Monday, 21 May 2012

Tinker, Tailor, Soldier ... Child

There has been a flood of articles and news reports recently about the high suicide rates of returning veterans - and in no way am I trying to minimize that segment of our population nor suggest that programs to support these combat soldiers are not worthy causes. They most certainly are.  I would - however - like to bring to everyone's attention a large segment of our population whose plight is continuously ignored; I'm referring to young people whose only means of coping with overwhelming emotional distress is to self-injure.

These are young people who can only find relief from emotional torment
[or sometimes dissociation] by cutting, burning, imbedding, piercing, hitting, or injuring themselves through other means.

To give you an idea on how large a problem this is, let's run some numbers using statistics gathered in British Columbia by Dr. M.K. Nixon of the University of Victoria [NIXON, ET AL, 2006];

The school district centered in Penticton
 [SD 67] and covering surrounding communities, - where my practice is located - has approximately 4200 students between the ages of 12 and 18 registered. Of these, 680 will use self-injury to cope with emotional distress for an average of a year and a half. Of those, 280 will become addicted to self-injury and continue into adulthood.

So why compare those who self-injure to returning combat veterans?

Eighty-five percent of young people who self-injure to cope with anxiety, stress, depression, and suicidal thoughts & urges, report experiencing traumatic child abuse and/or child sexual abuse. Experiencing trauma - be it on a battle field, or in an abusive situation as a child - can leave people unable to cope with recurring nightmares, flashbacks, fears, and general anxiety that all too often follows trauma.

News reports are quoting sources that say suicide rates among combat veterans are four times higher than average.

Try this one on for size; from a 15 year study concluded in 2011, [HAWTON, ZAHL, 2011] - One year after an individual begins to use self-injury to cope, their completed suicide rate is
66 times higher than average, after 5 years it is 160 times higher, after 10 years it is 226 times higher, and after 15 years it is 283 times higher than the average population.

Our combat veterans have placed themselves in harm's way out of duty to our country and they deserve all our support and help when they return with overwhelming emotional distress. So too, do the 1 in 4 girls and 1 in 6 boys who have been sexually abused as children, and the 17 out of a hundred young people between the ages of 12 and 18 who turn to self-injury to cope. Their trauma is just as life-altering as anyone else's and their pain is just as real.

Aaron D. McClelland, RPCc

Saturday, 12 May 2012

Neuroplasticity: How Talking and Walking Can Heal

Neuroplasticity is a fairly new buzzword in the field of treating anxiety, depression, and emotional trauma, but the idea behind it has been around for decades. The term "neuroplasticity" was first coined by Polish Neuroscientist Jerzy Konorski, in 1948.

Dr Norman Doidge, author of “The Brain That Changes Itself: Stories of Personal Triumph from the Frontiers of Brain Science”, defines neuroplasticity as: “that property of the brain that allows it to change its structure and its function by basically three things ... by perceiving the world, by acting in the world, and by thinking and imagining”.

For example: a traumatic event can alter the brain's structure and function resulting in symptoms of anxiety, depression, and shrinking of the memory centers of the brain. A person experiencing the tragic loss of someone they love, being in a terrifying car accident, or experiencing rape or abuse can be left with life-altering feelings of anxiety, depression and memory impairment.

What about healing?
Modern research is providing evidence disproving the old belief that the function and structure of the brain can’t be changed. The brain can be changed, and we are learning how that change occurs to help people heal.

For years, counsellors and therapists have seen positive results when using "talk therapies" such as Psychoanalysis, Psychodynamic Therapy, Cognitive Behaviour Therapy, EMDR, and other techniques. One vital part of these therapies is having their clients use a personal narrative to "tell their story" in a safe, non-judgmental environment. What is going on inside the brain during this process is only now becoming clear.

What "telling the story" does is to activate the brain structure where the traumatic memory is stored. This is an important part of recovery: Brain structure and function can only become plastic when the affected parts of the brain are active.

During this "plastic" stage, other parts of therapy can help the client reintegrate those memories and to reduce or even completely remove the anxiety or depressive symptoms that have accompanied them. The brain's own natural healing abilities come into play during this stage of therapy.

