living resilience: my journey from suicide to post ...€¦ · living resilience: my journey from...

Living Resilience: My Journey from Suicide to Post-Traumatic Growth

October 14, 2017Reno, NV

Leah Harris, M.A.CEO, Shifa Consulting

Resilience Factors

• Relationships• Mind-body skills• Trauma treatment• Creative expression• Storytelling• Advocacy/Activism

Trauma-Informed Suicide Prevention

We Must Shift the Paradigm!

“We have failed to bend the curve when it comes to suicide prevention” – Dr. Thomas Insel, former director, NIMH

What Causes Trauma?Individual trauma results from an event, series of events, or set of circumstances that is experienced by an individual as physically or emotionally harmful or life threatening and that has lasting adverse effects on the individual’s functioning and mental, physical, social, emotional, or spiritual well-being.Substance Abuse and Mental Health Services Administration. SAMHSA’s Concept of Trauma and Guidance for a Trauma-Informed Approach. HHS Publication No. (SMA) 14-4884.

Presenter

Presentation Notes

This framework for understanding trauma was developed by a working group of researchers, practitioners, trauma survivors, and family members convened by SAMHSA. It is important because it creates a framework for understanding the complex nature of trauma.

Trauma Prevalence in Children

71% Number of

children who are exposed to violence each

year (Finklehor, et al, 2013)

3 million Number of

children maltreated or

neglected each year

(Child Welfare Info.Gateway, 2013)

3.5-10 million

Children witness violence

against their mother each

year (Child Witness to

Violence Project, 2013)

1 in 4 girls & 1 in 6 boys

Number who are sexually

abused before adulthood

(NCTSN Fact Sheet, 2009)

94%Percentage of

children in a study of juvenile justice settings who have

experienced trauma

(Rosenberg, et al, 2014)

Slide 8

Presenter

Presentation Notes

A high percentage of children are exposed to potentially traumatizing events on a regular basis. Exposure to traumatic events greatly increases the likelihood that children will eventually receive behavioral health and social services. These statistics are so high that many social service settings assume that every child they see may have had some form of trauma in their background, whether anyone knows about it or not. Statistics: 60% of children 17 or younger are exposed to violence every year (Finklehor, et al, 2009) 3 million children are maltreated or neglected every year (Child Welfare Information Gateway, 2013) 3.5-10 million children witness violence against their mother every year (Child Witness to Violence Project, 2013) 1 in 4 girls and 1 in 6 boys are sexually abused before adulthood (NCTSN Fact Sheet, 2009) 94% of children in a study of juvenile justice settings have experienced trauma�(Rosenberg, et al, 2014)

Trauma in Adults: Mental Health, cont.

Clients with

histories of

childhood abuse

• Earlier first admissions

•More frequent and longer hospital stays

•More time in seclusion or restraint

•Greater likelihood of self-injury or suicide attempt

•More medication use

•More severe symptoms (Read et al, 2005)

Slide 9

Things to Remember

Underlying question = “What

happened to you?”

Symptoms = Adaptationsto traumatic

events

Healing happens In relationships

Presenter

Presentation Notes

The underlying question is not “What’s wrong with you?” but “What happened to you?” What are often called symptoms are actually adaptations to traumatic events. Healing happens in relationships. Power of Empathy (Video - Brene Brown) available at https://www.youtube.com/watch?v=1Evwgu369Jw

Events

Events/circumstances cause trauma.

Experience

An individual’s experienceof the event determines whether it is traumatic.

Effects

Effects of trauma include adverse physical, social, emotional, or spiritual

consequences.

The Three E’s in Trauma

Slide 11

Presenter

Presentation Notes

The focus on events places the cause of trauma in the environment not in some defect of the individual. This is what underlies the basic credo of trauma-informed approaches: “It’s not what’s wrong with you, but what happened to you.” The focus on experience highlights the fact that not every child or adult will experience the same events as traumatic. The identification of a broad range of potential effects reminds us that our response must be holistic—it’s not enough to focus on symptoms or behaviors. Our goal is to support a child to learn and grow or an adult to live a satisfying life.

