ICARUS Online in the News


At the beginning of the week I was interviewed by a journalist from my local paper the Press and Jornal and talked about the work that me and David Bellamy are doing to help bring change to the military charities sector and also to speed up access to treatment for veterans, uniformed services & their immediate families.

Have a read and please share.

Thanks

https://www.pressandjournal.co.uk/fp/news/aberdeenshire/1438690/turriff-based-ex-marine-sets-up-new-helpline-for-former-military-personnel/

Mind-Body Health and Your Vagus Nerve


For me, being a therapist, counsellor or coach is just like being a good host at a dinner party, because a client is a guest in my practice and they have come because they need something from me that I can give them so I invite them in.

If my guest is thirsty, I give them a drink. If they’re belly is rumbling with hunger, I give them food. This is a basic duty of being the host with the most. And in my mind, the same principle applies to a client suffering from stress (and almost every client I see is).

When treating a negatively emotionally aroused client, the first thing I need to do is calm them down.

Don’t get me wrong, calm empathic listening can take the wind out of the sail of rising cortisol. But sometimes clients need immediate help. Their level of stress has become an emergency, and until you apply therapeutic psychological first aid, other diagnostics and treatments have to wait.

It’s equally useless to try to get someone who is dying of thirst to think about their long-term finances, you won’t get anywhere by attempting to help a stressed person until you address their need for relaxation and calm.

But why do people suffer stress in the first place?

People become stressed when they are not meeting their needs, or fear their needs will stop being met. (What if he/she leaves me? What if I lose my job?) A great visual for our needs is this image below which is an adapted version of Maslow’s Hierarchy of Needs. When these needs, starting from the bottom up, are not met we begin to suffer psychologically and then physically.

Maslow's Hierarchy of Needs

Emotional stress is a signal that needs are not being met adequately, just as thirst is a physical stress signal that the body is dehydrated. Knowing how to deeply relax stressed clients – offering ‘psychological & physical first aid’ – is a prerequisite skill to make any other therapy or coaching remotely possible.

Quench That Thirst 

Using talk therapy or getting all analytical when someone is crippled by stress is like giving salted food to a dehydrated guest. Quench their urgent thirst first, then work out how you can help them in the long term.

Stress is the one thing almost all psychological conditions have in common. Depressed people always have more of the stress hormone cortisol in their bloodstreams (1). Addicted people are stressed because they aren’t meeting their needs, and they try to relieve that stress through the escapism of addiction (2). People develop panic attacks when they’re generally stressed. Emotional problems are caused by stress, but in turn cause more stress.

So, to me, it seems almost unforgivable for any therapist not to be exquisitely skilled in the art and science of relaxation. And this is why I believe all people helpers should be able to heal through calm – and why I have always trained coaches and therapists to do this.

Here are three reasons why it’s not just ethical but essential to know how to relax your clients deeply.

1. You can’t help your client until they’re relaxed and ready

sp_image_role_of_vagus_nerve

Pete was clearly on the brink of either exploding or imploding, I wasn’t quite sure which one at first. His facial muscles were rigid, and the deeply etched creases in his face indicated long term tension and stress. Sitting in front of me his breath was shallow, fast and heavy, just like he’d run to my practice – yet he looked frozen in place. It was blatantly obvious that he needed help and right now.

Crucially, as I began engaging in conversation I found that he couldn’t think. Every time I asked a question I could see his mind wander off somewhere else. He did say one very important thing though.

When I asked what it was that he wanted, he looked straight at me and said “Not to feel like I’m dying inside!”

“I can’t relax, ever”, he said. Yet relaxation was precisely what he needed. Natural, mind-clarifying relaxation, that is, not the alcohol and sleeping tablet induced semi-coma that he’d become accustomed to.

We know that depressed brains are stressed brains. Pete was depressed because his needs weren’t being met. And the double bind was that in order to help meet his needs, he needed to become less stressed.

