![Page 1: BUILDING RESILIENCE E Szabo C., KelemanO., & Keri S. (2013) Bol Psychiatry Lauren Ashbaugh, Ph.D., NCSP Continua Consulting Group, LLC NOW THAT WE KNOW, WHAT DO WE NEED? Lauren Ashbaugh,](https://reader030.vdocuments.us/reader030/viewer/2022041200/5d40dcc888c99391748d3f5e/html5/thumbnails/1.jpg)
BUILDING RESILIENCE
• February 21st, 2019
Lauren Ashbaugh, Ph.D., NCSP
![Page 2: BUILDING RESILIENCE E Szabo C., KelemanO., & Keri S. (2013) Bol Psychiatry Lauren Ashbaugh, Ph.D., NCSP Continua Consulting Group, LLC NOW THAT WE KNOW, WHAT DO WE NEED? Lauren Ashbaugh,](https://reader030.vdocuments.us/reader030/viewer/2022041200/5d40dcc888c99391748d3f5e/html5/thumbnails/2.jpg)
AGENDA
8:35-8:45 Setting the stage
8:45-9:00 Defining resilience
9:00-9:20 ACEs, trauma, & toxic stress
9:20-9:30 Trauma & the body
9:30-10:00 Building resilienceContinua Consulting Group, LLCLauren Ashbaugh, Ph.D., NCSP
![Page 3: BUILDING RESILIENCE E Szabo C., KelemanO., & Keri S. (2013) Bol Psychiatry Lauren Ashbaugh, Ph.D., NCSP Continua Consulting Group, LLC NOW THAT WE KNOW, WHAT DO WE NEED? Lauren Ashbaugh,](https://reader030.vdocuments.us/reader030/viewer/2022041200/5d40dcc888c99391748d3f5e/html5/thumbnails/3.jpg)
REFLECTION PAGE
• Find the numbers on the slides:
• Match the numbers to the questions on the reflection sheet.
• Voluntary and entirely for you.
1
Lauren Ashbaugh, Ph.D., NCSP
![Page 4: BUILDING RESILIENCE E Szabo C., KelemanO., & Keri S. (2013) Bol Psychiatry Lauren Ashbaugh, Ph.D., NCSP Continua Consulting Group, LLC NOW THAT WE KNOW, WHAT DO WE NEED? Lauren Ashbaugh,](https://reader030.vdocuments.us/reader030/viewer/2022041200/5d40dcc888c99391748d3f5e/html5/thumbnails/4.jpg)
YOUR RIGHTS
• You have the right to take all the space you need. Please do. Some content is distressing.
• You have the right to choose how you prefer to participate.
• You have the right to use humor and laughter.
• You have the right to speak and be heard.
• You are invited to talk to me about any and all of this.
Continua Consulting Group, LLCLauren Ashbaugh, Ph.D., NCSP
![Page 5: BUILDING RESILIENCE E Szabo C., KelemanO., & Keri S. (2013) Bol Psychiatry Lauren Ashbaugh, Ph.D., NCSP Continua Consulting Group, LLC NOW THAT WE KNOW, WHAT DO WE NEED? Lauren Ashbaugh,](https://reader030.vdocuments.us/reader030/viewer/2022041200/5d40dcc888c99391748d3f5e/html5/thumbnails/5.jpg)
• Do your best to be present.
• Do no harm.
• Be kind to yourself.
• Remember that vulnerability often leads to growth.
MY REQUESTS
Continua Consulting Group, LLCLauren Ashbaugh, Ph.D., NCSP
![Page 6: BUILDING RESILIENCE E Szabo C., KelemanO., & Keri S. (2013) Bol Psychiatry Lauren Ashbaugh, Ph.D., NCSP Continua Consulting Group, LLC NOW THAT WE KNOW, WHAT DO WE NEED? Lauren Ashbaugh,](https://reader030.vdocuments.us/reader030/viewer/2022041200/5d40dcc888c99391748d3f5e/html5/thumbnails/6.jpg)
![Page 7: BUILDING RESILIENCE E Szabo C., KelemanO., & Keri S. (2013) Bol Psychiatry Lauren Ashbaugh, Ph.D., NCSP Continua Consulting Group, LLC NOW THAT WE KNOW, WHAT DO WE NEED? Lauren Ashbaugh,](https://reader030.vdocuments.us/reader030/viewer/2022041200/5d40dcc888c99391748d3f5e/html5/thumbnails/7.jpg)
Chapter: SUDS: The Subjective Units of Distress Scale
From: Concurrent Treatment of PTSD and Substance Use Disorders Using Prolonged Exposure (COPE): Patient Workbook
![Page 8: BUILDING RESILIENCE E Szabo C., KelemanO., & Keri S. (2013) Bol Psychiatry Lauren Ashbaugh, Ph.D., NCSP Continua Consulting Group, LLC NOW THAT WE KNOW, WHAT DO WE NEED? Lauren Ashbaugh,](https://reader030.vdocuments.us/reader030/viewer/2022041200/5d40dcc888c99391748d3f5e/html5/thumbnails/8.jpg)
www.anxietybc.com
![Page 9: BUILDING RESILIENCE E Szabo C., KelemanO., & Keri S. (2013) Bol Psychiatry Lauren Ashbaugh, Ph.D., NCSP Continua Consulting Group, LLC NOW THAT WE KNOW, WHAT DO WE NEED? Lauren Ashbaugh,](https://reader030.vdocuments.us/reader030/viewer/2022041200/5d40dcc888c99391748d3f5e/html5/thumbnails/9.jpg)
1
![Page 10: BUILDING RESILIENCE E Szabo C., KelemanO., & Keri S. (2013) Bol Psychiatry Lauren Ashbaugh, Ph.D., NCSP Continua Consulting Group, LLC NOW THAT WE KNOW, WHAT DO WE NEED? Lauren Ashbaugh,](https://reader030.vdocuments.us/reader030/viewer/2022041200/5d40dcc888c99391748d3f5e/html5/thumbnails/10.jpg)
TENDING TO MY INTROVERTS .
Optional means optional
Feel free to choose to focus on empathy, listening, & reflection.
