Feeling stressed and anxious after a disaster is normal. Here is some information on what feelings are normal after a disaster, with tips on managing and reducing feelings of stress and anxiety - and also, information on when to get professional help for serious stress or mental health symptoms.

It’s normal to feel stressed or anxious after experiencing or even witnessing a disaster. Feelings of stress may emerge very quickly after the event, or they may emerge in the days, weeks and even months after the fact.

What Are Some Normal Reactions to a Disaster?

Although feelings of stress and anxiety are unpleasant, they are normal reactions to abnormal events, and in most cases, stress and anxiety will subside in time.

According to SAMHSA’s National Mental Health Information Center, some normal stress reactions to a disaster or traumatic event can include:¹

• Feelings of anxiety, tension and nervousness
• Finding yourself crying easily
• Excessive drug or alcohol use
• Emotional numbness
• Feelings of anger or irritation
• Social isolation
• Insomnia
• Fatigue
• Problems of attention and memory

How to Cope with Post-Disaster Anxiety and Stress

Stress reactions after a disaster may be normal, but they are mostly unpleasant and can interfere with your quality of life and your interactions with friends, family and co workers.

Here are some techniques that you can use to help manage and minimize the post disaster stress and anxiety you may be feeling.

• Get back into a ‘normal’ daily routine. Although you may not feel much like attending to the groceries and the kids’ soccer practice, by keeping busy and ‘back to normal’ you accelerate your recovery.

• Stop your news vigil – If you’ve been pouring over the internet and glued to the TV for latest breaking disaster news, you may only be feeding your feelings of anxiety. It’s unlikely that your vigilance will do any good, so give yourself a breather.

• Take care of your physical health. Eat nutritious meals, get out and do some vigorous exercise and try to get enough sleep every night. You are far less able to manage stress when you let your body get run-down.

• Try to find a way to genuinely help – feelings of helplessness can stoke the fires of anxiety, so take back some control and make a productive difference. Volunteer your time and energy with an organization that’s helping in the rebuilding process – burn off your restless energy to good purpose!

• Don’t bottle-up the feelings you have – Talk with others in your family and community about how you, and they, are feeling and coping.

• Don’t dwell on the negative – although it’s normal to feel overwhelmed in the face of death and destruction (especially when it’s close to home) you can start feeling better faster by remembering what is good in your life and what you still have to hope and live for.

When to Seek Help for Post-Disaster Stress and Anxiety

Although for most people, feelings of stress and anxiety will subside in time, for some people, disaster exposure can cause PTSD and other mental disorders – conditions that do not necessarily get better or go away on their own.

Talk to a mental health professional if:

• You can’t get back into a normal routine, can’t function normally on the job or at home
• You are abusing drugs or alcohol to cope with your feelings
• You’re worried that you are going to hurt yourself or someone else
• You notice symptoms of mental illness
• You have feelings of sadness or depression that persist beyond 2 weeks

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While few things hurt like the sudden loss of a loved one, grief is a necessary and ultimately healthy process. Unfortunately, people who lose family and friends to disasters may be at an increased risk of a disorder known as traumatic or complicated grief.

Few things hurt like the death of a loved one, especially when that loss comes suddenly or violently, such as in a natural disaster or terrorist attack.

Grieving is a normal human process of dealing with great loss, and although it’s very painful, it’s also healthy and necessary.

In some cases though, people get stuck in perpetual or very severe grieving (traumatic grieving), or intense grieving triggers another serious problem, like a major depression.

While normal grieving is a process that eases over time, traumatic grieving or other mental illnesses do not necessarily get better without treatment. People who have lost loved ones to natural disaster may be at greater risk of traumatic grieving and so it is helpful to understand the differences between normal grieving and complicated grieving.

What Is Grief?

Grief is the process and feeling of loss, experienced most intensely after the loss of a loved one. The emotions of grief can include sadness, loneliness, fear, guilt, anger, anxiety and others, and physical symptoms of bereavement can include insomnia, a loss of appetite, trembling, dry mouth and others.

Grief is an individual process, and the duration of the grieving process can range from weeks to years, depending on how close the loss, the circumstances of the loss, your personality, culture and coping style, the nature of the death and other factors.

According to SAMHSA, the grieving process occurs over 4 distinct stages, and the grieving period ends only after a person progresses through all stages and moves on with life.

The 4 stages of grief

1. Accepting the death
2. Coming to feel and processing through the emotions of grief (loss, sadness, anger, guilt, etc.)
3. Accepting a life without your loved one
4. Moving on in life

Normal grief is a painful but healthy process. In some cases, the grieving process seems to go on indefinitely or with too much intensity, as people get ‘stuck’ in perpetual bereavement – a condition called traumatic grief or complicated grief.

The Risk of Complicated Grief after a Disaster

While it’s difficult to put into words the pain and suffering of loss, healthy grief eases in time – things do get better. Unfortunately, people who have lost a loved one in a disaster may be more likely to experience traumatic grief or have intense grief trigger another mental illness.

For those that have also experienced a traumatic event, the grieving process is complicated by stress reactions to the disaster. The person in bereavement may feel emotionally numb at first or they may have difficulty with the bereavement process that triggers stressful memories of the disaster experience.

People grieving a loved one lost to trauma are at an increased risk of...¹

• Traumatic grief
• PTSD
• Depression
• Alcohol or drug abuse
• Decreased health
• Suicidal thoughts
• Panic disorder
• Others

What is Traumatic Grief (Complicated Grief)?

Complicated grief is bereavement without end and without progress. While for most people the intensity of grief symptoms will diminish somewhat in time (within a few months) someone with complicated grief may experience no reduction or even intensification in grief symptoms over many months or even years.

Also known as ‘unresolved grief’ someone with complicated grief is stuck in the sadness, anger and loneliness of the bereavement process, and may need some help to break free.

