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Stress Inoculation Training

Reprinted from:Meichenbaum, D. (1996). Stress inoculation training for coping with stressors. The Clinical Psychologist, 49, 4-7.

What is Stress Inoculation Training

Stress Inoculation Training (SIT) emerged out of an attempt to integrate the research on the role of cognitive and affective factors in coping processes with the emerging technology of cognitive behavior modification (Meichenbaum, 1977). SIT has been employed on a treatment basis to help individuals cope with the aftermath of exposure to stressful events and on a preventative basis to “inoculate” individuals to future and ongoing stressors.

SIT is a flexible individually-tailored multifaceted form of cognitive-behavioral therapy. In order to enhance individuals’ coping repertoires and to empower them to use already existing coping skills, an overlapping three phase intervention is employed. In the initial conceptualization phase a collaborative relationship is established between the clients and the therapist (trainer). A Socratic-type exchange is used to educate clients about the nature and impact of stress and the role of both appraisal processes and the transactional nature of stress (i.e., how clients may inadvertently, unwittingly, and perhaps, even unknowingly, exacerbate the level of stress they experience). Clients are encouraged to view perceived threats and provocations as problems-to-be-solved and to identify those aspects of their situations and reactions that are potentially changeable and those aspects that are not changeable. They are taught how to “fit” either problem-focus or emotion-focus to the perceived demands of the stressful situation (e.g., see Folkman et al., 1991). The clients are taught how to breakdown global stressors into specific short-term, intermediate and long-term coping goals.

As a result of interviewing, psychological testing, client self-monitoring, and reading materials, the clients’ stress response is reconceptualized as being made-up of different components that go through predictable phases of preparing, building up, confronting, and reflecting upon their reactions to stressors. The specific reconceptualization that is offered is individually-tailored to the client’s specific presenting problem (e.g. anxiety, anger, physical pain, etc.). As a result of a collaborative process a more hopeful and helpful model is formulated; a model that lends itself to specific intervention.

The second phase of SIT focuses on skills acquisition and rehearsal that follows naturally from the initial conceptualization phase. The coping skills that are taught and practiced primarily in the clinic or training setting and then gradually rehearsed in vivo are tailored to the specific stressors clients may have to deal with (e.g., chronic illness, traumatic stressors, job stress, surgery, sports competition, military combat, etc.). The specific coping skills may include emotional self-regulation, self-soothing and acceptance, relaxation training, self-instructional training, cognitive restructuring, problem-solving, interpersonal communication skills training, attention diversion procedures, using social support systems and fostering meaning-related activities.

The final phase of application and follow through provides opportunities for the clients to apply the variety of coping skills across increasing levels of stressors (inoculation concept as used in medical immunization or in social psychology to prepare individuals to resist the impact of persuasive messages). Such techniques as imagery and behavioral rehearsal, modeling, role playing, and graded in vivo exposure in the form of “personal experiments” are employed. In order to further consolidate these skills individuals may even be asked to help others with similar problems (Fremouw & Harinatz, 1975; Meichenbaum, 1994). Relapse prevention procedures (i.e., identifying high risk situations, warning signs, and ways to coping with lapses), attribution procedures (i.e., ensuring clients take credit for and appropriate ownership by putting into their own words the changes that have taken place), and follow-through (i.e., booster sessions) are built into SIT.

SIT also recognizes that the stress an individual experiences is often endemic, institutional and unavoidable. As a result, SIT has often helped clients to alter environmental settings and or worked with significant others in altering environmental stressors (e.g., hospital staff for medical patients, Kendall, 1983; coaches for athletes, Smith, 1980; drill instructors for recruits, Novaco et al., 1983; and so forth). SIT recognizes that stress is transitional in nature and that there is a need to not only work with clients to bolster and nurture flexible coping repertoires, but it is also necessary, on some occasions, to go beyond individual and group interventions and to adopt a community based focus.

SIT has been conducted with individuals, couples, small and large groups. The length of intervention has varied from being as short as 20 minutes for preparing patients for surgery (Langer et al., 1975) to 40 one hour weekly and biweekly sessions administered to psychiatric patients or to individuals with chronic medical problems (Meichenbaum, 1994; Turk et al., 1983). In most instances, SIT consists of some 8 to 15 sessions, plus booster and follow-up sessions, conducted over a 3-to-12-month period.

A Video about Stress Inoculation Training.  source: youtube

Clinical References Describing the Approach

Meichenbaum, D. (1985). Stress inoculation training. New York: Pergamon Press.

