Hello, and welcome. I'm Amy Cohen, Associate Director for SMI Advisor and a clinical psychologist. I am pleased that you're joining us for today's SMI Advisor webinar, Safety, Support, and Growth, Effective Trauma-Informed Peer Support, and Post-Traumatic Growth. SMI Advisor, also known as the Clinical Support System for Serious Mental Illness, is an APA and SAMHSA initiative devoted to helping clinicians implement evidence-based care for those living with serious mental illness. Working with experts from across the SMI clinician community, our interdisciplinary effort has been designed to help you get the answers you need to care for your patients. And now, I'd like to introduce you to the faculty for today's webinar, Patrick Henry and Kelly Davis. Patrick is Vice President of Peer Advocacy, Supports, and Services for Mental Health America. He provides national advocacy and develops new services and training for peers within the behavioral health system. Patrick has worked as an advocate and initiator of peer-run services for 27 years in a variety of leadership roles, including former Director of NCSTAC, as a consultant for the National Council for Behavioral Health, the University of South Florida, SAMHSA, NASMHP, among many other agencies. Kelly currently works in Peer Advocacy, Supports, and Services, where she is involved in promoting peer support, peer certification, youth and young adult leadership, and college mental health. Patrick and Kelly, thank you for leading today's webinar. Thank you, Amy. And I just want to start off by saying that we have no conflicts of interest with the material to be presented today. So we're going to be talking, as Amy said, we're talking about trauma-informed peer support, post-traumatic growth. And so our objectives really are we want people to be able to identify the roles and values of peer support in the provision of support for people who have experienced trauma and are moving through it. We also want people to be able to describe the values of peer support and how they align with what we know about supporting individuals who've experienced trauma. And we want to be able to describe multiple ways in which trauma can negatively impact mental health and well-being. So we know that safety is a basic human need. Our feeling of safety in the world and around people and in everything we do is a social determinant that has extremely broad consequences. When people grow up with a feeling of lack of safety or they experience lack of safety for a long time, they're severely impacted by that. When safety is violated, our sense of security is broken. Our worldview is threatened. And we experience traumatic stress. One of the things that's most devastating about the effect of severe trauma is the shattering of our sense of trust and loss of faith that there is any safety or predictability or meaning in the world. It's a loss of innocence. So we know that what is stressful varies from person to person. Some people experience what we would consider to be extreme stress and are able to cope with that and move on from it. But they may experience something else that then they get that traumatic stress response from. When you're confronted with something or someone that is highly stressful, we have natural reactions and it's called the stress response. And we might more typically here refer to as fight or flight or fight or flight or freeze. During the stress response, our nervous system really activates, kicks into kind of high gear, and it releases stress hormones like cortisol, which are the body's way of getting us ready for action to deal with the source of stress. So this goes back to the dawn of mankind and the ways and types of stressors that we face. When the stress is relieved, our system tries to return the body back to balance. And we can feel the effects of those stress hormones as they begin to leave the body. When they don't and we're not able to return to balance, then we are experiencing trauma. The stressor is when it's something that really threatens our sense of safety, not just our momentary safety, but our sense overall of safety, or it's unrelenting and goes on for long periods of time. It's referred to as traumatic stress. So trauma is a reaction to an event or a prolonged event or a series of events that really threatens our sense of physical, psychological, social, spiritual, and our worldview safety. It's something that encompasses every way that we perceive the world around us. And it's really a very natural thing. It's a protective response that our body has to abnormal extreme experiences. And so it's a way that the body deals with what it perceives as a life-threatening event, even if it doesn't involve physical threats. So something that can be traumatic or traumatic stress-producing can be something that is a threat to our family, a threat to our position, a threat to us economically, the type of threats that we're experiencing now with the COVID-19 crisis, isolation and loneliness can be perceived by the body as traumatic stress. And so we have many of those same reactions when we experience all of those things, along with what we would traditionally or typically, more typically think of as the threat of violence or bodily harm. We know that the impact of stress can really vary from person to person, and it can be extremely subtle, or it can be just really downright destructive. Sometimes people experience one traumatic event and it stays with them for months, years, and sometimes even for a lifetime. Other times you can have a series of multiple traumatic events that maybe are of a lesser degree, but ends up with that