There is Hope – Cognitive Behavioral Therapies for Treating Trauma

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Trauma is prevalent in our society. Turn on the TV or go on any social media and there’s no shortage of natural disasters, accidents and injuries, abuse, threats of violence, violence itself, and sudden deaths. Sadly, this does not include traumatic events that have happened to you or to those you know. In my previous post, I gave an overview on trauma. In this post and next, I’ll be covering treatments for trauma.

Evidence-based treatments for Posttraumatic Stress Disorder (PTSD)

In the field of psychotherapy, “evidence-based treatments” are treatment modalities that have been proven by scientific research to be effective for treating a particular set of symptoms. In the case of PTSD, a subset of Cognitive Behavioral Therapies (CBT) have shown to significantly decrease PTSD symptoms and related conditions, and these benefits are sustained well after treatment is over. I’ll be writing about two types of CBT approaches that I practice at my Redmond office. I’ll also be calling on trauma experts in the larger Seattle community to comment on other approaches that they specialize in.

Trauma-Focused Cognitive Behavioral Therapy (TF-CBT)

Trauma-Focused Cognitive Behavioral Therapy (TF-CBT) is designed to help children, adolescents and their families recover from trauma and related symptoms. Over the course of 12-16 sessions, children and their caregivers will learn about the particular trauma the child has experienced, common trauma symptoms, as well as the roadmap for treatment. Caregivers will also get support around parenting and learn ways to manage the child’s emotional and behavioral difficulties related to the trauma. Children will develop and practice relaxation techniques, ways to regulate their emotions, and skills to begin thinking about their trauma differently. They will also be asked to tell/write about their trauma experience in a safe environment, share it with a special person and learn ways to safely navigate the world going forward. At the end of treatment, many kids feel really empowered and their caregivers proud! And, the tools gained from treatment can be easily adapted to cope with other life stressors.

Cognitive Processing Therapy (CPT)

First developed for use with veterans who have experienced PTSD symptoms, Cognitive Processing Therapy (CPT) has been shown effective in treating other types of trauma. As in traditional CBT, CPT sees a strong connection between your thoughts, feelings, actions, and body sensations. And, to the extent that you have some unhelpful ways of seeing the world before and/or after the traumatic event, those beliefs will keep you “stuck in non-recovery”. When you’re “stuck,” you tend to be hard on yourself and others, mistrustful of the world, and feel numbed out and angry. The ultimate goals of CPT are to help you: 1) accept the reality that the traumatic event happened, 2) fully experience the emotions about the event in a safe environment, and 3) develop more balanced, realistic views about the event, yourself, and others. Clients who have completed 12-20 sessions of CPT have shown a decrease in PTSD and trauma-related symptoms such as depression, anxiety, shame or guilt. They have also reported feeling more present in their everyday life.

Now, calling my first expert! *Drumroll*

Prolonged Exposure Therapy (PE)

For years, Caitlin Vincent, MS, LMFT, CDP provided therapy at the King County Sexual Assault Resource Center. She writes, “I find people struggle most with the re-experiencing symptoms of PTSD (flashbacks, nightmares, intrusive memories and strong physical and emotional reactions when reminded of their experience). They often say that they feel haunted and raw, like the event just happened, even if it didn't. Prolonged Exposure (PE) is a form of therapy that is especially helpful for alleviating these symptoms of PTSD by safely revisiting painful memories in detail, from start to finish, in a process called Imaginal Exposure. Just as a once-scary movie becomes less shocking if you watch it several times, this process can allow someone to regain more control over their minds and bodies. By facing these memories thoroughly and directly, and then talking about the thoughts and feelings that arise, people can start to put the experience behind them, because finally allowing the brain to process the memory relieves its instinct to replay details over and over. PE is best for someone who has a clear and identifiable 'worst' traumatic incident that they can refer to and focus on, but can easily also be used for multiple traumas.”

There is hope for you

If you suffer from trauma symptoms and these CBT approaches to treatment resonate with you, there is hope. Yes, it is scary. Caitlin and I hear you. We’ve been there with countless clients and have walked them through this painful and frightening journey into hope and recovery. We'd want to do the same for you. Let us know how we can help. I’m here and Caitlin is here.

Up ahead

Stay tune for other evidence-based approaches to treating trauma that I cannot even begin to describe! I’ll leave it to the experts.

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Ada Pang, MS, LMFT is the proud owner of People Bloom Counseling, a Redmond psychotherapy practice in WA. She helps distressed couples and breast cancer patients. She understands that she cannot be known for too many things, but yes, she loves helping amazing but struggling people recover from trauma as well. When she’s not working or thinking about work, she’s eating or thinking about food. 

How to be with the 2016 US Election Results

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Unexpected results

Wow! What a week and it’s not over yet. Tuesday seems like eons ago. The election results shocked the whole world, leaving some celebrating, others protesting. On the one hand, as an immigrant and a woman of color, I hear and identify with the concerned voices of my fellow brothers and sisters as they face an amplified fear to the already prevalent racism, xenophobia, islamophobia, homophobia and sexism in our society. On the other hand, republican voters speak to the hopelessness and oppression they felt under the Obama administration. Each has a story to tell.

