strengthening the safety net of love

copyright 2009

Trauma Summit Iowa Annual Conference

Strengthening the Safety Net of Love

Presented by Laurie Leitch, PhD Co-Founder and Director

Trauma Resource Institute (TRI)

Website www.traumaresourceinstitute.com

Everything is a possibility in a universe of interaction and mutuality of all beings. This optimistic message allows us to entertain the possibility of intervening in systems whose rules and relationships have created conditions that cause suffering in the world.

Merle Lefcoff

CALLS •  Are essentially questions, not to be

answered, but to be responded to  Where am I willing to be led?  Is my energy growing or shriveling?

•  The “answers” are usually metaphor, poetic, paradoxical, dream-like

 Song lyrics, recurring dream images, overheard conversations

•  Rock the boat (cocoon & imaginal disks) •  Often require sacrifice

 What are you willing to give up to ensure your own unfolding and the unfolding of what is holy in your life?

•  Are like a scavenger hunt •  Come in many disguises

The Engaged Citizen: An Emerging Archetype

•  Levoy: see our lives as a process of calls and responses   “saying yes to the call can put you on a path that half of

yourself thinks doesn’t make sense and the other half knows your life won’t make sense without it.”

  “ Life is a great devourer, and dreams get swallowed at an alarming rate.”

•  Torah: “ if you listen from down below you will hear from up above.”

•  Revelation 21:5: “Behold I make all things new.”

•  Old Roman Saying: “ The fates lead those who will, those who won’t they drag.”

Callings

“A mystery that leaves itself like a trail of bread crumbs and by the time your mind has eaten its way to the maker of the tracks, the mystery is inside you.”

Tom Brown The Tracker

The Clues are all around us •  Joseph Campbell said we’re having

experiences all the time that hint at our hungers

•  Our practices can help us stay awake and curious to the soul’s whispers

•  Many spiritual traditions say any sign or story must be examined from 3 points of view:   Literal   Metaphorical   Universal/transpersonal

Essential Principles in Following a Calling

•  Presence- the transition zone between the fullness of opinions and the emptiness of no thought.

•  “Radical Optimism” (Roshi Joan Halifax) Holding the vision for a successful future

•  Solidarity rather than Charity: Lila Watson

Principles continued

•  Self-Inquiry/Introspection:  How do my actions prevent or perpetuate

disparities & inequalities?  What are my internalized “isms”?  How do I bring my shadow to my calling?  How does my biography shape what I

bring to the work?  Where have I avoided going in my own

self-inquiry?  Where am I willing to be led?

Self-inquiry (continued)

•  What’s saving me right now? •  What are my basic intentions •  What am I sure of?

Is the compassion and kindness we talk about in all spiritual traditions possible if the mind-body system is contracted due to traumatic events? Can we live in harmony if below the level of consciousness lies an array of perceptions and sensations biologically imprinted following these events? What do those of us who attempt to respond to the suffering of others (and our own) need to know about the mind-body system and traumatic response?

What is TRI?

• The Trauma Resource Institute (TRI) is a non-profit organization. TRI’s global mission is to promote healing in adults and children suffering from trauma through education and integrative interventions that link mind, body and the human spirit.

• TRI’s goal is to expand access to treatment by training frontline service providers who do the hardest work with the least resources.

What is the Trauma Resiliency Model? •  A biologically-based intervention

•  Focused on stabilizing, reducing and/or preventing the symptoms of traumatic stress

•  Restores the body’s natural resiliency through skills that rebalance the nervous system

•  Demonstrated to be effective in low dosages

•  Also used for self-care of practitioner and client

Why is a Biological Model needed?

•  New information from neuroscience about the role of the nervous system in situations of threat and fear

•  The value of models that are not primarily psychological or insight-oriented

•  Their efficiency in re-stabilizing people and giving hope

•  Their gentleness…they do not re-traumatize •  The skills-based focus allows individuals and

their families to use the skills independently

A Brief History

•  Thailand Tsunami •  Catholic Charities USA: Katrina project •  China Earthquake project •  Africa Projects:

  Rwanda   Kenya

•  Middle East- Gaza •  USA-

 Disaster response teams  Community Resiliency Projects  Public training  Veterans Affairs projects: chronic pain, combat trauma  Sex-trafficking of domestic minors

•  Spiritual leaders as first responders

•  High potential for secondary traumatization

•  Potential for burnout

•  Importance of self-care skills

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In your work with trauma:

•  What are the common physical reactions? •  What are the common emotional

reactions? •  What are the common cognitive reactions? •  What are the common behavioral

reactions? •  What are the common spiritual reactions?

Orientation to TRI

Nervous system becomes dysregulated

Trauma

Trauma = TOO much & TOO fast!

