The Impact of Trauma with Dr. Andy Santanello

Episode Summary of “The Impact of Trauma with Dr. Andy Santanello”

Welcome back to The Communicate & Connect Podcast! In today’s compelling episode, your host, Dr. Elizabeth Polinsky, engages in a profound discussion on the impact of trauma with esteemed guest, Dr. Andy Santanello—a clinical psychologist and expert in PTSD. Together, they will dissect the nuances of trauma definitions from the DSM-5 and ICD-10, revealing how understanding these distinctions can aid in proper diagnosis and recovery.

Dr. Santanello brings his extensive experience with the VA system and the Center for Deployment Psychology to shed light on the short-term and long-term symptoms of trauma, including intrusive memories, heightened alertness, and emotional numbing. We’ll explore why some individuals naturally recover over time, while others might struggle with conditions like depression or PTSD. In addition, Dr. Santanello will walk us through effective, evidence-based trauma therapies, such as Cognitive Processing Therapy and EMDR, offering hope and practical steps for those seeking help.

We’ll also delve into how trauma uniquely affects personal relationships, especially for military personnel and their families. Dr. Santanello will share insights on the challenges of emotional vulnerability and intimacy issues that trauma survivors often face. He’ll provide valuable advice for spouses and family members on supporting their loved ones—including the critical importance of self-care.

Listeners will find guidance on leveraging resources like the PTSD VA page and Vet Centers, as well as Dr. Santanello’s professional contact for those in the Baltimore area. This episode promises to be both enlightening and supportive, whether you’re directly affected by trauma or seeking ways to better understand and support someone who is.

Stay tuned for an in-depth exploration of trauma and recovery, and don’t forget to subscribe, rate, and review our podcast to continue receiving valuable content. Let’s dive into this essential conversation and learn how to better communicate and connect through the complexities of trauma.

Don’t forget to check out our free 10-week relationship email course! Let’s get started!

Guest Speaker Bio – “Dr. Andy Santanello”

Dr. Andy Santanello is a distinguished psychologist and a leading authority in the realm of mental health and mindfulness, celebrated for his deep expertise in Acceptance and Commitment Therapy. With a particular focus on trauma, Dr. Santanello has dedicated his career to helping individuals live more fulfilling lives through mindful living practices and encouraging values based living.

Dr. Santanello also has an interest in language and its use socially. In this episode, he discusses the phenomenon known as “concept creep,” where precise psychological terms expand and morph when they enter the general vocabulary, often losing their specific clinical meanings. A prime example he frequently discusses is the term “depression.” In clinical settings, depression is a well-defined diagnosis characterized by persistent and profound sadness, among other symptoms. However, in everyday language, people often casually use “depressed” to describe feeling down after a tough day, thereby blurring the line between temporary emotional states and serious mental health conditions.

Through his clinical teaching, consultation, and public speaking, Dr. Santanello strives to clarify these distinctions and promote a more accurate understanding of psychological terminology while helping therapists intervene effectively with their cleints. He emphasizes the importance of maintaining the integrity of these terms to ensure that mental health conditions are recognized and treated with the seriousness they deserve. His work not only educates the public but also provides valuable insights for mental health professionals, fostering a more precise and compassionate approach to mental health discourse.

Dr. Santanello’s contributions are most notable in the realm of therapists training and supervision in Acceptance and Commitment Therapy and Cognitive Processing Therapy for PTSD. His efforts continue to shape the landscape of mental health education, advocating for evidence based treatments for Veterans and those with PTSD or other trauma related diagnoses.

Want to learn more about trauma and PTSD? Explore these helpful resources:

• The National Center for PTSD
• Support for Family Members
• The Center for Deployment Psychology

For more information or to connect with Dr. Andy Santanello, visit his website at www.andysantanellopsyd.com

Free Relationship Pattern Assessment

Many couples assume they have a communication problem when they’re actually stuck in a relationship pattern that keeps creating the same conflict.

Take the free Relationship Pattern Assessment to discover what pattern may be keeping you stuck and learn what to focus on next.

👉 https://pages.communicateandconnect.com/relationship-quiz

Episode Transcript for “The Impact of Trauma with Dr. Andy Santanello”

Dr. Elizabeth Polinsky [00:00:01]:
This podcast is sponsored by Communicate and Connect Counseling, where we have a team of therapists who provide individual couples and family therapy services, all tailored to meet the needs of military and veteran families. To learn more about our services, visit www.communicateandconnect.com.

Welcome to the Communicate and Connect podcast for military Relations relationships with your host, Elizabeth Polinsky, a military marriage counselor. If this is your first time listening to the Communicate and Connect podcast, please take a second to go, rate, review, and subscribe to make sure you get all our future episodes.

We also really want to know what it is you love about our podcast. And if for some reason you’re not loving it, we want to know that too, because we’re committed to providing the best quality content to help you improve your relationships.

This is episode 10 on the impact of trauma. So I am really excited today because I have my friend Andy here who is going to talk a lot about trauma, how that impacts an individual, but also really how that impacts a relationship and how partners and spouses of someone who’s gone through a trauma can really help and be supportive, both to improve the relationship, but also to help the person kind of like, recover from the traumatic things that they experienced.

