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TRAUMA-INFORMED PEACEBUILDING

Participant Training Manual

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ACKNOWLEDGMENTSTrauma-Informed Peacebuilding is a product of MBB Consulting, a division of Mediators Beyond Borders International. It is the result of the generous contributions of skills, resources and expertise by a multidisciplinary team of people with a passion for peace. This team is lead by:

Mary Jo Harwood, MSW, LSW Ginny Morrison, JDSuzanne Dobson, MD Barbara Melamed, PhDRochanne Vincent, LCSW Prabha Sankaranarayan, MS

ABOUT THE PROJECTTrauma-Informed Peacebuilding: Transforming Communities

• About 300 million people now live amidst violent insecurity around the world.1 • More visible perhaps, the number of people forcibly displaced because of

conflict or persecution exceeded 50 million by the end of 2013 – the highest number since World War II.2

• One-third of all women in the world experience sexual, physical or other abuse in their lifetimes.3

Mediators Beyond Borders International believes that post conflict reconstruction and peacebuilding must integrate Trauma-Informed Principles in order to build sustainable peace.

MBB’s TRAUMA-INFORMED PEACEBUILDING workshops and this manual, provide guidance for donors, multinational organizations and practitioners in the fields of healthcare, education, human rights, conservation, and humanitarian aid who are considering integrating trauma-responsive theory and practices to meet local needs. At the completion of TIP training, participants understand the bio-psychosocial impact of traumatic experiences, the cultural variations in its behavioral expression, and the critical design elements of effective programs that build on the resources of communities.1Geneva Declaration (2011) Global Burden of Armed Violence 2011:

Lethal Encounters. Geneva: Small Arms Survey and GD Secretariat2UNHCR (2014) Annual Global Trends Report 2014.United Nations

High Commission of Refugees (UNHCR). Geneva: UNHRC. Available

at: unhcr.org/53a155bc6.html. This statistic is part of the earlier cited statistics on political and criminal violence3Advocates for Human Rights (2012) Stop Violence Against Women.

Available at: stopvaw.org/Prevalence of Violence

TERMS OF USEWhile this is not a clinical manual, it is meant to be used in trainings delivered by individuals or teams that must include those with clinical experience. Prior permission is required for mechanical, electronic, or any other manner of reproduction or use of this manual. Contact Mediators Beyond Borders at [email protected]

Copyright © 2016

James Longo, EdDMillicent Otieno, MA

This manual is dedicated to Florence and all those who, after having been hurt,

contribute to transforming the lives of others.

THE PILLARS OF TRAUMA-INFORMED PEACEBUILDING 1-5

CONFLICT COMPETENCY & TRAUMA AWARENESS 6-9

NEUROBIOLOGY, IMPACT & EXPRESSION 10-17

INTERGENERATIONAL TRAUMA, EPIGENETICS 18

A STRENGTHS BASED APPROACH, RESILIENCE 19-26

RESTORATIVE NARRATIVES — POST TRAUMATIC GROWTH 27-36

VICARIOUS TRAUMA 37

INTEGRATING PROGRAM DESIGN 38-43

TABLE OF CONTENTS

Trauma-Informed Peacebuilding ii

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Foundation under the pillars of building sustainable communities post conflict.

Over the last decade, there has been increasing recognition that

peacebuilding/conflict resolution and the field of trauma are interconnected.

“Since 2004, many programs came through here, but this is the first one that brought us together. You didn’t bring us money, you brought us knowledge.”

— Women Hold Up Half the Sky Participant

The Pillars of Trauma-Informed Peacebuilding (TIP)

The foundation of successful peacebuilding is to acknowledge and address the intersection of conflict resolution and trauma.

Trauma-Informed Peacebuilding 2

An important first step in moving beyond the traditional “working around conflict” approach: to use analytical tools

to ensure that at both the macro and micro levels, the intervention efforts themselves do not exacerbate an already tense situation.

