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Survival Tips for PPD moms who experienced a past sexual trauma

Here is a recent blog post by Postpartum Progress written by Karen Morelli, LPC. She shares tips for new mom’s surviving past sexual trauma. As a clinician that works with survivors of trauma everyday, I found this piece important and one that is often not shared. See below.

“Childhood sexual abuse and a woman’s subsequent reproductive years, including menstruation, pregnancy, birth and ongoing sexuality, occurs years or even decades apart. Yet, in my clinical practice, I have found these issues to be intertwined. Sexual themes resonate with… a woman on multiple levels: within her body, her emotions and her psychology. And distress from childhood sexual abuse can resurface during the emotionally and hormonally charged time of pregnancy and postpartum. What research exists, finds that women who suffered from childhood sexual abuse have an elevated risk of postpartum depression, besides other physical and emotional symptoms. Related triggers around reproductive health:

During Pregnancy Body-based feelings in pregnancy can be re-triggering to a woman who has deep, somatic memories of childhood sexual abuse. Simple things such as the position of your body during vaginal exams can bring back emotional memories of past abuse. The baby moving inside your body might cause intense joy, but might also create an underlying uneasiness.

During Birth Childbirth is an intense experience; a time of hormonal, physical and emotional exertion. Early trauma can be triggered by a particular scent for example, or a body position. If you feel powerless, not heard, or disregarded by your healthcare providers during childbirth, it can activate the symptoms of post-traumatic stress and flashbacks of your past trauma.

During Postpartum There are many physical, emotional and psychological factors feeding your emotional health during this time. And it’s true that a pre-existing personal depressive or anxiety disorder, or pre-existing PTSD, sets your body up for another episode postpartum. Intense physical and hormonal changes, plus adjusting to a new lifestyle caring for an infant is physically and emotionally challenging. Feelings of frustration emerge as you adjust your schedule to accommodate your baby. The endless touching may leave you feeling like your body isn’t your own anymore. Breastfeeding may feel triggering to some, as it too may cause confusing sexual feelings.

So what can you do to proactively manage your mental health during these phases of motherhood? First, I want you to know that your childhood sexual abusive does NOT define you. Your past does NOT have to be your destiny. With perseverance, you can move beyond being a survivor towards thriving and blooming beautifully. It’s not an easy task, but your self-esteem is worth the fight! Managing the effects of an abusive childhood is an on-going deeply personal experience. It’s honorable life work, and highly individualized. As you move along your healing path, you’ll choose what’s right for you.

Tips to help enhance your experience of pregnancy, birth and postpartum:

1.Recognize that post-traumatic stress is a real disorder, not some fake diagnosis.

2.Practice Self-Love. Self-love is not just an empty clich , it’s something worth fighting for. Allow yourself to rest and be gentle with yourself during all three stages of motherhood.

3.Try to make time to get help with a licensed mental health professional before pregnancy. It’s best to put in your emotional work before starting a family, but it can also be done if you are already pregnant or postpartum (see below.) It’s never too late to begin.

4.Face your fears and past, at your own pace, in a safe and professional environment.

5.Work with a gynecologist/obstetrics/midwifery provider with whom you feel comfortable enough to discuss your history of trauma. Investigate the hospital or birth center where your provider practices to make sure it’s the right fit for you. If your provider or institution don’t meet your needs, you are empowered to find another. It’s important to advocate for your own health care.

6.Find an experienced childbirth educator who is accepting of your personal choices. Birthing and breastfeeding classes really do help on an emotional level as well.

7.Remember that birth is an unpredictable experience. If your birth experience doesn’t follow your birth plan, you can still feel good about it. You are not less of a woman or mother, no matter how your birth happens.

8.Honor the achievement of childbirth and motherhood. You are growing a life! That is a huge accomplishment.

9.Understand that your hormonal balance takes at least three months after birth to come back to pre-pregnancy levels.

10.Honor and protect yourself during ”the fourth trimester” and beyond, as your body shift towards balance:

  • Rest; develop the mindset of being, not doing.
  • Practice good nutrition with whole foods and good supplements.
  • Get help. If you can afford it, set up some time with a postpartum doula or a baby nurse so you can rest. Enlist the help of family or friends. You don’t have to do this on your own.
  • Don’t underestimate the power of sleep. Work out a sleep plan. Even if you are breastfeeding, don’t be the only one getting up to feed the baby.
  • Practice mindfulness and relaxation to counteract the inevitable challenges of caring for a newborn and the emotional change of identity in motherhood
  • Nurture yourself with complementary care. Safe touch such as shiatsu and acupuncture can re-balance your body and mind.Expect some emotional ups and downs and realize these are normal.
  • Social support is important. Women who ”Tend and Befriend” in real life and online feel supported.
  • If you feel very sad or anxious, there is a lot of professional help available to you. You are not less of a mother if you see a doctor or therapist. Taking care of you makes you a better mother. A beautiful book about healing from child sexual abuse that I highly recommend is ”A River of Forgetting” by Jane Rowan.
  • If you had the experience of childhood sexual abuse, know that post-traumatic growth is possible. Don’t wait to honor yourself by doing the emotional work. You can ask for and get help. You and your family are worth it. And know that you are not alone.

