Cognitive Behavioral Principles and Trauma Infromed

Transcription

1 Dimensions of Correctional Ministry CM301 LESSON 14 of 24 This course is offered through Christian University GlobalNet (CUGN). To learn more, visit us at Dr. Karen Swanson Director of the Institute for Prison Ministries (IPM) at the Billy Graham Center at Wheaton College. In this lecture we will take a closer look at cognitive behavior principles and trauma informed care which are used with inmate programming. Cognitive behavior therapy is one of the few forms of psychotherapy that has been scientifically tested and found to be effective in hundreds of clinical trials for many different disorders. In contrast to other forms of psychotherapy, cognitive therapy is usually more focused on the present, more time-limited, and more problem-solving oriented. In addition, inmates learn specific skills that they can use for the rest of their lives. These skills involve identifying distorted thinking, modifying beliefs, relating to others in different ways, and changing behaviors. Researchers have found that criminals who persist in a life of crime often hold a distinct set of beliefs, immoral cognitions that lead to criminal behavior. The conceptual framework used with cognitive behavior begins with an event. Belief and attitudes about the event influence the person s thinking and feelings, which lead to their actions or behavior. Let s look at each of the parts of the framework in more depth. An event occurs in a person s life, for example, getting stopped by the police. Beliefs are formed about an object, people, or people group. They are formed by direct observation and experiences (for example, a bad or unjust experience with the police leads to a belief that all cops are bad) or formed inferentially by an outside source (people what they hear or read or past experiences), what is taught (hearing someone tell about an unjust interaction with the police). The strength of beliefs varies. It depends on the importance of the object, people, or people group and the intensity of the experience. An attitude represents a person s general feelings of favorableness or unfavorableness toward some stimulus object or event. In the conceptual framework, as a person forms beliefs about an object, he automatically and simultaneously acquires an attitude toward that object. Factors such as race, gender, and community influences attitudes. Attitudes are reflected through feelings (sad, angry, happy, etc.) and verbal statements such as I like the police or I am afraid of the police. 1 of 12

2 A person often has several thoughts about a situation or event. Not all thoughts result in an action or behavior. Having self-awareness of one s thoughts and thinking about the consequences can help prevent impulsive and poor decisions. Feelings are emotions that influence our behavior. The same event may trigger an angry response in one person and a neutral response in another just as an event may trigger an excited response in one person and no response in another. Beliefs, attitudes, thinking, and feelings lead to observable actions or behaviors. If I believe that life is unfair and I can t do anything about it, I have a feeling of hopelessness and little to no motivation to pursue goals, which leads to reactive responses to life rather than being proactive and pursuing goals that can improve life. The two major components of cognitive behavior intervention are cognitive restructuring, which addresses the antisocial beliefs and thinking patterns which contribute to crime or what they think; and cognitive skills help to develop social interaction skills or how they think. This includes anger management skills, social skills, and problem-solving skills. Thinking for a Change is a program developed by the Institute of Corrections and available for free. Thinking for a change or making positive-thinking changes is a skill. The following steps are used: 1. Pay attention to your thoughts and feelings. This involves selfawareness. 2. Recognize when there is risk, that your thoughts and feelings are leading you into trouble. 3. Identify any beliefs or attitudes contributing to thinking errors. 4. Replace beliefs, attitudes, and thinking errors with responsible, prosocial, and moral thinking. Let s look at each of these steps. First is learning to pay attention to your thoughts and feelings. For example, you are walking down the street and see a wallet on the sidewalk. What are the thoughts and feelings of a criminal? Thoughts: Only an idiot would have lost their wallet. Did anyone see me pick it up? This is my lucky day. How much money is in the wallet? 2 of 12

3 Feelings: You feel excited, entitled, energized. Belief: I have to get mine before someone else. Action: Take the wallet. Now think like a Christian. Thoughts: Someone must be missing the wallet. How much money is in the wallet? Who does it belong to? How can I return it to the owner? I can use the money. This is a gift from God, I can keep some, and pay tithe off of it. I need to find a name and get it back to the person. This isn t mine to keep. Feelings: You are concerned for the person who lost it, but conflicted because you want to keep it. Beliefs: Do unto others as you would have them do unto you. Be honest. What would Jesus do? Action: Find the owner. Step 2: Identify risky thoughts. Risky thoughts will lead to harmful or unlawful actions. Scenario: Your friend offers you a drug to get high. You are on probation and will be drug tested. Thoughts: Man, I d like to smoke a fat log. I d have time to get clean before my next test. Screw the man, there s nothing wrong with it. It helps me sleep good. One joint wouldn t hurt me. Feelings: Desperate, defiant Attitude/Belief: No one has the right to tell me what to do. I deserve this. Action: Get high. Most of the thoughts, feelings, attitudes, and beliefs were risky. The only one that wasn t was, What if I don t pass my next test? Learning to identify thinking errors and replacing them with prosocial and biblical thinking will increase responsible, Christlike behavior. 3 of 12

