Pandemic Wall or Traumatic Stress?: A look at our psychological landscape

A beloved Supreme Court Justice and feminist icon, Ruth Bader Ginsburg, has died, leaving many of us grief stricken and anxious at a time when our basic human rights are already in the balance. Simultaneously, fires continue to sear large swaths of the west coast with accompanying smoke that is making it hard for people to breathe. In the south the weather forecasters tell us we’re in the midst of a highly active hurricane season. Not only do we live in a country facing previously unfathomable  political turbulence and climactic disasters, we are each inevitably coping with the changing reality of covid-19, as well as a very real and visible escalation in racial violence and injustice, a struggling economy, and questions about how to safely educate our kids.

As a psychologist in private practice offering virtual therapy  since mid March, I have had the opportunity to speak with health care workers assigned to our local COVID unit, teachers who miss their students yet fear being infected with COVID-19 when they return to the classroom, people of color scared for their safety, and working parents, already depleted, who are being called on to homeschool their children.

Over the past six months I’ve been extremely concerned about the additive stress caused by the multiplicity of co-occurring challenges initiated by the current time period. Additionally, given the reality that life in this country is less than idyllic for most, each of us entered 2020 with our own unique baseline of pre-existing circumstances. All of this left me wondering whether we’ve already reached an emotional tipping point in this country. I explored the available research, looking to the data for some answers.

To be clear, feeling anxious or depressed at this time is a perfectly appropriate response to the current state of affairs in this country. In the month of July 2020, respondents to a survey by the American Psychological Association reported feeling increasingly frustrated (40%), scared (24%), and angry (18%). Furthermore, a full 60% of U.S. adults said that they considered police violence toward people of color to be a significant source of stress. Emotional struggles have even been expressed by public figures such as Michelle Obama, who recently shared that she’s suffering from a “low-grade depression” (Aug. 5, 2020) and Brene Brown who disclosed that “some days I feel on top of my anxiety and some days it crashes over me”. (Aug. 7, 2020)

More somber though, is the data indicating an onset of trauma related symptoms, suicidal ideation, and increased substance use during this time. A study released by the CDC on August 14, 2020, surveyed close to 5,500 respondents in the US, and found that in addition to relatively high rates of depression and anxiety (30.9%), 13% reported increased substance use, 26% reported increased trauma and stress disorders (TSRD) related to COVID-19, and 11% had given serious thought to suicide. When compared with white respondents, individuals who identified as Hispanic or Black scored significantly higher on the measures of TSRD, substance use, and suicidal thoughts. 

It appears that for many, the tipping point has already been reached. As a trauma therapist, this has been my singular fear and gravest concern. The fact that many individuals are suicidal and experiencing traumatic stress, tells us that they  have reached the point of being completely overwhelmed. Trauma is defined by renowned trauma researcher, Dr. Bessel Van der Kolk as “an experience that basically leaves people stuck in a state of helplessness and terror. Mind and brain become overwhelmed, resulting in a change over how you perceive danger, and what you consider relevant and irrelevant to your survival”.

While this data is clearly very concerning, I do believe that with early intervention we can help prevent catastrophic outcomes. Although the external stress we’re currently experiencing doesn’t show signs of abetting any time soon, we do have choices, including the courageous act of seeking assistance from a psychotherapist when necessary. We must do our best to overcome the urge of falling into a chronic state of despair especially when the magnetism to do so feels impossible to resist.

Survive 

Seek emotional connection and Stay connected to your Support network

Understand that you’re not alone 

Reflect on your strengths 

Verbalize your truths by sharing your story.  

Intentionally find meaning and purpose in your daily life

Validate your feelings even when others don’t acknowledge them.

