Enhancing Trauma Resiliency with Dr. Dawn Elise Snipes

I'd like to welcome everybody to today's presentation on enhancing trauma resiliency. I am your host, Dr. Donnelly Snipes. We're going to learn about the effects of acute and intergenerational trauma review risk and protective factors for ptsd. Because not all trauma recognized results in traumatic injury and will identify strategies to enhance resiliency in people who have experienced past trauma or who are experiencing trauma right now. When people are not resilient in their lives, then their reaction to trauma can manifest in a whole bunch of different ways. Some people may feel anxious when they experience a traumatic reaction. They then their fight or flight kicks in and they're afraid that it's going to happen again, so they stay anxious. Some people may get depressed and feel helpless and hopeless. Some people may develop symptoms of ptsd. Others may self medicate their anxiety or their depression or their trauma symptoms with addictive behaviors. In some people, especially people who experience enduring traumas or significant traumas in early childhood, they may develop symptoms of personality disorders. We may have relationship issues, poverty, and reduced success. Now how can that happen from trauma? Well, it's really simple. If you are anxious, if you feel helpless, if you feel hopeless, if you've got symptoms of ptsd, if you've got an addiction, any or all of those, it's probably going to impact your, your employment and your success. Not everybody, but a lot of people who have uncontrolled or unmanaged mental illnesses often have reduced success compared to what they could have. We do want to look at that. People who have experienced trauma may develop stress related physical health problems like hypertension and diabetes and autoimmune issues. Other issues that may relate to inter generational trauma can come up. And intergenerational trauma occurs when you have a major trauma that occurs, you know, two, three, four, seven generations ago. Whatever that happens, that impacts the people that are living during that generation, that impacts the caregivers that are living during that generation. And they have may have more difficulty being consistent, available, responsive, validating, empathetic, and helping their young ones develop solutions which are all the things that are needed in order to develop secure attachment. So because of the trauma back then, that generation may end up raising people, raising youth who have some attachment issues through no fault of their own, but because it was such an unusual experience, it created that situation. So then Junior grows up. Junior never addresses those attachment issues and is insecurely attached. So Junior has children and Junior ends up raising children who have attachment issues because Junior is still struggling with, or Juniors are still struggling with their own issues related to helplessness, hopelessness, self esteem, you know, all the stuff that goes along with insecure attachment. So intergenerational trauma really impacts attachment. It also impacts the messages that those people get that the grown ups at that time get and communicate to the young people. The young people learn those messages and communicate them to their young people and their young people grow up and have children. And you see how we're passing along the knowledge that we gain during that traumatic experience which influences the way we perceive the world. Couple that with attachment issues and you can see how trauma that happened even 50, 75, 100 years ago might still be impacting people today. Unless somewhere along the way someone has taken active steps to try to break that chain. Let's talk about signs of resilience. Though I don't want to talk a lot about trauma today. I want to talk about resilience. When you have someone who is resilient, they tend to be optimistic, empowered, flexible, confident, competent, insightful. They tend to have perseverance or determination, perspective and self control. These are all things that we can help people develop. If you are familiar with dialectical behavior therapy, Linehan talks a lot about dialectics and embracing that two seemingly opposite things can exist at the same time. You can be optimistic and pessimistic at the same time. How does that happen? You can be optimistic about the things that you have control over and maybe pessimistic about the things you don't have control over. But you don't have to be 100% optimistic about everything all the time or 100% pessimistic. We want to help people embrace both and recognize what they do have control over and recognize that there are things that they can be optimistic about. Empowerment versus helplessness. Encouraging people to focus on the things that they do have control over, the things that they can change. In substance abuse recovery, we say the serenity prayer a lot. Grant me the serenity to accept the things I cannot change, the courage to change the things I can, and the wisdom to know the difference. Well, okay, so recognizing there are things we cannot change. Here in middle Tennessee, it has been raining for, you know, I don't know, four solid days now and I'm about tired of it. But I can't change that. What can I change? Well, I have got broad spectrum lights in my office that I can turn on and kind of trick my brain into thinking that it's not quite as gross outside we are. A lot of us are on stay at home orders. They're stopping short of Calling it quarantine and been there for a while now. And some of this we can't control. You know, we can't control how fast, you know, this bug mutates or whatever. What can we control? We can control our contact with people, we can control our hand washing, we can control our behaviors. We can control our reaction to the situation. Does sitting around the house fretting about it and worrying about it help us at all? And you know, generally people are going to say no, not really. It just burns up a lot of energy and reduces our immune system. So what can we do? We want to empower people. As I was talking about before class started, empower them to add in the happy. What can they do to