UNDERSTANDING PTSD (Pt. 2): Mythology

by Lucas Myers 08/16/2013

Last week I shared a little bit about my experience working with San Diego’s veterans at Stand Down. This week I will address the questions and misconceptions that come up for many people in any conversation about Post-Traumatic Stress Disorder.

It has had many names, some going back as far as the American Civil War: shell shock, combat fatigue, soldier’s heart, combat neurosis, and, most recently, Post Traumatic Stress Disorder (PTSD). Some experts predict that as many as 30% of Iraq and Afghanistan combat veterans will receive treatment for PTSD. What was first observed as changes in soldiers that had survived combat is now recognized in many people who have witnessed, experienced, or even been affected by any of a variety of traumatic experiences.

It is becoming increasingly common, affecting as many as 3.5 out of every 100 US residents according to the National Institute of Mental Health. Symptoms may include nightmares, flashbacks, uncontrollable thoughts about the traumatic event and severe anxiety. These experiences, along with very disruptive physiological effects related to anxiety, can persist for weeks, months, or years. 

Most Americans are familiar with PTSD; it has been featured in major motion pictures from The Deer Hunter to Forrest Gump. Unfortunately, as with many complex subjects that receive the pop-culture treatment, PTSD is sometimes portrayed in a confusing and even irresponsible manner. Because of the widespread misunderstanding about PTSD and veterans who have been through combat, this week we will take a moment to address a few myths you may have heard.

MYTH: Everyone has been through a frightening experience that resulted in symptoms like PTSD. Eventually people get over it.

Fact: Frightening experiences may create vivid memories, however most people do not suffer the impairment and severity of symptoms characteristic of PTSD. Although there are many similarities between PTSD and other forms of anxiety, PTSD is unique in its effects on the brain's responses to events. PTSD can sometimes cause serious disability. It is a medical disorder than sometimes becomes complicated by co-occurring anxiety, mood, and substance-abuse disorders. It may cause significant problems in social interactions, relationships and ability to work.

MYTH: PTSD is a sign of “weakness” and “lack of character” in people who are unable to cope with difficult situations in the same way most people do.

Fact:  For many people who have been exposed to markedly abnormal situations PTSD is a normal reaction. A person experiencing a traumatic event undergoes chemical changes in the brain in order to survive and function through his or her experience and these create symptoms that we recognize as PTSD. PTSD is not a result of moral failing or a weak character. Some studies suggest that half of all Americans will meet the criteria for a mental health diagnosis at some time in their lives.

MYTH: PTSD causes people to become violent and unpredictable. 

Fact: Many people believe that mental health problems are associated with violence and unpredictability but this is rarely true. Someone with PTSD or another psychological condition should not be viewed as dangerous in the home or workplace. These fears result in stigmatizing diagnosis and treatment for people that need and deserve our respect, acceptance and help. PTSD and other psychological conditions only very rarely result in acts of aggression.

MYTH: Once you've been diagnosed with PTSD you will never recover. Therapy is a waste of time.

Fact: New studies are emerging all the time that show that most people with PTSD and other mental illnesses do get better and make full recoveries. Recovery may mean reduced symptoms and or the ability to lead a productive and fulfilling life. Many people recover their ability to live, work, learn, and participate in their communities. Some combination of therapy and medication plays a role in many recoveries and science has shown that hope and positive social support are two of the most important factors in predicting success.

MYTH: People with PTSD can't handle the everyday stress of finding and keeping a job.

Fact: If jobs weren't difficult and stressful we wouldn't pay people to do them. As with any other psychological condition, the severity of PTSD and an individual's path to recovery can vary widely. Balancing stress and stress tolerance well by matching employees’ needs to their work conditions leads to productivity and success. Studies show that most people with PTSD and other mental illnesses demonstrate motivation, punctuality, quality work, high attendance, and job tenure. Any employer can improve their gauge of workload and performance by considering these factors. 

