormonal?

Cortisol is a mobilizing hormone.  We need it. We might not even get up off the couch without it. However, it is most widely known for its assistance motivating the body for rapid and effective response to a stressful or life-threatening event – our “fight or flight” reaction.

Problems result because our brains and bodies are not designed
to live in a state of persistent and protracted stress.

Scientists have long suspected the role of cortisol in PTSD.  They have been studying it, with inconclusive results, since findings in the 1980s connected abnormal cortisol levels to an increased PTSD risk

A study reported in early 2011 by researchers at Emory University and the University of Vermont found that high blood levels of the hormone PACAP (pituitary adenylate cyclase-activating polypeptide), produced in response to stress, are linked to PTSD in women — but not in men.

PACAP is known to act throughout both body and brain, modulating metabolism, blood pressure, immune function, CNS activity [central nervous system], and pain sensitivity.

Its identification as an indicator of PTSD may lead to new diagnostics and to effective treatments — for anxiety disorders overall, as well as PTSD in particular.

But maybe not cortisol alone

Findings published early this year in the journal Psychoneuroendocrinology point to cortisol’s critical role in the emergence of PTSD only when levels of testosterone are suppressed [April 2017, Volume 78, Pages 76–84 ]

Testosterone is one of most important of the male sex hormones,
but is is also found in women, albeit in much lower concentrations.

According to UT Austin professor of psychology Robert Josephs, the first author of the study:

“Recent evidence points to testosterone’s suppression of cortisol activity, and vice versa.

It is becoming clear to many researchers that you can’t understand the effects of one without simultaneously monitoring the activity of the other.

Prior attempts to link PTSD to cortisol may have failed because the powerful effect that testosterone has on the hormonal regulation of stress was not taken into account.”

PTSD Risk Can Be Predicted by Hormone Levels Prior to Deployment, Study Says

What we think we know for sure

What science does believe it now knows is that PTSD is a result of both the event that threatens injury to self or others, and the emotional, hormonal response to those events that involve persistent fear or helplessness.

At this time, the goal of PTSD treatment is to reduce, if not eliminate, chronic fear-based emotional and physical symptoms to improve the quality of day-to-day life.

Research is ongoing to see if it is possible to chemically block the development of PTSD by blocking the formation of fear memories.

Blocking human fear memory with the matrix metalloproteinase inhibitor doxycycline

Current treatments are limited to psychotherapy, CBT (cognitive behavioral therapy) or other types of counseling/coaching, and/or medication, along with less well-known and less widely accepted attempts at intervention like EFT (Emotional Freedom Technique: “tapping”) and EMDR (Eye Movement Desensitization and Reprocessing).

The value of information

Before we explore the variety of treatments currently available (in a future article), let’s take a look at some of the symptoms associated with PTSD.  It will help you understand your own or those of a loved-one with PTSD.

Understanding, empathy and self-acceptance walk hand in hand – which are healing all by themselves.

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2017 PTSD Awareness Post – Part I


June is PTSD Awareness Month
Adding to our awareness and understanding

© Madelyn Griffith-Haynie, CTP, CMC, ACT, MCC, SCAC
from the Self-Health Series
Refliections Post

“Emotions are very good at activating thoughts,
but thoughts are not very good at controlling emotions.

~  Joseph LeDoux

What We’ve Learned from LeDoux: Mechanisms of Fear

Cognitive neuroscientist Joseph LeDoux is an NYU professor and a member of the Center for Neural Science and Department of Psychology at New York University.

In addition to his work focused on the neural mechanisms of emotion and memory, he is also the director of the Center for the Neuroscience of Fear and Anxiety — a multi-university Research Center in Manhattan using research with rats to explore and attempt to understand the mechanisms of pathological fear and anxiety in humans (which LeDoux prefers to call “extreme emotional reactions to the threat response”)

Essentially, when we are looking at PTSD, we are talking about individuals stuck in a particular type of FEAR response — responding in the present to threats from the past.

PTSD sufferers appear to be at the mercy of the reappearance of memories and resulting emotions because they lack immediate conscious control.

For many years, neuroscientists believed that the cortex, the most recently evolved, wrinkly outer covering of the human brain, was required for the processing of any kind of conscious experience, even those triggered by a sensory input resulting in an emotional response.

Thanks to the work of LeDoux and his colleagues at The LeDoux Lab, we now know that this information can be chemically transmitted through the brain in an additional manner using a pathway that bypasses the cortex, allowing our emotions to be triggered unconsciously, faster than the speed of thought.

In other words, our brains are designed to respond neuro-chemically when our safety is threatened, regardless of what we think about it logically or how we feel about it emotionally.

How traumatic events intensify the threat response

According to current scientific understanding, experiencing traumatic events can change the way our brains function.

