Essential Workers & COVID: Time and Space for You

By Concentric Psychotherapist Kylie Cherpes, LCSW, MFT-IT, CYT

In times of great stress, such as now with the COVID-19 pandemic, we each find that we have our own unique way of getting through. Some people find comfort by burrowing in at home and disconnecting from constant reminders of their fears. Others juggle between caring for their vulnerable loved ones and carving out time to connect with the support that they themselves need. Some turn their stress into energy towards solving problems or creating something new. While others hit the ground running, called to serve their community. Though we are all under cumulative stress and doing our best to face changes in our day-to-day norms, some, such as Essential Workers, are being impacted exponentially. Essential Workers are being asked to do more and risk more, all while having less access to what would normally help them respond to and recover from their stress.  

Essential Workers continue their work in environments physically underprepared for a pandemic. In a time that feels precarious, Essential Workers are asked both to stay calm and to stay flexible while managing ever-changing recommendations on how to keep their workplace, selves, and families safe. They spend hours reading, learning, and preparing protocols and responses to “what-if” scenarios that breed uncertainty and anxiety. Even after all of the precautions they take, they wonder if it will be enough to keep their work-family safe. When they leave work to go home they find it hard to relax as guilt, worry, and fear about possibly carrying the virus home to their loved ones enters their mind. Though they may have reached for their family and friends for help, love, and reassurance before, it now seems too risky. Where they would go for support and stress relief before, like churches, gyms, bars, and social outings, are no longer options. And even when there is time for it, it is hard to get restful sleep. 

When unable to respond to stress, especially on-going (chronic) or traumatic stress, the body, mind, emotions, and spirit start to show wear and tear. Those under chronic stress may notice that raw feelings such as fear, anger, helplessness, and sadness seem to be lingering, or other common changes such as an increase in irritability, numbness, bitterness, or detachment (that “spaced-out” or “distant” feeling). Chronic stress can also show up as headaches, stomach aches, and muscle pain, or changes in appetite and sleep. Sometimes those under chronic stress may not even be the first to notice the impact it is having, but instead, those closest to them do. For instance, slips in memory or ability to recall information, mistakes at work that used to be uncommon, or shifts in hygiene and self-care regime may be noticed by work colleagues. Family and friends of those under chronic stress may see their loved one’s constant exhaustion, zoning out, adopting an abnormally cynical outlook on life, or lacking the ability to find pleasure in things they had once experienced as enjoyable. 

As therapists, we can close gaps in the care being offered to Essential Workers by providing access to the mental and emotional support they deserve. To support Essential Workers’ day-to-day functioning and healing, we hold space for them to process and release stress and trauma. Just as each Essential Worker has their own unique way of responding to their stress and trauma, each therapist has their own unique approach and is able to tailor care to each individual they work with. Whether it be brief or long-term, therapy is a safe place for self-expression and a secure place to find relief from fears, anxieties, anger, and sadness. Further, therapy is a place of creativity and strategy, used for building coping skills to reduce distress and restore feelings of stability and hope. 

At this time, we know that the Coronavirus is not going away anytime soon and that things may indeed get worse before they get better. We also know Essential Workers will continue to be asked to bear the brunt of this pandemic with limited space (time, resources, and support) to respond to their stress in their own unique ways. It is not an option to wait to address the physical, mental, emotional, and spiritual needs resulting from the chronic and traumatic stress being endured by our Essential Workers. Unaddressed chronic and traumatic stress does not just go away, it accumulates. As therapists, we see the effects of these stressful days mounting on our Essential Workers, and we respond to say, “We are your Allies.”

Special Announcement: During April through May 2020, Concentric Counseling & Consulting is offering short-term telehealth and virtual video counseling to Essential Workers during these challenging times due to Coronavirus (COVID-19). We are all incredibly grateful for all that you do and we want to give back! You can use your health insurance for teletherapy. Also, for those who do not have insurance coverage or have certain insurance plans and have endured financial hardship due to the impact of COVID, we are offering sliding fee and pro bono to a limited number of Essential Workers.

How to Open a Door When Coronavirus is Closing our Doors

By Concentric Owner Jennifer Larson, LCPC, NCC

Originally posted in The Sounds newspaper, Volume 43, Number 15 on April 4, 2020 and later in published in the Illinois Mental Health Counselors Association (IMHCA), a division of Illinois Counseling Association (ICA), News Update. Click here.

You know the saying “When One Door Closes, Another Door Opens”? During this time, we can’t help to notice closed doors everywhere, from schools to restaurants to places of worship to retailers. Even our home doors are closed, keeping others away and containing us inside.  It may seem overly optimistic to think this quote holds true during this extraordinary and challenging time with COVID-19 knocking on everyone’s door.  Alarm bells are sounded within us daily, the threats are real and experienced by so many, and some of us feel our life has been hijacked.  So how can we during this time envision doors opening up or experience something positive from all of this? 

