Trauma is ‘Written Into Our Bodies’—but Educators Can Help

Some of the first adorable patients to trickle into Dr. Nadine Burke Harris’s pediatric clinic when it opened in 2007—long before she was named the first surgeon general of California—were referred by teachers and principals.

Sitting in her examination rooms back then, in one of San Francisco’s poorest neighborhoods, Burke Harris knew almost immediately that something was amiss. Her young patients arrived with tentative diagnoses of oppositional defiant disorder or learning deficits, but routine exams uncovered a host of more serious physical ailments: asthma, autoimmune hepatitis, and even growth failure. Almost inevitably, the children’s caretakers—also sick with advanced diabetes, heart disease, or cancer—relayed harrowing stories of family incarceration, sexual abuse, and even murder.

“I’d have this snapshot of multigenerational adversity in one room,” Burke Harris said, still looking worried decades later. How did the pieces fit together? What did a learning problem have to do with asthma, or with exposure to trauma? Could any of it be connected to terminal conditions like cancer?

An answer arrived “like a bolt of lightning” in 2008, when Burke Harris read a seminal study from the Centers for Disease Control and Prevention (CDC) linking childhood trauma—which the researchers called adverse childhood experiences (ACEs)—to dramatically higher rates of heart disease, stroke, cancer, and diabetes in middle-aged patients. Burke Harris’s own groundbreaking research in 2011completed the picture, revealing an astonishing relationship between childhood trauma and the onset of learning and behavioral issues.

Today, the implications of those insights still feel revolutionary, blowing a hole in pious American myths about equity, social mobility, and financial success. Our good fortune, or rotten luck, is “written into our biology,” Burke Harris asserts in her 2018 book, The Deepest Well—wired into synapses and coiled within strands of DNA—where it exerts a stealthy and persistent influence on our bodies and minds, for better or worse.

For children with ACEs, the damage is reversible, and teachers can help, Burke Harris says—but she’s adamant that they can’t do it alone. “We all have to play our positions,” she insists, emphasizing the need for broader coordination between medical, educational, and emergency systems. “It’s unfair to ask teachers to be therapists or doctors. The role of educators is in delivering that daily dose of buffering care that’s so important for healing.”

I sat down with Burke Harris recently to talk about how she came to her vocation, whether our traditional school disciplinary policies are supported by science, and how she overcame her skepticism about meditation.

STEPHEN MERRILL: In your book The Deepest Well, you say your father taught you that “there is a molecular mechanism behind every natural phenomenon.” There’s just such a deep curiosity about how the world works running through the book.

NADINE BURKE HARRIS: Yeah. That is just part of my DNA. It’s the way that I was raised—my dad is an organic chemist. When we were little kids—when my four brothers and I were throwing paper airplanes at each other—your typical parent would be like, “Stop that or else you’ll put an eye out.”

My dad would come in and he would say, “OK, let’s time your throws. Then let’s measure the distance so we can calculate the velocity. Then we know that gravity is 9.8 meters per second squared, so we can calculate the lift under the wings.” It was science all day, every day in my house.

MERRILL: Right, and on one level the book reads like a scientific mystery. At your clinic, you’re surrounded by kids with really serious illnesses—but for years the “molecular mechanism” beneath them eludes you. Can you take me back to that moment in 2008 when you were handed the CDC’s study on ACEs? What were you feeling when you read that?

BURKE HARRIS: It was like being hit with a bolt of lightning. You remember in that movie The Matrix, when all of a sudden Neo can see what the universe is really made out of? It was just such a validation—a coming together of all of these disparate pieces—that I feel I had been seeing throughout my career.

Keep in mind, I had done research in college about the effects of stress hormones like cortisol and how they affect development. And I had been—day in, day out—caring for patients at Bayview Hunters Point clinic, hearing their stories and seeing over and over again how they were impacted by the harms of poverty, trauma, and adversity.

Almost every cell in your body has a receptor for cortisol. When the stress response is triggered too frequently, or too severely, it can change the structure and function of children’s developing brains, their immune and hormonal systems—and even the way their DNA is read and transcribed. Those changes are what we now refer to as a toxic stress response.

