Wolkin PTSDAwarenessSeries 2016

06/01/16
Dear anyone whose life has been impacted upon by trauma,
I’m so glad you downloaded my 2016 edition of the BrainCurves™ PTSD Resource
Packet, which I hope will be an invaluable resource for you, your loved one, your
patient/client, and/or anyone else you know who might benefit from it as you navigate the
terrain of healing from the effects of trauma.
In honor of Post-Traumatic Stress Disorder (PTSD) Awareness Month, I wanted to write

and curate a series of posts addressing PTSD in general, and as it relates to gender,
relationships with others, chronic pain, heart health, and traumatic brain injury (TBI).
I officially started this series last year, but I’m committed to revising it, adding to it, and
updating it annually. This year, I’ve added a new post about the possibility of
mindfulness meditation as an integrative treatment option, as well as a post addressing
ways in which we can help our children cope through trauma, and finally, a post that
discusses a lesser-known concept, called Post Traumatic Growth (PTG). I’ve also
updated and added to the list of helpful links.
Trauma is one of the most sensitive issues I will ever speak about. In my writing, I want
to make information as accurate and accessible as possible, but also go to the nth degree
to create a sensitivity and respect for all those who have been affected by trauma of any
kind. I write this with the utmost respect for those who have, and continue to, suffer.
My wish is that by creating awareness more people will feel able and comfortable
reaching out for help. This packet provides information about the depth and breadth of
the suffering that PTSD can create, but also emphasizes the prospect of effective
treatment and conveys the possibility of healing.
While PTSD is relentless and pervasive, there IS hope for recovery. PLEASE hold on.
To Thriving,
Jennifer Wolkin, PhD

Licensed Psychologist
Clinical Neuropsychologist
PTSD Resource Packet

©Jennifer Wolkin, PhD/BrainCurves™, Updated 2016. All Rights Reserved.

TABLE OF CONTENTS
Page 4 Updated: Characteristics of Trauma and PTSD
Page 7 Updated: PTSD and Interpersonal Relationships
Page 9 Updated: PTSD and Chronic Pain
Page 11 Updated: PTSD and Heart Health
Page 13 Updated: PTSD and TBI
Page 15 Updated: PTSD and Gender
Page 18 Updated: PTSD and Treatment
Page 21 New Article: PTSD, Neural Mechanisms, and Mindfulness Meditation
Page 25 New Article: Five Ways to Help our Children Cope through Trauma
Page 27 New Article: Post Traumatic Growth (PTG)
Page 30 Updated: Trauma and PTSD Resources
Page 32 Author’s Bio

“There are wounds that never show on
the body that are deeper and more “The conflict between the will
hurtful than anything that bleeds.”  to deny horrible events and
the will to proclaim them
- Laurell K. Hamilton, Mistral's Kiss aloud is the central dialectic of
psychological trauma.” 
- Judith Lewis Herman,

Trauma and Recovery
“Some people's lives seem to flow in a

narrative; mine had many stops and starts.
That's what trauma does. It interrupts the
plot. You can't process it because it doesn't
fit with what came before or what comes
afterwards.” 
- Jessica Stern, Lecturer in Public Policy


CHARACTERISTICS OF PTSD AND TRAUMA
As a clinical health and neuropsychologist, I am witness to those suffering from trauma
on a daily basis. Trauma is a broad term, and according to the American Psychological
Association (APA), it is an emotional response to a terrible event. Unfortunately, the said
terrible event can constitute a plethora of possibilities, including combat, rape, natural
disasters and assaults. There are other potentially traumatic events, and though less talked
about, are no less palpable. These can include illness, intra-psychic identity struggles and
others’ responses to these struggles, divorce, and constant relocation as a child.
Ultimately, any event might be considered traumatic if you have experienced and/or
witnessed a threat to your life, a threat to your body, and/or moral integrity and/or
witnessed or experienced a close encounter with violence or death.
Usually, when we are faced with danger, we go into fight or flight mode during which
our bodies release hormones to help us act faster, to either fight or take flight. Trauma
inhibits this very normal and evolutionary response to impending danger. What trauma
does is render someone helpless; instead of reacting to trauma with a natural response, we
are paralyzed, a sense of control is lost, and we lose any ability to do anything to be
relieved from the circumstance.
Symptoms of PTSD:
Those experiencing PTSD often experience a negative change in one’s beliefs, including
the way one thinks about oneself and others. Difficulty trusting someone, and guilt and
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or shame are often felt as well.
PTSD is most powerfully characterized by the experience of three prominent symptoms,

which include Re-Experiencing the event, Avoiding any reminders or feeling emotionally
numb, and Hyper-arousal, which consists of a sensitive startle response. I am going to
parse out each further.
In terms of Re-Experiencing, many people who experience PTSD relive the trauma after
it has passed. The reliving feels as if the event was occurring at present as either or both
nightmares or flashbacks. The trauma literally takes hold of someone’s life because it
intrudes and fixates itself, and decreases someone’s ability to function day by day.
Many people who experience trauma actually feel compelled to re-experience the event,
either literally or figuratively in order to “fix” the original outcome. As trauma is distinct
in its feeling of utter helplessness, it is understandable that many want to reenact the
trauma in order to take control and restore a sense of self-efficacy. This is very
precarious, however, and can create a lot more suffering.
Avoidance/Numbing corresponds to a state of indifference, emotional detachment and

