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Developing Skills and Strategies
There are some common areas that young people who have experienced trauma struggle with and that may create some difficulties in their life. These include decision-making, managing emotions, helpful thinking and social connections. By helping them improve on these often basic skills they may not have learnt, they may see some real difference in their lives.
The first thing to do in each area is to help the young person understand a bit about how their experience of trauma has impacted on the problem they are having. For instance if the young person was struggling to problem-solve you could say…
You know that many young people who have had experienced trauma often have lots of problems to deal with and that can make them feel pretty overwhelmed. Trauma can really impact on how you may manage the problem and see some solutions. There are things I could help you with that might come in handy when something comes up.
Is it familiar that the young person you care for struggles to tackle challenges or solve problems that they come across? The effects of trauma i.e. changes in attention and concentration skills, difficulties with organising, and a lack of time and space to work through things, can all impact on the young person’s ability to make decisions, particularly when they are triggered. A lot of the time this means they choose the first, instinctual option. This is often one that has been unhelpful but heavily reinforced as effective i.e. substance use.
Here are some simple ways you can help a young person build on their decision-making skills:
1. Help the young person put the problem and what they want to happen into words. Have a think firstly about whether the young person is in control of this problem. Also is it actually something you can help with. Ask them where they want to start – somewhere simple.
2. Brainstorm solutions with the young person. Explore lots of possible solutions before even thinking about what might work best. Questions like:
- “How have you managed problems like this in the past?”
- “How do you want to see this problem resolved?”
- “Do you know of anything that has worked well for other young people?”
- “Do you want to hear about what I have found has worked for other young people?”
Only offer your own suggestions as a last resort. It is better for a young person to think about their own skills and supports that could help.
3. Help the young person pick a solution. Make sure it is realistic. Maybe look at the pros and cons of different solutions.
4. When you have chosen a solution, try making a plan with them about where to go from here. Set some small, realistic, specific steps, - what, with who and when. Maybe even brainstorm things that might get in their way. What has caused problems in the past?
An example in this situation is of a young person who has been victimised repeatedly in his past and now has become violent himself. He sees a solution to this as getting bigger and scarier to stop people coming near him. How realistic is this? You could ask “How is that going to work out for you? I wonder if you are putting less blood in the water, are the sharks going to snap less?”
Help the young person identify their triggers and how they experience these reactions.
Remember that triggers may be really obvious or they may be things that a young person might not even realise such as a smell, noise or subtle sign of rejection for instance. Exploring these after they have happened is a good way to unpack it a bit further.
- “In the last few weeks, when have you had a really strong reaction to something or felt really distressed?”
- “What is going on when this happened” Consider their thoughts, physical feelings and emotions as well as what was actually happening in their environment.
Explore current coping strategies
When people are aroused they often look to engage in activities that are congruent with their level of arousal. A lot of the time this means risk-taking behaviours. Always try to remember that the way young people are managing difficult and stressful situations is the best possible way they can. A good way to start to explore these strategies is to ask how they are working for them at the moment.
- “How do you manage difficult situations, or manage the way you feel?”
- “How well is that working for you?”
- “Do you want to keep using these strategies or ways of coping?”
- “Do you want to think about some other ways to manage these reactions?”
Alternative ways of coping
There are many different strategies that can help with managing difficult and distressing emotions. Attending to the physiological impacts i.e lower physiological arousal, is usually best first step. Sometimes you only have a short time to explore some of these skills with a young person. If so, consider calming skills like the following.
1. Controlled Breathing
Most people tend to take quick, shallow breaths when they are feeling anxious or distressed. Unless you are in a really dangerous situation, you probably don’t need to breathe like that. One of the best ways to respond to a young person who is aroused is to help them find a way to get some control over their breathing. Try this exercise:
- Take a normal breath in through your nose with your mouth closed
- Breathe out slowly through your nose or mouth and very slowly say (out loud of in your head) a word like ‘calm’ or ‘relax’.
- Count to four slowly, and then take another breath. Take about 10 breaths or more.
- Practicing this a few times, even when you aren’t distressed can be really helpful
For more ideas have a look at Smiling Mind.
2. Isometrics or exercise
Another great way to help young people release the tension they are feeling when they are in an arousal or flight/fight response state is by getting them to release some of the tension. This could be as simple as getting them to:
- Tense and release muscles in their body, whether this be making a fist and then relaxing it or tensing their legs and then relaxing, or
- Dropping and giving you twenty i.e. physical exercise such as push ups or squats
Both of these not only help shut down the flight/fight response but also means the young person stops focusing on what they are angry/frustrated about and instead on managing the exercise.
