Back From the Brink: A Family Guide to Overcoming Traumatic Stress, by Don R. Catherall, Ph.D.
Table of Contents | Introduction | Afterword
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8
OVERCOMING
THE
Feeling Yourself Again
The more time has passed since the initial trauma occurred, the more the symptoms have become a way of life, so much so that they may persist even if the trauma itself has been resolved. These symptoms include: physical symptoms associated with anxiety, depression, and hyperarousal; symptoms of a damaged sense of self (problems controlling rage and maintaining self‑esteem); and interpersonal symptoms of distrust and an inability to maintain intimacy.
These problems must be worked on directly—they won't
necessarily improve when the initial trauma has been resolved. The resolution
of the initial trauma sometimes leads to an immediate reduction in these
symptoms, but the longer you've lived with the trauma, the more the symptoms
will have become part of your life.
Stress is the cause of many of these symptoms, and
the name Post‑Traumatic Stress Disorder implies that trauma stresses the individual beyond normal
limits. When you stop and examine the effects of excessive stress, the results
are awesome. It is the cause of a huge number of physical illnesses, as well
as the more obvious manifestations—headaches, muscular tension, and ulcers.
Many people see cardiopulmonary fitness—via aerobic exercise—as the best
defense against stress. Yet stress still affects even those people who are in
the best physical condition. And if "ordinary" stress is so powerful,
what must we conclude about the power of traumatic
stress?
The stress caused by traumatization can be so severe
that it would literally overwhelm people if they allowed themselves to
experience it fully. When the traumatization involves a single event, it's
virtually impossible to fully experience all the feelings evoked at that
moment. Those feelings come back over time as the person recalls the event and
relives it in her mind. So trauma survivors learn to rely upon mechanisms that
allow them to dilute, contain, avoid, deny, forget, and otherwise remain
distant from these feelings. Meanwhile, they experience stress.
Everyone lives with a certain amount of stress in
their daily life. Current thinking is that although this is not necessarily a
bad thing, it can contribute to problems if they don't deal with it
constructively. It appears that each person has an optimal stress level, at
which they are energized and challenged to perform at their maximum. But when
a person goes over that optimal level, his performance falls and he begins to
suffer physical consequences. There may be good stress and bad stress, but
whatever way you look at it, traumatic stress is not good. If you're living
with the stress of an unresolved trauma, most of your resistance to stress has
been absorbed in your daily dealings with this hidden burden. Therefore, your
tolerance for additional stress is low—you’re already beyond your optimal level
of stress before you even get out of bed in the morning!
Everyone reacts to excessive levels of stress in
their own peculiar ways. Some people become sick a lot. Others get angry, or
depressed, or fatigued. Still others get ulcers or heart attacks. It helps to
figure out your own unique ways of reacting to stress. Then you can spot it
more easily when you're stressed and try to take action sooner.
Tune In to Your Physical Experience
If you are a trauma survivor, many of your present
symptoms can be traced back to your efforts to avoid feelings associated with
the trauma. Many survivors begin to drink or work too much or withdraw socially
because they are trying to stay away from the feelings associated with the
trauma. Are you trying to avoid feeling a certain way? As you reflect on this,
bear in mind that feelings are experienced as physical, bodily sensations.
Different people experience similar feelings in different ways. One person
knows he's fearful because he has butterflies in his stomach, while another
feels his heart pounding, another gets a lump in his throat, and another gets
watery legs.
How do you know when you're fearful? Or when you're anxious, angry, or excited? These feelings may increase your metabolism, elevating your blood pressure, heart rate, and muscle tension. Your breathing rate may also increase, and you're likely to consume more oxygen and produce adrenaline. These are all part of the fight‑or‑flight response, in which the body goes into a state of arousal to deal with whatever it is that the person is excited about. But if there's nothing to be done once you're geared for action and you maintain this aroused state for extended periods of time, you'll begin to stress your bodily resources.