Empower and encourage others to do all of the above as well

References 

Obama, M. (Producer). (2020, August 5). The Michelle Obama Podcast. [Audio podcast]. https:www.spotify.com

Brown, B. (2020, August 7). Some days I feel on top of may anxiety and some days it crashes over me. [Excerpt from status update]. Retrieved from https:www.facebook.com/brenebrown/

Czeisler MÉ , Lane RI, Petrosky E, et al. Mental Health, Substance Use, and Suicidal Ideation During the COVID-19 Pandemic — United States, June 24–30, 2020. MMWR Morb Mortal Wkly Rep 2020;69:1049–1057. DOI: http://dx.doi.org/10.15585/mmwr.mm6932a1

external icon

Guzman, IB. How the Body Keeps the Score: An Interview with Dr. Bessel Van der Kolk. Brainworldmagazine.com; August 14, 2019.

Advertisement

Disrupted Family Bonds: An Extremely Adverse Type of Childhood Experience, by Yael Gold, Ph.D.

My last entries have focused on reviewing and defining various types of Adverse Childhood Experiences (ACEs). As a psychologist and as a humanitarian I feel compelled to write about the crisis that is unfolding right now before our very eyes, on our own soil, in the United States of America. I make this emphasis because until recently, while I was aware that these types of atrocities had occurred in this country historically, I wanted to believe that this form of abuse was behind us. I have come to realize that this simply isn’t true.

For many of us, it is not possible to witness these occurrences without being individually traumatized.  Often we’re reminded of painful events from our past experiences, from the collective histories of our ancestors, and even from historical events we’ve learned about. For me it serves as a reminder of my mother’s separation from her parents during the holocaust. While I am not comparing current events to the annihilation of six million people, what I am referring to is the forceful separation of children from parents with no explanation, no explicit plan of reconciliation, nor any knowledge of potential outcomes. If you imagine yourself as a child in this situation the degree of implicit terror is made clear.

One of the most important functions  of parent child relationships is the creation of safety and protection. This is critical to the developing child’s brain and influences both mental and physical health. When attachment to a parent is disrupted the child’s development is derailed and a whole host of problems ranging from difficulty with emotional rergulation, to learning problems, to anxiety, depression, and oppositional behavior are likely to ensue. 

Over time, unresolved traumatic effects can include cancer rates that are double those of the general population, and extremely high rates of alcoholism and suicide (ACEs). Much of the damage already experienced by these children is likely irreparable. They will always remember the abject terror of being separated from their parents. In order to prevent further harm to these children they need to be reunited with their parents right away. My hope is that an organized approach which includes locating the parents who have already been deported, and reunifying these families, will be enacted promptly and efficiently.

References

Green, D. (Host). (2018, June 20). Separating Kids From Their Parents Can Lead To Long-Term Health Problems. [Radio broadcast episode]

http://www.npr.org/templates/transcript/transcript.php?storyid=621872722

https://acestoohigh.com/2012/10/03/the-adverse-childhood-experiences-study-the-largest-most-important-public-health-study-you-never-heard-of-began-in-an-obesity-clinic/

Adverse Childhood Experiences: What is my Score? (Part 2) By Yael Gold, Ph.D.

In my previous post I discussed the “ACE Study”, which looked at the occurrence of Adverse Childhood Experiences in a group of 17,337 adults. It was the largest and most comprehensive study of this type to date and looked at people’s experiences across ten different types of child sexual abuse. The questionnaire utilized for the ACE’s study appears below. If you would like to take it please feel free to, otherwise you may skip down to the section below.

Prior to your 18th birthday:

Did a parent or other adult in the household often or very often… Swear at you, insult you, put you down, or humiliate you? or Act in a way that made you afraid that you might be physically hurt?
No___If Yes, enter 1 __
Did a parent or other adult in the household often or very often… Push, grab, slap, or throw something at you? or Ever hit you so hard that you had marks or were injured?
No___If Yes, enter 1 __
Did an adult or person at least 5 years older than you ever… Touch or fondle you or have you touch their body in a sexual way? or Attempt or actually have oral, anal, or vaginal intercourse with you?
No___If Yes, enter 1 __
Did you often or very often feel that … No one in your family loved you or thought you were important or special? or Your family didn’t look out for each other, feel close to each other, or support each other?
No___If Yes, enter 1 __
Did you often or very often feel that … You didn’t have enough to eat, had to wear dirty clothes, and had no one to protect you? or Your parents were too drunk or high to take care of you or take you to the doctor if you needed it?
No___If Yes, enter 1 __
Were your parents ever separated or divorced?
No___If Yes, enter 1 __
Was your mother or stepmother:
Often or very often pushed, grabbed, slapped, or had something thrown at her? or Sometimes, often, or very often kicked, bitten, hit with a fist, or hit with something hard? or Ever repeatedly hit over at least a few minutes or threatened with a gun or knife?
No___If Yes, enter 1 __
Did you live with anyone who was a problem drinker or alcoholic, or who used street drugs?
No___If Yes, enter 1 __
Was a household member depressed or mentally ill, or did a household member attempt suicide? No___If Yes, enter 1 __
Did a household member go to prison?
No___If Yes, enter 1 __
Now add up your “Yes” answers: _ This is your ACE Score.

You may be wondering what your ACE score may tell you about yourself and I’d like to discuss this, along with providing a few thoughts also, about other factors that can help protect us from the potential harmfulness of These adverse childhood experiences. ACE scores of 4 and higher have been found to correlate with a high incidence of physical illnesses, mental health issues, alcoholism and drug dependency, and interpersonal difficulties.

What this means, is that typically, the more types of traumatic experiences a person endures in childhood, the more difficulty he/she will have later in life. In order to understand this at a deeper level it’s important to know that traumatic experiences affect many areas of our personal functioning including brain development, attachment patterns, the ability to feel connected with our bodies, and emotional regulation. Traumatic experiences also are associated with feelings of shame and self blame, feeling generally unsafe, flashbacks, and dissociation.

I’ll go into these long term effects in subsequent posts but wanted to make sure to also mention that it’s possible for individuals to experience adverse childhood experiences and not go on to develop some of the long term issues mentioned above.

One of the factors that differentiates whether or not long term impact will ensue is whether the child had the emotional support of a caring adult such as a grandparent, aunt or uncle, or a teacher. Feeling valued by a caring individual often helps to mitigate and lessen the long term effects of negative childhood experiences. Similarly, early intervention by helping professionals can help children work though their traumas at a young age.

For adults, “trauma informed” therapy can offer many options for healing from the long term effects of childhood abuse and neglect. This too will be covered in future posts on this blog. My hope is that by reading this post you’ll come away knowing that no one is “doomed”. While we know, beyond the shadow of a doubt, that adverse childhood experiences are detrimental in numerous ways, it is also the case that with compassion, support, insight, and patience, wounds from the past do heal and people go on to be happy and to have meaningful and productive lives.

References

Starecheski, L. (2015, March 2), Take the ACE Quiz [Blog post] Retrieved from: http://www.npr.org/sections/health-shots/2015/03/02/387007941/take-the-ace-quiz-and-learn-what-it-does-and-doesnt-mean

Van der Kolk, B., (2014). The body keeps the score. New York, New York: Viking.

Graphic animation figure- GIPHY app

Adverse Childhood Experiences: Why the past won’t just go away (Part 1).

As a psychologist who provides therapy to adults, I am often struck by how often it becomes clear to me, early on in therapy, that so many of the individuals I treat have survived one or more adverse experiences from childhood. Sometimes these are extreme and fall into the category often referred to as a “Capital T trauma” but other times these adverse events took the form of repeated emotional abuse or neglect over time, resulting in what is often referred to as “developmental trauma” (Van dear Kolk). Either way, it has been intuitively clear to many of us in the field of psychotherapy for a number of years, that direct links exist between individuals’ negative childhood experiences and the myriad of issues that bring them to therapy as adults years later. Fortunately we now have research data that supports and validates these clinical “hunches”.

