Scott Webb (Host): This is Healthy Vitals, a podcast from Summa Health. I'm Scott Webb. And right now in the United States, many everyday pressures are weighing on people's minds and impacting overall mental health. And joining us today is Dr. Jennifer Knetig, a psychologist with Summa Health Behavioral Health Institute's Traumatic Stress Center, to talk about the difference between stress and trauma and how people can manage both while supporting their mental wellbeing.

 

Jennifer, it's nice to have you on today. We're actually going to do two podcasts, so part one and part two. So, today is part one, and we're talking about stress or trauma and really understanding the difference between the two and what do we do once we understand the difference between the two. So, let's start there. Like, when people say they're stressed or traumatized, what do those words actually mean, and why does the difference matter?

Dr. Jennifer Knetig: Thanks so much for having me, Scott. So when we think about stress and trauma, while, you know, the experience certainly is different for different people. No one's experience is the same. When people say they're feeling stressed, they're typically referring to feeling overwhelmed or, like, stretched. And people who feel stress are often, I would say, experiencing a sense of urgency. They're rushing from thing to thing, either in their lives or mentally in their heads, and they may be feeling nervous. I would say that people who've been traumatized, again, everyone's experience is unique, but they tend to be feeling like they need to be more on guard. They're looking to defend themselves, to protect themselves against threats.

Host: Yeah.

Dr. Jennifer Knetig: And really, many things can feel threatening for people who've been traumatized, even everyday things like going to the grocery store on Saturday or being around family at a birthday party.

 

Scott Webb: Yeah, it's interesting, right? Like, they may sort of manifest themselves in similar feelings or emotions, but it's not a minor difference, I think, between the two. Just learning from you a little bit already. I'm wondering, is it possible for something to be very stressful but not traumatic and maybe vice versa?

 

Dr. Jennifer Knetig: Yes, definitely. So, stress really happens when we are feeling stretched beyond what is usual for us, beyond our limits. And importantly, this can be positive, right? Like a date with someone we're interested in or can be negative, like paying bills on a fixed income. I would say that things are traumatic when we are exposed to something where we are afraid for our lives or the lives of somebody else. So, this can look like a natural disaster, an accident, an assault, and I would say that traumatic events are inherently stressful.

 

Host: Oh, that's so interesting, right? That not all stressful moments are traumatic, but most traumatic reactions or emotions are probably stressful for people, right?

 

Dr. Jennifer Knetig: Well put. Yes.

 

Host: Yeah. That's interesting. I got a lot to think about today . So then, let's talk about, let's say, a normal stress reaction versus a trauma response, and maybe after an experience, what are some common reactions that can be normal, in quotes, in the short term?

 

Dr. Jennifer Knetig: Yeah. So when you think about what is normal and again, kind of prefacing with, you know, everyone's experience is different, but a normal stress reaction can look just like a trauma response. So, it can be hard for those of us on the outside knowing what is actually going on with the person. I would say that people having normal stress reaction can have thoughts that just come up and bother them during the day, when maybe they're engaged in something else. They're at work with family. They feel on edge and anxious. They may have trouble sleeping. They can feel cranky. This can be part of a very normal stress or common stress reaction.

 

And comparing it with trauma, so trauma can look like that and often does look like that, and the feelings that people have become so difficult to manage that they have to learn new ways to cope, new ways to kind of change their lives, fit this new experience, this new reality. And I would say that it's that coping that often becomes a problem for people and may be what brings them into treatment.

 

Host: Because I'm thinking about this as a person myself. You're a person, I'm a person. We're all people presumably listening to this. There's no AI involved as far as I know. So, maybe when those reactions, like I said, you know, short term, but maybe what happens, like, if they don't fade and they start interfering with our daily lives, is that what you're referring to sort of that coping and kind of sort of living with the trauma and the stress?

 

Dr. Jennifer Knetig: Yes. Yes. Like, it's a new reality. People in that state, they become more distressed. It can be harder for them to feel joy. So it's not just I'm feeling stretched, I'm feeling overwhelmed, but it gets deeper. It's like family or my loved ones are starting to notice. They may be impacted by it. My work, you may see can be affected. This is when it moves into this like longer term experience, physical health can start to be affected. Worst case scenario, people can get really depressed and think about suicide.

