PTSD – Page 3 – Coming Back Home

Spouses want to know: “Where does the anger come from?”

Published on September 15, 2013July 11, 2022 by Dr. Dee Rajska, C. Psych6 Comments

I have a few more questions from spouses, and this is a really important one.

The answer is pretty straight forward: PTSD is basically the fight/flight/freeze reflex gone into overdrive, and anger is part of the “fight” part of that reflex. You might remember that we discussed anger in this post.

Well then… that would make for a really short blog post, wouldn’t it?

If you’re reading this, then anger has probably had an impact on your life. I’m going to talk about it in more detail below, and that might be hard to read.

So – don’t go any further if you’re having a bad day and don’t need to be reminded of how anger has made life worse. Save it for another day. Otherwise, find a nice quiet spot where you won’t be disturbed. Set aside time to do a relaxation exercise when you’re done reading this – here‘s one that I’ve posted previously. Here‘s another.

Gee, I’m being a little bossy today, aren’t I?

If you’re just waiting for me to tell you to go pee before you read on, don’t worry. I’ll restrain myself.

Ready?

Okay.

If you’re a spouse, then you need to know where the anger does NOT come from: it doesn’t come from you, or what you said, or because you’re making the wrong thing for dinner. It’s not coming from the kids playing too loudly. It isn’t your fault. It’s easy to lose your confidence and start to blame yourself.

It’s also easy to get frustrated and blame your spouse – the anger is not coming from him/her either.

Look – you didn’t marry an idiot. (Well – if you did, then, this blog can’t help you with that…)

But – if you didn’t marry an idiot, then your spouse didn’t just magically become an angry jackass overnight for the fun of getting under your skin. PTSD makes a person feel like they’re under attack all the time, and anger is part of the reflex of reacting to threat.

PTSD is an injury. Anger is one of the ways that this injury hurts. It hurts anyone who might be on the receiving end of that anger – spouse, kids, random clerk at the grocery store.

It hurts the person with PTSD; they don’t choose to act like this, and a moment after they say something hurtful, scream at someone, or put their fist through the wall – they feel terrible about it.

As the spouse, you feel caught between trying to understand that this is an injury, but also feeling frustrated and angry that they can’t just cut it out.

Understanding is the first tool in making things better: the person with PTSD needs to understand that their anger is coming from their PTSD, and not from anything you did. So the solution is to manage their anger, not manage you. And as the spouse, you also need to know that their anger is coming from their PTSD, and not from them being a jerk. So the solution is to help them manage their anger, and to take care of yourself, because this is a lot for you to deal with too.

How’re ya doing? I warned you – it got a little heavy. If you feel a bit like this post punched you in the gut today, please take a minute to look after yourself. You don’t even have to scroll back up to find the hyperlinks to the relaxation exercises – here‘s the woods. Here‘s the water.

I’d love to have you share your thoughts, comments, and questions. If you do post a comment, please don’t give specific details of your trauma – these may be triggering to another reader. If you’d like to offer criticism, I’ll take it – I know I’m not perfect, and I’m always willing to learn. If you do offer criticism though, I’d really appreciate it if you could do so constructively (ie., no name-calling, please). Thanks…

You can find me on Twitter and on Facebook.

~ Dr. Dee Rajska, C. Psych.

*Fine print: Please feel free to share the link to this blog wherever you think it might be helpful! Reading this blog is a good start, but it’s no substitute for professional help. It takes a different kind of courage to admit to yourself that you’re struggling. PTSD is not a sign of failure – it’s a sign that you’ve been through a lot, and have tried to stay strong for too long. If you need help – you’re in some pretty great company. Reach out, and give yourself a chance to feel better.

**Really fine print: The content of Coming Back Home is copyrighted; please feel free to share the link, but do not copy and paste content. Unless otherwise noted, all original photography on Coming Back Home is copyrighted. The photo gracing today’s post was taken by Murray Chappell, and I’d like to thank him for generously allowing me to use his work. Please do not copy photographs from Coming Back Home without permission.

Spouses want to know: “Why isn’t the medication helping?”

Published on September 14, 2013July 12, 2022 by Dr. Dee Rajska, C. PsychLeave a comment

Today’s question is, “If my husband is medicated, shouldn’t we see some signs of him getting better?”

