How Our Occupational Therapists Help Trauma Patients
Most of us take for granted our ability to complete the most basic steps associated with self care and social engagement. We never really consider that brushing one’s teeth, taking a shower, or having even the briefest social interaction with a stranger may be an emotionally strenuous task for some individuals. Naturally, when a person suffering from post traumatic stress disorder (PTSD) tries to explain the difficulty they experience executing daily tasks, it is not uncommon for them to be met with objections or to have their issues dismissed and be told to simply “get over it.” This advice is in no way helpful to the firefighter who is triggered by the sound of their own children crying, after witnessing children dying in a fire while on the job. And this certainly does nothing to assist the war veteran who relives moments on the battlefield everytime they hear the sound of aircraft overhead. From the decades of research on PTSD, one thing is abundantly clear—avoidance is not a viable option. Enter occupational therapy.
What Is Occupational Therapy?
Occupational therapy is a form of treatment for individual suffering from addiction or mental health disorders that interfere with their ability to perform daily tasks associated with living a normal, healthy. Occupational therapy focuses on three main areas:
- Self Care: includes personal hygiene, grooming, and healthy eating
- Productivity: includes maintaining employment or attending school
- Leisure: includes playing sports, team activities, and personal hobbies
Occupational therapists will often try to restore a patient’s self-confidence by breaking down big tasks into smaller, more manageable subtasks for the patient. This approach prevents the patient from feeling overwhelmed and gives them a sense of achievement by proving a series of small wins that bring them incrementally closer to achieving a big goal.
Symptoms of Post-Traumatic Stress Disorder
The biggest commonality among first responders, veterans, and survivors of abuse with post-traumatic stress disorder (PTSD) is that it impairs their abilities to move forward after the traumatic event. PTSD symptoms create severe psychological limitations that promote self-destructive behaviors. Through repetition, these behaviors become habits that an individual will feel unable to control, much less stop. PTSD symptoms are usually grouped into four categories:
- Intrusive memories
- Avoidance of triggering situations and emotions
- Negative changes in thinking and mood
- Changes in physical and emotional reactions
In his book, The Evil Hours: A Biography of Post-Traumatic Stress Disorder, David J. Morris describes the aftermath of trauma as follows:
Trauma destroys the fabric of time. In normal time you move from one moment to the next, sunrise to sunset, birth to death. After trauma, you may move in circles, find yourself being sucked backwards into an eddy or bouncing like a rubber ball from now to then to back again. … In the traumatic universe the basic laws of matter are suspended: ceiling fans can be helicopters, car exhaust can be mustard gas.
Understanding Your Emotions Helps Manage Symptoms
Our emotions are an important part of our individual growth and development. They can help us with everything from situational awareness to establishing healthy relationships. Distinguishing between an appropriate emotional response and a dysfunctional one can be a challenge for individuals with post-traumatic stress disorder (PTSD). Our occupational therapists teach patients principles and skills to help them better understand their emotions:
- Your emotions can provide you with useful information or important signals.
- Emotional signals can often be useful, but they should not be treated as facts.
- Your emotions are important, but keep them out of the driver’s seat when it comes to making certain types of decisions.
- Staying connected to your emotions is essential for developing useful coping techniques. However, you must also maintain the capacity for rational analysis of your reactions to situations and be able to evaluate whether or not your reaction is appropriate.
- In some situations, the appropriate action for you to take may be the opposite of what your emotions are telling you to do—this is called “opposite to emotion action.”
The process of working with occupational therapists is both collaborative and goal oriented, making it easy for patients to track their progress.
The Wise Mind: Balancing Emotion and Reason
When we are in our emotional mind, our actions are predominately based on our emotions and how we are feeling. Our response to stress or triggering situations is extremely reactive as we abandon logic, fact, and reason when our emotional mind has taken over. An example of your emotional mind taking over is when you overreact to a situation because it triggers a negative memory of a similar situation; your fear that something similar to your memory may happen again drives your overreaction, even if it is actually extremely unlikely.
We would all like to believe that we operate from our reasonable mind, however this is not always the case. The reasonable mind is the part of us that is based solely on logic and rational information. It gathers and interprets empirical information from our observations and forms beliefs and opinions based on that information. If drives actions that are are cool, controlled, and strategic. The reasonable mind is very useful in crisis situations. Many military personnel and first responders can tell you, being able to access the reasonable mind when you need it can be the difference between life and death. The reasonable mind is excellent for planning and evaluating big life decisions, however, it is possible to overdo it and fail to recognize and consider the significance of our emotional signals. Overuse can create habits such as minimizing our feelings, and compartmentalizing events that could be pivotal to our development by diminishing our emotional connections to them. Such habits could lead to depression, burn out, or feeling numb.
The wise mind is the integration of the reasonable mind and the emotional mind. It is a functional blend of strategic thinking guided by healthy emotional awareness. It is the capacity to consider past experiences, current perceptions, and theoretical knowledge, to arrive at a constructive understanding of one’s present situation. Our occupational therapists teach our patients techniques to make the wise mind more easily accessible and available to help them manage their trauma symptoms.
Problem Solving: Barriers and Strategies
Problem solving can be difficult for the average person on any given day. It requires us to use all aspects of our mental capacity to analyze a particular set of circumstances and available choices, and then produce a solution. An ideal solution would not only satisfy our immediate need, but would also be consistent with our long-term goals. This process can be extremely difficult for individuals suffering from mental health or substance use disorders as they may not trust their own judgement and or accuracy in assessing a situation.
Barriers to Effective Problem Solving
The first step that our occupational therapists take with patients is to help them identify common barriers to solving problems quickly and effectively, including the following:
- Looking for a perfect solution
- Feeling hopeless or helpless; believing that a satisfactory solution does not exist
- Feeling depressed, distressed, or anxious to the point that one cannot focus on problem solving
- Excessive fatigue to the point that impairs cognitive ability
- Underdeveloped problem-solving skill set
Strategies for Effective Problem Solving
Occupational therapist also teach patients a range of effective problem-solving strategies that can be used in different situations, including the following:
- Algorithms: An algorithm is a iterative, step-by-step procedure that produces a better solution with each iteration. While it has a high change of producing a good solution, it can be very time consuming.