By contrast, depression and sadness tend to be
associated with decreases in heart
rate and oxygen consumption. Indeed, severe depression slows down your
reflexes, both mentally and physically. You're not as quick‑witted, and
you can't perform at your usual physical level. So whether you're experiencing
an arousing feeling, such as fear, or a retarding feeling, such as depression,
you come to identify the feeling in part by how you "feel"
physically.
If you think about this physical aspect of feelings,
you begin to understand why stress can produce physical illnesses, aches, and
pains. Under stress, your muscles are tensing, your glands increase the
production of certain hormones, and your body overtaxes systems designed to
run at rest most of the time. If you are not aware of this inner turmoil you
get a situation where the water is boiling over and nobody is watching the
stove. Your immunity system is overtaxed but you don't recognize the need to
do something about it.
So I recommend that you tune in to your physical experience and notice these physical
changes. You might stop and consider right now: What muscles are you tensing?
Try relaxing your shoulders. Do they droop? If so, you may have been tensing
them unconsciously.
Learn to Breathe
Breathing is an amazingly important part of your
ongoing state of tension versus relaxation. The natural rate, flow, volume,
rhythm, and depth of breathing vary with the situation. It speeds up to deal
with increased demands and stimulating emotions. When you relax, your
breathing slows down and becomes less laborious; you breathe more shallowly and
rapidly when you're in a stressed state, more slowly and deeply when you're
relaxed and free of anxiety.
Becoming more aware of your breathing can help you
relax and deal with your tension and stress more effectively. Breathing
awareness is an essential part of meditation, which basically clears the mind
while the body is relaxed. Using breathing techniques, you can just take a
moment, relax, and slow down internally. You may also become more aware of how
you sit, and notice when your posture is interfering with deeper breathing.
Your most critical step here is to take seriously
the need to relieve stress. Keep yourself in the best possible physical health:
this means attending to your diet, getting enough exercise, sleep, rest, and
free time, and controlling what goes into your body. You also need to keep
yourself in the best possible mental health;
this means maintaining relationships in which you feel sufficiently accepted to
be emotional and discuss stressful events.
Decide what specific things you will do to relieve
stress. It helps to have regular devices—such as daily exercise time—and
optional devices—such as the breathing exercises that you can employ as
needed. Doing some kind of exercise is important, but don't pursue it to the
degree that it feels like self‑punishment. And think about the things
that help you relax. You may get more relaxation and enjoyment out of listening
to music or building birdhouses than out of doing aerobics.
Learn to recognize when you're stressed and need relief. To improve your awareness of your physical state, take a yoga class, or tai chi chuan, or transcendental meditation, or dance, or massage. Join a softball team. Do whatever you can lose yourself in as you focus on your physical experience. Becoming so engrossed in an activity that you "lose yourself" is probably a good indicator that you've found an effective form of relaxation. Some forms of relaxation, such as sports, are very active, while others, such as reading, are very quiet and slow. It's best to have both kinds in your repertoire. The wider the range of activities to which you can turn, the more resilient you will tend to become to daily stress.
In Chapter 4 we discussed how trauma survivors can
become embedded in a niche that's not good for them. They may be pursuing
stress relief in nonproductive ways. If you're still trying to recover from a
traumatization that occurred quite a few years ago, the chances are that
you've developed some unhealthy ways of coping. These "unhealthy"
ways may work to some degree, but unhealthy coping usually creates new problems
even as it deals with the old problems.
Turning to alcohol is an example. Many trauma survivors
drink as a way of coping. It takes the edge off the intrusive traumatic
memories, helps the person be more social and get to sleep at night, and
generally makes life more bearable. But if the drinking goes too far, it
creates a rash of new problems. The memories leak out anyway, and the person
acts foolishly when drunk; new social problems develop, he wakes up in the
middle of the night and can't get back to sleep, and life becomes a different
kind of hell. Now alcohol has become the problem.
Obviously, alcohol is a problem for many people, not
just people who have been traumatized. If you are abusing alcohol, you'll need
help overcoming it—independent of dealing with your traumatization. A variety
of professional programs are available to help you, but don't rule out
Alcoholics Anonymous, one of the most powerful and effective sources of help.
