Trauma Responses Can Change Over Time

If you’re a woman in San Diego County who has lived through trauma, you may notice that your reactions don’t stay the same over time. Symptoms that once felt manageable can intensify after returning from deployment, transitioning out of active duty, navigating divorce, or trying to manage southern California housing costs while caring for family.

Across SoCal, roughly one in 20 adults lives with a serious mental illness, and these numbers climb in lower-income communities. In a region with one of the largest military populations in the country, exposure to trauma, deployment cycles, interpersonal violence, and high-pressure life transitions are part of many families’ daily experience. In environments like ours, it isn’t unusual for trauma responses to change over time as a result of new experiences or new experiences triggering older memories

Recognizing these shifts can reduce self-blame and help you see them as signs of stress overload, not personal failure. Think of them as your body’s response to accumulated strain.

To better understand trauma responses, it helps to look more closely at how they show up over time and what that can mean for women in recovery.

What Trauma Responses Can Look Like

Trauma responses aren’t always obvious, and they don’t look the same for everyone.

Some notice:

• feeling constantly on guard or easily startled

• difficulty calming down even when you are physically safe

• pulling away from others or feeling emotionally distant

• disrupted sleep, including trouble falling or staying asleep

• difficulty concentrating or feeling mentally scattered

• stronger reactions to reminders of past experiences

Women are more likely than men to develop post-traumatic stress disorder at some point in their lives. About 8 out of every 100 women will experience Post-Traumatic Stress Disorder (PTSD) during their lifetime, compared with about 4 out of every 100 men. Symptoms of PTSD can include heightened alertness, sleep disturbance, difficulty concentrating, and emotional withdrawal, and these patterns may fluctuate in intensity over time.

While not all trauma responses meet the criteria for PTSD, many women still experience shifts in how they respond to stress in relationships or at work. You might even notice symptoms ramp up during periods of pressure, transition, or reduced support.

If you notice your trauma responses becoming more intense or harder to manage, small, steady habits can help your body settle. These approaches do not replace trauma-focused therapy, but they can support recovery between sessions. 

For some women in San Diego County, that might include early weekend mornings at Torrey Pines State Natural Reserve, breath-based yoga in Carlsbad Village, or regular movement within a small accountability-based fitness group in North County.

Trauma responses that intensify or resurface over time should not be considered signs of weakness. They are protective survival patterns your mind and body developed to survive overwhelming experiences.

Why Trauma Responses Can Change Over Time

Trauma responses progress through lived experience and the circumstances someone has had to adapt to. As life progresses, these responses can begin to feel differently than they once did.

Increased responsibilities, reduced support, or ongoing stress can make reactions that once felt manageable feel more intense. In Southern California, housing expenses, military transitions, and juggling work with caring for aging parents without extended family nearby can intensify your existing strain.

You might find that reactions you used to brush off are harder to ignore now.

These feelings don’t indicate that you’re unraveling. Often, they reflect how your body is responding to increased caregiving, work pressure, or stress related to returning from active duty.

When Trauma Surfaces Later or Intensifies

In San Diego County, where many families are connected to military service, symptoms may intensify after returning from deployment, transitioning out of active duty, or navigating reintegration into civilian life. High housing costs, shifts in family structure, or caregiving responsibilities can also create conditions where previously manageable reactions feel stronger.

Delayed symptoms can feel confusing, especially when your original trauma feels distant. The National Center for PTSD notes that delayed expression is a recognized pattern in post-traumatic stress disorder, meaning full diagnostic criteria may not be met until at least six months after the traumatic event.

When to Consider Additional Support

For some women, there comes a point when familiar coping strategies no longer provide meaningful relief. This does not automatically mean healing has failed. It may signal that symptoms are interfering with daily routines in new ways.

Signs that additional support may be needed can include persistent sleep disruption, missing work, struggling to complete daily tasks, or feeling unable to meet caregiving responsibilities, increased avoidance of previously manageable situations, increased irritability, withdrawal, or repeated arguments at home. You may also feel detached from loved ones, unable to experience joy, or on edge most of the day.

