We’ve come a long way in our understanding of Post-Traumatic Stress Disorder (PTSD). From the early designation of “shell shock” for military veterans to transforming the label of “hysteria” to PTSD for survivors of rape, we know that trauma can have lasting physical and emotional effects on those who experience it. However, often we default to discussing only soldiers and victims of sexual violence when we talk about PTSD. These experiences are certainly among the leading causes, yet they aren’t the only type of trauma that result in PTSD. Let’s expand on how trauma of any kind changes us and how that impacts the way we think about PTSD. Looking at Big ‘T’ Trauma Trauma is generally categorised by what experts call big ‘T’ trauma or little ‘t’ trauma. Officially, PTSD diagnoses result after big ‘T’ trauma, events that anyone would consider extremely distressing. Combat and sexual violence certainly qualify, but so do major car accidents, plane crashes, and living through natural disasters. Following Hurricane Sandy in 2012, for example, a study that screened residents along the New Jersey coast found that 14.5 percent of adults were likely suffering from PTSD six months after the hurricane hit. Add to the list school shootings, terrorist attacks, residing in war zones; relational violence like domestic abuse, physical abuse, and emotional abuse; to the violence of incarceration and crime — PTSD-causing big ‘T’ trauma casts a wide net. Witnessing Trauma PTSD can also be caused by witnessing trauma happening to others or learning a loved one has experienced a traumatic event. According to a World Health Organisation survey of citizens in 21 countries, 10 percent of respondents reported witnessing violence (21.8 percent; the largest response in the survey) and trauma to a loved one (12.5 percent). Big ‘T’ Versus Little ‘t’ Trauma The causes above cover what the Diagnostic and Statistical Manual of Mental Health Disorders specifies in diagnosing PTSD: “Exposure to actual or threatened death, serious injury, or sexual violence” and witnessing “the event(s) as it occurred to others.” As researchers delve deeper into PTSD, they are finding that these qualifications may be limiting. We talked about big ‘T’ trauma, but there’s also that little ‘t’ trauma. Little ‘t’ traumas are classified as stressful events that happen to all of us at one point or another. Think more “personal” stressors, like job changes, messy breakups, unplanned major expenses, and the loss of a loved one. These instances, which seriously challenge our ability to cope, have traditionally been left out of the conversation about PTSD. “One of the most overlooked aspects of small ‘t’ traumas is their accumulated effect,” writes psychologist Elyssa Barbash in Psychology Today. “While one small ‘t’ trauma is unlikely to lead to significant distress, multiple compounded small ‘t’ traumas, particularly in a short span of time, are more likely to lead to an increase in distress and trouble with emotional functioning.” Expanding How We Approach PTSD Barbash stops short of saying that a collection of small ‘t’ traumas can cause PTSD but admits “it is possible that a person can develop some trauma response symptoms.” Psychotherapist Sara Staggs offers a similar perspective in her blog for Psych Central, pointing out that PTSD and stress reactions following trauma are tied not so much to the event itself but to the way our brain processes the information. “Then there is any other type of event which exceeds our capacity to cope, and can be stored as trauma,” Staggs said. “To some degree, it doesn’t matter what propels us into fight-flight-freeze mode, but only that the event was experienced and then stored that way.” How the Brain Stores Traumatic Memories We know that the brain stores traumatic memories differently than regular ones. These memories are so overwhelming our brain doesn’t process them completely the first time around. It can be described as the difference between putting your canned goods neatly away on the shelf versus shoving everything in a cabinet and slamming the door shut in a hurry. The latter is how the brain might handle traumatic information, which can lead to the tell-tale symptoms of PTSD: flashbacks and nightmares, isolation, dissociation, emotional detachment, heightened anxiety, and avoidance of trauma reminders, among other symptoms. What We Know About PTSD’s Development Additional research suggests there are many factors at play that determine who develops PTSD, since only an estimated 3.6 percent of the global population lives with PTSD in any given year. Not all of us who experience trauma will develop PTSD, even if we’ve lived through or witnessed the same exact experience. For example, we’re more susceptible when we’ve had a major trauma in the past. There may be a genetic predisposition to PTSD. Having limited social support following a stressful event also increases our risk for PTSD, as does experiencing multiple traumas at the same time. In time, how trauma is defined when diagnosing PTSD may change to incorporate a growing understanding of how we’re impacted by traumas large and small. Seeking Help for PTSD By expanding how we look at PTSD beyond just veterans and rape survivors, we can raise awareness that there are many traumatic experiences that can lead to PTSD. And when we do that, we reduce the stigma of reaching out for help when we need it. If you, or you know someone, who is struggling with PTSD of the after affects of a traumatic experience please do get in touch with us today. We are here to support you.
