Monsters on a healing journey

The following video explains how trauma happens, how it effects our lives, and how we cope and then heal from it. It is told in a form of story involving pictures of monsters and stick people. I believe it helps understand what trauma does to us on a more emotional level. Please, watch and comment.

"Monsters in our lives" video

National PTSD Awareness Month

     June 2013 is a PTSD awareness month. Different events are being held across the nation to improve understanding of experiences and awareness of signs and treatments of PTSD. As I am waiting for the start of the community discussion on PTSD facilitated by Dr. Susan Fuhr (http://www.yourjourneys.net/), I am reflecting on what it means to be diagnosed with PTSD, to live with PTSD. On a daily basis I talk to folks, who survived different kinds of traumas. I hear the stories of survival and struggle. Often there is a lot of hopelessness and despair. Always there is a lot of pain. It is very understandable given what trauma survivors went through. They experience normal reaction to the abnormal situation, even though many of them and their significant others do not think that survivor's response is normal.
     I would like to share some of my thoughts on PTSD. In the past two decades our understanding of this disorder changed a lot due to developing research and clinical practice. We know now that this disorder has neurological underpinnings, and that it changes brain. We know that it affects individuals on all levels: physical, cognitive, emotional, social, and spiritual. We also understand that trauma wounds are not healed by just time and do not go away on their own.
     In spite of all the pain and hardship that PTSD comes with, there is a lot of hope too. In the past decade a number of treatments became available to trauma survivors. Among them are EMDR (http://www.emdria.org/),Internal Family Systems (http://www.selfleadership.org/), Somatic Experiencing (http://www.traumahealing.com/), Sensorimotor therapy (http://www.sensorimotorpsychotherapy.org/), and cognitive processing therapy (http://www.ptsd.va.gov/public/pages/cognitive_processing_therapy.asp). All of these treatment modalities have shown tremendous success in treating the effects of trauma and helping survivors find a way to make sense of what happened to them, assimilate their experiences, and truly move forward with their lives.
     In addition, a number of complimentary approaches were introduced, including yoga (http://www.yogajournal.com/) and mindfulness (http://www.mindful.org/). These practices help survivors re-learn how to be present with their current experiences. They help people stay grounded in the present moment as opposed to the past events. They also have tremendous calming effect on the nervous system and brain.
     If you were to take  away  just one point from this post, let it be the following: PTSD can be treated. Get professional help! The sooner you address it, the better results you will get.
   

Packing for a journey: tools and skills

     Healing from trauma is a long process and a substantial journey. As any big trip it requires preparation and right gear. For some journeys we need clothes and a sleeping bag for others we need tools and skills. This post will help you understand a broader picture of what you may need to support your healing journey. The posts that follow will expand on each category and teach you specific skills.

     Very often when trauma is over, we find ourselves behaving in self-destructive ways, such as abusing alcohol or drugs, cutting self, taking unjustified risks, engaging in unsafe sex and so forth. This happens not because we really want to hurt ourselves but because we are reaching for what is available and quick to relieve our emotional pain. A couple of drinks can really take the edge off in this moment. A one night stand can temporarily relieve loneliness and create a moment of pleasure.  

     The truth is we want to cope. We want to feel better. But we don’t know of lasting and effective ways to bring relief. Nobody teaches us in school or college the skills we might need if we get traumatized. Good news is that we can obtain what we need at any age by understanding common emotional needs of trauma survivors and learning specific ways to address them. So, let’s get to the bottom of it. The table below  summarizes common emotional needs and issues of trauma survivors and suggests different tools and skills that can be helpful in dealing with each one of those. 

