Ep. 158 | Healing from Trauma: How to Know if You Are Suffering From PTSD

Hello and welcome to another episode of Everyday Therapy. I am Dr. Karin Ryan, licensed psychologist, and I am here with Brett Cushing, licensed marriage and family therapist. And today we are talking about healing from trauma, understanding PTSD, and finding your way forward. So our hope today is to help you have a really good understanding of what PTSD is, what it looks like, what it can feel like, how it develops, and then really

recognizing that there is a way forward, right? That there is absolutely ways for healing and hope. So welcome, and we are glad you're here. Thank you for joining us. And so as I promised, like talking about like, what is PTSD, Brett? So as we're thinking about it, we hear it all the time, PTSD, post-traumatic stress disorder. What is it? What is PTSD? I'm glad.

We're asking and defining that question because it is one of those things you hear often in our culture. I have PTSD. I'm triggered. That's a big one. And I think it can cheapen sometimes what PTSD actually is. And so we're going to define this a little bit and really what it is, what we're saying it's post-traumatic stress disorder. it, it involves trauma. what is trauma? Trauma can include a number of things. It can include

violence, can include abuse, it can be car accidents, can be disasters, natural disasters, it can be sudden losses, it can be actually prolonged losses as well. It's really any kind of experience where there's perceived threat of violence, of loss of life, but that sense of perception that there is a threat is I think key aspect of post traumatic stress.

not just a threat that's minor, it's significant life threatening, life altering kind of situation. Yeah. And really, really feeling unsafe and really feeling like your, your wellbeing and your physical mental health is at severe threat. Absolutely. And you highlighted many different ways, you know, that there's ways where sometimes PTSD develops from one specific incident. So sometimes people feel like, well, yeah, I know I have PTSD because here's the one thing that happened.

We know that PTSD can also develop from repeated, we call them like smaller or little T traumas. So that might be kind of chronic neglect or verbal abuse, sexual abuse, put downs that are, that build up and are so intense over time that then your sense of safety, security truly is threatened. And so that sometimes are the times that people have a harder time kind of recognizing that I might have some trauma and have PTSD.

when it has been through a pattern of abuse, neglect, violence that absolutely can lead to PTSD because you truly were unsafe in those environments. You might think, well, what a name calling, is that, how could that be? Well, if your parent or loved one is calling you stupid and putting you down and making you feel threatened if they're going to love you and care for you, your physical wellbeing is being threatened because you're not sure you're going to be cared for. So trying to articulate this is important because oftentimes people

can either, like you said at the beginning, over be like, oh, I have PTSD, and do it kind of like lighthearted. And other times, people can not realize that they do have it, and then not be getting the support they deserve. Right, right. And you and I have done training on domestic violence, too, where that is. I remember in our training.

I think you had said that one act of physical violence makes any other threat or perception of it very viable and credible. so people can have, you can ask somebody, you ever had physical violence? No, not really. Well, there was one time when my mom or my dad did this and then did it ever happen again? No, no, it was just that one time. But when it's coupled with threats without physical violence, that threat is

very serious and there is a perception that I'm could be seriously harmed here again. So yeah one thing to also distinguish is maybe now's a good time to talk about capital T versus small t and there's PTSD that we're very familiar of usually from like combat.

Veterans who've been in combat, people who have had significant traumas, they have had sexual abuse. And then there's small t traumas that isn't really talked about a lot. I quite small t traumas as maybe not as intense and yet they continually happen over time. And it's sort of like a low grade fever that never ends. you might not bother you at first and over time it can be very

debilitating to a person and how would you explain that turning into PTSD then over time? Yeah, I think you did you're doing a great job of explaining it. I think what's helpful is to tie in how our bodies and our brains respond to stress and trauma and that'll kind of fit in and explain that what you just asked, right? So our brains are amazing, right? The frontal part of our brain is like decisions and reasoning and abstract thought. The middle part of our brain is kind of emotions and tying in emotions and that