If you or someone you care about is struggling with PTSD or heightened anxiety as a result of serving in combat or another traumatic experience, and would like to speak with a professional at The Center for Stress and Anxiety Management, you may contact us at 858-354-4077 or csamsandiego@gmail.com

References:

American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders, Fifth 

Edition. Arlington, VA, American Psychiatric Association, 2013. Web. [access date: 1 June 

2013]. dsm.psychiatryonline.org

http://www.americasheroesatwork.gov/

http://www.nimh.nih.gov/health/topics/post-traumatic-stress-disorder-ptsd/index.shtml

Reno, J. “Nearly 30% of vets treated by BA have PTSD”. Retrieved on August 18, 2003: 

http://www.thedailybeast.com/articles/2012/10/21/nearly-30-of-vets-treated-by-v-a-have-ptsd.html

Tags: anxiety, PTSD, therapy, mental health treatment, San Diego, veterans, military, heroes, support

UNDERSTANDING PTSD (Pt. 1): Stand Down San Diego

by Lucas Myers 7/19/13

A hero is a person who is admired for overcoming great adversity through extraordinary courage and ability. With Comic Con recently taking over downtown San Diego they were easy to spot: heroes wearing capes and brightly colored costumes. But it was prior to Comic Con that I learned how to spot San Diego's real heroes. To most of us they are invisible. You probably passed one on the way to work. As you sat in your car waiting for the light to change one walked right by you. They wear disguises. He might have covered his face with a bushy beard. She might have hidden behind a cardboard sign. But the reason that most people don't see San Diego's invisible heroes is because they choose not to. It is uncomfortable. Maybe they are asking for spare change. Maybe shabby, mismatched clothes and an unfamiliar odor make you nervous. They sleep in doorways. They push shopping carts. They have given everything in defense of our way of life. They are San Diego's homeless veterans.

I recently had the opportunity to meet over a thousand homeless veterans at the annual Stand Down San Diego event in Balboa Park. Stand Down is held every year for 3 days every July. Veterans Village of San Diego organizes the event to offer these soldiers, seamen, airmen, and marines a helping hand. It has become so successful that it has become a model for Stand Down events held all over the country. As one of hundreds of volunteers, I assisted veterans and their families with accessing showers, clean clothes, barbers, doctors, dentists, optometrists, counselors, chaplains, legal assistance, and a safe place to sleep.  In addition, Stand Down offers help with accessing benefits, finding employment, and seeking shelter. For those three days, these heroes are not invisible. Lives are changed and lives are saved as thousands of caring volunteers and professionals give their time to address the challenges facing so many of San Diego's veterans.

I spoke with military spouses and children that volunteered at Stand Down. Many of them were transformed by their experience. They told me about how meeting other veterans and hearing their stories helped them understand how their husbands and fathers had been changed by combat duty. They cried as they talked about the time they had missed with an absent or angry veteran. But this event was characterized by love and hope.

Many past Stand Down attendees returned to help and to spread their stories of healing, inspiration, transformation, and redemption. Stand Down is a second chance that these men and women deserve. A chance to overcome great adversity. A chance to be admired. A chance to be heroes.

If you would like more information about how to help with next year’s Stand Down, click here.

If you are, or know a veteran or veteran's family member who may be struggling with homelessness or needs assistance accessing resources, please encourage them to contact the Veterans Crisis Line (1-800-273-8255) for free, confidential support 24/7.