Meichenbaum, D. (1994). A clinical handbook/practical therapist manual for assessing and treating adults with post traumatic stress disorder. Waterloo, Ontario: Institute Press.

Meichenbaum, D., & Deffenbacher, J. L. (1988). Stress inoculation training. Counseling Psychologist, 16, 69-90.

Meichenbaum, D., & Jaremko, M. (Eds.) (1983). Stress prevention and management: A cognitive-behavioral approach. New York: Plenum Press.

Turk, D. C., Meichenbaum, D., & Genest, M. (1983). Pain and behavioral medicine: A cognitive-behavioral perspective. New York: Guilford Press.

Meichenbaum, D. (1977). Cognitive behavioral modification: An integrative approach. New York: Plenum Press.

Resources for Training

There are no formal programs where professional can obtain specific training in SIT. Dr. Donald Meichenbaum often gives one, two and five day workshops on SIT and related cognitive-behavioral interventions. For information contact him at the

University of Waterloo
Department of Psychology
Waterloo, Ontario, Canada, N2L 3G I
e-mail: dmeich@watarts.uwaterloo.ca

Eye Movement Desensitization and Reprocessing (EMDR)

The information included in this post is taken directly from EMDR Institute, INC.  It is advised that you view the information directly from the source website.

WHAT IS EMDR?

EMDR psychotherapy is an information processing therapy and uses an eight phase approach to address the experiential contributors of a wide range of pathologies. It attends to the past experiences that have set the groundwork for pathology, the current situations that trigger dysfunctional emotions, beliefs and sensations, and the positive experience needed to enhance future adaptive behaviors and mental health.

During treatment various procedures and protocols are used to address the entire clinical picture. One of the procedural elements is “dual stimulation” using either bilateral eye movements, tones or taps. During the reprocessing phases the client attends momentarily to past memories, present triggers, or anticipated future experiences while simultaneously focusing on a set of external stimulus. During that time, clients generally experience the emergence of insight, changes in memories, or new associations. The clinician assists the client to focus on appropriate material before initiation of each subsequent set.

Eight Phases of Treatment

The first phase is a history taking session during which the therapist assesses the client’s readiness for EMDR and develops a treatment plan. Client and therapist identify possible targets for EMDR processing. These include recent distressing events, current situations that elicit emotional disturbance, related historical incidents, and the development of specific skills and behaviors that will be needed by the client in future situations.

During the second phase of treatment, the therapist ensures that the client has adequate methods of handling emotional distress and good coping skills, and that the client is in a relatively stable state. If further stabilization is required, or if additional skills are needed, therapy focuses on providing these. The client is then able to use stress reducing techniques whenever necessary, during or between sessions. However, one goal is not to need these techniques once therapy is complete.

In phase three through six, a target is identified and processed using EMDR procedures. These involve the client identifying the most vivid visual image related to the memory (if available), a negative belief about self, related emotions and body sensations. The client also identifies a preferred positive belief. The validity of the positive belief is rated, as is the intensity of the negative emotions.

After this, the client is instructed to focus on the image, negative thought, and body sensations while simultaneously moving his/her eyes back and forth following the therapist’s fingers as they move across his/her field of vision for 20-30 seconds or more, depending upon the need of the client. Although eye movements are the most commonly used external stimulus, therapists often use auditory tones, tapping, or other types of tactile stimulation. The kind of dual attention and the length of each set is customized to the need of the client. The client is instructed to just notice whatever happens. After this, the clinician instructs the client to let his/her mind go blank and to notice whatever thought, feeling, image, memory, or sensation comes to mind. Depending upon the client’s report the clinician will facilitate the next focus of attention. In most cases a client-directed association process is encouraged. This is repeated numerous times throughout the session. If the client becomes distressed or has difficulty with the process, the therapist follows established procedures to help the client resume processing. When the client reports no distress related to the targeted memory, the clinician asks him/her to think of the preferred positive belief that was identified at the beginning of the session, or a better one if it has emerged, and to focus on the incident, while simultaneously engaging in the eye movements. After several sets, clients generally report increased confidence in this positive belief. The therapist checks with the client regarding body sensations. If there are negative sensations, these are processed as above. If there are positive sensations, they are further enhanced.

In phase seven, closure, the therapist asks the client to keep a journal during the week to document any related material that may arise and reminds the client of the self-calming activities that were mastered in phase two.

