 This episode was prerecorded as part of a live continuing education webinar. On-demand CEUs are still available for this presentation through all CEUs. Register at allceus.com slash counselor toolbox. I'd like to welcome everybody to today's presentation, a strengths-based approach to treating PTSD. One of the things that we're going to talk about in this presentation is really looking at how some of the symptoms of PTSD are kind of functional when you look at it from a survival point of view. We're going to highlight how that stuff is functional, define PTSD, examine the function and meaning of these symptoms, and we're going to spend a fair amount of time there. Develop an understanding of why some people develop PTSD and others don't. We've found that a lot of people who experience a trauma go through it, deal with it, and don't develop PTSD. So what's different about the people who do? And the short answer is we're not 100% sure, but we do know that there are some risk factors. And then we'll explore some useful interventions for people with PTSD. So humans and animals experience reactions to prompt behaviors. You know, when something happens, when we feel a feeling, it's our brain telling us you need to either fight or flee, or, you know, that was really awesome. Let's do it again. But our emotions are basically kind of our brain signal that helps us understand what to do. So we are rewarded for things that help us survive. We're rewarded for eating. We're rewarded for, you know, getting away from the hungry lion. Reactions are designed to protect life, you know, that's kind of primary. Achieve a reward or avoid punishment, or, you know, if you can get a reward and avoid punishment at the same time, doubly better. But we want to look at things in terms of why is this happening? We know that living organisms typically do things that are most rewarding. And when we're working with clients, changing that concept of most rewarding to help them look at what's most rewarding in the right now, may not be most rewarding in the big scheme of things. So a lot of times we're trying to get them to move from a emotional, reactive, impulsive sort of action to looking at the big picture and choosing behaviors that'll help them get towards those goals of happiness and health that are rewarding in the long term. But we've got to make sure that they're at least somewhat rewarding in the present. PTSD, the way we typically think about it, traditional exposure to an event or multiple events. People who are in the military or crime victims may experience PTSD if you were in a situation where there was an extreme trauma. My stepfather's family was killed on Christmas Eve in a house fire, entire family. That's definitely traumatic. It only took one instance of that for him to develop PTSD, no doubt. Now there's also what we call gradual onset PTSD, which develops in result to repeated exposure to horrific or threatening events causing a sense of helplessness. And you're like, well, what does that mean? Well, these may not be ones that you encounter one time and it's enough to cause PTSD, it may. But when we look at it, we see people who are involved in law enforcement who have been survivors of child abuse or neglect or domestic violence. Think about their situations. They're encountering bad stuff and mega bad stuff sometimes on a daily or almost daily basis. And even if one episode wasn't enough to develop the PTSD, continually being bombarded by that trauma, by that powerlessness really starts changing the way they view the world in general. So the definition of PTSD, and I'm going to go through this quickly because you all have a DSM-5, exposure to a horrifying event in which there was a sense of helplessness. All right, now we've all seen things where we felt helpless and it hasn't caused PTSD. So, you know, again, we're going to say, all right, that's a starting point. And then we want to look at what are the rest of the symptoms. So for each of the symptoms that follows will identify the function, what may trigger that symptom or make it worse. We're going to try to encourage clients to look at how do you deal with it right now and what helps mitigate it, what helps make it so it's not quite so intense. And what are some other things that you think you might be able to do. So if you want to think back to Tuesday's presentation, when we started talking about a strengths-based approach, there are two basic things that we're looking at. Prevention, you know, vulnerability prevention, trying to make sure that they have as much energy and as much stuff kind of built up and going in the right direction as possible. They want to make sure that they're ready to handle anything that comes their way. We all do that to some extent, but we want to make sure that they are trying to prepare. And then there's sort of what I call reactive strengths-based coping skills. And those are ways that you deal with the current stressor. So you're not preventing vulnerabilities, you're actually dealing with that particular stressor. So re-experiencing the traumatic event can be experienced by clients through intrusive or upsetting memories, flashbacks, nightmares. Those are the three big ones. And then when these happen, the person has feelings of intense distress and intense physical panic reactions to reminders. So understanding that when people experience a trauma, they may re-experience it over and over again. And that is so frustrating for a lot of people with PTSD. They're like, I understand it's in the past. I want it to go away. I don't want to think about it anymore, but it seems like it's constantly coming back and it's getting triggered. And I'm having, you know, I can't go to sleep without waking up and having a nightmare. So what's the function of re-experiencing it? Well, you know, I generally ask clients what their thought is before I go on, you know, a tangent, but think about it. If your brain is bringing something to the forefront, remembering that it wants you to survive. You know, the best reward of any behavior is helping you survive. So