March 21, 2022

We’re all tired. I try not to speak in hyperboles or to make assumptions about a collective group, but I feel confident about this presumption. Whether you work in education, acute care, outpatient therapy, or early intervention – these past two years have affected us in profound ways. They have pushed us to be our most adaptable and vigilant versions of ourselves, particularly as clinicians. Our clients and students feel this same strain.

This pandemic is collective trauma, the full effects of which are only just slowly emerging. While the nature of our jobs requires us to be mindful of serving the emotional needs of our clients and students, it’s important to consider how these past two years have affected SLPs as well and how we can work to combat the effects of intense stress and trauma.

Signs of Trauma and Intense Stress

Recognizing signs of trauma and intense stress is the first step to proper management. For short periods of time, stress is normal. Events such as taking an exam, writing a paper at the last minute, or meeting someone new unexpectedly are all situations that produce normal amounts of stress if they occur infrequently and over short periods of time. Other events such as a fundamental disruption in lifestyle or routine (re: an international pandemic) lead to larger amounts of prolonged stress, the effects of which are much more damaging. Excessive stress and trauma can affect language, cognition, emotional and sensory systems.

Sometimes symptoms of extreme stress can be subtle: avoiding eye contact, fidgeting, pacing. If left unattended, these behaviors can evolve into disruptive and even aggressive outbursts. Noticing small behavioral changes in our students can help us respond quickly to help them meet their baseline needs first and avoid escalation.

It is equally important to recognize similar symptoms within ourselves. In a recent study conducted and published by ASHA, 90.9% of surveyed SLPs report increased stress. Increased heart rate, rapid breathing, and sensory aversion (the lights feel too bright, sounds feel too loud, etc.) are all ways that our brain is trying to tell us that we are experiencing intense stress.

Over long periods of time, we might notice ourselves losing energy more quickly, experiencing more headaches, or feeling muscle tension. It is often more difficult to recognize these internal symptoms in ourselves than the external symptoms of our clients or students, but in both scenarios, the response is the same: implementing a trauma-informed approach.

Trauma-Informed Approach

One of the most important aspects of helping our students (and ourselves!) cope with trauma or times of intense stress is to meet baseline neurological needs first. This often involves creating a supportive framework that is regularly utilized in the absence of extreme stress or escalation, to aid in maintaining a regulated state or returning to a regulated state following periods of escalation.

This framework can look different for everyone and is in fact most effective when it is tailored to our individual needs or those of our clients. Routines, regular breaks, and repetition of expectations can all help to create a supportive framework in our therapy sessions.

In times of escalation, having an individualized plan to meet baseline brainstem needs and stimulate the vagus nerve (or slow heart rate) is vital to return to homeostasis and regulation. Activities to stimulate the vagus nerve include humming, rocking, and deep breathing. It can also be beneficial to reduce eye contact and verbal communication during this time, sticking to short phrases with minimal intonational shifts to reduce pressure on decoding (this is particularly important for our clients on the autism spectrum).

So – outside of your therapy sessions – what does this have to do with you?

So much of our energy is consumed by how to regulate our clients, how to treat our clients, how to maximize our productivity. As a result, meeting our own baseline neurological needs often becomes a secondary priority. When you have professional development days/meetings discussing “self-care” – what they are really encouraging you to do is meet your baseline neurological needs first. To take care of yourself before you attempt to take care of anyone else.

Again, this looks different for every individual. For some, it means bringing your own lunch to work so you have a set expectation of what you’ll be eating throughout the day. For some, it means maintaining a steady workout routine or setting up regular dates with friends or significant others. For some, it means turning off their phone or deleting social media apps for a weekend.

The difficult part is incorporating these steps and prioritizing yourself while you are serving your clients. It is imperative that we as clinicians create pockets in our day to promote our own emotional regulation. Whether that’s a few minutes to take deep breaths in a room by ourselves, sticking to a regular daily schedule to create a steady routine, or asking our coworkers for a break when we feel overwhelmed – meeting your own needs first is the only way that you’re going to help your clients effectively meet their needs as well.

Resiliency

By helping ourselves and our clients recognize signs of intense stress and implementing a trauma-informed support system, we are fostering the ability to form resiliency. The more that we practice our trauma-informed support in times of escalation, the easier the practice becomes. As it begins to take less effort to return ourselves to homeostasis, we grow as individuals and begin to form resiliency to the more difficult aspects of life. Resiliency is a key component for growth and is a large goal of implementing a trauma-informed approach in response to stress.

What are the ways that you help yourself and help your students form resiliency?

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References & For Further Reading

Burke Harris, N. (2020). Toxic childhood stress: The legacy of early trauma and how to heal. Pan Macmillan.

Cénat, J. M., & Dalexis, R. D. (2020). Letter to the Editor. The complex trauma spectrum during the COVID-19 Pandemic: A threat for children and adolescents’ physical and mental health. Psychiatry Research, 293: 113473.

Eichhorn, N. (2015). Trauma treatment from a global perspective. Somatic Psychotherapy Today, 5(4), 18–27.

Member Responses and ASHA Resources Related to Loss of Communication Skills During the COVID-19 Pandemic. (n.d.). Retrieved March 7, 2022, from https://leader.pubs.asha.org/do/10.1044/2021-12-13-learning-loss-covid-long.

Mikolajczak, M., Gross, J. J., & Roskam, I. (2019). Parental burnout: What is it, and why does it matter? Clinical Psychological Science, 7(6), 1319–1329.

Rudland, J. R., Golding, C., & Wilkinson, T. J. (2020). The stress paradox: How stress can be good for learning. Medical Education, 54(1), 40–45.

About the Author

Marisa Julius is a speech-language pathologist that has worked in both public and private school settings with a focus in pediatric augmentative and alternative communication therapy. She currently works for a private specialized school setting with children 5-21 with complex communication needs and a variety of disorders including Autism Spectrum Disorder, Down Syndrome, Childhood Apraxia of Speech, Language Delays, Reactive Attachment Disorder, and more. She is a Missouri native and earned two Bachelor degrees from Truman State University in Communication Disorders and German Studies. She received her M.A. in Communication Sciences and Disorders from Saint Louis University. She considers herself a lifelong learner, and is thrilled to be writing for SLP Toolkit, if only for an additional excuse to read more. In her free time, you can find her cooking, reading, hiking, or showing everyone unsolicited pictures of her dog.