I remember when I first graduated from Occupational Therapy school…I was working in an outpatient department with patients with workplace injuries. I was inexperienced in many way, and had much to learn. I was embarrassed one day when a patient (not my own) pulled me aside and said, “You know, your client doesn’t speak English very well, but her hearing is fine. When you are speaking to her, it’s like you think if you speak loud enough she will get it.” As humiliating as that feedback was, I remember it as being profoundly helpful.
It did more than change how I spoke to people for whom English is an additional language.
It remains an illustration of how we tend to apply the adage of “If a little is good, then more must be better”. Nice idea, huh? Speaking slowly and clearly to a person whose first language is not English helps comprehension, but speaking louder and clearer doesn’t actually improve understanding—rather, there is actually a point at which it is insulting.
More of a good solution often creates its own problems.
I’ve come to see anxiety is rather like that:
It’s helpful for a person to experience some anxiety about how a dinner will go, or in preparation for an exam. The anxiety serves as a helpful internal cue to become motivated to reduce the anxiety. So, recipes are researched and effort is put into shopping for all the ingredients, and the cooking starts early allowing time for unforeseen circumstances for a good outcome. Notes are reviewed and the text read more diligently in preparation for an exam—and people do better when they study.
But too anxious, and a person isn’t calm enough to follow the steps to the recipe, or be calm enough to double check the grocery list—and mistakes made. Or studying for an exam—the student is too anxious to concentrate on the material, and sleeps so poorly that they aren’t in a good space to write the exam.
One of the important part of changing behavior that is painful and out of keeping with what a person really desires, is to look at how the behavior (however misguided) is/was actually intended to help the person engaging in the dysfunctional behavior. Often these motivations are so hidden under entrenched behavior that it is only with therapy that they emerge.
With that insight comes new possibilities and options for behaving in a way that both allows the original goals to be accomplished, and with strategies that fit the situation in a comfortable and synchronous way with a person’s values and ideals.
More on anxiety in a day or two...
Link with Love
Topic: Anxiety
Anxiety--A Strategy Gone Wrong
June 22nd, 2009 // By Carolyn
Post Traumatic Stress Disorder
March 6th, 2009 // By Carolyn
Years ago I happened to be at the school yard in the morning on the first day of school in September. The bell had rung about 5 minutes before...the excitement of the first day of school that had the hard top vibrating only a short time ago was now in the school. However, the fire alarm rang. Suddenly the playground was unexpectedly flooded with people again. Not being a teacher or involved directly at the school, I pulled off to the side to get out of the way. On one end of the school yard was utter chaos...the children in the lower grades were, well, to put it politely, chaotic. Actually, many were completely losing it.
I'm not sure if it was grief that the school would burn down before they had a chance to even experience 1st grade, or if it was terror from what that very loud sound was, and wondering about their personal safety. The first grade teachers--well, they weren't doing so well either...they couldn't line the children up to do a head count, and there was this sense of hopelessness that the class lists in their hand were virtually useless because there hadn't even been an opportunity for the teachers to learn the students' names--if someone was missing, how would they ever figure out who?
The other side of the school yard, where the bigger children were, was completely different. They were more or less organized--they knew about fire alarms and knew that every alarm they had ever known was a false alarm. They were more or less in line, cuz they literally, "knew the drill". Of course, they saw this as an opportunity for an extra 15 minutes of summer vacation--they were laughing and joking--quite content to visit for as long as they could before they filed past.
Post traumatic stress disorder is a condition that follows the experiencing of something that is traumatic to a person. We are all unique, and so 2 people could be in the same car accident, with one person experiencing the event as traumatic and the other being nonplussed by the event.
