Trauma-Sensitive Mindfulness: Providing A Choice of Anchors

David Treleaven recently published a book on Trauma-Sensitive Mindfulness. The book enables mindfulness trainers to recognise a trauma-affected individual, provide appropriate modifications to their mindfulness processes and avoid aggravating the individual’s trauma experience.

David argues that two factors are foundational to trauma-sensitive mindfulness, (1) choice and (2) anchors.  He observes that people who are trauma-affected have experienced an unwanted negative event that endangered them, a total loss of control over the situation and a lack of agency (capacity to influence the outcomes).  Providing choice, especially in relation to anchors, is critical for the welfare of the trauma-affected individual – it avoids reactivating the sense of helplessness associated with the traumatic event and reduces the likelihood of triggering a painful “body memory”.

Providing a choice of anchors – internal sensations

An anchor enables an individual to become grounded in the present moment despite being buffeted by distractions, negative self-stories or endless thoughts.  The choice of an anchor is a very personal aspect of mindfulness – it relates to an individual’s preferences, physical capacity and emotional state.  An anchor enables a person to experience ease and emotional stability.

Jessica Morey, an experienced teacher of trauma-sensitive meditation, begins a meditation training session by offering participants a choice of three internally-focused anchors – a bodily sensation, attention to sound within their immediate environment (e.g. the “room tone”) or a breath sensation (air moving through the nostrils, abdomen rising and falling or movement of the chest).

Participants are given the opportunity to try out these different anchors over a five-minute period and to make a choice of an anchor for practice over a further period.  Providing this choice of anchors avoids locking individuals into a mindfulness process that can act as a trigger for reexperiencing trauma, e.g. sustained focus on breathing.

Alternative anchors – external sensing

David notes that the five senses offer further choices of anchors – in addition to the internally focused anchors suggested by Jessica.  The senses enable a participant in meditation training to focus on some aspect of their external environment:

  • Hearing – tuning in to the external sounds such as birds singing, the wind blowing or traffic flowing past.  The downside of this approach is that it may trigger our innate tendency to interpret sounds and this may lead to focusing on a particular sound – trying to identify it and its potential source. So, this may serve as a distraction pulling us away from experiencing (the “being” mode) to explaining (the “thinking” mode).  The aim here is to pay attention to the experience of hearing, not to focus on a single sound. Sam Himelstein has found that listening to music can be a very effective anchor for a person who is in a highly traumatised state – choosing music that aligns with the individual’s musical preferences can serve as a powerful anchor.
  • Touch – a trauma-affected person could have an object, e.g. a crystal or a stone, that provides comfort and reassurance and enables them to become grounded in the present moment through the sensation of touch.
  • Seeing – taking in the natural surroundings, e.g. by observing closely the foliage of a tree – its colours, shape and texture or observing the patterns in the clouds.

Other options include sensations of smell or taste.  However, in my view, these tend to be less neutral in character and can re-traumatise a trauma-affected person.

David Treleaven offers a wide range of resources to help meditation trainers build their awareness, skills and options in the area of trauma-sensitive mindfulness (TSM).  These include an online training course, interview podcasts, a TSM Starter Kit (incorporating an introductory video and a comprehensive “TSM Solutions Checklist”) and a live meetup of the TSM Community (registered members of a community of TSM-aware practitioners).

Reflection

As we grow in mindfulness through meditation, research and reflection, we can become more flexible about how we offer mindfulness training.  A trauma-sensitive approach to mindfulness requires an awareness of the manifestations of trauma and post-traumatic stress disorder (PTSD), identification of different sources of anchors and the willingness and capacity to offer participants the choice of an anchor and an approach to mindfulness.  This means that we need to move beyond our own fixation with “meditation logistics” and be flexible enough to offer trauma-informed mindfulness practices.

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Image – Trees on the foreshore, Wynnum, Brisbane

By Ron Passfield – Copyright (Creative Commons license, Attribution–Non Commercial–No Derivatives)

Disclosure: If you purchase a product through this site, I may earn a commission which will help to pay for the site, the associated Meetup group and the resources to support the blog.