the back part of our brain kind of closest to our neck, that's like our quick fight or flight like keeps us safe. So that's when if you've ever been in a car and you swerve and then all of a sudden you're like my gosh I almost hit that person, my heart's racing, I'm a little shaky too. Your body has responded to that trauma or that stress before you have even thought about it, right? And so when we experience a big trauma, a capital T trauma,

our brains are automatically going through that. So we are processing that information in a different way. Our brains and our bodies are activated. When we are repeatedly experiencing the small T traumas, we are in this fight or flight. are in this activation. We call it hypervigilance where you're always worried about, I safe or not? So if you are chronically living in this environment of like, I don't know if I'm safe or not, that biological and that neurobiological impact on our mind and our body, and then our emotions.

That's kind of what builds up to be it because now we are in this chronic state of feeling unsafe and feeling threatened. Yes, and that chronic state never gives us time to.

recover either and it's so debilitating and there's other effects too because cortisol is continually being released in the body and kind of continually in this stress response cycle and you're never able to fully recover and then that becomes normal and almost like muscle reflex. You're just there all the time and now it seems normal and so do you have trauma? No, I don't have trauma. I'm fine, but not realizing I'm hypervigilant constantly. I'm everything in my

arena that wherever I go I might my sleep is being disrupted. Mm-hmm. I'm having insomnia or hypersomnia and then then the thought might be well I've never slept well. Yeah, right. You'll hear that one I've never really slept well Yeah, right and it's recognizing that PTSD is not weakness like it is the brain protecting you it is our amazing human bodies like adapting to the environment or to the stressor now to try and keep us safe and so it's really when you can like

decrease that like that it's some sort of like character flaw or has something to do with like your personality or who you are and just be like, no, this reaction is completely adaptive to either this huge, this big significant capital T trauma I went through or the repeated little traumas I've experienced in my life. And then when there's anything that reminds us of that trauma.

the brain associates that with the original trauma and we go back into fight or flight very quickly. And like you said, the brain reacts or it actually processes it, that part of the brain processes that perceived threat.

Literally a hundred times faster than how we normally do. So then the other rational part of our brain kind of arrives on the scene a little late to the party. And we can't assume that the brain is very reliable because the brain will arrive on the scene, notice that our body is activated and just conclude, wow, there really is a threat. And so that's why when we're talking to people...

And they don't seem to make sense. You're like, why? Well, this isn't that big of a deal, is highly invalidating to that person because their body has reacted to this. And it's extremely real. And you're thinking, can't, I can't reason with this person right now, which is evidence of trauma and why treating it, which we'll talk about at the end requires usually a different approach. Yes. And what you're talking about is when the brain, right? Like it processes differently, like sometimes our body

will react to a reminder, to a trigger, to something that is connected with a past trauma oftentimes before we even realize what it is. Right? So if you have been

experienced trauma by somebody that wore a certain cologne or a perfume. Right. If there was a song playing in the background or a song that they always played. So like our olfactory or our sense of smell is like, I'm snapping at like one of the fastest, like, because it is connected to that emotion center and that trauma center of the brain. And so there are going to be times where we are triggered and then it hasn't even made it to the, like the front part of our brain to understand,

that smell reminds me of this trauma that I experienced is, it makes perfect sense that when I smell that cologne, I have this emotional response and I feel unsafe and now I need to use my skills to get in a safe place. Oftentimes, that's one of the benefits of therapy and trauma work is it helps you make those connections. But when we experience a trauma, our brain takes in all this information around us.

And then sometimes grabs onto things that are not helpful, that are not connected, but we've connected with it because there's a scent or a sound or a smell or a visualization. And then it also sometimes will pair it way down and only remember a small part of it. So again, it's our brains being adaptive and either taking in a lot of stuff that is going to trigger us and be connected. That's not actually connected or have a hard time remembering details because the brain was just so focused on staying safe.

