Tag Archives: PTSD & Stress

Is stress a diagnosable reason for time off from work?

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By David Joel Miller, MS, Licensed Therapist & Licensed Counselor.

Stress person

Stress.
Photo courtesy of Pixabay.com

Stress and time off from work – Morning Question #18

Short answer – Yes, no, and maybe.

Yes. – Stress is diagnosable – IF the person’s reaction to the stress is extreme and they are unable to work, have relationship problems, or are upset about the way the stress is affecting them. It could be Acute Stress Disorder, Posttraumatic Stress Disorder, or possible an Adjustment Disorder.

No – not everyone who has stress at work should get a diagnosis. Everyone has some stress, even good things like a new job or a promotion can be stressful. So just having stress is not enough for the diagnosis.

Maybe – Maybe you can take stress time off with pay, maybe you won’t get paid for time off.

Time off from work is a legal issue. If you have leave coming or qualify for disability then you might get paid time off. Sometimes a counselor will suggest it would be good for you to take some time off even if you do not qualify for paid time off. Self-employed people probably will not get any paid time off but the counselor may recommend it anyway.

Check the laws in your jurisdiction and the rules for your workplace regarding the issue of the time off being paid.

Staying connected with David Joel Miller

Seven David Joel Miller Books are available now!

My newest book is now available. It was my opportunity to try on a new genre. I’ve been working on this book for several years, but now seem like the right time to publish it.

Story Bureau.

Story Bureau is a thrilling Dystopian Post-Apocalyptic adventure in the Surviving the Apocalypse series.

Baldwin struggles to survive life in a post-apocalyptic world where the government controls everything.

As society collapses and his family gets plunged into poverty, Baldwin takes a job in the capital city, working for a government agency called the Story Bureau. He discovers the Story Bureau is not a benign news outlet but a sinister government plot to manipulate society.

Bumps on the Road of Life. Whether you struggle with anxiety, depression, low motivation, or addiction, you can recover. Bumps on the Road of Life is the story of how people get off track and how to get your life out of the ditch.

Dark Family Secrets: Doris wants to get her life back, but small-town prejudice could shatter her dreams.

Casino Robbery Arthur Mitchell escapes the trauma of watching his girlfriend die. But the killers know he’s a witness and want him dead.

Planned Accidents  The second Arthur Mitchell and Plutus mystery.

Letters from the Dead: The third in the Arthur Mitchell mystery series.

What would you do if you found a letter to a detective describing a crime and you knew the writer and detective were dead, and you could be next?

Sasquatch. Three things about us, you should know. One, we have seen the past. Two, we’re trapped there. Three, I don’t know if we’ll ever get back to our own time.

For these and my upcoming books; please visit my Author Page – David Joel Miller

Want the latest blog posts as they publish? Subscribe to this blog.

For videos, see: Counselorssoapbox YouTube Video Channel

Sleep Paralysis – What causes it? Is it related to PTSD or demons?

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By David Joel Miller, MS, Licensed Therapist & Licensed Counselor.

Sleep paralysis.
Photo courtesy of Pixabay.com

Is Sleep Paralysis related to PTSD or the supernatural?

Imagine awakening suddenly in the middle of the night. Sitting on your chest is a demon; there are ghosts, dead people, or spirits standing around your bed. You try to scream but nothing comes from your throat. You would run if you could but your legs won’t work. You are awake and paralyzed. Looking up at the demons you are helpless to do anything beyond saying a silent prayer inside your head. You are experiencing Sleep Paralysis.

Sleep Paralysis is one of those unusual problems. This condition is especially terrifying to someone who has the disorder.  If you have a belief in the supernatural you may dread falling asleep.

Sleep Paralysis has long been more the province of legends and the supernatural than included in the area of mental health. This experience has been connected to many otherworldly phenomena. Similar experiences were described during the Salem witchcraft trials.

Today we have a scientific explanation that satisfies some, some of the time, but are we sure?

In Sleep Paralysis you can see, move your eyes and breathe, but the rest of your body is unable to move.  Some episodes of Sleep Paralysis last seconds. The average is six minutes. Occasional an episode of sleep paralysis will last longer than 6 minutes or on rare occasion’s hours.

Many people with Sleep Paralysis, up to 30% also have a history of Panic Attacks. It is more common among those with PTSD or anxiety disorders. Sleep Paralysis is also most common among those with minority status, especially African-Americans (Sharpless et al 2010.)

Other researchers have suggested that dissociation may be related to the old or “Lizard brains” freeze response to threat or danger. The same mechanism might explain the inability to move despite overwhelming terror found in Sleep Paralysis. Fear and anxiety may both cause and be the consequence of Sleep Paralysis.

Sleep paralysis is more common with overtired or sleep-deprived individuals. It is also associated with taking Antidepressants, Benzodiazepines, and some other medications. Ohayon et al., 1999 (Cited by Sharpless) also suggested a relationship between SSRIs and Sleep Paralysis but Sharpless did not find a connection.

Sleep paralysis can occur when falling asleep or when awakening from sleep. Its main characteristic is not being able to move for an extended period of time. This condition occurs naturally during REM sleep but we don’t know we are becoming paralyzed when we are asleep.

The episodes of paralysis while awake are most often accompanied by very vivid hallucinations. The more vivid the hallucinations the more terrifying the Sleep Paralysis. Sometimes the person will experience hearing sounds. Even when experiencing the full symptoms of Sleep Paralysis, both the visions and the inability to move, many people describe the experience as a “dream” (Fukuda et al, 2000.)

If the hallucinations occur when falling asleep they are called Hypnogogic. Hallucinations that occur when awakening are called Hypnopompic.

Sleep paralysis may be connected with a physical disorder such as Narcolepsy. Reports suggest that those who hear sounds are most likely to also have narcolepsy. Sleep paralysis has also been associated with Migraines. If this occurs more than once or causes significant distress it is wise to seek medical attention.

Sleep paralysis is more likely to occur when someone has moved to a new location, is under stress, or has consumed an excessive amount of alcohol.

Mental health practitioners, therapists, and counselors are mostly concerned with two relationships between sleep and mental health. Is the problem with sleep caused by a mental illness? Symptoms of depression include changes in sleep and appetite. Depression can be seen as the cause of a sleep problem.