Disconnection from Childhood Trauma: A Potential Determinant of Depression and Ill-Health

Johann Hari, in his book Lost Connections: Uncovering the Real Causes of Depression, identified seven social causes of depression including the loss of connection to other people.  One of the surprising findings in his discussions with researchers and his colleagues, was the link between obesity, childhood trauma and depression.  In the final analysis, collectively they established that in many instances unresolved childhood trauma was a determinant of obesity and depression. 

Obesity and depression

Johann drew on the ground-breaking research of Dr. Vincent Felitti, Founding Chairman of the Department of Preventative Medicine of Kaiser Permanente – a fully integrated medical provider offering not only health care plans but also services such as specialist medical practitioners, a dynamic medical school, mental health services and education and an affordable housing initiative.  Kaiser Permanente views a healthy life for all as a cause to pursue, and is a pioneer in offering seamless health services along with leading edge research into preventative methods and treatment approaches.

Kaiser Permanente commissioned Vincent to undertake research into obesity because it was becoming the major factor in the growth of its operational costs.  Vincent started out by using a specialised diet plan supported by vitamin supplements that was designed to help obese people lose weight.  This approach appeared highly successful on early indications, but Vincent noticed that the people most successful at losing weight were dropping out of the program and returning to their eating habits and becoming overweight again.  Additionally, they often experienced depression, suicidal thoughts, rage or panic. 

Research by way of interview of 286 participants dropping out of the obesity program established that most had been sexually abused or experienced some other form of childhood trauma.   Obesity was their way to deal with the aftereffects of childhood trauma, including fear of sexual assault and the desire to hide their shame.

Childhood trauma and depression

Vincent was surprised by the findings of the initial study and realised that research of childhood history as a determinant of adult ill health had been avoided previously because of shame, secrecy and the taboo nature of the topic.  Yet his early findings established that childhood trauma played out powerfully decades later in terms of emotional state, biomedical disease and life expectancy.  He found, for example, that 55% of participants in the obesity study had suffered childhood sexual abuse.

The link between obesity, depression and childhood trauma was not well received by the established medical profession.  The video, A Tribute to Dr. Vincent Felitti, highlights the scorn he experienced when first announcing his findings at a medical conference and demonstrates the resilience of a man who had the courage to back his research and the bravery to pursue his creativity.

Vincent was convinced that he had to undertake research with a larger and broader sample of people to establish the credibility of his findings.  Through Kaiser Permanente’s processes of capturing the medical history of patients he was able, in collaboration with Dr. Robert Anda of the Center for Disease Control (CDC), to add additional questions relating to life history.  The questions picked up on the 10 types of childhood trauma identified by participants in the earlier study. The 17,500 participants involved in the second study were representative of the broader population of California where the study was done.  They were middle class with an average age of 57 and were employed.

The research titled the Adverse Childhood Experience Study (ACE) highlighted even more surprising results.  Two thirds of the participants in the research program had experienced one or more traumatic events.  One in nine had experienced 5 or more adverse childhood events.  They also established that the higher the number of different adverse childhood events experienced by an individual (their ACE Score), the greater the likelihood of that person committing suicide.

Typical strategies adopted by individuals to cope with the impacts of childhood trauma only exacerbate the problem of ill health, e.g. smoking or over-eating.  Vincent maintained that the experience of chronic, unrelieved stress affects the nervous system and the brain and can produce “the release of pro-inflammatory chemicals in a person’s body”, leading to suppression of the immune system.

What can be done about childhood trauma?

I have previously discussed principles and guidelines for trauma-informed mindfulness practice.  Johann Hari, in the section of his book on reconnection strategies offered several strategies that could have a positive effect on the negative impacts of childhood trauma, such as obesity and depression.  His recommended reconnection strategies include social prescribing and reconnection with nature, meaningful work and meaningful values.

