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I recently enhanced my pop culture knowledge. I watched my first episode of the long-running BBC television show, “Dr. Who.” A friend had purchased a DVD containing the 50 anniversary special. Now I have a clue as to what the fuss is all about.

With quotes by Elaine Miller-Karas, director of the Trauma Resource Institute

By the Rev. Beth Turner, St. Thomas, Burnsville

In February and August of this year, St. Thomas Church, Burnsville hosted basic skills trainings in a cutting-edge wellness and prevention program called the Community Resiliency Model (CRM). The focus of this model is to re-set the natural balanceof the nervous system.

The Trauma Resiliency Model, a Portal to Healing, a blog by Katie Klein, Mirasol Newsletter, April 13, 2015

"What is TRM?"

TRAUMA RESLIENCY MODEL®

by

Elaine Miller-Karas, MSW, LCSW

The goal of the Trauma Resiliency Model® (TRM) is to provide training in biologically based skills that increase resiliency and decrease the debilitating effects of traumatic stress. The models assume that responses to threats—real or imagined—are biologically based and primarily autonomic. Accordingly, the cognitive and psychological aspects of trauma are secondary to the biological response to fear.

The Trauma Resiliency Model ®(TRM) uses a set of nine skills to stabilize the nervous system and reduce or prevent the symptoms of traumatic stress. TRM is a clinical intervention based on current research about the brain that reflects the knowledge that there is a biological response to stressful and traumatic events. The model provides a perspective that views the reactions experienced after traumatic events as common reactions, thereby depathologizing symptoms and shifting the paradigm from one of human weakness to one of biology. The first six skills of TRM are called the Community Resiliency Model® (CRM).

TRM helps individuals learn to track their nervous systems and concentrate on sensations that are connected to well-being. As a person begins to pay attention to sensations of well-being, his nervous system can return to a state of balance. Clients are informed about the neurobiology of traumatic symptoms with simple explanations about the nervous system and the common responses to threat and fear. The six wellness skills help a person learn to monitor his own sensations and begin to tell the difference between sensations of distress and those of well-being. Once his awareness expands, a person, through his own intention, can begin to bring his nervous system back into balance. When using TRM to help an individual reprocess a traumatic experience, the clinician first helps the client learn the wellness skills for self-care. Once the client knows he can regulate his own nervous system during times of distress, the clinician can focus on helping the client reprocess traumatic experiences. There are three additional skills of the TRM that can be implemented by the clinician for reprocessing. Mind and body are interdependent and as the body is stabilized, the mind can bring new meaning to the traumatic experience and this results in a reframed narrative that can now include the survival story. Individuals often a greater sense of hope, now anchored in the body and have an increased capacity to be in what TRM calls the Resilient Zone.

TRM was inspired by the work of Dr. Peter Levine’s Somatic Experiencing® , Gendlin’s Focusing, Jean Ayres’ Sensory Integration Theory, neuro-scientific research about the brain, basic anatomy and physiology, Lamaze Childbirth Education, Dr. Insoo Kim-Berg’s Solution-Focused Psychotherapy and the laws of nature.

KEY CONCEPTS OF THE TRAUMA RESILIENCY MODEL

The body and mind have a natural capacity to heal. When we are faced with physical and/or psychological danger, the human body automatically goes into instinctual survival responses. The accelerator of our nervous system (sympathetic branch) goes into action, the result is faster breathing and heart rate and stress hormones are released in order to increase survival. When the threat passes, the brake of the nervous system (parasympathetic branch) brings the system back into balance, back to the Resilient Zone, resulting in breathing and heart rate slowing down. There is a natural balance.

When human beings are threatened, there are four possible survival strategies: tend and befriend, fight, flight, and freeze. The elegant design of the human nervous system triggers survival responses when there is a perceived threat. Following a traumatic event, a person can be triggered by almost anything reminiscent of the event. In some instances, the traumatic experience overwhelms the person ability to respond and escape. The natural rhythm of the autonomic nervous system may not return. The person can get stuck in the high zone that can result in chronic symptoms of anxiety, panic, rage, and/or hyperactivity. Conversely, the person’s nervous system can get stuck in the low zone and fall into the depths of depression, disconnection, and exhaustion. Both systems can get stuck at the same time as with one foot on the accelerator of a car and the other on the break. This results in what is called the freeze response and feelings of chronic helplessness, fatigue, numbness and poor concentration may result. In additional response more common in women than men is called “tend and befriend.”   For most women, men are physically stronger and she may have a sense of not being able to escape the threat, she may try to tend and befriend the perpetrator to protect herself, her offspring and the social group. If the natural survival responses are blocked, the energy meant for survival can become trapped in the body and result in behaviors that can impact a person’s ability to experience well-being.

It is helpful to help clients understand that triggers can be anything that reminds the nervous system of a life-threatening event. This information can reduce the shame and self-blame that can be a constant bedfellow for those who are triggered frequently.

