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rachelmanija Apr. 6th, 2013 04:12 pm)
rachelmanija Apr. 6th, 2013 04:12 pm)Reading for one of my trauma classes. I’m not summarizing the whole thing, just bits I found especially interesting.
Chapter One: Clinical Features of PTSD. Nothing new here.
Chapter Two: Cognitive and Behavioral Features of PTSD.
Amnesia. People rarely have global amnesia for traumatic events (not even knowing it happened or having no memories of any of it), unless they also had a head injury or other physical damage (ETA: or are children, or there were a whole series of similar events, of which only some are remembered. What doesn't happen often: a sober adult has something horrible happen to them, and later does not even recall that it ever happened.) But partial amnesia is extremely common. A typical example is “weapon focus,” in which a person might recall every detail of the gun but nothing about the attacker’s face.
Taylor suggests that this is caused by “attentional narrowing,” which is a common result of extreme arousal. The apparent amnesia is caused by hyperfocus on certain details and total ignoring of others, so the ignored details were never encoded into memory at all. (As opposed to being forgotten or being present but inaccessible.)
My note: be upfront with people about this – they may never be able to recall everything, and that’s okay. Total recall is not necessary to healing.
Guilt. Trauma survivors tend to have a number of incorrect beliefs about the trauma which cause them a lot of pain and suffering. Helping them identify and argue with these beliefs can be very helpful. Great breakdown of common false beliefs on p. 34-35. I’ll just list a few.
- Hindsight bias. “I should have (magically) known the drink was roofied.”
- Justification distortion. “What I did/did not do during the trauma was unjustified.”
- Responsibility distortion. “It was entirely my fault.”
- Wrongdoing distortion. “What I did during the trauma went against my morals and ethics.”
These come about for the following reasons (I only excerpt a few); unraveling them and making them explicit may be very helpful.
- Judging your actions not based on the reality of the situation, but against an ideal or fantasy that didn’t actually exist. “I should have disarmed and kicked the asses of the men who were holding me at gunpoint.”
- Blaming yourself for not acting on ideas you didn’t get until after the fact. “I should have memorized the license plate.”
- Overlooking actual benefits of actual actions. (ie, you got out alive, possibly because of what you actually did.)
- Focusing only on imaginary good outcomes of actions you didn’t take. “If I’d tried to disarm him, I definitely would have succeeded.”
- Not taking into account that when all options are bad, selecting the least bad is a highly moral choice.
- Not taking time and emotional factors into consideration – what you’d do if you had an hour to contemplate it in the peace of your own living room is different from what you do when you have seconds and a gun to your head.
Beliefs about Symptoms
- People with PTSD often think their symptoms mean they’re “going crazy.”
- They tend to interpret emotions or physiological responses as objective truth. “My heart is pounding and I’m frightened, therefore the situation is dangerous.”
- Physical/emotional arousal has become so entwined with negative feelings that they may avoid all arousal, including that caused by exercise or positive feelings. (Anxiety sensitivity.) Interoceptive exposure (inducing arousal in a safe, controlled manner) is good for this.
Clinician's Guide to PTSD: A Cognitive-Behavioral Approach
Chapter One: Clinical Features of PTSD. Nothing new here.
Chapter Two: Cognitive and Behavioral Features of PTSD.
Amnesia. People rarely have global amnesia for traumatic events (not even knowing it happened or having no memories of any of it), unless they also had a head injury or other physical damage (ETA: or are children, or there were a whole series of similar events, of which only some are remembered. What doesn't happen often: a sober adult has something horrible happen to them, and later does not even recall that it ever happened.) But partial amnesia is extremely common. A typical example is “weapon focus,” in which a person might recall every detail of the gun but nothing about the attacker’s face.
Taylor suggests that this is caused by “attentional narrowing,” which is a common result of extreme arousal. The apparent amnesia is caused by hyperfocus on certain details and total ignoring of others, so the ignored details were never encoded into memory at all. (As opposed to being forgotten or being present but inaccessible.)
My note: be upfront with people about this – they may never be able to recall everything, and that’s okay. Total recall is not necessary to healing.
Guilt. Trauma survivors tend to have a number of incorrect beliefs about the trauma which cause them a lot of pain and suffering. Helping them identify and argue with these beliefs can be very helpful. Great breakdown of common false beliefs on p. 34-35. I’ll just list a few.
