Category: Trauma

3 Teaching children about trauma-e64c0cff78bc1c36a18b5896fe10be70f88635cd

Teaching Children about Trauma: The “River Speaks” Series

00Child Development, Emotion Regulation, Family Dynamics, Featured news, Grief, Therapy, Trauma March, 16

Source: Freaktography on Flickr

In her latest series of children’s books, River Speaks, author Sandy Stream conveys the emotional turmoil that children and families go through when dealing with trauma.

Children who have undergone loss, abuse, and other traumatic experiences are often unable to fully understand or express their feelings. Their inability to verbalize the emotional impact the crisis had on them makes it difficult for therapists to determine how to best help them heal.

Although research has shown children’s literature to be a helpful tool in therapy, its use is still not particularly common.

The stories found in Stream’s books are meant to help therapists provide relatable experiences for children to help them come to terms with their own trauma. They revolve around a baby bird, Sparky, who is snatched away from his family. In dealing with his captivity, escape, and eventual return, Sparky and his family learn to articulate the complex feelings they experience.

Sparky does return home, but the series does not employ the conventional happily-ever-after ending. Instead, the stories address the turmoil felt by everyone both during his captivity and after his return.

The seven books in this series, Sparky Can Fly, Sparky’s Mama, Tweets and Hurricanes, Feathers, Flex, Roots, and The River, all feature a different main character, retelling the narrative from the perspective of the victim, the parents, the siblings, and the therapist. Each book also deals with different emotional themes, including grief, loss, isolation, and acceptance.

Many of the communication strategies seen in River Speaks can be linked to Jean Piaget’s work on child development. According to Piaget, healthy coping and a sense of self cannot exist without establishing trusting relationships during childhood. Trauma can interrupt this process, and the River Speaks series is intended to restart and re-establish healthy connections.

Research, including that of psychiatrist Bessel van der Kolk, professor at Boston University, shows that children must understand the emotions caused by trauma. This research emphasizes that therapists should teach children to regulate emotional distress, with the first step being acknowledgment of the distress’ severity.

Stream’s metaphorical approach helps children grasp the complex concepts that make the healing process. Comparing Sparky’s inability to express anger and grief to “hurricanes” and “tweets” helps make the abstract more tangible.

This strategy allows the River Speaks stories to personify complex psychological issues such as emotional defense mechanisms like denial, fear of abandonment, and Stockholm syndrome, making her books well-suited to children as young as three or four years of age.

Stream’s stories are accompanied by illustrations from Yoko Matsuoka. The colourful drawings were designed to keep the oftentimes-dark subject matter child-friendly, and work well in conjunction with Stream’s metaphorical portrayals of emotions and trauma.

Such illustrations are a common tool in dealing with childhood trauma. The use of visual art to depict emotional reactions has been found to benefit children during the normal grieving process. A paper by Cynthia O’Flynn at North Central University explains that art therapy can be especially beneficial for children suffering from serious traumatic grief.

The article cites numerous other studies reporting that art allows children to bypass the language and vocabulary needed to explain their grief or loss, making self-expression much easier. The children are able to perceive greater control over their emotions and feel safe while reflecting upon their experiences.

Alexa S. Rabin of Alliant International University reinforced these findings in 2012, stating that art is an exercise which allows children to assert themselves and their boundaries. Rabin explained that such therapy significantly decreases acute stress symptoms, noting that the purpose of trauma treatment is to help children find a way to cope.

Stream’s books bridge the two sets of findings—using both art and language to reach out to children and better their self-expression across both media. A therapist using Stream’s books would be more flexible in tailoring the therapeutic style to the child’s age and individual needs.

Feedback from psychologists such as Jacqueline A. Carlton and fellow author Cheryl Eckl, applaud Stream’s attempt at tackling such difficult subject matter. And while research would be needed to gauge the helpfulness of her specific stories, existing research suggests that her books may ease therapy for both clinicians and children.

– Olivia Jon, Contributing Writer, The Trauma and Mental Health Report

– Chief Editor: Robert T. Muller, The Trauma and Mental Health Report

Copyright Robert T. Muller

This article was originally published on Psychology Today

2 Srebrenica massacre-8ac208cedd5330bee7a98e22e648c46166fec975

Srebrenica Massacre Continues to Haunt Victims

10Featured news, Law and Crime, Politics, Post-Traumatic Stress Disorder, Resilience, Trauma March, 16

Source: Sara Benceković

The defendant entered the courtroom, giving a thumbs-up to the judges and clapping mockingly at the spectators watching from a glass-walled gallery. His name: Ratko Mladić, a 70-year-old former Bosnian Serb army general whose troops committed the single largest war crime in Europe since the Second World War.

In July 1995, a 15-square-kilometre area around the city of Srebrenica had been designated to offer shelter to Muslims fleeing Serbian armed forces. 400 Blue Berets were deployed by the United Nations to safeguard the area and over 10,000 people from all over Bosnia flocked to it for safety.

When Mladić’s troops arrived, they overcame the UN forces and most of the men and boys were slaughtered, while women were forced to flee. Over the course of four days, eight thousand people died.

After 16 years of hiding from UN accusations, Mladić was arrested in 2011 and has been on trial for his involvement in the massacre since June of the same year. He is accused of persecution on political, racial and religious grounds, extermination, murder, deportation, inhumane acts, terror, unlawful attacks on civilians, and taking peacekeepers as hostages.

