Monday, March 30, 2020

Dealing with direct impact of acute trauma - Part 1


This post is devoted to all people who are directly fighting COVID-19 right now, such as individuals who are diagnosed, patients, medical professionals, or first responders of all kinds.
     I would like to start by stating several basic things:
1) I have a lot of compassion for your situation. I am very sorry that you are between the rock and the hard place right now.
2) Your pain is real and it deserves care and respect.
3) There is nothing I or anyone else can do to fix your pain and suffering; however, there is something you can do to alleviate it to some extent – this is what the post is about.
4) Even though it might feel this way, you are NOT alone; even if it feels that you are fighting for or against the whole world on your own right now, there is at least your internal compassionate witness that is present there with you and, at most, Higher Power (of your understanding). Of course, there are also multiple people around the country and the world, who are experiencing similar struggles.
     In the next two posts, I will review the impact of acute trauma on human brain and nervous system, ways to cope with acute stress during demanding and catastrophic situations, and ways to reduce probability of psychological traumatization, which is often an outcome of an extreme hardship.
Impact of acute trauma
     When we, as human beings, face the situation of overwhelming need and suffering, which is what autonomic nervous systems tend to get overwhelmed and push us out of our regular functioning modes into survival responses. For some people, it means being in the state of hyperarousal (fight or flight response) which manifests in the increase of anxiety or agitation, frenetic energy, difficulties sleeping with possible flight of ideas and difficulty focusing or with tunnel vision and hyper concentration. Maintenance of this state requires a lot of internal resources. It is not sustainable over the long term. However, a lot of first responders, as well as doctors and nurses in critical care, will be functioning in this state for a very long time. For other people, survival mode is associated with the state of hypoarousal (freeze response), which manifests in slowing down of cognitive processes, low energy levels and fatigue, depressed or blue mood, sometimes to the point of feeling paralyzed or disconnected from themselves or others. This is the mode that a lot of ICU patients will be finding themselves in.
you are facing right now, our
     It is also common for folks to go between these two modes multiple times a week. For example, being in “fight or flight” state at work and then shifting into “freeze” response once off the shift. Living in either one of these states for a long period of time is very taxing for our bodies and our souls. It often leads to us being more traumatized in the end of the catastrophic situations.
     On the level of the brain, when we are outside of our regular nervous system functioning mode, our frontal lobes tend to go offline. They are responsible for us being able to critically evaluate situations and make sound decisions based on facts and data. When we don’t have access to these areas of our brains, we tend to make more mistakes and lapses in judgment. At the same time, amygdala, the area of our brains that processes threats, gets over-activated and pushes us to look at events and people through the lenses of fear and danger. This often results in us being overly reactive and impulsive in our decisions and actions.
     In terms of our psychological and social functioning, the shift into survival mode often leads to us feeling disconnected and alone. Empathizing with ourselves and others becomes a real challenge. We may feel anxious, angry, sad, overwhelmed, guilty, ashamed or a combination of those emotions most of the time. We may become intolerant of other people’s traits, actions, mistakes. We may also develop negative and/or hopeless perspective on the world, future, or our own prospects. It may become difficult to stay embodied, meaning connected to our bodies and aware of our needs. We may struggle with balancing other people’s needs and demands with our own needs.
Coping with acute stress
     When we are in the middle of a critical situation we often need to “collect ourselves” and act. In these circumstances we often have to neglect our own needs. We are often called to do more than we humanely can. How can one cope with those overloading demands? Few suggestions below are not a cure or a magic wand; however, following them may help take some pressure off.
1.     Protecting your vulnerabilities.
It is important to shield tender and vulnerable sides of you. We all have them, and we all get hurt when they are present in the harsh environments. So, let us focus on several steps of protection. (If you have even a few minutes after you read this article and there is only one practice you can do, I invite you to focus on the next three steps of protection.)
Step 1. Create an internal safe place.
     Simply imagine a place where young and tender aspects of you will be comfortable. It maybe a cabin in the woods, a bungalow on the beach, or a cave in the mountains, or anything else that calls your name. Really develop this place in your mind’s eye so that you can see the colors and experience the smells. Your vulnerable parts can have anything they need for life and comfort in that spot, for example, food, pets, blankets, toys, etc. Now, invite your young and vulnerable sides to come to that place and explain to them that this is a place for them to be when you are in crisis situation, whether it is at your work, in the hospital, in the ICU or somewhere else.
     If you are not a very visual person, you can create a safe place in your body, such as behind your heart or in your gut.
Step 2. Invite your parts to stay in a safe place
     Before you go into a high demand, scary, or crisis situation, invite your vulnerable aspects to go to a safe place and stay there until you let them know it is over. Let them know that they do not have to participate in anything that is about to happen or track anything. They can simply put headphones on and rest or do what they like. Reassure them that adult sides of you can take care of work or crisis and that you will let them know when it is safe to come out.
Step 3. Check in or invite parts out. (very important and makes the whole practice work).
     When you reach respite, whether it is the end of the shift, temporary relief from pain, or any other moment of safety, check in with the parts in a safe place to let them know you remember them and reassure they are not alone. When the situation is over, let the parts know that they can come out of the safe place and join you again. Please, do not simply exile or abandon your younger and vulnerable parts in that safe place. It will be hurtful rather than helpful in the long run.
2.     Checking, keeping, and regaining perspective.
In the midst of chaos, it is very easy to forget simple facts. When you have a moment to breathe, maybe when you are going to the bathroom or before you pass out in your bed, remind yourself:
* the situation is much bigger than you
* you are only ONE person doing the best they can
*it will pass too
*Higher Power (God, Community, Family, whatever calls your name) is there for you and has your back
3.     Hand on the heart – 1 min practice

