Tag Archives: PTSD

The Mind & Post-Traumatic Stress Disorder, Part 2

by Kassandra Lamb

PTSD brain

public domain, Wikimedia Commons

There are still some aspects of PTSD that we psychologists can’t fully explain, but there’s a lot that we do now understand. And our more recent discoveries about the brain, that offer those explanations, give me confidence that someday we will have all the explanations.

Here’s a short list of the most common symptoms of Post-Traumatic Stress Disorder:

  1.  Experienced an event that involved a significant threat to the physical integrity of self or others.
  2.  Recurrent and intrusive thoughts or images of the event and/or flashbacks (acting or feeling as if the event was reoccurring).
  3.  Recurrent nightmares, insomnia.
  4.  Intense distress and physiological arousal when exposed to internal or external cues (triggers) that symbolize or resemble some aspect of the event; avoidance of those triggers.
  5.  Anxiety attacks and/or outbursts of anger.
  6.  Hypervigilance and exaggerated startle response.
  7.  Depression and/or irritability (an early symptom of mild to moderate depression).
  8.  Difficulty concentrating, memory problems.
  9.  Numbing of feelings and/or general responsiveness.
  10.  Inability to recall important aspects of the event (dissociative amnesia).
  11.  Feelings of detachment or estrangement from others.

PTSD is the only psychological disorder in the Diagnostic and Statistical Manual (the bible of mental health professionals) where the cause of the disorder is listed as one of its criteria for diagnosis. The person has to experience a traumatic event, and it’s not hard to figure out how something that overwhelming would cause intrusive thoughts, flashbacks and nightmares.

But why #4 and #5? Why such an intense physical and emotional reaction to some minor reminder, that can even lead to a full-blown anxiety attack? Let me repeat the definition of trauma from a previous post: an event so emotionally overwhelming that it cannot be processed emotionally or cognitively at the time that it happens.

The emotions of that event have not yet been processed. They’re stored in the brain in their raw and still quite intense form.

revolving brain

The two hemispheres of the brain color-coded as red; the cerebellum as beige (animated image by -Database Center for Life Science CC-BY-SA-2.1-Japan via Wikimedia Commons)

Also, think back to last week’s post about where things are stored in the brain and what parts of the brain are and are not easily accessed consciously. Negative emotions, mental images, and learned associations are all stored in relatively inaccessible places–in either the right hemisphere of the cerebral cortex or the cerebellum.

So it’s difficult sometimes to intentionally bring these memories and emotions back into conscious awareness so that they can be processed and put to rest. But because of learned associations with those “internal and external cues,” it’s all too easy for the intense emotions from the traumatic event to get triggered in day-to-day life.

How does this work? Let me give you an example.

One of my clients experienced a trauma during her childhood while she was standing across the room from a large fan. (For the sake of confidentiality, I won’t go into details.) Later in adulthood, she became phobic of fans. Whenever she saw a moving fan blade, she would have a full-blown, run-screaming-from-the-room anxiety attack. But she had no idea consciously why she had these attacks over something as dumb as a fan (The fan itself had nothing to do with the traumatic event; it was just present in the room.)

The memory of trauma was stored–as images and raw emotions–in her right hemisphere. The learned association (classical conditioning a la Pavlov’s slobbering dogs) between the sight of that fan and those intense emotions was stored in her cerebellum.

The neural impulses that were triggered whenever she saw a fan would look like a big V on the right side of her brain–the image of the fan in the here and now is processed in the right hemisphere, the neural impulse zips down and back to her cerebellum to the learned association, then is flung back up to the right hemisphere to stir up that old memory and its associated feelings.

Voila, anxiety attack. And with little or no awareness in the conscious mind of what was going on (because it tends to be focused mostly on left hemisphere activity, i.e. verbal thoughts).

angry woman

(photo by Lisa Brewster CC-BY 2.0 Wikimedia Commons

Intense anger can also occur with PTSD. This anger is a leftover feeling from the traumatic event. Whenever we feel threatened, anger is part of our response, even if it is trumped by fear at the time. Later, when we are once again in a safe environment, that anger can surface. And it can come out in ways that make it appear (even to the person feeling it) to be about here-and-now events, when it’s really about the past. This can be very destructive to relationships.

