Understanding Understanding the role of the role of

trauma in patient trauma in patient carecareDarryl Tonemah PhDDarryl Tonemah PhD

Who? What? Where? When? Who? What? Where? When? Why? How?Why? How?

GracieGracie

MWBMWB

https://www.youtube.com/watch?https://www.youtube.com/watch?v=Ahg6qcgoay4v=Ahg6qcgoay4

From Biology to From Biology to SociologySociology

High 5’sHigh 5’s

When the midbrain is activated a non-When the midbrain is activated a non-traumatized patient reacts in elevated traumatized patient reacts in elevated arousal-with several possible self-regulatory arousal-with several possible self-regulatory responses, based on resources. Signals are responses, based on resources. Signals are sent simultaneously to the frontal brain and sent simultaneously to the frontal brain and lower brain for appropriate responses lower brain for appropriate responses

MRI’s show that for a patient who has been MRI’s show that for a patient who has been traumatized the perceived threat is NOT traumatized the perceived threat is NOT processed through dual signals. Instead processed through dual signals. Instead ONLY the lower brain –amygdala-survival ONLY the lower brain –amygdala-survival instincts is activated. instincts is activated. (Levine, Kline, et. Al) (Levine, Kline, et. Al)

Trauma is the unfinished cycle of Trauma is the unfinished cycle of energy, it is stored in our nervous energy, it is stored in our nervous system. We’ve learned a lot from system. We’ve learned a lot from animal research on why Zebras don’t animal research on why Zebras don’t get ulcers. get ulcers. (Sapolsky, 1994)(Sapolsky, 1994)

Trauma is in the constriction (lack of Trauma is in the constriction (lack of options) and incompletion of the cycleoptions) and incompletion of the cycle

We think too much! Don’t rationalize We think too much! Don’t rationalize fear, shame, blamefear, shame, blame

The baby brain The baby brain (Stiles, 2008)(Stiles, 2008)

500,000 cells per minute-Neurogenesis500,000 cells per minute-Neurogenesis 8000 cells per second8000 cells per second Synaptogenesis-1.8 million connections Synaptogenesis-1.8 million connections

per second to make a complete brainper second to make a complete brain Even at this rate baby brains never Even at this rate baby brains never

make the birth deadline. About 83% of make the birth deadline. About 83% of synaptogenesis continues after birth.synaptogenesis continues after birth.

Wiring isn’t complete until the early Wiring isn’t complete until the early 20’s20’s

Stress In Utero Stress In Utero (Beydoun, 2008), (Lou, (Beydoun, 2008), (Lou,

1994)1994)

-Lower baby IQ, averaging around 8 points -Lower baby IQ, averaging around 8 points lower in the babies first year of lifelower in the babies first year of life

-Inhibit babys future motor skills, -Inhibit babys future motor skills, attentional states, ability to concentrate, attentional states, ability to concentrate, difference still observable into school years, difference still observable into school years, if chronic stress is not alleviatedif chronic stress is not alleviated

Stressed cont. Stressed cont.

Damage the babys stress response Damage the babys stress response system, epigeneticssystem, epigenetics

Shrink the size of the babys brainShrink the size of the babys brain

Types of Toxic Stress Types of Toxic Stress (Guttelning, 2006)(Guttelning, 2006)

Too Frequent- no breakToo Frequent- no break Too Chronic- Break up, divorce, Too Chronic- Break up, divorce,

death of loved onedeath of loved one Too much for you- If you are Too much for you- If you are

stressed all the time, so is the babystressed all the time, so is the baby

““I need to be safe”I need to be safe” (Gopnik, 2000), (Gopnik, 2000),

(Wilson, 1998)(Wilson, 1998)

During the attachment process the brain is seekingDuring the attachment process the brain is seeking

““Am I being touched?”Am I being touched?”

““Am I being Fed?”Am I being Fed?”

““Who is safe?”Who is safe?”

If the brains requirements are being fulfilled the If the brains requirements are being fulfilled the baby develops healthy bonds and healthier baby develops healthy bonds and healthier behaviorsbehaviors

If they are not being fulfilled and the baby regularly If they are not being fulfilled and the baby regularly experiences angry or hostile environments the experiences angry or hostile environments the babys stress responders become babys stress responders become hyperactivehyperactive

Safety cont.Safety cont.

