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Trauma and PTSD

All of us experience stress at some point in our lives. But when stress is a repeated event, it can lead to a trauma response or a psychological condition called post-traumatic stress disorder (PTSD). We often think of trauma happening to soldiers in combat but anyone can experience or witness traumatic or life-changing events. Trauma can cause you to have physical and emotional disturbances, nightmares, and sleep problems if it is not addressed. Not only that, trauma can also disrupt your communication, relationships, and nearly all facets of life.

What is PTSD?
PTSD is a mental health condition that’s triggered after experiencing or witnessing a terrifying event. Symptoms can include flashbacks, nightmares, severe anxiety, hyperawareness, and uncontrollable thoughts about the event. These symptoms can last for months or years, interfering with your day-to-day functioning. People with PTSD may try to avoid thinking or talking about the traumatic event or avoid places, activities, or people that remind them of the event.

People can experience PTSD after an event involving actual or threatened death, severe abuse or neglect, serious injury, or a sexual violation. People who have experienced trauma early on, such as in childhood, may be at more risk of developing PTSD. When not treated, PTSD can increase your risk of other mental health conditions such as depression and anxiety, problems with drugs or alcohol, or suicidal thoughts.

What does trauma/PTSD therapy involve?
Some common types of therapy used for people with trauma or PTSD are cognitive behavioral therapy, brainspotting, and eye movement desensitization and reprocessing. These therapies focus on identifying and correcting unhealthy and negative thoughts about past traumatic events. The benefits of therapy for PTSD include reduced anxiety and depression and better coping skills.

Cognitive behavioral therapy focuses on talking about the traumatic event and challenging negative thoughts and replacing them with more positive ones. This in turn creates less emotional distress and allows you to think less negatively about the traumatic event.

Brainspotting uses your visual field to access the area of trauma where the painful emotion is stored. Once accessed, processing can take place to allow for healing. Your therapist will ask you to talk about what feelings come up when the brainspot is accessed and work with you to process those feelings.

Eye movement desensitization and reprocessing focuses on changing the way memory is stored in the brain. This allows you to process the feelings that go along with the traumatic memories and reduce problematic symptoms. Your therapist will guide you to shift your thoughts to more positive memories.

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Substance Abuse

Substance abuse involves the excessive use of drugs or alcohol. Substance abuse can lead to problems with your health and difficulties in interpersonal relationships. The exact cause of substance abuse is not known and some people do not recognize that it is a problem. It’s believed that both biological and environmental factors can lead to substance abuse. Substance abuse is often a sign of untreated mental health issues. The most commonly abused substances are alcohol, opioids, amphetamines, and cocaine.

What is the best type of therapy for substance abuse?
Cognitive behavioral therapy (CBT) often works best for people with substance abuse and also helps manage underlying mental health issues. This type of therapy allows you to recognize unhealthy behavioral patterns, identify triggers, and develop better coping skills. CBT can help you anticipate problems and enhance your self control. This is done by exploring the positive and negative consequences of continued drug use, recognizing cravings, and identifying situations that might put you at risking for using.

Research shows that the skills you learn in CBT remain in place even after treatment is complete. In some cases, CBT may be even more powerful when combined with medication for substance abuse. If your therapist thinks you would benefit from medication, they will refer you to a psychiatrist for further evaluation.

How does substance abuse affect mental health?
Chronic use of drugs or alcohol can lead to permanent changes in the brain, making you more susceptible to other mental health conditions. For instance, alcohol is a depressant and can cause disruptions in the balance of the brain affecting thoughts, feelings, and actions. Likewise, other drugs overstimulate the reward circuit of the brain, making you act more impulsively and increasing cravings.

People who suffer from substance abuse disorders are almost twice as likely to also suffer from a mood or anxiety disorder. On the other end of the spectrum, people with mood or anxiety disorders may self-medicate with drugs or alcohol, leading to a problem with substance use. It’s unclear which causes the other, but there is a known link between substance abuse and mental health problems.

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Anxiety

Anxiety is a feeling of fear or excessive worry. Most people have experienced anxiety at some point in their lives. Anxiety can be a normal response to stressful life events. However, in some cases, anxiety can manifest as a reaction to everyday situations such as going to work or socializing. Anxiety is a common reason why people seek out the help of a therapist.

What are the symptoms of anxiety?
People with generalized anxiety disorder experience persistent anxiety that interferes with daily life. The anxiety can last for months if not addressed by medication or therapy. The most common symptoms of generalized anxiety are:

Feeling on edge

Fatigue

Difficulty concentrating

Excessive worrying

Irritability

Difficulty falling or staying asleep

Having headaches, muscle aches, stomachaches, or other unexplained pains

How can I calm my anxiety?
Therapy can be helpful for learning how to calm your anxiety. Your therapist may use different methods to help ease your worries. One approach is cognitive behavioral therapy, which focuses on being aware of your thoughts and how they impact your feelings. For example, your therapist may ask you to describe your anxious thoughts. They will then help you challenge those thoughts and replace them with more positive ones.