Potential Traumatic Events

AbuseEmotional

Sexual

Physical

Domestic violence

Witnessing violence

Bullying

Cyberbulling

Institutional

LossDeath

Abandonment

Neglect

Separation

Natural disaster

Accidents

Terrorism

War

Chronic Stressors

Poverty

Racism

Invasive medical procedure

Community trauma

Historical trauma

Family member with substance use disorder

Slide 12

Presenter

Presentation Notes

There is a very wide range of events that can potentially cause trauma. Trauma can be caused by events that the individual doesn’t remember, such as events that occurred in early childhood. Trauma can be caused by events that are well-intentioned and necessary, such as medical procedures. Trauma can be caused by an event that didn’t happen to the person but to a group that he or she identifies closely with—as in slavery or the Holocaust or the genocide of the Native American people. Over time, chronic stressors can accumulate to cause trauma.

Experience of Trauma

Experience of trauma affected by:

How When Where How Often

Slide 13

Presenter

Presentation Notes

The individual’s experience of trauma may be profoundly affected by when, how, where and how often it occurs. Trauma can result from a single devastating event, called single-episode trauma (sometimes called acute trauma), or it can result from multiple traumatic events over time. Most individuals served in the public system have complex trauma, which comes from experiencing multiple sources of trauma over a lifetime. Trauma can be totally unintentional, as when an organization does harm through its procedures. For example, the routine practice of undressing for a medical exam can re-traumatize a person. Systems can also unintentionally replicate the dynamics of an earlier trauma, causing re-traumatization. Trauma can occur from hearing about, watching, or interacting with others who have had traumatic experiences. The context, expectations, and meaning assigned to an event or circumstance may determine how it is experienced. Trauma often includes a threat to life, bodily integrity or sanity and/or the feeling of being overwhelmed and unable to cope. Even interventions that are necessary or life-saving may be experienced as traumatic (e.g., medical interventions or removal from an abusive home). Humiliation, betrayal, or silencing may compound the traumatic experience. The individual experience of trauma is not necessarily conscious or recognized either by the individual or by others, and it may include physiological as well as cognitive experience.

Effect of Trauma

The effect of trauma on an individual can be conceptualized

as a normal response to an abnormal situation.

Slide 14

Presenter

Presentation Notes

The effect of trauma on an individual can be conceptualized as a normal response to an abnormal situation.

Trauma and the Brain• Fight-flight-freeze response: the brain signals

the body to respond to a perceived threat and the body prepares

• Ordinarily, when the threat is gone, the body returns to “baseline”

• If an ongoing threat is perceived, the body doesn‘t return to baseline, remains prepared for threat, resulting in a “trauma response”

• The switch is stuck in the “on” position 17

Problems OR Adaptations?

FIGHT“Non-compliant, combative” ORStruggling to regain or hold onto personal power

FLIGHT “Treatment resistant, uncooperative” ORDisengaging, withdrawing

FREEZE “Passive, unmotivated” OR Giving in to those in power

Slide 19

Presenter

Presentation Notes

The fight, flight or freeze responses are activated by danger. Some common behaviors of trauma survivors—behaviors that are often labeled as “problems” by the mental health system—can be directly linked to these responses and to the effects that trauma has on the brain. This slide lists three sets of “problems” that are often attributed to people in the mental health system and shows how the behavior may be a survival mechanism tied to a flight, flight or freeze response. First is the fight response. In the mental health system, someone who struggles too hard to hold onto personal power may be labeled as non-compliant or combative. Second is the flight response. In the mental health system, anyone who emotionally withdraws or disengages too much may be labeled as treatment resistant or uncooperative. Third is the freeze response. In the mental health system, anyone who gives in too easily to authority may be labeled as passive or unmotivated. Many of the people we serve have survived circumstances we can hardly imagine. What we often label as pathological may be the very things that helped them to survive. When we take a trauma-informed approach, we recognize “symptoms” and “problem behaviors” as adaptations to trauma.