why would your brain do that? Well, your brain is going, okay, this particular incident doesn't make sense. I want to make sure that this doesn't happen again. I want to make sure that you're protected. Okay. So if you've got this reminder going, you know, think about all the advertisements we see on TV for breast cancer prevention and all these other things, the constant reminders coming up going, you need to be aware. You need to remember to protect yourself. And you know, people may or may not want to see those all the time. Same thing with sort of, with re-experiencing traumatic events. Your brain is trying to make sure that you don't get in that situation again. So depending on the client, depending on the cause, whatever the traumatic event or events were, then we need to look at triggers. So what triggers this re-experiencing? Well, being in the same place or a similar place, we know that smells are some of our strongest memory triggers. So if they smell something, I worked with a client who was a law enforcement officer and responded to a crash on the interstate. Well, long story short, one of the people in the crash got pinned in the vehicle and the vehicle blew up and the officer had to watch the person burn to death. Totally traumatic, felt totally helpless. And, you know, I get that. Smells getting on the interstate and smelling exhaust, even being in the city and being at a stoplight and smelling car exhaust could trigger a flashback. So helping him understand that when he smelled that his brain was going, okay, seems like somewhere we've been before. Don't want to go there again. Helped him get a better understanding of why it was happening. And then we wanted to look at what can you do to help your brain understand you're not there anymore. You're in the present. So we started talking about what mitigates these flashbacks or nightmares or intrusive memories. We want to help people become aware of the things in their environment that may trigger it. If they are a rape victim, watching law and order special victims unit or criminal minds, probably not the best thing, because, you know, there are a lot of sexual assault scenes. In those sorts of, in those sorts of shows. I have a good friend who was in the military did eight tours, and he will not watch certain shows or most shows that have to do with sort of docu dramas about the military black Hawk down won't go anywhere near it. So, being aware of the things that will trigger it and a lot of people think about visual triggers. But we want to make sure they're aware of smell triggers, as well as maybe time of day triggers or even time of season. If you've ever gone outside, I love the fall. It's my favorite season. Go outside and I can smell the crispness in the air, and it reminds me of, you know, past falls. That's a pleasant reminder. But so something is innocuous as the smell of the air can trigger a flashback for people. Things that they see, etc. So make sure they go through all of their senses, seeing, hearing, smelling, even tasting. Sometimes when you're in a situation you get a certain taste in your mouth. And whenever you have that taste in your mouth again, it puts you back there. And in touch. What did they feel at that particular point in time? When, you know, you're in a situation where there's fire involved, you may feel the intense heat from the fire, which may come back and trigger a flashback. So encourage people to be aware of all the triggers. Does that mean they have to avoid all these? Heck no. They would end up not having a quality of life. Once they become aware of them, then they can develop some grounding techniques that can help them stay in the present and go, okay, I'm safe right now. Nothing bad is happening. Exacerbating factors would be other things that they're not doing preventatively. So I might ask, you know, are there times when you're not having as many nightmares or as many flashbacks? And what's different then? Maybe they're getting more sleep. Maybe they are exercising more. Again, maybe it's a different time of year. Maybe there's a particular time of year for my stepfather, obviously the holidays themselves beginning like right before Thanksgiving and all the way through Christmas are really tough for him. And that's when he starts having more symptoms. Being aware of that so he can take better care of himself and know how to set certain boundaries and go, I can't do that right now. And the supportive people in your client's network also need to be able to be aware of that so they can be supportive and go, okay, I know this is a rough time of year for you. How can I help? So re-experiencing is one of the symptoms that brings a lot of clients into treatment with us because this oftentimes impairs their activities of daily living. I mean, they feel like they can't get away from it. When I worked in community mental health, we had one unit that was filled exclusively with military and former military people, and they would have night terrors a lot. So we would want to talk about what's making them worse, what's making them better. These particular gentlemen, it was a male unit, were also detoxing. It was a co-occurring disorders facility. And they were detoxing from substances that they'd been using to numb and silence, if you will, the memories and the flashbacks. And when they couldn't access that, guess what? It got worse for a little while. So they had to figure out, okay, what can I do to deal with this? The intense panic reactions will talk about what a panic attack feels like. What's the purpose of it? You know, that's your body really gearing up to help you fight or flee. Okay, so if you notice that you actually don't need to fight or flee, you look around and you go, okay, I'm safe. How do you diffuse that? And we talk about, and I referred to it last presentation, combat breathing. Breathe in for four, hold for four, exhale for four. By slowing down your breathing, your heart rate automatically starts to slow down. The faster people's heart beats and the faster and shallower they're breathing, the more