Anxiety

Transitions, Change and Loss

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This time last year I’d not long arrived in Kansas and it’s been a long time since my last blog, I just want you all to know that this blog site is far from finished as there are many more reflections, topics and visits I want to share with you all.  Obviously I’m home now and have been on Australian soil for some time.  The title of this blog which was already next in line for publication is also true and reflective of why it’s been so long between posts… transitions, change and loss, but more about that later on…

Visiting Mount Saint Vincent Home I spent time reflecting on the impact of change, loss and transition.  On my first day with them, the Clinical Director Kirk Ward, advised me that they were facing all sorts of changes, transitions and loss.  It was coming up to the end of the school year and children were graduating out of the school, out of the program or going off on summer break for the day treatment clients, there had been some staff turnover resulting in a lot of retraining of new staff and to top it off the County had started to refer a slightly different demographic of child.

As a result of all of this, staff and clients were struggling.  Emotions were running higher, people more reactive and that week staff and I often reflected on the struggle they faced given old strategies were not working as successfully as they had been.  When we are faced with challenges as such it’s not surprising that we think it’s time to try something new or change things up.  We can find ourselves feeling stressed and anxious about the seemingly little impact we are making.  We know from my prior blogs and the work of Dr Perry and Dr Siegel that the more stressed we become the more reactive we become.  The more reactive we become the less we are able to really think creatively and reflectively about a situation.  This is a universal human phenomenon, not only does it happen to our troubled and traumatised clients, but it happens for every one of us.

When we are stressed and reactive, the danger in changing it up or trying something new is further increasing the uncertainty, predictability and routine and in turn further exacerbating stress levels and reactivity of all involved.  I’m not saying that we should always soldier on and hold firm to our way of operating, not in the least as it could very well be the way we are doing things is problematic or part of the issue.  What I am saying though is that we need to take space, calm ourselves so to really be able to think more reflectively and creatively about what we are doing, and how we move forward in making a difference in the lives of others.

My time with Mount Saint Vincent home highlighted again the absolute importance of staff being emotionally regulated and emotionally safe within themselves.  The ability to take time as a staffing group, reflect and seek supervision and manage ourselves is paramount in the treatment, care and healing of trauma. I was impressed with the clinical, residential and educational team at Mount Saint Vincent and their ability to support children and young people at times of emotional and behavioural escalation.  Staff would come away from these situations and interactions concerned and worried for the wellbeing of the children, the success of their interventions, in turn requiring regulation and support from each other and their management.   However when engaged and interacting with the young people in their program and the emotional and behavioural distress these kids demonstrated, the Mount Saint Vincent staff were focussed, centred, and on the whole all about co regulating these kids.  I witnessed clever use of movement, music, and sensory input to keep young people regulated and/or regulate them.

The challenges facing Mount Saint Vincent during my visit could easily have derailed them, left them focussing on new and different strategies. I’m not saying as a program emotions weren’t running high and the staffing group were certainly concerned, but I watched them rally together and co regulate each other so as to not to let the transitions, chaos and loss their program was experiencing result in organisational reactivity, but instead continue in the provision of safe, predictable and thoughtful care to their clients.

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Greater and Less Than – Lessons in learning Through Movement

Somatosensory activities and education, this is a topic close to my heart.

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For a little over two years now I have been consultant and then project manager of a pilot project in Australia looking at the inclusion of patterned, repetitive somatosensory activities in primary school classes.

So often we hear teachers and educators ask about strategies for managing traumatised children and their resultant behaviours in the classroom.   All too often in my clinical practice teachers have looked at me, perplexed when I suggested they could include somatosensory activities into curriculum.  In fact I had almost got to the point that I believed this maybe wasn’t achievable and that I had to enlist an education champion to help me articulate my meaning more clearly.  The latter may still be the case, but in Charlotte NC I had the professionally heart warming experience of watching a relatively new teacher to the Alexander Youth Network (AYN) Psychiatric Residential Treatment Facility (PRTF) School do exactly what I’ve been talking about for years.

The PRTF School do what most neurodevelopmentally and “trauma” informed education programs do, by providing frequent “brain breaks” for their children.  Essentially this is where they step down from academic learning and engage in some form of somatosensory activity such as playing outside, water play, sand play, play doh, calming corners with sofas, bean bags, blankets and soft toys etc. They do this routinely, repetitively and frequently – in fact given the arousal and dysregulation of the children AYN sees in its PRTF, these breaks seemed to work best when applied every 10 or so minutes.  Having access to a staff member dedicated to leading these breaks and co-regulating the children in between them worked a treat as well.   All of this impressed me, but what really stood out was this one teacher who found a way to incorporate somatosensory activities into curriculum based learning!IMG_7140

You know maths and mathematical concepts is a difficult gig at any school, let alone a classroom of children struggling with emotional, social and behavioural difficulties.  So when this teacher came in to teach the concepts of less than and greater than I thought to myself this will be interesting.

