Mindfulness: Learning to Observe Without Judging

As I was saying a couple of posts ago – mindfulness is about learning to be fully present in the moment.

Tall order, I know. Hey – it’s a skill. You know how you develop skills? Through practice.

One of the things that often keeps us from being fully in the present is a tendency to constantly critique what we’re doing and how we’re doing it: chances are, whatever you do, there’s a little voice in the back of your head. Let’s call it The Critic. When you’re trying to do something, The Critic may offer up all sorts of unhelpful commentary:

“Seriously? What’s taking you so long? Do you realize how many other things you need to get done today? You’re already running late! You’ll never get it all finished at this rate – so you’ll have to do some of it tomorrow. You’re already late for tomorrow – you’ve just ruined the whole week!!!”

The Critic quickly fills up your head with unpleasant thoughts coming at you a mile a minute; when you’re drowning inside your own head, it’s hard to focus on what you’re actually trying to do. Your brain is spending a great deal of time and energy bullying you and slowing you down.

So – one important step toward mindfulness is learning to silence The Critic.

How do you do that?

You remind yourself that The Critic doesn’t help you get things done; it just fills your head up with negativity and worry, and slows you down and distracts you.

Start by just trying to notice The Critic when it starts coming at you. When you get good at doing this, you might be shocked at how it criticizes your every move.

Then, once you get good at noticing that it’s happening – start responding. Basically, every time you hear The Critic inside your head – tell it to go pound salt, and tell yourself to go back to paying attention to what you’re doing.

Sounds pretty simple, right?

Yeah – well, simple and easy are two very different things – and this will take lots of practice.

Then, mindfulness is basically paying attention to what you’re doing as you’re doing it, without The Critic commenting on your every move.

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Please feel free to share this post, and any other on this blog, with anyone who might benefit.

I’d love to have you share your thoughts, comments, and questions. If you do post a comment, please don’t give specific details of your trauma – these may be triggering to another reader. If you’d like to offer criticism, I’ll take it – I know I’m not perfect, and I’m always willing to learn. If you do offer criticism though, I’d really appreciate it if you could do so constructively (ie., no name-calling, please). Thanks…

You can find me on Twitter and on Facebook.

~ Dr. Dee Rajska, C. Psych.

*Fine print: Please feel free to share the link to this blog wherever you think it might be helpful! Reading this blog is a good start, but it’s no substitute for professional help. It takes a different kind of courage to admit to yourself that you’re struggling. PTSD is not a sign of failure – it’s a sign that you’ve been through a lot, and have tried to stay strong for too long. If you need help – you’re in some pretty great company. Reach out, and give yourself a chance to feel better.

**Really fine print: The content of Coming Back Home is copyrighted; please feel free to share the link, but do not copy and paste content. Unless otherwise noted, all original photography on Coming Back Home is copyrighted.  The photo gracing today’s post was taken by M & C Charbonneau, and I’d like to thank them for generously allowing me to use their work. Please do not copy photographs from Coming Back Home without permission.

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Military Training vs. Mindfulness

I’d like to start on a new topic today: mindfulness. It’s going to take a few posts to talk about it, because there’s a fair bit to say.

If you haven’t heard of it before, I think you’ll like it. Mindfulness is a way to let go of the self-criticism, shame and guilt that often contributes to keeping us stuck in misery.

Mindfuless is so awesome, I could almost say it’s nutritious and delicious, and I’d only be exaggerating a little.

Not only that, but mindfulness is… the exact opposite of everything you have learned in your entire military career, EVER.

So, wrapping your head around it is going to feel a bit like learning to live on an alien planet.

In the military, you learn to push yourself to your limits, and then to push yourself some more. If that doesn’t work, then the answer is to push yourself even harder – never yield, never, ever give up.

Now – I’m not pointing this out to in any way disrespect military culture – your perseverance is something that I respect and admire. I understand that, in your line of work, expecting yourself to succeed against impossible odds is necessary.

Here’s the thing, though: when dealing with your mental health, that dogged determination can contribute to grinding you deeper into your misery.

It’s like this: maybe you went through some stuff, and it rattled you, and you just can’t shake it. But, you might believe that failure is unacceptable, and you feel like a failure that you can’t shake it. You also might believe that the way to success is to push yourself harder (because that’s what life in the military taught you).

The thing is – when you’re depressed, overwhelmed, stressed out, not sleeping well, having nightmares and panic attacks – then pushing yourself harder, and expecting yourself to suck it up and soldier on doesn’t magically make your issues go away. In fact, it often does just the opposite – it might make you feel worse.

In your training and your work in the military, pushing yourself harder is often your best tool. In your mental health, it’s your worst enemy.

So – this is why we’re going to learn about mindfulness. Mindfulness is about noticing our own experience without judging it; no shame, no guilt, no self-criticism, just a “here’s where I’m at now”.

NO, it doesn’t magically solve all of your problems in an instant – but, it gives you a chance to stop being your own worst enemy. And once you stop putting all of your energy into beating up on yourself, well, then it actually becomes a lot easier to cope.

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I’d love to have you share your thoughts, comments, and questions. If you do post a comment, please don’t give specific details of your trauma – these may be triggering to another reader. If you’d like to offer criticism, I’ll take it – I know I’m not perfect, and I’m always willing to learn. If you do offer criticism though, I’d really appreciate it if you could do so constructively (ie., no name-calling, please). Thanks…

You can find me on Twitter and on Facebook.

~ Dr. Dee Rajska, C. Psych.

*Fine print: Please feel free to share the link to this blog wherever you think it might be helpful! Reading this blog is a good start, but it’s no substitute for professional help. It takes a different kind of courage to admit to yourself that you’re struggling. PTSD is not a sign of failure – it’s a sign that you’ve been through a lot, and have tried to stay strong for too long. If you need help – you’re in some pretty great company. Reach out, and give yourself a chance to feel better.

**Really fine print: The content of Coming Back Home is copyrighted; please feel free to share the link, but do not copy and paste content. Unless otherwise noted, all original photography on Coming Back Home is copyrighted. The photo gracing today’s post was taken by Larry M. Jaipaul, and I’d like to thank him for generously allowing me to use his work. Please do not copy photographs from Coming Back Home without permission.

