Post-traumatic Stress Disorder

Post-traumatic stress disorder, or PTSD, is characterized by negative symptoms and behaviors surrounding a traumatic event or events. Not all traumatic experiences lead to PTSD, and not all PTSD is chronic. The lifetime prevalence rate is about 8.7%, with 3.5% of Americans dealing with PTSD per year. Exposure to trauma can be direct or indirect, like sexual assault or the death of a loved one. Afterward, a number of symptoms occur: one or more symptoms of intrusion, where the trauma is re-experienced. One or more symptoms of avoidance, where anything related to the trauma is avoided. Two or more symptoms of negative alterations in mood or cognition, where beliefs surrounding the event or self are skewed. Finally, two or more alterations in arousal and reactivity, where the body reacts to stimuli in a different way than before the trauma. These symptoms must last for at least one month, cause clinically significant distress, and are not attributable to any other condition. Treatment consists of medication and psychotherapy. Medication is usually an antidepressant, though there is a medication used for treating sleep problems and nightmares. Cognitive behavioral therapy works to restructure thoughts surrounding the trauma, creating healthier responses to the event and reminders, and dealing with guilt or shame surrounding the event. Unlike some other mental illnesses, it is possible to recover from PTSD completely.

 

PTSD can be overwhelming. For a college student, this can mean a variety of things. Concentration is inhibited, making it difficult to complete assignments or study for exams. Depending on the trauma, certain normal college situations may be triggering to the individual. Students with PTSD can be self-destructive in a number of ways, including not going to class and alcohol or drug abuse. Many people with PTSD also have other mental illnesses, like depression, anxiety, or eating disorders. These problems simply compound the issue. Students with PTSD may need accommodations specific to reducing stress and anxiety, like more time for assignments or exams. Treatment is also essential to this process. Students with PTSD can and do succeed in college, they just need the right support in order to cope with their trauma and reduce its effects on their ability to function.

Resources:

https://www.nimh.nih.gov/health/topics/post-traumatic-stress-disorder-ptsd/index.shtml

http://www.mayoclinic.org/diseases-conditions/post-traumatic-stress-disorder/symptoms-causes/dxc-20308550

https://www.psychologytoday.com/blog/somatic-psychology/201208/students-ptsd

https://www.mirecc.va.gov/visn19/docs/presentations/Overview_PTSD_College_Setting.pdf

101 Fantastic Ideas for Students when Feeling College is TOO MUCH

I think that, for most of us, there are times in life when it all just feels like Too Much. Can you say #SelfCare?

There may be some days, weeks, months, maybe even years when — for whatever reason — just getting through the day or going to work or putting one foot in front of the other feels hard. Really, really hard.


Maybe it’s because you’re wrestling with anxiety, depression, or some other mental illness.

Maybe it’s because you’ve had your heart broken. Maybe you’ve gone through a physical or emotional trauma. Maybe you’re deeply grieving. Or maybe there’s no easily understood reason for why you’re feeling bad.

Whatever the case, I want you to know that it’s OK if you’re going through a tough time.

This doesn’t make you any less lovable, worthy, or capable. This just means you’re human. Being a human can be a messy, hard, confusing, painful experience sometimes.

So if you or someone you love is going through one of these tough times right now, a time where it all just feels like too much, I want to offer up 101 suggestions for self-care to help you or your loved one get through this time.

Photo via iStock.

1. Have a good, long, body-shaking cry.

2. Call a trusted friend or family member and talk it out.

3. Call in sick. Take comp time if you can. Take a mental health day.

4. Say no to extra obligations, chores, or anything that pulls on your precious self-care time.

5. Book a session (or more!) with your therapist.

6. Dial down your expectations of yourself at this time. When you’re going through life’s tough times, I invite you to soften your expectations of yourself and others.

7. Tuck yourself into bed early with a good book and clean sheets.

8. Watch a comforting/silly/funny/lighthearted TV show or movie. (“Parks and Recreation,” anyone?)

9. Reread your favorite picture and chapter books from childhood.

10. Ask for some love and tenderness from your friends on social media. Let them comment on your post and remind you that you’re loved.

