Brain on Trauma: Domestic Violence and PTSD

all right we are officially recording all right so we'll officially get into it i'm going to keep this section about women's advocates really brief since the focus is on you know trauma and the brain um but i did want to mention the organization that i am from which is indeed the first domestic violence shelter in the nation um over the past 45 years we've learned so much about domestic violence we've expanded our physical space into three victorian homes which are all interconnected and located in st paul minnesota where our mission is to walk with victim survivors in our community to break the cycle of domestic violence we provide prevention and education services provide shelter to 50 women and children every day with various advocacy and support programs and a housing program to help survivors find and maintain safe sustainable affordable housing for them and their children so now that you know a little bit more about us i'd love to know a little bit more about you so here's our second poll to ask about your professional position your role in the community um so this will help me gear some of the content a little bit specifically to your work and again if what if it's not represented here you can add it in the chat if you've already introduced yourself you don't need to um add it in again if you don't want to but it's just helpful for me to know the majority of people who are here um and it looks like someone has their hand raised if you could send your message you could send it directly to me in the chat if you have a specific question or you can add it to the q a all right so i'll give you about five more seconds it seems like most of us are social service providers so whether that's a social worker case manager domestic violence advocates are 22 percent we also have some other ones in the chat a youth counselor court appointed special advocate for children recruit and work mostly with hotline volunteers um a mckinsey friend i don't know what that is if you could explain that or add some things that would be great dance movement therapist and clinical mental health counselor in baltimore um work with clients going through courts survivor of domestic abuse for 32 years and i had ptsd thank you for joining all right i'm going to end the poll and share the results with everyone so yeah uh 29 social service provider 25 domestic balance advocates so thank you all so much for being here um that will help me um as i continue on um throughout the webinar all right so we'll get into some brief definitions so first domestic violence there are a lot of different terms for domestic violence there's relationship violence intimate partner violence family violence child abuse i wanted to include this definition so we're all on the same page about what we mean when we say domestic violence which isn't necessarily the legal definition per se to qualify for a protective order but this definition helps us really understand the scope and different tactics that are used in abusive relationships and what the goal is which almost always is to gain power control over another person um so the component that makes domestic violence different from violence from a stranger is that close intimate relationship right so the fact that this violence and pain is being caused by someone who claims that they love you and care about you um whether that's a former partner current spouse a parent grandparent uncle aunt or even roommate someone that you live with that adds an added layer of complexity and they hold a unique power to hurt you in a way that a stranger never could so we'll discuss this a little more later i'm going to turn my ac off because that may be loud so i want everyone to be able to hear me um i do see that we have a question [Music] um so hopefully you all can see this question abigail asks can you speak to coercive control abuse been going on for years but just realizing it now especially concerned because my son has special needs and permanently disabled with multiple health conditions and he has a pattern of preventing me from getting my son what he needs um now that we are separated had permanent orders hearing already waiting for final words with parenting and truly weaponizing our son i feel to really punish intimidate manipulate and control me yeah so um hopefully everyone can see that question um but you can definitely connect with me one-on-one if you want um specific support with this but yes coercive control is absolutely a huge factor of domestic violence we'll talk about it a little bit later um but the webinars that i linked at the bottom of the screen on intimate partner violence and family violence they really talk about those different dynamics talking about the power and control wheel about how using children is a big tactic um as a part of maintaining that power and control so i really appreciate you bringing that up and let me know if you want to connect kind of offline one-on-one or if you kind of wanted me to just talk about it um but let me know if i addressed that question okay so the next definition that we're going to talk about is trauma right so most of us especially those doing domestic violence related work know the word trauma but there are actually a lot of different definitions of trauma um and it can be difficult to define so one definition that i found that i think sets up the basis for today's discussion is the following so individual trauma results from an event series of events or set of circumstances that is experienced by an individual as physically or emotionally harmful or threatening and that can have lasting adverse effects on the individual's functioning and physical social emotional well-being so it is kind of big but also all-encompassing at the same time there are a lot of different types of trauma including acute um so acute trauma can include events like a natural disaster um a single event of sexual assault or the accidental passing or unexpected unexpected passing of a loved one um chronic trauma is repeated and prolonged so domestic violence can fall under this type it can also fall under the type of complex trauma which has a little bit more criteria than the other types so that criteria includes being repetitive prolonged or cumulative in nature as well as typically interpersonal involving direct harm exploitation and maltreatment including neglect abandonment by primary caregivers or other seemingly supposed responsible adults and it often occurs at developmentally vulnerable times in the victim's life so especially in early childhood and adolescence but it can absolutely still occur later in life and in conditions of vulnerability that are associated with different things like disability disempowerment dependency age and other characteristics so we'll talk a little bit more about trauma here so in 1914 here's another definition freud defined trauma as a breach in the protective barrier against stimuli leading to feelings of overwhelming helplessness it's common for traumatized individuals either to get stuck into the trauma vortex or to avoid the breach entirely by staying distance from the region where the breach or the trauma occurred and then a hallmark of traumatic experience is that it typically overwhelms an individual mentally emotionally and physically all right so i'm gonna launch another poll before we move on to exactly what ptsd is so i just want to know when you hear the term ptsd or post traumatic stress disorder what do you typically associate with it so you can select as many options as you would like um and that will help us kind of understand where we're all at what we are currently associating what our beliefs are because this will kind of shape how we respond to um different um individuals who may have said that they have ptsd or you're concerned that they do okay i'll give a couple more seconds but it seems like um a very high percentage of us 87 84 now now 93 um are saying combat or experiencing war and then acts of violence like assault abuse terrorist attacks mass shootings um natural disasters seeing something violent um being exposed to something bad that happened to a loved one oh something not mentioned on the poll childhood sexual assault absolutely um that would probably fall under um like acts of violence but that's good um check out john cena's mind body prescription book thank you diana for adding that i'm going to add that to my notes to send it out with the powerpoint slides so make sure if you have any suggestions recommendations for different things please send them my way in the chat so i can share with everyone else as well so i'm gonna add that here all right i'm gonna end this poll thank you so much for participating in that so 92 percent acts of violence thank you so much for sharing your perspective and your current associations will dive a little bit more into what ptsd is um so it's actually a pretty recent diagnosis it was developed in 1980 and for those who associate ptsd with combat vets there's a reason for that the diagnosis was developed by a group of vietnam vets in collaboration with some psychoanalysts in new york um current day there's a lot of research and funding that goes toward understanding ptsd within the va system but back