About the Hosts

Christy Wilkieprovides therapy for children and adolescents, ages 5-25, who have complex behavioral health issues. She combines her extensive clinical expertise with a belief in kids, and has a unique ability to find and develop their strengths. She works hard to be an ideal therapist for her clients, doing what is best to fit their needs.

Lucas Mitzel provides therapy for children, adolescents, and adults, ages 5 - 30. He believes building relationships with clients is the most important piece of successful therapy. He loves what he does because it allows him to walk next to people he would never have met had he chosen a different profession, as they work to make amazing life changes. He has the honor of meeting people at their worst, all while watching them grow into the people they’ve always wanted to be.

Transcript
The Art of Overcoming Trauma

Featuring Christy Wilkie, LCSW, and Lucas Mitzel, LCSW, Dakota Family Services

  Announcer (00:00):

This episode of, is It Just Me, is brought to you by Dakota Family Services, your trusted partner in mental and behavioral health, whether you need in-person or virtual care, the team of professionals at Dakota Family Services is dedicated to supporting children, adolescents, and adults in their journey to better mental health,

Christy Wilkie (00:21):

Disrupting life patterns and life routines that aren't serving you.

Lucas Mitzel (00:26):

It's how we feel that keeps us going.

Christy Wilkie (00:29):

You can be a masterpiece in a work of art all at the same time.

Lucas Mitzel (00:40):

Hey everyone, I'm Lucas.

Christy Wilkie (00:41):

And I'm Christy.

Lucas Mitzel (00:41):

And you're listening to the Is It Just Me podcast

Christy Wilkie (00:43):

Where we aim to provide education, decrease the stigma and expel some myth around mental health.

Lucas Mitzel (00:48):

Christy, is it just me or is everyone talking about trauma? Lately?

Christy Wilkie (00:51):

I do feel like trauma is very much a trending word, and I'm not mad about it.

Lucas Mitzel (00:58):

No, it's great. It's great. And we've talked about this before, like with social media stuff, but with more exposure to mental health things. also increases the amount of misinformation that might be out there as well. And trauma's part of that <laugh>

Christy Wilkie (01:12):

It Is. I think this is, it's a really cool thing for us, I think, because, I mean, it's fun to watch the stigma kind of be slowly lifted from mental health and people are talking about it and it's not like, you're not like shunned if you have trauma, go through a traumatic event. So people are becoming more open about talking about it. And I just think the more education people have about it, the more we can understand our own thoughts and bodies and what's going on.

Lucas Mitzel (01:34):

Absolutely. And as we learn more about trauma and as we learn more about any other mental illness, we are able to then treat it better because we can identify it in ourselves. We're listening to somebody talk about some symptoms, even if it may not be like the perfect explanation, it gets you asking questions. And then getting into a professional who can then help you sort of figure that out. So before we go down rabbit holes right away. <Laugh>, what is trauma? How would you define it?

Christy Wilkie (02:00):

Trauma is something that you experience that causes a very emotional and distressing reaction that's out of the norm, out of the ordinary, which can be one singular trauma. You can get mugged. That would, that would be a singular trauma. Yes. There's all sorts of singular traumas or like, there's longstanding chronic trauma that's like an abusive situation, abusive relationships, child abuse, war. Yeah. Those kinds of things.

Lucas Mitzel (02:26):

Yeah. I think one of the biggest, as you were defining it, I was noticing in this is every definition of trauma, it's incredibly broad. It's a huge umbrella term. And I don't know that people realize how easy it is to develop a trauma disorder. Or, or experience trauma because it's very subjective to the person. Right. And even though something could be traumatic, maybe your brain handled it really well. And we'll get into that in a little bit. But it's a very subjective experience.   And it doesn't just happen to veterans. Right. <laugh> or somebody who's experienced some horrific event. It can be for, I mean, air quotes here, like easy or something that could another air quote like belittle to somebody else. Right. <laugh>

Christy Wilkie (03:08):

You guys get the air quotes and I get the finger quotes. Yeah. <Laugh>

Lucas Mitzel (03:12):

Christy gets to see this madness happen. And so it's just, it's much easier and much more common than people understand.

Christy Wilkie (03:19):

Well, and I, in my experience anyway, because especially, I mean, we are hardy Midwesterners, I find it very common for people to downplay traumatic events Yeah. And be like, I mean, how many times do we say a week? It's fine. We're all fine. Everything's fine's. Fine. <laugh>. And I hear that a lot. And people come into the office and, and they talk about some of the things they've gone through. And I was like, wow, that's pretty traumatic. They're like, what? That's a traumatic event. Yeah. Yeah. <Laugh>. Yes. Yes, it is actually. Right. Oh, that's why I'm doing all of these things. Yeah.

Lucas Mitzel (03:48):

Yeah. And or they, they compare, I get this a lot. So they'll say, well, I, mine isn't as bad as so-and-so's.

Christy Wilkie (03:53):

All the time.

Lucas Mitzel (03:54):

Like that doesn't matter. Right.

Christy Wilkie (03:55):

This is not a trauma contest. Right.

Lucas Mitzel (03:57):

And if you, I mean, I, this is my reaction to this every time, if you follow that logically, then there's only one person that gets to say that they've had a bat or that they had a rough time. because there's only one person who's had it the worst. Right. Whatever that means. Right.

Christy Wilkie (04:11):

There's not a pageant for that.

Lucas Mitzel (04:13):

Right, No. We don't like, have contests. No. So that means everybody would need to just shut up and stop complaining about it.   And you would never tell anybody else to do that. Right. So why are we telling ourselves to do that? Right.

Christy Wilkie (04:23):

And it's all, it's all relative. What what could be a very traumatic experience for me, might not be for Lucas. It depends on my life circumstances and his, and how we've been equipped to deal with it. If we've gone to therapy before, if we have skills, like there's just so many things that, that go into trauma and no two traumas are the same.

