powerpoint - Canadian Domestic Violence Conference

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Understanding
Trauma:
Workshop #2
SAIL Program
• As before, self care is one of the most
important things to learn and practice in
the healing journey.
• As the workshop continues, keep one part
of your mind on observing how you’re
doing.
• If you need to - get up, stretch, get a cup
of tea, deep breathe or practice a
grounding exercise.
4/13/2015
Welcome!
• This workshop will take about 3 hours, and
we will have 2 10 minute breaks in the
middle of it.
• Washrooms are located outside. Get up
and go at any time if you wish.
• Help yourself to coffee or tea at any time.
• You will not be asked to share any personal
information.
4/13/2015
Understanding Trauma
• If you meet someone you know here,
respect their confidentiality outside of our
agency.
• We hope that in this process, you can feel
good about having been here today, and in
beginning, or continuing, your healing
journey.
• Feel free to ask questions at any time!
4/13/2015
Remember Self Care
• Sit where you are most comfortable.
Some may want to face the door or have
no one behind them.
• Feel free to bring a small comfort object,
or grab a stone.
• You may ‘zone out’ or find yourself
daydreaming. It’s ok.
• You can help yourself with this here also
by ‘grounding’ yourself.
4/13/2015
Remember Self Care
• Last time we learned the ‘breath’ exercise.
This time, a different grounding exercise.
• 5-5-5
• Take several deep elevator breaths.
• Look around you, and mentally pick out 5
things you see, then 5 things you hear,
then 5 things you can feel.
• Repeat, 4-4-4, then 3-3-3
4/13/2015
Grounding Exercise
• Learning about trauma is important to
help in the healing from it
• There are many steps to healing, helping
yourself is often a forward and back
process of gradually making shifts in your
thinking and behaviour
• Change is hard…appreciate yourself for the
task you have taken on! Have compassion
for yourself in this journey.
4/13/2015
Healing from Trauma
• You can increase your resilience through
focussing on two main areas
• MIND – the way you perceive information
and think - determining how you feel
• BODY – the way your body is able to
achieve sleep and rest, deal with stress
and change its response
• Mind and body are connected.
4/13/2015
Increase your resilience
• Western medicine is gradually coming to recognize
that viewing mental health as separate from
physical health is wrong (some drs)
• Events that change ‘wiring’ in the brain change it in
bodily systems too.
• ‘Disease’ may stem from the body’s attempts to
manage something unmanageable. Emotions
influence physical changes. Dr. Gabor Maté
4/13/2015
Mind and Body are ONE
• By choosing to come to these workshops,
you are choosing to care for yourself.
• The next part of our workshop will be on
helping you begin to recognize and work
with some of the ways abuse trauma has
impacted you.
4/13/2015
Healing
• People who live through the trauma of
sexual abuse or other forms of violence
may develop symptoms of post trauma
stress as a reaction to the violence they
have lived and witnessed.
• Post trauma stress involves changes to
many systems of the body – we are wired
for survival and the experiences change
our ‘wiring’. Remember, we are mammals.
4/13/2015
Abuse can be traumatic
• Exposure to event(s) that separate you
from a sense of safety and security in your
life
• There is a threat or violation of bodily
integrity
• Survival may be questioned
• Witnessing of such an event with another
4/13/2015
Trauma occurs when there is:
• Our bodies are designed to help us
survive.
• Various reactions in the body are designed
to help us cope – the fight/flight/freeze
response
• Your body will choose the best response
for survival, and store as trauma memory
many markers associated with the event.
4/13/2015
At the time of trauma
• Many people can describe the fight/flight
response but know less about the freeze
response, most common in child sexual
abuse.
• Children are unable to fight or run from
adults, so the body releases chemicals
(opioids) to distract and lessen pain.
• This dissociated state may repeat many
times in response to abuse, or just stress.
4/13/2015
The Freeze Response
• After any traumatic event, it is common to
experience intrusive thoughts or flashbacks,
difficulties with hyperarousal – sleep problems,
startle easily, anxiety and possibly a sense of
unreal withdrawal from life
• Experiencing this for 8 weeks after is normal
• Past 8 weeks, the body’s ability to heal may
become more compromised if there is an
ongoing stress response – post traumatic stress
disorder?