According to Goodhand (2001), this can be seen as “working in conflict,” where organizations begin to reflexively integrate conflict considerations into their internal and external operations as the situations evolve (Zelizer, 2013).

Why is TIP important?...and the role of Mediators Beyond Borders

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Understanding Conflict

Every conflict reveals an internal crossroads with each path branching and

leading off in radically different directions.

At the center or heart of every conflict lies a pathway to resolution, forgiveness, and reconciliation.

No single human being is the same from one moment to the next. Therefore, no matter how stuck anyone is, they can become unstuck at any moment.

backward

forward

deeper

• impasse• enmity

• respect• resolution

• transformation• learning


• Different than trauma treatment• Emphasis is on looking at the whole

person and appreciating the context in which that person is living their life

• Goal is to return sense of control and autonomy to survivor. Builds skills. Strength based.

• How providers and survivors understand roles impacts the services themselves

• Open and genuine collaboration• Participants set priorities for services

Trauma-Informed Care

PTSD Treatment

• The individual and the problem are synonymous

• Cost conscious environment. Services must be completed in a certain time frame. Also must manage risk. Manages symptoms. Outcome focused with stabilization as goal

• Providers viewed as having superior knowledge. Power is in the hands of provider which hinders collaboration. Survivors are often apprehensive and sometimes frightened.

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Trauma Exposure: “Four Violences”

Direct Violence

• No less than 1.5 billion people currently live in countries afflicted by political or criminal violence and war (The World Bank, 2011)

• At the end of 2012 45.2 million people were “forced displaced” (UNHCR, 2013)

• One third of all women in the world experience sexual, physical, or other abuse in their lifetime (Advocates for Human Rights, 2012)

Natural Violence

• Worldwide, an annual average of 268 million people are affected by natural disasters (IDD, 2012)

• Natural Disasters caused by climate change are becoming a recurring pattern ---in the future will likely affect larger popula-tions

• 2012, 56 Million people died worldwide (WHO, n.d.)

Structural Violence

• 1,22 billion people worldwide lived in extreme poverty on $1.50 a day in 2010 (World Bank, 2014)

• Some 260 million persons who live in absolute poverty have a disability (McClanin-Nhlapo, 2006)

• Worldwide some 202 million peo-ple are unemployed in 2014 (ILO, 2014)

• The number of child laborers in 2012 is 168 million

(Carrier, 2014)

Cultural Violence

• Apartheid• Discrimination• Oppression• Colonialism• Exploitation• Racism• Sexism

Others?


Why Increase Conflict Competency?

Most conflicts are triggered by external experiences and

information regarding them is conveyed to us by sensory inputs that have been gathered from our environment. Our conflicts therefore seem to us to take place externally, yet everything we understand about the meaning of what happened, and all of our responses to the actions of others are initiated and coordinated internally by our brains. (Cloke, 2009)

“By acting compassionately by helping to restore justice and encourage peace, we are acknowledging that we are all part of one another.” — Ram Dass

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Over the last decade, there has been increasing recognition that

peacebuilding/conflict resolution and the field of trauma are interconnected.

Leading experts assert the role of trauma must be integrated into conflict resolution applications as well as in the education of practitioners.

They further state that unresolved trauma leaves people vulnerable to future conflict.

MBB believes Trauma is a barrier to trust, resolving conflicts, attending school, and sustaining livelihood, the very things needed for a united, prosperous state (See, e.g., J. Lederach, Preparing for Peace; M. Lange and M. Quinn, Conflict, Humanitarian Assistance and Peacebuilding: Meeting the Challenges, Reilly, McDermott and Coulter, Mass Trauma and Violence, Living in the Shadow of Community Violence in Northern Ireland, J. Gilligan, Preventing Violence)

Why Conflict Competency and Trauma Awareness?


