What is complex trauma?

A counselorssoapbox.com video by David Joel Miller, LMFT, LPCC

What is complex trauma?

Not everyone who experiences a trauma ends up with a mental illness. Some traumas are easier to heal from than others. Researchers have described a condition called complex trauma which is a subtype of PTSD and more difficult to heal from. This video explores what complex trauma is and the signs and symptoms someone with complex trauma would experience.

Could you have Posttraumatic Stress Disorder (PTSD)?

A counselorssoapbox.com video by David Joel Miller, LMFT, LPCC

Could you have Posttraumatic Stress Disorder (PTSD)?

Posttraumatic Stress Disorder (PTSD) is a mental illness caused by exposure to stress. It is similar to some other trauma and stress are related disorders. People with PTSD may also experience several other mental illnesses. What are some of the signs and symptoms of PTSD? How would you know if you were experiencing PTSD?

What is Post-Traumatic Stress Disorder PTSD?

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

What is

What is Post-Traumatic Stress Disorder PTSD?
Photo courtesy of Pixabay.

Would you know PTSD if you experienced it?

PTSD is something that we hear a lot about, but most people have only a general idea what it involves.  PTSD was first recognized in returning military veterans. It has since been recognized in children who were abused, in cases of domestic violence, as the result of sexual assaults as well as the result of other traumas. While each case of PTSD is unique, they have many features in common.  Many people with PTSD may also have one or more other psychiatric disorders, some of which are likely the result of traumatic incidents. Below is a list of the features that professionals use to identify PTSD.

PTSD involves a specific trauma.

Something has happened or there was a high risk it would happen.  This trauma involved death, possible serious bodily injury, or a sexual assault. This event needs to happen to you or someone close to you, not just be something you saw on the television.  This event was either violent or sudden and unexpected.

Also included in the definition of a trauma below, are the effects which dealing with the incident has on first responders or other emergency personnel.

This traumatic event keeps forcing its way back into your life.

Part of PTSD symptoms are the recurrent memories of the event.  You may have nightmares about what happened or things connected to that event.  Some people with PTSD experience spacing out or dissociation.  You may also experience flashbacks and in these times it can feel like the event is happening again.

These recurrent intrusive memories are easily triggered.  Both internal triggers, thoughts and feelings, and external triggers, people, places, and things, may bring back the memory.

People with PTSD try to avoid reminders.

There are all kinds of ways to avoid being reminded of something that has happened. You may avoid going to certain places or events. People may turn to drugs, alcohol or other distractions.  They may try to avoid having feelings, or other thoughts about the incident.

Sometimes the brain does this job for you.  You may find that there are periods of time for which you have no memory. Some people describe this as having a blackout or amnesia.  They may avoid activities which are in any way connected to these unpleasant memories.

Behavior changes when you experience Post-Traumatic Stress Disorder.

People with this disorder often become irritable and angry.  They may become either self-destructive or reckless.  Part of this condition is having an exaggerated startle response.  In the aftermath of the trauma, people may develop poor concentration and impaired sleep.  Someone with PTSD may stop engaging in activities that used to be fun, they detach from others and may say that they just can’t feel happy.  These behavioral changes are also characteristic of depression, and the two disorders often occur together.

PTSD can cause cognitive changes.

In the aftermath of trauma, it is common for people to blame themselves.  They may tell themselves that if they hadn’t been there, or had been more careful, it would not have happened.  Negative thought patterns may develop.  People begin to feel bad about themselves, other people, and the future.  These cognitive changes can result in developing depression.

PTSD needs to last a while and not be something else.

This condition is expected to last more than a month after the stressor.  As with the other things we are calling a mental illness this needs to interfere with your ability to work or go to school, your relationships, your enjoyable activities or cause you personal distress. Otherwise, you may have the issues but you will not get the diagnosis. If the only time this happens is when you are under the influence of drugs or medicines or because of some other physical or medical problem we’re likely to think this is something other than PTSD.

FYI These “What is” sometimes “What are” posts are my efforts to explain terms commonly used in Mental Health, Clinical Counseling, Substance Use Disorder Counseling, Psychology, Life Coaching, and related disciplines in a plain language way. Many are based on the new DSM-5; some of the older posts were based on the DSM-IV-TR, both published by the APA. For the more technical versions please consult the DSM or other appropriate references.

