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Using Components of an Evidence-Based Therapy in the Classroom SPARCS SPARCS Angel Knoverek, MS, LCPC Chaddock, Director of Trauma Initiative

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Presentation on theme: "Using Components of an Evidence-Based Therapy in the Classroom SPARCS SPARCS Angel Knoverek, MS, LCPC Chaddock, Director of Trauma Initiative"— Presentation transcript:

1 Using Components of an Evidence-Based Therapy in the Classroom SPARCS SPARCS Angel Knoverek, MS, LCPC Chaddock, Director of Trauma Initiative

2 Copyright 2008 by North Shore - Long Island Jewish Health Systems, Inc., Great Neck, New York SPARCS:Structured Psychotherapy for Adolescents Responding to Chronic Stress A Trauma-Focused Guide Ruth DeRosa, Mandy Habib, David Pelcovitz, Jill Rathus, Jill Sonnenklar, Julian Ford, Suzanne Sunday, Christopher Layne, William Saltzman, Ayme Turnbull, Karen Mahoney, Victor Labruna, & Sandra Kaplan North Shore University Hospital Manhasset, New York

3 Copyright 2008 by North Shore - Long Island Jewish Health Systems, Inc., Great Neck, NY SPARCS Why SPARCS:

4 Copyright 2008 by North Shore - Long Island Jewish Health Systems, Inc., Great Neck, NY Sparc To set in motion; activate To rouse to [mindful] action A latent element capable of growth or development

5 Copyright 2008 by North Shore - Long Island Jewish Health Systems, Inc., Great Neck, NY For adolescents between years old For adolescents between years old 16 Sessions (60 minutes per session) 16 Sessions (60 minutes per session) History of chronic (interpersonal) trauma History of chronic (interpersonal) trauma Designed for adolescents who may be living with significant ongoing stressors Designed for adolescents who may be living with significant ongoing stressors May or may never have met full criteria for PTSD May or may never have met full criteria for PTSD Exhibit functional impairment Exhibit functional impairment Present-focused and Strength-based Present-focused and Strength-based No systematic exposure component included No systematic exposure component included SPARCS

6 Copyright 2008 by North Shore - Long Island Jewish Health Systems, Inc., Great Neck, NY SPARCS Core Skills MAKE A LINK = communication & connecting with others MAKE A LINK = communication & connecting with others LetMGo = problem-solving and creating meaning LetMGo = problem-solving and creating meaning Distress Tolerance = coping more effectively in the moment Distress Tolerance = coping more effectively in the moment Mindfulness = cultivating awareness Mindfulness = cultivating awareness

7 Copyright 2008 by North Shore - Long Island Jewish Health Systems, Inc., Great Neck, NY Session 1Welcome and Intro Session 2Stress, trauma & the body Session 3Mindfulness: States of Mind Session 4Mindfulness: Path to Wise Mind Session 5Distress Tolerance: Self-Soothe Session 6Distress Tolerance: Distract Session 7What is Trauma? Session 8 LETM GO Session 8 LETM GO Treatment Overview

8 Copyright 2008 by North Shore - Long Island Jewish Health Systems, Inc., Great Neck, NY Session 9LETM GO, Part 2 Session 10MAKE a LINK Session 11MAKE a LINK, Part 2 Session 12Anger & Triggers Session 13Portrait of My Life Session 14Expectations & Beliefs Session 15LETM GO & MAKE a LINK, Revisited Session 15LETM GO & MAKE a LINK, Revisited Session 16Graduation Session 16Graduation Treatment Overview

9 Copyright 2008 by North Shore - Long Island Jewish Health Systems, Inc., Great Neck, NY SOS S LOW DOWN Take a time out; calm your body; one thought at a time O RIENT YOURSELF Bring your mind & body back to the present time and place S ELF-CHECK Rate your level of personal distress and sense of control here and now

10 Copyright 2008 by North Shore - Long Island Jewish Health Systems, Inc., Great Neck, NY See SPARCS Handout H 1.2 SOS Slow Down OrientSelf-Check Ford et al., 2001

11 Copyright 2008 by North Shore - Long Island Jewish Health Systems, Inc., Great Neck, NY Feeling Intensity Thermometer Personal Distress Right now I feel … Completely Calm Most Distressed Ever Personal Control Right now I feel … In complete control Totally out of control

