by Tara J Lal
Life continues to surprise me in its twists and turns, but I’m excited for what the future may hold. Perhaps there’s another book in the making, perhaps there’s a TED talk, and hopefully a completed PhD. Or perhaps life will throw some more curve balls. I’m better at catching them these days.
Stay safe, live large, stay connected, find meaning and be bold.
Tara x
TRAUMA AND POSTTRAUMATIC GROWTH (PTG)
When a psychologist first mentioned to me that what I had experienced during my childhood was trauma, I didn’t believe her. In my head, a few people had died and I grieved. That was it. I have since come to understand that my childhood experiences were, in fact, deeply traumatic. Trauma comes in many forms: suicide, sudden loss and parental illness in childhood are just some of them. In fact, trauma can be any event or ongoing intense stress that shatters our sense of safety and trust in the world. Despite what we hear in the media, trauma is equally if not more likely to manifest itself as depression, anxiety or substance misuse as it is in post traumatic stress disorder (PTSD). Whilst I didn’t ever suffer from PTSD, I did suffer the effects of trauma in my childhood and they played themselves out throughout my life, in terms of my behaviour, thought patterns and emotions. Adverse childhood events are one of the primary risk factors for subsequent mental illness because of the way that they change how our brains develop, impacting on the reactivity of certain areas in our brains and the neural pathways and connections that are laid down. Learning this made me realize that I had not simply imagined my hypersensitivity to stress and rejection. It was hard wired in my brain. It gave me compassion for myself as to why I had to work so hard to form secure attachments in my relationships and to change some of my destructive behaviours.
The upside of trauma is the potential for post traumatic growth (PTG). PTG has been defined as the positive psychological changes that can occur in the wake of trauma as a result of the struggle with highly challenging and stressful life circumstances.1 It is not merely the return to normal functioning after a period of adversity. It is essentially a transformational process which results in fundamental changes in the self, in relationships and in one’s outlook on life. It is characterized by some or all of the following: a greater appreciation of life, an increased sense of personal strength, closer relationships, an openness to more meaning and possibilities in life and spiritual development.
Recently I came across some research that suggested there is an inverse relationship between resilience and post traumatic growth, meaning that those individuals that are resilient are less likely to experience growth after trauma because they don’t struggle enough to drive it. It is the struggle to accommodate the trauma into one’s life view that creates the growth.2 I hope that anyone reading this who may be in the midst of their fight can draw hope and courage from this. I was not what I consider to be a resilient child and I struggled for many years. I often think that the depth and extent of my struggle was directly proportionate to the growth that I now feel. Only now do I bear the fruits of my labour. It’s never too late. Research has demonstrated that PTG can and does continue to evolve many years after the event.
In this edition I wanted to add a section on tools that helped me. In doing so I must acknowledge the wonderful book What is Post Traumatic Growth? by Miriam Akhtar3 for which I wrote a case study. What follows is a fusion of the things that I used along the way to help me grow and the evidence for them, much of which is put forward in Miriam’s book. Each and every tool, at different times, served their purpose in processing trauma and driving growth.
1 Tedeschi, R. G., & Calhoun, L. G. (2004). Posttraumatic growth: Conceptual foundations and empirical evidence. Psychological Inquiry, 15(1), 1–18
2 Moore, M. M., Cerel, J., & Jobes, D. A. (2015). Fruits of trauma? Crisis
3 Akhtar, Miriam. What is Post-Traumtic Growth? Published by Watkins, London, England 2017
My Tool Kit for Growth
Tools to stabilize the ground:
As I said, trauma and loss can take the solid ground from beneath our feet by shattering our sense of safety and trust in the world. The simple tools that follow helped to give me a solid enough footing to enable me to do the emotionally hard work involved firstly in recovery and later in growth. None on their own ‘fixed’ anything, but together they are a powerful ‘stabilizer’ that helps to give some solidity to the ground on which you stand.
Sleep: Sleep is when our body and our brains recover and process information. Unfortunately, it can also be hard sought after trauma as our body goes into ‘fight flight’ mode. All the other ‘stabilizers’ I mention can also assist with sleep. Aim for seven to eight hours per night. Sleeping between the hours of 10pm and 1am is particularly important as this is when we tend to experience deep sleep. Sleep can be improved by avoiding food, alcohol and the use of screens in the two hours before bed. Keeping the room cool, dark and quiet is also helpful, as is establishing a wind down routine that works for you.
Healthy food: Evidence is mounting for the impact of our diet on our mental health (www.foodandmoodcentre.com.au). It’s worth using a food and mood app to help keep track if you’re not sure. Keeping it simple works for me (bearing in mind I don’t have any food allergies or intolerances). I stay away from sugar and processed foods, eat a lot of fresh vegetables, legumes and brown rice and drink a lot of water.
