Understanding Change Part IV: Trauma and Change

For the past three days I have been focusing on the elements of any change process—the success factors for preparing for change, readiness for change and resistance to change, mostly in anticipation of the biggest ‘change week’ of the year: New Year’s.

I have focused primarily on the aspects of change that anyone would encounter and now want to add in some thoughts about change and how surviving trauma affects your connection to change.

Yesterday when I was talking about resistance to change I talked about how the behaviors or habits that we have that are hard to change are often a form of protection. The industry term for these protections is “defense” but it is simpler to think of it as something that makes you feel better or less anxious in the short term, though often you feel worse in the long term.

These habits exist for people who have lived through trauma and those who have not. Most people have habits and behaviors they are trying to change. That’s normal. What I have found is that for people who have lived through trauma, the habits are way more entrenched—and it can feel like more of a life and death struggle to give them up.

This is not because they are necessarily more destructive habits or that people who have lived through trauma have less motivation to change. Most of it lies in the experience of anxiety. The experience of trauma creates a level of terror and fear that can come back at a moments notice and the protections or defenses that trauma survivors create to get through the trauma become the talismans against that terror and fear. It is hard to untangle giving up the habit with the old terror:  at the neural level they are inextricably linked.

So when you have lived through trauma and you want to make changes, it can often feel like you are giving up the very thing that had you feel safe. YES, I know it doesn’t sound logical. And YES, I know that your present life isn’t filled with that terror. But your brain still links them, so change can be more tricky than for people who have not lived through trauma. Which is bad news because change is hard, period. And it's even harder for you.

What I have found is that trauma survivors are well served by smaller and more structured increments in change. They are well served by having better supports in place. Really, most people are. Small changes are absorbed better by our systems and we build self-efficacy for change through the repetition of successful actions. So regardless of what change program you are using as a survivor, or you are using with the survivors you are treating, three things are really important: be respectful of pace, be respectful of ‘dosage’ and be respectful of the role that the habit was playing.

Pace: Go slowly. Trust your pace of change. Imagine that your inner wisdom really knows how fast you can change and just trust it. Take time to talk about the pros and cons of change. Take time to prepare so that you are creating a stable environment for change. Take time to get the resources you need. Take time to make small changes, talk about them, absorb them and move to the next small piece. Trust lulls in the change process and trust moments of moving ahead.

Dosage: What is the smallest increment that you can change and try that. Then shift it only a bit. Remember that each experience of doing it differently is exposing you to experience both a bit of the old horror/anxiety and a bit of a new experience. Both of these can be overwhelming emotions—and so you want to be mindful of the pace you are moving and the amount you are taking on so that the experience is tolerable. There is an old adage in working in residential treatment that growth only happens at a point of struggle, but you want it to be challenging not overwhelming. Because if you get to the point of overwhelm you are more likely to relapse and go back to the old behavior because that old behavior made you feel better. Overwhelm doesn't lead to change. Overwhelm leads to relapse. So titrating the amount of challenge is key to success

Respect the Role the Habit Played: Yesterday when I was talking about the Immunity to Change work with resistance, I was essentially outlining their program which was designed to illuminate your hidden competing commitment—the thing that is more important to you than the stated behavior change you are trying to make. It is a great exercise and it can and likely will illuminate the survival behaviors that you used. I remember doing the exercise for the first time—and the behavior I was trying to change was to have a cleaner house, have less clutter in my work areas. And I eventually came to a place where I realized through the exercise that clutter was my way of remaining invisible. I used my messes to ‘hide.’ And hiding made me feel safe. Insight is great. But it isn’t what makes change. Practice make change. And I had to find ways of experiencing ‘being visible’ and ‘not hiding’ in small, incremental ways that I could tolerate. I had to respect that protection and not just bust it up all at once. I think that all of this is true for anyone who is trying to make change. But it is crucial for trauma survivors.

© Gretchen L. Schmelzer, PhD 2016

5 Important Ways to Honor Anniversaries of Loss

Many anniversaries mark the happy moments in our lives, but many also mark the sad or frightening. Life happens in cycles and on anniversaries we cycle back to the event—the loss—the fear—the experience. We see it in hindsight, we see at as we saw it, we see ourselves then and we see ourselves now. Whether the anniversary is of a trauma, like the Marathon Bombing, or 9/11, the Moore tornado, Sandy Hook, or the death of a loved one—anniversaries are important for our healing and our growth. They help us integrate what was lost, what was found, and where we are headed.  But there needs to be attention paid to the ‘how’ of anniversaries. You can’t just live in the old story—and thanks to a 24 hour media cycle—this is a dangerous possibility. To just live in the traumatic event or loss is to be re-traumatized for a day. Anniversaries need more than just re-living the event or the loss, they need five aspects to create the ground for healing and growth. These five tasks are: Creating a Caring Environment, Honoring the Experience, Mourning What was Lost, Acknowledgment for What was Found, Envisioning the Future.