Lucas Mitzel (04:40):

Right? Yeah. Oh my goodness. Yes. Yeah. Like, people like to think we, we talk about mental illness being on a spectrum. And I think when people picture that, they think of like the color spectrum, which is on one line and you fall somewhere in severity on that line. trauma is not a single line, if you know what I'm talking about. If not, you can Google it. <Laugh>. But a radar, it's called a radar graph. And I picture trauma like that Sure. Where you have all these individual symptoms and each one might be sliding up and down on that. But when you compare each person's trauma symptoms or exposure to an event or whatever, it's gonna look very different. Mm-Hmm. <Affirmative>, there's gonna be a different, they kinda like fill in the middle of it or whatever. And so that's gonna, it's just gonna look have a different picture. Yeah. But there's also protective factors that go into that as well, that all impact this disorder. Right. Which it's just, it is so subjective. to the person. And so like, being confused as to why I'm being affected like this versus somebody else is a fair question. Yeah. Because it can be confusing, but it's just, it's so much more complex than I think people understand.

Christy Wilkie (05:49):

Let's you said protective factors. Yeah. What, what does that mean?

Lucas Mitzel (05:53):

So protective factors are things that protect you from something or from developing something, right?   So when we talk about PTSD or any sort of trauma happening to you, a protective factor would be how open you felt or how safe you felt communicating what happened to you with people that are around you or with loved ones or expressing your feelings around that. People on the opposite side, people who feel like they just have to lock it all down and can't talk about it and just need to like push it away and pretend it never happened. are at a higher risk for developing a mal or maladaptive coping skills or developing symptoms of PTSD, etc. Another protective factor like you had mentioned earlier, is going to therapy. or having experience building up those skills. And so if you haven't done that, you're gonna be at a higher risk potentially. if you've experienced trauma before, that's gonna be lead you to be more at risk.   Whereas the other side, if you've never experienced trauma, you're gonna, that's a protective factor for you. Yeah.

Christy Wilkie (06:49):

Anything that is a supportive thing that you have in your life. A a church group a a group of friends that you'd like to go out with. A supportive partner. Yeah. Supportive parents. All of those things are protective factors that all impact how you experience trauma. Yeah.

Lucas Mitzel (07:06):

Having even as simple as having stable housing. is a protective factor. If you are constantly having to move or constantly having to figure out where you're gonna stay, you're never gonna feel safe.   And then your, the trauma symptoms or the arousal responses that happen with the trauma, they're never gonna go down.   And so then you're gonna, it's just gonna keep getting worse and worse and worse.   So there's a, there's a million different factors that can influence trauma.

Christy Wilkie (07:30):

Right. I also, I'm gonna throw this one in there 'cause it's weird, but like having a car Yeah. You'll, you'll find a lot of people who have gone through traumatic experiences often wanna drive themselves someplace so they can, they know that they can leave whenever they feel uncomfortable or whenever there's a trigger that comes up. Just being able to leave a space and knowing that you have an out is a very powerful thing.

Lucas Mitzel (07:49):

Yeah. There's a bunch of different kinds of trauma disorders. We're not gonna talk about everyone today because it would be like a three hour podcast

Christy Wilkie (07:56):

<Laugh> and nobody needs that. Nobody

Lucas Mitzel (07:57):

Needs that <laugh>. So we're gonna talk about really just two, but they're very related to each other. But I'll go in order of some of the other ones just to mention them. So we have reactive attachment disorder. and disinhibited social engagement disorder, which are very similar in that how they develop. And that's because of severe neglect early on in childhood, like within like the first couple of years of life. And causes the brain to form differently or adapt differently. And so then you have difficulty with attachment. Either you cannot attach with somebody or you overly attach with people very quickly.   Both are obviously not good. And it comes from that, early on, those changes or the caregivers early on.

Christy Wilkie (08:36):

You find a lot of reactive attachment in the foster care system. Yeah. 'cause A lot of kids who have been through an abusive situation, neglectful situation, end up in foster care and then they're with parents and they that when you learn at such a young age that the people that are in charge of you are not trustworthy and you don't form those neural pathways that everybody's born with. Their brains wired for connection. Yeah. Right. That's from the get go. That's why they do skin to skin. That's, I mean, everybody's wired for connection. When that gets disrupted, your brain rewires itself for protection. And that can, that happens at a very young age. And so when your brain is wired for protection, the way that you respond to people and things in your, in your environment is totally different. So you get these kids that are in the foster care system that are expected to kind of bond with an adult, but they never form those neuro pathways. So they come off as being a behavioral problem when that's really not what's going on. Exactly.

Lucas Mitzel (09:31):

Our brains develop more in the first five years of life than they do in our, the rest of our life combined. and especially that very first year. I mean, that's where we learn how to connect with people. how we learn attachments, how we know who's safe and who's not. And we can't even say words yet. Right. You know, so like, it's, it is very, that first, that first year is extremely important. And oftentimes we screen for that when looking into trauma. Like was there any disruption in caregivers that first year? Were there any symptoms of neglect? Mm-Hmm. <Affirmative>, anything like that. Because that'll lead to a lot of issues down the line if that happened. Potentially. Right. Not always. Right. Right.

Christy Wilkie (10:05):

Not all. It's, it's never a one size fits all. Right. Right. These are just things that could happen.

Lucas Mitzel (10:10):

Yes.The next one is adjustment disorder. Oh yeah. And that is essentially you are going through a major adjustment in life and it's just causing a lot of disruption and emotional distress. Typically these will pass within a year. You can't have this diagnosis for more than a year technically, then it has to be something else. Right. But it can be as simple as like, you have a really big move. I, I shouldn't say simple <laugh> because it's not simple. Yeah. But something like that can cause a lot of distress in somebody which could be considered an adjustment disorder then.

Christy Wilkie (10:41):

Yeah. And I think, I always think it's so funny when there's an adjustment disorder in that, that they put a timeline on it because it, it feels to me that it, it timelines grief. Right. And there isn't a timeline for grief. And so it's like, just because the book says that it has to be over in a year, like having a traumatic loss or going through a traumatic situation often is not resolved in a year. So then it's just people start judging themselves. 'cause They're like, well, it was a year ago. I should be over it by now. And that's just not how it works. Yeah. You know, and so it's like, yeah, it's an adjustment disorder probably for the rest of your life figuring out how to deal with it and managing it. But the good news is, is that there are skills and things that you can do to manage it. But I always, always think it's funny when they timeline the way that you're, that you feel

Speaker 4 (11:25):

<Laugh>. Yeah.