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Relaxation to Control Panic: What You’re Doing Wrong

So – we’ve been talking about panic – where it comes from, and some basic fears and facts.

You may have read those posts, tried some of the strategies, and concluded that they don’t work.

If that’s the case – let me assure you that they do work; let’s just tweak how and when you use them.

Let’s put anxiety on a scale of 0 to 10. 0 means you’re so relaxed that you’re barely conscious; 10 is a full-blown panic attack.

If you’re living with PTSD, then chances are, you never actually get all the way down to 0; your best day is a 5. Your average day is more like a 7.

That means that on an average day, you’re already over two-thirds of the way to panic. (Yes, this is precisely why I keep carrying on about relaxation – because if you do some sort of relaxation exercise regularly, it will help to bring down that average. Even if you get your average down to a 6, you’ve already given yourself a little extra breathing room).

So – on a typical day, even something small is enough to get your anxiety to start creeping up.

You feel the familiar tell-tale signs – your heart starts beating a little quicker. Your muscles start to tense up. You feel a little more nervous.

And what do you do? Well, if you’re like most of the patients that I work with, you do your best to ignore it.

It’s kind of like a really annoying neighbour. The kind who talks your ear off about nothing, boring you to tears. If that guy is knocking on your door, you might decide to sit really quietly, pretend you aren’t home, and hope he goes away.

Well – it might work with your neighbour. But with anxiety? Here’s what your head is doing while you’re trying to ignore anxiety:

“Uh oh… I know that feeling… Oh crap, are we gonna do this again? CRAP. I really, really don’t want this to happen again. Please, please, please, not this nonsense again….”

Yeah. Just reading that makes you feel a little nervous right? Stop. Breathe. You’re okay.

The point is – thinking that way makes you feel completely helpless, and that makes the panic worse. So, while you’re busy trying to ignore your panic – it just builds and builds. And then, when you get to a 9.5 out of 10 – then you think: “Oh, crap. It’s coming. Quick – what was I supposed to do? Breathe, and tell myself some reassuring stuff? How did that go again?”

Folks – by the time you get to 9.5, trying to remember what you’re supposed to do to relax is a lot like trying to hold back Niagara Falls with a paperclip. It’s not going to do much to help you out at that point.

Your timing’s off. You’re doing the right things, at the wrong time.

Here’s how to tweak it to get more control: the moment you start to feel your anxiety inching up – right when you start to get the urge to try to ignore it – that is when you need to remind yourself that you are not helpless. Now is your chance to be proactive and take control. Yes this will be unpleasant – but it can’t hurt you, and the more you focus on taking control, the more you’ll be successful in making this kind of thing shorter and less frequent.

…And when you start your slow, deep breathing, keep breathing – your panic will make you want to give up after just a few seconds and go, “It’s not working, it’s not working!!! I can’t do this!”

Hey – it’s not working yet, okay? It works. Keep doing it. Give it at least ten minutes of good, focused, slow, deep breaths. It’ll work. And with practice, it’ll get easier.

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I’d love to have you share your thoughts, comments, and questions. If you do post a comment, please don’t give specific details of your trauma – these may be triggering to another reader. If you’d like to offer criticism, I’ll take it – I know I’m not perfect, and I’m always willing to learn. If you do offer criticism though, I’d really appreciate it if you could do so constructively (ie., no name-calling, please). Thanks…

You can find me on Twitter and on Facebook.

~ Dr. Dee Rajska, C. Psych.

*Fine print: Please feel free to share the link to this blog wherever you think it might be helpful! Reading this blog is a good start, but it’s no substitute for professional help. It takes a different kind of courage to admit to yourself that you’re struggling. PTSD is not a sign of failure – it’s a sign that you’ve been through a lot, and have tried to stay strong for too long. If you need help – you’re in some pretty great company. Reach out, and give yourself a chance to feel better.

**Really fine print: The content of Coming Back Home is copyrighted; please feel free to share the link, but do not copy and paste content. Unless otherwise noted, all original photography on Coming Back Home is copyrighted. The photo gracing today’s post was taken by M & C Charbonneau, and I’d like to thank them for generously allowing me to use their work. Please do not copy photographs from Coming Back Home without permission.

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PTSD: Dissociative Symptoms

Holy feedback!

As soon as I put up the last blog post, there was a stampede of comments and emails saying, “Yes! Talk about this more!!!”

Okay.

So we left off talking about how the “freeze” response is part of the fight/flight/freeze reflex. It’s how we defend ourselves when we can’t fight or run away; it dulls the pain of whatever is happening.

Let’s put this together with some information we have from before, about how reflex learns: it learns that any reminder of the trauma is a sign of danger.

So – a reminder of your trauma might set off a “freeze” reaction.

Here’s what it feels like: you might feel like you’re not really in your body so it’s not really happening to you (this is called depersonalization); or you might feel like the whole thing is a dream, a movie, or happening in slow motion like it’s not real (this is called derealization). You might feel like you’re just losing chunks of time – ‘waking up’ and not knowing how you got to be wherever you are (this is called, WTF just happened to me?).

Here’s what it feels like to have PTSD do this to your life: it’s terrifying. You feel like you have no control over your mind or body. You want to do everything you can to grip onto reality, but you get sucked into this rabbit hole. You might feel angry at your mind for betraying you this way.  You might feel guilty, weak, and ashamed for not being “strong enough” to somehow hang on tighter and not let this happen to you. It can leave you feeling traumatized again and again, every time it happens, because being helpless to stop yourself from dissociating can remind you of being helpless to stop your trauma when it happened. You might feel depressed, useless, worthless.

…Boy, sounds like fun, doesn’t it?

Lookit – I’m not gonna try and tell you that getting out of that hot mess is easy, quick, or painless. It’s none of those. If your PTSD includes this stuff, research suggests that, as far as PTSD goes, you won the bleeping jackpot.

What makes it worse is, every time it happens, you might feel disappointed in yourself, like you should be stronger. This just erodes whatever self-respect you have left. You’d never say stuff like that to a buddy to encourage them when they’re struggling…

You need to start by realizing that this happens to you because you don’t feel safe; so, how you start to fix it, is to work on increasing your sense of safety.