I think #6 and #7 are fairly self-explanatory. If something really scary has taken you by surprise in the past, you’re likely to be more on guard all the time, and startle more easily. And struggling with all this would certainly be depressing.

 

photo by cellar door films, from WANA Commons

photo by cellar door films, from WANA Commons

Up to this point, we have been talking about the intrusive symptoms of PTSD–the ways that this disorder intrudes into and disrupts the person’s life. Numbers 8 through 11 refer to the dissociative symptoms.

The human psyche, like the rest of our internal systems, is designed to help us survive. If something is too emotionally overwhelming, the psyche strives to block it out of awareness.

It may do this by suppressing the feelings, but often it’s not able to just suppress the specific feelings related to the trauma. So all feelings become numbed out to some degree. In the extreme, all or part of the memory of the event may be blocked out. But again this blocking of memory may be more generalized, making it hard to concentrate and remember things in general.

I’ve had several clients who had memory and/or concentration problems that interfered with their schoolwork or jobs. But once certain traumatic events (that their minds were working overtime to suppress) had been processed, they rather suddenly went from C to A students or could now easily remember things (like people’s names) that they’d had great difficulty with in the past.

image by Khaydock, CC-BY-SA 3.0, Wikimedia Commons

image by Khaydock, CC-BY-SA 3.0, Wikimedia Commons

(Note: How the mind blocks out feelings and/or memories is one of those things we don’t yet have an explanation for, but lots of scientific research confirms that this does happen.)

Sometimes that numbing of feelings makes it hard for the person to connect with others. Also, the experiences they’ve had may leave them feeling irrevocably different from most people. Group therapy and support groups are particularly helpful for this symptom, as well as the others.

Besides group support, the most effective therapies for PTSD are the ones that help the person finally process the memories and feelings related to the trauma. Depending on the trauma (and the therapeutic approach used), this can take some time, and it can be painful to relive those feelings. But releasing the emotional charge on those events and putting their meaning into perspective allows the person to move from trauma survivor to getting on with living and thriving.

And here’s an interesting tidbit from the scientific research. In last week’s post, I talked about how memories are stored where they are first processed. Research has found that traumatic memories are stored in the cerebral cortex right next to the emotional parts of the brain (called the limbic system). But after therapy, when those memories have been re-processed, they are now stored further out in the cerebral cortex, away from the emotional limbic system. Concrete proof that the feelings have truly been discharged and the experience of that memory has been changed!

Any thoughts on all this? Do you know someone who suffers from PTSD, or have you struggled with this disorder?

PTSD is on my mind these days because of my new series, About a young woman who trains service dogs for PTSD sufferers. Please take a moment to check out Book 1 in the series, To Kill A Labrador.

Posted by Kassandra Lamb. Kassandra is a retired psychotherapist turned mystery writer. She is the author of the Kate Huntington psychological suspense series, set in her native Maryland, and a new series, the Marcia Banks and Buddy cozy mysteries, set in Central Florida.

We blog here at misterio press once (sometimes twice) a week, usually on Tuesdays. Sometimes we talk about serious topics, and sometimes we just have some fun.

Please follow us so you don’t miss out on any of the interesting stuff, or the fun! (We do not lend, sell nor otherwise bend, spindle or mutilate followers’ e-mail addresses. 🙂 )

6 Fascinating Things to Understand About the Mind (and PTSD)

by Kassandra Lamb

I started out today with the goal of writing about Post-Traumatic Stress Disorder. Then I realized I needed to start elsewhere, with a bit of an explanation of how the human mind really works. So this is Part 1 of a two (maybe three) part series on the mind and PTSD.

Freud

Sigmund Freud (public domain)

Sigmund Freud introduced the concepts of the conscious mind and the unconscious mind in the early 1900s. His theory was quite controversial in its day and for quite a few decades afterwards. But a century after its introduction, most of us accept that there is stuff going on in our brains that we’re not currently aware of consciously.

But what exactly are these things called a conscious or unconscious mind (or the term often used by lay people–the subconscious mind)?

They aren’t really things at all. These aren’t actual places in the physical brain. There is no barrier somewhere in there that separates what is conscious from what is unconscious. Indeed, information flows back and forth between the two states of awareness all the time.

