Jeanette*, a 17 year-old high school student, found herself in my office trying to describe the shock of losing her father:
“I just can’t….” and she trailed off. “I mean I don’t know, I just, I don’t, I can’t…” and she stopped again.
She couldn’t speak because her brain was down regulating. The outer most part of her brain was shutting down as her mind/body was shifting into a traumatic response that made it difficult for her to use the function of language. Jeanette in fact had been through a slew of traumatic experiences; she grew up in an impoverished neighborhood, witnessed countless acts of violence, was abused herself, and most of her family members, including her father, were addicted to drugs. She and I had been working with each other for a while when she started talking about wanting to reconcile with her estranged father. We were even at the stage of starting to think about people we could call to get in touch with him. And then we got the tragic news that he passed away via overdose.
As we met in session the day her father passed away my main prerogative was to stay as present and attuned as possible. It was clear that because her extensive trauma was getting triggered (on top of this being another traumatic event) that conventional talk therapy or mindfulness meditation wasn’t going to work, despite her being a champion of both therapy and mindfulness. She was shifting out of the window of tolerance, meaning it would be difficult for her to be receptive to any intervention that relied heavily on talking, being instructed, or learning anything new.
“Don’t worry about talking right now,” I said. “Forget about this therapy thing. How about we just listen to some music for a while,” I offered.
She nodded in agreement. We listened to two or three of her favorite songs. Slowly she started moving her head with the rhythm and the beat of the music. Before the music her ability to talk and cognitive function were fragmented. Now, after about 10 minutes of listening to music, I could see the difference in her face. She was still grief-stricken, but something was different.
“I just can’t believe he’s gone. We were literally just talking about him in our last session, remember?” She managed to say through her tears.
The bilateral stimulation from the rhythmic movement she engaged in while listening to the music regulated her central nervous system, brought her back into the window of tolerance, and the function of language came back (we did also have a strong relationship at this point which contributed to her feeling safe with me). We were then able to process her experience. She was able to express her sadness, anger, and other emotions. We even did a short breathing and compassion practice as well.
That is the power of practicing an INCRA to help someone back into the window of tolerance. Jeanette was by no means in a positive mood when we ended our session, but she also wasn’t in the midst of a traumatic reaction that would cause great concern in ending the session.
*all identifying information was changed for confidentiality.
If I tried to facilitate Jeannette through a meditation when her brain was down regulating it could’ve made things worse. Her mind probably would’ve become even more fragmented and she could have gone deeper into the fight/flight/freeze autonomic response (for her it would’ve been freeze), which could’ve lead to a number of safety concerns. We as mindfulness facilitators must understand that the intersection between mindfulness and trauma can be extremely transformational but without proper consideration can also be harmful. Staying attuned, promoting interpersonal safety first, and being ready to advise against mindfulness when contraindicated are all necessary when working with experiences like Jeannette’s and others, especially for the sake of maintaining trust and not worsening the traumatic response. When we take these principles into account, we practice trauma-informed mindfulness.
Simply put, trauma-informed mindfulness is practicing and/or teaching mindfulness in a way that doesn’t violate the basic premises of trauma-informed care. The below 10 points are an abridged version of the trauma-informed mindfulness guidelines that I will no doubt expand upon in more detail in my upcoming book Trauma-Informed Mindfulness With Teens: A Guide for Mental Health Professionals (Norton, forthcoming). Some of these also are discussed by my friend and colleague David Treleaven in his book Trauma-Sensitive Mindfulness which is a great resource. It is my hope that these are starting points in discussions rather than the end all be all.
1) First, Do No Harm
In mental health and health professions alike, we are taught at the bedrock of our work to first, do no harm. The first principle in the American Psychological Association’s ethics code for example is that “psychologists strive to benefit those with whom they work and take care to do no harm.” Just like in psychotherapy, harm can be done when teaching young people mindfulness. To that end, we must strive to first and foremost do no harm. When we know it’s possible, we can at least try our best to not create situations that make traumatic reactions worse with the youth we work with. Check out my friend and colleague Chris Willard’s 7 Ethical Guidelines for Teaching Mindfulness and Willoughby Britton and David Treleaven’s Do No Harm Tool Box for more resources.
2) Establish Safety
Going hand in hand with doing no harm is establishing a sense of safety. This in many ways is the active implementation of attempting to do no harm, and is a pillar of trauma-informed care (whether in mindfulness work or not). If a sense of safety isn’t established a young person will most likely not feel comfortable being lead through a mindfulness practice. This includes physical safety; we shouldn’t be facilitating mindfulness in unsafe environments, interpersonal and emotional safety; we should strive to create atmospheres of trust and authenticity, and cultural and intersectional safety; we should strive to understand the many intersecting forces of oppression that create a lack of safety. While physical safety may be obvious, relational and cultural safety may need further reflection and I felt it necessary to expand on them in their own guidelines that follow.
