Here and now by kolofon

A self-help manual for survivors of human trafficking. BY BENED I C TE EK M AN

ÂŠ Benedicte Ekman, clinical psychologist / For Freedom Here and now: A self-help manual for survivors of human trafficking Kolofon Forlag AS 2019 Illustrations by Kristin Huang Design by Opplett, Siv-Elin Skoglund This project is produced by order from Benedicte Ekman / For Freedom. All rights and liability for the project belongs to Benedicte Ekman / For Freedom. All inquiries should be directed to For Freedom. ISBN 978-82-300-0000-0 Production: Kolofon Forlag AS, 2019 This book can be ordered as PDF from book@forfreedom.no, or read at forfreedom.no The material is protected by the Norwegian copyright act. All copies, such as printout and other means of copying, is only permitted when it is authorized by law (copying for private use, quote, and such), by the author or after agreement with Kopinor (www.kopinor.no). Any other use in contradiction with law or agreement may result in liability and criminal liability.

Here & Now

A self-help manual for survivors of human trafficking

BY BENED I C TE EK M AN

Content 00. Letter to the reader

08-11

01. Normal reactions to abnormal events

12-15

02. The brain and the body during trauma

16-19

03. Closing the trauma album

20-27

04. Dealing with emotional reactions

28-33

05. Stopping anxious thoughts

34-37

06. Depression and rumination

38-49

07. Difficulty with concentration, learning and memory

50-53

08. Pain and fatigue

54-61

09. Dealing with your trafficking story

62-65

10. Emotional bonding

66-73

11. Connection, support and community

74-79

12. About

80-83

F OR F R E E DOM | PR EFAC E

Preface I am a survivor of human trafficking. That experience and the abuse I suffered led me to being described as someone who has complex trauma. In freedom, I was able to explain to people my physical abuse and scars, but my deep and complex mental trauma was not obvious. I am now working with my 7th therapist, Bonnie Martin. She has helped me to explore and explain my psychological scars and how traumatic experiences shaped my relationship with others, my outlook on myself and my worldview. After telling Bonnie how I sometimes felt crazy and how my behavior could be erratic, she drew my brain on paper, explaining how trauma had changed the way I process the world around me. She explained to me that I had complex trauma, this was now my norm, and how there is a solution. While I could identify key problems in my life and knew the root causes, I know I didn’t have the proper tools in my tool box to bring about the change I wanted for myself and my relationships with others. My therapist gave me the tools to heal the deep scars that I felt were embedded in my soul. Of course I know am very fortunate, many survivors are in therapy but it’s just one type of «talk» therapy with no other needed therapeutic tools, and many survivors have no access to therapeutic care. I welcome this book! It will help survivors to move beyond their physical traumatic experience and take a closer look at the psychological impact of trauma. This book han help survivors break free of their psychological prison, gain understanding of behaviors and thoughts that otherwise seem abnormal. This manual helps us to embrace our whole being by understanding that our thoughts and behaviors are shaped by our experiences and that we do not have to remain in a constant state of questioning or uncertainty because there is hope. Shamere McKenzie BA CEO Sungate Foundation Washington DC

F OR F R EEDOM | LE T TE R TO TH E R E AD E R

Letter to the reader You are a survivor. You may have experienced pain and suffering, but you have come through. You are stronger than you think, and more powerful than you know! Though you have survived, you may not feel like you have survived with your soul intact. You may feel pain, loneliness and even hopelessness resulting from your experiences. You have seen evil and felt betrayal. This may have left you with a strong belief that people cannot be trusted, that love is impossible, and freedom is out of reach. This book is meant to be a tool to help you find not only the physical freedom you now have, but also a sense of freedom for your mind and heart. I believe that the information and exercises provided in this book can help you to understand and cope with your trauma and the reactions it has caused.

SELF -H ELP Information and teaching has coloured text and self-help excersises and tips are inside boxes. The colour coding is meant as a help for you to quickly find the self-help again if you need it in a hurry.