If the brains requirements are being If the brains requirements are being fulfilled the baby develops healthy bonds fulfilled the baby develops healthy bonds and healthier behaviorsand healthier behaviors

-If they are not being fulfilled and the baby -If they are not being fulfilled and the baby regularly experiences angry or hostile regularly experiences angry or hostile environments the babys stress responders environments the babys stress responders become hyperactive.become hyperactive.

-If they are exposed to silence and neglect- -If they are exposed to silence and neglect- hyPOcorticalism- Unplugging, blank stareshyPOcorticalism- Unplugging, blank stares

The brain itself is changed by stress

“What fires together, wires together” Complex process of “sculpting” the brain,

converting experience into neuronal changes Cortisol, Brain-Derived Neurotrophic Factor

(BDNF) Chronic stress and depression:

shrink the hippocampus and prefrontal cortex ↓ Memory, selective attention, executive function/decision

making potentiate growth of the amygdala

↑ Fear/hypervigilience, anxiety, aggression

McEwen, Physiol Rev 2007;87:873-904

Original Trauma

Amygdala

Any input which amygdala interprets as like original trauma

Recreates body state at time of original trauma

Cortisol Adrenaline

Original emotion re-experienced: fear, rage, sadness Adapted from LeDoux, The Emotional Brain,

1996

Big feeling are confusing Big feeling are confusing to little kids. to little kids. (Lebrach, 2008) (Tucker, (Lebrach, 2008) (Tucker,

1995)1995)

Ability to verbally label an emotion is Ability to verbally label an emotion is an important self regulation an important self regulation strategy.strategy.

If a young person is not aware of the If a young person is not aware of the emotion they are experiencing, they emotion they are experiencing, they may not understand how to react to may not understand how to react to it sociallyit socially

We are born with We are born with survival mechanisms survival mechanisms (Levine (Levine

2001)2001)

The basis of trauma is physiologicalThe basis of trauma is physiological Often there is no time to THINK when Often there is no time to THINK when

facing a threat, our primary response is facing a threat, our primary response is instinctive, in the midbrain, not the instinctive, in the midbrain, not the frontal cortexfrontal cortex

It is difficult to THINK our way to healingIt is difficult to THINK our way to healing Cognitive behaviorism is more effective Cognitive behaviorism is more effective

with stress and cognitive self calming with stress and cognitive self calming methodsmethods

Stress in Children Positive

Normal/necessary part of healthy development First day with new caregiver; immunization

Brief increases in heart rate and stress hormones Tolerable

More severe, longer lasting stressor Loss of a loved one, natural disaster, injury

If buffered by relationship with supportive adult(s), brain and body can recover

Toxic Strong, frequent, prolonged adversity

Abuse, neglect, caregiver mental illness, poverty If no adult support, can disrupt brain and organ

development long-term Center on the Developing Child

at Harvard Univ.

Stress and TraumaStress and Trauma

StressStress: anything that requires a response, : anything that requires a response, can be “good” or “bad”can be “good” or “bad”

TraumaTrauma: anything that : anything that overwhelmsoverwhelms our our ability to respond, especially if we perceive ability to respond, especially if we perceive that our life or our connection to things that that our life or our connection to things that support us physically or emotionally is support us physically or emotionally is threatenedthreatened

So what factors make it more likely that a So what factors make it more likely that a stressful situation will become stressful situation will become traumatizing?traumatizing?