in the 80s learning more about the experience of ptsd was not the priority of the va it wasn't something that they thought concerned them which currently now a lot of us think of soldiers as ptsd the only people experiencing it so it's interesting to see how that has progressed over the past few decades but we now know that 20 percent of veterans who served in military operations um for iraqi freedom and um enduring freedom have ptsd in a given year and approximately 30 of all vietnam war veterans have received diagnoses of ptsd at some point um so veterans do experience ptsd at a disproportionate rate compared to the general population in which seven to eight percent of the general population is diagnosed with ptsd at some point so all these statistics are also based in the us so i know we do have some people joining us from outside of the us so i just wanted to state that as well similarly to trauma there's a lot of different descriptions of what ptsd is so generally it develops in some people who have experienced a shocking scary or dangerous event right so fit very simply nearly everyone will experience a range of reactions after trauma yet most people recover from initial symptoms naturally but those who continue to experience problems may be diagnosed with ptsd people who have ptsd may feel stressed or frightened even if they're not in danger um so there's a few things in the chat people are recommending the body keeps the score absolutely um i've read that a lot of that is in this um in this webinar so if you have always wanted to read the bodykeeps score there's a bunch of chunks of information on in this webinar um taylor says i'd love to know why trauma is widely used in court by perpetrators accusing their victim of mental health i see this happen almost 100 percent of the time yeah it's because there is a misunderstanding of what trauma really is and even what mental health is you know everyone has mental health but not everyone has mental illness but oftentimes if those two things are used interchangeably um and so we actually kind of talk about that in our emotional abuse webinar so at the end i'll put a link to all of our previous webinars and our emotional abuse webinar we talked about gaslighting and what you're talking about happening in court and using these different things of saying oh this person is crazy or this person's unwell um when really they are causing the harm that is a very common form of gaslighting so hopefully um that answers your question because not a lot of people understand what trauma is so people can start to distort that um and use that to blame the victim so thank you for bringing that up um oh there's a mention that the bodykit discovers a free audio book recording on youtube i'm going to find that and add it to the resources thank you for adding that there's a question about what is one of the biggest misconceptions about ptsd in your opinion in general terms i'm going to discuss that in the next and about two slides so thank you so much for bringing it up that's perfect um there's another comment of intergenerational trauma especially around war violence and prosecution for example refugees and immigrants during vietnam war um the khmer rouge rouge regime and other southeast asian recipients of political extremism absolutely that is another serious form of trauma we also talk about domestic violence as being intergenerational so that's very very relevant um i'm trying to keep track of the questions in the chat it might be a little easier to add them to the q a so i make sure i get to all of them um oh there's a okay so they added the link perfect thank you so much the link and the end the body keeps a score has a workbook perfect thank you so much um i'm gonna make a note of some of these other questions um write them down but if i don't answer your question in the chat it might be because it just got a little lost so please add it to the q a okay um all right so we're gonna move on to ptsd diagnosis so symptoms usually begin early within three months of a traumatic incident but sometimes they begin years afterward so once these symptoms have begun they must last for more than a month and be severe enough to interfere with relationships or work to be considered ptsd in the course of this condition ptsd can vary right so some people can recover within six months while others have symptoms that last much longer um and some people the condition becomes chronic right so a doctor who has experience helping people with mental illnesses so psychiatrists or psychologists can diagnose ptsd and these are the different types of symptoms that they look for so re-experiencing symptoms these may cause problems in a person's everyday routine so the symptoms can start from the person's own thoughts and feelings words objects or situations that are reminders of the event can also trigger re-experiencing symptoms things that remind a person of the traumatic events can trigger avoidance symptoms these symptoms may cause a person to change his or her personal routine for example after a bad car accident a person who usually drives may avoid driving or riding in a car arousal symptoms are usually constant instead of being triggered by things that remind one of traumatic events so these symptoms can make the person feel stressed and angry that may make it hard for them to do daily tasks such as sleeping eating or concentrating and then lastly cognition and mood symptoms can begin or worsen after the traumatic event but are not due to injury or substance use these symptoms can make the person feel alienated or detached from friends or family members so some people wonder why two people who experience the same traumatic event why one of them may develop ptsd and the other doesn't um and studies have found that being able to move and do something to protect oneself is a critical factor in determining whether or not a horrible experience will leave long lasting scars and the hope center actually did a really wonderful webinar about um immobilization which is absolutely related to like the freeze response that we'll talk about today but i'm going to include that making a note to include that in the follow-up email so you have access to learn more about that um there's also in the chat intergenerational and historical trauma in the native american culture absolutely we know that there's a big intersection with that because um indigenous women native american alaska native women they are the ethnicity that experiences domestic violence and sexual assaults at the highest rate compared to any other ethnicity um and so if you think about that compounded with that historical and cultural and intergenerational trauma which there's a resource later on um that talks about blood memory that's a great resource to learn more about how all that can compound um so thank you to bernice for mentioning that i want to make sure that doesn't get lost as well all right so as we talk about trauma in the brain today i also thought it was very important to mention the prevalence of domestic violence and head injuries um which a lot of people describe as like the invisible injury they directly impact the brain so an abuser most often targets a person's head neck or face more than anywhere else on the body if the violence is physical someone does not have to have any bruises swelling or obvious sign of damage outside of one's body or their brain to be hurt on the screen there's a list of ways that head injuries can be caused by an abuser followed by a list of common problems that victims experience after a head injury um and if you compare this list to some of the impacts of trauma say psychological trauma you'll see that there's an overlap if you're working with someone who has trouble remembering things or has difficulty concentrating or paying attention for long periods of time it could be a result of trauma but it could also be a result of a head injury which could also be you know related to one another so we won't dive too much into traumatic brain injuries in this particular webinar because it could be a webinar on its own but the links on the slide provide a more more information about screening um if you are a health care provider or concrete ways to mitigate some issues that come up as a result from a brain injury so if you're an advocate and you're working with someone with a cbi traumatic brain injury um there's a bunch of resources for that as well on the screen so i encourage you to check those out all right so another really common experience that survivors unfortunately face that can impact their brain and overall health is strangulation so you can't see some of the most dangerous injuries because they happen under the skin they can get worse over a few days and they can cause permanent brain damage and even death it usually stays with someone even after it's over many victims have been choked many times and thought that they were going to die when it happened it often causes normal emotional and physical trauma reactions which sometimes go away but sometimes they last for a long time so i'm curious to know if any of you have worked with a victim survivor who has reported any of the following so strangulation traumatic brain injury ptsd a different head injury