Dr. Elizabeth Polinsky [00:01:45]:
And so maybe we could just start off, Andy, with you introducing yourself.

Dr. Andy Santanello [00:01:49]:
Hey, I’m Andy Santinello, and I’m a clinical psychologist. I’m in private practice, and I also work for a nonprofit called the center for Deployment Psychology, and I’m a PTSD subject matter expert for cdp. And so before I came to cdp, it’s been about five years now. It’s hard to believe. I worked in the VA system for over 10 years, and the whole time I was in VA, I was on the trauma recovery team working with veterans and service members around issues of trauma and ptsd.

Dr. Elizabeth Polinsky [00:02:25]:
Yeah, this is. I’m so excited because you have a lot of, you know, experience and, like, training and, like, this is, like, your area. So I’m so excited for this. So excited for this. So I think we should probably just start off and make sure we’re on the same page because, you know, based on our field, you and I know what we’re talking about when we say the words trauma. But I want to make sure everybody who’s listening to this has an idea of what, what is trauma and how does a trauma impact somebody?

Dr. Andy Santanello [00:02:56]:
Really important question. And it’s. It’s a little bit of a complicated question. You know, the word trauma, like a lot of words that start out as, you know, precise psychological, mental health terms, has, you know, when it enters kind of the general vernacular. It goes through something called concept creepy, you know, and so, like, an example of concept creep is depression. Depression is a very specific word to describe a diagnosis. But, you know, I know that I find myself saying every once in a while, if I had a bad day, I’m depressed today.

Dr. Elizabeth Polinsky [00:03:35]:
Oh, yeah, that’s common.

Dr. Andy Santanello [00:03:37]:
And what I’m not saying is, you know, for the last two weeks, more days than not, I’ve had five symptoms of depression. You know, I’m. You know, I’m expressing like I had a bad day. So another one is adhd. You know, a lot of folks these days will say, oh, I’m really ADHD today. And what they mean is they’re having trouble focusing and concentrating. They don’t mean I’ve suddenly come down with adhd, the syndrome.

Dr. Elizabeth Polinsky [00:04:03]:
Yeah, that makes a lot of sense. I hear that a lot with manic. Like I got manicy or something is a common one that I hear sometimes.

Growing trauma awareness, yet definitions cause confusion.

Dr. Andy Santanello [00:04:12]:
That’s another good example of that. And trauma, I think. So on the one hand, it’s fantastic that there’s so much more awareness of what trauma is and that it’s an important thing to. First of all, it exists, and it’s an important thing for us to be on the lookout for because that helps to reduce stigma and becomes something that we can talk about.

On the other hand, there can be some confusion, you know, about what that term means, and I think that’s why you brought it up. So the colloquial sort of way of thinking about trauma, if you look at Webster’s definition, is really, really broad. In fact, one of the definitions Webster gives is an emotional upset. And so I would say that’s probably way too broad.

Dr. Andy Santanello [00:05:01]:
And I remember once I was looking at one of the things I like to do in my spare time is, you know, look at mental health professionals on YouTube to see how they’re talking about things. And I came across this one video where a person was talking about all the traumas that they had experienced that day. And I thought, oh, wow, what a terrible day. And they said, you know, I went to the refrigerator and my spouse had eaten all the ice cream, and that was a trauma. And I was thinking, no, that’s not quite. You know.

Dr. Elizabeth Polinsky [00:05:33]:
Yeah, but with that definition being so broad, if it’s just emotionally. If anything’s emotionally upsetting, then it’s true. Traumatic, then eating ice cream would be. Would be traumatic for sure, you know.

Dr. Andy Santanello [00:05:45]:
So the way I think about trauma, and it’s not just the way I Think about it. The way it’s kind of defined is, you know, first I look at the spectrum of things that can happen in a person’s life that would be stressful or upsetting. And on the very low end of that would be kind of normal stress.

Dr. Elizabeth Polinsky [00:06:04]:
Which would be someone eating their ice cream.

Dr. Andy Santanello [00:06:07]:
Well, maybe that’s towards the middle of the spectrum.

Dr. Elizabeth Polinsky [00:06:10]:
Okay, that might be in the middle. Okay. Yeah.

Dr. Andy Santanello [00:06:13]:
I mean, it could be. It could be just, you know, this distress you feel just living your life. You know, going to work can be stressful. Even if it’s a good type of stress. If you have children, you know, raising children can be stressful. Getting out of bed Monday morning can be stressful.

You know, so it’s sort of the kind of challenges emotionally, but also, you know, in terms of the things that happen in life that are normal. And then when you start to get towards the middle of that spectrum, sort of the middle or even towards the end, you might have what I would think of as, you know, being sort of non traumatic adverse events.

Dr. Andy Santanello [00:06:51]:
So these might be things that are out of the ordinary and pretty disruptive. I would put things like, you know, losing a loved one, you know, in this category I would put divorce. Even if it’s an amicable divorce, it’s still really disruptive. I might even put things like moving in that category which are good. They’re certainly, you know, good things most of the time for folks, but, you know, it can be extremely stressful and disruptive.

