Stress Response

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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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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The Impact of Fear: My Firsthand Experience.

It has been a while since my last entry and I apologise for that.  The last 3 weeks have been so very busy and I became a little unwell (nothing too serious – just allergies) so that’s put me a little behind on the documentation of reflections. I can’t help but wonder however if some of the delay in getting another story out, was because I’m a stickler for chronology and really wanted to talk about & reflect on an experience I had in Albuquerque, the night before heading to Cal Farley’s in Texas.  The difficulty being that I was auditory witness to what sounded like a horrible domestic violence incident in my hotel that left me nothing short of scared if I’m to be honest.  I think it’s taken me time to process and think about that experience and how to reflect upon and turn it into something I have learnt from, but can also help others to learn from.images-3

In all the training and staffings I have done as part of my NMT certification with the ChildTrauma Academy I have a pretty good understanding of Dr Perry’s notion of the arousal continuum and the impact of increasing levels of stress and fear on the way in which our brain operates.  I even use examples of my own stressful situations to illustrate the arousal continuum when I teach and train.

Arousal continuum, Chelle what are you talking about? In short, there is a universal human phenomenon whereby activation of the stress response system or the experience of stress or threat, moves us along a continuum of arousal from calm to alert to alarm to fearful to terrified.  Now as Dr Perry often says, in today’s world it’s quite rare to achieve a state of calm and for most of us we operate on a day to day basis in the mental state of alert.  At each different state of arousal and because all of our functioning is brain mediated, there is a different part of the brain that is most active.

So when we are in a state of calm or alert this is when we have access to our cortex – the thinking and problem solving part of our brain.  We can recall information, manipulate thoughts and come up with solutions.  Moving up the arousal continuum to a state of alarm, fear and then terror sequentially reduces the access we have to our cortex.  Essentially the more stressed or afraid we become the less access we have to our thinking brain and our ability to problem solve and think clearly. Dan Seigel describes this here in his hand brain model https://www.youtube.com/watch?v=DD-lfP1FBFk when he talks about rising emotions leading us to flip our lids.

Unfortunately on the evening of the 17th of May, I was staying in Albuquerque, where after tucking up in bed, excited about the week ahead of me I could hear very clearly the screams and pleas for help from a woman.  Coupling these terrifying screams were loud bangs, the sounds of things being thrown around, threatening yelling from a male voice and then the sound of skin hitting skin.  It was clear that somewhere very close to me a woman was being assaulted and needed assistance.

Now if I were in my own country and feeling less isolated I may have had a different response, but what happened that night was that I became overwhelmed with fear.  Here I was a woman, alone, in another country and not having immediate access to the things that make me feel safe – my husband or my family.  I could feel my heart racing and I found myself almost paralysed with fear.  I couldn’t move, didn’t want to move.  Initially I thought about the notion of calling 911, but the fear of being heard or drawing attention to myself was so great and the possible threat to my own safety took hold.  Instead I found myself lying completely still, like a mouse not making a sound and jumping on Facebook messenger to connect with my safe base – my husband. Essentially in that moment I “flipped my lid”.

Not only did I have the first hand experience of the arousal continuum where I found myself unable to do anything but focus on what I needed to do for my own safety.  I couldn’t think, sort out solutions or even contemplate what I might need or be able to do to assist this poor woman being assaulted.  My cortex, the thinking part of my brain was shut down and the survival parts of my brain in full force – keeping me safe.  I didn’t sleep a wink that night, not even after the three hour ordeal settled, I was hypervigilantly on guard for additional threat.

The next morning, when I had resumed a baseline level of alert arousal and my cortex accessible again, I was struck by my experience of shame.  I didn’t let this consume me – reminding myself of neurobiology and the response I had as being natural, but nonetheless for a short period of time, with emerging access to my cortex, I felt bad for not having acted to protect that woman.  For those concerned, someone who wasn’t as scared was able to seek help for the woman and her abusive partner was arrested and taken away.

