CBT Counseling for Addressing Trauma

Hey there, everybody, and welcome to this presentation on CBT strategies for addressing trauma. I'm your host, Dr. Donnellice Snipes. In this presentation, we're going to define trauma and traumatic experiences, identify the goals of trauma recovery, and then describe the steps in processing trauma. Trauma in general can be thought of as any event that overwhelms your ability to cope. So when somebody dies, that can be traumatic. When we have a. When we lose our job, that can be traumatic. When we break up, that can be traumatic. So it can be traumatic. Trauma can alter people's perception of safety and empowerment, themselves, other people, and even the world. Trauma causes grief, and grief causes trauma. And that's important to remember, because when we experience trauma, we experience this loss of a sense of safety and empowerment. So we may need to grieve that, especially if it permanently alters our perception of the world. If we all of a sudden see the world as a more hostile place, we feel less safe, then we may need to grieve the loss of that notion that we lived in a safe environment. Traumatic injury is mental and physical health problems that develop as a result of trauma. And it's important to recognize that for the majority of people, and most traumatic experiences do not produce traumatic injury. Yes, they're traumatic. Yes, they suck. But within a relatively short period of time, they're able to integrate that and it doesn't negatively impact their health, their mental health, and their relationships. All experiences are influenced by and influence our schema. And so you may be asking, what are schema? And I do have other videos about that on the YouTube channel. But briefly, schema are basically our expectations based on prior experiences. It's a Cliff Notes, if you will, of what to expect in certain situations that we form as the result of prior experiences. So the example I usually use is stoplights. My schema about stoplights is if it is green, then it will turn yellow, then it will turn red. You know, that kind of makes sense. However, if I'm pulling up to a stoplight and there's an emergency vehicle coming up behind me, it may go from green all of a sudden to red because they need the traffic to stop. So it's important to recognize that our schema give us the shorthand to expect it. So it's automatic. We're not having to think every time we come to a stoplight about, okay, what's going to happen? We form schema about everything. You have a schema about what to expect when you go to work or to school, when you go into a restaurant, when you, you know, everything that you have experienced in the past, you form sort of a shorthand about what to experience in the future. So if you've had a negative traumatic experience with something and you experience it in the future, then you may be expecting it be extremely traumatic. For example, my father passed away from cancer many, many years ago, and that was an extremely traumatic experience. And my expectations for what happens when somebody is dying of cancer is based on my schema about cancer is based on what I saw my daddy go through. When I went through it with my mother, it was somewhat different than what he went through. So my schema were inaccurate. I had to alter my expectations about the cancer experience because what she went through was somewhat different than what he went through. So it's important to recognize that we will alter our schema with new experiences. But until we have those newer experiences, we're relying on old information. And if that old information is inaccurate or for the current situation, then it may set us up to expect something more traumatic or more dangerous than might actually be happening. And that keeps our anxiety levels up. If schema changed to make the person feel unsafe and disempowered or unable to keep themselves safe or make things better, then whenever they're reminded of the trauma, it will trigger their threat response system. So when they're reminded of a traumatic experience that they went through, maybe you went through a particularly bad hurricane and it's hurricane season again. Well, just hearing that it's hurricane season again can trigger those prior traumatic memories and cause you to experience a much higher level of pretty much ongoing anxiety during that. During that hurricane season. So what do we do about it? The goals of trauma processing are to help you identify the traumas that you've experienced. And it'll be important to look at the big traumas, but also to consider other traumas that have informed your perceptions going forward. So if you had experiences when you were a child that you felt helpless, disempowered, unsafe, then you may have formed this schema about the world that it was unsafe. So whenever you, you know, went out into the world, you were looking at it through, through goggles, through a lens of unsafeness. Instead of looking for what's safe in the world, you were more likely to notice the threats which kept your anxiety high. We'll evaluate the memories of the traumas based on the facts, other factors that you may not have considered, and cognitive distortions. When we are going through a trauma, when our HPA axis, our threat response system is triggered, that is not the time our Brain is engaging in this higher order processing, stepping back and going, okay, what are all the factors in this situation? What's my part? We're not in our logical mind. We are in our fight or flight mind. We are in the I want to survive, get me the heck out of here mind. Which means that our perceptions of the situation may not be wholly accurate because we had