passivity. Most people diagnosed with PTSD most blatantly restrict their lives by
purposeful and conscious avoidance of any situation that would appear to elicit any
reaction other than a sense of safety and security. Some actually dissociate from reality
without conscious choice. When people cannot purposefully detach, or dissociate, they
often look toward drugs and alcohol to numb the pain. So, to reiterate, those with PTSD
go on to live a narrowed life because they avoid experience and shy away from new
opportunities.
With regard to Hyper-arousal, many people with PTSD will react in such a way that they
enter a state of permanent alertness. They are on guard at all times as if the danger will
return at any point. This heightened state of arousal is induced really around the clock,
like swimming in a constant pool of physiological stimulation. Many people startle to
both factors associated with the trauma, as well as unpredictable stimuli (a door bell
ringing for example).
In addition to the expressions of symptoms as described above, PTSD causes a huge deal
of distress and severely limits functioning on social, personal, and occupational levels.
At the heart of PTSD is an exquisite attempt for the sufferers to try and find balance in
their life. This is often reflected in the cyclical expression of re-experiencing and
avoiding. There is a great attempt of the trauma sufferer to both deny the events of the
past and at the same time proclaim their experience “out loud”; sometimes one will feel
numb to the point of detachment and dissociation, and sometimes relive the event as if it
was occurring at present. Neither symptom allows for the true integration of the


traumatic event. Therefore, this pattern is ultimately self-perpetuated.
Symptoms of PTSD can last from months to even years. Symptoms are sometimes
experienced consistently, and sometimes an acute flare-up is experienced upon coming
into contact with a precipitating reminder (i.e, anniversary of a specific event).
Regardless of the manifestations and progression of the difficulties, it is important to
recognize that not all post-traumatic experiences fit neatly into a labeled disorder with
established criteria.
Being told you do not suffer from PTSD does not mean that you are not suffering or
experiencing many emotions and or physical changes. A diagnosis of PTSD can help
inform treatment, but it is important to seek treatment if you are experiencing fear,
anxiety, depression, anger, and/or disconnection. These are all plausible feelings
generated by unfathomable circumstances.
Early intervention might help stave off whatever you are experiencing from
progressing for the worse. Remember, being labeled or not labeled does not take away
from the suffering you experience. You do NOT need to be diagnosed with PTSD to
receive the best treatment for what you are experiencing.


PTSD AND INTERPERSONAL RELATIONSHIPS
Trauma calls into question the basic foundation of trust in human relationships.
Traumatic events not only have effects on the psychological structures of the self, but
also on the attachments that link an individual to a greater community. A trauma
sufferer is likely to feel as though every relationship is infused with a sense of
alienation and disconnection.
The impact of trauma pulls and pulls at the threads of relationships until they tear, or in
many cases, disintegrate completely. Sometimes, when I work with the significant other
of a trauma sufferer, I am shocked by how far the trauma reaches. It goes inward and
outward. Its tentacles have few boundaries.
It is so pervasive, that I often wonder: Is Trauma Contagious?
The literature has demonstrated that PTSD affects family cohesion, parenting satisfaction,
romantic partnership, and functioning and emotional security of children. Consequently,
poor functioning in these domains is associated with higher rates of divorce and higher
occurrences of clinically significant levels of relationship distress in the families of
veterans with PTSD than in the families of veterans without PTSD or in the general
population.
It probably can’t be overemphasized that poor health outcomes for children (poor
development, higher rates of illness, lower academic performance, and cardiovascular
disruption) are closely linked to this now-stressful family environment, which is created
when the symptoms of PTSD literally intrude upon the family or relationship structure.
PTSD symptoms affect personal relationships indirectly as well. For example, veterans
with PTSD are more likely than members of the general population to have clinically
significant levels of depression, anxiety, anger, and violence. They are more likely to
abuse substances and less likely to hold steady employment. All of these play a role in
the breakdown of interpersonal functioning.
The nature of interpersonal problems experienced by combat exposed veterans appears to

be correlated with the presence in particular of the avoidance and numbing characteristics
of PTSD. In families and relationships, avoidance and numbing may create social
isolation, a cold, and unresponsive parenting style, anger, and an absence of emotional
warmth.
One of the most consistent relationships observed in trauma research is the inverse
relationship between PTSD symptoms and social support (that is, the more social support,
the fewer symptoms). The ultimate sad irony is that the people in the world of the trauma
survivor are pushed away, though connection is the very thing that is needed.
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A supportive response has shown to mitigate the impact of trauma, as the survivor yearns
to establish a basic sense of safety and trust. The trauma survivor needs the help of
others to rebuild his or her shattered sense of self. Yet, it is a long arduous process during
which the survivor cycles between the need for extreme closeness and the need for
distance and time to reestablish self-autonomy.
During this process, the toll that these cycles take is hard to gauge. In some cases,
members of the support system suffer their own kind of trauma. If merely witnessing the
person you love suffering through trauma is not a sort of trauma unto itself, then I
don’t know what is.
Recovery for the sufferers and support systems is possible. It is crucial that health
professionals understand the impact of PTSD on interpersonal functioning in order to
provide the best treatment approaches for the sufferers and their social systems.


PTSD AND CHRONIC PAIN
PTSD is mostly known for its impact on overall mental health. There is research,
however, to support the fact that PTSD is increasingly being recognized for its effect on
physical wellness as well. Many who suffer with PTSD (veterans in particular) have a
higher lifetime prevalence of circulatory, digestive, musculoskeletal, nervous system,
respiratory, and infectious disease. There is also an increased co-occurrence of chronic
pain in those who suffer with PTSD.
In 1979, the International Association for the Study of Pain (IASP) officially redefined
pain as, “An unpleasant sensory and emotional experience associated with actual or
potential damage or described in terms of such damage”. This definition takes into
account the fact that pain involves thoughts and feelings. Meaning, pain is real whether or
not the biological “causes” are known, and it is ultimately a subjective experience.
Pain experienced by veterans is reported as significantly worse than the pain of the public
at large because of increased exposure to injury and psychological stress during combat.
Rates of chronic pain in veteran women are even higher.
All veterans with chronic pain often report that pain interferes with their ability to
engage in occupational, social, and recreational activities. This leads to increased
isolation, negative mood, and physical deconditioning, which all actually exacerbate
the experience of pain.


