Understanding Trauma and how to help survivors March 2018

The adrenal system “fight or flight or freeze”

Normal danger response Symptoms? Normally an “acute” response. Body and mind in state of alert, attention on how to react, feelings of fear and anger resulting in strenuous focussed effort to restore SAFETY. Traumatic symptoms arise when this does not work, when the person is powerless.

Hormone balance In severe trauma, it looks like the hormones dysfunction, the cortisol is not enough to turn off the adrenaline and the body doesn’t calm down. The survivor continues to experience the world as DANGEROUS and cannot locate the memory in the past, rather than the present. There is often a “freeze” response

Psychological trauma is an affliction of the powerless Trauma overwhelms Trauma produces feelings of intense fear or terror, helplessness, loss of control, or uncertainty that cannot be resolved.

Trauma survivors have symptoms instead of memories (Harvey 1990)

3 main categories of symptoms 1. Hypervigilance – persistent expectation of danger or the event happening again, startles easily, reacts irritably, sleeps badly. Loss of trust 2. Intrusive memories and flashbacks - as if happening now (time stopped), triggered by small reminders, usually only images, no words 3. Numbing – surrender when powerless, detachment, dissociation, altered consciousness

How to help There are 3 stages of recovery 1. Establish a sense of safety in the present 2. Remember and mourn losses safely 3. Reconnect with ordinary life Some of this should be done with therapists but all support workers can contribute.

Good listening Good listening enters into the pain without judging it or being overwhelmed by it but validating it. Good listening listens just in order to understand the person and enter their world as far as possible. Good listening reflects back what they hear and see

Good reflections So what I’ve understood is…. I sense that you’re feeling….. I’ve noticed you clenching your fists as if you want to hit somebody – is that how you feel? That experience sounds really painful/hurtful/damaging/sad/distressing I’m really sorry that happened to you, it makes me feel sad/angry/distressed

Good listening is NOT A conversation Bringing in your own story Fixing problem feelings or facts Shoulds and oughts

Good listening establishes 1. A safe place – same person and place every time, secure, uninterrupted, calm 2. Safe boundaries – confidentiality unless they are at risk or risk to others, time boundaries and availability 3. Safe talking – within their COMFORT ZONE (or not talking but engaging in play or creativity). There is a “window of tolerance” for each person.

How to Help

Safety Give them skills to calm themselves when stress and anxiety are increasing –grounding and slow breathing . 1. Grounding Eyes open notice details in the room – floor, walls, furniture. Eyes closed notice sounds, then notice your body as it sits…. then your body as it breathes. Focus on breathing in through your nose and out through your mouth, feeling your chest and stomach movements.

Safety Slow breathing exercise

Safety Establish a safe relationship and find out if they are living in present fear. Give them information about the 3 common symptoms so that they are prepared for them. Emphasise that they will recover Give them 2 suggestions – that they choose to TALK (or write or draw ) about what has happened and that they choose NOT to use alcohol or drugs or self-harm as a way of coping

Accepting help is an act of courage

Safe talking If they have had severe or multiple trauma, encourage them to go for therapy. In the meantime you can still enable them to talk and stay safely within their comfort zone, by checking that they are still feeling calm and safe. Begin by asking them about their story BEFORE the trauma. Find out about their hopes and dreams as well as their struggles. This begins to restore continuity with the past

Safe talking If they want to talk about the trauma itself, and you feel able to listen, suggest that they stand outside of the story and relate it in the third person “he” or “she”, and describe the facts, what they saw and heard as well as how they felt. GO SLOWLY. A little at a time is best. Keep checking that they are still feeling ok and not becoming agitated or numb.

If you see stress levels rising bring them back into the safe room and stop. Only work within your limits. Reflect back and validate the story and the pain as it goes along. You are co-creating their story. Write down both the story and the feelings for them as it develops. Encourage drawing whenever they lose words Keep encouraging them to go to a therapist to complete the work of recovery

Self Care When you are listening to trauma, remember you can pick it up. It is called vicarious traumatisation. Be self-aware and notice how you are feeling Try to consciously put it down, it is not yours. Look after your own wellbeing – use a toolbox of things that keep you feeling good. Have a regular “Happiness hour”.