Dr. Elizabeth Polinsky [00:07:22]:
Yeah, I was even thinking like having a baby could be a positive thing, but could really be very stressful and overwhelming.

Stress Impact: Routine Disruption to Trauma Spectrum

Dr. Andy Santanello [00:07:31]:
Yeah, exactly. And so I think the impact of those stressors makes a difference. So you know, what you just said there about having a baby, you know, one of the impacts could be the development of postpartum depression, for example, you know, which. So that might be one impact. Another might be just that it’s a disruption in your routine and stressful, but doesn’t sort of graduate to the level of sort of a psychiatric or psychological mental health condition.

And then when we start to get to the really extreme end of that spectrum of things that can happen in someone’s life that are upsetting or stressful, we get to sort of trauma territory. DSM 5 defines trauma in a specific way. ICD 10 defines it in a different way.

Dr. Andy Santanello [00:08:21]:
And so if you look at both kind of sets of definitions, so can.

Dr. Elizabeth Polinsky [00:08:25]:
We real fast, I don’t know if everybody’s going to know what those two things are. How would you describe the DSM 5 in that. You said ICD 10, right, yeah.

Dr. Andy Santanello [00:08:36]:
So thank you for mentioning that.

Dr. Elizabeth Polinsky [00:08:39]:
Yeah, no problem.

Dr. Andy Santanello [00:08:39]:
As folks who have been around the government and the military, we just throw out acronyms like they’re nothing. So.

Dr. Elizabeth Polinsky [00:08:46]:
Yeah, absolutely.

Dr. Andy Santanello [00:08:47]:
It’s important to define them. So I forget that sometimes. So DSM is the Diagnostic and Statistical Manual of Mental Disorders. And it’s published by the American Psychiatric association and they’re in their fifth edition. And at least in the United States, it’s sort of the main diagnostic system we use for mental health conditions.

And the ICD10 is published by the WHO, and it’s includes essentially all of the physical, medical and mental health diagnoses that are known to mankind, so to speak, or agreed on as being areas of concern. And so it’s an international coding system that is used by most of the world, and it’s actually used in the US too. Insurance companies actually prefer using ICD10 codes over DSM codes.

Dr. Andy Santanello [00:09:38]:
So. So the definitions of trauma in each of these two diagnostic systems are a little bit different. DSM 5 has a more restrictive definition. So it limits, you know, so in the definition of trauma, they. Trauma and ptsd. Criterion A is how they define trauma. And Criterion A in DSM 5 is an experience of either witnessing or being exposed to death, serious injury or sexual assault. So those three specific types of or categories of experiences are set aside as being trauma in DSM.

Dr. Andy Santanello [00:10:20]:
In ICD10, the definition is a bit broader. I’m not remembering the exact language of it. I was actually just looking at it yesterday. Essentially. It doesn’t. It includes. Well, so it includes those three categories of experiences, but it also includes experiences that would likely to be. Would likely put a person in danger of being physically or psychologically injured.

Dr. Andy Santanello [00:10:47]:
So that a bigger definition would probably include things like the experience of systemic racism, for example, or the accumulation of a lifetime of microaggressions for someone who’s, you know, getting a lot of that happening to them, or there’s even some evidence that, you know, for folks of color, you know, seeing and hearing about people in their community being killed by police, just hearing about that and the accumulation of that can actually be a chronic stressor. So depending on the definition that you choose, what’s considered trauma and not trauma can vary.

Dr. Elizabeth Polinsky [00:11:31]:
Okay. But what is common in both the definitions is maybe that it’s on this extreme side of life. Stressors that have a really large impact on you. Yes, that would be out of the. Out of the norm, so to say, of everyday life.

Dr. Andy Santanello [00:11:50]:
Yeah, absolutely. I think that would probably be a fair statement.

Dr. Elizabeth Polinsky [00:11:54]:
Okay, and so how does going through something like this impact somebody?

Dr. Andy Santanello [00:12:01]:
Well, it really depends. So I. Yeah, it’s funny, I had a professor in graduate school and he was, he always liked to. We asked him what we thought were really straightforward questions. And you always say it depends. Yeah, and we hated that. But it’s true. So let me, let me clarify what I mean by that.

Trauma Recovery: Most Overcome PTSD Symptoms Quickly.

Dr. Andy Santanello [00:12:20]:
So there’s some pretty decent research that looks at the impact of trauma on ongoing, you know, mental health. And there’s a few studies in particular that had kind of an interesting design where they recruited women who either were reporting a sexual assault or physical assault at their local emergency room.

And then they followed these women for the course of about three months. And essentially it wasn’t a treatment study. Essentially what they did is they met with them every week and assessed them for symptoms.

And what they found is at the end, so right at the beginning, the week after experiencing either a sexual assault or physical assault, most of the women in both samples, I think was over 90% in the sample of women who experienced sexual assault, and mid 70% of women who had experienced non sexual assault were reporting really significant symptoms that would have met threshold for ptsd.

