“Don’t be Ashamed of your Story,it will Inspire Others.”

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Introduction Page 3

Useful Contacts Page 5

Section 1: Why do I feel like this?

About Trauma Page 6

Brain responses to Trauma Page 8

Triggers Page 11

Flashbacks Page 12

Section 2: What can I do now? Page 13

Practical techniques for managing responses and emotions.

Window of tolerance Page 15

Managing Trigger Page 17

Managing Flashbacks Page 19

Generally Helpful Techniques Page 22

Anger Script Page 24

Mindfulness Page 25

Colouring Patterns Page 27

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Purpose of this pack

You have received this pre-counselling pack because you have been referred to EVA for coun-selling following domestic and/or sexual abuse. We are aware that these traumatic experiences can be highly distressing in the long term and have created a pack that we hope will provide some insight into some of the things you are thinking and feeling. We also hope that it may pro-vide you with an increased understanding of what counselling is and how to approach it so that you can get the most out of your sessions when you reach the top of the list. Finally we also hope that this booklet will provide some psycho-education and simple starting strategies for you to practice while you wait for 121 counselling.

What to expect from counselling

The leaflet attached to this document details further what counselling is, what to expect from counselling and how it can help.

Additional Support Services

Whilst you wait for counselling you may find it helpful to know about some of the other services at EVA that are available to you.

IDVA

IDVA stands for an Independent Domestic Violence Advocate. Our IDVA’s support people who have experienced domestic abuse and are involved in the judicial service. They work within a multi-agency setting but offer an independent service. IDVA’s also offer information and support, crisis intervention, safety planning, advocacy and practical and emotional support to enable survi-vors to make positive changes, reduce risk and minimise the risk of repeat victimisation.

ISVA

ISVA stands for Independent sexual violence advocate. They work in the same way as IDVA’s offering similar support for survivors of recent or historic sexual violence. The ISVA can advise around reporting sexual violence and attend the Sexual Assault Referral Centre (SARC) with cli-ents and offer support throughout the court process.

The work of IDVAs and ISVA’s helps to ensure that all agencies involved in an individual case fulfil their obligations.

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Freedom Programme

The Freedom Programme examines the roles played by attitudes and beliefs on the actions of abusive men and the responses of victims and survivors. The aim is to help make sense of and understand what has happened, instead of the whole experience just feeling like a horrible mess.

Other Sources of support.

Mind offer a road to recovery course and also run the Connect Recovery College. Courses include:

Improve your well being

Develop your skills and understanding

Identify your personal goals

Explore recovery and what it means to you

Increase your confidence

Details can be found at:

http://rcmind.org/rcmind.org/client-support-services/connect-courses/index.html

Alternatively you can call: 01642 296 052

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Useful Contacts

Eva Women’s Aid, General Enquires – 01642 490677 Victim Support – 01287 630009

Sexual Assault Referral Centre—01642 516888 James Cook Hospital—01642 850850

Redcar Crisis Team– 01287 284141 Middlesbrough Crisis Team– 01642 835296

Police HQ, Ladgate Lane – 01642 326326 D.V. Officers – Police - 01642 302669

Citizens Advice Bureau– 01642 469880 Samaritans - 01642 217777

NSPCC – 0808 800 5000 Childline – 0800 1111

Alcohol / Drug advice – 01642 516351 Mental Health Matters - 0800 0520658

Homeless Service – 01287 612444 Homeless out of hours – 01642 457326

Social Services – 01642 771500 Emergency Access Team – 0870 402994

* Please note the enclosed leaflet refers to a number of useful websites. *

In addition to these DABS signposts to a directory and books for abuse and sexual

assault support: http://www.dabs.uk.com/

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What is Trauma?

Trauma is a psychophysical experience, meaning it can impact our thoughts, emotions, feelings and our physical bodies, even if the traumatic event caused no direct bodily harm. People can experience trauma and trauma responses from a one-off event or from repeated events which perhaps would not have caused trauma as a one-off event but the repetition over time results in trauma. Traumatic events shake the foundation of a person’s life.

Common Reactions to Trauma

Below is a table with some common reactions to trauma, you may find you recognise some of them. However each individual will experience traumatic events differently and this list is by no means exhaustive so if you are experiencing something that is not in the table, don’t worry.

(Taken from Rosenbloom et al, 2010 p.15).

Physical Nervous energy, jitters, muscle tension, upset stomach, rapid heart

Reaction rate, dizziness, lack of energy, fatigue, teeth grinding, feeling out oftouch with your body, difficulty sleeping.

