Month: January 2016

Self Compassion Eases the Distress at the Heart of Addiction

This blog was just linked to by an article in The Huffington Post – so good enough for then, good enough to get a reblog! 🙂

Inside The Alcoholic Brain

I can change my brain and behaviour via neuroplasticity by behaving differently towards myself!

Here we look at one study on self compassion in relation to those who have alcohol  use disorders.

It will be a first in a series of blogs about the role of the heart in addiction and recovery.

Why the heart?

I thought this blog was about neuroscience and the brain which is the head? Not completely true. The heart has a role to play in stress and emotion regulation and in craving and helps prompt neuro transmission of various brain chemicals. The heart has a reciprocal relationship with the brain as we will see in later blogs.

We have had a neuroscientific “decade of the brain” so perhaps we need a “decade of the heart”? As we say in recovery circles, recovery is a journey from the head to the heart, which is so true whatever…

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A Safe Place To Visit

Just finished my third EMDR terapy session and thought I would write now otherwise I probably will not get around to it. I find I am so exhausted the next day that it is difficult to blog.

I am finding that I have a lot of therapeutic benefit already from the treatment.

Today we got into the EMDR  protocol which mainly looked at mechanisms we will adopt if I dissociate while doing the actual eye movement desensitization and reprocessing (EMDR) which we will tentatively start next week.

Essentially we spent 15-20 minutes learning the relaxing techniques and “safe place” techniques I will use if I dissociate as the result of the EMDR.

It is mainly to do with “safety of the client” protocols. I felt a great relaxing benefit from doing it today. I will practice the techniques once a day while I am doing this course of treatment.

We will also use smell as a way of coming out of dissociation if need be.

We may not need these techniques but they have to be put in place just in case.

My recent dissociation has been to do with feeling detached from “me” – my body and immediate environment. We discussed how we could deal with this possibility.

I have also dissociated to childhood on occasion and this was discussed too. This type of dissociation seems to take one back to the heart of the trauma. It is like a re-experiencing without having the memory associated  with it.  It is like being behind a wall on the other side of our life, aware of certain things but not able to see it clearly

I am not fearful of dissociating – I have a grasp now of what it is and how much I have been doing it over the course of my life.

I even research the brain regions involved in dissociation and it seems the parts that deal with self reference deactivate and there is a “coming away” from representations of self and associated memory.

I have the type of head that likes to know these things – you may have noticed!?

It is a disquieting, unsettling and stressful experience but is manageable I believe with these techniques.

I  have noticed how after only a few weeks my mind and behaviour has been tied to looking at photos of the past, my old friends and my family.

My nephew also contacted me out of the blue to say he wanted to visit  and I have resumed closer contact with one of my  sisters.

I have made it clear that I am doing therapy for trauma, whether my sisters need it too I am not sure. I am the youngest in the family and a boy so my circumstances might have meant I was more traumatised by events in my early childhood than others.

Interestingly I have found a school photo  of my sister and I which is a photo of us looking a bit shell shocked, in comparison to our smiling faces of the previous year’s school photo when we were beaming more confident, mischievous smiles at the camera. I am presuming this second photo was around the time of the major trauma(s) .

I also found a photo of me in my late 20s after a cocaine psychosis and I look haunted in the same way as the school photo.

I had presumed this was due to the psychosis which is not a very pleasant experience I can assure you. I now know where the phrase “climbing the walls” comes from after that experience I can assure  you!

Now, although the psychosis obviously affect me deeply I can also see trauma in this photo and many other photos of me. My wife told me I was very paranoid at the time too which is linked to psychosis but much of the paranoia linked clearly to what I had experienced in childhood.

It was not only alcoholism and addiction that ate into my soul like a parasite feeding on my troubled emotions,  in these photos of my emaciated drug using self but also complex post trauma.

Unresolved trauma too is like a parasite feed on one’s nerves too.

Then yesterday a person who married my cousin sent me a photo of me in a underage football team that  my dad and his friend organised. My dad is in the photo too of our team.   I suddenly realised how heart breaking it must have been for my dad, what happened to our family, my mothers breakdown and eventual Valium dependence. And the decades of consequence after.

My heart  went out o him. God bless him, he was a loving father, I miss greatly.

The plan now is to finish treatment – finish a novel I was writing for many years while drinking (which is 2/3s finished) and get my driving licence. I once passed the theory part but banged my head , got concussion and could not take the practical test.

