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Women’s Health Part III: Frozen…Flight or Fright - Post Traumatic Stress Disorder and Panic & Anxiety Disorder, by Beverly Hicks Burch
Posted on Sunday,April,22,2007 by bamasteelmagnolia
In the week since the Virginia Tech tragedy, it seems our country has been caught in a cycle of insanity, with wackos, nuts and copycats coming out of the woodwork. As I was pondering the next installment of the “Women’s Health Series” and gathering some of the research on my subject, the news broke on the Johnson Space Center incident in Houston, TX. At the moment, it appears an individual with a gun has barricaded himself in one of the buildings of the space center campus…whether shots have been fired, it’s unclear and if there are hostages it is still unclear. (It was later discovered a man had indeed taken two co-workers hostage. He killed one male hostage, and turned his own weapon on himself, taking his life, before authorities were able to rescue a female hostage. The three had lunched together earlier in the day and evidently argued about something.)

This week saw the unbelievable, unprecedented playing of the Cho Seung Hui video, his still photos and manifesto. I am still incensed this psychopathic, ticking time bomb…who left road signs and red flags every where was allowed to stay at Virginia Tech AND allowed to buy two guns. I would ask the Administration of the college…knowing what you knew about Cho Seung Hui since 2005, would you have allowed your children to be suite mates and dorm mates with Cho?

And then, just this morning (Friday) as I watched the morning news with my husband, I heard something almost unthinkable. A mother…here in Tennessee took her child to kindergarten, went into her child’s classroom, pointed a toy gun at the class…a room full of kindergarten age children…and clicked the gun at the children as if to shoot them! My God in heaven, what was she thinking?! To do this to babies! Was she reacting in duress to this week, or is she another psychopath, seeking a moment of fame?

So, as the week progressed, I began to think of the aftermath, the recovery, and what the people and survivors at VT will most likely have to deal with…but, as I look at our country, I’m beginning to wonder if it’s not going to be a national thing…a national recovery. And I know you’re asking, “What does this have to do with women’s health?” Well, let me explain.

The survivors and their families may have to deal with Post Traumatic Stress Disorder (PTSD) and/or Panic & Anxiety Disorder. PTSD is a type of panic disorder, and is more familiar as a disorder that has afflicted war combatants over the ages. (Life can be and has its battles.) During the US Civil War, PTSD was known as “soldier’s heart”; during WWI it was known as “shell shock” and during WWII it was commonly known as “combat fatigue”. The reason I want to cover it in the “Women’s Health” series is because women have a twice higher incident of PTSD than men (women 10.4% rate; men 5% rate). It is also a topic I am all too familiar with, because during the 1990’s, I was diagnosed with both disorders.

So what is Post Traumatic Stress Disorder? Well, as I said before, it is a type of panic disorder. It can develop immediately after a major traumatic, stressful, life altering event or confrontation, or it may develop over time…sometimes it can take months or years to develop. What type of events? Or who should we be concerned about? Consider some of the situations below:

· Anyone who has been victimized or seen a violent act

· A survivor of rape, domestic violence, physical assault or random act of violence

· A survivor of an unexpected event such as an automobile wreck, terrorist attack, fire, etc.

· A survivor of sexual or physical abuse

· Soldiers, veterans and victims of war and combat

· Anyone who responds to traumatic events

· Trauma in the work place

· Anyone diagnose with a life-threatening illness; those who have had surgery

· Anyone who has experienced unexpected grief, for example, the loss of a loved one

· According to research, and this is one my oncologist, Dr. Kent Tucker, talked to me about during my last lung cancer, there is a growing number of cancer patients that report PTSD. Some studies show an incidence of between 5 – 20%. Some reasons for this is the stress of living with the possibility of recurrence and the stress of living with life threat and shortened life expectancy.

How will you know if your stress has taken over your life and developed into something that you need help with? Here are some symptoms of PTSD:

· Feeling like the event is happening again, bad memories, flashbacks, hallucinations

· Trouble sleeping and nightmares

· Trying not to think about the trauma and/or staying away from people and things that remind you of the trauma and/or event; extreme distress at exposure to reminders of the “trigger”

· Staying away from and avoiding people who remind you of the event or stressor

· Feeling emotionally numb; detached from others; extreme distress when exposed to reminders or “triggers” of the event

· Irritable, jumpy, becoming easily angered

· Not feeling close to people

· Not being able to recall parts of the event

· Feeling guilty because others died and you survived an event

· Hypervigilance, memory loss, excessive startle response, anxiety

By now you may be asking about the Panic & Anxiety Disorder. The response that occurs during a panic attack is that “Fight or Flight” response reflex…you know the one we see in babies sometimes when they hear a sudden loud noise and they’re startled. It’s almost like a survival instinct, but our bodies are not designed to handle that response over a prolonged, sustained period of time.

What are some of the symptoms of a panic attack? Well, if you have ever had one, you will certainly recognize the symptoms below:

· Racing heart; heart palpitations

· Rapid breathing

· Nausea, vomiting

· Diarrhea

· Loss of bladder control

· Trembling and shaking

· Excessive perspiration

· Hot flashes; flushed face

· Pins and needles feeling

· Light headedness, dizziness and feeling faint

· Lump in the throat

· Dissociation – out of body experience

· Feeling as if you are looking at things through a fog

There is hope. As I mentioned before, I was diagnosed with both disorders in the 1990’s. Now, as a first born, it is my nature and tendency to seek help and fix things. (I learned this little tidbit when I read Dr. Kevin Leman’s book, The Birth Order Book: Why You Are the Way You Are, Revell 2004.) If you had a broken leg, the flu, TB, cancer, or any other physical malady you would fairly readily consult your physician. And, you should with an emotional, mental or psychological malady, but, most folk don’t because they are concerned there may be an associated stigma carried with seeking counseling or therapy. My personal philosophy…”if it’s broke, fix it…if it’s not broke…don’t fix it”…pure and simple.