Prosecutors have been building a case against Mladić, claiming that he led a coalition to ethnically cleanse parts of Bosnia of non-Serbs. His intentions, they say, were guided by the Serbian nationalist ideology of the Great Serbia, which aspired to claim territories of modern-day Croatia, Bosnia, Montenegro and Macedonia. However, his defence counsel describes Mladić as a patriot who merely fought to defend his people.

Although Mladić denies the allegations, many survivors consider him directly responsible for their trauma. Nineteen years have passed since the end of the war, but the sorrow still hangs heavy over Srebrenica. Over four hundred witnesses flew in from all over Bosnia to testify against him before the tribunal.

In witness testimony during the trial, one survivor said: “My neighbours have gone to live in some other world, my schoolmates lie buried beneath the old playfields. My husband, once warm and loving, now lies bloodless and breathless. My life is an illusion; I died long before I will be buried.”

To this day, mass graves continue to be discovered across Bosnia. So far, nearly 5,000 victims of the bloodshed have been laid to rest, yet similar numbers remain undiscovered. A list with the names of missing people has since been compiled and published in the hope of gathering information from the public that could bring closure to family members.

Despite these efforts, many victims and their families have not yet found peace.

Elvedin Pašić, a witness at the UN trial, testified about being separated from his father when they were captured by Serbian soldiers. Women and children were forced onto buses to be dispatched from what is now Serbian territory, while men, including Pašić’s father, were required to stay behind. Most of them were never seen again.

During Pašić’s testimony, Mladić did not react and later denied feeling any guilt for his participation. His defence team claims that he suffers from a memory disorder that makes it impossible for him to differentiate between truth and fiction.

If the allegations against Mladić are proven in court, he will face a life sentence in prison. Many of those affected by the Srebrenica massacre see his captivity as justice that would end their suffering.

Witnesses have called for a restoration of the region back to its pre-war state. The area of south-eastern Europe used to be a mosaic of overlapping minorities, in which residents rarely had a sense of their neighbours’ nationality. Inter-marriage was common, children were bi-religious, and conflict was far from people’s minds.

Although it will likely take more than the imprisonment of war criminals to heal the trauma endured, Srebrenica survivors have united under the collective vision of rebuilding for the future. By seeking redress in the Mladić trial, the survivors of the region have generated empathy and support from those around them.

They continue to challenge the official history of events and in doing so have become prosecutors and judges in their own right, seeking justice for these crimes.

– Sara Benceković, Contributing Writer, The Trauma and Mental Health Report

– Chief Editor: Robert T. Muller, The Trauma and Mental Health Report

Copyright Robert T. Muller

This article was originally published on Psychology Today

Pregnancy Centers

Crisis Pregnancy Centers Traumatize Women Through Deception

10Deception, Featured news, Gender, Politics, Pregnancy, Religion, Trauma February, 16

Source: Heartbeat International on Flickr

In 2002, U.S. President George W. Bush enacted a policy allowing faith-based organizations to receive government grants to provide social services. America’s Crisis Pregnancy Centers (CPCs) were a major beneficiary, receiving an estimated $60 million in federal grants for abstinence promotion between 2001 and 2006.

More recently, access to abortion clinics has become a great concern in the United States, with 70 laws cutting abortion funding passed in 2013. It is estimated that as of 2014, CPCs outnumber abortion clinics five to one.

Founded on Christian ideology, CPCs are at the forefront of the pro-life movement and are gaining popularity among American conservatives. Often presenting themselves as abortion clinics, they claim to offer free pregnancy tests, sonograms and abortions to attract women facing unwanted pregnancies.

But these centres are not medical clinics and do not offer abortions. Women who walk into CPCs seeking guidance are often bombarded with images of aborted fetuses and religious propaganda to dissuade them from aborting unwanted pregnancies. Often located near actual abortion clinics, CPCs attempt to confuse visitors, induce guilt, and pathologize abortion through misinformation.

Misconception is a short documentary from Vice News that exposes unethical practices occurring in crisis centers. The film features hidden camera footage of lies told to women designed to scare them out of terminating their pregnancies.

The documentary shines light on the psychological distress women experience in these centers. CPC counsellors are seen telling women that abortion causes long-term psychological damage, infertility and can lead to complications for future pregnancies.

“If people die due to an abortion, later on they’re finding parts of the fetus in the lungs or the heart,” one counsellor told a client.

Donna, featured in the documentary, recounted a disturbing experience at a CPC in Texas. Thinking that the White Rose was an abortion clinic, she went in to receive a free sonogram and counselling. When she told her story to Vice, Donna was emotionally distraught: “It didn’t occur to me that there was a catch. It’s an awful feeling, being in that place, and I can’t explain why. You go in asking for help, but they’re not giving you the kind of help that you’re asking for. I feel like I was lied to. I feel like I was tricked.”

While some lie outright, other CPCs use controversial studies to dissuade women from aborting. Care Net, one of the largest American CPC networks, distributes a national brochure that purports a significant correlation between abortion and breast cancer, citing a single study that has since been called into question. Multiple other sources have demonstrated that abortion does not affect a woman’s risk of developing breast cancer.

