Self-Care for Mental Health Professionals

In his book, Trauma Informed-Mindfulness With Teens, Sam Himelstein stresses the need for self-care for mental health professionals dealing with traumatised teens.   His final chapter is devoted to self-care and professional practice.  Dr. Cirecie West-Olatunji, counsellor educator,  also stresses the need for self-care for professionals working with people experiencing traumatic stress.  Her video presentation is available as part of the courses provided by the Mental Health Academy.   Both experts in the area of counselling for trauma highlight the impact of vicarious trauma, especially the risk of mental health professionals experiencing compassion fatigue.

Mindfulness for self-care

Sam himself experienced trauma in his early 20s when he lost his sister through suicide. He makes the point that most health professionals will have experienced trauma of some kind and that this experience leaves them open to triggering their own traumatic response through exposure to the trauma stories of other people.  Cirecie highlights the fact that the trauma stimulus can be exacerbated where the professional has previously experienced combined or cumulative trauma. 

Sam emphasises the role of mindfulness in helping the professional to deal with their own re-traumatisation as a result of interaction with others and their emotionally draining stories.  He stresses the role of a personal mindfulness practice in helping him deal with the trauma of his sister’s suicide.

Sam  suggests that a personal approach to mindfulness as a protective mechanism could involve the following:

  • Silent retreat(s): Sam found these exceedingly helpful because they enable you to fully experience your emotions, gain a deep insight into your inner landscape and develop strategies to maintain or regain your equilibrium.
  • Formal practice: this entails inculcating a regular mindfulness practice (either sitting, standing, or walking) where you engage in some form of formal meditation.  This helps to build your concentration to enable deep listening, empathetic response, and the ability to promote wise action.  It also assists you to deal with your own difficult emotions (such as anger, resentment, or frustration), challenge self-defeating narratives and develop resilience in the face of challenging interactions.
  • Beyond meditation: Sam suggests that bringing mindfulness into your everyday life (in daily activities such as walking, washing clothes, eating, shopping), is effectively “mindfulness-in-action”.  It is particularly relevant to your relationships and interactions with others, especially in times of conflict.  One way to develop the necessary calmness and equanimity in the face of emotional challenges is to practice reflection-on-action to eventually cultivate the capacity to reflect-in-action, in the course of something adverse happening to you (whether that adversity is real or imagined).  Sam stresses the importance of daily mindfulness practices in controlling the “ego” which can get out of hand when  it perceives a threat (physical, emotional, or intellectual).

Professional development

Both Sam and Cirecie stress the importance of professional development to build competence and confidence to enable you to operate effectively within your chosen arena of professional practice.  For Sam this is the arena of traumatised youth, especially those who have been incarcerated.  He offers specialised training for health professionals through his Center for Adolescent Studies.  Cirecie’s professional arena includes trauma stress service delivery and training professionals who provide counselling in different countries following disasters such as earthquakes and pandemics.  She conducts research and training through her Xula Center for Traumatic Stress Research.

Cirecie stresses the need to gain control over your workload and, where necessary, seek to negotiate a lighter load (for your psychological welfare and that of your clients).  She maintains that every mental health professional, irrespective of their level of experience and training, has their window of tolerance beyond which they are unable to function effectively.  She gave an example of how a racist client triggered her and how  her experience in working in South Africa with a community where people were consistently dying from AIDS took her outside her window of tolerance and led to a severe illness.  In both cases, she sought professional counselling and recommends this form of professional development for other mental health professionals.

Cirecie highlights the importance of self-knowledge and self-awareness as critical factors in professional counselling, particularly understanding your own negative triggers.  She encourages too the development of your own professional support network that you can draw on for knowledge, experience, resources, and emotional support.  

In Cirecie’s view, personal and professional development extends to conscious awareness of the physical and psychological health risks inherent in the role of a mental health professional.  She urges appropriate preparation for the role through education which will provide motivation for health self-care (e.g., exercise, stretching (to release physical tension), diet, and drinking water).

Reflection

There are many reasons why mental health professionals do not undertake adequate self-care.  When working with clients who have suffered trauma or are currently experiencing trauma, it is critical that the health professional takes time for self-care to enable them to function at their best for the sake of their clients, as well as for their own welfare.  Mindfulness practice is recognised as a key component of this necessary self-care.  As mental health professionals grow in mindfulness, they are better able to identify personal triggers, develop resilience for their challenging work and build the capacity to engage in deep listening.  However, mindfulness practice needs to be supported by an appropriate lifestyle. 