Let me explain it another way. In days gone by, it was very popular for women to cook with a pressure cooker. (I’ve heard they are making a resurgence…who would have “thunk it”.) The pressure cooker was a pot in which you could place something, say like a roast, put a lid with a special seal on the pot and then cook the roast under pressure. The lid had a valve and the purpose of that valve was to allow the build up of steam inside the pot to escape. The gimmick was that the roast cooked in less than normal time and was suppose to be super moist. There was one problem…on occasion, something would go awry and if the pressure cooker was damaged in any way, the valve could pop off, the pressure cooker could explode and major damage could happen…yes, the proverbial eye could be put eye. Not to make light of the situation, but we would have a pressure cooker with PTSD.

Now, to relate that to humans…the human body can deal with the build up of so much stress for so long. Yes, it is normal to have stress in your life…it won’t totally go away, but there is a difference in what we are talking about. After too much build up, and no way for the steam to let off, the valve pops off. Let me give you some examples:

I can only give you two…a personnel one, and one that I feel affects our nation. Personally, I know this, I am normal person…I’m probably pretty much like you. My friends have told me, “Bev, you should write a book.” I just laugh because I think, “Nah, I just normal, and who would believe some of these things could happen to a normal person.” I’ve often thought if I did write a book, I call entitle it, “The Extraordinary Life of an Ordinary Person”.

When I say there is hope, I know that…I found that out. I sought out help when I started having MAJOR panic attacks. I went to counseling and my doctor, Dr. Dan, was fantastic, he was patient and empathetic.” (As a matter of fact, I returned to him a few years later, when my husband of 27 years walked out on me after being unfaithful.) I remember him saying at one point I had been through more than most people my age. I was taken aback by that and he asked me why. I had told him, “Well, it’s just my life and I guess I thought it was normal.” Dr. Dan confirmed what Dr. Tucker had told me about cancer and panic attacks. It was probably after my last cancer surgery when I had one of my first major attacks. Then he explained what was happening to me; he explained PTSD and Panic and Anxiety Disorder. He gave me homework…some reading…and actually some movies to watch, and yes, there were some medications to take…some, only as needed. What else helps? Faith, friends and loved ones…we’re told to lay up our treasures in heaven, and I do believe in that, but I must say, I have receive a special blessing down here…in the form of the right man…a kind, caring, compassionate man…

Nationally, I’m beginning to wonder if we are dealing with a delayed case of PTSD. Consider what we have been through in the last 20 - 25 years as a nation…and remember…it can take years to build up a case of PTSD: Just to name a few events, starting in late 1979 we had the Iranian hostage crisis that captivated this nation for over a year; in early 1980 Mt. St. Helens erupted…a natural disaster like we had never seen; we watched on TV as we lost the Challenger and her brave crew as it exploded before our very eyes and that of the families of the crew…and wounded the soul of America; then the unbelievable happened…again…as the shuttle Columbia disintegrated on re-entry…once again caught on camera; the Marine barracks were bombed in Lebanon; the USS Cole was assaulted on foreign shores, leaving us to ask why; will you forget the gut-wrenching scream of a mother at the airport in New York when she found out her child had been on PanAM 103 when it exploded over Lockerbie, Scotland; we’ve lived through more school shootings than parents and a nation should have to in a lifetime, little less than in a decade or two…Columbine, Paducah, Pearl and now Virginia Tech; there was the Oakland Earthquake…caught on TV during the Word Series…who can forget those images; and then the hurricanes, Hugo, Frederick, Andrew, the season of 2004 when Florida was battered one right after another…and then Katrina…the mother of all hurricanes and sorrow; Waco; Oklahoma City; our national grit was sorely tested September 11, 2001 when we lost almost 3,000 souls…not at the hands of gunmen, but at the hands of gutless terrorists who have no meaning of what true freedom really means. We watched that day as they assaulted our Twin Towers…for the second and final time…and then turned their deadly aim toward the heart of our government.

So what must we do? Individually AND as a nation…we must not be afraid to seek the help we need to heal, to become stronger, to help others, to recognize those that need our help and to recognize the evil that may lurk amongst us. We can not and will not let the evil doers and circumstances of life win!

All that is essential for the triumph of evil is that good men do nothing. Edmunde Burke

References:

http://www.amazon.co...u/dp/080075977X

http://familydoctor.org/624.xml

http://www.nlm.nih.g...ssdisorder.html

http://en.wikipedia....stress_disorder

http://www.mayoclini...isorder/DS00246

http://www.apa.org/t...xietyqanda.html

© 2007 Beverly Hicks Burch All rights reserved.
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http://www.bodywork-...d...ment&part=7



Therapeutic Bodywork for Survivors of Trauma and Sexual Abuse
Treatment for survivors of trauma and childhood physical and sexual abuse is a highly specialized field, in part because of the complexity of issues involved in both the original trauma and in the psychological and physical symptoms that can emerge in the aftermath. Resolution of the trauma is never final; recovery is never complete. The impact of a traumatic event continues to reverberate throughout the survivor’s lifecycle. With each new life event comes the potential of a stress-induced return of traumatic memories.

Psychotherapy has been and continues to be the first-line order of treatment for survivors and is essential in working through deep-seated impairments in trust, relationships, body image and self-perception. For many, the adaptations they created to cope with the abuse will later emerge as maladaptive barriers to healthy functioning in adult life. While verbal therapy is critical to retrieval and integration of the fragmented mind, there is another aspect to recovery that has more recently gained attention and validity: that of retrieving the body as well.

Recognition that the body holds the scars of trauma has led to increasing use of bodywork as a valid treatment for survivors. In addition to traditional massage, some therapists have developed specialized modalities. Other somatic therapies integrating aspects of body awareness and emotional release as part of a body/mind approach are also helpful. Since the body was integral to the trauma, it must be integrated into the healing process.

Quite commonly, the traumatized person resorts to defensive coping mechanisms, dissociation, that can carry into adult life. With any future stress can come a tendency to escape through dissociation and a separation from awareness of the body’s experience. While dissociation may temporarily serve an adaptive function, in the long term, lack of integration of traumatic memories seems to be the critical element that leads to the development of the complex behavioral change that we call Post Traumatic Stress Disorder.

The effects of abuse on regulation of bodily and emotional states are well documented. Chronic hyperarousal and attempts to adapt can lead to disturbances with sleep and digestion, eating disorders, and other forms of body distress. Survivors are prone to experience depression and anxiety, and in some cases resort to self-mutilation to block out emotional pain. As the child grows up the fragmentation of self, both in body and mind, increases fragility as the adult tries to navigate life with maladaptive defenses. What occurs is a gradual breakdown of defenses, surfacing as problems in maintaining relationships, jobs; alcohol and substance abuse, or even suicidal thoughts.