MERRILL: You’ve said that school-aged children with ACEs often present with oppositional defiant disorder, impulse control issues, or difficulty focusing. What can teachers do? Does the science support social and emotional learning (SEL)?

BURKE HARRIS: Absolutely. Those are the tools to help kids understand how to recognize and regulate their emotions and their behaviors. One of the things that I think is really crucial: As a doctor, I may be the one who’s screening for ACEs, but I might see the child at the most a couple of times a year.

Educators can deliver the daily doses of healing interactions that truly are the antidote to toxic stress. And just as the science shows that it’s the cumulative dose of early adversity that’s most harmful, it also shows that the cumulative dose of healing nurturing interactions is most healing.

Giving children the tools to understand how to recognize what’s going on with them, then how to respond—especially to be able to calm their bodies down—truly is healing.

In her 2011 study, Burke Harris found a powerful link between the number of childhood ACEs and the onset of learning and behavioral issues. 

MERRILL: I think our teachers will be glad to hear it.

BURKE HARRIS: I cannot tell you the number of kids that I have cared for who, when I say to them, “You know what? Because of what you’ve experienced, your body might be making more stress hormones than it should. That can look and feel like being quick to anger, or having trouble controlling your impulses, or getting sick easily”—I can’t tell you the number of kids who have looked at me and literally said, “Oh, you mean I’m not crazy?”

Many of our kids have been told that they are the problem. Helping them to understand that what’s going on in their bodies is actually a normal response to the abnormal circumstance that they find themselves in, giving them tools to understand how to calm themselves down, how to keep themselves safe, how to connect with nurturing relationships—I’ve seen it be life-changing and life-saving.

MERRILL: Have you given thought to whether our discipline policies in schools are informed by science? Are punitive tactics like loss of recess, shaming, expulsion, suspension—are those going to work for kids with trauma?

BURKE HARRIS: I have a feeling that is a setup, but I’m grateful for it [laughs]. Because that’s really the whole point. If the science shows us that many of these behaviors are associated with a toxic stress response, then blaming and shaming that child is not going to improve that.

For example, if you have a child who is experiencing adversity at home and is being defiant, acting out, having a terrible time with impulse control, suspending them so that they can go home to be in that environment may be doing more harm than good.

We obviously need school safety policies and policies that support the orderly functioning of the school environment. But the science suggests that those should be things like in-school suspensions, restorative justice, opportunities to de-escalate and give a child the time and space to allow their adrenaline and cortisol levels to come down. It could be as simple as 15 minutes in a quiet area to get back to self-regulation. That’s a way to work with a child’s biology instead of working against the child’s biology.

MERRILL: That reminds me of this school in Nashville where I first saw a peace corner. Have you heard of these? Kids can go there just to calm down. There are even activities to get them to self-regulate.

BURKE HARRIS: Yes, I’ve seen that! There’s one in California that has a similar space—it’s beautiful. I think it was in Fresno. When I saw it I was just like, “This is awesome. This is science being implemented in our classrooms.”

MERRILL: Can you talk to me about meditation? I know you were a little wary of the practice at first, but now you seem to prescribe it.

BURKE HARRIS: Yeah. That’s no joke—I really do prescribe it as part of my clinical practice. If you are experiencing an overactive stress response, there’s cortisol, adrenaline, all these stress hormones—those are what leads to long-term harm.

So I went through the literature and said, “OK, well, what does the opposite?” I was skeptical at first, but meditation helps to regulate the part of the brain that is associated with recovery post-provocation; it’s associated with reduced levels of cortisol and other stress hormones; and it also reduces the physiological indicators of an active stress response, like blood pressure and heart rate.

So I implemented a program in my clinical practice—we taught mindfulness as part of our treatment protocol for kids with toxic stress.

MERRILL: How young can the kids start?

BURKE HARRIS: Mindfulness practices can be done itty-bitty, for kids as young as 3 in my practice. The modality might change a little bit depending on the developmental stage. From 3 to 6, you might do one type. Then as kids get older, you can do more things, like downloading a mindfulness app on your phone and practicing 10 or 20 minutes a day.

MERRILL: Is there anything else you want to say? Anything I missed?

BURKE HARRIS: The last thing that I want to say—especially in light of Covid and all of the anxiety around that issue—is for our educators. We know that educators are the backbone of our society. As we do this work, I want to encourage you to put your own oxygen mask on first. Because we need you in this fight. We need you in this struggle.