When trauma responses begin to significantly affect safety, stability, or the ability to function, a higher level of trauma-informed care may be appropriate. Structured residential programs can provide consistent clinical support, medication management when needed, and a contained environment designed for stabilization.

For women in North County and the greater San Diego area, AMFM Mental Health Treatment’s Carlsbad residential mental health program provides structured residential treatment designed for stabilization when outpatient care is no longer sufficient.

If you or someone you love may benefit from guidance in determining the appropriate level of care, you can contact CSAM at (619) 566-6620‬ or info@csamsandiego.com. You can also learn more about A Mission for Michael’s Carlsbad residential mental health program through the resources provided above.

Sources: 

1. https://health.ucsd.edu/news/press-releases/2024-09-24-uc-san-diego-health-and-san-diego-county-partner-on-behavioral-health-care-hub/

2. https://www.ptsd.va.gov/understand/common/common_adults.asp

3. https://www.parks.ca.gov/?page_id=657

4. https://breathedegrees.com

5. https://www.haus-of-fitness.com/ 

6. https://www.ptsd.va.gov/professional/treat/essentials/history_ptsd.asp

7. https://amfmtreatment.com/california/carlsbad-residential-mental-health-treatment-for-females/

8. https://www.csamsandiego.com/contact

What Would Oprah Do: Harnessing a Wise Guide to Motivate Values-Based Living

Many years ago, one of my therapy clients came to session beaming over the values-​based choices she had made during the previous week. When I asked what helped her to succeed, she said, “Every time I faced a choice, I just thought, WWJD?” At first, I anxiously thought, What would Jesus do? Oh no, I didn’t know she was religious! But then she went on to explain that the “J” she was referring to was not Jesus, it was…me! She said each time she faced a tough choice, she thought about our sessions and what I would do if faced with a similar choice. Then she harnessed her psychological flexibility skills and did it!

I loved this so much that I adopted it as a regular values exercisethat I use with all my clients. I ask them to think about who their J would be--someone they know (like a coach, friend, or family member), someone they feel like they know (like a celebrity), or even a fictional character. Someone who embodies the qualities they would most like to embody in their own lives. A person, or persons, who represents the Me they most deeply desire to be.

Here's my own example: if you know me, you know I have a mild Oprah obsession. I look up to Oprah because she has endured poverty, abuse, racism, sexism, and body shaming and has never let it stop her from being herself and pursuing what matters to her. Though I don’t know Oprah personally (yet!), she also seems to want to leave the world better than she found it. So when I’m faced with a tough choice—one where I have an opportunity to do something values aligned, but avoidance beckons—I think, WWOD: What would Oprah do?

This strategy was THE way I chose to do a TEDx talk during a time I felt paralyzed with fear and woefully inadequate, and I’ve used it many, many times in the four years since.

Who is your ‘J’ or ‘O’? How might they help motivate you to show up as the Me you most deeply desire to be, especially when feeling challenged to do so?

Perinatal and Postpartum OCD

by Auti Scolman

Obsessive-Compulsive Disorder, or OCD, is a disorder distinguished by the presence of obsessive thoughts and/or compulsions that soothe the distress brought on by the obsessions. OCD can manifest in many different ways and often revolves around a theme, like contamination, sexuality, harm, or needing things to be “just right.”. A lesser spoken about manifestation of OCD can occur during pregnancy and/or the postpartum period, called Perinatal or Postpartum OCD (-). “Perinatal” refers to the time during pregnancy and “postpartum” refers to the time immediately following birth. The rates of Perinatal/Postpartum OCD range from 7-11% in the perinatal period and typically peak around 8 weeks postpartum. Folks who are pregnant or have recently given birth are vulnerable to developing Perinatal/Postpartum OCD symptoms, especially if they experienced symptoms prior to pregnancy. Although it is normal to feel stressed or anxious about a major life transition like having a child, there are certain markers that can help differentiate expected anxiety and Perinatal/Postpartum OCD. 

