A Trauma Informed Approach to Creating Safety

Foreign. I'd like to welcome everybody to today's presentation on creating safety from a psychodynamic perspective. I'm your host, Dr. Donnelly Snipes. In this presentation, we will review the basics of psychodynamics and phenomenological reality. We'll talk about transference, learn how to help people compare and contrast the past when they were traumatized from the present. Are you safe now? So they can recognize. Recognize the difference between memories and schema and facts in context at this time. And we will create it's now pieces, not pacer. Safety and mindfulness strategies to help the person feel safe in all pieces of their life. Trauma is often at the root of mood, developmental, believe it or not, and addictive disorders. So when we look at what's going on, we people who are coming into our office, people who have depression, anxiety, obviously ptsd, people who have addictive disorders, people who have autoimmune issues. I should have put that up there too. Trauma affects all pieces of our life. It affects us physically by keeping us feeling unsafe and powerless, which keeps our stress response triggered, increases inflammation, disrupts our sleep. Stress. It impacts us interpersonally, how we feel about ourselves, how we whether we can trust other people. It impacts us emotionally and cognitively, how we think about things and how we feel about things. And it impacts us environmentally. Do we feel safe or are we being triggered? Lots of places we go, I don't want to say everywhere, but lots of places we go. And people who've experienced trauma are, are impacted in all of those domains. And it's important as clinicians that we recognize that and we get curious. If somebody is still not feeling safe, we need to put on our detective hat with them and try to figure out why that is. We also need to remember that trauma can be caused by physical or mental health issues. If somebody has adhd, for example, and it goes undiagnosed for a while, they may have experienced a lot of rejection, a lot of criticism, a lot of ridicule which made them feel bad about themselves and feel hopeless and helpless and powerless. And so they have developed a sense of trauma. They have been traumatized by other people's reactions because they were doing their very best and they were still getting punished for it or criticized for it. We need to recognize that it goes both ways. Mental illness. Mental. Mental health issues can cause trauma and trauma can cause mental health issues. Unsafeness, as we're going to talk about today, because we're trying to talk about how to create safety. Well, first we have to know what Unsafeness is. Unsafeness is a sense of feeling vulnerable, threatened, or in danger. Now, I want you to think for a second about times in the past week where you have felt vulnerable. Whether it was at work, whether it was at home with a friend, whether, you know, whatever it was, whether. And vulnerability is not just physical. You know, it can be interpersonal vulnerability. You were telling somebody something you didn't know if they would react well to. It can be emotional vulnerability, fear. It can be cognitive vulnerability. You are sharing your thoughts about something and you don't know if somebody is going to accept them. And it goes back to acceptance. It goes back to feeling safe enough to be authentic in the moment and with the people that you're with. Unfortunately, people can feel unsafe in their own heads, and we talked about this a little bit before class started today. But as children or, well, not even as children, as adults, when we have experiences, we may internalize what some people said, and that internalization becomes a tape we may play back in similar situations. It or some people will say, it becomes part of the inner critic, however you want to describe it. We internalize messages that we get from other people, and we can use those messages to encourage and support and help ourselves feel loved, or we can use those messages to be critical and rejecting and unpleasant, unkind. We need to examine those messages with people and say, all right, what are you telling yourself when this happens? And what. Where did that message come from? Is that something that you came up with on your own? Is that something you believe? Is that something somebody told you at some point that you internalized? And again, is it something you believe? And we may need to explore? Did. When we look back at that situation when it happened, do you believe that that was an accurate criticism or response from that person at that time? Maybe, maybe not. Not for me to say. Now, let's look in the present. Do you believe that that criticism or that response is accurate and appropriate in the present? Said another way, if your best friend was in this situation, would you say that to them? Do you think that would be appropriate to say to another human being? And a lot of times the answer is no. People cannot feel unsafe around certain people. Now, if you've got social anxiety, you feel unsafe around a lot of people. If you've had traumatic experiences, you. You may feel unsafe around certain types of people, whether it be authority figures or people who share different belief systems or, you know, whatever the characteristics are of the person who traumatized you, you may feel unsafe around them. People can feel unsafe in certain environments. Again, it goes back to the experiences you've had in those environments. If you've gone to the gym or, you know, gone jogging or whatever for five years, the same place, never had a problem, you may feel completely safe and at home and relaxed and not vulnerable at all if you've never been there before. Whenever I go to a place that I haven't been to before, even if it's a new gym, I feel a little vulnerable at first. I don't know anybody, I don't know where anything is. It's a little uneasy. It's not a big deal, but I feel a little bit vulnerable. And we want to recognize that if people have never been in that situation, or if they've been in that situation and it has been unpleasant for some reason, then they may feel unsafe for, for some of the people that we work with who, especially ones who've been involuntarily hospitalized, they may feel very anxious and unsafe. If when you, you start working with them, you go get them from the lobby and then you've got to swipe to get through three, four doors that lock behind them. That can be terrifying. I mean, I don't even like the feeling