Thursday's Therapy Ways We Grieve, Part Nine - PTSD in Child-Loss Grief

Thursday's Therapy

Ways We Grieve

Part Nine

Post-Traumatic Stress Disorder

in Child-Loss Grief

Definition

Post-traumatic stress disorder, often abbreviated as PTSD, is a complex disorder in which the affected person's memory, emotional responses, intellectual processes, and nervous system have all been disrupted by one or more traumatic experiences.

PTSD is sometimes summarized as "a normal reaction to abnormal events."

The DSM-IV-TR (the professional's diagnostic manual) classifies PSTD as an anxiety disorder.

The most frequently mentioned traumas are:

• witnessing someone being badly hurt or killed
• involvement in a fire, flood, earthquake, severe hurricane, or other natural disaster
• involvement in a life-threatening accident (workplace explosion or transportation accident)
• military combat

The traumatic events most frequently mentioned by men diagnosed with PTSD are rape, combat exposure, childhood neglect, and childhood physical abuse. For women diagnosed with PTSD, the most common traumas are rape, sexual molestation, physical attack, being threatened with a weapon, and childhood physical abuse.

Description

PTSD has a unique position as the only psychiatric diagnosis (along with acute stress disorder ) that depends on a factor outside the individual, namely, a traumatic stressor. A patient cannot be given a diagnosis of PTSD unless he or she has been exposed to an event that is considered traumatic.

Causes and symptoms

Causes

When PTSD was first suggested as a diagnostic category for DSM-III in 1980, it was controversial precisely because of the central role of outside stressors as causes of the disorder. Psychiatry has generally emphasized the internal weaknesses or deficiencies of individuals as the source of mental disorders...

BIOCHEMICAL/PHYSIOLOGICAL CAUSES. Present neurobiological research indicates that traumatic events cause lasting changes in the human nervous system, including abnormal secretions of stress hormones. In addition, in PTSD patients, researchers have found changes in the amygdala and the hippocampus—the parts of the brain that form links between fear and memory. Experiments with ketamine, a drug that inactivates one of the neurotransmitter chemicals in the central nervous system, suggest that trauma works in a similar way to damage associative pathways in the brain. Positron emission tomography (PET) scans of PTSD patients suggest that trauma affects the parts of the brain that govern speech and language.

Symptoms

DSM-IV-TR specifies six diagnostic criteria for PTSD:

• Traumatic stressor: The patient has been exposed to a catastrophic event involving actual or threatened death or injury, or a threat to the physical integrity of the self or others. During exposure to the trauma, the person's emotional response was marked by intense fear, feelings of helplessness, or horror. In general, stressors caused intentionally by human beings (genocide, rape, torture, abuse, etc.) are experienced as more traumatic than accidents, natural disasters, or "acts of God."

• Intrusive Symptoms: The patient experiences flashbacks, traumatic daydreams, or nightmares, in which he or she relives the trauma as if it were recurring in the present. Intrusive symptoms result from an abnormal process of memory formation. Traumatic memories have two distinctive characteristics: 1) they can be triggered by stimuli that remind the patient of the traumatic event; 2) they have a "frozen" or wordless quality, consisting of images and sensations rather than verbal descriptions

• Avoidant symptoms: The patient attempts to reduce the possibility of exposure to anything that might trigger memories of the trauma, and to minimize his or her reactions to such memories. This cluster of symptoms includes feeling disconnected from other people, psychic numbing, and avoidance of places, persons, or things associated with the trauma. Patients with PTSD are at increased risk of substance abuse as a form of self-medication to numb painful memories.

• Hyperarousal: Hyperarousal is a condition in which the patient's nervous system is always on "red alert" for the return of danger. This symptom cluster includes hypervigilance, insomnia, difficulty concentrating, general irritability, and an extreme startle response. Some clinicians think that this abnormally intense startle response may be the most characteristic symptom of PTSD.

• Duration of symptoms: The symptoms must persist for at least one month.