Narrowing the great divide

Our country is facing unprecedented polarization. That leaves a “we” versus “them” mentality with little room to hear the other. Whether you are a distraught Clinton voter who has taken to the streets, a victorious Trump supporter beaming with pride or a secretive Republican supporter afraid to come out of the closet, here are some ways to be post election.

1. Come together – be with those who share your viewpoint. Find company. Look around you and know that you’re not alone.
2. Express yourself – silence is dangerous. Speak to your hopes, fears, frustration and disappointment. Use words, art, music, anything.
3. Let your feelings come and go, come again and go again – if you’re experiencing shock, denial, anguish, sadness, fear, anxiety, anger, joy, thrill or whatever else, acknowledge them. Pushing away unpleasant feelings will only make them stronger; prolonging pleasant feelings will make you miss out on the here and now.
4. Revisit your values – remind yourself what you’re about and how you want life to be for you, your family, your neighbors, your community, the environment, animal life, and human kind.
5. Know your impact – your beliefs and thoughts carried out in words and actions will affect another. Your choices have consequences, positive or negative. Imagine the effect of those same choices when done to YOUR father, mother, brother, sister, son, daughter, best friend and those your love.
6. Listen closely – you come with your worldviews, life experiences and biases as you encounter another’s worldviews, life experiences and biases. Listen and understand another’s perspective even though that has and might never be your reality.
7. Stand up for justice – give voice to those who are silenced or are afraid to speak up. Stand with those who are treated less than because of their race, gender, sexual orientation, age, religion, class, abilities, looks or ethnicity. Pause to reflect on what each of these even mean. 
8. Teach the next generation – when your children, grandchildren, nieces and nephews inherit this earth, what do you want them to know about caring for ourselves and each other?
9. See our humanity – we are first human beings BEFORE our differences divided us. Strip us to the core, we have the same needs for safety, love and connection:

I might not know your story, but let me hear it. 

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Ada Pang, MS, LMFT is the proud owner of People Bloom Counseling, a Redmond therapy practice in WA. At the heart of what she does, she’s about helping people flourish and live compassionate and vital lives. She can be found at PeopleBloomCounseling.com.

Body Image after Breast Cancer – What is Visible to the World

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In my last blog post, I gave an overview on body image after breast surgery and radiation. I invited you to befriend your breasts and come to accept them as they are. This takes time. When you’ve reconciled this loss, breast prostheses, mastectomy bras or reconstruction is the icing on the cake, rather than the cake itself.

Now, while it is devastating to lose a boobie or two, it is something private and can be covered up. What about the body changes that scream, “Cancer!” to the rest of the world? Treatment will lead to body changes that are visible to all. How do you involuntarily give yourself away?

Hair on your head

A study done by Dove in Dec 2015 found that only 11% of women love their hair as is. The rest of us wish that it was less wavy, more fine, less grey, more thick or, just fill in the blank. You never come to appreciate your hair as much as you do, until it starts falling off in clumps. In the shower, as you’re brushing it, while you’re going about your life: you’re shedding everywhere.

Some women choose to shave their heads early on to avoid the pain and the clean up of such a visible loss. Others choose to keep every strand of their hair until chemo is over and then get the shave to ready for new hair growth. Often times, patients speak to how difficult it is to face hair loss: there is no hiding that you have cancer and you’re going through treatment. A scarf or a wig simply don’t do the job of your own hair.

Overtime, if you are able to adorn beautiful head scarves, find a wig (or two) that lets you be yourself or wear your bald cut with pride, kudos to you sister! Whatever you choose, women can look amazing without long, thick, and shiny Pantene hair! But, what about other facial hair you had taken for granted?

Hair on your face

Brows look better thick and lashes long and thick, so says society. Regardless of whether you’ve totally bought into that message, we can’t argue the fact that your brows do help to shape your face and your lashes emphasize your eyes. When you’re going through chemo, your brows will likely thin out and your lashes fall out. These small changes can make you look and feel more vulnerable.

Let’s take a step back from these aesthetic features. Did you know that brows and lashes have actual functions? Brows help keep sweat and moisture out of your eyes while lashes protect your eyes from debris. Sensitive to the touch, lashes will also trigger the eyes to shut when there’s a foreign object near the eye. In light of that, can you imagine coming to appreciate why we have these hairy facial features? And, the next time you look into the mirror, remind yourself that these features have a purpose before the definition of beauty find them lacking and needing “modifications”.

Weight gain

Aside from hair loss, the other most noticeable change to the body during breast cancer treatment is weight gain. Perhaps you used to be active and lived a busy life. You might not have been training for a triathlon (or maybe you have been), but your schedule was full. During chemo, you inevitably experience early menopause and a drop in metabolism. Feeling tired and nauseated, you become less physically active and your previous lifestyle seems miles away. Side effects of meds can also cause increase in appetite and weight gain.

