Trauma & PTSD Awareness – Podcast
We don’t have to be defined by our trauma. LeeAnn Barkman, LISW-S discusses how we can overcome historical trauma, symptoms of PTSD and ways to establish safety in your life.
Nicholette Leanza:
Welcome to Convos from the Couch from LifeStance Health. For each episode, you’ll hear engaging and informative conversations with leading mental health professionals that will help guide you on your journey to leading a healthier, more fulfilling life.
Nicholette Leanza:
Hello, everyone, and welcome to Convos from the Couch from LifeStance Health. I’m Nicky Leanza, and on today’s episode, I’ll be talking with LeeAnn Barkman, a clinical social worker and regional clinical director, who will help us understand trauma. So welcome, LeeAnn. Great to have you on.
LeeAnn Barkman:
Thank you, Nikki. It’s so great to be here.
Nicholette Leanza:
Let’s get started. Tell us a little bit about yourself.
LeeAnn Barkman:
Well, I’ve worked in the field of mental health, psychiatry, for 25 years. I’ve worked in inpatient, outpatient, emergency, and forensic psychiatric settings, so I’ve experienced a little bit of all of it. I’m currently, as you mentioned, the regional clinical director for the Cincinnati offices at LifeStance, and I specialize in the treatment areas of trauma, major mental illness, and substance abuse, and dual diagnosis, of course. So in my free time, I train and compete in martial arts, I run, I love music and photography, and I really love spending time with my friends and family.
Nicholette Leanza:
Great. It sounds like you’re very balanced in what you do for fun and-
LeeAnn Barkman:
I try to be. Life is a balancing act.
Nicholette Leanza:
That it is, that it is. Well, can we get started with the conversation regarding trauma and you sharing with us some statistics that you’ve gathered?
LeeAnn Barkman:
Sure. Well, it just so happens that trauma is a lot more common than we think it is. Most people experience at least one traumatic incident in their life. According to the Center for Disease Control, in our childhoods alone, 25% of us grew up with an alcoholic parent, which is not traumatic in and of itself. However, it does tend to come with a lot of trauma and trauma incident. So one in eight experienced their mother being abused, one in five Americans have experienced sexual abuse in childhood, one in four experienced physical abuse by a parent so badly that it left a mark, and one in three couples have engaged in physical violence.
Nicholette Leanza:
Wow. When you really share those statistics, it really does hit a broader population of people that… I’m sure there’s a lot of people out there who don’t even realize, wow, I’ve experienced trauma and didn’t even realize it.
LeeAnn Barkman:
Most definitely. And in fact, in practice, over the years, I’ve noticed that people don’t often even… or excuse me, define their own traumas as a trauma. If you say to someone, “So, have you experienced any trauma,” they’ll say, “No.” It’s, “Have you ever been in a domestic violence situation,” they’ll say, “No.” However, during conversation later, during therapy sessions later, they start describing situations that you’re like, “That is a domestic violence situation.” We just don’t tag it that way in our own brain, or we think, well, it wasn’t that big of a deal. We minimize it. Or we say, “I made it through that,” or we try to avoid it, or all the things that our brain tries to do with trauma, so it is a lot more common than we think.
Nicholette Leanza:
So how would you define trauma?
LeeAnn Barkman:
Simply put, I would define trauma as an emotional response to a distressing event. I think it is important to realize though, that, and we can’t completely explain this, okay, you can have two people who experience similar traumas or even the same trauma. One may walk away and experience symptoms of PTSD later, and the other one may not. The other one may not seem very affected by it at all. And of course, there are some risk factors there for people. If you have a history of trauma, that puts you at greater risk for experiencing symptoms of PTSD, if you suffer with depression or anxiety or anything like that, substance abuse, all kinds of things.
Nicholette Leanza:
You mentioned PTSD, post-traumatic stress disorder. Can you share with us some symptoms of PTSD and how it might be diagnosed?