or something else that you think is related to this conversation especially because there's been a lot of studies um kind of reported especially by valencia minnesota the minnesota state coalition of being choked or strangulation being a lethality factor meaning that it increases the chances of an abuser um having making a fatal decision um to take their victim's life um it increases those chances by seven percent um there's another in the chat substance abuse prior to dv abuse um yes absolutely that can be you know used and manipulated in an abusive relationship if someone did has struggled with substance abuse in the past or currently did while they were in their relationship um so it seems like 89 um of people who have voted in the poll have said that they've worked with someone who has reported ptsd um and then 62 percent have reported that they've worked with someone um who's told them that they've been choked or strangled absolutely thank you for participating in that absolutely very relevant um diana attended a forensic nursing conference conference with a two-hour workshop on strangulation there's a big connection between strangulation and a stroke absolutely i'm gonna add this link diana into um to add to the powerpoints later so thank you so much for adding that there's a lot of things that are tied here um that impact the brain as well so i'm gonna end the poll show the results so everyone can see how everyone else voted so thank you for participating in that we're gonna move on to some more stats so um some people um uh what am i saying uh it was difficult for me to find these stats um there aren't a ton of recent studies um so you'll see some of these in 1999 like pretty old um that explored this intersection these are the ones i could find so hopefully maybe these resources that were sent out i can update these stats but one study did find that 88 of women in domestic violence shelters reported experiencing ptsd so if you directly work with victim survivors of domestic violence it can be really important to understand these fundamental um these fundamental aspects of trauma um taylor says i'm dash trained choking is automatic high risk yes so i think dash is like danger assessment you can define that if that's wrong um but yes choking is very it's a sign of high risk absolutely thank you for adding that's healing okay so there are a few components of domestic violence that make it different from other forms of trauma so compared to a natural disaster or a mass shooting these events may have a more concrete beginning and end so whereas with domestic violence this experience of trauma is chronic constant and ongoing as a result victim survivors experience constant and several traumatic responses and have little time to recover because their brains are always on high alert and in survival mode another difference is that this trauma is caused by a loved one so someone who says that they love and care about you but in the same breath they manipulate diminish deteriorate control and isolate you it's different from experiencing a horrific hurricane because the survivor might live with the abuser resulting in regular interaction or even dependence on the person or thing causing them harm one common tactic that abusers use is creating an environment of helplessness and hopelessness so imagination is absolutely critical to the quality of our lives imagination gives us the opportunity to envision new possibilities um it's an essential launch pad for making our hopes come true and if that's taken away because an abuser um you know makes it so the victim survivors feel like they can't escape or that escape isn't even an option or possibility um that can you know make someone feel hopeless that you know their situation will never change um but for real change to take place the body needs to learn that the danger has passed and to live in the reality of the present which is difficult to do if a survivor is living with the person that's caused that causes their trauma um and lastly the most natural way for human beings to calm themselves when they're upset is by clinging to another person so this means that victim survivors who have been physically or sexually violated they face this dilemma of desperately maybe craving touch while simultaneously being terrified of body contact so something that's something to keep in mind as well all right um so back to that um question from earlier on this slide kind of relates to that we'll discuss a few commonly held beliefs about trauma so i'll read these from the screen and i would like you all to use the rey's hand feature if you've heard or have believed at least three out of five of these statements so the first one is anyone who experiences a trauma will eventually have ptsd trauma and conditions like ptsd only impact people who have had a near-death experience post-traumatic stress disorder only impact soldiers strong people can deal with trauma on their own and don't need help and trauma reactions last forever and are incurable um so i do see a number of people raising their hands i have you know it's increasing i'm at 20 20 participants okay thank you so much for participating in that there's one last comment about choking i do want to make sure i read it um lori says choking is something you do on food or drink or something swab not by restricting airflow to to the brain from the outside of the body by another person so yes we are specifically talking about strangulation which strangulation can better um explain what we're talking about with that but something that is a little more receptive or friendly to survivors is saying that i have been choked um so that is why we use that language but thank you for mentioning that okay so addressing some of these commonly held beliefs um some of these you know are inaccurate right they're not complete um no shame if you currently believe or have previously believed any of these statements there's a reasons why there's a reason why these are misconceptions and that's because they're so widespread so we'll break down a few of these but if you want to learn even more about the facts behind these statements i encourage you to go to the source that i linked at the top of the slide okay so for the first one anyone who experiences a trauma will eventually have ptsd some people hold the belief that if you're seemingly unaffected by an event for an example not having ptsd that means that the event wasn't traumatic there are a lot of different reasons as to why some people develop ptsd um but that doesn't mean that the event wasn't traumatic there are a lot of different reasons as to why they develop ptsd and others don't like i said earlier um it can depend on the context but again two people experience the same event the way it impacts them afterward can largely depend on if they were able to receive support immediately after the event so someone can have experienced trauma without developing ptsd especially if it was addressed early on um next trauma and conditions like ptsd only impact people who have a near-death experience so sometimes people who have um who have experienced things like domestic violence may not believe that they could have ptsd maybe because they were never explicitly threatened but their abuser created an environment that made the victim afraid or feel loss of control of what happens to them and these conditions can absolutely cause ptsd so we'll talk more about how the brain plays a role in identifying danger later but it's absolutely related to the statement okay so we'll talk about three super quick um the next statement we already kind of debunked with the statistics we discussed earlier um but it's commonly believed that soldiers are the only ones who experience um war especially if it's only direct combat um but we know that that's not true that soldiers do experience ptsd at higher rates but there are other events unrelated to war that can be traumatic another commonly held belief especially related to domestic violence is that strong people can handle trauma can deal with trauma on their own they don't need help um this can be a prominent belief within specific cultures too the idea that if you push it down or work harder or distract yourself and numb the pain you're somehow more strong or that that's what being resilient means but the suppressed pain and unresolved trauma can cause even further distress down the line um and strength absolutely does look like acknowledging that a struggle exists and getting support to reduce the negative impacts that it has on someone's life relationships daily functioning sleep and more and finally the idea that trauma is a life sentence so that it's forever and it won't ever go away and while someone may never forget something that was traumatic there have been various treatments and therapeutic techniques and approaches that have been successful and many of them are discussed in the books that i reference at the end of the webinar so be sure to check those out all right so well i think it's time for us to officially start talking about the brain um so we'll begin with the initial instincts of someone in the face of trauma so say you experience something really devastating like the unexpected loss of a close family member what is