For the next minute, bring your hand to your heart area, focus on the contact between your palm and your chest, feel the warmth emanating from your hand and say to yourself something like: “I know this situation really sucks. I know it is hard and painful, and I am sorry. I see that you are doing your best. I love you and I accept you just the way you are.” Feel free to modify those phrases so that they sound true and authentic to you. The important thing is that words express validation, understanding, and acceptance of you as a person.
4.     Mindful Movement
It does not have to be anything fancy like a yoga practice or a pilates session. Simply walking down the hall with the full attention to your feet hitting the ground and awareness of your breath is a potent way to bring yourself inside of your body and regulate your brain and your nervous system. Some other ideas here for variety:
* Arm lifts: from standing upright or sitting in the chair with a straight back and an open chest, raise both of your arms on inhalation and release them in exhalation – repeat 5-7 times, using breath as a vehicle for motion.
* Balancing rises: from standing upright, with both of your feet on the ground, rise to your toes extending your arms out on the inhalation, bring your heels to the ground and hands to your heart/chest on the exhalation - repeat 5-7 times, using breath as a vehicle for motion.
* For more one minute movement ideas, visit my YouTube channel at:
http://www.youtube.com/c/IrinaDiyankova
     Steps 2-4 are mini practices. Each takes only a minute or two to perform. They can be used individually and multiple times a day to create a moment of regulation and a moment of calm. The more frequently you practice, the more resilience you will create and tap into. There is no need for perfection. If you forget for a day, a week or a month to do those things, you always have a chance in this next coming moment to choose to practice one of them.
5.     Clean the slate
Ideally, we will do it every 24 hours. However, when we are in crisis situations it is not always possible. I suggest that you take a few minutes before you fall asleep or while you are in the shower to release the day (previous 48 hours or week). With every exhalation, release pressure, tension, physical pain, negative thoughts. Ask white light to surround you and bring safety, love, joy, connection, forgiveness or something else your system desperately needs in the moment. Extend compassion to yourself.
      I would like to end part 1 of this post with a brief summary. Crisis situations often push us into survival mode, which can help us deal with life and death.  While it could be useful in a short-term, it really tends to hurt us in a long-term. So, we don’t want to live and function in this mode. I discussed five different strategies that can help shift from survival into regular mode of functioning and provide a needed respite. These strategies are very brief and could be utilized multiple times a day to create mini breaks for the nervous system, brain, and mind. Using these practices on a regular basis may also protect us from a long-term negative impact of acute stress.











