living resilience: my journey from suicide to post ...€¦ · living resilience: my journey from...
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Living Resilience: My Journey from Suicide to Post-Traumatic Growth
October 14, 2017Reno, NV
Leah Harris, M.A.CEO, Shifa Consulting
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Resilience Factors
• Relationships• Mind-body skills• Trauma treatment• Creative expression• Storytelling• Advocacy/Activism
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Trauma-Informed Suicide Prevention
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We Must Shift the Paradigm!
“We have failed to bend the curve when it comes to suicide prevention” – Dr. Thomas Insel, former director, NIMH
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What Causes Trauma?Individual trauma results from an event, series of events, or set of circumstances that is experienced by an individual as physically or emotionally harmful or life threatening and that has lasting adverse effects on the individual’s functioning and mental, physical, social, emotional, or spiritual well-being.Substance Abuse and Mental Health Services Administration. SAMHSA’s Concept of Trauma and Guidance for a Trauma-Informed Approach. HHS Publication No. (SMA) 14-4884.
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Trauma Prevalence in Children
71% Number of
children who are exposed to violence each
year (Finklehor, et al, 2013)
3 million Number of
children maltreated or
neglected each year
(Child Welfare Info.Gateway, 2013)
3.5-10 million
Children witness violence
against their mother each
year (Child Witness to
Violence Project, 2013)
1 in 4 girls & 1 in 6 boys
Number who are sexually
abused before adulthood
(NCTSN Fact Sheet, 2009)
94%Percentage of
children in a study of juvenile justice settings who have
experienced trauma
(Rosenberg, et al, 2014)
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Trauma in Adults: Mental Health, cont.
Clients with
histories of
childhood abuse
• Earlier first admissions
•More frequent and longer hospital stays
•More time in seclusion or restraint
•Greater likelihood of self-injury or suicide attempt
•More medication use
•More severe symptoms (Read et al, 2005)
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Things to Remember
Underlying question = “What
happened to you?”
Symptoms = Adaptationsto traumatic
events
Healing happens In relationships
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Events
Events/circumstances cause trauma.
Experience
An individual’s experienceof the event determines whether it is traumatic.
Effects
Effects of trauma include adverse physical, social, emotional, or spiritual
consequences.
The Three E’s in Trauma
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Potential Traumatic Events
AbuseEmotional
Sexual
Physical
Domestic violence
Witnessing violence
Bullying
Cyberbulling
Institutional
LossDeath
Abandonment
Neglect
Separation
Natural disaster
Accidents
Terrorism
War
Chronic Stressors
Poverty
Racism
Invasive medical procedure
Community trauma
Historical trauma
Family member with substance use disorder
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Experience of Trauma
Experience of trauma affected by:
How When Where How Often
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Effect of Trauma
The effect of trauma on an individual can be conceptualized
as a normal response to an abnormal situation.
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Trauma and the Brain• Fight-flight-freeze response: the brain signals
the body to respond to a perceived threat and the body prepares
• Ordinarily, when the threat is gone, the body returns to “baseline”
• If an ongoing threat is perceived, the body doesn‘t return to baseline, remains prepared for threat, resulting in a “trauma response”
• The switch is stuck in the “on” position 17
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Problems OR Adaptations?
FIGHT“Non-compliant, combative” ORStruggling to regain or hold onto personal power
FLIGHT “Treatment resistant, uncooperative” ORDisengaging, withdrawing
FREEZE “Passive, unmotivated” OR Giving in to those in power
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What we learned
■ Childhood trauma was very common■ 2/3 of the 17,000 people in the ACE Study
had an ACE score of at least one■ 87 percent of those had more than one■ Findings have been replicated in over 28
subsequent studies
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The higher the ACE Score, the greater the likelihood of…■Severe and persistent emotional problems ■Health risk behaviors ■Serious social problems■Adult disease and disability■High health and mental health care costs■Poor life expectancy
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ACEs and Suicide
■ ACEs have a strong, graded relationship to suicide attempts during youth and adulthood.
