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So what’s the big deal about having  a cocktail after WLS?    WLS has been shown to drastically lower alcohol tolerance – to the point that some post-surgery patients have a blood alcohol content above the legal driving limit after just one drink.  Alcohol is absorbed more rapidly into the blood and small intestines due to the reduction of hydrochloric acid in addition to the alteration of shape & size of the stomach.  Bariatric patients will be more sensitive to the affects due to their low caloric intake, metabolic changes and hypoglycemia is more likely to occur.

As far as cooking with alcohol, people believe once heat is added all the alcohol burns off and only the flavor is left.  This is a myth.  The US Dept of Agriculture shares that if alcohol is added to boiling water and quickly removed from a flame, 85% of the alcohol is retained in that dish.  Simmering a meal with alcohol can take as long as 2 hours or more to burn off.

The American Society of Metabolic and Bariatric Surgery recommends high-risk groups (those with any history of psychiatric illness, substance abuse or addiction) who have had gastric bypass should completely eliminate alcohol consumption due to impaired alcohol metabolism and risk of alcohol abuse post-operatively.

Remember you’ve had a surgery that puts you at risk for malnutrition.  Alcohol inhibits the absorption of thiamin which is a vitamin that can already be deficient in many bariatric patients due to malabsorption. B1 depletes quickly with chronic vomiting or increased alcohol intake because B1 is essential for glucose metabolism.  Regular alcohol consumption is strongly correlated with thiamine deficiency.  Symptoms of thiamine deficiency may include headaches, brain fog, nausea, muscle aches and pains.  It can progress to worse symptoms such as depression, amnesia, unstable gait, motor weakness, peripheral edema, hallucinations and even congestive heart failure.  If anyone is experiencing these symptoms, please check that your multivitamin includes at least 1.2 mg of thiamine.  Share your symptoms with your doctor immediately.  Early diagnosis is extremely important.

If you still choose to consume alcohol after WLS, wait until after the first year during the most rapid weight loss period.  Find a designated driver. It is apparent that alcohol affects people very quickly after their procedure. Be cautious and keep your low sugar drinks to a minimum as you learn how alcohol will affect you and to prevent dumping syndrome. If you are drinking to cope with emotions and feel it may be an issue, seek professional support to address the underlying issues.  The Chrysalis Center offers a Bariatric Recovery Group if you are struggling with alcohol addiction or dependency.


Ed Cochard, LPA
17/Aug/2017

Anger in its’ proper form is a healthy emotion despite all of the bad press it has been getting. Healthy anger helps to mobilize our internal resources in order to respond to external threats and injustices. The key term in that statement is “healthy.” Many however struggle to determine what constitutes healthy anger and how to properly express it or manage it.

In order to better understand anger, we need to first know where anger comes from. From the perspective of Cognitive Therapy, anger occurs when we perceive a violation to our Personal Domain. Our Personal Domain consists of our values, our rules about the world, our needs, our wants and our expectations of others. Our physical being is also an element of our Personal Domain. An example of how anger is triggered from this perspective might be the anger most of us feel when a child or some innocent person is terribly harmed. For many of us, when we see a news story depicting someone being unjustifiably harmed-we become angry. We were not personally harmed, yet we still feel angry. The reason is because our value or our rule about the world that innocent people should not be harmed was violated. In order to determine if we are experiencing healthy anger, we need to evaluate our anger using the following criteria:

Are you making something out of nothing?

1. What did we “perceive” to have happened? We need to determine what did we see or “perceive” to have happened. We need to determine if what we “think” occurred actually did occur as we saw it by reviewing facts or using sound logic. If our perception is supported by facts or sound logic-then we are probably experiencing healthy anger.

2. What aspect of our Personal Domain was violated. We need to determine what value, rule, need, want or expectation was not met. Once we are able to identify this, we need to evaluate if this element of our Personal Domain is reasonable. Just because we feel things “should” be a certain way, does not mean is has to be that way. Objectively, if we are able to determine that our value, rule… is valid-then we are experiencing healthy anger.

Are you making a mountain out of a molehill?

