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Although they might look like the wrong decisions to onlookers, they make crystal clear sense to the person living with trauma.

Why Do We Make Trauma Driven Decisions?

Trauma impacts all parts of a person’s life. It influences their emotions, their brain, and, unsurprisingly, their decisions. Those struggling with conditions such as post-traumatic stress disorder (PTSD) or complex PTSD (C-PTSD) often find their decision-making alters after experiencing or witnessing a traumatic event. This is because people make decisions based on emotion rather than logic.

Research has shown that those who experience childhood trauma may encounter moral decision-making in adulthood. Here, decisions typically tend to be more utilitarian than others.^[1] These findings also speculate that this utilitarian style may be associated with protection, with the person attempting to shield themselves from unnecessary emotional harm.

Those who experience trauma can have trouble regulating emotions, such as anger, sadness, anxiety, and shame.^[2] This is known as emotional dysregulation. Emotional dysregulation affects how people dealing with trauma make decisions. For example, some individuals can struggle with feeling too much or feeling numb. In turn, they use drugs or alcohol in an attempt to curb these feelings. They may also participate in other unhealthy behaviours, such as gambling or overworking.

This dysregulation stems from the changes that trauma creates in the brain. Here, the amygdala, which is the part of the brain responsible for sending warning alerts to our body, sends us a message whenever it feels like we may be in danger. However, for those living with trauma, the amygdala can’t recognise the difference between a past threat and a current threat.^[3] If a person is triggered, the amygdala responds as if experiencing the actual traumatic event for the first time.

Unfortunately, this has a significant impact on decision-making. Upon experiencing a trigger, an individual may make unwise decisions to escape the situation. These can include some of the following responses:

• Fight – Struggling or lashing out to escape a scenario which they perceive as dangerous.
• Flight – Running or hiding to get away from a situation.
• Flop – Doing what you are told without protest to get through a problem.
• Fawn – Attempting to please someone who is harming you.
• Freeze – Being unable to move or do anything.

Trauma-driven decisions can include any of these actions. For instance, a flight response to a trigger may suddenly cause someone to quit their job or break up with their partner. In contrast, someone in an unhealthy relationship might flop and stay with the other person, as their trauma drives them to attempt to get through the situation.

Avoiding Trauma-Driven Decisions

Breaking the habit of making trauma-driven decisions can be challenging. However, doing so benefits many. Once an individual can step back and look at a situation without reacting instinctively, they will be able to make the best decisions for themselves and their well-being.

To avoid trauma-driven decisions, doing the following may help.

• Recognise your triggers – Knowing your triggers can help you avoid them or plan for them in the future. In turn, this can help you when you’re trying to make decisions. Particular dates or certain places may see you encounter pessimistic emotions. For this very reason, it may be best to try and avoid them when trying to make important decisions.
• Talk to someone – Trauma can make it challenging to open up to others, but you don’t have to discuss your trauma to secure help when it comes to making a decision. You can talk to a trusted loved one or a professional about a decision that you want to make.
• Forgive yourself – If you have made a trauma-driven decision in the past that you deeply regret, know that you deserve to forgive yourself. Mistakes happen – it’s what you do moving forwards that counts.
• Keep a journal – A journal is a great space to scribble down your thoughts and feelings to help you process them and aid in your decision-making. If you’re faced with a decision that has a deadline, try writing down everything that comes to mind about it for a set amount of time. From here, take the time to read over your notes later to process them better.
• Give yourself time – When it comes to making significant decisions, give yourself plenty of time to think, feel, and process so that you can make the best choice. Try not to put yourself on a deadline. Doing so may put pressure on yourself that could result in making a wrong decision. You can even give yourself time for small decisions. For example, read the menu ahead of time, or wait to place that online order.

Conclusion

Preventing trauma-driven decisions is not an easy process. However, by choosing to actively work on how you make decisions, you can teach yourself the best ways to manage your triggers and make good decisions that work for you.

If you have a client or know of someone struggling to heal from vicarious trauma, reach out to us at Khiron Clinics. We believe that we can improve therapeutic outcomes and avoid misdiagnosis by providing an effective residential program and outpatient therapies addressing underlying psychological trauma. Allow us to help you find the path to realistic, long-lasting recovery. For more information, call us today. UK: 020 3811 2575 (24 hours). USA: (866) 801 6184 (24 hours).

Sources:

^[1] Larsen, Emmett M. et al. “Effects Of Childhood Trauma On Adult Moral Decision-Making: Clinical Correlates And Insights From Bipolar Disorder”. Journal Of Affective Disorders, vol 244, 2019, pp. 180-186. Elsevier BV, doi:10.1016/j.jad.2018.10.002. Accessed 8 Nov 2021.

^[2] (US), Center. “Understanding The Impact Of Trauma”. Ncbi.Nlm.Nih.Gov, 2021, https://www.ncbi.nlm.nih.gov/books/NBK207191/.

^[3] Zotev, Vadim et al. “Real-Time Fmri Neurofeedback Training Of The Amygdala Activity With Simultaneous EEG In Veterans With Combat-Related PTSD”. Neuroimage: Clinical, vol 19, 2018, pp. 106-121. Elsevier BV, doi:10.1016/j.nicl.2018.04.010. Accessed 8 Nov 2021.

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Numerous studies have demonstrated that our social relationships have short-term and long-term health effects. These effects initiate in childhood and create the positive or negative interactions and relationships we have throughout life.^[1]

The group offers safety and protection from threats, whether it be the predators that our ancient ancestors faced or the varying adversities of our modern-day lives. We learn, grow, work, and contribute to our communities. And in turn, the communities and wider society that we are a part of shape our personalities and identities.

What are Social Relationships?

