Healing the Experience of Trauma

Healing the Experience of Trauma TRAUMA INTERVENTION PROGRAM

Caelan Soma, PsyD, LMSW

Healing the Experience of Trauma: A Path to Resilience

HEA L I N G THE EX P E R I E N C E OF T R AU M A : A PATH TO RESILIENCE – PROGRAM MANUAL – Dr. Caelan Soma

ISBN: 1-931310-64-5 ©2017, Revised 2018 Starr Commonwealth 13725 Starr Commonwealth Road, Albion, Michigan 49224 www.starr.org

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About the Author Dr. Caelan Soma, PsyD, LMSW, Starr Commonwealth’s Chief Clinical Officer, provides oversight for all clinical operations and research at Starr Commonwealth.

Dr. Soma provides trauma assessment and trauma-informed, resilience-focused intervention for youth utilizing evidence-based practices, including Starr’s SITCAP® model programs.

She has been involved in helping with the aftermath of disasters such as Sandy Hook, Hurricanes Katrina and Rita and others. She is has authored several books, the most recent, 10 Steps to Create a Trauma-Informed School.

She is an internationally acclaimed speaker and trainer, and is the instructor for many Starr courses, including Children of Trauma and Resilience and Structured Sensory Interventions II. She received her doctorate in clinical psychology at California Southern University, where she received the 2013 CalSouthern President’s Award.

Starr Commonwealth The Starr Professional Training and Coaching emerges from the vision that: knowledge + empowerment = impact.

Starr provides guidance and expertise to educators, clinicians, and many others who care for children from around the world in the form of research, publications, e-learning courses, in-person trainings, conferences and events, professional certifications, as well as school/organization-wide accreditation. These products and services have been developed through our three key legacy training programs: The National Institute for Trauma and Loss in Children (Starr), Reclaiming Youth International (RYI), and Glasswing (GW).

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Table of Contents Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . v About the Program . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 Questionnaires . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25 Curriculum . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 39 Session One . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 45 Session Two . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 55 Session Three . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 61 Session Four . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 67 Session Five . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 73 Session Six . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 79 Session Seven . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 83 Session Eight . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 87 Session Nine . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 93 References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 99

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Introduction Healing the Experience of Trauma: A Path to Resilience Healing the Experience of Trauma: A Path to Resilience builds upon and enhances Starr’s evidence based, SITCAP® (Structured Sensory Interventions for Traumatized Children, Adolescents and Parents) model programs and is the result of: • A dvancement in brain science related to the impact of stress and trauma on the developing brain • Lessons learned from the Adverse Childhood Experiences Study (ACEs) • Direct practice with at risk and traumatized youth • Feedback from Starr Certified Trauma Practitioners • Prioritized use of mind-body skills for emotional regulation The ACE study has provided us with solid research supporting the connection between trauma and toxic stress with negative implications for both mental and physical health problems. With one out of every four children experiencing trauma and still more living with toxic stress, the ACE study confirms trauma and toxic stress as a public health crisis. It is rare for any child caring professional to meet a child who has experienced only one traumatic event. The unfortunate reality is that many of the youth trauma practitioners serve today experience trauma from multiple exposures or from living in a state of toxic stress.

As trauma-informed practitioners, we learn to ask, “What happened” to better understand a child’s experience rather than label or judge them based upon their symptoms and behavior alone. However, the answers to this question can leave even the most experienced practitioner unsure of how to help. When practitioners ask, “What happened?” stressed and traumatized children respond with answers such as “I don’t know”, “I can’t explain it” “too many things” or “nothing”. Perhaps the child recalls an exhaustive list of trauma and loss. Maybe their life, perceived traumatic to an outsider, is completely normal to them. Family secrets also keep children from sharing their stories. Others, who have experienced pre-verbal trauma, may not even remember what happened. Most children of trauma simply do not have the words to describe their terror.

