In this video, Dr. Tony Madril provides a practical definition of Ego States Therapy and discusses how it may enhance EMDR for resolving trauma. Click here to watch the video…

Vicarious trauma and empathic distress are by-products of engaging in work that includes ongoing exposure to distressing images, sights, and sounds and as well as exposure to personal stories of trauma. Research suggests that such repeated vicarious exposure to human suffering places human service professionals at high-risk for experiencing some form of work-related stress. Over time, this type of stress can have deleterious effects upon the well-being of the helper and their ability to deliver quality human services over time. In fact, research suggests that repeated exposure to traumatic material creates a certain vulnerability for developing vicarious trauma or some form of traumatic stress; therefore, it is imperative to the health and well-being of human service teams to have an active awareness of the signs and symptoms of vicarious trauma as well as various practical tools and techniques to help mitigate the emotional burden of regularly working with trauma.

I’ve developed one such tool that I call REAP. REAP is a tool that may be used by helping professionals to identify and release empathic distress while working on the front lines. The acronym REAP stands for Recognize, Establish, Adjust, and Practice and may help professionals to cultivate compassion while delivering services to others in need. I invite you to listen to my YouTube video to learn more…

In this short video, I will discuss the difference between “top-down” and “bottom-up” trauma therapies. See my other videos on my YouTube channel https://www.youtube.com/channel/UCKBpNrB5fYklr9zjEIRPCfg

By Tony Madril, LCSW, BCD

Making a conscious choice to assert yourself in a stressful situation may help you to reprocess past psychological trauma and counteract its long-term effects on the body and mind. We know from scientific research that most people automatically respond to traumatic experiences by preparing to fight a potential perpetrator, by fleeing a dangerous situation, or by physically freezing in the moment. If your body reacted to past trauma with some form of freezing, it is possible that you are unusually sensitive to situations that are reminiscent of past traumatic events and that you may respond to minor threats in your daily life by momentarily regressing to a state of immobility, especially if you have not processed your injury with a trauma specialist. For instance, while being confronted by a demanding co-worker, alone, would not qualify as a traumatic event, this minor threat can nevertheless activate the brain’s release of stress hormones in your body if the trauma you experienced involved some sort of intimidation against you. The “post-trauma brain” is wired to notice and quickly respond to situations that appear similar to the traumatic event of the past. This is its primary form of defense, of keeping you safe from further harm.

While it may not have been humanly possible for you to have taken action to escape the traumatic event of your past, it is now possible for you to take action by asserting your needs when faced with situations that threaten your sense of integrity or emotional wellbeing. How? I have written a set of three questions that, in conjunction with therapy, you can ask yourself during moments of distress to help clarify: (1) whether the situation you’re in may be linked to past trauma; (2) how practicing self-assertion may help to counteract the feeling of immobility.

The first question: What am I feeling in my body? By using your concentration to quickly scan the body from head-to-toe like a copy scanner, you can gather important information about how the body is physiologically reacting to your immediate situation. Whereas uncomfortable or unusual body sensations such as a rapid heartbeat, shallow breathing, or a sense that you cannot move (or act as you would like) may suggest that something about your situation may be linked to past trauma, neutral or pleasant body sensations may suggest that you are experiencing an ordinary day-to-day stressor with no particular ties to past critical events.

The second question: Does this situation threaten my sense of safety or cause me fear? Defining what makes you feel unsafe or fearful is something only you can determine. Simply put, if you answer “yes” to this question, it would be important for you to determine a clear course of action to take care of yourself in the moment; answering the next question may help you do this.

The third question: Would asserting myself help restore my sense of safety? If you answer yes, you might consider the choices you have to assert yourself in your moment of distress. Returning to the example of the demanding co-worker, asserting yourself may come in the form of taking any of the following actions: making a request, saying no, resisting pressure from the person, or maintaining a particular position or personal point-of-view. On the other hand, if you notice that you are feeling oddly frozen to act, self-assertiveness may be that you walk away from the situation or simply acknowledge that “feeling frozen is happening” and soothe yourself with kind words of self-compassion such as: “I’ve got you sweetheart” “This is temporary” “Don’t worry, you will have more chances to assert yourself in the future.”

Over time, this ongoing practice of asserting yourself in challenging situations may improve the effects of past trauma by helping you develop new core beliefs about your ability to take care of yourself in the world. Gradually, you may begin to think (and believe): “I can do this!” “I can learn to do whatever it is necessary to take care of myself.” Feeling frozen to act may, therefore, become less and less of a problem as your ability to assert yourself and your sense of personal safety increase. When you feel safe, there is little need to fight, to flee, or to freeze.

