By Dr. Aimee Vaughn
Are you feeling stressed and overwhelmed because of the Covid-19 pandemic? You are not alone my friends. I have had several people ask about suggestions for dealing with the stress of the situation, so I decided to put together a short video with some quick tips to help manage the stress and anxiety you might be experiencing.
Do you have questions or want me to cover specific topics? Email me and I will see what I can do! Be well my friends.
By- Dr. Aimee Vaughn LPCC-S
Many of you know that I have spent the last year and change researching moral injury in veterans and the impact of learning about moral injury on clinicians who work with veterans. Today I want to start by just introducing the concept of moral injury to those who may not be familiar.
Most people are familiar with the term Posttraumatic Stress Disorder (PTSD), especially in relation to combat veterans. PTSD is when a person has experienced or witnessed a traumatic event AND then has symptoms such as intrusive thoughts about the traumatic event, avoiding situations that remind them of the event, hyperarousal, and negative or counterproductive thoughts about themselves or the world, lasting longer than a month (APA, 2013). The symptoms of PTSD are fear responses to traumatic memories. Operation Iraqi and Enduring freedom veterans are twice as likely (14%) to experience PTSD than their civilian counterparts (7%) (Tanielian, & Jaycox, 2008; Kessler et al., 2005). Researchers have been working hard to develop and improve current PTSD treatment for veterans with a fair amount of success. However, many veterans, two thirds according to Steenkamp et al. (2015), still meet the PTSD diagnosis criteria after being treated with frontline treatments such as Prolonged Exposure, Cognitive Processing Therapy, and EMDR. So, what are we missing?
It is possible that the problem, or part of the problem, may be some veterans experiencing moral injury. Moral injury is what happens when a person engages in or fails to prevent something that goes against deeply held beliefs and values (Litz et al., 2009). It does not matter if it was part of their job, if they had to do it to save their own lives, or they were commanded to do it, the veterans experience deep guilt and shame about what has transpired. Some examples include killing, torture, damage of property or failing to prevent others from harming people or property. Additionally, moral injury can include instances where a person experienced betrayal from leadership or was the betrayer of others (Shay, 2014). Without being able to process those experiences and separate the events from who they are as a person or make amends in some way, it can cause some serious symptoms such as spiritual concerns, loss of trust of self (Jinkerson, 2016), issues related to meaning of life, depressive symptoms, anxiety symptoms, reexperiencing, avoidance (Jinkerson & Battles, 2019), poor physical health (Yan, 2016), social isolation and interpersonal issues (Litz et al., 2009; Shay, 2014).
Yes, the average person does feel guilt and/or shame when they do something wrong. Usually that guilt or shame will help them realize that they should not do that thing again and possibly try to fix the wrong they have committed. Moral injury is something that is far more severe. Sure, most of us have done a few things that continue to randomly pop into our heads at night when we are trying to sleep, causing negative feelings. Moral injury does not allow the person to compartmentalize the event to “I did something wrong”, instead the person sees themselves or the world as bad and unworthy. They may feel so much guilt and shame that they isolate themselves from those they love because they believe they are unworthy or they fear what the person might think of them if they knew what kind of person they were and what they had done.
This is a tough one and the jury is still out. Some of the current PTSD treatments are manualized and so have little room for deviation. Further, it is possible that a clinician might treat moral injury as a cognitive distortion, or inaccurate view of the themselves or what happened, which is really may not be appropriate. A key to working with moral injury is allowing the client to choose what is a true violation of right and wrong. If a person believes it is wrong to take a life, and they took a life, no matter what the circumstances, then according to that person’s values, they did wrong. Instead of fighting that and saying that anyone would have done that in that situation, a clinician must allow the client to then make meaning of that experience and find a way to move forward by either seeking forgiveness, making amends, doing an act of service, or whatever is deemed appropriate by the client and counselor.
That being said, it is possible for a veteran to experience PTSD and moral injury at the same time, and so in this case it would be important to address both the PTSD and moral injury. There are treatment interventions that are currently being developed to specifically do this called Impact of Killing and Adaptive Disclosure.
They certainly do. I have worked with those in the medical field who care for the sick and dying who report having done things as directed by superiors that they did not feel was what the client wanted and caused suffering. Many case-workers are put into no-win situations where they are trying to make the best choices on the behalf of children, only to find out the child is in a worse situation. Those in civil service often have to bring harm to others in order to do their jobs, and while it is part of the job, there are those that suffer greatly for having harmed another or failed to prevent harm. These are just some jobs in which moral injury occurs, but the list is not exclusive.
