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Understanding Trauma

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Heather Ponech

on 17 November 2012

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Transcript of Understanding Trauma

Understanding The Impact Of
Trauma On Students Levine, P.A., & Kline, M. (2007).Trauma Through A Child’s Eyes: Awakening the Ordinary Miracle of Healing. North Atlantic Books: CA

Levine, P.A. (2008). Healing Trauma. Sounds True, Inc. Boulder, CO.

Levine, P.A. (1997). Waking The Tiger. North Atlantic Books: CA References
Material Presented Trauma happens when any experience stuns us like a bolt out of the blue; it overwhelms us, leaving us altered and disconnected from our bodies

Often debilitating symptoms that many people suffer from in the aftermath of perceived life-threatening or overwhelming experiences What Is Trauma? Due to the fact that when we face threat, we are responding instinctually as our brain’s main function is survival
This survival instinct resides in the oldest and deepest structures of the brain known as the reptilian brain

When these primitive parts of the brain perceive danger, they automatically activate an extraordinary amount of energy Redirection of blood flow away from the digestive and skin organs and into the large motor muscles of flight
Fast and shallow respiration and a decrease in saliva
Pupils dilate to increase the ability of the eyes to take in more information
Blood-clotting ability increases
Verbal ability decreases
Muscle fibers become highly excited or may collapse in fear as the body shuts down in overwhelm Examples May Include: We are biologically programmed to freeze (or go limp) when flight or fight is either impossible or perceived to be impossible
Infants and children, because of their limited capacity to defend themselves, are particularly susceptible to freezing and therefore vulnerable to being traumatized
This is why adult support is so crucial in preventing trauma and helping our youngsters heal Underneath the freeze response is a variety of physiological effects

With the freeze response, the body may look inert, those physiological mechanisms that prepare the body to escape may still be on “full charge” The Physiology of Trauma The sensory-motor-neuronal blueprint that was set into motion at the time of threat is paradoxically thrown into a state of immobility or “shock”
When in shock the skin is pale and the eyes appear vacant
Sense of time is distorted
Yet underlying this situation of helplessness, there is an enormous amount of vital energy
This energy lies in wait to finish what has been started Very young children tend to bypass active responses and go right into shutdown

Many young children protect themselves not by running away, but by running towards the adult attachment figure To help the child resolve a trauma, there needs to be a safe adult available

How does this outpouring of energy and multiple changes in the physiology affect us in the long run? The answer depends on what happens during and after the potentially overwhelming event

The excess energy evoked in our defense must be “used up” When the energy is not fully discharged, it does not simply go away; instead it stays trapped, creating the potential for traumatic symptoms

The likelihood of developing traumatic symptoms is related to the level of shutdown a well as to the undischarged survival energy that was originally mobilized to fight or flee Prenatal infants, newborns, and very young children are the most at risk to stress and trauma due to their underdeveloped nervous, motor, and perceptual systems

When the brain sets a sensory-motor impulse into motion but the limbs cannot move, symptoms are likely to develop Discomfort can be experienced as irritability, anxiety, butterflies, and numbness

When the body can no longer bear the overwhelming feelings it collapses into fearful resignation (learned helplessness) – which is what any animal does in a situation where active escape from threat is impossible The event may have disappeared from conscious memory; the body does not forget

The emotion of fear has a very specific neural circuitry etched in the brain corresponding to specific physical sensations from various parts of the body When something we see, hear, smell, taste, or feel signals the original threat, the experience of fear helps the body to organize a “flee or freeze” plan to remove us from the danger

The trigger produces more than a memory, the heart rate rapidly escalates, sweat is produced, and the anguish occurs because the body is totally re-engaged as if the threat is still happening Neo-cortex
Limbic Brain
Reptilian Brain The Brain The amygdala is responsible for activating quickly when threat is perceived (Van der Kolk)

It is highly responsive to sights and sounds, and it recruits many areas of the brain to deal with the situation

That is why muscles begin to tense and hormones (designed to aide our survival) are released, flooding our body and brain The frontal cortex, which thinks and reasons, then plays a critical role in sorting out the danger

The cortex then sends the message back to the amygdala to quiet the fear response

In the traumatized person, the cortex is unable to allay the fear response With this ‘cortical bypass’ we cannot reason away the fear and inadvertently are left either to act it out on others with extreme emotions, suffer silently from overwhelming feelings, or blank out from the distressing fear-response signals

People with PTSD are very sensitively tuned to respond to even very minor stimuli as if their life is in danger (Van der Kolk) Potential Causes Of Trauma Some events are overwhelming to almost any child including exposure to violence, kidnapping, physical and sexual abuse.