For more on this topic see Trauma- and Stressor-Related Disorders. 

See Recommended Books.     More “What is” posts will be found at “What is.”

What is an Adjustment Like Disorder? (F43.9)

Is it Anxiety, Stress or PTSD?

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

Stress person

Stress.
Photo courtesy of Pixabay.com

Just how stressed out are you?

Everyone experiences a little stress in their day-to-day life.  Having anxiety in your life is considered just a part of modern life.  But sometimes that stress and anxiety overwhelm people.  The things that get called trauma come in all shapes and sizes.  Many times these traumas resolve in a short period of time.  Traumas that don’t resolve, that hang on for long periods of time and interrupt your daily life, can turn into a serious mental illness such as an anxiety disorder a stress-related disorder or even Posttraumatic Stress Disorder.

If you’re struggling with difficulties, anxieties, stress or even some traumatic events it is helpful to know just what kind of problem you’re dealing with.  Some things will sort themselves out on their own.  Other times anxiety, stress, and trauma need professional help.  Here are some of the problems that you might be experiencing and some thoughts about how to tell the different problems apart.

Stress.

Stress is that reaction the body has to challenges from the environment.  Stress can be small and repeated or large and dramatic.  Even good things can be stressful.  That first day on a new job can be full of stress even when you really want that job.  Many people get sick the first week on a new job.  Weddings or the birth of a baby can be stressful also, even when these have been something you have looked forward to.

Most of the time people have stress and it goes away.  But over time people can accumulate a great deal of stress, and this can result in physical, emotional and mental illnesses.  One very important life skill is learning how to manage and reduce stress.  Take a look at the other posts on counselorssoapbox.com about stress and stress management.

Animals get stressed and so do people.

Humans are not the only creatures to get stressed.  Animals in the wild can have a very stressful life.  Sapolsky wrote a very interesting book called Why Zebras Don’t Get Ulcers.”  The main difference between humans and animals seems to be how they adjust to stress after it has come and gone.  Animals who were stressed returned to a low-stress state very quickly.  Humans get stressed and years later they are still experiencing that stress.  For humans, this accumulation of stress over time can result in chronic illnesses.

Anxiety.

Anxiety is a normal human response.  But when it gets out of control it can become a disease.  If you’re in a dangerous situation, anxiety and even fear can help you stay safe.  If the volume on your anxiety is turned up too high, it can cause you to overreact to many everyday situations.  Sometimes people have what they call anxiety attacks.  For a brief period of time, they feel excessive anxiety but eventually, these anxieties attacks subside.

When this high anxiety continues too long and begins to interfere with your daily life, your job, or your relationships, it is excessive and may be diagnosed as an anxiety disorder.  There are a number of different recognized Anxiety disorders depending on the particular features of your anxiety.

Post-Traumatic Stress Disorder or PTSD.

Post-traumatic Stress Disorder or PTSD is a diagnosable mental illness.  Sometimes in life people experience overwhelming traumatic experiences.  They may witness a violent death, a tornado, hurricane, or other natural disasters.  In these events, the person may fear that they or someone close to them is going to die.

This condition was originally identified in the veterans returning from war zones.  It has since been identified in civilian populations who have been exposed to traumatic events and feared for their lives.

As a result of this trauma, people begin to develop difficulties functioning.  Some people will struggle with these problems for a short period of time, a month or so.  Other people will very quickly return to normal function.  In some cases, as a result of these traumatic experiences, people will continue to have symptoms for years afterward.  These continuing symptoms may be PTSD.

Complex trauma.

Repeated traumatization becomes more difficult to heal from.  There has been a good deal of research and writing about a condition that is sometimes called complex trauma.  While it’s not an official diagnosis, is helpful for many people to think about it this way.  Someone may be able to experience a trauma and recover from it.  If that same person experiences the same trauma repeatedly, each time it becomes more difficult to recover.

If you are struggling with anxiety, stress or PTSD consider getting professional help.

Staying connected with David Joel Miller

Six David Joel Miller Books are available now!

Dark Family Secrets: Some family secrets can be deadly.

What if your family secrets put you in danger?

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?

Casino Robbery is a novel about a man with PTSD who must cope with his symptoms to solve a mystery and create a new life.

Planned Accidents  The second Arthur Mitchell and Plutus mystery.

SasquatchWandering through a hole in time, they encounter Sasquatch. Can they survive?

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.