Why are veterans and others who suffer with PTSD more likely to experience co-
morbid chronic pain?
Well, for veterans in particular, the pain itself is a reminder of a combat-related injury,
and therefore can act to actually elicit PTSD symptoms (ie, flashbacks). Additionally,
psychological vulnerability such as lack of control is common to both disorders. When a
person is exposed to a traumatic event, one of the primary risk factors related to
developing actual PTSD is the extent to which the events and one’s reactions to them are
unfolding in a very unpredictable and therefore uncontrollable way. Similarly, those with
chronic pain often feel helpless in coping with the perceived unpredictability of the
physical sensations.
Some say that those who experience PTSD and Chronic Pain share the common thread of
“anxiety sensitivity.” Anxiety sensitivity refers to the fear of arousal-related sensations
because of beliefs that these sensations have harmful consequences. A person with high
anxiety sensitivity would most likely become fearful in response to physical sensations
such as pain, thinking that these symptoms are signaling that something is terribly wrong.
In the same vein, a person with high anxiety sensitivity will be at risk for developing
PTSD because the fear of the trauma itself is amplified by a fearful response to a
“normal” anxiety response to the trauma (meaning, it is very “normal” to have a strong
reaction to trauma, but most sufferers actually tend to be fearful of their own response).
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PTSD AND HEART HEALTH
As aforementioned, trauma can literally render sufferers unable to connect with/to love
either their SELVES or OTHERS. Therefore, in the philosophical sense, it is no shock
that PTSD can lead to the proverbial ‘broken’ heart, which is not a cardiovascular
disease, but a disease of the soul and spirit.
Ironically, PTSD has recently been deemed a major risk factor for cardiovascular disease.
Research studies over the last decade have illustrated that people who experience PTSD
are at increased risk of heart attack and cardiovascular death. As with pain, many
mechanisms have been implicated in this relationship. Why are veterans likely to
experience comorbid cardiovascular disease (CVD)?
On a purely biological level, PTSD leads to physiological changes, including states of

“hyper-arousal,” characterized by increased sympathetic system activity (i.e., increased
blood pressure, heart rate, etc). This constant physiological arousal (constant “fight or
flight” mode) can damage the cardiovascular system. Meaning, the actual physical toll
that constant hyper-arousal takes is that it places a huge BURDEN on one’s heart.
In addition to a biological explanation, there are many poor health behaviors associated
with this risk as well.
• People who experience psychological stress, including PTSD, are more likely to
be non-adherent to medication and other treatment recommendations. Those with
PTSD suffering from, for example, hypertension (high blood pressure) or diabetes
are more likely to suffer a related cardiac event if they don’t take medication and
leave the disease uncontrolled.
• People suffering with PTSD are at increased risk for tobacco use (almost twice as
high as the general populations) as a way to self-medicate to decrease anxiety
levels. Smoking, however, can cause CVD through atherosclerosis (hardening of
the arteries) and increased risk for thrombosis (blood clot). Quitting also becomes
more difficult because the withdrawal period will likely also lead to amplified
physiological hyper-arousal.
• Those with PTSD are not future-oriented and are often shortsighted about their
health, making it appear unnecessary to take any preventive measures, such as
physical exercise, which is essential for heart health.
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• Additionally, many with PTSD fear that exercise might actually cause increased
health difficulties. Increased physical activity leads to increased physical arousal,
and therefore, exercise is avoided so as not to recreate that “fight or flight”
feeling.
Overall, on a behavioral level, those suffering with PTSD have a greater tendency toward
the adoption of high-risk behaviors (i.e., smoking, drug use, etc). At the same time, they
are less likely to take preventive measures.
It is crucial that those with PTSD are informed about the need to adopt a healthy
lifestyle. In addition to interventions specifically tailored to symptoms of PTSD,
interventions geared toward specific lifestyle changes are warranted (i.e., smoking
cessation programs, treatment compliance programs, etc) to prevent cardiovascular
events.
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PTSD AND TRAUMATIC BRAIN INJURY (TBI)
As a neuropsychologist, I’ve had humbling interactions with those who have suffered
trauma, in both mind AND brain. That’s why I feel it is incumbent to create awareness
regarding co-occurring PTSD and TBI.
TBI is a traumatic injury to the brain as a consequence of an external impact injury and/or
from the influences of rapid violent acceleration and deceleration of the head (impact of
your brain moving in your skull). TBI can cause a host of Physical, Cognitive, Social,
Emotional, and Behavioral symptoms. TBI is categorized as mild, moderate or severe;
most TBI’s in general are mild in nature (mTBI). They are typically characterized by:
• A period of lost or decreased consciousness (30 minutes or less).
• Retrograde or anterograde amnesia (loss of memory for events immediately

before or after the injury) which lasts less than 24 hours.
• A variation in baseline mental status at the time of the trauma (i.e., confusion,
disorientation, etc.)
• Neurological and Neurocognitive deficits including sensory loss, aphasia

(difficulties with speech), sensory perception, loss of balance, weakness, etc.
Both independently and additively TBI and PTSD are responsible for most post-
deployment impairments. They often, however, coexist.
It is difficult to differentiate between symptoms caused by PTSD and those by TBI,

because they are often so similar. For example, both PTSD and TBI produce symptoms
such as confusion, impaired learning, forgetfulness, attention and concentration
difficulties, decreased processing speed, impulsivity, reduced insight, impaired work and
school performance, fatigue, insomnia, headaches, and reduced motivation. This overlap
makes diagnosis, and subsequent treatment, that much more complex.
In a large military sample, almost three times as many troops who sustained a mild TBI
screened positive for PTSD versus those who sustained “only” a significant bodily injury.
It is said that TBI actually increases the risk of PTSD.
From a neurobiological standpoint, it is likely that neural damage sustained during the
injury compromises the fine-tuned circuitry required to regulate fear following a
traumatic experience (most of our fear reaction is mediated by fronto-temporo-limbic
regions).
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On a cognitive level, the effects of TBI at the time of trauma could influence the
encoding of the traumatic event, how emotions are processed, and the degree to which
trauma-related memories and feelings can be retrieved in a controlled, verbally accessible
manner during therapy.
One of the most crucial steps in early mTBI management is dispensing information
outlining the nature of expected symptoms and providing ways to best cope with them.
This information should be imparted in the context of reassurance that symptoms will
likely resolve: The literature indicates that individuals who assume the damage is
permanent might actually be more vulnerable to a prolonged presentation of symptoms
because they are more likely to become anxious over them.
A challenge for clinicians is to determine whether self-reported, non-specific

