The Trauma Resiliency Model: Building Strength and Resilience
When individuals experience traumatic events, it can have profound effects on their physical, emotional, and psychological well-being. However, there is hope for recovery and rebuilding resilience. One such effective approach is the Trauma Resiliency Model (TRM), a therapeutic framework that empowers individuals to heal from trauma and develop resilience.
A foundational concept to the trauma resiliency model is that “when faced with the most challenging of life experiences, hope can be found and can fundamentally transform our life’s journey.” Basically, our biological make-up has built in functions to heal from life’s traumas. Elaine Miller-Karas, LCSW, the creator of the trauma resiliency model explains, that “the ‘elegant design’ of the nervous system offers hope.” She continues, “understanding the neuroscience behind our suffering reframes our experience.” Markedly, she posits that our biological system functions “to heal and create new meanings and purpose from our suffering” (Miller-Karas, 2015).
Miller-Karas designed the trauma resiliency model to assist individuals maximize their healing potential after suffering trauma. The model is centered on psychological concepts of stress, regulation, resilience, and trauma. The proposed therapies include a variety of cognitive behavioral techniques combined with body based methods.
Understanding the Trauma Resiliency Model (TRM)
Elaine Miller-Karas first presented the Trauma Resiliency Model in 2015. The model is based on the understanding of the neurobiology of trauma and the body’s natural ability to heal itself. TRM focuses on addressing the physiological and psychological imbalances caused by trauma and provides individuals with skills and tools to regulate their nervous system to aid their body in healing to promote recovery.
The trauma resiliency model utilizes current literature on the role of stress to motivate behaviors, explaining that stress is a natural function of life, however, when stress exceeds a person’s ability to process, it causes harm. Overregulated and underregulated stress invites emotional dysregulation, maladaptive behaviors, and disease and illness.
Therapists utilizing this model assist clients in two primary ways. First, they educate clients about the nature of trauma and resiliency. Second, they help the client learn skills to assist with healing.
Educating Clients About Trauma
Linda Grabbe and Elaine Miller-Karas present that in TRM the clients are instructed in “the resiliency zone, the nature of trauma, and types of emotional, cognitive, behavioral, spiritual, and physical responses to stress and trauma; the neurobiology of traumatic symptoms with simple explanations about the nervous system, autonomic nervous system responses to threat and fear, trauma and memory, (explicit vs. implicit), and the three-part brain model (survival, emotional, thinking)” (Grabbe & Miller-Karas, 2018).
Teaching Skills to Stabilize Nervous System
Miller-Karas presents nine skills in her model for regulating emotions to stabilize the nervous system, reduce or prevent the symptoms of traumatic stress, and reprocess traumatic experiences. These skills fall under two separate categories. The first six fall under the Community Resiliency Model (CRM) and are fundamental throughout TRM therapy. Miller-Karas designates the remaining three skills for reprocessing traumatic memories and these require the professionals assistance of a competent psychotherapist.
The Community Resiliency Model (CRM)
The Community Resiliency Model is a form of self-care designed to stabilize emotions, making more adaptive thinking available during emotional and physical distress. Miller-Karas refers to the first six skills as the community resource model because they can be practiced by anyone to settle emotions, bringing stress back into the resiliency zone, during stressful and threatening situations. Miller-Karas explains that “CRM skills are used to develop resources that increase resilience and the ability to function under stress” (Grabbe & Miller-Karas, 2018).
To utilize these skills, individuals do not need the assistance of a trained therapist. They just need to be practiced in their use, and capable of pulling them up in a time of need.
I watched an odd YouTube video that somehow appeared in my newsfeed. A survivalist demonstrated how to survive breaking through thin ice into freezing water. Usually, such videos hardly grab my attention; however, this one piqued my interest when the survivalist began his life-saving measures by practicing two of the first three CRM skills (tracking and grounding) before responding with behavior taking action to escape. He explained that after plunging into the freezing water, one should take a moment to feel the water and experience bodily sensations. He coached that this would help reawaken the mind from the immediate shock. The survivalist coach then proceeded to give step-by-step behavioral actions for pulling oneself out of the water.
