TRT Teaching Recovery Techniques

Teaching Recovery Techniques
Dr. Mohammad Hussein

1. TRT Dr. Muhammad Hussein Psychiatrist www. NfsyTflk.net Teaching Recovery Techniques ? ?

2. Teaching Recovery Techniques (TRT)

3. early help for children in how to cope with the stresses of disaster can be beneficial and may prevent later problems from developing.

4. After disaster? ?

5. After disaster? nervous, jumpy, and fearful, scared of loud noises , and sometimes too frightened to go outside Withdrawn, depressed , crying easily getting upset over minor things didn’t want to play and lost interest in the things they used to do worried and anxious

6. After disaster? irritable and were quick to anger, or had temper tantrums restless and had problems concentrating at school problems sleeping, waking up in the night crying and said that they had nightmares about what they had experienced Some children and adolescents coped very well

7. -nervous , jumpy , and fearful, scared of loud noises , and sometimes too frightened to go outside - Withdrawn, depressed, crying easily getting upset over minor things didn’t want to play and lost interest in the things they used to do - worried and anxious - irritable and were quick to anger, or had temper tantrums restless and had problems concentrating at school - problems sleeping, waking up in the night crying and said that they had nightmares about what they had experienced

8. Program (Teaching Recovery Techniques program) Age: 8 years and older Number: less than 15 children

9. Program (Teaching Recovery Techniques program) Age: 8 years and older Number: less than 15 children 1 2 3 4 5

10. Program (Teaching Recovery Techniques program) Age: 8 years and older Number: less than 15 children 1 2 3 4 5 Intrusion Arousal Avoidance

11. SESSION I 1 2 3 4 5

12. Principles the most distressing phenomena are intrusive memories, thoughts, and feelings. These come undesired at any time of the day , out of the blue; or in response to triggers or reminders in the environment. Because these memories are so vivid and frightening , many children fear they are going crazy , or that they are out of control . The main aims of the first sessions to show children that such reactions are normal and that they are not going crazy; & to give them the skills to regain control over their memories . Children will not be able to forget things they witnessed or experienced, but they can learn to remember without becoming overwhelmed with emotion ; and they can learn to be in charge of their memories rather than being at the mercy of them . SESSION I INTRUSION 1

13. Session Goals - children get to know each other - aims and structures of the groups described - education and normalisation of common reactions - learn techniques for mastery of intrusive thoughts and images - practice these techniques for homework . 1 SESSION I INTRUSION

14. Materials 1 SESSION I INTRUSION

15. Getting to know each other Ball pair up 1 SESSION I INTRUSION Group Activities

16. Introducing the group tell the children the reasons for the group and that this is the first of 5 meetings be direct about you will be discussing the disaster and how it affects children, and to say that this might be difficult and upsetting at times, but also to engender a sense of hope and optimism in coping with difficult feelings. 1 SESSION I INTRUSION Group Activities

17. Introducing the group 1 SESSION I INTRUSION Group Activities set some ground rules at the beginning, Confidentiality Respect for each other No-one has to talk, but everyone should listen to each other Talk only about yourself, not others Come to all meetings

18. Reactions to the stresses of disaster: normalising and educating Aims: Educate children about known reactions to disaster stress so that their own problems become definableand manageable ; to normalise their reactions so that they don’t feel so alone and crazy For children to begin to share some of their disaster stories so that they come together as a group 1 SESSION I INTRUSION Group Activities

19. Reactions to the stresses of disaster: normalising and educating 1 SESSION I INTRUSION Group Activities example of another child Ask for comments & questions identify with the child

20. Reactions to the stresses of disaster: normalising and educating 1 SESSION I INTRUSION Group Activities a- list Traumatic events

21. Reactions to the stresses of disaster: normalising and educating 1 SESSION I INTRUSION Group Activities b- Normalising traumatic stress reactions

22. Reactions to the stresses of disaster: normalising and educating 1 SESSION I INTRUSION Group Activities c- reminders

23. Reactions to the stresses of disaster: normalising and educating 1 SESSION I INTRUSION Group Activities d- Treatment and prevention

24. Activity : Establishing a Safe Place practise creating a “safe place” in imagination 1 SESSION I INTRUSION Group Activities

25. Safe Place Before work with intrusive memories, practice creating a “safe place” in imagination . It also serves as a secure base in imagination to which children can return if they need to reduce the emotions being felt as they are carrying out later techniques It is a non-threatening and fun way to begin working with visual imagery. If following on directly from the education section above, have the children stand up and move around , or jump up and down, or shake themselves so that they are refreshed to begin. Come back in a wide circle , sitting on the floor, making sure that everyone is comfortable.

26. Safe Place Imagine superhero

27. Safe Place ask the group what they imagined . Ask how it made them feel. Point out the connection between imagination and feelings. Point out that they can have control over what they see in their mind’s eye, and therefore over how they feel. Reinforce that this is a fun thing to do, and that they can imagine being there whenever they feel miserable or scared, Safe place will get easier to imagine the more they practise it.

