Three on-the-ground skills for managing flashbacks.

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Flashbacks are entirely about our brain getting worried that Here and Now is actually Back There and Back Then. 

What happens is, your brain gets triggered by something. You’re exposed to something sensory— a sight, a smell, a sound— or a situation that your brain knows full well is associated with something traumatic you went through. 

“HEY!” your brain says. “I KNOW THIS (sight/smell/sound/whatever)! IT’S ASSOCIATED WITH BACK THERE AND BACK THEN…AND BACK THERE AND BACK THEN WAS DANGEROUS!!” 

Your brain’s trying to do a good thing here. It’s trying to keep you safe. That’s kind of its most important goal: to keep you alive and away from pain and danger. 

So your brain, having sensed the presence of a trigger it associates with Back There and Back Then, really, really wants you to pay attention to what it has to say— right here, right now. 

Your brain really, really wants you to know that “BASED ON MY CALCULATIONS, WE MAY BE IN DANGER!” 

So what it does is what anybody does when it wants you to pay attention to it right away: it barges in and demands your attention. 

This is why flashbacks feel so abrupt and intrusive: because your brain is literally interrupting whatever else is going on with you in that moment, to try to get you to pay attention to it. 

The thing is, your brain isn’t always great at using its words. It can’t just SAY to you, “Hey, I’m sensing the presence of something I strongly associate with danger— can we just stop and make sure we’re not Back There and Back Then, please?” 

The brain’s often not quite that articulate. Plus, in fairness, it’s triggered and kind of panicky. 

So instead of using words, the brain uses pictures. 

Big, immersive, intrusive pictures. 

That’s why, when you’re triggered, a flashback seems so all consuming, as if you were plucked from your seat in the movie theater and thrust into the movie itself. 

Your brain is literally doing everything it can to arrest your attention and remind you of why we want to avoid anything associated with Back There and Back Then. 

It’s essentially saying to you: “HEY, REMEMBER THIS? REMEMBER HOW SCARY AND OVERWHELMING IT WAS? THIS IS WHY WE WANT TO AVOID THIS THING, YOU KNOW?” 

Again: it’s important to remember that your brain is trying to help here. It really is. 

So what are the specific skills necessary to get out of a flashback once it’s been triggered? 

Your mileage may vary, but for most people it’s a combination of grounding, emotional focus shift, and self talk. 

Grounding is using your senses to reestablish contact with the present moment. What this does is reorient you to time and place, so you’re not swept away in the movie your brain is trying to stick you in the middle of. 

The easiest way to get grounded is to make sure your feet are on the floor; make sure your eyes are open; and then look around you, identifying three things you can see, three things you can hear, and three things you can physically feel. 

Emotional focus shift is a skill wherein you use an emotionally-charged tool to introduce a competing emotion to the fear and panic that your brain is experiencing. Your nervous system has trouble processing two completely different emotional states at once, so you’re trying to stoke an emotion— even a little bit— that can compete for bandwidth in your brain with the fear and panic. 

This can be accomplished by listening to a song (I have my patients create emergency playlists for just this kind of thing); reciting song lyrics; reciting or reading quotes that are meaningful to you; looking at pictures of your kids; or quickly accessing an emotionally charged memory (like your wedding, your graduation, your Confirmation, or another occasion that evokes a strong emotional response). 

Self talk is exactly what it sounds like. You’re trying to reassure your brain that you are not Back There, Back Then. Your brain literally needs to be convinced, in order to let go of the flashback. 

What this looks like on a practical level is you building the case that you are not Back There, Back Then. It may sound strange, but you start at the beginning, and calmly, patiently explain to yourself how you know you are Here and Now. 

You observe what’s different between Here and Now and Back There, Back Then. You remind yourself of who is in your life now, that wasn’t then. You remind yourself of the year. You remind yourself of where you physically are. You can even go so far as to reference specific pieces of clothing or jewelry you have on now, that you didn’t even own then. 

Grounding, emotional focus shift, and self-talk are three on the ground skills to manage flashbacks. 

