This stress management techniques for healing trauma blog post is dedicated to helping adoption triad members learn skills to help them heal from trauma. Traumatizing experiences have created an everyday normative state of high stress. Then when a stressful event happens, it can cause a person to overact or shut down due to a small window of tolerance for stress. Research has shown that healing from trauma requires more than talking about traumatic experiences. Healing from trauma includes becoming aware of the inner experience and learning to befriend what is going on inside ourselves [1]. This blog post includes information on emotional regulation skills as part of the process of healing from trauma. After introducing the term window of tolerance, detailed information on breathing exercises, grounding techniques, and other stress management techniques are included.
Adoption Triad Members’ Stress Experiences
It is important to acknowledge the negative impact family, friends, society, and mental health professionals have had on adoptees, birth parents, and adoptive parents. The horrific treatment adoption triad members have experienced includes both harmful actions and traumatic invalidation. Traumatic invalidation includes when individuals interact with adoption triad members and act as if relinquishment and adoption never happened. Emotional regulation for adoption triad members is complicated because the brain and body are reacting to a stressor that family, friends, and society say should not be a stressor. When adoption triad members’ experiences are not acknowledged, it makes emotional regulation and healing from trauma more difficult.
Complicating the adoption triad members’ path to healing trauma is that many mental health providers do not recognize relinquishment and adoption experiences as being traumatic. Many adoption triad members do not get a diagnosis of post-traumatic stress disorder (PTSD) or complex PTSD because their trauma experiences are not a DSM 5 [2]traditionally defined trauma experience. Mental health providers often do not recognize losing a child to adoption as a traumatic experience due to the birth parent “did a good thing”. Nor do many mental health providers recognize spending time in an orphanage, infant home, or newborn foster care as having a long-term impact on an adopted person because they grew up in a “loving home” [3]. When adoptive parents discuss their trauma from parenting their adopted child with attachment issues due to pre-adoption traumas, they are often blamed by psychotherapists for being the source of the adopted child’s lack of attachment. Additionally, many counselors do not know stress management techniques to help their clients with emotional regulation. For further reading on adoption traumas, visit the Adverse Relinquishment and Adoption Experiences Assessment blog post and the Core Issues of Adoption blog post. The Adoption Competent Counselor Expertise blog post has information on adoption competency training for mental health providers.
Learning stress management techniques alone is not enough to heal trauma symptoms [4]. Healing from complex post-traumatic stress disorder often requires a 3 stage treatment approach [5], with stage one including using emotional regulation skills to widen the window of tolerance.
Window of Tolerance
The term window of tolerance was coined by Dr. Daniel Siegel [6] to describe an emotional zone where individuals can manage their emotions and actions productively. When individuals are in their window of tolerance, they are aware of their body sensations, can identify their feelings, and think abstractly. Individuals with a wide window of tolerance can ride the waves of their emotions when triggered without shutting down or overreacting. If someone has a history of high stress, it is common for them to have a smaller window of tolerance. A minor upsetting situation can cause a person to overreact or underreact.
Hyperarousal is the term for the dysregulated state of over-arousal. Hyperarousal may result in defensiveness, anger, flight, hypervigilance, racing thoughts, intrusive imagery, emotional outbursts, and agitation. An analogy for a person in hyperarousal is as if their body is like a pot with simmering water on a stove. It does not take much heat to send the water in the pot to boil over. Hypoarousal is the term for the dysregulated state of under-arousal. Examples of a person in under-arousal include spacy, losing track of time, sluggishness, absence of emotions, numbness, frozen, emotionally, or physically shutdown. An analogy for a person in hypoarousal is as if the body is like an ice cube tray with ice-cold water. When the ice cube tray is placed in the freezer, the water will turn into solid ice cubes quickly.
There are numerous reasons individuals have developed an inability to tolerate stress. A normative high-stress state can start in utero due to a high-stress pregnancy. It can happen when a child had caretakers who were agitated, frightening, or unavailable. Self-soothing is a learned behavior that originates from co-regulating with another person, usually an infant with a parent. Children who experience environments that were unsafe, chaotic, or abusive grow up to have a small window of tolerance. As a result, trauma survival symptoms (i.e. hypervigilance, perfectionism, anger, dissociation, people pleasing) become prominent coping strategies. Trauma symptoms develop because the brain and body believe these trauma survival skills are the best way to avoid future pain. Over time the brain and body lose the ability to feel safe even in a safe environment. For some, feeling calm is such an unnatural feeling it can feel dangerous. For individuals who do not know how to feel safe, widening their window of tolerance includes learning to assess people and situations for safety.