Vincent Felitti, too, was concerned that people who had experienced childhood trauma need some form of hope about their ability to redress its negative effects.  He decided to do further research involving medical practitioners who were treating patients through Kaiser Permanente.  He provided them with a few simple questions to ask patients that related to life history and covered childhood experiences, and asked them to express genuine empathy and respect for the patient. 

Vincent found that the participants showed “a significant reduction in illness” once a patient shared their story of childhood trauma with a doctor.  He thought that the explanation for this was twofold – (1) the person was sharing their story with another person for the first time and (2) the recipient of the disclosure was a trusted authority figure who treated them with kindness and respect.  He postulated that the intermediate effects related to the fact that the experience removed the shame and self-loathing associated with the adverse childhood event.  The association of the childhood trauma with the experience of humiliation was broken. Vincent acknowledged that this was an area for further research.

Vincent argued that the ultimate solution to childhood trauma lay in “primary prevention” and advocated for the integration of their research findings into primary care medical practice.  He also supported the development of a life experience questionnaire reporting on childhood trauma as a part of a patient’s medical record that could subsequently be viewed by the treating doctor.  A healing conversation could take place if the patient was willing and able to share their story.

David Treleaven warns, however, that when dealing with someone suffering from post-traumatic stress disorder (PTSD), it is imperative not to tackle the trauma experience head-on.  He advocates a trauma-sensitive mindfulness approach.  Sam Himelstein also cautions against the use of direct questioning and talking where a person is outside their window of tolerance

Reflection

As we grow in mindfulness through research, meditation and reflection, we can begin to recognise the impact of our own experience of childhood trauma and address the negative impacts it has on our own life and relationships. We can also become sensitised to the experience of others who have experienced adverse childhood events and take this into account when dealing with individuals and groups who are seeking to use a mindfulness approach to improve their quality of life.

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Image by Pete Linforth from Pixabay

By Ron Passfield – Copyright (Creative Commons license, Attribution–Non Commercial–No Derivatives)

Disclosure: If you purchase a product through this site, I may earn a commission which will help to pay for the site, the associated Meetup group and the resources to support the blog.

Trauma-Informed Mindfulness: Relationship Building through Music

Sam Himelstein has developed several basic principles and a series of guidelines to assist mindfulness teachers to sensitively work with people who are impacted by trauma. While these principles have been developed over more than a decade working with trauma-impacted teens, the principles and guidelines are also relevant to anyone working with adults who have experienced trauma. 

Relationship building through music

In his podcast interview with David Treleaven, Sam discussed a particular case that was a primary catalyst to the development of his principles and guidelines.  He provides a more detailed discussion of the case in his blog post, Trauma-Informed Mindfulness with Teenagers – 9 Guidelines.  The case involved a 17-year-old high school student, Jeanette, who had experienced a traumatic childhood with many categories of traumatic events in her life, including drug addiction of her father.  She had approached Sam, a registered psychologist, for help with her trauma-related issues.

During initial psychotherapy treatment, Sam was helping her to locate her estranged father so she could establish a connection with him.  However, before this reconnection happened, the young woman learned that her father had died from a drug overdose.  This intensified her trauma and when she presented at Sam’s clinic after the death of her father, she was unable to talk about her father, follow a line of discussion or formulate coherent sentences.  Sam described this in terms of “her brain down regulating”.

Sam’s first principle – “do no harm” – came into play as he realised that getting her to talk would take her outside her window of tolerance.  As he knew about her interest in music and her favourite genre, he intuitively realised that listening to music that she liked would enable her to establish some degree of equanimity, build trust and reinforce the relationship through a shared pleasant experience. 

As they listened to the music together, she slowly began to move her head in line with the beat and rhythm of the music.  Then, she began to talk.  Sam described the effect on Jeanette of listening to the music as regulating her central nervous system, bringing her back within the window of tolerance and enabling her to access her language ability so that she could express her emotions such as anger, grief and sadness.