1. Does the severity of our anger equal the situation that occurred? Now that we have determined that our anger is justified, we now need to make sure the level of anger we are feeling is equal to the situation. We need to make sure that our anger does not supersede what occurred. If our anger is proportional to the situation-then we are experiencing healthy anger.

Healthy anger consists of ensuring that you are “not making something out of nothing” and “not making a mountain out of a molehill.” Now, if you are reasonably able to determine that you are experiencing healthy anger, there is still one very important final step. You still need to express your anger in a healthy and productive manner that helps to resolve whatever issues triggered your anger in the first place. Healthy anger also warrants a healthy expression.

If you are interested in learning more about healthy anger and how to manage anger in a healthy manner, please feel free to contact our clinic and schedule an appointment with one of our clinicians.


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“Your body cannot heal without play. Your mind cannot heal without laughter. Your soul cannot heal without joy.” – Catherine Rippenger Fenwick

Sure, it’s fun to have a good laugh, but did you know it can improve your health? I’m not joking! Laughter can “strengthen the immune system, improve mood, reduce pain, and protect from the damaging effects of stress.” As children, we used to laugh on average over 200 times daily, but as we age into adulthood, life tends to be more serious and laughter more infrequent. To counteract this barrier, it is important to intentionally seek out more opportunities for humor and laughter in everyday life, and that includes in the therapy setting. Mental health professionals can safely incorporate tools such as psychodrama and other experiential exercises in session that extract humor to address the mental, physical and emotional needs of clients.

The Science Behind Laughter & Humor

When a person is depressed, neurotransmitters in the brain [dopamine and serotonin] are reduced and the ‘mood control circuit of the brain’ is impaired. Laughter can repair malfunction by fluctuating dopamine and serotonin activity. Laughter can also alleviate the effects of stress by decreasing stress-making hormones and serum levels of cortisol and epinephrine found in the blood steam. Humor and laughter can shift perspective and change the way the mind views or experiences an event. Looking at a problem from a different perspective can create psychological distance. help diffuse conflict, feelings of being overwhelmed and even increase objectivity and insight.

Laughter & Humor in the Therapeutic Environment

Laughter Yoga

Laughter Yoga was created by Indian physician Dr. Madan Kataria in collaboration with his wife Madhuri, a yoga teacher in 1995. Its principle follows a “body-mind approach” to laughter by inviting participants to laugh for no reason”, which sometimes entails faking a laugh until it becomes real. This is possible since the body can functionally laugh regardless of what the mind has to say. A few studies have examined the effects of laughter yoga applied in the workplace and nursing home facilities, and the results show that engaging in exercises that simulate laughter can “increase self-efficacy in employees and reduce depression in the elderly.”

Click this link to hear more from Dr. Kataria and join in on some laughing exercises! https://www.youtube.com/watch?v=5hf2umYCKr8

Improvisation

Improvisation, or improv, has more recently been applied to group therapy for the treatment of psychological issues and provide opportunities for personal growth and exploration. The benefits of practicing aspects of improv comedy in group therapy include, “active listening,” “risk-taking,” and “group-mind” (Steitzer, 2011). Comedic improv therapy (CIT) a group therapy model inspired by the practice of improv comedy, provides the therapeutic elements of “group cohesiveness, play, exposure, and humor.” Operating in collaboration with The Second City Training Center in Chicago, Mark Pfeffer and Becca Barish have facilitated a program known as Improv for Anxiety for the treatment of social anxiety disorder in adults and adolescents. Improv for Anxiety involves participants meeting twice a week for a period of 8 weeks. Each weekly session provides an opportunity for participants to engage in a traditional improv comedy class led by skilled improvisers at The Second City Training Center and mental health professionals experienced in group facilitation that utilize the proposed CIT model, in combination with other empirically-based models of therapy. They also provide psycho-education about unhelpful thinking styles and discuss methods of restricting negative cognitions. The response from the program’s participants has been positive, and is currently being empirically evaluated by the University of Chicago using the Liebowitz Social Anxiety Scale.

 

References:

Phillips Sheesley, A., Pfeffer, M., & Barish, B. (2016). Comedic Improv Therapy for the Treatment of Social Anxiety Disorder. Journal of Creativity in Mental Health, 11(2), 157-169.