I am by no means suggesting doors are flying wide-open given the sheer number of doors that are literally closed and even locked. But, if you can take a moment to pause, focus and be intentional, you may find that you can open doors to otherwise missed opportunities. 

Psychotherapist and author Esther Perel states when faced with our own existential anxieties it can open the door to fully living.  Some of us may have been living life on auto-pilot depriving ourselves of certain reflections, experiences or opportunities. So, what does living fully exactly mean?

It can mean a lot of things, but to start, it can mean experiencing each moment and each day in the here-and-now noticing and appreciating all of life’s offerings. Perhaps you had been more disconnected from yourself, no longer appreciating your talents, thoughts, feelings and your body’s capabilities -- which you can now fully appreciate.  Or taking a moment to get out of your head to be fully present and connected with another person can offer you an opportunity to be transported, experiencing life through a different lens other than your own.  Also, fully activating your senses can bring about a subtle, yet powerful sense of fully living.  Consider next time you take a walk outside, notice all of your surroundings paying attention to each of your senses. Notice your positive feelings as you attune to your senses.  

Shawn Achor, an educator, researcher, and author, offers a number of research-based ways to live a happier life. One of them is to take a few minutes each day to write down 1 positive experience within the last 24 hours and provide 3 rich details about that experience. Also, write down your gratitudes, giving specific details.  And reach out to someone to fully express why you appreciate them.  We know giving to others not only makes us feel better, but helps the person on the receiving end feel happier too.

And last, what is something you can look forward to when the shelter-at-home Executive Order is lifted and you can bust out the sheltered seams?  Will it be something specific such as dining at your favorite restaurant?  A ritual or practice you will reacquaint with again?  For me, it will be telling myself “I get to go here or I get do this” which represents a door opening into seeing how choice and freedom are true gifts.

Remember The Weatherperson?

By Concentric Counselor Christian Younginer, LPC, NCC

What We Wish Life Were Like

The Curiosity rover landed on Mars August 6th, 2012, the end of a flight that began November 26th, 2011-- 9 months prior. At its traveling speeds, all predetermined by NASA’s Jet Propulsion Laboratory (JPL), scientists had to calculate where an orbiting planet would be 9 months from the moment of launch. In fact, they needed to know where Mars would be years in advance as they began building and programming the rover. They were able to plan for, predict, and pinpoint the location of a planet hurtling through space at 53,600 mph, rotating at 532 mph down to the meter to land a rover on its surface.

This is possible due to the predictability of the celestial bodies. Astronomers from thousands of years ago plotted out eclipses for hundreds of generations into the future, with impressive accuracy. It’s that there just aren’t very many variables in space; bodies in motion stay in motion, unless a force acts on them. And if no force does, they keep on trucking. Thus, their location is predictable. This does not mean that any part of landing a rover on another planet is easy--it’s just possible.

What Life Is Actually Like

Conversely, it is a common occurrence that shuttle launches are cancelled, last minute, tanks fueled, on the pad- due to weather… Earth weather. A shuttle, bound for space, to another planet, is grounded because humans cannot accurately predict the weather more than a couple of days out. And even then it can be a crapshoot. 

The reason for this comes down to something much more akin to living life: variables and information. There are simply too many variables to predict and too much information we’re not able to know. For example, if I knew the direction and velocity of every air particle on Earth, I could give you an accurate weather model. Obviously, this is not possible. So we’re left making educated guesses, working with what we have, and most importantly a social understanding that forecasts are guesses, not gospel. With this understanding comes a grace--sometimes annoyance--but a grace for being wrong. An ‘it’s out of our hands’ amenableness that wonderfully conflicts with the modern American desire for planning, preparation, and predictability. 

What Can We Do?

So often we try to plan for every eventuality, scrutinizing the details, languishing in an anxious mire of a desire for control, only to see our plans crash into a Martian hillside, due to an unforeseen variable. 

Often, the anxious try to view life with such a level of predictability. Hopes that the world will fit into plans and preparations, only to be disappointed when something unaccounted for goes awry. Often times this desire for control flows into our lives as a nagging generalized anxiety, a worry for all things in an effort to be prepared for every outcome. We wish life were as predictable as space travel. As oxymoronic as it sounds, going about our day may be more complicated than rocket science. And we tell ourselves that the stakes are just as high. 

As mentioned in regards to weather, the secret lies in the ability to tolerate the ambiguity of an uncertain system. We can be disappointed with an inaccurate weather report, but continue on to the next day. Yes it can suck when it rains when the news said it wouldn’t, but we don’t hold ourselves responsible for the outcome. In our own lives, we can place an enormous amount of responsibility on ourselves, often for things not in our control. We can assault ourselves with a barrage of ‘should have planned for it’ , ‘should have seen it coming’, or ‘should have done it differently’. All of which are the equivalent of looking at Tuesday’s weather and telling yourself you should’ve known that on Monday. 