Common emotional concerns of survivors	Focus of learning	Skills & Techniques
Mood & affect instability	How to tolerate distress and pain without falling apart; How to improve mood	Distraction Self-soothing Mind-body techniques Containment
Anxiety, hyperarousal, stress and tension	How to tolerate anxiety; How to reduce anxiety	Mind-body techniques Imagery techniques, i.e. Safe Place
Relieving past traumatic experiences: flashbacks, obsessive thoughts, sudden intense emotions	How to be in and return to the present moment	Grounding Mind-body techniques Containment Safe Place Visualization
Difficulty communicating with or relating to others	How to express self effectively; How to listen to others efficiently	Expressing your thoughts and feelings Asking for what you need Effective use of “no”
Non-specific difficulties functioning at the “normal” level	How to take good care of self	Basic  self-care: sleeping, eating, exercising
Negative self-image & shame	How to focus on the core goodness; How to focus on the positive aspects of self	Loving kindness meditation Positive self-talk & affirmations Discovering anger
Persistent feelings of guilt		Loving kindness meditation Forgiveness practice
Intense anger	Validation & safe expression of emotions	Coping affirmations Time out Safe expressions of anger
Suicidal thoughts, impulses to self-harm, homicidal thoughts	Understanding the nature of the thoughts/impulses	Survival kit/box

     In the next several posts I will describe the skills summarized in the table above in detail. Each post will focus on the specific emotional concern (left column of the table) and teach you skills to address or cope with this concern. Some of the skills or concerns have been described in the previous posts. You will find links to those posts in the table.
     As a conclusion, healing from trauma is a long process that takes courage, perseverance, time, and multiple resources. It is a long journey. As any successful journey, it has to be planned and prepared for. Think of learning and practicing coping skills as a very important preparation step.You need those tools in order to cross the "oceans" and "desserts" that you will meet on your way and to reach the oasis of  healed and whole self. So, do not regret time and energy you spend at this step of the process. It will serve you very well once you delve into reprocessing traumatic memories, the most painful part of the .journey.

Tools and skills: Calming and safe place visualization

Many people that I have talked to throughout the years are on the lookout and in search for solutions, prescriptions, and things to do to improve their current mental health situation. I often share this wonderful tool, which proved very helpful to many of my clients. Now, here is a caveat. In order for this tool to be helpful it has to be learned, practiced, and then used. It seems obvious. However, folks often forget this banal truth and expect the tool to work just because they read about it and maybe did it once.

     Calming or safe place visualization is a tool that is helpful in managing anxiety, dealing with stress, re-establishing sense of safety after painful and traumatic experiences, and improving mood.

     This is how it works:

1.     Identify a place that seems calming to you. It may be a natural scene, like an ocean beach or a meadow. It may be a man-made place, like a house or a room or a cave. It may be real, such as a cabin you visited in the past, or completely imaginary, such as a yurt on a faraway star. There are two very important considerations, when you work on identifying the calming place:

a.     Nothing remotely negative has ever happened there. For example, often people choose their former room in the childhood house. This place maybe associated with a lot of positive memories and experiences. However, for most folks something not that pleasant probably happened in that room as well. Maybe they were punished and isolated there at one point or had a fight with their friend or a sibling there. In those kinds of situations, the place can be easily “contaminated” by not so pleasant and relaxing feelings stemming from the past memories.

b.     The image of the place makes you feel good, such as calm, relaxed, joyful, safe and so forth. If this is not the case, choose a different place or a different image.

2.     Give this place a name, so that you can pull it up in your mind easily. I suggest that the name is simple but specific. For example, “Blue condo on the beach” or “Moon cave” or “Eagle Mountain”. It is again important that this name has only positive or neutral associations in your mind.

3.     After you identified a place and gave it a name, you are ready for visualization. Recording posted in this post will lead you through further developing and strengthening this place in your mind. It is 11-12 minutes long. I suggest that you listen to it during the time when you are not likely to be interrupted.

4.     Once you listened to the recording several times in the course of several days or a week, you are ready to start practicing without the recording. I suggest taking few minutes every day to imagine that you are in that calming place, while breathing deeply and relaxing. The best times to practice are the following: just before you fall asleep in the evening and the first thing after you wake up in the morning. Practicing daily for a week will strengthen the image and its association to relaxation response.

