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Trauma Summit
      Iowa Annual Conference

Strengthening the Safety Net of Love
        Presented by Laurie Leitch, PhD
           Co-Founder and Director
        Trauma Resource Institute (TRI)

    Website www.traumaresourceinstitute.com

                                              copyright 2009
Everything is a possibility in a universe
of interaction and mutuality of all
beings. This optimistic message
allows us to entertain the possibility of
intervening in systems whose rules and
relationships have created conditions
that cause suffering in the world.
                 Merle Lefcoff
CALLS
•  Are essentially questions, not to be
   answered, but to be responded to
       Where am I willing to be led?
       Is my energy growing or shriveling?
•  The “answers” are usually metaphor, poetic,
   paradoxical, dream-like
       Song lyrics, recurring dream images, overheard
        conversations
•  Rock the boat (cocoon & imaginal disks)
•  Often require sacrifice
       What are you willing to give up to ensure your own
        unfolding and the unfolding of what is holy in your life?
•  Are like a scavenger hunt
•  Come in many disguises
The Engaged Citizen: An Emerging
               Archetype
•  Levoy: see our lives as a process of calls and
   responses
     “saying yes to the call can put you on a path that half of
      yourself thinks doesn’t make sense and the other half
      knows your life won’t make sense without it.”
     “ Life is a great devourer, and dreams get swallowed at an
      alarming rate.”
•  Torah: “ if you listen from down below you will hear from up
  above.”
•  Revelation 21:5: “Behold I make all things new.”

•  Old Roman Saying: “ The fates lead those who will,
  those who won’t they drag.”
Callings

“A mystery that leaves itself like a trail of
 bread crumbs and by the time your
 mind has eaten its way to the maker of
 the tracks, the mystery is inside you.”
          Tom Brown The Tracker
The Clues are all around us
•  Joseph Campbell said we’re having
   experiences all the time that hint at our
   hungers
•  Our practices can help us stay awake and
   curious to the soul’s whispers
•  Many spiritual traditions say any sign or
   story must be examined from 3 points of
   view:
    Literal
    Metaphorical
    Universal/transpersonal
Essential Principles in Following a
                  Calling

•  Presence- the transition zone between
   the fullness of opinions and the
   emptiness of no thought.

•  “Radical Optimism” (Roshi Joan Halifax) Holding
   the vision for a successful future

•  Solidarity rather than Charity: Lila Watson
Principles continued

•  Self-Inquiry/Introspection:
    How do my actions prevent or perpetuate
     disparities & inequalities?
    What are my internalized “isms”?
    How do I bring my shadow to my calling?
    How does my biography shape what I
     bring to the work?
    Where have I avoided going in my own
     self-inquiry?
    Where am I willing to be led?
Self-inquiry (continued)

•  What’s saving me right now?
•  What are my basic intentions
•  What am I sure of?
Is the compassion and kindness we talk
about in all spiritual traditions possible if the
mind-body system is contracted due to
traumatic events? Can we live in harmony if
below the level of consciousness lies an
array of perceptions and sensations
biologically imprinted following these
events? What do those of us who attempt to
respond to the suffering of others (and our
own) need to know about the mind-body
system and traumatic response?
What is TRI?

• The Trauma Resource Institute (TRI) is a non-
profit organization. TRI’s global mission is to
promote healing in adults and children suffering
from trauma through education and integrative
interventions that link mind, body and the human
spirit.

• TRI’s goal is to expand access to treatment by
training frontline service providers who do the
hardest work with the least resources.
What is the Trauma Resiliency Model?
•  A biologically-based intervention

•  Focused on stabilizing, reducing and/or preventing
   the symptoms of traumatic stress

•  Restores the body’s natural resiliency through skills
   that rebalance the nervous system

•  Demonstrated to be effective in low dosages

•  Also used for self-care of practitioner and client
Why is a Biological Model needed?

•  New information from neuroscience about
   the role of the nervous system in situations
   of threat and fear
•  The value of models that are not primarily
   psychological or insight-oriented
•  Their efficiency in re-stabilizing people and
   giving hope
•  Their gentleness…they do not re-traumatize
•  The skills-based focus allows individuals and
   their families to use the skills independently
A Brief History

•    Thailand Tsunami
•    Catholic Charities USA: Katrina project
•    China Earthquake project
•    Africa Projects:
       Rwanda
       Kenya
•  Middle East- Gaza
•  USA-
         Disaster response teams
         Community Resiliency Projects
         Public training
         Veterans Affairs projects: chronic pain, combat trauma
         Sex-trafficking of domestic minors
•  Spiritual leaders as first responders

•  High potential for secondary
   traumatization

•  Potential for burnout

•  Importance of self-care skills
In your work with trauma:

•  What are the common physical reactions?
•  What are the common emotional
   reactions?
•  What are the common cognitive reactions?
•  What are the common behavioral
   reactions?
•  What are the common spiritual reactions?

                                    Orientation to TRI
                                                         16
Trauma

Trauma =
TOO much
& TOO fast!



                       Nervous system
                       becomes
                       dysregulated
Trauma

 Trauma =
  Too Little
for Too Long!