11. Look at some some really gorgeous pieces of art.

12. Watch YouTube videos of Ellen DeGeneres and the adorable kids she has on her show.

13. Look at faith-in-humanity-restoring lists from around the internet.

14. Ask for help. From whomever you need it — your boss, your doctor, your partner, your therapist, your mom. Let people know you need some help.

15. Wrap yourself up in a cozy fleece blanket and sip a cup of hot tea.

16. Breathe. Deeply. Slowly. Four counts in. Six counts out.

17. Hydrate. Have you had enough water today?

18. Eat. Have you eaten something healthy and nourishing today?

19. Sleep. Have you slept seven to nine hours? Is it time for some rest?

20. Shower. Then dry your hair and put on clothes that make you feel good.

21. Go outside and be in the sunshine.

22. Move your body gently in ways that feel good. Maybe aim for 30 minutes. Or 10 minutes if 30 feels like too much.

23. Read a story (or stories) of people who overcame adversity or maybe dealt with mental illness, too. (I personally admire J.K. Rowling’s story.)

24. Go to a 12-step meeting. Or any group meeting where support is offered. Check out church listings, hospital listings, or school listings, for example.

25. If you suspect something may be physiologically off with you, go see your doctor and/or psychiatrist and talk to them. Medication might help you at this time, and professionals can assist you in assessing this.

26. Take a long, hot bath. Light a candle and pamper yourself.

27. Read inspirational quotes.

28. Cuddle someone or something. Your partner. A pillow. Your friend’s dog.

29. Read previous emails, postcards, letters, etc. from friends and family reminding you of happier times.

30. Knit. Sculpt. Bake. Engage your hands.

31. Exhaust yourself physically — running, yoga, swimming, whatever helps you feel fatigued.

32. Write it out. Go free-form in a journal or on a computer. Get it all out and vent.

33. Create a plan if you’re feeling overwhelmed. List out what you need to do next to tackle and address whatever you’re facing. Chunk it down into manageable and understandable pieces.

34. Remind yourself you only have to get through the next five minutes. Then the next five. And so on.

35. Take five minutes to meditate.

36. Write out a list of 25 reasons you’ll be OK.

37. Write out a list of 25 examples of things you’ve overcome or accomplished.

38. Write out a list of 25 reasons you’re a good, lovable person.

39. Write out a list of 25 things that make your life beautiful.

40. Sniff some scents that bring you joy or remind you of happier times.

41. Ask for support from friends and family via text if voice-to-voice contact feels like too much. Ask them to check in with you via text daily or weekly, whatever you need.

42. Lay down on the ground. Let the Earth or floor hold you. You don’t have to hold it all on your own.

43. Clean up a corner of a room of your house. Sometimes tidying up can help calm our minds.

44. Ask yourself: What’s my next most immediate priority? Do that that. Then ask the question again.

45. Read some poetry. RumiHafiz, and Mary Oliver are all excellent.

46. Take a tech break. Delete or deactivate social media if it feels too triggering right now.

47. Or maybe get on tech. If you’ve been isolating, maybe interacting with friends and family online might feel good.

48. Go out in public and be around others. You don’t have to engage, but maybe sit in a coffee shop or on a bench at a museum and soak up the humanity around you.

49. Or if you’re feeling too saturated with contact, go home. Cancel plans and tend to the introverted parts of yourself.

50. Ask friends and family to remind you that things will be OK and that what you’re feeling is temporary.

51. Put up some Christmas lights in your bedroom. They often make things more magical.

52. Spend a little money and treat yourself to some self-care and comfort. Maybe take a taxi versus the bus. Buy your lunch instead of forcing yourself to pack it. Buy some flowers that delight you.

53. Make art. Scribble with crayons. Splash some watercolors. Paint a rock. Whatever. Just create something.

54. Go wander around outside in your neighborhood and take a look at all the lovely houses and the way people decorate their gardens. Delight in the diversity of design.

