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Episode 229: PTSD


And hello to you, and welcome to the Richard Nicholls Podcast. The personal development podcast series that's here to help inspire, educate, and motivate you to be the best you can be. I'm psychotherapist Richard Nicholls, and this episode is titled PTSD. And if you're ready, we'll start the show.

Alright there, you beautiful people. How are you doing? Did you have a good summer? A good August? Catch up with some friends? Although that might be what makes a good summer for one person, but for somebody else, that's hell! I'm a people person, I guess, so the more chances to catch up with friends, old and new, the better. I love it when you've not seen someone for ages, an old friend, and you just sort of carry on as you were, as if no time has passed. Love that! And your brain says, Hello? This is familiar, it's safe, and everything just clicks into place. That's amazing! And being a psychotherapist, those sorts of processes fascinate me. That our brain can time travel by firing off neurons and create feelings that actually don't belong in the now, but help us to enjoy the now.

I love it. Although, as I'm sure you know, that process isn't always good. The same thing applies for things that are traumatic. So, slight trigger warning for today's episode, because I want to talk a little bit about post traumatic stress disorder. So if you're not ready to hear about things that might cause it, you might want to get ready with the skip 15 seconds button if your app does that.

Just in case things get a bit pokey for you, but I'm not going to go into great detail, don't worry. But I know not everyone who listens to these episodes has major issues. You might just be interested in what makes people tick. So if you've never had PTSD yourself, it can be hard to understand why a friend or family member isn't moving on or getting over it.

But it's a big thing. It's not like grieving for a dead fairground won, pet fish that soon becomes forgotten. Although grief can definitely create PTSD, and it's nasty. PTSD is basically an effect upon the makeup of the brain that can happen when you experience something traumatic. If you've ever had deja vu, because of smelling some perfume, or found that a piece of music can take you back in time, you often find these things bring in emotions, rather than mental images.

If you have a link to the past which gets triggered by a smell or something, it's not usually an image that jumps into your mind, it's an emotional memory, how you felt at the time. And more often than not, that's a nice thing. Something takes you back to an early exciting relationship, or a youthful freedom and innocence.

Because when we experience a strong emotion, our brain goes into super sticky learning mode, possibly to do with a chemical called myelin, that helps insulate neurological signals in the brain. We produce more myelin when we're focused, some neurologists suggest you see. But, not all experiences that our brain focuses on, and makes links with, are pleasant.

Sometimes we go through some pretty awful stuff, and basically the brain learns, very quickly, how to feel bad. Now, when most people think about PTSD, they think about soldiers returning from conflict, or the old. Shellshock from the first world war, but literally anything that traumatises you can, in that instant, make the brain latch on to something.

When you were young and pulled a face at someone, did they ever say, If the wind changes, you'll stick like that. That's kind of what happens in the brain to cause PTSD. It's not necessarily the trauma itself that causes it. Rather, it's that the conditions were just right to make the emotions stick like that.

So it's not just life threatening stuff that can cause it. It's not just witnessing war or being in a car accident that creates it. A relationship coming to an end dramatically, can cause PTSD. Losing your job, being caught by your partner naked with their best friend, that sounds traumatic. Anything that is traumatic can cause the wind to change and make you stick like that.

And it can create serious, serious problems. And most people don't realise this. In fact, often people with PTSD might not realise that that's what's going on. They often just think that they're overreacting or something. Now there's also another way that the brain can make these links, because as well as the super learning state of mind that being terrified can create, the other way of learning something so that it sticks is with repetition.

A lot of social workers and people in child protection services get bombarded on a daily basis with things that upset them. And over time, it can create these pathways in the brain that make it easier and easier to feel something. To feel scared. To feel hopeless. It's the same with someone who was abused as a child on a regular basis.

And it does need working with in a slightly different way to anxiety, even though it does have similar symptoms. Being unable to concentrate. Feeling on edge. All the time, having trouble sleeping, feeling irritable. Now, the difference between PTSD and an anxiety disorder is that with PTSD the irritability is angrier and uncontrollable.