Right, and I so appreciate you mentioning the physiological aspects of all of this because when other people understand that they can have a little more understanding, compassion, and realize, ooh, okay.

they're perceiving a threat. I know it's not their, they don't know. Their body doesn't know. Yes. It's helpful for other people to realize their body doesn't know. And for the person who is experiencing that, when they can, like you said, my body is doing what it's supposed to do when there is a threat. It takes all that self blame and condemnation out of it because many people, when they have those reactions to trauma, they're upset with themselves because it doesn't even make sense to them.

Yes, and they're thinking I'm so stupid. Why do I overreact? Yeah time and so it's So important for us to remember this is exactly how our brain operates our body operates when there is threat I'm doing what I'm supposed to be doing. I just don't know that there's not a threat. Yes. Yes, really Yeah, it's such a huge thing too I'm so glad you're highlighting that Brett and PTSD like symptoms of PTSD what that looks like it falls into four categories kind of typically and so that

That is the first is intrusive symptoms. So what we mean by intrusive symptoms are gonna be flashbacks. So as I highlighted a little bit ago, like the brain takes in information in a different way to keep us safe. And so it's almost, it can be like a flash bulb where some people it's like if you were a whole movie with slides, it's like you just flash like one scene is all I can remember, or there's pieces of it. And oftentimes when you're talking with somebody about their trauma as a therapist, you're being trauma informed and letting them share it but.

what I see again and again is it's not a chronological perfect explanation of the trauma. It is kind of piecemeal and it's parts of it. And so if you find yourself feeling that that's true for you, knowing that's normal, that the brain is not just storing it as you would like detailing what you had, how dinner went last night that was a neutral, whatever dinner, it's going to be different. And so we can have flashbacks, nightmares, oftentimes when we're sleeping, having those images of it.

and unwanted memories. So that's kind of those intrusive symptoms. Yes, and there's avoidance.

avoidance of anything that can remind us of the trauma. So we might avoid people, certain people that remind us of that. And it could be places. of course, this is a very traumatic thing. Why would I want to be around somebody or some situation that reminds me of that? The difficulty is we don't oftentimes realize that consciously. It can be a certain person, even a family member who reminds me of some traumatic event. Why am I always avoiding this person?

or why is this holiday or this particular season, why is this so hard for me? What am I avoiding? And it can be real specific. So it might be I'm going to avoid this bridge where this accident happened, or it be I'm finding myself avoiding all bridges or feeling really uncomfortable and then I'm not driving. And so it's recognizing that sometimes it's specific and sometimes it's generalized. And I also think we can have a heightened

reactivity to situations.

where we have kind of this hyper arousal. Someone comes up from behind and gives you a quick hug. Hey, how you doing? And your body goes into this full flight alarm. Yeah. And there's this overreaction for that particular situation. But in the midst of the trauma that that reminds you of, that would be very appropriate. And so we have this heightened arousal, overreaction for the situation. We also can have poor sleep, something else.

where we're constantly on edge and just alert. Yeah and there's also can be negative changes in mood or thinking. So shame, we know that right can come with when when hard things happen to us as humans we oftentimes internalize it and think we're the problem when it was not. It was an external factor and a trauma that happened to you. Guilt, hopelessness and it can even give sometimes like a shortened sense of like the future. And so it's not that you don't want a future for yourself but it like

Like when somebody says, what do want in five years? Sometimes when you're experiencing trauma, like, I don't know. Like you can't even fathom. Again, because your body's just trying to, and your mind's trying to like just stay safe right now and figure it out.

I don't want it to sound like it's dramatic because it's not. what I want to do is validate, if you're like, what is wrong with me? There's nothing wrong with you. Right. Right. So if all of a sudden you just feel less hopeful, less like mad and kind of mad about things for a lot of times when people have experienced a trauma, like little things they used to care about, like they're like, what does that matter? And so they'll find when family members are talking about something or friends are complaining about something like, are you, are you kidding me? Like, how can you act like that's so dumb?