Sometimes sleep issues can create symptoms that are diagnosed as mental illness. Nightmares play a role in maintaining depression and PTSD.

Beyond those two alternatives, most other sleep issues are in the providence of medical doctors. There are plenty of sleep problems that are in the International classification of sleep disorders that are not directly included in the DSM.

The following are past posts on connections between sleep and mental health issues.

Getting Rid of Nightmares that Maintain Depression and PTSD

Trauma Steals Your Sleep 

Staying connected with David Joel Miller

Seven David Joel Miller Books are available now!

My newest book is now available. It was my opportunity to try on a new genre. I’ve been working on this book for several years, but now seem like the right time to publish it.

Story Bureau.

Story Bureau is a thrilling Dystopian Post-Apocalyptic adventure in the Surviving the Apocalypse series.

Baldwin struggles to survive life in a post-apocalyptic world where the government controls everything.

As society collapses and his family gets plunged into poverty, Baldwin takes a job in the capital city, working for a government agency called the Story Bureau. He discovers the Story Bureau is not a benign news outlet but a sinister government plot to manipulate society.

Bumps on the Road of Life. Whether you struggle with anxiety, depression, low motivation, or addiction, you can recover. Bumps on the Road of Life is the story of how people get off track and how to get your life out of the ditch.

Dark Family Secrets: Doris wants to get her life back, but small-town prejudice could shatter her dreams.

Casino Robbery Arthur Mitchell escapes the trauma of watching his girlfriend die. But the killers know he’s a witness and want him dead.

Planned Accidents  The second Arthur Mitchell and Plutus mystery.

Letters from the Dead: The third in the Arthur Mitchell mystery series.

What would you do if you found a letter to a detective describing a crime and you knew the writer and detective were dead, and you could be next?

Sasquatch. Three things about us, you should know. One, we have seen the past. Two, we’re trapped there. Three, I don’t know if we’ll ever get back to our own time.

For these and my upcoming books; please visit my Author Page – David Joel Miller

Want the latest blog posts as they publish? Subscribe to this blog.

For videos, see: Counselorssoapbox YouTube Video Channel

6 ways to recover from Complex Trauma or Complex PTSD

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By David Joel Miller, MS, Licensed Therapist & Licensed Counselor.

Words about PTSD

PTSD.
Photo courtesy of Pixabay.com

You can recover from Complex Trauma or Complex PTSD.

Complex Trauma or Complex PTSD is the result of repeated injuries, each of which creates additional trauma. Complex Trauma frequently arises in children who are abused or neglected over long periods of time or survivors of sexual assaults who are re-assaulted.

Being injured once is bad enough but repeated traumatization can result in problems far in excess of those caused by a single trauma. People who were traumatized in childhood and then retraumatize in later life are likely to develop severe and debilitating symptoms. Some researchers have suggested the name of Complex Trauma or Complex PTSD for this condition.

It appears that many people can experience severe trauma, recover, and not develop PTSD. Some of the symptoms of PTSD are normal reactions to experiencing trauma – in the short run. If the reaction is excessive, interferes with a job, friendships or relationships then it first becomes Acute Stress Disorder when the symptoms continue for long periods of time and seriously interfere with functioning the name and diagnosis is changed to Posttraumatic Stress Disorder (PTSD).

Complex Trauma adds trauma upon trauma and results in long-term suffering.

Some treatments make the symptoms of Complex Trauma worse and some things are effective in treatment. Here are the basic rules for recovering from Complex Trauma. I based this on the research of Conner & Higgins and their description of the work of Chu, with my own usually twists.

1. CAUTION – do not start digging until you know what is buried out there, avoid black holes.

The first reaction of someone trying to recover from complex trauma and the approach of many counselors is to go searching for the buried details. People ask “Why can’t I remember things?” Counselors are tempted to try to recover those lost memories. This can result in more trauma and pain and runs the risk of digging up stuff that wasn’t really buried in your yard but the yards of neighbors or even fictional characters.

Some serious damage has been done by forcing people to remember things way before they were ready and by hunting for things that you are not sure happened. Ask a kid often enough about sexual abuse and they will begin to “remember” things that “may have happened” or they “think” happened. These contaminated memories have resulted in a lot of extra pain.

There are a number of other steps that need to be completed before you go digging into the past for answers. The brain tries to protect us by hiding details from us that might keep us from functioning well enough to survive. Trust the process.

2. Have a supportive therapist or counselor as well as a support system in place.

You can’t make this journey of healing alone and the more capable the companions you have on the journey the better. Professionals are important because there may be things you need to tell them that you won’t feel safe telling others. Peers are also helpful for similar reasons.

Group counseling can be especially effective when and if you are ready to talk in front of others.

3. Ensure your personal safety

If you are in a dangerous situation healing is not likely until you deal with the current emergency. Make a safety plan and execute it. You need to feel safe and have reliable food clothing and shelter before you think about other aspects of recovery. But don’t put off recovery waiting for the day you will miraculously feel safe. Get started on the safety part first. Just taking steps to move to a safe place can be empowering.

Challenges to your safety don’t only come from outside. You may be a big part of the danger. Avoid, control, or work on urges and cravings. Confront any urges to commit suicide and seek help immediately if you have thoughts of suicide. Recognize and deal with non-suicidal self-injury, substance abuse, eating disorders, and the urge to try out risky behaviors. Don’t put yourself at risk to be victimized anymore.

4. Get your daily routines and rituals in place.

Most people who experience a crisis lose that ability to get up, eat, care for themselves, and then move about their day. The sooner you re-establish your daily routine the better.

When children are involved the recommendation is the sooner you can resume family rituals the better. Get back to your spiritual home. Remember to have some sort of ritual in your life; birthdays, Christmas, or any other familiar activity makes everyone feel better.

Returning to a job or other activity can be a great way to begin your recovery. If you can’t work at a paid job consider volunteering. Having a reason to get up and out of the house can jump-start your recovery.

A regular and consistent amount of sleep is important. So is some form of exercise. Be as consistent as possible with mealtimes and bedtimes. Include time for relaxation and positive activities.