Continua Consulting Group, LLCLauren Ashbaugh, Ph.D., NCSP
![Page 12: BUILDING RESILIENCE E Szabo C., KelemanO., & Keri S. (2013) Bol Psychiatry Lauren Ashbaugh, Ph.D., NCSP Continua Consulting Group, LLC NOW THAT WE KNOW, WHAT DO WE NEED? Lauren Ashbaugh,](https://reader030.vdocuments.us/reader030/viewer/2022041200/5d40dcc888c99391748d3f5e/html5/thumbnails/12.jpg)
BUILDING RESILIENCE
![Page 13: BUILDING RESILIENCE E Szabo C., KelemanO., & Keri S. (2013) Bol Psychiatry Lauren Ashbaugh, Ph.D., NCSP Continua Consulting Group, LLC NOW THAT WE KNOW, WHAT DO WE NEED? Lauren Ashbaugh,](https://reader030.vdocuments.us/reader030/viewer/2022041200/5d40dcc888c99391748d3f5e/html5/thumbnails/13.jpg)
WHAT IS RESILIENCE?
Lauren Ashbaugh, Ph.D., NCSP
![Page 14: BUILDING RESILIENCE E Szabo C., KelemanO., & Keri S. (2013) Bol Psychiatry Lauren Ashbaugh, Ph.D., NCSP Continua Consulting Group, LLC NOW THAT WE KNOW, WHAT DO WE NEED? Lauren Ashbaugh,](https://reader030.vdocuments.us/reader030/viewer/2022041200/5d40dcc888c99391748d3f5e/html5/thumbnails/14.jpg)
![Page 15: BUILDING RESILIENCE E Szabo C., KelemanO., & Keri S. (2013) Bol Psychiatry Lauren Ashbaugh, Ph.D., NCSP Continua Consulting Group, LLC NOW THAT WE KNOW, WHAT DO WE NEED? Lauren Ashbaugh,](https://reader030.vdocuments.us/reader030/viewer/2022041200/5d40dcc888c99391748d3f5e/html5/thumbnails/15.jpg)
Continua Consulting Group, LLCLauren Ashbaugh, Ph.D., NCSP
![Page 16: BUILDING RESILIENCE E Szabo C., KelemanO., & Keri S. (2013) Bol Psychiatry Lauren Ashbaugh, Ph.D., NCSP Continua Consulting Group, LLC NOW THAT WE KNOW, WHAT DO WE NEED? Lauren Ashbaugh,](https://reader030.vdocuments.us/reader030/viewer/2022041200/5d40dcc888c99391748d3f5e/html5/thumbnails/16.jpg)
AMAZING TACOMA KIDS2
![Page 17: BUILDING RESILIENCE E Szabo C., KelemanO., & Keri S. (2013) Bol Psychiatry Lauren Ashbaugh, Ph.D., NCSP Continua Consulting Group, LLC NOW THAT WE KNOW, WHAT DO WE NEED? Lauren Ashbaugh,](https://reader030.vdocuments.us/reader030/viewer/2022041200/5d40dcc888c99391748d3f5e/html5/thumbnails/17.jpg)
3
Lauren Ashbaugh, Ph.D., NCSP
![Page 18: BUILDING RESILIENCE E Szabo C., KelemanO., & Keri S. (2013) Bol Psychiatry Lauren Ashbaugh, Ph.D., NCSP Continua Consulting Group, LLC NOW THAT WE KNOW, WHAT DO WE NEED? Lauren Ashbaugh,](https://reader030.vdocuments.us/reader030/viewer/2022041200/5d40dcc888c99391748d3f5e/html5/thumbnails/18.jpg)
RESILIENCE
(1) the ability to face and cope with challenges;
(2) adapt to the changes created by these challenges; and
(3) recover and even grow from these setbacks.
Seelig et al. (2016) Sleep and health resilience metrics in a large military cohort.
Continua Consulting Group, LLCLauren Ashbaugh, Ph.D., NCSP
![Page 19: BUILDING RESILIENCE E Szabo C., KelemanO., & Keri S. (2013) Bol Psychiatry Lauren Ashbaugh, Ph.D., NCSP Continua Consulting Group, LLC NOW THAT WE KNOW, WHAT DO WE NEED? Lauren Ashbaugh,](https://reader030.vdocuments.us/reader030/viewer/2022041200/5d40dcc888c99391748d3f5e/html5/thumbnails/19.jpg)
RESILIENT TO WHAT?
ACEs, Trauma, & Toxic Stress
Continua Consulting Group, LLCLauren Ashbaugh, Ph.D., NCSP
![Page 20: BUILDING RESILIENCE E Szabo C., KelemanO., & Keri S. (2013) Bol Psychiatry Lauren Ashbaugh, Ph.D., NCSP Continua Consulting Group, LLC NOW THAT WE KNOW, WHAT DO WE NEED? Lauren Ashbaugh,](https://reader030.vdocuments.us/reader030/viewer/2022041200/5d40dcc888c99391748d3f5e/html5/thumbnails/20.jpg)
What are Adverse Childhood Experiences (ACEs)?
Source: Robert Wood Johnson Foundation
Continua Consulting Group, LLCLauren Ashbaugh, Ph.D., NCSP
![Page 21: BUILDING RESILIENCE E Szabo C., KelemanO., & Keri S. (2013) Bol Psychiatry Lauren Ashbaugh, Ph.D., NCSP Continua Consulting Group, LLC NOW THAT WE KNOW, WHAT DO WE NEED? Lauren Ashbaugh,](https://reader030.vdocuments.us/reader030/viewer/2022041200/5d40dcc888c99391748d3f5e/html5/thumbnails/21.jpg)
HOW DID THE "ACES" STUDY ARISE?
Original question arose in 1985 in obesity clinic
Vincent Felitti, M.D.
Continua Consulting Group, LLCLauren Ashbaugh, Ph.D., NCSP
![Page 22: BUILDING RESILIENCE E Szabo C., KelemanO., & Keri S. (2013) Bol Psychiatry Lauren Ashbaugh, Ph.D., NCSP Continua Consulting Group, LLC NOW THAT WE KNOW, WHAT DO WE NEED? Lauren Ashbaugh,](https://reader030.vdocuments.us/reader030/viewer/2022041200/5d40dcc888c99391748d3f5e/html5/thumbnails/22.jpg)
When he finished, one of the experts stood up and blasted him. “He told me I was naïve to believe my patients, that it was commonly understood by those more familiar with such matters that these patient statements were fabrications to provide a cover explanation for failed lives!”