One of the most important skills a trauma practitioner can have is the ability to understand how chronic exposure(s) to toxic stress shape a traumatized child’s private logic. Private logic, the

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way children view themselves, others and the world around them certainly drives their emotions and behavior but does not seal their fate. In fact, trauma practitioners can interrupt the mental and physical health risks children experience following adversity when they help youth process the impact of adverse experiences while also engaging them in new experiences to uncover and create characteristics of resilience. The result is a new lens through which children view themselves and others. When youth integrate all of their experiences and use their bodies as resources for healing, they thrive.

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About the Program The bad news is trauma is a fact; the good news is that so is resilience.

Levine & Kline, 2008 Healing the Trauma Experience: A Path to Resilience is for multiply and chronically stressed and traumatized children and for the practitioners who want to help. This program does not directly ask a child “what happened” but instead keeps children focused on what is happening - how they are experiencing their lives in the present. While helping children manage overwhelming feelings and sensations through activities needed for healing, the program also offers several engaging opportunities to spend time with experiences that foster strength and resilience.

Similar to Starr’s SITCAP® model programs Healing the Experience of Trauma: A Path to Resilience is a sensory-based trauma intervention program and draws from principles included in Somatic Experiencing, developed by Peter Levine. Somatic Experiencing focuses on resolving the symptoms of chronic stress and post-traumatic stress. Its major interventional strategy involves bottom up processing by directing attention to internal sensations, both visceral and musculoskeletal, rather than primarily cognitive or emotional experiences. In other words, interventions target deep brain structures that rule the central nervous system rather than the upper brain structures that are responsible for higher level thinking processes. Instead of reliving trauma experiences through drawing a picture of “what happened” in Healing the Experience of Trauma: A Path to Resilience, the child visits the impact of negative experiences by way of their body sensations and the themes of trauma, as they are experienced in the here and now. This gentle exposure helps promote safety. In addition, the practitioner does not have to ask what happened but rather maintains focus on what is happening in present time. Each session integrates exposure to the more difficult themes of trauma such as worry and anger, with mind-body skills and expressive art activities that provide the child with body based experiences of themes like hope and joy. The activities provide opportunities that allow children to be active participants in uncovering and cultivating their own characteristics of resilience including curiosity, courage, openness to relationships, the ability to set boundaries and body awareness.

Neuroscience and Psychophysiology Support this Program If a child is living in an activated state, their body is still experiencing a flight and/or fight trauma

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response. This could be because 1) they continue to live in a state of toxic stress (i.e. poverty, abuse, bullying) or, 2) the trauma incident is over but their body is still re-experiencing it as if it is still happening. In other words, the child is trying to escape or to fight and neither is working, so they remain in that activated state. Their body naturally wants to return to balance but will not do so until it senses the escape or fight is completed and genuinely experiences sensations associated with calm, safety and goodness.

If the child is living in a collapsed state, they have been trying to escape and/or fight without success – also called the “fold” response. Collapse occurs when someone who has been trying to escape or has been fighting for quite some time has now reached the point of exhaustion. Even though they were not successful in completing their escape or fight, their body shuts down but the unwanted symptoms and reactions of stress and trauma persist.

When exposed to trauma, we enter a state of “arrest”. In the arrest state, our body’s central nervous system engages because we sense that something is wrong. Perhaps we hear a loud noise, see impending danger or feel something physically hurt us. When this happens, the first thing most people (both children and adults) do is to try to get away from whatever is happening that we perceive as dangerous or frightening. We attempt to flee (flight) and if we are successful, the stress system in our body returns to balance. While we may experience some residual symptoms and reactions from the acute stress response, we usually return to our normal state within 4-6 weeks’ time. However, if we are not successful in our attempt to escape, we will then engage in the fight response. Like flight, if we are successful in our fight, the stress system in our body returns to balance. While we may experience some residual symptoms and reactions from the acute stress response, we return to our normal state within 4-6 weeks’ time.

However, if we are NOT successful with the flight and/or fight responses, we continue to try to escape or fight in an effort to resolve our alarming experience. This is why in many cases, we see a person still fighting or trying to escape even though the experience they had is over. In essence, their body continues to respond.