5. Learn as much as you can about stress, acute stress, and the more difficult forms of PTSD and Chronic Stress. Learn to manage your primary symptoms.

Knowledge is power. When you know you are not “crazy” or “losing your mind” but that the things you are experiencing are common responses to what you have been through, then it is easier to look for the things others have found useful in recovering from their chronic stress.

Accept what you feel. Try to learn to feel what you are feeling rather than run from the uncomfortable feelings. The feelings will come and go. Learn that you don’t have to run from feelings, but you do need to move away from real danger.

6. Begin work on your long-term issues, the chronic stress symptoms, the problems you had before the stressor, and lastly the actual event.

Often people who develop PTSD or a chronic stress disorder discover they had other issues before the stress that put them at risk for PTSD.

Begin to talk about you. What does the experience mean to you? Who are you aside from the trauma? What does the trauma say about the person or thing that hurt you? What if any sense can you make of this?

The discussion of what actually happened should occur when you are ready to tackle this information.

7. Have patience with yourself and the persistence to work through your problems.

Recovery does not happen all at once. There may be sudden leaps forward or slips back but a continued effort will get you to recovery.

Use tools like positive affirmations. You are a worthwhile person no matter what has happened to you. Give yourself credit for the things you accomplish.

You can recover from Complex Trauma or Complex PTSD.

Staying connected with David Joel Miller

Seven David Joel Miller Books are available now!

My newest book is now available. It was my opportunity to try on a new genre. I’ve been working on this book for several years, but now seem like the right time to publish it.

Story Bureau.

Story Bureau is a thrilling Dystopian Post-Apocalyptic adventure in the Surviving the Apocalypse series.

Baldwin struggles to survive life in a post-apocalyptic world where the government controls everything.

As society collapses and his family gets plunged into poverty, Baldwin takes a job in the capital city, working for a government agency called the Story Bureau. He discovers the Story Bureau is not a benign news outlet but a sinister government plot to manipulate society.

Bumps on the Road of Life. Whether you struggle with anxiety, depression, low motivation, or addiction, you can recover. Bumps on the Road of Life is the story of how people get off track and how to get your life out of the ditch.

Dark Family Secrets: Doris wants to get her life back, but small-town prejudice could shatter her dreams.

Casino Robbery Arthur Mitchell escapes the trauma of watching his girlfriend die. But the killers know he’s a witness and want him dead.

Planned Accidents  The second Arthur Mitchell and Plutus mystery.

Letters from the Dead: The third in the Arthur Mitchell mystery series.

What would you do if you found a letter to a detective describing a crime and you knew the writer and detective were dead, and you could be next?

Sasquatch. Three things about us, you should know. One, we have seen the past. Two, we’re trapped there. Three, I don’t know if we’ll ever get back to our own time.

For these and my upcoming books; please visit my Author Page – David Joel Miller

Want the latest blog posts as they publish? Subscribe to this blog.

For videos, see: Counselorssoapbox YouTube Video Channel

Why research is not about your problems – co-occurring diagnoses

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By David Joel Miller, MS, Licensed Therapist & Licensed Counselor.

White mouse

Sometimes the mice get it wrong.
Photo courtesy of Pixabay.com

Feeling left out? You probably have been.

Have you had difficulty finding information that applies to the problems you are facing? You are not alone. The latest research usually doesn’t apply to your condition and should you find a relevant article it may end with the statement, this treatment has not been studied in patients with X, Y, or Z.  In the mental health field, this issue is especially acute, “acute” meaning sharp and painful not “a cute” as in nice to look at.

Most people don’t have only one problem. We have many, many problems. So when we look for treatment we want something that might help us. When people have multiple problems we call that dual diagnosis or co-occurring disorders. You may have two mental health diagnoses, maybe more. Sometimes this is called multi-occurring or even “complex.”

Most people with a mental illness will meet the criteria for two or more conditions. The overlap between substance abuse and mental illness is the rule, not the exception. People with mental illnesses are more likely to develop an addiction or substance abuse disorder than those without mental illness.

People with a mental illness often have a physical illness. People with an earlier physical illness are more likely to develop a mental illness. If you are seriously and chronically ill you might be a little depressed and anxious wouldn’t you?

As a therapist and a blog writer, I am always looking for the latest in research, things that might help my client. There are some new things, but frankly, there are a lot of studies that are not very helpful.

Most studies exclude from their population anyone who had a substance abuse problem until they are clean and sober for at least 6 months or more. They also exclude from studies those who have had a psychosis such as schizophrenia.

Most of my career has been spent in substance abuse facilities, crisis units, and psychiatric hospitals. Clients there have the greatest need for new effective treatments. They also have the most co-occurring disorders.  The newest treatments have not been tested on the people who need the help the most.

Drug companies would love to play this game. Many psychiatric meds cause weight gain. This excess weight gain can result in obesity and diabetes. So if I am a drug manufacturer and want to minimize side effects which I need to report to the government I would want to exclude a person who had diabetes, better yet let’s leave out anyone who is overweight. When it comes to drug companies there are regulatory agencies that keep an eye out for this sort of thing, with psychotherapy not so much.

Recently I have been doing some reading on the problems related to treating people with PTSD. We need to find better ways to help people with this condition. Right now there are lots of possible treatments but even the big names in therapy don’t seem to agree on the best approach. If therapists don’t agree on the best treatment how is the client to know if the treatment will help or harm them?

Most of the clients I see who have PTSD also have other problems. Substance Abuse is common. With those recurring intrusive memories that keep you from a good night’s sleep for years on end would you be tempted to drink?  Most of the “controlled” studies on PTSD exclude anyone with a substance use disorder or psychosis. These are the clients for whom we most need to find better treatments.

People who have a combination of PTSD and depression or substance abuse are at greater risk. Does it make sense to exclude high-risk clients from efforts to evaluate treatment for high-risk clients?

Recently I came across a study on a new treatment for PTSD. I won’t spoil the fun by telling you whose study this was.