Maybe we can have the same grace for the weatherperson, AND with ourselves. If we get it wrong, be disappointed for a bit, be annoyed, but let it go. Tomorrow is another day to try again. If we find ourselves feeling anxious about the ambiguity of life, rather than try to think out the outcomes, what if we gave ourselves permission to feel anxious for a bit? Feeling anxious about the ambiguity of every day is not a failing, but rather an admission to one’s self that we don’t have enough information. And instead of punishing ourselves for trying to know something we can’t, maybe we can have a little grace with ourselves, and remember the weatherperson. 

The Trap of Anxiety and Trauma

By Concentric Owner Jennifer Larson, LCPC, NCC

This blog post was originally posted on the Anxiety Relief Project’s website as the Founder was asked to be an expert contributor. The Anxiety Relief Project and website are no longer active. Jennifer Larson, LCPC, NCC is the Owner of Concentric Counseling & Consulting, a private practice group in Chicago that specializes in relationship and couples struggles; tween, adolescent and family issues; complex and relational trauma; anxiety, depression and bi-polar disorders; mind-body connection; life transitions and stress; the self and identity; substance abuse; and unresolved family-of-origin issues. Jennifer has experienced complex trauma, anxiety, and post-traumatic growth and is passionate about helping others who have endured similar struggles. Over the past 2 years, Jennifer has started sharing more about her personal struggles and growth in an effort to help de-stigmatize mental health.

Driving my car in my early adult years filled me with freedom and curiosity. Didn’t matter if I was driving by myself, on city streets, highways or traversing the deserts of Arizona, I loved driving. Toggling between radio stations to find the right tune, opening up the windows to feel the fresh air hitting my face and throwing my hair around, hanging out with my thoughts, or being mesmerized by the pink and purple hues of Arizona’s sunsets were met and felt with ease, peace, and freedom. Fast forward several years later, and my experience of driving catapults me into feelings and sensations of feeling trapped and crippled by anxiety, panic attacks, and at times, dissociation.

White-knuckling my steering wheel bound by the perpetual ticking of the clock, shouting at me to be here and there at this time. “Hurry up!” is my internal mantra. Truth be told, my life was definitely more stressful during that time. Let’s face it, chronic stress does not do anyone any favors, much less me who has endured the impact of years of complex trauma and its anxieties that are married to it. 

It started with commuting on I-90 expressway in Chicago as I began to feel a tinge of anxiety and thoughts about possibly becoming trapped in gridlocked traffic with no easy way to escape. The first spider silk strand of anxiety over time grew and grew into an unwieldy, dense web that ended up trapping me. Inching closer as I merged onto the express lane, I experienced frantic and dreadful panic as I imagined being stuck in the express lanes flanked by 4 rows of cars on either side of me where escape was next to impossible. Knowing the gift of extra time – a much coveted commodity - would be more favorable to me if I chose the express lane during my commutes. However, I now found myself avoiding it all together because my anticipatory anxiety of driving in the express lane, even the night prior, crept in and simply took over me. 

Avoiding the express lane did mitigate my anxiety, but it was a temporary solution at best. The same level of anxiety and panic now started to emerge when driving on the regular lanes on the highway. My heart-racing, tingling sensations in my lower legs, sweating hands and unfriendly thoughts befriended me. Panic attacks started to fuse into a strange hybrid of disconnect and escape sensations. I wish I were describing a feel-good, daydream-state of imagining being in a beautiful place that evokes happiness and ease, but this type of disconnect and escape experience that later emerged is called dissociation. 

When dissociation occurred, I would experience a sense of not feeling attached or even inside of me, but rather sucked into a vast abysmal, ominous space from above me. This experience was the most terrifying of them all. Other times, I would experience my surroundings as a surreal place, almost as though the cars and buildings were toy-like, not real. These experiences felt like transactional moments as if I was holding onto a roll of processed film looking at each frame-by-frame. During these times, I was not embodied, but rather detached from myself as I experienced both de-personalization and de- realization which are dissociative states.  These were all very new experiences for me.

Drifting in and out of anxiety, panic, and dissociation soon became more commonplace. Perpetual thoughts and sensations of being revved up, anxious, scared, wanting to escape, and seeking a place of refuge became a part of my lived experiences. 

This Is The Trap of Anxiety and Trauma

Learning about the connection of anxiety and trauma from a neurobiological or neuroscience perspective greatly helped to illuminate and normalize my experiences of anxiety and traumatic stress, and allowed me to move from being the driver to a driving instructor. I started to understand how my own past complex trauma coupled with chronic stress impacted my health. This knowledge also helped me in my own therapy journey as well as with helping my client’s. To better understand the neuroscience of anxiety and trauma, let’s first begin with a basic understanding of human’s nervous system and the brain. 