4/13/2015
Post Trauma Stress?
• When children undergo years of living in an
abusive and/or neglectful environment, trauma
is occurring over years and through their
developmental stages of growth
• This kind of trauma affects them on many levels,
as their bodies are developing in this ‘soup of
stress’. The results don’t show up till later.
• Many SAIL clients have experienced this, and
healing from it takes time, and focus on learning
some skills not learned in childhood.
4/13/2015
Complex Trauma
• Many survivors share the following
experiences, as a result of our ‘survival’
wiring.
• Healing is helped when you begin to
recognize when your body is ‘reacting’ as
though abuse might happen at any time,
even though you are safe.
• Your body acts this way as part of its
wiring for survival…that’s just normal.
4/13/2015
Common Experiences
• A ‘trigger’ may be a person, place, thing,
smell, sound, expression, season, or even
a cloud formation…an endless list.
• A trigger represents a piece of information
your body stored as a marker of a time
when you experienced trauma.
• It is your body’s way of alerting you that
there might be danger in the present, but
you may not relate the trigger to the
trauma.
4/13/2015
Triggers
• Your perception of a trigger sets off the
alert system in your body. You may
experience heart racing, a feeling of fear
or rage, a need to escape, or a strong
sense you are in danger.
• Many survivors describe feeling they are
going crazy, as this comes on so suddenly,
and they ‘know’ they are safe.
• Work on identifying and recognizing the
pattern of your triggers will help you.
4/13/2015
Triggers
• Blue screen
• Taxi driver’s hands
• White truck
• Common examples of triggers for sexual
assault survivors include the smell of
alcohol on breath, and particular seasons
or times of year, or times of day.
• Issues with touch/sexuality are almost
universal for survivors of sexual abuse.
4/13/2015
Trigger Examples
• You might be aware of some of your
triggers, but may not be aware of others.
• Begin to make a list of known triggers for
yourself…you can help yourself by doing
this when you are not triggered.
• Learning to recognize that you are
triggered helps you realize you are not
crazy, it is just a normal reaction to the old
abuse trauma.
• You are OKAY NOW…. (we have to teach your body that too)
4/13/2015
Try and Identify Triggers
When you are triggered:
• Ground yourself, get your self a little
physically calmed down asap.
• Remind yourself of your triggers, it is your
body remembering the ‘marker’, but you
are safe now.
• Talk to yourself, reassuring yourself and
comforting yourself.
• Try to be compassionate with yourself.
4/13/2015
Trigger ‘Retraining’
• It isn’t always possible to ‘avoid’ a trigger
but many survivors will try this as a
solution, sometimes greatly restricting
their lives in the process.
• Try ‘working’ your trigger.
• Desensitize yourself through gradual
exposure to the trigger. (can do in therapy)
• Communicate with others about a trigger.
4/13/2015
‘Work’ your Triggers
• Change it up using the senses…if a smell is a
trigger, mindfully introduce a smell you like.
• Put visual reminders around your home, or in
your purse, that represent 2012, not when you
were a child. Remove childhood objects.
• If some triggers are related to times of year,
mindfully prepare, and create a ‘new, good story’
for this time period. (like holidays, do something
different this year, that you will enjoy)
• Use your creativity.
4/13/2015
How do I work it?
• Many of you have experienced flashbacks
or intrusive thoughts, ‘thought movies’,
nightmares or even physical sensations in
your body which make you think you are
re-living the traumatic event.
• These are very troubling, as the old
emotions (fear) return with the
thought…more on this in workshop #3.
4/13/2015
Flashbacks and Intrusive
Thoughts
• Flashbacks also can create a sense of
feeling ‘crazy’, but they usually occur in
response to a trigger in the present
environment.
• Ground yourself after a flashback.
• Take steps to look at your present
situation. Is there a trigger for past abuse
in the present? Even a subtle one?
• Work on reducing stress and increasing
safety, reminding self of safety now.
4/13/2015
Ground after a Flashback
• This refers to the body’s almost constant
state of stress for people with
posttraumatic stress.
• Hyperarousal means an overload of stress
hormones - adrenaline and cortisol in the
system, resulting in difficulties relaxing,
sleeping, or feeling calm.
• Many survivors will show an exaggerated
‘startle’ response.