likely they are to start getting dizzy, which tends to make them feel even more scared and exacerbate the panic reaction. Okay, so you have that whole flashback thing, and I just kind of put re-experiencing in terms of flashbacks, whether it's in nightmares or memories or whatever. Then we have this next category, which are symptoms of avoidance and emotional numbing. Well, golly, if you've been through a traumatic event, do you want to keep going through that? Do you want to experience it? Do you want to feel it? No, I have never met a person with PTSD or who's gone through a trauma that goes, yeah, you know, let's do that every day. No, it sucks. So understanding that avoidance and emotional numbing is protective. It's you going, I can't, that's painful. I don't want to do that again. So that's the function. Understanding that the mind is going, you need a break. You need a breather. Avoiding reminders of the trauma. Again, depending on the situation, reminders of the trauma can be in the news. They can be on regular TV shows. They can be in books. They can be driving down the road. There are probably a lot of triggers out there helping people become aware and desensitize to some of those reminders is going to be helpful. I ask clients when they're exposed to reminders of the trauma, again, what helps them not have a flashback? What helps them get through that situation? Inability to remember important aspects of the trauma. And this is one that befuddles a lot of people. And, you know, we're not really sure exactly why, but there is a hypothesis that during a traumatic event, the brain actually secretes certain chemicals that prevents memory formation. It's kind of protective because you really don't want to remember this. You know, we're going to break up those memories so they're not there. Another theory, which is a little less neurobiological is that people remember stuff, their brain allows them access to things when they have the ability to deal with them. I've worked with clients who they write their autobiography and, you know, I'll read it and but over the course of 30 days, 60 days, 90 days that they were in treatment, they would remember more things. They're like, hey, I had, I didn't even remember that happened or I hadn't thought about that in 20 years. Okay, you know, why did you not think about it when you first wrote your autobiography? You know, you had a lot of other stuff going on and maybe it was just too much for you to handle. So subconsciously, you put it behind a wall. Whatever makes sense to the clients. One of the things I like about the second theory is that when it does or if it does come out, if they start having these memories later on, they can understand it a little bit better than if they started out with a belief that the brain prevented that memory consolidation. Again, we don't know why it happens, but think about how it's benefiting you. If you can't remember important aspects of this trauma, important details, how can that be protective for you? And that's where I come, come at it from or the direction I look at it is each one of these symptoms. How is it protective for you? Because a lot of people look at their symptoms as harmful, you know, and negatively impacting their quality of life. And that's true. I am not disputing that in one bit, but let's walk the middle path, if you will. What's the benefit to it? In what way has it served you until now? You know, we can develop new skills, so you don't have to use that one anymore. But until now, how has it helped you stay safe, healthy and sane? Loss of interest in activities and life in general. Well, when the brain is really stressed, sometimes it quits sending out norepinephrine and dopamine. It goes into conservation mode and it goes, I'm really stressed. I'm feeling like there's threats everywhere. I don't feel safe. So I'm going to go into conservation mode because fighting this PTSD trigger and this PTSD thing, I'm not winning. So there's no point to continue fighting. Well, and one aspect that's good because it's not putting out as much energy on, you know, fighting a losing battle. On the other side, when you don't have norepinephrine and dopamine, you're not going to experience pleasure either. So understanding that HPA axis and helping clients understand it can help them understand some of their emotional numbing. Sometimes they've already dumped as much of their get up and go chemicals as they've made, you know, they are just running on empty, which can help them or cause them to feel a loss of interest and detached from others or emotionally numb. Think about a time when you've been really stressed and I mean really, really stressed, not just it was a bad day at work. And you were just like, you know what? I like my friends. I like my family, whatever, but I cannot take input from one other thing. I'm just I'm at that point where I can't do that PTSD is kind of the same way. When someone is experiencing PTSD they haven't moved to the place where it's not causing a constant threat a constant bombardment with signals that you may not be safe. So feeling detached from others or emotionally numb is also a way to protect oneself because you're already kind of overwhelmed. What do we look at for mitigating factors? So we look at each one of these and we've already talked about reminders of the trauma. Mitigating factors with remembering important aspects. A lot of times I'll talk to my clients about what, why is it so important to remember all the details to you right now? You know, help me understand what you're going to gain by remembering that. And a lot of times it comes down to a sense of power and control. I want to be able to remember it so, you know, I don't feel like I'm going crazy. Okay, I get that. Looking at the underlying motivations, then we can start saying, okay, you may not be able to remember those things right now. What can you do to help yourself move past that? Loss of interest in activities and life in general. What are you doing? Because you're probably not experiencing that every single day. And if