Great question, and thanks for asking!

…And you might be frustrated that I don’t have a quick, easy, one-size-fits-all answer.

First of all – let me just clarify: as a clinical psychologist, I don’t prescribe medication. That doesn’t mean that I’m opposed to medication; I have some patients who won’t take medication no matter what, and I respect that. I also work with others who consider their medication to be an important part of the mix that works with for them. I respect whatever path to recovery is the best fit for each individual person.

So, you might wonder, what is it, exactly, that medication is supposed to help with? Well – it depends on the diagnosis and the type of medication Antidepressants do something very different than anti-anxiety medication, for instance.

In general, meds are supposed to dial back your symptoms. Finding the right dose often takes a bit of trial and error; antidepressants in particular can take up to six weeks to build up in your system and start to make an impact. And you need to start off at a lower dose and gradually build it up to the dose that you need, to give your body a chance to adjust. So, it can take a while to get to the point where the medication has its full effect. When it comes to finding the best medication for you, it also might take a bit of trial and error – you may need to try a few different medications before finding the best one for you. So, medication might seem like a quick solution, but like anything else – you need to hunker down and arm yourself with a lot of patience, because it might take a while.

The other issue is, pills don’t give you skills: they don’t teach you to understand what’s happening to your brain, or where it comes from or how to cope with it.

So – in a nutshell, it may take some time before you start to see a difference. You might have to try a few before you find the right one. And medication alone is frequently not enough to change behaviour.

You can find me on Twitter and on Facebook.

~ Dr. Dee Rajska, C. Psych.

Spouses want to know: “Will he always have PTSD?”

Published on September 13, 2013July 12, 2022 by Dr. Dee Rajska, C. Psych3 Comments

You may have gathered from the title of today’s post that I’m throwing something new into the mix. A few days ago, a support group for spouses asked me to answer a few questions about PTSD. I’m grateful for their permission to post the answers here, so everyone who might be wondering about this stuff can jump into the discussion.

Of all the questions they asked, I wanted to address this one first because I get asked some form of it almost every day – people ask, “Will I ever get better?”, or “Will I always be like this?”

I’d love to give you a money-back guarantee that everything will be just fine.

The honest answer though, is that how much better you will get (or your spouse or loved one will get) depends on a number of factors. Some of them we can predict; others, we can’t.

Single trauma events in an otherwise mentally healthy person, treated quickly after the event, tend to have the best outcomes. In many cases, people can make a full recovery from these types of injuries.

On the other hand, if you’ve had decades of trauma, and it’s taken several years to find a knowledgeable practitioner that you feel comfortable working with – it’s gonna be a longer, steeper, more grueling climb uphill for you. That doesn’t mean that you can’t do it, and no one has a crystal ball that can predict your specific outcome. In fact, my personal experience is that some of the patients who came to me in the worst shape are the ones who have made progress in leaps and bounds, once they’re given the right tools to do so.

Most importantly – even if you can’t be fully cured, you can get better. In many cases, you can get a lot better.

Nothing we do in therapy can take the awful thing(s) that happened to you and make them unhappen. However – how those experiences impact you now, is something we can work on. If you have a lengthy trauma history, and it’s hard for you to trust or hope, then that work might need to happen very slowly and very gently, so it doesn’t overwhelm you. If you’re a spouse trying to be supportive, it may be hard to be patient, because for the first while it might seem like therapy isn’t making any difference.

Here’s your best bet for trying to get better: find a skilled, patient, knowledgeable therapist whom you feel comfortable working with, who won’t give up on you. Let them know when the tools they give you don’t work for you – getting better is a partnership, and finding what works for you can take some trial and error.

Good therapy has two parts: tools that help you manage your symptoms, and ways to try and heal your trauma. If you and your therapist have a good partnership and you are willing to work hard on your recovery, then you will start to see a difference.

It might take a long time and a lot of hard work to get a lot better. But, “a lot better” might mean that you can manage your symptoms most of the time, and the stuff that happened might not bother you as much anymore. Worth a try, no?

You can find me on Twitter and on Facebook.

~ Dr. Dee Rajska, C. Psych.