Posttraumatic Stress Responses

“the long-term consequences of trauma are

far-reaching…”Context of the traumaAge/stage of lifeLoss of family/cultural coherencePre-trauma characteristicsLife conditions post-trauma

Trauma is in the nervous Trauma is in the nervous system, not the event system, not the event -M. Kline -M. Kline

Fight-Flight-FreezeFight-Flight-Freeze

Because of their limited capacity to Because of their limited capacity to defend themselves children are defend themselves children are particularly susceptible to Freezing particularly susceptible to Freezing and therefore are very vulnerable to and therefore are very vulnerable to being traumatizedbeing traumatized

How does the jolt of How does the jolt of energy in trauma affect energy in trauma affect

us in the long run?us in the long run? Depends on what happens during and after Depends on what happens during and after

the overwhelming eventthe overwhelming event The excess “Jolt” of energy, must be used The excess “Jolt” of energy, must be used

upup The younger the child the few resources The younger the child the few resources

he/she has to protect him/herselfhe/she has to protect him/herself When a traumatic event occurs, the When a traumatic event occurs, the

imprinting of neurological patterns is imprinting of neurological patterns is dramatically heightened. Remember why dramatically heightened. Remember why are brain is put in our noodle? are brain is put in our noodle? (Sapolsky, Kline, Levine (Sapolsky, Kline, Levine

2007)2007)

Developing Trauma Developing Trauma SymptomsSymptoms

Related to the level of shutdown as well as Related to the level of shutdown as well as the undischarged survival energy that was the undischarged survival energy that was originally mobilized for flight or fleeoriginally mobilized for flight or flee

When the brain sets a sensory motor When the brain sets a sensory motor impulse into action but the limbs cannot impulse into action but the limbs cannot move (or if the movement itself could be move (or if the movement itself could be dangerous e.g. Molestation, surgery) dangerous e.g. Molestation, surgery) symptoms are likely to developsymptoms are likely to develop

Although the event may have lessened in Although the event may have lessened in conscious memory, the body doesn’t forget conscious memory, the body doesn’t forget (Levine, Van Der Kolk)(Levine, Van Der Kolk)

Learning to “befriend” the feeling in Learning to “befriend” the feeling in small increments, we can make the small increments, we can make the connection to the past and connection to the past and discharged the paralyzing sensations discharged the paralyzing sensations we experience.we experience.

The heightened arousal state should The heightened arousal state should be time sensitive, not constantbe time sensitive, not constant

Universal Symptoms of Universal Symptoms of TraumaTrauma

1. Hyperarousal1. Hyperarousal 2. Constriction2. Constriction 3. Dissociation3. Dissociation 4. Feelings of numbness or 4. Feelings of numbness or

shutdown (or “freeze”) shutdown (or “freeze”) (Levine Et al)(Levine Et al)

HyperarousalHyperarousal

Revved up internal state. The stimulation is Revved up internal state. The stimulation is coming from within the child, from the coming from within the child, from the nervous system that they cannot turn down. nervous system that they cannot turn down. When there is perceived stress, the When there is perceived stress, the sympathetic nervous system acts to engage sympathetic nervous system acts to engage the child. The child who cannot pendulate the child. The child who cannot pendulate gets stuck in this mode. Hyperactivity, can’t gets stuck in this mode. Hyperactivity, can’t sleep, cannot deeply relax, hypervigilance, sleep, cannot deeply relax, hypervigilance, difficulty falling and staying asleep, difficulty falling and staying asleep, exaggerated startle response. Often exaggerated startle response. Often resembles ADHDresembles ADHD

ConstrictionConstriction

Once the bodys CNS has been Once the bodys CNS has been hyperaroused, adrenaline is released into hyperaroused, adrenaline is released into the blood stream to preapre the large the blood stream to preapre the large motor muscles for moveent. Certain motor muscles for moveent. Certain muscles, by their nature, must tense or muscles, by their nature, must tense or constrict in order to perform. But with constrict in order to perform. But with trauma, the whole body braces. This trauma, the whole body braces. This includes tightening of the mucles, joints, includes tightening of the mucles, joints, and internal organizes, as well as the and internal organizes, as well as the sensory and respiratory systems. The sensory and respiratory systems. The primary symptom is shutdown.primary symptom is shutdown.

Constriction cont.Constriction cont. Child more withdrawn, shy, more dependent than Child more withdrawn, shy, more dependent than

before, lethargy, fatigue, stiff awkward before, lethargy, fatigue, stiff awkward appearance, rigid gait, poor coordination. Ability appearance, rigid gait, poor coordination. Ability to see hear, smell feel, taste decreases-food may be to see hear, smell feel, taste decreases-food may be less interesting to them.less interesting to them.

