What is Trauma Resilience and How to Improve it?

This episode was pre recorded as part of a live continuing education webinar on demand. CEUs are still available for this presentation through all CEUs. Register@allceus.com Counselortoolbox you. I'd like to welcome everybody to today's presentation on enhancing trauma and resiliency. I am Dr. Donnelly Snipes. In this presentation, you're going to learn about the effects of acute and intergenerational trauma. Obviously, we're just hitting the highlights here because we've only got an hour. We'll review risk and protective factors for ptsd, for developing PTSD as the result of acute or intergenerational trauma. And we'll identify strategies to enhance resiliency in persons who have experienced past trauma and also in to help break that intergenerational trauma cycle. What effects do we see from a lack of resilience from primary and intergenerational trauma? Well, let me start out by defining primary and intergenerational trauma. Primary trauma, as we're going to use it in this presentation, is something that happens to the person directly right now. They are the primary victim, survivor, whatever word you want to use. Intergenerational trauma is a trauma that occurred generations ago but continues to impact everyone in that family for a variety of reasons. And, you know, let's kind of look at that because we talk a lot, we hear the word intergenerational trauma a lot, but we don't really talk about, you know, what is it, how is it transmitted? So let's look at that. Well, anxiety and depression. When you're working with people who have experienced trauma, they may experience anxiety and depression. If they have experienced intergenerational trauma, they may be being raised by someone who experiences anxiety and depression and doesn't have the coping skills to teach how to deal with those things. When people experience trauma sometimes, especially if it's not something that they, they come to an acceptance state with, they resolve whatever word you want to use. It changes their, or it can change their perspective, their outlook on the world, on people's trustworthiness, on whether they have hope, whether they feel empowered, all those sorts of things. So when you change somebody's viewfinder, if you will, that the lens that they're looking through the world can become very different. If you're being raised by someone who sees the world as dangerous and malevolent and filled with unhappiness, then you're going to probably feel like the world is dangerous and malevolent and filled with unhappiness, which is going to cause or Prompt potentially the development of anxiety and depressive symptoms. Obviously, PTSD can develop post traumatic stress disorder. We look at people who experience trauma and this is, you know, not a huge leap to go from experiencing an acute trauma to development of ptsd. We've seen this. We've also seen trauma when in people who experience multiple or PTSD and people who experience multiple traumas, for example, law enforcement officers, military personnel, people who see bad stuff on unfortunately a regular basis. And any one event, and this is especially true for like law enforcement and ems, any one event may not be a defining event in their trauma history. But all of those seeing those traumas repeatedly is cumulative. When you're seeing that day after day after day, it starts to look like it's everywhere all the time. So people can develop PTSD from chronic stress, chronic traumas. People can develop PTSD from chronic traumas in their own home. If they're living in a house that is wrought with violence, for example, they can develop ptsd. So we know that PTSD can develop post traumatic stress disorder. What do we talk about? We're talking about someone who is hypervigilant. We. Well, if you're being raised in an environment and you're being taught inadvertently or overtly that the world is a dangerous, malevolent place, then you're probably going to be more hyper vigilant. If you are being taught that people are not trustworthy, you're probably going to be more likely to be withdrawn. If you look at the symptoms of ptsd, they make sense from a survival perspective. If you see the world as dangerous and malevolent personality disorders. We talked about this a little bit in our trauma and personality disorder symptoms class. When people experience traumas at a young age, they may not have the skills to deal with them and they may develop coping tools that help them survive the moment back then that are never developed further when they move to adulthood. So they're still using those primitive coping skills that they may have used in childhood to deal with that trauma and that's not working for them as adults. What works for a two year old to survive is not going to work for a 20 year old. So we may see some personality disordered behavior, we may see that lack of trust, we may see impulsive behavior. Because in addition to lacking coping skills or developing unhealthy coping skills, when people experience trauma, we know there are brain changes. We know that there are changes in the HPA axis and the cortisol system. We know there are changes in neurotransmitter levels in People who experience trauma, we know that from research that people who have disruption of that primary attachment and have adverse childhood experiences in childhood are more likely to have problems with impulse control and mood regulation and things like that because they didn't have the foundation, they didn't have the support that they needed and, or they were exposed to traumatic events that altered their neurobiological makeup. They've actually shown, doing PET scans on veterans, for example, that trauma, psychological trauma, can cause actual changes in the brain similar to what you might see with traumatic brain injury, a physical, traumatic brain injury. And some of those studies are really interesting to look at. Looking at the brain changes, you can google brain changes that result from ptsd. So my point here as we're going through this is that whether it's acute trauma or whether it's something that the child grew up with because the parents were traumatized, or the grandparents or the great grandparents, there is some passing down of that and we're going to talk about that more in just a minute. Relationship issues can develop as a result of trauma. People wanting to withdraw, people being emotionally numb, people being less trusting of others, poverty and reduced success. You know what, when you're traumatized, when you are experiencing the symptoms of PTSD or acute stress disorder, it's really hard to stay focused. You have a lot of difficulty with concentration, insomnia, hyper vigilance, that's keeping you from focusing, which means you can have, you may have reduced success temporarily, but