Magazine For Hypnosis and
DEALING WITH TRAUMA (uploaded 4/12/2001)
by Dr. Maurice Kouguell
In an article, Antidote for the Psychological Effects of Terrorism: A Rapid, Biological Technique for Clearing Trauma from Mind and Body, Judith Swack, Ph.D. writes:
“Since September 11, 2001, have you noticed any of the following symptoms:
- When you think of the terrorist attacks you can’t believe it; it seems like a bad movie
- You can’t bear to think about it or you can’t stop watching the news on TV
- You can’t believe that anybody could do such evil (particularly in the name of God) and you’ve lost your faith mankind
- You feel betrayed by God, the President, or the US government for not protecting us
- You feel guilty that we were attacked for something we did or did not do. The world seems dark and sinister even on sunny days
- You are scared about anthrax or what might come next
- You feel numb
- You cry more easily or you cry all the time
- You feel crabbier than usual or you feel extraordinarily angry
- You are afraid to fly
- You are frightened by airplanes flying overhead
- You don’t want to leave home
- You don’t want to go anywhere on vacation
- You don’t want your relatives and friends to go out of town
- You don’t want to go out to restaurants or other entertainment
- You are afraid to spend money
- You feel lethargic. Your life feels meaningless, put on hold, or derailed
- You find it more difficult to deal with your already stressful life
- You feel isolated
- Previous loss or violence traumas now feel worse or reactivated
If you have any of these symptoms then you have been traumatized to some degree by the terrorist attack on our country. In addition to the direct attack on our country, many people have been traumatized by additional shocks caused by the ripple effect on our economy such as the loss of jobs and investment money or continued terrorist activity such as the anthrax scare. In one way or another this attack has affected most of us personally.”
Webster’s New Twentieth Century Dictionary defines trauma as “an injury or wound violently produced” and “as an emotional experience or shock which has a lasting psychic effect.” The psychiatric definition as described in the American PsychiatricAssociation Diagnostic and Statistical Manual of Mental Disorders, 4th Edition includes “the person experienced, witnessed or was confronted with an event or events that involved actual or threatened death or serious injury, or a threat to the physical integrity of self or others (and) the person’s response involved intense fear, helplessness or horror.” We observe that although the trauma, the event itself has ended, the reaction has not. The memory of the precipitating incident leaves the individual with an imprint, a feeling of being stuck, frozen.
Environmental factors will then easily trigger the memory of the incident with its full impact. The incident, the memory resurfaces and frequently takes such proportions that it becomes real to the victim. Those can become subject to flashbacks, nightmares and may continue to struggle with emotional unrest, fears, and anxiety, very similar in intensity to their initial reaction to the precipitating event.
It is not possible to estimate how many people have been affected as a result of the destruction of the Twin Towers in New York. The numbers of victims go beyond the astronomical numbers of persons whose family members, friends and co-workers died on that day, traumatized people who were in the area, people who saw the event live or on television. But the number does not stop there. There is and will continue to be a ripple effect which will trigger in so many post traumatic stress reactions. Traumatic stress encompasses the emotional, cognitive behavioral and psychological experience of individuals who have witnessed or have been direct victims of overwhelming events.
Some react to stress by expressing their fears openly. However, it is reported that the vast majority of traumatized people ”act in.” They will turn the terror, the rage, the shame and the guilt inwards. All those bottled up feelings will in time begin to undermine their emotional and physical health as well as their sense of well-being. Although those feelings are translated into physical manifestation, physicians report that they can find nothing medically wrong with at least eighty percent of patients who seek their help. A significant portion of these people are probably suffering from undiagnosed symptoms related to trauma and stress.
According to Brown and Fromm,(1) “events that typically cause PTSD fall into two classes: natural disasters (tornadoes, earthquakes, volcanic eruptions, storms, floods, fires and animal attacks); and human aggression (assault, rape, burglary, kidnapping, high jacking, political incarceration, torture and holocaust) These situations are so removed from ordinary everyday experience that even the healthiest of people are ill equipped to cope with them.”
No two people react to trauma in similar ways. The same event which can be harmful to one individual can be exhilarating to another. During my tour of duty with the U.S. Army, my entire company was shipped to Korea except for three of us. I was assigned to the Mental Health Unit and the Neuro-Psychiatric Service. I saw several of my “buddies”, after their experience in Korea, return to our camp. Some where severely traumatized, experiencing shell shock, some continued to experience flash backs and some felt great about their experience during “that police action”.
Although symptoms of trauma may appear shortly after the precipitating event, others develop over time. The end of a war or a terrorist attack or liberation from a concentration camp does not mean the end of the internal or psychological liberation. So even if one has physical security, one looses emotional security. One may have lost a sense of security, a sense of trust. Sometimes repeated nightmares are reported; at times one may experience startled reactions such as flashbacks.