Some of the symptoms of complicated grief include:

• Feeling angry about the death
• Having a hard time accepting the death
• Thinking obsessively about the deceased (also, having nightmares or intrusive thoughts about the deceased)
• Feeling deep loneliness and longing for the deceased loved one
• Feeling distrustful of others
• Minimizing social contact or feeling unable to maintain regular responsibilities
• Maintaining an artificial or pretend relationship with the a deceased loved one (setting a plate at the table, for example)
• Feeling bitterness about life and envying others not affected
• Losing interest in others beyond the deceased
• Hearing the voice or even seeing the deceased

Getting Help

Most major centers have grief support groups, and these can provide comfort to those going through a difficult but normal grieving process.

Anyone with a very intense or long lasting bereavement (or anyone who feels stuck in grief) should consider talking to a mental health professional. This professional can determine whether a treatable condition exists (she will be looking for complicated grief, depression, PTSD, anxiety and others). The treatment will depend on the diagnosis, but some options may include:

• Cognitive behavioral therapy
• Talk therapy
• Medication, such as anti-depressants or anti anxiety medications
• Others

Image Copyright: United Nations Development Programme

Could childhood trauma, abuse or neglect be the root cause of your substance abuse or unhappiness in adulthood? Learn how to recognize adult symptoms of complex childhood traumas and learn what types of treatment work best to help you move beyond a difficult past.

This is the second segment of a two part article on childhood trauma and adult health consequences, and on therapy as an adult to address complex childhood trauma.

In the first article in this series, we looked at how childhood traumas lead to a wide range of adult mental, emotional and physical health diseases and ultimately to early death.

So if you’ve got a trauma history, things can seem pretty bleak – but remember, statistics just represent an ‘average’ experience – you do not have to live this negative trajectory. By addressing your past, learning to cope with symptoms and ultimately reprocessing your memories so they no longer hold such power over you, you can earn a great health and quality of life increase.

Read on to learn how to get started. By the end of this article, you’ll know

• If your current symptoms likely originate from childhood experiences
• Why you should consider treatment
• About trauma specific treatment and about how and where to find this specialized care.
• About the 3 phases of trauma therapy and about how long you can expect the process to take.
• About learning to cope with symptoms and manage your emotions without getting overwhelmed.

Is Childhood Trauma Affecting You as an Adult?

Though exposure to adverse experiences in childhood increases the risks for many diseases and conditions, many people with terrible childhood abuse histories grow into healthy and well adjusted adults.

So, if you experienced adverse events as a child, are they affecting you today, as an adult?

To help with finding an answer to this question, it's a good idea to learn a little about how childhood trauma usually manifests in adulthood.

Childhood trauma can lead to a wide range of cognitive and emotional symptoms across the lifespan, but in general, childhood traumas tend to cause adulthood symptoms that fall into 2 primary categories:

1. Avoidance symptoms, such as disassociation or escape through substance use
2. Re-experience symptoms, such as intrusive thoughts or flashbacks

As an illustration, consider how avoidance and re-experience symptoms manifest across a range of domains:¹

• Cognitive – Avoidance symptoms such as dissociation (daydreaming or spacing out during difficult moments) or amnesia of past events. Re-experience symptoms such as flashbacks or intrusive thoughts or recurring nightmares.
• Emotional – Avoidance symptoms such as feeling numb much of time or re-experience symptoms such as anger, hopelessness, shame, loneliness, depression and anxiety.
• Behavioral – Avoidance symptoms such as excessive sleep, substance use and abuse, avoiding people, places and things that remind of past traumas. Re-experience symptoms such as aggression or a high tolerance for inappropriate behaviors.

Considering Treatment

Overcoming ambivalence about treatment.

For adult survivors dealing with a legacy of childhood trauma, the idea of revisiting the past through treatment may provoke anxiety and uncertainty. So, should you get treatment now, so long after the fact?

There are no easy answers and no single right answer for every person, but in making a decision, consider the following four truths:²

1. Childhood trauma can have lasting impacts. Many people subjected to childhood abuse or neglect develop maladaptive thinking strategies that lead to poor decision-making and snowballing life-consequences.
2. Many people exposed to childhood traumas use drugs or alcohol as a way to self-medicate and to avoid dealing with difficult feelings.
3. Though you may feel imprisoned by your habits, thinking patterns and choices, there are people and programs to turn to for help.
4. People that seek professional assistance can learn effective coping skills and this can translate into a happier life, free from the depression, anxiety or intrusive thoughts and memories that characterize unresolved trauma. 

Seeking Trauma Specific Treatment

If you suffer with substance abuse, depression, anxiety, depersonalization, unhappiness or other complaints that you believe are at least partially caused by traumatic childhood experiences, you should consider seeking out treatment that is trauma informed or trauma specific.

Trauma specific services are set-up to address past traumas and the symptoms and syndromes that can occur after trauma exposure. Key interventions typically include:

• Learning grounding techniques to manage disassociation symptoms.
• Working through desensitization therapies to reduce the power of negative memories or images.
• Learning behavioral therapies that help you temper and manage powerful emotions in effective and healthy ways.

Trauma specific programs also:

• Acknowledge that your symptoms are actually adaptive responses to impossible situations in childhood.
• Acknowledge that childhood traumas, such as abuse and neglect, can lead to lasting interpersonal difficulties based on excessive fear and mistrust.
• Make emotional and physical safety a high priority.
• Avoid certain types of interventions that may actually re-traumatize by reproducing emotional situations that are similar to the original traumatizing experience.

So, if seeking help for adult difficulties with childhood trauma origins, it makes sense to seek out a trauma informed or trauma specific provider or program. By doing so, you avoid making your problem worse through re-traumatization, your mistrust or worries about betrayal won’t seem abnormal and most importantly, you’ll learn specific skills that can really help you get to the root of your problems.

How to Find Trauma-Informed Treatment

To find trauma informed care you can:

Call up local programs or counselors and ask each specifically about their trauma informed or trauma-specific practices – and if a provider claims trauma-sensitive capabilities, ask again for specifics on how these practices differ from standard care.