Tuesday, March 17, 2020

During Crisis Time


     As I am reflecting on the state of developing national and international crisis, I am noticing my own protective parts shifting into survival mode and getting activated. I hear internal messages of fear, lack, deprivation, stress. I am noticing my body tensing up and my breathing becoming shallow. When I look outside myself I see a lot of fearful behaviors and messages. It seems like the world is rolling out of control in one huge ball of fear and panic. So, how do I preserve my sanity and stability? How can I support you, my clients and readers, as your healing journeys get even more complicated by the first in our lifetimes pandemic that is deeply affecting livelihoods of communities and nations around the world?
   
  I do it in four small steps, one at a time. As a  first step, I put my two feet on the ground and take a couple of deep breaths. As I inhale, I expand my belly. As I exhale, I contract it. I ask my nervous system and my brain to notice that I still have support of the ground underneath me. Then, I take second step by reaching towards my Higher Self, which to me is the Universe (for you it might be something different, such as Nature, Higher Power, Community, God, Spirit, or something else) that supports all of us energetically and spiritually. And, I ask Universe and then allow it to have my back.
     Afterwards, I take third step by  repeating to myself: “I am OK here now. I am supported. I am working through it one step at a time. And, Higher Power has my back”,  while continuing to breath deeply, with both of my feet on the ground and my back protected by the Universe.  
    Finally, in my fourth step, I am sending this energy of compassion, calmness, and support to the parts of me that are worried, fearful, angry, lonely, sad or struggling in some other way. I remind them that I love and accept them just as they are.
     I may need to practice these three steps many times a day during the next several weeks or months. Sometimes it will create only a fleeting relief or none at all. However, I know that I can always come back to this practice and use it as an anchor to support me throughout critical times.
     Next, I invite you to take these four steps with me by following the instructions below:
1.     Please, stand up. With both of your feet on the floor or ground, gently push them down and feel into the support of Earth underneath you. Breathe into your feet. Ask your nervous system and brain, ask with compassion and understanding, to notice that you are firmly standing on your two feet and you are supported by gravity.
2.     While continuing to stand with both of your feet on the ground reach physically, emotionally, and spiritually through your compassionate and loving core towards the Higher Power of your choice, which maybe Nature, Community, Universe, God, Spirit, or something else. Ask this Entity to have your back. Lean into it, breathe into it, absorb it.
3.     While continuing to breathe deeply with both of your feet gently pushed into the ground and your back towards your Higher Power, say something along the lines: “I am OK here now. I am supported. I am working through it one step at a time. And, Higher Power has my back”.  
4.     Finally, send this energy of compassion and support that you absorbed from your Higher Power and accessed in yourself to all of your struggling parts, those that are afraid, in pain, overwhelmed, sad and so on. Remind them that they are loved by your compassionate core.
After completing these four steps, take a moment to notice how you are feeling right now. Maybe you are breathing a bit easier? Maybe your posture is more confident? Maybe you feel more energized?
If you would like to listen to the instructions for this practice, go to
     If I have time and at least once a day, I am sitting down afterwards to listen to my internal parts. I try to tend to them with interest, compassion, serenity and patience. I invite them to share their concerns with me, and I just witness and let them know they are heard. I do not need to fix anything, change anything, evaluate or criticize anything. I just need to be present. When you have a few minutes today, I invite you to do this listening to your parts practice and perhaps journal for a few minutes about your experience.
     I am far from suggesting that if you do the aforementioned two practices regularly, you will breeze through the crisis. Not at all. I know that I will have tough days and overwhelming feelings at times. However, I have my tools that I can come back to and use over and over again to bring me back to the center. I know that I will need to do it every day and on some days multiple times. Of course, there are more tools available and I invite you to use as many of them as possible in the days to come. What tends to nourish your body and your spirit? Maybe its yoga, running, walking in the park, making art, journaling, meditating, reading uplifting books, spending time with your pets, or talking to your loved ones. Whatever it is, I encourage you to make a point of utilizing even more of those activities in the days and weeks to come.
     During a day, when you have a free minute, such as waiting on the phone, pausing in cooking a meal, washing dishes, or laying in bed getting ready to go to sleep, I invite you to utilize the four steps described above to reconnect with yourself and present moment. How you and I care for ourselves and our nervous systems will make a huge difference in how we will weather this crisis and how we will feel when it is over. I am sending you lots of compassion and hope for the crisis time. And, I would like to remind all of us that this will pass too. 