same type of response from your body and your nervous system. And again, somebody else might experience those things right along with you and not get the same response that you do. And so we're not able to come up with a single answer for people about how to deal with stress because each of us deals with it in our own ways. It depends on the history of our life, the characteristics of us as individuals, the characteristics of the events and how we relate to those types of events. So the threat of bodily harm may have more impact on someone who's not in a role where that's a typical type of thing, like a law enforcement officer or a soldier. Threat of bodily harm may not impact them as much as they might me or any one of us working in a different type of role in society. And then it also has to do with developmental processes. So as we grow up, if we've experienced ongoing stress, even if it's a low grade of stress, but we've experienced it for long times, we become more sensitized to trauma and to stress. And so it can be cumulative as we grow up. And I'm sure everybody has experienced something traumatic in our lives. We all do. But most of us, it may take a little bit of time, but most of us eventually return to that balance and find ways to process that experience and perhaps even use it to build upon for the future. So there are stages of the impact of stress. So when stressors become traumatic, the way our body returns to balance can be affected. So some of our initial reactions that we might have if we experience a traumatic event would be fear, confusion, anxiety, a feeling of numbness, just kind of numb to what's going on around us. And that's part of that freeze type of reaction that some people have. Some people, physical arousal, they get pumped up, they're ready for action. Their body is preparing to fight or flight. Some of us may feel exhaustion, particularly when the stressor is removed from the scene. Exhaustion is a typical response, sadness, not unusual, agitation, you know, that feeling of nervousness and kind of anticipation that something might happen again or something else might happen, but something bad is happening. We also can typically feel dissociation, and that can be very short-lived for most people, but for some people, it can be prolonged, and this is where we kind of step outside of ourselves in a protective mode so that we're almost an observer of what's happening to us in the moment. And then many people get a blunted affect, particularly right after a stressful event where they don't show any emotion. And this can be really confusing for the people around them because when they see that, when the person doesn't express openly that they're fearful or they're confused or they have high levels of anxiety and they don't have the physical manifestations of it or the ability to express it, they may think that the person is fine, that it hasn't affected them at all when what they might really need in that moment is the opportunity to process what they've experienced. So the release from stress is interesting because most responses are normal. Most of the time, we react to a stressful situation in a normal way that our body and our mind uses to prepare us for those events. And then as it's over, we are able to return back to a state of balance, and it's kind of like ripples in water in the sense that, you know, when a pebble is thrown into a body of water, you get the series of ripples going outward, and then they begin to calm and calm and calm until it goes back to the normal surface of the lake. This is a little bit the way that our body responds to what we might call more normal type of stress. Traumatic stress may not be self-limited, or it may even begin to increase as time goes by. So some of the indicators that we've experienced more severe type of stress or trauma, again, it can be very individual, but when we talk about the severity of trauma, we're really talking about a reaction to some event. And again, as I've said before, it affects each person differently, but it also affects a lot of us in multiple ways. So there are some severe responses that are really quite common. There's the feeling of kind of continuous distress without a period of calm or rest. And so, you know, if you think about the times in your life when you've experienced something that was very scary, very stressful for you in that moment, like an automobile accident would be something that many people have experienced. And so they go through it, and right after it happens, they may even react very quickly to deal with what's going on around them. But then they begin to feel like something, you know, they can't settle back down. They begin to be agitated, they begin to be ready for something else, and yet the accident itself is over. So the stressor is gone, but the effects of the stressor are continuing, and that's the effects of trauma. Some people have severe dissociative symptoms. So many people will feel like they have frequent times in their life when they are separate from what's going on around them, and they feel like they're observers of their own actions and their own thoughts. This is not unusual, particularly for people who suffer from, you know, post-traumatic stress disorder, but also people who have experienced childhood events that maybe didn't have an immediate effect, and these things begin to take place years afterwards. And we're not even quite sure what the trigger is, but we begin to, again, have that feeling of kind of withdrawing from the world around us. Some people have that periodically for years to come, and some even for the lifetime. Another