The Triune Brain 

There is some debate around this; some people believe in the triune or 3-part brain model, while others believe this is too simplistic. For brevity sake, let’s look at the different parts of the triune brain and its respective functions: 

• Brain stem: This is often referred to the reptilian or primal part of the brain which is responsible for instincts, survival and autonomic body processes, such as breathing, eating, blood pressure, sleep, and regulating the central nervous system. 

• Mid-brain: This is where the limbic system is housed and is often referred to the mammalian or emotional part of the brain. The limbic system is largely responsible for processing emotions and feelings, implicit memory, sensory somatic experiences, and hormonal secretions. The amygdala plays a role in autonomic responses to fear. The hippocampus plays a role in memory. 

• Fore-brain: This is where the neocortex is located and is often considered the Homo Sapiens, modern or highly evolved part of the brain. This part is responsible for processing intellectual, language, abstraction, and executive functioning, such as decision-making. The dorsolateral prefrontal cortex is the time-keeping part of the brain. 

The Nervous System 

The nervous system has 2 parts - the limbic system and the autonomic nervous system. The limbic system is a portion of the brain that deals with the functions of our emotions, memory formation, and arousal. The limbic system consists of the hypothalamus, the hippocampus, the amygdala, and several other structures. The hippocampus helps to regulate our autonomic nervous systems by regulating our breathing, blood pressure, pulse, and arousal in response to emotional circumstances. The amygdala plays a role in autonomic responses to fear and the hippocampus plays a role in memory, such as converting short-term memory into long-term memory. 

The autonomic nervous system is composed of 2 opposing parts: the sympathetic nervous system (arousing) and parasympathetic nervous system (calming). When both systems our in sync, we feel 

balanced and centered. The sympathetic part our system is highly involved when we face a threat or something dangerous as it enables us to go into “fight or flight” mode. Eventually, the opposing parasympathetic system helps bring our nervous system back to a state of calm and relaxation. For people who feel too much sympathetic arousal, the parasympathetic system can take over causing a person to go into “freeze of collapse” mode, otherwise known as shutdown. In the shutdown mode, the dorsal vagal, parasympathetic system is activated causing a person to dissociate, faint, or become immobile. This survival mechanism is similar to an animal that lies completely still, feigning its death hoping for the predator to go away. 

Anxiety 

Anxiety is a psychological and physiological response to fear, danger, or threat. When we are faced with a threat – a real or perceived threat - or memory that reminds us of former threat, our nervous system swiftly responds through an intricate and interconnected network by going into fight-flight-freeze-or collapse mode. The amygdala gets activated, certain hormones are secreted pouring into the body, and the body is primed to behaviorally respond in either fight-flight-freeze-or collapse mode. This amygdala activation is akin to a smoke detector going off when there is an excess of smoke that is trapped in a home. The alarm system goes off to warn and signal people to get out of a dangerous situation. As in the case with anxiety or trauma, actual smoke or perceived smoke trip the smoke detectors to go off. 

Many studies have shown there is a link between what happens in one’s nervous system and those who suffer from anxiety. For instance, when a person is faced with a fear or even a conditioned fear (such as arachnophobia or any other type of phobia), the amygdala is activated, signaling to the person’s body that they are in danger. Neuroscience explains what occurs within the brain and autonomic nervous system. Therapy can help people understand how anxiety impacts 4 areas: cognitions (or thoughts), emotions, physical sensations, and behaviors. To illustrate, a person who has social anxiety (or fear of public speaking) may think others will judge or criticize them, feel insecure and embarrassed, have physical sensations of heart racing, dry mouth, shallow breathing, and behaviorally may pace back-and-forth when speaking. A person who suffers from panic attacks might think they are going crazy, feel overwhelmed and anxious, experience intense and overwhelming physical sensations, and may behaviorally try to escape their environment. All of these examples of anxiety involve the nervous system. Similarly, those who suffer from traumatic stress experience thoughts, emotions, behaviors, and sensations as those with anxiety. 

Trauma 

Trauma involves a loss of choice in which a person faces a single dangerous event, series of overwhelming threats (or neglect) or when a person recalls threatening memories in which that person feels unsafe or trapped. Not everyone who faces a threat or something dangerous will experience traumatic stress, but for those who do, their autonomic nervous system continues to be in a longer-term state of dysregulation. People who have a traumatic response may find daily life as threatening even if there is no actual or rational threat present. Studies* have shown the dorsolateral prefrontal cortex or the time-keeping part of the brain goes offline and shuts down, consequently, the traumatic memory 

and internal experience feels like it is perpetually present (*nicamb, National Institute for the Clinical Application of Behavioral Medicine, Treating Trauma Master Series). People who suffer from Post Traumatic Stress Disorder (PTSD) or Complex Trauma (C-PTSD) share feeling unsafe, trapped, crippled, or limited. 

In addition to feeling anxious, people with traumatic response can also become disembodied and detached from oneself by route of dissociation. When someone dissociates, the dorsal vagal nerve shuts down and immobilizes the body. As people have described (and I surely can attest), it feels like one has been hijacked or assaulted from within. 