Strategies for Coping with Nightmares

Published on August 17, 2013July 12, 2022 by Dr. Dee Rajska, C. Psych1 Comment

Unfortunately, nightmares are part of PTSD for many people. They aren’t easy to get rid of. However, if you get nightmares, here is a list of things that you can do to try to make them a little easier on yourself:

– Did I mention that relaxation is really good for you? I did actually; so many times that you might be getting tired of hearing it. I even posted a relaxation exercise here. Some people felt triggered by that one (and I thank them for telling me), so I posted a different one here. I keep talking about relaxation because it’s good for you. Try to do some every night before you go to bed. It will make you less tense, and if you’re less tense you’re less likely to have nightmares.

– Anniversaries of your trauma events are likely to be particularly difficult. But, any days when you’ve been triggered, upset, stressed, or even excited (in a happy way), you’re more likely to have nightmares. Knowing this, you can work to compensate: on days like that, try to do more to relax before going to bed than you normally would. Then, as you lie in bed, take some time to look around the room, and remind yourself that you’re home, and that you’re not in danger. Putting this thought in your head right before you fall asleep will make it easier to bring yourself back into the here-and-now if you do wake up with a nightmare.

There’s a couple of things you can do to set up your bedroom to make it easier to cope with nightmares:

– Keep the room dark enough to sleep, but leave a small nightlight on to make it easier and quicker to orient yourself if you wake up from a nightmare.

– Keep the space uncluttered; have a couple of objects around the room that will help you to quickly and easily orient you to the here and now. Any object that you didn’t have at the time that the trauma happened can work; that way, if you do wake up with a nightmare, you can quickly scan the room to know where and when you are.

– Use your grounding skills: usually, waking up from a nightmare means waking up drenched in sweat. Lying in bed, drenched in sweat and shivering will do absolutely nothing to help you recover from your nightmare. So get up, run to the bathroom, and splash some water on your face. Get in the shower, and have a nice warm relaxing shower. Lavender-scented soap is also relaxing. Put on warm dry pajamas. Turn on soft, relaxing music. Fix yourself a cup of tea or warm milk (or another beverage that soothes you). The idea at this point is to soothe and comfort yourself, to help yourself recover as quickly as possible, rather than allowing the suffering to continue.

If you tend to have the same nightmare over and over again, there’s a type of therapy for that.

If your nightmare is overwhelming and terrifying to even think about, please don’t try this on your own – find a qualified mental health professional to help you.

The treatment involves writing out your nightmare in detail, with a different (positive) ending. You basically train yourself to re-imagine the nightmare with a positive ending, and then train yourself to take control of the nightmare. This takes a lot of work to do successfully, and it’s hard to do by yourself. So please reach out to get some help if you need it.

You can find me on Twitter and on Facebook.

~ Dr. Dee Rajska, C. Psych.

**Really fine print: The content of Coming Back Home is copyrighted; please feel welcome to share the link, but do not copy and paste content. Unless otherwise noted, all original photography on Coming Back Home is the copyrighted property of Larry M. Jaipaul; please do not copy images without permission.

What-to-do-when-you-can’t-Sleep Strategies for PTSD

Published on August 16, 2013July 19, 2022 by Dr. Dee Rajska, C. Psych3 Comments

Hi again!

So – the last post was about sleep strategies… And since I acknowledged that none of those strategies were quick fixes, I figured it would make sense to follow up with strategies about what on Earth to do with yourself when you can’t sleep. Because, even if you do everything I just suggested in the last post, chances are some of the time you’ll still be up, unable to sleep.

Or, chances are that you’ll get to sleep and then be woken up with nightmares. If that’s the case, check out this post.

If you’re lying in bed and you can’t sleep – don’t just keep lying there tossing and turning. Get up. Go to a different room.

Turn on only soft, dim lights. Try NOT to turn on the TV, the computer, or your phone; your brain interprets the type of light emitted by those devices as daylight, so looking at them will only get you more alert and wired, and will make it harder to get back to sleep.

Instead, do things that feel either relaxing and/or a little boring to you – some examples might include playing soft music; flipping through a magazine; folding laundry; working on a jigsaw puzzle.