What tended to happen over time, over the course of those three months, is that a very large portion? Actually the majority of both samples, by the time they get to the, that three month mark at the end of the study, no longer were meeting criteria for ptsd. So those studies and some of the other things that have been out there suggest that most people, when they experience trauma, are going to recover.

Dr. Andy Santanello [00:13:41]:
So one actually likely possibility is recovery. And there are some things that can help or hinder that, which we’ll get into, I think, in a little bit. Another possibility is having another mental health issue that isn’t ptsd. So depression, an anxiety disorder, like generalized anxiety disorder, panic, an adjustment disorder, where maybe they are having some difficulties sort of coming to terms with what happened, but you know, not necessarily graduated to something like major depressive disorder, complicated grief.

You know, that could be another possibility. And then for some folks, because maybe they’re not able to process what they’ve been through either because it’s too painful and they’re not willing to go there or they can’t go there, or something has gotten in the way and they don’t have the opportunity to work through sort of the emotions and get their mind around what happened. Those folks tend to get stuck in the recovery process. And when they get stuck chronically, then we’re looking at Something like post traumatic stress disorder.

Dr. Elizabeth Polinsky [00:14:57]:
Okay, so let me make sure I’m following and I might have a follow up question. So a lot of people who have gone through a trauma, they have a lot of symptoms and like challenges with that directly following whatever happened to them. But most of them will get better over time, and it’s more so, like that’s what’s likely, is that a lot of people will recover kind of naturally. And for the ones that don’t, some of them go on to develop ptsd, but others may have something else, like may be experiencing more depression or more anxiety and they may never have ptsd.

Dr. Andy Santanello [00:15:38]:
Yeah, that’s right.

Dr. Elizabeth Polinsky [00:15:39]:
Okay, and so what are some of those symptoms or like challenges that someone might have directly after a trauma?

Intrusive Memories, Emotional Changes After Trauma Recovery

Dr. Andy Santanello [00:15:47]:
Well, right after a traumatic event, what is really normal to experience is this kind of sense of memories of what just happened intruding into one’s mind. So that can happen out of the blue, just sort of memories or feelings or thoughts or things they experience during their traumatic event just sort of come up.

Sometimes they’re triggered by things that happen in the environment or being around certain people, or, you know, just things that might remind them in some other way. Often what happens too is there are some important changes in the way somebody thinks and how they feel. So not just the content of how they think and what they feel, but also the way that information is processed and emotions are experienced.

So for example, one of the things that seems to be true for most folks who survive trauma, at least in the short term, and certainly if they go on to continue to struggle with ptsd, is there’s sort of a cognitive bias or proneness to look for signs of threat in the environment, which kind of leads to sense of being keyed up, you know, emotions, the way emotions are processed, there’s some either, you know, a tendency towards numbness or the opposite, you know, feeling like they’re kind of stuck in depression or anxiety or anger irritability.

So disruption emotionally, there’s often changes to the way that somebody experiences anxiety. So for example, if you think about the fight, flight or freeze reaction, and I think most people are probably familiar with that, but if you aren’t, you know, it’s.

Trauma can cause prolonged heightened threat response.

Dr. Andy Santanello [00:17:38]:
It’s sort of the hardwired full body, full mind response that, you know, human beings have evolved to have in response to threat. So it’s normal. It’s actually a good thing for us to have this. And it includes, you know, the changes in the body, so muscles getting ready to run away or fight, blood pressure changing Heart rate changing.

You know, cognitively, we’re really not thinking about anything but what’s happening in the moment. It’s a very reactive state that’s meant to keep us safe. For folks who experience trauma, they can kind of get sort of stuck in that hyperarousal state, which could include things like being really sort of jumpy. And even slight startle responses or things that would cause most people to startle a little bit, will have sort of an exaggerated startled response.

Dr. Andy Santanello [00:18:28]:
And then it takes them a while to get back to baseline, or just kind of always feeling like they need to be on guard, you know, looking around for danger if they’re in a public place, wanting to have a really good field of vision, to know where all the exits are. Trouble concentrating, you know, because they’ve got their head on a swivel, sort of looking around for, you know, what.

What might be coming. Difficulty sleeping. It’s hard to sleep when you can’t settle your mind down. And then the last sort of piece of this is kind of the way that folks tend to cope. And it’s. It’s a way of coping that makes a lot of sense, because in most situations in life, this type of coping is going to keep you safe.

Dr. Andy Santanello [00:19:10]:
And that’s avoidance. So when something is painful or potentially painful and you can stay away from it, generally that’s good judgment. So what tends to happen is as. As folks experience these other types of symptoms because they’re painful and upsetting and distressing, they may try to suppress them, you know, by distracting themselves or just, you know, trying to will themselves not to think about the trauma and feel the emotions attached with it.

Or they may start staying away from people, places, things and situations that remind them. And it’s that last bit there, that avoidance, which seems to be the real key to whether or not somebody’s going to be able to recover from their trauma or they’re going to get stuck.