We have a wide-ranging terminology for the varying types of relationships we create and join during our lifetimes. Each of these relationships affects health, overall well-being, and our perception of the world around us. The key types are as follows: ^[2]

• Social isolation – refers to the absence of relationships. Research shows that social isolation has detrimental effects on mental health and can carry a similar level of risk for mortality as smoking, obesity, and high blood pressure.
• Social integration – refers to the overall level of involvement with a variety of social relationships such as having a spouse or being part of a religious institution, a sports club, or volunteering activities. These relationships improve the ability to interact on a wide level and give a person a sense of purpose.
• Quality of relationships – refers to the emotional aspect of relationships, whether positive or negative, e.g. emotional support provided by loved ones or strained relationships with co-workers. Having a high level of quality relationships has been proven to reduce stress and increase confidence and self-esteem.
• Social networks – refers to the interplay of an individual’s relationships. The type, variety, quality, and strength of each relationship combine to form a positive or negative relationship web.

Social Development During Childhood

Social interactions are one of the earliest developmental stages of a child. A baby will develop an attachment bond with its primary caregiver. Trauma specialist Benjamin Fry states, “A child’s physical, emotional, psychological, and cognitive development is greatly influenced by the quality of this relationship, as are all future relationships in the child’s life.” ^[3] The attachment type that is created acts to regulate the baby’s nervous systems. Threat response will be learnt through the relationship with their caregiver. The quality of this relationship affects the child’s ability to self-regulate their nervous system in response to threat.

A 20-year longitudinal study demonstrated that Kindergarten children who displayed a propensity to positive socialising and sharing were more likely to become healthier, well-balanced, driven adults.^[4] The children who lacked social skills or tended towards isolation were found to be more likely to develop negative behaviours such as substance abuse.

Relationships and Threat

Through our understanding of our evolution as social creatures and our knowledge of the autonomic nervous system, it is evidenced that a positive connection with others enforces a calm behavioural state. Dr Stephen Porges, author of The Polyvagal Theory^[5], proposes that social engagement enhances our sense of safety, causing physiological changes within the body, including reduced heart rate, steadier breathing, relaxed digestion, and a reduction in stress hormones.

The Vagus Nerve is the longest cranial nerve within the body and is central to Dr Porges’ theory. The nerve connects to many different areas of the body and carries messages quickly from the brain to the lungs, heart, and intestines, as well as regulating facial muscles and skin sensations.

Dr Porges’ theory explains how the Vagus Nerve is a key component in our response to threat as it is involved in the stimulation of our fight, flight, freeze response.  The fight, flight, freeze response is an automatic survival response to threat, perception of threat, and how we react to stress and recover from stress.

The way we perceive and react to threats is automatic and subconscious; however, we can recognise our triggers and seek out conditions that foster calm and enable personal growth. In social conditions where we feel safe, confident, and comfortable, our stress response is deactivated, encouraging our heart rate, and breathing to slow down. By surrounding ourselves with positive connections, we can encourage this sense of calm to radiate out in all areas of our lives, whether at home, in social groups, or at work.

If you have a client, or know of someone who is struggling to heal from psychological trauma, reach out to us at Khiron Clinics. We believe that we can improve therapeutic outcomes and avoid misdiagnosis by providing an effective residential program and out-patient therapies addressing underlying psychological trauma. Allow us to help you find the path to realistic, long-lasting recovery. For information, call us today. UK: 020 3811 2575 (24 hours). USA: (866) 801 6184 (24 hours).

[1] Umberson, Debra, and Jennifer Karas Montez. “Social Relationships And Health: A Flashpoint For Health Policy”. Journal Of Health And Social Behavior, vol 51, no. 1_suppl, 2010, pp. S54-S66. SAGE Publications, doi:10.1177/0022146510383501. Accessed 25 May 2021.

[2] Umberson, Debra, and Jennifer Karas Montez. “Social Relationships And Health: A Flashpoint For Health Policy”. Journal Of Health And Social Behavior, vol 51, no. 1_suppl, 2010, pp. S54-S66. SAGE Publications, doi:10.1177/0022146510383501. Accessed 25 May 2021.

[3] Fry, Benjamin. “Attachment Theory”. Benjamin Fry, 2019, https://www.benjaminfry.co.uk/post/24-attachment/.

[4] Jones, Damon E. et al. “Early Social-Emotional Functioning And Public Health: The Relationship Between Kindergarten Social Competence And Future Wellness”. American Journal Of Public Health, vol 105, no. 11, 2015, pp. 2283-2290. American Public Health Association, doi:10.2105/ajph.2015.302630. Accessed 25 May 2021.

[5] Porges, Stephen W. “The Polyvagal Theory: New Insights Into Adaptive Reactions Of The Autonomic Nervous System”. Cleveland Clinic Journal Of Medicine, vol 76, no. 4 suppl 2, 2009, pp. S86-S90. Cleveland Clinic Journal Of Medicine, doi:10.3949/ccjm.76.s2.17. Accessed 26 May 2021.

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Psychologist William James and physiologist Carl Lange coined the term ‘Fight and Flight’ in the 1920s as an evolutionary survival mechanism.   It is the body’s automatic response to danger and consists of a series of physical changes designed to assist you in overcoming the threat in question.

Although only coined in the 1920s this is an ancient response to physical threat which would have been essential to our prehistoric ancestors as they faced numerous dangers over a short life span.

Our perception of threat is largely an emotional one and it is now understood that emotions occur as a result of physiological reactions to events. Emotions are a complex reactionary pattern involving experiential, physiological and behavioural elements. ^[1]

• Experiential – This refers to a stimulus or subjective experience, which triggers an emotion.
• Physiological – Our physiological response to threat is the result of the autonomic nervous system’s reaction to the emotion triggered by the stimulus.
• Behavioural – This is the actual response to, and expression of, the emotion.

The Fight and Flight response is an automatic response to danger, where strong emotion is invoked and the three elements above demonstrate how emotion is much greater than a mental state.

What is Fight & Flight?

Our prehistoric ancestors, and all mammals, have evolved to demonstrate the same automatic survival action of fight, flight and freeze.  Our bodies respond with one of the survival mechanisms depending on the threat in question:

• Fight – You respond with Fight if you feel confident you can face or defeat the danger.
• Flight – You respond with Flight if you cannot defeat the threat but feel you can run from it.
• Freeze – If you cannot defeat the threat, and additionally cannot run from it the body has a third response which causes us to freeze. ^[2]

In our daily lives this response is activated either when in the face of imminent danger, such as at the top of a skyscraper, or as a result of psychological threat, such as a presentation at work.

