Professional Documents
Culture Documents
Psychological Trauma:
A type of damage to the mind that occurs as a result of a severely distressing event. Trauma is often the result of
an overwhelming amount of stress that exceeds one's ability to cope, or integrate the emotions involved with
that experience. A trauma can be result of a single event, or repeating events of being overwhelmed over a
period of time of various length.
What are the stress mechanism?
Occurs through the activation of the sympathetic-
adrenal medulla (SAM) complex:
• Perception of stress causes the hypothalamus
(via nervous connection) to activate
sympathetic fibers
• Sympathetic fibers activate the adrenal medulla
• Adrenal medulla secretes the catecholamines:
epinephrine & norepinephrine
This causes:
• Increased heart rate, blood pressure, breathing
rate & blood glucose levels
• Shuts down digestive system
• Rapid, short-lived response to stress
Health Consequences of Chronic Stress
Physical:
Weakened immune system
Inhibits GI system; reduced nutrient absorption
Reduced, dysregulated reproductive hormones
Increased vulnerabilities in cardiovascular system
Disturbed nervous system
Mental:
Lowers mood; increases pessimism
Increases anxiety and irritability
Increases learned helplessness (especially if no escape)
Often reduces approach behaviors (less for women)
Primes aversion (SNS-HPAA negativity bias)
4
Negativity Bias: Some Consequences
Negative stimuli get more attention and processing.
People work harder to avoid a loss than attain an equal gain (“endowment
effect”)
There’s a place for negative emotions:
Anxiety alerts us to inner and outer threats
Sorrow opens the heart
Remorse helps us steer a virtuous course
Anger highlights mistreatment; energizes to handle it
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But is there really any shortage of negative experiences?
A Major Result of the Negativity Bias:
Threat Reactivity
Two mistakes:
Thinking there is a tiger in the bushes when there isn’t one.
Thinking there is no tiger in the bushes when there is one.
We evolved to make the first mistake a hundred times to avoid making the
second mistake even once.
Thus we end up with views of ourselves, others, and the world that are
ignorant, selective, and distorted.
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Costs of Threat Reactivity
(Personal, Organizational, National)
Feeling threatened feels bad, and triggers stress consequences.
The boy who cried tiger: flooding with paper tigers makes it harder to see the real
ones.
Acting while feeling threatened leads to over-reactions, makes others feel threatened,
and creates vicious cycles.
In the Attach system, we bond tighter to “us,” with more fear and anger toward 9
“them.”
Neurobiology of Secondary
Trauma
• Depression
• Aggression
• Low Self-Esteem
• Identity Confusion
• Difficulties in Interpersonal Relationships
• Guilt
Moral Distress: Definition (ANA, 2008)
“Moral distress is the pain or anguish affecting the mind,
body or relationships in response to a situation in which
the person is
aware of a moral problem,
acknowledges moral responsibility, and
makes a moral judgment about the correct action;
yet, as a result of real or perceived constraints, participates in
perceived moral wrongdoing.”
Moral Distress
Obstacles may be internal and/or
external
Acting in a manner contrary to
personal & professional values
undermines the individual’s
integrity & authenticity
Causes painful feelings and/or
psychological disequilibrium
Given this definition of Moral
distress…
Over the last 6 months, how often have you experienced moral distress
in your professional role?
Daily
Weekly
Monthly
Never
Debrief
What were the situations, challenges,
or problems that resulted in moral
distress?
What causes these challenges or
problems for you?
Moral Distress Impact
Affects the Whole person
Physical
Emotional
Behavioral
Spiritual
Moral residue
“is that which each of us
carries with us from those times
in our
lives when in the face of moral
distress
we have seriously compromised
ourselves or allowed ourselves
to be
compromised”
(Webster and Baylis, 2000)
On empathy and compassion: Batson (1987)
Daniel
Lamm, C.; Batson, C.D.; Decety, J. (2007). "The neural substrate of human empathy: effects
of perspective-taking and cognitive appraisal". Journal of Cognitive Neuroscience 19 (1):
42–58.doi:10.1162/jocn.2007.19.1.42. PMID 17214562.
Empathic concern:
"Other-focused, congruent
emotion produced when
witnessing another person’s
suffering"
Often accompanied by feelings
such as tenderness, empathy,
compassion
Lamm, C.; Batson, C.D.; Decety, J. (2007). "The neural substrate of human empathy: effects
of perspective-taking and cognitive appraisal". Journal of Cognitive Neuroscience 19 (1):
42–58.doi:10.1162/jocn.2007.19.1.42. PMID 17214562.