symptoms, long after an injury, are related, partially related, or unrelated to the
original injury and to make a proper diagnosis. Of course, the sooner an mTBI is
identified, the sooner proper care is received.
Both mTBI and PTSD are complex and multifaceted, and therefore, both require
multifaceted treatment. Studies supporting the simultaneous treatment of both are sparse.
Some clinicians, therefore, treat whatever is treatable to try and reduce overall suffering
and improve functioning. Treating specific complaints (such as pain and insomnia) might
result in a concomitant benefit in other realms (such as cognitive difficulty and anxiety).
After all, any potential decrease in suffering is a step in the right direction.
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PTSD AND GENDER
Both women and men are at risk of enduring unfathomable trauma, but it’s important to
emphasize gender differences here, with the hopes that they can ultimately be a much-
needed catalyst for improved preventative measures, diagnosis, and treatment.
In 2006, Tolin and Foa reviewed the results of about 25 studies, and indicated that women
are approximately 2x as likely to meet criteria for PTSD than men, and also
approximately 4x as likely to have more chronic iterations of PTSD.
The question that is begged is, what might account for the higher rates of diagnosis in
women?
• Women are NO more likely to experience trauma in general, but ARE more likely
to experience certain types of trauma, including sexual abuse and assault. These
types of trauma are associated with greater risk for PTSD.
• When compared with male trauma survivors, women tend to react with self-
blame, belief that their incompetence leads to trauma, and coping skills that are
maladaptive such as mental disengagement and suppression of traumatic
memories. This seemingly gender-specific expression of emotional distress post-
trauma might explain greater rates of PTSD in women.
• Increased baselines of anxiety and depression might put women at greater risk for
developing PTSD. Most studies assess participants after trauma has occurred,
without taking into account base rates of premorbid psychological distress. This
limitation can inflate the risk of PTSD.
• Women are more likely than men to experience multiple traumas across their
lifespan and the cumulative effects of repeated traumas likely increase their risk
of developing PTSD.
Research directed toward specific details regarding gender differences and veterans is
still scarce. It is incumbent upon any clinician, who is screening for PTSD and related
difficulties, to be sensitive to this difference.
Female Veterans and PTSD
Women veterans are particularly at risk of being involved in different types of traumatic
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incidences. There are reports of being sexually (rape) and physically assaulted during
military duty, as well as experiencing “duty-related” trauma as part of their military
exposure (i.e., warzone exposure).
Also, it is not uncommon to hear that many women in the military have suffered
preliminary trauma that might predispose them to the development of full-blown PTSD
following a subsequent traumatic exposure.
Recently, research indicated that screening positive for PTSD is associated with a range
of self-reported health problems and functional impairments specifically among female
VA patients. These include fibromyalgia, stroke, irritable bowel syndrome, chronic pelvic
pain, and obesity. In some studies, women reported poor health-related quality of life
(HRQoL) relative to both male veterans and non-veteran women. Veteran women with
PTSD have significantly more somatic distress, co-morbid medical conditions,
psychiatric difficulty, and substance abuse rates than non-veteran women.
Female Veterans and PTSD + Chronic Pain
Women veterans specifically diagnosed with PTSD usually have significantly higher
rates of pain and overall poorer health than women in the general population. There is not
a lot known about the context of “military culture” that might have implications for
women’s health behaviors. Yet, veteran women’s increased prevalence of chronic pain is
probably because their pain is compounded upon by extreme conditions that are not
experienced by civilian women. The ability to manage chronic pain is probably
egregiously limited within military context, such that pain is probably maintained or
progressively worsens with little relief.
When chronic pain cannot be readily explained as the direct consequence of tissue
damage, some people treating veteran women are apt to think, “It is all in the head.”
Although at greater risk for experiencing PTSD and co-morbid pain, women veterans
are usually under-diagnosed and also under-use mental health services. A reason cited
is that even in our progressed society, women in this position continue to be
stigmatized.
I want to take a moment to mention the obvious: both PTSD and Chronic Pain sufferers
are often stigmatized. They are relegated to the “outskirts” of the community, and
become “liminal” creatures. I see time and again that those who experience either trauma
and/or pain are perceived as victims of their own devices rather than just as sufferers.
Fibromyalgia is a common diagnosis given to women post-deployment. As such, women