Numerous physiological changes occur during a Fight and Flight response. ^[3] In response to acute stress the central nucleus of the amygdala (the part of your brain involved in fear learning and the activation of fear) it sends signals to the hypothalamus which in turn stimulates the autonomic nervous system. ^[4]  This system has two parts, the sympathetic and parasympathetic.  The parasympathetic instigates the Freeze response and the sympathetic nervous system stimulates the Fight and Flight response.

The sympathetic nervous system triggers the release of catecholamines, including adrenaline and noradrenaline, through the stimulation of the adrenal glands. ^[5]

The following changes happen automatically and unconsciously:^[6]

• Lungs: In order for more oxygen to enter the blood your breathing rate increases, and airways dilate.
• Heart: For your oxygenated blood to reach your muscles quickly, to be used for energy, your heart beats faster.
• Ears: Your hearing becomes more acute.
• Eyes: Peripheral vision is heightened and your pupils dilate to help you see better.
• Brain: Mental activity increases to allow for quick decision making.
• Legs and arms: To help you run or fight sugar and fats are converted into energy and sent to major muscles.
• Skin and sweat glands: Blood supplies diverted to the brain and muscles can cause skin to sweat, become cold, pale and for goosebumps to form.
• Salivary glands: Your mouth becomes dry as salivary glands decrease function.
• Gut muscles: As blood supply is decreased to the gut in preference of the brain and muscles digestion is affected and becomes
• Liver and fat tissue: Glucose and fats are mobilised to fuel the muscles.

In a single situation a person may shift between Fight, Flight or Freeze spontaneously and the reaction depends on their subjective interpretation of the three emotional elements experience, physiology, and behaviour.

Although it is a physically uncomfortable response by priming your body for action, you are better prepared to survive, or perform under pressure.

When the Fight & Flight Response Becomes a Problem

The physiological reactions to the Fight and Flight response are often critical in surviving life-threatening situations.  However, individuals who have trauma disorders such as PTSD, major anxiety, panic disorder or acute stress may find that their nervous systems become over reactive to the presence of threat. The parasympathetic nervous system becomes dysregulated and will respond with an exaggerated, or inappropriate response to everyday situations which are incorrectly perceived as threatening.

The physiological arousal stimulated by the Fight and Flight response is draining on both body and mind and will result in acute emotional distress, a worsening of an individuals mental health, or even chronic physical ailments due to the toll stress takes on the body.

Coping with Fight and Flight

Understanding the body’s natural fight-or-flight response is the first step in healing from an overreactive stress response. Self-compassion is essential whilst gaining clarity over an individual’s personal life history and corresponding factors that cause Fight and Flight to be triggered.

The Fight and Flight response has been proven to be reduced with medications that alleviate anxiety. ^[7]  However, medication is not a guaranteed fix, and a combined therapeutic approach is the best way forward.  Somatic Experiencing Therapy^[8],  focuses on the mind and body as one entity. It is extremely helpful in alleviating symptoms in those who have a heightened Fight and Flight response as this response is a combination of mental and physical and should be addressed as such.

Somatic experiencing allows people to explore traumatic events with awareness as to how the threat perception is played out in the body. This connects the mind and body whilst uncovering perceived fears, renegotiating reactions, and aiming to replace the stress with self-compassion and calm.

The stress response is a major topic within the growing field of health psychology. Through continued understanding of the fight-or-flight response, psychologists can help people live more productive, healthier, happier lives.

If you have a client, or know of someone who is struggling to heal from psychological trauma, reach out to us at Khiron Clinics. We believe that we can improve therapeutic outcomes and avoid misdiagnosis by providing an effective residential program and out-patient therapies addressing underlying psychological trauma. Allow us to help you find the path to realistic, long-lasting recovery. For information, call us today. UK: 020 3811 2575 (24 hours). USA: (866) 801 6184 (24 hours).

[1] “The Science Of Emotion: Exploring The Basics Of Emotional Psychology | UWA Online”. UWA Online, 2019, https://online.uwa.edu/news/emotional-psychology/.

[2] Schmidt, Norman B. et al. “Exploring Human Freeze Responses To A Threat Stressor”. Journal Of Behavior Therapy And Experimental Psychiatry, vol 39, no. 3, 2008, pp. 292-304. Elsevier BV, doi:10.1016/j.jbtep.2007.08.002. Accessed 12 May 2021.

[3] Hagenaars, Muriel A. et al. “Updating Freeze: Aligning Animal And Human Research”. Neuroscience & Biobehavioral Reviews, vol 47, 2014, pp. 165-176. Elsevier BV, doi:10.1016/j.neubiorev.2014.07.021. Accessed 12 May 2021.

[4] Robertson, David, and I Biaggioni. Primer On The Autonomic Nervous System. Elsevier/AP, 2012. Robertson, David, and I Biaggioni. Primer On The Autonomic Nervous System. Elsevier/AP, 2012.

[5] Heckman, William. “How The Fight and Flight Response Works – The American Institute Of Stress”. The American Institute Of Stress, 2021, https://www.stress.org/how-the-fight-or-flight-response-works.

[6] “What Is ‘Fight, Flight Or Freeze’?”. North West Boroughs Healthcare, 2021, https://www.nwbh.nhs.uk/healthandwellbeing/Pages/Fight-or-Flight.aspx.

[7] Milosevic, Irena. “Fight-or-flight response.” Phobias: The Psychology of Irrational Fear: The Psychology of Irrational Fear 196 (2015): 179

[8] Brom, Danny et al. “Somatic Experiencing For Posttraumatic Stress Disorder: A Randomized Controlled Outcome Study”. Journal Of Traumatic Stress, vol 30, no. 3, 2017, pp. 304-312. Wiley, doi:10.1002/jts.22189. Accessed 12 May 2021.

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Why do we feel overwhelmed?