Creating a Caring Environment: People always forget that emotional work requires preparation. Anniversaries are tough days. You need to be extra kind to yourself on these days and make sure that you have more resources available to yourself than usual: more sleep, good food, lowered stress (perhaps fewer appointments or commitments if possible). You need to over-support yourself if you can—let loved ones know you need more support, have a friend ‘on-call,’ do those things that lower your stress: go for a walk, play with your kids, dog or cat, meditate, listen to music. Bring a picture to put on your desk at work, or have on your phone. The tasks of healing and growing through an anniversary will require a lot of you. It is important to create an environment where you feel supported through this day and this work.

Honoring the Experience: The first task is to honor what was experienced. What happened? What is the narrative of the event? What was I thinking? Feeling? Doing? Who was with me? Ideally you could honor your experience in a conversation with someone else, or with others to have your story witnessed and witness others. Do what you can to let others know that this is an anniversary for you. Let others help you honor it too. Be kind to yourself as you remember the story and tell the story. Trauma and loss can make us feel helpless and helplessness can make us feel shame. Honoring your story and your experience can be healing, but you need to be kind to yourself –knowing that in surviving you did the best you could.

Mourning What was Lost:  Grieving is an intermittent experience. It can come and it can go. It is like the weather—one minute calm, the next minute a gale force wind. Anniversaries heighten this experience because it creates its own schedule of mourning. It brings us back to the loss and we are caught again in the storm of the experience. Mourning helps us see what happened, what we lost. But mourning is often bigger than the loss we can initially see. Mourning can be about what did happen, but it can also be about what didn’t happen—the things that couldn’t happen because of the loss or traumatic event. Allow yourself to acknowledge these things and hold them close to your heart—rock them inside you like an inconsolable infant. Everyone has their own rhythm and pace of mourning. Trust yours.

Acknowledgement for What was Found: This is what makes trauma so complicated. Just when you want to completely hate something in your life or your experience, you find something as well. Sometimes it is small, and sometimes it is large—but there is always something new in the experience of surviving a trauma or a loss. You come to know yourself or your community differently. You learn about a capacity you didn’t know you had. You grow bigger than you were. Your heart can hold more than you thought. What do you know about yourself that you didn’t know before? What do you see in your life that you didn’t see before? What might you even be grateful for now after having come through this experience? How has this changed over time?

Envision the Future. Anniversaries are focused on the past—but just the fact that the year has gone by is the proof that time marches forward. What are your hopes for the future? How do you want to honor the past in the next year? How can you bring the wisdom of what you have learned through this difficult experience to benefit your life and the lives of others? What do you still need to do to support your healing and growth?

© 2015 Gretchen L. Schmelzer, PhD

Parent's Corner: The Letter Your High School Senior Can't Write You.

Dear Parent-

Stop talking about next year. I mean it. Stop it. I can’t deal with it right now. You ask me about my applications, my essays, my recommendations, and ‘have you talked to your guidance counselor?’ You see this as my job and all I can see is loss.  I can’t stand your excitement because it isn’t how I feel about it. Can you please stop talking about it?

I know. I know. I know all of the things I have to do, but it's hard enough doing what I need to do for tomorrow, let alone next year. I am swamped with everything I have to do right now –how do you expect me to do all of this work for next year at the same time? And I know. This is what I have been working for. And this is what I do want. And I know it’s hard for you. And it’s a big sacrifice for you and it’s what I have asked for. But not right now. I want it and I don’t want it.

Every time you talk about next year my stomach drops. I feel empty. I know I act like I can’t stand you sometimes but when you talk about next year all I can feel is fear and panic. I can’t imagine myself living anywhere else—when I try, it is as if I have just disappeared. It’s like I don’t exist. I feel desperate. When you talk about next year what you are really talking about is me moving out, being gone. Leaving you and everyone here. Leaving my friends.

I am afraid of having to leave and I am afraid that I won’t be able to. What if they don’t like me? What if no one wants me? I want to stay and I want to be chosen. I want both. I want to be wanted. Somewhere. Right now, you are pushing me to go and no one has taken me in. I am nowhere. Absolutely nowhere.

How did you do it? How did everyone else do it? Leave? Leave everything behind? It looks impossible. It hurts. All I want to do is cry and ask you to stop. Beg you not to forget me. I want the impossible: I want to stop time so everything stays the same. I just want to stay here.

