Secondary Traumatic Stress: A NeuroscienceBased Approach to Understanding Secondary Trauma and Building Resiliency

Presenters: Cynthia Packer, MSW, LICSW Linda Gensheimer, MSW, LICSW, PhD October 30, 2014

Workshop Objectives • Provide information on secondary trauma and resiliency

as well as how developments in neuroscience help us to understand the impact of working with those who have experienced trauma.

• Provide some tools and resources to assess and address

secondary trauma

• Support you in building your capacity to develop and

implement a resiliency plan for yourself and your organization.

Why Is This Important?

Increasing protective factors related to secondary trauma and enhancing staff resiliency = better outcomes

RESILIENCE IENCE • Ability to recover quickly and to bounce back from

change, misfortune, difficulty or setbacks. • Developing resilience is a process. Resilience is not a

trait which some have and others do not. • Individuals develop coping strategies within an

environment which promotes well-being and safety.

TO QUALITIES THAT PROMOTE RESILIENCY • Having a sense of humor

• Ability to accept circumstances that cannot be

changed • Ability to develop realistic goals and to move toward

them • Having meaningful connections with others

Resilience Resilience Alliance Program • Developed in New York City to mitigate the impact of

secondary traumatic stress on child protective workers and their supervisors • Goal is to increase staff resilience, self care,

optimism, social support and job satisfaction at all levels of the agency including upper management and to reduce stress reactivity, burnout and attrition

It is not the strongest of the species that survives, nor the most intelligent that survives. It is the one that is the most adaptive to change. Charles Darwin

Trauma and Burnout • Primary Trauma – Direct experience of trauma • Secondary Traumatic Stress - The experience of

people who are exposed to the trauma of others and who as a result develop their own traumatic symptoms and reactions.

• Burnout is a process that involves gradual exposure

to job strain that results in exhaustion, feelings of cynicism and detachment from the job, and a sense of ineffectiveness and lack of accomplishment

Vicarious Trauma

• Vicarious Trauma – The process of change that

happens because you care about other people who have been hurt, and feel committed or responsible to help them. Over time this process can lead to changes in your psychological, physical and spiritual well-being.

“Secondary traumatic stress is nearly identical

to post-traumatic stress including symptoms associated with PTSD such as intrusive imagery, avoidance, hyper-arousal, distressing emotions, cognitive changes, and functional impairment” (Bride, in Radey & Figley, Eds., 2007, pp.155-156)

Vicarious trauma does not imply inadequacy on the part of the social worker. It is an occupational hazard (Sommer, p. 63) “One can give nothing whatever without giving oneself, that is to say risking oneself” (James Baldwin, 1963)

Compassion Satisfaction • The pleasure and feelings of fulfillment that can be

derived from doing one’s work well, contributing to the work setting, an individual’s life or even the greater good of society.

Trauma in the Workplace • Can be in the form of hearing stories of trauma from

people we work with • Can be in the form of being at risk for verbal or

physical assaults • Direct experience of trauma

Risk Factors for Secondary Trauma • People who have a personal history of trauma

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may be triggered by traumatic stories or reactions (a shared experience) Certain coping styles People who are new to working with or parenting children and youth who have experienced trauma Those who have limited personal resources or external support, guidance or supervision Being human (a mammal with a limbic brain)

The Brain What happens to our brain when we experience trauma directly or indirectly?

Brain Structure Changes in Response to Experience • Brain Stem – Instinctive physiological responses • Limbic System – Body sensations, feelings, implicit

memories, amygdala

• Cortex – Thinking, concentrating, explicit memory

• Neuroplasticity - changes in neural pathways and synapses

which are due to changes in behavior, environment and neural processes

• Neurogenesis – Ability of the brain to heal through creating

new cells

Some Ways the Brain Responds to Stress • When we experience a significant trauma or stressor, our physiology is

affected. • Neurotransmitters in our brain tell our body that we are undergoing

some type of threat. • The adrenal glands, on top of our kidneys, get the message and flood

our entire body with stress hormones. • These hormones affect all bodily systems (cardiovascular, digestive,

immune, metabolic, inflammatory, renal, etc.).

Some Ways the Brain Responds to Stress • Research indicates that, over time, with exposure to

overly stressful situations, the amygdala (the alarm bell or freak out center) grows denser or bigger.

• The prefrontal cortex and hippocampus are affected

and decrease in size from the same experiences.

(Headington Institute; Dr. Richard Davidson, UW Madison Neuroscience Lab)

Some Ways the Brain Responds to Stress • The hippocampus is like a shock absorber for the

amygdala. When the amygdala perceives a threat and sends out the screaming message for flight or fight, the hippocampus tries to figure out whether such a response is necessary.

• But if this process is repetitive, then the

hippocampus starts to not function well.