tunnel vision. We. We weren't considering the other people that were there, the other factors, et cetera. Once you evaluate the memories, then you'll acknowledge and integrate the trauma. Some traumas are off. Well, all traumas are awful. But sometimes you can't put, as my mother would say, lipstick on a pig. It was a sucky situation, and there's no way to look back at it and say, okay, let's make this, you know, a happier experience. It just wasn't. So it's important at that point to acknowledge and figure out how to grieve or integrate that trauma into your time going forward. There are other traumas that you may look back at and go, you know what? I've been looking at that all wrong all these years, and maybe I need to reframe what happened. And that happens a lot, especially for traumas that occurred when you were a child or when you were under an exceeding amount of stress, but especially when you were a child, because children think differently than adults do. Children think in all or nothing terms. Children think very personally, and I see this a lot with people who grew up in a family where one or more of the caregivers had a substance abuse disorder and ended up either going to jail or abandoning the family or having to go to residential treatment multiple times or, heaven forbid, overdosing. And a lot of those children didn't understand, you know, why would my caregiver choose to use the drugs instead of be with me? They must have loved the drugs more than me. And it's important to go back and really examine the whole situation and help the child recognize, or the adult recognize that as a child, it. Most of the time I've never had an experience where it wasn't, but I'm sure somebody can come up with it. But every time I've gone back over it with people, it had nothing to do with the child. It had everything to do with the person with the addiction. And the child just personalized it. So it helped them feel better about themselves as adults and process some of their feelings of anxiety about abandonment once they started to recognize that their caregiver did not abandon them because they were unlovable. Their caregiver, you know, abandoned the situation because you know, and fill in the blank. There are a lot of reasons it happens. And then explore and address how the trauma is currently impacting you in the present. Things that happened when you were 6, 16, 26, if they're not, well, even if they are resolved, they're part of your schema, they're part of who you are. If they were not resolved in a positive way, if they left you feeling unsafe and anxious, then that's probably still affecting you in the present. It's still impacting the way you perceive the world and others and even yourself. If you processed the trauma in a different way and you emerged from it feeling empowered and safe, you know, maybe recognizing that, hey, I couldn't prevent this, but I am able to keep myself safe in the future, then that is probably having a different impact on you. Steps in processing the trauma. It's not. You don't want to just sit down and go, okay, here's my trauma, let's go to it. You need to prepare because the definition of trauma is it overwhelmed your ability to cope. Well, why in the world would you start trying to rip open that wound before you make sure that you have some tools before you make sure that you have a safety net? So the first thing is to identify, prevent and mitigate vulnerabilities that may make it more difficult for you to deal with distress. You don't want to be going through this when you're also going through a divorce, when you're also struggling with something else in your life, when you're under the influence of substances or sleep deprived. All of those things can make it more difficult to cope. So those are vulnerabilities, particular ones that I encourage people to look at. Substance use. You know, as I've said already a couple of times, processing trauma while under the influence of substances is a bad idea. So I encourage people to evaluate where they are with that. Sleep disturbances. You want to make sure that you are already, you know, feeling relatively rested because this is exhausting work and you don't want to start out exhausted because then you're just going to go down, you know, to this completely burnt out place, potentially. So making sure that you're rested, making sure that you're not in extreme pain, you know, if you're having a flare up of your autoimmune issue, if you're, you've got a lot of other pain going on and it may be more difficult to deal with the stuff and focus on what you're dealing with. Affectively, if you have anger or anxiety about other stuff, you know, ideally you really want to be in a place where you are okay, you know, if you're processing trauma, then you're probably experiencing some unpleasant feelings, but you don't want to generally, you know, start ripping open these wounds and processing these traumas. When you are at the depths of clinical depression or experiencing panic attacks. If you are experiencing those, it's definitely important to seek help from a medical professional in order to get that stabilized, and they can also guide you through this process cognitively. If you are negative and pessimistic, it's important to at least acknowledge that, because when we are in a negative frame of mind, then we tend to notice the threats and the negative in the environment, and it's harder to feel safe and empowered. So it may be important to do some work on adjusting your attitude so you can feel optimistic about the fact or the hope that working through this will help you feel better environmentally. If you have a lack of a sense of safety, if you fear