you are, are there any periods during the day where there's something that might pique your interest a little bit? These are the same questions we ask clients with major depressive disorder. If you are generally apathetic and can't find pleasure in much of anything, is there anything that makes you smile? What can you do and what are you doing right now to help yourself keep moving forward? Same thing with feeling detached from others or emotionally numb. Social support is so important. However, you know, there's a difference between having a friend that you call or text with when you're feeling really stressed out versus going out on a Friday night, which can be completely overwhelming. So what are you doing to maintain your social support network and allow them to be able to be there to help you when you need it? Symptoms have increased arousal. So we've got some emotional numbness, but we may also have increased arousal. So how does that happen? Think about a soldier in a foxhole. That's the best analogy I can give you where they may be exhausted. They may just kind of be emotionally numb. They don't even have the energy or the neurochemical balance to feel pleasure and excitement right now, but they are always on. They're always listening. They're always waiting for whatever is going to come towards them to hurt them, which results in difficulty falling or staying asleep. And when you do get to sleep, it's probably not that good deep sleep that we all love so much. I'm going to have a whole bunch of side effects from that because the brain's not having time to rest and rebalance irritability or outbursts of anger. Again, even if you haven't had PTSD, think to a time when you've been really stressed and somebody has come up and said something that normally wouldn't bother you. But this time you just you didn't have anything else left to give you had no filters left. You were just irritability. Well, what's the function of that? What does the outburst of anger do? A lot of times it pushes people away. It sets a wall between you. It gives you some power over them, protects yourself. You know, I ask clients, what does anger do for you? Because it's different for each client. Difficulty concentrating. Well, if you're trying to pay attention to every single stimulus that comes in and make sure that nothing sneaks up and bites you in the butt. Yeah, it's going to be difficult to concentrate because you're not filtering out the extraneous stimuli. You're on high alert, which takes us to hyper vigilance. So you hear things and you startle and you jump and you're trying to assign meaning, which it gets exhausting. I love my children. I volunteered at their preschool when when they were little, obviously their teenagers now. But being in a preschool room with 15 little people who all wanted something had to go to the bathroom. We're putting the wrong things in their mouth and this and that and the other thing. I developed a huge appreciation for preschool and kindergarten teachers because I'm like, by the end, I was just over it. I was exhausted. Well, think about living like that day in and day out where you can't not pay attention to what every little kid in the room is doing. So anytime you hear something fall, you're going to be like, okay, who broke something? What happened? It wears on you after a while. So understanding the function obviously is to protect the person. So we want to look at what are some of the triggers for it. And we're going to talk about some interventions later, but I do ask them what do you do now to help yourself fall or stay asleep? A lot of times I get answers that aren't necessarily the healthiest way of responding, but they are trying. They realize they need sleep. What triggers irritability and outbursts of anger? So we want to look at for that particular person. Are there particular types of things that just really get under their skin when they're under stress? How do you help yourself concentrate when you've got to and when we talk about concentrating, I'm not necessarily saying solve a calculus problem. I'm saying focus on driving from point A to point B and not get lost in La La Land or in the middle of a flashback. So we want to talk about what they're already doing to deal with these symptoms. And then once they understand the function of the symptoms, we can look at other ways to also help them deal with the symptoms. So how can you deal with this increased arousal? And here's a hint, cutting back on stimulants usually ranks right up there in addition to environmental interventions to help them feel safe. So other common symptoms of PTSD, anger and irritability, headaches, stomach problems, chest pain. Do these sound a lot like anxiety symptoms too? Guilt, shame or self-blame. Now I put assimilation here. If you remember back, golly, and I think it was Piaget, who talked about assimilation and accommodation. Well, whatever happened does not fit into Jim Bob's schema of what life was supposed to be like and what's fair and what's supposed to happen. So this event is out here and sometimes people will say, okay, I must have done something because life wouldn't do that. So what did I do to bring this on myself? Remember assimilation instead of changing your schema is changing your memory about what happened to make it fit in your schema so they can make it somehow fit into their just world belief. So that's another thing that we can talk about. Where is the guilt coming from? What do they have guilt for? Substance abuse. A lot of times that will come up and it may not be addiction. What we're looking at is substance misuse if they're drinking so they can drink enough that they pass out and get to sleep at night. You know, breaks my heart when I hear that and we talk about the side effects of the alcohol and all that kind of stuff. But I also don't want to tell people what they're doing is wrong because it's helped them survive until now. So I want to say, all right, I want to assess how they feel about their alcohol use or their abusive sleeping pills or whatever it is. And we'll talk