Identifying Barriers

Individual Impact• Lack of Trust, People,

Collaborative Planning• Disempowered• Self-Identity• Victim• Perpetrator• Witness• Expectation of group versus

needs of Individual

Collective Impact• Disconnect and Disempowerment• Focus on survival and safety• Us versus Them• Population Displacement• Cultural “Markers” destroyed

Far beyond the scope of any “quick impact projects”, “the path towards reconciliation is a marathon, not a sprint” (President Bronislaw Komorowzki). Thus the critical importance of addressing this from a trauma-informed lens.

The body feels before the brain connects the uncomfortable sensations and feelings to the traumatic history! Because self-regulation can be difficult, a person then goes from stimulus to response without taking the time to connect the fear, anger, and anxiety to the trauma history. Instead it is associated with the current situation.

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Trauma

Trauma: Brain Processing

First, trauma happens in your life…..

Then, trauma affects your life…..

Then, trauma becomes your life….

— Hadar Lubin

At the time of a traumatic incident, stress hormones are released. Hormones such as adrenaline and testosterone assist in getting the information quickly from the emotional part of the brain (limbic) to the instinctual part of the brain (reptilian) responsible for the fight, freeze and flee reaction. The thinking part of the brain (neocortex) shuts down temporarily, and the reactive part of the brain is highly activated. This happens very quickly. Some people describe it as a “bolt of lightning”. The release of the stress hormones cause a part of the brain called the hippocampus to become suppressed. The hippocampus, is associated with the ability to place memories in the correct context of space and time. Because it

is suppressed, whenever a traumatized individual undergoes stimuli (sight, sound, smell) similar to the traumatic event, the body perceives the event as occurring again because the event was never properly recorded in the person’s memory.

When we validate someone’s trauma reactions, and remind them that what they are experiencing is a memory, not the real thing happening again, we assist them with moving the charged memory from the limbic brain---(emotional brain), to the neocortex—(thinking brain), where the brain is more efficient in its storage and allows for the development of communicative narrative and chronology. We assist in helping the person to create new neuropathways. Or, new associations to the trauma stimuli.


Trauma and Brain Processing

The reptilian brain, the oldest part of the brain, controls the body’s vital functions such as:• Heart rate, • Breathing • Body temperature and balance. The reptilian brain is reliable but tends to be rigid and compulsive.The reptilian brain’s main function is to help with survival. Responsible for Fight, Freeze or Flee

The Limbic System• Houses the primary center of

emotion.• Amygdala – tells the body how to

respond-- emotions like fear, pity, anger, or outrage.

• Hippocampus – places the event in time and space. It converts information into long term memory as well as memory recall.

• Links emotions with behavior • Is also involved in primal activities

related to food and sex; our sense of smell and bonding needs, and activities related to expression and emotions

The Neocortex• Also called the cerebral cortex• Makes language, including speech

and writing possible. • It renders logical and formal

operational thinking possible and allows us to see ahead and plan for the future.

• Contains two specialized regions for voluntary movement and processing sensory information.

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Trauma and Brain Processing

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Reactions

Hormones and Neurotransmitters

• Adrenaline: triggers fight or flight response

• Testosterone: stimulates aggression• Oxytocin: instills trust,

increases loyalty• Estrogen: triggers the release

of oxytocin• Endorphins: reinforces collaborative

experiences with pleasure• Serotonin: regulates mood

The biological response

• Increased blood pressure• Increased heart rate• Pupils dilate• Breathing short and shallow• Muscles tighten• Digestion shuts down• Elimination can speed up• Glucose to the muscles• 5 senses on hyper alert• Adrenaline and cortisol

Emotional Reactions

• Shock• Disbelief• Denial• Cataclysm of Emotion• Fear• Anger• Confusion• Guilt• Shame• Grief


Fight

Flight

Freeze

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Impacts and Expression

Reconciliation can be understood as a way to

build “relationships today that are not haunted by the conflicts and hatred of yesterday”. From that perspective, the critical question is not only “what happened?”, but also – and above all – “what shall we do with the past?” Similarly, one of the most fundamental issues is not whether to remember or forget, but how to remember and forget in order to move forward. (Rosoux, V. 2015)


Cycle of Violence – Hurting People Hurt

(Adapted from D. Tutu and M. Tutu, 2014)

REVENGE

VIOLENCECRUELTY

HURTLOSS

PAIN

CHOOSING HARM

REJECTING SHARED

HUMANITY

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Impacts and Expression

Working on livelihood programs for people who have gone through

traumatic experiences cannot be “business as usual.”

