healing complex societal trauma with our human superpowers · human connection and our inherent...
TRANSCRIPT
Healing Complex Societal
Trauma with our Human Superpowers
Elizabeth Rocco MD
Karen Ekwueme MDPrevious Collaborators
Karen Burt Imira MD Bonnie Cohen MD
Demie Stathoplos MSW
Human Connection and our inherent Healing Processes
can be more Powerful than the Hurts of our Communities
bull
Listening Partnerships and Communities
bull EmotionalAwareness
bull Human Connection
bull Attentive Listening
bull Empowerment
Emerging evidence of the benefits of emotional release such as laughing crying yawning and even swearing
Key Assumptions
1 Humans are equally precious and significant Our feelings thoughts actions and lives matter
2 Humans are good resilient flexible intelligent and caring by nature
3 Humans have inherent emotional healing processes to help us manifest our true nature
copy Elizabeth Rocco MD
Guidelines for Listening Session
1 Set a time limit and split time evenly
2 Do not interrupt do not give advice tell your own story or share your feelings during the speakerrsquos time
3 Strict confidentiality
Basic Steps in Peer Listening Session
Step 1 Connect with yourself body mind and emotionsStep 2 Hold non-judgmental space to be seen and heardStep 3 See the speaker and anyone referenced as able
to manifest their true human nature and evolve using inherent healing abilities
Step 4 Listen to the speaker in a deep connected way sending the message that their thinking feelings and being matters to you copy Elizabeth Rocco MD
Silent Listening Practice
Messages Received by Young People in Under Served Communities
The Reality
Facing the Impact of Racism Poverty and Sexism
Behavioral Learning and Mental Health Diagnoses in Children
In New England
63 of Children
[1]Wen Patricia (2010) ldquoA legacy of unintended side effectsrdquo Boston Globe December 12
Use of Psychiatric Drugs in Children
Children on Psychiatric Drugs in the US in 2013
bull 0-1 Years 2748042-3 Years 3707784-5 Years 500948
bull 6-12 Years 413034013-17 Years 3617593
bull 8389034 children on psychiatric drugsbull [2]CCHR International (2014) [Online] Number of Children amp Adolescents Taking Psychiatric Drugs in the US
Aprilwwwcchrintorgpsychiatric-drugschildren-on-psychiatric-drugs
Facing the Impact of Trauma
An Alternative Model
Listening Practice
bull Turn to the person next to you
bull The person on the left will be the listener first and the other the speaker
bull Listener will listen while the speaker shares
bull Switch when time is called
When we define the effects of oppression as someonersquos ldquoillnessrdquo and ignore the root causes we obscure our path
forward in healing our communities
What if we reframed ldquochronic illnessrdquo as a societal struggle that requires societal
change and healing in community
1 Institutionalized oppression
2 Personally-mediated oppression or micro-aggressions
3 Internalized oppression
Teamnofearorg
Manifestations of Societal Oppression
Institutionalized Racism
Micro-aggressions
Internalized Racism
StressCumulative Effects
COGNITIVE BEHAVIORAL
EMOTIONAL NEURO PHYSIOLOGICAL
STRESS
Complex Societal Trauma (CST)Total Negative Health Impact over Generations
Societal Oppression
Familial Trauma
Societal Trauma
Complex Societal Trauma
copy Elizabeth Rocco MD
Intergenerational TransmissionHow is CST passed down to our children
1 Yehuda R et al (2015) ldquoHolocaust Exposure Induced Intergenerational Effects on FKBP5 MethylationrdquoBiol Psychiatry Aug 12 httpwwwncbinlmnihgovpubmed26410355B
2 Buss C et al (2011) ldquoMaternal pregnancy-specific anxiety is associated with child executive function at 6-9 years agerdquo Stress Nov14(6)665-76 httpwwwncbinlmnihgovpubmed21995526
3 Shankardass K et al (2014) ldquoParental stress increases body mass index trajectory in preadolescentsrdquoPediatr Obes Dec9(6)435-42 httpwwwncbinlmnihgovpubmed24311567
Complex Societal Trauma
is Toxic to the Developing Brain
Pat Levitt developmental neuroscientist and Dr Jack
Shonkoff part of the National Scientific Council on
the Developing Child
ACE (Adverse Childhood Experience) Study
Childhood neglect abuse and household dysfunction impacts health through out life
Vincent J Felitti et al (1998) ldquoRelationship of Childhood Abuse and Household Dysfunction to Many of the Leading Causes of Death in Adults
The Adverse Childhood Experiences (ACE) Studyrdquo May Volume 14 Issue 4 Pages 245ndash
258 httpsacestoohighcom
Healing Complex Societal Trauma
Social Engagement Ventral Vagal Complex
Reach for Help Ventral Vagal FEAR
Fight or FlightSympathetic
FEAR
FEAR
Freeze Collapse Dorsal Vagal
Pre-frontal CortexThe Voice of Reason
Human Healing and Evolution through Self-Awareness Embodiment Empowerment and Connection
Mindfulness Breath work Martial Arts Exercise Yoga Singing Dancing
Acupuncture Massage ReikiCommunity Groups Animals Church Nature
Final Listening Practice and Closing Circle
Bibliography
bull Special Acknowledgement of Demie Stathoplos MSW and Bonnie Cohen MD who collaborated with Elizabeth Rocco MD on the IM4US August 2015 presentation ldquoListening to Each Other Healing the Negative Health Impacts of Racism Poverty and Trauma through Human Connectionrdquo
bull Special Acknowledgement of Karen Burt MD who collaborated with Elizabeth Rocco MD and Karen Ekwueme MD on the IM4US August 2016 presentation ldquoListening to Ourselves and Each Other Healing the Negative Health Impact of Racism Poverty Sexism and Traumardquo These bibliographies are included below
bull [1]Wen Patricia (2010) ldquoA legacy of unintended side effectsrdquo Boston Globe December 12 httpwwwbostoncomnewslocalmassachusettsarticles20101212with_ssi_program_a_legcy_of_unintended_side_effects
bull [2]CCHR International (2014) [Online] Number of Children amp Adolescents Taking Psychiatric Drugs in the US Aprilwwwcchrintorgpsychiatric-drugschildren-on-psychiatric-drugs
bull [3]Whitaker R (2010) Anatomy of an Epidemic Magic Bullets Psychiatric Drugs and the Astonishing Rise of Mental Illness in America Crown Publishing Company httprobertwhitakerorgrobertwhitakerorgAnatomy20of20an20Epidemichtml
bull [3]CDC (2013) [Online] MMRW Mental Health Surveillance Among Children mdash United States 2005ndash2011 Supplements May 17 62(02)1-35 httpwwwcdcgovmmwrpreviewmmwrhtmlsu6202a1htm
bull [4]Patricia N Pastor PhD Cynthia A Reuben MA Catherine R Duran BS and LaJeana D Hawkins MPH CHES (2015) [Online] CDC NCHS Data Brief Association Between Diagnosed ADHD and Selected Characteristics Among Children Aged 4ndash17 Years United States 2011ndash2013 May Number 201 httpwwwcdcgovnchsdatadatabriefsdb201htm
bull [5]Mental Health America (2014) Parity or Disparity The State of Mental Health in America 2015 NovwwwmentalhealthamericanetsitesdefaultfilesParity20or20Disparity20201520Reportpdf
bull [6]Bruce S Jonas ScM PhD Qiuping Gu MD PhD and Juan R Albertorio-Diaz MA (2013) [Online] CDC NCHS Data Brief Psychotropic Medication Use Among Adolescents United States 2005ndash2010 Dec Number 135httpwwwcdcgovnchsdatadatabriefsdb135htm
bull [7] C Buss EP Davis CJ Hobel and CA Sandman (2011) Maternal pregnancy-specific anxiety is associated with child executive function at 6ndash9 years age Stress Nov 14(6)665-676
bull [8] Council for Evidence-Based Psychiatry (UK) Web presentation ldquoUnrecognized Factsrdquo Authors James Davies Peter C Goetzsche Peter Kinderman Joanna Moncrieff Phillip Thomas Sami Timimi John Sandwich Melanie Davis Luke Montague httpcepukorgunrecognised-facts
bull [9] Johnstone Lucy (2015) A Straight Talking Introduction to Psychiatric DiagnosisPCCS Books 1st edition (February 3 2015)
bull [10] Brewin CR Andrews B Valentine JD (2000) ldquoMeta-analysis of risk factors for posttraumatic stress disorder in trauma-exposed adultsrdquo J Consult Clin Psychol2000 Oct68(5)748-66 httpwwwncbinlmnihgovpubmed11068961
bull [11] Williams Monica T (2013) ldquoCan Racism Cause PTSD Implications for DSM-5rdquoPsychology Today May 20 httpswwwpsychologytodaycomblogculturally-speaking201305can-racism-cause-ptsd-implications-dsm-5
Bibliography
bull [12] Yuan Chengmei et al (2011) ldquoProtective factors for posttraumatic stress disorder symptoms in a prospective study of police officersrdquo Nov 23httpwwwncbinlmnihgovpmcarticlesPMC3071439
bull [13] Chou Tina BA Anu Asnaani MA and Stefan G Hofmann PhD (2012) ldquoPerception of Racial Discrimination and Psychopathology Across Three US Ethnic Minority Groupsrdquo APA PsychNET Jan httpwwwncbinlmnihgovpmcarticlesPMC3505377
bull [14] Watson Laurel B Jacob M Marszalek Franco Dispenza and Christopher M Davids 2015 Understanding the Relationships Among White and African American Womenrsquos Sexual Objectification Experiences Physical Safety Anxiety and Psychological Distress Sex Roles 72 (34) 91-104
bull [15] Holland Julie (2015) ldquoMedicating Womenrsquos Feelingsrdquo New York TimesOpinion Feb 28 httpmobilenytimescom20150301opinionsundaymedicating-womens-feelingshtmlreferreramp_r=1
bull [16] Solinas M Thiriet N El Rawas R Lardeux V and Jaber M (2009) ldquoEnvironmental Enrichment During Early Stages of Life Reduces the Behavioral Neurochemical and Molecular Effects of Cocainerdquo Neuropsychopharmacology 34 1102ndash1111
bull [17] Hari Johann Chasing The Scream The First and Last Days of the War on Drugs Bloomsbury USA (January 20 2015)bull [18] Hughes Caitlin Elizabeth and Alex Stevens (2010) ldquoWhat Can We Learn From The Portuguese Decriminalization of Illicit
Drugsrdquo British Journal of Criminology July 21 httpbjcoxfordjournalsorgcontent506999abstractbull [19] Fournier Jay C et al (2009) ldquoAntidepressant Drug Effects and Depression Severityrdquo JAMA January
6th httpjamajamanetworkcomarticleaspxarticleid=185157[20] Currie J Stabile M Jones L (2013) Do Stimulant Medications Improve Educational and Behavioral Outcomes for Children with ADHD NBER Working Paper No 19105
bull [21] Mora-Ripoli R Organizacioacuten Mundial de la Risa Barcelona Spain ldquoThe therapeutic value of laughter in medicinerdquo Altern Ther Health Med 2010 Nov-Dec16(6)56-64 httpwwwncbinlmnihgovpubmed21280463
bull [22] Gracanin Asmir Lauren M Bylsma and Ad J J M Vingerhoets (2014) ldquoIs Crying a Self-Stoothing Behaviorrdquo Frontiers in Psychology May 28httpwwwncbinlmnihgovpmcarticlesPMC4035568
bull [23] Trimble Michael (2010) ldquoI Cry Therefore I Amrdquo New York Times Nov 10 httpwwwnytimescom20121111opinionsundayi-cry-therefore-i-amhtmlemc=eta1amp_r=0
bull [24]Gallup Andrew C et al (2007) ldquoYawning as a brain cooling mechanism Nasal breathing and forehead cooling diminish the incidence of contagious yawningrdquo httpwwwepjournalnetarticlesyawning-as-a-brain-cooling-mechanism-nasal-breathing-and-forehead-cooling-diminish-the-incidence-of-contagious-yawning
bull [25]Sharat Gupta and Shallu Mittal Int (2013) Yawning and its physiological significance Intl J Appl Basic Med Res Jan-Jun 3(1) 11ndash15
bull [26] Stephens R Atkins J Kingston A (2009) ldquoSwearing As a Response to Painrdquo NeuroReport Aug 5 httpwwwncbinlmnihgovpubmed19590391
bull [27]Morelli SA Lieberman MD(2013) rdquoThe role of automaticity and attention in neural processes underlying empathy for happiness sadness and anxietyrdquo Front Hum Neurosci May 87160
Bibliography
bull [1] Committee on Psychosocial Aspects of Child and Family Health Committee on Early Childhood Adoption and Dependent Care andSection on Developmental and Behavioral Pediatrics Andrew S Garner Jack P Shonkoff et al (2012) ldquoEarly Childhood Adversity Toxic Stress and the Role of the Pediatrician Translating Developmental Science Into Lifelong Healthrdquo Pediatrics January VOLUME 129 ISSUE 1 From the American Academy of Pediatrics Policy Statementhttppediatricsaappublicationsorgcontent1291e224fullref-23
bull [2] COUNCIL ON COMMUNITY PEDIATRICS Benjamin A Gitterman et al (2016) ldquoPoverty and Child Health in the United Statesrdquo Pediatrics March From the American Academy of Pediatrics Policy Statement Published Online March 09American Academy of Pediatricshttppediatricsaappublicationsorgcontentearly20160307peds2016-0339info
bull [3] Paul W Newacheck et al (2003) ldquoDisparities in Adolescent Health and Health Care Does Socioeconomic Status Matterrdquo Health ServRes Oct 38(5) 1235ndash1252 httpwwwncbinlmnihgovpmcarticlesPMC1360944
bull [4] Larson et al (2007) ldquoPoverty during pregnancy Its effects on child health outcomesrdquo Paediatr Child Health 2007 Oct 12(8) 673ndash677 httpwwwncbinlmnihgovpmcarticlesPMC2528810
bull [5] Lara J Akinbami et al (2012) ldquoTrends in Asthma Prevalence Health Care Use and Mortality in the United States 2001ndash2010rdquo NCHS Data Brief No 94 May httpwwwcdcgovnchsproductsdatabriefsdb94htm
bull [6] Cynthia L Ogden et al (2010) ldquoObesity and Socioeconomic Status in Children and Adolescents United States 2005-2008rdquoNCHS Data Brief No 51 Decemberhttpwwwcdcgovnchsproductsdatabriefsdb51htm
bull [7] Shonkoff JP et al Committee on Psychosocial Aspects of Child and Family Health Committee on Early Childhood Adoption and Dependent Care Section on Developmental and Behavioral Pediatrics rdquoThe lifelong effects of early childhood adversity and toxicstressrdquo Pediatrics 2012129(1) wwwpediatricsorgcgicontentfull1291e232
bull [8] Virginia A Rauh et alldquoHousing and HealthIntersection of Poverty and Environmental Exposuresrdquo (2008) Annals of the New York Academy of Sciences Volume 1136 Reducing the Impact of Poverty on Health and Human Development Scientific Approaches pages 276ndash288 June httponlinelibrarywileycomdoi101196annals1425032full
bull [9] Yehuda R et al (2015) ldquoHolocaust Exposure Induced Intergenerational Effects on FKBP5 MethylationrdquoBiol Psychiatry Aug 12 httpwwwncbinlmnihgovpubmed26410355
bull [10] Buss C et al (2011) ldquoMaternal pregnancy-specific anxiety is associated with child executive function at 6-9 years agerdquoStress Nov14(6)665-76 httpwwwncbinlmnihgovpubmed21995526
bull 11] Shankardass K et al (2014) ldquoParental stress increases body mass index trajectory in pre-adolescentsrdquoPediatr Obes Dec9(6)435-42 httpwwwncbinlmnihgovpubmed24311567
bull [12] Vincent J Felitti et al (1998) ldquoRelationship of Childhood Abuse and Household Dysfunction to Many of the Leading Causes of Death in Adults The Adverse Childhood Experiences (ACE) Studyrdquo May Volume 14 Issue 4 Pages 245ndash258 httpsacestoohighcom
bull [13]Jones CP Levels of Racism a Theoretic Framework and the Gardenerrsquos Tale Am J Public Health 200090(8) 1212-1215bull [14]Dion KL The Social Psycology of Perceived Perjudice and Discrimination Canadian Psychology (2002)431 pp 1-10bull [15]Sue D W Bucceri J Lin AI Nadal K L and Torino J C Racial Microaggressions and the Asian American experience APA (2007) Vol
13 No 1 pp 72-81bull [16]James S A (School of Public Health U of North Carolina Chapel Hill NC 27514) D S Strogatz S B Wing and D L Ramsey
Socioeconomic status John Henryism and hypertension in blacks and whites Am J Epidemiol 1987 126664ndash73bull [17]httpwwwapaorgpioemaresourcesethnicity-healthindexaspxbull [18]Porges SW Clinical Insights from the Polyvagal Theory The Transformative Power of Feeling Safe (Norton Series on Interpersonal
Neurobiology) W W Norton Apr 7 2014 - Psychology - 288 pagesbull [19]The Polyvagal Theory (Porges SW Social Connectedness as a Biological Imperative Understanding Trauma Through the Lens of
thePolyvagal Theory presentation 82015)bull [20]McEwen BS Allostasis and allostatic load implications for neuropsychopharmacologyNeuropsychopharmacology 2000
Feb22(2)108-24bull [21] McEwen BS adaptation and disease Allostasis and allostatic load Ann N Y Acad Sci 1998 May 184033-44bull [22] Arline T Geronimus ScD Margaret Hicken MPH Danya Keene MAT and John Bound PhD Weatheringrdquo and Age Patterns of
Allostatic Load Scores Among Blacks and Whites in the United States Am J Public Health 2006 May 96(5) 826ndash833bull [22]Stephen Porges PhD Polyvagal Perspective Biological Psychology 2007 Feb 74(2) 116ndash143 Published online 2006 Oct 16 bull [23]Stephen W Porges PhD The Polyvagal Theory Neurophysiological Foundations of Emotions Attachment Communication and
Self-regulation WWNorton and Company Inc 2011bull [24]Maggie Phillips PhD Reversing Chronic Pain North Atlantic Books 2007bull [25]Peter Levine PhD Waking the Tiger North Atlantic Books 1997bull [26]Bessel VanderKolk MD The Body Keeps the Score Viking Penguin 2014bullAcknowledgmentsbull Group Medical Visits and Group Facilitation Jeff Geller MDbull Re-evaluation Counseling Community bull Insight Meditation Communitybull Biodynamic Osteopathy Communitybull Learning To Breathe Mindfulness Training for Adolescents 2015 Patricia C Broderick PhD bull Stanford Chronic Disease Self Management Program Training 2014 Kate Lorig MPH RNbull Motivational Interviewing Training 2015 Steven Berg-Smithbull Centering Pregnancy Training 2014 Centering Healthcare Institutebull Motivating Change in Groups Training 2013 Kaiser Permanente Oakland Cabull Group Facilitation Training Sara Fisk PhD Community at Work San Francisco Cabull Tribes Training 2013 Center for Human Developmentbull Cultural Humility Training 2016 Melanie Tervalon MD
Bibliography
Intermediate Steps to Listening Session Handout
bull Step 1 Connect with yourself body mind and emotions
bull Step 2 Hold a non-judgmental space to be seen and heard
bull Step 3 See the speaker and anyone referenced as able to manifest their true human nature and evolve using inherent healing abilities
bull Step 4 Listen to the speaker in a deep connected way sending the message that their thinking feelings and being matters to you
bull Step 5 Encourage the speaker to express feelings or thoughts describe body sensations or share a story relevant to the feelings at hand
bull Step 6 Validate intense emotional expression and release such as crying laughing shaking yawning sweating as a sign of healing
bull Step 7 Remind the speaker of their underlying goodness intelligence strength and caring and your confidence in their ability to heal and manifest their true human nature
copy Elizabeth Rocco MD
Contact Information
bull Elizabeth Rocco MD -egroccogmailcom
bull Karen Ekwueme MD-impactdoc1gmailcom
Human Connection and our inherent Healing Processes
can be more Powerful than the Hurts of our Communities
bull
Listening Partnerships and Communities
bull EmotionalAwareness
bull Human Connection
bull Attentive Listening
bull Empowerment
Emerging evidence of the benefits of emotional release such as laughing crying yawning and even swearing
Key Assumptions
1 Humans are equally precious and significant Our feelings thoughts actions and lives matter
2 Humans are good resilient flexible intelligent and caring by nature
3 Humans have inherent emotional healing processes to help us manifest our true nature
copy Elizabeth Rocco MD
Guidelines for Listening Session
1 Set a time limit and split time evenly
2 Do not interrupt do not give advice tell your own story or share your feelings during the speakerrsquos time
3 Strict confidentiality
Basic Steps in Peer Listening Session
Step 1 Connect with yourself body mind and emotionsStep 2 Hold non-judgmental space to be seen and heardStep 3 See the speaker and anyone referenced as able
to manifest their true human nature and evolve using inherent healing abilities
Step 4 Listen to the speaker in a deep connected way sending the message that their thinking feelings and being matters to you copy Elizabeth Rocco MD
Silent Listening Practice
Messages Received by Young People in Under Served Communities
The Reality
Facing the Impact of Racism Poverty and Sexism
Behavioral Learning and Mental Health Diagnoses in Children
In New England
63 of Children
[1]Wen Patricia (2010) ldquoA legacy of unintended side effectsrdquo Boston Globe December 12
Use of Psychiatric Drugs in Children
Children on Psychiatric Drugs in the US in 2013
bull 0-1 Years 2748042-3 Years 3707784-5 Years 500948
bull 6-12 Years 413034013-17 Years 3617593
bull 8389034 children on psychiatric drugsbull [2]CCHR International (2014) [Online] Number of Children amp Adolescents Taking Psychiatric Drugs in the US
Aprilwwwcchrintorgpsychiatric-drugschildren-on-psychiatric-drugs
Facing the Impact of Trauma
An Alternative Model
Listening Practice
bull Turn to the person next to you
bull The person on the left will be the listener first and the other the speaker
bull Listener will listen while the speaker shares
bull Switch when time is called
When we define the effects of oppression as someonersquos ldquoillnessrdquo and ignore the root causes we obscure our path
forward in healing our communities
What if we reframed ldquochronic illnessrdquo as a societal struggle that requires societal
change and healing in community
1 Institutionalized oppression
2 Personally-mediated oppression or micro-aggressions
3 Internalized oppression
Teamnofearorg
Manifestations of Societal Oppression
Institutionalized Racism
Micro-aggressions
Internalized Racism
StressCumulative Effects
COGNITIVE BEHAVIORAL
EMOTIONAL NEURO PHYSIOLOGICAL
STRESS
Complex Societal Trauma (CST)Total Negative Health Impact over Generations
Societal Oppression
Familial Trauma
Societal Trauma
Complex Societal Trauma
copy Elizabeth Rocco MD
Intergenerational TransmissionHow is CST passed down to our children
1 Yehuda R et al (2015) ldquoHolocaust Exposure Induced Intergenerational Effects on FKBP5 MethylationrdquoBiol Psychiatry Aug 12 httpwwwncbinlmnihgovpubmed26410355B
2 Buss C et al (2011) ldquoMaternal pregnancy-specific anxiety is associated with child executive function at 6-9 years agerdquo Stress Nov14(6)665-76 httpwwwncbinlmnihgovpubmed21995526
3 Shankardass K et al (2014) ldquoParental stress increases body mass index trajectory in preadolescentsrdquoPediatr Obes Dec9(6)435-42 httpwwwncbinlmnihgovpubmed24311567
Complex Societal Trauma
is Toxic to the Developing Brain
Pat Levitt developmental neuroscientist and Dr Jack
Shonkoff part of the National Scientific Council on
the Developing Child
ACE (Adverse Childhood Experience) Study
Childhood neglect abuse and household dysfunction impacts health through out life
Vincent J Felitti et al (1998) ldquoRelationship of Childhood Abuse and Household Dysfunction to Many of the Leading Causes of Death in Adults
The Adverse Childhood Experiences (ACE) Studyrdquo May Volume 14 Issue 4 Pages 245ndash
258 httpsacestoohighcom
Healing Complex Societal Trauma
Social Engagement Ventral Vagal Complex
Reach for Help Ventral Vagal FEAR
Fight or FlightSympathetic
FEAR
FEAR
Freeze Collapse Dorsal Vagal
Pre-frontal CortexThe Voice of Reason
Human Healing and Evolution through Self-Awareness Embodiment Empowerment and Connection
Mindfulness Breath work Martial Arts Exercise Yoga Singing Dancing
Acupuncture Massage ReikiCommunity Groups Animals Church Nature
Final Listening Practice and Closing Circle
Bibliography
bull Special Acknowledgement of Demie Stathoplos MSW and Bonnie Cohen MD who collaborated with Elizabeth Rocco MD on the IM4US August 2015 presentation ldquoListening to Each Other Healing the Negative Health Impacts of Racism Poverty and Trauma through Human Connectionrdquo
bull Special Acknowledgement of Karen Burt MD who collaborated with Elizabeth Rocco MD and Karen Ekwueme MD on the IM4US August 2016 presentation ldquoListening to Ourselves and Each Other Healing the Negative Health Impact of Racism Poverty Sexism and Traumardquo These bibliographies are included below
bull [1]Wen Patricia (2010) ldquoA legacy of unintended side effectsrdquo Boston Globe December 12 httpwwwbostoncomnewslocalmassachusettsarticles20101212with_ssi_program_a_legcy_of_unintended_side_effects
bull [2]CCHR International (2014) [Online] Number of Children amp Adolescents Taking Psychiatric Drugs in the US Aprilwwwcchrintorgpsychiatric-drugschildren-on-psychiatric-drugs
bull [3]Whitaker R (2010) Anatomy of an Epidemic Magic Bullets Psychiatric Drugs and the Astonishing Rise of Mental Illness in America Crown Publishing Company httprobertwhitakerorgrobertwhitakerorgAnatomy20of20an20Epidemichtml
bull [3]CDC (2013) [Online] MMRW Mental Health Surveillance Among Children mdash United States 2005ndash2011 Supplements May 17 62(02)1-35 httpwwwcdcgovmmwrpreviewmmwrhtmlsu6202a1htm
bull [4]Patricia N Pastor PhD Cynthia A Reuben MA Catherine R Duran BS and LaJeana D Hawkins MPH CHES (2015) [Online] CDC NCHS Data Brief Association Between Diagnosed ADHD and Selected Characteristics Among Children Aged 4ndash17 Years United States 2011ndash2013 May Number 201 httpwwwcdcgovnchsdatadatabriefsdb201htm
bull [5]Mental Health America (2014) Parity or Disparity The State of Mental Health in America 2015 NovwwwmentalhealthamericanetsitesdefaultfilesParity20or20Disparity20201520Reportpdf
bull [6]Bruce S Jonas ScM PhD Qiuping Gu MD PhD and Juan R Albertorio-Diaz MA (2013) [Online] CDC NCHS Data Brief Psychotropic Medication Use Among Adolescents United States 2005ndash2010 Dec Number 135httpwwwcdcgovnchsdatadatabriefsdb135htm
bull [7] C Buss EP Davis CJ Hobel and CA Sandman (2011) Maternal pregnancy-specific anxiety is associated with child executive function at 6ndash9 years age Stress Nov 14(6)665-676
bull [8] Council for Evidence-Based Psychiatry (UK) Web presentation ldquoUnrecognized Factsrdquo Authors James Davies Peter C Goetzsche Peter Kinderman Joanna Moncrieff Phillip Thomas Sami Timimi John Sandwich Melanie Davis Luke Montague httpcepukorgunrecognised-facts
bull [9] Johnstone Lucy (2015) A Straight Talking Introduction to Psychiatric DiagnosisPCCS Books 1st edition (February 3 2015)
bull [10] Brewin CR Andrews B Valentine JD (2000) ldquoMeta-analysis of risk factors for posttraumatic stress disorder in trauma-exposed adultsrdquo J Consult Clin Psychol2000 Oct68(5)748-66 httpwwwncbinlmnihgovpubmed11068961
bull [11] Williams Monica T (2013) ldquoCan Racism Cause PTSD Implications for DSM-5rdquoPsychology Today May 20 httpswwwpsychologytodaycomblogculturally-speaking201305can-racism-cause-ptsd-implications-dsm-5
Bibliography
bull [12] Yuan Chengmei et al (2011) ldquoProtective factors for posttraumatic stress disorder symptoms in a prospective study of police officersrdquo Nov 23httpwwwncbinlmnihgovpmcarticlesPMC3071439
bull [13] Chou Tina BA Anu Asnaani MA and Stefan G Hofmann PhD (2012) ldquoPerception of Racial Discrimination and Psychopathology Across Three US Ethnic Minority Groupsrdquo APA PsychNET Jan httpwwwncbinlmnihgovpmcarticlesPMC3505377
bull [14] Watson Laurel B Jacob M Marszalek Franco Dispenza and Christopher M Davids 2015 Understanding the Relationships Among White and African American Womenrsquos Sexual Objectification Experiences Physical Safety Anxiety and Psychological Distress Sex Roles 72 (34) 91-104
bull [15] Holland Julie (2015) ldquoMedicating Womenrsquos Feelingsrdquo New York TimesOpinion Feb 28 httpmobilenytimescom20150301opinionsundaymedicating-womens-feelingshtmlreferreramp_r=1
bull [16] Solinas M Thiriet N El Rawas R Lardeux V and Jaber M (2009) ldquoEnvironmental Enrichment During Early Stages of Life Reduces the Behavioral Neurochemical and Molecular Effects of Cocainerdquo Neuropsychopharmacology 34 1102ndash1111
bull [17] Hari Johann Chasing The Scream The First and Last Days of the War on Drugs Bloomsbury USA (January 20 2015)bull [18] Hughes Caitlin Elizabeth and Alex Stevens (2010) ldquoWhat Can We Learn From The Portuguese Decriminalization of Illicit
Drugsrdquo British Journal of Criminology July 21 httpbjcoxfordjournalsorgcontent506999abstractbull [19] Fournier Jay C et al (2009) ldquoAntidepressant Drug Effects and Depression Severityrdquo JAMA January
6th httpjamajamanetworkcomarticleaspxarticleid=185157[20] Currie J Stabile M Jones L (2013) Do Stimulant Medications Improve Educational and Behavioral Outcomes for Children with ADHD NBER Working Paper No 19105
bull [21] Mora-Ripoli R Organizacioacuten Mundial de la Risa Barcelona Spain ldquoThe therapeutic value of laughter in medicinerdquo Altern Ther Health Med 2010 Nov-Dec16(6)56-64 httpwwwncbinlmnihgovpubmed21280463
bull [22] Gracanin Asmir Lauren M Bylsma and Ad J J M Vingerhoets (2014) ldquoIs Crying a Self-Stoothing Behaviorrdquo Frontiers in Psychology May 28httpwwwncbinlmnihgovpmcarticlesPMC4035568
bull [23] Trimble Michael (2010) ldquoI Cry Therefore I Amrdquo New York Times Nov 10 httpwwwnytimescom20121111opinionsundayi-cry-therefore-i-amhtmlemc=eta1amp_r=0
bull [24]Gallup Andrew C et al (2007) ldquoYawning as a brain cooling mechanism Nasal breathing and forehead cooling diminish the incidence of contagious yawningrdquo httpwwwepjournalnetarticlesyawning-as-a-brain-cooling-mechanism-nasal-breathing-and-forehead-cooling-diminish-the-incidence-of-contagious-yawning
bull [25]Sharat Gupta and Shallu Mittal Int (2013) Yawning and its physiological significance Intl J Appl Basic Med Res Jan-Jun 3(1) 11ndash15
bull [26] Stephens R Atkins J Kingston A (2009) ldquoSwearing As a Response to Painrdquo NeuroReport Aug 5 httpwwwncbinlmnihgovpubmed19590391
bull [27]Morelli SA Lieberman MD(2013) rdquoThe role of automaticity and attention in neural processes underlying empathy for happiness sadness and anxietyrdquo Front Hum Neurosci May 87160
Bibliography
bull [1] Committee on Psychosocial Aspects of Child and Family Health Committee on Early Childhood Adoption and Dependent Care andSection on Developmental and Behavioral Pediatrics Andrew S Garner Jack P Shonkoff et al (2012) ldquoEarly Childhood Adversity Toxic Stress and the Role of the Pediatrician Translating Developmental Science Into Lifelong Healthrdquo Pediatrics January VOLUME 129 ISSUE 1 From the American Academy of Pediatrics Policy Statementhttppediatricsaappublicationsorgcontent1291e224fullref-23
bull [2] COUNCIL ON COMMUNITY PEDIATRICS Benjamin A Gitterman et al (2016) ldquoPoverty and Child Health in the United Statesrdquo Pediatrics March From the American Academy of Pediatrics Policy Statement Published Online March 09American Academy of Pediatricshttppediatricsaappublicationsorgcontentearly20160307peds2016-0339info
bull [3] Paul W Newacheck et al (2003) ldquoDisparities in Adolescent Health and Health Care Does Socioeconomic Status Matterrdquo Health ServRes Oct 38(5) 1235ndash1252 httpwwwncbinlmnihgovpmcarticlesPMC1360944
bull [4] Larson et al (2007) ldquoPoverty during pregnancy Its effects on child health outcomesrdquo Paediatr Child Health 2007 Oct 12(8) 673ndash677 httpwwwncbinlmnihgovpmcarticlesPMC2528810
bull [5] Lara J Akinbami et al (2012) ldquoTrends in Asthma Prevalence Health Care Use and Mortality in the United States 2001ndash2010rdquo NCHS Data Brief No 94 May httpwwwcdcgovnchsproductsdatabriefsdb94htm
bull [6] Cynthia L Ogden et al (2010) ldquoObesity and Socioeconomic Status in Children and Adolescents United States 2005-2008rdquoNCHS Data Brief No 51 Decemberhttpwwwcdcgovnchsproductsdatabriefsdb51htm
bull [7] Shonkoff JP et al Committee on Psychosocial Aspects of Child and Family Health Committee on Early Childhood Adoption and Dependent Care Section on Developmental and Behavioral Pediatrics rdquoThe lifelong effects of early childhood adversity and toxicstressrdquo Pediatrics 2012129(1) wwwpediatricsorgcgicontentfull1291e232
bull [8] Virginia A Rauh et alldquoHousing and HealthIntersection of Poverty and Environmental Exposuresrdquo (2008) Annals of the New York Academy of Sciences Volume 1136 Reducing the Impact of Poverty on Health and Human Development Scientific Approaches pages 276ndash288 June httponlinelibrarywileycomdoi101196annals1425032full
bull [9] Yehuda R et al (2015) ldquoHolocaust Exposure Induced Intergenerational Effects on FKBP5 MethylationrdquoBiol Psychiatry Aug 12 httpwwwncbinlmnihgovpubmed26410355
bull [10] Buss C et al (2011) ldquoMaternal pregnancy-specific anxiety is associated with child executive function at 6-9 years agerdquoStress Nov14(6)665-76 httpwwwncbinlmnihgovpubmed21995526
bull 11] Shankardass K et al (2014) ldquoParental stress increases body mass index trajectory in pre-adolescentsrdquoPediatr Obes Dec9(6)435-42 httpwwwncbinlmnihgovpubmed24311567
bull [12] Vincent J Felitti et al (1998) ldquoRelationship of Childhood Abuse and Household Dysfunction to Many of the Leading Causes of Death in Adults The Adverse Childhood Experiences (ACE) Studyrdquo May Volume 14 Issue 4 Pages 245ndash258 httpsacestoohighcom
bull [13]Jones CP Levels of Racism a Theoretic Framework and the Gardenerrsquos Tale Am J Public Health 200090(8) 1212-1215bull [14]Dion KL The Social Psycology of Perceived Perjudice and Discrimination Canadian Psychology (2002)431 pp 1-10bull [15]Sue D W Bucceri J Lin AI Nadal K L and Torino J C Racial Microaggressions and the Asian American experience APA (2007) Vol
13 No 1 pp 72-81bull [16]James S A (School of Public Health U of North Carolina Chapel Hill NC 27514) D S Strogatz S B Wing and D L Ramsey
Socioeconomic status John Henryism and hypertension in blacks and whites Am J Epidemiol 1987 126664ndash73bull [17]httpwwwapaorgpioemaresourcesethnicity-healthindexaspxbull [18]Porges SW Clinical Insights from the Polyvagal Theory The Transformative Power of Feeling Safe (Norton Series on Interpersonal
Neurobiology) W W Norton Apr 7 2014 - Psychology - 288 pagesbull [19]The Polyvagal Theory (Porges SW Social Connectedness as a Biological Imperative Understanding Trauma Through the Lens of
thePolyvagal Theory presentation 82015)bull [20]McEwen BS Allostasis and allostatic load implications for neuropsychopharmacologyNeuropsychopharmacology 2000
Feb22(2)108-24bull [21] McEwen BS adaptation and disease Allostasis and allostatic load Ann N Y Acad Sci 1998 May 184033-44bull [22] Arline T Geronimus ScD Margaret Hicken MPH Danya Keene MAT and John Bound PhD Weatheringrdquo and Age Patterns of
Allostatic Load Scores Among Blacks and Whites in the United States Am J Public Health 2006 May 96(5) 826ndash833bull [22]Stephen Porges PhD Polyvagal Perspective Biological Psychology 2007 Feb 74(2) 116ndash143 Published online 2006 Oct 16 bull [23]Stephen W Porges PhD The Polyvagal Theory Neurophysiological Foundations of Emotions Attachment Communication and
Self-regulation WWNorton and Company Inc 2011bull [24]Maggie Phillips PhD Reversing Chronic Pain North Atlantic Books 2007bull [25]Peter Levine PhD Waking the Tiger North Atlantic Books 1997bull [26]Bessel VanderKolk MD The Body Keeps the Score Viking Penguin 2014bullAcknowledgmentsbull Group Medical Visits and Group Facilitation Jeff Geller MDbull Re-evaluation Counseling Community bull Insight Meditation Communitybull Biodynamic Osteopathy Communitybull Learning To Breathe Mindfulness Training for Adolescents 2015 Patricia C Broderick PhD bull Stanford Chronic Disease Self Management Program Training 2014 Kate Lorig MPH RNbull Motivational Interviewing Training 2015 Steven Berg-Smithbull Centering Pregnancy Training 2014 Centering Healthcare Institutebull Motivating Change in Groups Training 2013 Kaiser Permanente Oakland Cabull Group Facilitation Training Sara Fisk PhD Community at Work San Francisco Cabull Tribes Training 2013 Center for Human Developmentbull Cultural Humility Training 2016 Melanie Tervalon MD
Bibliography
Intermediate Steps to Listening Session Handout
bull Step 1 Connect with yourself body mind and emotions
bull Step 2 Hold a non-judgmental space to be seen and heard
bull Step 3 See the speaker and anyone referenced as able to manifest their true human nature and evolve using inherent healing abilities
bull Step 4 Listen to the speaker in a deep connected way sending the message that their thinking feelings and being matters to you
bull Step 5 Encourage the speaker to express feelings or thoughts describe body sensations or share a story relevant to the feelings at hand
bull Step 6 Validate intense emotional expression and release such as crying laughing shaking yawning sweating as a sign of healing
bull Step 7 Remind the speaker of their underlying goodness intelligence strength and caring and your confidence in their ability to heal and manifest their true human nature
copy Elizabeth Rocco MD
Contact Information
bull Elizabeth Rocco MD -egroccogmailcom
bull Karen Ekwueme MD-impactdoc1gmailcom
Listening Partnerships and Communities
bull EmotionalAwareness
bull Human Connection
bull Attentive Listening
bull Empowerment
Emerging evidence of the benefits of emotional release such as laughing crying yawning and even swearing
Key Assumptions
1 Humans are equally precious and significant Our feelings thoughts actions and lives matter
2 Humans are good resilient flexible intelligent and caring by nature
3 Humans have inherent emotional healing processes to help us manifest our true nature
copy Elizabeth Rocco MD
Guidelines for Listening Session
1 Set a time limit and split time evenly
2 Do not interrupt do not give advice tell your own story or share your feelings during the speakerrsquos time
3 Strict confidentiality
Basic Steps in Peer Listening Session
Step 1 Connect with yourself body mind and emotionsStep 2 Hold non-judgmental space to be seen and heardStep 3 See the speaker and anyone referenced as able
to manifest their true human nature and evolve using inherent healing abilities
Step 4 Listen to the speaker in a deep connected way sending the message that their thinking feelings and being matters to you copy Elizabeth Rocco MD
Silent Listening Practice
Messages Received by Young People in Under Served Communities
The Reality
Facing the Impact of Racism Poverty and Sexism
Behavioral Learning and Mental Health Diagnoses in Children
In New England
63 of Children
[1]Wen Patricia (2010) ldquoA legacy of unintended side effectsrdquo Boston Globe December 12
Use of Psychiatric Drugs in Children
Children on Psychiatric Drugs in the US in 2013
bull 0-1 Years 2748042-3 Years 3707784-5 Years 500948
bull 6-12 Years 413034013-17 Years 3617593
bull 8389034 children on psychiatric drugsbull [2]CCHR International (2014) [Online] Number of Children amp Adolescents Taking Psychiatric Drugs in the US
Aprilwwwcchrintorgpsychiatric-drugschildren-on-psychiatric-drugs
Facing the Impact of Trauma
An Alternative Model
Listening Practice
bull Turn to the person next to you
bull The person on the left will be the listener first and the other the speaker
bull Listener will listen while the speaker shares
bull Switch when time is called
When we define the effects of oppression as someonersquos ldquoillnessrdquo and ignore the root causes we obscure our path
forward in healing our communities
What if we reframed ldquochronic illnessrdquo as a societal struggle that requires societal
change and healing in community
1 Institutionalized oppression
2 Personally-mediated oppression or micro-aggressions
3 Internalized oppression
Teamnofearorg
Manifestations of Societal Oppression
Institutionalized Racism
Micro-aggressions
Internalized Racism
StressCumulative Effects
COGNITIVE BEHAVIORAL
EMOTIONAL NEURO PHYSIOLOGICAL
STRESS
Complex Societal Trauma (CST)Total Negative Health Impact over Generations
Societal Oppression
Familial Trauma
Societal Trauma
Complex Societal Trauma
copy Elizabeth Rocco MD
Intergenerational TransmissionHow is CST passed down to our children
1 Yehuda R et al (2015) ldquoHolocaust Exposure Induced Intergenerational Effects on FKBP5 MethylationrdquoBiol Psychiatry Aug 12 httpwwwncbinlmnihgovpubmed26410355B
2 Buss C et al (2011) ldquoMaternal pregnancy-specific anxiety is associated with child executive function at 6-9 years agerdquo Stress Nov14(6)665-76 httpwwwncbinlmnihgovpubmed21995526
3 Shankardass K et al (2014) ldquoParental stress increases body mass index trajectory in preadolescentsrdquoPediatr Obes Dec9(6)435-42 httpwwwncbinlmnihgovpubmed24311567
Complex Societal Trauma
is Toxic to the Developing Brain
Pat Levitt developmental neuroscientist and Dr Jack
Shonkoff part of the National Scientific Council on
the Developing Child
ACE (Adverse Childhood Experience) Study
Childhood neglect abuse and household dysfunction impacts health through out life
Vincent J Felitti et al (1998) ldquoRelationship of Childhood Abuse and Household Dysfunction to Many of the Leading Causes of Death in Adults
The Adverse Childhood Experiences (ACE) Studyrdquo May Volume 14 Issue 4 Pages 245ndash
258 httpsacestoohighcom
Healing Complex Societal Trauma
Social Engagement Ventral Vagal Complex
Reach for Help Ventral Vagal FEAR
Fight or FlightSympathetic
FEAR
FEAR
Freeze Collapse Dorsal Vagal
Pre-frontal CortexThe Voice of Reason
Human Healing and Evolution through Self-Awareness Embodiment Empowerment and Connection
Mindfulness Breath work Martial Arts Exercise Yoga Singing Dancing
Acupuncture Massage ReikiCommunity Groups Animals Church Nature
Final Listening Practice and Closing Circle
Bibliography
bull Special Acknowledgement of Demie Stathoplos MSW and Bonnie Cohen MD who collaborated with Elizabeth Rocco MD on the IM4US August 2015 presentation ldquoListening to Each Other Healing the Negative Health Impacts of Racism Poverty and Trauma through Human Connectionrdquo
bull Special Acknowledgement of Karen Burt MD who collaborated with Elizabeth Rocco MD and Karen Ekwueme MD on the IM4US August 2016 presentation ldquoListening to Ourselves and Each Other Healing the Negative Health Impact of Racism Poverty Sexism and Traumardquo These bibliographies are included below
bull [1]Wen Patricia (2010) ldquoA legacy of unintended side effectsrdquo Boston Globe December 12 httpwwwbostoncomnewslocalmassachusettsarticles20101212with_ssi_program_a_legcy_of_unintended_side_effects
bull [2]CCHR International (2014) [Online] Number of Children amp Adolescents Taking Psychiatric Drugs in the US Aprilwwwcchrintorgpsychiatric-drugschildren-on-psychiatric-drugs
bull [3]Whitaker R (2010) Anatomy of an Epidemic Magic Bullets Psychiatric Drugs and the Astonishing Rise of Mental Illness in America Crown Publishing Company httprobertwhitakerorgrobertwhitakerorgAnatomy20of20an20Epidemichtml
bull [3]CDC (2013) [Online] MMRW Mental Health Surveillance Among Children mdash United States 2005ndash2011 Supplements May 17 62(02)1-35 httpwwwcdcgovmmwrpreviewmmwrhtmlsu6202a1htm
bull [4]Patricia N Pastor PhD Cynthia A Reuben MA Catherine R Duran BS and LaJeana D Hawkins MPH CHES (2015) [Online] CDC NCHS Data Brief Association Between Diagnosed ADHD and Selected Characteristics Among Children Aged 4ndash17 Years United States 2011ndash2013 May Number 201 httpwwwcdcgovnchsdatadatabriefsdb201htm
bull [5]Mental Health America (2014) Parity or Disparity The State of Mental Health in America 2015 NovwwwmentalhealthamericanetsitesdefaultfilesParity20or20Disparity20201520Reportpdf
bull [6]Bruce S Jonas ScM PhD Qiuping Gu MD PhD and Juan R Albertorio-Diaz MA (2013) [Online] CDC NCHS Data Brief Psychotropic Medication Use Among Adolescents United States 2005ndash2010 Dec Number 135httpwwwcdcgovnchsdatadatabriefsdb135htm
bull [7] C Buss EP Davis CJ Hobel and CA Sandman (2011) Maternal pregnancy-specific anxiety is associated with child executive function at 6ndash9 years age Stress Nov 14(6)665-676
bull [8] Council for Evidence-Based Psychiatry (UK) Web presentation ldquoUnrecognized Factsrdquo Authors James Davies Peter C Goetzsche Peter Kinderman Joanna Moncrieff Phillip Thomas Sami Timimi John Sandwich Melanie Davis Luke Montague httpcepukorgunrecognised-facts
bull [9] Johnstone Lucy (2015) A Straight Talking Introduction to Psychiatric DiagnosisPCCS Books 1st edition (February 3 2015)
bull [10] Brewin CR Andrews B Valentine JD (2000) ldquoMeta-analysis of risk factors for posttraumatic stress disorder in trauma-exposed adultsrdquo J Consult Clin Psychol2000 Oct68(5)748-66 httpwwwncbinlmnihgovpubmed11068961
bull [11] Williams Monica T (2013) ldquoCan Racism Cause PTSD Implications for DSM-5rdquoPsychology Today May 20 httpswwwpsychologytodaycomblogculturally-speaking201305can-racism-cause-ptsd-implications-dsm-5
Bibliography
bull [12] Yuan Chengmei et al (2011) ldquoProtective factors for posttraumatic stress disorder symptoms in a prospective study of police officersrdquo Nov 23httpwwwncbinlmnihgovpmcarticlesPMC3071439
bull [13] Chou Tina BA Anu Asnaani MA and Stefan G Hofmann PhD (2012) ldquoPerception of Racial Discrimination and Psychopathology Across Three US Ethnic Minority Groupsrdquo APA PsychNET Jan httpwwwncbinlmnihgovpmcarticlesPMC3505377
bull [14] Watson Laurel B Jacob M Marszalek Franco Dispenza and Christopher M Davids 2015 Understanding the Relationships Among White and African American Womenrsquos Sexual Objectification Experiences Physical Safety Anxiety and Psychological Distress Sex Roles 72 (34) 91-104
bull [15] Holland Julie (2015) ldquoMedicating Womenrsquos Feelingsrdquo New York TimesOpinion Feb 28 httpmobilenytimescom20150301opinionsundaymedicating-womens-feelingshtmlreferreramp_r=1
bull [16] Solinas M Thiriet N El Rawas R Lardeux V and Jaber M (2009) ldquoEnvironmental Enrichment During Early Stages of Life Reduces the Behavioral Neurochemical and Molecular Effects of Cocainerdquo Neuropsychopharmacology 34 1102ndash1111
bull [17] Hari Johann Chasing The Scream The First and Last Days of the War on Drugs Bloomsbury USA (January 20 2015)bull [18] Hughes Caitlin Elizabeth and Alex Stevens (2010) ldquoWhat Can We Learn From The Portuguese Decriminalization of Illicit
Drugsrdquo British Journal of Criminology July 21 httpbjcoxfordjournalsorgcontent506999abstractbull [19] Fournier Jay C et al (2009) ldquoAntidepressant Drug Effects and Depression Severityrdquo JAMA January
6th httpjamajamanetworkcomarticleaspxarticleid=185157[20] Currie J Stabile M Jones L (2013) Do Stimulant Medications Improve Educational and Behavioral Outcomes for Children with ADHD NBER Working Paper No 19105
bull [21] Mora-Ripoli R Organizacioacuten Mundial de la Risa Barcelona Spain ldquoThe therapeutic value of laughter in medicinerdquo Altern Ther Health Med 2010 Nov-Dec16(6)56-64 httpwwwncbinlmnihgovpubmed21280463
bull [22] Gracanin Asmir Lauren M Bylsma and Ad J J M Vingerhoets (2014) ldquoIs Crying a Self-Stoothing Behaviorrdquo Frontiers in Psychology May 28httpwwwncbinlmnihgovpmcarticlesPMC4035568
bull [23] Trimble Michael (2010) ldquoI Cry Therefore I Amrdquo New York Times Nov 10 httpwwwnytimescom20121111opinionsundayi-cry-therefore-i-amhtmlemc=eta1amp_r=0
bull [24]Gallup Andrew C et al (2007) ldquoYawning as a brain cooling mechanism Nasal breathing and forehead cooling diminish the incidence of contagious yawningrdquo httpwwwepjournalnetarticlesyawning-as-a-brain-cooling-mechanism-nasal-breathing-and-forehead-cooling-diminish-the-incidence-of-contagious-yawning
bull [25]Sharat Gupta and Shallu Mittal Int (2013) Yawning and its physiological significance Intl J Appl Basic Med Res Jan-Jun 3(1) 11ndash15
bull [26] Stephens R Atkins J Kingston A (2009) ldquoSwearing As a Response to Painrdquo NeuroReport Aug 5 httpwwwncbinlmnihgovpubmed19590391
bull [27]Morelli SA Lieberman MD(2013) rdquoThe role of automaticity and attention in neural processes underlying empathy for happiness sadness and anxietyrdquo Front Hum Neurosci May 87160
Bibliography
bull [1] Committee on Psychosocial Aspects of Child and Family Health Committee on Early Childhood Adoption and Dependent Care andSection on Developmental and Behavioral Pediatrics Andrew S Garner Jack P Shonkoff et al (2012) ldquoEarly Childhood Adversity Toxic Stress and the Role of the Pediatrician Translating Developmental Science Into Lifelong Healthrdquo Pediatrics January VOLUME 129 ISSUE 1 From the American Academy of Pediatrics Policy Statementhttppediatricsaappublicationsorgcontent1291e224fullref-23
bull [2] COUNCIL ON COMMUNITY PEDIATRICS Benjamin A Gitterman et al (2016) ldquoPoverty and Child Health in the United Statesrdquo Pediatrics March From the American Academy of Pediatrics Policy Statement Published Online March 09American Academy of Pediatricshttppediatricsaappublicationsorgcontentearly20160307peds2016-0339info
bull [3] Paul W Newacheck et al (2003) ldquoDisparities in Adolescent Health and Health Care Does Socioeconomic Status Matterrdquo Health ServRes Oct 38(5) 1235ndash1252 httpwwwncbinlmnihgovpmcarticlesPMC1360944
bull [4] Larson et al (2007) ldquoPoverty during pregnancy Its effects on child health outcomesrdquo Paediatr Child Health 2007 Oct 12(8) 673ndash677 httpwwwncbinlmnihgovpmcarticlesPMC2528810
bull [5] Lara J Akinbami et al (2012) ldquoTrends in Asthma Prevalence Health Care Use and Mortality in the United States 2001ndash2010rdquo NCHS Data Brief No 94 May httpwwwcdcgovnchsproductsdatabriefsdb94htm
bull [6] Cynthia L Ogden et al (2010) ldquoObesity and Socioeconomic Status in Children and Adolescents United States 2005-2008rdquoNCHS Data Brief No 51 Decemberhttpwwwcdcgovnchsproductsdatabriefsdb51htm
bull [7] Shonkoff JP et al Committee on Psychosocial Aspects of Child and Family Health Committee on Early Childhood Adoption and Dependent Care Section on Developmental and Behavioral Pediatrics rdquoThe lifelong effects of early childhood adversity and toxicstressrdquo Pediatrics 2012129(1) wwwpediatricsorgcgicontentfull1291e232
bull [8] Virginia A Rauh et alldquoHousing and HealthIntersection of Poverty and Environmental Exposuresrdquo (2008) Annals of the New York Academy of Sciences Volume 1136 Reducing the Impact of Poverty on Health and Human Development Scientific Approaches pages 276ndash288 June httponlinelibrarywileycomdoi101196annals1425032full
bull [9] Yehuda R et al (2015) ldquoHolocaust Exposure Induced Intergenerational Effects on FKBP5 MethylationrdquoBiol Psychiatry Aug 12 httpwwwncbinlmnihgovpubmed26410355
bull [10] Buss C et al (2011) ldquoMaternal pregnancy-specific anxiety is associated with child executive function at 6-9 years agerdquoStress Nov14(6)665-76 httpwwwncbinlmnihgovpubmed21995526
bull 11] Shankardass K et al (2014) ldquoParental stress increases body mass index trajectory in pre-adolescentsrdquoPediatr Obes Dec9(6)435-42 httpwwwncbinlmnihgovpubmed24311567
bull [12] Vincent J Felitti et al (1998) ldquoRelationship of Childhood Abuse and Household Dysfunction to Many of the Leading Causes of Death in Adults The Adverse Childhood Experiences (ACE) Studyrdquo May Volume 14 Issue 4 Pages 245ndash258 httpsacestoohighcom
bull [13]Jones CP Levels of Racism a Theoretic Framework and the Gardenerrsquos Tale Am J Public Health 200090(8) 1212-1215bull [14]Dion KL The Social Psycology of Perceived Perjudice and Discrimination Canadian Psychology (2002)431 pp 1-10bull [15]Sue D W Bucceri J Lin AI Nadal K L and Torino J C Racial Microaggressions and the Asian American experience APA (2007) Vol
13 No 1 pp 72-81bull [16]James S A (School of Public Health U of North Carolina Chapel Hill NC 27514) D S Strogatz S B Wing and D L Ramsey
Socioeconomic status John Henryism and hypertension in blacks and whites Am J Epidemiol 1987 126664ndash73bull [17]httpwwwapaorgpioemaresourcesethnicity-healthindexaspxbull [18]Porges SW Clinical Insights from the Polyvagal Theory The Transformative Power of Feeling Safe (Norton Series on Interpersonal
Neurobiology) W W Norton Apr 7 2014 - Psychology - 288 pagesbull [19]The Polyvagal Theory (Porges SW Social Connectedness as a Biological Imperative Understanding Trauma Through the Lens of
thePolyvagal Theory presentation 82015)bull [20]McEwen BS Allostasis and allostatic load implications for neuropsychopharmacologyNeuropsychopharmacology 2000
Feb22(2)108-24bull [21] McEwen BS adaptation and disease Allostasis and allostatic load Ann N Y Acad Sci 1998 May 184033-44bull [22] Arline T Geronimus ScD Margaret Hicken MPH Danya Keene MAT and John Bound PhD Weatheringrdquo and Age Patterns of
Allostatic Load Scores Among Blacks and Whites in the United States Am J Public Health 2006 May 96(5) 826ndash833bull [22]Stephen Porges PhD Polyvagal Perspective Biological Psychology 2007 Feb 74(2) 116ndash143 Published online 2006 Oct 16 bull [23]Stephen W Porges PhD The Polyvagal Theory Neurophysiological Foundations of Emotions Attachment Communication and
Self-regulation WWNorton and Company Inc 2011bull [24]Maggie Phillips PhD Reversing Chronic Pain North Atlantic Books 2007bull [25]Peter Levine PhD Waking the Tiger North Atlantic Books 1997bull [26]Bessel VanderKolk MD The Body Keeps the Score Viking Penguin 2014bullAcknowledgmentsbull Group Medical Visits and Group Facilitation Jeff Geller MDbull Re-evaluation Counseling Community bull Insight Meditation Communitybull Biodynamic Osteopathy Communitybull Learning To Breathe Mindfulness Training for Adolescents 2015 Patricia C Broderick PhD bull Stanford Chronic Disease Self Management Program Training 2014 Kate Lorig MPH RNbull Motivational Interviewing Training 2015 Steven Berg-Smithbull Centering Pregnancy Training 2014 Centering Healthcare Institutebull Motivating Change in Groups Training 2013 Kaiser Permanente Oakland Cabull Group Facilitation Training Sara Fisk PhD Community at Work San Francisco Cabull Tribes Training 2013 Center for Human Developmentbull Cultural Humility Training 2016 Melanie Tervalon MD
Bibliography
Intermediate Steps to Listening Session Handout
bull Step 1 Connect with yourself body mind and emotions
bull Step 2 Hold a non-judgmental space to be seen and heard
bull Step 3 See the speaker and anyone referenced as able to manifest their true human nature and evolve using inherent healing abilities
bull Step 4 Listen to the speaker in a deep connected way sending the message that their thinking feelings and being matters to you
bull Step 5 Encourage the speaker to express feelings or thoughts describe body sensations or share a story relevant to the feelings at hand
bull Step 6 Validate intense emotional expression and release such as crying laughing shaking yawning sweating as a sign of healing
bull Step 7 Remind the speaker of their underlying goodness intelligence strength and caring and your confidence in their ability to heal and manifest their true human nature
copy Elizabeth Rocco MD
Contact Information
bull Elizabeth Rocco MD -egroccogmailcom
bull Karen Ekwueme MD-impactdoc1gmailcom
Emerging evidence of the benefits of emotional release such as laughing crying yawning and even swearing
Key Assumptions
1 Humans are equally precious and significant Our feelings thoughts actions and lives matter
2 Humans are good resilient flexible intelligent and caring by nature
3 Humans have inherent emotional healing processes to help us manifest our true nature
copy Elizabeth Rocco MD
Guidelines for Listening Session
1 Set a time limit and split time evenly
2 Do not interrupt do not give advice tell your own story or share your feelings during the speakerrsquos time
3 Strict confidentiality
Basic Steps in Peer Listening Session
Step 1 Connect with yourself body mind and emotionsStep 2 Hold non-judgmental space to be seen and heardStep 3 See the speaker and anyone referenced as able
to manifest their true human nature and evolve using inherent healing abilities
Step 4 Listen to the speaker in a deep connected way sending the message that their thinking feelings and being matters to you copy Elizabeth Rocco MD
Silent Listening Practice
Messages Received by Young People in Under Served Communities
The Reality
Facing the Impact of Racism Poverty and Sexism
Behavioral Learning and Mental Health Diagnoses in Children
In New England
63 of Children
[1]Wen Patricia (2010) ldquoA legacy of unintended side effectsrdquo Boston Globe December 12
Use of Psychiatric Drugs in Children
Children on Psychiatric Drugs in the US in 2013
bull 0-1 Years 2748042-3 Years 3707784-5 Years 500948
bull 6-12 Years 413034013-17 Years 3617593
bull 8389034 children on psychiatric drugsbull [2]CCHR International (2014) [Online] Number of Children amp Adolescents Taking Psychiatric Drugs in the US
Aprilwwwcchrintorgpsychiatric-drugschildren-on-psychiatric-drugs
Facing the Impact of Trauma
An Alternative Model
Listening Practice
bull Turn to the person next to you
bull The person on the left will be the listener first and the other the speaker
bull Listener will listen while the speaker shares
bull Switch when time is called
When we define the effects of oppression as someonersquos ldquoillnessrdquo and ignore the root causes we obscure our path
forward in healing our communities
What if we reframed ldquochronic illnessrdquo as a societal struggle that requires societal
change and healing in community
1 Institutionalized oppression
2 Personally-mediated oppression or micro-aggressions
3 Internalized oppression
Teamnofearorg
Manifestations of Societal Oppression
Institutionalized Racism
Micro-aggressions
Internalized Racism
StressCumulative Effects
COGNITIVE BEHAVIORAL
EMOTIONAL NEURO PHYSIOLOGICAL
STRESS
Complex Societal Trauma (CST)Total Negative Health Impact over Generations
Societal Oppression
Familial Trauma
Societal Trauma
Complex Societal Trauma
copy Elizabeth Rocco MD
Intergenerational TransmissionHow is CST passed down to our children
1 Yehuda R et al (2015) ldquoHolocaust Exposure Induced Intergenerational Effects on FKBP5 MethylationrdquoBiol Psychiatry Aug 12 httpwwwncbinlmnihgovpubmed26410355B
2 Buss C et al (2011) ldquoMaternal pregnancy-specific anxiety is associated with child executive function at 6-9 years agerdquo Stress Nov14(6)665-76 httpwwwncbinlmnihgovpubmed21995526
3 Shankardass K et al (2014) ldquoParental stress increases body mass index trajectory in preadolescentsrdquoPediatr Obes Dec9(6)435-42 httpwwwncbinlmnihgovpubmed24311567
Complex Societal Trauma
is Toxic to the Developing Brain
Pat Levitt developmental neuroscientist and Dr Jack
Shonkoff part of the National Scientific Council on
the Developing Child
ACE (Adverse Childhood Experience) Study
Childhood neglect abuse and household dysfunction impacts health through out life
Vincent J Felitti et al (1998) ldquoRelationship of Childhood Abuse and Household Dysfunction to Many of the Leading Causes of Death in Adults
The Adverse Childhood Experiences (ACE) Studyrdquo May Volume 14 Issue 4 Pages 245ndash
258 httpsacestoohighcom
Healing Complex Societal Trauma
Social Engagement Ventral Vagal Complex
Reach for Help Ventral Vagal FEAR
Fight or FlightSympathetic
FEAR
FEAR
Freeze Collapse Dorsal Vagal
Pre-frontal CortexThe Voice of Reason
Human Healing and Evolution through Self-Awareness Embodiment Empowerment and Connection
Mindfulness Breath work Martial Arts Exercise Yoga Singing Dancing
Acupuncture Massage ReikiCommunity Groups Animals Church Nature
Final Listening Practice and Closing Circle
Bibliography
bull Special Acknowledgement of Demie Stathoplos MSW and Bonnie Cohen MD who collaborated with Elizabeth Rocco MD on the IM4US August 2015 presentation ldquoListening to Each Other Healing the Negative Health Impacts of Racism Poverty and Trauma through Human Connectionrdquo
bull Special Acknowledgement of Karen Burt MD who collaborated with Elizabeth Rocco MD and Karen Ekwueme MD on the IM4US August 2016 presentation ldquoListening to Ourselves and Each Other Healing the Negative Health Impact of Racism Poverty Sexism and Traumardquo These bibliographies are included below
bull [1]Wen Patricia (2010) ldquoA legacy of unintended side effectsrdquo Boston Globe December 12 httpwwwbostoncomnewslocalmassachusettsarticles20101212with_ssi_program_a_legcy_of_unintended_side_effects
bull [2]CCHR International (2014) [Online] Number of Children amp Adolescents Taking Psychiatric Drugs in the US Aprilwwwcchrintorgpsychiatric-drugschildren-on-psychiatric-drugs
bull [3]Whitaker R (2010) Anatomy of an Epidemic Magic Bullets Psychiatric Drugs and the Astonishing Rise of Mental Illness in America Crown Publishing Company httprobertwhitakerorgrobertwhitakerorgAnatomy20of20an20Epidemichtml
bull [3]CDC (2013) [Online] MMRW Mental Health Surveillance Among Children mdash United States 2005ndash2011 Supplements May 17 62(02)1-35 httpwwwcdcgovmmwrpreviewmmwrhtmlsu6202a1htm
bull [4]Patricia N Pastor PhD Cynthia A Reuben MA Catherine R Duran BS and LaJeana D Hawkins MPH CHES (2015) [Online] CDC NCHS Data Brief Association Between Diagnosed ADHD and Selected Characteristics Among Children Aged 4ndash17 Years United States 2011ndash2013 May Number 201 httpwwwcdcgovnchsdatadatabriefsdb201htm
bull [5]Mental Health America (2014) Parity or Disparity The State of Mental Health in America 2015 NovwwwmentalhealthamericanetsitesdefaultfilesParity20or20Disparity20201520Reportpdf
bull [6]Bruce S Jonas ScM PhD Qiuping Gu MD PhD and Juan R Albertorio-Diaz MA (2013) [Online] CDC NCHS Data Brief Psychotropic Medication Use Among Adolescents United States 2005ndash2010 Dec Number 135httpwwwcdcgovnchsdatadatabriefsdb135htm
bull [7] C Buss EP Davis CJ Hobel and CA Sandman (2011) Maternal pregnancy-specific anxiety is associated with child executive function at 6ndash9 years age Stress Nov 14(6)665-676
bull [8] Council for Evidence-Based Psychiatry (UK) Web presentation ldquoUnrecognized Factsrdquo Authors James Davies Peter C Goetzsche Peter Kinderman Joanna Moncrieff Phillip Thomas Sami Timimi John Sandwich Melanie Davis Luke Montague httpcepukorgunrecognised-facts
bull [9] Johnstone Lucy (2015) A Straight Talking Introduction to Psychiatric DiagnosisPCCS Books 1st edition (February 3 2015)
bull [10] Brewin CR Andrews B Valentine JD (2000) ldquoMeta-analysis of risk factors for posttraumatic stress disorder in trauma-exposed adultsrdquo J Consult Clin Psychol2000 Oct68(5)748-66 httpwwwncbinlmnihgovpubmed11068961
bull [11] Williams Monica T (2013) ldquoCan Racism Cause PTSD Implications for DSM-5rdquoPsychology Today May 20 httpswwwpsychologytodaycomblogculturally-speaking201305can-racism-cause-ptsd-implications-dsm-5
Bibliography
bull [12] Yuan Chengmei et al (2011) ldquoProtective factors for posttraumatic stress disorder symptoms in a prospective study of police officersrdquo Nov 23httpwwwncbinlmnihgovpmcarticlesPMC3071439
bull [13] Chou Tina BA Anu Asnaani MA and Stefan G Hofmann PhD (2012) ldquoPerception of Racial Discrimination and Psychopathology Across Three US Ethnic Minority Groupsrdquo APA PsychNET Jan httpwwwncbinlmnihgovpmcarticlesPMC3505377
bull [14] Watson Laurel B Jacob M Marszalek Franco Dispenza and Christopher M Davids 2015 Understanding the Relationships Among White and African American Womenrsquos Sexual Objectification Experiences Physical Safety Anxiety and Psychological Distress Sex Roles 72 (34) 91-104
bull [15] Holland Julie (2015) ldquoMedicating Womenrsquos Feelingsrdquo New York TimesOpinion Feb 28 httpmobilenytimescom20150301opinionsundaymedicating-womens-feelingshtmlreferreramp_r=1
bull [16] Solinas M Thiriet N El Rawas R Lardeux V and Jaber M (2009) ldquoEnvironmental Enrichment During Early Stages of Life Reduces the Behavioral Neurochemical and Molecular Effects of Cocainerdquo Neuropsychopharmacology 34 1102ndash1111
bull [17] Hari Johann Chasing The Scream The First and Last Days of the War on Drugs Bloomsbury USA (January 20 2015)bull [18] Hughes Caitlin Elizabeth and Alex Stevens (2010) ldquoWhat Can We Learn From The Portuguese Decriminalization of Illicit
Drugsrdquo British Journal of Criminology July 21 httpbjcoxfordjournalsorgcontent506999abstractbull [19] Fournier Jay C et al (2009) ldquoAntidepressant Drug Effects and Depression Severityrdquo JAMA January
6th httpjamajamanetworkcomarticleaspxarticleid=185157[20] Currie J Stabile M Jones L (2013) Do Stimulant Medications Improve Educational and Behavioral Outcomes for Children with ADHD NBER Working Paper No 19105
bull [21] Mora-Ripoli R Organizacioacuten Mundial de la Risa Barcelona Spain ldquoThe therapeutic value of laughter in medicinerdquo Altern Ther Health Med 2010 Nov-Dec16(6)56-64 httpwwwncbinlmnihgovpubmed21280463
bull [22] Gracanin Asmir Lauren M Bylsma and Ad J J M Vingerhoets (2014) ldquoIs Crying a Self-Stoothing Behaviorrdquo Frontiers in Psychology May 28httpwwwncbinlmnihgovpmcarticlesPMC4035568
bull [23] Trimble Michael (2010) ldquoI Cry Therefore I Amrdquo New York Times Nov 10 httpwwwnytimescom20121111opinionsundayi-cry-therefore-i-amhtmlemc=eta1amp_r=0
bull [24]Gallup Andrew C et al (2007) ldquoYawning as a brain cooling mechanism Nasal breathing and forehead cooling diminish the incidence of contagious yawningrdquo httpwwwepjournalnetarticlesyawning-as-a-brain-cooling-mechanism-nasal-breathing-and-forehead-cooling-diminish-the-incidence-of-contagious-yawning
bull [25]Sharat Gupta and Shallu Mittal Int (2013) Yawning and its physiological significance Intl J Appl Basic Med Res Jan-Jun 3(1) 11ndash15
bull [26] Stephens R Atkins J Kingston A (2009) ldquoSwearing As a Response to Painrdquo NeuroReport Aug 5 httpwwwncbinlmnihgovpubmed19590391
bull [27]Morelli SA Lieberman MD(2013) rdquoThe role of automaticity and attention in neural processes underlying empathy for happiness sadness and anxietyrdquo Front Hum Neurosci May 87160
Bibliography
bull [1] Committee on Psychosocial Aspects of Child and Family Health Committee on Early Childhood Adoption and Dependent Care andSection on Developmental and Behavioral Pediatrics Andrew S Garner Jack P Shonkoff et al (2012) ldquoEarly Childhood Adversity Toxic Stress and the Role of the Pediatrician Translating Developmental Science Into Lifelong Healthrdquo Pediatrics January VOLUME 129 ISSUE 1 From the American Academy of Pediatrics Policy Statementhttppediatricsaappublicationsorgcontent1291e224fullref-23
bull [2] COUNCIL ON COMMUNITY PEDIATRICS Benjamin A Gitterman et al (2016) ldquoPoverty and Child Health in the United Statesrdquo Pediatrics March From the American Academy of Pediatrics Policy Statement Published Online March 09American Academy of Pediatricshttppediatricsaappublicationsorgcontentearly20160307peds2016-0339info
bull [3] Paul W Newacheck et al (2003) ldquoDisparities in Adolescent Health and Health Care Does Socioeconomic Status Matterrdquo Health ServRes Oct 38(5) 1235ndash1252 httpwwwncbinlmnihgovpmcarticlesPMC1360944
bull [4] Larson et al (2007) ldquoPoverty during pregnancy Its effects on child health outcomesrdquo Paediatr Child Health 2007 Oct 12(8) 673ndash677 httpwwwncbinlmnihgovpmcarticlesPMC2528810
bull [5] Lara J Akinbami et al (2012) ldquoTrends in Asthma Prevalence Health Care Use and Mortality in the United States 2001ndash2010rdquo NCHS Data Brief No 94 May httpwwwcdcgovnchsproductsdatabriefsdb94htm
bull [6] Cynthia L Ogden et al (2010) ldquoObesity and Socioeconomic Status in Children and Adolescents United States 2005-2008rdquoNCHS Data Brief No 51 Decemberhttpwwwcdcgovnchsproductsdatabriefsdb51htm
bull [7] Shonkoff JP et al Committee on Psychosocial Aspects of Child and Family Health Committee on Early Childhood Adoption and Dependent Care Section on Developmental and Behavioral Pediatrics rdquoThe lifelong effects of early childhood adversity and toxicstressrdquo Pediatrics 2012129(1) wwwpediatricsorgcgicontentfull1291e232
bull [8] Virginia A Rauh et alldquoHousing and HealthIntersection of Poverty and Environmental Exposuresrdquo (2008) Annals of the New York Academy of Sciences Volume 1136 Reducing the Impact of Poverty on Health and Human Development Scientific Approaches pages 276ndash288 June httponlinelibrarywileycomdoi101196annals1425032full
bull [9] Yehuda R et al (2015) ldquoHolocaust Exposure Induced Intergenerational Effects on FKBP5 MethylationrdquoBiol Psychiatry Aug 12 httpwwwncbinlmnihgovpubmed26410355
bull [10] Buss C et al (2011) ldquoMaternal pregnancy-specific anxiety is associated with child executive function at 6-9 years agerdquoStress Nov14(6)665-76 httpwwwncbinlmnihgovpubmed21995526
bull 11] Shankardass K et al (2014) ldquoParental stress increases body mass index trajectory in pre-adolescentsrdquoPediatr Obes Dec9(6)435-42 httpwwwncbinlmnihgovpubmed24311567
bull [12] Vincent J Felitti et al (1998) ldquoRelationship of Childhood Abuse and Household Dysfunction to Many of the Leading Causes of Death in Adults The Adverse Childhood Experiences (ACE) Studyrdquo May Volume 14 Issue 4 Pages 245ndash258 httpsacestoohighcom
bull [13]Jones CP Levels of Racism a Theoretic Framework and the Gardenerrsquos Tale Am J Public Health 200090(8) 1212-1215bull [14]Dion KL The Social Psycology of Perceived Perjudice and Discrimination Canadian Psychology (2002)431 pp 1-10bull [15]Sue D W Bucceri J Lin AI Nadal K L and Torino J C Racial Microaggressions and the Asian American experience APA (2007) Vol
13 No 1 pp 72-81bull [16]James S A (School of Public Health U of North Carolina Chapel Hill NC 27514) D S Strogatz S B Wing and D L Ramsey
Socioeconomic status John Henryism and hypertension in blacks and whites Am J Epidemiol 1987 126664ndash73bull [17]httpwwwapaorgpioemaresourcesethnicity-healthindexaspxbull [18]Porges SW Clinical Insights from the Polyvagal Theory The Transformative Power of Feeling Safe (Norton Series on Interpersonal
Neurobiology) W W Norton Apr 7 2014 - Psychology - 288 pagesbull [19]The Polyvagal Theory (Porges SW Social Connectedness as a Biological Imperative Understanding Trauma Through the Lens of
thePolyvagal Theory presentation 82015)bull [20]McEwen BS Allostasis and allostatic load implications for neuropsychopharmacologyNeuropsychopharmacology 2000
Feb22(2)108-24bull [21] McEwen BS adaptation and disease Allostasis and allostatic load Ann N Y Acad Sci 1998 May 184033-44bull [22] Arline T Geronimus ScD Margaret Hicken MPH Danya Keene MAT and John Bound PhD Weatheringrdquo and Age Patterns of