55. Go visit or volunteer at your local animal rescue. Pet some animals.

56. Look at photos of people you love. Set them as the wallpaper of your phone or laptop.

57. Create and listen to a playlist of songs that remind you of happier times.

58. Read some spiritual literature.

59. Scream, pound pillows, tear up paper, shake your body to move the energy out.

60. Eat your favorite, most comforting foods.

61. Watch old “Mister Rogers’ Neighborhood” videos online.

62. Turn off the lights, sit down, stare into space, and do absolutely nothing.

63. Pick one or two things that feel like progress and do them. Make your bed. Put away the dishes. Return an email.

64. Go to a church or spiritual community service. Sit among others and absorb any guidance or grace that feels good to you.

65. Allow yourself to fantasize about what you’re hoping or longing for. There are clues and energy in your reveries and daydreams that are worth paying attention to.

66. Watch autonomous sensory meridian response videos to help you calm down and fall asleep at night.

67. Listen to monks chantingsinging Tibetan bowls, or nature sounds to help soothe you.

68. Color in some coloring books.

69. Revisit an old hobby. Even if it feels a little forced, try your hand at things you used to enjoy and see what comes up for you.

70. Go to the ocean. Soak up the negative ions.

71. Go to the mountains. Absorb the strength and security of them.

72. Go to the forest. Drink in the shelter, life, and sacredness of the trees.

73. Put down the personal help books and pick up some good old-fashioned fiction.

74. Remember: Your only job right now is to put one foot in front of the other.

75. Allow and feel and express your feelings — all of them! — safely and appropriately. Seek out help if you need support in this.

76. Listen to sad songs or watch sad movies if you need a good cry. (“Steel Magnolias,” anyone?)

77. Dance around wildly to your favorite, most cheesy songs from your high school years.

78. Put your hands in dirt. If you have a garden, go garden. If you have some indoor plants, tend to them. If you don’t have plants or a garden, go outside. Go to a local nursery and touch and smell all the gorgeous plants.

79. If you want to stay in bed all day watching Netflix, do it. Indulge.

80. Watch or listen to some comedy shows or goofy podcasts.

81. Look up examples of people who have gone through and made it through what you’re currently facing. Seek out models of inspiration.

82. Get expert help with whatever you need. Whether that’s through therapy, psychiatry, a lawyer, clergy, or something else, let those trained to support you do it.

83. Educate yourself about what you’re going through. Learn about what you’re facing, what you can expect to feel, and how you can support yourself in this place.

84. Establish a routine and stick to it. Routines can bring so much comfort and grounding in times of life that feel chaotic or out of control.

85. Do some hardcore nesting and make your home or bedroom as cozy and beautiful and comforting as possible.

86. Get up early and watch a sunrise.

87. Go outside, set up a chair, and watch the sunset.

88. Make your own list of self-soothing activities that engage all five of your senses.

89. Develop a supportive morning ritual for yourself.

90. Develop a relaxing evening ritual for yourself.

91. Join a support group for people who are going through what you’re going through. Check out the listings at local hospitals, libraries, churches, and universities to see what’s out there.

92. Volunteer at a local shelter or hospital or nursing home. Practice being of service to others who may also be going through a tough time.

93. Accompany a friend or family member to something. Even if it’s just keeping them company while they run errands, sometimes this kind of contact can feel like good self-care.

94. Take your dog for a walk. Or borrow a friend’s dog and take them for a walk.


This kangaroo dog loves walks.

95. Challenge your negative thinking.

96. Practice grounding, relaxation techniques.

97. Do something spontaneous. Walk or drive a different way to work. Order something new off the menu. Listen to a playlist of new songs.

98. Work with your doctor, naturopath, or nutritionist to develop a physical exercise plan and food plan that will be supportive to whatever you’re facing right now.

99. Pray. Meditate. Write a letter to God, the universe, the Source, your higher self — whatever you believe in.

100. As much as you can, try and trust the process.

101. Finally, remember, what you’re going through right now is temporary. It may not feel like that from inside the tough time you’re in, but this too shall pass and you will feel different again someday. If you can’t have faith in that, let me hold the hope for you.

