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The Impact of Trauma Our Patients and Our Selves

This article explores the acute, chronic, and institutional impact of trauma on patients and professionals, and provides strategies for prevention and recovery. It discusses secondary traumatic stress (STS) and vicarious trauma (VT), and how they can be experienced behaviorally, interpersonally, and intrapersonally. It also highlights the importance of identifying STS and VT, and offers strategies for prevention, such as psycho-education, clinical supervision, and self-care. Additionally, it discusses the concept of a trauma-informed system and the impact of trauma on patients and families. The article emphasizes the need to reframe our approach by focusing on what has happened to the patient rather than what is wrong with them, and introduces the 4 R's of Trauma Informed Care: realizing the impact of trauma, recognizing the signs and symptoms, resisting re-traumatization, and responding by integrating knowledge about trauma into policies and practices.

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The Impact of Trauma Our Patients and Our Selves

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  1. The Impact of TraumaOur Patients and Our Selves

  2. Let’s Meditate Briefly…

  3. Narratives of TraumaAcute, Chronic, & Institutional

  4. Impact of Trauma on Professionals

  5. Secondary Traumatic Stress

  6. How do we experience STS & VT? • Behaviorally • Example: Sleeplessness, Cynicism • Interpersonally • Example: Blaming others, Lack of collaboration • Intrapersonally • Example: Self-esteem, Hopelessness NCTSN, 2016; ACA, 2014

  7. How do we experience STS & VT? • Personal Values / Beliefs • Example: Irritability, Rejecting emotional closeness • Job Performance • Example: Low motivation, Over-involved in perfectionism • Cognitive Changes • Example: Sense of self NCTSN, 2016; ACA, 2014

  8. Identifying STS & VT • Supervisors • Organizations • Peers / Colleagues • Formal Assessments NCTSN, 2016; ACA, 2014

  9. Strategies for prevention • Psycho-education • Clinical supervision • Ongoing training • Work-place self-care groups • Self-care • Balanced work-load • Appropriate boundaries NCTSN, 2016; ACA, 2014

  10. Trauma-Informed System • Recognize impact • Recognize exposure is work-place risk • Understand trauma can shape organization • Develop capacity to integrate trauma-informed practice AND policies

  11. Sanctuary Model (2015)

  12. Trauma-Informed System A Trauma-Informed Organization: • Has made trauma-responsive practices the organizational norm. • The trauma model has become so accepted and so thoroughly embedded that it no longer depends on a few leaders. • The organization works with other partners to strengthen collaboration around being trauma informed.

  13. Impact of Trauma on Patients& Families

  14. Exposure to Trauma – Why do some people respond differently? • It is an individual’s experience of the event, not necessarily the event itself that is traumatizing

  15. Reframing Our Approach • What has happened to the patient (caregiver, sibling, community)?” versus “What is wrong with this patient (caregiver, sibling, community)?” (The Sanctuary Model, 2015)

  16. 4 R’s of Trauma Informed Care • Realizing the widespread impact of trauma and understanding potential paths for recovery • Recognizing the signs and symptoms of trauma in patients, families, staff and others involved with the system • Resisting re-traumatization • Responding by fully integrating knowledge about trauma into policies, procedures, practices and settings http://www.samhsa.gov/nctic/trauma-interventions

  17. REALIZING the widespread impact of trauma and understanding potential paths for recovery http://www.balancedweightmanagement.com/TheSocio-EcologicalModel.htm

  18. Domains Impacted by Trauma • Developmental • Young Children • School Aged Children • Adolescents • Adults • Elderly http://www.ncbi.nlm.nih.gov/books/NBK207191/

  19. Domains Impacted by Trauma • Emotional • Young Children: General sense of fear that extends beyond the event • School-Aged Children: Guilt/Shame • Adolescents: Depression, vulnerability • Adults: Increased anger/agitation • Elderly: Depression, fear, confusion • Physical • Somatic Complains • Cognitive • Intrusive thoughts/memories http://www.ncbi.nlm.nih.gov/books/NBK207191/

  20. Domains Impacted by Trauma • Behavioral • Young Children: Difficulty separating from parents; loss of previously acquired developmental skills (Speech, toileting) • School-Aged Children: Sleep disturbances (Difficulty falling asleep, nightmares); difficulty concentrating • Adolescents: Increased risky behaviors • Adults: Substance use • Elderly: Refusal to leave home; withdrawal/isolation • Social/Interpersonal http://www.ncbi.nlm.nih.gov/books/NBK207191/

  21. Resilient Responses to Trauma • Increased bonding with family/community • Redefined or increased sense of purpose and meaning • Increased commitment to a personal mission • Revised priorities • Increased charitable giving and volunteerism http://www.ncbi.nlm.nih.gov/books/NBK207191/

  22. RECOGNIZING the signs and symptoms of trauma in patients, families, staff and others involved with the system

  23. Recognize • Signs of trauma • Behavioral, Emotional, Physical, Relational • Signs dependent upon age, gender, system, culture • Signs manifest differently within different settings • Signs dependent upon family, community, & systems response SAMHSA, 2016

  24. Recognize: Emotional Reactions to Traumatic Events • Internalizing: Depression • Externalizing: Acting out/hostility • Traumatic Stress Reactions: • Re-experiencing • Avoidance • Arousal • Changes in mood • Impairment in functioning: • School success • Quality of life • relationships