The next session begins with phase eight, re-evaluation of the previous work, and of progress since the previous session. EMDR treatment ensures processing of all related historical events, current incidents that elicit distress, and future scenarios that will require different responses. The overall goal is produce the most comprehensive and profound treatment effects in the shortest period of time, while simultaneously maintaining a stable client within a balanced system.

After EMDR processing, clients generally report that the emotional distress related to the memory has been eliminated, or greatly decreased, and that they have gained important cognitive insights. Importantly, these emotional and cognitive changes usually result in spontaneous behavioral and personal change, which are further enhanced with standard EMDR procedures.

Theory

Shapiro developed an information processing theory1,2,3 to explain and predict the treatment effects seen with EMDR therapy. This theoretical model also describes the development of personality, psychological problems and mental disorders. The following is a simplified description of Shapiro’s theory.

All humans are understood to have a physiologically-based information processing system. This can be compared to other body systems, such as digestion in which the body extracts nutrients for health and survival. The information processing system processes the multiple elements of our experiences and stores memories in an accessible and useful form. Memories are linked in networks that contain related thoughts, images, emotions, and sensations. Learning occurs when new associations are forged with material already stored in memory.


When a traumatic or very negative event occurs, information processing may be incomplete, perhaps because strong negative feelings or dissociation interfere with information processing. This prevents the forging of connections with more adaptive information that is held in other memory networks. For example, a rape survivor may “know” that rapists are responsible for their crimes, but this information does not connect with her feeling that she is to blame for the attack. The memory is then dysfunctionally stored without appropriate associative connections and with many elements still unprocessed. When the individual thinks about the trauma, or when the memory is triggered by similar situations, the person may feel like she is reliving it, or may experience strong emotions and physical sensations. A prime example is the intrusive thoughts, emotional disturbance, and negative self-referencing beliefs of posttraumatic stress disorder (PTSD).

It is not only major traumatic events, or “large-T Traumas” that can cause psychological disturbance. Sometimes a relatively minor event from childhood, such as being teased by one’s peers or disparaged by one’s parent, may not be adequately processed. Such “small-t traumas” can result in personality problems and become the basis of current dysfunctional reactions.

Shapiro proposes that EMDR can assist to successfully alleviate clinical complaints by processing the components of the contributing distressing memories. These can be memories of either small-t or large-T traumas. Information processing is thought to occur when the targeted memory is linked with other more adaptive information. Learning then takes place, and the experience is stored with appropriate emotions, able to appropriately guide the person in the future. A variety of neurobiological contributors have been proposed.

If you are interested in EMDR and want to learn in a distance education format click here.

 

The following is a short and simplified explanation of EMDR found on youtube:

Cognitive Processing Therapy (CPT)

All information on CPT was taken from CPTWeb and should be attributed to that source. In some small cases some modifications have been made to enhance clarity.  It is strongly recommended that you go to the original source for the best information.

WHAT IS COGNITIVE PROCESSING THERAPY?

Cognitive processing therapy (CPT) is an adaptation of the evidence-based therapy known as cognitive behavioral therapy (CBT) used by clinicians to help consumers explore recovery from posttraumatic stress disorder (PTSD) and related conditions.  CPT  is a cognitive behavioural therapy treatment that has been approved by the International Society of Traumatic Stress Studies.  To see the Practice Guidelines for CPT provided by the ISTSS please click here and scroll down to the section entitled Cognitive Processing Therapy.

CPT involves a structured, sequenced approach to address the unique needs of each patient suffering from PTSD and/or depression. Specifically, CPT is a short-term treatment that may work in as few as 12 treatment sessions. Of course, treatment may be provided for longer periods depending on each individual’s needs. Sessions address the following issues:

  • Educating patients about PTSD and explaining the nature of their symptoms
  • Helping patients explore how traumatic events have affected their lives
  • Learning about connections between trauma-related thoughts, feelings, and behaviors
  • Remembering the traumatic event and experiencing the emotions associated with it
  • Increasing patients’ ability to challenge maladaptive thoughts about the trauma
  • Helping patients increase their understanding of unhelpful thinking patterns and learn new, healthier ways of thinking; and
  • Facilitating patients’ exploration of how each of 5 core themes have been affected by their traumatic experiences

There is strong scientific evidence that CPT helps patients overcome PTSD and depression that are associated with trauma exposure.

  • Multiple randomized, controlled clinical trials have found that CPT is better than no treatment or good comparison treatments in reducing symptoms related to trauma.
  • CPT is effective in both military/veteran and civilian populations.
  • Though this course focuses on use of CPT as an individual treatment, there is evidence that CPT can also be delivered effectively in a group format.
  • CPT was developed and tested with patients presenting with a wide range of comorbid disorders and complicated trauma histories.