about is that concerning to you and what else could we do instead? Depression and hopelessness and suicidal thoughts. Well, if you're feeling this way for a long time and when you're feeling this way two, three, six weeks is a long time. Then you might start feeling hopeless and helpless because you feel like your brain is out of control. You're having these flashbacks. You're not feeling anything. Nothing makes you happy anymore, which can lead to suicidal thoughts. So we want to be aware that sometimes clients who come in with what we would initially term generalized anxiety or depression with suicidal ideation may also have a PTSD component. Feeling alienated and alone. Well, going back to this last slide. Well, no, the one before that feeling detached from others or emotionally numb makes sense that you feel alienated and alone. It's not that you want them to go away, but you can't, you're not feeling the same thing. And feelings of mistrust and betrayal. When your entire world has been turned upside down, or the thoughts that you have about justice and fairness and how life is supposed to be. Then it's easy to have feelings of mistrust and betrayal of people around you as well as your own spidey senses. A lot of times people with PTSD have difficulty identifying what's safe and what's unsafe and what's a helpful intervention and what's not so helpful, especially in the moment because they don't trust themselves anymore. They trusted themselves when whatever happened happened and look how that turned out. So now they're questioning their own judgment. So triage. I said not everybody develops PTSD. Well, this is not a be all and all for identifying who will and who won't, but it does give you some indication. If the person was similar to the victim or they were the victim, then they may develop PTSD. So when we're talking about law enforcement officers who go on scene to situations and they see they have maybe they have a five year old at home and they see a five year old who was abused within an inch of his life or who drowned in a swimming pool. Well, they're really similar to that parent who is grieving and traumatized now. So they may feel similarly because they can imagine themselves so much easier in that position. Proximity to your safe zones, either home or work. Now this isn't as much true for military unless they get ambushed in their at their camp, but being aware that when things happen. If it happens in a place where you were supposed to be safe, your office, your, your car, if you get car jacked, your, your home, then it may be more traumatic because that schema. Remember, you had was that these are the safe places in your mind. You knew there are other places that aren't safe, but you believe that you had this safe bubble around wherever it was. I felt that way when I was in college, I went to the University of Florida during the murders back in 1990. And that shocked all of us, because the campus, everybody thought that was safe. I mean, you'd see all of us out running and jogging and headphones on in the middle of, in the middle of the night, 10 o'clock jogging down the street, because we felt safe we had that fallacy that we were in a protective bubble. So it's important to look at how close to this occur and it did it burst somebody's safe bubble because that makes them more vulnerable to PTSD and not just the normal progress. How much social support did they have after the trauma? Now this is interesting because they find that social support is crucial, most effective within the first 24 hours. After that, you know, it's still crucial, but people who get social support within the first 12 to 24 hours tend to fare better than people who don't. In the military, you know, this is not the time where you can be like, okay, that was really awful. Let's talk about it. And that might not be it. In law enforcement, a lot of times after a critical incident, they're told they can't talk to anybody because it's under investigation. The only people they can talk to are licensed clinicians that have privilege. But a lot of times they don't want to talk to us either because there's a stigma in their minds about talking to us. So we want to find out how much social support the person had. One of the things you can do when you're working with people who may be from law enforcement or whatever, or helping somebody who has PTSD is to help them understand that social support doesn't necessarily mean knowing all the details about what happened. Social support just means being there and going, whatever you need, I'm here. And maybe it just means sitting with them or calling and checking in on them once in a while. It may not mean talking about anything at all. So it's important for the person to understand and be mindful if they can of what they need. But it's also important to educate the social support others about what social support looks like. It's not always talking. If the person has a history of mental health problems, and I don't like that word, but if they do have a history of depression, anxiety, other PTSD incidences, substance abuse, then there is a greater likelihood that they might develop PTSD. And I want to make sure to hedge that as much as possible because none of these are truly indicative. There's just correlations here. And how many stressors have they had in the past six months? This comes up to that prevention on strengths-based interventions. What have they been doing? Were they taking care of themselves? Were they well-rested? Did they have their mental and physical house in order ahead of time? Or were they already exhausted, worn down, angry, anxious, yada-yada? Well, if you're already kind of struggling, then when life hands you lemons, you may just not know what to do with them. You may not have the energy to deal with it. You may not have the neurotransmitter balance to deal with it because they're already at a whack. So we want to look at these things and say, is there a likelihood that this person who's just recently experienced a trauma might develop PTSD? And why? Well, the reason is