100% Accurate Trauma & PTSD Symptom Assessment by Expert Scott Giacomucci, MSS, LSW, CTTS, CET III

Scott Giacomucci, MSS, LSW, CTTS, CET III

A colleague and friend of mine, Scott Giacomucci, MSS, LSW, CTTS, CET III has been up to some pretty amazing things in the world of trauma, psychodrama and PTSD healing.  He was kind enough to share some information he put together for his clients with us.  The following is a handout on Trauma and PTSD.  Let us know what you think and if you have any questions in the comment section below:

 

Trauma and PTSD

                                by Scott Giacomucci, MSS, LSW, CTTS, CET III

Client: "What's wrong with me?"

Therapist: "Well, given your symptoms, I think you have Post Traumatic Stress Disorder."

Client: "Post Traumatic Stress Disorder?  What are you talking about?  Trauma?  It doesn't make  sense.  What trauma did I have?  I wasn't in a war or survive a holocaust or anything.  I didn't even really get hurt."

This is a typical response following an assessment and diagnosis of this poorly understood disorder.  It seems appropriate that this diagnosis - like many other serious medical diagnoses - would be initially met with denial to temporarily protect the person from the reality of his/her own vulnerability.  However, in order to effectively treat the condition, the diagnosis eventually needs to be accepted, and in order to accept the diagnosis, one needs to understand it. To this end, I offer the following answers to the two most frequently asked questions: What is trauma? and How bad does it have to be to be traumatic? 

What Is Trauma?

According to one of the foremost experts in healing trauma, Dr. Peter Levine,

“Trauma is a basic rupture - loss of connection to ourselves, our families, and the world.  The loss, although enormous, is difficult to appreciate because it happens gradually. We adjust to these slight changes, sometimes without taking notice of them at all…although the source of tremendous distress and dysfunction, it (trauma) is not an ailment or a disease, but the by-product of an instinctively instigated, altered state of consciousness. We enter this altered state let us call it "survival mode” when we perceive that our lives are being threatened. If we are overwhelmed by the threat and are unable to successfully defend ourselves, we can become stuck in survival mode. This highly aroused state is designed solely to enable short-term defensive actions; but left untreated over time, it begins to form the symptoms of trauma. These symptoms can invade every aspect of our lives.”

One of the most effective ways to evaluate if you have been traumatized is to answer these simple questions about a significant incident: when you remember the incident, is the memory exactly the same every time? Is the memory unusually fragmented or difficult to recall?

If an answer is yes, then the memory is likely a traumatic one.  By no means does one traumatic memory constitute a diagnosis of PTSD; however it does indicate that the traumatic event has been dysfunctionally stored; remains inadequately processed; and continues to cause you distress.

What is a PTSD Diagnosis?

A diagnosis of PTSD is different from most mental-health diagnoses in that it is the only diagnosis that explore and places emphasis on “what happened to you”. The Diagnostic and Statistical Manual of Mental Disorders (5th edition) offers 4 criteria for a PTSD diagnosis.

1.     The first criterion relates to the actual trauma:

•  Directly experiencing the traumatic event(s)

• Witnessing, in person, the event(s) as it occurred to others

• Learning that the traumatic event(s) occurred to a close family member or friend

• Experiencing repeated or extreme exposure to aversive details of the traumatic event(s); this does not apply to exposure through media such as television, movies, or pictures

2.     The second criterion involves the persistent re-experiencing of the event in 1 of several ways:

• Thoughts or perception
• Images
• Dreams
• Illusions or hallucinations
• Dissociative flashback episodes
• Psychological distress or reactivity to cues that symbolize some aspect of the event

3.     The third criterion involves avoidance of stimuli that are associated with the trauma and numbing of general responsiveness, as determined by the presence of 1 or both of the following:

• Avoidance of thoughts, feelings, or conversations associated with the event
• Avoidance of people, places, or activities that may trigger recollections of the event

4.     The fourth criterion is 2 or more of the following symptoms of negative alterations in cognitions and mood associated with the traumatic event(s):

• Inability to remember an important aspect of the event(s)
• Persistent and exaggerated negative beliefs about oneself, others, or the world
• Persistent, distorted cognitions about the cause or consequences of the event(s)
• Persistent negative emotional state
• Markedly diminished interest or participation in significant activities
• Feelings of detachment or estrangement from others
• Persistent inability to experience positive emotions

5.     The fifth criterion is marked alterations in arousal and reactivity, as evidenced by 2 or more of the following:

• Irritable behavior and angry outbursts
• Reckless or self-destructive behavior
• Hypervigilance
• Exaggerated startle response
• Concentration problems
• Sleep disturbance

6.     The duration of symptoms is more than 1 month

7.     The disturbance causes clinically significant distress or impairment in functioning

8.     The disturbance is not attributable to physiological effects of a substance or medical condition

According to Levine,

“The symptoms of trauma may be continually present or they may come and go. They may even surface after being hidden for decades. Usually, symptoms do not occur individually, but in clusters grow increasingly complex over time. Unfortunately, they become less and less connected with the original traumatic experience, making it increasingly difficult to trace the symptoms to their cause, and easier to deny the importance of the traumatic event in one's life. However, if we pay attention to these symptoms, for what they are -internal wake up calls - we can address and begin to heal our trauma.”