If you've been traumatized and are
alcoholic, make sure you see a professional therapist who can help you juggle both these aspects of recovery. There
are other drugs that people often abuse in their efforts to deal with
stress—and not only illegal drugs. Many people abuse legal, nonprescription
drugs, such as caffeine and nicotine.
Changing your niche means making the changes in your
life‑style that will allow you to live a healthier life. By niche I mean your external environment,
as opposed to your psychological or internal environment. Changing your niche
means developing new and different social relationships and doing different
activities—in other words, new habits. Three guidelines can help you in your
efforts to change your niche:
1. Focus on your external environment. If you're trying to stop
drinking, don't hang out at the bar. Move the liquor out of the house, and
don't hang around with your drinking companions. Changing the external setting
can make it easier to uphold your internal decisions.
2. Replace bad
habits with good habits. Don't just stop what you've been doing; replace it
with something better. Pursue an exercise program, take up a class in
something of interest, or start a new project at home—these can focus your
energies in a positive direction, rather than keep you trying not to focus them in a negative
direction.
3. Don't
define slipping as failure. Rather than promising yourself that you'll
never return to the old habit, focus instead on always returning to the new
habit, should you ever temporarily lose your way. Many people fail to develop a
new habit because they approach it as if any regression to the old habit
indicates failure. How many people have you known who tried to quit smoking,
smoked one cigarette, then decided they'd "failed" and resumed
smoking?
People with stress disorders have sleep problems for
a variety of reasons, and they have to be approached in different ways. First,
if you have sleep problems, you must identify what kind you have. Some people
have difficulty falling asleep, while others have difficulty staying asleep or
getting out of bed in the morning. Some awaken early and can't go back to
sleep. (Most people with stress disorders don't have the problem of sleeping too much.) Different sleep problems stem
from different causes; thus, a person can have more than one kind of sleep
problem and more than one reason for any given sleep problem.
The problem of waking early and lacking motivation
to get out of bed is most clearly associated with major depression. If you
have this problem, you should see a mental health professional.
If you're having problems falling asleep, depression can again be the culprit, although it's less likely to be a debilitating major depression. Trauma survivors suffering from hyperarousal are most likely to overexert themselves or overuse alcohol in order to get themselves to sleep. Many of these people stay up late every night and still go to work in the morning—but remain chronically exhausted.
If difficulty falling asleep is your problem,
relaxation training can probably help you. You can learn to relax with the help
of a mental health professional through psychotherapy or biofeedback. (We'll
discuss biofeedback later in this chapter.) A course in yoga or meditation will
teach you to relax, or you can teach yourself through audiotapes, books, or
friends. Progressive relaxation exercises with visual imagery have been shown
to be very helpful in falling asleep. People with difficulty falling asleep
should avoid caffeine, vigorous physical activity too close to bedtime, and
daytime naps. Get into bed only when sleepy, use the bedroom only for sleep and
sex, and get up at the same time every morning.
Awakening in the middle of the night is a different
problem. It can also be caused by depression and could require medication, but
it's very important to know why you're
waking up, since there are different medical approaches for different
problems. Some trauma survivors have anxiety attacks in their sleep. What do
you feel when you awaken at night? Are you anxious, or simply unable to sleep?
Do you have traumatic dreams? If so, your initial trauma needs to be talked
about.
Some people awaken as a result of their state of
hyperarousal, because they're startled by something. Relaxation training tends
to help such people more than medication. Even if your awakening is due to
depression or anxiety, it may not be severe enough to warrant medication. You
and your physician must make that decision. In any case, if you're awake for
more than fifteen or twenty minutes, get out of bed. The bed should be reserved
for sleeping and not become associated with lying awake.
Physical problems demand a
concrete approach, something more than just talking, whether in psychotherapy
or therapeutic talking with loved ones. People with very pronounced physical
problems need physical relief, and until that relief arrives, talking and
processing the trauma do not seem terribly relevant. Let's look at the forms of
physical relief that are available from professionals and from various
organizations.