LeeAnn Barkman:
Sure. Well, first of all, PTSD is unlike any other diagnosis in our Diagnostic and Statistics Manual for mental health, right, for psychiatry, so because there has to be the presence of a traumatic event. You don’t have to have that with bipolar disorder or depression or anything like that, but for PTSD, you do. You have to have the presence of at least one traumatic event, okay. And then that person has to be exposed to a real or perceived threat of death, bodily harm, or sexual violence. That experience can be direct to the person, it can be witnessed, or we can learn that a traumatic event has happened to a loved one. So being repeatedly exposed to the details of trauma is another way that we can develop PTSD, such as your first responders who may… They don’t necessarily experience the trauma itself, but they are responding to scenes of traumatic events, or they are constantly taking reports of child abuse or violent situations.
Nicholette Leanza:
And makes me note too, that it’s very specifically defined in the DSM. I’ve worked with some clients who’ve been traumatized from a breakup of a relationship, traumatized from the point of view that they weren’t expecting it, or they’re heartbroken, and really difficult to navigate through. And so, even though I might put to them an idea of like, “Boy, they’re literally traumatized from this,” that does not fit the specific definition that we see in the DSM either. But I think sometimes it could be beyond that too.
LeeAnn Barkman:
Well, also, I think it’s important to recognize that a person can experience trauma and have an adverse reaction to that. That’s more a trauma to the psyche, a trauma to our emotions, and it doesn’t necessarily have to fit the diagnostic criteria for PTSD. That doesn’t mean you’re not affected by it. And in addition to that, trauma and all mental health issues, right, follow that all continuum, so some people may experience it mildly while other people may experience symptoms severely, and then we have this whole gray area in between.
LeeAnn Barkman:
So I did not go over the symptoms, so let me jump back to that. So the symptoms for PTSD, anyway, are experiencing recurrent, intrusive, or involuntary memories of the event, having distressing dreams or nightmares that are related to the event, and of course, all of this starts after the event, right, flashbacks or feeling that the event is reoccurring, distress at internal or external cues that are symbolic of the trauma, avoiding things or people that remind us of the trauma, negative thoughts or mood worsening after the traumatic event. We can also experience irritable, angry outbursts, hyper vigilance, exaggerated startle response, interruptions in concentration, sleep problems, dissociative symptoms. It seems like the list of symptomology for trauma or PTSD just is a long list. But those are some of the main symptoms that we use to diagnose PTSD.
Nicholette Leanza:
Mm-hmm. And so, either somebody’s experience of trauma or formally diagnosed with PTSD, are there some specific things that you help guide them and help them with as you’re working with them?
LeeAnn Barkman:
That you help guide people to help them prepare?
Nicholette Leanza:
Yeah, or what are you, I guess-
LeeAnn Barkman:
Sure. Well, I mean, it’s important to realize that when we experience a traumatic event, we experience it with all five of our senses. So one of the things that we often work on in therapy is also learning to heal ourself using those five senses. And so, we want to be able to stay in the here and now, especially if we’re experiencing flashbacks or feeling like we’re re-experiencing the trauma. So I mean, obviously, with every illness, we’re going to address whatever symptoms that person’s having, right, so not everyone experiences, flashbacks.
LeeAnn Barkman:
However, you may not experience flashbacks, but the brain remembers sometimes, but we don’t necessarily realize it or want it to. An example of that could be, let’s say that a person had an attempt on their own life and now it’s two years later and they find themselves in the middle of the day, just uncontrollably crying and not really understanding why. Sometimes, later, we’re going to recognize, oh my gosh, this is the day, two years ago, that I tried to hurt myself.
LeeAnn Barkman:
And sometimes we may not realize that and it doesn’t make a whole lot of sense to us, but if we can realize that, well, and even if we can’t, actually, we can use those five senses to try and help us stay in the here and now. What is it that I see around me right here and right now? What is it that I hear around me right here and right now? Smell, taste, what did I leave out, touch, what do I feel? Yeah, and using all of those things, because I mean, I’m going to assume that we’re not going through a trauma, right, at the moment, right, and that we’re in a safe spot, which safety is another thing that we have to work on establishing after a person has experienced trauma.