CPT is appropriate for patients who have experienced a traumatic event and are suffering from PTSD and/or depression. CPT is probably not appropriate for patients who are currently a danger to themselves or others, or who are in imminent danger due to their involvement in an abusive relationship (or due to being stalked). Also, if a patient is so dissociative or has such severe panic attacks that they cannot discuss the trauma at all, then other therapy may need to precede the onset of CPT. CPT has als o been used with patients who have co-morbid substance abuse problems, but only after they have stabilized following detoxification, though not all patients with substance abuse problems may be able to tolerate CPT; these decisions should probably be made on a case-by-case basis.

Although CPT has a manual and is designed to be delivered in a structured sequence, it is not a “cookbook” of regimented procedures delivered in an impersonal manner. As this site makes clear, CPT is best delivered by creative, resourceful therapists w ho have developed close therapeutic alliances with their clients.

CPT can be used by psychologists, social workers, professional counselors, psychiatrists, clinical counselors, or other trained professionals.

If you are interested in training in CPT click here.

The INFORMATION ON CPT INCLUDED IN THE WEB SITE IS NOT MEANT FOR CLIENTS TO ADMINISTER WITHOUT THE GUIDANCE OF A PROPERLY TRAINED PROFESSIONAL.

The following is a short video from youtube that explains Cognitive Processing Therapy: 

How to Create a Trigger Record

The folllowing content was found at afterdeployment.org.

Trigger Records can help you recognize what situations are triggering you.  Recognizing what is triggering you:

Helps you regain a sense of control.

Helps you realize when you truly are not in danger.

Helps you prepare when you know you’re going to face a trigger.

For example, let’s say you are at a friend’s barbecue when a small child starts to cry. Your heart starts racing and you begin feeling afraid and irritable. You make up some excuse and go home.  Back home, you feel safer and less afraid, but isolated, alone, and sad that you left the party.  Using the Trigger Record guides you to understand that the smell of barbecue and the crying child were triggers—they reminded you of a traumatic experience you had in the war zone. You are now aware of the link between your war zone experiences and your discomfort at the party.  With awareness about your triggers comes a sense of control. The next time you encounter these triggers, you will realize more quickly that the current situation is not the war zone. It will also help you prepare yourself for the next time you go to a barbecue or a social outing such as a restaurant where you hear a child crying. Following is a Trigger Record and explanations of how to complete it. Feel free to complete the columns in any order. It’s okay if you are unable to pinpoint exactly what is triggering you. Just do the best you can. And remember: ―That was then, this is now,‖ (this takes away some of the trigger’s power over you).

Trigger Record 

Image 

COLUMN A:  What was Your Trigger? 

Indicate the date and describe the situation where you got triggered. Include as much detail as you can so it is easier to pick out what may have triggered you. Once you’ve written down everything you can remember, underline thing(s) that you think triggered you. If you know what triggered you, it’s fine just to list the trigger itself.

Example: ―February 16.  “I was walking to the bus stop and I had to wait at a crosswalk until the light changed. I smelled diesel fuel from a truck going by.”

 

COLUMN B: What were You Feeling? 

List all of the feelings you had when you were triggered, including any positive feelings. Examples of feelings are listed below.

Example: ―”scared, exposed, freaked out, on edge.”

Image

 

COLUMN C: How did your Body React? 

List all sensations in your body, including those that other people would be able to see (like sweating), as well as ones that only you would know about (like heart racing). Get as descriptive as you can.

Example: ―heart racing, felt hot, shoulders tensed up

 

COLUMN D: What Did You Do? 

Describe everything about your actual actions. Get specific! Describe as if you were a movie camera watching your own behavior. Did you move your body in any way (away from/towards the trigger)? Did you say anything out loud? Did you hit the dirt? Did you leave the situation?

Example: “I looked around frantically. I began watching all of the people that were passing me on the street very carefully – I was looking for weapons or signs that they were dangerous. I walked faster.”

COLUMN E: How Was the Trigger Situation Different From Original Trauma? 

List all of the ways in which the current situation differs from the original traumatic event.  Think about where you are, who you’re with, etc. to highlight the differences.  By doing this, you will recognize that the two situations are different.  And, you will begin disconnecting the triggers from your learned reactions.  When this happens, you will begin to relearn that you are safe.