So I will try again and then take time out, a month or so to travel back to Ireland and revisit my past and see some people I haven’t seen in many many  years.

Northern Ireland has been at peace for two decades but I have yet to call a complete ceasefire with myself and my past. Hopefully I will later this yer.

Recovery has given me so much and while others hit their mid life crisis I have barely begun living. I am a published scientific writer and want to follow that by the end of this year with a published novel too.

I have a very fragmented self, blow to bits by my traumatised mother and family and my traumatised, brutalised and war torn upbringing in Northern Ireland.

I can feel these disparate parts of self slowly and naturally drifting back into shape.

It will be a new me, the composite parts that make up me no doubt but it will have the same character I am sure.

I got lost thanks to trauma and chronic alcoholism and addiction. Ten years into recovery I am still beginning the amazingly exciting journey of uncovering, recovering, the person I am and the person I am supposed to become.

When the parts reunite I will be the fullness of me.

 

Well that’s the First Session Done!?

Just had my first session of therapy for my Complex-PTSD (C-PTSD) two days ago. Still a bit tired. It is good to have gotten the process going.

But it may take some time. I was hoping the therapist would say we should get this done in 20 sessions but it seems we will be in this process for quite a while.

Possibly most of this year!

My Complex PTSD is very complex and involves repeated traumas inside and outside the home so will take time to process my past.

The good news is that I really like and respect the therapist.

I like her as a person, she is nice and considerate which is important.

I have heard it mentioned that the relationship with the therapist is often key in these therapeutic sessions.

She looks like she knows her stuff and can help me get a bit healthier.

C-PTSD appears to fragment the self and the processing and reprocessing memories from the past also appears to be a process of unifying shattered fragments of the self at the same time. This is my intuition that this will occur anyway.

One of my main issues with C-PTSD is dissociation. I simply had not realised how much I  dissociate and have dissociated throughout my life. In fact, I have probably been doing this since very early childhood.

So what is dissociation?

In psychology, the term dissociation describes a wide array of experiences from mild detachment from immediate surroundings to more severe detachment from physical and emotional experience. The major characteristic of all dissociative phenomena involves a detachment from reality, rather than a loss of reality as in psychosis.

Dissociation is commonly displayed on a continuum.[5] In mild cases, dissociation can be regarded as a coping mechanism or defense mechanisms in seeking to master, minimize or tolerate stress – including boredom or conflict.

More pathological dissociation involves dissociative disorders – These alterations can include: a sense that self or the world is unreal (depersonalization and derealization); a loss of memory (amnesia); forgetting identity or assuming a new self (fugue); and fragmentation of identity or self into separate streams of consciousness (dissociative identity disorder, formerly termed multiple personality disorder) and complex post-traumatic stress disorder.

Disassociation is very common to PTSD and C-PTSD.

Obviously it is something that has bothered me. I have thought that maybe I have dissociated a few times in recovery under extreme distress but there appears to be smaller more moderate dissociations going on a lot of the time.

It is essentially a coping mechanism against  emotional distress and anxiety but also it seems to have become a coping mechanisms in terms of troubling emotions.

I have learnt to regulate my emotions in maladaptive ways. I dissociate and use other use immature ego defense mechanisms such as denial, rationalising, minimising, justifying, projection etc. I hasten to add that after 10 years in recovery I also have learnt to adaptively regulate emotions so this process has become more automatic as my brain as healed and my emotion regulation improved.

However, this ego defense mechanisms have been rife throughout most of my life.

Especially denial.

One of my first reactions to any extreme emotional disturbance is to deny it’s happening or has happened.

This is the main reason I have not entered into treatment for PTSD before. There is a large part of me that denies I was traumatized although the evidence is there in so many ways. Chronic dissociation, regression to traumatized childhood experience, explicit memories of trauma incidents  etc etc would suggest not only that I have been traumatized but on multiple occasions over a long period of time.

Regardless, my head tells me “are you sure this happened? But your parents loved you?” It is very similar to when I finally went into recovery after almost dying from alcoholism, my head would say “yeah but you didn’t drink that much?” This isn’t simply denying alcoholism it is also denying the fact I have lost control over me. My denial minimised and rationalised this so that it was not overwhelming. This is why we need to be careful accusing newcomers about being in denial about their alcoholism. We tell them our story and let them identify, this is much better as it does not scare them into even more denial as ego defense.