are stereotyped as somatisizers and told that their pain is elicited from the mental
construct called the psyche, and not the brain. This concept of somatization implies that
pain symptoms are exaggerated or feigned and ultimately within the control of the
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sufferer.
A variety of social and medical critics view chronic pain in women as a post-modern
illness sharing a lineage with nineteenth-century pseudo-maladies like hysteria. These
illnesses, they contend, originate in vulnerable human psyches. Central to these
suspicions is the seemingly unshakable belief that chronic pain is a psychosomatic
disorder, with the implication that the sufferer’s pain is not medically “real.” Within this
conceptual framework is the archetype of the traumatized woman who experiences her
trauma symptoms in her body. I urge women to take a stand against stereotyping and to
pursue quality treatment despite critics who might make it seem unwarranted.
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PTSD AND TREATMENT
PTSD’s overall impact depends on the severity of the disorder, associated co-morbidity
(i.e., substance abuse, mTBI, chronic pain), the duration of the disorder, and of course the
individual sufferer’s predisposing neural, genetic, and psychological framework. This all
needs to be taken into account when a therapist determines which psychotherapeutic
approach is warranted.
Early assessment by the right source will help cultivate a comprehensive and individually
tailored treatment plan. Informed treatment is the key to healing, and the treatment of
trauma is as delicate as the subject matter itself. Pushing “too hard” or not using
treatments well validated in the scientific literature will only decrease chances for
improved functioning and increased quality of life.
The course of treatment with someone suffering with PTSD is a long term one, as the
capacity of the traumatized “self” is limited. When working with people who are
traumatized it should be universally understood that the basic tenants of empathy,
creating trust and positive rapport, strengthening positive transference, and making the
therapy a “safe space” are probably never more relevant.
That being said, there are a number of different therapeutic techniques implicated in
treatment for PTSD. Three common treatment protocols include: Cognitive Behavioral
Therapy (CBT) including Prolonged Exposure (PE), Eye Movement Desensitization and
Reprocessing (EMDR), and Psychopharmacologic Treatment.
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CBT:
Different clinicians use different techniques, but meta-analytic findings indicate that CBT
elicits the most robust results. A particularly effective type of CBT is called Prolonged
Exposure. Exposure is used to enhance emotional processing of traumatic events and
helps someone face traumatic memories and situations associated with them. A goal in
therapy is for the person suffering with PTSD to learn to distinguish memories and
associated situations from the actual event itself. Most importantly, the one is encouraged
to gradually learn to safely experience reminders, as well as tolerate any resulting stress,
which will hopefully decrease in time.
Imaginal exposure to the trauma entails having someone describe a traumatic experience
at an increasing level of detail. A key factor in exposure is an understanding that
confronting situations or memories of trauma triggers increases the urge to escape and
avoid (which is a primary characteristic of PTSD in general). When this occurs, the
therapist acknowledges the one’s feelings and reminds the person suffering with PTSD
that avoidance reduces anxiety in the short-term, but will maintain fear and also prevent
the learning that the feared situations or memories can eventually be perceived as less
dangerous in the long-term.
A more general CBT approach might include the therapist helping the someone to
explore schemas and self-talk, which mediate trauma-related fears, challenge negative
biases, and generate appraisals that correct for the biases (cognitive restructuring), which
helps build confidence.
EMDR:
A well-known, effective, but still slightly controversial treatment for PTSD is known as
EMDR. According to the theory behind the treatment, when a traumatic or distressing
experience occurs, it may overwhelm usual cognitive and neurological coping
mechanisms. The memory and associated stimuli of the event are inadequately processed,
and are dysfunctionally stored in an isolated memory network.
The goal of EMDR therapy is to help process these distressing memories, reducing their
lingering influence and allow someone to develop more adaptive coping mechanisms.
EMDR integrates elements of many different therapies, including cognitive therapy,
imaginal exposure, interpersonal, psychodynamic, and somatic therapies, to name a few.
EMDR is distinguishable from these other therapies by its use of bilateral stimulation
during each session (i.e., eye movements, tones, tapping, etc). Briefly, in EMDR a
qualified therapist guides someone in vividly but safely recalling distressing past
experiences (“desensitization”) and gaining new understanding (“reprocessing”) of the
events, the sensations, feelings, thoughts and self-images associated with them. The “eye
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movement” aspect of EMDR involves the client moving his/her eyes in a back-and-forth
(“saccadic”) manner while recalling the event(s).
Psychopharmacologic Treatment
In general, one of the greatest challenges in the field of PTSD is that there has been
relatively little study of medications. The Selective Serotonin Reuptake Inhibitors
(SSRI’s) are, according to the research, most effective with the lowest side effect profile.
Yet, only two, Zoloft (Sertraline), and Paxil (Paroxetine), have been FDA-approved for
actually treating PTSD. New studies are exploring the possibility of Ketamine treatment.
Ketamine works on the glutamate pathway in the brain, pathways involved in memory
and mood regulation, which might explain some preliminary results with positive
outcomes. Research is ongoing, and Ketamine is a long way from being used in clinical
practice specifically for PTSD. Consulting with a trained psychiatrist or psycho-
pharmacologist is most prudent.
Again, no matter the treatment of choice, the goals of the therapist should be maintained
throughout. These include emphasizing a sense of self-esteem and personal
empowerment while helping someone make sense of confusing and disturbing
experiences. Creating a sense of safety and working collaboratively with someone at
his/her individual pace will help create a space conducive for healing.
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TRAUMA, MINDFULNESS, AND PTSD
An exploration of the how the brain responds to traumatic events, and what science says
about the role of mindfulness meditation in helping people better process trauma, and
decrease their suffering.
If we were able to prove that individuals suffering from PTSD are experiencing
reversible neurological changes, would that help to alleviate any taboo associated with
trauma so that sufferers are able to get the treatment they need? New treatment protocols
for PTSD that integrate mindfulness techniques may make that a possibility in the near
future.
Mindfulness based techniques in this context have recently gained traction with the
support of more empirical findings. Overall, there is a lot of evidence supporting
mindfulness as a treatment approach for adults with PTSD, and a recent burgeoning
literature corroborating positive neurological changes is following suit.
The Brain and PTSD
In order to understand the neurological implications of PTSD, it is important to quickly

parse the concept of neuroplasticity. For many hundreds of years scientists thought that,
like physical development, once the brain reached maturity, it ceased to grow and
develop in any way.
The modern view is antithetical to this, given research that continues to show ways in
which the human brain is in a constant state of change. In this way, it is believed, new
experiences actually impact our neural circuitry; that over the course of a life, our brain
map reflects new and changing pathways. This idea is expressed eloquently, and through
case examples, in one of my favorite books: The Brain that Changes Itself, by Norman
Doidge, MD.
Most of us view this notion of a neuroplastic brain through a rose-colored lens. Yes,
neuroplasticity affords the brain an opportunity to heal from injury. Let’s not forget,
though, that experience can also negatively change someone’s neuro-profile. So, in sync
with neuroplastic principles, when trauma is encountered, the brain changes in response
to the event in order to cope and adapt to the situation. These brain changes often don’t
serve us going forward. While our brain adapts to develop a psychological defense
against further trauma, it is not a brain that thrives long-term.