Panksepp, J. (2000). The riddle of laughter: Neural and psychoevolutionary underpinnings of joy. Current Directions in Psychological Science, 9(6), 183-186.

Steitzer, C. (2011). The brilliant genius: Using improv comedy in social work groups. Social Work with Groups, 34(3-4), 270282.

Yim, J. (2016). Therapeutic Benefits of Laughter in Mental Health: A Theoretical Review. The Tohoku journal of experimental medicine, 239(3), 243-249.

 

 

 



Whether you are contemplating weight loss surgery or are post-surgery, lifestyle changes are the key to optimize your outcome. Having the right team members with you on this journey will ensure a healthier you and make transitions smoother.
Research shows that individuals who remain in touch with their bariatric centers maintain weight loss and are in better health. Follow ups with your surgeon or Primary Care Provider (who is knowledgeable of post- surgery care) are essential over your life time.
Prior to surgery attendance at one or two nutritional seminars is the norm. The information provided invaluable but often overwhelming. Often your handouts end up loss in a drawer and you struggle with how to vary your diet over time or revert to some unhealthy habits. Learning all you need to know before you have surgery is almost impossible. It’s like reading a book on how to swing a golf club and actually hitting the ball straight onto the green. Consider a Bariatric Specialized Dietician to help over the course of weight loss and management as a valuable team member.
Your significant other and family are crucial members of your team. The more they understand your new normal, both changes in diet and exercise, the more support can be provided. Let family members know your needs, be firm that your health is a priority and what they can do concretely to assist.
Friends become team members only when they are included in your journey. Not all friends may remain on your team. Accept new members who support your lifestyle and cut those who are not able to make the transition with you.
A bariatric support group is another member to add. These groups are a resource to gather new ideas, compare experiences and learn about your new lifestyle.
If you are struggling with emotional hunger, depression or anxiety, counselors can provide a safe place to help learn new coping skills, examine new life goals and resolve any unfinished issues before you sabotage your success.
Most importantly is your bariatric surgery itself on your team? Is it your friend or rival? The framework you place your surgery helps determine future behaviors and motivations. If you treat your surgery as a team mate, one who assists you in keeping obesity in remission, who deserves attention and respect; the guidelines and rules are just part of the game. If you see your surgery as an obstacle, barrier to get around or beat, compliance and ultimately optimal results suffer. Make your surgery your MVP.
So, who is on your team? Add those individuals who will assist you on the way to new opportunities and success.



These days one can’t go anywhere without hearing nutrition chatter. You’ve probably heard things like:

  • “Don’t eat gluten.”
  • “Eat more coconut oil.”
  • “Fat is bad.”
  • “Bananas are too high in sugar.”
  • “Eat clean”
  • “(Insert food rule here).”

These and many other rigid suggestions are being tossed around casually and though each statement might seem a bit different they all portray the same underlying message that what you are eating is wrong and you should be doing it differently.  Harsh, isn’t it? Consider yourself introduced to diet mentality and the diet paradigm. More formally, the diet paradigm includes patterns of eating that are:

Inflexible, quantitative, prescriptive, rigid, perfection-seeking, good or bad foods, rules, deprivation, time-based, fear-driven, guilt-inducing, shaming, body hatred, hunger, struggle, rationalising, temptation, thought-consuming, punishing (Willer, 2013).

If the way you are eating and your relationship with food feels like the above, then it is diet behavior. You are not alone in thinking the above is what you should do to “be healthy.” We live in a diet culture where dieting to lose weight or change body shape has been normalized. Our society promotes weight loss diets, puts thinness on a pedestal and advocates the belief that weight loss is the way to improve self-esteem, become respected, feel effective and in control, and avoid criticism (Mehler, 2010).  The messages, strict weight loss strategies, rule driven diets, and marketing that saturates us with these ideas come from a 60 billion dollar industry. You read that correctly, the diet industry is worth sixty billion dollars. The pushers of  “Weight is the problem and dieting is the answer” are making bank off of our insecurities and drive for thinness. That doesn’t sit well with me.