seize this moment, to feel empowered, to feel like they have some control not over their physical health, but also their mental health. Flexibility versus rigidity. You know, in this time I am one of those people, I like structure. Actually I love structure. Who am I kidding? I love structure. But during this period of time, everything has changed and it is a little stressful for me. If you look on the Myers Briggs, I am like over here on the J side, I'm not spontaneous at all. However, I can embrace flexibility when I have to. And so that kind of puts me a little bit more towards the middle. Do I prefer structure? Yes, but I don't have to have it resilient. People are able to say, okay, I can't have my structure right now. So let me figure out how to be flexible. What can I do? Our gyms are closed. I work out every day and it's been raining. So going outside and running, I guess you could run in the rain, but I'm not going to do it. I'm too much of a sissy. But since it's been raining and the gyms are closed, what do I do? Well, thankfully I have a stationary bike at home, so I have a plan C. But trying to be flexible, what can I do to have, as Hayes would say in acceptance and commitment therapy, what can I do during this time in order to maximize my ability to have a rich and meaningful life? How can I be flexible? Right now I can't do what I usually do, but how can I be flexible and still have a rich and meaningful life? And he would also talk about acceptance and commitment therapy, talks about living in the and during this period of time, how can we both be under self isolation and have a rich and meaningful life? You know, would we ideally have this other thing? No. However, it is what it is right now and there's not much we can do to change it until, you know, some other steps are taken and they find some, you know, a for sure medical treatment for it and vaccination and all that kind of stuff. So in the meantime, let's live in the and this virus can exist and we can still have a rich and meaningful life. We may just have to be a little more creative. Helping people develop their confidence and their assertiveness. A lot of times people feel like they should be a chameleon and try to please everybody else. And encouraging people to live authentically and be confident in who they are, having good self esteem and assertive in their communication about what they want, what their needs are. Will they always get everything they want? No, none of us does. But when we are confident, we have that air about us that we're not apologizing for wanting spaghetti tonight. We're not apologizing for having a bad day for something, you know, we're saying, all right, it is what it is. Competence is just what it sounds like. When we feel like we are competent to control our lives, it is really hopeful. Encouraging people to set small goals in order to enhance their sense of self efficacy or their sense of confidence in managing their feelings, in managing their thoughts, and in managing their life. Right now, especially right now and especially during a crisis, it is really hopeful or after a trauma, it is really helpful for people to set stuff small goals so they can develop that sense of confidence that they are competent to protect themselves and their family. Insightfulness is always great. When people are resilient and when they're insightful, they can see what caused it or realize that maybe they'll never know what caused it and they're able to be insightful about what is important in their lives. Perseverance requires people to feel like they have the ability to make a change. Think of that internal locus of control, recognizing we can't change everything. But perseverance helps people keep going. Even though, you know, it looks a little dicey right now. People who are persevering are still getting up in the morning and still saying, you know what? This too shall pass. They are invoking positive cognitions. They are doing things persevering during the storm, persevering after the trauma to put one foot in front of the other and keep walking towards those things, keep moving towards those things that are important in their rich and meaningful life. Perspective is so helpful. Trauma, I don't know. Some of y' all are new and welcome, by the way, but a couple of weeks ago we had an EF4 tornado go through this area and just decimated schools and buildings and houses and, you know, people. Unfortunately we did have, you know, couple dozen people die. However, perspective, instead of seeing that as how it's always going to be, perspective helps us step back and say, alright, you know, that was a really unpleasant, awful, horrific situation. But in the big scheme of things, what are the chances that another EF5 or four, heaven forbid a five EF4 is gonna come through here in the next, you know, five years, let alone in the next five months? So we get some perspective, we get some perspective with this virus that's going around looking at if you are, for example, in that 10 to 49 year old age group and you have no underlying health conditions, what is your risk versus someone who unfortunately is 50 or older and has three or more underlying health conditions? When we look at the data, the data looks awful. But when you start filtering it out and saying which group do I belong in? And what's the perspective? How at risk am I? How at risk is my family? My daughter has asthma, she's 16, but she has asthma, which is a big no go if you get this particular virus. But overall she's relatively healthy. We've still been kind of restricting ourselves even more than usual because of that though. So gaining perspective. So you have factual knowledge of about your level of risk and about your level of success after a traumatic event happens. You know, what's your perspective that you're going to be able to recover? In the big scheme of things, how big of a deal was this to you? In the big scheme of things, how big of a deal was this to your community and rippling out from there? You know, in the big scheme of things, the tornado that hit Middle Tennessee was not that big of a deal for the country. You know, they have totally forgotten about that like