Trauma and Health Risk
Let’s start with a definition. What is trauma? We often quote the work of Dan Siegel, MD at Open Sky. Dr. Siegel defines trauma as an experience that overwhelms our capacity to cope. In other words, if one doesn’t have sufficient coping skills or resources to deal with an overwhelming experience, trauma may be the result. You don’t need to be physically wounded. You don’t need others to perceive the experience in the same way. It is one’s own perception.
Potentially traumatic events and environments that occur in childhood (age 0-17) are referred to as adverse childhood experiences, or ACEs. The CDC-Kaiser Permanente Adverse Childhood Experiences Study is one of the largest investigations on the link between ACEs and well-being later in life. The study found that the higher the number of ACEs in one’s life, the higher the risk for negative health outcomes, such as alcoholism, drug use, depression, suicide attempts, heart disease, and more. Sustained and toxic stress resulting from ACEs can also cause biochemical changes in the brain and affect brain development.
Neurological Response
Many individuals who have experienced trauma or ACEs don’t have the coping skills to live in and maintain a “grounded” neurological state as a result. Instead, they are in a more constant “fight/flight” or “freeze” state.
These states are described in Dr. Stephen Porges’ Polyvagal Theory. When our bodies perceive threats to our safety, our nervous system responds. The grounded, or Ventral Vagal, state is indicated by social engagement, play, and intimacy. When we perceive danger or life-threat, the nervous system responds with what is called, “sympathetic arousal”. Organisms and individuals in sympathetic arousal first attempt to move away from danger, the response known as “flight”. If the flight system doesn’t work, then “fight” kicks in with increased aggression and confrontation. If all else fails, then the Dorsal Vagal branch of the nervous system activates with a “freeze” response. Freeze often presents as numbness, rigid body posture, and slowness in speech, movement, and thought.
Many of my students who have experienced trauma or ACEs have distorted neuroception. This is the “radar” that senses safety/security or danger/life-threat. Because of this distorted radar, they may place themselves in dangerous situations. Parents may often wonder, “What were you thinking?!” In reality, the child’s neuroception wasn’t working correctly and they weren’t able to clearly think through the consequences of events. This has implications for the development of the executive functioning of adolescents and young adults.
Without healthy coping skills, this is often why these students turned to addictive substances or behaviors: to manage the state of their nervous system, or more plainly, to change how they feel. Addictive substances or behaviors have a powerful short-term effect and long-term detriment.
Clinical Approach
Because of this link between trauma and addiction, it’s crucial to dig deeper with a student beyond the addiction itself that brought them to Open Sky. We start with a thorough assessment—an investigation into the history of substance use, stressful life events, and relationship history (including changes in family and friend relationships).
We do a lot of psychosomatic and breath work. The root of the name Polyvagal Theory is vagus, referring to the vagus nerve. This nerve runs throughout the upper chest and interfaces closely with the heart, lungs, and digestive tract. One of the most powerful tools in managing changes in our nervous system is to regulate our breath. Tactical Breathing is used to great effect by military and first responders to manage their stress levels. I teach specific skills such as 3-fold breathing, the 4-line feelings check, sensory orientation, and grounding exercises. Mindfulness meditation also has a profound effect on an individual’s ability to be aware of shifts in their nervous system.
From the grounded state, I help students build awareness of any shifts in the direction of fight, flight, or freeze. A foundational skill I work on with students is interoception. This is the ability to recognize what is going on inside the body and identifying links between those sensations and what is going on emotionally. Emotions and feelings are often indicators of nervous system state changes, so the physical-emotional awareness through interoception keeps us a step ahead. From there, we can more successfully choose a healthy way of balancing that shift.
Another key part of my treatment approach is the emphasis on connection. In his Ted Talk “Everything you think you know about addiction is wrong,” journalist and author Johann Hari said, “the opposite of addiction is not sobriety; the opposite of addiction is connection.” The essence of this quote is, in a lot of ways, the essence of my work at Open Sky with individuals struggling with addiction. I help them establish and develop meaningful connections. Yes, sobriety is an essential part of this, and connection is what ultimately fills the void of what sobriety removed from that person’s life.
How does Wilderness Therapy Help?
Wilderness therapy is the perfect setting to develop a sense of tribe and connection; love and belonging. It removes students from the distractions of everyday living. It gets them out of the potentially unhealthy environment they were in and into an environment based on physical and emotional safety and connection. In that context, a nervous system can actually start to ‘downshift’ into this socially engaged, connected, and grounded place. The peer group and staff at Open Sky are all focused on regulating and supporting each other in the process, too.
Another huge way wilderness therapy supports this process is by simply being in nature. There is a lot of research that shows that being in nature just for a matter of hours can help to ground us and regulate our nervous systems. Taking in the colors of the sunset, listening to the sound of the falling rain, feeling the breeze on our face… Our students are in that setting day-in and day-out. Along with that, there are inherent challenges when it comes to living amongst Mother Nature. These challenges develop resilience. That resilience can then be taken with them when they leave Open Sky.
One of the foundational components of programming at Open Sky is mindfulness. Teams practice yoga and meditation throughout the week and gather once a week for Community Meditation, led by Family Wellness Counselor, Norman Elizondo or other members of the Family Services team. Consistent mindfulness practices like these support emotional regulation and attunement to oneself and to others.
Family Engagement
Because human connection is an antidote to an addiction that results from trauma, the family systems work at Open Sky is really important to the healing process. (I speak to this work in more detail HERE.) Open Sky provides opportunities for students and their families to heal the damaged relationships or fragile connections they had before. Letter writing and parent phone calls give weekly opportunities for honest and authentic communication, building a new foundation for healthy connection.
The Family QuestTM wilderness intensive allows families and their loved one to interact face-to-face. With Family Services staff facilitating, families work through past resentments and regrets, share respects, and make requests of each other in the future. Prior to my role as the primary therapist for Team Bodhi, I worked as a Family Services therapist for 3 ½ years and facilitated over 130 Family QuestTM experiences for families. It is inspiring to see how the connection being re-built with their family members (in addition to connection with peers, guides, and the team therapist) begins to fill the void that the addictive substances or behaviors once filled.
Parents also have the opportunity to work on their own mindfulness, emotional regulation, communication, and interoception skills during Wellness Weekend. By caring for their own well-being and understanding the skills their child is learning in the field, parents are better positioned to show up in healthy connection with their child.
Transition
By the time students graduate Open Sky, they are empowered with a set of tools and coping skills to help keep them grounded and regulated. These are resources they utilize when feeling shifts in the nervous system they would have previously fixed with addictive substances and unhealthy behaviors. When the state of their nervous system begins to shift to flight, fight, or freeze; when the overwhelm of past trauma or ACEs starts to creep back in; or if they experience overwhelming or potentially traumatic events in the future, they are equipped with skills to help them regulate and heal.
Part of treatment at Open Sky is developing a plan for transitioning and moving forward after Open Sky. How will you be intentional about creating a healthy community? How will you form meaningful connection with others? How will you continue to take care of your hygiene, self-care, sleep, and overall wellness? How will you pursue your goals and dreams? What are the red flags along the way that may indicate you’re not on the path to reaching these goals or maintaining well-being? What are the symptoms that your nervous state is not regulated? What are the signs that you are going in the direction of the addictive patterns you relied on previously? These are some of the questions students consider during their time at Open Sky and beyond.
Addressing these questions, and others, sets students up for success in the next steps, whatever that looks like for a given student. Their past traumas do not keep them on a path of disconnection and disease. They are empowered to regulate, connect with others, and make healthy, life-giving choices.
January 27th, 2020