Responding to Behavior Through a Trauma Informed Lens Jennifer Hixson, PsyD, BCBA Corporate Clinical Director Piney Ridge Center Waynesville MO Objectives! Day 1:! Subjective Units of Distress! Stress Response System! Day 2:! Trauma Informed Ways of Being with youth! Frameworks! Messages in the Behavior! What to do?! Other Resources! Subjective! Units of! Distress! Scale 1
9 8 10 6 7 4 5 2 1 3 0 SUDS Williams & Poijula, 2002! 0 I am completely relaxed, with no distress. I may be deep in sleep.! 1 I am very relaxed. I may be awake but dozing off.! 2 I am awake but feel no tension! 3 I feel a little bit of tension; it keeps my attention from wandering.! 4 I am feeling some mild distress, apprehension, fear, or anxiety, and body tension! 5 My distress is somewhat unpleasant but I can still tolerate it.! 6 I am feeling moderate distress and unpleasant feelings. I have some worry and apprehension.! 7 My body tension now is substantial and unpleasant, though I can still tolerate it and think clearly.! 8 I am feeling a great deal of distress with high levels of fear, anxiety, and worry. I can t tolerate this level of distress for very long.! 9 The distress is so great that it is impacting my thinking. I just can t think straight.! 10 I am in extreme distress. I am totally filled with panic and I have extreme tension throughout my body. This is the worst possible fear and anxiety I could ever imagine. It is so great that I just can t think at all. 9 8 10 6 7 4 5 2 1 3 0 2
2! 1! 3! 4! 5! 6! 0! 7! 8! 9! 5/11/15 Anger to Emotion! 10! Distress 9 8 10 6 7 4 5 2 1 3 0! Stress Response System! The way the Body! Responds! To Stress 3
Window of Tolerance Green Zone Hyper-arousal Pink Zone Flooded Red Zone 4
Hypo-Arousal Light Blue Zone Dissociation Blue Zone Brake Pedal Gas Pedal Combo 5
Dissociation Brake Pedal Gas Pedal Blue Zone Freeze Hyper-Vigilance Combo 9 8 10 7 6 5 4 3 2 1 0 Stress Response System Fear Response System Dissociation Freeze Combo Fight Flight Thinking System is Off-Line 6
Trauma Informed Ways of Being with Youth Neurorelational Framework Lillas, Turnbull 2010 Attachment, Regulation and Competency Model Bluestein and Kinnigburgh Systemicc A.R.C.: A Framework For Intervention with Complexly Traumatized Youth Familiall Individuall TRAUMA EXPERIENCE INTEGRATION COMPETENCY SELF- REGULATION Executive functions Self development ATTACHMENT Affect Identification Modulation Affect Expression Caregiver affect management Attunement Consistent response Routines and Rituals Kinniburgh & Blaustein (2005); Blaustein & Kinniburgh (2010) 7
Messages Under the Behavior! Attachment Regulation Competency Framework! Teach caregivers to be Feelings Detectives look beyond the behaviors to determine the underlying emotion, learn to interpret the function of behavior and identify triggers Attunement! Attachment Regulation Competency Framework! Capacity of caregiver to accurately read child s cues and respond appropriately, responding to the underlying emotion rather than the behavior! What is the SUDs level?! What is the color? Competency Vs. Capacity! What the youth is able to do! How well the youth is able to do at any given moment 8
Know the Regulation System! The capacity for deep sleep cycling! The capacity for alert processing! The capacity for the adaptive expression of all stress responses! The capacity for distinct states of arousal and smooth transitions between them! The capacity for connection to visceral cues! The capacity for efficient stress recovery When meeting with Youth! Know the sensory preferences that might help keep the youth regulated Sense: Trigger Preference Sight A baseball cap An item placed in an office A preferred picture Safe Place Sound Loud Noises Preferred Music Touch Smell Taste Any unsolicited Certain parts of the body * Anything link from a past trauma Anything connected to past stressors Felt / Fuzzy Material A anchor item Vanilla Lavender Sucking Crunching * Keep in mind smell goes right to the limbic system and bypasses the EF When meeting with Youth! Know the sensory preferences that might help keep the youth regulated Sense: Trigger Preferences / Supports Vestibular Being off balance Have a sturdy chair with arms Proprioceptive Not feeling solidly grounded in his/her body, space, and time Have a sturdy chair, where feet can be placed solid on the ground Slow down movement during transitions Take a non-cluttered route to your office 9