• And we begin to react to every bump in the road with

an all hands on deck alarm – not a good thing.

First Aid Kit 4-1-5 Breath How: Deep inhale, hold it for a moment and then a longer exhale Why: Research shows that purposeful, regulated breathing helps to calm the amygdala (smoke detector for the brain) and decreases the amount of adrenalin, stress hormones, cortisol being released into our body Make an “O” shape with your mouth and breathe out slowly and completely Why: The tongue is connected to the heart by a tendon. This breathing technique causes the heart to send a message to the brain to release oxytocin – the calming biochemical.

How Stress and Trauma Affect our Brain & Body “Stress hormones move from the downstairs

brain to the upstairs brain…If these hormones and chemicals go uncontrolled, they shut down our ability to make good decisions or think about anything other than the immediate threat. If our system stays on high alert, we end up with a brain that isn’t thinking clearly and every physiological system is on overload.” (Buckwalter, 2011)

Some Interesting Research, cont’d Karatsoreos & McEwen hypothesize that underlying all the systems that help your body modulate stress is sleep.

A biological process called allostasis attempts to get all of the physiological systems back to their steady state after the stress response. Nearly all systems that help with allostasis are affected by the sleep-wake cycle (circadian rhythms), which hints at an important relationship between disrupted sleep and allostatic load. Karatsoreos, I.N. and McEwen, B.S. (2011)

What happens when we don’t get enough sleep? •

Increased reaction time

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Compromises formation of new memories

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Increases the amygdala’s response to negative stimuli (higher reactivity)

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Impulsivity

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Neural circuits become more vulnerable to stress

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Allostatic responses that might otherwise help are compromised

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Throws off the metabolism (weight gain, etc.)

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Sleep deprivation elevates cortisol, glucose, insulin and insulin resistance

(Karatsoreos and McEwen, 2011 )

SYMPTOMS OF COMPASSION FATIGUE AND VICARIOUS TRAUMA Physical • Increased illnesses • Headaches • Gastrointestinal complaints • Fatigue/chronically tired, lethargy • Weight changes: over- or under-eating • Sleep disturbances • Rapid breathing • Increased use of drugs/alcohol

SYMPTOMS OF COMPASSION FATIGUE AND VICARIOUS TRAUMA Emotional/Psychological • Anger • Sadness • Anxiety • Depression • Hopelessness • Numbing • Overwhelmed • Less ability to feel joy • Apathy • Irritabilility

SYMPTOMS OF COMPASSION FATIGUE AND VICARIOUS TRAUMA Social • Isolation • Cynicism, stuck in negativity • Withdrawn • Blaming

SYMPTOMS OF COMPASSION FATIGUE AND VICARIOUS TRAUMA Workplace • Increased sick days • Lack of motivation • Reduced productivity • Job dissatisfaction • Apathetic • Overworking

How does STS Affect Organizations? • Low rates of staff satisfaction and retention • More use of sick time • Decrease in morale and efficiency

• Increase in staff turnover • Increase in overall stress • Poorer outcomes for clients

NEUROPLASTICITY • The capacity of the brain to rewire itself, to grow new

neurons and new connections among those neurons, thus new neural pathways and circuits, even repair brain structure, lifelong. • Recovering our resilience means choosing the experiences that will cause neurons to fire together and wire together – self-directed neuroplasticity – in ways that create new patterns and/or rewire old ones. (Linda Graham, MFT – “Bouncing Back”)

NEURONS THAT FIRE TOGETHER, WIRE TOGETHER

First Aid Kit Tapping

How: Alternate tapping our index fingers on various strategic points on our bodies (temples, beneath the eyes, upper chest, legs) Why: This is not completely understood at this time but it appears that alternate tapping may cause rapid communication between the left and right hemispheres of the brain. This is related to EMDR.

First Aid Kit “Taking in the Good” How: • Actively notice positive experiences • Hold it in awareness for a while (5, 10, 20 seconds) • Focus on the emotions and body sensations that are part of this awareness Why: This practice allows neurons in our brain to fire @ this positive experience and increases dopamine release. Dopamine is associated with rewards and helps the awareness of positive experiences be wired into our implicit memory. Rick Hanson calls this “pull weeds and plant flowers.” It can also decrease our reactive response to stress triggers.