for your personal safety, then obviously that's not the time to start processing trauma. You need to be able to be in a place where, even when you're processing the trauma, you're able to relax at night and get a good night's sleep. You're able to actually truly feel safe enough to get into a deep sleep. Interpersonally, isolation or lack of healthy support is problematic when you're going through this. It's hard, it's exhausting, and most people need other supports. Maybe not to process the trauma with. Maybe that trauma is too personal, but maybe to help them, you know, after they do their trauma work, help them switch gears and start doing something else. Help them get some parameters, Help them, you know, feel safe, that they're not going to spiral. And then unhealthy relationships, if you are in a particularly unhealthy relationship, then that can be causing extra stress. That can be actually reducing your social supports and your ability to cope with trauma. So all of these things, you kind of want to get as many of them as possible. Either prevent the problems, or if they're unavoidable, you know, maybe you have chronic pain or like I said, you are struggling with generalized anxiety. Okay, well, what can you do to mitigate them? What can you do to get it as under control as possible for you? So you have. You freed up the most energy that you can, and you've created a situation where you feel as safe as possible. Going into this, the next step is to develop at least 10 distress tolerance skills and make a list of them. A list that you keep somewhere handy that you can actually look at when you're in distress. It's going to be hard to remember them, so write them down. Now the categories I use the mnemonic tags to help people remember the things that they can do. Thoughts Thought stopping is a technique and there are a lot of different ways to practice thought stopping. You can either tell yourself, no, I'm not going to think about that, or you can, sometimes I'll sing a song or I'll say the rosary, or I'll just say Hail Marys, whatever. But that helps me with thought stopping because I'm telling myself I am not going to have that thought right now. Unhooking is another technique where instead of saying I am depressed, I am unsafe, I say I am having the thought that I am unsafe. I am having the feeling that I am unsafe because thoughts and feelings change. It's not part of who I am. So unhooking can be helpful and then developing distress tolerant thoughts. And again, I have a lot of videos on distress tolerance skills on the YouTube channel, so I'm not going to go into a lot of detail here, but basically distress tolerance thoughts are things that you tell yourself that are encouraging, that say, you know, this sucks right now. However, I know I can get through it or it will end soon. A stands for activities to distract or trigger opposite emotions. And I think it's important for everybody to include in their toolbox focused breathing. Focused breathing is breathing in for four, holding for four, and exhaling for four. Now, one way you can do this, and you can even do it with adults this way, is with bubbles. You can blow bubbles when you try to blow a bubble. Imagine trying to blow one big bubble instead of lots of little bubbles. Blow one big bubble. So you inhale and then you've got to slowly exhale in order to, you know, create that great big bubble. When you do that, you actually trigger the rest and digest reaction, which is opposite of fight or fleet. So that can be helpful, but also identifying other activities. For me, it's gardening or playing with my dogs or listening to music. What things can you do? Guided imagery to help you feel safe and trigger the relaxation response. You may envision your safe place, whatever that looks like to you. When you envision it, use as many sights, sounds and smells as you can think of. I usually say at least four of each in order to help give that image some depth, to help it give it some more realism. But also when you're focusing on all those things, then you're not focusing on the distress. You may envision your favorite place, maybe an amusement park that you went to or something, and remember that favorite memory and walk yourself through that again, remembering what you were smelling, what you were hearing, the sun beating down in your arms, whatever it was. Or you can do something as simple as envisioning and feeling the hug of a comforting person. And sometimes you can do it by sort of hugging yourself and closing your eyes and imagining that you're feeling. Feeling the arms of your caregiver or somebody just giving you a great big hug. There are a lot of different types of guided imagery you can use. Those are just a few. You can go online and find different strategies and sensations. These are sights, smells, sounds, or even physical sensations like cold water splashing on your face or holding ice cubes. That can distract you from what you're upset about or trigger safe and calming memories. Maybe the smell of Pine Sol always reminds me of my grandma's house. So that smell, when I smell it, can kind of trigger those memories and put me back into that safe, happy place, happy time. So develop a list of at least 10 distress tolerance skills. You've identified and mitigated as many vulnerabilities as possible. You have the distress tolerance skills. Now the final thing that you're. Well, almost final thing that you're going to do is learn how to use cognitive restructuring skills. And this kind of laps over two different slides. So bear with me. I couldn't fit it all on one slide. So you're going to identify when you have a thought like I am unsafe or it was my fault