Allison Yarrow’s August 2014 report, The Abortion War’s Special Ops, documents the emotional trauma that women experience from this ongoing deception. The report speaks of counsellors repeatedly warning clients that abortion can lead to ‘post-abortion syndrome’, a supposed condition that includes a combination of suicidal thoughts and depression. Unsurprisingly, an American Psychological Association report found no significant increase in negative emotions or psychiatric illness as a result of having an abortion.

At a pro-life conference in 2012, Abby Johnson, a supporter of CPCs, explained their main strategy. “We want to appear neutral from the outside. The best call, the best client you ever get, is one who thinks they’re walking into an abortion clinic. The one that thinks you provide abortions.”

In an effort to reveal the deceptive tactics of CPCs, some women are fighting back. Pro-choice activist Katie Stack campaigns against anti-abortion legislation after her own disturbing experience at a local crisis center.

In 2011, she started The Crisis Project which exposes the “medical misinformation, emotional manipulation, and religious doctrine” within these clinics across the United States. As an undercover reporter, Stack frequents CPCs in an effort to reveal the harmful inaccuracies they spread.

The fight to end CPC deception comes with its challenges. Earlier this year, Missouri Bill HB 1848, which would have required clinics to notify patrons that they do not perform abortions or give referrals for abortion services, failed to pass. Many states have faced similar roadblocks in establishing pro-choice legislation.

While anti-CPC activists have a long way to go to acquire legislative change in the United States, they are making some headway on an international scale. Global organizations like Google have agreed to remove CPCs’ deceptive advertisements from search results.

On September 18, 2014, Yarrow told the Huffington Post: “We are all entitled to our own positions on abortion, but I bet many people disagree with taxpayer-funded deception.”

– Lauren Goldberg, Contributing Writer, The Trauma and Mental Health Report

– Chief Editor: Robert T. Muller, The Trauma and Mental Health Report

Copyright Robert T. Muller

This article was originally published on Psychology Today

Listening to voices

Can Some Lead A Better Life Listening to their Voices?

10Cognition, Cognitive Behavioral Therapy, Featured news, Psychopathy, Therapy, Trauma February, 16

Source: rumeysa babadostu on Flickr

Hearing voices is usually considered a sure sign of mental illness, but recent studies suggest that hearing voices is more common in the general population than previously thought. Though inconclusive, research estimates are that between 2 and 10% of people hear voices, with only 45% actually qualifying for a psychiatric diagnosis.

The notion that hearing voices can be non-pathological is still controversial.  Contemporary psychiatry views hallucinations (auditory or otherwise) as the result of abnormal brain function, representative of a more pervasive psychotic disorder.  Coming from a disordered brain, the content of voices are said to have no inherent meaning.  Treatments minimize or eliminate symptoms (usually through the use of medication) and provide coping strategies through cognitive behavioural therapy (CBT).

The ‘Hearing Voices Movement’ challenges the medical model.  Started in the early 1990s, the movement provides an alternative, non-pathological framework, claiming that hearing voices is fairly common in the general population and can exist outside of psychotic disorders.  They view voices as resulting from life events, (e.g., traumatic experiences), and that better coping comes from gaining insight into how the voices relate to unresolved trauma.

In a Dutch study published in 1989, Marius Romme, at the University of Limburg in Maastricht, and science journalist Sandra Escher found that out of 450 participants, about one third reported being able to cope well with their voices.  Of this group, people were more likely to have a positive interpretation of the voices, accepting them as part of their life instead of trying to fight or ignore them.   Although many of these participants still found some voices distressing, they were able to draw firmer boundaries and felt less powerless than the group that did not cope as well.

Building on the fundamentals revealed by their research, Romme and Escher were able to translate their findings into a therapeutic approach.  Known as the Maastricht approach, the aim is to foster curiosity about the content of the voices in order to gain insight, resolve underlying emotional problems due to past traumas, and eventually accept the voices as a part of the client’s life and self.

Voices can be positive, negative or banal –many voice hearers have some combination of the three.   In treatment, the client is asked to set aside a time to listen to the voices nonjudgmentally, as if they were talking to an actual person.  Along with the therapist, they try to unravel when the voices began and why.

In contrast, treatments like cognitive behavioural therapy (CBT) and similar methods aim to reduce the frequency, intensity and believability of hallucinations.  People receiving this type of therapy are encouraged to directly challenge the content of the voices, and cope by focusing on other things in their environment and use distraction to redirect their attention.

But when techniques like distraction and redirecting attention are used incorrectly, they result in people suppressing and fighting their symptoms, rather than learning to live with them.

Several studies show that individuals who try to suppress thoughts and hallucinations may increase their frequency and intensity, and exacerbate distress   (described in the work of Social Psychologist, Daniel Wegner of Trinity College).  Alternatively, the Maastricht approach encourages the client to eventually accept their voices without challenging their content or trying to fight them.

Some claim success for this kind of acceptance-based treatment, even in cases of psychosis.  In a study by clinical psychologists, Patricia Bach and Steven Hayes at the University of Nevada, Reno, 80 inpatients with schizophrenia were assigned to either continue their treatment as usual or engage in four sessions of acceptance and commitment therapy (ACT) in addition to usual treatment.