if this has been going on for a long time, you may have a long history of reduced success because that trauma is keeping you from being able to focus, to learn infinite new information, to sleep well enough that your brain can, you know, process everything. So we do see increases in the gap between people if we look at intergenerational trauma, if we look at, you know, vulnerabilities that each person brought with them to the classroom. People who come from families with intergenerational trauma tend to have more vulnerabilities which make it more difficult for them to focus and learn. Stress related physical health problems are common in both. You have GI disturbances, you have again, insomnia, you have autoimmune disorders, you have Crohn's disease, autoimmune issues. Sometimes you have chronic pain. There are a lot of different things, migraines, a lot of different things that can happen physically to a person when they're under lot of stress. And what trauma does is turn that stress response system on high alert and intergenerational trauma. And this is where we're Going to talk a lot about breaking the cycle in this particular presentation because even if the trauma didn't occur to this person or to this person's mom and dad, there are things that are being passed on. So if this person grows up in a household or where, let's say grandma had experienced a significant trauma and developed certain viewpoints about people, places and things, you know, her lens, how she viewed the world, how she interpreted things, is going to be a particular way and very influenced by that trauma. Well, as she raises her children, those children are going to be influenced by her viewpoints. And as those people raise their children, those children are going to be influenced by those viewpoints. So it's important to look at that social learning component of intergenerational trauma. People who have trauma issues often have difficulty with attachment. So as parents, they may have more difficulty forming that primary attachment relationship with their children, which sets their children up. That's, you know, adverse childhood experience number one. It sets their children up to experience trauma from, you know, from jump. Pessimism. If you're seeing the world as malevolent, unsafe and untrustworthy, then it's easy to be pessimistic. It's easy to see as nobody being willing to help you, everybody out to get you sort of thing. Rigid thinking. We see this a lot in people who've experienced trauma. They're trying to hold some sort of control over a world that seems chaotic to them. It just, it got turned upside down or it never made any sense. So they may have very rigid ways of thinking. This is the way it has to be done to stay safe. And that leads to lack of psychological flexibility. If you see an event and this is the way it has to be done, or this is the way I've always done it, it, so this is the way I have to continue doing it, then it keeps people from being able to develop new skills or look at things from a different perspective. So signs of resilience. This is what we want to foster in people. It doesn't matter if they are somebody who has experienced intergenerational trauma or who has experienced direct trauma, or we want to help them develop optimism, empowerment, flexibility, confidence with an F, competence with a P, insightfulness, perseverance, perspective and self control. So let's go through those a little bit. Well, obviously optimism versus pessimism. When you experience something bad, you know, we're hardwired, if you will, to notice the threat, to notice the danger, because that helps us notice what we need to do to survive, which makes it sometimes Hard to be optimistic if you're raised in an environment that is pessimistic, and then that encourages or reinforces the notion that these bad things that happen, well, that's just the way it is, because bad things always happen. Pessimism is one of those things that we may need to address through cognitive behavioral techniques and dialectics in order to help people learn, as Martin Seligman would say, learn optimism, help them learn to balance. Because, yes, bad things happen. Pain is inevitable. That's just the way it is. However, there are also good things in life. And we're going to talk about a lot of interventions once we get past the theory part. We want to help people develop a sense of empowerment. People who have experienced trauma may feel disempowered. You know, they may feel a loss of control. People who experience intergenerational trauma receive the message that they continue to be powerless for whatever reason. So we want to look at how can we empower people if we want to look at indigenous peoples, American Indians, you know, obviously they had their land taken away, and that was extremely disempowering. Their children were sent to boarding schools, and that was extremely disempowering. There was a lot of stuff that the government did that was totally wrong, and that was disempowering. So you can see how, you know, even if that happened to Great Grandma, you can see how Grandma would have learned those lessons and be suspicious of government and people. And you can see how, you know, mom and dad may have learned from that, because, you know, those are the messages they got when they were growing up. And when they get those messages, when we get messages, what do we do? We tend to look at and see things that are confirming. We don't see things that are counter to what we've always been taught. We tend to notice and explain things in terms of what we know. So people who have felt helpless and disempowered, we want to help them figure out how can they be empowered? How can we help them feel empowered to take back their sense of personal agency? We want to help people be flexible. When people are stressed, the more stressed they become, typically the more rigid they become in how they deal with things, in how they interact with other people, in how they see things. It's either, you know, all, or you see a lot of all or nothing thinking and people in crisis. So we want to help them develop psychological flexibility, which starts with mindfulness. We want to help them develop confidence in themselves. You know, it goes along with confidence and empowerment so they don't feel anxious all the time, so they don't feel like they can't do something, so they don't feel like the world is against them. We want to help them develop self confidence and we want to help them develop a sense that I'm okay, I'm good. You know, even though something bad may have happened to me or to my. To my kin, that doesn't mean I'm a bad person. It doesn't mean I'm broken. It doesn't mean I'm, you know, defunct in some way. It means I just have a different experience and I am a good, lovable, whole person. We