Relaxing would mean letting down the guard of Relaxing would mean letting down the guard of protectionprotection

Digestion problems, tummy aches, diarrhea and Digestion problems, tummy aches, diarrhea and constipation.constipation.

Shallow breathing, hyperventilation can limit Shallow breathing, hyperventilation can limit oxygen flow to the brain and body, causing fatigue oxygen flow to the brain and body, causing fatigue and lethargic behavior, often mistaken for lazinessand lethargic behavior, often mistaken for laziness

Freeze/DissociationFreeze/Dissociation

A child experience freeze will often be A child experience freeze will often be spared the initial impact of the incident spared the initial impact of the incident thorugh the mechanism of physiological thorugh the mechanism of physiological shock and dissociation. This numbing shock and dissociation. This numbing (mediated by internal secretions of (mediated by internal secretions of endorphins) serves to stamp down the endorphins) serves to stamp down the physical and emotional pain of the eventphysical and emotional pain of the event

Unable to cryUnable to cry DazedDazed

Freeze cont.Freeze cont.

Sometimes we say “They are tough”Sometimes we say “They are tough” ShockShock Too numb to feel pain or emotions Too numb to feel pain or emotions

due to endorphins and epinephrine due to endorphins and epinephrine boostboost

Can last decadesCan last decades

Recognizing SymptomsRecognizing Symptoms

Physical: Physical: Loss of appetite, sleep disturbanceLoss of appetite, sleep disturbance

Emotional: Emotional: Anger, shame, irritabilityAnger, shame, irritability

Spiritual: Spiritual: Feeling, alone, isolation, shameFeeling, alone, isolation, shame

Cognitive: Cognitive: Confusion shortened attention spanConfusion shortened attention span

Behavioral: Behavioral: Repetitive play, aggressionRepetitive play, aggression

Posttraumatic Stress Responses

PTSDDepression AnxietyDemoralization- To

undermine the confidence or morale of; dishearten:

Kroll, JAMA 2003;290:667-670

Adverse Childhood Experiences Adverse Childhood Experiences (ACE) (ACE)

Physical, emotional, sexual abuse; Physical, emotional, sexual abuse; mentally ill, substance abusing, mentally ill, substance abusing, incarcerated family member; seeing incarcerated family member; seeing mother beaten; parents mother beaten; parents divorced/separateddivorced/separated--Overall Exposure: 86%--Overall Exposure: 86% (among 7 tribes) (among 7 tribes)

Non-Native Non-Native NativeNativePhysical Abuse-M 30% 40%Physical Abuse-M 30% 40%Physical Abuse-F 27 42Physical Abuse-F 27 42Sexual Abuse-M 16 24Sexual Abuse-M 16 24Sexual Abuse-F 25 31Sexual Abuse-F 25 31Emotional Abuse 11 30Emotional Abuse 11 30Household alcohol 27 65Household alcohol 27 65Four or More ACEs 6 33Four or More ACEs 6 33

Am J Prev Med 2003;25:238-244Am J Prev Med 2003;25:238-244

ACEs and Adult HealthACEs and Adult Health ACE Score ≥4ACE Score ≥4

4-12 x risk for alcoholism, drug abuse, depression 4-12 x risk for alcoholism, drug abuse, depression and suicide attemptand suicide attempt

2-4 x risk for smoking, teen pregnancy, STDs, 2-4 x risk for smoking, teen pregnancy, STDs, multiple sexual partnersmultiple sexual partners

1.4-1.6 x risk for severe obesity1.4-1.6 x risk for severe obesity Strong graded relationship at Strong graded relationship at allall levels of ACEs for levels of ACEs for

almost all outcomes, including heart diseasealmost all outcomes, including heart disease Am J Prev Med Am J Prev Med 1998;14:245-258 and 1998;14:245-258 and Circulation Circulation

2004;110:1761-62004;110:1761-6

Across 10 countries, adults who experienced ≥3 Across 10 countries, adults who experienced ≥3 childhood adversitieschildhood adversities Hazard ratios 1.59 for diabetes, 2.19 for heart diseaseHazard ratios 1.59 for diabetes, 2.19 for heart disease Risk similar to the association between cholesterol and Risk similar to the association between cholesterol and

heart diseaseheart disease Both in magnitude as well as population prevalenceBoth in magnitude as well as population prevalence

Arch Gen Psychiatry Arch Gen Psychiatry 2011;68:838-844 2011;68:838-844

--What is your ace --What is your ace score?score?