Therapeutic Bodywork
As the body was integral to the trauma, it is also integral to the healing process. In the past, psychotherapy was a stand-alone treatment, and it remains a necessary element for processing and reframing the psychological effects of abuse. But with the growing understanding of body/mind connection, there has been increased interest and practice of providing bodywork to facilitate wholeness. For some clients, after years of verbal therapy, there comes a time when they need and want to reclaim the body.

It is important to note that not all survivors are appropriate candidates for this approach. Several factors can influence suitability, including ego strength, the readiness to embrace change, level of dissociation, potential for psychosis, and a desire to explore this option for resolution at a deeper body level.

As a backlash to abuse, aversion to touch leaves some victims touch-deprived. The experience of touch is an other important benefit of bodywork. It involves learning that touch can be pleasurable and positive experience. Even for those in a relationship, may have difficulties with intimacy, receiving touch and feeling comfortable sexually.

The therapist has to find the appropriate touch for each individual client. Bodyworkers engaged in this type of therapy should have a good understanding of the psychological dynamics involved and there is a moral, ethical, and legal obligation to keep the client safe. It’s the immediacy of touch, the caring and nurturing it conveys, that makes it highly therapeutic and there are “miraculous” examples of survivors who had been shut down in their body and after bodywork, were able to regain that connection.




Treatment Sessions
Therapeutic Bodywork protocol with survivors of trauma differs from standard massage in that permission is sought at every stage of the session and there is focus on sensory and emotional awareness, with the goal being an integration of body and mind. Asking for constant feedback, clients can assume ownership of their body and within this safe environment, determine the boundaries — where, with what pressure, and when to be touched, or not touched at all. It seems so simple and something many of us take for granted, but it can be very important work.

Within body-oriented therapy are a graduated series of steps, taking the client from body literacy and the development of language to describe what they are experiencing, bringing their attention to what is happening to their bodies. Because of the focus on body and emotional awareness in body-oriented therapy, some flashbacks can occur and are addressed therapeutically in the session. Through incorporating bodywork, with increased awareness and embodiment, the client can find empowerment and change perceptions of themselves both in relationship to the trauma and in their whole concept of touch.
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http://www.pandys.or...rywounding.html

Forms of Secondary Wounding and Overcoming Secondary Wounding Exercises

© Pandora's Aquarium 2006


(Adapted from I Can't Get Over It: A Handbook for trauma survivors, Aphrodite Matsakis Ph.D, New Harbinger Publications Inc., California, 1992)

1. Identifying Secondary Wounding Responses

*Denial and disbelief: Statements such as “You’re exaggerating”, “That could never happen” or simply “I don’t believe it”. People who respond to you in this way are denying the reality of your trauma

*Discounting: In denial, people do not believe your story. When you are being discounted, people do not deny that the traumatic even occurred. However, they minimize its effect on you or the magnitude of the event. An example might be, something like “yeah, but what you’re talking about wasn’t nearly as bad as the girl down the road. You should be thankful”. Or the author cites and example of a woman having trouble responding sexually, and her partner says, “How could one little rape have affected you that much? I know some women who have been raped three of four times, but they still like sex” It might also include the friend who ridicules you for being afraid to go into pubs.

*Blaming the victim: When you hear things like “but what where you wearing? You must have provoked it”

*Ignorance: Ignorance of trauma and its effects plays a major role in secondary wounding experiences. People are also often ignorant about possible economic, social and psychological consequences of trauma. An example of this might be the person who believes that rape by somebody you’ve had sex with before is not rape at all, or who interprets your PTSD symptoms as “craziness” or “self-pity”, insisting that you should just think more positively and get over it.

*Generalization: One of the social consequences of being victimized is being labeled a victim. Once you are labeled, there is a tendency for others to interpret most, if not all of your emotions and behaviour in light of that label. Examples of this might include not being given a promotion in your place of work because the boss is aware of your PTSD history; even though you could more than adequately fill the requirements, it’s assumed that you will be too unstable. You might also hear comments about, “Oh, you know she tends to be a bit neurotic about things after what happened”, etc.

*Cruelty: Most secondary wounding experiences feel cruel. Therefore it is often difficult to assess whether the secondary wounding arises from a desire to cause pain, or whether it is caused by ignorance, generalization or some other secondary wounding process. In many cases, a mixture of cruelty and some other process is at work as some of the preceding examples illustrate. Sometimes the fact of your PTSD may be used by people you know. In the absence of trauma, they would have found something else to use as a weapon against you.
An example might include somebody who brings the fact of your rape up in front of others because they want to embarrass or humiliate you in some way. What has happened to another board member, being harassed and ridiculed on another site, is an example of secondary wounding by deliberate cruelty along with ignorance.<p>

There are other forms of secondary wounding such as when somebody insists on you telling him or her every little detail because they are getting a thrill from your trauma. It is also partners who might start to engage in rough sex-play once they find out you were sexually assaulted. This could be coupled with ignorance; “Oh, she must like the rough-stuff” etc. (I think some survivor’s experiences of legal process have are a good example of secondary wounding which can entail several of the above categories).

Secondary wounding may also include betrayal of confidence. An example of this is the teen survivor who finds out her friends are gossiping about her assault, or the church pastor who confronts a perpetrator of partner abuse thereby endangering the victim.

It may also include people who "make it all about them." Your family or friends may naturally be upset about your assault(s), but they shouldn't make you responsible for their feelings or expect you to comfort them. People who "make it all about them" may engage in "one-upmanship" such as "Oh but wait until you hear what happened to me." Your assaults and your healing are about you.

Identifying Your Secondary Wounding Experiences

You need a journal for this. In it, list as many secondary wounding experiences as you can remember, including any current ones, one experience to a page. You will need to leave space for analysing and commenting on each experience.

When you have finished, review your list and categorise each experience as denial or disbelief, discounting, generalization, victimizing, ignorance or cruelty etc. Include as many labels as apply, for example a single experience can contain elements of many of these categories.<p>After you have completed the labeling for each experience, identify your emotional response. Did you have no feeling at all? Did you experience irritation, anger, hurt, disappointment, disgust, desire to retaliate or any other feeling? List as many feelings as apply.

