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Section 7
Physiological Aspects of Trauma and Grief

CEU Question 7 | CEU Test | Table of Contents | Grief
Psychologist CEs, Social Worker CEUs, Counselor CEUs, MFT CEUs

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On the last track we discussed Healing Self-Statements.  In my version of this technique, I use three steps in helping clients to create healing self-statements.  They are considering grief neutrally, identifying needs, and identifying strengths.

On this track we will discuss the physiology of grief as it relates to clients suffering from post-traumatic stress syndrome.  I have found that there are three major physiological aspects of grief.  They are the mind-body connection, acute stress reactions, and emotional triggers.  As I describe the physiological aspects of grief, evaluate the ways in which I communicate the information to various clients.  You may want to compare these case studies to clients you are currently treated.

Three Major Physiological Aspects of Grief

#1 The Mind-Body Connection

Sam, age 52, was a former boxer and an ex-Marine.  Sam was robbed in his home when he experienced an odd mind-body connection that he couldn’t explain.  The thief demanded Sam open his safe.  Sam stated, "My mind froze.  It was like I was dumbstruck.  When I could think again, I remembered the gun hidden in my pocket.  When I went for it, my hand froze.  Now, I’ve lived my whole life around violence and I know how to kick some ass.  Why would I just freeze up like that?" 

I explained to Sam that there is no single definitive theory as to how trauma affects the body.  I stated, "Your autonomic nervous system may have been destabilized or perhaps your body chemistry was changed.  When we experience danger, our bodies try to react in a self-preserving manner.  Your body was trying to save itself, Sam."  Do you have a client who has experienced a mind-body connection?

#2 Acute Stress Reactions
As you know, there is a critical moment in stressful interactions when clients can feel anxiety start to increase.  In my experience, clients tend to have two types of acute stress reactions.  The two types of acute stress reactions are hyper-arousal and hypo-arousal.  

Lori, age 49, experienced hyper-arousal.  Lori stated, "I always thought that if I were to be mugged, I’d just do whatever the mugger told me.  You know, hand him my purse, write him a check, whatever he wanted so I wouldn’t get hurt.  But when I actually got mugged, boy did I fight back!  I punched the mugger, pulled his hair, and tried to tear his clothes off of him.  Now he was probably twice my size, but something came over me.  I’m normally shy and timid, but I was a wild woman that day!" I explained to Lori that she was experiencing hyper-arousal.  I stated, "Hyper-arousal is when the body secretes adrenaline in higher amounts than normal to enable an efficient ‘fight or flight’ response."

 In addition to hyper-arousal, the other acute stress reaction clients may experience is hypo-arousal, in which the client enters a state of numbness.  As you are aware, clients who experience hypo-arousal can react to stressful situations through dissociating.  Hypo-aroused clients may even enter an altered state of consciousness. 

For example, Mark was a combat medic in Iraq.  Mark stated, "I was living on adrenaline for days on end.  Then, one day, there was a car bomb.  We had to triage seven patients.  On my way to pull the last victim from the scene, I froze.  I couldn’t move even though I wanted to.  Then I just sort of blacked out.  I woke up three days later in a sick bay.  I can’t remember anything between the time I froze and the time I woke up."  As you know, Mark had experienced hypo-arousal.  I explained to Mark that his body had secreted non-adrenaline in an effort to effect a numbing reaction , much the same as when animals play dead.

#3 Emotional Triggers
In addition to mind-body connection and acute stress reactions, the third physiological aspect of grief I have found is emotional triggers.  As you are obviously aware, the two types of emotional triggers are external and internal.  Clearly, external triggers are located within the environment.   

For example, Mary, age 29, responds fearfully to anger in other people’s voices.  Mary stated, "My girlfriend, Cindy, and I were driving to the mall when a carjacker caught us at a stoplight.  He seemed so mad.  He was yelling and screaming.  I was so scared and then he dragged us out of the car.  When he took off, he tried to run us over.  To this day, whenever I hear someone get mad, I get so scared."  Mary was so traumatized that she perceived any type of hostility as a threat to her existence.  Mary stated, "It’s so bad that if someone gets annoyed and speaks out, I start crying." 