PTSD develops when we get stuck in the “ready to act” survival mode as the memory cycle repeats and strengthens the emotional responses to the original traumatic event in reaction to some sort of trigger.

The stress hormone cortisol strengthens memories of traumatic experiences, both while the memory is being formed for the first time, and afterwards.

Every time our brain gathers the pieces of memory’s puzzle and puts them back together – a process known as reconsolidation – cortisol is released anew as we are reminded of a traumatic experience.

Previous studies using scanning technology have shown that people with PTSD have altered brain anatomy and function.

Subsequent research on the connection between PTSD and brain-based disorders — including those associated with dementia and TBI [traumatic brain injury] — indicate that trauma itself actually changes structures in the brain.

In the face of an overwhelming feeling of fear, our lifesaving-in-the-moment set of adaptive responses leave behind ongoing, long-term and brain scan-observable physical residuals that can result in psychological problems as well as attendant physical symptoms.

Trauma upsets the brain’s chemical balance

Synchronization of the activity of different networks in the brain is the fundamental process that facilitates the transmission of detailed information and the triggering of appropriate behavioral responses. The brain accomplished this task through the use of chemical messengers known as neurotransmitters.

Synchronization is crucial for sensory, motor and cognitive processes, as well as the appropriate functioning of the circuits involved in controlling emotional behavior.

Synchronization is a balancing act

Researchers from Uppsala University and the medical university Karolinska Institutet in Stockholm have shown that in people with PTSD there is an imbalance between serotonin and substance P, two of the brain’s neuro-chemical signalling systems.

The greater the imbalance,
the more serious the symptoms.

It seems that repeated experience of traumatic events, especially when left to fester unprocessed, can prevent rebalancing, which prevents healing (meaning, allowing the past to remain in the past, feeling confident that you have the strength to handle whatever life throws your way in the future).

Related Post: PTSD reveals imbalance between signalling systems in the brain

Responding to threats of danger

Our nervous system developed to greatly increase the chances that we would remain alive to procreate in the presence of threats to safety and security. We wouldn’t live long at all if we lacked a mechanism to allow us to detect and respond to danger – rapidly.

When our safety is threatened, a survival response automatically kicks in — before the brain circuits that control our slower conscious processes have had time to interpret that physiological response that is occurring “under the radar.”

Initially, there is no emotion attached to our automatic response to threat. In other words, fear is a cognitive construct.

Our individual perceptions of the extent of the danger we just experienced or witnessed is what adds velocity to the development of fearful emotions, even if our feeling response follows only a moment behind.

Some of us are able to process those perfectly normal and appropriate fearful responses and move forward. Others of us, for a great many different reasons, are not.

Many of those who are not able to process and move forward are likely to develop one or more of the anxiety disorders, while others will develop a particular type of anxiety disorder we call PTSD — Post Traumatic Stress Disorder.

Related articles:
When Fear Becomes Entrenched & Chronic
Understanding Fear and Anxiety

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Complex PTSD Awareness


C-PTSD Awareness
Signs and Symptoms of Chronic Trauma

© Madelyn Griffith-Haynie, CTP, CMC, ACT, MCC, SCAC
from the Self-Health Series

One of the factors of PTSD is that some people seem to have severe cases while others do not — that some soldiers were more vulnerable to extreme trauma and stress than others.

As an explanation for some of these complications it has been suggested and researched that there is a form of PTSD that is called DESNOS [Disorders of Extreme Stress Not Otherwise Specified]. Another term is C-PTSD or Complex-PTSD. ~  Allan Schwartz, LCSW, Ph.D

 

Relatively Recent Distinction & Debate

Many traumatic events that result in PTSD are of time-delimited duration — for example, short term military combat exposure, rape or other violent crimes, earthquakes and other natural disasters, fire, etc.  However, some individuals experience chronic trauma that continues or repeats for months or years at a time.

There is currently a debate in the Mental Health community that centers around the proposed need for an additional diagnosis. Proponents assert that the current PTSD diagnosis does not fully capture the core characteristics of a more complex form – symptoms of the severe psychological harm that occurs with prolonged, repeated trauma.

Let’s DO It

One of the longest-standing proponents is Dr. Judith Herman, a professor of clinical psychiatry at Harvard University Medical School. She is well respected for her unique understanding of trauma and its victims, and has repeatedly suggested that a new diagnosis of Complex PTSD [C-PTSD] is needed to distinguish and detail the symptoms of the result of exposure to long-term trauma.

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PTSD Overview – Awareness Post


June is PTSD Awareness Month
PTSD Signs and Symptoms

© Madelyn Griffith-Haynie, CTP, CMC, ACT, MCC, SCAC
from the Self-Health Series

“Emotions are very good at activating thoughts,
but thoughts are not very good at controlling emotions.

