SUMMARY: Kim Smith discusses post traumatic stress with Phillip Crum and Kathleen Mills.
Episode #46 | Kim Smith | PTSD-Post Traumatic Stress Disorder
Kathleen Mills-Proprietor, Counselor at Life Tree Counseling
Phillip Crum-The Content Marketing Coach
Kim Smith-Life Tree Counseling
Phillip Crum: Did somebody put the coffee on?
Kathleen Mills: I did.
PC: Good, because do you know what time it is? It is time for episode number 45 and the good news is my meds have kicked in and I’m feeling pretty good right now so.
KM: I’m so glad. We had to wait a couple minutes for this to start.
PC: It’s time for Kathleen Mills and her weekly foray into the minds and musings of the various mental health professionals that are out there. And today you’ve got Kim Smith with you –
KM: I do.
PC: One of your own. One of your very own.
KM: Yeah. Showcase day.
Kim Smith: Hello.
PC: One of your brood.
KM: Hi, Kim. How are you?
KS: Good. How are you, Kathleen?
KM: Good. You’re all chipper. She’s more chipper than…
PC: Chipper is good.
KM: Chipper is awesome.
KS: I’ve had my caffeine.
PC: It comes right after the –
KM: Yep, you have.
PC: Alright, well good. So the topic for today is?
KS: Post-traumatic stress disorder.
PC: Okay. Good.
[PC adjusts microphone for KS]
PC: Post-traumatic stress disorder. PTSD. Is that army stuff?
KS: Well, yes and no. Definitely can be associated. Many military, army, navy, marines, air force – I can’t leave them out.
PC: Doesn’t have to be any one branch, does it?
KS: My dad was an air force man. But, yes, many veterans have post-traumatic stress disorder unfortunately from things that they’ve been through. If they’ve been in any kind of war situation or any kind of hostile area that they-
PC: Is it a big a problem as it really seems to be? It’s on the news all the time.
KS: Yes. It’s probably a bigger problem than is recognized even. It’s becoming more prevalent as far as recognition for it. And there is finally some help for veterans. There are hospitals that actually have specialty programs for military so that they can be treated for post-traumatic stress. And when I was in the hospital when I was in that service, we had a specialty program at the hospital I was affiliated with and I saw a lot of veterans come in.
PC: I was watching where I get most of my education – Law & Order. And one of their episodes, somebody had a case of PTSD and it was from some accident they had been in as opposed to being shot at in the military. So there are non-military sources?
KS: Absolutely. And that’s where I was actually going to go next. Most people associate PTSD with military veterans, war. But PTSD can actually occur for anyone. Anybody can suffer from that if they’ve been through a traumatic experience. If there’s been anything in their life – lots of children even suffer – that unfortunately from abusive situations, assault situations. So it’s more common than most people might think in terms of happening to the general population. Some people don’t even realize that they have it or suffer from it.
PC: So what does it look like? What does it look like – I’m married to somebody-
KM: You mean some of the symptoms?
PC: Yeah – what do the symptoms look like? How would I recognize that somebody I know might be suffering from PTSD?
KS: Well, if a person that suffers from PTSD, most of the time you’re going to see some type of trigger – some type of anxious response to certain triggers. Anything that they associate cognitively with the incident/trauma that happened to them, they may have frequent panic attacks. They might withdraw and try to avoid certain situations because that situations are too painful or too scary for them. They may have extreme negative mood shifts as far as going into deep depression on certain occasions that may be trigger responses. In more extreme cases, there could be flashbacks where they are reliving the incident basically whenever they have a trigger that occurs, that reminds them of the incident. So there are a number of ways. Not all of them are that extreme. Some people suffering from PTSD, it may not be as noticeable, but if there is some occurrence of panic attacks or extreme anxiety in certain situations, it’s very possible that they’re suffering from PTSD.
PC: How do they act out?
KS: Um well a number of ways. There could be some self-destructive behavior such as using alcohol or drugs to cope with the pain and the memories and trying to numb themselves to that. They can act out with anger sometimes, depending on what the situation is. They might lash out at family or close friends. Panic attack-wise, they’re probably going to go into a state of protection kind of self-preservation, withdrawing, and engaging in what you would call the flight-or-fight response. Either they’re going to come out punching or they’re going to run from the trigger. So a number of ways.
PC: Are they dangerous?
KS: They can be, depending on the situation again. I’ve known instances where veterans – I’m going back to that example – are maybe reliving flashbacks or sometimes have dreams when they’re sleeping of flashback responses and wake up punching/hitting/doing whatever to protect themselves and they may have a spouse there with them, or partner that could essentially be in harm’s way. Or if they go into some sort of dissociative state, which means they kind of shut down – their consciousness kind of shuts down – and they go into acting out without realizing what they’re doing, almost like hallucination or that type of behavior. They might harm someone. So it is possible.
