Monday, April 14, 2014

The Many Layers of Post-Traumatic Growth

The Many Layers of Post-Traumatic Growth

Psychologist Richard Tedeschi shares his research and insight into the concept of growth as a potential consequence of grappling with trauma.

In the past decade due to the conflicts in Iraq and Afghanistan, the term post-traumatic stress disorder has become the focus of countless headlines and has entered the collective conscience. But it is far from a new concept. During previous wars in history, the term for PTSD was known as soldier’s heart, shell shock, battle fatigue, and war neurosis, among others. As ancient, is its flipside: post-traumatic growth.
The term was coined in 1995 by Richard Tedeschi, PhD and Lawrence Calhoun, PhD to focus on the idea of growth as a potential consequence of grappling with trauma. There have always been people who, faced with a major life crisis or trauma, have been able to use that opportunity to make positive, meaningful change.
BrainLine talked with Dr. Tedeschi about post-traumatic growth, why some people seem to experience it while others don’t, and how it can help transform a person’s life into something far better than ever imagined. A psychologist at the University of North Carolina, Charlotte, Dr. Tedeschi is a researcher and a clinician.
BrainLine: What is post-traumatic growth, exactly?
Richard Tedeschi: The term post-traumatic growth (PTG) has been defined as the experience of positive change resulting from the struggle with major life crises. The concept is, of course, ancient and has been prevalent in the literature, philosophy, and religion of almost all cultures.
It’s important to note that we’re not talking about the traumatic event itself, but how the event becomes a catalyst for positive change. PTG is the process after the traumatic event.
BL: Why did the topic interest you in the first place?
RT: Lawrence Calhoun and I, both at UNC, decided we wanted to study wise people, resilient people. Maybe we’d learn something about ourselves in the process, right? We started interviewing survivors of severe injuries, people who had survived something physical or emotional in their adult life like a brain injury, blindness, paralysis, or being held as a prisoner of war (POW). Over and over, we heard how people and their families were deeply saddened by the losses and changes, but nevertheless, the experience had changed them for the better.
BL: In what parts of people’s lives does PTG tend to emerge after a trauma?
RT: While studying the concept of PTG over many years, Lawrence Calhoun and I established five domains in which PTG can arise most prevalently. We did this by statistical analysis; basically, conducting a series of interviews with survivors of severe injuries. As we heard about the changes these people went through after their life crisis, we created general statements and the following areas, or domains, emerged:
  • new opportunities or possibilities in life
  • increased sense of personal strength
  • change in relationships with others
  • greater appreciation for life in general
  • deepening of spiritual life
Some of the statements included sentiments like “I realize the importance of being present in daily living”; “I have more compassion for others; I’m more open”; “I can accept help from others more easily”; and “I can do things I hadn’t considered before.”
BL: Is there a certain type of person who is more prone than others to experience PTG?
RT: I’d say the type of people who may tend to experience PTG are those who would actively approach difficulty rather an avoid it. Someone who is open to change, open to the novelty and serendipity of life. People who can accept that bad things happen, that they can no longer do certain things, but who focus on engaging in the things that they can still do. And people who are open to new opportunities … possibilities and choices that may not have presented themselves before the tragedy.
BL: Why do some people emphasize what they have lost while others take that loss and turn it into a gain or opportunity?
RT: I know this sounds counterintuitive, but people who were less resilient before their tragedy tend to be more open to PTG. If someone is already resilient, he doesn’t need to change so drastically. PTG involves big change.
BL: People must experience some negative feelings and positive feelings after a trauma. How does this ambivalence manifest itself? Do you work to help the person get rid of the negative feelings and only work on the positive, or to see a yin-yang-type balance?
RT: To move toward PTG, you have to go through a phase of intense reflection. A person has to get through the emotional pain following a serious injury or trauma, a phase that is necessary but is non-productive in moving forward. Once dealing with the feelings of loss, anger, and other emotional pain is done, a person can then reflect and begin to let in opportunities for change and growth. A lot of this process depends on the type of support a person receives. If you are surrounded by loving people who are encouraging change and reflection, you will be in a better spot to grow than if you are surrounded by people who are naysayers to your ideas of how you might want to change and grow.
Most people who have traumatic events don’t get professional psychological help. They may instead rely on family and friends, or community. And again, the attitude and support of those people will play a huge role in a person’s ability to grow post-tragedy.
If a person does seek the help of someone like me, I will ask the person to tell me the story of what happened — how he got his brain injury, or how he became a quadriplegic. From there, we will work on tools to deal with non-constructive emotions like anger or self-pity. I will help the person get to a point where he is open to new opportunities, to new ways of seeing and living in the world. This is called expert companionship.
BL: What is that?
RT: An expert companion can be a therapist like me. It could also be a person in a social network who has gone through a similar tragedy who understands and who can act like a positive mentor. Or if the person is lucky, it can be a family member or friend. The expert companion needs to be open to hearing the person’s story, to hearing his feelings and emotions no matter how intense and repetitive in the long haul. This expert needs to be able to tolerate challenging, confusing, uncomfortable questions in the aftermath of the person’s trauma. The expert companion will not offer platitudes or quick fixes; above all else, he has to be a good listener. The expert also needs to be able to help the person see opportunities for useful change and to encourage him in the aftermath of this trauma to find some benefits. Everyone is different. An expert companion cannot make assumptions; he has to understand what this person has gone through, where the person came from, and how this brain injury, paralysis, or experience as a POW, for example, changes everything.