LeeAnn Barkman:
Trauma greatly shakes our sense of safety in the world. It can shake it emotionally, it can shake it physically. Depending on your trauma, I mean, it can shake it financially. There are all different ways that our safety can be affected, and so we have to work on reestablishing that safety. That is something that I think is usually guided better during a therapy session, and then the therapist can also provide exercises and a bit of homework for the person to work on developing safety. A lot of times, people have actually already started reestablishing safety in their life, but they haven’t thought about it. I mean, if I say to you, “How do you have safety in life, Nicky…” Have you really ever thought about that before?
Nicholette Leanza:
No.
LeeAnn Barkman:
But I bet you have some. I bet you have quite a bit. You have safe relationships and people who you feel safe with. You might also have some people that maybe you don’t feel completely safe with. And by safe, I don’t necessarily mean physically not safe, but maybe you say, “I don’t want to tell my deep, dark secrets to this person because they’re not safe with them.” But we have safe people, we have safe places, hopefully, that we can go to or that we can establish for ourselves. And so, obviously, if the person doesn’t have safety in their life, we might work on establishing safety and then recognizing that safety.
Nicholette Leanza:
So it sounds like making sure they have safety in their life, helping them ground themselves to their senses, mindfulness with that. What else do you do in helping them navigate maybe thoughts that might be adding to their traumatic thoughts or thinking?
LeeAnn Barkman:
In navigating thoughts, did you say? I’m sorry.
Nicholette Leanza:
Yeah, yeah.
LeeAnn Barkman:
Okay, well, so one of the things that happens when we experience trauma, especially repeated trauma, is that we can develop what are called cognitive distortions. And that basically means we’re not thinking about it appropriately, right? We’re getting mixed messages and maybe our brain is making those messages mixed. So I often think about this as, when was the last time you went to Coney Island?
Nicholette Leanza:
I’ve actually never been to Coney Island, yeah, but-
LeeAnn Barkman:
Oh, you haven’t?
Nicholette Leanza:
No, I’ve not.
LeeAnn Barkman:
Okay. Well, anyway, you’ve probably been to some amusement park, okay. So here in Cincinnati, we have Coney Island, right, and at Coney Island, they have these four fun mirrors. And when you walk up to the first one, you look in the mirror and it makes you look short and wide on the top and long and thin on the bottom, right? When you go up to the second, it’s the opposite of that. You’re long and narrow on top, you’re short and wide on the bottom. The third one, everybody loves because you are very tall and very thin, but you’re 7′ tall. At least, I look 7′ tall in it, and I don’t really want to be 7′ tall, so I’m good with 5’7″. And then the last one, you look very short and wide, okay.
LeeAnn Barkman:
So this is a distorted image of us, right? We know that we don’t look that way, and that’s why everybody stands there and laughs at them, and we giggle and it makes for a fun afternoon to… But it’s a distortion. That’s not really what we look like, and we probably wouldn’t think it was very funny if we didn’t know how we looked. It would be very-
Nicholette Leanza:
Right.
LeeAnn Barkman:
Right, because in this mirror, you look this way, and in this mirror, you look this way, and you have four different ways you can look. And then obviously, if we take our hands and we move them from our shoulders down to our feet, I don’t feel short and wide on the top and tall and thin on the bottom, I don’t feel the way the mirror makes me look, so I can become very confused by that. And we get these kind of mixed messages, though, in different ways. Sometimes people may think that anytime they see a man taking a child to the bathroom, that something bad is going to happen because that was connected to their trauma when they were a child.
Nicholette Leanza:
Right, so they perceive their environment almost through the eyes of their own trauma.
