What you should know about trauma....

...if you work with potentially traumatized people, live with them, or are affected yourself.

Blog-Article by Myrtha Faltin, stART international e.V. emergency aid for children©, excerpt from stART's handout for training refugee workers.

In the current global crisis, stART international e.V., based in Gröbenzell near Munich, is making its 17 years of experience in dealing with traumatized people available online.

1. What is a traumatic event?

The founders of psychotraumatology, Fischer and Riedesser, define a psychotrauma as an objectively ascertainable event outside the norm of experience, which includes the (imminent) death, serious injury or danger to the physical integrity of one's own or one or more other persons, as well as the subjective experience of powerlessness, being at the mercy of others, helplessness, intense fear and horror.

Traumatic events leave demonstrable traces in those affected, especially the communication of the left and right hemispheres of the brain is restricted. At the same time, it is part of the nature of trauma that it cannot be seen externally.

Even though the word trauma (which originally comes from the Greek and means "injury") is currently used inflationarily, it is important to distinguish between emergencies and traumas.

An emergency can also be a subjectively experienced stress, whereas a trauma is always due to an event that has objectively taken place.

What we consider to be an emergency depends essentially on

• our life situation,
• our set of values and our understanding of the world
• our mental resilience.

Whether a therapeutic necessity arises from an emergency is decided by the individual distress of the person concerned. Basically, it must be assumed that an emergency can have a traumatizing effect.

Whether a therapeutic need arises from a traumatic experience is decided by the course of events, by the question of whether it is possible to cope with what has been experienced without lasting psychological impairment.

2. Characteristics of potentially traumatizing events

• High identification
• Massive personal involvement
• High intensity
• Existential character
• Loss of control
• Feelings of guilt (e.g., survivor guilt)

People who witness a traumatic event can also be traumatized.

3. What is the impact of trauma?

We have to assume a processual development.

• An extremely stressful event (or events) occurs.
• The affected person reacts spontaneously with evolutionary reactions (3.1)
• An immediate acute stress reaction follows (3.2)
• The acute stress reaction subsides and the affected person integrates the experience into his or her biography.
  OR they develop post-traumatic stress disorder (3.3).

3.1. The immediate reaction in the traumatic situation

It is impossible to predict how a person will react in a traumatic situation. Evolution has given us three options for this, which tend to be different:

• Either we try to flee
• or we go into a combative confrontation,
• or we feel unable to react. In this case we freeze, perhaps we even play dead.

3.2. The acute stress disorder (ASD)

Immediately after the event, different symptoms appear than weeks/months later:

First, an acute stress disorder, also known as acute stress reaction (according to ICD 10, this belongs to the adjustment disorders) occurs. This is a normal reaction to an abnormal event and in most cases subsides after about 4-6 weeks without any treatment. If this does not happen, the symptoms change.

During the period of acute stress reaction, a general disorientation prevails, the individual symptoms intermingle, overlapping each other. For example, affected persons may perceive themselves as completely numb, "completely empty" and at the same time suffer from survivor's guilt. Aggressive episodes and helplessness can also occur in combination.

In the period of the acute stress reaction, it is decided whether the stressful event can be overcome.

3.3. Post-traumatic stress disorder (PTSD)

The following table illustrates how people feel immediately after a potentially traumatizing event and how these complaints change if processing is not successful.

Post-traumatic stress disorder results in permanent changes and impairments in mental life. Not only can it affect the lives of those directly affected, it can somatize, i.e., cause physical discomfort, and it can also have transgenerational effects. For example, there are still people now who suffer from the traumas of their parents and grandparents during the Second World War.

In both cases: Considerable severity

4. What needs to be considered when dealing with potentially traumatized people?

You can't tell by looking at people that they have been traumatized. Every help, every therapeutic effort should be resource-oriented. Resource-oriented means exploring:

• What gives the person strength? What enables him to be here today and possibly to ask for help?
• Their own coping? Family, friends, partner? Nature? Religion? Spirituality?
• What has always been more important to her/him than anything else?
• What coping strategy has been used so far?

Resource-oriented approaches strengthen the self-healing powers by reminding what was or still is positive.

It is essential to orient oneself to the other person with his/her history, experiences and especially with his/her cultural background. If the cultural background of the people concerned is not taken into account, this can have an additional destabilizing effect, especially in the beginning.

Especially in the beginning, refugees are confronted with so many different stimuli that it would be wrong to confront them with integration efforts right away. Each individual must first also arrive inwardly in the host country.

People who have lost everything as a result of flight or expulsion often cling more strongly to their cultural expressions and their religious and traditional ideas in order not to lose themselves. Only when they have been able to get to know the foreign culture somewhat are they able to integrate its elements into their own world view.

5. Can trauma be healed?

Basically, the majority of people are able to overcome traumatic experiences. This does not mean that they do not leave scars in their soul life. Whether overcoming is possible depends on the mental makeup of the individual and also on what previous experiences the new event encounters. Of additional importance is the period of time over which the traumatic event or recurring events occur.