BL: Does the type or severity of trauma have some bearing on a person’s ability to experience PTG?
RT: The more severe the event, the more post-traumatic growth we’ll see. For example, if you get in a fender-bender in the parking lot, you may be shaken for a few days or weeks, but the incident will probably not prompt you to make significant changes in your life. While if you have been in a serious car crash where you almost died, you will probably be open to bigger change. After a more significant trauma, you will likely have more questions and thoughts about mortality, about how you want to spend your time on Earth.
BL: Is there an average time frame where people start to experience fewer negative reactions to their trauma and move more into the PTG camp? And does the level of someone’s PTG grow or diminish as more time elapses since the traumatic event?
RT: In our studies, we have found that PTG generally occurs most commonly in the short to medium term, around 1-2 years. Once the emotional processing from the tragedy is mostly over, people can move quickly into the opportunities for new change and growth.
We recently finished a study with POWs from Hanoi. They were evaluated directly after the Vietnam War. Our study retested them. We found stability in the PTG changes that they made; they made significant changes and kept them all these years.
There are other instances when people come back to us with concerns. I had one patient who had cancer. The diagnosis made him reevaluate his life and his priorities and he made significant changes on how he lived his life. Five years after his treatment ended, he returned to me to say that he thought he was “losing his edge,” that the changes he’d made were fading. He said he did not want to return to who he was before his cancer diagnosis. But most times, like the POWs prove, people tend to stick with the changes they made in the wake of tragedy.
BL: Are there certain actions that a person takes that manifest PTG?
RT:  When people make radical changes after a significant life tragedy or trauma, they usually put into action what is changing about them. They develop a mission, a purpose so that they can live differently. Their purpose is often altruistic in nature. For example, we treated a guy who because of a car crash became a paraplegic. As a result, he transformed from a stereotypical drug-taking, risk-taking rock-and-roll musician to a rehabilitation psychologist who works with disabled people. Because of his experience, he is able to relate to his patients on a deeper level and offer genuine encouragement. He turned what was horrible into a way to benefit others. He told me that he felt very grateful for the accident and how his life changed. If it hadn’t, he said, he would never have found this path, which to him is his true calling.
BL: How can clinicians use interventions to encourage PTG?
RT: Clinicians have to give the person’s traumatic event enough respect but at the same time, encourage the person to see directions that are still open to them.
For someone with a TBI, for example, the person may have been very capable and successful in the traditional sense before his injury. And now, post-injury, it may be hard for him to see a way to be successful. Working with him would entail helping him to redefine success. It would entail philosophical discussions, careful, attentive conversations. There are no easy answers, but to examine what it means to live a well-lived life can open up many possibilities for positive change.
Working with a person who has sustained a TBI depends greatly on the level and location of injury. Sometimes, we start simply by helping the person gain awareness of what abilities are still available to him. Then we might help reteach social skills in a deliberate way and teach him how to deal with his emotions. Once some of the more pragmatic skills are relearned, there will be more opportunities for that person. We had one woman in her 20s whose brain injury left her disabled. She had been in a doctoral program; she had been a champion swimmer. Now she had to walk with a walker and she had a hard time writing and thinking clearly. What had once been her strengths were no longer. She did a lot of work with us to learn to accept, without anger, that people saw her differently now, saw her as diminished. Her struggles helped transform her into a more compassionate person.
Another guy we worked with had a stroke at 40 years of age. Because of the stroke, he learned that he had a genetic anomaly in his heart that could cause an aneurysm at any time. Any exertion, any raise in his blood pressure might trip the weakness. So, he learned to live each day as if it were his last. He learned that his role in life after his stroke was to live calmly, slowly, and presently. He lives a sort of meditative lifestyle, listening and noticing the small details of the world. He found he became closer to his wife and children than he ever would have been had he continued his previous, frenetic lifestyle.
It is crucial to understand that PTG does not make everything all better; it does not make all the stress disappear. But it can bring true meaning to a person’s life. PTG forces us to focus on bigger questions — questions and concepts about wisdom, virtue, and values.
BL: Have you made any changes in your life based on what you’ve learned working with people who have experienced trauma?
RT: I have come to feel a great deal of respect for survivors of various traumas, and hope that I can handle my own with as much grace as many of my clients have. I do try to savor things, and separate the important from the trivial.  I try to catch myself when I am overreacting, and remember what is truly important. I also realize more acutely what I am doing wrong with my life, and struggle to change — sometimes with good effect, sometimes not. I am a work-in-progress and am still trying to learn, and my clients who have survived trauma are often excellent teachers.