Allostatic Load Scores Among Blacks and Whites in the United States Am J Public Health 2006 May 96(5) 826ndash833bull [22]Stephen Porges PhD Polyvagal Perspective Biological Psychology 2007 Feb 74(2) 116ndash143 Published online 2006 Oct 16 bull [23]Stephen W Porges PhD The Polyvagal Theory Neurophysiological Foundations of Emotions Attachment Communication and
Self-regulation WWNorton and Company Inc 2011bull [24]Maggie Phillips PhD Reversing Chronic Pain North Atlantic Books 2007bull [25]Peter Levine PhD Waking the Tiger North Atlantic Books 1997bull [26]Bessel VanderKolk MD The Body Keeps the Score Viking Penguin 2014bullAcknowledgmentsbull Group Medical Visits and Group Facilitation Jeff Geller MDbull Re-evaluation Counseling Community bull Insight Meditation Communitybull Biodynamic Osteopathy Communitybull Learning To Breathe Mindfulness Training for Adolescents 2015 Patricia C Broderick PhD bull Stanford Chronic Disease Self Management Program Training 2014 Kate Lorig MPH RNbull Motivational Interviewing Training 2015 Steven Berg-Smithbull Centering Pregnancy Training 2014 Centering Healthcare Institutebull Motivating Change in Groups Training 2013 Kaiser Permanente Oakland Cabull Group Facilitation Training Sara Fisk PhD Community at Work San Francisco Cabull Tribes Training 2013 Center for Human Developmentbull Cultural Humility Training 2016 Melanie Tervalon MD
Bibliography
Intermediate Steps to Listening Session Handout
bull Step 1 Connect with yourself body mind and emotions
bull Step 2 Hold a non-judgmental space to be seen and heard
bull Step 3 See the speaker and anyone referenced as able to manifest their true human nature and evolve using inherent healing abilities
bull Step 4 Listen to the speaker in a deep connected way sending the message that their thinking feelings and being matters to you
bull Step 5 Encourage the speaker to express feelings or thoughts describe body sensations or share a story relevant to the feelings at hand
bull Step 6 Validate intense emotional expression and release such as crying laughing shaking yawning sweating as a sign of healing
bull Step 7 Remind the speaker of their underlying goodness intelligence strength and caring and your confidence in their ability to heal and manifest their true human nature
copy Elizabeth Rocco MD
Contact Information
bull Elizabeth Rocco MD -egroccogmailcom
bull Karen Ekwueme MD-impactdoc1gmailcom
Key Assumptions
1 Humans are equally precious and significant Our feelings thoughts actions and lives matter
2 Humans are good resilient flexible intelligent and caring by nature
3 Humans have inherent emotional healing processes to help us manifest our true nature
copy Elizabeth Rocco MD
Guidelines for Listening Session
1 Set a time limit and split time evenly
2 Do not interrupt do not give advice tell your own story or share your feelings during the speakerrsquos time
3 Strict confidentiality
Basic Steps in Peer Listening Session
Step 1 Connect with yourself body mind and emotionsStep 2 Hold non-judgmental space to be seen and heardStep 3 See the speaker and anyone referenced as able
to manifest their true human nature and evolve using inherent healing abilities
Step 4 Listen to the speaker in a deep connected way sending the message that their thinking feelings and being matters to you copy Elizabeth Rocco MD
Silent Listening Practice
Messages Received by Young People in Under Served Communities
The Reality
Facing the Impact of Racism Poverty and Sexism
Behavioral Learning and Mental Health Diagnoses in Children
In New England
63 of Children
[1]Wen Patricia (2010) ldquoA legacy of unintended side effectsrdquo Boston Globe December 12
Use of Psychiatric Drugs in Children
Children on Psychiatric Drugs in the US in 2013
bull 0-1 Years 2748042-3 Years 3707784-5 Years 500948
bull 6-12 Years 413034013-17 Years 3617593
bull 8389034 children on psychiatric drugsbull [2]CCHR International (2014) [Online] Number of Children amp Adolescents Taking Psychiatric Drugs in the US
Aprilwwwcchrintorgpsychiatric-drugschildren-on-psychiatric-drugs
Facing the Impact of Trauma
An Alternative Model
Listening Practice
bull Turn to the person next to you
bull The person on the left will be the listener first and the other the speaker
bull Listener will listen while the speaker shares
bull Switch when time is called
When we define the effects of oppression as someonersquos ldquoillnessrdquo and ignore the root causes we obscure our path
forward in healing our communities
What if we reframed ldquochronic illnessrdquo as a societal struggle that requires societal
change and healing in community
1 Institutionalized oppression
2 Personally-mediated oppression or micro-aggressions
3 Internalized oppression
Teamnofearorg
Manifestations of Societal Oppression
Institutionalized Racism
Micro-aggressions
Internalized Racism
StressCumulative Effects
COGNITIVE BEHAVIORAL
EMOTIONAL NEURO PHYSIOLOGICAL
STRESS
Complex Societal Trauma (CST)Total Negative Health Impact over Generations
Societal Oppression
Familial Trauma
Societal Trauma
Complex Societal Trauma
copy Elizabeth Rocco MD
Intergenerational TransmissionHow is CST passed down to our children
1 Yehuda R et al (2015) ldquoHolocaust Exposure Induced Intergenerational Effects on FKBP5 MethylationrdquoBiol Psychiatry Aug 12 httpwwwncbinlmnihgovpubmed26410355B
2 Buss C et al (2011) ldquoMaternal pregnancy-specific anxiety is associated with child executive function at 6-9 years agerdquo Stress Nov14(6)665-76 httpwwwncbinlmnihgovpubmed21995526
3 Shankardass K et al (2014) ldquoParental stress increases body mass index trajectory in preadolescentsrdquoPediatr Obes Dec9(6)435-42 httpwwwncbinlmnihgovpubmed24311567
Complex Societal Trauma
is Toxic to the Developing Brain
Pat Levitt developmental neuroscientist and Dr Jack
Shonkoff part of the National Scientific Council on
the Developing Child
ACE (Adverse Childhood Experience) Study
Childhood neglect abuse and household dysfunction impacts health through out life
Vincent J Felitti et al (1998) ldquoRelationship of Childhood Abuse and Household Dysfunction to Many of the Leading Causes of Death in Adults
The Adverse Childhood Experiences (ACE) Studyrdquo May Volume 14 Issue 4 Pages 245ndash
258 httpsacestoohighcom
Healing Complex Societal Trauma
Social Engagement Ventral Vagal Complex
Reach for Help Ventral Vagal FEAR
Fight or FlightSympathetic
FEAR
FEAR
Freeze Collapse Dorsal Vagal
Pre-frontal CortexThe Voice of Reason
Human Healing and Evolution through Self-Awareness Embodiment Empowerment and Connection
Mindfulness Breath work Martial Arts Exercise Yoga Singing Dancing
Acupuncture Massage ReikiCommunity Groups Animals Church Nature
Final Listening Practice and Closing Circle
Bibliography
bull Special Acknowledgement of Demie Stathoplos MSW and Bonnie Cohen MD who collaborated with Elizabeth Rocco MD on the IM4US August 2015 presentation ldquoListening to Each Other Healing the Negative Health Impacts of Racism Poverty and Trauma through Human Connectionrdquo
bull Special Acknowledgement of Karen Burt MD who collaborated with Elizabeth Rocco MD and Karen Ekwueme MD on the IM4US August 2016 presentation ldquoListening to Ourselves and Each Other Healing the Negative Health Impact of Racism Poverty Sexism and Traumardquo These bibliographies are included below
bull [1]Wen Patricia (2010) ldquoA legacy of unintended side effectsrdquo Boston Globe December 12 httpwwwbostoncomnewslocalmassachusettsarticles20101212with_ssi_program_a_legcy_of_unintended_side_effects
bull [2]CCHR International (2014) [Online] Number of Children amp Adolescents Taking Psychiatric Drugs in the US Aprilwwwcchrintorgpsychiatric-drugschildren-on-psychiatric-drugs
bull [3]Whitaker R (2010) Anatomy of an Epidemic Magic Bullets Psychiatric Drugs and the Astonishing Rise of Mental Illness in America Crown Publishing Company httprobertwhitakerorgrobertwhitakerorgAnatomy20of20an20Epidemichtml
bull [3]CDC (2013) [Online] MMRW Mental Health Surveillance Among Children mdash United States 2005ndash2011 Supplements May 17 62(02)1-35 httpwwwcdcgovmmwrpreviewmmwrhtmlsu6202a1htm
bull [4]Patricia N Pastor PhD Cynthia A Reuben MA Catherine R Duran BS and LaJeana D Hawkins MPH CHES (2015) [Online] CDC NCHS Data Brief Association Between Diagnosed ADHD and Selected Characteristics Among Children Aged 4ndash17 Years United States 2011ndash2013 May Number 201 httpwwwcdcgovnchsdatadatabriefsdb201htm
bull [5]Mental Health America (2014) Parity or Disparity The State of Mental Health in America 2015 NovwwwmentalhealthamericanetsitesdefaultfilesParity20or20Disparity20201520Reportpdf
bull [6]Bruce S Jonas ScM PhD Qiuping Gu MD PhD and Juan R Albertorio-Diaz MA (2013) [Online] CDC NCHS Data Brief Psychotropic Medication Use Among Adolescents United States 2005ndash2010 Dec Number 135httpwwwcdcgovnchsdatadatabriefsdb135htm
bull [7] C Buss EP Davis CJ Hobel and CA Sandman (2011) Maternal pregnancy-specific anxiety is associated with child executive function at 6ndash9 years age Stress Nov 14(6)665-676
bull [8] Council for Evidence-Based Psychiatry (UK) Web presentation ldquoUnrecognized Factsrdquo Authors James Davies Peter C Goetzsche Peter Kinderman Joanna Moncrieff Phillip Thomas Sami Timimi John Sandwich Melanie Davis Luke Montague httpcepukorgunrecognised-facts
bull [9] Johnstone Lucy (2015) A Straight Talking Introduction to Psychiatric DiagnosisPCCS Books 1st edition (February 3 2015)
bull [10] Brewin CR Andrews B Valentine JD (2000) ldquoMeta-analysis of risk factors for posttraumatic stress disorder in trauma-exposed adultsrdquo J Consult Clin Psychol2000 Oct68(5)748-66 httpwwwncbinlmnihgovpubmed11068961
bull [11] Williams Monica T (2013) ldquoCan Racism Cause PTSD Implications for DSM-5rdquoPsychology Today May 20 httpswwwpsychologytodaycomblogculturally-speaking201305can-racism-cause-ptsd-implications-dsm-5
Bibliography
bull [12] Yuan Chengmei et al (2011) ldquoProtective factors for posttraumatic stress disorder symptoms in a prospective study of police officersrdquo Nov 23httpwwwncbinlmnihgovpmcarticlesPMC3071439
bull [13] Chou Tina BA Anu Asnaani MA and Stefan G Hofmann PhD (2012) ldquoPerception of Racial Discrimination and Psychopathology Across Three US Ethnic Minority Groupsrdquo APA PsychNET Jan httpwwwncbinlmnihgovpmcarticlesPMC3505377
bull [14] Watson Laurel B Jacob M Marszalek Franco Dispenza and Christopher M Davids 2015 Understanding the Relationships Among White and African American Womenrsquos Sexual Objectification Experiences Physical Safety Anxiety and Psychological Distress Sex Roles 72 (34) 91-104
bull [15] Holland Julie (2015) ldquoMedicating Womenrsquos Feelingsrdquo New York TimesOpinion Feb 28 httpmobilenytimescom20150301opinionsundaymedicating-womens-feelingshtmlreferreramp_r=1
bull [16] Solinas M Thiriet N El Rawas R Lardeux V and Jaber M (2009) ldquoEnvironmental Enrichment During Early Stages of Life Reduces the Behavioral Neurochemical and Molecular Effects of Cocainerdquo Neuropsychopharmacology 34 1102ndash1111
bull [17] Hari Johann Chasing The Scream The First and Last Days of the War on Drugs Bloomsbury USA (January 20 2015)bull [18] Hughes Caitlin Elizabeth and Alex Stevens (2010) ldquoWhat Can We Learn From The Portuguese Decriminalization of Illicit
Drugsrdquo British Journal of Criminology July 21 httpbjcoxfordjournalsorgcontent506999abstractbull [19] Fournier Jay C et al (2009) ldquoAntidepressant Drug Effects and Depression Severityrdquo JAMA January
6th httpjamajamanetworkcomarticleaspxarticleid=185157[20] Currie J Stabile M Jones L (2013) Do Stimulant Medications Improve Educational and Behavioral Outcomes for Children with ADHD NBER Working Paper No 19105
bull [21] Mora-Ripoli R Organizacioacuten Mundial de la Risa Barcelona Spain ldquoThe therapeutic value of laughter in medicinerdquo Altern Ther Health Med 2010 Nov-Dec16(6)56-64 httpwwwncbinlmnihgovpubmed21280463
bull [22] Gracanin Asmir Lauren M Bylsma and Ad J J M Vingerhoets (2014) ldquoIs Crying a Self-Stoothing Behaviorrdquo Frontiers in Psychology May 28httpwwwncbinlmnihgovpmcarticlesPMC4035568
bull [23] Trimble Michael (2010) ldquoI Cry Therefore I Amrdquo New York Times Nov 10 httpwwwnytimescom20121111opinionsundayi-cry-therefore-i-amhtmlemc=eta1amp_r=0
bull [24]Gallup Andrew C et al (2007) ldquoYawning as a brain cooling mechanism Nasal breathing and forehead cooling diminish the incidence of contagious yawningrdquo httpwwwepjournalnetarticlesyawning-as-a-brain-cooling-mechanism-nasal-breathing-and-forehead-cooling-diminish-the-incidence-of-contagious-yawning
bull [25]Sharat Gupta and Shallu Mittal Int (2013) Yawning and its physiological significance Intl J Appl Basic Med Res Jan-Jun 3(1) 11ndash15
bull [26] Stephens R Atkins J Kingston A (2009) ldquoSwearing As a Response to Painrdquo NeuroReport Aug 5 httpwwwncbinlmnihgovpubmed19590391
bull [27]Morelli SA Lieberman MD(2013) rdquoThe role of automaticity and attention in neural processes underlying empathy for happiness sadness and anxietyrdquo Front Hum Neurosci May 87160
Bibliography
bull [1] Committee on Psychosocial Aspects of Child and Family Health Committee on Early Childhood Adoption and Dependent Care andSection on Developmental and Behavioral Pediatrics Andrew S Garner Jack P Shonkoff et al (2012) ldquoEarly Childhood Adversity Toxic Stress and the Role of the Pediatrician Translating Developmental Science Into Lifelong Healthrdquo Pediatrics January VOLUME 129 ISSUE 1 From the American Academy of Pediatrics Policy Statementhttppediatricsaappublicationsorgcontent1291e224fullref-23
bull [2] COUNCIL ON COMMUNITY PEDIATRICS Benjamin A Gitterman et al (2016) ldquoPoverty and Child Health in the United Statesrdquo Pediatrics March From the American Academy of Pediatrics Policy Statement Published Online March 09American Academy of Pediatricshttppediatricsaappublicationsorgcontentearly20160307peds2016-0339info
bull [3] Paul W Newacheck et al (2003) ldquoDisparities in Adolescent Health and Health Care Does Socioeconomic Status Matterrdquo Health ServRes Oct 38(5) 1235ndash1252 httpwwwncbinlmnihgovpmcarticlesPMC1360944
bull [4] Larson et al (2007) ldquoPoverty during pregnancy Its effects on child health outcomesrdquo Paediatr Child Health 2007 Oct 12(8) 673ndash677 httpwwwncbinlmnihgovpmcarticlesPMC2528810
bull [5] Lara J Akinbami et al (2012) ldquoTrends in Asthma Prevalence Health Care Use and Mortality in the United States 2001ndash2010rdquo NCHS Data Brief No 94 May httpwwwcdcgovnchsproductsdatabriefsdb94htm
bull [6] Cynthia L Ogden et al (2010) ldquoObesity and Socioeconomic Status in Children and Adolescents United States 2005-2008rdquoNCHS Data Brief No 51 Decemberhttpwwwcdcgovnchsproductsdatabriefsdb51htm
bull [7] Shonkoff JP et al Committee on Psychosocial Aspects of Child and Family Health Committee on Early Childhood Adoption and Dependent Care Section on Developmental and Behavioral Pediatrics rdquoThe lifelong effects of early childhood adversity and toxicstressrdquo Pediatrics 2012129(1) wwwpediatricsorgcgicontentfull1291e232
bull [8] Virginia A Rauh et alldquoHousing and HealthIntersection of Poverty and Environmental Exposuresrdquo (2008) Annals of the New York Academy of Sciences Volume 1136 Reducing the Impact of Poverty on Health and Human Development Scientific Approaches pages 276ndash288 June httponlinelibrarywileycomdoi101196annals1425032full
bull [9] Yehuda R et al (2015) ldquoHolocaust Exposure Induced Intergenerational Effects on FKBP5 MethylationrdquoBiol Psychiatry Aug 12 httpwwwncbinlmnihgovpubmed26410355
bull [10] Buss C et al (2011) ldquoMaternal pregnancy-specific anxiety is associated with child executive function at 6-9 years agerdquoStress Nov14(6)665-76 httpwwwncbinlmnihgovpubmed21995526
bull 11] Shankardass K et al (2014) ldquoParental stress increases body mass index trajectory in pre-adolescentsrdquoPediatr Obes Dec9(6)435-42 httpwwwncbinlmnihgovpubmed24311567
bull [12] Vincent J Felitti et al (1998) ldquoRelationship of Childhood Abuse and Household Dysfunction to Many of the Leading Causes of Death in Adults The Adverse Childhood Experiences (ACE) Studyrdquo May Volume 14 Issue 4 Pages 245ndash258 httpsacestoohighcom
bull [13]Jones CP Levels of Racism a Theoretic Framework and the Gardenerrsquos Tale Am J Public Health 200090(8) 1212-1215bull [14]Dion KL The Social Psycology of Perceived Perjudice and Discrimination Canadian Psychology (2002)431 pp 1-10bull [15]Sue D W Bucceri J Lin AI Nadal K L and Torino J C Racial Microaggressions and the Asian American experience APA (2007) Vol
13 No 1 pp 72-81bull [16]James S A (School of Public Health U of North Carolina Chapel Hill NC 27514) D S Strogatz S B Wing and D L Ramsey
Socioeconomic status John Henryism and hypertension in blacks and whites Am J Epidemiol 1987 126664ndash73bull [17]httpwwwapaorgpioemaresourcesethnicity-healthindexaspxbull [18]Porges SW Clinical Insights from the Polyvagal Theory The Transformative Power of Feeling Safe (Norton Series on Interpersonal
Neurobiology) W W Norton Apr 7 2014 - Psychology - 288 pagesbull [19]The Polyvagal Theory (Porges SW Social Connectedness as a Biological Imperative Understanding Trauma Through the Lens of
thePolyvagal Theory presentation 82015)bull [20]McEwen BS Allostasis and allostatic load implications for neuropsychopharmacologyNeuropsychopharmacology 2000
Feb22(2)108-24bull [21] McEwen BS adaptation and disease Allostasis and allostatic load Ann N Y Acad Sci 1998 May 184033-44bull [22] Arline T Geronimus ScD Margaret Hicken MPH Danya Keene MAT and John Bound PhD Weatheringrdquo and Age Patterns of
Allostatic Load Scores Among Blacks and Whites in the United States Am J Public Health 2006 May 96(5) 826ndash833bull [22]Stephen Porges PhD Polyvagal Perspective Biological Psychology 2007 Feb 74(2) 116ndash143 Published online 2006 Oct 16 bull [23]Stephen W Porges PhD The Polyvagal Theory Neurophysiological Foundations of Emotions Attachment Communication and
Self-regulation WWNorton and Company Inc 2011bull [24]Maggie Phillips PhD Reversing Chronic Pain North Atlantic Books 2007bull [25]Peter Levine PhD Waking the Tiger North Atlantic Books 1997bull [26]Bessel VanderKolk MD The Body Keeps the Score Viking Penguin 2014bullAcknowledgmentsbull Group Medical Visits and Group Facilitation Jeff Geller MDbull Re-evaluation Counseling Community bull Insight Meditation Communitybull Biodynamic Osteopathy Communitybull Learning To Breathe Mindfulness Training for Adolescents 2015 Patricia C Broderick PhD bull Stanford Chronic Disease Self Management Program Training 2014 Kate Lorig MPH RNbull Motivational Interviewing Training 2015 Steven Berg-Smithbull Centering Pregnancy Training 2014 Centering Healthcare Institutebull Motivating Change in Groups Training 2013 Kaiser Permanente Oakland Cabull Group Facilitation Training Sara Fisk PhD Community at Work San Francisco Cabull Tribes Training 2013 Center for Human Developmentbull Cultural Humility Training 2016 Melanie Tervalon MD
Bibliography
Intermediate Steps to Listening Session Handout
bull Step 1 Connect with yourself body mind and emotions
bull Step 2 Hold a non-judgmental space to be seen and heard
bull Step 3 See the speaker and anyone referenced as able to manifest their true human nature and evolve using inherent healing abilities
bull Step 4 Listen to the speaker in a deep connected way sending the message that their thinking feelings and being matters to you
bull Step 5 Encourage the speaker to express feelings or thoughts describe body sensations or share a story relevant to the feelings at hand
bull Step 6 Validate intense emotional expression and release such as crying laughing shaking yawning sweating as a sign of healing
bull Step 7 Remind the speaker of their underlying goodness intelligence strength and caring and your confidence in their ability to heal and manifest their true human nature
copy Elizabeth Rocco MD
Contact Information
bull Elizabeth Rocco MD -egroccogmailcom
bull Karen Ekwueme MD-impactdoc1gmailcom
Guidelines for Listening Session
1 Set a time limit and split time evenly
2 Do not interrupt do not give advice tell your own story or share your feelings during the speakerrsquos time
3 Strict confidentiality
Basic Steps in Peer Listening Session
Step 1 Connect with yourself body mind and emotionsStep 2 Hold non-judgmental space to be seen and heardStep 3 See the speaker and anyone referenced as able
to manifest their true human nature and evolve using inherent healing abilities
Step 4 Listen to the speaker in a deep connected way sending the message that their thinking feelings and being matters to you copy Elizabeth Rocco MD
Silent Listening Practice
Messages Received by Young People in Under Served Communities
The Reality
Facing the Impact of Racism Poverty and Sexism
Behavioral Learning and Mental Health Diagnoses in Children
In New England
63 of Children
[1]Wen Patricia (2010) ldquoA legacy of unintended side effectsrdquo Boston Globe December 12
Use of Psychiatric Drugs in Children
Children on Psychiatric Drugs in the US in 2013
bull 0-1 Years 2748042-3 Years 3707784-5 Years 500948
bull 6-12 Years 413034013-17 Years 3617593
bull 8389034 children on psychiatric drugsbull [2]CCHR International (2014) [Online] Number of Children amp Adolescents Taking Psychiatric Drugs in the US
Aprilwwwcchrintorgpsychiatric-drugschildren-on-psychiatric-drugs
Facing the Impact of Trauma
An Alternative Model
Listening Practice
bull Turn to the person next to you
bull The person on the left will be the listener first and the other the speaker
bull Listener will listen while the speaker shares
bull Switch when time is called
When we define the effects of oppression as someonersquos ldquoillnessrdquo and ignore the root causes we obscure our path
forward in healing our communities
What if we reframed ldquochronic illnessrdquo as a societal struggle that requires societal
change and healing in community
1 Institutionalized oppression
2 Personally-mediated oppression or micro-aggressions
3 Internalized oppression
Teamnofearorg
Manifestations of Societal Oppression
Institutionalized Racism
Micro-aggressions
Internalized Racism
StressCumulative Effects
COGNITIVE BEHAVIORAL
EMOTIONAL NEURO PHYSIOLOGICAL
STRESS
Complex Societal Trauma (CST)Total Negative Health Impact over Generations
Societal Oppression
Familial Trauma
Societal Trauma
Complex Societal Trauma
copy Elizabeth Rocco MD
Intergenerational TransmissionHow is CST passed down to our children
1 Yehuda R et al (2015) ldquoHolocaust Exposure Induced Intergenerational Effects on FKBP5 MethylationrdquoBiol Psychiatry Aug 12 httpwwwncbinlmnihgovpubmed26410355B
2 Buss C et al (2011) ldquoMaternal pregnancy-specific anxiety is associated with child executive function at 6-9 years agerdquo Stress Nov14(6)665-76 httpwwwncbinlmnihgovpubmed21995526
3 Shankardass K et al (2014) ldquoParental stress increases body mass index trajectory in preadolescentsrdquoPediatr Obes Dec9(6)435-42 httpwwwncbinlmnihgovpubmed24311567
Complex Societal Trauma
is Toxic to the Developing Brain
Pat Levitt developmental neuroscientist and Dr Jack
Shonkoff part of the National Scientific Council on
the Developing Child
ACE (Adverse Childhood Experience) Study
Childhood neglect abuse and household dysfunction impacts health through out life
Vincent J Felitti et al (1998) ldquoRelationship of Childhood Abuse and Household Dysfunction to Many of the Leading Causes of Death in Adults
The Adverse Childhood Experiences (ACE) Studyrdquo May Volume 14 Issue 4 Pages 245ndash
258 httpsacestoohighcom
Healing Complex Societal Trauma
Social Engagement Ventral Vagal Complex
Reach for Help Ventral Vagal FEAR
Fight or FlightSympathetic
FEAR
FEAR
Freeze Collapse Dorsal Vagal
Pre-frontal CortexThe Voice of Reason
Human Healing and Evolution through Self-Awareness Embodiment Empowerment and Connection
Mindfulness Breath work Martial Arts Exercise Yoga Singing Dancing
Acupuncture Massage ReikiCommunity Groups Animals Church Nature
Final Listening Practice and Closing Circle
Bibliography
bull Special Acknowledgement of Demie Stathoplos MSW and Bonnie Cohen MD who collaborated with Elizabeth Rocco MD on the IM4US August 2015 presentation ldquoListening to Each Other Healing the Negative Health Impacts of Racism Poverty and Trauma through Human Connectionrdquo
bull Special Acknowledgement of Karen Burt MD who collaborated with Elizabeth Rocco MD and Karen Ekwueme MD on the IM4US August 2016 presentation ldquoListening to Ourselves and Each Other Healing the Negative Health Impact of Racism Poverty Sexism and Traumardquo These bibliographies are included below
bull [1]Wen Patricia (2010) ldquoA legacy of unintended side effectsrdquo Boston Globe December 12 httpwwwbostoncomnewslocalmassachusettsarticles20101212with_ssi_program_a_legcy_of_unintended_side_effects
bull [2]CCHR International (2014) [Online] Number of Children amp Adolescents Taking Psychiatric Drugs in the US Aprilwwwcchrintorgpsychiatric-drugschildren-on-psychiatric-drugs
bull [3]Whitaker R (2010) Anatomy of an Epidemic Magic Bullets Psychiatric Drugs and the Astonishing Rise of Mental Illness in America Crown Publishing Company httprobertwhitakerorgrobertwhitakerorgAnatomy20of20an20Epidemichtml
bull [3]CDC (2013) [Online] MMRW Mental Health Surveillance Among Children mdash United States 2005ndash2011 Supplements May 17 62(02)1-35 httpwwwcdcgovmmwrpreviewmmwrhtmlsu6202a1htm
bull [4]Patricia N Pastor PhD Cynthia A Reuben MA Catherine R Duran BS and LaJeana D Hawkins MPH CHES (2015) [Online] CDC NCHS Data Brief Association Between Diagnosed ADHD and Selected Characteristics Among Children Aged 4ndash17 Years United States 2011ndash2013 May Number 201 httpwwwcdcgovnchsdatadatabriefsdb201htm
bull [5]Mental Health America (2014) Parity or Disparity The State of Mental Health in America 2015 NovwwwmentalhealthamericanetsitesdefaultfilesParity20or20Disparity20201520Reportpdf
bull [6]Bruce S Jonas ScM PhD Qiuping Gu MD PhD and Juan R Albertorio-Diaz MA (2013) [Online] CDC NCHS Data Brief Psychotropic Medication Use Among Adolescents United States 2005ndash2010 Dec Number 135httpwwwcdcgovnchsdatadatabriefsdb135htm
bull [7] C Buss EP Davis CJ Hobel and CA Sandman (2011) Maternal pregnancy-specific anxiety is associated with child executive function at 6ndash9 years age Stress Nov 14(6)665-676
bull [8] Council for Evidence-Based Psychiatry (UK) Web presentation ldquoUnrecognized Factsrdquo Authors James Davies Peter C Goetzsche Peter Kinderman Joanna Moncrieff Phillip Thomas Sami Timimi John Sandwich Melanie Davis Luke Montague httpcepukorgunrecognised-facts
bull [9] Johnstone Lucy (2015) A Straight Talking Introduction to Psychiatric DiagnosisPCCS Books 1st edition (February 3 2015)
bull [10] Brewin CR Andrews B Valentine JD (2000) ldquoMeta-analysis of risk factors for posttraumatic stress disorder in trauma-exposed adultsrdquo J Consult Clin Psychol2000 Oct68(5)748-66 httpwwwncbinlmnihgovpubmed11068961
bull [11] Williams Monica T (2013) ldquoCan Racism Cause PTSD Implications for DSM-5rdquoPsychology Today May 20 httpswwwpsychologytodaycomblogculturally-speaking201305can-racism-cause-ptsd-implications-dsm-5
Bibliography
bull [12] Yuan Chengmei et al (2011) ldquoProtective factors for posttraumatic stress disorder symptoms in a prospective study of police officersrdquo Nov 23httpwwwncbinlmnihgovpmcarticlesPMC3071439
bull [13] Chou Tina BA Anu Asnaani MA and Stefan G Hofmann PhD (2012) ldquoPerception of Racial Discrimination and Psychopathology Across Three US Ethnic Minority Groupsrdquo APA PsychNET Jan httpwwwncbinlmnihgovpmcarticlesPMC3505377
bull [14] Watson Laurel B Jacob M Marszalek Franco Dispenza and Christopher M Davids 2015 Understanding the Relationships Among White and African American Womenrsquos Sexual Objectification Experiences Physical Safety Anxiety and Psychological Distress Sex Roles 72 (34) 91-104
bull [15] Holland Julie (2015) ldquoMedicating Womenrsquos Feelingsrdquo New York TimesOpinion Feb 28 httpmobilenytimescom20150301opinionsundaymedicating-womens-feelingshtmlreferreramp_r=1
bull [16] Solinas M Thiriet N El Rawas R Lardeux V and Jaber M (2009) ldquoEnvironmental Enrichment During Early Stages of Life Reduces the Behavioral Neurochemical and Molecular Effects of Cocainerdquo Neuropsychopharmacology 34 1102ndash1111
bull [17] Hari Johann Chasing The Scream The First and Last Days of the War on Drugs Bloomsbury USA (January 20 2015)bull [18] Hughes Caitlin Elizabeth and Alex Stevens (2010) ldquoWhat Can We Learn From The Portuguese Decriminalization of Illicit
Drugsrdquo British Journal of Criminology July 21 httpbjcoxfordjournalsorgcontent506999abstractbull [19] Fournier Jay C et al (2009) ldquoAntidepressant Drug Effects and Depression Severityrdquo JAMA January
6th httpjamajamanetworkcomarticleaspxarticleid=185157[20] Currie J Stabile M Jones L (2013) Do Stimulant Medications Improve Educational and Behavioral Outcomes for Children with ADHD NBER Working Paper No 19105
bull [21] Mora-Ripoli R Organizacioacuten Mundial de la Risa Barcelona Spain ldquoThe therapeutic value of laughter in medicinerdquo Altern Ther Health Med 2010 Nov-Dec16(6)56-64 httpwwwncbinlmnihgovpubmed21280463
bull [22] Gracanin Asmir Lauren M Bylsma and Ad J J M Vingerhoets (2014) ldquoIs Crying a Self-Stoothing Behaviorrdquo Frontiers in Psychology May 28httpwwwncbinlmnihgovpmcarticlesPMC4035568
bull [23] Trimble Michael (2010) ldquoI Cry Therefore I Amrdquo New York Times Nov 10 httpwwwnytimescom20121111opinionsundayi-cry-therefore-i-amhtmlemc=eta1amp_r=0
bull [24]Gallup Andrew C et al (2007) ldquoYawning as a brain cooling mechanism Nasal breathing and forehead cooling diminish the incidence of contagious yawningrdquo httpwwwepjournalnetarticlesyawning-as-a-brain-cooling-mechanism-nasal-breathing-and-forehead-cooling-diminish-the-incidence-of-contagious-yawning
bull [25]Sharat Gupta and Shallu Mittal Int (2013) Yawning and its physiological significance Intl J Appl Basic Med Res Jan-Jun 3(1) 11ndash15
bull [26] Stephens R Atkins J Kingston A (2009) ldquoSwearing As a Response to Painrdquo NeuroReport Aug 5 httpwwwncbinlmnihgovpubmed19590391
bull [27]Morelli SA Lieberman MD(2013) rdquoThe role of automaticity and attention in neural processes underlying empathy for happiness sadness and anxietyrdquo Front Hum Neurosci May 87160
Bibliography
bull [1] Committee on Psychosocial Aspects of Child and Family Health Committee on Early Childhood Adoption and Dependent Care andSection on Developmental and Behavioral Pediatrics Andrew S Garner Jack P Shonkoff et al (2012) ldquoEarly Childhood Adversity Toxic Stress and the Role of the Pediatrician Translating Developmental Science Into Lifelong Healthrdquo Pediatrics January VOLUME 129 ISSUE 1 From the American Academy of Pediatrics Policy Statementhttppediatricsaappublicationsorgcontent1291e224fullref-23
bull [2] COUNCIL ON COMMUNITY PEDIATRICS Benjamin A Gitterman et al (2016) ldquoPoverty and Child Health in the United Statesrdquo Pediatrics March From the American Academy of Pediatrics Policy Statement Published Online March 09American Academy of Pediatricshttppediatricsaappublicationsorgcontentearly20160307peds2016-0339info
bull [3] Paul W Newacheck et al (2003) ldquoDisparities in Adolescent Health and Health Care Does Socioeconomic Status Matterrdquo Health ServRes Oct 38(5) 1235ndash1252 httpwwwncbinlmnihgovpmcarticlesPMC1360944
bull [4] Larson et al (2007) ldquoPoverty during pregnancy Its effects on child health outcomesrdquo Paediatr Child Health 2007 Oct 12(8) 673ndash677 httpwwwncbinlmnihgovpmcarticlesPMC2528810
bull [5] Lara J Akinbami et al (2012) ldquoTrends in Asthma Prevalence Health Care Use and Mortality in the United States 2001ndash2010rdquo NCHS Data Brief No 94 May httpwwwcdcgovnchsproductsdatabriefsdb94htm
bull [6] Cynthia L Ogden et al (2010) ldquoObesity and Socioeconomic Status in Children and Adolescents United States 2005-2008rdquoNCHS Data Brief No 51 Decemberhttpwwwcdcgovnchsproductsdatabriefsdb51htm
bull [7] Shonkoff JP et al Committee on Psychosocial Aspects of Child and Family Health Committee on Early Childhood Adoption and Dependent Care Section on Developmental and Behavioral Pediatrics rdquoThe lifelong effects of early childhood adversity and toxicstressrdquo Pediatrics 2012129(1) wwwpediatricsorgcgicontentfull1291e232
bull [8] Virginia A Rauh et alldquoHousing and HealthIntersection of Poverty and Environmental Exposuresrdquo (2008) Annals of the New York Academy of Sciences Volume 1136 Reducing the Impact of Poverty on Health and Human Development Scientific Approaches pages 276ndash288 June httponlinelibrarywileycomdoi101196annals1425032full
bull [9] Yehuda R et al (2015) ldquoHolocaust Exposure Induced Intergenerational Effects on FKBP5 MethylationrdquoBiol Psychiatry Aug 12 httpwwwncbinlmnihgovpubmed26410355
bull [10] Buss C et al (2011) ldquoMaternal pregnancy-specific anxiety is associated with child executive function at 6-9 years agerdquoStress Nov14(6)665-76 httpwwwncbinlmnihgovpubmed21995526
bull 11] Shankardass K et al (2014) ldquoParental stress increases body mass index trajectory in pre-adolescentsrdquoPediatr Obes Dec9(6)435-42 httpwwwncbinlmnihgovpubmed24311567
bull [12] Vincent J Felitti et al (1998) ldquoRelationship of Childhood Abuse and Household Dysfunction to Many of the Leading Causes of Death in Adults The Adverse Childhood Experiences (ACE) Studyrdquo May Volume 14 Issue 4 Pages 245ndash258 httpsacestoohighcom
bull [13]Jones CP Levels of Racism a Theoretic Framework and the Gardenerrsquos Tale Am J Public Health 200090(8) 1212-1215bull [14]Dion KL The Social Psycology of Perceived Perjudice and Discrimination Canadian Psychology (2002)431 pp 1-10bull [15]Sue D W Bucceri J Lin AI Nadal K L and Torino J C Racial Microaggressions and the Asian American experience APA (2007) Vol
13 No 1 pp 72-81bull [16]James S A (School of Public Health U of North Carolina Chapel Hill NC 27514) D S Strogatz S B Wing and D L Ramsey
Socioeconomic status John Henryism and hypertension in blacks and whites Am J Epidemiol 1987 126664ndash73bull [17]httpwwwapaorgpioemaresourcesethnicity-healthindexaspxbull [18]Porges SW Clinical Insights from the Polyvagal Theory The Transformative Power of Feeling Safe (Norton Series on Interpersonal
Neurobiology) W W Norton Apr 7 2014 - Psychology - 288 pagesbull [19]The Polyvagal Theory (Porges SW Social Connectedness as a Biological Imperative Understanding Trauma Through the Lens of
thePolyvagal Theory presentation 82015)bull [20]McEwen BS Allostasis and allostatic load implications for neuropsychopharmacologyNeuropsychopharmacology 2000
Feb22(2)108-24bull [21] McEwen BS adaptation and disease Allostasis and allostatic load Ann N Y Acad Sci 1998 May 184033-44bull [22] Arline T Geronimus ScD Margaret Hicken MPH Danya Keene MAT and John Bound PhD Weatheringrdquo and Age Patterns of
Allostatic Load Scores Among Blacks and Whites in the United States Am J Public Health 2006 May 96(5) 826ndash833bull [22]Stephen Porges PhD Polyvagal Perspective Biological Psychology 2007 Feb 74(2) 116ndash143 Published online 2006 Oct 16 bull [23]Stephen W Porges PhD The Polyvagal Theory Neurophysiological Foundations of Emotions Attachment Communication and
Self-regulation WWNorton and Company Inc 2011bull [24]Maggie Phillips PhD Reversing Chronic Pain North Atlantic Books 2007bull [25]Peter Levine PhD Waking the Tiger North Atlantic Books 1997bull [26]Bessel VanderKolk MD The Body Keeps the Score Viking Penguin 2014bullAcknowledgmentsbull Group Medical Visits and Group Facilitation Jeff Geller MDbull Re-evaluation Counseling Community bull Insight Meditation Communitybull Biodynamic Osteopathy Communitybull Learning To Breathe Mindfulness Training for Adolescents 2015 Patricia C Broderick PhD bull Stanford Chronic Disease Self Management Program Training 2014 Kate Lorig MPH RNbull Motivational Interviewing Training 2015 Steven Berg-Smithbull Centering Pregnancy Training 2014 Centering Healthcare Institutebull Motivating Change in Groups Training 2013 Kaiser Permanente Oakland Cabull Group Facilitation Training Sara Fisk PhD Community at Work San Francisco Cabull Tribes Training 2013 Center for Human Developmentbull Cultural Humility Training 2016 Melanie Tervalon MD
Bibliography
Intermediate Steps to Listening Session Handout
bull Step 1 Connect with yourself body mind and emotions
bull Step 2 Hold a non-judgmental space to be seen and heard
bull Step 3 See the speaker and anyone referenced as able to manifest their true human nature and evolve using inherent healing abilities
bull Step 4 Listen to the speaker in a deep connected way sending the message that their thinking feelings and being matters to you
bull Step 5 Encourage the speaker to express feelings or thoughts describe body sensations or share a story relevant to the feelings at hand
bull Step 6 Validate intense emotional expression and release such as crying laughing shaking yawning sweating as a sign of healing
bull Step 7 Remind the speaker of their underlying goodness intelligence strength and caring and your confidence in their ability to heal and manifest their true human nature
copy Elizabeth Rocco MD
Contact Information
bull Elizabeth Rocco MD -egroccogmailcom
bull Karen Ekwueme MD-impactdoc1gmailcom
Basic Steps in Peer Listening Session
Step 1 Connect with yourself body mind and emotionsStep 2 Hold non-judgmental space to be seen and heardStep 3 See the speaker and anyone referenced as able
to manifest their true human nature and evolve using inherent healing abilities
Step 4 Listen to the speaker in a deep connected way sending the message that their thinking feelings and being matters to you copy Elizabeth Rocco MD
Silent Listening Practice
Messages Received by Young People in Under Served Communities
The Reality
Facing the Impact of Racism Poverty and Sexism
Behavioral Learning and Mental Health Diagnoses in Children
In New England
63 of Children
[1]Wen Patricia (2010) ldquoA legacy of unintended side effectsrdquo Boston Globe December 12
Use of Psychiatric Drugs in Children
Children on Psychiatric Drugs in the US in 2013
bull 0-1 Years 2748042-3 Years 3707784-5 Years 500948
bull 6-12 Years 413034013-17 Years 3617593
bull 8389034 children on psychiatric drugsbull [2]CCHR International (2014) [Online] Number of Children amp Adolescents Taking Psychiatric Drugs in the US
Aprilwwwcchrintorgpsychiatric-drugschildren-on-psychiatric-drugs
Facing the Impact of Trauma
An Alternative Model
Listening Practice
bull Turn to the person next to you
bull The person on the left will be the listener first and the other the speaker
bull Listener will listen while the speaker shares
bull Switch when time is called
When we define the effects of oppression as someonersquos ldquoillnessrdquo and ignore the root causes we obscure our path
forward in healing our communities
What if we reframed ldquochronic illnessrdquo as a societal struggle that requires societal
change and healing in community
1 Institutionalized oppression
2 Personally-mediated oppression or micro-aggressions
3 Internalized oppression
Teamnofearorg
Manifestations of Societal Oppression
Institutionalized Racism
Micro-aggressions
Internalized Racism
StressCumulative Effects
COGNITIVE BEHAVIORAL
EMOTIONAL NEURO PHYSIOLOGICAL
STRESS
Complex Societal Trauma (CST)Total Negative Health Impact over Generations
Societal Oppression
Familial Trauma
Societal Trauma
Complex Societal Trauma
copy Elizabeth Rocco MD
Intergenerational TransmissionHow is CST passed down to our children
1 Yehuda R et al (2015) ldquoHolocaust Exposure Induced Intergenerational Effects on FKBP5 MethylationrdquoBiol Psychiatry Aug 12 httpwwwncbinlmnihgovpubmed26410355B
2 Buss C et al (2011) ldquoMaternal pregnancy-specific anxiety is associated with child executive function at 6-9 years agerdquo Stress Nov14(6)665-76 httpwwwncbinlmnihgovpubmed21995526
3 Shankardass K et al (2014) ldquoParental stress increases body mass index trajectory in preadolescentsrdquoPediatr Obes Dec9(6)435-42 httpwwwncbinlmnihgovpubmed24311567
Complex Societal Trauma
is Toxic to the Developing Brain
Pat Levitt developmental neuroscientist and Dr Jack
Shonkoff part of the National Scientific Council on
the Developing Child
ACE (Adverse Childhood Experience) Study
Childhood neglect abuse and household dysfunction impacts health through out life
Vincent J Felitti et al (1998) ldquoRelationship of Childhood Abuse and Household Dysfunction to Many of the Leading Causes of Death in Adults
The Adverse Childhood Experiences (ACE) Studyrdquo May Volume 14 Issue 4 Pages 245ndash
258 httpsacestoohighcom
Healing Complex Societal Trauma
Social Engagement Ventral Vagal Complex
Reach for Help Ventral Vagal FEAR
Fight or FlightSympathetic
FEAR
FEAR
Freeze Collapse Dorsal Vagal
Pre-frontal CortexThe Voice of Reason
Human Healing and Evolution through Self-Awareness Embodiment Empowerment and Connection
Mindfulness Breath work Martial Arts Exercise Yoga Singing Dancing
Acupuncture Massage ReikiCommunity Groups Animals Church Nature
Final Listening Practice and Closing Circle
Bibliography
bull Special Acknowledgement of Demie Stathoplos MSW and Bonnie Cohen MD who collaborated with Elizabeth Rocco MD on the IM4US August 2015 presentation ldquoListening to Each Other Healing the Negative Health Impacts of Racism Poverty and Trauma through Human Connectionrdquo
bull Special Acknowledgement of Karen Burt MD who collaborated with Elizabeth Rocco MD and Karen Ekwueme MD on the IM4US August 2016 presentation ldquoListening to Ourselves and Each Other Healing the Negative Health Impact of Racism Poverty Sexism and Traumardquo These bibliographies are included below
bull [1]Wen Patricia (2010) ldquoA legacy of unintended side effectsrdquo Boston Globe December 12 httpwwwbostoncomnewslocalmassachusettsarticles20101212with_ssi_program_a_legcy_of_unintended_side_effects
bull [2]CCHR International (2014) [Online] Number of Children amp Adolescents Taking Psychiatric Drugs in the US Aprilwwwcchrintorgpsychiatric-drugschildren-on-psychiatric-drugs
bull [3]Whitaker R (2010) Anatomy of an Epidemic Magic Bullets Psychiatric Drugs and the Astonishing Rise of Mental Illness in America Crown Publishing Company httprobertwhitakerorgrobertwhitakerorgAnatomy20of20an20Epidemichtml
bull [3]CDC (2013) [Online] MMRW Mental Health Surveillance Among Children mdash United States 2005ndash2011 Supplements May 17 62(02)1-35 httpwwwcdcgovmmwrpreviewmmwrhtmlsu6202a1htm
bull [4]Patricia N Pastor PhD Cynthia A Reuben MA Catherine R Duran BS and LaJeana D Hawkins MPH CHES (2015) [Online] CDC NCHS Data Brief Association Between Diagnosed ADHD and Selected Characteristics Among Children Aged 4ndash17 Years United States 2011ndash2013 May Number 201 httpwwwcdcgovnchsdatadatabriefsdb201htm
bull [5]Mental Health America (2014) Parity or Disparity The State of Mental Health in America 2015 NovwwwmentalhealthamericanetsitesdefaultfilesParity20or20Disparity20201520Reportpdf
bull [6]Bruce S Jonas ScM PhD Qiuping Gu MD PhD and Juan R Albertorio-Diaz MA (2013) [Online] CDC NCHS Data Brief Psychotropic Medication Use Among Adolescents United States 2005ndash2010 Dec Number 135httpwwwcdcgovnchsdatadatabriefsdb135htm
bull [7] C Buss EP Davis CJ Hobel and CA Sandman (2011) Maternal pregnancy-specific anxiety is associated with child executive function at 6ndash9 years age Stress Nov 14(6)665-676
bull [8] Council for Evidence-Based Psychiatry (UK) Web presentation ldquoUnrecognized Factsrdquo Authors James Davies Peter C Goetzsche Peter Kinderman Joanna Moncrieff Phillip Thomas Sami Timimi John Sandwich Melanie Davis Luke Montague httpcepukorgunrecognised-facts
bull [9] Johnstone Lucy (2015) A Straight Talking Introduction to Psychiatric DiagnosisPCCS Books 1st edition (February 3 2015)
bull [10] Brewin CR Andrews B Valentine JD (2000) ldquoMeta-analysis of risk factors for posttraumatic stress disorder in trauma-exposed adultsrdquo J Consult Clin Psychol2000 Oct68(5)748-66 httpwwwncbinlmnihgovpubmed11068961
bull [11] Williams Monica T (2013) ldquoCan Racism Cause PTSD Implications for DSM-5rdquoPsychology Today May 20 httpswwwpsychologytodaycomblogculturally-speaking201305can-racism-cause-ptsd-implications-dsm-5
Bibliography
bull [12] Yuan Chengmei et al (2011) ldquoProtective factors for posttraumatic stress disorder symptoms in a prospective study of police officersrdquo Nov 23httpwwwncbinlmnihgovpmcarticlesPMC3071439
bull [13] Chou Tina BA Anu Asnaani MA and Stefan G Hofmann PhD (2012) ldquoPerception of Racial Discrimination and Psychopathology Across Three US Ethnic Minority Groupsrdquo APA PsychNET Jan httpwwwncbinlmnihgovpmcarticlesPMC3505377
bull [14] Watson Laurel B Jacob M Marszalek Franco Dispenza and Christopher M Davids 2015 Understanding the Relationships Among White and African American Womenrsquos Sexual Objectification Experiences Physical Safety Anxiety and Psychological Distress Sex Roles 72 (34) 91-104
bull [15] Holland Julie (2015) ldquoMedicating Womenrsquos Feelingsrdquo New York TimesOpinion Feb 28 httpmobilenytimescom20150301opinionsundaymedicating-womens-feelingshtmlreferreramp_r=1
bull [16] Solinas M Thiriet N El Rawas R Lardeux V and Jaber M (2009) ldquoEnvironmental Enrichment During Early Stages of Life Reduces the Behavioral Neurochemical and Molecular Effects of Cocainerdquo Neuropsychopharmacology 34 1102ndash1111
bull [17] Hari Johann Chasing The Scream The First and Last Days of the War on Drugs Bloomsbury USA (January 20 2015)bull [18] Hughes Caitlin Elizabeth and Alex Stevens (2010) ldquoWhat Can We Learn From The Portuguese Decriminalization of Illicit
Drugsrdquo British Journal of Criminology July 21 httpbjcoxfordjournalsorgcontent506999abstractbull [19] Fournier Jay C et al (2009) ldquoAntidepressant Drug Effects and Depression Severityrdquo JAMA January
6th httpjamajamanetworkcomarticleaspxarticleid=185157[20] Currie J Stabile M Jones L (2013) Do Stimulant Medications Improve Educational and Behavioral Outcomes for Children with ADHD NBER Working Paper No 19105
bull [21] Mora-Ripoli R Organizacioacuten Mundial de la Risa Barcelona Spain ldquoThe therapeutic value of laughter in medicinerdquo Altern Ther Health Med 2010 Nov-Dec16(6)56-64 httpwwwncbinlmnihgovpubmed21280463
bull [22] Gracanin Asmir Lauren M Bylsma and Ad J J M Vingerhoets (2014) ldquoIs Crying a Self-Stoothing Behaviorrdquo Frontiers in Psychology May 28httpwwwncbinlmnihgovpmcarticlesPMC4035568
bull [23] Trimble Michael (2010) ldquoI Cry Therefore I Amrdquo New York Times Nov 10 httpwwwnytimescom20121111opinionsundayi-cry-therefore-i-amhtmlemc=eta1amp_r=0
bull [24]Gallup Andrew C et al (2007) ldquoYawning as a brain cooling mechanism Nasal breathing and forehead cooling diminish the incidence of contagious yawningrdquo httpwwwepjournalnetarticlesyawning-as-a-brain-cooling-mechanism-nasal-breathing-and-forehead-cooling-diminish-the-incidence-of-contagious-yawning
bull [25]Sharat Gupta and Shallu Mittal Int (2013) Yawning and its physiological significance Intl J Appl Basic Med Res Jan-Jun 3(1) 11ndash15
bull [26] Stephens R Atkins J Kingston A (2009) ldquoSwearing As a Response to Painrdquo NeuroReport Aug 5 httpwwwncbinlmnihgovpubmed19590391
bull [27]Morelli SA Lieberman MD(2013) rdquoThe role of automaticity and attention in neural processes underlying empathy for happiness sadness and anxietyrdquo Front Hum Neurosci May 87160
Bibliography
bull [1] Committee on Psychosocial Aspects of Child and Family Health Committee on Early Childhood Adoption and Dependent Care andSection on Developmental and Behavioral Pediatrics Andrew S Garner Jack P Shonkoff et al (2012) ldquoEarly Childhood Adversity Toxic Stress and the Role of the Pediatrician Translating Developmental Science Into Lifelong Healthrdquo Pediatrics January VOLUME 129 ISSUE 1 From the American Academy of Pediatrics Policy Statementhttppediatricsaappublicationsorgcontent1291e224fullref-23
bull [2] COUNCIL ON COMMUNITY PEDIATRICS Benjamin A Gitterman et al (2016) ldquoPoverty and Child Health in the United Statesrdquo Pediatrics March From the American Academy of Pediatrics Policy Statement Published Online March 09American Academy of Pediatricshttppediatricsaappublicationsorgcontentearly20160307peds2016-0339info
bull [3] Paul W Newacheck et al (2003) ldquoDisparities in Adolescent Health and Health Care Does Socioeconomic Status Matterrdquo Health ServRes Oct 38(5) 1235ndash1252 httpwwwncbinlmnihgovpmcarticlesPMC1360944
bull [4] Larson et al (2007) ldquoPoverty during pregnancy Its effects on child health outcomesrdquo Paediatr Child Health 2007 Oct 12(8) 673ndash677 httpwwwncbinlmnihgovpmcarticlesPMC2528810
bull [5] Lara J Akinbami et al (2012) ldquoTrends in Asthma Prevalence Health Care Use and Mortality in the United States 2001ndash2010rdquo NCHS Data Brief No 94 May httpwwwcdcgovnchsproductsdatabriefsdb94htm
bull [6] Cynthia L Ogden et al (2010) ldquoObesity and Socioeconomic Status in Children and Adolescents United States 2005-2008rdquoNCHS Data Brief No 51 Decemberhttpwwwcdcgovnchsproductsdatabriefsdb51htm
bull [7] Shonkoff JP et al Committee on Psychosocial Aspects of Child and Family Health Committee on Early Childhood Adoption and Dependent Care Section on Developmental and Behavioral Pediatrics rdquoThe lifelong effects of early childhood adversity and toxicstressrdquo Pediatrics 2012129(1) wwwpediatricsorgcgicontentfull1291e232
bull [8] Virginia A Rauh et alldquoHousing and HealthIntersection of Poverty and Environmental Exposuresrdquo (2008) Annals of the New York Academy of Sciences Volume 1136 Reducing the Impact of Poverty on Health and Human Development Scientific Approaches pages 276ndash288 June httponlinelibrarywileycomdoi101196annals1425032full
bull [9] Yehuda R et al (2015) ldquoHolocaust Exposure Induced Intergenerational Effects on FKBP5 MethylationrdquoBiol Psychiatry Aug 12 httpwwwncbinlmnihgovpubmed26410355
bull [10] Buss C et al (2011) ldquoMaternal pregnancy-specific anxiety is associated with child executive function at 6-9 years agerdquoStress Nov14(6)665-76 httpwwwncbinlmnihgovpubmed21995526
bull 11] Shankardass K et al (2014) ldquoParental stress increases body mass index trajectory in pre-adolescentsrdquoPediatr Obes Dec9(6)435-42 httpwwwncbinlmnihgovpubmed24311567
bull [12] Vincent J Felitti et al (1998) ldquoRelationship of Childhood Abuse and Household Dysfunction to Many of the Leading Causes of Death in Adults The Adverse Childhood Experiences (ACE) Studyrdquo May Volume 14 Issue 4 Pages 245ndash258 httpsacestoohighcom
bull [13]Jones CP Levels of Racism a Theoretic Framework and the Gardenerrsquos Tale Am J Public Health 200090(8) 1212-1215bull [14]Dion KL The Social Psycology of Perceived Perjudice and Discrimination Canadian Psychology (2002)431 pp 1-10bull [15]Sue D W Bucceri J Lin AI Nadal K L and Torino J C Racial Microaggressions and the Asian American experience APA (2007) Vol
13 No 1 pp 72-81bull [16]James S A (School of Public Health U of North Carolina Chapel Hill NC 27514) D S Strogatz S B Wing and D L Ramsey
Socioeconomic status John Henryism and hypertension in blacks and whites Am J Epidemiol 1987 126664ndash73bull [17]httpwwwapaorgpioemaresourcesethnicity-healthindexaspxbull [18]Porges SW Clinical Insights from the Polyvagal Theory The Transformative Power of Feeling Safe (Norton Series on Interpersonal
Neurobiology) W W Norton Apr 7 2014 - Psychology - 288 pagesbull [19]The Polyvagal Theory (Porges SW Social Connectedness as a Biological Imperative Understanding Trauma Through the Lens of
thePolyvagal Theory presentation 82015)bull [20]McEwen BS Allostasis and allostatic load implications for neuropsychopharmacologyNeuropsychopharmacology 2000
Feb22(2)108-24bull [21] McEwen BS adaptation and disease Allostasis and allostatic load Ann N Y Acad Sci 1998 May 184033-44bull [22] Arline T Geronimus ScD Margaret Hicken MPH Danya Keene MAT and John Bound PhD Weatheringrdquo and Age Patterns of
Allostatic Load Scores Among Blacks and Whites in the United States Am J Public Health 2006 May 96(5) 826ndash833bull [22]Stephen Porges PhD Polyvagal Perspective Biological Psychology 2007 Feb 74(2) 116ndash143 Published online 2006 Oct 16 bull [23]Stephen W Porges PhD The Polyvagal Theory Neurophysiological Foundations of Emotions Attachment Communication and
Self-regulation WWNorton and Company Inc 2011bull [24]Maggie Phillips PhD Reversing Chronic Pain North Atlantic Books 2007bull [25]Peter Levine PhD Waking the Tiger North Atlantic Books 1997bull [26]Bessel VanderKolk MD The Body Keeps the Score Viking Penguin 2014bullAcknowledgmentsbull Group Medical Visits and Group Facilitation Jeff Geller MDbull Re-evaluation Counseling Community bull Insight Meditation Communitybull Biodynamic Osteopathy Communitybull Learning To Breathe Mindfulness Training for Adolescents 2015 Patricia C Broderick PhD bull Stanford Chronic Disease Self Management Program Training 2014 Kate Lorig MPH RNbull Motivational Interviewing Training 2015 Steven Berg-Smithbull Centering Pregnancy Training 2014 Centering Healthcare Institutebull Motivating Change in Groups Training 2013 Kaiser Permanente Oakland Cabull Group Facilitation Training Sara Fisk PhD Community at Work San Francisco Cabull Tribes Training 2013 Center for Human Developmentbull Cultural Humility Training 2016 Melanie Tervalon MD
Bibliography
Intermediate Steps to Listening Session Handout
bull Step 1 Connect with yourself body mind and emotions
bull Step 2 Hold a non-judgmental space to be seen and heard
bull Step 3 See the speaker and anyone referenced as able to manifest their true human nature and evolve using inherent healing abilities
bull Step 4 Listen to the speaker in a deep connected way sending the message that their thinking feelings and being matters to you
bull Step 5 Encourage the speaker to express feelings or thoughts describe body sensations or share a story relevant to the feelings at hand
bull Step 6 Validate intense emotional expression and release such as crying laughing shaking yawning sweating as a sign of healing
bull Step 7 Remind the speaker of their underlying goodness intelligence strength and caring and your confidence in their ability to heal and manifest their true human nature
copy Elizabeth Rocco MD
Contact Information
bull Elizabeth Rocco MD -egroccogmailcom
bull Karen Ekwueme MD-impactdoc1gmailcom
Silent Listening Practice
Messages Received by Young People in Under Served Communities
The Reality
Facing the Impact of Racism Poverty and Sexism
Behavioral Learning and Mental Health Diagnoses in Children
In New England
63 of Children
[1]Wen Patricia (2010) ldquoA legacy of unintended side effectsrdquo Boston Globe December 12
Use of Psychiatric Drugs in Children
Children on Psychiatric Drugs in the US in 2013
bull 0-1 Years 2748042-3 Years 3707784-5 Years 500948
bull 6-12 Years 413034013-17 Years 3617593
bull 8389034 children on psychiatric drugsbull [2]CCHR International (2014) [Online] Number of Children amp Adolescents Taking Psychiatric Drugs in the US
Aprilwwwcchrintorgpsychiatric-drugschildren-on-psychiatric-drugs
Facing the Impact of Trauma
An Alternative Model
Listening Practice
bull Turn to the person next to you
bull The person on the left will be the listener first and the other the speaker
bull Listener will listen while the speaker shares
bull Switch when time is called
When we define the effects of oppression as someonersquos ldquoillnessrdquo and ignore the root causes we obscure our path
forward in healing our communities
What if we reframed ldquochronic illnessrdquo as a societal struggle that requires societal
change and healing in community
1 Institutionalized oppression
2 Personally-mediated oppression or micro-aggressions
3 Internalized oppression
Teamnofearorg
Manifestations of Societal Oppression
Institutionalized Racism
Micro-aggressions
Internalized Racism
StressCumulative Effects
COGNITIVE BEHAVIORAL
EMOTIONAL NEURO PHYSIOLOGICAL
STRESS
Complex Societal Trauma (CST)Total Negative Health Impact over Generations
Societal Oppression
Familial Trauma
Societal Trauma
Complex Societal Trauma
copy Elizabeth Rocco MD
Intergenerational TransmissionHow is CST passed down to our children
1 Yehuda R et al (2015) ldquoHolocaust Exposure Induced Intergenerational Effects on FKBP5 MethylationrdquoBiol Psychiatry Aug 12 httpwwwncbinlmnihgovpubmed26410355B
2 Buss C et al (2011) ldquoMaternal pregnancy-specific anxiety is associated with child executive function at 6-9 years agerdquo Stress Nov14(6)665-76 httpwwwncbinlmnihgovpubmed21995526
3 Shankardass K et al (2014) ldquoParental stress increases body mass index trajectory in preadolescentsrdquoPediatr Obes Dec9(6)435-42 httpwwwncbinlmnihgovpubmed24311567
Complex Societal Trauma
is Toxic to the Developing Brain
Pat Levitt developmental neuroscientist and Dr Jack
Shonkoff part of the National Scientific Council on
the Developing Child
ACE (Adverse Childhood Experience) Study
Childhood neglect abuse and household dysfunction impacts health through out life
Vincent J Felitti et al (1998) ldquoRelationship of Childhood Abuse and Household Dysfunction to Many of the Leading Causes of Death in Adults
The Adverse Childhood Experiences (ACE) Studyrdquo May Volume 14 Issue 4 Pages 245ndash
258 httpsacestoohighcom
Healing Complex Societal Trauma
Social Engagement Ventral Vagal Complex
Reach for Help Ventral Vagal FEAR
Fight or FlightSympathetic
FEAR
FEAR
Freeze Collapse Dorsal Vagal
Pre-frontal CortexThe Voice of Reason
Human Healing and Evolution through Self-Awareness Embodiment Empowerment and Connection
Mindfulness Breath work Martial Arts Exercise Yoga Singing Dancing
Acupuncture Massage ReikiCommunity Groups Animals Church Nature
Final Listening Practice and Closing Circle
Bibliography
bull Special Acknowledgement of Demie Stathoplos MSW and Bonnie Cohen MD who collaborated with Elizabeth Rocco MD on the IM4US August 2015 presentation ldquoListening to Each Other Healing the Negative Health Impacts of Racism Poverty and Trauma through Human Connectionrdquo
bull Special Acknowledgement of Karen Burt MD who collaborated with Elizabeth Rocco MD and Karen Ekwueme MD on the IM4US August 2016 presentation ldquoListening to Ourselves and Each Other Healing the Negative Health Impact of Racism Poverty Sexism and Traumardquo These bibliographies are included below
bull [1]Wen Patricia (2010) ldquoA legacy of unintended side effectsrdquo Boston Globe December 12 httpwwwbostoncomnewslocalmassachusettsarticles20101212with_ssi_program_a_legcy_of_unintended_side_effects
bull [2]CCHR International (2014) [Online] Number of Children amp Adolescents Taking Psychiatric Drugs in the US Aprilwwwcchrintorgpsychiatric-drugschildren-on-psychiatric-drugs
bull [3]Whitaker R (2010) Anatomy of an Epidemic Magic Bullets Psychiatric Drugs and the Astonishing Rise of Mental Illness in America Crown Publishing Company httprobertwhitakerorgrobertwhitakerorgAnatomy20of20an20Epidemichtml
bull [3]CDC (2013) [Online] MMRW Mental Health Surveillance Among Children mdash United States 2005ndash2011 Supplements May 17 62(02)1-35 httpwwwcdcgovmmwrpreviewmmwrhtmlsu6202a1htm
bull [4]Patricia N Pastor PhD Cynthia A Reuben MA Catherine R Duran BS and LaJeana D Hawkins MPH CHES (2015) [Online] CDC NCHS Data Brief Association Between Diagnosed ADHD and Selected Characteristics Among Children Aged 4ndash17 Years United States 2011ndash2013 May Number 201 httpwwwcdcgovnchsdatadatabriefsdb201htm
bull [5]Mental Health America (2014) Parity or Disparity The State of Mental Health in America 2015 NovwwwmentalhealthamericanetsitesdefaultfilesParity20or20Disparity20201520Reportpdf
bull [6]Bruce S Jonas ScM PhD Qiuping Gu MD PhD and Juan R Albertorio-Diaz MA (2013) [Online] CDC NCHS Data Brief Psychotropic Medication Use Among Adolescents United States 2005ndash2010 Dec Number 135httpwwwcdcgovnchsdatadatabriefsdb135htm
bull [7] C Buss EP Davis CJ Hobel and CA Sandman (2011) Maternal pregnancy-specific anxiety is associated with child executive function at 6ndash9 years age Stress Nov 14(6)665-676
bull [8] Council for Evidence-Based Psychiatry (UK) Web presentation ldquoUnrecognized Factsrdquo Authors James Davies Peter C Goetzsche Peter Kinderman Joanna Moncrieff Phillip Thomas Sami Timimi John Sandwich Melanie Davis Luke Montague httpcepukorgunrecognised-facts
bull [9] Johnstone Lucy (2015) A Straight Talking Introduction to Psychiatric DiagnosisPCCS Books 1st edition (February 3 2015)
bull [10] Brewin CR Andrews B Valentine JD (2000) ldquoMeta-analysis of risk factors for posttraumatic stress disorder in trauma-exposed adultsrdquo J Consult Clin Psychol2000 Oct68(5)748-66 httpwwwncbinlmnihgovpubmed11068961
bull [11] Williams Monica T (2013) ldquoCan Racism Cause PTSD Implications for DSM-5rdquoPsychology Today May 20 httpswwwpsychologytodaycomblogculturally-speaking201305can-racism-cause-ptsd-implications-dsm-5
Bibliography
bull [12] Yuan Chengmei et al (2011) ldquoProtective factors for posttraumatic stress disorder symptoms in a prospective study of police officersrdquo Nov 23httpwwwncbinlmnihgovpmcarticlesPMC3071439
bull [13] Chou Tina BA Anu Asnaani MA and Stefan G Hofmann PhD (2012) ldquoPerception of Racial Discrimination and Psychopathology Across Three US Ethnic Minority Groupsrdquo APA PsychNET Jan httpwwwncbinlmnihgovpmcarticlesPMC3505377
bull [14] Watson Laurel B Jacob M Marszalek Franco Dispenza and Christopher M Davids 2015 Understanding the Relationships Among White and African American Womenrsquos Sexual Objectification Experiences Physical Safety Anxiety and Psychological Distress Sex Roles 72 (34) 91-104
bull [15] Holland Julie (2015) ldquoMedicating Womenrsquos Feelingsrdquo New York TimesOpinion Feb 28 httpmobilenytimescom20150301opinionsundaymedicating-womens-feelingshtmlreferreramp_r=1
bull [16] Solinas M Thiriet N El Rawas R Lardeux V and Jaber M (2009) ldquoEnvironmental Enrichment During Early Stages of Life Reduces the Behavioral Neurochemical and Molecular Effects of Cocainerdquo Neuropsychopharmacology 34 1102ndash1111
bull [17] Hari Johann Chasing The Scream The First and Last Days of the War on Drugs Bloomsbury USA (January 20 2015)bull [18] Hughes Caitlin Elizabeth and Alex Stevens (2010) ldquoWhat Can We Learn From The Portuguese Decriminalization of Illicit
Drugsrdquo British Journal of Criminology July 21 httpbjcoxfordjournalsorgcontent506999abstractbull [19] Fournier Jay C et al (2009) ldquoAntidepressant Drug Effects and Depression Severityrdquo JAMA January
6th httpjamajamanetworkcomarticleaspxarticleid=185157[20] Currie J Stabile M Jones L (2013) Do Stimulant Medications Improve Educational and Behavioral Outcomes for Children with ADHD NBER Working Paper No 19105
bull [21] Mora-Ripoli R Organizacioacuten Mundial de la Risa Barcelona Spain ldquoThe therapeutic value of laughter in medicinerdquo Altern Ther Health Med 2010 Nov-Dec16(6)56-64 httpwwwncbinlmnihgovpubmed21280463
bull [22] Gracanin Asmir Lauren M Bylsma and Ad J J M Vingerhoets (2014) ldquoIs Crying a Self-Stoothing Behaviorrdquo Frontiers in Psychology May 28httpwwwncbinlmnihgovpmcarticlesPMC4035568
bull [23] Trimble Michael (2010) ldquoI Cry Therefore I Amrdquo New York Times Nov 10 httpwwwnytimescom20121111opinionsundayi-cry-therefore-i-amhtmlemc=eta1amp_r=0
bull [24]Gallup Andrew C et al (2007) ldquoYawning as a brain cooling mechanism Nasal breathing and forehead cooling diminish the incidence of contagious yawningrdquo httpwwwepjournalnetarticlesyawning-as-a-brain-cooling-mechanism-nasal-breathing-and-forehead-cooling-diminish-the-incidence-of-contagious-yawning
bull [25]Sharat Gupta and Shallu Mittal Int (2013) Yawning and its physiological significance Intl J Appl Basic Med Res Jan-Jun 3(1) 11ndash15
bull [26] Stephens R Atkins J Kingston A (2009) ldquoSwearing As a Response to Painrdquo NeuroReport Aug 5 httpwwwncbinlmnihgovpubmed19590391
bull [27]Morelli SA Lieberman MD(2013) rdquoThe role of automaticity and attention in neural processes underlying empathy for happiness sadness and anxietyrdquo Front Hum Neurosci May 87160
Bibliography
bull [1] Committee on Psychosocial Aspects of Child and Family Health Committee on Early Childhood Adoption and Dependent Care andSection on Developmental and Behavioral Pediatrics Andrew S Garner Jack P Shonkoff et al (2012) ldquoEarly Childhood Adversity Toxic Stress and the Role of the Pediatrician Translating Developmental Science Into Lifelong Healthrdquo Pediatrics January VOLUME 129 ISSUE 1 From the American Academy of Pediatrics Policy Statementhttppediatricsaappublicationsorgcontent1291e224fullref-23
bull [2] COUNCIL ON COMMUNITY PEDIATRICS Benjamin A Gitterman et al (2016) ldquoPoverty and Child Health in the United Statesrdquo Pediatrics March From the American Academy of Pediatrics Policy Statement Published Online March 09American Academy of Pediatricshttppediatricsaappublicationsorgcontentearly20160307peds2016-0339info
bull [3] Paul W Newacheck et al (2003) ldquoDisparities in Adolescent Health and Health Care Does Socioeconomic Status Matterrdquo Health ServRes Oct 38(5) 1235ndash1252 httpwwwncbinlmnihgovpmcarticlesPMC1360944
bull [4] Larson et al (2007) ldquoPoverty during pregnancy Its effects on child health outcomesrdquo Paediatr Child Health 2007 Oct 12(8) 673ndash677 httpwwwncbinlmnihgovpmcarticlesPMC2528810
bull [5] Lara J Akinbami et al (2012) ldquoTrends in Asthma Prevalence Health Care Use and Mortality in the United States 2001ndash2010rdquo NCHS Data Brief No 94 May httpwwwcdcgovnchsproductsdatabriefsdb94htm
bull [6] Cynthia L Ogden et al (2010) ldquoObesity and Socioeconomic Status in Children and Adolescents United States 2005-2008rdquoNCHS Data Brief No 51 Decemberhttpwwwcdcgovnchsproductsdatabriefsdb51htm
bull [7] Shonkoff JP et al Committee on Psychosocial Aspects of Child and Family Health Committee on Early Childhood Adoption and Dependent Care Section on Developmental and Behavioral Pediatrics rdquoThe lifelong effects of early childhood adversity and toxicstressrdquo Pediatrics 2012129(1) wwwpediatricsorgcgicontentfull1291e232
bull [8] Virginia A Rauh et alldquoHousing and HealthIntersection of Poverty and Environmental Exposuresrdquo (2008) Annals of the New York Academy of Sciences Volume 1136 Reducing the Impact of Poverty on Health and Human Development Scientific Approaches pages 276ndash288 June httponlinelibrarywileycomdoi101196annals1425032full
bull [9] Yehuda R et al (2015) ldquoHolocaust Exposure Induced Intergenerational Effects on FKBP5 MethylationrdquoBiol Psychiatry Aug 12 httpwwwncbinlmnihgovpubmed26410355
bull [10] Buss C et al (2011) ldquoMaternal pregnancy-specific anxiety is associated with child executive function at 6-9 years agerdquoStress Nov14(6)665-76 httpwwwncbinlmnihgovpubmed21995526
bull 11] Shankardass K et al (2014) ldquoParental stress increases body mass index trajectory in pre-adolescentsrdquoPediatr Obes Dec9(6)435-42 httpwwwncbinlmnihgovpubmed24311567
bull [12] Vincent J Felitti et al (1998) ldquoRelationship of Childhood Abuse and Household Dysfunction to Many of the Leading Causes of Death in Adults The Adverse Childhood Experiences (ACE) Studyrdquo May Volume 14 Issue 4 Pages 245ndash258 httpsacestoohighcom
bull [13]Jones CP Levels of Racism a Theoretic Framework and the Gardenerrsquos Tale Am J Public Health 200090(8) 1212-1215bull [14]Dion KL The Social Psycology of Perceived Perjudice and Discrimination Canadian Psychology (2002)431 pp 1-10bull [15]Sue D W Bucceri J Lin AI Nadal K L and Torino J C Racial Microaggressions and the Asian American experience APA (2007) Vol
13 No 1 pp 72-81bull [16]James S A (School of Public Health U of North Carolina Chapel Hill NC 27514) D S Strogatz S B Wing and D L Ramsey
Socioeconomic status John Henryism and hypertension in blacks and whites Am J Epidemiol 1987 126664ndash73bull [17]httpwwwapaorgpioemaresourcesethnicity-healthindexaspxbull [18]Porges SW Clinical Insights from the Polyvagal Theory The Transformative Power of Feeling Safe (Norton Series on Interpersonal
Neurobiology) W W Norton Apr 7 2014 - Psychology - 288 pagesbull [19]The Polyvagal Theory (Porges SW Social Connectedness as a Biological Imperative Understanding Trauma Through the Lens of
thePolyvagal Theory presentation 82015)bull [20]McEwen BS Allostasis and allostatic load implications for neuropsychopharmacologyNeuropsychopharmacology 2000
Feb22(2)108-24bull [21] McEwen BS adaptation and disease Allostasis and allostatic load Ann N Y Acad Sci 1998 May 184033-44bull [22] Arline T Geronimus ScD Margaret Hicken MPH Danya Keene MAT and John Bound PhD Weatheringrdquo and Age Patterns of
Allostatic Load Scores Among Blacks and Whites in the United States Am J Public Health 2006 May 96(5) 826ndash833bull [22]Stephen Porges PhD Polyvagal Perspective Biological Psychology 2007 Feb 74(2) 116ndash143 Published online 2006 Oct 16 bull [23]Stephen W Porges PhD The Polyvagal Theory Neurophysiological Foundations of Emotions Attachment Communication and