12 Copyright 2008 by North Shore - Long Island Jewish Health Systems, Inc., Great Neck, NY See SPARCS Handout H 1.3 SOSThermometer

13 Copyright 2008 by North Shore - Long Island Jewish Health Systems, Inc., Great Neck, NY Woven Throughout the Treatment

14 Copyright 2008 by North Shore - Long Island Jewish Health Systems, Inc., Great Neck, NY Paying attention in a particular way: On purpose, in the present moment, and nonjudgmentally Kabat-Zinn, 1994

15 Copyright 2008 by North Shore - Long Island Jewish Health Systems, Inc., Great Neck, NY The quality or state of being mindful ….of being AttentiveHeedfulThoughtfulEarnestIntentional Adapted from the Oxford Dictionary

16 Copyright 2008 by North Shore - Long Island Jewish Health Systems, Inc., Great Neck, NY Mindfulness Practice: Observe Your Thoughts ObserveDescribeParticipate Without Judgment Stay Focused Do What works

17 Copyright 2008 by North Shore - Long Island Jewish Health Systems, Inc., Great Neck, NY Its not just WHAT youre thinking but HOW youre experiencing it. Its not just WHAT youre thinking but HOW youre experiencing it. What youre thinking is separate from who you are. What youre thinking is separate from who you are.

18 Copyright 2008 by North Shore - Long Island Jewish Health Systems, Inc., Great Neck, NY

19 Wise Mind & Mindfulness: Regulation of Affect and Impulses Regulation of Affect and Impulses Somatization Somatization Attention Attention Self-perception Self-perception Rated most helpful Rated most helpful Pieces of the Intervention for…

20 Copyright 2008 by North Shore - Long Island Jewish Health Systems, Inc., Great Neck, NY Mindfulness Research Mindfulness Research Mindfulness practice associated with: changes in brain function improved physical health- improvement in symptoms: –cancer, diabetes, fibroymyalgia, psoriasis, chronic pain improvements in psychological well-being –Decreased rate relapse and recurrence of MDD (Baer, 2003) –Decrease in anxiety (Baer, 2003) –Improvements in general mood and decrease in stress (Baer, 2003)

21 Copyright 2008 by North Shore - Long Island Jewish Health Systems, Inc., Great Neck, NY Mindfulness Practice: Changes in Brain Function Mindfulness Practice can produce increases in relative left-sided anterior activation that are associated with reductions in anxiety and negative affect and increases in positive affect (Davidson, et al., 2003) Mindfulness Practice can produce increases in relative left-sided anterior activation that are associated with reductions in anxiety and negative affect and increases in positive affect (Davidson, et al., 2003) –Still evident 4 months later Activates the neural structures involved in attention and arousal/autonomic control of the nervous system (Lazar et al., 2000) Activates the neural structures involved in attention and arousal/autonomic control of the nervous system (Lazar et al., 2000)

22 Copyright 2008 by North Shore - Long Island Jewish Health Systems, Inc., Great Neck, NY Mindfulness Practice: Changes in Brain Function Monks & Mindfulness (Lebow, 2005): Monks brain waves were better organized and coordinated Monks brain waves were better organized and coordinated Higher activity in left prefrontal cortex = associated with happiness Higher activity in left prefrontal cortex = associated with happiness Differences apparent during periods of non-meditation = Differences apparent during periods of non-meditation = fundamental changes in how the brain operates Magnitude of differences related to length of practice Magnitude of differences related to length of practice

23 Copyright 2008 by North Shore - Long Island Jewish Health Systems, Inc., Great Neck, NY Mindfulness Practice: Improved Physical Health Increased flu antibodies following 8 weeks of mindfulness Increased flu antibodies following 8 weeks of mindfulness (Davidson 2003) Improvements in symptoms related to numerous medical conditions Improvements in symptoms related to numerous medical conditions –Chronic pain (Kabat-Zinn 1982, 1987; Randolph et al. 1999) –Fibroymyalgia (Goldenberg et. al. 1994) –Psoriasis (Kabat-Zinn, et. al. 1998)

