Looking at Addiction through a Trauma Informed Lens Allison Sampson Jackson PhD LCSW LICSW CSTOP Family Preservation Services of VA Providence Service Corporation 3 Defining Trauma a traumatic event either witnessed or experienced representing a fundamental threat to ones phy ID: 644408
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Slide1
Trauma Past, Trauma Present:Looking at Addiction through a Trauma Informed Lens
Allison
Sampson Jackson, PhD, LCSW, LICSW, CSTOP
Family Preservation Services of VA
Providence Service Corporation Slide2Slide3
3Defining Trauma:a traumatic event, either witnessed or experienced, representing a fundamental threat to one’s physical integrity or survival
responses involve intense fear, helplessness or horror
the
meaning
of the event may be as important as the actual physical act/experience
what we want to emphasize is that it is an individual's subjective experience that determines whether an event is or is not traumatic http://www.lisaferentz.com/Slide4
4Key Component of Trauma
Is the experience of
loss!
Loss of:
boundaries
safetytrustpower and controlinnocence
protection
attachment
possessions
consistency/predictability
sense of self/body image
http://www.lisaferentz.com/Slide5Slide6
Exposure to Violence in Childhood 46 million of 76 million children are exposed to violence, crime and abuse each year
Finkelhor
, D., et al. (2010). Trends in childhood violence and abuse exposure: evidence from 2 national surveys.
Archives of Pediatric and Adolescent Medicine, 164
(3),
238–242. Information and slide part of Dr. Allison Sampson's Trauma PresentationSlide7
Trauma impacts learning and academic outcomes
Decreased IQ and reading ability
(Delaney-Black et al., 2003)
Lower grade-point average
(Hurt et al., 2001)
More days of school absence
(Hurt et al., 2001)
Decreased rates of high school graduation
(
Grogger
, 1997)
Increased expulsions and suspensions
(LAUSD Survey)Slide8
Impact of being in Child Welfare System for Foster Care Children25% will be incarcerated within first 2 years of aging out of the system More than 20% will become homeless Only 58% will have a High School Diploma
Less than 3% will have a college education by age of 25
Many will re-enter the system as parents
For children under age of 5, increase likelihood of developmental delays 13-62% compared to 4-10%
Conradi
, L. (2012) Chadwick Trauma Informed System Project p. 54
Leslie et. al. (2005).
Developmental and Behavioral Pediatrics 26
(3), 177-185Slide9
The breakdown per child is:• $32,648 in childhood health care costs
• $10,530 in adult medical costs
• $144,360 in productivity losses
• $7,728 in child welfare costs
• $6,747 in criminal justice costs
• $7,999 in special education costs
1 year of violence=
124 billion dollars in recovery costs Slide10
223,400,000
317,572,282
223,400,000 Slide11
ACE SCREEN Slide12
Alcoholism and alcohol abuseChronic obstructive pulmonary disease (COPD)DepressionFetal deathHealth-related quality of life
Illicit drug use
Ischemic heart disease (IHD)
Liver disease
Risk for intimate partner violence
Multiple sexual partners
Sexually transmitted diseases (STDs)
Smoking
Suicide attempts
Unintended pregnancies
Early initiation of smoking
Early initiation of sexual activity
Adolescent pregnancySlide13Slide14
14Unlocking the Brain At least for today…3 brain levels-they each speak a different language
Brainstem-
housekeeping of the
Body, sleeping, eating, breathing
Limbic-
smoke alarm, implicit memoriesCortex-planning, logic, reason, judgmentSlide15
A Person’s Response to Perceived DangerTrauma Event
Danger
Response
Fight
Flight Freeze
Aggression Run Away Dissociate
Verbal attack Substance Abuse Non-emotionality
Slide from Ellen Williams, LCSW
Center for Child & Family
ServicesSlide16
Looking Through The Eyes of a Traumatized Child- How it looks to Us….
Slide from Ellen Williams, LCSW
Center for Child & Family
Services
ServicesSlide17
How it looks to The Traumatized Child
Slide from Ellen Williams, LCSW
Center for Child & Family
Services
ServicesSlide18
18The Hand Model of the Brain
http://www.youtube.com/watch?v=DD-lfP1FBFkSlide19
19The Handy ModelSlide20
20Trauma and the BrainHippocampus-remembers the facts but not the emotions.
