Monday, September 15, 2014

How Common is the Experience of Trauma?

by Andrea Kapeleris Ph.D

More common than you think! About 20-50% of children and teens who have experienced trauma meet criteria for Post-Traumatic Stress Disorder (PTSD), and nearly 75% also experience depression and substance use (Elwood, Hahn, Olatunji, & Williams, 2009). Statistics also show that about 14% of people exposed to a major stressor go on to develop PTSD (Terhakopian, Sinaii, Engel, Schnurr, & Hoge, 2008), and women are about twice as likely as men to develop PTSD after a trauma (Kessler, Berglund, & Demler, 2005). Stressors can be one-time events that cause actual or threatened death or harm to yourself or a loved one (such as, a car accident, sexual assault, mugging, natural disaster), or they can include on-going negative and damaging experiences – such as, chronic stress resulting from military service, or childhood experiences in which there was repeated damage to the attachment relationship between you and your caregiver. These chronic experiences can shatter a child’s sense that the world is benign, the world is meaningful, and the self is worthy, and often results in avoidance coping and an increase in overall level of arousal and anxiety (Roth et al., 1997).

Symptoms of PTSD are Normal Reactions to a Non-Normal Experience

  • Re-experiencing the event in a number of ways including, flashbacks, nightmares, or vivid memories that come to you unexpectedly 
  • Avoiding any reminders of the event (people, places, or things associated with the event), and a feeling of numbness
  • Increased feelings of anxiety or emotional arousal

Treating Trauma

Overstuffed Cupboard Metaphor

The mind is like a pantry cupboard. When a traumatic event occurs, it is as if very large and oddly-shaped boxes were hurriedly stuffed into the pantry. Since there was no time to properly place the boxes in the pantry in an organized fashion, each time you open the pantry to get something you need, a box suddenly and unexpectedly falls on you – startling you and possibly hurting you! The same thing happens when our mind experiences trauma. Due to the sudden and overwhelming nature of the traumatic event, the mind doesn’t have the opportunity to process all of the emotions associated with it, and as a result, unpleasant memories or emotions may come to us when we least expect them too. For example, you may become startled by an unsettling memory or emotion when you are relaxing at home, watching TV, or spending time with friends. As a result, you may begin to avoid things you previously enjoyed. 

The purpose of therapy is to help you organize this pantry. We need to take each box out of the pantry slowly and carefully, examine its contents, and then place it in its proper place. Once all of the boxes are organized accordingly, you will be able to enter the pantry without fear, and will no longer need to avoid that part of your home. Similarly, the goal is to slowly process the trauma and place events and their accompanying emotions into sequential order. In this way, your mind will be able to integrate the trauma and make sense of it. You will be able to think more freely and move forward with your life. 

Fight or Flight mode

When we encounter a traumatic event (something that threatens our physical or psychological integrity) our bodies enter a process called the “Fight or Flight” mode. This mode is evolutionarily necessary and served an important purpose – in the times of cavemen and women, when our ancestors were being chased by predators (e.g., a tiger) all of the resources in their bodies left the frontal cortex (the part of our brain used to reflect on our thoughts and feelings, and make decisions) and automatically went to their muscles (to prepare them to flee or fight the predator), and also went to pump up their heart rate, breathing, and overall adrenaline (again, to make it easier for them to flee or fight predators). In modern times, when we are faced with a trauma, our bodies go into ‘Fight or Flight’ mode in order to protect us. Later, any experiences, people, places, or things that remind us of the trauma stimulate our body to again go into this fight/flight mode in case we need to be protected again. Part of our work in therapy is to help your body and mind recognize that this threat occurred in the past and that you are no longer in danger. We foster this safety on many different levels:

1) Physiologically. We must help the physical body itself feel safe, and come down from overarousal. This may partly be achieved through learning relaxation strategies or overcoming avoidance-coping strategies that maintain and intensify anxiety.
2) Emotionally. We must help the mind itself feel safe, and come down from overarousal. This is achieved through:
a) processing the trauma as described above in ‘the cupboard metaphor’;
b) learning Emotion Regulation strategies

Emotion Regulation
Emotion regulation is a process of 1) identifying and increasing awareness of your feelings (e.g., what are the names/labels for the vague and sometimes uncomfortable sensations that happen inside?), and 2) ‘sitting with’ the sensations that go on inside and experiencing the waxing and waning of your feelings – all feelings do wax/wane, come and go – the only thing we can be certain of is change from moment to moment. Physiologically, our bodies experience of any emotion follows a bell-shaped curve (i.e., it must come down from it’s peak) – our bodies can not maintain the high emotional arousal indefinitely – but sometimes, our feelings about our feelings (feeling angry that we are sad, for example) may intensify our original emotion. In therapy, we help to disentangle this, and in effect, help you to regulate your emotions. Importantly, we also begin to look at your feelings as an important signal that there is something inside that needs our attention.