-Karen Morelli,LPC

Reference: Perez-Fuentes, G., Olfson, M., Villegas, L., Morcillo, C., Wang, S. & Blanco, C., (2013). Prevalence and correlates of child sexual abuse: a national study. Comprehensive Psychiatry, 5(1), 16-27.

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Surviving and Enjoying the Holidays

As the Holidays are fast approaching, I have spent much of my time during sessions preparing clients for visiting and enjoying their time with their families and loved ones. Most vacations away visiting families or staying home are wonderful and full of long lasting positive memories. Sometimes, this is not the case with all families or all trips. One idea to help navigate through potential troubled waters, is to create a mini traveling survivlal kit that will help soften some of the intense feelings that occur after a family trigger. Trauma Expert, Janine Fischer suggests this with people who are at risk for self harm, but I have found that this idea helps many people cope in all situations. We are always packing for EVERYTHING–why not “pack” a kit that will help you cope with potential family triggers. Triggers can occur in any sensory experience: sight, taste, smell and auditory.

The contents of the kit depends on YOU and the details surrounding the trip. To prepare, you must think about potential pit falls and triggers, as well as, the events that you really want to ENJOY! With this in mind, pay attention to how you are feeling when thinking of the triggers — how intense are they? where are you feeling them in your body? Now — what are some things that might help you cope IF this situation occurs during your home holiday or your vacation away. Some suggestions are: exercise, going to the movies, listening to a great song list, knitting/sewing, reading a book that is pleasurable, calling/texting a friend…. . Make list and practice preparing to use it. You can literally create a box to bring or even something in a separate bag that would also include your favorite quote, stones or other “grounding” objects.

When faced with difficult family situations, this survival kit gives you a plan to help control feelings that can be overwhelming and can cause you to feel flooded. Most importantly, the goal is to ENJOY the events that are important to you and not remain STUCK in the emotional storm. Hope this tip helps you in enjoy your holiday.

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PTSD Memories: The Body Always Remembers

Most of us have had feelings of nostalgia once in a while. We might see yellow school buses go by and think of our children long ago getting on the bus for the first time. Maybe it is when the weather changes, we remember our college days or hear an old song that reminds of times past. Sometimes we can’t remember exactly in detail the event, but our body and brain reminds us of that particular time in our lives.

When people experience a trauma, the body and brain also remember. People recovering from traumas can witness in themselves very intense feelings or ”memories” of the situation that occurred (Fisher, 2013). This onset is often triggered by any sensory experience: sight, smell, auditory, and so on.

What outsiders may not realize is that these emotions can be very scary and overwhelming. Everyone has heard that saying ”it is like riding a bike ’ you will remember what to do”. Well’this is the way the body is reminding the survivor — but it is the type of muscle memory one must learn to cope successfully with.

 

Some examples of experiences are: feelings of panic, apprehension, shame, depression, numbness, sense of abandonment, impulses to run or leave, self mutilation, shakiness, rapid heartbeat, and suicidal ideations. All of these reactions or feelings is the body’s way of remembering what happened. Very often, clients will say to me ’ ”I don’t really remember all the details”, ”there are lapses in my memory from growing up”. Yet, the body is recalling ’ communicating in feelings and behaviors.

Having this cognitive understanding, allows clients to begin strengthening their ability to tolerate this hyper or hypo arousal state that is so very uncomfortable (Fisher, 2013). They can then remind themselves they are in the present day. This helps build new muscle memory that the feelings – aka- the memories, can be tolerated with new coping skills. The goal is to change the default setting — to tolerance ’and hopefulness.

(Fisher, 2013)

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Mindfulness Based Cognitive Therapy does reduce stress, anxiety and depressive features! 2 tips to help you TODAY

Do you often feel STRESSED at work or at home?

Do you or someone you know suffer from DEPRESSION and/or ANXIETY? Do you often feel paralyzed and overwhelmed by intense emotions?

Do these feelings leave you with negative thoughts that may NOT even be accurate?

Learn two strategies to help you cope with these symptoms through Mindfulness Based Cognitive Therapy!

Mindfulness Based Cognitive Therapy (MBCT):

  • Helps people disengage from unproductive thought patterns and remain unengaged. Helps stop the downward spiral.
  • Helps people live in this moment, rather than worrying about the past or future; leading to more fulfilling lives and less suffering.