Furthermore, while this industry rakes in the dough and promotes the diet paradigm as the “norm,” clinical practice and research tell us that these messages and eating patterns are dangerous. Eating disorder specialist, Phillip Mehler, MD, and Psychiatrist, Arnold Anderson, MD, (2010) state that dieting is the most common contributing factor to eating disorders. Wow. Dieting also leads to being obsessed with food, nutritional deficiencies, increased psychological stress, impaired social functioning, increased intake of substances, food and body preoccupation and distraction from other personal health goals, reduced self esteem, weight stigmatization, discrimination, weight gain, and – because it is worth mentioning again – an increase in the risk of developing disordered eating.

You haven’t failed your diet, diet culture has failed you!

For more information check out the links below and stay tuned for Courtney’s future follow-up posts including topics such as non-diet nutrition and the Health at Every Size approach.  If you are looking to further explore your relationship with food and your body seek out a non-diet dietitian or therapist that specializes in eating disorder treatment.

Resources:

https://daretonotdiet.wordpress.com/

http://www.healthnotdiets.com/for-the-public

https://www.intuitiveeating.org/

http://www.unh.edu/health/ohep/nutrition/non-diet-approach-health-every-size-haes

 

References:

Mehler, P. S., & Anderson, A. E. (2010). Eating disorders: A guide to medical care and  

     complications. Baltimore, MD: The John Hopkins University Press.

Tribole, E., & Resch, E. (2017). The intuitive eating workbook: 10 principles for nourishing a

     healthy relationship with food. Oakland, CA: New Harbinger Publications.

Willer, F. (2013). The non-diet approach guidebook for dietitians: A how-toguide for applying the non-diet approach to individual dietetic

     counseling. Raleigh, NC: Lulu Publishing Ltd.



All too often when someone asks me what I do for a living and I tell them I’m a psychologist who specializes in treating eating disorders, they will jokingly say, “I have one those, I eat too much” and sometimes laugh and pat their stomach. As no laughing matter, in actuality, binge eating disorder is the most common eating disorder in the U.S. An estimated 3.5% of women, 2% of men, and 30% to 40% of those seeking weight loss treatments can be clinically diagnosed with binge eating disorder. The disorder impacts people of all ages (including children and adolescents), races, and levels of education and income.
According to the diagnostic criteria for binge eating disorder (BED), the behavioral and emotional signs or symptoms include:

• Recurrent episodes of binge eating occurring at least once a week for three months
• Eating a larger amount of food than normal during a short time frame (considered any two-hour period)
• Lack of control over eating during the binge episode (feeling you can’t stop eating or control what or how much you are eating)

Binge eating episodes are also associated with three or more of the following:
• Eating until feeling uncomfortably full
• Eating large amounts of food when not physically hungry
• Eating much more rapidly than normal
• Eating alone out of embarrassment over quantity eaten
• Feeling disgusted, depressed, ashamed, or guilty after overeating

It is important to note that people with binge eating disorder tend to have higher rates of depression and other mood disorders, greater incidence of other addictions, and significantly higher rates of traumatic experiences. Therefore, it is crucial that treatment providers understand how to treat not only the eating disorder, but the co-occurring issues that contribute to and maintain binging behavior. The following excerpt from one brave client’s testimony of battling binge eating disorder highlights some of these facts:

“My addiction to food started at a very young age, about 4 years old. The insanity of using food to numb the fear, shame, pain and abandonment by my parents, an active alcoholic and drug addict, worked at the time to bring me comfort and enabled me to survive and function in my dysfunctional home. As I grew older and attended school I was ridiculed for being a fat kid and had few friends, I isolated more and more with the food, usually sugary, fatty, high-carb items. I ate in secret, I ate in my bedroom especially at night. I wanted to stop but could not. By the time I was almost through my first year of college I ate myself up to 265 pounds – gaining almost 75 lbs. in less than 9 months. I was gaining weight so fast I used to fall down the stairs – my sense of balance was off in more ways than one.

I used drugs, nicotine, speed and crystal meth as my own treatment to curb ‘my appetite’ and it worked for a while. When I was 23, I was introduced to the 12- step program Overeaters Anonymous; I was so unhappy with myself and my weight, but I wasn’t ready and left the program. I finally went back at 31. I was desperate and surrendered to the 12-step program, doing everything they told me, lost about 100 pounds, and kept almost all of it off for about 12 years. However, I relapsed when I thought I could try a little compulsive eating and some of my favorite sugary foods. This started the insanity of food addiction for me again, put on about 80 pounds, then my husband died in 2006 and I gained more and more weight until I weighed 330 lbs.