Christy Wilkie (11:27):

Yeah. It's a year in one day. You are no longer now you should be adjusted. <Laugh>

Speaker 4 (11:32):

<Laugh>,

Lucas Mitzel (11:34):

The DSM five is a great tool, but it is not perfect. Correct.

Speaker 4 (11:37):

Correct. Correct.

Lucas Mitzel (11:38):

Next we have acute stress disorder and post-traumatic stress disorder. And acute stress disorder is basically post-traumatic stress disorder. But within the first 30 days.   So you can't have PTSD within the 30 days. It's called an acute stress disorder. And if it goes over the 30 days, then we flip it into P-T-S-D.   So it's same symptoms, it's just timelines are a little bit different. Yeah.

Christy Wilkie (11:57):

And I think it's important to note that not all traumatic events will result in a diagnosis at all. 'cause I think some people think if they have trauma that they should have PTSD and that's not, that's just not how it works. People can go through traumatic events and never develop PTSD symptoms. That doesn't mean that they shouldn't process through their trauma, but Right. It's not necessarily gonna result in a trauma diagnosis depending on how you process it.

Lucas Mitzel (12:20):

Yeah. So as just, I wanna go through some of the, the diagnostic criteria for P TS D because I think,

Christy Wilkie (12:26):

Oh, that sounds so fun. I think that's

Lucas Mitzel (12:27):

Helpful, Christy. We're gonna make it fun.

Christy Wilkie (12:29):

We are gonna make it so fun. -

Lucas Mitzel (12:30):

We make everything fun. We do. And I think it's, it's good because when you go through some of this stuff, I think people who are listening who maybe don't realize that they have it are like, oh my gosh. Yeah, that's true. That's me. And then they can come in and get some help. Christy.

Christy Wilkie (12:42):

Okay. Yes. I support that <laugh>, I support us helping people get help.

Lucas Mitzel (12:47):

Okay. So the very first part is how to, like what has to happen in order for you to even develop PTSD. And that is you have to either directly experience a traumatic event, you witness in person the events as it occurs to other people learning that the traumatic event occurred to a close family member or a close friend in cases of actual or threatened death of a family member or friend. The events must have been violent or accidental.   Then lastly, experiencing repeated or extreme exposure to aversive details of traumatic events. So when we were talking earlier about how it's a lot easier to develop PTSD than people think, you don't just have to experience something, you can hear details of a traumatic event or see something on the news. and develop PTSD. We saw this a ton with Covid. Yep. Kids who are experiencing trauma symptoms or adults even Yep. Experiencing trauma symptoms because of all of the death that they were seeing. Yep. On the news. Yep. It's not just because you didn't actually experience it in person. doesn't mean that you can't develop the symptoms.

Christy Wilkie (13:48):

I think 9-11 is also a good example of that because we were all impacted by that. I mean, even if you weren't in New York City, it was all over the news. It impacted our travel. It, I mean, every time you get on a plane, think about think every time you go through TSA bet people it goes through their head. This is post 9 -11. How many times do we say that post? 9- 11. Yeah. Like post nine. And now we're doing post covid post 2020. And those are all traumatic things. I think the one too that a lot of people downplay is either hearing some, like hearing that something terrible happened to a loved one or somebody that you're close to. Yeah. Because oftentimes they'll come in and they'll say, I just feel guilty because I shouldn't feel this bad 'cause it didn't happen to me. I said, but it did <laugh>. Yeah. Yep. It happening to your close family or friend means that it happened to you watching your friend go through something terrible or watching somebody in your family go through something terrible. Just because it's not happening to you does not mean that you are not experiencing it. But people will downplay it all the time. Like, I don't have any right to feel this way because my friend is going through it way worse. You know? Yeah. Stop comparing your trauma.

Lucas Mitzel (14:55):

Yes.

Christy Wilkie (14:56):

Just Stop that

Lucas Mitzel (14:57):

<Laugh>. It's all subjective. It is. Yeah. Some of examples of traumatic events because I think a lot of people don't understand what a traumatic event can entail. Sure. I'm gonna read off a list. It's a trauma history checklist. And so just a little bit of a trigger warning here for people just in case. 'cause We're gonna talk about some very specific traumas,

Christy Wilkie (15:14):

And yours might come to mind, right?

Lucas Mitzel (15:15):

Yeah. Have you ever been in a natural disaster like a hurricane and an earthquake or a flood?

Christy Wilkie (15:20):

Fargo, North Dakota?

Lucas Mitzel (15:21):

Right? Have you ever been directly affected by a terrorist attack, like 9- 11   Have you or anyone in your family been involved or affected by war? Have you ever been in a fire? Have you ever been in a serious car accident? Has there ever been a time where you were seriously hurt or injured? Have you ever been in the hospital or undergone treatment for any serious or life-threatening illness or injuries? Have your parents or siblings ever been in the hospital or undergone treatment for any serious or life-threatening problems? Has anyone ever hit you or beaten you as in physically assaulted you? Has anyone ever threatened to, have you ever been hit or intentionally hurt by a family member? Did you have bruises, marks, or injuries? Was there a time when adults who were supposed to be taking care of you? Didn't have you lived with someone other than your parents while you were growing up?

Lucas Mitzel (16:08):

Have you ever seen or heard someone in your family or house being beaten up or get threatened with bodily harm? Have you ever seen or heard someone being beaten or seen someone who was badly hurt? Has anyone ever told you details of how someone you were close to was injured or killed? Have you ever been threatened with a weapon? Has anyone anyone ever stalked you? Did anyone ever try to kidnap you? Has anyone ever made you do sexual things you did not want to do? And then is there anything else that's scary or very upsetting because this is not a comprehensive list. Correct. Some things that I, that got triggered while I was reading that, that people often don't remember or don't consider traumatic is the hospital situations. Yeah. Being in a hospital situation where you or a family member was being treated for something that was really serious, oftentimes gets overlooked as trauma when that stuff is scary.