Long-term stress inhibits the function of the left prefrontal lobe, which generates feelings of enjoyment and satisfaction (3) and facilitates calm cognition (4). To put it simply, stress inhibits cognitive function. We can’t think or learn when we’re highly stressed.

Without wanting to overcook the analogy, you can’t teach someone calculus when they are desperate for water. And good luck trying to do cognitive therapy with someone whose thinking brain is crippled by anxiety.

I gave Pete what he needed in that first session, which was deep rest and relaxation. He was a different person at the end of that first session: clear, calm and hopeful. I didn’t just tell him he could feel different. I showed him how to feel different. Pete now had some clear space in his mind to really think about what else he wanted from therapy, beyond the relaxation.

Constant stress and failure to relax makes people feel hopeless, disassociated from their personal resources, and therefore helpless. From there it’s not far to go to reach crisis point.

Of course, we can’t disentangle body from mind – it’s a false dichotomy. Helping your clients relax will also greatly help their physical wellbeing.

2. You can’t heal the body without healing the mind

vagus nerve

For me, a good therapist, counsellor or coach should be able to improve the physical health of their clients by quickly improving their emotional health.

High levels of stress are correlated with increased risk of obesity and diabetes (5), and can damage immunity (6) and working memory (7). Prolonged stress (ongoing activation of the sympathetic nervous system or ‘fight or flight’ response) also increases inflammation in the body (8), which can adversely affect digestion (9).

Stress-induced inflammation is also implicated in the onset of some cancers (10), heart disease (11), and the physical manifestations of depression (12). This is hardly surprising, as depression is essentially a sense of nervous exhaustion from the stress of unresolved worry and rumination (13).

On the other hand, good immune function, clear thought, and feelings of wellbeing can all be promoted through an amazing mechanism that is closely tied to the relaxation response. Let me explain.

The Vagus Nerve and Your Mind-Body Health

As a therapist or coach, your job is to help people feel better, to give them the calm and confidence to pursue their goals. When the mind is troubled, the body is troubled – and vice versa. Fortunately for us, there’s something we can use to dramatically improve mental and physical health and reduce inflammation throughout the entire body. It’s called the vagus nerve.

The vagus nerve is an incredible meandering bundle of nerve fibres that extends from the brainstem, through the neck and thorax, and finally to the abdomen, where it supplies the gut. This is the widest nerve distribution of any nerve in the body.

The function of the vagus nerve is closely tied to your health, both mental and physical. It interfaces with your parasympathetic nervous system (relaxation response) and controls the healthy functioning of the heart, digestive tract and lungs.

Low ‘vagal tone’ has been linked to higher levels of inflammation in the brain and body (14). Conversely, when the vagus nerve is stimulated and strengthened, inflammation is lowered throughout the entire body.

Social connections (15) and healthy diet (16) both stimulate the vagus nerve, but perhaps the most important and practical way of stimulating the vagus nerve is by practising deep relaxation. In fact, just the simple act of breathing slowly in and out (the exhalation needs to be longer than the inhalation) activates the vagus nerve (17).

Relaxation helps our clients feel healthier, not ‘just’ physically but mentally too. Relaxing distressed clients is not just dealing with the symptom – it’s also helping alleviate the cause. When people improve their vagal tone they become more able to make emotional, cognitive and behavioural changes.

But as well as all the benefits of relaxation in and of itself, the relaxed state offers a perfect medium for psychological change. It’s during relaxation that we can best help our clients by treating the cause of long-term distress – and here’s how.

3. Relaxation primes your client for inner work

vagus-nerve-x

I remember a client coming to see me who used to have CBT. He recounted how the ‘therapy’ would make him feel so stressed (with all the health implications that entailed) because the practitioner would ask him to replay in the sessions by focusing on all that was and had ever been bad in his life.

He learned to schedule the sessions on Fridays because he’d tried other days but found he had to take up to three days off work to recover from the ‘therapy’. So his weekends were ruined which added more stress from frustration.

This is absolutely insane. Our clients should feel better after every session.

