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for April, 2015

Acceptance in the Treatment of Trauma

Posted on April 17, 2015 in Uncategorized - 0 comments - 0
Clinical Psychogist, Erika Fiorenza

Clinical Psychogist, Erika Fiorenza

By Erika Fiorenza, Clinical Psychologist

Psychological distress is considered a normal and natural reaction to trauma. However, a small proportion of trauma survivors may go on to develop trauma associated disorders which have a significant impact on their functioning and quality of life. Individuals with Post Traumatic Stress Disorder (PTSD) often struggle with painful and unwanted memories, thoughts and feelings. They may, quite naturally, spend a lot of energy on avoiding or escaping these painful private experiences and situations or cues related to the trauma (Walser & Hayes, 2006). This avoidance is considered to be a core psychological process in both the development and maintenance of PTSD (Orsillo & Batten, 2005).

Acceptance and Commitment Therapy (ACT) is a behaviourally based and empirically validated intervention that is well suited to the treatment of PTSD. It targets decreasing experiential avoidance, including unwanted feelings, thoughts or memories, while increasing acceptance of these painful experiences in order to move in a valued direction.

Dr Robyn Walser, a leading expert on the use of ACT for PTSD, was recently in Australia conducting her training workshops. She highlights the paradox that can occur following a trauma. As clients do everything to avoid all the things related to the trauma, the trauma is always present. As such, the past becomes their future (Walser & Westrup, 2007). As she succinctly puts it: If you don’t want it, you’ve got it.

Dr Walser differentiates pain from suffering. She explains that it is the judgement, evaluation and avoidance of the pain that leads to suffering. “It is in this place that suffering occurs and grows” (Walser & Westrup, 2007).

ACT focuses on helping clients shift from a position of avoidance to one of acceptance and willingness. Acceptance can be defined as openness to internal experiences. To “willingly take what is offered… without protest or reaction” (Walser & Westrup, 2007). Acceptance does not suggest that the trauma was ‘okay’, but teaches an alternative to the usual response to pain by reducing the struggle with it.

Clients are taught to “decrease suffering by showing up to the natural response and letting it be what it is: a thought, a feeling, a memory…it is not a diminishing of experience, but a presence to and acknowledgement of it – a gentle observing” (Robyn D. Walser, 2015).

In the treatment of PTSD acceptance further suggests that individuals are more than their experience of the trauma. We are beings who experience, not beings who are the experienced (Robyn D. Walser, 2015). This position of acceptance helps broaden a survivor’s range of responses so that other meaningful outcomes can be pursued.

In ACT, acceptance is taught through a variety of mindfulness skills. Mindfulness creates a place from which acceptance is possible (Walser & Westrup, 2007).  Mindfulness teaches clients to be aware in the moment, and be present to ongoing experiences. This is particularly relevant to individuals with PTSD who can be caught in the past, or worrying about the future.

Through mindfulness and acceptance, clients are taught to connect with their sense of self and move forward in the direction of their values. This is a crucial next step in acceptance as it emphasises taking action in the presence of painful and unwanted private experiences.

For more information on Erika and the team of Psychologists at Psychology Consultants, visit www.psychologyconsultants.com.au

References 

Orsillo, S.M. & Batten, S.V., (2005). Acceptance and Commitment Therapy in the Treatment of Posttraumatic Stress Disorder. Behaviour Modification, 95, 95-129

Robyn. D. Walser http://www.tlconsultationservices.com

Walser, R.D. & Hayes, (2006), Acceptance and Commitment Therapy in the Treatment of Posttraumatic Stress Disorder. In V.M. Follette & J. I. Ruzek (eds.), Cognitive Behavioural Therapies Trauma. Guildford Press: New York

Walser, R. D. & Westrup, D., (2007). Acceptance and Commitment Therapy for the Treatment of Post-Traumatic Stress Disorder and Trauma-Related Problems. New Harbinger: Oakland, CA.

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Therapy dogs: Posttraumatic stress disorder treatments continue to evolve

Posted on April 14, 2015 in Uncategorized - 0 comments - 0

Therapydogs2By Dr Stan Steindl, Clinical Psychologist

As the 100th anniversary of the Battle of Gallipoli approaches, we are inspired by the great heroics of soldiers in combat serving and protecting our nation, and we are humbled by the enormous sacrifices they’ve made. Many men and women over the last 100 years have made the ultimate sacrifice for their country, and we remember them. A great many other men and women who returned from the various wars and overseas missions have gone on to live under the heavy burden of posttraumatic stress disorder (PTSD).
Though for a long time not formally recognised, the psychological effects of combat-related trauma have been observed and documented throughout the twentieth century. ‘Shell shock’, ‘combat fatigue’ and other more disparaging terms have been used to describe combat veterans suffering from PTSD. References to this condition can be found in many writings from Ancient Greek texts through to Shakespeare’s works, through to articles at the time of the American Civil War. However, PTSD became a recognised psychiatric condition in the early 1980s after our experience of veterans returning from the Vietnam War.