                         Nervous system
                         becomes
                         dysregulated
Big “T” Trauma
 Natural Disasters                                        “C” Trauma
Man-Made disasters                                        Homophobia
 Disruption Trauma                                       Heterosexism
  Sexual Assaults                                          Classism
  Acts of Terrorism                                         Poverty
  Acts of Violence          Little “t” Trauma               Neglect
Economic collapse                Dog Bites                  Racism
    Child Abuse            Dental Procedures             Chronic Abuse
   Car Accidents            Routine Surgeries             Colonialism
  Physical trauma                  Falls              Forms of Oppression
                           Minor car accidents            Other “isms”
                      Arguments with significant others




           When the nervous system is overwhelmed,
                  individuals can lose capacity
              to stabilize and regulate themselves
The Individual’s Perception is
 what triggers the cascade of
          responses
The perception of
the event as life
threatening
combined with
feelings of
helplessness &
terror
Primary Focus of TRM

 The patterns that
cause physiological
     as well as
   psychological
   suffering are
 entrenched in the
 nervous system.


                                 21
Autonomic Nervous
                                      System



     Sympathetic (SNS)                           Parasympathetic (PSNS)
     Prepares for Action                            Prepares for Rest

The SNS controls organs during                   The PSNS controls the body
       times of stress                                  during rest

       Breathing rate                                 Breathing rate
          Heart rate                                     Heart rate
        Pupils Dilate                                  Pupils Dilate
       Blood Pressure                                 Blood Pressure
          Sweating                                       Sweating
      Stress Hormones                                Stress Hormones

          Digestion                                      Digestion
           Saliva                                         Saliva

                                                              Key Concepts of TRM
Strengthening the Safety Net of Love
The Autonomic Branch of the
           Nervous System

 The ANS has 2 important roles:

  1. In emergencies, that cause
       stress and require us to
          "fight" or take "flight
  This is the sympathetic branch of the ANS


2. In non-emergencies that allow
      us to "rest" and "digest.“
This is the parasympathetic branch of the ANS
Rhythmic Cycling
                   A Natural Process

•  Allows the person to respond
   to constant input from the
   environment in an adaptive
   way
•  Balance typifies most of nature
   (Seasons, Day-Night Cycles,
   moon, tides, etc…)
•  The human body will regulate
   back to balance
The Reciprocal Relationship in ANS



sympathetic




                                              Resilient Zone
                                              Balancemind
                           Release
 charge
                                     charge



              parasympathetic
•  ..”Our system is self-regulatory in the
   highest degree: self maintaining, repairing,
   readjusting and even improving. The
   chief, strongest, and ever-present
   impression …. nothing remains stationary,
   unyielding; and everything could always
   be attained, all could be changed for the
   better, were only the appropriate
   conditions realized.”
                            Pavlov


                                           27
Traumatic                                        Hyperactivity
                                                 Hypervigilance
Event!                 Stuck on “high”
                                                 Mania
                                                 Anxiety & Panic
                       Hyper-activation          Rage




                                                                          Resilient Zone
                                                                          Balancemind
  Depression
  Disconnection
  Exhaustion/Fatigue      Stuck on “low”
  Numbness
                          Hypo-activation
                                                            Key Concepts of TRM
                             Graphic adapted from original by Diane Poole Heller
When neither resistance nor escape is
 (perceived to be) possible, the human
 system of self-defense becomes
 overwhelmed and disorganized. Each
 component of the ordinary response to
 danger, having lost its utility, tends to
 persist in an altered and exaggerated
 state long after the actual danger is
 over.
                            Herman 1992
• Some have a very shallow Resilient Zone where even small stressors
                       bump you out of the Zone.




                                                                            Resilient Zone
                                                                            Balancemind
• Some have a deep Resilient Zone where there is a higher tolerance for a
                       wide range of stressors.




                                                                            Resilient Zone
                                                                            Balancemind
                                                                                    30
THE NERVOUS SYSTEM AND HUMAN
          RESPONSES TO TRAUMA
 •  The nervous system (NS) unconsciously and
    continually evaluates risk
 •  Traumatic events unbalance the NS, which
    affects perceptions of safety, danger, or life
    threat
 •  Practitioners can use TRM to help stabilize the
    NS and promote social engagement and positive
    attachment.

 S. Porges, 2004

Slides by Miller-Karas&Leitch 2008(c)
Porges 2004
                      Neuroception
                                          Senses Safety
      Threat
    Response



  •  Sympathetic NS                  Parasympathetic NS



    Fight & Flight

                                     Social Engagement
    FREEZE RESPONSE
The Triune Brain
        •  Neo cortex: Thinking
            Cognition, beliefs, language,
           thought, speech
        *Integrates input from all 3 parts

        •  Limbic Area
           Emotional - Expression and
           mediation of emotions and
           feelings, including emotions
           linked to attachment
        * Assess risk….negative focus

        •  Survival Brain
           Instinctual/unconscious -
           Digestion, reproduction,
           circulation, breathing, and
           the execution of the "fight or
           flight"
“We have a brain that was field-tested
millions of years ago in the wild. I call it the
wild brain to distinguish it from the logic
brain that so many people revere. The
logic brain can’t do much for you once the
situation becomes critical…”

                        Lt. Col. Dave Grossman
POTENTIAL PATHWAYS FOLLOWING A TRAUMATIC EVENT




                              Traumatic
                                Stress
Traumatic Event               Responses
    Little “t”                                            Mind and Body
        &                                                 Self-Regulation
    Big “T”                     Grief                   Homeostasis Returns
        &
                              Reactions
  “C” Trauma


                               Somatic
                              Complaints

       Not every one who experiences a traumatic event will develop PTSD
What Are the Three Resiliency Models?