■ An ACE score of 7 or more increased the risk of suicide attempts 51-fold among children/adolescents and 30-fold among adults (Dube et al, 2001).
■ Nearly two-thirds (64%) of suicide attempts among adults were attributable to ACEs and 80% of suicide attempts during childhood/adolescence were attributed to ACEs.
Linda Chamberlain, PhD. An Early Pathway to Preventing Suicide: The Role of Adverse Childhood Experiences. http://www.instituteforsafefamilies.org/early-pathway-preventing-suicide-role-adverse-childhood-experiences
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ACES and Suicide
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Lancet ACEs Study: Findings■ Outcomes showing the strongest relations with multiple
ACEs (violence, mental illness, and problematic substance abuse) can represent ACEs for the next generation (exposure to parental domestic violence, mental illness, and substance use) and thus are indicative of the intergenerational effects that can lock families into cycles of adversity, deprivation, and ill health.
■ Although research into ACEs is far from complete, a compelling case exists for increased international focus on prevention of ACEs, development of programmes to bolster resilience, and implementation of policies that support a sustainable life-course approach to health.
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Epigenetic discoveries“According to the new insights of behavioral epigenetics, traumatic experiences in our past, or in our recent ancestors’ past, leave molecular scars adhering to our DNA.
Jews whose great-grandparents were chased from their Russian shtetls; Chinese whose grandparents lived through the ravages of the Cultural Revolution; young immigrants from Africa whose parents survived massacres; adults of every ethnicity who grew up with alcoholic or abusive parents — all carry with them more than just memories.”
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Epigenetics & Suicide■ In a 2008 paper, they [Meaney and Szyf] compared
the brains of people who died by suicide with the brains of people who had died suddenly of factors other than suicide.
■ They found excess methylation of genes in the suicide brains’ hippocampus, a region critical to memory acquisition and stress response. If the suicide victims had been abused as children, they found, their brains were more methylated.
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Historical Trauma■ Historical trauma is cumulative emotional and
psychological wounding over the lifespan and across generations, emanating from massive group trauma.
■ Historical unresolved grief is the grief that accompanies the trauma.
■ This response is observed among Lakota and other Native populations, Jewish Holocaust survivors and descendants, Japanese American internment camp survivors and descendants.
(Brave Heart, 1998, 1999, 2000)
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Healing From Trauma • Regaining a sense of control over one’s
life and one’s environment• Maintaining a sense of safety• Developing the ability to trust self & others• Reconnecting with self and others
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Bessel van der Kolk, MD: Four Truths of HealingTruth #1: “Our capacity to destroy each other is matched by our capacity to heal each other. Restoring relationships and community is central to well being.”
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Four Truths of Healing, continued
Truth #2: “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.” – Bessel van der Kolk, MD
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Envisioning an End to Stigma
“I want to live in a world where we can talk openly about what happens to us, our feelings and our dreams, including the feelings we sometimes have of wanting to die.”
– Will Hall, suicide attempt survivor, mental health counselor, teacher, and advocate
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What Storytelling Does■ Similarities in our stories
point to a collective struggle but also a collective path of recovery, healing and change
■ When we share our story, it gives others the permission to tell theirs
■ Inspires people and changes hearts and minds like nothing else
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LiveThroughThis.org
Live Through This is a collection of portraits and stories of suicide attempt survivors, as told by those survivors.