Dr. Felitti at the North American Association for the Study of Obesity conference in 1990:
Continua Consulting Group, LLC
Source: J.E. Stevens, Huffington Post, 10/2012
Lauren Ashbaugh, Ph.D., NCSP
![Page 23: BUILDING RESILIENCE E Szabo C., KelemanO., & Keri S. (2013) Bol Psychiatry Lauren Ashbaugh, Ph.D., NCSP Continua Consulting Group, LLC NOW THAT WE KNOW, WHAT DO WE NEED? Lauren Ashbaugh,](https://reader030.vdocuments.us/reader030/viewer/2022041200/5d40dcc888c99391748d3f5e/html5/thumbnails/23.jpg)
THE ORIGINAL CDC/KAISER ACES STUDY*:
• Original question arose in 1985 in obesity clinic
• CDC partnered study spanned 1995-1997
• Kaiser Permanente in San Diego, CA
• 17,421 participants
Vincent Felitti, M.D.
Robert Anda, M.D., M.S.
Almost 2/3 had at least 1 ACE
40% had 2 or more ACEs
One in five had >3 ACEs
*Felitti & Anda et al, American Journal of Preventative Medicine, 1998
Continua Consulting Group, LLCLauren Ashbaugh, Ph.D., NCSP
![Page 24: BUILDING RESILIENCE E Szabo C., KelemanO., & Keri S. (2013) Bol Psychiatry Lauren Ashbaugh, Ph.D., NCSP Continua Consulting Group, LLC NOW THAT WE KNOW, WHAT DO WE NEED? Lauren Ashbaugh,](https://reader030.vdocuments.us/reader030/viewer/2022041200/5d40dcc888c99391748d3f5e/html5/thumbnails/24.jpg)
Without intervention, 20 year difference in life expectancy with 4+ ACEs
Source: CDC
Continua Consulting Group, LLCLauren Ashbaugh, Ph.D., NCSP
![Page 25: BUILDING RESILIENCE E Szabo C., KelemanO., & Keri S. (2013) Bol Psychiatry Lauren Ashbaugh, Ph.D., NCSP Continua Consulting Group, LLC NOW THAT WE KNOW, WHAT DO WE NEED? Lauren Ashbaugh,](https://reader030.vdocuments.us/reader030/viewer/2022041200/5d40dcc888c99391748d3f5e/html5/thumbnails/25.jpg)
CDC/KAISER ACES STUDY: WHAT’S MISSING?
• Peer victimization/bullying
• Deportation of family member
• Racism/institutional oppression
• Multiple deployments/military
• Caretaking an elderly or ill parent
• Acute health issue
• Car accident, health aftermath
• Natural disaster
• Multiple moves
• Losing a home/homelessness
• Loss of a colleague or teacher
• Poverty
• Disability
• Exposure to community violence
• Exposure to school violence
• Death of a family member
Continua Consulting Group, LLCLauren Ashbaugh, Ph.D., NCSP
![Page 26: BUILDING RESILIENCE E Szabo C., KelemanO., & Keri S. (2013) Bol Psychiatry Lauren Ashbaugh, Ph.D., NCSP Continua Consulting Group, LLC NOW THAT WE KNOW, WHAT DO WE NEED? Lauren Ashbaugh,](https://reader030.vdocuments.us/reader030/viewer/2022041200/5d40dcc888c99391748d3f5e/html5/thumbnails/26.jpg)
ACEs in WASHINGTON SCHOOLS – SOPHOMORES AND SENIORS(2010)
4
![Page 27: BUILDING RESILIENCE E Szabo C., KelemanO., & Keri S. (2013) Bol Psychiatry Lauren Ashbaugh, Ph.D., NCSP Continua Consulting Group, LLC NOW THAT WE KNOW, WHAT DO WE NEED? Lauren Ashbaugh,](https://reader030.vdocuments.us/reader030/viewer/2022041200/5d40dcc888c99391748d3f5e/html5/thumbnails/27.jpg)
• Behavioral Risk Factor Surveillance System (BRFSS)
• Over 23 states, 200,000+ participants
• Higher frequency of ACEs reported in:
• Women, young adults vs. men, older adults
• Less than high school diploma vs. HS graduate
• Multiracial, Hispanic, black vs. white
• Bisexual, LGBTQ vs. heterosexual
THE 2018 JAMA PEDIATRICS* ACES STUDY:
Merreck et al, 2019 JAMA Pediatrics. Graphic: CDC
Continua Consulting Group, LLCLauren Ashbaugh, Ph.D., NCSP
![Page 28: BUILDING RESILIENCE E Szabo C., KelemanO., & Keri S. (2013) Bol Psychiatry Lauren Ashbaugh, Ph.D., NCSP Continua Consulting Group, LLC NOW THAT WE KNOW, WHAT DO WE NEED? Lauren Ashbaugh,](https://reader030.vdocuments.us/reader030/viewer/2022041200/5d40dcc888c99391748d3f5e/html5/thumbnails/28.jpg)
ACES AND INTERSECTIONALITY
• Race
• Gender identity
• Sexual orientation
• Nationality
• Disability
• Available resources and support
Source: YW Boston
Continua Consulting Group, LLCLauren Ashbaugh, Ph.D., NCSP
![Page 29: BUILDING RESILIENCE E Szabo C., KelemanO., & Keri S. (2013) Bol Psychiatry Lauren Ashbaugh, Ph.D., NCSP Continua Consulting Group, LLC NOW THAT WE KNOW, WHAT DO WE NEED? Lauren Ashbaugh,](https://reader030.vdocuments.us/reader030/viewer/2022041200/5d40dcc888c99391748d3f5e/html5/thumbnails/29.jpg)
Intersectionality, n.
The interconnected nature of social categorizations such as race, class,
and gender, regarded as creating overlapping and interdependent
systems of discrimination or disadvantage; a theoretical approach based
on such a premise.