In the time that has passed since then however, I have spent a lot of time thinking about being a child in another room of the house, while those you love are being hurt and/or hurting each other.  I am a grown adult, I’ve had a really solid upbringing and I have relative security in my attachment and relationships, I had no personal connection to those individuals being violent and yet I still found myself terrified and immobilised by fear.  Imagine being a child, vulnerable, alone, scared and unable to do anything to help your loved one from being hurt.

I’ve heard all too often from parents, “the kids don’t know or see it”, “they are in another room”, “our fighting (aka domestic violence) doesn’t have an impact on them”.  I have always challenged these notions and beliefs of parents, knowing that this is nothing short of a fallacy.  Of course kids know and hear.  What concerns me more now though as I reflect on my experience in Albuquerque, is that when you can hear domestic violence and not see it, it might be just as, if not more scary than actually witnessing it.  When it is not in front of you and you “flip your lid”, your imagination about what is happening or what might happen can take hold, exacerbating your fear.

What’s more, if you have grown up in an environment of such violence and aggression between those you love, you are more likely to have an overactive stress response and hence be more alert to the cues of aggression and violence and more reactive to them.  The witnessing, be that visual or just auditory, will only serve to reinforce and exacerbate that overreactive stress response and possible resultant shame for not being able to help due to fear.

My experience has left me further adamant of the fact that hearing and not seeing domestic violence is absolutely in NO way less frightening or  damaging to children, than being visual witness to it!!

Therapeutic Preschool: Building Emotional Regulation

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Dr Rick Gaskill: Clinical Director Sumner Mental Health Services

Sumner Mental Health Services provide therapeutic support to the Futures Unlimited Preschools in Wellington KS. Specifically they provide support via the provision of Mental Health Case Management and a role called Individual Psychosocial Rehabilitation workers (IPR), for children classified with Severe Emotional Disturbance (SED). Provision of these services is made available via the USA Medicaid system, and each of the children receiving these services must have met diagnostic classification to receive services.

I observed the absolute value of the IPR role in the preschool setting as I watched an IPR with a 6 year old child with significant emotional disturbance.  From the outset of allocated time, the IPR provided this child with one to one, undivided attention, co-regulation and supported emotionally and developmentally respectful redirection when necessary.  Enacting her role, the IPR was regularly in physical contact with the child in the classroom.  During circle time the child placed herself in the lap of the IPR, leaning back and cuddling into the worker, while the worker provided gentle touch, stroking and running her fingers through the child’s hair.

The IPR worker scaffolded the child from activity to activity in transitions, keeping distractions to a minimum and providing nothing short of opportunities for success for the child, all of this done through largely relational based interaction and regulation.  At the outset of their time, I watched the IPR prepare the child for her impending departure and watched her regulate the rhythm of the hour for the child, so that in the 10 minutes before the IPR’s departure, they moved to a corner and engaged in a quiet activity, drawing together so that their separation provided drawings that could be swapped as transitional objects.  The IPR giving the girl the drawing she had done and vice versa – the child then able to take and keep a piece of her precious IPR worker.  In the two minutes prior to the IPR leaving – the teacher joined the dyad and a process of “handover” occurred and here again while the IPR made her exit, the teacher provided hugs and relational interaction to enable the child to succeed in the moment emotionally.

What really stood out to me was the fact that this child, in the hour supported by the IPR was able to experience success and a baseline level of emotional regulation, contrary to descriptions that had been given of her.  Her IPR remained attuned to her emotional state and danced the dance of catching early signs of emotional dysregulation, such that the child was able to be redirected, be that via comfort, movement, touch or scaffolding to another activity.

Imagine the long term benefits we could achieve if our kindergarten/preschool children who struggle emotionally, received opportunities like this at the time when their brains are still actively organising neural networks.  Could we start to create early changes in neural templates from over active stress response systems and emotional dysregulation to enable younger children a better platform for self regulation?