- Heuristics: A heuristic is a mental rule of thumb, such as an educated guess, stereotype, or generalization. Many people tend to employ this particular strategy when faced with a series of complex problems to reduce the possibilities to a more manageable number.
- Trial and error: This approach can be effective when the number of potential solutions is small and the cost of failure is low. The idea is to try solutions, learn from the results, and keep trying until a satisfactory solution is discovered.
- Insight: With this strategy, the solution to a problem may appear “all of a sudden.” Many researchers believe that insight occurs when a person recognizes features of a current problem that are similar to a problem that the person has successfully solved in the past.
Subjective Unit of Distress Scale and Coping Strategies
It can be very difficult for those suffering from substance use and mental health disorders to clearly recognized and understand how they are feeling at any given time. Occupational therapists provide patients with tangible metrics to help them the recognize, isolate, and react appropriately to negative stimuli. The Subjective Unit of Distress Scale (SUDS) works as an emotional gauge, and is a crucial part of therapy. The SUDS protects patients from their more destructive emotions by teaching them practical ways to distract themselves from what they are feeling. The objective is to turn this distraction, which may be unusual to the patient in the beginning, into their habitual response to extreme stressors.
Occupational Therapists Help Patients Get Back to Their Lives Faster and Better
Recovery from post-traumatic stress disorder is a difficult process that requires hard work and commitment from the patient. Occupational therapists help facilitate this process and allow patients to return to their normal lives more quickly, with effective coping skills, useful habits, practical knowledge, and effective problem-solving strategies.
Call Us for More Information
If you would like to learn more about the treatment programs provided by EHN Canada, enrol yourself in one of our programs, or refer someone else, please call us at one of the numbers below. Our phone lines are open 24/7—so you can call us anytime.
- 1-800-387-6198 for Bellwood Health Services in Toronto, ON
- 1-587-350-6818 for EHN Sandstone, in Calgary, AB
- 1-800-683-0111 for Edgewood Treatment Centre in Nanaimo, BC
- 1-888-488-2611 for Clinique Nouveau Depart in Montreal, QC
Integrated Treatment of Substance Use Disorders and Concurrent Post-Traumatic Stress Disorder (PTSD) Is The Most Effective Approach
Post-traumatic stress disorder (PTSD) can develop after an individual has been exposed to a traumatic event such as death, serious injury, or a threat of harm to themselves or to others. When exposed to such events, it is normal to feel intense fear, helplessness, and horror, but in most cases, these feelings are eventually resolved—but, unfortunately, not always. Some people experience long-lasting and intrusive symptoms such as disturbing flashbacks, heightened states of arousal, mood disturbances, and avoidance of memories about the event. These are the symptoms associated with PTSD.
Post-traumatic stress disorder (PTSD) is more common than you might think. An estimated 1-in-10 Canadians will experience PTSD at some point in their lives. Certain populations are at higher risk of developing PTSD because they are more likely to experience traumatic events. Members of the military are often seriously injured, witness the death or injury of others, and have their lives seriously threatened. Many veterans returning from Iraq and Afghanistan report being targets of enemy gunfire, knowing someone who was injured or killed, or even having to handle dead bodies. Such experiences can have a lasting effect on an individual’s mental and emotional well-being.
There appears to be a bi-directional causal relationship between developing post-traumatic stress disorder (PTSD) and developing a substance use disorder. People with PTSD experience persistent and disturbing psychological symptoms, which make them more likely to use alcohol or drugs as coping mechanisms. Conversely, people with substance use disorders are both more likely to experience traumatic events and less likely to be able to process them effectively.
Compared to either disorder alone, concurrent post-traumatic stress disorder (PTSD) and substance use disorders are associated with worse mental and physical functioning, and higher levels of psychological distress. When these two disorders are concurrent, the negative effects can be quite severe: they can impair a person’s ability to work, to maintain healthy relationships, and to maintain a positive outlook on life. As a result, people with concurrent PTSD and substance use disorders will often experience rapidly deteriorating physical and mental health, and should therefore get treatment as soon as possible.
There are several treatment options available for individuals with concurrent post-traumatic stress disorder (PTSD) and substance use disorders, including both medical therapy and psychotherapy. Historically, treatment focused on resolving the substance use disorder first, before proceeding to address the PTSD. However, the historical approach risks exacerbating a patient’s PTSD symptoms: when a patient with PTSD narrowly focuses on trying to resolve their substance use disorders, they are likely to be confronted with challenges and discomfort for which they are not yet adequately prepared. Today, however, most clinicians recognize that patients’ substance use is closely related to their PTSD symptoms. Hence, at EHN Canada, we believe that the most effective treatment approach is through integrated treatment programs that address both disorders together.
EHN Canada’s integrated treatment model acknowledges the fundamental interdependence between post-traumatic stress disorder (PTSD) and substance use disorders. Therefore, we address the two disorders at the same time, usually within the the same treatment program. Substance use disorders are conceptualized as tools—albeit highly dysfunctional ones—that people use to try to manage their PTSD symptoms. We educate patients and provide them with a new, healthier, and more effective set of tools, early on in their treatment programs. This reduces the likelihood that a patient’s PTSD will compromise their recovery from their substance use disorders. Our conviction that the integrated treatment model produces superior outcomes is also supported by patients’ attitudes: research has found that patients with concurrent PTSD and substance use disorders report an overwhelming preference for the integrated approach.
Post-traumatic stress disorder (PTSD) and substance use disorders have a complex interrelationship. EHN Canada treatment programs teach patients how to recognize and manage their symptoms and triggers. We also help patients create solid recovery plans that serve to guide their long-term behaviour changes. EHN Canada’s individualized treatment programs also push each patient to discover their own unique strengths and skills. We encourage and support our patients to further develop these abilities to support their successful recoveries and recovery maintenance. Patients complete EHN Canada treatment programs having developed functional and adaptive coping strategies, as well as assertiveness and effective communication skills. They walk out our doors ready to face the world, full of optimism, and eager to get back to their relationships, families, friends, and careers.