Personal Distress
Motivates individuals to help in relieving another’s suffering
Focused on the self
Prompted by need to relieve one’s own uncomfortable feelings,
leading to behaviors motivated by desire to protect oneself from
negative emotional arousal
Appear to be related to individual differences in self-regulatory
capacities (Eisenberg, 2002).
Lamm, C.; Batson, C.D.; Decety, J. (2007). "The neural substrate of human empathy: effects
of perspective-taking and cognitive appraisal". Journal of Cognitive Neuroscience 19 (1):
42–58.doi:10.1162/jocn.2007.19.1.42. PMID 17214562.
Regulation/Balance
When arousal in response to another’s suffering is not regulated, it
can give rise to personal distress (Eisenberg, et al., 1994), thereby undermining
the possibility for expressing compassion.
This can lead to self-focused behaviors such as avoidance,
abandonment, numbing (common stress responses) aimed at
relieving the distress
Preconditions for empathic arousal
(N. Eisenberg,1994.2002)
Empathy (emotional
attunement),
Perspective taking (cognitive
attunement) and
Memory (related to personal
experience)
“Empathic arousal ”
Lamm, et al., 2007; Singer et al., 2004; Singer, T., Seymour, B., O’Doherty, J., Kaube, H.,
Dolan, R.J., & Frith, C.D. (2004). Empathy for pain involves the affective but not sensor
y components of pain. Science, 303, 1157-1161.
Definition of empathic
“over-arousal”
Empathic arousal escalates to
high levels
If the arousal is perceived as
negative, focus shifts to relieving
personal distress rather than the
distress of the other. (Eisenberg &
Fabes, 1992)
Moral Sensitivity (James Rest, 1984)
the ability to attune to the distress of others,
“to discern the morally salient dimensions of the situation,
to be aware of ethically justified options for addressing an ethical issue,
the ability to discern how one’s actions affect self and others”(Rushton and
Penticuff, 2007)
Be
Present 30
HISTORY OF MINDFULNESS
Ancient Eastern religious practices, particularly India, China, Tibet, and
Japan
Mindfulness and Buddhism
7th step of the noble eight fold path as taught by the originator of
Buddhism, Siddhartha Gautama
Mindfulness led to the ‘cessation of personal suffering’
Although taught as part of Buddhism, there is nothing religious about
mindfulness
Mindfulness is a translation of the Indian word, Sati, which means
awareness, attention and remembering.
What is Mindfulness:
Control of attention
Bringing your mind back to the present moment
Willing / accepting stance
It’s not primarily about altering a feeling state
CONTRAST
Relaxation
Distraction
The anti-thesis of Mindfulness
Mindfulness is an acceptance based strategy that is directly opposite to
avoidance
36
Elements of Mindfulness Practice
Intention: set a goal to reach it
(e.g. self-exploration, stress management, self-
liberation and compassion)
38
Inexpensive (purchase books, attend class) Decreased task effort
An Invitation:
Connecting with Ourselves
Engage within your comfort zone
Notice and explore
Sensations in the body
Breath
Heart rate
Muscular tension or relaxation
Shifts in posture
Movements of your body
Feelings that arise
Thoughts
The 3 Minute Breathing Space
Use the three-minute breathing space in moments of stress, when you are troubled in thoughts or feelings. You can use it to step out of
automatic pilot; to reconnect with the present moment and your own inner wisdom.
1: Acknowledging
Bring yourself into the present moment by deliberately adopting a dignified posture. Then ask: ‘What’s going on with me at this
moment? What thoughts, feelings and body sensations am I experiencing right now?
You could put your inner experience into words, for example, say in your mind, ‘A feeling of anger is arising’ or ‘self-critical thoughts are
here’ or ‘my stomach is clenched and tense.’
2: Gathering
Gently bring your full attention to the breathing. Experience fully each in-breath and each out-breath as they follow one after the other. It
may help to note at the back of your mind ‘breathing in…breathing out’, or to count the breaths. Let the breath function as an anchor to
bring you into the present and to help you tune into a state of awareness and stillness.
3: Expanding
Expand your awareness around the breathing to the whole body, and the space it takes up, as if your whole body is breathing. Especially
take the breath to any discomfort, tension or resistance you experience, ‘breathing in’ to the sensations. While breathing out, allow a sense
of softening, opening, letting go. You can also say to yourself ‘it’s ok to feel whatever I’m feeling.’ Include a sense of the space around
you too. Hold everything in awareness. As best you can, bring this expanded awareness into the next moments of your day.