Sam had realised that while Jeanette was positive about the utility of mindfulness in the context of therapy, “conventional talk therapy or mindfulness meditation wasn’t going to work”.  This music intervention was in line with what he described as practising an INCRA, an “inherently non-clinical relational activity” that is not a therapy technique in itself but effectively builds the relationship.  Sam discusses case studies where he has used INCRA in a clinical setting with teens in his forthcoming book, Trauma-Informed Mindfulness for Teens: A Guide for Mental Health Professionals.

Reflection

As we grow in mindfulness through meditation and reflection, we can better access our intuition when working with or training people who have suffered trauma.   Being present to the person needing help will enable us to let go of conventional, trained responses and be open to activities that are non-clinical in nature but develop the relationship – the foundation for all helping.  Trauma-informed mindfulness, then, involves not only sensitivity to trauma-impacted people but also the flexibility to depart from habituated responses or processes.  Mindfulness helps us to tap into our innate curiosity and creativity.

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Image by obBilder from Pixabay

By Ron Passfield – Copyright (Creative Commons license, Attribution–Non Commercial–No Derivatives)

Disclosure: If you purchase a product through this site, I may earn a commission which will help to pay for the site, the associated Meetup group and the resources to support the blog.

Trauma-Informed Mindfulness: Guidelines for Effective Helping

Sam Himelstein, in a podcast interview with David Treleaven, discussed the principles for teaching mindfulness that he has developed over more than 12 years working with teens impacted by trauma.  His principles and related guidelines have relevance for anyone using mindfulness to help people who have experienced trauma. 

Besides his discussion in the interview mentioned above, Sam provided a blog post that addresses the guidelines explicitly.  The principles and guidelines (together with examples from real cases, teaching material and  practical exercises) are explained in depth in his forthcoming book,  Trauma-Informed Mindfulness for Teens: A Guide for Mental Health Professionals.

Guidelines for effective helping of people impacted by trauma

The guidelines developed by Sam Himelstein provide clear and consistent actions that can be taken by anyone helping people impacted by trauma:

  • Do no harm – this is a fundamental guideline informing the others.  Through research, study and practice of trauma-informed mindfulness practice, we can be more aware of potential harm and have the tools to do the best we can to avoid further harming the person suffering from trauma.  Sam mentions two resources that he draws on, The Meditation Safety Toolbox and Chris Willard’s Guidelines for Ethical Teaching of Mindfulness.
  • Avoid prescription about “meditation logistics” – people who are impacted by trauma are often unable or unwilling to start with formal meditation.  Sam urges us to avoid being inflexible through insisting on a set posture or closed eyes when initiating our helping interaction.  This requires letting go of the structural prescriptions of our own meditation training.  It is important to recognise that the people we are helping will be in a “different space” but can still develop mindfulness (inner and outer awareness) with processes other than formal meditation.  We need to acknowledge that mindfulness is more than just meditating.
  • Establish safety – it is critical that the person we are helping feels safe.  If they do not feel safe, they may experience re-traumatisation.  In addition to physical safety, this involves relationship and emotional safety through developing trust, being authentic and being prepared to modify our approach to suit where the person is at.  A more involved aspect of safety is what Sam calls cultural safety developed through “intersectional awareness”.  This requires an awareness of our implicit biases when dealing with people who have characteristics different to our own, e.g. gender, ethnicity, religion, age, sexual preference, disability or “class”.
  • Employ somatic practices first – this involves recognising the role of body memory in trauma and being cognisant that cognitive approaches commenced too early in the intervention can exacerbate the situation for the trauma-affected person.  Sam indicated that he often uses deep breathing exercises and basic somatic meditations.
  • Understand the “window of tolerance” – relates to a personal zone within which a person is able to effectively employ their cognition to “receive, process and integrate information”.  If a person is outside their window of tolerance than are unable to engage effectively in talking, telling stories or undertaking meditation practices.  Sam suggests that a sign of this “intolerance” is the person’s inability to use language, e.g. unable to formulate complete sentences or follow a line of discussion.  He recommends the book Trauma and the Body, as a resource for understanding the “window of tolerance” and learning about somatic approaches to trauma healing.