Usually within 3 months, but sometimes much (even decades) later the symptoms of PTSD begin to appear...there is an intrusive reexperiencing of the event. This might be in nightmares, or with uninvited thoughts during the day. It might be when the situation is similar (e.g. walking down a sidewalk when robbed while walking home from work), or during an anniversary (e.g. having trouble at a certain time of year, or day, or time of day similar to the original trauma). This is disturbing, even alarming--and can be so distressing that a person can begin to avoid certain situations that might trigger that reexperiencing. At times, the reaction can appear out of proportion to the trigger. For example, a person who has been choked with rope may get agitated even seeing someone with a scarf around the neck. There is sometimes a "hypervigilance" where the sufferer becomes a detective waiting and watching and expecting the trauma to reoccur. Often a PSTD sufferer will say that their head knows it's safe, but their body doesn't get the message (e.g. a person who was assaulted in a high risk country with significant security issues still anticipates being "jumped" while walking down a Winnipeg street)
The person can become disengaged with people around them, as the inner feelings of fear are hugely distracting and managing them takes an enormous amount of energy. They may "put up a wall" to avoid being affected by triggers. They may pull away so as not to have others affected by their symptoms which feel so overwhelming.
Sleep is often affected. A person can have difficulty focusing, or concentrating. Other reactions can happen as well...increased irritability, impulsiveness, guilt, altered appetite, accompanying depression.
Therapy can be helpful to help work through the trauma of the experience and work to have a client understand their body's reactions and what they can do about it. Over time, the traumatic reexperiencing and other symptoms of PTSD can diminish. Part of this process is understanding bodily sensations of PTSD and knowing how to handle them...
In essence, one of the goals of treatment for PTSD is to help a person handle the re-experiencing like a grade 6 kid, and not a grade 1 kid at an unexpected fire drill. In both cases, there is an automatic complete response--filing out and waiting on the school yard, but the older kids are able to understand what it means and what to do with it in such a way that they can handle the reaction much more effectively.
I'm not sure if it was grief that the school would burn down before they had a chance to even experience 1st grade, or if it was terror from what that very loud sound was, and wondering about their personal safety. The first grade teachers--well, they weren't doing so well either...they couldn't line the children up to do a head count, and there was this sense of hopelessness that the class lists in their hand were virtually useless because there hadn't even been an opportunity for the teachers to learn the students' names--if someone was missing, how would they ever figure out who?
The other side of the school yard, where the bigger children were, was completely different. They were more or less organized--they knew about fire alarms and knew that every alarm they had ever known was a false alarm. They were more or less in line, cuz they literally, "knew the drill". Of course, they saw this as an opportunity for an extra 15 minutes of summer vacation--they were laughing and joking--quite content to visit for as long as they could before they filed past.
Post traumatic stress disorder is a condition that follows the experiencing of something that is traumatic to a person. We are all unique, and so 2 people could be in the same car accident, with one person experiencing the event as traumatic and the other being nonplussed by the event.
Usually within 3 months, but sometimes much (even decades) later the symptoms of PTSD begin to appear...there is an intrusive reexperiencing of the event. This might be in nightmares, or with uninvited thoughts during the day. It might be when the situation is similar (e.g. walking down a sidewalk when robbed while walking home from work), or during an anniversary (e.g. having trouble at a certain time of year, or day, or time of day similar to the original trauma). This is disturbing, even alarming--and can be so distressing that a person can begin to avoid certain situations that might trigger that reexperiencing. At times, the reaction can appear out of proportion to the trigger. For example, a person who has been choked with rope may get agitated even seeing someone with a scarf around the neck. There is sometimes a "hypervigilance" where the sufferer becomes a detective waiting and watching and expecting the trauma to reoccur. Often a PSTD sufferer will say that their head knows it's safe, but their body doesn't get the message (e.g. a person who was assaulted in a high risk country with significant security issues still anticipates being "jumped" while walking down a Winnipeg street)
The person can become disengaged with people around them, as the inner feelings of fear are hugely distracting and managing them takes an enormous amount of energy. They may "put up a wall" to avoid being affected by triggers. They may pull away so as not to have others affected by their symptoms which feel so overwhelming.
Sleep is often affected. A person can have difficulty focusing, or concentrating. Other reactions can happen as well...increased irritability, impulsiveness, guilt, altered appetite, accompanying depression.
Therapy can be helpful to help work through the trauma of the experience and work to have a client understand their body's reactions and what they can do about it. Over time, the traumatic reexperiencing and other symptoms of PTSD can diminish. Part of this process is understanding bodily sensations of PTSD and knowing how to handle them...