I use this MBCT technique with women struggling with depression and anxiety, especially Postpartum Depression, and Social Anxiety/Panic Attacks.

Learn more about MBCT from my interview below with Meredith McEver, LCSW of Arlington Virginia, a seasoned MBCT individual and group leader:

(Meredith G, LCSW): I work with many women who struggle with depression, anxiety and mood swings. Some have been suffering with these symptoms their whole life. Other women have experienced a trauma either small or large — that have left them in despair.

In therapy, I use a number of approaches to assist clients in easing and reducing these plaguing symptoms. I have incorporated mindfulness based cognitive therapy and have found that it really helps many of my patients.

Tell me more about this approach and how you use it in your individual and group work. For starters – – who is most appropriate to benefit from this type of intervention?

(Meredith McEver, LCSW) – Mindfulness Based Cognitive Therapy or MBCT helps people struggling with a wide range of issues. It was originally developed for people with recurrent depression, but has been used with people with other concerns such as generalized anxiety, Bipolar Disorder, and health anxiety. I even use it when I work with organizations to prevent burnout.

The research shows that MBCT helps people suffering from depression to recover. It’s considered to be the”gold standard” in the treatment of depression. Some people have more than one episode of depression. For the subset of people with 3 or more episodes of depression, MBCT has been shown to be 40-50 % more effective than individual CBT in preventing depression relapse. For those who recovered using antidepressants as part of their treatment, MBCT was found to be as effective, if not more effective, than continued antidepressants use in preventing depression relapse.

Its effectiveness has also been shown in increasing emotional regulation and psychosocial functioning for people with Bipolar Disorder and decreasing anxiety for anxious individuals. It has been incorporated in a program to prevent substance abuse relapse, which has been shown to be more effective in preventing relapse than treatment as usual.

Meredith G — Wow, I did not know MBCT was so effective and that it really helps in preventing relapse — which is one of the biggest fears among clients. Can you describe 2 techniques that you have found most helpful with those who have been in your groups or techniques that people can use as needed to ease work related stress that you spoke about.

(Meredith McEver, LCSW)

Taking a “BREATHING SPACE” has been very helpful to many of my clients. To do so, you

  • Bring your attention to the present moment;
  • Notice any body sensations that are present, doing your best not to comment on the body sensation or try to change it, just notice it;
  • Refocus your attention to your body and notice any emotions. Most people feel their emotions in their belly, chest, throat, corner of the mouth, eyes, or all over. Not trying to create emotions or push them away, just notice them with acceptance;
  • Refocus you attention to your thoughts. Sometimes when you focus on your thoughts, they go away, so noticing the lack of thoughts until a thought arises and then noticing that;
  • Refocus your attention to your breath for a few breaths. Then notice your facial expression, posture and your whole body.

It’s very simple and takes just a few minutes. Strange as it may seem, noticing and accepting your body sensations, emotions and thoughts just as they are and not trying to change them can lead to relaxation. Spending time denying that we’re in a bad mood is draining and prevents us from taking the action needed to feel better. This moment of noticing what’s going on gives you the space to calm down a little and allows your inner wisdom to emerge so you know what action to take rather than reacting reflexively.

A last technique is learning that ”Thoughts are NOT facts”has also been very helpful. And while everyone intellectually knows that thoughts aren’t facts, we sometimes react as though our thoughts are true. For example, a friend doesn’t respond to an email and we think that they’re mad at us.

  • Thinking it is one thing, but automatically believing it can lead us to feel depressed or angry and behave in a way different than we would if we believed that the email got lost.
  • Experiment with it yourself and notice what some of your automatic thoughts are and what emotions they lead to.

So we teach people in MBCT how to be mindful of thoughts, which is being aware of thoughts when they occur without judging the thought or yourself. This moment of mindfulness, being aware of what is happening in this moment without judgment, gives us an opportunity to decide how to respond to the thought rather than jumping to our conditioned, automatic response. You have an opportunity to realize that there are a myriad of reasons why that person didn’t respond to your email and you really don’t know what their reason is.

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Squashing the Worry Bug

Do you have a child that worries? Does the anxiety get in the way of having fun, participating in activities, with friendships? Does your child have the following traits?

  • DemonstrateS excessive distress with crying, physical symptoms, sadness, anger etc.
  • Easily agitated or angry in stressful situations accompanied by stomach aches or headaches.
  • Needs repetitive reassurance to ”what if” concerns

These are just a few symptoms of children who worry excessively. There are few ways to combat anxiety and, at the same time, give your child the confidence to manage it. Tamar Chansky, PhD, author of ”Freeing your Child from Anxiety” has identified 5 steps in creating this management plan.