Common symptoms of Perinatal/Postpartum OCD:

1. Symptoms that begin or worsen at the time of pregnancy or birth

2. Unwanted, obsessive thoughts about harming the unborn or newborn baby that cause significant fear and distress

3. Secrecy around the experienced symptoms for fear of being judged, hospitalized, or having the child removed 

4. The presence of compulsions meant to control the obsessive thoughts (i.e. excessive checking on the baby, washing, etc.)

5. Avoidance of activities that may cause the baby harm (i.e. using stairs, changing diapers, handling sharp objects around the baby, bathing, etc.)

6. Co-occuring symptoms of postpartum depression (research shows up to 70% of folks with Perinatal/Postpartum OCD have postpartum depression)

7. Overwhelm or obsessional fear getting in the way of caring for baby

8. Needing to have a partner nearby when handling the baby out of worry or fear

9. Issues bonding with the baby because of Perinatal/Postpartum OCD symptoms

10. Trouble sleeping

Why does Perinatal/Postpartum OCD happen?

The occurrence of Perinatal/Postpartum OCD is due to a combination of factors including hormone changes and environmental contributors. The levels of oxytocin and neurotransmitter, serotonin, are impacted during and after pregnancy. Research suggests that an imbalance of oxytocin can then shift levels of serotonin and this may play a role in the development of OCD. Along with hormonal changes, the responsibility of having a child will likely cause increased stress and anxiety. It is important to note that Perinatal/Postpartum OCD can show up in all parents, not just the birthing person. 

How is Perinatal/Postpartum OCD treated?

The treatment for Perinatal/Postpartum OCD looks similar to treatment for OCD and will typically involve Exposure and Response Prevention (ERP), a form of Cognitive-Behavioral Therapy (CBT) that has strong research evidence supporting its efficacy. ERP involves safely confronting avoided situations and lessening the exercising of rituals to manage obsessive fear and worry. Another treatment intervention is the use medicine, particularly selective serotonin reuptake inhibitors (SSRI). Please check with your medical doctor to assess the safety of these medications while pregnant or breastfeeding. 

If you are struggling with Perinatal/Postpartum OCD, please know that you are not alone and there are options out there to support your journey. If You Or Someone You Love Might Benefit From Cognitive Behavioral Therapy (CBT), Acceptance And Commitment Therapy (ACT) For Perinatal Or Postpartum OCD, Or If You Would Like More Information About Our Therapy Services, Please Contact Us At (858) 354-4077 Or At Csamsandiego@Gmail.Com.

Sources:

https://iocdf.org/wp-content/uploads/2014/10/Postpartum-OCD-Fact-Sheet.pdf

https://iocdf.org/perinatal-ocd/

https://womensmentalhealth.org/posts/perinatal-obsessive-compulsive-related-disorders/

https://www.webmd.com/mental-health/what-is-postpartum-obsessive-compulsive-disorder

https://www.psychguides.com/ocd/

A Look Into EMDR

by Auti Scolman

In the world of therapy, several evidence based approaches have emerged to help individuals overcome traumatic experiences and distress associated with Post-Traumatic Stress Disorder (PTSD). One powerful approach is Eye Movement Desensitization and Reprocessing (EMDR). This innovative method has gained significant recognition for its ability to alleviate symptoms related to trauma, and in some cases, certain kinds of anxiety. Let’s dive into what happens during an EMDR session and the benefits that can follow.

What happens in a typical EMDR session?

EMDR is a specific protocol that requires the therapist undergo intensive training in order to become certified. During an EMDR session, a certified therapist will engage the client in some form of bilateral stimulation while they focus on a specific traumatic memory. Bilateral stimulation is theorized to engage and connect the brain’s two hemispheres as it processes the trauma, and can involve moving the eyes from side to side, hearing a tone that alternates between ears, or tapping that alternates on each side of the body. The aim is to access and reprocess the trauma, allowing the individual to create new, adaptive associations and perspectives. In turn, clients strengthen their ability to cope with the emotional distress. 

Benefits of EMDR:

1. Trauma recovery: Reduction in avoidance of reminders of trauma, changes in cognition and beliefs around trauma, reduction in hyperarousal symptoms.

