disclosures rulesmedia.virbcdn.com/files/4a/...beyondtrauma2pptx.pdf · kolk, b. (2014.). the body...

11/8/16

BeyondTrauma:understandings,neuroscience,epigene9csandhealthjus9ce

LydiaAnneMBartholow,PMHNP

HouseKeeping--AMBreakaround11AM--Luncharound12:30--PMBreakaround3:30PM--Bathroomsare?

SupportFolks--LTisinthebackleN--Ebonyisinthebackright

Disclosures Rules

•  Don’tconflateanatomicalbodypartsandfunc9onswithgenderiden9ty

•  Don’tconflatebodysizeandhealth•  DoMoveUpandMoveback

•  Dopriori9zeyourownwellness

Agenda

•  Whatthefistrauma?•  Understandingsandunderpinnings•  Neuroscience•  Epigene9cs•  Interven9ons•  TraumaStewardship

Agenda

• Whatthefistrauma?•  Understandingsandunderpinnings•  Neuroscience•  Epigene9cs•  Interven9ons•  TraumaStewardship

11/8/16

Whatthe*f*istrauma?

•  Subjec9ve,changing– Moreques9onsthananswers

– Risksandbenefitsoflanguageu9liza9on– Tvsttrauma

•  ZoomIn//ZoomOut– PTSD/I– A^achment– Historical,Systemic,Ontological

Whatthe*f*istrauma?

– Risksandbenefitsoflanguageu9liza9on•  ZoomIn//ZoomOut– PTSD/I– A^achment

– Historical,Systemic,Ontological

Post-Trauma9cStress

•  Injuryvs.disorder– Peoplefirstlanguage– Traumainformedcare– Normalizing,hopeful

HistoryofPTSD

•  Connectedwithpost-combatexperiencesinceancientGreece

•  Mul9plevaria9onsandconceptualiza9onsinthe20thcentury

•  Begantoiden9tyandtreatin1970/1980s•  SmallshiNswitheachDSM

TraumaisbiggerthanPTSD•  ACESstudy

–  Kaiser/CDC–  SoCalin1990s

TheACES:-  Emo9onalAbuse-  PhysicalAbuse-  SexualAbuse-  Emo9onalNeglect-  PhysicalNeglect-  Lossofparenttodivorceordeath-  IPVinthehome-  Substanceabuseinthehome-  MentalIllnessinthehome-  Lossofafamilymembertoprison

ACESStudy

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Whatthe*f*istrauma?

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Attachment •  The infants neural pathways are informed by their

relationship with their primary caregiver •  Infant use the primary care giver to regulate inner

states and that is reflected in brain structures •  The neural pathways of attachment become the

hiking paths and roads of how we perceive reality, feel and respond – which ultimately becomes our personality and reality.

Why address attachment? •  Explains why our brain makes the neural

connections it does (i.e. creates the paths it does) •  Which explains why I do the things I do/think the

things I do/respond the way I do/feel the way I do •  And explains why the client might do the things

we do/think the things they do/respond the way they do/feel the way they do

Anyreasonnottou9lizea^achmenttheory?

Whatthe*f*istrauma?

Historical,Systemic,Ontological,Cultural

•  ReturntoACES–whatcommuni9eshavethehighestincidence?

•  Post-trauma9cSlaverySyndrome

•  HistoricalTrauma(Na9venamed)

•  Epigene9cs

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Agenda

•  Whatthefistrauma?

•  Understandingsandunderpinnings•  Neuroscience•  Epigene9cs•  Interven9ons•  TraumaStewardship

AmericanPsychiatricAssocia9on

•  AuthorsoftheDSM•  DSMisen9relyahumanconstruct

•  DSMisnon-scien9fic(but,whatisscienceanyhow?)

•  Drivenbypersonalvisions

•  Remember:traumaisbiggerthantheAPAdefinesassuch.