the first thing that you automatically do or that immediately comes to your mind for most of us we'll think about telling someone what has happened or going to someone to be comforted and to be supported so our initial responses to physical threats abuse and loss are healthy and they're designed to preserve us so from like an evolutionary standpoint right so first we seek out connection and comfort as we did as infants and small children we call and look for help this response is facilitated by what dr bezel van der kolk describes as the most evolutionary advanced part of the vagus nerve which is the central element and the parasympathetic half of our autonomic nervous system um it's responsible for you know rest and digest to relax then in the next box here you'll see fight or flight which taps into a different nervous system called the sympathetic nervous system when safety and reassurance um are unavailable or inadequate and the threat requires an immediate reaction we experience that fight or flight response more on that later then if fighting or flighting is not an option or accessible to us in the moment we freeze so freezing is mediated by the oldest part of the vagus nerve deep in our brain stem it produces physiological collapse and a release of pain numbing endorphins when humans freeze we may experience a self-protective detachment from our helpless ravaged body called dissociation um something to note is that survivors might feel shocked or ashamed of their reaction to a traumatic event survivors might blame themselves if they froze and did not resist during an attack however survivor responds as outside of their control so sharing this information with survivors can help decrease some of those negative feelings around how the individual responded to the traumatic situation um it's also important to recognize that survivors usually do not consciously choose their particular fight flight or freeze response in addition survivors may feel a significant amount of shock or shame about how they reacted in those moments of traumatization um so finally this point in time is not a good time for trying to teach or provide new information if they are in this current state of shape of shock and shame um so the person is only focused on those immediate needs so that's one thing to keep in mind with that okay so now we're going to move on to the core of a traumatic reaction so we'll dive a little bit deeper into that it's made up of four different components so hyperarousal constriction dissociation and freezing or immobility so trauma evokes a biological response that needs to remain fluid and adaptive not stuck and maladaptive a maladaptive response is not necessarily a disease but a dis ease a discomfort that can range from mild uneasiness to downright debilitation so they are the first to appear when a traumatic event occurs throughout our lives we have all experienced these as normal responses however when they occur together over an extended period of time there are an almost certain indication that we have experienced an event that has left us with unresolved traumatic residue hyperarousal is the nervous system's response to threat whether that threat is internal external real or imagined while the function of hyper-arousal is to keep the survivor safe from further danger constantly being in a state of high alert wears on the body both physically and emotionally survivors are not able to manage effectively when they are hyper alert to danger so survivors might feel this way regardless of whether there is real danger in the present um so it can look like hyper vigilance so survivors may be constantly on the lookout for danger and it can also look like exaggerated startle reflex so survivors may be easily started or unable to get used to sudden sounds or movements so this can also look like panic attacks nightmares or trouble sleeping having difficulty concentrating irritability to minor provocations um exaggerated startle reflex feeling constantly on guard or jumping and then the next core of the reaction can be described as constriction or avoidance so constriction refers to the cluster of traumatic reactions that involve the narrowing down of consciousness or numbing the feelings and thoughts associated with the traumatic situation so these reactions include ways in which a person tries to avoid thoughts feelings or memories of the traumatic events while protective and helpful in coping with the trauma these reactions can also result in a general feeling of detachment from more positive or pleasurable feelings that survivors have often the numbness is frightening for survivors who feel disconnected from their lives so there are three d's that are associated with constriction so the first one is detachment so that describes withdrawal from people and activities that are typically a part of a survivor's life this can also include dissociative responses and then disorientation so the sense of feeling dazed or as if their perceptions aren't quite on target and then denial so this is an unwillingness to look at the hard facts related to the trauma or the rejection of the idea that something is wrong so trauma symptoms begin to develop as short-term solutions to the dilemma of discharged energy dissociation occurs in a variety of ways each having a common fundamental disconnection between either the person and the body a part of the body or a part of the experience so this can look like a split between the consciousness and the body one part of the body and the rest of the body um i mentioned this in the last one it's called um never have i ever i think a show on netflix and the main i don't know if it's a spoiler i don't think it's a spoiler um she um witnessed her dad have a heart attack um and passed away while she was um you know at a concert like she was giving concert she like played um an instrument and um later she had like a psychosomatic experience where she couldn't move her legs um so that can be that dissociation is split between you know one part of the body and there's the body or the brain isn't functioning communicating to the legs so that's an example of that in mainstream media um but it could also be a dissociation between the self and emotions thoughts or sensations the self and the memory um of parts or all of the events um so the sense of being completely immobilized and helpless is not a perception belief or a trick of imagination it's real like they feel as though their body cannot move um so this is object helplessness a sense of paralysis that is so profound that a person cannot scream or move or feel um so that freezing is associated with that feeling of helplessness um so again tonic immobility i'll be sure to link that webinar um in the resources when i send out the powerpoint slides um so i want to launch another poll to see if any of these traumatic reactions if you've encountered any of these in the people that you work with so whether that's hyperarousal constriction dissociation freezing or something else that you think is important to the reaction that's not described by these four components all right i'll give a couple more seconds but it seems like um a lot of these traumatic reactions we're familiar with um with construction or avoidance being one of the top reactions that we've encountered and the people that we work with all right so i'll go ahead and end the poll share the results so you all can see what people have to say um and we'll continue to talk a little bit more about common reactions autumn okay already links tonic and mobility on the screen here perfect okay so for common reactions as an advocate um or a social service provider um you should be ready for any of these um emotions from survivors in the left box here so um a key um that a skilled advocate you know must develop is the ability to accept a wide range of emotions and feelings even ones that are difficult to deal with such as anger irritability or other intense emotions all these emotions are normal responses to experiencing trauma we'll talk about emotions a little bit later but trauma can also make everyday tasks such as concentrating organizing focusing on something for long periods of time or remembering details it can make that process overwhelming trauma can inhibit learning problem solving and making decisions so advocates may need to help survivors compensate for this by using memory tricks writing things down having survivors report important information back and using other strategies to support survivors and achieving their goals so i'd like you to think about what we've learned so far about the brain and connect that to how that could result in any of these different reactions on the screen so the psychological and then other behavioral and physical symptoms that we've talked about as well our reactions rather okay i'm going to check to see it doesn't seem like we have any other questions all right great we'll move on um so studies have discussed how we have three different brains so we'll talk about those more um and this is from um the body keeps the score so our rational cognitive brain is actually the youngest part of the brain and it occupies only about 30 of the area inside our skull um so the rational brain is primarily concerned with the