Taking into account the particular economic environment as well as the psychosocial impacts resulting from what people have been through is the starting point in program design.

Programs need to offer different things to different people, whether they are vocational training, micro-credit, or other assets.

The reality is that people respond to offers differently based on their vulnerabilities. Similarly, programs too must respond differently to the new realities on the ground.

(The World Bank Group, “INVISIBLE WOUNDS”: A PRACTITIONERS’ DIALOGUE ON IMPROVING DEVELOPMENT OUTCOMES THROUGH PSYCHOSOCIAL SUPPORT” May 6, 2014)


Intergenerational Trauma

Events such as particularly traumatic violations of human rights can remain

unexpressed for a period of time – a period that psychoanalysts often call “latent”.

Some specialists refer to a period of 25 years. However, there does not appear to be any standard time-period in this matter. In Greek tragedies, for instance, old debts were only paid after three generations. This trans-generational transmission is absolutely critical in post-conflict situations.

Case studies show that the second and third generations remain preoccupied with continuing feelings of guilt or victimization, especially when past injustices have not been adequately addressed by their parents’ generation. The families of holocaust survivors, the Afghans, Japan and Korea, Rwanda, ... the literature is rife with examples. (Salles, 2012)

Without knowing what it is, “I knew I carried slippery, combustible things more secret than sex and more dangerous than any shadow or ghost.” — Helen Epstein, Children of the Holocaust

Children of PTSD-diagnosed Holocaust survivors are 3x as likely to also have PTSD diagnosis. — R. Yehuda

“Transgenerational transmission is when an older person unconsciously externalizes his traumatized self onto developing child’s personality.” — Vamik Volkan

What can a child experience?

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Creating Trust by Providing Safety and Security

• Build Survivors sense of control by providing choices. Do not assume you know what they need.

• Attend to basic needs such as refreshments, other tools necessary for participation.

• Use respectful titles when addressing individuals.

• Be mindful of “power differentials.” Boss verses Employee. Visitor verses Host. Role in Community, etc.

• Respect privacy and confidentiality• Communicate clearly---check

for understanding• Provide adequate time for digestion

of information before requiring a response.

• Be consistent and predictable with behavior, schedules, reactions

• Be transparent when addressing issues of concern or confusion.

• Assist and support with identifying practical issues or concerns.

• Support appropriate solutions to concerns.

Diaphragmatic Breathing

Diaphragmatic breathing or “belly breathing” is a purposeful breath which inhibits the “fight or flight” response associated with trauma. For this breath, air should fill the diaphragm causing the abdomen to enlarge while inhaling and compressing on the breath out until all of the air is out of the lungs.

• Find a comfortable position. Sitting upright or lying down is best.

• Breathe in through the nose while expanding the abdomen/belly. *If the shoulder and/or chest are moving the breath is not getting to the abdomen.*

• Breathe in fully as if no more air is able to fit into the abdomen.

• Exhale slowly through the mouth and the abdomen should contract.

• Fully exhale until abdomen is contracted and feels as though it is pressing against the spine.

“I believe that we humans have the innate capacity not only to heal ourselves, but our world, from the debilitating effects of stress, and overwhelm, and trauma.”

— Peter A. Levin, PhD.

