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Trauma and Resilience

PTSD6-27-13The United States Senate has designated today (June 27, 2013) as PTSD Awareness Day, while also setting aside June as “PTSD Awareness Month.” To honor this worthy intent, Mom Psych is working with the National Center for PTSD to help educate the public about the causes, symptoms and treatment of traumatic stress.

One of the most common questions people ask about post-traumatic stress disorder (PTSD) has to do with why some people “get” PTSD and others don’t.  There may not be one simple answer, but researchers are closing in on some important influences. One important consideration is our level of resilience.

What is resilience and where does it come from?  From a psychological perspective, resilience is the ability to return to a healthy emotional baseline after adversity or stress. Like most of our traits, there’s a genetic component that contributes to where we fall on the resilience scale. But that’s not all there is to it. We know that our environment plays on our genetics to help determine which genes are “expressed” or activated, and which are not. We also know that there are certain key windows for this activation.

While the brain remains malleable to a certain degree our whole lives long, there are key developmental periods for shaping its basic substrates. Whether or not we reach our full genetic potential in terms of resilience depends to a great degree on our interpersonal history, particularly during the first two years of life:

[See: Born to Connect: The Role of Secure Attachment in Resilience to Trauma]

Clearly, it’s during these early years that we’re most vulnerable to the effects of abuse. But even more so when the abuse comes from those who are supposed to protect and nurture us:

[See: Betrayed: Why All Trauma Is Not Equal]

So, even though there are complexities to the question of why some people end up with PTSD while others don’t, we are beginning to piece together a general picture:

[See: Why Some Soldiers Develop PTSD and Others Don’t

As this particular bit of research points out, pre-war vulnerability is just as important as combat-related trauma in predicting whether veterans’ symptoms of post-traumatic stress disorder (PTSD) will be long-lasting. And one of the most common problems contributing to that pre-war vulnerability is, as you might suspect by now, child abuse:

[See: Embattled Childhoods May Be the Real Trauma for Soldiers with PTSD]

All of this said, we aren’t stuck with our pre-existing resilience levels. Yes, we can work toward increasing our stores of resilience, and there are effective therapies for PTSD.

Interestingly, the most effective therapists are those who instinctively provide that interpersonal connection we need so we can use the brain of another as a scaffold to our own brain’s rebuilding process. As therapist Tom Cloyd puts it:

When you run into a rough patch and all your tools are failing, the number one fallback really is the same for child or adult: another person who is NOT a participant in your distress and is compassionate in relation to you—tolerant of your drama, understanding of the experience, interested in staying connected to you—and who follows through, etc. Because of the way feelings jump back and forth between people (it’s about mirror neurons, if you want to look up the neurology), a calm person will tend to propagate calmness to (or “infect,” if you will) a distressed person. Good parents do this all the time for children.

In addition to surrounding yourself with a good support network (including a knowledgeable therapist) there are a few practical things you can do to make the most of your own capacity for resilience.

The first key is to take care of your physical health: good nutrition, regular sleep and exercise will help give you the strength necessary to support psychological health.

But you can also apply these same concepts to your brain as you work to support neurogenesis (the birth of new neurons) and lay the groundwork for successful therapy.

  • Feed your brain with positive, health-promoting experiences such as reaching out to help others or accomplishing a task that has a clear and beneficial outcome.
  • Rest your brain through meditation or by focusing on those things that give your life meaning.
  • Exercise your brain by learning something new.  Behavioral biologist Paul Martin notes in his 2006 book Making Happy People, that learning helps us reduce unpleasant emotions like anxiety, anger and depression, as well as aches and pains (which often accompany PTSD). He suggests that this is because the knowledge and problem-solving ability we gain—and the resulting sense of mastery—liberates us from worries and concerns that would otherwise make us anxious.

It should be clear by now that there is much hope for PTSD sufferers and their loved ones. Realizing this hope begins with educating the public about this debilitating condition. And that, after all, is the point of having an “awareness day.”

For more information about causes, symptoms and therapies for PTSD, I’d like to recommend three great resources. There are more, but these are great places to begin:

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June is PTSD Awareness MonthDuring the last week of May I blogged about post-traumatic stress disorder (PTSD) and pointed to some of the interesting new information that has turned up on this topic over the last few years. As luck would have it, yesterday—barely two weeks later—the United States Senate passed a resolution naming June as PTSD Awareness Month.

I must say this is a gratifying development. As someone who isn’t generally recognized as the poster-child for punctuality, I find myself in the unusual position of having shown up impressively early to an event.  In case you’re wondering whether there’s anything left to say after my rather lengthy May post on the topic, however, let me assure you there is plenty. That’s why we need a whole month to raise awareness.

As a side note, it should be understood that this is not simply an American effort, despite the Senate resolution. The International Society for Traumatic Stress Studies (ISTSS) is also honoring PTSD Awareness month, right alongside the National Child Traumatic Stress Network (NCTSN) and the National Center for PTSD (which is a division of the United States Department of Veteran’s Affairs). 

All of that said, this post isn’t going to focus on the trauma side of PTSD. Instead, it seems appropriate to talk about resilience: that quality that helps us cope with crisis and heal after trauma. This is all the more appropriate because of the fortunate timing of a couple of recent studies.