Mental Changes in the way you think about yourself, the world, other peo-

Reactions ple,. Heightened awareness of your surroundings. Disconnection fromyourself. Difficulty concentrating, poor attention, memory problems,difficulty making decisions, intrusive images, nightmares.

Emotional Fear, sadness, grief, depression, shame, guilt, anger, irritability, numb-

Reactions ness, lack of feelings, inability to enjoy anything, loss of trust, low self-esteem, helplessness, emotional distance from others, intense or ex-treme feelings.

Behavioural Withdrawing or isolating self, easily startled, avoiding places or situa-

Reactions tions, becoming confrontational and aggressive, change in eating hab-its and or weight, restlessness, increase or decrease in sexual activity.

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Trauma responses

Trauma and the crisis response that follows doesn’t take just one form. At the core of each of these clusters of symptoms is a sense of overwhelming panic, powerlessness and loss of control and of the unbearability of emotions. In times of crisis we say “I can’t” a lot and mean it. I can’t go on, I can’t cope, I can’t manage, I can’t sleep, I can’t calm down, I can’t see a way through this, I can’t do this anymore. This is a very difficult experience, but it’s also a very normal response.

The cartoon below explains why this is a normal response and the science behind

our responses to trauma.

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The Brain’s Response to Trauma

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What is a trigger?

Triggers are like little memory explosions that suddenly and unexpectedly bring past traumatic experiences crashing back into our conscious awareness and therefore into the present.

A trigger is any event or object that reminds you of, or subconsciously con-nects you to, an aspect of your abuse. Triggers cause you to behave in thesame way you did during or immediately after the traumatic event because your brain does not differentiate what happened then from what is going on around you now. Often they bring with them all the bodily reactions and emotions that would have been present at the time. We are sud-denly catapulted back and the natural fight-flight-freeze response is activated. In this moment they often hijack us from whatever had our attention at the time. Triggers are internal or external stimuli which remind us of past traumatic experiences.

We might be consciously aware of what there triggers are, or they could affect us at an uncon-scious level so that we react but we don’t even know why. A trigger might be a sight, a sound, a taste, a smell, a touch, a feeling in a particular situation (such as being powerless), a location, even a body position or body movement.

Triggers can be managed, we can train our brains rather than being hijacked by them.

Why triggers occur.

Research shows that such emotional explosions are neural hijackings. In such a moment, a cen-ter in the limbic system (a part of the brain), the Amygadala, theseat of all emotions in the brain, takes over the neocortex. The neocortex is the part of the brain that is responsible for our think-ing. During this moment the neocortex stops functioning. The amygdala gets triggered and in an instant takes control of the brain, in a sense hijacking it. Thus, it is called emotional hijack-ing.

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What are flashbacks?

Anyone who has experienced sexual abuse, rape or any other traumatic event can experience flashbacks. Flashbacks are a memory of a frightening or painful experience, which occurred ei-ther in childhood or adult life. It tends not to be like an ordinary memory, but more a sudden and unexpected intrusion. Flashbacks can be experienced as a single slide from a slide show, a snapshot or photograph that flashes repeatedly or like a video clip. A flashback can feel almost as real as when it originally happened and can also be as frightening. Not everyone’s flashbacks are visual. Some take the form of words and phrases or sounds that were heard in the past. They can be accompanied by intense feelings e.g. shame, sadness, anger, or physical sensations known as ‘body memories’, which may have been felt at the time of the original abuse.

Flashbacks can happen at any time, anywhere and often occur without warning. They can be trig-gered by, the time of year or day, TV programme, film, smells, words, phrases, a song, places, someone who reminds you in some way of your abuser, pictures, taste, a particular feeling such as fear or anxiety, having sex or being intimate with your partner. These can occur instantly or sometime later. Sometimes a flashback can occur in response to hearing voices that tell you to do things e.g. harm yourself or someone else. Hearing voices can be very frightening.

When do flashbacks occur?

Flashbacks can occur at unpredictable and unexpected times. They can be triggered by anything that serves as a reminder of the rape or assault or the perpetrator, for example they can occur if you’re feeling any of the following:

Low or vulnerable Helpless or powerless Exhausted or tired

Sad or tearful Angry or resentful Embarrassed or ashamed

Anxious or worried Trapped or hounded Sexual or intimate

Happy or excited Calm or relaxed

As this list shows, flashbacks can occur regardless of how you are feeling. The list is not intended to be exhaustive as there are so many ways you could be feeling when a flashback occurs.

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Do flashbacks differ in any way?