In essence, one of the goals of treatment for PTSD is to help a person handle the re-experiencing like a grade 6 kid, and not a grade 1 kid at an unexpected fire drill. In both cases, there is an automatic complete response--filing out and waiting on the school yard, but the older kids are able to understand what it means and what to do with it in such a way that they can handle the reaction much more effectively.
The Walking Wounded
March 5th, 2009 // By Carolyn
I was having a conversation today about the news story of Stephen and Isabelle Allison, a young couple moving to Winnipeg with big dreams and ambitions. They happened to sit towards the rear of a certain Greyhound bus last summer and their move to Winnipeg hasn't been anything like they expected. They witnessed the brutal killing of a man, imprinted with images that have been indelibly printed like photographs in their brain...perhaps still frames of images with the color red appearing starker than the rest of the frame. The feeling in the pit of their stomach, vaguer now, but reminding them of the terror that immobilized Isabelle, watching the horror, and anticipating her own death as she witnessed unspeakable brutality.
Neither Stephen and Isabelle are doing what they set out to do in Winnipeg. They are the walking wounded, not able to concentrate sufficiently to take courses, not able to maintain normal routines that jobs require, and struggling with finding meaning, purpose and safety as they endeavor to move on.
The interview with the couple states they received compensation to cover their material losses, and six sessions of counselling. Six.
SIX!
The woman I had the conversation said, "If one of them would have had even one slash on part of their body, on a leg maybe, then they would have gotten so much more care and attention. A physical cut would have received extensive treatment. But the wounds they have are so very real...but invisible...and so they are not recognized and not treated."
The conversation perked my ears up...I got an email yesterday about a videoconference happening today out of the University of California at San Francisco by the PainCARE center on, "Post Traumatic Stress Disorder and Pain". I couldn't watch the conference as I wasn't near a viewing site, but I found some of its promotional information compelling:
I had coffee with a friend this morning who was in a serious car accident..she walked away from the accident, but the car was demolished. She finds herself anticipating disaster, bracing herself at intersections for another collision, and now has less reserve for the normal ups and downs of her life...small things are irritating and potentially overwhelming, she's tired, and finds herself noticing things and dreading some things in ways she is not familiar with. Her doctor diagnosed her with PTSD--this was a relief because she had understanding for what was happening in her body and mind.
I read an article reviewing the research on pain and PSTD in the Psychotherapy Networker the other day (it was an October issue, but better late than never, right?!), recommending sincere and effective collaboration between physicians and therapists to work in their areas of expertise to help people with that which they struggle:
More on PTSD in a couple of days.
Neither Stephen and Isabelle are doing what they set out to do in Winnipeg. They are the walking wounded, not able to concentrate sufficiently to take courses, not able to maintain normal routines that jobs require, and struggling with finding meaning, purpose and safety as they endeavor to move on.
The interview with the couple states they received compensation to cover their material losses, and six sessions of counselling. Six.
SIX!
The woman I had the conversation said, "If one of them would have had even one slash on part of their body, on a leg maybe, then they would have gotten so much more care and attention. A physical cut would have received extensive treatment. But the wounds they have are so very real...but invisible...and so they are not recognized and not treated."
The conversation perked my ears up...I got an email yesterday about a videoconference happening today out of the University of California at San Francisco by the PainCARE center on, "Post Traumatic Stress Disorder and Pain". I couldn't watch the conference as I wasn't near a viewing site, but I found some of its promotional information compelling:
In recent studies:Post Traumatic Stress Disorder is a significant factor that is often overlooked as we look to understand what a person is struggling with. Physical problems like pain in the joints, muscles, headaches, bowel pain are connected to PTSD. Emotional problems of anxiety and depression result from unresolved trauma in a person's life. Relational problems develop as the symptoms of PTSD ripple throughout the relaltionships in a person's life.
The numbers are staggering and should concern us all regardless of our respective areas of practice.