Use the Substance Abuse and Mental Health Services Administration’s (SAMHSA) treatment locator tool, which lets you search by zip code for mental health or addiction treatment providers in your area. To use the locator:

1. Search by zip code to find a list of behavioral health treatment providers within a radius around your home.
2. Click on the change service selections button at the top of the list to get to an advanced selection menu.
3. On this menu, click on the 'individuals with post traumatic stress disorder' button (people with childhood trauma may not have PTSD, but this selection is the most likely to get you to trauma-informed providers able to help you with early life trauma, abuse or neglect).
4. If you also need addiction treatment, also click on the button for ‘individuals with co-occurring mental and substance abuse disorders’.

The Importance of Phased Treatment

You can’t run before you learn to walk…

Experts agree that for complex trauma, such as for adult survivors of child abuse or neglect, therapy works best when it is delivered in phases and when people learn coping skills first before delving into memories of traumatic events.

Treatment usually occurs in three phases:

Phase 1, Stabilization and Safety

In phase 1 you first address your physical and emotional safety. This may mean addressing dangerous behaviors, such as substance abuse or self harm and also learning grounding techniques to manage your emotional responses and to develop safety and other coping skills (see below for ‘staying in the window of tolerance’). This first stage can take a while, but you can’t make meaningful progress in stage 2 until you’re capable of managing your reactions to difficult emotions and stressors.³

Phase 2, Working through Traumatic Memories

The second phase focuses on the processing and resolution of traumatic memories. By exploring traumatic memories you can shape them into something that makes sense to you and become desensitized from the intense emotional reactions they can provoke. Therapeutic techniques you might use during this second phase include eye movement desensitization response therapy (EMDR), exposure therapies and cognitive processing therapies.

Phase 3, Reintegration

In the last phase, you turn away from the past and look at the present and future. You start addressing how the avoidance of trauma reminders may have limited your choices and look toward broadening your range of everyday experiences. You address, work, relationship, spiritual and recreational aspects of life as you strive to build a satisfying existence for yourself.⁴

Note – There is wide expert consensus on the importance of phased treatment for complex trauma. Some of the organizations recommending a phased approach include: the Australian Center for Posttraumatic Mental Health, the International Society for the Study of Trauma and Dissociation, the National Institute for Clinical Excellence, the Canadian Centre for Addiction and Mental Health, the American Psychological Association Division 56 (Trauma Psychology) and the International Society for the Study of Trauma and Dissociation.⁵

How Long Does Phased Treatment Take?

There are no definitive length of treatment guidelines for adults dealing with complex trauma histories, however, according to an expert consensus panel from the International Society for Traumatic Stress Studies, reasonable time-frame expectations for the 3 phases of treatment are:

• Phase 1 – 6 months
• Phase 2 – 3 to 6 months
• Phase 3 – 6 to 12 months 

Staying in the ‘Window of Tolerance’

One of the skills you'll learn in trauma therapy is expanding your 'window of tolerance' so negative emotions and environmental stressors don’t overwhelm and so you can start to address your past in ways that free you from its legacy.

One model used to explain how complex childhood traumas lead to lasting emotional and behavioral problems is called the ‘window of tolerance model’. In this model, overwhelming and inescapable occurrences in childhood cause extremely high arousal states that effectively dysregulate (break or alter) your arousal regulation systems for life.

People with normally functioning arousal regulation abilities are able to self soothe and draw support from others as a way to stay within the window of tolerance, except in extreme situations. People with dysregulated arousal regulation systems, such as those affected by complex childhood traumas, have a diminished ability to self sooth or control arousal, and so moderate environmental stressors or difficult emotions or memories can easily lead to hyper or hypoarousal, and all the negative reactions and behaviors that accompany these states.⁶

According to the autonomic arousal model, we have three basic states of consciousness:

1. Hyerparousal – Sympathetic nervous system-based fight or flight type states - when we’re overstimulated and overwhelmed
2. The window of tolerance – normal functioning and thinking – feeling OK,  emotions are tolerable
3. Hypoarousal – parasympathetic nervous system-based states of understimulation - we shut down and go numb

Hyperarousal – emotional reactivity, emotional meltdowns, fight-or-flight mode, panic, racing thoughts, hypervigilance,

___________

Window of tolerance – Stay in the present and successfully process and integrate life events. In the window of tolerance our feelings are tolerable and we retain the ability to think and feel at the same time and so our responses to external stimuli are appropriate to the situation.

____________

Hypoarousal – slow thinking, disassociation, low motivation and energy, feeling numb, can’t defend yourself.⁷

Therapy to Widen the Window of Tolerance

Every person has a window of tolerance – an optimal level or brain arousal. When we’re inside our window of tolerance, we function well, feel OK and think clearly.

People who experienced childhood trauma often have an arousal dysregulation problem. They have a relatively narrow window of tolerance and they are easily knocked into hyperarousal or hypoarsoual by stressful or difficult life events or emotional states. They may also cycle quickly between states and have trouble drawing calm and strength from emotional attachment relationships with others.

Fortunately, with mindful awareness of bodily states you can retake control of your dysregulated arousal systems.

Mindfulness

To remedy this situation, in the first phase of therapy, a person can learn to feel and listen to the body and to develop an awareness of how different emotional states feel in the body. Once you gain an understanding of how your body  feels in your window of tolerance and how you feel as slip up or down out of it, you can learn to focus on the  body for calm and use mindfulness of bodily states as an anchor that keeps you tethered to your window of tolerance state.

Grounding Therapies

Complex trauma causes flashback/re-experience symptoms and disassociation symptoms – all phenomena that remove a person from staying focused on the present moment.

Because emotional stress prompts trauma symptoms, to benefit from reprocessing therapies, it’s important to learn self-soothing techniques that help you control your emotional/cognitive arousal and grounding techniques which keep your attention rooted in the here and now.