Cook, Cook, et alet al. 2005. . 2005. Psychiatric AnnalsPsychiatric Annals 35(5) p. 392 35(5) p. 392

GoldilocksGoldilocks

Historical Trauma-Historical Trauma-Colonization, Residential Colonization, Residential

SchoolsSchoolsTrauma is in the freeze-Lack of OptionsTrauma is in the freeze-Lack of Options

SqueezeSqueeze

Imagine your home, your Imagine your home, your neighborhood, your community, neighborhood, your community, without the sound of childrens laughterwithout the sound of childrens laughter

What is What is multigenerational/historic multigenerational/historic

trauma? trauma? Cultural traumaCultural trauma::

––is an attack on the fabric of a society, affecting the is an attack on the fabric of a society, affecting the essence of the essence of the community and its members community and its members

Historical traumaHistorical trauma::––cumulative exposure of traumatic events that affect an cumulative exposure of traumatic events that affect an individual and individual and continues to affect subsequent continues to affect subsequent generations. “The collective generations. “The collective emotional and emotional and psychological injury both over the life span and psychological injury both over the life span and across across generations, resulting from a cataclysmic history of generations, resulting from a cataclysmic history of

genocidegenocide.”.”

Multigenerational traumaMultigenerational trauma::––occurs when trauma is not resolved, subsequently occurs when trauma is not resolved, subsequently internalized, and internalized, and passed from one generation to the passed from one generation to the next. next.

Maria Yellow Horse Maria Yellow Horse Brave HeartBrave Heart

Historical Trauma Trauma(s) that are often intentionally inflicted

and occur at more or less the same time to a defined group of people—these traumas:

Have effects like individual traumas, plus Because the traumas are so pervasive, affect

caregivers and elders, affect community and cultural infrastructures and are targeted at a specific group—they have huge effects on:

People’s/communities’ abilities to cope with and adapt to traumatic event and aftermath

Abilities to interpret the meaning/psychologically incorporate the trauma

Patterns of trauma transmission to subsequent generations

Some Behaviors/Beliefs We Some Behaviors/Beliefs We Can Have as the Result of Can Have as the Result of

TraumaTrauma Distrust—of the government, institutions, Distrust—of the government, institutions,

our own leaders, supervisors, etc. even to our own leaders, supervisors, etc. even to our own detriment--“they” are out to get usour own detriment--“they” are out to get us

Sense of never having “enough”Sense of never having “enough” Spend/eat/use what you have now as it may Spend/eat/use what you have now as it may

be taken from yoube taken from you We will not live to be old, so it doesn’t We will not live to be old, so it doesn’t

matter what we do now.matter what we do now. ““Love” is not to be trusted and is often Love” is not to be trusted and is often

linked with emotional/physical/sexual abuselinked with emotional/physical/sexual abuse

Behaviors cont.Behaviors cont. Different threshold for “normal” behaviors Different threshold for “normal” behaviors

(That’s just the way it is)(That’s just the way it is) Anger, rage “out of proportion” to situationAnger, rage “out of proportion” to situation

Escalation of emotions/voice if demands aren’t Escalation of emotions/voice if demands aren’t metmet

Dissociation: can look like disinterest, Dissociation: can look like disinterest, “spaciness”“spaciness”

Desensitized to loss Desensitized to loss Distrust of providersDistrust of providers Overly dependent on providersOverly dependent on providers Its genesis was relatively recent and its Its genesis was relatively recent and its

transmission is consistenttransmission is consistent

Intergenerational Transmission of Intergenerational Transmission of HTR: Research FindingsHTR: Research Findings

No clinically significant difference between children ofNo clinically significant difference between children of holocaust survivors and Jewish non-survivor controls holocaust survivors and Jewish non-survivor controls in terms of PTSD; however, when the survivor children in terms of PTSD; however, when the survivor children were exposed to stressful events, they were were exposed to stressful events, they were significantly more likely to develop PTSD or sub-significantly more likely to develop PTSD or sub-threshold PTSD symptoms than controlsthreshold PTSD symptoms than controls (Danieli, 1998) (Danieli, 1998)..

