Rattled Now Hmmmmm

It has been quite some time since writing my last post about my daughter leaving for college two thousand miles away. I am happy to report we all survived and, and for the most part, flourished through the transition. I am grateful she is home for the summer allowing me to soak up as much mother/daughter time as she permits. My reasons for not posting throughout the year are partially the positive consequence of a busy practice compounded with the realization that after several years of writing I found my energy and creativity lagging. I think this was somewhat due to the psychological toll of adjusting to my new developmental phase of empty nester. In any case, I recently realized it was once again time to pop open my laptop and pour out my thoughts and feelings into another post. I feel I use this venue as if it were a psychological Rubik's cube--I shift my thoughts around in my head, turning things this way, then that, working toward my own solution or greater understanding until a pattern emerges and things finally snap into place with a satisfying click. Once I feel the pouring out of words has helped relieve and release the tension in my mind, the post is ready for you, the reader. Today's topic is a new one for me: Acute Stress Disorder.

Up until last week I was training for an annual sprint triathlon I enjoy each July near my home. I sign up only to embrace the experience and to revel in the agility and strength my body still possesses in spite of passing the half-century mark. The course is breathtaking: first a swim in the usually calm salt water sound, then a bike ride along the coast and around a century old lighthouse, and capping off the experience with a run along the shore and a return to the start line. I have participated in this particular triathlon for about 10 years or so. Each summer I wonder if this should or would be the last, but then after the event I am pleased to have participated in the challenge. Last week, however, things took unanticipated change. After swimming with my two friends, Robin and Beth, I hopped on my sleek triathlon bike for the ride home. As I left the beach, I contemplated my route. I recall making three decisions while on my way: Should I go on the bike path? No, I wanted a greater challenge. Should I turn right at this street and go around the lighthouse? No, I already biked that route on my way to the swim today. I chose to continue straight, onto a busier portion of road so I could include a section of the race route on my ride home. Staying within the marked bike lane, I mentally took note of the rise and fall of the slightly hilly course to remind myself of gear shifting strategies for the day of the triathlon. As I peddled, a brownish-gray pick up truck gunned past me, crossing fully into the oncoming traffic lane. The driver's irritation seemed directed at me, a biker daring to share the road, and I remember watching the back of the truck as he zoomed ahead and around the curve in the road, still on the opposite side of the road. As I progressed, I remember hoping that there were no oncoming cars as the driver of the truck hadn't moved back into the correct lane when I lost sight of him. A few moments later I came around the curve and noticed a small gathering of people on my side of the road. I remembering thinking their presence was odd as it is not a road where pedestrians typically hang out since there is no sidewalk. In seemingly sluggish, slow motion I looked to my left and saw what appeared to be the same truck that passed me seconds before, now off road and deeply imbedded in the bushes. I felt myself pedaling forward in a dreamlike manner while my mind grappled with the incoming information. Then I looked forward and saw a smaller second car, the front end crumpled into a broken and leaning telephone pole, facing the wrong direction on the opposite side of the road. Fortunately, a fire station was less than 2/10 of a mile away and aid arrived quickly for the injured. The jaws of life were required to extricate driver of the smaller car who was then airlifted to a nearby trauma unit and his passenger was taken to the local hospital by ambulance with minor injuries. The driver of the pick up was also taken to the hospital with minor injuries. Rattled, I provided what information I could to the police officer at the scene, then biked very carefully and slowly home, silently repeating prayers of health and healing to those injured. My husband and daughter offered me comfort as I recounted the incident to them later on. That night my dreams were filled with repetitive, instant replays of the events. Awaking earlier than usual the next morning, I believed I was unaffected by the experience--after all, I was grateful not to be involved in nor injured in the accident. I did notice I held onto worry about the driver of the smaller car and searched the internet a few times over the course of the coming days to learn more of the seriously injured driver.