  The Trauma Resiliency Model (TRM) is a condensed
    course designed to teach skills to stabilize and
   reduce and/or prevent the symptoms of traumatic
                        stress

 The Veterans’ Resiliency Model (VRM) is focused on
                 combat-zone trauma

The Community Resiliency Model (CRM) helps create a
   network of trauma-informed community members
  and organizations using the biologically-based skills



                                             Key Concepts of TRM
The Trauma Resiliency Model™
              Key Concepts of TRM
                 are based on:
1.     Laws of Nature
2.     Human Anatomy and Physiology
3.     Current Scientific Research on the Brain
4.     Somatic Experiencing® & Sensory
      Integration Theory, Gendlin’s Focusing
Biological Focus

•  TRM uses observation and knowledge of
   neurobiological patterns

•  TRM brings the client’s awareness to sensation
   to help interrupt the disorganized automatic
   nature of the traumatic responses

•  The client learns:
    •  to attend to the non-traumatic sensations
    •  to regulate affect and internal sensations
Goals of TRM
  To depathologize trauma symptoms by focusing on the
   biology rather than the psychology of trauma response

  To teach TRM skills to clients and practitioners so that use
   the skills to self-regulate

  To elicit release of blocked energy from the nervous
   system, to reduce or eliminate symptoms

  To work gently without re-traumatizing

  To restore balance and resiliency to the Nervous System
Who does TRM treat?
•  TRM can be used to treat any person who has
   experienced or witnessed any event that was
   perceived as life threatening or posed a serious
   injury to themselves or to others

•  TRM can be used with immediate as well as past
   trauma

•  Adults and children
The Importance of Information

 Education about the human responses
  to trauma….normalizes

 Education about the psychobiology of
  trauma

 Education shifts perceptions from
  pathology to biology…reduces shame
  and restores hope
Restoring the body to equilibrium can be
         accomplished gently




  Frozen in trauma   A smiling child after treatment
The Underlying Principle of TRM


The human body
has the inner
capacity to heal
and restore itself!
Life Trauma in Humans
•  A series of traumas or one trauma
   can:
    Lead to an alteration in the cycle of
     homeostasis and regulation
    Produce a process that is self-
     perpetuating in the absence of
     ongoing external stressors or threats
    For many, these symptoms cannot
     be “talked away”
    Although insight is helpful, it may
     not lead to regulation of the NS
                                   Key Concepts of TRM
Three Symptoms Categories of Post-Traumatic
          Stress & Acute Stress Disorders
            Re-living the Event                        Avoidance of Reminders
“I have nightmares and it pops in                      “I can’t go back to that
        my mind and feels                              place where it happened
    like it’s happening again.”                        and often I just feel numb.”

                                          Increased Arousal
                               “I am always afraid something
                              bad will happen and I jump at any
                              loud noise .”
                               “I can’t sleep and can’t
                              concentrate on my work.”

  Slides by Miller-Karas&Leitch 2008(c)
Trauma and Development
•  As the brain grows and organizes, the higher, more
   complex areas begin to control and modulate the more
   reactive, primitive functioning areas like the Survival
   Brain.

•  The person becomes less reactive, less impulsive, and
   more thoughtful as the brain becomes more complex.

•  Shock and Developmental Trauma can increase the
   activity or reactivity of the brainstem level and
   decrease the moderating capacity of the cortical areas

•  Thus, as children develop, this can increase the
   likelihood of aggression, impulsivity, and capacity to
   be violent on one end of a continuum and depression
   and disconnectedness on the other end.
Developmental & Shock Trauma


         Two Kinds of Trauma


       Developmental Trauma
                              and



                Shock Trauma


        Many children have experienced both


Slides by Miller-Karas&Leitch 2008(c)
Children’s Defenses

•  Parents, family members
   and teachers often
   underestimate children’s
   reactions to a traumatic
   event
•  Children may not show their
   true feelings to protect their
   parents and other family
   members


Slides by Miller-Karas&Leitch 2008(c)
Stages of the Defense Response Cycle
       High Activation is Designed to Enable Short-Term
                       Defensive Actions

        Stage 1: Prepare for Defensive Action
         Muscles tense, orient to source of threat

                 Stage 2: Mobilization
      Production of Adrenalin and Cortisol in order to
             provide energy needed to defend
  Stage 3: Release of Energy through Fight or Flight
       Running, Defensive Responses, Vocalizations

Stage 4: Return to Central Nervous System Equilibrium
         Parasympathetic responses-Homeostasis
Fight, Flight and Freeze
•  TRM works with the
   understanding of the
   natural defensive
   responses of fight,
   flight and freeze

