What happens in trauma therapy?

It’s interesting to look back on what has helped me to journey through PTSD towards ‘normality’.  I have had 4 therapists, 3 of whom have used a remarkable technique called ‘EMDR’.  The other used ‘Cognitive Behavioural Therapy’.  My major observation is that I made more progress with therapists who paid a great deal of attention to me and to my reactions, and had a range of techniques they could use as tools.  That takes a lot of experience!

‘Cognitive Behaviour Therapy’ helped me to MANAGE the trauma/head injury.  the therapist encouraged me to plan forward carefully for anything I was going to do, to pace myself and to find simple ways of reducing the adrenalin levels when I got over-stimulated.  For example, she introduced me to a very simple breathing exercise that really works:  you breath right out, then breath in and out but deliberately make the ‘out’ breath longer than the ‘in’ breath.  You can make it a bit more effective by counting and increasing the ‘out’ time e.g. in-2-3-4 out-2-3-4-5 in-2-3-4 out-2-3-4-5-6 in-2-3-4 out-2-3-4-5-6-7 etc.

Then, she tried to help me deal with my ‘startle response’ – that is, the way that I jump and ‘freeze’ in response to certain stimuli.  I was to choose something positive and think of that every time a certain stimulus arose.  For example, traffic could make me ‘freeze’ – so she asked me to think of something positive about people driving cars past me.  The problem was that I couldn’t think of anything that I really believed was positive about all those cars.  Eventually, I decided that I would find something to thank God for every day, and deliberately thank Him for it when I met traffic.  It did help me to manage my immediate problems, but I don’t think it dealt with the underlying condition.

I realized that people with PTSD need both to learn to manage their immediate reactions and to deal with the memories that are producing the trauma.  CBT helps with the former but not, I think, with the latter.  It also helps with something else that is very important:  teaching the body to react to stimuli in different ways.

People can help!

So thankful that I could be part of the Wycliffe Hall commissioning day yesterday!  I’m very tired today, and haven’t even tried to go to church or to anything else.  But I have a great sense of achievement, and of being INCLUDED.

I am not only thankful for the therapy that has got me well enough to cope.  I am also thankful to the people who helped me to cope.

My David came too, and was there to stand with me after I got shocked by a boom over the loud speaker system, and to take me home at the end, when the adrenalin ran down and I was so tired I could hardly walk.

Some of the students know that I have problems with noise and crowds, and were very considerate when I needed to get somewhere quiet.

Kerstin, the college receptionist, and Kristina, the principal’s PA, made sure I had a seat at the end of a row (I find it difficult to have people sitting on both sides of me and I need to be able to go somewhere quiet during the hymns) and made sure that I got into that seat.

If anyone reading this knows someone suffering from PTSD:  be assured that your help in thinking about how that person can be included in things will be hugely appreciated.

The medics for whom I am thankful

I’m thankful for the physiotherapists:  one who helped me with my walking while I was in hospital, and one who help me with coordination and with the pain caused by the lumbar puncture after I came out of hospital.  They took time with me, and gave me exercises that made me feel I could actually do something about my situation.  Most important:  they treated me as a struggling human being rather than as a malingerer who had nothing really wrong and was wasting their time.

The third neuropsychologist helped me to manage my time and to work out how best to function in my impaired state.  She used some Cognitive Behavioural Therapy, which helped ease some of my symptoms.  She tried hard, maybe partly because she was still in training.  But the NHS only offered a limited number of sessions because (yes, you’ve guessed it!) I was functioning at a relatively high level so didn’t merit any more.

All of the neuropsychologists thought that a large part of the problem was ‘post-concussion’, for which there is no treatment other than waiting for it to get better (people say that it continues to  slowly for 10 years, after which no further improvement is very likely).  They realized that the trauma was interacting with the ‘post concussion’, but they didn’t think there was anything much that the NHS could offer to help.  It was not until I’d been working with my present, private, therapist for about 6 months that I began to hope that MOST of the problem had always been the trauma – and that can be treated!

Disorientation and keeping going

After hitting my head, I was taken back into the shop and given a cup of tea, and then I went back to see if there was anyone in the church where I had my office (there wasn’t) and then found my way home.

I knew that I was very shaken, and felt kind-of-as-if I’d stepped into a different world.  But I kept trying to do what I had to do.  I went to bed, but got up for a very important meeting I was to lead that evening.  Next morning, I went to the optician to get my spectacles mended.  They were bent, and had a scratch on the lens that was somehow very familiar.  I was feeling very strange, and the optician told me to go and see a doctor.