- Hindsight bias. “I should have (magically) known the drink was roofied.”
- Justification distortion. “What I did/did not do during the trauma was unjustified.”
- Responsibility distortion. “It was entirely my fault.”
- Wrongdoing distortion. “What I did during the trauma went against my morals and ethics.”
These come about for the following reasons (I only excerpt a few); unraveling them and making them explicit may be very helpful.
- Judging your actions not based on the reality of the situation, but against an ideal or fantasy that didn’t actually exist. “I should have disarmed and kicked the asses of the men who were holding me at gunpoint.”
- Blaming yourself for not acting on ideas you didn’t get until after the fact. “I should have memorized the license plate.”
- Overlooking actual benefits of actual actions. (ie, you got out alive, possibly because of what you actually did.)
- Focusing only on imaginary good outcomes of actions you didn’t take. “If I’d tried to disarm him, I definitely would have succeeded.”
- Not taking into account that when all options are bad, selecting the least bad is a highly moral choice.
- Not taking time and emotional factors into consideration – what you’d do if you had an hour to contemplate it in the peace of your own living room is different from what you do when you have seconds and a gun to your head.
Beliefs about Symptoms
- People with PTSD often think their symptoms mean they’re “going crazy.”
- They tend to interpret emotions or physiological responses as objective truth. “My heart is pounding and I’m frightened, therefore the situation is dangerous.”
- Physical/emotional arousal has become so entwined with negative feelings that they may avoid all arousal, including that caused by exercise or positive feelings. (Anxiety sensitivity.) Interoceptive exposure (inducing arousal in a safe, controlled manner) is good for this.
Clinician's Guide to PTSD: A Cognitive-Behavioral Approach
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Confirm - double barreled shotgun being pulled out of a trash bag. Can see it. Wearing purple and white. Yes, but I haven't a clue if it was purple pants and white shirt, or purple shirt and white pants. I think the latter, but I don't know.
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Have you come across a lot of cases in which people had a single traumatic event occur as an adult or teenager, and they blanked it out so thoroughly that they don't even remember that it happened, but had to be told by others? I know it happens sometimes, but my own experience also jibes with "rare." The only times I've ever encountered that, drugs or head trauma were involved.
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This is a grumble more about the book than your summary: I wish people would specify when they're talking about single events vs. complex ongoing trauma. The two are really different, and the latter is not nearly as rare as clinicians would like to think.
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This is what I tell myself, that if I can't come up with a better plan after the fact, with all the time in the world to strategize, then I'm not very clever, am I? (Not that I've ever had a gun literally held to my head, but the principle is the same.)
I did, in a traumatic event at the age of five, experience partial amnesia. I remember clearly everything up to the point at which I realized it was life or death and I was on my own, and I've never had any memories after that point, not a couple hours later, not twenty five years later. I can only deduce what I did based on the fact that I did in fact make it out alive.
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It's interesting to read this checklist because it rather precisely parallels both some of the thoughts she describes having in the aftermath and the "arguing back" as she recognizes her own tendency to make assumptions. She was visiting a friend's apartment when she heard terrified screaming; she ran out of the apartment and up the stairs to intervene, and encountered a woman who was being threatened by a man with a gun.
In replaying the event in her head, she remembered that across the hall, a woman had opened her door, and she wondered later if it would have been better if she hadn't intervened; the woman might have simply run into her neighbor's apartment and perhaps they could have locked the door and barricaded it. Instead, Elizabeth grabbed the woman's hand and they ran down the hallway together, then down some stairs, where there was a heavy fire door and Elizabeth knew that if only her friend opened the door for them they could get through and close it and this man would never be able to get in. Only, of course, her friend wasn't there to open the door; the man wound up shooting the woman right in front of Elizabeth, and then shot himself about a half-hour later, during a standoff with police. (This was a domestic violence incident.)
She beat herself up for all sorts of mistakes, including her failure to kick the guy in the nuts at one point as he stood, legs spread, the gun pointed at that other woman. In the play, she talks both about the self-reproach and the sense she gained over time that she had no reason to assume that things would have turned out better without her intervention, or if she'd done anything differently.