•  TRM helps relieve the
   traumatic stress
   symptoms through
   restoring regulation to
   the nervous system
                             Key Concepts of TRM
The Freeze Response

   THE FREEZE RESPONSE happens
    when both the Parasympathetic and
      Sympathetic are activated and
      overwhelmed at the same time.
•  Fear and Terror overwhelm biological
          & psychological coping
•  Freezing during a traumatic event is a
      major predictor of who develops
   more serious symptoms as described
     as Post-Traumatic Stress Disorder
The Freeze Response

The Freeze Response may be
  experienced as:
•  An altered state of reality
•  The slowing down of time
•  Diminished awareness of fear &
   pain

    The Freeze Response may
  increase the chance of surviving
         a traumatic event



         Slides by Miller-Karas&Leitch 2008(c)
Traumatic Symptoms & the Nervous System


 Symptoms arise when residual energy from
  the experience is not released from the body
  The Goals of TRM are:
    1.  to educate the client about the normal and
        automatic defensive responses of fight, flight,
        & freeze….depathologizes
    2.  use TRM skills to elicit release of thwarted
        defensive energy, to reduce symptoms, and to
        restore balance to the nervous system



                                              Key Concepts of TRM
The Sensations of the Nervous System Release
            Sensations can include the following:


•  Tingling                                 •  Crying
   sensations                               •  Laughing
•  Warmth                                   •  Burping and
•  Vibrations or                               stomach gurgling
   Trembling                                •  Itching
•  Shaking                                  •  Yawning
•  Expanded                                 •  Cooling
   breathing

    Slides by Miller-Karas&Leitch 2008(c)
Trauma and Memory
Slides by Miller-Karas&Leitch 2008(c)
Implicit Memory: essential in
         understanding trauma
     IMPLICIT MEMORY(IM)
  We use IM in learning most
   physical activities like
   walking, skating, & biking
  Mental models are formed
   from the experience
  Body memories are created
   during traumatic events
   including sensations
   associated with Big “T”,
   little “t”, and “C” traumas

                                 Key Concepts of TRM
“Some aspects of traumatic events
  appear to get fixed in the mind,
  unaltered by the passage of time or by
  the intervention of subsequent
  experience.”

(van der Kolk, Blitz, Burr & Hartmann, 1984).
External Trigger                                  Internal Trigger

                                                                    Internal body sensation
       Sounds
                                                                     -tightness in stomach
        Smells                                                           -muscle tension
Visuals(people, places
                                                                           -headache
       & things)


                                   Dissociative Capsule of Trauma



                                Pain, numbness, dizziness
                                    Trembling, paralysis
                                   Nausea, palpitations
                             Anxiety, terror, shame, anger, rage
                                Flashbacks, nightmares or
                                     intrusive thoughts
Robert Scaer, MD


 Slides by Miller-Karas&Leitch 2008(c)
  Sensory  images, sounds
  Motor actions
  Sympathetic/Parasympathetic
   symptoms
  Perceptual alterations
  Emotions linked to the
   traumatic experience
Scaer, R,(2007) The Body Bears the Burden
External Trigger                                  Internal Trigger

                                                                    Internal body sensation
       Sounds
                                                                     -tightness in stomach
        Smells                                                           -muscle tension
Visuals(people, places
                                                                           -headache
       & things)


                                   Dissociative Capsule of Trauma



                                Pain, numbness, dizziness
                                    Trembling, paralysis
                                   Nausea, palpitations
                             Anxiety, terror, shame, anger, rage
                                Flashbacks, nightmares or
                                     intrusive thoughts
Robert Scaer, MD


 Slides by Miller-Karas&Leitch 2008(c)
Brief Overview of TRM Skills
How does TRM work?

• TRM works with the patterns of response that are stuck in
implicit memory that cause suffering in the present

• TRM uses observation and knowledge of neurobiological
patterns to bring the client’s attention to the internal
sensation associated with the implicit memory system

•  TRM brings the client’s awareness to sensation associated
with resources to help interrupt the automatic nature of the
implicit memory of their trauma…and extinguish cues that
trigger the memories

                                                 Key Concepts of TRM
THE TRM Model
•  It is skill based so that at the end of the
   training, the participants are prepared to
   incorporate skills into their scope of
   practice
•  It provides basic information about the
   neuroscience of the brain that is easily
   understood and can be translated to
   clients
•  Concrete educational tools are given to
   help participants teach their clients about
   their symptoms and their inherent
   resiliency…promotes independence
•  Can be used for clinician self-care

                                      Key Concepts of TRM
THE SEVEN CORE SKILLS*
 * TRM includes the skills of Somatic Experiencing

                                                     TITRATION
          TRACKING                     Working with small increments of
Using observation as a diagnostic      traumatic material and activation
              tool

                                                   PENDULATION
                                       Alternating between traumatic and
        GROUNDING                             resource sensations
    Being fully present in the
            moment
                                                  SHIFT AND STAY
                                       Shifting attention from traumatic sensation and
                                         staying with neutral or positive sensations

         RESOURCING
Using positive or neutral factors to        COMPLETION OF
 create non-traumatic sensations         DEFENSIVE RESPONSES
                                       Inviting completion of motions, vocalizations, actions
                                                 that were blocked during the event