of it. And I work there, for goodness sake. So think about people who've been put in jail. Think about people who've been involuntarily committed. Think about people who have been taken from their family and put in foster care. Yeah, they probably weren't taken behind a locked door, but it's that same sort of sense of disempowerment that, oh my gosh, you know, I'm not in total control here. And certain times of day, based on people's experiences, based on their beliefs and things, certain times of day may cause them to feel more vulnerable. Basic assumptions of psychodynamics. Well, let's start out with a definition. Psychodynamics includes the behavior and feelings that are significantly impacted by our unconscious and subconscious motives. Now, what are those motives? Survival. However, remember as a child growing up in a chaotic household, whether it's abusive, neglectful, abandoning, well, that's kind of neglectful, chaotic. You don't know what to expect. The child has to figure out how to survive. They can't go shopping on their own. They can't know, just move out. They've got to figure out how to fly under the radar and stay safe. So the child, in their own child mind, in their own child way, develops coping skills in order to survive. That is their unconscious motive. You know, we're wired to try to survive and Those behaviors were the only responses that that child could figure out how to use in order to survive that situation. The feelings, remember, anger and anxiety are both feelings that are triggered when we feel threatened, when we feel unsafe, when we're traumatized. And the feelings of anger, say fight. The feelings of anxiety, say flee. But ultimately they're saying, you need to do something so you can survive. And. And helping people recognize, where is this feeling coming from? Why do I feel so vulnerable right now? Why do I feel so afraid to do this? Why do I feel so angry at this person who's done objectively nothing wrong? To me, it may be that we've got to go back to those schema, those memories that were placed into the memory banks from traumatic experiences, and see in what ways is this situation bringing up those feelings, those memories, and those expectations? Our behavior and feelings as adults are rooted in our childhood experiences, including the quality of our attachment. If our caregivers were critical and rejecting pretty much consistently, the person may have developed avoidant attachment. If the caregiver was sometimes there, sometimes critical, sometimes not there, and it was kind of chaotic, the child often developed an anxious attachment where they would fawn, they would try to do whatever it took in order to get caregiver to love them. Now, when children are very young, I mean, very, very young, they don't have object permanence. That's why you can play peekaboo with a toddler for a really long period of time, and they seem to never tire of it. They're so surprised when you pop up from behind the sofa and you're like, we've been doing this for 30 minutes. You're not picking up on it yet. But their brains don't recognize that. So from a child, remember, survival. Survival from a child's perspective, who doesn't have object permanence yet. When caregiver goes out of sight, caregivers all gone. And that's terrifying, which is why children, children at a certain period that, you know, 12 to 18 months for a lot of children, go through a period of separation anxiety where they protest and they feel, you know, really anxious, and they may cry when their caregiver leaves. Now, generally, they can be consoled by a responsive alternate caregiver. And then when primary caregiver comes back, the kid's happy, and it's like, oh, my gosh, you came back. Imagine that. And then the child starts to learn that, okay, somebody can go away and they will come back. And that's a schema. But if they learn that sometimes my caregiver goes away and they don't come back, you know, they go to jail, they stay out for a week on a cocaine bender, whatever it is, then that makes the child start feeling insecure because they can't count on their caregiver to come back and meet their needs. Which is why we start having people develop anxious attachment and even separation anxiety into adulthood. Because the child doesn't learn the skills and tools to survive independently and consistently feels like that vulnerable child whose needs weren't met. And all behavior is communication. All behavior has a cause and a function. It's just figuring out what it is. If you're working with somebody, for example, not totally related, who has dementia, and they keep taking everything out of their closet, and you're like, why are you doing this? And they're just setting it on the, on the bed. The question is, what's causing them to want to do that? For what purpose? And it could be that their current clothes are uncomfortable and they're looking for something else they just can't find. They don't know what's going to make them feel better. It could be that they're bored and they're looking for something to do. It could be a host of things, but we don't know. It could be that there's this one outfit that they. They do remember that they're looking for. Now, that outfit may have gone to goodwill 15 years ago, but they don't remember that. So they may be looking for that outfit that reminds them of a good time. I don't know. But ultimately, as caseworkers, as clinicians, we need to try to help the person if, if they can figure out what's the function of this. Now, as somebody who has advanced dementia, it's up to us to really do a lot more of the detective work, because many times they may not be able to articulate exactly why, but when we're working with adults with ptsd, when we're working with adults with mood disorders or addictions, we want to look at the behavior and instead of pathologizing it, saying, why in the world are you doing this? It's obviously hurting you. Well, it may be better than the alternative. What's the alternative? So how is this behavior helping the person survive? And it may not seem to make a lot of sense in the present because the way a five year old responds and survives is different than the way a 25 year old responds and survives. But if the 25 year old didn't develop additional skills, then when they start feeling overwhelmed, they may Just withdraw, because that's all they know how to do. Examples of psychodynamics, fear of dogs, or your response to dogs. And I use this one a lot because I've been raised around animals. I live on a