three days later. But for our community and for, you know, Middle Tennessee, which is, you know, like 15 counties, it had much more of an impact. So gaining that perspective is helpful to help people get out of that trauma focus where they feel like, oh my gosh, this is going to go on forever or I'm always going to be at high risk. Addressing those cognitive distortions is really important in helping people gain perspective and take out those words like always and everybody. And finally self control versus dysregulation. After a trauma, most people, I'm not going to say all after a trauma, most people experience some level of dysregulation because that fight or flight system, that HPA Axis turned on and it was in full, you know, full wide open. Whatever it gets into because your body was trying to protect you from whatever the trauma was, that's your way of trying to survive. Okay, cool. So you were dysregulated, you were upset, you were furious, you were terrified, you were fill in the blank and that's how you felt. Dysregulation momentarily or for a short period right after a trauma or during a crisis, totally expected, but the ability to re regulate the ability to notice that you're dysregulated and engage those distress tolerance skills. See Linehan's work on dialectical behavior therapy for example. In order to get reregulated and get into that wise mind is really important. So self control is not about not feeling. Feelings are normal and we want people to be able to feel, but we also want them to feel confident that they are competent at reregulating themselves and controlling, you know, getting control of their emotions and their thoughts after a dysregulation. People who are at risk of PTSD during any trauma depends on their age. Younger children have fewer life experiences to compare it to, so it may seem more overwhelming. They tend to think dichotomously. So it's all good or all bad, it is all dangerous or all safe. They tend to think personally, whatever happened somehow must have been their fault. Younger people can experience can be more at risk for developing PTSD after a trauma. Same thing with the developmental level. Some people are chronologically older, but developmentally not so much. We do need to not just assume that because somebody is chronologically 16 years old or 24 years old that they are as able to handle it as every other 16 or 24 year old. We also want to remember that the prefrontal cortex, our impulse control area, higher order cognitions, doesn't finish developing until the person is about 24 years old. So thinking of soldiers who enlist when they're 18 and a lot of them have gone on their first tour of duty before they're 20, their brain was still developing during that period. If somebody has a prior history of mental health or substance abuse issues, then they are at a greater risk for developing ptsd. A lot of times a history of mental health issues means that there were periods in their life where their HPA axis was over activated and they may be struggling with hypocortisolism. Substance abuse issues may also create situations in the brain that make it more susceptible to to trauma from to traumatic injury. After a trauma, the number of stressors in the prior six Months is another risk factor that a lot of times we don't consider. If something happens, you're just going along and everything's ducky for a year, two years, whatever. You're just having a grand old time and then something happens. It may be devastating, but you may have more resources, recovery resources, cognitive resources, energy, physical resources to deal with it. If you have had crisis after crisis after crisis over the past six months, then you are likely worn down cognitively, emotionally, physically and even, you know, interpersonally. Your resources may also be worn down, which makes people, puts people at risk. The availability of social support. After a trauma within 4, 24 or 72 hours, and these roughly correspond to our ability or the time frame in which we compartmentalize. During the first four hours after a traumatic event. After a crisis, our HPA axis is still pretty revved, our cortisol still coursing through our system. You know, we're still in that fight or flight, hyperactive sort of dysregulated mode. We haven't started compartmentalizing that and putting it somewhere between 4 and 24 hours we start, your brain starts saying, you know, we got to figure out what to do with this. We've got to figure out how to deal with it or how to, you know, put it aside because I can't keep feeling like this. So in that first 24 hours, people start to make sense of it or just compartmentalize it. A lot of times they just stick it in a little mental box and put it back in the, in the recesses of their mind somewhere. After 72 hours, most people are not able, nor should they be expected to be, to sustain that extreme dysregulation and distress caused by the original crisis. So within 72 hours, the body and the person have figured out a way to try to live with that. They're not, they probably haven't found their new normal yet, but they have down regulated some. They may start feeling numb at this point, but at that point the access to those memories is going to be even harder. Under trauma, our brain does something really cool and it seems secretes a bunch of chemicals into our brain, some of which help us not form solid memories, help us not take our memories from that short term and put it in the long term. So during that first four hours, those memories are still there and accessible. After that, it's kind of like soup. You know, you take Alphabet soup and it kind of gets dumped into there and things get a little, little foggy, which is kind of a cool self protective mechanism. But it can be really frustrating for people who want to remember what happened. Some people want answers. If someone doesn't have effective problem solving or coping skills, they're at risk. Because after a trauma or during a crisis, we're exposed to something that makes us feel threatened. If we can't figure out, if we can't feel competent and confident in our ability to handle that stressor, then it's going to put us in a place where we may