Call Us For More Information About Our Programs
If you would like to learn more about the treatment programs provided by EHN Canada, enrol yourself in one of our programs, or refer someone else, please call us at one of the numbers below. Our phone lines are open 24/7—so you can call us anytime.
- 1-800-387-6198 for Bellwood Health Services in Toronto, ON
- 1-587-350-6818 for EHN Sandstone, in Calgary, AB
- 1-800-683-0111 for Edgewood Treatment Centre in Nanaimo, BC
- 1-888-488-2611 for Clinique Nouveau Depart in Montreal, QC
Yoga Therapy – A Path to Healing and Connection
Written By: Courtney Strong, LMHC, CDP- Director, Clinical Manager
Yoga is a practice of many elements focused on the physical, mental and spiritual. In EHN Seattle’s Yoga Therapy group, clients cultivate both a sense of integration between physical, mental and emotional experience. In addition, clients learn how to differentiate between one’s self and an experience.
The Connection Between Yoga & Recovery
Yoga offers several benefits towards recovery. Practicing yoga allows you to be present and attentive to an experience while simultaneously providing you the ability to observe, not react to or feel controlled by the experience. Often with addiction people become adversaries to themselves. Individuals can physically and emotionally become disconnected. Yoga can give you the opportunity to create a connection using mindfulness, breathe awareness and body awareness.
Mindfulness is a foundation to yoga and essential to the yoga groups at EHN Seattle. By using mindfulness, a person can observe experiences, thoughts, emotions and sensations in real time, as they happen without judgment or reaction to them.
Author and spiritual teacher Pema Chodron describes this experience as, “You are the sky, everything else is just the weather.” Individuals often forget that they’re not their thoughts. Thoughts are just a part of them. People tend to get caught up in a thought or a feeling and lose perspective beyond it. When it comes to addiction, cravings are an example of that. It’s a sensation and a series of thoughts. Part of the work in recovery is to observe cravings as they arise with the perspective that they are an experience that will pass. When individuals get caught up in the experience itself they react impulsively. People will use behaviors that are automatic instead of responding with a sense of perspective and understanding for what’s really need.
In EHN’s yoga therapy groups, the practice of mindfulness is developed through breath and body awareness. We observe the quality of how we breathe and realize how we feel in our own skin, taking note of where there is physical tension or pain. Our bodies carry memories of experiences from our history and impact our choices about how we treat ourselves.
David Emerson and Elizabeth Hopper, PhD, authors of Overcoming Trauma through Yoga: Reclaiming Your Body, wrote about the effects of movement and breathing practiced in yoga and how they facilitate the healing of physical trauma that has been stored in our bodies as physical tension, restriction or pain. According to this book, individuals become physically and mentally hard, increasingly restricted and judgmental over time, because instead of compassionately paying attention to their experiences they run from themselves through addictions.
Practices of breath and body awareness create the possibility for softening, releasing and healing because they cultivate space in our experience to observe and pay attention to experiences without collapsing into judgment or reaction. Out of that space of attention and observation we come to a sense of connection, of care for ourselves, and find ways to address what we really need in order to heal.
The Unexpected Benefits of Yoga
Often what initially draws individuals to explore yoga is the physical side of it, increasing strength and flexibility. Yoga has a profound physical impact. It can increase flexibility after a single class, decrease chronic pain and improve strength within a few months. Yoga philosophy conceptualizes the self as composed of layers (physical, psychological, breath, spiritual) and therefore has a profound impact on all aspects of our experience.
Harvard Medical School has been studying the impact of yoga on physiological and mental functioning since the 1970s. They have produced studies on Yoga’s ability to improve cardiovascular health and significantly decrease symptoms of anxiety and depression resulting from a consistent yoga practice.
Yoga groups at the Edgewood Health Network involve two parts. First, a gentle yoga practice that includes stretching, mild strength-building, breathing practices, mindfulness and meditation. The second part is to provide a time to process. Following the yoga practice group members are invited to reflect on their experience and discuss insights into their recovery process.
Paramanhansa Yogananda, one of several teachers to introduce yoga to North America in the early 1900s, describes the purpose of yoga to condition the body to be able to sit and be still. Yoga therapy groups at EHN Seattle features a combination of movement and stillness, self-reflection and group processing with four goals in mind:
- Cultivate a sense of integration between body and mind;
- Build a sense of compassion and acknowledgement of our experience that will allow one to reflect on judgments and reactions;
- Develop a healthy sense of differentiation between our deeper selves, our thoughts and emotions;
- Encourage a positive relationship with our physical selves while giving gracious attention to areas of tension and physical restriction.
If this sounds like something you’d like to try, give us a call at 206-402-4115. Our Yoga Therapy Groups currently run on Tuesdays throughout the day and evening.
A part of Edgewood Seattle since the summer of 2012, Courtney Strong specializes in the treatment of trauma and addiction, as well as other related mental health disorders. Courtney is passionate about the opportunity Edgewood offers individuals in the Seattle area, regularly revamping services to provide the highest sophistication in treatment of substance use disorders.
Treating Partners of Sex Addicts is a Must! Here’s Why.
Written By: Nelson Sacristan, MA, CSAT, Clinical Manager-EHN Vancouver
Just as the rise of patients identifying their own compulsive sexual behaviors is increasing, partners of people with compulsive sexual behaviors are also seeking treatment in greater numbers. What type of treatment should partners receive? Why do partners need treatment if they aren’t the ones with the compulsive sexual behaviour? Experience and research tells me that partners are emotionally and psychologically affected by this disorder and they too, need therapy and support to heal from the damage that comes with compulsive sexual behaviour.
Partners, most of them women, struggle with the betrayal and accompanied unraveling of what might have appeared to be a satisfying relationship. Statistics on infidelity are difficult to compile but conservative estimates range between 30% to 60% of marriages in the U.S. feature infidelity. These estimates do not include infidelity where partners are not married, nor do they account for same sex marriages, which only recently have become legal in the U.S. Still, let’s be clear. Partners of people with compulsive sexual behaviors include men and women of any sexual orientation and level of commitment. Depending on how ‘infidelity’ is defined, the figure would be greater if the myriad expressions of compulsive sexual behaviors, like problematic pornography use by a partner, are included.