 

Host: Yeah, you used the word notice there, and I was thinking, "Okay, we might notice or others might notice especially." Like, are there some common emotional and physical reactions that we or others might notice?

 

Dr. Jennifer Knetig: Yes. So, kind of when I talk to my clients or people I know, I'll explain kind of these different groups of reactions that you're talking about. That first group, we call it re-experiencing clinically. But I like to think of it as really, you know, we're being haunted by this experience. So, it's like a recurring nightmare in a way. And that can show up while you're awake. You know, things just come out of nowhere. You can't get your mind out of that mental space. You can, you know, really struggle with nightmares. I think that's a common response people can point to.

 

I think the other parts that we can see that tend to happen for folks who've gone through trauma is that their bodies get put on high alert. If you're being haunted by your own mind, you're going to be on guard. It's going to show up— 

 

Host: All the time. 

 

Dr. Jennifer Knetig: Yeah, right. Like, day-to-day talking, you and I, like, it could be hard to focus on a conversation like this. It could be you may pick up on this person just doesn't seem present. They're on edge. They're really distracted. They're more likely to get angry, and that shows up in their relationships. Maybe they don't know why they're getting into, you know, driving too fast and feeling more impulsive.

 

It can affect the body, that being on high alert state can really hurt your body, because your body's cranking out chemicals you don't need, except if you're running away from, you know, something scary or trying to fight it off. And folks in this state, they don't need those chemicals, but it's happening. So, it really has a potentially global effect. And then, there's that group of reactions that we call avoidance clinically. It's the ways people learn to cope that are not healthy, that actually hurt them more than they help.

 

And then, finally, really depression. So, for a lot of people who've gone through trauma, depression, really, thinking about, you know, the ways that their experiences can really alter their own views of themselves and the world can be more long-lasting.

 

Host: Yeah, a lot to unpack there. Being haunted, I think we can all sort of identify with that fight or flight and, as you say, those chemicals firing off that we really don't need, that aren't really beneficial to us, especially in those situations where we're not really "fighting." Is that when it becomes clinical, right? When it just becomes this thing that's just sort of overtaking our lives, whether it manifests in itself in avoidance or being on edge or nightmares or—you know, is that when we really need to talk to somebody, Jennifer, when it just is just all too much?

 

Dr. Jennifer Knetig: Yeah, I would agree with you that that's often a time when people are able, they seek out help from a clinician. I think that, it's at that point where people begin to notice, just as you said, the avoidance. The things that they've learned to do to try to make it better, they maybe make it better in the short term. They get temporary relief. That's why we do those things. But then as a long-term strategy, it actually makes it worse. So, those things we learn to do to make it better, in the short term, you know, it can help. Like, 'I don't have to think about this."

 

Host: "I can just not think about this thing right now. "Sure.

 

Dr. Jennifer Knetig: Yeah. Right. "I don't have to feel this way. I don't have to go back there." And I think some common ways we do that, using substances, you know, drinking, other drugs, for some people, they get to the point where there's a numbing that happens where, you know, they've learned to kind of numb out the fear, the guilt, shame, anger, whatever it is.

 

But, unfortunately, it's hard to numb out the negatives without also numbing out the positives. So, people who get to this point where maybe they, you know, they want to bring a clinician in may share, you know, "I don't feel happy anymore. I don't get the same satisfaction out of my work, my activities, family." It can move into being more isolated. And then, you know, we talk about dissociation in my field, where, you don't really know what's happening, but your body's there, your mind is not. That's more serious.

 

Host: You know, I don't want to speak for everybody but myself, you know, I'm sure I know that there have been times in my life where—and it wasn't just because I was distracted by my phone or something, where there's something more serious troubling me, be it stress or trauma and I'm there but I'm not really there, right?

 

Dr. Jennifer Knetig: Yep. I would agree. And unfortunately, the people on the receiving end of that, they don't know why you're not there.

 

Host: Right, right. They're like, "What's wrong with him?"