It was less about denying alcoholism than denying reality and actual lived experience. I will deny anything which I find threatening to my sense of self.  Without consciously knowing I am in denial.

Anyway, my dissociation also appears linked to very insecure attachment to primary care giver, e.g. a parent like one’s mother. It is particularly common among those with disorganised attachment styles and very much so with children how have reacted at a young age to their mother’s fear and trauma.

Basically when events are traumatic or overwhelming emotionally it is often common for children to dissociate. Also growing up in a extremely stressful outside environment and society can lead to using this coping mechanism to survive. So in essence a survival mechanism that was crucial to surviving trauma in childhood.

My dissociations over the years has covered so many emotional states. I grew up in a very violent society so dissociated to deal with physical threat. I could and still can dissociate into a “powerful alpha male” state when threatened with violence for example.

I can dissociate to the extent I have no idea who significant people are in my life are, can’t remember names, etc, can dissociate to the extent that I feel my body isn’t mine and so on. I can also dissociate in a way which somehow returns me to feelings of early childhood, almost like I am temporarily a child again which is very traumatic to re-experience. I discussed some of these with my therapist.

She was very enlightened about the subject. She said it was just as it is,  for now, it is neither good or bad. It was and is a coping mechanism.

It is not to be feared as it passes but we will become more aware of it’s triggers. It is good to know that it is not “Bad” it just is. It will be dealt with in due time. I liked how she took the “sting” out of my anxieties over it.

I actually dissociated prior to the therapist session, a couple of nights previously as it was obviously distressing me at some unconscious level, the idea of starting treatment, the idea of the emotional pain to come.

The other point that was discussed a lot was the overlap between guilt and shame.

I generally believe shame is a major controlling emotion with me but that I had dealt with my guilt a lot during my 12 steps, steps 4-9 in particular. I have since realised that this guilt over wrongdoings to others primarily as a result of my drinking is very different to post traumatic guilt. All the way through the session I had this knot of guilt in my heart so tightly wound up it felt like a chestnut.  I tried to talk about shame but the guilt kept getting in the way.

We discussed this. Essentially PTSD and C-PTDSD are linked, one affects the other. Essentially we have PTSD with complex other issues added on.

I had trauma incidents which would constitute PTSD diagnosis alone plus other things too.

When a person has experienced trauma,  one has an overriding feeling of terror and helplessness and a very strong feeling of guilt.

This guilt tells one that they are somehow to blame for everything happening as it did – it whispers that one could have somehow prevented it happening. The self balks against helplessness.

We may feel that it was our fault that it happened. For me this is one of the roots of my troubles.

I once dissociated back to childhood (regressed perhaps) and I suddenly said “when I make mistakes people die!” which is a very extreme thing to say and a statement obviously steeped in trauma.

This memory related response and  associated networks of memory still lives in me and it is this and other traumatic memory  associations which need to be reprocessed.

It may even be that there are memories preceding this that I cannot access in my memory at present but which will crop  up in my mind as all memories are linked in memory networks to other memories. It is in reprocessing certain memories that other memories appear in one’s mind too.

It may even be a “memory” of something that did not happen in the sense that I interpreted something as happening in a way it didn’t. For example, two parents having a violent argument in front of a child may lead to the child blaming himself instead of the parents as it would be too emotionally overwhelming to blame the idealised “perfect” parents. This is more interpretation of events rather than the actual events themselves.

This is called the encoding of a memory. Memories are often encoded emotionally especially if the memory was encoded during a moment of emotional distress. Mood congruent memories, for example, happen when we remember something from the past because we are in similar mood to when other memories were encoded, hence the emotion helps us retrieve this and similar memories.

The same happens with trauma memories. They are often retrieved during similar heightened distress or states of hyperarousal as when first encoded.

A problem with C-PTSD memories is that we cannot always consciously access them at times or sometimes we have little memory at all of traumatic events.

This does not mean they are not in our memory banks are that they do not have influence on our behaviours, they simply do so implicitly without much explicit and conscious representation in our minds.

They do still influence our reactions and behaviours regardless of being really recalled. I used to say they lived in our bones but they more accurately they  live in our nervous systems.

The guilt and helplessness is linked to shame in me. The situations of my trauma were exposed to the community I lived in – people in the surrounding area had to intervene  in certain traumatic episodes to help us and so knew about our crazy family.

