Treleaven, D. A., & Britton, W. (2018).
Trauma-sensitive mindfulness: Practices
for safe and transformative healing. New York: W.W. Norton & Co.
Part
I – Foundations of Trauma-Sensitive Mindfulness
The Ubiquity of Trauma:
Visible and Invisible Forms
Meeting the Moment:
Mindfulness and Traumatic Stress
Shaped by the Past: A
Brief History of Mindfulness and Trauma
The Brain and the Body in
Trauma and Mindfulness
·
Definition of trauma-sensitive practice (4
Rs): xxiii
o
A program, organization, or system that is
trauma-informed realizes the widespread impact of trauma and understands
potential paths for recover; recognizes the
signs and symptoms of trauma in clients, families, staff, and others involved
with the system; responds by fully integrating knowledge about trauma into
policies, procedures, and practices; and seeks to actively resist re-traumatization.
·
In adopting trauma-sensitive mindfulness,
it is useful to be aware of these distinctions along the spectrum of trauma –
from stress, to traumatic and posttraumatic stress, to PTSD. 12
o
Realizing
the pervasive impact of trauma
o
Recognizing
symptoms
o
Responding
to them skillfully
o
Preventing re-traumatization 13
·
Integration
– the linkage of differentiated elements of a system (Siegel, 2011, p. 64); integration
happens when our left and right hemispheres of the brain communicate, or
parallels are drawn between thoughts and physical sensations 13
o
Posttraumatic stress creates disintegration – thoughts, memories and
emotions become cut off from our experience or continually flood our field of
consciousness 14
o
Integration is a powerful frame within
trauma-sensitive practice – integration highlights the fact that there is a
distinct boundary between events we can metabolize and those we cannot 14
·
It is important for trauma-sensitive
practitioners to respect the fear and shame that can endure in [trauma]
survivors; it can be tempting to think of trauma as simply an intensely
negative emotion, trauma is an incapacitating form of stress 22
·
Definition of mindfulness:
a power of mind that helps us recognize what is happening, without added
commentary or judgement. It involves maintaining a moment-by-moment awareness
of various aspects of our experience, including thoughts, body sensations, and
feelings 25
·
[Mindfulness]
practiced with discernment, it can increase one’s capacity to integrate trauma
… by enhancing self-regulation – the ability to control emotions, thoughts, and
behavior
26
o
Trauma is a dysregulating experience – often leaving us feeling disconnected
from our bodies and out of control – mindfulness can help regain a sense of
agency 26
o
Our task is to respect the potency and
complexity of trauma, and to learn what we can do to serve our students and clients
who are facing it. This involves educating ourselves on the many dimensions of
trauma – biological, psychological, and social – and the way they intersect
with mindfulness 27
·
Dual awareness:
o
Experiencing
self
– the internal sense of trauma; stark, visceral signs of traumatic stress (i.e.
feeling alarmed, heart racing, shallow-rapid breath, etc.) 37
o
Observing
self
– has some distance from an experience, witnessing what is happening rather
than becoming overwhelmed by it 37
§ With
practice, survivors can learn to witness their experience without becoming
identified with it 38
·
Exposure therapy
– turning toward what is arising instead of away from it; exposure plays a role
in mindfulness practice, and can ideally expand one’s tolerance for trauma-relevant
stimuli that can help with integration 38-9
o
Exposure is only useful when someone can
tolerate what they are being exposed to 39
·
Direct, sustained contact with traumatic
stimuli – without adequate preparation – locks survivors into a potentially
debilitating loop. Mindfulness meditation can end up triggering traumatic
symptoms that follow people into their lives … it is easy for survivors to
become discouraged and daunted … [can] become hopeless and abandon mindfulness
altogether 42
·
The Women’s Movement
– challenged the shame, skepticism, contempt, and ridicule that women who spoke
out about their experiences of sexual or domestic violence faced.
