Registration now open for September 21, 2020 session

TraumaOnline

The newsletter of the

International Trauma Training Institute (ITTI)

www.traumaonline.net

Mike Dubi, Ed.D., LMHC, Editor

Jeanne Thomas, MBA, Associate Editor

Summer/Fall 2020, Vol. 3, No. 3

I am pleased to announce that our expanded Substance Use Disorders course has been approved for the Certified Addictions-Informed Professional (CAIMHP) designation through Evergreen Certifications. This certification will begin with the session starting September 21. This new version contains 8 modules and will provide 17 continuing education hours.

ITTI will also be launching its new Trauma Road Map Webinar series on September 30 with a one-hour presentation by Mike entitled Trauma and Brain Basics.

We have expanded and updated our Child and Adolescent Trauma Professional course which will also begin on September 21. Dr. Cheryl Paulhus has made this great course even better.

Some other course changes that we are currently working on are certification for Erasing Anxiety: Understanding & Treatment and Bilateral Hypnotherapy. We expect to have both completed sometime in the Fall.

We are in the process of completing a course on Motivational Interviewing for the Fall by Dr. Jim Reynolds. I hope this will be ready to begin on September 21.

If you have suggestions for new ITTI courses please contact me at mdubi@comcast.net

As always we are seeking contributions to our newsletter and to our professional journal, The Practitioner Scholar. If you have ideas or suggestions please contact me.

Best Regards,

Mike Dubi

ITTI President

ANNOUNCING NEW TRAININGS & CERTIFICATION

Trauma Road Map Webinar Series - periodic 1-hour webinars via Zoom on current topics. The first, Trauma and Brain Basics, will be on September 30, 1-2pm EST. Mike Dubi, Ed.D. presenter. Cost $25. One CE Hour awarded for verified completion.

Substance Use Disorders (SUD) now eligible for certification!! This NAADAC-approved course has been expanded from 6 to 8 weeks (17 CE Hours) and will include additional modules on process addictions and special populations.

Child & Adolescent Trauma Professional (CATP). Newly revamped by Dr. Cheryl Paulhus, this updated version incorporates a more comprehensive view of child & adolescent trauma treatment. See the expanded description below under COURSE UPDATE.

COMING SOON: Motivational Interviewing. This course created by Dr. Jim Reynolds will be ready in time for the September 21 session.

TRAUMA ROAD MAP

WEBINAR SERIES

(via Zoom)

This series of 1-hour long webinars will cover topics such as Trauma and Brain Basics, What Works in Trauma Treatment, and Basic Techniques in Trauma Treatment. These webinars will provide a road map to help inexperienced professionals begin training in trauma treatment. They will also provide experienced professionals with a review of trauma fundamentals.

These webinars will allow 15 minutes of Q&A. One (1) CE Hour will be awarded upon verified completion.

Click here for details and to register

September 30

1-2pm EST

Trauma and Brain Basics

Presented by

Mike Dubi, Ed.D., LMHC

Trauma and Brain Basics will cover:

Trauma Overview

Trauma Settings

Medical and Psychological Consequences

Rates and Incidence

Trauma Response

Risks

Brief History of PTSD

Brief Diagnosis Discussion of PTSD

Brain Basics

Anatomy

Survival

Fear

Physiological Aspects

Cost: $25

Click to register

beginning on

September 21, 2020

To see course descriptions and to register, click this link:

http://traumaonline.net/online-training/

ARTICLE

EXISTENTIAL EXPOSURE:

THAWING FROZEN GRIEF FROM

COVID-RELATED LOSS

Andy Brown, Ed.D.

Justina Wong

Lindsey Bass

As soon as Marie closed the browser on her laptop after her godmother’s virtual funeral, she began weeping uncontrollably. She realized in all her 36 years she had never known a place as warm and as safe than her godmother’s house where, as a young child, she escaped her physically abusive father for a few hours or sometimes even overnight. Her godmother spent hours with her teaching her the recipe for El Salvadoran pupusas; shoulder-to-shoulder they worked the masa harina into pliable dough before filling it with the spicy pork mixture and beans and cheese. Marie has fond memories of her godmother putting her in charge of making the curtido. As Marie watched the pupusas grill in the skillet, she felt her fears melt away and she knew she was safe and belonged in this kitchen. Marie began to feel loved, and with a warm pupusa in her hand and the assuring sound of her godmother’s Salvadoran Spanish, she would feel nourished before she returned home. Now as a non-traditional college student and a reservist in the Army National Guard, Marie fights the guilty feelings that she should have been able to do more to honor the woman who did so much for her. Marie thinks about the way her godmother fought pancreatic cancer bravely, and largely alone, during the recent COVID-19 pandemic. As she reflects on the past few months and the ensuing anger, sadness, and frustration she experienced, she realized it was time to defrost her frozen grief.