 

COLUMN F: How Difficult Was the Trigger to Handle? 

Rate how hard it was for you to handle this trigger on a scale of 1 to 10, where 1 is not  difficult at all and 10 is extremely difficult.  After you use the Trigger Record and skills provided on this site for a while, your ratings should go down.

Example: ―”7″


Trauma Triggers and Memories—Overview

The folllowing content was found at afterdeployment.org.

Trauma Triggers are reminders of traumatic events.  Everyone has their own unique things that trigger them.  Triggers can be people, places, or situations. Thoughts,  emotions and sensations can also trigger trauma memories.  Triggers can be something specific tied to the memory of the traumatic event (like bridges, the smell of fuel or feeling afraid) or  something general (like being in a crowd).

You can be triggered when you expect it, or a trigger can come out of the blue.

Getting triggered can set off upsetting emotions such as: Fear, Anger,  Sadness, Guilt, and Shame. 

Getting triggered can set off physical sensations such as: Racing heart,  Shortness of breath, Sweating. 

The Importance of Understanding Triggers 

The circumstances surrounding the traumatic event, including sights, sounds, smells, and thoughts, may have become connected in your day- to-day thinking with the trauma itself. During your deployment, these connections helped you survive. The sights, sounds, and smells helped you to recognize signs of danger and react more quickly. But many of the things that signaled danger in the past, which “trigger” you now, are harmless in the present.

Your body can become stressed and you can have strong emotions just by thinking that you are under attack.  Now that you are in the present, and safe, the steps below aim to “disconnect” old reminders from your brain’s  danger circuits. This can help ease the way the reminders affect your mood, relationships, health, work, concentration, or general functioning.  You can ease the impact that reminders have by retraining yourself to recognize when in fact you are safe, even if your habit has been to tell yourself that you are in danger.

Identifying Your Trauma Triggers 

Trauma triggers are highly individual. So, you will have to put some time and energy into determining what triggers you. Using a Trigger Record can help in identifying your triggers.

Coping Once You’ve Been Triggered 

The Trigger Record and the RID Tool can help reduce the negative effects that trauma triggers have on you.

Preparing for Triggers That You Expect to Face 

Sometimes you know beforehand that you are going to be in a situation that may have triggers that remind you of your traumatic experience(s). The PLAN Tool is a strategy to manage situations that you anticipate will be difficult.

Step 1: Prepare for the situation

Step 2: Let go of your worry

Step 3: Accept that you will experience distress and it is possible to manage your reaction

Step 4: Note all of your coping skills and helpful resources

 

Tools for Reducing the Distress that Trauma Triggers Cause for You 

If you feel ready to deal directly with a trigger, try to remain in the presence of the trigger until you feel less distressed by it. Here is the idea: don’t leave the situation until you feel that the trigger is not as powerful as it was when you first confronted it. This will retrain your brain.  Your brain will learn to tolerate the trigger. Your brain will learn that you are not in actual danger, and your response to the trigger will gradually weaken.

In order to do put these tools and recommendations into practice safely and effectively:

1. Actively talk yourself through the situation.

2. Use relaxation or breathing skills while you are dealing with the trigger.

 


The PLAN Tool—Prepare to Face Triggers

The folllowing content was found at afterdeployment.org.

There are situations that you know about that will affect you emotionally or physically because they remind you of your traumatic experience. PLAN can be a helpful strategy in these circumstances.

Step 1: Prepare for the situation.

Step 2: Let go of your worry.

Step 3: Accept that you will experience distress and it is possible to manage your reactions.

Step 4: Note all of your coping skills and help resources.

 

Step 1: Prepare for the situation. 

Your sense of control may have been weakened by experiencing a trauma. A great way to begin regaining your sense of control is by preparing for the trigger or stressful situation. Think about the upcoming situation and how to handle it. Talk about it with someone whose judgment you respect.

How can you relax yourself before the situation?

Would it help to take a friend along who knows what you might experience?

Can you discuss it with a family member and decide on a plan if things don’t go well?

Can you change the situation in some way that will make it easier to deal with?

What is it about the situation that causes you distress?

Is this a situation you would be better off avoiding (e.g., you know the situation will provoke extreme anger)?

Step 2: Let go of your worry. 