Empathize with your child what you are feeling:

  • Acknowledge what is going on with her. Don’t tell her not to worry, but reflect her feelings by saying: ”this seems so hard, so unfair”, ”this is making you so upset”…
  • Relabel the problem ’ give it a name.
  • This allows the child to determine what thoughts are from her worry voice and what she really THINKS.
  • Give it a name like ”worry bug”, make a puppet to remind her, or even draw pictures of it.

Rewire and Resist

  • Help her find the truth and not let the powerful feelings get in the way
  • Teach her to say things like ”my parents would never let me be in danger — I am not listening to you worry bug!”

Get the body on board

  • Slow the body down by counting, deep breaths, thinking of something that makes her happy and calm.
  • Remind your child that anxiety always passes

Refocus on what you want to do

  • Ask your child what she would be doing if she was not worrying? Then get into the activity ’ or something like it — the brain will follow but not the worry bug!

Reinforce your child’s efforts at fighting her worries!

  • Reward any behavior that demonstrates any coping, effort at beating this worry bug!
  • Change the reward after a partial goal is met

You can use these steps with children and adults at all ages, just adapt to their age and maturity level. Chansky and others believe that it takes about 2-3 weeks for a new behavior to really be established, so practice and reward consistently! For more information regarding anxiety in adolescent girls and women visit the blog section of my website at www.mgelman.com

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Time Outs for Everyone

As a parent of three young children, the days of time outs are not far behind me. What I find interesting is how this behavioral tactic is so useful for children and adults of all ages. When Time Outs are used with self-soothing techniques (ways to calm yourself down), the road to compromise with your offending partner is not so bumpy! But how do you know when to take a Time Out during a disagreement?

John Gottman talks about this important break in his book ”And Baby Makes Three”. The first important step is identifying what you are feeling and if you are becoming flooded. Yes – just like your basement flooding or sadly the Titanic, but it happens more quickly and is felt differently across gender lines.

For some people they may feel:

  • Knots in their stomachs
  • Jaw tightening
  • Changes in their breathing patterns
  • Freezing/or difficulty moving

Gottman describes this as a tidal wave of physiological sensations: called Diffuse Physiological Arousal: DPA. When we are in this state, our reasoning, hearing, and rational self are altered. Thus the fight or flight sensation is activated. According to Gottman, we must then know to take a break and calm down in order to effectively navigate (and compromise) within the argument. If not, we end of saying and doing things that we often regret later. Sound familiar?

Gottman believes that we need to first understand and recognize the signs of DPA so that it does not suck us into a vortex of an alarmist state ’ ready and mobilized for action! Taking this break has to happen before the flooding. It is also important to indicate when you will resume talking about the issue at hand. It is recommended at least a half an hour, but not more than one day.

During that time, our systems have calmed down and we will be better able to compromise with our partner, child, and co ’worker. The details of the time out (the identified mutually agreed upon sign that a break is needed, for how long and can we commit to this ritual) with a partner / child can be discussed during calm times before a heated discussion.

With outside people, one can simply say ”it seems as though we don’t agree, why don’t we talk about this situation later when we can have some time to think about it?” .

Don’t forget to calm yourself down when the time out is happening. Some clients of mine write, other listen to music, exercise, and take deep breathes. This part of the ritual must happen or you won’t be ready or able to do the next big step: compromise!

Try this method out! You will be surprised how well it works.

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Postpartum Depression in Women

”I am supposed to be so happy — why am I not?”

Having a new baby can often be difficult for women when they are first home with their child. At a time when mothers believe they should be excited and happy over the birth of their child, some report being miserable, sad, and regretful- – struggling with Postpartum Depression (PPD). Postpartum Support of Virginia (2011) reports most common PPD symptoms as:

  • regrets having a baby
  • having trouble sleeping, even when baby sleeps
  • thinks her family would be better off without her
  • fears leaving the house or being alone
  • isolates herself from friends and family
  • has unexplained anger or irritability
  • fears she might harm herself or her baby
  • has trouble coping with daily tasks
  • has difficulty concentrating or making simple decisions
  • feels ”out of control”
  • feels guilty for feeling this way

Some root causes of this depression are the result of hormone fluctuations after giving birth, the decrease in amount of sleep a new mom receives, isolation, a history of depression prior to pregnancy or birth of baby, the birth experience, and any concerns related to the baby — feeding issues, colic, a Neonatal Intensive Care Unit experience, etc. These symptoms can be very overwhelming at times and difficult for spouses and partners to understand. Getting help as soon as possible is very important.

Some steps to cope with this illness include getting enough sleep (up to 5 hours a night), having a healthy diet — including 64 oz. of water if you are breast feeding, and etting regular exercise. Ask for help from outside family and friends to assist with laundry, food shopping, and childcare. Sometimes writing in a journal can help process some of the difficult feelings that you may be having. Lastly, consult a mental health professional who can support you with more coping strategies. Please feel free to contact me if you are interested in hearing about more ways to treat Postpartum Depression.