In the last two chapters, we have established that mindfulness and continuum movement practices are important healing resources for you. They help you participate with and encourage nature’s restorative forces and prepare you for the healing powers of both traditional and nontraditional health care. When we become more skilled in the art of seeing and encouraging flow, our minds and bodies become healthier and our emotions become lubricated and move through us more easily. This is a good thing. It means we are more alive and are becoming more fully integrated. In some cases, emotions we didn’t even know we had may fl oat to the surface of our consciousness. In other cases, the true nature of the things that are affecting us becomes clearer. That’s what you want to happen. You want to learn what your emotions have to teach you, to figure out how to process these feelings, and then to move on. The final goal is to have everything that happens to us and everything we feel about it to be appropriate to the present moment we are in and to flow through us in that moment. Your feelings, thoughts, and sensations should be seen as moving through you and should be recognized as temporary. This understanding can give us better control over how we react to these feelings, how we behave when we experience them, and how we can act in a way that creates the life we want. On the other hand, if we allow our feelings to become more than simply transient occurrences, then those feelings will be too strong and they will just push us around. Even if you happen to have the strength to try and resist or ignore these feelings, then they will only be pushed down deeper into our system, ready to resurface again and again. They will weigh us down from within, just as too much weight can weigh us down from the outside, no matter how fancy a set of clothing we wear. All of these feelings can make us seem out of control or, just as bad, if we repress them, they can make us incapable of feeling anything at all. That’s hard on you and the people around you.
Being in war means you have been exposed to extreme situations that bring up correspondingly extreme emotions. There is a good probability that you have experienced many things that were too difficult, too painful, or too inappropriate to experience fully at that moment. If you lose a buddy in the middle of a battle or see some horrific things, you may not be able to fully deal with the rage and grief you feel at the time. If you had dealt with it, it would probably have put you on hold, or even paralyzed you to the point where you might not be around to be reading this now. So, you had to suck it up and drive on, just as you had to keep moving and staying on mission if you had a physical injury. Even if something didn’t happen directly to you or your friends, living with the anxiety and fear that something might happen at any minute, which is a common feeling when you’re in a battle zone, can be just as overwhelming. Actually, being in war also means that these strong emotions, like anger, hate, and rage, have been purposely ignited and even cultivated to get the job done. Although it may not be hard to stir up these feelings when the heat of battle is upon you, it is hard on your mind and body to continually be at this fever pitch and also hard to eventually rid itself of these extreme feelings. None of these emotions are easily shed when the job is over. So how can you begin this process?
The next step in your healing mission, getting a better handle on emotions, requires you to learn another set of skills. Unlike most of the exercises we’ve shown you up to this point, this one can only be done right with the help of experts. People who can partner with you to get this process started. Just like no matter how handy you may be around your car or your home, there are some things that just need to be kicked up to the specialists, so you don’t end up with a bigger problem than you started (or a bigger bill) — just think about the last time you messed with your plumbing or your transmission. You need to work with an expert to understand what makes you tick inside your head. That’s the work of psychotherapy and, to be done right, it should be done with a licensed psychologist.
You’ve already begun the process of preparing yourself for the next part of the mission. Two of the things we’ve already learned about, meditation and continuum movement, serve as a foundation for the work of psychotherapy. Learning how to better question yourself and look inward for answers, giving your body and mind the needed rest by improving sleep, putting healthy nutrition into your tank, exploring the healing power of movement, adding regular exercise to your routine, making sure you had the right clinicians helping you, and giving the right kinds of medicines a chance to work have all been necessary steps in recovery that you could be responsible for. All of these self-care tools have been necessary to prepare you for this next, harder step. Even if you’ve tried before and failed, armed with the tools and resources you’ve reviewed in the past several chapters, you can now more fully engage and benefit from therapy. Now it’s time to take advantage of all of the tools you have been equipped with so far and to partner with a professional to take you even further along the path. Even if your problems feel mostly or all physical — like pain, dizziness, or poor coordination — therapy is a vital step in recovery. As we said before, the body and the mind are so interwoven that it’s really quite impossible to separate them.
There are very real changes that occur to the brain from post-deployment syndrome (PDS) that directly affect the way your mind and body works. In order to give yourself the best chance for returning to normal, it is crucial to get your brain working better. To do this, the two approaches are to either reverse the changes in your brain brought on by PDS or rev up other parts of your brain to make do for these injured areas. You’ve already begun that process with the advice and exercises within this book, using the body’s neuroplasticity (brain and nervous system’s ability to regrow and to rewire) and adaptation (the brain and body’s ability to adjust itself). A psychologist can further bring out these brain improvements. In this chapter we’ll show you how and why this works and give you some ideas about how to best work with your psychologist. Let’s first look at how the how the brain works, what it’s doing when it’s healthy, and what’s happening when it’s not.
The Brain: How Does PDS Affect It?
The brain is the most complex structure in the body and more complex than any computer or machine ever developed. It makes the most sophisticated computers used by governments and militaries look like children’s toys. Like all complex machines, it can easily get off kilter or broken and needs frequent readjustment. Because the brain is so complex and has so many interconnections across the body and even within itself, it’s really not accurate to just blame one part of the brain for difficulties you’re having. It’s also not accurate to assume that each person’s brain is built or wired in the same way. So we’ll talk about the way the brain works in a general sense and try to give you an idea of what may happen with PDS and related diagnoses.
There are definite changes that happen to your brain when you develop PDS. These are changes that we can see with special x-rays (functional magnetic resonance imaging, diffusion tension imaging), electrical (or neurophysiologic) testing, computerized evaluations, and even simple pen and paper tests. In some cases this may be obvious, such as if you’ve had a mild brain injury or concussion, where the blast waves from improvised explosive devices and rocket-propelled grenades can cause some really horrific damage to the brain. But, even when the difficulties you’re having deal with purely emotional issues or involve pain in a part of your body far away from the brain, there are changes in the way your brain functions, talks to the body and itself, and even the way it looks on tests. We’ll give you a basic framework of how to understand your brain’s structure and function, so that you will have at least some understanding of what you and your psychologist will be working on.
