USING SELF-DEFENSE TRAINING AND GROUP THERAPY AT A COLLEGE COUNSELING CENTER TO TREAT FEMALE TRAUMA SURVIVORS

Transcription

1 USING SELF-DEFENSE TRAINING AND GROUP THERAPY AT A COLLEGE COUNSELING CENTER TO TREAT FEMALE TRAUMA SURVIVORS AMERICAN GROUP PSYCHOTHERAPY ASSOCIATION FEBRUARY 27, 2016 KAREN CHASEN, JD, PREPARE/IMPACT JENNIFER VOGEL- DAVIS, PSYD, MONTCLAIR STATE UNIVERSITY LISA WEINBERG, PHD, MONTCLAIR STATE UNIVERSITY

2 OBJECTIVES Provide information about how trauma impacts the mind and body Provide rationale for developing this program Discuss related research Support for a group therapy component Description of the development and implementation of the program Data collected from the participants in years 1-3 Provide an experiential component of self-defense training Provide an experiential component of trauma-informed group therapy Discussion of experiential components

3 HISTORY OF TRAUMA Childhood sexual abuse Physical abuse Assault Rape Relationship violence

4 STATISTICS OF MSU STUDENTS WITH A HISTORY OF TRAUMA Approximately 22 % of students seen for an intake evaluation at CAPS reported a history that includes an unwanted sexual experience Approximately 33% of students seen at CAPS reported a history of harassing, controlling and/or abusive behavior from another person

5 RESEARCH ON FEMALE STUDENTS WITH A HISTORY OF TRAUMA Women with a history of trauma: Are more likely than other women to be revictimized Frequently blame themselves for their victimization Often don t have the confidence or skills to verbally assert themselves or physically defend themselves Don t believe they have the right to advocate for themselves Are less likely to attend a more traditional self-defense course taught by police officers since it may not feel safe

6 SYMPTOMS RELATED TO STUDENTS WITH A HISTORY OF TRAUMA PTSD symptoms (DSM 5, 2013) - Intrusion, avoidance, negative changes in thoughts and mood, marked alterations in arousal and reactivity Decreased self-efficacy Decreased self-esteem Poor body image Shame/self-blame about trauma history Difficulty with assertiveness Decreased academic success

7 RESEARCH ON EFFECTIVENESS OF SELF- DEFENSE TRAINING AND FOR THIS POPULATION Improvements in the following: personal safety skills feelings of self-efficacy perceptions of one s body assertiveness in relationships feelings of empowerment self-confidence Decreases in the following: psychological distress shame and self-blame PTSD symptoms feelings of vulnerability, fear & anxiety

8 Instilling hope BENEFITS OF GROUP FORMAT Feeling less alone and learning that they are not crazy. Providing support and group cohesiveness Providing psychoeducation Building stronger connections

9 DEVELOPMENT AND IMPLEMENTATION OF THE PROGRAM

10 PARTNERSHIP WITH SELF-DEFENSE TRAINING PROGRAM Program was coordinated with Karen Chasen of Prepare, Inc/IMPACT in New York City

11 RECRUITMENT All-campus s and flyers Collaborated with University Health Center, Women s Center, Women and Gender Studies Program, University Police Department, Dean of Students, LGBTQ Center Psychoeducation about program for all CAPS staff CAPS website, other MSU websites

12 SCREENING FOR PARTICIPANTS minute individual screenings for the group minute clinical intake Criteria for inclusion: 18+ year old female MSU student History of trauma Psychologically stable enough (not in crisis) In individual therapy or agreed to work with an individual therapist at CAPS or in the community

13 STRUCTURE OF THE PROGRAM 9 GROUPS Group #1 and #2: 90 minute group sessions to help students bond and prepare for the self-defense class (discuss confidentiality, possible retriggering, supports, coping mechanisms, crisis resources) Groups #3-8: 3 hour empowerment self-defense class followed by a 1-hour group counseling component Group #9: 90 minute group session to process their experiences and impact of the program and termination

14 CONTENT OF THE PROGRAM

15 WHAT HAPPENS DURING TRAUMA During trauma the fight/flight response is activated by the sympathetic nervous system (adrenaline rush increases the heart rate and respiration) Another common response that is not talked about as much, but is very prevalent in relational trauma survivors is a freeze /submit response that is activated by the parasympathetic nervous system (decreased heart rate and respiration leading to physical collapse) In order to mobilize survival responses, the frontal lobes ( the thinking brain ) go off-line, making it very difficult to problem-solve or reason.