This list is really just a starting point meant to catalyze your own thinking about how you can best take care of yourself during life’s tough times and to spark your curiosity and interest in strengthening your self-care now and ongoing.

It’s not meant to be prescriptive nor do I mean to imply you need to do all or any of these things to take good care of yourself. You are the expert of your own experience, and I trust that you know what’s best for you.

Also, my hope is that in reading this, you’re hearing me say how normal and natural it is to struggle and to have these tough, hard times. It’s part of being human.

You’re not alone in this.

The suggestions and ideas mentioned herein— in no way are a substitute for care or advice from a licensed mental health care clinician, doctor, or other accredited professional. These are self-care coaching suggestions, not therapeutic advice. Moreover, if you feel suicidal or find yourself having suicidal ideations, call the 24/7 National Suicide Prevention Lifeline at 800-273-8255.

Racism’s Emotional Toll on Student Minds

Our screens and feeds are filled with news and images of black Americans dying or being brutalized. A brief and yet still-too-long list: Trayvon MartinTamir RiceWalter ScottEric GarnerRenisha McBride. The image of a white police officer straddling a black teenager on a lawn in McKinney, Tex., had barely faded before we were forced to grapple with the racially motivated shooting in Charleston, S.C.

I’ve had numerous conversations with friends and colleagues who are stressed out by the recent string of events; our anxiety and fear is palpable. A few days ago, a friend sent a text message that read, “I’m honestly terrified this will happen to us or someone we know.” Twitter and Facebook are teeming with anguish, and within my own social network (which admittedly consists largely of writers, academics and activists), I’ve seen several ad hoc databases of clinics and counselors crop up to help those struggling to cope. Instagram and Twitter have become a means to circulate information about yoga, meditation and holistic treatment services for African-Americans worn down by the barrage of reports about black deaths and police brutality, and I’ve been invited to several small gatherings dedicated to discussing these events. A handful of friends recently took off for Morocco for a few months with the explicit goal of escaping the psychic weight of life in America.

It was against this backdrop that I first encountered the research of Monnica Williams, a psychologist, professor and the director of the University of Louisville’s Center for Mental Health Disparities. Several years ago, Williams treated a “high-functioning patient, with two master’s degrees and a job at a company that anyone would recognize.” The woman, who was African-American, had been devastated by racial harassment by a director within her company. Williams recalls being stunned by how drastically her patient’s condition deteriorated as a result of the treatment. “She completely withdrew and was suffering from extreme emotional anxiety,” she told me. “And that’s what made me say, ‘Wow, we have to focus on this.’ ”

In a 2013 Psychology Today article, Williams wrote that “much research has been conducted on the social, economic and political effects of racism, but little research recognizes the psychological effects of racism on people of color.” Williams now studies the link between racism and post-traumatic stress disorder, which is known as race-based traumatic stress injury, or the emotional distress a person may feel after encountering racial harassment or hostility. Although much of Williams’s work focuses on individuals who have been directly targeted by racial discrimination or aggression, she says race-based stress reactions can be triggered by events that are experienced vicariously, or externally, through a third party — like social media or national news events. She argues that racism should be included as a cause of PTSD in the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders (D.S.M.).

Williams is in the process of opening a clinical program that will exclusively treat race-based stress and trauma, in a predominantly black neighborhood in Louisville. Shortly after the Charleston shooting, I called Williams to discuss her work; what follows is a lightly edited and condensed transcript of our conversation.

What is race-based stress and trauma?

It’s a natural byproduct of the types of experiences that minorities have to deal with on a regular basis. I would argue that it is pathological, which means it is a disorder that we can assess and treat. To me, that means these are symptoms that are a diagnosable disorder that require a clinical intervention. It goes largely unrecognized in most people, and that’s based on my experience as a clinician.

What are the symptoms?