want people to develop a sense of competence so they have the sense that if they try to do something, they're going to most of the time be able to achieve it. None of us achieves everything all the time. You know, we all have things that we are not talented at, and that's okay. But helping people identify, okay, there are these things over here that you're out of that are out of your control. There are these things over here that you're not good at, and that's okay, you know, when it comes to woodworking tools, I am completely incompetent. When it comes to plumbing or electrical, I am completely incompetent. You know, don't put me near electricity. It's a bad thing, but I'm okay with that. I have confidence in myself and I know what my limitations are and I know what my strengths are. You know, so my husband, he's really good with plumbing and a electricity, which is awesome because I'm not. I'm really good with, you know, other things like growing our food and, you know, whatever. So we have a sense of competence. We know what our strengths are. We want to help people develop insightfulness. To be curious to ask, why am I feeling this way? Or why do I interpret this as threatening? We want to help people develop perseverance after a trauma. People are exhausted. If you experience intergenerational trauma or if you have PTSD and are hypervigilant all the time, or most of the time, it's exhausting. So it is really hard to persevere. It's really hard to keep going because, you know, it feels like you just can't get a win. So people who have experienced trauma may tend to throw in the towel easier. They just don't have the energy. Their body is using as much energy as it has to survive and to protect them. Help them gain perspective, help them look at the bigger picture. Sometimes things that seem like it's the end of the world really aren't. But it's a matter of being able to help somebody unhook from that situation and step back. You know, the old saying, can't see the forest for the trees. Well, helping the person get out on the road, look from an aerial view at the forest to figure out which way they're going to go. And self control versus dysregulation. A lot of people who've experienced trauma experience emotional dysregulation partially because of hypocortisolism. And we do see hypocortisolism more in children who've experienced trauma, especially children who have experienced repeated traumas or, you know, are coming from an environment where there's lack of attachment and multiple adverse childhood experiences. We want to help people develop a sense of personal control so they don't feel like they're being controlled by the outside. When you're hyper vigilant, it's exhausting. And it's also frustrating because you feel like you can't control your startle response. When somebody slams the door or in the dogs start barking or like crazy or something, and you jump out of your skin. You know, you feel like that cat on the Tom and Jerry cartoons that just like goes up and grabs onto the ceiling. It's very frustrating. We want to help people develop a sense of personal control over their behavioral and emotional reactions. So what are some of the risk factors? Well, age, for one. You know, we've talked about intergenerational trauma. When a child is zero, you know, they are completely dependent on their caregiver for everything. And if that caregiver is not emotionally available, if that caregiver is not responsive and the primary attachment doesn't develop, then that child is, we know from the research, is going to likely have anxiety and attachment issues and later conduct issues growing up. And you can look at Bowlby's research to learn more about that developmental level. And it's not the same as age because you can have somebody who is 8, 12, 18, 28 who has the developmental level of somebody who is much younger. You can also have, in some cases, children who are more developmentally advanced than their peers. But generally it's not by decades, it's by a year or two. You know, if you look at Piaget's stages, there are very clear periods where people go from sensorimotor to pre operational to concrete operational to formal operational thought. So if somebody's right on the precipice of one of those, maybe on the Precipice between concrete operational and formal operational thought. You know, some kids who are at that age may be informal operational and understand a little bit more, others may not. We do want to look at developmental level based on not only chronological age but also what else is going on. Youth or people? I shouldn't just say youth. People with fetal alcohol spectrum disorders, for example, often talk at a level that's above their chronological level. They may be 14 and talking at the level of an 18 or 20 year old be able to carry on a very, you know, fluid conversation. However, what they're receiving and what they're interpreting and what they're understanding, their receptive language is that of more of an 8 year old in many cases. So somebody with FAO, with an FASD, we do have to be aware of their developmental level on multiple fronts. That's for the FASD course. If somebody has a prior history of trauma, then another trauma is probably going to be more traumatic. It's probably going to compound the risk for PTSD because it starts seeming like the world is not safe. One thing happens, an isolated incident, you might be able to wrap your head around it, explain it, come to some understanding. When you have it, something else happen again, you might feel like you've just got a target on your back. Prior history of mental health or substance abuse issues. If somebody has a prior history of depression or anxiety or bipolar disorder or schizophrenia, then these things could resurface as a result of trauma. And when they resurface, they also increase the risk of the development of ptsd. We also want to look at people with autism and people with autism because they have difficulty with sensory processing because of their unique neurological makeup. Things that are not traumatic to those who are neurotypical can be traumatic and overstimulating to someone who's neuroatypical. We do want to pay attention to that. The number of stressors somebody's experienced in the prior six months, even if they don't rise to the level of trauma, if somebody's had a really bad six months and you know, their car broke down, their roof got a leak, their kid flunked out of college, you know, yada yada yada, then if a trauma happens, they're already worn down, they are already exhausted, so they are more at risk for ptsd, the availability of social support. And we're not going to talk a lot about that on interventions because I'm just going to say right now that it is vital for people to get social support for trauma within 4, 24 or 72 hours, 