                                                              Trauma Resource Institute
“The range of what we think and do is
limited by what we fail to notice.”
            RD Laing
Telling the Trauma story

•  Must be titrated
        T-1   T   T+1
•  Starts with a resource:
       When did help come?
       When did you know you had survived?
       Who else lived?
       What is giving you strength now?
       What do you notice having told me just this much?
•  Focuses on telling the story from inside the
   Resilient Zone
CHILDREN’S ART




Slides by Miller-Karas&Leitch 2008(c)
HEALING
The individual can:
•  learn to distinguish between
   sympathetic and
   parasympathetic responses
   and
•  Learn to apply the TRM
   skills to daily life to reduce
   or eliminate the symptoms
   that emerged in the
   aftermath of the trauma
•  Hope and relief from shame
                                    Key Concepts of TRM
O God who makes days and pronounces them
  good, who sings in the everlasting rhythm of
  dark and light, of risings and fallings, of
  cycles, of one thing following another, who
  makes time for all things in the cycle of
  seasons and tides, break the plane of our
  quiet desperation and lift up our brief years
  that we may find peace, and trust in the
  Everlastingness of your purpose.
                      Iona Center, Spring/summer 2009
Thank you!




www.traumaresourceinstitute.com
                         Key Concepts of TRM

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Strengthening the Safety Net of Love