What is now commonly referred to as the “ACE Study” involved a collaboration between Kaiser Permanente (a managed care consortium)and the Centers for Disease and Control. Although research studies had already looked at specific types of child abuse individually, this was the most comprehensive study of this type to date, in that it looked at ten types of potentially abusive experiences simultaneously. The participants were 17,337 individuals who received routine medical services from Kaiser Permanente at a facility in San Diego. They completed questionnaires between the years of 1995 and 1997 and were subsequently followed for fifteen additional years.The results of this study provided data that unquestioningly bridged the gap between childhood trauma and the long term negative effects that often show up later in life. The Table below provides information about the percentages of individuals  who experienced each of the 10 ACE’s defined in the original study. It is worth noting that at least two thirds of the participants reported having experienced at least one ACE.

The prevalence estimates reported below are from the entire original ACE Study sample (n=17,337).

Prevalence of ACEs by Category for CDC-Kaiser ACE Study Participants by Sex, Waves 1 and 2.

ACE Category	Women	Men	Total
	Percent (N = 9,367)	Percent (N = 7,970)	Percent (N = 17,337)
ABUSE
Emotional Abuse	13.1%	7.6%	10.6%
Physical Abuse	27%	29.9%	28.3%
Sexual Abuse	24.7%	16%	20.7%
HOUSEHOLD CHALLENGES
Mother Treated Violently	13.7%	11.5%	12.7%
Household Substance Abuse	29.5%	23.8%	26.9%
Household Mental Illness	23.3%	14.8%	19.4%
Parental Separation or Divorce	24.5%	21.8%	23.3%
Incarcerated Household Member	5.2%	4.1%	4.7%
NEGLECT
Emotional Neglect3	16.7%	12.4%	14.8%
Physical Neglect3	9.2%	10.7%	9.9%

Note: 3Collected during Wave 2 only (N=8,629). Research papers that use Wave 1 and/or Wave 2 data may contain slightly different prevalence estimates.

Additionally since 2010, Washington, DC and ten states (HI, ME, NE, NV, OH, PA, UT, VT, WA, and WI) have been systematically collecting information about ACE’s with the purpose of obtaining data to support the need for specific types of social programs that address the needs of abused children and their families.

My main hope in writing this piece is to share with you just how prevalent childhood traumatic experiences are. If you’ve had these experiences, please know that you are not alone. Since adverse childhood experiences often occur in the isolation of one’s family home, they can be very stigmatizing and difficult to discuss. This becomes especially true when children are specifically instructed not to disclose these experiences outside of the family. These requests that are often accompanied with explicit or implicit threats. According to Felitti, one of the chief investigators in this study, “Traumatic experiences are often lost in time and concealed by shame, secrecy, and social taboo”. In my own dissertation research I examined the prevalence of disclosure to a trusted person following experiences of child sexual abuse. Sadly, I discovered that as children, the majority of individuals in my study either hadn’t told anyone for fear of negative reprisals, or found that when they did tell, they typically  were met with dismissive responses.

In subsequent posts I’ll offer you a chance to gauge your own ACE score, I’ll go over  the relevance of high ACE scores and how they correlate with mental and physical health challenges, and I’ll discuss how “trauma informed” therapy can assist with the healing process from these past ACE’s no matter how long ago they occurred.

References

http://www.cdc.gov/ace/findings.htm

https://acestoohigh.com/2012/10/03/the-adverse-childhood-experiences-study-the-largest-most-important-public-health-study-you-never-heard-of-began-in-an-obesity-clinic/

Van der Kolk, B., (2014). The body keeps the score. New York, New York: Viking.

Post-election Stress

Despite the ideological divisions in our country, one thing we can all agree on is that this election cycle has been exceptionally stressful. The ITA founder, Dr. Yael Gold, was recently interviewed by WECT News regarding post-election stress. Dr. Gold provided helpful strategies for managing stress related to the election as well as signs that may suggest seeking help from a professional would be beneficial. A link to her interview is below. We hope our followers will find this information helpful in managing their own post-election stress.

Dr. Gold Discusses Tips for Post-election Stress

Introducing Brenda Knierim, MSW, LCSW

Hello friends! Thank you for visiting our newly formed blog: healing insights. I am Brenda Knierim, one of the clinical social workers (LCSW) at ITA. I have been fortunate to be a part of this wonderful group for the past four years!