4 hours is your first window. That is before people start moving that to long term storage. Compartmentalizing. Whatever they're doing, it is there, it's acute, it's raw, and it can be dealt with. Now, obviously this doesn't apply to intergenerational. Within 24 hours, the person has compartmentalized it a little bit because, you know, hopefully they've gotten some sleep and been able to regulate their emotions a little bit, return to baseline a little. It's still pretty raw, but not quite as bad. And then 72 hours, that's kind of the end of the window before somebody has taken the trauma, boxed it up and put it on a shelf in their mental closet for hopefully dealing with later. But a lot of times it just ends up getting stuck back there. If they don't have effective problem solving and coping skills, then they are at greater risk for ptsd. And if they don't have effective distress tolerance skills, then they may be at greater risk for PTSD because that trauma is just completely overwhelming and almost palpable. So what can we do? You know, this is the more interesting part of the class, Psychological flexibility. Let's start by helping them figure out what they do. And in psychological flexibility, this is kind of taken out of acceptance and commitment therapy and modified a little bit here and now. This is accepting. This is what it is. What's going on? Here's how I feel now. Our away behaviors that we see in people who have experienced trauma, regardless of the type, we see hyper vigilance, irritability and aggression, which either gives them power or pushes people away. But it's protective addictive behaviors which may help numb emotions and feelings of distress, withdrawal or isolation and giving up easily. So if somebody that we're working with is in the here and now and they're experiencing distress, these may be their autopilot behavioral reactions. Their autopilot feelings may be of anger, anxiety, pessimism, distrust, guilt, loneliness, or just a lack of perspective. Just seeing everything in a certain way through a negative lens. That's autopilot. That's what they've always done. And you know, they may not know, they may not even realize they're doing it and they may not know how to switch gears and take it off autopilot. What we want to help them learn is when they're experiencing distress in the here and now, yes, they can get irritable, they can engage in addictive behaviors. They can do all this. They can. That's a choice. Or we can help them learn mindfulness. Patience, vulnerability, prevention, how to seek social support and problem solving skills. We can help them develop these tools. So when they feel distress, when they experience trauma, when they experience an extreme stressor or just a regular old stressor, they have choices. And they can say, which one is going to get me closer to being the happy healthy person I want to be? Is it going and having a drink or is it calling a friend and maybe engaging in some dialectical behavior activities? They have choices in the here and now. It's unpleasant, it's uncomfortable. How can we improve the next moment? Well, you can stick with that initial feeling of anger or anxiety or pessimism or all of those, or you can say, all right, this is how I'm feeling right now. How can I improve the next moment? We can help them learn how to cultivate optimism, curiosity, perspective, insight, flexibility, empowerment, confidence, trust, confidence, self control. So these are all things we can help them add to their repertoire. So they have choices. Not saying that they're always going to choose those, but then they can stop and go, okay, what thoughts? If I'm having these thoughts, the whole world is against me. Is that helping me be the happier, healthier person I want to be? Probably not. If I have the thought that maybe use perspective here. If I have the thought that this person that I'm interacting with is really unhappy and unhealthy, however, it's more about them than about me. How does that affect my mood? Does that help me deal with this situation differently? So I am using my energy to become more of the happy, healthy person I want to be. Mindfulness and these everything we're going to talk about henceforth are your toward behaviors and your toward thoughts and feelings. These are the things we want to cultivate. And I've tried to give suggestions for how we can do it with adults as well as how we can do it with children. Mindfulness is the awareness of the present moment, you know, what is right now and one's needs in the present moment without judgment. If what it is right now is, you know, this is horrible and I'm feeling really uncomfortable and sad and angry and I need a hug. Okay, that's what you need. It is what it is. But it takes people a while to get there because in our society we typically are not very mindful. We typically just kind of go on autopilot constantly, not checking in, going, how am I feeling? What am I needing? So some activities you can use to just start having people develop a sense of mindful awareness. This isn't even full out mindfulness just mindful awareness. Five, four, three, two, one. And we've talked about this before. Five things you see, four things you hear, three things you can smell, two things you can feel, and one thing you can taste or whatever. Use your senses and you don't have to do. You can do five things you can taste if you want to. It doesn't matter. Just 5, 4, 3, 2, 1. That helps people get grounded in the present moment and notice what's going on around them. How often do you think, what am I feeling right now? Unless you're just really uncomfortable because it's hot or you're wearing a scratchy wool sweater or something. A lot of times you're not thinking about what you're feeling or you know, what your physical sensations are. Another activity that I. And kids can do the 5, 4, 3, 2, 1. Pretty easily, too. They kind of like that. What's in the room? This is another activity that you can do. And you can do one like words in a word. So if you're having somebody, you're all sitting in a group room, or it's a family and you're all sitting in the living room, have everybody get out a piece of paper and spend five minutes writing down everything they see, everything they they visually see or everything they hear. You can just choose a sense, and then everybody shares what they noticed. Because a lot of times people will overlook things and somebody else points it out and they're like, oh, yeah, I didn't notice that. And once you see it, you can't unsee it. That's just a whole different. Whole different thing. Another what's in the room sort of activity. You can do a scavenger hunt, and this is more fun. You can do it, families can do it, or you can do it in treatment with a group of people. Maybe have everybody spend 10 minutes