PTSDCriteriaperAPA

•  CriterionA:stressor–  Thepersonwasexposedto:death,threateneddeath,actualor

threatenedseriousinjury,oractualorthreatenedsexualviolence

•  CriterionB:intrusionsymptoms–  Thetrauma9ceventispersistentlyre-experiencedinthe

followingway•  CriterionC:avoidance

–  Persistentefforlulavoidanceofdistressingtrauma-relateds9muliaNertheeven

•  CriterionD:nega;vealtera;onsincogni;onsandmood–  Nega9vealtera9onsincogni9onsandmoodthatbeganor

worsenedaNerthetrauma9ceven

JudithHerman,M.D.

-  Feminist,psychiatrist,aboli9onist-  AuthorofTraumaandRecovery(1992)

-  Proposedthatwomen,too,couldbetrauma9zedandthatwomen’smentalhealthalsoma^ered

-  ProposedC-PTSD-  ProposedType1andType2traumas

-  Proposed39ersoftraumarecovery

MarshaLinehan,PhD

•  Psychologist•  Self-iden9fiesashavingborderlinepersonalitydisorder(nolongermeetscriteria)

•  Feministtransforma9onwithinCBT

•  CreatorofDBT

LisaNajavits,PhD

•  Addic9onsresearcher,PTSDsurvivor•  ReviewedtheprevalenceofPTSDandsubstanceabusedisorder

•  Createdprogramsthat: – Treatedco-occurringPTSI/Addic9on– Proposednon-hierarchialhealingasapossibility– Honoredtraumastewardship

Najavits,L.(2002).Seekingsafety:AtreatmentmanualforPTSDandsubstanceabuse.NewYork:GuilfordPress.

11/8/16

BesselvanderKolk,MD

-  Psychiatrist,researcher-  FounderoftheTraumaCenteratJRI

-  Grandfatherofmostofwhatweknowoftheneuroscienceoftrauma

-  Brought“alterna9ve”traumatreatmentstothemainstream

-  HascontributedtoparadigmshiN:traumaisinthebody

PeteLevine,PhD

•  EncouragedparadigmshiN:traumaisinthebody

•  “Bo^omuppsychotherapy”(ratherthaninsightoriented)

•  Peoplecanhealthemselves,withoutpsychotherapy,byu9lizingsoma:ctechniques

•  Or,soma9cproviderscantransformtraumasurvivors

StephenPorges

•  Introducedthepolyvagaltheory•  Transformsthewayweunderstandtheverybasicsofthehumannervoussystem

Porges,S.(2011).Thepolyvagaltheory:Neurophysiologicalfounda9onsofemo9ons,a^achment,communica9on,andself-regula9on.NewYork:W.W.Norton.

JoyDeGruyLeary

-  PostTrauma9cSlaveSyndrome-  AfricanAmericansaretrauma9zedbyhistoricallegacyofwhitesupremacy,overtone-oneracismandsystemicoppression

Leary,J.(2005).Posttrauma9cslavesyndrome:America'slegacyofenduringinjuryandhealing.Milwaukie,Oregon:Uptone

Press.

BruceMcEwen,PhD

-  Proposedallosta:cload-  Offeredthatsmall-ttrauma/stresscouldchangephysiology/healthoutcomesonapopula9onbasedlevel

McEWEN,B.(2001).Stress,Adapta9on,AndDisease:AllostasisAndAllosta9cLoad.AnnalsoftheNewYorkAcademyofSciences,33-44.

MariaYellowHorse,LCSW,PhD

•  Proposed“historicaltrauma”(&soulwound)•  “Thecumula9veemo9onalandpsychologicalwoundingoverthelifespanandacrossgenera9onsemana9ngfrommassivegrouptrauma”

BraveHeart,M.Y.H.(2000)Wakiksuyapi:CarryingthehistoricaltraumaoftheLakota.TulaneStudiesinSocialWelfare,21-22,245-266.