(Oxford Dictionary)
Continua Consulting Group, LLCLauren Ashbaugh, Ph.D., NCSP
![Page 30: BUILDING RESILIENCE E Szabo C., KelemanO., & Keri S. (2013) Bol Psychiatry Lauren Ashbaugh, Ph.D., NCSP Continua Consulting Group, LLC NOW THAT WE KNOW, WHAT DO WE NEED? Lauren Ashbaugh,](https://reader030.vdocuments.us/reader030/viewer/2022041200/5d40dcc888c99391748d3f5e/html5/thumbnails/30.jpg)
CHRONIC EXPOSURES
Rejection
Exclusion
Oppression
Threat
Neglect
Continua Consulting Group, LLCLauren Ashbaugh, Ph.D., NCSP
![Page 31: BUILDING RESILIENCE E Szabo C., KelemanO., & Keri S. (2013) Bol Psychiatry Lauren Ashbaugh, Ph.D., NCSP Continua Consulting Group, LLC NOW THAT WE KNOW, WHAT DO WE NEED? Lauren Ashbaugh,](https://reader030.vdocuments.us/reader030/viewer/2022041200/5d40dcc888c99391748d3f5e/html5/thumbnails/31.jpg)
REVISIT THE ORIGINAL CDC/KAISER ACES STUDY:
• Original question arose in 1985 in obesity clinic
• CDC partnered study spanned 1995-1997
• Kaiser Permanente in San Diego, CA
• 17,421 mostly middle-class adult participants
• 80% white, 10% black, 10% Asian
• 74% college-educated
• Average age: 57
Vincent Feletti, M.D.
Robert Anda, M.D., M.S.
Almost 2/3 had at least 1 ACE
40% had 2 or more ACEs
One in five had >3 ACEs
Continua Consulting Group, LLCLauren Ashbaugh, Ph.D., NCSP
![Page 32: BUILDING RESILIENCE E Szabo C., KelemanO., & Keri S. (2013) Bol Psychiatry Lauren Ashbaugh, Ph.D., NCSP Continua Consulting Group, LLC NOW THAT WE KNOW, WHAT DO WE NEED? Lauren Ashbaugh,](https://reader030.vdocuments.us/reader030/viewer/2022041200/5d40dcc888c99391748d3f5e/html5/thumbnails/32.jpg)
WHAT DOES THIS MEAN ABOUT OUR STAFF? OURSELVES?
ASSUME ACES
Are we walking the talk?
With ourselves?
With each other?
ASSUME SECONDARY TRAUMATIZATION/COMPASSION FATIGUE
Continua Consulting Group, LLCLauren Ashbaugh, Ph.D., NCSP
![Page 33: BUILDING RESILIENCE E Szabo C., KelemanO., & Keri S. (2013) Bol Psychiatry Lauren Ashbaugh, Ph.D., NCSP Continua Consulting Group, LLC NOW THAT WE KNOW, WHAT DO WE NEED? Lauren Ashbaugh,](https://reader030.vdocuments.us/reader030/viewer/2022041200/5d40dcc888c99391748d3f5e/html5/thumbnails/33.jpg)
LANGUAGE
Toxic Stress
Adversity, Challenges, Setbacks
Chronic Trauma
Are we supporting a deficit model?
Are we underemphasizing resilience?
Continua Consulting Group, LLCLauren Ashbaugh, Ph.D., NCSP
![Page 34: BUILDING RESILIENCE E Szabo C., KelemanO., & Keri S. (2013) Bol Psychiatry Lauren Ashbaugh, Ph.D., NCSP Continua Consulting Group, LLC NOW THAT WE KNOW, WHAT DO WE NEED? Lauren Ashbaugh,](https://reader030.vdocuments.us/reader030/viewer/2022041200/5d40dcc888c99391748d3f5e/html5/thumbnails/34.jpg)
WHY WAS THE ACES STUDY REVOLUTIONARY?WE DON’T LIKE TO SIT WITH TRAUMA
5
Continua Consulting Group, LLCLauren Ashbaugh, Ph.D., NCSP
![Page 35: BUILDING RESILIENCE E Szabo C., KelemanO., & Keri S. (2013) Bol Psychiatry Lauren Ashbaugh, Ph.D., NCSP Continua Consulting Group, LLC NOW THAT WE KNOW, WHAT DO WE NEED? Lauren Ashbaugh,](https://reader030.vdocuments.us/reader030/viewer/2022041200/5d40dcc888c99391748d3f5e/html5/thumbnails/35.jpg)
EVIDENCE-BASEDTREATMENTS
FOR PTSD
Heal the wound
Enhance strengths
Continua Consulting Group, LLC
Lauren Ashbaugh, Ph.D., NCSP
![Page 36: BUILDING RESILIENCE E Szabo C., KelemanO., & Keri S. (2013) Bol Psychiatry Lauren Ashbaugh, Ph.D., NCSP Continua Consulting Group, LLC NOW THAT WE KNOW, WHAT DO WE NEED? Lauren Ashbaugh,](https://reader030.vdocuments.us/reader030/viewer/2022041200/5d40dcc888c99391748d3f5e/html5/thumbnails/36.jpg)
HISTORICAL CONSEQUENCE OF AVOIDANCE
• Missed opportunities for intervention
• Misdiagnosis and misuse of funds
• Neglect of impact on society, community, individuals
• Erasing history to avoid responsibility, accountability
• Perpetuate shame, guilt, overresponsibility in survivors
Continua Consulting Group, LLCLauren Ashbaugh, Ph.D., NCSP
![Page 37: BUILDING RESILIENCE E Szabo C., KelemanO., & Keri S. (2013) Bol Psychiatry Lauren Ashbaugh, Ph.D., NCSP Continua Consulting Group, LLC NOW THAT WE KNOW, WHAT DO WE NEED? Lauren Ashbaugh,](https://reader030.vdocuments.us/reader030/viewer/2022041200/5d40dcc888c99391748d3f5e/html5/thumbnails/37.jpg)
WE ARE ALONE WITH IT.
WE LEAVE OTHERS ALONE WITH IT.