Nervous system becomes dysregulated

Trauma

Trauma = Too Little

for Too Long!

Big “T” Trauma Natural Disasters

Man-Made disasters Disruption Trauma Sexual Assaults Acts of Terrorism Acts of Violence

Economic collapse Child Abuse

Car Accidents Physical trauma

Little “t” Trauma Dog Bites

Dental Procedures Routine Surgeries

Falls Minor car accidents

Arguments with significant others

When the nervous system is overwhelmed, individuals can lose capacity

to stabilize and regulate themselves

“C” Trauma Homophobia Heterosexism

Classism Poverty Neglect Racism

Chronic Abuse Colonialism

Forms of Oppression Other “isms”

The Individual’s Perception is what triggers the cascade of

responses The perception of

the event as life threatening combined with feelings of helplessness & terror

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Primary Focus of TRM

The patterns that cause physiological

as well as psychological suffering are

entrenched in the nervous system.

Key Concepts of TRM

Sympathetic (SNS) Prepares for Action

Parasympathetic (PSNS) Prepares for Rest

Autonomic Nervous System

The SNS controls organs during times of stress

Breathing rate Heart rate

Pupils Dilate Blood Pressure

Sweating Stress Hormones

Digestion Saliva

The PSNS controls the body during rest

Breathing rate Heart rate

Pupils Dilate Blood Pressure

Sweating Stress Hormones

Digestion Saliva

The ANS has 2 important roles:

1. In emergencies, that cause stress and require us to "fight" or take "flight

This is the sympathetic branch of the ANS

2. In non-emergencies that allow us to "rest" and "digest.“

This is the parasympathetic branch of the ANS

The Autonomic Branch of the Nervous System

Rhythmic Cycling A Natural Process

•  Allows the person to respond to constant input from the environment in an adaptive way

•  Balance typifies most of nature (Seasons, Day-Night Cycles, moon, tides, etc…)

•  The human body will regulate back to balance

The Reciprocal Relationship in ANS

sympathetic

parasympathetic

charge Release

charge

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•  ..”Our system is self-regulatory in the highest degree: self maintaining, repairing, readjusting and even improving. The chief, strongest, and ever-present impression …. nothing remains stationary, unyielding; and everything could always be attained, all could be changed for the better, were only the appropriate conditions realized.”

Pavlov

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Key Concepts of TRM

Traumatic Event! Stuck on “high”

Hyper-activation

Stuck on “low” Hypo-activation

Hyperactivity Hypervigilance Mania Anxiety & Panic Rage

Depression Disconnection Exhaustion/Fatigue Numbness

Res

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Bal

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min

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Graphic adapted from original by Diane Poole Heller

When neither resistance nor escape is (perceived to be) possible, the human system of self-defense becomes overwhelmed and disorganized. Each component of the ordinary response to danger, having lost its utility, tends to persist in an altered and exaggerated state long after the actual danger is over.

Herman 1992

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Res

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Bal

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min

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30

Res

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Bal

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• Some have a deep Resilient Zone where there is a higher tolerance for a wide range of stressors.

• Some have a very shallow Resilient Zone where even small stressors bump you out of the Zone.

THE NERVOUS SYSTEM AND HUMAN RESPONSES TO TRAUMA

•  The nervous system (NS) unconsciously and continually evaluates risk

•  Traumatic events unbalance the NS, which affects perceptions of safety, danger, or life threat

•  Practitioners can use TRM to help stabilize the NS and promote social engagement and positive attachment.

S. Porges, 2004

Slides by Miller-Karas&Leitch 2008(c)

Threat Response

Neuroception

Senses Safety

Parasympathetic NS

Social Engagement

Fight & Flight

•  Sympathetic NS

FREEZE RESPONSE

Porges 2004

The Triune Brain •  Neo cortex: Thinking

Cognition, beliefs, language, thought, speech

*Integrates input from all 3 parts

•  Limbic Area Emotional - Expression and mediation of emotions and feelings, including emotions linked to attachment

* Assess risk….negative focus

•  Survival Brain Instinctual/unconscious - Digestion, reproduction, circulation, breathing, and the execution of the "fight or flight"

“We have a brain that was field-tested millions of years ago in the wild. I call it the wild brain to distinguish it from the logic brain that so many people revere. The logic brain can’t do much for you once the situation becomes critical…”

Lt. Col. Dave Grossman

Traumatic Event Little “t”

& Big “T”

& “C” Trauma

Mind and Body Self-Regulation

Homeostasis Returns

Traumatic Stress

Responses

Somatic Complaints

POTENTIAL PATHWAYS FOLLOWING A TRAUMATIC EVENT

Not every one who experiences a traumatic event will develop PTSD

Grief Reactions

Key Concepts of TRM

What Are the Three Resiliency Models?