For me, I found driving on the highway with limited ability to escape as threatening. It didn’t matter if it was a real or perceived because my mind and body responded as though it was a real threat. It is critical that our built in alarm systems in the brain and body respond when faced with real threats so we can find a way to escape them and ultimately survive in the end. But as you may suspect, it’s not so good when our alarm systems are going off constantly when there are no or minimal threats. 

Once the threat retreats or we are able to thwart off the threat, for some people, their body discharges the excess energy caused by hormonal secretions that had been initially resourced and ignited to return back to a state of balance and integration. This is a healthy response as people can function well and go back to business as usual with a sense of ease, mobility, curiosity, and even play. However, for some other people, as in the case with me, people who face anxiety, chronic stress, or trauma, this discharge of energy does not occur, but rather the brain and body are stuck in a recycling and dysregulation mode. In these occurrences, people walk through life seeing, feeling, or sensing threats around them as though they are walking in a minefield, which in turn, constantly pulls on those internal alarm systems, secreting and overloading the system with hormones, and maintaining dysregulation. 

Free Yourself from The Trap of Anxiety and Trauma 

Knowledge and research provides concrete explanations as to what happens to people when faced with anxiety, chronic stress, and trauma. And, research has demonstrated what can help people manage and overcome its impact. Knowledge is power. There are a number of respectable and beneficial treatment options, both traditional and non-traditional. I do not believe in a one-size-fits-all approach. Medications, supplements, and a healthy diet are important considerations. Mental health therapy, both top-down and bottom-up approaches are helpful remedies, such as Cognitive Behavioral Therapy (CBT), Somatic Experiencing (SE), Prolonged Exposure Therapy (PE), and Sensorimotor Psychotherapy. Learning how to practice being in the here-and-now with mindfulness, meditation, and grounding techniques is useful. Good sleep and exercise are essential. And, of course, surrounding yourself with healthy, safe people and spending time in nature and spirituality are key. I can personally attest to the power and effectiveness of an integrated approach to escaping the trap of anxiety and trauma. Your options are limitless and there is hope for healing. 

I would like to acknowledge the following professionals as my blog post draws from the expertise, work, and writings of Bessel van der Kolk, MD, Stephen Porges, Ph.D., Pat Odgen, Ph.D., Peter Levine, Ph.D., Dan Siegel, MD, Ruth Lanius, MD, Ph.D, Paul Maclean, MD, David Carbonell, Ph.D., C. George Boeree, Ph.D., David Puder, MD, and nicamb, National Institute for the Clinical Application of Behavioral Medicine, Treating Trauma Master Series.

Let's Talk About Complex Trauma

By Concentric Counselor Jordan Perlman, LPC, NCC

I imagine many people have heard of Post-Traumatic Stress Disorder (PTSD) but not nearly as many are familiar with Complex Post-Traumatic Stress Disorder (C-PTSD) which is lesser-known and unfortunately, not yet recognized in the Diagnostic and Statistical Manual of Mental Disorders Fifth Edition (DSM-V). And while an individual with a PTSD diagnosis, which is often the result of an isolated incident, a person who experienced complex or repeated traumas requires different considerations.

But first, it’s important to understand the differences between each:

PTSD

According to the DSM-V, PTSD is diagnosed when an individual meets the following criteria that create distress or functional impairment last more than one month, which is not a result of medication, substance use, or other illness. The individual was exposed to one of the following: 

• Death or threatened death 

• Actual or threatened serious injury

• Actual or threatened sexual violence 

• Witnessing trauma

• Learning that a relative or close friend was exposed to trauma 

Indirect exposure to aversive details of the trauma (usually in the course of professional duties), the individual must have at least one intrusive symptom that causes the persistent re-experience of the trauma in the following ways:

• Nightmares

• Flashbacks

• Emotional distress after exposure to traumatic reminders

• Physical reactivity after exposure to traumatic reminders

The individual must also experience avoidance of trauma-related stimuli after trauma either by trauma-related thoughts or feelings, or trauma-related external reminders.

Two negative alterations in cognitions and mood must be present where the negative thoughts or feelings began or worsened after trauma in the following ways:

• Inability to recall key features of the trauma

• Overly negative thoughts and assumptions about oneself or the world

• Exaggerated blame of self or others for causing trauma

• Negative affect

• Decreased interest in activities

• Feeling isolated

• Difficulty experiencing positive affect

 Lastly, there must be alterations in trauma-related arousal and reactivity that began or worsened after trauma in the following ways: 

• Irritability or aggression

• Risky or destructive behavior

• Hypervigilance

• Heightened startle reaction

• Difficulty concentrating

• Difficulty sleeping

 C-PTSD

Trauma typically associated with C-PTSD tends to be long-term, where the individual is generally held in a state of captivity, physically or emotionally. In these situations, the victim under the control of the perpetrator has little or no chance to get away or escape from the danger. Some examples might include:

• Long-term domestic violence

• Long-term child physical and/or sexual abuse

• Neglect

• Organized exploitation rings

• Concentration/Prisoner-of-War Camps

• Prostitution brothels

• Recruitment into armed conflict as a child

• Sex trafficking or slave trade

• Experiencing torture

• Exposure to genocide campaigns

• Other forms of organized violence

Some might be wondering, why is this difference important then? This is because of exposure to long-term or prolonged or repeated trauma results in a broad range of symptoms that go beyond the diagnostic criteria of PTSD, a.k.a “simple” PTSD.  As such, the basic symptoms of C-PTSD are:

• Somatization (physical problems, associated pain, and functional limitations)

• Dissociation (a division of the personality into one component that attempts to function in the everyday world and another that regresses and is fixed in the trauma, spacing out, daydreaming, or feeling strong sensations of being disconnected from one self or the world)

• Affect Dysregulation (difficulty with emotions, such as experiencing and/or expressing them, alteration in impulse control, attention and consciousness

• Self-Perception (experience of their own perspective tends to be drastically different from how others perceive them)

• Interpersonal Relationships (tend to be a struggle, difficulty with engaging with others, feeling distrustful of others)

• Perception of Perpetrators (can be skewed, or longing to be loved by their abuser)

• Systems of Meaning (doubt there is any goodness in the world, outlook on life can be dark)

Further, a 2018 study by Karatzias et al. found the most important factor in the diagnosis of C-PTSD was negative cognitions about the self, characterized by a “generalized negative view about the self and one’s trauma symptoms; attachment anxiety which is defined as involving a fear of interpersonal rejection or abandonment and/or distress if one’s partner is unresponsive or unavailable; and expressive suppression, conveyed by efforts to hide, inhibit, or reduce emotional expression.”

For those who may wonder why people affected by a long-term trauma “can’t just get over it,” the answer lies in the fact that even after a person is removed from the event, their brain may be permanently affected by that intense and prolonged trauma. And since a person’s nervous system is shaped by his or her experiences, stress and trauma over time, can lead to changes in the parts of the brain that control and manage feelings and the long-term effects are found on a physical and emotional level.  

Symptoms may manifest as:

• Eating disorders

• Substance abuse

• Alcoholism

• Promiscuity

• Chronic pain

• Cardiovascular and gastrointestinal problems

• Migraines

• Rage displayed through violence, destruction of property, or theft

• Depression, denial, fear of abandonment, thoughts of suicide, anger issues

• Flashbacks, memory repression, dissociation

• Shame, guilt, focusing on wanting revenge

• Low self-esteem, panic attacks, self-loathing

• Perfectionism, blaming others instead of dealing with the situation, selective memory

• Loss of faith in humanity, distrust, isolation, inability to form close personal relationships

Special Considerations for Survivors of C-PTSD from Childhood 

Many survivors of C-PTSD also experience Attachment Disorder which is a huge consequence of individuals who suffered complex trauma as children. Attachment Disorder is the result of a person growing up with primary caregivers who were regularly dangerous. Recurring abuse and neglect habituate children living in fear and sympathetic nervous system arousal, which over time creates them an easily triggerable abandonment mélange of overwhelming fear, shame, and depression. 

Because a child’s main attachment (to their primary caregiver) helps them learn to control their emotions and thoughts, when a caregiver’s responses are in tune with a child’s needs, the child feels secure. The child then uses this relationship pattern as a practice to build coping skills.

However, children who receive prolonged confusing or inconsistent responses from their primary caregiver are prone to be fussy, have a hard time calming down, may often withdraw from others and may have frequent tantrums. Unlike adults who have more tools to understand what is happening to them, children often do not possess these skills or have the ability to separate themselves from another’s unconscionable actions. Consequently, the resulting psychological and developmental implications become complexly woven and spun into who that child believes themselves to be, thereby creating a messy web of core beliefs that are harder to untangle than the flashbacks, nightmares and other posttraumatic symptoms that may surface later. Further, these disorganized attachments and mixed messages from those who are supposed to provide love, comfort, and safety - all in the periphery of extreme trauma - can create even more unique struggles that PTSD-sufferers alone don't always face.

Treatment Considerations 

While the symptoms can be daunting and the future seems bleak for someone who appears to be suffering from C-PTSD regardless of whether an individual has been diagnosed with a trauma-related disorder or not, there is help out there and there are ways to manage and help the individual cope. 