not want to persevere and we may start feeling hopeless and helpless. And finally, those effective distress tolerance skills. Sometimes during a crisis, especially an ongoing one like this one, you can't necessarily know that you're safe in two hours or four hours after a car accident, you know, the car accident's over and you can start assessing the damage and figuring out, okay, what are the next steps? Right now we've been going on, you know, a week, two weeks, where everything, as everything is unknown. There's a lot of ambiguity in what's going on. So just like when you go to the doctor and he or she draws your blood in order to run tests to see what's wrong with you, and you have to wait a week and you're going, I want answers now, doc. I need to know what's happening now. You have to figure out how to wait for that week. We're going through the same thing, just on our ramped up scale right now, and it's requiring everybody to pull down their best distress tolerance skills until we can get some answers. Protective factors. Psychological flexibility is great about helping us deal with crisis and deal with any kind of situations. When we are psychologically flexible, we identify how we feel and what we need. In the here and now. We say, okay, this is how it is. You know, I'm fond of saying it is what it is. I feel how I feel. The situation is as it is. I cannot change it. Now what do I do with that? What do I do with that? How can I improve my next moment? How can I help myself feel better emotionally? How can I address my cognition? So I am thinking more empowered? How can I keep myself physically safe? What can I do? I am right here, right now. How can I improve my next moment? So those toward behaviors we want to encourage people and teach people include mindfulness, being aware of how you're feeling and what you're needing and, you know, being knowledgeable about what's going on. Taming that monkey mind right now, our minds can go off in 6 million different catastrophic directions. And encouraging people to practice being one with the moment. And when they notice that they're developing monkey mind and their thoughts are, like, all over the place and causing them distress, encouraging them to practice, you know, five, four, three, two, one. What are five things that they see, four things that they hear, three things they smell, two things that they feel, and one thing they can taste. Or even easier, just fives. What are five things that you see in the room that are green or something to help you get grounded in what's going on in this place right now, in this moment? That encourages people to redirect their attention to the present moment. And when they're looking for those things, guess what? They're not thinking about all that other stuff. Maribel suggests scavenger hunting. That is a great activity for, you know, people who are at home right now, and, you know, you're. You're kind of getting a little cabin fever. So scavenger hunting, especially if you can go scavenger hunting and include, like, the front and backyard and stuff, that can be a really fun activity. But mindfulness really encourages people to focus on. Now think about, you know, if you hunted Easter eggs when you were little, going out. We do that every day right now, our chickens and ducks will not lay in their boxes. So every day is an Easter egg hunt. Lucky us. But we have to be mindful when we go out there and pay attention as we're walking to every little pile of brush to see if there's a hidden nest, which right now can be kind of fun. We need to encourage people to practice patience, whatever it takes for them. And I've shared with y' all before. When my kids were young, I'd be pushing the buggy through the store with two kids in tower, just repeating to myself and sometimes mumbling out loud, God grant me patience. And just over and over again. And maybe it helped, maybe it didn't. You know, it seemed to get me through. But we need to help people figure out how they can tap into their patience, and that is their ability to, you know, tolerate not only their feelings of distress, but tolerating other people's distress and other people's expressions of distress. Children may be a little bit, as one of my best friends used to call her son, disorganized. Right now when he'd be bouncing off the walls, she'd be like, well, he's feeling kind of disorganized right now. I'm like, I'm feeling kind of disorganized just watching him. We need to help people figure out when they're feeling stressed, when they're feeling like their patience is wearing thin. What can they do? And in order to reregulate, belly breathing is great. You know, kids are probably, especially if they're home from school right now, are probably struggling to be patient with one another. I remember car trips and stuff with my kids. You know, he touched me, she grabbed my iPad, you know how it goes. But encouraging them to practice patients, whatever that looks like in your household. Vulnerability prevention, this is the big one. Let's set our body machine up to have the best chance to regulate itself, which means staying hydrated, relatively adequate nutrition. You know, try to eat three colors on every plate and that doesn't mean Skittles and Cheerios or not Skittles and Cheerios, Skittles and Cheetos. That's probably what I would eat if I didn't have a little more self control. But that's not healthy. That's not what we want to do for vulnerability prevention. So hydration, relatively adequate nutrition, sleep, good quality sleep. If you are after a trauma, some people have difficulty sleeping and it's important that they develop skills to regulate their sleep so they feel safe enough to go to sleep. When we are sleep deprived or we don't get enough deep sleep, our brain doesn't clear out the adenosine which was created from thinking and existing the day before. So we tend to feel sleepy, fatigued and foggy headed all day long and that tends to make a lot of us a little bit cranky. So looking at your vulnerabilities, basic physical health behaviors can help increase people's sense of energy and willingness to persevere. Encouraging people to seek social support. Reach out. You