The simplest way to picture the brain is as an onion folded over like a fist, with millions of two-way connections going in all directions and between all of the layers. The brain can be thought of as having three major parts: the neocortex (new brain), the limbic system, and the paleocortex (old or original brain). The outer layer (neocortex) allows us to consciously integrate with the world, the middle layer (limbic system) allows us to process how our body and brain perceive and respond to the world, and the deep layer (original brain) manages the internal workings of the body.
The neo- or cerebral cortex (also called your gray matter or cell bodies of the brain), plays a key role in memory, attention, perceptual awareness, thought, language, and consciousness. It’s what makes us the advanced functioning human beings we claim to be. High-level thinking or executive functions occur in the front part of this neocortex, movement and touch occur just behind this, perception and spatial orientation behind that, and hearing and seeing closer to the back. High-level memory and communication functions are located on either side of this cortex, around the level of the ears. For our discussions, the front-most portion of the neocortex, called the prefrontal cortex, is particularly important in helping to integrate what we perceive all around us with what we know, remember, and feel, so that we can function and interact with the world. This prefrontal cortex and its linkages to the midbrain limbic system are one of the first regions injured with mild brain injury and are commonly found to be abnormal with stress disorders.
The region of the brain just beneath the neocortex is often referred to by the collective term limbic system (a part of your brain’s white matter or connecting wires) and has a number of structures that help to integrate the outside world and the inner body. The components of the limbic system have multiple roles, many of which are affected or are malfunctioning with PDS. One role of the limbic system is to help to integrate sensory and motor signals between the body and the brain, so that we can be aware of and use our bodies effectively. Oftentimes, after being in combat or when exposed to trauma, people may complain of problems with coordination, balance, or just general moving around. You may feel slower to react than before or a step or two off your game. That’s your middle brain layer not integrating well with the rest of your body and deeper brain structures.
This middle section of the brain also plays an important role in regulating sleep and maintaining an appropriate level of arousal. Altered levels of arousal can be seen with post-traumatic stress disorder (too much), anxiety (too much), pain syndromes (too little), and brain injury (too little). The limbic system also helps to control the numerous brain hormones that affect the body’s responses and emotions. These hormones represent one of the direct linkages between your brain and the rest of your body. Probably the most important role of the limbic system for folks with PDS is its responsibility in emotions and long-term memories.
Two key structures of the limbic system, the amygdala and hippocampus, are particularly important in dealing with significant events and stressors and in putting down long-term memories of these events. The limbic system is directly linked by nerves and brain chemicals to all of the organs and parts of the body that may be involved in these emotions. These linkages, particularly the vagus nerve, result in all of the bodily responses (sweating, rapid breathing, fast heart rate, tightening of the gut, bowels, and bladder) to fear and other emotions. Fear response and conditioning (such as with PTSD, anxiety, or pain) are two common emotional issues that the limbic system regulates. The amygdala is the center of emotional memory, emotional learning, behavior, alcohol overuse, and long-term memory development. The other key structure, the hippocampus, plays key roles in long-term memory and spatial navigation. Although the amygdala may house the primary emotional responses to stress or trauma, it requires integration of the stress or trauma experience by the hippocampus to truly recall, be able to process, and clearly remember the specifics of the exposure. Otherwise, you may recall how you felt during your periods of stress (anxious, uneasy, palpitations, short of breath) without actually be able to objectively recall the specific events that initially made you feel that way. This disconnect between how you feel about an event, what you remember about that event, and what you think may be causing those feelings is a common factor limiting recovery. Injury to or disease of the hippocampus, such as with PTSD or Alzheimer’s disease, results in memory problems and disorientation as the fi rst symptoms.
The original or paleocortex (also part of your white matter brain or connecting wires) joins all elements of the body, from the nerves receptors of the skin, joints, and the internal organs to the action nerves of the muscles and heart, to the higher centers of the brain, including the limbic system and neocortex. In addition to providing the pathway for all of this sensory data to be transmitted to the higher brain, signals from the brainstem are essential to maintaining the minute-to-minute life functions of the body. The main cells of the vagus nerve are located in the brainstem and any injury or other problem to this nerve can cause issues with regulation of heart, breathing, stomach and intestinal motility, and bladder functioning. The vagus nerves connect your brain to the largest collection of nerves outside of the brain, the huge celiac plexus, which goes all through your stomach and intestines.
It’s important for you to have some understanding of how your emotions work. Emotions are chemicals and nerve impulses that wash through the brain and the body. They create the way you feel, put color in your world, and motivate you to act. Without them, we just wouldn’t give a damn one way or the other. If they disappeared, then we wouldn’t even get up. Apathy would overwhelm us. We wouldn’t even feel too depressed to get up. We just wouldn’t feel anything. Our emotions are affected and stimulated by things that happen outside of us — a funny joke, an attractive person, a gorgeous sunset, a fi refight, a painful accident, an idiot on TV, an obnoxious salesperson, the birth of a child, music that touches us, watching our favorite sporting event. And they are affected and stimulated by things that happen inside of us — the things we eat, drugs or alcohol, body illness, and, most importantly, our thoughts, beliefs, and memories. All these things stimulate our emotions, but we also need to remember that all our emotions stimulate us. They stimulate us to think and act in certain ways. It’s all part of the way our bodies and brains work. The emotions that we had as infants and children actually determined the way our brains are initially wired. These also determine how our brains are wired now. They determine what we like and don’t like, how hard we work or don’t work, and how we relate to others. We don’t always have to do what they say, but they prod us never the less.