3) Practice Relational Mindfulness for Emotional Safety
Mindfulness doesn’t happen in a vacuum. There is a relationship (whether strong or not) between our clients/students and us. We should strive to practice relational mindfulness; the explicit practice of relationship building to promote trust and authenticity so that interpersonal and emotional safety results. Relational mindfulness is what’s getting activated when we think strategically and authentically about how to relate to the young person we’re working with. It’s practicing INCRAs like listening to music to promote safety and trust (as I did with Jeannette) and is the bedrock of all work with young people.
4) Understand and Be Aware of Intersectionality
In order to promote interpersonal, emotional, and cultural safety, we need to attempt to understand the many intersecting oppressive forces that promote a lack of safety; racism, sexism, classism, ageism, able-ism, etc. If we are teaching mindfulness to young people of a different sex, gender, ethnicity, or class than ourselves for example, we run the risk of saying or doing things that can be offensive, creating impasses, and flat out triggering youth. To a young person with multiple traumas this can make things worse and totally invalidate our good intentions of sharing mindfulness. Make sure to do your work and learn about your implicit biases and own your oppressor roles so you can best regulate them when practicing trauma-informed mindfulness. Also make sure to reflect on your relationship with mindfulness as a practice as it didn’t develop in a vacuum, but a culture that should be appreciated when appropriate (and not appropriated).
5) Understand the Window of Tolerance
The window of tolerance, also referred to by some as the therapeutic window, is that window in which a young person can engage with and be receptive to a number of different interventions that require some form of cognitive function (talk therapy, mindfulness meditation, etc.). We should use extreme caution in facilitating formal mindfulness meditations when a young person is outside the window of tolerance and their brain is down regulating, as was the case with Jeannette’s story above. A good way to assess if someone is out of the window of tolerance is if it’s difficult for them to use language. I really like Pat Ogden’s book Trauma and the Body as a resource for learning more about the window of tolerance and somatic approaches to trauma.
6) Embrace the Paradox of Trauma-Informed Mindfulness
As shown in Jeannette’s experience, when the brain down regulates the conventional functions of the mind can go offline. Not being sensitive to this and trying interventions that require those parts of cognition to be functioning can make the trauma response worse. But does that mean we never teach them these practices? Practices that we know could actually help them in the long run? Therein lies the paradox: the mind can go offline and we shouldn’t push extensive formal mental training in those moments but we should think strategically of how to help the young person develop the ability to bring back cognitive function in those moments. We want to “strike when the iron is cold” as one of my colleagues likes to say so that over time the skill of mindfulness develops and one day they may be able to engage in a practice like that when they start getting triggered.
7) Prioritize Bottom-Up, Somatic Awareness Practices First
One way to strategically embrace the above paradox and orient youth toward awareness when triggered is to prioritize bottom-up, somatic practices over top-down cognitive awareness practices. “Bottom-up” relates to the bottom or older structures of the brain that have to do more with somatic mechanism and are awareness practices that don’t take as much cognitive functionality. Because we know the brain’s cognitive functions have a tendency to get comprised in a triggered state, facilitating exercises that require stable cognition run the risk of further fragmenting the young person’s experience. It’s not that you can never do these practices, just think more along the lines of somatic, bottom-up practices first. I often use basic body meditations and deep breathing exercises.
8) Don’t Over Identify With Meditation Logistics
When you do teach formal meditation to youth, both somatic and cognitive forms, I highly recommend not getting caught up in overemphasizing the formal logistics of sitting a certain way, closing eyes, etc. Trauma can get triggered by something as simple as closing one’s eyes. In order to promote safety, offer the opportunity for them to get comfortable (keep eyes open, lean back, crouch over on their desk, etc.). You can work with them over time (if you have the luxury) to develop some of these more traditional logistics if you build trust through relational mindfulness.
9) Mindfulness is more than meditation
The final guideline is the reminder that mindfulness is much more than formal meditation. Because it’s formal meditation that often can often trigger youth more into their trauma responses, it’s important to have your tool belt of informal mindfulness activities that promote self-awareness ready as strategies both for general use and if a young person is shifting out of the window of tolerance. These are often short practices that don’t require much logistical repositioning like closing one’s eyes or sitting in a certain posture. I personally use the mindful check-in, awareness of hands and feet, and basic mindful movements often with young people. It’s best to introduce these practices first when a young person isn’t in a triggered state so that if they do start to move out of the window of tolerance and you offer the practice the youth aren’t completely caught off guard.
I want to restate that these guidelines are a work in progress and a starting rather than ending point. Hopefully they will help you continue to promote mindfulness to youth in your work in a trauma-informed way. If you want to learn more about trauma-informed mindfulness and get expanded narrative on some of the above guidelines, check out my friend and colleague David Treleaven’s book Trauma-Sensitive Mindfulness and make sure to get on the list below to be updated about my forthcoming book, Trauma-Informed Mindfulness With Teens: A Guide for Mental Health Professionals.