Treatment challenges include, Survivors:

• Avoiding thinking and talking about trauma-related topics because the feelings associated with the trauma are often overwhelming

• Relying on alcohol or other substances as a way to avoid and numb feelings and thoughts related to trauma

• Engaging in self-mutilation and other forms of self-harm

• Who have been abused repeatedly are sometimes mistaken as having a “weak character” or unjustly blamed for the symptoms they experience as a result of victimization and often have comorbid disorders such as dissociative identity disorder (DID), other specified dissociative disorder (OSDD), borderline personality disorder (BPD), depressive or bipolar disorders, anxiety disorders, obsessive-compulsive disorders, eating disorders, and substance abuse

Since many trauma specialists see Attachment Disorder as one of the key symptoms of C-PTSD, a relational, individual, approach will often be most beneficial for many of these clients. For many survivors, therapy is the first opportunity to have a safe and nurturing relationship.  Therefore, the therapist must be especially skilled to create the degree of safety that is needed to build trust or risk adding to the attachment trauma. Working with these clients is essential to the development of trust and relational healing and the four key qualities are empathy, authentic vulnerability, dialogically (when two people move fluidly and interchangeable between speaking and listening) and collaborative relationship repair. This makes therapy a teamwork approach where there is mutual brainstorming and problem-solving in a respectful way implying mutuality. All of these steps will provide the client with a “good enough secure attachment” to serve as a model for other relationships. 

However, and as expected, there is no “one size fits all” approach to working with individuals who have survived trauma, but one thing is for certain: recovery from Complex PTSD requires restoration of control and power for the traumatized person. Survivors can become empowered by healing relationships which create safety, allow for remembrance and mourning, and promote reconnection with everyday life. 

If you feel as though you have experienced complex trauma, it is important to know what happened to you was not your fault. While it is undeniable trauma changes the way we experience the world, I strongly believe like a phoenix, a person who suffered from trauma can arise from the ashes, stronger than ever before. This “stronger than ever before” is also known as “Post-Traumatic Growth.” Post-Traumatic Growth identifies a shift in personal strength and worldview as a consequence of trauma. Although you can’t change it, you can change what your life looks like going forward. One step you can take towards recovery is calling to schedule an appointment with a therapist who can help guide and support you on your healing journey. 

The Value of Vulnerability

By Concentric Counselor Christian Younginer, LPC, NCC

Life XXXV by Emily Dickinson

I CAN wade grief,

Whole pools of it,—

I ’m used to that.

But the least push of joy

Breaks up my feet,         5

And I tip—drunken.

Let no pebble smile,

’T was the new liquor,—

That was all!  

Power is only pain,         10

Stranded, through discipline,

Till weights will hang.

Give balm to giants,

And they ’ll wilt, like men.

Give Himmaleh,—         15

They ’ll carry him!

Emily Dickinson’s word choice in the first line sticks with me- she can “wade” grief. She can trudge through the thick, tarry mire of sadness, pain, loss, and sorrow. It really feels like that, doesn’t it? This viscous bog of grief, she’s “used to that”. It’s familiar for her. But joy is foreign. 

Although she can bear the pain of life, let life surprise her with joy and she will stumble, drunkenly. This voices a common human experience: Let something test our resolve, and we will meet that challenge. But let us be vulnerable, and we will dissolve.

It is easier to harden, than to soften. Give comfort and love to giants, and they will “wilt” into ordinary men, but ask them to carry mountains (‘Himmaleh’ is the archaic form of ‘the Himalayas’), and they will offer up themselves.

This brings us to the question of this post: How does a person allow themselves to be vulnerable, without wilting? How do they remain resilient when life gets hard, without hardening themselves?

What is vulnerability?

The insightful Brené Brown defines vulnerability as both “the birthplace of love, belonging, joy, courage, empathy and creativity”, but also as “uncertainty, risk and emotional exposure” (Daring Greatly). So, our options are: recoil at the latter and tell ourselves we don’t need the former OR accept the latter because we accept that we need the former.

There were times in my life where I clung to the idea that ‘ I don’t need others’- to avoid feeling exposed. That idea eventually spoiled, and I was faced with the reality that I DO need others. While I was aware of the fact, I had not yet accepted it. It was not until I accepted that I need others that my journey towards understanding vulnerability began.

Being vulnerable feels like the difference between writing in the 3rd person and 1st person. It is keeping others at a distance, to avoid the pain of feeling exposed- of not being accepted. If you notice, I switched from using “they” and “them” to “I” and “we”. As I wrote, I noticed feeling exposed, but I also noticed feeling satisfied with my self-awareness and honesty. That is, I felt joy in sharing this part of myself so that it might be of help to someone. It is this ‘trade-off’ that I believe Brené Brown is describing. If we can be ok with feeling a little exposed, we can receive wonderful gifts of acceptance, approval, validation, and love.

The Alternative.

In my pursuit of understanding vulnerability, I came to a choice. Would I rather feel uncomfortable or alone? My choice to embrace vulnerability and accept the possible “emotional exposure”, speaks to not only my desire for connection with others, but to the horror of the alternative: feeling alone. Jumping from a burning building does not mean that jumping is not scary, rather the alternative is too horrifying to consider.

Resilience.