Frozen Grief

The restrictions that COVID-19 brought to our world have challenged everyone in a unique way. One might argue that an introvert could feel comforted by the lack of social pressure, while an extrovert could describe these past eight months as the worst months of their lives. Alternatively, ambiverts and omniverts may view the quarantine as a much-needed recharge. We are all unique in the ways in which we are processing these unchartered waters with extensive icebergs over every wave, yet we are all simultaneously grieving the loss of the life we knew before the pandemic.

While many have been able to stay symptom-free in quarantine, over three-quarters of a million people have died because of the coronavirus pandemic (Johns Hopkins University of Medicine, 2020). The scope of traumatic impact for these deaths is inestimable. Further, discussions surrounding death in these times have brought about a plethora of grief-related symptoms into focus—particularly grief that has been left beneath the surface. Questions regarding the true nature of death aim to put blame on something that seems evident yet may have had no true impact on someone like Marie’s godmother with cancer. When a loved one gets sick and no one can visit them, it can feel like a morbid disappearing act. This sudden disappearance can freeze the grief of the bereaved, impeding the current grief process and preventing future grief manifestations.

Icebergs are a serious maritime hazard, comparable to the iceberg of frozen grief that can emerge as unprocessed grief when you are in the wake of loss. Behaviors, such as visiting a hospital, sitting by the bedside of a loved one as they pass, or hugging and crying together at a funeral are all cherished moments that have been altered or denied completely to those grieving during this pandemic. Learning to grieve in a new, socially acceptable, and CDC-approved manner may help in melting the iceberg of grief before it becomes an emotional hazard.

Certainly, ‘normal’ is not a word that can be used these days without the conditional ‘new’ precedent. Similarly, grief does not run a ‘normal’ course in anyone. Yet, the pressure to compartmentalize the horrific number of deaths this world has seen and somehow accept the inability to find closure through a culturally appropriate celebration of life, funeral service, or burial has become a far too common state of affairs since the first death on January 11, 2020. People who are grieving in this pandemic have not had the opportunities to work through their grief in the typical ways. Finding new ways to thaw the frozen grief will be imperative to ensure that future grief can also be handled and experienced rather than buried in frozen darkness.

Neuroscience of Loss

A chorus of neurochemical and neurological interactions are triggered at the introduction of loss. Anticipatory grief can consume our senses at the mere words that embody the potential loss - words like “cancer” or “COVID”. The senses are the first responders, via the thalamus, which internally indicate that the threat of loss exists. If you have ever received a phone call from a previous partner muttering the words, “we need to talk”, suffice it to say that your sense of hearing can now be used to trigger your amygdala by listening to those unfortunate words the next time they are echoed by another. If you have ever encountered a loved one, and when in the moment of greeting noticed something wrong, your sense of sight may have filtered their sad demeanor and macabre, tacit facial expressions through to your inner brain’s alert system, leaving you with sense-based memories that become triggers. No doubt that Marie experienced a flood of chemical and mechanical neurological reactions when she first learned of her godmother’s pancreatic cancer.

Loss, and that anticipation of loss, enters through our senses and journeys from the thalamus to the amygdala. The amygdala sends signals throughout the body and to the cortex. There are fewer roads from the cortex to the amygdala; however, they can play a vital role in long-term, or complicated grief. Marie’s left prefrontal cortex has a memory function, which can exacerbate the negative expectancy which supports anticipatory grief and complicated grief. However, using Marie’s sense of smell or taste can activate memories that may help in thawing grief which has been frozen.

The same pathways that trigger grief can also be used to encourage someone through the grieving process. The hippocampus and the amygdala play a role in the regulation of emotions. When the hippocampus is activated by loss or the threat of loss, it forms sense-based memories. These memories could include Marie preparing and cooking her godmother’s pupusa recipe. Initially, these memories could trigger a release of negative chemical reactions, which include the stress hormone cortisol. However, by using positive coping strategies and gradual exposure to the preparation and cooking of her godmother’s recipes, Marie could desensitize negative reactions and positively rewire emotional circuitry. The existential exposure may help to connect her to feelings which aid Marie in feeling emotions which had been previously shut down.

