Ourselves develop in relationship. Initially, in attachment relationships in early childhood. And then later, in the world of social connection. This development is in every aspect of our being: physical, psychological, emotional, cultural, spiritual. This connectedness for development and well-being is a theme you have been hearing about throughout the MOOC. When we have flowing and lively sense of self, we tend to feel well and tend to flourish. This talk however is about trauma, and trauma is a difficult subject because it's a difficult experience. Trauma breaks down our being, our sense of self. And can break down how we feel about ourselves, others, and the world. So, it's an important experience that impacts profoundly on our well-being. We could think back to Tina's story in the first week of our MOOC, and the impact of childhood trauma on her sense of self, and her important and long road to recovery. For a time, we didn't pay enough attention to just how common and just how damaging trauma could be. We didn't realize just how many people seeking or needing help for their mental health had been impacted on by trauma. Sometimes, sadly, the experience of mental illness and its treatment was traumatic in itself. The good news is that we're in a time where we are realizing the huge impacts of trauma, and are actively developing our approach to it to help people, families, and communities recover and return to thriving. In a phenomenon called post-traumatic growth, we can actually grow through trauma and eventually become stronger, more resilient than before. This was Tina's story and it is the story of many. We are realizing that repair, recovery, resilience, require us to foster personal and interpersonal connections, and over time integrate traumatic experiences into a new story of our self and a new way of being. We both repay the old aspects of self and the old connections and we nurture the new. I often think of this is the way trees heal. The rings they lay down at their core will always tell the story of a tough year. But if the tree survives, it often becomes stronger than before. We are more than the story of our traumatic times. We are people that reflect on ourselves and make meaning of our experiences and so, our recovery can be rich at multi-layered. So what is trauma? We certainly all have stress. And we've heard about how universalities and ways to manage it are discussed in other MOOC talks. The trauma is however more than simple stress. It is a highly stressful life event or actually cumulative amount of stress that exceeds a person's capacity to regulate themselves and manage in the face of it. So the event disturbs their equilibrium or what we call "Homeostasis". Traumatic events include single events like a serious accident, assault, or disaster. And also include long term situations like domestic violence, entrapment, or child abuse. The stress diathesis model is central to understanding the distress associated with onset of mental health problems and stress system disorders. It says that everyone has a level of risk for disorders to which stress adds. And where there's enough of it, symptoms and disorders emerge. A self-regulation involves every level of being. So when trauma breaks it down, it can happen at any or all of these parts of our life. Part of being tuned in to trauma is a challenge to health. It's to recognize that I might notice the effects on my body, my mind, my relationships, my cultural life, or my spiritual life. And those who know me or work with me might feel that in those areas where we come into contact and connection. This recognition of trauma or in its effects is a crucial current issue in health. Trauma can break down how we connect to others and tell our story and breakdown our trust in the world. When trauma happens in childhood and adolescence. In the very relationships of care in a home or community that is meant to keep us safe and help us grow, it can impact on how we develop and regulate ourselves in adulthood. It can then become a risk factor in mental and physical health. The big ace study in the USA investigating these adverse childhood experiences showed the knock on effects on mental and physical health of childhood trauma. So, post traumatic stress disorder which can follow experiencing or witnessing a single life threatening event is an important disorder. Features of PTSD include nightmares, flashbacks, anxiety, and a tendency to avoid reminders of the trauma. People with PTSD often have insomnia and/or depression, or use substances to try to deal with the symptoms. However, we now understand that the most severe dysregulation occurs in people who as children lack a consistent caregiver or adequate experiences of safety and comfort. The cumulative effect of this kind of trauma is called "Complex trauma" and is a big contributor to many mental health disorders. We need positive connection. So for example, even daily devaluation in childhood, or neglect, can lead to an ongoing sense that I'm not worthwhile and impact my attachment state of mind and how I view myself. Trauma causes shock, numbness, and feel and can cause dissociation or disconnection in the individual experiencing it, and those around them. Dissociation describes the disconnection or disorganization of parts of mental and physical life that would normally be connected and healthily organized. For some people these disconnections, dissociations or disorganizations are very severe. For example, those with dissociative identity disorder can be disconnected from whole parts of themselves that then function at times as another state of self. This problem with remembering who they are at different times can be very confusing for them and for those around them. Strong feelings of confusion, disorientation, rage, disgust, helplessness, hopelessness, can emerge too. The strong feelings and associations around trauma probably partly explain why trauma has often been hard to examine or recognize and can lie out of direct sight, out of mind. When trauma happens in secrecy like abuse often does, then the difficulty in recognizing it and in seeing it is compounded. These days we're trying to develop trauma-informed care, ways of caring for others and ourselves that understand how trauma breaks down consciousness and self. And then, explores the pathways back to feeling whole and to flourishing. Now, we often talk about a faith based approach to treatment. Fundamentally, we first have to establish safety for those experiencing trauma, and the families and systems of care around them. You can probably imagine that if I have grown up in an unsafe home or community, that safety might take a while to set up. This step requires the listening, validation, and tuning in of carers and clinicians. We take time to notice if someone is terrified and engage them in ways that help them feel safer. After safety comes stabilization where we try to help the person find ways to feel supported. Ways that can help them manage safely, to minimize the ongoing breakdown effects of trauma. This helps them move away from other unsafe strategies like drugs and alcohol or self-harm. Here some of the skills and strategies discussed in the MOOC can be crucial in fostering calm and hope, and settling down our body and mind which might be feeling terrified, anxious, angry, or frozen. Here, relaxation, breathing, exercise, being validated in a caring relationship, mindfulness and meditation are some ways that help. Each person needs the strategies to fit well with them. And practicing them may also take some time. Then, and only then, when we feel ready and supported, can we then think, feel, and work through what happened to us in a number of ways. As trauma affects all aspects of being. Any of these can be an initial window into recovery. Trauma focused cognitive behavior therapy and Eye Movement Desensitization are types of psychotherapy used for PTSD. Body therapies, creative therapies, other psychotherapies, and neurofeedback can all have a place. For some spiritual frame is important. Something like meditation can work in a number of levels to bring about reconnection and new connections between mind and body. So, integrative approaches help us counter the disconnections in mind, body, and soul caused by trauma and help us become whole again. Those who've been through trauma need support to recover. But sometimes they need time and evidence to believe that they can trust others again. Trust the care we offer and even trust themselves. Yet, we can resolve trauma to recover, grow from it, and flourish. And it seems that the best way to do this is to do it together in safe company. We don't have to do it alone.