Peter Levine (1997) conceptualized that when a human being is threatened, massive amounts of energy are mobilized within the body for self-defense. If the person can complete the defensive response, there is a natural discharge of energy. The discharge sensations can include movements, such as shaking, trembling, and deep spontaneous breaths. Levine postulates that this discharge process resets the autonomic nervous system, restoring balance. What is problematic for human beings is that we place a brake on experiencing these sensations for many reasons, including the tendency to judge ourselves harshly. When we stop the natural release of these sensations, the energy meant for defensive responses becomes “stuck” in the body. The “stuck” energy leads to physical, behavioral, cognitive, spiritual and psychological symptoms.

Education about basic neuroscience can help individuals understand that some of the reactions that have occurred since experiencing traumatic events are part of common reactions of our survival brain that are triggered by the amygdala (a threat detecting part of our brain) to keep us alive, to help us survive. Although descriptions of the brain’s functions are very complex, in TRM we describe the mind-body connection in simple terms.

In organizing principle is that there are three parts of the brain: Thinking, Feeling and Survival parts. If our survival brain is triggered into action, humans go into survival responses that are automatic. This happens without thinking. Thus, it does not work for most of us to say, “stop being anxious or stop breathing fast.” Symptoms connected to our traumatic memories cannot be “talked away” but can be “sensed away.”

The application of TRM skills does not necessitate the telling of the traumatic story. TRM can work with the current symptoms in the body and can help the individual become aware of the ability to read sensations and learn to develop awareness to tell the differences between states of distress and of well being. Thus, when introducing TRM to people who have been highly traumatized, a common response is relief as there is a paradigm shift that takes their traumatic symptoms out of the “pathological or mental weakness realm” to one of common biological responses of the human nervous system.

HOW THE TRAUMA RESILIENCY MODEL WORKS

The Trauma Resiliency Model re-stabilizes a highly activated nervous system by balancing trauma-oriented sensations with states that resource the body and the mind. Resources are the positive internal and external experiences in our lives, e.g. the people we love who inspire us, pets, places, spiritual beliefs, music, dance, art, etc. TRM connects us to our internal and external resources, reminding us of our own strength and resilience by assisting us to experience those qualities in our own bodies and participate in the moment more fully. When we are in highly aroused states, we can become disconnected from our inner capacities. It is not guided imagery in that when we identify a resource, such as a beloved friend, we not only ask the person to describe at least three qualities about the friend, we draw the person’s attention to the sensations that are associated with the beloved friend. As simple as this sounds, the tracking of sensation, can help shift a highly activated nervous system, into a parasympathetic response, thereby stabilizing the nervous system, returning the person to his Resilient Zone.

When we balance trauma-oriented sensations with resource states we restore well-being by supporting the nervous system’s return to balance. We work gently, helping the client experience a small surge of activation, process it and then another small surge, and so on until balance is restored and the normal functioning of the nervous system takes over. This gentle approach to trauma protects the client from re-traumatization. It does not have to be an ordeal to heal. A helpful metaphor is to think of helping the nervous system to digest small bites of activation one bite at a time. Once sensations of well-being are experienced, the person is asked to sense into a tiny edge of the activation or constriction or traumatic material within the body. We call this titration. The person is then invited to shift or pendulate back to a pleasant or neutral sensation within the body. As trauma-oriented sensations are digested and released, one begins to feel better. The person is helped to embody the resource by bringing present moment to the sensations that are pleasant or neutral.

The following is an example of how one can implement TRM after a natural disaster:

In Haiti, we traveled to different locations within Port au Prince to introduce TRM skills and begin to build capacity by training Haitians to be TRM trainers. We went to a day-care center and were asked to work with a group of teachers. Ten percent of the population was killed in Port au Prince so most people we worked with had lost family members and/or friends. A woman named Lisette was one of the managers of the day-care center and she shared the fear that had occurred the day of the earthquake.

The treatment goal when working with individuals after a natural disaster is to not only support the expressions of grief that may arise but also to help the person sense into his/her Resilient Zone which expands well being. The intervention did not begin by asking more details about her story but, instead, asked her a question that could help access a resource and stimulate a parasympathetic response that could calm her body and her mind and return her to her Resilient Zone. Survival stories are often very powerful ways to bring awareness to positive body sensations that stabilize the nervous system. The practitioner’s first question was, “Could you tell me the moment you knew you had survived the earthquake?” and then “Who else survived?” This survival-oriented focus oriented her to the fact that she had lived and others she cared about survived too.