Overwhelming feelings arise when a person feels that life stressors are too much to manage by themselves. Overwhelm is more than just stress. Many of us can face stress and eventually return to normal. This ‘returning to normal’ can be difficult for some trauma survivors as our ability to effectively manage stress has been compromised by our past experiences.^[1]

To be emotionally overwhelmed is to feel as though one is submerged or drowning in their own thoughts and emotions to a degree at which all sense of agency is lost and the person is psychologically paralysed or ‘frozen’.^[2]

Overwhelm can happen for a variety of reasons and what might cause overwhelm in one moment may not cause it in another. It can occur in short bursts, or it can persist for much longer depending on the individual, their relative ability to manage stress, and the occurrence of other stressors in close succession. Common factors that can contribute to feeling emotionally overwhelmed include^[3]:

• Persistent work stress and burnout
• Loss of a loved one
• Relationship problems
• Poor physical or mental health
• Improper nutrition
• Financial insecurity
• Time pressure
• Personal traumas such as abuse or neglect
• Poor sleep hygiene

The Biology of Emotional Overwhelm

Emotional overwhelm can take many forms. Negative emotions are more likely to come up when we feel overwhelmed, such as anger, fear, and anxiety. For many, describing the experience can be difficult due to its overwhelming nature.

Overwhelming negative emotions strongly impact our physiology due to the release of the stress hormone cortisol.^[4] As we begin to feel overwhelmed, cortisol is released and surges throughout the body. The surge of cortisol leaves us overloaded with anxiety and it can feel there is no outlet, so it is kept, frozen, in the body. As more cortisol is released and anxiety builds, our serotonin stores begin to deplete.^[5] Serotonin is one of the main chemicals involved in alleviating and preventing feelings of depression and anxiety.^[6] As a result of increased cortisol and depleted serotonin, we are subject to feelings of hopelessness and despair, which perpetuate the overwhelm.

The experience of overwhelm is distressing and deeply uncomfortable. It often manifests as maladaptive anger, increased irritability, and seemingly endless worry. The experience can manifest physically as lashing out, crying, or through panic attacks. These behaviours happen in tandem with an increased heartbeat, difficulty breathing, and even muscle tension and chest pain.

Tools for dealing with Emotional Overwhelm

Frequent emotional overwhelm is a sign of unresolved trauma.^[7] Trauma can be treated and managed with the aid of professional help, but there are some basic tools and techniques you can use outside of therapy, many of which can be learned and developed within therapy sessions. Whatever the reason for your feelings of overwhelm, consider the following tips to help you cope.

Acceptance

Anyone who has experienced emotional overwhelm or panic knows that resistance to the feeling does not help, and can in fact worsen the experience. It is important for those suffering to remember that anxiety is a normal, natural experience. Acceptance is a tool we can use to allow ourselves to experience whatever comes up without too much harsh judgment or shame.

Unfortunately, some of us believe that crying is a sign of weakness. However, it is important to accept that crying is just as normal as laughter and need not be met with judgment or perceived as weakness, and is even considered to be an effective self-soothing behaviour.^[8]

Challenge your Thoughts

Overwhelm and anxiety are fueled by further worry and rumination. If you feel able, challenge your maladaptive thoughts and judgments to prevent your thoughts from fueling the fire of your experience. Ask yourself if the thoughts you are having are in any way reasonable or helpful. Again, if you feel able, try to replace some of your negative thoughts with more positive ones, such as thoughts of gratitude and self-acceptance. This is by no means easy in the throes of overwhelm, but it is possible and can make a significant difference to your outcomes.

Use Deep, Diaphragmatic Breathing

Consciously taking in deep, full breaths signals to the nervous system that you are not in danger. Overwhelm and anxiety relate to activation of the sympathetic nervous system^[9] (SNS), and relaxation and feelings of safety and social engagement are associated with activation of the parasympathetic nervous system^[10] (PNS). Deep breathing encourages activation of the PNS and reduces SNS activity^[11], so it helps you return to a state of calm relaxation. Mindful exercises like yoga and Tai Chi can encourage one to develop conscious, deep breathing techniques.

Gather Resources

Developing skills for relaxation, such as mindfulness and meditation practices, can go a long way in helping the mind and body come out of overwhelm and return to a place of calm. Other than these tools, it helps to educate oneself about the nature of anxiety, panic, and how the nervous system functions. Peter Levine’s Waking the Tiger, Bessel Van der Kolk’s The Body Keeps the Score, and Benjamin Fry’s The Invisible Lion are all excellent resources for learning about the nervous system and how it is affected in both the short and long term by traumatic experiences.

The Benefits of Therapy for Emotional Overwhelm

While at times we may be able to manage stress, there are other times when doing so seems impossible. It is normal to feel overwhelmed from time to time, but if you believe that you are feeling overwhelmed too frequently, then speak to a mental health professional.

Therapy can be of significant help in identifying stressors and addressing how we react and respond. With the support and guidance of a trained professional therapist, we can better process our issues and gain insight into their root causes. Understanding what is happening in the mind and body sets up for a calmer, more compassionate frame of mind later when feelings of overwhelm begin to come up.

When seeking therapy, the approach taken should incorporate effective modalities such as meditation, exploration of the mind-body connection, and grounding techniques. With a combination of learned coping and self-management techniques and professional therapy, we give ourselves the best chance of preventing or minimising the experience of overwhelm and living a life less impacted by an inability to tolerate distress.

If you have a client, or know of someone who is struggling to heal from psychological trauma, reach out to us at Khiron Clinics. We believe that we can improve therapeutic outcomes and avoid misdiagnosis by providing an effective residential program and out-patient therapies addressing underlying psychological trauma. Allow us to help you find the path to realistic, long-lasting recovery. For information, call us today. UK: 020 3811 2575 (24 hours). USA: (866) 801 6184 (24 hours).

^[1] Marshall-Berenz, Erin C et al. “Multimethod study of distress tolerance and PTSD symptom severity in a trauma-exposed community sample.” Journal of traumatic stress vol. 23,5 (2010): 623-30. doi:10.1002/jts.20568

^[2] Riskind, John H et al. “Dysfunctional Freezing Responses to Approaching Stimuli in Persons with a Looming Cognitive Style for Physical Threats.” Frontiers in psychology vol. 7 521. 19 Apr. 2016, doi:10.3389/fpsyg.2016.00521

^[3] “Warning Signs And Risk Factors For Emotional Distress”. Samhsa.Gov, https://www.samhsa.gov/disaster-distress-helpline/warning-signs-risk-factors. Accessed 26 Nov 2020.