The introduction sounded good until I read further. They excluded from their study anyone with Bipolar Disorder, Psychosis, or a history of addiction. By the time they got done excluding they were down to less than ten subjects. They had excluded more people than they included. To me, this means they should have gone the other way and tried this new treatment on the people with the most problems, the larger group. When they did their study they found out that all but one of their subjects had a history of alcohol abuse. While they had screened out current alcoholics they missed that all the people they serve had at some time or other had an alcohol problem.

A further concern should be mentioned here. Treatment should not make a client worse. Some of the current treatments for PTSD seem to make clients worse off, the treatment can retraumatize them.  Treatments that are too painful result in clients dropping out of treatment. I continue to believe that people do not benefit from the treatment they do not receive, no matter how great the treatment looked in a research study.

I will post more about treatments for PTSD as I wade through the newer studies.

For more blog posts on PTSD, substance abuse, or Co-occurring disorders see the newly revised list by categories to the right.

Staying connected with David Joel Miller

Seven David Joel Miller Books are available now!

My newest book is now available. It was my opportunity to try on a new genre. I’ve been working on this book for several years, but now seem like the right time to publish it.

Story Bureau.

Story Bureau is a thrilling Dystopian Post-Apocalyptic adventure in the Surviving the Apocalypse series.

Baldwin struggles to survive life in a post-apocalyptic world where the government controls everything.

As society collapses and his family gets plunged into poverty, Baldwin takes a job in the capital city, working for a government agency called the Story Bureau. He discovers the Story Bureau is not a benign news outlet but a sinister government plot to manipulate society.

Bumps on the Road of Life. Whether you struggle with anxiety, depression, low motivation, or addiction, you can recover. Bumps on the Road of Life is the story of how people get off track and how to get your life out of the ditch.

Dark Family Secrets: Doris wants to get her life back, but small-town prejudice could shatter her dreams.

Casino Robbery Arthur Mitchell escapes the trauma of watching his girlfriend die. But the killers know he’s a witness and want him dead.

Planned Accidents  The second Arthur Mitchell and Plutus mystery.

Letters from the Dead: The third in the Arthur Mitchell mystery series.

What would you do if you found a letter to a detective describing a crime and you knew the writer and detective were dead, and you could be next?

Sasquatch. Three things about us, you should know. One, we have seen the past. Two, we’re trapped there. Three, I don’t know if we’ll ever get back to our own time.

For these and my upcoming books; please visit my Author Page – David Joel Miller

Want the latest blog posts as they publish? Subscribe to this blog.

For videos, see: Counselorssoapbox YouTube Video Channel

Acute Stress Disorder vs. PTSD

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By David Joel Miller, MS, Licensed Therapist & Licensed Counselor.

Stress.
Photo courtesy of Pixabay.com

What is the difference between stress, Acute Stress Disorder, and PTSD?

Stress is a normal human reaction to something that threatens us or challenges our ability to cope. When challenged our bodies to respond. Even good things we have looked forward to, like new jobs, marriages, or the birth of a child, can cause stress. Negative events, loss of a job, divorce, sickness, or the death of someone we love can be even more stressful. Stress is a normal part of life unless it gets out of control.

Acute stress disorder is when something stresses us out and this stress results in impairment of our ability to function. It goes far beyond just being stressed out and needing time to recuperate.

Acute Stress Disorder is a diagnosable mental illness, though much of it goes untreated and unnoticed and like adjustment problems or a mild depressive episode may go away by its self, untreated. If it becomes severe enough it needs treatment before the symptoms get out of hand. The symptoms of Acute Stress Disorder must last for at least two days and must happen during the thirty days after the stressful event. Once the episode lasts more than 30 days we reclassify it as PTSD. PTSD may also intensify and produce symptoms that are in excess of those seen in Acute Stress Disorder.

Acute Stress Disorder.

Acute Stress Disorder is not just being stressed out or needing time off from work, it is far more debilitating than those symptoms.

Here are the things that need to happen for the stress to be Acute Stress Disorder. This is in my words, not the official DSM language.

Warning: This description is not meant as a diagnose-your-self project. If you think you recognize yourself, a family member, or friend in these descriptions you really should see a professional.

1. You experience or see something that makes you afraid you or someone close to you like a friend or family member will be killed or seriously injured. This could be an actual event or someone who threatened you and you believed them. As a result of this harm or risk of harm, you become intensely fearful, helpless, or horror-struck. Note this is pretty bad stuff, not just being chewed out by your boss or the risk of being fired. Those milder things are stressful and might result in an adjustment disorder if they affect you enough, but those non-life-threatening things don’t get called Acute Stress Disorder or PTSD.

2. You get lots of DISSOCIATIVE symptoms – 3 or more. Dissociative symptoms, those are bad.  Here is the list:

A. Numbing or not feeling emotions

B. You don’t feel like things are real – called derealization

C. You can’t be sure you are you – called depersonalization

D. You get dissociative amnesia – can’t remember big chunks of what happened.

3. You keep reliving this experience, like that episode of Star Trek where every day they got up and it all happened again. Your life turns into a rerun.

4. You would go a mile out of your way to avoid places or people like that again.

5. You are on edge, jumpy and the least little thing sets you off again.

6.  You get so upset you can’t go to work, avoid friends and are afraid to talk about this let alone ask for help.

7. This experience and all its terror lasts 2 days to 30 days.

8. By the way, if you did bad drugs and imagined this or there is something medically wrong with you – forget all the above and get to a doctor right away.

So what makes it PTSD?

If you have the above and it goes on over thirty days we change the name to PTSD. But then the longer this goes on the more the symptoms. This is one reason we are thinking that if we could get to people who have been injured and treat them right away we just might keep this Acute Stress Disorder from turning into PTSD. That means treating some people who could get better on their own without treatment in order to prevent others from getting PTSD, but given the long-term debilitating results of PTSD, a little extra treatment might be worth it.

Not sure what you think, but I believe that if we could provide appropriate services to all those returning GI’s from the Middle East we could prevent a lot of long-term suffering.

Those guys are worth the effort right? For the accountants out there, prevention saves a lot of money on long-term treatment also.

As Acute Stress Disorder goes past the 30-day mark lots of more severe symptoms develop, nightmares, extreme efforts to avoid anything that might remind them of the trauma, and lots of drug and alcohol abuse. PTSD and alcoholism are best friends.