5.     After a week of practicing during generally calm times, you can start using this image to cope with stressful situations. Say you are in a stressful meeting at work and feeling so frustrated that you are ready to pull your hair out. Allow yourself to withdraw from discussion for a few moments. Take a mental pause, recall the name of your calming place, and imagine that you are there. Breathe deeply as your mind is relaxing into the image of that place. When you are ready or need to leave the calming place, remind yourself that you can come back anytime. Leave the place in your imagination and bring focus of your attention back to the meeting.

Relaxing place is a wonderful coping tool if used on the regular basis. Take any opportunity to practice the safe place, such as standing in line at the grocery store, stopping your car at the red light, being put on hold during a phone conversation, during a tense conversation and so forth.

Let me know what experiences you had with this tool and whether you have any questions or concerns about it.

Healing is a journey

     As I was looking at the posts from the previous months, I realized that even though they have been covering important healing issues, they felt very random. The main framework, the bigger picture was left out. So, this post looks at the forest not the trees of healing.

     I often hear from my clients that they want to be over their ordeal NOW or even better LAST WEEK, MONTH OR YEAR. My heart goes out to them and all other survivors struggling in this very moment, as I understand this desire very well. Who would like to spend another second suffering from anxiety, depression, panic attacks, feeling suicidal or stuck in the nightmares or horrible memories of what happened? Clearly, no one.

     From my perspective, here is the biggest challenge of a sudden trauma, such as an assault, a military attack, an earthquake, a murder or a sudden death of someone close. It kicks us out of our normal ordinary comfortable life and destroys all the paths back to it. We cannot go back no matter how much we want to or how hard we try. But we continue to carry with us a memory of how it was before. We desperately want to recreate it. We do not understand that it is as if a nuclear bomb was dropped on our house and we need to leave that place behind and move to the new grounds. Now, chronic traumas, such as childhood abuse, domestic violence, living in a criminal environment have somewhat different major challenge. We get so accustomed to living in the war zone, that we either forget or do not know that it is not like this everywhere, that there are safe places and caring people outside of the fence. We do not believe that a better life is possible, if we dare to leave the current situation. Whether we suffered from a sudden or chronic trauma or both, there are several general tendencies that are associated with healing from the aftermath.

     Many people ask me and themselves why it takes such a long time to heal from something that took few seconds, minutes, hours or something that is so far in the past. My understanding is that it is very easy to destroy something and much more difficult to create, grow, and heal. A production of a human being  takes nine months in the mother’s womb, multiple years of caregivers taking care of him/her,  loving and teaching, before a person can be self-sufficient and stand on his/her own. How much does it take to destroy this precious life? Often, just few seconds. Another less horrid example is getting injured while going through some kind of athletic training. Again, takes just a moment. A second ago you were strong capable athlete and now you are lying on the ground screaming from the pain of a broken ankle. It will take months of careful treatment and rehab to heal it and more months to get back in the pre-injury shape.  SO, here is the first important fact of healing. It takes time.

     When we get a small physical injury, like a paper cut, it can heal on its own with minimal effort on our part. When an injury is more serious, such as a bullet wound, it requires much more attention and effort in order to be remedied. We have to clean the wound, medicate it, bandage it and so forth on the regular basis. It is very similar but more complex, when it comes to a psychological wound. We need to tend to it in order for it to heal. But tending to it is painful and the wound is not visible, so the temptation to avoid dealing with it is often very strong. We often pretend that it is not there, while it continues to fester. Alternative of acknowledging it, looking at it, talking about it is so frightening. But the wound will not heal unless paid attention to. The second important fact of healing is: it takes effort.

     Traumatic events stand out of the realm of the ordinary human experiences. Those are things that should not be happening in the normal human life or things that happen once in a lifetime. As a result, we are not equipped to deal with them. We simply do not have knowledge, skills and tools necessary to patch those wounds. No one is prepared. It is not our fault. However, now that we have been injured, it is our responsibility to learn those new skills. We need to figure out how to re-create a sense of safety to continue functioning. We need to learn who and how we can trust. We have to develop an ability to take extra-good care of ourselves. We have got to learn how to cope with anxiety, depression, desire to self-harm, nightmares and other things we might have never experienced before. Many of us also have to put together a new picture of the world, because often the old one was blown up in pieces by the traumatic events. The third important fact of healing: new knowledge and skills have to be obtained.