know, right now you may have to reach out through one of some app on your mobile device or calling because you can't be face to face. My stepfather is 87 years old, so there is no way in anybody's world that I am going to be face to face with him right now because he's like highest risk. But reaching out via email, reaching out via text or screen chat can be helpful when people have experienced a trauma or even right now seeking out support groups face to face or online. You know, right now we may have to be doing online, but support groups are going to be really important support for coping with whatever trauma it was and problem solving skills, being creative and tapping into that creativity. One of the things I used to do with my class when I taught at UF was we would spend one day working on problem solving skills and I'd break them up into groups and each group would have a different material. And I would have them identify 10 things that they could do with that material other than its intended purpose. One would have bubble gum, one would have duct tape, one would have a coat hanger. And then the fourth one, you know, I'd pick something. But the first three were always, you know, staples that, that we would use. Paper clips. That was another one that, that was a frequent, frequent flyer. And I would encourage them to think of, you know, creative ways they could do it. And then we would talk about, you know, problems that people typically have and creative ways they can be solved. You know, like a leaky sink or something like that that people actually encounter. Not a mental health problem, but just regular problems. Just to encourage them to get out of the box where they think that it has to be done a particular way to be done. Right, it may have to be done a particular way to be done. For the moment, you know, we may be able to get creative toward thoughts and feelings. And when I say toward behaviors and toward thoughts and feelings, what I'm talking about is using our energy. Once we realize how things are and accept it is what it is, using our energy to move us toward what's important in our life, to move us toward happiness. How can we use our energy to do things that are going to help us feel happier or help us emerge out the other side where we can be happier? Toward thoughts and feelings include optimism, curiosity, perspective, insight, mental flexibility, empowerment, confidence, trust, competence, and self control. We've already talked about some of those, but we want to encourage clients to develop self statements that embody these. So identify three optimistic statements you could use after this tragedy. Identify three things that are still going well. Identify, you know, three things that you are in control of right now in order to, you know, enhance that empowerment area. I like the number three. That's just me. You can choose any old number. But encouraging them to develop a list of positive self statements that can help them feel happy and help them feel empowered and confident and competent and all those other things. From the resiliency list, I'm just briefly going to highlight the away behaviors, thoughts and feelings because we want to notice these, but encourage people to evaluate whether using energy for those things is helping them move toward their rich and meaningful life and helping them move toward happiness, or it is draining their energy. Like sitting in your car stuck in the mud and just revving that engine and spinning those wheels. Are we spinning the wheels or are we getting traction? Kind of how I'm looking at it. So away behaviors Include hyper vigilance. And yes, this is one of those feelings and one of those reactions that happens after trauma. Even if you don't develop acute stress disorder or ptsd, there's going to be at least a little period of time where you're hypervigilant because your HPA axis, your threat response system is saying, hey, that was really unpleasant. You need to protect yourself. All right, I got that. Encourage them to notice. Use their mindfulness to notice when they're being hyper vigilant. And instead of continuing to be anxious and on edge and jumpy, however they want to describe hyper vigilance, what can they do? How can they use their energy to help themselves feel safe? You know, once we feel safe, then we can relax. When we can relax, we can sleep. When we can sleep, we get our energy. It's just a wonderful cascade of things. Using their mindfulness to notice when they're feeling irritable and aggressive. Irritable or aggressive, and understanding that those feelings are part of the fight or flight reaction. That means that somewhere in their brain, they're still not feeling safe. So they're still on edge. Recognizing that and then accepting here and now and choosing, what can I do in order to help myself improve the next moment. These are normal feelings reactions. You know, I don't want to make people feel broken or something for feeling or reacting in a certain way, but I want them to notice them, then be able to be mindful of them and evaluate whether it's helpful and if not, what can they do differently. Addictive behaviors. Withdrawal, isolation, and just giving up easily are common. You know, addictive behaviors help medicate withdrawal and isolation. When we just feel like we can't take anything else because we are overstimulated, we're not feeling safe. We're. There's a lot of stuff that happens after a trauma or giving up easily, sometimes after a traumatic incident, whether it's something like a tornado or something like this, you know, coronavirus crisis. At a certain point, some people may run out of gas and they may feel like nothing I do is going to make any difference. So they may just give up away. Thoughts and feelings again, feelings are normal. They're our body's reaction that tells us that tell us to do something. If we feel happy, that's our body saying, do that again. If we feel scared, that's our body saying, get off the couch and do something. So feelings are normal. It's what we do with them. Whether we nurture them or we say, okay, my body's telling me Something, let me choose the best way to deal with it in order for me to be