We humans need each other. We are not created to live on our own; we are created for relationship and community. When we are happy, we seek others to share our joy. When we are sad, we seek others to share the burden. We are social beings. So, it is a paradox that I have written a book about helping yourself. Please hear me when I say: this book can never replace real human connection, support and care. This book is meant as a supplement to human care for survivors of human trafficking. Not all survivors live in a culture or community where their experiences are understood and met with the right kind of help. That is why this book is necessary â&#x20AC;&#x201C; it can help you understand yourself and your needs as you heal from your trauma. But it should never replace relationship and support from other people. Focusing on self-help alone without seeking support from others may result in an even stronger feeling of loneliness and helplessness. Do not choose this book instead of real human care; choose this book in addition to human care and relationship.

F OR F R E E DOM | LE T T E R TO T H E R E ADER

The assignments in this book are designed to help you overcome your anxiety and fear, and learn to identify thoughts and feelings that are preventing you from finding trust in people again. The assignments will also help you to identify the strengths and skills you already have to help yourself, and to use these in your everyday life. The book also contains some reading that can help you understand how and why your symptoms and reaction have developed. It is crucial for your recovery that you learn to see your symptoms as normal reactions to abnormal events, and that you repeatedly place the responsibility and shame where it belongs; with the people who hurt you and took advantage of you. In the same way as a physical trauma, a psychological trauma can leave an open wound. If the wound is not tended to and treated right, it will not heal properly. It might even become infected and the healing process will take longer. The same can be said for psychological trauma; if it is not tended to and treated right, the wound can get infected by anxiety, depression, fear and pain. But if it is treated right, the wound can heal. And, like a physical wound, it will only remain as a scar, which over the years will fade and bother you less and less. This book is meant as a tool to help you tend to your own psychological wounds, so that they can heal and only leave a scar. This book is intended to help you feel like you are no longer living in captivity; to help you tell yourself: â&#x20AC;&#x153;I am free. The trauma happened to me, but now I am free and the trauma is over. I am in control of my life, my thoughts and my feelings. I am in control of my future.â&#x20AC;? In the book, we will go through information that may trigger some strong emotions or bad memories in you. You may feel like it is too much for you to keep reading. If this happens, take a break and come back to the book when you are ready. Hopefully, this book will also help you find trust and faith in people again. Finally, I hope that it will help you see that a good future is possible. A future without fear, with joy and freedom. That you are safe; here and now. If you have any feedback to give on the contents of this book, please do not hesitate to contact me by e-mail on my address: benedicte@forfreedom.no. Best regards, Benedicte

F OR F R EEDOM | HOW H E LPE R S C AN US E TH IS B OOK

How helpers can use this book The goal of this book is to help the survivor experience that the trauma is over, that post-traumatic reactions can be controlled, and that hope for a safe future is possible. As described in my letter to the survivor, my goal is for this book to be a tool for healing the psychological wounds that the trauma has caused. The goal of any trauma treatment is for the survivor to no longer feel as if the trauma continues, or live in fear of further trauma, but to experience freedom psychologically, as well as physically. When he or she can look back on the trauma as something of the past, and not the present or the future, and when they can remember the trauma without being overwhelmed by fear or an urge to flee, then the treatment has succeeded. However, this book is not a replacement for psychological therapy. If there is any possibility for the survivor to receive face-to-face therapy with a clinical psychologist or otherwise qualified mental health professionals, this should always be administered. In that case, this book can be used as a tool for therapy, either through guided self-help, or as a reference tool for therapists or helpers with little or no experience in working with survivors of human trafficking. Being provided with this book can give the survivor something to hold on to when they go back to their home country. If you have questions or feedback on the contents of this book, please do not hesitate to contact me per e-mail on benedicte@forfreedom.no.

F OR F R E E DOM | W H AT I S H U M A N T R AFFIC K I N G?