     There are many tasks in life that we can accomplish self-sufficiently on our own. Healing from trauma is not one of them. We need help and support from others in order to heal. For many people, who have experienced interpersonal traumas of abuse and betrayal by other humans, seeking support is very tough. How do we know that those in helping role will not take advantage of us or betray us? How can we rely on someone, when we survived only because we relied on ourselves and our strengths? How can we overcome shame and embarrassment of telling another human being of what happened and how we coped? How can we trust them to not reject us after they learn what we have been through? Those and others are complicated questions. Many survivors struggle with them for years. Some make decisions to avoid relationships all together.  Others stumble through and get hurt over and over again. If you cannot fathom asking another human being for support, I suggest starting with individual therapy and developing supportive relationship with your therapist. The fourth important fact of healing: we need support of other humans to heal and move forward.     

     The process of healing also has its own rhythm and structure. Years of clinical experience and research suggest that there are certain stages that trauma therapy has to go through. In general, the process is described as having three stages: (1) stabilization stage includes learning new skills, coping with current issues and symptoms effectively, developing a sense of normalcy and safety; (2) reprocessing trauma stage is about reconstructing traumatic experience or processing it, as well as mourning losses associated with it; (3) integration stage includes assimilating new experiences and perspectives, such as new picture of trauma and new perspective on the world; it also includes internal integration of different parts of self that were and were not affected by the events. This framework can be applied to the effective healing process. In addition, timing is an important consideration too. Many of my clients have experienced feeling stuck and frustrated for month only to experience sudden insight one day. Many are also familiar with the experience of taking a step forward only to take two steps back. All of those experiences are normal and a part of healing. Sometimes survivors try to push through and expedite the process of healing. It can be facilitated but only so much. Like a plant has to be a seed and a sprout before it becomes a full-grown plant, so the process of healing has to unravel. It is important to know and respect this gradual growth.  The fifth important fact of healing is that the process has its own rhythm, timing, and structure that have to be respected.

     Finally, we also have to respect our own internal rhythm of coming to terms with what happened. Our psyches are complex and adjusting to the injury takes a number of different steps. Many people go through the following stages: (1) initial shock and feeling numb or overwhelmed; (2) denial that trauma was a big deal or that it had any impact, trying to persuade self and others that they are coping well or are over it; (3) anger often comes next brining in focus realization that they were wronged and that what happened was extremely unfair; folks may also just be angry and irritable at others around them and at the small life stresses without realizing the underlying cause; (4) profound sadness and depression is the stage that is associated with realization of how much was lost; the most difficult realization of all is associated with the loss of parts of self and  ability to enjoy life; (5) finally, acceptance sets in; with it comes a deeper level of understanding about what happened  and that old reality is gone forever; survivors may not like this fact at all but they don’t fight against it anymore. Most folks go through these stages multiple times, back and forth, feeling completely done and accepting, only to find themselves in the throws of anger or denial again. It is a normal process. It feels painful but there is nothing wrong with the process itself. It often helps survivors to understand the dynamics and not blame themselves for the “slow progress” or “relapse”. The sixth important fact of healing: our psyche moves back and forth and gets stuck and unstuck multiple times as we heal.

     I understand that the steps and big picture of healing may seem overwhelming at first. It may take you reading and reflecting on this post a number of times or digesting it in small portions. The idea behind it is to give you hope and understanding that healing is possible and that you have some control over the process. You can take helpful steps, you can stay away from interfering with it too much. You can heal!