Since then, we have developed a number of evidence-based treatments for PTSD. Multidisciplinary approaches, incorporating medicines, psychological counselling, coping skills development and exposure-based therapies seem to help with this condition, making things more manageable and aiding the veteran to return to higher levels of functioning and quality of life. However, PTSD does not yet seem to be something that can be ‘cured’ and constant efforts are being made to improve treatments and services for supporting veterans.

I have now had the opportunities to work with hundreds of veterans over about the last twenty years. They have always impressed me with their ingenuity and advocacy, and to be frank many of the veteran support initiatives have come from the veteran community themselves. Over recent years I have started to notice the latest in such initiatives: therapy dogs.

Many veterans now have therapy dogs, designed to offer companionship, support and comfort to veterans with PTSD. One veteran and defence force personnel support organisation, Young Diggers, has set up The Dog Squad, which connects veterans with puppies and rescue dogs. An intensive training program is undertaken so that these dogs and their owners become very well-trained and disciplined with one another.

So, how might a dog be helpful for veterans?

Well, dogs are vigilant and protective. They can wake a veteran from nightmares or reassure them during flashbacks. They respond well to authority, which many veterans and military personnel are used to. They love unconditionally and uncomplicatedly, welcoming the veteran home every single time, and not playing complex emotional games. They can help the veteran to relearn trust and safety, and to relearn how to love and be loved. And they offer the veteran meaning, purpose, connection and a reason to get into the day.

None of this has been empirically validated as yet, but it seems to have a lot of face validity. Dogs are our best friends after all! But also, I have seen it work. Veterans, who soften, relax, smile and simply become comfortable in a situation where a well-trained therapy dog is present. I hope that this approach can continue to be explored, and properly developed, into a program that can really add value to veterans’ PTSD treatment.

For more information on Stan and the team of Clinical Psychologists at Psychology Consultants, visit www.psychologyconsultants.com.au

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Trying to forget the unforgettable- musing on PTSD and sleep

Posted on April 8, 2015 in Uncategorized - 0 comments - 0

By Towards Better Sleep Facilitators, Kathryn Smith, Clinical Psychologist & Dr Curt Gray, Psychiatrist

veteran_overexposedLest We Forget will be pledged across the nation this Anzac Day as we approach 100 years since Gallipoli but for many of our veterans and ex-servicemen, forgetting the unforgettable seems a challenge too great.

Trauma regularly touches our community. Watch the evening news and you will witness traumatic events like car accidents, assaults, hold ups, natural disaster, terrorism and war.

Experiencing a traumatic event or the atrocities of war can have a marked impact on people’s lives. While most people are able to recover from trauma, others go on to develop psychological disorders such as posttraumatic stress disorder (PTSD).

PTSD is characterized by sufferers persistently re-experiencing the traumatic event, through intrusive recollections, distressing dreams, or flashbacks. Sufferers may also try to cope through avoiding things that may be associated with the event, or memory. They may also experience mood and other changes such as irritability, anger, concentration difficulties, hypervigilance or being startled easily.

But consistent amongst PTSD sufferers is disturbed sleep with symptoms of increased arousal, nightmares, dream re-enactment on occasion, and excessive movements during sleep. Many of these problems contribute to insomnia.

Recent studies by University of Calfornia’s Berkeley research team led by Prof. Matthew Walker found that REM (Rapid Eye Movement) sleep, the vivid dreaming stage of sleep that comprises 20% of a normal person’s sleep cycle, is compromised in PTSD sufferers. This has significant implications for well-being and recovery.

“The dream stage of sleep, based on its unique neurochemical composition, provides us with a form of overnight therapy, a soothing balm that removes the sharp edges from the prior day’s emotional experiences,” explains Dr Walker.

The good news is treatment can help to improve sleep disturbance in PTSD, particularly taking a holistic approach that combines psychological treatment like cognitive behavioural therapy and image rehearsal therapy with medication for sleep.