because if we can prevent it, it's going to be a whole lot easier to help the person than if we wait through that acute stress phase to see if, you know, in a few weeks the person develops PTSD. So let's look at prevention. So when you're talking to the client or the person, maybe you are a first responder. If you weren't the victim, how were you similar to the victim? How are people around you similar to the perpetrators? You know, that can be another trigger. What was or would have been helpful for people to do for you after the trauma? Because sometimes we're, oftentimes we're seeing someone a week, two weeks, six weeks later. So this is giving us an insight into what kind of social support might have been helpful because we can start doing that now. It's never too late. I mean, it's better to start earlier, but it's never too late. And what symptoms are you having? What makes each better? What makes each worse? I don't want to go into a whole bunch of detail about superfluous things. If somebody is presenting right after a trauma, I want to help them identify kind of what's going on, understand it, and develop some preventative and strengths-based steps that they can take. So like I said, you have prevention and resilience strengths, which are things they will do on a daily basis to stay healthy and happy. They have nothing to do with the trauma. It's just doing what you need to do to be your Uber self. And then intervention and coping strategies. We want to look at, in the past, when you felt this way, what helped. And they may not have had PTSD before. You know, hopefully they haven't. But in the past, when you felt anxious or you couldn't sleep or you were depressed or feeling isolated, what has helped. So we want to look at the specific symptom and ask them what has worked in the past. And again, it may not have worked to fix it. They started doing it and all of a sudden they never had that symptom again. But if they started having a symptom and they did something and it helped for four hours, well, score. That's somewhere to start. We know that works at least a little bit. So how can we help you integrate that into your recovery plan now? And what makes these things worse? When you experience similar symptoms in the past and you've tried to fix it, what made it worse? What can you do to take back your safe zones? And how are you protecting yourself now? So we want to ask them, how can you feel calmer? How did the experience change how you view things, what's important to you, and how you will live your life now? Most people, when they go through a trauma, the effects are far reaching. It doesn't just affect one or two things. It affects how they interact and how they perceive the world and maybe even whether they, how they interact with their higher power and all that kind of stuff. So we want to know how this changed the person. Does that mean we have to unchange them? No, but we want to help them integrate this into what I call their life narrative. So they're writing a book and all of a sudden they come to this chapter where this awful thing happens. And how do you close out the chapter and what happens to you, the protagonist in the book, throughout the next few chapters? What do you see happening and how do you want it to play itself out? Encourage people to identify places and times when they feel safe versus unsafe and compare them. And brainstorm different ways to create safety at home, at night, in the car, at your office. You know, I told you my husband was in law enforcement for 20 years and I've got friends who are in the military. None of them will sit with their back to the door. And I just know that. So I automatically choose the seat with my back to the door. Understanding what makes you feel more comfortable. At night, you know, some people prefer and I'm one of them. I draw my blinds at night. I hate being able to not see out and know everybody else can see in. In the car, what can you do to feel safe? You know, putting on your seatbelt, locking the doors. How can you make sure that you feel safe when, when I was pregnant with my son, I had something called superventricular tachycardia, which, you know, is just a really long way of saying my heart would start racing for no apparent reason. So when I was driving, I learned to stay in the far right lane so I knew I could always get off onto the shoulder. Should I start having one of those episodes and it helped me feel calmer because the, my doctor was like, yeah, really the only way to fix that problem is to have the baby. I'm like, well, I got six months left before that happens. So that was one thing I did to help myself feel safer so I didn't feel, you know, trapped at home or at work. And what can you do at your office? You know, for us, we go through all the training about how we need to make sure that the client is never between us and the door. And we want to make sure any weapons, anything on our desk couldn't be used as a weapon. Have, have clients do the same thing, assess their environment and see what makes them feel unsafe and what could be changed. Sleep balances neuro, neurochemicals helps reduce cortisol and may help improve adrenal fatigue or the effects of having an HPA axis that's been on overdrive for a while because of the PTSD. In order to feel safe enough to sleep and to actually relax enough to sleep, what do you need to do? I encourage people to look at Feng Shui. They can get the, I think it's the for dummies guide. I always get all those for dummies and idiots guide mixed up. But it's real basic principles. They can also go online and look at real basic principles. One of them, for example, is putting mirrors up. So in places where somebody may walk behind you, so you're never startled. That way you can always see people coming up behind you. And just using common sense, lock your door. Those are certain things that people can do anchoring. Sometimes people with PTSD wake up with nightmares, you know, go figure, or they just wake up and they can't quite get grounded or they feel startled. What can you do or what can they