Christy Wilkie (16:56):

Yeah. I look, I think of a lot of people because honestly, cancer is so prevalent recently. I mean, it always has been, but it feels like it. I don't know. Maybe it's just my age. <Laugh>. Yeah. But it feels like a lot of my friends that are my friends' parents are, have a cancer diagnosis. And it's, even if you're not the one going through the cancer, watching someone go through chemotherapy or watching someone that you love, go through that. I mean, it is exhausting. It is emotionally taxing, and you're playing life or death with people that you love. That is traumatic.

Lucas Mitzel (17:29):

Absolutely. Super scary.

Christy Wilkie (17:30):

Yeah. And it, and on top of it, there's a very hopeless feeling that comes along with, with that. It's because there's literally nothing that you can do to make it better other than just be around and support the people that you love. But it's a very helpless feeling. And that, and that is very, that's very difficult for people to deal with.

Lucas Mitzel (17:47):

One of the biggest emotions or feelings that people have to wrestle with as they go through treatment is that feeling of no control. Mm-Hmm. <affirmative>, all of your control is taken away a lot of times when it comes to trauma. And the hospital situation is no different. seeing somebody or going through that yourself can cause a lot of issues immensely down the road. And this is why they're, I think they're starting to do more mental health assessments at hospitals after big events, or making sure that you are at least referred out to see somebody for like, after like a major surgery. to just double check to make sure that everything is good. Right. Which I think is wonderful that we're doing it. I also don't know that everybody takes that super seriously. Right. Because maybe right away they're feeling okay. Yeah. and then later they're like, oh man, something's wrong. Right.

Christy Wilkie (18:32):

I think, I mean, you, you mentioned surgeries, surgery in general can be a very isolating experience because depending on what you have surgery on, let's just hypothetically say a knee extraordinarily hypothetical. Yeah. Right. You go through the surgery, which is, it is what it is. But people don't take into consideration that there's eight weeks of recovery after that. Where you are, you, you don't see anybody. Yep. You can't drive a car, you can't go to work. You're, I mean, there's just the isolation that comes with going through things like that can also be very traumatic. And I think people take for granted how important it's to have human interaction, <laugh>. Yeah. And that when you have a surgery, you don't, that gets cut down significantly. Right. And that is hard,

Lucas Mitzel (19:15):

Especially if this hypothetical person is an extrovert and really needs people to be around.

Christy Wilkie (19:21):

Yeah. It'd be terrible. Right.

Lucas Mitzel (19:24):

<Laugh>, oh man. Moving. So if you were like, oh, man, I, I experienced a traumatic event, like we said, just because you experienced something doesn't mean that you have PTSD   So moving on to some of the other symptoms to try and tease out what's going on.

Christy Wilkie (19:37):

I do wanna say really quick Yeah, please, please, interrupt me whenever you want to. Like, I think I think about the flood in Fargo, right? Yeah. In 2009 ish. Yes. Thanks. Doug says I'm that he fact checked me and that is correct. So good for me. Perfect. Thanks Doug. That it's, it's, and this is the case with a lot of traumas, but everybody in this town went through that trauma. Yeah. Right. I mean, we were all sandbagging, we were all eating Uncrustables out of the Red Cross van. Oh my God. We were all, I mean, we were, we were in it together and it was like a disaster area, right? Yeah. And I think sometimes, and, and some of those people owned those houses and some people were just helping. And because it's our city and you take pride in the city, and it was a very emotional year for everybody.

Christy Wilkie (20:20):

And I think everybody, because we get to comparing trauma is that we look around. It's like, well, if they're making it through it, okay, then I should be able to make it through it. Okay. Because if they are just walking around being fine, then I should also be fine. I think about that often, even with like police officers who Yeah. Who witness something. 'cause They're like, well, my buddy over there, like, he seems to be doing okay and I'm struggling intensely, but I don't wanna show him I'm struggling intensely because we're going through the same thing together. Why is he experiencing it so much different than I am? And it's like, just because you all went through the same trauma doesn't mean that you, Lucas Mitzel or me, Christy Wilkie experienced that anywhere near the same. I feel like that is, that's a very common thing for people to think or experience. Just be like, I have to be okay because everybody else is okay. And we all went through the same thing. It's like, you do not <laugh> Right. You do not have to be okay because you went through the same thing as somebody else because it's you. Everybody experiences it differently. Right. Everybody's circumstances were different during that time.

Lucas Mitzel (21:15):

Yeah. You didn't experience the same thing because it was your experience. Yeah. Christie and I could be in the same car and get into the same car accident, and the only difference between us is one was driving and one was in the passenger seat. So like, what, six inches between us. Yeah. And she could come out of it just fine, and I could come out of it never wanting to be in a car again. Right. Because our brains just process through the information differently. There's different protective factors, different risk factors associated and different histories.   And that's, that's okay. Yeah. So we just gotta work through that. Right. And not, not invalidate ourselves.

Christy Wilkie (21:46):

No. Don't expect the same thing out of you that you expect out of somebody else that you see even somebody else. Right. Go on. Thank you. With whatever it is that you were gonna say.

Lucas Mitzel (21:53):

Just moving on to some of the other diagnostic criteria. So like, the next part is presence of one or more of the following intrusion symptoms associated with the traumatic event. So, and this, all of this has to begin after the traumatic event. So if it was happening before that, it doesn't count <laugh> unless like it got significantly worse afterwards, then there might be something there. Yeah. So recurrent, involuntary and intrusive, distressing memories. So this is like when your brain just like out of nowhere pops up, there's a memory of what happened. And it's not necessarily a flashback where you're like, reliving it.   But it's the memory of it and you can't maybe get it out. Yeah. I think of this like, and I'm dating myself here a little bit like the Kool-Aid man. Yeah, yeah. Kool-Aid man, right? <Laugh>. Yeah. There you go. Pops through the bust through the wall, right. And goes, oh yeah. Everybody's like, oh, no. That's what an intrusive thought is. Like, yeah. It just pops in. We have no control over that. We just have to work on controlling what we do with it.   We don't need to let it sit there, even though it's really difficult. Therapy can help teach you skills to get rid of that.