Secret suffering only gets worse with time. The best thing you can do is talk about it with someone you trust. Maybe it is a family member, a friend, a counselor, or a spiritual adviser, but holding the pain inside you and suffering alone will not make things better. If you are supporting a person experiencing moral injury, be sure to let them know that you accept them just as they are. If you choose to seek professional help, you can ask your therapist if they have any training in moral injury or specifically search for those who do.
If you have any questions, feel free to message me at Guidestar Counseling and Consulting on facebook or www.guidestarcounseling.com
Be well friends.
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders, (5th ed.). Washington, DC: Author.
Finlay, L. D. (2015). Evidence-based trauma treatment: Problems with a cognitive reappraisal of guilt. Journal of Theoretical and Philosophical Psychology, 35(4), 220–229. https://doi.org/10.1037/teo0000021
Jinkerson, J. D. (2016). Defining and assessing moral injury: A syndrome perspective. Traumatology, 22(2), 122–130. https://doi.org/10.1037/trm0000069
Jinkerson, J. D., & Battles, A. R. (2019). Relationships between moral injury syndrome model variables in combat veterans. Traumatology. https://doi.org/10.1037/trm0000163
Kessler, R.C., Berglund, P., Delmer, O., Jin, R., Merikangas, K.R., & Walters, E.E. (2005). Lifetime prevalence and age-of-onset distributions of DSM-IV disorders in the National Comorbidity Survey Replication. Archives of General Psychiatry, 62(6), 593-602.
Litz, B. T., Stein, N., Delaney, E., Lebowitz, L., Nash, W. P., Silva, C., & Maguen, S. (2009). Moral injury and moral repair in war veterans: A preliminary model and intervention strategy. Clinical Psychology Review, 29(8), 695-706. doi:10.1016/j.cpr.2009.07.003
Shay, J. (2014). Moral injury. Psychoanalytic Psychology, 31(2), 182-191. doi:10.1037/a0036090
Steenkamp, M. M., Litz, B. T., Hoge, C. W., & Marmar, C. R. (2015). Psychotherapy for military-related PTSD: A review of randomized clinical trials. JAMA: Journal of the American Medical Association, 314(5), 489–500. https://doiorg.ezproxy.lib.apsu.edu/10.1001/jama.2015.8370
Yan, G. W. (2016). The invisible wound: Moral injury and its impact on the health of Operation Enduring Freedom/Operation Iraqi Freedom veterans. Military Medicine, 181(5), 451-458. doi:10.7205/MILMED-D-15-00103
Yan, G. W. (2016). The invisible wound: Moral injury and its impact on the health of Operation Enduring Freedom/Operation Iraqi Freedom veterans. Military Medicine, 181(5), 451-458. doi:10.7205/MILMED-D-15-00103
Every January gym memberships soar, health foods are purchased, cigarettes are thrown out, financial savings plans are made, family time is instituted, and stress management strategies are created. People set goals every year to improve their lives, and yet only months later many will have given up on their resolution. Do those that fail to complete their resolutions just have less willpower? The answer is no, they have just either not chosen the right goal or need to plan more effectively. To help increase your chance of success with your resolution, here are some basic success strategies:
If you are going to set a goal that will be difficult to achieve, it is critical that it is important to you or that you can see the importance of doing it to improve your life. Basically, when the going gets tough, will you care enough about the goal to keep on keeping on? Goals that are set to make someone else happy or are superficial in nature are often more difficult to achieve. The more meaningful the result of the goal, the easier it is to keep going during hard times. It helps to focus on why the goal is important to you.
Find a way to set up your surroundings with reminders about the goal and why it is important, to help you stay motivated during difficult times. Carry or display a picture of your family, a letter you wrote to yourself at the beginning of the journey, a medical report, or a picture of that dream item you are saving for, anything that you can look at to remind you of your goal. The constant connection with what your goal is and what it means to you will help you stay motivated.
Often people want a great radical change but may not have the ability to make that great of a change right away. Huge lifestyle shifts can be difficult, and sometimes life circumstances make drastic changes impossible. Those who adopt an “I am either a success or failure” attitude, are likely to give up completely and label themselves as a failure at the first setback. Consider the amount of time and effort your goal requires and create a plan you can sustain through the most difficult and stressful times of your year.