Dr. Elizabeth Polinsky [00:19:54]:
Yeah. So sort of the more you avoid it, the harder it’s going to be to recover.

Dr. Andy Santanello [00:20:00]:
Yeah, that seems to be the case.

Dr. Elizabeth Polinsky [00:20:02]:
And so this is a lot about, like, we’ve been talking about how this impacts an individual, but I’m imagining that it impacts couples and families. Also. Do you have thoughts about how when someone has gone through a trauma and maybe they’re dealing with all of these symptoms and challenges, either directly following a traumatic event, or if it’s sort of like been prolonged and it’s developed into PTSD or another type of diagnosis, do you have thoughts about how it impacts couple relationships? Or family relationships.

Dr. Andy Santanello [00:20:39]:
Absolutely. So, you know, if you think about. Imagine you were in that trauma survivor shoes in their boots and how it would feel to have all of these different symptoms. So PTSD is one of the most complex diagnoses in the. In the DSM 5. There are so many different symptoms that cluster together. You know, I’ve often heard trauma survivors who I’ve worked with say, I just feel like I’m going crazy because they’ve kind of lost the sense of control of how they feel and what they think. And often they find themselves doing things that are uncharacteristic.

Dr. Andy Santanello [00:21:19]:
And so that can impact relationships. It can impact one’s ability to work. It can impact almost everything in someone’s life. So when it comes to relationships, one of the things that can be really difficult for trauma survivors is intimacy. And I don’t just mean sexual intimacy, although that. That certainly could be the case. I mean, you know, being able to allow oneself to be emotionally close to others. So that’s a.

Dr. Andy Santanello [00:21:44]:
That’s a really big one right there with work. Sometimes trauma survivors become almost afraid of themselves and what they might do, particularly if they’re feeling really irritable and angry a lot. And if they’ve had sort of angry outbursts. Reactive. Angry outbursts. Because really, underneath it is a sense of threat and fear. They may start to worry that if they allow themselves to be around other people in stressful situations, they might react in a way that’s dangerous. And so that can make it really difficult to work, especially if, you know, you’re around other people with friends and family.

Dr. Andy Santanello [00:22:20]:
Because trauma is. Especially if it’s an interpersonal trauma and the person feels like. And was, in their experience, really sort of singled out in a way. The sense of being alone and having real difficulty relating to other people and in believing, you know, no one could really understand what I’ve gone through.

And so therefore, how can I relate to them in any way that starts to fuel this sense of, maybe it’s better off if I just push everyone away. So even just a little bit I’ve mentioned, you can start to imagine how that would impact all sorts of relationships and one’s ability to do the things that are important to them.

Dr. Elizabeth Polinsky [00:23:02]:
Yeah, absolutely. One of the things that I think got me really curious about what you just said was that it’s hard to be emotionally vulnerable with your spouse or your partner. And I was just maybe wondering what about it makes it. What about going through a trauma like that makes it hard to be vulnerable with your spouse?

Trauma affects vulnerability and emotional closeness.

Dr. Andy Santanello [00:23:25]:
You know, I think it’s maybe different for different folks, but my sense of it is that it’s hard to feel like you want to be physically or emotionally close to someone if you’re feeling incredibly vulnerable.

And if you think about the heart of trauma, regardless of the experience, it involves being in a situation where you are either physically. Well, probably physically and psychologically, you were harmed in a very significant way.

And so to be close with people means to make the choice to allow them into your comfort zone. The word vulnerable actually comes from. I can’t remember exactly what language, but I think it’s Old English or Old Norse. The root of it is vulm, which means wound. And so to be close with people, you have to be willing to make yourself woundable.

Dr. Andy Santanello [00:24:18]:
And if you’ve just, you know, experienced a trauma or, you know, even if it’s in a remote past, the. The prospect of putting yourself in a position on purpose where you might be hurt is incredibly difficult.

Veterans find comfort and vulnerability among peers.

Dr. Elizabeth Polinsky [00:24:31]:
Yeah, that makes a lot of sense to me. I was. I was thinking about some of the veterans I’ve worked with in the past and their comfortableness being vulnerable with each other, like in a support group or there are like, you know, veteran biker bar gangs type situations where I hear, like, they get lots of support.

Or like the VA vfw, I think, is one of the other places that I’ve heard there’s like, that sense that they can be vulnerable with each other. But then sometimes couples are in my office and there’s a block to being vulnerable with the spouse.

But it makes me think that if I am with the people who were there when I was harmed and we kind of all went through something similar, there’s sort of a sense of it’s safe to be vulnerable here. It’s safe to risk opening up and sharing myself, because these people get it or they’ve been through something similar and they know, like, the pain points versus maybe a spouse may be scary to open up and be vulnerable with because they may not get it. And they could say something that’s maybe judgmental or critical or.

Dr. Elizabeth Polinsky [00:25:45]:
And that would just hurt so much more.