My primary care physician suggested I consider weight loss surgery and I met with a surgeon and a therapist. I started counseling for my eating disorder in 2010. After about 6 or 7 months of soul searching and therapy I decided to have Gastric Bypass surgery in February of 2011. The surgery, along with a recommitment to the Overeaters Anonymous program saved my life. I lost a little over 180 pounds and have maintained at least a 160 weight loss for about 5.5 years.

Regarding maintaining my recovery, I knew I didn’t have brain surgery (although sometimes I’d wish I had!) and it really helped me to see my counselor, attend support groups, and be very committed to my OA program. The gastric bypass, my new commitment to taking care of myself, and following all the weight loss surgery eating guidelines have been a life saver – I am much more aware of my actions and sometimes unhealthy behaviors with food and my 12-step program reinforces the fact that I truly have a food disorder, a compulsive eating disease that tells me “it’s okay” to start down that destructive eating path again! One day at time I do my best to choose not to do that.”

If you or someone you love is struggling with binge eating disorder, know that you are not alone and that help is available. The Chrysalis Center’s team of experts offers both therapy and nutritional counseling for binge eating disorder.

Additional resources:
https://bedaonline.com/
https://www.eatingrecoverycenter.com/conditions/binge-eating
http://www.midss.org/sites/default/files/yale_food_addiction_scale.pdf

Kelly Broadwater, LPA, LPC, CEDS is a certified eating disorder specialist whose clinical practice is strongly focused on binge eating disorder, weight loss surgery patients, trauma, and addiction.



The journey towards recovery can take many forms, but every person has to follow their own path towards health and make choices along the way. Some of these choices may come in the form of different treatment centers or levels of care to address the difficulties someone is having at that stage of their recovery. Every person’s process is different.

Eating disorders are very complex illnesses that require specialists to treat not only the emotional and behavioral facets of an illness, but the medical one as well. For these reasons, the American Psychological Association (APA) established guidelines for appropriate levels of care with eating disorders.

Chrysalis Center is an outpatient program and will soon be adding intensive outpatient (IOP) services. The other levels include partial hospital (PHP), residential, and inpatient levels; these last two are sometimes combined into an “IP-Res” format. To see the full APA criteria for eating disorders, click here. There are some other resources for eating disorder treatment in North Carolina, including Veritas Collaborative, Carolina House, and UNC’s Center for Eating Disorders.  Other treatment centers around the country specialize in eating disorders as well, and sometimes these other programs are a better fit for clients in terms of their individual needs and experiences.  Though not for eating disorders, there are several other levels of care in the Wilmington area for adolescents and adults in general psychiatry.

Usually, these difficult conversations start when we as clinicians recommend a higher level of care for someone who we do not think is appropriate for outpatient or IOP treatment. To be appropriate for outpatient or IOP, a person must be:

  • Medically and psychologically stable to the point that they are not a danger to themselves or others
  • Motivated to recover
  • Cooperative
  • Self-sufficient
  • Able to control their thoughts and behaviors using appropriate social support

 

When someone needs a higher level of care, they are usually:

  • Medically compromised (by weight, bloodwork, EKG, etc.)
  • Unable to manage their behavior
  • Un- or under-motivated
  • Not functioning in their lives in some significant way (work, family, relationships, etc.)
  • Unable to manage a co-morbid condition (psychological or medical) because of their eating disorder

Levels of care indicate how much structure, support, and observation a client requires at that stage in their recovery.

When someone needs a higher level of care, it can be a very difficult discussion between provider and client. Sometimes, we all know it is coming and have been trying to avoid it but it just is not working. Other times, clients may take a sudden turn. This could be for many reasons, but the important thing is that clients get the help that they need to recover from their eating disorder and co-occurring disorders. Our goal is always to help our clients and keep them focused on living healthy and productive lives, and we try to balance all their individual needs while keeping the goal of a full recovery foremost in our minds.