 

Dr. Jennifer Knetig: Right. And then, they may blame themselves and think there's something wrong with them. And I think you raise a good point that often a common outcome for people who've gone through trauma is the effects on relationships

 

Host: Yeah, I wanted to ask you about that because I'm thinking about where the sort of venues, if you will, like does stress and/or trauma manifest differently at work versus home or in relationships? It seems like it may not always sort of, you know, be the same in each of those areas of our lives.

 

Dr. Jennifer Knetig: Right. Yeah, I would say that some kind of concrete examples of this, people who've been through trauma are more likely to call off, you know, from work, be late, have a hard time holding a job, and as a result, they struggle financially. There's the struggle in relationships. You describe this experience, if I'm checked out, you know, I don't feel present, you know, to my loved ones and, they may not know why, because part of this for a lot of people is shame and hiding actually what happened. 

 

I think kind of the worst kind of like most extreme levels of relationship impact are intimate partner violence. People with PTSD are more vulnerable to experiencing violence in relationships and to struggling with their own anger. I think when we think about family impact, trauma survivors are more likely to be like these helicopter parents who are more, more anxious and controlling. It's coming from a place of protection, their kids don't feel that. And they feel like I'm being controlled, and sometimes intimate partners can have like—it'll be a similar dynamic, you know, where they're experiencing this control, but the survivor is just trying to protect. I would argue that is not always the case, but that's the motivation.

 

And I think kind of extending that out to like loss, we talked earlier about numbing out numbs out the good and the bad for a lot of people. So, losing interest in sex, having sexual dysfunction. So again, going back to if you're in a relationship, you know, the other person may not know why their partner's pulled away and can cause real conflict and sadness.

 

Host: Yeah. You know, as I mentioned, as we got rolling here, we're going to have a part two of this episode, so a lot more to get to. So, I don't have to feel like I have to squeeze it all in today. But just want to finish up, if someone realizes like, "Okay, this is more than everyday stress," right? What are some maybe helpful first steps they can take right away? Like, what can we do to help ourselves before we meet with a clinician?

 

Dr. Jennifer Knetig: So right away, I want to tell listeners, you know, don't judge yourself. But that's easier said than done. I would say that survivors often do that. So, I would encourage people, try to catch any judgments that you have for yourself, like, I'm overreacting," or, "Why am I so upset?" Or, you know, "Something must be wrong with me. Just get over it."

 

I would say that doing those things and validating how you feel, how you think, is the opposite of what you need. What people need, number one, in my opinion, and just me, is gentleness, is self-compassion, is really striving to understand what's going on that I'm so angry, that I keep thinking about this. What's going on that I've pulled away from my family? So really, you know, just approaching with curiosity. It's important for listeners to know that the more we try to block these things out and just get over it, stop thoughts, stop feelings, the longer they stay and the stronger they come.

 

Host: Yeah. Yeah, the word that came to mind listening to you there was grace. Just allowing ourselves some grace and to just work on, you know, trying to understand what is this and where is this coming from? And, you know, as you say, the approach of get over it, that doesn't work in the long term. That's a short-term thing. You know, "Rub some dirt on it, you'll be fine." Yeah, maybe today I'll be fine. In this moment, I'll be fine, but I'm not fine, right?

Dr. Jennifer Knetig: That's right. That's right. And finding people, if you have that luxury of having a safe person who isn't there to judge you, they will can just sit with you and be with you, witness this, you know just be present can help you, I think, get to that place of more compassion and grace, as you say.

 

Host: Right. Well, I'm looking forward to part two. The thing about podcasts which is great is we can listen to things and we can replay them over and over and over and refer back to them. So, I hope that folks do. But I know we're going to talk again soon, and I look forward to it. Thanks so much.

Dr. Jennifer Knetig: Thank you. 

 

Host: And to learn more about Summa Health Behavioral Health Services, visit summahealth.org/behavioral or call 234-475-HELP. That's (4357). That's 234-475-HELP, (4357).

 

And if you enjoyed this episode of Healthy Vitals, we'd love it if you'd leave us a review. Your review helps others find our educational content. I'm Scott Webb. Thanks for listening, and we'll talk again next time.