Here are six pieces of information one needs to know to understand the workings of our conscious/unconscious minds. I find them fascinating and hope that you do too.

NUMBER 1: Limited Time and Space
What we think of as our conscious minds, memory experts would call our working memories. Whatever one is thinking about at any given moment is in his/her working memory.

brain scan of working memory at work

The active parts of the brain during working memory tasks. (public domain)

Unfortunately, working memory is a pretty small space. There’s only room for about five to nine “chunks” of information at any given time. And unless one is actively focused on/thinking about a particular piece of info, it will drop out of working memory in about ten seconds or so.

Makes you wonder how we humans ever accomplish anything intellectual, doesn’t it?

NUMBER 2: Attention
If we pay attention to something, we can hold it in working memory (aka our conscious awareness) much longer. And if we are not focused on something (some verbal thought, piece of information, feeling, mental image, etc.), it will fade into the background (i.e., slide back into the unconscious mind), crowded out of working memory by whatever we are paying attention to at that moment.

Most information stored in our brains is available to our conscious minds IF the right memory cue comes along to bring it to the surface. But some things can get buried pretty deep in the unconscious, either due to lack of attention for a long time or to active pushing aside by our defenses (more on this next week).

Have you ever had the experience of something triggering a very old memory and you think, Gee, I haven’t thought about that in years?

NUMBER 3: Connections
The third thing to understand is that our minds automatically make a lot of connections between various things. This is called conditioned learning.

Ivan Pavlov

Personally, I think Ivan’s a lot cuter than Sigmund. (public domain)

Anyone who’s ever taken a psychology class has heard about Ivan Pavlov, the Russian physiologist who first had the Eureka moment regarding conditioning. He was studying the rate of salivation in dogs when presented with food, but after a while, he noticed that the dogs in his lab were salivating before the food was presented. They’d start slobbering in response to the sight of the equipment used to measure their drool, or to the lab attendant’s footsteps coming to get them out of their cages.

The dogs’ brains had learned to associate these other sights and sounds with the fact that they were about to be fed. And a biological phenomenon over which the dogs had no conscious control, salivating, occurred whenever they experienced these cues.

It’s imperative to our survival and sanity that our brains make all these little connections. They make life so much easier.

A moment ago, I scratched my hand without thinking about it. I hadn’t even noticed consciously that the hand had an itch until I was scratching it. And even then I might not have noticed if I hadn’t been casting about for an example of unconscious connections.

Without these learned associations, I wouldn’t have automatically scratched that little itch. The itch would have had to build until it was so annoying that I became consciously aware of it. Then I would have to stop and think and ask myself what has helped make something stop itching in the past. Oh yes, scratching the itchy spot usually helps.

Humans would have long since died off if they had to give that much conscious thought to every little need. There would be no time nor space in their working memories to solve problems or invent things.

NUMBER 4: The Form Our Thoughts Take
Neural impulses are firing in various parts of our brains all the time, but once we develop a fair amount of active language (usually by age 4 or 5), we tend to be most aware of our verbal thoughts. In other words, we consciously think in language most of the time.

Visual images also play a role. We may consciously call up an internal vision of something that happened in the past, or of a place we’re planning to go.

This morning, I accidentally drove past the post office, where I had planned to mail some letters. No problem, I thought as I visualized the big blue mailbox in front of my grocery store. I can mail them at the store. (My next errand.)

wedding day

I can recall being hot but I can’t feel it again consciously.

Memories of other things we’ve sensed may come into our conscious awareness as well, but most likely those thoughts will be verbal. When I think about my wedding day, during one of the hottest Augusts in Maryland’s history, I remember that it was hot. But I don’t actually feel that heat again. Likewise, I can recall that I felt both scared and excited that day. But I’m thinking about those feelings, not actually re-experiencing them.

The visceral sensations associated with memories and previous feelings are not all that accessible via our conscious minds.

Which brings us to…

NUMBER 5: Where Things Are Stored
First, let me point out that information tends to be stored in the part of the brain where it was first processed (or later, where it was re-processed; more on this next time). There’s a long biological explanation for that, which I think we’ll skip. Please just take my word for this little tidbit.