It is not unusual for difficult and stressful situations to make young people feel ‘unreal’ or disconnected from what is going on around them. This can be a risky thing to have happen, because it makes it difficult for them to stay connected with the here and now. Often, though they have learnt this as a useful way of coping. Here’s a basic exercise you can walk through with them when they may have become disconnected or dissociated:
- Get the young person to sit down or hold onto something solid
- Encourage them to feel the sensation of being connected to the floor, wall, chair or thing.
- Get them to think or talk about three things they can feel – e.g. clothes on their skin, chair under their legs, wind
- Get them to notice three things they can see – what is happening around them in the here and now
- Get them to notice three things they can hear around them now
- Remind themselves of where they are and what they are doing.
4. Other Strategies
Some other ideas could be using music, blowing bubbles or other sensory distractions such as a strong nice smell such as lavender. All of these indicate to the body and mind that it is unlikely there is a current threat.
Be careful, sometimes techniques such as relaxation or calming triggers a young person as this feeling may be associated with their trauma or it may be a feeling of vulnerability that then triggers their arousal.
Sometimes, though you may have some more time to explore different strategies and make a bit more of a plan about how they might manage a difficult situation in the future.
A great way to have this chat is to get them to think about a simple and common trigger for them such as a place or person. Something that may trigger an increase in heart rate and shallow breathing provides a good opportunity to practice these more helpful strategies. Then use this to reflect on strategies that may be useful to cope with the situation before it happened, during the event and afterwards.
This may be simple things such as looking after themselves by getting enough sleep, eating well and drinking enough water or may look at them prepping themselves before they know they may be triggered.
By preparing in these ways a young person can tolerate extra distress without feeling out of control and then reduce their chance of using unhelpful strategies such as substance use.
Also for young people who have experienced complex trauma, they can often exist at a very high level of arousal day to day (e.g. present as constantly irritable) and therefore, they do not need much to tip them over into a flight/fight response. Integrating strategies to reduce arousal state into day to day life e.g. regular exercise, can be very helpful.
A way to understand this is to imagine a young person walking around day-to-day carrying two buckets of water that are both nearly full. It takes lot of energy and effort to keep these from tipping throughout the day, leaving them exhausted, frustrated and vulnerable. For them, it doesn’t take much more water for the bucket to overflow. Alternatively, finding ways to tip even smalls bits of the water out over the day will mean the buckets are easier to manage and more is needed for them to overflow. In other words, helping a young person to find ways to reduce arousal level over the day may reduce their chance of becoming emotionally overwhelmed.
This is about young people finding useful quick exercise such as controlled breathing or grounding that work in the moment. Having a range of things that work for them within different situations is important. Practicing these when they are least distressed can make it easier for them to use them when they are.
Reflecting on their learning is important. Give them some praise and reward for coping in more helpful ways.
Trauma can affect the way young people think about themselves, other people, and the world. These thoughts are often really strong and persistent – things like “The world is a dangerous place”, “People can’t be trusted”, “I’m unlovable” and “I’m to blame for what has happened to me”. These can often make young people feel really ‘stuck’.
Supporting a young person to introduce helpful thinking instead is about helping them look at whether their thoughts make things seem worse or harder (unhelpful thoughts), or more manageable and less painful (helpful thoughts).
What are the thoughts that bother the young person the most, are most painful or get in the way of them doing things? What could be an alternative?
A good way to work out what these might be is to ask a young person about the thoughts they have when they are feeling really distressed. This could be something like “I can’t cope. I’m terrible at dealing with situations like this.” A young person’s response to this is a sense of hopelessness, helplessness and feeling quite incompetent. Helping them reframe this to something like “I got myself here today and that says that I am coping ok” can be useful and change their response. Explore with them different ways of looking at situations or get them to try and see ways they would support another young person having the same thought.
This can be very difficult as often their views and beliefs are strongly ingrained however by shining a light on these thoughts and how they are linked to their experience of trauma can be a first step towards a young person seeing ways that things could be better.
Being connected and having positive supports is really important however it is often a really difficult thing for a young person who has experienced trauma to do. A young person’s ability to establish trusting and safe relationships is really difficult when they have experiences of trauma, particularly trauma that involved other people such as sexual or physical abuse. Being patient and making efforts to build rapport and trust is crucial to the success of any intervention with a young person.
Encourage them to think broadly, not only about supports from friends or family but also people that can support them with practical things, who can help them get things done or someone who will just spend time with them without feeling like they have to talk.
Sometimes young people will find re-connecting with social networks or re-discovering enjoyable activities difficult, and often there will be a period where engaging with these things will still feel like ‘pulling teeth’. However, it is important to encourage young people to persist – fake it until they make it.