Setbacks happen. You have a busy week and can’t get to the gym, you take a week-long binge on junk foods, you light up a smoke after a stressful day, you made an impulse purchase, or the family has hardly seen one another in weeks, sometimes we just get off track. Does that mean you failed? No, it means you need to revamp that plan so you can be more successful in the future. Ask any great athlete, scholar, actor/actress, or business person and they will tell you their careers are built on learning from failure. So, if you experience a setback, look over your plan and see what you can do to make it better, and get back to it!
One way to help stay on top of your plan is to share what you are working on with someone else. Let that person help you look for potential areas where you might struggle for planning purposes. Then encourage them to check in with you regularly to check up on that goal. Just knowing that another person is going to ask you about your goal can sometimes instill motivation to stick with it.
If you want to be successful in your New Year’s resolution, planning is key. If you choose a meaningful but realistic goal, set your surroundings to remind yourself why that goal is important, plan for difficult times and setbacks, and have some support for your process, you will be better prepared to take on that resolution. Above all else, take a moment to be proud of yourself for trying something new and be kind to yourself when things aren’t going well. Remember, failure only happens when you fail to try. If you have questions, feel free to reach on on the Guidestar Counseling Facebook page or at www.guidestarcounseling.com.
Happy New Year! May it be your best yet!
By Dr. Aimee Vaughn LPCC-S
Self-care is a buzzword flying around to describe things we do for ourselves in order to ensure our well-being in a high stress world. While a bath bomb, an evening with a good book, or splurging on something special might feel great in the moment, they often don’t have lasting effects on our mental health. When a person lives in a state of high stress, anxiety, and/or depression, one or two self-care acts are not going to be enough to make the impact we need to get our heads in the right space to feel better. Effective self-care is a lifestyle change and requires action every single day. Here are a few areas that I suggest incorporating into a daily self-care plan.
Do you ever take time out of your day to just give yourself a pat on the back for the awesome job you did today? We can be our own worst critics and negative self-talk is not going to make us feel any better. Take some time out of your day to celebrate your successes! Not every success has to be a life altering event. Getting out of bed in the morning is a success when you really struggled to do it. We spend too much time thinking about ways in which we are not enough. There is a difference between working to be better and holding unrealistic standards to are either unachievable or are achievable, but at great cost to your personal health.
If you want to engage in self-improvement then I encourage you to make a practice of taking at least 5 minutes of your day and thinking only about how you have succeeded today. Reflect on the things you feel good about having done. Nothing is too small. If you can only list a couple of things, spend that time really digging into how good that experience was for you. It will give your brain a workout an teach it too look at yourself in a better and more accurate light.
Despite what you might think, the average person needs 7-8 hours of sleep to function his or her best. Lack of sleep can negatively affect mental health and reduce performance and reaction time in important tasks. Think you can sleep 12 hours on Saturday to make up for only getting 4 hours of shut eye through the week? It doesn’t quite work like that. Sleep debt is accrued, and it takes time to pay it back.
So how do we deal with the things that are keeping us up? Here are some tips: If your thoughts are going 100 miles an hour, write them down on a list that you can look at later. Engage in guided meditation or progressive muscle relaxation to relax the body and help focus the mind; there are a lot of free apps you can use. Use a sleep routine that helps the brain recognize when it is bedtime. Unplug: turn off the phones and other devices at a set time to help prevent staying up later than intended.
A well-rested brain and body can make a huge difference in your preparedness to take on the day.
Have you ever noticed when you have been sitting nonstop or eating nothing but junk food you start feeling bad? The state of our bodies strongly impacts mental health. Getting some exercise every day is important to staying mobile and able to do the things you enjoy while also getting those happy endorphins kicked up a notch. You don’t have to hit the gym if you don’t have time; go for a walk, do some yoga, or anything that will get you up and moving throughout the day. The important part is that you make movement a regular part of your daily routine and do it even when you don’t feel like it.
Also pay attention to what you put into your body. We have all had to hit drive-thru because we are short on time, but constant high fat and unhealthy diets can lead to physical discomfort and unwanted weight gain. Try to ensure that you are getting some fresh fruits and vegetables every day!
And there you have it friends! If you want to improve your mental health and generally try to take better care of yourself, self-care needs to be an intentional and daily practice. Consider creating a self-care plan that you can post somewhere and will have to look at every day as a commitment to yourself. The key to making gains is continuing with the self-care tasks even when it isn’t convenient or you don’t feel like it, because that is when you need to do it most.
Stay tuned to www.guidestarcounseling.com or follow me on FB at Guidestar Counseling or @guidestarcounseling for more informative blogs!