Implications for Existential Exposure

Existential exposure focuses on the human connection that we have to other individuals, places, and materialistic things. This human connection guides us during challenging times in life, such as the current COVID-19 pandemic. Grief and loss have come to the forefront of the pandemic because people have died thinking that they would not get sick or be so sick that they would have to be put on ventilators. The trauma associated with grief and loss during the pandemic is unique. Before the pandemic, death, funerals, and grieving existed. When the pandemic started, the way society dealt with those factors changed. Deaths still occur every day. Losses associated with the COVID-19 pandemic are tragic. Funerals are being pushed back, skipped altogether, being held virtually, or only in small gatherings of less than 10 attendees. The grieving process has changed because individuals are not given the same options to process their grief as they had previously. They are not getting the closure that they need from attending funerals and paying their respects to their loved ones. This is especially traumatic to individuals who come from specific cultures and religious backgrounds where certain rituals and traditions must be performed during the funeral services. Some states have even given families the option to hold funerals at the end of the year with the hopes that the virus will not be as prevalent then.

Implications for existential exposure regarding the case vignette focuses on the human connection between Marie, her godmother, and what her godmother symbolizes. Existential exposure encourages individuals to engage in sense-based activities that trigger feelings, sensations and memories surrounding loss, while simultaneously initiating the parasympathetic nervous system. Marie recalls the fondest memories of her childhood being spent at her godmother’s house. When she thinks of her godmother, she connects her godmother to a safe environment. In that safe environment, she did not have to fear being physically harmed, verbally abused, or judged. She felt accepted. Marie connects the thoughts of her godmother with her cooking and the different types of food she made every time Marie slept over at her house. These fond memories are reminiscent of the smell and taste of her godmother’s famous pupusas. Her godmother was the one who taught her how to cook traditional El Salvadoran food. When Marie sees, tastes, or smells pupusas they remind her of her godmother and her childhood. This reminder brings Marie to a special place filled with happiness, laughter, safety, and acceptance. Marie connects pupusas to feeling as though she is safe and at home; therefore, initiating existential exposure can help Marie push past the icy tendrils of her frozen grief as she takes in the warmth and richness of an important nurturing relationship.

References/Bibliography

Johns Hopkins University of Medicine. (2020). New cases of COVID-19 in world countries. https://coronavirus.jhu.edu/data/new-cases

Kral, T. R., Schuyler, B. S., Mumford, J. A., Rosenkranz, M. A., Lutz, A., & Davidson, R.J. (2018). Impact of short- and long-term mindfulness meditation training on amygdala reactivity to emotional stimuli. NeuroImage, 181, 301-313

Pittman, C., & Karle, E. (2015). Rewire your anxious brain: How to use the neuroscience of fear to end anxiety, panic & worry. Oakland, CA: New Harbinger Publications, Inc.

Reinecke, A., Thilo, K. V., Croft, A., & Harmer, C. J. (2018). Early effects of exposure-based cognitive behaviour therapy on the neural correlates of anxiety. Translational Psychiatry, 8, 1-9.

About the Authors

Andy Brown, Ed.D., LCMHC has completed his doctorate in Counseling Psychology and is currently a fulltime Professor in Mental Health Counseling at the Chicago School of Professional Psychology. Dr. Brown has also served as an adjunct professor in various Universities around the United States and in other countries. Dr. Brown is a Master Traumatologist and serves as the Vice President of Education for the International Trauma Training Institute.

Justina Wong is a master’s level graduate student enrolled in the Clinical Mental Health Counseling program at The Chicago School of Professional Psychology. Justina's primary research interests include military mental health, racial trauma, suicide prevention, and creative interventions. She is currently interning at a non-profit organization working with student veterans and female veterans who have experienced military sexual trauma.

Lindsey Bass is a graduate student in the Counselor Education Department of The Chicago School of Professional Psychology. She will begin her fieldwork in August to a private practice focusing on trauma and grief within the military community. Lindsey is a military spouse to her husband, a submariner. Together they have a one-and-a-half-year-old son, two shiba inu's, and live on the seacoast of Maine.

COURSE UPDATE

CHILD & ADOLESCENT TRAUMA PROFESSIONAL

Cheryl Paulhus, Ed.D.

We are pleased to present a newly updated, comprehensive, and revised course for Child & Adolescent Trauma Professional training.

Children and adolescents who suffer from child traumatic stress are those who have been exposed to one or more traumas over the course of their lives and develop reactions that persist and affect their daily lives after the events have ended. Traumatic reactions can include a variety of responses, such as intense and ongoing emotional upset, depressive symptoms or anxiety, behavioral changes, difficulties with self-regulation, problems relating to others or forming attachments, regression or loss of previously acquired skills, attention and academic difficulties, nightmares, difficulty sleeping and eating, and physical symptoms, such as aches and pains. Older children may use drugs or alcohol, behave in risky ways, or engage in unhealthy sexual activity.

Without treatment, repeated childhood exposure to traumatic events can affect the brain and nervous system and increase health-risk behaviors (e.g., smoking, eating disorders, substance use, and high-risk activities). Research shows that child trauma survivors can be more likely to have long-term health problems (e.g., diabetes and heart disease) or to die at an earlier age (ACE Study).