Flee/Flight Symptoms and Reactions • • • • • •

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Running away (from home, school, relationships) • Feeling alone • Anxiety/worry • Not following through with plans, an activity • Substance abuse • Eating disorders

Isolation Not sitting still Jumpy/nervous Not taking a risk Perfectionism

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Fight Responses • • • •

Oppositional • Defiant • Anger Feeling stuck • Helplessness • Fear Hurt • Physical and verbal aggression • Self-harm Destruction of property

If a person experiences toxic stress, they are constantly trying to escape or fight whatever is happening in life.

The incident is never “over.”

In some cases, you may also see a “freeze” response. Freeze responses are also in an attempt to survive or save others and happen without intention, thought or logic.

Freeze Examples

• I will have a chance to escape.

In the wild, animals often play dead when they their survival is threatened. Prey will often move motionless animals to a safe place and return to them later after they have captured others. This gives the animal who is pretending to be dead a chance to flee or escape. A child may think, I will hide under my bed and remain as quiet and still as I can and when he goes to the bathroom, I will run.

• They cannot see me.

When motionless, animals often believe they are invisible. A child may think, if I do not move a muscle, he will not touch me.

• If the predator gets me, he will not harm the others.

A child may think, I will let him get me so my sister will remain safe. There is an analgesic effect when the body engages in the freeze response. Many will report not feeling any pain despite physical assault.

• I cannot feel it. I am numb A child may think, I did not even feel the pain when it happened, I was bleeding, but I felt nothing.

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Core Regulation Network A network of regulatory systems, called the core regulation network (CRN), is located deep inside the CNS. The CRN consists of the limbic system, autonomic nervous system, reticular activation system and the motor system (Payne, Levine & Crane-Godreau, 2015). This system responds very quickly to arousing or threatening stimuli, with little input from higher-level thought processes.

When a person is in the “arrest” state, there is emergency activation of their CRN but compromised access to decision-making or cognition. The core regulation network excels in the short term. Nevertheless, when activated for a prolonged period, it becomes dysregulated. The bottom or deep brain activates while access to higher-level brain structures is impaired.

• Limbic System The Limbic System includes the amygdala. The amygdala acts like a smoke detector. When stimulated it signals distress.

• Autonomic Nervous System The Autonomic Nervous System can intensify or calm the activity of the body. This system influences alterations in heart rate, blood flow, respiration rates, hormone and endocrine activity.

• Motor Cortex The motor cortex tenses or calms muscles in response to input from the limbic and autonomic nervous systems.

• Reticular Activation System This system involves multiple networks, which trigger arousal through sensory pathways (olfactory, auditory, etc.)

These responses should last only for a short time – but when the Core Regulation Network has prolonged engagement (more than 4-6 weeks) individuals become trapped in this space. They are always on the lookout for danger and often perceive non-threatening stimuli as dangerous.

Their heart and respiration rates are high, muscles tense, and they are highly sensitive to sensory inputs.

Many will attempt to complete the loop back to balance for a long time. They will fight, run and/

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or numb out. At some point however, the parasympathetic nervous system will kick on and the person will move to a state of collapse. At this point, they have reached complete defeat and exhaustion.

We used to believe there was only one parasympathetic nervous system (PNS) within our Autonomic Nervous System. However, there are actually two branches of the PNS. First, the branch that eventually leads to complete collapse and the other branch that results in feelings of goodness, calm and joy. This branch is the social engagement system (SES).

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The Polyvagal Theory We have learned how the sympathetic nervous system influences activation or arousal. The PNS is deactivating or calming. The polyvagal theory (Porges, 2007) postulates that there are actually two branches of the PNS. The branch that turns on during collapse is the well-known dorsal branch of the PNS. When a person experiences complete exhaustion it is because the dorsal branch of the PNS is activated. However, there is a lesser-known branch of the PNS called the social engagement system. The social engagement system has gained attention in recent years.

When the social engagement system is active, rather than a collapse response, it provides a gentle calming response. This is great news for trauma practitioners.