Continua Consulting Group, LLCLauren Ashbaugh, Ph.D., NCSP
![Page 38: BUILDING RESILIENCE E Szabo C., KelemanO., & Keri S. (2013) Bol Psychiatry Lauren Ashbaugh, Ph.D., NCSP Continua Consulting Group, LLC NOW THAT WE KNOW, WHAT DO WE NEED? Lauren Ashbaugh,](https://reader030.vdocuments.us/reader030/viewer/2022041200/5d40dcc888c99391748d3f5e/html5/thumbnails/38.jpg)
Toxic Stress & the Brain
• Overactive ”Fight, Flight, or Freeze” – amygdala changes
• Changes to reward system functioning and pleasure centers (VTA)
• Structural changes to executive functioning/prefrontal cortex
• Memory center: hippocampal neurotoxicity; reduced volume
Ulrich-Lai 2009, Roth 1988, Iperato1991, Charmandari2005, McEwen 2010, McEwen 2007, Bierhauset al. 2003; Kiecolt-Glaser et al. 2003
Continua Consulting Group, LLC
Can result in:
Lauren Ashbaugh, Ph.D., NCSP
![Page 39: BUILDING RESILIENCE E Szabo C., KelemanO., & Keri S. (2013) Bol Psychiatry Lauren Ashbaugh, Ph.D., NCSP Continua Consulting Group, LLC NOW THAT WE KNOW, WHAT DO WE NEED? Lauren Ashbaugh,](https://reader030.vdocuments.us/reader030/viewer/2022041200/5d40dcc888c99391748d3f5e/html5/thumbnails/39.jpg)
• inflammation
• Infection
• cardiovascular problems
• chronic diseases
Toxic Stress & the Body
Ulrich-Lai 2009, Roth 1988, Iperato1991, Charmandari2005, McEwen 2010, McEwen 2007, Bierhauset al. 2003; Kiecolt-Glaser et al. 2003
Continua Consulting Group, LLC
• HPA axis & cortisol response
• Adrenaline
• Growth hormone/thyroid
• Pubertal hormones
• Levels of leptin and ghrelin
• satiety & appetite
Miller 2007
Increased risk of changes to:Increased risk of:
Lauren Ashbaugh, Ph.D., NCSP
![Page 40: BUILDING RESILIENCE E Szabo C., KelemanO., & Keri S. (2013) Bol Psychiatry Lauren Ashbaugh, Ph.D., NCSP Continua Consulting Group, LLC NOW THAT WE KNOW, WHAT DO WE NEED? Lauren Ashbaugh,](https://reader030.vdocuments.us/reader030/viewer/2022041200/5d40dcc888c99391748d3f5e/html5/thumbnails/40.jpg)
• Epigenetic changes & impact
• Biological mechanisms that turn genes on and off
• Affected by what you eat, where you live, how you
sleep, exercise, aging, and by your experiences
Toxic Stress & the Body
Su 2014
Continua Consulting Group, LLCLauren Ashbaugh, Ph.D., NCSP
![Page 41: BUILDING RESILIENCE E Szabo C., KelemanO., & Keri S. (2013) Bol Psychiatry Lauren Ashbaugh, Ph.D., NCSP Continua Consulting Group, LLC NOW THAT WE KNOW, WHAT DO WE NEED? Lauren Ashbaugh,](https://reader030.vdocuments.us/reader030/viewer/2022041200/5d40dcc888c99391748d3f5e/html5/thumbnails/41.jpg)
Toxic Stress & the Body
Childhood
Learning difficulties
Behavioral difficulties
Asthma & allergies
Infections
Atopic diseases
Pneumonia
Early Childhood
Developmental delay
Growth delay
Failure to thrive
Sleep disruption
Behavioral disruption
Adolescence
Learning difficulties
Behavioral difficulties
Obesity
Diabetes
Headache & abdominal pain
Hyperthyroidism
Pubertal changes
Adapted from: Burke-Harris 2018; Oh et al., in press, Matheson, 2016; Kerker 2015, Shen 2016, Ryan 2015, Giordano 2014, Rhodes 2012, Thompson 2017, Bjorkenstam 2015
Continua Consulting Group, LLC
6
Lauren Ashbaugh, Ph.D., NCSP
![Page 42: BUILDING RESILIENCE E Szabo C., KelemanO., & Keri S. (2013) Bol Psychiatry Lauren Ashbaugh, Ph.D., NCSP Continua Consulting Group, LLC NOW THAT WE KNOW, WHAT DO WE NEED? Lauren Ashbaugh,](https://reader030.vdocuments.us/reader030/viewer/2022041200/5d40dcc888c99391748d3f5e/html5/thumbnails/42.jpg)
What does trauma look like in a classroom?
Arousal & Reactivity
Avoidance
Distorted thinking
Reexperiencing
Sleep disturbanceProblems concentrating
It’s not safe. I’m not safe. Gotta watch my back.
No way will I stay in that class.
(I could be embarrassed or fail again.)
I will fail if I try.
It happened because of me.
He sounds just like my stepdad.
I hate being yelled at.
I’m so tired. I can’t stay awake. I – I’m confused. Did we do this
yesterday?
I don’t know why I blew up like that
Continua Consulting Group, LLCLauren Ashbaugh, Ph.D., NCSP
![Page 43: BUILDING RESILIENCE E Szabo C., KelemanO., & Keri S. (2013) Bol Psychiatry Lauren Ashbaugh, Ph.D., NCSP Continua Consulting Group, LLC NOW THAT WE KNOW, WHAT DO WE NEED? Lauren Ashbaugh,](https://reader030.vdocuments.us/reader030/viewer/2022041200/5d40dcc888c99391748d3f5e/html5/thumbnails/43.jpg)
Symptom PTSD Depression ADHD Anxiety ODD (Oppositional)
Anger/Irritability X X X
Difficulty concentrating X X X X
Recklessness/impulsivity X X X
Trouble sleeping X X X
Social problems X X X X X
Lack of interest X X
Difficulty relaxing X X
Agitation/Restlessness X X X X
Youth Mental Health and Symptom Overlap:
Is it really ADHD?
Lauren Ashbaugh, Ph.D., NCSP
![Page 44: BUILDING RESILIENCE E Szabo C., KelemanO., & Keri S. (2013) Bol Psychiatry Lauren Ashbaugh, Ph.D., NCSP Continua Consulting Group, LLC NOW THAT WE KNOW, WHAT DO WE NEED? Lauren Ashbaugh,](https://reader030.vdocuments.us/reader030/viewer/2022041200/5d40dcc888c99391748d3f5e/html5/thumbnails/44.jpg)
TRIGGERS:
• Can be external (environment) reminders or internal (eg., thoughts)
• Can be reminders of the feelings related to the event(s)
• Guilt, shame, worthlessness, powerlessness
• Embarrassment, humiliation, rage
If the response seems to be much bigger than the situation
seems to call for, there is likely powerful historical context.