Now take some time to reflect on the process you have just been through. Were you surprised at how many secondary wounding experiences you have endured? Did the labelling process help to ease the pain, or did it make you more furious and sad?

Did any of the secondary wounding experiences ignite your anger, lower your self-esteem, or make you feel hopeless or helpless? In your journal, write more about these particular experiences. Once these feelings are faced, their intensity may be lessened. You will likely never feel neutral in the midst of a secondary wounding experience or when you are remembering one. If you can feel your feelings, you are going to feel angry, sad, powerless, betrayed and a host of other emotions. But that does not mean that you are hopelessly bound to the past and will never feel joy again.

2. Secondary Wounding-Your Attitudes Today

In your journal, do some writing on how your secondary wounding experiences are still affecting your life. More specifically, for each experience, consider whether or not that experience had the following affects:

1. Did it alter your views of your social, vocational and other abilities?

2. Did it change your attitudes towards certain types or groups of people and/or certain government or social institutions?

3. Were your religious or spiritual views affected?

4. Did it affect your family life, friendships, or other close relationships?

5. Did it alter your ability to participate in groups or belong to associations or your attitudes towards the general public?

6. Now look at what you’ve written and ask yourself “which of these attitudes do I wish to retain? Which of them are in my best interest to reconsider? Which ones would I like to discard because they hamper my life in the present?"

Secondary Wounding and your activities

Suppose that one of your worst secondary wounding experiences was being treated like the criminal, rather than the victim in court. Now someone owes you several thousand dollars and in order to get it you need to take that person to court.

If you hadn’t had the experience that you had in court, you would probably have already begun the paperwork for the lawsuit. However, because of your hatred of courts and fear of being once again denied justice, you procrastinate about pursuing the litigation. At this point, what do you think is in your best interest – avoiding the courtroom with all it’s secondary wounding memories and the risk of repeated victimization, or pursuing the thousands of dollars you are due? The decision is yours. It may be that if you receive some healing assistance for your secondary wounding experiences, you will be able to tolerate being in court.

Counselling can assist you in differentiating you past experience with the present situation. And with support, you might be able to manage any PTSD symptoms that emerge as a result of placing yourself back in that setting.
On the other hand, you might decide that you simply can’t handle it. You’d rather do without the money than subject yourself to another courtroom experience. This is not cowardice. Rather, it is a respectable, life preserving decision. At all times, it is very important for you to know and respect your limits, and not be pushed into activities that are emotionally overwhelming or otherwise destructive for you. Your emotional health comes first, not some inner voice that says you “should” be able to handle anything. This is the same voice that has probably been telling you “you should have been able to go through the trauma and everything that’s happened since without it getting to you. You just aren’t strong enough”. This “should has no basis is emotional reality. But even after you let go of this unrealistic expectation of yourself, others may still believe in it. They may encourage you to do things you know are not in your best interest, or denigrate you for letting your “fears and neuroses” or “skeletons from the past” control your life. Close your ears to these voices and listen to your own inner voice – the one that knows what you’ve been through and what you can tolerate. With hat caution in mind, list the activities that your secondary wounding has taught you to curtail or avoid in your journal. Then for each of them do the following:

1. Ask yourself whether at this particular time in your view (not someone else’s) you can tolerate the activity. What will be the emotional cost? Is it worth it? Once again the main point is to realize you do have a choice. During the original trauma and the subsequent secondary wounding experiences, you had either no choices or very few, or all the options available were so aversive they were not really choices.

2. For each of the activities you have decided you currently cannot tolerate, or do not feel it’s in your best interest to attempt, consider whether counselling or some other form of assistance might make them more tolerable. Do you want to make the attempt? If you don’t feel you can or want to, you may wish to in the future when you are further along in your healing process.
This article is copyrighted and unauthorized reproduction is prohibited. If you wish to use this article online or in print, please contact admin @ pandys.org to request permission.

Pandora's Aquarium - www.pandys.org: An online support group, message board, and chat room for rape and sexual abuse survivors.

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http://www.matsakis.com/books.html#1


Aphrodite Matsakis, Ph.D.
Licensed Counseling Psychologist






Books authored by Dr. Matsakis





Books for Clients and Therapists:

Back from the Front: Combat Stress, Love and the Family
Click the book name above for a discription or vist the book web site by clicking www.backfromthefront.org

In Harm's Way

“I Can't Get Over It!” – A Handbook for Trauma Survivors

Trust After Trauma: A Guide to Relationships for Trauma Survivors and Those Who Love Them

Survivor Guilt: A Healing Manual

The Rape Recovery Handbook: Step-by-Step Help for Survivors of Sexual Assault

When the Bough Breaks: A Helping Guide for Parents of Sexually Abused Children

Emotional Claustrophobia

Vietnam Wives: Women and Children Facing the Challenge of Living with Veterans with Post-Traumatic Stress Disorder

“Compulsive Overeaters and Relationships”

“Please Don't Send Me Chocolates” – For the Family and Friends of Compulsive Overeaters"



Professional Reading:

Post-Traumatic Stress Disorder: A Complete Treatment Guide

Managing Client Anger: What to do when your Clients are Angry with You



Other:

Growing up Greek in St.Louis



“ I Can't Get Over It!” – A Handbook for Trauma Survivors I found this at the library, but I didn't finish the section I wanted.
(New Harbinger Publications, Oakland , CA Second Edition)

Have you ever been beaten, robbed, raped, or forced do have sex or do other things against your will? Were you ever forced to stand by while someone else injured or killed someone you loved?

Has someone you loved committed suicide or been murdered, raped or assaulted?

Do you work in an occupation, such as police work, rescue work, emergency room work, cancer or burn treatment, or firefighting, where you deal with death and dying on a daily basis?

Were you ever in a natural catastrophe, such as an earthquake, fire, flood, or hurricane

or in a man-made catastrophe, such as a war or concentration camp? Were you, or one of your loved ones, ever the victim of an automobile, motorcycle, train or airplane accident, a technological disaster or medical malpractice horror story?

If you can answer “yes” to any of the above questions, you are a trauma survivor.

