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Nearly everyone has experienced emotional distress after a traumatic event - but not everyone who experiences trauma develops post-traumatic stress disorder. Psychologist Chivonna Childs, PhD, talks about the ways that standard responses to trauma differ from clinical PTSD, and how those living with PTSD can identify and manage their disorder to ease the long-lasting impact of trauma.

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Identifying and Treating Post-Traumatic Stress Disorder with Dr. Chivonna Childs

Podcast Transcript

Intro:
There's so much health advice out there. Lots of different voices and opinions, but who can you trust? Trust the experts, the world's brightest medical minds, our very own Cleveland Clinic experts. We ask them tough, intimate health questions so you get the answers you need. This is the Health Essentials Podcast brought to you by Cleveland Clinic and Cleveland Clinic Children's. This podcast is for informational purposes only and is not intended to replace the advice of your own physician.

Kate Kaput:
Hi. Thank you for joining us for this episode of the Health Essentials Podcast. My name is Kate Kaput, and I'll be your host. Today, we're talking to Psychologist Chivonna Childs about living with posttraumatic stress disorder or PTSD, a mental health issue that can develop after exposure to trauma. Dr. Childs, thank you so much for being here with us today.

Dr. Chivonna Childs:
Thank you for having me.

Kate Kaput:
I'd Like to start by asking you to tell us about your work here at Cleveland Clinic. What kind of work do you do and what sort of patients do you typically see?

Dr. Chivonna Childs:
So I am a Staff Psychologist here at the Cleveland Clinic. I am working out of the Solon office primarily, though, primarily I'm also remote right now. My clientele are families, individuals, and couples counseling.

Kate Kaput:
On today's topic of posttraumatic stress disorder, I'd love to start with the basics. What exactly is PTSD and what are some of the symptoms? How does it feel to have PTSD? We hear that term tossed around a lot, but what is it clinically?

Dr. Chivonna Childs:
So clinically when we think about PTSD, it is a reaction to a traumatic event. That reaction can be flashbacks, nightmares about the event, feeling as if we're reliving the events, being triggered by people, places, things, situations that remind us of the event. That can send us into what we would normally feel like is a panic attack, which could be sweaty palms, racing heartbeat, trouble breathing, trouble focusing, concentrating. For some people they'll explain it or it'll sound like a panic attack, they'll say something to the effect like, "I thought my heart was going to beat out of my chest," or "I felt like I was having a heart attack," or "I couldn't get my breathing together." So it can have some very physical impact on your system when we're experiencing it.

Kate Kaput:
So it's normal to feel upset after something bad happens to you. A lot of people experience varying degrees of sort of emotional distress after a traumatic event. But not everyone who experiences something traumatic develops posttraumatic stress disorder, right? So what is considered a standard response to a traumatic life event, or like you said, maybe just standard panic attacks? How does that compare to actual PTSD as a clinical diagnosis?

Dr. Chivonna Childs:
So a typical response to a traumatic event, let's say the loss of a loved one. You're going to be sad. You're going to cry. You're going to miss them. You're going to go through the stages of grief, and we kind of just go and it doesn't really impact our life. We can still go to work. We can still have good relationships with our family members, coworkers, friends, we're still functioning. The difference with the PTSD is that it's lasting for a long period of time, and it's impacting your ability to function socially, occupationally, school, work. It impacts all those areas, when you are no longer able to focus and do your job, when you are pushing people away, you're becoming isolated because you're losing trust. People don't feel safe. Places don't feel safe. We don't feel safe. That is the difference. It's the way that you're being impacted by it.

Kate Kaput:
That makes a lot of sense. So it sounds like it's really kind of impacting your life deeply kind of all the time in an ongoing way. You mentioned loss of a loved one as the kind of traumatic event that could, but doesn't always result in PTSD. Another thing that a lot of people are familiar with as it relates to PTSD is the experience of combat veterans who have returned home from overseas. Talk a little bit about who else PTSD impacts, and what other kinds of traumatic life events might trigger PTSD.

Dr. Chivonna Childs:
So how we came about recognizing PTSD was through World War I veterans, and they were calling it shell shock. So that's how we get into this realm of, hey, something's going on, they're coming back. They're not as good. They're still having nightmares. They're waking up screaming. They're irritable. They're angry. They're drinking. They're doing drugs. These are all things they were not doing prior to the war. So that's how we figured this out. One of the common myths about PTSD is that it only is a combat veteran diagnosis. That is not true. Actually, one of the things that is true is that women experience it more often than men. I think it's because of the types of trauma that women go through, sexual abuse as a child or as an adult, any sexual assault, trauma, children experience PTSD in relation to neglect and abuse in the family.