PC: How common is it? One out of 100 get dangerous, or one out of 10? What’s the norm?
KS: Statistically, I don’t know if I can give you a number, I don’t think the acting out in a dangerous and harmful way is as common as some of the more minor responses. But it’s not extremely common as far as that’s concerned.
PC: What are the treatment options for PTSD?
KS: There are several. One is your basic psychotherapy. So cognitive behavioral therapy is used pretty frequently – that’s a method that I’m most familiar with and I use personally. And that’s basically reframing the incident, helping the person reprocess that in a different way so that their emotional response… basically you’re reprocessing the data in your brain so you’re helping them to see it from a different perspective and helping them to do that changes the emotions associated with it and the immediate responses change. So you’re trying to help them process it in a way that feels safe so that when they do get exposed to triggers and things that remind them of the incident, they have a way of coping with it that doesn’t lead them straight into that panic and fight-or-flight mode.
PC: So you’re telling me that the original event programmed them to respond in a certain way – everything that happens to use every day is an event. We respond accordingly like we did the first time or the initial times that it happened in our life. So that event evoked a response that has become a pattern or a way of thinking. And we’re going to go back and start over again and reprogram – clean the hard drive – and reprogram my responses, or remap them to that event, so that when the triggers happen in the future then I can react differently to it in a way that allows me to deal with it without hurting myself or somebody else.
KS: Exactly. Are you sure you’re not a therapist, Phillip?
KM: Well I think one of the things that makes a trauma a traumatic event is that you didn’t see it coming. You were completely blindsided from this catastrophic event that occurred. So there wasn’t any time to prepare to get ready for it and I think that’s what happens with a lot of people is it was not on the to do list or a bad event. This was like totally not in their window of things.
PC: Because I’m a guy. I’m a grown guy and I don’t want to sit in a room full of people and share my feelings. That sounds too… you know. That just sounds too fill in the blank.
PC: Yeah, too girly. So that’s not really what’s going on here. This is more, as I described it earlier, this is get in your head and rebuild something.
KM: That’s the cognitive part.
PC: Yeah. That makes sense to me.
KS: Another thing to touch on is that it can be done in a group setting. There are group therapies to help with PTSD since you said that. And part of that, part of the help for that is obviously helping multiple people at one time with the therapy. But also it helps to find that other people suffering with similar problems kind of gives them a sense of unity with a group of people. So that can be helpful.
PC: The interaction between people with the same problem – in this case, the PTSD – is helpful at times?
KS: It is. Yes. It has proven to be helpful. Another method of therapy is also EMDR. What that stands for is eye movement desensitization reprocessing. And what that means is the therapist works with the person suffering from PTSD in a way that helps them neurologically restructure things and cognitively at the same time. They basically bring up the event and at the same time have the person do certain eye movements. And this is not done all in one session. Obviously it’s process of steps over – it could be up to eight sessions or more. But they really kind of re-expose the person to the event in a safe environment and then have them do certain movements and things that affect them neurologically and that re-maps in their brain the emotions tied to the event. So while that’s kind of a cognitive… well, it is a cognitive thing as well. It’s different than the cognitive talk therapy in that it actually works with the nerves and sense directly to re-map the responses. And that is proven to be really successful with PTSD.
PC: So in your therapy programs – the different ones that are available – do you utilize I’m going to say other patients. I’m not talking about the group setting, but other people who have been there, done that, and are on a decent road to recovery. Are they involved in some manner or not?
KS: In the therapy session?
PC: Yes. At some point.
KS: I’m going to say it depends, only because with HIPA you have to be really careful as to who’s exposed to what in terms of information given. So I probably would never have another patient come in unless they volunteered.
PC: Well perhaps what I’m thinking about is I’ve got it plugged in to the wrong segment of the entire process. Maybe that’s something that’s utilized in the very beginning to get somebody help and into treatment to begin with. You know what I’m saying? Seargent Joe who had the problem and is dealing with it now and has had treatment and whatnot at the VA meetings. You know, he talks to people that think they may or may not, not aware they have a problem. So I’m thinking I just plugged Joe into the wrong part of the process.
KS: Sure. I think I understand what you’re saying. So, in other words, like a mentoring situation where there’s somebody that’s been through that. Sure, I mean I think that would be helpful. Particularly in a situation where it’s military related.
KM: It’s part of the recovery.
KS: It is.
KM: To have mentors who have been there, done that, and can kind of-
PC: Is it?