11/8/16

MaxineHarris&RogerFallot

•  Introducedtheideathatwecantransformserviceprovisiontorespondto,andbeinformed,bytrauma

•  Applyuniversalprecau9ons

Agenda

•  Understandingsandunderpinnings

•  Neuroscience– BrainBasics&NervoussystemOrganiza6on

– Stress&Trauma– Polyvagaltheory

•  Epigene9cs

•  Interven9ons

•  TraumaStewardship

Remembera^achmentthe

Here’swhere

itcomesinto

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NervousSystemOrganiza9on

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Ini9alsignsandsymptomsofthestressresponse: (akafight,flightorfreezeorHPAaxis)

Blurredvision

Increasedheartrate

Inabilitytofocus/thinkstraight

Thoughtsofimpendingdoom

Sweatypalms

Muscletension

Increasedbloodpressure

nausea

StressororThreat:(copinrearviewmirror)

Amygdala attaches fear to stimuli

AmygdalaHypothalamus

Directs9mula9onoffightorflightneurons

AdrenalGlands

pituitary

AdrenalGlandsadrenaline/catecholamines

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AdrenalGlands

adrenaline/catecholamines

--pupildila9on--sweat--driedoutmucousmembraines--musclecontrac9lity--increasedHR--increasedBP--blowflowawayfromstomach--blowflowawayfromprefrontalcortex--bloodflowtovitalorgans--increasedbloodsugar

+newneuron

connec9onsa

fearfuls9muli!

EffectsofParasympathe9cS9mula9on

•  DecreasedHR•  DecreasedBP(2/2bloodvesseldila9on)•  Increasedmuscularrelaxa9on

•  Bronchialconstric9on•  Increaseddiges9vemo9lity

•  Pupilconstric9on+new

neuronal

connec9ons

fornon-

fearbasedc

ogni9on!

VagusNerve:Primarilyresponsibleforparasympathe9cs9mula9on.

Alsomediatesthe“freeze”aspectofourstressresponse.

Agenda

•  Epigene9cs

•  Interven9ons

11/8/16

AdrenalGlandsadrenaline/catecholamines

AdrenalGlands cortisol

--immunesystemsuppression--suppressionofinflamma9on--waterreten9on--hyperglycemia--insulinresistance--musclebreakdown--increasedgastricjuices--removalofcalciumfrombones

--pupildila9on--sweat--musclecontrac9lity--increasedHR--increasedBP--blowflowawayfromstomach--blowflowawayfrombrain--bloodflowtovitalorgans--increasedbloodsugar

+irritability,moodsw

aggression!

Affects of long term cortisol… --immunesystemsuppression/suppressionofinflamma9on=

--waterreten9on=

--hyperglycemia=

--fatredistribu9on=

--decreasedgastricintegrity=

--Thyroiddownregula9on=

--decreasedserotonin(forsomepeople)=

--dopaminedysregula9onintheNA=

Affects of long term cortisol… --immunesystemsuppression=

--downregula9onofmetabolism(thyroid)=

--waterreten9on=

--hyperglycemia=

--musclebreakdown=

--fatredistribu9on=

--removalofcalciumfrombones=

--decreasedserotonin=

--increasedintes9nalpermeability=

--increasedgastricacid=

Emo;onalComponent:

Irritable

AngryFragile

Gastric Permeability? Leakygut!SystemicInflamma9on

1.  Largeproteinsenterbloodstream

2.  Livercalledupontoremovetoxins

3.  Immunesystemengages

4.SystemicInflamma9on

(5.Ac9vatedimmunesystemencouragesmorecor9sol)

Affects of long term cortisol --immunesystemsuppression/suppressionofinflamma9on=

--waterreten9on=

--hyperglycemia=

--fatredistribu9on=

--decreasedgastricintegrity=

--Thyroiddownregula9on=hypothyroidism

--decreasedserotonin(forsomepeople)=

--decreaseddopamine=

Autoimmunedisease

CancerHighBloodPressure

CardiacDisease

DiabetesIBS/Foodsensi9vi9es/ETC

DEPRESSION

Addic9on

11/8/16

Whitefolks

Cisgenderedfolks

HigherSES

StraightFolks

FolksofColor

Transgenderfolks

LowerSES

LGBTQIFolks

Privelege Oppression

Who’smorelik

elytohave

higherlevels

ofcor9sol?