What is it like for a female partner of a ‘sex addict’?
Many women describe an experience as having their world flipped upside down. What was once a familiar person to you is now revealed to have a completely different life from the one you thought you shared. Even when there have been some indications of infidelity, confirmation carries with it an overwhelming shock to the relationship and all that surround it, including children, families, finances, sexuality and community. Questions that typically arise are:
- – How did this happen to me?
- – How did I not know?
- – Is there more I don’t know?
- – What do I tell the kids? My family? My friends?
– Many partners vacillate between shock, anger, denial and grief.
First Steps Towards Recovery
A useful first step is to seek the support of a non-judgmental and trusted confidante. Someone who need only listen and help the partner through the first hours and days to regain calm and a sense of self.
The next step would be to consider the immediate implications of the discovery:
- 1. Does the partner move out temporarily?
- 2. Who in the community can help contextualize the infidelity and provide guidance for the way forward?
- 3. Whom can I count on?
Many partners will seek out the comfort of family and friends, others find help through a marriage or relationship counselor. It used to be common that partners would start marriage counseling, with an examination of the marital dynamics which ‘led’ to the infidelity. If the offending partner is acting out compulsively, it’s likely that an emphasis on what triggers the behavior, apart from the relationship, is a better place to start.
Addiction treatment, with its understanding of compulsively driven behavior, is the current standard for treatment of sex addiction.
What Help Is Available For The Partner?
Counseling help for the partner has gone through a dramatic shift in recent years. Some therapists treat partners of sex addicts as if they were partners of alcoholics or chemically addicted people. This included framing the problems and solutions, through a ‘co-dependency model. This model implies enabling, rescuing and efforts to control the addict by the co-dependent. While those behaviors are often present, the co-dependent model leaves out a critically important piece of the puzzle. That is, the trauma of the betrayal.
Research indicates that betrayed partners experience post-traumatic stress disorder (PTSD) symptoms. These symptoms include heightened anxiety, intrusive thoughts about the addict and/or the behaviors, sleeplessness and avoidance of relevant stimuli.
Trauma therapy, along with the support of others in similar circumstances in self-help settings, helps the partner to work through the betrayal and regain empowerment. Trauma therapy also helps a partner to work through much of the lasting damage to self. These include sexual shame, broken trust, body image issues, rage and aversion to sex.
At the Edgewood Health Network Clinic in Vancouver, we provide sex addiction therapy to men and women struggling with compulsive sexual behaviours. In addition, we provide support and therapy to partners who have been affected by this disorder. Our team consists of Certified Sex Addiction Therapists (CSAT), which who are qualified to help a partnership understand the behaviors and provide a roadmap for successful treatment.
If you’d like to learn more about our services offered at our Vancouver clinic, please call 604-734-1100 or call our toll free 1-800-683-0111 to learn more about the range of treatment programs we offer under the Edgewood Health Network across Canada.
Nelson Sacristan, MA, CSAT, Clinical Manager of EHN Vancouver holds a Master’s Degree in Counselling Psychology as well as certification in substance abuse counseling. He has been working in the addictions field for 20 years. Nelson sees his role as helping our clients and their families to understand the nature of addictions, and to facilitate discovery of their inner strengths and integrity. As a Certified Sex Addiction Therapist, he is also available to help men and women struggling with compulsive sexual behaviours
Facts and Statistics About Infidelity. Retrieved on July 2016 at https://www.truthaboutdeception.com/cheating-and-infidelity/stats-about-infidelity.html
Can Therapy Dogs Play a Role in Addiction Recovery?
Do therapy dogs have a place in addiction treatment? According to a 2015 research initiative by three Canadian universities (University of Regina, University of Saskatchewan, McMaster University) therapy dogs can help people with addiction and mental illness. The study had therapy dogs visit patients at various addictions and mental health treatment centres for six months.
The study found that therapy dogs can help people with mental health, addiction, and trauma concerns. According to this study, “in 2014, the Substance Abuse and Mental Health Services Administration (SAMHSA) identified six evidence- based principles for service providers to address the consequences of trauma in the individual and to facilitate healing.” These principles focus on supporting recovery, resilience, emotional regulation and relational connection.
It was discovered at the end of the study that the dog’s instincts and “effortless interactions” with participants were in accord with those principles. These principles are:
- Trustworthiness and transparency
- Peer Support and mutual self-help
- Collaboration and mutuality
- Empowerment, voice and choice
- Cultural, historical and gender issues
One of the researchers from the University of Regina states that dogs can help patients focus and feel more comfortable to open up during counselling sessions. The interaction with man’s best friend “initiates the release of the hormone oxytocin in humans, which makes us feel good.” Edgewood Health Network last year introduced a therapy dog at each of our addiction treatment centres.
Findlay, a beautiful Rhodesian Ridgeback trained therapy dog, owned by Cara Heitmann- therapist at Bellwood Health Services introduced him to Bellwood’s inpatient community last December and so far the feedback has been positive. Cara says that clients and staff love having Findlay at Bellwood. “Clients comment on how much they love him, how it brightens their day to see him, and how it helps clients who are missing their pets while they are here.”
Cara believes having a therapy dog like Findlay provides many benefits for clients and clinical staff during therapy sessions and for overall mental health. “Findlay attends group therapy and individual therapy sessions with me because with his mere presence he can calm the room. As for staff, we have a job that can be highly stressful and I have heard many staff members share that seeing Findlay’s face brightens their day and their interaction with him is very soothing.”
Cara remembers a time where Findlay helped a new client entering treatment feel welcomed, “Introducing Findlay certainly has made a difference. An example that immediately springs to mind is a first day client who came to group late due to an orientation of sorts, knocked on the door before entering and was immediately greeted by a smiling face with a wagging tail. I can’t imagine that didn’t ease some discomfort! I have had many, many clients share how Fin has helped them while in treatment and they are shocked that anyone would not just automatically know that. It’s a no brainer.”
