It was late afternoon when Lanna gave me a call.
Although I specialize in anxiety and trauma, I commonly receive referrals through the generalist side of my practice.
I enjoy the variety of challenges but to be honest, trauma is often the underlying cause of their distress as well.
Lanna shared with me that she was struggling with two seemingly unrelated problems.
The first was the extreme fear of closed spaces.
She shared that this was something she struggled with most of her life.
Recently it was generalizing out to a wide range of circumstances.
Elevators, cars and crowded social environments created a great deal of anxiety.
Lately, Lanna was experiencing panic attacks on a far more common basis.
The other challenge that brought her to treatment had to do with her inability to maintain serious relationships.
Lanna had just broken up with yet another boyfriend.
She said this pattern was longstanding and she was becoming discouraged.
"I really want to get married but I am afraid that I will never be able to do it" My first impression of Lanna was that if anyone could overcome her issues, she could.
Why did I think that?My office was on the nineteenth floor and obviously required an elevator for transport.
Despite her fear of closed spaces, she was willing to confront it head-on to work with me.
That took a lot of courage and I knew that this quality would serve her well as we negotiated the rigors of psychotherapeutic treatment.
Our sessions would start on the first floor of my building.
By escorting her up the elevator, I was able to join in her distress.
This provided me with a unique window into her struggle.
It also became obvious to me that her pain and anxiety likely had a traumatic foundation.
When a traumatic experience occurs, our fight or flight response becomes activated.
Our bloodstream is bathed in adrenaline.
Interesting enough, at the same time, the thinking centers of our brain go offline.
This makes practical sense because if we are in danger, we don't have time to think.
We must act immediately in accordance to the threat.
If we do not sufficiently recover from the original trauma, a type of short-circuit occurs within the Limbic system of the brain.
The memory of the experience in not appropriately processed.
It's as if it remains "hot" like a live wire.
Anything in the environment that reminds the brain of the original trauma ends up re-igniting the fight or flight response over and over again.
As I watched Lanna struggle in the elevator, she reported all the classic symptoms of an adrenaline surge.
Lanna became frightened as her heart started pumping furiously and her breathing became rapid.
She felt light-headed and tingling sensations traveled down her arms.
What a scary experience!Whatever was driving her distress became my primary focus.
Working with trauma is similar to being a private investigator.
By searching for evidence and clues, I can begin to formulate some ideas related to the origin of her intense fears.
Through this process, we discovered that a specific early life trauma had served as the foundation of her current life distress.
At four years of age, when Lanna and her mother went for a shopping trip at a department store, they became separated.
Lanna found herself underneath a shoe display table surrounded by a fabric trim.
She was terrified and from this point forward, every time she felt trapped, it reignited her anxiety and fear.
So later when her brother playfully locked her in the closet or circumstances reminded her of being lost and encased, she became increasingly terrified.
With the stresses of adulthood upon her, these fears just became more intense.
Even the simple occasion of riding in a car reminded her brain of being trapped and in danger.
We solved the first part of our mystery.
Obviously the second problem could not have anything to do with it, or could it?A little insider information about child development ended up being the key to Lanna's second dilemma.
At three years of age.
children go through a stage of development fondly referred to as "narcissistic.
"Children believe that everything that is good in the world is because of them.
I know, you have bosses or acquaintances who feel the same way.
Now you know why.
They never moved past this stage of development.
Unfortunately, at age four, a new dimension is added.
Not only is everything good because of them but everything bad is their fault as well.
So in Lanna's kid mind, she was not just lost in the department store, but rather, she was abandoned.
Little Lanna believed that she had done something wrong that made her Mom go away.
This set into motion a fear of abandonment that just grew stronger as she matured.
To avoid the pain and loss, Lanna would reject her boyfriend before he would inevitably leave her.
This gave her a sense of control but at a very steep price.
Defining trauma as a foundation of distress is an important aspect of psychotherapeutic treatment.
One major mistake made by mental health professionals is to believe that trauma-related illnesses should be treated using the same method as other mental health challenges.
What makes this assumption problematic is that the simple act of describing the trauma will re-ignite the fight or flight response.
As mentioned before, adrenaline interferes with the ability to think.
That is why traditional talk therapy alone is not effective in dealing with this neurological response.
So phase one of treatment requires a specific intervention that severs the connection between the trauma and the hypersensitivity of the Limbic system.
This generally takes about 5-8 sessions.
Once freed from this adrenaline-laden response, Lanna was then able to look at her life experience through a very different lens.
Adrenaline would no longer interfere with her ability to think and problem solve.
The insight she was able to gain into the origins of her distress became the springboard for change.
She saw herself as who she really was:A courageous young woman with a bright future.
Through the process of rescripting, Lanna was able to reinvent herself.
Instead of feeling like she was failing in life, she was able to embrace it from the stance of compassion and understanding.
I heard from Lanna a year after completing our work.
She was smiling brightly and she told me that she was engaged to a "great guy.
"She was no longer plagued with fear and trepidation.
The incredible courage and effort displayed throughout treatment was undoubtedly the driving force in her success.