world outside us so understanding how things and people work and figuring out how to accomplish our goals manage our time and sequence our actions so beneath the rational brain lie two evolutionarily older and to some degree separate brains which are in charge of everything else so the moment by moment registration and management of our bodies physiology and the identification of comfort safety threat hunger fatigue desire longing excitement pleasure and pain um the brain is built from the bottom up it develops level by level within every child in the womb just as it did in the course of evolution so the most primitive part the part that is already online when we are born is the ancient animal brain which is often called the reptilian brain um it's located in the brain stem just above the place where our spinal cord enters the skull um the reptilian brain is responsible for all the things that newborn babies can do so things like eat sleep wake cry breathe feel temperature um be hungry feel wetness and pain and rid the body of talks of toxins um so the brain and the hypothalamus which sit directly above it um together control the energy levels of the body they coordinate the functioning of the heart and lungs and also the endocrine and immune systems ensuring that these basic life-sustaining symptoms systems are maintained within the relatively stable internal balance known as homeostasis homeostasis um so breathing eating sleeping pooping and peeing they're so fundamental that their significance is easily neglected when we're considering the complexities of mind and behavior however if your sleep is disturbed or your bowels don't work or you feel hungry all the time or if being touched makes you want to scream as is often the case with traumatized children and adults the entire organism is thrown off into disequilibrium so it's amazing how many psychological problems involve difficulties with sleep appetite touch digestion and arousal so any effective treatment for trauma has to address these housekeeping functions of the body um right above the reptilian brain is the limbic system it's also known as the mammalian brain because all animals that live in groups and nurture their young possess one um development of this part of the brain um truly takes off after the baby is born so it's the seat of the emotions um the monitor of danger the judge of what is pleasurable or scary um decides what is or what is not important for survival purposes it's also the central command post for coping with the challenges of living within our complex social networks so the olympic system is shaped in response to experience in partnership with the infant's own genetic makeup and inborn temperament so as you know all parents with more than one child they can quickly notice that babies differ from birth in the intensity and nature of their reactions to similar events um so whatever happens to a baby contributes to the emotional and perceptual map of the world that is that its developing brain creates so in some um the reptilian brain and the limbic system make up the emotional brain um so it's at the heart of the central nervous system and it's key task is to look out for your welfare so the emotional brain initiates pre-programmed escape plans like the fight or flight responses and then at the top there the top layer is the neocortex i'm seeing some requests for getting copies of the presentation slides if you are on this webinar it means that you registered for the webinar and i have your email and you will receive a copy of the recording of the entire webinar and the slides i just wanted to reiterate that to make sure if you can if you're taking notes you don't have to screenshot everything you will have access to all of the power the power power point presentation slides i'm just gonna answer that and say yes yes you will great okay all right that seemed a lot of people had that question so wonderful i'm glad i got that addressed all right so hopefully all that made sense we're gonna move on to some other key players um in the brain that process trauma so i want to take a sip here but we can look at this for a second all right so we're going to use some analogies to better understand the different parts of the brain we're going to start in the middle section here with the cook or the thalamus so danger is a normal part of life and the brain is in charge of detecting that danger and organizing our response to it sensory information about the outside world arrives through our eyes nose ears and skin these sensations converge in the thalamus an area inside the limbic system that acts as the cook within the brain so the thalamus the cook right stirs all the input from our perceptions into a fully blended audiobiographical soup an integrated coherent experience of this is what is happening to me then those sensations are passed on in two directions so first down to the amygdala um the two small almond shaped structures that lie deeper in the limbic unconscious brain and up to the frontal lobes where they reach our conscious awareness so sight sounds smells and touch they're encoded as isolated dissociated fragments and normal memory processing disintegrates um so time freezes so that the present danger feels like it will last forever and so we'll talk about that a little bit more when we talk about memories um but that's important to to understand of how you might talk to someone about either a flashback that they're having or an experience that they had that was traumatic and it might not make coherent sense to us um but that's how they processed it and they received that information um so we'll talk about that later okay so now we're down at the amygdala right so we can understand that as the brain smoke detector so it identifies whether incoming input is relevant for our survival it does this quickly and automatically and with the help of feedback from the hippocampus which is a nearby structure that relates the new input to past experiences so if the amygdala senses a threat a potential collision with an oncoming vehicle a person on the street who might look threatening or something it sends an instant message down to the hypothalamus and the brain stem so it recruits the stress hormone system and the autonomic nervous system to orchestrate a whole body response so because the amygdala processes the information it receives from the thalamus faster than the frontal lobes do it decides whether incoming information is a threat to our survival before we're even consciously aware of the danger so by the time we realize what's happening our body may already be on the move we may already be running away from someone you know trying to grab our wallet or whatever the case is um so the amygdalas danger signals trigger the release of powerful stress hormones which include things like cortisol and adrenaline which increase the heart rate blood pressure and the rate of breathing it prepares us to fight back or to run away um so once the danger is passed the body returns to its normal state fairly quickly but when recovery is blocked and the body is triggered to defend itself which makes people feel agitated and aroused um so the frontal lobes so we're back up there particularly the medial prefrontal cortex um or it might be referenced later in the slides as mpfc um located directly above our eyes is the watchtower so the amygdala doesn't make judgments about the stimuli it just gets you ready to fight back or escape even before the frontal lobes get a chance to weigh on their assessment okay so now we're going to talk a little bit more about the emotions before we do talk about emotions i just want to do a basic quick check-in to see if all this brain stuff that i've been kind of throwing at you is making sense so let me know i mean if you do have a specific question i can go back um or it might be something that you can you know look at the slides later and understand a little better okay great it seems like most of us are saying that yes we're following or that um we think that we can catch up so always kind of give us our brains a moment taking all this new information or potentially a review there's a question about does chemical health impact any of the key players in the brain yeah absolutely so i'm not an expert on substance use or abuse or anything of that nature so i will state that but i do know that one of the main key players that you know talk about all this is like the dopamine reward system right so when the dopamine reward system is kind of impacted and influenced you know through maybe chemical dependency or different things that can interact with the amygdala and can interact with the prefrontal cortex so that's the basic level knowledge i can say on that but i can look up i'm going to make a note to look up on the relationship between chemical health and see if i can get some more information um for you on those specific regions of the brain but i do know the main thing with dopamine reward system okay great so it seems like people are understanding that um great and there's a question about what is the best form of therapy to recover from brain injury um so i do have some there's the results if people want to know how others were doing um i do have some resources for that i don't