My guilt has thus been compound by shame, by not only being guilt but my self-perceived “guilt” and it’s repercussions had been exposed to wider society. Everyone knew what I did and that I was to blame  for everything that happened. They knew it was all my fault and what I was really like. A secret I have kept hidden since then, decades later. So toxic shame is linked to traumatic guilt.

This fear that people die when I make mistakes has led to a chronic perfectionism for myself and those around me. If I am perfect then all will be well. All will be controlled and bad things will not happen and everyone will be not fighting.

I set the bar high for many other people too as well as myself. It is like I can’t afford to make mistakes and either can others, particularly men as I have obviously blamed my father for our shared traumas and assigned my mother as the victim of the trauma. Hence I am wary often of men and protective of woman.

In fact, I grew up too quickly because of this, to protect my mother and guard against my father.

Although I consciously love both and have forgiven both and myself for what happened in our shared traumatic past, the memories of the events live on and colour my responses to and views of the world, men and women, even today. My memories of decades ago are like a computer virus corrupting my data files.

I write all this to process my therapy but hopefully to connect with others who are experiencing this stuff too.

I need to write to understand exactly how I am feeling and also to make connections in my brain/mind.

Whatever happened prior to my trauma episodes from childhood which led I believed to a life and death situation in more than one occasion was not the fault of a child who was say 6-7 years old. A child does not affect the behaviour of adults in such a profound way.

What happened, as is common in PTSD, is a mis-appraisal of what happened, a levying of unfair guilt on the person who witnessed the event. This guilt,  that it was their fault or they could have done something, keeps the trauma going – it becomes post trauma but still lives on in one’s mind and body and behaviours.

It is the misinterpretation of events that is internalised and processed as memory. It is this mis-appraisal that gets embedded in memory as if it was the truth, as a true reflection and recollection of what actually occurred when it was not what actually occurred.

Sometimes the trauma is so profound that the child does not want to think his parents did not love him or would hurt him (why would the be acting the way they do if they did?) and takes the blame rather than face this overwhelming emotion.

It being his or her fault is more tolerable at the moment. This too lies on in inaccurately embedded memory. It is a memory that perpetuates a traumatic lie throughout our lives. It is this lie which lives on in our negative self concepts. Telling us untruths about ourselves, that we are defective, not good enough, that if people really knew US?

It is a poisonous, malevolent neural and mnemonic ghost which haunts us decades later.

It needs to be re-addressed and the memories need to re- encoded accurately instead, that way we allow them to rest, embedded in our long term memory.

Via this process memories are reconsolidated, all the fragmented parts of self, stored away from each other in faulty interpretations and falsehoods about ourselves, that we keep alive in our memory networks and listen to as if they were the truth.

This is how I think EMDR helps exorcise the past leaving a past reality closer to the truth.

More will be revealed…

 

“My Name Is Paul. I’m A Recovering Alcoholic”

For all my US friends and friends from around the world who did not have access to UK television here is the link to “I’m An Alcoholic: My Name Is…” documentary on alcoholism which aired last night on Channel 5. Well worth checking out.

It was like a “collective” experience strength and hope (to use 12 step terminology) and will hopefully have highlighted the progressive nature of alcoholism as well as highlighting that there is treatment for and recovery from alcoholism. It was a message of hope. I’m sure it will be a useful starting point for many in “identifying” with other alcoholics to help in the process of self diagnosing.

It was great to see a documentary in the UK address alcoholism and recovery “from the horses mouth” – too often in the UK alcoholics are marginalised or absent in informing the public, by telling their story, of their alcoholism.
It was informative also that we could see the progression of this condition via all the interviewees regardless of how they later described or named their condition, how they “treated” it themselves or described their “recovery” from it.
So at least we can all agree, it starts in a seemingly innocuous manner, gets worse, then a whole lot worse, then chronic and life threatening, causes untold emotional damage to loved ones and requires both acute and long term therapeutic redress. Sounds a bit like a disease state to me that but each to their own.

As long as we all pass on the message, you can stop, you can recover from your present condition. There are lots of help in various places, in different organisations, thousands of people who suffer from the same condtion as you. They want to help you too, and you can even recovery to such an an extent that life becomes more fulfilling than anything you could ever have imagined. All the things you “treated” with substances and behaviours can be “treated” via recovery, this will happen and a whole lot more it you put the effort in.

Just click the image.

full_left_column_HD_My-Name-is---And-I'm-Alcoholic_40

Getting Past Your Past

 

For those of you who read this blog, you will know I start EMDR treatment this week for my Complex PTSD.

