Surfing the Wave of Activation

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Surfing the Wave of Activation

• Using Resources when Working with Cancer Trauma

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Goals for todays presentation

• Cancer as potentially traumatic, life threat
• Overview limbic system, stress response
• Introducing Self Regulation Therapy
• Implications for working with cancer pts
• Accessing Resources
• Case Examples- Group, Individual
• Specific applications with cancer pts

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Definition of trauma

• Traumatic events overwhelm the ordinary systems
  of care that give people a sense of control,
  connection, and meaningthey generally involve
  threats to life or bodily integrity (p. 33,
  Herman, 1992)

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Cancer sometimes experienced as traumatic

• Surgery (anesthetic)
• Invasive treatment (eg immobility, needles)
• Diagnostic tests
• Waiting, waiting, waiting
• Patient identity
• Fear of recurrence
• System is on red alert

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Who is more Vulnerable?

• Past experiences
• Family of origin
• Intensity of the experience
• Current supports and conditions
• Age
• Gender
• Socio economic status

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The Stress Response

• What is Stress?
• - Stress is the physical, mental or
  emotional tension experienced in reaction to
  an event.
• What is the FIGHT-OR-FLIGHT?
• - When you encounter a stressful situation,
  a variety of physiological responses take
  place.

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Brain Physiology
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The Blessing and the Curse of Imagination

• Bear in the woods- we need to be able to
  respond quickly
• Our physiology does not distinguish between real
  and imagined
• Fight/ flight activated around interpersonal
  stressors, worries
• Note freeze is another possible response

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Self Regulation- Quick Snapshot

• Work with the limbic system first, then with
  cortex (meaning)
• Reduce activation in the nervous system
• Discharge flight/ fight energy
• Boost resources

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SRT Change in Practice

• Less likely to allow patient to weep in silence
  for a long time
• More active around interrupting a negative
  downward spiral
• More likely to slow things down, use my voice and
  words as a brake
• More active around asking about a patients
  resources
• Change the subject more often
• Access imagination, breath, body sensations more
• Access future imagined state- move around the
  time continuum
• Use imagination to discharge fight/ flight energy

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Note about Theoretical Framework

• Does not have to be SRT, can be another theory
• I think experienced therapists do some of these
  things automatically, but it helps to have a
  framework to know why you are doing what you do
• Often helpful to share this framework with
  patients- can feel crazy when limbic system is
  activated sharing the framework can be a
  resource, help settle the system
• SRT can be incorporated in a session easily, but
  as with any framework sometimes let it go and
  just listen

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How to speak to the limbic system

• Limbic system is non verbal
• You can not talk to it with words
• Need to use non verbal approaches eg sensation,
  imagination, breath
• When limbic system is on, often cortex is off
• Deer in the headlights

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Activation

• The term used in SRT to describe that jittery,
  hard to settle anxiety, response to stress
• Activation builds in the nervous system as a
  result of traumatic events (e.g., developmental
  trauma, car accidents, falls, surgeries, invasive
  medical procedures, life threatening situations,
  natural disasters)
• Cancer can sometimes be the straw that breaks
  the camels back

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What is a Resource

• Can be anything that induces a calming, settling
  in the nervous system (relaxation response)
• Can be imagined or real
• Can be a thought, image, sensation (tingling,
  warmth, breath, support of the chair)

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Trauma and Resource Vortices

• Weave between activation and resource
• Only work with small amounts of each
• Dip your toe
• Eg. Track the path of one tear Track your in
  breath, out breath

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Surfing the Waves

• Metaphor Sipping the ocean
• Working with small amounts of a resource and
  small amounts of activation (titration idea)
• Moving back and forth between the vortices

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Accessing Resources

• When trying to decide what resource to target?
  Ask what is the missing resource eg, if time is
  the missing resource, have person imagine own
  personal supply of time

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Access Sensation

• Where do you feel a little bit better? Even just
  a little bit?
• What are the sensations of comfort like?
• Please just take a moment to savour these
  sensations, and to book mark them, what is it
  like when your body is comfortable

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Notice breath

• Fear is excitement without the breath
• Have someone notice where they are breathing, how
  they are breathing, what happens when they notice
  they are breathing
• Track one breath
• Track in breath, out breath
• Track temperature of the breath

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Access Imagination

• What is that sensation like in your chest
• What does it look like, a picture, what is it
  made out of, texture etc
• If you could change that picture in any
• way to make it feel just a tiny bit better,
  how would you change it
• Imagine that change even 1

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Access Meaning

• Offer a reframe, a different way of thinking
• Have someone notice what happens in body when
  he/she thinks that new thought
• Get curious about that difference
• What would a day be like if they believed that
  new thought, even a little bit
• Imagine the new day

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Imagine the way you want something to go

• Use creative visualization to imagine the
  perfect surgery experience
• Imagine resources to support this
• Have patient imagine it going well, supportive
  doctors, nurses angel to watch over him etc
• Positive worry use this energy to imagine it
  going well

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Finish the Story

• With traumatic experiences, one sometimes gets
  stuck in the worst moment
• Can ask someone to think of a time when s/he felt
  safe again, were in less pain, were able to move
  freely
• Just take in that you are alive now, in this
  moment
• Eg use this with medical procedures