  25. Recognize: Emotional Reactions to Traumatic Events Moms of cancer survivors: • Worried about relapse • Seeing my child in pain • Scared about death • Diagnosis – Finding out • Knowing others that died • Feeling sad / scared • Staying in the hospital • Shots • Bone Marrows • Losing hair Pediatric cancer survivors: • Shots • Losing hair • Staying in the hospital • Being in pain • Bone Marrows • Know others that died • Scared about death • Worried about relapse • Feeling sad / scared • Diagnosis –Finding out

  26. RESISTING Resisting retraumatization

  27. RESPONDING by fully integrating knowledge about trauma into policies, procedures, practices and settings

  28. Respond: How Can I Manage My Own Reactions? • Awareness • Normalizing • Taking a time out • Peer Support • Professional Support

  29. End of Session One

  30. Session TwoChaplain Care in Trauma • What Have You Learned So Far? • About the nature of trauma? • About the Impact of trauma on the Caregivers? • About the Impact of trauma on the Patient, Family, and Community? • What can you do to be a more effective Caregiver… • For YOUR population? • For YOUR self?

  31. Time to Meditate

  32. Processing… • What was it like to use your mind that way? • Focus on the Body • Relaxation Response? Stress response? • Focus on the Mind • Judging? Accepting? • Focus on the Present Moment • Lapsing into mental narratives? Letting go of mental narratives?

  33. Mindfulness: An Intentional Break From Stressful Living • The capacity to be fully present • Noticing • Non-Judgmentally • With Authenticity • Non-Reactive Stillness

  34. Psychology & SpiritualityMeeting People “Where They Are” • What is Religion? • What does it mean to “be religious”? • What is Spirituality? • What does it mean to “be spiritual but not religious”? • Can we have a framework to guide us in our Spiritual tasks?

  35. Some Definitions • Religion: The search for significance in ways related to the sacred. • What is the sacred? • Those things set apart from the ordinary, and worthy of veneration and respect. • For Example: concepts of higher powers (God, the divine, and the transcendent) • Objects that are sanctified or take on sacred status by virtue of their association with or representation of the holy • What Else comprises the sacred?

  36. More Definitions • Being Religious = Valuing the search for the sacred, whether formally (Religion) or informally (Spirituality) • Spirituality: The Experience of the sacred • Visceral, often non-rational • May lead to Noesis (the cognitive process that results from spiritual experience)

  37. I’m Spiritual but not Religious • Actually may mean: • I am very concerned with Religious Questions, but… • I’m not satisfied with the answers that dogmatic religions have for these kind of questions. • I want to find my own answers.

  38. What works? • What ways has “Religion” helped you to help others? • Or been an impediment to your helping relationship? • What ways has “Spirituality” helped you to help others? • Or been an impediment to your helping relationship? • How have you worked with people who describe themselves as neither spiritual nor religious?

  39. Negative (Religious) Coping • Includes • Questioning the powers of God • Expressions of anger toward God • Expressions of discontent with Religion • Punitive religious appraisals of life & suffering • Demonic religious appraisals. • Derived from an insecure Attachment Style with: • God, Religion, and..relationships in general • Our job is to establish Secure Attachment

  40. Positive (Religious) Coping • Includes • Benevolent (religious) appraisals of negative situations • Collaborative (religious) coping • Seeking (spiritual) support from God and others • Valuing (religious) forgiveness. • Derived from a Secure Attachment Style with: • God, Religion, and..relationships in general • relationship with God, a sense of spirituality, belief that there is meaning in life, sense of spiritual connectedness to others. • Our job is to establish Secure Attachment

  41. (Religious) Coping • Self directed coping: I have to do this on my own • (i.e. God can’t help me) • Deferring coping: I can’t do this at all. I have to completely depend on some other power • (i.e. Only God can help me) • Collaborative coping: I can do this but I need help and will accept that help • (i.e. God and I must work together) • Of the three, Collaborative coping has the highest associations with overall well-being

  42. What about Self Care? • Self Care = Promoting Resilience • Resilience = Successful Adaptation to Adversity • A quality that people have to one extent or another (i.e. Resilient People) • Two Factor Model of Resilience • Recovery (How well people bounce back and recover from challenge; i.e. loss of equilibrium regained equilibrium) • Sustainability (Capacity of people to continue forward in the face of adversity; i.e. not lose equilibrium)

  43. Resilience in Two Factors • Recovery from Current Adversity: • You Lose Equilibrium • Go through a process of recovery (exercise resilience) • Return to Equilibrium (and previous level of Sustainability) • Sustained Individual Resilience: • The amount of stress that a person can endure without a fundamental change in capacity to pursue aims that give life meaning • Sustainability = Preserving valuable engagements in life’s tasks at work, play, and in social relations

  44. Everyday Resilience • Positive Religious Coping Skills • Benevolent (religious) appraisals of negative situations • Collaborative (religious) coping • Seeking (spiritual) support from God and others • Valuing (religious) forgiveness.

  45. Everyday ResilienceAntidotes that Work • Rest • The Relaxation Response Restores • e.g. Mindful activities • Nutrition • Glucose Replenishment • Positive Affect • Laughter IS the best medicine! • Exercise • Balance Rest With Aerobic Exertion

  46. Sustaining Resilience • How do you build up the “muscle” of ego strength? • Living Intentionally • Strong Commitments to Religious and/or Spiritual Practices • And any practice that requires Persistence • Establishing structure and routine in your life

  47. Resilience and Well Being • It’s a hard life sometimes! • Learn to be mindful of your mind/body • Accept when you’re overwhelmed • Know the Antidotes • Establish Resilience Practices • Build Inner Strength EVERY day!

  48. What are your “Take Aways”?

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