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Image by Vanessa Kenah 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.

Building Cognitive Resilience through Mindfulness

Research conducted by Jamie Bristow and Rosie Bell supports the view that mindfulness builds cognitive resilience – “the ability to overcome negative effects or stress on cognitive functioning” (as defined by Staal and colleagues).  In times of stress or serious setbacks, we can experience cognitive confusion and disorientation.  When the perceived threat to our wellbeing is considerable our “thinking brain” tends to shut down and our “survival brain” takes over – we can be controlled by our negative emotions and engage in fight, flight or freeze behaviour.  In these challenging times we can experience emotional inflammation as we are challenged on many fronts.

The impact of information overload

Information overload is a characteristic of our times with the ever-present and pervasive information highway.  With COVID19, we not only have to cope with the emotional strain of illness and death amongst our families , friends and colleagues but also the vast amounts of complex health advice and restrictions – information that is often conflicting and exacerbated by misinformation peddled by vested interests.  

The stress of information overload can be compounded by what Jamie and Rosie refer to as a our “digital and media diet” – a bias towards distressing information, rather than information that inspires, uplifts, or motivates.  An obsession with the news can be a daily diet of information that disturbs, distresses, distracts and debilitates us and severely limits our effective cognitive functioning.

Unfortunately, our natural tendency is to close down emotionally and avoid facing the pain of negative emotions.  We can block out difficult emotions such as fear, anxiety, and depression until such time as they take their toll on our physical health.  Liz Stanley, for example, explains how she lost her sight temporarily by “soldiering on” despite traumatic stress.

The role of mindfulness in developing cognitive resilience

Mindfulness practices can help us face raw and difficult emotions such as fear and build resilience through accepting our current reality, rather than denying its existence.   Rick Hanson, for example, provides a meditation practice designed to turn fear into resilience.   Bob Stahl, meditation teacher and author, offers a mindfulness practice to address fear and anxiety that are exacerbated by negative self-stories.

Mindfulness meditation can be a source of refuge in times of turbulence when we feel our minds and emotions whirling.  It enables us to restore our equilibrium and find peace and calm despite the waves of change and challenge crashing down on us.   We can build our resilience by taking time out to become grounded and to reconnect with ourselves. 

Jamie and Rosie point out the research that demonstrates that mindfulness can enhance both working memory and long-term memory.  Working memory constitutes our temporary storage facility that enables us to utilise information to effectively make decisions, act wisely and communicate appropriately.  It can become overwhelmed and degraded by stress and trauma and negatively impact our window of tolerance – narrowing it and thus reducing our capacity to cope with further stressors, however minor.

Reflection

As we grow in mindfulness we can increase our sense of agency in the face of stress and setbacks by facing up to our negative emotions and diffusing their impact, accessing our memory and cognitive faculties without the befuddlement of emotional overload, making sound choices about information that we expose ourselves to and developing groundedness despite the turbulent winds of change.  In this way, we can progressively build our cognitive resilience by reducing the negative impacts of stress on our cognitive functions and limiting emotional turmoil.  Hence, we will be better able to access our creative faculties and take wise actions such as scenario thinking to deal with ongoing stressors. 

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Image by Leni_und_Tom 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.

Healing from Trauma and Building Resilience to Manage Stress

Liz Stanley recently provided an introductory webinar for her course on Mindfulness-based Mind Fitness Training (MMFT)®.  The webinar explains the components of the course and how it helps people recover from trauma and enable anyone to build resilience and effectively manage stress.  She also discusses the traumas she has experienced, her personal search for healing and resilience and her in-depth training including her doctorate. 

The components of MMFT®

The online course covers 8 modules over 8 weeks (that you can undertake within your own time and availability).  The first four modules provide the framework to understand how stress and trauma affects us and provides an insight into the neurobiology involved.  As she explains in the webinar, stress and trauma reduce our window of tolerance (our tolerance of stress arousal).  In her view, each of us have our own window of tolerance which has been shaped from birth, and continuously widened or narrowed through our life experiences, encounter with trauma, our lifestyle choices and our stress response (creating implicit learning about what is threatening). 

If we are within our window of tolerance, we are better able to access our thinking brain (enabling accurate perception, clarity of thinking and wise decision making); when we are outside our window of tolerance we are captured by our survival brain and habituated stress responses in terms of bodily sensations, difficult emotions and harmful choices.