The social engagement system consists mainly of the vagus nerve. The vagus nerve travels from the brain stem via the heart, lungs and esophagus to the stomach. It includes numerous branches. It controls unconscious body reactions like heart rate, breathing, sweating and loss of bladder control under stress. The vagus nerve also orchestrates relaxation, self-soothing, social interaction reactions and fight, flight and freeze responses. It acts as our “reset” button because it tells the body and brain that the threat is over and it can return to calm.

Social engagement and connection help make the vagus nerve accessible. When the muscles of the eyes, ears, throat, and viscera are stimulated so is the vagus nerve (i.e. eye contact, voice and verbal interaction). Other ways to access the vagus nerve are to draw awareness to internal sensations or body movements. For example, being curious about what you imagine to be the person’s inner state (i.e. I imagine that sweatshirt is really soft and comfortable).

The SES governs goodness and belonging. When overly activated or in collapse, it is difficult for a person to access their vagus nerve. In trauma, there is a significant need for social engagement.

Nevertheless, at a time when needed, most traumatized individuals do not want to engage with others because their experiences with people have not been or are not rooted in trust or safety.

When dominated by shutdown, collapse and fold, traumatized individuals are unavailable for true calming feelings of attachment and even when they are in the company of others, they often feel alone. The activities in Healing the Experience of Trauma help children “reset” their vagus nerve.

Most stressed and traumatized people focus immediately on negative inner states and this increases fear reactions. Levine encourages the drawing of attention to positive, non-aversive inner states, which help bring the Autonomic Nervous System into a less fearful state. This is why the Healing the Experience of Trauma: A Path to Resilience program includes a significant focus and time on body awareness of positive somatic markers and introductions to several relaxation opportunities and positive experiences through body-based activities.

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Vagus Nerve The vagus nerve travels from the brain stem via the heart, lungs and esophagus to the stomach. It includes numerous branches.

I t controls unconscious body reactions like heart rate, breathing, sweating and loss of bladder control under stress.

n The vagus nerve orchestrates: • Relaxation • Self-soothing • S ocial Interaction reactions • F ight/flight/freeze responses n Responds positively to tone quality. n I t is our “Reset Button” because it tells the body/brain that the threat is over– return to calm. n R epeated unregulated stress/trauma freezes the reset button.

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BALANCE

RAUMA FEAR/T CE(S) IEN EXPER First Attempt FLIGHT If Not Successful

If Successful

Will attempt to FIGHT If Not Successful

If Successful

Will continue FLIGHT, FRIGHT or FREEZE This is meant to be a short-term response.

If this becomes a long-term response, the core regulation system (CRS) will become dysregulated

POLYVAGAL

CORE REGULATION SYSTEM Limbic System Motor Cortex RAS ANS

FIGHT FREEZE immediate terror terror muscular tension frozen/helpless intense sensory arousal numb/can’t feel sympathetic N.S. arousal parasympathetic N.S. activation (2 branches) UNMYELINATED

STUCK IN CHRONIC ACTIVATION UNTIL

Exhaustion, collapse

MYELINATED

Vagus nerve

Fold, defeat Everyone forgets about this one

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BALANCE RETURN BACK TO BALANCE Discharge activation and experience belonging and goodness

Helps discharge activation

Pendulation between sensations of activation and calm

THEORY

Titrate sensations of activation Themes of trauma

Once vagus activated practice

Helps discharge activation

Grounding Centering Resourcing Mind Body Skills

Safety

Human Contact Muscles of face, throat, ears The vagus nerve needs help being Position activated, but it can be. It is known as Awareness of the social engageSensations Helps discharge ment system. activation Movement Mind Body Skills Sensory Interventions Created by Dr. Caelan Soma Š Starr Commonwealth 2016

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Program Goal The goal of Healing the Experience of Trauma: A Path to Resilience program is to regulate the Autonomic Nervous System and Core Regulation Network by decreasing sympathetic nervous system arousal and activating the social engagement system (vagus nerve) through the use of sensory interventions and mind-body skills including affirmations, journal prompts, body awareness, movement and expressive arts.

Program Format Today I Feel Each session begins with the child identifying an emoji that best represents how they feel at that particular time. This should be short and used as an icebreaker. However, it is also a good way to compare how the child reports they are feeling from session to session.