Applying a Strength Based Approach Healing the Whole Person


Establishing Safe States

Grounding

Grounding is an exercise to take an individual from internal states of thinking where the individual may be reliving traumatic events and feeling unsafe to the external present moment to “ground” the individual to the here and now establishing safety. There are two types of grounding, both physical and mental grounding.

Mental Grounding:• Look around and begin describing what you

experience using all of the senses. For example, what do you see? Describe this in detail in your mind or aloud. What do you hear, smell, taste, and feel? Describe each in detail.

• Take a daily activity and describe this in your mind or aloud in detail. For example describe making a meal or daily chore.

• Remind yourself you are safe…

Physical Grounding:• Touch items near or around you, notice them

and describe them aloud or in your mind. • Jump up and down or push your feet into

the ground.

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Mindfulness Similar to grounding, mindfulness is another strategy to focus on the here and now in order to establish safety in the present moment. Mindfulness can be used with any activity or object including our own person. Mindfulness is simply noticing or becoming aware of whatever we would like to focus on. Here are some mindfulness techniques to practice however, the intervention of mindfulness can be used with any object or activity.

Establishing Safe States: Mindfulness

Mindful Noticing: • Notice where you are right now. Are you sitting

or standing? • What do your surroundings look like? • What is the temperature of where you are right now? • What do the objects around you feel like? • Describe in detail your present moment using sight,

smell, hearing, and feeling.

Mindful Breathing: • Notice your breath. • Close your eyes and feel the air flow into

your nostrils. • Notice whether the air is cool or warm as you inhale

and feel the air as it moves into your lungs. • Breathe out and notice the air as it moves out of the

body. Is it warm? • Notice the air leaving the body and become aware of

the movement of your body as you breathe. • Continue to notice the breath being careful not to

speed up or slow down the breath. Just notice the breath.

• Continue this for as long as needed.

Mindful Walking: • Begin by finding a quiet space and begin by standing

and noticing your feet on the ground. • As you begin to walk become aware of the movement

of your feet, what the movement feels like. • Then begin to notice your feet touching the ground. • Become aware of the movement and begin walking

slowly gradually picking up your pace. • Become aware as thoughts enter your mind but focus

on the movement of your feet as you continue to walk.

• Notice any other sensations in your body. • Continue this mindfulness for about 10 minutes



Creating a Safe Place

In order to regain control and establish safety, creating a ‘safe place’

visualization can be useful.

Find a quiet place and sit in a comfortable position. Close your eyes and recall a favorite memory or place, this could be anything from your memories or a place you may have never been. Imagine being in this place engaging all the senses including what you see, the smells, sounds, and feeling of being here. Notice everything about this place and the reason you chose this as your most favored place. Become aware of what makes this place safe and comfortable. Stay in this place for as long as needed to regain a sense of safety.

Establishing “Safe States” Sometimes it can be too painful to think about a favorite place. That place may no longer be available due to violence or protracted war. Establishing a “safe state” is recalling a time when you felt safe.

• When did you feel safe?• What did your body feel like when

you felt safe?• What emotions do you remember

experiencing when you felt safe?• To calm yourself, what can you do

to access those memories whenever you feel unsafe?

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Self- Regulation “Standing in the Need of Care” during an Activated Trauma Memory Grounding Exercise at a glance:• Don’t try to talk someone out of a

bad memory• Don’t touch him or her• Remind them it is a memory of

what happened not the real thing happening again

• Use a calm tone of voice• Validate how fearful, angry, anxious

or disorienting they may be feeling. • Remind them to take deep breaths• Engage in active listening and reflect

back to them what you are hearing them describe

• Empathize and validate• Provide water and perhaps some

physical movement

Ask them to: 1. Look around the room or area

you are in2. Describe one or two things that you

see. Color, texture, size etc.3. What do you see?4. What do you smell?5. What do you taste?6. What do you feel beneath your feet?

Your hands? Your bottom?7. What do you hear around you?8. Remind the person where they are

and not where their memory wants to take them.