Do this until you feel sleepy (until you’re yawning and feeling like you could fall asleep). Then go back to bed.

There’s a reason behind this approach:

If you can’t sleep and you don’t get up, you end up spending night after night tossing and turning in bed. After a while, you don’t think of bed as “a relaxing place to go to get some rest”; instead, you think of bed as “that awful place where you toss and turn all night long every night”. If you’ve been doing that for a while, you’ll tense up a bit as soon as you think of bed. You might find it easier to fall asleep on the couch or in a big armchair – anywhere but bed.

So, getting up when you can’t sleep basically re-teaches your brain that bed is a comfortable place where you can sleep, and not an awful place where you toss and turn for hours on end.

And doing relaxing, boring, quiet stuff gives you another chance to lull yourself to sleep. Even if you don’t get back to sleep that night, doing quiet, relaxing stuff during the night helps to re-teach your brain that night-time is for sleeping, or at least for resting.

Again – no quick fixes here, folks. But this is important stuff to know, and if you try it, it might make a bit of a difference.

Good night, and I hope you’re able to get some rest.

You can find me on Twitter and on Facebook.

~ Dr. Dee Rajska, C. Psych.

Sleep Strategies for PTSD

Published on August 15, 2013July 12, 2022 by Dr. Dee Rajska, C. Psych1 Comment

Well – this is NOT going to be a “Get a great night’s sleep in five easy steps!” kind of post.

I wish there were easy solutions.

The reality is, PTSD wreaks havoc with your ability to get a good night’s rest, and there’s no quick fix.

But – I’d like you to try these strategies. They’re not a miracle fix, but they may help somewhat. These are ideas and suggestions, not marching orders; try the ones that you feel comfortable with.

– Try to set a regular bedtime routine. Do something relaxing, like having a warm shower; listening to some soothing music, or drinking a cup of chamomile tea.

– Keep the temperature in your bedroom a little on the cool side. Not cold, but a little cooler than you’d want for sitting around. (Our body temperature naturally drops a little to sleep, so being too warm will actually keep you awake).

– If sudden noises from outside make you jump awake, a fan can provide a gentle soothing noise to help you sleep; soft music can also be helpful.

– Use a relaxation exercise before going to bed.

– Keep your feet and hands warm. Cold hands and feet are a signal of stress for your body – if necessary, wear socks and/or gloves to bed.

– Try to exercise regularly, but not just before bed: exercising right before bed can make you feel revved up, so it’s harder to go to sleep. There is good evidence that regular exercise improves restful sleep, so it’s important to try to get some exercise each day. Try to finish your workout at least three hours before bed.

– Try not to do stimulating activities just before bed: This includes stuff like playing a competitive game, watching an exciting movie or TV show, or having an important discussion with a loved one. Looking at your computer screen or checking your cell phone shortly before bed may also interfere with sleep, because the kind of light given off by these devices registers in our brain as bright daylight, so it makes your brain think it’s time to wake up.

– Try not to have caffeine for at least six hours before bed. This includes coffee, many teas, chocolate, sodas, etc.

– Bed is for two things, both of which start with “s”. Don’t read, watch TV, or work in bed – that will make it harder to fall asleep.

– Try not to use alcohol to help you sleep. It might help you fall asleep, but it will make you more likely to wake up a couple of hours later and have trouble getting back to sleep.

– Try not to go to bed too hungry or too full: it’s hard to sleep well after a big meal – you’ll wake up with heartburn during the night. On the flip side, going to bed hungry makes it difficult to fall asleep. Have a light, well-balanced meal at least two hours before bed instead.

Like I was saying… None of this advice will magically fix your sleep problems. But, if you keep trying, it may help a bit.

Still having trouble sleeping? You can find some ideas on what to do here.

Waking up with nightmares? Here‘s some advice on how to cope.

You can find me on Twitter and on Facebook.

~ Dr. Dee Rajska, C. Psych.

PTSD and Relaxation: When and Why

Published on August 14, 2013July 12, 2022 by Dr. Dee Rajska, C. Psych1 Comment

So – have you noticed that lately, I’m talking a lot about relaxation…?

Well – today I’d like to talk to you a bit why relaxation is important, and how to use it to manage your symptoms.

