Behavioral Alternatives

AWE! A TASTE WON'T HURT!

My counseling career began 20 plus years ago in a substance abuse treatment facility. I will never forget my first day! A drink was smuggled in to a person. The person had a “Slug”! He later left and  died! How tragic! Addiction is cunning , baffling and powerful. I’ve seen many deaths both by accidents and suicides because of taking that first slug.

There is a part  deep in the unconscious part of the brain that automatically makes the heart beat and drives other automatic behaviors such as addiction! This part of the unconscious stores feelings. Especially,  euphoric experiences and how one reached that state of euphoria. That memory is carved into the brain and never goes away.

One little taste or one little innocent  hit can remind the brain just how great it felt. The good feelings outweigh the bad so the brain does not automatically bring up the memories of puking in the gutter at 4am. Or, countless days of looking at oneself in the mirror asking why do I keep doing what I don’t want to do.

Yes! Just a slug does hurt!  A Slug or a hit can lead a person to a relapse where there may be no return! I have never met an addict who could honestly predict behavior once the decision was made to use! If you are in need of counseling for addictions please give me a call! Also please visit my Facebook fan page

jack lee psychotherapist

Letting Go of the Grip of PTSD

Training the Brain to Respond rather than React

in recovery from PTSD

PTSD is a reaction based disorder. Survivors and people with untreated PTSD have anchors of horror that could come up with a familiar smell in the air, a tome of someones voice, something they see, hear taste or touch.  During 4th of July fireworks combat veterans could have flashbacks as the sounds are similar to the battlefield. Just the sound of a firecracker could lead to a PTSD reaction. Core Mindfulness is just one way of many that can be used to retrain the brain to respond. Core mindfulness comes from Buddha’s Philosophy and  means totally experiencing the moment, utilizing the body’s 5 sensory pathways. These sensory pathways are sight, smell, hearing, touch and taste. Utilizing these pathways to totally experience the moment the moment helps lower anxiety and helps one train the brain to respond rather than react. People go all out to exercise their bodies but how many really make it a point to exercise their minds?

For many years while treating people with schizophrenia I taught core mindfulness as part of my group therapy. Surprisingly, many who practiced learned to tune out the voices they were hearing. The first step is, What leads up to the reaction of hearing voices? One popular technique many began to practice was utilizing the self talk: “Stop!” “This isn’t me!” This is my illness.” For a few this began to really work. Then those who really applied it were ready to take it a step further. What I taught them next was how the brain receives its information through their five senses. What one saw, felt, heard, or smelled sometimes could trigger a reaction. Interestingly, this small group really got into this as they were realizing and experiencing how their positive self-talk seemed to help. I then would take them for a walk to get into the moment. By totally focusing on the experience of what the rose smelled like, what the trees looked like, what the chirping of the birds sounded like, and what the lemonade tasted like, people with schizophrenia began to experience the voices quieting down. By focusing on the experience of the moment they were also slowly training their minds to new habits which could lead to tuning down the volume of the voices.  They continued to practice focusing on the wind against their chin and hearing the birds. Then they slowly began to experience how, when they would even talk to another person, the voices they heard in their heads would become softer and not as noticeable. By learning to turn down the voices, by practicing in the moment techniques, many began to stay out of the inpatient unit.

I had one case of a person who was on the list to go to the state hospital because of multiple inpatient episodes in one year. After time spent building a relationship, establishing trust and teaching the person to experience what happens to the voices while practicing positive self-talk and experiencing the moment, the person began to realize the voices weren’t as loud.  Today this person is no longer at risk for more intensive treatment. In fact, they have gone years now without an inpatient episode.

Practicing core mindfulness works! If practicing core mindfulness can work with the voices of schizophrenia, it can certainly work with the reactions of PTSD.  In fact, often the intrusive thoughts and intrusive images related to trauma are often misdiagnosed as psychosis.  The difference is that the intrusive thoughts of PTSD are more focused and related to trauma. Psychotic voices are part of a disorganized thought process and are more outside of the body like one would hear sounds through a set of headphones. Intrusive thoughts are inside one’s head.