And just validating for yourself like, that makes sense. Like my worldview is shifted and it won't be like this forever, right? With care, but that piece of knowing it makes sense. makes sense. I love that phrase too. It is so empowering because also this important little note I want to make sure we touch on is that what's traumatic for one person may not be for another. And I remember being a police chaplain doing the debriefing where two guys were held up at gunpoint and one

The gun was fired at a guy and the gun just misfired. so... Yeah. He didn't have any trauma response to that. He was like, wow, that was fortunate. The other guy, the gun wasn't even pointed at him.

And he had serious trauma from that. His wife happened to be eight and a half months pregnant. He was just having all sorts of thoughts. His life is going to end. His wife's going to be alone, etc. Yeah, life is unpredictable. Yes. What's traumatic for one person is not necessarily for another. I know a Navy SEAL who didn't have any problems being a Navy SEAL. Didn't even have any post-traumatic stress. Yeah. And later when he didn't know what to do after he retired, he started to have anxiety.

tough-as-nails kind of person and yet can have trauma very differently. Mm-hmm. Yeah, car accident. One person would be like, shoot, man, now I gotta pay for my car. Another person be like, have a really hard time getting behind the wheel. And we're gonna say it again, right Brett? That is not about your strength or your character, about being a better person. It is oftentimes about a whole handful of different factors coming into play. What was your body like at the time? What was the thought process? What was happening?

around you? How did your brain interpret that information? Even based on like where you were standing, what else was happening in your world. So again, like if you experience PTSD and another person doesn't, that does not make you less than. Yes. Mm-hmm.

You had touched on, don't feel like myself anymore. And the way that manifests off is this emotional disconnect with people and the world in general. can even dissociate to kind of deal with life where you're sort of losing touch with time and events and you're just on autopilot, almost daydreaming, but going through life. You can have difficulty relaxing, feeling exhausted, and yet you can't sleep. I'd mentioned detached from relationships and just in that

survival mode to get through life. Yeah, I'm so glad you're highlighting that Brett because I feel like most of us have a good grasp of what it means to be activated, to be worried, right? So that's when we're like, we're jumping, we're startling, we're, kind of aware of our environment and dancing around our heart rates up. That's like that fight or flight when we're ready, you know, we're kind of activated and our body is responding to that. But what you just highlighted as well is when our bodies, when we have gone through a trauma, what our bodies also learn to do at times is

to shut down because it's too much. So if you're experiencing those little traumas or you're experiencing a longer lasting big T, what the body does and the mind does, says, this is too much. The brain says, you know what? In order to keep Karin safe, we're not going to take in as much information.

We're going to have Karin just kind of shut down and get through this right now. Again, completely adaptive. And so what the mind and the body then learns is, when things get too much, we shut down. And so this is like when we kind of highlight that trauma can, we can be presented as like activation or kind of shutting down as well. Again, very adaptive and helpful to recognize when those are happening and then being able to work with that with your therapist. Glad you touched on that too. So let's talk about recovery.

Recovery is much more than getting over it, whatever that means. It's a nice phrase, but I don't think we know exactly what that means. Getting over it, it's a major misconception. Healing from trauma doesn't mean forgetting about what happened. That's living in It is part of your story. It is. It is part of your story. And there's a redemptive aspect to this where all this pain can result in something positive for you and even for other people through.

your life. And there are really effective treatments for PTSD. Yes, yes. We're not gonna lie to you, they're hard. They are. Trauma work is hard and it is helpful and there is hope and I'm telling you, you ask somebody who has been through trauma treatment, they're gonna say yeah it's worth it. In fact some military combat veterans have said trauma therapy

was scarier than the actual trauma itself. Because when you're experiencing the trauma, you're in this fight or flight mode, and you're running and you're doing everything you can just to get through. You haven't even processed everything. And at least on a conscious level. And then when you do trauma therapy, it can be very terrifying. It can be exhausting as well. And the rewards far outweigh the costs. Yes. Yes. And when we, you know, I'm a trauma therapist, as is Brett here. Like when we are helping an individual

or a client through trauma, yes, it's difficult. Yes, it's hard. And our job is we pair with you and partner with you to help it feel as safe as possible and as manageable as possible. So that is what you'll find in the really evidence-based trauma treatment, is, know, ProLon Exposure, EMDR, what is going to be the focus is we are helping you reprocess this trauma in a state where it feels manageable and you can...