If you or someone you care about is struggling with PTSD or heightened anxiety as a result of serving in combat or another traumatic experience, and you would like to speak with a professional at The Center for Stress and Anxiety Management, you may contact us at 858-354-4077 or csamsandiego@gmail.com

Tags: anxiety, PTSD, therapy, mental health treatment, Comic Con, Stand Down, San Diego, veterans, military, heroes, support

Get Your Geek On: Comic Con Can Help Anxiety, Depression & Stress

By: Janina Scarlet, PhD

It is that time of the year again, the San Diego Comic Con. For some, it is a joyous time of year, Geek Christmas if you will, whereas for others, it is the time of strange people dressed in capes and tights, and severe traffic delays, accompanied by zombie walks. Whatever your take on the Comic Con is, I wanted to dedicate this post to this event and to discuss how comic books, fantasy, and other works can be used to help cope with a difficult loss, social anxiety, depression, post traumatic stress, and many other universal struggles.

I say “universal” here because these difficulties exist in one way or another throughout the world. Depression, anxiety, and many other emotional and psychological concerns can be especially alienating when we have no one to talk to and, as it often happens, think that no one will understand. It is for this reason that comic books, as well as fantasy and science fiction books, can be especially helpful for recovery. Allow me to elaborate. Have you ever had an experience where you read a book or watched a movie or a TV show only to find a character going through the same thing that you are currently going through or have recently experienced? Suddenly, there’s a spark, a moment of connection, as if this character can truly understand, as if he/she is “just like me.” And suddenly, it’s easy to understand how this character feels as well, because you have felt the exact same way! This realization can be quite cathartic as you might not feel as alone in the world, if even for a moment, and this experience can potentially open the door to insight and recovery.

Comic books have been used in therapy for children and adults alike. For example, Dr. Patrick O’Connor, a clinical psychologist, described his experience in using comic books with a teenage gang member, who was able to identify with a specific character, which allowed him to be able to express his point of view and greatly helped in his therapeutic process. In addition, UCLA psychologist and researcher, Dr. Andrea Letamendi, has been successful in using comic books to assist veterans and other trauma survivors in the treatment of post traumatic stress disorder (PTSD). I have used some examples from comic books and related media when working with active duty marines with PTSD. For example, I used examples from a recent movie, Iron Man 3, to demonstrate that even superheroes can develop PTSD, as well as examples of Kryptonite’s devastating effects on Superman when working with patients with depression or pain disorders to illustrate that even superheroes have limitations.   

Comic books are not the only medium that can be used to help us feel connected and to help us identify our feelings. Books, movies, and others can also be extremely effective. For instance, Harry Potter books have been used in therapy to assist children with loss of a loved one. I sometimes use The Lord of The Rings or The Hobbit books to illustrate that one does not have to feel brave to be brave.

A book that truly spoke to me when I was growing up was The Three Musketeers, as it demonstrated camaraderie and the meaning of true friendship: “all for one and one for all.” What about you? Which books, comics, movies, TV shows, paintings, or other forms of media have moved you?

If you would like to see Dr. Scarlet for therapy, contact The Center for Stress and Anxiety Management at 858-354-4077 or csamsandiego@gmail.com

Hoarding and Cognitive Behavioral Therapy

By: Sarah Bond 

Within the past couple years, the issue of hoarding has become polarized by the means of reality television shows and late night pundits.  Although this media attention has contributed to an increased public awareness, interest, and concern, the long-term implications that hoarding can have are often overlooked.  While hoarding has been associated with the diagnosis of obsessive-compulsive disorder (OCD) and obsessive compulsive personality disorder for many years, it was not until the recent publication of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) that it became its own diagnosis. 

Hoarding is characterized by collecting possessions that create clutter and serve minimal functional purpose (Tolin, Frost, & Steketee, 2007).  Anything living or non-living can be hoarded.  “Clothes, newspapers, and books” are reportedly the most common items hoarded (International OCD Foundation, 2010, p. 1).  However, fifty-percent of hoarders choose to amass complimentary items, such as bubble wrap and fast food containers, and some even acquire large numbers of living animals. 