At the end, patients who attended the ACT sessions were three times less likely to be hospitalized again, and were more likely to question the voices’ control over them and evaluate the reality of the voices’ claims.  Bach and Hayes think the acceptance component allows people to be less distressed overall and view the voices as ‘just thoughts’ that don’t necessarily have meaning or power over them.

While ACT is a widely validated therapy, the Maastricht approach has less research to back up its claims.

The Maastricht approach is still considered peripheral in many circles, especially the idea of voices as an extension of human experience.   And critics of the treatment take issue with the implication that almost all auditory hallucinations are caused by traumatic experiences, overlooking or down-playing evidence regarding genetic and biological influences.  While it is true that many people who hear voices have experienced traumas in their lifetime, there is little evidence that trauma alone can directly cause auditory hallucinations.

And, some claim the Hearing Voices Movement ignores the needs of people with severe mental illnesses such as schizophrenia, which involves a host of other symptoms in addition to hearing voices.  Using the ‘hearing voices therapy’ only addresses one aspect of a multifaceted syndrome and may be harmful if the other symptoms worsen.

Still, when we look at the idea of hearing voices in a way that is not exclusively pathology-based, we open new possibilities, and we engage in what psychologist Andrew Moskowitz (University of Aarhus, Denmark) claims to be a necessary paradigm shift.  Indeed, it may be time for one.

– Jennifer Parlee, Contributing Writer, The Trauma and Mental Health Report

– Chief Editor: Robert T Muller, The Trauma and Mental Health Report

Copyright Robert T Muller 

This article was originally published on Psychology Today

Female Inmates and Psychological Impacts

Prisons Perpetuate Trauma in Female Inmates

40Bullying, Featured news, Health, Law and Crime, Post-Traumatic Stress Disorder, Therapy, Trauma January, 16

Source: r. nial bradshaw on Flickr

In May 2012, the Equal Justice Initiative (EJI) filed a complaint with the U.S. Justice Department for maltreatment of inmates in Alabama’s Julia Tutwiler Prison for Women. EJI urged an investigation of the Alabama Department of Corrections, claiming they fail to protect inmates from sexual violence.

After an on-site inspection, federal investigators confirmed allegations that officers were frequently engaging in sexual violence against inmates.

Instances of repeated rape, sodomy, fondling, and exposure were reported.

According to its website, “The mission of the Alabama Department of Corrections is to confine, manage and provide rehabilitative programs for convicted felons in a safe, secure and humane environment.”

But the reality of the modern prison system paints a very different picture.

Allen Beck, Senior Statistical Advisor for the Bureau of Justice Statistics (BJS) reported that “of the 1.4 million adults held in prison, an estimated 57,900 said they had been sexually victimized.” Statistics of abuse in local jails are similar.

Even more startling is a report by the BJS stating that 49% of nonconsensual sexual abuse in prisons involves staff sexual misconduct or sexual harassment toward prisoners.

Among those who experience the most damaging effects of sexual abuse are female inmates with preexisting mental health disorders or past trauma. These women make up a large number of prison inmates.

Charlotte Morrison, a senior attorney with the EJI, explains that to participate in the prisons’ rehabilitative programs, women are required to go through an invasive strip-search in front of male officers each day, a distressing experience for any woman, but especially difficult for those with a history of trauma or abuse.

And mental health services in prisons are either nonexistent or inadequate in supporting prisoner needs. BJS found that only 22% of prison abuse victims receive crisis counseling or mental health treatment.

The consequences are devastating. Higher rates of posttraumatic stress disorder, anxiety, depression, and suicide are frequently reported in female inmates, as well as exacerbation of preexisting psychiatric disorders.

“The key takeaway here is the levels of impunity in detention facilities” says Jesse Lerner-Kinglake, spokesperson for Just Detention International. Prison guards are often exempt from any punishment after assaulting or sexually abusing prisoners.

According to the BJS report, only 46% of sexual assault cases between staff and prisoners were referred for prosecution. In about 15% of cases, staff members were allowed to keep their jobs.

Lerner-Kinglake goes on to say that women underreport abuse because of limited legal options, and because they fear segregation and retaliation by staff.

In 2003, the Prison Rape Elimination Act (PREA) was passed into law to analyze the incidence and effects of prison rape and to provide resources, recommendations, and funding for protection. Yet a decade later, abuse persists and statistics have barely improved.

This may soon change, however, as May 15, 2014 marked thedeadline for U.S. states and territories to submit certificates or assurances agreeing to comply with PREA standards. Those not following PREA regulations face potential reductions in grant funding.

While the U.S. government is finally enforcing prisoner safety laws, inmates still suffer from limited access to mental health services.

Many organizations recognize the limitations of the prison system and work to make these services available to prisoners. For example, Just Detention International (JDI), a health and human rights initiative, provides prisons with links to community hotlines and crisis counseling for rape victims. Public ads from such organizations are also being aimed at addressing the stigma surrounding prison rape.

While these may be positive steps to improve prisoner safety, further advocacy and legislation is necessary to protect inmates’ legal rights and to facilitate rehabilitation.