Self-regulation WWNorton and Company Inc 2011bull [24]Maggie Phillips PhD Reversing Chronic Pain North Atlantic Books 2007bull [25]Peter Levine PhD Waking the Tiger North Atlantic Books 1997bull [26]Bessel VanderKolk MD The Body Keeps the Score Viking Penguin 2014bullAcknowledgmentsbull Group Medical Visits and Group Facilitation Jeff Geller MDbull Re-evaluation Counseling Community bull Insight Meditation Communitybull Biodynamic Osteopathy Communitybull Learning To Breathe Mindfulness Training for Adolescents 2015 Patricia C Broderick PhD bull Stanford Chronic Disease Self Management Program Training 2014 Kate Lorig MPH RNbull Motivational Interviewing Training 2015 Steven Berg-Smithbull Centering Pregnancy Training 2014 Centering Healthcare Institutebull Motivating Change in Groups Training 2013 Kaiser Permanente Oakland Cabull Group Facilitation Training Sara Fisk PhD Community at Work San Francisco Cabull Tribes Training 2013 Center for Human Developmentbull Cultural Humility Training 2016 Melanie Tervalon MD
Bibliography
Intermediate Steps to Listening Session Handout
bull Step 1 Connect with yourself body mind and emotions
bull Step 2 Hold a non-judgmental space to be seen and heard
bull Step 3 See the speaker and anyone referenced as able to manifest their true human nature and evolve using inherent healing abilities
bull Step 4 Listen to the speaker in a deep connected way sending the message that their thinking feelings and being matters to you
bull Step 5 Encourage the speaker to express feelings or thoughts describe body sensations or share a story relevant to the feelings at hand
bull Step 6 Validate intense emotional expression and release such as crying laughing shaking yawning sweating as a sign of healing
bull Step 7 Remind the speaker of their underlying goodness intelligence strength and caring and your confidence in their ability to heal and manifest their true human nature
copy Elizabeth Rocco MD
Contact Information
bull Elizabeth Rocco MD -egroccogmailcom
bull Karen Ekwueme MD-impactdoc1gmailcom
Messages Received by Young People in Under Served Communities
The Reality
Facing the Impact of Racism Poverty and Sexism
Behavioral Learning and Mental Health Diagnoses in Children
In New England
63 of Children
[1]Wen Patricia (2010) ldquoA legacy of unintended side effectsrdquo Boston Globe December 12
Use of Psychiatric Drugs in Children
Children on Psychiatric Drugs in the US in 2013
bull 0-1 Years 2748042-3 Years 3707784-5 Years 500948
bull 6-12 Years 413034013-17 Years 3617593
bull 8389034 children on psychiatric drugsbull [2]CCHR International (2014) [Online] Number of Children amp Adolescents Taking Psychiatric Drugs in the US
Aprilwwwcchrintorgpsychiatric-drugschildren-on-psychiatric-drugs
Facing the Impact of Trauma
An Alternative Model
Listening Practice
bull Turn to the person next to you
bull The person on the left will be the listener first and the other the speaker
bull Listener will listen while the speaker shares
bull Switch when time is called
When we define the effects of oppression as someonersquos ldquoillnessrdquo and ignore the root causes we obscure our path
forward in healing our communities
What if we reframed ldquochronic illnessrdquo as a societal struggle that requires societal
change and healing in community
1 Institutionalized oppression
2 Personally-mediated oppression or micro-aggressions
3 Internalized oppression
Teamnofearorg
Manifestations of Societal Oppression
Institutionalized Racism
Micro-aggressions
Internalized Racism
StressCumulative Effects
COGNITIVE BEHAVIORAL
EMOTIONAL NEURO PHYSIOLOGICAL
STRESS
Complex Societal Trauma (CST)Total Negative Health Impact over Generations
Societal Oppression
Familial Trauma
Societal Trauma
Complex Societal Trauma
copy Elizabeth Rocco MD
Intergenerational TransmissionHow is CST passed down to our children
1 Yehuda R et al (2015) ldquoHolocaust Exposure Induced Intergenerational Effects on FKBP5 MethylationrdquoBiol Psychiatry Aug 12 httpwwwncbinlmnihgovpubmed26410355B
2 Buss C et al (2011) ldquoMaternal pregnancy-specific anxiety is associated with child executive function at 6-9 years agerdquo Stress Nov14(6)665-76 httpwwwncbinlmnihgovpubmed21995526
3 Shankardass K et al (2014) ldquoParental stress increases body mass index trajectory in preadolescentsrdquoPediatr Obes Dec9(6)435-42 httpwwwncbinlmnihgovpubmed24311567
Complex Societal Trauma
is Toxic to the Developing Brain
Pat Levitt developmental neuroscientist and Dr Jack
Shonkoff part of the National Scientific Council on
the Developing Child
ACE (Adverse Childhood Experience) Study
Childhood neglect abuse and household dysfunction impacts health through out life
Vincent J Felitti et al (1998) ldquoRelationship of Childhood Abuse and Household Dysfunction to Many of the Leading Causes of Death in Adults
The Adverse Childhood Experiences (ACE) Studyrdquo May Volume 14 Issue 4 Pages 245ndash
258 httpsacestoohighcom
Healing Complex Societal Trauma
Social Engagement Ventral Vagal Complex
Reach for Help Ventral Vagal FEAR
Fight or FlightSympathetic
FEAR
FEAR
Freeze Collapse Dorsal Vagal
Pre-frontal CortexThe Voice of Reason
Human Healing and Evolution through Self-Awareness Embodiment Empowerment and Connection
Mindfulness Breath work Martial Arts Exercise Yoga Singing Dancing
Acupuncture Massage ReikiCommunity Groups Animals Church Nature
Final Listening Practice and Closing Circle
Bibliography
bull Special Acknowledgement of Demie Stathoplos MSW and Bonnie Cohen MD who collaborated with Elizabeth Rocco MD on the IM4US August 2015 presentation ldquoListening to Each Other Healing the Negative Health Impacts of Racism Poverty and Trauma through Human Connectionrdquo
bull Special Acknowledgement of Karen Burt MD who collaborated with Elizabeth Rocco MD and Karen Ekwueme MD on the IM4US August 2016 presentation ldquoListening to Ourselves and Each Other Healing the Negative Health Impact of Racism Poverty Sexism and Traumardquo These bibliographies are included below
bull [1]Wen Patricia (2010) ldquoA legacy of unintended side effectsrdquo Boston Globe December 12 httpwwwbostoncomnewslocalmassachusettsarticles20101212with_ssi_program_a_legcy_of_unintended_side_effects
bull [2]CCHR International (2014) [Online] Number of Children amp Adolescents Taking Psychiatric Drugs in the US Aprilwwwcchrintorgpsychiatric-drugschildren-on-psychiatric-drugs
bull [3]Whitaker R (2010) Anatomy of an Epidemic Magic Bullets Psychiatric Drugs and the Astonishing Rise of Mental Illness in America Crown Publishing Company httprobertwhitakerorgrobertwhitakerorgAnatomy20of20an20Epidemichtml
bull [3]CDC (2013) [Online] MMRW Mental Health Surveillance Among Children mdash United States 2005ndash2011 Supplements May 17 62(02)1-35 httpwwwcdcgovmmwrpreviewmmwrhtmlsu6202a1htm
bull [4]Patricia N Pastor PhD Cynthia A Reuben MA Catherine R Duran BS and LaJeana D Hawkins MPH CHES (2015) [Online] CDC NCHS Data Brief Association Between Diagnosed ADHD and Selected Characteristics Among Children Aged 4ndash17 Years United States 2011ndash2013 May Number 201 httpwwwcdcgovnchsdatadatabriefsdb201htm
bull [5]Mental Health America (2014) Parity or Disparity The State of Mental Health in America 2015 NovwwwmentalhealthamericanetsitesdefaultfilesParity20or20Disparity20201520Reportpdf
bull [6]Bruce S Jonas ScM PhD Qiuping Gu MD PhD and Juan R Albertorio-Diaz MA (2013) [Online] CDC NCHS Data Brief Psychotropic Medication Use Among Adolescents United States 2005ndash2010 Dec Number 135httpwwwcdcgovnchsdatadatabriefsdb135htm
bull [7] C Buss EP Davis CJ Hobel and CA Sandman (2011) Maternal pregnancy-specific anxiety is associated with child executive function at 6ndash9 years age Stress Nov 14(6)665-676
bull [8] Council for Evidence-Based Psychiatry (UK) Web presentation ldquoUnrecognized Factsrdquo Authors James Davies Peter C Goetzsche Peter Kinderman Joanna Moncrieff Phillip Thomas Sami Timimi John Sandwich Melanie Davis Luke Montague httpcepukorgunrecognised-facts
bull [9] Johnstone Lucy (2015) A Straight Talking Introduction to Psychiatric DiagnosisPCCS Books 1st edition (February 3 2015)
bull [10] Brewin CR Andrews B Valentine JD (2000) ldquoMeta-analysis of risk factors for posttraumatic stress disorder in trauma-exposed adultsrdquo J Consult Clin Psychol2000 Oct68(5)748-66 httpwwwncbinlmnihgovpubmed11068961
bull [11] Williams Monica T (2013) ldquoCan Racism Cause PTSD Implications for DSM-5rdquoPsychology Today May 20 httpswwwpsychologytodaycomblogculturally-speaking201305can-racism-cause-ptsd-implications-dsm-5
Bibliography
bull [12] Yuan Chengmei et al (2011) ldquoProtective factors for posttraumatic stress disorder symptoms in a prospective study of police officersrdquo Nov 23httpwwwncbinlmnihgovpmcarticlesPMC3071439
bull [13] Chou Tina BA Anu Asnaani MA and Stefan G Hofmann PhD (2012) ldquoPerception of Racial Discrimination and Psychopathology Across Three US Ethnic Minority Groupsrdquo APA PsychNET Jan httpwwwncbinlmnihgovpmcarticlesPMC3505377
bull [14] Watson Laurel B Jacob M Marszalek Franco Dispenza and Christopher M Davids 2015 Understanding the Relationships Among White and African American Womenrsquos Sexual Objectification Experiences Physical Safety Anxiety and Psychological Distress Sex Roles 72 (34) 91-104
bull [15] Holland Julie (2015) ldquoMedicating Womenrsquos Feelingsrdquo New York TimesOpinion Feb 28 httpmobilenytimescom20150301opinionsundaymedicating-womens-feelingshtmlreferreramp_r=1
bull [16] Solinas M Thiriet N El Rawas R Lardeux V and Jaber M (2009) ldquoEnvironmental Enrichment During Early Stages of Life Reduces the Behavioral Neurochemical and Molecular Effects of Cocainerdquo Neuropsychopharmacology 34 1102ndash1111
bull [17] Hari Johann Chasing The Scream The First and Last Days of the War on Drugs Bloomsbury USA (January 20 2015)bull [18] Hughes Caitlin Elizabeth and Alex Stevens (2010) ldquoWhat Can We Learn From The Portuguese Decriminalization of Illicit
Drugsrdquo British Journal of Criminology July 21 httpbjcoxfordjournalsorgcontent506999abstractbull [19] Fournier Jay C et al (2009) ldquoAntidepressant Drug Effects and Depression Severityrdquo JAMA January
6th httpjamajamanetworkcomarticleaspxarticleid=185157[20] Currie J Stabile M Jones L (2013) Do Stimulant Medications Improve Educational and Behavioral Outcomes for Children with ADHD NBER Working Paper No 19105
bull [21] Mora-Ripoli R Organizacioacuten Mundial de la Risa Barcelona Spain ldquoThe therapeutic value of laughter in medicinerdquo Altern Ther Health Med 2010 Nov-Dec16(6)56-64 httpwwwncbinlmnihgovpubmed21280463
bull [22] Gracanin Asmir Lauren M Bylsma and Ad J J M Vingerhoets (2014) ldquoIs Crying a Self-Stoothing Behaviorrdquo Frontiers in Psychology May 28httpwwwncbinlmnihgovpmcarticlesPMC4035568
bull [23] Trimble Michael (2010) ldquoI Cry Therefore I Amrdquo New York Times Nov 10 httpwwwnytimescom20121111opinionsundayi-cry-therefore-i-amhtmlemc=eta1amp_r=0
bull [24]Gallup Andrew C et al (2007) ldquoYawning as a brain cooling mechanism Nasal breathing and forehead cooling diminish the incidence of contagious yawningrdquo httpwwwepjournalnetarticlesyawning-as-a-brain-cooling-mechanism-nasal-breathing-and-forehead-cooling-diminish-the-incidence-of-contagious-yawning
bull [25]Sharat Gupta and Shallu Mittal Int (2013) Yawning and its physiological significance Intl J Appl Basic Med Res Jan-Jun 3(1) 11ndash15
bull [26] Stephens R Atkins J Kingston A (2009) ldquoSwearing As a Response to Painrdquo NeuroReport Aug 5 httpwwwncbinlmnihgovpubmed19590391
bull [27]Morelli SA Lieberman MD(2013) rdquoThe role of automaticity and attention in neural processes underlying empathy for happiness sadness and anxietyrdquo Front Hum Neurosci May 87160
Bibliography
bull [1] Committee on Psychosocial Aspects of Child and Family Health Committee on Early Childhood Adoption and Dependent Care andSection on Developmental and Behavioral Pediatrics Andrew S Garner Jack P Shonkoff et al (2012) ldquoEarly Childhood Adversity Toxic Stress and the Role of the Pediatrician Translating Developmental Science Into Lifelong Healthrdquo Pediatrics January VOLUME 129 ISSUE 1 From the American Academy of Pediatrics Policy Statementhttppediatricsaappublicationsorgcontent1291e224fullref-23
bull [2] COUNCIL ON COMMUNITY PEDIATRICS Benjamin A Gitterman et al (2016) ldquoPoverty and Child Health in the United Statesrdquo Pediatrics March From the American Academy of Pediatrics Policy Statement Published Online March 09American Academy of Pediatricshttppediatricsaappublicationsorgcontentearly20160307peds2016-0339info
bull [3] Paul W Newacheck et al (2003) ldquoDisparities in Adolescent Health and Health Care Does Socioeconomic Status Matterrdquo Health ServRes Oct 38(5) 1235ndash1252 httpwwwncbinlmnihgovpmcarticlesPMC1360944
bull [4] Larson et al (2007) ldquoPoverty during pregnancy Its effects on child health outcomesrdquo Paediatr Child Health 2007 Oct 12(8) 673ndash677 httpwwwncbinlmnihgovpmcarticlesPMC2528810
bull [5] Lara J Akinbami et al (2012) ldquoTrends in Asthma Prevalence Health Care Use and Mortality in the United States 2001ndash2010rdquo NCHS Data Brief No 94 May httpwwwcdcgovnchsproductsdatabriefsdb94htm
bull [6] Cynthia L Ogden et al (2010) ldquoObesity and Socioeconomic Status in Children and Adolescents United States 2005-2008rdquoNCHS Data Brief No 51 Decemberhttpwwwcdcgovnchsproductsdatabriefsdb51htm
bull [7] Shonkoff JP et al Committee on Psychosocial Aspects of Child and Family Health Committee on Early Childhood Adoption and Dependent Care Section on Developmental and Behavioral Pediatrics rdquoThe lifelong effects of early childhood adversity and toxicstressrdquo Pediatrics 2012129(1) wwwpediatricsorgcgicontentfull1291e232
bull [8] Virginia A Rauh et alldquoHousing and HealthIntersection of Poverty and Environmental Exposuresrdquo (2008) Annals of the New York Academy of Sciences Volume 1136 Reducing the Impact of Poverty on Health and Human Development Scientific Approaches pages 276ndash288 June httponlinelibrarywileycomdoi101196annals1425032full
bull [9] Yehuda R et al (2015) ldquoHolocaust Exposure Induced Intergenerational Effects on FKBP5 MethylationrdquoBiol Psychiatry Aug 12 httpwwwncbinlmnihgovpubmed26410355
bull [10] Buss C et al (2011) ldquoMaternal pregnancy-specific anxiety is associated with child executive function at 6-9 years agerdquoStress Nov14(6)665-76 httpwwwncbinlmnihgovpubmed21995526
bull 11] Shankardass K et al (2014) ldquoParental stress increases body mass index trajectory in pre-adolescentsrdquoPediatr Obes Dec9(6)435-42 httpwwwncbinlmnihgovpubmed24311567
bull [12] Vincent J Felitti et al (1998) ldquoRelationship of Childhood Abuse and Household Dysfunction to Many of the Leading Causes of Death in Adults The Adverse Childhood Experiences (ACE) Studyrdquo May Volume 14 Issue 4 Pages 245ndash258 httpsacestoohighcom
bull [13]Jones CP Levels of Racism a Theoretic Framework and the Gardenerrsquos Tale Am J Public Health 200090(8) 1212-1215bull [14]Dion KL The Social Psycology of Perceived Perjudice and Discrimination Canadian Psychology (2002)431 pp 1-10bull [15]Sue D W Bucceri J Lin AI Nadal K L and Torino J C Racial Microaggressions and the Asian American experience APA (2007) Vol
13 No 1 pp 72-81bull [16]James S A (School of Public Health U of North Carolina Chapel Hill NC 27514) D S Strogatz S B Wing and D L Ramsey
Socioeconomic status John Henryism and hypertension in blacks and whites Am J Epidemiol 1987 126664ndash73bull [17]httpwwwapaorgpioemaresourcesethnicity-healthindexaspxbull [18]Porges SW Clinical Insights from the Polyvagal Theory The Transformative Power of Feeling Safe (Norton Series on Interpersonal
Neurobiology) W W Norton Apr 7 2014 - Psychology - 288 pagesbull [19]The Polyvagal Theory (Porges SW Social Connectedness as a Biological Imperative Understanding Trauma Through the Lens of
thePolyvagal Theory presentation 82015)bull [20]McEwen BS Allostasis and allostatic load implications for neuropsychopharmacologyNeuropsychopharmacology 2000
Feb22(2)108-24bull [21] McEwen BS adaptation and disease Allostasis and allostatic load Ann N Y Acad Sci 1998 May 184033-44bull [22] Arline T Geronimus ScD Margaret Hicken MPH Danya Keene MAT and John Bound PhD Weatheringrdquo and Age Patterns of
Allostatic Load Scores Among Blacks and Whites in the United States Am J Public Health 2006 May 96(5) 826ndash833bull [22]Stephen Porges PhD Polyvagal Perspective Biological Psychology 2007 Feb 74(2) 116ndash143 Published online 2006 Oct 16 bull [23]Stephen W Porges PhD The Polyvagal Theory Neurophysiological Foundations of Emotions Attachment Communication and
Self-regulation WWNorton and Company Inc 2011bull [24]Maggie Phillips PhD Reversing Chronic Pain North Atlantic Books 2007bull [25]Peter Levine PhD Waking the Tiger North Atlantic Books 1997bull [26]Bessel VanderKolk MD The Body Keeps the Score Viking Penguin 2014bullAcknowledgmentsbull Group Medical Visits and Group Facilitation Jeff Geller MDbull Re-evaluation Counseling Community bull Insight Meditation Communitybull Biodynamic Osteopathy Communitybull Learning To Breathe Mindfulness Training for Adolescents 2015 Patricia C Broderick PhD bull Stanford Chronic Disease Self Management Program Training 2014 Kate Lorig MPH RNbull Motivational Interviewing Training 2015 Steven Berg-Smithbull Centering Pregnancy Training 2014 Centering Healthcare Institutebull Motivating Change in Groups Training 2013 Kaiser Permanente Oakland Cabull Group Facilitation Training Sara Fisk PhD Community at Work San Francisco Cabull Tribes Training 2013 Center for Human Developmentbull Cultural Humility Training 2016 Melanie Tervalon MD
Bibliography
Intermediate Steps to Listening Session Handout
bull Step 1 Connect with yourself body mind and emotions
bull Step 2 Hold a non-judgmental space to be seen and heard
bull Step 3 See the speaker and anyone referenced as able to manifest their true human nature and evolve using inherent healing abilities
bull Step 4 Listen to the speaker in a deep connected way sending the message that their thinking feelings and being matters to you
bull Step 5 Encourage the speaker to express feelings or thoughts describe body sensations or share a story relevant to the feelings at hand
bull Step 6 Validate intense emotional expression and release such as crying laughing shaking yawning sweating as a sign of healing
bull Step 7 Remind the speaker of their underlying goodness intelligence strength and caring and your confidence in their ability to heal and manifest their true human nature
copy Elizabeth Rocco MD
Contact Information
bull Elizabeth Rocco MD -egroccogmailcom
bull Karen Ekwueme MD-impactdoc1gmailcom
The Reality
Facing the Impact of Racism Poverty and Sexism
Behavioral Learning and Mental Health Diagnoses in Children
In New England
63 of Children
[1]Wen Patricia (2010) ldquoA legacy of unintended side effectsrdquo Boston Globe December 12
Use of Psychiatric Drugs in Children
Children on Psychiatric Drugs in the US in 2013
bull 0-1 Years 2748042-3 Years 3707784-5 Years 500948
bull 6-12 Years 413034013-17 Years 3617593
bull 8389034 children on psychiatric drugsbull [2]CCHR International (2014) [Online] Number of Children amp Adolescents Taking Psychiatric Drugs in the US
Aprilwwwcchrintorgpsychiatric-drugschildren-on-psychiatric-drugs
Facing the Impact of Trauma
An Alternative Model
Listening Practice
bull Turn to the person next to you
bull The person on the left will be the listener first and the other the speaker
bull Listener will listen while the speaker shares
bull Switch when time is called
When we define the effects of oppression as someonersquos ldquoillnessrdquo and ignore the root causes we obscure our path
forward in healing our communities
What if we reframed ldquochronic illnessrdquo as a societal struggle that requires societal
change and healing in community
1 Institutionalized oppression
2 Personally-mediated oppression or micro-aggressions
3 Internalized oppression
Teamnofearorg
Manifestations of Societal Oppression
Institutionalized Racism
Micro-aggressions
Internalized Racism
StressCumulative Effects
COGNITIVE BEHAVIORAL
EMOTIONAL NEURO PHYSIOLOGICAL
STRESS
Complex Societal Trauma (CST)Total Negative Health Impact over Generations
Societal Oppression
Familial Trauma
Societal Trauma
Complex Societal Trauma
copy Elizabeth Rocco MD
Intergenerational TransmissionHow is CST passed down to our children
1 Yehuda R et al (2015) ldquoHolocaust Exposure Induced Intergenerational Effects on FKBP5 MethylationrdquoBiol Psychiatry Aug 12 httpwwwncbinlmnihgovpubmed26410355B
2 Buss C et al (2011) ldquoMaternal pregnancy-specific anxiety is associated with child executive function at 6-9 years agerdquo Stress Nov14(6)665-76 httpwwwncbinlmnihgovpubmed21995526
3 Shankardass K et al (2014) ldquoParental stress increases body mass index trajectory in preadolescentsrdquoPediatr Obes Dec9(6)435-42 httpwwwncbinlmnihgovpubmed24311567
Complex Societal Trauma
is Toxic to the Developing Brain
Pat Levitt developmental neuroscientist and Dr Jack
Shonkoff part of the National Scientific Council on
the Developing Child
ACE (Adverse Childhood Experience) Study
Childhood neglect abuse and household dysfunction impacts health through out life
Vincent J Felitti et al (1998) ldquoRelationship of Childhood Abuse and Household Dysfunction to Many of the Leading Causes of Death in Adults
The Adverse Childhood Experiences (ACE) Studyrdquo May Volume 14 Issue 4 Pages 245ndash
258 httpsacestoohighcom
Healing Complex Societal Trauma
Social Engagement Ventral Vagal Complex
Reach for Help Ventral Vagal FEAR
Fight or FlightSympathetic
FEAR
FEAR
Freeze Collapse Dorsal Vagal
Pre-frontal CortexThe Voice of Reason
Human Healing and Evolution through Self-Awareness Embodiment Empowerment and Connection
Mindfulness Breath work Martial Arts Exercise Yoga Singing Dancing
Acupuncture Massage ReikiCommunity Groups Animals Church Nature
Final Listening Practice and Closing Circle
Bibliography
bull Special Acknowledgement of Demie Stathoplos MSW and Bonnie Cohen MD who collaborated with Elizabeth Rocco MD on the IM4US August 2015 presentation ldquoListening to Each Other Healing the Negative Health Impacts of Racism Poverty and Trauma through Human Connectionrdquo
bull Special Acknowledgement of Karen Burt MD who collaborated with Elizabeth Rocco MD and Karen Ekwueme MD on the IM4US August 2016 presentation ldquoListening to Ourselves and Each Other Healing the Negative Health Impact of Racism Poverty Sexism and Traumardquo These bibliographies are included below
bull [1]Wen Patricia (2010) ldquoA legacy of unintended side effectsrdquo Boston Globe December 12 httpwwwbostoncomnewslocalmassachusettsarticles20101212with_ssi_program_a_legcy_of_unintended_side_effects
bull [2]CCHR International (2014) [Online] Number of Children amp Adolescents Taking Psychiatric Drugs in the US Aprilwwwcchrintorgpsychiatric-drugschildren-on-psychiatric-drugs
bull [3]Whitaker R (2010) Anatomy of an Epidemic Magic Bullets Psychiatric Drugs and the Astonishing Rise of Mental Illness in America Crown Publishing Company httprobertwhitakerorgrobertwhitakerorgAnatomy20of20an20Epidemichtml
bull [3]CDC (2013) [Online] MMRW Mental Health Surveillance Among Children mdash United States 2005ndash2011 Supplements May 17 62(02)1-35 httpwwwcdcgovmmwrpreviewmmwrhtmlsu6202a1htm
bull [4]Patricia N Pastor PhD Cynthia A Reuben MA Catherine R Duran BS and LaJeana D Hawkins MPH CHES (2015) [Online] CDC NCHS Data Brief Association Between Diagnosed ADHD and Selected Characteristics Among Children Aged 4ndash17 Years United States 2011ndash2013 May Number 201 httpwwwcdcgovnchsdatadatabriefsdb201htm
bull [5]Mental Health America (2014) Parity or Disparity The State of Mental Health in America 2015 NovwwwmentalhealthamericanetsitesdefaultfilesParity20or20Disparity20201520Reportpdf
bull [6]Bruce S Jonas ScM PhD Qiuping Gu MD PhD and Juan R Albertorio-Diaz MA (2013) [Online] CDC NCHS Data Brief Psychotropic Medication Use Among Adolescents United States 2005ndash2010 Dec Number 135httpwwwcdcgovnchsdatadatabriefsdb135htm
bull [7] C Buss EP Davis CJ Hobel and CA Sandman (2011) Maternal pregnancy-specific anxiety is associated with child executive function at 6ndash9 years age Stress Nov 14(6)665-676
bull [8] Council for Evidence-Based Psychiatry (UK) Web presentation ldquoUnrecognized Factsrdquo Authors James Davies Peter C Goetzsche Peter Kinderman Joanna Moncrieff Phillip Thomas Sami Timimi John Sandwich Melanie Davis Luke Montague httpcepukorgunrecognised-facts
bull [9] Johnstone Lucy (2015) A Straight Talking Introduction to Psychiatric DiagnosisPCCS Books 1st edition (February 3 2015)
bull [10] Brewin CR Andrews B Valentine JD (2000) ldquoMeta-analysis of risk factors for posttraumatic stress disorder in trauma-exposed adultsrdquo J Consult Clin Psychol2000 Oct68(5)748-66 httpwwwncbinlmnihgovpubmed11068961
bull [11] Williams Monica T (2013) ldquoCan Racism Cause PTSD Implications for DSM-5rdquoPsychology Today May 20 httpswwwpsychologytodaycomblogculturally-speaking201305can-racism-cause-ptsd-implications-dsm-5
Bibliography
bull [12] Yuan Chengmei et al (2011) ldquoProtective factors for posttraumatic stress disorder symptoms in a prospective study of police officersrdquo Nov 23httpwwwncbinlmnihgovpmcarticlesPMC3071439
bull [13] Chou Tina BA Anu Asnaani MA and Stefan G Hofmann PhD (2012) ldquoPerception of Racial Discrimination and Psychopathology Across Three US Ethnic Minority Groupsrdquo APA PsychNET Jan httpwwwncbinlmnihgovpmcarticlesPMC3505377
bull [14] Watson Laurel B Jacob M Marszalek Franco Dispenza and Christopher M Davids 2015 Understanding the Relationships Among White and African American Womenrsquos Sexual Objectification Experiences Physical Safety Anxiety and Psychological Distress Sex Roles 72 (34) 91-104
bull [15] Holland Julie (2015) ldquoMedicating Womenrsquos Feelingsrdquo New York TimesOpinion Feb 28 httpmobilenytimescom20150301opinionsundaymedicating-womens-feelingshtmlreferreramp_r=1
bull [16] Solinas M Thiriet N El Rawas R Lardeux V and Jaber M (2009) ldquoEnvironmental Enrichment During Early Stages of Life Reduces the Behavioral Neurochemical and Molecular Effects of Cocainerdquo Neuropsychopharmacology 34 1102ndash1111
bull [17] Hari Johann Chasing The Scream The First and Last Days of the War on Drugs Bloomsbury USA (January 20 2015)bull [18] Hughes Caitlin Elizabeth and Alex Stevens (2010) ldquoWhat Can We Learn From The Portuguese Decriminalization of Illicit
Drugsrdquo British Journal of Criminology July 21 httpbjcoxfordjournalsorgcontent506999abstractbull [19] Fournier Jay C et al (2009) ldquoAntidepressant Drug Effects and Depression Severityrdquo JAMA January
6th httpjamajamanetworkcomarticleaspxarticleid=185157[20] Currie J Stabile M Jones L (2013) Do Stimulant Medications Improve Educational and Behavioral Outcomes for Children with ADHD NBER Working Paper No 19105
bull [21] Mora-Ripoli R Organizacioacuten Mundial de la Risa Barcelona Spain ldquoThe therapeutic value of laughter in medicinerdquo Altern Ther Health Med 2010 Nov-Dec16(6)56-64 httpwwwncbinlmnihgovpubmed21280463
bull [22] Gracanin Asmir Lauren M Bylsma and Ad J J M Vingerhoets (2014) ldquoIs Crying a Self-Stoothing Behaviorrdquo Frontiers in Psychology May 28httpwwwncbinlmnihgovpmcarticlesPMC4035568
bull [23] Trimble Michael (2010) ldquoI Cry Therefore I Amrdquo New York Times Nov 10 httpwwwnytimescom20121111opinionsundayi-cry-therefore-i-amhtmlemc=eta1amp_r=0
bull [24]Gallup Andrew C et al (2007) ldquoYawning as a brain cooling mechanism Nasal breathing and forehead cooling diminish the incidence of contagious yawningrdquo httpwwwepjournalnetarticlesyawning-as-a-brain-cooling-mechanism-nasal-breathing-and-forehead-cooling-diminish-the-incidence-of-contagious-yawning
bull [25]Sharat Gupta and Shallu Mittal Int (2013) Yawning and its physiological significance Intl J Appl Basic Med Res Jan-Jun 3(1) 11ndash15
bull [26] Stephens R Atkins J Kingston A (2009) ldquoSwearing As a Response to Painrdquo NeuroReport Aug 5 httpwwwncbinlmnihgovpubmed19590391
bull [27]Morelli SA Lieberman MD(2013) rdquoThe role of automaticity and attention in neural processes underlying empathy for happiness sadness and anxietyrdquo Front Hum Neurosci May 87160
Bibliography
bull [1] Committee on Psychosocial Aspects of Child and Family Health Committee on Early Childhood Adoption and Dependent Care andSection on Developmental and Behavioral Pediatrics Andrew S Garner Jack P Shonkoff et al (2012) ldquoEarly Childhood Adversity Toxic Stress and the Role of the Pediatrician Translating Developmental Science Into Lifelong Healthrdquo Pediatrics January VOLUME 129 ISSUE 1 From the American Academy of Pediatrics Policy Statementhttppediatricsaappublicationsorgcontent1291e224fullref-23
bull [2] COUNCIL ON COMMUNITY PEDIATRICS Benjamin A Gitterman et al (2016) ldquoPoverty and Child Health in the United Statesrdquo Pediatrics March From the American Academy of Pediatrics Policy Statement Published Online March 09American Academy of Pediatricshttppediatricsaappublicationsorgcontentearly20160307peds2016-0339info
bull [3] Paul W Newacheck et al (2003) ldquoDisparities in Adolescent Health and Health Care Does Socioeconomic Status Matterrdquo Health ServRes Oct 38(5) 1235ndash1252 httpwwwncbinlmnihgovpmcarticlesPMC1360944
bull [4] Larson et al (2007) ldquoPoverty during pregnancy Its effects on child health outcomesrdquo Paediatr Child Health 2007 Oct 12(8) 673ndash677 httpwwwncbinlmnihgovpmcarticlesPMC2528810
bull [5] Lara J Akinbami et al (2012) ldquoTrends in Asthma Prevalence Health Care Use and Mortality in the United States 2001ndash2010rdquo NCHS Data Brief No 94 May httpwwwcdcgovnchsproductsdatabriefsdb94htm
bull [6] Cynthia L Ogden et al (2010) ldquoObesity and Socioeconomic Status in Children and Adolescents United States 2005-2008rdquoNCHS Data Brief No 51 Decemberhttpwwwcdcgovnchsproductsdatabriefsdb51htm
bull [7] Shonkoff JP et al Committee on Psychosocial Aspects of Child and Family Health Committee on Early Childhood Adoption and Dependent Care Section on Developmental and Behavioral Pediatrics rdquoThe lifelong effects of early childhood adversity and toxicstressrdquo Pediatrics 2012129(1) wwwpediatricsorgcgicontentfull1291e232
bull [8] Virginia A Rauh et alldquoHousing and HealthIntersection of Poverty and Environmental Exposuresrdquo (2008) Annals of the New York Academy of Sciences Volume 1136 Reducing the Impact of Poverty on Health and Human Development Scientific Approaches pages 276ndash288 June httponlinelibrarywileycomdoi101196annals1425032full
bull [9] Yehuda R et al (2015) ldquoHolocaust Exposure Induced Intergenerational Effects on FKBP5 MethylationrdquoBiol Psychiatry Aug 12 httpwwwncbinlmnihgovpubmed26410355
bull [10] Buss C et al (2011) ldquoMaternal pregnancy-specific anxiety is associated with child executive function at 6-9 years agerdquoStress Nov14(6)665-76 httpwwwncbinlmnihgovpubmed21995526
bull 11] Shankardass K et al (2014) ldquoParental stress increases body mass index trajectory in pre-adolescentsrdquoPediatr Obes Dec9(6)435-42 httpwwwncbinlmnihgovpubmed24311567
bull [12] Vincent J Felitti et al (1998) ldquoRelationship of Childhood Abuse and Household Dysfunction to Many of the Leading Causes of Death in Adults The Adverse Childhood Experiences (ACE) Studyrdquo May Volume 14 Issue 4 Pages 245ndash258 httpsacestoohighcom
bull [13]Jones CP Levels of Racism a Theoretic Framework and the Gardenerrsquos Tale Am J Public Health 200090(8) 1212-1215bull [14]Dion KL The Social Psycology of Perceived Perjudice and Discrimination Canadian Psychology (2002)431 pp 1-10bull [15]Sue D W Bucceri J Lin AI Nadal K L and Torino J C Racial Microaggressions and the Asian American experience APA (2007) Vol
13 No 1 pp 72-81bull [16]James S A (School of Public Health U of North Carolina Chapel Hill NC 27514) D S Strogatz S B Wing and D L Ramsey
Socioeconomic status John Henryism and hypertension in blacks and whites Am J Epidemiol 1987 126664ndash73bull [17]httpwwwapaorgpioemaresourcesethnicity-healthindexaspxbull [18]Porges SW Clinical Insights from the Polyvagal Theory The Transformative Power of Feeling Safe (Norton Series on Interpersonal
Neurobiology) W W Norton Apr 7 2014 - Psychology - 288 pagesbull [19]The Polyvagal Theory (Porges SW Social Connectedness as a Biological Imperative Understanding Trauma Through the Lens of
thePolyvagal Theory presentation 82015)bull [20]McEwen BS Allostasis and allostatic load implications for neuropsychopharmacologyNeuropsychopharmacology 2000
Feb22(2)108-24bull [21] McEwen BS adaptation and disease Allostasis and allostatic load Ann N Y Acad Sci 1998 May 184033-44bull [22] Arline T Geronimus ScD Margaret Hicken MPH Danya Keene MAT and John Bound PhD Weatheringrdquo and Age Patterns of
Allostatic Load Scores Among Blacks and Whites in the United States Am J Public Health 2006 May 96(5) 826ndash833bull [22]Stephen Porges PhD Polyvagal Perspective Biological Psychology 2007 Feb 74(2) 116ndash143 Published online 2006 Oct 16 bull [23]Stephen W Porges PhD The Polyvagal Theory Neurophysiological Foundations of Emotions Attachment Communication and
Self-regulation WWNorton and Company Inc 2011bull [24]Maggie Phillips PhD Reversing Chronic Pain North Atlantic Books 2007bull [25]Peter Levine PhD Waking the Tiger North Atlantic Books 1997bull [26]Bessel VanderKolk MD The Body Keeps the Score Viking Penguin 2014bullAcknowledgmentsbull Group Medical Visits and Group Facilitation Jeff Geller MDbull Re-evaluation Counseling Community bull Insight Meditation Communitybull Biodynamic Osteopathy Communitybull Learning To Breathe Mindfulness Training for Adolescents 2015 Patricia C Broderick PhD bull Stanford Chronic Disease Self Management Program Training 2014 Kate Lorig MPH RNbull Motivational Interviewing Training 2015 Steven Berg-Smithbull Centering Pregnancy Training 2014 Centering Healthcare Institutebull Motivating Change in Groups Training 2013 Kaiser Permanente Oakland Cabull Group Facilitation Training Sara Fisk PhD Community at Work San Francisco Cabull Tribes Training 2013 Center for Human Developmentbull Cultural Humility Training 2016 Melanie Tervalon MD
Bibliography
Intermediate Steps to Listening Session Handout
bull Step 1 Connect with yourself body mind and emotions
bull Step 2 Hold a non-judgmental space to be seen and heard
bull Step 3 See the speaker and anyone referenced as able to manifest their true human nature and evolve using inherent healing abilities
bull Step 4 Listen to the speaker in a deep connected way sending the message that their thinking feelings and being matters to you
bull Step 5 Encourage the speaker to express feelings or thoughts describe body sensations or share a story relevant to the feelings at hand
bull Step 6 Validate intense emotional expression and release such as crying laughing shaking yawning sweating as a sign of healing
bull Step 7 Remind the speaker of their underlying goodness intelligence strength and caring and your confidence in their ability to heal and manifest their true human nature
copy Elizabeth Rocco MD
Contact Information
bull Elizabeth Rocco MD -egroccogmailcom
bull Karen Ekwueme MD-impactdoc1gmailcom
Facing the Impact of Racism Poverty and Sexism
Behavioral Learning and Mental Health Diagnoses in Children
In New England
63 of Children
[1]Wen Patricia (2010) ldquoA legacy of unintended side effectsrdquo Boston Globe December 12
Use of Psychiatric Drugs in Children
Children on Psychiatric Drugs in the US in 2013
bull 0-1 Years 2748042-3 Years 3707784-5 Years 500948
bull 6-12 Years 413034013-17 Years 3617593
bull 8389034 children on psychiatric drugsbull [2]CCHR International (2014) [Online] Number of Children amp Adolescents Taking Psychiatric Drugs in the US
Aprilwwwcchrintorgpsychiatric-drugschildren-on-psychiatric-drugs
Facing the Impact of Trauma
An Alternative Model
Listening Practice
bull Turn to the person next to you
bull The person on the left will be the listener first and the other the speaker
bull Listener will listen while the speaker shares
bull Switch when time is called
When we define the effects of oppression as someonersquos ldquoillnessrdquo and ignore the root causes we obscure our path
forward in healing our communities
What if we reframed ldquochronic illnessrdquo as a societal struggle that requires societal
change and healing in community
1 Institutionalized oppression
2 Personally-mediated oppression or micro-aggressions
3 Internalized oppression
Teamnofearorg
Manifestations of Societal Oppression
Institutionalized Racism
Micro-aggressions
Internalized Racism
StressCumulative Effects
COGNITIVE BEHAVIORAL
EMOTIONAL NEURO PHYSIOLOGICAL
STRESS
Complex Societal Trauma (CST)Total Negative Health Impact over Generations
Societal Oppression
Familial Trauma
Societal Trauma
Complex Societal Trauma
copy Elizabeth Rocco MD
Intergenerational TransmissionHow is CST passed down to our children
1 Yehuda R et al (2015) ldquoHolocaust Exposure Induced Intergenerational Effects on FKBP5 MethylationrdquoBiol Psychiatry Aug 12 httpwwwncbinlmnihgovpubmed26410355B
2 Buss C et al (2011) ldquoMaternal pregnancy-specific anxiety is associated with child executive function at 6-9 years agerdquo Stress Nov14(6)665-76 httpwwwncbinlmnihgovpubmed21995526
3 Shankardass K et al (2014) ldquoParental stress increases body mass index trajectory in preadolescentsrdquoPediatr Obes Dec9(6)435-42 httpwwwncbinlmnihgovpubmed24311567
Complex Societal Trauma
is Toxic to the Developing Brain
Pat Levitt developmental neuroscientist and Dr Jack
Shonkoff part of the National Scientific Council on
the Developing Child
ACE (Adverse Childhood Experience) Study
Childhood neglect abuse and household dysfunction impacts health through out life
Vincent J Felitti et al (1998) ldquoRelationship of Childhood Abuse and Household Dysfunction to Many of the Leading Causes of Death in Adults
The Adverse Childhood Experiences (ACE) Studyrdquo May Volume 14 Issue 4 Pages 245ndash
258 httpsacestoohighcom
Healing Complex Societal Trauma
Social Engagement Ventral Vagal Complex
Reach for Help Ventral Vagal FEAR
Fight or FlightSympathetic
FEAR
FEAR
Freeze Collapse Dorsal Vagal
Pre-frontal CortexThe Voice of Reason
Human Healing and Evolution through Self-Awareness Embodiment Empowerment and Connection
Mindfulness Breath work Martial Arts Exercise Yoga Singing Dancing
Acupuncture Massage ReikiCommunity Groups Animals Church Nature
Final Listening Practice and Closing Circle
Bibliography
bull Special Acknowledgement of Demie Stathoplos MSW and Bonnie Cohen MD who collaborated with Elizabeth Rocco MD on the IM4US August 2015 presentation ldquoListening to Each Other Healing the Negative Health Impacts of Racism Poverty and Trauma through Human Connectionrdquo
bull Special Acknowledgement of Karen Burt MD who collaborated with Elizabeth Rocco MD and Karen Ekwueme MD on the IM4US August 2016 presentation ldquoListening to Ourselves and Each Other Healing the Negative Health Impact of Racism Poverty Sexism and Traumardquo These bibliographies are included below
bull [1]Wen Patricia (2010) ldquoA legacy of unintended side effectsrdquo Boston Globe December 12 httpwwwbostoncomnewslocalmassachusettsarticles20101212with_ssi_program_a_legcy_of_unintended_side_effects
bull [2]CCHR International (2014) [Online] Number of Children amp Adolescents Taking Psychiatric Drugs in the US Aprilwwwcchrintorgpsychiatric-drugschildren-on-psychiatric-drugs
bull [3]Whitaker R (2010) Anatomy of an Epidemic Magic Bullets Psychiatric Drugs and the Astonishing Rise of Mental Illness in America Crown Publishing Company httprobertwhitakerorgrobertwhitakerorgAnatomy20of20an20Epidemichtml
bull [3]CDC (2013) [Online] MMRW Mental Health Surveillance Among Children mdash United States 2005ndash2011 Supplements May 17 62(02)1-35 httpwwwcdcgovmmwrpreviewmmwrhtmlsu6202a1htm
bull [4]Patricia N Pastor PhD Cynthia A Reuben MA Catherine R Duran BS and LaJeana D Hawkins MPH CHES (2015) [Online] CDC NCHS Data Brief Association Between Diagnosed ADHD and Selected Characteristics Among Children Aged 4ndash17 Years United States 2011ndash2013 May Number 201 httpwwwcdcgovnchsdatadatabriefsdb201htm
bull [5]Mental Health America (2014) Parity or Disparity The State of Mental Health in America 2015 NovwwwmentalhealthamericanetsitesdefaultfilesParity20or20Disparity20201520Reportpdf
bull [6]Bruce S Jonas ScM PhD Qiuping Gu MD PhD and Juan R Albertorio-Diaz MA (2013) [Online] CDC NCHS Data Brief Psychotropic Medication Use Among Adolescents United States 2005ndash2010 Dec Number 135httpwwwcdcgovnchsdatadatabriefsdb135htm
bull [7] C Buss EP Davis CJ Hobel and CA Sandman (2011) Maternal pregnancy-specific anxiety is associated with child executive function at 6ndash9 years age Stress Nov 14(6)665-676
bull [8] Council for Evidence-Based Psychiatry (UK) Web presentation ldquoUnrecognized Factsrdquo Authors James Davies Peter C Goetzsche Peter Kinderman Joanna Moncrieff Phillip Thomas Sami Timimi John Sandwich Melanie Davis Luke Montague httpcepukorgunrecognised-facts
bull [9] Johnstone Lucy (2015) A Straight Talking Introduction to Psychiatric DiagnosisPCCS Books 1st edition (February 3 2015)
bull [10] Brewin CR Andrews B Valentine JD (2000) ldquoMeta-analysis of risk factors for posttraumatic stress disorder in trauma-exposed adultsrdquo J Consult Clin Psychol2000 Oct68(5)748-66 httpwwwncbinlmnihgovpubmed11068961
bull [11] Williams Monica T (2013) ldquoCan Racism Cause PTSD Implications for DSM-5rdquoPsychology Today May 20 httpswwwpsychologytodaycomblogculturally-speaking201305can-racism-cause-ptsd-implications-dsm-5
Bibliography
bull [12] Yuan Chengmei et al (2011) ldquoProtective factors for posttraumatic stress disorder symptoms in a prospective study of police officersrdquo Nov 23httpwwwncbinlmnihgovpmcarticlesPMC3071439
bull [13] Chou Tina BA Anu Asnaani MA and Stefan G Hofmann PhD (2012) ldquoPerception of Racial Discrimination and Psychopathology Across Three US Ethnic Minority Groupsrdquo APA PsychNET Jan httpwwwncbinlmnihgovpmcarticlesPMC3505377
bull [14] Watson Laurel B Jacob M Marszalek Franco Dispenza and Christopher M Davids 2015 Understanding the Relationships Among White and African American Womenrsquos Sexual Objectification Experiences Physical Safety Anxiety and Psychological Distress Sex Roles 72 (34) 91-104
bull [15] Holland Julie (2015) ldquoMedicating Womenrsquos Feelingsrdquo New York TimesOpinion Feb 28 httpmobilenytimescom20150301opinionsundaymedicating-womens-feelingshtmlreferreramp_r=1
bull [16] Solinas M Thiriet N El Rawas R Lardeux V and Jaber M (2009) ldquoEnvironmental Enrichment During Early Stages of Life Reduces the Behavioral Neurochemical and Molecular Effects of Cocainerdquo Neuropsychopharmacology 34 1102ndash1111
bull [17] Hari Johann Chasing The Scream The First and Last Days of the War on Drugs Bloomsbury USA (January 20 2015)bull [18] Hughes Caitlin Elizabeth and Alex Stevens (2010) ldquoWhat Can We Learn From The Portuguese Decriminalization of Illicit
Drugsrdquo British Journal of Criminology July 21 httpbjcoxfordjournalsorgcontent506999abstractbull [19] Fournier Jay C et al (2009) ldquoAntidepressant Drug Effects and Depression Severityrdquo JAMA January
6th httpjamajamanetworkcomarticleaspxarticleid=185157[20] Currie J Stabile M Jones L (2013) Do Stimulant Medications Improve Educational and Behavioral Outcomes for Children with ADHD NBER Working Paper No 19105
bull [21] Mora-Ripoli R Organizacioacuten Mundial de la Risa Barcelona Spain ldquoThe therapeutic value of laughter in medicinerdquo Altern Ther Health Med 2010 Nov-Dec16(6)56-64 httpwwwncbinlmnihgovpubmed21280463
bull [22] Gracanin Asmir Lauren M Bylsma and Ad J J M Vingerhoets (2014) ldquoIs Crying a Self-Stoothing Behaviorrdquo Frontiers in Psychology May 28httpwwwncbinlmnihgovpmcarticlesPMC4035568
bull [23] Trimble Michael (2010) ldquoI Cry Therefore I Amrdquo New York Times Nov 10 httpwwwnytimescom20121111opinionsundayi-cry-therefore-i-amhtmlemc=eta1amp_r=0
bull [24]Gallup Andrew C et al (2007) ldquoYawning as a brain cooling mechanism Nasal breathing and forehead cooling diminish the incidence of contagious yawningrdquo httpwwwepjournalnetarticlesyawning-as-a-brain-cooling-mechanism-nasal-breathing-and-forehead-cooling-diminish-the-incidence-of-contagious-yawning
bull [25]Sharat Gupta and Shallu Mittal Int (2013) Yawning and its physiological significance Intl J Appl Basic Med Res Jan-Jun 3(1) 11ndash15
bull [26] Stephens R Atkins J Kingston A (2009) ldquoSwearing As a Response to Painrdquo NeuroReport Aug 5 httpwwwncbinlmnihgovpubmed19590391
bull [27]Morelli SA Lieberman MD(2013) rdquoThe role of automaticity and attention in neural processes underlying empathy for happiness sadness and anxietyrdquo Front Hum Neurosci May 87160
Bibliography
bull [1] Committee on Psychosocial Aspects of Child and Family Health Committee on Early Childhood Adoption and Dependent Care andSection on Developmental and Behavioral Pediatrics Andrew S Garner Jack P Shonkoff et al (2012) ldquoEarly Childhood Adversity Toxic Stress and the Role of the Pediatrician Translating Developmental Science Into Lifelong Healthrdquo Pediatrics January VOLUME 129 ISSUE 1 From the American Academy of Pediatrics Policy Statementhttppediatricsaappublicationsorgcontent1291e224fullref-23
bull [2] COUNCIL ON COMMUNITY PEDIATRICS Benjamin A Gitterman et al (2016) ldquoPoverty and Child Health in the United Statesrdquo Pediatrics March From the American Academy of Pediatrics Policy Statement Published Online March 09American Academy of Pediatricshttppediatricsaappublicationsorgcontentearly20160307peds2016-0339info
bull [3] Paul W Newacheck et al (2003) ldquoDisparities in Adolescent Health and Health Care Does Socioeconomic Status Matterrdquo Health ServRes Oct 38(5) 1235ndash1252 httpwwwncbinlmnihgovpmcarticlesPMC1360944
bull [4] Larson et al (2007) ldquoPoverty during pregnancy Its effects on child health outcomesrdquo Paediatr Child Health 2007 Oct 12(8) 673ndash677 httpwwwncbinlmnihgovpmcarticlesPMC2528810
bull [5] Lara J Akinbami et al (2012) ldquoTrends in Asthma Prevalence Health Care Use and Mortality in the United States 2001ndash2010rdquo NCHS Data Brief No 94 May httpwwwcdcgovnchsproductsdatabriefsdb94htm
bull [6] Cynthia L Ogden et al (2010) ldquoObesity and Socioeconomic Status in Children and Adolescents United States 2005-2008rdquoNCHS Data Brief No 51 Decemberhttpwwwcdcgovnchsproductsdatabriefsdb51htm
bull [7] Shonkoff JP et al Committee on Psychosocial Aspects of Child and Family Health Committee on Early Childhood Adoption and Dependent Care Section on Developmental and Behavioral Pediatrics rdquoThe lifelong effects of early childhood adversity and toxicstressrdquo Pediatrics 2012129(1) wwwpediatricsorgcgicontentfull1291e232
bull [8] Virginia A Rauh et alldquoHousing and HealthIntersection of Poverty and Environmental Exposuresrdquo (2008) Annals of the New York Academy of Sciences Volume 1136 Reducing the Impact of Poverty on Health and Human Development Scientific Approaches pages 276ndash288 June httponlinelibrarywileycomdoi101196annals1425032full
bull [9] Yehuda R et al (2015) ldquoHolocaust Exposure Induced Intergenerational Effects on FKBP5 MethylationrdquoBiol Psychiatry Aug 12 httpwwwncbinlmnihgovpubmed26410355
bull [10] Buss C et al (2011) ldquoMaternal pregnancy-specific anxiety is associated with child executive function at 6-9 years agerdquoStress Nov14(6)665-76 httpwwwncbinlmnihgovpubmed21995526
bull 11] Shankardass K et al (2014) ldquoParental stress increases body mass index trajectory in pre-adolescentsrdquoPediatr Obes Dec9(6)435-42 httpwwwncbinlmnihgovpubmed24311567
bull [12] Vincent J Felitti et al (1998) ldquoRelationship of Childhood Abuse and Household Dysfunction to Many of the Leading Causes of Death in Adults The Adverse Childhood Experiences (ACE) Studyrdquo May Volume 14 Issue 4 Pages 245ndash258 httpsacestoohighcom
bull [13]Jones CP Levels of Racism a Theoretic Framework and the Gardenerrsquos Tale Am J Public Health 200090(8) 1212-1215bull [14]Dion KL The Social Psycology of Perceived Perjudice and Discrimination Canadian Psychology (2002)431 pp 1-10bull [15]Sue D W Bucceri J Lin AI Nadal K L and Torino J C Racial Microaggressions and the Asian American experience APA (2007) Vol
13 No 1 pp 72-81bull [16]James S A (School of Public Health U of North Carolina Chapel Hill NC 27514) D S Strogatz S B Wing and D L Ramsey
Socioeconomic status John Henryism and hypertension in blacks and whites Am J Epidemiol 1987 126664ndash73bull [17]httpwwwapaorgpioemaresourcesethnicity-healthindexaspxbull [18]Porges SW Clinical Insights from the Polyvagal Theory The Transformative Power of Feeling Safe (Norton Series on Interpersonal
Neurobiology) W W Norton Apr 7 2014 - Psychology - 288 pagesbull [19]The Polyvagal Theory (Porges SW Social Connectedness as a Biological Imperative Understanding Trauma Through the Lens of
thePolyvagal Theory presentation 82015)bull [20]McEwen BS Allostasis and allostatic load implications for neuropsychopharmacologyNeuropsychopharmacology 2000
Feb22(2)108-24bull [21] McEwen BS adaptation and disease Allostasis and allostatic load Ann N Y Acad Sci 1998 May 184033-44bull [22] Arline T Geronimus ScD Margaret Hicken MPH Danya Keene MAT and John Bound PhD Weatheringrdquo and Age Patterns of
Allostatic Load Scores Among Blacks and Whites in the United States Am J Public Health 2006 May 96(5) 826ndash833bull [22]Stephen Porges PhD Polyvagal Perspective Biological Psychology 2007 Feb 74(2) 116ndash143 Published online 2006 Oct 16 bull [23]Stephen W Porges PhD The Polyvagal Theory Neurophysiological Foundations of Emotions Attachment Communication and
Self-regulation WWNorton and Company Inc 2011bull [24]Maggie Phillips PhD Reversing Chronic Pain North Atlantic Books 2007bull [25]Peter Levine PhD Waking the Tiger North Atlantic Books 1997bull [26]Bessel VanderKolk MD The Body Keeps the Score Viking Penguin 2014bullAcknowledgmentsbull Group Medical Visits and Group Facilitation Jeff Geller MDbull Re-evaluation Counseling Community bull Insight Meditation Communitybull Biodynamic Osteopathy Communitybull Learning To Breathe Mindfulness Training for Adolescents 2015 Patricia C Broderick PhD bull Stanford Chronic Disease Self Management Program Training 2014 Kate Lorig MPH RNbull Motivational Interviewing Training 2015 Steven Berg-Smithbull Centering Pregnancy Training 2014 Centering Healthcare Institutebull Motivating Change in Groups Training 2013 Kaiser Permanente Oakland Cabull Group Facilitation Training Sara Fisk PhD Community at Work San Francisco Cabull Tribes Training 2013 Center for Human Developmentbull Cultural Humility Training 2016 Melanie Tervalon MD
Bibliography
Intermediate Steps to Listening Session Handout
bull Step 1 Connect with yourself body mind and emotions
bull Step 2 Hold a non-judgmental space to be seen and heard
bull Step 3 See the speaker and anyone referenced as able to manifest their true human nature and evolve using inherent healing abilities
bull Step 4 Listen to the speaker in a deep connected way sending the message that their thinking feelings and being matters to you
bull Step 5 Encourage the speaker to express feelings or thoughts describe body sensations or share a story relevant to the feelings at hand
bull Step 6 Validate intense emotional expression and release such as crying laughing shaking yawning sweating as a sign of healing
bull Step 7 Remind the speaker of their underlying goodness intelligence strength and caring and your confidence in their ability to heal and manifest their true human nature
copy Elizabeth Rocco MD
Contact Information
bull Elizabeth Rocco MD -egroccogmailcom
bull Karen Ekwueme MD-impactdoc1gmailcom
Behavioral Learning and Mental Health Diagnoses in Children
In New England
63 of Children
[1]Wen Patricia (2010) ldquoA legacy of unintended side effectsrdquo Boston Globe December 12
Use of Psychiatric Drugs in Children
Children on Psychiatric Drugs in the US in 2013
bull 0-1 Years 2748042-3 Years 3707784-5 Years 500948
bull 6-12 Years 413034013-17 Years 3617593
bull 8389034 children on psychiatric drugsbull [2]CCHR International (2014) [Online] Number of Children amp Adolescents Taking Psychiatric Drugs in the US
Aprilwwwcchrintorgpsychiatric-drugschildren-on-psychiatric-drugs
Facing the Impact of Trauma
An Alternative Model
Listening Practice
bull Turn to the person next to you
bull The person on the left will be the listener first and the other the speaker
bull Listener will listen while the speaker shares
bull Switch when time is called
When we define the effects of oppression as someonersquos ldquoillnessrdquo and ignore the root causes we obscure our path
forward in healing our communities
What if we reframed ldquochronic illnessrdquo as a societal struggle that requires societal
change and healing in community
1 Institutionalized oppression
2 Personally-mediated oppression or micro-aggressions
3 Internalized oppression
Teamnofearorg
Manifestations of Societal Oppression
Institutionalized Racism
Micro-aggressions
Internalized Racism
StressCumulative Effects
COGNITIVE BEHAVIORAL
EMOTIONAL NEURO PHYSIOLOGICAL
STRESS
Complex Societal Trauma (CST)Total Negative Health Impact over Generations
Societal Oppression
Familial Trauma
Societal Trauma
Complex Societal Trauma
copy Elizabeth Rocco MD
Intergenerational TransmissionHow is CST passed down to our children
1 Yehuda R et al (2015) ldquoHolocaust Exposure Induced Intergenerational Effects on FKBP5 MethylationrdquoBiol Psychiatry Aug 12 httpwwwncbinlmnihgovpubmed26410355B
2 Buss C et al (2011) ldquoMaternal pregnancy-specific anxiety is associated with child executive function at 6-9 years agerdquo Stress Nov14(6)665-76 httpwwwncbinlmnihgovpubmed21995526
3 Shankardass K et al (2014) ldquoParental stress increases body mass index trajectory in preadolescentsrdquoPediatr Obes Dec9(6)435-42 httpwwwncbinlmnihgovpubmed24311567
Complex Societal Trauma
is Toxic to the Developing Brain
Pat Levitt developmental neuroscientist and Dr Jack
Shonkoff part of the National Scientific Council on
the Developing Child
ACE (Adverse Childhood Experience) Study
Childhood neglect abuse and household dysfunction impacts health through out life
Vincent J Felitti et al (1998) ldquoRelationship of Childhood Abuse and Household Dysfunction to Many of the Leading Causes of Death in Adults
The Adverse Childhood Experiences (ACE) Studyrdquo May Volume 14 Issue 4 Pages 245ndash
258 httpsacestoohighcom
Healing Complex Societal Trauma
Social Engagement Ventral Vagal Complex
Reach for Help Ventral Vagal FEAR
Fight or FlightSympathetic
FEAR
FEAR
Freeze Collapse Dorsal Vagal
Pre-frontal CortexThe Voice of Reason
Human Healing and Evolution through Self-Awareness Embodiment Empowerment and Connection
Mindfulness Breath work Martial Arts Exercise Yoga Singing Dancing
Acupuncture Massage ReikiCommunity Groups Animals Church Nature
Final Listening Practice and Closing Circle
Bibliography
bull Special Acknowledgement of Demie Stathoplos MSW and Bonnie Cohen MD who collaborated with Elizabeth Rocco MD on the IM4US August 2015 presentation ldquoListening to Each Other Healing the Negative Health Impacts of Racism Poverty and Trauma through Human Connectionrdquo
bull Special Acknowledgement of Karen Burt MD who collaborated with Elizabeth Rocco MD and Karen Ekwueme MD on the IM4US August 2016 presentation ldquoListening to Ourselves and Each Other Healing the Negative Health Impact of Racism Poverty Sexism and Traumardquo These bibliographies are included below
bull [1]Wen Patricia (2010) ldquoA legacy of unintended side effectsrdquo Boston Globe December 12 httpwwwbostoncomnewslocalmassachusettsarticles20101212with_ssi_program_a_legcy_of_unintended_side_effects
bull [2]CCHR International (2014) [Online] Number of Children amp Adolescents Taking Psychiatric Drugs in the US Aprilwwwcchrintorgpsychiatric-drugschildren-on-psychiatric-drugs
bull [3]Whitaker R (2010) Anatomy of an Epidemic Magic Bullets Psychiatric Drugs and the Astonishing Rise of Mental Illness in America Crown Publishing Company httprobertwhitakerorgrobertwhitakerorgAnatomy20of20an20Epidemichtml
bull [3]CDC (2013) [Online] MMRW Mental Health Surveillance Among Children mdash United States 2005ndash2011 Supplements May 17 62(02)1-35 httpwwwcdcgovmmwrpreviewmmwrhtmlsu6202a1htm
bull [4]Patricia N Pastor PhD Cynthia A Reuben MA Catherine R Duran BS and LaJeana D Hawkins MPH CHES (2015) [Online] CDC NCHS Data Brief Association Between Diagnosed ADHD and Selected Characteristics Among Children Aged 4ndash17 Years United States 2011ndash2013 May Number 201 httpwwwcdcgovnchsdatadatabriefsdb201htm
bull [5]Mental Health America (2014) Parity or Disparity The State of Mental Health in America 2015 NovwwwmentalhealthamericanetsitesdefaultfilesParity20or20Disparity20201520Reportpdf
bull [6]Bruce S Jonas ScM PhD Qiuping Gu MD PhD and Juan R Albertorio-Diaz MA (2013) [Online] CDC NCHS Data Brief Psychotropic Medication Use Among Adolescents United States 2005ndash2010 Dec Number 135httpwwwcdcgovnchsdatadatabriefsdb135htm
bull [7] C Buss EP Davis CJ Hobel and CA Sandman (2011) Maternal pregnancy-specific anxiety is associated with child executive function at 6ndash9 years age Stress Nov 14(6)665-676
bull [8] Council for Evidence-Based Psychiatry (UK) Web presentation ldquoUnrecognized Factsrdquo Authors James Davies Peter C Goetzsche Peter Kinderman Joanna Moncrieff Phillip Thomas Sami Timimi John Sandwich Melanie Davis Luke Montague httpcepukorgunrecognised-facts
bull [9] Johnstone Lucy (2015) A Straight Talking Introduction to Psychiatric DiagnosisPCCS Books 1st edition (February 3 2015)
bull [10] Brewin CR Andrews B Valentine JD (2000) ldquoMeta-analysis of risk factors for posttraumatic stress disorder in trauma-exposed adultsrdquo J Consult Clin Psychol2000 Oct68(5)748-66 httpwwwncbinlmnihgovpubmed11068961
bull [11] Williams Monica T (2013) ldquoCan Racism Cause PTSD Implications for DSM-5rdquoPsychology Today May 20 httpswwwpsychologytodaycomblogculturally-speaking201305can-racism-cause-ptsd-implications-dsm-5
Bibliography
bull [12] Yuan Chengmei et al (2011) ldquoProtective factors for posttraumatic stress disorder symptoms in a prospective study of police officersrdquo Nov 23httpwwwncbinlmnihgovpmcarticlesPMC3071439
bull [13] Chou Tina BA Anu Asnaani MA and Stefan G Hofmann PhD (2012) ldquoPerception of Racial Discrimination and Psychopathology Across Three US Ethnic Minority Groupsrdquo APA PsychNET Jan httpwwwncbinlmnihgovpmcarticlesPMC3505377
bull [14] Watson Laurel B Jacob M Marszalek Franco Dispenza and Christopher M Davids 2015 Understanding the Relationships Among White and African American Womenrsquos Sexual Objectification Experiences Physical Safety Anxiety and Psychological Distress Sex Roles 72 (34) 91-104
bull [15] Holland Julie (2015) ldquoMedicating Womenrsquos Feelingsrdquo New York TimesOpinion Feb 28 httpmobilenytimescom20150301opinionsundaymedicating-womens-feelingshtmlreferreramp_r=1
bull [16] Solinas M Thiriet N El Rawas R Lardeux V and Jaber M (2009) ldquoEnvironmental Enrichment During Early Stages of Life Reduces the Behavioral Neurochemical and Molecular Effects of Cocainerdquo Neuropsychopharmacology 34 1102ndash1111
bull [17] Hari Johann Chasing The Scream The First and Last Days of the War on Drugs Bloomsbury USA (January 20 2015)bull [18] Hughes Caitlin Elizabeth and Alex Stevens (2010) ldquoWhat Can We Learn From The Portuguese Decriminalization of Illicit
Drugsrdquo British Journal of Criminology July 21 httpbjcoxfordjournalsorgcontent506999abstractbull [19] Fournier Jay C et al (2009) ldquoAntidepressant Drug Effects and Depression Severityrdquo JAMA January
6th httpjamajamanetworkcomarticleaspxarticleid=185157[20] Currie J Stabile M Jones L (2013) Do Stimulant Medications Improve Educational and Behavioral Outcomes for Children with ADHD NBER Working Paper No 19105
bull [21] Mora-Ripoli R Organizacioacuten Mundial de la Risa Barcelona Spain ldquoThe therapeutic value of laughter in medicinerdquo Altern Ther Health Med 2010 Nov-Dec16(6)56-64 httpwwwncbinlmnihgovpubmed21280463
bull [22] Gracanin Asmir Lauren M Bylsma and Ad J J M Vingerhoets (2014) ldquoIs Crying a Self-Stoothing Behaviorrdquo Frontiers in Psychology May 28httpwwwncbinlmnihgovpmcarticlesPMC4035568
bull [23] Trimble Michael (2010) ldquoI Cry Therefore I Amrdquo New York Times Nov 10 httpwwwnytimescom20121111opinionsundayi-cry-therefore-i-amhtmlemc=eta1amp_r=0
bull [24]Gallup Andrew C et al (2007) ldquoYawning as a brain cooling mechanism Nasal breathing and forehead cooling diminish the incidence of contagious yawningrdquo httpwwwepjournalnetarticlesyawning-as-a-brain-cooling-mechanism-nasal-breathing-and-forehead-cooling-diminish-the-incidence-of-contagious-yawning
bull [25]Sharat Gupta and Shallu Mittal Int (2013) Yawning and its physiological significance Intl J Appl Basic Med Res Jan-Jun 3(1) 11ndash15
bull [26] Stephens R Atkins J Kingston A (2009) ldquoSwearing As a Response to Painrdquo NeuroReport Aug 5 httpwwwncbinlmnihgovpubmed19590391
bull [27]Morelli SA Lieberman MD(2013) rdquoThe role of automaticity and attention in neural processes underlying empathy for happiness sadness and anxietyrdquo Front Hum Neurosci May 87160
Bibliography
bull [1] Committee on Psychosocial Aspects of Child and Family Health Committee on Early Childhood Adoption and Dependent Care andSection on Developmental and Behavioral Pediatrics Andrew S Garner Jack P Shonkoff et al (2012) ldquoEarly Childhood Adversity Toxic Stress and the Role of the Pediatrician Translating Developmental Science Into Lifelong Healthrdquo Pediatrics January VOLUME 129 ISSUE 1 From the American Academy of Pediatrics Policy Statementhttppediatricsaappublicationsorgcontent1291e224fullref-23
bull [2] COUNCIL ON COMMUNITY PEDIATRICS Benjamin A Gitterman et al (2016) ldquoPoverty and Child Health in the United Statesrdquo Pediatrics March From the American Academy of Pediatrics Policy Statement Published Online March 09American Academy of Pediatricshttppediatricsaappublicationsorgcontentearly20160307peds2016-0339info
bull [3] Paul W Newacheck et al (2003) ldquoDisparities in Adolescent Health and Health Care Does Socioeconomic Status Matterrdquo Health ServRes Oct 38(5) 1235ndash1252 httpwwwncbinlmnihgovpmcarticlesPMC1360944
bull [4] Larson et al (2007) ldquoPoverty during pregnancy Its effects on child health outcomesrdquo Paediatr Child Health 2007 Oct 12(8) 673ndash677 httpwwwncbinlmnihgovpmcarticlesPMC2528810
bull [5] Lara J Akinbami et al (2012) ldquoTrends in Asthma Prevalence Health Care Use and Mortality in the United States 2001ndash2010rdquo NCHS Data Brief No 94 May httpwwwcdcgovnchsproductsdatabriefsdb94htm
bull [6] Cynthia L Ogden et al (2010) ldquoObesity and Socioeconomic Status in Children and Adolescents United States 2005-2008rdquoNCHS Data Brief No 51 Decemberhttpwwwcdcgovnchsproductsdatabriefsdb51htm
bull [7] Shonkoff JP et al Committee on Psychosocial Aspects of Child and Family Health Committee on Early Childhood Adoption and Dependent Care Section on Developmental and Behavioral Pediatrics rdquoThe lifelong effects of early childhood adversity and toxicstressrdquo Pediatrics 2012129(1) wwwpediatricsorgcgicontentfull1291e232
bull [8] Virginia A Rauh et alldquoHousing and HealthIntersection of Poverty and Environmental Exposuresrdquo (2008) Annals of the New York Academy of Sciences Volume 1136 Reducing the Impact of Poverty on Health and Human Development Scientific Approaches pages 276ndash288 June httponlinelibrarywileycomdoi101196annals1425032full
bull [9] Yehuda R et al (2015) ldquoHolocaust Exposure Induced Intergenerational Effects on FKBP5 MethylationrdquoBiol Psychiatry Aug 12 httpwwwncbinlmnihgovpubmed26410355
bull [10] Buss C et al (2011) ldquoMaternal pregnancy-specific anxiety is associated with child executive function at 6-9 years agerdquoStress Nov14(6)665-76 httpwwwncbinlmnihgovpubmed21995526
bull 11] Shankardass K et al (2014) ldquoParental stress increases body mass index trajectory in pre-adolescentsrdquoPediatr Obes Dec9(6)435-42 httpwwwncbinlmnihgovpubmed24311567
bull [12] Vincent J Felitti et al (1998) ldquoRelationship of Childhood Abuse and Household Dysfunction to Many of the Leading Causes of Death in Adults The Adverse Childhood Experiences (ACE) Studyrdquo May Volume 14 Issue 4 Pages 245ndash258 httpsacestoohighcom
bull [13]Jones CP Levels of Racism a Theoretic Framework and the Gardenerrsquos Tale Am J Public Health 200090(8) 1212-1215bull [14]Dion KL The Social Psycology of Perceived Perjudice and Discrimination Canadian Psychology (2002)431 pp 1-10bull [15]Sue D W Bucceri J Lin AI Nadal K L and Torino J C Racial Microaggressions and the Asian American experience APA (2007) Vol
13 No 1 pp 72-81bull [16]James S A (School of Public Health U of North Carolina Chapel Hill NC 27514) D S Strogatz S B Wing and D L Ramsey
Socioeconomic status John Henryism and hypertension in blacks and whites Am J Epidemiol 1987 126664ndash73bull [17]httpwwwapaorgpioemaresourcesethnicity-healthindexaspxbull [18]Porges SW Clinical Insights from the Polyvagal Theory The Transformative Power of Feeling Safe (Norton Series on Interpersonal
Neurobiology) W W Norton Apr 7 2014 - Psychology - 288 pagesbull [19]The Polyvagal Theory (Porges SW Social Connectedness as a Biological Imperative Understanding Trauma Through the Lens of
thePolyvagal Theory presentation 82015)bull [20]McEwen BS Allostasis and allostatic load implications for neuropsychopharmacologyNeuropsychopharmacology 2000
Feb22(2)108-24bull [21] McEwen BS adaptation and disease Allostasis and allostatic load Ann N Y Acad Sci 1998 May 184033-44bull [22] Arline T Geronimus ScD Margaret Hicken MPH Danya Keene MAT and John Bound PhD Weatheringrdquo and Age Patterns of
Allostatic Load Scores Among Blacks and Whites in the United States Am J Public Health 2006 May 96(5) 826ndash833bull [22]Stephen Porges PhD Polyvagal Perspective Biological Psychology 2007 Feb 74(2) 116ndash143 Published online 2006 Oct 16 bull [23]Stephen W Porges PhD The Polyvagal Theory Neurophysiological Foundations of Emotions Attachment Communication and
Self-regulation WWNorton and Company Inc 2011bull [24]Maggie Phillips PhD Reversing Chronic Pain North Atlantic Books 2007bull [25]Peter Levine PhD Waking the Tiger North Atlantic Books 1997bull [26]Bessel VanderKolk MD The Body Keeps the Score Viking Penguin 2014bullAcknowledgmentsbull Group Medical Visits and Group Facilitation Jeff Geller MDbull Re-evaluation Counseling Community bull Insight Meditation Communitybull Biodynamic Osteopathy Communitybull Learning To Breathe Mindfulness Training for Adolescents 2015 Patricia C Broderick PhD bull Stanford Chronic Disease Self Management Program Training 2014 Kate Lorig MPH RNbull Motivational Interviewing Training 2015 Steven Berg-Smithbull Centering Pregnancy Training 2014 Centering Healthcare Institutebull Motivating Change in Groups Training 2013 Kaiser Permanente Oakland Cabull Group Facilitation Training Sara Fisk PhD Community at Work San Francisco Cabull Tribes Training 2013 Center for Human Developmentbull Cultural Humility Training 2016 Melanie Tervalon MD
Bibliography
Intermediate Steps to Listening Session Handout
bull Step 1 Connect with yourself body mind and emotions
bull Step 2 Hold a non-judgmental space to be seen and heard
bull Step 3 See the speaker and anyone referenced as able to manifest their true human nature and evolve using inherent healing abilities
bull Step 4 Listen to the speaker in a deep connected way sending the message that their thinking feelings and being matters to you
bull Step 5 Encourage the speaker to express feelings or thoughts describe body sensations or share a story relevant to the feelings at hand
bull Step 6 Validate intense emotional expression and release such as crying laughing shaking yawning sweating as a sign of healing
bull Step 7 Remind the speaker of their underlying goodness intelligence strength and caring and your confidence in their ability to heal and manifest their true human nature
copy Elizabeth Rocco MD
Contact Information
bull Elizabeth Rocco MD -egroccogmailcom
bull Karen Ekwueme MD-impactdoc1gmailcom
Use of Psychiatric Drugs in Children
Children on Psychiatric Drugs in the US in 2013
bull 0-1 Years 2748042-3 Years 3707784-5 Years 500948
bull 6-12 Years 413034013-17 Years 3617593
bull 8389034 children on psychiatric drugsbull [2]CCHR International (2014) [Online] Number of Children amp Adolescents Taking Psychiatric Drugs in the US
Aprilwwwcchrintorgpsychiatric-drugschildren-on-psychiatric-drugs
Facing the Impact of Trauma
An Alternative Model
Listening Practice
bull Turn to the person next to you
bull The person on the left will be the listener first and the other the speaker
bull Listener will listen while the speaker shares
bull Switch when time is called
When we define the effects of oppression as someonersquos ldquoillnessrdquo and ignore the root causes we obscure our path
forward in healing our communities
What if we reframed ldquochronic illnessrdquo as a societal struggle that requires societal