What to do about visible body changes

What would be giving and nurturing to you? Would you enjoy going for a makeover? Donning ginormous earrings? Loving your beret turban? Going for a head massage? Whatever it is, I invite you to be gentle with yourself. Your body needs A LOT of comfort and care, not a focus to return to status quo. Just as treatment is for a period of time, so some of the side effects of treatment will also be.

There is no returning to what is normal; rather, it’s about establishing a new normal. While it’s wise to have less on your schedule, you might try to slowly phase in a physical activity or two while on hormone therapy. Start with short walks and lengthen them with time. Be around good company for accountability sake. Above all, listen to your body; it has a lot to tell you.

If you need help reconciling these changes during and post treatment, let me know!

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Ada Pang, MS, LMFT is the proud owner of People Bloom Counseling, a Redmond psychotherapy practice in WA. She helps distressed couples and breast cancer patients. That can also mean couples distressed by a partner’s cancer diagnosis, or couples wishing to use their marriage as a resource during their cancer journey. When she’s not at work, she has found yoga to be a wonderful practice to nurture self-compassion. 

Body Image after Breast Cancer – Boobies Then & Now

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I've been doing a breast cancer series on the messy feelings of cancer and the fear of reoccurrence. Another common theme I see facing cancer patients is the feeling of being "disfigured or damaged" after breast cancer treatment. 

Society's narrow definition of femininity

Let’s be honest here, our society has a general opinion about what constitutes femininity: thick lush hair and curvy body. There’s also something about a wrinkle-free forehead, better shaped brows, longer and thicker eyelashes and the list goes on. Wait, I should mention the many push-up bras and what?! A padded underwear? I had to look that one up. Needless to say, isolate any one of your body’s features and there’s a product or service to sell you because what you got, ain’t good enough. And that was pre-cancer.

Your body pre-cancer

You might not have bought into all the lies about what makes a woman beautiful, but let’s face it, none of us are immune to it. Whether you were satisfied with your body pre-cancer, or you were struggling with your body image, cancer treatment will rock your world.

Breasts

Boobies. You’ve got two of them, like you do two eyes, ears, hands, feet. No matter their shapes and sizes, they are visible to you, day in, day out. You look at them and they are a pair, a two-some, partners. As a society, we are fascinated with them. We are told they look better full (with no account for the back and shoulder problems they cause), symmetrical, and lifted and firm, and soft and supple to the touch. Aside from the visual aspects, women who became mothers and nursed their babies spoke about providing to their child nutrition, protection from illness, and a connection that, without one or both boobs, might be hard to rig up.

Breast surgery and radiation

In comes lumpectomy, single or double mastectomy and you lose fullness, symmetry and the ability to nurse on one or both sides. Radiation destroys breast tissue and often makes your breast more firm or “rubbery” in the long-run. Radiation also damages the milk ducts; stories of women who were able to breastfeed on that side are anecdotal. Whatever your boobs have meant to you, it’s time for a re-definition.

Breasts re-defined

Your boobies are yours. You’ve had them and you grew up together. You were on the monkey bars, went on field trips, pulled all-nighters, traveled, and shared them with someone you love. They might not have turned out the way you hope they would, but they were loyal to you and stuck by you through thick and thin. Now, they’re sick. Your good friends have fallen ill. Cancer cells are growing inside of them and in order to save your life, you have to bid goodbye to one, both or subject one to radiation. It’s hard to see them go or suffer. It’s like you’ve taken them for granted all this time. You don’t remember the last time you’ve given them close attention, complemented them or told them you love them just the way they are.

Post treatment and your boob(s) might no longer be there. If there, it has changed form and you’ve seen it suffer through the burn and rash of radiation. Whatever the state of your boobies, the soul of your boobies are still there. That spirit of love and companionship is still there. It has never left. If anything, it has grown stronger. You and your boobies have braved a very courageous endeavor, together. And, like before, you will continue forward, together. Whether you decide to seek reconstruction or not, it doesn’t change the fact that the spirit of your boobies live on. While your baby might have limited experience with nursing, you will bond with your child and they can learn all about your boobies, from you.

Compassion for your body

I don’t mean to be weird here; I’m speaking about self-compassion. Pre-cancer, people are often living busy lives, lugging their bodies around, subjecting them to caffeine overload, dehydration, stressful days and little sleep. We take our body's functions for granted, until something happens to them, then we give them attention. What if we take better care of our bodies and show more appreciation for our body’s features? What if we take the time to accept them rather than spend so much time covering them up, changing them, and rejecting them? What if we care for them, now?

Going forward

Just when I thought I could write one post on body image, I talked all about boobies. I will have to write a sequel on having a healthy relationship with the rest of your body post cancer treatment. In the meantime, if you are a breast cancer thriver and you need help extending compassion to yourself and caring for you, let me know!

