understanding resonse to trauma

[@taniasuzukipichlercastilho2900]

Patricia! I've been binge watching your videos!! I love your clarity! Thanks so much for putting all this wisdom out available here!!!

[@patriciacoughlinphd1852]

My pleasure

[@SylviabombsmithUjhy75bd34]

You can't choose how you are going to respond to trauma anymore than you can choose what meaning you want to ascribe to something. Both are unpredictable, but not undetermined. "You can prefer a choice, but you can't choose your preferences". All the people in the normal part of the distribution do not experience ptsd because they (through no fault of their own) were lucky enough to have the nervous systems, genes, and experiences which where protective factors against them developing ptsd in the face of truama. "Distributed causation" is difficult for people to grasp, yet we do live in a mechanistic, determined world..

[@patriciacoughlinphd1852]

As Victor Frankl noted in "Man's Search for Meaning" our final freedom is the freedom to choose our attitude no matter the circumstances - and this from a man who was in a concentration camp and lost his whole family during the Holocaust.

[@SylviabombsmithUjhy75bd34]

@@patriciacoughlinphd1852 However, unfortunately, people do not "choose" whether or not they realize they can "choose" their attitudes etc. Even THAT is a matter of luck. It's luck all the way down Patricia, with no room for agency/free will. The Buddhists recognized this illusory nature of the "self" some 2500 years ago, and now neuroscience is beginning to confirm it. For example, Daniel Kahneman's System 1/System 2 can be thought of as the unconscious/conscious. Or Implicit Biases can be thought of as the unconscious. Or attachment theory, traumatology research, and even psychodynamic approaches all share the tacit recognition that nothing happens "randomly" (i.e., distal disturbances cause disturbances in the present). Yes I love Victor Frankl, especially his contention that just as there is a statue of Liberty on the East Coast, so too should there be a statue of Responsibility in the West Coast, as too often people only want to take the liberties, without taking the responsibility...

[@SylviabombsmithUjhy75bd34]

@@patriciacoughlinphd1852 But to get back to this point...people are ALWAYS choosing, whether they are choose to remain "stuck", or pull themselves up by their bootstraps and get out of the rut, both are a choice. This is why the critique of "fatalism" that determinist's sometimes face doesn't make sense. People will say: "well if nobody has any free will, then why do anything? why not just sit on the couch and let life happen to you if everything's already predetermined??" The answer is, TO DO NOTHING IS A CHOICE TOO! That IS a choice, YOU ARE ALWAYS MAKING CHOICES, what really matters is what you attribute your choices to. Do you erroneously attribute your success to "your" hard work, or do you recognize distributed causation and all the things that led you to where you are (of which you had no control over, and therefore can take no credit for). This deterministic view does great work to alleviate feelings of guilt/blame/shame in clients when they see they are not responsible for their feelings and thoughts. People who usually tend to reject this are successful people (cough cough), because it implies they cannot take credit for their successes...nobody chooses how they turn out, or their personality, you just are who you are in every moment based on how life has shaped you up until that point.

[@patriciacoughlinphd1852]

Actually the research is clear that such a fixed and deterministic view of things is associated with depression and low levels of functioning.. I would suggest acquainting yourself with the research of Carol Dweck on fixed vs growth mindset and Ellen Langer's work on the power of mindfulness - noticing new things and questioning all assumptions.

[@SylviabombsmithUjhy75bd34]

@@patriciacoughlinphd1852 Yes! Excatly! The Stanford Neuroendrocrinologist Dr. Robert Sapolsky reminds us that from this perspective "Major depression can be seen as a pathological failure to rationalize away reality, highlighting the importance of our ability to maintain a sense of agency for our well-being". Respectfully, I would rather know what is true rather than engage in self-deception (the anathema of psychodynamic work) for the sake of what makes me feel good/functional. To this end, we may have reached an epistemological impasse... I would also push back/challenge the assertion that such a deterministic worldview necessitates "fixed" ways of being. People can still act in ways that they feel are "autonomously free will choices"...that doesn't stop...all I'm saying is that it matters what they end up attributing those choices to...Finally, whether someone has been endowed with a "growth mindset" or conversely a "fixed mindset" is yet another instantiation/instance of luck..you cannot escape it..

[@heiditrydal9287]

Thank you Patricia for this important video with all very interesting and powerful examples of how the most important factor is the persons ability to deal with the complex feelings connected to traumas and emotions in a meaningful way. I find literature and research on post-traumatic growth extremely interesting and share my knowledge of this topic with my patients. It very often gives them hope and enhanced strength to work through feelings connected to their own traumas or negative experiences

[@patriciacoughlinphd1852]

Thanks Heidi!