Here is my philosophy on the
use of medications for relief from depression and anxiety:
1. Go to a psychiatrist
to be evaluated for medication. Many internists and family practitioners
will prescribe minor tranquilizers and antidepressants for psychological
conditions. But psychiatrists are trained to know more about psychological
conditions and are more familiar with the drugs used to treat them. If you get
your medications from your family doctor, there's less of a chance that psychotherapy
will accompany the medications.
2. You should be in psychotherapy if you're taking
medications. That means you should be regularly seeing and talking to a
professional—either the psychiatrist supplying the medication or another therapist.
3. You and your physician should make the decision together. If the
physician just throws the pills at you and says to take them, you may want to
look for another physician. A good psychiatrist will explain the pros and cons
of using medication and will follow your use of medications carefully to deal
with any unwanted side effects.
Unfortunately, most mood‑altering drugs—such
as antidepressants and tranquilizers—have undesirable side effects, which
vary in their impact from individual to individual. It can take time to find
the best medication for you, and during that time, your physician should stay
abreast of the situation. Whether or not you're in personal therapy with your
physician, you need to feel you trust her and that she is accessible.
As I indicated in the discussion on sleep problems,
my approach to using medications is conservative. There's not really an exact
point at which medications should automatically be used. It varies with the
individual; some people wish to hold off on using medications, when others want
the help right away. Obviously, there does come a point where medications
absolutely must be used, but it's not far from the point where hospitalization
is required.
If you have a problem with alcohol or drug abuse, be
particularly conservative in your approach to mood‑altering drugs. Many
of them can interact with alcohol, magnifying its effects and possibly
producing life‑threatening consequences.
You'll find that psychiatrists vary considerably in
how much they use medications. Some try to solve every problem through drugs
and view all problems as biological problems. They're really no different from
the people who think symptoms of traumatization only occur among people whose
personalities predispose them. But other psychiatrists will evaluate whether
there's a biological component (such as a family history of depression) to your
symptoms. They will not approach your case with preconceived ideas about this,
and they may or may not prescribe medications for you.
I encourage you to pursue non-drug solutions—such as
relaxation training or exercise—to manage anxiety. If your anxiety is so
extreme that you can't function adequately, you may need tranquilizers. But
that's not often the case.
On the other hand, antidepressants do have an
important place in the treatment of stress disorders. If you're severely
depressed, literally slowed down to a crawl, it can be very difficult to get
out of your rut long enough to do things that make you feel better. If you have
significant physical symptoms of depression (such as mental or physical
lethargy, difficulty keeping your mind on the topic, sleep problems, and
appetite and weight changes), you should at least discuss the possibility of
medication with a qualified professional. And if you have emotional symptoms of
depression, you should be talking with a qualified professional about that,
whether or not you're interested in medication. In addition, one class of
antidepressants (the Selective Seritonin Reuptake Inhibitors or SSRIs) has been
found to help with some of the other symptoms of PTSD and one SSRI, Zoloft, has
already been approved for treatment of PTSD by the FDA.
Antidepressants come in different classes with
different levels of impact and are suited for different kinds of depression.
The effects of some antidepressants may be similar to those of tranquilizers,
but they're not the same. Tranquilizers treat anxiety, while antidepressants
treat depression. Antidepressants with a short‑acting sedating effect
have been found to be very helpful with many of the hyperarousal‑induced
sleep problems of people with PTSD. If taken at bedtime, the medication wears
off in time for the person to function the next day. A person with severe PTSD,
with arousal‑related insomnia and symptoms of depression, might profit
from being on more than one kind of antidepressant at a time. But decisions
like these should only be made in consultation with a psychiatrist.
Some types of antidepressant (MAO inhibitors)
require a very strict diet and should not be used if you are too impulsive or
are poorly disciplined. Be honest with yourself and your physician if you
aren't likely to be able to follow strict dietary—including drinking‑restrictions.