A Personal Medical Cannabis Journey With TBI and Epilepsy

Dear friends, my name is Debbie Wilson. I was born in 1953. At age 35
I was a wife and mother of three when I was backed over by a pickup truck
as a pedestrian, on July 2, 1989. I was able to learn how to walk and talk again
and even go back to my career at the Florida Department of Corrections. Two years
later I started having seizures. and my supervisor was the first person to notice
them in August of 1991. Seizures are a ban from any kind of law enforcement
career. I later learned that "uncontrolled seizures" are a workman's
compensation risk so I was never able to use my education and go back to work
again.  On July 22, 1996 I had my second and most severe brain injury due to a fall
caused by medication that negatively affected my balance. My "uncontrolled seizures"
then became life threatening. I tried 19 different anti epileptic drugs unsuccessfully.
I lost my teeth, gall bladder and colon to the side effects of the mega doses of seizure medicines, I was prescribed.  I was evaluated by UCLA for brain seizure surgery twice
and turned down both times.  I was also evaluated for the vagal nerve stimulator twice
and again not found to be a suitable candidate.  My lungs had stopped twice and my
heart once due to the seizures by 2010. I realized I had run out of time and there was
still no treatment available for me.

I made the decision to detox off of my over 40 prescription pills a day and try medical cannabis. Once I detoxed off the prescription medicine I felt much less brain injured. I
never had a clue how much more unaware I was cognitively due to all the medicine I
was taking, instead I blamed it on my brain injury. Once I was using medical cannabis
I was ableto learn how to write a sentence again after 15 years. I was a brain injury and epilepsy writer long ago and I wanted badly to share with my fellow brain injury survivors what was finally working for me! My new found ability to write enabled me to create a written journal of my medical cannabis trials. It also gave me the ability to interact with others again. I have severe memory problems and did not know anyones name. I also had no idea who may one day need the information I was collecting. That is how my Dear friends journal began and I am so thankful to Michael Lee for putting all of them together so that others can learn from my personal medical cannabis journey. Just check out this link.