Dissociation As A Stress Response
Dissociation is a mental ability that instinctively happens during high-demand situations or when our attention becomes unfocused. Dissociative behaviors are on a continuum. On one end of the continuum are healthy/normal dissociative responses of daydreaming, getting lost in thought, and highway hypnosis when the driver spaces out on the specifics of a long trip. Dissociation can happen during high-demand situations. Examples include medical professionals and emergency responders, actors, athletes, and speakers who all get in the zone so they can focus on the task without distraction.
The other end of the continuum is the dissociation that results from hypoarousal. Individuals who use dissociation are more likely to have been unable to leave the traumatic event when it occurred. When the brain and body found the terror too overwhelming to be emotionally present, the survival response used is dissociation. It is so effective in alleviating stress that many individuals use dissociation instinctually to minor stressors. Examples of dissociative behaviors include fantasy, numbing, and being spacey. Depersonalization is when a person feels detached as if they are an observer of their mental processes or body. Derealization is when a person experiences unreality of surroundings – unreal, dreamlike, distant, or distorted. At the far end of the continuum, dissociation involves splitting into protective parts that involve significant memory lapses. When this happens, individuals will find they do not have memories of how they got somewhere, have no memory of buying things, or forget how they have the ability to do something. Individuals with complex post-traumatic stress disorder or dissociative identity disorder may have additional dissociative symptoms.
Stress Management Skills
The good news is that individuals can learn to calm their brain and body. Neuroplasticity, also known as brain plasticity, is the brain’s ability to change due to an experience. Each time a person has a moment of calmness, it strengthens the brain’s pathway to find a state of calmness in the future. Improving stress tolerance is done in numerous ways. Learning to identify the triggers for feelings and being curious about what is going on not only provides insight but is also an important step in healing trauma. Taking a moment to be curious slows down the innate response to overreact or underreact. This is important because individuals with trauma histories live as if the trauma is happening in the present. Often the current trigger is not the underlying cause of the over or under reaction. Having a moment to gain perspective and do a calming exercise can rebalance the nervous system.
With everyone being different, some individuals will find better results with some of the below exercises than others. Individuals with a constant state of stress need to practice calming and grounding exercises multiple times a day over an extended time to see significant results. In time, an individual can learn to regulate strong emotions as they ride the wave of emotions and return to calmness. It is important to mention that these calming exercises are not enough to heal trauma disorders. Individuals with trauma diagnoses should consult a trained trauma-competent therapist to help them with the complexities of trauma treatment. Emotional regulation skills should supplement counseling, not be a replacement for counseling.
The first stress management techniques described in this article -breathing, grounding, havening, guided imagery, mindfulness – are exercises that can be self-taught. While the Emotional Freedom Technique (EFT) two-part intervention can be self-taught, some will find better results with a trained EFT therapist. Neurofeedback needs is done with a trained psychotherapist. While the cost of psychotherapy for neurofeedback is the more expensive option, it could be one of the quickest ways to quiet parts of their brain that need to be quieted and strengthen parts of their brain that are underactive.
Mindfulness exercises should not be confused with meditation. Meditation is the practice of going inside oneself and observing breath or the flow of thoughts, feelings, and sensations as they arise. In psychotherapy, mindfulness is the intersubjective practice of “being in the here now”. It is slowing down to be curious about what you are experiencing. Is the response due to a present problem or is the response due to the past being triggered? Mindfulness is grounding oneself in the present. It is an important tool for trauma survivors because they often do not feel safe even when they are in a safe situation.
Finding Your Voice and Owning Your Experience
Some adoption triad members find expressing their feelings and thoughts to be an unsafe experience. It is easy to get in the habit of not using your voice when no one around you wants to hear what you have to say or what you feel. Many have been shamed or even harmed for stating their beliefs and needs. Some trauma survivors stopped using their voices because it would have been too overwhelming to say out loud what they have experienced. No matter how it happens, learning to say what you think and feel is key to healing trauma because you are no longer suppressing your truth.