Other sources of possible traumatic reactions include falls, accidents, and invasive medical/surgical procedures Falls – stairs, beds, and high chairs

Sports injuries

Auto accidents

Near drowning and near-suffocation Accidents and Falls Surgical and medical procedures – stitches, needles, and IV’s
Dental procedures
Life threatening illnesses and high fevers
Prolonged immobilizations – casting, splinting, and traction
Poisoning
Fetal distress and birth complications Medical and Surgical Procedures
(are one of the more commonly overlooked sources of trauma) Divorce

Death of a loved one or pet

Separation

Being lost

Possessions – disaster or theft Loss Exposure to extremes of temperature

Natural disasters

Sudden noises for babies and young children – arguments, violence, and thunder (especially if left alone) Environmental Stressors What’s important to remember is that anything that overwhelms the ability of the child to cope, process strong emotions, and to defend themselves has the potential to create symptoms SE is based on biology (the effect on the individuals nervous system), not on biography, so the method of working to alleviate suffering does not rely on knowing the story

The body holds the story so the source is often revealed. Most importantly, the body holds the solution Symptoms of Trauma Signs And Symptoms Of Trauma In Children Hyperarousal
Constriction
Dissociation
Feelings of numbness or shutdown (freeze)

This results in a sense of helplessness and
hopelessness Children have symptoms that are distinctively different from those of adults

This is due to a combination of factors including brain development, level of reasoning and perceptual development, incomplete personality formation and dependency, as well as attachment to their adult caregivers Together with restricted motor and language skills, children have limited capacities to cope or respond

Whereas adults have the freedom to access resources that reduce stress and anxiety, children are totally dependent on their grown ups to read and meet their needs for safety, support, nurturance, self-regulation, and reassurance When children do not “act out”, they often “act in”, giving adults subtler clues that something is wrong

It’s important to remember: Some trauma symptoms are normal responses to overwhelming circumstances The heightened arousal energy together with shutting down (when there is no escape) are biologically hard-wired survival mechanisms

However, this protective system is meant to be time-limited; our bodies were designed to return to a normal rhythm soon after the danger ends Without specific and directed help from caring adults to aid children, the unresolved energy eventually finds expression in a wide variety of behaviours and symptoms Hyperarousal, dissociation, constriction, and shutdown

Susceptibility to re-living the event, having sleep disturbances, suffer from somatic complaints, and exhibit inconsistent behaviour punctuated with new fears and aggression Recognizing Symptoms in School-Aged Children (5-11 Years Old) For many children who have experienced trauma, the signs and symptoms may surface (or become more pronounced) at school due to the additional pressures of academic achievement and socialization Many times teachers are the first to notice trauma symptoms as they manifest in the classroom and on the playground

This is sometimes diagnosed as school phobia, ADHD, depression, and/or conduct disorder Lack of ability to concentrate, finish a task, or process new information

Chronic hyperarousal can quickly become hypervigilance
- fidgeting, a quick startle reflex, and darting eyes Symptoms at School Shutdown and dissociation might be observed as inattentiveness, fatigue, and daydreaming

It can also be observed in social interactions as extreme shyness, withdrawal, and even isolation from peers

Gender differences include: boys have a predilection for externalized symptoms while girls tend to internalize their symptoms Tend to re-experience the events through flashbacks and make every effort to avoid activities, thoughts, and feelings that trigger recollection of distressing events

If they do not dissociate the unpleasant memories, they will go to any length to numb out. For this reason, it is common for traumatized teens to turn to drugs, alcohol, nicotine, sex, and dangerous thrill-seeking behaviour as avoidance mechanisms to self-medicate and cope Symptoms of Trauma During Adolescence They also tend to suffer more sleeplessness, irritability, depression, anxiety, and inattentiveness than their younger siblings

Immobility, freeze, helplessness, and dissociation are involuntary psycho-physiological reactions to overwhelm and are meant to be time limited When the tremendous “fight/flight” energy that was frozen begins to release, it can be terrifying without the gentle voice of an adult to help the youngster feel safe

They symptoms of shame and guilt arise as a normal part of coming out of freeze. The body was helpless but, unlike other mammals, the human mind passes judgment anyway These intense feelings of helplessness and vulnerability can be extremely painful, especially for adolescents whose identity and reputation may be at stake Trauma is in the nervous system rather than in the event itself

Trauma symptoms develop when the physiological mechanisms for self protection, set into motion for escape, are thwarted Understanding Why Some Children Have Trauma Symptoms and Others Do Not In other words, the child or adult didn’t get to accomplish the full cycle of:
Utilizing the chemical and hormonal program
Energizing the sensory-motor activities of protection, orientation, and defense
Discharging the excess activation
Returning to a relaxed alertness or physiological homeostasis Some factors that affect the ability of a child to respond appropriately, complete the cycle mentioned previously, and emerge victorious include:
The child’s physical characteristics
The child’s external resources
Their skills and capabilities
The event itself The child’s physical characteristics include age, strength, agility, speed and overall fitness. It also includes constitution, which is a combination of genetics, temperment, and early environment