Pete found that after months of building stress, the simple act of relaxing was incredibly therapeutic in itself. But we needed to deal with the reasons for the stress to prevent it from happening again in future.

All coaching and counselling uses inner work and what I mean by that is that even if you just ask a client what they want or ask them to think about the past, you are inviting them to go inside their minds to find the answer, to forget the room for a little while and enter a kind of light trance.

As a therapist, counsellor or coach, you are using a kind of trance focus whether you know it or not. Relaxed trance (and note that not all trance is relaxing) is the gentle medium through which change work can be done more powerfully and quickly. The relaxation part of any session is also the perfect time for a client to psychologically process earlier work.

People make intuitive leaps when they are relaxed and the unconscious mind has a chance to form new possibilities and solutions. Sometimes a reframe won’t take when a person is too stressed, but can be offered and digested in the mind during a state of deep calm and rest. It’s during deep relaxation that we can encourage real insight by having the client calmly use their dissociated, ‘Observing Self’.

You can help your client inwardly rehearse new positive behaviours by talking to them gently while they are deeply calm, resting with their eyes closed. This kind of rehearsal makes it more likely a client will actually carry out the behaviours required to help them toward their goals. And there’s more.

Relaxation is also the medium through which severe PTSD and phobias are lifted. The brain works through association but sometimes, as with phobias, addictions or low self-esteem, those associations can be harmful. We can use relaxed trance states as a way to unhook damaging pattern matches.

To put it another way, relaxation isn’t just the part of the medicine that makes it ‘taste good’. This natural and wonderful mind/body medicine also packs a real ‘nutritional’ punch.

Pete learned to relax himself once I’d helped him do it a couple of times. We used deeply relaxed hypnosis to not only help his vagus nerve adjust to a new, more generally relaxed Pete, but also to de-traumatise an old memory so that his flashbacks stopped and his nightmares faded away fast.

It was during deep relaxation that I helped Pete rehearse new, healthy behaviours to help him meet his needs better in future. What he said as he left the final session was brilliant:

“I never knew therapy was so enjoyable – I actually had fun!”

This is why I strongly believe that every therapist, counsellor and coach must to know how to deeply, quickly, easily and conversationally relax their clients.

Never let a client leave a session in need in any way, ever.

References:

1 http://ajp.psychiatryonline.org/doi/abs/10.1176/ajp.2007.164.4.617
2 https://www.youtube.com/watch?v=ao8L-0nSYzg
3 http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2907136/
4 http://www.sciencedirect.com/science/article/pii/S0896627301003592
5 http://www.sciencedirect.com/science/article/pii/S0889159103000485
6 http://www.nature.com/nri/journal/v5/n3/abs/nri1571.html
7 http://www.tandfonline.com/doi/abs/10.1080/10253890600678004
8http://www.huffingtonpost.com/2013/11/07/chronic-stress-health-inflammation-genes_n_4226420.htm and http://www.nature.com/nri/journal/v5/n3/abs/nri1571.html
9 https://dl.sciencesocieties.org/publications/jas/abstracts/87/14_suppl/0870101
10 http://www.sciencedirect.com/science/article/pii/S0889159112001833
11 http://www.sciencedirect.com/science/article/pii/S0022399901003026
12 http://www.sciencedirect.com/science/article/pii/S0006322308015321
13 http://www.bbc.co.uk/news/magazine-24444431
14 http://www.ncbi.nlm.nih.gov/pubmed/17192580
15 https://genomebiology.biomedcentral.com/articles/10.1186/gb-2007-8-9-r189
16 http://www.ncbi.nlm.nih.gov/pubmed/17192580
17 http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3216041/

A Look At the Link Between PTSD and Substance Abuse


Post Traumatic Stress is an extremely emotionally debilitating state resulting in intense anxiety, intrusive memories and vivid flashbacks that interfere with daily life.