as happy and healthy as possible. So anxiety, anger, pessimism, distrust, guilt, loneliness, and a lack of perspective are all things that can happen after a trauma or during a crisis that can contribute to people feeling stuck or continuing to feel threatened. So we want to help them notice these things, develop insight about what these things are telling us. You know, why is this happening? What is this feeling telling me that is going on? And what are some strategies that might help me cope with it? Mindfulness, you know, we're just going to talk about some activities and protective factors real quick. Mindfulness is the awareness of the present moment and somebody's needs, your needs in the moment. Without judgment. That's the hard part. The. Without judgment. Noticing that I feel anxious or I feel frustrated. Okay, you do. That's how you feel. That's the first step, is noticing. Becoming aware of how you feel and what you need, but also becoming aware of what's going on in order to help you or help your body get to the point where you're in your wise mind, where you're not in this flood of adrenaline. Five, four, three, two, one. We already talked about five things you see, four things you hear, three things that you smell, two things that you can feel, and one thing that you can taste. What's in the room. You can do scavengers hunt, like all things green. We talked about that. Or just a noticing log. Have people, you know, periodically stop. You know, encourage themselves to even set a timer on their phone to stop maybe once an hour and just take 30 seconds and notice what's going on, how they feel. Mindfulness activities that you can do with people. You can put this on a whiteboard at home. If you're home with family, you can put this. You can use this as a group activity or just a daily journal. But in the morning, have people check in with themselves and think, how did I sleep? Do I feel rested? Do I feel healthy? Do I have pain anywhere? Pain tends to make us a little bit more vulnerable to distress. What am I thinking about the most? How do I feel emotionally? What am I looking forward to? What am I dreading? What's one thing I'm grateful for? And what can I do to get energized for the day? You know, if they think through all these things while they're drinking their morning milk or juice or coffee or whatever, it is cool. That's awesome. And then after school or after work, you know, towards the end of the Day reviewing. All right, it's been a long day. How do I feel physically and emotionally? What was the worst thing that happened today? Let's just kind of get that out there. And then what was the best thing that happened today? We need to follow that up with, ok, there was some sucky stuff that happened, but what was the best thing that happened today? To remember that there were glimmers of sunshine. What do I need or want right now to help me finish the day? So noticing, you know how after a long day you're driving home and sometimes you're like, I just need 10 minutes of quiet or I need to play with my dog, whatever it is you need, Those are the things that I need. But noticing and becoming aware of what you feel like you would benefit from right now, distress tolerance, activity, social support. And I put food here because sometimes when we're driving home from work or after school, our blood sugar is low. I'm not saying food as a coping skill, but food, Food in reaction to low blood sugar. And then in the evening before bed, how do I feel physically? Do I have pain anywhere? What am I thinking about the most? How do I feel emotionally? What's one thing I'm grateful for today? And what do I need to do right now so I can get relaxed enough to go to sleep? Just paying attention sometimes and asking yourself these things when brings it to the forefront of your mind. So you do it instead of just kind of going through life on autopilot and maybe overlooking some things that seem simple for distress tolerance and self control. If you remember dialectical behavior therapy, she has the two acronyms, accepts and improve. Accept stands for activities. Anything that you can do to distract yourself. For me, is gardening or cleaning. Contributing. Doing something to help somebody else out gets you out of your own head. Comparisons, for example, to when you were in a worse state or to how things really could be worse right now. Comparisons can go either way for people. Emotions doing the opposite. Doing something that's going to make you feel happy. Getting on Pinterest and looking for silly animal videos or YouTube or wherever you go, or listening to a comedian. Pushing away, actively pushing away those unpleasant thoughts. Engaging positive thoughts, thoughts of empowerment, or S stands for sensations. Doing something that will kind of jolt you into the moment. Putting your hands in a bucket of ice water. I do that especially during the spring season when I'm planting a lot. And I'll tell you, you don't focus on anything else except for how unpleasant it feels to have your hands in a bucket of ice water. But you can also do something like splash cold water on your face or do 50 push ups really fast so you get your heart rate up for improve. I stands for imagery. Guided imagery. Seeing yourself successfully moving through this meaning, finding meaning in whatever's happening, you know, how can you. What is the positive side? If we want to embrace the dialectic, Prayer, relaxation activities, making sure to focus on one thing at a time, not try to do too much because that can get overwhelming. Take a mental vacation and, or give yourself encouragement and get encouragement from other people. Find people who can be supportive. Those are all activities that people can do and some people will prefer some over others. That's cool. But encourage them to have a list of distress tolerance activities that they can engage in. If you are home with your family, develop a family list of distress tolerance activities. Maybe have it on the refrigerator so when people are feeling frustrated, bored, lonely, irritable, they don't have to think about what could I do? They can go and just kind of go down the list and see if they find