Yes, flashbacks can be experienced in many forms and combinations which include some or all of the following:

Visual flashbacks:

This is like watching a film or slideshow of the original rape or assault. You may ex-perience this as happening inside your head or you may experience this as happening outside of you and involving other people. This might be likely to happen if people around you remind you of the rape/assault or the perpetrator by doing or saying similar things. You may find your-self watching and/or re-experiencing all of the rape/assault scene or tiny fragments of it. The images you see could be clear or distorted and you may see the same picture from different an-gles at different times. For example, you may see a picture of the perpetrator coming towards you, or grabbing you and you may then re-experience the feelings you had when you were raped or assaulted; or you may see the perpetrator and yourself in the same picture, so you are watching the picture from an observers perspective and you may feel cut off from any feeling.

Auditory flashbacks:

This is described as hearing conversations or sounds which are associated with the rape/ assault. You might experience these sounds as being inside your head or outside of you i.e. in the same room. These sounds could be clear or distorted and may sound near or far away.

Sensory flashbacks:

This is described as feeling bodily sensations associated with the rape/assault. This type of flashback could manifest in the following ways:

During this type of flashback you may re-experience the physical sensations and/or pain that you felt when being raped or assaulted. These sensations could be experienced as happen-ing anywhere on, or inside of your body. You may feel as if you are being touched on any part of your body when in reality, there is no one there. This could range from feeling some-one touch your arm to feeling as though someone is lying on top of you. Depending on the severity of this experience, you may feel anxious, frightened, confused or that you are going

mad, particularly if you do not understand what is happening to you, or if you try to consciously stop it happening and are unable to.

This type of flashback can also include strong, overwhelming sensations of taste and/or smell.

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Becoming aware of the effects of the trauma on you and your responses to them is the first step to recovery. As with everything this is a learning process and will take time. One of the ways in which increasing your awareness helps is that it will help you to recognise your window of toler-ance and to begin practising staying within it. The cartoon below explains more about the window of tolerance.

(Taken from: The courage to be me by Nina Burrows)

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Managing Triggers

When being triggered people often try really hard ‘just to calm down’ and get frustrated and upset that they are unable to, often reinforcing the situation. The first step to managing triggers is to begin recognising your behaviour or physical symptoms that occur as a result of a trauma trigger.

Then focusing on activating different parts of the brain and not ‘trying’ to calm down may be more successful. This is because the front and back part of our brain act like a see-saw. By turning the front part of our brain on the back-brain begins to get turned off.

There are three parts of our front brain that we can engage with in different ways to regain con-trol when a trigger knocks us off course.

The first is the front left brain, the part that holds information as facts. For example this is where Redcar is in the North East, Shakespeare wrote Macbeth and I am safe here (the logical part of that statement not the emo-tional part) are stored. This part of the brain gets ‘switched on’ by doing low -level mental activities such as counting, Sudoku, logic puzzles or factual

quizzes. It’s often hard to concentrate when we’re stressed and panicky, so pick something that doesn’t matter like a Sudoku or a puzzle game on a smartphone or ordering DVD’s.

The second is the front right brain, the part responsible for human relation-ships and attachments. It is switched on at ‘attachment moments’ such as when a mother soothes her baby with touch, eye contact or a reassuring voice. We can engage this part of our brain by connecting with someone else and allowing them to help you be soothed and calmed down. This could be a friend, partner or even a pet.

The third is the front middle brain, the part of the brain that can reflect upon itself, looking inside and thinking ‘how am I feeling? What’s going on for me now? By turning our attention inwards and just being curious it encourages the back brain to begin calming down.

The important thing is to find activities that help you ground yourself when triggered.

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How can I help myself during and after flashbacks?

If you have experienced one or more flashbacks, you may be feeling frightened, confused,

disorientated, and/or overwhelmed. Theses feelings are understandable and they are normal re-actions to what can be a terrifying experience.

It is important that you reassure yourself with the knowledge that this is a temporary state, it will not last forever and through time, the flashback will reduce in frequency and Intensi-ty. You may find yourself trying to avoid all potential triggers for these memories; this is not possi-ble as there are so many situations that could trigger memories. While it is not possible to control the nature and strength of the flashbacks, you can do a lot of things to help lessen the power and impact that they have on your life.

Take yourself to a safe place.

This may be in your home, curled up on the settee with a warm quilt around you, or in the bath, or in your favourite chair, or at a good friends house. Go wherever you need to go, in order to feel safe and where you know you will be safe. If you are not able to go to a safe place at the time of the flashback, remind yourself that what you have experienced is a memory, take several deep breaths and promise yourself that as soon as you can, you will take time out to explore the flash-back in more detail.