28. نهاية الجلسة الأولى know each other Introducing the group normalising and educating Safe Place

29. Program (Teaching Recovery Techniques program) 1 2 3 4 5 Intrusion Arousal Avoidance

30. SESSION 2 INTRUSION 1 2 3 4 5

31. Goal: to develop the child’s ability to deliberately bring up their intrusive image, to change the image in various ways, and to be able to switch it off . SESSION 2 INTRUSION 2 5. Imagery techniques

32. following characteristics of visual images can be changed : □ brightness □ contrast □ focus □ movement □ distance □ detail □ colour □ speed □ location □ form □ duration □ dimension □ clarity □ posture □ depth recommend that they spend 10 minutes a day to play around with the memories, calling them to their mind, introducing changes, moving them around and in many ways taking control over them. SESSION 2 INTRUSION 2 5. Imagery techniques

33. Screen technique SESSION 2 INTRUSION 2 5. Imagery techniques

34. b Hand and distance techniques SESSION 2 INTRUSION 2 5. Imagery techniques

35. b Positive counter images SESSION 2 INTRUSION 2 5. Imagery techniques

36. نهاية الجلسة الثانية Screen technique Hand and distance techniques Positive counter images

37. Program (Teaching Recovery Techniques program) 1 2 3 4 5 Intrusion Arousal Avoidance

38. SESSION 3 Arousal 1 2 3 4 5

39. Agenda - review last session’s homework - education: over arousal - skills teaching: anxiety management and relaxation training - skills teaching: sleep management - review session and homework SESSION 3 Arousal 3

40. Introducing the topic children should understand the connection between feeling scared and bodily sensations; and be able to describe their bodily sensations. Elicit examples from the group. I almost jumped out of my seat at school the other day when the door slammed! Lead this into a brainstorming session for symptoms of increased arousal. SESSION 3 Arousal 3

41. Thinking about your body, what happens when you get really scared like this? What things do you notice happening to your body? بالنسبة لأجسامنا: بتحس بأيه لما تكون خايف أو مرعوب ايه التغيرات اللي ممكن تحصل لجسمك وقتها؟ SESSION 3 Arousal 3 increased heart rate ! heart racing ! breathing quickly ! shallow breathing ! pain in the chest ! feel dizzy, sick ! out of breath ! feel shaky, trembly , palpitations ! legs or knees wobbly ! hands shake ! hands or feet tingle ! sweating ! body feels out of control, haywire

42. SESSION 3 Arousal 3 ?

43. SESSION 3 Arousal 3

44. SESSION 3 Arousal 3 Muscle relaxation

45. SESSION 3 Arousal 3 Breath control

46. SESSION 3 Arousal 3 Breath control Guided imagery Muscle relaxation

47. SESSION 3 Arousal 3 Sleep Ask what the children did about their sleep problems if they managed to beat them. Ask the rest of the group to make suggestions to help them.

48. Sleep SESSION 3 Arousal 3 1.A regular routine before bed is helpful. Tell children that their parents know all about nighttime routines, and will help them in this. 2 . away from caffeine and nicotine in general, but before bed in particular. 3. Check on sleeping arrangements. 4 . Prayers before bed are very helpful for many children, and can help them to feel safer. 5 . practice muscle relaxation before bed, every day. 6. Once in bed, children may like to hear stories read to them, or like to read to themselves . 7. When laying in bed, breathing exercises such as those above, combined with using relaxing imagery ,

49. نهاية الجلسة الثالثة Muscle relaxation Breath control Sleep assistance

50. Program (Teaching Recovery Techniques program) 1 2 3 4 5 Intrusion Arousal Avoidance

51. SESSION 4 Avoidance 1 2 4 3 5

52. SESSION 4 Avoidance 4

53. SESSION 4 Avoidance 4 Session Goals review last session’s homework skills teaching: imaginal exposure skills teaching: in vivo graded exposure review all sessions: homework and preparing for the future

54. SESSION 4 Avoidance 4 Materials - flip chart and markers - individual drawing and writing paper and pencils for each child

55. SESSION 4 Avoidance 4 the hardest for children because it involves confrontation of traumatic memories. Introducing avoidance and exposure

56. SESSION 4 Avoidance 4 The first step in facing up to traumatic reminders is to be aware of what the reminders are. Using a flip chart r ecord what the group says, ask them what their traumatic reminders are . Brainstorming traumatic reminders Places and things people situations sounds sensations

57. SESSION 4 Avoidance 4 Every child record his own list Individual list of reminders

58. SESSION 4 Avoidance 4 The idea of graded exposure

59. SESSION 4 Avoidance 4 Constructing a personalised fear hierarchy 1 . Choose one reminder from the list they made previously; 2 . Make a ladder in relation to this reminder; 3 . Use some techniques from the toolbox to h elp them to go up the ladder.

60. SESSION 4 Avoidance 4 Planning for real-life exposure Positive talk: I can do it It can’t really hurt me I know I can cope I’m going to beat my fear My fear will go away soon

61. نهاية الجلسة الرابعة Introducing avoidance and exposure Brainstorming traumatic reminders as a group Individual list of reminders Constructing a personalised fear hierarchy Planning for real-life exposure

62. Program (Teaching Recovery Techniques program) 1 2 3 4 5 Intrusion Arousal Avoidance

63. SESSION 5 Avoidance 5 Exposure to traumatic memories: drawing, writing, and talking deliberately expose themselves to their traumatic memories

64. نهاية الجلسة الخامسة Drawing Writing talking

65. TRT 1 2 3 4 5 Intrusion Arousal Avoidance Drawing Writing talking Introducing avoidance and exposure Brainstorming traumatic reminders as a group Individual list of reminders Constructing a personalised fear hierarchy Planning for real-life exposure Muscle relaxation Breath control Sleep assistance Screen technique Hand and distance techniques Positive counter images know each other Introducing the group normalising and educating Safe Place

66. محمد حسين شكرا لكمـ