It is important to use the right tool to complete a task, and sometimes that tool needs to be a higher level of care in order for someone to truly recover. Often, IP-Res levels of care can get clients back on track faster than outpatient could and sometimes that is necessary for someone’s well being or even survival. PHP and IOP levels can provide support to keep someone out of the hospital or they can provide support as a step-down program. The transition between inpatient and home can be very stressful and there are a lot of facets to consider including social, family, academic, or work stressors. All of these are affected by or contribute to eating disorder behavior. A person cannot live in a vacuum so all of these need to be managed before someone goes back to their regularly scheduled lives.

By adding IOP services, Chrysalis hopes to provide a bridge for clients on their journey in recovery. It is an important stage or facet in that process. If you need us, we will be honored to work with you on that journey.

 

Kendra is a Senior Staff Therapist and soon to be Clinical Director of Chrysalis’s new Intensive Outpatient (IOP) program with 13 years of experience working with eating disorders in various settings, including inpatient, PHP, IOP, and outpatient treatment facilities.


Rachel Hendricks
17/Aug/2017

 

Do you ever feel like you don’t have relationships, like you are alone or isolated, or that you are often misunderstood, overlooked, or unable to connect with others?

Does it ever seem that everyone else your age is doing other things while you feel “stuck” or left behind?

Have you ever seen someone look at you or heard someone say something to you, and your mind was suddenly flooded with eating disorder thoughts?

Or, maybe you experienced a loss, and seemingly the only solution was to turn to your eating disorder to manage your grief.

For many with eating disorders, you already know how interactions with others can impact you. In fact, there is a fair amount of research that shows that people with eating disorders have a vulnerability to over-assessing the verbal and nonverbal feedback from others as a way of checking to see if they are okay.

Research also shows that eating disorders can start or re-occur in the context of major life transitions such as during the grieving process, in mid-life, or starting middle school, high school, or college. One of the reasons these transition periods can be so fraught is because of how our roles and identities change, creating space for an eating disorder to slip in if one is struggling with the transition.

While many people have heard of using CBT (cognitive behavior therapy) or DBT (dialectical behavior therapy) for treating eating disorders, there is another treatment that can be just as helpful but is often not as well known. This therapy is IPT (interpersonal psychotherapy). IPT is a therapy that focuses on relationships and how relationships can affect one’s eating disorder or life, in general.

IPT targets five major domains of functioning:

interpersonal deficits and/or lack of intimacy

interpersonal role disputes (conflict)

role transitions

grief

life goals (like role transitions but for those who missed out on role transitions due to interference from their eating disorder or other barriers)

Like CBT and DBT, it is a time-limited intervention that has multiple phases. Usually, the treatment lasts 16-20 sessions and is broken into identifying the problem area on which to focus, understanding and addressing the interpersonal challenges that were identified, and reviewing the treatment and planning how to maintain the gains made with the treatment.

Generally, one area will be the focus of the treatment though at times 2 areas might be addressed, or an additional area might be addressed after focusing on another area (for example, working initially on grieving and adding life goals as you progress through treatment).

While IPT does not always have the same effect initially as CBT, research shows that the positive effect of IPT grows with time. That means the more you use the skills and strategies you learn with the sessions, the more effective the treatment is- even well after you stop getting additional IPT.

IPT is also a good option for people who struggle with the structure of CBT or DBT or who are unsure about addressing their eating disorder directly, and it has been shown to be helpful for depression, some personality disorders, and social anxiety, as well. Further, IPT is an excellent option for people who have completed CBT but still need supplementary work.

If you have questions about IPT and whether it might be a good fit for you, please don’t hesitate to reach out or consult with your treatment team about if IPT is the right option for you!

Rachel Hendricks, LCSW is a new addition to the clinical team at Chrysalis and loves providing IPT to clients when it is appropriate! She also specializes in working with clients who have had their eating disorder for ten or more years, clients with co-occurring substance use behaviors, as well as working with couples and families. She is excited to be making the transition to Wilmington from the Center for Eating Disorders in Baltimore, Maryland and looks forward to becoming more familiar with the area as well as continuing her reputation for providing excellent clinical care in the field of eating disorders.