Reducing feelings of stress is imperative when on the road to emotional and mental recovery after experiencing trauma. A few simple ways to help improve sleep health include:

  • Making sure your sleep environment feels safe and comfortable. If darkness causes feelings of anxiety, which is common amongst PTSD sufferers, try keeping the room dimly lit.
  • Avoid watching the news before bed.
  • Develop a relaxation routine before bed. This can be as simple as a warm bath or listening to relaxing music.
  • Avoid stimulants like coffee after 3pm.
  • Try not to consume more than one alcoholic drink within 3 hours of bed.

Psychology Consultants run a long standing group programme for insomnia sufferers called Towards Better Sleep, a cognitive behavioural treatment programme that uses evidenced based techniques that focus on sleep education, behavioural techniques, correction of unhelpful thinking about sleep and insomnia, and relaxation strategies.

The next programme commences on 14th May 2015 and runs over 6 weeks, visit www.towardsbettersleep.com.au or www.psychologyconsultants.com.au for more information and talk to your GP about the suitability of this programme for you.

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Courage: The Heart of Compassion

Posted on April 7, 2015 in Uncategorized - 0 comments - 0

By Dr Stan Steindl, Clinical Psychologist

wizard_of_oz-618x451Compassion is a feeling AND an action.

Paul Gilbert, in his 2009 book The Compassionate Mind, emphasises this action component of compassion:

Compassion can be defined as behaviour that aims to nurture, look after, teach, guide, mentor, soothe, protect, offer feelings of acceptance and belonging – in order to benefit another person.

Many people feel compassion for another who they see is suffering. However, it seems that a fewer number of people act compassionately, especially when the person suffering is a stranger or someone from outside their family, friendship or cultural group.

It’s easy (or at least easier) to act compassionately towards someone we love. Picking up our own child when they fall and scrape their knee comes very naturally. So too, offering our best friend support during their time of need. Much more difficult is acting compassionately towards a stranger, let alone someone we actively don’t like or perhaps is our enemy.

But here in lies an opportunity for us all. As the Dalai Lama wrote:

And who creates such opportunities [to practice compassion]? Not our friends, of course, but our enemies. They are the ones who give us the most trouble, so if we truly wish to learn [compassion], we should consider enemies to be our best teacher! (www.dalailama.com/messages/compassion).

How can we cultivate compassion in our society so that we are all acting more compassionately, even if it is to people we don’t know or don’t like?

Many people would like to act compassionately, the desire is there. The reasons to be compassionate are many and varied, and we now know that compassion can benefit the person giving, as well as receiving, the compassionate action. And many people see helping others as important. In fact, lots of us would list kindness, helpfulness and compassion as important parts of our values system. We probably even often know what to do: “I should just walk up to that man and see if he needs help!”

What quality, at the heart of compassion, helps us to move from feeling compassion for another human being who is suffering to taking action to relieve that suffering?

So often, the quality required to go ahead and take committed compassionate action is confidence, or more pointedly, courage.

The idea of stepping forward to help someone, especially a stranger, can evoke all sorts of fears: How will they react? What if they get angry at me? I might get abused or attacked! What if people think I’m being silly? They might judge me or laugh at me. What if it makes me late and my boss gets annoyed? It all might go bad for me.

Compassionate action takes a lot of courage. As Aristotle said:

Courage is the first of human virtues because it makes all others possible.

Honesty can take courage. Loyalty can take courage. Authenticity can take courage. So too, compassion can take courage in order to push through our fear. We never really know what might happen next, and it can feel like there could be some sort of negative consequence. Once a person has a feeling of compassion, often the blocks to action are low confidence, self-consciousness, anxiety and fear. But as the Cowardly Lion learned in the Land of Oz, courage means taking action even in the face of fear.

And so it is with compassion: planning for little gestures to begin with, taking little steps, gradually building confidence with some small success, and taking opportunities that present around you for spontaneous acts of kindness, helpfulness and compassion. So why wait? Let’s get started!

10 small steps to build the courage for compassionate action:

  1. Smile to a stranger in the street
  2. Say “good morning” to the next person who crosses your path
  3. Express sincere appreciation to a shop assistant
  4. Let an anxious looking driver merge in front of you in traffic
  5. Be patient with airline staff when planes are delayed
  6. Offer help to a stranger struggling with a heavy load
  7. Give directions to someone who might be lost
  8. Write a note to someone, or their boss, about the great job they did
  9. Offer some change when the person in front of you can’t quite pay the bill
  10. Ask someone “Are you ok?” – and then really listen to their response.

For more information on Stan and the team of Psychologists at Psychology Consultants, visit www.psychologyconsultants.com.au

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