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Ada Pang, MS, LMFT is the proud owner of People Bloom Counseling, a Redmond psychotherapy practice in WA. She helps distressed couples and breast cancer patients. That can also mean couples distressed by a partner’s cancer diagnosis, or couples wishing to use their marriage as a resource during their cancer journey. When she’s not at work, she has found yoga to be a wonderful practice to nurture self-compassion. 

Living with the Fear of Cancer Recurrence

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In my last post, I talked about the complex feelings of cancer diagnosis and treatment. I wanted a separate post to specifically target the fear around cancer recurrence.

Whether you’re still going through cancer treatment or it has been years since you were treated, the fear of cancer coming back is very real. You’re attuned to every ache and pain in your body and instead of thinking that these discomforts stem from sore muscles or the beginning of a cold, you think cancer. Perhaps you secure message your doctor’s office for reassurance or you talk yourself down from feeling anxious. Nonetheless, the thought of cancer is ever looming.

Anxiety about cancer recurrence is normal

While most cancer patients who initially reported depression at the time of diagnosis experienced little to no depressive symptoms 10-years post treatment, the anxiety stemming from cancer is still there. After all, to have a cancer history is to face realities that cannot be fully changed or influenced. Sure, you might decide to eat healthier, stay physically active, manage stress better and maintain supportive relationships around you. While these are all good lifestyle habits to have and nurture, nothing you do can guarantee a cancer-free future.

What to do with healthy anxiety

First of all, if you feel something unusual during a breast exam (and the best time to do a breast exam is at day seven of your menstrual cycle), please do contact your oncology clinic. Similarly, if your body is exhibiting symptoms you don’t recognize or common symptoms are lingering, it is wise to seek medical advice. It is important to listen to your body and care for it; otherwise to ignore these symptoms is to deny that something is wrong. Burying your head in the sand only increases the likelihood of you getting your ass kicked.

What is constant anxiety

There is a difference between caring for your body and smothering it. You know your anxiety is in the driver’s seat when you’re constantly thinking about cancer, Googling every body discomfort known to man, and seeing your providers above and beyond normal follow-up appointments. You might be very rigid about the lifestyle choices you make. For example, you can’t miss a day at the gym, there is little to no flexibility in your dietary choices (unrelated to allergies), or you get easily agitated when you perceive that others are critical of how you’re managing your cancer. In other words, your world evolves around your cancer.

What to do with constant anxiety

Your body responds with anxiety when there’s a perceived threat. After all, cancer was and still is a huge threat to your existence. Doesn’t it make sense that you be constantly watchful of it? Knowing that, it’s important to realize that fear is your friend, not your foe. It is there to protect you; to preserve you. The key here is to befriend your body and to acknowledge your fear while putting it in the passenger seat.

Anxiety management techniques

What to do with your thoughts

Just because you think something does not mean it’s happening or that it’s true. Try it: think of a pot of gold. Think super, uber hard. What happened? Did you get rich from conjuring up images of gold? If you did, please come to my office and have those same thoughts. Okay, so you know I’m being facetious here. What I mean is that when your mind thinks something, that’s all it’s doing: a string of words came and went. You can entertain these words and attach a lot of meaning to them, or you can let them come and let them go.

Put simply, thoughts are either helpful or unhelpful. Helpful thoughts can be, "How do I make the most of what I have?" or "These things are meaningful to me and I'm going to do them!" When these thoughts come, listen to them and act accordingly. These thoughts are serving you. 

On the other hand, with thoughts like, "I can't enjoy my life because of my cancer!" or "Cancer is just going to come back; I know it!" acknowledge them and let them go. Like the pot of gold, just because you think it does not mean anything. In learning to have a different relationship with your thoughts, you’re essentially saying, “I hear you thoughts and I won’t be minding you so much. Here, why don’t you sit in the back? I’m still the one driving.”

What to do with your feelings

Similarly, when feelings of anxiety come, let them be there. Don’t push them away; they will only come back stronger. Acknowledge them; sit with them; talk to someone about them. While these feelings are scary, you can make space for them. What do they feel like? Does your heart pound? Do you get sweaty palms? Is your stomach churning? Know that these sensations will pass. As you ride through the waves of these feelings and body sensations, you can still be in the driver's seat, making the most out of life. 

Staying present

The fear of cancer recurrence has you looking into the future. It is thus hard to focus on the present and what’s going on right now. What have you been missing out on? Is it the changing colors of the leaves? Conversations with your loved ones where you’re only half listening? Finished a meal and you don't remember what you ate? When you find your mind focused repeatedly on your worries, acknowledge your mind, and come back to the present moment. Right now is the only moment you can do something about. Don’t miss out.

Need more?

Often times it helps to have someone come alongside you as you learn how to put cancer in the passenger seat. At the very least, because you’ll still have follow-up diagnostic tests and exams, you know the thoughts of cancer recurring are not going away. However, it doesn’t have to dictate your life. Let me know how I can help!

