Crisis: Knowing When to Call

Crisis: Knowing When to Call

Simply put, a crisis is when you need serious and urgent help from others because your own ways of coping are not effective enough at the moment.

On July 16th, the new number for the mental health crisis changed to an easy to remember three digit number, 988.  So many people hear about crisis resources and helplines, but never believe they will be in the situation where they need these resources for themselves. Even the word “crisis” elicits all sorts of ideas from different people. Maybe you think about someone who is suicidal or someone who seems “out of control.”

While these are common and important examples of what a crisis might be, there are other types of crises that you may have not considered. A family who is going hungry due to lack of food resources, an elderly person in need of healthcare access, or someone who needs to get connected to metal healthcare providers are all additional examples of what a crisis may look like.

When you experience a crisis, you may feel certain sensations in your body. Your breathing may be strained, your heart may race, or your chest may feel heavy. Internally, you may feel confused, angry, helpless, shame/guilt, vulnerable, anxious, or hopeless. It may be difficult to self-regulate during a crisis and bring your body back to its natural equilibrium state.

Simply put, a crisis is when you need serious and urgent help from others because your own ways of coping are not effective enough at the moment.

Many external and internal factors can lead to a moment of crisis. Perceived loss and traumatic experiences can cause someone to depend on coping and problem-solving skills to regulate. When these skills are not sufficient for the individual to return back to a state of being emotionally regulated, this increases the individual’s anxiety and fear. Often in this elevated state, external regulators such as substances, other people, or belief systems may be utilized. An individual usually comes out of crisis once the situation or internal experience is changed in some way. Making a call is one of the best ways to deescalate the situation.

Luckily, making the call in a crisis has become simpler and easier than before. Tennessee offers two numbers, the 211 helpline and 988 hotline.

When to call 211

The new Tennessee helpline is now active and ready to provide callers with the resources they need. The 211 helpline is active 24/7, 365 days a year. The professionals on the other end have access to 10,000 health and human service programs, so you can be pointed towards the arms of others waiting to help. If you need immediate food, water, shelter, or safety, call 211. If you need housing or employment assistance, call 211. If you are struggling with your mental health, but not in crisis, call 211 to get mental health resources.

When to call 988

Another important three-digit number to remember is the 988 Mental Health Crisis and Suicide Hotline. If you or anyone you know is in crisis, especially if that includes considering suicide, calling this number will connect you with trained mental health professionals to deescalate the situation. Depending on the intensity of the need, the professional on the other end of the line will help walk you through your moment of crisis, refer you to local mental health providers, or provide you with immediate emergency services. The 988 line is there to serve you no matter if you are experiencing a panic attack or actively wanting to complete suicide. 988 also works for text or you can even chat online at

Regardless of your circumstances, if you find yourself in a situation and don’t know the way out, just dial three numbers and speak with someone who can offer a helping hand. You don’t deserve to sit in the darkness alone, there is hope at the other end of the helpline.

If you are unsure if you are having a crisis, it never hurts to call 211 or 988. There is no shame in saying “I need help.”

If you do not believe you are in crisis and would like to get connected to mental health professionals, The Refuge Center for Counseling is also waiting with open arms. To make the first step and schedule an appointment, call 615-591-5262.

If you would like additional information on the new 211 helpline, you can find it here If you would like additional information on the new 988 mental health crisis hotline, please visit

Blog written by Master’s Level Intern, Madison Josey and edited by Weatherly Hulsey

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Healing and PTSD

Healing and PTSD

"Our capacity to destroy one another is matched by our capacity to heal one another. Restoring relationships and community is central to restoring well-being. " -Bessel Van Der Kolk

I’m fine. Everything is fine. If I just close my eyes and take some deep breaths my heart will stop racing. I’ll just keep rubbing my palms on my jeans. This is ridiculous. 


It was only a text. Just a stupid text. So why are my breaths so shallow? Why is the room spinning? 


She curls up on her bed, hugging her knees to her chest. Raggedy, guttural crying only adds to the shaking. Nobody is there to hold her. Her children hesitate on the other side of her bedroom door, listening to their mom’s stifled sobs.


What is wrong with me? This is not a big deal. I wasn’t beaten. I wasn’t raped. I wasn’t tortured or shot at … It was just a text from him … the man I finally walked away from. 