farm, and I am the one that's more likely to walk up to the mangy dog that's half foaming at the mouth and be like, oh, come here, puppy, you must just be thirsty. Now, obviously I'm exaggerating. I use a little bit more prudence than that. But I am the one who will go chasing down stray dogs in the neighborhood to try to find out where they belong and just assume that they're all friendly. And based on my experiences now, I have encountered a couple that, you know, put me on my guard. But in totality, my experiences with dogs have been positive and rewarding. I know some people whose experiences with, with dogs have not. And when they see dogs, they feel vulnerable. It triggers those memories of when that dog bit another dog, bit them or scared them, or maybe their, one of their family members had this dog that was totally psycho and whenever they'd go over to that person's house, the dog would just, you know, bark and growl and carry on and it terrified them. Okay, well, their impression of dogs is probably going to be different. Remember, children think globally. They think in all or nothing terms. So they can't say, oh, well, Auntie Smith's dog was just psycho. And it all. Dogs aren't that way. It's just Auntie Smith's dog had, you know, a puppy screw loose. They can't say that. So the memory, the schema, the belief system they form about dogs is all dogs are dangerous. And as clinicians, we can help people start evaluating their experiences. And we'll just stick with dogs for the moment in, you know, you're working with somebody who's 20 in the 20 years of your life. Let's think about the number of times you've encountered dogs and let's think about how many times they. The dog itself, objectively, in retrospect, has been aggressive, has been negative, has been something versus the dog itself, has been neutral, or you were just assuming the dog was dangerous. Helping people examine, once they have more formal operational thinking in place, examine and sort instead of grouping everybody together, all dogs, we want to say, okay, this dog and or dogs that are like this. And I don't want to group even species together because that's a whole different diatribe. Dogs are like humans. There are good ones, there are bad ones, and you can't just say that all dogs of this particular species are, are problems. But it's important to help people start developing the knowledge to sort but also understand, you know, why certain dogs may be, may be more prone to be aggressive. And instead of assuming it's because they're a dog, assuming it's because they were raised to be, to be fighters. They were bred to be fighters. They were bred for their aggressive tendencies. Distrust of counselors or distrust of people in the system, whether it's your counselors, your caseworkers, or even your attorney, if you've had bad experiences, if you've been in the system, then people who are a part of that system represent the organization or the entity that caused you distress, that caused you trauma and grief. Even if it is a totally different state, it's not the same caseworker. It's still that same system in general. Clinginess and enmeshment in adult relationships, we can see that child who was scared, who, if they didn't stick like glue to their caregiver, if they didn't do everything the caregiver wanted, if they weren't the perfect little chameleon child, they were rejected. So they learned that the only way to be loved and accepted and stay safe is to be a chameleon. Be clingy, be enmeshed, make sure that that other person doesn't get away. Anger when people don't like us. Well, why is that anger is that fight response? Why, why would we want to fight? What, what would prompt that feeling of vulnerability that would cause us to feel angry if somebody doesn't like us? Well, we want to look back. What were we taught? Were we taught that everybody has to like us all the time? Well, we know that ain't gonna happen. Were we taught that we were only lovable if other people said we were? Oh, there's a big one. A lot of people who don't have a good self esteem, who rely on others for validation, who rely on others to tell them that they're okay. When people don't like them, it feels like they are being abandoned all over again. Anxiety at night, anxiety during thunderstorms, and anger when feeling out of control again. We want to look back at prior experiences in which the person felt threatened, felt vulnerable, felt unsafe. I have a whole video on anxiety through the eyes of a child. Because what is stressful and anxiety provoking to a child is very different than what's stressful for us. Hopefully as adults, we don't still believe that there are monsters in the closet. As a child, that's certainly something. If they've seen Monsters, Inc. They believe it. But even if they haven't seen that video, children have these beliefs that come up. And if those beliefs are never challenged, if they're never felt taught how to address them to feel safe and empowered, then they may continue holding on to those faulty beliefs until challenged. If these videos are helpful, please like share and subscribe. If you need CEUs, remember that live and on demand CEUs are available@Allce.com for $59. Now let's talk about the impact of feeling unsafe. Because, you know, after all, we're talking about how to feel safe. HPA axis dysregulation. This is your stress response system. When you feel unsafe, you can't relax. It's like a soldier in a foxhole. You may be able to doze, but it's not going to be good quality sleep. You may be able to talk to your buddy, but you're still not relaxed. And I think most of us have gone through periods where we felt unsafe, where we were keyed up for something before. My dissertation defense, for example, I think for like a day and a half ahead of time, my HPA axis was all over the place and I was keyed up. I was stressed, I was irritable, wasn't sleeping well. GI disturbances, the, the whole gamut before that, because I felt vulnerable. My. And in retrospect, I realized it probably wasn't quite as catastrophic. But at that point, I was seeing my entire future was in the hands of these six people, which was a little intimidating. But for people who have had trauma in their lives and they haven't resolved that trauma, they continue to feel unsafe and powerless, dealing with others in their own skin. Then they constantly feel unsafe. They constantly have this underlying current of stress that keeps them from getting good sleep. Disrupts their gut microbiome. It disrupts their