Although there are pervasive misconceptions about trauma, PTSD is neither rare nor unusual. But unlike seeking treatment for symptoms related to diabetes or glaucoma, seeking treatment for the symptoms of PTSD is somehow interpreted as a weakness. Although this couldn’t be further from the truth, you may believe it. Maybe even said something like it; Real men don’t ask for help; Trauma couldn't possibly affect a well balanced person, there must be something wrong with me; or the all time favorite, It wasn’t really that bad; I should just get over it.

Don’t you think that if that were an option, you would have done just that?

(reference: DSM5 & Linda Curran)

Scott Giacomucci, MSS, LSW, CTTS, CET III is a certified trauma treatment specialist and licensed social worker in Pennsylvania. He is a graduate of Bryn Mawr College where he received his Masters in Social Service (MSS) with a concentration in clinical social work. He facilitates trauma treatment services at Mirmont Treatment Center serving a variety of populations including young adults and emergency responders (veterans, police, fire, etc..) in both individual therapy and group sessions. Scott has a gentle, non-judgmental treatment approach that honors the inherent worth of each individual. He utilizes a blend of treatment modalities including both traditional talk therapy and experiential therapy which have been research-proven as the treatment of choice for treating trauma. 

To learn more about Scott Giacomucci and the work he does, you can visit his website at: http://sgiacomucci.com/

WHAT IS PTSD AND DO I HAVE IT?

Post-traumatic stress disorder, also known as PTSD, is an indication from your body that it needs support in sorting some things out.  Traumatic memories are stored in a different part of your brain than the rest of your memories.  When therapy is completed successfully, brain scans show that the trauma memory has been moved to a different area of the brain.  This alternate area of the brain doesn’t trigger your mind to get confused, your adrenaline to rush, and your body to be on alert.

Here are some of the symptoms of Post Traumatic Stress Disorder from the Diagnostic and Statistical Manual (DSM-V):

A stressor such as actual or threatened serious injury, threatened death or witnessing of death or actual or threatened sexual violence.

Intrusion symptoms such as

• intrusive memories
• traumatic nightmares
• dissociative reactions such as flashbacks
• prolonged or intense distress after being exposed to a trigger

Avoidance symptoms such as persistent efforts to avoid anything that triggers traumatic memories.

Alterations to thoughts and mood symptoms such as

• not being able to remember important parts of the traumatic event
• believing bad things about yourself and/or the world
• blaming yourself for the traumatic event
• overwhelming emotions such as horror, shame or anger related to the trauma that continue to happen even long after the event
• losing interest in things that you used to enjoy
• not being able to feel positive emotions such as joy

Reactive symptoms such as

• exaggerated startle response
• difficulty concentrating
• sleep difficulties
• hypervigilance
• aggressive or irritable behavior
• reckless or self-destructive behavior

If you are ready to listen your body signals and get some support to untangle the memories and put them in their proper place, I can help.  My name is Tiffany Spilove and I LOVE working with people to heal their past.  I want to make sure that you find peace inside your body and your mind.  I have specialized training and experience helping people who have gone through sexual abuse, physical trauma and emotional pain.    

Call me today for your free 15-minute phone consultation at 610-314-8402 and find out if therapy is a good option for you

How to Find an Expert on PTSD & Trauma for Therapy on The Main Line of Philadelphia

The Main Line of Philadelphia

is a very special place to live.  If you already live here, you know how unique this place is - if you don't live here, you are in for quite a treat.  The suburban area to the west of Philadelphia has been referred to as The Main Line because of the main train line that connects Philadelphia to all the beautiful towns built up along the train tracks: Lower Merion includes Overbrook, Merion, Bala Cynwyd, Wynnewood, Narberth, Ardmore, Bryn Mawr and Rosemont.  Further out we have Radnor, Villanova, Wayne, St. Davids, Berwyn, Paoli, Malvern, Exton and Frazier.  Each town is unique and has it’s own spin on charm.