PTSD is a reactive disorder. The brain uses the same senses to send and receive information as in core mindfulness training. In the transmission of information to the perception part of the brain, traumatic thoughts and memories emerge from the amygdala, the part of the brain where they are permanently stored. This process is also connected to one’s fight or flight response and one’s sense of perception.  When a dog sees fire, the dog runs away. The dog smelled the smoke long before it saw or felt the heat of the fire. The same is true with humans. The transmission of information from the sensory system is about self protection. That self protection is heightened in a person with PTSD.

One of the things I may do with a client is go for a walk in a safe secure place While walking I request the client to focus on the  feeling of one’s feet while taking each step. Total focus was in the moment, being aware of where one was walking, and emphasizing safety. I then asked the client, while walking, to inhale counting up to four steps, then hold their breath for four steps, then exhale slowly for the next 8 steps and do this for a cycle of ten. I would then ask the client to sit and feel the warm sun, feel the breeze flow against their face, or hear any noises as there are often birds. I would I then ask them to focus on the moment by experiencing what the wooden bench felt like, to smell the smell of the air, and to look at the trees. I asked them to focus on the experience of the moment and to maintain this for 3 minutes. Even three minutes for a person with PTSD could be very difficult to accomplish. The goal would be to find a starting point. If one could completely focus for 2 or 3 minutes then with practice the next week the person may be able to focus for 4-5 minutes. By practicing core mindfulness skills, one is exercising the mind’s ability to focus and training the mind to respond. Often with PTSD one habitually reacts to similar events. By practicing, the reactions decrease and the ability to respond increases.

Teaching people to practice a combination of breathing exercises and core mindfulness helps people practice a new behavior of being more in control of the way their brain habitually reacts to similar events. The more core mindfulness is practiced, the more the brain will be trained to cope with what was once a debilitating reaction.  Core mindfulness helps teache the brain how to respond to information received by the sensory system of touch, vision, hearing, taste and smell.

Some describe PTSD as a time bomb encased with bricks! A similar smell or similar sound can set it off. People with PTSD often don’t understand the “Why” behind the time bomb! By practicing breathing exercises, self hypnosis and core mindfulness behaviors, the brain is learning more positive habits to deal with stressors. A person can actually teach himself or herself to form a new habits of responding to familiar stressors. The more these new behaviors are practiced the more reprogrammed the brain becomes to respond rather than to react.

Copyright 1/28/10

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Loosening the Grip of PTSD: Normal Human Reactions in Response to a Horrific Event

My heart goes out to the people in Haiti and to their loved ones here in America. I practice in South Florida and have been called upon to provide critical incident stress debriefing to people who have been affected by the earthquake. I’ve spoken with people who were there and now back here, people who do not know the status of their loved ones, and people who have lost multiple family members.

Just like I remember what I was doing when President Kennedy was assassinated or what I was doing when other disasters hit, I will always remember what I was doing when I received my first call last Wednesday afternoon. The terror in people’s eyes! Not wanting to believe what just happened! Not knowing if…..! Not being able to call…! Calling cell phones and not hearing the ring or voice mail! Terror! Absolute Terror!

I am sharing this experience because I need to provide more information on what to expect when trauma strikes!  It is normal to have a reaction to tragedy or trauma. Trauma can happen to anyone. Normal everyday people have normal reactions to trauma! Accepting that it is OK to experience this kind of shock is very, very hard.  It is very important for people to have an understanding of some of the normal reactions to really bad events which normal people experience.

Sometimes these reactions happen right away and sometimes they might happen a few days later. Less than 24 hours after the earthquake, what I saw from victims was shock, desperation, wanting answers and wishing we could wake up from a really bad nightmare. Not only do people have reactions to the event but also events like this can bring up other memories of “Trauma” from years ago. For example, someone can have a nightmare two days later of another horrible event.

People try their best to deal with the emotional part of trauma on their own. However, sometimes the “Normal reactions” are just too much to bear. It doesn’t mean you are going crazy or becoming mentally ill! It just means there is help out there to assist with the normal recovery process. It is especially important to seek help to prevent later issues like Post traumatic stress disorder or severe depression.

The following are normal reactions to Traumatic Events.

