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5/11/15 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

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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

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2 3 4 5 6 7 8 9 10 1

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.

2 3 4 5 6 7 8 9 10 1

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Anger to Emotion

!

0! 2! 3! 4! 5! 6! 7! 8! 9! 10! 1!

Distress

2 3 4 5 6 7 8 9 10 1

Stress/Fear Response System

Stress Response System

  • The way the Body
  • Responds
  • To Stress
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Stress/Fear Response System

Window of Tolerance Green Zone

Stress/Fear Response System

Hyper-arousal Pink Zone

Stress/Fear Response System

Flooded Red Zone

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Stress/Fear Response System

Hypo-Arousal Light Blue Zone

Stress/Fear Response System

Dissociation Blue Zone

Stress/Fear Response System

Combo Brake Pedal Gas Pedal

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Stress/Fear Response System

Combo Brake Pedal Gas Pedal

Dissociation Blue Zone

Freeze

Hyper-Vigilance

2 3 4 5 6 7 8 9 10 1

Stress Response System

Fear Response System Dissociation Combo Fight Flight

F r e e z e

Thinking System is Off-Line

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Trauma Informed Ways of Being “with” Youth Neurorelational Framework

Lillas, Turnbull 2010

Attachment, Regulation and Competency Model – Bluestein and Kinnigburgh Systemicc

Familiall Individuall

ATTACHMENT

  • Caregiver affect management
  • Attunement
  • Consistent response
  • Routines and Rituals

SELF-

REGULATION

  • Affect Identification
  • Modulation
  • Affect Expression

COMPETENCY

  • Executive functions
  • Self development

A A. .R R. .C C. .: : A A F Fr ra am me ew wo

  • r

rk k F Fo

  • r

r I In nt te er rv ve en nt ti io

  • n

n w wi it th h C Co

  • m

mp pl le ex xl ly y T Tr ra au um ma at ti iz ze ed d Y Yo

  • u

ut th h Kinniburgh & Blaustein (2005); Blaustein & Kinniburgh (2010) TRAUMA EXPERIENCE INTEGRATION

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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

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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 Any unsolicited Certain parts of the body Felt / Fuzzy Material A anchor item Smell * Anything link from a past trauma Vanilla Lavender Taste Anything connected to past stressors 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

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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!

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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

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

E N G A G E M E N T

  • 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

What to do in a Crisis

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Websites

q www.childtrauma.org q www.traumacenter.org q www.nctsn.org q csefel.uiuc.edu q ConsciousDiscipline.com q http://developingchild.harvard.edu

References / Resources

ž 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

ž 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

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5/11/15 ¡ 13 ¡ 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