Lauren Ashbaugh, Ph.D., NCSP
![Page 45: BUILDING RESILIENCE E Szabo C., KelemanO., & Keri S. (2013) Bol Psychiatry Lauren Ashbaugh, Ph.D., NCSP Continua Consulting Group, LLC NOW THAT WE KNOW, WHAT DO WE NEED? Lauren Ashbaugh,](https://reader030.vdocuments.us/reader030/viewer/2022041200/5d40dcc888c99391748d3f5e/html5/thumbnails/45.jpg)
We know that toxic stress changes the body.
Positive experiences do too.
Continua Consulting Group, LLC
7
Lauren Ashbaugh, Ph.D., NCSP
![Page 46: BUILDING RESILIENCE E Szabo C., KelemanO., & Keri S. (2013) Bol Psychiatry Lauren Ashbaugh, Ph.D., NCSP Continua Consulting Group, LLC NOW THAT WE KNOW, WHAT DO WE NEED? Lauren Ashbaugh,](https://reader030.vdocuments.us/reader030/viewer/2022041200/5d40dcc888c99391748d3f5e/html5/thumbnails/46.jpg)
• General definition: The quality of being shaped or molded.
• Biology: The adaptability of an organism to changes in its environment or
differences between its various habitats.
• Neuroscience: The brain’s ability to change – for better or for worse
What is plasticity?
Continua Consulting Group, LLCLauren Ashbaugh, Ph.D., NCSP
![Page 47: BUILDING RESILIENCE E Szabo C., KelemanO., & Keri S. (2013) Bol Psychiatry Lauren Ashbaugh, Ph.D., NCSP Continua Consulting Group, LLC NOW THAT WE KNOW, WHAT DO WE NEED? Lauren Ashbaugh,](https://reader030.vdocuments.us/reader030/viewer/2022041200/5d40dcc888c99391748d3f5e/html5/thumbnails/47.jpg)
Changing thoughts, changing body
12 week course of CBT for PTSD
• Statistical increase in hippocampal volume
• Significant increase in gene expression of FKBP5
• Significant improvement in PTSD symptoms
Levi-Gigi, E Szabo C., Keleman O., & Keri S. (2013) Bol Psychiatry
Continua Consulting Group, LLCLauren Ashbaugh, Ph.D., NCSP
![Page 48: BUILDING RESILIENCE E Szabo C., KelemanO., & Keri S. (2013) Bol Psychiatry Lauren Ashbaugh, Ph.D., NCSP Continua Consulting Group, LLC NOW THAT WE KNOW, WHAT DO WE NEED? Lauren Ashbaugh,](https://reader030.vdocuments.us/reader030/viewer/2022041200/5d40dcc888c99391748d3f5e/html5/thumbnails/48.jpg)
NOW THAT WE KNOW, WHAT DO WE NEED?
Continua Consulting Group, LLCLauren Ashbaugh, Ph.D., NCSP
![Page 49: BUILDING RESILIENCE E Szabo C., KelemanO., & Keri S. (2013) Bol Psychiatry Lauren Ashbaugh, Ph.D., NCSP Continua Consulting Group, LLC NOW THAT WE KNOW, WHAT DO WE NEED? Lauren Ashbaugh,](https://reader030.vdocuments.us/reader030/viewer/2022041200/5d40dcc888c99391748d3f5e/html5/thumbnails/49.jpg)
Between stimulus and response, there is a space.
In that space lies our freedom and our power to choose our response.
In our response lies our growth and our happiness.
-Steven R. Covey, summarizing Viktor Frankl’s work
![Page 50: BUILDING RESILIENCE E Szabo C., KelemanO., & Keri S. (2013) Bol Psychiatry Lauren Ashbaugh, Ph.D., NCSP Continua Consulting Group, LLC NOW THAT WE KNOW, WHAT DO WE NEED? Lauren Ashbaugh,](https://reader030.vdocuments.us/reader030/viewer/2022041200/5d40dcc888c99391748d3f5e/html5/thumbnails/50.jpg)
RESEARCH ON RESILIENCE
1st wave: Inherent characteristics of the children that fared better than others
2nd wave: How resilience factors of children led to better outcomes
3rd wave:
How do we promote resilience through prevention, intervention, and policy change?
1. Traub, F & Boynton-Jarrett, R. 2017
Lauren Ashbaugh, Ph.D., NCSP
![Page 51: BUILDING RESILIENCE E Szabo C., KelemanO., & Keri S. (2013) Bol Psychiatry Lauren Ashbaugh, Ph.D., NCSP Continua Consulting Group, LLC NOW THAT WE KNOW, WHAT DO WE NEED? Lauren Ashbaugh,](https://reader030.vdocuments.us/reader030/viewer/2022041200/5d40dcc888c99391748d3f5e/html5/thumbnails/51.jpg)
RESILIENCE
“Far from being inherent to the child, resilience
results from a complex interplay between the
child’s genetics, natural temperament, knowledge
and skills, past experiences, social supports, and
cultural and societal resources.”
- Traub, F & Boynton-Jarrett, R. 2017, emphasis mine
Lauren Ashbaugh, Ph.D., NCSP
![Page 52: BUILDING RESILIENCE E Szabo C., KelemanO., & Keri S. (2013) Bol Psychiatry Lauren Ashbaugh, Ph.D., NCSP Continua Consulting Group, LLC NOW THAT WE KNOW, WHAT DO WE NEED? Lauren Ashbaugh,](https://reader030.vdocuments.us/reader030/viewer/2022041200/5d40dcc888c99391748d3f5e/html5/thumbnails/52.jpg)
TWO-PRONGS, SAME IDEA
Prevention
Reduce harm/exposures
Increase regulation & adaptive coping
Enhance positive identity formation, tenacity, competence
Increase connection and deepen meaningful relationships
Continua Consulting Group, LLCLauren Ashbaugh, Ph.D., NCSP
Prevention
Reduce harm/exposures
Increase regulation & adaptive coping
Enhance positive identity formation, tenacity, competence
Increase connection and deepen meaningful relationships
![Page 53: BUILDING RESILIENCE E Szabo C., KelemanO., & Keri S. (2013) Bol Psychiatry Lauren Ashbaugh, Ph.D., NCSP Continua Consulting Group, LLC NOW THAT WE KNOW, WHAT DO WE NEED? Lauren Ashbaugh,](https://reader030.vdocuments.us/reader030/viewer/2022041200/5d40dcc888c99391748d3f5e/html5/thumbnails/53.jpg)
Sleep Mindfulness
Exercise Healthy Relationships
Nutrition Mental Health
EVIDENCE-BASED RESILIENCE BUILDING
Continua Consulting Group, LLCLauren Ashbaugh, Ph.D., NCSP
![Page 54: BUILDING RESILIENCE E Szabo C., KelemanO., & Keri S. (2013) Bol Psychiatry Lauren Ashbaugh, Ph.D., NCSP Continua Consulting Group, LLC NOW THAT WE KNOW, WHAT DO WE NEED? Lauren Ashbaugh,](https://reader030.vdocuments.us/reader030/viewer/2022041200/5d40dcc888c99391748d3f5e/html5/thumbnails/54.jpg)
ANY DATA ON THOSE?