^[4] Yaribeygi, Habib et al. “The impact of stress on body function: A review.” EXCLI journal vol. 16 1057-1072. 21 Jul. 2017, doi:10.17179/excli2017-480

^[5] Tafet, G E et al. “Correlation between cortisol level and serotonin uptake in patients with chronic stress and depression.” Cognitive, affective & behavioral neuroscience vol. 1,4 (2001): 388-93. doi:10.3758/cabn.1.4.388

^[6] Cowen, Philip J, and Michael Browning. “What has serotonin to do with depression?.” World psychiatry : official journal of the World Psychiatric Association (WPA) vol. 14,2 (2015): 158-60. doi:10.1002/wps.20229

^[7] Center for Substance Abuse Treatment (US). Trauma-Informed Care in Behavioral Health Services. Rockville (MD): Substance Abuse and Mental Health Services Administration (US); 2014. (Treatment Improvement Protocol (TIP) Series, No. 57.) Chapter 3, Understanding the Impact of Trauma. Available from: https://www.ncbi.nlm.nih.gov/books/NBK207191/

^[8] Gračanin, Asmir et al. “Is crying a self-soothing behavior?.” Frontiers in psychology vol. 5 502. 28 May. 2014, doi:10.3389/fpsyg.2014.00502

^[9] Roth, Walton T et al. “Sympathetic activation in broadly defined generalized anxiety disorder.” Journal of psychiatric research vol. 42,3 (2008): 205-12. doi:10.1016/j.jpsychires.2006.12.003

^[10] de Looff, P C et al. “Associations of sympathetic and parasympathetic activity in job stress and burnout: A systematic review.” PloS one vol. 13,10 e0205741. 18 Oct. 2018, doi:10.1371/journal.pone.0205741

^[11] Gerritsen, Roderik J S, and Guido P H Band. “Breath of Life: The Respiratory Vagal Stimulation Model of Contemplative Activity.” Frontiers in human neuroscience vol. 12 397. 9 Oct. 2018, doi:10.3389/fnhum.2018.00397

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At Khiron we believe that treating trauma at its root with a bespoke combination of therapeutic modalities yields the best results for our clients. Whilst we know that trauma can have a lasting physical impact on survivors, we also acknowledge that no two trauma survivors are the same. This is why we tailor our program of trauma treatment to suit each individual client’s needs; for many of them psychoeducation proves to be a very effective way of doing this.

Characteristics of Trauma and Stress

A key characteristic of stressful and traumatic situations is a sense of unpredictability and a lack of control. Psychoeducation reduces these feelings by making clients aware of why a certain stress response may be happening, and equips them with the tools to reduce the intensity or severity of their response.

‘The ability to understand and influence one’s own responses can reduce the immediate negative impact of a highly stressful situation,’^[1] says Bethany J. Phoenix, Associate Health Sciences Professor and Program Director for the Psychiatric/Mental Health Nursing Graduate Program at the University of California, San Francisco. ‘Understanding the reasons for stress responses can also help to minimize inappropriate self-criticism and damage to self-esteem’.^[2]

Self-criticism and low self-esteem are highly damaging to our mental health, especially to the health of those who have experienced the lasting impact of trauma. Very often, our threat responses and long-term symptoms are met with shame, mostly from ourselves. Psychoeducation is a way of lifting the shame of our responses to trauma, as it serves to assure clients that their traumatic experiences and memories do not have to define them as a person. With an understanding of how the natural threat response works, in terms of the autonomic nervous system, the amygdala, and the fight/flight/freeze response, clients can come to realise that their reactions and responses were and are natural, and need not be met with shame.

‘An abnormal reaction to an abnormal situation is normal behaviour.’^[3]

                                                                                             – Bethany J. Phoenix

Understanding Psychological Phenomena

Psychoeducation also makes room within for self-compassion. For those whose symptoms persist and have a significant impact on their well-being, psychoeducation can make a positive difference. Clients may be educated on the ‘physiological basis for psychological phenomena’^[4], which may include:

• Flashbacks
• Mood swings
• Poor memory and concentration
• Depression
• Anxiety
• Dissociation

If a client can be guided towards an understanding of these phenomena as symptoms of a response that was, in context, adaptive and ensuring of survival, and not as indicators of personal failure, there is room to show oneself more compassion and help people feel less ‘crazy’.

Other than educating clients on the reasons for their particular responses and symptoms, psychoeducation also serves to shed light on the therapeutic process. Clients can be prepared for trauma-specific treatment by becoming educated on relevant treatment modalities and the rationale behind using them.^[5] A client educated on how coping behaviours such as avoidance can exacerbate and perpetuate symptoms may be more motivated to engage with and commit to a certain type of treatment, with an understanding that some time is needed for the healing process to take place. With unrealistic expectations about the goals and potential results of a treatment, some symptoms may become exacerbated.^[6]

Unhealthy vs. Healthy Coping Behaviours

Psychoeducation promotes resilience in clients and reduces the need to engage in unhealthy coping behaviours like substance abuse or avoidance, and instead provides healthier alternatives, such as the seeking of social support and the practice of deep breathing and relaxation exercises.

Those who have experienced trauma often engage in unhealthy behaviours to deal with their pain and suffering, Such behaviours include substance use and abuse, avoidance of others, or social withdrawal and isolation, hyper-vigilance, anger and aggression, and high-risk, behaviour, such as driving under the influence or unprotected sex.

These coping mechanisms may serve to distract a traumatised individual from their uncomfortable or disturbing thoughts, feelings, and memories in the short term, but can have a lasting negative impact on one’s overall health in the long term. For this reason, psychoeducation is provided to help clients discover and utilise healthier coping behaviours and self-management techniques.