Cognitive Processing Therapy or CPT is an evidence-based talk therapy for working through psychological trauma. It is a technique that I regularly offer my clients and one that I’ve found it to be very effective in resolving troublesome trauma-related symptoms like anxiety, depression, and panic-like sensations in the body. If you are curious about CPT or about the process of working through trauma, I invite you to listen to the podcast (accessible by clicking on the link) that lets you listen in on an entire course of CPT with a real client who wanted to share with others her journey through trauma therapy…

https://pca.st/S4erjj

There are several types of anxiety disorders that a person may experience, which may cause any level of emotional discomfort and, in some cases, may become an obstacle to accomplishing daily tasks necessary for living. For example, the fear of being trapped in a public space where help may not be available, characteristic of Agoraphobia, may cause someone to become social isolated over time as a result of avoiding public spaces. The Diagnostic and Statistical Manual of Mental Disorders, 5^th Edition (DSM-5) lists seven other anxiety disorders, including:

• Separation Anxiety Disorder
• Selective Mutism
• Specific Phobia
• Social Anxiety Disorder
• Panic Disorder
• Generalized Anxiety Disorder
• Substance/Medication-induced Anxiety Disorder

Some of these disorders may be more recognizable to you than others such as Generalized Anxiety Disorder characterized by uncontrollable worry about a number of situations and Panic disorder, which involves surges of intense emotion often accompanied by body sensations like heart palpitations, dizziness, and sweating. While each of the disorders listed above have trait symptoms unique to the specific disorder, they are all unified by intense worry and extreme focus on anxiety-related thoughts. For example, people suffering from anxiety may have rigid thoughts about the future that they can’t seem to get out of their heads such as: “What if I have a serious medical condition and die?” “What if I’m rejected?” “I’m a complete failure!” As such, first-line treatment for any anxiety disorder necessarily involves addressing these types of distorted thoughts with tools and techniques from Cognitive Behavioral Therapy (CBT), a heavily researched type of talk therapy proven useful in working with these types of thinking errors. A psychotherapist trained in CBT will help you work through your anxiety by teaching you how to identify and challenge thoughts that typically trigger feelings of anxiety. CBT sessions are designed to help you develop the skills to successfully build resilience to acute anxiety in about 12-14 sessions.  Depending upon the severity of your anxiety symptoms, your CBT therapist may also recommend that you schedule a medication evaluation by a medical doctor to assess whether adding a psychotropic medication to your treatment plan may further help feel better!

I am a trained CBT-trained psychotherapist and having been using it to help hundreds of people successfully work through their anxiety over the 22 years I have been practicing in the field of behavioral health. Please feel free to call or e-mail me if you have any questions about CBT and how we might work together to resolve your anxiety-related problems.

Written by Tony Madril, LCSW, BCD

Post-traumatic stress disorder or PTSD is a mental health condition that is triggered by experiencing or witnessing a terrifying event that involved serious injury, sexual violence, death or threatened death. Symptoms may occur immediately and may include any or all of the following: problems sleeping, flashbacks, nightmares, severe anxiety, avoidance of reminders of the trauma, distressing body sensations, and uncontrollable thoughts about the event. Moreover,

Symptoms of PTSD fall into the following four categories:

1. Intrusive thoughts such as repeated, involuntary memories; distressing dreams; or flashbacks of the traumatic event. Flashbacks may be so vivid that people feel they are re-living the traumatic experience or seeing it before their eyes.
2. Avoiding reminders of the traumatic event may include avoiding people, places, activities, objects and situations that bring on distressing memories. People may try to avoid remembering or thinking about the traumatic event. They may resist talking about what happened or how they feel about it.
3. Negative thoughts and feelings may include ongoing and distorted beliefs about oneself or others (e.g., “I am bad,” “No one can be trusted”); ongoing fear, horror, anger, guilt or shame; much less interest in activities previously enjoyed; or feeling detached or estranged from others.
4. Arousal and reactive symptoms may include being irritable and having angry outbursts; behaving recklessly or in a self-destructive way; being easily startled; or having problems concentrating or sleeping

If you have experienced these symptoms over a month or longer and notice that they have interfered with your regular day-to-day activities, you might consider seeing your primary care physician or a mental health professional who can help you determine if you qualify for the disorder and discuss how you might benefit from PTSD treatment.

If you believe that you might have PTSD, it may be helpful to know that there are several treatments that research has found to be effective in helping people work through their symptoms. Cognitive Processing Therapy or CPT is one such evidence-based treatment. CPT is a twelve-session, manualized treatment protocol which focuses on helping a traumatized person modify negative cognitions related to themes of safety, trust, power and control, and esteem and intimacy. CPT has one of the largest bodies of evidence to support its effectiveness than any other treatments for PTSD. Other research-based PTSD treatments are Eye Movement Desensitization and Reprocessing (EMDR) therapy, Prolonged Exposure (PE) and medication.

If you would like more information about PTSD treatment, you may contact me by telephone, (323) 315-2598, or by e-mail: tony@tonymadriltherapy.com

Exercising Choice & Past Trauma

Saying “no” when you would typically say “yes”; replying to a friend or coworker: “let me think about it” instead of immediately deciding; leaving a stressful situation for a few minutes to find your center. These are all examples of choices you can make to promote your well-being when feeling cornered by circumstance. Choosing to place your needs first can have profoundly positive effects upon your life; it has the power to loosen old patterns that don’t serve you anymore.

What is more, if you have experienced any type of trauma in your lifetime, choosing to do something to take care of yourself in a moment when you are feeling “stuck,” can counteract the feeling of being “frozen” in your body. Feeling as though you cannot or should not move in a moment of distress is often a by-product of having experienced trauma and is very much related to the automatic “fight, flight, freeze” response you are probably familiar with. Making practical choices to take care of you when you think you cannot, can help to replace the constant replay button of trauma with a renewed sense of self-confidence and safety.

What choices can you make today to take better care of you?