Kid /Teen Strategy of the Week:  

Emotional Thermometer: Understanding emotions and how we experience them in response to a significant life event can help to build awareness and resilience in the midst of trauma. Also, knowing about the range of intensity with feelings supports kids and teens in recognizing both the natural and manageable experience of emotions. The emotional thermometer provides a helpful visual and analogy of the range of emotional experiences:

o Start by having the client draw a thermometer, with the number 0 at the bottom and 10 at the top.
 Ask the client to mark where they feel a little emotion (0-3), medium emotion (4-6), a lot of emotion (7-8) and very strong emotion (10).
o Then inquire with the client about a feeling they are having in the moment and ask them to mark what number on the thermometer they feel this.
o You can also engage the client in a reflection on a recent emotion or emotions (that day/or before) that was higher, have them mark this on the thermometer and ask how it was higher than what they feel now (in mind/body/actions).
 It may be helpful to ask the client to remember how they felt/noticed their emotion change from a higher to a lower number on the thermometer.
o The client can keep coming back to the thermometer in and out of session to identify their emotion and intensity level to continue building awareness.

Source: https://tfcbt.org/wp-content/uploads/2019/02/Revised-Dealing-with-Trauma-TF-CBTWorkbook-for-Teens-.pdf

Sample Progress Note: The focus of the session was (tailor based on treatment plan). The therapist engaged the client in activity on building emotional awareness by identifying feelings on a thermometer ranging from 1 to 10 in intensity. The client responded to the activity by (fill in the blank).

Adult Strategy of the Week:  

Window of Tolerance:  Our bodies have a natural system (i.e. window of tolerance) to handle stressful experiences, and when that system is activated we become hyperaroused (i.e., fight or flight) and/or hypoaroused (i.e., freeze). Knowing how one’s body reacts in each of these states can help to recognize stress earlier, and therefore allow one to engage coping strategies earlier. The graphic provides a helpful framework for providing psychoeducation on these concepts.

o Following psychoeducation, engage the client in a reflection on how they experience their window of tolerance
• It may be helpful for them to draw/graph their experience as well.

Source: https://www.nicabm.com/trauma-how-to-help-your-clients-understand-their-window-of-tolerance/

Sample Progress Note:   The focus of this session was… The therapist used psycho-education about hyperarousal, hypoarousal, and the window of tolerance to help client recognize how they experience stress and safety in their bodies. Client reported that the psycho-education was (interesting/helpful), and they (did/did not) integrate the psycho-education into their narrative.

Trauma Strategy of the Week: 

Seeking Safety:   When we experience a significant life event it can evolve our idea of safety, in our mind, body, and relationships. Reestablishing a sense of safety psychologically, mentally, physically, and socially, can support one in feeling more secure navigating life. Here are ideas on how you can begin exploring the idea of safety with clients:

o What is safety to you?
• Who do you feel safe with?
• What activities do you feel safe doing?
• Where do you feel safe?
• Are there quotes that they feel express their idea of safety?
o Have the client describe in detail a safe space that helps them feel calm and connected, a place that can ground them in a feeling of relief/peace.
• If helpful, engage the client in drawing this, finding an image that represents, and so forth.

• Then, engage the client in an activity of identifying safety coping skills such as utilizing the five senses, asking for helping, listing options, setting a boundary, self/other-compassion, imagination, listening to their needs, self-soothing talk, DBT distress tolerance skills, and so forth.

Source: Najavits, L. M. (2007). Seeking safety: An evidence-based model for substance abuse and trauma/PTSD.

Sample Progress Note: The focus of this session was… The therapist provided psychoeducation on the idea of safety and engaged the client in an activity of defining what safety means to them as well as identifying safety coping skills. The client reported that it was (helpful/not helpful/etc) to reflect on their idea of safety and was able to identify (one/a couple/several) safety coping skills to utilize outside of session.

Mindfulness/Meditation of the Week:  

Emotional diffusion:  Creating distance from the experience of a strong emotion can support one in developing greater tolerance of distress and a sense of safety in their emotional experiences. Acceptance and Commitment Therapy has various metaphors that help to illustrate how one can de-fuse from emotions to promote awareness, mind-body connection, and resilience with stressful life experiences.

o Identify an internal experience that is uncomfortable or that you wish would go away. If you are experiencing anger, fear, anxiety, or sadness, you can often feel it physically somewhere in your body.

o If you are in physical discomfort, you can certainly identify a place in your body where that is most significant. For now, focus on the most intense area of sensation in your body.
o Begin by gently closing your eyes and finding a position that is as comfortable as possible. Breathe deeply, focusing on the rhythm of your breathing. As you breathe, identify a place in your body where you are experiencing an uncomfortable sensation or pain. This could be a racing heartbeat, tightness in the chest, tingling in the limbs, pain somewhere in the body, a headache, tension in the head or muscles, stomach pain, or nausea. Wherever the pain or discomfort is, focus on that area of the body.
o Imagine that the part of your body where you experience the discomfort is a mature dandelion head; round, fuzzy, and covered with white seeds. Imagine a big, fluffy dandelion where your discomfort is.
o Breathe into the area of your body where you feel the pain or uncomfortable sensation. As you breathe in, notice the dandelion representing the discomfort you are experiencing. As you breathe out, notice that you blow on the dandelion and the seeds holding your discomfort float around in the wind.
o Continue for five to ten minutes, focusing your attention on the area of pain or discomfort, breathing in and out, and with each breath, notice the dandelion seeds holding your inner experience and watch them float by.
o When you are ready to conclude this exercise, gently allow your awareness to expand back into the room, noticing sounds you hear and the temperature of the room, and open your eyes.

Source:   Stoddard, Jill A.; Afari, Niloofar (2014-04-01). The Big Book of ACT Metaphors: A Practitioner’s Guide to Experiential Exercises and Metaphors in Acceptance and Commitment Therapy. New Harbinger Publications. Kindle Edition.

Sample Progress Note: The focus of this session was… The therapist led Ct. in an ACT mindfulness activity around defusing from emotional experiences. Ct. (engaged/did not engage in the activity), and they reported that the mindfulness activity was (helpful/difficult/not helpful).