something that they're willing to try. Framing a perspective skills, encouraging people to gain perspective by asking themselves, what is the evidence for and against my fear right now? What is the evidence for and against my belief right now, for example, that, you know, the economy is going to completely collapse and everybody is going to get this virus? You know, those are some extreme thoughts, cognitive distortions. We want to look at the evidence for those things and the evidence against those beliefs and figure out, you know, what is where reality is. Am I considering the big picture, all of the factors, such as what's my active part? You know, in terms of the tornado, there wasn't much I could do, you know, that that was one of those acts of, acts of nature in terms of the flu. There's a lot that I can do actively to prevent myself from getting it. So it's not something that I have to be. I can protect myself in other ways. Am I considering my current situation and vulnerabilities that are contributing to it? Am I considering other people's active part in this situation? And am I considering any transference issues? And depending like after the, after the tornadoes, it was important for people to look at the big picture, look at their active part. What did they do to stay safe? What were other people's parts in what happened and the recovery process and how are they feeling about it? And am I catastrophizing or confusing high and low probability events now the chances of me getting the flu, you know, especially, you know, just the regular Old flu during flu season, even though I get a flu shot is pretty good, you know, there's a chance I could get it because I'm out a lot. I go to the gym every day. But what is the probability that I am going to get it and end up in the hospital and die from it? You know, that's the catastrophizing part. We want to look at gaining that perspective. Problem solving skills start out with brainstorming. How can we solve this problem? And children can draw on paper, you know, different ways to solve it. And there may be a lot of things that are going on right now. You know, having to switch from, you know, brick and mortar school to virtual school and new chores and how to deal with certain situations. There's probably a lot of stuff that's coming up at home right now, including the family in the brainstorming, including the support group. If it's not a family situation, ask someone who's been through it, you know, how are you? I've seen a lot of people talking on the, on forums right now about, you know, how are you helping your kids and schooling your kids right now since they're all home and how does this keep me from moving closer to my goals and what can I do about it? Sometimes problems we get caught up trying to solve and try to fix and we realize, you know what, this problem really has no effect on my long term goals. So I'm using a lot of energy to try to figure out how to solve this and in the big scheme of things, doesn't make a difference. Might be better to use my energy elsewhere. Flexibility helps people learn that things won't always go the way they want. But it doesn't mean it'll be awful. It does not come easy. For those with the J personality. It's important that we identify things we need to be flexible in, such as if you're with a family going on vacation, you know, not everybody's going to want to go to Disney World or wherever, job duties, you know, sometimes you're going to have to do things that you don't want to do. In relationships, there's compromise. You know, compromise and flexibility kind of go hand in hand. Activities you can do to practice developing flexibility include the choices. Hat. If you are going to go on vacation, your family vacation, everybody writes down where they want to go and they put it in a hat and you draw out one of those things. You know, not exactly democratic, but that's one way to do it. Same thing about what are we going to watch On TV tonight, schedule a spontaneous day. Yes, I know that sounds ironic, but that works in our family because my husband is very spontaneous and I'm not. So instead of, you know, fly by the seat of our pants, I got okay with the fact that, okay, Saturdays is going to be our spontaneous day. I'm not going to have control over what we're doing that day. And I just knew Saturdays I was going to have to be hands off how many uses game we talked about that one and how I used to use it in class. Oh, coconut oil, plastic shopping bags, cardboard boxes. Those are all really cool things. You can go online and look for suggestions. It's a fun family activity. If you're just bored and you want to do something and then how are you like a. How are you like a dog? How are you like a cat? This obviously goes over better with young children, but it's one way to teach flexibility so they can think about, okay, I'm like a bunny rabbit. Because learned optimism comes from Martin Seligman, the traumatized brain stays on alert and notices the dangers or potential threats. Teaching people to identify the good things as well can be helpful. We want to help people notice that they can live in the and and Kobasa in 1979 proposed the idea of hardiness, which said people who are hardy have three personality traits, commitment, control, and challenge. With commitment, they recognize that the current situation is unfortunate and there are other aspects of their life that they are committed to which are going okay. So increasing commitment to our whole life, not just focusing on this one slice that's not going so well right now. Control. What parts of this situation can you control and what aspects of other parts of your life are you in control of? Recognizing the crappy situation. What parts can you control? But then the other pieces of the pieces. What aspects of that are you in control? Encouraging people to develop that sense of empowerment. Challenge. In what ways can the current situation be viewed as a challenge or an obstacle? Like an obstacle course instead of a barrier. And barriers keep you from going over, under, around. But challenges and obstacles are things that we do. They encourage us to tap into our curiosity. Other