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Neurological Components of PTSD
Neuro-imaging techniques, such as MRI and FMRI, have allowed scientists to examine
brains of patients suffering from PTSD. Three of the areas impacted by trauma include
the following:
1. Amygdala
2. Hippocampus
3. Pre-frontal cortex (PFC) (see
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3181836/ and/or
http://ase.tufts.edu/psychology/shinlab/documents/pubsShinAmygdala.pdf)
The amygdala is a structure in the brain’s limbic system (known as the emotional seat of
the brain) that helps determine whether or not a threat is approaching, and if so, sends out
a danger signal, initiates the fight-or-flight response, and then helps indicate when the
threat is gone. When one has experienced trauma, the amygdala remains hyper-alert to
even non-threatening stimuli, and activates the fight-or-flight response system despite
being safe. While experiencing PTSD, the amygdala can get caught up in a highly alert
and activated loop during which it looks for and perceives threat everywhere.
The hyperactive amygdala is constantly interacting with the hippocampus, the area of the
brain that plays a role in memory function. Brain scans have found smaller hippocampi in
those with PTSD, perhaps reflecting the impaired memory experienced post trauma.
Usually, the hippocampus works to connect and organize different aspects of memory,
and is responsible for locating the memory of an event in its proper time, place, and
context. When experiencing PTSD, memory becomes fragmented, and the hippocampus
has trouble coherently piecing together memory, from discriminating from past or
present, and from integrating memory of experiences with feelings and factual
knowledge. This is an extraordinarily distressing component of PTSD and manifests in
the form of intrusive memories and flashbacks. Triggering memories provoke the
amygdala, maintaining its hyper-activity.
The third area of the brain affected by trauma is the frontal lobe; specifically, the PFC.
This area of the brain is involved in regulating behaviors, impulses, emotions, and fear
responses. In those with PTSD, the PFC is notably less active and less able to override
the hippocampus as it flashes fragments of memory, nor to signal the amygdala that the
danger is not real.
As the above research suggests, the neuroplastic brain indeed responds to trauma. As
certain areas of the brain become hyperactive, and others deregulated, throwing off the
fine-tuned and exquisite orchestration that usually works to keep someone safe from real
threats, PTSD is cultivated.
22


What are the positive benefits of mindfulness for adult patients suffering from
PTSD in relation to the brain?
Mindfulness and the Brain
There is a significant amount of data supporting mindfulness as a treatment approach for

patients with PTSD (see: http://www.bcosi.ca/resources/publications-
archive/publications-archive-2011/mindfulness-in-the-treatment-of-posttraumatic-stress-
disorder-among-military-veterans). Much of the literature, however, doesn’t speak to the
neurological changes that occur during the mindfulness process. Research regarding
mindfulness mediation’s impact upon the brain in general points to changes in brain
structure and function that could account for the reduction of symptoms of PTSD.
Changes in Brain Structure:
As I mentioned earlier, deregulation of the brain areas associated with emotional

regulation and memory are key contributors to the symptoms associated with PTSD in
addition to the over activity of the fear center, the amygdala. Mindfulness reverses these
patterns by increasing prefrontal and hippocampal activity, and toning down the
amygdala (see: http://jhp.sagepub.com/content/46/4/474.abstract).
In fact, brain scans confirm that mindfulness meditation is correlated with an increase in
gray matter in the hippocampus, a decrease of gray matter in the amygdala, and
neuroimaging studies have found that mindfulness meditation also helps to activate the
PFC. (see: http://www.ncbi.nlm.nih.gov/pubmed/19941676).
Impact on Brain Function:
A recent study looking at the neural functional impact of mindfulness meditation on those
with PTSD implicates the interaction of two “opposing” brain networks in mediating
beneficial outcomes.
In a recent study, 23 male veterans who served in Afghanistan and Iraq were divided into
different treatment groups, one of which included Mindfulness-Based Exposure Therapy
(MBET).
Results indicated that while each treatment group showed promise, the men in the group
receiving Mindfulness-Based Exposure Therapy (MBET) experienced actual brain
changes that indicate mechanisms by which mindfulness could potentially help in the
treatment of PTSD.
Functional magnetic resonance imaging (fMRI) indicated that at the start of the study, the
veterans showed increased activity in regions associated with perceived external threats.
23


After receiving MBET, fMRI showed increased activity in what is known as the brain’s
default mode network (DMN). The DMN consists of interacting brain regions associated
with internally focused meandering and wandering thought. Additionally, fMRI also
showed that the DMN increased its connections with what’s known as the Executive
Network, associated with the purposeful shifting of attention.
Both these networks were working in sync, providing insight into the potential ability of
mindfulness treatment to help people train themselves to get unstuck from a vicious cycle
of negative thinking, often a cornerstone of trauma.
The small sample size, the gender bias of the group, and the inclusion of only veterans
means that there is room for much more extensive empirical exploration with regards to
mindfulness as applied specifically to those with PTSD.
Yet, overall, these neural correlates of symptom reduction can potentially shed light on
the therapeutic possibility of mindfulness-based treatments going forward. There is,
without a doubt, great potential for these treatments in helping people better process
trauma, and hopefully, decrease a lot of potential suffering.
A caveat worth heeding, however: Given the precarious nature of the symptoms of
PTSD, the most efficient and safe treatment should only be obtained by a professional. It
is my opinion that mindfulness, as an integrative approach under professional
supervision, is the most prudent.
24