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Ping! A message arrives on your phone. And another Ping! Just in case you missed it the first time. You lift your eyes from your computer to the phone sitting beside you and pick it up. Oh, it’s the plumber confirming she can come next Thursday. You bring your eyes back to the computer and refocus on the article you’re reading. A pop up appears in the corner of your computer screen ‘New message received!’. You glance up at it, just a message to one of the discussion groups you belong to. Nothing urgent, although actually now perhaps you’ll just have a look at the whole email, it looks vaguely interesting and relevant to your work. Five minutes of email later, you’re back with the article. Now, what was it about again? Ah yes. Ping! It’s your phone again. This time it’s a notification from BBC Sky at Night, letting you know what articles you can expect to read if you go to their website. You’re not sure why you get notifications from them as you’re not really interested in space, but it’s not obvious how to stop them coming and you’ve been getting them for over a year. You turn your phone down, you really don’t need the pings. Back to the article. BUZZ!! Your phone is vibrating. It’s Candy Crush, telling you that they miss you and you haven’t played for a week. You swipe it away. Briiiing. It’s the oven timer. Dinner is ready. The 15 minutes you had to sit down and read have gone. You feel frazzled, divided – and you haven’t managed to concentrate on anything for longer than a few minutes. You’re not sure quite how, but somehow the time is never there. Sound familiar? We live in a world of constant interruptions. Our attention is pulled back and forth, with Pings and pop-ups for all messages, no matter how banal. Little red circles draw our attention to the fact that one of our Facebook friends has posted a photo of their lunch. Notifications on our phone welcome screen tell us that our distant relatives are playing games and want to play with us. And we’re told that this is all for us, that it’s in order to make our life easier and more connected. Perhaps particularly for those of us whose jobs involve helping other people, it’s all too easy to feel that we can never switch off. And now technology has evolved to the point to enable us to be always contactable, whether we are in the middle of a forest, on a train, or reading a bedtime story to our children. We are never, ever, free from the possibility of interruption – and that interruption could range from an urgent life-changing message, to the game Zombie Tsunami which regularly sends me messages claiming that ‘The Zombies Are Coming’. There’s a growing body of research which shows the impact on the human brain of this constant stream of interruptions. A recent study found that just having their own mobile phone visible on the table – even if they didn’t use it - affected the working memory and cognitive performance of research participants, as compared to those who left their phone in another room. We sign up for notifications, we may welcome them or think they are essential – but they prevent our brains from functioning at full capacity. Because we may imagine that we are multi-tasking, but in fact research shows that our brains are switching between tasks, and that this isn’t quick or easy. We know that each interruption disrupts our attention for far longer than the length of the interruption itself – some studies show that it takes 15-20 minutes to re-orientate ourselves after a brief interruption. The cost isn’t just to memory and cognitive performance. Being constantly interrupted is bad for our mental health too. The interruptions keep us in a state of hyper-alert, because when every little ping might be a life-changing opportunity or disaster you can never truly relax. It’s like being continuously poked – and that can leave us feeling jittery and stressed, even apparently when we have time off. Because you’re never ‘off’ from that possibility of a message arriving and needing immediate attention. It leads to heightened anxiety and poor sleep, as well as poor concentration and jumpiness. And the paradox that I’ve noticed with myself and people I work with is that the more anxious we feel, the more we attend to our notifications - ‘just in case’, and the less we feel like we could turn them off. Many of us have signed up for notifications without considering the negative impact on us; unsurprisingly since the apps and computer programmes themselves always focus on the positives. “Help us keep in touch’, they say. Or ‘Never miss out again!’. No one ever says ‘Sign up to be constantly interrupted!’ or ‘Give us permission to wake you up in the middle of the night!’. So we end up with a stream of notifications without ever having made the conscious decision that this is the way we want to live our lives. All is not lost – it’s possible to change your behaviour to give yourself some space again. But unlike getting into this, in order to take back control a conscious decision is definitely necessary. Here are four steps which I’ve found helpful with people I work with, to help them reclaim their mental space.
You’ve probably decided already that this isn’t realistic for you, that you need to be constantly available, and I just don’t understand how important your job is. And perhaps it is. Or perhaps that feeling itself is a symptom of your life of constant interruptions, and until you try something different you’ll never know. What’s stopping you from giving it a go? Dr Naomi Fisher Clinical & Chartered Psychologist and EMDR Consultant (EMDR-Europe) |
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