Allosta;cloadMcEWEN,B.(2001).Stress,Adapta9on,AndDisease:AllostasisAndAllosta9cLoad.AnnalsoftheNewYorkAcademyofSciences,33-44.

Butthat’sgene9cs,right?

Barr,D.(2008).Healthdispari9esintheUnitedStates:Socialclass,race,ethnicity,andhealth.Bal9more:JohnsHopkinsUniversityPress.

Stress Trauma

Traumais:--aghostthathauntsyourbodyandbrain

--a“blowout”ofyourfightorflightsystem

--“Theresultofexposuretoaninescapablystressfuleventthatoverwhelmsaperson’scopingmechanism”–BesselVanderKolk

2centralaspectsoftrauma:

•  Lackofcontrol

•  Lackofbeingseen(mirrorneurons)

AdrenalGlands

cortisol adrenaline/catecholamines

Hippocampusnegative feedback

11/8/16

Hippocampuscont.

Thehippocampusisresponsiblefortransformingmemoriesfromfeltexperiencetoanexplicitnarra9ve.

So,ifthisstructureisrela9velysmall,howmightthatlookintraumasurvivors?

Hippocampuscont.

Thehippocampusplaysanimportantroleintheconsolida9onofshorttermmemorytolongtermmemory.

So,ifthisstructureisrela9velysmall,howmightthatpresentintraumasurvivors?

Hippocampuscont.

Thehippocampusplaysanimportantroleinmakingsenseoutoflivedexperiencedandpuxngthoseexperiencesintoourlargerself-narra9ve.

So,ifthisstructureisrela9velysmall,howmightthatpresentintraumasurvivors?

Amygdala

Theamygdalaconnectsdirectlywiththepaincentersinthebrainandcommunicateswithourbrainsleepcenters.

So,ifit’snotbeing“calmed”,whatcouldbepresent?

Amygdala

Whentheamygdalaiss9mulatedandour“fight,flightorfreeze”systemisalwaysonandrestandrepairisrarelyengaged(homeosta9cimbalance).

So,whathappensiftheamygdalaisnotbeing“calmed”andwecan’trestandrepair?

11/8/16

PsychoneuroImmunologicalPTSIProfile

•  Cor9solis_______,butCRFandcatecholaminesareincreased.

Kolk,B.(2014.).Thebodykeepsthescore:Brain,mind,andbodyinthehealingoftrauma.

AdrenalGlands

LocusCeruleus->s9mula9onofadrenergicneurons

•  Increasedinflamatorycytokines(TNFalpha)andinflammatorytranscrip9onfactors!increasedinflamma9on

•  ImbalanceinTh1/Th2!increasedsystemicinflamma9on

Gola,H.,Engler,H.,Sommershof,A.,Adenauer,H.,Kolassa,S.,Schedlowski,M.,...Kolassa,I.T.(2013).Pos^rauma9cstressdisorderisassociatedwithanenhancedspontaneousproduc9onofpro-inflammatorycytokinesbyperipheralbloodmononuclearcells.BMCPsychiatry,13:40.doi:10.1186/1471-244X-13-40

•  Telomeres(DNAendcaps)shorten

•  DecreasedGABA

•  DecreasedDAinNucleusaccumbens

•  DecreasedBDNF

Andrews,J.A.,&Neises,K.D.(2012).Cells,biomarkers,andpost-trauma9cstressdisorder:Evidenceforperipheralinvolvementinacentraldisease.JournalofNeurochemistry,120(1):26-36.

Inreview,symptomsandcopingstrategiesfoundinsometraumasurvivors.