Two days later while walking one of my dogs near the beach, I happened to witness another accident--this one was minor and involved a motorcyclist. Fortunately, the helmeted driver had slowed down to make a left, but as he entered the intersection, his tire hit a patch of sand and he lost control of his bike. As the heavy motorcycle slid out from under him, the driver tumbled and rolled helplessly into the street. Cars stopped and a woman, who appeared to be a physician, ran to his aid. Scraped and stunned, the driver did not appear to be badly injured but was taken anyway to the hospital by an ambulance. Rattled once again, I walked home and told my surprised family of the morning drama. Later that day I decided to ride my "clunker" bike to the grocery store for a few items. In my mind I was calm but I realize now the recent events had taken up space in my head. As I approached an intersection on a fairly quiet road I overreacted when I believed a car was not slowing as she approached the stop sign. Next, I did something I have never done in all the years i have been riding a bike, I hit the front brake instead of the back one, thus I unceremoniously propelled myself, like a game show contestant on "Wipe Out", up and over the handlebars and onto the pavement. The startled driver stopped and I apologetically picked myself up off the ground and explained that I erroneously assumed she was not going to stop. I realized then that witnessing the two events had had a greater impact on me than I first believed. Thankfully, my injuries were minor; a couple of bruised ribs, a banged up knee and a lovely deeply purple bruise on my thigh, are all I have to show for my jumpy judgment. Taking a single deep breath has been painful and uncomfortable, let alone taking several in a row, coupled with the fact that I have to take many consecutive deep breaths in order to swim, bike and run, I pulled out of the triathlon. Disappointing yes, but most troubling for me has been the psychic injuries related to the traumas I observed.

I have developed dog ears' keenness in the past week for the distant wail of an emergency vehicle's siren.
I tense when I hear cars speeding unnecessarily on our narrow roads.
I startle when I hear unexpected loud noises.
I awaken earlier than usual and find my thoughts turning toward rumination about the car accident.
I want to avoid the road where the car accident took place.
Tears spring easily to my eyes.
I feel guilt by my presence on the road prior to the car accident.
I am puzzled by my hypervigilance and hypersensitivity.
I am embarrassed by my emotional overreaction.

Wait a second; I am the psychologist. With all my training and book-learning, shouldn't I be immune or something from this type of reaction? Does my reaction make me a less competent professional? Asking for comfort has always been difficult for me. I pride myself (and maybe there lies the problem) of being a strong, competent person. I am the one whom others rely upon; I am the one others turn to for assistance and guidance. I am the one who has taken hours and hours of CE courses devoted to stress management, diagnosing psychological distress and the most effective treatment for PTSD. I treat patients who have endured sexual abuse and combat trauma. I bear witness to the confidences and aftereffects of horrific things humans do to other humans. Despite of my third person exposure to years of trauma, here I am the one experiencing the effects of witnessing a series of traumatic events. To borrow loosely from an old U2 album title, Rattle and Hum--I have most certainly been rattled and now its time for the hmmmm, the wonder, the desire for greater understanding as to what has happened inside my head. You, reader, will now gain insight into what happened to me psychologically. My hope is that by reading this, you may gain an understanding of your own reaction or that of a loved one after exposure to a real or perceived serious threat or injury.