that my caregiver left. Identify what is the thought? Is it related to prior traumas or experiences? So maybe you're in a relationship now or just got out of a relationship, and the way you're processing it, you're linking it to all of the other bad relationships or bad endings to relationships. So they're starting to become sort of additive. So how are those prior relationships influencing your perception of this current one? Are they helping you make the current perceptions more or less accurate in the current context? And that's really important because sometimes our experiences from the past are very wise and they help us understand what's going on in the future and or in the present and figure out what we need to do. But sometimes they're inaccurate and we are taking baggage from our past and we're making somebody in our present carry it. What's the difference in the present context? How is this situation different. How am I different in this situation at this point in time than in prior situations? So maybe something happened when you were a kid, you were eight, you were 10. Well, that you have a lot of changes that you've gone through and a lot of different resources now that you are 28 or 30. So what's different? How are you more able to keep yourself safe and how are you more empowered in this situation than maybe you were in the past? What are the facts for and against your belief in the current context? So whatever your belief is, what are the facts? Not what are you assuming? What are you expecting, but what do you actually know to be true in this current context? If you're using any of the following unhelpful thinking strategies, restate your thoughts and use the suggestions in parentheses. These are sometimes referred to as cognitive distortions, mind reading, or jumping to conclusions. Counter that with the facts. If you assume that somebody is mad at you, you know you believe somebody's mad at you. Examine that belief based on the facts. What facts do you have that make you know that that person's mad at you? If they gave you a dirty look or if they didn't return your phone call, there could be a lot of other reasons for that. So making sure that you are using the facts, making decisions without sufficient information is another problem. You want to make sure you have the big picture. You're looking at the big picture. You don't have tunnel vision and you're considering all the information that you need to make an informed decision. And then play the tape all the way through on your reactions. If I do this, what's going to be the consequence? Not only right now, but a week from now or six months from now? Emotional Reasoning Remind yourself that emotions are your smoke alarm. Emotions trigger you to get up and do something if you are feeling anxious or angry. That's that fight or flight system saying, hey, there might be a problem based on prior experiences. Based on our schema, this is similar to past situations, so you may want to check it out and see if the same thing is happening again. It's not your brain saying there is a problem and this is happening again. See, there's a slight difference there. All or nothing thinking. It's important to restate using moderate words and identifying exceptions instead of saying every relationship I've ever been in has been a disaster, saying, you know, I've been in a lot of bad relationships. However, there have been some that have been better than others and identifying exceptions. Personalization what are three other explanations for what's going on? Besides you, what are three other explanations for why your best friend didn't call you or failed to show up for dinner, besides the fact that they were trying to diss you for some reason? Catastrophizing. Go back to those facts again. Facts are your friends. Based on the facts in this situation, what is the probability of this catastrophe? You know, I mentioned hurricanes earlier and we all watch those spaghetti models and a lot of those spaghetti models are sort of assumptions, sort of mind reading of the hurricane about what's going on. We don't know for certain exactly what's going to happen based on the current facts that we have. What's the probability of catastrophe? And then you can make decisions from there. You know, if it looks like you're getting ready to get slammed with a Category 4 hurricane, then you probably want to get out of there, you know, because catastrophe is possible. Fallacies of Control and Fate what parts of this situation can you control and how can you cope with things that are not in your control in any situation? Well, most situations at least, we cannot control everything. But by the same token, everything is not out of our control. We always have some element of control of either how we react or sometimes we can even affect the situation itself. So thinking about fallacies of control, if you try to control things that are out of your control, it's like trying to push against a building to move it. It just ain't going to happen and you're going to get frustrated and exhausted and feel disempowered and defeated. So focus on what you can control and then identify what you can do with the rest. And finally minimizing your strengths or accomplishments. A lot of times people will say, well, anybody would have done that. It wasn't a big deal when it was. So giving yourself credit, you don't have to necessarily say it to everybody and their brother, but giving yourself credit. Self talk saying I am proud of myself for I did a good job with. In order to remind yourself, you know, positive, positive self talk helps increase our sense of self esteem, self empowerment and safety. And finally, once you