going around the facility or going around the house in the yard, identifying all the things they can find that are green. And you'll never notice or never realize how many things there are that are green until you pay attention to it. These are just fun ways to get people to start noticing that there's a lot more around them than they're really paying attention to. Noticing log is kind of a bridge between mindful awareness and mindfulness. When you're working with somebody, for example, maybe you're working with a teenager who's trying to do their homework and they're having a difficult time because their mind keeps wandering and thinking about what they did in gym class and how embarrassed they are about that or what they said at lunch or the test that they've got in a week. And they're not focusing on what they're doing right now, but they've got all this anxiety going on. A noticing log is just having somebody having that individual keep a log of each time they notice that their mind has wandered. Each time they notice that they've got monkey mind. And for kids, you can do a monkey on a piece of paper. You can have a drawing of a monkey and then little hoops or something or little clouds that he's holding. And that represents monkey mind. And you can let them color it. You can do all kinds of things. But encourage people to start noticing and paying attention to their monkey mind and give them the tools to just say, you know what? Nope, I don't need to worry about that right now. I need to focus on whatever this is to help them start taming that monkey mind. They're not going to be perfect with it. But as people start noticing their monkey mind and start returning their attention to the present, gradually, they're going to just naturally start taming that monkey mind. Another activity which can be really fun to do for families, and we used to do this in the residential treatment center that I worked in is mindfulness activities. And there I have these three times a day. You don't have to do it three times a day. You can just choose once a day if you want to. But there are different things to ask at different times a day. In the morning, you can be sitting around the breakfast table, or you can have somebody drinking their coffee, filling this out. If it's just an individual, how did I sleep? Do I feel rested? Do I feel healthy? Do I have pain anywhere? What am I thinking about the most right now? How do I feel emotionally? What am I looking forward to and what am I dreading? What's one thing I'm grateful for and what can I do to get energized for the day? Encourage people to fill that out first before they start problem solving. Just pay attention to the moment, you know, what is it, is what it is. And then they can look and say, all right, now what do I do about it? So if they didn't sleep well on my worksheets that I have people do I have a line underneath each one of them. And if there's a negative, if they didn't sleep well, for example, what do you need to do to mitigate that vulnerability? You know, you probably can't go back to sleep. So if they know when they're Sleep deprived, they tend to be more irritable and have more difficulty focusing. What do they need to do to make their day go smoother knowing that they're already. They have that vulnerability going on. If they feel like they're getting sick, what do they need to do? I know when my kids were little, I could almost always tell when they were getting ready to get sick about a day or two ahead of time before they actually broke the fever or whatever, because they would start to become very disorganized and very chaotic. And that's not how my children normally were. So that was a clue to me that they were getting ready to get sick. Most of us have signs, you know, warning signs that we're getting ready to get sick. Knowing how to mitigate those vulnerabilities so we can keep our stress low, prevent ourselves from getting sick, and prevent ourselves from becoming dysregulated when things occur during the day. For me, if I'm sleep deprived or if I'm getting ready to get sick, a lot of times I will shut my door because I tend to be less patient and I have difficulty dealing with interruptions. So I will shut my door when I'm trying to focus on things. So it's not as likely that somebody's going to walk in on me and I'm going to bite their head off inadvertently. But sometimes it happens. Encouraging them. You know, how do I feel emotionally? If the person feels flat or blah or depressed or something other than happy, then what do I need to do about that? How can I add in some happy? How can I improve the next moment? If you're already starting the day and you got up on the wrong side of the bed and you're feeling cranky, then how do you mitigate that vulnerability so you're less likely to dysregulate during the day? Okay, after school, after work. Mindfulness, I find, or I found when my kids were younger and they would get out of school, they had held it together all day for, you know, so long. For a kid, it's a really long time. And as soon as they get home, they would lose their ever loving minds. They just had that energy cooped up and they had, you know, been good for so long that they needed to let loose, they needed to get rid of some of that nervous energy. So paying attention to mindfulness because I think a lot of us are the same way. We are so focused all day at work and then when we get out of work, sometimes you're just like, oh my gosh, I just Want to watch TV and turn my brain to jelly or I want to do something else. But it's important to encourage people to check in with themselves. When people check in with themselves, then they are able to mitigate those vulnerabilities. So if you're talking about somebody who has a trauma history, this can be very empowering and can encourage a sense of self control and competence in themselves, because they start realizing how they feel. And this emotional dysregulation doesn't come from out of the blue. They see where it came from and they start going, okay, I see the connection. I know how I can start addressing this anyway, after school or work. How do I feel physically? If you're exhausted, that's fine. How do I feel emotionally? What was the worst thing that happened today? A lot of times we think about that. What was the best thing that happened today? Encouraging people to embrace the dialectics. Yeah, crappy things happened. You know, it's possible, but likely some decent things happen too. It may not rise to the same level. I want people to recognize that there is good with the bad. What do I need to do right now to help me finish the day? You know, you're driving home from work and you're doing this mindfulness activity, or you're driving the kids home from school and you're processing how their day went. What do I