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

Books are now available on Amazon.

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

For videos see: Counselorssoapbox YouTube Video Channel

Want the latest on news from recoveryland, the field of counseling, my writing projects, speaking, and teaching? Please sign up for my newsletter at – Newsletter. I promise not to share your email or to send you spam, and you can unsubscribe at any time.

For more about David Joel Miller and my work in the areas of mental health, substance abuse, and Co-occurring disorders see my Facebook author’s page, davidjoelmillerwriter.

How Stress destroys your health.

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

Stress person

Stress.
Photo courtesy of Pixabay.com

Your body stores up stress and then makes you sick.

Most of us know the effects that stress can have on our mental health but few people notice that the way they feel emotionally is affecting their physical health. We use that same word “feel” for both sensations in the body and emotions we attribute to the mind. This leads to lots of confusion. Your mind, by which most people mean their thinking, is not all that separate from your body.

What you think about can take its toll on your physical health.

Physical symptoms are often the first indicators of a serious mental illness. It is smart to get your health checked out by a medical doctor. Having physical illnesses that are caused by stress or trauma does not mean you are going crazy and it sure does not mean that your problems are “all in your head.” Your body participates in everything your mind experiences.

When we say someone is a pain in the neck, take that literally. That unpleasant experience has caused your neck muscles to tighten. That person who makes you sick to your stomach really is affecting your digestion. So if you have seen a doctor and they can’t find anything medically wrong with you, consider getting some emotional help.

Here are some of the physical signs and symptoms that you are under too much stress or that your feelings are signaling your body they need some attention.

Appetite changes reflect feelings.

Can’t eat? Constantly hungry? Changes in appetite that are not connected to physical activity and caloric needs are a common indicator of an emotional crisis. Changes in appetite along with a loss of pleasure are at the top of the list for symptoms of depression. Loss of appetite can signal an anxiety disorder. Relationship issues and all manner of other stresses change your appetite.

Sleep responds to emotions.

Sleep, too much or too little is another mental health indicator. Sleep changes are a feature of depression. Low need for sleep or not sleeping at all and having plenty of energy could be signs of Bipolar Disorder. Just because you have not been diagnosed with Bipolar in the past is no reason to ignore this. Many people have had only episodes of depression and the blues before that first big manic break.

Aches and pains can be from stress.

Stress impacts your nerves and your muscles. One study reported that more than half of those with Fibromyalgia also met criteria for PTSD. Living with lots of stress or trauma extracts a price from your nervous system. Do not wait till your nerves quit to get that stress under control. While thinking things away will not cure physical illnesses alone, what you do about that stress can affect the course of your physical illness.

Cravings signal something is going on in your feelings life.

Cravings for foods could be a nutritional deficiency but it could also be the warning sign of depression coming. Craving for behaviors or chemicals are hallmarks of addiction. While most behavioral addictions have not yet made the list of recognized mental illness, counseling is helpful if you find yourself craving things that could be harmful to your health or your life.

Loneliness can cause or be caused by emotional issues.

Feeling lonely or emotionally needy is a sign that your feelings life is in need of help. You should not hesitate to get assistance for emotional cravings. Loneliness is a recognized cause of relapse for substance use disorders. What is often missed is that feelings of loneliness and neglect can be triggers for mental and emotional disorders.

Lowered resistance to colds and flu may have an emotional cause.

Depression, Trauma, and stressor-related disorders all lower your resistance to illness. Happy people have more resistance to physical illness and are more resilient to emotional letdowns. If you are having trouble getting over a physical illness, take another look and see if your emotions need mending also.

Temperature regulation – sweating could be anxiety or panic disorder.

Sweating and poor temperature regulation has been connected to anxiety and stress-related disorders. Learn deep breathing, meditation, and mindfulness. Cut back on the high rumination diet and see if your body does not stop sweating things.

Out of willpower – procrastination? Is it caused by stress?

Lack of energy, low willpower, and a general malaise are all signs of emotional disorders. Depression and anxiety are the chief suspects here but other mental disorder can result in low motivation and a lack of willpower.

Irritable – low blood sugar – the two are connected.

Low blood sugar makes people more irritable and leads to anger and conflict. The opposite connection can exist. Poor emotional regulation can play having with your efforts to regulate blood sugar and other hormones. Make sure you are taking care of your emotional health and see if that does not help you improve your physical health.