- Hyperarousal- Nightmaresandbaddreams- Intrusivethoughts- Fa9gue- Difficultyconcentra9ng- Muscletension- Sleepproblems/insomnia- Avoidanceofreminders- Angryoutbursts- Memoryloss- Memoryconfusion

- MoodSwings- SuicidalIdea9on- Self-injuriousbehaviors- Depression/sadness- Numbing- Feelingsofhopelessness,worthlessnessandguilt- Memoryconfusion- Anxiety- Chronicmedicalproblems- Panica^acks- Decreasedcri9calthinking/personalityengagement

Thinkofhowyoufeelwhenthere’sconstantlyacopintherearviewmirror!

11/8/16

Inreview,symptomsandcopingstrategiesfoundinsometraumasurvivors?

- Hyperarousal- Nightmaresandbaddreams- Intrusivethoughts- Fa9gue- Difficultyconcentra9ng- Muscletension- Sleepproblems/insomnia- Avoidanceofreminders- Angryoutbursts- Memoryloss- Memoryconfusion

- MoodSwings- SuicidalIdea9on- Self-injuriousbehaviors- Depression/sadness- Numbing- Feelingsofhopelessness,worthlessnessandguilt- Memoryconfusion- Anxiety- Chronicmedicalproblems- Panica^acks- Decreasedcri9calthinking/personalityengagement

Addiction

Agenda

•  Epigene9cs

•  Interven9ons

VagusNerve:Primarilyresponsibleforparasympathe9cs9mula9on.

Alsomediatesthe“freeze”aspectofourstressresponse.

PolyvagalTheory

•  TransformshowwethinkoftheVagusnerve•  Proposestovagusnervesistwoparts– >whichthenincreasesstressresponse“system”to3branches

Porges,S.(2011).Thepolyvagaltheory:Neurophysiologicalfounda9onsofemo9ons,a^achment,communica9on,andself-regula9on.NewYork:W.W.Norton.

PolyVagalPhylogeny

SocialEngagementviaVentralVagalcomplex

Mobiliaza;onviasympathe;cs;mula;on

Immobiliza;onViaDorsalVagalComplex

Firstinterven9onunderthreat,.e.gcalloutforhelp

Secondinterven9onunderthreat,e.g.runorfight

Finalinterven9onunderthreat,e.g.“freeze”

Recentwithinevolu9on,humansunique

Limbicsystem Lizardbrain

MyelinatedVagusNerve Sympathe9cneurons,HPAAxis

Unmyelinatedvagusnerve

Asthreatincreases,sodoesourresponse.

11/8/16

VagalTone

•  Introducedininfancyinrela9onshiptoprimarycaregiver

•  ShiNsthroughoutlifebasedonresponsetostress,thoughbaselineismedicatedbya^achment

•  Indexforthefunc9onalstateoftheen9reparasympathe9cnervoussystem

•  CanbemeasuredviaHRV(and“trained”)

Agenda

•  Whatthefistrauma?•  Understandingsandunderpinnings•  Neuroscience•  Epigene6cs•  Interven9ons•  TraumaStewardship

Epigene9cs

•  ThestudyofheritablechangesingeneexpressionthatarecausedbyfactorssuchasDNAmethyla9on(primarily)ratherthanbyachangeinthesequenceofbasepairsinDNAitself.

•  Ourfocus:epigene9cshiNs2/2traumainA)onegenera9onB)mul9plegenera9ons(heritableshiNs)

Epigene9cs

•  ThestudyofheritablechangesingeneexpressionthatarecausedbyfactorssuchasDNAmethyla9onratherthanbyachangeinthesequenceofbasepairsinDNAitself.