It records the time-frame of significant events, the start, the middle, the end of an event and sends the facts to the cortex-the thinking part of the brain (logic, reason, common sense). Slide21Slide22
Chasing BehaviorsAgitationT
Traumatic Event
Depression
Intrusive Memories
Nightmares
Hopelessness
Numbing
Insomnia
Shame & Self-Hatred
Panic
Attacks
Substance Abuse
Somatic Symptoms
Eating Disorders
Self-Destructive
Behavior
Dissociation
Poor Impulse Control
Defiance
Withdrawal
Slide by Trish Mullen, Chesterfield CSB Slide23
We must ……Respond to the need ….Not react to the behavior Slide24
Resilience Trumps Aces
From Trish Mullen, Chesterfield Community services Board Slide25
Trauma and Attachment Slide26
AttachmentInformation and slide part of Dr. Allison Sampson's Trauma Presentation
Many argue that these early relationships (experiences) shape neuronal circuits which regulate emotional and social functioning Slide27
Attachment’s PurposeSiegel, 1999
Information and slide part of Dr. Allison Sampson's Trauma Presentation
Evolutionary Level – biological
Infant Survival (
Bowlby
)
Mind Level – biological and social
Caregiver’s brain helps child’s brain to organize regulation
Caregiver’s brain teaches child self-soothing
Child experience of safety allows for exploration Slide28
Attachment’s PurposeInformation and slide part of Dr. Allison Sampson's Trauma Presentation
Experience of safety is encoded in child’s implicit memory and provides secure base from which to grow and access higher levels of information processing
Slide29
Trauma and the Brain Slide30
Understanding “why” … Information and slide part of Dr. Allison Sampson's Trauma Presentationhttp://www.childwelfare.gov/pubs/issue_briefs/brain_development/effects.cfm Slide31
Brain and StressInformation and slide part of Dr. Allison Sampson's Trauma Presentation
When stress is predictable and moderate, stress can facilitate resiliency and enhance memory
When stress is unpredictable and severe, stress can create vulnerability and memory impairment
Severe and chronic stress in childhood via multiple traumas from caregivers can impact affect regulation, interpersonal relationship skills, and states become traits (fight/flight/freeze… disassociation or hyper arousal)Slide32
Types of Stress Information and slide part of Harris (2013) Buzz on Brain and Babies Presentation
Positive
Stress
Tolerable Stress
Toxic Stress
Normal and essential part of healthy development
Body’s alert systems
activated to a greater degree
Occurs with
strong, frequent or prolonged adversity
Brief
increases in heart rate and blood pressure
Activation is time limited and buffered by caring adult
Disrupts
brain architecture and other organ systems
Mild elevations
in hormonal levels
Brain and organs recover
Increased risk of stress-related disease and cognitive impairment
Example: Tough test at school or a playoff game Example: Death of a loved one, divorce, natural disaster Example: abuse, neglect, caregiver substance dependence or mental illness Slide33
Three parts of the brain … Information and slide part of Dr. Allison Sampson's Trauma PresentationBrain StemLimbic Brain Cerebral Cortex Slide34
Stress and the Brain Slide35Slide36
Vulnerability MountainInformation and slide part of Dr. Allison Sampson's Trauma PresentationSlide37
What does this mean for children who have experienced trauma?EXPERIENTIAL EXERCISE Slide38
Attachment and BRAIN … what we already know Information and slide part of Dr. Allison Sampson's Trauma PresentationReview of the exercise … what did you notice about caregiver touch between the two sets of pictures …
What do you think the implicit memories are about
caregiving
relationships ? About authority figures? About their ability to be safe ?Slide39
The needs of the adults and caregivers with trauma …. are no different Slide40
Cross-Generational Trauma Hendricks (2012) Chapter 12 of Creating Trauma Informed Child Welfare SystemsUsing Trauma Informed Services to Increase Parental Protective Factors Women who have experienced trauma are more likely to self- medicate with a substance (55-99%) (1)Intergenerational transmission of trauma (Depression, PTSD) (2)
Unresolved childhood trauma can lead to reenactments with partners in adult relationships and/or with their children (3)
Unresolved childhood trauma can lead to difficulty forming secure attachments with their children (4)
Childhood trauma can result in parenting styles that include threats & violence (2)
Childhood sexual abuse survivors can miss “red flags” of sexual abuse with their own children due to avoidance of trauma memories themselves (2
)
Najavits
, Weiss, & Shaw (1997)
The American Journal on Addiction, 6
(4), 273-283
Hendricks, A. (2012).
Using Trauma-Informed Services to Increase Parental Factors (pp. 89-91)
Walker (2007) Journal of Social Work Practice, 21 (1), 77-87.