Sometimes these emotional chemicals and impulses are just way too intense. They can burn us. They can blind us. Anger, fear, distress, grief, and guilt can become the only thing we are aware of. Or, they can control us from beneath our awareness. Sometimes they get stuck in a holding pattern, recorded in our amygdala but not processed by our hippocampus or prefrontal neocortex. Long-term moods that won’t go away, like depression, can be thought of as a stagnant internal chemical environment or an electrical short circuit. When they become stuck in us or live beneath our awareness, we can become our own worst enemies. We can try to avoid them or just seek relief from them, but that’s not the same as understanding what they are trying to tell us or trying to change them. As all of us know, sometimes these emotions are much stronger than anything that’s actually happening to us at that moment should warrant. We are walking around mad, sad, or in some other emotional state for no clear reason. They are conditions within us. They are coming from our thoughts, our attitudes, our belief systems, our chemicals, and our internal wiring. There may be no relationship between what’s going on inside and what’s actually occurring outside of us in the present.
When we take the time to examine the emotions, the sensations, and the thoughts we are having, we become freer. We have more choice. If we are aware that “emotions are chemicals and impulses” and that they are tied up with our thoughts, we may come to some new perspectives. Our executive function can say: “Whoa, this is some interesting and wild stuff I’m seeing going on in my body and mind. I better take the time here to make sure I’m seeing this situation clearly so I don’t do something stupid.” Or we might be like one of those logical characters or robots from science fiction and say to ourselves, “Fascinating, there is sadness moving through this biological system that my awareness occupies,” rather than saying, “I am sad.” Or we might say, “Wow, this thing they call anger is like a burning fluid that streams through the veins of this body I live in. It’s very uncomfortable, but it’s also very interesting and a wild thing to watch. Maybe I should take a few of those breaths I learned and let it die down a might before I do anything.” It’s a weird little mental Jujitsu trick that can make all the difference, but it’s not necessarily something that comes easy or naturally to us. It’s all about freedom and it’s one of the healing results of following the steps in this book, especially the ones we are coming to.
You might have already guessed that there is a big problem here. We want to examine and feel what’s happening in the chemicals, impulses, and emotions of our bodies. We want to examine them so that we can understand what they are telling us, allow them to move through us, let them do what they need to do. But, if emotions are chemicals and sensations, which can be deeply painful, and by bringing awareness into your body you will be reactivating these emotions, why in the world would you want to do it? Frequently, a body and mind that’s been through hell won’t stop feeling like hell. It’s hard to live in a body that has been wracked by trauma. Who wants to live in hell? All of those internal chemicals and electrical discharges are still burning. It means your own body does not feel safe to live in. No wonder the oblivion of drugs or alcohol is so attractive. At least they temporarily deaden the pain and emotions. So, we resist feeling things and, in turn, drive them deeper into our body and subconscious. But, remember that these chemicals and impulses we call emotions have, or had, a function. We need emotions to live and prosper. With PDS, they’ve just gotten channeled into a blind alley or loop. They have overstayed their welcome and we have to show them to the door. But you must first recall and understand where they are coming from, acknowledge them, and learn to live productively with (or sometimes, despite) them. Although all the work of mindfulness and movement will create a body that can really feel, the big problem is that war creates a body that does not want to feel anymore or only wants to feel certain things. It is very difficult to enter a body you don’t want to be in. But, the good (or bad) news is that you really have no choice; you already live in there. What we need to do is to find ways of being in the body that feel safe, to find little pockets of security, and then expand them. It’s a bit like establishing a beachhead in enemy territory from which to launch your next mission.
It is extremely common for warriors with PDS to become sleepy, disinterested, freeze, shut down, or agitated (fight or flight) when starting mindfulness or sensation increasing movement exercises. These are defense mechanisms. You may have already experienced this when trying to do the simple exercises in the previous chapters. This is also common with psychotherapy. We’ve talked about the body and mind connection, the way the brain works, the nature of emotions, how the violence of war can produce such extreme emotion, and why it so difficult for many returning warriors to deal with the illness of war. Before we show you some of the types and choices of psychotherapy, let’s first talk about what role medications may have in your recovery because they are so commonly used after PDS and can often further prepare your body and mind for the healing powers of therapy.
There are hundreds of medication used to treat PDS and the common diagnoses that are part of it. If you’ve had PDS for any period of time, then you probably are already very aware of this. So, if you are suffering from depression, anxiety, pain, headaches, insomnia, stress, or any other of a host of psychological and physical ailments associated with PDS, there are a host of old and new medications that can help you. Although most of you reading this may not have had the best of success with some of these medications, there are many, many people who respond well to their effects. Even without all of the annoying commercials, medications are big sellers because they help a lot of people. In many cases, they can fairly quickly alleviate suffering with little to no side effects and, when used with care, can be an important part of your recovery process. You may not need them at all or not for a very long time, but if you do need them they are meant to be a stepping stone from illness to wellness. They are not the whole answer, but rather a temporary solution that can help you get your feet on the ground so that you can begin to walk the path of healing. Once you can keep your feet on the ground, you may not need them anymore.
Although medications alone will never be the entire solution for PDS, for many of you it could be a way to bring some cooling waters to your emotions or pain or a way to put a little more gas in your tank. The only way to know exactly which medications may be best for you is to fi nd the right doctor for your difficulties, work with them to identify the symptoms you’re having, and to see if a specific medication or medications can get you moving in the right direction. The specific types of physicians to seek out and the types of medications that are usually most effective for each of the common symptoms of PDS are listed in Chapter 5. The Internet, e-mail, your neighbor, or even this book is not a substitute for good medical care. It’s important to realize that medications are not miraculous; they need to be administered for the right diagnosis, by the right person, in the right way, and for the right period of time. If you are about to begin a medication or are currently taking some, you should make sure you follow the following recommendations;
- Be sure you understand why you are taking a medication and what are potential effects or side effects to watch out for, so you can keep track of how things are working or not working.
- Keep a written or digital log of what your target symptoms are like before beginning the medication and how they are doing each day. Also, record any other affects you notice. Share this log with your clinician.
- Take the exact dose (number of pills, how often, what times) that your doctor and nurse told you — make sure they write it down for you. Make sure you understand how to use the medications before you leave the clinic, hospital, or pharmacy. Taking a higher dose because they are only partially effective may not always be the right thing to do and can even be dangerous, so don’t do it.