Learning to find the words to describe your experience and identify your feelings may be difficult. If this process is difficult, be kind to yourself as you learn to find your voice. Not expressing thoughts and feelings is a trauma survival strategy. It takes time to learn to feel safe enough to express your thoughts and feelings. If you have a history of putting other people’s feelings before yours, it will take time to internalize your feelings and voice matter. It is not selfish to have feelings, needs, goals, and beliefs. Acknowledging your thoughts and feelings is connecting to your inner self.
Identifying feelings includes labeling the emotion, being aware of any body sensations that go with the feeling, and the source of the feeling. When you experience a feeling, notice how it feels in your body. Be aware of judgments that say your thoughts and feelings are not valid. Past experiences may cause you to falsely believe you are “too sensitive” or you are “upset about nothing”. Psychoeducation on how the brain and body change due to trauma may help to internalize your trauma symptoms are a normative response to abnormal events [7]. How you decide to express your thoughts and feelings (journaling, telling a trusted person, creating art, writing poetry or a song, participating in a support group) does not matter. What is important is you are true to yourself and what you have been through.
Deany Lailotis with the Center for Excellence in EMDR Therapy developed the TOUCH Technique strategy for understanding responses and learning to connect to your experiences [8]. The goal is to learn to shift from an automatic reaction, to an observing reaction. This process helps to move from the reactive emotional trigger to an informed state of understanding the reaction. It is about being mindful of your emotional response that moves you to hyperarousal or hypoarousal.
T is for Trigger: Pause and take a moment to recognize you are triggered. The past has become the present. Observe if the current emotional response matches the intensity of the present event.
O is for Observe: Observing your response -body sensations, thoughts. This step allows you to know you are not your trauma response. It acknowledges it is a reaction.
U is for Understand It: Be curious about how the current situation may have a connection to the past. The current event does not need to be the same as the past traumas for there to be a connection. This step is about understanding the cause of the emotional response. Understanding can help with learning how to prepare for the next time the trigger happens.
C is for Contain It: By noticing and understanding the emotional response, it helps to redefine the experience to make it more manageable. Stress management skills help to lessen the emotional response so it is contained.
H is for Hold on to it for Healing: Learn from the experience and bring what you have learned into a psychotherapy appointment. Being able to do the TOUCH response helps individuals prepare for reprocessing of trauma triggers in EMDR therapy.
Breath Work for Calming and Mindfulness
Breathing exercises help to improve emotional regulation since they help the parasympathetic nervous system decrease the hyper or hypo arousal response.
448 Breathing
448 breathing can help to slow down a rapid heart rate. This exercise is helpful because it can be done anywhere without a person feeling self-conscious about doing it in front of others.
Breathe in for 4 counts, hold breath for 4 counts, and exhale breath for 8 counts.
If you do not have enough air in your lungs to exhale for a count of 8, try taking a deeper breath for breathing in for the count of 4 so you have enough air in your lungs to do a full count of 8 exhaling.
Alternate Nostril Breathing
Alternate Nostril Breathing is a yoga breathing technique. It helps to create a feeling of calmness since the right nostril is connected to the sympathetic nervous system (fight, flight response), and the left nostril is connected to the calmer parasympathetic nervous system.
- Bring your hand to your nose and move your three middle fingers down to your palm.
- Place your thumb on your right nostril to close the nostril. With the right nostril covered, breathe in deeply and slowly from the left nostril for a count of 6. Release your right nostril.
- Put your pinky finger on the left nostril and close the nostril. With your left nostril closed, breathe in deeply and slowly from the right side for a count of 6. Release your left nostril.
- Repeat the steps two or more times.
Alternate Nostril Breathing
Box breathing
The box breathing exercise has inhalation, breath holds, and exhales equal. When this is done it forces breathing into a steady rhythm creating a relaxed feeling. Box breathing can also help with being alert and energized. It can lower blood pressure and cortisol. Box breathing works so well it is one of the techniques used by the Navy Seals to stay calm when under pressure.