do? So when they awaken, they can get in or stay in the present moment so they can get oriented, especially if you get awakened from deep sleep. It takes a minute to kind of get your bearings and that's really freaky for somebody with PTSD. With the clients that I worked with that were, had military history, sometimes for them keeping a small nightlight on in the room and we used the red light night lights so it wasn't as problematic for their sleep. And we also made sure that they had a bed, a bed, a light right beside their bed that they could turn on as soon as they woke up so they could see clearly what was around and get regrounded instead of having to kind of grope around and try to find the light switch on the wall across the room. Encourage them to have a safety item, whatever that is that helps them feel safe, and that can include installing alarms in the house, or even just having a dog that will bark. You know, dogs are great support, emotional support companions, if you will, for people with anxiety and PTSD. Pay attention to sounds, smells and sights in your environment when you're going to sleep. A lot of people with PTSD wake up at the slightest little sound and they'll wake up with a start because their brain is telling them they're not safe. So what can you do to kind of drown out, if you will, some of those sounds like the house creaking or the owl flying by or whatever it is. White noise machines are really helpful, earplugs, if they're willing to do that. A lot of people with PTSD are not willing to do earplugs because they feel it makes them more vulnerable not being able to hear. And that's cool. We want to see what works for that person. I don't want to push them in a direction that's, you know, even more stressful. What smells are around? Can you put smells in your environment that help you feel relaxed and prevent any that might make you feel stressed out? And then sights, when you're going to sleep, you know, you close your eyes and whatever's in your room is kind of the last thing you see. So what things can you put in your room that can help you feel safe and relaxed? Encourage people to develop a sleep routine to let their bodies know when it's time to sleep. Find ways to release stress and tension. Maybe it's exercise, maybe it's journaling, maybe it's, I don't know what it is. Help people figure out how they can release some of that nervous energy that they may have and then create that sleep routine. And especially avoid triggers before bed like television shows, news, email. If email is one of those that's kind of weird, but for some, for some people it is a trigger. And we're also talking about anything that may trigger a person's sense of powerlessness, not necessarily just triggers related to the PTSD, because that can set them down a road. There is medication, they can talk with their doctor about it if they feel they need assistance getting to sleep. Guided imagery is a wonderful tool to help people relax and get to sleep. I've told you all before, I usually plan my garden, you know, I'm not one that can think about going to a deserted beach somewhere or whatever. I guess I could, but that usually doesn't put me to sleep. I know that if I start planning out my garden or some home improvement project I'm getting ready to do. I think I bore myself to sleep quite honestly, but it helps because I'm focused on that and its detail, not on the sounds that I'm hearing or anything else. And progressive relaxation, scripts are online, they can download those. Social support, encourage them to find friends, family, support groups, they're out there, and clergy that could be social supports. Have them of course look at what they've got in their arsenal right now and enhance those relationships. But these people need to be non-judgmental and available, and I say 24-7-ish, because you know nobody's available 24-7-365. But they need to know they have someone they can call at three in the morning if they wake up and they're in the middle of a wicked night terror. There are hotlines available, PTSD hotline, PTSDUSA.org. Those are both generally directed towards soldiers, there are other PTSD resources out there. And if someone's been a survivor of sexual assault, the rain.org also has a 24-hour hotline. So take whatever the particular trauma was, Google it, see if there's some sort of hotline or support group. Most cities, counties, parishes have some sort of crisis intervention hotline. So even if you can't find a particular one that's geared towards a particular trauma, make sure they have someone they can call even if it's just the crisis hotline so they can reach another human being. Friends, anybody they reach out to needs to be empathetic and willing to help them meet their health and safety needs. And if it's calling the crisis hotline, you know that person can't do a whole lot, but they're going to be there and willing to talk, which fills that gap. And sometimes people will need somebody else to help handle the details, especially right after the trauma. So who can help you handle the details about what you need to do? And this is daily activities, getting the kids to school and doing laundry and everything else. Depending on the level of trauma, the person may not be planning that far in advance, everything just may be a jumble. So initially, after a trauma, it's good to have somebody who can help you do whatever you need to do to kind of get back into that rhythm of daily living. Some things you logically know are not threatening, but still evoke a startle response. So desensitization can help. Acknowledge the event. For example, if you're in an event where there was either a car crash or somebody got shot, you know, those are two really loud bang type noises. And, you know, later on down the road, when somebody slams a cabinet door, it makes you crawl out of your skin. Okay, well, logically, you know that that was a cabinet door not threatening, but momentarily it threw you back into that situation. So acknowledge the event. Be kind to yourself, not the, oh, I should not be getting upset