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Ada Pang, MS, LMFT is the proud owner of People Bloom Counseling, a Redmond psychotherapy practice in WA. She helps distressed couples and breast cancer patients. That could also mean couples distressed by a partner’s cancer diagnosis, or couples wishing to use their marriage as a resource during their cancer journey. When she’s not thinking about work, she loves spending time with her hubby, eating good food and more recently, watching Harry Potter. 

“I was Diagnosed with Breast Cancer. What am I to Feel?”

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October is Breast Cancer Awareness Month. I’m putting on hold my blog post on trauma to address the emotional needs facing breast cancer patients. Granted, cancer patients often talk about their experience of cancer to be traumatic, even though many do not meet full criteria of Post-traumatic Stress Disorder.

To hear that, “You’ve got cancer” is enough to unravel any brave soul. The urgency of the news leaves little room for reflection, for contemplation. You’re scheduled with the surgeon, followed by the radiation oncologist and likely the oncologist. Some medical facilities fit all three appointments into a four-hour meeting; others schedule them one at a time. Either way, your head is full and it’s hard to digest information about the stage, tumor size and grade, if it’s hormone dependent and whatever else you’re supposed to know.

All this knowledge; all these next steps, but how are you feelin’?

Facing a loss

Being diagnosed and treated for breast cancer is to face your own mortality. Your vision for what your life would be like is called into question. You thought you would live to hike the Annapurna Circuit, see your kids graduate and hold your grandkids in your arms. All these plans are now up in the air. Even if you were told the type of cancer you have is highly treatable, you’re starting to envision a very different future.

The pendulum through the messiness of grief

Being diagnosed with cancer or other chronic illness is to grieve a loss. Sure, you’re used to your body having some aches and pains, but you’re definitely not as healthy as you had thought. Thus, it makes sense that women going through breast cancer would face different stages of grief in no linear fashion.

Denial

Also known as non-acceptance, denial happens because you’re in shock and overwhelmed by the news of cancer. “Were those really my test results? Did the doctor make a mistake?” You might weep and you might also feel numb. You might wake up in the middle of the night wondering if it was all a dream. It is common for you to feel out of touch with the rest of the world because quite frankly, you would much prefer a life without cancer, thank you very much.

Bargaining

Your mind races through choices that could have detoured cancer. “What if I had lived a healthier lifestyle? What if I had gotten a second opinion? What if I had reconciled that relationship rather than let it eat at me all these years?” There are no answers to these questions but it doesn’t stop you from asking them. Conscious or not, when you consider how you could’ve affected the outcome, it’s a way to take back the control you feel like you’ve lost. Similarly, you might bargain with God or a higher power to give you another chance at a life without cancer. Or, at least not now, though there really isn’t a good time.

Depression

While not all breast cancer patients meet criteria for clinical depression, sadness is very much a part of the grieving process. When you think about how your body is sick, the possible side effects of treatment and how cancer might affect your quality and quantity of life, you understandably would feel sad. Women have often talked about treatment leaving them feeling “disfigured” or “damaged.” This might lead to feelings of shame and negative self-worth and the tendency to isolate and push people away.

Anger

“Why is this happening? Why me? What have I done to deserve this?” are some of the questions that breast cancer patients might ask. Implied in these questions is a sense of unjust, that this shouldn’t be happening. Sometimes, you might feel anger towards yourself, if you think you could’ve somehow prevented cancer. Other times, you might be angry at God or a higher power from “allowing it to happen,” or at your healthcare providers for not doing more to help. Unfortunately, your loved ones might get the blunt of your anger, simply because they’re the closest to you.

Acceptance

If denial is synonymous with non-acceptance, then acceptance is to face the reality of what is: “You have cancer.” It’s hard to read those words and to face them head on, but to keep on denying that fact is to say, “Cancer has you.” To accept something does not mean you have to like it, or that you approve of it; it only means you’re not fighting the reality of cancer diagnosis, treatment and prognosis. You’re more willing to look it in the eye, and say, “Okay, let’s do this.”

The actual stages of grief

The five stages of grief originally coined by Elisabeth Kübler-Ross is actually in the order of denial, anger, bargaining, depression and acceptance. I mixed up the order to show that there really isn’t a right or wrong way to go through grief because mourning a loss is meant to be messy.

You could be accepting the side effects of chemo one moment and then be very angry that you missed the toilet and barfed all over the floor the next. You could have a good cry and feel at peace, and the next crying episode could make you very angry at God. You might want to cancel your MRI and be in denial about what your doctors would want to say to you and the next day, invite a friend to come along to your imaging appointment.

It’s okay

The Kübler-Ross model likely does not encompass the emotional complexity of your cancer journey. Nonetheless, your cancer experience is your experience. It is okay to feel the way you do; all of your feelings are valid and normal. Allow yourself to go to these places; it’s a part of the healing process.

If you need help navigating through the messiness of these feelings, I’m here.