The ability to feel safe is like a muscle – and yours is, well… It’s not so strong. You strengthen it with exercises – stuff like relaxation. Grounding skills. These are your drills: practice this stuff. Be patient with yourself. What you’re trying to accomplish here is very hard work, so give it time.

Finally – you know that fine print I put at the end of every post? You know, the stuff that none of you ever read, because you don’t think there’s anything important under the pretty picture?

Yeah; it says that this blog is not a substitute for therapy. If you’re dealing with PTSD with dissociative symptoms and trying to fix it on your own, it’s a bit like trying to perform open heart surgery on yourself. I’m just sayin’ – there’s help out there. Go get some.

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~ Dr. Dee Rajska, C. Psych.

I’d love to have you share your thoughts, comments, and questions – but before you post, can you take a quick peek at the guidelines? Thanks…

If you’d like to get more updates from me, you can find me on Twitter and on Facebook.

Fine print: Reading this blog is a good start, but if you’re having a hard time, it’s no substitute for getting actual help (like, therapy). It takes a different kind of courage to admit to yourself that you’re struggling, and to seek help. Getting help is not a sign of failure – it’s a sign that you’ve been through a lot, and have tried to stay strong for too long. If you need help – you’re in some pretty great company. Reach out, and give yourself a chance to feel better.

Really fine print: Unless otherwise noted, all original photography on Coming Back Home is copyrighted. The photo gracing today’s post was taken by Larry Jaipaul, and I’d like to thank him for generously allowing me to use his work. Please do not copy photographs from Coming Back Home without permission.

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PTSD: Reflex and The “Freeze” Response

…You know I’m all about feedback, right? You know this is YOUR blog, and I’ll write about whatever you need?

Well – my stats tracker thingy tells me somebody ended up on Coming Back Home by Googling “PTSD + Freeze response”.

And I thought, Huh – I don’t really have a good article on that. I mean, if I was Random Google Person, I’d be a little disappointed.

So – good suggestion, Random Google Person! This post is for you!

If you recall from previous discussions, PTSD is basically a survival reflex stuck in a loop with no off switch. This reflex has three parts, depending on what kind of threat you’re up against:

fight is where you respond to a threat by beating up on it. Military training works to strengthen this part of your survival reflex.

flight is where you run for the hills to get away from the threat.

freeze is what you do when neither of the above is an option.

In this post, we’re going to discuss the freeze response, the way it happens in the face of an actual threat. Next post, we’ll talk about dissociation, which is what happens when the “freeze” reaction gets stuck, like in PTSD or dissociative disorder.

It’s like this: imagine a goldfish.

It’s in a fishbowl. The cat just jumped on the table and stuck his paw into the bowl. What’s the fishy gonna do?

He’s can’t fight off the cat, and he can’t run away, because he’s in a fishbowl. Poor little fishy. The cat is about to enjoy some fresh sushi.

So – what does the fish do? He freezes; freezing helps him feel less pain, both physically and emotionally.

Freezing might feel like time has slowed down; like what’s happening isn’t real; or like he isn’t really there. The goldfish might feel like he’s floating above his body, watching the cat enjoy his sushi.

Feeling this way is a normal reaction to a situation of extreme, life-threatening danger, where you can’t fight and can’t get away.

If you’re a goldfish who’s about to get eaten by a cat, feeling like you’re floating above your body and the whole thing is not really happening is less terrifying, which is why our reflex is built this way.

But – suppose just as the cat is scooping up the goldfish, someone comes along and screams, startling the cat. Poor little fishy lives, but is scarred by this near-death experience: he might get stuck in this “freeze” reaction. He might end up with severe PTSD, and symptoms that we call dissociation. We’ll talk a bit more about that in the next post.

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I’d love to have you share your thoughts, comments, and questions. If you do post a comment, please don’t give specific details of your trauma – these may be triggering to another reader. If you’d like to offer criticism, I’ll take it – I know I’m not perfect, and I’m always willing to learn. If you do offer criticism though, I’d really appreciate it if you could do so constructively (ie., no name-calling, please). Thanks…

You can find me on Twitter and on Facebook.

~ Dr. Dee Rajska, C. Psych.

*Fine print: Please feel free to share the link to this blog wherever you think it might be helpful! Reading this blog is a good start, but it’s no substitute for professional help. It takes a different kind of courage to admit to yourself that you’re struggling. PTSD is not a sign of failure – it’s a sign that you’ve been through a lot, and have tried to stay strong for too long. If you need help – you’re in some pretty great company. Reach out, and give yourself a chance to feel better.

**Really fine print: The content of Coming Back Home is copyrighted; please feel free to share the link, but do not copy and paste content. Unless otherwise noted, all original photography on Coming Back Home is the copyrighted property of Larry M. Jaipaul; please do not copy images without permission.

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The many flavours of PTSD: It’s not a competition!

Today – by request – we’re going to talk a bit about what trauma actually is.

It turns out, different people have different ideas about what’s awful enough to be “real trauma”.

You might have a buddy who went through some really messed up stuff. You might think, he or she “earned” their right to have PTSD because of what they went through.

In comparison, what you went through might not seem as bad. Maybe you have nightmares, and you avoid things that remind you of what happened. And you get angry at yourself. You start telling yourself that if you should be able to handle it, and what’s wrong with you that you can’t.

Worse still – it might be other people telling you this stuff. They might they have a different flavour of PTSD than yours, because they went through different stuff. Somehow they might think that their trauma is bigger and better than yours, and yours isn’t “real” enough.

It’s not a competition.

To put it in perspective, imagine it was a broken leg. You could break your leg getting hit by a stampeding hippopotamus. (Hey, you never know). Or, you could trip over your kid’s toy and fall down the stairs. The difference is, with scenario #1 you get an awesome story… story #2 doesn’t sound as cool. Leg’s still messed up though.

Trauma that causes PTSD is sort of like that too – sometimes, it’s a hippopotamus – it comes with the type of “Rambo” story that movies are made of. Other times, it doesn’t make for a great story.