24 Copyright 2008 by North Shore - Long Island Jewish Health Systems, Inc., Great Neck, NY Mindfulness Practice: Improvements in Psychological Well Being Rated as most helpful by teens diagnosed with BPD Rated as most helpful by teens diagnosed with BPD (Miller et al., 2000) Improvements in general mood and decrease in stress Improvements in general mood and decrease in stress (Baer, 2003) Decrease in anxiety Decrease in anxiety (Baer, 2003) Decreased rate of relapse and recurrence of MDD * Decreased rate of relapse and recurrence of MDD (Baer, 2003) * Findings evident in many populations Findings evident in many populations –e.g. cancer patients - maintained at 6 months –e.g. patients with anxiety disorders - maintained at 3 years Research in its infancy Research in its infancy Meta-analysis: effect size =.74 - (i.e. 74% did better than tau or no treatment) Meta-analysis: effect size =.74 - (i.e. 74% did better than tau or no treatment)

25 Copyright 2008 by North Shore - Long Island Jewish Health Systems, Inc., Great Neck, NY Mindfulness: States of Mind Linehan, 1993

26 Copyright 2008 by North Shore - Long Island Jewish Health Systems, Inc., Great Neck, NY Traumatic Reminders/Triggers

27 Copyright 2008 by North Shore - Long Island Jewish Health Systems, Inc., Great Neck, NY Distress Tolerance: (Hanging In) –When? Situations you cant fix right now Situations you cant fix right now To get through the moment- (short-term solution!) To get through the moment- (short-term solution!) After SOS or Wise Mind After SOS or Wise Mind –What are Distract and Self-Soothe? Distract- not as simple as it sounds Distract- not as simple as it sounds Self-Soothe with the 5 senses Self-Soothe with the 5 senses

28 Copyright 2008 by North Shore - Long Island Jewish Health Systems, Inc., Great Neck, NY Distress Tolerance: Distract & Self-Soothe –How? On purpose & mindfully On purpose & mindfully –Why? To manage the moment To manage the moment To keep from doing something that might make the situation worse To keep from doing something that might make the situation worse To avoid engaging in a harmful behavior To avoid engaging in a harmful behavior

29 Copyright 2008 by North Shore - Long Island Jewish Health Systems, Inc., Great Neck, NY Distract With… A ctivities A ctivities Hobbies, exercise, cleaning, go to events, call or visit a friend, play computer or video games, go online, go for a walk, read a magazine or book, do homework, play sports, go out to eat, draw, paint, listen to music. Hobbies, exercise, cleaning, go to events, call or visit a friend, play computer or video games, go online, go for a walk, read a magazine or book, do homework, play sports, go out to eat, draw, paint, listen to music. Contributing Contributing Contribute to someone else, do volunteer work, give something to someone else, make something nice for someone, do a surprising, thoughtful thing for someone you care about or someone you dont even know. Contribute to someone else, do volunteer work, give something to someone else, make something nice for someone, do a surprising, thoughtful thing for someone you care about or someone you dont even know. Comparisons Comparisons Compare yourself to others who are also in tough situations. Compare yourself to others who are also in tough situations. Opposite Emotions Opposite Emotions Read emotional books or stories, listen to emotional music. Be sure the event creates different emotions. Ideas: scary movies, joke books, comedies, funny records, go to the store & read funny greeting cards. Read emotional books or stories, listen to emotional music. Be sure the event creates different emotions. Ideas: scary movies, joke books, comedies, funny records, go to the store & read funny greeting cards.

30 Copyright 2008 by North Shore - Long Island Jewish Health Systems, Inc., Great Neck, NY Distract With… Pushing away Pushing away Leave the situation mentally for a while. Just for now, build an imaginary wall between and you the situation or block it from your mind. Refuse to think about the situation. Censor ruminating. Put the pain on a shelf. Box it up and put it away for a while. Leave the situation mentally for a while. Just for now, build an imaginary wall between and you the situation or block it from your mind. Refuse to think about the situation. Censor ruminating. Put the pain on a shelf. Box it up and put it away for a while. Other Thoughts Other Thoughts Count to 10, count colors in a painting or tree, work, do puzzles, watch TV, read. Deliberately engage in other thoughts. Count to 10, count colors in a painting or tree, work, do puzzles, watch TV, read. Deliberately engage in other thoughts. Intense other Sensations Intense other Sensations Hold ice in hand, squeeze a ball very hard, stand in a hot shower, listen to loud music. Hold ice in hand, squeeze a ball very hard, stand in a hot shower, listen to loud music.