• Significance: The patient suffers from significant social, interpersonal, or work-related problems as a result of the PTSD symptoms. A common social symptom of PTSD is a feeling of disconnection from other people (including loved ones), from the larger society, and from spiritual or other significant sources of meaning.

To Recap Symptoms:

*Exposure to a traumatic event

having witnessed or been confronted with an event, either natural (such as a flood or hurricane) or man-made (such as rape, war, physical, or sexual assault), in which one was actually injured or threatened with injury or death.

The traumatic events cause the victim to experience an intense response such as tremendous fear, terror, or helplessness. The event could have occurred at any time in the past.

*Persistent re-experiencing of the trauma, including

• nightmares,
• flashbacks,
• insomnia,
• intrusive thoughts of the trauma,
• becoming panicky and shaky when thinking of the trauma,
• becoming upset around the anniversary of the event.

The re-experiencing of feelings such as fear, shame, and guilt, among others, leads to avoidance of the pain of re-experiencing the trauma, (this leads to a greater need for help). Avoidance can take many forms such as not wanting to talk or think about the trauma and avoiding certain places or activities in order not to be reminded of the trauma.

*Increased arousal, including

• becoming irritable and angry,
• being unable to sleep or sleeping too much,
• becoming overly concerned with one’s safety,
• exaggerated startle response.

BIOCHEMICAL/PHYSIOLOGICAL CAUSES.

Present neurobiological research indicates that traumatic events cause lasting changes in the human nervous system, including abnormal secretions of stress hormones.

In addition, in PTSD patients, researchers have found changes in the amygdala and the hippocampus—the parts of the brain that form links between fear and memory.

Experiments with ketamine, a drug that inactivates one of the neurotransmitter chemicals in the central nervous system, suggest that

Trauma works in a similar way to damage associative pathways in the brain.

Positron emission tomography (PET) scans of PTSD patients suggest that trauma affects the parts of the brain that govern speech and language.

We now understand that autonomic nervous system arousal is the basis of Post-Traumatic Stress Disorder. PTSD is a very real, physical injury to the autonomic nervous systems fight or flight response. PTSD is classified as an anxiety disorder.

Post-traumatic stress disorder (PTSD) is a complex disorder in which the affected person's

• memory,
• emotional responses,
• intellectual processes, and
• nervous system

have all been disrupted by one or more traumatic experiences.

PTSD is a normal reaction to trauma, NORMAL.

PTSD is NOT evidence of a MENTAL Illness.

PTSD does not mean you are weak, defective, or crazy.

Having PTSD after a trauma means you are perfectly NORMAL, and sane.

You did not deserve what happened to you.

You do deserve to recover.

Research from

http://www.minddisorders.com/Ob-Ps/Post-traumatic-stress-disorder.html

http://www.aftermathofwarcopingwithptsdtoo@groups.msn.com

http://vets.yuku.com/topic/7787/t/Wives-Combat-PTSD-support-site.html

GRIEF THERAPY

GRIEF THERAPY

For years, we psychotherapists got it wrong!

We meant well. We went with the most current studies and 

research at the time.  But we got it wrong. When traumatized 

grievers walked into our offices, we "helped" them by asking 

them to verbally relate to us what happened to throw them into 

such traumatized grief.  Such therapy was misguided! There is 

indeed a time for talk-therapy, but this was not the time!

We got it wrong!

We learn now that the "left-brain" (which includes analytical 

thinking, cognitions, and language) is traumatized during the 

tumultuous experience of a loved one's death. 

To ask clients immediately to talk about 

the death can simply re-traumatize them! 

What IS called for initially is "right-brain" therapy, a therapy 

that utilizes the senses ... what you see-hear-smell-taste-touch, 

also the perceptions, the emotions, as well as the creative aspects 

of one's personality: painting, drawing, playing a musical instrument, 

gardening, walking in the park, writing poetry, etc. -- all right-brain 

activities.

Only when sufficiently calmed can attention be focused 

on ideas and the meaning of words.

