This blog is my place to vent and share resources with other parents of children of trauma. I try to be open and honest about my feelings in order to help others know they are not alone. Therapeutic parenting of adopted teenagers with RAD and other severe mental illnesses and issues (plus "neurotypical" teens) , is not easy, and there are time when I say what I feel... at the moment. We're all human!

Friday, February 14, 2014

Books and Methods Review - Methods - Calming Techniques

Realized I've been talking about calming and relaxation techniques for years, but never gave any details.

An important thing to remember is that when a child is in full meltdown - fight/ flight/ freeze mode the thinking part of their brain is shut down.  Most likely they won't even remember what happened.  Talking, appealing to their better nature (guilt), providing logical arguments, threatening punishment/ consequences... will NOT work.  Usually when my child gets to this point it ends up becoming physical and might end up restraining/ holding her until she calms down.  Then I usually hold and comfort her longer, assuring her she is safe and still loved.  This is a good time for real conversation about her emotions and feelings (as is the time right before sleep and after a good workout).

Only after she's calm does her brain start working again.  I usually wait until a later time, when she's in a good state, to talk to her about any consequences or other things I know might trigger her.
I'll be honest, we rarely gave her consequences, especially for what she did in a meltdown, because they triggered her right back into dysregulation. When she was dysregulated (about 90% of the time), emotionally she was like a toddler, and you don't punish a toddler for throwing a fit, you just calm them down, childproof a little better in the future (to avoid having to give a lot of "No"s), and move on. For me, not giving consequences is SUPER HARD! because I want to give her consequences and punishments! It helped me to go back and read Beyond Consequences to access my empathy and understanding.

Emotional Age
It also helped to discover her developmental emotional age and start treating her as though she were that age (as respectfully as possible - we didn't tell her that was what we were doing). To truly change my expectations, I had to develop a mantra, "She's only 6. She's only 6. She's only 6." When I focused on that, I realized a LOT of the meltdowns were because she was overwhelmed.

Reduce Stressors 
We reduced expectations (like chores). She still had them, but they were simpler. Tasks were broken in to smaller pieces (only 1 task at a time instead of a series of instructions). Her room was stripped to a bed, one cuddle toy and maybe a book. In school we fought hard to get things less chaotic as well (safety/ crisis plan, no homework, smaller class sizes, avoiding the cafeteria and hallways during passing periods...).

One thing that helps us avoid a meltdown is to try to make her environment as low stress as possible – including school. It's not always possible, but I try to avoid her triggers and be especially understanding when she's feeling unsafe (which is a perceived unsafe feeling not necessarily based in reality), hungry, tired, sick and during traumaversaries (anniversaries of traumatic events like gotcha days, day they went into foster care, holidays, birthdays...) Kitty meltdown triggers.

At one point Kitty yelled at me for not calming her down.  I remember thinking, "How ridiculous!  She's 18.  She's stable.  It shouldn't be my job to calm her down... oh wait.  It is.  I took a deep breath, stuffed down my anger and frustration, hitched up my big girl panties, and calmed her down.  Changed the subject, distracted her, and moved on.  Nothing was resolved, but it wasn't going to be anyway.
We processed her meltdown a couple of days later in therapy, where she admitted that she's deathly afraid of emotions leading her back to being unstable.  This is why she's been isolating more and more.  She's trying to turn off her emotions.  This is a terrifying life or death feeling for her.  She blames me for trying to drag her back to the family and not allowing her to shut herself off.  I'm the evil witch who is trying to force her to be unstable.  No, it's not rational.

Many children of trauma are not able to regulate their emotions.  They need parents to help them.  The biggest calming technique I have is to stay calm myself (if I can't then I switch out with Hubby!).  I try to speak to her in a calm voice and breathe loudly (slowly and deeply) to see if I can help her regulate (wish I had a Darth Vader mask!). 

Avoiding escalation is the most important tool.  If I can see her escalating toward a meltdown, and I'm lucky, I can keep her calm enough to avoid a total meltdown.  If I work it out just right I can actually get her to do, fix, calm down about some, if not all, of whatever it is she's upset about.

Generally I don't think Kitty has control of meltdowns (and I frequently have to remind myself of this), but I also think she has occasionally escalated because in her past if she pitched a big enough fit she got what she wanted. Each meltdown she had seemed a little more extreme then the last one, because we were not giving her her way.  Made it very hard, but we had to be consistent in how we helped her regulate.

49 Phrases to Calm an Anxious Child -
1. “Can you draw it?”
Drawing, painting or doodling about an anxiety provides kids with an outlet for their feelings when they can’t use their words.
2.  “I love you. You are safe.”
Being told that you will be kept safe by the person you love the most is a powerful affirmation. Remember, anxiety makes your children feel as if their minds and bodys are in danger. Repeating they are safe can soothe the nervous system.
3. “Let’s pretend we’re blowing up a giant balloon. We’ll take a deep breath and blow it up to the count of 5.”
If you tell a child to take a deep breath in the middle of a panic attack, chances are you’ll hear, “I CAN’T!” Instead, make it a game. Pretend to blow up a balloon, making funny noises in the process. Taking three deep breaths and blowing them out will actually reverse the stress response in the body and may even get you a few giggles in the process.