Dr. Andy Santanello [00:25:47]:
Absolutely right. And often spouses and folks who haven’t experienced trauma don’t get it because they haven’t. They haven’t experienced it. They get what it means to feel upset. Everybody has pain in their life, and they’ve suffered in some way or another. And I think out of a place of wanting to help, sometimes what the people around trauma survivors tend to do is kind of say and do the things that might be comforting in other circumstances, but really come across as invalidating. And that’s not to, I’m not judging, you know, folks who care about trauma survivors for doing this. It makes sense that they would do it.

Dr. Andy Santanello [00:26:26]:
But saying something like, you know, if a trauma survivor is really struggling with a sense of guilt and shame around their trauma and they express that to a loved one, and the loved one says, it wasn’t your fault, I get why they would say that. But for the trauma survivor, they’re thinking, you weren’t there, you don’t know what happened, it was my fault. And it sort of, that invalidation sort of makes it harder for that person to open up more.

Dr. Elizabeth Polinsky [00:26:56]:
They feel shut down. And so why would you open up again when you were shut down, when you opened up before?

Dr. Andy Santanello [00:27:01]:
Along with that is sort of the idea. Like, you know, some of the, a lot of, especially for service members, a lot of the trauma traumatic events they experience are really complicated and involve really horrible things that they’ve been through that, you know, if most people heard about them, you know, depending on how open minded that person was, they might be horrified themselves.

And so I work with a lot of vets who, you know, attempted to talk about their experiences with friends and loved ones, and the reaction they got was a sort of a sense of being overwhelmed. I mean, and I don’t mean just the veteran or service member talking about the person they were saying those two got overwhelmed, they couldn’t handle it.

And so that creates a difficult situation too, because the loved one wants to be helpful. They absolutely want to be there for, you know, the person they care about who’s suffering. And they may not really be able to fully be present with that person because what the story of the trauma kicks up in them is just too upsetting.

Dr. Elizabeth Polinsky [00:28:04]:
Yeah, I can, I can understand that. I’ve, you know, I’m married to someone in the Navy and I’ve had a few partners in the past that were military, different military branches. But I remember one of my partners, when they came back from deployment, sort of had this feeling of like, I need to protect you from knowing this information.

So, like it’s, yeah, like sharing it would be hard for the person hearing the story and so not wanting to hurt or cause an emotional reaction in the person who wasn’t there. So that makes me maybe switch to thinking about what could partners do that would be actually helpful because, you know, there are lots of things that maybe people do all the time to try to be helpful that don’t aren’t actually helpful. So what could people do if they are with a partner who’s gone through some sort of traumatic event?

Learn PTSD resources; support loved ones empathetically.

Dr. Andy Santanello [00:29:04]:
There’s a lot of things that can be absolutely helpful, and I think the first, maybe most important thing is to learn as much as you can about trauma and ptsd. And the good news is that there are a lot of really good resources that are free and easy to access.

So one in particular, if I just had to say one, would be the national center for PTSD website, which is ptsd.va.gov and there’s lots of information on there, but there’s a session specifically for family members and for spouses.

And so on the website, there’s a ton of information about what trauma is, what PTSD is, how it affects families, and also, most importantly, information about what family members and spouses can do to support their loved ones. So that’s sort of the first thing I think that could be really helpful.

Another thing that could be really helpful is simply letting your loved one know that if they want to talk to you about how they’re feeling, and it doesn’t even need to be about the trauma, but just opening the door, like, you know, if you want to talk to me about what’s going on, even if it’s just to say, I’m having a bad day, I need some space, you know, that you’re willing to do that.

And along with that, if you notice your family member really struggling, you know, offering to go with them to doctor visits or helping them to make appointments at the VA or with another professional. I guess one caveat to that, though, would be it’s not a great idea to try to force somebody to go into treatment, because you might be successful if you threaten the person with taking something away from them and they might actually go.

Dr. Andy Santanello [00:30:56]:
But that doesn’t necessarily mean that they’re going to be there, because they are choosing to be there and they want to be there, which can be frustrating, especially if you’re seeing the person struggle. Some other things are, you know, planning activities together. And as you’re planning activities, really asking your loved one what their comfort level is with certain things.

So, I mean, these days with COVID we’re not going out a whole lot in public places, but even, you know, at some point, I’m guessing that will be a thing that we can do again, hopefully. Right? But, you know, so if it’s. If it’s something like having dinner or going to a movie, you know, asking your family member, what’s your comfort level with that? Is that something you’re willing to do.

How can we do this in a way that feels okay to you? And also, so if the person’s in treatment, what they might start to need to do, if this is what, you know, the professional they’re working with is suggesting, they might need to start to put themselves in situations that don’t feel comfortable, not dangerous, but just don’t feel comfortable, to sort of regain a sense of being able to do things that might feel difficult but are important to them. And so that might be part of it too.

Dr. Andy Santanello [00:32:05]:
I think a really important thing to do also, and I probably should have started with this, is to take care of yourself. So it’s hard to really be a caretaker for someone else if you’re not meeting your own needs. And particularly if you’re a caretaker, you may not have anybody else in your life who is supporting you in the way you need to. Making it a priority to do what you need to do to take care of yourself.