Study offers a clearer picture of brain at rest

By Paul Mayne
February 06, 2014

Brain at restPaul Mayne, Western News
Physics and Astronomy professor Andrea Soddu said his research into the brain at rest could offer a fresh approach to accurately forecasting consciousness conditions in an individual’s brain.
New research from Western into the resting state of the brain could lead to better treatment for patients suffering from head injuries.
Led by Physics and Astronomy professor Andrea Soddu, in collaboration with The University of Liège in Belgium and Central University Colombia, the new strategy offers a fresh approach to forecasting consciousness conditions in an individual’s brain. The findings were published recently inCortex, an international journal devoted to the study of the nervous system and behaviour.
While the brain is always active, Soddu’s research into spontaneous brain activity, utilizing functional magnetic resonance imaging (fMRI) technology, looks at a patient studied for a period of approximately 10-15 minutes with the absence of outside stimuli.
“There is no participation in the fMRI scanner, such as counting or any visual stimuli, so measurements are not biased by the participants,” said Soddu, a principal investigator at Western’s Brain and Mind Institute.
Should a patient suffer serious head trauma, having this clearer picture of the brain at rest will more accurately detect differences in the brain patterns.
While the ability for every patient to have his or her own personal study is not logistically possible, the creation of a common network, based on age and sex, can be of tremendous assistance in determining a patients state of consciousness, Soddu said.
“By being able to recognize the networks of (brain) activity in a state of rest, should you suffer a brain injury, these regions can be partially or completely destroyed,” he said. “The first thing a patient would have is an MRI, and you’d see right away where the damage is, so you can expect functionality to be damaged or affected.
“But imagine if you had the spontaneous activity of everybody, and the moment something happens you could check where the changes are. In the brain, we know certain regions are connected. Using the fMRI as a clinical tool, we can see if these same regions are doing the same things at the same time functionally.”
Classifying patients automatically based on fMRI resting state data is the first step toward single subject objective diagnostics, said Soddu, which he sees as imperative as the global medical community investigates the customization of health care.  
Soddu said this new approach could even have clinical possibilities for patients suffering from brain-related diseases such as Alzheimer’s and Parkinson’s.

Transition to Independence After a Brain Injury

Caregiver Abby Maslin talks about the process of helping her injured husband gain more independence, especially in caring for their young son.
Produced by Victoria Tilney McDonough, Justin Rhodes, and Christian Lindstrom, BrainLine.

Head Injuries Can Affect Children’s Social Lives

By  Associate News Editor
Reviewed by John M. Grohol, Psy.D. on April 12, 2014
Head Injuries Can Affect Children's Social LivesNew research has found that suffering a head injury can affect children’s social lives for years to come.
For their study, neuroscientists at Brigham Young University (BYU) examined a group of children three years after each had suffered a traumatic brain injury, most commonly from car accidents. They found that a lingering injury in a specific region of the brain predicted the health of the children’s social lives.
“The thing that’s hardest about brain injury is that someone can have significant difficulties but they still look okay,” said Shawn Gale, Ph.D., a neuropsychologist at BYU.
“But they have a harder time remembering things and focusing on things and that affects the way they interact with other people. Since they look fine, people don’t cut them as much slack as they ought to.”
For the study, published in the Journal of Head Trauma Rehabilitation, Gale and Ph.D. student Ashley Levan compared the children’s social lives and thinking skills with the thickness of the brain’s outer layer in the frontal lobe.
The brain measurements came from magnetic resonance imaging (MRI) scans, while the social information was gathered from parents on a variety of subjects, such as their children’s participation in groups, number of friends, and the amount of time spent with friends.
The BYU scientists also found that physical injury and social withdrawal are connected through “cognitive proficiency,” defined as the combination of short-term memory and the brain’s processing speed.
“In social interactions we need to process the content of what a person is saying in addition to simultaneously processing nonverbal cues,” Levan said. “We then have to hold that information in our working memory to be able to respond appropriately. If you disrupt working memory or processing speed it can result in difficulty with social interactions.”
Separate studies on children with ADHD, which also affects the frontal lobes, show that therapy can improve working memory, according to the researchers. The researchers hope that future studies using BYU’s MRI facility will look into whether improvements in working memory could “treat” the social difficulties brought on by head injuries.
“This is a preliminary study, but we want to go into more of the details about why working memory and processing speed are associated with social functioning and how specific brain structures might be related to improve outcome,” Gale said.