2. Reduction in anxiety and panic: Similar to CBT and ACT approaches, as clients willingly approach the traumatic memory and associated feelings of discomfort including anxiety and panic, they increase their ability to sit with anxiety. With EMDR, the distressing emotions around a traumatic memory typically reduce dramatically on their own through the reprocessing in a single session.

3. Enhanced self-compassion: Clients may find they are more capable of showing themselves compassion, and may begin to reclaim a sense of agency and empowerment in their lives.

4. Accessible care for those who struggle to articulate thoughts: Because EMDR is not an approach that relies on a great deal of talking, clients who struggle to articulate their thoughts may find this modality beneficial.

5. Accelerated healing : EMDR, like CBT approaches, is a short term modality. A typical course of treatment is typically somewhere between 6-12 sessions.

EMDR at CSAM:

Our very own Dr. Terra Fuhr is EMDR trained. She decided to pursue training back in 2017 because she saw several colleagues find great success using EMDR. In her experience, she has found EMDR can help clients break through in places where they may have gotten stuck with CBT approaches alone. She is grateful to have an additional evidence based approach in her tool kit to help tailor treatment to each clients’ individual needs.To make an appointment with Dr. Fuhr, please use our website contact form or call the clinic line at (858) 354-4077.

CSAM IS HERE TO HELP

If you or someone you love might benefit from eye movement desensitization and reprocessing (EMDR), cognitive behavioral therapy (CBT), acceptance and commitment therapy (ACT), or biofeedback for anxiety, depression, stress, or PTSD, or if you would like more information about our therapy services, please contact us at (858) 354-4077 or at csamsandiego@gmail.com.

For more information about Eye Movement Desensitization and Reprocessing, visit The EMDR Institute.

Sources:

https://psychcentral.com/health/emdr-therapy#how-does-it-work

Menopause and Mental Health

by Auti K Scolman

Mood swings, insomnia, hot flashes, oh my! Do these symptoms sound familiar? We’re talking about menopause and the transitional period leading up to it called perimenopause. Menopause can have a major impact on a person’s mental health. During this time, hormone levels fluctuate greatly, leading to uncomfortable psychological and physical changes. The realities of menopause may come as a shock to menstruating people because of the lack of awareness and open communication around the topic. How can someone be prepared for a shift like this if they aren’t given the tools to succeed? Educating mentruators about this mid-life event, its symptoms, and treatments can help smooth the path through this natural transition.

How Menopause Can Manifest In the Mind and Body

1. Mood Swings

2. Anxiety and Depression

3. Insomnia

4. Difficulty with Memory and Concentration

5. Hot Flashes/Night Sweats

6. Changes in Libido

7. Vaginal and Bladder Issues

8. Headaches

9. Bone Loss

10. Changing Cholesterol Levels

It’s only human to look at the list above and feel overwhelmed or discouraged. Rest assured there are solutions to help in the management of the symptoms brought on by “the change”. Both Cognitive Behavioral Therapy (CBT) and Acceptance and Commitment Therapy (ACT) offer beneficial strategies to utilize while going through menopause. CBT helps clients understand the way their thoughts, behaviors, and feelings - including both emotions and uncomfortable physiological sensations - interact and influence each other. Rather than focusing on changing their feelings, clients learn to change their behaviors and the way they think about their symptoms and situation in order to respond more effectively to pain and discomfort. ACT focuses on teaching clients to be more psychologically flexible. This involves teaching clients acceptance and mindfulness skills to respond to their feelings of discomfort, and teaching them to observe their thoughts, all of which are in service of creating space for clients to continue to move toward their personally chosen values regardless of what painful internal experiences arise. Both approaches offer techniques to build empowerment around the obstacles presented during this life stage.

To schedule with Dr. Jill Stoddard, give us a call at (858) 354-4077 or email us at info@csamsandiego.com.