Often individuals with Post Traumatic Stress turn to drugs and/or alcohol as a way to numb their emotional and psychological pain or to gain some measure of control in their lives. Unfortunately, chronic substance abuse creates a complicated Dual Diagnosis through the co-existence of a serious psychiatric disorder and an addictive disorder. Recovering from this Dual Diagnosis requires a careful exploration of the causes of Post Traumatic Stress, combined with treatment for drug or alcohol addiction.

What Is Post-Traumatic Stress Disorder?

PTSD is a condition in which an individual experiences extremely high levels of stress and/or anxiety after witnessing or being involved in a traumatic event in which physical or psychological trauma that leaves the individual feeling powerless and out of control can lead to PTSD. The most common causes of the condition include:
• Military combat
• Violent assault
• Natural disasters
• Sexual assault
• Childhood abuse

The nightmares and flashbacks experienced with PTSD tend to be based around incidents that have never been fully resolved in the individual’s psyche. For example, a soldier who survived an ambush and his friends and colleagues died may well have flashbacks related to that incident as a way to work through unresolved guilt, anger and fear. A child who felt powerless while being sexually abused by an older relative might develop and grow up living with constant intrusive feelings of helplessness, guilt and revenge.
In women, sexual abuse is one of the most common causes of PTSD and addiction. Combat is another common reason for PTSD, especially in men and this will only continue to increase as a result of Iraq and Afghanistan. In Vietnam veterans seeking treatment for PTSD, between 60 and 80 percent also require treatment for substance abuse and in the UK veterans of the Falklands and Northern Ireland are now displaying signs and symptoms of PTSD, with a growing number living homeless and committing suicide. Many are struggling with alcohol and drug addictions that complicate their situation further. Veterans of WWII never received any form of treatment and still suffer 70 years on.

Symptoms of PTSD include nightmares, flashbacks, avoidance of situations, thoughts and anything related to the event, severe anxiety, sleeplessness, aggressive behaviour and often severe and aggressive mood swings. These symptoms can strike the individual at any time, mainly when that person is reminded of the events in question and this doesn’t have to be consciously reminded.

People who meet the diagnostic criteria for PTSD and substance abuse often experience other serious disorders, such as:

  • Depression
  • Mood disorders
  • Panic/anxiety attacks
  • Attention deficit disorder
  • Chronic pain
  • Chronic illness such as diabetes, liver disease or high blood pressure

The symptoms of PTSD can be divided into three main categories:

  • re-experiencing the traumatic incident
  • avoiding experiences that evoke memories of the incident
  • symptoms of hyper-arousal, such as irritability, anger or extreme anxiety. People who experience these symptoms for at least one month can potentially be diagnosed with PTSD. Alcoholism and drug abuse fall into the category of avoidance symptoms, as the person may use these substances to avoid intrusive/traumatic memories or to numb fear.

When alcohol or drugs are used to cope with PTSD symptoms, the symptoms become more severe. As a central nervous system depressant, alcohol worsens depression and anxiety and disrupts normal sleep patterns. Under the influence of alcohol, someone with PTSD is more likely to engage in risk-taking behaviour, such as driving under the influence, or to become aggressive and/or violent towards other people.

This is a significant reason why PTSD and substance abuse often lead to legal problems, incarceration, poverty, broken homes and chronic unemployment. Getting the right treatment for this Dual Diagnosis early on can make the difference between an individual leading a satisfying, healthy life, or, losing their relationship, their job, home etc.

PTSD and Addiction
Symptoms or PTSD can be extremely real, vivid and distressing and because they place such a huge amount of stress on the person, many people with PTSD feel unable to cope and turn to drugs or alcohol as a means of escaping a distressing, altered reality. Self-medication has led to very high percentages of PTSD suffers with alcohol dependence (over 50 percent) and drug dependence (over 30 percent).