Depression, intrusion (the inability to get the thoughts about what happened out of one’s mind), vigilance (an inability to sleep, out of fear of danger), anger, loss of appetite, apathy and avoidance symptoms and emotional numbing. My training and study has been on post-traumatic stress disorder for a long time, and the two look very much alike.

Over the weekend, I received several distressing emails and texts from friends who were suffering from feelings of anxiety and depression. Do you think we should all be in treatment?

I think everyone could benefit from psychotherapy, but I think just talking to someone and processing the feelings can be very effective. It doesn’t have to be with a therapist; it could be with a pastor, family, friends and people who understand it and aren’t going to make it worse by telling you to stop complaining.

What do you think about the #selfcare hashtags on social media and the role of “Black Twitter” as resources for people who may not have the resources they need to help process this? Are online interactions like that more meaningful than they initially might seem?

Online communities such as VitalStudentMinds.com — can be a great source of support, of course — with the caveat that even just one hater can be stressful for everyone, and that’s the danger of it. But if you don’t have a friend or a family member, just find someone who is sensitive and understanding and can deal with racial issues.

In our initial email about the ripple effects of the murders in Charleston, you used the phrase “vicarious trauma.” What does that mean?

Because the African-American community has such a long history of pervasive discrimination, something that impacts someone many miles away can sometimes impact all of us. That’s what I mean by vicarious traumatization.

Is racial trauma widely recognized as a legitimate disorder?

The trauma of events like this is not formally recognized in the D.S.M. It talks about different types of trauma and stress-related ailments, but it doesn’t say that race trauma can be a factor or a trigger for these problems. Psychiatrists, unless they’ve had some training or personal experience with this, are not going to know to look for it and aren’t going to understand it when they see it. In order for it to be recognized, we have to get a good body of scientific research, a lot of publications in reputable peer-reviewed journals. Right now, there’s only been a few. And we need to produce more.

On your blog, you chronicled the experience of a woman who encounters a therapist who dismisses her fears about racism. Is one barrier to treatment getting the medical community to acknowledge that racism exists?

Yes. A lot of people in the medical community live very privileged lives, so racism isn’t a reality to them. When someone comes in and talks to them, it might sound like a fairy tale, rather than a real daily struggle that people are dealing with. Research shows that African-Americans, for example, are optimistic when they start therapy, but within a few sessions feel less optimistic and have high early dropout rates. It could be that clinicians don’t know how to address their problems, or they may even be saying things that are subtly racist that may drive their clients away. If the patient feels misunderstood or even insulted by the therapist and they don’t go back and get help, they end up suffering for years or even the rest of their lives for something that is very treatable.

Is there a recommended model for treatment?

We have great treatments that are empirically supported for trauma, but the racial piece hasn’t really been studied very well. That’s no easy task, because when we write these articles, they go to journals, where an editor looks at it and decides if it’s worthy and applicable to go in the journal. And then it goes to reviewers who decide if it’s a worthy and applicable topic.

Why has it taken so long to get momentum?

If you think about it, they weren’t even letting black people get Ph.D.s 30 years ago in a lot of places. Ethnic minority researchers are the ones who are carrying the torch, by and large. We’re only to the place now where we have enough researchers to do the work. And there’s so much work that needs to be done.

Checkout our handout for more information on coping with trauma. 

Unique Hurdles to Managing Stress in College

Managing Stress

College requires significantly more effort from students than high school.  Once you enter college, you will probably find that your fellow students are more motivated, your instructors are more demanding, the work is more difficult, and you are expected to be more independent. These higher academic standards and expectations are even more evident in graduate school. As a result of these new demands, it is common for college students to experience greater levels of stress related to academics.

Many students find that they need to develop new skills in order to balance academic demands with a healthy lifestyle.  Fortunately, the University of Michigan offers many resources to help students develop these skills.  Many students find that they can reduce their level of academic stress by improving skills such as time management, stress management, and relaxation.