Stress and trauma incurred during the period from fetus to 3 years old, with no corrective experience, predisposes the young child to vulnerability later in life The child’s external resources include supportive and loving family, teachers, and friends. It also includes healthy outlets for stress that bring pleasure to the child. Examples include:
Sports, games, hobbies
Performing arts, music, pets
Play, drawing and painting
Community groups (scouts and girl guides) Other factors in determining symptom development have to do with the intensity of the event, whether there were multiple events, and if the traumatic stress was prolonged Finally, a large factor that can prevent or exacerbate symptoms is the quality of the care the child receives immediately after the frightening incident

When a child has the ability to move out of freeze into a state of flow, resources build within the child’s own body that promote confidence, fortitude, and self-esteem As we have learned, the instinctual brain is responsible for our survival and the brain of a traumatized child has been altered.

It is tuned to “high alert’ and sensitive to the tiniest trigger.

The trigger can be general, specific, or a mystery Why “Anger Management” Doesn’t Work for Traumatized Students Strategies To Use In The Classroom A single facial expression, words, smells can set off an alarm that in a flash brings the past to the present

The way to safely release or discharge these strong and persistent stimulus-response reactions is through experiencing the sensations of how the body wanted to protect and defend itself through fight or flight, duck or cover, but was unable to do so at the time Associations that act as triggers don’t go away by talking

Neither do they go away by stopping to think about possible consequences

Once the instinctual brain gears up for survival, it has no use for words

When the amygdala is on alert, the language centers of the brain so little or no electrical activity With PTSD, one is hard-wired to bypass cognition (the rational brain) when danger is perceived

In those suffering from trauma the circuitry takes a different route than for people who have not been traumatized Rather than sending simultaneous messages to the thinking brain (to assess whether the threat is real) and to the instinctual brain (to protect itself if it is), the message speeds involuntarily along the shortest path possible to the instinctual brain for survival Anger management approaches used in schools do not take this brain research into account

Once it’s understood that the traumatized brain has a distinctly different physiology from a non traumatized brain, it becomes clear why current methods fail While CBT programs may be effective in helping students calm down when irritated or frustrated, they are of little use to a student being driven by the “survival alarm” of PTSD

Counting to ten, slowing the breath, thinking of options, talking and problem-solving are great stress-busters under ordinary circumstances

But it is naïve to expect students riddled with traumatic imprints to stop acting out by “thinking” when triggered The most valuable competency, through an SE view, is the ability to experience and tolerate internal sensations of both pleasure and pain without becoming overwhelmed, withdrawn, acting out, or numbing out

Once traumatized students gain a greater capacity for self-regulation, they automatically possess more self-control Creating Competence Through Play and Pleasure How? Educators help build competency by filling up their students “sensory bank accounts” with rich experiences in movement, music, art, and interactive play.

We know that new neuronal connections are built through enriched sensory experiences Because the capacity to heal is innate, your role as an adult is simple: it is to help the child access this capacity

Your calmness is essential. The goal is to minimize-not compound-feelings of fright, shame, embarrassment, and guilt the child is likely to be experiencing already Emotional First Aid Allow time for your own bodily responses to settle as often the most frightening part of an incident is the adult’s reaction

Once the nervous system learns “what goes up (charge/excitation) must come down (discharge/relaxation),” a more resilient nervous system is developing Through the mechanisms of body language, facial expressions, and tone of voice, your own nervous system communicates directly with the child’s nervous system

This attunement process is to understand the importance of experiencing both comfortable and uncomfortable, incrementally tolerating and “tracking” them as they progress through a natural cycle towards more comfort and completion Unlike the “newer” thinking and feeling bring segments, the primitive reptilian brain speaks the unfamiliar but vastly important language of sensation

It is the undeniable dread in the pit of the stomach, a racing heart, the tightness in the chest, or the “lump in the throat” Cold/warm/hot/chilly Numb/prickly/jumpy
Twitchy/butterflies Owie/tearful/goose-bumpy
Sharp/dull/itchy Light/heavy/open
Shaky/trembly/tingly Tickly/cool/silky
Hard/soft/stuck Still/clammy/loose
Jittery/icy/weak Dizzy/fuzzy/blurry
Relaxed/calm/peaceful Strong/tight/tense
Empty/full Flowing/spreading Sensation Vocabulary In SE, the term “pendulation” refers to a natural rhythm (of contraction and expansion) inherent within us that guides us back and forth between uncomfortable sensations, emotions, and images to more comfortable ones, allowing for new experiences and meanings to emerge With this rhythm restored, there is, at least, a tolerable balance between the pleasant and the unpleasant

And, no matter how bad a particular feeling may be, we know that it will soon change.