Finding an expert trauma therapist on the Main Line of Philadelphia

seems harder than it should be.  With Bryn Mawr's Graduate School of Social Work close by, Villanova University, Rosemont College, Saint Joseph's University, Widener, Immaculata, Cabrini, Ursinus and not to mention University of Pennsylvania, Swarthmore and LaSalle, we have so many talented therapists, social workers and counselors.  So, how do you find the therapist who knows just how to help you manage your post-traumatic stress symptoms?  How do you find the counselor you can click with and trust to guide you through an evidence-based method of healing your past traumatic memories?  Choosing a therapist is a very personal decision.  You can have three great therapists, but if you don’t feel safe with them, what’s the point?  If you are looking for a counselor, psychologist, life coach or therapist - I'd like to help you find someone who can help.

Here are some ways to search

Educate Yourself About Methods that Work for PTSD

When you have PTSD, there are only a few ways of treating your symptoms that have been studied and proven to effectively reduce or eliminate symptoms.  Those nightmares you’ve been dealing with, the heightened startle response, hypervigilance, and avoidance of triggering situations – those are the things that get in the way of your life.  These are the issues you’ll want to be sure your therapist knows how to help you manage and heal, not just talk about.  One of the top researched methods for eliminating these symptoms is a method called Eye Movement Desensitization and Reprocessing (EMDR). 

EMDR has been studied and proven as an evidence-based treatment method.  You can learn more about EMDR and how it works here.  Here is a short explanation: when we have traumatic memories, the memories tend to get stuck on one side of the brain and our body tries to heal it by re-playing it over and over, but it stays stuck.  EMDR is a technique that stimulates each side of the body alternately while the patient processes the traumatic material.  This technique helps the brain move the traumatic memory from one side of the body through to be able to process it so it’s not stuck on a loop any longer.  You can find therapists who are trained and certified to utilize EMDR by going on the EMDRIA.org website or asking people who know therapists in the area.  Think about asking friends who have or know therapists, your doctor or someone at your school.  Therapists that come highly recommended and are known to work with PTSD through EMDR methods are a good way to make sure they have a good reputation.  

Google

Type into Google your town and the issue you are looking for help with.  For example, "Bryn Mawr and PTSD" or "Rosemont and Trauma" and see what comes up.  In the top listings that come up in your search, you will hopefully see some links to therapists that specialize in your particular need and are trained in EMDR.    

Psychology Today

What you will most likely see is a result that links to a Psychology Today profile for therapists in your area that have indicated these specialties.  Psychology Today is a great site that is most commonly used for therapists to post their profiles and for clients to find a therapist nearby.  It’s very helpful that you can refine your search by specialty.  The unfortunate thing is that therapists can indicate that we specialize in as many topics as we'd like.  Although a therapist might indicate that they specialize in PTSD, if it's really something we know a lot about, we obtain specialized training in evidence-based methods specifically for PTSD and we will often note areas we are trained in on our websites, so don’t stop with Psychology Today, make sure you read through the clinician’s website as well.

Websites

Check out the websites of potential therapists.  If you are looking for help with flashbacks and the website you are visiting talks a bunch about flashbacks, that's a great sign!  If you are looking for help with a heightened startle response and you're on a website that doesn't mention this symptom, you might want to keep looking.  

Phone consultation

Some therapists offer a free 15-minue phone consultation which is a great service and an excellent opportunity for you to interview your potential trauma therapist.  You are going to be spending a good amount of time and finances on effective therapy, it is very important that you find the right fit for you.

Here are some questions to help you navigate your phone consultation:

1.     What methods do you use to treat PTSD?

2.   How do you help your clients manage overwhelming emotions while they work on traumatic memories?

3.   What do you do to treat the symptoms versus the root of the problem?

4.   How long does it usually take before your clients start to see relief from their symptoms?

5.   How effective are the methods you use?

6.   Given my specific set of symptoms and needs, do you think you can help me and have you helped many others’ with my specific symptoms before?

In an ideal world, you would find a therapist who has special training and expertise in the methods that show the best results and someone who has tons of experience working with eating disorders and trauma.  Unfortunately, this is not an ideal world.  So you'll need to search a bit further.  You'll be searching for someone that you connect with, who you feel comfortable talking to, someone who will be honest with you and you'll know you can be honest with them.  

I hope this helps you in your search for the right therapist on the Main Line of Philadelphia.  If you want some tools to help now, sign up for my newsletter to get some tips and tools for managing PTSD and eating disorders.  If you are still feeling stuck, feel free to call me at 610.314.8402 for a free 15 minute phone consultation.  I am available to listen to what's happening and help direct you to the right person.  If you are looking for help with eating disorders or PTSD, you can read more about how I can help here.

Sure Fire Ways to Get Grounded and Reduce Anxiety

Your body feels jittery and like you want to crawl out of your skin.  Your heart races, your mind goes a million miles a second and you can't sleep.  Sometimes, you just wish you could find a little peace - a little reprieve from this constant state of feeling charged up.  Anxiety, social anxiety and panic are such difficult things to have to deal with.  The good news is that there's hope and some sure fire things you can do to help calm your nervous system.

