#AskTheExpert with Doc Joan Rifareal | Ep. 1: Recovering From Trauma (PTSD)

Watch episode 1 in our special #AskTheExpert series for International Women’s Day 2022, tackling mental health issues that continue to plague women today. Our expert is none other than psychiatrist Dr. Joan Mae Perez-Rifareal.

[What follows is the complete episode transcript]

Kai Magsanoc: Hello po sa inyong lahat. Welcome po sa special series ng #AskTheExpert ngayon pong International Women’s Month. Syempre, pag-uusapan po natin ang mga issues na kinakaharao ng mga kababaihan lalo na sa kanilang mental health na importante pagusapan hindi lang po sa International Women’s Day, which is on March 8, pero kung pwedeng araw-araw itong conversation. And syempre po, hindi po magiging kumpleto ang ating International Women’s Day celebration sa Hello Doctor kung wala po ang aming favorite na mental health champion. Walang pong iba kundi si Doc Joan Rifareal. Hi, Doc Joan.

Doc Joan Rifareal: Hello hello, Kai at sa lahat po. Happy International Women’s Month sa lahat and here sa Philippines, Happy National Women’s Month this month of March. Hello sa lahat po. Thank you for having me, Kai. Thank you. 

Kai Magsanoc: Of course, Doc Joan. When we thought of having this series, we couldn’t think of anyone else but you, like it was a unanimous, like your name was out of everyone’s mouth. Doc Joan, before we start with the topic, why do you think it is important for us to talk about mental health in relation to women?

Doc Joan Rifareal: Oh, of course, very important and relevant lalo na ating celebration this month, International Women’s Month. We know na talagang in our communities na sobrang laki ng roles na ginagampanan ng mga females. So, we always take into consideration na ang dami, especially during this time of pandemic. Ang females, in fact, are taking on multiple roles, multiple tasks. At kailangang pagtuunan din natin ng pansin iyong overall health and well-being ng mga kababaihan, especially iyong mga nagtatake-on ng multiple roles, at alam natin na studies have shown na mas affected ang females during this time of pandemic especially because of, again, from the roles, cuts sa mga jobs natin , or sa mga trabaho. May mga nagkakaroon din ng mga concerns about their relationships. So, studies have shown that tumataas ang numbers ng mga nakakaedxperience ng abuse in the homes during this time of pandemic na lahat tayo ngayon, or may time noon na almost all of us nanatili ssa ating mga tahanan because of stay-at-home measures. So, may mga domestic violence and abuse also na narereport. Kaya kailangan bigyan natin ng importance ang mental health at ang overall health and well-being ng mga kababaihan, especially sa ating pagcommemorate natin ng month of March ng National Women’s Month. 

Kai Magsanoc: So Doc Joan, let’s start for this particular episode talking about PTSD or trauma. What is PTSD?

Doc Joan Rifareal: Yes, ang PTSD ang ibig sabihin po nito ay Posttraumatic Stress Disorder, meaning from the term itself, ito iyong mga stress-related reactions secondary or pagnakararanas ang isang individual ng something traumatic. Traumatic meaning mayroon siyang impact sa life, something life-threatening, mayroong impact sa security at safety ng isang individual.

Kung mayroong impact kasi na parang naapektuhan ang safety, security ng isang individual siguro dahil sa, halimbawa lang po, pangaabuso, be it may mga sexual assault, abuse, for example, especially for women. So, it can be very traumatic. So parang itong PTSD ay parang mga reactions because of the stress from the trauma. Again ang trauma na sinasabi natin dito ay life-threatening. Usually ang mga forms ng trauma kasi mayroong tinatawag na trauma from calamities (bagyo, typhoon), mayroon din mga accidents.

But, studies have shown na mas matindi ang impact ng trauma from interpersonal experiences or events. Experiences like abuse, rape, trauma sa personhood, sa pagiging tao ng isang individual. So, iyon po ‘yung PTSD. Again, ito po ay karaniwan po na nararanas natin ‘pag after exposure to a life-threatening event, kapag tayo mismo as individuals ang naexpose, or ‘pag mayroon tayong narinig na dumaan sa ganoong traumatic experience. So, parang nakararanas din tayo ng trauma dahil sa ating mga nalaman at narinig. Or, ‘pag tayo naman po ay nawitness natin ang isang accident, na halimbawa pangyayari in front of us. So, be it to us, ourselves, experience it, or we heard about it, or we witnessed it happening to someone. 

Kai Magsanoc: Wow, pwede pa lang secondary, Doc Joan. Parang narinig ko lang tapos natrauma rin ako. 

Doc Joan Rifareal: Ah oo,  pwede iyon. Ang tawag doon ay secondary or vicarious trauma.

Kai Magsanoc: I see, that’s a nice thing I learned from today. So, that can explain a lot, especially when you are a very compassionate or empathic person. 

Doc Joan Rifareal: Yes, oo. Nangyayari iyon Kai, in fact, nangyayari iyon kahit sa mga healthcare workers, frontliners. Halimbawa itong panahon ng COVID, hindi sila directly ang nagkaroon ng infection, for example ng COVID, but because kasi nga nasa hospital sila, frontliners, nakikita nila iyong mga experiences ng iba, sa mga patients nila. So, they can also feel that secondary trauma kaya nagkakaroon ng PTSD even iyong mga frontliners natin during this time because of that secondary traumatic experience. 

Kai Magsanoc: Okay so, naexplain niyo naman na doc iyong causes ng PTSD ‘no. So, what are the long-term effects of PTSD?