Okay, so we know that being able to fit our experiences into a coherent narrative helps us cope with all kinds of negative events. Well, one of the best ways to construct that narrative seems to be along the lines of seeing a positive outcome from the experience, as difficult as that task may seem. However, a study from current issue of the journal Psychological Trauma published by the APA’s Division 56 points to an interesting silver lining for people who have experienced trauma: they tend to be more prosocial and perceive more meaning in their life—even as they have more PTSD symptoms. Their traumatic experiences actually lead them to care for and help others more than those who haven’t experienced trauma.

In fact, wrote the researchers, when people said their volunteer work was related to a life experience, the most common motivations were negative life events. . . . (e.g., ‘My mother was hit and badly injured by a drunk driver. Ever since I have volunteered for Mothers Against Drunk Driving.’)”

“Our findings,” they wrote, “consistently indicate that trauma exposure is positively associated with engaging in prosocial [helping] behavior. Individuals who reported experiencing more traumatic events in their lifetime reported engaging in more helping behaviors during a 2-week period and more volunteer activities annually than those who had experienced fewer traumas.”

Now, that seems like good fodder for constructing a positive narrative. It’s the essence of post-traumatic growth. And to take it a step further, that extra helping behavior comes with a payback: helping others helps us. We know this on a gut level, but here’s confirmation in case it—er—helps:

Resilience in Trying Times: A Result of Positive Actions

Humans are happier when they do the right thing; it also helps them overcome difficulties

Communities that stick together and do good for others cope better with crises and are happier for it, according to a new study by University of British Columbia researcher John Helliwell and colleagues. Their work suggests that part of the reason for this greater resilience is the fact that humans are more than simply social beings, they are so-called ‘pro-social‘ beings. In other words, they get happiness not just from doing things with others, but from doing things both with and for others. The paper is published online in Springer’s Journal of Happiness Studies.

How does the social fabric of a community or nation affect its capacity to deal with crises and to develop resources that maintain and improve people’s happiness during those difficult times?
(Full story . . . )

If you click through to the article you’ll get half of the answer to that question. But the other half may be found in an old study of  a community of Italian immigrants in Roseto, Pennsylvania. I think we’ll talk about that in a future post.

PTSDFacesRecently in an online community dedicated to the discussion of trauma, I came across a comment that I’ve heard many times before. The gist was, “Whenever people find out I have post-traumatic stress disorder (PTSD), they assume I must be a combat veteran.”

Now, it’s true that way too many soldiers end up with PTSD. And it’s true that we can thank soldiers for the fact that PTSD was ever taken seriously enough to study in the first place. But almost twice as many women succumb to PTSD than men, and only a relatively small number of these women are soldiers. Most, in fact, are survivors of child abuse. And while that might not surprise you, here’s something that might: Even among soldiers, child abuse may lie at the root of PTSD, as this study suggests:

Embattled Childhoods May Be the Real Trauma for Soldiers with PTSD

This makes perfect sense, of course, when we consider how the brain develops. We are born to connect with other people, and it’s through nurturing interactions early in life that our self-regulatory systems—including fear and stress circuitry—are calibrated.

Born to Connect: The Role of Secure Attachment in Resilience to Trauma

Considering the far-reaching effects of our first experiences with caretakers, we can see why neglect counts as trauma alongside physical and sexual abuse, and we can also see why adults who have been abused as children are so much more vulnerable to stress than others.

Child Abuse Changes the Brain

This vulnerability to stress can lead to a host of mental health challenges. But, here’s a duh! moment: The brain controls processes in the body as well as thinking processes, right? So how is it we’ve managed for so long to overlook the fact that harmful effects of abuse in childhood are not confined to mental health issues? We’re only just beginning to acknowledge that we can’t really separate notions of the biological, the psychological, and the social aspects of human well-being. So, what does child abuse do to the body? Not only does developmental stress accelerate aging,

Risk of Accelerated Aging Seen in PTSD Patients with Childhood Trauma

but it also makes us vulnerable to cancer,

Study: Children Abused by Parents Face Increased Cancer Risk

as well as cardiovascular problems. In men who have been abused as children, this tends to be seen in an increased risk for heart attack,

Childhood Sexual Abuse Linked to Later Heart Attacks in Men

while in women, it’s high blood pressure, poor cholesterol levels, and metabolic issues like diabetes.

Middle-Aged Women Survivors of Child Abuse at Increased Risk for Heart Disease, Diabetes

PTSD is a complex disorder, and the costs to human potential and national budgets are equally devastating. And child abuse is a major contributor to PTSD, for soldiers as well as civilians. With that in mind, perhaps when we read studies like the next one, we’ll remember that it isn’t only the soldiering that that led to these findings, but life before soldiering too.

For Combat Veterans with PTSD, Fear Circuitry in the Brain Never Rests

And instead of asking civilians with PTSD whether they’re veterans, maybe we’ll start asking veterans whether they’re survivors of developmental trauma. Or maybe we’ll just offer them the nurturing support and friendship they need to work through the healing process, instead of making assumptions about them. Hey—It could happen! 

On the bright side, good relationships later in life can help repair the effects of abuse.

Marriage, Education Can Help Improve Well-Being of Adults Abused as Children

And while some relationships will certainly have challenges, it is well worth the time to find support for them.

Couple’s Therapy Appears to Decrease PTSD Symptoms, Improve Relationships

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