~  Joseph LeDoux

Responding in the present to threats from the past

Life itself required the development of the ability to detect and respond to danger – so our nervous system evolved to greatly increase the chances that we will remain alive in the presence of threats to safety and security.

When our lives are threatened, a survival response automatically kicks in — before the brain circuits that control our conscious awareness have had time to interpret that physiological response occurring “under the radar.” Initially, there is no emotion attached to our automatic response to threat.  Fear is a cognitive construct.

Our individual perceptions of the extent of the danger we just witnessed or experienced personally is what adds velocity to the development of fearful emotions, even if our feeling response follows only a moment behind.

Some of us are able to process those perfectly appropriate fearful responses and move forward. Others of us, for a great many different reasons, are not.

Many of those who are not able to process and move forward are likely to develop one or more of the anxiety disorders, while others will develop a particular type of anxiety disorder doctors call PTSD — Post Traumatic Stress Disorder.

Related articles:
When Fear Becomes Entrenched & Chronic
Understanding Fear and Anxiety

An Equal Opportunity Destroyer

While we hear most about the challenges of PTSD in soldiers, it is not limited to those returning from combat.

Individuals have been diagnosed with PTSD as the result of a great many different traumas: accidents, assaults, natural disasters, serious illnesses and more. It can develop in the wake of almost any traumatic event. (Situations in which a person feels intense fear, helplessness, or horror are considered traumatic.)

Trauma is especially common in women; 50% – five out of every ten women – will experience a traumatic event at some point during their lifetime, according to the The National Center for PTSD, a division of the U.S. Department of Veterans Affairs.

According to VA research and experience, approximately eight million Americans will experience PTSD in a given year, including both civilian and military populations.  That number is quite likely to be low, since many people never seek treatment for PTSD, or even admit to themselves that PTSD is what they are experiencing.

Related Post: Interesting PTSD Statistics

According to The National Center for Biotechnology Information, individuals likely to develop PTSD include:

  • Victims of violent crime (including victims of physical and sexual assaults, sexual abuse, as well as witnesses of murders, riots, terrorist attacks);
  • Members of professions where violence is likely, experienced, or witnessed often or regularly, especially first-responders (for example, anyone in the armed forces, policemen and women, journalists in certain niches, prison workers, fire, ambulance and emergency personnel), including those who are no longer in service, by the way;
  • Victims of war, torture, state-sanctioned violence or terrorism, and refugees;
  • Survivors of serious accidents and/or natural disasters (tornadoes, hurricanes, earthquakes, wildfires, floods, etc.);
  • Women following traumatic childbirth, individuals diagnosed with a life-threatening illnesses;
  • Anything resulting in a traumatic brain injury (TBI), leaving you struggling with the ongoing trauma of trying to live a life without the cognitive or physical capabilities you thought you would always be able to count on.

Sufferers may also develop further, secondary psychological disorders as complications of PTSD.  At its base, however, we are talking about individuals stuck in a particular type of FEAR response.
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PROGRESS, not Perfection


The Long Road Back:
Learning patience – Recovering Resilience

© Madelyn Griffith-Haynie, CTP, CMC, ACT, MCC, SCAC
from the Self-Health & Walking a Mile in Another’s Shoes Series

A Little Background

wallpaperweb.org: click picture to visit source

wallpaperweb.org: click picture to visit source

“The journey toward resilience is the great moral quest of our age.”
~ Andrew Zolli, co-author of
Resilience: Why Things Bounce Back.

Bouncing back myself

Regular readers know already that, between Christmas and New Years, I was mugged at gunpoint getting out of my van in front of my house, and that the thugs shattered my dominant hand. 

That left me pretty much helpless – and unable to work – until the cast came off in the second week of March. 

Since I work for myself there is no regular paycheck if I can’t do the work, so it’s been a scary time.

Only once my cast came off, about 75 days later, am I finally able to really concentrate on jumping through all the hoops necessary to put things back together – a DAUNTING idea! (See When Fear Becomes Entrenched & Chronic for just HOW daunting!)

Not only do I need to recover my sense of safety and security in my world and get back to work, I need to recover my STUFF!

  • The band of thugs made away with my purse, containing my make-up and favorite hairbrush, my brand new iPhone, the keys to house, car and storage space, and a-whole-lot-more, and my wallet (with all forms of identification, the plastic cards one uses for money these days, and all the merchant cards one shows to buy much of anything anymore).
  • They also grabbed my tote containing a number of things, the most devastating to my ongoing functioning being my datebook and address book.
  • It ALL needs to be replaced – starting with figuring out who and what I call to DO that – along with everything that expired while I was incapacitated (like my car insurance and tags, for example), and making sure all my regular bills are paid through the end of March.

If you’re one of my few neurotypical readers, you’re probably not envying my process, but my ADDers (etc) r-e-a-l-l-y get what a terrifying process that is!!