If you’re like most of the patients that I work with, you might think of relaxation as something you do when you’re feeling really wound up to bring yourself back down.

If you use relaxation this way, that’s a great start. The next step is to get into a routine of doing some sort of relaxation every day, even when you aren’t feeling really wound up and you don’t think that you need it.

Think of doing relaxation the same way as you think of brushing your teeth: you don’t wait until you have a toothache to brush your teeth. You do it regularly because it helps to prevent a toothache. Same with relaxation: try an exercise like this every day. If you prefer to relax by imagining a hike in the woods, you can do this instead.

Here’s why: when you have PTSD, even at your most calm, you are probably still pretty wound up and vulnerable to stress as compared to a person without PTSD. That increased vulnerability can be pretty stressful in itself – you might spend much of your time worrying about how you cope with unexpected stress, or feeling embarrassed about how you react to stressful events.

Put simply, doing relaxation exercises regularly can help to rebuild your resilience. It can help you feel calmer and more centered, so that you can handle stressful events with more confidence. It’s not a miracle; it’s a skill, and just like any other skill, it takes time and practice to get better at it. But it’s worth it – over time and with practice, relaxation can make a difference.

You can find me on Twitter and on Facebook.

~ Dr. Dee Rajska, C. Psych.

Finding Solid Ground When You’re Triggered

Published on August 7, 2013July 11, 2022 by Dr. Dee Rajska, C. Psych11 Comments

Hi!

Today, I want to tell you about grounding skills – the kind that you use when you’re being triggered, and you’re starting to feel sucked into an ugly old memory. Those of you who are getting help probably have a few of these already; for everyone else, these are your life jacket when you feel that you’re drowning. Learning to use these is an important investment in your well-being.

The key in this type of a situation is to use whatever tricks or strategies you can, in order to remind yourself that you are here in the present and the danger is over.

Some ideas for doing that include:

– look around the room; notice and name some of the things that you see. Becoming more aware of where you are now helps you fight off being sucked back into the past.

– rub the palms of your hands together. Pay attention to the sensation of warmth that this creates in your hands. Usually, our hands get cold and clammy when we’re nervous – so this little trick makes you feel calmer by changing how your hands feel.

– listen to music. You can pick either soothing, calming music to relax you, or you can pick something loud that you can sing along to, something that reminds you of a pleasant memory. (Singing out loud also makes you breathe deeper – and since we often hyperventilate when we’re triggered, this helps too).

– do any kind of physical activity that your pain and/or physical ability allows. Focus on how it makes your body feel. Your muscle tension will go down as you do this, and that will make you feel calmer.

– if you have a pet – touch your pet’s fur, talk to your pet, and/or hug your pet.

– carry something meaningful in your pocket, something that reminds you that you are here now, and that the danger is over. Touch it to re-orient yourself. If you didn’t have your current car or home when the trauma happened, your car or house keys will do: touch them to remind yourself that you are here now, and that event was in the past.

– remind yourself of today’s date. If you carry a cell phone, looking at your phone can be a good trick for this – look at today’s date, remind yourself of the date when the bad memory happened, and then firmly tell yourself, This is now, that was then; I am here now. Feeling scared is not the same as being in danger; I may be reminded of back then, but I am here now and the danger is over.

(Of course, if the anniversary of the trauma is what’s triggering you – looking at the date is NOT the way to calm yourself. Here‘s some tips on how to get through it).

These are skills – so the more you practice, the better you get at using them…

You can find me on Twitter and on Facebook.

~ Dr. Dee Rajska, C. Psych.

**Really fine print: The content of Coming Back Home is copyrighted; please feel welcome to share the link, but do not copy and paste content. Unless otherwise noted, all original photography on Coming Back Home is copyrighted. The photo gracing today’s post was taken by Wojtek Rajski, and I’d like to thank him for generously allowing me to use his work. Please do not copy photographs from Coming Back Home without permission.

Where PTSD comes from, Part 3: How Reflex Messes with Your Thinking

Published on August 3, 2013March 12, 2017 by Dr. Dee Rajska, C. PsychLeave a comment

Hi there!