Psychoeducation for Healthcare Staff

 Psychoeducation is not just for survivors of trauma; it is also an important tool for healthcare staff to improve their understanding of trauma symptoms and responses. This ensures that care can be provided with minimal risk of client retraumatisation and vicarious trauma in staff. Staff educated on the potential risk of vicarious trauma can develop skills to maintain their own mental and emotional health, and can provide trauma-informed treatment for clients.

With proper psychoeducation, care staff can carry out more accurate assessments of client well-being and provide more appropriate interventions where necessary. Clients who have experienced persistent, long-term adverse effects of trauma may have been on more than one occasion labelled with diagnoses that only look at surface behaviours, and don’t take into account ‘underlying pathological processes’^[7] Informed staff can provide appropriate care when they recognise the deeper, root causes of feelings and behaviours and how they manifest in trauma survivors.

Psychoeducation for Personal Empowerment

‘By assisting survivors to develop compassionate self-understanding and emotional self mastery, we can help to make the unbearable bearable.’ ^[8]

Trauma survivors can be empowered by psychoeducation. It acts as a means of validating one’s experiences, offering explanations as to why an individual might have behaved a certain way in a given situation. The coping skills and self-management techniques learned through psychoeducation can return some autonomy to trauma survivors, allowing them to live a life significantly less inhibited by their traumatic feelings and memories than would be possible without psychoeducation.

There is also a  wealth of information available online and in print about psychoeducation and the impact of trauma on individuals. Trauma and Recovery^[9], written by Judith Herman and published in 1992, is one source of valuable information on the subject of trauma and its impact. The book provides an overview of the variety of ways in which a person can be impacted by trauma. Glenn Schiraldi’s The Post Traumatic Stress Disorder Sourcebook: A Guide to Healing, Recovery, and Growth^[10] is another example of literature that provides useful, applicable information for those  looking to educate themselves on trauma, covering available treatment and techniques for self-management. Benjamin Fry’s The Invisible Lion^[11] is a source of clearly outlined and accessible information regarding the nervous system and out responses to threat, and includes a workbook section for readers to apply the knowledge gained from the main body of the book.

Get in touch

If you have a client, or know of someone who is struggling to heal from psychological trauma and could benefit from Psychoeducation, reach out to us at Khiron Clinics. We believe that we can improve therapeutic outcomes and avoid misdiagnosis by providing an effective residential program and out-patient therapies addressing underlying psychological trauma. Allow us to help you find the path to realistic, long lasting recovery. For information, call us today. UK: 020 3811 2575 (24 hours). USA: (866) 801 6184 (24 hours).

Sources

^[1] Phoenix, B.J. (2007), Psychoeducation for Survivors of Trauma. Perspectives in Psychiatric Care, 43: 123-131. doi:10.1111/j.1744-6163.2007.00121.x

^[2] Phoenix, B.J. (2007), Psychoeducation for Survivors of Trauma. Perspectives in Psychiatric Care, 43: 123-131. doi:10.1111/j.1744-6163.2007.00121.x

^[3] Frankl, Viktor E. Man’s Search For Meaning. Boston : Beacon Press, 2006.

^[4] Phoenix, B.J. (2007), Psychoeducation for Survivors of Trauma. Perspectives in Psychiatric Care, 43: 123-131. doi:10.1111/j.1744-6163.2007.00121.x

^[5] Phoenix, B.J. (2007), Psychoeducation for Survivors of Trauma. Perspectives in Psychiatric Care, 43: 123-131. doi:10.1111/j.1744-6163.2007.00121.x

^[6] Allen, J. G. (2001). Traumatic relationships and serious mental disorder. Chichester, UK: John Wiley & Sons.

^[7] Phoenix, B.J. (2007), Psychoeducation for Survivors of Trauma. Perspectives in Psychiatric Care, 43: 123-131. doi:10.1111/j.1744-6163.2007.00121.x

^[8] Phoenix, B.J. (2007), Psychoeducation for Survivors of Trauma. Perspectives in Psychiatric Care, 43: 123-131. doi:10.1111/j.1744-6163.2007.00121.x

^[9] Herman, J. (1992). Trauma and recovery. New York: Basic Books.

^[10] Schiraldi, G. R. (2000). The post-traumatic stress disorder sourcebook. New York: McGraw-Hill.

^[11] Fry, B., 2019. The Invisible Lion: Flatpack Instructions For Life. Independently Published.

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The state of boredom itself is often considered to be a negative experience, and many associate it with feelings of apathy and depression. When one experiences boredom, they are faced with nothingness, or the void, outlined by absurdist philosophers like Camus, who suggests that we seek pursuits and develop habits as a means of avoiding the realisation that we exist in an apparently meaningless universe.^[2] However, a general disinterest in one’s environment characterised by boredom isn’t inherently negative. Boredom can have a function, it can be a strong motivator for change, encouraging us to seek out activities that are satisfying or meaningful. The bored individual finds no satisfaction or meaning in their environment, but their emotional state in response suggests that satisfaction and meaning is to be found elsewhere.

For boredom to arise in the first place, an individual must be energised or psychologically aroused to some degree. The feeling of boredom then comes from having no satisfactory channel or output through which to expend that energy. A bored individual will experience a lack of engagement in what they’re doing and see no meaning or purpose for themselves in their circumstances.

Boredom can be a problematic state, in that if a person were able to take action against their boredom, they would. Being bored, then, implies a lack of control, or powerlessness over one’s environment. This sense of powerlessness can lead to feelings of irritation and frustration, even anger. Anger, left unexpressed, can become sadness, which could, over time, develop into depression. Feeling as though one has no control over their life or their environment can develop into the belief that one is helpless, unable to take any action to alleviate their negative feelings. Such a belief is a major contributing factor in the onset of depression, emphasising the problematic nature of boredom.

German researchers Thomas Goetz, Anne C. Frenzel, et. al,  conducted a study on boredom and identified five main types: Indifferent, Calibrating, Searching, Reactant, and Apathetic.^[3]

Indifferent Boredom

This type of boredom is associated with a low state of arousal, and minimal aversiveness, or positive valence, to one’s situation. A person experiencing indifferent boredom may at the same time feel relaxed and generally indifferent to their environment, with no strong desire to take action to change it.