- Most medications for PDS symptoms will take a minimum of 2 weeks to begin to work and won’t have maximal effect until 4 to 6 weeks after starting them, so be patient. If medications are working, do not stop taking them until your doctor tells you to. Some problems of PDS, like depression, must be treated for a full year to prevent relapses. Giving up on medications too early is the most common reason for medication failure and for medication and doctor shopping.
- Figure out in advance when you will run out of medications and make sure you get refills way in advance. Medications don’t work at all when you don’t take them.
- Most medications that work on the brain will make you feel a bit odd (dizzy, sleepy, disconnected) for the first several days, but this should improve by the fifth day or so. If it doesn’t, call your doctor or clinic.
- If the medications don’t work well enough for you to want to continue, discuss this with your doctor. Don’t just stop them on your own or change the dosing. It can be just as dangerous to suddenly stop a medication, as it is to take the wrong dosage.
- Don’t take anyone else’s medications or share yours with anyone. It’s not only illegal, it’s also pretty dumb. If you and your clinician agree that a medication is not for you, then properly dispose of the extra pills (give them to your doctor or ask them how to get rid of them).
I went to this one Doctor at the VA and he kept telling me I was depressed. I was like: Duh! All he did was give me anti-depressants. Then all he did was try to find different combinations that would make me better. But none of them did anything for me. I couldn’t feel anything. Well, I guess they kept me from killing myself.
—PFC Lori Stefano
As a way to help jumpstart your body and mind’s recovery, you may wish to treat yourself to a new experience through bodywork, which is likely to both help begin your actual physical mobilization and help prepare you for the benefits of psychotherapy. Bodywork is a term used to describe any therapeutic, healing, or personal development technique that involves working with the human body using manipulative therapy, breath work, or energy medicine. In addition to making you feel great, bodywork techniques also aim to improve posture, promote awareness of the mind–body connection, manipulate the energy field surrounding the body, and improve your overall health. It would be ideal to establish an ongoing relationship with a skilled body-worker or alternative medicine practitioner. They will help you in ways that no one else can. The array of possible styles and philosophies is astonishing, from traditional physical therapy to massage therapy to energy work therapy. You might try acupuncture, Reiki, Tragerwork, or any of the varied styles of massage. Some of these “alternative therapies” are so effective that they are less and less being called alternative and more mainstream medicine. Some of these practitioners are even covered by insurance; however, most are not. Do not let that stop you. Make it a priority. Find the money. Nothing comes close to being as important as your health. Instead of having your truck detailed or eating out at a fast food restaurant, treat your body right. The important thing is to fi nd someone with whom you feel comfortable and see them with some regularity. Just like with psychotherapists, the methods or even credentials can be inconsequential, compared to the presence and sensitivity of the person treating you. Bodywork can be challenging for warriors who are in the defensive mode, particularly when you have PDS. Allowing someone to touch you means that you have to drop any defensive postures. But you need to know that, when you feel ready, it is an extremely important resource for you.
What Comes First: The Body or the Mind?
With emotions, it’s very difficult to figure out which comes first: the chemicals and electrical impulses, or the thoughts and beliefs that accompany them. Sometimes thoughts and emotions mirror each other and, at other times, they don’t seem to be connected at all. It’s certainly true that if you change the chemicals in the body your emotions and thoughts will change. Exercise alone can do that. It’s also true that seeing where your thoughts and beliefs are distorted, and changing them, can change your emotions. Changing either thoughts or actions can change chemicals and changing chemicals can change thoughts. Are exhilarating or depressing thoughts the result of exhilarating or depressing chemicals, or are exhilarating or depressing chemicals the result of exhilarating or depressing thoughts? It’s not always clear. We don’t know. We do know you can work both angles and should. One of the key principles of this book is that your recovery doesn’t require you to choose either a traditional or a nontraditional approach. This blending of approaches will help to lead you to a more complete healing.
Excellent therapists have the ability to shift approaches dependent on what you need in the moment. We are going to talk about a few therapy methods you should be aware of, but let us state the key to success with using therapy in the mission to recover from PDS: If you have been diagnosed with or suspect that you have PDS, you must find a therapist that you trust and feel comfortable with.
Although you should choose a therapist based on how well you connect to them and the logistics of getting to actually see them, we have identified four broad psychotherapeutic approaches that would be helpful for you to know about.
- Cognitive behavioral therapy (or CBT)
- Byron Katie’s approach, known as The Work
- Somatic Experiencing and Peter Levine’s trauma-oriented therapy
- Daniel Siegel’s interpersonal neurobiology
The Two Basic Types of Psychotherapy
1. Mind centered, or top down
These approaches use the language and logic of the upper brain, executive function, to correct distorted thoughts and beliefs in order to bring harmonious ï¬‚ow into life.
2. Body centered, or bottom up
These approaches work directly with the physical body. They work with sensations and energies in the body to help induce healing. Their focus is on listening into the body for clues to what needs to happen in order to jumpstart the body’s natural capacity for self-regulation. Sometimes this can be as simple as getting a massage.
The Stigma of Therapy
In the past there has been stigma against admitting the need for, and seeking, psychological help. There are still some in the military who think that a soldier who admits that he or she has mental or emotional difficulties, even as a result of war, is weak, perhaps even morally inferior. They think you are supposed to just get over it. We do not mean to be unkind, but that is ignorance of the highest order. Who would dream of not going to the hospital if you had a heart attack? Or, who would not seek out the emergency room in the event of a broken leg? Fortunately, this stigma about seeking help is rapidly dissolving. Knowing you need help and seeking out a therapist is really the sign of a healthy mind. If you get drunk all the time, have bouts of volatile rage, get fired from a job, are in the middle of a divorce, can’t get your bills in order, and generally feel like your life’s a bummer and you don’t think you need help, well, that’s the sign of another kind of mind. Of course you wouldn’t even be reading this book if that was the case, but you get the picture.