Panic happens more often when you are stressed.

Panic may be appropriate if they are shooting at you or if the lion is hunting you. Panic in the sense of a sudden mobilization of effort. But if you are having panic attacks on a regular basis, if the setting on your anxiety or panic meter is turned up way too high, your emotions are going to create a lot of physical symptoms that will not respond well to the doctor’s prescription of medication.

Is emotional stress having an impact on your physical health?

Anxiety

Depression

Emotions and Feelings.

Obsessive-Compulsive Disorders (OCD)

PTSD & Stress

Staying connected with David Joel Miller

Six David Joel Miller Books are available now!

Dark Family Secrets: Some family secrets can be deadly.

What if your family secrets put you in danger?

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?

Casino Robbery is a novel about a man with PTSD who must cope with his symptoms to solve a mystery and create a new life.

Planned Accidents  The second Arthur Mitchell and Plutus mystery.

SasquatchWandering through a hole in time, they encounter Sasquatch. Can they survive?

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.

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

Books are now available on Amazon.

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

For videos see: Counselorssoapbox YouTube Video Channel

Want the latest on news from recoveryland, the field of counseling, my writing projects, speaking, and teaching? Please sign up for my newsletter at – Newsletter. I promise not to share your email or to send you spam, and you can unsubscribe at any time.

For more about David Joel Miller and my work in the areas of mental health, substance abuse, and Co-occurring disorders see my Facebook author’s page, davidjoelmillerwriter.

Support Groups for people with PTSD or Complex Trauma.

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

Group.
Photo courtesy of Pixabay.com

Anyone know of support groups for people with PTSD?

This question came in from a reader. They were specifically asking about local support groups here in Fresno. I did not come up with much and so I thought I would offer a few suggestions and then ask those of you out there if anyone else knows of any other resources.

Unfortunately, most of my suggestions may not help the person who asked the question, the resources are limited.

1. Try on-line groups.

I am familiar with some groups or communities on the internet. More and more the specialized groups are becoming self-help or peer-run groups on the internet.

One, in particular, is Trauma and Dissociation which is a Google+ community. You have to have a google+ account to access this but opening an account is easy and free.

You can also try the WordPress Blog: http://traumaanddissociation.wordpress.com/

2. Larger insurance providers may have something to offer if you have private insurance. Kaiser for one has offered some groups. Can anyone add to that list?

3. Your insurance provider may be able to refer you to a private therapist and some few of them specialize in PTSD an even smaller number may offer group formats.

4. If you are in substance abuse recovery some A.A. and N. A. groups, while not specifically devoted to people with PTSD can be supportive places for people in substance use recovery who have PTSD or another mental health issues also. Check out the group and make sure you feel comfortable with them before divulging the details of things other than the official topic.

5. VA has some groups and more likely to come in the future as so many veterans are returning from multiple deployments with PTSD and the related MST (Military Sexual Trauma.)

6. Those people who are receiving services through their local Community Mental Health Department should check with them for available groups. In Fresno County, if you have no insurance there are county-run programs for those on Medi-Cal and those with no or very low-income.

It remains to be seen if these groups will be expanded. Personally, I think specialty groups for people with specific issues can be especially powerful. I anticipate that as more people become eligible for services in the government-run systems we will increase the number of groups run by both peers and professionals.

Any other suggestions?

Complex Trauma, Stress and PTSD

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

Words about PTSD

PTSD.
Photo courtesy of Pixabay.com

What is Complex Trauma and how is it connected to other emotional problems?

Most therapists recognize the existence of a “thing” that might be called Complex Trauma. We are pretty sure it exists. We see clients with it all the time.  Only it looks different in different people. Sometimes it looks like a stress disorder, sometimes it looks more like Post Traumatic Stress Disorder (PTSD) other times it looks a lot like depression or anxiety.

We, professionals, are just not sure what to call this thing and worse yet we are not all sure how to treat it.

This confusion is aggravated by the problem that there is was no diagnosis for this thing, this complex trauma monster, in the DSM-4. Worse yet, even with the increased attention to stress caused disorders in the new DSM-5 Complex trauma did not make the new book either.

The result is that we have a disorder that we all see in our clients but it looks different in different light and we give it different names depending on who has this issue.

This problem, this idea that multiple, complex trauma is different from single trauma and that the results of multiple traumas are not a case of two plus two equaling four is not new. With complex trauma two plus two maybe six or even seven.