If you have been traumatized or suffered great stresses or losses in life, this book can help you through the healing process. “I Can't Get Over It” is one of the first books to guide readers through the healing process of recovering from a trauma and post-traumatic stress disorder, one step at a time. It helps survivors cope with memories and emotions; identify triggers that reactivate traumatic stress; relieve secondary wounding (the rejection and misunderstanding of others) and gain a sense of empowerment and hope. This book will soon be available in Hebrew.

“I Can't Get Over It:”: A Handbook for Trauma Survivors ($15.95, 395 pages) is available from New Harbinger Publications, 5674 Shattuck Avenue , Oakland , CA , 94609 or call 1 800 748 6273. Fax orders to 510 652 54722 or visit New Harbinger's web site at www.newharbinger.com

Reviews for “I Can't Get Over It: A Handbook for Trauma Survivors”

“For the trauma survivor and the field professional, Dr. Matsakis has written one of the most informative and sensitive books on surviving violent trauma. I Can't Get Over It covers most useful techniques and self-help suggestions for safe recovery, empowerment, and growth following trauma.”

Yigal Ben-Haim, Ph.D., with the Veterans

Assistance Center Berkeley , California





Trust after Trauma: A Guide to Relationships for Survivors and Those Who Love Them

(New Harbinger Publications, Oakland , CA )

Were you ever traumatized? Are you now dismayed to find that traumatic events not only shatter your internal sense of well-being, but also left you withdrawn or isolated?

This book helps guide you through a process of strengthening your existing bonds, building new ones (of your choice), and ending self-perpetuating cycles of withdrawal, isolation and loneliness. Step-by-step exercises help you learn how to manage your emotions, handle unresolved issues, accept realistic limitations, and find ways to make your relationships a place where you can experience healing from the pain of your past. A special section is devoted to grieving and your relationship to people whom you cherished but who are now dead as the result of the trauma.

Table of Contents

Introduction

1. Taking an Inventory of Your Relationships

2. Exile: Feeling like Frankenstein

3. Trust

4. Relationships and the Physiology of Trauma

5. Limited Psychic Energy: Causes and Coping Techniques

6.Guilt

7. Mindsets

8. When Your Loved Ones Set Off your Triggers

9. Positive Contributions of Trauma to Relationships

10. You and Your Traumatized Self

11. Protectiveness, Entitlement and Jealousy

12. Revictimization and Reenactment

13. Telling Your Story

14. To Significant Others

Appendix A: Helpful Books and Resources

Appendix B Reactions to Traumatic Stress

Reviews of Trust After Trauma

“In Trust After Trauma , Dr. Matsakis takes on the make-or-break issue of trust in survivors' relationships. She shows her readers what it takes to develop the capacity for wise, selective, eyes-open trust. This gives them a real shot at a flourishing life.”

Jonathan Shay, M.D., Ph.D. author of Achilles in Vietnam: Combat Trauma and the Undoing of Character

“Aphrodite has done it again. I highly recommend this book for clients and mental health professionals alike.”

Larry Smyth, Ph.D., director of the Post Traumatic Stress Disorder Clinical Team, Veterans Affairs Maryland Health Care System – Perry Point Division

“From a warm and caring therapist and survival expert comes a superb guide to relationships between survivors and those who love them.”

Carole A. Rayburn, Ph.D., past president of the APA's division of the Psychology of Religion and the Clinical Psychology section on the Psychology of Women.

“This book is a gift to trauma survivors, their loved ones, and their friends and associates.”

Christine Courtois, Ph.D. clinical director of The Center: Posttraumatic Stress Disorders Program. Psychiatric Institute of Washington : author of Healing the Incest Wound: Adult Survivors in Therapy

“For the trauma survivor and the field professional, Dr. Matsakis has written one of the most informative and sensitive books on surviving violent trauma. I Can't Get Over It covers most useful techniques and self-help suggestions for safe recovery, empowerment, and growth following trauma.”

Yigal Ben-Haim, Ph.D., with the Veterans

Assistance Center Berkeley , California

Trust After Trauma: A Guide to Relationships for Trauma Survivors and Those Who Love Them ( 352 pages, $13.95) is available from New Harbinger Publications, 5674 Shattuck Avenue , Oakland , CA , 94609 or call 1 800 748 6273. Fax orders to 510 652 54722 or visit New Harbinger's web side at www.newharbinger.com



Survivor Guilt: A Self-Help Guide :

(New Harbinger Publications, Oakland , CA )

Many people feel that “guilt” is their middle name. Most people who survive a traumatic event feel guilty-especially if other people were killed or injured. Anyone who's lived through a natural or man-made catastrophe, suffered a deep personal loss, or succeeded while friends or family failed can suffer from this type of guilt.

Whether you try to ignore it or let it dominate your life, survivor guilt can affect your self-esteem, emotional or physical health, personal relationships, and career. There is no magic formula that will erase the feelings of grief for people you have lost or those you have seen harmed, but there are practical steps you can take right now to cope with these feelings and overcome the negative hold guilt has on your life.

As a psychotherapist specializing in post-traumatic stress disorder, Dr. Matsakis has counseled thousands of clients, ranging from combat veterans to victims of crime, abuse and other traumatic events. In this break-through book she shares the step-by-step strategies that have helped so many survivors overcome their chronic guilt and regain the ability to enjoy life

Contents

Acknowledgments

Introduction

Part 1 Understanding Survivor Guilt

1. What is Guilt

2. Existential Survivor Guilt

3. Content Survivor Guilt

4. Causes and Circumstances

5. Psychological Consequences of Survivor Guilt

Part 2 The Healing Process

6. Healing From Survivor Guilt

7. Remembering

8. Mentally Reconstructing Your Critical Event

9. Exercises for Coping with Guilt

Appendix A Getting Help: Survivor Groups and Therapy Programs

Appendix B Resources

Appendix C Deep Breathing Techniques and Muscle Relaxation Exercises

Appendix D Self-Assessment: Depression and Post-Traumatic Stress Disorder

References

283 pages; $14.95 Available in paperback from from New Harbinger Publications, 5674 Shattuck Avenue, Oakland, CA 94609; or call 1 800 748 6273; or visit New Harbinger's web site at www.newharbinger.com



The Rape Recovery Handbook: Step-by-Step Help for Survivors of Sexual Assault

(New Harbinger Publications, Oakland , CA $15.95 185 pages)

If you are a survivor of sexual assault, you may be suffering from symptom of depression, substance abuse, an eating disorder, panic and anxiety or post-traumatic stress (PTSD). The Rape Recovery Handbook provides an effective framework in which you can heal. Healing begins by establishing a safety plan that includes how to use this book and what to expect from recovery.