For additional research, information, or references for this blog:

https://www.eatingdisorderhope.com/information/anorexia/social-relations

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3886290/



Image credit: dreamstime.com

What is traumatic stress?

Traumatic stress and posttraumatic stress disorder (PTSD) are unique mental health problems in that they have a known cause – a traumatic event. Life is filled with stressors. There are typical daily stressors such as a car breaking down or a large bill to pay. There are also bigger stressors such as getting divorced, losing your job, or the death of a grandparent. Even positive events can be stressful including buying a home or getting married. However, none of these positive or negative daily stressors are considered traumatic events.

Traumatic events are different in that they are events in which someone believes that their life or the life of others is being threatened. Traumatic events can be witnessed, such as watching a friend get mugged, or experienced directly, such as being sexually assaulted, fighting in a war, experiencing a serious accident or natural disaster, or being abused as a child. These are the types of traumatic events that can lead to PTSD.

How common are traumatic events?

Unfortunately, traumatic events are common. Statistics from the National Center for PTSD show that more than 60% of men and 50% of women have had at least one traumatic event in their lives. This means that most people have experienced a traumatic event at some point. However, among the people who have experienced a traumatic event, most do not develop PTSD. While about 7% of people develop PTSD in their lifetime, this is actually a substantial number, representing 1 out of every 15 people. So, it is likely that your or someone you know may have experienced PTSD at some point.

What happens after a traumatic event?

After people experience a traumatic event, it is useful to have a strong reaction. Remembering what was dangerous and staying away from that can help you stay safe after a traumatic event. However, once that threat has been removed, it is healthiest for our brains and bodies, if our strong reactions decrease to pre-trauma levels. For most people, this happens within about a month after a traumatic event. But, for people with traumatic stress and PTSD, these strong reactions do not disappear and they start negatively impacting daily life. In fact, if the traumatic stress or PTSD symptoms do not return to pre-trauma levels within a year, it is highly unlikely that they will go away without evidence-based treatment from a professional.

How do I know if I have PTSD?

If you have experienced a traumatic event and are having difficulty in areas of your life or find that you are coping with behaviors that are unhealthy, such has drinking heavily or drug use, self-injury, significant changes in eating or sleeping, or other high-risk activities, you may have PTSD.

To diagnose PTSD, individuals need to consult with a licensed mental health professional who specializes in PTSD. Symptoms of PTSD include experiencing a traumatic event and having specific symptoms that cause significant distress or impairment for more than one month including:

1) intrusion of traumatic memories or uncontrollable reminders of traumatic events

2) avoidance of safe people, places, activities, or behaviors that are in some way associated with the traumatic event

3) negative changes in thinking or mood

4) alterations in arousal or reactivity, which include feeling numb, also called dissociation, or feeling on edge, also called hyperarousal

What should I do if I think I have traumatic stress or PTSD?

It is not a good idea to “self-diagnose” if you think you have PTSD. Self-diagnosis can lead to increase in trauma symptoms and other problematic behaviors. The best course of action if you think you may have PTSD is to seek an evaluation from a licensed mental health professional who specializes in treating traumatic stress and PTSD.

How can I get help for traumatic stress or PTSD?

The Chrysalis Center for Counseling offers compressive treatment for traumatic stress, PTSD, and many co-occurring problems. At Chrysalis we have licensed professionals, who used evidence-based treatments to decrease trauma symptoms and help people live their best lives following trauma.

Future blog posts will describe the specific evidence-based traumatic stress and PTSD treatments offered at Chrysalis. However, you can call at any time to hear about these treatments and to schedule a time to talk with one of our licensed professionals.

You can also find out more about evidence-based treatment for PTSD at the National Center for PTSD: www.ptsd.va.gov. This site has useful posts and videos on PTSD treatment, including many of the treatments we offer at Chrysalis.

Dr. Kate Brody Nooner is a licensed clinical psychologist and associate professor of psychology at UNCW. She also holds an adjunct appointment at Duke University and is the principal investigator of NIH-funded grants aimed at reducing child and adolescent trauma and preventing alcoholism.