We know this from reading books and articles on zoology. Humans are not the only creatures who suffer more from repeated traumatization. Other creatures can recover from a single large trauma but when subjected to repeated traumas they lose the ability to adjust.

Let me attempt to explain this problem by using a far-fetched analogy.

Complex Trauma is kind of like a hurricane or monsoon.

Most of us know what a hurricane is, sort of. The wind blows really hard. It damages things and knocks things down. A tree may blow over and smash your roof or the wind may break some windows and blow over some things breaking them. But that is not all.

With the wind comes a lot of rain. The rain fills up creeks and small rivers and then they overflow. Your house may get flooded.

That tree may miss your house when it falls and hit a power pole. That pole may start a fire and your house could burn down. If you live near the coast the tide from the ocean may become a tide surge and sweep your home away.

All of these things are the consequences of the hurricane, but the effect on you and the way your insurance company sees things may be very different depending on whether your house is damaged by a falling tree, flooded, swept away by the tide or burns due to a falling power line.

Complex trauma is a lot like that. Different people are affected differently. Some get depressed, some get anxious, some people dissociate and others think of harming themselves or others. All of these possibilities and more are the result of the stress or trauma but each person experiences them slightly differently and they all may get different diagnoses.

A different diagnosis may result in different treatment which means some people are way more responsive to a particular treatment.

We used to think that there were a discrete number of mental illnesses, two, neurosis or psychoses. Then a hundred or so and in the DSM-4 about 400. Now we are thinking that if we keep splitting up these problems of living we are going to end up with one diagnosis per person. So we are trying to think more in terms of a continuum. Some people are only a tiny bit depressed occasionally and others are major depressed all the time.

This variation in features is also impacting the way professionals see and respond to stress-related problems.

Over the next few weeks as time and space permits, I want to talk more about complex trauma, how it develops and why it is sort of like PTSD, anxiety and other named disorders and why it is enough different from those other disorders that clinicians are developing specialized treatments for this issue.

People can and do recover from complex trauma so stay tuned and we will talk about the steps to recovery from this misunderstood disorder.

Staying connected with David Joel Miller

Two David Joel Miller Books are available now!

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.

Casino Robbery is a novel about a man with PTSD who must cope with his symptoms to solve a mystery and create a new life.

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

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

Want the latest on news from recoveryland, the field of counseling, my writing projects, speaking and teaching? Please sign up for my newsletter at – Newsletter. I promise not to share your email or to send you spam, and you can unsubscribe at any time.

For more about David Joel Miller and my work in the areas of mental health, substance abuse, and Co-occurring disorders see my Facebook author’s page, davidjoelmillerwriter. A list of books I have read and can recommend is over at Recommended Books. If you are in the Fresno California area, information about my private practice is at counselorfresno.com.

Drinking a little alcohol can make PTSD worse

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

Nightmare

Nightmares maintain depression and PTSD.
Photo courtesy of Pixabay

The Alcohol and PTSD connection.

Alcohol has some strong effects on people with PTSD and those effects turn out to not be what we expected.

Recently I came across a couple of studies about the interaction of alcohol and PTSD. There may be more studies about this and I will keep looking. But here are some things we think we know.

The way in which memories are stored will depend on the level of alcohol in the bloodstream when the traumatic event occurs. Alcohol consumption is related to trauma; more than one study has indicated that people who perpetrate violence are more likely to be intoxicated.

I know that this does not mean that drinking makes you violent. Millions of people have a drink every day and do not go out and perpetrate violence. But among those who do get violent, a great many are under the influence of drugs or alcohol. It is easy to see that when someone is drunk they have reduced control of their behavior and having lowered inhibitions they are more likely to engage in violent behavior.

What we also find is that victims of violence are frequently under the influence of drugs and alcohol. Being intoxicated reduces you self-protective behavior and you are more likely to put yourself in a dangerous situation, more likely to look like an easy target to someone with a violent intent and intoxicated people are more likely to “not take it anymore” and engage in argumentative and assertive behavior.

So why would drinking by someone who had been the victim of a violent trauma make the PTSD symptoms worse?

A small amount of alcohol in someone’s system may increase PTSD symptoms rather than anesthetize them for several reasons. Maintaining control of thoughts and emotions especially the intrusive memories from PTSD requires sustained effort. Alcohol reduces the ability to ward off those emotions.