Christy Wilkie (22:56):

People don't realize how annoying those thoughts really are because they can, they can really get in the way of like your daily life.   Like, I, I have a friend who was in the grocery store doing groceries, shopping, no big thing, intrusive thought, bursts out into tears, has to leave the cart in the aisle, get outta the, the store. And that's literally how it happens. Yeah.

Lucas Mitzel (23:16):

It's so annoying.

Christy Wilkie (23:17):

There's, there's no, there's just, you can find ways to help manage it, but for a while there, there's not a lot of control over. I mean, that's the whole point of it being intrusive, I guess. Right. But <laugh> Yes. They're very distressing for people. Yeah.

Lucas Mitzel (23:32):

And once you work through that in therapy and, and develop some skills and process through the trauma, those things will lessen. Next thing is recurrent distressing dreams or nightmares. Yeah. And this nightmares don't have to be associated with the event. It can be just a nightmare. oftentimes you might have a similar feeling to what happened or not.   But having more nightmares when you've had a traumatic event is very normal.   And it's just a sign that maybe we gotta work through some of it. Mm-Hmm. Because it's unprocessed. Yeah. And be a little bit more severe. There

Christy Wilkie (23:59):

Are some thoughts that are going on in your head that you're maybe not aware of, or you're trying to repress or push down. Dreams in general are tend to be a reflection of something that we've thought about throughout the day in one way or the other. Right. And so if your your mind is full of negative things, you're probably not gonna have dreams of unicorns and rainbows and lollipops. Yeah.

Lucas Mitzel (24:20):

You Know? Yeah. And with kids, it, it might be completely unrecognizable. Right. They may not be able to tell you what was in it. or it's, it may be completely illogical, make no sense whatsoever. Right. But just the fact that they're really scared Yeah.

Christy Wilkie (24:34):

Is enough enough.

Lucas Mitzel (24:34):

Yeah. the next thing is dissociative reactions, thought flashbacks, where you're like re experiencing the traumatic event. These can occur on a, a continuum of severity. The biggest could be just complete loss of consciousness. Like of, or awareness of like your surroundings.   And that is scary.

Christy Wilkie (24:54):

Yeah.

Lucas Mitzel (24:54):

That's pretty bad.

Christy Wilkie (24:54):

And I think triggers are, are difficult to even sometimes identify, which is so funny. But you, when your brain goes through a traumatic event, it doesn't always put all of the, the memories together in a correct way. Like sometimes it leaves things out. Yep. Sometimes it creates things because that, that's your reality and doesn't matter. Your reality is your reality, and that's what you're experiencing. But because of that, triggers can be a smell, it can be a color, it can be a time of year, it can be weather. I mean it, and because our brain isn't always inherently aware of what our triggers are, it's very hard to avoid them. Yeah.

Lucas Mitzel (25:34):

Yeah.

Christy Wilkie (25:34):

It's kind of scary.

Lucas Mitzel (25:35):

It's, yeah. Especially the smell is most connected to our memory. Yep. And so it's very common where I'm sure everybody has experienced something like this where you go walk into a place, you smell something and the memory pops up. Right. Right. It's just that for some reason, our brains are super awesome, and the bad memories are the ones that pop up like, really easy.   'cause Our brains wanna protect us from it happening again. Right. And so we've made these pathways where, so our body never experiences that event again. So it's like, if you smell this run. Yeah.

Christy Wilkie (26:07):

Yeah. That was when I was, when I was in college back in 1824. It was the late nineties, but like, the smell of vanilla was very popular back then with candles and ins. Like vanilla was the it smell. Yeah. so when I was going through college, a lot of people kids that were in abusive situations, the smell of vanilla was so triggering, and, and they don't, they didn't, they couldn't put it together. But it's like, if that smell was present while you were in a house getting abused, that's going to be a trigger for you. Yeah. Cologne is another one that is very, or perfume is can bring somebody right back to where they were.

Lucas Mitzel (26:44):

We, we, like Christie had said, we don't actually know what our brain grabbed onto.   It's just something in the surrounding environment. Our brain picked up a pattern and is like, we're not gonna experience this again. And so if that thing comes up, we're gonna have a reaction potentially to that. And that could be psychological or physiological. to any sort of internal or external cues, internal being inside of us happening, external being outside of us. occurring. So, which goes to the next part. We actively avoid those. Right.

Christy Wilkie (27:15):

Right. So, 'cause our brain is like, no, we don't wanna feel like that again.

Lucas Mitzel (27:19):

So going back to the car analogy, right. Like, this is what I was talking about where like, I might avoid getting into a car because my brain is like, if you go into a car, you're gonna die. Yep. And when a lot of times this can be fine, where we just avoid, like for example, if it was a person, I'll just avoid that person.   And maybe I can get away with that, and that's just fine. other times I can't get away from that. And I, it's, it's really impactful Yeah. Of my life. Like, if I chose to never get into a car and I'd have to bike or walk everywhere, that's a big deal.

Christy Wilkie (27:46):

Yeah. <laugh>,

Lucas Mitzel (27:48):

It's a long way to work.

Christy Wilkie (27:49):

It's, it's, and then you're sweaty when you get here. Right. That'd be unfortunate. I think of big crowds too. People who've experienced an acute trauma. You like something like that because you go into this place where you want to be able to control things. Yeah. When that control's been taken away from you, you kind of overcompensate for that in whatever way you can. And when you are in a large crowd of people, you cannot control every single person in that crowd. And that becomes very overwhelming because your brain starts to think that anybody has a potential to hurt you once you've been hurt in that way. And so we'll get into this in treatment, but like having people expose themselves to crowds or to whatever it is that's causing them distress Okay. Is part of the treatment for that. But there's Yeah. All sorts of things that people will avoid that end up becoming very distressing and interrupts their life Yeah. Doing things they like to do.