4 Dysfunctional thinking is foolish thinking that leads to solving problems without proper regard for others and leads to irresponsible behavior. Everyone at times exhibits dysfunctional thinking, but dysfunctional thinking is a lifestyle for offenders and often more than one thinking error is occurring simultaneously. Samenow is credited with identifying criminal thinking. These thinking errors were introduced in Lecture 13. The thinking errors often lead to irresponsible behavior and society promotes responsible thinking and behavior. But as Christians our thinking should go beyond being responsible and we should think Christianly. God s Word tell us in Romans 12:2, Do not conform any longer to the pattern of this world, but be transformed by the renewing of your mind. Then you will be able to test and approve what God s will is his good, pleasing, and perfect will. As we work with justice-involved persons, we need to teach biblical truths. Let s look at the thinking errors versus what Christians should think. Please refer to the Truthought.com Corrective Thinking Process pocket guide. Closed thinking is characterized by an unwillingness to listen to others and belief that everyone lies, cheats, and steals. Closed thinking is a failure to be receptive, failure to disclose information, and failure to be self-critical. It is the most common thinking barrier. Believers listen to wisdom and are truthful with God, ourselves, and others. The victim role or victim stance is when they feel like authorities unfairly pick on them and blame others for their problems. As Christians, we need to be responsible for our beliefs, attitudes, and actions so that they reflect Christ. We cannot control what life brings us, but we can control our response. I m okay self-image is a failure to be self-critical taken to an extreme, and a disproportionate amount of attention is focused on the things they view as good in themselves. For example, they believe they are a good parent because they say they love their children and don t prostitute them for drugs. A Christian should acknowledge their anti-social behaviors, not compare themselves to others but to God s standards, and respect others. Reckless careless attitude: Where they look for the easy way out of any problem--not long-term solutions and make decisions without thinking about how it affects those around them. Christians should plan and persevere. They do not quit when things get tough, and they show empathy for others Instant gratification is where they look for short-term pleasures, but never consider long-term consequences. As Christians, we should be patient and willing to delay gratification (staying sexually pure until married, not overspending on our credit cards). 4 of 12

5 Fear of losing face is a pattern of thinking that protects a false image of themselves. They act over-confident to avoid revealing their insecurities. As Christians, we need to be self-aware, open, and honest about our weaknesses and our need for help at times. Power control are people with a compulsive desire to control every person and situation. They view relationships from an exploitive position, what s in it for me, not sharing. Christians should be unselfish and loves others. Possessive attitude: They take because they want it not because they earned it. Christians should respect the property of others and not steal. Superior uniqueness: They believe rules and laws don t apply to them because it s an unfair world, whereas Christians are humble and accountable to God. Truthought identifies tactics that those with thinking barriers use to block change and nurture harmful, destructive lifestyles while continuing to live irresponsibly. These tactics are identified and grouped into three categories. Shifts blame or focus. Attempts to confuse. Points out others faults. Builds up self by putting others down. Makes a big scene over minor issues. Accuses others of misunderstanding. Uses anger as a way to control others. Argues over words to avoid the real issue. Introduces irrelevant issues (race/gender). Puts others on the defense by embarrassing. Lies and deceives. Deliberately vague. I was hanging out with some friends. Avoids obligations. I forgot. You didn t tell me. Tells others what they want to hear, not the whole truth. I need to go to church. Omits facts, exaggerates, tells what pleases self. Says yes or agrees without meaning it. 5 of 12