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Ada Pang, MS, LMFT is the proud owner of People Bloom Counseling, a Redmond psychotherapy practice in WA. She helps distressed couples and breast cancer patients. That could also mean couples distressed by a partner’s cancer diagnosis, or couples wishing to use their marriage as a resource during their cancer journey. When she’s not thinking about work, she loves spending time with her hubby, eating good food and more recently, watching Harry Potter. 

An Overview on Trauma

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My trauma story

In June of 2014, my maternal aunt passed away. It was very sudden and traumatic. I still remember the call I got from mom and her words, verbatim, though spoken in Cantonese, “Ning has passed away.” It seemed very surreal, and I still remember I was in the kitchen, holding my phone, in shock.

What followed was an hour phone call with mom as she told the story and we wept together. Actually, I wasn't sure if it has been an hour because time took on a different dimension. My husband didn't know what to do. Though mom and I spoke in Cantonese, he was able to make out the content of what we were talking about. He just sat next to me and held me as I held the phone, and my mom.

My body's response to trauma

As mentioned in an earlier post, my body tends to hold stress and tension. In the days following, my body locked up and I felt very tensed. I went for my one and only massage with a gift certificate I have received years ago. It provided temporary relief. I went through waves of normal work and home life, followed by strong emotions and uncontrollable sobbing when a co-worker asked me how I was doing.

I stayed up in the middle of the night, recounting what happened, hearing my mom's voice, remembering the last encounter with my aunt. I was more sensitive to others' stories about the death of their loved ones, however they might have passed. I had a strong desire for people to stay alive. Above it all, I was angry that the sun was still shining, that life kept going for the rest of the world.

I know I needed to let go of this pain, this hurt and I finally went on a very long bike ride on my day off. I wasn't in bike-shape, but that didn't matter. It was also one of the hotter days in Seattle; 88-degrees outside. While I filled up on water at every juncture, I was still low at the end of the day. However, nothing compared to the flying feeling I experienced while on petals. It was as if the breeze took with it my burden, my tension, and leaving with me memories of my aunt. That was just the beginning of my healing process.

Trauma definition

The truth is, one in two people will experience trauma in their lifetime. That's 50%. And with the never-ending breaking news, I can only imagine that statistic going up.

Trauma is an emotional response to stressful and dangerous events that happened to you or other people. Examples of traumatic events include:

• living through natural disasters
• experiencing serious accident or injury
• being a victim of crime, violence or abuse
• witnessing someone else as a victim of crime, violence or abuse
• going through a scary medical procedure
• someone close to you dying suddenly

Trauma symptoms

Trauma symptoms are best described in four clusters:

1. Re-experiencing: as you go about your day, you might experience intrusive thoughts about what happened. These thoughts take you back to the event as if you're re-living it. At night, you might dream about what happened. Sometimes you can pinpoint what triggered these memories; other times they come out of no where. You're likely to experience these symptoms at night, and when you're relax and less occupied.

2. Arousal: memories of the trauma often bring strong emotions and physical sensations. Examples of arousal symptoms include trouble falling or staying asleep, anger and irritability, and difficulty concentrating. You might also have feelings of being on guard, like you're constantly watching over your shoulder, and being easily startled.

3. Unhelpful mood and cognitions: as a result of the traumatic event, you might experience a lot of shame and guilt and blame yourself or others for what has happened. You might report feeling sad or hopeless, becoming less engaged in life and feeling cut-off from the rest of the world. It is also possible for you to have trouble remembering key aspects of what happened.

4. Avoidance: because memories of the trauma are so hard to bear, there's a tendency to push away any thoughts, places, activities, people, facts or associations related to the trauma. You might avoid media content that reminds you of the event. You might actively try to avoid thinking about the trauma or feeling your feelings about what happened. Sometimes, avoidance strategies include the use of drugs and alcohol, staying busy, being promiscuous, or making other choices that provide temporal relief.

Diagnosis of Posttraumatic Stress Disorder (PTSD)

While most traumatic symptoms surface within three months of the event, sometimes they remain dormant for a long time. It is normal to experience these stress reactions following a traumatic event and for some of us, these symptoms naturally dissipate. For others, these symptoms linger for at least a month and can affect home, work and social life. If that's you, it is important to meet with a mental health professional to determine whether you meet criteria for Posttraumatic Stress Disorder (PTSD).

Hope for trauma survivors

The initial symptoms I experienced following the death of my aunt were a normal trauma response. While I recovered naturally, I know that many people who have experienced trauma have not, and I want to help. If that's you, there is hope. PTSD is treatable. Trauma treatment is hard work but the results are evident and sustained overtime. In my next posts, I'll talk about the different ways of treating PTSD: Cognitive Behavioral approaches and mind-body integration.

In the meantime, let me know if you need help.

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Ada Pang, MS, LMFT is the proud owner of People Bloom Counseling, a Redmond counseling practice in WA. She helps distressed couples and breast cancer patients. She has also seen a lot of improvement in her work with trauma clients. Since that initial massage, she has had many more massages. She realizes that when she is stressed and tensed, it feels good to be touched and cared for. She hopes you'll also find ways to care for you.