There is disagreement right now about the best way to treat PTSD. I will write more in future posts on PTSD, stress, and some available treatments and new approaches that sound really interesting.

For more information on Stress and PTSD see:

Posttraumatic Stress Disorder – PTSD and bouncing back from adversity

8 warning signs you have PTSD

Posttraumatic Growth (PTG) vs. Posttraumatic Stress Disorder

Staying connected with David Joel Miller

Seven David Joel Miller Books are available now!

My newest book is now available. It was my opportunity to try on a new genre. I’ve been working on this book for several years, but now seem like the right time to publish it.

Story Bureau.

Story Bureau is a thrilling Dystopian Post-Apocalyptic adventure in the Surviving the Apocalypse series.

Baldwin struggles to survive life in a post-apocalyptic world where the government controls everything.

As society collapses and his family gets plunged into poverty, Baldwin takes a job in the capital city, working for a government agency called the Story Bureau. He discovers the Story Bureau is not a benign news outlet but a sinister government plot to manipulate society.

Bumps on the Road of Life. Whether you struggle with anxiety, depression, low motivation, or addiction, you can recover. Bumps on the Road of Life is the story of how people get off track and how to get your life out of the ditch.

Dark Family Secrets: Doris wants to get her life back, but small-town prejudice could shatter her dreams.

Casino Robbery Arthur Mitchell escapes the trauma of watching his girlfriend die. But the killers know he’s a witness and want him dead.

Planned Accidents  The second Arthur Mitchell and Plutus mystery.

Letters from the Dead: The third in the Arthur Mitchell mystery series.

What would you do if you found a letter to a detective describing a crime and you knew the writer and detective were dead, and you could be next?

Sasquatch. Three things about us, you should know. One, we have seen the past. Two, we’re trapped there. Three, I don’t know if we’ll ever get back to our own time.

For these and my upcoming books; please visit my Author Page – David Joel Miller

Want the latest blog posts as they publish? Subscribe to this blog.

For videos, see: Counselorssoapbox YouTube Video Channel

Posttraumatic Growth (PTG) vs. Posttraumatic Stress Disorder (PTSD)

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By David Joel Miller, MS, Licensed Therapist & Licensed Counselor.

Words about PTSD

PTSD.
Photo courtesy of Pixabay.com

How are PTSD, PTG, and Resilience related?

Is some sort of personal growth possible as a result of living through a traumatic experience? Recently researchers have begun to study the concept of Posttraumatic Growth (PTG.) There has always been a body of literature about how some difficulty might spur changes in a person and lead to a new way of seeing life. But could something that was so severe a stressor as to be traumatic really lead to positive growth? And if that change might happen, why? What characteristics of the person, the treatment they received, or their support system might transform Posttraumatic Stress into Posttraumatic Growth?

Zoellner & Maercker defined PTG as “the subjective experience of positive psychological change reported by an individual as a result of the struggle with trauma.” So far studies of PTG have been lacking and those that have taken place include mostly groups of people who are different from the clients we see in therapy who have PTSD. For example, many patients with PTSD also have co-occurring substance abuse disorders. Most studies of PTG have excluded clients with substance use disorders. We know from many individual reports that overcoming substance abuse especially in clients with PTSD can result in the client developing a new way of seeing the world and many in recovery report that they have grown as a result. Clients with suicidal thoughts have also been excluded from studies of PTG despite the recurrence of clients telling us that being hospitalized for a mental illness, especially with suicidal thoughts, can be a life-altering experience.

Hagenaars & van Minnen (Journal of Traumatic Stress, Vol. 23, No. 4, August 2010, pp. 504–508 (c 2010), conducted a study using Exposure Therapy. The therapy included steps beginning with low-intensity experiences such as “Patients were asked to close their eyes and talk about the traumatic event in the first person and in the present tense, recollecting as many sensory details as vividly as possible, i.e., as if the trauma was happening “here and now.” The intensity progressed to real-life situations. This procedure is similar to systematic desensitization procedures in use for specific phobias.

So what did they find? The more PTG the less PTSD and vice versa. Also, the more someone was “emotionally numb” the less likely they were to benefit from the treatment, and the less likely they were to have PTG. They concluded that an inability to feel emotions is related to an inability to grow. So the ability to face problems leads to growth and the inability to face problems leads to staying stuck in the problem. Unfortunately, this leads us around in a circle to the place we started. Resilient people can grow as a result of trauma but trauma can make you less resilient especially repeated traumas.

Some clients who have been forced to relive traumatic events become re-traumatized. So sometimes the exposure techniques make you better but the same treatment can also make you sicker. How do you choose? Clients who share about trauma in a safe environment seem to get positive benefits; those who are cross-examined for details get worse. So, in the end, the value or damage of the technique depends on the relationship. This is one reason that group counseling is so appealing. People with similar traumas feel safer in talking about them in a group that has had a similar experience. Counselors who are seen as accepting help and rejecting professionals harm. It is in the case of PTSD as in other therapy – all about the relationship.

One further problem with the concept of PTG, how do we know it happens? Mostly we measure it by the client’s subjective report. They say they grew as a result of the trauma so that is evidence. But how did they grow? Did they take new actions or did they have a change of attitude? Maybe both? People who are spurred to action appear to grow more.

We also suspect that PTG is related to resilience. So do resilient people have more growth as a result of a traumatic event or do people who overcome a traumatic event become more resilient?

We know that PTG reduces PTSD symptoms and that the process of growth is related to resilience somehow. It is also clear that there is a lot more PTSD out there than we wanted to recognize. The challenge is making use of the things we learn in research and theory to help the clients who walk in the door in their journey from Posttraumatic Stress Disorder (PTSD) to Posttraumatic Growth (PTG.)

Do any of you have experiences with Posttraumatic Stress Disorder (PTSD) or Posttraumatic Growth (PTG) you would care to share?

This post was featured in “Best of Blog – May 2012”

For more information on Stress and PTSD see:

Posttraumatic Stress Disorder – PTSD and bouncing back from adversity

8 warning signs you have PTSD

Acute Stress Disorder vs. PTSD 

Staying connected with David Joel Miller

Seven David Joel Miller Books are available now!