impact or a symptom of severe distress or severe trauma is intense recollections, so that they keep coming back, whether you're returned to a point of safety or not, and we might refer to these as flashbacks. Very typically, something that's talked about for combat survivors, people who've experienced the intensity of combat and having to be in a prolonged period of time in a life-threatening situation. You know, some of that type of burnout is what's going on right now for many people because of their reactions to all of these unknowns that we face. Right now, we're in a situation that is really unique in our lives. We've never experienced anything quite like this in modern history, and so we not only have the fear that we may become ill ourselves or that our loved ones may become ill, but we also have to experience the things that would normally support us through that, and so we have to withdraw from contact. Some people are able to withdraw to their home and they have family with them or family and friends live with them, but a lot of people, particularly people who are receiving mental health services, frequently live alone or they live with a roommate who has similar types of reactions. And so this crisis that we're in right now, I think that we are going to see the ramifications of it for many years to come, and it's really interesting because in some ways, some people will learn to be stronger by going through this experience, and it may even help them to learn to deal with something that had occurred previously and had been having a lasting effect on them. One of the things that we know that helps people to deal with stressors and traumatic responses is when we're able to successfully go through another type of stressor and come out the other side in a more calm way and return to that balance that we've talked so much about. So people who are able to experience change in their life a lot may have less of a difficult time than people who are used to things staying the same. One of the things we know for people who have experienced mental health disorders, who frequently are forced to live in poverty because of the inability to work and having to go on SSI or SSDI, SSI being well below the poverty line, and so they may find that they end up moving a lot. They may receive their services at a community mental health center, and they get a constant rotation of the people that are providing them with the care that they need. So they're used to a lot of change in their life. So when they come into a situation like this where everything is changing quite rapidly, they may actually be in a position to experience some of it in a safer way than other people who are used to life being safe on an ongoing basis. There's also delayed impact of trauma. Some of those effects of traumatic experience can show up days or months or even years after the actual event, and these may be things like feeling fatigued and exhausted. We frequently, after a period of excitation, so we may have had an alert-type response to a noise or a touch or a smell or anything that can evoke memories of a prior event, after that part of the body's reaction to go on high alert, then we go into a feeling of extreme exhaustion or persistent fatigue. People experience sleep disorders. That's something that we're hearing a lot about currently from people who are, you know, for instance, people I work with who normally work in an office setting, and most Americans are experiencing this to some degree right now. They're used to going to work. You know, how do we identify ourselves in modern society? It's usually by what we do. It's one of the first questions we ask somebody when we meet them. What do you do? Well, now we're finding people either losing their job or finding themselves having to work remotely and often in isolation. And so, for instance, in our organization, behavioral health organization, we have some people who have always worked remotely, and they're able to cope with this feeling of being separate better than some of our other staff who are used to working in that group kind of setting of a normal office. And they're struggling, and consequently, people are experiencing sleep difficulties. It exacerbates eating disorders. All type of things kind of react to the way that we or our body reacts to this new type of stressor that we haven't, you know, that we're not used to. We have anxiety that focuses on flashbacks, so memories of the event. And memories may not even be realistic memories of what actually happened. It's the way that we have processed the event and created this lasting kind of nightmarish memory that can continue on for long periods of time. Many times, people will then eventually kind of move into depression or avoidance of emotions. As soon as they begin to feel emotional about a situation, they may shut down and, you know, become unresponsive or seem to have very low affect, very little ability to respond to what's actually going on around them, because they're still processing this feeling of depression, dissociation, separateness, anxiety, and panic even. And then some people have sensations or activities that are associated with trauma. So these can be our triggers. And like I said, for some people, it might be a sound. It might be a loud noise. But for some, it can be even something like a piece of music. I experienced some trauma in my life, and PTSD happened to be part of my own life experience. And my primary trigger for many, many years was a particular song that when it would come on the radio, I was inclined to have flashbacks and to have periods where I just was really