AL* was walking one day when she noticed a man on the other side of the street. She didn’t think anything of it at first, but the next thing she knew, he had run across the street and put a knife to her throat.

A thousand questions ran through AL’s mind in that moment – Does this man want to rob me? Does he want to hurt me? Can I get away? – but she never got answers. Luckily, the man saw or heard something that scared him off, and he ran away. AL filed a police report, but the man was never caught. AL tried to put the incident behind her – or so she thought.

For more than 20 years after the incident, AL continually felt anxious, had panic attacks and trouble sleeping, wasn’t motivated at work or at home, and would get easily irritated with her family. Her health and relationships were suffering, and she didn’t know why or what to do about it.

So when her primary care clinician at Venice Family Clinic, where she had been a patient for more than 25 years, asked her how she was feeling during a routine visit, she finally decided to share.

“My doctor offered medication for anxiety, but I wanted to find other ways to overcome my problems. I was worried about how my family or friends might react if they knew I was taking this kind of medication,” said AL, who is in her late 50s and is originally from Mexico. “My doctor also said she could refer me to therapy. I had some of this same fear about starting therapy, but I was desperate to feel better. I decided I had to do something, so I gave therapy a try.”

AL is glad she took that leap because now she understands what had been bothering her for decades, why she had been experiencing it, and how to deal with it when it happens.

Benefits for older adults

Since last June, AL has been working with Dayana Perez, LMFT, a therapist in the Clinic’s Behavioral Health department.

“We know that mental health is linked to medical issues. Our clinicians ask patients about anxiety and depression at their medical visits, and that’s fantastic because it can open the door for people who have never been to therapy, many of whom are older people,” Perez said. Behavioral health care for seniors at the Clinic is supported in part by a grant from SCAN Health Plan.

Perez explains how older adults are in a stage of life that’s about reflection – they often think about what they’ve accomplished or have yet to do or could have done, and about the people they’ve lost over the course of their lives.

“There’s often so much trauma and unprocessed grief, and they don’t realize it’s affecting them,” she said. “It can be eye opening just to have someone say I see you, I hear you, and we should talk about it. It can be a beautiful journey for people to go on.”

Gaining knowledge

Perez educated AL about trauma and post-traumatic stress, and the ways she could respond to both.

“I learned that my trauma is connected to what I had been feeling, like my panic attacks. I didn’t even know what a panic attack was before,” AL said. “With this new knowledge, I realized I had a lot of trauma symptoms, like vividly remembering what I was wearing and what my attacker was wearing 22 years ago.”

To help AL cope with the effects of trauma, Perez taught her mindfulness and breathing techniques, as well as the grounding exercise of using ice or cold water to calm down. Perez also found ways to incorporate AL’s cultural and religious beliefs, encouraging her to do things that she found comfort in, such as reading Bible verses and praying. Perez also helped AL get to a place where she was more comfortable discussing her feelings with and asking for help from loved ones. By doing so, AL discovered that she wasn’t the only person she knew who felt the way she did.

About halfway through treatment, AL experienced a breakthrough. Ever since the assault two decades ago, AL had experienced difficulty swallowing saliva when she became anxious.

“We didn’t know why at first, but as we continued processing her trauma, AL came up with the connection of the knife to her throat to how her body was responding to stress,” Perez said. “This was huge progress, because it signaled that she was really embracing the process and trying to figure out why she was having these triggers.”

Forging a new path

Over time, AL started feeling better: She was sleeping through the night, feeling less anxious, and making more meaningful connections with family and friends.

“Sometimes I still have feelings of nervousness and panic, and that’s when I use the skills I’ve learned to overcome it in that moment,” AL said. “In the past, I was really afraid to go outside because I kept thinking that something bad would happen to me. But after talking to Dayana, I figured out my trauma triggers, so they don’t happen to me much anymore.”

After about four months, Perez felt AL was doing well enough to be discharged from therapy. She still checks in with AL once a month to review the skills AL learned during their initial round of therapy sessions and to make sure her situation is stable.

“It’s nice that we can do that at the Clinic because it gives patients the feeling that they don’t have to be on their own,” Perez said. “Some of my older patients have told me that they’ve told their friends they go to therapy now and how nice it is to be able to talk to someone. They’ve told me that they’ve learned a lot about themselves.”

*Patient’s full name not shared.