need right now to help you finish out the day? Distress tolerance activities. You know, thinking about getting involved in some sort of activity to distract yourself from the day or to blow off some steam or whatever. Do I need social support that's there. And when I put food here, I don't mean as a coping tool, but sometimes, if, you know, a lot of us will go the entire day, we'll skip lunch, we'll just kind of be pounding back coffee all day long. And our blood sugar is really low. And if we just get some nutritious food into our system, it can help our mood and our energy go back up so we're less irritable. When our blood sugar goes low, our HPA axis ramps up. So you're talking about somebody with trauma whose HPA axis is already ramped up. And then they reduce what they're eating so their blood sugar gets low and their HPA axis ramps up even more. So, yeah, they're gonna be more vulnerable to dysregulation. Encouraging people. What do I need? Some people, you know, you know, the old stereotype of the person who wants to come home and hang out in their cave for a little while to De stress, you know, that's what some people need to do. Introverts typically de stress by thinking and that's not good or bad, it just is. Then there's those of us like me. I'm an extrovert. I de stress by talking. So I need to talk it out. Which people, thankfully, now that we have Bluetooth and everything, people don't think I'm near as crazy when I'm like driving down the road talking to myself. We won't tell them I don't have a Bluetooth in. I'm just talking to myself. But I talk things out and that's how I de stress and get through the day. But knowing this helps improve. So the evening goes a little bit more smoothly. And then in the evening, kind of before bed, how do I feel physically? If you're in pain somewhere, then guess what, you're probably not going to sleep as well. So that's one of those things you need to go back and mitigate in a while. But again, ask all the questions first and then go back and figure out how to mitigate any vulnerabilities. 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 so I can get relaxed enough to go to sleep? People with PTSD often have a hard time or people who've experienced trauma even if they don't develop full blown PTSD often have a hard time relaxing enough to get to sleep because their HPA axis is revved up. So what do you need to do? And it's really important to help. Work with clients who have difficulty sleeping to help them develop a sleep routine. Distress tolerance and self control. If you remember the DBT acronyms, Accept and improve. That's what we're talking about here. Encourage people to make a list of what they can do. Just giving them this handout that has the acronyms on it doesn't do a lot when somebody is stressed out, when they're in crisis, when they're, you know, whatever. So what kind of activities can you do when you're feeling angry? What kinds of activities can you do when you're feeling bored? Have them make a list of those so they're handy. What can they do to contribute if they want to contribute something, if they want to volunteer, how can they compare themselves to when they were in a worse state or to how things could be worse to help them recognize that, alright, this really is unpleasant. Right now, however, you know, it could be worse. And sometimes that helps us get perspective. Emotions pushing them away or doing things that are, that bring out the opposite emotion. So listening to comedy, doing things that make you happy, playing with your dog, My dog's a big goofball, so that always helps. Pushing away thoughts. Sometimes you just got to tell your brain, you know what? Nope, we're not thinking about that right now. And you know, sing a happy song in your head and sensations, engage in powerful sensations, such as holding an ice cube. Or even worse, in my opinion, putting your hands in ice baths up past your wrist because it really hurts a lot. And you aren't going to focus on anything but that until. Until you have your hand out of there. So that gives your brain a chance to focus on something besides the trauma or whatever you're thinking about. Imagery. Imagine yourself successfully completing something. Imagine it successfully completing. Have people create imagery that is comforting to them. Maybe a guardian angel. And you know, they can draw it. It can be a great art activity. Help them find meaning in the event. Prayer. Help them develop relaxation skills. Remind them to just take one thing at a time. Sometimes after a trauma, our world gets turned upside down, it becomes chaotic, and we want everything back the way it was now. And everything isn't going to be back the way it was right now. Maybe not ever. So one thing at a time. What do I need to do right now? Take a mental vacation and get social support. Get encouragement. And sometimes you need to be your own best cheerleader. Helping them develop framing or perspective skills. What is the evidence for and against that fear or belief? You know, if you're feeling that the world is unsafe or that people are malevolent, what is the evidence for and against that? Am I considering the big picture? All of the factors that are going into this. What was my active part in this situation? What part of my current situation and my current vulnerabilities are contributing to my reaction? What are other people's active part in it? And am I having transference issues? You know, maybe I am reacting really strongly to this because the person that I am engaging with reminds me of something. An engagement with somebody from my past. And I'm. And am I catastrophizing and confusing high and low probability events? Is it the worst thing in the world? So for example, when my husband was on the road, if he hadn't eaten in a while, he would become hypoglycemic and he would often draw a complaint. Okay, so if he got that, thankfully he didn't catastrophize but, but some people do, they get a complaint and they're like, oh my gosh, I'm going to lose my job and I'm going to lose my house and I'm going to be homeless and then I'm going to, oh, my gosh. How did we get from a complaint to homelessness? You know, so what is the evidence for and against that belief? What part are we considering in that? You know, what was his active part? Well, his active part was he was a great big old cranky pants. What part of the situation contributed to that? Well, his blood sugar was low. Is it an excuse? No, but it is something that he can mitigate in the future. What were other people's active part in the situation? Whoever made the complaint, you know, what were they doing and why may they have perceived that as more aggressive or offensive or whatever than he intended it to be? And were they potentially having transference issues? Or is that person