Bisby, in his study, found that intrusive memories in PTSD were most likely to be suppressed at the extremes of blood alcohol content. So with no alcohol in the bloodstream, the memories could be shut off by the person’s effort. As the level rose they were less able to control those intrusive, memories until the blood alcohol levels reached the legally drunk point. While this study stopped with a blood alcohol level of .08, the definition of legally drunk, it is likely that the memories would have continued to decline as the person became progressively more intoxicated (Bisby et al. 2009.)

Now, this study did find that memory for facts, the verbal memory portion, was impaired and the more alcohol in the bloodstream the less accurately the person remembered precisely what had happened.

What they did remember more of when under the influence was the emotional feelings associated with the traumatic experience.

Additionally, I suspect that some of this increased recall of trauma with a low-level of alcohol in the bloodstream is the result of state-dependent learning. The presence of alcohol in the bloodstream opened up the memories that had been stored away and sealed off when sober.

Further, this study concluded that people with small amounts of alcohol were more likely to develop PTSD as a result of a traumatic event. As I mentioned in a previous post the presence of alcohol in the bloodstream increases the storing of the emotions of the event while surprising the factual memories.

Having alcohol in the system during stressful events may not calm your nerves and improve your coping skills. It is more likely to reduce the ability to cope and increase the risk of developing a PTSD response to being the victim of trauma.

So for any number of reasons consuming a small amount of alcohol is not a good idea for someone who has experienced a trauma. A small amount will increase traumatic memories and it will take highly intoxicating levels of alcohol to shut those memories off.

The result is that people with PTSD who drink any alcohol are at high risk to develop a severe case of alcoholism.

This is one more case where the use of chemicals to avoid pain can, in fact, result in increased pain when the chemicals drop below intoxicating levels.

Staying connected with David Joel Miller

Two David Joel Miller Books are available now!

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.

Casino Robbery is a novel about a man with PTSD who must cope with his symptoms to solve a mystery and create a new life.

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

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

Want the latest on news from recoveryland, the field of counseling, my writing projects, speaking and teaching? Please sign up for my newsletter at – Newsletter. I promise not to share your email or to send you spam, and you can unsubscribe at any time.

For more about David Joel Miller and my work in the areas of mental health, substance abuse, and Co-occurring disorders see my Facebook author’s page, davidjoelmillerwriter. A list of books I have read and can recommend is over at Recommended Books. If you are in the Fresno California area, information about my private practice is at counselorfresno.com.

Getting rid of Nightmares that maintain Depression and PTSD

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

Nightmares maintain depression and PTSD.
Photo courtesy of Pixabay

Then Come Nightmares.

Frequent nightmares play a major role in maintaining depression, PTSD, and other mental health problems. It is common for people to think that they need to cure the PTSD or Depression and then the nightmares will go away.  The opposite approach is more likely to be productive.

Most treatments for PTSD do not target the nightmares. There are treatments for nightmares available, some as brief as three sessions. These have been shown to help reduce nightmares and promote recovery from other problems.

Treatment for nightmares has been shown to reduce symptoms of PTSD and depression.

Children also suffer from nightmare related problems. Children who are fearful because of a family problem, moves, divorces or separation develop symptoms of mental illness. “Bad dreams” are the result of the child’s out of control fear and are at the root of many childhood attention or conduct disturbances. When the child gets a good nights sleep they behave, when they don’t sleep they don’t pay attention, and they don’t mind.

Nightmares are associated with high levels of anxiety. They are fear based.

Most people who have PTSD, depression, bipolar disorder or any other diagnosis also have a co-occurring anxiety problem. Now sometimes anxiety is good, it protects you from danger. But when the anxiety circuits do not turn off the anxiety gets to be the problem rather than the solution.

We also see lots of disturbing dreams in clients recovering from substance abuse problems. Substance abuse counselors report clients sharing about drug using dreams. We have some simple interventions around those issues, but not much research has been done in this area because substance abusers, people with Bipolar Disorder and people with psychosis are routinely excluded from research studies. I believe that the treatment for nightmares will work for anyone.

The solution is to tone down that fear circuit.

Before I describe a treatment method for reducing nightmares – a word of caution, working on nightmares, especially those that maintain PTSD, can be a painful process. It is best to work with a therapist or other professional person, and you need to make sure you have a strong support system in place in case you have difficulty coping.  For more on support systems see “How to develop a support system” or “How supportive is your support system?”