(HEADS UP: I’m going to describe the kinds of stuff that might cause PTSD. I’m NOT going to use examples, but it still might be tough to read. If you get unsettled, remind yourself that what happened is over. If you need more help coping, try these. )

A “traumatic event” is any situation where you’re exposed to actual or threatened death, serious injury, or sexual violence.

Actual or threatened means that even if it doesn’t end up happening, if you were scared because there was a real risk that it was going to happen, that can still mess you up.

It doesn’t have to happen to you; you can witness it happening to someone else, and be helpless to stop it.

Even if you aren’t there when it happened, learning the gory details of what happened to someone else can mess with you.

This is the way your brain works; trauma comes in many different flavours.

Maybe you didn’t get your PTSD from combat. Maybe you weren’t even deployed. So, it might seem that your trauma isn’t quite as “sexy” as someone else’s.

Really, people: It’s trauma. It ain’t lingerie. It don’t need to be sexy.

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I’d love to have you share your thoughts, comments, and questions. If you do post a comment, please don’t give specific details of your trauma – these may be triggering to another reader. If you’d like to offer criticism, I’ll take it – I know I’m not perfect, and I’m always willing to learn. If you do offer criticism though, I’d really appreciate it if you could do so constructively (ie., no name-calling, please). Thanks…

You can find me on Twitter and on Facebook.

~ Dr. Dee Rajska, C. Psych.

*Fine print: Please feel free to share the link to this blog wherever you think it might be helpful! Reading this blog is a good start, but it’s no substitute for professional help. It takes a different kind of courage to admit to yourself that you’re struggling. PTSD is not a sign of failure – it’s a sign that you’ve been through a lot, and have tried to stay strong for too long. If you need help – you’re in some pretty great company. Reach out, and give yourself a chance to feel better.

**Really fine print: The content of Coming Back Home is copyrighted; please feel free to share the link, but do not copy and paste content. Unless otherwise noted, all original photography on Coming Back Home is copyrighted. The photo gracing today’s post was taken by M&C Charbonneau, and I’d like to thank them for generously allowing me to use their work. Please do not copy photographs from Coming Back Home without permission.

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Sexual Dysfunction and Relationships, Part I

*Disclaimer: This is a really broad topic, and I’m not a sex therapy expert, so unfortunately, I won’t be able to cover everything that’s relevant. Most of my patients are male and heterosexual, so I’m addressing the topic from that perspective. I don’t mean to leave anyone else out, I just try to stick to writing about what I know.  

So… Judging by the number of pageviews on the last post, it looks like some of you find it less awkward to discuss sexual dysfunction on the blog than in person.

Good – you need to have access to this information, even if you feel too embarrassed to ask about it face-to-face.

You know, I briefly considered writing the last post about Dave the Zebra. I thought, maybe that would be less awkward for people?

However – Dave the Zebra is actually named after Dave the Dude. I value my friendship with Dave the Dude. Somehow, he didn’t like the idea of putting his name in the same sentence as sexual dysfunction, in a blog read by thousands of people. Go figure, eh?

Well – let’s talk about it. (Dave the Dude, you can relax. I’m keeping you totally out of this…)

In the last post, we talked about how and why PTSD can mess up your sex life.

Today, we’re going to discuss how the mess in your sex life can have a ripple effect on the rest of your life.

Sexual dysfunction messes up your relationships, starting with the relationship that you have with yourself.

(Hey – can we try to focus please? I’m talking about the emotional relationship with yourself – not the five-knuckle-shuffle relationship with yourself! …Not that there’s anything wrong with that…)

Look – who you are in bed is part of your identity. You don’t need to go through life being Mr. Don Juan – even if you’re a relatively vanilla kind of dude, you have a sense of how your plumbing works and what you enjoy doing with it.

When that changes, it can have a big impact on how you feel about yourself. We live in a culture where, as a guy, you’re supposed to be obsessed with sex, or so the media would have you believe. So a lot of guys end up feeling like they’re somehow less of a man when stuff like this happens. You might feel angry and ashamed, and try not to think about it.

If you’re a single dude, this might really have an impact on your confidence about getting into a new relationship. You might question whether a woman would want to be with you, if things don’t quite work the way they used to.

(Answer: yes, the right woman would still want to be with you. The right woman would love you for your sense of humour, your smile, and whatever else it is that makes you awesome in her eyes. And you can sweep her off her feet with flowers and chocolates and kisses and dancing and backrubs and… Well, when it actually comes to sex, most women like all that stuff that most guys rush through to get to the main course. So, serve up a really good appetizer, and she won’t really miss the main course, you catch my drift?)

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I’d love to have you share your thoughts, comments, and questions. If you do post a comment, please don’t give specific details of your trauma – these may be triggering to another reader. If you’d like to offer criticism, I’ll take it – I know I’m not perfect, and I’m always willing to learn. If you do offer criticism though, I’d really appreciate it if you could do so constructively (ie., no name-calling, please). Thanks…

You can find me on Twitter and on Facebook.

~ Dr. Dee Rajska, C. Psych.

*Fine print: Please feel free to share the link to this blog wherever you think it might be helpful! Reading this blog is a good start, but it’s no substitute for professional help. It takes a different kind of courage to admit to yourself that you’re struggling. PTSD is not a sign of failure – it’s a sign that you’ve been through a lot, and have tried to stay strong for too long. If you need help – you’re in some pretty great company. Reach out, and give yourself a chance to feel better.

**Really fine print: The content of Coming Back Home is copyrighted; please feel free to share the link, but do not copy and paste content. Unless otherwise noted, all original photography on Coming Back Home is copyrighted. The photo gracing today’s post was taken by Wojtek Rajski, and I’d like to thank him for generously allowing me to use his work. Please do not copy photographs from Coming Back Home without permission.

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Spouses want to know: PTSD and Sexual Dysfunction

So – guess what we’re talking about today? (Go ahead, check the title again). That’s right.

*Disclaimer: This is a really broad topic, so I won’t be able to cover everything that’s relevant. The question was originally asked by a female spouse of a male veteran. Most of my patients are male and heterosexual, so I’m addressing the topic from that perspective. I don’t mean to leave anyone else out, I just try to stick to writing about what I know.

In person, some of the patients that I work with find this really awkward to discuss.