• Sleep: Rosenbaum, Vancamfort, & Steel et al (2015) Psychiatry Research
• Exercise: Ho, Chan, & Tang (2016). Psychiatry Research
Talbot, Maguen, & Metzler et al (2014) Sleep
• Nutrition: Clay (2017) Monitor on Psychology
• Mindfulness: Ortiz & Siibinga (2017) Children
• Healthy Relationships: Jaffe et al (2013) J of Adolescent Health
• Mental Health: Rolfsnes & Idsoe (2011) J of Traumatic Stress;
Kowalick et al (2011) J of Behavior Therapy and Experimental Psychiatry
Continua Consulting Group, LLCLauren Ashbaugh, Ph.D., NCSP
![Page 55: BUILDING RESILIENCE E Szabo C., KelemanO., & Keri S. (2013) Bol Psychiatry Lauren Ashbaugh, Ph.D., NCSP Continua Consulting Group, LLC NOW THAT WE KNOW, WHAT DO WE NEED? Lauren Ashbaugh,](https://reader030.vdocuments.us/reader030/viewer/2022041200/5d40dcc888c99391748d3f5e/html5/thumbnails/55.jpg)
INCREASING SAFETY, REGULATION, CONNECTION
• Diet, exercise, sleep
education, access, advocacy, opportunity, parent engagement, health care
• Family health & engagement
connecting resources, increasing engagement, collaboration
• Social competence & belonging
SEL, culturally responsive, restorative practices, activities, leadership opportunities
• Executive functioning, locus of control, growth mindset, grit, optimism
PBIS; clear, consistent, predictable, rigorous content, high expectations
• Facing fears, reappraising experiences
counseling, mental health, cognitive therapy, graduated exposure, mindfulness
8
Lauren Ashbaugh, Ph.D., NCSP
![Page 56: BUILDING RESILIENCE E Szabo C., KelemanO., & Keri S. (2013) Bol Psychiatry Lauren Ashbaugh, Ph.D., NCSP Continua Consulting Group, LLC NOW THAT WE KNOW, WHAT DO WE NEED? Lauren Ashbaugh,](https://reader030.vdocuments.us/reader030/viewer/2022041200/5d40dcc888c99391748d3f5e/html5/thumbnails/56.jpg)
Continua Consulting Group, LLC
![Page 57: BUILDING RESILIENCE E Szabo C., KelemanO., & Keri S. (2013) Bol Psychiatry Lauren Ashbaugh, Ph.D., NCSP Continua Consulting Group, LLC NOW THAT WE KNOW, WHAT DO WE NEED? Lauren Ashbaugh,](https://reader030.vdocuments.us/reader030/viewer/2022041200/5d40dcc888c99391748d3f5e/html5/thumbnails/57.jpg)
Predictability
Consistent expectations
High expectations
Welcoming and warm
Engaging content and approach
Opportunities to start over
Avoiding power struggles
Opportunities for leadership
Co-Constructed Norms
Classroom community
Tier I: T-MTSS Principles
Arousal
Avoidance
Sudden, intense anger
Distorted thoughts
Concentration problems
Reexperiencing
Sleep problems
I can be safe here
I am valued here
I can be successful here
I am worth something
I matter to other people
Mistakes are learning
People believe in me.
Symptoms of trauma
I can trust other people
Why T-MTSS?
How does T-MTSS relate to a trauma-responsive school?
Lauren Ashbaugh, Ph.D., NCSP
![Page 58: BUILDING RESILIENCE E Szabo C., KelemanO., & Keri S. (2013) Bol Psychiatry Lauren Ashbaugh, Ph.D., NCSP Continua Consulting Group, LLC NOW THAT WE KNOW, WHAT DO WE NEED? Lauren Ashbaugh,](https://reader030.vdocuments.us/reader030/viewer/2022041200/5d40dcc888c99391748d3f5e/html5/thumbnails/58.jpg)
MECHANISM: HEALTHY RELATIONSHIPS
Continua Consulting Group, LLCLauren Ashbaugh, Ph.D., NCSP
![Page 59: BUILDING RESILIENCE E Szabo C., KelemanO., & Keri S. (2013) Bol Psychiatry Lauren Ashbaugh, Ph.D., NCSP Continua Consulting Group, LLC NOW THAT WE KNOW, WHAT DO WE NEED? Lauren Ashbaugh,](https://reader030.vdocuments.us/reader030/viewer/2022041200/5d40dcc888c99391748d3f5e/html5/thumbnails/59.jpg)
A SECURE, SUPPORTIVE RELATIONSHIP WITH AN ADULT
Dr. Emmy Werner
Hawaii: 700 people over 40 years – all the babies born on the island of Kauai in 1955 —from infancy through
adolescence and adulthood.
Werner found that one-third of the high-risk children grew into adults who were caring and successful.
“Having a secure, supportive relationship in early childhood is one of best predictors of whether you’d be resilient later in
childhood and into adulthood. If you had at least one relationship where people were able to do that soothing,
protecting…or help you build strength, if you had at least that one relationship at least that could protect you from many
other stress exposures.”
Lauren Ashbaugh, Ph.D., NCSP
![Page 60: BUILDING RESILIENCE E Szabo C., KelemanO., & Keri S. (2013) Bol Psychiatry Lauren Ashbaugh, Ph.D., NCSP Continua Consulting Group, LLC NOW THAT WE KNOW, WHAT DO WE NEED? Lauren Ashbaugh,](https://reader030.vdocuments.us/reader030/viewer/2022041200/5d40dcc888c99391748d3f5e/html5/thumbnails/60.jpg)
A trauma-informed practice requires us to respond neutrally or constructively.
How do we increase reflection, compassion, and curiosity?