I am fine. I will get over this.


But she wasn’t fine. She was not okay. No matter how much she tried to convince herself, no matter how many times she lied to her heart, she was in no way fine. And she would definitely not be getting over anything … 


Not without real help. 


Yet she didn’t really know what was happening to her. Clearly, panic had gripped her body and her mind. Her trigger was obvious—the text. But why did just seeing his name on her phone screen cause an uncontrollable visceral reaction?


Because this is the veiled face of a PTSD flashback. 


This is the face of PTSD that people don’t recognize. It’s the face that you walk around with every day, going to work, cooking dinner, running errands, grabbing dinner with friends. It’s the face that smiles, laughs, lends a listening ear, and offers a kind word. This is a face that just keeps on going, day in and day out. 


The feeling of anxiety and tension, staying in high-alert mode, blaming yourself, waking throughout the night, crying yourself to sleep, crying in the shower, avoiding certain places, feeling irritable, startling easily, and feeling overwhelmed have just become your norm. You’re used to it. 


It’s just part of your life.


And it’s just a little thing called Complex PTSD. C-PTSD is sneaky. It tucks itself away in the corners of your mind and recesses of your body, keeping just enough of a grip on you that you’re not quite sure it’s there … Until some outwardly benign thing comes into view. A phrase, a sound, a look, a song on the radio, a particular restaurant, a simple text. Any of those things might trigger your body and mind so sharply that you feel like you have no control over what’s happening. You feel like something else has overtaken you and you’ve become a prisoner in your skin.


When we think of post-traumatic stress, we picture Vietnam War vets who are re-traumatized by loud noises and experience nightmares that cause them to cry out in their sleep. We think of people who have survived a mass shooting. We think of women who survived sexual assault. That’s because we associate PTSD with major traumas. 


But there is another common cause of PTSD called complex post traumatic stress disorder (C-PTSD) which is made up of “little t” traumas that happen over and over again. These cumulative, unresolved traumas, like bullying, neglect from a parent or partner, or rejection or abandonment from social supports. These are the kind of traumas that somebody may have told you are no big deal, but our little traumas matter. And healing from those little traumas is possible. 

In the book, The Body Keeps the Score, Dr. Bessel Van Der Kolk highlights four fundamental truths about post-traumatic stress disorder (PTSD) and healing:

  • “Our capacity to destroy one another is matched by our capacity to heal one another. Restoring relationships and community is central to restoring well-being. 
  • Language gives us the power to change ourselves and others by communicating our experiences, helping us to define what we know, and finding a common sense of meaning. 
  • We have the ability to regulate our own physiology, including some of the so-called involuntary functions of the body and brain, through basic activities such as breathing, moving, and touching; and 
  • We can change social conditions to create environments in which children and adults can feel safe and where they can thrive.” 

These truths are meant to help people suffering from PTSD to own their healing journey and become a participant in the process, rather than being a passive patient. They point your healing journey inward and place the keys to healing in the hands of those who are suffering and their community of support. 


Relationships and Community

 Dr. Van Der Kolk’s first point claims that while humans have the capacity to deeply wound one another, they also have the radical ability to help in the healing process. This is consistent with the view that humans are highly relational beings, and that when our needs cannot be met by others we are met with suffering. From birth, we cry out to others to fulfill our needs. Unfortunately, we learn as we grow that our cries are not always met with the comfort our souls crave. When our sense of identity and hope is marred by the hands of another, we may run far away from relationships and cling to the fear that we’ll just be wounded again.  Self-protection drives us to make vows to decrease our vulnerability, hoping to never experience the trauma, heartbreak, or suffering again. The ironic thing is that when we decrease our vulnerability, we increase our shame. And shame? Shame weighs on you like a wet blanket.


When others see us just as we are, that allows us to understand and embrace ourselves. The problem is that when we are hurting we believe we’re alone. We might know that we need relationship, but we don’t know who would be safe to talk to and let our guard down. You may have tried this. You may have offered your heart on a silver platter only to have it sprinkled with empty platitudes, promised prayers, and a good old broom to sweep it under the rug. If this has happened to you, it is awful. It is not okay.  And those are not your people. 