Lowering your vulnerability to flashbacks is the work of longer term therapy. It can’t be rushed, and it requires you to develop multiple skills and interrupt multiple patterns. 

But for starters: try those three skills and their associated tools. 

Trying to use any skill is better than surrendering to using no skills. 

 

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Let’s talk self-esteem and narcissism.

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When we believe one thing, but we’re acting like we believe something else— our self esteem suffers. 

It’s a particular problem when we believe one thing, but we’re forced, by circumstance, to do things that are not consistent with what we believe. 

It’s usually not our fault. 

Usually we’re being bullied, or threatened, or deceived into behaving the way someone ELSE wants us to behave— but not in accordance to what we truly believe. 

Our self esteem is sensitive to contradiction. It’s sensitive to whether we’re walking our talk— or whether we’re talking a good game, but not following through. 

Normal people with the potential to be psychologically healthy struggle with a phenomenon called “cognitive dissonance” when our walk doesn’t match our talk. 

We’re aware that something’s not right when we’re being inconsistent with what we believe. It nags at us. It makes us anxious. 

And, over time, if we consistently fail our own standards and don’t follow through on what we say we’re all about, our self esteem suffers. 

It’s just hard to have healthy self-esteem when we’re all over the place with our beliefs and our behavior. 

There is a subset of humans who AREN’T bothered by the disconnect between what they say and what they do, however. It’s questionable whether these people even experience cognitive dissonance like the rest of us. 

Those people are called narcissists. 

Narcissists tend to consider it okay to not behave consistently with what they say they value— because they don’t believe the “rules” apply to them. 

They think of themselves as “special.” Everybody else might have to walk their talk and behave consistently with their own values— but not them. 

It’s not that narcissists are “bad people.” I’m not a fan of slapping moral labels like that on to people because of how they process information and the world around them. 

(And, when we’re talking about narcissism, that’s what we’re talking about: narcissists truly experience the world in a way that convinces them they are the center of it.)

But it is important to remember that narcissists don’t feel the obligation to live up to their stated values the way the rest of us do. 

Whether or not we think of them as inherently “good” or “bad” people— it objectively makes them harder to trust. Because a narcissist doesn’t feel an obligation to the truth like the rest of us do. 

The reason why lie detectors work is because most of us get anxious when we knowingly tell a lie. That anxiety ripples through our bodies and is often detectable in biometric markers like our blood pressure, heart rate, and galvanic skin response, even if behaviorally we can remain more or less stoic. 

One of the reasons why lie detectors aren’t considered reliable forensic evidence, however, is because narcissists and sociopaths don’t feel that anxiety like the rest of us. They consider it perfectly fine to say what they need to say to elicit a certain response from the people around them. 

Why does any of this matter? 

Because, when we’re building our self esteem, we need to acknowledge the important role of consistency. 

We need to be consistent with who we say we are and what we say we believe if we’re going to build health self esteem. 

We need to walk our talk. 

We need to be true to ourselves, if we expect to like, respect, and— yes— esteem ourselves. 

It also matters because there are people around us who are not wired like us. 

We don’t need to judge them— at least, not on the basis of their neuropsychological wiring alone. 

But we do need to be careful when trying to relate to them. 

Stay true to yourself— and keep your eyes open. 

 

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The lies depression tells.

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Depression lies to you. 

When you’re depressed, you see the world through a filter. And that filter doesn’t let a lot of light in. 

That filter makes things seem true that are not. 

Depression has an array of lies it tries to tell you. 

“You are worthless.” 

It’s a lie. You may FEEL worthless; but our worth is not determined by how we feel. 

Many people have faulty ideas for what makes someone “worthy” in the first place. They believe that accomplishment or the love of others makes someone “worthy.” If that was true, then rich and famous people would be somehow more “worthy” than non rich and famous people— but that’s obviously not true. 

“Nobody loves you.” 

It’s a lie. Your depression is not keeping track of who loves you and who does not. 

It wants you to believe that nobody loves you, because it knows you are insecure about your lovability (possibly because of your beliefs about what makes someone worthy— see above). 

“You don’t matter.” 

It’s a lie. Your depression does not get to determine whether your life, your feelings, or your behavior matters to anyone else. 