During the first phase of trauma therapy, you’ll likely learn one or more of the following self-soothing or grounding techniques:

• Progressive muscle relaxation or relaxation breathing exercises. By consciously controlling your physiological response to stress you can calm your emotional and mental response as well.⁸
• Looking around your environment and describing it to yourself in great detail.⁹
• Asking yourself a set series of questions (what time is it, where am I, how old am I, what is happening around me right now…?
• Stepping outside and noticing the current weather and then describing it yourself in detail.
• Calling up a friend or family member to talk about something recent.
• Washing your hands or spritzing water on your face. Feel the water on your skin. Rub your hands together and feel the sensation – clap your hands and listen to the sound.
• Carry something meaningful around with you in your pocket that keeps you focused on the present. When feeling overwhelmed, rub it like a talisman and remind yourself that you are an adult and you are safe.
• Stretch and take some time to feel the muscles in your body. Walk slowly around the room and focus completely on the feeling of your feet on the floor.¹⁰

The Importance of Early Intervention

Since trauma leads to social, emotional and cognitive impairments and these impairments cause all sorts of developmental problems and increase the likelihood of high risk behaviors, the earlier a person gets treatment to address a trauma legacy, the more avoidable damage can be averted.

Take-Home Ideas

If someone you love, especially a young person, struggles with the legacy of childhood trauma, the sooner they get trauma-specific therapy to resolve issues from childhood, the sooner they can start experiencing a full range of activities and environments and the better their long-term quality of life prognosis.

If childhood traumas keep you from living to your full potential, know that trauma-sensitive therapy can help open you up to a fuller and more satisfying range of experiences. Although the idea of re-approaching the past can be upsetting, since trauma therapy occurs in phases, you won’t have to relive anything until you’ve learned to control your emotions and manage your symptoms. You take things one step at a time, and step-by-step, get too the other side.

Image Copyright: Yuri Samoilov

Part 1 of a 2-part article on how childhood trauma leads to lifelong challenges – like addiction and other mental and behavioral health problems. Also, how to know if childhood trauma affects someone you love.

This is part one of a two part series of articles exploring how adverse childhood experiences and complex trauma lead to lifelong physical and mental health problems, such as addiction.

In this first section we’ll look at the Adverse Childhood Experiences study, which links childhood traumas with a host of specific lifelong health problems – and at the end you’ll also find a list of specific questions to ask if you suspect a loved-one’s current problems may originate from long-ago causes.

In the second article, we’ll explore how treatment as an adult can lead to processing and resolution of childhood traumas and to improved health and quality of life – examining why getting treatment so long after the fact makes sense and looking at what type of specific treatment to look for.

What Was the ACE Study?

The Adverse Childhood Experiences (ACE) study was run by Kaiser Permanente and the CDC.

For the study, researchers collected information on the childhood stress experiences and current behavioral, emotional and physical health of more than 17 000 adults in Southern California

• After analyzing this data, they determined that childhood stress exposure significantly raises a person’s risk of lifelong behavioral, mental and physical health problems.

Each study subject received an ACE score based on how many significant adverse childhood experiences they faced. The possible scores ranged from 0 to 7.  Exposure to any of the following before the age of 18 earned subjects one point.

1. Childhood emotional or physical neglect
2. Childhood emotional, physical or sexual abuse
3. Witnessing violence against your mother
4. Living with any drug or alcohol abusing family member
5. Living with any family member who was depressed or mentally ill, or who attempted suicide
6. Living through divorce or separation
7. Living in a household where one or more members were sent to prison.

How Prevalent are Childhood Adverse Experiences?

Based on the study results, we see that 2 out of 3 children will experience one or more adverse events before adulthood.

Study participants were predominantly white middle–class adults with health insurance. In this sample, the prevalence rates were:¹

• 36.1% of study participants reported no adverse childhood experiences
• 26.0 % reported 1
• 15.9 % reported 2
• 9.5% reported 3
• 12.5 % reported 4 or more²

Adverse Childhood Experiences and Addiction

There is a strong correlation between adverse childhood events and addiction risks, and the more adverse experiences you have, the greater your risk.

• Slightly under 3% of people with an ACE Score of 0 report adult alcoholism. For people with an ACE score of 1 that becomes 6%, for a score of 2, the percentage climbs to 10%, for 3 to just under 12% and for people with a score of 4, the percentage tops at 16%. Experiencing 4 or more adverse childhood experiences raises your adult alcoholism risk by more than 500%.
• A male with an ACE score of 6 is 46 times more likely to become an injection drug user at some time in life than a male with an ACE score of 0.
• A person with an ACE score of 6 or greater is 2.5 times more likely to be a current smoker than a person with an ACE score of 0 and more than 3 times as likely to have current emphysema or bronchitis.
  

ACE Score and Lifelong Health

As a person’s ACE score goes up, their risk for the following conditions/high risk behaviors also increases:³

• Depression
• Suicide attempts
• Heart disease
• Domestic violence
• Fetal death
• Multiple sexual partners
• STDs
• Unintended pregnancy
• Teen pregnancy
• Liver disease
• Early initiation of smoking 

Compared to a person with an ACE score of 0, a person with an score of 4 or greater is 4.6 times more likely to experience lifetime depression, 12.2 times more likely to ever attempt suicide, 2.5 times more likely to ever get an STD times 4.5 more likely to experience domestic violence, 5.3 times more likely to ever be raped and 2.4 times more likely to get hepatitis.⁴

Why the Adulthood Influence?

So the statistics paint a startling picture – difficult childhood experiences cause an incredibly strong predisposition to lifelong challenges; but what’s happening that could explain such a strong linkage?

Well, according to the theory, adverse childhood experiences grow into lifelong consequences via the following mechanism:

• Early-life adverse experiences -> social, emotional and cognitive impairments -> the adoption of health risk behaviors -> adulthood disease and disability -> early death.

Research is ongoing, but scientists can already see that early-life traumatic experiences affect the size and functioning of the hippocampus and corpus calosum as well as permanently changing how the brain responds to environmental stress.⁵

Early Death?

Is there any research to back-up this early-death hypothesis?

Unfortunately, yes there is.

Research backs-up the association between adverse childhood experiences and an increased risk of early death. When scientists followed a cohort of people with known ACE scores over a 10 year period they found that:⁶

• People with an ACE score of 6 or more were 1.5 times more likely to die during the 10 year window than matched subjects with an ACE score of 0.
• The average age of death for people with an ACE score of 6 or more was 60.6 years. The average age of death in a matched control group over this same period was 79.1. Among those who died over the 10 year period, having an ACE score of 6 or greater led to an average decrease in lifespan of 18.5 years. 