– Eleenor Abraham, Contributing Writer, The Trauma and Mental Health Report

– Chief Editor: Robert T. Muller, The Trauma and Mental Health Report

Copyright Robert T. Muller

This article was originally published on Psychology Today

Nasal Spray May Prevent PTSD, Study Finds

Nasal Spray May Prevent PTSD, Study Finds

00Ethics and Morality, Featured news, Law and Crime, Memory, Neuroscience, Post-Traumatic Stress Disorder, Therapy, Trauma January, 16

Source: Stan Dominguez on Flickr

The emotional connection between a memory and an event can be powerful. A child rescued from a house fire or a soldier returning from Afghanistan may be plagued by flashbacks that elicit guilt, fear, and anxiety. These associations may disrupt daily functioning, causing social isolation, difficulty sleeping, and paranoia—all symptoms of Post-Traumatic Stress Disorder (PTSD).

Traditionally, PTSD has been treated with counseling and cognitive behavioural therapy, as well as psychiatric medications. Now, new research by biochemistry professor Esther L. Sabban and colleagues at New York Medical College is exploring how to stop the negative emotional association from being formed in the first place. They developed a nasal spray that, when administered before, during, or after crises, may do just that.

The spray contains Neuropeptide Y (NPY) which, at low levels, is associated with reduced negative emotional processing of events. Increased NPY in the amygdala and hippocampus—structures of the brain involved in processing memory and emotional responses—is associated with decreased anxiety, fear, and depression resulting from stressful situations.

Sabban and colleagues found that, when inhaled, the peptide acts as a neurotransmitter that has an immediate effect on the brain and prevents the development of PTSD symptoms in rats. In their study, rats were first subjected to stress by being immobilized, forced to swim, and exposed to chemicals which made them lose consciousness. Thirty minutes before or after the stress, some rats were given NPY. After seven days, rats that received NPY had lower levels of anxiety, decreased avoidant behaviour, and fewer startle responses.

Similar results were obtained when the spray was administered a week after the stressful event.

If effective for people, the spray might benefit those with high-risk jobs or those who help others during emergencies. By reducing negative emotional processing of a traumatic event, victims and responders might have a weaker emotional reaction to the memory, limiting the subsequent development of PTSD symptoms.

But there are many questions as well as practical impediments.

Professor Evelyn Tenanbaum of Albany Law School outlines a number of legal and ethical issues that using this spray might have. She argues that blunting the emotional impact of such an event could hinder a victim’s ability to impact a judge or jury in criminal trials. Social change may also be more difficult as the emotional stories of trauma victims often act as catalysts.

Informed consent before administration must also be considered. Victims need to know they may no longer be a reliable witness to a crime and that their memory of the incident may become unclear. Informed decisions may be hard to make during crisis situations.

It is also important to remember that the spray has only been tested on animal populations. NPY purportedly severs ties between emotion and memory; it is unclear what this would mean for humans. Would individuals be left feeling neutral regarding the traumatic event?

A lack of emotion may leave some victims confused or depressed in an entirely different way. Philosophical counselor Elliot Cohen writes how some individuals may become depressed over not feeling guilt, even if they were not personally responsible for the event’s occurrence. And, some victims find their traumatic histories become vital parts of their identities. Personal experiences, memories, and feelings about painful events inform how we see ourselves. What does blunting memory do to a person’s sense of who they are?

NPY’s unpredictable effects on human emotion require much research. If effective, the spray might be a powerful tool for preventing PTSD in some.

Still for others, a painful memory may be preferable to none at all.

– Anjali Wisnarama, Contributing Writer, The Trauma and Mental Health Report

– Chief Editor: Robert T. Muller, The Trauma and Mental Health Report

Copyright Robert T. Muller

This article was originally published on Psychology Today

When A Loved One Attempts Suicide

When A Loved One Attempts Suicide

10Depression, Featured news, Forgiveness, Post-Traumatic Stress Disorder, Suicide, Therapy, Trauma January, 16

Source: Wayne S. Grazio/Flickr

About two years ago, I personally came face to face with the suicide attempt of my best friend, Bella.  Distraught, she had called to tell me she loved me and that I was the best thing that ever happened to her.  I listened to her cry for a few minutes until she suddenly disconnected.  I was immediately filled with a sense of fear and dread.

Soon in my car breaking the speed limit, I was yet unaware how my life was about to change.

Bella suffered from clinical depression and although she kept it a secret from most, I was well aware of her struggles.  She had two kinds of days:  bad and terrible.  Her boyfriend had just broken up with her, which sent her into a tailspin.  She was in an inescapable depressive state, filled with thoughts of suicide.

Many parents who experience such episodes with their children are plagued with mixed emotions of self-blame, anger, shock, and grief.  They often feel powerless, not knowing how to help their children, and the threat of losing them is ever present.  Bella’s parents were no different.  They were emotionally exhausted and needed a break.  When I got to Bella’s house I told her parents that I would stay with her for a couple of hours.

We watched TV in silence, and soon Bella looked toward me decidedly, as if she had finally settled on a course of action.  She told me she had to go to the washroom downstairs.

Minutes passed and she had not returned.  An overwhelming anxiety came over me, I had to check on her.  As I walked down the stairs –my heart beating rapidly and my mind venturing to the unthinkable– I saw her.  Face blue, eyes red.  She was attempting to strangle herself with a rope she had found in the basement.