Well – look on the bright side: this is a blog! You don’t have to ask this stuff in person! All the answers, none of the awkwardness!

The research is pretty clear that there’s a link between PTSD and sexual dysfunction. Most studies show that in veterans with PTSD, about 8 to 9 out of every 10 have some sort of sexual dysfunction. That’s much higher than combat veterans without PTSD, and higher than veterans with other mental health diagnoses. “Sexual dysfunction” can be a whole list of different problems – including having less sexual desire; erectile dysfunction; premature ejaculation, or inability to reach orgasm.

8 to 9 out of every ten. That means that, if you have PTSD and you don’t have some sort of sexual dysfunction – you’re the exception.

If you didn’t know that before, then it’s important that you know this about your body, and what PTSD can do to it. It’s not you, it’s not your fault, it’s not because you’re doing something wrong. It’s not your partner’s fault either. Add it to the long list of things you dislike about PTSD.

But – let’s talk about how and why this happens, and then, most importantly, let’s talk about what to do about it.

First, the “why”: remember that PTSD is survival reflex on overdrive; remember how we talked about reflex making all your big muscle groups tense up? Yeah – apparently, your survival reflex doesn’t consider that part of your body as a big muscle… Go figure.

Basically, reflex thinks that anything that doesn’t help you fight or flee is a waste of energy.

PTSD also makes you feel anxious and hyper-alert pretty much all the time, and that makes it hard to get in the mood and stay in the mood for long enough. Many people who have PTSD also feel disconnected and detached from loved ones, and that can make it hard for both partners to get in the right headspace. Increased anger and irritability can also put a damper on your relationship, and that can make the physical part of your relationship suffer too.

…Sounds pretty bad, huh?

Yeah… I know…

It can get better. Not magically, overnight better, but slowly and with some work – it can get better.

(Yes, pills can help. Talk to your doctor about getting some. But don’t expect pills to be a quick, easy, magic cure-all.)

First – go to therapy, and work on learning to manage your PTSD. When you learn more about how to manage your symptoms, this will make a difference.

Next – consider couples therapy. Especially if you’ve been struggling with this stuff for a long time, chances are there’s a lot of misunderstandings and hurt feelings from both of you that are driving a wedge between you. Couples therapy may help you to reconnect and feel closer, and that might help.

Third – don’t give up. Don’t lose hope. As long as you’re willing to try, things can get better.

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I’d love to have you share your thoughts, comments, and questions. If you do post a comment, please don’t give specific details of your trauma – these may be triggering to another reader. If you’d like to offer criticism, I’ll take it – I know I’m not perfect, and I’m always willing to learn. If you do offer criticism though, I’d really appreciate it if you could do so constructively (ie., no name-calling, please). Thanks…

You can find me on Twitter and on Facebook.

~ Dr. Dee Rajska, C. Psych.

*Fine print: Please feel free to share the link to this blog wherever you think it might be helpful! Reading this blog is a good start, but it’s no substitute for professional help. It takes a different kind of courage to admit to yourself that you’re struggling. PTSD is not a sign of failure – it’s a sign that you’ve been through a lot, and have tried to stay strong for too long. If you need help – you’re in some pretty great company. Reach out, and give yourself a chance to feel better.

**Really fine print: The content of Coming Back Home is copyrighted; please feel free to share the link, but do not copy and paste content. Unless otherwise noted, all original photography on Coming Back Home is copyrighted. The photo gracing today’s post was taken by Wojtek Rajski, and I’d like to thank him for generously allowing me to use his work. Please do not copy photographs from Coming Back Home without permission.

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Spouses want to know: PTSD, Withdrawing, and How to Respond

Today’s question is: “What’s the best way to deal with withdrawal by a spouse with PTSD – call them on it, or what????”

As luck would have it, just as I was sitting down to write this post, I also received the flipside of the question:

“My wife more or less just gets mad at me when I leave the room to cool down; she says I’m running away to hide… How can I help her understand?”

If you’re the spouse of someone who has PTSD, it can be lonely and frustrating to be married to someone who keeps pulling a disappearing act. Even at the best of times, you might feel rejected and pushed away. At the worst of times, when your partner takes off while the kids are screaming and dinner’s burning, you might feel downright abandoned that your partner isn’t pulling their weight.

An important part of how you cope is to get some support for YOU – whether that means therapy, peer support, family or a babysitter to help if you have young kids, whatever you might need. You’ve got a lot on your plate, and you need to be able to vent to someone who won’t judge you or your partner.

As a spouse, you have every right to feel angry and frustrated – BUT, remind yourself that you’re angry and frustrated with your partner’s illness, not with your partner. If your partner is withdrawing because they are overwhelmed or triggered, this is very different from running away because they’re a lazy, selfish jerk who won’t lift a finger to help out, or because they don’t care about your feelings. Don’t confuse illness with selfishness; don’t treat one as if it was the other.

On the other hand, the stuff that’s going on inside the head of a person with PTSD is more than most of us can imagine. If it sometimes seems like your spouse with PTSD is only going through the motions of day-to-day life, it’s because at that moment, that might be the best they can do. Chances are, they realize that they aren’t there enough for you, and they carry a lot of guilt and shame about not being able to do more. They may be feeling helpless, worthless, and angry that they can’t do more to beat this thing. Feeling this way doesn’t help them get a leg up on coping – it just pushes them down more.

The best way to try to cope is together, as a team. Realize that you’re not angry at each other – you’re both angry at the PTSD, and at what it’s doing to your family. Thinking this way puts you on the same side, and that makes it easier to support each other.

Here’s some statements to try out:

Spouse of person with PTSD: “I know you’re doing your best; I’m not blaming you. I just hate that this happened to you. I hate that it gets in the way of things you would like to do.”

Person with PTSD: “I hate that it gets so bad that sometimes crawling into my shell is all I can do. I wish I could just shake this thing off. I know it’s not fair to you.”

Hug each other. Support each other. It won’t magically fix things, but it will get easier if you and your spouse feel like you’re on the same team, and you have each other’s back.