Session Affirmation Affirmations are statements designed to reiterate or help shift a child’s view of self to one that is positive. Briefly state the affirmation at the beginning of each session and tell the child you will come back to it again at the end of the session. At the end of each session, you will ask the child to reflect upon what the session affirmation means to them. Listen. Validate their responses and offer a brief reflection if needed.

The affirmation acts as an anchor to the positive session theme. There is an affirmation card in each journal session that the child can color in if there is time left in the session. Alternatively, they may cut out the card, take it home with them, and color it on their own.

Mindfulness Activity The program includes a variety of mindfulness activities including breath work, body awareness, guided imagery, journal prompts and coloring. Each session starts with a mindfulness activity. As the practices are introduced, if there is a certain activity that appeals to youth, you can repeat it during subsequent sessions either in addition to or in place of the mindfulness practice assigned in that particular session.

The best way to explain mindfulness to youth is to tell them mindfulness means paying attention to what is happening right now with kindness and curiosity. Some mindfulness for children experts like to explain mindfulness to children by taking a scientific approach. The following script or a variation of it can be helpful.

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When you learn about mindfulness, pretend you are being a scientist. You study your own self and your own mind. You study your thoughts, feelings and body sensations. Like any scientist, you do experiments and you discover things by paying attention to yourself and to what you are doing. For example: •P erhaps you will discover there is a happy or quiet place inside yourself that you never visited before.

• You might discover ways to calm yourself down and lift your mood when you are upset, angry or sad.

• You might discover ways to be kinder to yourself, others and the world.

Individual Sessions versus Group Sessions If you are working with a child individually, you may choose only the individual mindfulness activity. However, if you are working with a group, there are group-based mindfulness activities that allow for connection and interaction among group members. You can choose to do one or more of the mindfulness activities in each session. Please note that group mindfulness activities often take more time than those done individually but are an excellent way to foster connections between group members which is another way to activate their social engagement system. The group mindfulness sessions are playful, non-intrusive and offer meaningful yet safe interactions between participants.

Body Maps In each session, the child will check in with their body using a body map to see what kinds of signals their body gives them. The more the child practices, the easier it will become.

This activity is so important that is done twice in each session. Complete each body map as indicated in each session. Each body map will focus upon a different theme and sensation to help the child pendulate between the session themes. This practice is an excellent way to reset the vagus nerve and practice body awareness. It is hard to manage emotions and behavior if children do not learn how to pay attention to the cues their body provides. Paying attention to body sensations is the foundation of body awareness. The more a child checks in and listens to their body, the easier it will be for them to regulate how they feel and act at home, in school and with friends. This practice will help.

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Body awareness MUST come before emotional regulation.

Remember:

• Awareness first, and then teach regulation strategies.

• Awareness first, and then practice regulation strategies.

• Awareness first, only then can you expect to see emotional regulation

This is not a process to rush. Spending time with body awareness will be worth the time and effort.

It is important that we teach each child the difference between feelings and sensations. There is a script for this in the first session but it is always a good idea to repeat this concept as often as necessary. Here is an introduction for you.

A feeling is the name we give to describe a sensation or group of sensations we experience in our body.

An example of a feeling is SAD. An example of sensations that describe the feeling of SAD might include things like a heavy head, watery and hot eyes, a sinking chest or nauseous stomach.

There is a chart on page 13 that lists different words and icons to refer to when looking for words to label feelings. There is a chart on page 14 that lists different words and icons to refer to when looking for words to describe sensations.

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Some words to label feelings

Confident

Playful

Silly

Mad

Passionate

Tired

Alone

Dominated

Irritated

Neutral

Appalled

Optimistic

Frustrated

Concerned

Thrilled

Distrustful

Enraged

Scared

Excited

Unhappy

Nervous

Annoyed

Energetic

Ashamed

Offended

Useless

Worried

Thankful

Cheerful

Bright

Sad

Aggressive

Relaxed

Interested

Anxious

Determined

Lost

Guilty

Upset

Comforted

Eager

Doubtful

Embarrassed

Impulsive

Accepting

Loving

Humiliated

Amazed

??