I assure you, you matter to someone. I can also assure you that when you’re depressed, you have a tremendously difficult time believing you matter. But that doesn’t make it true. 

“Things will never get better.” 

It’s a lie. Your depression doesn’t know if things will get better. 

You cannot tell the future, and your depression ABSOLUTELY cannot tell the future. 

“Everybody hates me.” 

It’s a lie. Just like your depression cannot tell the future, your depression cannot read others’ minds. 

Your depression wants you to THINK that other people dislike or hate you, because it knows that is a tremendously effective way to keep you depressed. 

You may start to notice a pattern here: your depression is making this up as it goes along. 

There’s no truth to any of it. 

But your depression is very, very good at making you THINK there’s truth to it. It knows you’re in a vulnerable spot, and it knows it doesn’t have to work very hard to make its lies seem very plausible to you when you’re in that spot. 

Depression is a bully. 

Depression is a coward. 

Depression is a liar. 

Depression comes disguised as a familiar old blanket, that may be a little coarse, but c’mon, at least it’s a known quantity, right? 

Depression comes disguised as a friend, a friend who really knows you well, a friend who knows the TRUTH about you, a friend who will tell it to you straight. 

It is none of those things. 

Depression doesn’t know you. 

All it knows about you are your vulnerabilities and your insecurities. Which it wishes to exploit. 

Friends don’t do that. Bullies do that. Abusers do that. 

Don’t let depression lie to you. 

 

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Beyond “it’s not your fault.”

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Many abuse survivors get told, over and over again, that it’s not their fault. 

I was sexually abused as a kid. I was told it’s not my fault. 

I’m not sure I necessarily ever thought it was my fault. 

I think I kind of had it in my head that I was sort of at fault, at least in a collaborative way. I knew that I had chosen not to tel my parents about  what was going on, and that that had likely given my abuser— a family friend, who regularly babysat me— both the opportunity to keep abusing me and the confidence that he wouldn’t be found out. 

So I suppose I sort of had the idea in my head that it was kind of my fault that the abuse continued. 

But I never had it in my head that I was getting abused because I was somehow a “bad” kid. 

I don’t remember ever thinking that I “deserved” what was happening to me. 

The thing is, however…I DID think I was a bad kid. But not because I was getting abused. 

Growing up, I didn’t have a lot of friends. I was an awkward, intense kid. 

I was EXTREMELY sensitive, and I just didn’t naturally have the tools I would have needed to connect easily or well with my peers. So I got rejected a lot. 

Which meant I was a lonely kid. 

I know now that I was also an anxious and depressed kid, who was struggling with Attention Deficit Hyperactivity Disorder— but at the time, from inside the fishbowl, there was no way I would have had the words for any of that. 

All I knew was that I was not popular. 

And I assumed THAT was because I was a bad kid. 

I didn’t think there was something wrong with me because I was being sexually abused. I assumed there was something wrong with me because no one wanted to hang out with me. 

Why am I telling you any of this? Because I want you to remember that how we think about ourselves— our ideas of whether we are good or bad, worthy or unworthy, normal or abnormal— are complicated. 

It’s often stated that abuse survivors often develop a sense of shame about being abused, because they assume they must be at fault. 

(Often, abuse survivors are explicitly TOLD they are at fault, over and over again.) 

But for many abuse survivors, that’s only one piece of the puzzle. 

If you are working to relate to someone who has been abused, or if you are struggling to come to terms with your own abuse history, I want you to remember that the aftereffects of abuse are frequently not straightforward or predictable. 

Knowing that I was sexually abused may tell you a part of my story. 

But if you didn’t know the rest of my story— about the social alienation, the highly sensitive temperament, the ADHD— you wouldn’t really know me as a kid. 

People are complex. 

Our histories are complex. Our stories are complex. Our reactions are complex. 

To really know someone— especially yourself— you have to dig deeper. 

Many people struggle with emotional pain that is not readily explained by what we know about abuse survivors, or depression, or anxiety. 

Everybody’s pain is unique. 

It can only be understood with patience and compassion. 