And whether that’s getting therapy yourself, whether it is getting involved with a spiritual group, if that’s your thing, making sure you’re staying connected with friends and family, that’s really, really vital, I guess. Another thing. So you mentioned VFW and stuff like that. One of the things that is really difficult for a lot of trauma survivors when it graduates to PTSD is that sense of isolation and feeling like they’re the only one going through what they’re going through.

Dr. Andy Santanello [00:32:59]:
So doing what you can to encourage that person to connect with others, you know, help them if they’re willing to begin to establish a support system.

Dr. Elizabeth Polinsky [00:33:10]:
Yeah, I really like that. And I’m. Right now, I’m thinking like, so we. We’ve been sort of talking like the military spouse is the. The one that’s gone through trauma. Maybe conceptually, in my mind, that’s what I’m visualizing. And, you know, the more civilian spouse is the one trying to be supportive. But I.

Dr. Elizabeth Polinsky [00:33:29]:
I’ve also seen a lot of couples where maybe the civilian spouse had childhood trauma or they went through some sort of traumatic event as well. Or even if we were talking to the service member who has gone through the trauma, I’m wondering, like, if. If I am somebody that’s experienced a trauma, are there things that I can do like knowing how this is going to. Is impacting me and how it’s going to impact my spouse and our relationship together, are there ways that as the person who’s gone through the trauma, I could help my partner who’s trying to help me?

Seek personal help before starting couple therapy.

Dr. Andy Santanello [00:34:02]:
This is another one of the it depends type of questions, but it’s a good option. I’m going to, I’d like to, to engage with it a little bit. So, you know, if we’re talking about someone who’s experienced trauma and they are themselves kind of continuing to deal with non resolution of that trauma and either they have PTSD themselves or continuing to struggle, that’s a really tough situation.

On the one hand, they are very likely to be able to empathize and sort of get where their spouse is at. That said, they may also be engaging in some ways of coping that are actually not helpful and may suggest those things. So it’s sort of a double edged sword there. I would say that if the best advice I can give or suggestion I can make is, you know, if you are a loved one of a veteran or service member who’s experienced trauma and you’ve experienced similar things yourself, the best thing that you can probably do is get help for yourself first. That said, sometimes couple therapy can be useful.

Dr. Andy Santanello [00:35:08]:
So there’s something called a couples based cognitive processing therapy, which is actually a PTSD treatment that couples can engage in together. And so that’s a possibility. I know that a lot of VAs are offering that now, but above all, again, I think it’s really important to take care of yourself because if you’re not meeting your own needs and you’re not taking care of yourself, it’s going to be really hard to be helpful to anybody else.

Dr. Elizabeth Polinsky [00:35:33]:
Yeah, that makes a lot of sense too. Sort of like making sure that you’re okay before you try to be super helpful to other people.

Dr. Andy Santanello [00:35:43]:
And also like with that, let me just be really clear what I mean. It could be going to therapy, but it could also be, you know, making sure you’re eating regularly and making sure that, you know, you’re finding time to be around people you care about doing things that are important and meaningful to you.

So it could be therapy, but it’s also taking care of the basics because sometimes that’s one of the first things to go, you know, not taking care of the basics in order to put all of your energy into caring for the person who needs it. And so starting with just those basic needs and making sure that you’re doing those things for yourself at a minimum is a good place to start.

Dr. Elizabeth Polinsky [00:36:22]:
Yeah, I like that. I’m glad that you clarified that point. So we are starting to be out of time and you’re a busy person, so I want to make sure that I also respect your time. But is there maybe like One or two takeaways for couples who are sort of navigating these waters when one or both of them have gone through some sort of traumatic event. Like what would be your top two bullet points, maybe?

Advanced, widely available PTSD and trauma treatments.

Dr. Andy Santanello [00:36:51]:
Well, one thing we haven’t talked about is treatment that’s available. And so I guess my first bullet point would be. I know. Like, I know in this podcast we’ve been talking about all the rough things that can happen and the struggles that folks can experience. And that’s really important to talk about. It’s also really important for folks to know that we are at a time and age where treatment for PTSD and trauma is much more advanced than it’s ever been.

And so we actually have some really good evidence based therapies for PTSD and things like depression and anxiety that even 20, 30 years ago we didn’t have or were just kind of starting to come on the scene. And also these treatments are much more widely available than they used to be.

Dr. Andy Santanello [00:37:36]:
So the first thing I really want folks to come away with is that even if folks are really struggling, there is definitely help available and these treatments are shown to be, you know, really effective for most of the folks who do them. So there’s definitely a reason to have hope.

Dr. Elizabeth Polinsky [00:37:51]:
Can I interject right there. I’m glad you brought that up. That sort of like spaced my mind. I didn’t even think about that. But I agree it’s really important to say in this podcast, so. And I can include links to information about this in the show notes, but are there certain ones that you would say somebody like a couple that’s trying to figure out what type of therapy or treatment they should consider either for the individual or for the couple? Are there certain ones that they could, you know, start googling to get more information about?