A large part of the cycle is the endorphin withdrawal process, which plays a large part in the use of alcohol or drugs to control the symptoms of PTSD. When a person experiences a traumatic event, their brain produces endorphins — neurotransmitters that reduce pain and create a sense of well-being — as a way of coping with the stress of the experience. When that experience is over, their body experiences an endorphin withdrawal, which is very similar and has the same symptoms as the withdrawal from drugs or alcohol:
• Anxiety
• Depression
• Emotional distress
• Physical pain
• Increased cravings for alcohol or drugs

According to Alcohol Research & Health, many with PTSD will turn to alcohol as a means of replacing the feelings brought on by the brain’s naturally produced endorphins. However, the positive effects of alcohol are only temporary.

With an increased use of alcohol, the person can become chemically dependent on the drug and as such will need more alcohol or drugs to continue to produce those numbing effects that temporarily relieve their symptoms. Eventually, dependence can turn into addiction, which is characterised by compulsive use of the substance, tolerance to the drug and an insistence on abusing the drug in spite of its devastating effects. The use of alcohol to numb PTSD symptoms leads to a vicious cycle. Drinking alcohol worsens the fear and anxiety of PTSD, which leads to the release of endorphins. As the effects of the endorphins subside, the individual needs more alcohol to escape the nightmares and flashbacks of PTSD. Anti-addiction medications like naltrexone, an opioid antagonist, can block the positive effects of alcohol, breaking this destructive cycle. Naltrexone, buprenorphine, acamprosate and other anti-addiction drugs can be used in the treatment of PTSD and substance abuse to reduce the overwhelming cravings that lead to relapse.
Hypnosis has also proven highly effective in the treatment of PTSD in enabling a person to relax, calm their body and mind, remove cravings, strengthen ego and build confidence, as well as deal with traumatic memories.

Finding Specialised Treatment

Recovering from a Dual Diagnosis of PTSD and an addictive disorder demands intensive support from psychiatric and/or psychological professionals, family members and peers. People who are struggling with PTSD and a substance use disorder can be reluctant to seek treatment or even admit that they need it in the first instance. Many who experience PTSD live with intense guilt and shame caused as a result of the traumatic event and their addictive behaviour may be adding to their guilt, making it even harder to reach out and ask for help.

Once they enter a treatment programme, they may have trouble finding the motivation to use their recovery resources at their disposal unless they have support and encouragement from an integrated treatment team.

Those with a Dual Diagnosis such as PTSD and drug addiction need to work with mental health professionals and addiction experts who understand their special needs. Conventional rehab facilities are likely to be ill equipped to deal with the intense psychological problems brought on by PTSD and equally, a psychiatric facility may not have the counselling and detox programmes available that the individual needs in order to successfully overcome the addiction. What the Dual Diagnosis patient needs is integrated care, where recovery resources are centralised in a single facility, and all the professionals on the treatment team have dealt extensively with Dual Diagnoses in the past.

An integrated treatment plan for PTSD and substance abuse needs to include:

  • Individual psychotherapy/hypnotherapy to teach the client how to recognise and deal with their triggers that lead them towards substance abuse
  • Counselling sessions with other clients struggling with PTSD and substance abuse/addictive disorder
  • Couples/Family therapy and counselling to help strengthen and rebuild relationships and educate family members about the condition and how they can help
  • Help clients build their own support network outside of therapy
  • Discuss medication options as a last resort to get them through the initial early stages if their condition and symptoms are severe

Sources:

http://www.hawaii.edu/hivandaids/The%20Role%20of%20Uncontrollable%20Trauma%20in%20the%20Development%20of%20PTSD%20and%20Alcohol%20Addiction.pdf

http://www.dualdiagnosis.org/post-traumatic-stress-disorder-and-addiction/

http://www.bhevolution.org/public/perspectices_201203.page

http://www.bellwood.ca/programs/post-traumatic-stress/

http://www.recoveryconnection.org/addiction-post-traumatic-stress-disorder-treatment/

http://healthland.time.com/2012/08/15/how-ptsd-and-addiction-can-be-safely-treated-together/

http://alcoholrehab.com/drug-addiction/ptsd-substance-abuse/

http://www.ptsd.va.gov/public/problems/ptsd_substance_abuse_veterans.asp

http://www.recoveryranch.com/articles/addiction-research/post-traumatic-stress-disorder-addiction-ptsd/

http://gsappweb.rutgers.edu/cstudents/readings/Summer/Heffernan_WorkingTrauma/brown_substance.pdf

http://www.combatstress.org.uk/medical-professionals/academic-publications/journal-publications/