Exercise: It is now well known that exercise helps relieve depression. In terms of trauma it can help to use up some of the excess adrenaline and ‘fight flight’ hormones that the body produces under stress. Gentle to moderate exercise is best and will have the added benefit of helping you sleep. Even better is if you do something you enjoy, with people you like and do it outside in a natural environment. This is why I call rowing ‘boat therapy’.
Breathing (and mindfulness): Breath brings oxygen to our body. It is the essence of life. Just ten slow deep breaths, in through the nose and out through the mouth focusing on the sensation of the breath, can help to dampen down the fight flight response in our body and activate the ‘rest and digest’ response). There are many good mindfulness based apps available now. I have used Headspace, Smiling mind and Calm.
Limiting or avoiding alcohol: I do drink alcohol and I love a good glass of wine with dinner. If I’m feeling wobbly, however, I steer away from it entirely or limit it to one or two glasses of wine with a friend. Alcohol is a mood amplifier and I certainly am aware that if I’m struggling, it will make things worse. It also negatively affects the quality of your sleep. A good question to ask yourself is ‘why’ you are drinking. If it is to numb or cope with a difficult emotion then it’s a good indicator to steer clear.
Limiting caffeine: I LOVE good coffee, so this measure is reserved for extenuating circumstances of extreme stress. I also don’t drink caffeine in any other form, like soft drinks. Unfortunately, caffeine is not good for anxiety, so I do recommend that if you’re anxious you limit your intake.
The heavy-duty tools that lay down roots and make trees grow:
Therapy: Therapy, without doubt, has been at the heart of my journey from trauma and anxiety to growth. Therapy comes in many forms and there is no one universal answer or treatment. It is ultimately about finding the right therapy, by the right therapist, at the right time. Trauma-focused cognitive behaviour therapy (CBT) and EMDR (eye movement desensitisation reprocessing) have the strongest evidence base in the treatment of trauma based ill health. That is not to say that other types of therapy don’t help. I have had three different psychologists or psychotherapists over a fifteen year period. They have all helped in different ways. The first therapist I saw used predominantly CBT, and I found this very helpful in ‘opening the door’ and taking off a few external layers. After a period without treatment I sought out a trauma focused therapist who introduced EMDR and really started to delve deep into my past and peel back many more layers. The most recent support I sought was from a psychotherapist who worked in a very different way, combining
several approaches. I credit him with allowing me to have the relationship I now have. Take the time to find the right therapist and approach for you. Do your research and if you don’t connect with the person after two to three sessions, it’s worth looking for someone else. Don’t give up. A good therapist is worth their weight in gold.
Expressive writing: The process of writing my life story was transformative. I highly recommend it for anyone reading this book. Initially I just wrote about what I was feeling: anything that was in my head or bothering me. It always surprised me where it took me. James Pennebaker has shown that fifteen to twenty minutes of writing down how you feel about any trauma in your life for four consecutive days can help process trauma and improve wellbeing. I didn’t know this when I started writing, but it certainly helped me. It was only later that it turned into my life story. As I wrote I saw my life before me like a jigsaw puzzle coming together. It gave me self-compassion and self-understanding that I could not have had had I not invested in the process. I now know that rescripting or creating a new narrative around traumatic events can also be an effective therapy for trauma. The combination of therapy and writing was absolutely transformative for me.
The tools that fertilize the ground:
Gratitude: I kept a little book of blessings by my bedside and every night before I went to bed, I would write down three things to be grateful for that day. Just small things like the sun shining, or a lovely cup of coffee. With time, I believe this helped shift my mindset from pessimism toward optimism. We all have a natural negativity bias. Focusing on and savouring the things that we can be grateful for helps to shift that.
Friendships: I invested a lot of time and energy in nurturing and building my closest friendships. Friendships where I could fully disclose my feelings with people I trust and I know love me. Self disclosure has been found to be one of the key processes that facilitates PTG. I had and have no family in Australia, so I invested in building one – from my friendships. We all have the capacity to do that.
Belonging and community: By undertaking community work, such as surf life saving and other charity work, I found a sense of belonging which helped me to feel like I had a place in the world. This was especially important, being a migrant and moving to a new country where I didn’t have any direct family. Social support and belonging are at the foundation of psychological wellbeing and resilience. Seek out voluntary work or organizations in your community that engage your passions and strengths.
Finding my truth: Making meaning from my experiences has been fundamental to driving a sense of purpose in my life. The negative or most challenging experiences in our lives are the most powerful propellars to finding our meaning and purpose. Ask yourself ‘what could I learn from what has happened and how can I use it to make a difference to the lives of others?’ This is the guide for the work and research that I now do in mental health and suicide. It is a powerful driver of growth and it helps keep us psychologically safe.