Hoarding may result in the impairment of functioning and create significant distress.  The disorder can pose additional health risks associated with sanitation and an increased risk of fire (Tolin et al., 2007).  Aside from the physical hazards, it can also have immense social and psychological ramifications.  For instance, hoarding will affect the lives of those who share living spaces and may adversely impact interpersonal relationships.  Its clinical repercussions interfere with daily routines that many take for granted.  Simple tasks, such as cooking and showering, may be hindered by the unnecessary accumulation of items hoarded.  Thus, it is understandable as to why hoarders are commonly diagnosed with elevated rates of depression (Tolin et al., 2007, p. 1461). 

Hoarders usually do not realize that they have a problem (International OCD Foundation, 2010).  Many have trouble with organization and decision making.  Thus, they find it difficult to arrange their possessions in a manner that makes efficient use of their living space.  Additionally, hoarders often have an emotional attachment to their objects, which makes it challenging for them to discard or give away their possessions (International OCD Foundation, 2010).  It may provoke a sense of fear in anticipation of losing the objects that are important to them.  Thus, hoarders may arrange their items compulsively to help alleviate distress (International OCD Foundation, 2010).  Hoarders do not typically exhibit ritualistic tendencies and the accumulation of items tends to be passive in nature.  This differs from OCD, in which individuals deliberately seek to rid themselves of unwanted emotions by actively seeking out behaviors or rituals that provide comfort (International OCD Foundation, 2010).

 If you or someone you know experience symptoms similar to the aforementioned, it is important to consult a professional.  Although there is still a lot to be learned about the disorder, interventions such as cognitive behavioral therapy (CBT) can be effective.

 Please contact CSAM if you are interested in speaking with a professional in the San Diego area who specializes in CBT.

References

International OCD Foundation. (2010). Hoarding. Retrieved from http://www.ocfoundation.org/hoarding/

Tolin, D.F., Frost, R.O., & Steketee, G. (2007). An open trial of cognitive behavioral therapy for compulsive hoarding. Behavior Research Therapy, 45(7), 1461.

Tags: CBT, Cognitive Behavioral Therapy, OCD, hoarding

The Importance of Clinical Research

By: Sarah Bond

Clinical research is fundamental to the advancement and understanding of the field of psychology.  It is important not to underestimate the significance that clinical research has had upon the development and implementation of psychological interventions.  This is accomplished by randomly selecting a subset of the population to serve as a sample in which the potential effect(s) of a given variable are observed.  Clinical research provides practitioners and researchers with insight into the effectiveness of the associated variable(s) under study.  It helps us examine isolated factors that may not be clearly evident outside of a controlled setting.  For example, we may examine the clinical treatment outcome of a specific intervention to determine whether or not it is an effective treatment for a given disorder.

In order to further advance standards of care, we must compare current treatment options to novel interventions.  This challenges us to continuously advance our understanding of the most relevant and beneficial treatments available for our clients.  We have an ethical obligation to ensure that we understand how a given intervention will likely influence the treatment outcome prior to determining the best approach to utilize when helping a client.

Clinical studies provide findings that allow practitioners to analyze data and generalize interpretations to help their clients.  For instance, both cognitive behavioral therapy (CBT) and acceptance and commitment therapy (ACT) have been indicated by clinical research to be efficacious treatments for anxiety disorders as well as many other conditions (e.g., depression, chronic pain, eating disorders).  Clinical research provides a means for psychologists to determine the best type of treatment for their clients.

Most clinical studies utilize human participants.  There are strict ethical guidelines set forth by the American Psychological Association (APA) that must be ensured prior to and throughout administration.  For this reason, all academic research studies must submit a research proposal to be reviewed by the respective university’s Institutional Review Board (IRB).  In doing so, the IRB is obligated to determine whether or not a given study is ethical prior to implementation.  During the study, participants are asked to sign an informed consent, which is similar to a contract.  It thoroughly explains the intention and potential risks associated with the study.  If any deception is used, it is mandatory to debrief participants following administration.