Main & Hess (1990) In M. Greenberg, D.
Cicchetti
, & E. Cummings (Eds.),
Attachment in the preschool years: Theory, research, and intervention (
pp. 121-160)
Slide41
BIG PICTURE with Caregivers Often the caregivers … are the kids we as a system “missed”They come to us with their own trauma historiesSuccessful outcomes with our clients means successful work with the family Screening all caregivers and finding them services is critical to the prevention/treatment/reduction of recidivism for children entering the juvenile justice systemSlide42
Cross-Generational Trauma Hendricks (2012) Chapter 12 of Creating Trauma Informed Child Welfare SystemsUsing Trauma Informed Services to Increase Parental Protective Factors
Caregiver
functioning following a child’s exposure to trauma is a major predictor of child’s functioning (1 & 2)
If we want to improve a child’s outcome, we must address parent’s trauma history … failure to do so can result in (2) …
- Failure to engage in treatment services
- An increase in symptoms
- An increase in management problems
-
Retraumatization
- An increase in relapse
- Withdrawal from service relationship
- Poor treatment outcomes
Linares et al (2001)
Child Development, 72, 639-652
Liberman
, Van Horn, &
Ozer
(2005)
Development and Psychopathology, 17
, 385-396
Hendricks, A. (2012) pp. 91Slide43
A Person’s Response to Perceived DangerTrauma Event
Danger
Response
Fight
Flight Freeze
Aggression Run Away Dissociate
Verbal attack Substance Abuse Non-emotionality
Slide from Ellen
Williams, LCSW
Center for Child & Family
ServicesSlide44
Chasing BehaviorsT
Agitation
Traumatic Event
Depression
Intrusive Memories
Nightmares
Hopelessness
Numbing
Insomnia
Shame & Self-Hatred
Panic
Attacks
Substance Abuse
Somatic Symptoms
Eating Disorders
Self-Destructive
Behavior
Dissociation
Poor Impulse Control
Defiance
Withdrawal
Slide by Trish
Mullens
, Chesterfield CSB Slide45
We must ……Respond to the need ….Not react to the behavior Slide46
PARADIGM SHIFT Slide47
What does TIC look like?Slide48
Information and slide part of Dr. Allison Sampson's Trauma PresentationCore areas of focus in Complex TraumaCourtois, C. & Ford, J. (2009), Introduction (p.2)
Self-Regulation
Affect Regulation
Disassociation (difficulty in being “present”)
Somatic
Dysregulation Self-Identity Impaired Self-ConceptImpaired Self-Development Co-regulation Secure working model of caring relationship
Disorganized Attachment PatternsSlide49
Creating a Culture for TICFive Core Values (Fallot, 2009)SafetyTrustworthinessChoice (and Voice !!)
Collaboration
Empowerment
W
e
can offer CAPPD to those with work with … http://www.multiplyingconnections.org/
Information and slide part of Dr. Allison Sampson's Trauma PresentationSlide50
Phase Oriented Care Slide51
Information and slide part of Dr. Allison Sampson's Trauma PresentationUnderstand what good trauma treatment looks like … Phase Oriented Treatment “ Gold Standard”
Phase I: Safety and Stabilization
Phase 2: Trauma Reprocessing
Phase 3: Reintegration
Handout on
questions to ask Mental Health Providers Resource http://www.nctsnet.org/nccts/nav.do?pid=ctr_top_trmnt_prom Slide52
Information and slide part of Dr. Allison Sampson's Trauma PresentationPhase Oriented Treatment for Trauma (
Herman 1992, Janet 1889) from
Courtois
, C. “Treating Complex Traumatic Stress Disorders
”)
PHASE
ONE: Safety and Stabilization
Personal and Interpersonal Safety Established: Education/Support/Safety Planning
Enhance Client’s ability to manage extreme arousal (hyper/hypo)
Active engagement in positive/negative experiences (deal with automatic avoidance behaviors, self awareness of avoidance, increase coping skills and use of coping skills)
Education (psychotherapy, trauma, skills to be learned)
Assess and develop relationship capacity (decrease avoidance of relationships or negative thoughts about relationships, build support network, define client’s attachment network)Slide53
Phase Oriented Treatment
Phase Oriented Treatment for Trauma
(
Herman 1992, Janet 1889) from
Courtois
, C. “Treating Complex Traumatic Stress Disorders”
PHASE TWO: Trauma Reprocessing
Disclosure of traumatic memories, development of an autobiographical narrative (identify emotions connected to trauma memories, grieve and mourn losses, resolution of relationships when appropriate, increased awareness, increase interpersonal and self-regulation skills)
Supporting client in maintaining functioning and not getting lost in memories or seeing themselves as “disabled”, need to affirm strengths, promote positive self-esteem, and internal and external resources now available to them
PHASE THREE: Re-Integration
Growth and period and reengagement in life
Can be time of client realizing losses, discover of unresolved developmental deficits, fine tuning of self-regulation skills Slide54