FIVE STRATEGIES TO HELP OUR CHILDREN
AND OURSELVES IN TIMES OF TRAUMA
Many of my clients struggling with their own response to trauma ask me how they can
both help themselves and also simultaneously guide their children, who are often privy in
some way to tragic and traumatic events.
1. Give Yourself Permission to Feel Many Emotions at Different Times:
One of the core concepts of mindfulness meditation is the idea of having an attitude
of non-judgment of, and openness towards, current experiences. After a tragedy, it is
natural to react with shock, anger, numbness, sadness, grief, confusion, and even
denial. Most often, grieving is not a linear process and you might experience yourself
fluctuating between different feelings at different times, on different days and during
different weeks. It is okay. Allow yourself to feel what you feel with as little judgment
as possible.
2. Take Care of Yourself, Then Take Care of Others:
This is true on any given day, but most importantly at a time like this. If you are
anxious and your symptoms continue to persist, please reach out for
support/professional guidance. More than ever, make a point to engage in your usual
routine. Eat well and sleep well. Engage in healthy coping strategies (breath from
your diaphragm, take a bath, journal, watch a comedy, create your own safe space and
let yourself cry). Managing your own stress is a precursor to helping your children
25


manage theirs.
3. Create a Sense of Safety:
For most children, their parents symbolize safety. In times of doubt, children look to
their primary attachment figures to cultivate a safe space. Let your children know you
are available if they have questions and actively make yourself available. Children
don’t yet have the same cognitive tools needed to cope. Model resilience in the face
of hardship without denying that hardship.
4. Recognize, Be Real, But Reassure:
It is important to recognize signs of your children’s distress. Sometimes it is not

obvious, as fear and anxiety might manifest as physical symptoms (stomach aches
and headaches) and/or insomnia (and other sleep difficulties). Children, especially
teens, might isolate and/or withdraw. Recognize the pain. Then, it is important to be
real with your children. In the case of a tragic news event, Limited media exposure is
a crucial element, but on the flipside, children need to know what happened. If your
children do not approach you, take the time to find out what kinds of questions they
are having and what kinds of feelings they are experiencing. Use discretion (talk to
them in an age-appropriate way) and be honest about what is happening; it is
important not to deny the events. After honest, but age-appropriate and discrete
discussion, reassure your children’s sense of safety. At this juncture, they are
internalizing and probably deeply personalizing the events, wondering “when will
something happen to ME.” Reassure through returning to normal routine and sending
messages of safety overall. Keep life feeling as safe and predictable as possible under
the circumstances.
5. Reassess and Regroup:
Different people, of different ages, express trauma differently, at different times. The
reaction to trauma will vary greatly. One thing, however, is for sure: The effects of
trauma don’t go away easily. They might remit, decrease in severity, but they usually
remain, often for a very long time. As children develop they will adopt more evolved
coping skills in order to adapt, and ideally the appropriate acute treatment will serve
as a tool to cultivate increased resilience as time goes on. Healing is possible. There is
hope amidst this gripping grief. Yet, it is important to continue to check in with
yourself and your children if symptoms reemerge, or if other traumatic circumstances
arise.
26


THE UPSIDE OF TRAUMA: POST TRAUMATIC
GROWTH
The meaning of human suffering has been the subject of psychological, philosophical,
and poetic inquiry from time immemorial. Yet, there is an angle to trauma that is not
talked about half as much as post-traumatic stress is. I’m referring to the upside of
trauma, known in the psychological literature as post-traumatic growth (PTG). Research
studies indicate that more than half of all trauma survivors report positive change.
PTG is radically changing and advancing our heretofore ideas of trauma and the notion
that trauma inevitably means life-long damage. It is challenging the traditional view of
trauma as solely destructive and making room for understanding that the struggle that
ensues from trauma can be used as a springboard toward growth.
Given the potential zeitgeist shift, it is important to understand a bit more about what
PTG really means.
Psychologists Richard Tedeschi and Lawrence Calhoun first coined the term PTG in
1996, after discovering some fundamental ways trauma was changing people for what
was reported as “the better”. They define PTG as “the experience of positive change
resulting from the struggle with major life crises.”
PTG has been noted as a result of many different types of trauma and stress, including
illness, loss, sexual assault, and military combat. Post-traumatic growth is differentiated
from resilience, which is akin to “bouncing back”, and connotes “bouncing even higher
than before”.
In understanding the concept, however, it’s important to underscore that PTG in no way
implies that trauma itself can be intrinsically positive; rather it can be a catalyst for
positive change. Despite popular opinion to the contrary, experiencing growth after
trauma is much more common than PTSD. While most people will suffer from post-
traumatic stress in the aftermath of trauma, few will develop full-blown PTSD, and even
of those, most will heal with therapy and time. Many more are likely to go on and
become stronger. This doesn’t mean though that everyone who faces a traumatic event
experiences growth.
It is also important to note that post-traumatic growth experiences aren’t exclusive from
distress. So, just because growth is involved, does not mean that someone doesn’t suffer.
In fact, Lawrence Calhoun wrote,
“The process of growth does not eliminate the pain of loss and tragedy. But out of loss
there is often gain. And in ways that can be deeply profound, a staggering crisis can
often change people for the better.”
27


Similarly, one woman who suffered a massive brain tumor said so vulnerably in a
popular TED talk:
“We can’t wipe away our history and maybe we should not want to. I would not change
my experience as it altered my life.”
Some survive from trauma, and others thrive through trauma
Many different variables play a role in cultivating the latter; if one is contextualized
within a supportive environment, and maintains an open mindset, the struggle elicited by
trauma is more likely to become a conduit for deep reflection, and search for meaning.
Research also indicates that there are certain personality traits and mood states that are
positively associated with PTG. These include extraversion, optimism, positive affect,
and openness to experience.
To conceptualize things more fully, Tedeschi and Calhoun developed five areas in which
PTG tends to arise:
1. Sometimes when people face a trauma, they begin to see new and positive
opportunities knocking. Doors that once seemed shut begin to open up. Many
begin to think: “This is possible for me now”.
2. After trauma, some people develop an increased sense of personal strength, “If I
can survive that, I can get through anything”.
3. Some people experience changes in relationships in general or with specific

others. Sometimes this includes connecting deeply with those who have had a
similar experience of pain. This can sound like, “I have more compassion for
others, as we are all just fighting our own hard battles”.
4. After trauma, and through healing, many people find a new perspective, and a
greater appreciation for life and this moment. For example, “I realize the
importance of being present in all aspects of my life, not just my work”.
5. Many people begin to experience a deepened sense of spirituality in the context of

their healing through trauma. Sometimes, people feel like: “I survived this
trauma for a reason and a purpose that is greater than my human
comprehension”.
28