KM: I would think so. It doesn’t isolate you. It helps break the ice.
PC: It works for the 12-step program.
KM: Yes. Right.
PC: As far as a structured program, you’d want a structured recovery program and I don’t know why a mentor- we’ll have to look into that.
KS: Absolutely. And not only that, but someone else that has been there and can mentor a person also helps normalize the emotions and the things that they’re going through because the person can see it’s not just me. There’s definitely someone else that understands this and they can kind of lead them through the process and help them understand what to expect along the lines of recovery.
PC: Are these sessions with you – are they one on one or is my spouse involved? Or, how does that work?
KS: It can be either way. Typically, it’s one on one, but certainly if the situation is affecting the marital relationship or if the person just wants additional support there with them in order to help them feel more safe in the counseling environment, there can certainly be spouses or other family members involved.
PC: How long does the treatment process last before I’m “normal” again?
KS: Well, that’s a good question. I think it depends. There again, I will say it depends because it wholly depends on the type of traumatic event that someone was exposed to. For example, someone that was sexually assaulted is probably going to have a longer period of trying to get back to the road of healthy (clears through), back to a normal mode of functioning that someone, say, for example, that has been involved in maybe an accident. And I’m talking about an accident where there is no fatalities – that sort of thing. So it depends on the type of trauma. But also, throughout the recovery process, there may be relapses so just because you’ve gone to therapy, you’ve gone through the steps, and you’re coping well with the situation, it doesn’t mean that you may not have some experiences that lead you back down that road a little bit. You’re going to have the tools to cope with it better but you may not necessarily never experience that again.
PC: Okay, so correct me if my understanding is off-track. The cognitive treatment that happens – we’re reprograming our responses, reprograming the way we think. Now we all have – I paid attention in eighth grade – we all have automatic responses and non-automatic responses… whatever that was called.
KS: Voluntary / involuntary?
PC: Thank you, there we go. That’s what I meant.
KM: There you go, Kim.
PC: And we blink without thinking. We can blink when we’re thinking about it, too. So if I understand what you’re saying, I’m going through treatment to reprogram the way I think, the way my response to a trigger. But I have to think about that to make it happen. And over a period of time, it’s going to become automatic. But in the beginning I have to think about it to make it happen, as a rule. And if I forget to think and just default to my automatic response that wakes me up in the middle of the night in the cold sweats swinging at imaginary people, that’s what you’re terming a “relapse”?
KS: Yes. Because even though over time you are going to develop the automatic response that is more healthy and structured way to cope with the trauma, there’s always a chance that you’re going to have triggers that catch you off-guard sometimes. Or possibly other stressors in your life can kind of bring back some of the unhealthy coping responses. So it’s always possible that you’re going to sometimes have a relapse. It doesn’t mean that you have to start back over again because you’ve got the tools there. It sometimes just helps to refresh yourself a little bit on healthy coping responses.
PC: It means you have to realize you got off track and need to get back on track.
KM: But part of the therapy is having that awareness that, “Oh I had a set back. I had… this kind of tipped me over the edge,” and you go back to the therapist and kind of process it. But you have that understanding that, “I think I had a set back,” and you understand it and you’re able to implement all the tools that you did learn but you still need to talk through it. It’s real important.
PC: Am I correct in assuming that because the event was something that happened and is now a memory, that memory is not going to go away. Treatment doesn’t mean that that memory is going to go away, does it?
KS: Right. No.
PC: It means the response is what we’re looking to change.
KS: Exactly. And I will say on that, no it’s important for people to deal with the post-traumatic stress as soon as possible after the event happens because if the person doesn’t seek some type of help in recovering from it, they get stuck in the event.
PC: And the behaviors that come from it.
KS: Right. And they push it back and push it back, trying to avoid dealing with it. But that response is going to come out somehow. It’s like if you keep filling a bucket up with water, eventually it’s going to overflow. You might tell yourself, “I’m not filling the bucket up,” but the bucket’s getting filled up and it’s eventually going to overflow. Same thing with someone that’s dealing with a traumatic event. If they keep avoiding thinking about it, dealing with it – which happens because people don’t want to deal with pain of memories of things. So it’s eventually going to spill out with however they cope.
PC: Does treatment involve… we know there’s talking: cognitive. Is there electrical shock or drugs? What’s involved? Is there a treadmill?
KS: Well I can’t speak to electroshock therapy because I don’t have a huge knowledge base about it.
PC: I was kidding. There’s no electric shock that I know of.
KS: But yes, there are other types of therapy. Exposure therapy was another thing I was going to bring up. What that means is you’re exposing the person to either a place, a similar event, or you’re as closely as possible simulating.
PC: Recreating the event.