activities include positive journaling, having people journal or reflect or talk about for 10 to 20 minutes a day, only the positive things. And, you know, the other 23 hours and 40 minutes they can talk about whatever they want, but for 20 minutes, we're just going to focus on what's going right what was awesome today and creating a gratitude wall, a gratitude tree, or a gratitude branch, you know, you can get Branches and then get present tags, the little ones that have the string on them, and write on each one of those tags something that you're grateful for and add to it every day so the tags become like the leaves on the branches for empowerment. Encourage people to learn about others that are like them who've overcome these same challenges. You know, right now we're looking at China, for example, to see how they're coping and what's happening for them. It's not a one to one comparison, but you know, we can learn. Break big tasks into small steps. After a trauma, a lot of times people are exhausted and feel overwhelmed very easily. Breaking big tasks into small steps gives them things that they can accomplish to enhance their sense of efficacy and competence. Give credit where credit is due. Encourage them to create. And I did that Wal, and it could be something I remember after my kids, you know, I did that. I took a shower today. That was like a big thing for me, especially after my daughter came. But encourage people to recognize their accomplishments, even the little ones. Make a my support list. Having them identify the people and things that are supportive in their life and encourage them not to put all their eggs in one basket. So have them get the little plastic Easter eggs and in each Easter egg, identify something that is going well or some empowering statement that they can say to themselves, and those are their eggs, and encourage them to, you know, reflect on those eggs. Confidence and competence. When people feel incompetent and lack confidence, the world seems much more threatening and they can feel more helpless. Encourage them to identify their signature strengths. They're going to create a campaign. It can be an ad campaign. They can do a body poster, so they draw an outline of themselves and they put pictures in that outline of themselves that represents all of their strengths. They can write their own biography. They can write who I look up to or create a personal scrapbook of accomplishments. They don't have to share it with anybody, but that way they have it and they recognize that they are competent and they can do things. They can also create a goals workbook, identifying what they want, why they want it, what could stand in their way and how they could deal with that. And then the steps they need to achieve their goals, such as being valedictorian. You know, life does not stop for most people after a trauma. So there is going to be a period of helping people, you know, get back into the, into the groove, find their new normal, Identify their goals, their new goals so they can start moving forward again. From a young age, it can be difficult to keep going in the face of adversity, especially if you're already stressed and feeling disempowered. Remember, as caregivers, sometimes we need to enact scaffolding. As clinicians, we do the same thing. You know, when people are struggling, let them do as much as they can up to the point they get stuck and then we help them on. Hopefully the next time they do it, they'll go a little farther before they get stuck. Eventually, they'll master the task. For adults, we typically call this mentorship. You know, basic, basic learning chunk things when you are feeling overwhelmed. Those small, you know, if you've got to do something like grade papers, do 10 minutes at a time. If you've got to write progress notes 10 minutes at a time or decisional balance. Encouraging people to look at the pros and cons of quitting versus continuing on. Social support is a great resource when trauma knocks people off their balance. So encourage them before the trauma ideally, but even after the trauma, to figure out ways to develop connectedness by participating in hobbies groups like knitting circles or that's again my things. But whatever their hobbies are, there are probably people who would like to get together and share that hobby, join clubs, faith organizations and put effort into developing their current relationships. And I really encourage people to look up the five love languages and recognize how your the people that are important in your life, how they communicate, what's their love language, and make sure to communicate to them in their love languages, not yours, because they will connect better if you use their love language for prevention and preparedness. Encourage people to have a plan. You know, okay, whatever it was, whatever trauma happened, it happened, or whatever crisis is going on is going on. Let's make a plan, starting right now, for how you can endure or for how you can emerge successful out of this. What do you need in order to keep on keeping on, so to speak? Trauma can enhance feelings of disconnectedness, helplessness, and anxiety. It impacts people emotionally, mentally, physically, interpersonally, and unfortunately, occupationally. By helping people develop trauma resiliency, we can assist them in preventing PTSD after a trauma or after a crisis and breaking the cycle of intergenerational trauma. Between writing notes, filing insurance claims, and scheduling with clients, it can be hard to stay organized. That's why I recommend Therapy Notes. Their easy to use platform lets you manage your practice securely and efficiently. Visit therapynotes.com to get two free months of therapy notes by just using the promo code CEU when you sign up for a free trial at therapynotes.com. If this podcast helps you help your clients or yourself, please support us by purchasing your ceus@allce.com or getting your agency to sponsor an episode. A direct link to the on demand CEUs for this podcast is@allce.com podcastceus that's allce.com podcastce to sponsor an episode of Counselor Toolbox and reach over 50,000 clinicians per week, go to allce.com sponsor thank you.