In this new book, which is the only step-by-step program that helps victims acknowledge and learn to manage the emotional pain caused by the trauma of a sexual assault, you will be provided with help for coping with the reality of this experience and dealing with the aftermath of conflicting and debilitating feelings.

Review of The Rape Recovery Handbook :

“In her latest book, The Rape Recovery Handbook , Matsakis has again demonstrated a unique level of compassion and concern for rape victims and their capacity for healing. While guiding her reader gently through numerous exercises specifically designed for maximum effect, Dr. Matsakis provides illumination into thought processes that often trap victims into believing that they are beyond hope. Gentle, empathize advice, along with a sincere belief that rape victims can restore their self-esteem and become rape survivors living full, joyful lives, make this book indispensable to both victim and therapist alike.” Teresa Lauer, MA RapeRecovery.com

Available from New Harbinger Publications, 5674 Shattuck Avenue, Oakland, CA, 94609 or call 1 800 748 6273. Fax orders to 510 652 54722 or visit New Harbinger's web site at www.newharbinger.com



When the Bough Breaks: A Helping Guide for Parents of Sexually Abused Children

This book provides parents with the information they need in order to help themselves, deal with the reactions of others and help their child. This book has also been popular and helpful to survivors of child sexual assault.

(272 pages; $13.95 plus Shipping and Handling). Available only from author. Use Contact Information Form.

Reviews for When the Bough Breaks: A Helping Guide for Parents of Sexually Abused Children

“This book provides a means of breaking the vicious psychological cycle of child sexual abuse. Dr. Matsakis writes with compassionate concern for both the child and parent.”

Christine Courtois, Ph.D.



Emotional Claustrophobia: Getting Over Your Fear of Being Engulfed by People or Situations

(New Harbinger Publications, Oakland , CA )

All I Want to Do is Leave!!!

You finally meet the right person, find the perfect job, plan the perfect vacation...but the closer you get , the more suffocated you feel. And so you leave the person, turn down the job, stay home. Relief and regret follow this scenario, over and over again.

You are not alone. This familiar psychological drain on energy and emotions is a common dilemma shared by about 87 million other people.

This new self-help guide, Emotional Claustrophobia , will help you uncover the origins of your fears, teach you how to cope with them, and guide you to either eliminate them or find ways to manage them so that they no longer control your life choices. Throughout, examples from Dr. Matsakis' work with her clients demonstrate how you no longer need be at the mercy of emotional claustrophobia.

Reviews for Emotional Claustrophobia

“Dr. Matsakis once again has written an insightful and completely helpful book. Anyone who feels claustrophobic distress in relationships and situations should read this book. -Matthew McKay, Ph.D., coauthor, Relaxation & Stress Reduction Workbook and Self-Esteem .

“Dr. Matsakis gently teaches how to explore the effects of early relationships on current ones and helps the reader to formulate a plan for how to achieve ‘breathing room' just one manageable step at a time.” Dr.Sally Winston, Anxiety and Stress Disorders Institute of Maryland

“I highly recommend that people who feel emotionally engulfed read this book to help them understand themselves. The book is an invaluable aid to self-discovery.”

-Clara E. Hill, Professor of Psychology, Department of Psychology, University of Maryland

Table of Contents

Acknowledgments; Introduction

Emotional Claustrophobia: A Common Dilemma* Costs of Emotional Claustrophobia* Causes of Emotional Claustrophobia Empowerment and the Empowerment Process* The Crisis of Recovery* Is This Book for You?* How to Use This Book* How This Book Is Organized* The Value of Writing about Painful Experiences* A Final Note

Part 1 Understanding Emotional Claustrophobia

Chapter 1 Did Your Family Contribute?

Parents and Care givers* Physical and Sexual Abuse* Emotional Abuse* Was

Your Privacy Invaded?* Jealousy and Possessiveness* Were You Expected to Do or Be the Impossible?* When Close Is Too Close* Were You Trapped in an Emotional Tug-of-War?* Self-Assessment for Triangulation* Family Hardships

Chapter 2 Did People or Events Outside Your Family Contribute?

Were You Ever Victimized or Traumatized?* Do You Have Difficulties Setting Boundaries?* All-or-Nothing Organizations and Belief Systems* Difficult Human Emotions* Grief Engulfing Personalities

Chapter 3 How Has Emotional Claustrophobia Impacted Your Life?

The Importance of a Personal Inventory* Beginning Your Inventory* Fear of Engulfment Inventory

Chapter 4 Do Your Fears Belong to the Past or the Present?

Causes Of Your Emotional Claustrophobia* How Valid Are the Causes Today?* Action Steps for Certain Causes

Chapter 5 Managing Your Anxiety

How Anxiety Can Affect Your Physical and Mental Powers* Your Physical Reactions to Fear* Techniques for Managing Anxiety* Medication

Chapter 6 Taking Charge of Your Mind: Evaluating Your Beliefs

How Thoughts and Feelings Relate* Challenging Untrue Beliefs* Identifying Your Self-Defeating Beliefs* Which of Your Beliefs Are Self-Defeating?* Desired Beliefs

Part 2 Identifying Self-Defeating Beliefs

Chapter 7 Making a Plan

Why You Need a Plan* How to Make Plan* Communication Skills* Connected but Free: Maintaining Connection without Engulfment* Emergency Plans* Anticipating the Worst

Chapter 8 Living Your Plan

Before You Try Out Your Plan* Coping Methods During the Event* Reviewing Your Progress

Appendix

Anger Management* Battering-Family Violence* Child Abuse* Guidelines for Interacting with/ Confronting Abusive Family Members* Depression* Rape and Sexual Assault* Relaxation: Anxiety and Panic Disorders Management* Self-Esteem and Assertiveness* Trauma Processing

References

To Order 165 pages; $25 + Shipping Costs. Available in paperback only from the author. Make request on contact information form. All orders must be prepaid.