What we learned

■ Childhood trauma was very common■ 2/3 of the 17,000 people in the ACE Study

had an ACE score of at least one■ 87 percent of those had more than one■ Findings have been replicated in over 28

subsequent studies

The higher the ACE Score, the greater the likelihood of…■Severe and persistent emotional problems ■Health risk behaviors ■Serious social problems■Adult disease and disability■High health and mental health care costs■Poor life expectancy

Presenter

Presentation Notes

I am going to skim through a few slides as examples ( Presenter must determine slides to skirt over or even delete – depending on time allowed for the presentation.) During presentation of these slides – be sure to occasionally point out the obvious graded relationship between the # of ACE categories experienced in childhood - and the adult problem being shown. Eg. The slide on rape – “note how the greated numbers of Adverse childhood experiences in childhood is linked to the rise in the chances of being raped as an adolescent or adult” – or with the slide on alcoholism, “look at how, with more and more accumulation of adverse childhood experiences shown across the bottom of the chart – it is more and more likely that when these children become adults, they will abuse alcohol”. I use a laser pointer to draw audience eyes toward what I am pointing out on the bargraph slide.

ACEs and Suicide

■ ACEs have a strong, graded relationship to suicide attempts during youth and adulthood.

■ An ACE score of 7 or more increased the risk of suicide attempts 51-fold among children/adolescents and 30-fold among adults (Dube et al, 2001).

■ Nearly two-thirds (64%) of suicide attempts among adults were attributable to ACEs and 80% of suicide attempts during childhood/adolescence were attributed to ACEs.

Linda Chamberlain, PhD. An Early Pathway to Preventing Suicide: The Role of Adverse Childhood Experiences. http://www.instituteforsafefamilies.org/early-pathway-preventing-suicide-role-adverse-childhood-experiences

http://www.ncbi.nlm.nih.gov/pubmed/11754674?dopt=Abstract

ACES and Suicide

Lancet ACEs Study: Findings■ Outcomes showing the strongest relations with multiple

ACEs (violence, mental illness, and problematic substance abuse) can represent ACEs for the next generation (exposure to parental domestic violence, mental illness, and substance use) and thus are indicative of the intergenerational effects that can lock families into cycles of adversity, deprivation, and ill health.

■ Although research into ACEs is far from complete, a compelling case exists for increased international focus on prevention of ACEs, development of programmes to bolster resilience, and implementation of policies that support a sustainable life-course approach to health.

Epigenetic discoveries“According to the new insights of behavioral epigenetics, traumatic experiences in our past, or in our recent ancestors’ past, leave molecular scars adhering to our DNA.

Jews whose great-grandparents were chased from their Russian shtetls; Chinese whose grandparents lived through the ravages of the Cultural Revolution; young immigrants from Africa whose parents survived massacres; adults of every ethnicity who grew up with alcoholic or abusive parents — all carry with them more than just memories.”

Epigenetics & Suicide■ In a 2008 paper, they [Meaney and Szyf] compared

the brains of people who died by suicide with the brains of people who had died suddenly of factors other than suicide.

■ They found excess methylation of genes in the suicide brains’ hippocampus, a region critical to memory acquisition and stress response. If the suicide victims had been abused as children, they found, their brains were more methylated.

Historical Trauma■ Historical trauma is cumulative emotional and

psychological wounding over the lifespan and across generations, emanating from massive group trauma.

■ Historical unresolved grief is the grief that accompanies the trauma.

■ This response is observed among Lakota and other Native populations, Jewish Holocaust survivors and descendants, Japanese American internment camp survivors and descendants.