However, though people with ACE scores of 4 and 5 have significantly higher risks for lifestyle diseases and emotional health problems, researchers did not find any increased risk of early death among people with scores of 1 to 5. Further research is clearly needed to better explain this phenomenon.

Asking a Loved-One about Past Traumas

Do you suspect that someone you care about might have lived through adverse experiences during childhood that may be affecting their health and happiness today?

If it’s an appropriate situation, to find out, ask about specifics from the past that might explain a current problem. Here are some questions you might consider using or basing your own on. These are questions that the Substance Abuse and Mental Health Administration (SAMHSA) advises counselors use when screening for a history of childhood abuse or neglect:⁷

1. Did your parents or guardians treat you harshly as a child?
2. Were you ever physically, sexually or emotionally abused as a child?
3. While you were growing up, did any adult or person 5 years or more older than you ever make sexual advances or contact?
4. Was there violence in your household, while you were growing up?
5. Did you ever have a very traumatic experience while you were growing up, like divorce, the death of a parent, serious sickness in the family or a member of the household getting sent to prison?
6. Was there ever a time while you were young that you didn’t have enough food to eat, clothing to wear or adequate shelter?
7. Was there ever a time growing up when your parents did not protect you as they should have?
8. Did your parents use drugs or drink alcohol frequently while you were growing up?
9. Did you ever feel that you deserved any abuse or neglect, while growing up? 

What Can You Do about Your Childhood Now?

So if you lived through traumatic early-life experiences, is it all doom and gloom? Are you destined to a life of mental and physical illness and early death?

No! Though difficult childhood experiences may lead to maladaptive coping strategies and an increased risk of health problems, you should keep 2 important points in mind:

• Some people are extremely resilient to early-life trauma. Though many people with high ACE scores experience health problems, many also do not.
• Though you can’t erase the past, you can come to terms with past traumas and you can learn healthier coping strategies that greatly reduce any increased health risks.

The take-home message then, is:

1. Childhood traumas have lifelong influences, and a difficult childhood can predispose you to disease and early death.
2. If you have current emotional or behavioral health problems and a history of childhood trauma, getting appropriate treatment to address past traumas may help you to overcome your current problems.

Read part 2 of this article for information on how adult treatment for childhood trauma works and on what types of treatment to look for.

Image Copyright: Pink Sherbet Photography

Drugs have been used to facilitate psychotherapy. MDMA has such a history and such a potential. What is MDMA, how is it used, and why might it be effective?

We live in an age of drugs. It is hard to imagine, but until a few hundred years ago the only psychoactive drug commonly available in the Western world was alcohol. Nicotine, in the form of tobacco, was introduced to Europe in 1559 and was considered a medicinal wonder drug for a few centuries. The first coffee houses in Europe came about 100 years later. But the modern use of drugs and their manufacture did not develop until the end of the 19th century and the beginning of the 20th century. That means that the development of the pharmaceutical industry happened at the same time as the development of psychotherapy.

A History of Drugs in Psychotherapy

Of course there are drugs that have been developed in order to “cure” mental and emotional disorders. Most of them have not proven very efficient at curing, even when they provide some relief from symptoms.

But there have also been many attempts to use drugs as aids in the course psychotherapy over the past hundred years. Freud, following the fashion of his times, experimented with cocaine, not only for himself, but also to assist in his newly developed “talking cure.” He abandoned it, but the idea of using drugs to help psychotherapy persisted and still persists.

One class of drugs that sparked particular interest is the hallucinogens. This includes drugs such as LSD, and MDMA (ecstasy). There was a period, from about 1950 till the mid 1960’s when there was a lot of interest and research into using such drugs to enhance psychotherapy.¹ With the growth of the use of these substances as recreational drugs, and abuse and negative side effects, they became illegal and the potential for enhancing psychotherapy became too difficult to investigate. MDMA was not one of the focuses even though it had been investigated as early as the 1950’s. Interest in MDMA as a psychiatric drug began in the 1970’s.² In fact, by 1985 there were more than 1000 documented MDMA assisted psychotherapy sessions.³ But research was thwarted by its popularity and abuse as a recreational drug and being illegalized in 1985.

Recreational vs. Therapeutic Use

MDMA was illegalized when it became popular and became known as “ecstasy”. It was (and is) commonly used in conjunction with other hallucinogens. It became popular in the “rave” scene, connected to psychedelic music. It is thought that it has a calming effect so it can prevent over-excitement and “bad trips” from LSD alone. This has not been substantiated. As a party drug it is still very popular but is becoming more dangerous due to the fact that many dealers and manufacturers are adding all sorts of chemicals and other additives that can make the pills lethal.⁴

However, it would be a mistake to equate irresponsible and illegal use of a substance with controlled responsible use. To be sure there was serious debate that led to the decision to make MDMA a strictly controlled substance, one that officially has no medicinal use.⁵ Because governments have equated the dangers of irresponsible use with responsible research, research in this country has fallen behind. Fortunately, there has been research in other countries and the research here has begun to pick up.

So, what do we know about the use of MDMA as an enhancer of psychotherapy? Much more than was known back in 1985 when it was made illegal. At that time therapy was different and our understanding of biology was very different. Although the research was prevented in the United States it continued in Europe, particularly in Switzerland, but also in Canada, Israel, Jordan and Australia.⁶ Originally MDMA was thought to be helpful for anxiety disorders. Currently, the focus of most of the research has been for Post Traumatic Stress Disorder (PTSD).

MDMA for PTSD Therapy

1. When being used as an adjunct to traditional psychotherapy, a low dosage of the drug is administered about an hour before an actual therapy session.
   
2. While the drug is taking effect the patient relaxes, might listen to relaxing music, and in some instances, will be comforted by hand-holding or other supportive touch.
3. As the drug takes effect the patient is encouraged to share the experience and engage in a therapy session.
   