I went.  Nothing wrong with me, said the doctor.  ‘Go home and rest and you’ll be fine!’  So I went home to bed, and that’s where David found me when he got back from the USA that evening.  When I got up the next day, I felt better and tried to get going, but was soon feeling strange again.

‘Take some time off to get better!’ said my line manager. So I tried to, but all the time I was obsessing about a paper I had to write, and wanting to keep on going, doing what I could do, treating this as a temporary ‘blip’ and ready to get back to full tilt work asap.

Maybe my tiredness this week is reflecting that pattern:  I may be ‘walking out of that door towards the head injury’ in my trauma journey, but there’s a lot to do in my 2015 life.  People have said, ‘Writing is therapeutic’ – in this case, it’s therapeutic because it reminds me that I’m dealing with more than my 2015 responsibilities.  I wasn’t ‘normal’ after I hit my head, and I am still not at the stage where I can work at full tilt for a whole week.  Better to take a break every day to recognize the trauma journey, to be still, to acknowledge the Loving Lord in control, to discern what not to do today!

Journey into reality

Shall I keep jotting down my thoughts for the day, shall I stop this blog, or shall I tell a bit of the story of my long journey through PTSD over nearly 9 years?  Please ‘like’ this post if you’d like me to do the journey.

I hope that I am now towards the end of the really incapacitating stages.  I knew I’d made a qualitative step forward when I awoke one morning last November and thought, ‘The world seems real,’ and I realized how unreal everything and everyone had felt for eight and a half years.

I hadn’t really been here – not quite in the present – and I’d been tired all the time because it had been such an effort to focus on anything – to drag my mind into the task for now, to listen to the person in front of me.  And, often, my system just switched off, and I had to stop what I was trying to do.  I could only do things in little bits, and hope that they would somehow hold together. (It’s called ‘dissociation’)

It’s wonderful to feel more engaged with the world, more part of the world (despite the mess in it!).  This spring, the sun and the flowers and the fresh green feels real, I feel as if there are fresh green shoots growing in my life,

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OLYMPUS DIGITAL CAMERA

and I’m thankful.  And God feels real again.  Which is the best of all!

The body remembers and reacts

It’s probably difficult for people who haven’t got ‘PTSD’ to understand how physical it is.  Coming out of church on Sunday, a child screamed:  I startled (jumped), froze (couldn’t move for a minute or more) and was then so dizzy and slowed down that I had to sit, breathe, wait till I could go on.

What was that about?  The traumatic response is usually to a physical stimulus that the body somehow remembers and associates with a traumatic event – in this case, I guess there was someone (everyone?) screaming as we went into the car crash.  My mind doesn’t remember it, but it seems like my body does.

So, the trigger is pressed and the adrenalin pumps and the body does its automatic response, leaving me in shock and needing to PHYSICALLY to get the adrenalin level down and MENTALLY trying to process whatever it is that my body has remembered.

At the same time, the child who is watching (was he the one that screamed?) and wondering why I’m ‘frozen’ needs reassuring, and the friendly person who comes to ask whether I am OK needs and explanation . . .   At least I am not in the middle of a shop, with people annoyed because I am in their way . . .

Studying my own ANGER

Next to fear, anger seems to be the biggest emotion produced by trauma.  The problem for some of us is that it’s an emotion that we couldn’t afford to feel THEN.  It got buried, and now it can come out in all sorts of inappropriate ways.

And, of course, buried anger doesn’t just lie down and die.  It can get turned in to wrong direction – most commonly towards oneself, so that you are beating yourself and blaming yourself for everything.  It can get turned towards God – much safer, if it can get expressed and we can hear that He, too, is angry at what happened and that He can knows what to do with anger.  It can be denied (I AM NOT ANGRY!!!!!!!!!!!!) and that is very tiring – squashing anger takes a lot of energy.

And all this is, I think, because anger is frightening.  My own anger is more frightening even than other peoples’ anger, and it feels as if it might be uncontrollable.

So, how should I begin to deal with some of the anger that is still in me from the time of my parents’ death?  The therapist said, ‘Just take an interest it in.’  That doesn’t sound too frightening.  I think I can do that.  In addition to all my other academic tasks this week, I shall study my own anger.