There is healing when you are seen and heard. There is healing when you find a safe person who allows you to lay your burdens down and rest awhile. But it starts with our own vulnerability. Start with one person you already trust or suspect is trustworthy–it could be a parent, partner, therapist, teacher, coworker, new or old friend, or anyone willing to listen. Start by asking if they’re open to a conversation and if so, take the risk of admitting the hurt and asking for what you need. You may not know what you need yet. That is okay. Your healing is worth it. 


Name it to tame it.


If you’ve experienced trauma, you may have an awareness of deep suffering but you may not grasp why or even how you are suffering. You may not even know how to put it into words. It may be painful, uncomfortable, or scary to speak the pain into existence. Remember, things fester in the dark. Dr. Van Der Kolk hints at this idea when he describes how language can help us make meaning out of our painful experiences. When you don’t know how to name your suffering, it can feel wildly overwhelming. Shame may kick in and whisper that there is something innately wrong with you and that’s why you have issues. But the truth is that your mind, body, and soul are having reactions to the unresolved pain in your life. 


Naming your pain may cause intense reactions such as emotional distress, flashbacks, or physiological symptoms such as shaking, sweating, etc. Having a trusted and qualified mental health professional to come alongside you and address the root of the pain can lead to greater freedom.  If you have PTSD, confiding in a mental health professional can help you understand how your trauma affects your life in the present and how to move forward. And wouldn’t it be amazing to be unstuck? Wouldn’t it be wonderful to see a path forward and walk on it?


Self- Regulation

When you are a victim of trauma, whether big or small, you may struggle to function in your everyday life no thanks to intense fight-or-flight responses to normal stimuli, like seeing an abuser’s name. Many combat veterans with PTSD are triggered by sights and sounds like fireworks. A therapist can help you identify your triggers and regulate your fight-or-flight responses in healthy ways. The good news is that there are quite a few ways to interrupt your fight-or-flight response. In Dr. Van Der Kolk’s third point, he states that involuntary actions such as breathing, moving, or touching can help regulate our nervous systems. 


You may have already discovered that deep breathing helps when triggers or anxious thoughts arise. When you take long and deep breaths, you communicate to the body that it is safe, that no threat is present. Breathing in, holding it, and slowly exhaling causes your heart rate to slow and the body returns to a sense of safety. 


Breathing may not do the trick. You may need to move by doing yoga or going for a walk. Getting physically active can be like balm for an overactive mind and body. Studies have shown that walking, or any bilateral movement, stimulates both sides of the brain. This paves the way for greater emotional processing, allowing your thoughts and feelings to become more coherent. 


When walking is not available, some people find tapping on both sides of the body provides similar effects. Whether you choose mindful breathing exercises, gentle movement, or both–utilizing these mechanisms can help calm a heightened nervous system and communicate peace and safety to the body. 

Safe Environments


Along with internal work, changing your environment can bring positive change when you have PTSD. Dr. Van Der Kolk emphasizes that social conditions play a large role in creating safe environments for people with PTSD. Participating in theater is a useful tool. People may come in highly unattuned to their bodies and uncertain how to engage with others in the space, so the director intentionally works to slow things down. 


A director who works with traumatized teens described to Dr. Van Der Kolk how he structures his theater practices. He first gets the participants up and walks around the room. He uses small steps to create safety. This example shows the need for those with PTSD to engage in social settings slowly and carefully.  Beginning with something like a theater, music, or dance class may help build social skills and awareness that translate to real-world scenarios. Additionally, utilizing the safe space of a therapist’s office may be a good first step if a class with other people seems too daunting. 


If you are a victim of trauma, big or small, one or many, know that healing is possible. There is no way to remove your past, but there is a way forward. You are not what happened to you. You are not your past. Your heart is worth healing. 


Here at the Refuge Center, we see you and want to honor your unique and valid needs. If you feel that the next step in your healing journey may be to reach out to a mental health professional for help, we would love to meet with you and walk alongside you in the process. You may reach us at 615-591-5262 to take the first steps. 


A., V. der K. B. (2015). The Body Keeps the Score: Brain, Mind, and Body in the Healing of Trauma. Penguin Books.

Blog written by Master’s Level Intern, Madison Josey and edited by Shelby Rawson

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Letting Go of the Struggle

We learn patterns of coping from a young age and often these same ways of coping that helped us survive in childhood become cumbersome later in life.