Although sparse, research on the effects of witnessing a peer’s suicide attempt shows that the event can have a strong impact on the witness.  Individuals may develop varying degrees of post-traumatic stress disorder (or PTSD) or other anxiety disorders.  Experiencing powerful and recurrent memories of the event and avoiding situations that may remind one of the trauma, create a cycle of negative thoughts and emotions that can make treatment challenging.

According to clinical psychologist, Daniel Hoover of Baylor College of Medicine, anyone in direct contact with a suicide attempt should seek out treatment following the event (which doesn’t necessarily have to be one-on-one counseling to be effective).

When I saw Bella trying to kill herself, I immediately rushed over, removed the rope and hugged her.  She cried, gasping for air, furiously yelling at me for stopping her.

For a long time afterward, this image of Bella was embedded in my mind.

And I felt profoundly guilty after the incident:  If I had not let Bella leave my sight, she might not have attempted suicide.  This thought often came to mind.  A vicious cycle of uncertainty plagued my daily activities.  I was holding myself accountable for actions that were ultimately out of my control.

I kept her suicide attempt a secret from everyone in my life.  I didn’t want to hurt her reputation or break her trust, and I became tormented by the trauma, but I couldn’t confide in family or friends for fear of having to explain Bella’s story.  For the first time in my life, I felt utterly alone.

Brian L. Mishara, author of The Impact of Suicide, suggests that telephone support programs can reduce the emotional burden on family and friends.  Counselors build a relationship with their client and provide information on healthy coping strategies and useful resources –all over the telephone.  Counseling calls tend to continue weekly over a period of time until the person feels comfortable coping with their traumatic experience.

Although challenging, recovery is possible.  Two years later, I’m doing much better.  For one thing, I needed to realize that Bella’s suicide attempt was not my fault.  You can only do so much to help a loved one when they are suffering from suicidal thoughts.  We want to protect our friends and family members, but we also need to protect ourselves.

And, suffering alone doesn’t work.  Withholding your thoughts after a traumatic event can compromise your physical, emotional, and psychological health.

Coping with a loved one’s suicide attempt is not easy.  Finding someone you trust and expressing your thoughts is helpful.  It’s much easier to cope when you have a trusted ally by your side.

– Alessandro Perri, Contributing Writer, The Trauma and Mental Health Report

– Chief Editor: Robert T. Muller, The Trauma and Mental Health Report

Copyright Robert T. Muller

This article was originally published on Psychology Today

Trauma Survivors at Risk for Future Abusive Relationships

Trauma Survivors at Risk for Future Abusive Relationships

10Child Development, Domestic Violence, Featured news, Identity, Post-Traumatic Stress Disorder, Relationships, Trauma January, 16

Source: David Dávila Vilanova/Flickr

In her 2012 TED talk on domestic violence, Leslie Morgan Steiner discusses what she calls “crazy love,” the irrational and often deadly tendency to be oblivious to the red flags that indicate you are sharing your life with an abusive partner.

After discussing the typical situations that often lead to an abusive relationship, Steiner states that by asking the  question, “Why doesn’t she just leave him?” we are blaming the victim for falling in love with someone who would go on to abuse them.

While Steiner was not a victim of childhood abuse, many women and men who find themselves in similar situations are.

Victims are never at fault; no one asks to be victimized by their relationship partner. But for those who do have a prior history of abuse and who might find themselves in repetitive abusive cycles, what ability do they have to become aware of their vulnerability to future abuse?  And more important, could such awareness be helpful to them?

When children witness or experience abuse, it can have a detrimental effect on their well being as an adult.  Their experiences have been linked to the development of depression, anxiety, substance abuse, as well as eating disorders later in life.  Early exposure can also place individuals at a higher risk of experiencing abusive relationships in the future.

Joanna Iwona Potkanska, a Toronto-based social worker and trauma-informed psychotherapist says, “We tend to remain in patterns that are familiar to us.   We often do not realize that the relationships we are in are abusive, especially if we grew up in dysfunctional families.”

Based on British psychiatrist John Bowlby’s original work on attachment, theorists view the attachment style one develops as a child as related to adult relational patterns.  Internal understanding of how relationships work derives from primary caregivers and is the basis of later interactions.

“It would be foolish to say that observing domestic abuse from a young age doesn’t have an impact on a person’s future relationships.  It contributes to the construction of a child’s belief system – on how a relationship should be and what it should look like,” says Whitney Wilson, a counselor for the Partner Assault Response program at the John Howard Society of Toronto.

Wilson considers exposure to early domestic abuse as altering one’s view of romantic relationships in many ways.  “It’s similar to having a parent that smokes; smoking becomes normalized and may influence your decision to smoke.  Or, you may dislike that your parent smokes and swear off it.  It really depends on your lived experience and how it affects the formation of your beliefs.”

According to Potkanska, when we experience interpersonal trauma, whether physical, emotional, sexual or spiritual, we often lose our sense of self.  The abuse becomes part of our story and is deeply internalized.

She says that when offenders are also caregivers, victims most often blame themselves.  “The idea that we are loved as we are being abused, or that we are being abused because we are loved(many perpetrators use this excuse to justify their actions) can become a template for the way we relate to the world and ourselves.”

So, if a woman grows up with a model of relationships that involved abuse, anger, and shame, will she believe that she deserves a different kind of relationship?  Or might she believe that a relationship based on support and love simply does not exist?