The purpose of behavior therapy is to change
behavior that has been learned, using
the techniques that help patients learn new ways of coping with their symptoms.
These techniques are most effective when directed at very specific,
identifiable problems, particularly those that involve anxiety. A number have
proved useful in treating symptoms of PTSD, such as relaxation training, guided
imagery, systematic desensitization, flooding, role playing, and biofeedback.
Relaxation training teaches you to let go of your
constant need to remain in control. It utilizes muscular relaxation exercises
but produces a feeling of freedom from trying to stay in control. It's like
learning to float in water—you must relax, not struggle, to allow your natural
buoyancy to work. Giving up that sense of control isn't easy if you're used to
staying on guard every minute, anticipating a recurrence of the trauma around
every corner. As you begin to relax, you may experience a panicky feeling of
losing control, similar to the feeling of helplessness that goes with your
trauma. But in relaxation training, you learn to give up muscular control and
see that you need not feel helpless just because you completely relax your
guard.
Once you have learned relaxation techniques, you can
practice them on your own, sometimes with the aid of audiotapes. Within a
short period of time, you can learn to relax more quickly, even at stolen
moments during the day, simply by sitting in a chair and adopting a restful
posture for a few moments. You may want to use little cues to remind yourself,
such as placing a colored dot on your desk to remind you to relax your
shoulders or hold your fingers in a way that you have learned to associate with
a state of relaxation. Relaxation training is a basic skill necessary for
employing other behavioral techniques. Any behaviorally trained therapist will
be able to provide you with relaxation training.
In guided imagery, a kind of relaxation technique, a
therapist describes images for you to imagine. Rather than focusing on the
tension in your muscles, you focus on your mind. You will be led through a
series of images that are designed to relax you and restore in you a feeling of
security. As with the muscular relaxation techniques, you learn cues that allow
you to create restful images quickly. The difference between muscular
relaxation and guided imagery techniques is like the difference between the
physical relaxation of yoga postures and the mental rejuvenation of meditation.
Both imagery and meditation work better when they are combined with muscular
relaxation. Many therapists who utilize guided imagery, by the way, also do
hypnosis.
Systematic desensitization is one of the best‑established
techniques for treating unrealistic fears. It places you in a state of
relaxation and gradually exposes you
to reminders of what you fear. Gradually you become able to deal with even the
more powerful reminders without getting anxious. This process has been very
helpful for people with phobias, who are excessively fearful about one
particular thing. It can also be helpful in dealing with traumatic memories. As
you become desensitized to the memories, running into reminders of the trauma
no longer stimulates a lot of anxiety.
A similar desensitization occurs during the processing of traumatic events. As you
process the trauma and get more comfortable talking about it, it loses some of
its power to provoke anxiety in you.
If you want to try systematic desensitization, you
must seek out a trained behavior therapist. It is not a skill that all
therapists possess.
Like
systematic desensitization, flooding involves exposing you to reminders of
your fear while you're in a state of relaxation. But where systematic
desensitization tries to slowly accustom you to the traumatic memory without
causing much anxiety and backs off when you feel anxious, flooding techniques
allow the stimulus to create as much anxiety as possible. You are repeatedly
exposed to it until it loses its power to provoke your anxiety. A woman who was
raped in an elevator, for example, might be directed to imagine being in an
elevator alone with a man who is staring at her. She would be directed to
imagine similar scenes until they fail to evoke anxiety in her.
Role playing is used to help patients prepare for
interpersonal situations that produce anxiety. Trauma survivors who have
difficulty dealing with authority figures, for example, might practice
situations in which they have to deal with authority figures. Role playing is
useful in learning to be assertive, in controlling anger and anxiety, and in
handling interpersonal conflict. A wide variety of therapists use role
playing; it's particularly common in group therapy.
Biofeedback is a technique in which you learn to
relax by monitoring your physiological state, giving you a better ability to
identify when you're relaxing and when you're speeding up. The goal is to
increase your awareness of your states of tension and relaxation and your
control over those states. If you take your pulse, breathe and relax, and find
that it slows down your heart rate, you have used a basic biofeedback
technique.