Liz explains that the second group of four modules of the MMFT® course deal with habits and related habituated responses, making effective decisions, managing difficult emotions and chronic pain, as well as ways to be more effective in our interpersonal interactions.  The course includes stress and trauma-sensitive mindfulness practices, ”somatic experiencing” and a unique sequence of exercises designed to achieve grounding and enable movement “from dysregulation to self-regulation”.

Liz’s course is offered through Sounds True and has been validated extensively through evidence-based research that has confirmed results in terms of improvements in cognitive performance, strengthened resilience and improved self-regulation, as well as positive developments in other areas of self-management.

Widening the Window of Tolerance

Liz explains that our repetitive experiences impact our implicit knowledge and shape our brains and neuroception (perception of threat/ safety).  We can choose experiences that are beneficial or others that are harmful – we have choice in how our brain is shaped and adapts (neuroplasticity).

In the MMFT introductory webinar and in her book, Widen the Window, Liz offers five lifestyle choices that can serve to widen our window of tolerance:

  1. Sleep
  2. Diet
  3. Exercise
  4. Awareness and reflection
  5. Social connection

She explains that the course details the beneficial effects of each of these elements and also the detrimental effects caused by their absence or deprivation.  She particularly notes the benefits of awareness and reflection.  Liz explains that awareness can be built through mindfulness practices, Tai Chi and yoga while reflective practices involve reflective thinking such as journalling, reading poems, reflecting on scriptural passages or work experiences and their implications, or maintaining some form of gratitude diary.  She highlights the benefits of mindfulness and reflective practices in terms of calmness, clarity, self-awareness, focus, resilience and intention building.

One of Liz’s key messages is that resilience is something that we can learn and develop through beneficial choices.  The result is that we will be better able to manage stress, heal from trauma and access our thinking brain which enables us to think clearly and creatively and choose wise actions – rather than be captive to stress-induced confusion and harmful habituated responses.

Reflection

Liz’s course focuses on how to heal from past, stressful experiences and how to deal effectively with future stressful situations, whether internal (e.g. chronic anxiety) or external (e.g. job loss or interpersonal conflict).  She emphasises the need for consistency not only in making beneficial lifestyle choices but also through engaging in regular mindfulness and reflective practices.   As we grow in mindfulness and the associated awareness of thoughts, emotions, and bodily responses, we can widen our window of tolerance and deal more effectively with the stressors in our life.

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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.

The Pandemic and Narrowing of the Window of Tolerance

David Treleaven and Liz Stanley discussed the current pandemic In their interview podcast on Widening the Window of Tolerance.  They both asserted that COVID-19 had effectively narrowed the window of tolerance of many people.  There are many people who are becoming increasingly stressed and traumatised by unfolding events, whether because of the death of relatives and friends, loss of a job, dislocation from their normal place of work (and way of working) and/or stringent “lockdowns”.

Narrowing the window of tolerance

In these very challenging times, people are becoming controlled by their “survival brain” – resorting to a fight, flight or freeze response.  Their window of tolerance is becoming narrowed, both in terms of their inner tolerance of challenges and external tolerance of differences.  Everything has been “thrown up in the air” so that they have lost their grounding in accurate perception and balanced body sensations. 

Polarisation , racism, and hate thrive in this disrupted state as people seek refuge in their “own tribe” (flight) and attack others who are different from themselves (fight).  Liz suggested that many people are “uncomfortable in their own skin” so that lockdowns and movement restrictions , creating disconnection, exacerbate the tendency to dysregulation (inability to control emotions).   The sense of hopelessness and helplessness in facing continuous and growing uncertainty adds to the incidence of anxiety and depression.

A compounding factor is that social media becomes what Liz calls an “echo chamber” – it gives unregulated voice to “dysregulated communications” that increase the tendency towards polarisation.  People retreat to social media and television only to find that these media are increasingly disorientating and disturbing.    

Further compounding the issues for individuals is the fact that we tend to make a “bargain” with ourselves – e.g. we can put up with lockdown for three weeks by adding some new routines such as working different hours, taking more regular breaks and expanding project timelines.  However, when other people blatantly and inconsiderately breach lockdown regulations or social distancing requirements leading to further lockdowns, conforming people can feel betrayed – intensifying a sense of hopelessness and helplessness.

