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. 

Where’s My Person? Complexities of Adult Friendships

By Concentric Counselor Kelsey Lamm Rottmuller, LPC, NCC

How do I feel by the end of the day? / Are you sad because you're on your own? / No, I get by with a little help from my friends — With a Little Help from My Friends | The Beatles

There isn't anything I wouldn't do for you / We stick together and can see it through / 'Cause you've got a friend in me — You’ve Got a Friend in Me | Randy Newman

If you wanna be my lover, you gotta get with my friends / (Gotta get with my friends) / Make it last forever, friendship never ends — Wannabe | The Spice Girls

And as our lives change / Come whatever / We will still be / Friends forever — Graduation (Friends Forever) | Vitamin C

Having come of age listening to song lyrics like these, and wistfully witnessing the implausible but admirable portrayal of kinship in the 90s sitcom Friends, I,  like many adults, developed certain ideas and expectations about friendship. For example, I grew up believing one should have a best friend and know how to not only make friends but keep those friendships thriving into adulthood.

But what happens when making friends isn’t as simple as swapping parts of your lunch with a classmate, or performing in the school play together? Even in college, school and extracurricular activities provided fertile ground in which the seeds of friendship could blossom, helped along by common interests and schedules structured around shared classes. Once the structured environment of school is removed and we are left to choose our own adventures, the work of maintaining and definition of friendship seems to dramatically shift for many adults. What perhaps once came relatively easily, now actually takes planning, work, and dedication.

In her Psychology Today article 5 Lies About Adult Friendships, Dr. Miriam Kirmayer unpacks and debunks commonly-held myths about friendships in adulthood. Primarily among these is that “by early adulthood, we should know how to make friends and handle the challenges that come with these relationships; that these are skills we learn early in childhood and adolescence, and that by the time we leave college or even high school, we should have it ‘figured out.’ The problem is, not only is this belief untrue, it can make us feel like we’re the only person who struggles and leaves us feeling disappointed, ashamed, or alone. This, in turn, makes it much less likely that we will reach out for guidance or support if (or when) we do struggle.”

The Struggle is Real

I’ve heard from clients, colleagues and compadres alike how challenging it can be to keep friendships alive, reciprocated, and not feeling like one more thing on a never-ending to-do list. Despite all the best intentions, life as an adult becomes increasingly busy as we fill our time with work, family, continued education, and expanding responsibilities. People move away, start families, follow jobs and hustle hard to build a life. This can leave little time and space for what feels like the luxury of friendship.

A friend from college once told me (before moving away and starting a family) that “being friends as an adult means you take turns texting each other ‘we should get together soon’ repeatedly until you die.” While that statement seemed morbid and pessimistic at the time, it also resonated with me as one of the many struggles faced in adult friendships. Everyone is so busy. Not spending time investing in and invigorating friendships can simultaneously feel like an uphill battle and a source of regret or shame.

Then there are those ‘rites of passage’ in adulthood that can make the lack of a best friend or even close friends acutely apparent. In the 2009 buddy/romance film I Love You Man, we see played out the challenge that can arise when one finds a partner to whom they want to commit but struggles to identify a platonic companion to stand by their side. This film has come up in my work time and again when discussing the loneliness and isolation experienced by clients who struggle similarly to identify close companions outside of family or casual work acquaintances. But why do we feel so driven toward close friendships? Why doesn’t simply having a safe, stable life, perhaps even shared with a romantic partner seem like enough?

The Psychology

In his Psychosocial Development Theory, ego psychologist Erik Erikson posited that young adults (defined by Erikson as ages 19-40 yrs) enter the Intimacy vs. Isolation (Sixth Stage) of development, in which they seek to resolve developmental conflicts related to emotionally intimate relationships. These relationships may be romantic and/or platonic in nature. Erikson believed that failure to resolve said conflicts by establishing close relationships could result in an experience of isolation and loneliness. According to the psychology, this sharing of self with others drives not only our romantic partnering, but also our urge to host a game night, share a multi-hour brunch, or schedule that phone call to dissect the latest Star Wars movie with our World of Warcraft guild buddy.

Psychosocial theory also suggests that a strong sense of self enables us to form intimate interpersonal relationships. Hence, feeling disconnected or unclear about our identity during adolescence - who am I? - can contribute to the struggles faced when striving for friendships as young adults. Sequentially, failure to master the formation of lasting relationships can then additionally hinder us from ‘making our mark on the world’, which is the major task of Erikson’s Generativity vs. Stagnation (Seventh Stage) of development (ages 40-65 yrs).

