1. Making It Better Without Making It Worse Angela Keen, Keystone Crisis Intervention Team Crisis Intervention Association of Pennsylvania Annual Conference November 12, 2015 KCIT 2015

2. Attendees will be able to: Describe the neurobiology of trauma reactions Idenitfy how empathy contributes to traumatic stress reactions that may be categorized as vicarious victimization, compassion fatigue and burnout Recognize their own traumatic exposure responses and learn self-soothing techniques to build resiliency and healthy coping skills KCIT 2015

3. Trauma Individual Trauma: A “blow to the psyche that breaks through one’s defenses so suddenly and with such force that one cannot respond effectively.” - Kai Erickson, In the Wake of a Flood, 1979 Collective Trauma: A “blow to the tissues of social life that damages the bonds attaching people together.” - Kai Erickson, In the Wake of a Flood, 1979 KCIT 2015

4. Trauma is any event that leaves a person feeling hopeless, helpless, fearing for their life and/or their safety. KCIT 2015

5. Fluctuating Equilibrium KCIT 2015

6. Impact of Trauma on Equilibrium KCIT 2015

7. Remember… Trauma is a sensory experience It is not cognitive! KCIT 2015

8. Sensory Path in the Non- Traumatized Brain KCIT 2015 Cortex- Neo Cortex Thalamus Amygdala Hippocampus

9. Sensory Path in the Traumatized Brain KCIT 2015 Cortex- Neo Cortex Thalamus Amygdala Hippocampus

10. During a Traumatic Event Right BrainLeft Brain KCIT 2015 The pathways between the right and left brain experience a disconnect. Memory Sensory Affect Regulation Making Sense Problem Solving Decision Making Language Impulse Control

11. Remember… Trauma is a sensory experience It is not cognitive! KCIT 2015

12. TRAUMA IMPAIRS Feeling internally connected over time to caring others Experiencing oneself as deserving and worthwhile Managing Feelings:  Recognize, tolerate, modulate, integrate feelings KCIT 2015

13. POTENTIAL IMPACT OF REPEATED TRAUMA KCIT 2015

14. POTENTIAL IMPACT OF REPEATED TRAUMA KCIT 2015

15. TRAUMATIC STRESS Shifts people away from emotional safety, emotional balance and predictability. Disrupts the ability to return-to-center. KCIT 2015

16. Stress Reactions of Caregivers KCIT 2015 16

17. Burnout: a chronic state of stress KCIT 2015 17

18. Signs of Burnout Exhaustion of mind and body Frustration, cynicism, negative thoughts Feelings of ineffectiveness and lack of accomplishment KCIT 2015 18

19. Contributing Factors to Burnout Emotional and physical drain of providing continual empathy Ambiguous successes Erosion of idealism Lack of expected rewards KCIT 2015 19

20. Burnout Causes Havoc with: Your health (poor sleep, illness) Your personal life Maintaining self-care Job performance Cognitive abilities (concentration, problem solving, decision making) KCIT 2015 20

21. Vicarious Victimization Counter-transference A recent or similar trauma in the caregiver’s life (does not have to be directly related to the current disaster) Similarities between victim and caregiver Physical and emotional fatigue KCIT 2015 21

22. Compassion Fatigue Caregivers experience trauma by: Listening to the story of the event Through empathetic contact with victims or survivors When they can’t distance themselves from the event KCIT 2015 22

23. Taking Care of Ourselves What activities do you do to take care of yourself? Emotionally Physically Spiritually Identify your support system Personal life At work KCIT 2015 23

24. Exercise KCIT 2015 24

25. Nutrition KCIT 2015 25

26. Humor KCIT 2015 26

27. RESILIENCY AND COPING KCIT 2015 27

28. RESILIENCY Resilience refers to a person’s inherent capacity to moderate and recover from traumatic experience. KCIT 2015 28

29. RESILIENCY Helps to: Prevent stress related disorders Recover faster Maintain peak performance Perform optimally during a crisis KCIT 2015 29

30. RESILIENCY ASSUMPTIONS Everyone has some Skills can be taught and learned Starts in childhood It’s never too late to learn One can prepare for specific, expected crises KCIT 2015 30

31. Resiliency Factors Attitudinal Emotional Behavioral KCIT 2015 31

32. Resiliency Traits Include: Easy temperament Social competence Creative problem-solving skills Ability to tolerate frustration and manage emotions Clear and consistent boundaries Belief in one’s effectiveness Persistence in the face of failure Optimistic outlook Ability to build friendships and seek out support Sense of humor KCIT 2015

33. Latipha Cross : A Story of Resiliency KCIT 2015 33

34. What are your sources of resiliency? 1. What resources have you relied upon since the event that has supported your recovery? 2. Identify individual, family and community resources which could support your recovery? 3. What personal strengths have you utilized to assist in your recovery? 4. Are there things you can learn now to improve your recovery? 5. What steps can you take to achieve a sense of recovery? KCIT 2015 34

35. What are your sources of resiliency? 6. What can you identify as steps to take to achieve your family’s recovery? 7. What steps can you take to help your community achieve its recovery? 8. What will resiliency look like for you, your family, your community? 9. What needs have you identified since the event? KCIT 2015 35

36. Community Resilience KCIT 2015 36 Page 371

37. Coping Expending conscious effort to solve or tolerate personal or interpersonal problems, stress or conflict. Skill The ability to do something from training, experience, or practice. KCIT 2015 37

38. Why Teach Coping Skills? When faced with a problem people first: A. Define the problem B. Try to solve the problem C. Try to live with the problem D. Try to hide from the problem E. Quit trying all together Coping skills are used in helping people try to solve the problem and live with the problem KCIT 2015 38

39. Why Teach Coping Skills KCIT 2015 39

40. Coping Active Coping thinks about a situation to improve or adjust to it Avoidant Coping seeks to keep the situation out of awareness KCIT 2015 40

41. Types of Coping KCIT 2015 41

42. SPECIFIC SKILLS Defense Mechanisms 4 Square Breathing Deep Muscle Relaxation Thought Stopping Journaling Mindfulness Distraction Guided Imagery Exercise Pets Cognitive Restructuring Relaxation Techniques Self Nurturing Prayer Problem Solve Humor Meditation Music Volunteering Sharing (Venting) Letter or Recording to Self Positive Affirmations Art KCIT 2015 42

43. Preparation, Preparation, Preparation 4 Elements of a Safety Plan 1) Outline healthy behaviors to help prevent crises. 2) Identify risk factors that may increase stress. 3) Identify symptoms that indicate a problem may be approaching. 4) Outline what to do in a crisis situation. 43 KCIT 2015

44. Wrap Up We all use skills to get us through the rough times. What other ideas do you have? KCIT 2015 44

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