- Breathe in slowly for a count of four. Feel the air enter your lungs.
- Hold your breath for 4 seconds.
- Slowly exhale through your mouth for 4 seconds.
- Breathe in slowly for a count of four.
- Hold your breath for 4 seconds.
- Slowly exhale through your mouth for 4 seconds.
Repeating the box breathing for thirty seconds should help you feel more relaxed and in control.
Grounding
The word grounded is used in many different ways. The most generic term for grounded is when a person is emotionally stable, realistic, and unpretentious. In reference to trauma survivors, grounded means being aware of the time and place with emotions and thoughts that reflect the current experience. The grounding exercise used should match the level of emotional dysregulation. Grounding for dissociation is about taking deliberate steps to bring oneself out of hypoarousal. Grounding is also acknowledging your feelings and experiences. The Emotional Freedom Technique is helpful with this type of grounding because the EFT set-up phrase includes being aware of the feelings, triggers, and self-compassion. Grounding can also be done by having an internal dialogue with the overwhelmed part of yourself.
An example of internal dialogue is when an adoptee’s inner child part is feeling unwanted. The self-dialogue could look something like this:
It makes sense to feel unwanted when in the womb I felt unwanted. It makes sense that I felt unwanted growing up when my adoptive parents rejected me due to their attachment issues. I am telling myself today that I matter to me. Today, I have self-compassion for my pain and struggles. Today, I acknowledge it is ok to have feelings and needs. Today, I want and accept myself.
It may feel awkward having these types of conversations. Compassionate internal dialogue helps because it acknowledges the parts of your inner self. Healing internal dialogues can include being curious about a thought or a reaction. Curiosity includes reflecting on whether things said to you, or you say to yourself are fair and accurate. Self-compassion includes reminding yourself that your trauma survival skills are how you survived.
Grounding for Dissociation
Dissociation is so effective as a stress response it can happen without a person being aware they are doing it. An example is when a person intends to do any activity (playing a video game, on social media, napping) for a few minutes and without realizing it, hours have passed. Ways to decrease using dissociation include learning to identify the ways you dissociate, developing an awareness as you begin to dissociate, and identifying stressors that cause dissociation. Learning to catch minor dissociation can help decrease the frequency of dissociation shutdown.
The first step is to make a list of the ways you dissociate. Examples of dissociation include fantasy life, daydreaming, difficulty paying attention, being overly absorbed in an activity to the extent you become unaware of surroundings, things in the room that do not seem real, and feeling numb. Once you identify the ways you dissociate, try to develop an awareness of the earliest warning signs when dissociating- tingling, sounds that are perceived farther away than they are, or difficulty concentrating. Then do stress management techniques to calm and ground yourself. Once you are grounded, be curious about the trigger for the dissociation. The trigger could be something or someone that provoked a strong feeling. Then be curious about what can help tolerate the stressor. In time, you can learn to identify what was the trigger that created the need for emotional distance and what were the feelings that were too overwhelming. The brain and body need to learn there is a difference between being stressed, which would benefit from a calming activity, and being in danger. With practice, individuals can learn to trust themselves to ride the wave of emotions and return to their window of tolerance. Additional grounding exercises can be found in The Finding Solid Ground Program Workbook (Schielk, Brand, Lanius).
The goal of these grounding exercises is to engage with your surroundings by using all of your senses to remove the dissociative experience.
Create a Feeling of Safety by Being Aware of Time and Place
Follow the steps below to use your senses to connect with the here and now.
- Look around the room and remind yourself where you are and the current date and time.
- Look around the room, do you see anyone or anything that makes you feel unsafe? If you feel unsafe, is it due to a current threat in the room, or is it a feeling you have? If the room is unsafe, seek safety. If there is no threat in the room, tell yourself the feeling of unsafe is due to the past, and the room is presently safe.
- Label the colors and shapes you see in the room.
- Listen for sounds. Label the sounds that you hear. If the sounds are safe, tell yourself there are no unsafe sounds.
- Touch things in the room for grounding purposes.
- Discontinue trancing activities: rocking, swaying, staring, rhythmic behaviors
- Walk barefoot. Notice how your feet feel on the ground.