Replacing Coping Behaviors Phase One Work Slide55
Chasing BehaviorsAgitationT
Traumatic Event
Depression
Intrusive Memories
Nightmares
Hopelessness
Numbing
Insomnia
Shame & Self-Hatred
Panic
Attacks
Substance Abuse
Somatic Symptoms
Eating Disorders
Self-Destructive
Behavior
Dissociation
Poor Impulse Control
Defiance
Withdrawal
Slide by Trish
Mullens
, Chesterfield CSB Slide56Slide57
Respond to the need Don’t react to the behavior Slide58
Post Traumatic Growth Typically 30-70 percent of survivors say that they have experienced positive changes of one form or another
Construct meaning from what happened
Survivor and
thriver
stories
What to do with the “broken vase” ? Slide59
Post Traumatic Growth http://ptgi.uncc.edu/Posttraumatic
growth tends to occur in five general areas.
S
ense
that
new opportunities have emerged from the struggle, opening up possibilities that were not present
before.
C
hanges
in
relationships
with
others (ex: closer relationships with some specific people,
increased sense of connection to others who
suffer)
Increased
sense of
one’s own strength
– “
if I lived through that, I can face anything”Greater
appreciation for life in generalExperience a deepening of their spiritual lives,
however, this deepening can also involve a significant change in one’s belief systemSlide60
Resilience http://acestoohigh.com/Resilience Factors (APA website) Caring/Supportive Relationships (primary) Capacity to make realistic plans and take steps to carry them out
A positive view of yourself and confidence in your strengths and
abilities
Skills in communication and problem
solving
The capacity to manage strong feelings and impulsesSlide61
Examples Protective Factors Families who thrive Slide62
Targeting Change One tool … Slide63
When in their upstairs brain Support folks you work with in developing goals based on their motivation … what do they want for their life today, what do they hope for, “magic wand questions”, what is their goal each day !!!Collaborative Planning with Consumers… Interviewing for hopesBrain storm how to get there
Creating a plan where they have a support system and access to skills that will help them reach their goal
Respecting their boundaries/contracting
LET’ PRACTICE …. Slide64
Skill Building Slide65
Replacing Coping Skills Slide66
Steps to replacing coping behaviors Identify current self-regulation strategies Help consumer make meaning out of why they chose these strategies (ex: brain, ACE score, etc)“Magic Wand” question … focus of changeTeach about the skills needed to build self-regulation Focus work on building resilience and new coping strategies like a muscle
Track progress with something like the diary card
Frame replacing coping behaviors as a journey, it will take time Slide67
Dialectical Behavioral Therapy – Informed DBT was developed in the late 1970s by Dr. Marsha Linehan and colleagues Main goals: cope with stress, regulate emotions, improve relationships with others Learning new behaviors
-- which can be anything a person thinks, feels or
does
Validation
– the push for change can feel like it invalidates the pain that a consumer feels, validation is critical to helping consumer move forward
i.e. the unhealthy coping strategy makes sense given your experience, even though it is not the best approach to solve the problem Slide68
Dialectical Behavioral Therapy – Informed Dialectics (opposites) Dialectics makes three basic assumptions: all things are interconnected change is constant and inevitable and opposites
can be integrated to form a closer approximation of the
truth
In DBT, the
work is focused on resolving seeming contradictions between self-acceptance and change in order to bring about positive changes for an individual Slide69
DBT – Informed Skills Self Regulation MindfulnessInterpersonal Relationship SkillsDistress Tolerance Skills Slide70
Accept and Change Slide71
Vulnerability Mountain Slide72
Self Regulation Self-Regulation (“sunscreen”)Relaxation and Grounding Exercises
Bilateral Movement
Attunement Exercises
Guided Imagery
http://
www.healthjourneys.com/Store/Products/Healing-Trauma-PTS-Health-Journeys/19
Self-Care
Plan (daily practice)Slide73
Mindfulness – art of being present in the moment Mindfulness Scale (MAAS)
Mindfulness Exercise (sheet) – breathing, “one thing
”
Mindfulness Principles
Mindfulness at UCLA
http://marc.ucla.edu
/Slide74
Self Awareness “knowing your skin” Educate children and adults
about their triggers and trauma responses
Wise old owl (Hawn Foundation)
Guard Dog (Hawn Foundation)
Smoke Detector (Van der
kolk
)
Alarm System ( ARC book pp.316-318)
Light Switch (“Please Explain Anxiety to Me”)
Teach and practice with them identification of feelings and needs
Engage them in “Behavioral Experiments” where the try something different
