Trauma and Its Impact Cathy Cave, Survivor Unlimited Mindfulness Consulting Cathycave@verizon.net Luz Marquez Benbow Com

1. Trauma and Its ImpactCathy Cave, SurvivorUnlimited Mindfulness ConsultingCathycave@verizon.netLuz Marquez BenbowCommunity AdvocateMarquezb1@yahoo.com

2. Guidance • Our intention is to provide information • Our journey together is important • Self care is essential

3. Self Care Belonging I am loved/valued Achieving I can succeed Relying I believe in others Believing I have power Giving I have purpose Seeing I know myself Unlimited Mindfulness Consulting

4. Foundations • Trauma occurs when an external threat overwhelms a person’s coping resources. • Individual, familial, and community experiences shape how we make meaning of what has occurred.

5. Sources of Trauma • Sexual abuse • Emotional abuse • Psychological abuse • Physical abuse • Neglect, abandonment • Domestic violence experienced or witnessed • Muggings, assault • Trafficking • Catastrophic injury or illness, death, loss, grief • Institutional abuse and neglect • Community and school violence, bullying • Historical/generational trauma; racism, genocide • Forced migration/immigration • War • Natural disasters • Terrorism • Invasive medical procedures 5

6. Foundations • Often trauma is the result of multiple experiences over time • Trauma can be transmitted from generation to generation

7. Cultural Experiences- Historical Trauma • Intergenerational trauma is real • Dr. Joy DeGruy- Post Traumatic Slave Syndrome www.joydegruy.com • Olga Trujillo- “Sum of All My Parts”- Latina advocate and survivor- www.olgatrujillo.com

8. Geographic Location Core dimensions influence “who” an individual is. Participatory dimensions influence an individual’s connections to others Family & Extended Family English Language Proficiency Community Networks C O N S I D E R A T I O N S Employment Age Knowledge/Experience Class Partnered History C U L T U R A L Income Economics Gender Ethnicity Language Perceptions of Qualities and Capabilities Spiritual Beliefs Political Affiliation Education Physical Abilities Country of Origin Literacy Geographic Location Race Sexual Orientation Incarceration experience Parental Status Immigration Status Physical Health Mental Health Military Experience 8 Unlimited Mindfulness Consulting

9. Foundations • Sometimes people are unaware that their current challenges relate to earlier trauma

10. Understanding Trauma • Trauma can affect a person over their lifetime. • People differ in their ability to give voice those experiences.

11. Our brains are sculpted by our early experiences. Trauma is a chisel that shapes a brain to contend with strife, but at the cost of deep, enduring wounds. Teicher, 2000 Trauma Sculpts the Brain 11

12. The Brain’s Response to Threat How we think and how we feel both involve chemical and physical processes within the brain. Trauma affects these processes by activating “fight or flight” responses in the primitive part of our brain (the amygdala) and physiological changes begin. Blood flows out of the thinking centers of the brain and into the limbs to prepare for action. (Miller, 2011)

13. The Brain’s Response to Threat Respiration and heart rate increases, pupils dilate to see better in the dark and hearing is sharpened. For survivors this level of readiness may not return to calm when the threat has passed. (Miller, 2011) 13

14. Factors That Intensify Trauma All forms of violence can be traumatizing: • The earlier in life trauma occurs, the greater the likelihood of severe, long term consequences. • Deliberate violence is particularly damaging, especially when it is inflicted by trusted caregivers.

15. Factors That Intensify Trauma • Systems, organizations, programs, and individuals within them can and have inflicted violence resulting in trauma • Violence, compounded by betrayal, silence, blame, or shame can disconnect a woman from herself, her family, and her community.

16. Geographic Location Core dimensions influence “who” an individual is. Participatory dimensions influence an individual’s connections to others Family & Extended Family English Language Proficiency Community Networks C O N S I D E R A T I O N S Employment Age Knowledge/Experience Class Partnered History C U L T U R A L Income Economics Gender Perceptions of Qualities and Capabilities Ethnicity Language Spiritual Beliefs TRAUMA Political Affiliation Education Physical Abilities Country of Origin Geographic Location Literacy Race Sexual Orientation Parental Status Immigration Status Physical Health Mental Health Military Experience Unlimited Mindfulness Consulting

17. Consider Trauma affects people differently across the lifespan. Younger survivors may experience trauma as a pivotal event around which the rest of their life becomes organized. Older survivors may have never shared their experiences with anyone. 17