Sunday, December 8, 2019

Coping with Stress as a Survivor


     Recently I went through a few stressful experiences that descended on me at the same time.  I  was reminded that my sensitive nervous system responds to stress differently, even today after multiple years of therapy and yoga and other healing adventures. This is not a cause for grief and sadness anymore but rather an opportunity to practice what I preach to my clients and readers.
     So, let’s do a quick review of what happens to the Autonomic Nervous System (ANS) after any complex or long-term traumatic situation. The two branches, sympathetic and parasympathetic, get easily dysregulated and stop “talking” to each other, which throws trauma survivor outside of the window of tolerance (or green zone, where we want to be to cope effectively) either in the Hyperarousal or Hypoarousal. 
     In the Hyperarousal, we may feel anxious/fearful/panicky or frustrated/annoyed/angry. We may have difficulty focusing because of being all over the place, as well as difficulty sleeping and relaxing. In the Hypoarousal, we may feel down or disconnected. We may have trouble thinking clearly and making decisions. Sometimes, being in the hypoarousal zone is also associated with difficulty knowing our needs and communicating them to other people, as well as challenges around maintaining healthy boundaries. For more on the review of the ANS after trauma and different ideas of how to rehabilitate it, see my blog post from June, 2017.
     With trauma, the window of tolerance tends to become very narrow and, as a result, a survivor is easily stressed. Little things that might have never bothered them before (if there was before) may become huge challenges. For example, calling utilities company to handle a mistake on a bill or talking about work needs to the employer may be experienced as overwhelming. Is there anything you can do about it when you are going through a stressful period in your life, such as approaching holiday season? ABSOLUTELY!
       I offer you a collection of different strategies from neuroscience and Internal Family Systems (IFS) verified by my clinical work and personal use. I divided them into two groups: 1) strategies that produce immediate change and can be used in a difficult moment; 2) strategies that produce long-term change, including expansion of the window of tolerance and reducing frequency of the “freak out” moments.

1     Immediate Change strategies
are meant to be used when you notice that you are stressed and/or outside of your window of tolerance. They maybe used multiple times a day. Most of them take only 1-2 minutes. When you choose to practice one of those techniques, give it your full attention for that minute. Notice and celebrate even the slightest change in your state.