Today we’re going to round out our discussion of what survival reflex does, by going over how it impacts our thinking.

Keep in mind that survival reflex is designed to save our life under circumstances of immediate threat. In those conditions, every moment counts, and every ounce of your energy could make the difference.

We discussed here how your reflex works differently (and much faster) than your usual, everyday thinking; and more recently, here, we talked about how reflex is run by a different part of your brain than conscious thinking. We’ve also covered how, to save energy, the body will interrupt day-to-day functions like the digestive system and the immune system, so it can redirect all available energy toward immediate survival.

When survival mode kicks in, your reflex takes energy away from the part of your brain that’s responsible for complex thinking. It redirects this energy toward your big muscle groups, to make it easier for you to fight or run. So – in the case of Dave the Zebra beating the daylights out of that lion, his survival reflex interferes with his ability to do stuff like: analyze things, think things through, look at a situation from a number of different perspectives, prioritize, look at the big picture, and so on. And reflex does this on purpose – because complex thinking takes up time and energy, neither of which can be spared in a life-threatening emergency situation.

What your survival reflex does instead is put you on high alert, on the lookout for danger. What that means is, Dave’s attention is constantly darting around looking at everything – paying attention to every sight, every sound, evaluating everything in front of him to see whether it’s a possible threat.

If you’re in danger, taking too much time to look/listen to one thing in specific could lead you to miss a potential threat somewhere else in your environment; so, in an effort to identify a threat and save your life, your survival reflex interferes with your ability to concentrate and sustain attention on any one thing for very long. Once a threat is identified, reflex makes you go into a sort of “tunnel vision”, where all of your energy goes toward just dealing with that lion, and nothing else. Often, in highly dangerous circumstances, you tend to flip back and forth between the tunnel vision and the darting around looking for other sources of danger.

This reflex is designed to work in brief bursts, and to maximize your chances of survival in life-threatening circumstances. Your military training strengthens the “fight” part of the fight/flight/freeze response, and builds on it to help you get through some nasty situations.

In PTSD, this reflex gets stuck in a constant loop, so it’s hard to shut it off.

In learning to control it, step #1 is getting a really good understanding of it. Once you know how it works, it gets easier to work against it.

You can find me on Twitter and on Facebook.

~ Dr. Dee Rajska, C. Psych.

Finding Solid Ground (Part 2) : Photography

Published on August 3, 2013March 12, 2017 by Dr. Dee Rajska, C. PsychLeave a comment

It’s been a bit since I last posted specifically about grounding skills, so, if you can’t even remember the previous post, here’s a handy link.

In a nutshell, grounding skills are things that we do to help ourselves stay in the present when an unpleasant memory tries to suck us back into the past. They are your first, most basic tool for managing your symptoms. Usually, grounding skills are activities that keep your mind focused on something in the here and now- so, when a bad memory pops up, your grounding skills keep you… grounded.

Let’s divvy up grounding skills into two basic categories: there’s what you do to cope in an emergency (like when you’re being triggered by things like fireworks or thunderstorms ) – those situations require a specific, immediate response to help you to re-orient that that was then, and you are here now, and you are not in danger.

But – aside from these “emergency grounding skills”, there’s what we’ll call the “everyday grounding skills”: when you feel wound up, your mind is racing, and you need something to do keep yourself from getting sucked in. Hobbies that keep your hands busy and your mind focused are a good way of “everyday grounding” yourself. Photography is a great example.

You don’t need to have a super fancy camera (although if you really get into photography, you may end up buying some fancy stuff).

It keeps your mind busy because you need to think: what do you want to photograph? Where are you going to go, to take the pictures that you want to take?

Once you find some sights that you want to photograph, you need to figure out how you want to capture those sights…

Do you want to focus on the tree in the foreground?

…Or, would you rather use the tree to frame the scene, and focus on the bridge in the background?

Which image do you like better?

It’s not a trick question, and there’s no right or wrong answer. But – if you can look at both pictures and have an opinion – then photography might be a hobby for you to consider. So grab a camera (or even your phone to start with), and go out for a hike. Find some stuff you want to take pictures of.

Have fun 🙂

You can find me on Twitter and on Facebook.

~ Dr. Dee Rajska, C. Psych.