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Creative Expression
■ Theater, improv, stand-up, performance
■ Storytelling■ Writing/memoir■ Hip- hop, spoken word, poetry■ Visual art■ Dance■ Music 43
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Native Survivors - Hooper Bay, AK■ Youth group, organized
through AmeriCorps (Rural AK Community Action Program), to revive old traditions and skills
■ Mission: stop teens & young adults from killing themselves and to live healthy lives
■ Intergenerational focus, but youth-led
■ Grassroots
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Four Truths of Healing, continued
Truth #3: “We have the ability to regulate our own physiology, including some of the so-called involuntary functions of the body and brain, through such basic activities as breathing, moving, and touching…” -- Bessel van der Kolk
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Self Awareness ■ “Physical self-awareness is the first
step in releasing the tyranny of the past.” - Bessel van der Kolk, The Body Keeps the Score
• “Interoception” = the ability to notice what is happening inside the body.
• Connecting emotions with physical sensations in the body.
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Mindfulness• Mindfulness: awareness that arises
through paying attention, on purpose, in the present moment, non-judgmentally. It’s about knowing what is going on in your mind.
--John Kabat-Zinn• Curious, open, nonjudgmental• The “observer” or witness”
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Mind-body skills
Breathing
Grounding - Centering
Movement
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Belly breathing
Belly (diaphraghmatic) breathing:■ Works to activate the parasympathetic
nervous system, or relaxation response.■ Decreases the power of the “fight or
flight” centers in the mind■ Restores the centers of self-control,
language, listening, and thinking. ■ Grounding.
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Grounding/Centering:■Invoke the senses: gateway to the body■Support a person to return to the present
moment■Helps if someone is emotionally
overwhelmed or stuck in a trauma response
Name 3 things I can…■See (the clock on the wall)■Hear (the ticking of the clock)■Feel: (the breeze on my skin) 50
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90 second sanity pit stopDeveloped by Josh Korda, dharmapunx NYC
■ The first 30 seconds: Become aware of your out breath and extend each exhalation as long and smooth as possible, until they’re at least three times as long as each in breath.
■ The second 30 seconds: Find the muscle groups in your body that are most constricted and use each out breath to release and relax the tension.
■ The last 30 seconds: Direct thoughts of kindness and compassion towards yourself: “I’m safe.” “I am OK.” “I love you, keep going,” etc.
Source: https://www.elephantjournal.com/2014/11/90-second-sanity-pit-stop-meditation-practice/
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Four Truths of Healing, continued
Truth #4: “We can change social conditions to create environments in which children and adults can feel safe and where they can thrive.” – Bessel van der Kolk
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The Four Rs
•Realizes widespread impact of trauma and understands potential paths for recoveryRealizes
•Recognizes signs and symptoms of trauma in clients, families, staff, and others involved with the system Recognizes
•Responds by fully integrating knowledge about trauma into policies, procedures, and practicesResponds
•Seeks to actively Resist re-traumatization.Resists
A trauma-informed program, organization, or system:
Slide 53SAMHSA, Concept and Guidance for a Trauma-Informed Approach
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SAMHSA’s Six Key Principles of a Trauma-Informed Approach
Slide 54
• Safety
• Trustworthiness and Transparency
• Peer Support
• Collaboration and Mutuality
• Empowerment, Voice, and Choice
• Cultural, Historical, and Gender Issues
SAMHSA, Concept and Guidance for a Trauma-Informed Approach
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• While there are many support groups for behavioral health conditions, there are few specifically designed for and led by suicide attempt survivors
• Didi Hirsch, Samaritans, and Alternatives to Suicide Peer-to-Peer Support groups
• Groups in existence report positive outcomes including: improvements in mood, thinking, impulsivity, connectedness/belonging, and hope; increased connectedness, decreased suicidal desire, and improved safety planning
Peer to Peer Support Groups
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Resource: The Way Forward
Access at: http://bit.ly/1k2nGvy
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■ Utilize collaborative approaches to assessment, screening, and treatment (CAMS)
■ Train staff in trauma-informed approaches■ Incorporate peer support and lived experience in
meaningful ways■ Teach mind-body resilience skills for emotional regulation
for staff and persons served■ Seek to build trusting, respectful relationships as a
cornerstone of care
Trauma-Informed Suicide Prevention
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Slide 58
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