What I am suggesting almost seems oxymoronic: Become vulnerable to become stronger. Invulnerability is not a superpower. Unless Superman exists and no one told me. Rather, accepting that we need others is the true superpower. One powerful result of letting ourselves connect is resilience. That is, if we temper ourselves in the furnace of vulnerability, we become stronger than we were. This is possible due to what Brené Brown references as the gifts of vulnerability: love, belonging, joy, courage, and empathy. Having these in our arsenal make us stronger humans, less prone to burnout and emotional distress.

Let us learn to enjoy the intoxicating effects of joy and not let it cause us to stumble. Carry the mountain if asked, because you are strong enough to shoulder it. But also do not wilt at receiving comfort or help. If we accept that we not only need others for support, but also that they have gifts to offer us, we become stronger. More resilient to carry the mountains when we need to and more courageous to be vulnerable when we just can’t carry anything else. It is the courage and strength to say: “ I’m not ok right now. But I will be.”

Finding Balance Between Healthy and Unhealthy Anxiety

By Concentric Counselor Charles Weiss, LPC

There are 10 seconds left of the clock in the state championship game and your team is down by 2 points.  You have the ball and the fate of the team is in your hands on what will you do next, either pass or take the game winning shot.  Sweat is protruding down your face, your heart is beating a thousand miles a hour, your mind is racing with a million and one different case scenarios on what you should do and then your anxiety starts to take over.  However, you realized that your anxiety has allowed you to think quicker on your feet and make better decisions, because you don’t let it control and consume you.  3, 2, 1 and throw up a prayer of shot from about 35 feet away from the basket, knowing that being vulnerable to your anxiety, you can live with the consequences…  Swish!  Game over and you have just won the state championship for your team.

Anxiety… What is it and what does to mean to us when it begins to take control; do we let it control our consciousness or embrace it as an opportunity of growth and self-discovery?  According to dictionary.com, anxiety is defined as “a feeling of worry, nervousness, or unease, typically about an imminent event or something with an uncertain outcome.”

When outcomes are uncertain to us in which we want to control, but can’t, anxiety can consume our every decision, thought and feeling.  It leads to panic, fear and vulnerability to the unknown, having us over-analyze every decision we make, postulating those “what if” scenarios.  Anxiety can so debilitating to someone when it’s severe and impacts our day-to-day activities.  Plain and simple, anxiety can suck!  Nobody wants to constantly live a life of panic, fear, worry and dread, wondering all the time, “What if?” When you let anxiety take control and inhibit your ability to just be “you”, it becomes unhealthy.

Is there a way to gain back that control over anxiety before it begins to consume us, crippling our sense of self and being vulnerable to “What if…?”  Anxiety is your body’s indication that something isn’t right, like a built-in warning system indicating that your homeostasis might be out of balance.  When we listen to our body as it talks to us and yes, our body does speak to us, you can begin to prepare and embrace for its impact and figure out how to manage it. Certain symptoms to be mindful of that can alert us when something “isn’t right” and anxiety begins to manifest itself within us, are the following:

·        Racing thoughts

·        Irritability

·        Headaches

·        Nausea/upset stomach

·        Disturbed sleep

·        Muscle tension/tightness

·        Shortness of breath

·        Mind going blank

·        Difficulty concentrating/focusing

·        Fatigued

·        Palpitations

When we are able to listen to these symptoms we experience, then we can to things to keep these symptoms in check before they exacerbate. Taking the time to do a body scan, deep breathing exercises, mindfulness exercises, progressive muscle relaxation techniques can all help keep the heightened level of anxiety at bay.

Can anxiety be healthy?

Anxiety can also be a way to motivate yourself to reach your goals and achievements that you have established.  It can better help prepare yourself to face as well as overcome challenges. When we approach anxiety as a hindrance, it can become unhealthy. You can instead capitalize on it as more of a way to inspire your self-growth and to live a more authentic life.  According to Katharina Star, Ph.D., anxiety is another way people can be more empathetic towards other people’s issues and concerns, and help with how they interact with others. She also stated that individuals who struggle with anxiety are often more cautious thinkers, problem solvers and decision makers because they are often building-in “back-up plans” for when things go wrong. 

Bottom line, anxiety isn’t always bad and unhealthy when individuals experience it, it can be a way people thrive if they are able to recognize it, understand it, and know how to cope and properly channel the healthy aspects of it. People can still live fully authentic lives when experiencing anxiety, it’s when it takes control and we begin to panic, that derails aspects of our lives.

If you are experiencing at least 3 symptoms of anxiety, that have been affecting your ability to function on a day-to-day basis in a variety of settings (i.e.: school, work, home) and those symptoms have been occurring for at least 6 months in which you find it very difficult to control that worry and anxiety, please contact your local mental health provider and schedule an appointment with a professional who can help you learn how to regain control over your anxiety and transform it into a healthier form of anxiety for you.