Retrain the Mind• Identify triggers• Notice reaction in body

While having a memory• Tell yourself it’s a memory• Look around – see what’s around you

is in the present• Look around for signs that you are in

safe place• Do something to be aware of your

body – tapping, hugging, jumping, stomping feet

Create new neuropathwaysAsk:• What does he/she do when he/

she feels good or when he/she celebrates?

• Who does she/he like to be with when she/he is worried or afraid?

• Invite or encourage them to write or draw pictures describing how they feel now and how they would like to feel in the future.

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Relaxation and Regulation• Scan your body• Notice where your body temperature

is different—some areas warmer or colder than others

• Tense your muscles then relax—Tense then relax

• Scan your body again for temperature differences

• Notice your breathing—mostly in your chest? Belly? Deep? Shallow?

• What is going on in your gut? Hunger? Butterflies? Tense?

• Notice your joints. • Notice your heart beat.• Stand up—stretch, move about—

bend left, then right—move in any direction

• Sit back down and scan your body• What has changed?

Calming Techniques / Body Literacy

Fire Drill (to be used to manage flashbacks)

Make a plan to implement for when a flashback may occur

• Stop• Look around• Name three things you see• Stomp your feet, wave your arms,

jump up and down (any movement will do)

• Tell yourself it is a memory not the real thing happening.


TRAUMA RESPONSE ANXIETY

Ice to wrIsts

BreathIng

groundIng

relaxatIon exercIses

weIghted Blankets

weIghted vests

relaxatIon

aromatherapy

weIghted Blankets

musIc

yoga

rockIng chaIrs

Calming Techniques

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Supporting Narrative

• Show that it is safe – Use a calm, low tone.

• Don’t get highly emotional or critical of the wrongdoer or of people who are meant to keep us safe.

• Follow their lead – what do they need?• VALIDATE and NORMALIZE their

reactions to the trauma• DON’T ask them to tell their story;

if they starts to tell it, listen and VALIDATE

- Okay to sit in quiet - DON’T say anything you don’t know for certain - Try not to show shock – reassures them you can bear the story - Provide opportunities to recognize the body’s response to the memory and encourage them to stretch, shake, move their body to release that tension.

Supporting the Development of Narratives


“Beneath the surface of the protective parts of trauma survivors there exists an undamaged essence, a Self that is confident, curious, and calm, a Self that has been sheltered from destruction by the various protectors that have emerged in their efforts to ensure survival. Once those protectors trust that it is safe to separate, the Self will spontaneously emerge, and the parts can be enlisted in the healing process”

― — Bessel A. van der Kolk, The Body Keeps the Score: Brain, Mind, and Body in the Healing of Trauma

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Programming and Accommodations

Attention and Concentration Memory Learning Problems

Eliminate background or competing noises

Repetition of new material Present information in multiple modalities, ex. Visual, auditory, tactile, movement, songs, art

Remove excess visual stimuli

Repeat important information

Ask how an individual learns best. Ex. Auditory, visual, tactile, experiential

Provide Private-Uncluttered spaces

Present one concept at a time

Provide a structured and predictable format

Capitalize on strengths-skills

Allow time to reflect and respond (15-20 seconds)

Present one concept at a time; allow for consolidation and assimilation of the information

Break down tasks to manageable chunks

Maintain instruction examples in a visible place such as whiteboard

Build in time to complete tasks

Be flexible with time limits Provide “cheat sheets” for essential information

For activities with multiple tasks, add one task at a time

Do not impose rigid methods for organization

Teach Visual Mnemonics Provide handouts and allow people to take notes, doodle etc.

