Helping Darling to relax has been vital – but unlike a human, she isn’t dealing with the ethical and cognitive issues often involved in post-traumatic stress
The modern mind is a column where experts discuss mental health issues they are seeing in their work
The word trauma has been so overused that it can sound meaningless.
Yet there are profound effects on the body and mind following exposure to traumatic events. Our capacity to cope becomes overwhelmed and we feel helpless as the limbic system, which is the part of the brain associated with fight flight and freeze, goes into overdrive.
This response often endures long after the event itself is buried in the past, resulting in the hallmark symptoms of post-traumatic stress disorder (PTSD) - flashbacks, nightmares and a raft of other symptoms associated with an over-reactivity of the body. However, our personality structure usually remains intact.
This is not the case when trauma occurs over a prolonged period, especially in our formative childhood years, as in child neglect or abuse, including emotional abuse. In this situation, the feelings of helplessness and the overactivation of the limbic system and the body are enduring, with personality structure often affected.
Frequently, individuals who are suffering from this complex form of post-traumatic stress disorder cannot regulate their emotions, leading to impulsivity, a poor sense of self, and interpersonal difficulties. Longer and more intense treatment is usually required for these cases than in the instance of a less complex post-traumatic stress response unwittingly induced in her canine companion by Jacqui.
Recently, while stopping to order coffee, Jacqui tied her dog Darling’s leash to what she thought was an immovable metal bench covered with plant pots while she went inside. In the midst of paying for her cappuccino, Jacqui heard an almighty clatter as Darling had lunged forward, causing the bench to tip over and the plant pots to crash to the ground. Frightened by the noise, Darling tried to run away from it, but of course the “monstrous” bench kept following her as she was tethered to it. By the time Jacqui reached her, Darling was sitting in the road with traffic roaring around her, having a full-fledged canine panic attack.
With the help of the very kind ladies from the coffee shop, Jacqui was able to get her inside and eventually calm her down enough to take her home. Back in the house, she settled down and Jacqui thought that was the end of what had been a very distressing morning.
However, the next time Jacqui ventured out with her, Darling immediately became agitated and afraid, and when they approached the corner where the incident had occurred, she froze. Her body quivered, her ears flattened back and her breathing became rapid. She was clearly experiencing primal and paralysing panic in relation to what she now associated with the setting.
Darling was displaying classic symptoms of acute traumatic stress, along with an associated instinct to avoid the trigger for her fear. Treatment has involved gradual exposure to the source of trauma (the road near the coffee shop), along with a lot of reassurance that she is safe and attempts to give her positive experiences there so that she can delink the setting from the traumatic experience.
Helping her to relax at a bodily level has been pivotal in this process, as while the body is over-adrenalised it remains trapped in a trauma response and unable to process an alternative experience.
Prior to this trauma, Darling had been a happy and relatively confident dog, raised with love and security from early puppyhood, and this will assist her to return to her former state of being with help.
Furthermore, Darling, unlike a human, is not dealing with the ethical and cognitive issues that are often involved in PTSD, as in returning veterans or the Lindt cafe victims. And her treatment could be more singularly focused on the body, which is implicated in all responses to trauma – whether complex or more acute – and includes a third state of trauma called continuing traumatic stress, in which the trauma is not located in the past, as in the previous two examples, but is continuing in the present.
This stress is usually induced by social conditions such as war, poverty and social disintegration. However, the Covid pandemic and its sequelae have also given rise to continuing traumatic stress, particularly in vulnerable communities, resulting in a global mental health crisis.
The problem with treating continuing traumatic stress is that it is not post, it is current. Treatment cannot focus on freeing the person from the impact of the stress in the past but must focus on strategies for coping with the stressors in the present, and for most of the world at the current time these include Covid-related stressors involving interruptions to family contact, career, schooling and income and living with uncertainty as we once again await information about the Omicron variant.
Dealing with any traumatic stress implicates a bio-psycho-social approach, and while our focus here is on the body, the psychological and the social aspects of traumatic stress are not just additive but are multiplicative. Nevertheless, there are some simple strategies that can be used at the level of the body to calm over-reactivity, an over-reactivity which can come upon us suddenly.
Deep-breathing techniques involving inhaling for six counts and exhaling for six counts repeated for some minutes is very helpful, as is tensing and relaxing feet and leg and arm and hand muscles. Both these exercises can be employed unobtrusively and immediately as soon as the over-arousal is felt.
A hibernating body requires some longer-term strategies involving the usual suspects of exercise, sleep hygiene and – for a short-term fix – ice on the back of the neck or a splash of cold water to the face.
However, if over-arousal or under-arousal persists after we have hopefully returned, for a more prolonged period, to a more “normal life”, then more intensive treatments that involve psychological processing and physiological reprogramming are indicated, as in the treatment of PTSD and complex PTSD.
In his seminal book The Body Keeps Score, Bessel Van Der Kolk details the pivotal link between the hyperactive alarm system mobilised by trauma, the default fight, flight, freeze response of the body, the secretion of excess stress hormones and the impact of this on bodily sensation, cognitive functioning and emotional regulation. Van Der Kolk emphasises that it is only by making it safe for trauma victims to inhabit their bodies and “to tolerate feeling what they feel and knowing what they know” that healing can occur.
This wisdom applies in acute, complex or continuing trauma but the timeframe, level of complexity and prognosis for this process is profoundly influenced by whether the trauma is acute, complex or continuous.
To end on a lighter note, we are happy to report that while Darling still approaches the coffee shop with some degree of trepidation, she is now able to wag her tale and accept a treat as she waits for Jacqui’s morning caffeine hit to arrive.