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New York State Office of Mental Health. Lessons Learned Conference May 24-25, 2011. Triggers, Warning Signs and Coping Strategies: Beyond the ICPP. What is Trauma?.
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New York StateOffice of Mental Health Lessons Learned Conference May 24-25, 2011 Triggers, Warning Signs and Coping Strategies: Beyond the ICPP
What is Trauma? • The personal experience of interpersonal violence including sexual abuse, physical abuse, severe neglect, loss, and/or the witnessing of violence, terrorism, and disasters. (NASMHPD, 2004) • It is extreme stress that overwhelms a person’s ability to cope or disrupts one’s sense of safety
State Change Aggression Fear Calm/ Continuous/ Engaged Dissociation
Parameters that change between states • Affect • Thought • Behavior • Sense-of-self • Consciousness
Learned Response • Brain chemistry/development affected by trauma • Immediate “fight or flight” response • Heightened sense of fear/danger
Between Stimulus and Response Cortex Hippocampus Slower Sensory Thalamus Amygdala Very Fast Response Stimulus (LeDoux, 1996)
Traumatic stress, when triggered, brings the past to the present.
Triggers • A trigger is something that sets off an action, process, or series of events(such as fear, panic, anger, anxiety or agitation). Examples include: • bedtime • room checks • presence of large men • yelling • people being too close • guilt, criticism or put downs
Trauma Assessment Risk Assessment Individual Calming Plan Clinical Interviews Informal discussions On-going process Identifying Triggers
Triggers are not always obvious: • Particular time of day/night • Particular time of year • Anniversary of a loss • Internal triggers • Someone who looks/sounds familiar • Staff issues/difficulty • Other idiosyncratic issues related to trauma. Consumers have unique histories with uniquely specific triggers – it is essential to ask & incorporate
Warning Signs A signal of distress or a physical precursor to crisis. This may be a manifestation of a developing crisis. Some signals are not observable, but some are, such as: • Restlessness • Agitation • Being argumentative • Pacing • Shortness of breath • Sensation of a tightness in the chest • Sweating
Dissociation Flashbacks Nightmares Hyper-vigilance Terror Anxiety Pejorative auditory hallucinations Difficulty w/problem solving Numbness Depression Substance abuse Self-injury Eating problems Poor judgment and continued cycle of victimization Aggression Typical Trauma-related Symptoms
Warning Signs • Atypical Behaviors • Not always disruptive • Could be an improvement in behavior • Something highly idiosyncratic • Can be extremely subtle • Not always displayed just prior to crisis
The Importance of Interaction • Day to day routine • Establishing rapport • On-going assessments • Personal greetings/farewells • Making ourselves available • Using activities as a forum
If I could say anything to all the staff in the world it would be this: forget everything you were taught in school and be prepared to listen…don’t criticize and think it’s a lie. Just listen and ask questions and be kind. Just take the time to listen…” (Interview with a adult trauma survivor (CD), 2005)
Strategies Strategies are individual-specific calming mechanisms to manage and minimize stress, those things that help to self-regulate such as: • time away from a stressful situation • going for a walk • talking to someone who will listen • working out • lying down • listening to peaceful music
Highly specific to the individual Must be practicable Must be attainable Need to be practiced May need additional strategies before/after Sensory modulation Reward versus coping Not always what we expect Building new cognitive pathways Developing Strategies
Coping Strategies(Activities that can be self initiated) • Reaching out to others for support • Eating comfort foods • Focusing Exercises • Stress Reduction and Relaxation Techniques • Doing things that divert your attention • Doing things you enjoy • Getting sunlight/fresh air There is a need to identify those things that the recipient has done when they begin to Feel “Triggered” or set off by a life event that helps them self-regulate.
What May Not Help…... • Being alone • Not being listened to • Being told to stay in my room • Loud tone of voice • Peers teasing • Humor • Being ignored • Having many people around me • Having space invaded • Staff not taking me seriously “If I’m told in a mean way that I can’t do something … I lose it.” -- Natasha, 18 years old
"We are continually faced with great opportunities which are brilliantly disguisedas unsolvable problems."Margaret Mead