BODY SCAN
Awareness of current physical sensations
Moving attention
Noticing automatic responses
(run… distract… change)
52
Impermanence
Everything changes
This too shall pass
Persian این نیز بگذرد
Arabic كله ماشي
Hebrew גם זה יעבור
Turkish Bu da geçer (yahu)
53
Mindfulness-Informed Therapy
No Self
No stable, solid, unchanging entity labeled
“self” exists
Experience the ever-changing and flowing reality
of self
“The mind changes with inconceivable rapidity.”
Subhuti 54
No Self (con’t)
Explore your own self through time
13 years old
21 years old
A year ago
55
Mindfulness-Informed Therapy
Accepting What Is
Resisting what is actually happening, wanting things to
be different than they are creates suffering
Suffering based on one’s relationship to what is
happening
Not accepting what is creates suffering
Goal: no resistance
56
Conscious Responding vs
Automatic Reaction
Let go of habitual problem
solving mode
Bring to awareness difficult
emotions
Feel the emotions in the
body
57
Conscious Responding vs
Automatic Reaction
Insanity: Doing the same
thing
over and over again and
expecting different results.
Albert Einstein
58
Paradox
Penetrate deeply into the
nature of things
Accept that one simply
does not know some
things
59
Mindfulness-Informed Therapy
Interdependence, Inter-being
All things are
intimately
connected
60
Mindfulness-Informed Therapy
Interdependence (con’t)
butterfly effect n (Physics / General
Physics) the idea, used in chaos theory,
that a very small difference in the initial
state of a physical system can make a
significant difference to the state at some
later time
61
Ethical Mindfulness
Adapted: Epstein RM: Mindful practice. JAMA 1999, 282:833-839; Halifax, 2010
A stance of clarity, non-reactivity, focused attention in the
present moment
Being present without being overwhelmed or disengaged
Accepting things as they are in this moment
Noticing judgment and reactivity to inner and outer experiences
Listening differently
doesn’t take more time~ takes discipline & practice
Attentiveness to experiences of others and one’s reactions
Active observation of self and others
Peripheral vision to see what is unseen
Seeing the situation with fresh eyes
Willingness to let go of assumptions
Ethical Mindfulness
Adapted: Epstein RM: Mindful practice. JAMA 1999, 282:833-839; Halifax, 2010
Humility
Curiosity, openness to learning from others; willing to be surprised
Capacity to be with awareness of one’s areas of confusion or incompetence
Discovering what would serve in this circumstance
Letting go of self interest, position, outcome
releasing thoughts, feelings, and situations that the mind seems to want to hold on to.
“the true test of a good will is if the person continues to act out of duty and reverence for
the moral law even when it has no personal benefit” (Morrison, p. 20).
Courageous action that preserves integrity
Includes principled moral outrage and conscientious objection
G.R.A.C.E©
(Joan Halifax, 2012)
• Gathering Attention
• Recalling intention
• Attuning to self and other
• Considering what would
really serve
• Ethically enacting, ending
The Art of Pause (adapted, Rushton, 2009)
Feel safe
Close eyes
Relax body
Breathe to go into meditative state (frontal lobe and insular cortex
engage)
Move consciousness to top of head and observe yourself
Move consciousness on top of that and observe self observing self
Come out of meditate state and open eyes when ready
Meditation to Dissipate Emotion
Imagine putting 1TS of salt in a glass of water and
how it would taste
Pour it into a pitcher of water
Pour it into a lake
Pour it into the ocean
71
Anxiety Meditation
Go into meditative state
Recall an unpleasant memory causing anxiety
Notice physical feelings
Stay with the physical feelings until they dissipate or
until concentration ends
Come out of meditative state
72
Decision-Making Meditation
Go into a meditative state
Feel heart and remember the feeling
Think of one option
Feel heart and remember the feeling
Think of another option
Feel heart and remember the feeling
Come out of meditative state and asset feelings to make decision
73
Six Focusing Movements:
Meditation for Self-Healing
Clearing a space: Ask yourself, “How do I feel?”
Felt sense of the problem: Ask yourself, “Which problem is the worst?”
Finding a handle: Name the problem
Resonating handle and felt sense: Ask, “Is the handle right?” Adjust the
handle as needed
Asking: Ask the problem
Receiving: Listen to the response