Don't fight the flashback.

Although this may feel difficult, try to breathe deeply and let the memory surface. Using alcohol, solvents, drugs, food and/or self-injury etc. to bury the feelings from a flashback can actually add to and prolong the trauma of recovering buried memories. It can be hard to change these famil-iar coping mechanisms, however it will be very helpful to you in the long run if you can manage to avoid coping with flashbacks in this way. If you try to ignore or push away emerging memories they are likely to feel stronger and more powerful as they fight for recognition.

Remind yourself that this is a memory.

This is a memory of something that has already happened to you and you have survived it. Reas-sure yourself that you are not being hurt in the present, even though you may feel as though it is happening now. It is important that you keep on reminding yourself that you have come through this experience and that you are now on the road to recovery.

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Ground yourself.

Remind yourself of the day, date, time etc. Look at your surroundings, where you are right now. Remind yourself of how old you are, where you live etc. Try to let part of yourself stay in the pre-sent while, at the same time allowing yourself to remember your past. You may find it reassuring to carry a stone or something familiar and comforting in your pocket that you can stroke, hold or rub when a flashback occurs. Some women keep an elastic band around their wrist and ‘ping it’ to try and bring them back to the here and now. Try to breathe from your diaphragm (put your hand just above your navel and breathe so your hand is pushed up and down.) This can help pre-vent a panic attack. If the flashback occurs whilst you are out and about try to get yourself to somewhere that you feel safe and secure.

Give yourself space and time to recover.

Reliving memories can be a painful and exhausting experience. It may take several hours or days for you to feel okay again. If you need to rest, sleep, cry or be angry, give yourself permission to do so. Don’t jump up and try to do something else straight away. If you are wakened by a flash-back, also known as a ‘night terror’, try to write it down, then go and have something warm to drink, watch some TV, listen to music or do something else that you find relaxing. It’s often best not to try and sleep until you have been able to relax for a while. Keep a list of people you can contact in the event of experiencing a flashback. If you start experiencing a flashback while hav-ing sex with your partner you can stop and take time to relax. It’s OK to take time out from the sexual side of your relationship to work through these memories if you need to. Your partner should respect your choice and support you.

Talk about the flashback.

Even though you may feel like keeping the flashback to yourself, it can be really helpful if you share it with a supportive person. In talking it through you may gain more insight to yourself and it may help you to put your experience into perspective. Remember, you have not done anything wrong, being raped or assaulted was not your fault and you do not have to suffer in silence. Give yourself permission to receive support and understanding from others.

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Comfort yourself.

After having one or more flashbacks, you may feel vulnerable and low. This is the time to give yourself a reward or treat for all of your hard work. It will be helpful if you can do something that makes you feel good, for example, a warm aromatherapy/bubble bath, a drink of hot chocolate or milk, a bunch of flowers, a long relaxing walk, meeting with supportive friends, seeing a movie, listening to your favourite music, cooking your favourite food etc.

Be proud of yourself.

You have come through a frightening experience and you’re still in one piece. You have let your-self remember a very traumatic time in your life and that takes a lot of courage and strength to do. Through this process of remembering and acknowledging your past, you have moved deeper into your journey of healing and have grown a little bit more. Well done!

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Generally Helpful Techniques

Breathing

As we’ve already mentioned breathing can help manage triggers, flashbacks and increase your window of tolerance by bringing you back into the here and now. Below are a number of breath-ing exercises you may wish to try (and as with anything these breathing techniques will take practice).

Candle exercise

Imagine that you have a candle set out in front of you. This is your own unique candle. You may want to think what size it is, is it tall, small, wide, thin. What colour is it? Are there any patterns on it? How big is the flame? What colour is the flame? Now as you imagine the candle breathe in through your nose for 4 counts and then slowly breathe out of your mouth for 6 counts. As you breathe out imagine that you are blowing the candles flame gently. You don’t want to breathe out too deeply so as to blow out the flame, just enough to make it flicker.

Body Scan

This is a brief meditation practice to relax your body and focus your mind. Find a comfortable po-sition. The body scan can be done while lying down, sitting or in other postures. The steps below are guided and designed to be done while sitting. You may wish to adapt them to a position you find comfortable.

Begin by bringing your attention into your body.

You can close your eyes if that’s comfortable for you.

You can notice your body seated, wherever you’re seated, feeling the weight of your body on the chair, on the floor.

