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Ptsd And Pots - Considerations For Therapy


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I've just started to work with a therapist to tackle my frustrations about how POTS changes my life as well as hopefully resolve PTSD caused by childhood trauma, which has resulted in insomnia, nightmares, and flashbacks for 20+ years. My therapist plans to talk to my doctor about possible implications of different types of therapy to see which will be the most helpful without causing enough stress to make my POTS symptoms flare up.

I feel like it's a really difficult balancing act. The flashbacks and POTS symptoms mirror each other - tachycardia, arrhythmias, difficulty breathing, numb or tingling hands and feet - but require very different approaches. If my symptoms are caused by POTS, I need to lie down and elevate my feet quickly to avoid fainting, and sometimes I still pass out (something I know most of the forum members are all-too-familiar with). If my symptoms are caused by a flashback, moving seems to be the most helpful.

We're specifically discussing exposure therapy regarding the PTSD, but have also discussed other therapy modalities. Does anyone have any suggestions for therapy options that would address childhood trauma without worsening POTS symptoms? My therapist has been checking out this website for more info on POTS and will follow this thread too. We're both open to suggestions!

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I know this may sound crazy but my understanding of exposure therapy begins by discussions of the triggering factor. (?) Is it possible to start the therapy with you laying down thereby decreasing the Pots type reaction factor? I'm sure it wouldn't remove it altogether but it may be worth a shot. Please pardon me if I am way off. I send you good wishes!

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Actually, raisins suggestion Of laying down for therapy is, I think, a pretty good one. My psychiatrist has a chair for a patient to sit in, or a sofa. I used to get through most of my sessions while sitting in the chair but occasionally I'd spent the time on the sofa with my feet up. At this time, every session I go to is spent on the sofa because I'm very 'potsy' at the moment. Also, most days we turn off artificial lighting and open the blinds to let in natural sunlight. Some days when I'm highly sensitive to light I will wear my sunglasses. He's got used to my ways. I pay his secretary the fee before I go into the appointment so that afterwards, when I am more likely to feel physically and emotionally drained I can leave straight away.

I find my psychiatrist is very flexible and accepting about me moving around or lying still or whatever and I appreciate it. I have been a bit of an education for him.


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  • 2 weeks later...

You may want to consider Somatic Therapy, Somatic Experiencing as put forth by Peter Levine, MD. It's been successfully used by many Vietnam Vets for PTSD and by people who "hold" muscular tension patterns. These will impact the body globally. The Philosophy is to never discuss the triggering factors since this in itself is traumatizing. You may want to Google it & explore.


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I hope you find something that helps and works for you!! We are each unique even though we share similar symptoms and life trials so I think you will find you have to try different things and see what works best for you.

You didn't mention if you were looking for medications or non-medication approaches. If you are looking for medication approaches then, in my experience and research, Have you had any catecholamine testing with your POTS medical workup? If not, it may be helpful to have this testing done (just do some research and find a facility that know how to do the test properly--I forget the exact protocol but you have to avoid certain foods, meds & activity for a period of time before the test. At the beginning of the test they insert an iv and draw blood and then I believe you lay down for 15-30 minutes in a still and calm environment and they may draw blood again from the iv somewhere in that time frame then they have you stand up for a few minutes at the very end and draw blood again. It's important to know what your levels are standing vs. laying down because that potentially gives you answers about whether or not you have any abnormal catecholamines causing issues for you (some people with POTS do and some people don't because there are so many reasons why people have POTS). Anyhow....if you have excess of any of the catecholamines that may help determine if/which meds you might tolerate best. I believe Lexapro is supposed to be one of the 'cleanest' SSRI's. The other suggestion I have if you decide to try medication to assist you---try to get medication in liquid form and start with very small doses--at least 1/2 the strength of what a Dr. would typically prescribe for a new patient (many people like us are extremely sensitive to meds)

For non-medication approaches....I agree with trying to recline when processing trauma memories. Also try to do some deep breathing work. Would it help to maybe get a product called therapy putty (comes in different colors for different strengths) if you recline to help control the POTS symptoms but get a flashback, rather than moving your whole body perhaps using a product like the therapy putty would give your body something to do and a way to release some of the energy/need to move that you feel while at the same time remaining relatively still so you can control the autonomic symptoms.

I also think it's important to take things slowly and make sure you allow your body 'recovery time' after a therapy session. Especially for intense sessions it may take a day or so for your body to calm. It's a delicate balance to try to work through memories so they don't keep haunting you and so that you can release them but at the same time doing it in a way that doesn't throw your autonomic stuff into too much chaos.

If you can find a therapy technique that doesn't require you to talk about those memories then you might try that because that might be less triggering to the ANS system. Those have never worked for me but again, everyone is different and it's worth exploring.

I wish you the best on your journey to health and healing!

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