who is, you know, all upset about the complaint having transference issues because they got a complaint in the past, which may have led to them getting dismissed or something? So encouraging people to, you know, get perspective and then really consider this situation that's in front of me, the reality of this situation, and how likely is it, you know, you drew a complaint, how likely is it you're going to get fired? And then even if you got fired, how likely is it that you would be unemployed long enough to lose your house and become homeless? Pretty low probability there. But we can use these perspective skills for everything from, you know, when somebody gets a divorce, when they're having relationship issues, if an adolescent is getting ready to go for some sort of team tryouts and they're thinking, well, if I don't make it, then my world is going to end. Or they get a grade that puts them out of the running for valedictorian, and they think that their entire academic career is over, encouraging them to get some perspective by asking some questions. Problem solving skills, brainstorming is one of my favorite because we tend to restrict ourselves or just jump on the first idea. So for children, you can have them draw pictures of what they might do. They can draw different ways to solve the problem. For adults, they've done studies and they found that our brain stays more active if our hands are active. So if you write down a solution and then you circle it and you draw a line and you write another solution, you want to make sure to keep your hand in motion the entire time, and that can help you tap into some of that Creativity a little interesting. Ask somebody who's been through a similar situation. That's another problem solving skill. Encourage people to remember that they can ask for information even if it's not asking for help. And in problem solving skills, always evaluating the solution and saying, how does this keep me from moving closer to my goals and what can I do about it when there's a problem, you know, maybe somebody got a complaint. We'll stick with the complaint for right now. Somebody drew a complaint. Well, that keeps the person from moving closer to their goals if they get fired, and they probably will get fired if they continue to do it. So what can they do so it doesn't. So they can improve from there on out. Flexibility helps people learn that things won't always go the way they want, but it doesn't mean that it'll always be awful. Flexibility does not come easy to those of us with a J personality. I am structured and I like my structure. It's important for people to learn how to be flexible though, and my children taught me that very quickly. We need to identify things we need to be flexible in. So have people brainstorm. What things do you need to be flexible in? Especially if you're in a family or in a group, such as vacations, relationships, time management. And then for me, for example, I need to be flexible in workouts because sometimes I want to go out on a run and it's raining outside and I need to do something else. It took me a while to get flexible with that, believe it or not. So activities to help people develop flexibility. The choices hat. Obviously you're not going to do this for big deal decisions, but you can put. If you want to decide what to have for dinner tonight, everybody can write down their favorite meal and put it into a hat and then you draw one out and that's the way it is and that's the meal we're going to have. So you're having to be flexible. Same thing for vacations. People can put down their opinions or television programs, draw it out of the hat. Whatever selected is what you have to be good with. Schedule a spontaneous day. Now isn't that ironic? But that's what we do in my household because I'm just not spontaneous. But I know that there are certain days that are family days and they're not pre planned. I just have to wipe everything off my schedule and go with the flow. And I can do that. How many uses game I love this game and you can play it with kids and of a lot of different ages. How many different things can you do with duct tape, with coconut oil, with plastic shopping bags, with cardboard boxes, wire coat hangers. Go on Pinterest, you'll be stuck there for hours. But that's not contributing to the overall family activity. It can give you some ideas for things to do with these various things. Just learning how to be flexible and not seeing something is as this is the way I've always seen it, so this is the only thing it can do. And play the how are you like a game? How are you like a giraffe or what wild animal are you most like? And why? Encouraging people to be sort of mentally flexible and explain things encourage learned optimism. Martin Seligman is the one who came out with this, But Kobasa in 1979 built off of it with her ideas about hardiness. And Russ Harris and Stephen Hayes with their acceptance and commitment therapy. And also Marsha Linehan with dialectical behavior therapy. You'll see a lot of optimism sort of things in there. Traumatized brains stay on alert and notice dangers or potential threats. That's that hyper vigilance. It's important that we teach people to also identify the good things in addition to those other things. According to hardiness, we can be happier if we have commitment, control and challenge. Commitment means accepting that the current situation is what it is. It's unfortunate. And what other aspects of your life are you committed to which are going, okay, so maybe work sucks right now, but your family's doing well and your dogs are doing well and whatever. So you can identify things that are important to you that are going well so it doesn't feel like your entire life is a disaster. And in act, they call that living in the and in dbt, she refers to it more as dialectics, recognizing that both good and bad things can be happening concurrently. Control. Encouraging people to look at what parts of the situation they feel they can control and what aspects or other parts of their life they do have control over. So again, there are certain things. If work is not good right now, there are certain things at work you can control. And some of that may even include applying for other jobs. But there are some things you just may not be able to control. All right, that's fine. Let's look at the rest of your life. You know, what parts of that do you have control over? And that helps people develop that sense of empowerment and agency and realize that they do have control over multiple aspects of their happiness and health. And in challenge, encourage people to look at whatever's distressing them as a challenge or an obstacle that needs to be overcome instead of a barrier that's just there and you can't get around it. Activities for learned optimism