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Coping with Triggers - Chat Transcript
The Pandora's Aquarium chat room welcomed Randi Nathenson, as a guest speaker on September 27, 2012. Randi is a clinical social worker based in the United States who works with clients with a trauma history. Her clinical interests are trauma, grief, and anxiety. She works with children, adolescents, and adults. She has also done advocacy work with rape crisis centers and domestic violence shelters, and particularly felt drawn to hospital advocacy work. Randi has a website: www.highlandcounseling.com
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Kadie: Welcome to tonight's guest speaker
chat with Randi Nathenson. Randi is a clinical social worker who has
worked with clients with a history of trauma. She has done chats with us
before and we are thrilled to have her return. The topic for this chat
is dealing with triggers. Thanks Randi for coming tonight. First we will
ask Randi questions you submitted prior to tonight. Second we will ask
questions you have submitted throughout the chat. We will try to answer
all questions but we do have a time limit. Let’s begin!
Question: I was held captive hear a bakery during my
abuse. Now the smell of fresh bread makes me sick and sends me into
flashbacks. Is it possible to get over this?
Randi Nathenson: The short answer is yes.
Flashbacks are normal responses to trauma. When you are triggered you
are responding as if the abuse is occurring in the present moment,
rather than in the past. When triggered the tendency is to want to avoid
the trigger, but triggers can be a very useful healing tool. They can
show you emotions and areas that need to be attended to. You can learn
to console yourself, and be consoled by others, and to express feelings
and pain that may have not been expressed before. By identifying
triggers such as these and working through them you can reach a place
where they do not send you into a flashback. Some may continue to remind
you of the abuse but won't have the same emotional impact. Some may
stop bothering you completely
Question: I was raped
in a back seat of a car. Ever since this happened I can't bring myself
to even sit in the back seat of a car let alone ride in one without
having a panic attack. What can I do?
Randi Nathenson: One of the most important
parts about dealing with triggers is understanding why you are being
triggered (through educating yourself) but also by allowing yourself the
feelings. Be gentle with yourself and understand why this scares you.
Of course it will, it is normal. You do not have to push yourself or
make yourself do anything that makes you uncomfortable, it is okay to
decide not to sit in the back until you have worked through the trigger.
We need to give ourselves permission to have our feelings. Prepare
yourself as much as you can, the more prepared you are, the more in
control you will feel
Question: Whenever I'm
around large groups of people I totally panic and start shaking because
I'm reminded of the worst night of my life. I rarely leave my apartment.
Any advice?
Randi Nathenson: Start small and go places
that are outside or not very crowded for short periods of time. You can
do breathing exercises as you go, listen to music, or carry a stone or
another small object for comfort. Try to identify what it is that is
triggering you, and write or draw about it. Make a plan for what you
will do if you are out and get triggered. If you are out and have a
panic attack, try to ground yourself, focus on your breathing, go touch a
tree, count to 100, recite the alphabet, something to distract you.
Question: How do you deal with being triggered in a public place? like the Dr. office, t office, etc?
Randi Nathenson: If you can let the person
know you are triggered. The best you can reach out and tell them how you
are feeling. It is VERY difficult, because the tendency is to shut
down, but if you can speak up about it, then hopefully they can help you
manage. Also as I said above try one of those techniques, or remove
yourself from the situation. You can leave, or move, or do whatever you
need to do.
Question: My family
vacationed at a very popular resort when I was growing up. One summer I
was attacked in the boathouse. I never told anyone. I pretended I was
fine. That doesn't work anymore. I'm terrified of boats and being near
the water. How can I get over this after so long?
Randi Nathenson: It sounds like what is
happening is old ways of coping just are not working anymore, which
often happens. Try writing or drawing what happened, or talking about it
to a therapist or friend who you can trust. It is something you can
work through.
Question: How do I prevent myself from "freezing" whenever I get triggered?
