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SAMHSA Definition�Substance Abuse and Mental Health Services

Individual trauma results from an event, series of events, or set of circumstances that is experienced by an individual as physically or emotionally harmful or threatening and that has lasting adverse effects on the individual's functioning and physical, social, emotional, or spiritual well-being...

In short, trauma is the sum of the event, the experience, and the effect.

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Three Types of Trauma

Acute (isolated event) Trauma	Chronic (repeated or prolonged) Trauma	Complex (developmental) Trauma
An isolated event such as being the victim of a crime, surviving a natural disaster, or a serious accident	Living through an ongoing situation such as experiencing domestic violence, or a war	Experiencing multi-layered traumatic circumstances such as caregiver abuse or neglect, or a combination of multiple trauma events, particularly in childhood.

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Prevalence

Adverse Childhood Experiences (ACE) reported by adults:

28% physical abuse, 21% sexual abuse, 15% emotional neglect

10% physical neglect, 13% domestic violence, 27% substance abuse in home

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The Impact of Trauma

About 80% of 21-year -olds who were abused as children met criteria for at least one psychological disorder (e.g. Depression, Anxiety)

ACE in any category increased the risk of attempted suicide 2- to 5-fold

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The Brain

Mid-Brain – Motor regulation, arousal, appetite, sleep

Brain Stem – blood pressure, heart rate, body temperature

Cortex – Abstract thought, concrete thought, language

Limbic System – Attachment, sexual behavior, emotional reactivity

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About The Human Brain

HHS Child Welfare Information Gateway

Develops in a use-dependent fashio

Repeated activation of specific nerve connections develops those connections and the areas required to sustain those connections

Areas that do not get consistent, repeated stimulation may not develop at all

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Acute Response To Trauma

Hyper or Hypo-arousal: Fight, Flight, Freeze, Submit.
Information is processed directly for survival purposes.

In the reptilian and animal brain:

New information is not processed or retained.
Rational thought is avoided in favor of survival-related activities.

In the cortex:

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About “Fight or Flight”

Fight When a threat can be conquered	Flight When a threat can be avoided	Submit When a threat can be mitigated	Freeze When there is no way to avoid harm
Posturing Verbal outbursts or threats Confrontation Physical aggression	Physically moving away Dissociation Hiding “shrinking” in posture, tone of voice	“if you can’t beat them, join them” Self-harm Instigating Defending the attacker	Complete helplessness Physical freezing Stupor Catatonia

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Lasting Effects of Trauma

Attachment and attunement:

Struggles to empathize with others
Difficulty identifying others’ feelings through verbal or visual cues OR extreme sensitivity to others’ feelings perceived through these cues
Isolation, or trouble developing safe, trusting relationships
Unhealthy physical boundaries (touch aversion, sexual or social permissiveness)

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Lasting Effects of Trauma

Physical challenges:

Problems with balance (e.g. uneven gait)
Movement coordination problems
Lack of hand/eye coordination
Delays in growth and development (e.g. “failure to thrive”)
Unexplained physical pain
Sleep disturbances, night terrors, or altered sleep pattern

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Effects of Trauma

Emotion and Mood:

Difficulty describing feelings
Feelings are experienced as overwhelming, with limited ability to modulate
Depression, anxiety, and numbness are common
Lack of affect

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Effects of Trauma

Arousal modulation:

Dissociative states (black outs, out-of-body experiences, a “blank stare”)
Abrupt outbursts of anger and/or aggression
Hyperactivity or “mania”-like presentation

Behavioral control:

Difficulties in impulse control
Self-destructive behavior

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Lasting Effects of Trauma

Cognition:

Problems with attention and concentration
Difficulty retaining new information
Short term memory problems
Limited autobiographical memory
Poor self-image and self-esteem
Persistent intrusive thoughts and images, sometimes resembling hallucinations
“Arrested development”