body's ability to absorb nutrients. It causes GI distress, which we won't go into detail. It impairs the immune system. It increases inflammation. That HPA axis is disregulated. There's a long version of it, but inflammation increases. We know this through the entire body. People have an increased perception of pain, even if the pain is actually theoretically the same because of alterations in neurotransmitters and nervous system sensitivity. Because you're hypervigilant, the pain feels more intense. There's difficulty managing blood sugar. HPA axis, when it kicks off, it says we need to get ready to fight or flee. It causes blood sugar to be Dumped. And if it's constantly telling the body, well, we need to keep fueling this puppy, then the blood sugar is going to be harder to manage. Hypervigilance in the. Wherever the person is in their environment, in their relationships, they're scanning, they're looking for clues that they are unsafe. Unfortunately, when we're in this mental mindset, we're looking for confirmation bias. We're looking for things to confirm that, hey, we're not safe. Instead of looking for all the things that say, you know what? This is a safe place. You're fine in this context at this time. And reduced libido. The body knows. If it's not safe, it's not time to procreate. So, long story short, the HPA axis will talk to the hpg, or hypothalamic pituitary gonadal axis and say, yeah, now's not the time for libido. Let's repurpose those hormones for something else. In terms of interpersonal s symptoms and behaviors, we have difficulty trusting self or others. And it's important to help people start recognizing their beliefs, their feelings, become more mindful of what's going on so they can learn to trust themselves. A lot of times, their opinions, their thoughts, their feelings were invalidated. So as clinicians, we need to help them learn that they can trust their own intuition. They can trust their spidey senses. If something feels wrong, then there may be something to it. I remember when my kids were younger, with both my son and my daughter, different instances, we went to the doctor for something, and the doctor just kind of know, poo pooed it or ignored it, whatever you say. And I was like, no, that's not right. But the person that was the doctor, what did I know? I didn't have an MD So I went home and the problem continued. And so instead of advocating at first blush, instead of advocating for my child with the doctor, I deferred and I assumed that I was wrong. White coat syndrome, whatever you want to call it. And then later, I, you know, found my backbone and I went in with research and I said, no, this is what's going on. We need to address it. And the doctor said, lo and behold, looks like you're right. Really. So because I didn't trust, have enough faith in myself, I didn't stand up for myself. In people who've been traumatized, if they have difficulty trusting, for example, their own intuition about who is safe and who is unsafe, then they're constantly feeling anxious if they don't believe their own selves then they don't believe themselves to be safe. So we need to help them figure out what makes somebody safe and what makes somebody unsafe. And how can you tell the difference? Mind reading is another symptom of feeling unsafe. If I'm trying to figure out what you're thinking, what you're assuming, that way I can defend myself against it. That's a threat reaction. I'm not waiting for you to tell me. I'm trying to anticipate ahead of time to protect myself. Maybe that's what I had to do with my caregivers to stay safe. I had to anticipate their every need in order to stay safe. So now as an adult, I, I engage in mind reading, helping people stop that and learn how to assertively communicate and ask, what are you thinking? What are you needing? What can I do? Is really helpful. Likewise, expecting other people to read your mind and do what you need or you want is faulty. A lot of times when people feel unsafe, it's more about them trying to read other people's minds and project what they're thinking. Social withdrawal. Well, if you don't feel safe around other people, it certainly makes sense. You ain't going to be around them because it's too stressful. Helping people figure out. Once they've determined how to figure. Once they've determined how to determine if people are safe or unsafe, then helping them figure out where is it that you can connect with people and feel supported and accepted and it may not be 20 people. You know, that's definitely not for an introvert. It may be one person. Where, where is, who is one person? Or where can you find one person that may share similar interests that might be safe and then helping them start to ease back in. After the pandemic, a lot of people withdrew. They didn't feel safe around others. They didn't feel safe for physical reasons. They also didn't feel safe for interpersonal reasons. Their belief systems about what had happened or what you should or shouldn't be doing or whatever. And there's still a lot of social withdrawal. There's still a lot of people who feel that others will attack them. Maybe not physically, but verbally, that others will attack them if they are authentic and exploring how to start getting back out there and finding the safe people. Yes, there, there are unsafe people, people who will be aggressive and nasty. But we need to help people figure out where the good ones are. Giving up easily. You're all already exhausted. If you don't feel safe, then why would you continue to do something that may not succeed, that risks rejection. Helping people develop the ability to persevere in the face of potential failure or in the face of something that's difficult is important. And a lot of people who have had trauma experiences who've been in unpredictable environments may not have ever had somebody encourage them. They may not have ever learned how to push through or how to fail and not feel like they are a failure. Yes, you failed at the task. It doesn't mean you are a failure. Self sabotage is another behavior that we see because if I succeed, then people may expect me to do it again and I don't know if I can do it again. If I fail, then I am playing into their already negative view that I assume they have of me. And self sabotage is a lot of times a self fulfilling prophecy that's created based on those internalized messages that the child got when they were growing up. You can't do this. Why are you trying creating chaos? Oh, we saw this in residential treatment a