When breathing doesn't come easy
Imagine, after surviving a trauma, you are so impacted that you have trouble breathing. It's like taking a breath that is shortened and never reaches your lung. It's stuck somewhere in your throat and your whole body tenses. It's hard to blink, hard to move and your body tightens up. And you're fighting the impulse to run, the impulse to explode or the wish to just disappear...somewhere, anywhere. While you're in this moment of fear and uncertainty, the world moves on. There's a street to cross, dinner to make, phone calls to answer and a shower to take. But, if you can't breathe... if you can't feel safe or in control of your own body, how well can you manage any of this?
Trauma impacts relationship building, physical health and self-care, emotional regulation, ability to orient self to environment and situations, and patterns of behavior such as sleep and social engagements, cognitive processing, self-identity and self-perception, and long-term medical health needs, often with cumulative economic stress and cost.
Whether defined as an individual, group, community or mass trauma, whether caused by natural events or by people, or as a single event, repeated or pervasive, the defining factor is the distress and life disruption that trauma causes. Interventions for trauma-specific treatment care include resiliency building; integration of self with positive coping skills to address immediate and delayed reactions to trauma; and building support systems and improving self-care with quality of life changes. While Trauma-Informed Care (TIC) is an excellent model for practice changes in the environment and systems of care, training in specific interventions for trauma care is a necessity, and must be culturally relevant and sensitive to gender identity and sexual identity. The therapist's self-awareness and reactions can be used as a barometer and may be reflective of the client's experience. Therefore, if, as a therapist you are having a physical reaction in the moment, check your client's emotional space. See how your client is breathing.
In the moments when even taking a breath is difficult for your client, these are the times when trauma care is most critical. Some examples of interventions include:
- Biofeedback to help the client identify their somatic responses and re-train complex response patterns. An example would be helping the client recognize a change in breathing connected to changes in body temperature and/or muscle tension with the correlating stimuli or trigger, and implementing a re-breathing training protocol. Consider appropriate and culturally relevant explanations of the mind-body experience to leverage this intervention and to lift the stigma of mental health care. Explain the biological experience as a way to emphasize active re-learning and empowering self-awareness and as a means of promoting self-care.
- Grounding techniques that help identify safe places in terms of environmental cues, as well as one's physical boundary in the environment. An example is a re-focusing exercise that centers on a safe body part and allows the individual to re-identify with their physical boundary and re-enforces physical and emotional integration. Use culturally relevant and gender-sensitive explanations of body integration after trauma. Allow variability in grounding techniques for various triggers.
- Object identification that connects to a supportive relationship or experience and allows for a safe, emotional attachment and experience of self. An example would be to have the physical object in-hand and to implement a training that encourages sensory connection to the object and arouses feelings of safety, familiarity, control, and support. When possible, encourage using culturally significant objects supportive of positive experiences of self and resiliency building.
Clinical assessment of the individual's ability to contain and be aware and cope before, during and after a flooding experience is an ongoing requirement in the active treatment of trauma. The ability to breathe is most basic, and if our client can learn to breathe with us, and on their own again, it is a measurable treatment change toward feeling whole again.
- SAMSHA's page on TIC: http://www.samhsa.gov/nctic/trauma-interventions
- SAE's Trauma-Informed Care and Evaluation: http://saeandassociates.com/issue-briefs/2015/8/28/trauma-informed-care-and-planning-an-evaluation
- Recent RFPs for HIV and Prevention where TIC is an integral model of care: http://saeandassociates.com/current-rfps/