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Trauma Treatment & Recovery

In order to foster change, people’s reparative experiences must be

Predictable
Consistent
Repetitive

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Attachment

Attachment is a relational (two-way) process, without which people do not develop the capacity to regulate their own emotions.
People with complex trauma histories often have problematic attachment styles due to repeated disruptions in attachment

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The Still Face Experiment

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Attachment Styles

Attachment Style	Behavior	Underlying beliefs	Previous caregiver’s behavior
Avoidant	Emotionally distant, does not connect with others	“I can’t rely on others to meet my needs.”	Never emotionally or physically available
Ambivalent	“push/pull”: fluctuates between connecting and rejecting	“There is no way to predict whether my needs would be met.”	Inconsistent in availability or response
Disorganized	No pattern: sometimes Avoidant, other times Ambivalent. Often dissociative.	“Those who meet my needs are also likely to hurt me.”	Intermittently aggressive and/or abusive

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Teacher Affect Management

Teachers can support students in developing healthy self-regulation skills through modeling the response they’d like the client to develop.

E.g. child falls down. Mother’s response determines whether the child will cry.

Challenges to teacher affect management

Student’s vigilance to caregiver cues
Intensity of students affect
Teacher’s own history and situation
Relational reenactments

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Addressing The Challenges

Encouraging self-awareness and self-monitoring
Building capacity for self-care
Developing a built-in support system
Practicing teamwork
Recognizing and addressing Secondary Traumatic Stress (STS), compassion fatigue, and burnout.
Supporting knowledge sharing activities
Identifying successes and failures and using them as teaching moments

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Integrating Who You Are Into Your Work

Your personality, communication style, and background will inevitably find their way into your interactions with students.

Past hurts, traumas, and fears are bound to influence these interactions- sometimes in unpredictable ways.

YOU can be a powerful catalyst for student growth and change:

Identify what you bring into different interactions
Recognize the impact of your life experiences on your work
Consciously choose which parts of YOU enter the interaction with students

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Attunement

Traumatized students often have difficulty communicating effectively.
Behavior is an attempt to communicate

Unmet needs
Unregulated affect

These difficulties may be global, or situation-specific
Teachers often respond to the most distressing symptom or behavior, rather than the underlying emotion or need.

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Value of Attunement

Helps students develop trust in caregiver system

students experience being understood
Demonstrates true compassion, caring
Allows students to learn that their needs and feelings will be addressed

Facilitates prevention and rapid de-escalation of high-intensity situations
Increases students’ engagement
Supports students’ behavior change

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Core Principles

Safety

How do we know whether a situation is safe?
How do we know if a person is safe?
How does our personal definition of safety impact our interactions with students?
Does our idea of safety translate into our work environment? Why? Why not?
What are the challenges in creating / maintaining safety in our environment and interactions? How do we overcome them?

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Core Principles

What are some challenges to consistency that we encounter in our day-to-day?
What can you do to create consistency? What support do you need, and from whom?

Consistency

Why is repetition important? Why is it good?
How much is too much repetition? How much is not enough?
How do we feel about repetition? How do we manage any potentially negative feelings?

Repetition

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How Attunement Happens

Become a “feelings detective”

When the students acts, consider what he/she might need or feel

Consider basic needs: hot, cold, tired, hungry, thirsty...
Consider the fight/flight response
Consider the client/studernt’s attachment style and possible triggers

Use reflective listening skills
Practice responding to feelings/needs and not to behavior

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Consistent Response

Predictability in teacher response helps students feel safe, and reduces their need to exert control
Limit-setting and praise are common triggers: they are often associated with powerlessness and vulnerability.

Where possible, reduce the need for limits
Adapt response to the individual needs of the client
Build on successes

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Routines and Rituals

Trauma is often associated with chaos and unpredictability
Routines enable students to feel safe, anticipate and evaluate their experience, and learn reliability
It is important to be selective in developing routines/rituals, build-in flexibility
Routines/rituals are often subtle