My newest book is now available. It was my opportunity to try on a new genre. I’ve been working on this book for several years, but now seem like the right time to publish it.

Story Bureau.

Story Bureau is a thrilling Dystopian Post-Apocalyptic adventure in the Surviving the Apocalypse series.

Baldwin struggles to survive life in a post-apocalyptic world where the government controls everything.

As society collapses and his family gets plunged into poverty, Baldwin takes a job in the capital city, working for a government agency called the Story Bureau. He discovers the Story Bureau is not a benign news outlet but a sinister government plot to manipulate society.

Bumps on the Road of Life. Whether you struggle with anxiety, depression, low motivation, or addiction, you can recover. Bumps on the Road of Life is the story of how people get off track and how to get your life out of the ditch.

Dark Family Secrets: Doris wants to get her life back, but small-town prejudice could shatter her dreams.

Casino Robbery Arthur Mitchell escapes the trauma of watching his girlfriend die. But the killers know he’s a witness and want him dead.

Planned Accidents  The second Arthur Mitchell and Plutus mystery.

Letters from the Dead: The third in the Arthur Mitchell mystery series.

What would you do if you found a letter to a detective describing a crime and you knew the writer and detective were dead, and you could be next?

Sasquatch. Three things about us, you should know. One, we have seen the past. Two, we’re trapped there. Three, I don’t know if we’ll ever get back to our own time.

For these and my upcoming books; please visit my Author Page – David Joel Miller

Want the latest blog posts as they publish? Subscribe to this blog.

For videos, see: Counselorssoapbox YouTube Video Channel

8 warning signs you have PTSD.

Posted on by
13

By David Joel Miller, MS, Licensed Therapist & Licensed Counselor.

Words about PTSD

PTSD.
Photo courtesy of Pixabay.com

Could you have PTSD?

There is a whole lot more Posttraumatic Stress Disorder (PTSD) around than we would like to recognize. People struggle with the symptoms, sometimes for a lifetime. Often they think they are weak or crazy when in fact they have a recognized illness. PTSD is treatable if only those who have it would seek help.

There are three main causes of PTSD. One huge source of the illness is living through the horrors of war, either as a combatant or a civilian in a war zone. The recurring theme of so many young Americans sent off to wars in distant lands guarantee’s that we will be seeing an expanding number of PTSD cases for years to come.

Other large groups with PTSD are children who were abused and those who have been victims of domestic violence. There can be other sources of PTSD, such as witnessing a violent death or living through a natural disaster.

So what are the warning signs that you or someone you know has PTSD?

With PTSD you relive the horror day after day.

If the memory never goes away, you have recurrent thoughts about that time, that place, and it upsets you, these are all signs of PTSD. The key here is, are the thoughts intrusive? Some people especially young children get “stuck” they relive the events over and over, incorporating the things they have experienced into their play and their daily routines

The pain of PTSD follows you into your dreams.

We all have dreams; the mind tries to work out problems and save memories. Dreams in PTSD are different. The same dream recurs. It is as if you are living through the event all over again. People with PTSD can wake up screaming. If you are afraid to go to sleep for fear you will have that dream again or you don’t remember the last time you had a full night’s sleep you should be checked out for PTSD.

The feeling that the trauma is still happening is a sign of PTSD.

The trauma does not slip into the past. Every day you live through it again. This feeling of reliving the horror can be heightened by alcohol, some drugs, or a new traumatic event.

If you avoid feelings, thoughts and can’t talk about the trauma it may be PTSD.

Many returning veterans have never been able to talk about the things they experienced. When they do talk, it is usually only with other military veterans who have had similar experiences. Many with PTSD are never able to talk about their trauma outside a peer group.

Avoiding anything that reminds you of the trauma is a symptom of PTSD.

Holiday celebrations, people who wear particular cultural styles of clothing, smells, and ethnic foods, all of these can trigger a recurrence of symptoms. These recurrences are not just memories but reliving both the facts and the feelings of the first event. People with PTSD may panic and be unable to be around particular things that remind them of the traumatic incident.

Blackouts and memory gaps are common in people with PTSD.

People with PTSD may be horrifically frightened of things that remind them of the trauma but unable to recall large parts of the incident. Frequently important facts are forgotten. They see small details with great accuracy but other important parts of the story are lost in the fog.

With PTSD you experience a loss of connection.

People with PTSD lose interest in people and things around them. They find it difficult to participate in activities with others. They may become detached or unable to feel. They don’t see themselves as having a future, no family, no career. They don’t expect to live long.

Lots of episodes of sudden excessive emotions may be PTSD.

If you have PTSD you may suddenly become angry. You may be extra anxious, jump at the smallest sound. You may have trouble concentrating, be irritable, and unable to relax or sleep.

A precise diagnosis of PTSD should be made by a professional. There are other illnesses and problems that could resemble this condition. But if you experienced trauma you probably recognized yourself in this list.

For more information on Stress and PTSD see:

Posttraumatic Stress Disorder – PTSD and bouncing back from adversity

Posttraumatic Growth (PTG) vs. Posttraumatic Stress Disorder

Acute Stress Disorder vs. PTSD 

Staying connected with David Joel Miller

Seven David Joel Miller Books are available now!

My newest book is now available. It was my opportunity to try on a new genre. I’ve been working on this book for several years, but now seem like the right time to publish it.

Story Bureau.

Story Bureau is a thrilling Dystopian Post-Apocalyptic adventure in the Surviving the Apocalypse series.

Baldwin struggles to survive life in a post-apocalyptic world where the government controls everything.

As society collapses and his family gets plunged into poverty, Baldwin takes a job in the capital city, working for a government agency called the Story Bureau. He discovers the Story Bureau is not a benign news outlet but a sinister government plot to manipulate society.

Bumps on the Road of Life. Whether you struggle with anxiety, depression, low motivation, or addiction, you can recover. Bumps on the Road of Life is the story of how people get off track and how to get your life out of the ditch.

Dark Family Secrets: Doris wants to get her life back, but small-town prejudice could shatter her dreams.

Casino Robbery Arthur Mitchell escapes the trauma of watching his girlfriend die. But the killers know he’s a witness and want him dead.

Planned Accidents  The second Arthur Mitchell and Plutus mystery.