lot. The person by creating chaos, remember, behavior has a purpose. Saying, look over there, don't look at me. I got this stuff going on and it makes me uncomfortable when you look at me because you know or you see or whatever, don't look at me, look over there. The other reason people create chaos, generally there's one of these two, I'll save the day. You don't think that I'm doing enough. You don't think that I'm making progress or you're focusing on something I don't want you to focus on. So I'll create some drama over here and then I'll come in and save the day. So I look like a hero and you're focusing on what I'm doing. Well, instead of this stuff that you're angry about in a dysfunctional family and you notice I didn't say the addictive family. This is true in all dysfunctional families. There tend to be several roles. There's the hero. There's the person that responds by being the one that gets all A's. That's the captain of the football team. That's whatever. The person that brings positive to the family. It's like, okay, I'm doing something good. Look over here and forget about all your drama over there. There's the mascot who tends to be sort of jovial and is distracting. Sort of like the court jester. There's the enabler who makes sure that the most dysfunctional person in the family, their problems don't get found out. They make sure to do for that person what that person should be doing for themselves, and they make sure the rest of the world doesn't see past the veil. There's the scapegoat. This is the person in the family that gets blamed for everything. I had a bad day. It's your fault me and your. Me and your mother are fighting. It's your fault the scapegoat gets blamed for everything. And then the lost child just tries to fly under the radar against, you know, a backdrop of all these other characters. They try not to be noticed because that's the safest thing for them. Unfortunately, in adulthood, people tend to recreate these roles. If they've always been the hero or the mascot or the lost child, they will typically assume that similar role in their adult relationships, in their personal life as well as at work. So we need to help them look at how those behaviors help them stay safe in the past. And are those behaviors helping them stay safe and effectively move toward their rich and meaningful life in the present? Or is there an alternative in terms of emotions? When people feel unsafe, they may fight, flee, freeze, or flop. And thank you, Adriana, for giving me that alternative for the last one. But people respond in their own way. And fighting can be through feeling angry, through being aggressive, through anything that would be pushing towards someone else, pushing towards the problem, trying to make the problem go away. Fleeing is anything that helps you escape. It's a fear behavior. It can be addiction. It can be physically running away. It can be going to sleep so you don't. Just don't have to even know, you know, sort of sticking your head in the sand. There are a lot of ways to flee freezing. The best example of that is rumination. Going over the same thing repeatedly, trying to figure out, okay, how can I get out of this? Or, what should I have done? And then withdrawal or depression. The person feels unsafe and powerless and just doesn't have any other options, doesn't have any other energy, and they're just like, screw it. Do to me what you will. And we need to recognize how we as individuals embody all of these, because we do. We all do all of these things to a greater or lesser degree. And. And what triggers that and help our clients recognize how their behaviors are connected to feeling unsafe and the consequent stress response. In terms of behaviors and emotions, we want to help people create safety by helping them figure out what makes you happy. A lot of people don't even know what makes you happy. What does contentment look like and what might make you feel content? And these can be activities that they try to learn throughout the between sessions. Because some people are like, I have no idea. We need to help people learn assertiveness in their communications with other people in order to feel confident in what they're doing. We need to help them feel confident and efficacious. They need to believe that they can do what they set out to do. And as clinicians, when we set smart goals, specific, measurable, achievable, time limited, relevant, relevant and time limited, we help them have some successes and start to see that, hey, maybe I can make a change, maybe I can do this. A lot of people set goals that are too big, too broad, too amorphous. So then they fail to achieve their goals and they feel like a failure. So helping them learn how to set good goals so they can succeed at tasks and separate the difference between being a failure as a human being and failing at a task, help them with determination and perseverance. When they start feeling like giving up, we've all been there. When they start feeling like giving up, what can they do to keep going forward or determine whether it's not worth it? There are some things at a certain point you got to say, this ain't working. When I switched my major in college to psychology, instead of persevering on the pre med track, I said, I'm miserable and I really suck at some of this stuff. So calculus is not my friend. Let me do something that I enjoy doing that I'm good at. And so I determined at that point to switch where I used my energy. I was continuing to persevere in college, but it was a slightly different track. Help people develop a sense of self esteem, that they're lovable for who they are. Help them learn how to relax. This is important. When we feel unsafe. Our muscles are tense, we're hypervigilant. We're kind of like that squirrel that's in the middle of the road that doesn't know whether it's going to go right or left or get squished. We need to help people relax. Until they do that, it's going to be hard to down regulate that stress response. Vagus nerve work is really helpful. Square breathing, singing, blowing bubbles. Anything that slows the breathing and makes it deeper and slower will trigger that vagus nerve. I have videos on the channel if you want some other tips on vagus nerve activation. And helping people develop interpersonal connectedness is also important for developing a sense of safety. What is it? In what ways do I impact other people and how do Other people impact me. And recognizing that some people impact you for good. If you're walking down