immobilized. And I don't think that's unusual. I think, you know, and then I was able over years to process it, some of it with professional help and some of it just as it dissipated with time. So then we can talk about the ongoing pervasive impact of trauma. It affects the way we see and think about ourselves. You know, we're very judgmental about ourselves. And one of the things that can be very beneficial in coming to terms with trauma are the concepts of self-compassion and the ability to not hold yourself responsible for what's occurring to you and blaming yourself for the feelings that you're having. Instead of finding ways to process them in a healthy way, it may end up producing huge amounts of guilt or feelings of inadequacy because one person maybe reacted in a different way than how you did. Consequently, it then affects how we interact with other people. So it affects how we feel about the world around us. Do we feel safe? Do we feel unsafe? You know, people need safety as a basic part of life. And when we, you know, this is a big issue for people, again, living with the diagnosis, end up say on SSI and waiting for decent housing, you know, for HUD housing, it can be years. So people find themselves frequently living in unsafe conditions. Many people find themselves homeless on the street. And when you live with that ongoing feeling of lack of safety, you don't even have a safe place to go to be alone, to be where you can just let down all of your guards. When we live that way, then our susceptibility to any other type of stressor is exacerbated. And it also affects our ability to regulate our emotions. And we see this frequently with people who've experienced severe trauma as children. And then as they grow up, emotional regulation is difficult. And so we find some people who seemingly their emotions don't match what's going on around them. And this can create huge problems for people. And unfortunately, most people knowing that person, their reaction to that will be to somehow blame that person for having this reaction that seems unusual or not. When in reality, what they need is to find a way that they can process that and begin to regulate their own emotions and feel a sense of control in their lives. We also talk about losing our physical health and our sense of wellbeing. Prolonged stress, like prolonged isolation, being a stressor, can have huge effects on physical health. We know that people who grow up feeling unsafe, experiencing traumatic events, people who are forced into isolation, they're not given the kind of social contact that people need, frequently end up being people who have multiple types of physical challenges. We see higher rates of diabetes. We see higher rates of COPD and asthma. Certainly we see higher rates of obesity because of poor diet that goes along with poverty. But it also goes along with the problems that people face when they're under stressful conditions for a long period of time. So when you're living with these physical challenges, and you're also living with the residual effects of the trauma itself, and all of the psychological problems, our sense of wellbeing is severely threatened. Now, wellbeing is not just having health, physical health. It's not just having mental health. It's the way we feel about ourselves in the world. It's the way that we perceive our situation. And so again, it can vary hugely from one person's experience to another. So one person, again, might have experienced lots of physical threats in their life. Again, the example of a law enforcement officer, a fireman, or a soldier, who are used to that type of effect. And they may go on to live a very calm life and a good sense of wellbeing. They may even experience feelings of wellbeing while those things are still occurring in their life. Somebody else might have experienced something that happened in their childhood. It could be loss of loved ones, loss of parents. Some people end up falling into the foster system, which can be very, very traumatic in itself. People end up with experiences with law enforcement and may end up in jails and prisons. And all of those kinds of things have a lasting, ongoing effect on our sense of wellbeing. And so it's very difficult for people to come back from that. We frequently talk about the high rates of re-hospitalization for people, or the high rates of recidivism for people who have committed criminal offenses, may have spent time in jail or prison. And then they're far more likely to come back into a hospital stay or come back into the law enforcement corrections justice system and end up perhaps incarcerated again. And part of the reason for that is because they haven't been able to come to terms with the initial things that drove them into those reactions in their life. So it takes a lot of work for people. One of the things that we know that can be very, very effective in all of this is peer support. When peer support is available to people, not only do you have somebody that may have experienced something similar to what you've experienced, but they're also somebody that can help you figure out your own solutions to your problems that you can trust and open up to and ask people, ask them for some advice, but mostly the peer supporter is there to help you figure out the answers to your own questions. So some of the ways that we can support people is by letting people know that we perceive them, perhaps in a much more positive way than they perceive themselves, by helping to develop supportive, healthy relationships. Over the years in the recovery movement, which really started in the 90s, in the beginning, a lot