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I’d love to have you share your thoughts, comments, and questions. If you do post a comment, please don’t give specific details of your trauma – these may be triggering to another reader. If you’d like to offer criticism, I’ll take it – I know I’m not perfect, and I’m always willing to learn. If you do offer criticism though, I’d really appreciate it if you could do so constructively (ie., no name-calling, please). Thanks…

You can find me on Twitter and on Facebook.

~ Dr. Dee Rajska, C. Psych.

*Fine print: Please feel free to share the link to this blog wherever you think it might be helpful! Reading this blog is a good start, but it’s no substitute for professional help. It takes a different kind of courage to admit to yourself that you’re struggling. PTSD is not a sign of failure – it’s a sign that you’ve been through a lot, and have tried to stay strong for too long. If you need help – you’re in some pretty great company. Reach out, and give yourself a chance to feel better.

**Really fine print: The content of Coming Back Home is copyrighted; please feel free to share the link, but do not copy and paste content. Unless otherwise noted, all original photography on Coming Back Home is copyrighted. The photo gracing today’s post was taken by Wojtek Rajski, and I’d like to thank him for generously allowing me to use his work. Please do not copy photographs from Coming Back Home without permission.

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Spouses want to know: “Where does the anger come from?”

I have a few more questions from spouses, and this is a really important one.

The answer is pretty straight forward: PTSD is basically the fight/flight/freeze reflex gone into overdrive, and anger is part of  the “fight” part of that reflex. You might remember that we discussed anger in this post.

Well then… that would make for a really short blog post, wouldn’t it?

If you’re reading this, then anger has probably had an impact on your life. I’m going to talk about it in more detail below, and that might be hard to read.

So – don’t go any further if you’re having a bad day and don’t need to be reminded of how anger has made life worse. Save it for another day. Otherwise, find a nice quiet spot where you won’t be disturbed. Set aside time to do a relaxation exercise when you’re done reading this – here‘s one that I’ve posted previously. Here‘s another.

Gee, I’m being a little bossy today, aren’t I?

If you’re just waiting for me to tell you to go pee before you read on, don’t worry. I’ll restrain myself.

Ready?

Okay.

If you’re a spouse, then you need to know where the anger does NOT come from: it doesn’t come from you, or what you said, or because you’re making the wrong thing for dinner. It’s not coming from the kids playing too loudly. It isn’t your fault. It’s easy to lose your confidence and start to blame yourself.

It’s also easy to get frustrated and blame your spouse – the anger is not coming from him/her either.

Look – you didn’t marry an idiot. (Well – if you did, then, this blog can’t help you with that…)

But – if you didn’t marry an idiot, then your spouse didn’t just magically become an angry jackass overnight for the fun of getting under your skin. PTSD makes a person feel like they’re under attack all the time, and anger is part of the reflex of reacting to threat.

PTSD is an injury. Anger is one of the ways that this injury hurts. It hurts anyone who might be on the receiving end of that anger – spouse, kids, random clerk at the grocery store.

It hurts the person with PTSD; they don’t choose to act like this, and a moment after they say something hurtful, scream at someone, or put their fist through the wall – they feel terrible about it.

As the spouse, you feel caught between trying to understand that this is an injury, but also feeling frustrated and angry that they can’t just cut it out.

Understanding is the first tool in making things better: the person with PTSD needs to understand that their anger is coming from their PTSD, and not from anything you did. So the solution is to manage their anger, not manage you. And as the spouse, you also need to know that their anger is coming from their PTSD, and not from them being a jerk. So the solution is to help them manage their anger, and to take care of yourself, because this is a lot for you to deal with too.

How’re ya doing? I warned you – it got a little heavy. If you feel a bit like this post punched you in the gut today, please take a minute to look after yourself. You don’t even have to scroll back up to find the hyperlinks to the relaxation exercises – here‘s the woods. Here‘s the water.

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I’d love to have you share your thoughts, comments, and questions. If you do post a comment, please don’t give specific details of your trauma – these may be triggering to another reader. If you’d like to offer criticism, I’ll take it – I know I’m not perfect, and I’m always willing to learn. If you do offer criticism though, I’d really appreciate it if you could do so constructively (ie., no name-calling, please). Thanks…

You can find me on Twitter and on Facebook.

~ Dr. Dee Rajska, C. Psych.

*Fine print: Please feel free to share the link to this blog wherever you think it might be helpful! Reading this blog is a good start, but it’s no substitute for professional help. It takes a different kind of courage to admit to yourself that you’re struggling. PTSD is not a sign of failure – it’s a sign that you’ve been through a lot, and have tried to stay strong for too long. If you need help – you’re in some pretty great company. Reach out, and give yourself a chance to feel better.

**Really fine print: The content of Coming Back Home is copyrighted; please feel free to share the link, but do not copy and paste content. Unless otherwise noted, all original photography on Coming Back Home is copyrighted. The photo gracing today’s post was taken by Murray Chappell, and I’d like to thank him for generously allowing me to use his work. Please do not copy photographs from Coming Back Home without permission.

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Spouses want to know: “Why isn’t the medication helping?”

Today’s question is, “If my husband is medicated, shouldn’t we see some signs of him getting better?

Great question, and thanks for asking!

…And you might be frustrated that I don’t have a quick, easy, one-size-fits-all answer.

First of all – let me just clarify: as a clinical psychologist, I don’t prescribe medication. That doesn’t mean that I’m opposed to medication; I have some patients who won’t take medication no matter what, and I respect that. I also work with others who consider their medication to be an important part of the mix that works with for them. I respect whatever path to recovery is the best fit for each individual person.

So, you might wonder, what is it, exactly, that medication is supposed to help with? Well – it depends on the diagnosis and the type of medication Antidepressants do something very different than anti-anxiety medication, for instance.

In general, meds are supposed to dial back your symptoms. Finding the right dose often takes a bit of trial and error; antidepressants in particular can take up to six weeks to build up in your system and start to make an impact. And you need to start off at a lower dose and gradually build it up to the dose that you need, to give your body a chance to adjust. So, it can take a while to get to the point where the medication has its full effect. When it comes to finding the best medication for you, it also might take a bit of trial and error – you may need to try a few different medications before finding the best one for you. So, medication might seem like a quick solution, but like anything else – you need to hunker down and arm yourself with a lot of patience, because it might take a while.