In essence, clinical research is important to providing optimal client care.  It not only deepens our understanding of current practices, but it also helps us advance and learn about new treatment options that can potentially improve treatment outcomes.  We depend upon clinical studies to help us understand how different variables influence our daily lives.

If you are interested in being a participant in clinical research, you can visit https://www.facebook.com/Paidresearchsandiego.

Tags: San Diego, psychology, psychologist, research, clinical research

Chronic Pain

By: Sarah Bond

From an evolutionary perspective, pain serves to warn us of potential injury to avoid subsequent danger.  Although acute pain affords a short-term advantage, its long-term persistence can lead to significant distress and suffering. According to the American Academy of Pain Medicine (2013), 100 million Americans are afflicted with chronic pain. Chronic pain can be defined as an uncomfortable feeling set off in the nervous system that persists for weeks, months, or even years. Although its onset may be attributed to injury, chronic pain can also occur without any predetermined indication.

The National Institutes of Health (NIH, 2006) found that the most common chronic pain complaints include: lower back (27 percent), head (15 percent), neck (15 percent), and facial (4 percent). Although the physical effects are evident, the psychological pain is equally burdensome for many. The implications of such physical pain can lead to emotional distress and discomfort.  In turn, emotional distress can also exacerbate the experience of physical pain.

Individuals may feel as though their pain prevents them from leading a ‘normal’ life. They feel as if they cannot partake in activities they found enjoyable in the past. This withdrawal may result when chronic pain is associated with a particular movement/activity (Dahl, Wilson, & Nilsson, 2004). In fact, lower back pain is the most common cause of disability among Americans under 45-years-old (The American Academy of Pain, 2013). When people refrain from participating in what gives them a purpose in life, it can have detrimental effects upon their psychological well-being.

Treatment for chronic pain patients can be challenging. Although 41 percent of those who take over the counter medications and 58 percent of those who take prescription medications reportedly express pain relief, there are many who do not benefit from pharmacological interventions (The American Academy of Pain, 2013). Thus, it is critical to consider other options when addressing chronic pain. 

Research suggests that psychotherapy is an effective method for treating chronic pain. Specifically, cognitive behavioral therapy (CBT) and acceptance and commitment therapy (ACT)address the psychological factors that accompany physical pain (McCracken, Vowles, & Eccleston, 2005; Dahl et al., 2004). If the emotional factors are ignored, they can exacerbate the physical pain. Similarly, if the physical factors are ignored, they can exacerbate emotional pain. Therefore, it is important that both the psychological and physical factors are treated appropriately.

If you or someone you know suffers from chronic pain, professional support is available. If you are in the San Diego area and would like to speak to a professional at CSAM who specializes in CBT and ACT, please contact us. 

References

Dahl, J., Wilson, K.G., & Nilsson, A. (2004). Acceptance and Commitment Therapy and the treatment of persons at risk for long-term disability resulting from stress and pain symptoms: A preliminary randomized trial. Behavior Therapy, 35, 785-801.

Institute of Medicine. (2011). Report from the Committee on Advancing Pain Research, Care, and Education: Relieving pain in America, a blueprint for transforming prevention, care, education and research. The National Academies Press. Retrieved from http://books.nap.edu/openbook.php?record_id=13172&page=1.

McCracken, L.M., Vowles, K.E., & Eccleston, C. (2005). Acceptance-based treatment for persons with complex, long standing chronic pain: a preliminary analysis of treatment outcome in comparison to a waiting phase. Behaviour Research and Therapy, 43(10), 1335-1346.

National Centers for Health Statistics. (2006). Chart Book on Trends in the Health of Americans 2006, Special Feature: Pain. Retrieved from http://www.cdc.gov/nchs/data/hus/hus06.pdf.

The American Academy of Pain Medicine. (2013). Retrieved from http://www.painmed.org/patientcenter/facts_on_pain.aspx.

Tags: Cognitive Behavioral Therapy, pain, chronic pain, headache, back, ache, somatic