1. Trauma: What is it? What can we do to help?
Philip G. Monroe, PsyD

2. 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

3. 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

4. What Causes Trauma? Anything that exceeds one’s capacity to cope
Image from:

5. Stress Continuum
Tolerable Toxic Traumatic

6. 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

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

8. 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

9. Trauma Affects Everything
Health
Work capacity
Relationships
Family members

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

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

12. 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

13. 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.

14. Moral Injury
When forced to violate values and beliefs

15. 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

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

17. Result: Shame
I am bad
I am desecrated

18. 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

19. What do traumatized people need?
What can we do?

20. What Trauma Brings

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

22. 1 3 Reconnection 2 Trauma Processing Safety/Stabilization
Recovery Stages 3
Reconnection 2
Trauma Processing 1
Safety/Stabilization

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

24. 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?

25. 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

26. 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

27. 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?

28. Concluding Thought
What is your tendency?
Despair
Presumption

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

30. 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

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

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

33. What is the goal?

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

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

36. 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.

37. 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, facilitators, 61 languages

38. 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.

39. 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