What is human trafficking? Human trafficking is the exploitation and trade of humans by the use of force and through restriction of freedom. It is a form of contemporary slavery because victims of human trafficking are forced to work or perform services against their will, under the control of other people, who are referred to as traffickers. The victims may be trafficked within their own country, or across borders and continents. Human trafficking can be found in every country around the world, and takes the form of forced labour, commercial sexual exploitation, child marriage and child soldiers, and organ trafficking. Children and adult men and women can all become victims of human trafficking. Human trafficking is a crime against humanity, because of the violation of its victims´ human rights and because of the crimes and abuse they are subjected to. Human trafficking is a complex form of traumatic experience because it is relational. It takes place in a relationship between the victim and the perpetrator/trafficker, through mechanisms of captivity and control (Courtois & Ford, 2009). Violence, threats and manipulation are common control mechanisms used by traffickers. Manipulation means to use behavior and words to influence the victim’s behavior or perception of reality – for example, if the trafficker makes the victim feel bad or guilty about not wanting to do what the trafficker wants them to do. The trafficker may also use control mechanisms like threats of violence against the victim or the victim’s family, or pressure the victim with threats of publishing sexualized photos or videos taken of the victim. Physical and psychological isolation is also a common way for the traffickers to make sure that the victims lose hope and don’t seek help. Control mechanisms like the ones mentioned above are used by the traffickers to break down the victim´s willpower. The traffickers’ goal is simply to use the victim as they choose. This can be traumatic, which means that it is physically or psychologically damaging. In addition, many victims of human trafficking are also traumatized by the actions and activities they are forced to do or take part in. If you feel like you are to blame for what happened to you, then I just want to reassure you that whatever has been done to you, or whatever you have been forced or manipulated into doing, the traffickers are to blame for it – not you! Placing the blame with the traffickers and abusers is the first step in the process of healing.

F OR FR EE D O M | C H AP TE R 1

Normal reactions to abnormal events

F OR F R E E DOM | C H AP T ER 1

You may have been in a dangerous situation for days, months or even years. You are probably reading this book because you have been through some type of abuse and trafficking situation. This may have left you with broken trust in other people and with no ability to feel safe in this world. Maybe you have lost your ability to believe in a good future or to hope for a better tomorrow. These are all normal reactions to the abnormal experiences that take place in human trafficking. What you have been through is not normal, but that does not mean that you are not normal for feeling the way you do. Reacting with anxiety, depression and distrust in other people is a normal reaction to abnormal events. In the face of danger and trauma, humans have a common set of reactions: first, we want to run away as fast as we can to find safety. If we cannot run, we prepare to fight. And if we cannot fight, we keep still and wait for the threat to pass without noticing us. If the danger does not pass, but instead approaches us, then we physically and mentally shut out what is happening to protect ourselves from being overwhelmed.

F OR F R EEDOM | C H AP TE R 1

These different reactions to danger and trauma engage our body, our mind and our emotions: We feel scared, maybe even terrified. If the trauma continues and we do not have the power to stop it, we feel alone, ashamed, angry and hopeless. Our bodies feel stress, pain, and loss of power. It disturbs our body’s ability to relax and sleep. It also disturbs our minds´ ability to concentrate and learn, play, laugh and enjoy life. Feeling fear, anger, hopelessness, anxiety, depression, and shame after what you have been through is normal. These are normal reactions to abnormal events, even though they may not feel normal to you. You may even feel like you are losing your mind. The reason it does not feel normal, is because these reactions would not be normal in a situation where everything is okay, where you are safe. But you have not been safe; you have been in real danger, and reacting this way has helped you survive. Now that you are safe, you no longer need these reactions to survive. However, your body may not have realized that you are safe, and your mind may not believe that this safety is real. And so, your mind and your body is still in survival mode. In this book, we will go through some information and exercises to help you understand your reactions, and show how you can take back control of your life and start feeling safe again.

Traumatic events

A traumatic event is a situations or experiences that causes physical or psychological harm. This could be an experience where you feel like you are in danger, or where you watch someone else in danger. Traumatic events usually involve violence, death, or threat of death or violence, alongside a feeling of helplessness to do something about it. Being trapped, controlled, threatened and abused, which is common in human trafficking, is a traumatic situation. When many types of trauma are experienced repeatedly over a longer period of time, this is called complex trauma. “Post-traumatic reactions” are the reactions you get after you have experienced traumatic events. (“Post” means “after”.) Usually, but not always, the more complex your traumatic experience is, the stronger your post-traumatic reactions are. Also, the closer the danger is to you personally, the

stronger your post-traumatic reactions will be. Someone who has experienced direct trauma, such as direct violence from another person, is usually more traumatized than someone who has only watched danger from a distance.