Randi Nathenson: Freezing is a normal
response to trauma, it is part of the whole fight/flight/freeze
response. Often people forget the freeze exists. The best thing you can
do when you freeze is to focus on your breathing, breathe in through
your nose and out your mouth counting your breaths. Breath as slowly as
possible. Count, again say the alphabet, console yourself and tell
yourself you are okay, this is not happening now it was then and you are
safe and okay. Once you can move try to go to another room or area and
comfort yourself, do something to take care of you.
Question: What can you
do if you're unsure what is triggering you? I sometimes have panic
attacks and have to leave my surroundings without knowing why.
Randi Nathenson: Sometimes it takes time to
figure out what might be triggering you. Triggers come from all of the
senses, touch, smell, taste, sight, and sound, and often it can be
difficult or impossible to pinpoint the exact cause. Work on grounding
yourself and later when you are able to process what happened and see
what feelings come up. it is okay if you do not identify the exact
trigger, the important part is working through the emotions.
Question: I am a
survivor of childhood sexual ritualistic abuse. During that abuse I was
taught to (read forced and programmed) to hurt myself sexually.
Masturbation was used as an entry point to the programming So even this
healthy activity is anything but for me. I would like to know if there
are any healthy ways of breaking this programming and if so what are
they?
Randi Nathenson: Yes, I think the most
important thing is finding a therapist who is very well trained in
dealing with trauma, and has experience specifically with childhood
sexual ritualistic abuse. EMDR has been found to be very effective, so
finding someone with that training would be great.
Question: When I get
triggered I tend to resort to unhealthy ways of dealing with it such as
drinking or self injury. are there ways of beating these triggers?
Randi Nathenson: One of the hardest things
for survivors is "unlearning" unhealthy coping skills. There is a great
Maya Angelou quote which is you do the best you can do and when you know
better you do better. The first step is identifying the triggers and
working toward making a plan so you can choose positive self care. Be
gentle with yourself and have multiple options. Listen to music, play
solitaire, play angry birds, knit, draw, journal, exercise. something
that gets you doing something.
Question: I have some
form of DID. I have adult alters and some younger ones. How can I cope
with the different ways they react to being triggered?
Randi Nathenson: Honestly, DID is not my
specialty, but I imagine it would be identifying the alters and
identifying what comforts each one and finding the coping skills which
might be different. You can see what works, it might take some
experimentation to see what works for what alters and to gain an
understanding of that.
Question: My family and
friends (that know) don't understand don't understand how scared I get
when I'm triggered and why. I don't want to do things they take for
granted. How can I explain it to them?
Randi Nathenson: It is really difficult to
have to educate others who really do not get it. One way to explain is
to say if you were attacked by a dog, you would have a fear o dogs and
it would be very difficult to be around dogs. Well with sexual abuse
there are a million things, that like dogs, are going to scare you and
trigger you. Maybe help them to understand what they can do to help YOU
ground yourself. They can remind you to breathe or reassure or console
you. They can hug you if you are comfortable, or help you find something
that comforts you.
Question: I'm in a new
relationship and every time we get close to becoming intimate I get
triggered and start to freeze or panic. Can you give me any suggestions
on how to deal with this?
Randi Nathenson: One thing that really
helps is to tell your partner when you are triggered or upset. You don't
have to share details, but find a way to communicate to them you are
not okay. Wendy Maltz wrote a fabulous book on the subject called the
Sexual Healing Journey. I recommend it to survivors and their partners
to read.
Question: Do you have
any suggestions for finding survivor groups in real-time, face to face
situations that might help me to connect with other survivors and give
me support when I get triggered?
Randi Nathenson: Contact a local rape
crisis center, or women's shelter, or sometimes churches or synagogues
might have names of support groups. Often therapists have groups going
on, or might be doing a group or know of someone who is. You could also
try RAINN and see if they know of any resources in your area.
Question: I have worked
diligently with my therapist on coping with triggers. However, I still
have a very difficult time coping with body sensations. For example, we
are entering the Fall Season where I live, and feeling physically cold
is has always been a tremendous trigger. What have you found works for
people coping with body sensations?