Here's a newspaper article about the play: http://www.bridgelandnews.org/2172
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But that itself suggests how the whole thing works: had she done nothing, she undoubtedly would have beaten herself up for being a coward and standing by while someone got killed. In fact, she courageously stepped forward... but only recalls her "mistakes."
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In the play she wrote about this incident, she talks about how as they ran down the hallway together, she put her arm around the woman and gave her sort of a sideways hug. And later she thought about how this was the last hug this woman ever got.
She did not, in the play, talk at all about the woman's family, because she felt it would be an invasion of their privacy. But the woman's family apparently was deeply grateful that Elizabeth had tried to help her. She didn't succeed, but it meant a lot to them that she'd tried.
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I'm working on training myself out of those habits of thought, but it's slow going.
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Focusing only on imaginary good outcomes of actions you didn’t take. “If I’d asked him out, he definitely would have said yes, and then we'd be happily married now.”
But, of course, they gather more force when they're applied to more serious situations.
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It's hard to say what's going on with memory for early childhood, though, because how much people remember of it varies wildly, even without trauma. My early childhood (as opposed to my later childhood) was quite nice, from the memories I do have and from what I've been told. But I have only one or two memories from before about age three or four, and not a whole lot from before six or seven.
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I do not think my car accident caused me trauma - I did end up in the mental hospital couple of months later, but it had to do with other factors.
And - even if I did mention the car accident, none of my doctors considered it important enough to talk about it. None of what I tell here I ever told to doctors, as they beandipped after the first mention of the accident and, as a good mannered person, I did not bring it up second time.
Unlike people with trauma I belived I saved lives of myself and my children by steering the car aside so that it was not head on collision.
But it still bothers me that I remember cursing at the car heading towards us from behind and upcoming truck (I thought it was a cocky driver attempting to pass the car, not someone who would just head at us), attempting to steer my car toward the side of road (I could not go much faster or slower, as there were other cars in front of me and right behind) ... and then I remember the smell of hot metal and car rolling over and my daughter screaming.
I cannot remember the collision itself and it bothers me very much.
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If this book is correct, the reason you don't remember may be because you were so completely focused on saving yourself and your children, that you had no attention to spare for the collision itself.
Maybe the only way you could have recalled the collision would have been if you'd been less focused on steering... and then maybe you would have had the head-on collision, after all.
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As I cannnot learn from something I do not remember and so I have stopped driving - as I have no memory of the collision itself and the unknown is scarier than the known.
One can deal with the known, even with the worst of it, but how does one deal just with a hole where a memory should be?
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I cannnot learn from something I do not remember
I'm not sure that the collision itself, even if you could retrieve it, would be anything you could learn from. Any potential learning probably comes from the parts you already remember - the parts leading up to the collision, in which you were taking effective and life-saving action, not the collision itself.
I don't know what your particular collision was like, but I've been in several car crashes, including one very serious one in which I was driving. They all felt exactly the same: a tremendous sense of impact, simultaneously shocking and inevitable, painless and terrifying and over by the time you've registered that it happened.
Have you ever asked your children what it felt like to them?
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Also, the collision itself tends to be rather abrupt and full of sensory information that mostly doesn't get processed.
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--this is one, too, that's not popular to think about in the general media. We don't like solutions to things that are only meh, or are actually kind of yuck. . . even if the alternatives are way worse yuck. And this is especially hard to deal with as one can never be sure about alternative courses of action, so if a course taken seems not good, it's very hard not to fall into thinking that some other course would have been better. (I'm talking more for general things, though, not for actual sudden, traumatic events. For them, I think it may actually be easier to come to realize you took the best of a number of bad options--once you are primed to realize the mental trap you've been putting yourself in.)
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- People with PTSD often think their symptoms mean they’re “going crazy.”
I've suffered from minor but real PTSD after a terrorist bombing here in Madrid nine years ago near my home. To this day, if I hear an explosion, I get excessively frantic to know what happened. But we had all been carefully warned by mental health authorities that we'd probably suffer something like that, so when it happens, I'm still frantic but I know it's okay to be frantic, it's a normal thing. Some of my neighbors and friends have similar sorts of over-reactions, and we all understand that we're fine.
Counseling works, even counseling via newspapers and television.
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I'm glad counseling via media was helpful!
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