o
The impact of sexism was designed to be borne in private. Race and economic class
played a role in this as well, whereas class and race privilege tended to fence
women more firmly into the privatized sphere of a nuclear family – with the
concordant taboos around revealing one’s personal life 54
o
[an example of institutional (or
structural) violence]: this repression ensured that women stayed isolated while
objectification and exploitation continued 54
·
Desmond Tutu
– “if you are neutral in situations of injustice you have chosen the side of
the oppressor.” 59
·
Panacea Problem –
pushback to the Mindfulness Movement
o
Varieties of Contemplative Experience
project (Britton)
§ Examined
the range of challenging experiences that can arise in the context of Buddhist
meditation – experiences that can resemble psychological dissociation,
depersonalization, and the reexperiencing of traumatic memories 65
·
Pain
paradox – the observation that our natural tendency to
escape, deny, or withdraw from pain only intensifies and prolongs the distress
– what we resist, as the saying goes, persists 66
o
Given that avoidance is a primary symptom
of posttraumatic stress, it is also logical to assume that the success of MBSR
would extend to people experiencing traumatic stress. But trauma is a different
kind of pain. 67
- Stay within the Window of Tolerance: The Role of Arousal
- Shift Attention to Support Stability: Avoiding the Fear/Immobility Cycle
- Keep the Body in Mind: Working with Dissociation
- Practice in Relationship: Supporting Safety and Stability in Survivors
- Understand Social Context: Working Effectively Across Difference
·
Window
of Tolerance – an internal zone of support for
survivors and a starting point for all trauma-informed practice. It is a way to
help ensure people are not exceeding how much they can handle. When people are
in their window, they are more likely to feel stable, present, and regulated.
When they are outside of this zone, they are more likely to feel triggered, out
of control, and dysregulated. Unless survivors can stay in their window during
mindfulness practice, they can simply end up recreating traumatic states. 88
·
Dysregulated
arousal – a state where our ability to
self-regulate becomes seriously compromised. Overly sensitized to traumatic
reminders, we end up experiencing too much arousal (hyperarousal) or too little
(hypoarousal) or swing uncontrollably between the two. It is a precarious
state, and one of the brutal costs of trauma 92
o
To find stability, survivors can begin
tracking their window so they can self-regulate. 95
o
The width of our window of tolerance is
also tied to our threshold of response
– the amount of stimulation required to provoke arousal
§ Low
threshold = it doesn’t take much to elicit a response
§ High
threshold = more input is required to provoke a reaction 96
o
Thresholds also apply to the concept of triggers – stimuli that can set off
memories or flashbacks related to the traumatic event 96
§ Triggers
can include people, places, things, situations, or internal experiences – each
is personal and unique 96
·
(Example of Brooke, p. 89 – 99) Brooke
lost her ability to self-regulate on her meditation retreat. She had felt
stable for most of the first day, but then started to experience intense
vacillations in her arousal. The invasive imagery she had been struggling with
grew worse, and she felt alternately overstimulated and dazed. Brooke was
outside her window of tolerance. Because
the group setting offered so little social support, self-regulation also became
more difficult. She spiraled out of control and could not bring herself
back into her window. 99
·
Apply the brakes
– a way to stay within one’s window of tolerance so mindfulness meditation
doesn’t become traumatizing 106-7
o
Open one’s eyes during meditation practice
o
Take structured breaks from mindfulness
practice (ex. walking, stretching, unstructured time)
o
Take a few slow, deep breaths
o
Engage in a soothing form of self-touch (ex.
hand on heart)
o
Focus on a resourceful, external object in
one’s environment
o
Engage in shorter practice periods
·
Stay within your own window
111
o
Monitor our own range using the 0 – 10 scale
as a way to assess the level of our internal resources
o
Engaging in personal activities that
foster wellbeing and resilience (exercise, time in nature, social action, etc.)