the road and you smile at somebody and they smile back at you, it's a little thing, but believe it or not, it actually does trigger oxytocin in our brains and helps us feel a little bit better. Now, if they scowl at you and walk away, some people will just shrug it off. Other people will feel devastated. So I'm not saying necessarily to try to go out and do that right away, but recognizing how individuals impact us, recognizing how certain people make us feel happy, safe, content, curious, childlike, any of those words and a bunch of others that are positive that you can find. And then also recognizing being aware of how other people impact you. And then exploring whether, for example, authority figures. If you're an adult and you still feel intimidated around authority figures, thinking to yourself, is this person intimidating in this situation at this time? Or am I reacting based on my prior experiences as a child with authority figures that were critical and rejecting, am I assuming this person is going to be critical and rejecting, or do I not know? In terms of cognitive symptoms, people who feel unsafe tend to have attention deficit. It's really hard to focus on training or learning. When you don't feel safe, they have learning problems. Well, if you can't concentrate and you're not sleeping well, if you is going to be hard to actually internalize and learn information. When people feel unsafe, they may use emotional reasoning instead of basing their logic on the facts in this context at this time, they're basing their logic or their conclusions on how they feel. I feel anxious. Therefore this must be a threatening situation. No, not necessarily. I feel anxious because I've had similar situations to this that were unpleasant. Okay, that's accurate. But I feel anxious about something that's getting ready to happen. I don't know how that's going to turn out. And being willing to be present in the moment instead of assume, project and create a self fulfilling prophecy can be really helpful. People who are feel unsafe. If you're in Fight or Flee, you're in your emotional mind. You are not in your wise mind. When you're in Fight or Flee, your body's saying get the heck out of there. To survive, do what you need to do to defend yourself. So you're not thinking with your wise mind. You're not thinking with your prefrontal cortex which causes problem solving issues. When you're in that stressed state, as I mentioned earlier, you're not scanning for all the cues. You're not scanning for all the things that tell you you're safe. You're scanning for all the things that could be a problem. I know when I'm sitting in the doctor's office, I'm not looking around at things that, you know, make me feel comfortable. I'm looking around and I see needles and I see sutures, and I see other things that I. I don't do needles. And so I. When I. If I go into the doctor's office and I'm in a threat state, I'm going to notice the things that I perceive as threatening. Helping people step back and widen their attention to all of the cues. All right, I see. This is threatening. What else is there that might not be threatening? It's an intentional attentional shift. Activation of prior schema. That critical inner voice expectations and interpretations based on the past is a natural reaction. That's your body shortcut. It says, hey, we've been here before. This is what happened. This is what you might expect, but it's up to us to say, okay, thanks for the heads up, but I don't know that that's going to happen this time. Let me proceed with caution and awareness. But an open mind. Hyper vigilance in the environment is also a big issue. And we need to help people when they're in our office, when they're in their home, when they're in their car, wherever, to identify triggers for feeling unsafe, but also for identifying triggers that help them feel safe and adding triggers that help them feel safe. Whether it is a. A picture or having a friend on speed dial or just locking their doors and knowing that they're safe in their car, whatever it is, helping them recognize those things in terms of behavior. When people don't feel safe, they are much more likely to be vulnerable to addiction. They get to the point where they feel hopeless and helpless, that the pain is overwhelming. So they start trying to distract themselves or numb the pain in some way. And it can be gambling, it can be food, it can be sex, it can be drugs, it can be. Be alcohol, video games. There are a lot of different addictive behaviors, but the function of that behavior is escape is temporary relief from this pain over here that I have no freaking idea how to resolve. When people don't feel safe, they tend to be more impulsive. Think about yourself in situations where you've been a little bit anxious. Have you been patient? You know, you get information and you're like, okay, well, let me think about it for a minute. Or have you been like, okay, if that'll Fix it, Make it happen. Make it so let's do it without thinking it through. Impulsivity, especially in relationships, is really common in people who've experienced trauma. The minute they start feeling unsafe or fearing abandonment, they cut ties. It's like fine, I'm going to be the dumper, not the dumpy. See you later. They may have insomnia or hypersomnia as a way of trying to sort of escape from what's going on. If I'm asleep, I'm not feeling now insomnia is. If I go to sleep then I'm even more vulnerable. So what's the function of the behavior? And non suicidal self injury is another behavioral consequence when people feel unsafe. NSSI behaviors are one way that some people find to help them feel they like they've got control over something or like they can feel something in terms of phenomenological reality. Situations in the present for all of us are filtered through and perceived through the lens of the past. Remember we're talking about dogs before, whether the experiences were personal, we actually had an interaction with a, a psycho dog or vicarious. A loved one had an interaction with a psycho dog or we saw it on tv. I mean we just kept being bombarded with it in tv. This thing is dangerous. Then we may assume that what's going on in the present is dangerous based on facts from the past. Our education also, whether it's from our family, from the media or from school, shape our beliefs and what we know about things. Remember, things are always changing and it's up to us to figure out based on the facts in this context at this time. I know I've said that like 