Being in private practice has taught me a tremendous amount about the resilience of the human spirit and drives me to continue this career path. I truly love my work!

So, a little about me and why I chose social work. Social work has been my passion since the mid 90s when I completed my BSW at Lock Haven University. I found myself simply drawn to the helping profession. Some may say I elicit an easy and compassionate approach. I want people to feel safe and free of judgement. My goal is to truly understand their struggle or situation and jointly create positive solutions for change.
I’ve experienced my work from many different angles and perspectives. I have met with individuals, children and families in their homes , in the community, in shelters, in hospitals, in treatment centers and offices. Each of us from different walks of life , an array of experiences that have shaped us ,yet the same commonality and need for a listening ear or yearn for feedback on a challenging life circumstance .

As Brene Brown states, the courage to “be vulnerable “or to “show up,”  the confidence that each individual has to walk into therapy ready to expose themselves emotionally, now that deserves a stand-up ovation! Everyone has a lesson to teach or a story to tell…my hope is that I will be able to assist even in the smallest way to navigate a path for wellness or to feeling whole again.

So along my journey, I felt compelled to go further with my education after working in the field for many years. I completed my MSW at UNC-Chapel Hill in 2007 and immediately pursued my clinical license. I wanted to go all the way and so I accomplished that goal after a long three-year program. Of course it was worth it!

I look forward to meeting you as well as having the access to post on interesting topics or innovative therapeutic interventions!
While I’m away from ITA, you can catch me at the beach, reading, or spending time with my husband and three children.

Introducing Dr. Yael Gold

Hello my name is Dr. Yael Gold. I am a licensed psychologist who has been living and working in Wilmington, NC for the past 22 years. Also, I am proud to have been affiliated with Integrated Therapy Associates (ITA) since its formation 10 years ago and I’m thrilled that we’re starting this blog. Let me tell you a little about myself.

I consider myself to be very fortunate in that I find my work as a psychotherapist to be both extremely fulfilling and endlessly rewarding. In fact I often wonder whether I chose this field or whether it chose me! Day in and day out I am deeply moved by the courage of the clients I serve and by the tenacity and resilience of the human spirit. As the daughter of a Holocaust survivor, I have witnessed firsthand, through my mother, what it means to rise above our own circumstances in order to do good in the world. At age 85, my mother, who is a retired therapist in her own right, continues to find ways to help others. She currently volunteers at a soup kitchen in New York City where she helps to feed those in need of a hot meal.

As for me, I am dedicated to a lifelong process of expanding my knowledge of the factors that promote growth, wholeness, well being, and a sense of meaning in our lives. Likewise, to the extent that we find ourselves facing obstacles based on past experiences, I do my best to help my clients overcome anything that might be blocking them from reaching their full potential. I believe that we’re each a tapestry woven from our experiences across our life time, our unique dispositions, and the ways in which we’ve attempted to make sense of these experiences. I also believe that the true self emerges as we sort through and heal from our past difficulties.

As a therapist and in my new role as a blogger, I am committed to staying engaged in my own growth process throughout my own lifetime. As I’m made aware of new and exciting developments in the field of psychology and beyond, I am passionate about passing them on to my therapy clients as well as to a broader audience, to you the readers of this blog. I hope that my contributions to healing insights are helpful to you wherever you might be on your own personal journey. Here’s to your wellbeing!

Intro and Welcome

Welcome to “Healing Insights”, Integrated Therapy Associates’ new blog! We look forward to having this new vehicle for communicating with you. We are a holistically oriented group of six practitioners in private practice all providing services under one roof. Currently we’re comprised of five psychotherapists and a registered dietician. Our intention for this blog is to focus our posts on topics related to the integration of the mind, body, and emotions as this pertains to mental health and emotional healing. At times we may also focus on the role of spirituality. We’ll  start with an introduction by each of our practitioners so you can get a better idea of who we are as individuals. New posts will appear about once every two weeks. We hope that you’ll find our posts to be informative, thought provoking, and inspiring!