o
Meeting regularly with other colleagues to
offer peer support and exchange ideas and challenges
·
The response of a monk-meditation-teacher
(at a retreat, speaking to one who is experiencing posttraumatic stress)
o
“Being mindful of this pain can be
helpful, but it alone won’t always help. You can stay here, but it may be best
for you to go home and be with family and friends. Sometimes, people – not
silence and solitude – are best medicine for such wounds.” 151
·
Other people
– who they feel are safe and trustworthy – can help survivors regulate arousal,
whether through settling eye contact, physical touch, or overall presence. 157
o
Inter-relational
psychobiology regulation – the way our relationships with
other people can help us regulate our arousal. When we are in safe, attuned
contact with other people, we can more easily access our social engagement
system and thereby coregulate each other’s arousal. 158
o
Whereas trauma disrupts connection within
ourselves and other people, community can bring us back into rhythm with one another – a state,
known as synchrony, that helps us
regulate our arousal. 159
·
For potential students and clients who are
actively experiencing traumatic symptoms, feel mentally unstable, or are
suicidal, group mindfulness practice is
not recommended 162
·
[Retreats could] hire a trauma therapist to be on-site during
meditation retreats of a day or longer 164
·
Interpersonal contact
o
Trauma-sensitive mindfulness involves balancing the benefits of solitary
mindfulness meditation practice with the potentially beneficial effects of
interpersonal relationship – this modification has two elements:
§ increasing
contact with mindfulness teachers where appropriate and
§ helping
facilitate more interpersonal connection between participants in participants
in group settings 168
o
participants have optional increased interpersonal
contact with each other while in group settings 168
§ offering
a ‘buddy system’ whereby participants have brief, scheduled interactions with
self-selected partners
o
Bottom line: turn up the amount of
interpersonal contact people receive to account for the potentially negative
effects of solitary practice 170
·
Flashback Protocol
o
Rather than relate explicitly to what is
happening inside the body – interoceptors – we want to help survivors ground their
attention in their surrounding environment as a way to come back to the present
171
·
Internal Family Systems
o
We all have parts of ourselves – parts
that want different things and experience the world in different ways; i.e.
part of us may want to open up and be vulnerable, while another part wants to
pull back in fear 172
§ Traumatic
stress leaves us with unintegrated parts of the self 173
o
One of the most important insights IFS
offers is that parts are often attempting to keep us from becoming overwhelmed
174
o
IFS relies on the belief of a core
universal ‘self’ that plays an essential role in our healing – placing it at
odds with Buddhist teaching. In IFS, its proposed that we are all born with a
Self that carries universal qualities: courage, calmness, compassion, and clarity,
for instance. You could think of the Self as the sun, in this respect, with the
parts being clouds that get in the way of the sun. The sun is always there, in
the background, but sometimes parts dominate the horizon and our view. The work
is to connect with the Self that is always there and have the Self come into
relationship with parts – bringing the qualities of the Self into the parts.
§ The
Self is an ever-resent essence that lies beneath protective parts and cannot be
damaged with trauma – only covered over 174
o
The notion of asking parts to step back
highlights one of the most powerful aspects of IFS when it comes to healing
trauma: making requests of parts in order to help them heal. 175
·
Social Context
o
“It took me a long time to see that the
great majority of individual deaths that don’t involve someone dying in peace
in old age are probably related to some form of exploitation and inequality,
despair, and lack of hope” 178
o
Many of us will be conditioned to think of
trauma as an individual experience; trauma-sensitive practice, however,
requires a holistic approach and must also factor in systems that live outside
the body 178
o
If we fail to actively engage with social
context, we become a liability in our mindfulness-based work.