Similar multigenerational effects have been Similar multigenerational effects have been documented among Japanese internment survivors documented among Japanese internment survivors and offspring.and offspring.

For AIAN offspring, increased sensitivity or For AIAN offspring, increased sensitivity or hyperarousal to stressful events, in particular to hyperarousal to stressful events, in particular to events that act as reminders of their colonized status events that act as reminders of their colonized status may predispose AIANs to trauma responses and may predispose AIANs to trauma responses and corresponding symptoms.corresponding symptoms.

Promoting ResiliencePromoting Resilience

Heavy Runner and Marshall (2003)Heavy Runner and Marshall (2003) SpiritualitySpirituality Family StrengthFamily Strength EldersElders Ceremonial RitualsCeremonial Rituals Oral TraditionsOral Traditions Tribal IdentityTribal Identity Support NetworksSupport Networks

Promoting ResiliencePromoting Resilience

Cutler (2006)Cutler (2006) SpiritualitySpirituality Social interest Social interest (giving back to the community)(giving back to the community) Acceptance of a Tiospaye Acceptance of a Tiospaye (identification of and (identification of and

being being welcomed into a traditional family and welcomed into a traditional family and community) community)

Support from family Support from family Cross-cultural competence Cross-cultural competence (ability to function in (ability to function in

both both traditional and non-traditional culture)traditional and non-traditional culture) Staying active and involved in growth activitiesStaying active and involved in growth activities Self-maintenance activities Self-maintenance activities (connection to the (connection to the

natural natural world, connection to sacred places, world, connection to sacred places, meditation, meditation, comfort from pets, sports, comfort from pets, sports, exercise, healthy diet, etc.) exercise, healthy diet, etc.)

Trauma isn’t in conversation, its in Trauma isn’t in conversation, its in sensationsensation

Good NewsGood News

The body wants to get rid of the The body wants to get rid of the traumatrauma

We just have to be good stewards of We just have to be good stewards of the processthe process

Preparation for the Preparation for the tough stufftough stuff

Dealing with trauma of others is Dealing with trauma of others is very hardvery hard

Dealing with our own is even harderDealing with our own is even harder We need to understand ours before We need to understand ours before

we can be helpful with otherswe can be helpful with others Prevents transference and counter-Prevents transference and counter-

transferencetransference

There is a dilemma when patients There is a dilemma when patients with trauma histories are placed with trauma histories are placed with providers who harbor their own with providers who harbor their own resolved trauma. The showdown is resolved trauma. The showdown is not pretty. It is predictably a not pretty. It is predictably a disaster. The student needs a disaster. The student needs a teacher who can access the best of teacher who can access the best of their humanity at the worst of times. their humanity at the worst of times. -Levine -Levine

Understanding the physiological (and Understanding the physiological (and to a lesser degree) the psychological to a lesser degree) the psychological aspects of trauma, harmful events that aspects of trauma, harmful events that often limit a patients potential to often limit a patients potential to fulfillment can be transformed into fulfillment can be transformed into experiences that expand their ability experiences that expand their ability to obtain a sense of mastery, to obtain a sense of mastery, resilience, power, and possibility resilience, power, and possibility (Kline (Kline 2001)2001)

Sensations Vocabulary Sensations Vocabulary BoxBox

Different then emotions Different then emotions listlist Cold/warm/hot/chillyCold/warm/hot/chilly

Twitchy/butterfliesTwitchy/butterflies Sharp/dull/itchySharp/dull/itchy Shaky/trebly/tinglyShaky/trebly/tingly Hard/soft/stuckHard/soft/stuck Jittery/weakJittery/weak Relaxed/calm/peacefulRelaxed/calm/peaceful Empty/fullEmpty/full

Sensations vocab cont.Sensations vocab cont.