Lucas Mitzel (28:39):

Right. The, you're also going to avoid distressing memories, thoughts or feelings that are close. And so not just the external stuff, but internal.   And so if you're not sure if you do this, if you can imagine for a second that I was gonna ask you to tell me what happened. And if you're like, heck no, <laugh> nope. Not doing that. Absolutely not. Or if you started sweating when I mentioned that   Yeah. You maybe you're avoiding <laugh>. Yeah. That could be a sign that there's something there. Right.

Christy Wilkie (29:04):

Which, which becomes, which becomes a problem in your relationships because you, you end up wanting to not connect with anybody. Right. You just take those emotions and you shut 'em off and then you just become closed off to everyone. And that, that becomes a huge problem.

Lucas Mitzel (29:17):

Right. Kids might react very strongly to this, especially the younger they are. 'cause They don't have the words. Mm-Hmm. And so if you start talking about it, or we see this in therapy a lot where there might be a very large emotional reaction as they try to push that away, rather than just saying, I don't want to talk about it. Mm-Hmm. <affirmative>, they maybe start to act out to make, to distract from that or to make it so that we don't talk about that. Mm-Hmm. They'd rather us talk about the specific behavior that's happening in front of, of them then anything related to the do with the trauma.

Christy Wilkie (29:43):

Right. Or they'll be like what size are your shoes? <Laugh>? Or, or, oh, did you watch that? I mean, they will just completely distract the conversation away from anything that has to do with anything that accesses the, that emotion that they don't wanna feel again. Right.

Lucas Mitzel (30:00):

I've even seen adults do that. Yeah.

Christy Wilkie (30:01):

Oh, adults do it all the time.

Lucas Mitzel (30:02):

Yeah. It's

Christy Wilkie (30:03):

Great all the time.

Lucas Mitzel (30:04):

Yes. That's when you know there's something there. Yeah. Other things that are really common with somebody who's undergone a trauma traumatic event is, like Christy had mentioned before, you might have a hard time remembering any details or specific details from it. There may be pieces of the memory that's gone, which can be really frustrating to a lot of people as they're trying to process through it. They're like, I don't remember.   That's okay.   So it might come back, it might not. It's fine. your brain probably did that as a, a defense mechanism to make, make it so you're not thinking about it anymore or whatever. If it comes back, we'll deal with it. If not, that's fine. Yep. Or persistent exaggerated negative beliefs about yourself or other people. Like, I'm bad, everything's unsafe. I can't trust people.   Those sorts of, that's super common. Mm-Hmm.

Christy Wilkie (30:45):

<Affirmative>, I've done something wrong. Yeah. I'm a bad person. I deserved it.

Lucas Mitzel (30:48):

Yeah. Or thinking that you blame like you're to blame Yeah. For whatever happened. You see this a lot with sexual assault victims. Yep. In particular. Or abuse victims. They'll say, well, it was my fault. I'm the one that did that. And that's not true.

Christy Wilkie (31:01):

No.

Lucas Mitzel (31:02):

It's just not true.

Christy Wilkie (31:03):

It isn't. And I think it becomes, it becomes difficult because in, in, in figuring out the details of the trauma. Right. Which is what we try to do. Yep. You have to be very careful with how you ask people about their experience because sometimes people who are not great at knowing how to ask questions in a way that's information seeking rather than, well, why were you there? Yeah. What were you doing there?

Lucas Mitzel (31:25):

What were you wearing?

Christy Wilkie (31:25):

Yeah. What were you wearing? Like, those are all those questions put you immediately on the defensive and all of a sudden it's like, I can in their head, 'cause they're already probably blaming themselves now, they think that you're blaming them too. And that's not ever what you wanna do with somebody who's gone through a trauma. You wanna be very kind, caring, supportive, information seeking, wanting to understand where they were coming from and what their experience was. Right.

Lucas Mitzel (31:46):

And honestly, if you're not trained in how to process trauma with somebody, maybe don't

Christy Wilkie (31:52):

<Laugh>. Right.

Lucas Mitzel (31:54):

There's a thing, there's a thing that can happen called flooding.   If you open up a box that you're not ready to open up and you don't know how to put it back together. Mm-Hmm. <affirmative>, we are trained in how to do that and how to tell when to push and how to tell when to pull back. Yep. And it's a very delicate process. And as soon as somebody who's flooding, you can't move forward. No. So just please be careful.

Christy Wilkie (32:12):

Yeah. That's not really where you wanna be.

Lucas Mitzel (32:13):

Yeah. And never do trauma treatment by yourself. No. I've had people try it doesn't work very well. Mm-Hmm. <affirmative>, you need to be have that, you need to be guided through that. Yeah. So just quickly

Christy Wilkie (32:22):

And by yourself, by yourself you mean without a therapist? Yes. Like, not just like not in your room by yourself. Literally.

Lucas Mitzel (32:29):

Like don't do a trauma narrative by yourself. Like in your bedroom. Yes. Thank you. Right. We'll get to that in a minute. Yeah. So also just you're feeling like there's a lot of negative emotions going on. You might have a diminished interest in participation with significant activities or feeling detached from other people. This is all protective stuff that your brain is trying to do. It's just maladaptive. Yep. Or you feel like you're not able to experience any sort of positive emotion. Yeah. If all of this is associated after a traumatic event, it's very likely that we're talking about trauma.   And then lastly, there's some finally Right. <Laugh>, you might be irritable or have some extra anger. Reckless or self-destructive behavior can happen as well after a traumatic event. Hyper vigilance, which means like you're on guard. Like if you're sitting in a room and you are constantly aware of every exit as soon as you walk into a room or where every single person is sitting, or you sit in a spot maybe in the back so that nobody can go behind you.   Or perhaps you're really jumpy and that all started after a traumatic event. There's probably something connected there.