16 ADRENALINE MANAGEMENT The process of learning self-defense is anxietyproducing and we want students to learn in this adrenalized state so that they learn to manage their anxiety and other physiological responses and are able to defend themselves even when they are highly anxious Self-defense training aims to teach individuals ways to bring the frontal lobes back online and activate their verbal and physical resources to defend themselves

17 WINDOW OF TOLERANCE After the trauma is over, trauma survivors remain prepared for danger Their ability to stay within a regulated state (the Window of Tolerance ) is compromised, leading to chronic hyperarousal and/or hypoarousal Adrenaline management helps individuals to stay within their Window of Tolerance so that they can more effectively manage threatening situations. Flipchart: Fisher, J. (2011). Psychoeducational Aids for Working with Psychological Trauma

18 GROUNDING TECHNIQUES Grounding is a technique that helps keep someone in the present. They help reorient a person to the hereand-now and in reality. Grounding skills can be helpful in managing overwhelming feelings or intense anxiety. They help someone to regain their mental focus from an often intensely emotional state. It helps them to stay within the Window of Tolerance so that they are able to defend themselves. Examples of grounding: using the 5 senses

19 THREAT ASSESSMENT Listening to/trusting your instincts which can be impeded by trauma Behavior: Reading people s actions and words Environment: Assessing situations for danger Context: Does behavior/situation match the environment and/or the relationship

20 THREAT MANAGEMENT Awareness of surroundings Using avoidance strategies Attending to your own body language Attending to non-verbal cues of people in your environment Organizing your body (orient, breathe, ground, confident posture)

21 VERBAL STRATEGIES Boundary-setting Negotiation De-escalation Lying Accessing help of allies, bystanders and others

22 PHYSICAL RESISTANCE STRATEGIES: TECHNIQUES Open-handed strikes (to throat and groin ) Eye strikes Elbow strikes (to head) Knee strikes (lower thigh to groin and head) Kicks (to the head and groin) Using hips, leverage, and strikes to escape from being pinned

23 RESEARCH COMPONENT OF THE PROGRAM Voluntary IRB approval Participants signed consent forms Research measures administered through pre and post testing (three times) At the beginning of group #1 After group #9 5 months after program completion

24 RESEARCH MEASURES Background Questionnaire Post-Traumatic Stress Disorder (PTSD) Checklist Interpersonal Self-Efficacy Scale Self-Defense Self-Efficacy Scale

25 RESULTS OF THE RESEARCH SURVEYS The pre and post data (1 st, 2 nd and 3 rd years of the program, N=22) from the surveys were analyzed using a paired samples t-test and the results were the following: Significant decrease in PTSD symptoms based on the results of the PCL Checklist. t=4.49, p>.001 Significant increase in interpersonal self-efficacy based on the results of the Interpersonal Self-Efficacy Scale. t=-11.61, p<.001 Significant increase in self-defense self-efficacy based on the results of the Self-Defense Self-Efficacy Scale. t=-9.37 p<.001

26 EXPERIENCE OF PROVIDING THIS PROGRAM ON A COLLEGE CAMPUS Roles of the self-defense trainers and the therapist Debriefing after each session by the facilitators Challenges faced by the participants and the facilitators Benefits for the participants

27 ROLES OF THE SELF-DEFENSE TRAINERS (KAREN AND ERNEST) Teach personal safety and self-defense skills through demonstrations, drills and role-plays Create scenarios that range from verbal harassment to realistic assault situations Teach students new responses to threatening situations and how to manage adrenalized reactions Create a safe environment Provide psychoeducation on patterns of interpersonal violence, risks of victimization & predatory patterns

28 ROLES OF THE THERAPISTS: IN THE SELF-DEFENSE CLASS (LISA AND JEN) Demonstrate techniques act as role models for the students and provide opportunities for observational learning (we each took the class before facilitating this program) Provide support to all the students by being present and active participants in the class Provide as-needed support to individual students through grounding, reassurance and assistance with re-engagement in the class

29 ROLES OF THE THERAPISTS: IN GROUP COUNSELING Provide psychoeducation on trauma reactions Create a safe and supportive environment Help students to identify triggers and develop a plan to work through triggers that may be activated in class (e.g. doing a sexual assault scenario or being touched on the neck) Help students to set boundaries (not do a particular scenario) if they are not comfortable Encourage students to develop a support system in the class and to utilize their support system outside (therapist, family, friends etc.) Help students to process their reactions in class and manage their symptoms