of the peer organizations sent out a surveys, and we did it for three years in the mid to late 90s. And one of the primary questions, and we were talking about recovery, and we were trying to understand, what is it that allows a person to recover? And the number one answer for three years in a row for these surveys that went out across the country was having at least one person who believed in you, one person who was supportive, one healthy relationship. If they had that, then they felt like they could move forward to their life and to create the life they wanted, which is really part of the definition of recovery itself. Also, having support and somebody to kind of test our belief systems with can help us have a different type of belief about the world around us. If we only experience things in isolation, if we only experience them inside of our own self, and we don't have a way of getting them out, we don't have a frame of reference to see how other people react to the same thoughts, then we can have very negative views of the world and negative views of going forward. And so consequently, it becomes very difficult for people who've experienced that type of situation to really set meaningful goals for their life. In the 90s, in the 80s, and even into the early 2000s, we had many, many people coming out of long-term stays in hospital systems. And frequently, when they were asked what their goals were, it was very simple. Their goals were so limited. It was to stay out of the hospital, to stay on their meds, to stay out of jail. One of the things that peer support, by being there for a person and letting them test their thoughts and their feelings, is that people begin to see that life can be much broader than that, and that they can actually plan for and build the life that they want in the world. So we say there are six key principles to trauma-informed approach to peer support. Most of this came out of a type of peer training called intentional peer support. This comes from a list in SAMHSA, Center for Mental Health Services. Providing a sense of safety is a necessary foundation to the relationship between the peer supporter and the individual. Trustworthiness and transparency. In other words, the person providing support needs to say what they mean and be open about their motives and to do what they say they will do. One-on-one peer support is very, very effective for people who are dealing with trauma and the effects of prolonged stress. Collaboration and mutuality. Peer support is not about me coming in or anybody else coming into somebody's life and telling them, well, if you just do this and you do this and you do this, you're going to have a better life. No, it's actually about collaborating, problem-solving together, and that's where we use this word mutuality. In peer support, you come together as equals who are going to address these issues as a team. It's about empowerment and giving people voice to their thoughts and giving them real meaningful choices in their life. It also really requires to do effective peer support is an awareness and a real true respect for cultural, historical, and gender issues. We're becoming more and more aware of this lately because as with all social movements, we've gone through periods of having to accept people for a variety of different reasons. We had the civil rights movement of the 60s, and then we had the gay rights movement, and we've had the transgender movement, and we have people learning to deal with other cultures and other faiths and everything. The world is becoming very, very mixed, and so people don't live in the little bubbles that they used to. We have to be aware of this, and we have to take it into consideration, and we have to give people the respect that they're due. With that, I'm going to turn it over to Kelly Davis. Thank you, Kelly. Thanks so much, Patrick. Thanks, everybody, and I just want to take a moment to acknowledge something that Patrick just said. Understanding trauma is really essential to the work that peer specialists do, but this is important, I think, in our approaches to all of our relationships right now as we're experiencing a collective trauma, and also for individuals, whether they're losing loved ones, losing their jobs, just grieving a way of life and uncertainty about the future. I think that this is really critically important. To continue on about trauma-informed peer support practices, Sherry Mead, Patrick mentioned intentional peer support. It's an amazing peer support training and approach to how peer specialists and people interact with and support one another, so here are the four trauma-informed peer support practices from Sherry Mead. The first is that it builds on shared experience and mutual exchange, so something that's very common in survivors of trauma is trauma can really make you feel separate from others, inherently different. A lot of folks will talk about themselves as being broken or damaged goods, and peer support is a way for folks to notice and acknowledge, oh, there is somebody who's gone through something that I've gone through. I respect them, and I have something to offer them, too. It eliminates the power differential inherent in traditional mental health settings and clinical relationships, so I am not going to kind of a clinical professional who knows more than I do, who knows about me, who knows what I should be doing, but I'm just talking and being supported by another person who's like me, and especially for when trauma was early on or when trauma was relational, so it was whether that's intimate partner violence, whether that's sexual abuse. Having power