Hopeful

Disinterested

Satisfied

Intrigued

Devoted

Calm

Pained

Curious

Joyous

Bold

Desperate

Surprised

Restless

Quiet

Bored

Certain

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Words to describe sensations

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Warm

Full

Empty

Cold

Heavy

Prickly

Fatigued

Flat

Paralyzed

Square

Shallow

Wavy

Soft

Burning

Curved

Knotted

Stuck

Sharp

Moving

Frozen

Spiky

Drilling

Beating

Flickering

Pointed

Hurting

Stinging

Intense

Stabbing

Tingling

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Sensations Healing the experience of trauma happens when we learn how to name, notice and explore body sensations, not feelings. Trauma is a body experience. Therefore, we must listen to our body to give it what it needs to feel better and achieve regulation. Our bodies communicate with us through sensations. Simply becoming aware of sensations will help to discharge the activation associated with feelings. This process also helps to engage children who have reached the point of exhaustion and collapse.

The body maps in each session will provide you with a script so that the child is able to explore body sensations specific to various themes of trauma as well as those sensations related to positive themed experiences.

Individual versus Group Sessions When working with children individually you can ask them to tell you about their body map findings and the sensations they have selected to describe their body signals. Normalize the body sensations indicated by children when they complete their body maps. In a group setting, you may invite children to share their body maps with the group. This process helps to normalize feelings and body sensations among the group members.

Journal Prompt Each session will also contain one or more journal prompts. Words, sentences or images like a simple drawing or a symbol complete each prompt. The child should be encouraged to respond to the prompt in whatever way they wish. Some children enjoy using stickers or magazine cut outs in this section. Be creative! If the child is having a hard time responding, ask them, What comes to mind when you read the prompt? Do you think of a word or an image or maybe it reminds you of someone or something. If the child is struggling with the prompt, you may ask them if they want you to put something on the paper for them – like a word or an image. This is okay too.

Attaching an image or word to a response will help make it more concrete. The journal prompts introduce the session themes and are often strength-based and resilience-focused.

Individual Sessions versus Group Sessions Complete journal prompts individually. If you are working with a group and a member of the group wants to share a response, they can certainly do so however, keep an eye on time. The purpose of the prompts are to act as a steppingstone to the session activities, where group members

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can share more if they wish.

Movement Each session has a brief body movement component to further support body awareness and improve the function of the CRN. Movements include stretching, simple poses and calisthenics. We know that proprioception (sense of position) and kinesthesis (sense of movement) are two great ways to access, regulate the CRN, and reset the vagus nerve. These activities are enjoyable and help improve a child’s balance, agility and coordination. They will not take longer than 5 minutes per session.

If you have additional movement ideas you would like to include or substitute for those provided, you are more than welcome to do so. Any movement or play will be beneficial.

Theme-Based Activities Traumatized children experience common trauma themes such as anger or fear that make their lives challenging. During each session of this program, the child will explore a common trauma theme and the influence it has on the child to help discharge some of the activation of that particular theme. Then the child will complete an activity to experience an alternate, positive theme. For example, one trauma theme is the experience of fear and an opposite experience of fear is safety. The approach of moving a child’s experience during each session between a challenging theme and a theme that offers feelings of relief works like a pendulum, swinging them from a challenging experience to a more inviting one. This approach is adapted from Somatic Experiencing a form of therapy aimed at relieving symptoms of trauma and stress by focusing on perceived body sensations (somatic experiences).

In the presence of a caring adult (the trauma practitioner), this approach provides the child with evidence that they can tolerate their overwhelming symptoms and reactions for a short time when provided with coping strategies and support. The program activities allow the child to gain awareness of how, in their bodies, they experience trauma-driven sensations and how they can experience sensations of relief too. Positive sensations may be foreign to children who have experienced trauma. The gradual exposure to these sensations throughout the program provide repeated opportunities to gain awareness of how their body responds to feelings of goodness. Instead of only telling a child how to feel better, the program provides activities that create actual sensations associated with feeling better.