4. After the session is over, the therapist will then supervise an additional stage called “integration.” This will take place over the next day or two. The integration stage is to help the patient incorporate the insights gained during the session into a reality based perception and his or her everyday life. This stage is considered critical⁵ and can include anything from family sessions to shamanistic rituals, depending on the needs of the patient.

Taking MDMA as a medicinal drug carries with it all the regular risks of any other serious drug. There are side effects that one needs to be aware of such as dry mouth, jaw clenching, elevated blood pressure, irritability, impaired judgment, and inability to concentrate, amongst many other potential side effects. Without extensive studies the frequency is not well documented. However, there are numerous studies that document a lack of significant long term negative effects. At least enough to justify the studies on human subjects. Additionally, there is strong evidence that this type of protocol actually helps the psychotherapy.⁷

Why Does It Seem to Help?

How does MDMA work? What does it do to a person, when properly administered, to actually help a person utilize the therapy session?

One possible answer is that it does three things to the patient.

1. First, it increases the level of oxytocin. Oxytocin is the hormone that makes us feel connected to other people. When we feel that we are in the presence of love and care our bodies produce oxytocin. This may strengthen the alliance between the patient and the therapist.
   
2. Second, it seems to increase the intellectual functioning of the brain while decreasing activity of the emotional areas of the brain. This can allow the patient to feel less fear while recalling and talking about the trauma.
   
3. Third, MDMA seems to encourage the body to ramp up the processes that we use to recover from stress.⁸

Not Yet Available for General Therapeutic Use

MDMA is not ready for general use by the average clinician. It is only used in research settings, which means one needs to volunteer to take part in experimental use of the drug. Even experienced psychiatrists do not use it. If it ever does become available it would have to be used by both a psychiatrist (MD) and a clinician. While it does seem to have promise for the future, we are not there yet. If you have suffered greatly and have an opportunity to participate in a study, it might be something to consider, but it is not for everybody.

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Like seeing eye dogs but for those suffering from PTSD symptoms, service dogs are ever vigilant so you don’t have to be, they are trained to wake you from nightmares, block others from intruding into your personal space, watch your back and even give you a doggy hug during moments of intense anxiety. While there is little research on the relatively new idea of pairing those with PTSD with service dogs, those who are already benefiting from this canine companionship say it makes a world of difference – that it can be a literal lifesaver.

For returning veterans of war suffering with PTSD, normal everyday tasks like heading to a busy supermarket or a crowded park can become frightening and anxiety ridden experiences. For some, the transition back to civilian life seems impossible - Eighteen American Veterans commit suicide every day, surviving the dangers of war only to become victims of its legacy once back home.¹

Who is hiding at the end of that aisle? Is someone sneaking up on me from behind?

For some, PTSD symptoms don’t go away easily, despite therapies tried and medications used, but now people having difficulty getting over the horrors of a war left behind have a new tool to make the transition back to safe society a little bit easier – specially trained PTSD helper dogs.

A vet with PTSD may know logically that the library or the supermarket holds little threat of attack, but the hyper vigilance of PTSD means that every situation is viewed as a potential threat and behind every bookshelf in that library is a potential enemy. Having a dog you trust maintain vigilance for you lets you lower your guard a bit.

Trained dogs assist people with PTSD perform basic tasks and overcome some of the more debilitating symptoms of the anxiety condition. The dogs can be trained to help veterans take medication at scheduled times or will awake a person having a nightmare. They are taught how to turn on the lights when their handler gets disoriented or confused and when out in public they act as an extra pair of eyes and ears to watch what’s coming from behind or what might be sneaking around corners. They are even trained to give their handlers a doggy hug on command, a gesture of reassurance that can relieve a lot of stress from a situation of temporary anxiety.

Some of the commands the dogs learn include:

• Block – a command given to have the dog move into a position to protect a buffer of personal space
• Hug – to have the dog give a sort of hug, in moments of anxiety
  
• Out – to have the dog move forward to check around unseen corners for any possible threats
  
• Watch – to have the dog take a position of vigilance behind you; to watch your back
  

According to PTSD expert, Tracy Stecker, Ph.D of Dartmouth Medical School, some reasons why trained service dogs can be so beneficial to people with PTSD are:

• They are Vigilant – They keep watch for you so you can lower your guard slightly
  
• They Take Orders – Dogs respond to commands. Things are very black and white and there is no debate about things, which can be a comfort to people used to a rigid military system
  
• They Are Ready to Protect You – Knowing your dog is always at your side and always ready to protect you can be a comfort
• They Offer Unconditional Love – They can help ease what is sometimes a difficult transition out of military life by loving you for you, no matter how difficult you are finding life in the real world
  
• Dogs Teach Trust and Love – A trained service dog is completely trustworthy. Through this perfect trust people can regain some faith notions of trust and love that are sometimes shattered by the experiences of war²

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How well does EMDR really work to treat PTSD? Read on to see a review of some of the latest research evidence on the effectiveness of EMDR and other treatments for PTSD.

EMDR is touted as an effective and fast acting therapy for the treatment of PTSD – but is it right for you, especially considering that no one really understands how or why it really works?

To help you make up your mind, here's a quick review of the basics of EMDR treatment and a presentation of the findings of some major research studies on EMDR for PTSD.

What Is EMDR?

Eye Movement Desensitization and Reprocessing (EMDR) is a therapy which is used to help people feel less anxiety, stress and depression after a traumatic experience.

During an EMDR session, a person will remember and visualize a traumatic memory for a short period of time (30 seconds) while simultaneously completing a muscle movement, such as moving the eyes back and forth to follow a moving finger. With repetition, this exercise reduces the feelings of distress that accompany traumatic memories.

While researchers can’t yet say how or why EMDR works to reduce trauma anxiety, they suspect that the process disrupts the storage of memories and allows for a reformation of these memories without the negative emotional and physical reactions that had previously been intertwined with the experience of remembering.