provide recovery for brain injury so i'll provide resources for that though but i can't speak on that directly and i do see some people raising their hands if you do have a specific question send it in the chat or in the q a okay um and then there is a suggestion that the brain the minnesota brain injury alliance is a really good resource for brain injuries yes that's probably the resource that i would send absolutely um so i'll make a note to add that in there is the resources as well okay wonderful so we will continue our conversation and talk a little bit more about emotions so neuroimaging studies of human beings is high and highly emotional states reveal that intense fear sadness and anger all increase the activation of subcortical brain regions involved in emotions and significantly reduce the activity in various areas in the frontal lobe particularly the mpfc so the medial prefrontal cortex so effectively dealing with stress depends upon achieving a balance between that smoke detector and the watchtower so regulating emotions from the top down or from the bottom up so top down regulation involves strengthening the capacity of the watchtower to monitor your body's sensations so some techniques for increasing top-down regulation would be things like mindfulness meditation and yoga and then bottom up regulation involves recalibrating the autonomic nervous system so accessing the autonomic nervous system through breath movement or touch so breathing is one of the few body functions under both conscious and autonomic control um and then our self-experience right is the product of the balance between our rational and our emotional brains so when these two systems are imbalanced you'll hear people say things like you know i feel like myself but when our survival is at stake these systems can function relatively independently um so when the alarm bell of the emotional brain keeps signaling that you're in danger and no you know no amount of insight will silence it so some people can say you know i cognitively know that i'm not in danger but my body thinks that it is and it's really hard to address that right so trauma can compound our difficulty to do our what am i saying can compound our difficulty in dealing with our emotions so the defenses we use to deal with overwhelming loss and grief may distance us from or numb our feelings as we've talked about earlier so they can prevent us from accepting experiencing and ultimately finding relief from painful feelings so these defenses also keep us from being joyful and loving um so that's something that if you've worked with survivors they might tell you that you know um even with i think i think it was brene brown who referenced um like star wars of like you know you you numb the dark you numb the light as well um so that's kind of you can't selectively choose which emotions you numb or block um so on the left here are some emotions that people who have experienced trauma and or domestic violence have reported um so are there any emotions that you'd like to add to this list so this list includes things like guilt anger fear anxiety shame sadness this is hopeness it should say hopelessness i'll try to remember to fix that um num so those are some of the things that we've talked about earlier so if there's any others that you want to add to this list i absolutely welcome that um but another note on emotions before i move on is that last bullet here on the screen um that you know emotions being the foundation of reason because they assign value to experiences that's important right so in working with survivors i found that there are specific emotions depending on that person that they believe are acceptable or unacceptable to experience so for example someone i worked through told me that it's okay for him to experience shame because he felt like the abuse was his fault but it wasn't okay for him to experience anger so some survivors don't want to experience any emotions at all um some people you know view emotions as weakness but we rely on our emotions to make sense of what has happened to us and our brain plays a large role on making those decisions that eventually influence how we react and how we are impacted later on okay so i'm not seeing anyone suggesting any other emotions which is totally fine um but feel free if you think of any you can send them in the chat all right so now we're going to talk a little bit more about trauma triggers um so triggers are events words actions or perceptions that in some way resemble and reawaken trauma um so i'm going to read this quote by neil gaiman um and he says they are trauma triggers our images or words or ideas that drop like trap doors beneath us throwing us out of our safe sane world into a place much more dark and less welcoming the past is not dead triggers have been waiting there in the darkness working out practicing their most vicious blows their sharp hard thoughtless punches into the gut killing time until we come back that way so once the trigger is pulled the consequences burst open in us like a fragmented bullet bringing back all the physical feelings all the emotions of earlier trauma and these triggers can cause the body to return to that fight flight freeze reaction which is common um to traumatic situations but when they're triggered survivors do not necessarily return to a full-blown traumatic response but they may experience discomfort or emotional and psychological distress so if you can think of any other triggers feel free to add them in the chat i know from the last webinar we did some people talked about you know specific anniversaries um if something traumatic happened during a particular holiday that happens every year that that can be a trigger um a certain color i know that's common with um childhood sexual assault of focusing on a certain color on the wall or in their room while it's happening um [Music] some others could be specific words that you know abuser would say to them a specific um you know sound or smell even depending on the situation holidays is being reiterated absolutely angelique asks have you ever heard of narrative exposure therapy trauma training yes i have um the nut training um for those of you i'll try to add a link to that but it talks about one of the main activities of narrative exposure therapy is doing this different timeline of your life and having different symbols to represent um you know different things that have happened in their life so both positive and negative or potentially traumatic events as well um and there's a bunch of therapists you know who are trained on being able to facilitate that but i'll definitely add some links people want to learn more about narrative exposure therapy all right let me know if there are any other triggers oh some people are saying music for specific songs that might be playing or specific restaurants absolutely okay so we will move on to some traumatic brain processes all right so we've talked about especially dissociation earlier so we'll talk a little bit about that um so dissociation is a protective strategic mechanism that's employed by the brain to protect survivors as they experience abuse so dissociation can be described as the essence of trauma so the overwhelming experience is split off and fragmented so that emotion sounds images thoughts and physical sensations related to the trauma they somehow you know kind of take on a life of their own so the sensory fragments of memory intrude into the present where they are literally relived so as long as the trauma is not resolved the stress hormones that the body secretes or produces to protect to protect itself keeps circulating and the defensive movements and emotional responses keep getting replayed similarly in the middle here we have flashbacks or intrusions which sounds like many of you are familiar with that so flashbacks and reliving are in some ways reported as being worse than the initial trauma itself so traumatic event can have a beginning and it ends at some point it's over but for people with ptsd a flashback can occur at any time whether they're awake or asleep so there's no way of knowing when it's going to occur again or how long it will last so if elements of the trauma are replayed again and again the accompanying stress the hormones engrave those memories ever more deeply in the mind so intrusive thoughts involve the ways in which survivors find themselves spending a lot of time thinking about the traumatic event regardless of whether they want to or not they might be doing something else maybe working or playing with their kids and all of a sudden they have a huge you know this flood of emotions or images that are related to the trauma that seem beyond their control um so another aspect of intrusive symptoms is their exacerbation at times of anniversaries right as we've talked about earlier or by things that remind the survivor of the original trauma so for example survivors may start to experience nightmares or intrusive thoughts at the same time every year so this typically corresponds with the anniversary of the significant aspect of the traumatic experience and additionally intrusive symptoms may be exacerbated around court dates counseling sessions or in other situations where the survivor might have to discuss