It depends…  The way people make sense of their early relationships, and the conclusions they draw from them, depend a good deal on what occurs in other important relationships in their lives.  And nowhere is this seen more clearly than in the area of counseling and psychotherapy.

By working with a therapist, individuals can learn to identify how they interpret experiences based on ‘old information’ and can learn to recognize the warning signs of an abusive relationship.

Potkanska says that “without learning how to set healthy boundaries, we allow others to harm us and we re-enact conscious or unconscious situations in an attempt to have either a different outcome, or to reinforce what we already believe about ourselves.”

Healthy attachments to other supportive family members and mentors can buffer the effects of childhood abuse.  For those not fortunate enough to experience positive relationships growing up, there are other ways to break the cycle.

The connection a survivor builds with their therapist is meant to act as a model for secure attachment.  This can then translate to the way the individual perceives themselves and how they interact with others.

Potkanska emphasizes safety and space within the therapeutic relationship, noting that “Simple actions like ensuring that adequate physical space exists between myself and my client shows that I respect their boundaries.”

A large part of the therapy process focuses on building an identity that is separate from the abuse.

“Romantic partners and relationships become a way to soothe and regulate, and so when clients are taught to self-soothe, they are less likely to look to their partner to provide what their perpetrator has failed to do. They eventually rely more on themselves and other resources, including healthy relationships, to meet their needs,” says Potkanska.

Even with therapy, breaking the cycle of abuse can be difficult.  Building an identity separate from abuse can take years of self-work, and often people cannot afford therapy or have limited access to resources.

And then there are the socio-political causes that force people to remain in abusive situations.  Potkanska points out, “Without adequate financial support, women and children are reliant on their perpetrators.  Our legal system does a poor job at protecting survivors of violence, even after they leave the abuser.”  Not only that, but it is usually after the victim has left that they are in the most danger.  Simply because, as Leslie Morgan Steiner states, “the abuser has nothing left to lose.”

So what do people who’ve experienced abuse as children, but go on to have normal and healthy relationships do so differently?

According to Wilson, “It’s really an active process for all of us, even those who were not abused.  Because we’ve allowed society to normalize things like verbal or emotional abuse you have to really know what a healthy relationship looks like and know that it’s hard work.”

Being in a healthy relationship is about giving yourself permission not to have to accept abuse.  And for many, that takes practice.  You have to first identify that you’re stuck in a cycle of violence, and then decide you have the right to break it.

– Jana Vigor, Contributing Writer, The Trauma and Mental Health Report

– Chief Editor: Robert T. Muller, The Trauma and Mental Health Report

Copyright Robert T. Muller

This article was originally published on Psychology Today

Is Online Treatment the Next Frontier for CBT?

Is Online Treatment the Next Frontier for CBT?

10Cognitive Behavioral Therapy, Depression, Featured news, Psychiatry, Therapy, Trauma December, 15

Source: Mark Anderson on Flickr

Social media have dramatically changed the way many of us connect with family and friends. Some are now proposing that online relationships, particularly online therapeutic relationships may revolutionize mental health services by giving people with limited access a viable alternative to traditional treatment approaches.

One of these online alternatives, iCBT (internet-based Cognitive Behavioural Therapy) was derived from the tenets of traditional CBT pioneered by psychiatrist Aaron Beck.

Both target automatic negative thoughts that people have about themselves, the world, and their future, thoughts considered to be central to disorders like depression and anxiety.

But unlike traditional CBT where clients and therapists regularly meet in person, iCBT requires individuals to keep a journal recording their state of mind on an ongoing basis. Clients are given cognitive exercises, and their progress is tracked remotely by a therapist who reads the self-reflective journals, with feedback provided by e-mail.

The approach is currently being tested for its effectiveness in treating Generalized Anxiety Disorder (GAD). Psychologist and online therapist Marlos Postel conceptualizes iCBT as an approach that combines the advantages of structured self-help materials with the expertise of a therapist who directs activities and encourages clients.

Research from the University of New South Wales in Australia reports promising results, including improvements in patients with GAD, even compared to face-to-face treatments, with therapeutic gains maintained over three years.

Notably, many argue that online treatments eliminate an important ingredient, the therapeutic relationship between clinician and client. Research on the importance of this clinical relationship, the working alliance, has consistently shown it to be the single largest factor in predicting outcome. A central element of psychotherapy, it fosters trust, collaborativeness, and therapeutic change.

And some argue that underlying a strong alliance is the ability to detect non-verbal cues and subtle shifts in emotion that a client may demonstrate during therapy. Psychologist Madalina Sucala and colleagues from Mount Sinai School of Medicine in New York found that these cues account for a greater proportion of psychotherapy outcome than does treatment modality.

Notably, a different study conducted by Sucala found e-therapy and face-to-face approaches equivalent in outcome, despite the absence of non-verbal cues in e-therapy.

These discrepancies led researchers Gerhard Anderssona and Erik Hedman to suspect that some aspects of e-therapy may foster a different type of alliance between therapist and client. In a recent study, they found that iCBT creates a strong emotional connection between client and therapist because the therapist has more time to critically reflect on clients’ cases. Similarly, the online interactions did not affect client perceptions of how much their therapist cared for them or how much they trusted the therapist.