Please: extend those to both yourself and the people around you today. 

 

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Getting older doesn’t mean what you think it does.

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You know how they say that “age is just a number?” 

I can assure you, it’s definitely more than “just a number.” 

But I can assure you also: age is not what the culture wants you to think it is. 

What does our culture try to tell us about age? 

You don’t have to look too far to find the answer. 

It tries to tell us that the most exciting times of our life are childhood and young adulthood— those times when we are just learning, just discovering, just exploring the world for the first time. 

Look at movies, TV shows, popular entertainment of all sorts: to say they focus disproportionately on young adults (conventionally attractive young adults, for that matter) is an understatement. 

When the culture portrays older people, it’s often in the context of how they can be mentors or resources for younger generations. That is to say: the younger characters still tend to be the stars and the focus of the adventure. 

This has emphatically been the case for as long as I can remember. 

Life so very, very often seems to be contextualized by the world as something primarily driven by “the young”— and very often older people are presumed to want to return to their youth. 

Old people are often assumed to be tired. Worn down. Jaded. 

Don’t get me wrong, I’ve worked with a lot of old people who ARE tired, worn down, and jaded— but I’ve also worked with an awful lot of young people who are tired, worn down, and jaded, as well. 

Moreover, I’ve worked with many older people who assume that they’ve somehow missed their chance to live an interesting, meaningful life, simply because they’ve passed a kind of arbitrary age cutoff. 

It’s true that, as we get older, it’s often harder to make our bodies conform to what the culture considers conventionally attractive. The pounds tend to be a little more stubborn; the skin tends to sag; the hair (on our heads, and elsewhere) tends to go into business for itself. 

But there is absolutely no reason why, as we get older, we cannot continue to create and enjoy a life that is meaningful, interesting, and fun. 

There is definitely no reason why, as we get older, we cannot build relationships that are not only deep and satisfying on every level (including physically)— but actually way more satisfying than any relationship even COULD be when we’re younger. 

Age is not “just a number.” 

It is experience. It is knowledge. It represents opportunities to learn what works and doesn’t work for you; what you like and what you don’t like; what you need more of and what you need less of. 

Age is really what makes it possible to live a life beyond the superficialities of appearance. 

As I write this, I’m 42 years old, on the cusp of turning 43. Statistically speaking, I’m maybe at about the halfway point of my life, assuming I don’t behave too stupidly in the upcoming decades. 

If you’d asked 20 year old me, he’d have told you that 42 seemed pretty grown up. 

20 year old me didn’t have a clue. 

If I’m any more grown up than I was, it’s ONLY to the extent that I now realize how child-like we ALL are in the grand scheme of things— intellectually, behaviorally, and ESPECIALLY spiritually. 

It is not easy to break free from the cultural conditioning about age and growing older that we are ALL relentlessly subjected to. 

But I want you to try. 

Because you have a life to build here— and that idea that all you can do is be the “wise old mentor” to a younger generation is gong to just drag you down. 

You REMAIN the hero of your own movie. 

Don’t forget whose movie this is. 

 

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No one else is going to seek out your needs for you.

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You may hate being told what to do. 

Or you may love it. 

Being told what to do may be the absolute worst thing, to get you to take action. 

Or it may work like a charm. 

People have very different relationships with and experiences of control and agency— and neither is “right.” 

The “right” relationship to control and agency is the one that works for YOU. 

There are a lot of people who will tell you that the only “right” way to respond to being controlled is to rebel— that no one should be able to tell you what to do. 

I agree that no adult should be forced to do anything against their will. That, in the end is slavery, and slavery is never okay— no matter what it comes disguised as. 

But I also think that a lot of people have been made to feel bad, inadequate, or unintelligent because their experience of submission is one of relief and freedom. 

For some people, it’s a normal and healthy impulse to submit to guidance and mentorship that they choose (and which they can opt out of when they choose). 

My point is not that either response to control and agency is “right.” 

There are lots of different people in the world with lots of different motivational matrices and learning styles. 

What motivates me might infuriate you. 

What causes me to try harder and take risks might make you rebel and shut down. 