Hope and widening the window of tolerance

In the previous post I discussed trauma-sensitive mindfulness and widening the window of tolerance.    Liz provides several strategies in her book, Widen the Window: Training Your Brain and Body to Thrive During Stress and Recover from Trauma.  In the interview podcast she shared some of her own strategies for becoming grounded during the current health and economic crisis – mindfulness meditation, gardening, walking and playing with the dog, and focusing on connectedness to others.

Liz’s Mindfulness-based Mind Fitness Training (MMFT)® provides detailed strategies and tools to navigate effectively through times of trauma and stress.  She makes the point that whenever we are controlled by our “survival brain”, we are disconnected from our “thinking brain” and shut off from the opportunity to access our creativity and ingenuity. In discussing “hope” in the current challenging times, David noted that the tendency to “hyperfocus on what is not working” (as he has done at times) tends to narrow the window of tolerance and our capacity to cope.  He suggests that accessing stories of successful transition can help to widen our window of tolerance, e.g. successful career changes by people who have lost their jobs. Another strategy that he suggests is to effectively reframe what is happening.  By way of example, he draws on the comments of Adrienne Maree Brown in her article on living through the unveiling:

Things are not getting worse, they are getting uncovered, we must hold each other tight and continue to pull back the veil.

Liz reinforces this view when she suggests that it is really only in times of turbulence when everything seems to be “thrown up in the air”, that genuine and sustainable change can happen.

Reflection

As David suggests, we can choose to stay in the fog bank by continuing to absorb negative messages, both external and internal, or we can free ourselves from this befuddled state by growing in mindfulness and developing our own strategies to build resilience and stay grounded.

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Image by My pictures are CC0. When doing composings: 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-Sensitive Mindfulness and the Window of Tolerance

In the previous blog post I discussed several resources on the topic of trauma-sensitive mindfulness.  One of these was David Treleaven’s Trauma-Sensitive Mindfulness Podcast which includes interviews with people who have expertise in the area or a related area.   In a recent podcast, David  had a conversation with Liz Stanley who not only experienced very considerable trauma, the impact of mindfulness meditation on her traumatic experience but also has developed her own resources and training for people, both civilians and military personnel, who have experienced trauma.  The conversation with Liz on the topic of Widening the Window of Tolerance draws on her personal experiences, study and training and incorporates ideas from her training program and her book, Widen the Window: Training Your Brain and Body to Thrive During Stress and Recover from Trauma.

The Window of Tolerance

The concept of the Window of Tolerance has been attributed to Dan Siegel, clinical psychologist and founding co-director of the Mindful Awareness Research Centre (MARC), UCLA.  Dan is the author many books, including Aware: The science and practice of presence.  Many people, including David Treleaven and Liz Stanley, have applied the concept of the Window of Tolerance in their research and training in relation to trauma-sensitive mindfulness.

The National Institute for the Clinical Application of Behavioral Medicine (nicabm) provides an infographic that illustrates the concept in a very clear and easy-to-understand way.  They explain that the window of tolerance is about our capacity to deal with the challenges and stresses of the moment and take wise action to deal with them.  When stress takes us outside our window of tolerance we can experience hyperarousal (related to the fight/flight response) which manifests in uncontrolled anger, emotional overwhelm, or extreme anxiety; or, alternatively, experience hypoarousal (related to the freeze response) which manifests in the body trying to shut down resulting in numbness, “zoning out” or “spacing out”.  

The Attachment and Trauma Treatment Centre for Healing (ATTCH), drawing on the work of Dan Siegel and colleagues, provides a more detailed explanation of the concept in an article titled, Understanding and Working with the Window of Tolerance.  Pooky Knightsmith, on the other hand, provides a simple explanation in her short video on the window of tolerance and how to apply it to managing our emotions in everyday life (for those who are not experiencing trauma or trauma stimuli).

Trauma and narrowing of the window of tolerance

In her podcast interview. Liz reinforced the view that trauma causes a narrowing of a person’s window of tolerance.  She explained that she is a living example of someone who has experienced multiple traumatic events and who tried to cope in the only way she knew how, conditioned as she was by familial and social determinants.  Liz suffered an incredible range of traumatic experiences – active military duty in Asia and Europe, PTSD,  a near-death experience (NDE), rape, and whistle-blower harassment as a result of formally complaining about sexual harassment by her senior officers.

Liz described her response in terms of the compulsivity that comes with hyperarousal (which can occur when a person is outside their window of tolerance).  Instead of dealing with her traumatic stress, she intensified her activities, completing two undergraduate degrees simultaneously.  She explained that like a lot of people, she “compartmentalised” the stress, suppressed it and just kept going harder than ever, managing on two hours sleep each night – she “soldiered on”, both literally and metaphorically.