Emphasize structure and timelines

Give Context—emphasis meanings and patterns

Check for learning frequently—as each new concept is presented

Schedule time for getting organized

Work on recognition before moving on to retrieval

Provide checklists for tasks Schedule time to practice previously learned information

Color code handouts

Plan substitute activities when people are overwhelmed


Programming: Accommodating the Challenges

Resilience and Post Traumatic Growth

Reconciliation can be understood as a way to build “relationships today that are not haunted by the conflicts and hatred of yesterday”. From that perspective, the critical question is not only “what happened?”, but also - and above all – “what shall we do with the past?” Similarly, one of the most fundamental issues is not whether to remember or forget, but how to remember and forget in order to move forward. (Rosoux, V. 2015)

“Forgiveness has nothing to do with absolving a criminal of his crime. It has everything to do with relieving oneself of the burden of being a victim--letting go of the pain and transforming oneself from victim to survivor.” ―— C.R. Strahan

“Resentment is like drinking poison and then hoping it will kill your enemies.”

—― Nelson Mandela

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Some of us have these “protective factors” in ourselves & through our loved ones:

• Caring, supportive relationships• Positive view of selves• Capacity to make & implement

realistic plans• Capacity to manage strong

feelings, impulses• Menu of self-care• Don’t compare self to others• Humor• Focus on what they have control over• Sense of Justice• Remain Hopeful• Focus on the future

When we look at different studies of what makes people resilient, we see some

patterns. Of course, there are differences depending on the context, but here are some features we’ve seen in studies around the world. Some of it has to with who we are; some resilience seems to flow if we take certain actions to respond to our situations; and sometimes resilience comes from supports around us, our personal environment.

The factors in common tended to have to do with (1) ideology and spirituality, (2) relational qualities, and (3) personal qualities illustrating agency and resourcefulness.

Characteristics of Resilient People


Personal characteristics

• Sense of purpose• Aspirations• Strong ideology• Spiritual support• Beliefs and values• Feeling a part of

something larger socially and spiritually

• Moral sense of reasoning--maintains connection to humanity

• Helping others• Empathy• Humor• Easy-going• Access to

autobiographical memory, invoke good & sustaining figures

• Flexibility in emotional experience, not suppressing major affects, direct expression, ability to defer or defend against overwhelming anxiety or depression when emergency resources are needed

• High cognitive capacity, critical thinking

• Sense of identity• Ability to effect change• Resourcefulness• Confidence• Curiosity

What one does

• Active response to the stressor

• Make sense/meaning of the suffering

• Taking care of one’s body

• Seeking help when needed

• Discuss the experience and feelings

• Extract warmth and kindness and most dire circumstances, including from enemies

• Caring for own needs

Environmental

• Parents had nurturing style

• Attachment to a parent • Parents providing

discipline• Caring adults outside

nuclear family • Access to supportive

relationships at all levels

• Meaningful role in community – acceptance and social equality

• Access to material resources – basic needs, $, education, employment

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The literature emphasizes that exit strategies should be built into the design of programs and projects—hence, principles for exit should also exist from the outset. However, this does not seem to be the reality. Instead, it seems that many organizations develop principles only once the decision to exit has been made, and suddenly staff are tasked with designing how exit will happen.

— NGO Training and Research Center, Rachel Hayman & Sarah Lewis

Sustainability and Exit Strategy

Decision Tree


Vicarious Trauma and Self Care

“The expectation that we can be immersed in suffering and loss daily and not be touch by it is as unrealistic as expecting to be able to walk through water without getting wet”

— Remen, 1996

Current Research on Vicarious Trauma

The Antares Foundation and the Center for Disease Control suggest

that nearly 1 out of 3 aid workers report significant symptoms of PTSD upon returning from assignment

Clinicians who listen to survivors’ stories of fear, pain, and suffering may develop deleterious emotional, cognitive, and physical consequences (Carbonell & Figley, 1996; Collins & Long, 2003; Danieli, 1996; McCann & Pearlman, 1990; Salston & Figley, 2003).