Dr. Andy Santanello [00:38:25]:
Yeah, absolutely. So the VA and DoD guideline for the management of Traumatic stress and the most recent update to that came out in 2017, I think so just a little background on that. I think this is the second or third iteration. VA and DOD got a task force together and, and sort of convened all the experts around PTSD and trauma and did a massive review of the available research on PTSD treatments.

And based on the best research available, they kind of made some recommendations for the different types of treatment that are probably going to be most helpful. And so the top tier treatment that’s most helpful is something called Trauma Focused therapy, which essentially is a collection of therapies that help the trauma survivor to engage with the memories and emotions and thoughts about their trauma. So they can process them and they can work through them. And so there are different types of trauma focused therapy.

Dr. Andy Santanello [00:39:25]:
The ones that seem to have the most support right now are cognitive processing therapy, prolonged exposure therapy, emdr, which I think is eye movement desensitization and reprocessing. I always kind of mess that up. But I think that, yeah, written exposure therapy, and there are a couple other ones. So if so there. They tend to be intensive treatments because they offer the survivor a way to really confront and process their emotions, but they tend to be the most effective. So those are a couple that I would say it would be a good idea for folks to check out.

Dr. Elizabeth Polinsky [00:40:00]:
Okay, great. Thank you for that. And I’ll get some links for that I can put in the show notes. I’m sure, like, the national center for PTSD probably has, like, pages on this, so. Yeah. Okay.

Dr. Andy Santanello [00:40:15]:
There’s also a really cool treatment decision making tool on the PTSD VA page. It’s actually like a set of questions that a person can go through about their treatment preferences, and it’ll give you recommendations for therapies that might be a good fit for you.

Dr. Elizabeth Polinsky [00:40:33]:
That is really cool. I did not know that existed.

Dr. Andy Santanello [00:40:35]:
Yeah, that’s pretty good.

Dr. Elizabeth Polinsky [00:40:36]:
That’s awesome. Okay, so one takeaway was that treatment is, you know, the. For PTSD and trauma is the best it’s ever been in history at this point, and that we have some strong evidence to support certain trauma focused therapies. Any other takeaways that you would want people to sort of like, leave this episode with?

Self-care ensures effective support for PTSD caretakers.

Dr. Andy Santanello [00:40:59]:
Yes, absolutely. So the second one is, you know, if I’m. If I’m talking specifically to a spouse or a family member of someone who is, you know, struggling with PTSD is to take care of yourself. And in the ways that we talked about in this podcast, you know, the basics.

Also getting support if you need it, if you are feeling like you’re in a situation where you’re not safe, you know, make sure you do what you have to do to get the support you need to be safe. Because if you’re not able to take care of yourself and you’re not able to stay, you know, in good health, mentally and physically, it’s going to be really difficult for you to be there for your loved one.

And I know that that may seem like you’re being, quote, unquote, selfish, but really, if you think about it, even though you are taking care of your needs, it absolutely can be in the service of being available to be a caretaker. So that’s kind of the other Thing I would suggest that people really think about.

Dr. Elizabeth Polinsky [00:42:05]:
Wonderful. So, Andy, if people want to work with you at all, how would they find you?

Dr. Andy Santanello [00:42:11]:
Good question. I’m under a rock in the middle of Maryland.

Dr. Elizabeth Polinsky [00:42:16]:
Okay.

Dr. Andy Santanello [00:42:19]:
I have a fairly small private practice just outside of Baltimore and my website is santinellopsych.com and we’ll put that in the program notes because Santinello is not the easiest last name to start.

Dr. Elizabeth Polinsky [00:42:33]:
It’ll definitely be in the notes.

Dr. Andy Santanello [00:42:36]:
Yeah. But I would say if folks are really looking to find trauma therapy and if you’re a veteran or a service member, VA is a great place to start. If you have experienced military sexual trauma or you have been in a combat situation, the Vet center. Vet centers are a great resource for you as also for family members. And then, you know, of course, if you’re still active duty, you know, there’s, there’s lots of resources for you there too. So yeah, I think just doing what you can to reach out. You don’t have to be struggling on your own to deal with this.

Dr. Elizabeth Polinsky [00:43:11]:
Well, Andy, thank you so much for being on the podcast. I really appreciate that you took the time and that we are all going to get to like learn from your expertise in this area. So thank you very, very much.

Dr. Andy Santanello [00:43:24]:
Well, Liz, you’re really welcome and it was really cool to get a chance to talk with you and maybe we’ll do it again sometime.

Subscribe, review podcast; explore relationship email course.

Dr. Elizabeth Polinsky [00:43:41]:
I hope you enjoyed today’s episode. If so, please take a second to go, rate, review and subscribe so you can all of our future episodes. Make sure to check out the show notes to sign up for our free 10 week relationship email course.

This email course is really designed for people who are maybe having trouble with communication or connection in their relationship and helping them develop some quick wins right away to start improving it. While I am a therapist, this podcast is for educational purposes only and is not considered therapy and it should also not be a replacement for therapy. If you think you need a professional of any kind, you should definitely go find one. Until next time.