With each developmental stage building or even hinging upon the completion of its predecessor, it makes sense that we would feel pressure to create and maintain friendships even if we are not sure why or tend to err on the side of introversion. How can I ever Pass Go and Collect $200 – or more so – contribute to the world at large and create greater fulfillment, if I don’t have any close friends?

What Can Be Done?

First and foremost, know that you are not alone. As Dr. Kirmayer notes, it is far from uncommon to struggle with friendship as an adult. Often times, our self-imposed beliefs about how a friendship should look, or roles we are meant to play as friends get in our way more than they motivate growth. If you notice yourself falling prey to the ‘shoulds’ and ‘have-tos’, it can be helpful to challenge and reframe those beliefs, by replacing “I really should call my college roommate back” to “I want to call them, I miss our connection”. Chances are, your friends are equally as busy and will be equally as understanding and appreciative to hear from you – even if just for a quick 10-minute catch-up while you finally fold that pile of clean laundry that’s been staring you down from atop the dresser for the past week. Small steps are ok.

A quick “I’m thinking” about you text – or even better, an actual card via snail mail still tells someone they are thought of and valued. It also goes much further than a “like” on social media or racking yourself with guilt to sustain the friendship. Lean into what brings you together rather than what pulls you apart. Did you first bond over a mutual love of quirky 80’s movies? Maybe it’s time for a movie night. You can debate the most quintessential piece of John Hughes’ filmography or how well or not The Breakfast Club translates to a post-baby-boomer demographic rather than bemoaning how you never see each other anymore despite living less than 30 minutes apart. It doesn’t have to be expensive. If going out for dinner or drinks is not in the budget while you save for a down payment on that first home or even just tickets to that music festival you’ve been pining for – perhaps split the cost of ingredients or encourage BYOB and host a make-your-own-pizza kind of night.

Finally, if you find yourself struggling with emotional intimacy in general or feel paralyzed by social anxiety or depression, consider reaching out to a trained therapist or a support group. There are those that want to help, if we let them and can find the courage to ask. It takes strength to reach out for help and trust someone – friend or otherwise – in which to confide.

Thank you for being a friend
Traveled down a road and back again
Your heart is true, you're a pal and a confidant

—Thank You for Being a Friend | Andrew Gold

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. 

Better Understanding Grief & Loss→

By Concentric Counselor Jennifer Larson, LCPC, NCC

During the Spring of this year, I popped onto the Dear Abel and Sofi advice column for the first time and came across a story about a Firefighter’s struggle with grief & loss after he needed to leave the workforce due to injuries he sustained on the job. He was in the rebuilding stage and had recently turned his passion for woodworking into a small business that had been met with tireless effort and financial struggles. While this former firefighter shared his story and posed questions on the advice column, I could not help but see his intrinsic desire to connect with other people as he grieved and was rebuilding his life. Seeking connection, feedback, validation, and ideas from others was a part of this man’s grieving and recovery process.

Reading this story jogged my memory about a blog post I started in August 2018 (and didn’t finish) about grief & loss. At that time, I became re-enlightened about the additional types of grief & loss that exist, namely the loss of thoughtfully designed objects and structures in our country, and the unfortunate outcome this can have on social and human connectivity. I’ll touch upon that later in this blog post.

For many, grief & loss cannot exist without experiencing some form of connection with oneself or others, and rebuilding in the wake of grief & loss cannot exist without human connection. The firefighter's story made me think about my own grief & loss experiences felt during the earlier part of the year.  The flood of feelings and experiences that emerged from within me were great, and subsequently, I decided to really reach out to others.      

During my grief & loss earlier this year, I allowed myself to feel and accept my grief by intentionally creating space and capacity to feel a myriad of feelings.  I also reached deep within to try to understand the messages, gifts, and lessons in my losses. Reaching out to family, friends, my therapist, and colleagues granted me the opportunity to take care of myself and to feel their heartfelt and unwavering support. The swell of feeling cared for, respected and supported by others was truly one of the best gifts I ever experienced.  Eventually, I felt myself naturally propelling forward by carrying my values with me and, yet, creating a semi-new reality ahead. My grieving process, particularly connecting with others, reminded me of the firefighter’s desire to connect with others through the advice column as he grieved and re-built his life.  