31 Copyright 2008 by North Shore - Long Island Jewish Health Systems, Inc., Great Neck, NY Distress Tolerance: Key Points – When not to use When you or someone else is in danger When you or someone else is in danger If its all you use all the time (avoiding things you can address) If its all you use all the time (avoiding things you can address) –Short vs. Long-Term Coping –Expand Repertoire –Distress Tolerance vs. Mindfulness Must be mindful to practice distress tolerance, Must be mindful to practice distress tolerance, but not all mindfulness is distress tolerance (e.g. mindfully observing thoughts when it might be better to distract) but not all mindfulness is distress tolerance (e.g. mindfully observing thoughts when it might be better to distract)

32 Copyright 2008 by North Shore - Long Island Jewish Health Systems, Inc., Great Neck, NY When faced with a stressful situation/reminder of the past: These steps were designed to help you figure out what you want to hold on towhat is important to you, These steps were designed to help you figure out what you want to hold on towhat is important to you, and what you want to let go of because its just causing you more problems. and what you want to let go of because its just causing you more problems. Its about making a mindful choice and listening to your wise mind. Its about making a mindful choice and listening to your wise mind. LET M GO

33 Copyright 2008 by North Shore - Long Island Jewish Health Systems, Inc., Great Neck, NY What We Dont Mean When youve been upset, mad, worried, etc. people may have said to you at one time or anotheror maybe you even said to yourselfjust let it go. Move on, get a grip. When youve been upset, mad, worried, etc. people may have said to you at one time or anotheror maybe you even said to yourselfjust let it go. Move on, get a grip. Thats not what these steps mean. If it were that easy, you would have done that a long time ago. Thats not what these steps mean. If it were that easy, you would have done that a long time ago.

34 Copyright 2008 by North Shore - Long Island Jewish Health Systems, Inc., Great Neck, NY What are you doing thats working – What are you doing thats working – why not do more of that why not do more of that And let go of what is not working And let go of what is not working LET M GO

35 Copyright 2008 by North Shore - Long Island Jewish Health Systems, Inc., Great Neck, NY Losing it Why am I losing it? What are my triggers? Emotions What am I feeling? Thoughts What am I thinking? MeaningWhat is really important to me? GoalsWhat do I want? OptionsWhat are my choices? LET M GO SOS BeMindful SOS BeMindful SOS BeMindful

36 Copyright 2008 by North Shore - Long Island Jewish Health Systems, Inc., Great Neck, NY Making Meaning Meaning is the sense that, no matter what is going on in your life, you can hang onto the things that really matter to you. It is the belief that there are elements and people and views that cannotno matter whatbe taken from you. Meaning is the sense that, no matter what is going on in your life, you can hang onto the things that really matter to you. It is the belief that there are elements and people and views that cannotno matter whatbe taken from you. -Viktor E. Frankl -Viktor E. Frankl

37 Copyright 2008 by North Shore - Long Island Jewish Health Systems, Inc., Great Neck, NY Making Meaning Identify beliefs and values Identify what went well, their contribution Look to the future Reframe

38 Copyright 2008 by North Shore - Long Island Jewish Health Systems, Inc., Great Neck, NY Making Meaning 1) Help them identify underlying sustaining beliefs and values driving behavior or goals What was most important to you in this situation?

39 The thing that upsets people is not what happens but what they think it means. Epictetus Copyright 2008 by North Shore - Long Island Jewish Health Systems, Inc., Great Neck, NY

40 MAKE a LINK Communication Skills Communication Skills Based upon Interpersonal Effectiveness skills taught in DBT (Dialectical Behavior Therapy) Based upon Interpersonal Effectiveness skills taught in DBT (Dialectical Behavior Therapy) When? When? Why? Why? –Get what you want or say no to a request –Keep the relationship –Keep your self-respect

41 Copyright 2008 by North Shore - Long Island Jewish Health Systems, Inc., Great Neck, NY In order to get what you want and need, you must MAKE A LINK or connection with the other person ( be) Mindful Act confident Act confident Keep a calm & gentle manner Keep a calm & gentle manner Express interest Express interest Ask for what you want Ask for what you want Let them know you get their point of view Let them know you get their point of view Include your feelings Include your feelings Negotiategive to get Negotiategive to get Keep your self respect Keep your self respect

42 For more information…. Contact Angel Knoverek at Contact Angel Knoverek at Contact Michele Stinnett in the Admissions Department at or call , ext. 347 Contact Michele Stinnett in the Admissions Department at or call , ext. 347


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