Flowing/spreadingFlowing/spreading Strong/tight/tenseStrong/tight/tense Dizzy/fuzzy/blurryDizzy/fuzzy/blurry Numb/prickly/jumpyNumb/prickly/jumpy Owie/tearful/goose-bumpyOwie/tearful/goose-bumpy Light/heavy/openLight/heavy/open Tickly/cool/silkyTickly/cool/silky Still/clammy/looseStill/clammy/loose

Practicing the felt sensePracticing the felt sense

WhereWhere Don’t rationalize just experienceDon’t rationalize just experience Let it relax voluntarilyLet it relax voluntarily Grounding and centeringGrounding and centering

Although few words are used to in Although few words are used to in the process of deactivating the the process of deactivating the trauma charge the ones you choose trauma charge the ones you choose are important. Equally important is are important. Equally important is your pace, your tone, and your own your pace, your tone, and your own sensation responses.sensation responses.

Not hard, just differentNot hard, just different It requires us to change from realm of thought It requires us to change from realm of thought

and emotion to that of sensationand emotion to that of sensation A significant amount of academic and social A significant amount of academic and social

success is gathered around ability to self success is gathered around ability to self soothesoothe

Do not attach meaning or definition-uses Do not attach meaning or definition-uses different part of the braindifferent part of the brain

As nature move in cycles, so do we. We have to As nature move in cycles, so do we. We have to accept the pacing-often we try to rush to the accept the pacing-often we try to rush to the conclusionconclusion

Taste and TouchTaste and Touch

CardsCards

A child resources- A child resources- external and internalexternal and internal

Children are born with natural Children are born with natural internal resources, but need an adult internal resources, but need an adult to mirror and nurture them, so they to mirror and nurture them, so they are readily accessible.are readily accessible.

Resources are uniquely personalResources are uniquely personal If an adult believes that it does or If an adult believes that it does or

should create comfort, but it does should create comfort, but it does not, it is not a resource for the childnot, it is not a resource for the child

External ResourcesExternal Resources

Loving caregivers who help Loving caregivers who help developmental needsdevelopmental needs

Other nurturing family membersOther nurturing family members Other resources that stimulate Other resources that stimulate

and/or comfortand/or comfort A caring communityA caring community

Internal resourcesInternal resources

Natural Gifts and TalentsNatural Gifts and Talents Energetic or Kinesthetic qualities-Energetic or Kinesthetic qualities-

making friends, high physical making friends, high physical intelligenceintelligence

Personality characteristic- Wit, Personality characteristic- Wit, Wisdom, Charisma, thoughtful, Wisdom, Charisma, thoughtful, integrityintegrity

SpiritualSpiritual

Resources ActivityResources Activity

Fold a piece of paper I half. On one side list Fold a piece of paper I half. On one side list your external resources, on the other your your external resources, on the other your internal resources. If you are not sure internal resources. If you are not sure which side it belongs on, put it on bothwhich side it belongs on, put it on both

Look at your list and notice which ones jump Look at your list and notice which ones jump out as the strongest supports in your times out as the strongest supports in your times of stress. Focus on each and notice of stress. Focus on each and notice sensations and emotions emerge, and where sensations and emotions emerge, and where they are located. List your sensationsthey are located. List your sensations

Resources activity cont.Resources activity cont.

Are there categories of missing or weak Are there categories of missing or weak resources such as few satisfying resources such as few satisfying relationships, or lack of spirituality.relationships, or lack of spirituality.

List ways to enhance these areasList ways to enhance these areas Make a list of your childrens external Make a list of your childrens external

and internal resourcesand internal resources Repeat steps Repeat steps Be sure not to impose ideas on the Be sure not to impose ideas on the

child, let the leadchild, let the lead

We are learning more and more We are learning more and more about trauma for individuals. The about trauma for individuals. The next challenge to assess how to deal next challenge to assess how to deal with it corporately.with it corporately.

Be Well, lets take care of each Be Well, lets take care of each otherother