There's so many other ways, a natural disaster, Hurricane Katrina, for example, a lot of people suffered PTSD. They lost their homes. They lost family members. They didn't know where they were going to be, how they were going to be. If they lived through the hurricane, they could wake up re-experiencing what that's like to find your house under water. So we find that it's more than combat, it's any disaster that significantly changes our life.

Kate Kaput:
That makes sense. I mean, so truly any kind of traumatic event or ongoing series of events can end up in PTSD. You just mentioned this, we sometimes hear about people with PTSD reliving or re-experiencing their trauma. What exactly does that mean? What might trigger that sort of trauma response in people who have PTSD?

Dr. Chivonna Childs:
So when we talk about triggers, we're talking about things that remind us of the event. It could be a smell, so it could be olfactory. It could be something that we're seeing. It could be a sound. So one of the things that people became more aware of is around the 4th of July, when we have the firecrackers going off and all those things. We were worried about our veterans that have been in the wars that come back, and we don't want to set their nervous systems off. To us they're just firecrackers, to them it may sound like bullets going off. It may sound like war time. It may sound like defending myself. It may sound like this is life or death. It can sound like a lot of things.

So all of a sudden, they're back to when they heard the bullets. They're back to that space when they were scared, and they were covering and they were protecting themselves trying to save their own lives. They were in survival mode. So that's what it can feel like is that you're in that space all over again. I think on some level we've all had that experience. You ever think back on something and you just shudder, oh my God, I can't believe that happened. That's kind of what it feels like, but on a hundred or PTSD, if that makes sense.

Kate Kaput:
Yeah. That makes sense. I think it's interesting that you said kind of any of your senses really can trigger that. It can be a sound, a smell, just sort of a vibe that can kind of take you back to that point of trauma. So let's talk a little bit about some of the ways that PTSD can impact a person's life. Does it interfere with the way they interact with others? Are people with PTSD more susceptible to anxiety, depression, or to substance abuse? Kind of tell us how PTSD manifests in people's everyday lives.

Dr. Chivonna Childs:
So with the PTSD, because it is under an anxiety disorder. So your system, I would say kind of feels like it's always on fire. So there's hypervigilance, which means you're always on guard, you're always looking around, you want to make sure you're safe. So then, if I'm always trying to make sure I'm safe, I have trust issues likely, and those trust issues seem to go outside of that situation. It can start to go to people, places, things, and if I'm at work and I don't trust people and two people are talking, I'm might think that they're talking about me. What are they planning? What are they going to do? So now I'm not focused on my job. I'm focused on what they're doing.

If I can't trust people, I'm no longer talking to my family. I'm no longer confiding in my friends. Again, I start to isolate, which makes the situation worse because there's no outlet. There's no one for me to talk to. There's no support system because I don't trust anybody and I've pushed everyone away. So that's how it can negatively impact us because our world gets very, very small when we don't trust.

Kate Kaput:
That makes a lot of sense. Yeah. It's sort of like you said, all permeating. So how do you know if you have PTSD? If you think you do, if you're maybe experiencing some of the symptoms and feelings that you just talked about. How does a person go about getting diagnosed and seeking treatment?

Dr. Chivonna Childs:
So if you believe that you have PTSD based on some of the things that we've discussed today, hypervigilant for no reason. If you're having flashbacks frequently of the event, and it feels like it was yesterday and not 10 years ago. If it feels like it's very fresh and it's very new, you're not functioning, you're not living a quality of life. If you are turning to substances, because sometimes that is an impact of this. We turn to substances, alcohol, cocaine, those types of things to mask the pain, to be away, to escape from the thing we don't want to be bothered with. So that's how substance abuse can come in. So if you are starting to see changes in your life that you know are not typical of you, or if others around you are saying, "Hey, I'm a little bit concerned about you because you're doing A, B, and C. Now, we haven't seen you around the family in a while. What's going on?"

If there are other things around you, other people around you that are pointing to this, and you're feeling it. Professional help, seek professional help, speak with a therapist, psychologist, a psychiatrist, and be able to talk about it at your comfort level about what's going on with you. Then, there are things that we can do, there are assessments that we can do that will allude to whether or not this is PTSD, or if this is acute stress disorder, or if this is anxiety, or if it's a combination of things.

Kate Kaput:
Okay. So we'll talk about individual treatment options in a moment. But what about counseling, support groups, mindfulness, things like that, sort of what kind of coping mechanisms can people who live with PTSD kind of turn to, to help manage what they're experiencing?