Treatment of anxiety associated with a single traumatic episode may require only 1-3 session. Treatment of more complex or lasting traumatic experiences likely requires a longer course of treatment.¹

Research Evidence Supporting the Use of EMDR for PTSD

A Large PTSD Literature Review Study

A 2007 Cochrane review study of 33 controlled clinical trials on PTSD found the following therapies effective in the treatment of PTSD

• EMDR
• Individual exposure therapy/trauma focused CBT
• Group exposure therapy/trauma focused CBT
• Stress management therapy

Other types of therapies, such as psychodynamic counseling, supportive therapy, non directive counseling and hypnotherapy were not found as effective in reducing symptoms of PTSD.²

Two Studies on the Effectiveness of EMDR for Rape Victims with PTSD

• A study which compared the effectiveness of prolonged exposure therapy and EMDR for rape victims with PTSD found no significant differences in the effectiveness of either treatment. Both were considerably more effective than no treatment in reducing the severity of PTSD symptoms.³
• A study on 62 women with rape related PTSD symptoms of avoidance found that EMDR and prolonged exposure therapy worked about equally as well in reducing avoidance coping symptoms.⁴

A Study Measuring PTSD Symptoms 15 Months after Treatment with EMDR

32 people diagnosed with PTSD were provided with three 90 minute EMDR sessions. After 15 months post treatment, 84% of the study participants no longer met the criteria for a PTSD diagnosis and there was a sustained 68% reduction in PTSD symptoms.⁵

A Study on the Effectiveness of EMDR for Children with PTSD

This study compared the effectiveness of EMDR versus a wait list control on 27 children between 6 and 12 years old with persistent PTSD symptoms following car accidents.

• Prior to treatment with EMDR all children reported at least 2 PTSD symptoms as measured by the Child Post-Traumatic Stress-Reaction Index.
• After 4 sessions of EMDR over a 6 week period only 25% of children in the treatment group still presented with at least 2 PTSD symptoms.
• In contrast, all (100%) of the children in the wait-list control group still presented with 2 or more PTSD symptoms after that same 6 week waiting period
• Gains made by children in the EMDR group endured at check-ups at 3 and 12 months post study

Based on the results, the study authors conclude that EMDR is a viable treatment for the treatment of PTSD in children.⁶

Conclusions

Based on current evidence, EMDR seems as effective as other evidence based treatments for PTSD, such as prolonged exposure therapy and other trauma CBT and exposure therapies.

EMDR is a valid and effective option for the treatment of PTSD.

Image Copyright: Dave-F

A guide to how children feel and act after experiencing a disaster and what parents can do to minimize fear and other harms.

A disaster is a big and very frightening event – and when something is scary enough to leave adults feeling shaken, it can be terrifying for kids.

Fortunately, children who get support, communication and reassurance from their parents and from other concerned adults in a disaster’s aftermath can come to understand and accept the event and move forward with a minimum of emotional baggage.

Here is some information about how children feel and act after a disaster and what parents and other concerned adults can do to help kids make it through a very tough time with a minimum of harm.

Some kids, unfortunately, will develop PTSD and other disorders from their experience, and so it’s important that parents also know how to recognize the signs and symptoms of PTSD and to know how and when to get help with the emergence of warning signs.

How Children Feel After a Disaster

A natural disaster is a big and very frightening event for a child. Children may see or experience death and destruction, they may get hurt or see others hurt, may lose their home and possessions and they may even lose people known or close to them. It’s natural for children to harbor fears after such an event, but it’s up to parents to help children manage and work through those fears in ways that won’t hinder future development.

Although if you’ve been through a disaster you are likely dealing with a lot already, you can help your child immensely with your extra understanding of their fears, and your patience and time during this initial period after the event.

Some of the primary fears children may have immediately after the event include:

• Worrying about a reoccurrence of the disaster
• Worrying that someone they care about will be hurt or will die
• Worrying about getting separated from their loved ones and left alone

It’s important to communicate honestly with you children in language they can understand to reassure them about their future safety and the safety of the family.¹

How Children May Act After a Disaster

How children act after a disaster depends on their age and developmental stage, and how intensely affected they were by the disaster.

Some common reactions to disasters by age include:²

• Preschool age – reverting to earlier developmental stage acts, such as thumb sucking or wetting the bed; clinging to parents and fearing outsiders or monsters, behavioral changes, a preoccupation with talking about the disaster

• Elementary age – regressing to earlier stage behaviors, withdrawing from friends, having trouble concentrating in school (or not wanting to go to school) behaving aggressively, clinging to family

• Adolescence – adolescents may not verbalize the extent of their worry but may show behavioral signs, such as a decline in school performance, aggressive or delinquent behavior, aches and pain without physical causes, sleeping problems, substance use or abuse.

Warning Signs of Childhood PTSD

According to the American Academy of Child and Adolescent Psychiatry, the signs and symptoms of childhood post traumatic stress disorder (PTSD) may arise soon after a disaster, but parents should also be aware the symptoms may not emerge until months or even years after the fact.

Children who lose a close friend or a family member during a disaster, who see a lot of carnage or who have their homes damaged or destroyed are at greater risk to experience PTSD,

Some of the warning signs of childhood PTSD include:

• Social withdrawal, lethargy, feelings of sadness and a focus on the disaster
• Aches and pains without physical cause (stomach ache, headache)
• Irritability and an inability to focus
• Lasting fears about the disaster, such as fears of separation
• Separation anxiety, and excessively clinging behavior with family – not wanting to leave the family to go to school
• Sleeping problems that last for more than a few days after the event (nightmares, bedwetting, night terrors)
• Seeming jumpy or is easily startled
• Sudden negative changes in behavior

Children with PTSD need professional treatment.

What Parents Can Do to Help

Some of the ways that parents can help kids cope through the initial period after a disaster include:

• Try to limit your own expressions of fear and panic. Kids look to adults as emotional barometers, and if you show panic – they’ll feel panicked too. Additionally, be careful of what you say to other adults while kids may be listening – even innocuous comments can get misinterpreted by younger children and cause fear and anxiety.

• Try to maintain ‘normal’ routines as well as you can – kids find comfort in the stability of routine

• Don’t let your children become overwhelmed by news coverage of the event – try to limit and regulate what they view. They’ve got enough on their own plate without worrying about more than their own surroundings.