the trauma or interact with someone who caused the harm so the traumatic moment becomes encoded in an abnormal form of memory which breaks simultaneous not simultaneously it breaks spontaneously into consciousness both as flashbacks during wake states and as traumatic nightmares during sleep so advocates need to recognize both the intensity of re-experiencing symptoms and how they impact survivors so validating these trauma reactions as normal responses to abnormal experiences can help survivors recognize these symptoms as adaptive and not signs that they are going crazy um so what might intrusion look like so some exam examples of that could be survivors report that they think that their experience they think about their experience when they don't want to it could be again those sights smells sounds that cause survivors to have a flashback or feel like they're in that traumatic situation again um survivors report nightmares or reoccurring dreams related to the trauma and then lastly emotional intensity is defined by that smoke alarm so returning back to the brain right so the amygdala and then the counterweight of the amygdala the watchtower or the medial prefrontal cortex so the context and the meaning of an experience are determined by the system that includes the dorsolateral prefrontal cortex and the hippocampus so the dorsolateral prefrontal cortex tells us how our present experience relates to the past and how it may affect the feature the future so it makes it the time keeper of the brain um so as you see we have a few questions can you experience dissociation during the trauma if it has gone on for many many years um i think i understand this question michelle i would say yes you can experience dissociation um during trauma that has been prolonged or ongoing so that can be right complex trauma and dissociation is a very common reaction to complex trauma so yes um angelique says isn't dissociation associated with people who have multiple personalities as in the person in the movie um psy bill um yes so there is a connection between dissociation um and this idea of you know multiple personality disorder um but there is you know of course a difference between those two um but the association is so i guess put plainly yes there is an association between those two things um but if someone does experience dissociation it doesn't mean that they have a personality disorder which i don't think you're implying but i just want to make sure that that's explicit as well okay so i think adjust all the questions and comments um alright so i do want to do a quick pull before we move on this is the last poll um and then we have we have quite a few slides left still so i want to go through them quickly so we have enough time for questions but i just want to know which of the following processes concern you the most about the survivors that you work with so we've talked a lot about these different components i just want to know more about um what you're concerned about or what comes to your mind as you think about these different processes i'm gonna give about five more seconds so we can cruise through the remainder of the information and get to more questions if you have any okay so it seems like a lot of us are saying intrusive thoughts i think especially if you're an advocate you know social worker social service provider you might be more privy to know more about these intrusive thoughts um and then a runner up is emotional intensity as well so thank you for sharing that we're gonna move on um so in the last time i gave this webinar people really appreciated me reading this quote um so i'm going to read it out loud and this kind of describes a traumatized person or someone who has experienced trauma what their reality can be like so this quote says i don't know of one thing i don't fear i fear getting out of bed in the morning i fear walking out of my house i have great fears of death not that i will die someday but that i am going to die within the next few minutes i fear anger my own and everyone else's even when anger is not present i fear rejection and or abandonment i fear success and failure i get pain in my chest and tingling and numbness in my arms and legs every day i almost daily experience cramps ranging from menstrual type cramps to intense pain i just really hurt most of the time i feel that i can't go on i have headaches i feel nervous all the time i have shortness of breath racing heart disorientation and panic i'm always cold and i have dry mouth i have trouble swallowing i have no energy or motivation and when i do accomplish something i feel no sense of satisfaction i feel overwhelmed confused lost hopeless and helpless daily i have uncontrollable outbursts of rage and depression so this is a really powerful quote um that i found and i want to make sure i cite this correctly um from waking the tiger so healing trauma um by peter levine um and he included this quote in his book to kind of depict what trauma can feel like look like um for not for everyone so again if these things aren't present um it doesn't mean that someone hasn't experienced trauma this is just one example um but having experienced trauma can mean continuing to organize your life as if the trauma was still going on um so unchanged and unmutable so as every new encounter or events it can be contaminated by the past so recognizing an object in the palm of your hand right it can require you sensing its shape weight temperature texture and position so each of these distinct sensory experiences is transmitted to a different part of your brain which then needs to integrate them into a single perception so alexander mcfarlane in australia found that people with ptsd often have trouble putting that picture that i just described together um trauma has shut down their inner compass and robbed them of the imagination they need to create something better right so traumatized people chronically feel unsafe in their own bodies the past is alive in the form of gnawing interior discomfort from within um and they learn to try to hide from themselves would you please add that to this in case we want to read it yes so i'm going to add the link um to if you want to read waking the tiger there you go okay we have a few more slides here we go so trauma is pre-verbal so i always pronounce this word wrong um but i think it's alex mathia alex alex mythia um so as greek for not having words for feelings so many traumatized children and adults simply cannot describe what they are feeling because they cannot identify what their physical sensations mean so not being able to discern what is going on inside their body can cause them to be out of touch with their needs so they might say things like i don't know what i feel it's like my head and my body aren't connected i'm living in a tunnel a fog no matter what happens it's the same reaction numbness nothing um having a bubble bath bath and being burned um is the same feeling my brain doesn't feel so that's something that someone has said and this failure to be in touch with their bodies contributes to their well-documented lack of self-protection and the high rates of re-victimization and their difficulties feeling pleasure sensuality and having a sense of meaning but i do want to say that that is not a reason to victim blame or anything the the cause of abuse is always going to be the person making that decision to cause harm um but that can be an explanation for those high rates degree victimization so silence can also equal death so um breaking that silence about trauma um kind of talks about silence about trauma can lead to a death a particular death of the soul so we may think we can control our grief our terror or shame by remaining silence but naming offers the possibility of a different kind of control so without language and context your awareness may be limited to i'm scared yet determined to stay in control you are likely to avoid anybody or anything that reminds you even vaguely of your trauma um so it kind of talks about and this is from dr bissell van der kauf culk's book as long as you keep secrets and suppressed information you are fundamentally at war with yourself hiding your core feelings takes an enormous amount of energy it stops your motivation to pursue worthwhile goals and it leaves you feeling bored and shut down meanwhile stress hormones keep flooding your body leading to headaches muscle aches problems with your bowels and sexual functions and irrational behaviors so these kind of like symptoms of ptsd can include different statements of i feel dead inside i have no future i will never be able to feel normal emotions again i don't feel like i know myself anymore um and maybe that language coding centers of the brain are inactivated during trauma as a part of the fight flight freeze response so that the memory is never encoded into language but rather it remains as images and sensations so that can be attributed to why it's difficult to explain that okay so i do see that there is a question could you include the quote that i read out loud yes let me find okay we're responding okay since it in the chat um i did see another hand raise so again please add it to the q a or the chat at the end if you want to speak and have me unmute you we can do that