over this. Well, you are. So it triggered that response. Let's just deal with it. Recognize the value of the startle response and remembering that when that sound happened in the past, you potentially were in danger and you felt helpless. So your brain's actually going, are you sure we're safe? Recognizing that is a huge step into accepting the bodily reactions. Identify times when your startle response might be greater. So if loud noises startle you, you know, what things, what environments might be more stressful and more likely to trigger that. Think about being in a library versus a restaurant. If you're in the library and somebody makes a loud bang. For most people, that's more startling than if they're in the middle of a restaurant and somebody drops a tray. Because in the restaurant, there's already a lot of ambient noise. So that doesn't change the decibels quite as much as being in a dead silent library and then all of a sudden pow. And identify ways to mitigate the startle response. Once you feel it, you acknowledge it, you realize you're not in danger, what can you do to help calm down? Take a few deep breaths. What is it that works for that person? Cognitive processing therapy can be helpful because it helps people ask themselves certain questions to identify whether their thoughts are kind of on point or a little off. So in the example of a rape victim, what happened? The person was raped. What's the belief? They may have beliefs like I will never be safe. It was my fault. All people like him, whatever that him is or her are bad. Okay. So we want to take one belief at a time and ask them, is the belief based on facts or feelings? And a lot of times it's based on feelings at this point because they're really feeling they're going from a gut instinct reactive point of view. How reliable is the source? Well, you know, the gut may feel kind of reliable at this point. Are you using extreme words? Well, I will never be safe. It was and I kind of interject in there all my fault. All people are bad. So we're using a lot of extreme words there so we can help people kind of rephrase it so it's more accurate. Is the belief based only on part of the picture? In what ways does the belief protect you? If you believe you will never be safe again. How does that protect you? Again, there's a purpose. There's a function. We just have to help help you figure out a better way to meet that need. How can you use your best, how can you best use your energy now? You know, do you want to continue fighting with that or what can you do that's more positive? Encourage people to engage in stress management activities when they're recovering from PTSD. And this is almost a second treatment plan issue. But you can't squeeze blood from a turnip. If they are already worn down and exhausted, they're going to have a hard time getting rebalanced and recharged. If they're draining the system with all these other stressors. You know, there's PTSD, which dealing with that's a full-time job. And then you've got your job and your family and whatever else is going on. So encourage people to look at their emotional health, physical health and their social needs. What works for them? Some people are not huge extra hearts. And that's cool. What do they need to feel supported, loved, you know, all that stuff. Trauma recovery. Help clients realize that there are a lot of things that they may need to grieve in the recovery process. They lost control in that situation. They lost a sense of safety, most likely. They may have lost some hope about mankind or about their ability to handle this. They may have lost some idealism. They may have a bunch of other losses that I don't even have listed here. Each one of those losses needs to be grieved. And, you know, just with any other grief thing, they need to go through the stages. Anger, bargaining. You know, some people don't really stay there very long. Depression and finally acceptance. So yes, you lost control. And, you know, let's talk about why you're angry about it. Move on to depression, the hopelessness, the helplessness. Now, how can we write that into your narrative? So, you know, you didn't lose control over everything all the time forevermore. For each loss, you want to ask people, what about this makes you angry? And how can you deal with this anger healthfully? Anger is there to protect you. It's your fight-or-flight mechanism. So just because it exists, you know, that's your body telling you something. How can you deal with it healthfully? Depression signals a sense of hopelessness or helplessness. So about what can you feel hopeful? And how can you help yourself feel empowered? Now, this particular situation, you know, there may not be a whole lot of things, but helping people move from the victim perspective to the survivor perspective is kind of where we're moving here. So PTSD can be from a single event or multiple ongoing stressors. Traumatic events can change people's beliefs about the world in an extreme way. Not just about this one thing, but about life in general. For some people, understanding the function of the symptom can help them desensitize to it. So when they feel it instead of going, oh my gosh, they're like, oh, this again. They can modify their beliefs and understand, okay, this is supposed to be protecting me. It's really starting to get annoying. This is what I can do. And it can help them make positive, mindful choices about what works for them, not only to help them feel energized and healthy and bolstered against the PTSD symptoms, but also to help them deal with the PTSD symptoms. If you enjoy this podcast, please like and subscribe, either in your podcast player or on YouTube. You can attend and participate in our live webinars with Dr. Snipes by subscribing at allceuse.com slash Counselor Toolbox. This episode has been brought to you in part by Allceuse.com, providing 24-7 multimedia continuing education and pre-certification training to counselors, therapists, and nurses since 2006. Use coupon code, Counselor Toolbox, to get a 20% discount off your order this month.