balance can really help you heal your relationships with other people because a lot of that is marked with a lack of a sense of control, especially with other people. It provides for reciprocal receiving and giving of support, so now I not only am receiving something from other people, but the peer specialist is making sure I'm not this person above you. You're teaching me things about myself as well, and this is us together discovering things, and the last piece is it fosters relationships that establish new ways of understanding their experience, not as clinical pathology but rather as understandable reactions to trauma, so a lot of folks, as I mentioned, have this sense, myself included. I'm a trauma survivor, have this sense that I'm somehow bad or damaged because of things that happened to me. And a lot of times, when you receive mental health services, especially with a lot of the stigma that exists, it just feels like it's another layer of something being bad or broken about me. But the peer relationship is really addressing that, no, there's other people like me, and my reactions align with theirs. They say, oh, you know, this is how I experienced it. I'm not alone in doing this. But it not only aligns with their or someone else's experience, it also aligns with the scientific literature that, you know, all the things Patrick said are true. These are really common, typical reactions to really hard things that people experience. When many of us and many trauma survivors either have their experiences flat out denied or downplayed by others or just excluded when they're looking for support, whether that's from the people around them or professionals, just acknowledging this basic humanity and the fact that this makes sense and how you feel makes sense is really validating. And these are some of the essential qualities for providing trauma-informed peer support. So empathy, compassion, the ability to talk openly and honestly, as Patrick mentioned, you know, meeting people where they are, but also doing what you're doing, what you'll say you'll do, establishing a trusting relationship, being comfortable with the unknown, with how people understand themselves. You know, trauma recovery is messy for many of us. It's fluid. And we're really just acknowledging people's core humanity in a way that we trust them to be experts on themselves and their experiences. So as a peer supporter, supporting somebody, you have to have, I think, practice the humility to be open to learning new ways of thinking, new things about people's experiences, and to be open to meeting them wherever they are, whenever they're ready. And then another really critical piece is that you also have to do it for yourself. So many folks who are working in peer support are trauma survivors. And for anybody who's working in a helping profession, but particularly a profession where you might be hearing details of people's trauma or just seeing and witnessing their trauma reactions, it's really important that not only are you taking care of yourself, but that you're doing your own emotional work in this relational, you know, equal capacity. You may discover things about yourself that can come up that are painful. So it's important that not only are you being there for other folks, but making sure you're there for yourself so you can provide this support in a sustainable way and in a mutual way. So peer support and trauma. So many of us who have learned about, you know, trauma-informed care before, we're switching the question or shifting the question from what's not what's wrong with you, but what happened to you. And the peer support movement in its, you know, history with the consumer and psychiatric survivor movement is really rooted in understanding how deeply trauma impacts people and how they show up in the world. And that's kind of, in any kind of peer support training or capacity, you know, that's at the core at the beginning of what you're learning. And peer support is really open to different ways that people tell their story. And so there's no, people are more than one story. People are more than one story about their trauma and people evolve and change over time. So as peer specialists, we're really open to giving people space and alternative ways to understand themselves and their experiences. So not just in a clinical capacity, but in a human capacity. And as we know, as people, that changes over time, as we remember things, as we learn new ways of being. And peers are really there for any and every which way people will show up and I'll support them on that journey. Peer support is strength-based. And the strength-based approach emphasizes crisis as an opportunity for growth. So when you're struggling, and this also comes from a lot of the work of sharing need and intentional peer support, a lot of times your clinical services or, you know, what you're reading or what you're seeing is all about kind of how to fix you. But we want to make sure that we're not just, it has to be bigger than just what people want to get away from and what people want to move towards. And supporting people as peers in this way with the strength-based approach that says, okay, yes, these hard things happen to you, but supporting people and figuring out, validating their trauma, but figuring out what they can learn about themselves and helping them understand as we're being pulled towards something, as we're using crisis as opportunities for growth, that you and every one of us, we are all bigger than the hard things that happen to us. And the last piece is developing a nurturing and trusting connection with individuals as