Don’t get us wrong, we are absolutely for sucking it up and toughing it out. That’s what standing up to what’s bothering you is. We are actually asking you to tough it out to read this book, to apply its principles, and to maintain the forward march. Like a true warrior, we are asking you to keep going with this mission, even if the idea of something like therapy feels weird to you, even if there are those around you who don’t understand, even if you feel like you can handle it, or even if you feel like you want to give up. How you think can determine the quality of your whole life. There is a profound mental component to many of the problems relating to PDS. Suffering itself has a huge mental component. It is how we respond to it that can make all the difference. While working with professionals, as well as in more informal support groups, your response to your PDS and your recovery process is extremely important to your overall recovery. We are guessing that if you are reading this book, your thinking is bugging you as much as your physical ills. The trick to healing is in getting a little distance from your problems by using your mind to look at them. In addition to the psychotherapy we’ll be describing, journal writing is an excellent way to do this. Write a thought down. Then ask yourself, is that true? We’ll talk more about keeping a journal in the next chapter.
You might as well stand and fight because if you run, you will only die tired.
—Vern Jocque, Sei Shin Kan student
The Therapist’s Presence
Therapy is human beings helping other human beings get through suffering. Although there are numerous philosophies and methods, basically, when it comes to human beings it takes one to know one. That’s where the healing power is: in actual face-to-face flesh and blood meeting. Our brains are wired and healed in relationship. The simplest form of therapy is just sharing your thoughts and feelings with an understanding friend. That’s why talking to a buddy can be so helpful. This book can’t do that. It’s not a human being. What it can do is give you some insights into how therapy works and why you need to make it an integral part of your healing mission. A good therapist is worth their weight in gold. They have made therapy their life’s work because they are interested in what makes us tick and how to help people end suffering. They will help you. It’s their job. We want you to consider the idea that seeing a therapist is like going to a dentist, a doctor, a chiropractor, or a podiatrist. It’s not a big deal. It’s just something you do on a regular basis. You may do it for a long time, maybe your whole life. You may find it’s one of the most important things you’ll ever do. It’s just like having a coach. Remember, even Michael Jordan, Tiger Woods, and Peyton Manning all had coaches.
One more thing about these psychotherapeutic methods: like meditation, they are not fluff. The way you think, and what you believe, and how you use your mind and body change the circuitry and the chemicals in your brain. Remember, that’s called neuroplasticity. Actually, the brain is one of the most changeable parts of the body. Over time, even people with profound difficulties from massive brain trauma learn to rewire their brains and learn to have happy functioning lives. Do not give up. Effort over time will yield results. The primary component of all therapy is listening. The most important tools you and your therapist have are presence and empathy. When you begin therapy hold these questions in your mind: “How present am I in this time with my therapist? How present is my therapist with me? How empathetic am I to this therapist, and how empathetic is this therapist to me. Do I feel like I have an ally here?”
What follows can get a little heady. If you don’t feel like messing with it right now just check out the guidelines for therapy at the end of this chapter and then skip to the next chapter. We think eventually you’ll find this information extremely helpful.
Cognitive Behavioral Therapy
If you have been pondering the questions that we have been posing throughout this book, then you have already been engaging in a type of top-down psychotherapy, called cognitive behavioral therapy, or CBT. Questions, especially if not answered too quickly, throw open the windows of the mind. They help make us open to other possibilities of thinking and being. They help us look beneath the surface of things. Many psychotherapeutic methods use questioning as a primary tool. Questioning reveals the nature of our thinking. Questioning is a primary tool of CBT. Restructuring your conscious thinking and learning to alter your behavior are primary ways of getting through the thicket of PDS. These are direct ways to get your higher brain to tell your lower brain to chill out and stop pushing you around. Seeing clearly that your thinking is distorted or that your behavior may be out of control is extremely important. CBT is the most commonly used psychotherapeutic method for PDS. It is useful in the treatment of traumatic brain injury, PTSD, generalized anxiety disorder, any combination of these diagnoses, and an array of other problems. CBT is like going to school, to study yourself. It is analyzing your own thinking and behavior. It is a training that gives you the skills to think and behave in a rational manner. It helps you see where your thinking is dysfunctional and how to change it. It helps you accept stuff you can’t change and do something smart about the stuff you can. It emphasizes that, by changing your behavior, you can change your thinking and feeling. It is an empowering process.
One of CBT’s great strengths is that it is interested in the present moment, rather than the past. It is particularly good at addressing specific fears and phobias and learning how to deal with stressful situations like fear of crowds, standing in lines, driving, or in being in situations one can’t control. One of its main behavioral tools is something called exposure therapy, where you are gradually exposed to the source of your anxiety. If going to the mall is too much for you to handle, for example, you just drive by it and feel what that feels like first. Then, you park in the parking lot and experience what that feels like. Then, you hang just outside the door of the mall for several sessions. Then, you enter the mall in a series of steps. Each step is done gradually to limit any elevation of your anxieties or fears. You learn to deal with your uncomfortable feelings and eventually they dissipate.
CBT teaches some very useful skills. It particularly suits people with a military background because it is a highly structured and easily measurable method. It is a process of asking lots of questions and making evaluations about how you feel about things. It helps you determine what’s bugging you and how severe those bugs are. It is a highly organized plan for examining your emotions, thoughts, beliefs, and actions and how they might be screwing up your life. It is a making sure that what you feel, what you think, and how you act are grounded in reality now, not fantasy, or in something that happened before. With the guidance of a therapist, CBT is a fine tool for healing.
Epictetus: The Ultimate Warrior
You should know the Greek Stoic philosopher Epictetus. He is a
favorite of many in the military. He said that what happens to you is a kind of fate you can’t do anything about, but how you respond and think about what happens to you is within your control. Therein lies freedom and happiness. Epictetus said that you can decide how you think and how you behave, that you are the master of your interior life. This is a central viewpoint of CBT. Like Epictetus, CBT says you can determine how you feel and behave if you can examine your thinking and behavior rationally. It is a noble proposition. If your therapist is a practitioner of CBT you will go through an entire program designed to help you do just that.