- What do you smell? If the smells are safe, tell yourself there are no unsafe smells in the room.
- Smell something strong for grounding purposes: scented candle, strong spice, scented hand lotion.
- Taste a food with a strong taste i.e. lemon, mints
- Say to yourself, I am safe at this moment.
Four Elements -Earth, Air, Water, Fire Exercise for Stress Reduction (Adapted from Elan Shapiro, 2012)
1- Earth: Grounding, Safety in the Present
- Take a minute to “land” in the here and now
- Notice how your feet feel on the ground feel
- Notice how your chair supports you
- Notice the details of 3 things in the room
- Notice any sounds that you hear
2-Air: Breathing for Centering
- Do a breathing exercise
3-Water: Calm & Controlled to switch on the relaxation response. When you are anxious or stressed, your mouth can dry out because of the stress emergency response.
- Notice do you have salvia in your mouth?
- Make more salvia. As you make saliva, focus on the action and body experience.
4-Fire: Light Up the Path of Your Imagination
- Think of a positive image. It could be your safe place, a memory of when you felt good about yourself, or a place in nature that is soothing.
- Notice how you feel and where you feel it in your body.
Havening Exercises to Increase Calmness
Self-havening is a soothing gentle light touch that activates skin receptors resulting in neurochemicals that can induce a feeling of safety and calm. It can decrease cortisol and norepinephrine which play a role in anxiety and stress. Havening can increase oxytocin, the hormone associated with safety. Other benefits of havening include increased connection with body and brain and helping the brain to notice present safety.
Havening Exercises -repeat the havening exercises to create the desired effect.
- Across the Brow of the Forehead. Place your fingertips of both hands in the middle of the forehead, and with a light gentle touch move both hands out to the sides of your head and down to your temples.
- Around the Eye. Place your fingertips at the corner of each eye by the nose. With a light touch, gently move your fingertips down to go under your eye and then across the bottom of your eye, as if to wipe a tear.
- Down the Arms. Cross your arms and place your hands lightly at the top of your arms. Then with a light touch, go down your arms to your wrists.
- Gentle Palm Touch. Place one hand on top of the other with palms facing one another so fingertips are gentling touching the bottom of your palms. With a gentle light touch, slide your fingertips toward the fingertips on your other hand. Gently rub your palms together as if washing your hands.
Visualization Exercises
Without consciously thinking we use visualization to help us with our day. Practicing visualization of positive things for stress management helps because the brain focuses on the negative quicker and more often than positive things. The brain thinks it is helping us prepare for stressful events by being hypervigilant and preparing for the negative. In actuality focusing on the negative, rather than the positive, increases stress and cultivates poor moods.
For positive and negative visualization exercises, adding bilateral tapping reinforces the image in the brain. Two of the most common types of bilateral tapping for visualization exercises are alternating right and left hands tapping on the tops of the thighs while sitting and crossing the arms and tapping the upper arm gently with the hands.
Upper Arm Tapping
Eye Movement and Reprocessing Therapy (EMDR) uses bilateral tapping with positive visualization (resource tapping) in the early stages of therapy and bilateral stimulation in the desensitization stage of EMDR. The difference between the two types of bilateral stimulation is that resource tapping is done slower and is time-limited (12-18 sets of tapping). Resource tapping is stopped if the visualization is no longer positive. Bilateral stimulation during the desensitization stage of EMDR is faster and is done for longer periods. The desensitization stage is always done with a trained EMDR therapist and could be destabilizing if done without a trained EMDR therapist.
Peaceful Place Visualization
Think of a place that feels calm and peaceful. It can be a place you have been, a place you have seen a picture of or an imaginary place. Once you identify your peaceful place, close your eyes and take a moment to notice specific things about your peaceful place.
- What are the colors, sounds, and scents of your peaceful place?
- How do you feel in your peaceful place?
- Do you feel a breeze or the relaxation of your muscles?
- You may invite a real or imaginary person to your peaceful place as long as their presence is completely positive.
- If you want extra security, you can add a protective barrier of a fence or a lock to make the peaceful place safe.
- Once you can fully visualize your peaceful place, take a few breaths to take it in.
- Add 12 sets of bilateral tapping.