In order for any of us to provide that safe, stable, and nurturing environment for the children that we serve, we have to practice self-care so that we can be available. Please make sure to put your own oxygen mask on and practice real care for yourself so that you can be there for the next generation. 

Trauma is ‘Written Into Our Bodies’—but Educators Can Help by Stephen Merrill was originally published on September 11, 2020 at Edutopia.

Nine Ways To Ensure Your Mindfulness Teaching Practice Is Trauma-Informed

A recent MindShift article highlighted some things teachers should be aware of if they’re bringing mindfulness into their classrooms. Students may have experienced trauma that makes sitting silently with their eyes closed feel threatening, and teachers can’t assume it will be an easy practice for every child. That awareness is important to create an inclusive environment, but it doesn’t mean that teachers shouldn’t cultivate their own mindfulness practice or use some techniques with students.

Often mindfulness is used as a way to help students build self-regulation skills and learn to calm down when they become frustrated or angry. Cultivating those skills can be powerful for students, but many teachers say mindfulness is crucial for themselves, helping them take an extra moment before reacting to students.

“The best way to practice trauma-informed mindfulness is [for teachers] to have their own practice and interpret the behavior of the youth through a trauma-informed lens, even if they never do mindfulness training with the kids,” said Sam Himelstein, a clinical psychologist, trainer and author who has spent most of his career working with incarcerated youth. He’s received a lot of questions about how to be trauma-informed while still using mindfulness in classrooms since the first article. He suggest nine guidelines for teachers that he uses to make sure mindfulness practice with youth is helping, not hurting.

1. Do No Harm

“The assumption behind that is that harm can be done,” Himelstein said. “If you teach someone mindfulness meditation who has had a lot of trauma in their life, in fact, harm can be done.” That’s important for teachers to know. Research on mindfulness shows the practice can bring up uncomfortable feelings, and layered on top of existing trauma can be frightening or psychologically dysregulating. That’s why Himelstein stresses that no one should be forced to close their eyes or sit a certain way.

“If you’re unintentionally portraying that it’s really important to close your eyes, they can misinterpret that,” Himelstein said. In fact, it’s common for folks who have been traumatized to misinterpret a neutral direction.

2. Establish a sense of safety

“There are some situations in some school settings where youth are not that safe because there’s violence that happens,” Himelstein said. “If you’re not in a place where kids feel physically safe, then you probably shouldn’t be doing any deep practices.”

Kids can feel vulnerable when attempting to be present in the moment, so physical safety is key. Establishing that kind of safety may take some extra culture-building in the classroom first.

3. Build relational mindfulness

This set of strategies is about building the type of community where students feel safe practicing mindfulness. Teachers can help make their classroom feel safe to students with clear boundaries that are predictable. Group norms or agreements developed with students are one way to do this.

“For people who have experienced trauma those things tend to not be present, so the more you practice predictability by practicing group agreements, and building authentic relationships between you and the youth, and among the youth, it starts to feel more safe,” Himelstein said.

It can be tricky to know if relational trust has been built, but Himelstein said when students are more willing to share openly about themselves or they’re relating class material to their own lives, that’s one sign they feel safe. Of course it’s complicated because of different personality types, some of which may naturally be more reserved. But even with introverted students, teachers can often tell if trust is there through their writing or if they share something out loud even once.

“You can check in with the youth and not just leave it up to your own assessment or guesswork in terms of where they’re at in feeling safe and that there’s trust in the room,” Himelstein said. If there’s more work to be done, trust games and icebreakers can help people get more comfortable.

4. Understand intersectionality. Be mindful of implicit bias and culture.

Mindfulness cannot be detached from the other ways teachers interact with students in the classroom. Himelstein said it’s important to take note if, for example, girls are being punished more harshly for the same behavior a male student exhibits, but for which he isn’t punished.

“It depends on the context, but I’ve definitely coached some teachers and therapists who work in diverse settings in terms of who they call on the most, who gets the most energy, how their expectations are shifting depending on different folks,” Himelstein said.

If students think a teacher is unfair based on race, gender, sexuality or any other identity marker, that will undermine the relational trust needed to facilitate mindfulness and mental health.