Exercise #21: Taking Inventory
CBT and complete healing deï¬nitely means looking at what we think and what we believe. To that end, we recommend taking a thorough inventory of your own thought processes. Ask yourself,
- What are the thoughts in my mind?
- What is my attitude?
- What is the nature of the thoughts in my mind?
- Do I assume the worst?
- Do I blame myself for some of the things that happened in theater?
- Do I blame others?
- How do I feel when things don’t work out the way I think they should?
- Is my thinking repetitive? Do I keep thinking the same thoughts over and over again?
- Do I feel that I am not able to control my behavior or that I am stuck in repetitive behaviors?
- Do I have thoughts that just won’t go away?
- How do my thoughts make me feel?
Byron Katie’s Approach
I discovered that when I believed my thoughts, I suffered, but that when I didn’t believe them, I didn’t suffer, and that this is true for every human being. Freedom is as simple as that. I found that suffering is optional. I found a joy within me that has never disappeared, not for a single moment.
Your healing will also require that you examine your own thinking and belief systems. Just as we don’t think as we did when we were 6 years old, we must examine our own beliefs and see where allowing for some change might be helpful. Byron Katie’s The Work is a very simple but very profound tool that can reveal where your belief system is causing you anguish. Although, again, we stress the importance of a professional therapist to help you engage in this, once you’ve worked with your therapist, you will find that Katie’s approach is simple enough to practice on your own. Katie’s approach is another top-down one that consists of four questions, which you can use to challenge the nature of any thought that takes away your sense of peace. It’s one of those tools that’s easy to acquire, but can take a lifetime to become skilled with. But, with an open attitude, it can be pretty helpful very quickly. These questions are particularly helpful if you can train yourself to ask them whenever you feel unsettled with negative emotions. So here are the questions to ask yourself:
- Is it true?
- Can you absolutely know it’s true?
- How do you react when you believe that thought?
- Who would you be without the thought?
Exercise #22: Byron Katie Questions
First, sit down in your chair or in the quiet place you’ve set up,
do some mindful breathing, and really feel into your body.
Take a thought or emotion that may be running through your mind,
- I’m alone; no one knows what it was like over there.
- This culture sucks. Everything happening in the U.S. is trivial and stupid.
- I got screwed for nothing. Life is not fair.
- I’m never safe.
- Now that I’m home, nothing matters.
- I’m a failure. It’s my fault. I could have done something. I should have (write in your perceived failure here).
- Or, any other thought that makes you feel bad.
Now, ask yourself Katie’s questions. Really reach down deep and inquire. Is it true? Can you absolutely know it’s true? Don’t answer right away. Really sit with it. No one is telling you what to do. It’s completely up to you how you answer these questions. Ask yourself the next question. How do I react when I believe that thought? What do you feel like inside when that thought shows up? Really sit with it. Now, answer the fourth question and really ask yourself, who would you be without the thought? Consider what your life would be like if the thought that is bothering you just weren’t in your mind. Who would you be? There is just the tip of this process. Please refer to Byron Katie’s book Loving What Is, or check out her website www.TheWork.com for more information.
Subjecting your emotions or thoughts to Byron Katie’s questions may seem silly at first, but, her point is, when you are in emotional pain, the thought is the problem. As her last question indicates, without that thought, whatever you were feeling in that moment would be very different. The beauty of this work is no one is asking you to do anything except think about it. No one is telling you to change your thinking or to drop the thought, but instead you’re being asked to consider what it might be like if you did. What tends to happen if you apply this approach to things is that you begin to realize that your thoughts are creating your life. They are how you see the world. Without them, you’d just be paying attention to what’s happening around you right now. You’d be free to just take it all in and enjoy the show. Sure, you could apply your thoughts or emotions to situations when you want to (like when you’re amazingly happy to be somewhere), but you’d only have to do that when you wanted to and when it created something positive for you. With time one becomes more able to let go of the thoughts and the feelings that accompany them. You could be taking fear and anxiety out of the system. Then you can just be. Change your thoughts; change your world.
Somatic Experiencing and Peter Levine’s Trauma Resolution Therapy
Trauma is a fact of life. It does not, however, have to be a life sentence. Not only can trauma be healed, but also with appropriate guidance and support, it can be transformative. Trauma has the potential to be one of the most significant forces for psychological, social, and spiritual awakening and evolution.
Somatic experiencingis a form of therapy, developed by Peter Levine, PhD, aimed at relieving and resolving the symptoms of PTSD and other mental and physical trauma-related health problems by focusing on the client’s perceived body sensations (or somatic experiences). It is a bottom-up approach that he based originally on his observations of animals in the wild and how they dealt with and recover from life-threatening situations. By understanding some of the reasons that wild animals can deal fluidly with almost daily life threatening experiences, you can also effectively deal with the traumatization that accompanies PDS. The procedure is done in face-to-face sessions and involves a client tracking his or her own felt-sense experience. Somatic experiencing attempts to promote awareness and release of physical tension that is felt to remain in the body in the aftermath of trauma or stress. These tensions have been aroused in the nervous system, but are not fully discharged after the traumatic situation has passed. Relieving these tensions restores your inborn capacity to self-regulate. There are a number of techniques used to dissipate the physical tensions, including tracking, titration, and pendulation.
Tracking involves using awareness to note and monitor the sensations moving through the body in the present moment as well as in relation to past memories. It’s labeling the quality of a sensation. It’s becoming more deeply aware of all the nuances of sensation occurring within you. Most of the time, when someone asks us how we are, we just say something like okay, fine, or not so good. But, what is the bodily sensation of those statements. What does “okay” really feel like? Does it mean you feel light, energized, calm, or something else? Does it mean your hands feel warm or your mouth is moist? In tracking, you may begin feeling the tip of a finger after you gently push into it. You may next note how the tip contrasts with the rest of the finger. Then, how does your entire hand feel compared to that, and so on. It is only in entering into these sensations in the present moment using mindfulness and then similarly noting the sensations that accompany emotions that we can join with the body and mind in its natural healing process.