There’s a lot of stuff constantly being processed and stored in various parts of our brains, but to keep this simple I’m going to focus on the functions of three parts of the brain.

For most people (all right-handed ones and some left-handed ones), language functions occur in the left hemisphere of the cerebral cortex. (The cerebral cortex is the outer layer and the highest level of the brain, where actual rational thinking occurs, among other things.)

The cerebral cortex hard at work.

The cerebral cortex hard at work.

Visual perception (i.e., the processing of what we see) and sound modulation processing (i.e., tone of voice, etc.) occur mostly in the right hemisphere.

So if someone says, “Now don’t you look lovely tonight, my dear,” in a mildly sarcastic voice with a slight sneer on their face, your left hemisphere processes the words themselves. But your right hemisphere sends out a “snark alert” after interpreting the body language and tone.

But here’s the thing–sometimes those interpretations of visual and auditory info don’t make it into the conscious mind, because that information is being processed in the right hemisphere and we are more prone to be aware of our verbal left hemisphere’s thoughts. If at that moment when the subtly snarky comment is being processed, we’re thinking, “Gee, I’m glad I wore this outfit tonight,” that thought may crowd the interpretation of the body language and tone of voice out of conscious awareness.

But they’ve still registered in the right hemisphere. That part of our brain knows we’ve just been dissed, even if our conscious mind is oblivious. (And the memory of that event is mostly stored in the right hemisphere–the images, tone of voice, etc.)

Okay, let’s look at where emotions tend to be processed and stored. Research indicates that our positive emotions–joy, pride, anticipation–tend to be processed mostly in the left hemisphere, while the negative ones–fear, anger, disappointment, sadness–are mostly in the right hemisphere.

Do you see where this is going? You walk away from that person assuming you’ve been complimented when in reality you’re feeling hurt and belittled, and you don’t even know you’re having those feelings, because none of that ever made it into conscious awareness. So you end up being in a bad mood or maybe you pick a fight with your mate, accusing him or her of never appreciating how you look.

And you’re totally oblivious to the fact that your mood and behavior have been affected by the jerk with a smirk on his face.

revolving brain

The two hemispheres of the brain color-coded as red; the cerebellum as beige (animated image by Database Center for Life Science CC-BY-SA-2.1-Japan, Wikimedia Commons)

This brings us to one more part of the brain that is important to understanding the conscious vs. unconscious mind. The cerebellum is a section of the brain at the lower back part of your head. It is not part of the cerebral cortex, so it is completely outside of conscious awareness and pretty much beyond the reach of logical thought processes.

Research indicates that all those learned associations I mentioned earlier are stored in the cerebellum. So they operate outside of conscious awareness.

Which brings us to the part of this that relates to PTSD.

NUMBER 6: Memories, Old Associations and Feelings Can Be Triggered Without Our Conscious Awareness
Let’s go back to the jerk with a smirk for a moment. I didn’t make that example up. That really happened to me. The host of a professional gathering met me at the door with that greeting.

My conscious mind (left hemisphere) was preening at the compliment but unconsciously, my right hemisphere picked up on the implied slam that I usually looked like crap.

As the evening progressed, I found myself feeling more and more insecure and self-conscious–not a normal reaction for me. I’m pretty secure in my ability to get along with people and be well-liked. But that evening, I found myself stumbling in conversations and even becoming physically clumsy.

mirror

For some reason, looking in the mirror often helps me connect with my unconscious mind (photo by Surii, CC-BY 3.0 Wikimedia Commons)

I finally took myself off to the ladies’ room to have a little chat with myself. Looking in the mirror, I thought, “What’s wrong with me? I haven’t felt this awkward since middle school.”

Sometimes when you ask your unconscious mind a direct question, it gives a direct answer, if you’re paying attention. I immediately flashed to a mental image of that scene at the door. Only this time I heard the tone and saw the sneer on a conscious level.

A little background info here. I was what my mother politely called a “late bloomer,” and my classmates in middle school, being the delightfully civilized creatures that they were, teased me unmercifully about my nonexistent figure and overall gawky appearance.