• Talk to you children honestly about what happened, why it happened and importantly, what you’re doing to keep the whole family as safe as you can. Make sure to use language they can understand when doing so.

• Teach your child what to do in the event of further dangers. Make sure they know where/how to get help if needed

• Make sure your children get enough to eat and drink and enough sleep each night

• Maintain expectations of behavior and family rules

• Try to replace a few much loved toys as quickly as you can

• Show them that there is hope and point out community rebuilding efforts.

• Be patient and spend as much time as you can with your children

• Encourage children to share their thoughts, worries and ideas about the disaster and the recovery

• Encourage children to participate in the rebuilding by assigning an appropriate recovery task

Getting Trauma Therapy for Children after a Disaster

Children that continue to have serious reactions to the disaster for more than 6 weeks following the event or those that show signs of PTSD may need professional help to move past the event.

Trauma therapy for kids typically means cognitive behavioral therapy (CBT) which is a fast acting therapy that gives kids the tools they need to start feeling a lot better about the past and future.

Image Copyright: United Nations Development Programme

Anyone who experiences or even witnesses a major disaster is at risk of serious stress response symptoms. However, people who have an existing serious mental illness are at an increased risk of a serious stress response, such as post traumatic stress disorder (PTSD).

If someone you love has a serious mental disorder and has just experienced or witnessed a disaster, you should be on the lookout for signs of PTSD and ready to intervene if necessary.

Why Are People With Mental Illness at Greater Risk of PTSD after a Disaster?

Research tells us that people with an existing serious mental illness are far more likely to have pre existing co-occurring PTSD (between 30% and 40% of people with a serious mental illness have a PTSD¹).

Why these disorders so often co-occur remains unknown. Scientists don’t know whether people with serious mental illness are also predisposed to stress disorders or whether people with serious mental illness are more likely to experience severe trauma.

Researchers suspect that people with mental illness may be more severely affected by traumatic events, and they know that people with pre-existing PTSD are likely to experience an increase in symptoms severity following exposure to a more recent disaster.

Helping a Loved One with Mental Illness after a Disaster

By learning the signs and symptoms of an unhealthy stress response (PTSD) you can be ready to intervene quickly at the onset of symptoms, and hopefully can minimize their impact. Also be watchful for a sudden worsening of a primary mental illness, which can also indicate an underlying stress disorder.

Effective treatments for PTSD are available. If you see PTSD symptoms, or a worsening of an existing disorder, talk to your loved one about getting a PTSD assessment, or depending on the situation, talk to your loved one’s psychiatric caregiver about your concerns and observations.

Many of us know someone deeply affected by the earthquake in Haiti. Even thousands of miles from the devastation, we can see the pain and worry in the faces of those we care about as they watch and wonder, or grieve, friends and family left behind in Port au Prince.

We cannot change the past, but we can offer our support to those that worry most fiercely, and in doing so we can help those we love make it through this difficult time.

How to Help

• Be there to listen – you don’t have to have answers, as long as you take the time to lend a sympathetic ear. You don’t have to cheer anyone up – just be there.

• Spend time with your loved one – you are a comfort with your presence, but also respect his or her sometimes need for space and privacy

• Be patient – during a period of great worry your loved one may display irritability, a lessening of intimacy, exhaustion, or psychosomatic illness as a reaction to the stress. Your extra understanding will be appreciated

• If possible, encourage and support healthy eating, sleep and exercise.

• Try to defray other life stresses from your loved one during this period

• Encourage your loved one to spend time away from computer or TV reports of Haiti – a constant vigilance only increases anxiety

• Understand that negative emotions are normal as a response to a disaster, but also take the time to learn the symptoms of PTSD and be ready to suggest an assessment of things don’t get better in time.

Image Copyright: United Nations Development Programme

If a traumatic event you’ve experienced, witnessed or witnessed via news media is causing you extreme and lasting stress, you may have a treatable stress disorder.

Do You Have a Stress Disorder?

According to the American Psychological Association (APA), anyone experiencing any of the following 12 symptoms for longer than 1 month should talk to a mental health professional for a stress disorder assessment.

Signs of a Stress Disorder:

1. Insomnia or changes in appetite
2. Feeling hyper-vigilant, or on edge all the time (easily startled)
3. Feeling depressed or sad a lot of the time – having little energy
4. Being unable to remember the traumatic event
5. Feeling like you can’t concentrate or make decisions, feeling scatterbrained
6. Feeling angry or irritable
7. Feeling like you can’t connect with others; feeling emotionally deadened
8. Finding yourself crying all of a sudden or feeling like there is no hope
9. Avoiding people places or things that trigger memories of the trauma
10. When something triggers a memory of the trauma, finding yourself feeling afraid or anxious
11. Experiencing exaggerated worry about the safety and well being of those you love
12. Experiencing reoccurring nightmares or thoughts about the trauma

If you think that you might have a stress disorder, talk to a mental health professional for an accurate diagnosis and possible treatment. Untreated stress disorders like PTSD do not necessarily get better in time; in fact, they can sometimes get worse. Fortunately, stress disorder treatments are available, minimally intrusive and very effective.

Read PTSD Facts to get a better understanding of stress disorders.

People who have survived a very traumatic event when others did not may feel guilty for their survival and they may blame themselves for things they did or could have done differently in the past.

“A woman in Chicago blames herself for spending money on a car last year instead of saving towards her Haitian sister’s potential immigration.”

While some guilt about things left undid or unsaid is a normal part of the grieving experience, excessive survivor guilt can lead to feelings of depression or anxiety and it can also make people more reluctant to seek out help for the way they feel.

Treatment for Survival Guilt

If your feelings of guilt aren’t going away and are interfering with your quality of life, it’s important that you make contact with a mental health professional to discuss effective treatments that can help you get past the legacy of trauma.

Cognitive Behavioral Therapy (CBT) is commonly used to treat PTSD and survival guilt to help people change negative patterns of thinking that produce negative and hurtful moods and behaviors. 

CBT can work quite quickly, it does not require of you to talk about your past or your subconscious dreams and it provides you with real world skills and techniques that you can practice in daily life to help you feel better.