Titration and Pendulation
Titration basically means changing little by little. Titration involves initially focusing on barely perceptible changes in the body, such as creating a slight loosening of tension in the muscles of the upper arm and then very gradually building this release to larger and larger areas. It means establishing locations or resources of safety such as familiar, normal sensations, so that you can comfortably visit the memory and, more importantly, the sensation of the traumatic event gradually. This little-by-little swinging between two extremes of feeling, from regulation (the sense of safety and security) to dysregulation (the sense of fear or danger) is called pendulation. This is a place where the earlier breath work you have done can be extremely helpful. It helps create a sense of ease and security. This movement process is done repeatedly and the body learns to discharge the energies that fear or horror can leave in the body. The more the therapist and client do this together, the more the body corrects itself. This work is best done with a professional therapist, but if you can understand why this tracking is important, and learn how to do it, you will become a much more powerful ally in this battle against PDS.
Exercise #23: Tracking
Although the process of tracking sensations or feelings in your body may bring up stored or repressed emotions, it is really about noticing what you feel in your body right now. A little bit of understanding about this process can go a long way. Here’s a short example of a possible tracking session between a therapist and our friend Lori Stefano,
Therapist: What are you feeling right now?
Lori: I don’t feel anything. I’m tired. This is stupid.
Therapist: What does the sensation of tired feel like?
Lori: Well, I feel kind of heavy, dull maybe. I’m sleepy.
Therapist: What do you notice in your body?
Lori: I don’t know. It’s just kind of there. ( Pause) Actually, now that
I think about it, my back aches a little bit.
Therapist: What does that ache feel like?
Lori: It’s like a brick. It’s knotted up. It’s really hard. I’ve been a
little numb to it, but it makes it a little hard to breath.
Therapist: Can you say more? What else do you notice?
Therapist: What does nothing feel like?
Lori: I guess it feels cold.
Therapist : Where do you feel cold?
Lori: I guess in my heart.
This process goes on for a long time, with the therapist being with Lori as she explores her own sensations and the memories and thoughts that arise along with them. There is no agenda. They are just looking together and trusting that what needs to happen will happen. The therapist is helping her look into her inner world. The therapist is also continually monitoring her own feelings. It’s hard for Lori because she is numb and, like a lot of us, she has difï¬culty ï¬nding language for all this. Most of us just don’t have the vocabulary for sensation besides words like: hot, cold, heavy, light, good, bad. For much of what we are feeling there are no words at all. But if we keep coming back to this tracking we start to hear what the body is telling us. Movement occurs. Things start to shift. We learn and grow. Eventually Lori starts to notice more about what she’s feeling and remember more details about what she has experienced. She becomes more comfortable with her therapist and the process and notices that she usually feels different after a session. Sometimes sadder but most of the time more relaxed as if some pressure within her is released. She is gradually feeling more ï¬‚ow in her emotional system and noticing that the therapist is not telling her what to think. She’s just curious about what’s happening with Lori. She’s an ally. They are tracking the movement in Lori together. The hope is that over time Lori’s biological and psychological system will become ï¬‚uid enough to self-regulate.
This approach of feeling into your body shouldn’t be new to you. It’s similar to many of the practices we have already explored. Our mindfulness practices focused on breath and witnessing internal sensation. Our movement practices helped to loosen, creating space and flow in the body, and thereby increasing sensation. You can use the light of illume to track exactly what you’re feeling. So much of the time what we are feeling and what we think we are feeling are not in line with each other. In the terms of somatic experiencing, in PDS all of the charged energy that we used to deal with the life-threatening situation was not discharged. It’s still stuck in the body and the brain is continuing to secrete chemicals and electrical signals into your system to deal with a crisis that is not even happening anymore. The upper brain, the prefrontal neocortex where your executive function is located, loses the ability to calm the system down. The three parts of the PDS brain are no longer in communication. As you do these somatizing exercises along with the work of tracking how you feel, you will become much more aware and interested in what you are feeling. As we watch how these feelings move, as we become interested in what is going on with them, a new emotion emerges, a sense of wonder about the whole process emerges. This means that there are always two levels of emotions within us. The one that is traveling through us as a result of history or unresolved trauma and the one that arises from taking an interest in these feelings that are traveling through. There is the emotion, the sensation we are watching and then there is the emotion, the sensation, that we get from watching. This may seem like a subtle distinction, but it’s not. It makes all the difference. That second emotion has the taste of freedom. That interest is pleasurable in and of itself and, whether we remember it or not, it is always an option for us. The emotion that interest creates, in this case a sense of wonder, begins to mix with and transform the original negative emotion. That is empowering and liberating and, more than anything, it increases our tolerance for the negative emotion we are feeling. In that way we are retraining the mind and that’s changing the chemicals in the body. By using mindfulness and movement, we can help to discharge the system, take notice of the feelings that arise from this, and create a restored system and positive feelings at the same time. If you think about it, this is probably the most important skill a human being can acquire. Because everything else depends on the way you think.
Interpersonal Neurobiology: Dr. Daniel Siegel’s Approach
When we feel presence in others we feel the spaciousness of our being received by them. And when we reside in presence in ourselves, others and indeed the whole world are welcome into our being.
A complete system of healing must take into account both the top-down and the bottom-up methods. It takes sensation, thinking, seeing, moving, emotions, and how we are in interpersonal relationships into account and learns to bring them together in the way that the brain and body are meant to work. It’s the way that highly functioning humans work. Putting all this together makes common sense. It’s a lot to understand, but basically, once again, it’s about flow. Things aren’t working right when there is rigidity (when we are over controlled and can’t stop doing the same behavior) or when there is chaos (when we are out of control). Flow feels good. Rigidity and chaos feel bad. The work of therapist Dan Siegel, MD, and his interpersonal neurobiology approach to psychotherapy focuses on creating flow. Siegel’s approach moves an individual towards connection, or integration, within him or herself and with others. The therapist works with his or her own presence, listening ability, and empathy for the client to help the client understand and create harmonious flow. This lack of flow, this chaos, this rigidity is symptomatic in conditions like those seen with PDS. Siegel’s work identifies nine different domains of integration that the therapy and concepts of interpersonal neurobiology can help bring about, which can give you a guide as to ways to look at the your healing brain.