In an interview dated 8/27/97, Dr Yael Danieli (3), states that “every one is affected for the rest of their lives. 15 to 35 percent of people are affected seriously… at one point or another they could be chronically affected for the rest of their lives. They may be seemingly non affected for a long time but then some reminder will happen or a change, such as change in life style or aging, can become very traumatic for survivors of past trauma, as a result of the trauma. It is important to realize that trauma is not a sickness or a disease. It is a dis-ease. Some loose the ability to sleep through the night. Should signs of trauma go on unattended, they could cause pathology.
The following is a list of symptoms as described by Peter A. Levine, author of ‘Waking the Tiger: Healing Trauma’. It should be noted that not all of the following symptoms can be caused only by trauma. The evaluation has to take into account that the dis-ease is not going away or getting better.
- Hyperarousal: Manifested by physical signs such as difficulty in breathing, increased heart rate, cold sweats, tingling, muscular tension, racing thoughts, worry.
- Constrictions: The nervous system reacts by constricting both the body and one’s perceptions. This affects the breathing, the body posture and the muscle tone.
- Dissociation: During a life threatening event one experiences a separation of awareness from physical realities which protects one (act of escalating arousal). If the precipitating event continues it protects the individual from the pain of death and allows him to endure the experience beyond expectation.
- Denial: a form of dissociation. Thus one may react as though the event was insignificant.
- Feeling of helplessness, or immobility or freezing. This can be described as being completely immobilized, paralyzed.
Other symptoms that surface shortly after trauma, although they can surface later, include:
- Hypervigilance: being on guard all the time.
- Intrusive imagery such as flashbacks.
- Extreme sensitivity to light and sound.
- Hyperactivity, restlessness.
- Exaggerated emotional and startled reaction to noise, quick movements, etc.
- Nightmares and night terrors.
- Abrupt mood swings such as rage reaction, temper tantrums, shame.
- Reduced ability to deal with stress (easily stressed out).
- Difficulty sleeping
- Fear of going crazy
- Other symptoms include: panic attacks, phobias, anxiety
- Mental blankness, or spaciness
- Avoiding circumstances which remind one of the previous experience
- Attraction to dangerous situations
- Frequent anger or crying
- Mood swings
- Exaggerated or diminished sexual activity
- Amnesia and forgetfulness
- Inability to love, nurture or bond with other individuals
- Fear of dying or having a shortened life
The following are symptoms which take longer to develop:
- Excessive shyness
- Diminished emotional response to make commitments
- Chronic fatigue or low physical energy
- Immune system and certain endocrine problems such as thyroid dysfunction or psychosomatic illnesses – particularly headaches, neck and back problems, asthma, digestive distress, spastic colon, severe premenstrual syndrome and eating disorders
- Depression, feeling of impending doom
- Feeling like the “living dead”: detached, alienated and isolated
- Reduced ability to formulate plans and carry them through.
The symptoms of the trauma can be present at all times or come and go. Usually they often grow increasingly complex over time, becoming less and less connected with the original trauma experience.
How Do People Respond During Traumatic Exposure?
The following emotional, cognitive, behavioral and physiological reactions are often experienced by people during a traumatic event. It is important to recognize that these reactions do not necessarily represent an unhealthy or maladaptive response. Rather, they may be viewed as normal responses to an abnormal event. When these reactions are experienced in the future (i.e. weeks, months or even years after the event), they can be joined by other symptoms (e.g., recurrent distressing dreams, “flashbacks,” avoidance behaviors, etc.), and interfere with social, occupational or other important areas of functioning, a psychiatric disorder may be in evidence. These individuals should pursue help with a mental health professional.
Emotional Responses during a traumatic event may include shock, in which the individual may present a highly anxious, active response or perhaps a seemingly stunned, emotionally-numb response. He may describe feeling as though he is “in a fog.” He may exhibit denial, in which there is an inability to acknowledge the impact of the situation or perhaps, that the situation has occurred. He may evidence dissociation, in which he may seem dazed and apathetic, and he may express feelings of unreality. Other frequently observed acute emotional responses may include panic, fear, intense feelings of aloneness, hopelessness, helplessness, emptiness, uncertainty, horror, terror, anger, hostility, irritability, depression, grief and feelings of guilt.
Cognitive Responses to traumatic exposure are often reflected in impaired concentration, confusion, disorientation, difficulty in making a decision, a short attention span, suggestibility, vulnerability, forgetfulness, self-blame, blaming others, lowered self-efficacy, thoughts of losing control, hypervigilance, and perseverative thoughts of the traumatic event. For example, upon extrication of a survivor from an automobile accident, he may cognitively still “be in” the automobile “playing the tape” of the accident over and over in his mind.