F OR F R E E DOM | C H AP T ER 1

Common reactions after traumatic experiences

The following are some of the common post-traumatic reactions people have after having been trafficked (Modum Bad, 2013). You may recognize some of these symptoms in yourself: Feelings •

Feeling scared, “on edge” or “jumpy”.

•

Feeling irritable or angry.

•

Feeling helpless and overwhelmed.

•

Feeling sad and hopeless.

•

Feeling lonely – like no one else can understand how you feel.

Physical symptoms •

Anxiety: Feeling restless, heart racing, sweating, tense muscles, difficulty concentrating, difficulty sleeping and resting (“over-activation”).

•

Depression: Feeling drowsy, no energy, numbing in your body, unfocused attention and trouble with concentration (“under-activation”).

•

Disturbed sleep patterns: Trouble falling asleep, waking up often during the night, waking early and not being able to sleep again.

Thoughts •

Flashbacks: Remembering the traumatic things you have experienced, even when you try not to.

•

Nightmares: Dreaming about the trauma, or about other things you fear.

•

Memory trouble: Forgetting details about the trauma.

•

Negative thoughts about yourself and the world: Blaming yourself, problems trusting others, expecting bad things to happen again.

•

Rumination: Constantly wondering why this happened to you, and not finding an answer.

Behavior patterns •

Denial: Unwillingness to admit what happened to you.

•

Avoidance: Unwillingness to talk about the trauma; avoiding objects, people or places that might remind you of the trauma.

•

Anger: Angry outbursts and pushing people away.

•

Hiding: Avoiding going to school or work, to be social or go out.

•

Some people get a paradoxical reaction to trauma where they seek the same traumatic relationships because they are known, and therefore feels safer than the unknown.

The rest of the chapters in this book are designed to address these post-traumatic reactions. Not all of them may feel relevant to you, but try to read through all the chapters regardless. There may be some helpful tips in there that can help you with other difficulties you may have.

F O R F R E E D O M | C H AP T E R 2

The brain and the body during trauma

F OR F R E E DOM | C H AP T ER 2

Your 3-in-1 brain:

Simply put, your brain consists of three main parts (MacLean, 1985): the “survival brain”, the “feeling and memory brain”, and the “thinking brain”. The survival brain is where all your instincts and automatic bodily functions (such as your breathing) are controlled. This part of the brain is important for your survival in dangerous situations. It is like a smoke detector – it senses the fire and sets the alarm off so that you will react in a way that will help you survive, prompting you to fight or flee from danger. The feeling and memory brain is closely connected to your survival brain. It processes information from your senses and stores memories. Feelings and memories are strongly connected. That is why some memories can activate strong emotions when we are reminded of them. If you are very happy when you are forming a new memory, the same happy feeling will fill you if you are reminded of this memory later. Sadly, this is also true for scary and sad memories. If you are extremely frightened or lonely when you form a new memory, the same feeling will fill you when you remember it. Your thinking brain is the part of your brain that helps you learn, plan and control your thinking and reactions. This part of the brain is often overruled by the survival brain and the feeling and memory brain when we are in danger. Learning how to deal with post-traumatic reactions strengthens the thinking brain, and helps this part of your brain to stay in control so that you can focus on learning, play and planning even while recovering from trauma.