KS: Yes. Recreating that event so that they have to basically face their fears. For example, if I had a fear of spiders – and this is not really PTSD – but if I had a phobia of spiders and I couldn’t leave my house all day because I was so terrified that I might run into a spider outside-
PC: Do you know what that’s called? Spiderphobia.
PC: C’mon. This is easy! It’s arachnophobia. I think.
KS: Exactly. It is. But one of the ways that I might be helped to progress beyond that fear is to be around spiders.
PC: You know what it’s called when you’re afraid of spiders and don’t want to leave your house?
KM: Go ahead.
KS: Wait. What?
PC: It is! I saw that on Law & Order, too.
KS: Too funny. You’re on a roll.
KM: You’re on a roll, Phillip.
PC: We may or may not edit that out. I don’t care.
KS: So yeah. So basically, you’re exposing the person to what they fear in a way that you’re also helping them feel safe because you’re there and by the time you expose them to it, you also help them gain some coping skills through the talk therapy or the EMDR therapy. So that when they do face it, they can use what they’ve learned and kind of practice that response so that when they associate the memory with anything else, any kind of triggers that come up, that response becomes natural for them. And so they’ve pretty much faced as close to the event as possible, faced their fear and learned how to respond to it.
KM: In your work with PTSD clients, what do you think is the most important thing that you’ve learned as a therapist to make that first appointment, the second appointment, the third appointment, with someone who’s really having a hard time just being in an office actually talking about it? Walk me through how, why people feel safe with you.
KS: Well, for one thing I verbally tell them, “This is a safe place for you to talk about this.” Secondly, I think using a calm and reassuring manner with the person helps them to feel at ease. Helping normalize the feelings for them is helpful as well. If I looked at them with shock and went, “Gasp! You’re kidding!” everytime they told me something-
KM: That’s not a comfortable place to be, is it?
KS: Right. They probably wouldn’t want to talk to me and so just helping them and empathizing with them and saying, “I would feel that way if I was in that situation as well.”
PC: So you’re specialization in trauma has taught you how to create the atmosphere that fosters recovery?
KS: Yes. Right.
KM: Yeah, your quiet spirit.
KS: Thank you.
KS: You’re welcome.
KS: One thing that I don’t do – and this is important for clinicians to understand – is to say… and a lot of people when they’re trying to reassure someone will say this, but it’s really not helpful in a therapeutic situation is to say, “I know exactly how you feel.” Because the bottom line is you don’t know how that person feels. You haven’t been in their situation, and even if you have, it’s not the same situation. So it’s okay to normalize and empathize with them, but to assume that you know how they feel about it is you kind of want to avoid saying that type of thing to the person.
PC: So in the treatment sessions, is there homework?
KS: Yes. Definitely.
PC: So if somebody wants to find out more about resources available for this, or coming to see you, how would they find you?
KS: They can certainly go online to Lifetreecounseling.com and they can click on my counselor page – Kim Smith. They can schedule an appointment online there if they want to. They can call me at 972-234-6634 ext. 305. They can email me at firstname.lastname@example.org.
PC: Could they just walk in the front door?
KS: Well, they can, but I might not be there.
KM: They could.
KS: But they can walk in the front door if they need help and you need to see somebody – certainly, we’re always there to assist them.
KM: What kinds of words of encouragement or what guidance could you recommend family members of that particular person who’s really suffering with traumatic events in their life? I mean, because a lot of families and friends, colleagues, are seeing their friend or colleague go through something and they don’t know how to help. I mean, what could you recommend to them?
KS: I would recommend trying to be patient with the person and understand that this is not something they’re voluntarily doing – some of the behaviors. They are, at this point, maybe not capable of making rational or appropriate decisions because of the state of mind that they’re in. So just being understanding and compassionate and having some patience with them is important. And if they’re not already getting help, to try to help them seek out therapy and encourage them to see someone.
PC: What I really want to know is: my dad’s turned into a pile of green Jello with this thing. Am I ever going to get him back?
PC: Is there a light at the end of the tunnel?
KS: There’s definitely a light at the end of the tunnel.
KM: It’s painful for those family members to see – that their loved one is not doing really great.
PC: Alright. So that is all the time we have. So we know where to find you, we know about you. And I’m still Phillip Crum, the content marketing coach, and Contentmarketingcoach.us. And the coffee pot is just about empty. So we’ll do it again another time and we’ll dig deeper into trauma and things of this nature. It’s been fun, Kim. Thank you very much.
KM: Thank you, Kim.
KS: Thank you. Thank you, both.
PC: And thanks for listening, everybody.
KM: Thank you, Phillip.
PC: See you next week. And on we go.