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4124907/

http://www.helpguide.org/articles/ptsd-trauma/post-traumatic-stress-disorder.htm

http://search.proquest.com/openview/ebb0d5f3fc85e2e1fbff439384205a5d/1?pq-origsite=gscholar

http://ajp.psychiatryonline.org/doi/abs/10.1176/ajp.153.3.369?journalCode=ajp

http://onlinelibrary.wiley.com/doi/10.1111/j.1521-0391.1997.tb00408.x/abstract

http://www.sciencedirect.com/science/article/pii/027273589290125R

http://ajp.psychiatryonline.org/doi/full/10.1176/appi.ajp.158.8.1184

http://onlinelibrary.wiley.com/doi/10.1002/jts.2490060409/abstract

http://www.nejm.org/doi/pdf/10.1056/NEJM198712243172604

http://ajp.psychiatryonline.org/doi/abs/10.1176/ajp.149.5.664

http://www.sciencedirect.com/science/article/pii/S0924977X03001779

http://psycnet.apa.org/books/10460/

http://archpsyc.jamanetwork.com/article.aspx?articleid=207281

http://journals.lww.com/jonmd/Abstract/1995/03000/Childhood_Trauma_and_Posttraumatic_Stress_Disorder.8.aspx

https://books.google.co.uk/books?hl=en&lr=&id=MFyEg007YEIC&oi=fnd&pg=PR1&dq=Combat+Stress+%2B+PTSD+%2B+Substance+Addiction&ots=ctPJqC2rSF&sig=iJPUmuMzIVOdZqBDMFX13PmKrvs#v=onepage&q=Combat%20Stress%20%2B%20PTSD%20%2B%20Substance%20Addiction&f=false

http://archpsyc.jamanetwork.com/article.aspx?articleid=495250

Leave Your Past in the Past 


At various times throughout our lives we can feel overwhelmed with sadness, loss, bitterness, anger etc and it’s hard to believe that your life will ever change, or you’ll ever be able to smile or laugh again. The truth is you will, it won’t always be this bad and there are things you can do to move on with your life in a truly happy and positive way:

1. Choose to face your pain. An unresolved past does not go away. You may think you have buried your anger and pain but the hurt is still there and it will surface later on. If you don’t face what happened and the feelings it unleashed, you will end up being ruled by your subconscious mind. So find the courage and a way to resolve the pain.

2. Accept there’s nothing you can do to change the past. What’s happened has happened, and what’s done is done. There’s nothing you can do to turn back time, however, there are ways such as Timeline Therapy, that enable you to rewrite the story so the ending’s positive for you. And, you can change how you think, and you can start over again, and build a different future that leads you to the life you want to have.

3. Be grateful for the good times. There’s usually something good that you can be thankful for. You don’t have to pretend that everything was bad – or write off any good times and happy memories.

4. Consciously let go and set your focus on the future: All your baggage, failures etc of the past, can affect your identity or self esteem, if you let them. When you see them as opportunities to learn and refine how and who you are, they empower you to become stronger and better equipped to live life to it’s fullest. You are NOT what you did, or how you acted previously. You’re not just a product of what happened to you. You are valuable, unique and you have so much to give. You’re the author of your future; you control your destiny.

5. Remove your past from your future. We can at times have a tendency to think that the past will morph into our future and become our lot in life. That only true if you think that’s true. The future’s a blank page. You can change your expectations and work towards those goals. Instead, look hard for the exceptions, the times when things went right and notice what you did that resulted in success. You still have those same strengths, skills and great qualities and more.

6. Be realistic and take small steps at first. You can’t snap your fingers – and find that life has changed. Accept it will take time, and you will still have some bad days and when you keep on going then the past will lose its grip.