  1.   Unblending from a part. When you are “kicked” outside of the window of tolerance by ANS, it often happens because one of your protective or wounded parts has flooded you. You may acknowledge the struggle that one or several of your parts are experiencing right now and send it/them compassion. After that ask the part to step back, so that you can listen to it and understand what the part needs. I am often surprised how little and trivial things could be very soothing and reassuring to our parts, such as listen and validate part’s feelings, or give it permission to do or not do something, or speak for the part in some relationship.
  2. Deep breathing. When you notice that your body is tensing up or level of irritability is increasing or some other sign that you are moving outside of the window of tolerance, take a moment and focus on your breathing. First notice, without judgement what your breathing pattern is like. Then work on lengthening your exhalation, so that it becomes a little longer then an inhalation. Count how long it takes you to inhale and then gradually increase your length of exhalation to + 3 counts. For example, if it takes you up to 3 counts to inhale, increase your exhalation to 6 counts. Don’t get too hung up on the numbers, just work on extending your exhalation for 5 breathing cycles or so.
  3. One yoga pose. Do your favorite yoga pose with full attention to your breath and body sensations. If you don’t have a favorite yoga pose, check out one pose videos on my youtube channel at: https://www.youtube.com/irinadiyankova for some inspiration.
  4.  One minute PAUSE. Stop whatever you are doing for just one minute, even 30 seconds would be good. Put your feet on the ground. Take a deep breath and remind yourself that you are OK here now. Repeat as many times as necessary. And, then take a moment to remember that you have all kinds or internal and external resources today and that you have coped with lots in the past. You can find a one minute video of a waterfall on my youtube channel that goes nicely with this practice.
  5. Self-hug. Give yourself a heartfelt hug and send compassion to all of your internal parts and your system as a whole for the pain that you are experiencing in the moment. Take a moment to really notice and enjoy this experience.
2.     Long-term and rehabilitation strategies
  1. Daily parts’ conference is an excellent preventative practice, which comes especially handy during stressful times. It works the best when you are consistent with it and parts “know” when to expect your attention. It can be as simple as checking in with your parts for 2-3 min before you go to sleep and sending all of them compassion and love. Or it can be more formal and involved, like taking 10-15 min a day to sit in quiet, center yourself through several deep breaths, and invite parts that would like your attention to express themselves one at a time. When you listen to a part, do it from a neutral stance. You don’t need to solve anything or promise anything, just your presence and attention are enough. Afterwards, it may be helpful to jot down some notes about different parts you heard from in your journal.
  2. Gratitude Journal is a strategy that gradually and slowly works on shifting perspective from one of negativity and deprivation, which is a staple mark of stress response to one of positive expectations and abundance, which is associated with relaxation response. It is very simple. Take a notebook or if you already have a journal, you can use it. Give yourself 3-5 minutes in quiet to reflect and write down 3-5 different things you are grateful for that day. Those things don’t have to be big and amazing. Anything that gave you a moment of joy or relaxation deserves to be put on the list. For example, inhaling fresh air as you stepped outside, exchanging smiles with someone, having a good meal, petting your cat or dog, and so on. Of course, big things can be included as well. Reread your entries often. With time and consistency you will notice gradual shift of your attention from things that are not going well to the things that are.
    Dr. Rick Hanson, neuropsychologist and author of several practical books on neuroscience, reminds us that what we focus on most frequently tends to grow and expand in our minds. Given that all humans have negativity bias predetermined by our survival orientation it is important to deliberately seek, enjoy, and recall positive experiences on the daily basis to develop more neutral stance and equilibrium in the functioning of the nervous system.
  3. Mindful Movement Practice. When we take a few minutes every day to focus on moving with intention and self-awareness, our nervous system pays us back through developing a base of calm and bringing us back inside that window of tolerance much quicker. Choose movement type that you enjoy. It maybe yoga, dancing, running, walking, swimming, something else. The key here is to focus on your breath and your body as you are performing that activity. It does not have to be long 10-15 minutes a day would work wonders.
If your major stressors during the holiday season are associated with the family gatherings, I refer you to my December 2018 blog post for some ideas on how to deal with challenging relationships during festive times. I wish you a happy and healthy Holiday Season filled with self-compassion and self-care.