have gone through and I'll just summarize, identified the thought, identify how it's related to prior traumas or experiences. What's different in the present context as opposed to back then, the facts for and against your belief in the current context, then identified any thinking errors or cognitive distortions. Ask yourself, with all this new perspective that I have on this situation, what is the best use of my energy to move toward the things that are Important for me in my rich and meaningful life. What is it that is most beneficial? Is holding onto this anger or resentment helpful? Is living in fear helpful? What is it that I can do to help myself feel? How can I use my energy to feel safer and more empowered? All right, finally, the last one. Before you begin, consider doing these activities with a therapist or a spiritual leader. Sometimes when we start processing intense traumas, it can get intense really quickly. So I always advise seeking counsel. Develop a safety plan in case you start feeling overwhelmed. Ask someone, a friend, to be on standby so you can call them if you start feeling like you're spiraling. You may even have them call and check on you in an hour. So, you know, you make sure that there's somebody checking on you. Consider doing it in private, but while other people are home so you're not alone, do not do it under the influence. And keep a list of your distress tolerance skills handy. Set a timer so you don't end up starting and then six hours later you're still working on it. Set a timer for 30 minutes, an hour. Generally any more than two hours is really too much. But whatever you want to do. And only process one trauma per session. So if you're going to work on the trauma from when you were in fourth grade, then process that and that's it for the day. That way your brain has time to, you know, reset and process everything that's happened, and you don't get overwhelmed and you don't get exhausted, and you don't proceed to try to process more traumas and become ineffective at it because you're already too exhausted. All right, so now processing those traumas, you didn't think we'd get here. Write your autobiography. Begin with your first memory. Who is important in your life? Are they supportive and nurturing or toxic? How's your health? Are you happy? If not, why not? What's important in your life and what significant events happened during this year? What caused them, and what was your reaction to them? So, you know, when I think back, first grade is when my parents got divorced, so that would be one of the significant events. We also moved that year, so that would be another significant event. And. And I would talk about, you know, what I know or what I think I know that caused them and my reaction. And then I would say, okay, so that was first grade. Now let me think about second grade. And for your early life, grades are usually pretty good anchors to help you remember kind of where you are at. If I say when I was 16, I don't really remember much about. I'm like, okay, when was that? But if I say when I was a junior in high school, okay, that's anchoring for me and I can remember my classmates, my classes, what I was doing. So repeat this for each grader year from that point until the present day. So, you know, if your first memory is when you were six years old and you are 46 years old, then you're going to go through this about 40 times now. Some years there may not be much. You know, it may be like my sophomore year in college wasn't much different than my junior year in college. So I don't have a whole lot to add there. But then there are other years, like my freshman year in college, there were a lot of, there was a lot of stuff. So that year would take a lot more time to process. Take your time doing your autobiography and either do it, I recommend either doing it on a computer or if you do want to handwrite it, skip lines. And for each year, use a different sheet of paper because you will almost inevitably remember more stuff as you go through this process and so you'll want to add it in there. So setting it up so you have the ability to go in and kind of insert information as you go along. Most people, it takes them about a week or maybe two to do their autobiography. Once you've done it, go through your autobiography and identify the traumatic experience experiences. Start with the first one and work forward since as you remember, each experience influences all future experiences. You may notice that the beginning of your sense of feeling helpless and hopeless and disempowered and unsafe started all the way back when you were knee high to a grasshopper. Or maybe it started in high school, but then it negatively influenced how you perceived everything after that. So you want to start at the beginning so you can get some insight as you move forward as to, oh, now I see why this seemed so overwhelming to me because of all these other experiences that I'd already had then Processing the trauma. And this is another two slider, so bear with me. The notes are in the for this are below on the YouTube video. So if you want to copy and paste these onto paper, you can. So processing the trauma. What are the facts of the event? Back to those facts again. So you're just going to write down a narrative. What are your beliefs about the event? So maybe you were in a environment in which maybe your little brother was getting bullied by somebody at school and you say to yourself, I should have protected him. Maybe you had A caregiver that abandoned you. And you're telling yourself, my belief is that that person didn't love me. Or maybe you were in a relationship and all of a sudden it broke up. And, and