Trauma Sensitive Checklist

Before we can respond to trauma, we first need to recognize it. As mindfulness providers, it’s up to us to notice nonverbal cues that someone is struggling with traumatic stress.

Trauma Sensitive Checklist

Trauma often lives on inside the body – often out of view to others. Traumatic events persist in the form of petrifying sensations, emotions, and intrusive thoughts. This is one of the most haunting, visceral costs of trauma: being forced to continually cope with gut-wrenching—often terrifying—sensations that live on inside.

Know the Signs

Those of us teaching mindfulness to groups rely heavily on observation. Given that, the following are some of the basic internal and external signals that suggest someone may be outside of their window of tolerance. These are not necessarily indicators that a student or client is actively experiencing traumatic stress, but they are signals that suggest an intervention of some kind is warranted:

Muscle tone extremely slack (collapsed, noticeably flat affect)
Muscle tone extremely rigid
Hyperventilation
Exaggerated startle response
Excessive sweating
Noticeable dissociation (person appears highly disconnected from their body)
Noticeably pale skin tone
Emotional volatility (enraged, excessive crying, terror)

Offer Different Anchors

Anchors of attention you can offer students and clients practicing mindfulness—besides the sensation of the breath in the abdomen or nostrils—include different physical sensations (feet, buttocks, back, hands) and other senses (seeing, smelling, hearing). One client of mine had a soft blanket that she would touch slowly as an anchor. Another used a candle. For some, walking meditation is a great way to develop more stable anchors of attention, such as the feeling of one’s feet on the ground—whatever supports self-self-regulation and stability. Experimentation is key.

Be an Invitation

Trauma survivors need to know they won’t be asked to override signals from their body, but listen to them. We can accomplish this, in part, through our selection of language. Rather than give instructions as declarations, we can offer invitations that increase agency. Here are a few examples: } “In the next few breaths, whenever you’re ready, I invite you to close your eyes or have them open and downcast” (as opposed to, “close your eyes”). }“You appeared to be hyperventilating at the end of that last meditation. Would you like to talk to me for a minute about it?” (versus, “You looked terrified. I need to talk to you”).

Incorporate Movement

For some trauma survivors, it will be much easier to stay present with sensations while moving—either in walking meditation or stretching. In most mindfulness-based programs, walking meditation is a key aspect of practice: participants alternate between periods of still practice and structured walking meditation.

Watch for Signs of Dissociation

Below are some possible signs of dissociation. Given that it’s difficult to detect dissociation purely by watching someone in meditation, I’ve included signs that can appear primarily in conversation:

Fogginess, appearing disconnected from their body.
Automated movements and intensely flat affect.
Person reports feeling they are a long way away.
Person cannot hear our voice and/or constantly asks others to repeat questions.
Person is staring off into space without blinking and not responding to any questions.
Person loses sense of time and cannot remember what happened previously.
Consciousness appears to fluctuate—you notice the person “isn’t there” or seems preoccupied with internal distraction.
Person cannot maintain a continuity of story or experience in conversation (e.g., jumping from topic to topic).
In conversation with the students or client, you yourself begin to feel foggy, confused, or like you’re floating. This can be a sign that the person you’re connected with is dissociating.

Focus Outside the Body

The five senses of touch, taste, smell, sight, and hearing can help a survivor arrive back in the present moment, supporting the window of tolerance. Here are some examples:

Touch: You can encourage a trauma survivor to find (or bring in) an object that feels grounding and stabilizing to touch. This might be a soft blanket or another object. It could also be placing a hand on a solid floor. You can also have survivors make contact with their own bodies (e.g., the feeling of hands pressing together, one’s tongue pressing into the roof of the mouth, or gently rubbing oneself on the chest).

Taste: Someone struggling with trauma who tends to dissociate during practice can carry a small food item that has a pleasant, intense taste. This can be a piece of candy or lozenge that can retain one’s focus and ground them in the here and now. As trauma-sensitive providers, you can also have these items on hand and offer them when appropriate.
Smell: Similar to taste, survivors can equip themselves with items they can use to reground themselves in the present, such as a small bottle of essential oil or hand lotion. If someone is feeling spacey, this can help bring them back to the present moment. These items conflict, however, with a suggested modification below on creating scent-free spaces, so it is recommended that people use these items outside instead of in a shared space.
Hearing: Survivors can use sounds around them to ground themselves in the present moment if they find themselves dissociating. Whatever the sound, it can be used as an anchor to return to the here and now.
Seeing: We can also encourage survivors to notice and name objects in the surrounding environment to ground attention in the present moment and support integration. This can be a particular piece of furniture, color, or object that one finds supportive to look at. Naming this object internally (e.g., “couch; the color blue”) can also be a valuable way to come into the present moment.

Hit the Brakes

Given that trauma so often leaves survivors feeling out of control, it’s important that they be fortified with strategies to selfregulate in the face of traumatic stimuli—to “brake” if they’re accelerating uncontrollably. There are many ways to apply the brakes:

Open one’s eyes during meditation practice.
Take structured breaks from mindfulness practice (e.g., walking, stretching, unstructured time).
Taking a few slow, deep breaths.
Engage in a soothing form of self-touch (e.g., hand on heart).
Engage in shorter practice periods.

Be Flexible with Posture

In trauma-sensitive mindfulness, we want to be flexible with posture, encouraging people to practice in ways that support their window of tolerance. When we’re offering mindfulness instruction, it’s useful to state these different options around practice, reminding people that it’s okay to move between postures while practicing. In collective spaces, we also want to make sure we have a sufficient number of chairs available for sitting meditation.

Leverage Interpersonal Contact

One recommendation is that participants in a mindfulness program have optional interpersonal contact with each other while in group settings. This can be achieved in a variety of creative ways and left to your discretion. Options include:

Taking 5 to 10 minutes with a group to debrief a meditation period, asking people for a brief checkin about their emotional state and what they learned. This helps us track people more closely and stimulate connection between others. These short check-ins also help normalize challenges and provides a space to share encouragement and success.
Offering an optional “buddy system” whereby participants have brief, scheduled interactions with self-selected partners. These check-ins can include a basic structure of sharing one’s mood, and both successes and challenges from their most recent periods of practice. While not all practitioners may want to participate in this process, it adds an additional layer of interpersonal contact and helps make sure that people don’t become lost and overwhelmed in practice.
Encouraging the formation of support or peer groups outside of the class or program that you’re offering. Any such group would be optional.

Respect Physical Boundaries

Respecting the physical boundaries of all clients and students is a fundamental part of trauma-sensitive practice. While being aware of other people’s boundaries is a generally good practice, it’s critical that we work to ensure trauma survivors feel safe, respected, and at choice in our presence and the environment we create. From asking people’s permission before touching them to making sure people feel in choice around their personal space, we want to continually attend to people’s physical and emotional safety.