Dr. Chivonna Childs:
So some of the best ways is to calm your system down, to be in a space where you feel peaceful. So I would say your home ideally should be a place of peace. If it's not your home because you're sharing it with a lot of people, then your room should be a place of peace. Meditation is awesome. There are all types of meditation, regardless of religious, ethnic, cultural backgrounds. There are tons of meditations that suit different people. So I think meditations are really good because they help you ground yourself. They help you to be in a place of peace, it settles your system down, your quiet, yoga, Tai chi, all of those types of things wonderful for the system. Because just think, yoga has you in poses for like a minute or less. So that's a minute of one pose that you have to concentrate only on yourself, that allows you to be with yourself and tap into how you're really feeling to be present in your body and in your mind, and not be in the past.

So those types of activities to help us be grounded and be in the present moment are awesome. Support groups, supporting, and being around people that understand you, that you feel free to talk to, that you feel safe to talk to, to share your story if you want to share it. Because it is not mandatory that you share it with friends and family. Friends and family should be aware of what the limits are, and not push and not make people talk about things they don't want to talk about. Sometimes people with PTSD and other anxiety disorders or depression for that fact, they just need somebody to listen. We don't always want people to fix it. Sometimes I just want to know that you're going to be there to listen to me. If I need your help, I trust that I can say, "Hey, I'm needing A, B, and C," and simple help could come from going to yoga class with them, sitting for a meditation with them, helping find the support group, or just sitting and listening, and giving them space to express themselves in the manner that they see fit.

Kate Kaput:
Great. That makes a lot of sense. So say that you're seeing a doctor for PTSD, let's talk about some of the individual treatment options and how doctors approach PTSD. So what are some of the ways that it's managed and treated? Is it something that can ever be fully cured or just sort of dealt with, and kind of how do doctors approach it?

Dr. Chivonna Childs:
So there are a number of ways that you can deal with PTSD. One is medication of course, to bring the nervous system down. However, there are some holistic ways to do that through therapy, there's cognitive processing therapy, there's prolonged exposure therapy. Cognitive behavioral therapy, where we talk and we change how we feel and think about the events. So we change how we think about the event, which changes how we feel about it, and hopefully brings our anxiety down. One of the evidence-based treatments that is being used is EMDR, which is Eye Movement Desensitization and Reprocessing, and what it does is it helps to desensitize our reaction to the event. So no, it's not going to be cured because the event has happened. We can not erase the event. We can change how our bodies respond to the event. We can change the negative thoughts that are going through our head because of the event.

We change out that negative belief system and we replace it with a positive belief system, and that brings down the anxiety. So therapy can be extremely helpful, and just know that this is a multifaceted approach. It's not just therapy. It's not just meds. It's not just meditation. It's a mind, body, soul thing. So let's get the meds in, let's get the meditation in, let's get the support groups in, let's get the therapy in. It's a multilayered issue so we need multilayers of treatment. So that we can be well-rounded, well-grounded, and very well supported, and to make it through. It won't disappear, but how you respond to it can very much change so that you're having a quality of life. Because at the end of the day, that's what we all deserve is a quality of life.

Kate Kaput:
I love that. It's not about kind of getting over it. It's about changing the way that your body responds and sort of processes that trauma, and kind of coping in a healthier way. That makes a lot of sense. Is there any way to prevent PTSD? If we've experienced something particularly traumatic, like an accident or the loss of a loved one, or we've been into natural disaster, as you mentioned. Is there anything that we can do to mitigate the long lasting impact of that trauma, sort of before that trauma sets in and becomes PTSD?

Dr. Chivonna Childs:
That is a very good question, because what we've also found is people think you have PTSD, so the event happens and boom, you have PTSD. It doesn't always work like that. Some people may take weeks, months, or even years before it develops. So one of the ways that I think that you could be really proactive is if you have an event, a death in the family, if you have a natural disaster, seek therapy right off the bat. Go into therapy right then and there, so you're not burying all these things only for them to come up later. As a society, we're very good at repressing things. We're very good at I'm okay, because we don't want people to know that we're not okay. It is okay to not be okay. We can't be Superman, Superwoman all the time. We're human beings. We all need an outlet and we all need to be able to let these things out.

I always tell people there's more room out than in, repression is not going to help. It's going to be like a tea kettle. After a while the fire's going to get so hot, you're going to blow. So instead of doing that, if we have some issues, let's pour some of them out now. Let's seek therapy early on so that we can prevent this from getting worse. You have a quality of life that you want to have. It is important like we check for ourselves, if we had a broken arm or you get a physical, you want that taken care of right away. You don't wait weeks or months to go and get your arms set in a cast, you do it right then and there. The day you break the arm, you go and have it set.

So if your mind is fractured, if your mind feels broken because an event, why would you wait weeks or months. Go right then and there, set up the appointment, do the therapy, see how it works for you, what is your other options are, take care of yourself. I always tell people the most important people in your life, me, myself, and I. By taking care of those three people, I can take care of everybody else. So prioritize yourself, prioritize your health.