Problem focused coping: I try to focus on the things that are within my sphere of control and that I have the capacity to change and then actively try to solve those problems. I’m not always successful but I’ve got better at it and I recognize that active problem solving is a core skill for life and for growth. Well worth practicing.
Passions: Finding my passions, whether creative or physical, enabled me to access feelings of pleasure and joy. It allowed me to not only experience and build a bank of positive emotions but also gave me a sense of clarity in discovering my strengths, which I could then build on. Accessing one passion seemed to open up other passions. Rowing was my first, but through the process of writing this book I discovered that I could also get that same feeling of ‘flow’ through writing. Passions can be creative or physical. They can be any activity that, when you’re engaged in it, you lose track of time, you’re totally immersed. This is ‘flow’, and it’s a wonderful feeling that feeds growth. It’s worth investing in finding your passions and following them.
DOS AND DON’TS OF TALKING TO SOMEONE IF YOU ARE CONCERNED THEY MAY BE HAVING THOUGHTS OF SUICIDE
Do . . .
• Ask the person how they are feeling.
• Listen non-judgmentally and be supportive.
• Mention ‘the word’ and ask the question, ‘Are you having thoughts of suicide?’
• Let the person know that you care and you want to help.
• Get informed yourself and seek help from any of the resources listed on pages 253–7.
• Be there even if you don’t know what to say. Just listen.
• Encourage the person to seek help and explore all options.
• Ask the person how you can help them.
• Help that person to stay safe by removing things that could be used for self-harm and ensuring they have someone with them at all times.
• Help the person to write a list of the positive things in their life and the people that care.
• Look out for warning signs, such as marked changes in behaviour or the person saying things like ‘You’d be better off without me.’
• Find out what support is available.
• Offer to accompany the person to appointments if they agree.
• Create a safety plan with the person, including contact details of close friends and family, mental health helplines and 24-hour services available. (See Suicide prevention apps under Resources p254)
• Let the person know that thoughts of suicide are often associated with a treatable mental illness and that suicide is a permanent solution to a temporary problem.
• Undertake a recognized suicide-prevention training course such as ASIST, run through Living Works (see page 256).
Don’t . . .
• Judge. No one can be wrong about how they feel.
• Avoid the topic of suicide.
• Express shock at what the person tells you.
• Tell someone what is best for them.
• Lecture the person on the value of life.
• Try to use guilt or threats to prevent suicide.
• Be sworn to secrecy. Instead, try to gain informed consent from the person to seek support.
RESOURCES
I hope you find the following list of resources useful. Of course it’s by no means exhaustive, but it’s based on those services that I feel provide accessible, relevant, up-to-date and evidence-based information and support for anyone affected by mental illness, grief or suicide.
Some Specific Suicide-prevention Resources
International Association for Suicide Prevention: www.iasp.info/resources/Crisis_Centres/
Provides information and contacts on crisis centres worldwide.
Papyrus: www.papyrus-uk.org
A UK organization dedicated to helping prevent youth suicide and giving young people hope.
American Foundation for Suicide Prevention: www.afsp.org
Aims to help people understand and prevent suicide through research and education.
Immediate Help in a Crisis
Befrienders Worldwide: www.befrienders.org
Provides emotional support to prevent suicide and local helplines around the world.
Australia: Lifeline Australia: 13 11 14
Suicide call back service 1300 659 467
UK: Samaritans: 08457 90 90 90
USA: National Suicide Prevention Lifeline: 1 800 273 8255
Suicide prevention apps:
Guide individuals and carers through making a plan to keep people that have suicidal thoughts safe. Available for free download in the App store.
Beyond Now Suicide Safety Plan (Australia)
Be Safe Suicide Safety Plan (UK)
Mental Health Organizations
Australia:
The Black Dog Institute: www.blackdoginstitute.org.au
Offers comprehensive information and resources for all mood disorders with a great library of fact sheets and self-test questionnaires.
Beyond Blue: www.beyondblue.org.a
u
1300 22 46 36
A national not-for-profit organization that raises awareness and provides support for those suffering from depression and anxiety. Offers evidence-based resources and a telephone and online support service.
UK:
Mind: www.mind.org.uk
A comprehensive mental-health website that provides advice, information and support to anyone experiencing a mental illness, as well as campaigning to raise awareness and understanding and improve services.
SANE: www.sane.org.uk
Provides help and support for anyone experiencing a mental illness as well as raising awareness and understanding of mental illness in the community.
Young Minds: www.youngminds.org.uk
Information about child and adolescent mental health. Services for parents and professionals.
USA:
National Institute of Mental Health: www.nimh.nih.gov
US government website with excellent, up-to-date information about mental illness and suicide, with access to downloadable booklets and fact sheets.
US government mental health site: www.mentalhealth.gov
Aims to educate the public and professionals on all issues relating to mental health. Also provides information about where to get help.