Calibrating Boredom 

This type of boredom is characterised by a slightly higher, but still relatively low, state of arousal. There is some aversiveness, or negative valence. As the name suggests, an individual experiencing this type of boredom is attentive to potential means of reducing the feeling, but is not particularly active in changing their situation.

Searching Boredom

Unlike the previous types, searching boredom is associated with a higher state of arousal and greater negative valence. In this type of boredom, individuals tend to experience restlessness and are more active in the search for stimuli than the previous two types.

Reactant Boredom

This type of boredom constitutes the highest arousal and greatest level of negative valence. Participants in Goetz’s study reported feelings of restlessness and aggression associated with this type of boredom^[4], as well as significant and persistent focus on alternative situations. This type of boredom was reported to be highly unpleasant and was found to be a strong motivator in changing one’s current situation.

Apathetic Boredom

The fifth, unanticipated type of boredom was also discovered. This was labelled apathetic boredom and is characterised by a lack of both positive and negative affectation. Instead, an individual experiencing this type of boredom will be generally apathetic to their circumstances and present a seeming inability to be emotionally aroused.

Boredom as an Adaptive Function

Boredom can be considered to have an adaptive function. It has been suggested that boredom facilitates the pursuit of alternative goals when current goals are not fulfilling. As humans, we are inclined to seek meaning and purpose in our goals and pursuits^[5]. If an activity fails to engage us or produce a sense of meaning, boredom ensues, and motivates us to seek out new methods of achieving meaning or purpose.

Emotions are temporary; they tend to fade over time. If they did not, they would hold no significance and our lives would be stagnant, with no motivation for change or growth. Once an emotion has arisen and been fully experienced, boredom eventually ensues and acts a signal to move on, to seek out new goals and pursuits.^[6]

Sources:

^[1] Fisherl, C., 1993. Boredom at Work: A Neglected Concept. Human Relations, 46(3), pp.395-417.

^[2] Plato.stanford.edu. 2020. Albert Camus (Stanford Encyclopedia Of Philosophy). [online] Available at: <https://plato.stanford.edu/entries/camus/> [Accessed 18 May 2020].

^[3] Goetz, T., Frenzel, A., Hall, N., Nett, U., Pekrun, R. and Lipnevich, A., 2013. Types of boredom: An experience sampling approach. Motivation and Emotion, [online] 38(3), pp.401-419. Available at: <https://www.researchgate.net/publication/261214289_Types_of_boredom_An_experience_sampling_approach> [Accessed 18 May 2020].

^[4] ibid.

^[5] Barbalet, J., 1999. Boredom and social meaning. British Journal of Sociology, 50(4), pp.631-646.

^[6] Bench, S. and Lench, H., 2013. On the Function of Boredom. Behavioral Sciences, 3(3), pp.459-472.

The post What is Boredom, and is it Functional? appeared first on Khiron Clinics.

As individuals and families across the country begin to acclimatise to the newly imposed restrictions in response to the COVID-19 pandemic people are now seeking ways to cope with the significant and sudden change to routine and lifestyle.  The world is simultaneously in panic and mourning; attempting to deal with and manage the uncertainty of what the future has in store, alongside the grief for a way life we once had that we know we are unlikely to ever go back to, and the thousands that have died as a result of the virus. At moments like this it can feel difficult to show gratitude. However reminding yourself daily of what you are grateful for, can have untold benefits especially in times like these.

There are various ways to protect oneself from the psychological effects of the pandemic; namely attempts to take attention away from the never ending news reports on the virus and to maintain as much of a routine as possible. However, one thing that is believed to be effective in reducing psychological and physical strain, is to practice gratitude as a way to focus on positive emotions to best integrate what has been lost; in terms of freedom of movement, our careers, financial loss, disruption in our social life and interaction our friends and family, and in the worst cases, the lives of loved ones.

While these losses are real and it is important to feel free (to) and unashamed to express these feelings of loss, it is also important and necessary to remember what we do have, what has not been lost, but in fact being appreciated, understood and therefore strengthened.

Research confirms that gratitude effectively increases happiness and reduces depression. According to a 2012 study by the University of Kentucky, gratitude enhances empathy and reduces aggression. Participants of the study experienced more sensitivity and empathy toward other people and a decreased desire to seek revenge[1].

Did you also know that grateful people sleep better?

It can be difficult to know what to give gratitude for. But in all honesty, we can give our gratitude to anything we like; big or small. Below are several ideas about what we can be thankful for, at any point and even in times of crisis.

Gratitude for human compassion

The incredible generosity and kindness shown by individuals and organisations in this difficult, dark time is something to be grateful for. While we may have seen pictures of empty shelves and heard reports of panic buying and hoarding, the vast majority are condemning this behaviour and many more stories evidence many people going out of there way to help the elderly and vulnerable as they are forced into self-isolation to either avoid or contain the virus.

We were aware of the growing strain on social care and extreme loneliness elderly people faced as a result, but very rarely did many people act on it, until now. Those choosing to self-isolate who had busy social lives now have an enhanced understanding of how damaging this can be to emotional wellbeing and in response, the majority of the country are now taking action. Celebrities are donating large amounts of money such the South African billionaire Motsepe, who has pledged a donation of $57 million to fight the virus, or the 750000 British volunteers willing to support the NHS, alongside endless small random acts of kindness normal people are now offering to each other as a result of this crisis.

Gratitude for our friendships, relationships and family

As society became increasingly fragmented, image conscious and inward looking, it is a good time to remember how important it is to nurture our social connections, support networks and most importantly, public services. A new appreciation for workers in, what were previously believed to be, low skilled jobs are now being revered for their hard work and dedication to provide services to the public putting their own life at risk. Refuse workers won a campaign for full time sick pay for their staff, encouraging other key workers to demand recognition for the important role they play in society.

Gratitude for our infrastructure, health services and the promise of positive change

Gratitude can expand to the recognition of how incredibly unusual and nearly incomprehensible the crisis is. Many countries face lethal diseases without a fraction of the resources or support from government and public services, we are truly lucky to have governments that are able to afford to subsidise large percentages of wages and are continuing to work tirelessly to ensure people are not left without food or accommodation.