As she recounted her survival story, a deepening of her breath could be seen as well as the relaxation of her facial muscles. Her attention was gently brought to her breath and she was asked if she could experience the release of tension in her face. A gentle smile emerged. She related that she wanted life to get back to normal and she was asked how she would know that life was becoming even a little bit more normal. She responded, “If I could think about my friend and co-worker who died in the earthquake without collapsing into sobs.” In order to reestablish her friend as a resource, the practitioner asked her to tell her a little about her friend and asked her to describe the characteristics that she liked about her. As she told the group about her friend, she smiled and there was a deepening of her breath and a further release of the tension in her body that was gently brought to her attention. She was invited to notice the sensation change as she remembered her friend. New meaning emerged and she said, “each day when I walk to work, I will remember her and when I take a step into life, I will step for her too.” Lisette smiled broadly and with the smile came a small tear. The TRM practitioner reflected to her about her smile and all present could see her return to her Resilient Zone. She was guided to notice the sensations connected to the memory of her friend. At the end of the short session, she indicated it was the first time since the earthquake that she could hold the positive memories of her friend. As she reported more meaning, she was invited to notice all the changes in her body that occurred since we had started the TRM, session. She took a deep breath and smiled and brought her hand to heart and she said Marie, her friend, would always be with her.

If the individuals have had longstanding trauma from their life experiences and the symptoms of trauma have been stuck in the high and low zones and have fluctuated between the two throughout their lifetime, it can be more challenging to learn to track pleasant or neutral sensations within the body. For some individuals the very introduction of a way to settle their nervous system can provide an immediate relief that they have rarely experienced since the traumatic events. A common response from has been, “ instead of the symptoms being in charge of me, I now can be more in control of them.”

HISTORY

While working at Arrowhead Regional Medical Center as the Associate Director of Behavioral Medicine, teaching in the family medicine program, I noticed that many patients seeking care in the primary care clinics complained about symptoms that were connected to traumatic experiences either as children or adults. I began conceptualizing a short-term interventions based on helping patients understand basic information about the autonomic nervous system and teaching simple skills to help the patient stabilize their nervous systems.

In January of 2005, I along with a team including Geneie Everett and Laurie Leitch, was invited to be part of an international relief team to help tsunami survivors in Kho Lak, Thailand by the Foundation of Human Enrichment. As a result of this experience, I began developing a short-term educational model with Geneie Everett to help first responders and survivors understand the symptoms of traumatic stress from a bio-psycho-social perspective. Geneie and I worked together refining this model, called Trauma First Aide in New Orleans and Baton Rouge through a project with Catholic Charities after Hurricanes Katrina and Rita. Laurie Leitch directed the research in Thailand and in New Orleans and Baton Rouge for the Foundation of Human Enrichment.

In October of 2005, Laurie and I started the Trauma Resource Institute (TRI), a nonprofit corporation, because of a shared vision to bring biological based models to individuals and communities around the world and were its co-directors. Geneie Everett went on separately and started a limited partnership, called Trauma First Aide Associates. Laurie and I collaborated, bringing our many years of experience as clinicians and educators and enhanced my original work that began in San Bernardino, California to create the Trauma Resiliency Model.  Laurie resigned from TRI in 2012 and since that time I have further developed the Trauma Resiliency Model® Level 1 and Level 2 and have been the Executive Director of TRI. FI

RESEARCH

The Department of Defense in a white paper presented to Congress in March 2011 named TRM a promising practice to heal active duty service members and veterans. Research about the Trauma Resiliency Model® and the Community Resiliency Model® is now underway in many academic institutions around the world including Loma Linda University, University of Hamburg, Syracuse University and Claremont Graduate University

OUTREACH

TRI and its collaborators have brought projects worldwide, including to the Philippines, Haiti, China, Turkey, Nepal, Mexico, the United States, Kenya, Tanzania, Darfur, the Ivory Coast, St. Vincent, Japan, Germany, Northern Ireland, South Africa, Rwanda, Uganda, Somalia, the Ukraine, Great Britain and Guatemala. Training has been offered at the Wounded Warrior Chronic Pain Clinic at Walter Reed National Military Medical Center’s Annual Conference in San Diego and Washington DC.

REFERENCES

Levine, P. (1997). Waking the tiger: Healing trauma. Berkeley, CA: North Atlantic Books.

Miller-Karas, E. (2015) Building Resilience to Trauma, Trauma and Community Resiliency Models, Routledge, NY, NY

TRM in Schools

Students experience high levels of distress as a result of issues related to poverty. This distress manifests as poor attendance, behavior problems, poor personal/social skills, emotional issues, and poor test scores. By Jean Berg - read more. . .

トリモ・メソッド ~自分らしさを取り戻す3つのストレス対処法 Community Resiliency Model by the Nichi Bei Care Network

Philippine Partnership for the Development of Human Resources in Rural Areas Living through the hardships of everyday life can be traumatic, especially when you’re someone on the margins of society - read more  . . .

Wednesday - Thursday, November 15-16, 2017

To see the Conference Agenda, List of All-Star Speakers, and to Register go to:

http://www.theresourceinnovationgroup.org/pnw-2017-conference/

 

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