Brain-Development Expert Bruce Perry

The trauma of the loved-one's death has basically "lodged" in the senses 

and the emotions of the right brain because the analytical, thinking, and 

verbal side (the left brain) was unable to receive all of the vital information 

because the brain was so traumatized by the life-or-death trauma. After such 

trauma, the right hemisphere of the brain is given extra "sensitivity and 

reactivity" within it to help compensate for the loss of power in the left-brain!  

(This explains to me why I started writing poetry "prolifically" after Merry 

Katherine's death.)

Therefore, it is very important for therapy to start with that creative 

right brain before including intensive talk-therapy.

If you have been to therapy and your therapist ever used such techniques 

as EMDR or maybe a Guided Imagery technique, s/he was using “right-brain” 

therapy.  EMDR is Eye-Movement Desensitization and Reprocessing, which 

is a rapid-eye-movement technique to reduce some of the trauma of your story 

for you, or if your therapist uses a Guided Imagery technique, s/he is teaching 

you how to stabilize your emotions so that you can learn to do the self-care that 

restores your calm should the emotions get stirred up too much at any given 

time and trigger your body back into "fight-or-flight" traumatic reactions.  

Ideally, you eventually will be able to use these techniques for yourself at 

home, both for times of crisis and also for healthy maintenance of your war-torn 

emotions. These are just two of the kinds of therapy we have discovered now 

(since the 90's) that best "work" to initially help traumatized grievers when they 

step into our offices.

            That is why interventions that are based on a strictly cognitive,             

problem-solving approach cannot impact terror-driven behavior. 

The primitive brain and mid-brain cannot process cognitive

            solutions aimed at the higher cortical functions.  But imagery,

            with its calming voice tones, soothing music and symbolic             

representations of safety, can settle down hypervigilant brain             

functioning and allow the higher brain to get back to doing its job.

Psychotherapist Belleruth Naparstek

 

In focusing on the right brain, your therapist must first teach you what you 

must do to get "centered" (stabilized emotionally). After such calming 

techniques are in place, then-and-only-then should the therapist proceed to tap 

into the left-brain's verbal skills.  If done in an appropriately timed way, then 

your thinking and verbal skills can be very helpful to process the grief on 

through with both left- and right-brains now working together!

 

For an excellent book to read that further articulates this research and 

stipulates the kinds of appropriate therapy called for to effectively treat the 

right brain first, you may want to read Invisible Heroes: Survivors of 

Trauma and How They Heal by Belleruth Naparstek (New York:  

Random House, 2004). (The quotes I have included in this post from 

other experts in the field are from Naparstek's book.)

 

Oftentimes in trauma, healing cannot be completed because             

traumatic experience becomes locked in various areas of the 

brain.  We don’t work trauma through by just talking about it.              

Talking is primarily a left hemisphere activity.  In order to complete             

the healing process, a traumatized person must access the limbic             

system and the right hemisphere of the brain, where images, body             

sensations and feelings are stored.  By activating this area of the

brain and accessing the stored images, body sensations and feelings,

a person is able to attach meaning to them and move this traumatic             

material to more adaptive resolution.                                              

Psychotherapist Linda Gould

Right-Brain Grief Work

Right-Brain Grief Work

(Poetry Prompt)

 

                                    Lost a loved one, and now you’re feeling droll,

                                    In circumstances beyond your control?

                                    Read the latest grief research; then decide . . .

                                    Landscape River’s beautiful countryside

                                    Could provide the best grief-relief for you!

                                    To glide in the water, bask in the view,

                                    Hear nature sing, smell arboraceous scents,

                                    And taste foggy damp air whets every sense.

                                    Oft-times talking about grief makes one balk;

                                    Reveling in God’s world often beats talk!

                                    So come alongside and ride beside me;

                                    Take a break from your grief; take time to “be.”

                                    The left brain, by death has been traumatized;

                                    The right brain brings rest when it’s sense-i-tized!

 

 

Painting:  Landscape River by Thomas Gainsborough, c1770

Prompt words:  damp, decide, droll

http://simplysnickers.blogspot.com/2009/05/poetry-prompt-through-sunday-may-17.html

 

written 5/16/09 – Right-Brain Grief Work – Angie Bennett Prince