o
Absent an understanding of how individual
and social systems interact, we can potentially cause harm, break people’s
trust, and perpetuate systems of domination. This isn’t a matter of political
correctness or saying the ‘right thing’ but offering a truly liberatory
framework for those we work with 179
o
Questions about origin and assumptions
about cultural practices – while not intended as invasive, and seemingly
innocuous – are constant reminders of the imbalance of agency that exists
between groups who have power and groups that don’t 181
o
9 social classifications – social
context in trauma work
§ Age
corresponds to the marginalization felt by those younger than 18 and those
older than 64 (186)
·
Losing or being denied a job
·
Refused travel or health insurance
·
Receiving a different or lower quality
service due to one’s age
§ Disability
refers to the experience of those with physical (or mental) impairments, both
visible and not (aka ableism)
·
Inaccessible public spaces
·
Violence perpetrated on disabled people
·
Inaccessibility to consistent employment
·
Language that intentionally or
inadvertently targets people (‘that’s lame’ or ‘that’s retarded’)
·
Objectification in medical and mental
institutions
§ Religious
culture refers to the religion in which one was
raised or participates
·
Xtians are privileged over non-Xtians
o
State-sanctioned holidays; pervasiveness
of its institutions and values in civic life in North America
·
Muslims targeted by oppression;
experiences levels of state-sanctioned violence both within and outside the US
·
Women’s reproductive rights are challenged
by Xtian hegemony, particularly for poor women and women of color 187
§ Ethnicity
denotes membership in ethnic or racial groups with privilege allocated to those
perceived as White (aka racism)
·
Through colonialism, the social construct
of race dehumanizes people of color as less deserving of basic human dignity,
and also privileges the extraction of resources from less valued peoples 187
§ Social
class culture describes the access to institutions
afforded based on class background with privilege conferred upon people from
middle- and upper-class backgrounds, while excluding these from poor and
working-class backgrounds 187
·
Assumptions about someone’s intelligence
founded on his/her class
·
Denial of educational opportunities to
poor or working-class children
§ Sexual
orientation relates to romantic or sexual
attractions, preferences, and choices
·
Heterosexism, homophobia, transphobia that
translates into denial of housing, employment, access to public services
§ Indigenous
heritage refers to the experiences of people whose
ancestors are native to the Americas; stems from the historic, systemic
genocide of European colonization of North America and extends today to such as
examples of
·
Misuse of traditional Native land for
waste storage and nuclear testing
·
Destruction of cultural artifacts
resources such as burial grounds
·
Ongoing occupation of Native lands which
forces displacement
·
Traditions romanticized and commodified
(cultural appropriation) 187-88
§ National
origin alludes to birth nationality – those born in the US
are privileged while those not face discrimination
·
Anti-immigrant oppression and manifests in
the barriers faced by undocumented immigrants as well as the threat of legal entanglement
and sudden deportation
·
While humans have migrated since time
immemorial, capitalist nationhood restricts, punishes, and maligns the
migration of people seeking a better life, while encouraging the migration of
corporations seeking cheaper costs and greater profits; nationhood defines who
belongs and is privileged (who have the right to be safe) and who does not
belong (who are criminals). 188
§ Gender
describes the range of characteristics pertaining to and differentiating
between masculinity and femininity, including nonbinary gender identities (aka
sexism)
·
Sexism is the oppression that divides
biological makes from females, transgender, and intersex people
·
Professionally: men usually enjoy higher
pay, more authority, and opportunities for advancement while institutions
uphold the myth of meritocraty – the notion that progress is based exclusively
on ability and talent versus one’s social status
o
Cisgender (gender identity corresponds
with the sex they were assigned at birth) are more privileged than those who
are transgender; cisgender privilege includes using a public restroom without
fear of verbal abuse, using public facilities (gym, locker room) without harassment
189
·
Trauma often refused to be buried, tamped
down, or pushed aside. Despite our best efforts to distract or numb ourselves,
shards of trauma eventually make their way to the surface. 202
·
To heal trauma, it must first be
addressed; it requires resolve, commitment, courage, and the right kind of
support 202
·
Adopting a trauma-sensitive mindfulness
framework is not as easy as simply making the decision to introduce mindfulness
as a tool in treatment; trauma-sensitive practice is an ongoing orientation to
practice and a commitment to be a continual learner 203
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