Know their meaning making system! The capacity to flexibly experience, express, and modulate a full range of emotions in ways that are appropriate to context! The capacity to learn from experience by scanning and accessing a full range of memories that are appropriate to the context! The capacity to create meanings that accurately reflect self and others When meeting with Youth! Keep Safety in Mind! Keep in mind, traumas don t disappear with age youth only heal through relationships and therapy! Know that complex trauma delays development keep the youth s developmental age in mind! Keep in mind youth may perceive threat where no threat is present What we teach Youth! We teach them to! Identify their feelings ask them?! Identify the intensity ask them?! Slow down & get calm give them time!! Use coping and calming skills let them use them!! Identify their triggers let them talk! 10
Know their Executive Functioning System! The capacity to express spontaneous, automatic, and consciously controlled behaviors in a flexible and purposeful manner! The capacity to integrate the bottom-up influences of emotions with the top-down control of thoughts! The capacity to assess, integrate, and prioritize one s own internal (self) needs in relation to external (context/other) needs E N G A G E M E N T When meeting with Youth! Keep the bottom of the brain active! Engage them in an activity! Throw a ball back and forth! Color with them! Give them play dough! Let them draw! Have easy dots to dot! Let them do a word search! Walk with them! Know their sensory preferences What to do in a Crisis! Grounding Exercises! Name 5 things you can see, hear, feel - Must be real things! Pick object or part of a person or self - Describe in detail! Make fists with hands/squeeze gently to slowly increase pressure in muscles! Make a noise! Using hand, rub or gently tap different body parts to feel where body begins & ends 11
Websites q q q q q q www.childtrauma.org www.traumacenter.org www.nctsn.org csefel.uiuc.edu ConsciousDiscipline.com http://developingchild.harvard.edu References / Resources Books Blaustein & Kinniburgh (2010) Treating Traumatic Stress in Children and Adolescents: How to foster resilience trough Attachment, Self-Regulation, and Competency Perry (2006) The Boy Who Was Raised as a Dog Courtois & Ford (2009) Treating Complex Traumatic Stress Disorders: An Evidence Based Guide Sunderland, M (2006). The Science of Parenting. DK Publishing, New York, NY References / Resources Books Craig, S (2008). Reaching and Teaching Children Who Hurt: Strategies for Your Classroom. Paul H. Brooks, Baltimore MD Hughes, D (2009). Attachment Focused Parenting: Effective Strategies to Care for Children. W.W. Noton and Company Inc. New York, NY Lillas, C. & Turnbull, J. (2009). Infant/Child Mental Health, Early Intervention, and Relationship Based Therapies: A Neurorelational Framework for Interdisciplinary Practice. Golding, K (2008). Nurturing Attachments: Supporting Children who are Fostered or Adopted. Jessica Kinsgely Publishers, London Ogden, Minton, Pain (2006). Trauma and the Body: A Sensorimotor Approach to Psychotherapy. W.W. Norton & Company, Inc. New York, NY 12
References / Resources! Books Cont:! Cohen, J. A., Mannarino, A. P., & Deblinger, E. (2012). Trauma-focused CBT for children and adolescents: Treatment applications. New York: Guilford Press.! Cohen, J. A., Mannarino A. P. & Deblinger, E. (2006). Treating trauma and traumatic grief in children & adolescents. New York: Guilford Press.! Articles! Cook, A., Blaustein, M., Spinazzola, J. & van der Kolk, B. (2003) Complex Trauma in Children and Adolescents White Paper from the National Child Traumatic Stress Network Complex Trauma Task Force Editors.! Cook et al. (2005) Complex Trauma in Children and Adolescents. Psychiatric Annals 35:5. May 2005 References / Resources! Articles! Perry, B & Hambrick E. (2008). The Neurosequential Model of Therapeutics. Reclaiming Children and Youth (www.reclaiming.com), V 17, n 3.! Van der Kolk, B & Pynoos R. (2009). Proposal to Include a Developmental Trauma Disorder Diagnosis for Children and Adolescents in the DSM-V! Perry, B. (2002). Helping Traumatized Children: A Brief Overview for Caregivers. Booklet developed by the ChildTrauma Academy. Caregiver Education Series.! Zero to Six Collaborative Group, National Child Traumatic Stress Network. (2010). Early Childhood Trauma. Los Angeles, CA & Durham, NC: National Center for Child Traumatic Stress! Van der Kolk, B. (2005). Developmental Trauma Disorder: Toward a rational diagnosis for children with complex trauma histories. Psychiatric Annals 35:5. May Thank You! Jennifer Hixson! 254-290-4048! Jhixson@woodridgecare.com! JLHixson@twinvalley.net 13