Other visualizations that can be tapped-in include nurturing figures, protective figures, positive experiences, and visualizing yourself doing a difficult task well. Laurel Parnell’s book Tapping In [9] has many examples of positive visualization.
Visualization for Negative Thoughts and Images
The goal of this container exercise is to assist a person in compartmentalizing upsetting things until they are ready to face them. It is a mental task that helps decrease the intrusive image.
Only do this exercise if you feel safe. If you are dissociating or extremely overwhelmed, focusing on upsetting thoughts and feelings can be destabilizing. You should be grounded for safety and not dissociating while doing the container exercise.
Step 1: Imagine a container to store disturbing thoughts, feelings, or memories. The container can be as elaborate as you like. It needs to be strong enough to hold your disturbing image and not something that you would have contact with in your life. As you design your container, it should have the ability to be accessed at a later time for processing in trauma therapy. Examples of containers include a trunk that can be locked or a bank safe with armed guards on the outside. Once you decide on the container, think about where you want the container placed. The container can be as far away as you like as long as you can access it later in therapy.
Step 2: Identify what you would like to put in the container. Things that can go into the container can be an event that happened, images, and negative statements.
Step 3: Close your eyes and visualize the container opened. Take deep breaths and visualize the negative thoughts, images, and feelings entering the container. Give as much detail as possible about what is going into the container without destabilizing yourself. The goal is to feel in control of putting things in the container. Take a deep breath and seal the container.
Step 4: While holding the image of the sealed container, add in bilateral tapping for a set of 12.
Step 5: Open your eyes and think of how you feel after doing the container exercise. This exercise should help you feel calmer.
If it was upsetting, practice a peaceful visualization or other calming exercise.
Supportive Interpersonal Relationships
Individuals who struggle with emotional dysregulation often have a history of interpersonal relationships that were not only not validating but were the source of the trauma. That is why safe and supportive relationships in the present can help with healing interpersonal trauma. It does not matter if the relationships are family, friends, or members of an adoption community. What is important is that the relationship is validating. They should be able to hear your pain without minimizing it. If your family and friends cannot tolerate your strong feelings or respond with judgment, you should seek out the support of the adoption community or a psychotherapist. For some, the trauma symptoms of shame, inability to trust, or hypervigilance can interfere with seeking out supportive relationships. If this happens, grounding in the present by acknowledging that the current relationships are not past relationships may help to quiet the trauma symptoms.
Neurofeedback Therapy
Neurofeedback is a form of biofeedback that is a noninvasive procedure that measures an individual’s brainwaves and provides real-time feedback about how the brain is functioning. [10] Neurofeedback targets dysregulation in the brain to lessen activity in parts of the brain that are overactive and to strengthen neural pathways that are underutilized. Neurofeedback therapy is effective because it rewards and inhibits brain frequencies. This results in reinforcing brainwave patterns while discouraging others. Like with other psychotherapies, neurofeedback uses different techniques for different targeted areas. A strength of neurofeedback therapy is that it can target brain patterns that are beyond an individual’s conscious awareness. As neurofeedback changes the innate brain patterns (i.e. fear, hypervigilance, anxiety, dissociation) it leaves room for the brain to focus on other things. Individuals who have not had good results with other therapies for emotional dysregulation may find better results with neurofeedback.
Emotional Freedom Techniques Psychotherapy
The Emotional Freedom Techniques (EFT) is an evidenced-based psychotherapy that uses tapping on acupressure points to decrease an individual’s stress level [11]. While the Emotional Freedom Techniques is referred to as tapping, it is different than the tapping done in visualization exercises and EMDR. The tapping done in EFT is along points on the body’s energy pathways. Tapping on specific acupressure points while saying statements related to a strong emotion can lower the brain’s amygdala stress response and create a calming response in the body. It helps with lowering the intensity of negative feelings and beliefs. The Emotional Freedom Techniques psychotherapy, like other psychotherapies, utilizes many different interventions. The most commonly known EFT tapping is a two-step tapping. The first step is to develop a setup statement that includes a feeling, the situation that is associated with the feeling, and an acceptance belief. The acceptance part of the statement helps ground an individual in the present and promotes self-compassion. Once the setup sentence is developed, it is repeated three times while tapping a spot on the side of the hand. The second step is done by saying the feeling(s) while tapping 9 acupressure points on the head, upper body, and hand. The feelings tapping is done in three rotations on the 9 acupressure points. The are numerous variations of this technique.