I stated, "Logically you know that the person is simply irritated and that you are safe from an attack, but on an emotional and physiological level you are on guard waiting for an attack.  How does this make you feel?"  Mary stated, "I feel like I have no control."  Are you treating a client like Mary who suffers from an emotional trigger?  You might try the Managing Triggers technique I will now describe.

4-Step "Managing Triggers" Technique
To help Mary manage her triggers and overcome the physiological aspects of grief she was experiencing, I decided to try the Managing Triggers technique.  The Managing Triggers technique combines stress reduction techniques with visualization.  I implement the Managing Triggers technique using four steps.  They are deep breathing, visualizing the trigger, stopping the visualization when the client gets upset, and repeating the exercise.  Evaluate my method of the Managing Triggers technique to see how it compares with yours.

--First, Mary did a deep breathing exercise.  Do you currently use a deep breathing exercise with your grief clients?  Mary found a comfortable position in which to sit and closed her eyes.  Next, she relaxed her neck and shoulders.  Mary then took a deep breath from her stomach and held it for two seconds.  After exhaling with a sigh and visualizing stress and tension leaving her body, Mary repeated the exercise until she felt relaxed. 

--Once Mary felt relaxed, we continued with the second step of the Managing Triggers technique.  The second step is to visualize the trigger.  I asked Mary to visualize someone other than her attacker yelling at her.  Mary stated, "I’m imagining my mom yelling at me and  I don’t feel relaxed anymore." 

--The third
step is to stop visualization when the client gets upset.  Mary stopped the visualization in order to calm down, if the focus is calming, or you might have the client vent the feeling before stopping.

In addition to deep breathing, visualizing the trigger, and stopping the visualization when the client gets upset, the fourth step in the Managing Triggers technique is to repeat the exercise.  With Mary I had to repeat the exercise several times before she could visualize an angry situation without fear.

Mary could eventually visualize her mother yelling at her without felling afraid.  Next, Mary repeated the exercise using more hostile visualizations.  In a later session, Mary stated, "It feels good to be able to imagine a pissed off carjacker and not start crying uncontrollably.  I feel like I’m in control again."  Are you treating a Mary who has very deep seated triggers and may need to practice visualization and stress reduction?

On this track, we discussed three major physiological aspects of grief.  They are the mind-body connection, acute stress reactions, and emotional triggers.

On the next track, we will discuss Mind Sets of Grief.  In my practice, I have found that there are three basic mind sets of grief.  They are absolutist thinking, intolerance of mistakes, and denial of personal difficulties.

Peer-Reviewed Journal Article References:
D'Andrea, W., & Pole, N. (2012). A naturalistic study of the relation of psychotherapy process to changes in symptoms, information processing, and physiological activity in complex trauma. Psychological Trauma: Theory, Research, Practice, and Policy, 4(4), 438–446. 

Diminich, E. D., & Bonanno, G. A. (2014). Faces, feelings, words: Divergence across channels of emotional responding in complicated grief. Journal of Abnormal Psychology, 123(2), 350–361. 

Katz, A. C., Norr, A. M., Buck, B., Fantelli, E., Edwards-Stewart, A., Koenen-Woods, P., Zetocha, K., Smolenski, D. J., Holloway, K., Rothbaum, B. O., Difede, J., Rizzo, A., Skopp, N., Mishkind, M., Gahm, G., Reger, G. M., & Andrasik, F. (2020). Changes in physiological reactivity in response to the trauma memory during prolonged exposure and virtual reality exposure therapy for posttraumatic stress disorder.Psychological Trauma: Theory, Research, Practice, and Policy. Advance online publication. 

Smith, K. V., & Ehlers, A. (2020). Cognitive predictors of grief trajectories in the first months of loss: A latent growth mixture model. Journal of Consulting and Clinical Psychology, 88(2), 93–105.

Taylor, S. (2020). Transformation through loss and grief: A study of personal transformation following bereavement. The Humanistic Psychologist. Advance online publication. 

Online Continuing Education QUESTION 7
What are three major physiological aspects of grief? To select and enter your answer go to CEU Test.

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