And there tends to be more intrusive thoughts about something specific. Some sort of event that keeps jumping into your mind, but not necessarily with any clarity. A bit like watching a horror film from behind a cushion, where you can imagine what's going on, but you don't have any of the details.

Anxiety can make us avoid things and avoid people. But we can still feel safe. We can still connect with loved ones. But with PTSD, we so often can't feel safe with anyone, even people that are really close to us. And the effects of it more often than not get worse over time unless treated. Whereas anxiety disorders usually get worse and better over time depending on other stresses going on in life. Someone with anxiety can have a good couple of months, maybe. Someone with PTSD can't. So when someone with anxiety gets reminded of a past experience that was painful, it doesn't bring back the same feelings as it did back then. Their anxiety might spike, might even have a panic attack.

But it's all in the now, if that makes sense. It feels current. They're remembering something and it makes them feel something now. But the flashbacks and what's called re experiencing that someone with PTSD gets is more like how they felt back then. When the traumatic thing happened, they don't just remember it, they relive it.

It's in their body, it's in their bones. It's not just a fight or flight adrenaline spike. They might even dissociate. Dissociation is this feeling of being detached from your own body. It's a defense mechanism that can happen during the trauma as a way of coping. As if because the body can't escape, the mind escapes instead, so that you don't feel the pain of whatever is about to happen, possibly.

But it comes at a cost, because it often means that people who dissociated during their trauma are more likely to continue dissociating when they're triggered in some way. And like I say, we can be triggered by just a familiar smell, a colour, the shape of someone's face in the coffee shop queue. And suddenly it's as if we've stepped out of our own body, and we're out of control.

In my youth, I'd have described it as pulling a whitey. As if you'd had too much smoke on an empty stomach, if you know what I mean. But it's more than nausea and fainting, because it can even create what we call depersonalisation. Not just dissociating and stepping out of your body. But still being in it, but not feeling like it's yours.

You can look in a mirror and you get a feeling that it's not you that's looking back at you. It's terrifying. You can look at your hands and it feels like they aren't your hands. That's more likely PTSD. One thing I've noticed is that when someone with anxiety feels a bit more anxious or unsafe than usual, they might remember a previous time, that they felt that way and make a connection.

They might say, I feel like I did when I was little. But with PTSD flashbacks, the feelings are from the past and being relived. But the person might not even see that. They might not know that they're having a flashback. And the terror that they feel seems as if it's coming from their experiences now. We often see this in what we tend to call complex PTSD, which is when the trauma has such an effect.

That the symptoms became almost part of somebody's personality and belief system. They see the world as a dangerous place and find it impossible to trust anyone. There's this constant hopeless and helpless feeling as if they're broken and worthless. These folks come to therapy usually for something else.

They might have drug problems, alcohol problems, that sort of thing. And through building trust with a therapist they can open up about their past. Because complex PTSD is more likely when someone experienced abuse over time, especially when they were young. Although not always. But if someone was being abused in some way and felt trapped and helpless, especially if their abuser was somebody that was close to them, then they could develop complex PTSD.

And they might be fine for years, to a degree. They might have self esteem issues and they might put themselves in possibly some quite dangerous situations. It's not uncommon for someone who was abused when they were young to feel the pull towards an abusive partner, or become an abusive partner. And they might have been mostly fine until there was maybe something on the news about child abuse.

Operation Yew Tree back in 2012, that uncovered the whole Jimmy Saville thing, that led to a lot of triggering of PTSD symptoms, because complex PTSD can do that. It affects the way you see yourself and the world, but might not give you flashbacks for decades. So, what do we do? How do we treat this? Well firstly, find a therapist you trust, especially with complex PTSD, because it might take a lot of sessions just to build up enough trust for you to be able to start to talk about it and gently begin to heal. What we tend to do with PTSD is start by teaching some coping strategies to help you get through it. Breathing exercises usually a great place to start, especially if you're dealing with flashbacks because people often hold their breath. So concentrating on your breathing.