The other issue is, pills don’t give you skills: they don’t teach you to understand what’s happening to your brain,  or where it comes from or how to cope with it.

So – in a nutshell, it may take some time before you start to see a difference. You might have to try a few before you find the right one. And medication alone is frequently not enough to change behaviour.

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I’d love to have you share your thoughts, comments, and questions. If you do post a comment, please don’t give specific details of your trauma – these may be triggering to another reader. If you’d like to offer criticism, I’ll take it – I know I’m not perfect, and I’m always willing to learn. If you do offer criticism though, I’d really appreciate it if you could do so constructively (ie., no name-calling, please). Thanks…

You can find me on Twitter and on Facebook.

~ Dr. Dee Rajska, C. Psych.

*Fine print: Please feel free to share the link to this blog wherever you think it might be helpful! Reading this blog is a good start, but it’s no substitute for professional help. It takes a different kind of courage to admit to yourself that you’re struggling. PTSD is not a sign of failure – it’s a sign that you’ve been through a lot, and have tried to stay strong for too long. If you need help – you’re in some pretty great company. Reach out, and give yourself a chance to feel better.

**Really fine print: The content of Coming Back Home is copyrighted; please feel free to share the link, but do not copy and paste content. Unless otherwise noted, all original photography on Coming Back Home is the copyrighted property of Larry M. Jaipaul; please do not copy images without permission.

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Spouses want to know: “Will he always have PTSD?”

You may have gathered from the title of today’s post that I’m throwing something new into the mix. A few days ago, a support group for spouses asked me to answer a few questions about PTSD. I’m grateful for their permission to post the answers here, so everyone who might be wondering about this stuff can jump into the discussion.

Of all the questions they asked, I wanted to address this one first because I get asked some form of it almost every day – people ask, “Will I ever get better?”, or “Will I always be like this?”

I’d love to give you a money-back guarantee that everything will be just fine.

The honest answer though, is that how much better you will get (or your spouse or loved one will get) depends on a number of factors. Some of them we can predict; others, we can’t.

Single trauma events in an otherwise mentally healthy person, treated quickly after the event, tend to have the best outcomes. In many cases, people can make a full recovery from these types of injuries.

On the other hand, if you’ve had decades of trauma, and it’s taken several years to find a knowledgeable practitioner that you feel comfortable working with – it’s gonna be a longer, steeper, more grueling climb uphill for you. That doesn’t mean that you can’t do it, and no one has a crystal ball that can predict your specific outcome. In fact, my personal experience is that some of the patients who came to me in the worst shape are the ones who have made progress in leaps and bounds, once they’re given the right tools to do so.

Most importantly – even if you can’t be fully cured, you can get better. In many cases, you can get a lot better.

Nothing we do in therapy can take the awful thing(s) that happened to you and make them unhappen. However – how those experiences impact you now, is something we can work on. If you have a lengthy trauma history, and it’s hard for you to trust or hope, then that work might need to happen very slowly and very gently, so it doesn’t overwhelm you. If you’re a spouse trying to be supportive, it may be hard to be patient, because for the first while it might seem like therapy isn’t making any difference.

Here’s your best bet for trying to get better: find a skilled, patient, knowledgeable therapist whom you feel comfortable working with, who won’t give up on you. Let them know when the tools they give you don’t work for you – getting better is a partnership, and finding what works for you can take some trial and error.

Good therapy has two parts: tools that help you manage your symptoms, and ways to try and heal your trauma. If you and your therapist have a good partnership and you are willing to work hard on your recovery, then you will start to see a difference.

It might take a long time and a lot of hard work to get a lot better. But, “a lot better” might mean that you can manage your symptoms most of the time, and the stuff that happened might not bother you as much anymore. Worth a try, no?

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I’d love to have you share your thoughts, comments, and questions. If you do post a comment, please don’t give specific details of your trauma – these may be triggering to another reader. If you’d like to offer criticism, I’ll take it – I know I’m not perfect, and I’m always willing to learn. If you do offer criticism though, I’d really appreciate it if you could do so constructively (ie., no name-calling, please). Thanks…

You can find me on Twitter and on Facebook.

~ Dr. Dee Rajska, C. Psych.

*Fine print: Please feel free to share the link to this blog wherever you think it might be helpful! Reading this blog is a good start, but it’s no substitute for professional help. It takes a different kind of courage to admit to yourself that you’re struggling. PTSD is not a sign of failure – it’s a sign that you’ve been through a lot, and have tried to stay strong for too long. If you need help – you’re in some pretty great company. Reach out, and give yourself a chance to feel better.

**Really fine print: The content of Coming Back Home is copyrighted; please feel free to share the link, but do not copy and paste content. Unless otherwise noted, all original photography on Coming Back Home is the copyrighted property of Larry M. Jaipaul; please do not copy images without permission.

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Depression: Defending Yourself Against The Bully Inside Your Head

So – how ya doin’, folks?

Has your depression magically disappeared from the couple pearls of wisdom I shared last week?

No, of course not. I hope you didn’t expect it to. Because if you read last week’s post and thought, “That’s easy, I can do this overnight”, and then started beating up on yourself when it didn’t work out that way – folks, that’s just your depression messing with you again. Digging yourself out of depression takes a lot of practice and hard work.

See – depression would be hard enough to deal with on its own. To make things worse, it often travels with friends, like PTSD or chronic pain. Or, you might be dealing with the trifecta: depression, PTSD and chronic pain.

Depression often sets in after something bad has happened in your life: stuff like going through a trauma; suffering a serious injury that changes how you can live your life; losing your job; losing a loved one; losing your marriage. You know, all the stuff that they write country songs about…

Then – just to be mean – depression starts comparing the new, not-so-improved you to the old you. And then, it starts nagging on you about how new-you should be able to live up to all the stuff that old-you was able to do. It keeps telling you how it’s so simple, and what’s wrong with you, you should be able to just suck it up, pull yourself together, and get on with it. And if you can’t do it, then depression starts telling you that you’re worthless, useless, and you should feel guilt and shame.

Honestly – depression is feeding you a bunch of… um, fresh manure.