Spending a few weeks with my friends in Little Rock has been very healing, and getting back at least partial use of my dominant hand has made a huge difference.

Yet, I still have a long way to go before I will be able to say that I have climbed out of the hole I found myself in rather unexpectedly, almost three intermidable months ago.

I feel SO far behind, wondering if I will EVER be able to catch up!!

Since I promised to let you know what I am doing to continue to heal and how its going, I’ll check in every week or so with an article that will be a bit like a diary of my progress, coupled with any related insights, thoughts or ideas about executive functioning as I step back from the PTSD edge.

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When Fear Becomes Entrenched & Chronic


Chronic Anxiety & PTSD
Understanding Fear & Anxiety – Part 2

© Madelyn Griffith-Haynie, CTP, CMC, ACT, MCC, SCAC
from the Self-Health Series

When what happened leaves marks

broken-legIf you broke your leg, you’d go get it set, right?

Whether it was a little break or something catastrophic that required an operation and pins, you would feel “entitled” to go for professional help and would have no doubt that you needed it, right?

While you were in a cast, you’d probably have the good sense not to try to walk on that broken leg. Most of the people around you would be able to understand without explanation that you needed crutches to get around.  Right? It would go without saying that you had to take it easy while you healed.

EVEN if you broke your leg doing something stupid that was entirely your own fault, you would probably feel very little shame about having a broken leg – a little embarrassed, perhaps, but you’d still allow yourself to get what you needed to heal.

YET, when the problem is mental, we tend to try to soldier on alone. 

  • Maybe we think things are not “bad enough” that we are entitled to professional help.
  • Maybe the stigma still associated with the term “mental illness” stops us cold.
  • We probably find ourselves struggling with the concern that others might believe we are weak or over-reacting if we can’t seem to pull things back together alone.
  • Perhaps we have collapsed psychological difficulties with “crazy,” and we certainly don’t want to believe we are crazy!

The only thing that is CRAZY is denying ourselves the help it would take to manage whatever it is that we are struggling with so that we can get back to being our own best selves – and most of us are a little bit crazy in that way.  I know I am, in any case.

In one masterful stroke of unconscious black and white thinking, we label ourselves powerless when we are unable to continue on without help, struggling against impossible situations sometimes, as things continue to worsen — if we’re lucky.

  • Because when things continue to get worse, it will eventually become obvious that we are clearly not okay.
  • We’ll eventually reach a place where it will be impossible to deny ourselves the help we need to heal.
  • If we’re not lucky, we are able to continue living life at half mast: limp-along lives that could be SO much healthier and happier.
  • If we’re not lucky, our mental reserves will be worn out by limping along, and we are likely to reach a place where it seems as if our dominant emotion is anger, or we will slide into chronic, low-level depression – or worse.

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ABOUT ADD Comorbidities


Cormorbid or Co-occuring?

by Madelyn Griffith-Haynie, CTP, CMC, ACT, MCC, SCAC

Wait!  Doesn’t comorbid mean
co-occuring?

Not exactly. Comorbidity refers to a specific KIND of “co-occurance.”

A comorbid disorder refers to additional conditions or syndromes or disorders frequently found in a specific diagnostic population.

In other words, we’re talking about accompanying conditions that are not part of the diagnostic criteria for the “main” condition, but are frequently seen in that particular population of individuals.

From a behavioral standpoint, these additional conditions occur sometimes with similar or overlapping symptoms, and sometimes they show up with additional symptoms – those not necessarily seen in those with the original or “base” diagnosis.

The overlap may reflect a causal relationship between the two diagnoses, and they may relect an underlying vulnerability in common, but the important concept is that they co-occur more frequently in our “target population” than in population norms otherwise, and to a statistically significant degree.

So, even if an entire hotel full of ADDers happens to be diabetic as well, we still would not say their diagnosis was ADD with comorbid diabetes, because the two conditions haven’t been proven to occur in tandem any more frequently than the incidence of diabetes in the general (non-ADD or “vanilla”) population.

So, in this example, the two conditions are co-occuring, NOT comorbid, even though it may not look that way to anyone staying in this particular hotel!

Muddying the waters further, the statistics change depending on which end of the diagnostic telescope you look through. For example, up to 60% percent of children with tic disorders also have ADD, but nowhere near 60% of ADDers have tic disorders.

The high possibility of comorbidities is yet another good reason to make sure you get an excellent differential diagnosis — but the articles in the Comorbidities Series are going to look at some of the diagnoses that frequenly hitch-hike along with ADD through another lens: SUCCESS!

Developing person-specific work-arounds and interventions to help you achieve that blessed state of Optimal Functioning that I believe is our birthright comes through identifying, understanding, and learning to work with and work around ALL of the “mix-ins” in your particular flavor of ADD.

“Learning to drive the very brain you were born with
– even if it’s taken a few hits in the meantime!”™

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