Teach about Thought Distortions (“thought distortion box”) so they can begin to recognize thoughts they tell themselves that take them down to “Distress Valley”
Supporting beliefs that child or adult deserves “good” things
Recognizing “bumps in the road” don’t mean “a crash”Slide75
Teaching About the Brain Upstairs/downstairs brain teaching practiceUsing of multiplying connection tools (amazing brain pamphlets) Partnering with Parents
Now you practice ……… Slide76
Interpersonal Effectiveness Skills Self Help Tools http://www.dbtselfhelp.com/html/interpersonal_effectiveness_ha.htmlEX: Cheerleading statements (connected to building positive self-identity)
“
Cheerleading statements are statements that people make to themselves in order to give themselves permission to ask for what they need or want, to say no, and to act
effectively”
ACTIVITY
Can you build some cheerleading statements with your neighbor ?? Slide77
DISTRESS TOLERANCE Slide78
Distress tolerance skills (taken from the Accepts skills … DBT informed)o Activities (physical and mental) – mental vacation, bi-lateral movement (walking), temperature change
o
Contributing
– helping others gets you out of yourself and your stress (smiling, give compliment, invite someone to coffee, hold a door, do a favor)
o
Comparisons – Bringing perspective to current situation, what skills have helped you cope before (have helped your children cope before) … validate yourself
o
Emotions
– Seek out activities that create feelings that are OPPOSITE from the painful ones you are experiencing (listen to music, favorite movie, work on a project --- favorite hobby)
o
Push Away
– Put away distressing memories in a “lock box” or in the “parking lot” for a little while … can do this in writing or mentally
o
Thoughts
– distract your thoughts with “one-thing” exercises, read something inspiring, “just worrying exercise”
o
Sensations
– Any physically vigorous activity or actively awakening senses (brisk walk, cold bath/hot bath, splash cold water on face, lotions on your wrist, strong taste, bold colors (Mandela), music)
Pederson
, L. (2012).
The Expanded Dialectical Behavioral Therapy Skills Training Manual .
Eau Claire: CMI Education Institute, Inc. pp. 45-50 Slide79
PRACTICE Using the ACCEPTS Model … turn to your neighbor and think through activities that will fall under 2 of these categories that you could use with consumers you work with … Slide80
Skill building resilience starts with you … Who is taking care of you ??Information and slide part of Dr. Allison Sampson's Trauma PresentationSlide81
Mirror Neurons Slide82
106
Impact of Working with Victims of Trauma
106
Trauma experienced while working in the role of helper has been described as:
Compassion
fatigue
Countertransference
Secondary traumatic stress
(STS)
Vicarious
traumatization
Unlike other forms of job “burnout,” STS is precipitated not by work load and institutional stress but by exposure to clients’ trauma.
STS can disrupt child welfare, police and juvenile justice workers’ lives, feelings, personal relationships, and overall view of the world.Slide83
Healing the hero https://www.youtube.com/watch?v=FdaJYEraGG0&feature=em-upload_owner
Produced by Trish Mullen, LPC
Chesterfield CSB Slide84
Impact of Chronic Stresshttp://www.helpguide.org/mental/stress_signs.htm
raise blood pressure
suppress immune system
increase the risk of heart attack and stroke
contribute to infertility
speed up the aging process (life expectancy)create vulnerability for anxiety and depression
obesity
skin conditions (ex: eczema)
sleep problems
digestive problems
Information and slide part of Dr. Allison Sampson's Trauma PresentationSlide85
Vicarious Trauma’s Impact Personally(Yassen, 1995)
Emotional
Roller coaster
Overwhelmed
Depleted
Behavioral Negative coping mechanism
Difficulty sleeping
Absent- mindedness
Information and slide part of Dr. Allison Sampson's Trauma Presentation
Cognitive
Spaciness
Apathy
Perfectionism
MinimizationSlide86
Personal Impact … (Yassen, 1995)SpiritualHopelessness
Anger at a Higher Power
Physical
Aches and pains
Impaired immune system
Breathing difficultiesInformation and slide part of Dr. Allison Sampson's Trauma Presentation
Interpersonal
Withdrawn
Intolerance
Loneliness
Projection of anger and blameSlide87
Professional Impact (Yassen, 1995)Performance of Job Tasks
Decrease in quality and quantity
Increase in mistakes
Avoidance of job tasks
Information and slide part of Dr. Allison Sampson's Trauma Presentation
Morale
Dissatisfaction
Negative attitude
DetachmentSlide88
Professional Impact (Yassen, 1995)Interpersonal
Withdrawn from colleagues
Impatience
Poor communication
Staff conflicts
Information and slide part of Dr. Allison Sampson's Trauma Presentation
Behavioral
Tardiness
Absenteeism
Faulty JudgementSlide89
107
Managing Stress
Request and expect regular supervision and supportive consultation.