The Nine Domains of Integration
- Conscious integration: You learn to see what’s in your own mind and you learn to direct your attention, to choose what you are conscious of. This is what mindfulness practice does.
- Vertical integration: You integrate the sensations occurring in your body into your awareness. You are aware of your physical being, from your head to your toes.
- Bilateral integration: You are aware of and have access to the way both the left and right side of your brain see and organize your world. The left side is great at logic and language. It likes counting, labeling things, and putting things in order. The right side is great at seeing things whole, like a whole picture all at once. It’s also the part of the brain where the story of your self is located. It’s thought of as the place where creative ideas just show up. We need both sides to work well and to work together smoothly.
- Integration of memory: You are able to recall in consciousness everything that’s happened to you. Memories, particularly traumatic ones, are not buried in your subconscious mind and don’t push your buttons every time there is a reminder of them. This is critical since you cannot deal with something that you cannot remember.
- Narrative integration: You have a sense of who you are, you understand how you have developed over time, and you have the ability to tell the story of your own life in a way that makes sense. You are also aware that you are writing the story of your life as you live it. You are aware of the patterns of your life and how you might be able to change them to create a future you envision.
- State integration: You become aware of the different states (peaceful, agitated, angry, fearful, relaxed) that move through you in the moment and are particularly aware of those states in which you become unraveled or out of control. You are able to monitor your own state of being and through mindfulness practice and things
- like breath awareness are able to have some control over those states. In this way you learn to have control over your actions.
- Interpersonal integration: You are aware of how you are connected to and affected by other people in your life. You can see how those around you literally change the way energy and information flows in your body. Empathy—the ability to feel and understand the way another person feels—is a big part of this. You have the ability to open yourself and join with others so that there is flow between you. You can fully link to another person.
- Temporal (time) integration: This is the ability to connect past, present, and future in your own mind and to consider the problem of how temporary life is. It’s the ability to see your own self as a changing process through time and that (whatever your beliefs about an after life) this life will one day end. It’s also about coming to grips with that.
- Transpirational integration: You start to feel that all of these other forms of integration are all connected with each other. Your story, your sensations, your awareness of death, the different ways the two sides of your brain work, your shifting inner state, and your relations with others are all breathing together. You also become aware of the infinite ways you are connected to everything else, even things not in your physical locality. You see that your being is composed of emotions (chemicals and impulses), water from a river, tomatoes from California, your grandfather’s DNA, old TV commercials, or memories of a dead child or friend in war. You become aware that your warrior’s heart and warrior’s mind are connected to everything. You are a part of the larger flow of the universe.
We think these nine domains of integration are really important and you should do your best to understand them. Even knowing about them can lift you into another state. If you learn about them, they can help you evaluate where you are in your own psychological healing, and help you cultivate it.
Siegel’s work clearly emphasizes how vital it is to integrate all aspects of yourself as well as yourself into the world around you. But all of these approaches, and the many others we haven’t discussed, can help you. There isn’t really a right or wrong therapy approach or place to start. Remember, it’s the actual relationship with your therapist that is most crucial. But your fi rst step has to be to spend time and feel how your emotions play through the body and mind. Sit still and watch. How do your belief systems fi t in with all of this? How does the way you move fit into all this? How can you coax the intelligence of the body and the mind to work together for you?
All of these thought and talking activities will lubricate the way emotions move within you. You will feel a whole lot more. Overall, that’s a really good thing, but as you’ve learned it’s also a bit of a problem. When what you experience is too much for your system, you will have the urge to either run away or shut down. As much as you might want to tackle these problems head on, your body, your nervous system, and your emotional being may have other ideas. It still wants to protect you even when the threat is just a residual memory. So that’s why you have a professional there to help you through this. And that’s why it may take some time, maybe even your whole life. We think of therapy as adult continuing education. You’re in the process of getting smarter on your way to getting better. You’re also getting healthier by doing this, a whole lot healthier. Here are a few guidelines to help with your therapy.
Guidelines for Therapy
- Go — Do not skip sessions
- Prepare for your sessions. Practice any exercises you’re given. If you have homework, do it.
- Plan what you will talk about but stay open to what’s on your mind at the moment.
- Before any session you have, practice mindful breathing and go into open attention.
- Ask you therapist to spend a few moments in mindful breathing with you before you start.
- Listen carefully to both what your therapist is saying and what you are saying. Learn to pause and let what you say echo in your mind.
These psychotherapeutic methods, like meditation, are not fl uff. They really work. The way you think, and what you believe, and how you use your mind and body change your brain. Remember, that’s called neuroplasticity. Actually, the brain is one of the most changeable parts of the body. Over time, even people with profound difficulties like severe brain trauma or devastating PTSD can rewire their brains and learn to have happy functioning lives. Do not give up. Effort over time will yield results. We guarantee it.
It does not matter how fast you go as long as you do not stop.
All of this is a lot to learn. But, don’t worry, if it seems a little overwhelming, you don’t have to get it all. All you have to do is take one step at a time. You just have to understand that you are in a process of using your own mind, no matter how challenged, to bring yourself together. Move at your own pace. You are becoming a fluid warrior. You will get stronger. You can change your inner world. You can heal. You can do it with mindfulness, you can do it with movement, you can do it with medication, you can do it with questions, you can do it by putting yourself in different environments, you can do it with both traditional and nontraditional methods, you can do it by engaging with others, and you can do it with the help of a professional ally, the therapist. You will know you are getting better when you sense the connection to those around you deepening. Eventually, if you are not already, it will be you that is reaching out to help others heal. It’s amazing, isn’t it, what conscious living beings can do?
From OVERCOMING POST-DEPLOYMENT SYNDROME: A six step mission to health by David X. Cifu, MD and Cory Blake. © 2011 Demos Medical Publishing, LLC. Used with permission. www.demosmedpub.com.