Christy Wilkie (33:26):

Well, you can tell when kids come into my office and I do have a lot of things to look at in there. So that is something. But you can tell the kids that are traumatized. 'cause They will, I mean, they are looking at everything all of the time and they, they see things other people don't see. They notice things other people don't, and not that they're not there. Right. It's just most of us can filter through what's important in our environment. And when you are traumatized, everything becomes important in your environment because everything might be out to attack you and any, anything could possibly hurt you. So they have very sensitive hearing. They maybe count steps even. There's all sorts of, there's all sorts of things that happen when you're traumatized that just like increase your sense. Like you get spidey senses. Yeah.

Lucas Mitzel (34:03):

Every noise is a potential danger. Yeah. And so they're gonna jump and be ready. A lot of times my clients, when they sit down, like it looks like they're ready to spring up at any time. because they need to move. Yep. If something as bad is going to happen,

Christy Wilkie (34:13):

Body's super tense. Yep. I'm like, dude, breathe.

Lucas Mitzel (34:16):

Right. <laugh>, let's, let's breathe. And then also just difficulties concentrating or going to sleep and how can you blame somebody if this is stuff that they're thinking about or having to deal with all the time.   So, so moving on to the, the different types of treatments Yeah. That we can do. I'll go through a lit. There's a ton of 'em. There are, there's so many different kinds of Yeah. And we're, so we're not gonna go through all of them, but if you have questions about which one might be right for you or whatever, I would encourage you to go to a therapist, talk to somebody and see what they can do with that. People are trained in different ones and so if you feel like one, doing some Google research and figuring out which one maybe would fit you and then go to one that fits that

Christy Wilkie (34:56):

Does that thing. Yeah.

Lucas Mitzel (34:57):

  So we have cognitive behavioral therapy for kids. This is trauma focused cognitive behavioral therapy, which we'll we'll cover in a little bit. We have cognitive processing therapy, cognitive therapy, prolonged exposure, eye movement, desensitization and reprocessing therapy, which is EMDR. Umer <laugh> and then narrative exposure. And there's even more than that. Yeah. But today we're just gonna focus on, I think we're gonna do T-F-C-B-T and EMDR. Yeah. So let's start with T-F-C-B-T. What is that Christy?

Christy Wilkie (35:25):

Trauma-Focused cognitive behavioral therapy. And it involves the, a non-offending parent by non-offending, I mean, not the person that caused the trauma to happen. Right. but people that are supportive of the child, they're a very integral part of T-F-C-B-T because we are also teaching them how they can best interact with their child who's gone through a traumatic event and how they can best respond to them. Because you have to learn how to create a safe environment and a trusting relationship with a child who's been through a traumatic event. It takes the trauma and it it works through, the goal is to minimize the emotional response to the trauma when they're thinking about it. And one of the big goals through T-F-C-B-T is to create a trauma narrative, which is essentially going through anything that people can remember about their trauma. And they can do it in any way, any way that you want to. I've had kids write songs, write a journal, write one kid wrote like a book. There's just, there's so many ways that you can do it. And a piece of art that we can go through and kind of figure out how that relates back to their trauma. And the goal is so they can, they can go through their trauma and eventually minimize the emotional response to thinking about the event. Right.

Lucas Mitzel (36:34):

There's a, so the structure of a session for T-F-C-B-T is typically you would meet, you might have a little bit of an update at the beginning, but then you're just gonna meet with a kid for half of a session and then you meet with the parents for half of a session.   And there's a lot of psychoeducation and skills going into that. And it's a very structured model. Right. If you're, if you're doing it to fidelity. Yeah. so the most updated acronym that they're using right now is a practice which A stands for assessment and engagement. The P is psychoeducation. So just education and then also parenting is involved in there. So what can the parents do to help for their specific kid? Then we first start with relaxation techniques because we have to

Christy Wilkie (37:13):

Start and end in a safe place.

Lucas Mitzel (37:15):

Yep. We always have to start there with any sort of trauma therapy. You are not allowed to leave the office if you are heightened or aroused.   So therapists will, oftentimes it's not uncommon to end a session early. because we don't have time to open something back up and put it back away. <Laugh>. Yeah. Right. Sessions might end 15 minutes early or something like that because the next thing is gonna take too long.   That's okay. That's normal. Mm-Hmm. <affirmative>, we never want you to leave upset. Right. we need you to leave. Good

Christy Wilkie (37:42):

Feeling. Okay.

Lucas Mitzel (37:42):

Next is affective modulation. That's just taking control of your thoughts, feelings and behavior and reacting to traumatic things and managing your affect or your mood. Cognitive coping. That's where we start to challenge the negative thoughts that might be associated with the trauma. Like we talked about the I am bad or everything is unsafe. Those things have fallen there. Or if there's any self blame that might be in there. And then the trauma narrative. occurs. So there's a lot of prep Yes. Before you get to a trauma narrative. Yeah. There's a lot of prep before you talk about any sort of trauma.   So it's not like you come in day one, this is for any trauma therapy. You don't come in day one and be like, Hey, share your entire life story. Give it all to me. Yeah. That, that would be horrible.

Christy Wilkie (38:27):

Yes.

Lucas Mitzel (38:29):

<Laugh> trauma therapy is hard enough. We don't need to make it harder.

Christy Wilkie (38:31):

It would be irresponsible of us Yes. To allow that to happen.

Lucas Mitzel (38:34):

Yes. So if, and if you feel like you're going too fast, you have to tell your therapist that.   And so this should be something that we're agreeing upon together. Now you're not gonna ever want to talk about it. Yeah. But to be ready to talk about it. Yeah. Right. The next part is in vivo exposure. So if there's any sort of exposure therapy that needs to occur, like with a car example, kids might be really scared to maybe sleep in their bed.   Or maybe it's a certain part, like a certain room. or a certain anything.   'cause Our brain's attached to weird stuff sometimes. Yeah. And so trying to expose ourselves to that so that we can desensitize ourselves to the events and

Christy Wilkie (39:12):

Just so, because we don't want anybody at home doing this on their own, when we say exposure therapy to a car, I mean it, we start, we meet clients where they're at. And so it's not like we go out and we throw them in a car. That would be like throwing somebody off of a dock and who doesn't know how to swim. We might start with a picture of a car. Yeah. We might start with the sound of a car. I mean, it's not like we're out in the parking lot going, okay, get in <laugh> and and I'll watch you drive away. No, we, we start very, very, we start, well, we start with the client's at. Yeah.