Traumatic experiences can set in motion a cascade of changes in children’s lives that can be challenging and difficult. Traumatic experiences leave a legacy of reminders that may persist for years. These reminders are linked to aspects of the traumatic experience, its circumstances, and its aftermath. Children may be reminded by persons, places, things, situations, anniversaries, or by feelings such as renewed fear or sadness. Physical reactions can also serve as reminders, for example, increased heart rate or bodily sensations. Identifying children’s responses to trauma and loss reminders is an important tool for understanding how and why children’s distress, behavior, and functioning often fluctuate over time. Trauma and loss reminders can reverberate within families, among friends, in schools, and across communities in ways that can powerfully influence the ability of children, families, and communities to recover. Addressing trauma and loss reminders is critical to enhancing ongoing adjustment.

In the newly revised course, “Child and Adolescent Trauma Professional” you will gain current understanding of trauma as it relates to new advances in trauma treatment and a comprehensive approach in the assessment and treatment of the whole child, mind, body and spirit. The participant will gain insight into the scope of childhood trauma, its prevalence and type and the role of the body in response to trauma. A broad range of topics will be covered to include: the interpersonal nature of trauma, overview of attachment, secure and insecure attachment styles, child maltreatment and its impact on the developing child and the brain.

The participant will learn how trauma impacts key structures underlying emotional regulation, and the long-term effect of child maltreatment on health across the lifespan. Complex Trauma and Bereavement will be addressed with comprehensive information on the complexity of adaptation to trauma, types of reactions to traumatic experiences and developmental considerations.

Participants will gain an understanding of classic conceptualizations of trauma, major developmental models and relate them to current formulations and research findings. Application of evidence-based models, strategies, trauma evaluation and interventions will be offered throughout the modules. Additional topics covered include trauma exposure, post-traumatic adaptation, posttraumatic growth, resilience factors and the key elements to consider regarding treatment planning.

The participant will learn a multitude and range of skills that they can implement right away in responding to traumatized youth and families, children & families in crisis, professional reflections (vicarious and secondary traumatization), ethics and reporting issues. The participant will be able to select trauma treatment approaches that best match symptom presentation and client characteristics. In addition, a comprehensive resource list, and the most current clinical and social considerations as it relates to culture, community, and trauma-informed care will be presented. This course will inform and assist Mental Health Professionals, Educators, Administrators, and anyone interested in the health and welfare of our children and youth providing a greater understanding of what is needed to treat the whole child, mind, body and spirit.

About Cheryl Paulhus, Ed.D.

Cheryl has been working in the Mental Health field for the past 35 years in numerous capacities from the ground up. In addition to teaching for ITTI, she is currently the Clinic Director for the Steven A. Cohen Military Family Clinic at Endeavors in Killeen, Texas. Paulhus received a BS in Dance/Psychology from Skidmore College, Saratoga Springs, NY and a Doctorate in Counseling Psychology from Argosy University School of Professional Psychology in Florida. She has extensive experience providing treatment, consultation and specialized programs for children, adolescents, and their families. She has a diverse skill set and experience in mental health, including clinical work in child & adolescent psychiatric inpatient units, consultation and program development for Community Mental Health Centers, Residential Treatment Centers, Juvenile Rehabilitation, Emergency Services and Leadership Positions in mental health. Dr, Paulhus was part of a CIT training team for police officers for the City of Alexandria, VA during her work there as supervisor of Emergency Services.

Cheryl specializes in the field of Trauma, with advanced clinical training in both the treatment of trauma and in assessing forensic issues. Advanced training includes a range of therapeutic modalities including, Crisis Intervention, Cognitive Processing Therapy; EMDR, Prolonged Exposure, CBT, DBT, Attachment, Regulation & Competency Model, Emotionally Focused Therapy, Trauma-Informed Care and Attachment Focused Therapy. She is trained in Trauma Sensitive Yoga, a Registered Yoga Teacher with specialized training for Military (Warriors at Ease, Level II Teacher). She has been a Dance & Movement Educator for 40 years.

Throughout her career Cheryl has served diverse populations and utilized her unique background in the arts and mental health to raise awareness of trauma related issues. She has advocated for greater awareness of mental health issues in the community by bringing artists, educators, therapists and stakeholders together; creating specialized programs that focus on wellness, resiliency & recovery and directing shows such as “The Triumph of the Human Spirit” honoring the resiliency of the human spirit of people who survived trauma.

Dr. Paulhus is passionate and committed to the realization of the values, principles, and goals of Integrated, holistic and trauma informed care addressing the mind, body, and spirit.