IF YOU OR SOMEONE YOU LOVE NEEDS SUPPORT AND MIGHT BENEFIT FROM COGNITIVE BEHAVIORAL THERAPY (CBT) OR ACCEPTANCE AND COMMITMENT THERAPY (ACT) FOR ANXIETY, PANIC, PHOBIAS, STRESS, PTSD, OCD, OR STRESS, OR IF YOU WOULD LIKE MORE INFORMATION ABOUT OUR TELEHEALTH SERVICES, PLEASE CONTACT US AT (858) 354-4077 OR AT INFO@CSAMSANDIEGO.COM

References:

https://fortune.com/well/2022/06/15/most-women-are-unprepared-for-menopause/ https://www.health.harvard.edu/womens-health/menopause-rocky-road-to-menopause https://bmcpsychiatry.biomedcentral.com/articles/10.1186/s12888-022-03768-8 https://www.womens-health-concern.org/wp-content/uploads/2023/02/02-WHC-FACTSHEET- CBT-WOMEN-FEB-2023-A.pdf https://www.psychotherapy.net/article/Acceptance-and-Commitment-Therapy- ACT#:~:text=The%20ACT%20interventions%20focus%20around,toward%20living%20a%20va lued%20life.

How Mindfulness Can Enrich Your Life

by Auti Scolman

Mindfulness. We hear that word all the time, but what exactly does it entail? Think of it as the practice of focusing your awareness on the present moment, and acknowledging and accepting your feelings, thoughts, and sensations in your body. In other words, mindfulness is the practice of paying attention to the here and now in a non-judgmental way.

There are so many benefits to practicing this therapeutic technique. Here are just a few:

Respond to Stress and Anxiety More Effectively:

One of the most well-known benefits of mindfulness is its ability to help us cope with stress and anxiety. When we’re mindful, we’re better able to regulate our emotions and handle difficult situations. Mindfulness takes us off autopilot and creates a space from which we are more able to identify our triggers and take thoughtful steps to manage them.

Improve Physical Health:

Research has shown that mindfulness can improve physical health in a number of ways. It has been linked to lowered blood pressure, improved sleep, and a strengthened immune system. It can also help ease chronic pain and other physical conditions that impact your quality of life. 

Enhance Mental Health:

Mindfulness can also improve our overall mental health. It’s been shown to reduce symptoms of depression and improve overall well-being. Many people who practice mindfulness report an increased ability to be present rather than stuck in rumination, a greater enthusiasm for life, and improved self-compassion.

Promote Better Relationships:

When we’re present and aware, we’re able to actively listen and be fully attuned in our interactions with others. This can lead to stronger communication and deeper connections.

Increase Self-Awareness:

When we’re mindful, we’re better able to witness our thoughts, feelings, and behaviors, which can help us make informed decisions that move us toward our values and help us live a more authentic life.

In conclusion, mindfulness is a powerful tool that can bring about a number of benefits to your daily life. Mindfulness, or Present Moment Awareness, is one of the six core processes taught in Acceptance and Commitment Therapy, and is one of the skills that helps increase our psychological flexibility. In other words, it helps us observe and make space for uncomfortable thoughts and feelings so that we’re able to move toward the things that matter most to us. There are a lot of activities that incorporate mindfulness and it may take some time to find what practices work for you. You can try journaling, meditating, or restorative yoga, or simply pay attention to the present moment using your senses—notice what you see, hear, smell, touch, and taste in a non-judgmental way. The key to developing a mindful mindset is consistent effort- you’ve got this! If you would like some support in practicing mindfulness and increasing psychological flexibility, CSAM can help.

IF YOU OR SOMEONE YOU LOVE NEEDS SUPPORT AND MIGHT BENEFIT FROM COGNITIVE BEHAVIORAL THERAPY (CBT) OR ACCEPTANCE AND COMMITMENT THERAPY (ACT) FOR ANXIETY, PANIC, PHOBIAS, STRESS, PTSD, OCD, OR STRESS RELATED TO COVID-19, OR IF YOU WOULD LIKE MORE INFORMATION ABOUT OUR TELEHEALTH SERVICES, PLEASE CONTACT US AT (858) 354-4077 OR AT INFO@CSAMSANDIEGO.COM

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Reference: 

https://greatergood.berkeley.edu/article/item/five_ways_mindfulness_meditation_is_good_for_your_health