One of the basic goals of CRM is to help individuals discern the difference between sensations of distress and well-being. Basically, according to the theory, once we deploy interoceptive mindfulness, we may choose what to pay attention to—sensations of distress or sensations of well-being. The idea is to escape automatic mode, become mindful of our experience, and to adaptively direct our thoughts. From this position of calmness we can refrain from saying something that hurts someone we love, or perform simple step by step behaviors for escaping freezing water after falling through thin ice.
In dialectic behavior therapy, they refer to acting adaptively from a calm mind as acting from our wise mind In Miller-Karas’s trauma resiliency model, she refers to it as acting from the resiliency zone.
The Resiliency Zone
The resiliency zone refers to a manageable level of stress. We need enough stress to motivate but not so much that we freeze in terror. Miller-Karas’s resiliency zone is akin to Daniel Siegel’s window of tolerance. Life events may excite high levels of stress pushing us out of the resiliency zone. It is normal to exceed our limits of comfortable processing. However, when stress is high our physiological response kicks in, changing our functioning. When stuck in high zone (chronic stress), we experience edginess, irritability, anxiety and panic.
Another reaction we may defensively employ in response to high stress is detachment. In the low zone, we experience exhaustion and fatigue, depression, and isolation. CRM skills bring us back to the resiliency zone whether we can resume normal functions, acting from our wise mind, and resolve threatening and hurtful situations.
Nine Key Skills of TRM
Community Resiliency Model Skills
Skill 1: Tracking
Tracking is the skill of describing the ‘felt-sense’ of internal and external bodily sensations. The ability to monitor physical reactions to stress in contrast to the sensations of well-being is essential for maintaining emotional stability and escaping automatic responses to experience. In psychology, we also refer to tracking as focusing. It is the ability to stay with the felt sense as it develops, examining it with curiosity, without labeling or judging.
Miller Karas explains that, “some individuals experience symptoms such as an elevated heart rate and respiration rate in the wake of a traumatic event. These symptoms cannot often be ‘talked away’ (e.g., we would not expect our heart rate to slow down no matter how much we tell it to do so).” She continues, “however, such symptoms may be able to be sensed away if the individual can learn to track their nervous system to intercept these sensations of distress and bring attention to sensations of well-being. The nervous system can return to balance, and toxic stress reactions can be reduced or eliminated” (Miller-Karas, 2015, pp. 26-27).
Skill 2: Resourcing and Resource Intensification
In resourcing, we identify and gather resources that “bring a sense of comfort, peacefulness, and joy” (Grabbe & Miller-Karas, 2018). A CRM guide can assist individuals intensify these resources through guiding the client to provide more detailed descriptions, while tracking the positive feelings associated with the resources. The theory is that by holding thoughts of our resources together in our working memory with associated experiencing of positive emotions, they create a bond. Consequently, when we purposely recall a resource during a time of stress, the positive felt sense will accompany the memory, helping to stabilize intense emotional stress.
Skill 3: Grounding
Grounding is a present-moment awareness of bodily sensations from contact with external objects. According to Miller-Karas this “felt-sense of contact in the present-moment provides gravitational security and a sense of safety and control” (Grabbe & Miller-Karas, 2018). Mindfulness instructors teach grounding as a primary skill. We can practice grounding anywhere by focusing attention on the sensation of our feet on the ground, or running water passing through our fingers. A popular grounding technique is directing attention to breathing, feeling the cool air pass through our nostrils, and the warm air expelled through our mouth.
Jon Kabat-Zin suggests that we can learn grounding through a formal practice, such as sitting meditation. He explains that “the formal practice can give you the strength and the self-knowledge to return to what you need or want to do and let the doing come out of your grounding in the domain of being” (Kabat-Zin, 2013).
Skill 4: Gesturing
Typically, gesturing occurs unconsciously, accompanying our spoken words. Gestures add meaning to conversation. As a coping skill, we can purposely employ gestures that self-soothe. In TRM, guides invite their clients “to identify gestures that are self-soothing that can be brought into present-moment awareness to return the nervous system back into balance—back to the Resilient Zone” (Miller-Karas, 2015, p. 47).