change and healing in community
1 Institutionalized oppression
2 Personally-mediated oppression or micro-aggressions
3 Internalized oppression
Teamnofearorg
Manifestations of Societal Oppression
Institutionalized Racism
Micro-aggressions
Internalized Racism
StressCumulative Effects
COGNITIVE BEHAVIORAL
EMOTIONAL NEURO PHYSIOLOGICAL
STRESS
Complex Societal Trauma (CST)Total Negative Health Impact over Generations
Societal Oppression
Familial Trauma
Societal Trauma
Complex Societal Trauma
copy Elizabeth Rocco MD
Intergenerational TransmissionHow is CST passed down to our children
1 Yehuda R et al (2015) ldquoHolocaust Exposure Induced Intergenerational Effects on FKBP5 MethylationrdquoBiol Psychiatry Aug 12 httpwwwncbinlmnihgovpubmed26410355B
2 Buss C et al (2011) ldquoMaternal pregnancy-specific anxiety is associated with child executive function at 6-9 years agerdquo Stress Nov14(6)665-76 httpwwwncbinlmnihgovpubmed21995526
3 Shankardass K et al (2014) ldquoParental stress increases body mass index trajectory in preadolescentsrdquoPediatr Obes Dec9(6)435-42 httpwwwncbinlmnihgovpubmed24311567
Complex Societal Trauma
is Toxic to the Developing Brain
Pat Levitt developmental neuroscientist and Dr Jack
Shonkoff part of the National Scientific Council on
the Developing Child
ACE (Adverse Childhood Experience) Study
Childhood neglect abuse and household dysfunction impacts health through out life
Vincent J Felitti et al (1998) ldquoRelationship of Childhood Abuse and Household Dysfunction to Many of the Leading Causes of Death in Adults
The Adverse Childhood Experiences (ACE) Studyrdquo May Volume 14 Issue 4 Pages 245ndash
258 httpsacestoohighcom
Healing Complex Societal Trauma
Social Engagement Ventral Vagal Complex
Reach for Help Ventral Vagal FEAR
Fight or FlightSympathetic
FEAR
FEAR
Freeze Collapse Dorsal Vagal
Pre-frontal CortexThe Voice of Reason
Human Healing and Evolution through Self-Awareness Embodiment Empowerment and Connection
Mindfulness Breath work Martial Arts Exercise Yoga Singing Dancing
Acupuncture Massage ReikiCommunity Groups Animals Church Nature
Final Listening Practice and Closing Circle
Bibliography
bull Special Acknowledgement of Demie Stathoplos MSW and Bonnie Cohen MD who collaborated with Elizabeth Rocco MD on the IM4US August 2015 presentation ldquoListening to Each Other Healing the Negative Health Impacts of Racism Poverty and Trauma through Human Connectionrdquo
bull Special Acknowledgement of Karen Burt MD who collaborated with Elizabeth Rocco MD and Karen Ekwueme MD on the IM4US August 2016 presentation ldquoListening to Ourselves and Each Other Healing the Negative Health Impact of Racism Poverty Sexism and Traumardquo These bibliographies are included below
bull [1]Wen Patricia (2010) ldquoA legacy of unintended side effectsrdquo Boston Globe December 12 httpwwwbostoncomnewslocalmassachusettsarticles20101212with_ssi_program_a_legcy_of_unintended_side_effects
bull [2]CCHR International (2014) [Online] Number of Children amp Adolescents Taking Psychiatric Drugs in the US Aprilwwwcchrintorgpsychiatric-drugschildren-on-psychiatric-drugs
bull [3]Whitaker R (2010) Anatomy of an Epidemic Magic Bullets Psychiatric Drugs and the Astonishing Rise of Mental Illness in America Crown Publishing Company httprobertwhitakerorgrobertwhitakerorgAnatomy20of20an20Epidemichtml
bull [3]CDC (2013) [Online] MMRW Mental Health Surveillance Among Children mdash United States 2005ndash2011 Supplements May 17 62(02)1-35 httpwwwcdcgovmmwrpreviewmmwrhtmlsu6202a1htm
bull [4]Patricia N Pastor PhD Cynthia A Reuben MA Catherine R Duran BS and LaJeana D Hawkins MPH CHES (2015) [Online] CDC NCHS Data Brief Association Between Diagnosed ADHD and Selected Characteristics Among Children Aged 4ndash17 Years United States 2011ndash2013 May Number 201 httpwwwcdcgovnchsdatadatabriefsdb201htm
bull [5]Mental Health America (2014) Parity or Disparity The State of Mental Health in America 2015 NovwwwmentalhealthamericanetsitesdefaultfilesParity20or20Disparity20201520Reportpdf
bull [6]Bruce S Jonas ScM PhD Qiuping Gu MD PhD and Juan R Albertorio-Diaz MA (2013) [Online] CDC NCHS Data Brief Psychotropic Medication Use Among Adolescents United States 2005ndash2010 Dec Number 135httpwwwcdcgovnchsdatadatabriefsdb135htm
bull [7] C Buss EP Davis CJ Hobel and CA Sandman (2011) Maternal pregnancy-specific anxiety is associated with child executive function at 6ndash9 years age Stress Nov 14(6)665-676
bull [8] Council for Evidence-Based Psychiatry (UK) Web presentation ldquoUnrecognized Factsrdquo Authors James Davies Peter C Goetzsche Peter Kinderman Joanna Moncrieff Phillip Thomas Sami Timimi John Sandwich Melanie Davis Luke Montague httpcepukorgunrecognised-facts
bull [9] Johnstone Lucy (2015) A Straight Talking Introduction to Psychiatric DiagnosisPCCS Books 1st edition (February 3 2015)
bull [10] Brewin CR Andrews B Valentine JD (2000) ldquoMeta-analysis of risk factors for posttraumatic stress disorder in trauma-exposed adultsrdquo J Consult Clin Psychol2000 Oct68(5)748-66 httpwwwncbinlmnihgovpubmed11068961
bull [11] Williams Monica T (2013) ldquoCan Racism Cause PTSD Implications for DSM-5rdquoPsychology Today May 20 httpswwwpsychologytodaycomblogculturally-speaking201305can-racism-cause-ptsd-implications-dsm-5
Bibliography
bull [12] Yuan Chengmei et al (2011) ldquoProtective factors for posttraumatic stress disorder symptoms in a prospective study of police officersrdquo Nov 23httpwwwncbinlmnihgovpmcarticlesPMC3071439
bull [13] Chou Tina BA Anu Asnaani MA and Stefan G Hofmann PhD (2012) ldquoPerception of Racial Discrimination and Psychopathology Across Three US Ethnic Minority Groupsrdquo APA PsychNET Jan httpwwwncbinlmnihgovpmcarticlesPMC3505377
bull [14] Watson Laurel B Jacob M Marszalek Franco Dispenza and Christopher M Davids 2015 Understanding the Relationships Among White and African American Womenrsquos Sexual Objectification Experiences Physical Safety Anxiety and Psychological Distress Sex Roles 72 (34) 91-104
bull [15] Holland Julie (2015) ldquoMedicating Womenrsquos Feelingsrdquo New York TimesOpinion Feb 28 httpmobilenytimescom20150301opinionsundaymedicating-womens-feelingshtmlreferreramp_r=1
bull [16] Solinas M Thiriet N El Rawas R Lardeux V and Jaber M (2009) ldquoEnvironmental Enrichment During Early Stages of Life Reduces the Behavioral Neurochemical and Molecular Effects of Cocainerdquo Neuropsychopharmacology 34 1102ndash1111
bull [17] Hari Johann Chasing The Scream The First and Last Days of the War on Drugs Bloomsbury USA (January 20 2015)bull [18] Hughes Caitlin Elizabeth and Alex Stevens (2010) ldquoWhat Can We Learn From The Portuguese Decriminalization of Illicit
Drugsrdquo British Journal of Criminology July 21 httpbjcoxfordjournalsorgcontent506999abstractbull [19] Fournier Jay C et al (2009) ldquoAntidepressant Drug Effects and Depression Severityrdquo JAMA January
6th httpjamajamanetworkcomarticleaspxarticleid=185157[20] Currie J Stabile M Jones L (2013) Do Stimulant Medications Improve Educational and Behavioral Outcomes for Children with ADHD NBER Working Paper No 19105
bull [21] Mora-Ripoli R Organizacioacuten Mundial de la Risa Barcelona Spain ldquoThe therapeutic value of laughter in medicinerdquo Altern Ther Health Med 2010 Nov-Dec16(6)56-64 httpwwwncbinlmnihgovpubmed21280463
bull [22] Gracanin Asmir Lauren M Bylsma and Ad J J M Vingerhoets (2014) ldquoIs Crying a Self-Stoothing Behaviorrdquo Frontiers in Psychology May 28httpwwwncbinlmnihgovpmcarticlesPMC4035568
bull [23] Trimble Michael (2010) ldquoI Cry Therefore I Amrdquo New York Times Nov 10 httpwwwnytimescom20121111opinionsundayi-cry-therefore-i-amhtmlemc=eta1amp_r=0
bull [24]Gallup Andrew C et al (2007) ldquoYawning as a brain cooling mechanism Nasal breathing and forehead cooling diminish the incidence of contagious yawningrdquo httpwwwepjournalnetarticlesyawning-as-a-brain-cooling-mechanism-nasal-breathing-and-forehead-cooling-diminish-the-incidence-of-contagious-yawning
bull [25]Sharat Gupta and Shallu Mittal Int (2013) Yawning and its physiological significance Intl J Appl Basic Med Res Jan-Jun 3(1) 11ndash15
bull [26] Stephens R Atkins J Kingston A (2009) ldquoSwearing As a Response to Painrdquo NeuroReport Aug 5 httpwwwncbinlmnihgovpubmed19590391
bull [27]Morelli SA Lieberman MD(2013) rdquoThe role of automaticity and attention in neural processes underlying empathy for happiness sadness and anxietyrdquo Front Hum Neurosci May 87160
Bibliography
bull [1] Committee on Psychosocial Aspects of Child and Family Health Committee on Early Childhood Adoption and Dependent Care andSection on Developmental and Behavioral Pediatrics Andrew S Garner Jack P Shonkoff et al (2012) ldquoEarly Childhood Adversity Toxic Stress and the Role of the Pediatrician Translating Developmental Science Into Lifelong Healthrdquo Pediatrics January VOLUME 129 ISSUE 1 From the American Academy of Pediatrics Policy Statementhttppediatricsaappublicationsorgcontent1291e224fullref-23
bull [2] COUNCIL ON COMMUNITY PEDIATRICS Benjamin A Gitterman et al (2016) ldquoPoverty and Child Health in the United Statesrdquo Pediatrics March From the American Academy of Pediatrics Policy Statement Published Online March 09American Academy of Pediatricshttppediatricsaappublicationsorgcontentearly20160307peds2016-0339info
bull [3] Paul W Newacheck et al (2003) ldquoDisparities in Adolescent Health and Health Care Does Socioeconomic Status Matterrdquo Health ServRes Oct 38(5) 1235ndash1252 httpwwwncbinlmnihgovpmcarticlesPMC1360944
bull [4] Larson et al (2007) ldquoPoverty during pregnancy Its effects on child health outcomesrdquo Paediatr Child Health 2007 Oct 12(8) 673ndash677 httpwwwncbinlmnihgovpmcarticlesPMC2528810
bull [5] Lara J Akinbami et al (2012) ldquoTrends in Asthma Prevalence Health Care Use and Mortality in the United States 2001ndash2010rdquo NCHS Data Brief No 94 May httpwwwcdcgovnchsproductsdatabriefsdb94htm
bull [6] Cynthia L Ogden et al (2010) ldquoObesity and Socioeconomic Status in Children and Adolescents United States 2005-2008rdquoNCHS Data Brief No 51 Decemberhttpwwwcdcgovnchsproductsdatabriefsdb51htm
bull [7] Shonkoff JP et al Committee on Psychosocial Aspects of Child and Family Health Committee on Early Childhood Adoption and Dependent Care Section on Developmental and Behavioral Pediatrics rdquoThe lifelong effects of early childhood adversity and toxicstressrdquo Pediatrics 2012129(1) wwwpediatricsorgcgicontentfull1291e232
bull [8] Virginia A Rauh et alldquoHousing and HealthIntersection of Poverty and Environmental Exposuresrdquo (2008) Annals of the New York Academy of Sciences Volume 1136 Reducing the Impact of Poverty on Health and Human Development Scientific Approaches pages 276ndash288 June httponlinelibrarywileycomdoi101196annals1425032full
bull [9] Yehuda R et al (2015) ldquoHolocaust Exposure Induced Intergenerational Effects on FKBP5 MethylationrdquoBiol Psychiatry Aug 12 httpwwwncbinlmnihgovpubmed26410355
bull [10] Buss C et al (2011) ldquoMaternal pregnancy-specific anxiety is associated with child executive function at 6-9 years agerdquoStress Nov14(6)665-76 httpwwwncbinlmnihgovpubmed21995526
bull 11] Shankardass K et al (2014) ldquoParental stress increases body mass index trajectory in pre-adolescentsrdquoPediatr Obes Dec9(6)435-42 httpwwwncbinlmnihgovpubmed24311567
bull [12] Vincent J Felitti et al (1998) ldquoRelationship of Childhood Abuse and Household Dysfunction to Many of the Leading Causes of Death in Adults The Adverse Childhood Experiences (ACE) Studyrdquo May Volume 14 Issue 4 Pages 245ndash258 httpsacestoohighcom
bull [13]Jones CP Levels of Racism a Theoretic Framework and the Gardenerrsquos Tale Am J Public Health 200090(8) 1212-1215bull [14]Dion KL The Social Psycology of Perceived Perjudice and Discrimination Canadian Psychology (2002)431 pp 1-10bull [15]Sue D W Bucceri J Lin AI Nadal K L and Torino J C Racial Microaggressions and the Asian American experience APA (2007) Vol
13 No 1 pp 72-81bull [16]James S A (School of Public Health U of North Carolina Chapel Hill NC 27514) D S Strogatz S B Wing and D L Ramsey
Socioeconomic status John Henryism and hypertension in blacks and whites Am J Epidemiol 1987 126664ndash73bull [17]httpwwwapaorgpioemaresourcesethnicity-healthindexaspxbull [18]Porges SW Clinical Insights from the Polyvagal Theory The Transformative Power of Feeling Safe (Norton Series on Interpersonal
Neurobiology) W W Norton Apr 7 2014 - Psychology - 288 pagesbull [19]The Polyvagal Theory (Porges SW Social Connectedness as a Biological Imperative Understanding Trauma Through the Lens of
thePolyvagal Theory presentation 82015)bull [20]McEwen BS Allostasis and allostatic load implications for neuropsychopharmacologyNeuropsychopharmacology 2000
Feb22(2)108-24bull [21] McEwen BS adaptation and disease Allostasis and allostatic load Ann N Y Acad Sci 1998 May 184033-44bull [22] Arline T Geronimus ScD Margaret Hicken MPH Danya Keene MAT and John Bound PhD Weatheringrdquo and Age Patterns of
Allostatic Load Scores Among Blacks and Whites in the United States Am J Public Health 2006 May 96(5) 826ndash833bull [22]Stephen Porges PhD Polyvagal Perspective Biological Psychology 2007 Feb 74(2) 116ndash143 Published online 2006 Oct 16 bull [23]Stephen W Porges PhD The Polyvagal Theory Neurophysiological Foundations of Emotions Attachment Communication and
Self-regulation WWNorton and Company Inc 2011bull [24]Maggie Phillips PhD Reversing Chronic Pain North Atlantic Books 2007bull [25]Peter Levine PhD Waking the Tiger North Atlantic Books 1997bull [26]Bessel VanderKolk MD The Body Keeps the Score Viking Penguin 2014bullAcknowledgmentsbull Group Medical Visits and Group Facilitation Jeff Geller MDbull Re-evaluation Counseling Community bull Insight Meditation Communitybull Biodynamic Osteopathy Communitybull Learning To Breathe Mindfulness Training for Adolescents 2015 Patricia C Broderick PhD bull Stanford Chronic Disease Self Management Program Training 2014 Kate Lorig MPH RNbull Motivational Interviewing Training 2015 Steven Berg-Smithbull Centering Pregnancy Training 2014 Centering Healthcare Institutebull Motivating Change in Groups Training 2013 Kaiser Permanente Oakland Cabull Group Facilitation Training Sara Fisk PhD Community at Work San Francisco Cabull Tribes Training 2013 Center for Human Developmentbull Cultural Humility Training 2016 Melanie Tervalon MD
Bibliography
Intermediate Steps to Listening Session Handout
bull Step 1 Connect with yourself body mind and emotions
bull Step 2 Hold a non-judgmental space to be seen and heard
bull Step 3 See the speaker and anyone referenced as able to manifest their true human nature and evolve using inherent healing abilities
bull Step 4 Listen to the speaker in a deep connected way sending the message that their thinking feelings and being matters to you
bull Step 5 Encourage the speaker to express feelings or thoughts describe body sensations or share a story relevant to the feelings at hand
bull Step 6 Validate intense emotional expression and release such as crying laughing shaking yawning sweating as a sign of healing
bull Step 7 Remind the speaker of their underlying goodness intelligence strength and caring and your confidence in their ability to heal and manifest their true human nature
copy Elizabeth Rocco MD
Contact Information
bull Elizabeth Rocco MD -egroccogmailcom
bull Karen Ekwueme MD-impactdoc1gmailcom
Facing the Impact of Trauma
An Alternative Model
Listening Practice
bull Turn to the person next to you
bull The person on the left will be the listener first and the other the speaker
bull Listener will listen while the speaker shares
bull Switch when time is called
When we define the effects of oppression as someonersquos ldquoillnessrdquo and ignore the root causes we obscure our path
forward in healing our communities
What if we reframed ldquochronic illnessrdquo as a societal struggle that requires societal
change and healing in community
1 Institutionalized oppression
2 Personally-mediated oppression or micro-aggressions
3 Internalized oppression
Teamnofearorg
Manifestations of Societal Oppression
Institutionalized Racism
Micro-aggressions
Internalized Racism
StressCumulative Effects
COGNITIVE BEHAVIORAL
EMOTIONAL NEURO PHYSIOLOGICAL
STRESS
Complex Societal Trauma (CST)Total Negative Health Impact over Generations
Societal Oppression
Familial Trauma
Societal Trauma
Complex Societal Trauma
copy Elizabeth Rocco MD
Intergenerational TransmissionHow is CST passed down to our children
1 Yehuda R et al (2015) ldquoHolocaust Exposure Induced Intergenerational Effects on FKBP5 MethylationrdquoBiol Psychiatry Aug 12 httpwwwncbinlmnihgovpubmed26410355B
2 Buss C et al (2011) ldquoMaternal pregnancy-specific anxiety is associated with child executive function at 6-9 years agerdquo Stress Nov14(6)665-76 httpwwwncbinlmnihgovpubmed21995526
3 Shankardass K et al (2014) ldquoParental stress increases body mass index trajectory in preadolescentsrdquoPediatr Obes Dec9(6)435-42 httpwwwncbinlmnihgovpubmed24311567
Complex Societal Trauma
is Toxic to the Developing Brain
Pat Levitt developmental neuroscientist and Dr Jack
Shonkoff part of the National Scientific Council on
the Developing Child
ACE (Adverse Childhood Experience) Study
Childhood neglect abuse and household dysfunction impacts health through out life
Vincent J Felitti et al (1998) ldquoRelationship of Childhood Abuse and Household Dysfunction to Many of the Leading Causes of Death in Adults
The Adverse Childhood Experiences (ACE) Studyrdquo May Volume 14 Issue 4 Pages 245ndash
258 httpsacestoohighcom
Healing Complex Societal Trauma
Social Engagement Ventral Vagal Complex
Reach for Help Ventral Vagal FEAR
Fight or FlightSympathetic
FEAR
FEAR
Freeze Collapse Dorsal Vagal
Pre-frontal CortexThe Voice of Reason
Human Healing and Evolution through Self-Awareness Embodiment Empowerment and Connection
Mindfulness Breath work Martial Arts Exercise Yoga Singing Dancing
Acupuncture Massage ReikiCommunity Groups Animals Church Nature
Final Listening Practice and Closing Circle
Bibliography
bull Special Acknowledgement of Demie Stathoplos MSW and Bonnie Cohen MD who collaborated with Elizabeth Rocco MD on the IM4US August 2015 presentation ldquoListening to Each Other Healing the Negative Health Impacts of Racism Poverty and Trauma through Human Connectionrdquo
bull Special Acknowledgement of Karen Burt MD who collaborated with Elizabeth Rocco MD and Karen Ekwueme MD on the IM4US August 2016 presentation ldquoListening to Ourselves and Each Other Healing the Negative Health Impact of Racism Poverty Sexism and Traumardquo These bibliographies are included below
bull [1]Wen Patricia (2010) ldquoA legacy of unintended side effectsrdquo Boston Globe December 12 httpwwwbostoncomnewslocalmassachusettsarticles20101212with_ssi_program_a_legcy_of_unintended_side_effects
bull [2]CCHR International (2014) [Online] Number of Children amp Adolescents Taking Psychiatric Drugs in the US Aprilwwwcchrintorgpsychiatric-drugschildren-on-psychiatric-drugs
bull [3]Whitaker R (2010) Anatomy of an Epidemic Magic Bullets Psychiatric Drugs and the Astonishing Rise of Mental Illness in America Crown Publishing Company httprobertwhitakerorgrobertwhitakerorgAnatomy20of20an20Epidemichtml
bull [3]CDC (2013) [Online] MMRW Mental Health Surveillance Among Children mdash United States 2005ndash2011 Supplements May 17 62(02)1-35 httpwwwcdcgovmmwrpreviewmmwrhtmlsu6202a1htm
bull [4]Patricia N Pastor PhD Cynthia A Reuben MA Catherine R Duran BS and LaJeana D Hawkins MPH CHES (2015) [Online] CDC NCHS Data Brief Association Between Diagnosed ADHD and Selected Characteristics Among Children Aged 4ndash17 Years United States 2011ndash2013 May Number 201 httpwwwcdcgovnchsdatadatabriefsdb201htm
bull [5]Mental Health America (2014) Parity or Disparity The State of Mental Health in America 2015 NovwwwmentalhealthamericanetsitesdefaultfilesParity20or20Disparity20201520Reportpdf
bull [6]Bruce S Jonas ScM PhD Qiuping Gu MD PhD and Juan R Albertorio-Diaz MA (2013) [Online] CDC NCHS Data Brief Psychotropic Medication Use Among Adolescents United States 2005ndash2010 Dec Number 135httpwwwcdcgovnchsdatadatabriefsdb135htm
bull [7] C Buss EP Davis CJ Hobel and CA Sandman (2011) Maternal pregnancy-specific anxiety is associated with child executive function at 6ndash9 years age Stress Nov 14(6)665-676
bull [8] Council for Evidence-Based Psychiatry (UK) Web presentation ldquoUnrecognized Factsrdquo Authors James Davies Peter C Goetzsche Peter Kinderman Joanna Moncrieff Phillip Thomas Sami Timimi John Sandwich Melanie Davis Luke Montague httpcepukorgunrecognised-facts
bull [9] Johnstone Lucy (2015) A Straight Talking Introduction to Psychiatric DiagnosisPCCS Books 1st edition (February 3 2015)
bull [10] Brewin CR Andrews B Valentine JD (2000) ldquoMeta-analysis of risk factors for posttraumatic stress disorder in trauma-exposed adultsrdquo J Consult Clin Psychol2000 Oct68(5)748-66 httpwwwncbinlmnihgovpubmed11068961
bull [11] Williams Monica T (2013) ldquoCan Racism Cause PTSD Implications for DSM-5rdquoPsychology Today May 20 httpswwwpsychologytodaycomblogculturally-speaking201305can-racism-cause-ptsd-implications-dsm-5
Bibliography
bull [12] Yuan Chengmei et al (2011) ldquoProtective factors for posttraumatic stress disorder symptoms in a prospective study of police officersrdquo Nov 23httpwwwncbinlmnihgovpmcarticlesPMC3071439
bull [13] Chou Tina BA Anu Asnaani MA and Stefan G Hofmann PhD (2012) ldquoPerception of Racial Discrimination and Psychopathology Across Three US Ethnic Minority Groupsrdquo APA PsychNET Jan httpwwwncbinlmnihgovpmcarticlesPMC3505377
bull [14] Watson Laurel B Jacob M Marszalek Franco Dispenza and Christopher M Davids 2015 Understanding the Relationships Among White and African American Womenrsquos Sexual Objectification Experiences Physical Safety Anxiety and Psychological Distress Sex Roles 72 (34) 91-104
bull [15] Holland Julie (2015) ldquoMedicating Womenrsquos Feelingsrdquo New York TimesOpinion Feb 28 httpmobilenytimescom20150301opinionsundaymedicating-womens-feelingshtmlreferreramp_r=1
bull [16] Solinas M Thiriet N El Rawas R Lardeux V and Jaber M (2009) ldquoEnvironmental Enrichment During Early Stages of Life Reduces the Behavioral Neurochemical and Molecular Effects of Cocainerdquo Neuropsychopharmacology 34 1102ndash1111
bull [17] Hari Johann Chasing The Scream The First and Last Days of the War on Drugs Bloomsbury USA (January 20 2015)bull [18] Hughes Caitlin Elizabeth and Alex Stevens (2010) ldquoWhat Can We Learn From The Portuguese Decriminalization of Illicit
Drugsrdquo British Journal of Criminology July 21 httpbjcoxfordjournalsorgcontent506999abstractbull [19] Fournier Jay C et al (2009) ldquoAntidepressant Drug Effects and Depression Severityrdquo JAMA January
6th httpjamajamanetworkcomarticleaspxarticleid=185157[20] Currie J Stabile M Jones L (2013) Do Stimulant Medications Improve Educational and Behavioral Outcomes for Children with ADHD NBER Working Paper No 19105
bull [21] Mora-Ripoli R Organizacioacuten Mundial de la Risa Barcelona Spain ldquoThe therapeutic value of laughter in medicinerdquo Altern Ther Health Med 2010 Nov-Dec16(6)56-64 httpwwwncbinlmnihgovpubmed21280463
bull [22] Gracanin Asmir Lauren M Bylsma and Ad J J M Vingerhoets (2014) ldquoIs Crying a Self-Stoothing Behaviorrdquo Frontiers in Psychology May 28httpwwwncbinlmnihgovpmcarticlesPMC4035568
bull [23] Trimble Michael (2010) ldquoI Cry Therefore I Amrdquo New York Times Nov 10 httpwwwnytimescom20121111opinionsundayi-cry-therefore-i-amhtmlemc=eta1amp_r=0
bull [24]Gallup Andrew C et al (2007) ldquoYawning as a brain cooling mechanism Nasal breathing and forehead cooling diminish the incidence of contagious yawningrdquo httpwwwepjournalnetarticlesyawning-as-a-brain-cooling-mechanism-nasal-breathing-and-forehead-cooling-diminish-the-incidence-of-contagious-yawning
bull [25]Sharat Gupta and Shallu Mittal Int (2013) Yawning and its physiological significance Intl J Appl Basic Med Res Jan-Jun 3(1) 11ndash15
bull [26] Stephens R Atkins J Kingston A (2009) ldquoSwearing As a Response to Painrdquo NeuroReport Aug 5 httpwwwncbinlmnihgovpubmed19590391
bull [27]Morelli SA Lieberman MD(2013) rdquoThe role of automaticity and attention in neural processes underlying empathy for happiness sadness and anxietyrdquo Front Hum Neurosci May 87160
Bibliography
bull [1] Committee on Psychosocial Aspects of Child and Family Health Committee on Early Childhood Adoption and Dependent Care andSection on Developmental and Behavioral Pediatrics Andrew S Garner Jack P Shonkoff et al (2012) ldquoEarly Childhood Adversity Toxic Stress and the Role of the Pediatrician Translating Developmental Science Into Lifelong Healthrdquo Pediatrics January VOLUME 129 ISSUE 1 From the American Academy of Pediatrics Policy Statementhttppediatricsaappublicationsorgcontent1291e224fullref-23
bull [2] COUNCIL ON COMMUNITY PEDIATRICS Benjamin A Gitterman et al (2016) ldquoPoverty and Child Health in the United Statesrdquo Pediatrics March From the American Academy of Pediatrics Policy Statement Published Online March 09American Academy of Pediatricshttppediatricsaappublicationsorgcontentearly20160307peds2016-0339info
bull [3] Paul W Newacheck et al (2003) ldquoDisparities in Adolescent Health and Health Care Does Socioeconomic Status Matterrdquo Health ServRes Oct 38(5) 1235ndash1252 httpwwwncbinlmnihgovpmcarticlesPMC1360944
bull [4] Larson et al (2007) ldquoPoverty during pregnancy Its effects on child health outcomesrdquo Paediatr Child Health 2007 Oct 12(8) 673ndash677 httpwwwncbinlmnihgovpmcarticlesPMC2528810
bull [5] Lara J Akinbami et al (2012) ldquoTrends in Asthma Prevalence Health Care Use and Mortality in the United States 2001ndash2010rdquo NCHS Data Brief No 94 May httpwwwcdcgovnchsproductsdatabriefsdb94htm
bull [6] Cynthia L Ogden et al (2010) ldquoObesity and Socioeconomic Status in Children and Adolescents United States 2005-2008rdquoNCHS Data Brief No 51 Decemberhttpwwwcdcgovnchsproductsdatabriefsdb51htm
bull [7] Shonkoff JP et al Committee on Psychosocial Aspects of Child and Family Health Committee on Early Childhood Adoption and Dependent Care Section on Developmental and Behavioral Pediatrics rdquoThe lifelong effects of early childhood adversity and toxicstressrdquo Pediatrics 2012129(1) wwwpediatricsorgcgicontentfull1291e232
bull [8] Virginia A Rauh et alldquoHousing and HealthIntersection of Poverty and Environmental Exposuresrdquo (2008) Annals of the New York Academy of Sciences Volume 1136 Reducing the Impact of Poverty on Health and Human Development Scientific Approaches pages 276ndash288 June httponlinelibrarywileycomdoi101196annals1425032full
bull [9] Yehuda R et al (2015) ldquoHolocaust Exposure Induced Intergenerational Effects on FKBP5 MethylationrdquoBiol Psychiatry Aug 12 httpwwwncbinlmnihgovpubmed26410355
bull [10] Buss C et al (2011) ldquoMaternal pregnancy-specific anxiety is associated with child executive function at 6-9 years agerdquoStress Nov14(6)665-76 httpwwwncbinlmnihgovpubmed21995526
bull 11] Shankardass K et al (2014) ldquoParental stress increases body mass index trajectory in pre-adolescentsrdquoPediatr Obes Dec9(6)435-42 httpwwwncbinlmnihgovpubmed24311567
bull [12] Vincent J Felitti et al (1998) ldquoRelationship of Childhood Abuse and Household Dysfunction to Many of the Leading Causes of Death in Adults The Adverse Childhood Experiences (ACE) Studyrdquo May Volume 14 Issue 4 Pages 245ndash258 httpsacestoohighcom
bull [13]Jones CP Levels of Racism a Theoretic Framework and the Gardenerrsquos Tale Am J Public Health 200090(8) 1212-1215bull [14]Dion KL The Social Psycology of Perceived Perjudice and Discrimination Canadian Psychology (2002)431 pp 1-10bull [15]Sue D W Bucceri J Lin AI Nadal K L and Torino J C Racial Microaggressions and the Asian American experience APA (2007) Vol
13 No 1 pp 72-81bull [16]James S A (School of Public Health U of North Carolina Chapel Hill NC 27514) D S Strogatz S B Wing and D L Ramsey
Socioeconomic status John Henryism and hypertension in blacks and whites Am J Epidemiol 1987 126664ndash73bull [17]httpwwwapaorgpioemaresourcesethnicity-healthindexaspxbull [18]Porges SW Clinical Insights from the Polyvagal Theory The Transformative Power of Feeling Safe (Norton Series on Interpersonal
Neurobiology) W W Norton Apr 7 2014 - Psychology - 288 pagesbull [19]The Polyvagal Theory (Porges SW Social Connectedness as a Biological Imperative Understanding Trauma Through the Lens of
thePolyvagal Theory presentation 82015)bull [20]McEwen BS Allostasis and allostatic load implications for neuropsychopharmacologyNeuropsychopharmacology 2000
Feb22(2)108-24bull [21] McEwen BS adaptation and disease Allostasis and allostatic load Ann N Y Acad Sci 1998 May 184033-44bull [22] Arline T Geronimus ScD Margaret Hicken MPH Danya Keene MAT and John Bound PhD Weatheringrdquo and Age Patterns of
Allostatic Load Scores Among Blacks and Whites in the United States Am J Public Health 2006 May 96(5) 826ndash833bull [22]Stephen Porges PhD Polyvagal Perspective Biological Psychology 2007 Feb 74(2) 116ndash143 Published online 2006 Oct 16 bull [23]Stephen W Porges PhD The Polyvagal Theory Neurophysiological Foundations of Emotions Attachment Communication and
Self-regulation WWNorton and Company Inc 2011bull [24]Maggie Phillips PhD Reversing Chronic Pain North Atlantic Books 2007bull [25]Peter Levine PhD Waking the Tiger North Atlantic Books 1997bull [26]Bessel VanderKolk MD The Body Keeps the Score Viking Penguin 2014bullAcknowledgmentsbull Group Medical Visits and Group Facilitation Jeff Geller MDbull Re-evaluation Counseling Community bull Insight Meditation Communitybull Biodynamic Osteopathy Communitybull Learning To Breathe Mindfulness Training for Adolescents 2015 Patricia C Broderick PhD bull Stanford Chronic Disease Self Management Program Training 2014 Kate Lorig MPH RNbull Motivational Interviewing Training 2015 Steven Berg-Smithbull Centering Pregnancy Training 2014 Centering Healthcare Institutebull Motivating Change in Groups Training 2013 Kaiser Permanente Oakland Cabull Group Facilitation Training Sara Fisk PhD Community at Work San Francisco Cabull Tribes Training 2013 Center for Human Developmentbull Cultural Humility Training 2016 Melanie Tervalon MD
Bibliography
Intermediate Steps to Listening Session Handout
bull Step 1 Connect with yourself body mind and emotions
bull Step 2 Hold a non-judgmental space to be seen and heard
bull Step 3 See the speaker and anyone referenced as able to manifest their true human nature and evolve using inherent healing abilities
bull Step 4 Listen to the speaker in a deep connected way sending the message that their thinking feelings and being matters to you
bull Step 5 Encourage the speaker to express feelings or thoughts describe body sensations or share a story relevant to the feelings at hand
bull Step 6 Validate intense emotional expression and release such as crying laughing shaking yawning sweating as a sign of healing
bull Step 7 Remind the speaker of their underlying goodness intelligence strength and caring and your confidence in their ability to heal and manifest their true human nature
copy Elizabeth Rocco MD
Contact Information
bull Elizabeth Rocco MD -egroccogmailcom
bull Karen Ekwueme MD-impactdoc1gmailcom
An Alternative Model
Listening Practice
bull Turn to the person next to you
bull The person on the left will be the listener first and the other the speaker
bull Listener will listen while the speaker shares
bull Switch when time is called
When we define the effects of oppression as someonersquos ldquoillnessrdquo and ignore the root causes we obscure our path
forward in healing our communities
What if we reframed ldquochronic illnessrdquo as a societal struggle that requires societal
change and healing in community
1 Institutionalized oppression
2 Personally-mediated oppression or micro-aggressions
3 Internalized oppression
Teamnofearorg
Manifestations of Societal Oppression
Institutionalized Racism
Micro-aggressions
Internalized Racism
StressCumulative Effects
COGNITIVE BEHAVIORAL
EMOTIONAL NEURO PHYSIOLOGICAL
STRESS
Complex Societal Trauma (CST)Total Negative Health Impact over Generations
Societal Oppression
Familial Trauma
Societal Trauma
Complex Societal Trauma
copy Elizabeth Rocco MD
Intergenerational TransmissionHow is CST passed down to our children
1 Yehuda R et al (2015) ldquoHolocaust Exposure Induced Intergenerational Effects on FKBP5 MethylationrdquoBiol Psychiatry Aug 12 httpwwwncbinlmnihgovpubmed26410355B
2 Buss C et al (2011) ldquoMaternal pregnancy-specific anxiety is associated with child executive function at 6-9 years agerdquo Stress Nov14(6)665-76 httpwwwncbinlmnihgovpubmed21995526
3 Shankardass K et al (2014) ldquoParental stress increases body mass index trajectory in preadolescentsrdquoPediatr Obes Dec9(6)435-42 httpwwwncbinlmnihgovpubmed24311567
Complex Societal Trauma
is Toxic to the Developing Brain
Pat Levitt developmental neuroscientist and Dr Jack
Shonkoff part of the National Scientific Council on
the Developing Child
ACE (Adverse Childhood Experience) Study
Childhood neglect abuse and household dysfunction impacts health through out life
Vincent J Felitti et al (1998) ldquoRelationship of Childhood Abuse and Household Dysfunction to Many of the Leading Causes of Death in Adults
The Adverse Childhood Experiences (ACE) Studyrdquo May Volume 14 Issue 4 Pages 245ndash
258 httpsacestoohighcom
Healing Complex Societal Trauma
Social Engagement Ventral Vagal Complex
Reach for Help Ventral Vagal FEAR
Fight or FlightSympathetic
FEAR
FEAR
Freeze Collapse Dorsal Vagal
Pre-frontal CortexThe Voice of Reason
Human Healing and Evolution through Self-Awareness Embodiment Empowerment and Connection
Mindfulness Breath work Martial Arts Exercise Yoga Singing Dancing
Acupuncture Massage ReikiCommunity Groups Animals Church Nature
Final Listening Practice and Closing Circle
Bibliography
bull Special Acknowledgement of Demie Stathoplos MSW and Bonnie Cohen MD who collaborated with Elizabeth Rocco MD on the IM4US August 2015 presentation ldquoListening to Each Other Healing the Negative Health Impacts of Racism Poverty and Trauma through Human Connectionrdquo
bull Special Acknowledgement of Karen Burt MD who collaborated with Elizabeth Rocco MD and Karen Ekwueme MD on the IM4US August 2016 presentation ldquoListening to Ourselves and Each Other Healing the Negative Health Impact of Racism Poverty Sexism and Traumardquo These bibliographies are included below
bull [1]Wen Patricia (2010) ldquoA legacy of unintended side effectsrdquo Boston Globe December 12 httpwwwbostoncomnewslocalmassachusettsarticles20101212with_ssi_program_a_legcy_of_unintended_side_effects
bull [2]CCHR International (2014) [Online] Number of Children amp Adolescents Taking Psychiatric Drugs in the US Aprilwwwcchrintorgpsychiatric-drugschildren-on-psychiatric-drugs
bull [3]Whitaker R (2010) Anatomy of an Epidemic Magic Bullets Psychiatric Drugs and the Astonishing Rise of Mental Illness in America Crown Publishing Company httprobertwhitakerorgrobertwhitakerorgAnatomy20of20an20Epidemichtml
bull [3]CDC (2013) [Online] MMRW Mental Health Surveillance Among Children mdash United States 2005ndash2011 Supplements May 17 62(02)1-35 httpwwwcdcgovmmwrpreviewmmwrhtmlsu6202a1htm
bull [4]Patricia N Pastor PhD Cynthia A Reuben MA Catherine R Duran BS and LaJeana D Hawkins MPH CHES (2015) [Online] CDC NCHS Data Brief Association Between Diagnosed ADHD and Selected Characteristics Among Children Aged 4ndash17 Years United States 2011ndash2013 May Number 201 httpwwwcdcgovnchsdatadatabriefsdb201htm
bull [5]Mental Health America (2014) Parity or Disparity The State of Mental Health in America 2015 NovwwwmentalhealthamericanetsitesdefaultfilesParity20or20Disparity20201520Reportpdf
bull [6]Bruce S Jonas ScM PhD Qiuping Gu MD PhD and Juan R Albertorio-Diaz MA (2013) [Online] CDC NCHS Data Brief Psychotropic Medication Use Among Adolescents United States 2005ndash2010 Dec Number 135httpwwwcdcgovnchsdatadatabriefsdb135htm
bull [7] C Buss EP Davis CJ Hobel and CA Sandman (2011) Maternal pregnancy-specific anxiety is associated with child executive function at 6ndash9 years age Stress Nov 14(6)665-676
bull [8] Council for Evidence-Based Psychiatry (UK) Web presentation ldquoUnrecognized Factsrdquo Authors James Davies Peter C Goetzsche Peter Kinderman Joanna Moncrieff Phillip Thomas Sami Timimi John Sandwich Melanie Davis Luke Montague httpcepukorgunrecognised-facts
bull [9] Johnstone Lucy (2015) A Straight Talking Introduction to Psychiatric DiagnosisPCCS Books 1st edition (February 3 2015)
bull [10] Brewin CR Andrews B Valentine JD (2000) ldquoMeta-analysis of risk factors for posttraumatic stress disorder in trauma-exposed adultsrdquo J Consult Clin Psychol2000 Oct68(5)748-66 httpwwwncbinlmnihgovpubmed11068961
bull [11] Williams Monica T (2013) ldquoCan Racism Cause PTSD Implications for DSM-5rdquoPsychology Today May 20 httpswwwpsychologytodaycomblogculturally-speaking201305can-racism-cause-ptsd-implications-dsm-5
Bibliography
bull [12] Yuan Chengmei et al (2011) ldquoProtective factors for posttraumatic stress disorder symptoms in a prospective study of police officersrdquo Nov 23httpwwwncbinlmnihgovpmcarticlesPMC3071439
bull [13] Chou Tina BA Anu Asnaani MA and Stefan G Hofmann PhD (2012) ldquoPerception of Racial Discrimination and Psychopathology Across Three US Ethnic Minority Groupsrdquo APA PsychNET Jan httpwwwncbinlmnihgovpmcarticlesPMC3505377
bull [14] Watson Laurel B Jacob M Marszalek Franco Dispenza and Christopher M Davids 2015 Understanding the Relationships Among White and African American Womenrsquos Sexual Objectification Experiences Physical Safety Anxiety and Psychological Distress Sex Roles 72 (34) 91-104
bull [15] Holland Julie (2015) ldquoMedicating Womenrsquos Feelingsrdquo New York TimesOpinion Feb 28 httpmobilenytimescom20150301opinionsundaymedicating-womens-feelingshtmlreferreramp_r=1
bull [16] Solinas M Thiriet N El Rawas R Lardeux V and Jaber M (2009) ldquoEnvironmental Enrichment During Early Stages of Life Reduces the Behavioral Neurochemical and Molecular Effects of Cocainerdquo Neuropsychopharmacology 34 1102ndash1111
bull [17] Hari Johann Chasing The Scream The First and Last Days of the War on Drugs Bloomsbury USA (January 20 2015)bull [18] Hughes Caitlin Elizabeth and Alex Stevens (2010) ldquoWhat Can We Learn From The Portuguese Decriminalization of Illicit
Drugsrdquo British Journal of Criminology July 21 httpbjcoxfordjournalsorgcontent506999abstractbull [19] Fournier Jay C et al (2009) ldquoAntidepressant Drug Effects and Depression Severityrdquo JAMA January
6th httpjamajamanetworkcomarticleaspxarticleid=185157[20] Currie J Stabile M Jones L (2013) Do Stimulant Medications Improve Educational and Behavioral Outcomes for Children with ADHD NBER Working Paper No 19105
bull [21] Mora-Ripoli R Organizacioacuten Mundial de la Risa Barcelona Spain ldquoThe therapeutic value of laughter in medicinerdquo Altern Ther Health Med 2010 Nov-Dec16(6)56-64 httpwwwncbinlmnihgovpubmed21280463
bull [22] Gracanin Asmir Lauren M Bylsma and Ad J J M Vingerhoets (2014) ldquoIs Crying a Self-Stoothing Behaviorrdquo Frontiers in Psychology May 28httpwwwncbinlmnihgovpmcarticlesPMC4035568
bull [23] Trimble Michael (2010) ldquoI Cry Therefore I Amrdquo New York Times Nov 10 httpwwwnytimescom20121111opinionsundayi-cry-therefore-i-amhtmlemc=eta1amp_r=0
bull [24]Gallup Andrew C et al (2007) ldquoYawning as a brain cooling mechanism Nasal breathing and forehead cooling diminish the incidence of contagious yawningrdquo httpwwwepjournalnetarticlesyawning-as-a-brain-cooling-mechanism-nasal-breathing-and-forehead-cooling-diminish-the-incidence-of-contagious-yawning
bull [25]Sharat Gupta and Shallu Mittal Int (2013) Yawning and its physiological significance Intl J Appl Basic Med Res Jan-Jun 3(1) 11ndash15
bull [26] Stephens R Atkins J Kingston A (2009) ldquoSwearing As a Response to Painrdquo NeuroReport Aug 5 httpwwwncbinlmnihgovpubmed19590391
bull [27]Morelli SA Lieberman MD(2013) rdquoThe role of automaticity and attention in neural processes underlying empathy for happiness sadness and anxietyrdquo Front Hum Neurosci May 87160
Bibliography
bull [1] Committee on Psychosocial Aspects of Child and Family Health Committee on Early Childhood Adoption and Dependent Care andSection on Developmental and Behavioral Pediatrics Andrew S Garner Jack P Shonkoff et al (2012) ldquoEarly Childhood Adversity Toxic Stress and the Role of the Pediatrician Translating Developmental Science Into Lifelong Healthrdquo Pediatrics January VOLUME 129 ISSUE 1 From the American Academy of Pediatrics Policy Statementhttppediatricsaappublicationsorgcontent1291e224fullref-23
bull [2] COUNCIL ON COMMUNITY PEDIATRICS Benjamin A Gitterman et al (2016) ldquoPoverty and Child Health in the United Statesrdquo Pediatrics March From the American Academy of Pediatrics Policy Statement Published Online March 09American Academy of Pediatricshttppediatricsaappublicationsorgcontentearly20160307peds2016-0339info
bull [3] Paul W Newacheck et al (2003) ldquoDisparities in Adolescent Health and Health Care Does Socioeconomic Status Matterrdquo Health ServRes Oct 38(5) 1235ndash1252 httpwwwncbinlmnihgovpmcarticlesPMC1360944
bull [4] Larson et al (2007) ldquoPoverty during pregnancy Its effects on child health outcomesrdquo Paediatr Child Health 2007 Oct 12(8) 673ndash677 httpwwwncbinlmnihgovpmcarticlesPMC2528810
bull [5] Lara J Akinbami et al (2012) ldquoTrends in Asthma Prevalence Health Care Use and Mortality in the United States 2001ndash2010rdquo NCHS Data Brief No 94 May httpwwwcdcgovnchsproductsdatabriefsdb94htm
bull [6] Cynthia L Ogden et al (2010) ldquoObesity and Socioeconomic Status in Children and Adolescents United States 2005-2008rdquoNCHS Data Brief No 51 Decemberhttpwwwcdcgovnchsproductsdatabriefsdb51htm
bull [7] Shonkoff JP et al Committee on Psychosocial Aspects of Child and Family Health Committee on Early Childhood Adoption and Dependent Care Section on Developmental and Behavioral Pediatrics rdquoThe lifelong effects of early childhood adversity and toxicstressrdquo Pediatrics 2012129(1) wwwpediatricsorgcgicontentfull1291e232
bull [8] Virginia A Rauh et alldquoHousing and HealthIntersection of Poverty and Environmental Exposuresrdquo (2008) Annals of the New York Academy of Sciences Volume 1136 Reducing the Impact of Poverty on Health and Human Development Scientific Approaches pages 276ndash288 June httponlinelibrarywileycomdoi101196annals1425032full
bull [9] Yehuda R et al (2015) ldquoHolocaust Exposure Induced Intergenerational Effects on FKBP5 MethylationrdquoBiol Psychiatry Aug 12 httpwwwncbinlmnihgovpubmed26410355
bull [10] Buss C et al (2011) ldquoMaternal pregnancy-specific anxiety is associated with child executive function at 6-9 years agerdquoStress Nov14(6)665-76 httpwwwncbinlmnihgovpubmed21995526
bull 11] Shankardass K et al (2014) ldquoParental stress increases body mass index trajectory in pre-adolescentsrdquoPediatr Obes Dec9(6)435-42 httpwwwncbinlmnihgovpubmed24311567
bull [12] Vincent J Felitti et al (1998) ldquoRelationship of Childhood Abuse and Household Dysfunction to Many of the Leading Causes of Death in Adults The Adverse Childhood Experiences (ACE) Studyrdquo May Volume 14 Issue 4 Pages 245ndash258 httpsacestoohighcom
bull [13]Jones CP Levels of Racism a Theoretic Framework and the Gardenerrsquos Tale Am J Public Health 200090(8) 1212-1215bull [14]Dion KL The Social Psycology of Perceived Perjudice and Discrimination Canadian Psychology (2002)431 pp 1-10bull [15]Sue D W Bucceri J Lin AI Nadal K L and Torino J C Racial Microaggressions and the Asian American experience APA (2007) Vol
13 No 1 pp 72-81bull [16]James S A (School of Public Health U of North Carolina Chapel Hill NC 27514) D S Strogatz S B Wing and D L Ramsey
Socioeconomic status John Henryism and hypertension in blacks and whites Am J Epidemiol 1987 126664ndash73bull [17]httpwwwapaorgpioemaresourcesethnicity-healthindexaspxbull [18]Porges SW Clinical Insights from the Polyvagal Theory The Transformative Power of Feeling Safe (Norton Series on Interpersonal
Neurobiology) W W Norton Apr 7 2014 - Psychology - 288 pagesbull [19]The Polyvagal Theory (Porges SW Social Connectedness as a Biological Imperative Understanding Trauma Through the Lens of
thePolyvagal Theory presentation 82015)bull [20]McEwen BS Allostasis and allostatic load implications for neuropsychopharmacologyNeuropsychopharmacology 2000
Feb22(2)108-24bull [21] McEwen BS adaptation and disease Allostasis and allostatic load Ann N Y Acad Sci 1998 May 184033-44bull [22] Arline T Geronimus ScD Margaret Hicken MPH Danya Keene MAT and John Bound PhD Weatheringrdquo and Age Patterns of
Allostatic Load Scores Among Blacks and Whites in the United States Am J Public Health 2006 May 96(5) 826ndash833bull [22]Stephen Porges PhD Polyvagal Perspective Biological Psychology 2007 Feb 74(2) 116ndash143 Published online 2006 Oct 16 bull [23]Stephen W Porges PhD The Polyvagal Theory Neurophysiological Foundations of Emotions Attachment Communication and
Self-regulation WWNorton and Company Inc 2011bull [24]Maggie Phillips PhD Reversing Chronic Pain North Atlantic Books 2007bull [25]Peter Levine PhD Waking the Tiger North Atlantic Books 1997bull [26]Bessel VanderKolk MD The Body Keeps the Score Viking Penguin 2014bullAcknowledgmentsbull Group Medical Visits and Group Facilitation Jeff Geller MDbull Re-evaluation Counseling Community bull Insight Meditation Communitybull Biodynamic Osteopathy Communitybull Learning To Breathe Mindfulness Training for Adolescents 2015 Patricia C Broderick PhD bull Stanford Chronic Disease Self Management Program Training 2014 Kate Lorig MPH RNbull Motivational Interviewing Training 2015 Steven Berg-Smithbull Centering Pregnancy Training 2014 Centering Healthcare Institutebull Motivating Change in Groups Training 2013 Kaiser Permanente Oakland Cabull Group Facilitation Training Sara Fisk PhD Community at Work San Francisco Cabull Tribes Training 2013 Center for Human Developmentbull Cultural Humility Training 2016 Melanie Tervalon MD
Bibliography
Intermediate Steps to Listening Session Handout
bull Step 1 Connect with yourself body mind and emotions
bull Step 2 Hold a non-judgmental space to be seen and heard
bull Step 3 See the speaker and anyone referenced as able to manifest their true human nature and evolve using inherent healing abilities
bull Step 4 Listen to the speaker in a deep connected way sending the message that their thinking feelings and being matters to you
bull Step 5 Encourage the speaker to express feelings or thoughts describe body sensations or share a story relevant to the feelings at hand
bull Step 6 Validate intense emotional expression and release such as crying laughing shaking yawning sweating as a sign of healing
bull Step 7 Remind the speaker of their underlying goodness intelligence strength and caring and your confidence in their ability to heal and manifest their true human nature
copy Elizabeth Rocco MD
Contact Information
bull Elizabeth Rocco MD -egroccogmailcom
bull Karen Ekwueme MD-impactdoc1gmailcom
Listening Practice
bull Turn to the person next to you
bull The person on the left will be the listener first and the other the speaker
bull Listener will listen while the speaker shares
bull Switch when time is called
When we define the effects of oppression as someonersquos ldquoillnessrdquo and ignore the root causes we obscure our path
forward in healing our communities
What if we reframed ldquochronic illnessrdquo as a societal struggle that requires societal
change and healing in community
1 Institutionalized oppression
2 Personally-mediated oppression or micro-aggressions
3 Internalized oppression
Teamnofearorg
Manifestations of Societal Oppression
Institutionalized Racism
Micro-aggressions
Internalized Racism
StressCumulative Effects
COGNITIVE BEHAVIORAL
EMOTIONAL NEURO PHYSIOLOGICAL
STRESS
Complex Societal Trauma (CST)Total Negative Health Impact over Generations
Societal Oppression
Familial Trauma
Societal Trauma
Complex Societal Trauma
copy Elizabeth Rocco MD
Intergenerational TransmissionHow is CST passed down to our children
1 Yehuda R et al (2015) ldquoHolocaust Exposure Induced Intergenerational Effects on FKBP5 MethylationrdquoBiol Psychiatry Aug 12 httpwwwncbinlmnihgovpubmed26410355B
2 Buss C et al (2011) ldquoMaternal pregnancy-specific anxiety is associated with child executive function at 6-9 years agerdquo Stress Nov14(6)665-76 httpwwwncbinlmnihgovpubmed21995526
3 Shankardass K et al (2014) ldquoParental stress increases body mass index trajectory in preadolescentsrdquoPediatr Obes Dec9(6)435-42 httpwwwncbinlmnihgovpubmed24311567
Complex Societal Trauma
is Toxic to the Developing Brain
Pat Levitt developmental neuroscientist and Dr Jack
Shonkoff part of the National Scientific Council on
the Developing Child
ACE (Adverse Childhood Experience) Study
Childhood neglect abuse and household dysfunction impacts health through out life
Vincent J Felitti et al (1998) ldquoRelationship of Childhood Abuse and Household Dysfunction to Many of the Leading Causes of Death in Adults
The Adverse Childhood Experiences (ACE) Studyrdquo May Volume 14 Issue 4 Pages 245ndash
258 httpsacestoohighcom
Healing Complex Societal Trauma
Social Engagement Ventral Vagal Complex
Reach for Help Ventral Vagal FEAR
Fight or FlightSympathetic
FEAR
FEAR
Freeze Collapse Dorsal Vagal
Pre-frontal CortexThe Voice of Reason
Human Healing and Evolution through Self-Awareness Embodiment Empowerment and Connection
Mindfulness Breath work Martial Arts Exercise Yoga Singing Dancing
Acupuncture Massage ReikiCommunity Groups Animals Church Nature
Final Listening Practice and Closing Circle
Bibliography
bull Special Acknowledgement of Demie Stathoplos MSW and Bonnie Cohen MD who collaborated with Elizabeth Rocco MD on the IM4US August 2015 presentation ldquoListening to Each Other Healing the Negative Health Impacts of Racism Poverty and Trauma through Human Connectionrdquo
bull Special Acknowledgement of Karen Burt MD who collaborated with Elizabeth Rocco MD and Karen Ekwueme MD on the IM4US August 2016 presentation ldquoListening to Ourselves and Each Other Healing the Negative Health Impact of Racism Poverty Sexism and Traumardquo These bibliographies are included below
bull [1]Wen Patricia (2010) ldquoA legacy of unintended side effectsrdquo Boston Globe December 12 httpwwwbostoncomnewslocalmassachusettsarticles20101212with_ssi_program_a_legcy_of_unintended_side_effects
bull [2]CCHR International (2014) [Online] Number of Children amp Adolescents Taking Psychiatric Drugs in the US Aprilwwwcchrintorgpsychiatric-drugschildren-on-psychiatric-drugs
bull [3]Whitaker R (2010) Anatomy of an Epidemic Magic Bullets Psychiatric Drugs and the Astonishing Rise of Mental Illness in America Crown Publishing Company httprobertwhitakerorgrobertwhitakerorgAnatomy20of20an20Epidemichtml
bull [3]CDC (2013) [Online] MMRW Mental Health Surveillance Among Children mdash United States 2005ndash2011 Supplements May 17 62(02)1-35 httpwwwcdcgovmmwrpreviewmmwrhtmlsu6202a1htm
bull [4]Patricia N Pastor PhD Cynthia A Reuben MA Catherine R Duran BS and LaJeana D Hawkins MPH CHES (2015) [Online] CDC NCHS Data Brief Association Between Diagnosed ADHD and Selected Characteristics Among Children Aged 4ndash17 Years United States 2011ndash2013 May Number 201 httpwwwcdcgovnchsdatadatabriefsdb201htm
bull [5]Mental Health America (2014) Parity or Disparity The State of Mental Health in America 2015 NovwwwmentalhealthamericanetsitesdefaultfilesParity20or20Disparity20201520Reportpdf
bull [6]Bruce S Jonas ScM PhD Qiuping Gu MD PhD and Juan R Albertorio-Diaz MA (2013) [Online] CDC NCHS Data Brief Psychotropic Medication Use Among Adolescents United States 2005ndash2010 Dec Number 135httpwwwcdcgovnchsdatadatabriefsdb135htm
bull [7] C Buss EP Davis CJ Hobel and CA Sandman (2011) Maternal pregnancy-specific anxiety is associated with child executive function at 6ndash9 years age Stress Nov 14(6)665-676
bull [8] Council for Evidence-Based Psychiatry (UK) Web presentation ldquoUnrecognized Factsrdquo Authors James Davies Peter C Goetzsche Peter Kinderman Joanna Moncrieff Phillip Thomas Sami Timimi John Sandwich Melanie Davis Luke Montague httpcepukorgunrecognised-facts
bull [9] Johnstone Lucy (2015) A Straight Talking Introduction to Psychiatric DiagnosisPCCS Books 1st edition (February 3 2015)
bull [10] Brewin CR Andrews B Valentine JD (2000) ldquoMeta-analysis of risk factors for posttraumatic stress disorder in trauma-exposed adultsrdquo J Consult Clin Psychol2000 Oct68(5)748-66 httpwwwncbinlmnihgovpubmed11068961
bull [11] Williams Monica T (2013) ldquoCan Racism Cause PTSD Implications for DSM-5rdquoPsychology Today May 20 httpswwwpsychologytodaycomblogculturally-speaking201305can-racism-cause-ptsd-implications-dsm-5
Bibliography
bull [12] Yuan Chengmei et al (2011) ldquoProtective factors for posttraumatic stress disorder symptoms in a prospective study of police officersrdquo Nov 23httpwwwncbinlmnihgovpmcarticlesPMC3071439
bull [13] Chou Tina BA Anu Asnaani MA and Stefan G Hofmann PhD (2012) ldquoPerception of Racial Discrimination and Psychopathology Across Three US Ethnic Minority Groupsrdquo APA PsychNET Jan httpwwwncbinlmnihgovpmcarticlesPMC3505377
bull [14] Watson Laurel B Jacob M Marszalek Franco Dispenza and Christopher M Davids 2015 Understanding the Relationships Among White and African American Womenrsquos Sexual Objectification Experiences Physical Safety Anxiety and Psychological Distress Sex Roles 72 (34) 91-104
bull [15] Holland Julie (2015) ldquoMedicating Womenrsquos Feelingsrdquo New York TimesOpinion Feb 28 httpmobilenytimescom20150301opinionsundaymedicating-womens-feelingshtmlreferreramp_r=1
bull [16] Solinas M Thiriet N El Rawas R Lardeux V and Jaber M (2009) ldquoEnvironmental Enrichment During Early Stages of Life Reduces the Behavioral Neurochemical and Molecular Effects of Cocainerdquo Neuropsychopharmacology 34 1102ndash1111
bull [17] Hari Johann Chasing The Scream The First and Last Days of the War on Drugs Bloomsbury USA (January 20 2015)bull [18] Hughes Caitlin Elizabeth and Alex Stevens (2010) ldquoWhat Can We Learn From The Portuguese Decriminalization of Illicit
Drugsrdquo British Journal of Criminology July 21 httpbjcoxfordjournalsorgcontent506999abstractbull [19] Fournier Jay C et al (2009) ldquoAntidepressant Drug Effects and Depression Severityrdquo JAMA January
6th httpjamajamanetworkcomarticleaspxarticleid=185157[20] Currie J Stabile M Jones L (2013) Do Stimulant Medications Improve Educational and Behavioral Outcomes for Children with ADHD NBER Working Paper No 19105
bull [21] Mora-Ripoli R Organizacioacuten Mundial de la Risa Barcelona Spain ldquoThe therapeutic value of laughter in medicinerdquo Altern Ther Health Med 2010 Nov-Dec16(6)56-64 httpwwwncbinlmnihgovpubmed21280463
bull [22] Gracanin Asmir Lauren M Bylsma and Ad J J M Vingerhoets (2014) ldquoIs Crying a Self-Stoothing Behaviorrdquo Frontiers in Psychology May 28httpwwwncbinlmnihgovpmcarticlesPMC4035568
bull [23] Trimble Michael (2010) ldquoI Cry Therefore I Amrdquo New York Times Nov 10 httpwwwnytimescom20121111opinionsundayi-cry-therefore-i-amhtmlemc=eta1amp_r=0
bull [24]Gallup Andrew C et al (2007) ldquoYawning as a brain cooling mechanism Nasal breathing and forehead cooling diminish the incidence of contagious yawningrdquo httpwwwepjournalnetarticlesyawning-as-a-brain-cooling-mechanism-nasal-breathing-and-forehead-cooling-diminish-the-incidence-of-contagious-yawning
bull [25]Sharat Gupta and Shallu Mittal Int (2013) Yawning and its physiological significance Intl J Appl Basic Med Res Jan-Jun 3(1) 11ndash15
bull [26] Stephens R Atkins J Kingston A (2009) ldquoSwearing As a Response to Painrdquo NeuroReport Aug 5 httpwwwncbinlmnihgovpubmed19590391
bull [27]Morelli SA Lieberman MD(2013) rdquoThe role of automaticity and attention in neural processes underlying empathy for happiness sadness and anxietyrdquo Front Hum Neurosci May 87160
Bibliography
bull [1] Committee on Psychosocial Aspects of Child and Family Health Committee on Early Childhood Adoption and Dependent Care andSection on Developmental and Behavioral Pediatrics Andrew S Garner Jack P Shonkoff et al (2012) ldquoEarly Childhood Adversity Toxic Stress and the Role of the Pediatrician Translating Developmental Science Into Lifelong Healthrdquo Pediatrics January VOLUME 129 ISSUE 1 From the American Academy of Pediatrics Policy Statementhttppediatricsaappublicationsorgcontent1291e224fullref-23
bull [2] COUNCIL ON COMMUNITY PEDIATRICS Benjamin A Gitterman et al (2016) ldquoPoverty and Child Health in the United Statesrdquo Pediatrics March From the American Academy of Pediatrics Policy Statement Published Online March 09American Academy of Pediatricshttppediatricsaappublicationsorgcontentearly20160307peds2016-0339info
bull [3] Paul W Newacheck et al (2003) ldquoDisparities in Adolescent Health and Health Care Does Socioeconomic Status Matterrdquo Health ServRes Oct 38(5) 1235ndash1252 httpwwwncbinlmnihgovpmcarticlesPMC1360944
bull [4] Larson et al (2007) ldquoPoverty during pregnancy Its effects on child health outcomesrdquo Paediatr Child Health 2007 Oct 12(8) 673ndash677 httpwwwncbinlmnihgovpmcarticlesPMC2528810
bull [5] Lara J Akinbami et al (2012) ldquoTrends in Asthma Prevalence Health Care Use and Mortality in the United States 2001ndash2010rdquo NCHS Data Brief No 94 May httpwwwcdcgovnchsproductsdatabriefsdb94htm
bull [6] Cynthia L Ogden et al (2010) ldquoObesity and Socioeconomic Status in Children and Adolescents United States 2005-2008rdquoNCHS Data Brief No 51 Decemberhttpwwwcdcgovnchsproductsdatabriefsdb51htm
bull [7] Shonkoff JP et al Committee on Psychosocial Aspects of Child and Family Health Committee on Early Childhood Adoption and Dependent Care Section on Developmental and Behavioral Pediatrics rdquoThe lifelong effects of early childhood adversity and toxicstressrdquo Pediatrics 2012129(1) wwwpediatricsorgcgicontentfull1291e232
bull [8] Virginia A Rauh et alldquoHousing and HealthIntersection of Poverty and Environmental Exposuresrdquo (2008) Annals of the New York Academy of Sciences Volume 1136 Reducing the Impact of Poverty on Health and Human Development Scientific Approaches pages 276ndash288 June httponlinelibrarywileycomdoi101196annals1425032full
bull [9] Yehuda R et al (2015) ldquoHolocaust Exposure Induced Intergenerational Effects on FKBP5 MethylationrdquoBiol Psychiatry Aug 12 httpwwwncbinlmnihgovpubmed26410355
bull [10] Buss C et al (2011) ldquoMaternal pregnancy-specific anxiety is associated with child executive function at 6-9 years agerdquoStress Nov14(6)665-76 httpwwwncbinlmnihgovpubmed21995526
bull 11] Shankardass K et al (2014) ldquoParental stress increases body mass index trajectory in pre-adolescentsrdquoPediatr Obes Dec9(6)435-42 httpwwwncbinlmnihgovpubmed24311567
bull [12] Vincent J Felitti et al (1998) ldquoRelationship of Childhood Abuse and Household Dysfunction to Many of the Leading Causes of Death in Adults The Adverse Childhood Experiences (ACE) Studyrdquo May Volume 14 Issue 4 Pages 245ndash258 httpsacestoohighcom
bull [13]Jones CP Levels of Racism a Theoretic Framework and the Gardenerrsquos Tale Am J Public Health 200090(8) 1212-1215bull [14]Dion KL The Social Psycology of Perceived Perjudice and Discrimination Canadian Psychology (2002)431 pp 1-10bull [15]Sue D W Bucceri J Lin AI Nadal K L and Torino J C Racial Microaggressions and the Asian American experience APA (2007) Vol
13 No 1 pp 72-81bull [16]James S A (School of Public Health U of North Carolina Chapel Hill NC 27514) D S Strogatz S B Wing and D L Ramsey
Socioeconomic status John Henryism and hypertension in blacks and whites Am J Epidemiol 1987 126664ndash73bull [17]httpwwwapaorgpioemaresourcesethnicity-healthindexaspxbull [18]Porges SW Clinical Insights from the Polyvagal Theory The Transformative Power of Feeling Safe (Norton Series on Interpersonal
Neurobiology) W W Norton Apr 7 2014 - Psychology - 288 pagesbull [19]The Polyvagal Theory (Porges SW Social Connectedness as a Biological Imperative Understanding Trauma Through the Lens of
thePolyvagal Theory presentation 82015)bull [20]McEwen BS Allostasis and allostatic load implications for neuropsychopharmacologyNeuropsychopharmacology 2000
Feb22(2)108-24bull [21] McEwen BS adaptation and disease Allostasis and allostatic load Ann N Y Acad Sci 1998 May 184033-44bull [22] Arline T Geronimus ScD Margaret Hicken MPH Danya Keene MAT and John Bound PhD Weatheringrdquo and Age Patterns of
Allostatic Load Scores Among Blacks and Whites in the United States Am J Public Health 2006 May 96(5) 826ndash833bull [22]Stephen Porges PhD Polyvagal Perspective Biological Psychology 2007 Feb 74(2) 116ndash143 Published online 2006 Oct 16 bull [23]Stephen W Porges PhD The Polyvagal Theory Neurophysiological Foundations of Emotions Attachment Communication and
Self-regulation WWNorton and Company Inc 2011bull [24]Maggie Phillips PhD Reversing Chronic Pain North Atlantic Books 2007bull [25]Peter Levine PhD Waking the Tiger North Atlantic Books 1997bull [26]Bessel VanderKolk MD The Body Keeps the Score Viking Penguin 2014bullAcknowledgmentsbull Group Medical Visits and Group Facilitation Jeff Geller MDbull Re-evaluation Counseling Community bull Insight Meditation Communitybull Biodynamic Osteopathy Communitybull Learning To Breathe Mindfulness Training for Adolescents 2015 Patricia C Broderick PhD bull Stanford Chronic Disease Self Management Program Training 2014 Kate Lorig MPH RNbull Motivational Interviewing Training 2015 Steven Berg-Smithbull Centering Pregnancy Training 2014 Centering Healthcare Institutebull Motivating Change in Groups Training 2013 Kaiser Permanente Oakland Cabull Group Facilitation Training Sara Fisk PhD Community at Work San Francisco Cabull Tribes Training 2013 Center for Human Developmentbull Cultural Humility Training 2016 Melanie Tervalon MD
Bibliography
Intermediate Steps to Listening Session Handout
bull Step 1 Connect with yourself body mind and emotions
bull Step 2 Hold a non-judgmental space to be seen and heard
bull Step 3 See the speaker and anyone referenced as able to manifest their true human nature and evolve using inherent healing abilities
bull Step 4 Listen to the speaker in a deep connected way sending the message that their thinking feelings and being matters to you
bull Step 5 Encourage the speaker to express feelings or thoughts describe body sensations or share a story relevant to the feelings at hand
bull Step 6 Validate intense emotional expression and release such as crying laughing shaking yawning sweating as a sign of healing
bull Step 7 Remind the speaker of their underlying goodness intelligence strength and caring and your confidence in their ability to heal and manifest their true human nature
copy Elizabeth Rocco MD
Contact Information
bull Elizabeth Rocco MD -egroccogmailcom
bull Karen Ekwueme MD-impactdoc1gmailcom
When we define the effects of oppression as someonersquos ldquoillnessrdquo and ignore the root causes we obscure our path
forward in healing our communities
What if we reframed ldquochronic illnessrdquo as a societal struggle that requires societal
change and healing in community
1 Institutionalized oppression
2 Personally-mediated oppression or micro-aggressions
3 Internalized oppression
Teamnofearorg
Manifestations of Societal Oppression
Institutionalized Racism
Micro-aggressions
Internalized Racism
StressCumulative Effects
COGNITIVE BEHAVIORAL
EMOTIONAL NEURO PHYSIOLOGICAL
STRESS
Complex Societal Trauma (CST)Total Negative Health Impact over Generations
Societal Oppression
Familial Trauma
Societal Trauma
Complex Societal Trauma
copy Elizabeth Rocco MD
Intergenerational TransmissionHow is CST passed down to our children
1 Yehuda R et al (2015) ldquoHolocaust Exposure Induced Intergenerational Effects on FKBP5 MethylationrdquoBiol Psychiatry Aug 12 httpwwwncbinlmnihgovpubmed26410355B
2 Buss C et al (2011) ldquoMaternal pregnancy-specific anxiety is associated with child executive function at 6-9 years agerdquo Stress Nov14(6)665-76 httpwwwncbinlmnihgovpubmed21995526
3 Shankardass K et al (2014) ldquoParental stress increases body mass index trajectory in preadolescentsrdquoPediatr Obes Dec9(6)435-42 httpwwwncbinlmnihgovpubmed24311567
Complex Societal Trauma
is Toxic to the Developing Brain
Pat Levitt developmental neuroscientist and Dr Jack
Shonkoff part of the National Scientific Council on
the Developing Child
ACE (Adverse Childhood Experience) Study
Childhood neglect abuse and household dysfunction impacts health through out life
Vincent J Felitti et al (1998) ldquoRelationship of Childhood Abuse and Household Dysfunction to Many of the Leading Causes of Death in Adults
The Adverse Childhood Experiences (ACE) Studyrdquo May Volume 14 Issue 4 Pages 245ndash
258 httpsacestoohighcom
Healing Complex Societal Trauma
Social Engagement Ventral Vagal Complex
Reach for Help Ventral Vagal FEAR
Fight or FlightSympathetic
FEAR
FEAR
Freeze Collapse Dorsal Vagal
Pre-frontal CortexThe Voice of Reason
Human Healing and Evolution through Self-Awareness Embodiment Empowerment and Connection
Mindfulness Breath work Martial Arts Exercise Yoga Singing Dancing
Acupuncture Massage ReikiCommunity Groups Animals Church Nature
Final Listening Practice and Closing Circle
Bibliography
bull Special Acknowledgement of Demie Stathoplos MSW and Bonnie Cohen MD who collaborated with Elizabeth Rocco MD on the IM4US August 2015 presentation ldquoListening to Each Other Healing the Negative Health Impacts of Racism Poverty and Trauma through Human Connectionrdquo
bull Special Acknowledgement of Karen Burt MD who collaborated with Elizabeth Rocco MD and Karen Ekwueme MD on the IM4US August 2016 presentation ldquoListening to Ourselves and Each Other Healing the Negative Health Impact of Racism Poverty Sexism and Traumardquo These bibliographies are included below
bull [1]Wen Patricia (2010) ldquoA legacy of unintended side effectsrdquo Boston Globe December 12 httpwwwbostoncomnewslocalmassachusettsarticles20101212with_ssi_program_a_legcy_of_unintended_side_effects
bull [2]CCHR International (2014) [Online] Number of Children amp Adolescents Taking Psychiatric Drugs in the US Aprilwwwcchrintorgpsychiatric-drugschildren-on-psychiatric-drugs
bull [3]Whitaker R (2010) Anatomy of an Epidemic Magic Bullets Psychiatric Drugs and the Astonishing Rise of Mental Illness in America Crown Publishing Company httprobertwhitakerorgrobertwhitakerorgAnatomy20of20an20Epidemichtml
bull [3]CDC (2013) [Online] MMRW Mental Health Surveillance Among Children mdash United States 2005ndash2011 Supplements May 17 62(02)1-35 httpwwwcdcgovmmwrpreviewmmwrhtmlsu6202a1htm
bull [4]Patricia N Pastor PhD Cynthia A Reuben MA Catherine R Duran BS and LaJeana D Hawkins MPH CHES (2015) [Online] CDC NCHS Data Brief Association Between Diagnosed ADHD and Selected Characteristics Among Children Aged 4ndash17 Years United States 2011ndash2013 May Number 201 httpwwwcdcgovnchsdatadatabriefsdb201htm
bull [5]Mental Health America (2014) Parity or Disparity The State of Mental Health in America 2015 NovwwwmentalhealthamericanetsitesdefaultfilesParity20or20Disparity20201520Reportpdf
bull [6]Bruce S Jonas ScM PhD Qiuping Gu MD PhD and Juan R Albertorio-Diaz MA (2013) [Online] CDC NCHS Data Brief Psychotropic Medication Use Among Adolescents United States 2005ndash2010 Dec Number 135httpwwwcdcgovnchsdatadatabriefsdb135htm
bull [7] C Buss EP Davis CJ Hobel and CA Sandman (2011) Maternal pregnancy-specific anxiety is associated with child executive function at 6ndash9 years age Stress Nov 14(6)665-676
bull [8] Council for Evidence-Based Psychiatry (UK) Web presentation ldquoUnrecognized Factsrdquo Authors James Davies Peter C Goetzsche Peter Kinderman Joanna Moncrieff Phillip Thomas Sami Timimi John Sandwich Melanie Davis Luke Montague httpcepukorgunrecognised-facts
bull [9] Johnstone Lucy (2015) A Straight Talking Introduction to Psychiatric DiagnosisPCCS Books 1st edition (February 3 2015)
bull [10] Brewin CR Andrews B Valentine JD (2000) ldquoMeta-analysis of risk factors for posttraumatic stress disorder in trauma-exposed adultsrdquo J Consult Clin Psychol2000 Oct68(5)748-66 httpwwwncbinlmnihgovpubmed11068961
bull [11] Williams Monica T (2013) ldquoCan Racism Cause PTSD Implications for DSM-5rdquoPsychology Today May 20 httpswwwpsychologytodaycomblogculturally-speaking201305can-racism-cause-ptsd-implications-dsm-5
Bibliography
bull [12] Yuan Chengmei et al (2011) ldquoProtective factors for posttraumatic stress disorder symptoms in a prospective study of police officersrdquo Nov 23httpwwwncbinlmnihgovpmcarticlesPMC3071439
bull [13] Chou Tina BA Anu Asnaani MA and Stefan G Hofmann PhD (2012) ldquoPerception of Racial Discrimination and Psychopathology Across Three US Ethnic Minority Groupsrdquo APA PsychNET Jan httpwwwncbinlmnihgovpmcarticlesPMC3505377