     To summarize, the bigger picture of the healing from any trauma includes the following aspects:

1.     Plenty of time

2.     Survivor’s effort

3.     Obtaining new knowledge and skills

4.     Support of other humans

5.     Respect for the rhythm, timing, and structure of the healing process

6.     Acceptance of the cyclical nature of healing and being stuck at times  

I am interested in your comments and questions. The best of luck on your journey!

Dealing with shame

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     Shame is a common consequence of trauma, especially interpersonal injury or stressful events that lasted for a while. When we are treated cruelly, when we are abused by other people, it leaves us feeling like we are bad and not deserving love. Because why else would we be subjected to violence? Trauma survivors may experience shame as ranging from nagging background feeling of not being good enough to the full-blown self-hatred and desire to kill themselves as they are not good.

     Shame maybe defined as a painful emotion caused by a strong sense of embarrassment, unworthiness, or disgrace. Feeling of shame is profound. It affects the way we perceive ourselves. It tells us that we are bad, incompetent, and unlovable. Shame is a toxic emotion, especially when it is experienced on the regular basis. People tend to hide shame, because nobody wants to seem inadequate or bad. As a result, shame is an emotion that is very difficult to express. It loves dark places. It tends to thrive in hiding. Because of the aforementioned qualities, shame is very difficult to deal with.

     I am going to discuss several approaches that compliment each other and can be used together to alleviate painful effects of shame.

     Developing a sense of worthiness and self-acceptance is a potent antidote to shame. There are many ways to work on that. I particularly like two practices described below. When exercised daily over several months to a year period of time, they may lead to dramatic positive change in the level of self-acceptance.

·        Loving kindness meditation is an ancient practice with its roots in Buddhism. The full practice has practitioner wishing wellness, health, love, and so forth to him or herself first, then to a friend, a neutral person, an enemy, and finally all humans. For our purposes, I suggest using only the first part of meditation, which is wishing yourself well.
Here are the instructions: Choose the phrases that you will be working with (repeating) that start with “May I” and focus on wishing yourself well. Usually, meditation consists of  3-4 phrases repeated over and over again. If you find it difficult to come up with those phrases, here is my suggestion:
- May I be well
-May I love myself no matter what
- May I accept myself just the way I am
- May I be content
After you identified and wrote down the phrases you are going to use, find a quiet place, where you will not be disturbed by anyone or anything. Sit in a comfortable position, such as with your legs crossed on a cushion or in the chair or on the sofa. Close your eyes and focus on your breathing for a few moments. Notice how you breathe air in and how you breathe it out. Then visualize yourself surrounded by white or yellow light. Feel the warmth of light on your skin. Enjoy the sensations. Now start saying the phrases that you identified out loud or silently in your mind. Pause after each sentence and connect to the wish it contains. Maintain awareness of your breathing and picture of yourself surrounded by white light. Spend 3-5 minutes repeating the phrases. Repeat this practice daily.
Note that for the first couple of months wishing yourself love and acceptance may feel false or wrong. Some parts of you may think that you don’t deserve all of those things. It’s OK. You don’t have to believe in what you are saying to get positive results. Additionally, the more often you practice this meditation the more you will feel and believe in your worthiness.

·        Affirmations, when used many times a day and especially during the times you feel unworthy or evil, are a great tool for reducing shame. Affirmation is a positive statement about yourself in the present tense. For example, I am wonderful just the way I am. The more specific and relevant  a statement is to the specific thoughts associated with shame the more effective it would be. I suggest working with 1-3 affirmations at a time. To develop helpful affirmation notice what thoughts come up for you when you feel inadequate. Then create a sentence that describes you as a complete opposite of that. So, if you think “I am unlovable”, the appropriate affirmation will be “I am lovable”. If you think “I am a bad person, who does not deserve to live”, a helpful statement will be “I am a good person, and I deserve a good life”. I hope you got the concept. Once you develop one to three affirmations, start using them multiple times a day. I suggest repeating them several times right upon awakening, when you feel ashamed, inadequate or bad, and right before you go to sleep.