For some, grief & loss can be experienced as a harrowing crisis and this crisis can truly be fodder for future opportunities and growth. And, through my own experiences as well as listening to others’ experiences, I have come to truly appreciate that grief & loss comes in many forms and shapes.

Long gone are the days when we thought of grief & loss solely as one facing their own mortality due to a terminal illness or losing a loved one to death. These are most certainly some of the most difficult types of grief & loss people can face in a lifetime as it can bring about great pain and suffering. The loss of a loved one can stir up a deep emotional response, physical and behavioral changes. Other forms of losses can bring about up deep emotional, physical, and behavioral responses and changes as well.

Experiencing a significant life transition (such as entering into college or parenthood), a childhood robbed of important attachment figures or childhood experiences, the demise of an intimate relationship through betrayal & infidelity, and the loss of being connected with one’s feelings or reality by route of escaping into addiction, perpetual distraction or fantasy -- all of these examples fall under the umbrella of grief & loss. 

People who experience grief & loss can go through a number of stages, sometimes in sequential order, other times bouncing back-and-forth among the stages, and for some, remaining stuck in a stage or bypassing certain stages all together. There are a number of identifiable stages of grief listed, one of the more common models is Dr. Kubler-Ross’ modified 7 Stages of Grief & Loss. For brevity, here are those 7 Stages:

1. Shock (Initial paralysis hearing the news)

2. Denial (Trying to avoid the inevitable)

3. Anger (Frustrated outpouring of bottled-up emotion)

4. Bargaining (seeking in vain to find a way out)

5. Depression (Final realizations of the inevitable)

6. Testing (seeking realistic solutions)

7. Acceptance (Finally finding the way forward)

Having the understanding and knowledge of The 7 Stages of Grief & Loss can be instrumental in cultivating understanding which can eventually contribute towards facilitating growth and change. As I highlighted earlier, I believe interpersonal relationships -- connecting with others -- is also important to incorporate during the grief & loss process and survival.  Whether it’s with a trusted family member or friend, therapist, or your community can be healing as your experience and move through your grieving process and recovery. 

Being there for people by exercising empathy, attunement, and being fully present is critical as one heals.  Also, giving yourself permission to be vulnerable to express yourself with people you feel safe with creates a holding space for you and your experiences. Emotional and relational connection like these brings about a deeper understanding of one’s experiences which can then help promote compassion, transformation, healing, and recovery. The emotional-felt experience within a relational context is vital for healing and survival during grief & loss.

I am going to revisit something I referenced earlier in the blog, and I know it may seem like I am veering off (which I am) and going on a tangent, but this is an area I want to weave into the area on grief & loss.   

Around last summer, my mother-in-law remarked how the United States tends to tear down old buildings to make space for newer buildings to be built.  She conveyed her concern about our country undermining the inherent value, respect of others, its history and imprint, and ultimately the loss of felt social and human connection by tearing down old buildings. The decimation of older structures and the lack of integrating new and old buildings together equates with grief & loss for the people of this country.  This was the message I heard, and it struck me.   

The following day after my mother-in-law shared her perspective, I had read "He Knows What You Really Need" article in Psychology Today which highlights Glenn Adamson's perspective on the value of knowing how objects or things are made or cultivated. The article revealed Adamson's book, "Fewer, Better Things"  which highlights the act of purchasing or collecting mass-produced items can water-down the value and connection between consumers (people) and goods. Glenn believes diving deeper into learning more about the maker and the making process promotes greater understanding and respect for the maker and object, and overall promotes social and emotional connectivity.  Mass produced items create a lack of human connection - loss, in other words. Experiencing an artisan’s creative piece awakens our senses and taps into an emotional and human connection with its maker.

And then the following night back in August 2018 (yes, I’m serious about these sequential events), I found myself seeing these same themes emerge in the then new show, "Making It" hosted by Amy Poehler and Nick Offerman. The show is about bringing master craftspeople and artisans together to compete in a friendly and fun environment.  During the crafters' introductions, one of the makers remarked that crafting in today's culture has dwindled down as people expend more time and energy on their phones. Crafting with others creates memories, she added.  Memories filled with emotional and social connections. 