In order to follow my progress it may be useful to know a bit more about what I am letting myself in for therapeutically.

Below I simply use excerpts from a great paper by Dr Shapiro, the originator of EMDR treatment who explains more eloquently than I can how EMDR works in freeing oneself from one’s past, suggesting perhaps that the negative “voice” of the past, but which stalks our living present,  talks to us via unprocessed memories from the past.

This makes sense to me because without memory we cease to be our SELF. It seems reasonable to suggest then that ironing out the temporal  wrinkles of the traumatic past by physiologically re-experiencing them in EMDR therapy will free us from maladaptive influence they have on our self perception and for them naturally to be replaced by more adaptive and realistic views of ourself as reflected by our relationships with significant others and via our life achievements.

The negative voices of the self are neural ghosts which still haunt us because they contain emotional and cognitive information in memory networks – previous experience became stuck like ghosts in the machine and by reprocessing these memories to disentangle their emotional grip we can safely exorcise these neural ghosts from our representations of self.

Borne in trauma, these responses were the responses often of children to trauma, they were traumatised responding to traumatising events.

They are out of kilter reactions to these events which colour present responding to everyday events although these events are no longer traumatising in themselves.

Previous events continue to colour our emotional responses to others and to ourselves. The critical voice that previous events were somehow our fault continue to live in negative critical self talk.

In other words we continue to be re-traumatised in our reactions to the world and ourselves. The voices of the child traumatised is the voice we still hear in our minds as adults. We still listen internally to a traumatised child’s voice in leading us in our responses.

It is not dificult to see how this becomes maladaptive and pathological. We are acting on cues from the past rather than seeing reality in the present as it is.

The past exercises an influence in us via these memory networks – when they are reprocessed and embedded in long term memory, replaced with more adaptive memory of who we are now then the past exerts less of an negative influence in the present. And we begin to heal in the present having gotten past our sometimes traumatic pasts.

That’s my take on the theory anyhow.

Here’s Shapiro’s take on it.

“EMDR is a comprehensive psychotherapy approach that is compatible with all contemporary theoretical orientations. Internationally recognized as a frontline trauma treatment, it is also applicable to a broad range of clinical issues. As a distinct form of psychotherapy, the treatment emphasis is placed on directly processing the neurophysiologically stored memories of events that set the foundation for pathology and health.

The adaptive information processing model that governs EMDR practice invites the therapist to address the overall clinical picture that includes the past experiences that contribute to a client’s current difficulties, the present events that trigger maladaptive responses, and to develop more adaptive neural networks of memory in order to enhance positive responses in the future.

While clinicians from the various psychological modalities agree on the symptomatology of the well-known disorders, their ways of conceptualizing and treating them differ as a result of the specific theoretical paradigm to which they adhere (Barlow et al. 2005). For EMDR (Eye Movement Desensitization & Reprocessing), this paradigm entails the view that psychopathology is based on memories of earlier disturbing experiences that have been incompletely processed by the brain’s inherent information processing system.

Incomplete processing means that a disturbing event has been stored in memory as it was originally experienced with the emotions, physical sensations, and beliefs fundamentally unchanged. Regardless of how much time has elapsed or whether the person remembers it, the memory remains unaltered and provides the basis of current responses and behaviors.

Most mental health professionals would agree that current clinical issues are based at least in part, on previous life experiences. However, the hallmark of EMDR therapy is the emphasis on the physiologically stored memory as the primary foundation of pathology, and the application of specifically targeted information processing as the primary agent of change.

The Adaptive Information Processing (AIP) model (Shapiro 1995, 2001, 2002, 2007; Solomon and Shapiro 2008) guides the clinical application of EMDR…

EMDR’s three-pronged approach of past, present and future guides the clinician in identifying and processing, (1) the relevant past experiences that inform the client’s problems in the present; (2) the ongoing present experiences that continue to trigger maladaptive responses to current life demands; and, (3) templates of future actions to optimize the client’s capacity to respond adaptively given the current context of their lives. This article provides an overview of both the theory and practice of EMDR as a distinct integrative psychotherapy approach…

EMDR processing can eliminate the dysfunctional emotions and physical sensations inherent in the memory itself changing the client’s experience in the present. Similarly, the processing of pivotal memories has been reported to result in the normalization of attachment style in adults and children (Madrid et al. 2006; Kaslow et al. 2002; Wesselman 2007; Wesselmann and Potter 2009). It is important to emphasize that memories of even ubiquitous events appear to set the foundation for a wide range of pathologies…

… its overarching goal is to achieve an alteration of the underlying condition that is generating the dysfunctional response in the present as part of a comprehensive treatment effect. These outcomes are achieved by placing memory networks and information processing at the center of both treatment and practice.