Miller-Karas provides this list of self-soothing gestures:
- Self-calming gestures: movements that bring comfort and safety (i.e., twisting strands of your hair; gently rubbing your hand, chin, or arm; moving your leg, arm or hand in a particular rhythm).
- Gestures of release: “movements that represent the body coming back into balance and a sensation of something distressing leaving the body.” There are colloquial expressions such as Taylor Swift’s popular song “shake it out” that assist the body to recalibrate, rediscovering balance.
- Universal movements that represent wholeness, spiritual beliefs, or deep personal meaning (i.e., bringing your hand to your heart, gently touching your fingertips together, placing the palms of your hands together as if in prayer).
- Protective movements (i.e., movement of the hands and limbs) (Miller-Karas, 2015, p. 47).
Skill 5: Help Now!
The help now! strategies help reset the nervous system stuck in the high or low zones. TRM provides 10 helpful, easy to use strategies to snap the individuals system back into manageable limits when hyper- or hypo aroused.
The ten help now! strategies are:
- Drink a glass of water, a cup of coffee or tea, or a cup of juice.
- Look around the room or wherever you are, paying attention to anything that catches your attention.
- Name six colors you see in your immediate environment.
- Open your eyes and soften your gaze if your eyes are tightly closed.
- Count backward from ten as you walk around the room.
- Touch a surface. Mindfully examine the texture and temperature.
- Notice the temperature in the room.
- Notice the subtle sounds (the clicking of a clock, distant traffic, the chirping of a bird, etc…).
- Walk and mindfully pay attention to the movement in your arms and legs and how your feet make contact with the ground.
- Push your hands against the wall or door slowly and notice your muscles pushing or standing against a wall, facing forward and gently pushing your back into the wall (Miller-Karas, 2015, p. 49-50).
These strategies incorporate mindfulness of a particular sensory experience as a form of grounding. The purposefulness of this trauma resiliency model exercise is to distract from stimuli disrupting the nervous system, giving the body a chance to recalibrate, before addressing the issue.
Skill 6: Shift and Stay
The sixth CRM skill is to shift and stay. Shift and stay is a skill of purposely choosing a CRM strategy when encountering a known distressing trigger. “When consciously aware of symptoms of distress, the client has a choice of what might work best to relieve the distress by shifting awareness from the distressing sensations” to one of the CRM skills (Grabbe & Miller-Karas, 2018).
Marshall Goldsmith explains that “a trigger is any stimulus that reshapes our thoughts and actions” (Goldsmith, 2015, Kindle location: 265). Triggers typically invite automatic reactions. The practice of shift and stay is to intervene between the trigger and the automatic maladaptive behavior early in the process. By becoming familiar with our emotional and behavioral patterns, we can recognize the trigger and interrupt the cycle with a CRM skill.
Reprocessing Trauma Skills
The reprocessing skills associated with traumatic memories require guided one-on-one assistance from “a trained therapist or psychiatric advanced practice registered nurse” (Grabbe & Miller-Karas, 2018).
Skill 7: Titration
The skill of titration refers to becoming aware of smaller, more manageable sensations associated with a traumatic experience. Trauma embeds heightened arousal to certain stimuli into an individuals biological make-up. Exposure to the stimuli may awaken painful and overwhelming emotions. In titration, the the therapist moves through subtle shifts, to help their clients experience emotion without overwhelm.
Lawrence Heller wrote, “in chemistry, when two containers, one with an acid and one with a base, are poured one into the other all at once, it produces an explosion. But if the two substances are combined drop by drop, the discharge is very small and gradually, the two substances neutralize each other. This analogy communicates the importance of taking highly charged emotional material one manageable piece at a time. This measured approach helps avoid catharsis—the explosion—and facilitates the integration of the highly charged affect” (Lawrence & Lapierre, 2012, Kindle location: 3,872).
Skill 8: Pendulation
Miller-Karas suggests that pendulation is to be used together with titration. Psychotherapists use this practice to find the optimum distance from a stimuli, to arouse the system but remain within a manageable state. The practice carefully takes a client in and out of an emotion that would be otherwise too painful.
