Project Reassure: For Families and Caregivers

Defining Trauma:

Around the world, about 7 out of every 10 people go through a traumatic experience during their life. Going through trauma in the past increases your chances of having more trauma in the future.

Trauma can change the way signals in the brain get sent to the rest of the body. Some effects of trauma can be seen right away, and some effects last for years. Some people may try to control trauma responses by overeating, drinking, or using drugs. Medical professionals often treat the symptoms of trauma without realizing what caused the symptoms.

• Trauma can be caused by many different things. Some of the most common experiences that cause trauma are neglect, abuse, sex trafficking, violence in the community or at school, serious accidents, separation from caregivers, and experiences with racism.
• Trauma and stress related disorders can happen in many different ways. People may go through an event themselves. For others, they may have trauma reactions from listening to others and learning about the event from someone else.

It’s important to realize everyone’s body may react differently, even if they are in the same situation. The brain signals and the way a person is supported by others can change how the body reacts to a traumatic experience. For some people, it may feel like “no big deal.” For other people, it could change the entire rest of their life.

Prevalence of Trauma:

One of the first major studies of trauma happened in the 1980’s. A lot of research has been done since that time. Thousands of people have been interviewed in the United States and all over the world.

Here is some information to help you understand how common trauma is.

• 70% of people around the world have been through at least 1 traumatic event.
• 82% of Americans have been through at least 1 traumatic event.
• 30% of people have been through at least 4 traumatic events.

One of the most famous studies of trauma was known as the ACES Study. The ACES Study has looked at the way trauma in kids can affect their health as an adult. 52% of people in the study had at least 1 traumatic experience as a child or teenager. As an adult they were at a higher risk for all of these problems:

• Heart disease
• Strokes
• Asthma
• Kidney disease
• COPD
• Cancer
• Risk of smoking
• Alcoholism
• Drug abuse
• Depression
• Obesity
• Suicide attempts
• STDs

Difficulties and Frustrations:

Recently there have been more efforts to support people with disabilities to get mental health treatment. There are some things that can make this treatment more difficult. This resource highlights three of the main challenges in offering treatment to individuals with disabilities. As a family member or caregiver, it is important to recognize what issues might be evident when trying to get the right support for your child.

Not enough knowledge about adults:

• A lot of the interest and support in the past has been on kids and teens rather than adults.
• Many therapists are not trained to work with people with disabilities as part of their classes in school.
• Most therapy treatments were designed for people without disabilities. There can be a lot of confusion about how to use those treatments with people with disabilities.

The challenges of autism and other developmental disorders:

• One of the most important parts of therapy is the relationship between therapist and client. However, people with autism can have difficulty building and maintaining relationships.
• Another common part of therapy is recognizing thoughts, emotions and feelings. The therapist helps the client to analyze and understand those experiences. People with autism often have trouble with their communication. They also might struggle with recognizing, naming and understanding their emotions.

Stress:

People who support or care for autistic individuals tend to feel more stress. Caregivers often share concerns about a lack of training and skills. They might question their ability to provide quality care. Raising or caring for more than one child with disabilities can be overwhelming. This can lead to selfdoubt, frustration, and burned out.

Consciousness

Consciousness refers to a person’s awareness. It could be an awareness of ourselves or the things around us. Consciousness is strongly influenced by the parts of our brains that we use for planning, problem-solving and other complicated tasks.

In the survival circuit, the first two steps are both automatic and unconscious. The brain claims something is a possible threat and sends signals to the body to be prepared for it. All of that happens before somebody is conscious of what is happening.

When the survival circuit gets activated, the future and planning parts of our brains get turned off. If we are in a real moment of danger, our brains want to react quickly. They don’t want to be distracted by anything else.

For individuals who experience post-traumatic stress disorder (PTSD) and have an overactive survival circuit, their brains could be sending warning signals of danger almost constantly. This can make it hard for them to keep their attention or even make plans. It also changes how they understand things in the world. People with an overactive survival circuit may overestimate or underestimate how risky certain choices are.

The Survival Circuit & PTSD

The survival circuit describes how the brain and body respond to threats. The survival circuit is a normal and natural part of being human. The survival circuit helps us to handle any threats that could threaten our safety. There are four main steps in the circuit:

1. Something that we see, hear, smell, taste or touch alerts the brain that there could be danger. The brain reacts immediately, unconsciously, and automatically.
2. The brain sends signals throughout the body to prepare for possible danger. It uses nerve cells that are called the sympathetic nervous system. Just like in step 1, the signals to the body are sent immediately, unconsciously and automatically.
   • Some examples of how the body reacts to these signals are:
   • Heart rate increases.
   • Breathing gets faster.
   • Body starts to sweat.
   • Digestion slows down or stops.
3. Other parts of the brain start to look at what is happening and try to gather more information. The brain compares what is happening to memories and other things we know. The brain tries to determine whether the threat is real or not.
4. If the brain decides the threat is not real or that it can be controlled, signals are sent to the body to begin relaxing. Nerve cells in the parasympathetic nervous system help the body to go back to normal.

Trauma changes the way brain cells connect to each other. In post-traumatic stress disorder (PTSD), the survival circuit becomes overreactive and sensitive to anything that might seem like a threat.

• The parts of the brain involved in fear production become over active.
• The parts of the brain that control fear, calm us down, and help us learn to overcome anxiety all get suppressed.
• The alarm signals from the brain may stay active, even when the threat is no longer present.
• The survival circuit may activate due to memories or reminders of memories. This includes objects and other things in the environment that do not actually pose a threat.
• When the person comes across these reminders or memories, they may have strong reactions and behaviors that don’t seem to fit the current situation.