Adaptive Information Processing Model

The theoretical foundation for the therapeutic application of EMDR is the Adaptive Information Processing (AIP) model developed by Shapiro (1995, 2001, 2002, 2007)…

According to this model, and consistent with neurobiological findings, one identifies and makes sense of new experiences within the context of existing memory networks. In addition, the information processing system functions to move disturbances to a level of adaptive resolution. What is useful is incorporated, what is useless is discarded, and the event serves to guide the person appropriately in the future…

…when an event is not fully processed, the experience remains stored in memory with the emotions, physical sensations, and beliefs that were part of the original event. As a result, the memory is not integrated with other memories that were successfully processed. Consequently, when a similar experience occurs in the future, perhaps involving an authority figure like an insulting teacher, it triggers the unprocessed memory, which then automatically colors the perception of the present experience.

When clients seek psychotherapy for current problems in their lives, they are often focused on their symptoms as the problem. Consequently, the clinician wants to understand what the client is actually experiencing in the present, i.e., negative thoughts and feelings, uncomfortable body sensations that are out of proportion to the situations that are triggering the negative responses. Additionally, similar to other approaches such as psychodynamic therapy, the EMDR clinician seeks to identify the relevant past experiences that are perpetuating the maladaptive patterns of response, resulting in the client’s clinical complaints. According to the AIP model, the pathology is not driven by the person’s reaction (e.g., belief, emotion) to the past event as is postulated in cognitive-behavioral approaches. Rather, the reaction itself is informed by the responses and/or perceptions inherent within a dysfunctionally stored memory or network of memories that are disconnected from networks containing adaptive information.

…Clients are often relieved to understand that their problems have a neurobiological basis, as well as the universality of their human experience as a counterpoint to the common belief that they ‘‘should have’’ been able to resolve their problems on their own. We suggest that the presence of these unmetabolized components of memory explains why clients will often describe their childhood traumas in the same kind of language and intonation they used when the event occurred, and demonstrate the emotions, postures and beliefs consistent with that developmental stage. They do not merely describe the feelings of shame and helplessness of the past, but actually experience these emotions and physical sensations in the present.

These unmetabolized components of memory are accessed in a systematic way during EMDR processing. The targeted memory that is ‘‘frozen’’ in time becomes ‘‘unfrozen,’’ and new associations are made with previously disconnected adaptive information related to survival, positive experiences, and one’s sense of identity…

…processing allows an unpeeling of the veil to reveal and then resolve the core emotional source of the imagery (Shapiro 2001; Wachtel 2002). As this assimilation occurs, new insights and emotions emerge and the earlier affect states and perceptions are generally discarded. With the foundation of the fully processed memory, clients are no longer subject to the same emotional volatility, distorted perceptions and intense somatic responses, and instead experience a new sense of self that is congruent with their current life situation…

The client’s experience is more informed by the present, allowing for greater flexibility in their reactions, thus increasing the likelihood of developing more adaptive patterns of response that are informed by the current context of their lives…

In addition, new memories can be successfully incorporated as the therapist assists clients to acquire the social learning necessary to fill in their developmental deficits. However, until the processing of the earlier memories is complete, the dysfunctional neural storage will hamper the desired personal growth…

While specific stabilization and affect regulation techniques may be effective and highly desirable in many cases (Schore 2003), the instability is often caused by the unprocessed memories that are contributing to the dysfunction.

The overall goal of EMDR, therefore, is to address the current problems of daily living by accessing the dysfunctionally stored memories that are being triggered by the client’s current life conditions, and engage the natural neural processes by which these memories are transmuted into appropriately stored memories (Shapiro 1995, 2001, 2007; Shapiro et al. 2007; Siegel 2002; Stickgold 2002, 2008; van der Kolk 2002). The end result is an assimilation of the new information into extant memory structures. When this has occurred, individuals discover that, while they are able to verbalize the event and what they have learned from it, they no longer experience the associated negative affects and physical sensations. It is this rapid form of learning (i.e., reprocessing) that is the essence of EMDR treatment.

If you link to this reference below it contains a case study of EMDR in practice.