According to the Executive Director of National Service Dogs (NSD) in Canada, they’ve received a ton of praise from their clients about the benefits of using service dogs in the treatment of PTSD. Last year, Wounded Warriors Canada donated $50,000 to help fund more certification of service dogs for Canadian Forces members, Veterans and First Responders with Post Traumatic Stress Disorder (PTSD) in BC and Alberta.
In addition, NSD believes animals can lower anxiety, reduce the cost of medication, provide comfort and security for a client and their loved ones. Cara believes therapy dogs work because the connection is different than that with other humans, “It’s less threatening and highly comforting. A dog’s instinct to sense when a person is struggling or having a difficult moment and seeing how they are comforted has no words.”
Colleen Dell one of the researchers that was part of the study last year was amazed to see how consistent the outcomes were from all the centres they had considered. It didn’t matter if they were youth, seniors or groups of people. In their study, therapy dogs had a positive impact on each person’s “healing journey in a multitude of ways, from providing comfort through to increasing therapeutic alliances with service providers.”
Chalmers, research from the University of Regina believes there are still other animals that need to be studied, such as horses to better understand the benefits of service animals. The three universities released their study’s findings during Addictions Awareness Week last year on purpose, “The theme of Addictions Awareness Week this year is ‘Addiction Matters.’ And it is precisely for this reason that our team has stepped outside the box, so to speak, to research an intervention that can potentially support long-term recovery.”
As more research is conducted and more testimonies are accrued, it seems therapy dogs can play a role in helping clients who are in rehab by providing comfort, security and non- judgmental love. Cara shares, “I am honoured to have Findley work for a number of years. Every time I see that interaction it warms my heart, puts a smile on my face, and makes me proud to be his mom.” At Bellwood it seems Findlay’s natural instincts and interactions continues to have a positive effect on our clients and team.
In our next issue of the Phoenix magazine we discuss in further detail EHN’s valuable experience introducing therapy dogs at our treatment centres. To subscribe to our magazine, please click here.
Want to learn more about our addiction treatment programs and what they include email us or give us a call at 1-800-387-6198.
Colleen Anne Dell, Nancy Poole, (2015). Taking a PAWS to Reflect on How the Work of a Therapy Dog Supports a Trauma-Informed Approach to Prisoner Health. Journal of Forensic Nursing, Volume 11, Issue 3.
CBC News Saskatchewan
National Service Dogs
CBC News British Columbia
5 Things you need to know about EMDR, Trauma and Addiction
By Nicole Makin, MACP, RCC
Having found my place in the rooms of Al-anon in my 20’s, I was blessed to find an incredible therapist who was 20 years sober in AA and highly trained in the treatment of trauma. With her support, I processed events from childhood that still overwhelmed me and contributed greatly to my codependent behaviors as an adult. With a sense of safety and trust established we moved on to EMDR therapy, a powerful form of trauma processing, and I rapidly moved from chronic anger, depression and insecurity to a sense of personal freedom and purpose in life that is still with me today. I learned how to inhabit and listen to my body’s messages through prayer, meditation, yoga, diet, exercise and daily affirmations. I reset my nervous system from stressed to calm and confident and was able to develop skills in areas I was deficient in due to traumatic childhood experiences. I went from feeling as though isolation was my only relationship skill to developing a sense of community and trusting myself with a variety of relationships. Now that we offer EMDR therapy in both our Vancouver and Victoria clinics, here are 5 things you need to know about EMDR, trauma and addiction:
1) Growth and development are stunted in addiction.
In treatment we say that a person’s mental and emotional age typically reflects the age when substance use begins. This is also true if you were raised in a home where substances were being abused and poor role modeling was mixed with the stress of living amidst addiction. In either case, the result is that we have a lot of people in recovery with adult bodies who have the emotional intelligence of 12-15 year olds. And like any 15 year old, they are often lacking in interpersonal communication, boundary setting, self-care, managing stress and problem solving. If we want to be healthy and reach our full potential in life, it is our job to become our own loving parent and help ourselves grow up!
2) Addiction and trauma often go hand in hand.
Addiction and trauma are often correlated. Amongst individuals with addiction disorders, many have experienced trauma while many trauma survivors struggle with addiction. What folks with addiction and trauma issues have in common is that we often arrive into adulthood lacking in the personal growth and development skills we talked about in number one. In fact, some people view addiction as a misguided attempt to gain a sense of control over the enormous stress that people experience when they lack the emotional maturity and healthy supports or coping skills to meet normal life challenges in resourceful ways.
3) Trauma effects the functioning of the brain and the nervous system.
Mental health researchers and neuroscientists are widely in agreement that emotional trauma impacts the brain and the nervous system, particularly when it takes place during critical child developmental years. Children and adults who experience trauma often become more sensitive to external stimuli and it is believed that this is due to several factors happening in the brain and nervous systems. This means that people who have experienced trauma are not as resilient as those who haven’t; they often feel unsafe when others don’t, and their brain can “shut down” during times of high stress. This means that their brains are more vulnerable to the risks of addiction, and less able to deal with triggers when in recovery.
4) You can learn to be more resilient to life challenges.
The notion of resiliency is commonly discussed in the psychology field and it is believed that regardless of the nature or severity of trauma an individual experiences, certain individuals have the ability to overcome challenges and emerge stronger and wiser. Can we learn to be more resilient? According to the American Psychological Association website (2015), “resiliency is not a trait people either have or don’t have” but rather it is a skill set made up of “behaviors, thoughts and actions that can be learned and developed in anyone.” Bottom line: trauma doesn’t have to stand in your way forever because you can learn the skills you need.
5) EMDR can help!