Liz had to make changes when she temporarily lost her eyesight – something she described as “cosmic coping pain” when her body which had “borne the brunt” of her hyperactivity decided “enough was enough”.  It was then that she explored mindfulness and researched trauma and trauma healing.

Liz explained “trauma” as impacting “neuroception” – “how neural circuits distinguish whether situations or people are safe, dangerous or life threatening”.  In effect, trauma can distort our neuroception and effectively narrow our window of tolerance.  She explains the effect in terms of our “thinking brain” and our “survival brain”.

Our thinking brain enables us to analyse, make decisions, accurately perceive stimuli, and take wise action; our “survival brain” responds to perceived threats with the fight/flight/freeze response.  With trauma, the connection between the two is “compromised” so that, for example, seemingly harmless stimuli can be perceived as a threat and engender an inappropriate response negatively impacting a person’s health, relationships and capacity to undertake their work.   When we perceive a situation as hopeless or ourselves as powerless, our survival brain and nervous system can become flooded with heightened “emotional arousal”.

Liz explains, however, that when the thinking brain and survival brain are in harmony and working together, we have a wider window of tolerance – e.g. better tolerance of ambiguity and uncertainty and the ability to identify and make effective choices, build sustainable connections, and perform optimally. 

Experience of mindfulness for dealing with trauma

Liz turned to mindfulness meditation to help her cope with her traumas which had deep-seated antecedents in the post-traumatic stress disorder (PTSD) experienced by her father and grandfather (along with all the distorted coping mechanisms and fractured relationships that this entailed). Her initial experience with mindfulness was one of helping her to achieve some degree of self-awareness and associated self-regulation.  However, over time, she found that her “survival brain” took over as it began to “peel back deeper layers” – deep emotional scars hidden behind her hyperactivity (just as the happy-go-lucky “joker” or “larrikin” can hide the deep emotional pain of depression).

As some mindfulness practices acted as “trauma stimuli” she experienced panic and shallow breathing in-the-moment and flashbacks, nausea, claustrophobia, and inability to sleep for days afterwards.  Liz explained that a potential problem with mindfulness done in isolation and without appropriate modifications can lead to such heightened emotional awareness and arousal that the traumatised person can lose their ability to regulate their emotions and their unhealthy condition can be exacerbated rather than diminished, both mentally and physically.

Developing a trauma-sensitive approach to mindfulness training

Liz explained that she spoke to scientists and neuroscientists, explored multiple skills and techniques, and wrote a book about her experiences and her journey out of trauma disablement.  She found that the myths surrounding mindfulness could make matters worse unless the mindfulness trainer recognised the impact of traumatic experience on a person’s window of tolerance.

In her book on widening the window, she draws on her own experiences and stories from people she has trained in a areas such as healthcare facilities and the armed forces.  Liz maintains that you can build resilience even in stressful jobs or when healing from traumatic experience(s).  She provides strategies involving paying attention in certain ways to increase the capacity to access choice and creativity and to make courageous decisions while effectively connecting with others through curiosity, openness, and compassion.

Liz’s Mindfulness-based Mind Fitness Training (MMFT)® which was developed in 2008 and evaluated on four occasions by neuroscientists and stress experts is now available online through Sounds True.  The comprehensive course includes video training and live sessions on topics such as resilience, stress and trauma recovery, effective decision making and relationship building along with “new tools for successfully navigating the interpersonal aspects of stress, trauma, emotions, and conflict”.

Reflection

When you first hear about the potential harmful effects of mindfulness meditation training for trauma sufferers, you can understandably become concerned about conducting mindfulness training for any group.  Alternatively, you might initially dismiss the trauma-sensitive mindfulness movement as a movement to counter the growing global popularity of mindfulness.  However, the evidence to support the trauma-sensitive approach is growing and cannot be ignored.

On the other hand, both Liz and David strongly encourage practitioners not to be put off from training others in mindfulness by this new information nor to behave as if they are “walking on eggshells”.  They strongly encourage mindfulness trainers to persist, especially in these challenging times when mindfulness and resilience is needed by some many people.  They do, however, suggest to proceed with “some discernment”, develop increased awareness of trauma and its impacts, learn about new tools available for trauma-sensitive mindfulness training and intensify their own efforts to grow in mindfulness so that they can train with increasing awareness, insight and sensitivity.

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Image by skeeze 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.