First Aid Kit “Taking in the Good”

http://www.youtube.com/watch?v=uPXOASa1shY

Mirror Neurons and Emotional/Social Contagion • Mirror neurons - brain cells that reflect or mirror the

activity of another person’s brain cells. • Individuals in close conversation will mirror each

other’s movements and facial expressions • Unconscious mirroring can also induce reactions in

our autonomic nervous system

Mirror Neurons and Emotional/Social Contagion An example of mirror neurons:

http://www.youtube.com/watch?v=HttF5HVYtlQ

Components of a Trauma Resilient System A neuroscience-informed integrative model that includes these components: • Individual self-care & resiliency • The role of supervision • Training, peer consultation and support • Organizational buy-in and commitment

How Do We Build Resilience in Daily Life and On the Job?  Choose new experiences that create new neural  

  

structure Rewire old pathways effectively and safely Mindfulness Empathy Compassion Taking in the Good

Five C’s of Coping • CALM – down regulate the nervous system, remain •

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level headed, become centered and peaceful CLARITY – reflect and make sense of the experience, gain a sense of understanding, evaluate and decide on a response CONNECT WITH RESOURCES – internal and external which expand our options for coping COMPETENT – through past experience we have learned skills and are able to draw on these competencies COURAGE – to persevere in coping with life experiences

(Linda Graham, MFT)

Reactivity Color Zone Zone Be cool monitor your heat level

The Science of Self-Care How do we build resilience? • Good physical health – sleep, balanced diet, sleep, physical

activity, sleep

• Good emotional health • Satisfying and meaningful social connections – living in

connection with others rather than trying to handle things on our own

• A sense of meaning and purpose in our life (could be

spirituality; is defined differently for each of us)

Neuroscience Informed Self-Care • Tuning into our bodies • Breathing

• Discharging negative/toxic energy – yoga, Qi Gong,

physical movement w/o thoughts • Mindfulness • Connecting with others • MAKE THIS A PRIORITY - Self-care is as important as theoretical orientations and models of practice (Sommer, 2008 and others)

Correlation between regular meditation and the following: • Shrinks the amydala (helps us be less reactive) • Thickens the prefrontal cortex (the thinking and reasoning part of our •

• • • • • • •

brain) Enlarges the hippocampus (Provides context for our emotional responses) Strengthens the posterior cingulate cortex (associated with creativity, self reflection and self-awareness) Builds the temporo-parietal junction (increases our ability to be empathetic) Reduces blood pressure Boosts our immune systems Improves our sleep Reduces risk factors for some types of heart disease Slows aspects of the brain’s natural aging process

*Choi (2013) Headington Institute; Hanson (2013)

Personal Resiliency Plan  Physical

 Emotional  Professional

 Spiritual  Social  Psychological

Core Mindfulness Skills

Emotion Mind

Wise Mind

Reasonable Mind

Use the mind to change the brain for the better through strengthening positive mind states

psycholog y

neurology

contemplative practice

A brief explanation of Mindfulness:

http://www.youtube.com/watch?v=HmEo6RI4Wvs

Creating a Sense of Belonging

 Relationships as positive resources – being seen

 Deep Listening  Resonance – felt sense, attunement, empathy  Becoming a “true other” – remembering our best self

when we are mired in our worst self and reflecting the best self back to us

Peer Consultation & Support

• Collegial support – Shift the focus away from what is

not working and increase their “positivity ratio.” (Gottman master’s vs. disasters) • Maintain optimism regarding their clients and their

work. (share success stories) • Green Cross Disaster Relief Group

Training • Can give staff needed tools, resources and skills to

feel greater sense of competency • Several studies reported a lack of training about

secondary trauma, or that it was sporadic (once a year 2 hour in-service) • Specialized trauma training did enhance CS and

reduce levels of CF and burnout

How Can Organizations Become More Trauma Resilient? MAKING A CULTURE SHIFT • Acknowledges secondary and vicarious trauma as a phenomenon that exists • Adopt policies that promote self-care

• Maintain healthy workplace expectations and

supports

• Promote a physical environment that is inviting and

welcoming

How Can Organizations Become More Trauma Resilient? • Have balanced/reduced caseloads for staff • Cultivate a team-oriented working environment of

competency, safety and trust • Offer access to flexible scheduling and adequate vacation,

sick time and personal time to deal with stress. • Provide opportunities for staff to be involved in social

change

How Can Organizations Become More Trauma Resilient? • Schedule team meetings that provide opportunities

for staff to talk about how they are doing • On site sensorimotor activities (e.g. yoga, Qi Gong,

meditation room) • Provide education and training to enhance competency

• Provide trauma-informed supervision to staff at all levels

How Can Organizations Become More Trauma Resilient? • Ensure adequate mental health benefits as well as

Employee Assistance Plans • Reward self-care

• Support and model self-care • Make the case to funders that a trauma resilient

organization leads to better client outcomes

Presenters Contact Information Linda Gensheimer, LICSW, MSW, PhD Bringing Together Art & Science Email: [email protected] Website: www.lglicsw.com Cynthia Packer, MSW, LICSW Email: [email protected] (cynthia underscore packer @ yahoo.com) A note about use of material in the PPT: Feel free to use this information and please reference source including bibliography in packet.