Prognosis varies for different types of trauma. One-time events (such as an earthquake) can usually be better tolerated than longer-lasting ones (e.g., wars, abuse), repetitive ones, or different ones that follow one another (called sequential).

Trauma caused by people at will (man made disaster) is the most difficult to overcome.

5.1. Trauma therapy approaches

There are various trauma therapeutic approaches, such as.

• Psychotherapeutic methods
• Psychoanalytical methods
• Behavioral therapy methods

These three are considered "recognized" procedures. Therefore, they are reimbursed or at least subsidized by health insurance.

Other effective methods that are used worldwide are

• Narrative methods
• Imaginative methods (e.g. according to Reddemann)
• EMDR =Eye Movement Desensitization and Reprocessing

5.2. Resource oriented methods

Within the resource-oriented methods, the following methods have proven to be particularly effective

• Mind-Body Medicine (according to Benson, Gordon, both Harvard Medical School)
  Lifestyle change towards a joyful, conscious way of life with creativity, yoga and mindfulness.
  Also proven to help with chronic illness and pain.
  Group settings.
• MBSR (Mindfullness-Based Stress Reduction according to Jon Kabat-Zinn)
  Body scan - yoga - silent meditation - informal mindfulness exercises in everyday life.
  High success rate with trauma, anxiety disorders and depression.

5.3. The treatment of traumatized children

The treatment of traumatized children presents us with a special challenge because, depending on their age, children do not yet have the opportunity for conscious reflection. They have to be addressed according to their needs and their world of experience.

stART international has developed its own concept for the treatment of traumatized children in many years of practice in crisis areas after wars and natural disasters. This concept is artistic-pedagogical and therapeutic.

Artistic

• Process-oriented,
• Drawing from the culture of the clients
• Includes visual arts, movement arts, music, theater, experiential education, arts and crafts
  

Pedagogical

• Striving for rhythmically designed joyful, lively learning processes that address head, heart and hand in equal measure.
• In group settings
• Promoting social competence
  

Therapeutic

• Supportive in overcoming trauma by strengthening the self-healing powers.

The interdisciplinary work of stART international aims to stabilize those affected. It is always oriented towards the resources of the children and their caregivers.

Very important: Trauma confrontation does not take place. When trauma memories arise, the suffering is clearly acknowledged ("That must have been very hard for you!) and questions are repeatedly asked about how the child coped with the situation: "What did you do then, what helped you, how did you manage to get out of it?"

Gradually, the child's own processing forces set in (with appropriate support), to the extent that the self-healing powers awaken. Non-verbal means of expression are helpful in this process.

The processing of traumatic experiences takes different lengths of time for individual people. It is impossible to predict the outcome of the processing. There are people who cannot completely overcome their trauma for a lifetime and others who are able to integrate the events into their biography. Few people even manage to grow internally from a traumatic event. Such a course is called post-traumatic growth.

6. Stabilizing work with Muslims - without cultural overpowerment.

What should be considered in any case:

• People who have lost everything do not bond easily or just too quickly.
• Reliability builds trust. It is better to make fewer offers, but to make them regularly.
• Refugees from Muslim countries are socialized differently than we are. For them, the community, the family, is of central importance. They often pursue less individual life goals than the interests and well-being of the family.
• Traditions and religion are anchors in their lives, which are flooded with impressions from the host country. An overstrained attitude toward life can manifest itself (especially in the case of older people), as can a temporary lack of stability (especially in the case of young people and younger adults).
• In the everyday life of Muslims there are rules that are incomprehensible to us. For example, they do not decorate their walls with pictures, which is due to the fact that they consider them distracting for their meditative life. So we do not hang up children's drawings when we look at them with the children and parents, we lay them out on the table.
• There are also stumbling blocks in the depiction of content: According to the Islamic prohibition of images, it is not allowed to depict the Prophet and saints, in very strict interpretation, nothing living may be depicted at all.
• It is rare that children are not allowed to draw and paint because of this, but often they are untrained in depicting people, animals and plants. We do not interpret this circumstance.
• Boys and girls from Muslim families are allowed to play together at most until they are about 9-12 years old. At the older age, they are usually separated. Even if it is different at school: it makes little sense to interfere with this rule. Accordingly, it is helpful to have male and female guardians for them.

7. Stabilization through movement

Movement creates joy, tension and relaxation.

After traumatic experiences, people often show inner numbness, corresponding to a certain inability to act. Others react with inner restlessness and hypermobility. The previous life is out of joint, orientation and inner balance are weakened.

Through offers such as juggling, body acrobatics, games, skill and confidence exercises, dancing and eurythmy therapy, children and adolescents are encouraged to feel themselves more strongly and to create their own space in the cramped conditions of a refugee or street camp.

Experiencing one's own dexterity strengthens self-confidence after the experience of total helplessness during a disaster. Team membership and choreographic group forms strengthen social skills and convey: together we are strong!