Utilize peer support.
Consider therapy for unresolved trauma, which your work may be activating.
Practice stress management through meditation, prayer, conscious relaxation, deep breathing, and exercise.
Develop a written plan focused on maintaining work–life balance.
107Slide90
Perry and Cost of Caring http://childtraumaacademy.com/cost_of_caring/index.html
Information and slide part of Dr. Allison Sampson's Trauma PresentationSlide91
Self-Care“Whether you and I and a few others will renewthe world some day remains to be seen.But within ourselves we must renew it each day.”—Hermann
Hesse
91Slide92
Self-care Strategieshttp://www.compassionfatigue.org/pages/Top12SelfCareTips.pdf
92
The best strategy to address compassion fatigue is to develop excellent self care strategies, as well as an early warning system that lets you know that you are moving into the caution zone of Compassion Fatigue.Slide93
Self Care: Need OptionsTime and Connection:10 second exercises2 minute exercises5-10 minute exercises20-30 minute GI, Walking Meditationhttp://
www.healthjourneys.com/default.asp
(
Belleruth
Naparstek) Trish Mullen, LPC
93Slide94
Brain Gym 94Slide95
Practice Figure 8 with whole right arm/left armFigure 8 with both arms
Cross crawl
(opposite right hand to bent left knee, then left hand to bent right knee)Slide96
Self Care Apps Provider ResilienceGPS for the SoulMediation Oasis AppsMindfulness Training SystemIChill App (Peter Levine) Narrative Therapy Questions (Narrative Q’s)Brain Wave http://
socialwork.buffalo.edu/resources/self-care-starter-kit.html
Flipagram
(example)
http://flipagram.com/f/nGbakYX6B5
NCTSN Self Care Inventory Slide97
Pocket TM … by Trish Mullen, LPCChallenge: Working with children who are in their downstairs brain and getting them back up to their upstairs brain … when we all use primarily upstairs techniques in our work … Self care targeted to the right brain and lower brain …
HAPPY PLACE
http://youtu.be/up_WSAYmn-s
Slide98
Caring For Yourself98Slide99
Creating Internal Awareness99Slide100
Creating Awaresness100Slide101
Window of Tolerance
Pat
Ogden
101Slide102
Using Grounding Techniques to Stay in the Window of Tolerance Mental GroundingPhysical GroundingSoothing GroundingSomatic Grounding
Najavitis
, L.M. (2002). Seeking safety: A treatment manual for PTSD and substance abuse. NY: Guilford.
102Slide103
Practice Examples Distress Tolerance “Down Stairs Brain” Temperature ChangeGrounding by looking up
Bi-lateral movement
Butterfly taps
Compassion Hold Slide104
“Dig where the ground is soft” Chinese proverbConclusion: “Dig where the ground is soft” Chinese proverb Instead of picking your trickiest area, pick the issue that you can most easily visualize improving on. (e.g.: “making a commitment to going for a walk every lunch time vs. getting rid of my difficult supervisor”).
You may not notice it right away, but making one small change to your daily routine can have tremendous results in the long term. Imagine if you started walking up two flights a stairs per day instead of using the elevator, what might happen after three months?
104Slide105
Together we can make a difference Becoming Trauma Informed is a process … https://www.youtube.com/watch?v=7wK2io3Z2KM&feature=em-upload_owner
105Slide106
THANK YOU …… Dr. Allison Sampson-Jackson Family Preservation Services, Inc804-432-0056
aajackson@provcorp.com
http://www.vscsw.org/continuing_education
/