Reflection

As we grow in mindfulness through meditation practices, research and reflection, we can develop our awareness and understanding of the sensitivity of trauma-impacted people to formal meditation.  This requires that we become more aware of the “window of tolerance” and develop our capacity to pay attention to the signs that someone we are working with is not coping with our processes.  Associated with this, is the need to build the relationship through establishing safety and trust.  Employing somatic approaches will be more effective if we have experienced their utility ourselves as part of our own mindfulness practice and experience.   The more mindful we become, the better we will be able to help people impacted by trauma – for one thing, we will be able to let go of our assumptions and become more aware of our biases.

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Image by enriquelopezgarre from Pixabay

By Ron Passfield – Copyright (Creative Commons license, Attribution–Non Commercial–No Derivatives)

Disclosure: If you purchase a product through this site, I may earn a commission which will help to pay for the site, the associated Meetup group and the resources to support the blog.

Trauma-Informed Mindfulness: Principles for Effective Helping

Sam Himelstein has specialised for more than 12 years in using mindfulness to help teenagers impacted by trauma.   In a podcast interview with David Treleaven, Sam explained in depth his approach to teaching mindfulness to teens affected by trauma, as well as the evolving principles that shape his practice. While his focus is primarily on teens and educating others to work with teens, his approach and principles have relevance to anyone who is using mindfulness to assist people impacted by trauma (or anyone who is teaching mindfulness where a participant is a trauma sufferer).  He has developed his principles through ongoing reflection on practice.

Sam is a psychologist and youth worker and the author of A Mindfulness-Based Approach to Working with High-Risk Adolescents and the forthcoming book, Trauma-Informed Mindfulness for Teens: A Guide for Mental Health Professionals.  He is also the founder of the Center for Adolescent Studies.

Principles for trauma-informed mindfulness practice

In discussing his approach to working with teens impacted by trauma, including incarcerated youth, Sam identified several principles that guide his practice:

  • Avoid “adultism” – the assumption that as an adult you are superior to teens and have a lot to teach youth and they have very little in the way of wisdom to offer.  Associated with this false belief, is the assumption that you know best what is good for them – implying that they should learn from your teachings (that you try to impose on them).  This also involves recognising the wisdom they gained in their transition to a teenager. [You can also test your assumptions when working with adults – do you assume that they have no insights into the nature and practice of mindfulness?]
  • Work from where they are at – do not begin with formal meditation as they are unlikely to be ready for this.
  • Focus on relationship-building – consciously build trust in every aspect of your interaction, as their level of trusting others will have been severely damaged by their trauma experience(s). 
  • Assist teens to become comfortable with “sitting with themselves” and exploring “inner awareness”.
  • Be genuinely curious about what is happening for them and what they are doing to cope – bring an open mind to the interaction.  It can be helpful to identify and test your own assumptions before interacting.
  • Develop your own mindfulness continuously – your inner and outer awareness – and learn to let go of “ego” and the need to control the process.

Reflection

When teaching mindfulness to adults and youth, we need to be aware of the possibility that they may have been impacted by trauma(s) in their life.  Being conscious of the principles employed by Sam will help us to demonstrate sensitivity, build trust and relationships, and work at their pace – rather than to a pre-ordained progress schedule.  It will be imperative for us to grow in mindfulness – becoming fully aware of the assumptions we bring to the teaching/interaction, letting go of ego and the need for control, and genuinely engaging with curiosity, humility and openness.

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Image by Lubos Houska from Pixabay

By Ron Passfield – Copyright (Creative Commons license, Attribution–Non Commercial–No Derivatives)

Disclosure: If you purchase a product through this site, I may earn a commission which will help to pay for the site, the associated Meetup group and the resources to support the blog.