The idea is that thoughtfully-designed, emotionally and physically labored crafts, objects, and buildings promote greater human connectivity. Eliminating them only promotes greater relational loss. I really started to sit with the idea of how the loss of certain physical objects or structures impact us psychologically, relationally, and culturally, and what this could mean for us and perhaps, for human evolution.

Of course, facing a terminal illness or experiencing the loss of a loved one pales in comparison to the loss of not knowing the maker of a vase on your dining room table. I am not making the comparison that both are similar in terms of its impact when it comes to grieving.  But, I do think it’s worth acknowledging that grief & loss comes in many different shapes and forms. It’s not black-and-white.

So, here are my hopes. My hope is we can continue to acknowledge, better understand and define the various forms of grief & loss that touch people in various ways both intimately and globally. That we can all take a leap by vulnerably reaching out to others for support during our own grieving journey. We can be truly available and present to those who are grieving. We can take a moment to think about preventing unnecessary losses. And, we can appreciate the preservation of human connection, particularly in the wake of grief & loss. Because human connection is truly a powerful thing, take it from me.      

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. 

Asking for Help - Not Waving but Drowning

By Concentric Counselor Christian Younginer, LPC, NCC

Not Waving but Drowning

By STEVIE SMITH

Nobody heard him, the dead man,   

But still he lay moaning:

I was much further out than you thought   

And not waving but drowning.

Poor chap, he always loved larking

And now he’s dead

It must have been too cold for him his heart gave way,   

They said.

Oh, no no no, it was too cold always   

(Still the dead one lay moaning)   

I was much too far out all my life   

And not waving but drowning.

I believe this poem verbalizes well a common societal pressure. That is, the need to be happy externally, even if drowning internally. As we go through our day, met with multiple “How’s it going?”, we invariably are trained to answer “fine” or “great”, without the slightest thought. The question we’re left with is: how would anyone know I’m drowning, when I always give them a friendly wave?

Asking for help can be deceptively difficult. Frequently I hear from clients that asking for help shows weakness, or is shameful, or too vulnerable. So, we strengthen our resolve, buckle down, and soldier on at the expense of our wellness and happiness. We become run down, exhausted, and deflated. Imagine a balloon trying to remain the same size, while its air slowly leaks. We receive messages from our families of origin, our employers, and consumer culture that tell us to harden. But the harder we get, the more brittle we become. Rather than naming our need for help, we’re now drowning with work, emotions, schedules, and isolation. 

Ultimately, this issue of asking for help comes down to a person’s struggle with taking care of themselves. Wellness, self-care, asking for help, boundary setting, etc all live in the same neighborhood: taking care of the self. A former supervisor of mine offered this metaphor:

You board an airplane, take your seat, and the flight attendant begins the safety protocols speech. They get to the section on the oxygen mask. They say, ‘please secure your own mask before attempting to assist anyone else.”

Why is that? Well, you can’t help anyone if you’re dead. The same concept applies here, albeit with less grim consequences. How can we expect to function, let alone help others, when we run ourselves ragged?

To return to the topic at hand, one way of taking care of the self is asking for help. Seeking therapy is a form of this. I often name the courage it takes for a client to find a therapist. As we know, it’s hard to find help for ourselves- especially for our mental health. As if the unfortunate stigma isn’t enough, busy schedules and work demands can get in the way. If therapy is two steps too far for you, there are smaller ways to open ourselves to the help of others.

We don’t have to instantly open up and adopt this idea. Rather we can take smaller steps that feel safer. For example, if we have created a default answer of “fine” when asked “how are you?” by random people, then that may have filtered into closer relationships. Those relationships where it may feel safer saying “Actually, I’m struggling.” So, what if we remove the automatic ‘fine’ from our vocabulary? Rather, when asked by a close friend or family member, “how are you?”, we take that question for what it is: an out-stretched hand to a drowning person.

 I think it is unfair to view this poem as an indictment of those who misread the author’s anguish. Rather, I believe it is a call to stop waving when we’re drowning. To let those looking out for our safety, save us. Only from this place of moaning, cold death does the author finally feel safe saying she was much too far out all of her life. If only we, the onlookers, knew this we could’ve helped.

 It is ok to feel you’re too far out. It is ok to feel like you’re drowning. There are those who want to help us, but only if we let them. When we don’t ask for help, we deny our friends and family the gift of being able to help someone they love.