Small versions of biofeedback devices are available,
and some therapists utilize these devices in their offices. But most serious
biofeedback work is done in laboratories with larger machinery. When you go to
a biofeedback lab, you are placed in a comfortable chair and trained to relax
while you watch a monitor that tells you how you're doing. The monitoring devices
vary, and some wires may be put on your head or your hand, to measure such
things as muscular tension, skin temperature, or your skin's conductivity to
electricity (which is affected by your perspiration).
It can be very encouraging to discover how much
control you can have over events that are usually unconscious. Biofeedback has
been shown to be particularly effective in dealing with headaches. You're most
likely to find adequate biofeedback treatment in a large clinic, particularly a
clinic associated with a hospital or educational setting.
Examples of Coping with Physical
Symptoms
In this chapter, we've discussed daily stress,
unhealthy mechanisms for coping with stress, and the importance of changing
your niche and doing tangible, physical things for your physical problems. I
haven't offered examples of actual patients in this chapter because many of
these coping strategies (except for the behavior therapy techniques) don't
have a one‑to‑one relationship with specific problems. Rather, I
recommended a number of sweeping changes that you can make in your life‑style
that can help you deal with the physical manifestations of stress. But the
following are some examples of things that people have done to overcome their
physical symptoms of traumatization.
Mickey, a well‑to‑do young man, had led
a relatively easy life. He was very large and had played football in high
school. After college, he went into the family business and rose rapidly to a
position of prominence. Then one night he was robbed at gunpoint and felt his
life was in danger. It was the first time he'd ever been in a situation where
he had absolutely no control whatsoever. Afterward, he developed a number of
physical symptoms, including startle response, sleep problems, and anxiety
attacks. He frequently awoke in the middle of the night in a panic and was
unable to go back to sleep. As a result, he took to eating and drinking heavily
and gained more than sixty pounds in one year.
Mickey tried to control his problem drinking but was
unable to stop it. Finally, he sought the help of a therapist, and together
they devised a plan of the changes that Mickey needed to make in his daily
life. The therapist also taught Mickey deep muscle relaxation and breathing
exercises. They used a combination of relaxation and imagery techniques so that
he could systematically reexperience the terror of the robbery. Eventually,
Mickey reached the point where he could discuss the experience without starting
to sweat and insisting on stopping. They also worked on developing cues for
Mickey, to use when he did relaxation on his own. He listened to audiotapes of
the therapist's voice and sat in certain postures that he had come to
associate with a state of relaxation.
Mickey started on a program of diet and exercise and
stopped drinking. He attended Alcoholics Anonymous meetings and went to some
Overeaters Anonymous lectures. Eventually, he started running and began to lose
weight and get into shape. He felt much more as he had when he played football.
Finally in shape, his confidence restored, he found that he no longer even
wanted to drink. When he encountered something that stirred up his anxiety, he
went running or did breathing and relaxation techniques. His startle response
faded, and he was able to sleep again, even though reminders of the robbery
continued to evoke considerable anxiety in him.
Randy, the policeman who was traumatized on his
high-stress job, developed a number of physical symptoms, including anxiety
attacks, when he encountered reminders of his work. He reacted very poorly to
daily stress, becoming irritable and overreacting to little problems with his
wife. He didn't sleep well and was continually on the verge of exhaustion.
Before the job finally became too much for him, he had pursued physical
exercise to the point that he was damaging his body. He was running so many
miles each week that he lost considerable weight and wasn't eating the food
necessary to support this demanding regimen. When he hurt his knees running,
he felt so depressed that he resumed it quickly, which made his knees worse. He
was eventually forced to give up running, which was a major loss, and ultimately
he felt he just couldn't keep at his job.