      Properly directing and expressing your anger is another powerful technique for combating shame. The theory behind it is that trauma survivors often couldn’t feel anger at their abusers at all or to the full extent, because it was very dangerous at the time and could have prolonged violence. So, substantial part of this anger was directed at self. It was an essential survival tool that helped survivors come out of trauma with minimal possible injuries (even if they were substantial, they would have been worse if a survivor expressed full extent of his or her anger at the perpetrator). If trauma is over at this point, anger can be reconsidered and directed properly.
     So, anytime you feel shame, ask yourself “Who am I angry at right now other than myself?” After you identify a person or situation you are angry at in the moment, find a way to safely express your anger. Some options include journaling about it, aerobic exercise, talking to a safe person about your feelings, singing or yelling in the shower. In some situations it may help to tell the person you are angry at how you are feeling. However, it is not advisable if your anger is too intense or if the person has a potential to become or has been violent in the past.  

          Talking to trusted others about your shame and experiences that caused it is one of the best ways to reduce or eliminate it. Remember that shame loves dark places and hiding. When you shed light on it by talking about it, shame runs away. There are several crucial considerations factoring into decision to open up to someone else. First, it is important to choose a person you trust. Ideally it should be someone, who is able to listen and understand difficult experiences, who is open about their own challenges and difficulties, and who responds with compassion to pain of other people. Second, be aware that initiating and having this conversation, especially for the first time, will not be a comfortable experience for you. And, it’s OK. Just prepare yourself for a challenge. Also, first couple of times you talk to others, shame may increase. Let the person you talk to know about that and ask for what you need from them whether it’s a hug or reassurance that they accept you or something else.

     Working on reducing or eliminating shame is a long-term process. Please, be patient with yourself. However, if the aforementioned techniques don’t make any difference in how you feel within a couple of months, seek professional help from a mental health professional.

     As always, I am interested in your feedback, questions, and comments. Please, share them on the blog page if at all possible.

How to care for self - part 3

    This last part of the self-care series is devoted to taking care of spiritual needs. Some folks may feel that it is not relevant to them and roll their eyes or skip this post altogether. However, all human beings are SPIRITUAL beings independent of their faith and religious affiliation or lack of it. We all share similar spiritual needs just like we share physical needs in sleep and food. We find different ways of attending to our spiritual needs.  At times we neglect them, because we are unaware or we don’t have time or it is too painful to tend to our spirit. This post will discuss our common spiritual needs and suggest some ways to meet them. It will also offer some direction for finding your own ways and practices to meet your spiritual needs.

     There are many different definitions of spirituality and spiritual needs. For the purposes of this article, I compiled my own definition based on multiple sources.  Spirituality is the individual’s search for connection with the Sacred, where sacred can be understood as something larger than oneself, different from the ordinary, not material, and worthy of veneration. For some people Sacred is equated with God, for others it is Universe or Nature or World or Community.

     According to Dr. Galek and her colleagues’ research published in 2005, there are seven major spiritual needs: (1) love, belonging, and respect; (2) connection with the Divine; (3) positivity, gratitude, hope, peace; (4) meaning and purpose; (5) morality and ethics; (6) appreciation of beauty; (7) resolution of death. It is important for us to be aware of what we struggle with and what we need in each of those areas.

     One of the most common and obvious ways to meet spiritual needs is by attending  a church. There are so many choices of churches in the United States today, and people of almost any religious tradition can find a place to go. Spending time with other believers, reflecting on religious teachings, praying, and participating in discussions help to meet many of those aforementioned needs. However, attending the church is NOT the only way to take care of your spirit. Some people find that their spiritual believes don’t fit in any particular tradition or that their believes change and evolve in a different way. Others find that attending the church meets only some of their needs and not others.

     If you feel like church is not for you or it is not enough, you can choose to develop your own spiritual self-care program. Here are some common practices that can help you feel spiritually well, when performed regularly.

