Trauma: What is it? What can we do to help? Philip G. Monroe, PsyD pmonroe@americanbible.org

Objectives What is trauma/PTSD? How do we help to traumatized people? Effects on the whole person How do we help to traumatized people? Listening is the first step to healing

The Trauma Cascade Result Event Experience Intense fear and paralysis inducing Experience Loss of voice, control, meaning Result Disorganized response system Relational pain, loss of trust, contempt for self Running from the past, afraid of the future

What Causes Trauma? Anything that exceeds one’s capacity to cope Image from: https://s-media-cache-ak0.pinimg.com/736x/4b/a4/e1/4ba4e18ffd05be7b029a5a50901f3203--lords-resistance-army-trauma-therapy.

Stress Continuum Tolerable Toxic Traumatic

Toxic and Traumatic Stress Normal Stress Toxic Stress or Traumatic Stress Normal stress response + adrenaline and cortisol Fight/flight; reduced words Returns to normal after event Toxic or traumatic stress Does not return to normal Disrupts brain development, especially language The effect of stress on the brain: Adrenaline and Cortisol production shuts down insulin. All sugars go to muscles to work. Blood flows to limbs to work. Memory is more picture oriented than language. (Consider image of barking dog): Children have higher likelihood of heart disease, addiction, cancer, and diabetes in later life

Processing Trauma A: Thinking/evaluating B: Feeling C: Reaction

A B C Thalamus – sensory relay center. Hypothalamus – part of HPA axis – stress response. When we talk about brain – focus on outside cortical layers – what makes us human – I think therefore I am. Forebrain. Frontal lobnes. Surprising how often its overlooked that most of brain used when people in danger, getting self into trouble, etc – inner section of brain – limbic system. Over which difficult/impossible to exert conscious influence. Automatic response. Survival centers of brain: Amygdala – emotional labeling. Hippocampus – consolidation of memory. Compromised by extreme threat. Stops functioning properly – amygdala keeps recording fragments of memories. Speechless terror. Memories not consolidated. When same aroused state gets activated by reminder  triggering of memory fragments, “as if” experiences C

Trauma Affects Everything Health Work capacity Relationships Family members

Key Losses Loss of voice Loss of power Loss of identity Loss of connection

Trauma Disrupts Faith/Identity Loss of meaning/connection Spiritual struggles Moral injury Disconnection: faith and community Shame

I was ready to tell the story of my life, but the ripple of tears, Angst I was ready to tell the story of my life, but the ripple of tears, and the agony of my heart, wouldn’t let me Rumi

Spiritual Struggles Two categories What does your faith community say Discontent Questioning What does your faith community say about God in times of crisis and trauma? In a recent study of 3000 individuals taking part of a Bible Based TH program, there is strong evidence that when trauma is experienced, spiritual struggles increase—God is experienced as distant, church is not safe, and the Bible is not something that seems to speak to their experiences. The way they thought life should go is no longer possible and this leads to the big existential questions, which the asking of which is both necessary and painful for most, especially in settings where such questions are not considered appropriate.

Moral Injury When forced to violate values and beliefs

Civilian Moral Injury? “I feel like a spiritual orphan, betrayed by what I loved, and I feel lost and alone” Kusner & Pargament, Trauma Therapy in Context, 2012

Disconnected! Now here I am Without myself Bitter How can I go back To whence I sprang? Mak Dizdar

Result: Shame I am bad I am desecrated

Complex Trauma? Loss of Meaning and Purpose Prolonged interpersonal trauma (betrayal) Loss of Meaning and Purpose No longer believe life has purpose Question self AND God

What do traumatized people need? What can we do?

What Trauma Brings

What do we Need? Safety Empathy and acceptance Listeners who bear witness Lament Take care of our bodies

1 3 Reconnection 2 Trauma Processing Safety/Stabilization Recovery Stages 3 Reconnection 2 Trauma Processing 1 Safety/Stabilization

Our Main Task? Listen and learn Be a student more than a teacher! Understand what encourages safety Bear witness Identify losses and resiliencies

Listener 101 Skills Don’t talk too much Don’t avoid emotions Validate Explore culture 3 questions? Consider good friends: how do you listen? What kind of help have you received?

Encourage Good Story Telling Tells story at own pace Can choose not to tell Listener shows interest Storytelling without words Start and end at safer points Coping skills practiced Resilience focus Told from the present Frequent interruptions Forcing the story Reliving the story Avoiding painful emotions Exhorting to get better Telling them how to feel Only talking of the trauma Ending a session without talking about the present or a safe place

Sacred Tears: Laments Complaints about injustice and loss Questioning God Asking for rescue, calling on promises Waiting expectantly Examples: Hebrew Bible, Beowolf, Ilyiad, Lament of Qur’an

Elie Wiesel on Lament I have not lost faith in God. I have moments of anger and protest. Sometimes I’ve been closer to him for that reason. Night Negative coping? Passive vs. active faith engagement? Acceptance of lament as act of faith?

Concluding Thought What is your tendency? Despair Presumption

Despair? Consider Job’s “friends” Curse God and die! When will you end this ranting?

Presumption? “For I know the plans I have for you,” declares the LORD, “plans to prosper you and not to harm you, plans to give you hope and a future” Jeremiah 29:11

Remember Safety and Integrity are a must Trauma isn’t the whole story Healing isn’t promised and is a process

Practice Asking 3 questions What happened? How did that make you feel? What was the hardest part?

What is the goal?

Resilience? Bouncing back or finding feet again? The courage to face the darkness and to begin to write another story

Healing the Wounds of Trauma How the church can help Healing the Wounds of Trauma

The Trauma Healing Institute materials and program model got their start 20 years ago, as more and more countries in Africa were experiencing war and civil unrest. Pastors came to Wycliffe missionaries and mental health professionals saying, “Our people are acting strangely since the attacks. What can we do?” They all met in Nairobi and worked on a response called Healing the Wounds of Trauma: How the Church Can Help. The book and program began to spread organically, by word of mouth. When American Bible Society encountered this program, it saw the promise it held. We realized we would could help make this program go from local to global, because we have access to 147 Bible societies around the world.

100 countries, 10000+ facilitators, 61 languages This program has been used by thousands of people—over 6000 to be exact. It is a community of people who care about helping people heal from trauma. 100 countries, 10000+ facilitators, 61 languages

Healing journey This diagram illustrated the healing journey used in our program… [explain experience arc] The method of instruction in this program is participatory and experiential. We use the insights of adult learning theory that people must participate in order to learn. So, we use stories, exercises, reflection, role play, practice, application.

Classic Children Teen Story-based Audio The original or “classic” program has evolved into many forms, with programs focused on children, oral learners who prefer a story-based approach, and an audio program for hard-to-reach areas. We’re in the process of creating a teen program. Audio