The Trauma Resiliency Model (TRM) is a condensed course designed to teach skills to stabilize and

reduce and/or prevent the symptoms of traumatic stress

The Veterans’ Resiliency Model (VRM) is focused on combat-zone trauma

The Community Resiliency Model (CRM) helps create a network of trauma-informed community members

and organizations using the biologically-based skills

Key Concepts of TRM are based on:

1.  Laws of Nature 2.  Human Anatomy and Physiology 3.  Current Scientific Research on the Brain 4.  Somatic Experiencing® & Sensory

Integration Theory, Gendlin’s Focusing

The Trauma Resiliency Model™

Biological Focus

•  TRM uses observation and knowledge of neurobiological patterns

•  TRM brings the client’s awareness to sensation to help interrupt the disorganized automatic nature of the traumatic responses

•  The client learns: •  to attend to the non-traumatic sensations •  to regulate affect and internal sensations

Goals of TRM

  To depathologize trauma symptoms by focusing on the biology rather than the psychology of trauma response

  To teach TRM skills to clients and practitioners so that use the skills to self-regulate

  To elicit release of blocked energy from the nervous system, to reduce or eliminate symptoms

  To work gently without re-traumatizing

  To restore balance and resiliency to the Nervous System

Who does TRM treat?

•  TRM can be used to treat any person who has experienced or witnessed any event that was perceived as life threatening or posed a serious injury to themselves or to others

•  TRM can be used with immediate as well as past trauma

•  Adults and children

The Importance of Information

 Education about the human responses to trauma….normalizes

 Education about the psychobiology of trauma

 Education shifts perceptions from pathology to biology…reduces shame and restores hope

Frozen in trauma A smiling child after treatment

Restoring the body to equilibrium can be accomplished gently

The Underlying Principle of TRM

The human body has the inner capacity to heal and restore itself!

Key Concepts of TRM

Life Trauma in Humans •  A series of traumas or one trauma

can:   Lead to an alteration in the cycle of

homeostasis and regulation   Produce a process that is self-

perpetuating in the absence of ongoing external stressors or threats

  For many, these symptoms cannot be “talked away”

 Although insight is helpful, it may not lead to regulation of the NS


Re-living the Event “I have nightmares and it pops in

my mind and feels like it’s happening again.”

Increased Arousal  “I am always afraid something bad will happen and I jump at any loud noise .”  “I can’t sleep and can’t concentrate on my work.”

Three Symptoms Categories of Post-Traumatic Stress & Acute Stress Disorders

Avoidance of Reminders “I can’t go back to that place where it happened and often I just feel numb.”

Trauma and Development

•  As the brain grows and organizes, the higher, more complex areas begin to control and modulate the more reactive, primitive functioning areas like the Survival Brain.

•  The person becomes less reactive, less impulsive, and more thoughtful as the brain becomes more complex.

•  Shock and Developmental Trauma can increase the activity or reactivity of the brainstem level and decrease the moderating capacity of the cortical areas

•  Thus, as children develop, this can increase the likelihood of aggression, impulsivity, and capacity to be violent on one end of a continuum and depression and disconnectedness on the other end.

Developmental & Shock Trauma

Shock Trauma

Developmental Trauma and

Two Kinds of Trauma

Many children have experienced both


Children’s Defenses

•  Parents, family members and teachers often underestimate children’s reactions to a traumatic event

•  Children may not show their true feelings to protect their parents and other family members


Stages of the Defense Response Cycle High Activation is Designed to Enable Short-Term

Defensive Actions

Stage 1: Prepare for Defensive Action   Muscles tense, orient to source of threat

Stage 2: Mobilization   Production of Adrenalin and Cortisol in order to

provide energy needed to defend

Stage 3: Release of Energy through Fight or Flight   Running, Defensive Responses, Vocalizations

Stage 4: Return to Central Nervous System Equilibrium   Parasympathetic responses-Homeostasis

Key Concepts of TRM

Fight, Flight and Freeze

•  TRM works with the understanding of the natural defensive responses of fight, flight and freeze

•  TRM helps relieve the traumatic stress symptoms through restoring regulation to the nervous system

THE FREEZE RESPONSE happens when both the Parasympathetic and

Sympathetic are activated and overwhelmed at the same time.