Letters from the Dead: The third in the Arthur Mitchell mystery series.

What would you do if you found a letter to a detective describing a crime and you knew the writer and detective were dead, and you could be next?

Sasquatch. Three things about us, you should know. One, we have seen the past. Two, we’re trapped there. Three, I don’t know if we’ll ever get back to our own time.

For these and my upcoming books; please visit my Author Page – David Joel Miller

Want the latest blog posts as they publish? Subscribe to this blog.

For videos, see: Counselorssoapbox YouTube Video Channel

Trauma Steals Your Sleep

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12

By David Joel Miller, MS, Licensed Therapist & Licensed Counselor.

sleep

Child sleeping.
Photo courtesy of Pixabay.com

Trauma alters your sleep.

Trauma, especially the kind that produces Post Traumatic Stress Disorder (PTSD) alters the brain in a host of ways. One major result of trauma is a change in sleep patterns. Those changes in sleep result in a host of other mental and behavioral changes. Children who are abused or neglected or witness a traumatic event have problems sleeping. Rates of sleep disorders in abused children and adults with PTSD range from 50% to 90%. The majority of all people who experience trauma have a sleep disruption that causes other mental health problems.

While the trauma and the resulting change in sleep often go unreported, other changes in behavior get noticed. These issues frequently follow child victims of trauma into adulthood. Adult victims of trauma have the same types of outcomes and they or others may think they are just acting childish. There are reasons the brain changes and things that can be done about those changes.

Not everyone who witnesses a traumatic event develops PTSD- we know that. There is a whole area of study on the topic of resilience and why some people can bounce back and others become “traumatized.” Even people with very high resilience can develop PTSD if they experience enough trauma often enough. Children who are abused, molested, or neglected are at high risk, so are women who are abused and anyone witnessing the horrors of modern warfare often enough is likely to develop PTSD.

One result of exposure to trauma is an increase in attention to things that look like the cause of the trauma. We call this hypervigilance and many times it is a good thing.

Say you walk into the street and are hit by a car. In the future, you will be much more careful. If it happens to you as a child you may grow up to be afraid to cross streets. You may even become fearful when your children need to walk to school and feel the need to go with them to keep them safe.

A woman who is beaten and raped by some men wearing a particular color of clothing, something gang-related or a sports team’s logo, will be very careful when she sees that style of clothing again. This may keep her safe if she avoids dangerous situations. But sometimes the increased vigilance becomes a problem.

When someone becomes afraid to leave the house or to go where there are crowds because that feared person can’t be seen? What if they become afraid of all people? What if a dangerous person changes their clothing and they do not get recognized because that woman is looking out for only one clothing style? The vigilance is now turned up too high and focused on too little.

A child who is punished for a poor score on a test may try harder the next time. But if the punishment is excessive – if it turns to abuse – that child may do anything to avoid taking a test – for the rest of their life!

How does this excess vigilance, which started out to protect the person begin to rob them of sleep and undermine their mental health?

The human body and brain move through a series of sleep stages during the night. Some stages are deep and some are shallow. Most people reach a shallow stage and then fall back asleep. Not someone with PTSD.

Children with PTSD as a result of abuse have difficulty falling asleep. Their sleep is shallower all through the night because of the hypervigilance. They wake up many times during the night. When they wake up they become fearful. Is something dangerous about to happen? Was there a sound that woke them up?

Children with disrupted sleep as a result of past trauma are more likely to wet the bed. They are also more likely to get up and check the house to see if they are safe. They may sleepwalk. They may have sudden awakenings as a result of the smallest of noise and it may be hard to get to sleep again after the awakenings. They often have nightmares and sometimes night terrors when they awaken suddenly screaming in fear.

Now a lack of sleep at night makes the person with PTSD very tired the next day. They often get diagnosed with ADHD or Bipolar disorder. I question sometimes, with the clients I see, if a large amount of trauma they experienced in childhood did not cause the brain to grow and connections to form that resulted in the Bipolar condition. Since there is a genetic component to many mental illnesses, and children who have a genetic risk factor may also have parents who have a mental illness. This is not an argument for taking more children away from parents. What I am suggesting is that we need more early intervention. Kids who grow up with PTSD may have trouble being appropriate parents and the problem gets passed on before it is recognized.

During the REM sleep stage, memories are moved from short-term memory to long-term memory. Poor sleep can result in things that were learned one day being forgotten when the person gets up the next morning. Lack of sleep can also result in conditions that look like psychosis.  Staying awake too long by choice or from PTSD results in the brain making things up. Before long you can have problems telling if something is real or if you are dreaming it up. You may walk around all day more than half asleep.

People who are traumatized, with or without PTSD, and who have a sleep disruption, as a result, are much more likely to abuse alcohol or drugs. In many drug treatment programs, clients who report trauma in the past exceed 50%, sometimes the rate approaches 100%.

When the thoughts of the past keep you awake at night it appears to make sense to take something to help you sleep. Many people turn to alcohol which does not make things better, it makes them worse.

As a person drinks more the body develops a tolerance to the alcohol. It takes more and more alcohol to knock the drinker out. Being unconscious is not the same thing as sleeping. This is one reason a person who drinks and passes out is so tired the next morning.

So there you have it. Trauma especially in large doses, the PTSD kind, results in poor sleep. The poor sleep results in lots of symptoms that look like other problems. The treatment of choice here is to work with someone who specializes in treating the Trauma or PTSD and at the same time make getting lots of good sleep a priority.

Staying connected with David Joel Miller

Seven David Joel Miller Books are available now!

My newest book is now available. It was my opportunity to try on a new genre. I’ve been working on this book for several years, but now seem like the right time to publish it.

Story Bureau.

Story Bureau is a thrilling Dystopian Post-Apocalyptic adventure in the Surviving the Apocalypse series.

Baldwin struggles to survive life in a post-apocalyptic world where the government controls everything.

As society collapses and his family gets plunged into poverty, Baldwin takes a job in the capital city, working for a government agency called the Story Bureau. He discovers the Story Bureau is not a benign news outlet but a sinister government plot to manipulate society.