When you can’t do the stuff you used to do because you’re sick, it’s healthy to grieve that loss. If you love to swim and you missed a whole summer of swimming because your leg was in a cast, you might feel frustrated and disappointed. But there’s a difference between those feelings, and calling yourself stupid and lazy for not making your bone heal faster. There’s a big difference between disliking the circumstances, and unfairly blaming yourself for them.

Depression also doesn’t give you any credit for how hard it is to actually live with depression. Stop for a second and consider that there are days when you deserve a medal just for getting out of bed.

Imagine you’re watching speed skating on TV (why speed skating? It just popped into my head, and it’ll work with my example, so let’s just roll with it).

There’s a bunch of guys racing and they’re all ridiculously super fast. And then, waaaaaaaaaaaaaaaaaaaay behind them, there’s this one dude who’s going so slow, he’s barely putting one foot in front of the other.

Oh – except he’s carrying a backpack, filled with 500 pounds of rocks.

So – who do you respect more, the bunch of dudes at the front, or the one guy managing to stay on his feet with the giant bag full of rocks?

(Hint: Vote for the guy with the rocks, he’s pretty incredible.)

And if you vote for him – try to also realize that all the stuff you’re dealing with is a lot like carrying around a bag with 500 pounds of rocks. And try to respect  yourself a little more.)

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I’d love to have you share your thoughts, comments, and questions. If you do post a comment, please don’t give specific details of your trauma – these may be triggering to another reader. If you’d like to offer criticism, I’ll take it – I know I’m not perfect, and I’m always willing to learn. If you do offer criticism though, I’d really appreciate it if you could do so constructively (ie., no name-calling, please). Thanks…

You can find me on Twitter and on Facebook.

~ Dr. Dee Rajska, C. Psych.

*Fine print: Please feel free to share the link to this blog wherever you think it might be helpful! Reading this blog is a good start, but it’s no substitute for professional help. It takes a different kind of courage to admit to yourself that you’re struggling. PTSD is not a sign of failure – it’s a sign that you’ve been through a lot, and have tried to stay strong for too long. If you need help – you’re in some pretty great company. Reach out, and give yourself a chance to feel better.

**Really fine print: The content of Coming Back Home is copyrighted; please feel free to share the link, but do not copy and paste content. Unless otherwise noted, all original photography on Coming Back Home is copyrighted. The photo gracing today’s post was taken by Benjamin Yost, and I’d like to thank him for generously allowing me to use his work. Please do not copy photographs from Coming Back Home without permission.

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Strategies for Coping with Nightmares

Unfortunately, nightmares are part of PTSD for many people. They aren’t easy to get rid of. However, if you get nightmares, here is a list of things that you can do to try to make them a little easier on yourself:

– Did I mention that relaxation is really good for you? I did actually; so many times that you might be getting tired of hearing it. I even posted a relaxation exercise here. Some people felt triggered by that one (and I thank them for telling me), so I posted a different one here. I keep talking about relaxation because it’s good for you. Try to do some every night before you go to bed. It will make you less tense, and if you’re less tense you’re less likely to have nightmares.

– Anniversaries of your trauma events are likely to be particularly difficult. But, any days when you’ve been triggered, upset, stressed, or even excited (in a happy way), you’re more likely to have nightmares. Knowing this, you can work to compensate: on days like that, try to do more to relax before going to bed than you normally would. Then, as you lie in bed, take some time to look around the room, and remind yourself that you’re home, and that you’re not in danger. Putting this thought in your head right before you fall asleep will make it easier to bring yourself back into the here-and-now if you do wake up with a nightmare.

There’s a couple of things you can do to set up your bedroom to make it easier to cope with nightmares:

– Keep the room dark enough to sleep, but leave a small nightlight on to make it easier and quicker to orient yourself if you wake up from a nightmare.

– Keep the space uncluttered; have a couple of objects around the room that will help you to quickly and easily orient you to the here and now. Any object that you didn’t have at the time that the trauma happened can work; that way, if you do wake up with a nightmare, you can quickly scan the room to know where and when you are.

– Use your grounding skills: usually, waking up from a nightmare means waking up drenched in sweat. Lying in bed, drenched in sweat and shivering will do absolutely nothing to help you recover from your nightmare. So get up, run to the bathroom, and splash some water on your face. Get in the shower, and have a nice warm relaxing shower. Lavender-scented soap is also relaxing. Put on warm dry pajamas. Turn on soft, relaxing music. Fix yourself a cup of tea or warm milk (or another beverage that soothes you). The idea at this point is to soothe and comfort yourself, to help yourself recover as quickly as possible, rather than allowing the suffering to continue.

If you tend to have the same nightmare over and over again, there’s a type of therapy for that.

If your nightmare is overwhelming and terrifying to even think about, please don’t try this on your own – find a qualified mental health professional to help you.

The treatment involves writing out your nightmare in detail, with a different (positive) ending. You basically train yourself to re-imagine the nightmare with a positive ending, and then train yourself to take control of the nightmare. This takes a lot of work to do successfully, and it’s hard to do by yourself. So please reach out to get some help if you need it.

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I’d love to have you share your thoughts, comments, and questions. If you do post a comment, please don’t give specific details of your trauma – these may be triggering to another reader. If you’d like to offer criticism, I’ll take it – I know I’m not perfect, and I’m always willing to learn. If you do offer criticism though, I’d really appreciate it if you could do so constructively (ie., no name-calling, please). Thanks…

You can find me on Twitter and on Facebook.

~ Dr. Dee Rajska, C. Psych.

*Fine print: Please feel free to share the link to this blog wherever you think it might be helpful! Reading this blog is a good start, but it’s no substitute for professional help. It takes a different kind of courage to admit to yourself that you’re struggling. PTSD is not a sign of failure – it’s a sign that you’ve been through a lot, and have tried to stay strong for too long. If you need help – you’re in some pretty great company. Reach out, and give yourself a chance to feel better.

**Really fine print: The content of Coming Back Home is copyrighted; please feel welcome to share the link, but do not copy and paste content. Unless otherwise noted, all original photography on Coming Back Home is the copyrighted property of Larry M. Jaipaul; please do not copy images without permission.

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