as well um but angelique says sally field portrays this sible a woman suffering from multiple personalities um 16 different personalities in order to cope and escape haunting memories of her halloween of her halloween childhood yeah i haven't watched that movie um but it does sound like there's a connection being made between multiple personality disorder and aces or adverse childhood experiences um so i'll definitely try to check that out but thank you for mentioning that okay so we're going to move on to memory we have two more slides and then we'll kind of get to the different resources and have more time for questions i just want to make sure we get through all the material um okay so breaking down the thalamus can help us explain why trauma is primarily remembered not as a story but as a narrative not as a story a narrative with the beginning middle and end but as an isolated sensory imprint so images sounds physical sensations that are accompanied by intense emotions usually terror and helplessness um so during normal circumstances um thalamus um the thalamus filter or the gatekeeper so the central component of attention concentration and new learning all of those things are compromised by trauma so people with ptsd have their floodgates wide open so lacking this filter so the thalamus or the gatekeeper right um they're on constant sensory overload so in order to cope they try to shut themselves down and develop tunnel vision and hyper focus if they can't shut down naturally they may enlist drugs or alcohol to block out the world so that's a little bit of a tie between substance use or abuse and trauma um traumatic memories are probably encoded into the brain differently due to the high levels of adrenaline and other stress hormones that are circulating through the body during the traumatic event it is not that these memories are forgotten by the traumatized person but they are stored in the brain differently and so survivors cannot access them as readily as other experiences so this is not to say that some memories of trauma are not clear and survivors remember events vividly um so for example sometimes survivors can tell advocates the exact moment during a traumatic experience when they decided that they were leaving their abuser but for others they may have an inability to recall important aspects of the trauma so this is a protective mechanism that the brain unconsciously employs to protect survivors so this means that the person cannot remember exactly what happened um so as patients mason and the trauma gazette observes many trauma survivors forget in order to survive so that's another common quote um okay lastly the biology of trauma so trauma can cause epigenetic changes so alterations in the structure of our chromosomes which can affect the way our genes function and make us less resilient and more vulnerable so these epigenetic changes can be transmitted to our children and grandchildren and make them as well as us less able to deal with stress and prevent illness um trauma can also accelerate the shortening of telomeres which are structures at the end of our chromosomes that diminish in size with age um so there's an assertion that trauma and the stress that it produces can shorten our lives sometimes especially when the trauma feels overwhelming and out of control we can completely lose our appetite more often after trauma we tend to eat compulsively and fast when we eat quickly the enzymes in our mouth don't have enough time to do their digestive job you know the saying like you know chew 30 times before swallowing um a lot of survivors don't do that and stress and trauma have a powerful effect on the microbiome so tons of trillions of bacteria that live in our small intestine trauma can turn this dynamic powerhouse from a beneficial protective friend to a dangerous enemy and then a healthy microbiome can stimulate the vagus nerve which i talked about earlier 90 of whose fibers are carrying messages back to the brain to its optimal stress reducing performance um it likely helps ensure that the message is the vagus nerve brings back to our brain promote nerve cell maintenance and the healing of damaged neurons um so i included this next slide just the different cycles of violence just for um honestly just reference as you're looking through the slides again if you want to try to see how these cycles of violence can be related to either any of the traumatic responses or previous um brain processes in experiencing trauma so i won't say too much about that but we do have five minutes left so i'm just gonna skip through to here these are a bunch of other resources about trauma and domestic violence um especially as a lot of us are um advocates trauma stewardship is a really really great resource that talks about vicarious trauma or like second-hand trauma um a lot of other great resources on here as well blood memory that talks about the indigenous and native american historical trauma experience um a bunch of resources here and then continued learning these are a bunch of book recommendations i'm going to add to this slide based on what people have sent in the chat but this is a great list of places to start to learn more not only about what is trauma and how is it connected to domestic violence but more so what are different treatments or different um ways to address trauma um i also want to acknowledge that we do have a handful of survivors on the call so if you do find that you would benefit from mental health resources this link is international so again i acknowledge we have viewers from outside of the us which is wonderful um so i wanted to make sure i provided a link for various different countries around the world and their supportive helplines so that link you can find there and then this is if you're specifically in the us and then if you're in the in minnesota i have another link for that but the national domestic violence hotline is great if you wanted to speak specifically to an advocate about domestic violence um and then we have all these other resources as well to include i will also include um a link to an emotional safety plan that we just developed that people have found really beneficial which can be helpful for people who have experienced trauma as well so i'll go ahead and link that um i'll send it in the chat as well and then more safety planning so that's the emotional safety plan right there i highlighted it because it's been very popular people have said it's been very beneficial to have um and then i did want to promote our website so www.w advocates.org we have a live chat feature so if you want to chat um with an advocate you can do that as well on our website oh no it's frozen um the next slide talks about um the different webinars that we have going on this month i don't know why it's being weird let's try it again um so we have two okay well i'm just gonna exit out of this so one is healing from trauma so this kind of talked a lot about what is trauma particularly how is the brain involved with trauma but if you want to learn more about okay what does healing look like we're having a panel of um right now it's five um different mental health providers psychologists um experts in this field who are experienced with helping survivors heal from trauma so i encourage you to register for that webinar and attend um so i'm going to send that link in the chat here because i'd love to have a great big audience um to ask a bunch of questions to our panel and then we also have a healthy relationships webinar as well which is going to be really great i encourage you to register for that as well the link for all the previous webinars and future webinars are linked on the screen as well um and then last lastly i wanted to promote our social media so we're on facebook instagram and twitter um definitely follow us um to stay up to date on different information and resources statistics what's going on with our organization how to help um contribute to our mission of breaking the cycle of domestic violence um and then lastly hopefully this will make me there we go now it's letting me make it big um so if you want a certificate of attendance for attending this webinar email me before i had a google form so if you've attended previous webinars you would have known that but that's um did it work as well so just send me an email saying that you attended this webinar and make sure you include the name that you want to be displayed on your certificates and i'll email it back to you um and then when you close out of this webinar you'll be directed to a post webinar survey it really helps to know your feedback how we can improve what you really like what you want to keep what you'd like to see next um so please give us your anonymous feedback and then add our crisis line i don't know why that's an equal sign i need to fix some things um our crisis line number to your phone so i will um be able to you know answer any questions if you want to send me an email um again you will receive an email it takes a little bit for the recording to be processed and put on youtube which i'm going to stop recording right now

Channel: Women's Advocates

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Length: 85min 56sec (5156 seconds)

Published: Mon Nov 09 2020