  • 1. Trauma Summit Iowa Annual Conference Strengthening the Safety Net of Love Presented by Laurie Leitch, PhD Co-Founder and Director Trauma Resource Institute (TRI) Website www.traumaresourceinstitute.com copyright 2009
  • 2. Everything is a possibility in a universe of interaction and mutuality of all beings. This optimistic message allows us to entertain the possibility of intervening in systems whose rules and relationships have created conditions that cause suffering in the world. Merle Lefcoff
  • 3. CALLS •  Are essentially questions, not to be answered, but to be responded to  Where am I willing to be led?  Is my energy growing or shriveling? •  The “answers” are usually metaphor, poetic, paradoxical, dream-like  Song lyrics, recurring dream images, overheard conversations •  Rock the boat (cocoon & imaginal disks) •  Often require sacrifice  What are you willing to give up to ensure your own unfolding and the unfolding of what is holy in your life? •  Are like a scavenger hunt •  Come in many disguises
  • 4. The Engaged Citizen: An Emerging Archetype •  Levoy: see our lives as a process of calls and responses   “saying yes to the call can put you on a path that half of yourself thinks doesn’t make sense and the other half knows your life won’t make sense without it.”   “ Life is a great devourer, and dreams get swallowed at an alarming rate.” •  Torah: “ if you listen from down below you will hear from up above.” •  Revelation 21:5: “Behold I make all things new.” •  Old Roman Saying: “ The fates lead those who will, those who won’t they drag.”
  • 5. Callings “A mystery that leaves itself like a trail of bread crumbs and by the time your mind has eaten its way to the maker of the tracks, the mystery is inside you.” Tom Brown The Tracker
  • 6. The Clues are all around us •  Joseph Campbell said we’re having experiences all the time that hint at our hungers •  Our practices can help us stay awake and curious to the soul’s whispers •  Many spiritual traditions say any sign or story must be examined from 3 points of view:   Literal   Metaphorical   Universal/transpersonal
  • 7. Essential Principles in Following a Calling •  Presence- the transition zone between the fullness of opinions and the emptiness of no thought. •  “Radical Optimism” (Roshi Joan Halifax) Holding the vision for a successful future •  Solidarity rather than Charity: Lila Watson
  • 8. Principles continued •  Self-Inquiry/Introspection:   How do my actions prevent or perpetuate disparities & inequalities?   What are my internalized “isms”?   How do I bring my shadow to my calling?   How does my biography shape what I bring to the work?   Where have I avoided going in my own self-inquiry?   Where am I willing to be led?
  • 9. Self-inquiry (continued) •  What’s saving me right now? •  What are my basic intentions •  What am I sure of?
  • 10. Is the compassion and kindness we talk about in all spiritual traditions possible if the mind-body system is contracted due to traumatic events? Can we live in harmony if below the level of consciousness lies an array of perceptions and sensations biologically imprinted following these events? What do those of us who attempt to respond to the suffering of others (and our own) need to know about the mind-body system and traumatic response?
  • 11. What is TRI? • The Trauma Resource Institute (TRI) is a non- profit organization. TRI’s global mission is to promote healing in adults and children suffering from trauma through education and integrative interventions that link mind, body and the human spirit. • TRI’s goal is to expand access to treatment by training frontline service providers who do the hardest work with the least resources.
  • 12. What is the Trauma Resiliency Model? •  A biologically-based intervention •  Focused on stabilizing, reducing and/or preventing the symptoms of traumatic stress •  Restores the body’s natural resiliency through skills that rebalance the nervous system •  Demonstrated to be effective in low dosages •  Also used for self-care of practitioner and client
  • 13. Why is a Biological Model needed? •  New information from neuroscience about the role of the nervous system in situations of threat and fear •  The value of models that are not primarily psychological or insight-oriented •  Their efficiency in re-stabilizing people and giving hope •  Their gentleness…they do not re-traumatize •  The skills-based focus allows individuals and their families to use the skills independently
  • 14. A Brief History •  Thailand Tsunami •  Catholic Charities USA: Katrina project •  China Earthquake project •  Africa Projects:   Rwanda   Kenya •  Middle East- Gaza •  USA-  Disaster response teams  Community Resiliency Projects  Public training  Veterans Affairs projects: chronic pain, combat trauma  Sex-trafficking of domestic minors
  • 15. •  Spiritual leaders as first responders •  High potential for secondary traumatization •  Potential for burnout •  Importance of self-care skills
  • 16. In your work with trauma: •  What are the common physical reactions? •  What are the common emotional reactions? •  What are the common cognitive reactions? •  What are the common behavioral reactions? •  What are the common spiritual reactions? Orientation to TRI 16
  • 17. Trauma Trauma = TOO much & TOO fast! Nervous system becomes dysregulated
  • 18. Trauma Trauma = Too Little for Too Long! Nervous system becomes dysregulated
  • 19. Big “T” Trauma Natural Disasters “C” Trauma Man-Made disasters Homophobia Disruption Trauma Heterosexism Sexual Assaults Classism Acts of Terrorism Poverty Acts of Violence Little “t” Trauma Neglect Economic collapse Dog Bites Racism Child Abuse Dental Procedures Chronic Abuse Car Accidents Routine Surgeries Colonialism Physical trauma Falls Forms of Oppression Minor car accidents Other “isms” Arguments with significant others When the nervous system is overwhelmed, individuals can lose capacity to stabilize and regulate themselves
  • 20. The Individual’s Perception is what triggers the cascade of responses The perception of the event as life threatening combined with feelings of helplessness & terror
  • 21. Primary Focus of TRM The patterns that cause physiological as well as psychological suffering are entrenched in the nervous system. 21
  • 22. Autonomic Nervous System Sympathetic (SNS) Parasympathetic (PSNS) Prepares for Action Prepares for Rest The SNS controls organs during The PSNS controls the body times of stress during rest Breathing rate Breathing rate Heart rate Heart rate Pupils Dilate Pupils Dilate Blood Pressure Blood Pressure Sweating Sweating Stress Hormones Stress Hormones Digestion Digestion Saliva Saliva Key Concepts of TRM
  • 24. The Autonomic Branch of the Nervous System The ANS has 2 important roles: 1. In emergencies, that cause stress and require us to "fight" or take "flight This is the sympathetic branch of the ANS 2. In non-emergencies that allow us to "rest" and "digest.“ This is the parasympathetic branch of the ANS
