1. Trauma Therapy Principles: Considerations for your Oncology Practice Marita Poll, M.Ed, RCC Clinical Counsellor Patient and Family Counselling Vancouver Island Centre

2. What are Stress and Trauma?  Stress:  Demands on an individual (physical or psychological) that produce a typical sequence of physiological arousal (e.g., stress hormones excreted)  Strain (psychological and physical) caused in response to pressure from the outside world (doing too much, for too long)

3. What are Stress and Trauma?  Common stress reactions include:  Physical: headaches, feeling excessively tired, trouble sleeping, dry mouth, pounding heart, difficulty breathing, upset stomach, sweating palms, tight muscles…  Psychological: irritability, easily overwhelmed or anxious, feeling isolated, difficulty concentrating, memory problems, racing thoughts, ongoing worry and negative thoughts…

4. What are Stress and Trauma?  Trauma (includes Post Traumatic Stress and Post Traumatic Stress Disorder):  Often discussed as either an event or a person’s reaction to an event (physical, psychological)  “Traumatic events overwhelm the ordinary systems of care that give people a sense of control, connection, and meaning…they generally involve threats to life or bodily integrity” (p. 33, Herman, 1992)  With events that involve danger or life threat, the nervous system responds instinctively to create mobilization or defense

5. Physiology:  When a person is experiencing threat to physical integrity or life, there is increased activation of the Sympathetic Nervous System (SNS).  The brain plays an important role in the acceleration process. Specifically, the brainstem continuously scans our environment to determine if we are safe or under threat.  The SNS is the acceleration system within the body that allows you to run away, defend yourself, or seek safety with “your herd”.

6. Physiology:  If this self-protective response is successful, and we return to safety, then the fight, flight or freeze response is “shut off”.  Typically cancer patients don’t typically get to physically fight or run away (in a manner that releases the physical acceleration). Therefore our patients need to discharge this activation, which can be effectively done through exercise and physical activity.

7. Physiology:  The Parasympathetic Nervous System is the braking system within the body that allows us to settle and relax.  This system can be engaged through activities such as yoga, meditation, Tai Chi – any activity that allow you to get settle and go “ahhh”.  We can also access this “ahhh” feeling by being with the people who make us feel safe.

8. Applying Trauma Therapy Principles in Your Oncology Practice:  Tri-Phasic Treatment Model (Herman, 1992):  Safety and Stabilization: being able to slow or reduced physical/psychological activation, involves titration (touch in on distress and then calm, back and forth, and developing the following:  Developing resources (functional, physical, psychological, interpersonal and spiritual),  Oasis (activity that gives you a break from the distress, typically an activity that requires concentration and paying attention)

9. Applying Trauma Therapy Principles in Your Oncology Practice:  Tri-Phasic Treatment Model (Herman, 1992):  Anchors (a concrete, observable resource that is either with you or you can bring up positive memories, e.g., pet, person)  Safe places  This may be all that we accomplish with patients, building tools and resources to decrease the stress response and increase coping

10. Applying Trauma Therapy Principles in Your Oncology Practice:  Tri-Phasic Treatment Model (Herman, 1992):  Remembrance and Mourning: this is the stage of “telling your story”, expressing the impact at tolerable levels (mentally, emotionally, physically…), completing what was likely a thwarted defensive response within a safe relationship  Sometimes we can get to this in PFC, other times with is done in support groups, community therapists, friends/family, or not at all  Reconnection with Ordinary Life  Survivorship counselling – life after treatment, who am I now after this experience, what role will cancer play in my life now, how has it added meaning or not

11. Applying Trauma Therapy Principles in Your Oncology Practice:  Discharge Sympathetic Activation:  Using exercise and movement to decrease the agitation  Normalizing the impact of stress, we all experience it, here are the common responses (physical, psychological), here’s how you/we can work with this  What are the body’s impulses and how can they be safely discharged – flight response (swimming with a kick board), fight response (pushing exercises)

12. Applying Trauma Therapy Principles in Your Oncology Practice:  Parasympathetic Activation:  Bringing in the activities that create the relaxation response  things/people/experiences that make us go “ahhhh

13. From Emotion-Focused Therapy  “Antidoting” – from Emotion-Focused Therapy (Dr. Les Greenberg), concept when difficult experiences arise, consider antidotes – stress with peace, sad with fun, heavy with light, busy with slow, angry with happy

14. My Treatment Plan:  Discharge sympathetic activation with exercise (Jazzercise class on Tuesdays, Thursdays, and Saturdays), tennis, and somatic counseling;  Amplify parasympathetic activation with 15 minutes of meditation (5 days a week), dog walks on Dallas Road (weekends), acupuncture (monthly), Reiki group (monthly), meditation group;  Antidoting – women’s social group (monthly), tennis (as time allows), weekly “date nights” with close friends/family, grounding (many times a day): tennis=joy, dinner out or a good meal=pleasure…

15. References and Recommended Reading  David Baldwin’s Trauma Information Pages www.trauma-pages.com www.trauma-pages.com  Anna Baranowsky, Eric Gentry, Franklin Schultz, Trauma Practice: Tools for Stabilization and Recovery (Hogrefe and Huber Publishers, 2005)  Edna Foa, Terence Keane, Mathew Friedman, Effective Treatments for PTSD (Guilford Press, 2004)  Les Greenberg, Emotion-Focused Therapy: Coaching Clients to Work Through Their Feelings (American Psychological Association, 2004)  Judith Herman, Trauma and Recovery: The Aftermath of Violence – From Domestic Abuse to Political Terror (Basic Books, 1992)

16. References and Recommended Reading  Peter Levine, Waking the Tiger: Healing Trauma (North Atlantic Books, 1997)  Lisa Najavits Seeking Safety (Guilford Press, 2002)  Babette Rothschild, The Body Remembers: The Psychophysiology of Trauma and Trauma Treatment (Norton, 2000)  Daniel Siegel, The Mindful Brain: Reflection and Attunement in the Cultivation of Well-Being (Norton, 2007)  Sharon Stanley (2007-2008) Somatic Transformation Psychotherapy Training Program