Vietnam Wives: Women and Children Facing the Challenge of Living with Veterans with Post-Traumatic Stress Disorder

(Second Edition, The Sidran Foundation, 1996. Lutherville , Md ; 440 pages, $19.95)

This book explores the inner life of combat veterans and their wives and children. This book is geared to increase a woman's awareness of her own needs and strengths, as well as to increase her understanding of the effects of combat on her husband and his ability to relate to her and their children. Children, parents, and other family members and friends of combat veterans will find this book useful in understanding their veteran's pain, and their own, and in providing practical suggestions for day-to-day life with post-traumatic stress disorder.

Vietnam Wives is available from the Sidran Institute, 200 East Joppa Road, Suite 207 Baltimore , MD. 21286 410 825 8888 or toll-free 1 888 825 8249 www.sidran.org

Reviews for Vietnam Wives: Facing the Challenges of Life with Veterans Suffering from Post-Traumatic Stress

Vietnam Wives is a profoundly moving book on the psychological and social consequences of war for families; a “must read” for anyone interested in the realities of war. It should be required reading for all politicians. There are lots of helpful suggestions for wives at the end.

Patience H. Mason, Author of Recovering from the War ; Editor of The Post- Traumatic Gazette

This book is a “must read” for families of Vietnam veterans who have PTSD from their war experiences. Compassionate, wise and useful, this down-to-earth book is a helpful guide which will benefit all who read it.

John P. Wilson, PH.D., Professor and Director of Center for Stress and Trauma, Cleveland , Ohio

There is a second edition of Vietnam Wives because the first edition struck a resonant chord among those who care most about the lessons it provides – the hundreds of thousands of wives who care deeply about their warrior husbands. They know about living with someone with a disability (PTSD) that, like a disease, destroys people and their relationships with others. Dr. Matsakis states on page 2, “To all of you Vietnam wives who think that your suffering is unique, I wish to assure you. You are not alone.” And we are all the better for it.

Charles Figley, Ph.D., Psychosocial Stress Research Program, Florida State University

Nothing I have ever read more convincingly illuminates the inner life of Vietnam wives and the family climate made toxic by war. Happily the postwar spouse has an ally now: The book Vietnam Wives was written expressly for her, for the woman caught up in the throes of Vietnam 's nightmarish existence. The book is geared to increase a woman's awareness of her own needs, strengths, and choices and to increase coping by learning practical techniques that put her in control of her situation and reduce her sense of being overwhelmed.

Erwin Randolph Parson, Ph.D. Editor-in-Chief, Journal of Contemporary Psychotherapy.



“ Please Don't Send Me Chocolates” – For the Friends of Compulsive Overeaters

Compulsive Overeating affects family members and friends as well as the overeater themselves. This booklet provides guidance for those who have a loved one who suffers from the devastation of an eating g disorder.” Originally published by Hazelden Educational Materials, this booklet is available now in xeroxed form only from the author. Order using the contact information form. ($14.95 plus Shipping and Handling).

Compulsive Overeaters and Relationships

Long term recovery from an eating disorder involves eating moderately and safely. It means developing a deep sensitivity that part of that process is examining how we relate to ourselves. This book helps you to take a close look at your relationships, why relationships can be difficult for overeaters and common struggles and themes. Using the Twelve Steps as a guide, this book examines relationship issues encountered by compulsive overeaters in their interactions with family, friends, lovers, and others; helps them consider their feelings towards thin people and overweight ones as well as their attitudes towards themselves.

Originally published by Hazelden Education Materials, the book is available in xerox form only from the author. Order using contact information sheet. 100 pages; $24. 99 + Shipping and Handling.)



Post Traumatic Stress Disorder: A Complete Treatment Guide .

(New Harbinger Publications, Oakland , CA )

This book helps balance the client's need for symptom management and control with work at aimed at re-experiencing the feelings of the trauma. Included are techniques for managing flashbacks, anxiety attacks, nightmares, insomnia, dissociation; working through deeper layers of pain, and handling survivor guilt, secondary wounding, low self-esteem, victim thinking, anger, and depression. (384 pages, $49.95 + SH).

Available from the author. Make request on contact information form.



Managing Client Anger: What to do When a Client is Angry with You.

(New Harbinger Publicatioins, Oakland , CA )

Helping clients get in touch with their feelings is one of the tasks of psychotherapy. But when clients get in touch with their agner at you – the therapist –the rsulting emotional overload affects the entire therapy process. Managing Client Anger is designed to help therapists understand their own reactions to client anger and guide constructive interventions when anger express anger toward them. Ways of dealing with client anger are examined from several theoretical perspectives.

Special chapters are devoted to helping therapists manage anger experienced by sexual, ethnic and racial minorities and by the disabled and anger stemming from trauma and personality disorders, such as borderline personality disorder.

Available from New Harbinger Publications, 5674 Shattuck Avenue, Oakland, CA, 94609 or call 1 800 748 6273. Fax orders to 510 652 54722 or visit New Harbinger's web site at www.newharbinger.com




By Aphrodite Matsakis, Ph.D.
To be released August, 2005
by New Harbinger Publications, Inc.
1 800 748 6273
IN HARM'S WAY

Help for the Wives of Military Men, Police, EMTs & Firefighters

How to cope when the one you love is in a high-risk profession

Imagine knowing that at any moment someone you love might be injured or killed. Such is the daily reality for the wives and partners of military men, police, EMTs, firefighters and men in other high-risk occupations. These unsung heroines live with the ongoing anxiety of not knowing when, or if, the man in their life will ever come home again. They also must shoulder the lion's share of domestic responsibilities when he's working long hours or away from home, For mothers this means not only assuming all the duties of childcare, but helping children cope with fears for their father's safety.

In Harm's Way offers concrete strategies for dealing with some of the most difficult aspects of loving someone in a dangerous occupation. Step-by-step, women reading this book can learn to examine and cope with fear, loneliness and emotional stress; discover strategies for handling time, money, sexual intimacy and sexual jealousy; address children's needs and build a strong, healthy family life; manage the readjustment issues that can occur during homecoming; learn to communicate more effectively about the issues that matter to them most; and develop helpful ways of communicating with their partner about the life and death experiences he faces on the job. In Harm's Way does not sugar-coated or oversimplified the many hardships facing families of men in dangerous occupations and readers are guided in adapting the suggested coping skills to their individual personalities and the unique needs of their particular situation.