your belief is that it came from out of the blue. Well, when something comes from out of the blue, it's hard to protect yourself. So it makes you be more hyper vigilant. A lot of times when you start examining the beliefs, you will find that there were other factors at play. I should have protected him. Well, why didn't you? What kept you from doing that? You were another kid. You know, your little brother was 9 and you were 10. You were in different grades, you were in a whole different school. I don't know. But there are often a lot of reasons that you didn't consider at that point in time. You feel guilty today for what happened, but in retrospect, maybe it's not really realistic to have expected that you would have been able to protect him. The person did not love me. We talked about that earlier. A lot of times what people do is more reflective of their stuff than your stuff. So examining, you know, why did your caregiver abandon the family? You know, do you know, what are the facts that you have that support that it was about you versus about them and their inadequacies, and then it came from out of the blue. I hear this about relapse a lot. And every time I've gone back over it with somebody, we've come up with warning signs that they ignored. So it didn't come from out of the blue. So now they are aware of their warning signs and they can be more mindful. So we want to examine the beliefs about the event. Are there any other factors, perspectives of things that you might not have considered? Remember, once you form a schema about a situation, it often doesn't change unless you evaluate or adjust it. So if you form this belief about yourself that you were not lovable and people were not trustworthy based on things that happened when you were a child, your future experiences may have not been as negative, but you may be still holding on to that schema. So you just anticipate that people are going to let you down or be harmful or abandon you. So it is important to actually examine those schema and, and evaluate them so you can figure out if they're still accurate. If they are okay. If they're not, what do you need to do to modify them to be more accurate in the present context? How was this influenced by prior experiences? How did this Experience shape your beliefs? There's that beliefs word again. How did how did this experience shape your beliefs about your ability to keep yourself safe, to improve the next moment and live a rich and meaningful life, to be loved and to love and trust others? How did the experience shape your beliefs and expectations about other people's trustworthiness and your general safety in the world? How did it shape your beliefs about the future and what to expect in the future? Go back over each of your beliefs that you've identified and complete the cognitive restructuring worksheet or questions that we went over in order to explore with a clear head in your wise mind as a observer of the situation, you know, was there information that you didn't have? And do you still hold the hold to the same beliefs now after answering all of these questions? What losses do you need to grieve as a result of this trauma? For example, maybe because of your prior traumas and your inability to trust people as a result of those early prior traumas, you sabotaged future relationships and you feel guilty about this now, and you've got to grieve the loss of some relationships that maybe could have been pretty good, but you were unable because of your trauma, you were unable to embrace that and see the safety in it. You reacted from a place of threat and danger. You may even need to grieve lost time because prior experiences left you feeling so helpless and hopeless that you were stuck. You were paralyzed in depression or trauma or hopelessness. So you didn't try, and now you're going, well, I could have been so much further along. We can't change the past, so you may need to grieve the fact that you've lost that time and decide what you're going to do henceforth. What can you do now to feel empowered and safe? How are you different, wiser and stronger now than you were then? How is this event influencing you in the present? Your health, your mood, your attitude, whether you're negative or positive, and your relationships. This experience is part of who you are. How can you use it to help you become more like the person you want to be? And as I said earlier, some traumas, like I had a dog that got hit by a car and that was extraordinarily traumatic for me. Our animals are part of our family and there is no way to put lipstick on a pig with that one. There's no way to make it a happy thing. The only way I can integrate it, or I could integrate it is by recognizing, okay, what can I do in the future to prevent that from happening. And remembering all of the positives that Kenny brought into our life when when he was with us, that's how I chose to integrate it. You know, you'll figure out what you need to do and a therapist can help you figure out how to integrate these and process the grief and the losses. Trauma can be insidious because unresolved, it can negatively impact your sense of safety and empowerment. When it's effectively resolved, you'll have a better idea of what happened, what your role actually was, losses and other traumas that need to be aggrieved as a result of the experience, and how you can integrate that experience in a way that can help you move forward toward a rich and meaningful life again. Remember, I'm going to put the notes for this in the video notes for the YouTube video, so if you want to copy and paste some of those discussion or thinking prompts, you can. Thank you for being with me.