EMDR is a form of psychotherapy designed to help treat the symptoms of trauma. It allows a client to to address a traumatic experience that has overwhelmed the natural resilience and coping mechanisms of the brain. The painful memory is reprocessed through an eight-phased technique until it is no longer psychologically disturbing. By working with a skilled clinician, individuals can learn to understand their body’s stress response and how to achieve a sense of calm in the nervous system so that the brain can do the processing needed in order to integrate past experiences and move on with healthy living in the present. EMDR has been shown to be particularly effective in overcoming trauma by assisting individuals to develop the tools to change their state from stressed to calm and to fully process traumatic events so that they are no longer disturbed or triggered by them in the present moment.
If you`re interested in speaking to a clinician about EMDR, please contact 1-250-590-3168 in Victoria or 1-604-734-1100 in Vancouver.
Seeking Treatment for PTSD: The Recovery Process
Post-traumatic stress disorder (PTSD) is by definition a set of symptoms resulting from a traumatic experience of “death, threatened death, actual or threatened serious injury or actual or threatened sexual violence. “ More broadly, PTSD can also be defined as having experienced an overwhelming situation where your normal coping strategies are not adequate. Symptoms of PTSD can vary, but most people with the disorder experience sleep disturbances, hyper-arousal, flashbacks and mood disturbances.
At Bellwood, we see clients who have experienced such traumas and are struggling with the symptoms of PTSD. Our program for hazardous employment groups includes members of the Canadian Forces, the RCMP, the police, EMS and fire services and would potentially be open to other work related traumas. We added the term of operational stress injury (OSI) to our program description since it is something first responders would often experience.
As a therapist in the Addiction & PTSD/ OSI program at Bellwood, I’ve found that the traumatic experiences at work change how a person functions and relates at home. Clients often experience alienation. For example, they report “not knowing where to put their keys in their own homes” and don’t know how to relate to normal life or perform day-to-day tasks, including shopping or driving in traffic. Everything feels too mundane to be of interest compared to active duty. In their deployments, they experienced high arousal and adrenaline-inducing activities.
As a result of their alienation, people with PTSD might resort to drugs or alcohol to find relief from the emotional pain, loneliness and the feeling of “going crazy.” They might find themselves covering up anger and pretending that things are alright. Using also becomes a way of dealing with the irritability, intrusive memories, and nightmares. Sometimes, the only time an individual with PTSD feels “normal” is when intoxicated or when involved with work. When at work or deployed, job tasks are pre–determined and the soldier or officer focuses only on work tasks – something at which they believe they excel.
Clients that I see often express the feeling that no one outside of work could possibly understand what they are going through and that no one is as “messed up” as they are. Many express the wish to either have been killed (because then, “at least my kids would think of me as a hero”) or physically injured because then they would receive support from the whole community upon their return home. With something physical, the nature of the injury is apparent and no one would think they are making it up. The problem with PTSD is that it is invisible and remains that way until the person realizes that they are not alone and accepts that their experiences have changed their feelings.
One of our goals in treatment is to reduce or eliminate the emotional disturbances related to the traumatic work experiences by learning grounding techniques and self- regulation tools. Our treatment approach is the establishment of safety and stabilization. Through this process, trust is built. This work is enhanced by successfully identifying and continuously managing environmental and emotional triggers. By employing the emotional regulation and grounding techniques, clients can ultimately master their triggers, lessening their impact on their mental health. Other key features of our program include: stress management techniques, anger management, sleep hygiene, resilience identification and recovery planning.
As a result, major PTSD /OSI symptoms are reduced and clients can begin to realize that when triggered the traumatic experience is not happening anymore and that they are able to deal with their feelings in more constructive ways. However PTSD/ OSI symptoms need long-term care and management. Treatment does not “cure” the individual but with ongoing support, the client can more successfully deal with life’s problems without the use of drugs and alcohol and can learn to put their traumatic experiences into a better perspective. At times people may learn to refer to their symptoms as post traumatic growth or post traumatic success and can appreciate their experiences as important.
Play It Forward for Mental Health Awareness
Henri Matisse said that creativity takes courage. That’s exactly how you would describe Shelley Marshall – courageous and creative. Hilarious is another word you might use. She’s a comedienne, a mother and a mental health warrior. And she’s partnered with the Edgewood Health Network to bring her award winning autobiographical play Hold Mommy’s Cigarette across Canada.
This one woman show is the story of Shelley’s life and the impact a history of mental illness has on a family and a young girl. It’s a story that touches audiences deeply and makes them laugh just as hard. As Shelley says, “I take them on an adventure, both emotionally and visually. There is no denying that my story is tragic, but it’s my story and time and writing without shame has been my comedic relief. Hold Mommy’s Cigarette is not an exploitation of what has happened in my life, but rather, an acceptance of where it may lead. It is a dark comedy, a vulnerable piece about life, mental illness and survival.”
The play chronicles her early life, leading up to her lowest point – a suicide attempt. Yet fate and her husband intervened, and Shelley survived. She now uses Hold Mommy’s Cigarette as a vehicle to talk about depression and to showcase how she was able to turn her deep sadness into tremendous success. It’s an inspiring experience that opens up a much needed conversation around suicide and mental illness.
As a part of the Edgewood Health Network, we’re very proud to be helping Shelley spread her message of hope. Especially since addiction is a disease that often leaves it’s sufferers feeling completely hopeless.
The Edgewood Health Network wants to “play it forward” by giving away free tickets to Hold Mommy’s Cigarette. We think everyone should have a chance to see this show! Tickets will be available for April 16, 17, 18 and 19 in Toronto. Go to https://www.ticketscene.ca/series/285to register and use the promo code EHN.
As Shelley often says, “best life ever!”
Nursing best care for clients with addictions starts with self-care
The notion of self-care is no longer an exotic or optional practice for healthcare workers. However, the way in which it is effectively incorporated into the life of a nurse working in a mental health setting is not routine by any means. Given my experience as a nurse for over a quarter century in the addiction treatment field, I have reflected on what it means to effectively integrate self-care into practice. In the “caring professions,” burnout is becoming more and more common. This unfortunate outcome may be intensified, given that individuals seeking help for addiction or other healthcare services are presenting with very complex problems. Therefore, self-care becomes imperative to ensure there isn’t a “cost of caring” for those providing the care.