  • 25. Rhythmic Cycling A Natural Process •  Allows the person to respond to constant input from the environment in an adaptive way •  Balance typifies most of nature (Seasons, Day-Night Cycles, moon, tides, etc…) •  The human body will regulate back to balance
  • 26. The Reciprocal Relationship in ANS sympathetic Resilient Zone Balancemind Release charge charge parasympathetic
  • 27. •  ..”Our system is self-regulatory in the highest degree: self maintaining, repairing, readjusting and even improving. The chief, strongest, and ever-present impression …. nothing remains stationary, unyielding; and everything could always be attained, all could be changed for the better, were only the appropriate conditions realized.” Pavlov 27
  • 28. Traumatic Hyperactivity Hypervigilance Event! Stuck on “high” Mania Anxiety & Panic Hyper-activation Rage Resilient Zone Balancemind Depression Disconnection Exhaustion/Fatigue Stuck on “low” Numbness Hypo-activation Key Concepts of TRM Graphic adapted from original by Diane Poole Heller
  • 29. When neither resistance nor escape is (perceived to be) possible, the human system of self-defense becomes overwhelmed and disorganized. Each component of the ordinary response to danger, having lost its utility, tends to persist in an altered and exaggerated state long after the actual danger is over. Herman 1992
  • 30. • Some have a very shallow Resilient Zone where even small stressors bump you out of the Zone. Resilient Zone Balancemind • Some have a deep Resilient Zone where there is a higher tolerance for a wide range of stressors. Resilient Zone Balancemind 30
  • 31. THE NERVOUS SYSTEM AND HUMAN RESPONSES TO TRAUMA •  The nervous system (NS) unconsciously and continually evaluates risk •  Traumatic events unbalance the NS, which affects perceptions of safety, danger, or life threat •  Practitioners can use TRM to help stabilize the NS and promote social engagement and positive attachment. S. Porges, 2004 Slides by Miller-Karas&Leitch 2008(c)
  • 32. Porges 2004 Neuroception Senses Safety Threat Response •  Sympathetic NS Parasympathetic NS Fight & Flight Social Engagement FREEZE RESPONSE
  • 33. The Triune Brain •  Neo cortex: Thinking Cognition, beliefs, language, thought, speech *Integrates input from all 3 parts •  Limbic Area Emotional - Expression and mediation of emotions and feelings, including emotions linked to attachment * Assess risk….negative focus •  Survival Brain Instinctual/unconscious - Digestion, reproduction, circulation, breathing, and the execution of the "fight or flight"
  • 34. “We have a brain that was field-tested millions of years ago in the wild. I call it the wild brain to distinguish it from the logic brain that so many people revere. The logic brain can’t do much for you once the situation becomes critical…” Lt. Col. Dave Grossman
  • 35. POTENTIAL PATHWAYS FOLLOWING A TRAUMATIC EVENT Traumatic Stress Traumatic Event Responses Little “t” Mind and Body & Self-Regulation Big “T” Grief Homeostasis Returns & Reactions “C” Trauma Somatic Complaints Not every one who experiences a traumatic event will develop PTSD
  • 36. What Are the Three Resiliency Models? The Trauma Resiliency Model (TRM) is a condensed course designed to teach skills to stabilize and reduce and/or prevent the symptoms of traumatic stress The Veterans’ Resiliency Model (VRM) is focused on combat-zone trauma The Community Resiliency Model (CRM) helps create a network of trauma-informed community members and organizations using the biologically-based skills Key Concepts of TRM
  • 37. The Trauma Resiliency Model™ Key Concepts of TRM are based on: 1.  Laws of Nature 2.  Human Anatomy and Physiology 3.  Current Scientific Research on the Brain 4.  Somatic Experiencing® & Sensory Integration Theory, Gendlin’s Focusing
  • 38. Biological Focus •  TRM uses observation and knowledge of neurobiological patterns •  TRM brings the client’s awareness to sensation to help interrupt the disorganized automatic nature of the traumatic responses •  The client learns: •  to attend to the non-traumatic sensations •  to regulate affect and internal sensations
  • 39. Goals of TRM   To depathologize trauma symptoms by focusing on the biology rather than the psychology of trauma response   To teach TRM skills to clients and practitioners so that use the skills to self-regulate   To elicit release of blocked energy from the nervous system, to reduce or eliminate symptoms   To work gently without re-traumatizing   To restore balance and resiliency to the Nervous System
  • 40. Who does TRM treat? •  TRM can be used to treat any person who has experienced or witnessed any event that was perceived as life threatening or posed a serious injury to themselves or to others •  TRM can be used with immediate as well as past trauma •  Adults and children
  • 41. The Importance of Information  Education about the human responses to trauma….normalizes  Education about the psychobiology of trauma  Education shifts perceptions from pathology to biology…reduces shame and restores hope
  • 42. Restoring the body to equilibrium can be accomplished gently Frozen in trauma A smiling child after treatment
  • 43. The Underlying Principle of TRM The human body has the inner capacity to heal and restore itself!
  • 44. Life Trauma in Humans •  A series of traumas or one trauma can:   Lead to an alteration in the cycle of homeostasis and regulation   Produce a process that is self- perpetuating in the absence of ongoing external stressors or threats   For many, these symptoms cannot be “talked away”   Although insight is helpful, it may not lead to regulation of the NS Key Concepts of TRM
  • 45. Three Symptoms Categories of Post-Traumatic Stress & Acute Stress Disorders Re-living the Event Avoidance of Reminders “I have nightmares and it pops in “I can’t go back to that my mind and feels place where it happened like it’s happening again.” and often I just feel numb.” Increased Arousal  “I am always afraid something bad will happen and I jump at any loud noise .”  “I can’t sleep and can’t concentrate on my work.” Slides by Miller-Karas&Leitch 2008(c)
  • 46. Trauma and Development •  As the brain grows and organizes, the higher, more complex areas begin to control and modulate the more reactive, primitive functioning areas like the Survival Brain. •  The person becomes less reactive, less impulsive, and more thoughtful as the brain becomes more complex. •  Shock and Developmental Trauma can increase the activity or reactivity of the brainstem level and decrease the moderating capacity of the cortical areas •  Thus, as children develop, this can increase the likelihood of aggression, impulsivity, and capacity to be violent on one end of a continuum and depression and disconnectedness on the other end.