can include positive journaling. Have them write for 20 minutes a day about just the positive things that happen that day to help them gain some perspective. Because they're thinking about the negative things. Encourage them to draw out those positives and a gratitude wall, tree or branch. You can do a wall and just put post it notes all over the wall. Every day somebody, each person in the family adds a post it note to the gratitude wall. Or you can do it as a tree or you can get a branch from outside and use paper clips and paperclip the sticky notes to the branch to make a little three dimensional tree with gratitude things. Empowerment activities encourage people to learn about others like them who've overcome similar challenges. Maybe they were adopted, maybe they were grew up with addicted parents or grew up in poverty or whatever it is. Break big tasks into small steps. Sometimes even things like spring cleaning can seem overwhelming and just not doable. But if you break it down and you say, okay, I'm going to do the living room today and I'm gonna do the dining room tomorrow or whatever, each time you finish that chunk, that small step, you have that sense of empowerment like I did that accomplishment. Give credit where credit is due. Encourage people to have and I did that notebook or wall so they can remind themselves that yeah, I did that, I graduated from college, I, you know, whatever. Encourage them to make a my support list. Who are their supports that they can turn to? Because asking for help is not necessarily a bad thing. And make sure not to put all your eggs in one basket. Encourage people to have multiple coping strategies. When people feel incompetent and lack confidence, the world seems much more threatening and they can feel more helpless. So encourage them to identify their signals, signature strengths. Have them create an ad campaign to sell themselves. You know, and it can be a written, it can be a graphic one, it can be a TV ad, whatever they want to do for kids. You can have a body poster, trace, have the trace the child on poster board or whatever and then have them either draw or cut out images that are descriptive of their strengths and their positive qualities. You can have them write a biography, not an autobiography, but a biography. So what would somebody say about you if they're writing your biography? You can have them identify who I look up to and why. So if they look up to Michael Jordan, why do they look up to him? And what characteristics do they share in common with him? And you can have them have a personal scrapbook of accomplishments. And I encourage them to have multiple sections. Emotional. What are their emotional accomplishments? When did they show courage, perseverance, dedication? What are their physical accomplishments? What are their mental accomplishments, such as occupation, creativity, hobbies, interpersonal accomplishments? When have they shown patience? When have they been an advocate for something? And potentially spiritual accomplishments. Spiritual accomplishments. When have they felt like they've been connected with the universe or their higher power? You can also have them do a goals workbook, encouraging them to learn how to set goals. My goal, have them write down what their goal is, why I want it, what could stand in my way, how I can deal with that, you know, if something's going to stand in my way, how can I overcome that? And what are the steps that I need to do in order to achieve my goal? Encourage people to start writing it down because that will help them feel empowered and competent and confident. 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. So activities with little kids, Scaffolding works really well. Like when they're tying their shoes, you know, first you teach them how to tie the. The first tie the laces together, and then you teach them how to make the bow, and then you teach them how to wrap the string around. There are multiple steps in tying your shoes. Each time the child learns a step. Then encourage them to do the next step and if they can't remember, maybe show them, and then the next time let them do the next step. For adults, find mentorship. You know, you're not going to find quite as much scaffolding, but a mentor is going to be there going, okay, you know, what do you need to do? Let me. You go through process, because I've been through it before. And when you get stuck, I'll help nude you along. Break things down into smaller tasks like we talked about before, and do a decisional balance exercise. What are the benefits of quitting whatever I'm doing right now or just keep on going? What are the drawbacks to quitting? What are the drawbacks to keeping on? And then enhance the benefits of keeping going and the drawbacks of quitting in order to increase motivation. Social support is a great resource when trauma knocks people off balance. So encourage people to develop connectedness by participating in hobby groups like Knitting Circles, one of mine. But join clubs like a hiking club or faith organizations and put effort into developing relationships. It's not a relationship. Relationships just don't magically happen. You've got to put effort into it. Have a plan when trauma happens, when things happen, it's easier to be less traumatized and feel less stressed if you've got a plan for how to deal with it. So plan financially now. If you don't have a lot of savings, some people just aren't able to save. Know where you can find resources United Way information and referral. Know what your housing is going to be. Know how you're going to pay for your medical bills or meet your medical needs. Sometimes those things make people feel calmer if they've got a bug out plan. Basically, trauma can enhance feelings of disconnectedness, helplessness, and anxiety. It impacts people emotionally, mentally, physically, interpersonally, and occupationally. By helping people develop trauma resiliency, we can assist them in preventing PTSD after a trauma and break the cycle of intergenerational trauma. This episode of Counselor Toolbox has been sponsored in part by Foundations Events. As the behavioral health industry evolves, the need for collaboration is greater than ever. Join Foundations Events at the Innovations in behavioral healthcare conference June 20th and 21st in Nashville. Focused on listening to both the patient and provider, this conference offers two days of sessions that follow the journey from meeting the patient where they are to helping them find recovery. Special pricing for licensed clinicians is available with the opportunity to earn over 20 CEUs. Visit foundationsevents.com counselortoolbox for more information and to register today. 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. 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