Lisa*, a 41-year-old woman, wakes up at 5:45am to the screeching sound of an alarm clock. She rolls over and slaps it furiously to silence the brain piercing sound. She sighs and says in a determined whisper, “Thirty-six days.” As she begins her daily routine, worries swirl around her mind…”Did I forget to wash my coffee cup before I went to bed last night? If I left it out again, I will get fined by the recovery house manager. What if the bus is running late this morning… they’ll fire me if I’m late again. How am I going to make it to my therapy appointment today? I think my roommate hates me. She’s always so mad that I have to be up before she wants to get up when I work a morning shift. Am I going to have enough money to pay my rent?” Her chest feels tight, and she is filled with dread before the day even begins. Lisa lives in a recovery house. A recovery house is a place where addicts live with other addicts who are working on recovery from addiction. The recovery house provides structure, accountability, and support to those who are willing to comply with the rules of that recovery house’s program and who are actively pursuing recovery. Lisa shares a room with another woman who is in recovery from heroin. She has been sober from heroin for 31 days, and Lisa has been sober from alcohol for 36 days. However, Lisa faces a challenge in her recovery that her roommate does not. Lisa has Generalized Anxiety Disorder in addition to her addiction.

The National Institute on Drug Abuse (NIDA) states that individuals diagnosed with a substance use disorder are twice as likely as a member of the general population to be diagnosed with a co-occurring mental health disorder. In addiction, when an individual stops using a substance such as alcohol or another drug, the body goes through a period of time, called withdrawal, where it is adjusting to the absence of the substance. During this time, it is particularly difficult for an individual to refrain from using since using is the easiest way to stop withdrawal symptoms. These symptoms vary depending on the substance(s) used by the individual and can include extraordinary pain, depression, sweats, goose flesh, vomiting, diarrhea, and seizures. This is considered “acute” withdrawal. Depending on the amount and duration of substance use, this can last for a few weeks. After these symptoms subside, a person will go through “post acute withdrawals” which can include forgetfulness, inability to focus, confusion, emotional disregulation, sleep disturbance, emotional numbness, depression, anxiety and more. This can last up to two years after completely ceasing use and generally lessens over time. During post acute withdrawal, the extreme experience of emotions, depression, anxiety, and feelings of boredom are major triggers to use.

So, as you think about Lisa’s story, imagine what it is like to have used alcohol to cope with anxiety, only to have become addicted to alcohol. Having realized that her life had become unmanageable, she sought help at a recovery house and at a clinic where they treat people who have co-occurring mental health and substance use disorders. She is motivated to “get her life back” and tries hard to follow the advice given by those who know more than she knows about the road to recovery, but she still struggles daily with overwhelming feelings of anxiety, all the while her brain is begging her to fix it the old way… with alcohol. She is also not immune to the emotional effects of post acute withdrawal symptoms that are common at this point in her recovery, and her anxiety can be exacerbated by these symptoms. She can seek medical attention for her anxiety but is afraid of becoming reliant on a pill to cope with anxiety. She only considers this as an option because the symptoms of her generalized anxiety are so severe that she is afraid she will relapse on alcohol if she doesn’t stabilize her mental health.

Individuals who suffer from co-occurring mental health and substance use disorders face the challenge of staying sober while not being able to lean on the substance that they have used for so long to medicate their mental health disorder. They also face the challenge of coping with mental health symptoms complicated by post acute withdrawal symptoms. Structure, accountability and support is often not enough to help them overcome this special challenge. Frequently, medication and psychotherapy are necessary to stabilize their mental health disorder symptoms while they build the skills for living a sober lifestyle. Programs that include this combination offer hope to those who are determined to make a change and willing to work hard to begin a new life.

*Lisa is a fictional character created to represent real circumstances and challenges faced by those who suffer from co-occurring mental health and substance use disorders.

Lillian Hood, LPA, LCAS
Psychologist and Clinical Addictions Specialist
At the Chrysalis Center, I specialize in treating individuals with co-occurring disorders. This includes working with individuals who have trauma, depression, bipolar, anxiety, and/or eating disorders along with an addiction. I use evidence-based practices to help patients develop skills for successfully facing this unique challenge.

Reference:
National Institute on Drug Abuse www.drugabuse.gov
National Association for Alcoholism and Drug Abuse Counselors www.naadac.org


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