an essential step. So safety, safety, safety. As Patrick mentioned, a lot of our trauma response, and there's a growing body of research about the physiological and nervous system response to trauma. So when folks are really activated and feeling really triggered, it's really hard to access, you know, the front part of your brain to really think through things. And if we're not providing that baseline sense of safety, we'll be disempowering, but we'll also, we'll not be able to support people in the way that they want because when their nervous system is activated, they can't be present in the ways that could be truly helpful in the peer support relationship particularly. So we're not only teaching folks and supporting folks and giving folks evidence that people can be safe, we're also trying to make sure that they have space to process things when they're, when they, they can be present in their body, when they're ready to be present in their body. And essential to, to the things that we've been saying so far, but it's really important, really important to mention is in maintaining connection versus disconnection, this relational mutuality focus of peer support, something we all can really learn from peer specialists, but need to keep front and center in our minds when providing peer support is support is not about fixing people. And many folks are receiving messages already that they need to be fixed. And that's a very quick way to shut people down who just want to be heard and who want to figure out how to move through their lives in the ways that they want to on their own time and terms. So I'll read a quick quote here. Patrick really loves this one as well. I think it's Parker Palmer and it's, when you speak to me about your deepest questions, you do not want to be fixed or saved. You want to be seen and heard to have your truth acknowledged and honored. If your problem is so deep, your soul alone knows what you need to do about it. And my presumptuous advice will only drive your soul back into the woods. So the best service I can render when you speak to me about such a struggle is to hold you faithfully in a space where you can listen to your inner teacher. So that's, that's really a beautiful way of saying we're not, as peers, we're not telling people what to do. We're holding space for them. And we believe in their inherent value and strength to figure things out in the ways that are important to them in the time that they need. So to move into this, in the strengths-based approach, there is something called post-traumatic growth. So some people with and without post-traumatic stress disorder experience positive changes in response to their traumatic experience. Sometimes we're, in the literature, referred to as post-traumatic growth. And this concept does not mean that people don't suffer. It doesn't mean that people would have chosen what happens to happen to them again. And it does not mean that as a public health perspective, as people, we should not, we shouldn't stop trying to prevent trauma. But really post-traumatic growth, Patrick mentioned earlier, trauma can really change your core beliefs about yourself, about the world. And post-traumatic growth is really about navigating those core beliefs and not about saying, oh, my bad experiences are good now. And it should not be used to invalidate people's pain. So something very common for folks who've experienced trauma or experienced something painful is people will say, oh, you'll grow stronger. What doesn't kill you makes you stronger. And those kinds of phrases that we use to respond to people. And if that's somebody's immediate response, it can really be a quick way to shut people down. So post-traumatic growth as a concept should not be used as a way to force people in that direction, but it's just something that people might experience after going through something traumatic. As I mentioned, it just refers to an internal process of transformation, and it can be aided by the support of others and understanding, like just as our stories about ourselves and our lives and our trauma and what it means changes over time. So it's not static, just as recovery is not static. And as a concept can be measured through the post-traumatic growth inventory, if you're interested, Calhoun is one of the major researchers in this space. So the components of post-traumatic growth, some similarities to kind of what we've talked about in terms of how trauma impacts people. The key components are changes in your appreciation of life, how you relate to other people, your sense of new possibilities in life, a sense of personal strength, and spiritual changes, and I'll go over in a little more detail on the next slide on each component. So this comes from the research. These are things that people might say or experience if they're experiencing post-traumatic growth. So appreciation of life, they might say, I noticed the things I took for granted. I've seen how deeply and quickly things can change, and I'm grateful to be here and to have what I have. Relating to others, my relationships with others have changed. My relationships are much more authentic. I found a new community of love and support. This is really common for folks in the recovery community, especially whether they're connected to 12-step or other people with lived experience. A lot of them say, you know, this is, I feel blessed to be part of this new, accepting community. New possibilities in life, so I don't feel the same limitations as before. I can get through things that I didn't think I could get through, and I'll live my life to the fullest now. Personal