Tuesday, September 9, 2014

Racial Microaggressions

By: Sela Kleiman

Within a few minutes of their first conversation, a White individual inquisitively asks a racialized minority a seemingly innocuous question they have likely been asked numerous times previously, “So, where are you from?” Now, imagine the above scenario but with the actors’ roles reversed (i.e., the racialized minority asks the White individual the same question). Which event is more common? Many people who live in Canada and the U.S would intuitively respond that the first scenario is more likely. The reason for this difference requires a contextual understanding of race relations; that is, knowing which social groups are dominant and as a consequence of this, who defines those that are normal from those that deviate from the norm. In our society, both historically and presently, White folks hold a disproportionate amount of power in society to institute and promulgate these definitions. Perhaps it is not surprising then, that as a result, White people receive messages daily which serve to confirm their sense of being normal. Contrarily, racial minorities often receive messages that convey the opposite sentiment. Given these realities, the question, “So, where are you from?” becomes rife with meaning. Indeed, what comes across as innocent curiosity may be read by those receiving it as reinforcement of a sense of un-belonging, especially given the frequency with which this event may occur. Inter-racial interactions between dominant and non-dominant group members are never just an isolated event; instead, they are historically and contextually grounded within the broader social systems that one lives.

The above incident highlights one of many examples of racial microaggressions which are subtle slights, jabs, and insults which convey demeaning messages to racialized minorities by dominant group members. Perpetrators of racial microaggressions are often well-meaning White folks, mostly unaware of the effect of their actions. This manifestation of racism, of course, stands in contradistinction to the overt, consciously directed racism more typical of a bygone era. And though most can agree that a dramatic decrease in “old-fashioned racism” is a good thing, one consequence has been that contemporary racism falls below the radar of most. Indeed, its subtle and insidious nature make modern-day racism appear virtually non-existent to those who perpetuate it. Unfortunately, a consequence of this is that racism is referenced as a problem “over there” or “back then” and as such not given the warranted attention. 

Research on racial microaggressions has exploded in recent years (read Derald Wing Sue as a starting point), and various empirical studies have documented their varied manifestations. Moreover, researchers have documented its adverse psychological and physiological effects. As a starting point, it is critical for clinicians working with clients to be aware of current racial dynamics so that discussions of race and racism are not minimized or ignored in therapy. By ignoring these critical issues, therapists unwittingly disempower their clients by locating the root of mental health issues associated with racism within the individual rather than due to prevailing social forces. Clinicians who convey this message risk perpetuating the very thing that may in part be responsible for their client’s mental health issues.

Internalized Racism

Internalized Racism

By: Sela Kleiman

Throughout life, especially during early life, we internalize messages sent to us by caregivers, siblings, extended family, peers, and larger social and cultural institutions. Growing up, if caregivers are attuned to our emotional needs and respond in a warm and empathic way, we are more likely to internalize, or have an unconscious felt sense, that we are a person worthy of being loved. If, on the other hand, caregivers respond to our emotional bids for affection with rebuke, derision, anger, and so forth, we instead may internalize a felt sense that we are unlovable in some way. The messages we receive about ourselves from others profoundly impact how we feel about ourselves and how we relate to others.

Messages sent from the cultural and social milieu in which one lives can greatly influence how we feel about our own worth. Growing up in North America where racism is prevalent, for instance, folks of colour are subject to many recurrent and demeaning messages about their racial identities. These messages often are subtle. For example, they may be revealed in television shows and movies where people of colour represented stereotypically and cast in a narrow range of roles. Additionally, these messages are found in schools. For instance, some children who have to pass through security guards checkpoints every morning before class undoubtedly receive the message that they are dangerous and not to be trusted. Unkempt school grounds and poorly supplied classrooms are a consistent reminder to some students that their education is not as important as those who live in more affluent neighborhoods. Consistently receiving these messages takes its toll on an individual; one result may be internalized racism.

Internalized racism is a phenomenon whereby people of colour constantly exposed to demeaning messages that imply their inherent badness or lower worth may unconsciously start to feel this way about themselves. One of the most disturbing yet illuminating examples of this was the doll experiments conducted by Clark and Clark in the late 1930s/early 1940s in which they asked children to rank Black and White dolls (everything the same except for their skin colour) on various characteristics. They showed that both Black and White children typically preferred White dolls over Black dolls in terms of appearance, niceness, and so forth. To Clark and Clark, Black children preferring White dolls for these reasons was an example of internalized racism.
Aside from cultural and social shifts needed to combat internalized racism, a more intimate domain to work through this issue is in therapy. For this to happen, psychologists, psychotherapists, and other helping professionals must be multiculturally-competent practitioners. Indeed, they must be well-versed in psychological and emotional manifestations of discrimination and be able to engage in meaningful dialogue with clients as these issues arise. Ignoring internalized discrimination and placing the locus of responsibility solely within the client risks reinforcing oppressive patterns responsible for internalized racism. Using therapy as a space to explore themes of badness, worthiness, and so on through a culturally sensitive lens can empower clients to gain a better understanding of their pathogenic beliefs and, through deep and meaningful processing of these themes, detoxify these negative feelings about the self.