Randi Nathenson: Sometimes for body
memories, some kind of body therapy helps. Either movement, or yoga, or
tapping, or going to an actual body therapist can help. I find that
verbalizing body memories does very little, those are emotions, and
often need to be expressed non-verbally through movement or art or dance
or music.
Question: I am
triggered by my T, just because she is a T and I have a history of
trauma related to a former T. I want to trust her and when I am not with
her, I believe I do but the minute I am face to face with her, I
flashback almost the whole time. In order to move forward, I have to get
through this particular trigger. Any ideas about how to get past this?
It's frustrating for both her and I.
Randi Nathenson: That is frustrating and
very difficult to deal with, I think it is great that you are working
with a T considering your history. Often the healing occurs within the
relationship, I would talk as much as possible about your feelings about
the relationship. Tell her how you feel, what you are experiencing etc.
If you cannot verbalize it, write it down. The more you can share about
how you feel about the relationship, the more healing it will be.
Question: I was assaulted by my best friend, who is
also a girl. I've always felt like it was bigger than just being
sexually assaulted by her. I had a flashback last night where I
remembered her actually raping me. She lives close to me, so whenever I
go to the mall, or other places like the movies, I always feel like
she's going to be there. Will I ever be able to go out in public without
panicking that she's going to be there?
Randi Nathenson: Yes, it is normal to have
that fear and that panic. I agree, it is bigger, and it sounds like
there are a lot of feelings and emotions wrapped up in it, particularly
in your latest memory. Try to make a plan to keep yourself safe, so if
you do see her, you feel you are in control, and know what you are going
to do. The more you can feel like you have regained control, and
empower yourself, the easier it will be. You can find ways to protect
you and you deserve to, and to take care of you.
Question: How do we deal with the triggers that make
no sense? I can't connect it to a memory, but whenever I hear muffled
voices, it's all I can do to not pass out. Same thing with bright
lights.
Randi Nathenson: Try drawing or other
non-verbal ways of expressing the feeling. You don't have to connect the
trigger to anything specific, it is really the emotion behind the
trigger that matters. Feelings are not logical or rational, if they were
we would not have them. Try using some self-care techniques and ways to
comfort yourself when this happens. Smells are often the strongest
triggers.
Question: Sometimes I have what I call
smell-o'vision hallucinations that are where I can smell different ones
of my rapists. Sometimes the smells are associated with clothing items,
so I just put them in the laundry. Other times they have no specific
source. Any suggestions?
Randi Nathenson: Find a smell that comforts
you. A food, a perfume, an herb, something that you can use to comfort
yourself. Smell is often connected to taste as well, so that is often
why smell is such a powerful trigger. Find things that give you comfort,
and remind yourself that you are safe and you are okay, ground yourself
as much as you can in the present moment.
Question: EMDR has proven ineffective and/or extremely triggering for me. Is there an alternative to the EMDR?
Randi Nathenson: There are definitely other
approaches, many therapies work and the key is finding what works for
you. For some it is CBT, for some it is more in depth therapy, for some
it is yoga. There is no right or wrong way to heal, find what works for
you. if EMDR is not working, don't do it
Lyndsie: For those of you who do not know, EMDR is a type of therapy.
Randi Nathenson: I am not trained in EMDR, so I cannot say much about it.
Lyndsie: There's an article in the Pandy's resource area that explains EMDR.
Question: When I get triggered in my T's office, and
I've worked through 'unfreezing' myself, I'm so shaky afterwards, like
I've run a marathon! I find it really hard to 'wind down' afterwards.
Any advice?
Randi Nathenson: You did run a marathon an
emotional one! Find something that you can do to comfort yourself. Maybe
have your t help you to find this, something you can do in their office
to get you "grounded". Sometimes moving positions in the room, or
spending the last few moments of a session just "chatting". Take a walk
after your session, eat something, play a game, do something that
distracts you and calms you. Water also can really help. Drinking or
splashing your face with it. That is something a lot of survivors have
to work through. Try to identify what it is about your body that makes
you feel triggered or uncomfortable. Remind yourself that there is
nothing wrong with you or your body, you did nothing wrong. There is no
shame in being a survivor.