“In brief, people’s sense of themselves, their relationships with others and their
philosophy of life changes,” Richard Tedeschi said. “Perhaps one of the most common
growth experiences triggered by a major stressor is an increased appreciation of life.”
In my own experiences with people who have suffered through trauma, I have been truly
blown away by both the pain that ensues, but also by their innate ability to triumph over
that trauma. I don’t think that there is a “cure” for trauma, per se. What I do believe,
however, is that a healing process is necessary, and often time serves as a catalyst for a
profound awakening to an emotional and spiritual transformation.
Individuals, couples, families, communities, and even nations of this world have the
capacity to heal and to grow. Perhaps, in doing so, we can witness both our individual
and collective dreams come true.
29


TRAUMA AND PTSD RESOURCES
• National Center for PTSD
http://www.ptsd.va.gov/
• Veteran’s Families United:

http://veteransfamiliesunited.org/
• The Wounded Warrior Project:

https://www.woundedwarriorproject.org/
• Peer Support Blog:

http://www.vets4vets.us/
• The Coming Home Project:

http://www.cominghomeproject.net/
• The Support and Family Education Program: Mental Health Facts For Families:
http://www.ouhsc.edu/safeprogram/
• International Sexual Assault Resources (RAINN):

https://www.rainn.org/get-help/sexual-assault-and-rape-international-resources
• Women Organized Against Rape:

http://www.woar.org/sexual-assault-resources/
• American Psychological Association:

http://www.apa.org/topics/ptsd/
• National Institute of Mental Health:

http://www.nimh.nih.gov/health/topics/post-traumatic-stress-disorder-ptsd/index.shtml
• National Alliance on Mental Illness:

http://www.nami.org/Learn-More/Mental-Health-Conditions/Posttraumatic-Stress-
Disorder
• Psychology Guides:
http://www.psychguides.com/guides/ptsd-post-traumatic-stress-disorder/
30


Here are links to two inspiring TED talks that reflects the concept of PTG:
http://www.ted.com/talks/stacey_kramer_the_best_gift_i_ever_survived
In this talk, Stacey Kramer offers a moving, personal, 3-minute parable that shows how
an unwanted experience — frightening, traumatic, and costly — can turn out to be a
priceless gift.
https://www.ted.com/talks/jane_mcgonigal_the_game_that_can_give_you_10_extra_year
s_of_life
In this talk, Jane McGonigal talks about how she created a healing game, called
SuperBetter, after a concussion left her bedridden and suicidal. McGonigal explains how
a game can boost resilience — and promises to add 7.5 minutes to your life.
31


Want more?
Schedule a presentation on the topic of PTSD for your
organization.
Author’s Bio: Jennifer Wolkin, PhD is an NYC-based licensed clinical psychologist,

neuropsychologist, writer, speaker, and adjunct professor.
Dr. Wolkin recently founded a bespoke private practice with an appreciation that our
mind, body, brain, and spirit are intimately intertwined, and impacted upon, by one
another. She draws heavily from such tools as cognitive behavioral therapy and
mindfulness-based techniques.
Her passion for connecting through thoughts, words, and ideas inspired her to create a
blog and online community space called BrainCurves™, where we may support one
another and learn together how to embrace all aspects of who we are: From the unique
neural tracts curving through our brains, to the unique curves of our bodies – no matter
what our background, shape, or size.
Contact DrWolkin@BrainCurves.com for more information.
32


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06/01/16

Dear anyone whose life has been impacted upon by trauma,

In honor of Post-Traumatic Stress Disorder (PTSD) Awareness Month, I wanted to write

Jennifer Wolkin, PhD

PTSD Resource Packet

- Judith Lewis Herman,

“Some people's lives seem to flow in a

- Jessica Stern, Lecturer in Public Policy

PTSD Resource Packet

PTSD Resource Packet

PTSD is most powerfully characterized by the experience of three prominent symptoms,

Avoidance/Numbing corresponds to a state of indifference, emotional detachment and

PTSD Resource Packet

PTSD Resource Packet

It is so pervasive, that I often wonder: Is Trauma Contagious?

The nature of interpersonal problems experienced by combat exposed veterans appears to

PTSD Resource Packet

PTSD Resource Packet

PTSD Resource Packet

PTSD Resource Packet

On a purely biological level, PTSD leads to physiological changes, including states of

PTSD Resource Packet

PTSD Resource Packet

• A period of lost or decreased consciousness (30 minutes or less).

• Retrograde or anterograde amnesia (loss of memory for events immediately

• Neurological and Neurocognitive deficits including sensory loss, aphasia

It is difficult to differentiate between symptoms caused by PTSD and those by TBI,

PTSD Resource Packet

A challenge for clinicians is to determine whether self-reported, non-specific

PTSD Resource Packet

Female Veterans and PTSD

PTSD Resource Packet

Female Veterans and PTSD + Chronic Pain

Fibromyalgia is a common diagnosis given to women post-deployment. As such, women

PTSD Resource Packet

PTSD Resource Packet

PTSD Resource Packet

PTSD Resource Packet

PTSD Resource Packet

The Brain and PTSD

In order to understand the neurological implications of PTSD, it is important to quickly

PTSD Resource Packet

PTSD Resource Packet

Mindfulness and the Brain

There is a significant amount of data supporting mindfulness as a treatment approach for

Changes in Brain Structure:

As I mentioned earlier, deregulation of the brain areas associated with emotional

Impact on Brain Function:

PTSD Resource Packet

PTSD Resource Packet

1. Give Yourself Permission to Feel Many Emotions at Different Times:

2. Take Care of Yourself, Then Take Care of Others:

PTSD Resource Packet

3. Create a Sense of Safety:

4. Recognize, Be Real, But Reassure:

It is important to recognize signs of your children’s distress. Sometimes it is not

5. Reassess and Regroup:

PTSD Resource Packet

PTSD Resource Packet

Some survive from trauma, and others thrive through trauma

3. Some people experience changes in relationships in general or with specific

5. Many people begin to experience a deepened sense of spirituality in the context of

PTSD Resource Packet