4/13/2015
Hyperarousal
• MRI snapshots of people who have PTSD
show differences in the brain’s adaptation
to the ongoing stress – the ability to calm
down becomes ‘burned out’ over time
• The constant release of adrenaline and
cortisol, the body’s main stress hormones,
can cause damage over time to many body
systems, with health issues arising
• Reducing stress is VITAL to healing
4/13/2015
The body’s response
• Often survivors have learned to dissociate
in childhood.
• Everyone dissociates sometimes –
daydreaming to more severe dissociation
• Dissociation may cause you to lose
concentration, and lose ‘time’.
• While helpful during the abuse itself,
frequent dissociation long after the abuse
has stopped causes many problems for
survivors. (can’t keep concentration)
4/13/2015
Dissociation or Withdrawal
• Many survivors have struggled with
addictions to illegal or prescription drugs,
alcohol, gambling and so on, in order to
cope with the difficulties caused by
triggers, flashbacks, hyperarousal and
dissociation. (Escape – but often with
other life consequences )
• As part of healing, resolving addictions
and developing other ways of coping are
part of the work…
4/13/2015
Coping with all this?
• Many who have suffered trauma feel guilt
or shame for the ‘freeze’ response and
‘failing’ to protect themselves or others
• It is important to understand these
responses are instantaneous instinctive
responses to perceived threat, not chosen
by careful consideration (Rothschild 2000)
• You cannot ‘choose’ how to respond, so
don’t feel guilty for something that
physically was beyond your choice.
4/13/2015
Trauma Guilt
• Prolonged, repeated, extensive exposure
to traumatic events through childhood, so
no 8 week response, then calm…
• Nature of trauma involved interpersonal
relationship (vs. natural disaster)
• Type of attachment with caregiver is a
factor (insecure vs secure)
• Majority of SAIL clients have these impacts
4/13/2015
Complex or Developmental Trauma
• Post Trauma there are changes in all the
systems in the body as our ‘calm down
now’ signals burn out and the adrenal
gland gets tired too
• Many survivors have ongoing anxiety,
fatigue and/or depression
• Sleep, stomach, bowel, nerve (pain or
numbness) and cardio problems all
connect to ongoing stress
4/13/2015
Symptoms in the body too
• Anxiety and ongoing stress wear on the body–
years of panic attacks, large startle response,
heart palpitations, hypervigilance
• Sleep affected-insomnia and sleep disorders
common (who can sleep if danger is present?)
• SNS takes energy away from normal body
functions like digestion
• Digestive system symptoms include reflux,
dietary changes (wheat/dairy) and irritable
bowel disorders
(Rochschild 2000)
4/13/2015
The body bears the burden
• The constant triggers break down brain
circuitry and body systems…
• Immune system suppressed
• Chronic pain or fatigue – fibromyalgia
associated with PTS
• Psychogenic seizures
• MS type symptoms also common (Gabor
Mate, 2003)
4/13/2015
Chronic Stress
• You have to teach your body to calm
• De-stressing can include many strategies
• Just a few include grounding yourself,
learning to breathe, mindfulness, yoga,
exercise and self care
• You can lower anxiety to help yourself
sleep
• Diet and vitamin supplements are also key
– more on this in workshop #4
4/13/2015
You can help your body heal
too
• At our 4th workshop, we will explore
further ways you can re train your mind
and body after trauma.
• Work on healing involves both ‘talking’
about what happened, but also
‘retraining’ your body to calm itself.
• There are many things you can do to help
yourself, therapy is just one of them…
4/13/2015
Self Care and Resiliency
• Workshop #3 next week will build on some
of the information here regarding trauma,
and the links with emotions and
memories, with more strategies for you to
use.
• Workshop #4 will be focussed on how you
can build your resiliency, and will offer
many strategies for healing. You will begin
to consider what your needs and next
steps are for healing.
4/13/2015
Workshops 3 & 4
• There has been a lot of information for
you today, and you may find that
discussion of trauma brings back a few
memories for you.
• Work on grounding yourself this week –
breathing, and 5-5-5.
• Allow yourself some leeway from the day
to day stresses and expectations, and give
yourself some ‘me’ time this week.
4/13/2015
Self Care
4/13/2015
Work on Relaxation
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