bull [14] Watson Laurel B Jacob M Marszalek Franco Dispenza and Christopher M Davids 2015 Understanding the Relationships Among White and African American Womenrsquos Sexual Objectification Experiences Physical Safety Anxiety and Psychological Distress Sex Roles 72 (34) 91-104
bull [15] Holland Julie (2015) ldquoMedicating Womenrsquos Feelingsrdquo New York TimesOpinion Feb 28 httpmobilenytimescom20150301opinionsundaymedicating-womens-feelingshtmlreferreramp_r=1
bull [16] Solinas M Thiriet N El Rawas R Lardeux V and Jaber M (2009) ldquoEnvironmental Enrichment During Early Stages of Life Reduces the Behavioral Neurochemical and Molecular Effects of Cocainerdquo Neuropsychopharmacology 34 1102ndash1111
bull [17] Hari Johann Chasing The Scream The First and Last Days of the War on Drugs Bloomsbury USA (January 20 2015)bull [18] Hughes Caitlin Elizabeth and Alex Stevens (2010) ldquoWhat Can We Learn From The Portuguese Decriminalization of Illicit
Drugsrdquo British Journal of Criminology July 21 httpbjcoxfordjournalsorgcontent506999abstractbull [19] Fournier Jay C et al (2009) ldquoAntidepressant Drug Effects and Depression Severityrdquo JAMA January
6th httpjamajamanetworkcomarticleaspxarticleid=185157[20] Currie J Stabile M Jones L (2013) Do Stimulant Medications Improve Educational and Behavioral Outcomes for Children with ADHD NBER Working Paper No 19105
bull [21] Mora-Ripoli R Organizacioacuten Mundial de la Risa Barcelona Spain ldquoThe therapeutic value of laughter in medicinerdquo Altern Ther Health Med 2010 Nov-Dec16(6)56-64 httpwwwncbinlmnihgovpubmed21280463
bull [22] Gracanin Asmir Lauren M Bylsma and Ad J J M Vingerhoets (2014) ldquoIs Crying a Self-Stoothing Behaviorrdquo Frontiers in Psychology May 28httpwwwncbinlmnihgovpmcarticlesPMC4035568
bull [23] Trimble Michael (2010) ldquoI Cry Therefore I Amrdquo New York Times Nov 10 httpwwwnytimescom20121111opinionsundayi-cry-therefore-i-amhtmlemc=eta1amp_r=0
bull [24]Gallup Andrew C et al (2007) ldquoYawning as a brain cooling mechanism Nasal breathing and forehead cooling diminish the incidence of contagious yawningrdquo httpwwwepjournalnetarticlesyawning-as-a-brain-cooling-mechanism-nasal-breathing-and-forehead-cooling-diminish-the-incidence-of-contagious-yawning
bull [25]Sharat Gupta and Shallu Mittal Int (2013) Yawning and its physiological significance Intl J Appl Basic Med Res Jan-Jun 3(1) 11ndash15
bull [26] Stephens R Atkins J Kingston A (2009) ldquoSwearing As a Response to Painrdquo NeuroReport Aug 5 httpwwwncbinlmnihgovpubmed19590391
bull [27]Morelli SA Lieberman MD(2013) rdquoThe role of automaticity and attention in neural processes underlying empathy for happiness sadness and anxietyrdquo Front Hum Neurosci May 87160
Bibliography
bull [1] Committee on Psychosocial Aspects of Child and Family Health Committee on Early Childhood Adoption and Dependent Care andSection on Developmental and Behavioral Pediatrics Andrew S Garner Jack P Shonkoff et al (2012) ldquoEarly Childhood Adversity Toxic Stress and the Role of the Pediatrician Translating Developmental Science Into Lifelong Healthrdquo Pediatrics January VOLUME 129 ISSUE 1 From the American Academy of Pediatrics Policy Statementhttppediatricsaappublicationsorgcontent1291e224fullref-23
bull [2] COUNCIL ON COMMUNITY PEDIATRICS Benjamin A Gitterman et al (2016) ldquoPoverty and Child Health in the United Statesrdquo Pediatrics March From the American Academy of Pediatrics Policy Statement Published Online March 09American Academy of Pediatricshttppediatricsaappublicationsorgcontentearly20160307peds2016-0339info
bull [3] Paul W Newacheck et al (2003) ldquoDisparities in Adolescent Health and Health Care Does Socioeconomic Status Matterrdquo Health ServRes Oct 38(5) 1235ndash1252 httpwwwncbinlmnihgovpmcarticlesPMC1360944
bull [4] Larson et al (2007) ldquoPoverty during pregnancy Its effects on child health outcomesrdquo Paediatr Child Health 2007 Oct 12(8) 673ndash677 httpwwwncbinlmnihgovpmcarticlesPMC2528810
bull [5] Lara J Akinbami et al (2012) ldquoTrends in Asthma Prevalence Health Care Use and Mortality in the United States 2001ndash2010rdquo NCHS Data Brief No 94 May httpwwwcdcgovnchsproductsdatabriefsdb94htm
bull [6] Cynthia L Ogden et al (2010) ldquoObesity and Socioeconomic Status in Children and Adolescents United States 2005-2008rdquoNCHS Data Brief No 51 Decemberhttpwwwcdcgovnchsproductsdatabriefsdb51htm
bull [7] Shonkoff JP et al Committee on Psychosocial Aspects of Child and Family Health Committee on Early Childhood Adoption and Dependent Care Section on Developmental and Behavioral Pediatrics rdquoThe lifelong effects of early childhood adversity and toxicstressrdquo Pediatrics 2012129(1) wwwpediatricsorgcgicontentfull1291e232
bull [8] Virginia A Rauh et alldquoHousing and HealthIntersection of Poverty and Environmental Exposuresrdquo (2008) Annals of the New York Academy of Sciences Volume 1136 Reducing the Impact of Poverty on Health and Human Development Scientific Approaches pages 276ndash288 June httponlinelibrarywileycomdoi101196annals1425032full
bull [9] Yehuda R et al (2015) ldquoHolocaust Exposure Induced Intergenerational Effects on FKBP5 MethylationrdquoBiol Psychiatry Aug 12 httpwwwncbinlmnihgovpubmed26410355
bull [10] Buss C et al (2011) ldquoMaternal pregnancy-specific anxiety is associated with child executive function at 6-9 years agerdquoStress Nov14(6)665-76 httpwwwncbinlmnihgovpubmed21995526
bull 11] Shankardass K et al (2014) ldquoParental stress increases body mass index trajectory in pre-adolescentsrdquoPediatr Obes Dec9(6)435-42 httpwwwncbinlmnihgovpubmed24311567
bull [12] Vincent J Felitti et al (1998) ldquoRelationship of Childhood Abuse and Household Dysfunction to Many of the Leading Causes of Death in Adults The Adverse Childhood Experiences (ACE) Studyrdquo May Volume 14 Issue 4 Pages 245ndash258 httpsacestoohighcom
bull [13]Jones CP Levels of Racism a Theoretic Framework and the Gardenerrsquos Tale Am J Public Health 200090(8) 1212-1215bull [14]Dion KL The Social Psycology of Perceived Perjudice and Discrimination Canadian Psychology (2002)431 pp 1-10bull [15]Sue D W Bucceri J Lin AI Nadal K L and Torino J C Racial Microaggressions and the Asian American experience APA (2007) Vol
13 No 1 pp 72-81bull [16]James S A (School of Public Health U of North Carolina Chapel Hill NC 27514) D S Strogatz S B Wing and D L Ramsey
Socioeconomic status John Henryism and hypertension in blacks and whites Am J Epidemiol 1987 126664ndash73bull [17]httpwwwapaorgpioemaresourcesethnicity-healthindexaspxbull [18]Porges SW Clinical Insights from the Polyvagal Theory The Transformative Power of Feeling Safe (Norton Series on Interpersonal
Neurobiology) W W Norton Apr 7 2014 - Psychology - 288 pagesbull [19]The Polyvagal Theory (Porges SW Social Connectedness as a Biological Imperative Understanding Trauma Through the Lens of
thePolyvagal Theory presentation 82015)bull [20]McEwen BS Allostasis and allostatic load implications for neuropsychopharmacologyNeuropsychopharmacology 2000
Feb22(2)108-24bull [21] McEwen BS adaptation and disease Allostasis and allostatic load Ann N Y Acad Sci 1998 May 184033-44bull [22] Arline T Geronimus ScD Margaret Hicken MPH Danya Keene MAT and John Bound PhD Weatheringrdquo and Age Patterns of
Allostatic Load Scores Among Blacks and Whites in the United States Am J Public Health 2006 May 96(5) 826ndash833bull [22]Stephen Porges PhD Polyvagal Perspective Biological Psychology 2007 Feb 74(2) 116ndash143 Published online 2006 Oct 16 bull [23]Stephen W Porges PhD The Polyvagal Theory Neurophysiological Foundations of Emotions Attachment Communication and
Self-regulation WWNorton and Company Inc 2011bull [24]Maggie Phillips PhD Reversing Chronic Pain North Atlantic Books 2007bull [25]Peter Levine PhD Waking the Tiger North Atlantic Books 1997bull [26]Bessel VanderKolk MD The Body Keeps the Score Viking Penguin 2014bullAcknowledgmentsbull Group Medical Visits and Group Facilitation Jeff Geller MDbull Re-evaluation Counseling Community bull Insight Meditation Communitybull Biodynamic Osteopathy Communitybull Learning To Breathe Mindfulness Training for Adolescents 2015 Patricia C Broderick PhD bull Stanford Chronic Disease Self Management Program Training 2014 Kate Lorig MPH RNbull Motivational Interviewing Training 2015 Steven Berg-Smithbull Centering Pregnancy Training 2014 Centering Healthcare Institutebull Motivating Change in Groups Training 2013 Kaiser Permanente Oakland Cabull Group Facilitation Training Sara Fisk PhD Community at Work San Francisco Cabull Tribes Training 2013 Center for Human Developmentbull Cultural Humility Training 2016 Melanie Tervalon MD
Bibliography
Intermediate Steps to Listening Session Handout
bull Step 1 Connect with yourself body mind and emotions
bull Step 2 Hold a non-judgmental space to be seen and heard
bull Step 3 See the speaker and anyone referenced as able to manifest their true human nature and evolve using inherent healing abilities
bull Step 4 Listen to the speaker in a deep connected way sending the message that their thinking feelings and being matters to you
bull Step 5 Encourage the speaker to express feelings or thoughts describe body sensations or share a story relevant to the feelings at hand
bull Step 6 Validate intense emotional expression and release such as crying laughing shaking yawning sweating as a sign of healing
bull Step 7 Remind the speaker of their underlying goodness intelligence strength and caring and your confidence in their ability to heal and manifest their true human nature
copy Elizabeth Rocco MD
Contact Information
bull Elizabeth Rocco MD -egroccogmailcom
bull Karen Ekwueme MD-impactdoc1gmailcom
What if we reframed ldquochronic illnessrdquo as a societal struggle that requires societal
change and healing in community
1 Institutionalized oppression
2 Personally-mediated oppression or micro-aggressions
3 Internalized oppression
Teamnofearorg
Manifestations of Societal Oppression
Institutionalized Racism
Micro-aggressions
Internalized Racism
StressCumulative Effects
COGNITIVE BEHAVIORAL
EMOTIONAL NEURO PHYSIOLOGICAL
STRESS
Complex Societal Trauma (CST)Total Negative Health Impact over Generations
Societal Oppression
Familial Trauma
Societal Trauma
Complex Societal Trauma
copy Elizabeth Rocco MD
Intergenerational TransmissionHow is CST passed down to our children
1 Yehuda R et al (2015) ldquoHolocaust Exposure Induced Intergenerational Effects on FKBP5 MethylationrdquoBiol Psychiatry Aug 12 httpwwwncbinlmnihgovpubmed26410355B
2 Buss C et al (2011) ldquoMaternal pregnancy-specific anxiety is associated with child executive function at 6-9 years agerdquo Stress Nov14(6)665-76 httpwwwncbinlmnihgovpubmed21995526
3 Shankardass K et al (2014) ldquoParental stress increases body mass index trajectory in preadolescentsrdquoPediatr Obes Dec9(6)435-42 httpwwwncbinlmnihgovpubmed24311567
Complex Societal Trauma
is Toxic to the Developing Brain
Pat Levitt developmental neuroscientist and Dr Jack
Shonkoff part of the National Scientific Council on
the Developing Child
ACE (Adverse Childhood Experience) Study
Childhood neglect abuse and household dysfunction impacts health through out life
Vincent J Felitti et al (1998) ldquoRelationship of Childhood Abuse and Household Dysfunction to Many of the Leading Causes of Death in Adults
The Adverse Childhood Experiences (ACE) Studyrdquo May Volume 14 Issue 4 Pages 245ndash
258 httpsacestoohighcom
Healing Complex Societal Trauma
Social Engagement Ventral Vagal Complex
Reach for Help Ventral Vagal FEAR
Fight or FlightSympathetic
FEAR
FEAR
Freeze Collapse Dorsal Vagal
Pre-frontal CortexThe Voice of Reason
Human Healing and Evolution through Self-Awareness Embodiment Empowerment and Connection
Mindfulness Breath work Martial Arts Exercise Yoga Singing Dancing
Acupuncture Massage ReikiCommunity Groups Animals Church Nature
Final Listening Practice and Closing Circle
Bibliography
bull Special Acknowledgement of Demie Stathoplos MSW and Bonnie Cohen MD who collaborated with Elizabeth Rocco MD on the IM4US August 2015 presentation ldquoListening to Each Other Healing the Negative Health Impacts of Racism Poverty and Trauma through Human Connectionrdquo
bull Special Acknowledgement of Karen Burt MD who collaborated with Elizabeth Rocco MD and Karen Ekwueme MD on the IM4US August 2016 presentation ldquoListening to Ourselves and Each Other Healing the Negative Health Impact of Racism Poverty Sexism and Traumardquo These bibliographies are included below
bull [1]Wen Patricia (2010) ldquoA legacy of unintended side effectsrdquo Boston Globe December 12 httpwwwbostoncomnewslocalmassachusettsarticles20101212with_ssi_program_a_legcy_of_unintended_side_effects
bull [2]CCHR International (2014) [Online] Number of Children amp Adolescents Taking Psychiatric Drugs in the US Aprilwwwcchrintorgpsychiatric-drugschildren-on-psychiatric-drugs
bull [3]Whitaker R (2010) Anatomy of an Epidemic Magic Bullets Psychiatric Drugs and the Astonishing Rise of Mental Illness in America Crown Publishing Company httprobertwhitakerorgrobertwhitakerorgAnatomy20of20an20Epidemichtml
bull [3]CDC (2013) [Online] MMRW Mental Health Surveillance Among Children mdash United States 2005ndash2011 Supplements May 17 62(02)1-35 httpwwwcdcgovmmwrpreviewmmwrhtmlsu6202a1htm
bull [4]Patricia N Pastor PhD Cynthia A Reuben MA Catherine R Duran BS and LaJeana D Hawkins MPH CHES (2015) [Online] CDC NCHS Data Brief Association Between Diagnosed ADHD and Selected Characteristics Among Children Aged 4ndash17 Years United States 2011ndash2013 May Number 201 httpwwwcdcgovnchsdatadatabriefsdb201htm
bull [5]Mental Health America (2014) Parity or Disparity The State of Mental Health in America 2015 NovwwwmentalhealthamericanetsitesdefaultfilesParity20or20Disparity20201520Reportpdf
bull [6]Bruce S Jonas ScM PhD Qiuping Gu MD PhD and Juan R Albertorio-Diaz MA (2013) [Online] CDC NCHS Data Brief Psychotropic Medication Use Among Adolescents United States 2005ndash2010 Dec Number 135httpwwwcdcgovnchsdatadatabriefsdb135htm
bull [7] C Buss EP Davis CJ Hobel and CA Sandman (2011) Maternal pregnancy-specific anxiety is associated with child executive function at 6ndash9 years age Stress Nov 14(6)665-676
bull [8] Council for Evidence-Based Psychiatry (UK) Web presentation ldquoUnrecognized Factsrdquo Authors James Davies Peter C Goetzsche Peter Kinderman Joanna Moncrieff Phillip Thomas Sami Timimi John Sandwich Melanie Davis Luke Montague httpcepukorgunrecognised-facts
bull [9] Johnstone Lucy (2015) A Straight Talking Introduction to Psychiatric DiagnosisPCCS Books 1st edition (February 3 2015)
bull [10] Brewin CR Andrews B Valentine JD (2000) ldquoMeta-analysis of risk factors for posttraumatic stress disorder in trauma-exposed adultsrdquo J Consult Clin Psychol2000 Oct68(5)748-66 httpwwwncbinlmnihgovpubmed11068961
bull [11] Williams Monica T (2013) ldquoCan Racism Cause PTSD Implications for DSM-5rdquoPsychology Today May 20 httpswwwpsychologytodaycomblogculturally-speaking201305can-racism-cause-ptsd-implications-dsm-5
Bibliography
bull [12] Yuan Chengmei et al (2011) ldquoProtective factors for posttraumatic stress disorder symptoms in a prospective study of police officersrdquo Nov 23httpwwwncbinlmnihgovpmcarticlesPMC3071439
bull [13] Chou Tina BA Anu Asnaani MA and Stefan G Hofmann PhD (2012) ldquoPerception of Racial Discrimination and Psychopathology Across Three US Ethnic Minority Groupsrdquo APA PsychNET Jan httpwwwncbinlmnihgovpmcarticlesPMC3505377
bull [14] Watson Laurel B Jacob M Marszalek Franco Dispenza and Christopher M Davids 2015 Understanding the Relationships Among White and African American Womenrsquos Sexual Objectification Experiences Physical Safety Anxiety and Psychological Distress Sex Roles 72 (34) 91-104
bull [15] Holland Julie (2015) ldquoMedicating Womenrsquos Feelingsrdquo New York TimesOpinion Feb 28 httpmobilenytimescom20150301opinionsundaymedicating-womens-feelingshtmlreferreramp_r=1
bull [16] Solinas M Thiriet N El Rawas R Lardeux V and Jaber M (2009) ldquoEnvironmental Enrichment During Early Stages of Life Reduces the Behavioral Neurochemical and Molecular Effects of Cocainerdquo Neuropsychopharmacology 34 1102ndash1111
bull [17] Hari Johann Chasing The Scream The First and Last Days of the War on Drugs Bloomsbury USA (January 20 2015)bull [18] Hughes Caitlin Elizabeth and Alex Stevens (2010) ldquoWhat Can We Learn From The Portuguese Decriminalization of Illicit
Drugsrdquo British Journal of Criminology July 21 httpbjcoxfordjournalsorgcontent506999abstractbull [19] Fournier Jay C et al (2009) ldquoAntidepressant Drug Effects and Depression Severityrdquo JAMA January
6th httpjamajamanetworkcomarticleaspxarticleid=185157[20] Currie J Stabile M Jones L (2013) Do Stimulant Medications Improve Educational and Behavioral Outcomes for Children with ADHD NBER Working Paper No 19105
bull [21] Mora-Ripoli R Organizacioacuten Mundial de la Risa Barcelona Spain ldquoThe therapeutic value of laughter in medicinerdquo Altern Ther Health Med 2010 Nov-Dec16(6)56-64 httpwwwncbinlmnihgovpubmed21280463
bull [22] Gracanin Asmir Lauren M Bylsma and Ad J J M Vingerhoets (2014) ldquoIs Crying a Self-Stoothing Behaviorrdquo Frontiers in Psychology May 28httpwwwncbinlmnihgovpmcarticlesPMC4035568
bull [23] Trimble Michael (2010) ldquoI Cry Therefore I Amrdquo New York Times Nov 10 httpwwwnytimescom20121111opinionsundayi-cry-therefore-i-amhtmlemc=eta1amp_r=0
bull [24]Gallup Andrew C et al (2007) ldquoYawning as a brain cooling mechanism Nasal breathing and forehead cooling diminish the incidence of contagious yawningrdquo httpwwwepjournalnetarticlesyawning-as-a-brain-cooling-mechanism-nasal-breathing-and-forehead-cooling-diminish-the-incidence-of-contagious-yawning
bull [25]Sharat Gupta and Shallu Mittal Int (2013) Yawning and its physiological significance Intl J Appl Basic Med Res Jan-Jun 3(1) 11ndash15
bull [26] Stephens R Atkins J Kingston A (2009) ldquoSwearing As a Response to Painrdquo NeuroReport Aug 5 httpwwwncbinlmnihgovpubmed19590391
bull [27]Morelli SA Lieberman MD(2013) rdquoThe role of automaticity and attention in neural processes underlying empathy for happiness sadness and anxietyrdquo Front Hum Neurosci May 87160
Bibliography
bull [1] Committee on Psychosocial Aspects of Child and Family Health Committee on Early Childhood Adoption and Dependent Care andSection on Developmental and Behavioral Pediatrics Andrew S Garner Jack P Shonkoff et al (2012) ldquoEarly Childhood Adversity Toxic Stress and the Role of the Pediatrician Translating Developmental Science Into Lifelong Healthrdquo Pediatrics January VOLUME 129 ISSUE 1 From the American Academy of Pediatrics Policy Statementhttppediatricsaappublicationsorgcontent1291e224fullref-23
bull [2] COUNCIL ON COMMUNITY PEDIATRICS Benjamin A Gitterman et al (2016) ldquoPoverty and Child Health in the United Statesrdquo Pediatrics March From the American Academy of Pediatrics Policy Statement Published Online March 09American Academy of Pediatricshttppediatricsaappublicationsorgcontentearly20160307peds2016-0339info
bull [3] Paul W Newacheck et al (2003) ldquoDisparities in Adolescent Health and Health Care Does Socioeconomic Status Matterrdquo Health ServRes Oct 38(5) 1235ndash1252 httpwwwncbinlmnihgovpmcarticlesPMC1360944
bull [4] Larson et al (2007) ldquoPoverty during pregnancy Its effects on child health outcomesrdquo Paediatr Child Health 2007 Oct 12(8) 673ndash677 httpwwwncbinlmnihgovpmcarticlesPMC2528810
bull [5] Lara J Akinbami et al (2012) ldquoTrends in Asthma Prevalence Health Care Use and Mortality in the United States 2001ndash2010rdquo NCHS Data Brief No 94 May httpwwwcdcgovnchsproductsdatabriefsdb94htm
bull [6] Cynthia L Ogden et al (2010) ldquoObesity and Socioeconomic Status in Children and Adolescents United States 2005-2008rdquoNCHS Data Brief No 51 Decemberhttpwwwcdcgovnchsproductsdatabriefsdb51htm
bull [7] Shonkoff JP et al Committee on Psychosocial Aspects of Child and Family Health Committee on Early Childhood Adoption and Dependent Care Section on Developmental and Behavioral Pediatrics rdquoThe lifelong effects of early childhood adversity and toxicstressrdquo Pediatrics 2012129(1) wwwpediatricsorgcgicontentfull1291e232
bull [8] Virginia A Rauh et alldquoHousing and HealthIntersection of Poverty and Environmental Exposuresrdquo (2008) Annals of the New York Academy of Sciences Volume 1136 Reducing the Impact of Poverty on Health and Human Development Scientific Approaches pages 276ndash288 June httponlinelibrarywileycomdoi101196annals1425032full
bull [9] Yehuda R et al (2015) ldquoHolocaust Exposure Induced Intergenerational Effects on FKBP5 MethylationrdquoBiol Psychiatry Aug 12 httpwwwncbinlmnihgovpubmed26410355
bull [10] Buss C et al (2011) ldquoMaternal pregnancy-specific anxiety is associated with child executive function at 6-9 years agerdquoStress Nov14(6)665-76 httpwwwncbinlmnihgovpubmed21995526
bull 11] Shankardass K et al (2014) ldquoParental stress increases body mass index trajectory in pre-adolescentsrdquoPediatr Obes Dec9(6)435-42 httpwwwncbinlmnihgovpubmed24311567
bull [12] Vincent J Felitti et al (1998) ldquoRelationship of Childhood Abuse and Household Dysfunction to Many of the Leading Causes of Death in Adults The Adverse Childhood Experiences (ACE) Studyrdquo May Volume 14 Issue 4 Pages 245ndash258 httpsacestoohighcom
bull [13]Jones CP Levels of Racism a Theoretic Framework and the Gardenerrsquos Tale Am J Public Health 200090(8) 1212-1215bull [14]Dion KL The Social Psycology of Perceived Perjudice and Discrimination Canadian Psychology (2002)431 pp 1-10bull [15]Sue D W Bucceri J Lin AI Nadal K L and Torino J C Racial Microaggressions and the Asian American experience APA (2007) Vol
13 No 1 pp 72-81bull [16]James S A (School of Public Health U of North Carolina Chapel Hill NC 27514) D S Strogatz S B Wing and D L Ramsey
Socioeconomic status John Henryism and hypertension in blacks and whites Am J Epidemiol 1987 126664ndash73bull [17]httpwwwapaorgpioemaresourcesethnicity-healthindexaspxbull [18]Porges SW Clinical Insights from the Polyvagal Theory The Transformative Power of Feeling Safe (Norton Series on Interpersonal
Neurobiology) W W Norton Apr 7 2014 - Psychology - 288 pagesbull [19]The Polyvagal Theory (Porges SW Social Connectedness as a Biological Imperative Understanding Trauma Through the Lens of
thePolyvagal Theory presentation 82015)bull [20]McEwen BS Allostasis and allostatic load implications for neuropsychopharmacologyNeuropsychopharmacology 2000
Feb22(2)108-24bull [21] McEwen BS adaptation and disease Allostasis and allostatic load Ann N Y Acad Sci 1998 May 184033-44bull [22] Arline T Geronimus ScD Margaret Hicken MPH Danya Keene MAT and John Bound PhD Weatheringrdquo and Age Patterns of
Allostatic Load Scores Among Blacks and Whites in the United States Am J Public Health 2006 May 96(5) 826ndash833bull [22]Stephen Porges PhD Polyvagal Perspective Biological Psychology 2007 Feb 74(2) 116ndash143 Published online 2006 Oct 16 bull [23]Stephen W Porges PhD The Polyvagal Theory Neurophysiological Foundations of Emotions Attachment Communication and
Self-regulation WWNorton and Company Inc 2011bull [24]Maggie Phillips PhD Reversing Chronic Pain North Atlantic Books 2007bull [25]Peter Levine PhD Waking the Tiger North Atlantic Books 1997bull [26]Bessel VanderKolk MD The Body Keeps the Score Viking Penguin 2014bullAcknowledgmentsbull Group Medical Visits and Group Facilitation Jeff Geller MDbull Re-evaluation Counseling Community bull Insight Meditation Communitybull Biodynamic Osteopathy Communitybull Learning To Breathe Mindfulness Training for Adolescents 2015 Patricia C Broderick PhD bull Stanford Chronic Disease Self Management Program Training 2014 Kate Lorig MPH RNbull Motivational Interviewing Training 2015 Steven Berg-Smithbull Centering Pregnancy Training 2014 Centering Healthcare Institutebull Motivating Change in Groups Training 2013 Kaiser Permanente Oakland Cabull Group Facilitation Training Sara Fisk PhD Community at Work San Francisco Cabull Tribes Training 2013 Center for Human Developmentbull Cultural Humility Training 2016 Melanie Tervalon MD
Bibliography
Intermediate Steps to Listening Session Handout
bull Step 1 Connect with yourself body mind and emotions
bull Step 2 Hold a non-judgmental space to be seen and heard
bull Step 3 See the speaker and anyone referenced as able to manifest their true human nature and evolve using inherent healing abilities
bull Step 4 Listen to the speaker in a deep connected way sending the message that their thinking feelings and being matters to you
bull Step 5 Encourage the speaker to express feelings or thoughts describe body sensations or share a story relevant to the feelings at hand
bull Step 6 Validate intense emotional expression and release such as crying laughing shaking yawning sweating as a sign of healing
bull Step 7 Remind the speaker of their underlying goodness intelligence strength and caring and your confidence in their ability to heal and manifest their true human nature
copy Elizabeth Rocco MD
Contact Information
bull Elizabeth Rocco MD -egroccogmailcom
bull Karen Ekwueme MD-impactdoc1gmailcom
1 Institutionalized oppression
2 Personally-mediated oppression or micro-aggressions
3 Internalized oppression
Teamnofearorg
Manifestations of Societal Oppression
Institutionalized Racism
Micro-aggressions
Internalized Racism
StressCumulative Effects
COGNITIVE BEHAVIORAL
EMOTIONAL NEURO PHYSIOLOGICAL
STRESS
Complex Societal Trauma (CST)Total Negative Health Impact over Generations
Societal Oppression
Familial Trauma
Societal Trauma
Complex Societal Trauma
copy Elizabeth Rocco MD
Intergenerational TransmissionHow is CST passed down to our children
1 Yehuda R et al (2015) ldquoHolocaust Exposure Induced Intergenerational Effects on FKBP5 MethylationrdquoBiol Psychiatry Aug 12 httpwwwncbinlmnihgovpubmed26410355B
2 Buss C et al (2011) ldquoMaternal pregnancy-specific anxiety is associated with child executive function at 6-9 years agerdquo Stress Nov14(6)665-76 httpwwwncbinlmnihgovpubmed21995526
3 Shankardass K et al (2014) ldquoParental stress increases body mass index trajectory in preadolescentsrdquoPediatr Obes Dec9(6)435-42 httpwwwncbinlmnihgovpubmed24311567
Complex Societal Trauma
is Toxic to the Developing Brain
Pat Levitt developmental neuroscientist and Dr Jack
Shonkoff part of the National Scientific Council on
the Developing Child
ACE (Adverse Childhood Experience) Study
Childhood neglect abuse and household dysfunction impacts health through out life
Vincent J Felitti et al (1998) ldquoRelationship of Childhood Abuse and Household Dysfunction to Many of the Leading Causes of Death in Adults
The Adverse Childhood Experiences (ACE) Studyrdquo May Volume 14 Issue 4 Pages 245ndash
258 httpsacestoohighcom
Healing Complex Societal Trauma
Social Engagement Ventral Vagal Complex
Reach for Help Ventral Vagal FEAR
Fight or FlightSympathetic
FEAR
FEAR
Freeze Collapse Dorsal Vagal
Pre-frontal CortexThe Voice of Reason
Human Healing and Evolution through Self-Awareness Embodiment Empowerment and Connection
Mindfulness Breath work Martial Arts Exercise Yoga Singing Dancing
Acupuncture Massage ReikiCommunity Groups Animals Church Nature
Final Listening Practice and Closing Circle
Bibliography
bull Special Acknowledgement of Demie Stathoplos MSW and Bonnie Cohen MD who collaborated with Elizabeth Rocco MD on the IM4US August 2015 presentation ldquoListening to Each Other Healing the Negative Health Impacts of Racism Poverty and Trauma through Human Connectionrdquo
bull Special Acknowledgement of Karen Burt MD who collaborated with Elizabeth Rocco MD and Karen Ekwueme MD on the IM4US August 2016 presentation ldquoListening to Ourselves and Each Other Healing the Negative Health Impact of Racism Poverty Sexism and Traumardquo These bibliographies are included below
bull [1]Wen Patricia (2010) ldquoA legacy of unintended side effectsrdquo Boston Globe December 12 httpwwwbostoncomnewslocalmassachusettsarticles20101212with_ssi_program_a_legcy_of_unintended_side_effects
bull [2]CCHR International (2014) [Online] Number of Children amp Adolescents Taking Psychiatric Drugs in the US Aprilwwwcchrintorgpsychiatric-drugschildren-on-psychiatric-drugs
bull [3]Whitaker R (2010) Anatomy of an Epidemic Magic Bullets Psychiatric Drugs and the Astonishing Rise of Mental Illness in America Crown Publishing Company httprobertwhitakerorgrobertwhitakerorgAnatomy20of20an20Epidemichtml
bull [3]CDC (2013) [Online] MMRW Mental Health Surveillance Among Children mdash United States 2005ndash2011 Supplements May 17 62(02)1-35 httpwwwcdcgovmmwrpreviewmmwrhtmlsu6202a1htm
bull [4]Patricia N Pastor PhD Cynthia A Reuben MA Catherine R Duran BS and LaJeana D Hawkins MPH CHES (2015) [Online] CDC NCHS Data Brief Association Between Diagnosed ADHD and Selected Characteristics Among Children Aged 4ndash17 Years United States 2011ndash2013 May Number 201 httpwwwcdcgovnchsdatadatabriefsdb201htm
bull [5]Mental Health America (2014) Parity or Disparity The State of Mental Health in America 2015 NovwwwmentalhealthamericanetsitesdefaultfilesParity20or20Disparity20201520Reportpdf
bull [6]Bruce S Jonas ScM PhD Qiuping Gu MD PhD and Juan R Albertorio-Diaz MA (2013) [Online] CDC NCHS Data Brief Psychotropic Medication Use Among Adolescents United States 2005ndash2010 Dec Number 135httpwwwcdcgovnchsdatadatabriefsdb135htm
bull [7] C Buss EP Davis CJ Hobel and CA Sandman (2011) Maternal pregnancy-specific anxiety is associated with child executive function at 6ndash9 years age Stress Nov 14(6)665-676
bull [8] Council for Evidence-Based Psychiatry (UK) Web presentation ldquoUnrecognized Factsrdquo Authors James Davies Peter C Goetzsche Peter Kinderman Joanna Moncrieff Phillip Thomas Sami Timimi John Sandwich Melanie Davis Luke Montague httpcepukorgunrecognised-facts
bull [9] Johnstone Lucy (2015) A Straight Talking Introduction to Psychiatric DiagnosisPCCS Books 1st edition (February 3 2015)
bull [10] Brewin CR Andrews B Valentine JD (2000) ldquoMeta-analysis of risk factors for posttraumatic stress disorder in trauma-exposed adultsrdquo J Consult Clin Psychol2000 Oct68(5)748-66 httpwwwncbinlmnihgovpubmed11068961
bull [11] Williams Monica T (2013) ldquoCan Racism Cause PTSD Implications for DSM-5rdquoPsychology Today May 20 httpswwwpsychologytodaycomblogculturally-speaking201305can-racism-cause-ptsd-implications-dsm-5
Bibliography
bull [12] Yuan Chengmei et al (2011) ldquoProtective factors for posttraumatic stress disorder symptoms in a prospective study of police officersrdquo Nov 23httpwwwncbinlmnihgovpmcarticlesPMC3071439
bull [13] Chou Tina BA Anu Asnaani MA and Stefan G Hofmann PhD (2012) ldquoPerception of Racial Discrimination and Psychopathology Across Three US Ethnic Minority Groupsrdquo APA PsychNET Jan httpwwwncbinlmnihgovpmcarticlesPMC3505377
bull [14] Watson Laurel B Jacob M Marszalek Franco Dispenza and Christopher M Davids 2015 Understanding the Relationships Among White and African American Womenrsquos Sexual Objectification Experiences Physical Safety Anxiety and Psychological Distress Sex Roles 72 (34) 91-104
bull [15] Holland Julie (2015) ldquoMedicating Womenrsquos Feelingsrdquo New York TimesOpinion Feb 28 httpmobilenytimescom20150301opinionsundaymedicating-womens-feelingshtmlreferreramp_r=1
bull [16] Solinas M Thiriet N El Rawas R Lardeux V and Jaber M (2009) ldquoEnvironmental Enrichment During Early Stages of Life Reduces the Behavioral Neurochemical and Molecular Effects of Cocainerdquo Neuropsychopharmacology 34 1102ndash1111
bull [17] Hari Johann Chasing The Scream The First and Last Days of the War on Drugs Bloomsbury USA (January 20 2015)bull [18] Hughes Caitlin Elizabeth and Alex Stevens (2010) ldquoWhat Can We Learn From The Portuguese Decriminalization of Illicit
Drugsrdquo British Journal of Criminology July 21 httpbjcoxfordjournalsorgcontent506999abstractbull [19] Fournier Jay C et al (2009) ldquoAntidepressant Drug Effects and Depression Severityrdquo JAMA January
6th httpjamajamanetworkcomarticleaspxarticleid=185157[20] Currie J Stabile M Jones L (2013) Do Stimulant Medications Improve Educational and Behavioral Outcomes for Children with ADHD NBER Working Paper No 19105
bull [21] Mora-Ripoli R Organizacioacuten Mundial de la Risa Barcelona Spain ldquoThe therapeutic value of laughter in medicinerdquo Altern Ther Health Med 2010 Nov-Dec16(6)56-64 httpwwwncbinlmnihgovpubmed21280463
bull [22] Gracanin Asmir Lauren M Bylsma and Ad J J M Vingerhoets (2014) ldquoIs Crying a Self-Stoothing Behaviorrdquo Frontiers in Psychology May 28httpwwwncbinlmnihgovpmcarticlesPMC4035568
bull [23] Trimble Michael (2010) ldquoI Cry Therefore I Amrdquo New York Times Nov 10 httpwwwnytimescom20121111opinionsundayi-cry-therefore-i-amhtmlemc=eta1amp_r=0
bull [24]Gallup Andrew C et al (2007) ldquoYawning as a brain cooling mechanism Nasal breathing and forehead cooling diminish the incidence of contagious yawningrdquo httpwwwepjournalnetarticlesyawning-as-a-brain-cooling-mechanism-nasal-breathing-and-forehead-cooling-diminish-the-incidence-of-contagious-yawning
bull [25]Sharat Gupta and Shallu Mittal Int (2013) Yawning and its physiological significance Intl J Appl Basic Med Res Jan-Jun 3(1) 11ndash15
bull [26] Stephens R Atkins J Kingston A (2009) ldquoSwearing As a Response to Painrdquo NeuroReport Aug 5 httpwwwncbinlmnihgovpubmed19590391
bull [27]Morelli SA Lieberman MD(2013) rdquoThe role of automaticity and attention in neural processes underlying empathy for happiness sadness and anxietyrdquo Front Hum Neurosci May 87160
Bibliography
bull [1] Committee on Psychosocial Aspects of Child and Family Health Committee on Early Childhood Adoption and Dependent Care andSection on Developmental and Behavioral Pediatrics Andrew S Garner Jack P Shonkoff et al (2012) ldquoEarly Childhood Adversity Toxic Stress and the Role of the Pediatrician Translating Developmental Science Into Lifelong Healthrdquo Pediatrics January VOLUME 129 ISSUE 1 From the American Academy of Pediatrics Policy Statementhttppediatricsaappublicationsorgcontent1291e224fullref-23
bull [2] COUNCIL ON COMMUNITY PEDIATRICS Benjamin A Gitterman et al (2016) ldquoPoverty and Child Health in the United Statesrdquo Pediatrics March From the American Academy of Pediatrics Policy Statement Published Online March 09American Academy of Pediatricshttppediatricsaappublicationsorgcontentearly20160307peds2016-0339info
bull [3] Paul W Newacheck et al (2003) ldquoDisparities in Adolescent Health and Health Care Does Socioeconomic Status Matterrdquo Health ServRes Oct 38(5) 1235ndash1252 httpwwwncbinlmnihgovpmcarticlesPMC1360944
bull [4] Larson et al (2007) ldquoPoverty during pregnancy Its effects on child health outcomesrdquo Paediatr Child Health 2007 Oct 12(8) 673ndash677 httpwwwncbinlmnihgovpmcarticlesPMC2528810
bull [5] Lara J Akinbami et al (2012) ldquoTrends in Asthma Prevalence Health Care Use and Mortality in the United States 2001ndash2010rdquo NCHS Data Brief No 94 May httpwwwcdcgovnchsproductsdatabriefsdb94htm
bull [6] Cynthia L Ogden et al (2010) ldquoObesity and Socioeconomic Status in Children and Adolescents United States 2005-2008rdquoNCHS Data Brief No 51 Decemberhttpwwwcdcgovnchsproductsdatabriefsdb51htm
bull [7] Shonkoff JP et al Committee on Psychosocial Aspects of Child and Family Health Committee on Early Childhood Adoption and Dependent Care Section on Developmental and Behavioral Pediatrics rdquoThe lifelong effects of early childhood adversity and toxicstressrdquo Pediatrics 2012129(1) wwwpediatricsorgcgicontentfull1291e232
bull [8] Virginia A Rauh et alldquoHousing and HealthIntersection of Poverty and Environmental Exposuresrdquo (2008) Annals of the New York Academy of Sciences Volume 1136 Reducing the Impact of Poverty on Health and Human Development Scientific Approaches pages 276ndash288 June httponlinelibrarywileycomdoi101196annals1425032full
bull [9] Yehuda R et al (2015) ldquoHolocaust Exposure Induced Intergenerational Effects on FKBP5 MethylationrdquoBiol Psychiatry Aug 12 httpwwwncbinlmnihgovpubmed26410355
bull [10] Buss C et al (2011) ldquoMaternal pregnancy-specific anxiety is associated with child executive function at 6-9 years agerdquoStress Nov14(6)665-76 httpwwwncbinlmnihgovpubmed21995526
bull 11] Shankardass K et al (2014) ldquoParental stress increases body mass index trajectory in pre-adolescentsrdquoPediatr Obes Dec9(6)435-42 httpwwwncbinlmnihgovpubmed24311567
bull [12] Vincent J Felitti et al (1998) ldquoRelationship of Childhood Abuse and Household Dysfunction to Many of the Leading Causes of Death in Adults The Adverse Childhood Experiences (ACE) Studyrdquo May Volume 14 Issue 4 Pages 245ndash258 httpsacestoohighcom
bull [13]Jones CP Levels of Racism a Theoretic Framework and the Gardenerrsquos Tale Am J Public Health 200090(8) 1212-1215bull [14]Dion KL The Social Psycology of Perceived Perjudice and Discrimination Canadian Psychology (2002)431 pp 1-10bull [15]Sue D W Bucceri J Lin AI Nadal K L and Torino J C Racial Microaggressions and the Asian American experience APA (2007) Vol
13 No 1 pp 72-81bull [16]James S A (School of Public Health U of North Carolina Chapel Hill NC 27514) D S Strogatz S B Wing and D L Ramsey
Socioeconomic status John Henryism and hypertension in blacks and whites Am J Epidemiol 1987 126664ndash73bull [17]httpwwwapaorgpioemaresourcesethnicity-healthindexaspxbull [18]Porges SW Clinical Insights from the Polyvagal Theory The Transformative Power of Feeling Safe (Norton Series on Interpersonal
Neurobiology) W W Norton Apr 7 2014 - Psychology - 288 pagesbull [19]The Polyvagal Theory (Porges SW Social Connectedness as a Biological Imperative Understanding Trauma Through the Lens of
thePolyvagal Theory presentation 82015)bull [20]McEwen BS Allostasis and allostatic load implications for neuropsychopharmacologyNeuropsychopharmacology 2000
Feb22(2)108-24bull [21] McEwen BS adaptation and disease Allostasis and allostatic load Ann N Y Acad Sci 1998 May 184033-44bull [22] Arline T Geronimus ScD Margaret Hicken MPH Danya Keene MAT and John Bound PhD Weatheringrdquo and Age Patterns of
Allostatic Load Scores Among Blacks and Whites in the United States Am J Public Health 2006 May 96(5) 826ndash833bull [22]Stephen Porges PhD Polyvagal Perspective Biological Psychology 2007 Feb 74(2) 116ndash143 Published online 2006 Oct 16 bull [23]Stephen W Porges PhD The Polyvagal Theory Neurophysiological Foundations of Emotions Attachment Communication and
Self-regulation WWNorton and Company Inc 2011bull [24]Maggie Phillips PhD Reversing Chronic Pain North Atlantic Books 2007bull [25]Peter Levine PhD Waking the Tiger North Atlantic Books 1997bull [26]Bessel VanderKolk MD The Body Keeps the Score Viking Penguin 2014bullAcknowledgmentsbull Group Medical Visits and Group Facilitation Jeff Geller MDbull Re-evaluation Counseling Community bull Insight Meditation Communitybull Biodynamic Osteopathy Communitybull Learning To Breathe Mindfulness Training for Adolescents 2015 Patricia C Broderick PhD bull Stanford Chronic Disease Self Management Program Training 2014 Kate Lorig MPH RNbull Motivational Interviewing Training 2015 Steven Berg-Smithbull Centering Pregnancy Training 2014 Centering Healthcare Institutebull Motivating Change in Groups Training 2013 Kaiser Permanente Oakland Cabull Group Facilitation Training Sara Fisk PhD Community at Work San Francisco Cabull Tribes Training 2013 Center for Human Developmentbull Cultural Humility Training 2016 Melanie Tervalon MD
Bibliography
Intermediate Steps to Listening Session Handout
bull Step 1 Connect with yourself body mind and emotions
bull Step 2 Hold a non-judgmental space to be seen and heard
bull Step 3 See the speaker and anyone referenced as able to manifest their true human nature and evolve using inherent healing abilities
bull Step 4 Listen to the speaker in a deep connected way sending the message that their thinking feelings and being matters to you
bull Step 5 Encourage the speaker to express feelings or thoughts describe body sensations or share a story relevant to the feelings at hand
bull Step 6 Validate intense emotional expression and release such as crying laughing shaking yawning sweating as a sign of healing
bull Step 7 Remind the speaker of their underlying goodness intelligence strength and caring and your confidence in their ability to heal and manifest their true human nature
copy Elizabeth Rocco MD
Contact Information
bull Elizabeth Rocco MD -egroccogmailcom
bull Karen Ekwueme MD-impactdoc1gmailcom
Institutionalized Racism
Micro-aggressions
Internalized Racism
StressCumulative Effects
COGNITIVE BEHAVIORAL
EMOTIONAL NEURO PHYSIOLOGICAL
STRESS
Complex Societal Trauma (CST)Total Negative Health Impact over Generations
Societal Oppression
Familial Trauma
Societal Trauma
Complex Societal Trauma
copy Elizabeth Rocco MD
Intergenerational TransmissionHow is CST passed down to our children
1 Yehuda R et al (2015) ldquoHolocaust Exposure Induced Intergenerational Effects on FKBP5 MethylationrdquoBiol Psychiatry Aug 12 httpwwwncbinlmnihgovpubmed26410355B
2 Buss C et al (2011) ldquoMaternal pregnancy-specific anxiety is associated with child executive function at 6-9 years agerdquo Stress Nov14(6)665-76 httpwwwncbinlmnihgovpubmed21995526
3 Shankardass K et al (2014) ldquoParental stress increases body mass index trajectory in preadolescentsrdquoPediatr Obes Dec9(6)435-42 httpwwwncbinlmnihgovpubmed24311567
Complex Societal Trauma
is Toxic to the Developing Brain
Pat Levitt developmental neuroscientist and Dr Jack
Shonkoff part of the National Scientific Council on
the Developing Child
ACE (Adverse Childhood Experience) Study
Childhood neglect abuse and household dysfunction impacts health through out life
Vincent J Felitti et al (1998) ldquoRelationship of Childhood Abuse and Household Dysfunction to Many of the Leading Causes of Death in Adults
The Adverse Childhood Experiences (ACE) Studyrdquo May Volume 14 Issue 4 Pages 245ndash
258 httpsacestoohighcom
Healing Complex Societal Trauma
Social Engagement Ventral Vagal Complex
Reach for Help Ventral Vagal FEAR
Fight or FlightSympathetic
FEAR
FEAR
Freeze Collapse Dorsal Vagal
Pre-frontal CortexThe Voice of Reason
Human Healing and Evolution through Self-Awareness Embodiment Empowerment and Connection
Mindfulness Breath work Martial Arts Exercise Yoga Singing Dancing
Acupuncture Massage ReikiCommunity Groups Animals Church Nature
Final Listening Practice and Closing Circle
Bibliography
bull Special Acknowledgement of Demie Stathoplos MSW and Bonnie Cohen MD who collaborated with Elizabeth Rocco MD on the IM4US August 2015 presentation ldquoListening to Each Other Healing the Negative Health Impacts of Racism Poverty and Trauma through Human Connectionrdquo
bull Special Acknowledgement of Karen Burt MD who collaborated with Elizabeth Rocco MD and Karen Ekwueme MD on the IM4US August 2016 presentation ldquoListening to Ourselves and Each Other Healing the Negative Health Impact of Racism Poverty Sexism and Traumardquo These bibliographies are included below
bull [1]Wen Patricia (2010) ldquoA legacy of unintended side effectsrdquo Boston Globe December 12 httpwwwbostoncomnewslocalmassachusettsarticles20101212with_ssi_program_a_legcy_of_unintended_side_effects
bull [2]CCHR International (2014) [Online] Number of Children amp Adolescents Taking Psychiatric Drugs in the US Aprilwwwcchrintorgpsychiatric-drugschildren-on-psychiatric-drugs
bull [3]Whitaker R (2010) Anatomy of an Epidemic Magic Bullets Psychiatric Drugs and the Astonishing Rise of Mental Illness in America Crown Publishing Company httprobertwhitakerorgrobertwhitakerorgAnatomy20of20an20Epidemichtml
bull [3]CDC (2013) [Online] MMRW Mental Health Surveillance Among Children mdash United States 2005ndash2011 Supplements May 17 62(02)1-35 httpwwwcdcgovmmwrpreviewmmwrhtmlsu6202a1htm
bull [4]Patricia N Pastor PhD Cynthia A Reuben MA Catherine R Duran BS and LaJeana D Hawkins MPH CHES (2015) [Online] CDC NCHS Data Brief Association Between Diagnosed ADHD and Selected Characteristics Among Children Aged 4ndash17 Years United States 2011ndash2013 May Number 201 httpwwwcdcgovnchsdatadatabriefsdb201htm
bull [5]Mental Health America (2014) Parity or Disparity The State of Mental Health in America 2015 NovwwwmentalhealthamericanetsitesdefaultfilesParity20or20Disparity20201520Reportpdf
bull [6]Bruce S Jonas ScM PhD Qiuping Gu MD PhD and Juan R Albertorio-Diaz MA (2013) [Online] CDC NCHS Data Brief Psychotropic Medication Use Among Adolescents United States 2005ndash2010 Dec Number 135httpwwwcdcgovnchsdatadatabriefsdb135htm
bull [7] C Buss EP Davis CJ Hobel and CA Sandman (2011) Maternal pregnancy-specific anxiety is associated with child executive function at 6ndash9 years age Stress Nov 14(6)665-676
bull [8] Council for Evidence-Based Psychiatry (UK) Web presentation ldquoUnrecognized Factsrdquo Authors James Davies Peter C Goetzsche Peter Kinderman Joanna Moncrieff Phillip Thomas Sami Timimi John Sandwich Melanie Davis Luke Montague httpcepukorgunrecognised-facts
bull [9] Johnstone Lucy (2015) A Straight Talking Introduction to Psychiatric DiagnosisPCCS Books 1st edition (February 3 2015)
bull [10] Brewin CR Andrews B Valentine JD (2000) ldquoMeta-analysis of risk factors for posttraumatic stress disorder in trauma-exposed adultsrdquo J Consult Clin Psychol2000 Oct68(5)748-66 httpwwwncbinlmnihgovpubmed11068961
bull [11] Williams Monica T (2013) ldquoCan Racism Cause PTSD Implications for DSM-5rdquoPsychology Today May 20 httpswwwpsychologytodaycomblogculturally-speaking201305can-racism-cause-ptsd-implications-dsm-5
Bibliography
bull [12] Yuan Chengmei et al (2011) ldquoProtective factors for posttraumatic stress disorder symptoms in a prospective study of police officersrdquo Nov 23httpwwwncbinlmnihgovpmcarticlesPMC3071439
bull [13] Chou Tina BA Anu Asnaani MA and Stefan G Hofmann PhD (2012) ldquoPerception of Racial Discrimination and Psychopathology Across Three US Ethnic Minority Groupsrdquo APA PsychNET Jan httpwwwncbinlmnihgovpmcarticlesPMC3505377
bull [14] Watson Laurel B Jacob M Marszalek Franco Dispenza and Christopher M Davids 2015 Understanding the Relationships Among White and African American Womenrsquos Sexual Objectification Experiences Physical Safety Anxiety and Psychological Distress Sex Roles 72 (34) 91-104
bull [15] Holland Julie (2015) ldquoMedicating Womenrsquos Feelingsrdquo New York TimesOpinion Feb 28 httpmobilenytimescom20150301opinionsundaymedicating-womens-feelingshtmlreferreramp_r=1
bull [16] Solinas M Thiriet N El Rawas R Lardeux V and Jaber M (2009) ldquoEnvironmental Enrichment During Early Stages of Life Reduces the Behavioral Neurochemical and Molecular Effects of Cocainerdquo Neuropsychopharmacology 34 1102ndash1111
bull [17] Hari Johann Chasing The Scream The First and Last Days of the War on Drugs Bloomsbury USA (January 20 2015)bull [18] Hughes Caitlin Elizabeth and Alex Stevens (2010) ldquoWhat Can We Learn From The Portuguese Decriminalization of Illicit
Drugsrdquo British Journal of Criminology July 21 httpbjcoxfordjournalsorgcontent506999abstractbull [19] Fournier Jay C et al (2009) ldquoAntidepressant Drug Effects and Depression Severityrdquo JAMA January
6th httpjamajamanetworkcomarticleaspxarticleid=185157[20] Currie J Stabile M Jones L (2013) Do Stimulant Medications Improve Educational and Behavioral Outcomes for Children with ADHD NBER Working Paper No 19105
bull [21] Mora-Ripoli R Organizacioacuten Mundial de la Risa Barcelona Spain ldquoThe therapeutic value of laughter in medicinerdquo Altern Ther Health Med 2010 Nov-Dec16(6)56-64 httpwwwncbinlmnihgovpubmed21280463
bull [22] Gracanin Asmir Lauren M Bylsma and Ad J J M Vingerhoets (2014) ldquoIs Crying a Self-Stoothing Behaviorrdquo Frontiers in Psychology May 28httpwwwncbinlmnihgovpmcarticlesPMC4035568
bull [23] Trimble Michael (2010) ldquoI Cry Therefore I Amrdquo New York Times Nov 10 httpwwwnytimescom20121111opinionsundayi-cry-therefore-i-amhtmlemc=eta1amp_r=0
bull [24]Gallup Andrew C et al (2007) ldquoYawning as a brain cooling mechanism Nasal breathing and forehead cooling diminish the incidence of contagious yawningrdquo httpwwwepjournalnetarticlesyawning-as-a-brain-cooling-mechanism-nasal-breathing-and-forehead-cooling-diminish-the-incidence-of-contagious-yawning
bull [25]Sharat Gupta and Shallu Mittal Int (2013) Yawning and its physiological significance Intl J Appl Basic Med Res Jan-Jun 3(1) 11ndash15
bull [26] Stephens R Atkins J Kingston A (2009) ldquoSwearing As a Response to Painrdquo NeuroReport Aug 5 httpwwwncbinlmnihgovpubmed19590391
bull [27]Morelli SA Lieberman MD(2013) rdquoThe role of automaticity and attention in neural processes underlying empathy for happiness sadness and anxietyrdquo Front Hum Neurosci May 87160
Bibliography
bull [1] Committee on Psychosocial Aspects of Child and Family Health Committee on Early Childhood Adoption and Dependent Care andSection on Developmental and Behavioral Pediatrics Andrew S Garner Jack P Shonkoff et al (2012) ldquoEarly Childhood Adversity Toxic Stress and the Role of the Pediatrician Translating Developmental Science Into Lifelong Healthrdquo Pediatrics January VOLUME 129 ISSUE 1 From the American Academy of Pediatrics Policy Statementhttppediatricsaappublicationsorgcontent1291e224fullref-23
bull [2] COUNCIL ON COMMUNITY PEDIATRICS Benjamin A Gitterman et al (2016) ldquoPoverty and Child Health in the United Statesrdquo Pediatrics March From the American Academy of Pediatrics Policy Statement Published Online March 09American Academy of Pediatricshttppediatricsaappublicationsorgcontentearly20160307peds2016-0339info
bull [3] Paul W Newacheck et al (2003) ldquoDisparities in Adolescent Health and Health Care Does Socioeconomic Status Matterrdquo Health ServRes Oct 38(5) 1235ndash1252 httpwwwncbinlmnihgovpmcarticlesPMC1360944
bull [4] Larson et al (2007) ldquoPoverty during pregnancy Its effects on child health outcomesrdquo Paediatr Child Health 2007 Oct 12(8) 673ndash677 httpwwwncbinlmnihgovpmcarticlesPMC2528810
bull [5] Lara J Akinbami et al (2012) ldquoTrends in Asthma Prevalence Health Care Use and Mortality in the United States 2001ndash2010rdquo NCHS Data Brief No 94 May httpwwwcdcgovnchsproductsdatabriefsdb94htm
bull [6] Cynthia L Ogden et al (2010) ldquoObesity and Socioeconomic Status in Children and Adolescents United States 2005-2008rdquoNCHS Data Brief No 51 Decemberhttpwwwcdcgovnchsproductsdatabriefsdb51htm
bull [7] Shonkoff JP et al Committee on Psychosocial Aspects of Child and Family Health Committee on Early Childhood Adoption and Dependent Care Section on Developmental and Behavioral Pediatrics rdquoThe lifelong effects of early childhood adversity and toxicstressrdquo Pediatrics 2012129(1) wwwpediatricsorgcgicontentfull1291e232
bull [8] Virginia A Rauh et alldquoHousing and HealthIntersection of Poverty and Environmental Exposuresrdquo (2008) Annals of the New York Academy of Sciences Volume 1136 Reducing the Impact of Poverty on Health and Human Development Scientific Approaches pages 276ndash288 June httponlinelibrarywileycomdoi101196annals1425032full
bull [9] Yehuda R et al (2015) ldquoHolocaust Exposure Induced Intergenerational Effects on FKBP5 MethylationrdquoBiol Psychiatry Aug 12 httpwwwncbinlmnihgovpubmed26410355
bull [10] Buss C et al (2011) ldquoMaternal pregnancy-specific anxiety is associated with child executive function at 6-9 years agerdquoStress Nov14(6)665-76 httpwwwncbinlmnihgovpubmed21995526
bull 11] Shankardass K et al (2014) ldquoParental stress increases body mass index trajectory in pre-adolescentsrdquoPediatr Obes Dec9(6)435-42 httpwwwncbinlmnihgovpubmed24311567
bull [12] Vincent J Felitti et al (1998) ldquoRelationship of Childhood Abuse and Household Dysfunction to Many of the Leading Causes of Death in Adults The Adverse Childhood Experiences (ACE) Studyrdquo May Volume 14 Issue 4 Pages 245ndash258 httpsacestoohighcom
bull [13]Jones CP Levels of Racism a Theoretic Framework and the Gardenerrsquos Tale Am J Public Health 200090(8) 1212-1215bull [14]Dion KL The Social Psycology of Perceived Perjudice and Discrimination Canadian Psychology (2002)431 pp 1-10bull [15]Sue D W Bucceri J Lin AI Nadal K L and Torino J C Racial Microaggressions and the Asian American experience APA (2007) Vol
13 No 1 pp 72-81bull [16]James S A (School of Public Health U of North Carolina Chapel Hill NC 27514) D S Strogatz S B Wing and D L Ramsey
Socioeconomic status John Henryism and hypertension in blacks and whites Am J Epidemiol 1987 126664ndash73bull [17]httpwwwapaorgpioemaresourcesethnicity-healthindexaspxbull [18]Porges SW Clinical Insights from the Polyvagal Theory The Transformative Power of Feeling Safe (Norton Series on Interpersonal
Neurobiology) W W Norton Apr 7 2014 - Psychology - 288 pagesbull [19]The Polyvagal Theory (Porges SW Social Connectedness as a Biological Imperative Understanding Trauma Through the Lens of
thePolyvagal Theory presentation 82015)bull [20]McEwen BS Allostasis and allostatic load implications for neuropsychopharmacologyNeuropsychopharmacology 2000
Feb22(2)108-24bull [21] McEwen BS adaptation and disease Allostasis and allostatic load Ann N Y Acad Sci 1998 May 184033-44bull [22] Arline T Geronimus ScD Margaret Hicken MPH Danya Keene MAT and John Bound PhD Weatheringrdquo and Age Patterns of
Allostatic Load Scores Among Blacks and Whites in the United States Am J Public Health 2006 May 96(5) 826ndash833bull [22]Stephen Porges PhD Polyvagal Perspective Biological Psychology 2007 Feb 74(2) 116ndash143 Published online 2006 Oct 16 bull [23]Stephen W Porges PhD The Polyvagal Theory Neurophysiological Foundations of Emotions Attachment Communication and
Self-regulation WWNorton and Company Inc 2011bull [24]Maggie Phillips PhD Reversing Chronic Pain North Atlantic Books 2007bull [25]Peter Levine PhD Waking the Tiger North Atlantic Books 1997bull [26]Bessel VanderKolk MD The Body Keeps the Score Viking Penguin 2014bullAcknowledgmentsbull Group Medical Visits and Group Facilitation Jeff Geller MDbull Re-evaluation Counseling Community bull Insight Meditation Communitybull Biodynamic Osteopathy Communitybull Learning To Breathe Mindfulness Training for Adolescents 2015 Patricia C Broderick PhD bull Stanford Chronic Disease Self Management Program Training 2014 Kate Lorig MPH RNbull Motivational Interviewing Training 2015 Steven Berg-Smithbull Centering Pregnancy Training 2014 Centering Healthcare Institutebull Motivating Change in Groups Training 2013 Kaiser Permanente Oakland Cabull Group Facilitation Training Sara Fisk PhD Community at Work San Francisco Cabull Tribes Training 2013 Center for Human Developmentbull Cultural Humility Training 2016 Melanie Tervalon MD
Bibliography
Intermediate Steps to Listening Session Handout
bull Step 1 Connect with yourself body mind and emotions
bull Step 2 Hold a non-judgmental space to be seen and heard
bull Step 3 See the speaker and anyone referenced as able to manifest their true human nature and evolve using inherent healing abilities
bull Step 4 Listen to the speaker in a deep connected way sending the message that their thinking feelings and being matters to you
bull Step 5 Encourage the speaker to express feelings or thoughts describe body sensations or share a story relevant to the feelings at hand
bull Step 6 Validate intense emotional expression and release such as crying laughing shaking yawning sweating as a sign of healing
bull Step 7 Remind the speaker of their underlying goodness intelligence strength and caring and your confidence in their ability to heal and manifest their true human nature
copy Elizabeth Rocco MD
Contact Information
bull Elizabeth Rocco MD -egroccogmailcom
bull Karen Ekwueme MD-impactdoc1gmailcom
Micro-aggressions
Internalized Racism
StressCumulative Effects
COGNITIVE BEHAVIORAL
EMOTIONAL NEURO PHYSIOLOGICAL
STRESS
Complex Societal Trauma (CST)Total Negative Health Impact over Generations
Societal Oppression
Familial Trauma
Societal Trauma
Complex Societal Trauma
copy Elizabeth Rocco MD
Intergenerational TransmissionHow is CST passed down to our children
1 Yehuda R et al (2015) ldquoHolocaust Exposure Induced Intergenerational Effects on FKBP5 MethylationrdquoBiol Psychiatry Aug 12 httpwwwncbinlmnihgovpubmed26410355B
2 Buss C et al (2011) ldquoMaternal pregnancy-specific anxiety is associated with child executive function at 6-9 years agerdquo Stress Nov14(6)665-76 httpwwwncbinlmnihgovpubmed21995526
3 Shankardass K et al (2014) ldquoParental stress increases body mass index trajectory in preadolescentsrdquoPediatr Obes Dec9(6)435-42 httpwwwncbinlmnihgovpubmed24311567
Complex Societal Trauma
is Toxic to the Developing Brain
Pat Levitt developmental neuroscientist and Dr Jack
Shonkoff part of the National Scientific Council on
the Developing Child
ACE (Adverse Childhood Experience) Study
Childhood neglect abuse and household dysfunction impacts health through out life
Vincent J Felitti et al (1998) ldquoRelationship of Childhood Abuse and Household Dysfunction to Many of the Leading Causes of Death in Adults
The Adverse Childhood Experiences (ACE) Studyrdquo May Volume 14 Issue 4 Pages 245ndash
258 httpsacestoohighcom
Healing Complex Societal Trauma
Social Engagement Ventral Vagal Complex
Reach for Help Ventral Vagal FEAR
Fight or FlightSympathetic
FEAR
FEAR
Freeze Collapse Dorsal Vagal
Pre-frontal CortexThe Voice of Reason
Human Healing and Evolution through Self-Awareness Embodiment Empowerment and Connection
Mindfulness Breath work Martial Arts Exercise Yoga Singing Dancing
Acupuncture Massage ReikiCommunity Groups Animals Church Nature
Final Listening Practice and Closing Circle
Bibliography
bull Special Acknowledgement of Demie Stathoplos MSW and Bonnie Cohen MD who collaborated with Elizabeth Rocco MD on the IM4US August 2015 presentation ldquoListening to Each Other Healing the Negative Health Impacts of Racism Poverty and Trauma through Human Connectionrdquo
bull Special Acknowledgement of Karen Burt MD who collaborated with Elizabeth Rocco MD and Karen Ekwueme MD on the IM4US August 2016 presentation ldquoListening to Ourselves and Each Other Healing the Negative Health Impact of Racism Poverty Sexism and Traumardquo These bibliographies are included below
bull [1]Wen Patricia (2010) ldquoA legacy of unintended side effectsrdquo Boston Globe December 12 httpwwwbostoncomnewslocalmassachusettsarticles20101212with_ssi_program_a_legcy_of_unintended_side_effects
bull [2]CCHR International (2014) [Online] Number of Children amp Adolescents Taking Psychiatric Drugs in the US Aprilwwwcchrintorgpsychiatric-drugschildren-on-psychiatric-drugs
bull [3]Whitaker R (2010) Anatomy of an Epidemic Magic Bullets Psychiatric Drugs and the Astonishing Rise of Mental Illness in America Crown Publishing Company httprobertwhitakerorgrobertwhitakerorgAnatomy20of20an20Epidemichtml
bull [3]CDC (2013) [Online] MMRW Mental Health Surveillance Among Children mdash United States 2005ndash2011 Supplements May 17 62(02)1-35 httpwwwcdcgovmmwrpreviewmmwrhtmlsu6202a1htm
bull [4]Patricia N Pastor PhD Cynthia A Reuben MA Catherine R Duran BS and LaJeana D Hawkins MPH CHES (2015) [Online] CDC NCHS Data Brief Association Between Diagnosed ADHD and Selected Characteristics Among Children Aged 4ndash17 Years United States 2011ndash2013 May Number 201 httpwwwcdcgovnchsdatadatabriefsdb201htm
bull [5]Mental Health America (2014) Parity or Disparity The State of Mental Health in America 2015 NovwwwmentalhealthamericanetsitesdefaultfilesParity20or20Disparity20201520Reportpdf
bull [6]Bruce S Jonas ScM PhD Qiuping Gu MD PhD and Juan R Albertorio-Diaz MA (2013) [Online] CDC NCHS Data Brief Psychotropic Medication Use Among Adolescents United States 2005ndash2010 Dec Number 135httpwwwcdcgovnchsdatadatabriefsdb135htm
bull [7] C Buss EP Davis CJ Hobel and CA Sandman (2011) Maternal pregnancy-specific anxiety is associated with child executive function at 6ndash9 years age Stress Nov 14(6)665-676
bull [8] Council for Evidence-Based Psychiatry (UK) Web presentation ldquoUnrecognized Factsrdquo Authors James Davies Peter C Goetzsche Peter Kinderman Joanna Moncrieff Phillip Thomas Sami Timimi John Sandwich Melanie Davis Luke Montague httpcepukorgunrecognised-facts
bull [9] Johnstone Lucy (2015) A Straight Talking Introduction to Psychiatric DiagnosisPCCS Books 1st edition (February 3 2015)
bull [10] Brewin CR Andrews B Valentine JD (2000) ldquoMeta-analysis of risk factors for posttraumatic stress disorder in trauma-exposed adultsrdquo J Consult Clin Psychol2000 Oct68(5)748-66 httpwwwncbinlmnihgovpubmed11068961
bull [11] Williams Monica T (2013) ldquoCan Racism Cause PTSD Implications for DSM-5rdquoPsychology Today May 20 httpswwwpsychologytodaycomblogculturally-speaking201305can-racism-cause-ptsd-implications-dsm-5
Bibliography
bull [12] Yuan Chengmei et al (2011) ldquoProtective factors for posttraumatic stress disorder symptoms in a prospective study of police officersrdquo Nov 23httpwwwncbinlmnihgovpmcarticlesPMC3071439
bull [13] Chou Tina BA Anu Asnaani MA and Stefan G Hofmann PhD (2012) ldquoPerception of Racial Discrimination and Psychopathology Across Three US Ethnic Minority Groupsrdquo APA PsychNET Jan httpwwwncbinlmnihgovpmcarticlesPMC3505377
bull [14] Watson Laurel B Jacob M Marszalek Franco Dispenza and Christopher M Davids 2015 Understanding the Relationships Among White and African American Womenrsquos Sexual Objectification Experiences Physical Safety Anxiety and Psychological Distress Sex Roles 72 (34) 91-104
bull [15] Holland Julie (2015) ldquoMedicating Womenrsquos Feelingsrdquo New York TimesOpinion Feb 28 httpmobilenytimescom20150301opinionsundaymedicating-womens-feelingshtmlreferreramp_r=1
bull [16] Solinas M Thiriet N El Rawas R Lardeux V and Jaber M (2009) ldquoEnvironmental Enrichment During Early Stages of Life Reduces the Behavioral Neurochemical and Molecular Effects of Cocainerdquo Neuropsychopharmacology 34 1102ndash1111
bull [17] Hari Johann Chasing The Scream The First and Last Days of the War on Drugs Bloomsbury USA (January 20 2015)bull [18] Hughes Caitlin Elizabeth and Alex Stevens (2010) ldquoWhat Can We Learn From The Portuguese Decriminalization of Illicit
Drugsrdquo British Journal of Criminology July 21 httpbjcoxfordjournalsorgcontent506999abstractbull [19] Fournier Jay C et al (2009) ldquoAntidepressant Drug Effects and Depression Severityrdquo JAMA January
6th httpjamajamanetworkcomarticleaspxarticleid=185157[20] Currie J Stabile M Jones L (2013) Do Stimulant Medications Improve Educational and Behavioral Outcomes for Children with ADHD NBER Working Paper No 19105
bull [21] Mora-Ripoli R Organizacioacuten Mundial de la Risa Barcelona Spain ldquoThe therapeutic value of laughter in medicinerdquo Altern Ther Health Med 2010 Nov-Dec16(6)56-64 httpwwwncbinlmnihgovpubmed21280463
bull [22] Gracanin Asmir Lauren M Bylsma and Ad J J M Vingerhoets (2014) ldquoIs Crying a Self-Stoothing Behaviorrdquo Frontiers in Psychology May 28httpwwwncbinlmnihgovpmcarticlesPMC4035568
bull [23] Trimble Michael (2010) ldquoI Cry Therefore I Amrdquo New York Times Nov 10 httpwwwnytimescom20121111opinionsundayi-cry-therefore-i-amhtmlemc=eta1amp_r=0
bull [24]Gallup Andrew C et al (2007) ldquoYawning as a brain cooling mechanism Nasal breathing and forehead cooling diminish the incidence of contagious yawningrdquo httpwwwepjournalnetarticlesyawning-as-a-brain-cooling-mechanism-nasal-breathing-and-forehead-cooling-diminish-the-incidence-of-contagious-yawning
bull [25]Sharat Gupta and Shallu Mittal Int (2013) Yawning and its physiological significance Intl J Appl Basic Med Res Jan-Jun 3(1) 11ndash15
bull [26] Stephens R Atkins J Kingston A (2009) ldquoSwearing As a Response to Painrdquo NeuroReport Aug 5 httpwwwncbinlmnihgovpubmed19590391
bull [27]Morelli SA Lieberman MD(2013) rdquoThe role of automaticity and attention in neural processes underlying empathy for happiness sadness and anxietyrdquo Front Hum Neurosci May 87160
Bibliography
bull [1] Committee on Psychosocial Aspects of Child and Family Health Committee on Early Childhood Adoption and Dependent Care andSection on Developmental and Behavioral Pediatrics Andrew S Garner Jack P Shonkoff et al (2012) ldquoEarly Childhood Adversity Toxic Stress and the Role of the Pediatrician Translating Developmental Science Into Lifelong Healthrdquo Pediatrics January VOLUME 129 ISSUE 1 From the American Academy of Pediatrics Policy Statementhttppediatricsaappublicationsorgcontent1291e224fullref-23
bull [2] COUNCIL ON COMMUNITY PEDIATRICS Benjamin A Gitterman et al (2016) ldquoPoverty and Child Health in the United Statesrdquo Pediatrics March From the American Academy of Pediatrics Policy Statement Published Online March 09American Academy of Pediatricshttppediatricsaappublicationsorgcontentearly20160307peds2016-0339info
bull [3] Paul W Newacheck et al (2003) ldquoDisparities in Adolescent Health and Health Care Does Socioeconomic Status Matterrdquo Health ServRes Oct 38(5) 1235ndash1252 httpwwwncbinlmnihgovpmcarticlesPMC1360944
bull [4] Larson et al (2007) ldquoPoverty during pregnancy Its effects on child health outcomesrdquo Paediatr Child Health 2007 Oct 12(8) 673ndash677 httpwwwncbinlmnihgovpmcarticlesPMC2528810
bull [5] Lara J Akinbami et al (2012) ldquoTrends in Asthma Prevalence Health Care Use and Mortality in the United States 2001ndash2010rdquo NCHS Data Brief No 94 May httpwwwcdcgovnchsproductsdatabriefsdb94htm
bull [6] Cynthia L Ogden et al (2010) ldquoObesity and Socioeconomic Status in Children and Adolescents United States 2005-2008rdquoNCHS Data Brief No 51 Decemberhttpwwwcdcgovnchsproductsdatabriefsdb51htm
bull [7] Shonkoff JP et al Committee on Psychosocial Aspects of Child and Family Health Committee on Early Childhood Adoption and Dependent Care Section on Developmental and Behavioral Pediatrics rdquoThe lifelong effects of early childhood adversity and toxicstressrdquo Pediatrics 2012129(1) wwwpediatricsorgcgicontentfull1291e232
bull [8] Virginia A Rauh et alldquoHousing and HealthIntersection of Poverty and Environmental Exposuresrdquo (2008) Annals of the New York Academy of Sciences Volume 1136 Reducing the Impact of Poverty on Health and Human Development Scientific Approaches pages 276ndash288 June httponlinelibrarywileycomdoi101196annals1425032full
bull [9] Yehuda R et al (2015) ldquoHolocaust Exposure Induced Intergenerational Effects on FKBP5 MethylationrdquoBiol Psychiatry Aug 12 httpwwwncbinlmnihgovpubmed26410355
bull [10] Buss C et al (2011) ldquoMaternal pregnancy-specific anxiety is associated with child executive function at 6-9 years agerdquoStress Nov14(6)665-76 httpwwwncbinlmnihgovpubmed21995526
bull 11] Shankardass K et al (2014) ldquoParental stress increases body mass index trajectory in pre-adolescentsrdquoPediatr Obes Dec9(6)435-42 httpwwwncbinlmnihgovpubmed24311567
bull [12] Vincent J Felitti et al (1998) ldquoRelationship of Childhood Abuse and Household Dysfunction to Many of the Leading Causes of Death in Adults The Adverse Childhood Experiences (ACE) Studyrdquo May Volume 14 Issue 4 Pages 245ndash258 httpsacestoohighcom
bull [13]Jones CP Levels of Racism a Theoretic Framework and the Gardenerrsquos Tale Am J Public Health 200090(8) 1212-1215bull [14]Dion KL The Social Psycology of Perceived Perjudice and Discrimination Canadian Psychology (2002)431 pp 1-10bull [15]Sue D W Bucceri J Lin AI Nadal K L and Torino J C Racial Microaggressions and the Asian American experience APA (2007) Vol
13 No 1 pp 72-81bull [16]James S A (School of Public Health U of North Carolina Chapel Hill NC 27514) D S Strogatz S B Wing and D L Ramsey
Socioeconomic status John Henryism and hypertension in blacks and whites Am J Epidemiol 1987 126664ndash73bull [17]httpwwwapaorgpioemaresourcesethnicity-healthindexaspxbull [18]Porges SW Clinical Insights from the Polyvagal Theory The Transformative Power of Feeling Safe (Norton Series on Interpersonal
Neurobiology) W W Norton Apr 7 2014 - Psychology - 288 pagesbull [19]The Polyvagal Theory (Porges SW Social Connectedness as a Biological Imperative Understanding Trauma Through the Lens of
thePolyvagal Theory presentation 82015)bull [20]McEwen BS Allostasis and allostatic load implications for neuropsychopharmacologyNeuropsychopharmacology 2000
Feb22(2)108-24bull [21] McEwen BS adaptation and disease Allostasis and allostatic load Ann N Y Acad Sci 1998 May 184033-44bull [22] Arline T Geronimus ScD Margaret Hicken MPH Danya Keene MAT and John Bound PhD Weatheringrdquo and Age Patterns of
Allostatic Load Scores Among Blacks and Whites in the United States Am J Public Health 2006 May 96(5) 826ndash833bull [22]Stephen Porges PhD Polyvagal Perspective Biological Psychology 2007 Feb 74(2) 116ndash143 Published online 2006 Oct 16 bull [23]Stephen W Porges PhD The Polyvagal Theory Neurophysiological Foundations of Emotions Attachment Communication and