For 15 years I worked at a women’s addiction treatment program and it was there the issue of self-care for staff became apparent. In particular, a counsellor who was working with women with identified trauma histories began experiencing unusual fatigue and a feeling of disconnection with some of her clients, canceling appointments and not sleeping. These symptoms are now recognized as possible manifestations of “vicarious traumatization.”
Vicarious trauma, sometimes also called compassion fatigue, can occur to individuals who care for others who are suffering or in distress. Being exposed to others who have experienced trauma – listening to their stories, bearing witness to the pain and fear, and working with them – can create vicarious trauma in counsellors and nurses.
It is my belief that nurses, and particularly those who work in addiction treatment, are at risk of experiencing vicarious trauma by the very nature of the people we are caring for on a daily basis. In the 25 years I’ve worked in this area I’ve seen the “typical client” change dramatically. In the 1980s and early 1990s, individuals seeking treatment for addiction were dependent mainly on alcohol, prescription drugs and cocaine. Clients usually had some family support, often some form of employment, and rarely disclosed a concurrent mental health issue. Now, the majority of individuals seeking addiction treatment is dependent on multiple substances, including highly addictive opiates, and also has histories of trauma – be it emotional, physical and/or sexual. In the past, these were not always recognized as underlying issues associated with the addiction and were certainly not addressed in treatment. But now, it is becoming the rule rather than the exception that clients being admitted for addiction treatment also present with a co-occurring mental health issue and require more complex care. This places more demands on the nurses and staff, who may begin to experience ongoing fatigue, stress and possible burnout as a result.
What makes self-care even more important is that most nurses experience the stresses of long shifts, overtime and the effects of shift rotation; all of which can be physically taxing and tough on family life and friendships. Given the emotional and physical demands of the job, nurses can sometimes internalize their feelings in order to stay in control and make tough decisions in a short period of time. At times, nurses can go from one emotionally and physically demanding situation to another, and may have little opportunity to process their experiences and decompress. It is these conditions that can contribute to burnout and compassion fatigue.
Nurses by their very nature are people drawn to help others, provide empathy and put others ahead of themselves. They must be mindful of the impact these increased demands have placed on them as primary care providers. Employers need to demonstrate recognition of this impact by providing education, support and opportunities for staff to debrief. They must ensure staff receive the training they need to offer care appropriately and to recognize when someone may be on the verge of burnout leading to blurred boundaries, unhealthy coping strategies and even depression and anxiety.
To avoid the pitfalls noted, it’s important for individuals in the caring professions to consider the following strategies for self-care:
- Get enough sleep – sleep deprivation is our worst enemy
- Maintain a good exercise and nutrition plan – these are the best tools for managing stress
- Engage in mindfulness meditation – it isn’t hard and it works!
- Talk it out with someone you trust – either a friend or colleague who understands, or a professional counsellor
- Leave work at work – that means ensuring you are supported by your supervisor to receive regular supervision and have in place boundaries between your work and personal life
- Keep your learning current so you have the right tools to do your job and know your limits
- Know when to say no – this is hard for women in general, and even harder for nurses who don’t want to let anyone down
Being committed to ensuring that you incorporate at least some of the above list into your personal commitment to health greatly increases the likelihood you won’t end up drained and disheartened to the point you believe you can’t do the work anymore. Addiction nurses are a special group of care providers and their contribution to someone’s recovery is, I believe, a fundamental component of their journey. But, it is nearly impossible to teach wellness to someone else if you don’t practice it yourself.
As someone who has often been identified as a “human doing” versus a “human being”, I know all too well the risks of over-extending. I wouldn’t stay working as a nurse in this field if I didn’t love what I do and have the chance to be a part of people’s journey back to good health and positive well-being. For me, the work is a privilege and keeps me grounded in what are the priorities in my life. To manage my choice to work in this area, I stay mindful of what is considered good self-care. That doesn’t mean I’m always successful at practicing self-care, but I’m a believer that being informed in what I can do gives me the tools I need to stay healthy and remain a good nurse.
By Nanci Harris, BSc Nursing
Originally published in the Spring 2014 issue of Moods Magazine, www.moodsmag.com.
Nanci Harris holds a BSc Nursing from the University of Western Ontario and a Masters in Library and Information Science. She has worked in various roles in the addiction treatment field since 1987 including: the Donwood Institute, the Jean Tweed Centre and Bellwood Health Services, where she has been a casual staff nurse since 1988. Nanci presently holds the position of Manager, Practice Assessment & Enhancement at The College of Physicians and Surgeons of Ontario.
Trauma, Addiction and Mood
Trauma, Addiction and Mood: Self-Regulation For Recovery
A favourite saying in 12-Step fellowships is: “It’s a simple program for complicated people.” To be human is to be complex, but that complexity can make addiction seem like a labyrinthine problem, both for the addicted person and for others seeking to help. Trauma, too, is a complex condition. Researchers and clinicians have identified a large number of facets that can be related to trauma: “stuck” (that is, undischarged) flight/fight responses, tonic immobility (“freeze” response) and dissociation, disrupted and damaged belief systems and self-image, chronic anger and rage, debilitating anxiety, major depression, suicidality and homicidal ideation, massive breakdown of lifestyle and relationships, deep shame, guilt, and distrust of people. When addictions and trauma occur together, the complexity can become quite daunting. However, understanding how trauma and addiction interact can open the door to understanding how to recover.
Addiction Can Be a Coping Method for Trauma
Traumatic events are shockingly common. The General Social Survey in 1998 reported that two-thirds of Canadians over the age of 15 had experienced at least one traumatic event in the previous 12 months; and more than one-third of Canadians had experienced multiple traumatic events in the previous year.1
Not knowing how to manage the emotional and physiological stress that may be experienced after a traumatic event, many people turn to addictive substances and behaviours as a means to cope with their discomfort and pain. Studies done in the United States have found that more than two-thirds of people seeking treatment for substance abuse report having experienced one or more traumatic events in their lives.2 Substance users are two to three times more likely than the general population to witness serious injury or death and to experience physical assault.