Immediately on entry into the room, she invited the children to the front of the class and had them all stand or sit around her as they preferred. She didn’t get flustered or annoyed when children came and went from her teaching space and in doing so, actually appeared to manage keeping them around her and in the vicinity of learning for the whole exercise.  Each child was given a piece of paper containing a number, each child read their number out aloud.  The greater than symbol was drawn on the board and there was minimal question and answer time to ensure that everyone understood the concept of the greater than symbol.

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Less than & Greater than

Then engaging the students in an activity based process, moving them around she asked them two by two (based on those most engaged in the moment) to identify their number and stand either side of her – as she held the greater than symbol.  The student’s task – to put themselves in the right spot – who’s number was greater than the other.  Each student excitedly took their turn and much celebration was had as each pair got it right.  In addition to the movement which we know provides sensory and motor based regulation to the lower parts of the brain, this teacher relied on her voice to ensure up regulation and down regulation in the moment and what was most impressive was that she made the lesson punchy and brief.  In and out in no more than 15  minutes and a key mathematical concept was taught and grasped by these children.

Can somatosensory activity be incorporated into curriculum?

I think it can.  It might take a bit of creativity and planning, and maybe even a shift in basic education philosophy about how to teach children, but I still think this is very achievable.

Adventure Therapy


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Think about a time when you took a risk, stepped out of your comfort zone, challenged yourself!

Scary right?

How did it feel when you succeeded in spite of your fear?

Did it feel good?

I bet you felt proud!

And you know what? If you reflect on that experience long enough and with a level of insight you will notice the skills you learnt or enhanced and the ways in which you coped and managed your anxiety.

Now think about a world where you never feel safe or secure.  A world full of fear and distrust. This is the life of the traumatised child. An existence where safety is stolen and experience leaves templates of mistrust.

Imagine a situation whereby the traumatised child can experience success and a sense of accomplishment in the context of relationships that demonstrate “in the moment” trust. Adventure based therapy like kayaking, ropes courses, wilderness adventure programs and the like can afford traumatised young people this opportunity.

The magic in adventure based therapy is in weaving together into one activity the following developmental and healing opportunities. Participants are faced with activities that challenge and extend them at a skill level, but are absolutely achievable.  What’s more many of these activities involve fear, risk taking and induce anxiety, but are provided in a way that they can be scaffolded for success and achievement. So in a direct experiential way the individual participant has to draw on their competencies, explore problems and difficulties to develop solutions and fundamentally achieve and succeed in the face of trauma. All of this is done in the context of a relationship that implicitly enforces trust and as a result of individual success provides a positive experience of helpful, supportive and trusting relationships.

I observed a kayaking adventure therapy session with a group of adolescent boys at Cal Farley’s. These young men were preparing for an open water kayaking trip the following week and were practicing the skills of rescue post capsizing.

Fascinating in this observation was watching these young men anxiously anticipate the notion of flipping their kayak and deliberately capsizing themselves. Staff engaged in a lot of cognitive discussion based reassurance, what was awesome was that this was done as they kayaked up and down the length of the pond, back and forth, repetitively paddling and talking. This allowed for somatosensory regulation of anxiety, or quietening down of the dysregulation caused by the anxiety, so that the discussion based reassurance and coaching could be heard and internalised by the young men.

Then in pairs – either paired with an intervention therapist, or in peer pairings with one more skilled peer as mentor for the other, these guys practiced capsizing their boats and rescuing each other. There was ample time provided to allow them to work up to and get themselves emotionally and cognitively ready to tip their kayaks, including repeat demonstrations from intervention staff and more competent peers, paddling laps and step by step instructions and reassurance.

Eventually one by one, these young men tipped their kayaks and capsized themselves, were successfully rescued and able to get back into their kayaks from in the water in the middle of the pond and fist pumped the air with the experience of success.

These lads were able to experience in the moment moderate levels of fear and anxiety activation paired with somatosensory regulation and the experience of relational trust all of which culminated in the experience of success. What was really nice was the processing or discussions that took place together about the experience and the learning for the young men after their initial success – talking about what it was like, how it felt, what they learnt about themselves, about their relationship with their partner – some really nice “talk based” therapeutic work attached to a really cool direct experiential learning opportunity.

Dr Perry talks about the importance of repetition to strengthen the new neural pathways and connections that are made with these experiences and you know repetition was not an issue after that first capsize and recovery – these guys just kept doing it over and over and over again.  I could see the increase in confidence right there in the moment by moment repeat of the activity.

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An Excuse for New Boots!