What grounds you?

Getting grounded, as in, feeling your feet on the earth rather than in your head - starts with your intention at the beginning of each day.  The things that help people feel grounded can be different for everyone, so you need to find things that work for you.  The first place to start is to think about what you can do each morning, upon awakening that will help you get centered and begin your day with a peaceful intent.  Some mindfulness meditation could be helpful, reading from a daily book of inspirational readings, praying, doing some deep breathing, singing, chanting, walking or exercising in a mindful way - these are a few ideas you can begin with.  

As far as inspirational reading goes, I personally like these two:

A Deep Breath of Life by Alan Cohen

The Language of Letting Go by Melody Beattie

Whatever you choose to do to help you get grounded in the morning, make it into a ritual.  

Our bodies find comfort in repeating the same actions on a regular basis.  You will be teaching your body that every morning, you find peace through grounding and it will set you up to stay grounded and calm through the rest of your day.

Here is an example of a morning ritual:

• wake

• go to comfortable spot in home designated to meditation

• light a candle or incense

• drink warm lemon water

• read from daily inspirational book

• say a few simple prayers for help with staying calm through the day

• set timer for 5 minutes 

• practice deep belly breathing for 5 minutes while focusing on flame of candle

• After breathing, spend 5 minutes making a gratitude list

• blow out candle and go for a 15-minute walk

Something as simple as this can really get your day off to a great start.  

Maintaining Balance

As you go about your day, when you notice your anxiety rising, come back to the breath you started with at the beginning of your day.  

Feel your feet

This is a tip I learned a while back that always seems to help.  As yourself "where are my feet right now?" and then look down at them and see them there on the earth.  Wiggle your toes a bit and feel them moving around in your sock.  Acknowledge that right now, in this moment, your feet are right there and they are safe, therefore you are safe.  When you start to feel panic and your thoughts race, remember to ask "where are your feet?"

Reduce or eliminate caffeine

caffeine is addictive and it's very activating.  If you are trying to eliminate anxiety, you might want to consider eliminating caffeine.  Many people will say that they use caffeine to help them find energy throughout the day and keep them going.  Well, it's a catch 22 because when we use caffeine, our bodies use cortisol to help regulate our adrenal glands.  When we over tax this part of our systems, it leaves us depleted and more tired than we started.  Therefore, if we eliminate caffeine, we may be a tired for a few days while detoxing, but after your body adjusts, you will find that you have more energy and that you sleep better.

Speaking of sleep

A large part of mental health when dealing with anxiety is getting a good amount of sleep.  When we sleep, our bodies do a lot of healing.  Our organs do their cleansing, our hormones rebalance and we are able to function more effectively during waking time.  Also, dreaming is very important for our psyches to process material from our conscious and integrate it with our subconscious.  

Here are a few tips on sleep hygiene:

• target bedtime for the same time every night

• eliminate all electronics from the bedroom

• reserve your bed for sleeping and sexual activity only - don't do work in bed

• if you are having trouble falling asleep, get up after 15 minutes and do something non-electronic for 15 minutes, then go back to bed and try to sleep again

• create a wind-down routine for the last hour before bed

For more information on sleep hygiene contact me at TiffanySpilove@yahoo.com

Anxiety reducing techniques

Here are some proven techniques to help your body and mind relax:

Tense and release

Tighten every muscle in your body.  Start with your head. Tense up your face, your jaw, your eyes, your neck.  Tense up your shoulders, your chest muscles, your stomach, your biceps, make fists as tight as you can.  Tense up your butt muscles, your thighs, your calves, your ankles, your feet and your toes.  Keep all these parts of your body as tense as possible and keep them  tensed up for a full 60 seconds.  Then release.  This tense and release will help your body reduce anxiety symptoms.

Deep Breathing

Put one hand on your belly and the other on your chest.  Take a deep breath in and try to push your belly hand all the way out with the breath into your diaphragm.  Inhale slowly to 4 counts, then hold for 4 counts, then release slowly for 4 counts and repeat.  When you practice breathing slowly, it will help to slow down your heart rate, thus reduce anxiety.

Bi-Lateral Movement

Any kind of bi-lateral stimulation can help reduce anxiety.  Here are some examples: walking, biking, shifting weight back and forth from one foot to the other, tapping your thighs alternately.  Some others: drumming, swimming, scanning your eyes from one side of the horizon to the other, back and forth.  The butterfly hug is an EMDR technique where you hook your thumbs together so that your hands form a figure that looks like a butterfly.  Put your hands on your chest and tap alternatively around your collar bone area.  This is a great way to self-soothe or find relaxation in times of stress. Here's a video on how to do a different version of a butterfly hug.