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Dr. Mark
Dr. Mark, Psychotherapist
Category: Mental Health
Satisfied Customers: 5132
Experience:  Dr. Mark is a PhD in psychology in private practice
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ihave ptsd and for the last 4 years have been unable to leave

Customer Question

ihave ptsd and for the last 4 years have been unable to leave home alone. depending on who i am with or where iam going i can be triggered when i go off the property. how do ihandle myself when i am triggered? in the past i have carried on but it is a hideous experience and i want to be kind to myself.
Submitted: 2 years ago.
Category: Mental Health
Expert:  Dr. Mark replied 2 years ago.
I will give you some behavioral tools to help. They are similar to social phobia tools. But I first want to make sure about your treatment:


You're seeing 3 psychologists and 3 counselors all right now? Or in the past?

What treatment are you currently receiving?


Are your psychologist/counselors not working with you on how to deal with the agoraphobia from the PTSD and the triggering?


If not, what are you working on in therapy?


I want to make sure that your therapy is geared toward PTSD.


Dr. Mark
Customer: replied 2 years ago.
in response to your questions that was a list of people i have tried to date. currently i work with a phone councillor, this is working towards relationships with people and trying to help me cope with symptoms rather than healing them,which i would prefer. to date the work you are talking about has not beene done with me
Expert:  Dr. Mark replied 2 years ago.

Thank you for the added information. It helps a lot. I believe I can now be of help with this issue.



First let me say that I can imagine how distressing and frustrating this situation must be for you. That you are seeking help is a very good thing. I will also at the end of the posting give you a technique you can use to help with your anxiety from the post traumatic stress disorder (PTSD) you are suffering. It will help you find some temporary relief with your anxiety.

I am concerned at the level of treatment you're getting. Or rather not getting. Your symptoms are way too severe for phone counseling. I am not going to give you any phobia self help techniques at this time because I am way too worried for you and concerned that you may get triggered without any adequate support. Any work on the phobic reactions that come with PTSD have to be judged very carefully as opposed to pure phobic disorders. This is because the triggering can be too strong. You have to have a therapist right there who's working with you and monitoring the pace of exposure and response. So let me focus on this aspect of what you need to do: getting proper treatment. Please take the steps to get proper treatment because it can help you so much.


Psychotherapy that is helpful for PTSD is some form of Exposure Therapy. I have found EMDR can be very useful especially for one time traumas. It is a type of therapy specifically for PTSD originally. Here is the International Society's website:

http://www.emdria.org/

On the web you will find many opinions on EMDR both for and against. I am trained in it and have found it useful. Exposure therapy is also very helpful. I have found that you need to combine these types of therapy with a more introspective, humanistic or psychodynamic approach. If we actually look inside, we can find great relief and meaning. And we can feel whole in ourselves in ways that we haven't for decades. But many EMDR practitioners and therapist working with Exposure Therapy do not take the time to insure the emotional safety of the patient and so that's why you need someone who is more humanistic or psychodynamic in approach.

If you don't have a good referral source, here is an online therapist finder for Australia that I like because you can see a picture of the person and read about them a bit.

http://www.findatherapist.com.au/

The Australian Psychological Society has a search. Scroll down and put in self-esteem in the search window.

http://www.psychology.org.au/FindaPsychologist/Default.aspx

Again, PTSD will get better with intensive psychotherapy where there is a strong trust between client to therapist. But it needs to be intensive because PTSD is such an overpowering disorder. I work via telephone and Skype also, but I do not work with PTSD symptoms like you are having that way, only in person. Because there has to be a lot of support and a lot of work in therapy to be done.

I wish you the very best!

Finally, I am going to put here a protocol that is used for anxiety. It's often that there's an underlying anxiety we have to address. So I want to give you this technique to help you!

Here are instructions on a therapeutic protocol called Progressive Muscle Relaxation (PMR). It's really quite easy to do almost anywhere. My patients suffering from anxiety, when I teach them PMR at first are amazed how simple it is and that it is a psychological protocol. It was first used in the 1920s! Since then, of course, it has been refined and many studies have been done showing its effectiveness. You will practice PMR at first when you don't wake up with an attack so that you will be familiar with it. I want you to practice the PMR at least 5-6 times before an attack or feeling acute anxiety. Why? Because when you're in the throes of anxiety, you will only remember to do something you are very familiar with it. So practicing 5-6 times is really a minimum. And this is good also for just general anxiety without panic attacks as well.


I want to stress the importance of breathing as well. Part of the physiology of what is happening to you in anxiety and negative thinking is that your breathing is getting shallower. This reduces the oxygen in your blood to your brain. That increases the anxiety reaction, which strengthens the attack and you are in a vicious cycle! Not good. So breathing is the primary tool. I have found in my practice that learning breathing techniques can be helpful. But some of my patients are not interested in learning more than one thing at the beginning, so I have found that just reminding you to BREATHE deeply at the same time you are doing PMR is almost as good. If you are willing to take a yoga class and learn breathing techniques, that's the best. But, breathing deeply with your PMR will help.

So, we're ready for learning PMR. I want you to print my instructions below my signature and have a copy in each of the rooms of your home where you may be when you have an attack. And again, you need to practice this easy technique at least 5-6 times as soon as you can. It needs to become as natural to you as breathing. Ah, remember breathing?


INSTRUCTIONS:

  1. After finding a quiet place and several free minutes to practice progressive muscle relaxation, sit or lie down and make yourself comfortable.
  2. Begin by tensing all the muscles in your face. Make a tight grimace, close your eyes as tightly as possible, clench your teeth, even move your ears up if you can. Hold this for the count of eight as you inhale.
  3. Now exhale and relax completely. Let your face go completely lax, as though you were sleeping. Feel the tension seep from your facial muscles, and enjoy the feeling.
  4. Next, completely tense your neck and shoulders, again inhaling and counting to eight. Then exhale and relax.
  5. Continue down your body, repeating the procedure with the following muscle groups:
    • chest
    • abdomen
    • entire right arm
    • right forearm and hand (making a fist)
    • right hand
    • entire left arm
    • left forearm and hand (again, making a fist)
    • left hand
    • buttocks
    • entire right leg
    • lower right leg and foot
    • right foot
    • entire left leg
    • lower left leg and foot
    • left foot
  6. for the shortened version, which includes just four main muscle groups:
    • face
    • neck, shoulders and arms
    • abdomen and chest
    • buttocks, legs and feet

Quickly focusing on each group one after the other, with practice you can relax your body like ‘liquid relaxation’ poured on your head and it flowed down and completely covered you. You can use progressive muscle relaxation to quickly de-stress any time.

What You Need:

  • A comfortable place.
  • Some privacy.
  • A few minutes.

Again:

Dr. Mark, Psychotherapist
Category: Mental Health
Satisfied Customers: 5132
Experience: Dr. Mark is a PhD in psychology in private practice
Dr. Mark and 2 other Mental Health Specialists are ready to help you
Customer: replied 2 years ago.
i am pressing accept answer to pay you and am getting your reply page each time. how do i pay you?
Expert:  Dr. Mark replied 2 years ago.
It shows here on the upper right of my answer to you that you accepted. So I thank you very much and wish you the very best. And please make sure to interview the psychologists or psychotherapists before you decide on the person you want to work with and that they have experience with PTSD therapies and are someone you feel comfortable and confident in.


All the best, XXXXX XXXXX

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