While we may be currently in the thick of the crisis, looking towards undoubtedly more weeks and even months of disruption to our routine, we are lucky to be assured that this is temporary and will come to an end eventually. Even though the pandemic may have lasting repercussions, we have the opportunity to learn valuable lessons. What and who are truly important, and to understand our value in society.

These things are worth considering, not only to protect our psychological wellbeing but also for the benefits that stress relief has on our physical health. Stress reduction has been proven to strengthen our immune systems and protect us from illnesses that typically occur as a result of burn-out and overworked nervous systems. Every night before we go to sleep and every morning we wake up, we could practice remembering at least three things that we are grateful for as an empowering orientation of our focus.

If you have a client, or know of someone who is struggling to find the right help for any form of mental health issue during this pandemic, reach out to us at Khiron Clinics. We believe that we can improve therapeutic outcomes and avoid misdiagnosis by providing an effective residential program and out-patient therapies addressing underlying psychological trauma. Allow us to help you find the path to realistic, long lasting recovery. For information, call us today. UK: 020 3811 2575 (24 hours). USA: (866) 801 6184 (24 hours)

[1] https://www.psychologytoday.com/us/blog/what-mentally-strong-people-dont-do/201504/7-scientifically-proven-benefits-gratitude (accessed 30/3/2020)

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History of General Adaptation Syndrome

The theory is an amalgamation of Cannon’s theory of homeostasis, Frank Hartmann’s general tissue hormone theory of the corticoids, Dustin’s observations on the caryoclastic poisons, the post operative disease the curative action of fever, foreign proteins and of other non-specific therapeutic agents, the nephrotoxic sera of Masugi and the Goldblatt clamp for the production of experimental renal hypertension.[2]

Selye wrote that at first these concepts had no relationship and there was no obvious reason why there should be; however after years of research he began to notice “bridges” between these concepts and began to develop theories to help improve the treatment of diseases.

Whats in the name?

Selye labelled this process general because it was produced only by agents which have a general effect upon large portions of the body, adaptive because it stimulated defence and, thereby, helped in the acquisition and maintenance of a state of inurement, and syndrome because its individual manifestations are coordinated and, even partly, dependent upon one another[3]

The process of General Adaptation Syndrome

Selye states that the process of GAS is specific and the same for every person, however the effects of GAS can vary, according to a plethora of external and internal factors in one’s life. The process Selye outlines is in three categories; the alarm reaction, the resistance stage and the exhaustion stage.

The alarm reaction

According to Selye, as a command is being considered and responses are preparing to be delivered, specific cells in the hypothalamus are being ‘alerted’ which causes a stimulation of the automatic nervous system (ANS) in the initial ‘shock’ phase. Following this, a general breakdown of resistance follows. The duration of this stage can be momentary, or up to 24 hours depending on the severity of the stressor, and the level of resistance the individual possesses.

A secondary shock phase can follow is the stressor is persistent or if the person it is affecting is vulnerable, or both. This phase is known as the ‘flight or flight’ response, whereby the sympathoadrenal medullary system is stimulated to release catecholamines, which is comprised of epinephrine and norepinephrine. Epinephrine causes increased lung capacity, pupil dilation, blood pressure, heard rate and perspiration amongst others, and norepinephrine causes sodium retention and potassium secretion. The release of catecholamines triggers corticortrophin and then adrenocorticotripic hormones which are carried through the vascular system, directly affecting the adrenal cortex and disrupts the regulation of hormones known as the corticoids. These hormones are responsible for maintaining healthy functioning in all parts of the body and when disrupted can cause a range of issues, including peptic ulcers and suppressed immune inflammatory reactions.

Resistance stage

This stage of GAS is characterised by a significant reduction in the alarm reaction, as a person develops a resistance against the stressor. Developmental, or homotropic adaptation to stressors can be identified as the tissues intensifies in order to surpass the stressor. The body will try and work at a higher rate while the adaptation process takes place, meanwhile heterotrophic adaptation involves readjustment and transformation of tissues in order to carry out further processes, which all aim to help the body survive, and coexist with the stressor

Exhaustion stage

If the body is not able to go back to its normal state, or homeostasis, or the stressor has been so overwhelming due to its severity or lack of resistance, the third stage of exhaustion follows. This stage can feel very similar to the primary alarm stage; endocrine activity is increased, cortisol levels significantly increase and circulate throughout the system which negatively impact on digestive, circulatory, immune systems, to name a few. At the exhaustion stage it is possible that permanent damage to the system as a result of continued disruption and impaired functioning as resistance levels are not able to keep up with the continued force of stressors.

GAS and Health Conditions

The general adaptation syndrome is believed to play a large part in why stress leads to such a wide, and far reaching range of health issues and conditions. Stress affects our body’s normal functions, disturbing the natural balance, or homeostasis, which is vital for healthy bodily functions. GAS is understood to reduce life expectancy, as the strain it puts on our body speeds up the aging process. In order to combat diseases and other health complications related to stress, it is important to practice stress relief and relaxation, in whichever form is preferred. Over time, if resistance to stress is worn away it leaves the body far more susceptible to what is known as the ‘exhaustion’ period, whereby inflammatory diseases are prevalent. Continuing to build resistance to stress and practicing coping strategies will help improve overall health and wellbeing, as well as preventing diseases[4]

If you have a client, or know of someone who is struggling to find the right help for any form of mental health issue, including stress, reach out to us at Khiron Clinics. We believe that we can improve therapeutic outcomes and avoid misdiagnosis by providing an effective residential program and out-patient therapies addressing underlying psychological trauma. Allow us to help you find the path to realistic, long lasting recovery. For information, call us today. UK: 020 3811 2575 (24 hours). USA: (866) 801 6184 (24 hours).

Sources

1. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2038162/?page=1 – accessed 11/01/2020
2. ibid.

3. Selye, H. (1976b). The stress of life (Rev. ed.).  New York, NY: McGraw-Hill

4. https://pdfs.semanticscholar.org/8bdd/71f8ffa51174d160fd67ef99139b243f6dce.pdf – accessed 11/01/2020

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