Reference

  1. Shapiro, F., & Laliotis, D. (2011). EMDR and the adaptive information processing model: Integrative treatment and case conceptualization. Clinical Social Work Journal, 39(2), 191-200.

Simplifying the Complex?

complex-post-traumatic-stress-disorder

 

Well I have booked my first two EMDR counselling sessions for next week and the week after. I also spoke with my counsellor who seemed a lovely, capable person.

We needed to differentiate in our conversation about suffering from PTSD and Complex PTSD.

I suffer from C-PTSD although I also fulfill the symptoms of PTSD as do the vast majority of those who suffer C-PTSD.

“The current PTSD diagnosis often does not fully capture the severe psychological harm that occurs with prolonged, repeated trauma. People who experience chronic trauma often report additional symptoms alongside formal PTSD symptoms, such as changes in their self-concept and the way they adapt to stressful events.

Dr. Judith Herman of Harvard University suggests that a new diagnosis, Complex PTSD, is needed to describe the symptoms of long-term trauma (1).

Another name sometimes used to describe the cluster of symptoms referred to as Complex PTSD is Disorders of Extreme Stress Not Otherwise Specified (DESNOS) (2). A work group has also proposed a diagnosis of Developmental Trauma Disorder (DTD) for children and adolescents who experience chronic traumatic events (3).

Because results from the DSM-IV Field Trials indicated that 92% of individuals with Complex PTSD/DESNOS also met diagnostic criteria for PTSD, Complex PTSD was not added as a separate diagnosis classification (4). However, cases that involve prolonged, repeated trauma may indicate a need for special treatment considerations.

What additional symptoms are seen in Complex PTSD?

An individual who experienced a prolonged period (months to years) of chronic victimization and total control by another may also experience the following difficulties:

  • Emotional Regulation. May include persistent sadness, suicidal thoughts, explosive anger, or inhibited anger.
  • Consciousness. Includes forgetting traumatic events, reliving traumatic events, or having episodes in which one feels detached from one’s mental processes or body (dissociation).
  • Self-Perception. May include helplessness, shame, guilt, stigma, and a sense of being completely different from other human beings.
  • Distorted Perceptions of the Perpetrator. Examples include attributing total power to the perpetrator, becoming preoccupied with the relationship to the perpetrator, or preoccupied with revenge.
  • Relations with Others. Examples include isolation, distrust, or a repeated search for a rescuer.
  • One’s System of Meanings. May include a loss of sustaining faith or a sense of hopelessness and despair.

What other difficulties are faced by those who experienced chronic trauma?

Because people who experience chronic trauma often have additional symptoms not included in the PTSD diagnosis, clinicians may misdiagnose PTSD or only diagnose a personality disorder consistent with some symptoms, such as Borderline Disorder.”

I mention these points because I have found that my wife, who has PTSD, reacts in very different ways to me and has different symptoms although I have PTSD as well as part of my C-PTSD.

I have a history, for example, of disassociating when very very distressed or angry which is linked to C-PTSD not PTSD. It is a maladaptive survival strategy and coping mechanism from childhood which is not longer required today. It once allowed me to abruptly distance myself from emotional turmoil. To cut myself off from what was happening around me, as if it wasn’t happening. This is often done in the face of extreme trauma/abuse.

I have other symptoms different from my wife too.

If you have been following this blogsite you will have appreciated some of my constant subject areas such as insecure attachment, co-dependency, emotional dysregulation, negative self schemata, and emotion processing deficits.

It appears that much of this actually comes under the umbrella diagnostic criterion of C-PTSD. This is actually a good thing as I can seek treatment for much of the difficulties of my past at the same time. It may and probably will take longer than your average PTSD therapy but I am hoping it will be worth it.

“Cook and others describe symptoms and behavioural characteristics in seven domains:[13][14]

  • Attachment – “problems with relationship boundaries, lack of trust, social isolation, difficulty perceiving and responding to other’s emotional states, and lack of empathy”
  • Biology – “sensory-motor developmental dysfunction, sensory-integration difficulties, somatization, and increased medical problems”
  • Affect or emotional regulation – “poor affect regulation, difficulty identifying and expressing emotions and internal states, and difficulties communicating needs, wants, and wishes”
  • Dissociation – “amnesia, depersonalization, discrete states of consciousness with discrete memories, affect, and functioning, and impaired memory for state-based events”
  • Behavioural control – “problems with impulse control, aggression, pathological self-soothing, and sleep problems“
  • Cognition – “difficulty regulating attention, problems with a variety of “executive functions” such as planning, judgement, initiation, use of materials, and self-monitoring, difficulty processing new information, difficulty focusing and completing tasks, poor object constancy, problems with “cause-effect” thinking, and language developmental problems such as a gap between receptive and expressive communication abilities.”
  • Self-concept – “fragmented and disconnected autobiographical narrative, disturbed body image, low self-esteem, excessive shame, and negative internal working models of self”.