Sample EFT setup statements include:
Even though I feel hurt that my relationship is not going in the direction I had hoped, I trust I can take care of myself as I go forward.
Even though I feel tremendous guilt that I didn’t keep my child, I accept I had no choice at the time and I did the best I could.
Even though I get mad at myself for being too sensitive, I believe I can love myself with nonjudgmental compassion as I work on healing my traumas.
How to Tap with Jessica Ortner: Emotional Freedom Technique Informational Video
Other Activities for Stress Management
- Listen to soothing music and hum along to stimulate your vagus nerve
- Dance to music that will lift your spirit
- Spend time in nature
- Exercise, go for a walk
- Yoga and Mindfulness Activities -A research study showed that 10 weeks of yoga practice markedly reduced PTSD symptoms of patients who had failed to respond to any medication or another treatment [12]. There are yoga professionals who have a certification for yoga for trauma [13]. Other mindful activities include tai chi and other martial arts, and rhythmical drumming. These techniques all involve movement, breathing, and being mindful.
- Polyvagal Theory is a therapy that emphasizes the role of the autonomic nervous system, especially the vagus nerve. It has many interventions and exercises that help to regulate health and behavior.
- Progressive muscle relaxation
- Co-regulate with a safe person in a comfortable hug
- Snuggle with a pet, stuffed animal, or soft blanket
- Use an essential oil like lavender for calming
- Review what food and drinks you consume. Minimize high inflammatory foods including refined sugar, alcohol, refined flour (especially gluten), processed foods, and fried foods.
- If you do not get enough rested sleep try new sleep habits. Things that may help with sleep include sleeping in complete darkness, cool room 60-65 degrees, eliminate use of technology with white light (cellphone, tablet, computer) 2 hours before bedtime, chamomile or other sleep time tea, and epsom salt baths. Eliminate caffeinated drinks and food with caffeine (chocolate) after 2 pm. Sleep apnea may interfere with sleep so being test and treated for sleep apnea may help.
- Visit your doctor and have an exam and bloodwork to rule out medical reasons that could cause mental health conditions.
Trauma-Informed Therapy
Practicing stress management techniques is only one part of what is needed to heal from complex post-traumatic stress disorder. Participating in counseling with a trauma competent psychotherapist who can complete trauma assessments [many diagnoses have overlapping symptoms] and can provide a range of trauma-informed psychotherapy interventions for all three stages of complex trauma treatment will increase the likelihood a trauma survivor can remove the symptoms of complex PTSD.
A complication with finding a trauma-competent therapist is that there is no national organization for trauma-informed psychotherapists that sets the standards for competency in trauma psychotherapy. There are trauma-informed training programs [14] that have a trauma certification for psychotherapists, but each organization develops its own curriculum for its trauma-informed certification. Ideally, a trauma competent therapist would have a treatment framework of the three stages of treatment for complex PTSD [diagram above] and have training in at least one evidence-based trauma therapy. Trauma therapies that utilize complex PTSD stage 2 reprocessing of trauma memories include Eye Movement and Desensitization and Reprocessing Therapy (EMDR), somatic therapies (i.e. sensorimotor psychotherapy somatic experiencing), and parts/ego state therapies (i.e. Internal Family Systems, Trauma-Informed Stabilization Treatment). If a trauma survivor has a dissociative diagnosis in addition to a post-traumatic stress disorder diagnosis, the psychotherapist should have training in the treatment of dissociative disorders.
Further complicating finding a competent therapist is that a therapist can be a trauma-competent therapist but not adoption-competent. If you are considering participating in psychotherapy, you should interview the therapist on their approach to trauma treatment and their training. Taking care of yourself includes asking questions on the competency of a psychotherapist.