Taming nightmares involves three steps.

1. Learn relaxation methods.

Nightmares are fear based, and the fear persists after you awake. Sitting thinking about the scary part of the dream might reinforce the nightmare and result in memorizing your nightmare. Fear and relaxations are not compatible. The more you relax, the less fear you will have. As you get better at relaxing your fear shrinks and your dreams become less traumatic.

2. Learn sleep hygiene

Keeping regular bedtimes, reducing or eliminating caffeine especially in the hours before bedtime and other efforts to improve sleep naturally are helpful. It is important to allow plenty of time for sleep.

People who stay up late and get up early gradually become sleep deprived. Lack of sleep aggravates all sorts of mental health issues. Insufficient sleep increases the possibilities that you will be suddenly awakened and will remember the “bad dreams.”

During sleep the brain keeps working on our issues, memories are consolidated and thoughts organized. We only call dreams “nightmares” if we awake during the dream and have memories of it. Better sleep can result in fewer nightmares.

3. Begin treatment of the nightmares once you are relaxed and well rested.

The process of “reframing” nightmares makes them less scary and more manageable. Reframing or reprocessing is helpful for intrusive daytime thoughts as well as for nightmares.  The application of this to reducing or eliminating nightmares was described by Rhudy et al. in their 2010 article on CBT treatment for nightmares in trauma-exposed people, where they called it “ERRT” therapy.  Ben Furman has also described a similar approach for use with children.

Disclaimer- Rhudy et al.’s study, like most research in the mental health area, excluded substance abusers, people with mania or psychosis and probably screened out all people with Bipolar Disorders. The sample size was also low with about twenty people per group. There is so much overlap between substance abuse, bipolar disorder and PTSD in the clients I see these studies leave out exactly the people who most need new effective treatments. That said – the ideas appear to be fully appropriate for clients with co-occurring disorders.

Here is how it works:

To reprocess or reframe nightmares do the following things:

A. Write out as full a description of the nightmare as possible.

Getting it down on paper tames the story and makes it manageable. It also allows you to go back over it and add missing details. In step C you will be rewriting it with added insight.

Remember that it is a normal process for your brain to use your dreams to make sense of your experiences. In dreams, your brain will turn the experience around and examine it from all sides. Your brain may also play out multiple alternative endings for the event. It is not the dream that is the problem; it is the connection between the dream and fear that makes this a nightmare.

If you have several versions of the dream try to write them all down.

B. Read the nightmare story aloud.

Listen for the themes in the story. What are the fear messages? I think it is helpful to be able to read this to a therapist or other support person who can keep you from being overwhelmed and can provide some insight into things you may not immediately see. Just don’t make someone listen to your nightmare that is not emotionally able to hear the story.

C. Re-script the nightmare.

What is the expected ending? What is an alternative ending? Write out the story this time with a new less scary ending. Read the new version out loud. Has seeing a new possible ending tamed the fear?

Furman described a story, not sure where it originated, in which a grandmother applied the sort of approach to her grandson’s nightmare.

The child came to grandmother scared because of a nightmare.

“Grandma, ” he said, “I had a nightmare.”

“There are no such things as nightmares,” The grandmother said “Only goodmares. All dreams should have happy endings. The problem is you keep waking up before the end. What is a good ending that could have happened?”

In this story, the child then works with his grandmother to find new happy endings for these scary dreams. The result – fewer scary dreams and less fear when bad dreams occurred.

Warring – in people with PTSD who were treated with re-scripting the fear declined first, anger later and the frequency and length of nightmares were the last things to decline.

Talk to your care provider about this process. If you try this process, see if it works. Learn to relax more. Tame your sleep. Then tame your nightmares. If you have had success in changing your nightmares ending please share your success with the rest of us.

Staying connected with David Joel Miller

Three David Joel Miller Books are available now!

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.

Casino Robbery is a novel about a man with PTSD who must cope with his symptoms to solve a mystery and create a new life.

SasquatchWandering through a hole in time, they encounter Sasquatch. Can they survive? The guests had come to Meditation Mountain to find themselves. Trapped in the Menhirs during a sudden desert storm, two guests move through a porthole in time and encounter long extinct monsters. They want to get back to their own time, but the Sasquatch intends to kill them.

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