There is a misconception that the majority of therapeutic work only takes place during the one hour a week we spend with our therapist. We now know that our brain continues to work on the problem on its own. Even while we are asleep, the hippocampus [our memory center] and the cortex [our higher functioning brain] are exchanging information. This is why so many people who are in recovery from trauma report disturbing dreams: This is our brain working to reorganize itself by making sense of the traumatic memory.

One way we can speed up this healing process is by "swift walking" - basically going for a brisk walk in a safe place. What "swift walking" does is stimulate the connections between the hippocampus and the cortex as we experience the ever-changing environment during our walks. Think of it as exercising the memory muscles of the brain - the more we use them, the stronger they become. As the connections between our hippocampus and cortex are stimulated, they work more effectively on the problem memories as well.

So not only is a brisk walk good for our body, it is good for our mind.

Dr. Doidge states in his research that therapists who are familiar with neuroplasticity and use personal narrative as part of their treatment plans are seeing more effective outcomes for their clients struggling with a wide range of emotional problems including Posttraumatic Stress.

Unfortunately, there is no way [as of yet] to form set protocols for clinicians to follow in treating any specific condition using neuroplasticity. Though extensive training in dozens of different techniques is available, therapy still remains somewhat of an art form and relies on the experience, knowledge, and skills of the therapist and the trust a client has in their therapist.

So, how do you find a therapist who will fill your needs? Research the various therapies to see which one might work for you. See if anyone you know can recommend a therapist that has helped them. Shop around amongst therapists in your community; Ask questions of the therapists: What methods do they use? What is their level of knowledge about neuroplasticity? How much experience do they have? Finding a therapist that fits your needs and preferences is vitally important to help you feel safe in therapy.

Aaron D. McClelland, RPCc

Friday, 11 May 2012

Posttraumatic Stress Disorder or Injury?

This past week, American Psychiatric Association psychiatrists held a public hearing in Philadelphia to discuss reclassifying Posttraumatic Stress from a disorder to an injury.

Part of the motivation to consider this change is to lessen the stigma that comes with the word “disorder” - a stigma that prevents many people from seeking treatment.  As General Peter Chiarelli - who led the US Army’s effort to reduce suicide rates amongst combat veterans - put it: “No 19-year-old kid wants to be told he’s got a disorder.”

Posttraumatic stress is unique in that it is the only mental illness that is always caused by an outside force.  Symptoms can include; flashback memories; recurring nightmares; avoidance of certain places or people; decreased involvement in life activities.

Psychiatry professor Dr. Frank Ochberg, of Michigan State University, states; “There is a certain kind of shattering experience that changes the way our memory system works. One could have a clean bill of health prior to the trauma, and then afterward, there was a profound difference.”

Through modern brain imaging we can now see that the intensity of a trauma can be so overwhelming that it causes dramatic changes to the brain’s function and structure, so it then follows posttraumatic stress is more like a bullet wound or broken leg than a mental or emotional disorder.

PTSD was originally created to classify symptoms of some returning combat veterans, but over the years clinicians came to realize that these same symptoms were found in survivors of other traumas such as child abuse, sexual abuse, rape, witnessing murder or extreme violence.

Recent studies indicate that among children who have been sexually abused or who have witnessed the murder of a parent, the instances of posttraumatic symptoms are nearly 100% (Evans, 2008).  Coupled with the knowledge that one in four girls, and one in six boys will experience sexual abuse, the problem of posttraumatic stress in our community is staggering. People who experience posttraumatic stress often turn to alcohol or drugs and sometimes resort to suicide to stop the symptoms.  And it goes beyond individual suffering; the Mental Health Commission of Canada reports that 500,000 people miss work each day because of mental health issues and this costs Canadian business $50 billion in lost revenue each year.

As it stands right now, government administered universal health care and extended health providers either do not cover therapeutic counselling or have monetary caps on treatment. Including PTSI in the same classification as other injuries and providing coverage for treatment will alleviate prolonged suffering, reduce drug and alcohol dependence, and lower suicide rates.

Aaron D. McClelland, RPCc