The host’s tone and sneer had triggered an association (via my cerebellum) to those middle school memories and the self-conscious feelings from that time in my life (stored in the right hemisphere). All this happened outside of my conscious awareness and created a totally out of character reaction, both in my emotions and behavior.

Knowing the man as I did, I suspected he’d done it on purpose. This guy, a colleague I could barely tolerate, liked to mess with people’s heads.

I slapped on a big smile and went back into the room where the event was being held. Sailing past him, head held high, I paused briefly to thank him for hosting such a successful gathering, with a hint of sarcasm in my tone. He gave me a strange look. I hope that I successfully hid my own smirk.

Next time – how all this explains PTSD symptoms.

How about you? Has anything like that ever happened to you, where you acted out of character without understanding why? Do you find the human mind as fascinating as I do?

Please take a moment to check out my new release, Book 1 in a new series about a young woman who trains service dogs for combat veterans with PTSD.

ToKillALabrador FINALTo Kill A Labrador, A Marcia Banks and Buddy Mystery

Marcia (pronounced Mar-see-a, not Marsha) likes to think of herself as a normal person, even though she has a rather abnormal vocation. She trains service dogs for combat veterans with PTSD. Then the ex-Marine owner of her first trainee is accused of murdering his wife, and Marcia gets sucked into an even more abnormal avocation–amateur sleuth.

Called in to dog-sit the Labrador service dog, Buddy, she’s outraged that his veteran owner is being presumed guilty until proven innocent. With Buddy’s help, she tries to uncover the real killer.

Even after the hunky local sheriff politely tells her to butt out, Marcia keeps poking around. Until the killer finally pokes back.

AMAZON US   AMAZON UK   AMAZON CA   AMAZON AUS   APPLE   KOBO

Posted by Kassandra Lamb. Kassandra is a retired psychotherapist turned mystery writer. She is the author of the Kate Huntington psychological suspense series, set in her native Maryland, and a new series, the Marcia Banks and Buddy cozy mysteries, set in Central Florida.

We blog here at misterio press once (sometimes twice) a week, usually on Tuesdays. Sometimes we talk about serious topics, and sometimes we just have some fun.

Please follow us so you don’t miss out on any of the interesting stuff, or the fun! (We do not lend, sell nor otherwise bend, spindle or mutilate followers’ e-mail addresses. 🙂 )

Service Dogs for PTSD (And a New Release)

by Kassandra Lamb

PTSD was my specialty when I was a practicing therapist, and yet I realized recently that I’ve never blogged about it to any great extent. Well, now I have a really good reason for doing so.

Lately I’ve become fascinated by the use of service dogs to help people suffering from this disorder. So much so that I’ve started a new mystery series about a woman who trains these service dogs for combat veterans, and her experiences with a variety of clients. (More on the first release in this series in a bit.)

service dog with his veteran handler

A service dog with his veteran handler (public domain, Wikimedia Commons)

Post-Traumatic Stress Disorder is the diagnosis given when a person suffers symptoms as a result of exposure to a severe trauma. In the general population, the life-time prevalence rate is 8%, which is pretty high. Only phobias, depression and drug abuse are more common.

The list of symptoms is extensive, so I’m just going to hit on the most common ones, and how service dogs can help manage them.

But first let’s define trauma. This is a word that tends to be overused in our society for anything that makes us feel bad. The best definition I’ve ever heard for trauma comes from Lenore Terr, MD in her book, Unchained Memories (I’m paraphrasing her a little here):

A traumatic event is so emotionally overwhelming that the person experiencing it cannot process it cognitively nor emotionally at the time that it happens.

Such events are often sudden and unexpected. They might be a bad car accident, a natural disaster, a criminal assault, being in combat, etc.

PTSD was first identified in combat veterans. It was once called shell shock or battle fatigue. And this group still has one of the highest rates of PTSD, ranging from 12% (Gulf War vets) to 30% (Vietnam-era vets). The rate of PTSD currently in veterans of the Iraqi and Afghanistan conflicts is 13.8%.

The most common and debilitating of the symptoms are anxiety attacks (triggered by reminders of the trauma), nightmares and flashbacks. Service dogs are trained to pick up on the early stages of these symptoms and interrupt them.