What Kinds of Rehabilitation Should a TBIPatient Receive?

National Institute of Neurological Disorders and Stroke

Rehabilitation is an important part of the recovery process for a TBI patient. During the acute stage, moderately to severely injured patients may receive treatment and care in an intensive care unit of a hospital. Once stable, the patient may be transferred to a subacuteunit of the medical center or to an independentrehabilitation hospital. At this point, patients follow many diverse paths toward recovery because there are a wide variety of options forrehabilitation.
In 1998, the NIH held a Consensus Development Conference on Rehabilitation of Persons with Traumatic Brain Injury. The Consensus Development Panel recommended that TBI patients receive an individualizedrehabilitation program based upon the patient's strengths and capacities and that rehabilitationservices should be modified over time to adapt to the patient's changing needs.* The panel also recommended that moderately to severely injured patients receive rehabilitation treatment that draws on the skills of many specialists. This involves individually tailored treatment programs in the areas of physical therapy,occupational therapy, speech/language therapy, physiatry (physical medicine), psychology/psychiatry, and social support. Medical personnel who provide this care includerehabilitation specialists, such as rehabilitationnurses, psychologists, speech/language pathologists, physical and occupational therapists, physiatrists (physical medicine specialists), social workers, and a team coordinator or administrator.
The overall goal of rehabilitation after a TBI is to improve the patient's ability to function at home and in society. Therapists help the patient adapt to disabilities or change the patient's living space, called environmental modification, to make everyday activities easier.
Some patients may need medication for psychiatric and physical problems resulting from the TBI. Great care must be taken in prescribing medications because TBIpatients are more susceptible to side effects and may react adversely to some pharmacological agents. It is important for the family to provide social support for the patient by being involved in the rehabilitation program. Family members may also benefit from psychotherapy.
It is important for TBI patients and their families to select the most appropriate setting for rehabilitation. There are several options, including home-basedrehabilitation, hospital outpatient rehabilitation, inpatient rehabilitation centers, comprehensive day programs at rehabilitation centers, supportive living programs,independent living centers, club-house programs, school based programs for children, and others. The TBI patient, the family, and the rehabilitation team members should work together to find the best place for the patient to recover.
* National Institutes of Health Consensus Development Conference Statement, October 26-28, 1998. Rehabilitation of Persons with Traumatic Brain Injury. Bethesda, MD, September 1999

Saturday, April 12, 2014

Medical Cannabis and Anxiety, Depression and PTSD

Dear friends, I want to share what I have learned about medical cannabis and anxiety, depression and PTSD. I am sure there are many of you that also deal with these particular issues. When I first started this medical cannabis journey I only had been told it would help with my post traumatic headaches. The most amazing surprise is what it did for all my brain trauma induced mental health issues. I had been told my brain did not make serotonin after I was injured. I had taken anti-depressants for 21 years.
I was afraid of what would happen if I went off my medications. I have anger issues and was afraid I may hurt someone! I am blessed to now say I have the best over all feeling of "well being" that I have had in all these years, thanks to medical cannabis. This was an immediate an constant response ever since. I did not realize that I had PTSD until I vaporized my first indica dominant strain and literally felt my anxiety and PTSD immediately fade! I immediately felt much less brain injured since I had always thought that my PTSD symptoms were symptoms of my brain injury itself. It was not. If you have anxiety problems a lower THC level or a 50:50 ratio of CBD to THC has been what has helped me the most. I hope and pray it helps some of YOU! 

Debbie M. Wilson