(Brave Heart, 1998, 1999, 2000)

31

Healing From Trauma • Regaining a sense of control over one’s

life and one’s environment• Maintaining a sense of safety• Developing the ability to trust self & others• Reconnecting with self and others

34

Bessel van der Kolk, MD: Four Truths of HealingTruth #1: “Our capacity to destroy each other is matched by our capacity to heal each other. Restoring relationships and community is central to well being.”

Four Truths of Healing, continued

Truth #2: “Language gives us the power to change ourselves and others by communicating our experiences, helping us to define what we know, and finding a common sense of meaning.” – Bessel van der Kolk, MD

Envisioning an End to Stigma

“I want to live in a world where we can talk openly about what happens to us, our feelings and our dreams, including the feelings we sometimes have of wanting to die.”

– Will Hall, suicide attempt survivor, mental health counselor, teacher, and advocate

What Storytelling Does■ Similarities in our stories

point to a collective struggle but also a collective path of recovery, healing and change

■ When we share our story, it gives others the permission to tell theirs

■ Inspires people and changes hearts and minds like nothing else

LiveThroughThis.org

Live Through This is a collection of portraits and stories of suicide attempt survivors, as told by those survivors.

Creative Expression

■ Theater, improv, stand-up, performance

■ Storytelling■ Writing/memoir■ Hip- hop, spoken word, poetry■ Visual art■ Dance■ Music 43

Native Survivors - Hooper Bay, AK■ Youth group, organized

through AmeriCorps (Rural AK Community Action Program), to revive old traditions and skills

■ Mission: stop teens & young adults from killing themselves and to live healthy lives

■ Intergenerational focus, but youth-led

■ Grassroots

Slide 44

Presenter

Presentation Notes

Bell-Joe stepped up to launch the group after an unusually bad year for suicide in the Bering Sea village, a stretch of despair in a state in which the rate of suicide tops or nearly tops the nation year after year. Among Alaska native teenage boys and young men, the problem is far more severe, with a rate of suicide more than seven times greater than that of the state as a whole. In 2010, Bell-Joe said, at least eight people committed suicide in Hooper Bay, a community of about 1,100 at the time. (The population has since grown to about 1,200.) One was the 15-year-old daughter of Bell-Joe’s now-husband. Since the formation of Native Survivors in 2013, something remarkable has happened: No one has committed suicide in Hooper Bay. “Because of us,” Bell-Joe said quietly in a room ringing with the sounds of song, the beat of drums, the voices of young men. There were some suicide attempts, but none led to death.


Truth #3: “We have the ability to regulate our own physiology, including some of the so-called involuntary functions of the body and brain, through such basic activities as breathing, moving, and touching…” -- Bessel van der Kolk

Self Awareness ■ “Physical self-awareness is the first

step in releasing the tyranny of the past.” - Bessel van der Kolk, The Body Keeps the Score

• “Interoception” = the ability to notice what is happening inside the body.

• Connecting emotions with physical sensations in the body.

46

Mindfulness• Mindfulness: awareness that arises

through paying attention, on purpose, in the present moment, non-judgmentally. It’s about knowing what is going on in your mind.

--John Kabat-Zinn• Curious, open, nonjudgmental• The “observer” or witness”

consciousness 47

Mind-body skills

Breathing

Grounding - Centering

Movement

48

Belly breathing

Belly (diaphraghmatic) breathing:■ Works to activate the parasympathetic

nervous system, or relaxation response.■ Decreases the power of the “fight or

flight” centers in the mind■ Restores the centers of self-control,

language, listening, and thinking. ■ Grounding.