6 Ignores obligations. Does not pay attention. Chooses only what is self-gratifying. Refuses to communicate or participate silence. Minimizes behavior. No big deal. I just got into a little trouble. Everybody does it. Says I ve changed after doing one right thing. Some of the ways to help combat thinking errors is to ask: What is your responsibility in this? What are you thinking about this situation? What tactic are you using? What thinking barrier are you using? What does the Bible say about this? They may not know. This is a time to educate on biblical truth. What choice are you making? Is this what you want? What do you think God wants you to do? We now move into trauma therapy. Trauma therapy is also an evidence-based practice. Expert Stephanie Covington has developed separate curriculum for male and female inmates. The material in this section comes from her teachings. A person who is dealing with trauma is not able to think clearly. Therefore trauma-informed practices should be utilized and used prior to cognitive behavioral practices. Addressing trauma is often avoided by those in ministry because of the fear that by dealing with it, it will bring up areas where the volunteer or chaplain may not be skilled or trained to deal with and cause more trauma. But this is an unfounded fear. Trauma occurs when an external threat overwhelms a person s internal and external positive- coping resources. It may be a single event or enduring, ongoing events which is more complex. For the purposes of this lecture, we will identify events experienced by offenders. Examples of events include: Emotional, sexual, or physical abuse Neglect Abandonment (especially for small children) Extremely painful and frightening medical procedures (I included this one because pregnant female offenders are often shackled to the bed when giving birth. This can be a painful and traumatic event.) 6 of 12

7 Domestic violence Victim of trafficking Stigmatization Immigration Witnessing violence such as a parent harming another parent The unexpected/violent loss of a loved one (even a pet) Intergenerational (cultural) trauma Rape or assault Muggings Burglary Other traumatic events: automobile accidents, natural disasters, terrorism, combat/war, torture, catastrophic injuries and illnesses, kidnapping Using trauma-informed practices means to: Take the trauma into account when providing services. Avoid triggering trauma reactions. What thoughts, smells, sights, actions may trigger a traumatic reaction? Adjust organizations so that trauma survivors can access and benefit from services. Are there any triggers in your organization? Trauma affects both males and females. As children, boys and girls suffer similar rates of abuse. For girls, it is typically sexual abuse; and for boys, it is typically emotional neglect or physical abuse. In adolescence, boys are at greater risk if they are gay, young men of color, or gang members. The abuse comes from people who dislike or hate them. For young women, the abuse comes from relationships, from the person to whom she is saying, I love you. In adult men, the trauma comes from combat or being a victim of a crime (most often by a stranger). For women, it is in a relationship, the person who says I love you or in the military by those who she serves with. The core values of a trauma-informed environment are: Safety: Ensuring physical and emotional safety Trustworthiness: Maximizing trustworthiness, modeling openness, maintaining appropriate boundaries, and making tasks clear (don t recreate a dysfunctional family, provide structure: start on time, be consistent) Choice: Emphasizing individual choice and control Collaboration: Providing equality in participation, sharing power, and creating a sense of belonging 7 of 12

8 Empowerment: Striving for empowerment and skill building Traumatic Event Overwhelms the physical and psychological coping mechanisms Response to Trauma Fight or flight, freeze, altered state of consciousness, body sensations, numbing, hypervigilance, hyperarousal Women who have experienced traumatic events describe feelings of intense fear, helplessness, and anxiety. These are normal reactions to an abnormal or extreme situation. There are changes in the brain, and the person s nervous system also becomes sensitized and is vulnerable to any future stressors. Sensitized Nervous System Changes in the Brain A person may be triggered in their current life by reminders of a past traumatic event. A single environmental cue related to the trauma such as a noise, a sound, a smell, or another person s presence can trigger a full fight-or-flight response. The trigger creates a painful emotional state and affects subsequent behavior. Women may overrespond to neutral cues and underrespond to danger cues. Learning to cope when becoming emotionally stressed is a skill that is taught when working with trauma victims. Current Stressors Reminders of trauma, life events, lifestyle 8 of 12

9 Painful Emotional State The behaviors often seen can be placed into three categories: retreat, selfdestructive action, and destructive action. People often have more than one type of response it is messy. Women tend to retreat and use self-destructive actions. Men tend to use self-destructive actions and destructive actions. Retreat S e l f - Destructive Actions Destructive Actions Isolation Substance Abuse Aggression Dissociation* E a t i n g Disorders Violence Depression Deliberate Self-Harm Rages Anxiety Suicidal actions *Those who have experienced trauma, particularly in childhood, often learn how to separate themselves from the distress associated with the trauma by using a psychological response called dissociation, a process that disconnects the mind from the body, for example sexual abuse. When individuals dissociate, they seem to watch from a distance to maintain a sense of what s happening without having to be part of the experience. When facilitating a group, you may have inmates who are attending but periodically aren t there. They have psychologically left the group. This defense mechanism is very useful when one is being abused. Decreasing dissociation consists primarily of first grounding the person, ensuring that they have the ability to self-soothe and manage stress. 9 of 12