•  ProvesDarwin(kinda)wrong•  Ourfocus:epigene9cshiNs2/2traumain

A)onegenera9on(“GeneenvironmentInterac9on”-GxE)

B)mulitplegenera9ons(heritableshiNs)

5-HTTLPR

•  Serotonin-transporter-linkedpolymorphicregion

•  Twoalleles:short(s)andlong(l)•  s+hypercor9solemia=downregula9onof5HTreceptors=depression,“neurosis”,increasedPTSD

D.A.Collier,G.Stober,T.Li,A.Heils,M.Catalano,D.DiBella,M.J.Arranz,R.M.Murray,D.Bengel,C.R.Muller,G.W.Roberts,E.Smeraldi,G.Kirov,[P.Sham&K.P.Lesch(December1996)."Anovelfunc9onalpolymorphismwithinthepromoteroftheserotonintransportergene:possibleroleinsuscep9bilitytoaffec9vedisorders".MolecularPsychiatry1(6):453–450.

11/8/16

•  Pituitaryadenylatecyclase-ac9va9ngpep9de•  PACAPisaneuropep9dethatinfluencesneuralgrowthandsynap9cplas9city

•  Polymorphism–ac9vatedbytrauma,impairscommunica9onbetweenhippocampusandamygdala

Ressler,K.J.,Mercer,K.B.,Bradley,B.,Jovanovic,T.,Mahan,A.,Kerley,K.,...May,V.(2011).Post-trauma9cstressdisorderisassociatedwithPACAPandthePAC1receptor.Nature,470(7335),492-497.

Epigene9cs

•  ThestudyofheritablechangesingeneexpressionthatarecausedbyfactorssuchasDNAmethyla9onratherthanbyachangeinthesequenceofbasepairsinDNAitself.

•  ProvesDarwin(kinda)wrong•  Ourfocus:epigene9cshiNs2/2traumain

A)onegenera9on(“GeneenvironmentInterac9on”)

B)mulitplegenera9ons(heritableshiNs)

HeritableshiNs

OfA^achmentandMice

•  Scien9stsdisruptedthea^achmentofbabymice(thinkwiremonkey)

•  4genera9onswereeffected–moreanxious,increasedCRFac9vity,lesscor9sol

•  4genera9onswereeffected–evenwhenitwaspassedfromthe“father”,whowasNOTpresent

•  HippocampalvolumewasdecreasedShah,P.,Fonagy,P.,&Strathearn,L.(2010).Isa^achmenttransmi^edacrossgenera9ons?Theplotthickens.ClinicalChild

PsychologyandPsychiatry,329-345.

Holocaustsurvivorsandrefugees

•  Thehormonal/psychoneuroimmunologicalprofilethatPTSDsurvivorscarriedwasmirroredintheiroffspring–whethertheywereinvolvedintheir“rearing”ornot.–  Increasedinflammatorycytokines– Hypocor:solemia– DecreasedGABAandDA

McFarlane,A.C.,&Yehuda,R.A.(1996).Resilience,vulnerability,andthecourseofpos^rauma9creac9ons.

11/8/16

AncestralMemory

•  Specificfearfuls9muli/memoriescanbecarriedfromonegenera9ontothenext

*B.G.DIAS,K.J.RESSLER.Influencingbehaviorandneuroanatomyinthemammaliannervoussystemviaancestralexperiences.2013.

HealingandResistance

11/8/16

Agenda

•  Whatthefistrauma?•  Understandingsandunderpinnings•  Neuroscience•  Epigene9cs•  Interven6ons– Psychological– Allopathicpsychiatric– NaturopathicandBotanical

Agenda

•  Whatthefistrauma?•  Understandingsandunderpinnings•  Neuroscience•  Epigene9cs•  Interven6ons– Hippocampalboosters–  Psychological– Allopathicpsychiatric– NaturopathicandBotanical

PsychologicalInterven9ons

•  Exposuretherapies•  EMDR–FrancineShapiro– Tapping

•  DBT–MarshaLineham

•  Arttherapies

TalktherapyDOESencourageneuronalgrowthinthehippocampus!

11/8/16

Agenda

AllopathicPsychiatric

•  Benzos•  Bloodpressuremeds:– Prazosin,Propranolol,Clonidine

•  SSRIs•  Cor9costeroids

SSRIsandlithiumencouragehippocampalgrowth!