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Move around time continuum

• Do not have to listen to the story in a linear
  fashion bounce between past, present and
  future/ avoid the rote reporting of events
• Interrupt a negative downward spiral by changing
  the time frame
• Imagine you have a video camera and you can
  fast forward, pause, stop, view from a safe
  distance etc

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Working with Small Change

• Imagine the 1 difference
• Track the path of one tear
• Take in one molecule of the love that surrounds
  you
• Dipping the toe in both the resource and the
  activation

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Case Study Use in Groups

• Online support group for caregivers, taking care
  of a loved one who is dying
• As a facilitator, I read the cues that I have
  re activation and modulate this using resources
• Example slowing down the pace, asking group
  members to access resources, using humour

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• 141307 A finding this very hard to talk
  about, big lump in my throat... (about a
  documentary on end of life issues)
• XXXX
• 141331 Heather Slowing down, slowing down...
  sending care
• XXXX
• 141638 Heather Because we are close to
  time, I would like to shift our focus for a
  moment... can each of you look around the room
  you are in and see one thing that makes you feel
  a little lighter and hopeful... when you see it
  let us know what it is
• 141713 J Toys for grandchildren for
  Christmas.
• 141714A a picture of my five granddaughters
  up on the wall...
• 141720 C pictures of my grandkids, with big
  cheeky grins
• 141757 Heather A picture of my kids and a
  poster with the word "Courage" and a beautiful
  picture
• 141759 A picture in my mind of all of us
  caregivers together giving big, reassuring
  hugs...
• 141847 A I can feel the strength in all of
  your arms...

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Case Study Cathy

• Cathy, age 57 husband Geoff has bony mets, stage
  4 urothelial cancer
• They have three adult children, son has moved
  home to help with dads care
• They have been married 34 years
• They have travelled a lot as a couple travelling
  is a resource
• Cathy is terrified that husband will
• die and she will not be able to cope

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Case Example- Individual

• I have been meeting Cathy individually in our
  third session she speaks openly about her fears
  around her husbands death
• She begins to cry and says she will not be able
  to cope, obvious look of fear on her face
  (trauma vortex)
• I ask her about trips she and her husband have
  made how have they prepared when they travel to
  a new place, how do they plan for the trip
  (resource vortex)

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Offer a reframe

• Talk about death as preparing for taking a trip
  to a new place only this time they each need to
  prepare a little bit differently
• They have always planned their trips very
  carefully down to where they will go for dinner
  in a new country, tourist attractions to visit
  etc
• Work with this metaphor of preparing for a trip
  to help her access her resources and know how
  around planning for a trip
• Encourage her to talk to her husband about this
  also how will they prepare together

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The conversation continues

• We shift back and forth between trauma and
  resource this idea of a trip really fits for
  her. She becomes more animated, more hopeful as
  she begins to view preparing for death in this
  way.
• Also talk about self care how did she take care
  of self when she had newborn babies (she had
  twins) same goes for care giving for her
  husband now eg nap when he rests instead of
  continuing to work

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Working with psychological reactions to cancer-
related issues

• Post- Surgery, Anesthetic
• Breathlessness
• Chemo
• RTX
• Unknown future

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Working with post - surgery/ anesthetic response

• Have someone remember when they knew they would
  survive surgery, felt a bit better etc
• Work with Im alive
• Working with anesthetic response can look like
  dissociation, person can look and seem sleepy,
  not well connected to their body
• Have someone notice what happens when his/her
  energy leaves body
• Track this and notice when they feel more in
  and more out
• Move around the time continuum and access
  resources
• Work with boundary rupture, left and right, front
  and back
• Slow things down

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Working with breathlessness

• Breath is often used as a resource
• If someone cant catch their breath, or has
  difficulty breathing, find another resource,
  place of comfort or grounding in the body
• Have someone imagine he/she has their own
  personal supply of oxygen
• Imagine body breathing you
• Notice the part of you that is breathing- even a
  little bit

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Working with chemo fears

• Find out what fears are around chemo
• Have person imagine that the chemo is very
  intelligent, will only target the tumor and spare
  organs, surrounding tissue
• Reframe chemo as medicine as opposed to poison
• Imagine colour of chemo, can it be imagined as
  a healing force?
• Imagine the tumour as smaller, less dense, a
  different colour etc

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Working with RTX

• Claustrophobia track breath, imagine all the
  space you need
• Work with flight activation- imagine the escape
  route from the hospital/ from the room, have pt
  practice this in their imagination with you
• Work with the resource of the weight of the body
  on the bed, or sensation in your toes etc
• Imagine RTX beam is very intelligent, specific,
  only targeting tumour etc

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Working with Unknown Future

• Im alive in this moment, sense into that, sing
  like a lullaby
• Imagine self at some future goal event eg.
  daughters wedding, birthday party five years
  from now
• Imagine your own personal supply of time, Time
  in a Bag enough time to do everything you need
  to do and more see yourself getting everything
  done with time to spare
• Telescope down this moment if it is okay lets
  just imagine you have all the resources that you
  need for this moment, just focus on being in this
  moment etc

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Want more information?

• Websites SRT website (www.cftre.com)
• Books
• Waking the Tiger Healing Trauma (Peter Levine,
  1998)
• The Body Remembers The Psychophysiology of
  Trauma and Trauma Treatment. (Babette Rothschild,
  2000)

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Questions, Comments