Thomas Scheff explains that “the main basis for the importance of this kind of alteration is that it provides a feeling of control.” He continues, “if the feeling gets too intense, one can pendulate out of it” (Scheff, 2007). Basically, pendulation is a moving in an out of arousal associated with a traumatic memory.
Skill 9: Completion of Survival Response
The final skill of the trauma resiliency model is completion of the survival response. The underlying theory is that our bodies mount a defensive response to threats. When the traumatic experience prevents the completion of an effective response, their remains a sense of unfished business within the system. In psychology, we refer to this as unprocessed trauma.
There are four phases of a trauma response:
- the orienting response
- mobilization of fight of flight
- completion of survival responses
- return to the resiliency zone
Miller-Karas explains that “each phase is part of the autonomic nervous system’s effort to assess, respond, and recover from a threat.” She continues that when “those somatic sensations that could not be completed at the time of the trauma may be carried out in vivo or mentally and may be critical to resolution of trauma symptoms” (Grabbe & Miller-Karas, 2018).
This skill is similar to the psychological concept of somatic experiencing. Somatic experiencing “is a step-by-step approach designed to treat shock trauma and the resulting nervous system dysregulation. It is a progressive and gentle approach that supports the biological completion and discharge of the intense survival energies of the body’s fight-flight responses” (Heller, 2012, Kindle location 481).
Benefits of the Trauma Resiliency Model
The traumatic resiliency model is a helpful compilation of skills and treatments to assist with regulating emotions. Individuals can adopt and practice many of these skills, adding to their personal repertoire of tools for coping with distress.
- Improved Self-Regulation: TRM equips individuals with practical tools to self-regulate their nervous system when triggered by trauma-related memories or stressors. This leads to a greater sense of stability and control over their emotions and reactions.
- Reduced Symptoms of Trauma: By addressing the underlying physiological and psychological impacts of trauma, TRM helps individuals mitigate symptoms such as anxiety, depression, hypervigilance, and intrusive thoughts. The model offers a path to recovery and a reduction in the overall impact of traumatic experiences.
- Enhanced Resilience: TRM empowers individuals to rebuild their resilience and restore a sense of safety, trust, and well-being. By using the model’s techniques and strategies, individuals can develop a greater capacity to adapt and cope with future challenges.
A Few Words from Psychology Fanatic
The Trauma Resiliency Model is a powerful therapeutic approach that provides individuals with practical skills for healing from trauma and building resilience. By incorporating the CRM skills, along with the therapeutic assistance of titration, pendulation, and completion, individuals may recover from the ill effects of trauma haunting their lives by regaining control over their nervous system and improve their well-being. Through this framework, individuals can work towards a path of recovery and rediscover a sense of strength and resilience in the face of distress and adversity.
Goldsmith, Marshall (2015) Triggers: Creating Behavior That Lasts–Becoming the Person You Want to Be. Crown Business; First Edition edition.
Grabbe, Linda, & Miller-Karas, Elaine (2018). The Trauma Resiliency Model: A “Bottom-Up” Intervention for Trauma Psychotherapy. Journal of the American Psychiatric Nurses Association, 24(1), 76-84. DOI: 10.1177/1078390317745133
Heller, Lawrence; LaPierre, Aline (2012). Healing Developmental Trauma: How Early Trauma Affects Self-Regulation, Self-Image, and the Capacity for Relationship. North Atlantic Books; 1st edition.
Kabat-Zinn, Jon (2013). Full Catastrophe Living (Revised Edition): Using the Wisdom of Your Body and Mind to Face Stress, Pain, and Illness. Bantam; Rev Updated edition.
Miller-Karas, Elaine. (2015). Building Resilience to Trauma: The Trauma and Community Resiliency Models. Routledge; 2nd edition.
Scheff, Thomas (2007). Catharsis and Other Heresies: A Theory of Emotion. Psychological Test Adaptation and Development, 1(3), 98-113. DOI: 10.1037/h0099826