From a therapeutic point of view, exercises that alternate between tension and relaxation, between large and small, fast and slow, loud and quiet, etc., can lead to a reduction of stress, as the soul's ability to vibrate is stimulated and lively dynamics can once again be allowed and controlled.

The regained rhythm has an immediate regulating effect on physical processes such as heartbeat, breathing, digestion, etc., which are often impaired as a result of shock and stress.

After the mostly cumulative traumas caused by war violence and flight experiences, the level of stress hormones such as cortisol and adrenaline remains high because, among other things, accommodation in initial reception facilities or even in transitional homes is not very suitable for reducing these excess hormones. Also, the often years-long uncertainty in the ongoing process around the right to stay means stress and stress hormones always signal:

Fight or flee!

Physiologically, stress hormones are reduced by movement, as we can observe in wild animals, which, having escaped the life-threatening threat, stand up, shake themselves and continue to live without trauma symptoms.

We humans do not succeed quite so easily in shaking off the horror we have experienced. We need time and space to find our own way to rebuild weakened neuronal structures and to integrate the memories.

Since every smallest brain activity is also connected to a feeling, movement can clear the way for a lively and stable soul life, in order to be able to think, feel and act in a balanced way.

Standing on one leg, walking with wide legs, rope skipping, balancing, etc., each time give a stabilizing impulse to the loosened/blocked nerve connections between the different brain areas and give security: I can find my way in time and space, I can do it!

The corpus callosum, the bridge between the two hemispheres of the brain, built up in the childhood years through imitation and joyful creative play, can be strengthened again after destabilization by the traumatic event through coordination exercises of left and right, up and down, front and back. Also movements like stroking along the arms, kneading hands, snapping fingers, making big eyes, mouth and tongue movements help to stabilize the brain structures again to give a new basis for fear-free and adequately linked sensory experiences in which the soul can develop well again.

8. Stabilization through creative offers: Drawing, painting, sculpting

For children as well as adults, it has proven successful to offer drawing, painting or sculpting with clay in the group. These elements of art therapy work in two ways: They help to find an expression for stressful things. But before this can happen, they impress with their beauty.

Every human being has inherent creative abilities. Even if these are sometimes buried, most people and especially children have a great joy in any kind of creation.

It is of crucial importance that traumatized people can experience themselves as creative or at least as creators. Only in this way can they gradually shed the role of victim.

9. Handwork and crafts

In creative activities, especially for adults, handwork and various handicraft techniques can and must be included. In every culture, making beautiful everyday objects is considered a virtue. Knitting, sewing, carving and many other handicrafts and arts and crafts techniques are well suited to enable an inner arrival and to promote the cooperation of the two hemispheres of the brain through the necessary movement sequences. In addition, such offers are culturally appropriate and help to come into contact with each other.

In our artistic and creative pedagogical approach to work, manual activity plays an important role. Just like large motor movement, fine motor movement contributes to the reorganization of brain structures that have been impaired by an acute traumatic experience. By interrupting the flow of information from the brain stem and cerebellum to the cerebrum in the limbic system during a shock, the experience settles in the body. Thus we say in colloquial language: "the shock sits in the limbs, an impression goes under the skin".

In the stabilization phase we therefore start with the body movement, because only this can trigger a mental and spiritual movement, get the energy flowing again and thus activate the self-healing powers. Rhythmic and repetitive activities, crossing movements, powerful sensory impressions are especially healing.

In mindful work, the children succeed more easily in keeping the focus in the "here and now", and so the concentration is better and the results more satisfying than with purely cognitive demands. In this sense, handicraft activity is an effective reorientation aid and counteracts dissociation.

In creative doing and designing, children and adults experience that they can become effective themselves and thereby increasingly escape the victim role. The feeling of satisfaction and the pleasant working atmosphere reduce the stress level and at the same time expand the well-being area.

For the children, who have often lost everything due to a catastrophe or flight, it is very important to create new "treasures" of their own, to which they can then build a relationship. Accordingly, we choose suitable pieces of work or handicrafts, such as bags, lucky charms, jewelry and games. It is also essential that the memory of the positive experience of doing handicrafts together as a beautiful experience can help to let dark traumatic images from the past gradually fade.

Eurythmy4you Trauma Conference

Myrtha Faltin, founding member and board member of stART international reports at the Eurythmy4you Trauma Conference about the interdisciplinary working approach of stART with photos from the intercultural work and shows practical exercises. The practical exercises are taken from her work as a eurythmy therapist, the theoretical background is explained above under point 7. The recordings of her lectures are included in the proceedings of the conference.

Eurythmy4you Trauma Conference
Trauma therapy and posttraumatic growth
Theory, first aid and complementary therapy
Proceedings, videos of lectures and workshops

Copyright: This handout, which was created for the training of refugee workers, can in no way claim to be complete. Rather, it is intended as a memory aid for participants in the stART seminar. It is protected by copyright. All rights are reserved by stART international e.V. emergency aid for children.

Training: If you are interested in training by a stART team, please contact us: info@start-international.org, www.start-international.org

Images: Myrtha Faltin, stART international