Another therapeutic approach is the practice of mindfulness. Mindfulness focuses on the act of being present. Your therapist will teach you how to be aware of your thoughts and observe them without judgment. They will help you focus on your breath, feelings, and sensations in your body. Mindfulness helps you be in the present moment and by focusing on your breathing, your anxious thoughts start to dissipate.

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Despression

Depression is a feeling of low mood and energy. It can be chronic in nature or situational, such as depression after a spouse has passed away. Depression can cause people to have a sense of hopelessness or a lack of interest in activities they normally enjoy. When depression is severe, it can lead to suicidal thoughts or behaviors. Depression is typically treated with a combination of medication and talk therapy.

Who is most at risk for depression?
Certain people are more at risk for depression than others. Genetics plays a role in depression and people with a family history of depression may be more likely to experience it themselves. Death, loss, or the end of a serious relationship can place you more at risk for depression. People with interpersonal conflicts, such as with family members or colleagues, are more likely to experience depression. Those with a history of any kind of abuse such as physical, sexual, or emotional abuse are more at risk for depression.

Depression can also come with common life events. This could include a new job, loss of employment or income, marriage, divorce, having a baby, or retirement. While some of these are positive life events, they still represent major life changes, which is a common cause of depression. Depression can also be a side effect of certain medications or can come about as a reaction to certain illnesses such as sleep problems or cancer.

What are the main ways to treat depression?
The most effective treatment for depression is a combination of medication and psychotherapy, or talk therapy. If you are already in therapy for depression and your symptoms are not improving or are getting worse, your therapist may refer you to a psychiatrist for medication. In some cases of severe depression, or if you are having suicidal thoughts or behaviors, a higher level of care, such as hospitalization, might be necessary.

Psychotherapy can help you explore the causes of your depression and make you more aware of your thoughts. The most common type of therapy for depression is cognitive behavioral therapy. This type of therapy focuses on becoming aware of your thoughts and how they affect your feelings. Your therapist works with you on replacing negative thoughts with more positive ones. The result is improved symptoms and less emotional distress.

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Bipolar Disorder

Bipolar disorder is a mood disorder in which a person has alternating cycles of a depressed mood and a heightened, or manic, mood. During a depressed state, a person may have trouble getting out of bed, have difficulty concentrating, or have low self-esteem. During a manic state, a person may feel euphoric or engage in risky behaviors such as spending a lot of money or having feelings of hypersexuality. Bipolar disorder is commonly caused by a combination of genetic, environmental, and physiological factors.

What are the different types of bipolar disorder?
The most common types of bipolar disorder are bipolar I and bipolar II. Bipolar I is characterized by cycles of depression and mania. To be diagnosed with bipolar I, a person must have had at least one manic episode in their life. A manic episode is typically a period of abnormally elevated energy or mood accompanied by behavior that disrupts everyday life. Some people with manic episodes also have psychosis.

Bipolar II is characterized by cycles of depression and hypomania. In hypomania, the person doesn’t experience the extreme “highs” of full-blown mania like that of bipolar I. To be diagnosed with bipolar II, the person must have had at least one episode of hypomania in their life. People with bipolar II suffer more often from episodes of depression than hypomania.

People with bipolar disorder can also experience something called a mixed state. This happens when there are simultaneous symptoms of depression and mania. The person may have high energy, sleeplessness, and racing thoughts, but also have hopelessness, despair, and irritability. People with bipolar disorder who are in a mixed state are more at risk of suicide than either a depressed or manic state alone.

What can trigger bipolar disorder?
It’s widely believed that bipolar disorder is a result of chemical imbalances in the brain. The disease also tends to run in families. People with bipolar disorder typically live normal lives in between a depressed or manic state. However, certain things can trigger a manic or depressive episode.

Usually, stressful circumstances will trigger a bipolar episode. This includes a breakdown of a relationship, abuse, loss of a job, or death of a close family member. An episode can also be triggered by a physical illness or lack of sleep. Other stressful problems such as with money, work, or relationships can trigger a bipolar episode.

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Borderline Personality Disorder

Borderline personality disorder (BPD) is a mental health condition characterized by unstable moods, behaviors, and relationships. The most common symptoms are emotional instability, feelings of worthlessness and insecurity, impulsivity, and impaired social relationships. People with borderline personality disorder often have an intense fear of abandonment. The cause of this condition is not fully understood but is thought to be linked to genetic factors, brain abnormalities, and environmental factors, such as childhood abuse or neglect.

Is borderline personality disorder the same as bipolar disorder?
While borderline personality disorder and bipolar disorder share some of the same characteristics, they are two entirely different conditions. BPD is a type of personality disorder while bipolar disorder is a mood disorder. People with bipolar disorder often have disrupted sleep when they are in the middle of a mood cycle while people with BPD experience regular sleep. And while both people with BPD and bipolar disorder experience variations in mood, people with bipolar disorder typically experience them for weeks or months, while people with BPD only have sudden, short-lived mood shifts that last for a few hours or days.