Adults with C-PTSD have sometimes experienced prolonged interpersonal traumatization as children as well as prolonged trauma as adults. This early injury interrupts the development of a robust sense of self and of others. Because physical and emotional pain or neglect was often inflicted by attachment figures such as caregivers or older siblings, these individuals may develop a sense that they are fundamentally flawed and that others cannot be relied upon.[7][15]

This can become a pervasive way of relating to others in adult life described as insecure attachment. The diagnosis of …PTSD do not include insecure attachment as a symptom. Individuals with Complex PTSD also demonstrate lasting personality disturbances with a significant risk of revictimization.[16]

Six clusters of symptoms have been suggested for diagnosis of C-PTSD.[5][17] These are (1) alterations in regulation of affect and impulses; (2) alterations in attention or consciousness; (3) alterations in self-perception; (4) alterations in relations with others; (5) somatization, and (6) alterations in systems of meaning.[17]

Experiences in these areas may include:[4][18][19]

  • Variations in consciousness, including forgetting traumatic events (i.e., psychogenic amnesia), reliving experiences (either in the form of intrusive PTSD symptoms or in ruminative preoccupation), or having episodes of dissociation.
  • Changes in self-perception, such as a chronic and pervasive sense of helplessness, paralysis of initiative, shame, guilt, self-blame, a sense of defilement or stigma, and a sense of being completely different from other human beings
  • Varied changes in the perception of the perpetrator, such as attributing total power to the perpetrator (caution: victim’s assessment of power realities may be more realistic than clinician’s), becoming preoccupied with the relationship to the perpetrator, including a preoccupation with revenge, idealization or paradoxical gratitude, a sense of a special relationship with the perpetrator or acceptance of the perpetrator’s belief system or rationalizations.
  • Alterations in relations with others, including isolation and withdrawal, persistent distrust, a repeated search for a rescuer, disruption in intimate relationships and repeated failures of self-protection.
  • Loss of, or changes in, one’s system of meanings, which may include a loss of sustaining faith or a sense of hopelessness and despair.”

 

As I research C-PTSD it seems this disorder describes many of my symptoms and behaviours very accurately and there is also reportedly a high co-occurrence with C-PTSD and alcoholism and addiction.

http://insidethealcoholicbrain.com/2015/12/13/do-the-12-steps-help-with-post-traumatic-stress-disorder/

I will be interested in how it “treats” my addictive behaviours too as I believe much of these addictive behaviours were borne out on childhood traumas and abuse.

In other words, the symptoms of C-PTSD and other related areas like attachment, co-dependency, abuse, maltreatment, neglect and other adverse circumstances appear to affect the human brain in similar ways and each contribute to an increase in addiction severity.

I wonder in some ways if I will be treating the “roots of all my troubles” in more ways than one.

I will keep you posted as best I can. It will no doubt be painful at times. I am glad to have made start anyway.

I will post before the first two sessions are done of the following areas

What is EMDR?

Treating C-PTSD with EMDR?

How does EMDR work?

 

Until then?

 

 

 

 

Original Link

http://www.ptsd.va.gov/professional/PTSD-overview/complex-ptsd.asp

References

  1. Herman, J. (1997). Trauma and recovery: The aftermath of violence from domestic abuse to political terror. New York: Basic Books.
  2. Ford, J. D. (1999). Disorders of extreme stress following war-zone military trauma: Associated features of Posttraumatic Stress Disorder or comorbid but distinct syndromes? Journal of Consulting and Clinical Psychology, 67, 3-12.
  3. van der Kolk, B. (2005). Developmental trauma disorder. Psychiatric Annals, 35(5), 401-408.
  4. Roth, S., Newman, E., Pelcovitz, D., van der Kolk, B., & Mandel, F. S. (1997). Complex PTSD in victims exposed to sexual and physical abuse: Results from the DSM-IV field trial for Posttraumatic Stress Disorder.Journal of Traumatic Stress, 10, 539-555.