LeeAnn Barkman:
Mm-hmm. Correct. Or people who have experienced trauma also tend to become very good at observing their surroundings and observing how other people are acting. A look can set off the brain to say, oh my gosh, I need to disappear, or hide, or whatever, and that look may not really mean that at that moment, but it did at some time when a person experienced high trauma in the past. And so, there again, the brain’s getting a message, it’s getting a little bit mixed up. Or we also have the issue of if a person is repeatedly traumatizing someone else, they may verbally give that person incorrect messages, if a sexual abuse victim is told, “This is how I make you feel special.” No, this is not how we make people feel special, but that is…
LeeAnn Barkman:
First of all, maybe we’re a child. And so, children, we believe what adults tell us, so as adults, it’s our responsibility to be good adults in those kids’ worlds, right? Unfortunately, that doesn’t always happen, so we sometimes, as adults, then, in treatment, or even as kids, depends on when you go to treatment, we work on changing those cognitive distortions around to something that is reasonable and rational and true. True is the key, because… And all of this goes back to safety as well, because when you cannot trust how you feel about something, then you don’t feel safe making your own decisions about things or guiding yourself.
LeeAnn Barkman:
I used to work in a forensic treatment program where the qualifications for being in the program were to be involved in the criminal justice system, to have psychiatric and substance use issues, and a history of trauma, right, so every person we had there had a significant history of trauma. And a lot of people there would say at one point, “I don’t trust the decisions that I make based on my history here,” and this trauma is playing a lot into that, right? And so, for a while, until they could learn to make better decisions, they say, “I just think about what I think I’m supposed to do and then I do the opposite of that,” so we go about it however we can, then we can get that brain rewiring so that it’s shooting those messages or shooting off the appropriate way and no longer distorted.
Nicholette Leanza:
For sure, which makes me think of a book. And I know, previous to us recording today, we were chatting earlier about the book The Body Keeps the Score by Bessel van der Kolk. Anyone who’s experienced trauma or is just really wanting to know more about it, I think that’s an excellent resource book to read.
LeeAnn Barkman:
Most [inaudible 00:17:58]-
Nicholette Leanza:
A lot of emphasis is grounding it back to the body and things like that.
LeeAnn Barkman:
And it’s really good, I think, for both clinicians and lay people both. It hits on a lot of good research, it hits on a lot of practical experience that Bessel van der Kolk had himself during his, well, he’s still treating, but during his early years of treatment and all of the things that he learned. So one of the things that I was really amazed about when I was reading that book was… He was talking about when he first started working in the VA, and he had all these veterans in there and he was relatively a new doc, and in this day and age, we know that we don’t really do trauma groups and allow people to process their trauma in those groups because we’ve learned that it’s not good for the other people in the group, to be exposed to that trauma, right, and that that is something better managed in an individual session.
LeeAnn Barkman:
But I guess during that time, they weren’t quite aware of that, right? And so, one of the things he talked about was that these veterans would come in and they would be very apathetic and almost void of emotions, just very flat. And when they would get together and start talking about some of the things from the military that they had been through, even including some of the trauma, it was like you could see them come alive, and the only thing that really sparked that was the trauma. And then after that was over, they returned to the flat affect and the void of emotion, and that’s really sad. It’s important information to know, however, I mean, we don’t want to go through life void of emotion. We don’t want to go through life that detached from our emotions and our physical body.
Nicholette Leanza:
Right. Oh, I agree, a hundred percent, which is why in therapy, what you’re showing your clients is how to bring them back into their body. [inaudible 00:20:10], for sure. Any other takeaways you have for us to help people understand trauma?
LeeAnn Barkman:
Well, yes, most… I’m sorry.
Nicholette Leanza:
To understand trauma, yeah. Takeaways?
LeeAnn Barkman:
Most definitely. And one thing that I did forget to mention was that when we experience trauma, that we really do become disconnected from our body. So one of the takeaways would be that we really do need to work on reconnecting to our body, be it through yoga, martial arts, running, drawing, music, whatever it is for that person, if you can feel it when you do it, then it is helping you reconnect to your body. So that would be one. My other takeaways would be that we should never minimize someone’s trauma, that we can overcome trauma, and that we should… Trauma happened to us, but we do not have to be defined by our trauma.
Nicholette Leanza:
That’s a big one there. I love that one, for sure. Thank you, LeeAnn. Thank you for sharing your information with us about trauma. And I think many people watching this, listening to us, are going to walk away like, “Wow, I didn’t realize how far-reaching trauma can be.”
LeeAnn Barkman:
Well, thank you so much for having me. It’s been great.
Nicholette Leanza:
Thank you.