Doc Joan Rifareal: Yeah, ‘pag ang PTSD kasi — it’s a trauma and stress-related problem. So, kung hindi ito naagapan agad or hindi siya naassess nang maayos at hindi nabigyan kaagad ng therapy o ng treatment, pwede magdevelop into other forms of mental health concerns. Pwede siyang magprogress — it can lead to symptoms of anxiety. Ito ‘yung mga pangamba, takot, excessive worrying. Again, there is that threat to one’s safety and security. So, pwede magdevelop also sa symptoms of depression, pagkalungkot, especially ang trauma is something na very tremendous, or huge ang impact, may lossess involved. Any form of loss, which can be traumatic, can also make us feel sad or depressed, so pwede magkaroon also ng symptoms of depression. Ang iba naman po, pwede it can be long term, lalo na kapag paulit-ulit iyong trauma. Halimbawa, hindi lang siya one time, but we are constantly exposed to the perpetrator, for example, ng trauma. So, pwedeng maglead to complex posttraumatic stress disorder. 

Kai Magsanoc: Okay doc. So, how does this manifest parang in our daily lives — how do we see someone with PTSD? How do they act out, ‘no? Kasi ‘pag sa mga movies and sa mga series, ‘pag sinabing PTSD diba usually depicted as war veterans, and then they end up hurting others, diba. Pero from what you have seen, especially with women, how does PTSD manifest, for us who are observing also?

Doc Joan Rifareal: Correct, oo. It can manifest in 4 general groups of behavior. Ang first noon is intrusive thoughts or experiences, meaning ‘pag minsan because of the traumatic experience, ang cinocomplain or laging inuulit-ulit during therapy is nagkakaroon sila ng nightmares about the traumatic experiences, flashbacks, and pauulit-ulit so talagang it’s intrusive to that point na ‘pag minsan naapektuhan na ang kanilang sleeping patterns because of this mga nightmares. Another group of symptoms is iyong hypervigilance. Iyong parang nagiging very ano sila, very vigilant, na parang konting sound na naassociate nila with the traumatic experience. Parang konting kalabog or parang bang, parang nagiging jumpy kaagad, so it’s a form also na nagiging anxious kaya para silang on the edge lagi. Laging silang naglolookout for possible dangers, so isa iyon. Another is dysregulation sa kanilang mood.

Ito iyong sinasabi mo Kai na sometimes they feel agitated, iritable, mabilis silang mawalan ng patience, madaling uminit ang kanilang ulo. It can also manifest on terms of mood  changes or dysregulation. And lastly, avoidance symptoms. For example, kung itong place na ito, dito nangyari ang traumatic experience nila, inaaavoid iyon kasi, again, may takot eh ‘pag babalik ka roon sa situation na iyon, place na iyon, or even talking about that place kung saan naganap or this person, bumabalaik lahat ng mga emotions from that traumatic experience, so inaaavoid nilang pagusapan, inaaavoid nilang balikan ang mga places as much as they can. So, those are the 4 groups of symptoms or behaviors.

Kai Magsanoc: Thank you, Doc Joan. So now we have a better understanding of PTSD, kung sakali pong mapansin niyo ‘yun sa mahal niyo sa buhay, sa kaibigan niyo, kaopisina, kaklase, let’s be very kind to them, ‘no. So, those who are suffering from PTSD, to close this first episode Doc Joan, I’ll let you close this. Let’s end this with practical tips on how a woman suffering from PTSD can overcome and manage. I’m sure there is a way out, diba, so go ahead, Doc Joan. 

Doc Joan Rifareal: Yeah, and it’s very important. Correct correct, Kai. First, let’s remember na it’s always a process. Mas maganda tandaan natin proseso siya lagi, and ‘yung healing and recovery from a traumatic experience. Hindi siya parang overnight, parang magic lang na tomorrow, okay na tayo, so hindi po. Mas maganda mas realistic din tayo sa ating mga thoughts about our healing, progress in therapy and treatment. Proseso po siya at mas maganda sa proseso po na ito towards healing and recovery. Ang tawag lagi namin dito ay transforming from victims to survivors. We survive a traumatic event. Sa prosesong ito — from transforming an individual from a victim to a survivor state,  mas maganda kung malakas ang ating social support system.

Tandaan natin na mas maganda na may nakakausap, someone we trust para bumabalik kahit slowly, again, it’s a process, iyong feeling na we are safe. Mayroon tayong mapagsasabihan ng ating thoughts, feelings about the experience. And through that, telling and retelling is important; proseso rin kasi iyon, and it can help in the process ‘pag tayo ay inuulit ulit natin — tell and then retell. Paulit-ulit lang to someone na we trust kasi sa ating pag-uusap, sa ating pagcommunicate ng feelings and thoughts about the traumatic experience, nagkakaroon din tayo ng way of expressing our emotions. Nagpprovide rin ito ng brighter or wider perspective (pananaw). Or, sometimes also naktutulong while we tell and retell, napaiiyak tayo, napaluluha, so it’s also a nice way of expressing everything.

Mas maganda ‘wag natin siya i-bottle-in, i-bottle-up ang ating feelings; mas maganda i-express natin. Ayaw po natin ‘yung parang nandito lang sa loob, and baka lang po ‘no, magmanifest into something na unhealthy na behavior later on ‘pag ito ay ating i-deny at hindi natin ito napoprosseso nang maayos with a loved one or with our family and friends. Make sure that you are safe always. Also, safety is the priority. Mas maganda kung tingin natin na kaya natin i-avoid iyong situation na iyon, especially kung may perpetrator; mas maganda i-avoid natin to keep ourselves safe always. And, make sure again na process siya. Do not feel or do not blame yourself sa kung ano man ang nangyari kasi, agai, it’s never your fault. At tandaan natin na help is always available for experiences like this. 

Kai Magsanoc: Okay, thank you Doc Joan!

Doc Joan Rifareal: Thank you!

Learn more about nurturing a healthy mind here.