Self-regulation WWNorton and Company Inc 2011bull [24]Maggie Phillips PhD Reversing Chronic Pain North Atlantic Books 2007bull [25]Peter Levine PhD Waking the Tiger North Atlantic Books 1997bull [26]Bessel VanderKolk MD The Body Keeps the Score Viking Penguin 2014bullAcknowledgmentsbull Group Medical Visits and Group Facilitation Jeff Geller MDbull Re-evaluation Counseling Community bull Insight Meditation Communitybull Biodynamic Osteopathy Communitybull Learning To Breathe Mindfulness Training for Adolescents 2015 Patricia C Broderick PhD bull Stanford Chronic Disease Self Management Program Training 2014 Kate Lorig MPH RNbull Motivational Interviewing Training 2015 Steven Berg-Smithbull Centering Pregnancy Training 2014 Centering Healthcare Institutebull Motivating Change in Groups Training 2013 Kaiser Permanente Oakland Cabull Group Facilitation Training Sara Fisk PhD Community at Work San Francisco Cabull Tribes Training 2013 Center for Human Developmentbull Cultural Humility Training 2016 Melanie Tervalon MD
Bibliography
Intermediate Steps to Listening Session Handout
bull Step 1 Connect with yourself body mind and emotions
bull Step 2 Hold a non-judgmental space to be seen and heard
bull Step 3 See the speaker and anyone referenced as able to manifest their true human nature and evolve using inherent healing abilities
bull Step 4 Listen to the speaker in a deep connected way sending the message that their thinking feelings and being matters to you
bull Step 5 Encourage the speaker to express feelings or thoughts describe body sensations or share a story relevant to the feelings at hand
bull Step 6 Validate intense emotional expression and release such as crying laughing shaking yawning sweating as a sign of healing
bull Step 7 Remind the speaker of their underlying goodness intelligence strength and caring and your confidence in their ability to heal and manifest their true human nature
copy Elizabeth Rocco MD
Contact Information
bull Elizabeth Rocco MD -egroccogmailcom
bull Karen Ekwueme MD-impactdoc1gmailcom
Internalized Racism
StressCumulative Effects
COGNITIVE BEHAVIORAL
EMOTIONAL NEURO PHYSIOLOGICAL
STRESS
Complex Societal Trauma (CST)Total Negative Health Impact over Generations
Societal Oppression
Familial Trauma
Societal Trauma
Complex Societal Trauma
copy Elizabeth Rocco MD
Intergenerational TransmissionHow is CST passed down to our children
1 Yehuda R et al (2015) ldquoHolocaust Exposure Induced Intergenerational Effects on FKBP5 MethylationrdquoBiol Psychiatry Aug 12 httpwwwncbinlmnihgovpubmed26410355B
2 Buss C et al (2011) ldquoMaternal pregnancy-specific anxiety is associated with child executive function at 6-9 years agerdquo Stress Nov14(6)665-76 httpwwwncbinlmnihgovpubmed21995526
3 Shankardass K et al (2014) ldquoParental stress increases body mass index trajectory in preadolescentsrdquoPediatr Obes Dec9(6)435-42 httpwwwncbinlmnihgovpubmed24311567
Complex Societal Trauma
is Toxic to the Developing Brain
Pat Levitt developmental neuroscientist and Dr Jack
Shonkoff part of the National Scientific Council on
the Developing Child
ACE (Adverse Childhood Experience) Study
Childhood neglect abuse and household dysfunction impacts health through out life
Vincent J Felitti et al (1998) ldquoRelationship of Childhood Abuse and Household Dysfunction to Many of the Leading Causes of Death in Adults
The Adverse Childhood Experiences (ACE) Studyrdquo May Volume 14 Issue 4 Pages 245ndash
258 httpsacestoohighcom
Healing Complex Societal Trauma
Social Engagement Ventral Vagal Complex
Reach for Help Ventral Vagal FEAR
Fight or FlightSympathetic
FEAR
FEAR
Freeze Collapse Dorsal Vagal
Pre-frontal CortexThe Voice of Reason
Human Healing and Evolution through Self-Awareness Embodiment Empowerment and Connection
Mindfulness Breath work Martial Arts Exercise Yoga Singing Dancing
Acupuncture Massage ReikiCommunity Groups Animals Church Nature
Final Listening Practice and Closing Circle
Bibliography
bull Special Acknowledgement of Demie Stathoplos MSW and Bonnie Cohen MD who collaborated with Elizabeth Rocco MD on the IM4US August 2015 presentation ldquoListening to Each Other Healing the Negative Health Impacts of Racism Poverty and Trauma through Human Connectionrdquo
bull Special Acknowledgement of Karen Burt MD who collaborated with Elizabeth Rocco MD and Karen Ekwueme MD on the IM4US August 2016 presentation ldquoListening to Ourselves and Each Other Healing the Negative Health Impact of Racism Poverty Sexism and Traumardquo These bibliographies are included below
bull [1]Wen Patricia (2010) ldquoA legacy of unintended side effectsrdquo Boston Globe December 12 httpwwwbostoncomnewslocalmassachusettsarticles20101212with_ssi_program_a_legcy_of_unintended_side_effects
bull [2]CCHR International (2014) [Online] Number of Children amp Adolescents Taking Psychiatric Drugs in the US Aprilwwwcchrintorgpsychiatric-drugschildren-on-psychiatric-drugs
bull [3]Whitaker R (2010) Anatomy of an Epidemic Magic Bullets Psychiatric Drugs and the Astonishing Rise of Mental Illness in America Crown Publishing Company httprobertwhitakerorgrobertwhitakerorgAnatomy20of20an20Epidemichtml
bull [3]CDC (2013) [Online] MMRW Mental Health Surveillance Among Children mdash United States 2005ndash2011 Supplements May 17 62(02)1-35 httpwwwcdcgovmmwrpreviewmmwrhtmlsu6202a1htm
bull [4]Patricia N Pastor PhD Cynthia A Reuben MA Catherine R Duran BS and LaJeana D Hawkins MPH CHES (2015) [Online] CDC NCHS Data Brief Association Between Diagnosed ADHD and Selected Characteristics Among Children Aged 4ndash17 Years United States 2011ndash2013 May Number 201 httpwwwcdcgovnchsdatadatabriefsdb201htm
bull [5]Mental Health America (2014) Parity or Disparity The State of Mental Health in America 2015 NovwwwmentalhealthamericanetsitesdefaultfilesParity20or20Disparity20201520Reportpdf
bull [6]Bruce S Jonas ScM PhD Qiuping Gu MD PhD and Juan R Albertorio-Diaz MA (2013) [Online] CDC NCHS Data Brief Psychotropic Medication Use Among Adolescents United States 2005ndash2010 Dec Number 135httpwwwcdcgovnchsdatadatabriefsdb135htm
bull [7] C Buss EP Davis CJ Hobel and CA Sandman (2011) Maternal pregnancy-specific anxiety is associated with child executive function at 6ndash9 years age Stress Nov 14(6)665-676
bull [8] Council for Evidence-Based Psychiatry (UK) Web presentation ldquoUnrecognized Factsrdquo Authors James Davies Peter C Goetzsche Peter Kinderman Joanna Moncrieff Phillip Thomas Sami Timimi John Sandwich Melanie Davis Luke Montague httpcepukorgunrecognised-facts
bull [9] Johnstone Lucy (2015) A Straight Talking Introduction to Psychiatric DiagnosisPCCS Books 1st edition (February 3 2015)
bull [10] Brewin CR Andrews B Valentine JD (2000) ldquoMeta-analysis of risk factors for posttraumatic stress disorder in trauma-exposed adultsrdquo J Consult Clin Psychol2000 Oct68(5)748-66 httpwwwncbinlmnihgovpubmed11068961
bull [11] Williams Monica T (2013) ldquoCan Racism Cause PTSD Implications for DSM-5rdquoPsychology Today May 20 httpswwwpsychologytodaycomblogculturally-speaking201305can-racism-cause-ptsd-implications-dsm-5
Bibliography
bull [12] Yuan Chengmei et al (2011) ldquoProtective factors for posttraumatic stress disorder symptoms in a prospective study of police officersrdquo Nov 23httpwwwncbinlmnihgovpmcarticlesPMC3071439
bull [13] Chou Tina BA Anu Asnaani MA and Stefan G Hofmann PhD (2012) ldquoPerception of Racial Discrimination and Psychopathology Across Three US Ethnic Minority Groupsrdquo APA PsychNET Jan httpwwwncbinlmnihgovpmcarticlesPMC3505377
bull [14] Watson Laurel B Jacob M Marszalek Franco Dispenza and Christopher M Davids 2015 Understanding the Relationships Among White and African American Womenrsquos Sexual Objectification Experiences Physical Safety Anxiety and Psychological Distress Sex Roles 72 (34) 91-104
bull [15] Holland Julie (2015) ldquoMedicating Womenrsquos Feelingsrdquo New York TimesOpinion Feb 28 httpmobilenytimescom20150301opinionsundaymedicating-womens-feelingshtmlreferreramp_r=1
bull [16] Solinas M Thiriet N El Rawas R Lardeux V and Jaber M (2009) ldquoEnvironmental Enrichment During Early Stages of Life Reduces the Behavioral Neurochemical and Molecular Effects of Cocainerdquo Neuropsychopharmacology 34 1102ndash1111
bull [17] Hari Johann Chasing The Scream The First and Last Days of the War on Drugs Bloomsbury USA (January 20 2015)bull [18] Hughes Caitlin Elizabeth and Alex Stevens (2010) ldquoWhat Can We Learn From The Portuguese Decriminalization of Illicit
Drugsrdquo British Journal of Criminology July 21 httpbjcoxfordjournalsorgcontent506999abstractbull [19] Fournier Jay C et al (2009) ldquoAntidepressant Drug Effects and Depression Severityrdquo JAMA January
6th httpjamajamanetworkcomarticleaspxarticleid=185157[20] Currie J Stabile M Jones L (2013) Do Stimulant Medications Improve Educational and Behavioral Outcomes for Children with ADHD NBER Working Paper No 19105
bull [21] Mora-Ripoli R Organizacioacuten Mundial de la Risa Barcelona Spain ldquoThe therapeutic value of laughter in medicinerdquo Altern Ther Health Med 2010 Nov-Dec16(6)56-64 httpwwwncbinlmnihgovpubmed21280463
bull [22] Gracanin Asmir Lauren M Bylsma and Ad J J M Vingerhoets (2014) ldquoIs Crying a Self-Stoothing Behaviorrdquo Frontiers in Psychology May 28httpwwwncbinlmnihgovpmcarticlesPMC4035568
bull [23] Trimble Michael (2010) ldquoI Cry Therefore I Amrdquo New York Times Nov 10 httpwwwnytimescom20121111opinionsundayi-cry-therefore-i-amhtmlemc=eta1amp_r=0
bull [24]Gallup Andrew C et al (2007) ldquoYawning as a brain cooling mechanism Nasal breathing and forehead cooling diminish the incidence of contagious yawningrdquo httpwwwepjournalnetarticlesyawning-as-a-brain-cooling-mechanism-nasal-breathing-and-forehead-cooling-diminish-the-incidence-of-contagious-yawning
bull [25]Sharat Gupta and Shallu Mittal Int (2013) Yawning and its physiological significance Intl J Appl Basic Med Res Jan-Jun 3(1) 11ndash15
bull [26] Stephens R Atkins J Kingston A (2009) ldquoSwearing As a Response to Painrdquo NeuroReport Aug 5 httpwwwncbinlmnihgovpubmed19590391
bull [27]Morelli SA Lieberman MD(2013) rdquoThe role of automaticity and attention in neural processes underlying empathy for happiness sadness and anxietyrdquo Front Hum Neurosci May 87160
Bibliography
bull [1] Committee on Psychosocial Aspects of Child and Family Health Committee on Early Childhood Adoption and Dependent Care andSection on Developmental and Behavioral Pediatrics Andrew S Garner Jack P Shonkoff et al (2012) ldquoEarly Childhood Adversity Toxic Stress and the Role of the Pediatrician Translating Developmental Science Into Lifelong Healthrdquo Pediatrics January VOLUME 129 ISSUE 1 From the American Academy of Pediatrics Policy Statementhttppediatricsaappublicationsorgcontent1291e224fullref-23
bull [2] COUNCIL ON COMMUNITY PEDIATRICS Benjamin A Gitterman et al (2016) ldquoPoverty and Child Health in the United Statesrdquo Pediatrics March From the American Academy of Pediatrics Policy Statement Published Online March 09American Academy of Pediatricshttppediatricsaappublicationsorgcontentearly20160307peds2016-0339info
bull [3] Paul W Newacheck et al (2003) ldquoDisparities in Adolescent Health and Health Care Does Socioeconomic Status Matterrdquo Health ServRes Oct 38(5) 1235ndash1252 httpwwwncbinlmnihgovpmcarticlesPMC1360944
bull [4] Larson et al (2007) ldquoPoverty during pregnancy Its effects on child health outcomesrdquo Paediatr Child Health 2007 Oct 12(8) 673ndash677 httpwwwncbinlmnihgovpmcarticlesPMC2528810
bull [5] Lara J Akinbami et al (2012) ldquoTrends in Asthma Prevalence Health Care Use and Mortality in the United States 2001ndash2010rdquo NCHS Data Brief No 94 May httpwwwcdcgovnchsproductsdatabriefsdb94htm
bull [6] Cynthia L Ogden et al (2010) ldquoObesity and Socioeconomic Status in Children and Adolescents United States 2005-2008rdquoNCHS Data Brief No 51 Decemberhttpwwwcdcgovnchsproductsdatabriefsdb51htm
bull [7] Shonkoff JP et al Committee on Psychosocial Aspects of Child and Family Health Committee on Early Childhood Adoption and Dependent Care Section on Developmental and Behavioral Pediatrics rdquoThe lifelong effects of early childhood adversity and toxicstressrdquo Pediatrics 2012129(1) wwwpediatricsorgcgicontentfull1291e232
bull [8] Virginia A Rauh et alldquoHousing and HealthIntersection of Poverty and Environmental Exposuresrdquo (2008) Annals of the New York Academy of Sciences Volume 1136 Reducing the Impact of Poverty on Health and Human Development Scientific Approaches pages 276ndash288 June httponlinelibrarywileycomdoi101196annals1425032full
bull [9] Yehuda R et al (2015) ldquoHolocaust Exposure Induced Intergenerational Effects on FKBP5 MethylationrdquoBiol Psychiatry Aug 12 httpwwwncbinlmnihgovpubmed26410355
bull [10] Buss C et al (2011) ldquoMaternal pregnancy-specific anxiety is associated with child executive function at 6-9 years agerdquoStress Nov14(6)665-76 httpwwwncbinlmnihgovpubmed21995526
bull 11] Shankardass K et al (2014) ldquoParental stress increases body mass index trajectory in pre-adolescentsrdquoPediatr Obes Dec9(6)435-42 httpwwwncbinlmnihgovpubmed24311567
bull [12] Vincent J Felitti et al (1998) ldquoRelationship of Childhood Abuse and Household Dysfunction to Many of the Leading Causes of Death in Adults The Adverse Childhood Experiences (ACE) Studyrdquo May Volume 14 Issue 4 Pages 245ndash258 httpsacestoohighcom
bull [13]Jones CP Levels of Racism a Theoretic Framework and the Gardenerrsquos Tale Am J Public Health 200090(8) 1212-1215bull [14]Dion KL The Social Psycology of Perceived Perjudice and Discrimination Canadian Psychology (2002)431 pp 1-10bull [15]Sue D W Bucceri J Lin AI Nadal K L and Torino J C Racial Microaggressions and the Asian American experience APA (2007) Vol
13 No 1 pp 72-81bull [16]James S A (School of Public Health U of North Carolina Chapel Hill NC 27514) D S Strogatz S B Wing and D L Ramsey
Socioeconomic status John Henryism and hypertension in blacks and whites Am J Epidemiol 1987 126664ndash73bull [17]httpwwwapaorgpioemaresourcesethnicity-healthindexaspxbull [18]Porges SW Clinical Insights from the Polyvagal Theory The Transformative Power of Feeling Safe (Norton Series on Interpersonal
Neurobiology) W W Norton Apr 7 2014 - Psychology - 288 pagesbull [19]The Polyvagal Theory (Porges SW Social Connectedness as a Biological Imperative Understanding Trauma Through the Lens of
thePolyvagal Theory presentation 82015)bull [20]McEwen BS Allostasis and allostatic load implications for neuropsychopharmacologyNeuropsychopharmacology 2000
Feb22(2)108-24bull [21] McEwen BS adaptation and disease Allostasis and allostatic load Ann N Y Acad Sci 1998 May 184033-44bull [22] Arline T Geronimus ScD Margaret Hicken MPH Danya Keene MAT and John Bound PhD Weatheringrdquo and Age Patterns of
Allostatic Load Scores Among Blacks and Whites in the United States Am J Public Health 2006 May 96(5) 826ndash833bull [22]Stephen Porges PhD Polyvagal Perspective Biological Psychology 2007 Feb 74(2) 116ndash143 Published online 2006 Oct 16 bull [23]Stephen W Porges PhD The Polyvagal Theory Neurophysiological Foundations of Emotions Attachment Communication and
Self-regulation WWNorton and Company Inc 2011bull [24]Maggie Phillips PhD Reversing Chronic Pain North Atlantic Books 2007bull [25]Peter Levine PhD Waking the Tiger North Atlantic Books 1997bull [26]Bessel VanderKolk MD The Body Keeps the Score Viking Penguin 2014bullAcknowledgmentsbull Group Medical Visits and Group Facilitation Jeff Geller MDbull Re-evaluation Counseling Community bull Insight Meditation Communitybull Biodynamic Osteopathy Communitybull Learning To Breathe Mindfulness Training for Adolescents 2015 Patricia C Broderick PhD bull Stanford Chronic Disease Self Management Program Training 2014 Kate Lorig MPH RNbull Motivational Interviewing Training 2015 Steven Berg-Smithbull Centering Pregnancy Training 2014 Centering Healthcare Institutebull Motivating Change in Groups Training 2013 Kaiser Permanente Oakland Cabull Group Facilitation Training Sara Fisk PhD Community at Work San Francisco Cabull Tribes Training 2013 Center for Human Developmentbull Cultural Humility Training 2016 Melanie Tervalon MD
Bibliography
Intermediate Steps to Listening Session Handout
bull Step 1 Connect with yourself body mind and emotions
bull Step 2 Hold a non-judgmental space to be seen and heard
bull Step 3 See the speaker and anyone referenced as able to manifest their true human nature and evolve using inherent healing abilities
bull Step 4 Listen to the speaker in a deep connected way sending the message that their thinking feelings and being matters to you
bull Step 5 Encourage the speaker to express feelings or thoughts describe body sensations or share a story relevant to the feelings at hand
bull Step 6 Validate intense emotional expression and release such as crying laughing shaking yawning sweating as a sign of healing
bull Step 7 Remind the speaker of their underlying goodness intelligence strength and caring and your confidence in their ability to heal and manifest their true human nature
copy Elizabeth Rocco MD
Contact Information
bull Elizabeth Rocco MD -egroccogmailcom
bull Karen Ekwueme MD-impactdoc1gmailcom
StressCumulative Effects
COGNITIVE BEHAVIORAL
EMOTIONAL NEURO PHYSIOLOGICAL
STRESS
Complex Societal Trauma (CST)Total Negative Health Impact over Generations
Societal Oppression
Familial Trauma
Societal Trauma
Complex Societal Trauma
copy Elizabeth Rocco MD
Intergenerational TransmissionHow is CST passed down to our children
1 Yehuda R et al (2015) ldquoHolocaust Exposure Induced Intergenerational Effects on FKBP5 MethylationrdquoBiol Psychiatry Aug 12 httpwwwncbinlmnihgovpubmed26410355B
2 Buss C et al (2011) ldquoMaternal pregnancy-specific anxiety is associated with child executive function at 6-9 years agerdquo Stress Nov14(6)665-76 httpwwwncbinlmnihgovpubmed21995526
3 Shankardass K et al (2014) ldquoParental stress increases body mass index trajectory in preadolescentsrdquoPediatr Obes Dec9(6)435-42 httpwwwncbinlmnihgovpubmed24311567
Complex Societal Trauma
is Toxic to the Developing Brain
Pat Levitt developmental neuroscientist and Dr Jack
Shonkoff part of the National Scientific Council on
the Developing Child
ACE (Adverse Childhood Experience) Study
Childhood neglect abuse and household dysfunction impacts health through out life
Vincent J Felitti et al (1998) ldquoRelationship of Childhood Abuse and Household Dysfunction to Many of the Leading Causes of Death in Adults
The Adverse Childhood Experiences (ACE) Studyrdquo May Volume 14 Issue 4 Pages 245ndash
258 httpsacestoohighcom
Healing Complex Societal Trauma
Social Engagement Ventral Vagal Complex
Reach for Help Ventral Vagal FEAR
Fight or FlightSympathetic
FEAR
FEAR
Freeze Collapse Dorsal Vagal
Pre-frontal CortexThe Voice of Reason
Human Healing and Evolution through Self-Awareness Embodiment Empowerment and Connection
Mindfulness Breath work Martial Arts Exercise Yoga Singing Dancing
Acupuncture Massage ReikiCommunity Groups Animals Church Nature
Final Listening Practice and Closing Circle
Bibliography
bull Special Acknowledgement of Demie Stathoplos MSW and Bonnie Cohen MD who collaborated with Elizabeth Rocco MD on the IM4US August 2015 presentation ldquoListening to Each Other Healing the Negative Health Impacts of Racism Poverty and Trauma through Human Connectionrdquo
bull Special Acknowledgement of Karen Burt MD who collaborated with Elizabeth Rocco MD and Karen Ekwueme MD on the IM4US August 2016 presentation ldquoListening to Ourselves and Each Other Healing the Negative Health Impact of Racism Poverty Sexism and Traumardquo These bibliographies are included below
bull [1]Wen Patricia (2010) ldquoA legacy of unintended side effectsrdquo Boston Globe December 12 httpwwwbostoncomnewslocalmassachusettsarticles20101212with_ssi_program_a_legcy_of_unintended_side_effects
bull [2]CCHR International (2014) [Online] Number of Children amp Adolescents Taking Psychiatric Drugs in the US Aprilwwwcchrintorgpsychiatric-drugschildren-on-psychiatric-drugs
bull [3]Whitaker R (2010) Anatomy of an Epidemic Magic Bullets Psychiatric Drugs and the Astonishing Rise of Mental Illness in America Crown Publishing Company httprobertwhitakerorgrobertwhitakerorgAnatomy20of20an20Epidemichtml
bull [3]CDC (2013) [Online] MMRW Mental Health Surveillance Among Children mdash United States 2005ndash2011 Supplements May 17 62(02)1-35 httpwwwcdcgovmmwrpreviewmmwrhtmlsu6202a1htm
bull [4]Patricia N Pastor PhD Cynthia A Reuben MA Catherine R Duran BS and LaJeana D Hawkins MPH CHES (2015) [Online] CDC NCHS Data Brief Association Between Diagnosed ADHD and Selected Characteristics Among Children Aged 4ndash17 Years United States 2011ndash2013 May Number 201 httpwwwcdcgovnchsdatadatabriefsdb201htm
bull [5]Mental Health America (2014) Parity or Disparity The State of Mental Health in America 2015 NovwwwmentalhealthamericanetsitesdefaultfilesParity20or20Disparity20201520Reportpdf
bull [6]Bruce S Jonas ScM PhD Qiuping Gu MD PhD and Juan R Albertorio-Diaz MA (2013) [Online] CDC NCHS Data Brief Psychotropic Medication Use Among Adolescents United States 2005ndash2010 Dec Number 135httpwwwcdcgovnchsdatadatabriefsdb135htm
bull [7] C Buss EP Davis CJ Hobel and CA Sandman (2011) Maternal pregnancy-specific anxiety is associated with child executive function at 6ndash9 years age Stress Nov 14(6)665-676
bull [8] Council for Evidence-Based Psychiatry (UK) Web presentation ldquoUnrecognized Factsrdquo Authors James Davies Peter C Goetzsche Peter Kinderman Joanna Moncrieff Phillip Thomas Sami Timimi John Sandwich Melanie Davis Luke Montague httpcepukorgunrecognised-facts
bull [9] Johnstone Lucy (2015) A Straight Talking Introduction to Psychiatric DiagnosisPCCS Books 1st edition (February 3 2015)
bull [10] Brewin CR Andrews B Valentine JD (2000) ldquoMeta-analysis of risk factors for posttraumatic stress disorder in trauma-exposed adultsrdquo J Consult Clin Psychol2000 Oct68(5)748-66 httpwwwncbinlmnihgovpubmed11068961
bull [11] Williams Monica T (2013) ldquoCan Racism Cause PTSD Implications for DSM-5rdquoPsychology Today May 20 httpswwwpsychologytodaycomblogculturally-speaking201305can-racism-cause-ptsd-implications-dsm-5
Bibliography
bull [12] Yuan Chengmei et al (2011) ldquoProtective factors for posttraumatic stress disorder symptoms in a prospective study of police officersrdquo Nov 23httpwwwncbinlmnihgovpmcarticlesPMC3071439
bull [13] Chou Tina BA Anu Asnaani MA and Stefan G Hofmann PhD (2012) ldquoPerception of Racial Discrimination and Psychopathology Across Three US Ethnic Minority Groupsrdquo APA PsychNET Jan httpwwwncbinlmnihgovpmcarticlesPMC3505377
bull [14] Watson Laurel B Jacob M Marszalek Franco Dispenza and Christopher M Davids 2015 Understanding the Relationships Among White and African American Womenrsquos Sexual Objectification Experiences Physical Safety Anxiety and Psychological Distress Sex Roles 72 (34) 91-104
bull [15] Holland Julie (2015) ldquoMedicating Womenrsquos Feelingsrdquo New York TimesOpinion Feb 28 httpmobilenytimescom20150301opinionsundaymedicating-womens-feelingshtmlreferreramp_r=1
bull [16] Solinas M Thiriet N El Rawas R Lardeux V and Jaber M (2009) ldquoEnvironmental Enrichment During Early Stages of Life Reduces the Behavioral Neurochemical and Molecular Effects of Cocainerdquo Neuropsychopharmacology 34 1102ndash1111
bull [17] Hari Johann Chasing The Scream The First and Last Days of the War on Drugs Bloomsbury USA (January 20 2015)bull [18] Hughes Caitlin Elizabeth and Alex Stevens (2010) ldquoWhat Can We Learn From The Portuguese Decriminalization of Illicit
Drugsrdquo British Journal of Criminology July 21 httpbjcoxfordjournalsorgcontent506999abstractbull [19] Fournier Jay C et al (2009) ldquoAntidepressant Drug Effects and Depression Severityrdquo JAMA January
6th httpjamajamanetworkcomarticleaspxarticleid=185157[20] Currie J Stabile M Jones L (2013) Do Stimulant Medications Improve Educational and Behavioral Outcomes for Children with ADHD NBER Working Paper No 19105
bull [21] Mora-Ripoli R Organizacioacuten Mundial de la Risa Barcelona Spain ldquoThe therapeutic value of laughter in medicinerdquo Altern Ther Health Med 2010 Nov-Dec16(6)56-64 httpwwwncbinlmnihgovpubmed21280463
bull [22] Gracanin Asmir Lauren M Bylsma and Ad J J M Vingerhoets (2014) ldquoIs Crying a Self-Stoothing Behaviorrdquo Frontiers in Psychology May 28httpwwwncbinlmnihgovpmcarticlesPMC4035568
bull [23] Trimble Michael (2010) ldquoI Cry Therefore I Amrdquo New York Times Nov 10 httpwwwnytimescom20121111opinionsundayi-cry-therefore-i-amhtmlemc=eta1amp_r=0
bull [24]Gallup Andrew C et al (2007) ldquoYawning as a brain cooling mechanism Nasal breathing and forehead cooling diminish the incidence of contagious yawningrdquo httpwwwepjournalnetarticlesyawning-as-a-brain-cooling-mechanism-nasal-breathing-and-forehead-cooling-diminish-the-incidence-of-contagious-yawning
bull [25]Sharat Gupta and Shallu Mittal Int (2013) Yawning and its physiological significance Intl J Appl Basic Med Res Jan-Jun 3(1) 11ndash15
bull [26] Stephens R Atkins J Kingston A (2009) ldquoSwearing As a Response to Painrdquo NeuroReport Aug 5 httpwwwncbinlmnihgovpubmed19590391
bull [27]Morelli SA Lieberman MD(2013) rdquoThe role of automaticity and attention in neural processes underlying empathy for happiness sadness and anxietyrdquo Front Hum Neurosci May 87160
Bibliography
bull [1] Committee on Psychosocial Aspects of Child and Family Health Committee on Early Childhood Adoption and Dependent Care andSection on Developmental and Behavioral Pediatrics Andrew S Garner Jack P Shonkoff et al (2012) ldquoEarly Childhood Adversity Toxic Stress and the Role of the Pediatrician Translating Developmental Science Into Lifelong Healthrdquo Pediatrics January VOLUME 129 ISSUE 1 From the American Academy of Pediatrics Policy Statementhttppediatricsaappublicationsorgcontent1291e224fullref-23
bull [2] COUNCIL ON COMMUNITY PEDIATRICS Benjamin A Gitterman et al (2016) ldquoPoverty and Child Health in the United Statesrdquo Pediatrics March From the American Academy of Pediatrics Policy Statement Published Online March 09American Academy of Pediatricshttppediatricsaappublicationsorgcontentearly20160307peds2016-0339info
bull [3] Paul W Newacheck et al (2003) ldquoDisparities in Adolescent Health and Health Care Does Socioeconomic Status Matterrdquo Health ServRes Oct 38(5) 1235ndash1252 httpwwwncbinlmnihgovpmcarticlesPMC1360944
bull [4] Larson et al (2007) ldquoPoverty during pregnancy Its effects on child health outcomesrdquo Paediatr Child Health 2007 Oct 12(8) 673ndash677 httpwwwncbinlmnihgovpmcarticlesPMC2528810
bull [5] Lara J Akinbami et al (2012) ldquoTrends in Asthma Prevalence Health Care Use and Mortality in the United States 2001ndash2010rdquo NCHS Data Brief No 94 May httpwwwcdcgovnchsproductsdatabriefsdb94htm
bull [6] Cynthia L Ogden et al (2010) ldquoObesity and Socioeconomic Status in Children and Adolescents United States 2005-2008rdquoNCHS Data Brief No 51 Decemberhttpwwwcdcgovnchsproductsdatabriefsdb51htm
bull [7] Shonkoff JP et al Committee on Psychosocial Aspects of Child and Family Health Committee on Early Childhood Adoption and Dependent Care Section on Developmental and Behavioral Pediatrics rdquoThe lifelong effects of early childhood adversity and toxicstressrdquo Pediatrics 2012129(1) wwwpediatricsorgcgicontentfull1291e232
bull [8] Virginia A Rauh et alldquoHousing and HealthIntersection of Poverty and Environmental Exposuresrdquo (2008) Annals of the New York Academy of Sciences Volume 1136 Reducing the Impact of Poverty on Health and Human Development Scientific Approaches pages 276ndash288 June httponlinelibrarywileycomdoi101196annals1425032full
bull [9] Yehuda R et al (2015) ldquoHolocaust Exposure Induced Intergenerational Effects on FKBP5 MethylationrdquoBiol Psychiatry Aug 12 httpwwwncbinlmnihgovpubmed26410355
bull [10] Buss C et al (2011) ldquoMaternal pregnancy-specific anxiety is associated with child executive function at 6-9 years agerdquoStress Nov14(6)665-76 httpwwwncbinlmnihgovpubmed21995526
bull 11] Shankardass K et al (2014) ldquoParental stress increases body mass index trajectory in pre-adolescentsrdquoPediatr Obes Dec9(6)435-42 httpwwwncbinlmnihgovpubmed24311567
bull [12] Vincent J Felitti et al (1998) ldquoRelationship of Childhood Abuse and Household Dysfunction to Many of the Leading Causes of Death in Adults The Adverse Childhood Experiences (ACE) Studyrdquo May Volume 14 Issue 4 Pages 245ndash258 httpsacestoohighcom
bull [13]Jones CP Levels of Racism a Theoretic Framework and the Gardenerrsquos Tale Am J Public Health 200090(8) 1212-1215bull [14]Dion KL The Social Psycology of Perceived Perjudice and Discrimination Canadian Psychology (2002)431 pp 1-10bull [15]Sue D W Bucceri J Lin AI Nadal K L and Torino J C Racial Microaggressions and the Asian American experience APA (2007) Vol
13 No 1 pp 72-81bull [16]James S A (School of Public Health U of North Carolina Chapel Hill NC 27514) D S Strogatz S B Wing and D L Ramsey
Socioeconomic status John Henryism and hypertension in blacks and whites Am J Epidemiol 1987 126664ndash73bull [17]httpwwwapaorgpioemaresourcesethnicity-healthindexaspxbull [18]Porges SW Clinical Insights from the Polyvagal Theory The Transformative Power of Feeling Safe (Norton Series on Interpersonal
Neurobiology) W W Norton Apr 7 2014 - Psychology - 288 pagesbull [19]The Polyvagal Theory (Porges SW Social Connectedness as a Biological Imperative Understanding Trauma Through the Lens of
thePolyvagal Theory presentation 82015)bull [20]McEwen BS Allostasis and allostatic load implications for neuropsychopharmacologyNeuropsychopharmacology 2000
Feb22(2)108-24bull [21] McEwen BS adaptation and disease Allostasis and allostatic load Ann N Y Acad Sci 1998 May 184033-44bull [22] Arline T Geronimus ScD Margaret Hicken MPH Danya Keene MAT and John Bound PhD Weatheringrdquo and Age Patterns of
Allostatic Load Scores Among Blacks and Whites in the United States Am J Public Health 2006 May 96(5) 826ndash833bull [22]Stephen Porges PhD Polyvagal Perspective Biological Psychology 2007 Feb 74(2) 116ndash143 Published online 2006 Oct 16 bull [23]Stephen W Porges PhD The Polyvagal Theory Neurophysiological Foundations of Emotions Attachment Communication and
Self-regulation WWNorton and Company Inc 2011bull [24]Maggie Phillips PhD Reversing Chronic Pain North Atlantic Books 2007bull [25]Peter Levine PhD Waking the Tiger North Atlantic Books 1997bull [26]Bessel VanderKolk MD The Body Keeps the Score Viking Penguin 2014bullAcknowledgmentsbull Group Medical Visits and Group Facilitation Jeff Geller MDbull Re-evaluation Counseling Community bull Insight Meditation Communitybull Biodynamic Osteopathy Communitybull Learning To Breathe Mindfulness Training for Adolescents 2015 Patricia C Broderick PhD bull Stanford Chronic Disease Self Management Program Training 2014 Kate Lorig MPH RNbull Motivational Interviewing Training 2015 Steven Berg-Smithbull Centering Pregnancy Training 2014 Centering Healthcare Institutebull Motivating Change in Groups Training 2013 Kaiser Permanente Oakland Cabull Group Facilitation Training Sara Fisk PhD Community at Work San Francisco Cabull Tribes Training 2013 Center for Human Developmentbull Cultural Humility Training 2016 Melanie Tervalon MD
Bibliography
Intermediate Steps to Listening Session Handout
bull Step 1 Connect with yourself body mind and emotions
bull Step 2 Hold a non-judgmental space to be seen and heard
bull Step 3 See the speaker and anyone referenced as able to manifest their true human nature and evolve using inherent healing abilities
bull Step 4 Listen to the speaker in a deep connected way sending the message that their thinking feelings and being matters to you
bull Step 5 Encourage the speaker to express feelings or thoughts describe body sensations or share a story relevant to the feelings at hand
bull Step 6 Validate intense emotional expression and release such as crying laughing shaking yawning sweating as a sign of healing
bull Step 7 Remind the speaker of their underlying goodness intelligence strength and caring and your confidence in their ability to heal and manifest their true human nature
copy Elizabeth Rocco MD
Contact Information
bull Elizabeth Rocco MD -egroccogmailcom
bull Karen Ekwueme MD-impactdoc1gmailcom
Complex Societal Trauma (CST)Total Negative Health Impact over Generations
Societal Oppression
Familial Trauma
Societal Trauma
Complex Societal Trauma
copy Elizabeth Rocco MD
Intergenerational TransmissionHow is CST passed down to our children
1 Yehuda R et al (2015) ldquoHolocaust Exposure Induced Intergenerational Effects on FKBP5 MethylationrdquoBiol Psychiatry Aug 12 httpwwwncbinlmnihgovpubmed26410355B
2 Buss C et al (2011) ldquoMaternal pregnancy-specific anxiety is associated with child executive function at 6-9 years agerdquo Stress Nov14(6)665-76 httpwwwncbinlmnihgovpubmed21995526
3 Shankardass K et al (2014) ldquoParental stress increases body mass index trajectory in preadolescentsrdquoPediatr Obes Dec9(6)435-42 httpwwwncbinlmnihgovpubmed24311567
Complex Societal Trauma
is Toxic to the Developing Brain
Pat Levitt developmental neuroscientist and Dr Jack
Shonkoff part of the National Scientific Council on
the Developing Child
ACE (Adverse Childhood Experience) Study
Childhood neglect abuse and household dysfunction impacts health through out life
Vincent J Felitti et al (1998) ldquoRelationship of Childhood Abuse and Household Dysfunction to Many of the Leading Causes of Death in Adults
The Adverse Childhood Experiences (ACE) Studyrdquo May Volume 14 Issue 4 Pages 245ndash
258 httpsacestoohighcom
Healing Complex Societal Trauma
Social Engagement Ventral Vagal Complex
Reach for Help Ventral Vagal FEAR
Fight or FlightSympathetic
FEAR
FEAR
Freeze Collapse Dorsal Vagal
Pre-frontal CortexThe Voice of Reason
Human Healing and Evolution through Self-Awareness Embodiment Empowerment and Connection
Mindfulness Breath work Martial Arts Exercise Yoga Singing Dancing
Acupuncture Massage ReikiCommunity Groups Animals Church Nature
Final Listening Practice and Closing Circle
Bibliography
bull Special Acknowledgement of Demie Stathoplos MSW and Bonnie Cohen MD who collaborated with Elizabeth Rocco MD on the IM4US August 2015 presentation ldquoListening to Each Other Healing the Negative Health Impacts of Racism Poverty and Trauma through Human Connectionrdquo
bull Special Acknowledgement of Karen Burt MD who collaborated with Elizabeth Rocco MD and Karen Ekwueme MD on the IM4US August 2016 presentation ldquoListening to Ourselves and Each Other Healing the Negative Health Impact of Racism Poverty Sexism and Traumardquo These bibliographies are included below
bull [1]Wen Patricia (2010) ldquoA legacy of unintended side effectsrdquo Boston Globe December 12 httpwwwbostoncomnewslocalmassachusettsarticles20101212with_ssi_program_a_legcy_of_unintended_side_effects
bull [2]CCHR International (2014) [Online] Number of Children amp Adolescents Taking Psychiatric Drugs in the US Aprilwwwcchrintorgpsychiatric-drugschildren-on-psychiatric-drugs
bull [3]Whitaker R (2010) Anatomy of an Epidemic Magic Bullets Psychiatric Drugs and the Astonishing Rise of Mental Illness in America Crown Publishing Company httprobertwhitakerorgrobertwhitakerorgAnatomy20of20an20Epidemichtml
bull [3]CDC (2013) [Online] MMRW Mental Health Surveillance Among Children mdash United States 2005ndash2011 Supplements May 17 62(02)1-35 httpwwwcdcgovmmwrpreviewmmwrhtmlsu6202a1htm
bull [4]Patricia N Pastor PhD Cynthia A Reuben MA Catherine R Duran BS and LaJeana D Hawkins MPH CHES (2015) [Online] CDC NCHS Data Brief Association Between Diagnosed ADHD and Selected Characteristics Among Children Aged 4ndash17 Years United States 2011ndash2013 May Number 201 httpwwwcdcgovnchsdatadatabriefsdb201htm
bull [5]Mental Health America (2014) Parity or Disparity The State of Mental Health in America 2015 NovwwwmentalhealthamericanetsitesdefaultfilesParity20or20Disparity20201520Reportpdf
bull [6]Bruce S Jonas ScM PhD Qiuping Gu MD PhD and Juan R Albertorio-Diaz MA (2013) [Online] CDC NCHS Data Brief Psychotropic Medication Use Among Adolescents United States 2005ndash2010 Dec Number 135httpwwwcdcgovnchsdatadatabriefsdb135htm
bull [7] C Buss EP Davis CJ Hobel and CA Sandman (2011) Maternal pregnancy-specific anxiety is associated with child executive function at 6ndash9 years age Stress Nov 14(6)665-676
bull [8] Council for Evidence-Based Psychiatry (UK) Web presentation ldquoUnrecognized Factsrdquo Authors James Davies Peter C Goetzsche Peter Kinderman Joanna Moncrieff Phillip Thomas Sami Timimi John Sandwich Melanie Davis Luke Montague httpcepukorgunrecognised-facts
bull [9] Johnstone Lucy (2015) A Straight Talking Introduction to Psychiatric DiagnosisPCCS Books 1st edition (February 3 2015)
bull [10] Brewin CR Andrews B Valentine JD (2000) ldquoMeta-analysis of risk factors for posttraumatic stress disorder in trauma-exposed adultsrdquo J Consult Clin Psychol2000 Oct68(5)748-66 httpwwwncbinlmnihgovpubmed11068961
bull [11] Williams Monica T (2013) ldquoCan Racism Cause PTSD Implications for DSM-5rdquoPsychology Today May 20 httpswwwpsychologytodaycomblogculturally-speaking201305can-racism-cause-ptsd-implications-dsm-5
Bibliography
bull [12] Yuan Chengmei et al (2011) ldquoProtective factors for posttraumatic stress disorder symptoms in a prospective study of police officersrdquo Nov 23httpwwwncbinlmnihgovpmcarticlesPMC3071439
bull [13] Chou Tina BA Anu Asnaani MA and Stefan G Hofmann PhD (2012) ldquoPerception of Racial Discrimination and Psychopathology Across Three US Ethnic Minority Groupsrdquo APA PsychNET Jan httpwwwncbinlmnihgovpmcarticlesPMC3505377
bull [14] Watson Laurel B Jacob M Marszalek Franco Dispenza and Christopher M Davids 2015 Understanding the Relationships Among White and African American Womenrsquos Sexual Objectification Experiences Physical Safety Anxiety and Psychological Distress Sex Roles 72 (34) 91-104
bull [15] Holland Julie (2015) ldquoMedicating Womenrsquos Feelingsrdquo New York TimesOpinion Feb 28 httpmobilenytimescom20150301opinionsundaymedicating-womens-feelingshtmlreferreramp_r=1
bull [16] Solinas M Thiriet N El Rawas R Lardeux V and Jaber M (2009) ldquoEnvironmental Enrichment During Early Stages of Life Reduces the Behavioral Neurochemical and Molecular Effects of Cocainerdquo Neuropsychopharmacology 34 1102ndash1111
bull [17] Hari Johann Chasing The Scream The First and Last Days of the War on Drugs Bloomsbury USA (January 20 2015)bull [18] Hughes Caitlin Elizabeth and Alex Stevens (2010) ldquoWhat Can We Learn From The Portuguese Decriminalization of Illicit
Drugsrdquo British Journal of Criminology July 21 httpbjcoxfordjournalsorgcontent506999abstractbull [19] Fournier Jay C et al (2009) ldquoAntidepressant Drug Effects and Depression Severityrdquo JAMA January
6th httpjamajamanetworkcomarticleaspxarticleid=185157[20] Currie J Stabile M Jones L (2013) Do Stimulant Medications Improve Educational and Behavioral Outcomes for Children with ADHD NBER Working Paper No 19105
bull [21] Mora-Ripoli R Organizacioacuten Mundial de la Risa Barcelona Spain ldquoThe therapeutic value of laughter in medicinerdquo Altern Ther Health Med 2010 Nov-Dec16(6)56-64 httpwwwncbinlmnihgovpubmed21280463
bull [22] Gracanin Asmir Lauren M Bylsma and Ad J J M Vingerhoets (2014) ldquoIs Crying a Self-Stoothing Behaviorrdquo Frontiers in Psychology May 28httpwwwncbinlmnihgovpmcarticlesPMC4035568
bull [23] Trimble Michael (2010) ldquoI Cry Therefore I Amrdquo New York Times Nov 10 httpwwwnytimescom20121111opinionsundayi-cry-therefore-i-amhtmlemc=eta1amp_r=0
bull [24]Gallup Andrew C et al (2007) ldquoYawning as a brain cooling mechanism Nasal breathing and forehead cooling diminish the incidence of contagious yawningrdquo httpwwwepjournalnetarticlesyawning-as-a-brain-cooling-mechanism-nasal-breathing-and-forehead-cooling-diminish-the-incidence-of-contagious-yawning
bull [25]Sharat Gupta and Shallu Mittal Int (2013) Yawning and its physiological significance Intl J Appl Basic Med Res Jan-Jun 3(1) 11ndash15
bull [26] Stephens R Atkins J Kingston A (2009) ldquoSwearing As a Response to Painrdquo NeuroReport Aug 5 httpwwwncbinlmnihgovpubmed19590391
bull [27]Morelli SA Lieberman MD(2013) rdquoThe role of automaticity and attention in neural processes underlying empathy for happiness sadness and anxietyrdquo Front Hum Neurosci May 87160
Bibliography
bull [1] Committee on Psychosocial Aspects of Child and Family Health Committee on Early Childhood Adoption and Dependent Care andSection on Developmental and Behavioral Pediatrics Andrew S Garner Jack P Shonkoff et al (2012) ldquoEarly Childhood Adversity Toxic Stress and the Role of the Pediatrician Translating Developmental Science Into Lifelong Healthrdquo Pediatrics January VOLUME 129 ISSUE 1 From the American Academy of Pediatrics Policy Statementhttppediatricsaappublicationsorgcontent1291e224fullref-23
bull [2] COUNCIL ON COMMUNITY PEDIATRICS Benjamin A Gitterman et al (2016) ldquoPoverty and Child Health in the United Statesrdquo Pediatrics March From the American Academy of Pediatrics Policy Statement Published Online March 09American Academy of Pediatricshttppediatricsaappublicationsorgcontentearly20160307peds2016-0339info
bull [3] Paul W Newacheck et al (2003) ldquoDisparities in Adolescent Health and Health Care Does Socioeconomic Status Matterrdquo Health ServRes Oct 38(5) 1235ndash1252 httpwwwncbinlmnihgovpmcarticlesPMC1360944
bull [4] Larson et al (2007) ldquoPoverty during pregnancy Its effects on child health outcomesrdquo Paediatr Child Health 2007 Oct 12(8) 673ndash677 httpwwwncbinlmnihgovpmcarticlesPMC2528810
bull [5] Lara J Akinbami et al (2012) ldquoTrends in Asthma Prevalence Health Care Use and Mortality in the United States 2001ndash2010rdquo NCHS Data Brief No 94 May httpwwwcdcgovnchsproductsdatabriefsdb94htm
bull [6] Cynthia L Ogden et al (2010) ldquoObesity and Socioeconomic Status in Children and Adolescents United States 2005-2008rdquoNCHS Data Brief No 51 Decemberhttpwwwcdcgovnchsproductsdatabriefsdb51htm
bull [7] Shonkoff JP et al Committee on Psychosocial Aspects of Child and Family Health Committee on Early Childhood Adoption and Dependent Care Section on Developmental and Behavioral Pediatrics rdquoThe lifelong effects of early childhood adversity and toxicstressrdquo Pediatrics 2012129(1) wwwpediatricsorgcgicontentfull1291e232
bull [8] Virginia A Rauh et alldquoHousing and HealthIntersection of Poverty and Environmental Exposuresrdquo (2008) Annals of the New York Academy of Sciences Volume 1136 Reducing the Impact of Poverty on Health and Human Development Scientific Approaches pages 276ndash288 June httponlinelibrarywileycomdoi101196annals1425032full
bull [9] Yehuda R et al (2015) ldquoHolocaust Exposure Induced Intergenerational Effects on FKBP5 MethylationrdquoBiol Psychiatry Aug 12 httpwwwncbinlmnihgovpubmed26410355
bull [10] Buss C et al (2011) ldquoMaternal pregnancy-specific anxiety is associated with child executive function at 6-9 years agerdquoStress Nov14(6)665-76 httpwwwncbinlmnihgovpubmed21995526
bull 11] Shankardass K et al (2014) ldquoParental stress increases body mass index trajectory in pre-adolescentsrdquoPediatr Obes Dec9(6)435-42 httpwwwncbinlmnihgovpubmed24311567
bull [12] Vincent J Felitti et al (1998) ldquoRelationship of Childhood Abuse and Household Dysfunction to Many of the Leading Causes of Death in Adults The Adverse Childhood Experiences (ACE) Studyrdquo May Volume 14 Issue 4 Pages 245ndash258 httpsacestoohighcom
bull [13]Jones CP Levels of Racism a Theoretic Framework and the Gardenerrsquos Tale Am J Public Health 200090(8) 1212-1215bull [14]Dion KL The Social Psycology of Perceived Perjudice and Discrimination Canadian Psychology (2002)431 pp 1-10bull [15]Sue D W Bucceri J Lin AI Nadal K L and Torino J C Racial Microaggressions and the Asian American experience APA (2007) Vol
13 No 1 pp 72-81bull [16]James S A (School of Public Health U of North Carolina Chapel Hill NC 27514) D S Strogatz S B Wing and D L Ramsey
Socioeconomic status John Henryism and hypertension in blacks and whites Am J Epidemiol 1987 126664ndash73bull [17]httpwwwapaorgpioemaresourcesethnicity-healthindexaspxbull [18]Porges SW Clinical Insights from the Polyvagal Theory The Transformative Power of Feeling Safe (Norton Series on Interpersonal
Neurobiology) W W Norton Apr 7 2014 - Psychology - 288 pagesbull [19]The Polyvagal Theory (Porges SW Social Connectedness as a Biological Imperative Understanding Trauma Through the Lens of
thePolyvagal Theory presentation 82015)bull [20]McEwen BS Allostasis and allostatic load implications for neuropsychopharmacologyNeuropsychopharmacology 2000
Feb22(2)108-24bull [21] McEwen BS adaptation and disease Allostasis and allostatic load Ann N Y Acad Sci 1998 May 184033-44bull [22] Arline T Geronimus ScD Margaret Hicken MPH Danya Keene MAT and John Bound PhD Weatheringrdquo and Age Patterns of
Allostatic Load Scores Among Blacks and Whites in the United States Am J Public Health 2006 May 96(5) 826ndash833bull [22]Stephen Porges PhD Polyvagal Perspective Biological Psychology 2007 Feb 74(2) 116ndash143 Published online 2006 Oct 16 bull [23]Stephen W Porges PhD The Polyvagal Theory Neurophysiological Foundations of Emotions Attachment Communication and
Self-regulation WWNorton and Company Inc 2011bull [24]Maggie Phillips PhD Reversing Chronic Pain North Atlantic Books 2007bull [25]Peter Levine PhD Waking the Tiger North Atlantic Books 1997bull [26]Bessel VanderKolk MD The Body Keeps the Score Viking Penguin 2014bullAcknowledgmentsbull Group Medical Visits and Group Facilitation Jeff Geller MDbull Re-evaluation Counseling Community bull Insight Meditation Communitybull Biodynamic Osteopathy Communitybull Learning To Breathe Mindfulness Training for Adolescents 2015 Patricia C Broderick PhD bull Stanford Chronic Disease Self Management Program Training 2014 Kate Lorig MPH RNbull Motivational Interviewing Training 2015 Steven Berg-Smithbull Centering Pregnancy Training 2014 Centering Healthcare Institutebull Motivating Change in Groups Training 2013 Kaiser Permanente Oakland Cabull Group Facilitation Training Sara Fisk PhD Community at Work San Francisco Cabull Tribes Training 2013 Center for Human Developmentbull Cultural Humility Training 2016 Melanie Tervalon MD
Bibliography
Intermediate Steps to Listening Session Handout
bull Step 1 Connect with yourself body mind and emotions
bull Step 2 Hold a non-judgmental space to be seen and heard
bull Step 3 See the speaker and anyone referenced as able to manifest their true human nature and evolve using inherent healing abilities
bull Step 4 Listen to the speaker in a deep connected way sending the message that their thinking feelings and being matters to you
bull Step 5 Encourage the speaker to express feelings or thoughts describe body sensations or share a story relevant to the feelings at hand
bull Step 6 Validate intense emotional expression and release such as crying laughing shaking yawning sweating as a sign of healing
bull Step 7 Remind the speaker of their underlying goodness intelligence strength and caring and your confidence in their ability to heal and manifest their true human nature
copy Elizabeth Rocco MD
Contact Information
bull Elizabeth Rocco MD -egroccogmailcom
bull Karen Ekwueme MD-impactdoc1gmailcom
Intergenerational TransmissionHow is CST passed down to our children
1 Yehuda R et al (2015) ldquoHolocaust Exposure Induced Intergenerational Effects on FKBP5 MethylationrdquoBiol Psychiatry Aug 12 httpwwwncbinlmnihgovpubmed26410355B
2 Buss C et al (2011) ldquoMaternal pregnancy-specific anxiety is associated with child executive function at 6-9 years agerdquo Stress Nov14(6)665-76 httpwwwncbinlmnihgovpubmed21995526
3 Shankardass K et al (2014) ldquoParental stress increases body mass index trajectory in preadolescentsrdquoPediatr Obes Dec9(6)435-42 httpwwwncbinlmnihgovpubmed24311567
Complex Societal Trauma
is Toxic to the Developing Brain
Pat Levitt developmental neuroscientist and Dr Jack
Shonkoff part of the National Scientific Council on
the Developing Child
ACE (Adverse Childhood Experience) Study
Childhood neglect abuse and household dysfunction impacts health through out life
Vincent J Felitti et al (1998) ldquoRelationship of Childhood Abuse and Household Dysfunction to Many of the Leading Causes of Death in Adults
The Adverse Childhood Experiences (ACE) Studyrdquo May Volume 14 Issue 4 Pages 245ndash
258 httpsacestoohighcom
Healing Complex Societal Trauma
Social Engagement Ventral Vagal Complex
Reach for Help Ventral Vagal FEAR
Fight or FlightSympathetic
FEAR
FEAR
Freeze Collapse Dorsal Vagal
Pre-frontal CortexThe Voice of Reason
Human Healing and Evolution through Self-Awareness Embodiment Empowerment and Connection
Mindfulness Breath work Martial Arts Exercise Yoga Singing Dancing
Acupuncture Massage ReikiCommunity Groups Animals Church Nature
Final Listening Practice and Closing Circle
Bibliography
bull Special Acknowledgement of Demie Stathoplos MSW and Bonnie Cohen MD who collaborated with Elizabeth Rocco MD on the IM4US August 2015 presentation ldquoListening to Each Other Healing the Negative Health Impacts of Racism Poverty and Trauma through Human Connectionrdquo
bull Special Acknowledgement of Karen Burt MD who collaborated with Elizabeth Rocco MD and Karen Ekwueme MD on the IM4US August 2016 presentation ldquoListening to Ourselves and Each Other Healing the Negative Health Impact of Racism Poverty Sexism and Traumardquo These bibliographies are included below
bull [1]Wen Patricia (2010) ldquoA legacy of unintended side effectsrdquo Boston Globe December 12 httpwwwbostoncomnewslocalmassachusettsarticles20101212with_ssi_program_a_legcy_of_unintended_side_effects
bull [2]CCHR International (2014) [Online] Number of Children amp Adolescents Taking Psychiatric Drugs in the US Aprilwwwcchrintorgpsychiatric-drugschildren-on-psychiatric-drugs
bull [3]Whitaker R (2010) Anatomy of an Epidemic Magic Bullets Psychiatric Drugs and the Astonishing Rise of Mental Illness in America Crown Publishing Company httprobertwhitakerorgrobertwhitakerorgAnatomy20of20an20Epidemichtml
bull [3]CDC (2013) [Online] MMRW Mental Health Surveillance Among Children mdash United States 2005ndash2011 Supplements May 17 62(02)1-35 httpwwwcdcgovmmwrpreviewmmwrhtmlsu6202a1htm
bull [4]Patricia N Pastor PhD Cynthia A Reuben MA Catherine R Duran BS and LaJeana D Hawkins MPH CHES (2015) [Online] CDC NCHS Data Brief Association Between Diagnosed ADHD and Selected Characteristics Among Children Aged 4ndash17 Years United States 2011ndash2013 May Number 201 httpwwwcdcgovnchsdatadatabriefsdb201htm
bull [5]Mental Health America (2014) Parity or Disparity The State of Mental Health in America 2015 NovwwwmentalhealthamericanetsitesdefaultfilesParity20or20Disparity20201520Reportpdf
bull [6]Bruce S Jonas ScM PhD Qiuping Gu MD PhD and Juan R Albertorio-Diaz MA (2013) [Online] CDC NCHS Data Brief Psychotropic Medication Use Among Adolescents United States 2005ndash2010 Dec Number 135httpwwwcdcgovnchsdatadatabriefsdb135htm
bull [7] C Buss EP Davis CJ Hobel and CA Sandman (2011) Maternal pregnancy-specific anxiety is associated with child executive function at 6ndash9 years age Stress Nov 14(6)665-676
bull [8] Council for Evidence-Based Psychiatry (UK) Web presentation ldquoUnrecognized Factsrdquo Authors James Davies Peter C Goetzsche Peter Kinderman Joanna Moncrieff Phillip Thomas Sami Timimi John Sandwich Melanie Davis Luke Montague httpcepukorgunrecognised-facts
bull [9] Johnstone Lucy (2015) A Straight Talking Introduction to Psychiatric DiagnosisPCCS Books 1st edition (February 3 2015)
bull [10] Brewin CR Andrews B Valentine JD (2000) ldquoMeta-analysis of risk factors for posttraumatic stress disorder in trauma-exposed adultsrdquo J Consult Clin Psychol2000 Oct68(5)748-66 httpwwwncbinlmnihgovpubmed11068961
bull [11] Williams Monica T (2013) ldquoCan Racism Cause PTSD Implications for DSM-5rdquoPsychology Today May 20 httpswwwpsychologytodaycomblogculturally-speaking201305can-racism-cause-ptsd-implications-dsm-5
Bibliography
bull [12] Yuan Chengmei et al (2011) ldquoProtective factors for posttraumatic stress disorder symptoms in a prospective study of police officersrdquo Nov 23httpwwwncbinlmnihgovpmcarticlesPMC3071439
bull [13] Chou Tina BA Anu Asnaani MA and Stefan G Hofmann PhD (2012) ldquoPerception of Racial Discrimination and Psychopathology Across Three US Ethnic Minority Groupsrdquo APA PsychNET Jan httpwwwncbinlmnihgovpmcarticlesPMC3505377
bull [14] Watson Laurel B Jacob M Marszalek Franco Dispenza and Christopher M Davids 2015 Understanding the Relationships Among White and African American Womenrsquos Sexual Objectification Experiences Physical Safety Anxiety and Psychological Distress Sex Roles 72 (34) 91-104
bull [15] Holland Julie (2015) ldquoMedicating Womenrsquos Feelingsrdquo New York TimesOpinion Feb 28 httpmobilenytimescom20150301opinionsundaymedicating-womens-feelingshtmlreferreramp_r=1
bull [16] Solinas M Thiriet N El Rawas R Lardeux V and Jaber M (2009) ldquoEnvironmental Enrichment During Early Stages of Life Reduces the Behavioral Neurochemical and Molecular Effects of Cocainerdquo Neuropsychopharmacology 34 1102ndash1111
bull [17] Hari Johann Chasing The Scream The First and Last Days of the War on Drugs Bloomsbury USA (January 20 2015)bull [18] Hughes Caitlin Elizabeth and Alex Stevens (2010) ldquoWhat Can We Learn From The Portuguese Decriminalization of Illicit
Drugsrdquo British Journal of Criminology July 21 httpbjcoxfordjournalsorgcontent506999abstractbull [19] Fournier Jay C et al (2009) ldquoAntidepressant Drug Effects and Depression Severityrdquo JAMA January
6th httpjamajamanetworkcomarticleaspxarticleid=185157[20] Currie J Stabile M Jones L (2013) Do Stimulant Medications Improve Educational and Behavioral Outcomes for Children with ADHD NBER Working Paper No 19105
bull [21] Mora-Ripoli R Organizacioacuten Mundial de la Risa Barcelona Spain ldquoThe therapeutic value of laughter in medicinerdquo Altern Ther Health Med 2010 Nov-Dec16(6)56-64 httpwwwncbinlmnihgovpubmed21280463
bull [22] Gracanin Asmir Lauren M Bylsma and Ad J J M Vingerhoets (2014) ldquoIs Crying a Self-Stoothing Behaviorrdquo Frontiers in Psychology May 28httpwwwncbinlmnihgovpmcarticlesPMC4035568
bull [23] Trimble Michael (2010) ldquoI Cry Therefore I Amrdquo New York Times Nov 10 httpwwwnytimescom20121111opinionsundayi-cry-therefore-i-amhtmlemc=eta1amp_r=0
bull [24]Gallup Andrew C et al (2007) ldquoYawning as a brain cooling mechanism Nasal breathing and forehead cooling diminish the incidence of contagious yawningrdquo httpwwwepjournalnetarticlesyawning-as-a-brain-cooling-mechanism-nasal-breathing-and-forehead-cooling-diminish-the-incidence-of-contagious-yawning
bull [25]Sharat Gupta and Shallu Mittal Int (2013) Yawning and its physiological significance Intl J Appl Basic Med Res Jan-Jun 3(1) 11ndash15
bull [26] Stephens R Atkins J Kingston A (2009) ldquoSwearing As a Response to Painrdquo NeuroReport Aug 5 httpwwwncbinlmnihgovpubmed19590391
bull [27]Morelli SA Lieberman MD(2013) rdquoThe role of automaticity and attention in neural processes underlying empathy for happiness sadness and anxietyrdquo Front Hum Neurosci May 87160
Bibliography
bull [1] Committee on Psychosocial Aspects of Child and Family Health Committee on Early Childhood Adoption and Dependent Care andSection on Developmental and Behavioral Pediatrics Andrew S Garner Jack P Shonkoff et al (2012) ldquoEarly Childhood Adversity Toxic Stress and the Role of the Pediatrician Translating Developmental Science Into Lifelong Healthrdquo Pediatrics January VOLUME 129 ISSUE 1 From the American Academy of Pediatrics Policy Statementhttppediatricsaappublicationsorgcontent1291e224fullref-23
bull [2] COUNCIL ON COMMUNITY PEDIATRICS Benjamin A Gitterman et al (2016) ldquoPoverty and Child Health in the United Statesrdquo Pediatrics March From the American Academy of Pediatrics Policy Statement Published Online March 09American Academy of Pediatricshttppediatricsaappublicationsorgcontentearly20160307peds2016-0339info
bull [3] Paul W Newacheck et al (2003) ldquoDisparities in Adolescent Health and Health Care Does Socioeconomic Status Matterrdquo Health ServRes Oct 38(5) 1235ndash1252 httpwwwncbinlmnihgovpmcarticlesPMC1360944
bull [4] Larson et al (2007) ldquoPoverty during pregnancy Its effects on child health outcomesrdquo Paediatr Child Health 2007 Oct 12(8) 673ndash677 httpwwwncbinlmnihgovpmcarticlesPMC2528810
bull [5] Lara J Akinbami et al (2012) ldquoTrends in Asthma Prevalence Health Care Use and Mortality in the United States 2001ndash2010rdquo NCHS Data Brief No 94 May httpwwwcdcgovnchsproductsdatabriefsdb94htm
bull [6] Cynthia L Ogden et al (2010) ldquoObesity and Socioeconomic Status in Children and Adolescents United States 2005-2008rdquoNCHS Data Brief No 51 Decemberhttpwwwcdcgovnchsproductsdatabriefsdb51htm
bull [7] Shonkoff JP et al Committee on Psychosocial Aspects of Child and Family Health Committee on Early Childhood Adoption and Dependent Care Section on Developmental and Behavioral Pediatrics rdquoThe lifelong effects of early childhood adversity and toxicstressrdquo Pediatrics 2012129(1) wwwpediatricsorgcgicontentfull1291e232
bull [8] Virginia A Rauh et alldquoHousing and HealthIntersection of Poverty and Environmental Exposuresrdquo (2008) Annals of the New York Academy of Sciences Volume 1136 Reducing the Impact of Poverty on Health and Human Development Scientific Approaches pages 276ndash288 June httponlinelibrarywileycomdoi101196annals1425032full
bull [9] Yehuda R et al (2015) ldquoHolocaust Exposure Induced Intergenerational Effects on FKBP5 MethylationrdquoBiol Psychiatry Aug 12 httpwwwncbinlmnihgovpubmed26410355
bull [10] Buss C et al (2011) ldquoMaternal pregnancy-specific anxiety is associated with child executive function at 6-9 years agerdquoStress Nov14(6)665-76 httpwwwncbinlmnihgovpubmed21995526
bull 11] Shankardass K et al (2014) ldquoParental stress increases body mass index trajectory in pre-adolescentsrdquoPediatr Obes Dec9(6)435-42 httpwwwncbinlmnihgovpubmed24311567
bull [12] Vincent J Felitti et al (1998) ldquoRelationship of Childhood Abuse and Household Dysfunction to Many of the Leading Causes of Death in Adults The Adverse Childhood Experiences (ACE) Studyrdquo May Volume 14 Issue 4 Pages 245ndash258 httpsacestoohighcom
bull [13]Jones CP Levels of Racism a Theoretic Framework and the Gardenerrsquos Tale Am J Public Health 200090(8) 1212-1215bull [14]Dion KL The Social Psycology of Perceived Perjudice and Discrimination Canadian Psychology (2002)431 pp 1-10bull [15]Sue D W Bucceri J Lin AI Nadal K L and Torino J C Racial Microaggressions and the Asian American experience APA (2007) Vol
13 No 1 pp 72-81bull [16]James S A (School of Public Health U of North Carolina Chapel Hill NC 27514) D S Strogatz S B Wing and D L Ramsey
Socioeconomic status John Henryism and hypertension in blacks and whites Am J Epidemiol 1987 126664ndash73bull [17]httpwwwapaorgpioemaresourcesethnicity-healthindexaspxbull [18]Porges SW Clinical Insights from the Polyvagal Theory The Transformative Power of Feeling Safe (Norton Series on Interpersonal
Neurobiology) W W Norton Apr 7 2014 - Psychology - 288 pagesbull [19]The Polyvagal Theory (Porges SW Social Connectedness as a Biological Imperative Understanding Trauma Through the Lens of
thePolyvagal Theory presentation 82015)bull [20]McEwen BS Allostasis and allostatic load implications for neuropsychopharmacologyNeuropsychopharmacology 2000
Feb22(2)108-24bull [21] McEwen BS adaptation and disease Allostasis and allostatic load Ann N Y Acad Sci 1998 May 184033-44bull [22] Arline T Geronimus ScD Margaret Hicken MPH Danya Keene MAT and John Bound PhD Weatheringrdquo and Age Patterns of
Allostatic Load Scores Among Blacks and Whites in the United States Am J Public Health 2006 May 96(5) 826ndash833bull [22]Stephen Porges PhD Polyvagal Perspective Biological Psychology 2007 Feb 74(2) 116ndash143 Published online 2006 Oct 16 bull [23]Stephen W Porges PhD The Polyvagal Theory Neurophysiological Foundations of Emotions Attachment Communication and
Self-regulation WWNorton and Company Inc 2011bull [24]Maggie Phillips PhD Reversing Chronic Pain North Atlantic Books 2007bull [25]Peter Levine PhD Waking the Tiger North Atlantic Books 1997bull [26]Bessel VanderKolk MD The Body Keeps the Score Viking Penguin 2014bullAcknowledgmentsbull Group Medical Visits and Group Facilitation Jeff Geller MDbull Re-evaluation Counseling Community bull Insight Meditation Communitybull Biodynamic Osteopathy Communitybull Learning To Breathe Mindfulness Training for Adolescents 2015 Patricia C Broderick PhD bull Stanford Chronic Disease Self Management Program Training 2014 Kate Lorig MPH RNbull Motivational Interviewing Training 2015 Steven Berg-Smithbull Centering Pregnancy Training 2014 Centering Healthcare Institutebull Motivating Change in Groups Training 2013 Kaiser Permanente Oakland Cabull Group Facilitation Training Sara Fisk PhD Community at Work San Francisco Cabull Tribes Training 2013 Center for Human Developmentbull Cultural Humility Training 2016 Melanie Tervalon MD
Bibliography
Intermediate Steps to Listening Session Handout
bull Step 1 Connect with yourself body mind and emotions
bull Step 2 Hold a non-judgmental space to be seen and heard
bull Step 3 See the speaker and anyone referenced as able to manifest their true human nature and evolve using inherent healing abilities
bull Step 4 Listen to the speaker in a deep connected way sending the message that their thinking feelings and being matters to you
bull Step 5 Encourage the speaker to express feelings or thoughts describe body sensations or share a story relevant to the feelings at hand
bull Step 6 Validate intense emotional expression and release such as crying laughing shaking yawning sweating as a sign of healing
bull Step 7 Remind the speaker of their underlying goodness intelligence strength and caring and your confidence in their ability to heal and manifest their true human nature
copy Elizabeth Rocco MD
Contact Information
bull Elizabeth Rocco MD -egroccogmailcom
bull Karen Ekwueme MD-impactdoc1gmailcom
Complex Societal Trauma
is Toxic to the Developing Brain
Pat Levitt developmental neuroscientist and Dr Jack
Shonkoff part of the National Scientific Council on
the Developing Child
ACE (Adverse Childhood Experience) Study
Childhood neglect abuse and household dysfunction impacts health through out life
Vincent J Felitti et al (1998) ldquoRelationship of Childhood Abuse and Household Dysfunction to Many of the Leading Causes of Death in Adults
The Adverse Childhood Experiences (ACE) Studyrdquo May Volume 14 Issue 4 Pages 245ndash
258 httpsacestoohighcom
Healing Complex Societal Trauma
Social Engagement Ventral Vagal Complex
Reach for Help Ventral Vagal FEAR
Fight or FlightSympathetic
FEAR
FEAR
Freeze Collapse Dorsal Vagal
Pre-frontal CortexThe Voice of Reason
Human Healing and Evolution through Self-Awareness Embodiment Empowerment and Connection
Mindfulness Breath work Martial Arts Exercise Yoga Singing Dancing
Acupuncture Massage ReikiCommunity Groups Animals Church Nature
Final Listening Practice and Closing Circle
Bibliography
bull Special Acknowledgement of Demie Stathoplos MSW and Bonnie Cohen MD who collaborated with Elizabeth Rocco MD on the IM4US August 2015 presentation ldquoListening to Each Other Healing the Negative Health Impacts of Racism Poverty and Trauma through Human Connectionrdquo
bull Special Acknowledgement of Karen Burt MD who collaborated with Elizabeth Rocco MD and Karen Ekwueme MD on the IM4US August 2016 presentation ldquoListening to Ourselves and Each Other Healing the Negative Health Impact of Racism Poverty Sexism and Traumardquo These bibliographies are included below
bull [1]Wen Patricia (2010) ldquoA legacy of unintended side effectsrdquo Boston Globe December 12 httpwwwbostoncomnewslocalmassachusettsarticles20101212with_ssi_program_a_legcy_of_unintended_side_effects
bull [2]CCHR International (2014) [Online] Number of Children amp Adolescents Taking Psychiatric Drugs in the US Aprilwwwcchrintorgpsychiatric-drugschildren-on-psychiatric-drugs
bull [3]Whitaker R (2010) Anatomy of an Epidemic Magic Bullets Psychiatric Drugs and the Astonishing Rise of Mental Illness in America Crown Publishing Company httprobertwhitakerorgrobertwhitakerorgAnatomy20of20an20Epidemichtml
bull [3]CDC (2013) [Online] MMRW Mental Health Surveillance Among Children mdash United States 2005ndash2011 Supplements May 17 62(02)1-35 httpwwwcdcgovmmwrpreviewmmwrhtmlsu6202a1htm
bull [4]Patricia N Pastor PhD Cynthia A Reuben MA Catherine R Duran BS and LaJeana D Hawkins MPH CHES (2015) [Online] CDC NCHS Data Brief Association Between Diagnosed ADHD and Selected Characteristics Among Children Aged 4ndash17 Years United States 2011ndash2013 May Number 201 httpwwwcdcgovnchsdatadatabriefsdb201htm
bull [5]Mental Health America (2014) Parity or Disparity The State of Mental Health in America 2015 NovwwwmentalhealthamericanetsitesdefaultfilesParity20or20Disparity20201520Reportpdf
bull [6]Bruce S Jonas ScM PhD Qiuping Gu MD PhD and Juan R Albertorio-Diaz MA (2013) [Online] CDC NCHS Data Brief Psychotropic Medication Use Among Adolescents United States 2005ndash2010 Dec Number 135httpwwwcdcgovnchsdatadatabriefsdb135htm
bull [7] C Buss EP Davis CJ Hobel and CA Sandman (2011) Maternal pregnancy-specific anxiety is associated with child executive function at 6ndash9 years age Stress Nov 14(6)665-676
bull [8] Council for Evidence-Based Psychiatry (UK) Web presentation ldquoUnrecognized Factsrdquo Authors James Davies Peter C Goetzsche Peter Kinderman Joanna Moncrieff Phillip Thomas Sami Timimi John Sandwich Melanie Davis Luke Montague httpcepukorgunrecognised-facts
bull [9] Johnstone Lucy (2015) A Straight Talking Introduction to Psychiatric DiagnosisPCCS Books 1st edition (February 3 2015)
bull [10] Brewin CR Andrews B Valentine JD (2000) ldquoMeta-analysis of risk factors for posttraumatic stress disorder in trauma-exposed adultsrdquo J Consult Clin Psychol2000 Oct68(5)748-66 httpwwwncbinlmnihgovpubmed11068961
bull [11] Williams Monica T (2013) ldquoCan Racism Cause PTSD Implications for DSM-5rdquoPsychology Today May 20 httpswwwpsychologytodaycomblogculturally-speaking201305can-racism-cause-ptsd-implications-dsm-5
Bibliography
bull [12] Yuan Chengmei et al (2011) ldquoProtective factors for posttraumatic stress disorder symptoms in a prospective study of police officersrdquo Nov 23httpwwwncbinlmnihgovpmcarticlesPMC3071439
bull [13] Chou Tina BA Anu Asnaani MA and Stefan G Hofmann PhD (2012) ldquoPerception of Racial Discrimination and Psychopathology Across Three US Ethnic Minority Groupsrdquo APA PsychNET Jan httpwwwncbinlmnihgovpmcarticlesPMC3505377
bull [14] Watson Laurel B Jacob M Marszalek Franco Dispenza and Christopher M Davids 2015 Understanding the Relationships Among White and African American Womenrsquos Sexual Objectification Experiences Physical Safety Anxiety and Psychological Distress Sex Roles 72 (34) 91-104
bull [15] Holland Julie (2015) ldquoMedicating Womenrsquos Feelingsrdquo New York TimesOpinion Feb 28 httpmobilenytimescom20150301opinionsundaymedicating-womens-feelingshtmlreferreramp_r=1
bull [16] Solinas M Thiriet N El Rawas R Lardeux V and Jaber M (2009) ldquoEnvironmental Enrichment During Early Stages of Life Reduces the Behavioral Neurochemical and Molecular Effects of Cocainerdquo Neuropsychopharmacology 34 1102ndash1111
bull [17] Hari Johann Chasing The Scream The First and Last Days of the War on Drugs Bloomsbury USA (January 20 2015)bull [18] Hughes Caitlin Elizabeth and Alex Stevens (2010) ldquoWhat Can We Learn From The Portuguese Decriminalization of Illicit
Drugsrdquo British Journal of Criminology July 21 httpbjcoxfordjournalsorgcontent506999abstractbull [19] Fournier Jay C et al (2009) ldquoAntidepressant Drug Effects and Depression Severityrdquo JAMA January
6th httpjamajamanetworkcomarticleaspxarticleid=185157[20] Currie J Stabile M Jones L (2013) Do Stimulant Medications Improve Educational and Behavioral Outcomes for Children with ADHD NBER Working Paper No 19105
bull [21] Mora-Ripoli R Organizacioacuten Mundial de la Risa Barcelona Spain ldquoThe therapeutic value of laughter in medicinerdquo Altern Ther Health Med 2010 Nov-Dec16(6)56-64 httpwwwncbinlmnihgovpubmed21280463
bull [22] Gracanin Asmir Lauren M Bylsma and Ad J J M Vingerhoets (2014) ldquoIs Crying a Self-Stoothing Behaviorrdquo Frontiers in Psychology May 28httpwwwncbinlmnihgovpmcarticlesPMC4035568
bull [23] Trimble Michael (2010) ldquoI Cry Therefore I Amrdquo New York Times Nov 10 httpwwwnytimescom20121111opinionsundayi-cry-therefore-i-amhtmlemc=eta1amp_r=0
bull [24]Gallup Andrew C et al (2007) ldquoYawning as a brain cooling mechanism Nasal breathing and forehead cooling diminish the incidence of contagious yawningrdquo httpwwwepjournalnetarticlesyawning-as-a-brain-cooling-mechanism-nasal-breathing-and-forehead-cooling-diminish-the-incidence-of-contagious-yawning
bull [25]Sharat Gupta and Shallu Mittal Int (2013) Yawning and its physiological significance Intl J Appl Basic Med Res Jan-Jun 3(1) 11ndash15