Do We Go Further in Relationships or Do I Go Faster on my Own?

I've been coming across this African proverb often within the Emotionally Focused Therapy community, “Alone I go faster. Together we go further.” I can really see this playing out during my trip to Orlando.

Husband and I were there for eight days, mostly play mixed in with some work. We visited Epcot, Magic Kingdom, Universal Studios, Typhoon Lagoon and Disney Springs. We played like kids, except our bodies don't do what they used to do.

During rides

You see, near the end of our trip, we wrote a journal account of where we've been and what we did. There was an underlying theme: we went on this 3-D simulator ride and husband got sick. We rested. We then went on this next ride, and husband got sick again. I clearly remember at the end of Harry Potter and Escape from Gringotts and husband turning to me, saying, “I need a break.” The lighting made it difficult to see whether he looked pale or not.

Now, am I bummed that we didn't get to go on as many rides as I'd like? Absolutely. The thunder storm was also a contributing factor. And, did I stretch husband and still took him on more rides than he would've liked? Absolutely. Meanwhile, all around me, I was reminded me how I could go faster on my own: wait times will be less for single riders. However, it wouldn't be nearly as fun without him next to me.

Here's why.

What I haven't told you is that I'm a screamer. I get startled easily and I let everyone know when I'm startled. Hence, while my husband might get sick, I'm the one who gets scared and I'm usually reaching for his hand at some point. And, the reason why I get to enjoy these rides is because I feel less scared when I have a hand to hold. As Jim Coan's research might tell us, while a stranger's hand is better than no hand, nothing compares to a lover's grip.

Throughout the day

Rides aside, I can see how having the company of each other helped us last the whole day for five straight days:

“Hon, can you hold this?”

“I have Tylenol.”

“You're about to go into this store for the 3rd time.” (Gift shops span the whole block with multiple entries.)

“We'll be eating at this award-winning theme park restaurant!”

“Let's go to Africa at the end because that's where the safari is. Nemo the Musical is in Dinoland.”

Not to mention on my own, I would've spent a lot of time getting lost.

With a friend

Husband and I often joke that when we go on vacation, I have pictures of him at Disney World or he has pictures of me in front of the Universal Studios rotating globe, but seldom is there a picture of us together. Technology supposedly solved this problem for us with the invention of the selfie stick. However, every picture has an extended arm, a background that's compromised, or the selfie stick just doesn't work very well for a DSLR.

Now what if we were not ONE couple but went with another friend or friends? Assuming we'll spend some time together, we can take each other's pictures.

In the meantime, I help strangers take pictures against the backdrop of Expedition Everest and we can usually get a picture in return. Sure it takes more time, but it helps to document that we were indeed in Orlando, together.

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Ada Pang, MS, LMFT is the proud owner of People Bloom Counseling, a Redmond counseling practice in WA. She helps distressed couples and breast cancer thrivers. When she's not working hard, she's playing hard. Her favorite Orlando theme park was Epcot and her favorite rides were Harry Potter and the Forbidden Journey, Expedition Everest, Soarin' and Despicable Me: Minion Mayhem. Nemo the Musical was also quite amazing!

The Subtle Communication in Relationships and Why it Matters so Much

We got this, right?

I'm on Orlando grounds writing this. Having written about a happily ever after wedding, it seems timely that my husband and I have been here for this past week, hanging out at Disney World and its rival, Universal Studios. Having traveled together, we've gotten into a groove. But every time we go somewhere new, there's a subtle shift in our routine.

This time, it involves a water bottle.

It's hot and humid in Orlando and we try to stay hydrated. This translates to me having to pee often. Usually, there's a water fountain by the bathroom and that's also the time when I'd have my husband do re-fills so we can save time.

I thought we have this routine down, until three days in, I again handed him the bottle before I slipped into the bathroom in a hurry. I came out to the same water level. “Husband?!” I joked, as I looked down at my water bottle. He was puzzled. He thought I had wanted him to hold onto it and that was it.

What was going on in my head

Now, I could've interpreted this many different ways:

“Husband doesn't care about me”

“Husband was distracted by the attractions at the Animal Kingdom”

“I didn't say so; hence, he didn't know”

“Why do I need to spell it out? Shouldn't he know by now?”

And depending on how close, connected and accepting I feel towards him, my interpretation, and hence my response, would differ.

Imagine if we've been fighting at the “happiest place on earth”, I'll be more prone to see this as further evidence of his insensitivity. And given we're on good terms, and I know he cares and loves me, I can joke about it.

We cannot NOT communicate

We're constantly communicating to and with our partner. Whether it's a handing over of a water bottle, a shrug, a turning away, or a leaning in. We cannot NOT communicate. And depending on the state of our relationship, a simple withdrawing of the hand can have huge implications.

“You don't care about me.”

“I don't matter to you.”

“You don't want to hold my hand.”

“Here we go again!”

“What's the matter with you?”

“I can't make you happy!”