30 DEBRIEFING AFTER EACH SESSION 45 minute phone conference between self-defense instructor and therapists after each session to do the following: Process what happened in class Therapist reports to instructor about group counseling Plan for the content of the next session Discuss the level of support needed overall and for individuals Plan to intervene as needed with various participants

31 CHALLENGES FACED BY THE PARTICIPANTS To come to class despite anxiety not using avoidance as a coping mechanism Staying present while facing painful memories and dealing with stressful situations (instead of dissociation or flashbacks) Managing shame and distress at having strong emotional reactions to class material (especially in the first few classes) Accessing voice under stress Feeling that you have the right to protect yourself Managing co-morbid problems (e.g. physical health, financial, dysfunctional families, contact with aggressors, academic issues, unhealthy eating and sleep issues)

32 GOALS FOR THE FACILITATORS Preparing participants for the group Creating a safe environment for individuals who tend to feel unsafe Encouraging the participants to stay with it even when they wanted to give up Coping with participants who dissociated in class and had flashbacks Learning each person s unique learning style and how they best like to be coached and supported Being aware of more subtle group dynamics

33 BENEFITS FOR THE PARTICIPANTS Reduction of PTSD Symptoms: Fewer nightmares and flashbacks Less anxiety Feeling safer in the world Becoming connected to others in a healthier way Feeling less ashamed of the past Feeling less self-blame and as damaged Having better functioning overall e.g. fewer missed classes or work days

34 BENEFITS FOR THE PARTICIPANTS Increase in Their Own Agency: Better able to set limits with other people Embodied confidence and empowerment to stand up for themselves Know they have the right to protect themselves Know how to use their voices and set boundaries Better able to use direct verbal communication Develop effective coping mechanisms

35 BENEFITS FOR THE PARTICIPANTS Improvement in Social Functioning and General Well-Being: Feeling less isolated, alone and misunderstood Able to engage in healthier intimate partner, friend, and family relationships Appreciating their role in their healing process and that it can be a life-long process Develop a deeper understanding of the role of society and culture with regard to interpersonal violence Experience a transfer of skills to all aspects of life able to take on new challenges

36 QUOTE FROM ONE PARTICIPANT The best part of this group was not only the physical selfdefense and verbal lessons, but the amazing women in the group. It really was eye-opening to see how I am not alone. Even though I knew I wasn t alone, the fact that other women who went through the same or similar situations were standing next to me, supporting me and each other, really made the difference. Many women of the group have trust issues, myself included, but I felt that we finally found a place where no judgment existed a trust that was immediately built because of our past. I know the knowledge I ve obtained and bonds created will last for a lifetime.

37 REFERENCES American Psychiatric Association : Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition. Arlington, VA, American Psychiatric Association, Brecklin, L.R. (2004). Self-defense/assertiveness training, women s victimization history, and psychological characteristics. Violence Against Women, 10, Brecklin, L.R. & Middendorf, R.K. (2014). The group dynamics of women s self- defense training. Violence Against Women, 10, Cermele, J.A. (2004). Teaching resistance to teach resistance: The use of self-defense in teaching undergraduates about gender violence. Feminist Teacher, 10 (1), Fraser, K.L. & Russell, G.M. (2000). The role of the group in acquiring self-defense skills: Results of a qualitative study. Small Group Research, 31, Hollander, J. (2004). I can take care of myself : The impact of self-defense training on women s lives. Violence Against Women, 10, Rosenblum, G.D. & Taska, L.S. (2014). Self-defense training as a clinical intervention for survivors of trauma. Violence Against Women, 20(3), Yalom, I.D., & Leszcz, M. (2005). The theory and practice of group psychotherapy (5 th ed.). New York: Basic Books.

38 VIOLENCE AGAINST WOMEN: AN INTERNATIONAL AND INTERDISCIPLINARY JOURNAL Special Issue: Self-Defense Against Sexual Assault. Volume 20, Number 3, March 2014

39 SPECIAL THANKS Thanks to a Community Action Grant from American Association for University Women (AAUW) I was able to bring this program to MSU. Thanks to Montclair State University for funding the yearly continuation of this program. Thanks to Karen Chasen and Ernest Wawiorko from Prepare, Inc/IMPACT for their collaboration with CAPS at MSU to make this program possible.

40 CONTACT INFORMATION For more information about this outreach program or for a copy of this presentation, please contact Lisa Weinberg at Montclair State University: weinbergl@mail.montclair.edu For more information about the personal safety/self-defense program, please contact Karen Chasen at Prepare, Inc/IMPACT in NYC: prepareinc@verizon.net