strengths, so I survived more than I ever thought that I could, and I can use these things that were in me the entire time. And the last component is spiritual change, so I now feel connected to something bigger than me. I have a sense of meaning that I didn't have before, and each of these, I think, are also really common experiences that folks who are in the peer support profession also experience and use and integrate into their work in serving others. And just one way or one exercise for promoting post-traumatic growth is redemptive narrative journaling, so storytelling is an important part of understanding ourselves and our trauma, and reframing or noticing things about our stories and ourselves can give us a sense of power or shift, as I mentioned, you know, we don't all, we're all more than one story, and doing this redemptive narrative journal where you're asking yourself or you're sharing this with others and they're asking themselves and thinking about and writing about some of the different experiences that they might have had following trauma in relation to trauma and how they understand themselves can really shift their sense of power and feelings about who they are and what they might like about themselves that they might be accustomed to not thinking about. So, the research on post-traumatic growth, so there might be certain characteristics that would increase somebody's likelihood to experience post-traumatic growth, so some of that research says that folks who have higher rates of, who are more optimistic and who are more open to new experiences are more likely to report post-traumatic growth. It's really critical to remember that post-traumatic stress is not the same as post-traumatic growth, so I've seen a lot of folks look at PTSD to PTG as kind of a continuum, and the research does not support that idea. Many folks experience both signs of post-traumatic stress and post-traumatic growth, and there is research specific to PTG for individuals with SMI, and I think there's two ways that folks have looked at that, is that understanding that the experiences that folks have related to their mental health can be traumatic, but also lots of folks who are diagnosed with SMIs or any mental illness have high rates of trauma and significantly higher experience of trauma than the general population, and in the research that's available for PTG, for folks with SMI, meaning-making and a sense of self-efficacy are predictors of PTG, and meaning-making and self-efficacy, I think, are also, as we've talked about before, two of the major things that peer specialists are supporting people in figuring out and promoting, so post-traumatic growth and peer support, so these concepts, peer support as a practice, but post-traumatic growth as a concept, are really aligned. They're both really focused on strength, growth, the importance of relationship and individual empowerment. The peer specialist role is very aligned with the domains of post-traumatic growth, so helping people, having the sense of being a part of something bigger than you, having a new community, helping people to understand and emphasize their own strengths. Recovery stories and personal narratives are important ways of understanding our experience. Many of us who have been in the mental health space know, especially in the peer world, the true power of other people hearing stories of hope, and understanding your own story through that capacity, through hope, through growth, is really important, too, as the person telling the story, not just the person listening to others, and peer support represents an opportunity to use relationship and tools to address trauma and PTSD, connecting with people where they are, supporting them in feeling safe, making them feel like you're not the only person who's had this lived experience, while also promoting post-traumatic growth, so connection to a loving, supportive, bigger community. If you're stepping into a role as a peer specialist, a sense of, you know, meaning and contribution to something bigger than yourself, whether that's just supporting people around you, or a more formal role, and just as I mentioned with PTG, with as being not a static concept, but something that changes over the time, it's always important to remember that trauma recovery is also not a static process, but something that changes over time, and the ball in the box is an illustration that I've always found to be really helpful, so if you can see, you know, when you're first experiencing trauma, or when you're first talking about it and noticing it, it might, it can feel like, you know, any little movement and lots of things, you kind of feel raw to the world, and being triggered by, you know, things around you, it can be really easy, and you can feel really incapacitated and not able to show up in the world and do the things that you want to do, but as time goes on, and you gain tools, and you gain community, you may still experience symptoms of PTSD, you may still live with PTSD, but the box, the ball gets smaller, so you're able to experience more, even if things might come up, it might not disappear completely, but you're able to do more of the things that are important to you, and live in the world in a way that feels safer to you, and that is it from my end. Thank you all so much for listening. I know we don't have too much time left, but wanted to turn it over to see if folks had any questions. you

Amy Cohen

SMI Advisor

trauma-informed peer support

post-traumatic growth

Patrick Henry

Kelly Davis

key principles of trauma-informed peer support

nurturing and trusting connection

trauma recovery