Growing up Greek in St.Louis
By: Aphrodite Matsakis, Ph.D. Arcadia Publishing, Chicago, IL 2002 128 pages; 90 photos

Since the beginning of the 20th century, St.Louis’ Greek-American community has been a vibrant part of the city’s fabric. Through a series of vivid personal accounts of growing up in two worlds during the post-WWII era, Growing Up Greek in St.Louis explores the challenges faced by Greek-Americans as they sought to preserve a rich cultural heritage while assimilating to American ways.

From a detailed account of her Grandmothers’ struggles during the occupation of Greece during WWII and the Asia Minor Holocaust to the first hand experiences faced by Greek-American children in Greek school, the celebration of name days, and the ever-present “evil eye,” the book captures the sense of tradition, history, hospitality (philotimo), and community so vital to the Greek experience.

In this book, author Aphrodite Matsakis reflects on her experience and identity within the community that has shaped her life. Dr. Matsakis, a native of St. Louis, has worked as a counseling psychologist for 30 years and has authored over twelve books on an array of psychological topics.

Contents

Introduction
1. From Karpathos to St.Louis
2. Shake, Rattle, and Roll
3. The Double House
4. Those Greek School Blues
5. An Old Fashioned Greek Christmas
6. “Give Me Liberty or Give Me Death”
7. The Grandmothers in Black
8. Goodbye Sweet Dreams
9. To Fast or Not To Fast
10. How I Got to Go to College
References

Synopsis

What was it like growing up Greek in a large mid-western city -- speaking two languages, going to two different schools (Greek school and American school), and having two sets of clothes (the Greek ones and the American ones)? What was it like solving equations in math class with melodies from last night’s Greek dance party ringing in one’s ears? What can a little girl learn rolling koulouria with her grandmothers or reciting poems on March 25th? For the first time, a practicing psychologists looks at her years growing up in a strong Greek-American community where traditions, such as Greek school, name day parties and homemade Greek pastries, were the rule of the day. She traces the history of her family from the island of Karpathos to the United States and shows how that history impacted on every aspect of family life . In this collection of stories, Growing Up Greek in America, the author hopes to capture in writing what she sees is now a rapidly fading world, a world which was rich with ethnicity, community spirit and emotional intensity. One grandmother survived the fascist occupation of Greece; another was deeply scarred by the Smyrna massacre. Their stories, along with the stories of other grandparents are included in the book. As people often say about these Greek old timers, “They just don’t make people like that anymore.” It is to such people that this book is sincerely dedicated. In sum, the purpose of this book is to capture the spirit of a vibrant Greek-American community, which was rich with tradition and love, as well as the stress of combining the old ways with the new. Ordering Information: Arcadia Publishing Chicago, IL Sales@arcadiapublishing.com Phone 843 853 2070 Customer service/orders Toll free 1 888 313 2665 $19.99



duty?

4. Emotional Distancing
5. Combat Stress and Sex
6. Anger, Grief and Guilt
7. The Reality of Multiple Roles
8. Battered Women
9. Women Veterans
10. Military Couples
11. Combat Stress and Children
12. Suicide and the Veteran Family
13. “I Believe in Love” – The Hope of Therapy

Appendix A Coping with Anger and Depression
Appendix B Help in Selecting a Therapist or Therapy Program.
Appendix C. Resources and Suggested Readings
Appendix D. Couples Counseling
Appendix E. Guidelines for Effective Communication
Appendix F. Some Do’s and Donts for Significant Others

duty?

4. Emotional Distancing
5. Combat Stress and Sex
6. Anger, Grief and Guilt
7. The Reality of Multiple Roles
8. Battered Women
9. Women Veterans
10. Military Couples
11. Combat Stress and Children
12. Suicide and the Veteran Family
13. “I Believe in Love” – The Hope of Therapy

Appendix A Coping with Anger and Depression
Appendix B Help in Selecting a Therapist or Therapy Program.
Appendix C. Resources and Suggested Readings
Appendix D. Couples Counseling
Appendix E. Guidelines for Effective Communication
Appendix F. Some Do’s and Donts for Significant Others



Back from the Front: Combat Stress, Love and the Family

www.backfromthefront.org
by Aphrodite Matsakis, Ph.D.
Sidran Institute 200 East Joppa Road
Suite 207 Baltimore, MD 21280-3107
(410) 825 8889 phone
(888) 825 8249 toll free phone
(410) 3370747 fax
sidran@sidran.org www.sidran.org

Summary

To write about the combat veteran is to write about fortitude, dedication and selflessness and about experiences unfathomable to those who have never known the indescribable horrors of war. To write about you – the veteran’s spouse or partner – is to write about another kind of loyalty and perseverance and yet another kind of pain and sadness.

The trauma of war can affect not only the warriors, but their partners and children as well. Often it is you, the veteran’s partner, who helps sustain the veteran during his or her depressions, anxiety attacks, and post-traumatic reactions and you, and perhaps you alone, who has sustained your veteran’s will to live during his or her most anguished moments. Unfortunately, some veterans vent their anger (at themselves or at others whom they felt betrayed them) on the people they love and who love them the most – their partners and children.

The purpose of this book is to help you (and your veteran) better understand combat trauma and its possible effects on intimate relationships and family life and to guide you to resources that can help strengthen every member of your family. The beginning chapters provide basic information about combat trauma and how it can lead to depression, post-traumatic stress disorder, and other forms of emotional pain. The remaining chapters focus on some of the most common problems confronting families of combat veterans: emotional numbing, sexual difficulties, anger, and guilt.

There are also chapters on family violence, children, women veterans and military couples and sections on how to cope with anger and depression, how to find helpful organizations and books, and how to communicate effectively on difficult issues.

In addition to describing the tensions that can result from combat trauma, this book emphasizes the many ways a veteran’s war experiences can help enrich individual family members and the family as a whole. Just as one part of your family cannot suffer without that suffering affecting the entire unit, if your veteran has grown emotionally (or spiritually) as the result of combat, his or her growth can influence



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