And all at the same time, I don’t. I can feel myself excited for next year. How can you want both? To go and to stay?  It makes me feel crazy. But I do. There are times when I am excited about next year. I’ll get to meet new people. I will get to do new things. I can see myself in my new world. I can feel a bit of the confidence I have. And the clearer the picture is, it can suddenly switch: I see myself doing well, feeling excited and then in a flash it switches to loss. I will lose you. I will lose all of this. And I want to crawl under my covers. I want to stop everything. Most of all I want to stop you from talking about next year. Because when you do, it feels too real.

I know you can’t. And I know I can’t. It feels like this kind of loss is not survivable. I know other people have done it. But I can’t imagine how.  I am not sure that I understood as much as I do now that there is loss in moving forward. In getting what you want. I know you can’t stop asking me about next year. And I don’t really want you to. I need your help. I need your nagging. I need your editing. And what I really need is your reassurance. I can’t do this by myself because I want both things: to stay and to go, which makes me kind of freeze up and go no where. I need your help and I need you to hear my frustration in this conversation as a backwards compliment: as much as I am excited to go, I want to stay. This is my way of surviving good-bye. 

Love, Your High School Senior

© 2015 Gretchen L. Schmelzer, PhD

Remembrance--holding and healing through stories

“Forty-three years old, and the war occurred half a lifetime ago, and yet the remembering makes it now. And sometimes remembering will lead to a story, which makes it forever. That’s what stories are for. Stories are for joining the past to the future. Stories are for those late hours in the night when you can’t remember how you got from where you were to where you are. Stories are for eternity, when memory is erased, when there is nothing to remember except the story.”

— Tim O'Brien, The Things They Carried

Remembrance is the holding of a story: and the eventual telling of a story. When people think about healing from trauma they most often think of people telling their story: the story of what happened to them. But the story of trauma is just not that simple. Every trauma is different yet shares one thing: the memories are fragmented pieces that must be reassembled in order to become the story that resembles the experience. The memories are nearly a million poppies that make sense only when they come together in one place.

Last year in London for Remembrance Day they amassed 888,246 ceramic poppies to represent the soldiers who died in World War I.  It was a staggering sight of red surrounding the entire Tower of London. You could not take in the entire installation in one view—thousands and thousands of poppies. It was beautiful which kept you looking. And devastating which helped you understand what you were really being asked to understand. The story of what a nation endured by looking at all 888,246 poppies and then imagining all of the losses for each family that went with each poppy, and and all of the communities. 

Trauma is so hard to absorb. Not just for what we would consider psychological reasons but because our physiology is designed to protect us. Our defenses against being overwhelmed and incapacitated help us not take in trauma as it is happening. There are a number of things that happen with the physiology of our brains that keep us from taking in the whole story. Trauma keeps our brains from encoding or storing the information in the way it typically takes in information. Stress activates our fear or emotional memory so that the memory gets stored as a memory that you know but don’t know how you know--they call this a procedural memory (like riding a bike or tying your shoes).

To make this even more likely, the high levels of stress hormones from trauma inhibit the neural networks of the hippocampus-cortex circuit —effectively taking our memory for knowledge “off-line” which means that the details of the memory, the story of the memory and the context of the memory are not properly “written down.”  The memory is there, your brain recorded the information, but the information was stored without a connection to context and often, time. Think of it as memory scattered. A red poppy here and a red poppy there.

Even more striking is the loss of language during and after trauma. During trauma, and even recalling trauma, the language center of the brain has reduced blood flow which inhibits the capacity for language. This inhibition impairs encoding the event into language and can impair the retrieval of memory into language.⁠ When we say that trauma is ‘unspeakable’ or that language fails us—it’s not just a metaphor: the language centers in our brain keep us from the story.

So we need patience, we need time and we need repetition to tell our stories. The stories that individuals need to tell. The stories that groups need to tell. The stories that countries need to tell. There is no one single war story. There is no single telling of any trauma. We need metaphors. We need art. We need 888,246 ceramic poppies and we also need the pictures and letters and crosses tied to the fence so that the stories can come together, the scale of the magnitude and the small love note for a country and for ourselves. 

Research: Trauma and Memory

1. Release of norepinephrine heightens activation of amygdala and intensifies memories of trauma. McGaugh, J. (1990). Significance and Remembrance: The role of neuromodulatory systems. Psychological Science, 1, 15-25.

2. Cozolino, L. (2002). The nueroscience of psychotherapy: Building and rebuilding the human brain. NY: WW Norton.

3. Rauch, s., van der Kolk, B., Fisler, R., Alpert, N., Orr, S., Savage, C., Fischman, A., Jenike, M., & Pitman, R. (1996). A symptom provocation study of posttraumatic stress disorder using positron emmission tomography and script driven imagery. Archives of general psychiatry, 53, 380-387.

© Gretchen L. Schmelzer, PhD 2014