Take a few deep breaths. Breathe in through your nose for 8 and our through your mouth slowly for 8 (or whatever feels comfortable for you).

And as you take a deep breath, bring in more oxygen enlivening the body. And as you exhale, have a sense of relaxing more deeply.

You can notice your feet on the floor, notice the sensations of your feet touching the floor. The weight and pressure, vibration, heat.

You can notice your legs against the chair, pressure, pulsing, heaviness, lightness.

Notice your back against the chair.

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Bring your attention into your stomach area. If your stomach is tense or tight, let it soften. Contin-ue taking deep breaths, allowing yourself to breath in relaxation and release the stress or pres-sure as you breathe out.

Notice your hands. Are your hands tense or tight. See if you can allow them to soften.

Notice your arms. Feel any sensation in your arms. Let your shoulders be soft.

Notice your neck and throat. Let them be soft. Breathe in and breathe out. Relax.

Soften your jaw. Let your face and facial muscles be soft.

Then notice your whole body present. Take one more deep breath.

Be aware of your whole body as best you can. Take a breath and then when you’re ready, you can open your eyes.

The power of taste

Strong mints or chewing can also be used as a grounding technique as it focuses your brain back to the present.

Anger Techniques

As mentioned anger is a normal response to abuse. As with all the other emotions part of manag-ing it is beginning to accept that this is how you feel and that’s ok. The exercises

below are about moving the angry energy from inside the body to outside the body.

Helpful exercises and techniques for discharging this energy are physical exercise, talking, throw-ing a stone, ball, bean bags or other appropriate objects (somewhere appropriate), hammering a nail each time you are angry into a piece of wood. There are also breathing techniques (as above) and relaxation techniques. Included on the next page is an anger

relaxation script you may find useful.

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What is mindfulness?

Mindfulness is a modern practice that involves paying full attention to your experiences, both good and bad. It encourages us to recognise our feelings without getting caught up in them and live more in the moment and less in the past. However, mindfulness requires continued practice.

The main ingredient in the mindfulness recipe is the pre-sent moment. It isn’t that you need to concentrate on the moment itself, since a moments is impossible to pin down. Instead what you do is focus on your experience in the present, forgetting about past and future, or time passing, being aware of any thoughts and emotions entering your mind but not dwelling on them, allow them to pass. You may choose to focus on something you’re doing, listening to, looking at or feeling as a sensation (such as breathing).In mindfulness practice you choose where to place your focus. You direct your attention there, but you don’t worry if distracting thoughts or feelings, or perhaps unexpected sensa-tions cross your path. You may note them but exercise your choice not to engage with them, instead redirecting your attention to the initial focus, such as breathing, colouring in, or your surroundings.

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Exercise

This is a basic introduction to what mindfulness involves. If any thoughts or emotions come into your mind while doing it, be aware of them but don’t dwell on them: return to your focus and let them pass away.

1. Sit down at a table with a small object in front of you such as a glass, mug, salt pot.

2. Look closely at the object

for a few minutes, taking in every-thing about it you can see withouttouching it or moving it or judgingit’s beauty or utility.

3. Focus on you sensations. Remain still, close your eyes and be aware of any physicalsensations, such as yourbreathing, where your body touches your clothes, where you feel the pressure from the chair or floor, etc.

4. Spend a few minutes focusing your mind on what you can hear, perhaps your breathing, the hum of the oven, a bird, neighbours radio.

Reflection: By focusing on an object, on sensations and then sounds you’ve given

yourself a break from pre-occupations. With practise this can be a primary way to enable mental refreshment.

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Mindful colouring

Art can be a really helpful way to practice mindfulness. Focussing our attention on the col-ours, staying within the lines and getting caught up in the art of creativity allows our atten-tion to shift from our pre-occupations to the present, allowing our mind some respite space.

Exercise

Below are a variety of patterns and designs. Allows yourself to put down your tasks, goals and worries, and just for a moment allow yourself to take a break and recharge by colouring in the shapes and patterns

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References

Resources from this pack have taken from the following books.

Dragon Slippers: This is what an abusive relationship looks like. By Rosalind Penfold.

The Courage To Be Me: A story of courage, self-compassion and hope after sexual abuse. By Nina Burrowes

The Body Remembers: The psychophysiology of Trauma and Trauma Treatment. By Babette Rothschild.

Life After Trauma 2nd Ed. By Dena Rosenbloom & Mary Williams.

Practical Mindfulness: A step by step guide. By Ken Verni.

The Mindfulness Colouring Book. By Emma Farronnes.

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