Question: I have always chalked everything up to not
being triggered ever. Today in T we were talking about triggers and how
to deal. Is it possible that I could just be living with triggers
everyday and not know it?
Randi Nathenson: Sometimes we are not aware
of our triggers, and sometimes people are not triggered. Not everyone
is going to respond in the same way to abuse. There is really no normal.
Often I do find that people who do not experience triggers are
experiencing some level of dissociation, it is a coping skill that
works. The thing about those defenses, is they work for us, and we need
to work with them, not against them. It is okay if you are not
triggered, you certainly do not have to be in order to heal.
Question: How do you know if talk therapy is enough?
I feel like I’m reporting when I feel triggered, what happened, and
sometimes work on what might be going on, but most of the time I just
feel like I'm reporting and letting my t observe me, it's all a reaction
to things instead of working on them... instead of actually moving
forward. My T just wants me to keep talking and it's hard to get any
direction from her.
Randi Nathenson: If you feel you need more,
that might be an indication that you need more. Try talking to your T
about it, or you can explore other options. You can also do things on
your own such as yoga or drawing or other exercise. I think the biggest
thing is letting her know how you feel and what you feel about the talk
therapy. Trust yourself.
Question: I used to have panic attacks
(hyperventilating, feeling scared), and have worked past that somewhat
with meds and breathing. but now my panic attacks involve dizziness,
nausea.... and I can't seem to shake them. they come on when I'm not
even aware of being triggered, so it's hard to figure out what set them
off. Do panic attacks evolve as you learn to cope with them?
Randi Nathenson: Yes, as we learn new
coping skills and how to work through things, often new symptoms appear
that we need to work through. Healing is not linear, it is more like a
spiral and we continually have to relearn ways to cope with things. The
good news is you found ways to work through it before and you can again.
It just stinks to have to figure it out all over again.
Question: I am doing cognitive processing therapy
(lots of talking and reading out loud is required) but having to talk
out loud is a huge trigger. I am frequently mute and can communicate on
paper if I am lucky. Do you know any alternative ways of dealing with
this trigger?
Randi Nathenson: It might be that you are
not ready for that type of therapy. Talk to your therapist and let them
know how you feel. Maybe a therapy that is more expressive or non-verbal
can help. Art or sand tray or movement are excellent ways to
communicate what is non verbal
Question: How do you know how much more work is needed in order to heal?
Randi Nathenson: Unfortunately you can't
know. There is no time-line for healing or sense of prognosis. Be gentle
with yourself and allow yourself the time it needs. You deserve it.
Question: Are there professional readings about the phenomenon of sexual self-injury and how to heal from this?
Randi Nathenson: Wendy Maltz's book might have some info, and there is another, I think it is called the Survivors Sexual Handbook?
Question: Does Randi have a website, book, or way of contacting her?
Randi Nathenson: I have a website, it is
www.highlandcounseling.com. I also have a page on psychology today,
where you can get my email address. I am in Ohio
Question: My daughter is 7 (she is the age around where my abuse started) how can I look at her without being triggered?
Randi Nathenson: Try your best to separate
her from you. I think the fact that you realize she is that age, and you
are conscious of it is the first step. Remember that she is not you and
you can protect her and keep her safe the best you can. She is okay. It
is you that you need to take care of.
Kadie: Okay everyone it's time for the chat to end.
Thanks again Randi for coming. Thank you to everyone for attending this
chat. We hope everyone found this chat to be helpful. A recap will be
posted on the board in the next few days
Randi Nathenson: I was glad to do it! Thanks again for having me. And thanks everyone for wonderful questions!
Lyndsie: Thank you, Randi! It's always a pleasure
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