Lucas Mitzel (39:46):

Yeah. Don't do this by yourself. No. If you are doing it by yourself, do it under the instruction of a therapist who's telling you exactly how to do it. Yeah. 'cause You can very easily make things worse. Yes. If you do it incorrect. The next part is conjoint sessions. So this is where everybody's together and this is where the child is going to share their trauma narrative with their trusted parent. or caregiver. This is a very, this is like the session.   It's very important. And the therapist is likely going to be kind of a control freak about it and give you a lot of coaching. on how to respond and what to do and what to expect. And please listen, <laugh>. Yes. This cannot go badly.

Christy Wilkie (40:22):

No. <laugh>

Lucas Mitzel (40:23):

It cannot. No. This is the session that we've all been working for. Yep.

Christy Wilkie (40:27):

To validate thoughts, feelings, experiences.

Lucas Mitzel (40:30):

So once, and then once we get there, we start looking at enhancing safety, which should be moved up if that's important. That's depends on the person, but just creating a safety plan to move forward. And then therapy oftentimes can be discontinued or just changed to a different goal.   But that's TF CBT. Yeah.

Christy Wilkie (40:48):

In a nutshell.

Lucas Mitzel (40:48):

Yeah. It works wonderful. It's for kids. Yeah. It's tons of research has been done on it. Yeah. And it's extremely effective. It can actually make it help kids go back to when they, before they were traumatized. Yeah. When it's what's called a quote unquote simple trauma Yeah. Rather than a complex trauma. Mm-Hmm. The difference being like how long they've been traumatized for how many times, that sort of thing. Yeah. So the next thing is EMDR,

Christy Wilkie (41:12):

EMDER <laugh>.

Lucas Mitzel (41:15):

EMDR is, it's really cool. I've done E-M-D-R-I personally for my own traumas. And it's, it was, it's been great. So I moved.

Christy Wilkie (41:25):

Not easy work.

Lucas Mitzel (41:26):

No, no. <Laugh>, there's no trauma therapy. That's easy. No. So EMDR is all about what's called bilateral stimulation. So the idea is that you have, we have two sides of our brain and we're trying to access both sides at the exact same time. Oftentimes when we have a traumatic event or anything, we are only accessing one part of the brain. And the theory is that our brain knows how to heal.   We just need to help them con communicate, talk to each other. Yeah. One another. And so the bilateral stimulation can look like a lot of different things. My favorite that I was using was called tapping. So I would cross my arms like an X and my right hand would be on my left shoulder. My left hand would be on my right shoulder. And then it would be tapping back and forth one at a time.

Lucas Mitzel (42:06):

And what that does is it makes the brain talk to itself. And then I start talking about a feeling or the memory itself for what was going on. And you only go for like maybe 10, 20 seconds. You stop, you check in, see how you're doing, and then we go forward from there and start processing even more. And what can happen is that you can start remembering things that maybe weren't, you didn't remember before, the memories that you experience and the feelings that you're talking about become very clear. and can be a little freaky <laugh> at first until you get used to it. I gotta be honest. But it's extremely helpful for desensitizing you to the memory and helping, the biggest thing is helping you change your thinking patterns about it.   And so, 'cause you always start each session with, okay, what is, what is the negative cognition that you, that you do hold?

Lucas Mitzel (42:56):

How true is that to you on like a scale of one to seven and then moving forward, what is the thought that you want to have? What's our goal thought here?   And then we slowly move towards that and it's, it can change when you get through it. You might be like, no, actually, like this is the positive thought that I have now.   And that's even better. Yeah. But it's a really cool therapy and it kind of feels like witchcraft, <laugh> if I'm being honest. It feels like magic is happening. Yeah. But yeah, you have a, you have a whole memory chain that you go through. There's a bunch of prep leading up to that as well, just like with everything else. And it's not like day one we sit down and we start tapping <laugh> if, and there's a bunch of skills that you'll learn to manage any of the distress.

Lucas Mitzel (43:36):

Again, it's not uncommon for sessions to be be done early. If we feel like we need to close up or if you're becoming distressed, we will slow down. But it's a really awesome therapy and it's been really helpful for a lot of people. There's a ton of awesome research about it.   And the cool thing about the bilateral stimulation is that there's a type of stimulation for, for everybody. Yeah. There's a visual one that you can use. There's an auditory one. Obviously the physical could use lights. Yeah. Yeah. There's a, the light bar is what is the most famous thing that they use. Yeah. But you can do it like, like I did it over telehealth Yep. With someone. And it was, it's great. Yeah.

Christy Wilkie (44:12):

And, and the, and the goal of all trauma therapies is the same really. It's, it's to change the way you think about it, change your emotions about it, figure out how you can quantify it in your head and move forward. And so whatever that means for you, whatever, whatever modality that means that is gonna work for you. Give it a shot.

Lucas Mitzel (44:30):

Yeah. You don't have to feel like this anymore.

Christy Wilkie (44:32):

No. We don't have to live miserably.

Lucas Mitzel (44:35):

Right. It's trauma. PTSD is one of the few disorders that you can actually quote unquote cure. Right. So if anything we have talked about, like describes what you've gone through or or how what you're experiencing, please get talk to someone. Yeah.

Christy Wilkie (44:51):

There's all sorts of help out

Lucas Mitzel (44:53):

There. We always want to encourage you to ask the question, is it just me? You're likely not alone. And there is always a way to help. If anything we have talked about today resonates with you, please reach out.

Christy Wilkie (45:01):

Do you have a topic you'd like us to talk about? Message us. We would love to hear from you. You can message us anyway. Facebook dm, shoot us a text. Our email is, is it just me@dakotaranch.org.

Lucas Mitzel (45:11):

And don't forget to share us with your friends and family.

  Announcer (45:13):

Thanks for listening to today's episode of Is It Just Me? To learn more or make an appointment for psychiatric or mental health services at Dakota Family Services, go to Dakota Family Services.org or call 1 800 201 6495.

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