18. Current Research Suggests • Betrayal Trauma:occurs when people or institutions that an individual is dependent on for survival is the violator. • Examples • Childhood physical, emotional, or sexual abuse • Abuse by a trusted adult outside of the home • In hospitals or where people worship www.loyola.edu/campuslife/healthservices/counselingcenter/trauma.html

19. Current Research Continued • Fear is a core component of trauma and • Depth of the betrayal make a difference in what is remembered

20. Emotional/Feeling Responses to Trauma • Anxiety • Social isolation • Anger or emotional numbing • Sudden mood shifts • Irritability • Grief • Depression • Identity problems • Guilt and shame • Denial • Feeling overwhelmed • Fear

21. Thought/Cognitive Responses to Trauma • Reliving the experience • Nightmares • Blaming someone • Hyper-vigilance • Poor problem solving ability • Loss of orientation • Memory, concentration, or attention problems • Flashbacks • Intrusive thoughts or images • Poor decision making • Dissociation • Blaming self

22. Physical Responses to Trauma • Shock symptoms • Dizziness • Headaches • Chest pain • Difficulty breathing • Muscle tremors • Hyper-arousal, extra sensitivity to sights, sounds, smells, touches and tastes associated with the traumatic event • Fatigue • Elevated blood pressure • Profuse sweating • Vomiting/nausea • Teeth grinding • Somatic disturbance

23. Behavioral/Interpersonal Responses • Behavioral • Withdrawal • Heightened startle reactions • Increased/decreased appetite • Avoiding reminders • Acting out • Pacing • Substance abuse • Homicidal/suicidal • Interpersonal • Difficulty forming intimate relationships • Sexual challenges • Change in usual communication patterns • Re-victimization • Suspiciousness

24. THE ACE STUDY • Collaboration between Centers for Disease Control and Prevention (CDC) and Kaiser Permanente HMO in California. • Largest study ever that determined both the prevalence of traumatic life experiences in the first 18 years of life and the impacts on later well-being, social function, health risks, disease burden, health care costs, and life expectancy. • More than 17,000 adult members of Kaiser Permanente HMO participated.

25. ACE STUDY What It Did – Looked at the impact of adverse childhood events. How Is It Helpful – Focuses on social functioning, health risks, disease burden, health care costs, later well-being and life expectancy. What Are The Insufficiencies - cultural and experiential limitations 25

26. FOLLOW – UP … 2010 FIVE-STATE STUDY Collaboration between CDC and State Health Departments of AR, LA, NM, TN and WA. Focused solely on prevalence of Adverse Childhood Experiences in a population-based representative sample from multiple states stratified by demographic characteristics, including sex, age, education, and race/ethnicity. 26,229 adults were surveyed. 26

27. ACE Comprehensive Chart 27

28. 28 www.acestudy.org

29. All Violence Does Not Become Trauma • In one survey, 9.2% of persons experiencing a trauma developed PTSD and 50% of those who had been raped or held captive, tortured, or kidnapped developed PTSD (SAMHSA, 2011) • The defining factor that separates a traumatic experience from distressing one is the perception of a threat to survival to self or a loved one • Dealing with the ongoing effects of the trauma is often more painful than the original event (Gillece, 2010)

30. Rochelle is Joelle’s older half-sister. Rochelle lived with her dad for part of her childhood, but moved in with Joelle when their mom remarried. Their mom’s new husband was controlling and violent. One night, the girls saw him break their mom’s nose. Rochelle was devastated. Joelle was traumatized.(Miller, 2011) 30

31. Self-Awareness Be aware of: the impact of trauma on your own life your own emotional “hotspots” Words, sights, smells, sounds, behaviors, characteristics, emotional responses how your own issues may influence your feelings and responses to women you support

32. Staff…“have a tendency to deal with their frustration by retaliating in ways that often uncannily repeat the earlier trauma” (van der Kolk, 2003)

33. Responding to Trauma • Trauma specific interventions • Trauma informed services, supports and practices

34. TRAUMA INFORMED PRACTICES What Happened to you not What’s wrong with you? Collaboration We understand what it means to the survivor? No Blame! Look Like Something! Choice Mutuality Define safety for ourselves Trustworthiness Power is shared Empowerment Incorporate cultural understanding 34

35. Healing from trauma, like healing from a physical injury, is a natural human process. Mollica 2006 Healing is Possible 35