bull [26] Stephens R Atkins J Kingston A (2009) ldquoSwearing As a Response to Painrdquo NeuroReport Aug 5 httpwwwncbinlmnihgovpubmed19590391
bull [27]Morelli SA Lieberman MD(2013) rdquoThe role of automaticity and attention in neural processes underlying empathy for happiness sadness and anxietyrdquo Front Hum Neurosci May 87160
Bibliography
bull [1] Committee on Psychosocial Aspects of Child and Family Health Committee on Early Childhood Adoption and Dependent Care andSection on Developmental and Behavioral Pediatrics Andrew S Garner Jack P Shonkoff et al (2012) ldquoEarly Childhood Adversity Toxic Stress and the Role of the Pediatrician Translating Developmental Science Into Lifelong Healthrdquo Pediatrics January VOLUME 129 ISSUE 1 From the American Academy of Pediatrics Policy Statementhttppediatricsaappublicationsorgcontent1291e224fullref-23
bull [2] COUNCIL ON COMMUNITY PEDIATRICS Benjamin A Gitterman et al (2016) ldquoPoverty and Child Health in the United Statesrdquo Pediatrics March From the American Academy of Pediatrics Policy Statement Published Online March 09American Academy of Pediatricshttppediatricsaappublicationsorgcontentearly20160307peds2016-0339info
bull [3] Paul W Newacheck et al (2003) ldquoDisparities in Adolescent Health and Health Care Does Socioeconomic Status Matterrdquo Health ServRes Oct 38(5) 1235ndash1252 httpwwwncbinlmnihgovpmcarticlesPMC1360944
bull [4] Larson et al (2007) ldquoPoverty during pregnancy Its effects on child health outcomesrdquo Paediatr Child Health 2007 Oct 12(8) 673ndash677 httpwwwncbinlmnihgovpmcarticlesPMC2528810
bull [5] Lara J Akinbami et al (2012) ldquoTrends in Asthma Prevalence Health Care Use and Mortality in the United States 2001ndash2010rdquo NCHS Data Brief No 94 May httpwwwcdcgovnchsproductsdatabriefsdb94htm
bull [6] Cynthia L Ogden et al (2010) ldquoObesity and Socioeconomic Status in Children and Adolescents United States 2005-2008rdquoNCHS Data Brief No 51 Decemberhttpwwwcdcgovnchsproductsdatabriefsdb51htm
bull [7] Shonkoff JP et al Committee on Psychosocial Aspects of Child and Family Health Committee on Early Childhood Adoption and Dependent Care Section on Developmental and Behavioral Pediatrics rdquoThe lifelong effects of early childhood adversity and toxicstressrdquo Pediatrics 2012129(1) wwwpediatricsorgcgicontentfull1291e232
bull [8] Virginia A Rauh et alldquoHousing and HealthIntersection of Poverty and Environmental Exposuresrdquo (2008) Annals of the New York Academy of Sciences Volume 1136 Reducing the Impact of Poverty on Health and Human Development Scientific Approaches pages 276ndash288 June httponlinelibrarywileycomdoi101196annals1425032full
bull [9] Yehuda R et al (2015) ldquoHolocaust Exposure Induced Intergenerational Effects on FKBP5 MethylationrdquoBiol Psychiatry Aug 12 httpwwwncbinlmnihgovpubmed26410355
bull [10] Buss C et al (2011) ldquoMaternal pregnancy-specific anxiety is associated with child executive function at 6-9 years agerdquoStress Nov14(6)665-76 httpwwwncbinlmnihgovpubmed21995526
bull 11] Shankardass K et al (2014) ldquoParental stress increases body mass index trajectory in pre-adolescentsrdquoPediatr Obes Dec9(6)435-42 httpwwwncbinlmnihgovpubmed24311567
bull [12] Vincent J Felitti et al (1998) ldquoRelationship of Childhood Abuse and Household Dysfunction to Many of the Leading Causes of Death in Adults The Adverse Childhood Experiences (ACE) Studyrdquo May Volume 14 Issue 4 Pages 245ndash258 httpsacestoohighcom
bull [13]Jones CP Levels of Racism a Theoretic Framework and the Gardenerrsquos Tale Am J Public Health 200090(8) 1212-1215bull [14]Dion KL The Social Psycology of Perceived Perjudice and Discrimination Canadian Psychology (2002)431 pp 1-10bull [15]Sue D W Bucceri J Lin AI Nadal K L and Torino J C Racial Microaggressions and the Asian American experience APA (2007) Vol
13 No 1 pp 72-81bull [16]James S A (School of Public Health U of North Carolina Chapel Hill NC 27514) D S Strogatz S B Wing and D L Ramsey
Socioeconomic status John Henryism and hypertension in blacks and whites Am J Epidemiol 1987 126664ndash73bull [17]httpwwwapaorgpioemaresourcesethnicity-healthindexaspxbull [18]Porges SW Clinical Insights from the Polyvagal Theory The Transformative Power of Feeling Safe (Norton Series on Interpersonal
Neurobiology) W W Norton Apr 7 2014 - Psychology - 288 pagesbull [19]The Polyvagal Theory (Porges SW Social Connectedness as a Biological Imperative Understanding Trauma Through the Lens of
thePolyvagal Theory presentation 82015)bull [20]McEwen BS Allostasis and allostatic load implications for neuropsychopharmacologyNeuropsychopharmacology 2000
Feb22(2)108-24bull [21] McEwen BS adaptation and disease Allostasis and allostatic load Ann N Y Acad Sci 1998 May 184033-44bull [22] Arline T Geronimus ScD Margaret Hicken MPH Danya Keene MAT and John Bound PhD Weatheringrdquo and Age Patterns of
Allostatic Load Scores Among Blacks and Whites in the United States Am J Public Health 2006 May 96(5) 826ndash833bull [22]Stephen Porges PhD Polyvagal Perspective Biological Psychology 2007 Feb 74(2) 116ndash143 Published online 2006 Oct 16 bull [23]Stephen W Porges PhD The Polyvagal Theory Neurophysiological Foundations of Emotions Attachment Communication and
Self-regulation WWNorton and Company Inc 2011bull [24]Maggie Phillips PhD Reversing Chronic Pain North Atlantic Books 2007bull [25]Peter Levine PhD Waking the Tiger North Atlantic Books 1997bull [26]Bessel VanderKolk MD The Body Keeps the Score Viking Penguin 2014bullAcknowledgmentsbull Group Medical Visits and Group Facilitation Jeff Geller MDbull Re-evaluation Counseling Community bull Insight Meditation Communitybull Biodynamic Osteopathy Communitybull Learning To Breathe Mindfulness Training for Adolescents 2015 Patricia C Broderick PhD bull Stanford Chronic Disease Self Management Program Training 2014 Kate Lorig MPH RNbull Motivational Interviewing Training 2015 Steven Berg-Smithbull Centering Pregnancy Training 2014 Centering Healthcare Institutebull Motivating Change in Groups Training 2013 Kaiser Permanente Oakland Cabull Group Facilitation Training Sara Fisk PhD Community at Work San Francisco Cabull Tribes Training 2013 Center for Human Developmentbull Cultural Humility Training 2016 Melanie Tervalon MD
Bibliography
Intermediate Steps to Listening Session Handout
bull Step 1 Connect with yourself body mind and emotions
bull Step 2 Hold a non-judgmental space to be seen and heard
bull Step 3 See the speaker and anyone referenced as able to manifest their true human nature and evolve using inherent healing abilities
bull Step 4 Listen to the speaker in a deep connected way sending the message that their thinking feelings and being matters to you
bull Step 5 Encourage the speaker to express feelings or thoughts describe body sensations or share a story relevant to the feelings at hand
bull Step 6 Validate intense emotional expression and release such as crying laughing shaking yawning sweating as a sign of healing
bull Step 7 Remind the speaker of their underlying goodness intelligence strength and caring and your confidence in their ability to heal and manifest their true human nature
copy Elizabeth Rocco MD
Contact Information
bull Elizabeth Rocco MD -egroccogmailcom
bull Karen Ekwueme MD-impactdoc1gmailcom
ACE (Adverse Childhood Experience) Study
Childhood neglect abuse and household dysfunction impacts health through out life
Vincent J Felitti et al (1998) ldquoRelationship of Childhood Abuse and Household Dysfunction to Many of the Leading Causes of Death in Adults
The Adverse Childhood Experiences (ACE) Studyrdquo May Volume 14 Issue 4 Pages 245ndash
258 httpsacestoohighcom
Healing Complex Societal Trauma
Social Engagement Ventral Vagal Complex
Reach for Help Ventral Vagal FEAR
Fight or FlightSympathetic
FEAR
FEAR
Freeze Collapse Dorsal Vagal
Pre-frontal CortexThe Voice of Reason
Human Healing and Evolution through Self-Awareness Embodiment Empowerment and Connection
Mindfulness Breath work Martial Arts Exercise Yoga Singing Dancing
Acupuncture Massage ReikiCommunity Groups Animals Church Nature
Final Listening Practice and Closing Circle
Bibliography
bull Special Acknowledgement of Demie Stathoplos MSW and Bonnie Cohen MD who collaborated with Elizabeth Rocco MD on the IM4US August 2015 presentation ldquoListening to Each Other Healing the Negative Health Impacts of Racism Poverty and Trauma through Human Connectionrdquo
bull Special Acknowledgement of Karen Burt MD who collaborated with Elizabeth Rocco MD and Karen Ekwueme MD on the IM4US August 2016 presentation ldquoListening to Ourselves and Each Other Healing the Negative Health Impact of Racism Poverty Sexism and Traumardquo These bibliographies are included below
bull [1]Wen Patricia (2010) ldquoA legacy of unintended side effectsrdquo Boston Globe December 12 httpwwwbostoncomnewslocalmassachusettsarticles20101212with_ssi_program_a_legcy_of_unintended_side_effects
bull [2]CCHR International (2014) [Online] Number of Children amp Adolescents Taking Psychiatric Drugs in the US Aprilwwwcchrintorgpsychiatric-drugschildren-on-psychiatric-drugs
bull [3]Whitaker R (2010) Anatomy of an Epidemic Magic Bullets Psychiatric Drugs and the Astonishing Rise of Mental Illness in America Crown Publishing Company httprobertwhitakerorgrobertwhitakerorgAnatomy20of20an20Epidemichtml
bull [3]CDC (2013) [Online] MMRW Mental Health Surveillance Among Children mdash United States 2005ndash2011 Supplements May 17 62(02)1-35 httpwwwcdcgovmmwrpreviewmmwrhtmlsu6202a1htm
bull [4]Patricia N Pastor PhD Cynthia A Reuben MA Catherine R Duran BS and LaJeana D Hawkins MPH CHES (2015) [Online] CDC NCHS Data Brief Association Between Diagnosed ADHD and Selected Characteristics Among Children Aged 4ndash17 Years United States 2011ndash2013 May Number 201 httpwwwcdcgovnchsdatadatabriefsdb201htm
bull [5]Mental Health America (2014) Parity or Disparity The State of Mental Health in America 2015 NovwwwmentalhealthamericanetsitesdefaultfilesParity20or20Disparity20201520Reportpdf
bull [6]Bruce S Jonas ScM PhD Qiuping Gu MD PhD and Juan R Albertorio-Diaz MA (2013) [Online] CDC NCHS Data Brief Psychotropic Medication Use Among Adolescents United States 2005ndash2010 Dec Number 135httpwwwcdcgovnchsdatadatabriefsdb135htm
bull [7] C Buss EP Davis CJ Hobel and CA Sandman (2011) Maternal pregnancy-specific anxiety is associated with child executive function at 6ndash9 years age Stress Nov 14(6)665-676
bull [8] Council for Evidence-Based Psychiatry (UK) Web presentation ldquoUnrecognized Factsrdquo Authors James Davies Peter C Goetzsche Peter Kinderman Joanna Moncrieff Phillip Thomas Sami Timimi John Sandwich Melanie Davis Luke Montague httpcepukorgunrecognised-facts
bull [9] Johnstone Lucy (2015) A Straight Talking Introduction to Psychiatric DiagnosisPCCS Books 1st edition (February 3 2015)
bull [10] Brewin CR Andrews B Valentine JD (2000) ldquoMeta-analysis of risk factors for posttraumatic stress disorder in trauma-exposed adultsrdquo J Consult Clin Psychol2000 Oct68(5)748-66 httpwwwncbinlmnihgovpubmed11068961
bull [11] Williams Monica T (2013) ldquoCan Racism Cause PTSD Implications for DSM-5rdquoPsychology Today May 20 httpswwwpsychologytodaycomblogculturally-speaking201305can-racism-cause-ptsd-implications-dsm-5
Bibliography
bull [12] Yuan Chengmei et al (2011) ldquoProtective factors for posttraumatic stress disorder symptoms in a prospective study of police officersrdquo Nov 23httpwwwncbinlmnihgovpmcarticlesPMC3071439
bull [13] Chou Tina BA Anu Asnaani MA and Stefan G Hofmann PhD (2012) ldquoPerception of Racial Discrimination and Psychopathology Across Three US Ethnic Minority Groupsrdquo APA PsychNET Jan httpwwwncbinlmnihgovpmcarticlesPMC3505377
bull [14] Watson Laurel B Jacob M Marszalek Franco Dispenza and Christopher M Davids 2015 Understanding the Relationships Among White and African American Womenrsquos Sexual Objectification Experiences Physical Safety Anxiety and Psychological Distress Sex Roles 72 (34) 91-104
bull [15] Holland Julie (2015) ldquoMedicating Womenrsquos Feelingsrdquo New York TimesOpinion Feb 28 httpmobilenytimescom20150301opinionsundaymedicating-womens-feelingshtmlreferreramp_r=1
bull [16] Solinas M Thiriet N El Rawas R Lardeux V and Jaber M (2009) ldquoEnvironmental Enrichment During Early Stages of Life Reduces the Behavioral Neurochemical and Molecular Effects of Cocainerdquo Neuropsychopharmacology 34 1102ndash1111
bull [17] Hari Johann Chasing The Scream The First and Last Days of the War on Drugs Bloomsbury USA (January 20 2015)bull [18] Hughes Caitlin Elizabeth and Alex Stevens (2010) ldquoWhat Can We Learn From The Portuguese Decriminalization of Illicit
Drugsrdquo British Journal of Criminology July 21 httpbjcoxfordjournalsorgcontent506999abstractbull [19] Fournier Jay C et al (2009) ldquoAntidepressant Drug Effects and Depression Severityrdquo JAMA January
6th httpjamajamanetworkcomarticleaspxarticleid=185157[20] Currie J Stabile M Jones L (2013) Do Stimulant Medications Improve Educational and Behavioral Outcomes for Children with ADHD NBER Working Paper No 19105
bull [21] Mora-Ripoli R Organizacioacuten Mundial de la Risa Barcelona Spain ldquoThe therapeutic value of laughter in medicinerdquo Altern Ther Health Med 2010 Nov-Dec16(6)56-64 httpwwwncbinlmnihgovpubmed21280463
bull [22] Gracanin Asmir Lauren M Bylsma and Ad J J M Vingerhoets (2014) ldquoIs Crying a Self-Stoothing Behaviorrdquo Frontiers in Psychology May 28httpwwwncbinlmnihgovpmcarticlesPMC4035568
bull [23] Trimble Michael (2010) ldquoI Cry Therefore I Amrdquo New York Times Nov 10 httpwwwnytimescom20121111opinionsundayi-cry-therefore-i-amhtmlemc=eta1amp_r=0
bull [24]Gallup Andrew C et al (2007) ldquoYawning as a brain cooling mechanism Nasal breathing and forehead cooling diminish the incidence of contagious yawningrdquo httpwwwepjournalnetarticlesyawning-as-a-brain-cooling-mechanism-nasal-breathing-and-forehead-cooling-diminish-the-incidence-of-contagious-yawning
bull [25]Sharat Gupta and Shallu Mittal Int (2013) Yawning and its physiological significance Intl J Appl Basic Med Res Jan-Jun 3(1) 11ndash15
bull [26] Stephens R Atkins J Kingston A (2009) ldquoSwearing As a Response to Painrdquo NeuroReport Aug 5 httpwwwncbinlmnihgovpubmed19590391
bull [27]Morelli SA Lieberman MD(2013) rdquoThe role of automaticity and attention in neural processes underlying empathy for happiness sadness and anxietyrdquo Front Hum Neurosci May 87160
Bibliography
bull [1] Committee on Psychosocial Aspects of Child and Family Health Committee on Early Childhood Adoption and Dependent Care andSection on Developmental and Behavioral Pediatrics Andrew S Garner Jack P Shonkoff et al (2012) ldquoEarly Childhood Adversity Toxic Stress and the Role of the Pediatrician Translating Developmental Science Into Lifelong Healthrdquo Pediatrics January VOLUME 129 ISSUE 1 From the American Academy of Pediatrics Policy Statementhttppediatricsaappublicationsorgcontent1291e224fullref-23
bull [2] COUNCIL ON COMMUNITY PEDIATRICS Benjamin A Gitterman et al (2016) ldquoPoverty and Child Health in the United Statesrdquo Pediatrics March From the American Academy of Pediatrics Policy Statement Published Online March 09American Academy of Pediatricshttppediatricsaappublicationsorgcontentearly20160307peds2016-0339info
bull [3] Paul W Newacheck et al (2003) ldquoDisparities in Adolescent Health and Health Care Does Socioeconomic Status Matterrdquo Health ServRes Oct 38(5) 1235ndash1252 httpwwwncbinlmnihgovpmcarticlesPMC1360944
bull [4] Larson et al (2007) ldquoPoverty during pregnancy Its effects on child health outcomesrdquo Paediatr Child Health 2007 Oct 12(8) 673ndash677 httpwwwncbinlmnihgovpmcarticlesPMC2528810
bull [5] Lara J Akinbami et al (2012) ldquoTrends in Asthma Prevalence Health Care Use and Mortality in the United States 2001ndash2010rdquo NCHS Data Brief No 94 May httpwwwcdcgovnchsproductsdatabriefsdb94htm
bull [6] Cynthia L Ogden et al (2010) ldquoObesity and Socioeconomic Status in Children and Adolescents United States 2005-2008rdquoNCHS Data Brief No 51 Decemberhttpwwwcdcgovnchsproductsdatabriefsdb51htm
bull [7] Shonkoff JP et al Committee on Psychosocial Aspects of Child and Family Health Committee on Early Childhood Adoption and Dependent Care Section on Developmental and Behavioral Pediatrics rdquoThe lifelong effects of early childhood adversity and toxicstressrdquo Pediatrics 2012129(1) wwwpediatricsorgcgicontentfull1291e232
bull [8] Virginia A Rauh et alldquoHousing and HealthIntersection of Poverty and Environmental Exposuresrdquo (2008) Annals of the New York Academy of Sciences Volume 1136 Reducing the Impact of Poverty on Health and Human Development Scientific Approaches pages 276ndash288 June httponlinelibrarywileycomdoi101196annals1425032full
bull [9] Yehuda R et al (2015) ldquoHolocaust Exposure Induced Intergenerational Effects on FKBP5 MethylationrdquoBiol Psychiatry Aug 12 httpwwwncbinlmnihgovpubmed26410355
bull [10] Buss C et al (2011) ldquoMaternal pregnancy-specific anxiety is associated with child executive function at 6-9 years agerdquoStress Nov14(6)665-76 httpwwwncbinlmnihgovpubmed21995526
bull 11] Shankardass K et al (2014) ldquoParental stress increases body mass index trajectory in pre-adolescentsrdquoPediatr Obes Dec9(6)435-42 httpwwwncbinlmnihgovpubmed24311567
bull [12] Vincent J Felitti et al (1998) ldquoRelationship of Childhood Abuse and Household Dysfunction to Many of the Leading Causes of Death in Adults The Adverse Childhood Experiences (ACE) Studyrdquo May Volume 14 Issue 4 Pages 245ndash258 httpsacestoohighcom
bull [13]Jones CP Levels of Racism a Theoretic Framework and the Gardenerrsquos Tale Am J Public Health 200090(8) 1212-1215bull [14]Dion KL The Social Psycology of Perceived Perjudice and Discrimination Canadian Psychology (2002)431 pp 1-10bull [15]Sue D W Bucceri J Lin AI Nadal K L and Torino J C Racial Microaggressions and the Asian American experience APA (2007) Vol
13 No 1 pp 72-81bull [16]James S A (School of Public Health U of North Carolina Chapel Hill NC 27514) D S Strogatz S B Wing and D L Ramsey
Socioeconomic status John Henryism and hypertension in blacks and whites Am J Epidemiol 1987 126664ndash73bull [17]httpwwwapaorgpioemaresourcesethnicity-healthindexaspxbull [18]Porges SW Clinical Insights from the Polyvagal Theory The Transformative Power of Feeling Safe (Norton Series on Interpersonal
Neurobiology) W W Norton Apr 7 2014 - Psychology - 288 pagesbull [19]The Polyvagal Theory (Porges SW Social Connectedness as a Biological Imperative Understanding Trauma Through the Lens of
thePolyvagal Theory presentation 82015)bull [20]McEwen BS Allostasis and allostatic load implications for neuropsychopharmacologyNeuropsychopharmacology 2000
Feb22(2)108-24bull [21] McEwen BS adaptation and disease Allostasis and allostatic load Ann N Y Acad Sci 1998 May 184033-44bull [22] Arline T Geronimus ScD Margaret Hicken MPH Danya Keene MAT and John Bound PhD Weatheringrdquo and Age Patterns of
Allostatic Load Scores Among Blacks and Whites in the United States Am J Public Health 2006 May 96(5) 826ndash833bull [22]Stephen Porges PhD Polyvagal Perspective Biological Psychology 2007 Feb 74(2) 116ndash143 Published online 2006 Oct 16 bull [23]Stephen W Porges PhD The Polyvagal Theory Neurophysiological Foundations of Emotions Attachment Communication and
Self-regulation WWNorton and Company Inc 2011bull [24]Maggie Phillips PhD Reversing Chronic Pain North Atlantic Books 2007bull [25]Peter Levine PhD Waking the Tiger North Atlantic Books 1997bull [26]Bessel VanderKolk MD The Body Keeps the Score Viking Penguin 2014bullAcknowledgmentsbull Group Medical Visits and Group Facilitation Jeff Geller MDbull Re-evaluation Counseling Community bull Insight Meditation Communitybull Biodynamic Osteopathy Communitybull Learning To Breathe Mindfulness Training for Adolescents 2015 Patricia C Broderick PhD bull Stanford Chronic Disease Self Management Program Training 2014 Kate Lorig MPH RNbull Motivational Interviewing Training 2015 Steven Berg-Smithbull Centering Pregnancy Training 2014 Centering Healthcare Institutebull Motivating Change in Groups Training 2013 Kaiser Permanente Oakland Cabull Group Facilitation Training Sara Fisk PhD Community at Work San Francisco Cabull Tribes Training 2013 Center for Human Developmentbull Cultural Humility Training 2016 Melanie Tervalon MD
Bibliography
Intermediate Steps to Listening Session Handout
bull Step 1 Connect with yourself body mind and emotions
bull Step 2 Hold a non-judgmental space to be seen and heard
bull Step 3 See the speaker and anyone referenced as able to manifest their true human nature and evolve using inherent healing abilities
bull Step 4 Listen to the speaker in a deep connected way sending the message that their thinking feelings and being matters to you
bull Step 5 Encourage the speaker to express feelings or thoughts describe body sensations or share a story relevant to the feelings at hand
bull Step 6 Validate intense emotional expression and release such as crying laughing shaking yawning sweating as a sign of healing
bull Step 7 Remind the speaker of their underlying goodness intelligence strength and caring and your confidence in their ability to heal and manifest their true human nature
copy Elizabeth Rocco MD
Contact Information
bull Elizabeth Rocco MD -egroccogmailcom
bull Karen Ekwueme MD-impactdoc1gmailcom
Healing Complex Societal Trauma
Social Engagement Ventral Vagal Complex
Reach for Help Ventral Vagal FEAR
Fight or FlightSympathetic
FEAR
FEAR
Freeze Collapse Dorsal Vagal
Pre-frontal CortexThe Voice of Reason
Human Healing and Evolution through Self-Awareness Embodiment Empowerment and Connection
Mindfulness Breath work Martial Arts Exercise Yoga Singing Dancing
Acupuncture Massage ReikiCommunity Groups Animals Church Nature
Final Listening Practice and Closing Circle
Bibliography
bull Special Acknowledgement of Demie Stathoplos MSW and Bonnie Cohen MD who collaborated with Elizabeth Rocco MD on the IM4US August 2015 presentation ldquoListening to Each Other Healing the Negative Health Impacts of Racism Poverty and Trauma through Human Connectionrdquo
bull Special Acknowledgement of Karen Burt MD who collaborated with Elizabeth Rocco MD and Karen Ekwueme MD on the IM4US August 2016 presentation ldquoListening to Ourselves and Each Other Healing the Negative Health Impact of Racism Poverty Sexism and Traumardquo These bibliographies are included below
bull [1]Wen Patricia (2010) ldquoA legacy of unintended side effectsrdquo Boston Globe December 12 httpwwwbostoncomnewslocalmassachusettsarticles20101212with_ssi_program_a_legcy_of_unintended_side_effects
bull [2]CCHR International (2014) [Online] Number of Children amp Adolescents Taking Psychiatric Drugs in the US Aprilwwwcchrintorgpsychiatric-drugschildren-on-psychiatric-drugs
bull [3]Whitaker R (2010) Anatomy of an Epidemic Magic Bullets Psychiatric Drugs and the Astonishing Rise of Mental Illness in America Crown Publishing Company httprobertwhitakerorgrobertwhitakerorgAnatomy20of20an20Epidemichtml
bull [3]CDC (2013) [Online] MMRW Mental Health Surveillance Among Children mdash United States 2005ndash2011 Supplements May 17 62(02)1-35 httpwwwcdcgovmmwrpreviewmmwrhtmlsu6202a1htm
bull [4]Patricia N Pastor PhD Cynthia A Reuben MA Catherine R Duran BS and LaJeana D Hawkins MPH CHES (2015) [Online] CDC NCHS Data Brief Association Between Diagnosed ADHD and Selected Characteristics Among Children Aged 4ndash17 Years United States 2011ndash2013 May Number 201 httpwwwcdcgovnchsdatadatabriefsdb201htm
bull [5]Mental Health America (2014) Parity or Disparity The State of Mental Health in America 2015 NovwwwmentalhealthamericanetsitesdefaultfilesParity20or20Disparity20201520Reportpdf
bull [6]Bruce S Jonas ScM PhD Qiuping Gu MD PhD and Juan R Albertorio-Diaz MA (2013) [Online] CDC NCHS Data Brief Psychotropic Medication Use Among Adolescents United States 2005ndash2010 Dec Number 135httpwwwcdcgovnchsdatadatabriefsdb135htm
bull [7] C Buss EP Davis CJ Hobel and CA Sandman (2011) Maternal pregnancy-specific anxiety is associated with child executive function at 6ndash9 years age Stress Nov 14(6)665-676
bull [8] Council for Evidence-Based Psychiatry (UK) Web presentation ldquoUnrecognized Factsrdquo Authors James Davies Peter C Goetzsche Peter Kinderman Joanna Moncrieff Phillip Thomas Sami Timimi John Sandwich Melanie Davis Luke Montague httpcepukorgunrecognised-facts
bull [9] Johnstone Lucy (2015) A Straight Talking Introduction to Psychiatric DiagnosisPCCS Books 1st edition (February 3 2015)
bull [10] Brewin CR Andrews B Valentine JD (2000) ldquoMeta-analysis of risk factors for posttraumatic stress disorder in trauma-exposed adultsrdquo J Consult Clin Psychol2000 Oct68(5)748-66 httpwwwncbinlmnihgovpubmed11068961
bull [11] Williams Monica T (2013) ldquoCan Racism Cause PTSD Implications for DSM-5rdquoPsychology Today May 20 httpswwwpsychologytodaycomblogculturally-speaking201305can-racism-cause-ptsd-implications-dsm-5
Bibliography
bull [12] Yuan Chengmei et al (2011) ldquoProtective factors for posttraumatic stress disorder symptoms in a prospective study of police officersrdquo Nov 23httpwwwncbinlmnihgovpmcarticlesPMC3071439
bull [13] Chou Tina BA Anu Asnaani MA and Stefan G Hofmann PhD (2012) ldquoPerception of Racial Discrimination and Psychopathology Across Three US Ethnic Minority Groupsrdquo APA PsychNET Jan httpwwwncbinlmnihgovpmcarticlesPMC3505377
bull [14] Watson Laurel B Jacob M Marszalek Franco Dispenza and Christopher M Davids 2015 Understanding the Relationships Among White and African American Womenrsquos Sexual Objectification Experiences Physical Safety Anxiety and Psychological Distress Sex Roles 72 (34) 91-104
bull [15] Holland Julie (2015) ldquoMedicating Womenrsquos Feelingsrdquo New York TimesOpinion Feb 28 httpmobilenytimescom20150301opinionsundaymedicating-womens-feelingshtmlreferreramp_r=1
bull [16] Solinas M Thiriet N El Rawas R Lardeux V and Jaber M (2009) ldquoEnvironmental Enrichment During Early Stages of Life Reduces the Behavioral Neurochemical and Molecular Effects of Cocainerdquo Neuropsychopharmacology 34 1102ndash1111
bull [17] Hari Johann Chasing The Scream The First and Last Days of the War on Drugs Bloomsbury USA (January 20 2015)bull [18] Hughes Caitlin Elizabeth and Alex Stevens (2010) ldquoWhat Can We Learn From The Portuguese Decriminalization of Illicit
Drugsrdquo British Journal of Criminology July 21 httpbjcoxfordjournalsorgcontent506999abstractbull [19] Fournier Jay C et al (2009) ldquoAntidepressant Drug Effects and Depression Severityrdquo JAMA January
6th httpjamajamanetworkcomarticleaspxarticleid=185157[20] Currie J Stabile M Jones L (2013) Do Stimulant Medications Improve Educational and Behavioral Outcomes for Children with ADHD NBER Working Paper No 19105
bull [21] Mora-Ripoli R Organizacioacuten Mundial de la Risa Barcelona Spain ldquoThe therapeutic value of laughter in medicinerdquo Altern Ther Health Med 2010 Nov-Dec16(6)56-64 httpwwwncbinlmnihgovpubmed21280463
bull [22] Gracanin Asmir Lauren M Bylsma and Ad J J M Vingerhoets (2014) ldquoIs Crying a Self-Stoothing Behaviorrdquo Frontiers in Psychology May 28httpwwwncbinlmnihgovpmcarticlesPMC4035568
bull [23] Trimble Michael (2010) ldquoI Cry Therefore I Amrdquo New York Times Nov 10 httpwwwnytimescom20121111opinionsundayi-cry-therefore-i-amhtmlemc=eta1amp_r=0
bull [24]Gallup Andrew C et al (2007) ldquoYawning as a brain cooling mechanism Nasal breathing and forehead cooling diminish the incidence of contagious yawningrdquo httpwwwepjournalnetarticlesyawning-as-a-brain-cooling-mechanism-nasal-breathing-and-forehead-cooling-diminish-the-incidence-of-contagious-yawning
bull [25]Sharat Gupta and Shallu Mittal Int (2013) Yawning and its physiological significance Intl J Appl Basic Med Res Jan-Jun 3(1) 11ndash15
bull [26] Stephens R Atkins J Kingston A (2009) ldquoSwearing As a Response to Painrdquo NeuroReport Aug 5 httpwwwncbinlmnihgovpubmed19590391
bull [27]Morelli SA Lieberman MD(2013) rdquoThe role of automaticity and attention in neural processes underlying empathy for happiness sadness and anxietyrdquo Front Hum Neurosci May 87160
Bibliography
bull [1] Committee on Psychosocial Aspects of Child and Family Health Committee on Early Childhood Adoption and Dependent Care andSection on Developmental and Behavioral Pediatrics Andrew S Garner Jack P Shonkoff et al (2012) ldquoEarly Childhood Adversity Toxic Stress and the Role of the Pediatrician Translating Developmental Science Into Lifelong Healthrdquo Pediatrics January VOLUME 129 ISSUE 1 From the American Academy of Pediatrics Policy Statementhttppediatricsaappublicationsorgcontent1291e224fullref-23
bull [2] COUNCIL ON COMMUNITY PEDIATRICS Benjamin A Gitterman et al (2016) ldquoPoverty and Child Health in the United Statesrdquo Pediatrics March From the American Academy of Pediatrics Policy Statement Published Online March 09American Academy of Pediatricshttppediatricsaappublicationsorgcontentearly20160307peds2016-0339info
bull [3] Paul W Newacheck et al (2003) ldquoDisparities in Adolescent Health and Health Care Does Socioeconomic Status Matterrdquo Health ServRes Oct 38(5) 1235ndash1252 httpwwwncbinlmnihgovpmcarticlesPMC1360944
bull [4] Larson et al (2007) ldquoPoverty during pregnancy Its effects on child health outcomesrdquo Paediatr Child Health 2007 Oct 12(8) 673ndash677 httpwwwncbinlmnihgovpmcarticlesPMC2528810
bull [5] Lara J Akinbami et al (2012) ldquoTrends in Asthma Prevalence Health Care Use and Mortality in the United States 2001ndash2010rdquo NCHS Data Brief No 94 May httpwwwcdcgovnchsproductsdatabriefsdb94htm
bull [6] Cynthia L Ogden et al (2010) ldquoObesity and Socioeconomic Status in Children and Adolescents United States 2005-2008rdquoNCHS Data Brief No 51 Decemberhttpwwwcdcgovnchsproductsdatabriefsdb51htm
bull [7] Shonkoff JP et al Committee on Psychosocial Aspects of Child and Family Health Committee on Early Childhood Adoption and Dependent Care Section on Developmental and Behavioral Pediatrics rdquoThe lifelong effects of early childhood adversity and toxicstressrdquo Pediatrics 2012129(1) wwwpediatricsorgcgicontentfull1291e232
bull [8] Virginia A Rauh et alldquoHousing and HealthIntersection of Poverty and Environmental Exposuresrdquo (2008) Annals of the New York Academy of Sciences Volume 1136 Reducing the Impact of Poverty on Health and Human Development Scientific Approaches pages 276ndash288 June httponlinelibrarywileycomdoi101196annals1425032full
bull [9] Yehuda R et al (2015) ldquoHolocaust Exposure Induced Intergenerational Effects on FKBP5 MethylationrdquoBiol Psychiatry Aug 12 httpwwwncbinlmnihgovpubmed26410355
bull [10] Buss C et al (2011) ldquoMaternal pregnancy-specific anxiety is associated with child executive function at 6-9 years agerdquoStress Nov14(6)665-76 httpwwwncbinlmnihgovpubmed21995526
bull 11] Shankardass K et al (2014) ldquoParental stress increases body mass index trajectory in pre-adolescentsrdquoPediatr Obes Dec9(6)435-42 httpwwwncbinlmnihgovpubmed24311567
bull [12] Vincent J Felitti et al (1998) ldquoRelationship of Childhood Abuse and Household Dysfunction to Many of the Leading Causes of Death in Adults The Adverse Childhood Experiences (ACE) Studyrdquo May Volume 14 Issue 4 Pages 245ndash258 httpsacestoohighcom
bull [13]Jones CP Levels of Racism a Theoretic Framework and the Gardenerrsquos Tale Am J Public Health 200090(8) 1212-1215bull [14]Dion KL The Social Psycology of Perceived Perjudice and Discrimination Canadian Psychology (2002)431 pp 1-10bull [15]Sue D W Bucceri J Lin AI Nadal K L and Torino J C Racial Microaggressions and the Asian American experience APA (2007) Vol
13 No 1 pp 72-81bull [16]James S A (School of Public Health U of North Carolina Chapel Hill NC 27514) D S Strogatz S B Wing and D L Ramsey
Socioeconomic status John Henryism and hypertension in blacks and whites Am J Epidemiol 1987 126664ndash73bull [17]httpwwwapaorgpioemaresourcesethnicity-healthindexaspxbull [18]Porges SW Clinical Insights from the Polyvagal Theory The Transformative Power of Feeling Safe (Norton Series on Interpersonal
Neurobiology) W W Norton Apr 7 2014 - Psychology - 288 pagesbull [19]The Polyvagal Theory (Porges SW Social Connectedness as a Biological Imperative Understanding Trauma Through the Lens of
thePolyvagal Theory presentation 82015)bull [20]McEwen BS Allostasis and allostatic load implications for neuropsychopharmacologyNeuropsychopharmacology 2000
Feb22(2)108-24bull [21] McEwen BS adaptation and disease Allostasis and allostatic load Ann N Y Acad Sci 1998 May 184033-44bull [22] Arline T Geronimus ScD Margaret Hicken MPH Danya Keene MAT and John Bound PhD Weatheringrdquo and Age Patterns of
Allostatic Load Scores Among Blacks and Whites in the United States Am J Public Health 2006 May 96(5) 826ndash833bull [22]Stephen Porges PhD Polyvagal Perspective Biological Psychology 2007 Feb 74(2) 116ndash143 Published online 2006 Oct 16 bull [23]Stephen W Porges PhD The Polyvagal Theory Neurophysiological Foundations of Emotions Attachment Communication and
Self-regulation WWNorton and Company Inc 2011bull [24]Maggie Phillips PhD Reversing Chronic Pain North Atlantic Books 2007bull [25]Peter Levine PhD Waking the Tiger North Atlantic Books 1997bull [26]Bessel VanderKolk MD The Body Keeps the Score Viking Penguin 2014bullAcknowledgmentsbull Group Medical Visits and Group Facilitation Jeff Geller MDbull Re-evaluation Counseling Community bull Insight Meditation Communitybull Biodynamic Osteopathy Communitybull Learning To Breathe Mindfulness Training for Adolescents 2015 Patricia C Broderick PhD bull Stanford Chronic Disease Self Management Program Training 2014 Kate Lorig MPH RNbull Motivational Interviewing Training 2015 Steven Berg-Smithbull Centering Pregnancy Training 2014 Centering Healthcare Institutebull Motivating Change in Groups Training 2013 Kaiser Permanente Oakland Cabull Group Facilitation Training Sara Fisk PhD Community at Work San Francisco Cabull Tribes Training 2013 Center for Human Developmentbull Cultural Humility Training 2016 Melanie Tervalon MD
Bibliography
Intermediate Steps to Listening Session Handout
bull Step 1 Connect with yourself body mind and emotions
bull Step 2 Hold a non-judgmental space to be seen and heard
bull Step 3 See the speaker and anyone referenced as able to manifest their true human nature and evolve using inherent healing abilities
bull Step 4 Listen to the speaker in a deep connected way sending the message that their thinking feelings and being matters to you
bull Step 5 Encourage the speaker to express feelings or thoughts describe body sensations or share a story relevant to the feelings at hand
bull Step 6 Validate intense emotional expression and release such as crying laughing shaking yawning sweating as a sign of healing
bull Step 7 Remind the speaker of their underlying goodness intelligence strength and caring and your confidence in their ability to heal and manifest their true human nature
copy Elizabeth Rocco MD
Contact Information
bull Elizabeth Rocco MD -egroccogmailcom
bull Karen Ekwueme MD-impactdoc1gmailcom
Social Engagement Ventral Vagal Complex
Reach for Help Ventral Vagal FEAR
Fight or FlightSympathetic
FEAR
FEAR
Freeze Collapse Dorsal Vagal
Pre-frontal CortexThe Voice of Reason
Human Healing and Evolution through Self-Awareness Embodiment Empowerment and Connection
Mindfulness Breath work Martial Arts Exercise Yoga Singing Dancing
Acupuncture Massage ReikiCommunity Groups Animals Church Nature
Final Listening Practice and Closing Circle
Bibliography
bull Special Acknowledgement of Demie Stathoplos MSW and Bonnie Cohen MD who collaborated with Elizabeth Rocco MD on the IM4US August 2015 presentation ldquoListening to Each Other Healing the Negative Health Impacts of Racism Poverty and Trauma through Human Connectionrdquo
bull Special Acknowledgement of Karen Burt MD who collaborated with Elizabeth Rocco MD and Karen Ekwueme MD on the IM4US August 2016 presentation ldquoListening to Ourselves and Each Other Healing the Negative Health Impact of Racism Poverty Sexism and Traumardquo These bibliographies are included below
bull [1]Wen Patricia (2010) ldquoA legacy of unintended side effectsrdquo Boston Globe December 12 httpwwwbostoncomnewslocalmassachusettsarticles20101212with_ssi_program_a_legcy_of_unintended_side_effects
bull [2]CCHR International (2014) [Online] Number of Children amp Adolescents Taking Psychiatric Drugs in the US Aprilwwwcchrintorgpsychiatric-drugschildren-on-psychiatric-drugs
bull [3]Whitaker R (2010) Anatomy of an Epidemic Magic Bullets Psychiatric Drugs and the Astonishing Rise of Mental Illness in America Crown Publishing Company httprobertwhitakerorgrobertwhitakerorgAnatomy20of20an20Epidemichtml
bull [3]CDC (2013) [Online] MMRW Mental Health Surveillance Among Children mdash United States 2005ndash2011 Supplements May 17 62(02)1-35 httpwwwcdcgovmmwrpreviewmmwrhtmlsu6202a1htm
bull [4]Patricia N Pastor PhD Cynthia A Reuben MA Catherine R Duran BS and LaJeana D Hawkins MPH CHES (2015) [Online] CDC NCHS Data Brief Association Between Diagnosed ADHD and Selected Characteristics Among Children Aged 4ndash17 Years United States 2011ndash2013 May Number 201 httpwwwcdcgovnchsdatadatabriefsdb201htm
bull [5]Mental Health America (2014) Parity or Disparity The State of Mental Health in America 2015 NovwwwmentalhealthamericanetsitesdefaultfilesParity20or20Disparity20201520Reportpdf
bull [6]Bruce S Jonas ScM PhD Qiuping Gu MD PhD and Juan R Albertorio-Diaz MA (2013) [Online] CDC NCHS Data Brief Psychotropic Medication Use Among Adolescents United States 2005ndash2010 Dec Number 135httpwwwcdcgovnchsdatadatabriefsdb135htm
bull [7] C Buss EP Davis CJ Hobel and CA Sandman (2011) Maternal pregnancy-specific anxiety is associated with child executive function at 6ndash9 years age Stress Nov 14(6)665-676
bull [8] Council for Evidence-Based Psychiatry (UK) Web presentation ldquoUnrecognized Factsrdquo Authors James Davies Peter C Goetzsche Peter Kinderman Joanna Moncrieff Phillip Thomas Sami Timimi John Sandwich Melanie Davis Luke Montague httpcepukorgunrecognised-facts
bull [9] Johnstone Lucy (2015) A Straight Talking Introduction to Psychiatric DiagnosisPCCS Books 1st edition (February 3 2015)
bull [10] Brewin CR Andrews B Valentine JD (2000) ldquoMeta-analysis of risk factors for posttraumatic stress disorder in trauma-exposed adultsrdquo J Consult Clin Psychol2000 Oct68(5)748-66 httpwwwncbinlmnihgovpubmed11068961
bull [11] Williams Monica T (2013) ldquoCan Racism Cause PTSD Implications for DSM-5rdquoPsychology Today May 20 httpswwwpsychologytodaycomblogculturally-speaking201305can-racism-cause-ptsd-implications-dsm-5
Bibliography
bull [12] Yuan Chengmei et al (2011) ldquoProtective factors for posttraumatic stress disorder symptoms in a prospective study of police officersrdquo Nov 23httpwwwncbinlmnihgovpmcarticlesPMC3071439
bull [13] Chou Tina BA Anu Asnaani MA and Stefan G Hofmann PhD (2012) ldquoPerception of Racial Discrimination and Psychopathology Across Three US Ethnic Minority Groupsrdquo APA PsychNET Jan httpwwwncbinlmnihgovpmcarticlesPMC3505377
bull [14] Watson Laurel B Jacob M Marszalek Franco Dispenza and Christopher M Davids 2015 Understanding the Relationships Among White and African American Womenrsquos Sexual Objectification Experiences Physical Safety Anxiety and Psychological Distress Sex Roles 72 (34) 91-104
bull [15] Holland Julie (2015) ldquoMedicating Womenrsquos Feelingsrdquo New York TimesOpinion Feb 28 httpmobilenytimescom20150301opinionsundaymedicating-womens-feelingshtmlreferreramp_r=1
bull [16] Solinas M Thiriet N El Rawas R Lardeux V and Jaber M (2009) ldquoEnvironmental Enrichment During Early Stages of Life Reduces the Behavioral Neurochemical and Molecular Effects of Cocainerdquo Neuropsychopharmacology 34 1102ndash1111
bull [17] Hari Johann Chasing The Scream The First and Last Days of the War on Drugs Bloomsbury USA (January 20 2015)bull [18] Hughes Caitlin Elizabeth and Alex Stevens (2010) ldquoWhat Can We Learn From The Portuguese Decriminalization of Illicit
Drugsrdquo British Journal of Criminology July 21 httpbjcoxfordjournalsorgcontent506999abstractbull [19] Fournier Jay C et al (2009) ldquoAntidepressant Drug Effects and Depression Severityrdquo JAMA January
6th httpjamajamanetworkcomarticleaspxarticleid=185157[20] Currie J Stabile M Jones L (2013) Do Stimulant Medications Improve Educational and Behavioral Outcomes for Children with ADHD NBER Working Paper No 19105
bull [21] Mora-Ripoli R Organizacioacuten Mundial de la Risa Barcelona Spain ldquoThe therapeutic value of laughter in medicinerdquo Altern Ther Health Med 2010 Nov-Dec16(6)56-64 httpwwwncbinlmnihgovpubmed21280463
bull [22] Gracanin Asmir Lauren M Bylsma and Ad J J M Vingerhoets (2014) ldquoIs Crying a Self-Stoothing Behaviorrdquo Frontiers in Psychology May 28httpwwwncbinlmnihgovpmcarticlesPMC4035568
bull [23] Trimble Michael (2010) ldquoI Cry Therefore I Amrdquo New York Times Nov 10 httpwwwnytimescom20121111opinionsundayi-cry-therefore-i-amhtmlemc=eta1amp_r=0
bull [24]Gallup Andrew C et al (2007) ldquoYawning as a brain cooling mechanism Nasal breathing and forehead cooling diminish the incidence of contagious yawningrdquo httpwwwepjournalnetarticlesyawning-as-a-brain-cooling-mechanism-nasal-breathing-and-forehead-cooling-diminish-the-incidence-of-contagious-yawning
bull [25]Sharat Gupta and Shallu Mittal Int (2013) Yawning and its physiological significance Intl J Appl Basic Med Res Jan-Jun 3(1) 11ndash15
bull [26] Stephens R Atkins J Kingston A (2009) ldquoSwearing As a Response to Painrdquo NeuroReport Aug 5 httpwwwncbinlmnihgovpubmed19590391
bull [27]Morelli SA Lieberman MD(2013) rdquoThe role of automaticity and attention in neural processes underlying empathy for happiness sadness and anxietyrdquo Front Hum Neurosci May 87160
Bibliography
bull [1] Committee on Psychosocial Aspects of Child and Family Health Committee on Early Childhood Adoption and Dependent Care andSection on Developmental and Behavioral Pediatrics Andrew S Garner Jack P Shonkoff et al (2012) ldquoEarly Childhood Adversity Toxic Stress and the Role of the Pediatrician Translating Developmental Science Into Lifelong Healthrdquo Pediatrics January VOLUME 129 ISSUE 1 From the American Academy of Pediatrics Policy Statementhttppediatricsaappublicationsorgcontent1291e224fullref-23
bull [2] COUNCIL ON COMMUNITY PEDIATRICS Benjamin A Gitterman et al (2016) ldquoPoverty and Child Health in the United Statesrdquo Pediatrics March From the American Academy of Pediatrics Policy Statement Published Online March 09American Academy of Pediatricshttppediatricsaappublicationsorgcontentearly20160307peds2016-0339info
bull [3] Paul W Newacheck et al (2003) ldquoDisparities in Adolescent Health and Health Care Does Socioeconomic Status Matterrdquo Health ServRes Oct 38(5) 1235ndash1252 httpwwwncbinlmnihgovpmcarticlesPMC1360944
bull [4] Larson et al (2007) ldquoPoverty during pregnancy Its effects on child health outcomesrdquo Paediatr Child Health 2007 Oct 12(8) 673ndash677 httpwwwncbinlmnihgovpmcarticlesPMC2528810
bull [5] Lara J Akinbami et al (2012) ldquoTrends in Asthma Prevalence Health Care Use and Mortality in the United States 2001ndash2010rdquo NCHS Data Brief No 94 May httpwwwcdcgovnchsproductsdatabriefsdb94htm
bull [6] Cynthia L Ogden et al (2010) ldquoObesity and Socioeconomic Status in Children and Adolescents United States 2005-2008rdquoNCHS Data Brief No 51 Decemberhttpwwwcdcgovnchsproductsdatabriefsdb51htm
bull [7] Shonkoff JP et al Committee on Psychosocial Aspects of Child and Family Health Committee on Early Childhood Adoption and Dependent Care Section on Developmental and Behavioral Pediatrics rdquoThe lifelong effects of early childhood adversity and toxicstressrdquo Pediatrics 2012129(1) wwwpediatricsorgcgicontentfull1291e232
bull [8] Virginia A Rauh et alldquoHousing and HealthIntersection of Poverty and Environmental Exposuresrdquo (2008) Annals of the New York Academy of Sciences Volume 1136 Reducing the Impact of Poverty on Health and Human Development Scientific Approaches pages 276ndash288 June httponlinelibrarywileycomdoi101196annals1425032full
bull [9] Yehuda R et al (2015) ldquoHolocaust Exposure Induced Intergenerational Effects on FKBP5 MethylationrdquoBiol Psychiatry Aug 12 httpwwwncbinlmnihgovpubmed26410355
bull [10] Buss C et al (2011) ldquoMaternal pregnancy-specific anxiety is associated with child executive function at 6-9 years agerdquoStress Nov14(6)665-76 httpwwwncbinlmnihgovpubmed21995526
bull 11] Shankardass K et al (2014) ldquoParental stress increases body mass index trajectory in pre-adolescentsrdquoPediatr Obes Dec9(6)435-42 httpwwwncbinlmnihgovpubmed24311567
bull [12] Vincent J Felitti et al (1998) ldquoRelationship of Childhood Abuse and Household Dysfunction to Many of the Leading Causes of Death in Adults The Adverse Childhood Experiences (ACE) Studyrdquo May Volume 14 Issue 4 Pages 245ndash258 httpsacestoohighcom
bull [13]Jones CP Levels of Racism a Theoretic Framework and the Gardenerrsquos Tale Am J Public Health 200090(8) 1212-1215bull [14]Dion KL The Social Psycology of Perceived Perjudice and Discrimination Canadian Psychology (2002)431 pp 1-10bull [15]Sue D W Bucceri J Lin AI Nadal K L and Torino J C Racial Microaggressions and the Asian American experience APA (2007) Vol
13 No 1 pp 72-81bull [16]James S A (School of Public Health U of North Carolina Chapel Hill NC 27514) D S Strogatz S B Wing and D L Ramsey
Socioeconomic status John Henryism and hypertension in blacks and whites Am J Epidemiol 1987 126664ndash73bull [17]httpwwwapaorgpioemaresourcesethnicity-healthindexaspxbull [18]Porges SW Clinical Insights from the Polyvagal Theory The Transformative Power of Feeling Safe (Norton Series on Interpersonal
Neurobiology) W W Norton Apr 7 2014 - Psychology - 288 pagesbull [19]The Polyvagal Theory (Porges SW Social Connectedness as a Biological Imperative Understanding Trauma Through the Lens of
thePolyvagal Theory presentation 82015)bull [20]McEwen BS Allostasis and allostatic load implications for neuropsychopharmacologyNeuropsychopharmacology 2000
Feb22(2)108-24bull [21] McEwen BS adaptation and disease Allostasis and allostatic load Ann N Y Acad Sci 1998 May 184033-44bull [22] Arline T Geronimus ScD Margaret Hicken MPH Danya Keene MAT and John Bound PhD Weatheringrdquo and Age Patterns of
Allostatic Load Scores Among Blacks and Whites in the United States Am J Public Health 2006 May 96(5) 826ndash833bull [22]Stephen Porges PhD Polyvagal Perspective Biological Psychology 2007 Feb 74(2) 116ndash143 Published online 2006 Oct 16 bull [23]Stephen W Porges PhD The Polyvagal Theory Neurophysiological Foundations of Emotions Attachment Communication and
Self-regulation WWNorton and Company Inc 2011bull [24]Maggie Phillips PhD Reversing Chronic Pain North Atlantic Books 2007bull [25]Peter Levine PhD Waking the Tiger North Atlantic Books 1997bull [26]Bessel VanderKolk MD The Body Keeps the Score Viking Penguin 2014bullAcknowledgmentsbull Group Medical Visits and Group Facilitation Jeff Geller MDbull Re-evaluation Counseling Community bull Insight Meditation Communitybull Biodynamic Osteopathy Communitybull Learning To Breathe Mindfulness Training for Adolescents 2015 Patricia C Broderick PhD bull Stanford Chronic Disease Self Management Program Training 2014 Kate Lorig MPH RNbull Motivational Interviewing Training 2015 Steven Berg-Smithbull Centering Pregnancy Training 2014 Centering Healthcare Institutebull Motivating Change in Groups Training 2013 Kaiser Permanente Oakland Cabull Group Facilitation Training Sara Fisk PhD Community at Work San Francisco Cabull Tribes Training 2013 Center for Human Developmentbull Cultural Humility Training 2016 Melanie Tervalon MD
Bibliography
Intermediate Steps to Listening Session Handout
bull Step 1 Connect with yourself body mind and emotions
bull Step 2 Hold a non-judgmental space to be seen and heard
bull Step 3 See the speaker and anyone referenced as able to manifest their true human nature and evolve using inherent healing abilities
bull Step 4 Listen to the speaker in a deep connected way sending the message that their thinking feelings and being matters to you
bull Step 5 Encourage the speaker to express feelings or thoughts describe body sensations or share a story relevant to the feelings at hand
bull Step 6 Validate intense emotional expression and release such as crying laughing shaking yawning sweating as a sign of healing
bull Step 7 Remind the speaker of their underlying goodness intelligence strength and caring and your confidence in their ability to heal and manifest their true human nature
copy Elizabeth Rocco MD
Contact Information
bull Elizabeth Rocco MD -egroccogmailcom
bull Karen Ekwueme MD-impactdoc1gmailcom
Reach for Help Ventral Vagal FEAR
Fight or FlightSympathetic
FEAR
FEAR
Freeze Collapse Dorsal Vagal
Pre-frontal CortexThe Voice of Reason
Human Healing and Evolution through Self-Awareness Embodiment Empowerment and Connection
Mindfulness Breath work Martial Arts Exercise Yoga Singing Dancing
Acupuncture Massage ReikiCommunity Groups Animals Church Nature
Final Listening Practice and Closing Circle
Bibliography
bull Special Acknowledgement of Demie Stathoplos MSW and Bonnie Cohen MD who collaborated with Elizabeth Rocco MD on the IM4US August 2015 presentation ldquoListening to Each Other Healing the Negative Health Impacts of Racism Poverty and Trauma through Human Connectionrdquo
bull Special Acknowledgement of Karen Burt MD who collaborated with Elizabeth Rocco MD and Karen Ekwueme MD on the IM4US August 2016 presentation ldquoListening to Ourselves and Each Other Healing the Negative Health Impact of Racism Poverty Sexism and Traumardquo These bibliographies are included below
bull [1]Wen Patricia (2010) ldquoA legacy of unintended side effectsrdquo Boston Globe December 12 httpwwwbostoncomnewslocalmassachusettsarticles20101212with_ssi_program_a_legcy_of_unintended_side_effects
bull [2]CCHR International (2014) [Online] Number of Children amp Adolescents Taking Psychiatric Drugs in the US Aprilwwwcchrintorgpsychiatric-drugschildren-on-psychiatric-drugs
bull [3]Whitaker R (2010) Anatomy of an Epidemic Magic Bullets Psychiatric Drugs and the Astonishing Rise of Mental Illness in America Crown Publishing Company httprobertwhitakerorgrobertwhitakerorgAnatomy20of20an20Epidemichtml
bull [3]CDC (2013) [Online] MMRW Mental Health Surveillance Among Children mdash United States 2005ndash2011 Supplements May 17 62(02)1-35 httpwwwcdcgovmmwrpreviewmmwrhtmlsu6202a1htm
bull [4]Patricia N Pastor PhD Cynthia A Reuben MA Catherine R Duran BS and LaJeana D Hawkins MPH CHES (2015) [Online] CDC NCHS Data Brief Association Between Diagnosed ADHD and Selected Characteristics Among Children Aged 4ndash17 Years United States 2011ndash2013 May Number 201 httpwwwcdcgovnchsdatadatabriefsdb201htm
bull [5]Mental Health America (2014) Parity or Disparity The State of Mental Health in America 2015 NovwwwmentalhealthamericanetsitesdefaultfilesParity20or20Disparity20201520Reportpdf
bull [6]Bruce S Jonas ScM PhD Qiuping Gu MD PhD and Juan R Albertorio-Diaz MA (2013) [Online] CDC NCHS Data Brief Psychotropic Medication Use Among Adolescents United States 2005ndash2010 Dec Number 135httpwwwcdcgovnchsdatadatabriefsdb135htm
bull [7] C Buss EP Davis CJ Hobel and CA Sandman (2011) Maternal pregnancy-specific anxiety is associated with child executive function at 6ndash9 years age Stress Nov 14(6)665-676
bull [8] Council for Evidence-Based Psychiatry (UK) Web presentation ldquoUnrecognized Factsrdquo Authors James Davies Peter C Goetzsche Peter Kinderman Joanna Moncrieff Phillip Thomas Sami Timimi John Sandwich Melanie Davis Luke Montague httpcepukorgunrecognised-facts
bull [9] Johnstone Lucy (2015) A Straight Talking Introduction to Psychiatric DiagnosisPCCS Books 1st edition (February 3 2015)
bull [10] Brewin CR Andrews B Valentine JD (2000) ldquoMeta-analysis of risk factors for posttraumatic stress disorder in trauma-exposed adultsrdquo J Consult Clin Psychol2000 Oct68(5)748-66 httpwwwncbinlmnihgovpubmed11068961
bull [11] Williams Monica T (2013) ldquoCan Racism Cause PTSD Implications for DSM-5rdquoPsychology Today May 20 httpswwwpsychologytodaycomblogculturally-speaking201305can-racism-cause-ptsd-implications-dsm-5
Bibliography
bull [12] Yuan Chengmei et al (2011) ldquoProtective factors for posttraumatic stress disorder symptoms in a prospective study of police officersrdquo Nov 23httpwwwncbinlmnihgovpmcarticlesPMC3071439
bull [13] Chou Tina BA Anu Asnaani MA and Stefan G Hofmann PhD (2012) ldquoPerception of Racial Discrimination and Psychopathology Across Three US Ethnic Minority Groupsrdquo APA PsychNET Jan httpwwwncbinlmnihgovpmcarticlesPMC3505377
bull [14] Watson Laurel B Jacob M Marszalek Franco Dispenza and Christopher M Davids 2015 Understanding the Relationships Among White and African American Womenrsquos Sexual Objectification Experiences Physical Safety Anxiety and Psychological Distress Sex Roles 72 (34) 91-104
bull [15] Holland Julie (2015) ldquoMedicating Womenrsquos Feelingsrdquo New York TimesOpinion Feb 28 httpmobilenytimescom20150301opinionsundaymedicating-womens-feelingshtmlreferreramp_r=1
bull [16] Solinas M Thiriet N El Rawas R Lardeux V and Jaber M (2009) ldquoEnvironmental Enrichment During Early Stages of Life Reduces the Behavioral Neurochemical and Molecular Effects of Cocainerdquo Neuropsychopharmacology 34 1102ndash1111
bull [17] Hari Johann Chasing The Scream The First and Last Days of the War on Drugs Bloomsbury USA (January 20 2015)bull [18] Hughes Caitlin Elizabeth and Alex Stevens (2010) ldquoWhat Can We Learn From The Portuguese Decriminalization of Illicit
Drugsrdquo British Journal of Criminology July 21 httpbjcoxfordjournalsorgcontent506999abstractbull [19] Fournier Jay C et al (2009) ldquoAntidepressant Drug Effects and Depression Severityrdquo JAMA January
6th httpjamajamanetworkcomarticleaspxarticleid=185157[20] Currie J Stabile M Jones L (2013) Do Stimulant Medications Improve Educational and Behavioral Outcomes for Children with ADHD NBER Working Paper No 19105
bull [21] Mora-Ripoli R Organizacioacuten Mundial de la Risa Barcelona Spain ldquoThe therapeutic value of laughter in medicinerdquo Altern Ther Health Med 2010 Nov-Dec16(6)56-64 httpwwwncbinlmnihgovpubmed21280463
bull [22] Gracanin Asmir Lauren M Bylsma and Ad J J M Vingerhoets (2014) ldquoIs Crying a Self-Stoothing Behaviorrdquo Frontiers in Psychology May 28httpwwwncbinlmnihgovpmcarticlesPMC4035568
bull [23] Trimble Michael (2010) ldquoI Cry Therefore I Amrdquo New York Times Nov 10 httpwwwnytimescom20121111opinionsundayi-cry-therefore-i-amhtmlemc=eta1amp_r=0
bull [24]Gallup Andrew C et al (2007) ldquoYawning as a brain cooling mechanism Nasal breathing and forehead cooling diminish the incidence of contagious yawningrdquo httpwwwepjournalnetarticlesyawning-as-a-brain-cooling-mechanism-nasal-breathing-and-forehead-cooling-diminish-the-incidence-of-contagious-yawning
bull [25]Sharat Gupta and Shallu Mittal Int (2013) Yawning and its physiological significance Intl J Appl Basic Med Res Jan-Jun 3(1) 11ndash15
bull [26] Stephens R Atkins J Kingston A (2009) ldquoSwearing As a Response to Painrdquo NeuroReport Aug 5 httpwwwncbinlmnihgovpubmed19590391
bull [27]Morelli SA Lieberman MD(2013) rdquoThe role of automaticity and attention in neural processes underlying empathy for happiness sadness and anxietyrdquo Front Hum Neurosci May 87160
Bibliography
bull [1] Committee on Psychosocial Aspects of Child and Family Health Committee on Early Childhood Adoption and Dependent Care andSection on Developmental and Behavioral Pediatrics Andrew S Garner Jack P Shonkoff et al (2012) ldquoEarly Childhood Adversity Toxic Stress and the Role of the Pediatrician Translating Developmental Science Into Lifelong Healthrdquo Pediatrics January VOLUME 129 ISSUE 1 From the American Academy of Pediatrics Policy Statementhttppediatricsaappublicationsorgcontent1291e224fullref-23
bull [2] COUNCIL ON COMMUNITY PEDIATRICS Benjamin A Gitterman et al (2016) ldquoPoverty and Child Health in the United Statesrdquo Pediatrics March From the American Academy of Pediatrics Policy Statement Published Online March 09American Academy of Pediatricshttppediatricsaappublicationsorgcontentearly20160307peds2016-0339info
bull [3] Paul W Newacheck et al (2003) ldquoDisparities in Adolescent Health and Health Care Does Socioeconomic Status Matterrdquo Health ServRes Oct 38(5) 1235ndash1252 httpwwwncbinlmnihgovpmcarticlesPMC1360944
bull [4] Larson et al (2007) ldquoPoverty during pregnancy Its effects on child health outcomesrdquo Paediatr Child Health 2007 Oct 12(8) 673ndash677 httpwwwncbinlmnihgovpmcarticlesPMC2528810
bull [5] Lara J Akinbami et al (2012) ldquoTrends in Asthma Prevalence Health Care Use and Mortality in the United States 2001ndash2010rdquo NCHS Data Brief No 94 May httpwwwcdcgovnchsproductsdatabriefsdb94htm
bull [6] Cynthia L Ogden et al (2010) ldquoObesity and Socioeconomic Status in Children and Adolescents United States 2005-2008rdquoNCHS Data Brief No 51 Decemberhttpwwwcdcgovnchsproductsdatabriefsdb51htm
bull [7] Shonkoff JP et al Committee on Psychosocial Aspects of Child and Family Health Committee on Early Childhood Adoption and Dependent Care Section on Developmental and Behavioral Pediatrics rdquoThe lifelong effects of early childhood adversity and toxicstressrdquo Pediatrics 2012129(1) wwwpediatricsorgcgicontentfull1291e232
bull [8] Virginia A Rauh et alldquoHousing and HealthIntersection of Poverty and Environmental Exposuresrdquo (2008) Annals of the New York Academy of Sciences Volume 1136 Reducing the Impact of Poverty on Health and Human Development Scientific Approaches pages 276ndash288 June httponlinelibrarywileycomdoi101196annals1425032full
bull [9] Yehuda R et al (2015) ldquoHolocaust Exposure Induced Intergenerational Effects on FKBP5 MethylationrdquoBiol Psychiatry Aug 12 httpwwwncbinlmnihgovpubmed26410355
bull [10] Buss C et al (2011) ldquoMaternal pregnancy-specific anxiety is associated with child executive function at 6-9 years agerdquoStress Nov14(6)665-76 httpwwwncbinlmnihgovpubmed21995526
bull 11] Shankardass K et al (2014) ldquoParental stress increases body mass index trajectory in pre-adolescentsrdquoPediatr Obes Dec9(6)435-42 httpwwwncbinlmnihgovpubmed24311567
bull [12] Vincent J Felitti et al (1998) ldquoRelationship of Childhood Abuse and Household Dysfunction to Many of the Leading Causes of Death in Adults The Adverse Childhood Experiences (ACE) Studyrdquo May Volume 14 Issue 4 Pages 245ndash258 httpsacestoohighcom
bull [13]Jones CP Levels of Racism a Theoretic Framework and the Gardenerrsquos Tale Am J Public Health 200090(8) 1212-1215bull [14]Dion KL The Social Psycology of Perceived Perjudice and Discrimination Canadian Psychology (2002)431 pp 1-10bull [15]Sue D W Bucceri J Lin AI Nadal K L and Torino J C Racial Microaggressions and the Asian American experience APA (2007) Vol
13 No 1 pp 72-81bull [16]James S A (School of Public Health U of North Carolina Chapel Hill NC 27514) D S Strogatz S B Wing and D L Ramsey
Socioeconomic status John Henryism and hypertension in blacks and whites Am J Epidemiol 1987 126664ndash73bull [17]httpwwwapaorgpioemaresourcesethnicity-healthindexaspxbull [18]Porges SW Clinical Insights from the Polyvagal Theory The Transformative Power of Feeling Safe (Norton Series on Interpersonal
Neurobiology) W W Norton Apr 7 2014 - Psychology - 288 pagesbull [19]The Polyvagal Theory (Porges SW Social Connectedness as a Biological Imperative Understanding Trauma Through the Lens of
thePolyvagal Theory presentation 82015)bull [20]McEwen BS Allostasis and allostatic load implications for neuropsychopharmacologyNeuropsychopharmacology 2000
Feb22(2)108-24bull [21] McEwen BS adaptation and disease Allostasis and allostatic load Ann N Y Acad Sci 1998 May 184033-44bull [22] Arline T Geronimus ScD Margaret Hicken MPH Danya Keene MAT and John Bound PhD Weatheringrdquo and Age Patterns of
Allostatic Load Scores Among Blacks and Whites in the United States Am J Public Health 2006 May 96(5) 826ndash833bull [22]Stephen Porges PhD Polyvagal Perspective Biological Psychology 2007 Feb 74(2) 116ndash143 Published online 2006 Oct 16 bull [23]Stephen W Porges PhD The Polyvagal Theory Neurophysiological Foundations of Emotions Attachment Communication and
Self-regulation WWNorton and Company Inc 2011bull [24]Maggie Phillips PhD Reversing Chronic Pain North Atlantic Books 2007bull [25]Peter Levine PhD Waking the Tiger North Atlantic Books 1997bull [26]Bessel VanderKolk MD The Body Keeps the Score Viking Penguin 2014bullAcknowledgmentsbull Group Medical Visits and Group Facilitation Jeff Geller MDbull Re-evaluation Counseling Community bull Insight Meditation Communitybull Biodynamic Osteopathy Communitybull Learning To Breathe Mindfulness Training for Adolescents 2015 Patricia C Broderick PhD bull Stanford Chronic Disease Self Management Program Training 2014 Kate Lorig MPH RNbull Motivational Interviewing Training 2015 Steven Berg-Smithbull Centering Pregnancy Training 2014 Centering Healthcare Institutebull Motivating Change in Groups Training 2013 Kaiser Permanente Oakland Cabull Group Facilitation Training Sara Fisk PhD Community at Work San Francisco Cabull Tribes Training 2013 Center for Human Developmentbull Cultural Humility Training 2016 Melanie Tervalon MD
Bibliography
Intermediate Steps to Listening Session Handout
bull Step 1 Connect with yourself body mind and emotions
bull Step 2 Hold a non-judgmental space to be seen and heard
bull Step 3 See the speaker and anyone referenced as able to manifest their true human nature and evolve using inherent healing abilities
bull Step 4 Listen to the speaker in a deep connected way sending the message that their thinking feelings and being matters to you
bull Step 5 Encourage the speaker to express feelings or thoughts describe body sensations or share a story relevant to the feelings at hand
bull Step 6 Validate intense emotional expression and release such as crying laughing shaking yawning sweating as a sign of healing
bull Step 7 Remind the speaker of their underlying goodness intelligence strength and caring and your confidence in their ability to heal and manifest their true human nature
copy Elizabeth Rocco MD
Contact Information
bull Elizabeth Rocco MD -egroccogmailcom
bull Karen Ekwueme MD-impactdoc1gmailcom
Pre-frontal CortexThe Voice of Reason
Human Healing and Evolution through Self-Awareness Embodiment Empowerment and Connection
Mindfulness Breath work Martial Arts Exercise Yoga Singing Dancing
Acupuncture Massage ReikiCommunity Groups Animals Church Nature
Final Listening Practice and Closing Circle
Bibliography
bull Special Acknowledgement of Demie Stathoplos MSW and Bonnie Cohen MD who collaborated with Elizabeth Rocco MD on the IM4US August 2015 presentation ldquoListening to Each Other Healing the Negative Health Impacts of Racism Poverty and Trauma through Human Connectionrdquo
bull Special Acknowledgement of Karen Burt MD who collaborated with Elizabeth Rocco MD and Karen Ekwueme MD on the IM4US August 2016 presentation ldquoListening to Ourselves and Each Other Healing the Negative Health Impact of Racism Poverty Sexism and Traumardquo These bibliographies are included below
bull [1]Wen Patricia (2010) ldquoA legacy of unintended side effectsrdquo Boston Globe December 12 httpwwwbostoncomnewslocalmassachusettsarticles20101212with_ssi_program_a_legcy_of_unintended_side_effects
bull [2]CCHR International (2014) [Online] Number of Children amp Adolescents Taking Psychiatric Drugs in the US Aprilwwwcchrintorgpsychiatric-drugschildren-on-psychiatric-drugs
bull [3]Whitaker R (2010) Anatomy of an Epidemic Magic Bullets Psychiatric Drugs and the Astonishing Rise of Mental Illness in America Crown Publishing Company httprobertwhitakerorgrobertwhitakerorgAnatomy20of20an20Epidemichtml
bull [3]CDC (2013) [Online] MMRW Mental Health Surveillance Among Children mdash United States 2005ndash2011 Supplements May 17 62(02)1-35 httpwwwcdcgovmmwrpreviewmmwrhtmlsu6202a1htm
bull [4]Patricia N Pastor PhD Cynthia A Reuben MA Catherine R Duran BS and LaJeana D Hawkins MPH CHES (2015) [Online] CDC NCHS Data Brief Association Between Diagnosed ADHD and Selected Characteristics Among Children Aged 4ndash17 Years United States 2011ndash2013 May Number 201 httpwwwcdcgovnchsdatadatabriefsdb201htm
bull [5]Mental Health America (2014) Parity or Disparity The State of Mental Health in America 2015 NovwwwmentalhealthamericanetsitesdefaultfilesParity20or20Disparity20201520Reportpdf
bull [6]Bruce S Jonas ScM PhD Qiuping Gu MD PhD and Juan R Albertorio-Diaz MA (2013) [Online] CDC NCHS Data Brief Psychotropic Medication Use Among Adolescents United States 2005ndash2010 Dec Number 135httpwwwcdcgovnchsdatadatabriefsdb135htm
bull [7] C Buss EP Davis CJ Hobel and CA Sandman (2011) Maternal pregnancy-specific anxiety is associated with child executive function at 6ndash9 years age Stress Nov 14(6)665-676
bull [8] Council for Evidence-Based Psychiatry (UK) Web presentation ldquoUnrecognized Factsrdquo Authors James Davies Peter C Goetzsche Peter Kinderman Joanna Moncrieff Phillip Thomas Sami Timimi John Sandwich Melanie Davis Luke Montague httpcepukorgunrecognised-facts
bull [9] Johnstone Lucy (2015) A Straight Talking Introduction to Psychiatric DiagnosisPCCS Books 1st edition (February 3 2015)
bull [10] Brewin CR Andrews B Valentine JD (2000) ldquoMeta-analysis of risk factors for posttraumatic stress disorder in trauma-exposed adultsrdquo J Consult Clin Psychol2000 Oct68(5)748-66 httpwwwncbinlmnihgovpubmed11068961
bull [11] Williams Monica T (2013) ldquoCan Racism Cause PTSD Implications for DSM-5rdquoPsychology Today May 20 httpswwwpsychologytodaycomblogculturally-speaking201305can-racism-cause-ptsd-implications-dsm-5
Bibliography
bull [12] Yuan Chengmei et al (2011) ldquoProtective factors for posttraumatic stress disorder symptoms in a prospective study of police officersrdquo Nov 23httpwwwncbinlmnihgovpmcarticlesPMC3071439
bull [13] Chou Tina BA Anu Asnaani MA and Stefan G Hofmann PhD (2012) ldquoPerception of Racial Discrimination and Psychopathology Across Three US Ethnic Minority Groupsrdquo APA PsychNET Jan httpwwwncbinlmnihgovpmcarticlesPMC3505377
bull [14] Watson Laurel B Jacob M Marszalek Franco Dispenza and Christopher M Davids 2015 Understanding the Relationships Among White and African American Womenrsquos Sexual Objectification Experiences Physical Safety Anxiety and Psychological Distress Sex Roles 72 (34) 91-104
bull [15] Holland Julie (2015) ldquoMedicating Womenrsquos Feelingsrdquo New York TimesOpinion Feb 28 httpmobilenytimescom20150301opinionsundaymedicating-womens-feelingshtmlreferreramp_r=1
bull [16] Solinas M Thiriet N El Rawas R Lardeux V and Jaber M (2009) ldquoEnvironmental Enrichment During Early Stages of Life Reduces the Behavioral Neurochemical and Molecular Effects of Cocainerdquo Neuropsychopharmacology 34 1102ndash1111
bull [17] Hari Johann Chasing The Scream The First and Last Days of the War on Drugs Bloomsbury USA (January 20 2015)bull [18] Hughes Caitlin Elizabeth and Alex Stevens (2010) ldquoWhat Can We Learn From The Portuguese Decriminalization of Illicit
Drugsrdquo British Journal of Criminology July 21 httpbjcoxfordjournalsorgcontent506999abstractbull [19] Fournier Jay C et al (2009) ldquoAntidepressant Drug Effects and Depression Severityrdquo JAMA January
6th httpjamajamanetworkcomarticleaspxarticleid=185157[20] Currie J Stabile M Jones L (2013) Do Stimulant Medications Improve Educational and Behavioral Outcomes for Children with ADHD NBER Working Paper No 19105
bull [21] Mora-Ripoli R Organizacioacuten Mundial de la Risa Barcelona Spain ldquoThe therapeutic value of laughter in medicinerdquo Altern Ther Health Med 2010 Nov-Dec16(6)56-64 httpwwwncbinlmnihgovpubmed21280463
bull [22] Gracanin Asmir Lauren M Bylsma and Ad J J M Vingerhoets (2014) ldquoIs Crying a Self-Stoothing Behaviorrdquo Frontiers in Psychology May 28httpwwwncbinlmnihgovpmcarticlesPMC4035568
bull [23] Trimble Michael (2010) ldquoI Cry Therefore I Amrdquo New York Times Nov 10 httpwwwnytimescom20121111opinionsundayi-cry-therefore-i-amhtmlemc=eta1amp_r=0
bull [24]Gallup Andrew C et al (2007) ldquoYawning as a brain cooling mechanism Nasal breathing and forehead cooling diminish the incidence of contagious yawningrdquo httpwwwepjournalnetarticlesyawning-as-a-brain-cooling-mechanism-nasal-breathing-and-forehead-cooling-diminish-the-incidence-of-contagious-yawning
bull [25]Sharat Gupta and Shallu Mittal Int (2013) Yawning and its physiological significance Intl J Appl Basic Med Res Jan-Jun 3(1) 11ndash15
bull [26] Stephens R Atkins J Kingston A (2009) ldquoSwearing As a Response to Painrdquo NeuroReport Aug 5 httpwwwncbinlmnihgovpubmed19590391
bull [27]Morelli SA Lieberman MD(2013) rdquoThe role of automaticity and attention in neural processes underlying empathy for happiness sadness and anxietyrdquo Front Hum Neurosci May 87160