1.      Prayer: talking to God. When you do this on the regular basis in any way that you find acceptable for you, you feel more connected with the Divine spiritual nature of human life. You may also feel loved by God, grateful for what you have, hopeful about the future, and more aware of your life’s meaning.
     There are so many different kinds and types of prayer and so many religious traditions that it is difficult to give an example without excluding or offending someone. Here is one prayer that many people struggling with addictions have found helpful over the years. It was originally written by the 20^th century American theologian Reinhold Niebuhr and later adapted by the Alcoholics Anonymous:      God, give me grace to accept with serenity the things that cannot be changed,  
     Courage to change the things  which should be changed,
    and the Wisdom to distinguish the one from the other. This prayer can be addressed to the Universe, the World, the Wind, Sacred Feminine, Universal Power or anything else that resonates with you.

2.      Meditation: quiet contemplation and reflection with the goal of training the mind to be a witness. There are many different techniques and approaches to meditation. Many past accounts and stories from such traditions as Buddhism and Yoga described very positive effects of regular meditation on mind, body, and spirit. In the past twenty years research has been catching up and showing multiple positive effects of meditation practice on a meditator’s emotional and physical health. This practice can help you meet a number of your spiritual needs, including but not limited to feeling connected with the Divine, feeling more positive, grateful, hopeful, being more aware of your motivations and the nature of choices you make.
     If you would like to read more about meditation or to learn some meditation techniques, visit http://www.project-meditation.org/.  For free guided meditations go to http://marc.ucla.edu/body.cfm?id=22 or to http://www.audiodharma.org/series/1/talk/1835/
     Here is a simple instruction for an insight meditation. Choose a place where you will not be disturbed, sit in a comfortable position, such as cross-legged on the cushion or in the chair with both feet on the floor. Decide for how long you are going to be meditating. To start with I suggest 5 or 10 min. As you get more comfortable with the practice, you can gradually increase time to 30-45 min. Set an alarm clock or a timer so that you don’t have to worry about the time. Then focus on your breath noticing how you breathe air in and how you breathe it out. Just pay attention to the process of breathing without any judgment or criticism. When you get distracted by a thought, sound, a feeling or something else, just acknowledge the distraction and bring your focus back to your breath. Mind always gets distracted, it is normal. So, you may have to bring yourself back to the focus on your breath multiple times during the 5 minute meditation.
     A helpful hint for the aforementioned meditation technique: find a part of your body that is affected by your breathing the most, such as area around your nostrils, your chest, or your stomach and focus on this area as you breath. It gives your mind something very concrete to focus on as opposed to the general idea of breath. Some people find it helpful to say in their minds something like “Inhale” every time they breathe in and “Exhale” every time they breathe out.

3.      Gratitude Journal. This practice consists of taking time every day to reflect on what you are grateful for in your life that day and then write it down. These may be big things like having a loving family or a beautiful house or little things, such as a smile of a stranger or a cup of warm tea. This practice, when performed regularly, may help you shift perspective from a glass half empty to a glass half full attitude and develop an appreciation for grace and beauty that all of us encounter every day.

4.      Loving Kindness or Metta Practice: helps you develop, deepen, maintain and exercise kindness to yourself and others. To do it, sit down and focus on repeating several phrases over and over again. First applying them to yourself, then a loved one, a neutral person, an enemy, and finally all people. Here are the examples of the phrases that can be used for this practice:     May I (he, she, they, the name of the person) be well
     May I be happy
     May I be free of suffering
As you repeat the phrases, visualize the person they are addressed to. Sometimes it helps to put one or both of your hands on your heart area and imagine that your heart is generating light and warmth.

5.      Spiritual reading and reflection. Choose a book by a spiritual leader/author, who inspires you. For me personally, books by Pema Chodron and Thich Nhat Hanh are always helpful, connecting and calming. If you are not sure, what book you would like to read, ask your family, friends, and mentors for recommendations. The following webpages contain the lists of “the best” or most popular spiritual books:
 http://www.abebooks.com/docs/ReligiousSpiritual/spiritual-books.shtml
http://www.spiritualityandpractice.com/books/features.php?id=21956
http://www.amazon.com/Best-Spiritual-Authors-Books-List/lm/RC93KEJHT46C
Alternatively, you can always choose the sacred text of your tradition, such as the Bible or the Qur’an or the Torah.
     Choose a quiet place and read 1-2 pages of the book your chose. Reflect on the writings and/or journal about them. Do it on a daily basis.
     This practice can help you feel more connected to the Divine, other spiritual beings, hope and meaning. It can also help develop and maintain “bigger picture” perspective on life.