- 51% of patients with chronic low back pain exhibited symptoms of PTSD
- 50% of patients experiencing chronic pain after motor vehicle accidents showed evidence of PTSD
- Nearly 50% of women with chronic pelvic pain reported a history of sexual or physical abuse with roughly 1 in 3 of those screening positively for PTSD
- Psychiatric casualties from soldiers serving in Iraq were estimated at 300,000 as of November 2007, a significant number of whom also currently have chronic pain
- Patients with chronic pain, IBS, depression, and anxiety disorder in one urban, hospital-based primary care practice accounted for more than 90% of all cases of PTSD
- In this same urban primary care practice, 25% of patients met the criteria for current PTSD, yet only 11% were identified correctly in the medical record.
I had coffee with a friend this morning who was in a serious car accident..she walked away from the accident, but the car was demolished. She finds herself anticipating disaster, bracing herself at intersections for another collision, and now has less reserve for the normal ups and downs of her life...small things are irritating and potentially overwhelming, she's tired, and finds herself noticing things and dreading some things in ways she is not familiar with. Her doctor diagnosed her with PTSD--this was a relief because she had understanding for what was happening in her body and mind.
I read an article reviewing the research on pain and PSTD in the Psychotherapy Networker the other day (it was an October issue, but better late than never, right?!), recommending sincere and effective collaboration between physicians and therapists to work in their areas of expertise to help people with that which they struggle:
Cummings estimates that at least 60 percent of physicians' patients seek treatment for conditions with major psychological components, such as stress, anxiety, depression, high blood pressure, fibromyalgia, digestive difficulties, eating disorders, nausea, headaches, and certain kinds of arthritis, that are usually more treatable with therapy than medications. Physicians are so eager for the kind of help therapists can provide that therapists who've integrated themselves into medical settings get substantial boosts in their caseloads and incomes.While physical symptoms need good medical care, they may also need good psychological care. And with trauma of the magnitude of Stephen and Isabelle Allison, psychological treatment will need to be more than lip service. Six sessions--that's lip service.
More on PTSD in a couple of days.
An End Run on Anxiety
February 25th, 2009 // By Carolyn
It seems like man's best friend is also a kid-who-is-struggling-to-read's best friend, too.
I heard an interview today with someone from the Humane Society describing a program where dogs help kids learn to read.
I perked my ears up when I heard this...cuz dogs can't read!
The guy says, "It's hard for some kids to read to grown ups or even to other kids. But it's not threatening to read to dogs".
Apparently, they give a dozen kids at a time a chance to come to the Humane Society a coupla times a week for 8 weeks to read to volunteer dogs who come by to be read to.
Sounds hokey right? Not so much, actually.
The results are amazing...some kids increase a grade level in reading.
The more he spoke about it, the more I could imagine how a dog, who will wag his tail with all efforts, and will provide the unconditional positive regard to the child no matter what lowers the risk and increases the safety for the child. When the child is less nervous, performance improves as all the energy can be directed productively towards the reading, without all the static that anxiety creates inside a person.
I love the creativity of this strategy to learning to read...finding novel (pun intended!) ways to help a student focus on the learning task, and not be distracted by the pressure of performance anxiety. Who woulda thunk that dogs could help kids read?
Might be a lesson there somewhere for all the grownups who are feeling the pressure...recession is raising our blood pressure.
I heard an interview today with someone from the Humane Society describing a program where dogs help kids learn to read.
I perked my ears up when I heard this...cuz dogs can't read!
The guy says, "It's hard for some kids to read to grown ups or even to other kids. But it's not threatening to read to dogs".
Apparently, they give a dozen kids at a time a chance to come to the Humane Society a coupla times a week for 8 weeks to read to volunteer dogs who come by to be read to.
Sounds hokey right? Not so much, actually.
The results are amazing...some kids increase a grade level in reading.
The more he spoke about it, the more I could imagine how a dog, who will wag his tail with all efforts, and will provide the unconditional positive regard to the child no matter what lowers the risk and increases the safety for the child. When the child is less nervous, performance improves as all the energy can be directed productively towards the reading, without all the static that anxiety creates inside a person.
I love the creativity of this strategy to learning to read...finding novel (pun intended!) ways to help a student focus on the learning task, and not be distracted by the pressure of performance anxiety. Who woulda thunk that dogs could help kids read?
Might be a lesson there somewhere for all the grownups who are feeling the pressure...recession is raising our blood pressure.