Bibliography
bull [1] Committee on Psychosocial Aspects of Child and Family Health Committee on Early Childhood Adoption and Dependent Care andSection on Developmental and Behavioral Pediatrics Andrew S Garner Jack P Shonkoff et al (2012) ldquoEarly Childhood Adversity Toxic Stress and the Role of the Pediatrician Translating Developmental Science Into Lifelong Healthrdquo Pediatrics January VOLUME 129 ISSUE 1 From the American Academy of Pediatrics Policy Statementhttppediatricsaappublicationsorgcontent1291e224fullref-23
bull [2] COUNCIL ON COMMUNITY PEDIATRICS Benjamin A Gitterman et al (2016) ldquoPoverty and Child Health in the United Statesrdquo Pediatrics March From the American Academy of Pediatrics Policy Statement Published Online March 09American Academy of Pediatricshttppediatricsaappublicationsorgcontentearly20160307peds2016-0339info
bull [3] Paul W Newacheck et al (2003) ldquoDisparities in Adolescent Health and Health Care Does Socioeconomic Status Matterrdquo Health ServRes Oct 38(5) 1235ndash1252 httpwwwncbinlmnihgovpmcarticlesPMC1360944
bull [4] Larson et al (2007) ldquoPoverty during pregnancy Its effects on child health outcomesrdquo Paediatr Child Health 2007 Oct 12(8) 673ndash677 httpwwwncbinlmnihgovpmcarticlesPMC2528810
bull [5] Lara J Akinbami et al (2012) ldquoTrends in Asthma Prevalence Health Care Use and Mortality in the United States 2001ndash2010rdquo NCHS Data Brief No 94 May httpwwwcdcgovnchsproductsdatabriefsdb94htm
bull [6] Cynthia L Ogden et al (2010) ldquoObesity and Socioeconomic Status in Children and Adolescents United States 2005-2008rdquoNCHS Data Brief No 51 Decemberhttpwwwcdcgovnchsproductsdatabriefsdb51htm
bull [7] Shonkoff JP et al Committee on Psychosocial Aspects of Child and Family Health Committee on Early Childhood Adoption and Dependent Care Section on Developmental and Behavioral Pediatrics rdquoThe lifelong effects of early childhood adversity and toxicstressrdquo Pediatrics 2012129(1) wwwpediatricsorgcgicontentfull1291e232
bull [8] Virginia A Rauh et alldquoHousing and HealthIntersection of Poverty and Environmental Exposuresrdquo (2008) Annals of the New York Academy of Sciences Volume 1136 Reducing the Impact of Poverty on Health and Human Development Scientific Approaches pages 276ndash288 June httponlinelibrarywileycomdoi101196annals1425032full
bull [9] Yehuda R et al (2015) ldquoHolocaust Exposure Induced Intergenerational Effects on FKBP5 MethylationrdquoBiol Psychiatry Aug 12 httpwwwncbinlmnihgovpubmed26410355
bull [10] Buss C et al (2011) ldquoMaternal pregnancy-specific anxiety is associated with child executive function at 6-9 years agerdquoStress Nov14(6)665-76 httpwwwncbinlmnihgovpubmed21995526
bull 11] Shankardass K et al (2014) ldquoParental stress increases body mass index trajectory in pre-adolescentsrdquoPediatr Obes Dec9(6)435-42 httpwwwncbinlmnihgovpubmed24311567
bull [12] Vincent J Felitti et al (1998) ldquoRelationship of Childhood Abuse and Household Dysfunction to Many of the Leading Causes of Death in Adults The Adverse Childhood Experiences (ACE) Studyrdquo May Volume 14 Issue 4 Pages 245ndash258 httpsacestoohighcom
bull [13]Jones CP Levels of Racism a Theoretic Framework and the Gardenerrsquos Tale Am J Public Health 200090(8) 1212-1215bull [14]Dion KL The Social Psycology of Perceived Perjudice and Discrimination Canadian Psychology (2002)431 pp 1-10bull [15]Sue D W Bucceri J Lin AI Nadal K L and Torino J C Racial Microaggressions and the Asian American experience APA (2007) Vol
13 No 1 pp 72-81bull [16]James S A (School of Public Health U of North Carolina Chapel Hill NC 27514) D S Strogatz S B Wing and D L Ramsey
Socioeconomic status John Henryism and hypertension in blacks and whites Am J Epidemiol 1987 126664ndash73bull [17]httpwwwapaorgpioemaresourcesethnicity-healthindexaspxbull [18]Porges SW Clinical Insights from the Polyvagal Theory The Transformative Power of Feeling Safe (Norton Series on Interpersonal
Neurobiology) W W Norton Apr 7 2014 - Psychology - 288 pagesbull [19]The Polyvagal Theory (Porges SW Social Connectedness as a Biological Imperative Understanding Trauma Through the Lens of
thePolyvagal Theory presentation 82015)bull [20]McEwen BS Allostasis and allostatic load implications for neuropsychopharmacologyNeuropsychopharmacology 2000
Feb22(2)108-24bull [21] McEwen BS adaptation and disease Allostasis and allostatic load Ann N Y Acad Sci 1998 May 184033-44bull [22] Arline T Geronimus ScD Margaret Hicken MPH Danya Keene MAT and John Bound PhD Weatheringrdquo and Age Patterns of
Allostatic Load Scores Among Blacks and Whites in the United States Am J Public Health 2006 May 96(5) 826ndash833bull [22]Stephen Porges PhD Polyvagal Perspective Biological Psychology 2007 Feb 74(2) 116ndash143 Published online 2006 Oct 16 bull [23]Stephen W Porges PhD The Polyvagal Theory Neurophysiological Foundations of Emotions Attachment Communication and
Self-regulation WWNorton and Company Inc 2011bull [24]Maggie Phillips PhD Reversing Chronic Pain North Atlantic Books 2007bull [25]Peter Levine PhD Waking the Tiger North Atlantic Books 1997bull [26]Bessel VanderKolk MD The Body Keeps the Score Viking Penguin 2014bullAcknowledgmentsbull Group Medical Visits and Group Facilitation Jeff Geller MDbull Re-evaluation Counseling Community bull Insight Meditation Communitybull Biodynamic Osteopathy Communitybull Learning To Breathe Mindfulness Training for Adolescents 2015 Patricia C Broderick PhD bull Stanford Chronic Disease Self Management Program Training 2014 Kate Lorig MPH RNbull Motivational Interviewing Training 2015 Steven Berg-Smithbull Centering Pregnancy Training 2014 Centering Healthcare Institutebull Motivating Change in Groups Training 2013 Kaiser Permanente Oakland Cabull Group Facilitation Training Sara Fisk PhD Community at Work San Francisco Cabull Tribes Training 2013 Center for Human Developmentbull Cultural Humility Training 2016 Melanie Tervalon MD
Bibliography
Intermediate Steps to Listening Session Handout
bull Step 1 Connect with yourself body mind and emotions
bull Step 2 Hold a non-judgmental space to be seen and heard
bull Step 3 See the speaker and anyone referenced as able to manifest their true human nature and evolve using inherent healing abilities
bull Step 4 Listen to the speaker in a deep connected way sending the message that their thinking feelings and being matters to you
bull Step 5 Encourage the speaker to express feelings or thoughts describe body sensations or share a story relevant to the feelings at hand
bull Step 6 Validate intense emotional expression and release such as crying laughing shaking yawning sweating as a sign of healing
bull Step 7 Remind the speaker of their underlying goodness intelligence strength and caring and your confidence in their ability to heal and manifest their true human nature
copy Elizabeth Rocco MD
Contact Information
bull Elizabeth Rocco MD -egroccogmailcom
bull Karen Ekwueme MD-impactdoc1gmailcom
Human Healing and Evolution through Self-Awareness Embodiment Empowerment and Connection
Mindfulness Breath work Martial Arts Exercise Yoga Singing Dancing
Acupuncture Massage ReikiCommunity Groups Animals Church Nature
Final Listening Practice and Closing Circle
Bibliography
bull Special Acknowledgement of Demie Stathoplos MSW and Bonnie Cohen MD who collaborated with Elizabeth Rocco MD on the IM4US August 2015 presentation ldquoListening to Each Other Healing the Negative Health Impacts of Racism Poverty and Trauma through Human Connectionrdquo
bull Special Acknowledgement of Karen Burt MD who collaborated with Elizabeth Rocco MD and Karen Ekwueme MD on the IM4US August 2016 presentation ldquoListening to Ourselves and Each Other Healing the Negative Health Impact of Racism Poverty Sexism and Traumardquo These bibliographies are included below
bull [1]Wen Patricia (2010) ldquoA legacy of unintended side effectsrdquo Boston Globe December 12 httpwwwbostoncomnewslocalmassachusettsarticles20101212with_ssi_program_a_legcy_of_unintended_side_effects
bull [2]CCHR International (2014) [Online] Number of Children amp Adolescents Taking Psychiatric Drugs in the US Aprilwwwcchrintorgpsychiatric-drugschildren-on-psychiatric-drugs
bull [3]Whitaker R (2010) Anatomy of an Epidemic Magic Bullets Psychiatric Drugs and the Astonishing Rise of Mental Illness in America Crown Publishing Company httprobertwhitakerorgrobertwhitakerorgAnatomy20of20an20Epidemichtml
bull [3]CDC (2013) [Online] MMRW Mental Health Surveillance Among Children mdash United States 2005ndash2011 Supplements May 17 62(02)1-35 httpwwwcdcgovmmwrpreviewmmwrhtmlsu6202a1htm
bull [4]Patricia N Pastor PhD Cynthia A Reuben MA Catherine R Duran BS and LaJeana D Hawkins MPH CHES (2015) [Online] CDC NCHS Data Brief Association Between Diagnosed ADHD and Selected Characteristics Among Children Aged 4ndash17 Years United States 2011ndash2013 May Number 201 httpwwwcdcgovnchsdatadatabriefsdb201htm
bull [5]Mental Health America (2014) Parity or Disparity The State of Mental Health in America 2015 NovwwwmentalhealthamericanetsitesdefaultfilesParity20or20Disparity20201520Reportpdf
bull [6]Bruce S Jonas ScM PhD Qiuping Gu MD PhD and Juan R Albertorio-Diaz MA (2013) [Online] CDC NCHS Data Brief Psychotropic Medication Use Among Adolescents United States 2005ndash2010 Dec Number 135httpwwwcdcgovnchsdatadatabriefsdb135htm
bull [7] C Buss EP Davis CJ Hobel and CA Sandman (2011) Maternal pregnancy-specific anxiety is associated with child executive function at 6ndash9 years age Stress Nov 14(6)665-676
bull [8] Council for Evidence-Based Psychiatry (UK) Web presentation ldquoUnrecognized Factsrdquo Authors James Davies Peter C Goetzsche Peter Kinderman Joanna Moncrieff Phillip Thomas Sami Timimi John Sandwich Melanie Davis Luke Montague httpcepukorgunrecognised-facts
bull [9] Johnstone Lucy (2015) A Straight Talking Introduction to Psychiatric DiagnosisPCCS Books 1st edition (February 3 2015)
bull [10] Brewin CR Andrews B Valentine JD (2000) ldquoMeta-analysis of risk factors for posttraumatic stress disorder in trauma-exposed adultsrdquo J Consult Clin Psychol2000 Oct68(5)748-66 httpwwwncbinlmnihgovpubmed11068961
bull [11] Williams Monica T (2013) ldquoCan Racism Cause PTSD Implications for DSM-5rdquoPsychology Today May 20 httpswwwpsychologytodaycomblogculturally-speaking201305can-racism-cause-ptsd-implications-dsm-5
Bibliography
bull [12] Yuan Chengmei et al (2011) ldquoProtective factors for posttraumatic stress disorder symptoms in a prospective study of police officersrdquo Nov 23httpwwwncbinlmnihgovpmcarticlesPMC3071439
bull [13] Chou Tina BA Anu Asnaani MA and Stefan G Hofmann PhD (2012) ldquoPerception of Racial Discrimination and Psychopathology Across Three US Ethnic Minority Groupsrdquo APA PsychNET Jan httpwwwncbinlmnihgovpmcarticlesPMC3505377
bull [14] Watson Laurel B Jacob M Marszalek Franco Dispenza and Christopher M Davids 2015 Understanding the Relationships Among White and African American Womenrsquos Sexual Objectification Experiences Physical Safety Anxiety and Psychological Distress Sex Roles 72 (34) 91-104
bull [15] Holland Julie (2015) ldquoMedicating Womenrsquos Feelingsrdquo New York TimesOpinion Feb 28 httpmobilenytimescom20150301opinionsundaymedicating-womens-feelingshtmlreferreramp_r=1
bull [16] Solinas M Thiriet N El Rawas R Lardeux V and Jaber M (2009) ldquoEnvironmental Enrichment During Early Stages of Life Reduces the Behavioral Neurochemical and Molecular Effects of Cocainerdquo Neuropsychopharmacology 34 1102ndash1111
bull [17] Hari Johann Chasing The Scream The First and Last Days of the War on Drugs Bloomsbury USA (January 20 2015)bull [18] Hughes Caitlin Elizabeth and Alex Stevens (2010) ldquoWhat Can We Learn From The Portuguese Decriminalization of Illicit
Drugsrdquo British Journal of Criminology July 21 httpbjcoxfordjournalsorgcontent506999abstractbull [19] Fournier Jay C et al (2009) ldquoAntidepressant Drug Effects and Depression Severityrdquo JAMA January
6th httpjamajamanetworkcomarticleaspxarticleid=185157[20] Currie J Stabile M Jones L (2013) Do Stimulant Medications Improve Educational and Behavioral Outcomes for Children with ADHD NBER Working Paper No 19105
bull [21] Mora-Ripoli R Organizacioacuten Mundial de la Risa Barcelona Spain ldquoThe therapeutic value of laughter in medicinerdquo Altern Ther Health Med 2010 Nov-Dec16(6)56-64 httpwwwncbinlmnihgovpubmed21280463
bull [22] Gracanin Asmir Lauren M Bylsma and Ad J J M Vingerhoets (2014) ldquoIs Crying a Self-Stoothing Behaviorrdquo Frontiers in Psychology May 28httpwwwncbinlmnihgovpmcarticlesPMC4035568
bull [23] Trimble Michael (2010) ldquoI Cry Therefore I Amrdquo New York Times Nov 10 httpwwwnytimescom20121111opinionsundayi-cry-therefore-i-amhtmlemc=eta1amp_r=0
bull [24]Gallup Andrew C et al (2007) ldquoYawning as a brain cooling mechanism Nasal breathing and forehead cooling diminish the incidence of contagious yawningrdquo httpwwwepjournalnetarticlesyawning-as-a-brain-cooling-mechanism-nasal-breathing-and-forehead-cooling-diminish-the-incidence-of-contagious-yawning
bull [25]Sharat Gupta and Shallu Mittal Int (2013) Yawning and its physiological significance Intl J Appl Basic Med Res Jan-Jun 3(1) 11ndash15
bull [26] Stephens R Atkins J Kingston A (2009) ldquoSwearing As a Response to Painrdquo NeuroReport Aug 5 httpwwwncbinlmnihgovpubmed19590391
bull [27]Morelli SA Lieberman MD(2013) rdquoThe role of automaticity and attention in neural processes underlying empathy for happiness sadness and anxietyrdquo Front Hum Neurosci May 87160
Bibliography
bull [1] Committee on Psychosocial Aspects of Child and Family Health Committee on Early Childhood Adoption and Dependent Care andSection on Developmental and Behavioral Pediatrics Andrew S Garner Jack P Shonkoff et al (2012) ldquoEarly Childhood Adversity Toxic Stress and the Role of the Pediatrician Translating Developmental Science Into Lifelong Healthrdquo Pediatrics January VOLUME 129 ISSUE 1 From the American Academy of Pediatrics Policy Statementhttppediatricsaappublicationsorgcontent1291e224fullref-23
bull [2] COUNCIL ON COMMUNITY PEDIATRICS Benjamin A Gitterman et al (2016) ldquoPoverty and Child Health in the United Statesrdquo Pediatrics March From the American Academy of Pediatrics Policy Statement Published Online March 09American Academy of Pediatricshttppediatricsaappublicationsorgcontentearly20160307peds2016-0339info
bull [3] Paul W Newacheck et al (2003) ldquoDisparities in Adolescent Health and Health Care Does Socioeconomic Status Matterrdquo Health ServRes Oct 38(5) 1235ndash1252 httpwwwncbinlmnihgovpmcarticlesPMC1360944
bull [4] Larson et al (2007) ldquoPoverty during pregnancy Its effects on child health outcomesrdquo Paediatr Child Health 2007 Oct 12(8) 673ndash677 httpwwwncbinlmnihgovpmcarticlesPMC2528810
bull [5] Lara J Akinbami et al (2012) ldquoTrends in Asthma Prevalence Health Care Use and Mortality in the United States 2001ndash2010rdquo NCHS Data Brief No 94 May httpwwwcdcgovnchsproductsdatabriefsdb94htm
bull [6] Cynthia L Ogden et al (2010) ldquoObesity and Socioeconomic Status in Children and Adolescents United States 2005-2008rdquoNCHS Data Brief No 51 Decemberhttpwwwcdcgovnchsproductsdatabriefsdb51htm
bull [7] Shonkoff JP et al Committee on Psychosocial Aspects of Child and Family Health Committee on Early Childhood Adoption and Dependent Care Section on Developmental and Behavioral Pediatrics rdquoThe lifelong effects of early childhood adversity and toxicstressrdquo Pediatrics 2012129(1) wwwpediatricsorgcgicontentfull1291e232
bull [8] Virginia A Rauh et alldquoHousing and HealthIntersection of Poverty and Environmental Exposuresrdquo (2008) Annals of the New York Academy of Sciences Volume 1136 Reducing the Impact of Poverty on Health and Human Development Scientific Approaches pages 276ndash288 June httponlinelibrarywileycomdoi101196annals1425032full
bull [9] Yehuda R et al (2015) ldquoHolocaust Exposure Induced Intergenerational Effects on FKBP5 MethylationrdquoBiol Psychiatry Aug 12 httpwwwncbinlmnihgovpubmed26410355
bull [10] Buss C et al (2011) ldquoMaternal pregnancy-specific anxiety is associated with child executive function at 6-9 years agerdquoStress Nov14(6)665-76 httpwwwncbinlmnihgovpubmed21995526
bull 11] Shankardass K et al (2014) ldquoParental stress increases body mass index trajectory in pre-adolescentsrdquoPediatr Obes Dec9(6)435-42 httpwwwncbinlmnihgovpubmed24311567
bull [12] Vincent J Felitti et al (1998) ldquoRelationship of Childhood Abuse and Household Dysfunction to Many of the Leading Causes of Death in Adults The Adverse Childhood Experiences (ACE) Studyrdquo May Volume 14 Issue 4 Pages 245ndash258 httpsacestoohighcom
bull [13]Jones CP Levels of Racism a Theoretic Framework and the Gardenerrsquos Tale Am J Public Health 200090(8) 1212-1215bull [14]Dion KL The Social Psycology of Perceived Perjudice and Discrimination Canadian Psychology (2002)431 pp 1-10bull [15]Sue D W Bucceri J Lin AI Nadal K L and Torino J C Racial Microaggressions and the Asian American experience APA (2007) Vol
13 No 1 pp 72-81bull [16]James S A (School of Public Health U of North Carolina Chapel Hill NC 27514) D S Strogatz S B Wing and D L Ramsey
Socioeconomic status John Henryism and hypertension in blacks and whites Am J Epidemiol 1987 126664ndash73bull [17]httpwwwapaorgpioemaresourcesethnicity-healthindexaspxbull [18]Porges SW Clinical Insights from the Polyvagal Theory The Transformative Power of Feeling Safe (Norton Series on Interpersonal
Neurobiology) W W Norton Apr 7 2014 - Psychology - 288 pagesbull [19]The Polyvagal Theory (Porges SW Social Connectedness as a Biological Imperative Understanding Trauma Through the Lens of
thePolyvagal Theory presentation 82015)bull [20]McEwen BS Allostasis and allostatic load implications for neuropsychopharmacologyNeuropsychopharmacology 2000
Feb22(2)108-24bull [21] McEwen BS adaptation and disease Allostasis and allostatic load Ann N Y Acad Sci 1998 May 184033-44bull [22] Arline T Geronimus ScD Margaret Hicken MPH Danya Keene MAT and John Bound PhD Weatheringrdquo and Age Patterns of
Allostatic Load Scores Among Blacks and Whites in the United States Am J Public Health 2006 May 96(5) 826ndash833bull [22]Stephen Porges PhD Polyvagal Perspective Biological Psychology 2007 Feb 74(2) 116ndash143 Published online 2006 Oct 16 bull [23]Stephen W Porges PhD The Polyvagal Theory Neurophysiological Foundations of Emotions Attachment Communication and
Self-regulation WWNorton and Company Inc 2011bull [24]Maggie Phillips PhD Reversing Chronic Pain North Atlantic Books 2007bull [25]Peter Levine PhD Waking the Tiger North Atlantic Books 1997bull [26]Bessel VanderKolk MD The Body Keeps the Score Viking Penguin 2014bullAcknowledgmentsbull Group Medical Visits and Group Facilitation Jeff Geller MDbull Re-evaluation Counseling Community bull Insight Meditation Communitybull Biodynamic Osteopathy Communitybull Learning To Breathe Mindfulness Training for Adolescents 2015 Patricia C Broderick PhD bull Stanford Chronic Disease Self Management Program Training 2014 Kate Lorig MPH RNbull Motivational Interviewing Training 2015 Steven Berg-Smithbull Centering Pregnancy Training 2014 Centering Healthcare Institutebull Motivating Change in Groups Training 2013 Kaiser Permanente Oakland Cabull Group Facilitation Training Sara Fisk PhD Community at Work San Francisco Cabull Tribes Training 2013 Center for Human Developmentbull Cultural Humility Training 2016 Melanie Tervalon MD
Bibliography
Intermediate Steps to Listening Session Handout
bull Step 1 Connect with yourself body mind and emotions
bull Step 2 Hold a non-judgmental space to be seen and heard
bull Step 3 See the speaker and anyone referenced as able to manifest their true human nature and evolve using inherent healing abilities
bull Step 4 Listen to the speaker in a deep connected way sending the message that their thinking feelings and being matters to you
bull Step 5 Encourage the speaker to express feelings or thoughts describe body sensations or share a story relevant to the feelings at hand
bull Step 6 Validate intense emotional expression and release such as crying laughing shaking yawning sweating as a sign of healing
bull Step 7 Remind the speaker of their underlying goodness intelligence strength and caring and your confidence in their ability to heal and manifest their true human nature
copy Elizabeth Rocco MD
Contact Information
bull Elizabeth Rocco MD -egroccogmailcom
bull Karen Ekwueme MD-impactdoc1gmailcom
Final Listening Practice and Closing Circle
Bibliography
bull Special Acknowledgement of Demie Stathoplos MSW and Bonnie Cohen MD who collaborated with Elizabeth Rocco MD on the IM4US August 2015 presentation ldquoListening to Each Other Healing the Negative Health Impacts of Racism Poverty and Trauma through Human Connectionrdquo
bull Special Acknowledgement of Karen Burt MD who collaborated with Elizabeth Rocco MD and Karen Ekwueme MD on the IM4US August 2016 presentation ldquoListening to Ourselves and Each Other Healing the Negative Health Impact of Racism Poverty Sexism and Traumardquo These bibliographies are included below
bull [1]Wen Patricia (2010) ldquoA legacy of unintended side effectsrdquo Boston Globe December 12 httpwwwbostoncomnewslocalmassachusettsarticles20101212with_ssi_program_a_legcy_of_unintended_side_effects
bull [2]CCHR International (2014) [Online] Number of Children amp Adolescents Taking Psychiatric Drugs in the US Aprilwwwcchrintorgpsychiatric-drugschildren-on-psychiatric-drugs
bull [3]Whitaker R (2010) Anatomy of an Epidemic Magic Bullets Psychiatric Drugs and the Astonishing Rise of Mental Illness in America Crown Publishing Company httprobertwhitakerorgrobertwhitakerorgAnatomy20of20an20Epidemichtml
bull [3]CDC (2013) [Online] MMRW Mental Health Surveillance Among Children mdash United States 2005ndash2011 Supplements May 17 62(02)1-35 httpwwwcdcgovmmwrpreviewmmwrhtmlsu6202a1htm
bull [4]Patricia N Pastor PhD Cynthia A Reuben MA Catherine R Duran BS and LaJeana D Hawkins MPH CHES (2015) [Online] CDC NCHS Data Brief Association Between Diagnosed ADHD and Selected Characteristics Among Children Aged 4ndash17 Years United States 2011ndash2013 May Number 201 httpwwwcdcgovnchsdatadatabriefsdb201htm
bull [5]Mental Health America (2014) Parity or Disparity The State of Mental Health in America 2015 NovwwwmentalhealthamericanetsitesdefaultfilesParity20or20Disparity20201520Reportpdf
bull [6]Bruce S Jonas ScM PhD Qiuping Gu MD PhD and Juan R Albertorio-Diaz MA (2013) [Online] CDC NCHS Data Brief Psychotropic Medication Use Among Adolescents United States 2005ndash2010 Dec Number 135httpwwwcdcgovnchsdatadatabriefsdb135htm
bull [7] C Buss EP Davis CJ Hobel and CA Sandman (2011) Maternal pregnancy-specific anxiety is associated with child executive function at 6ndash9 years age Stress Nov 14(6)665-676
bull [8] Council for Evidence-Based Psychiatry (UK) Web presentation ldquoUnrecognized Factsrdquo Authors James Davies Peter C Goetzsche Peter Kinderman Joanna Moncrieff Phillip Thomas Sami Timimi John Sandwich Melanie Davis Luke Montague httpcepukorgunrecognised-facts
bull [9] Johnstone Lucy (2015) A Straight Talking Introduction to Psychiatric DiagnosisPCCS Books 1st edition (February 3 2015)
bull [10] Brewin CR Andrews B Valentine JD (2000) ldquoMeta-analysis of risk factors for posttraumatic stress disorder in trauma-exposed adultsrdquo J Consult Clin Psychol2000 Oct68(5)748-66 httpwwwncbinlmnihgovpubmed11068961
bull [11] Williams Monica T (2013) ldquoCan Racism Cause PTSD Implications for DSM-5rdquoPsychology Today May 20 httpswwwpsychologytodaycomblogculturally-speaking201305can-racism-cause-ptsd-implications-dsm-5
Bibliography
bull [12] Yuan Chengmei et al (2011) ldquoProtective factors for posttraumatic stress disorder symptoms in a prospective study of police officersrdquo Nov 23httpwwwncbinlmnihgovpmcarticlesPMC3071439
bull [13] Chou Tina BA Anu Asnaani MA and Stefan G Hofmann PhD (2012) ldquoPerception of Racial Discrimination and Psychopathology Across Three US Ethnic Minority Groupsrdquo APA PsychNET Jan httpwwwncbinlmnihgovpmcarticlesPMC3505377
bull [14] Watson Laurel B Jacob M Marszalek Franco Dispenza and Christopher M Davids 2015 Understanding the Relationships Among White and African American Womenrsquos Sexual Objectification Experiences Physical Safety Anxiety and Psychological Distress Sex Roles 72 (34) 91-104
bull [15] Holland Julie (2015) ldquoMedicating Womenrsquos Feelingsrdquo New York TimesOpinion Feb 28 httpmobilenytimescom20150301opinionsundaymedicating-womens-feelingshtmlreferreramp_r=1
bull [16] Solinas M Thiriet N El Rawas R Lardeux V and Jaber M (2009) ldquoEnvironmental Enrichment During Early Stages of Life Reduces the Behavioral Neurochemical and Molecular Effects of Cocainerdquo Neuropsychopharmacology 34 1102ndash1111
bull [17] Hari Johann Chasing The Scream The First and Last Days of the War on Drugs Bloomsbury USA (January 20 2015)bull [18] Hughes Caitlin Elizabeth and Alex Stevens (2010) ldquoWhat Can We Learn From The Portuguese Decriminalization of Illicit
Drugsrdquo British Journal of Criminology July 21 httpbjcoxfordjournalsorgcontent506999abstractbull [19] Fournier Jay C et al (2009) ldquoAntidepressant Drug Effects and Depression Severityrdquo JAMA January
6th httpjamajamanetworkcomarticleaspxarticleid=185157[20] Currie J Stabile M Jones L (2013) Do Stimulant Medications Improve Educational and Behavioral Outcomes for Children with ADHD NBER Working Paper No 19105
bull [21] Mora-Ripoli R Organizacioacuten Mundial de la Risa Barcelona Spain ldquoThe therapeutic value of laughter in medicinerdquo Altern Ther Health Med 2010 Nov-Dec16(6)56-64 httpwwwncbinlmnihgovpubmed21280463
bull [22] Gracanin Asmir Lauren M Bylsma and Ad J J M Vingerhoets (2014) ldquoIs Crying a Self-Stoothing Behaviorrdquo Frontiers in Psychology May 28httpwwwncbinlmnihgovpmcarticlesPMC4035568
bull [23] Trimble Michael (2010) ldquoI Cry Therefore I Amrdquo New York Times Nov 10 httpwwwnytimescom20121111opinionsundayi-cry-therefore-i-amhtmlemc=eta1amp_r=0
bull [24]Gallup Andrew C et al (2007) ldquoYawning as a brain cooling mechanism Nasal breathing and forehead cooling diminish the incidence of contagious yawningrdquo httpwwwepjournalnetarticlesyawning-as-a-brain-cooling-mechanism-nasal-breathing-and-forehead-cooling-diminish-the-incidence-of-contagious-yawning
bull [25]Sharat Gupta and Shallu Mittal Int (2013) Yawning and its physiological significance Intl J Appl Basic Med Res Jan-Jun 3(1) 11ndash15
bull [26] Stephens R Atkins J Kingston A (2009) ldquoSwearing As a Response to Painrdquo NeuroReport Aug 5 httpwwwncbinlmnihgovpubmed19590391
bull [27]Morelli SA Lieberman MD(2013) rdquoThe role of automaticity and attention in neural processes underlying empathy for happiness sadness and anxietyrdquo Front Hum Neurosci May 87160
Bibliography
bull [1] Committee on Psychosocial Aspects of Child and Family Health Committee on Early Childhood Adoption and Dependent Care andSection on Developmental and Behavioral Pediatrics Andrew S Garner Jack P Shonkoff et al (2012) ldquoEarly Childhood Adversity Toxic Stress and the Role of the Pediatrician Translating Developmental Science Into Lifelong Healthrdquo Pediatrics January VOLUME 129 ISSUE 1 From the American Academy of Pediatrics Policy Statementhttppediatricsaappublicationsorgcontent1291e224fullref-23
bull [2] COUNCIL ON COMMUNITY PEDIATRICS Benjamin A Gitterman et al (2016) ldquoPoverty and Child Health in the United Statesrdquo Pediatrics March From the American Academy of Pediatrics Policy Statement Published Online March 09American Academy of Pediatricshttppediatricsaappublicationsorgcontentearly20160307peds2016-0339info
bull [3] Paul W Newacheck et al (2003) ldquoDisparities in Adolescent Health and Health Care Does Socioeconomic Status Matterrdquo Health ServRes Oct 38(5) 1235ndash1252 httpwwwncbinlmnihgovpmcarticlesPMC1360944
bull [4] Larson et al (2007) ldquoPoverty during pregnancy Its effects on child health outcomesrdquo Paediatr Child Health 2007 Oct 12(8) 673ndash677 httpwwwncbinlmnihgovpmcarticlesPMC2528810
bull [5] Lara J Akinbami et al (2012) ldquoTrends in Asthma Prevalence Health Care Use and Mortality in the United States 2001ndash2010rdquo NCHS Data Brief No 94 May httpwwwcdcgovnchsproductsdatabriefsdb94htm
bull [6] Cynthia L Ogden et al (2010) ldquoObesity and Socioeconomic Status in Children and Adolescents United States 2005-2008rdquoNCHS Data Brief No 51 Decemberhttpwwwcdcgovnchsproductsdatabriefsdb51htm
bull [7] Shonkoff JP et al Committee on Psychosocial Aspects of Child and Family Health Committee on Early Childhood Adoption and Dependent Care Section on Developmental and Behavioral Pediatrics rdquoThe lifelong effects of early childhood adversity and toxicstressrdquo Pediatrics 2012129(1) wwwpediatricsorgcgicontentfull1291e232
bull [8] Virginia A Rauh et alldquoHousing and HealthIntersection of Poverty and Environmental Exposuresrdquo (2008) Annals of the New York Academy of Sciences Volume 1136 Reducing the Impact of Poverty on Health and Human Development Scientific Approaches pages 276ndash288 June httponlinelibrarywileycomdoi101196annals1425032full
bull [9] Yehuda R et al (2015) ldquoHolocaust Exposure Induced Intergenerational Effects on FKBP5 MethylationrdquoBiol Psychiatry Aug 12 httpwwwncbinlmnihgovpubmed26410355
bull [10] Buss C et al (2011) ldquoMaternal pregnancy-specific anxiety is associated with child executive function at 6-9 years agerdquoStress Nov14(6)665-76 httpwwwncbinlmnihgovpubmed21995526
bull 11] Shankardass K et al (2014) ldquoParental stress increases body mass index trajectory in pre-adolescentsrdquoPediatr Obes Dec9(6)435-42 httpwwwncbinlmnihgovpubmed24311567
bull [12] Vincent J Felitti et al (1998) ldquoRelationship of Childhood Abuse and Household Dysfunction to Many of the Leading Causes of Death in Adults The Adverse Childhood Experiences (ACE) Studyrdquo May Volume 14 Issue 4 Pages 245ndash258 httpsacestoohighcom
bull [13]Jones CP Levels of Racism a Theoretic Framework and the Gardenerrsquos Tale Am J Public Health 200090(8) 1212-1215bull [14]Dion KL The Social Psycology of Perceived Perjudice and Discrimination Canadian Psychology (2002)431 pp 1-10bull [15]Sue D W Bucceri J Lin AI Nadal K L and Torino J C Racial Microaggressions and the Asian American experience APA (2007) Vol
13 No 1 pp 72-81bull [16]James S A (School of Public Health U of North Carolina Chapel Hill NC 27514) D S Strogatz S B Wing and D L Ramsey
Socioeconomic status John Henryism and hypertension in blacks and whites Am J Epidemiol 1987 126664ndash73bull [17]httpwwwapaorgpioemaresourcesethnicity-healthindexaspxbull [18]Porges SW Clinical Insights from the Polyvagal Theory The Transformative Power of Feeling Safe (Norton Series on Interpersonal
Neurobiology) W W Norton Apr 7 2014 - Psychology - 288 pagesbull [19]The Polyvagal Theory (Porges SW Social Connectedness as a Biological Imperative Understanding Trauma Through the Lens of
thePolyvagal Theory presentation 82015)bull [20]McEwen BS Allostasis and allostatic load implications for neuropsychopharmacologyNeuropsychopharmacology 2000
Feb22(2)108-24bull [21] McEwen BS adaptation and disease Allostasis and allostatic load Ann N Y Acad Sci 1998 May 184033-44bull [22] Arline T Geronimus ScD Margaret Hicken MPH Danya Keene MAT and John Bound PhD Weatheringrdquo and Age Patterns of
Allostatic Load Scores Among Blacks and Whites in the United States Am J Public Health 2006 May 96(5) 826ndash833bull [22]Stephen Porges PhD Polyvagal Perspective Biological Psychology 2007 Feb 74(2) 116ndash143 Published online 2006 Oct 16 bull [23]Stephen W Porges PhD The Polyvagal Theory Neurophysiological Foundations of Emotions Attachment Communication and
Self-regulation WWNorton and Company Inc 2011bull [24]Maggie Phillips PhD Reversing Chronic Pain North Atlantic Books 2007bull [25]Peter Levine PhD Waking the Tiger North Atlantic Books 1997bull [26]Bessel VanderKolk MD The Body Keeps the Score Viking Penguin 2014bullAcknowledgmentsbull Group Medical Visits and Group Facilitation Jeff Geller MDbull Re-evaluation Counseling Community bull Insight Meditation Communitybull Biodynamic Osteopathy Communitybull Learning To Breathe Mindfulness Training for Adolescents 2015 Patricia C Broderick PhD bull Stanford Chronic Disease Self Management Program Training 2014 Kate Lorig MPH RNbull Motivational Interviewing Training 2015 Steven Berg-Smithbull Centering Pregnancy Training 2014 Centering Healthcare Institutebull Motivating Change in Groups Training 2013 Kaiser Permanente Oakland Cabull Group Facilitation Training Sara Fisk PhD Community at Work San Francisco Cabull Tribes Training 2013 Center for Human Developmentbull Cultural Humility Training 2016 Melanie Tervalon MD
Bibliography
Intermediate Steps to Listening Session Handout
bull Step 1 Connect with yourself body mind and emotions
bull Step 2 Hold a non-judgmental space to be seen and heard
bull Step 3 See the speaker and anyone referenced as able to manifest their true human nature and evolve using inherent healing abilities
bull Step 4 Listen to the speaker in a deep connected way sending the message that their thinking feelings and being matters to you
bull Step 5 Encourage the speaker to express feelings or thoughts describe body sensations or share a story relevant to the feelings at hand
bull Step 6 Validate intense emotional expression and release such as crying laughing shaking yawning sweating as a sign of healing
bull Step 7 Remind the speaker of their underlying goodness intelligence strength and caring and your confidence in their ability to heal and manifest their true human nature
copy Elizabeth Rocco MD
Contact Information
bull Elizabeth Rocco MD -egroccogmailcom
bull Karen Ekwueme MD-impactdoc1gmailcom
Bibliography
bull Special Acknowledgement of Demie Stathoplos MSW and Bonnie Cohen MD who collaborated with Elizabeth Rocco MD on the IM4US August 2015 presentation ldquoListening to Each Other Healing the Negative Health Impacts of Racism Poverty and Trauma through Human Connectionrdquo
bull Special Acknowledgement of Karen Burt MD who collaborated with Elizabeth Rocco MD and Karen Ekwueme MD on the IM4US August 2016 presentation ldquoListening to Ourselves and Each Other Healing the Negative Health Impact of Racism Poverty Sexism and Traumardquo These bibliographies are included below
bull [1]Wen Patricia (2010) ldquoA legacy of unintended side effectsrdquo Boston Globe December 12 httpwwwbostoncomnewslocalmassachusettsarticles20101212with_ssi_program_a_legcy_of_unintended_side_effects
bull [2]CCHR International (2014) [Online] Number of Children amp Adolescents Taking Psychiatric Drugs in the US Aprilwwwcchrintorgpsychiatric-drugschildren-on-psychiatric-drugs
bull [3]Whitaker R (2010) Anatomy of an Epidemic Magic Bullets Psychiatric Drugs and the Astonishing Rise of Mental Illness in America Crown Publishing Company httprobertwhitakerorgrobertwhitakerorgAnatomy20of20an20Epidemichtml
bull [3]CDC (2013) [Online] MMRW Mental Health Surveillance Among Children mdash United States 2005ndash2011 Supplements May 17 62(02)1-35 httpwwwcdcgovmmwrpreviewmmwrhtmlsu6202a1htm
bull [4]Patricia N Pastor PhD Cynthia A Reuben MA Catherine R Duran BS and LaJeana D Hawkins MPH CHES (2015) [Online] CDC NCHS Data Brief Association Between Diagnosed ADHD and Selected Characteristics Among Children Aged 4ndash17 Years United States 2011ndash2013 May Number 201 httpwwwcdcgovnchsdatadatabriefsdb201htm
bull [5]Mental Health America (2014) Parity or Disparity The State of Mental Health in America 2015 NovwwwmentalhealthamericanetsitesdefaultfilesParity20or20Disparity20201520Reportpdf
bull [6]Bruce S Jonas ScM PhD Qiuping Gu MD PhD and Juan R Albertorio-Diaz MA (2013) [Online] CDC NCHS Data Brief Psychotropic Medication Use Among Adolescents United States 2005ndash2010 Dec Number 135httpwwwcdcgovnchsdatadatabriefsdb135htm
bull [7] C Buss EP Davis CJ Hobel and CA Sandman (2011) Maternal pregnancy-specific anxiety is associated with child executive function at 6ndash9 years age Stress Nov 14(6)665-676
bull [8] Council for Evidence-Based Psychiatry (UK) Web presentation ldquoUnrecognized Factsrdquo Authors James Davies Peter C Goetzsche Peter Kinderman Joanna Moncrieff Phillip Thomas Sami Timimi John Sandwich Melanie Davis Luke Montague httpcepukorgunrecognised-facts
bull [9] Johnstone Lucy (2015) A Straight Talking Introduction to Psychiatric DiagnosisPCCS Books 1st edition (February 3 2015)
bull [10] Brewin CR Andrews B Valentine JD (2000) ldquoMeta-analysis of risk factors for posttraumatic stress disorder in trauma-exposed adultsrdquo J Consult Clin Psychol2000 Oct68(5)748-66 httpwwwncbinlmnihgovpubmed11068961
bull [11] Williams Monica T (2013) ldquoCan Racism Cause PTSD Implications for DSM-5rdquoPsychology Today May 20 httpswwwpsychologytodaycomblogculturally-speaking201305can-racism-cause-ptsd-implications-dsm-5
Bibliography
bull [12] Yuan Chengmei et al (2011) ldquoProtective factors for posttraumatic stress disorder symptoms in a prospective study of police officersrdquo Nov 23httpwwwncbinlmnihgovpmcarticlesPMC3071439
bull [13] Chou Tina BA Anu Asnaani MA and Stefan G Hofmann PhD (2012) ldquoPerception of Racial Discrimination and Psychopathology Across Three US Ethnic Minority Groupsrdquo APA PsychNET Jan httpwwwncbinlmnihgovpmcarticlesPMC3505377
bull [14] Watson Laurel B Jacob M Marszalek Franco Dispenza and Christopher M Davids 2015 Understanding the Relationships Among White and African American Womenrsquos Sexual Objectification Experiences Physical Safety Anxiety and Psychological Distress Sex Roles 72 (34) 91-104
bull [15] Holland Julie (2015) ldquoMedicating Womenrsquos Feelingsrdquo New York TimesOpinion Feb 28 httpmobilenytimescom20150301opinionsundaymedicating-womens-feelingshtmlreferreramp_r=1
bull [16] Solinas M Thiriet N El Rawas R Lardeux V and Jaber M (2009) ldquoEnvironmental Enrichment During Early Stages of Life Reduces the Behavioral Neurochemical and Molecular Effects of Cocainerdquo Neuropsychopharmacology 34 1102ndash1111
bull [17] Hari Johann Chasing The Scream The First and Last Days of the War on Drugs Bloomsbury USA (January 20 2015)bull [18] Hughes Caitlin Elizabeth and Alex Stevens (2010) ldquoWhat Can We Learn From The Portuguese Decriminalization of Illicit
Drugsrdquo British Journal of Criminology July 21 httpbjcoxfordjournalsorgcontent506999abstractbull [19] Fournier Jay C et al (2009) ldquoAntidepressant Drug Effects and Depression Severityrdquo JAMA January
6th httpjamajamanetworkcomarticleaspxarticleid=185157[20] Currie J Stabile M Jones L (2013) Do Stimulant Medications Improve Educational and Behavioral Outcomes for Children with ADHD NBER Working Paper No 19105
bull [21] Mora-Ripoli R Organizacioacuten Mundial de la Risa Barcelona Spain ldquoThe therapeutic value of laughter in medicinerdquo Altern Ther Health Med 2010 Nov-Dec16(6)56-64 httpwwwncbinlmnihgovpubmed21280463
bull [22] Gracanin Asmir Lauren M Bylsma and Ad J J M Vingerhoets (2014) ldquoIs Crying a Self-Stoothing Behaviorrdquo Frontiers in Psychology May 28httpwwwncbinlmnihgovpmcarticlesPMC4035568
bull [23] Trimble Michael (2010) ldquoI Cry Therefore I Amrdquo New York Times Nov 10 httpwwwnytimescom20121111opinionsundayi-cry-therefore-i-amhtmlemc=eta1amp_r=0
bull [24]Gallup Andrew C et al (2007) ldquoYawning as a brain cooling mechanism Nasal breathing and forehead cooling diminish the incidence of contagious yawningrdquo httpwwwepjournalnetarticlesyawning-as-a-brain-cooling-mechanism-nasal-breathing-and-forehead-cooling-diminish-the-incidence-of-contagious-yawning
bull [25]Sharat Gupta and Shallu Mittal Int (2013) Yawning and its physiological significance Intl J Appl Basic Med Res Jan-Jun 3(1) 11ndash15
bull [26] Stephens R Atkins J Kingston A (2009) ldquoSwearing As a Response to Painrdquo NeuroReport Aug 5 httpwwwncbinlmnihgovpubmed19590391
bull [27]Morelli SA Lieberman MD(2013) rdquoThe role of automaticity and attention in neural processes underlying empathy for happiness sadness and anxietyrdquo Front Hum Neurosci May 87160
Bibliography
bull [1] Committee on Psychosocial Aspects of Child and Family Health Committee on Early Childhood Adoption and Dependent Care andSection on Developmental and Behavioral Pediatrics Andrew S Garner Jack P Shonkoff et al (2012) ldquoEarly Childhood Adversity Toxic Stress and the Role of the Pediatrician Translating Developmental Science Into Lifelong Healthrdquo Pediatrics January VOLUME 129 ISSUE 1 From the American Academy of Pediatrics Policy Statementhttppediatricsaappublicationsorgcontent1291e224fullref-23
bull [2] COUNCIL ON COMMUNITY PEDIATRICS Benjamin A Gitterman et al (2016) ldquoPoverty and Child Health in the United Statesrdquo Pediatrics March From the American Academy of Pediatrics Policy Statement Published Online March 09American Academy of Pediatricshttppediatricsaappublicationsorgcontentearly20160307peds2016-0339info
bull [3] Paul W Newacheck et al (2003) ldquoDisparities in Adolescent Health and Health Care Does Socioeconomic Status Matterrdquo Health ServRes Oct 38(5) 1235ndash1252 httpwwwncbinlmnihgovpmcarticlesPMC1360944
bull [4] Larson et al (2007) ldquoPoverty during pregnancy Its effects on child health outcomesrdquo Paediatr Child Health 2007 Oct 12(8) 673ndash677 httpwwwncbinlmnihgovpmcarticlesPMC2528810
bull [5] Lara J Akinbami et al (2012) ldquoTrends in Asthma Prevalence Health Care Use and Mortality in the United States 2001ndash2010rdquo NCHS Data Brief No 94 May httpwwwcdcgovnchsproductsdatabriefsdb94htm
bull [6] Cynthia L Ogden et al (2010) ldquoObesity and Socioeconomic Status in Children and Adolescents United States 2005-2008rdquoNCHS Data Brief No 51 Decemberhttpwwwcdcgovnchsproductsdatabriefsdb51htm
bull [7] Shonkoff JP et al Committee on Psychosocial Aspects of Child and Family Health Committee on Early Childhood Adoption and Dependent Care Section on Developmental and Behavioral Pediatrics rdquoThe lifelong effects of early childhood adversity and toxicstressrdquo Pediatrics 2012129(1) wwwpediatricsorgcgicontentfull1291e232
bull [8] Virginia A Rauh et alldquoHousing and HealthIntersection of Poverty and Environmental Exposuresrdquo (2008) Annals of the New York Academy of Sciences Volume 1136 Reducing the Impact of Poverty on Health and Human Development Scientific Approaches pages 276ndash288 June httponlinelibrarywileycomdoi101196annals1425032full
bull [9] Yehuda R et al (2015) ldquoHolocaust Exposure Induced Intergenerational Effects on FKBP5 MethylationrdquoBiol Psychiatry Aug 12 httpwwwncbinlmnihgovpubmed26410355
bull [10] Buss C et al (2011) ldquoMaternal pregnancy-specific anxiety is associated with child executive function at 6-9 years agerdquoStress Nov14(6)665-76 httpwwwncbinlmnihgovpubmed21995526
bull 11] Shankardass K et al (2014) ldquoParental stress increases body mass index trajectory in pre-adolescentsrdquoPediatr Obes Dec9(6)435-42 httpwwwncbinlmnihgovpubmed24311567
bull [12] Vincent J Felitti et al (1998) ldquoRelationship of Childhood Abuse and Household Dysfunction to Many of the Leading Causes of Death in Adults The Adverse Childhood Experiences (ACE) Studyrdquo May Volume 14 Issue 4 Pages 245ndash258 httpsacestoohighcom
bull [13]Jones CP Levels of Racism a Theoretic Framework and the Gardenerrsquos Tale Am J Public Health 200090(8) 1212-1215bull [14]Dion KL The Social Psycology of Perceived Perjudice and Discrimination Canadian Psychology (2002)431 pp 1-10bull [15]Sue D W Bucceri J Lin AI Nadal K L and Torino J C Racial Microaggressions and the Asian American experience APA (2007) Vol
13 No 1 pp 72-81bull [16]James S A (School of Public Health U of North Carolina Chapel Hill NC 27514) D S Strogatz S B Wing and D L Ramsey
Socioeconomic status John Henryism and hypertension in blacks and whites Am J Epidemiol 1987 126664ndash73bull [17]httpwwwapaorgpioemaresourcesethnicity-healthindexaspxbull [18]Porges SW Clinical Insights from the Polyvagal Theory The Transformative Power of Feeling Safe (Norton Series on Interpersonal
Neurobiology) W W Norton Apr 7 2014 - Psychology - 288 pagesbull [19]The Polyvagal Theory (Porges SW Social Connectedness as a Biological Imperative Understanding Trauma Through the Lens of
thePolyvagal Theory presentation 82015)bull [20]McEwen BS Allostasis and allostatic load implications for neuropsychopharmacologyNeuropsychopharmacology 2000
Feb22(2)108-24bull [21] McEwen BS adaptation and disease Allostasis and allostatic load Ann N Y Acad Sci 1998 May 184033-44bull [22] Arline T Geronimus ScD Margaret Hicken MPH Danya Keene MAT and John Bound PhD Weatheringrdquo and Age Patterns of
Allostatic Load Scores Among Blacks and Whites in the United States Am J Public Health 2006 May 96(5) 826ndash833bull [22]Stephen Porges PhD Polyvagal Perspective Biological Psychology 2007 Feb 74(2) 116ndash143 Published online 2006 Oct 16 bull [23]Stephen W Porges PhD The Polyvagal Theory Neurophysiological Foundations of Emotions Attachment Communication and
Self-regulation WWNorton and Company Inc 2011bull [24]Maggie Phillips PhD Reversing Chronic Pain North Atlantic Books 2007bull [25]Peter Levine PhD Waking the Tiger North Atlantic Books 1997bull [26]Bessel VanderKolk MD The Body Keeps the Score Viking Penguin 2014bullAcknowledgmentsbull Group Medical Visits and Group Facilitation Jeff Geller MDbull Re-evaluation Counseling Community bull Insight Meditation Communitybull Biodynamic Osteopathy Communitybull Learning To Breathe Mindfulness Training for Adolescents 2015 Patricia C Broderick PhD bull Stanford Chronic Disease Self Management Program Training 2014 Kate Lorig MPH RNbull Motivational Interviewing Training 2015 Steven Berg-Smithbull Centering Pregnancy Training 2014 Centering Healthcare Institutebull Motivating Change in Groups Training 2013 Kaiser Permanente Oakland Cabull Group Facilitation Training Sara Fisk PhD Community at Work San Francisco Cabull Tribes Training 2013 Center for Human Developmentbull Cultural Humility Training 2016 Melanie Tervalon MD
Bibliography
Intermediate Steps to Listening Session Handout
bull Step 1 Connect with yourself body mind and emotions
bull Step 2 Hold a non-judgmental space to be seen and heard
bull Step 3 See the speaker and anyone referenced as able to manifest their true human nature and evolve using inherent healing abilities
bull Step 4 Listen to the speaker in a deep connected way sending the message that their thinking feelings and being matters to you
bull Step 5 Encourage the speaker to express feelings or thoughts describe body sensations or share a story relevant to the feelings at hand
bull Step 6 Validate intense emotional expression and release such as crying laughing shaking yawning sweating as a sign of healing
bull Step 7 Remind the speaker of their underlying goodness intelligence strength and caring and your confidence in their ability to heal and manifest their true human nature
copy Elizabeth Rocco MD
Contact Information
bull Elizabeth Rocco MD -egroccogmailcom
bull Karen Ekwueme MD-impactdoc1gmailcom
Bibliography
bull [12] Yuan Chengmei et al (2011) ldquoProtective factors for posttraumatic stress disorder symptoms in a prospective study of police officersrdquo Nov 23httpwwwncbinlmnihgovpmcarticlesPMC3071439
bull [13] Chou Tina BA Anu Asnaani MA and Stefan G Hofmann PhD (2012) ldquoPerception of Racial Discrimination and Psychopathology Across Three US Ethnic Minority Groupsrdquo APA PsychNET Jan httpwwwncbinlmnihgovpmcarticlesPMC3505377
bull [14] Watson Laurel B Jacob M Marszalek Franco Dispenza and Christopher M Davids 2015 Understanding the Relationships Among White and African American Womenrsquos Sexual Objectification Experiences Physical Safety Anxiety and Psychological Distress Sex Roles 72 (34) 91-104
bull [15] Holland Julie (2015) ldquoMedicating Womenrsquos Feelingsrdquo New York TimesOpinion Feb 28 httpmobilenytimescom20150301opinionsundaymedicating-womens-feelingshtmlreferreramp_r=1
bull [16] Solinas M Thiriet N El Rawas R Lardeux V and Jaber M (2009) ldquoEnvironmental Enrichment During Early Stages of Life Reduces the Behavioral Neurochemical and Molecular Effects of Cocainerdquo Neuropsychopharmacology 34 1102ndash1111
bull [17] Hari Johann Chasing The Scream The First and Last Days of the War on Drugs Bloomsbury USA (January 20 2015)bull [18] Hughes Caitlin Elizabeth and Alex Stevens (2010) ldquoWhat Can We Learn From The Portuguese Decriminalization of Illicit
Drugsrdquo British Journal of Criminology July 21 httpbjcoxfordjournalsorgcontent506999abstractbull [19] Fournier Jay C et al (2009) ldquoAntidepressant Drug Effects and Depression Severityrdquo JAMA January
6th httpjamajamanetworkcomarticleaspxarticleid=185157[20] Currie J Stabile M Jones L (2013) Do Stimulant Medications Improve Educational and Behavioral Outcomes for Children with ADHD NBER Working Paper No 19105
bull [21] Mora-Ripoli R Organizacioacuten Mundial de la Risa Barcelona Spain ldquoThe therapeutic value of laughter in medicinerdquo Altern Ther Health Med 2010 Nov-Dec16(6)56-64 httpwwwncbinlmnihgovpubmed21280463
bull [22] Gracanin Asmir Lauren M Bylsma and Ad J J M Vingerhoets (2014) ldquoIs Crying a Self-Stoothing Behaviorrdquo Frontiers in Psychology May 28httpwwwncbinlmnihgovpmcarticlesPMC4035568
bull [23] Trimble Michael (2010) ldquoI Cry Therefore I Amrdquo New York Times Nov 10 httpwwwnytimescom20121111opinionsundayi-cry-therefore-i-amhtmlemc=eta1amp_r=0
bull [24]Gallup Andrew C et al (2007) ldquoYawning as a brain cooling mechanism Nasal breathing and forehead cooling diminish the incidence of contagious yawningrdquo httpwwwepjournalnetarticlesyawning-as-a-brain-cooling-mechanism-nasal-breathing-and-forehead-cooling-diminish-the-incidence-of-contagious-yawning
bull [25]Sharat Gupta and Shallu Mittal Int (2013) Yawning and its physiological significance Intl J Appl Basic Med Res Jan-Jun 3(1) 11ndash15
bull [26] Stephens R Atkins J Kingston A (2009) ldquoSwearing As a Response to Painrdquo NeuroReport Aug 5 httpwwwncbinlmnihgovpubmed19590391
bull [27]Morelli SA Lieberman MD(2013) rdquoThe role of automaticity and attention in neural processes underlying empathy for happiness sadness and anxietyrdquo Front Hum Neurosci May 87160
Bibliography
bull [1] Committee on Psychosocial Aspects of Child and Family Health Committee on Early Childhood Adoption and Dependent Care andSection on Developmental and Behavioral Pediatrics Andrew S Garner Jack P Shonkoff et al (2012) ldquoEarly Childhood Adversity Toxic Stress and the Role of the Pediatrician Translating Developmental Science Into Lifelong Healthrdquo Pediatrics January VOLUME 129 ISSUE 1 From the American Academy of Pediatrics Policy Statementhttppediatricsaappublicationsorgcontent1291e224fullref-23
bull [2] COUNCIL ON COMMUNITY PEDIATRICS Benjamin A Gitterman et al (2016) ldquoPoverty and Child Health in the United Statesrdquo Pediatrics March From the American Academy of Pediatrics Policy Statement Published Online March 09American Academy of Pediatricshttppediatricsaappublicationsorgcontentearly20160307peds2016-0339info
bull [3] Paul W Newacheck et al (2003) ldquoDisparities in Adolescent Health and Health Care Does Socioeconomic Status Matterrdquo Health ServRes Oct 38(5) 1235ndash1252 httpwwwncbinlmnihgovpmcarticlesPMC1360944
bull [4] Larson et al (2007) ldquoPoverty during pregnancy Its effects on child health outcomesrdquo Paediatr Child Health 2007 Oct 12(8) 673ndash677 httpwwwncbinlmnihgovpmcarticlesPMC2528810
bull [5] Lara J Akinbami et al (2012) ldquoTrends in Asthma Prevalence Health Care Use and Mortality in the United States 2001ndash2010rdquo NCHS Data Brief No 94 May httpwwwcdcgovnchsproductsdatabriefsdb94htm
bull [6] Cynthia L Ogden et al (2010) ldquoObesity and Socioeconomic Status in Children and Adolescents United States 2005-2008rdquoNCHS Data Brief No 51 Decemberhttpwwwcdcgovnchsproductsdatabriefsdb51htm
bull [7] Shonkoff JP et al Committee on Psychosocial Aspects of Child and Family Health Committee on Early Childhood Adoption and Dependent Care Section on Developmental and Behavioral Pediatrics rdquoThe lifelong effects of early childhood adversity and toxicstressrdquo Pediatrics 2012129(1) wwwpediatricsorgcgicontentfull1291e232
bull [8] Virginia A Rauh et alldquoHousing and HealthIntersection of Poverty and Environmental Exposuresrdquo (2008) Annals of the New York Academy of Sciences Volume 1136 Reducing the Impact of Poverty on Health and Human Development Scientific Approaches pages 276ndash288 June httponlinelibrarywileycomdoi101196annals1425032full
bull [9] Yehuda R et al (2015) ldquoHolocaust Exposure Induced Intergenerational Effects on FKBP5 MethylationrdquoBiol Psychiatry Aug 12 httpwwwncbinlmnihgovpubmed26410355
bull [10] Buss C et al (2011) ldquoMaternal pregnancy-specific anxiety is associated with child executive function at 6-9 years agerdquoStress Nov14(6)665-76 httpwwwncbinlmnihgovpubmed21995526
bull 11] Shankardass K et al (2014) ldquoParental stress increases body mass index trajectory in pre-adolescentsrdquoPediatr Obes Dec9(6)435-42 httpwwwncbinlmnihgovpubmed24311567
bull [12] Vincent J Felitti et al (1998) ldquoRelationship of Childhood Abuse and Household Dysfunction to Many of the Leading Causes of Death in Adults The Adverse Childhood Experiences (ACE) Studyrdquo May Volume 14 Issue 4 Pages 245ndash258 httpsacestoohighcom
bull [13]Jones CP Levels of Racism a Theoretic Framework and the Gardenerrsquos Tale Am J Public Health 200090(8) 1212-1215bull [14]Dion KL The Social Psycology of Perceived Perjudice and Discrimination Canadian Psychology (2002)431 pp 1-10bull [15]Sue D W Bucceri J Lin AI Nadal K L and Torino J C Racial Microaggressions and the Asian American experience APA (2007) Vol
13 No 1 pp 72-81bull [16]James S A (School of Public Health U of North Carolina Chapel Hill NC 27514) D S Strogatz S B Wing and D L Ramsey
Socioeconomic status John Henryism and hypertension in blacks and whites Am J Epidemiol 1987 126664ndash73bull [17]httpwwwapaorgpioemaresourcesethnicity-healthindexaspxbull [18]Porges SW Clinical Insights from the Polyvagal Theory The Transformative Power of Feeling Safe (Norton Series on Interpersonal
Neurobiology) W W Norton Apr 7 2014 - Psychology - 288 pagesbull [19]The Polyvagal Theory (Porges SW Social Connectedness as a Biological Imperative Understanding Trauma Through the Lens of
thePolyvagal Theory presentation 82015)bull [20]McEwen BS Allostasis and allostatic load implications for neuropsychopharmacologyNeuropsychopharmacology 2000
Feb22(2)108-24bull [21] McEwen BS adaptation and disease Allostasis and allostatic load Ann N Y Acad Sci 1998 May 184033-44bull [22] Arline T Geronimus ScD Margaret Hicken MPH Danya Keene MAT and John Bound PhD Weatheringrdquo and Age Patterns of
Allostatic Load Scores Among Blacks and Whites in the United States Am J Public Health 2006 May 96(5) 826ndash833bull [22]Stephen Porges PhD Polyvagal Perspective Biological Psychology 2007 Feb 74(2) 116ndash143 Published online 2006 Oct 16 bull [23]Stephen W Porges PhD The Polyvagal Theory Neurophysiological Foundations of Emotions Attachment Communication and
Self-regulation WWNorton and Company Inc 2011bull [24]Maggie Phillips PhD Reversing Chronic Pain North Atlantic Books 2007bull [25]Peter Levine PhD Waking the Tiger North Atlantic Books 1997bull [26]Bessel VanderKolk MD The Body Keeps the Score Viking Penguin 2014bullAcknowledgmentsbull Group Medical Visits and Group Facilitation Jeff Geller MDbull Re-evaluation Counseling Community bull Insight Meditation Communitybull Biodynamic Osteopathy Communitybull Learning To Breathe Mindfulness Training for Adolescents 2015 Patricia C Broderick PhD bull Stanford Chronic Disease Self Management Program Training 2014 Kate Lorig MPH RNbull Motivational Interviewing Training 2015 Steven Berg-Smithbull Centering Pregnancy Training 2014 Centering Healthcare Institutebull Motivating Change in Groups Training 2013 Kaiser Permanente Oakland Cabull Group Facilitation Training Sara Fisk PhD Community at Work San Francisco Cabull Tribes Training 2013 Center for Human Developmentbull Cultural Humility Training 2016 Melanie Tervalon MD
Bibliography
Intermediate Steps to Listening Session Handout
bull Step 1 Connect with yourself body mind and emotions
bull Step 2 Hold a non-judgmental space to be seen and heard
bull Step 3 See the speaker and anyone referenced as able to manifest their true human nature and evolve using inherent healing abilities
bull Step 4 Listen to the speaker in a deep connected way sending the message that their thinking feelings and being matters to you
bull Step 5 Encourage the speaker to express feelings or thoughts describe body sensations or share a story relevant to the feelings at hand
bull Step 6 Validate intense emotional expression and release such as crying laughing shaking yawning sweating as a sign of healing
bull Step 7 Remind the speaker of their underlying goodness intelligence strength and caring and your confidence in their ability to heal and manifest their true human nature
copy Elizabeth Rocco MD
Contact Information
bull Elizabeth Rocco MD -egroccogmailcom
bull Karen Ekwueme MD-impactdoc1gmailcom
Bibliography
bull [1] Committee on Psychosocial Aspects of Child and Family Health Committee on Early Childhood Adoption and Dependent Care andSection on Developmental and Behavioral Pediatrics Andrew S Garner Jack P Shonkoff et al (2012) ldquoEarly Childhood Adversity Toxic Stress and the Role of the Pediatrician Translating Developmental Science Into Lifelong Healthrdquo Pediatrics January VOLUME 129 ISSUE 1 From the American Academy of Pediatrics Policy Statementhttppediatricsaappublicationsorgcontent1291e224fullref-23
bull [2] COUNCIL ON COMMUNITY PEDIATRICS Benjamin A Gitterman et al (2016) ldquoPoverty and Child Health in the United Statesrdquo Pediatrics March From the American Academy of Pediatrics Policy Statement Published Online March 09American Academy of Pediatricshttppediatricsaappublicationsorgcontentearly20160307peds2016-0339info
bull [3] Paul W Newacheck et al (2003) ldquoDisparities in Adolescent Health and Health Care Does Socioeconomic Status Matterrdquo Health ServRes Oct 38(5) 1235ndash1252 httpwwwncbinlmnihgovpmcarticlesPMC1360944
bull [4] Larson et al (2007) ldquoPoverty during pregnancy Its effects on child health outcomesrdquo Paediatr Child Health 2007 Oct 12(8) 673ndash677 httpwwwncbinlmnihgovpmcarticlesPMC2528810
bull [5] Lara J Akinbami et al (2012) ldquoTrends in Asthma Prevalence Health Care Use and Mortality in the United States 2001ndash2010rdquo NCHS Data Brief No 94 May httpwwwcdcgovnchsproductsdatabriefsdb94htm
bull [6] Cynthia L Ogden et al (2010) ldquoObesity and Socioeconomic Status in Children and Adolescents United States 2005-2008rdquoNCHS Data Brief No 51 Decemberhttpwwwcdcgovnchsproductsdatabriefsdb51htm
bull [7] Shonkoff JP et al Committee on Psychosocial Aspects of Child and Family Health Committee on Early Childhood Adoption and Dependent Care Section on Developmental and Behavioral Pediatrics rdquoThe lifelong effects of early childhood adversity and toxicstressrdquo Pediatrics 2012129(1) wwwpediatricsorgcgicontentfull1291e232
bull [8] Virginia A Rauh et alldquoHousing and HealthIntersection of Poverty and Environmental Exposuresrdquo (2008) Annals of the New York Academy of Sciences Volume 1136 Reducing the Impact of Poverty on Health and Human Development Scientific Approaches pages 276ndash288 June httponlinelibrarywileycomdoi101196annals1425032full
bull [9] Yehuda R et al (2015) ldquoHolocaust Exposure Induced Intergenerational Effects on FKBP5 MethylationrdquoBiol Psychiatry Aug 12 httpwwwncbinlmnihgovpubmed26410355
bull [10] Buss C et al (2011) ldquoMaternal pregnancy-specific anxiety is associated with child executive function at 6-9 years agerdquoStress Nov14(6)665-76 httpwwwncbinlmnihgovpubmed21995526
bull 11] Shankardass K et al (2014) ldquoParental stress increases body mass index trajectory in pre-adolescentsrdquoPediatr Obes Dec9(6)435-42 httpwwwncbinlmnihgovpubmed24311567
bull [12] Vincent J Felitti et al (1998) ldquoRelationship of Childhood Abuse and Household Dysfunction to Many of the Leading Causes of Death in Adults The Adverse Childhood Experiences (ACE) Studyrdquo May Volume 14 Issue 4 Pages 245ndash258 httpsacestoohighcom
bull [13]Jones CP Levels of Racism a Theoretic Framework and the Gardenerrsquos Tale Am J Public Health 200090(8) 1212-1215bull [14]Dion KL The Social Psycology of Perceived Perjudice and Discrimination Canadian Psychology (2002)431 pp 1-10bull [15]Sue D W Bucceri J Lin AI Nadal K L and Torino J C Racial Microaggressions and the Asian American experience APA (2007) Vol
13 No 1 pp 72-81bull [16]James S A (School of Public Health U of North Carolina Chapel Hill NC 27514) D S Strogatz S B Wing and D L Ramsey
Socioeconomic status John Henryism and hypertension in blacks and whites Am J Epidemiol 1987 126664ndash73bull [17]httpwwwapaorgpioemaresourcesethnicity-healthindexaspxbull [18]Porges SW Clinical Insights from the Polyvagal Theory The Transformative Power of Feeling Safe (Norton Series on Interpersonal
Neurobiology) W W Norton Apr 7 2014 - Psychology - 288 pagesbull [19]The Polyvagal Theory (Porges SW Social Connectedness as a Biological Imperative Understanding Trauma Through the Lens of
thePolyvagal Theory presentation 82015)bull [20]McEwen BS Allostasis and allostatic load implications for neuropsychopharmacologyNeuropsychopharmacology 2000
Feb22(2)108-24bull [21] McEwen BS adaptation and disease Allostasis and allostatic load Ann N Y Acad Sci 1998 May 184033-44bull [22] Arline T Geronimus ScD Margaret Hicken MPH Danya Keene MAT and John Bound PhD Weatheringrdquo and Age Patterns of
Allostatic Load Scores Among Blacks and Whites in the United States Am J Public Health 2006 May 96(5) 826ndash833bull [22]Stephen Porges PhD Polyvagal Perspective Biological Psychology 2007 Feb 74(2) 116ndash143 Published online 2006 Oct 16 bull [23]Stephen W Porges PhD The Polyvagal Theory Neurophysiological Foundations of Emotions Attachment Communication and
Self-regulation WWNorton and Company Inc 2011bull [24]Maggie Phillips PhD Reversing Chronic Pain North Atlantic Books 2007bull [25]Peter Levine PhD Waking the Tiger North Atlantic Books 1997bull [26]Bessel VanderKolk MD The Body Keeps the Score Viking Penguin 2014bullAcknowledgmentsbull Group Medical Visits and Group Facilitation Jeff Geller MDbull Re-evaluation Counseling Community bull Insight Meditation Communitybull Biodynamic Osteopathy Communitybull Learning To Breathe Mindfulness Training for Adolescents 2015 Patricia C Broderick PhD bull Stanford Chronic Disease Self Management Program Training 2014 Kate Lorig MPH RNbull Motivational Interviewing Training 2015 Steven Berg-Smithbull Centering Pregnancy Training 2014 Centering Healthcare Institutebull Motivating Change in Groups Training 2013 Kaiser Permanente Oakland Cabull Group Facilitation Training Sara Fisk PhD Community at Work San Francisco Cabull Tribes Training 2013 Center for Human Developmentbull Cultural Humility Training 2016 Melanie Tervalon MD
Bibliography
Intermediate Steps to Listening Session Handout
bull Step 1 Connect with yourself body mind and emotions
bull Step 2 Hold a non-judgmental space to be seen and heard
bull Step 3 See the speaker and anyone referenced as able to manifest their true human nature and evolve using inherent healing abilities
bull Step 4 Listen to the speaker in a deep connected way sending the message that their thinking feelings and being matters to you
bull Step 5 Encourage the speaker to express feelings or thoughts describe body sensations or share a story relevant to the feelings at hand
bull Step 6 Validate intense emotional expression and release such as crying laughing shaking yawning sweating as a sign of healing
bull Step 7 Remind the speaker of their underlying goodness intelligence strength and caring and your confidence in their ability to heal and manifest their true human nature
copy Elizabeth Rocco MD
Contact Information
bull Elizabeth Rocco MD -egroccogmailcom
bull Karen Ekwueme MD-impactdoc1gmailcom
bull [13]Jones CP Levels of Racism a Theoretic Framework and the Gardenerrsquos Tale Am J Public Health 200090(8) 1212-1215bull [14]Dion KL The Social Psycology of Perceived Perjudice and Discrimination Canadian Psychology (2002)431 pp 1-10bull [15]Sue D W Bucceri J Lin AI Nadal K L and Torino J C Racial Microaggressions and the Asian American experience APA (2007) Vol
13 No 1 pp 72-81bull [16]James S A (School of Public Health U of North Carolina Chapel Hill NC 27514) D S Strogatz S B Wing and D L Ramsey
Socioeconomic status John Henryism and hypertension in blacks and whites Am J Epidemiol 1987 126664ndash73bull [17]httpwwwapaorgpioemaresourcesethnicity-healthindexaspxbull [18]Porges SW Clinical Insights from the Polyvagal Theory The Transformative Power of Feeling Safe (Norton Series on Interpersonal
Neurobiology) W W Norton Apr 7 2014 - Psychology - 288 pagesbull [19]The Polyvagal Theory (Porges SW Social Connectedness as a Biological Imperative Understanding Trauma Through the Lens of
thePolyvagal Theory presentation 82015)bull [20]McEwen BS Allostasis and allostatic load implications for neuropsychopharmacologyNeuropsychopharmacology 2000
Feb22(2)108-24bull [21] McEwen BS adaptation and disease Allostasis and allostatic load Ann N Y Acad Sci 1998 May 184033-44bull [22] Arline T Geronimus ScD Margaret Hicken MPH Danya Keene MAT and John Bound PhD Weatheringrdquo and Age Patterns of
Allostatic Load Scores Among Blacks and Whites in the United States Am J Public Health 2006 May 96(5) 826ndash833bull [22]Stephen Porges PhD Polyvagal Perspective Biological Psychology 2007 Feb 74(2) 116ndash143 Published online 2006 Oct 16 bull [23]Stephen W Porges PhD The Polyvagal Theory Neurophysiological Foundations of Emotions Attachment Communication and
Self-regulation WWNorton and Company Inc 2011bull [24]Maggie Phillips PhD Reversing Chronic Pain North Atlantic Books 2007bull [25]Peter Levine PhD Waking the Tiger North Atlantic Books 1997bull [26]Bessel VanderKolk MD The Body Keeps the Score Viking Penguin 2014bullAcknowledgmentsbull Group Medical Visits and Group Facilitation Jeff Geller MDbull Re-evaluation Counseling Community bull Insight Meditation Communitybull Biodynamic Osteopathy Communitybull Learning To Breathe Mindfulness Training for Adolescents 2015 Patricia C Broderick PhD bull Stanford Chronic Disease Self Management Program Training 2014 Kate Lorig MPH RNbull Motivational Interviewing Training 2015 Steven Berg-Smithbull Centering Pregnancy Training 2014 Centering Healthcare Institutebull Motivating Change in Groups Training 2013 Kaiser Permanente Oakland Cabull Group Facilitation Training Sara Fisk PhD Community at Work San Francisco Cabull Tribes Training 2013 Center for Human Developmentbull Cultural Humility Training 2016 Melanie Tervalon MD
Bibliography
Intermediate Steps to Listening Session Handout
bull Step 1 Connect with yourself body mind and emotions
bull Step 2 Hold a non-judgmental space to be seen and heard
bull Step 3 See the speaker and anyone referenced as able to manifest their true human nature and evolve using inherent healing abilities
bull Step 4 Listen to the speaker in a deep connected way sending the message that their thinking feelings and being matters to you
bull Step 5 Encourage the speaker to express feelings or thoughts describe body sensations or share a story relevant to the feelings at hand
bull Step 6 Validate intense emotional expression and release such as crying laughing shaking yawning sweating as a sign of healing
bull Step 7 Remind the speaker of their underlying goodness intelligence strength and caring and your confidence in their ability to heal and manifest their true human nature
copy Elizabeth Rocco MD
Contact Information
bull Elizabeth Rocco MD -egroccogmailcom
bull Karen Ekwueme MD-impactdoc1gmailcom
Intermediate Steps to Listening Session Handout
bull Step 1 Connect with yourself body mind and emotions
bull Step 2 Hold a non-judgmental space to be seen and heard
bull Step 3 See the speaker and anyone referenced as able to manifest their true human nature and evolve using inherent healing abilities
bull Step 4 Listen to the speaker in a deep connected way sending the message that their thinking feelings and being matters to you
bull Step 5 Encourage the speaker to express feelings or thoughts describe body sensations or share a story relevant to the feelings at hand
bull Step 6 Validate intense emotional expression and release such as crying laughing shaking yawning sweating as a sign of healing
bull Step 7 Remind the speaker of their underlying goodness intelligence strength and caring and your confidence in their ability to heal and manifest their true human nature
copy Elizabeth Rocco MD
Contact Information
bull Elizabeth Rocco MD -egroccogmailcom
bull Karen Ekwueme MD-impactdoc1gmailcom
Contact Information
bull Elizabeth Rocco MD -egroccogmailcom
bull Karen Ekwueme MD-impactdoc1gmailcom