Agenda

NaturopathicandBotanical

•  Biofeedback•  Acupuncture•  Yoga•  Addressingadrenalfa9gue•  GIRepair•  Nervines•  Adaptogens

Lemonbalm,turmeric,acupunctureandexerciseincreasehippocampalvolume!

11/8/16

•  Biofeedback•  Acupuncture•  Yoga•  GIRepair•  Nervines•  AddressingAdrenalFa9gue//Adaptogens

AdrenalGlands

Nervines

•  Cratageussp(Hawthorne)[Flowersvsfruits]•  Scu^eleriasp(Skullcap)•  Pedicularissp(Louseworts)•  Melissaofficinalis(LemonBalm)

•  Avenasp.(Oats)

Gastric Permeability?

A.Leakygut1. Licorice2. Marshmallow

B.SystemicInflamma9on1. Turmeric?2. Licorice?3. Chamomile?

11/8/16

AdrenalGlands

BotanicalsforAdrenalFa9gue

•  Glycyrrhizasp.(Licorice)•  Withaniasomnifera(Ashwaghanda)

•  Avenasp.(Oats)

•  Non-botanical:Phospha9dylserine

Agenda

•  Understandingsandunderpinnings•  Neuroscience•  Epigene9cs•  Interven9ons•  TraumaStewardship

AdrenalGlands cortisol

--immunesystemsuppression--suppressionofinflamma9on--waterreten9on--hyperglycemia--insulinresistance--musclebreakdown--fatredistribu9on/obesity--increasedgastricjuices--removalofcalciumfrombones--decreasedserotonin

--pupildila9on--sweat--musclecontrac9lity--increasedHR--increasedBP--blowflowawayfromstomach--blowflowawayfrombrain--bloodflowtovitalorgans--increasedbloodsugar

OR---- afloodofdarkness!

Trauma stewardship calls us to engage oppression and trauma by caring for, tending to, and responsibly guiding beings who are struggling – including ourselves. It is not just an idea, but can be defined as a daily practice.

-- paraphrased and stolen from Laura van Dernoot

11/8/16

Take Aways in Trauma Stewardship

•  acknowledging that vicarious trauma is real

•  being present in the trauma

•  prioritizing self-care

•  recognizing the difference between self-care and “checking out”

•  creating systems and organizations that promote self-care and trauma stewardship

Whatisyoursafeplace?

MajorReferences•  Barr,D.(2008).Healthdispari:esintheUnitedStates:Socialclass,race,ethnicity,

andhealth.Bal9more:JohnsHopkinsUniversityPress.•  Herman,J.(1992).Traumaandrecovery.NewYork,N.Y.:BasicBooks.•  Jordan,M.(1995).Thereturntothesacredpath:Healingfromhistoricaltrauma

andhistoricalunresolvedgriefamongtheLakota:Adisserta:onbaseduponanindependentinves:ga:on.

•  Kolk,B.(2014).Thebodykeepsthescore:Brain,mind,andbodyinthehealingoftrauma.

•  Leary,J.(2005).Posttrauma:cslavesyndrome:America'slegacyofenduringinjuryandhealing.Milwaukie,Oregon:UptonePress.

•  Mate,G.Whenthebodysaysno:Understandingthestress-diseaseconnec:on.(2003).Hoboken,N.J.:J.Wiley.

•  Mate,G.Intherealmofhungryghosts:Closeencounterswithaddic:on.(2010).Berkeley,Calif.:NorthAtlan9cBooks

•  Vandernoot-Lipske,L.(2013)TraumaStewardship.•  Yehuda,R.(1999).RiskfactorsforposSrauma:cstressdisorder.Washington,DC:

AmericanPsychiatricPress.

disclosures rulesmedia.virbcdn.com/files/4a/...beyondtrauma2pptx.pdf · kolk, b. (2014.). the body...

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