Behavioral Responses in the face of a traumatic event may include withdrawal, “spacing-out,” non-communication changes in speech patterns, regressive behaviors, erratic movements, impulsivity, a reluctance to abandon property, seemingly aimless walking, pacing, an inability to sit still, an exaggerated startle response and antisocial behaviors.
Physiological Responses may include rapid heart beat, elevated blood pressure, difficulty breathing*, shock symptoms*, chest pains*, cardiac palpitations*, muscle tension and pains, fatigue, fainting, flushed face, pale appearance, chills, cold clammy skin, increased sweating, thirst, dizziness, vertigo, hyperventilation, headaches, grinding of teeth, twitches and gastrointestinal upset.
* Require immediate medical evaluation
Reprinted from Acute Traumatic Stress Management ™
by Mark D. Lerner, Ph.D. and Raymond D. Shelton, Ph.D.
© 2001 by The American Academy of Experts in Traumatic Stress, Inc.
How Can Emergency Responders Manage their Own Response to a Traumatic Event?
Addressing the emergent psychological needs of others during a traumatic event can be a draining experience.
Working with individuals who are in acute emotional distress requires an intensity that, for the provider, is both mental and physical. It is imperative that you consider your own state of mind prior to engaging in the provision of ATSM. If you are currently experiencing a time of emotional distress in your life, it would be wise to have another responder assist the victim. In this way, you lessen your chance of becoming victimized yourself by the event.
As an emergency responder, you will likely be exposed to the very events that you are called upon to help others. For example, after arriving at an automobile accident, a police officer had the responsibility of preserving the scene. While holding back bystanders, he provided psychological support. Yet he too had seen a gruesome dismembered body on the roadway. As an emergency responder, you will be exposed to seemingly overwhelming physical events as well as the psychological impact that these events have on others.
There will be times when you will identify personally or “link with” an individual with whom you are working—or perhaps with some aspect of the situation. For example, a young detective was called upon to deliver a death notification to the parents of a 10 year-old girl. After sharing the news, she and her partner offered support for the grieving parents. Her feelings of discomfort shifted very quickly to feelings of being overwhelmed when she saw a photograph of the deceased child – the girl looked very much like her own daughter.
Despite drawing upon a specific strategy that will help you to remain “professionally detached” (e.g., empathic communication—as described in the upcoming section, “Provide Support”), powerful thoughts and feelings have a way of piercing professional detachment. This is a normal response to an abnormal situation.
If you find yourself feeling emotionally overwhelmed during the provision of ATSM, try the following:
• Maintain an awareness of your state of mind, as well as your physical reactions. Consider the effect the person is having on you. Acknowledge to yourself that your involvement with the individual is creating various physical and psychological reactions.
• If you find that the discussion is causing you to react physically (i.e., rapid heart rate, breathing increase, sweating, etc.) take a slow deep breath and tell yourself to relax—take a second deep breath and relax. If possible, separate from the event, grab a cup of decaffeinated coffee, and share your feelings with a peer.
“High-risk” indicators for Posttraumatic Stress Disorder (PTSD)
• prior exposure to severe adverse life events (e.g., combat)
• prior victimization (e.g., childhood sexual and physical abuse)
• significant losses
• close proximity to the event
• extended exposure to danger
• pre-trauma anxiety and depression
• chronic medical condition
• substance involvement
• history of trouble with authority (e.g., stealing, vandalism, etc.)
• mental illness
• lack of familial/social support
• having no opportunity to vent (i.e., unable to tell one’s story)
• strong emotional reactions upon exposure to the event
• physically injured by event, etc.
Reprinted from Acute Traumatic Stress Management ™
by Mark D. Lerner, Ph.D. and Raymond D. Shelton, Ph.D.
- Hypnotherapy and Hypnoanalysis by Brown and Fromm; Laurence Erlbaum Associates, publishers, page 262-264
- Waking The Tiger: Healing Trauma by Peter A. Levine and Ann Frederick; North Atlantic Books publishers (page 147-148)
- Healing War’s Trauma From an interview with Dr. Daniely, director, group project for Holocaust survivors and Their children aired 8/27/96.
Dr. Kouguell is a diplomate of The American Academy of Experts in Traumatic Stress. He offers free consultations to individuals and groups related to the September incident.
His website www.brooksidecenter.com. features extensive resources and self help techniques for individuals affected by PTSD
For Hypnotherapy in Glasgow contact: Linda Alexander on 07875 493 358 and 0141 632 1440