HTWW 028 – The Impact of PTSD on Families

CouplePorblems David Castillo Dominici FDPThe Impact of PTSD on the Family

In this episode we discuss:

  • Secondary traumatization
  • Ways families respond to stress (and Post-Traumatic Stress)
  • Two key areas of stress for the family
  • Resources for the family

The family’s response to increased stress: (In part based on Kerr & Bowen, 1988)

  1. Grow distant from each other
  2. One will take on the traditional role of another member of the family.
  3. An individual may sacrifice themselves for the sake of “peace”
  4. Conflict
  5. Adapt, bond together and grow

Two significant problem areas the anger outbursts and emotional numbing

Anger outbursts 

  • May be verbal or physical
  • Not necessarily directed at spouse or children
  • Aggression may have been adaptive and appropriate during war
  • Fear and guilt both past and present are foundations of anger
  • May lead to the family members developing maladaptive coping skills
  • See more an anger in “Healing The Wounds of War” episodes: 13, 14, and 15)

Emotional Numbing

  • Isolation for social situations and from family members
  • My become more withdrawn after anger outburst – fear of again losing control
  • Seems unable to experience the good emotions
  • Fears experiencing the “bad” emotions associated with the past
  • May adopt an authoritarian way of dealing with family members

Survivor guilt can make it difficult to connect with family.

Resources for Family Support

  • NAMI.org (National Alliance on Mental Illness: Family-to-Family peer support) This group offers peer support for mental problems of many kinds. They offer a 12 session class at no cost.  It is not necessarily specific to PTSD, but many of the family coping skills needed cross boundaries.  Classes are offered around the country.  Check out their website for more information.
  • MilitaryOnesource.mil (for military members and their families) or you can call 800-342-9647
  • ptsd.va.gov/public/web-resources/web-families.asp (A good place to start for veterans and their family members)

More references

Image courtesy of David Castillo Dominici on freedigitalphoto.net

HTWW 015 – Restoring Reason During Anger

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Are you ready to take back control?

 Anger, Stress, Anxiety and Post-Traumatic Stress response can all involve the Fight/Flight response.  We do not have to let this response take, or keep, control of our actions.

 In this episode we will discuss:

  • Physical manifestation (symptoms) of acute “stress” and escalating anger.
  • The Autonomic Nervous System (ANA or aka. involuntary nervous system): responsible for heart rate, respiratory rate, digestion, perspiration, urination and much more.  http://en.wikipedia.org/wiki/Autonomic_nervous_system
  • Heart Rate: An accelerated heart rate due to stress indicates other physical changes are taking place as well.

Condition: (base on heart rate beats per minute -bpm)

  • White: 60-80 bpm (at rest)
  • Yellow: 80-114 bpm
  • Red: 115-145 bpm (optimal performance level for combat and survival)
  • Gray: 146-174 bpm
  • Black: 175 bpm (significant ruduction in cognitive (thinking) ability)
  • [Chart and further discussion available at: http://www.killology.com/art_psych_combat.htm]
  • Affect of stress, anger, anxiety on the brain
  • Controlled breathing = direct way to impact the Autonomic Nervous System!
  • Tactical Breathing: (starting at 12:48): A pattern of 4s

Featured Resource: On Combat: The Psychology and Physiology of Deadly Conflict in Ware and Peace by Dave Grossman and Loren Christenson

On Combat Book Cover

HTWW 014 – 3 Practical Steps to Gaining Control Over Anger

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Last week in “Anger!!! What Lies Beneath” we discussed the fuel underneath anger.  It seems to be largely connected to fear and its friends: shame, guilt, etc.  This week we continue on our path toward growth and victory.

Out of control anger does not only affect our relationship; but it also physically affects our hearts—and a lot more of our bodies.  So how do we START to deal with problematic anger?

1. The R and E of RESTORE

Recognize and Evaluate:

But there is more to it R and E.  We can learn to detect the sings in our bodies as we start to escalate.  We can learn to identify the thinking patterns that start to lead us down the road toward rage.

(See Episodes 002 RESTORE and 003 Recognize)

2. Physically Prepare: Sleep, Eat and Exercise

Sleep:

What happens when you do not get enough sleep?  For starters: increased depression and moodiness.  Your brain goes through a rest process when you sleep.  While sleeping the electrical and chemical makeup of the brain changes.  This is apparently necessary for proper function while you are awake.  Without proper sleep we are also likely to gain weight, have trouble learning, focusing and remembering.

