MANAGING STRESS IN OUR LIVES

Entries in PTSD (8)

Tuesday
Oct302018

IS LONELINESS AT THE HEART OF ADDICTION?

Recently I listened to a TED talk by Rachel Wurzman entitled: "How isolation fuels opioid addiction." She discribes her experience of having tics [Tourettes Disorder] that she calls "unvoluntary." Dr. Wurzman experiences her involuntary tics as unvoluntary meaning that she feels like she is doing the tic movement and not an external force. However, Dr. Wurzman recognizes that her tics are not related to her conscious intentions or attention. Dr. Wurzman then makes the point that we all have things that we do in healthy ways and other things that are not healthy and this can help us to understand what others are experiencing, including those with tic disorders and addiction. So, why is it important that we can understand each other? Dr. Wurzman goes on to talk about the opioid epidemic and it's connection to being lonely. She states that this epidemic is killing 91 people every day and it is getting worse. Dr. Wurzman understands that addiction is a medical, neurobiological problem and yet she feels that we can help people with addictions by changing how we respond to them. To change how we respond to people with addictions she feels that it is helpful if we understand how and why our brains cause behaviors like urges to use substances. Dr. Wurzman's research suggests that loneliness may be reinforcing the brains of addicts to seek comfort from substances as their striatum's are seeking things that have most frequently been associated with reducing their feelings of loneliness. These responses [seeking things] are like they are on autopilot, so that when there is a stimulus there is then a very rapid and automatic response from their brains. 

Importantly, according to Dr. Wurzman, feeling socially connected to others is part of what the striatum does. The experience of feeling pleasure in social interactions is modulated by opioid receptors in the striatum. If some one is experiencing intense loneliness the opioid receptors are sensitized so that anything that reduces this sense of loneliness, such as taking opioids, is intensely and very rapidly sought. Therefore, loneliness may keep people addicted and social connections may help people not be addicted. However, those social connections need to be strong enough to convince the striatum that it is safe to let go of the immediate and reliable relief that taking opioids [and other drugs] represents. Dr. Wurzman also believes that to establish powerful social connections, it is better to connect with each other not focused on one aspect of ourselves/others [like addictive behavors] but recognize how we all have unvoluntary or automatic type behaviors. This helps us to realize that we are connected to people who happen to have different unvoluntary or automatic type behaviors. 

After listening to Dr. Wurzman, I wondered about a connection between the social isolation experiences of people with addictions and those who suffer from Post Traumatic Stress Disorder [PTSD]. If so, then does the isolation theory apply to people who have PTSD? And how would this influence treatment of PTSD?

What do you think? 

Monday
Jul172017

ARE WE FREE TO VIOLATE OTHERS WITH OUR SPEECH?

The first amendment to our constitution prohibits the making of any law abridging the freedom of speech.  The supreme court has clarified the extent of the protection for free speech.  This applies only to speech against the government and more recently has been broadened to allow for more political dissent.  Of significance lately is concern about protests on college campuses that are against certain speakers that the students disagree with.  This has involved violence at times.  The concern is that the stuent protests will have the impact of supressing free speech. This then has led to concern about any effort to restrict speech such as those who are spreading hate comments on the internet and those who bully others on the internet via social media. There has been increasing concern expressed about bullying as it is connected to increased risk of suicide [many studies indicate an increased risk for suicide in children and adolescents who are being bullied although it is difficult to be precise about the impact of bullying on suicides].  So is it free speech vs increased risk of suicide?  Or is it free speech vs chronic stress traumatizing our brain cells that can lead to cell death. [This will be clarified below.]

Dr. Lisa Feldman Barrett, a professor of psychology at Northeastern University, wrote an opinion piece in the July 16, 2017 edition of the New York Times, entitled: "When is Speech Violence?' She makes the point that some speech is abusive while other speech is offensive but not abusive.  She considers bullying to be abusive as well as when people trade insults with each other over and over. Dr. Barrett considers prejudiced and judgmental views to be offensive but not abusive as these views do not create a prolonged stress for people and therefore do not trigger brain reactions that can be destructive.  It is like the difference between acute, temporary stress where the brain copes without leading to any damage to the brain.  On the other hand, abusive stresses lead to prolonged stress in people who are traumatized by these speech patterns and this leads to challenges to their immune systems that can compromise their DNA and even lead to neuron [brain cell] death. This repetitive abusive speech can lead to someone developing a post traumatic stress disorder [PTSD]. They often cope by blaming themselves and trying to keep things from getting worse. This on going stress reaction damages their immune systems. In addition, since they feel hopeless and like they have no control over their lives, they are at risk for suicidal behavior.

So, some speech is violent in the way other people respond to it. The abusive nature of the speech seems connected to it being repetitive and ongoing even if intermittant. So, free speech would not seem to include this type of speech.  What do you think?