People with BPD are more likely to self-harm while people with bipolar don’t experience this as much. Both people with BPD and bipolar can experience trouble in their relationships due to disruptive behaviors and both may experience periods of impulsivity. Mood disorders, such as bipolar disorder tend to run in families and people with a close relative with BPD may also be more likely to develop the condition.

How is borderline personality disorder treated?
The most common form of treatment for BPD is talk therapy, although in some cases, medication may also be used. The most effective form of talk therapy for BPD is dialectical behavior therapy, which was developed specifically for people with BPD. Dialectical behavior therapy employs both mindfulness and cognitive behavioral therapy. The aim is to support individuals in paying attention to behavioral patterns and assist them in challenging maladaptive behaviors. Dialectical behavior therapy has been shown to help people reduce self-harm, improve relationships, and control intense emotions.

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Behavioral Issues

Most people have experienced a problem with their behavior whether it be a conflict with a friend or an issue at work. However, for some people behavioral issues can be a chronic problem. Problem behaviors are those that aren’t considered acceptable by most people. Behavioral issues can cause disruptions in a person’s life as well as in the lives of their friends and family.

What are some behavioral issues?
There are several types of behavioral issues, including oppositional defiant disorder, attention deficit hyperactivity disorder, obsessive compulsive disorder, and addiction. Some of these behavioral disorders start in childhood. Others, such as addiction, may start in young adulthood. Behavioral issues can lead to inattention, impulsivity, defiant behavior, and in some extreme cases, criminal activity.

Behavioral issues can also be caused by mental health conditions such as bipolar disorder or schizophrenia. These types of behavioral issues may have a genetic link and parents with these disorders may be more likely to have a child with the same behavioral issue.

How are behavioral issues treated?
The most effective way to treat behavioral issues is with talk therapy. Your therapist will help you become more aware of your disruptive behaviors and explore what is behind them. They will help you develop better coping mechanisms and think of ways you can change your behavior. If behavioral issues are causing problems with everyday functioning, your therapist may suggest you see a psychiatrist who can prescribe medication. However, it’s still important to go to therapy until your behavioral issues get better.

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Relationship/Family Conflict

Relationships are hard at times and can cause us emotional distress. Relationships can be between spouses, siblings, or a parent and child. When relationship conflicts get to a point where both people are at a standstill, sometimes therapy can help. Your therapist may ask you to come in individually or together to discuss what the problem is.

How do you resolve conflict in a relationship?
In all healthy relationships, it’s important to set boundaries and make those boundaries known to the other person. Everyone deserves to be treated with respect, even in an argument. It’s also important to get to the heart of the real issue. It’s easy during the heat of an argument to bring up past problems or grievances, but it’s important to pay attention to the current issue.

Sometimes, when you just can’t come to an agreement, it’s okay to agree to disagree. When possible, try to compromise and take the other person’s point into consideration. In healthy relationships, both people make compromises but not at the expense of their own personal happiness.

Is conflict good in a relationship?
Most relationships have some level of conflict involved at times, which isn’t a bad thing. Conflict can signal a need for change for both parties. Relationships that don’t have conflict may start to grow stagnant, with each person growing apart. Healthy conflict, on the other hand, gives you a chance to work on problems in the relationships.

When conflict turns into yelling or disrespecting each other, that’s when negativity can impact the relationship. However, when both people can talk calmly and feel heard, that’s when true change can happen. Every relationship has problems but it’s how both people handle the problems that matter.

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Life Transitions

Life transitions are times of major change in a person’s life. Some examples include going off to college, getting married, having a baby, or starting a new job. Everyone, at some point, has experienced a life transition and sometimes, it can be difficult to cope with. Even happy life transitions can bring up feelings of doubt or anxiety. In some cases, therapy can help with coping with the stress of life transitions. Just having someone to talk to can reassure you that your feelings are normal and only temporary.

How do you deal with life transitions?
When facing a life transition, try to prepare for it as best you can. For example, if you’re starting a new job, try to ask questions about what you’re training will be like and what your responsibilities will be each day. When you know what to expect, it can help you feel less anxious. It’s also important to set realistic expectations. For example, if you’re about to have a baby, know that you will need help from people and expect to ask for help when you need it.

It's also important to pay attention to your self-talk. Notice if you are having negative thoughts during a life transition. One way of doing this is practicing mindfulness. This is the process of noticing your thoughts without judgment and just concentrating on the present moment, not your past or future worries.

How do life transitions affect mental health?
Everyone adjusts differently to life transitions. Some people may experience temporary feelings of anxiety or depression with a major life change. Other people may experience more long-lasting effects. In people who already have a mental health condition, it can trigger a mood or anxiety episode.

Usually, the emotional distress associated with a life transition is temporary and goes away after a period of adjustment. But if you find your symptoms are lasting for more than a few months, it’s important to get help from a qualified therapist. They can help you explore your feelings and work with you to develop better coping mechanisms.

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