6.      Being in nature. Spend some time outside on a regular basis, whether it means going for a walk in the park, fishing, gardening, or just seating and watching the natural surroundings. Pay attention to all of your senses. What do you see, smell, hear?
     This practice can be very connecting and help you develop deep understanding of you as a part of the whole. It can also help get in touch with gratitude, joy, and hope.

     If you did not find anything that resonates with you in the list of practices that I described above, explore a list of 37 spiritual practices at  http://www.spiritualityandpractice.com/practices/. So, choose one practice and focus on performing it regularly, preferably on a daily basis. Of course, if the practice you chose, does not feel helpful or seems harmful, stop doing it. Choose a different practice or consult with your therapist, spiritual counselor, or another healer.

     Often people recovering from trauma have many difficult spiritual and religious questions that they are either afraid of approaching or have difficulty finding an answer to. Why did this happen to me? Where was God? My perpetrator was never punished, where is justice? People are saying I need to forgive, why should I? Those and others are very important questions. It may help to seek some spiritual counseling and advice from the religious/ spiritual leaders in your community that feel trustworthy to you. It may also help to talk to a mental health professional about those struggles.

     Spiritual healing is as important as physical and emotional healing. Without acknowledging and addressing our spiritual wounds, we cannot properly heal. However, it is important to remember that focusing on spiritual aspects of healing, does not mean pushing yourself to go, where you are not ready to go. For example, trauma survivors often feel pressure from others to forgive their perpetrators, especially if it is a family member. They work on it. They either make themselves forgive before they are ready or find that they cannot no matter how hard they try. As a result, this kind of forgiveness either covers up and further buries non-expressed anger and hurt or leaves survivors feeling inadequate, because they cannot forgive. Both of those outcomes slow down or interfere with emotional healing. Therefore, be gentle with yourself. Healing is a process and timing is everything. It is perfectly OK to be where you are at right now. It is perfectly OK to take your time to heal and do it at your own, not someone else’s, pace.

     There are a lot of resources available to spiritual seekers today. I listed some of them in the article. I would like to mention a couple more resources here:

·        www.spiritualityandpractice.com – website that supports people in their own spiritual journeys with multiple resources, such as descriptions of different practices, bibliographies and filmographies, e-classes, newsletter, etc.

·        http://www.contemplativemind.org/practices/tree - this website is about contemplative practices; the page that I refer you to has a very nice classification of these practices with descriptions.

     In the past three posts we talked about different ways to take care of yourself. Now is the time to put it all in practice and create a comprehensive mind-body-soul self-care program. Sounds pretty serious, doesn’t it? It does not have to be dead serious and solemn. I invite you to play and experiment with different practices. It can become a process of learning and self-exploration. As you work on developing or modifying your self-care program there are a couple of things I would love for you to keep in mind:

1.      No matter what you believe in the moment, you deserve to be taken care of! Can you repeat to yourself as often as possible something like “I am worthy of care”? The more you repeat it, the more you start believing it. The more you believe it, the more you will act like it.

2.      Be compassionate towards yourself. Compassion creates environment conducive to healing. I believe that any wounded being can heal over time surrounded by kindness and compassion. Who can do it for you better than yourself? You are with you 24/7. If there is just one practice that I consider to be fundamental for survivor’s healing, it is Metta or Loving-Kindness. Do it for yourself on a daily basis, let it become your mantra, and you will start seeing positive changes very soon.

I am always interested in your comments and questions. Please, post, and I will try to respond ASAP J