“In my work with youth, I never divorce the practice of mindfulness from the greater sphere of building an authentic relationship with that young person,” Himelstein said. “I don’t divorce intersectionality from the practice of mindfulness.”

5. Understand the “window of tolerance” and be on the lookout for it

Imagine two parallel lines. Within those lines is the window of tolerance for physiological arousal. Outside of that is when people may experience tunnel vision, when they can’t think straight. Outside the window of tolerance students may be hyperaroused when they’re extremely angry or hypervigilant. But students can also be hypo-aroused, when they’re disassociated from their surroundings. In both of these states, students won’t be able to follow directions.

Himelstein remembers meeting his wife for lunch after a therapeutic session with a client that triggered him. He couldn’t physically read the menu because his prefrontal cortex was offline. “My brain was down regulating,” he said. “I wasn’t quite in fight, flight or freeze, but I was on the way there.”

If teachers can recognize those moments with students, they can use other interventions to help students get back into the window of tolerance. Those might include listening to music, playing a rhythm game, dancing — something that doesn’t require the student to process directions.

A teacher might notice a student is getting triggered and naturally take a break from instruction to listen to some music or play a quick game without calling attention to the student who is triggered. This works better if these types of movement or music breaks are already part of the DNA of the classroom. Then it doesn’t feel odd or out of place to students when a teacher uses it as a tool to intentionally support a specific student.

“You’re hoping in some way the music moves them, not emotionally, but there’s something about the music they like,” Himelstein said. “Maybe they get that head bob going. That’s what you’re looking for.”

He remembers one young woman he worked with who had been estranged from her father for several years because of his drug addiction. She finally felt ready to reach out to him to try to build a new relationship when she found out he had died of an overdose. Himelstein was with her when she got the news. The young woman was in shock and no mindfulness techniques would have worked at that moment. Instead, Himelstein put on a song he knew his client liked, and they sat and listened until she came out of shock and back into her window of tolerance.

6. The paradox of mental training

The paradox is that paying attention to the present moment — the heart of a mindfulness practice — won’t always make a person feel calmer. But, at the same time, practicing mindfulness when one isn’t upset builds a toolkit that could be useful to stay calm in stressful situations. Himelstein said this is a contradiction teachers have to embrace in this practice.

Deep breathing exercises or a body scan are strategies to practice in a calm state. They can help with stress reduction and emotional management. The goal is to make them part of everything that happens in the classroom so they’re second nature, and students can draw on these tools when they need them without thinking.

Himelstein trains youth and guards in juvenile detention centers in these techniques. Recently a young person told him that when a guard called him a name he naturally took a deep breath, providing him the slightest bit of space to consider the consequences of taking action, and preventing him from getting triggered.

“I’ve heard that in juvenile hall, in education settings, in so many situations,” Himelstein said.

7. When teaching mindfulness, prioritize somatic-based exercises.

“The body tends to have the ability to help ground people a little more, or at least not trigger as much,” Himelstein said. Especially if students are not used to mindfulness, or don’t feel comfortable with it, keeping them out of their heads can be a good thing. Instead focus on how deep breathing feels in the belly and the chest. Do body scans or remind young people to think about the sensations in their bodies.

“When youth don’t have a clear sense of what they’re supposed to be doing, and it’s not as tangible, it’s easier for their minds to wander and stumble upon traumatic memories,” Himelstein said.

8. Don’t over-identify with mindfulness logistics

It can be counterproductive to insist too strenuously that mindfulness look a certain way. Things like keeping eyes closed, holding the hands in a certain way, or having a particular body posture really don’t matter, and can lead to power struggles.

9. Think about daily mindfulness interventions.

There are lots of informal ways to bring some of the benefits of focusing on the present into the classroom. It might become routine at the start of the day, or when class begins, to do a mindful check-in: Each student takes a deep breath, and shares how they are feeling at the present moment. Himelstein always encourages youth to use a real emotion like angry/frustrated/happy/sad, as opposed to more generic statements like good/bad. It’s also not too much of a stretch to add some element of academic content to these activities.

“It’s a great way to embed a mindfulness practice in the DNA of the classroom and also you can easily add a prompt to the end of it,” Himelstein said.

Article source: KQED MindShift