Acute Stress Disorder (also called acute stress reaction or psychological shock) is the diagnosis found in the Diagnostic and Statistical Manual (DSM IV) mental health professionals refer to for answers to diagnostic questions. Acute Stress Disorder (ASD) can surface as the result of a traumatic event in which the person experiences or witnesses an event that causes the victim/witness to experience extreme, disturbing or unexpected fear, stress or pain, and that involves or threatens serious injury, perceived serious injury or death to themselves or someone else. ASD is the mind's and body's response to feelings of intense helplessness. Although there are a myriad of physiological responses which take place when one is under stress, I am going to first focus on the reaction of stress hormones in the face of trauma then describe behavioral reactions in this writing, specifically the "fight or flight response". When our fight or flight response is activated, sequences of nerve cell firing occur and chemicals like adrenaline, noradrenaline and cortisol are released into our bloodstream. The chemical release causes our body to undergo a series of dramatic changes. Our respiratory rate increases. Blood is shunted away from our digestive tract and directed into our muscles and limbs, which require extra energy and fuel for running and fighting. Our pupils dilate. Our awareness intensifies. Our sight sharpens. Our impulses quicken. Our perception of pain diminishes. Our immune system mobilizes with increased activation. We become prepared—physically and psychologically—for fight or flight. We scan and search our environment, "looking for the enemy." When our fight or flight system is activated, we tend to perceive everything in our environment as a possible threat to our survival. By its very nature, the fight or flight system bypasses our rational mind—where our more well thought out beliefs exist—and moves us into "attack" mode. This state of alert causes us to perceive almost everything in our world as a possible threat to our survival. As such, we tend to see everyone and everything as a possible enemy. Fear becomes the lens through which we see the world. My reaction and responses described earlier fit this fight or flight description exactly.

Other changes in the brain occur hours after exposure to the trauma. Some symptoms include an initial state of "daze", with some constriction of the field of consciousness and narrowing of attention, inability to comprehend stimuli, and disorientation. This state may be quickly followed by either further withdrawal from the surrounding situation (to the extent of a dissociative stupor), or by agitation and overactivity, anxiety, impaired judgment, confusion, detachment, and depression. Common symptoms that sufferers of acute stress disorder experience are continued re-experiencing of the event by such ways as thoughts, dreams, and flashbacks; and avoidance of any stimulation that reminds them of the event. The symptoms usually appear within minutes of the impact of the stressful stimulus or event, and disappear within 2–3 days (often within hours). Partial or complete amnesia for the episode may be present. The symptoms usually appear within minutes of the impact of the stressful stimulus or event, and last for a minimum of 2 days, and a maximum of 4 weeks, and occur within 4 weeks of the event. Acute Stress Disorder is not the same as Post Traumatic Stress Disorder (PTSD) in that Acute Stress Disorder typically abates within hours or weeks of the event. If the stress response continues beyond one month, then the diagnosis then changes to Post Traumatic Stress Disorder. Treatments range from various forms of therapy to relaxation strategies, including cultivation of the "relaxation response." Typical psychological treatment of ASD include cognitive behavioral therapy, debriefing, hypnotherapy, exposure therapy and sometimes pharmacotherapy, particularly if sleep is significantly impaired. Other strategies, as those described by Herbert Benson, suggest that by keeping cortisol levels healthy and under control, the body’s relaxation response should be activated after the fight or flight response occurs. One can learn to relax with various stress management techniques, such as those listed below:

Guided Imagery
Journaling
Self-Hypnosis
Exercise
Yoga
Listening to Music
Breathing Exercises
Meditation


Today at this writing I am a week beyond the trauma and I am relieved to report I just returned from a 5 mile run and I am looking forward to a swim later today. The bruises are fading and my body aches are diminishing. My hypervigilance and jumpiness has lessened, my sleep has returned and my super-keen hearing unfortunately appears to be returning to its 30+years of loud concerts and blowing out numerous sound systems, a decibel range of a jet engine. Gratitude flows to my family and neighbors who patiently listened as I recounted the witnessed events. Earlier this week I discovered the airlifted driver's condition was upgraded to "good" and I assume the others involved are recovering equally as well. The passing of time, coupled with the research involved in the writing of this post, has helped me immensely in my recovery. What I have realized is that being schooled in a specific field does not immunize one from reactions to stress and trauma. Although I am a trained and licensed psychologist, I am also a resilient human who responds to events just like any other person. Plus I have the added advantage of knowing what I need to do to reestablish psychological homeostasis. I am putting into practice what I encourage my patients to do: talk, write, exercise and be kind to oneself and others. Making it through this experience has allowed me to gain additional empathy, compassion and understanding for those who experience stress reactivity. Wishing you health and healing.