Kate Kaput:
That's a really beautiful way of looking at it. You talked a little bit about this already, but can you talk any more about, if someone you love has posttraumatic stress disorder, how else can you best support a loved one who is experiencing PTSD? Sort of what are the most helpful ways to be there for someone?

Dr. Chivonna Childs:
So one of the things is, not with all people who have PTSD, but with some is there's anger there, there's frustration, there's irritability because I can't control what's going on around me. We don't know how they felt about the event. They may have felt it was their fault, or they should have done more. There's so many negative cognitions going on. So we may not know that because we're not them, but what we can do is when they're angry, provide them space to do so. Clearly don't be in a dangerous situation, but if they're frustrated, they need to yell, they need to get it out, give them that space to do so. Help them to build routines. Routines are great for keeping us on track. If we eat dinner at the same time, if we have family night at the same time, give them something that's a routine. Because if I have a routine, I have trust, I have something that I know is stable. I have something that I know is going to happen. I have something that I can go to. So building that routine for them.

Again, listening is the best thing that we can do. Sometimes they don't want to be talked to or talked at. Sometimes they just want to say what they want to say without being judged, without being told how to fix it. You just need to vent. So be that space for them, create spaces of peace for them, ask them what they need, what they like, what they want, and indulge in that with them and say, with appropriate coping skills, because there are some are inappropriate skills that we don't want them to indulge in, such as substance use. But so let's make some alternatives, being in nature, going to the park, going by the lake, going to the beach, meditation, finding a guided meditation, finding a meditation with campfire sounds or beach sounds, something that helps to relax their system. So just being there for them and helping them find a good support group. The are plenty of good PTSD support groups, there are for men, there are for women, there are for children, there are for caregivers of those with PTSD. So there's a lot of ways that we can support them.

Kate Kaput:
So you mentioned earlier, being sensitive to people's boundaries and that goes for not just people with PTSD, but everybody all the time. But is there anything else that you can say about how to be respectful of the boundaries of loved ones with PTSD, and sort of how to identify what those boundaries are. Particularly, if the person who's experiencing PTSD maybe isn't able to express them clearly or doesn't know themselves. Kind of, how do we approach being respectful of people's boundaries in trying to support them?

Dr. Chivonna Childs:
So that can somewhat be a little bit of a guessing game. But the first step I would think is just to ask, specifically about the triggers. What reminds you of A, B, or C? Smells, let's tap into all of that, and then as a support system, let's make sure we avoid those things because we don't want them being triggered. But we do have to ask, communication is key. While they may not know, you've already opened the door to, hey, I'm here for you. If you figure it out, please just let me know so I can be here for you. Another good way of being a good support system is, again, taking care of yourself as the caregiver. Again, if you don't take care of that most important person in your life, you don't have it to give. They need us. We need us too. So we need to be in a space to provide them with what they have.

This PTSD is like throwing a rock in a pond. The rock is the event, they're experiencing it, and then because we love them, we experience it. So it's not just them being affected. It's us too. We've got to be on the lookout for compassion fatigue. This can be tiring. We don't know what's going to happen. We're not exactly sure what they need, especially if they don't know what they need. So we have to be hypervigilant for ourselves as well and tap in to make sure we're getting rest. We're getting meditation. We're getting good self-care. Everybody has to indulge in the self-care routine for themselves, and then for the people around them.

Kate Kaput:
That sounds like a whole podcast topic in itself. Self-care for caregivers and-

Dr. Chivonna Childs:
Absolutely. Compassion fatigue is real.

Kate Kaput:
Yeah, absolutely. Dr. Childs, before we wrap up, is there anything else that you'd like to tell us on this topic? Anything that we haven't talked about that you think is important, whether for listeners who are experiencing PTSD or have a loved one who are experienced think PTSD?

Dr. Chivonna Childs:
I think that my main point would be to let people know you are not alone. You don't have to be a veteran to experience it. We women tend to be at higher risk for very different reasons. There is help out there. This doesn't make you crazy. There's nothing wrong with you. It can be discussed. It can be worked on. There is help out here, and you don't have to do this alone. You do not have to do this alone. There's so much help, and there's so many ways to deal with it. So people get scared, I don't want to be on medications, medications aren't the only way. It's a good way in combination with other things.

So there's a plethora of things out here that can treat PTSD, and just being willing to take the step for your own health, mental, physical, and emotional. For your own health, to be the best version of yourself that you can be. The world is waiting. If you're not taking care of you, then the world is missing out on this great gift that you have. So we want to be able to bless the world with the greatest part of us, and that means taking care of ourselves.

Kate Kaput:
Perfect. Dr. Childs, thank you so much for being here with us today. If you would like to schedule an appointment with Cleveland Clinic's Center for Behavioral Health, please visit clevelandclinic.org/behavioralhealth, or call 216-636-5860. Thank you so much for joining us today.

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