A large component of the program focuses how to pay attention to all body sensations and presents a variety of ways the child can practice using their body as a resource to notice and manage

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emotions – both overwhelming sensations and those that are more pleasant. The sensory-based experiences allow children to view themselves in new ways, shifting them from victim to survivor thinking. There is evidence that the more a child experiences positive body experiences, the more readily they will be able to notice and integrate other experiences that provide them with similar body results.

Individual Sessions versus Group Sessions If working individually, you will ask the child to tell you about their activities as they complete them. If working with a group, as the activities are completed, provide opportunities for the children to share their experience of the activities with others.

Body Map 2 As mentioned, there will be two body map activities during each session. It is important to complete both maps. Keep in mind: The more body awareness practice, the better the child will be at regulating emotions and behavior. Regulation cannot develop without awareness. In trauma, youth feel stuck and find it hard to see anything other their trauma experiences, bad feelings and behavior. Body maps are a great way to show youth shifts, changes and differences in how they experience themselves, others and the world around them between sessions. Compare the body maps. The tangible images of the body maps provide much more meaning than words alone.

Youth will often spontaneously reflect on how the maps compare.

Individual Sessions versus Group Sessions Allow the child(ren) either individually or within the group to reflect upon their body maps. A simple prompt is to say, tell me what you notice the most when you look here.

Standout(s) & Symbol At the end of each session the youth is asked, If you think back to our session today, what stands out the most to you? This does not have to be what they liked the most, but rather what stands out the most to them.

If they need more help, you may ask questions such as: • Of all the things you drew, wrote, heard or felt today during our session, what

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stands out to you the most?

• Which activity stands out the most?

• Is there something that I said, you said or another group member that stands out the most to you from today’s session?

• Did you notice a particular body sensation today more than another?

After the child identifies one or two standouts, ask them, What symbol would help you remember what stands out most from today’s session? This is a way to anchor them to the implicit experience of the session and attaches an image to the memory of the entire session. For example, maybe the child identifies a breathing activity as the standout and the symbol representing the activity might be wind or just the word, “breathe”. Another option is that the standout could be an activity they enjoy or person who supports them. Then the symbol might be a soccer or basketball or the name of a friend or relative to represent that part of the session. There is no right or wrong standout or symbol. Whatever the child selects is perfect. If the child has difficulty selecting a standout or symbol you may want to tell them a few moments that stand out most to you from the session and see if they can then select a symbol. It is optional for the practitioner to select a standout and symbol for the session. Some symbols are listed on page 20.

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sample journal pages Healing the Experience of Trauma Workbook

Healing the Experience of Trauma Workbook

- Session one -

journal prompt

ALL ABOUT ME

My favorIte things are...

(Hint: colors, food, animals, sports, movies, places, people)

date: Today I feel:

Body Map: Intro 1

Body map: intro 2

standouT:

syMbol:

© 2017 The National Institute for Trauma and Loss in Children

1

2

© 2017 The National Institute for Trauma and Loss in Children

Session page

Journal prompt page

Healing the Experience of Trauma Workbook

Healing the Experience of Trauma Workbook

activity

affirmation card

feelings and sensations Feelings are words to describe emotional states or reactions.

i am

Sensations are physical states we experience in our bodies.

How does your body let you know when you feel Stress? Calm?

Complete the chart below. Try to be as descriptive as you can!

If you get stuck, use the charts on pages viii and ix to help.

STRESS

unique

CALM

Smell Sound Color Temperature Texture © 2017 The National Institute for Trauma and Loss in Children

Activity page

3

© 2017 The National Institute for Trauma and Loss in Children

7

Affirmation card journal page

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Symbol samples

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Healing the Experience of Trauma: A Path to Resilience

Individual Sessions versus Group Sessions If you are working with an individual, take the time to reflect on the standout and symbol the child selected. If you are working with a group, you may ask one or two members to share their standouts and symbols with the group as time permits. Be sure to rotate through the group of children as you proceed through the sessions so that each child has an opportunity to share if they wish to do so.

Affirmation End the session by going back to the affirmation. State the affirmation again and see if there are any reflections about it now that the child(ren) has participated in the program activities. If needed, use the reflection statement provided for the affirmation.