It's tiring when we're stuck at seeing ourselves and our partners in this way. There is a reason why this happens. It's because our attachment to our partner is not too different than an infant's attachment to his/her caregiver.

Longing for connection with our partner

Psychologist Sue Johnson, co-founder of Emotionally Focused Therapy, speaks about a dance that we get into with our partners. To summarize, here are the rough steps:

• we invite connection with our partner by reaching for them. We're basically asking, “Are you there for me? Are we still connected?”
• if we don't see a response, we protest and push for one. “It's too frightening to see that we're disconnected and so out comes Anger from Inside Out.”
• If there continues to be a lack of response, or the protesting becomes too much, we turn away or shut down as a way of coping. “It hurts too much to feel rejected, or I feel too threatened when I'm attacked. I need to hide out to protect myself.”
• as a step up from protest and push, we melt down and frantically demand from our partner as a last resort. “Hello, anybody home?! Don't withdraw from me; this hurts too much!!!”
• in a secure relationship, we find a way to turn back to each other and reconnect. “You're really important to me and to be reassured and comforted by you is all that I really need.”

Along with developmental psychologist Edward Tronick, Johnson made a short clip demonstrating how we've been doing this dance since infancy:

Here's an earlier blog that explains this experiment further (How to Talk to your Partner about your Problems and Why this Works). 

Back to the water bottle

To the extent that I know my husband and I were still connected and he didn't perceive my teasing as criticism, we averted the full dance. That is not to say that we won't ever go back to moments of painful disconnection; rather, we'll find a way to each other again.

I love how Johnson quoted Walt Whitman at the end, “We were together, I forget the rest.”

Need help?

Navigating this dance is hard work. Need some coaching help? Give me a call!

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Ada Pang, MS, LMFT is the proud owner of People Bloom Counseling, a Redmond counseling practice in WA. She loves helping distressed couples learn to connect in a safe and secure way. When she's not working hard, she's playing hard. Her favorite Orlando theme park was Epcot and her favorite rides were Harry Potter and the Forbidden Journey, Expedition Everest, Soarin' and Despicable Me: Minion Mayhem. Nemo the Musical was also quite amazing!

Have you Forgotten your Happily Ever After?

Conscious coupling

I recently came back from my cousin's wedding. It was a gorgeous day, cloudy and 70's outside. Inside a beautiful gazebo, we witnessed the story of two people who met at work, started dating, and will continue to work together and go home together. Their vows spoke perfection: a promise to care and hold each other. The bride couldn't keep a dry eye. Outside, they topped it off with a popsicle vendor. I had a raspberry coconut. Amazing!

At the reception, it was Disney themed. Happily ever after. We sat at the Beauty and the Beast table and wrote in a card that they will read at their 10th year anniversary. I don't remember what I wrote but I meant every word of it.

Are you sure about this?

Cousin, I believe in a strong, happy marriage so keep working at it. Otherwise, I do tend to be skeptical at weddings as I question whether people really know what they're getting themselves into. Cuz picture this: at a certain time in your life, sometimes before your brain fully develops, you make a lifelong decision to commit to ONE other person. Does that sound crazy or what? And yet, people all around the world are sharing vows as I type this.

Why is it so hard?

When the adrenaline is gone, the toilet seat is up, and you realized you married your mom/dad, things are rough. Throw in the stress of raising kids, an uneven distribution of household chores, and conflict with in-laws and you have it made. What about disagreement in how you manage finances and the use of substances, food or gambling to cope with stress?

When have you ever seen Disney couples fight? All you see is the kiss that ends the tale. Is happily ever after even possible?

Be prepared to work hard

I want to say yes, but be prepared to work your butt off. Relationships are hard work. You're either building up your partner or you're tearing them down; drawing them close or pushing them away. As psychiatrist Robert Waldinger might add, “Relationships are messy, complicated, and the hard work of attending to family and friends are not sexy, but lifelong.” Happily ever after is in the daily grind of doing the small things that would create safety and security for your partner to come close and for them to do the same for you.

Are you ready?

Often times by the time couples come into my office, they've forgotten the vows said years ago. How I so want the DeLorean time machine from BTTF so I can witness their wedding, their longing for each other til death do them apart. And sometimes, I have the privilege of catching glimpses of that hope, the love once shared, but we have to dig through the mud to get there.

Patterns of relating take years to form but possibly only months to unravel and rebuild. Would it be worth it to devote an hour a week to deepen a connection that will last a lifetime? Emotionally Focused Therapy (EFT) has shown such results! Compared to a 35% success rate with other forms of couple therapy, 86% of couples "report feeling happier in their relationships" with EFT. 

If happily ever after is what you're striving for, give me a call!

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Ada Pang, MS, LMFT is the proud owner of People Bloom Counseling, a Redmond counseling practice in WA. She loves helping distressed couples learn to connect in a safe and secure way. She enjoys the Seattle summers and last week, went SUPing with her husband on Lake WA. At one point he tied his ankle bracelet to her paddle board. Let's just say it was a bad idea.