Bumps on the Road of Life. Whether you struggle with anxiety, depression, low motivation, or addiction, you can recover. Bumps on the Road of Life is the story of how people get off track and how to get your life out of the ditch.

Dark Family Secrets: Doris wants to get her life back, but small-town prejudice could shatter her dreams.

Casino Robbery Arthur Mitchell escapes the trauma of watching his girlfriend die. But the killers know he’s a witness and want him dead.

Planned Accidents  The second Arthur Mitchell and Plutus mystery.

Letters from the Dead: The third in the Arthur Mitchell mystery series.

What would you do if you found a letter to a detective describing a crime and you knew the writer and detective were dead, and you could be next?

Sasquatch. Three things about us, you should know. One, we have seen the past. Two, we’re trapped there. Three, I don’t know if we’ll ever get back to our own time.

For these and my upcoming books; please visit my Author Page – David Joel Miller

Want the latest blog posts as they publish? Subscribe to this blog.

For videos, see: Counselorssoapbox YouTube Video Channel

Post Traumatic Stress Disorder – PTSD, and bouncing back from adversity

Posted on by
6

By David Joel Miller, MS, Licensed Therapist & Licensed Counselor.

Words about PTSD

PTSD.
Photo courtesy of Pixabay.com

We have been hearing a lot more about PTSD these days.

The returning military is experiencing this problem in larger numbers than in the past. The military is not the only place we see PTSD. Children who have been abused, battered women and men, and people who have lived through traumas like hurricanes and tornadoes are also experiencing PTSD. The counseling profession, as well as society in general, is looking for solutions to this problem.

Recently at a convention for therapists and counselors, PTSD and the need to improve treatment was a major topic. I listened to the big-name people; the ones who have written books and given lectures, as they talked about how we should treat the disorder. Two of the biggest names in therapy did not agree on the best treatment. If they disagree, what is the person with PTSD to think? This made me start searching for answers.

Why do some people get PTSD and others do not experience it. In combat, let’s say ten men are in the same incident some get PTSD and some do not, why? Stix in a Scientific American article reported that of people who were traumatized by a single traumatic event, 90 % recovered from the trauma without therapy. So some people have concluded that PTSD is not a normal response to trauma. Maybe some form of resiliency is more common than PTSD. Maybe we have been doing it backward by studying the few who get PTSD instead of the many who bounce back from adversity.

We know from another study that kids who grow up in dysfunctional homes are more likely to suffer from PTSD, depression, and anxiety. From 50% to 67% of exposed kids develop some mental health issue, but the other one-third to one-half does not. Kids from this sort of background have repeated trauma and they have less social support. I wanted to know why some got PTSD and others did not.

There is a lot of research going on right now into the area of resilience. Some people seem to not develop PTSD when exposed to trauma. Others bounce back quickly. A few have lifelong problems. We need to know why these variations and how do we improve the ability to bounce back from adversity. A quick check of one journal database disclosed over 1400 articles about resiliency. I haven’t read them all yet but I will try to tell you the things I learn as I read them.

One thing seems clear from the articles I have read so far, and I am always comparing the research I read to what my clients tell me. Resilience, that ability to bounce back from adversity, is not something we are born with. Resilience can be learned and it can vary from situation to situation.

The subject is of such importance that I think there needs to be a book or books on how people can increase their resilience. So my plan at this stage is to share with you the things I learn and to add your comments and suggestions to what I find. In the process there just might be a book that needs writing. I will keep you posted on my efforts to write that book.

There are lots of writings on recovery, particularly from substance abuse or dependence, what it means to recover and be recovered. We are concluding that many people have both substance abuse disorders and mental health issues. It would be important to know how recovery is like resilience and how it is different, assuming these two terms do not describe the same thing.

One more thing I need to tell you about at this time. Some people experience a traumatic event and it changes their lives forever in a positive way. We call this Post Traumatic Growth (PTG). This intrigued me. Why and how is it that some people use a traumatic experience to transform their lives and grow into a stronger better person? We talk a lot about the way PTSD damages people but not much about the way in which it might inspire them. So I have been reading everything I can find on PTG. But I am also listening with new ears to the stories people tell about their life-changing experiences.

There is more to come on this subject so I hope you stay tuned for my postings and a possible book on Posttraumatic Stress Disorder (PTSD), Posttraumatic Growth (PTG), and the whole issue of how resilience is created and how you or someone you know can learn to bounce back from adversity.

For more information on Stress and PTSD see:

8 warning signs you have PTSD

Posttraumatic Growth (PTG) vs. Posttraumatic Stress Disorder

Acute Stress Disorder vs. PTSD 

Staying connected with David Joel Miller

Seven David Joel Miller Books are available now!

My newest book is now available. It was my opportunity to try on a new genre. I’ve been working on this book for several years, but now seem like the right time to publish it.

Story Bureau.

Story Bureau is a thrilling Dystopian Post-Apocalyptic adventure in the Surviving the Apocalypse series.

Baldwin struggles to survive life in a post-apocalyptic world where the government controls everything.

As society collapses and his family gets plunged into poverty, Baldwin takes a job in the capital city, working for a government agency called the Story Bureau. He discovers the Story Bureau is not a benign news outlet but a sinister government plot to manipulate society.

Bumps on the Road of Life. Whether you struggle with anxiety, depression, low motivation, or addiction, you can recover. Bumps on the Road of Life is the story of how people get off track and how to get your life out of the ditch.

Dark Family Secrets: Doris wants to get her life back, but small-town prejudice could shatter her dreams.

Casino Robbery Arthur Mitchell escapes the trauma of watching his girlfriend die. But the killers know he’s a witness and want him dead.

Planned Accidents  The second Arthur Mitchell and Plutus mystery.

Letters from the Dead: The third in the Arthur Mitchell mystery series.

What would you do if you found a letter to a detective describing a crime and you knew the writer and detective were dead, and you could be next?

Sasquatch. Three things about us, you should know. One, we have seen the past. Two, we’re trapped there. Three, I don’t know if we’ll ever get back to our own time.

For these and my upcoming books; please visit my Author Page – David Joel Miller

Want the latest blog posts as they publish? Subscribe to this blog.

For videos, see: Counselorssoapbox YouTube Video Channel