Breathing in for the count of four, holding for four, breathing out for eight, that sort of thing. Time honoured. Helps ground you in the present moment rather than the past. Another thing that can help to do that is deliberately taking your attention to the present, to your environment. Look around you.

Count any switches, or buttons, or people. Look for something blue, or red, or square. Describe your surroundings to yourself, out loud if you have to, just pretend you're talking to somebody on the phone. Actually a smartphone can be quite helpful sometimes to keep you grounded, especially if you've got photos on there that you can, you can use to distract you.

Some people carry a little pebble in their pocket or their bag, something to remind them. We set that up in therapy sometimes. Especially if because of holidays there might be a big break in therapy. When I work face to face rather than online, I might give people a gemstone or something. Something to remind them about their therapy.

To remind them. that they're safe. And if they need to pull it out and remind themselves that they're safe, they can. It can be worth doing that, actually. Just saying to yourself, I am safe. Everything is fine. I can do this. I am safe. Everything is fine. I can do this. Over and over again, if you have to.

Whilst taking some deep breaths. Of course it's not going to be a magic wand that erases lifelong trauma, but it helps you to cope in the moment. Overcoming it completely is not impossible, but it is going to take a bit of time, so if this is you be patient. And if you're with someone who's having these flashbacks, you can help them if you stay calm, you don't make any sudden movements, just being there, reminding them that they're safe, that everything's going to be okay, that it's just a flashback, they're safe.

That can really help. Ask them to describe the room that you're in, or wherever. Encourage them into the present moment. Remind them to breathe. All that sort of thing. As long as you're patient, you can have a very, very positive impact on somebody who's got PTSD symptoms and triggers. Learn about what those triggers are.

If slamming doors or shouting at the telly is a trigger for them, it's good you know that. Especially if you're prone to slamming doors and shouting at the telly. One thing I would say is if someone's having a flashback, it's really important to bear in mind. Don't touch them. Keep your distance. Don't crowd them.

I know it's tempting to give someone a hug or a touch for support. Please don't. It's not worth the risk. It usually doesn't bring them into the present. Often it can make things worse because it brings all sorts of brain signals from the past into the present. But, and I'm not just saying this because I'm a therapist, the most effective way of healing from trauma is to see a professional and talk it through.

You might have to tread very gently, very, very gently sometimes, but a good therapist who's trauma informed, you ask them that, they will help you with that. And it might be that you've been avoiding thinking about it because it's so painful, let alone talking about it. But when done safely, It really can help.

I often think of it like missing a couple of important episodes of a TV series. The rest of the show might not make proper sense, and a part of you will keep going back, wondering about those missing episodes. And the more you try not to think about it, the more another part of you keeps trying to. But it needs to be done properly.

And safely, because I'm not going to lie, it can be really painful at first for a lot of people to face their trauma. But it's like strengthening steel. If your steel bar isn't strong enough, you need to heat it up until it's soft. It has to be soft and vulnerable first before it hardens up again.

Stronger than it was before. Nice cheesy metaphor to end on there for you. Right, I'll love you and leave you for now. As you know, there's an episode each Monday morning on Patreon if you want to hear more. Quick shout out to some new 2023 Patrons actually. Let me pull up my list. Let's have a look. We've got Josh, Barry, Melanie, Thomas, Scott, Lilith, Jerome, Claire, Ellen, Lily, Lorraine, Gemma, Lynette, another Claire, Helen, Sam, Kevin, Pam, Max, Carl, Kit, MG, Kaushal, Jen, James, Greg, Bernadette.

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So, everyone's a winner. So, let's go! Enjoy your month! And I'll be back on Friday with a five minute bonus episode, and on Patreon with a full one on Monday. And no matter when you're listening that's always going to be the case, even if it's a week after Pancake Tuesday next year. Oh, pancakes!

I've got some spare eggs. Right, I'm off to make pancakes! I love you all! See you soon! Bye!