Trauma can impact a person’s attention, memory (both short-term and long-term), and how they process information. The brain changes the way a person sees, experiences, and understands the world. These changes in the brain typically result in new behaviors, which are often labeled as symptoms. These symptoms can lead to a variety of problems and diagnoses. Many professionals frequently focus on the symptoms and overlook the person’s trauma experience.

The Four F’s

When your brain detects a threat, your body will react to
survive. It does not matter if the threat is real or not.
There are four common ways people will react to threats:

Being resilient, or having resilience, means being able to deal with
and quickly recover from a problem. Resilience allows individuals to
be flexible when something happens. They can think about what
happened to them and learn to how to change, respond, and heal.

Why is Resilience Important?

Resilience is important because it helps people deal with the bad things that happen to them. This means that people are strong enough to recover from difficult situations.

Resilience allows us to manage things in a healthy way and stay or get back on track when we are faced with difficult situations.
When we have resilience, it means that we’re able to face difficult things and keep moving forward.

People with less resilience may use unhealthy ways to overcome tough times. This can often lead to more issues later.
It can also make it difficult to fully recover from the stressful or traumatic event that happened in the first place.

How Do You Know if You’re Resilient?

Everyone is resilient but you can always learn, grow, and strengthen the resilience you have.

If you have ever fallen to the ground and were able to get it back up, then you’re resilient. Even if you had help getting back up, you still have resilience. Being resilient doesn’t mean only relying on yourself to get through difficult times but learning to lean on support systems to work through challenges when needed.

Becoming more resilient also doesn’t mean you won’t experience stress or any other difficult emotions anymore. However, it does mean that while you may experience difficult times in your life, you are able to cope with those situations and get stronger because of them.

Resilience skills are a set of skills that can help you to build your resilience and stay within the resilient or “OK” zone. There are six different resilience skills that can be practiced and used to widen your zone. The resilience skills can also help you monitor where you are in the zone and realize when you may be starting to feel stressed and get pushed toward the edges of your zone. These skills can be used alone or together to help you stay in or get back into your resilient zone. 

Resilience Skills

• Tracking: This skill helps someone figure out where they are in the resilient zone by paying attention to their thoughts and senses.
• Resourcing: This skill can help when someone is near the edge of their resilient zone or if they’ve been bumped out of it, by paying
  attention to memories, people, places, things, and ideas that help them feel better.
• Grounding: This is a good skill to use when someone is having trouble staying in their resilient zone by paying attention to things that are around them at the moment.
• Gesturing: This is another skill someone can use to help move themselves away from the edges of their resilient zone by paying attention to their movements and using gestures to help them relax.
• Shift and Stay: This skill is a powerful way to help someone stay in their resilient zone by learning to shift their own thoughts away from things that are bothering them to stay on neutral or happier thoughts.
• Help Now!: This is a skill that can be used if someone is stuck outside their resilient zone. These strategies focus on calming
  their body and bringing them closer to their resilient zone.

Recognizing and Managing a Mental Health Crisis

A mental health crisis means that a person’s feelings or problems are so strong that they cannot do what they need to do that day. A mental health crisis may also mean that the person is at risk of hurting themselves or others.

Signs of a mental health crisis:

These are some common signs that a person may be having a mental health crisis:

• Not able to do daily activities like bathing, brushing teeth, or changing clothes.
• Changes in mood, increased energy level, or restless.
• Suddenly sad, withdrawn, not wanting to be around other people.
• Angry, verbal threats, violent, destroying property.
• Using drugs or other substances, self-harm like cutting, abusive behavior.
• Not able to recognize family or friends, confused, strange ideas, thinks they are someone they are not, hearing voices, seeing things that are not there.

How long does a mental health crisis last?

Sometimes a crisis will only last a few minutes, other times a crisis can last for days or months. It depends on how quickly the person is able to get help and the type of coping skills they have. If a person is able to widen their resilient or “OK” zone they may be able to recover from a mental health crisis more quickly.

What should I do if my child or the person I care for is having a mental health crisis:

The most important thing to do in a crisis is to TELL SOMEONE, this could be talking to you as their parent or caregiver, a friend, other support staff, therapist, or trusted adult. Encourage the person to be honest about the thoughts and feelings they are having. Be open and
nonjudgemental and let them know you are there to support them. If they need more help, they can talk to a professional by calling or texting the National Suicide Helpline at 9-8-8. If they need immediate help to stay safe, you should CALL 9-1-1.

How can I help prevent a mental health crisis?

It is helpful to plan how to handle a crisis before it happens. Having a plan can help your child or the person you care for get through a mental health crisis more easily or even prevent a crisis from happening.
Their plan should include:

• A list of triggers that may cause a mental health crisis along with warning signs that a person may be having a hard time and need additional supports.
• Strategies to help them feel calm again. These can include things like the resilience skills, coping strategies they’ve learned from a therapist, or even simple things like going for a walk or listening to music. The strategies should be individualized for each person.
• Phone numbers for trusted adults and emergency providers, in case they are not with you.

You or a mental health professional can help them create a mental health crisis plan. They can also help them to learn and practice skills for managing their emotions.

Once a crisis plan has been developed, a copy of the plan should be available for all support staff and the individual to access when needed. This could mean keeping a printed copy in a common area, or even having a version that is able to be saved on a smartphone or tablet for easy access.