Time Ins
Sometimes talking to her (especially with eye contact) just escalates her.  So I try staying near her, but not interacting. Sometimes this makes her feel rejected. Sometimes when she storms out, and I don’t go after her, I'm sure she sees it as me not loving her.

Being around me (or my husband) often triggers her, but rather than leave the room (which sometimes wasn't safe), I used a technique similar to Super Nanny's sleep technique  I'd sit nearby (usually on the other side of the room, sometimes up against the door if she was sitting on the other side holding it shut. I usually grabbed a book to read as a "reason" for not engaging.

I'd breath slowly (and as loudly as I could) so she would unconsciously mimic my calm breathing.

When she tried to engage me (so she could use my response as an excuse to escalate), I would calmly disengage. I wouldn't make eye contact at all, wouldn't even look at her (except maybe out of the corner of my eye to make sure she was being safe). If she said something to me, rather than "ignoring" her, so I'd make short statements like, "I'm sorry you feel that way." or "I'll leave when I'm sure you're safe." Then I'd quickly go back to reading my book.

4 Foot Rule
If she makes threats to herself or others we go to the "4 Foot Rule." She knows this is what we do, so I think she does it deliberately sometimes so she feels safer.  The "4 Foot Rule" means an adult must be within (approximately) 4 feet of the child at all times (usually just means line of sight).  If I know she can't hurt herself (like if she's holding the door shut so can't hurt herself without moving away from the door), I might sit outside the door.

Empathy Not Logic
Example of my probably too logical way to deal with a PRE-meltdown:

"There is No way I am EVER going to do my schoolwork."
I calmly sympathized that it is hard and I understand that she doesn't like it, but it has to be done.

"You're an idiot if you think I'm going to do any schoolwork again and you can't make me." 
I admit I got a little frustrated at this point and spoke firmly about calling me names. I warned her that if she didn't do her school work, she would go to work with me - where she would have to do schoolwork. She calmed down a little so I was able to switch back to "nurturing mode." I told her that she can't drop out of school. That she didn't want to be 14 and held back to 5th or 6th grade....

"I'm going to go emo."
I hear this a lot and she knows how I feel about it. I told her that I would have to assume that someone/ something was negatively influencing her and would start taking away TV shows, makeup, music...

"You hate me. You don't care about me. I'm going to crawl in a box and not eat. You want me to be in a box and die."
I told her I love her even if she doesn't believe that right now. That she can only know how she feels, not how I feel. That if I didn't love her I wouldn't care if she was in a box.

Get Moving/ Eat
I let her go outside to walk/stalk for 10 minutes, but told her she then needed to come back in and do 3 pages of math and 3 of word building. She had a snack. Went outside. Came back in, and verified that she only had to do 6 pages and she was done for the day. I said no. When she was done with the six pages we would talk. She left and did the 6 pages.

Success! No meltdown. No regression to fight, flight, or freeze mode. AND some actual schoolwork done!
[Now I no longer address homework at all. I've decided that attachment is waaaayyyy more important than an education. There's time for education later. Think about it. Would you rather have a well-educated sociopath?}

Ways to AVOID meltdowns:
  • Reduce Responsibilities and Expectations {Effective, but with drawbacks. This works well in the short term, but obviously can't continue forever.  It's very important to remember that kids with trauma are usually developmentally socially/ emotionally much younger than their chronological age}
  • Safe Environment - structured with consistently, enforced rules helps, but remember it's perceived safety - which is different for kids of trauma {Effective. Is what we provide at home, but we're unable to treat all kids exactly the same as they are of extremely differing abilities and levels.  Unlike residential treatment who have 24/7 staff with shifts.}
  • Consistent, caring caregivers - providing loving structure {Effective. Responds well}
  • Frequent, gentle reminders to stay focused and on task.  Can be just using the child's name at the beginning of a sentence {Effective.}
  • Teachers/ staff monitor her stress level and cue her to take a break. {Effective at home. We had trouble with getting the school to help with this. One proposed option was the Anxiety Scale.}
  • Staff trained in helping Kitty with stress management/ relaxation techniques. {Effective at home and Summer Camp}
  • Predictability of routine {Fairly Effective}
  • Work with her on Social Skills training {Fairly Effective}
  • Self-Confidence Building activities and training {Fairly Effective}
  • Provide goals for managing stress and anxiety on her own. {Currently ineffective as she is unable to access these skills independently when she is actively stressed and anxious - although responds well to cuing by someone when she is starting to escalate.}

Calming Techniques:

Deep breathing - slow, deep, even breaths from the diaphragm, rather than short, shallow breaths from the chest. Can try counting - especially if trying to go to sleep
- Get comfortable and relax muscles.
- Inhale deeply and hold it.
- Exhale and repeat.
- Try adding stretching.