Trauma Symptoms Fuel Addiction
Overwhelming emotions, along with frequent physical arousal and tension, are primary symptoms of trauma that sufferers have great difficulty regulating. The biological threat response (flight/fight/freeze) appears to become lodged in the nervous system of the survivor, with the result that their body feels as though – and gives their brain the message that – they are constantly in mortal danger. In addition, multisensory images of traumatic experiences may intrude frequently on the mind – images that are charged with intense feelings such as fear, rage, guilt or grief. A leading clinician and research psychiatrist in the field of trauma, Dr. Bessel A. van der Kolk, has said that, “The inability to modulate emotions gives rise to a range of behaviors that are best understood as attempts at self-regulation. These include aggression against others, self-destructive behavior, eating disorders, and substance abuse.”
People who suffer from concurrent trauma and addictions are often able to identify the specific symptoms that they have been seeking to regulate with their addictive behaviour. For example, both alcohol and cannabis can temporarily reduce chronic hypervigilance and thus help people sleep, function at work, and maintain relationships. These substances, as well as opiates or disordered eating, can also be used to “numb out” chronic anxiety by facilitating a dissociative state. On the other hand, self-harming behaviour (including some types of disordered eating) can counteract numbing and help the person feel more alive. Similarly, cocaine and stimulants can increase hypervigilance and associated feelings of power and control.
Activities that re-enact traumatic arousal can counteract a prevailing sense of emotional numbness, and may also be driven by the “stuck” flight/fight energy that is seeking to discharge itself. For example, addictive sexual behaviour can be a (not necessarily literal) re-enactment of sexual trauma, and high-risk behaviour as a result of alcohol or cocaine use can also be a way of re-enacting the anxious arousal of past traumatic experiences. Gambling, along with the sometimes consequent levels of debt, borrowing, and sketchy companions, can in itself be a high-risk re-enactment. Different types of physical exertion may replicate aspects of the flight (such as bicycling or running) or fight (such as weight training or martial arts) response, and as such can become a form of compulsive re-enactment. Sometimes people combine the functions of different addictive behaviours to move sequentially between, for instance, the arousal of re-enactment and sleep.
Another favourite 12-Step fellowship saying is: “The good news about recovery is that you get your feelings back; and the bad news is that you get your feelings back.” For survivors of trauma, this can be bad news indeed. The very symptoms they have been using substances and addictive behaviours to manage may now emerge in full force. For people in recovery, learning and practicing healthy means to self-regulate mood and physiological state is an urgent need.
Stabilizing Emotions for Recovery
Stabilization is a central principle of addiction relapse prevention. It involves establishing a balanced and health-promoting routine that includes appropriate nutrition, physical exercise, and rest, along with recovery-focused activities, work, family life and leisure. The first stage of recovery from trauma is often termed “safety and stabilization,” and is a vital foundation for the eventual work of processing and releasing traumatic memories. For the person recovering from both trauma and addiction, stabilization has an internal as well as an external component. Along with the balanced lifestyle, a trauma survivor must learn how to pay on-going attention to their internal state.
It can be extremely helpful for a traumatized person to become aware of the specific symptoms they were seeking to regulate through their addiction. Someone who had been drinking to get to sleep can focus on sleep hygiene to begin creating a sense of safety and stability. A person who has been on a roller coaster of anxious hyperarousal followed by depressed lethargy can prioritize the learning of methods to bring down the highs and bring up the lows. And if intrusive memories and images have been haunting or flooding the person’s mind, then she or he can focus on techniques for mindfully containing the images, without numbing or fearfully seeking to suppress them. Thankfully, there are methods available that can, with determined practice, effectively address the full range of trauma symptoms.
A fundamental practice for anyone seeking to recover from the suffering of concurrent trauma and addiction is to use tension reducing methods to regulate the nervous system. These techniques also help people to gradually become re-acquainted with, and accepting of their internal states, both positive and negative. A few of the most beneficial are gentle, mindful breathing, progressive muscle relaxation, specific types of soothing imagery, listening deeply to calming music, walking outdoors at a relaxed pace, and engaging in mutually nurturing social interaction and connectedness.
Recovery from the combination of trauma and addiction is absolutely possible. For as long as there have been mood altering substances, mood-altering behaviours, and human beings experiencing the trials of living, it is probable that the two conditions have been afflicting people; but recovery has also been occurring. Certainly, since Alcoholics Anonymous began in the mid-1930s, many addicted people with trauma have succeeded in regaining health and a satisfying way of life.
However, this does not mean that such recovery is easily achieved, nor has there has been a 100% success rate. As more effort has been devoted to understanding the interaction between trauma and addiction, we’ve come to understand how challenging the work of recovery can be. At the same time, a much wider array of approaches has emerged for responding to the challenges. The simple good news for complicated people is that anyone entering into recovery can learn techniques to manage traumatic emotions and memories – and physical arousal and tension – in a way that the addiction never could. While it takes a lot of work to recover from trauma and addiction, there is a very thorough set of tools at our disposal.
Originally published in the Fall 2012 issue of Moods Magazine, www.moodsmag.com.
- Statistics Canada, General Social Survey 1998
- O’Brien JM, Addiction and Trauma, Presented at the 3rd Annual Co-Occurring Disorders Institute, University of Maine at Augusta, 2011, citing Back et al, 2000
- O’Brien JM. Addiction and Trauma. Presented at the 3rd Annual Co-Occurring Disorders Institute, University of Maine at Augusta, 2011, citing Cottler et al, 2001, & Kessler et al, 1995. [Kessler RC, Sonnega A, Bromet E, Hughes M, Nelson CB. Posttraumatic stress disorder in the National Comorbidity Survey. Archives of General Psychiatry. 1995 Dec;52(12):1048-60.]
- Van der Kolk, BA, Fisler, RE. Childhood abuse and neglect and loss of self-regulation. Bulletin of the Menninger Clinic. 1994 Spring;58(2):145-68
- Janina Fisher, Addictions and Trauma Recovery, Paper presented at the International Society for the Study of Dissociation. San Antonio, Texas, November 13, 2000