49

Presenter

Presentation Notes

Diaphragmatic Breathing: This is breathing that uses muscles in the diaphragm and abdomen. During diaphragmatic breathing, the diaphragm is tightened and pulls the lower part of the lungs down so that more air can be inhaled. On the inhale, the abdomen swells, the rib cage expands, and at the end of the inhalations the upper chest expands. Sample Script/Instructions: Sit in a comfortable position Place one hand on your abdomen and one hand on your chest Take a deep breath that fills out your abdomen Close your eyes, if comfortable, inhale through nose on a count of 3 Hold for 3 Exhale through your open mouth on 3 With each exhale, feel your body sinking into the chair With each breath in, scan your body to find where you are holding tension With exhale, let that area relax You can see a Diaphragmatic Breathing explanation as well as a demonstration here: https://www.youtube.com/watch?v=_7ySGgAFAAo

Grounding/Centering:■Invoke the senses: gateway to the body■Support a person to return to the present

moment■Helps if someone is emotionally

overwhelmed or stuck in a trauma response

Name 3 things I can…■See (the clock on the wall)■Hear (the ticking of the clock)■Feel: (the breeze on my skin) 50

90 second sanity pit stopDeveloped by Josh Korda, dharmapunx NYC

■ The first 30 seconds: Become aware of your out breath and extend each exhalation as long and smooth as possible, until they’re at least three times as long as each in breath.

■ The second 30 seconds: Find the muscle groups in your body that are most constricted and use each out breath to release and relax the tension.

■ The last 30 seconds: Direct thoughts of kindness and compassion towards yourself: “I’m safe.” “I am OK.” “I love you, keep going,” etc.

Source: https://www.elephantjournal.com/2014/11/90-second-sanity-pit-stop-meditation-practice/

51


Truth #4: “We can change social conditions to create environments in which children and adults can feel safe and where they can thrive.” – Bessel van der Kolk

The Four Rs

•Realizes widespread impact of trauma and understands potential paths for recoveryRealizes

•Recognizes signs and symptoms of trauma in clients, families, staff, and others involved with the system Recognizes

•Responds by fully integrating knowledge about trauma into policies, procedures, and practicesResponds

•Seeks to actively Resist re-traumatization.Resists

A trauma-informed program, organization, or system:

Slide 53SAMHSA, Concept and Guidance for a Trauma-Informed Approach

Presenter

Presentation Notes

Trauma-informed approaches reflect a fundamental shift in the culture of an entire organization. The four R’s highlight basic aspects of culture change that an organization will demonstrate as it becomes trauma-informed. The Four R’s reflect that it is not enough to simply know about trauma. To be trauma-informed, people must be able to identify trauma when they see it, and they must know how to respond in a way that doesn’t unintentionally re-traumatize people. Trauma-Informed approaches can be implemented anywhere, by anyone. Everyone in the organization has a role to play in becoming trauma-informed.

SAMHSA’s Six Key Principles of a Trauma-Informed Approach

Slide 54

• Safety

• Trustworthiness and Transparency

• Peer Support

• Collaboration and Mutuality

• Empowerment, Voice, and Choice

• Cultural, Historical, and Gender Issues

SAMHSA, Concept and Guidance for a Trauma-Informed Approach

Presenter

Presentation Notes

We will discuss each principle in detail.

• While there are many support groups for behavioral health conditions, there are few specifically designed for and led by suicide attempt survivors

• Didi Hirsch, Samaritans, and Alternatives to Suicide Peer-to-Peer Support groups

• Groups in existence report positive outcomes including: improvements in mood, thinking, impulsivity, connectedness/belonging, and hope; increased connectedness, decreased suicidal desire, and improved safety planning

Peer to Peer Support Groups

Resource: The Way Forward

Access at: http://bit.ly/1k2nGvy

■ Utilize collaborative approaches to assessment, screening, and treatment (CAMS)

■ Train staff in trauma-informed approaches■ Incorporate peer support and lived experience in

meaningful ways■ Teach mind-body resilience skills for emotional regulation

for staff and persons served■ Seek to build trusting, respectful relationships as a

cornerstone of care

Trauma-Informed Suicide Prevention

Contact me!

www.leahidaharris.comwww.shifaconsulting.netTwitter: @leahidaFacebook: Facebook.com/HarrisLeah

http://www.leahidaharris.com/

living resilience: my journey from suicide to post ...€¦ · living resilience: my journey from...

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