EFT EmotionalFreedom Techniques  aka Tapping.  This can be a full tapping routine, or just something simple like a side hand chop.

Mantra (can be used with tapping) - Choose a positive, calming word or phrase. Repeat it over and over to yourself silently to prevent distracting thoughts from entering and calm yourself.

Brain Gym – exercises that cross the mid-brain.  EMDR works in similar ways.  I do a variation of these with Kitty.  Sometimes it's just rubbing her back from side to side (crossing the mid-brain).  Sometimes I can talk her into tapping herself (like patting her left knee or upper arm and then her right, over and over), but she finds it embarrassing and most of the time we've missed the window where she can access calming techniques for herself.

Exercise - Going for a walk or run, yoga, jumping on a trampoline to clear the mind and reduce stress.

Distraction/ Redirection - Find a different activity or something to focus on that distracts from event that is causing stress.  Lots of ideas in this post about the Attachment Challenge.
- Read a book or magazine.
- Listen to relaxing music or watch a video.
- Do a crossword puzzle, or play an electronic game.
- Make cookies.
- Play with playdoh
- Try lying down and taking a nap.
- Go somewhere in your imagination.
- Cocooning (create a cozy, womb-like area with books and soft toys).
TRE Tension & Trauma ReleasingExercises  this intrigues me, but I haven't tried it.

Biofeedback – training in how to calm the body and brain.  

Mindfulness - staying focused and in the present moment.
- Take a break and make yourself acutely aware of your surroundings.
- Take deep breaths and feel your lungs swell.
- Allow yourself to think about your feelings, but do so without judgment.

Flooding - a type of exposure treatment, often used for treating phobias - which is basically what the Attachment Challenge does.  Hugs cause Kitty's nervous system to instinctively flood.  Flooding involves immersing the person in the fear reflex until the fear itself fades away.

The therapist recommended something more like Counter-conditioning*.  Instead of hugs and pressured attachment activities with extended eye contact (which is also very hard for Kitty).  We'd change it to her sitting next to me on the couch while we watch TV and I put my hands on her shoulders (eventually working up to pressure on her upper arms and neck), plus warmth and light pressure on her lower back (fingers in line with her lower rib cage) which effects her kidneys.  Kitty isn't happy about it, but she agrees it's better than the way we were doing it.

*Counter-conditioning - (Watson, 1924). In this form, one is trained to substitute a relaxation response for the fear response in the presence of the phobic stimulus. Relaxation is incompatible with feeling fearful or having anxiety, so it is said that the relaxation response counters the fear response. This counter-conditioning is most often used in a systematic way to very gradually introduce the feared stimulus in a step-by-step fashion known as systematic desensitization, first used by Joseph Wolpe (1958). This desensitization involves three steps: (1) training the patient to physically relax, (2) establishing an anxiety hierarchy of the stimuli involved, and (3) counter-conditioning relaxation as a response to each feared stimulus beginning first with the least anxiety-provoking stimulus and moving then to the next least anxiety-provoking stimulus until all of the items listed in the anxiety hierarchy have been dealt with successfully.

Some really good tips for helping children deal with anxiety.

Making Empathy Books

Angry Octopus: An Anger Management Story introducing active progressive muscular relaxation and deep breathing by Lori Lite
Angry Octopus is a story that teaches children how to use progressive muscle relaxation and breathing techniques to calm down, lower stress, and control anger. Children relate to the angry octopus in this story as the sea child shows the octopus how to take a deep breath, calm down, and manage his anger. 
Children learn to unwind, relax, and control anger with this fun exercise known as progressive muscle relaxation. Children relate to the angry octopus in this story as the sea child shows him how to take a deep breath, calm down, and manage his anger. These effective stress and anger management techniques for children focus awareness on various muscle groups to create a complete resting of the mind and body. Progressive muscle relaxation can be used to lower stress, decrease pain, and manage anger. 
This engaging story quiets the mind and relaxes the body so your child can let go of anger, relax, and fall asleep peacefully. This story is longer making it ideal for older children or those with a longer attention span. 
Note to Parent: Angry Octopus is a kid favorite. Parents report that their children use the techniques in the story to calm themselves and also remind their parents to use the same technique. This story received national attention on ABC’s Shark Tank. Every child has a different emotional maturity, attention span, and need. While the stories are best suited for ages 6-12, do not let this be your primary reason for selecting. You know your child best and remember this is not about the reading level. The focus is on the actual techniques.

Other posts:
Handling Child Stress