[CDC Sleep Report; Effects of the Lack of Sleep; Anger and Heart Disease]

A few things about PTSD that can add extra complication to the sleeping problem. 

Hypervigilance (always on guard) can make it difficult to fall asleep.  For some, they are easily awoken by sounds.

Nightmares: These can interfere with sleep on many levels: (a) wake you out of sleep; (b) keep you from falling back to sleep; (c) interfere with the quality of sleep.  Even if it does not wake you out of sleep the thrashing screaming and sweating can interfere with the quality of sleep.

What can I do to get a better night sleep?

  • Exercise – 5 to 6 hours before attempting to sleep.  20 min of intensive activity (Talk with your Doctor before starting an exercise plan) [Exercise and Sleep]
  • Get rid of the electronics/TV watch from the bedroom
  • Exposure to outdoor (bright) light in the morning

Eat:  Ok, we constantly being told how we need to eat a balance and healthy diet.  Well, it is true.  But there is too much to really get into this topic here – although I mention a couple of things that you may find useful in the show.

“But caffeine doesn’t keep me awake.”  I hear this a lot!  Studies show that it does interfere with the quality of sleep.  In other words, even when you sleep it decreases the quality of sleep.  Suggestion: don’t drink caffeine after lunch and only a couple cups of caffeinated coffee or tea in the morning.

[Effects of caffeine on sleep]

3. Practice Tactical Breathing

Say what?  Yes, you can significantly change your body and mind by learning and practicing a breathing technique known as “Tactical Breathing”.

When the body is in the fight-flight response the blood flow decreases to the reasoning center of the brain and increases to the mid-brain focused on preserving your life.  Researchers have developed a breathing technique that has proven useful to people in tactical situations to help them lower their heart rate and help reestablish more control.

It is not difficult but it takes practice.  Like with most skills used during a crisis mode we need to first practice them when we are not in a crisis mode.

Question: What helps you deal with anger?

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How can we successfully deal with angry people?

So, you are not a hot head.  But you have to deal with one or two or three.  Below are some ideas to consider when dealing with outwardly angry people—note: we will have to talk about the quiet angry types in another post.

[Most important: your safety!  If the angry person becomes abusive (or you believe it is heading in that direction) you should remove yourself from the situation and seek appropriate help.  What we are discussing here is anger that does not result in abuse.]

Anger usually comes from some insecurity, fear, guilt, sense of inadequacy, etc.:

Understanding this can help us to NOT internalize the other person’s expression of anger.  When we internalize someone else’s anger we tend to get defensive—at least this is true for me.  When we get defensive we can get side tracked from the real issues at hand.

Expectations: Do you have unrealistic expectations about the reasonableness of the angry person?

It is unreasonable to expect a person in the passion of anger to be completely reasonable.  The biology of anger does not support it.  The more angry the individual the less the reasoning center of the brain can operate.  The blood flow actually decreases to the reasoning center (pre-frontal cortex—the part behind your forehead).  Instead the body/brain puts its resources in to the fight/flight response.

Anger, fear, anxiety and alike all have a similar physiological response.  It is important that this balance be restored before attempting to engage in a reasonable discussion.  Justifying our actions—even if we are in the right—accomplishes nothing in the heat of the moment.

Post-traumatic stress responses can involve anger outbursts.  PTSD is not a means for excusing inappropriate actions.  However, it can be helpful to keep in mind that the stress and anxiety that accompany PTSD can help contribute to a shorter fuse.

Diffuse before Engaging:                 

In the heat of anger (our own or that of another) our goal should be to diffuse the situation before attempting to solve the problem(s) surrounding the event.  Time is an important ingredient in this mix.  People’s bodies need time to work out the rush of hormones that accompanies anger and the fight/flight response.

It may not be helpful to declare an official “time-out”.  However, some kind of separation in time and space should be considered.

It is important that the individuals involved reengage the issues when all have had an opportunity to cool down.  If we are not careful time and space can lead to avoidance and the underlying problems will never get resolved.

Get someone else involved:

I don’t mean that you should drag someone else into the middle of the argument.  Rather, when a relative calm has set in, invite someone to help mediate the discussion.  This person should be perceived by all involved as being relatively neutral.