50 times today but it's so important because a 25 year old is much different than a 5 year old. The situation that a 25 year old is in is much different than the situation that a five year old's in. And developmental conceptualization, the way a five year old conceptualizes something. Remember, it's all or nothing and it tends to be very personalized. It's all or nothing and it's it's my fault. Whatever happens, it's my fault. Whereas an adult is able to see different categories, is able to think in hypotheses, is able to examine alternate explanations. Besides it's me. Seeing through the same lens helps us understand people's reactions and interpretations. So imagine yourself as that person when they were five going through what they were going through. Then imagine yourself as that person as in when they were 25 going through the current situation and See, you know, what was triggered between those situations. You can have people write a anchored autobiography to help them explore their current reactions. And when it. When I say anchored, I mean have them start with, ideally their first memory. But if they can't get before, like first grade, then have them anchor for each grade. When I was in first grade, these were my teachers. This is where I lived, this is what I did, this is how I felt, blah, blah, blah. I actually have a worksheet that I give people and I have them fill it out for every single year, starting with their first memory. And they add to it as we go through, because we never. I've never had anybody write a complete autobiography where they remembered everything, but it does start helping them enlighten them about why they react in the present to things that remind them of traumas or things in the past. Transference can be positive or negative. We can transfer feelings onto somebody. If somebody reminds me of my first love and I see them, then I may have automatic positive feelings for them. I don't know them from Adam's house cat, but my brain goes, oh, I remember somebody like this. Probably going to be a good thing. No, not necessarily. Same thing with bad things. I remember somebody like this who traumatized me in the past. Oh my gosh, maybe now I remember a situation like this that was traumatic in the past. I'm in a similar situation now, so I'm going to transfer those feelings. I'm going to assume that this situation is going to be exactly the same. Transference can be triggered by sights, somebody's appearance, how they move, the environment, smells, sounds, or even situations like going to the doctor, going to bed, or going to school. So if those situations are similar to a traumatic situation, it may trigger those trauma feelings. Likewise, situations from the past that were positive can trigger positive feelings in the present. Have people review current situations that trigger unpleasant feelings and explore how they are shaped by their prior learning. It's vital for people to be aware of how thoughts, emotions, and reactions from their past experiences can translate into thoughts, emotions, and reactions in the present. Thinking again, Thunderstorms, dogs, drinking alcohol, or having somebody around you drink alcohol. Raised voices, people who are of a different gender, school. Just being in school. I know one of the issues that we had getting people to participate in some prevention activities we did many years ago was that we were hosting them at school. And school was not a happy place for a lot of the parents of the kids that we were trying to advocate for. Same thing. If you offer the prevention activities at churches, some people have such a strong transference reaction towards a church building based on their experiences with religion and church in their past that they won't go through the walls or go through the doors. In terms of addressing transference, we want to increase mindfulness, help people increase their mindfulness about their signs of anger. What, what are your warning signs of anger? Physical, emotional, mental, cognitive. Same thing for anxiety and depression. Help them recognize, okay, when I start to feel this way, this is anger. We're developing that emotional intelligence. Help them develop mindful awareness slowly. Have them really focus on being present in the moment while they're cooking. For example, noticing what they're doing when they're cooking, not watching TV while they're making eggs or something, but actually being present in the moment when they're eating, when they're just sitting, when they're waking up or going to sleep, or driving or walking. If they're doing it during a prescribed time limited period, it's easier. And then you start stringing together those periods. So if they get used to being mindful while they're eating, then okay, that's great. That's three times a day. Now let's talk, let's add a couple more times. And so eventually, hopefully they're mindful most of the time. In terms of grounding, we can help people differentiate between then and now by asking themselves how the current situation is similar to and different from the prior situations. Let's look at sights, smells, sounds, and the situation in general. What's similar? What's different? So you can understand why it's being triggered, but you can also understand why or speculate why this time might be different. How are you, the person, the same as you were back then? I mean, you're, you've still got some things that are similar, but how are you different now? And a lot of times the person has more knowledge, more skills, more independence, more resources, more something that helps them be safer. They're not dependent on whatever they, they're able to keep themselves safer. And what are the facts for and against your beliefs that you are currently not safe? There may be some facts that say you're currently not safe, but let's look at them and then figure out for the factual I'm not safe things, how can you get safe? And for the ones that I feel unsafe, but they're not actually accurate. How can you address those in terms of physical safety? At home, work in the car, in treatment, wherever the person is, have them examine how they can moderate triggers that cause them stress or tension. How can they deal with the inevitable unpleasant triggers and how can they be aware of when they're getting triggered so they're not in a full spiral by the time they notice? What can they do to help themselves feel more relaxed in those different environments? The sites and we need to pay attention to those as clinicians in our decor