•  Fear and Terror overwhelm biological & psychological coping

•  Freezing during a traumatic event is a major predictor of who develops

more serious symptoms as described as Post-Traumatic Stress Disorder

The Freeze Response


The Freeze Response

The Freeze Response may be experienced as:

•  An altered state of reality

•  The slowing down of time

•  Diminished awareness of fear & pain

The Freeze Response may increase the chance of surviving

a traumatic event

Key Concepts of TRM

Traumatic Symptoms & the Nervous System

 Symptoms arise when residual energy from the experience is not released from the body

  The Goals of TRM are: 1.  to educate the client about the normal and

automatic defensive responses of fight, flight, & freeze….depathologizes

2.  use TRM skills to elicit release of thwarted defensive energy, to reduce symptoms, and to restore balance to the nervous system


The Sensations of the Nervous System Release Sensations can include the following:

•  Tingling sensations

•  Warmth •  Vibrations or

Trembling •  Shaking •  Expanded

breathing

•  Crying •  Laughing •  Burping and

stomach gurgling •  Itching •  Yawning •  Cooling

Trauma and Memory

Key Concepts of TRM

Implicit Memory: essential in understanding trauma

IMPLICIT MEMORY(IM)  We use IM in learning most

physical activities like walking, skating, & biking

 Mental models are formed from the experience

  Body memories are created during traumatic events including sensations associated with Big “T”,

little “t”, and “C” traumas

“Some aspects of traumatic events appear to get fixed in the mind, unaltered by the passage of time or by the intervention of subsequent experience.”

(van der Kolk, Blitz, Burr & Hartmann, 1984).

Pain, numbness, dizziness Trembling, paralysis Nausea, palpitations

Anxiety, terror, shame, anger, rage Flashbacks, nightmares or

intrusive thoughts

External Trigger

Dissociative Capsule of Trauma

Robert Scaer, MD

Internal Trigger


Internal body sensation -tightness in stomach �

-muscle tension -headache �

Sounds �Smells �

Visuals(people, places & things)

 Sensory images, sounds  Motor actions  Sympathetic/Parasympathetic

symptoms  Perceptual alterations  Emotions linked to the

traumatic experience

Scaer, R,(2007) The Body Bears the Burden

Pain, numbness, dizziness Trembling, paralysis Nausea, palpitations

Anxiety, terror, shame, anger, rage Flashbacks, nightmares or

intrusive thoughts

External Trigger

Dissociative Capsule of Trauma

Robert Scaer, MD

Internal Trigger


Internal body sensation -tightness in stomach �

-muscle tension -headache �

Sounds �Smells �

Visuals(people, places & things)

Brief Overview of TRM Skills

Key Concepts of TRM

• TRM works with the patterns of response that are stuck in implicit memory that cause suffering in the present

• TRM uses observation and knowledge of neurobiological patterns to bring the client’s attention to the internal sensation associated with the implicit memory system

•  TRM brings the client’s awareness to sensation associated with resources to help interrupt the automatic nature of the implicit memory of their trauma…and extinguish cues that trigger the memories

How does TRM work?

Key Concepts of TRM

THE TRM Model •  It is skill based so that at the end of the

training, the participants are prepared to incorporate skills into their scope of practice

•  It provides basic information about the neuroscience of the brain that is easily understood and can be translated to clients

•  Concrete educational tools are given to help participants teach their clients about their symptoms and their inherent resiliency…promotes independence

•  Can be used for clinician self-care

THE SEVEN CORE SKILLS* * TRM includes the skills of Somatic Experiencing

Trauma Resource Institute

GROUNDING Being fully present in the

moment

TITRATION Working with small increments of traumatic material and activation

TRACKING Using observation as a diagnostic

tool

PENDULATION Alternating between traumatic and

resource sensations

RESOURCING Using positive or neutral factors to create non-traumatic sensations

COMPLETION OF DEFENSIVE RESPONSES

Inviting completion of motions, vocalizations, actions that were blocked during the event

SHIFT AND STAY Shifting attention from traumatic sensation and

staying with neutral or positive sensations

“The range of what we think and do is limited by what we fail to notice.” RD Laing

Telling the Trauma story

•  Must be titrated   T-1 T T+1

•  Starts with a resource:  When did help come?  When did you know you had survived?  Who else lived?  What is giving you strength now?  What do you notice having told me just this much?

•  Focuses on telling the story from inside the Resilient Zone

CHILDREN’S ART


Key Concepts of TRM

HEALING The individual can: •  learn to distinguish between

sympathetic and parasympathetic responses and

•  Learn to apply the TRM skills to daily life to reduce or eliminate the symptoms that emerged in the aftermath of the trauma

•  Hope and relief from shame

O God who makes days and pronounces them good, who sings in the everlasting rhythm of dark and light, of risings and fallings, of cycles, of one thing following another, who makes time for all things in the cycle of seasons and tides, break the plane of our quiet desperation and lift up our brief years that we may find peace, and trust in the Everlastingness of your purpose.

Iona Center, Spring/summer 2009

Thank you!

www.traumaresourceinstitute.com Key Concepts of TRM

strengthening the safety net of love

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