Addressing their anger issue:

Yelling back, “You have anger issues!” In the middle of their outburst is not likely to be helpful. (I know, I have tried it.)  When all is calm it may be possible to discuss your concern for how they are handling anger.

However, in order to be able to successfully deliver this message, it helps if you actually care.  I have not found many people ready to accept a “critical” message from someone who does not care.  If that is the case, then try and find someone who does care to deliver the message of concern.

This is by no means a complete list of things to help deal with angry people.  What ideas or strategies have helped you deal with angry people? (Please share your thoughts in the comments section.)

Check out the first part of our podcast series on anger: “Anger!!! What Lies Beneath

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013 – Anger!! What Lies Beneath

Anger affects more than just people with Post-Traumatic Stress Disorder (PTSD).  Some people just seem to be wired to be more volatile.  All of our life circumstances and experiences help us cope with the “stuff” that we encounter.  We can learn new ways of dealing with whatever we experience or feel.

People dealing with PTSD are often also dealing with deep anger.  Learning to “manage” anger is extremely important.  Part of that process is gaining insight to what lies beneath the anger.

In today’s episode:

  • Is anger “bad”?
  • Quiet vs. Loud Anger
  • Physical Impact of Anger (+ stress and fear)
  • Can anger be managed?
  • Analogies of anger: Diet Coke; lighter
  • The Fuel of Anger
  • PTSD and Anger
  • Taking responsibility

Some quotes on anger:

“Anger is an acid that can do more harm to the vessel in which it is stored than to anything on which it is poured.” Mark Twain

“Holding on to anger is like grasping a hot coal with the intent of throwing it at someone else; you are the one who gets burned.” Buddha

From —   http://www.brainyquote.com/quotes/topics/topic_anger.html

Yoda on fear and anger … 

“Fear leads to anger, anger leads to hate, hate … to suffering” Star Wars Episode 1

http://youtu.be/kFnFr-DOPf8

Is anger “bad”?

No.  Anger is a normal human emotion.  It is what we do when we are angry that brings most of the problems.  It can have bad physical results on our health when it dominates our emotions.  Consider these words of wisdom, “And “don’t sin by letting anger control you. Don’t let the sun go down while you are still angry,” Ephesians 4:26a (Holy Bible, New Living Translation).  Mahatma Gandhi made a similar observation, “Man should forget his anger before he lies down to sleep.”    It is what we do as a result of anger that gets us in the most trouble.  The Buddha on anger: “A man conquered by anger is in a mass of darkness.” Kodhana Sutta: An Angry Person

Loud vs. Quiet Anger (Aggressive vs. Passive)

Not everyone screams and shouts when they are angry.  Sometimes passive aggressive behavior is rooted in anger.  Also some people will hold it in and withdraw from relationships.  It can show up in giving someone a cold shoulder or a fake smile.  Anger may also be behind some self-destructive behaviors.  Some may quietly literally feed their anger with food.

The Biological Reality of Anger (+ stress and fear) 

Anger is a biological process…

Hormones and Steroids flood the body causing, among other things, a rise in blood pressure, decrease blood flow to the reasoning center of the brain (pre-frontal cortex).  All this is part of the Fight or Flight response—very much like stress and fear.

Can anger be managed?

Yes! (Don’t miss next weeks episode when we discuss strategies we can do before during and after we are angry.

Analogies of anger: Diet Coke + Mentos(TM) (thank you Mythbusters); a lighter

 Diet_Coke_Mentos_CC

Courtesy of Zan  FreeDigitalPhotos.net
Courtesy of Zan FreeDigitalPhotos.net

The Fuel of Anger – What lie beneath?

Anger does not just happen.  It is tied to deeper emotions.  Most of us may rather admit we are angry than afraid.

PTSD and Anger

A great book on PTSD by Dr. Shay: “Achilles in Vietnam”
PTSD anger complicated by “What’s right” being violated.  Trust is lost …

Taking responsibility

People may push our buttons; but they are our buttons.

 Sometimes when I’m angry I have the right to be angry, but that doesn’t give me the right to be cruel.  – Author Unknown

Check out some other resources:

How Anger Words  http://science.howstuffworks.com/life/inside-the-mind/emotions/anger2.htm

Understanding Your Emotions  http://www.wire.wisc.edu/yourself/Emotions/Understanding_emotions.aspx

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