  • 47. Developmental & Shock Trauma Two Kinds of Trauma Developmental Trauma and Shock Trauma Many children have experienced both Slides by Miller-Karas&Leitch 2008(c)
  • 48. Children’s Defenses •  Parents, family members and teachers often underestimate children’s reactions to a traumatic event •  Children may not show their true feelings to protect their parents and other family members Slides by Miller-Karas&Leitch 2008(c)
  • 49. Stages of the Defense Response Cycle High Activation is Designed to Enable Short-Term Defensive Actions Stage 1: Prepare for Defensive Action   Muscles tense, orient to source of threat Stage 2: Mobilization   Production of Adrenalin and Cortisol in order to provide energy needed to defend Stage 3: Release of Energy through Fight or Flight   Running, Defensive Responses, Vocalizations Stage 4: Return to Central Nervous System Equilibrium   Parasympathetic responses-Homeostasis
  • 50. Fight, Flight and Freeze •  TRM works with the understanding of the natural defensive responses of fight, flight and freeze •  TRM helps relieve the traumatic stress symptoms through restoring regulation to the nervous system Key Concepts of TRM
  • 51. The Freeze Response THE FREEZE RESPONSE happens when both the Parasympathetic and Sympathetic are activated and overwhelmed at the same time. •  Fear and Terror overwhelm biological & psychological coping •  Freezing during a traumatic event is a major predictor of who develops more serious symptoms as described as Post-Traumatic Stress Disorder
  • 52. The Freeze Response The Freeze Response may be experienced as: •  An altered state of reality •  The slowing down of time •  Diminished awareness of fear & pain The Freeze Response may increase the chance of surviving a traumatic event Slides by Miller-Karas&Leitch 2008(c)
  • 53. Traumatic Symptoms & the Nervous System  Symptoms arise when residual energy from the experience is not released from the body   The Goals of TRM are: 1.  to educate the client about the normal and automatic defensive responses of fight, flight, & freeze….depathologizes 2.  use TRM skills to elicit release of thwarted defensive energy, to reduce symptoms, and to restore balance to the nervous system Key Concepts of TRM
  • 54. The Sensations of the Nervous System Release Sensations can include the following: •  Tingling •  Crying sensations •  Laughing •  Warmth •  Burping and •  Vibrations or stomach gurgling Trembling •  Itching •  Shaking •  Yawning •  Expanded •  Cooling breathing Slides by Miller-Karas&Leitch 2008(c)
  • 57. Implicit Memory: essential in understanding trauma IMPLICIT MEMORY(IM)   We use IM in learning most physical activities like walking, skating, & biking   Mental models are formed from the experience   Body memories are created during traumatic events including sensations associated with Big “T”, little “t”, and “C” traumas Key Concepts of TRM
  • 58. “Some aspects of traumatic events appear to get fixed in the mind, unaltered by the passage of time or by the intervention of subsequent experience.” (van der Kolk, Blitz, Burr & Hartmann, 1984).
  • 59. External Trigger Internal Trigger Internal body sensation Sounds -tightness in stomach Smells -muscle tension Visuals(people, places -headache & things) Dissociative Capsule of Trauma Pain, numbness, dizziness Trembling, paralysis Nausea, palpitations Anxiety, terror, shame, anger, rage Flashbacks, nightmares or intrusive thoughts Robert Scaer, MD Slides by Miller-Karas&Leitch 2008(c)
  • 60.   Sensory images, sounds   Motor actions   Sympathetic/Parasympathetic symptoms   Perceptual alterations   Emotions linked to the traumatic experience Scaer, R,(2007) The Body Bears the Burden
  • 61. External Trigger Internal Trigger Internal body sensation Sounds -tightness in stomach Smells -muscle tension Visuals(people, places -headache & things) Dissociative Capsule of Trauma Pain, numbness, dizziness Trembling, paralysis Nausea, palpitations Anxiety, terror, shame, anger, rage Flashbacks, nightmares or intrusive thoughts Robert Scaer, MD Slides by Miller-Karas&Leitch 2008(c)
  • 62. Brief Overview of TRM Skills
  • 63. How does TRM work? • TRM works with the patterns of response that are stuck in implicit memory that cause suffering in the present • TRM uses observation and knowledge of neurobiological patterns to bring the client’s attention to the internal sensation associated with the implicit memory system •  TRM brings the client’s awareness to sensation associated with resources to help interrupt the automatic nature of the implicit memory of their trauma…and extinguish cues that trigger the memories Key Concepts of TRM
  • 64. THE TRM Model •  It is skill based so that at the end of the training, the participants are prepared to incorporate skills into their scope of practice •  It provides basic information about the neuroscience of the brain that is easily understood and can be translated to clients •  Concrete educational tools are given to help participants teach their clients about their symptoms and their inherent resiliency…promotes independence •  Can be used for clinician self-care Key Concepts of TRM
  • 65. THE SEVEN CORE SKILLS* * TRM includes the skills of Somatic Experiencing TITRATION TRACKING Working with small increments of Using observation as a diagnostic traumatic material and activation tool PENDULATION Alternating between traumatic and GROUNDING resource sensations Being fully present in the moment SHIFT AND STAY Shifting attention from traumatic sensation and staying with neutral or positive sensations RESOURCING Using positive or neutral factors to COMPLETION OF create non-traumatic sensations DEFENSIVE RESPONSES Inviting completion of motions, vocalizations, actions that were blocked during the event Trauma Resource Institute
  • 66. “The range of what we think and do is limited by what we fail to notice.” RD Laing
  • 67. Telling the Trauma story •  Must be titrated   T-1 T T+1 •  Starts with a resource:  When did help come?  When did you know you had survived?  Who else lived?  What is giving you strength now?  What do you notice having told me just this much? •  Focuses on telling the story from inside the Resilient Zone
  • 68. CHILDREN’S ART Slides by Miller-Karas&Leitch 2008(c)
  • 69. HEALING The individual can: •  learn to distinguish between sympathetic and parasympathetic responses and •  Learn to apply the TRM skills to daily life to reduce or eliminate the symptoms that emerged in the aftermath of the trauma •  Hope and relief from shame Key Concepts of TRM
  • 70. O God who makes days and pronounces them good, who sings in the everlasting rhythm of dark and light, of risings and fallings, of cycles, of one thing following another, who makes time for all things in the cycle of seasons and tides, break the plane of our quiet desperation and lift up our brief years that we may find peace, and trust in the Everlastingness of your purpose. Iona Center, Spring/summer 2009