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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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