[@ApatheticGod0]

'what do they make it mean?' what fascinating, profound question I've never asked myself before. I've never studied psychology, so I always assumed trauma is something that happens to you. while it is, it isn't only that. perhaps trauma is more like a physical wound: it consists of both the trauma but also the reaction to that trauma which can cause secondary trauma. Sometimes we think of what happened but perhaps we don't think of HOW people react to it. I think that might be just as important as what happened to them.

[@patriciacoughlinphd1852]

Just as important, or more so. What we make it mean and how we deal with the intense feelings that traumatic events trigger is what determines outcome.

[@maryo4863]

Critical Incident Stress Debriefing is on the list of potentially harmful psychotherapies, along with Dissociative Identity Disorder related treatment, and Recovered Memory Therapy among others. "Trauma therapies" like that are often very dangerous and detrimental to the patients. I lost many years of my life to the aftereffects of "DID" related therapy. Your video is a good reminder to clinicians to avoid thinking about "trauma" in some of the usual ways.

[@patriciacoughlinphd1852]

Thanks.

[@taniasuzukipichlercastilho2900]

Hello @maryo4863. Thanks for your comment here. I would love to hear more about your experience around DID related therapy. Wondering if and how we could connect...

[@RenskevdWaal]

One very important aspect is not mentioned in this video: a global research on trauma in war torn countries and western countries etc showed a shocking discovery that in wealthy war free countries trauma is significant higher. This due to lack of collective support of the trauma like within war torn countries and the notion of "you should be happy"/ you have it all. Trauma survivers cary there burden more alone and feel less validated in there experiance. This leads to more symptoms and deeper longer lasting affects. I wasnt there, but I can see why 911 could result in these test results. Because it was collectively grieved, instead of a sexual abuse situation where the person was very isolated for a long period of time. Yet overal thank you for you videos I've learned a lot! Keep up the good work! :D

[@patriciacoughlinphd1852]

You are absolutely right. The fact that everyone acknowledged what happened on 911 and publicly expressed a myriad of feelings about it was a huge factor.

[@jonz9296]

Thank you, Patricia. Please keep making videos. Your knowledge and presentation skills are invaluable. I definitely think some of my patients make their life about trauma, almost as if identified with it. It’s very sad.

[@patriciacoughlinphd1852]

Thanks for the encouragement.

[@newcures7813]

Thank you. I appreciate your videos 🙏

[@patriciacoughlinphd1852]

Glad they are helpful!

[@BrandonYarnsMD]

Love it, Patricia! Great video and very important 😊

[@patriciacoughlinphd1852]

Thanks Brandon. I appreciate that!

[@valduguay5773]

Love this, thank you

[@swedishfolkrap3175]

I feel like 9/11 was so widely understood as a tragedy that the consequential patriotism/such fostered a sense of comfort/support for those affected. I'm overall interested in the role of compassion and what constitutes resilience-- I'll have to read more on that. The idea of them getting worse upon seeking therapy also gives me the impression that maybe they weren't all that well beforehand? Like, isn't a kind of regression to be expected when you, say, "pop a bottle open?" Not meaning to argue-- I think I misunderstand, or maybe even disagree, about what qualifies someone as "worse."

[@patriciacoughlinphd1852]

We all have different experiences and opinions. That's what familiarity with the research is so important. Check out Bonanno's work.

[@dkmagos]

but why do some struggle with making meaning on events in an effective way? Why do some have difficult relationships with their private experiences? Could traumatic sequalae impair these abilities? (some evidence points to possible biological natal underpinnings - "anxiety sensitivity" and neurodivergence etc. OF course this opens doors to remain in a victim mentality but still, can help with context and compassion in a healing recovery. Also, ome evidence (I think) shows that people who are overly "resilient" may rate higher on NPD/Anti-social scales. In other words resiliense perhaps is tempered by other pro-social emotions and behaviors (shame, the tribe, empathy, etc.). In the end your point is empowering for patients - and implies to me the following: you DO Have the capacity to change the relationship with your feelings and make effective meaning out of it, and you're not a loser for having done so in the first place. (thats my own shit there hah) Great video as always, thank you Dr.!

[@dkmagos]

also, those were very moving, powerful stories.

[@patriciacoughlinphd1852]

Yes, it's good news. We are not our circumstances. In contrast, our mindset has a huge impact on health and well being.

[@SylviabombsmithUjhy75bd34]

@@patriciacoughlinphd1852 Again, nobody chooses their "mindset", or even whether they have the motivation, desire, internal resources, commitment, dedication, whatever to change......that is a matter of luck (variance in baseline personality traits/characteristics). Anyone who has dabbled in mindfulness meditation will tell you it is impossible to "think about, or choose your thoughts before you think them", or "feel your feelings before you felt them". Thoughts and feelings emerge spontaneously, but not randomly. NO LEAF FALLS RANDOMLY (it just appears as if it does, but individual wind currently are actually blowing it). You are being fool'd by the illusory nature of agency that our hominid brains have evolved to see (for albeit adaptive reason).