Friday
Mar032017

WHEN ARE PHYSICAL SYMPTOMS SIGNS OF ANXIETY?

It is clear that stress can lead to many types of physical symptoms. It seems that some of the physical symptoms we have are related to past physical symptoms we had that did not appear to be caused by stress. I wonder if the brain thinks that a new situation that we react to in a similar way as our reaction to the original physical symptom, requires the same type of symptom to help us to cope. This may be what happens when people have "pseudoseizures" as these look like actual seizures but there is no evidence of electrical disturbances in the brain that characterize actual seizures.  On the other hand, there is a strong correlation between pseudoseizures and actual seizures as if the actual seizures may have been the model for the pseudoseizures. Then there are physical symptoms that seem related to the impact of chronic stress.  Dr. Sapolsky at Stanford University, in a lecture series from "The Great Courses" entitled "Stress and Your Body," reports that chronic stress can lead to chest pain [heart muscle lack of oxygen], headaches from high blood pressure, obesity, abdominal pain or bloating, acid reflux, difficulty getting pregnant, increased miscarriages, low libido, etc. Some of these symptoms may be caused by actual neuronal cell death that is caused by the repeated stress reactions.

Importantly, even intermittant but repeated experiences of stress can lead to the same type of symptoms. This intermittant stress may represent what happens with PTSD, when past stresses are repeatedly recalled. It takes our brains longer and longer to recover from our brain's response to stress, thus becoming like a constant stress reaction. Apparently our lives are not supposed to be made up of frequent stresses, as our brains have trouble managing these. 

There are a number of physical symptoms related to stress that are familiar to us from our own experiences.  These include: gatrointestinal [GI] symptoms such as pain, cramping and diarrhea; neck pain and pain in the occipital [back of the head] area of the head; and pain in muscles as stress can cause us to tense muscles for extended periods. Stress can also lead to changes in women's menstrual cycles including stopping them. 

I wonder if these physical symptoms are ways that our brain's are helping us cope with the stress even if these symptoms are uncomfortable. What do you think?


Monday
Dec192016

"I DON'T CARE AND I DON'T CARE THAT I DON'T CARE."

Recently one of my patients came in and announced that "I don't care and I don't care that I don't care."  She said that she realized this just the day before.  She reflected on this and indicated that it was a relief not to care.  She feels less stressed and yet still feels responsible for others and realizes that she takes care of others better than she takes care of herself.  She believes that "not caring" is helping her to feel less stress and take better care of herself.  

So, what is this "not caring?"  I am treating this person for severe PTSD symptoms that include paranoid thinking, frequent flashbacks and dissociative symptoms.  One of the treatment goals has been to not feel a need to react to the past and also to no longer fear past traumatic experiences, recognizing that they have no power anymore. The growing success not reacting to the past seems to have led to being able to "not care" about things from the past, and "not care" about things that are happening now or that might happen in the future.  It is like a weight has been lifted as worries about the past and fears about the future have lessoned. There is a calm more of the time now and it is easier to be around people. A feeling of responsibility for others is still a problem but is also more contained than before. It is also easier to focus on self care.

My wish for the universe is that all living things can learn to "not care" what happens, so that they can experience the joys of living, without being distracted by "caring."

Confusing? Imagine that you don't care and don't care that you don't care, and see what happens.  

Monday
Jul042016

TO KEEP THINGS FROM GETTING WORSE

My patients have made it clear to me how important their feeling responsible for others is in maintaining PTSD symptoms. It seems that taking responsibility for others develops as a way of coping with abuse.  It makes sense in that people who are being abused are not being protected by adults around them and therefore they can feel more in control by taking on responsibility for others.  However, I have wondered what the nature of the control experience is.  Now I believe that it is to prevent things from getting worse. This idea has surfaced with many of my patients who come to me for help with PTSD. They believe that the abusing person will be less likely to lose control if they do this. They also do not feel confident enough to resist taking responsibility for others and standing on their own. Any person who loses control, or threatens to, can cause someone who has PTSD to respond by feeling responsible for them. This maintains the old pattern and as I have previously discussed the brain is very good at helping us to maintain old patterns of behavior.

The significance of feeling responsible for others is that when we act this way because of a fear that things will get worse tells our brains that we need to be on guard to be alert in case the something worse happens.  For this reason it is very important for people with PTSD to have a goal of no longer doing things to keep things from getting worse.  They need to be able to identify all the ways that they act this way and make it clear to themselves [their brains] that they want to stop doing this.  It also helps to be able to tell themselves that they no longer need to fear past stressful situations as they do not have any power over them now.  This requires that we choose to think of past stressful events and then, staying calm, tell ourselves that we no longer need to be stressed by these memories.  Even with this accomplished, the behavior pattern of doing things to keep things from getting worse can continue unless stopping it is addressed directly.  If it is not stopped, automatic stress reactions to past events will continue.