If there is time, invite the child to color in and cut out their affirmation card to have with them in between sessions. If time is limited, you can have them cut out ahead of time and the child(ren) can take it with them to complete at home.

A Note about the Activities Thousands of children have used the activities in the program successfully. You may want to explain how the activities have helped many other children who have also experienced trauma.

However, if you suggest an activity that the child does not feel comfortable with, all the child has to do is let you know. It is imperative that the child feels empowered to say no at any time during the session. For this reason, there is also a collection of fun coloring pages in the child’s journal to use at any time throughout the program. Have a collection of games and art supplies available if a child needs a break from the program activities. For example, other expressive art activities including collage, music, dance, dramatic play, sand tray and bibliotherapy will enhance the activities. Add any activity into your sessions as you see appropriate or as a fun way to start or end each session. Remember, this program encourages exposure to pleasurable experiences followed by awareness of how these good experiences make the child feel in their body. This focus on the good is equally, if not more important, than the successful processing and discharge of trauma themes and the body sensations attached to them.

The program activities are for use with youth between the ages of 6 and 17 years old. You may be surprised how well older children respond to activities you think might appeal to younger children and how well younger children respond when presented with what appears to be a more sophisticated activity. Remember that when we work at a sensory level or at a body level, we are not accessing the cognitive parts of our brain and because of this, the activities in this program will

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appeal to all ages.

Journals Each child will receive a journal to keep. Each session has its own section with corresponding worksheets in the journal. The journal can contain both visual and written content. Some children use words, phrases and sentences while others provide images, symbols and color. There is not a right or wrong way to complete the journal. Some will be elaborate and others simple. The journal content serves as a visual representation of the work the child completes.

Materials For each session, the child will complete most of the activities in their journals. Additional materials needed are colored pencils and/or crayons. There are one or two additional supplies needed for some activities and there is a materials list at the beginning of each session. Optional supplies include stickers, magazine cutouts, scissors and glue sticks. The optional supplies may be used to complete journal prompts, activities and the for the symbol identification at the end of each session if the child does not wish to write words or draw illustrations for their answers.

Body Awareness Questionnaire (BAQ) During the first and last session, it is helpful to ask the child complete the Body Awareness Questionnaire. This evaluation tool is an excellent way to determine progress made during the program in the child’s ability to notice and regulate their body sensations. A copy of the BAQ is available on page 27. You may duplicate the questionnaire.

Child and Adolescent PTSD Questionnaire (CAQ) During the first and last session, it is helpful to have the child complete the CAQ. This evaluation tool will help determine if post-traumatic stress symptoms and reactions have improved during the program sessions.

You can administer the questionnaires (BAQ and CAQ) during the first and last sessions. However, if you have the ability to administer them outside of those sessions (especially if running a group), that is optimal. If you need to administer them during the session times, plan to spend an extra 15-20 minutes during each session for children to complete the questionnaires. A copy of the CAQ is available on pages 25-38. You may duplicate the questionnaire.

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Healing the Experience of Trauma: A Path to Resilience

Flexibility and Time Every practitioner has a different pace for session implementation. Session length is approximately 60 minutes, however, this may vary. Sometimes children complete activities quickly and at other times more slowly. Some practitioners also like to integrate other activities into this program’s format. It is okay if you take more than one session to complete each session. The important thing is to start and end each session in a safe and regulated place. It is also okay to skip some of the sessions if you are working with a child for only certain number of sessions. Go through the session titles and select the themes you feel will be most helpful to complete with the child. Even if you only implement a few sessions, try to administer the BAQ and the CAQ to evaluate improvements of body awareness and reductions of posttraumatic stress symptoms.

Feedback Starr values your feedback. Please share your experience of implementing Healing the Experience of Trauma: A Path to Resilience. We appreciate comments and suggestions related to session format, activities and any changes in the pre and post evaluation scores using the BAQ and CAQ. We look to our Starr Certified Trauma Practitioners’ feedback to help us update and enhance our programs. Email Dr. Caelan Soma at somac@starr.org.

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