The following exercise will further deepen your awareness of sensations, as well as give you a sense of your natural rhythm of pendulation This exercise was intended to acquaint you with a variety of sensations that occur in different situations such as frustration, expectancy, relief, conflict, and surprise

If you noticed different feeling states and were able to move smoothly from the pleasant to the unpleasant and back again, you now have an ideas what it feels like to pendulate When you are in touch with sensations, you can begin to move with fluidity out of one state into another Attuning to Children’s Rhythms, Sensations, and Emotions It is important to let children know that any powerful emotions they are having are OK

Children tend to move through their feelings rather quickly when they are not hurried by an adult’s time schedule or emotional agenda Often children react the way they think the adults expect them to because of a desire to please, avoid criticism, or do the ‘right’ thing Open-Ended

What do you notice in your body? Rather than are you feeling tense

Where in your body do you feel that? Rather than do you feel it in your chest

What are you experiencing now? Rather than do you still feel shaky Questions of Sensations Invitational

What else are you noticing about your eyes? Rather than notice your eyes twitching

Would you be willing to explore how your foot wants to move? Rather than it looks like your foot wants to move

Would you be willing to stay with that feeling and see what happens next? Rather than stay with that feeling Explore Sensation with Details

What are the qualities of that sensation?

Does it have a size? Shape? Color? Weight?

Does it spread? Notice the direction as it moves

Does the (pressure, pain, warmth, etc) go from inward to outward or vice versa?

Do you notice a center point? An edge? (or where the sensation begins and ends?) Broaden Awareness of Sensation

When you feel ______ what happens in the rest of your body?

When you fell that ______ in your ______ how does it affect your _______ now? Move Through Time

What happens next? (even if the person reports feeling “stuck”)

As you follow that sensation, where does it go? How does it change?

Where does it move to (or want to move to if it could?) Savoring and Deepening Sensations

Allow yourself to enjoy that (warm, expansive, tingly, etc.) sensation as long as you’d like.
Students’ level of excitement and competition can be provoked to arouse the flight/fight response

Activities need to be structured so that highly energized periods are interspersed with states of calmness with sufficient time for settling Activities and Games That Foster Healthy Defensive Responses, Boundary Setting, and Group Cohesiveness Children who have experienced early trauma and neglect may also have undeveloped reflexes as well
Students lacking agility or proficiency in self-defense may develop adaptive strategies that are fatiguing, rob self-confidence, and create a poor body image Although the primary need for healthy reflexes is self-protection, they are also necessary for brain integration

Students with underdeveloped or “frozen” reflexes are more susceptible to learning problems, especially with reading and writing

Activities that improve balance and motion have significant effect on visual processing and academics When there are incomplete motor responses due to trauma, the information needed to create new images may be distorted due to past experiences

Competence in these areas is of particular assistance to students diagnosed with attention-deficit/hyperactivity disorder, dyslexia, and other learning disabilities When students rely more on their kinesthetic, tactile, and vestibular sensory systems, they are less likely to be overly dependent on their vision for balance.

Energy that was used up by the visual system to aid in balance is now available for reading and writing We also know that neural involvement increase with higher levels of challenge difficulties; thus increasing vestibular balance increases the brain’s ability to process information with speed and efficiency

Examples: Roll-Around, Push Me Around, and Bean Bag Balancing What children need in order to feel whole rather than frightened is a sense of safety, connection, grounding, and the actual experience of defending their boundaries or fleeing from danger

Games and physical activities are designed to restore lost resources while at the same time providing fun and a sense of connection with classmates Resources in the Aftermath of Trauma Because events that overpower happen quickly, children have few choices

Activities to prevent and heal trauma need to include the following elements: extended time to restore a sense of preparedness, a variety of choices to select from, and the chance to discover and build new skills In order for children to thrive at school, they need to be able to function beyond a survival level

When trauma symptoms are addressed and strategies developed to intervene, students’ energy is freed up to learn and engage in pro-social behaviour In Conclusion Many students, whether suffering from post-traumatic stress disorder or simply overwhelmed by a fast-paced world, can benefit from an increase in self-regulation

In summary, the first step is to recognize what trauma “looks like” in your students.

The next is to become skillful in working with the dynamics of autonomic nervous system cycles of charge and discharge by tracking the sensations both in yourself and in those you work with Van der Kolk, Bessel. A. (2004). “Psychobiology of Post-Traumatic Stress Disorder,” Chapter 11 in Textbook of Biological Psychiatry, edited by Jaak Panksepp. Whiley-Lisi, Inc.

www.traumahealing.com

hponech@edeninc.ca Additional Information and References Vulnerability to trauma differs from person to person depending on a variety of factors, especially age and trauma history Somatic Experiencing (SE) purposes that, "trauma is not in the event itself; rather trauma resides in the nervous system WHY?
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