The Pros and Cons of Stress

Stress is anything that alters your natural balance. When stress is present, your body and your mind must attend to it in order to return you to balance. Your body reacts to stress by releasing hormones that help you cope with the situation.  That in turn takes energy away from the other functions of your brain, like concentrating, or taking action.  There are two different sources of stress: external triggers, like getting a poor grade or breaking up with your girlfriend/boyfriend, and internal triggers, like placing high expectations on yourself.

La Di Da by Asher Roth:
“How are you dealing?”

Watch this music video which shows how six college students deal with stress.
From halfofus.com

Stress is a part of everyday life. There are many instances when stress can be helpful. A fire alarm is intended to cause the stress that alerts you to avoid danger. The stress created by a deadline to finish a paper can motivate you to finish the assignment on time. But when experienced in excess, stress has the opposite effect. It can harm our emotional and physical health, and limit our ability to function at home, in school, and within our relationships. But the good news is that, since we are responsible for bringing about much of our own stress, we can also do much to manage stress by learning and practicing specific stress-reduction strategies.

Click here to learn more about academic stress.  This link will take you to information and helpful tips including a study skills checklist.

Are you experiencing too much stress?

Here are a few common indicators:

  • Difficulty concentrating
  • Increased worrying
  • Trouble completing assignments on time
  • Not going to class
  • Short temper or increased agitation
  • Tension
  • Headaches
  • Tight muscles
  • Changes in eating habits (e.g., “stress eating”)
  • Changes in sleeping habits

People with mental health disorders are more likely to notice that their specific symptoms reemerge or grow worse during stressful times. In many cases, stress can act as the “spark” that ignites a mental health episode. But this does not mean that every time you are busy or face a difficult challenge you will have a mental health episode. Not everyone responds the same way to potentially stressful circumstances. For example, during final exams many students feel very overwhelmed and anxious, while others are able to keep their stress under control. If you are one of the many people who have difficulty managing stress during difficult times, look for some helpful tips below.

Ways of reducing and managing stress

  • A feeling of control and a healthy balance in your schedule is a necessary part of managing stress. Learning how to manage your responsibilities, accomplish your goals and still have time for rest and relaxation requires that you practice time management skills.
  • Try setting a specific goal for yourself that will improve your mood and help you reduce stress. Start by filling out a goal-setting worksheet.
  • Avoid procrastination. Putting off assignments or responsibilities until the last minute can create more mental and physical stress than staying on top of them.  Procrastination can affect many aspects of daily life, such as the quality of your work, the quality of your sleep, and your mood.
  • Exercise regularly. Physical activity can help you burn off the energy generated by stress.
  • Practice good sleep habits to ensure that you are well-rested. Sleep deprivation can cause many physical and mental problems and can increase stress.
  • Try mindfulness meditation.
  • Limit (or eliminate) the use of stimulants like caffeine, which can elevate the stress response in your body.
  • Pace yourself throughout the day, taking regular breaks from work or other structured activities. During breaks from class, studying, or work, spend time walking outdoors, listen to music or just sit quietly, to clear and calm your mind.
  • Start a journal. Many people find journaling to be helpful for managing stress, understanding
    emotions, and making decisions and changes in their lives.
  • Realize that we all have limits. Learn to work within your limits and set realistic expectations for yourself and others.
  • Plan leisure activities to break up your schedule.
  • Recognize the role your own thoughts can play in causing you distress. Challenge beliefs you may hold about yourself and your situation that may not be accurate. For example, do you continuously fall short of what you think you “should” accomplish? When our minds continuously feed us messages about what we “should” achieve, “ought” to be, or “mustn’t” do, we are setting ourselves up to fall short of goals that may be unrealistic, and to experience stress along the way. Learn techniques for replacing unrealistic thoughts with more realistic ones.
  • Find humor in your life. Laughter can be a great tension-reducer.
  • Seek the support of friends and family when you need to “vent” about situations that bring on stressful feelings. But make sure that you don’t focus exclusively on negative experiences; try to also think of at least three things that are going well for you, and share those experiences.
  • Try setting a specific goal for yourself that will improve your mood and help you reduce stress. Start by filling out a goal-setting worksheet then help yourself stay on track.