Saturday, December 22, 2018

If holiday family gatherings are dysfunctional …


Then there is a high potential for re-wounding and re-traumatization, especially if healing on individual and/or family levels has not been completed yet. Does it mean that we need to spend holidays alone or with a tight circle of close and trusted friends? Not necessarily.       
     But what it means is that we need to tend to our vulnerable young parts before, during, and after the family visit. Here are some ideas of how you can protect and care for your parts during the dysfunctional family gathering (or in any emotionally unfriendly environment):
·       Before the visit:
o   Have an internal conversation with any parts of you that are worried about seeing the family. Ask them what they need during the visit and discuss what you can provide.
o   Follow through on what you promised. It is really important for the  maintenance of internal harmony and trust to follow through on your promises and commitments, just like it is important to actually do what you promised in interpersonal relationships.
o   If there is a part or several that do not want to participate in a family visit or a specific activity, you can accommodate such a request through a creation of an internal safe place (see below for specific instructions on how to do it). Once a part has a safe place to go to, just remind it before the visit or an activity that it is time to go to a safe place and then let the part know when it is safe to come out. This technique may feel strange and even uncomfortable at first; however, when done consistently, parts often come to appreciate such an option for safety. Please, be aware that it is not a magic wand though and your parts may still get triggered by things happening around you. This technique just reduces probability and intensity of such triggering.
o   Create a plan of how to leave dysfunctional interactions, as well as overall exit plan. It is good to be prepared. Ideas for graciously leaving unwanted conversations: excusing yourself to go to the bathroom, changing a topic to something fun (have ideas ready), inviting a safe(r) person nearby to join your group. When you are asked a question that you are not comfortable responding to, remember that you don’t have to. You can always say that you would rather not talk about it or that it is a topic for a different time and different place. If things at the gathering develop in a negative direction for you, remember that you can always excuse yourself and leave. It is good to have a plan prepared beforehand for such a possibility, which includes having an independent means of transportation and a place to stay. For transportation, if you don’t have your own car at hand, you can always rent a car, call a cab (have a local number on hand) or use a Lyft (have an app downloaded and ready to go beforehand). In regards to the place to stay, have an alternative arrangement researched and ready to go, such as a friend, who is willing to host you if needed or information about nearby hotels and their rates/availability.
·       During the visit:
o   Remember your rights and exercise them as needed during the visit, such as: a) to say ”NO” to anything you are not comfortable with; b) to set the boundaries that are healthy for you; c) to leave the situation that makes you feel hurt, violated, or overwhelmed; d) to care for yourself and your parts.
o   Set, Re-set, and Maintain boundaries. Very often our family members have to be reminded in gentle and firm ways about our boundaries. For example, my mother tends to forget that I do not like being asked questions like “Are you happy?”. So, when she does it again, I say something like: “Mom, remember we talked about it before? I do not like questions like that and I do not answer them. So, can I tell you about this really fun movie I watched last week instead?” When your boundaries have been violated more than once, remind the “offender” what your consequences are. This is an important part of teaching people to respect your boundaries. Consequences often center around disruption of connection and maybe things like not talking for certain period of time, leaving the situation for a short period of time, or leaving the gathering all together. So, when you re-set the boundaries with a person, who you know is likely to disrespect them, let that person know what will happen if they cross your boundary again. For example: “Uncle Bob, I told you multiple times that I do not appreciate hugs from you. If you attempt to hug me again, I am going to turn around a walk away and I am not going to talk to you for the next half an hour”.
·       After the visit:
o   Spend time with your parts, especially the ones that were triggered during the visit. Once you are in your own space and alone, spend at least 15-30 min with your parts, asking them about their experiences during this latest visit with the family and listening to them from the place of compassion and care. Journal. Care for them in the  ways that they ask to be cared for.
o   If a part was hurt, ask it to tell you both about the present hurt and about the past hurts that she was reminded of and perhaps relived as a result. Be gentle. Ask the part how you can help it heal the hurt. Do what the part requests. Ask for forgiveness, if you were not able to properly protect the part from being re-wounded.
o   If a part hurt someone else, ask the part what it was trying to protect you from. Listen and acknowledge parts reasons for acting the way it did. When the part feels heard and understood by you, ask it if it know how its behavior affected other people. If the part does not know, tell it. Discuss with the part ways to remedy the situation and repair with those that were hurt. Forgive the part, it had a positive intention of protecting your system.
How to create a safe place to contain and protect the part that is likely to get hurt?

     When we visit with our family of origin, very often the parts that are at most risk, are the wounded young parts. So, when we talk with them about the upcoming visit, it is important to hear their concerns and to assess whether they are healed enough to participate 100% in the family visit. If in the process of talking to the part we determine and the part agrees that protection is important. Then we can offer the part an idea of an internal virtual safe place.
     If the part is open to the idea, ask it to show you an image of a real, imaginary, or combination place, where part would feel protected and relaxed. Ask the part to not choose a place that has any negative memories attached to it. Once the part shows you the image or gives you the description, see how safe and protected this place seems to you. If you have doubts about the place, voice them and discuss with the part. If it appears to be a good enough place, proceed telling the part that it can have anything it needs to make her stay at that spot enjoyable, for example, comfortable furniture, blankets, toys, books, pets, food, etc. Encourage the part to make that imaginary place as safe and comfortable as possible. Inform the part that No One is allowed into that place without the part’s permission. Once the place is ready, in your mind’s eye invite the part go to that place and give it some time to stay there and see how it feels. If the part feels good and comfortable, the place is ready for the future use. If the part feels uncomfortable ask the part what needs to be changed or added in order to increase safety and continue working with the part on modifying the place until part feels good about it.

I am wishing you healthy holidays that are supportive of your healing journey!