A SECURE, SUPPORTIVE RELATIONSHIP WITH AN ADULT
Continua Consulting Group, LLCLauren Ashbaugh, Ph.D., NCSP
![Page 61: BUILDING RESILIENCE E Szabo C., KelemanO., & Keri S. (2013) Bol Psychiatry Lauren Ashbaugh, Ph.D., NCSP Continua Consulting Group, LLC NOW THAT WE KNOW, WHAT DO WE NEED? Lauren Ashbaugh,](https://reader030.vdocuments.us/reader030/viewer/2022041200/5d40dcc888c99391748d3f5e/html5/thumbnails/61.jpg)
WORKING TOWARDS A TRAUMA-INFORMED SYSTEM
Key principles of a trauma-informed approach:
1. Safety (physical and emotional)
2. Trustworthiness and transparency
3. Peer support
4. Collaboration and mutuality
5. Empowerment, voice, and choice
6. Recognition of historical and ongoing systematic traumatization
Source: SAMHSA, 2018Lauren Ashbaugh, Ph.D., NCSP
![Page 62: BUILDING RESILIENCE E Szabo C., KelemanO., & Keri S. (2013) Bol Psychiatry Lauren Ashbaugh, Ph.D., NCSP Continua Consulting Group, LLC NOW THAT WE KNOW, WHAT DO WE NEED? Lauren Ashbaugh,](https://reader030.vdocuments.us/reader030/viewer/2022041200/5d40dcc888c99391748d3f5e/html5/thumbnails/62.jpg)
Lauren Ashbaugh, Ph.D., NCSP
![Page 63: BUILDING RESILIENCE E Szabo C., KelemanO., & Keri S. (2013) Bol Psychiatry Lauren Ashbaugh, Ph.D., NCSP Continua Consulting Group, LLC NOW THAT WE KNOW, WHAT DO WE NEED? Lauren Ashbaugh,](https://reader030.vdocuments.us/reader030/viewer/2022041200/5d40dcc888c99391748d3f5e/html5/thumbnails/63.jpg)
Anticipate needs and create safe environments
Maintain composure in the face of fear and uncertainty
Respond to crises without personalizing, becoming defensive, or panicking
Perform to the best of our ability when we are needed most
Lean on and build the strengths of others; empower and support
What do we need from our pilot and flight crew?
Continua Consulting Group, LLCLauren Ashbaugh, Ph.D., NCSP
![Page 64: BUILDING RESILIENCE E Szabo C., KelemanO., & Keri S. (2013) Bol Psychiatry Lauren Ashbaugh, Ph.D., NCSP Continua Consulting Group, LLC NOW THAT WE KNOW, WHAT DO WE NEED? Lauren Ashbaugh,](https://reader030.vdocuments.us/reader030/viewer/2022041200/5d40dcc888c99391748d3f5e/html5/thumbnails/64.jpg)
“We all carry within us places of exile, our crimes, our
ravages. Our task is not to unleash them on the world;
it is to transform them in ourselves and others.”
― Albert Camus
Continua Consulting Group, LLCLauren Ashbaugh, Ph.D., NCSP
![Page 65: BUILDING RESILIENCE E Szabo C., KelemanO., & Keri S. (2013) Bol Psychiatry Lauren Ashbaugh, Ph.D., NCSP Continua Consulting Group, LLC NOW THAT WE KNOW, WHAT DO WE NEED? Lauren Ashbaugh,](https://reader030.vdocuments.us/reader030/viewer/2022041200/5d40dcc888c99391748d3f5e/html5/thumbnails/65.jpg)
ATTENDING TO YOURSELF IS TAKING CARE OF THEM.
• Kids respond to our emotions and reactions.
• Kids know when adults are lying or are inauthentic.
• We need to model what we want to see in them.
• We need to be able to problem-solve with peers for their benefit.
What are you most afraid of in your building/office/classroom?
Who do you go to for help? How safe does it feel to ask for help?
Continua Consulting Group, LLCLauren Ashbaugh, Ph.D., NCSP
![Page 66: BUILDING RESILIENCE E Szabo C., KelemanO., & Keri S. (2013) Bol Psychiatry Lauren Ashbaugh, Ph.D., NCSP Continua Consulting Group, LLC NOW THAT WE KNOW, WHAT DO WE NEED? Lauren Ashbaugh,](https://reader030.vdocuments.us/reader030/viewer/2022041200/5d40dcc888c99391748d3f5e/html5/thumbnails/66.jpg)
IT’S A MINDSET, AND PRACTICES ARISE FROM MINDSET
• Students (and staff) want to do well.
• Something (skills deficit, crisis) may be getting in their way.
• Students and staff have tremendous potential and strengths. Build up both.
• Behavior has meaning and function. Look for both.
• Value the person, address the behavior
• Asking for help is a sign of strength and reflectiveness.
• Everyone needs help and connection.
Continua Consulting Group, LLC
9
Lauren Ashbaugh, Ph.D., NCSP
![Page 67: BUILDING RESILIENCE E Szabo C., KelemanO., & Keri S. (2013) Bol Psychiatry Lauren Ashbaugh, Ph.D., NCSP Continua Consulting Group, LLC NOW THAT WE KNOW, WHAT DO WE NEED? Lauren Ashbaugh,](https://reader030.vdocuments.us/reader030/viewer/2022041200/5d40dcc888c99391748d3f5e/html5/thumbnails/67.jpg)
UNIQUE
https://changingmindsnow.org/
![Page 68: BUILDING RESILIENCE E Szabo C., KelemanO., & Keri S. (2013) Bol Psychiatry Lauren Ashbaugh, Ph.D., NCSP Continua Consulting Group, LLC NOW THAT WE KNOW, WHAT DO WE NEED? Lauren Ashbaugh,](https://reader030.vdocuments.us/reader030/viewer/2022041200/5d40dcc888c99391748d3f5e/html5/thumbnails/68.jpg)
INSPIRATIONS
Laura van Dernoot Lipsky, MSW Rachel Lloyd, MA
Mary Oliver , Ph.D. Viktor Frankl, MD, Ph.D.
Jackson Katz, Ph.D. Patricia Resick, Ph.D.
Nadine Burke-Harris, MD, MPH
Robert Waldinger, MD Audre Lorde, MLS
Documentary: The Mask You Live In Documentary: Miss Representation
Continua Consulting Group, LLCLauren Ashbaugh, Ph.D., NCSP