In some ways, it’s helpful to know ahead of time when you are going to confront a trigger. Unfortunately, it can also lead to a lot of worry about how you will manage the trigger and the painful reactions you might have. Getting stuck in a struggle with the “what ifs” or drowning in dread is often much worse than going through the actual thing you are worried about. Here aresome things you can do to help you let go of your worry:

Focus on the specific things you have to do and what you’ve prepared already.Think about what exactly you are scared of. Ask yourself if the upcoming situationwarrants your fears.Mentally rehearse that you are successfully managing the situation.Focus on the positives that the situation offers instead of the negatives.

If you catch yourself worrying, focus on different thoughts, or direct your attention to an activity.

Step 3: Accept that you will experience distress, AND it is possible to manage your reactions.   

 Life is stressful sometimes no matter what. After a trauma, the stresses of life can seem even more difficult to manage. Accepting that you will experience upsetting emotions and stress if you are triggered can actually make the stress feel less overwhelming.  Accepting distress means having realistic expectations about your reactions. It does not mean that you like the situation or feel good about being upset.  Accepting distress means, that even though you may have upsetting emotions, you will not allow those emotions to control or limit your life.  Accepting distress means that your feelings don’t have to dictate your behavior.  You can choose how you respond, even when you feel bad.

 

Step 4: Note all of your available coping skills and helpful resources.   

 Think about all of the skills you have for managing stressful situations (including the ones you are learning here). Say to yourself: “During the stressful situation, I can…”

Have a friend or a loved one with me.

Refocus my attention on enjoying myself.

Use relaxation exercises.

Tell myself things that relax and settle me (e.g., “I’m safe.” “That was then, this is now.”).

Use strategies that have worked in the past when I’ve been triggered.


The RID Tool – Dealing with Triggers

The folllowing content was found at afterdeployment.org

The RID Tool 

The RID Tool is a 3-step skill you can use when triggered to help  “RID” yourself of problems coping with triggers:

Step 1: Relax

Step 2: Identify the trigger

Step 3: Decide your response

 

Step 1: Relax 

When you’ve been triggered, do something to help you relax right away.

Here are some helpful options:

Tell yourself something calming like “I’m safe” and “I’m going to be okay.” Or you can tell yourself to “stay calm” or “relax.”

Remind yourself that the trauma occurred in the past and isn’t happening now. Tell yourself, “That was then, this is now.”

Take a few deep breaths or use other relaxation exercises.

Get centered (for example, get a drink of water, go to the bathroom, splash some water on your face, etc.).

Remind yourself that getting triggered is a common experience for many people who have experienced trauma. It doesn’t mean there’s anything wrong with you.

Step 2: Identify the trigger 

Figuring out exactly what caused your reaction, and figuring out how now is different from then, can help you think clearly about why the trigger affected you. And, it will help you avoid being triggered in the future.  After relaxing and calming yourself, think back over the last few minutes and figure out what got you unsettled.  If you can, look at your Personalized Trigger List and see if  you’ve accidentally walked into one of your triggers. If you don’t have the list available, you can think about the common triggers that affect you.  Once you have identified the trigger, take a moment to :

 

recognize how it differs from what it reminds you about.

Ask yourself, “How is this situation different from my trauma?

It is important for you to see how the current trigger is different from the trauma because it will help you to realize that you are not in danger right now—your mind and body are reacting to the original trauma, not to the present situation. Doing this will help you more quickly regain your sense of control and safety.  Sometimes it’s not possible to pinpoint what exactly has triggered you. If this happens, don’t worry; just continue working to relax and calm yourself.

Step 3: Decide your response 

In order to strengthen your sense of control over the situation and your reactions, it’s helpful for you to actively decide what to do next.  The idea is to consciously choose how you want to respond to the trigger, instead of just going on “auto pilot” and letting triggers control you.

 

Option 1: Cope with the trigger. 

If you are experiencing fear, you can retrain your brain by staying in the presence of the trigger until you are gradually less upset.

 

Bring your attention back to what you were doing before you were triggered.

Focus your attention on what you are doing, and the sights and sounds around you.

Seek support from someone you trust.

Find a positive distraction. For example, going for a walk, exercising, doing something healthy and fun.

Actively talk yourself through the situation. Repeat to yourself that:

I’m okay and safe in this situation. 

My trauma happened in the past—this situation is different. 

My thoughts and emotions are normal and cannot harm me. 

These feelings won’t last forever. 

I can tolerate these feelings, and they will gradually become less powerful.

 

Option 2: Take a time out. 

If you are very angry, it may be best for you to walk away from the situation and continue working on the Relax skill for the moment.  That way, you won’t do anything that you will later regret. When you’re feeling calmer, think through the situation and how it was different from your trauma so that next time you can stay in the presence of the trigger.