Conclusion
As you reflect on this blog post, please keep in mind a few things. Practice the exercises when you are calm, not just when stressed. It may be harder to remember the specifics of the exercises when you are overwhelmed if you have not practiced them when you are calm. Develop a plan that identifies calming exercises that work best when your window of tolerance is small. Reflect afterward about the stressful situation and think about what you would do again or not do. This could include not engaging with someone, not thinking the worst, or doing an action sooner. Individuals who struggle with severe emotional dysregulation may want to consider how to add numerous calming activities into their daily routine. An example of this is to start the day with exercising followed by a breathing activity and end the day with an Emotional Freedom Technique directed to that day’s stressor and yoga.
Your healing journey may also benefit from trauma-informed therapy and support groups. There are also apps and podcasts dedicated to stress management. A medical evaluation should be considered as some mental health conditions are caused by vitamin deficiencies or other medical problems.
Be compassionate with yourself. It is easier to learn new behaviors when you acknowledge this is a process. I wish you the best on your healing journey.
This blog post was written in the summer of 2024. The plan is to follow up this blog post on a series of blog posts on complex post-traumatic stress disorder for adoption triad members. Follow Marie Dolfi on social media for updates on when new blog posts are available.
Footnotes
1 van der Kolk, B. (2014). The Body Keeps the Score- Brain, Mind, and Body in the Healing of Trauma.
2 The DSM V is the diagnostic manual of psychiatric conditions published by the American Psychiatric Association.
3 Attachment and Trauma Network Developmental Trauma Disorder https://www.attachmenttraumanetwork.org/developmental-trauma-disorder/
4 van der Kolk, B. (2014). The Body Keeps the Score- Brain, Mind, and Body in the Healing of Trauma.
5 Judith Herman MD was the first to propose complex post-traumatic stress disorder and a 3 stage approach to treatment in her book Trauma and Recovery: The Aftermath of Violence From Domestic Abuse to Political Terror (1992). The 3 stages of treatment for complex post-traumatic stress disorder are an evidence-based research treatment approach.
6 Siegel, D. J. (1999). The Developing Mind: Toward a Neurobiology of Interpersonal Experience. Guilford Press.
7 The Body Keeps the Score- Brain, Mind, and Body in the Healing of Trauma (van der Kolk, B., 2014) and Transforming the Living Legacy of Trauma: A Workbook for Survivors and Therapists (Fisher, J., 2021) are excellent resources for understanding the science of how trauma impacts a person.
8 Information on the TOUCH process can be found on The Center for EMDR Excellence website.
9 Parnell, L., (2008). Tapping In: A Step-By-Step Guide to Activating Your Healing Resources Through Bilateral Stimulation. Sounds True.
10 To learn more about neurofeedback read chapter 19 in The Body Keeps The Score van der Kolk, B. (2014) or visit the International Society for Neuroregulation and Research .
11 Research on the Emotional Freedom Techniques can be found on the Association for Comprehensive Energy Psychology’s website
12 van der Kolk, B., (2014). Yoga as an Adjunctive Treatment for PTSD, Journal of Clinical Psychiatry, 75 (6), 559-565.
13 Trauma Center for Trauma Sensitive Yoga
14 A few organizations that provide certificates for trauma competency for therapists include PESI, the Trauma Research Foundation, the International Society for Study of Trauma and Dissociation, and the Trauma Institute and Child Trauma Institute. Psychotherapists may also get certifications for completing training for Eye Movement and Desensitization and Reprocessing therapy as well as other trauma therapies.
Books and Websites on Healing From Trauma
- Association for Comprehension Energy Psychology’s website has exercises for relaxation and resilience
- Baldwin, M., Korn, D., (2021). Every Memory Deserves Respect: EMDR, the Proven Trauma Therapy with the Power to Heal. Workman Publishing Company
- EMDR International Association has information on EMDR therapy and a directory of certified EMDR therapists.
- Fisher, Janina (2021), Transforming the Living Legacy of Trauma: A Workbook for Survivors and Therapists. PESI Publishing and Media
- Schielk, H., Brand, B., Lanius, R., (2022). The Finding Solid Ground Program Workbook
- Schwartz, A., (2020). A Practical Guide to Complex PTSD: Compassionate Strategies to Begin Healing From Childhood Trauma, Rockridge Press.
- van der Kolk, B. (2014). The Body Keeps the Score- Brain, Mind, and Body in the Healing of Trauma. Viking
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