too, including the egress, light levels, the people that are around. For example, if somebody had a traumatic experience as a child, then they may bring their child to therapy for whatever issue. But they don't feel comfortable sitting in a waiting room with a lot of adults that they don't know if those adults are safe or not. So some places have a special waiting room for families with children. Sounds including volume smells including the intensity of the smell. Some smells will just trigger memories for people and behaviors. What can you do in terms of behaviors that can help you feel more relaxed? How can you feel safer around others? What can you do to feel safe from your inner critic? And I have a whole video on silencing the inner critic, but we do need to start reprogramming or un or erasing those tapes that are not useful and that are actually harmful and abusive to ourselves. What are your the boundaries that you have in all the pieces of your life and how can you enforce them? What are your physical boundaries, interpersonal boundaries, emotional, cognitive, environmental and spiritual? How can you more accurately respond to triggers of abandonment or danger in the present? If you're being triggered and you start feeling like you're going to be abandoned or feeling like you're in danger, how can you remember to downregulate and examine the facts in this context at this time? What can you do to help yourself feel confident and loved? As clinicians, we can provide people with self esteem enhancement activities and help them learn assertiveness and interpersonal skills. We want to help people moderate triggers for unpleasant emotions in terms of cognitive safety, we want to help people figure out how to moderate. And I'm not saying get rid of, I'm just moderate. Cope with deal with unhelpful or distressed intolerant thoughts. When they start saying I can't do this or this is the worst thing ever, how can we help them reframe or restructure those thoughts? What can you do to help yourself think more positively? Helping people use guided imagery or thought rehearsal in order to expect to be safe and empowered instead of expecting to be unsafe and disempowered. What can you do? What can the person do to help themselves improve their attention? When you feel unsafe, you're not going to pay attention very well. So what can you do to help yourself out? What tools can you use when you're having difficulty with attention to do the best you can. And what works for the person to address rumination so they don't say stay stuck on those same self defeating thoughts. And finally, what aspects of different environments make the person feel vulnerable or are triggering like crowds, locked doors or being in small rooms, like claustrophobic small rooms. From the moment we're born, we start gathering data about our world. We we remember sensory cues that indicate safety or threat. Once learned, those cues continue to trigger emotions, thoughts and behaviors designed to ensure continued survival. Those cues unfortunately often become overgeneralized. Going back to the dogs, it was designed to keep you safe from the that crazy dog down the street. But you overgeneralized it and started believing that all dogs were crazy. And helping people become more mindful of the present moment instead of relying on old unchecked data in order to help them feel safer. Alrighty, I know I ran over a little bit. I am going to go back through some of these questions real quick. I saw a few come in if you are ready to go. It's been a pleasure having you in today's presentation. You can if you're taking this for continuing education, log into allce.com take your quiz. You can do it tonight too if you've got to go see a client. And I will see you next week. All right. Hello to everybody. Whistleblowing Goodwitch pointed out that people who are on the spectrum often are not diagnosed early enough and they may experience bullying even after they've been diagnosed, but they may be experience bullying and criticism and a sense of not being accepted. And, and that's exactly what I was talking about on that second slide about how mental health issues can actually cause trauma. Because if you're neurotypical then the neurotypical environment doesn't feel like it fits and you feel powerless and potentially overwhelmed and that stimulation can be painful. So there can be a lot of even unintentional trauma that happens. Is there a way to determine what a warning from the gut and what a trauma based unrealistic feeling feeling? The best way or the tools that I typically suggest it's not necessarily the best way is again I ask people to examine the current situation and identify the facts, not just what do you actually know, not what are you assuming what are the facts in the current context, recognize how that's similar to prior traumatic instances and then try to differentiate whether what's going on right now based on the facts is actually threatening or dangerous. If you're still on the fence, if you're still unsure, then deciding what is it that you can do to either test the facts or to tread lightly and protect yourself while exploring with an open mind. Golgi, baby, I'm glad you enjoyed today's presentation. Mahalo. And I hear what you're saying. Whistleblowing Good witch. And it really sucks that you have to go through that. And it really sucks that we have to do so much to try to keep ourselves safe in an environment, in a culture in which people often are insensitive and so self consumed because they're so anxious that they aren't aware of their impact on others. Yes, signs of being on the spectrum may show up as PTSD symptoms or likewise, signs of PTSD may show up as symptoms that you might see in someone who's on the spectrum. For example, difficulty with eye contact can be a symptom of being on the spectrum. It can also be a symptom of or a reaction that developed as a result of abuse. So we do need to look at when did it start and. Get a chronological history. If it started as, you know, a really young child, probably more likely developmental, obviously on if you're on a spectrum, there's a whole group of symptoms that you need to have. But a psychologist can diagnose people as being on on the spectrum. Great questions, everybody. Alrighty. Well, I think we are at the end of the questions for today. If you are going to be in Georgia this weekend for the conference at in Moultrie, I look forward to seeing you there. Otherwise, I will see you back same time, same station, next Wednesday.