If you have a dog, you know how sensitive they can be to their owner’s moods. When you’re depressed or anxious, they tend to sense it and often try to offer comfort. In service dogs, this natural tendency is enhanced through training and then the dog is taught to do something about it.

I’m still learning about all this myself for my new mystery series, but I know that for nightmares, this may mean waking their handlers by barking or nudging him/her with their noses. The service dogs also provide grounding and a calming effect. Again, if you have a dog (or a cat), you know how soothing it can be to stroke their coat and their silky ears.

hand petting dog

Both human and dog benefit from pets and ear scratches. 🙂 (public domain, Wikimedia Commons)

(Research has been done on this aspect of therapy/service dogs in general. Petting and interacting with them lowers heart rate and blood pressure and improves mood.)

With anxiety attacks, the dog often can alert their human that the attack is starting before the person has become consciously aware of the building anxiety. Then s/he can implement strategies (taught by his/her counselor) to nip the attack in the bud.

Service dogs also make it easier for veterans suffering from PTSD to go out in public. Two other PTSD symptoms are hypervigilance and an exaggerated startle response. Scary things have taken this person by surprise before, so now their nervous system is constantly on the alert, which is not good for their mental nor physical health.

There are two things the service dogs are trained to do to help with this hypervigilance. One is called the cover command. Whenever their human stops moving, the dog turns around and faces the way they came. The dog literally has the person’s back. S/he signals the handler if someone is approaching from behind, usually with a perking of their ears or a tail wag.

The dogs are also trained to step between their handler and anyone approaching them. These may sound like small things to most of us, but for those who suffer from PTSD, they can allow the person to relax a good bit more when out and about in the world.

service dog with his handler

public domain, Wikimedia Commons

This and also the strong sense of connection with the dog are particularly helpful for overcoming one of the most subtle and potentially destructive of the symptoms, a sense of isolation from others. People who have experienced extreme events sometimes are left feeling like they are different from others in some irrevocable way; they may even feel like they are “damaged goods.”

Being more comfortable in public and experiencing the unconditional love of a canine companion can go a long way toward overcoming this feeling of otherness, and help the veteran become more integrated into his/her community.

Combat veterans should only feel set apart in a proud way, that they have served their country well and are respected for their sacrifices. Service dogs can help them hold their heads high and get on with their lives.

(Stay tuned for more about this wonderful boon for veterans as I learn more myself.)

And today is the cover reveal for my new series. Another masterpiece by Melinda VanLone. Ta-da!! (Psst! The book is available for pre-order for just $1.99; it goes up after the release.)

ToKillALabrador FINALTo Kill A Labrador, A Marcia Banks and Buddy Mystery

Marcia (pronounced Mar-see-a, not Marsha) likes to think of herself as a normal person, even though she has a rather abnormal vocation. She trains service dogs for combat veterans with PTSD. Then the ex-Marine owner of her first trainee is accused of murdering his wife, and Marcia gets sucked into an even more abnormal avocation–amateur sleuth.

Called in to dog-sit the Labrador service dog, Buddy, she’s outraged that his veteran owner is being presumed guilty until proven innocent. With Buddy’s help, she tries to uncover the real killer.

Even after the hunky local sheriff politely tells her to butt out, Marcia keeps poking around. Until the killer finally pokes back.

AMAZON US  AMAZON UK   AMAZON CA   AMAZON AUS   APPLE   KOBO

AND, I’m having a Facebook party next week to celebrate the new series. Click here to check it out and sign up. There’ll be lots of prizes and fun!!

FB party banner

Are you a combat veteran or do you know one personally? What obstacles have you/they encountered in the reentry-into-civilian-life process?

Posted by Kassandra Lamb. Kassandra is a retired psychotherapist turned mystery writer. She is the author of the Kate Huntington psychological suspense series, set in her native Maryland, and a new series, the Marcia Banks and Buddy cozy mysteries, set in Central Florida.

We blog here at misterio press once (sometimes twice) a week, usually on Tuesdays. Sometimes we talk about serious topics, and sometimes we just have some fun.

Please follow us so you don’t miss out on any of the interesting stuff, or the fun! (We do not lend, sell nor otherwise bend, spindle or mutilate followers’ e-mail addresses. 🙂 )