10 Grounding Exercise Anytime a person feels uncomfortable, they can utilize the grounding exercise. The grounding exercise involves your 5 senses. Let s practice it. Name 5 things you can see. Name 4 things you can touch. Name 3 things you hear. Name 2 things you can smell. Name 1 thing you can taste. This grounding exercise brings you right here in the moment rather than back to the trauma experience. A history of abuse or family violence drastically increases the likelihood that a person will abuse alcohol and other drugs. Survivors of abuse can become dependent on alcohol and/or other drugs in part as a way of managing their trauma symptoms and reducing the tension and stress from living in violent situations. Many addicted women are trauma survivors who use alcohol or drugs in order to medicate the pain of trauma. They are also more vulnerable to violence because of relationships with others who abuse substances, impaired judgment while using alcohol or drugs, and finding themselves in risky and violence-prone situations. These create a cycle of victimization, abuse of alcohol and other drugs, interrupted emotional development, limited coping skills, more substance abuse, and increased vulnerability to further victimization. The primary responses to trauma include our emotions: dysregulation difficulty regulating emotions; behavior: unmanageable relationships; lack of connection; trust. Primary issues for children are attachment has not been developed so it hinders their ability to develop healthy relationships; regulation they have a difficult time regulating their feelings and behavior; competencies trauma affects their ability to learn. Traumatic experiences often play an important role in an individual s physical and mental health problems. A number of disorders are related to trauma, including post-traumatic stress disorder (PTSD). Some symptoms of PTSD are: Reexperiencing, including intrusive symptoms such as flashbacks, nightmares, intense or prolonged distress, and viewing the world as unsafe. Numbing and avoiding symptoms such as emotional numbness, memory loss for certain events, ability to remember memories or feelings but not both, mistrust of others, avoiding people, places, and 10 of 12

11 situations which are triggers or reminders, and disconnection. Negative emotions and thoughts such as blaming, excessive negativity, fear, anger, shame, diminished interests, feelings of isolation, loss of faith and hope. Arousal symptoms such as angry outbursts, reckless and dangerous behavior, hypervigilance, difficulty sleeping. The ACE Study (Adverse Childhood Experiences) is a series of 10 questions. For the following questions, answer yes or no. Before age 18, you experienced: Recurrent and severe emotional abuse Recurrent and severe physical abuse Inappropriate contact sexual abuse Emotional neglect Physical neglect Grew up in a household with: Both biological parents not being present Your mother being treated violently An alcoholic or drug user A mentally ill, chronically depressed, or family member attempting suicide A family member being imprisoned. A score of 4 or more has adverse effects. Women are more likely to have a score of 5 or more. ACEs still have a profound affect 50 years later, although now transformed from psychosocial experience into organic disease, social malfunction, and mental illness. Smoking Alcoholism Injection of illegal drugs Obesity There are critical and interrelated issues of addiction, mental health, trauma, physical health, and crime. You don t need to assess; it is safe to presume the people we serve have a history of traumatic stress and exercise universal precautions. We need to be 11 of 12

12 more caring in all interactions with inmates. This lecture is just an introduction to trauma-informed practices, and I encourage you to gain more training. Provide short-term intervention. Train volunteers in trauma. Utilize curricula on trauma such as Beyond Trauma: A Healing Journey for Women; Beyond Trauma: A Healing Journey for Men by Stephanie Covington. Integrate faith and learning. Provide friendship/counseling one hour makes a difference. Spend time with an individual. I understand that you have experienced. Tell me how that has affected you later in your life. Then apply reflective and empathetic listening. Listening for both the content and the emotions. Don t try to fix or explain the experience. You are giving them the gift of love through quality time and acknowledging their life experience. For many, they may have never talked about it with anyone. You can also provide coping tools such as the Grounding Exercise and asking, Who in your life is in your support system of who you can call when you feel overwhelmed or stressed? People who share often feel overwhelmed. Covington has taught incarcerated women to be able to listen and facilitate groups. You do not have to be a trained counselor, but you do need to have quality listening skills and be empathetic. This lecture has provided an introduction of trauma therapy and cognitive behavior principles. These practices will be further developed in the course The Dynamics of Working with Offenders. This course is offered through Christian University GlobalNet (CUGN). To learn more, visit us at 12 of 12