Life can be hard.

The ways we learn to cope with life’s pain can be learned in childhood or during a tough season of adulthood. We learn patterns of coping from a young age and often these same ways of coping that helped us survive in childhood become cumbersome later in life.

Sometimes, after a season of hardship or struggle, we can forget what it feels like to be in a healthy cycle of rest, times with a healthy amount of stress that is followed by another time of rest. Some common coping behaviors are drinking, worrying when there’s no clear benefit, getting used to chaos and struggling to enjoy good times when things get easier.  

A good example of this is the usefulness of snow chains on a tire when it’s snowing outside. When the weather is bad, those snow chains are essential, you couldn’t get anywhere without them!

But what about when it’s summer and the roads are dry and dusty? I am not a mechanic, but I do know that in that scenario, snow chains would be harmful, not helpful.

We can think of our own learned coping mechanisms in the same way. When we were in childhood or going through a hard time following a death in the family as an adult for example, we needed those coping mechanisms to keep us afloat. When the sun comes back out and life is good again, how do we take off the snow chains from our proverbial tires? Well, one way to start examining those things that have helped us cope in the past, but may not be as helpful now, is to just start observing when you do that behavior.

An article on the Good Therapy website describes this struggle in these words:

“Oddly enough, painful feelings can be comfortable, especially if they’re all you know. Some people have trouble letting go of their pain or other unpleasant emotions about their past because they think those feelings are part of their identity. In some ways, they may not know who they are without their pain.”   

So, who would you be without your pain and negative coping mechanisms?

Some good ways to start learning this about yourself is through these three options:

  1. Beginning therapy
  2. Finding your trigger points. When do you feel a spike in those anxious and painful feelings?
  3. Observe them, but don’t judge. Simply start becoming aware when and how often you engage in that behavior.

If you’d like to begin therapy and explore these topics, give us a call at 615-591-5262.

Cohen, I. S. (2017, Aug 7). Important Tips on How to Let Go and Free Yourself.

Retrieved from

Written by Refuge Center Masters Level Counseling Intern Tiffany Miller.

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Five Tips for Relieving Stress

Before we find the solution to the problems we experience, we can carry a lot of stress. Here are a few tips to help manage the stress before the solution is found.

Life can be unpredictable and painful, and sometimes even when things are good, day to day life can feel overwhelming and stressful. Learning what you need to help release that negative stress can go a long way in gaining energy and health. In a 2018 Time magazine article, stress is described as “an imbalance between a challenge and the resources they have to deal with it…” Before we find the solution to the problems we experience, we can carry a lot of stress. Here are a few tips to help manage the stress before the solution is found.

  1. Stop and acknowledge: When you feel pressure mounting at work, or home, a good first step is to stop and acknowledge to yourself that you are feeling stress. Simply stating that you are stressed out loud to yourself or someone else can help take the edge off.
  2. Body Scan: Try and identify what that stress feels like in your body. A simple way to do this is to close your eyes, start at your toes and scan your body for where you feel any tightness, shortness of breath, tingling or warmth. You may feel something that isn’t listed here, and if you notice that, that’s great! You are making great strides in getting to know your own body and how you experience stress. Once you identify where your body most feels your stress, try to soften it and send some love to it.
  3. Deep breaths: Calm, deep breaths can help send the signal to your physical body that everything is ok. Try to make the exhale twice as long as your inhale breath to help your body kick back into a resting state.
  4. Remind: Remind yourself that all stress is not negative, and that it can be incredibly useful! In small amounts on a daily basis, it can help you be a better problem-solver and gain new skill sets which then boosts self-confidence. The key is to view it as a friend, not an enemy.
  5. Assess: Assess the activities and obligations in your life to see if anything could be reduced, cut out or altered in any way. Don’t do this step until you are in a calm state as it will be difficult to problem solve when in an anxious state.

If you’d like to explore how stress is impacting your life and daily activities and relationships, counseling is a great way to make that step. Give us a call at 615-591-5262.

Selna, E. (2018, November). How some stress can actually be good for you. Time. Retrieved from

Written by Refuge Center Masters Level Counseling Intern Tiffany Miller.

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