Many people experience Physical, Cognitive or Thinking, Emotional, Behavioral and Spiritual reactions. Physical reactions may include extreme tiredness, nausea, fainting, vomiting, chest pain, high blood pressure, difficulty breathing and heart attacks.

Cognitive or thinking reactions include not being able to think, not being able to make a decision, nightmares, memory loss, becoming fearful, feeling lost, forgetfulness. Many confuse some reactions to psychosis. Some people may experience seeing things or loud intrusive thoughts. Seeing things and voices are part of psychosis. However, when the thoughts or hallucinations are trauma related it becomes a very treatable issue. This is why it is so important to know this is a reaction. If you experience these frightening reactions say to yourself, “Stop!” This is a reaction!” I can get help and I will be OK! “This will pass!” Again, there is a big difference between psychotic voices and hallucinations and intrusive thoughts or images that are trauma related.

Emotional reactions include guilt, depression, anger, NS fear. Don’t feel bad if you need to scream out or cry! It is OK. Express your feelings. If you feel you will lose control, talk to a friend or reach out to a professional. Constantly remember, “What I am experiencing are normal reactions to a horrible event.”

Behavioral reactions include: not being able to sleep, inability to sit still, getting into “If I woulda,  coulda, shoulda things would have been different,” giving up or neglecting personal hygiene, not wanting to go to work, avoiding people, places and things. Often there is a huge tendency to drink alcohol or use street drugs to kill the pain or get some relief. However, drinking takes away judgment and often people take out their loss on others. Many domestic cases of violence are related to reactions from trauma and alcohol and drug use. You might find yourself taking out your anger on an innocent bystander. Again, if you are experiencing loss of control or uncontrollable anger, get help!d

Often people could feel suicidal or homicidal. Feeling “I wish I could just die” is a normal symptom of depression and sometimes a normal reaction to trauma! Are you experiencing these kinds of thoughts? Then stop what you are doing and get help. Right now!

Other less severe behavioral reactions include feeling paralyzed like you can’t move! Often there is a big tendency to stay away from people! This is the time when people need to be around others. Helping others is a great way to distract yourself from the tragedy. This is the time to be a friend for somebody who needs a friend.

Spiritual reactions include anger at God, asking yourself “If there is a God, how could this happen!”  Another spiritual reaction is stopping your normal religious practice.

It is important not to suppress your feelings. This is not the time to pretend everything is OK. Don’t say things like “I am OK!” “I can handle it!” Trauma is huge! Please give yourself permission to get the emotional help you need to recover!

If you don’t feel eating, make yourself eat! Drink plenty of water! Take vitamins! Force yourself to eat a nutritious balanced diet, even if you don’t want to. Not wanting to eat is a normal reaction!

Go for a long walk. While walking, don’t go over the trauma in your head. During the first 4 steps, take in a slow deep breath. The next 4 steps hold your breath, and the next 8 steps exhale pulling your navel towards your spine. Do this cycle of breathing for 8 times. And, practice it at least 8 times per day. If traumatic thoughts come into your mind, refocus on your breathing.

Many  people find getting back to work is helpful. While working, if your thoughts become distracted on the trauma, refocus on your work. Ever see the movie “Karate Kid?” “Wax on. Wax off.” The character concentrated on applying the wax and removing the wax. He became totally focused.

Some people find journaling or writing is good to stop recurring thoughts. If you can’t get to sleep because you keep going over and over the trauma, write it down and tell yourself,  “I have it written down; I can go back to it in the morning. I don’t have to do it now.”

One thing I feel is the most important thing to do for yourself. If you love someone, call them up right now and tell them you love them!

Remember, everything I wrote about is a possible normal reaction to trauma. It is important to experience the reactions and not to suppress them. Stuffing the feelings is what could later turn into problems like PTSD. Give yourself permission to seek help. Work through the different stages of grief.  What do you tell someone who lost many family members? What do you tell someone who actually saw the devastation? Answer? Listen to them and provide an open ear and an open heart. What happened in Haiti could happen anywhere, which is why I wrote, “If there is someone you love, Call them up Right Now and tell them you Love Them!