What’s more, what motivates me in some situations or with some people might completely infuriate me and lead to a meltdown in other situations. 

It’s our responsibility to always be gathering data on what works for us. 

Even if you’re the type of person who functions better when you’re being closely guided and supervised, it’s STILL your responsibility to know what works for you— and to seek out situations and relationships that fit your motivational style. 

I’ve seen lots of people try, and try, and try to cram themselves into someone else’s idea of what works for them. 

I’ve seen people who naturally crave a great deal of freedom, autonomy, and creativity try to submit themselves to the mentorship or leadership of other strong personalities— with disastrous results. 

I’ve also seem people who are naturally more comfortable with submitting to the structure, guidance, and instruction of someone else, try to assume leadership roles they didn’t wan tor need…with equally disastrous results. 

What works for you is what works for you. 

You don’t need to justify it. 

You don’t need to feel bad about it. 

You don’t need to fit perfectly into someone else’s “box.” 

See clearly and seek out what works for you. 

Whether you function better from the top or the bottom— seek it out. 

Whether you work best at a faster or slower pace— seek it out. 

Whether you need a lot of structure or more creativity and flow— seek it out. 

No one’s going to seek it out for you. 

Once we quit apologizing for who we are and what we need, and assume responsibility for seeking it out, our life changes dramatically. 

The road ahead might be tough when we’re clear on and committed to our needs. But building stable, healthy self-esteem is worth it. 

 

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Trying to outrun your symptoms WILL make them worse.

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You can’t manage symptoms you’re running away from. 

In order to manage symptoms, we have to accept that we’re experiencing them, be able to describe them, and investigate what triggers or exacerbates them. 

We have to look at them, in other words— even if we’re afraid. 

We have to look at our symptoms even if we’re disgusted. 

We have to look at our symptoms even if we’re worried about becoming overwhelmed— or feeling overwhelmed. 

That doesn’t mean we have to like our symptoms, though. 

It doesn’t mean we have to pretend we’re not afraid of them or frustrated by them. 

Make no mistake: I get why so many people run away from their symptoms as fast as they can. 

I get why people effortfully deny and disown their symptoms. 

It’s because symptoms suck. 

They’re painful. 

They  make us feel weak and inadequate. 

Usually the very LAST thing ANY of us want to do is hang out with our symptoms for any length of time— let alone get curious enough about them to keep track of when they’re occurring, how they’re occurring, and what triggers are sparking them or feeding them. 

It’s completely normal to WANT to run away from our symptoms. 

But, if we want to get better, we don’t have that option. 

Trying to outrun our symptoms may, in the short term, produce a decrease in anxiety. 

Many of our symptoms, especially when we’re talking about post traumatic symptoms, trigger what’s called the fight/flight/freeze response, in which our sympathetic nervous system takes over our decision making and does what it thinks it needs to do to survive. 

Thus doing whatever we can do to just get away from our immediate experience of our symptoms makes a lot of sense— to our revved up sympathetic nervous system, that is. 

The thing is, when we run away from our symptoms, we are GUARANTEEING that those symptoms will stick around. 

We can’t change anything about those symptoms in a positive way if we’re constantly trying to avoid thinking about, let alone experiencing, them. 

The only change that will happen as a result of avoiding our symptoms is, they WILL get worse. 

Why? Because the temporary decrease in anxiety we experience by running has negatively reinforced that behavior. 

(Negative reinforcement happens when a painful stimulus is removed— such as what happens when anxiety decreases. Whatever happened to cause that removal of pain becomes “reinforced,” meaning it’s more likely to happen again— and we say it’s been “negatively” reinforced because the reinforcement was accomplished by removing something.) 

We don’t need to run from our symptoms. 

We do need to figure out what skills and tools are necessary to tolerate our symptoms long enough so we can stay present and actually deal with them. 

Fear and disgust have a way of convincing us that we can’t handle situations that we actually CAN handle. 

You’re capable of handing a lot more than you think you are. 

We really do have to make a choice: retreat from our symptoms, or stand our ground and actually try to deal with them? 

Only one of those options has a long term benefit. 

 

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