The first hurdle for Randy was to accept that his
high-stress job was too much for him. This was very difficult for him to do
since he came from a family of policemen. He saw his traumatization as an
indication that he was a wimp who just couldn't hack it. He gave no credit to
the fact that he had spent six years on a highly intense, inner‑city
tactical unit and had seen more violence and dealt with more stressful
situations in that short time than any of his policeman relatives had
encountered in their entire careers. Indeed, a huge number of his peers from
that unit became drug dependent, divorced, and stressed out, and two committed
suicide. But despite all this, Randy still expected that he should be able to
experience such stress without being affected by it. Eventually, he realized
that he had to leave.
Once Randy accepted the need to make this most important
niche change, he was more quickly able to pursue a number of lesser changes. He
looked for something to replace his career and ended up going back to school
to study architecture, a subject he had enjoyed but abandoned fourteen years
before to enter the police force. While going to school, he busied himself in
his home workshop and began to produce woodwork that he was able to sell to
local businesses. He put his woodworking skills together with his wife's
artistic skills, and together they produced fancy lamps and other artistic
forms that sold successfully. Randy found this hobby to be enormously relaxing
but made a choice to keep it as a hobby rather than turn it into a new career.
He continued his studies in architecture and got a job in the field shortly
after completing them.
Randy missed his old athletic pursuits, but he felt
that it would be a mistake to try to resume his former frantic pace. He did not
go back to running. Instead, he explored new territory and ended up taking
classes in tai chi, a martial art whose goal is the development of inner calm
more than outward aggression. Randy found it to be a soothing and
"centering" experience, and he also took classes in meditation.
Randy also found that his friendships changed, especially
those with policemen. This was particularly difficult for him. He didn't
abandon these friendships but he wasn't as interested in pursuing them as he
had been before. He had feared that he had nothing in common with anyone and
would not make new friends, but to his surprise he discovered that he already
knew many other kinds of people and that they were interested in knowing him
better. Randy is a good example of someone who changed his niche, eliminated a
lot of the stress in his life, and developed new ways of dealing with stress.
Lynn's traumatization occurred outside of her
stressful job. After she was mugged, she developed anxiety symptoms when she
had to leave home, particularly on plane trips to other cities, which her job
required. She had considerable responsibility in her job, and insufficient
personnel to accomplish all the work. Instead of confronting her superiors
about the way her position was set up, she worked nights and weekends to get
everything done herself and ended up in a constant state of exhaustion. But she
had trouble getting to sleep. She dealt with both this and her anxiety by
drinking wine in the evenings. Due to her exhausted physical condition and
lowered resistance, she caught every virus that came along. Her mugging was a
frightening memory, but it was her daily stress that was wearing her down.
Lynn, too, had been quite athletic before her
traumatization. Now her physical condition deteriorated. Like Randy, it took
her time before she was able to turn things around. She did it not through one
major move but a series of minor ones. She moved to a part of town where the
crime rate was lower and where a friend lived. She replaced the wine with an
exercise class and took up tennis at a local health club. She made a number of
trips to her grandparents' old farm; this was not only a powerful emotional
experience but a chance to get out into the fresh air and hike in the
countryside. On a physical level, Lynn began to recover her athletic condition
and resistance to disease.
Lynn also made changes in her job situation. As she
began to feel stronger, she asserted herself at work and insisted on better
support for herself and her staff. As her work situation improved, she freed up
some time to pursue a social life. She arranged to have a weekly massage and,
in other ways, took better care of herself. She joined the choir at church and
made new friends. Her anxieties returned occasionally, but she learned to deal
with them by talking to friends and engaging in various activities. As a
result, the episodes of anxiety didn't last as long. Her health was noticeably
better, her sleep problems disappeared, and she felt she now knew how to deal with
stress on a daily basis.
These examples show you the range of things you can
do to change your niche and find better ways of dealing with stress. As usual,
the people in the examples had relatively extreme traumas, but the underlying
issues are similar for all kinds of
traumatization. If you've been through a traumatic divorce or a financial
upheaval, you may find that daily stress is exacting a greater toll on you than
you should be paying. The kinds of changes I've described in this chapter will
help you cope better with your physical reaction to stress. In the next
chapter, we'll examine ways of improving your emotional reaction to stress.