Few studies to date have focused on Humanitarian Aid Workers

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Recognizing Trauma

Sympathetic Branch: activates during positive and negative stress states

Noticeable Signs• Faster respiration• Quicker heart rate• Increased blood pressure• Pale skin color• Sweating• Skin cold• Digestion decreases

Parasympathetic Branch: activates during rest and relaxation

Noticeable Signs• Slower, deeper respiration• Slower heart rate• Decreased blood pressure• Flushed skin color• Skin dry• Digestion increased

AUTONOMIC NERVOUS SYSTEM


PREVENTION TIP: AROUSAL AWARENESS

PREVENTION TIP: THINKING CLEARLY

PREVENTION TIP: BODY BOUNDARIES

PREVENTION TIP: CONTROLLING EMPATHETIC IMAGERY

When at rest, take notice of your body: • Skin temperature• Blood circulation• Facial expression• Breathing• Muscles • HeartbeatThink of something pleasant in your life – what changes?Think of something unpleasant in your life – what changes?

Challenging Situation• Start with an easy situation• Take note of the differences in your

body• Tune in every 15 to 20 min• Compare to more difficult situations

or relationships

• Change body posture, position, expression, breathing while listening to a traumatic story or supporting a difficult conversation

• Switch focus to external stimuli (here and now objects) to remind yourself of your role, your surroundings.

• Establish rituals to take care of yourself and remind yourself there is a beginning, middle and end at the conclusion of conversations, meetings or difficult situations that you find yourself in. It can be something as simple as hand washing or listening to a favorite song.

Autonomic SystemThe hippocampus assists in passing information to the cortex. It is vulnerable to stress hormones released by the amygdala’s alarm. When hormones are high, they suppress the hippocampus. If false alarms continue to fire, there is no beginning, middle or end to traumatic events.

Putting on the BrakesStress hormone levels are reduced by controlling hyper arousal. The hippocampus works and the cortex recognizes the traumatic event is over and stops sounding the alarms.• Become calmer and think clearly• Allow it to rise when necessary (for

situations that require follow through, or assertiveness)

• Important to stay grounded, remind yourself of where you are (here and now), your role, purpose, and that you bare witness. It is not your story

(Adapted from Rothschild, 2006)

It is not uncommon when we hear other’s stories of pain, those stories “hitch a ride with us.” It can be helpful to determine if you are seeing, hearing or tactile empathizing with what you have heard.

Once your main modality is identified, prepare and protect yourself by monitoring how you are taking in stories of pain. • Is visualization necessary for empathy?• Auditory- How do you hear the

experience? • First person?• Tactile Technique: Submodalities• Manipulate your images, sounds,

textures in as many ways as you can think of.

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Vicarious Trauma

Vicarious Trauma Indicators• Guilt• Fear• Anger and Cynicism• Inability to empathize/Numbing• Addictions• Grandiosity/Inflated sense of

importance related to your work• Helpless and Hopeless• Sense that you can never do enough• Hypervigilance• Diminished Creativity• Inability to embrace complexity• Minimizing• Chronic exhaustion/Physical Ailments• Inability to listen/

Deliberate Avoidance• Dissociative Moments• Sense of Persecution


Project Designs

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Lessons• Conflict is about

relationships• Trauma affects

relationships• Trauma therefore

affects work requiring collaboration, initiative and follow through

(Invisible Wounds)


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NOTES


NOTES

This teaching tool would not be possible if it weren’t for the people who honored us with their stories of surviving destruction, war and violence. They welcomed us while on their journey toward healing. They humbled us with their resilient hearts. They taught us that true transformation and rebuilding of lives after the ravages of devastation, is through the human bond of love, not hate, through reconciliation, not revenge. To all survivors, thank you!

THANK YOU

LET’S WORK TOGETHER

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Arlington, Virginia 22209 USA

Phone: +1 703.528.6552

[email protected]

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The only lasting peace is the one built by the disputants themselves.

Designed by Niki Borofsky | [email protected]

trauma-informed peacebuilding€¦ · • one-third of all women in the world experience sexual,...

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