And co-director of the eCentreClinic and psychologist Nickolai Titov, an advocate for e-therapy, lists a number of advantages of the approach in a recent report. He found that iCBT is less-expensive—often 20-40% the cost of traditional therapy—and presents a viable alternative for rural locations where therapists are less accessible. Titov also found that many people can benefit from the relative anonymity of iCBT, as a common barrier to seeking therapy is embarrassment and fear of disclosure.

Therapists using modalities other than CBT have also started to come online. Clinicians using behavioural, interpersonal, and emotion-focused approaches have also begun offering online treatments. Even psychodynamic psychotherapy, which is traditionally a long-term, relational form of counselling, has been adapted into online formats.

Still, face-to-face mental health treatments are far from being replaced. Just as older styles of therapy are used alongside newer ones, online therapy may represent a promising treatment option for those comfortable with the format.

– Sumeet Farwaha, Contributing Writer, The Trauma and Mental Health Report

– Chief Editor: Robert T. Muller, The Trauma and Mental Health Report

Copyright Robert T. Muller

This article was originally published on Psychology Today

Officers with PTSD at Greater Risk for Police Brutality

Officers with PTSD at Greater Risk for Police Brutality

00Featured news, Health, Law and Crime, Post-Traumatic Stress Disorder, Stress, Therapy, Trauma November, 15

Source: Thomas Hawk on Flickr

After dropping off a colleague on September 14, 2013, Jonathan Ferrell began his journey home.  That night, the North Carolina highway proved more treacherous than he expected.  He veered off an embankment and, shaken but uninjured, made his way over to the first house he saw to get help.  But residents mistook his intentions and called police.

It’s unclear what transpired when three officers arrived 11 minutes later.  In moments, Ferrell lay dead with 10 bullets in his body.  Autopsy reports suggest he was on his knees when shot.

Victims of police brutality have been people of all ages, races, and walks of life – from 84-year old Kang Wong, beaten for jaywalking, to a 14-year-old boy disfigured for shoplifting, to two married university professors, one of whom had undergone open heart surgery only several days prior to being struck and dragged off in handcuffs.

Police violence does not confine itself to any one area.  Hundreds of protestors suffered physical and sexual assaults at the hands of police officers during the 2010 Canadian G20 protests.  Civilians were killed and publicly tortured by police as protestors pushed for democracy in Kiev, Ukraine.

But what puts officers at risk for engaging in police brutality?  New research from the Buffalo School of Medicine and Biomedical Science points to links between police brutality and pre-existing post-traumatic stress disorder (PTSD) in the officers themselves.

PTSD is a diagnosis traditionally used for victims of overwhelmingly stressful experiences, such as rape, combat, and natural disasters.  Many victims of police violence often experience PTSD, which manifests as severe agoraphobia and paralyzing panic attacks.  This creates a downward spiral of isolation, depression, and even suicide.  Treatments for PTSD involve facing the trauma and reconsolidating the memories in more constructive ways.

But the link between PTSD and police violence appears to be a two-way street.  Not only does police brutality have the potential to cause PTSD in victims, but according to psychiatrist, Ben Green of the University of Liverpool, violence among officers may be exacerbated by their prior experiences, their previous high incidence of PTSD, which stems from being exposed to many of the same traumas as soldiers in combat.

Yet because mental health issues continue to be a source of stigma in law enforcement, many police officers suffer in silence.

In the U.S., police officer deaths from gun violence and other causes have gone up by 42% from 2009 to 2011.  And each year, 10% of all law enforcement officials are assaulted, with a quarter of them sustaining injuries.  At the same time, public pressure on police to restrain their use of firearms against the public has reduced the number of bullets fired by officers by over 50% in the last decade.  This means that police officers are finding themselves in life-threatening situations more often, but are less able to respond, creating a state of fear and tension, factors that give rise to PTSD.

For the public, the danger of police officers developing PTSD comes from an increased startle response, suspicion, and aggressiveness.  These tendencies can make officers more likely to lash out at the public and result in the deadly overreactions that sometimes occur.

Symptoms of PTSD are often triggered by the same situations that caused the trauma.  This may be why officers who kill unarmed civilians report feeling confused and suffer from memory loss when they lose control.

While many officers cite unmanageable work stress and traumatic incidents suffered on the job when explaining misconduct, few law enforcement agencies offer comprehensive mental health care for dealing with PTSD.  Among the officers themselves, talking about trauma and mental health is oftentimes discouraged, leaving sufferers isolated or stigmatized.  At the same time, the justice system also serves to cover up the problem, imposing minimum punishments for officers and giving victims of police brutality no closure to initiate their own recoveries.

Better mental health awareness would help.  Allowing police officers to speak freely and receive treatment for their job-related stress would reduce PTSD.  Teaching fellow officers to recognize the symptoms of PTSD –including social withdrawal, personality changes, and poor decision-making – would allow them to help their partners and coworkers before problems escalate.

Giving officers access to treatment and support early on can reduce future incidents of police brutality and ensure that they get the help they need.

And understanding that police officers are often victims of violence is important for continued public trust in law enforcement.  The key is education and access to treatment.

– Nick Zabara, Contributing Writer, The Trauma and Mental Health Report

– Chief Editor: Robert T. Muller, The Trauma & Mental Health Report

Copyright Robert T. Muller

This article was originally published on Psychology Today