pull in adaptive parts of your brain. It's a really amazing work that helps you process that differently. So you're less likely to be triggered. You're less likely to be having those flashbacks and those intrusive images because your brain is pre-processing it in a way that allows you to.

adaptively respond to your environment better. Yes. And I think to put it in a little more technical and also in a practical sense too, I heard it put this way when I went through a certification of trauma that in essence, when we are into a trauma response and we've had trauma, it's our sympathetic nervous system. That is what's activated, puts us into this fight or flight. We also have a parasympathetic nervous system, which when that comes online, we go,

everything's okay. So I open the door and my gosh, it's a tiger, you know, and I'm immediately at my sympathetic nervous system. And then when I realize, it's just a big stuffed animal and I feel this whoosh of relief, that's my parasympathetic nervous system kind of coming online. So that's really what we're trying to do with trauma therapies, get that parasympathetic nervous system to be activated in the presence of this perceived threat so that you're calm when you

longer have that or when in the presence of that perceived threat. it's, and another way I put it is trauma a lot of times is it's the meaning attached to the event. like you said earlier, it's sort of a narrowed focus. And I know when trauma is being resolved with clients, not only when their parasympathetic nervous system is dominant in the midst of threat, but simply when they can zoom out sort of

from the trauma and they have greater meaning and greater context and they kind of go, now I understand better. Yes. Yes. that's when we know that this is being actually rectified and Yes. Yeah. And like cognitive processing therapy is another form of really effective treatment. And in that it ties in, highlight it, you know, when we're kicking that parasympathetic nervous system, then we're also able to better validate like what is and isn't our fault. And there is a

difference between like logically thinking, you know, therapists telling you that wasn't your fault is one thing, but emotionally experiencing that and really truly reprocessing that for yourself and being able to feel.

The truth of that wasn't your fault is part of the healing. Yeah. I know you and I went through EMDR training together years ago. And in that training, I remember the example being told of many of our memories are just kind of a long-term memory on a bookshelf. can pull it off the bookshelf and you can read it and no problem. This was the summer of 1984 and you put it back. No problem. You just retell it. When we've had traumatic memories, it's as though it's on a different bookshelf and we pull it off and we don't just retell that.

We are reliving it and we're reliving that trauma all over again. So when it's resolved It gets yeah. Yes, and we can retell it without having to relive it and now you feel much more empowered. Mm-hmm. That's the whole yeah, I really exactly Yes. Yeah that you know trauma it's like validating how it changes you and changes your experience of the world and then also remembering that healing is possible that progress isn't regret is like gradual up and down

and all around, like that's why we have our trail mark as our Sagent behavioral health is like our progress isn't always linear, it's up and down and all around.

And that, you know, oftentimes people will be like, well, my trauma isn't bad enough, or I don't know, does it really qualify? Or that is a ridiculous question, lovingly. Come in and get some support and we'll help you with it, right? It doesn't have to meet a certain qualification. We're going to help you with your trauma, right? Absolutely. And for those of you who know somebody that has trauma, can feel very powerless for you. What do I do? What do I say? And hopefully this has been encouraging and empowering for you and enabling you when you're interacting with

with somebody you love and care for who has trauma, maybe this has helped you move from a perspective of what is their problem to, wonder what all really happened. Yeah, and just validating that their body and minds are doing what it needs to do and that you're there with them and for them. Yeah. Well, we thank you all for joining us and take care, everyone.