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The Sandhill Trail Ride with Acacia Riding Adventures: San Lorenzo Canyon New Mexico.

I’m always looking for a reason to add to my collection of cowboy boots. Now there’s more to this story and while this blog is really about neurodevelopmentally informed interventions and I’ll get there in this one, just let me set the scene a little.

There I was in Denver – a little over a week of being in the States and well I hadn’t really packed for a cold snap.  In fact, despite what seemed to be seamless organisation in relation to my packing – I really didn’t consider or even think about researching the spring weather conditions for places like Denver, Banff and Calgary.  So after a 102/38 degree day in Wichita, I head to Denver – where it was a crisp 63/17 degrees and my footwear is pretty much a pair of canvas Toms and two pair of open toe summer sandals!  This coupled with a Facebook post from a dear colleague in Calgary showing their spring snowfall (looks like our winter on the ski slopes) resulted in a rapid move up the arousal continuum to a state of mild stress activation.  “Will it be like that when I get there in June ?” “I’ve only canvas and open toed shoes, hello frostbite…”  and then as I engaged some self regulation, calmed and regained access to my thinking brain, came the problem solving “…Hello Boots!” On that very same day I get an email from Cal Farley’s to let me know that I’d be doing a trail ride – on a horse.  It is meant to be and now the deal is sealed, new boots for me!

I haven’t ridden for over 23 years, so the idea of getting back on a horse caused me some apprehension, however in the last two weeks I’ve now had opportunity to do two trail rides, firstly with Sandhill in one of the most picturesque canyons, secondly at Cal Farley’s around the treatment centre campus.  I’d love to be able to tell you that it’s just like riding a bike and one of my observers suggested to me that it looked just like that – on the back of that animal although – that’s not how it felt.

The mere idea of getting back up on horseback was in and of itself anxiety provoking for me.  I’m not a lover of heights, and well I’ve put on a bit of weight since I was a kid riding and being a lover of animals was quite concerned about my horse having to bear my weight.  On both rides what was fantastic was the reassurance from experienced horse handlers that both of my horses were more than capable of carrying me and doing so safely.  The other thing that I loved about both Dacodah and David was their ability to scaffold a feeling of competence and in turn begin the process of co-regulation of my anxiety.  I couldn’t help but think about what this experience would be like for a child or young person so used to negative human interaction, to have both an animal and its handler working together in the most natural of ways and leaving you feeling nothing but important and what’s more, even with skill.

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Cal Farley’s Trail Ride

Once on the back of the horse, there was no going back on either occasion.  In fact on the first ride there may not have been any going forward either had the horse not clearly communicated to me that I was anxious and she was not enjoying that experience.  My horse kept looking at me and snorting almost with derision.  Initially this did nothing to quell my anxiety and left me thinking all sort of negative self talk about my weight and the horse’s experience of it.  Not unlike the float tank, it was interesting to notice the thought processes that emerged about myself and the importance of sorting that stuff out or at the very least challenging it, for the success of the experience.

Dacodah and David on both occasions reminded me that the horse, being a prey animal, have an overactive stress response system – not unlike the abused and traumatised kids we work with and that they are finely attuned to threat.  Sensing my anxiety both the horses had started to become a bit “on edge” really just feeding off my own anxiety.  So in order to calm them, I had to calm myself.  The horse like the frightened and traumatised child, at the heart of it, really wants a calm, regulated, nice, nurturing, rewarding rider who can take control and be respectful of them.  The more I was able to manage my anxiety and relax into the animal while at the same time retain a sense of confident control the more attuned the horse and I became, the more responsive they were to me and the more confident and skilled I felt.

I can only imagine living a life where you feel out of control all the time and then having an experience like this where you have capacity to control the success of your interaction.  Yeah sure we could argue that our kids have capacity to control the success of their interactions with us all the time, but the immediate feedback from the animal that is without judgement, mixed messages and completely non verbal is so very powerful.  If you don’t get yourself sorted and regulated then your horse is going to do what it needs to take care of itself. There’s not going to be responsivity, let alone the chance of working together.   I watched young people who got this and were able to, in the moment, do what they needed to do to have a successful and pleasant ride with their horse.  I also watched other young people struggle to manage themselves, then end up more dysregulated when their horse wouldn’t do what they wanted, making the horse even more non compliant and not interested in the process.  I could absolutely see the benefit for in the moment reflection and wondering about the experience with the kids and the power of experiential learning when observations and interactions could be reflected on and internalised.  Aside from the physical sensory experience of riding there is definitely something in this equine based work!!

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Not so new anymore

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San Lorenzo Canyon

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On the trail

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A Self Portrait on horseback

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Canyon Pictures

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More of the Canyon

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Pictures do not capture the beauty of this place

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Just like in the movies

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Views from a top San Lorenzo Canyon