F OR F R EEDOM | C H AP TE R 2

Over-activation and under-activation

When you face danger, as you may have when you were trafficked, your survival brain instinctively reacts to help you survive. It prepares your body to fight or flee from the danger by increasing your heart rate and rate of breathing. Digestion is put on hold, blood rushes to the big muscle groups in your arms and legs so that you feel energized, and all your senses are sharpened. We call this reaction pattern over-activation because your body is working harder than it does when you feel safe and at rest. This reaction helps you survive through danger, and is the same physical reaction that happens during anxiety. But what happens if you are not able to fight or flee? What if fighting or fleeing will actually cause you more harm, because you are facing a danger that is stronger than you? In this situation, your body will do the exact opposite – your heart rate and breathing will slow down, your arms and legs feel heavy, and the connection to your thinking brain is cut. It feels like your body freezes, and you may even faint. We call this reaction pattern under-activation, because your body is shutting down to protect itself from harm, like a small animal that plays dead when a larger animal hunts it. Because this under-activation cuts off the connection to your thinking brain, you may have trouble remembering the details of what happened later, but you may still remember how you felt. This reaction is helpful when the danger you face is too strong to fight or flee from. Freezing or fainting may protect you from further harm you may suffer if you fight back. Sometimes these reactions, over-activation or under-activation, can be triggered even after you are free from the trafficking situation. This happens because your brain and your body have not yet learned that you really are safe, or because some things in your life are still difficult. Maybe your living situation, financial situation or relationships are troubling you. Difficult emotions in the present can trigger some of the same reactions you had when you were trafficked. These feelings can also occur because you realize that you should not have to react like this, because the trauma should never have happened to you in the first place. It is also common for victims of trauma to feel shame after abuse because they did not fight or flee from the abuse, but instead they froze or “blacked out”. For some victims, this makes them feel like they are to blame for what happened, like they surrendered or accepted the abuse. This is hindsight and you need to remember that how you reacted in the trauma situation was pure instinct with a goal to survive. Now that you are safe, it is easy to judge yourself for your seemingly poor decisions, but these instincts helped you survive. All humans are hard-wired to react in the way you did.

F OR F R E E DOM | C H AP T ER 2

SELF -H ELP

Try to identify situations in the present where you experience over-activation, and where you experience under-activation. Try to find the triggers that causes your reactions.

SI T UATI ONS

TR I GGER

U N D ER AC T I VAT I O N

OV ER AC TI VATI ON

R E ACT ION

F O R F R E E D O M | C H AP T E R 3

Closing the trauma album

F OR F R E E DOM | C H AP T ER 3

Flashbacks

Memories of traumatic experiences are not stored in our mind the same way our ordinary everyday memories are (Brewin, 2003). They are so-called “hot memories”, while normal memories are “cold memories”. Our “cold memories” are either emotionally neutral, or are enjoyable to think about. “Hot memories” activate feelings of fear and anxiety, and sometimes feelings of helplessness and shame. Your memories are not organized by year like a timeline, but by how similar they are to each other, like a network (Schauer, Neuner, & Elbert, 2011). Memories that are closely connected to an event or emotion are all stored together, almost like an emotional photo album. So, all the “hot memories” from the abuse you have experienced, and all of the accompanying fear, loneliness, pain, shame, and anger, are all stored together in what we can call “the trauma album”. When you are reminded of just one of these memories, it is like opening the whole photo album. It all comes rushing back to you – feelings, memories and all. We call this a flashback; and what made the photo album open is called a trigger. A flashback can feel like watching a movie or viewing a picture of the trauma. It can bring back the same feelings that you felt when the trauma happened because the memory and the feeling have been stored together in your “trauma album”. When this happens, your mind cannot separate memory from reality, and you feel like you are back in the traumatic situation. Here are provided tools to help you close the trauma album again so you can reconnect with reality in the present.

F OR F R EEDOM | C H AP TE R 3

SELF -H ELP

What helps when the trauma album is opened might differ from person to person. When you get flashbacks and relive your trauma, you need to be reminded that the trauma is over, and that you are safe in the present. Here are some techniques by Dyregrov (2019) you can use when the trauma album is opened and anxiety is activated:

The TV This exercise works best with flashbacks that are visual – mental images of the trauma. In this exercise, you think of the hot memories as a film you are watching on TV. In your mind, frame the hot memories on the screen, slowly turn away from the TV and walk out of the room where the TV is located. This might sound simple, but it might take some exercise to be able to practice. Try it a few times first with a cold memory, so that when the trauma album is opened, you already have a sense of what to do.

The radio This exercise is like the previous one, but works best with flashbacks that are auditory; like the sound of screaming or gunshots. In this exercise, you imagine that the sounds in your flashback are coming from a radio; in your mind, you then turn down the volume on the radio to the point where the sounds disappear. This also might require some practice with an imaginary neutral sound before you can use on a flashback sound.

The window This exercise is like “the TV”, in that it can be used on visual flashbacks. You imagine that you are watching the image or flashback you are experiencing through a window. You are safe inside your house, and to stop the flashback, you close the curtains and turn away from the window.

Social support If you find it hard to use these techniques to distract yourself from flashbacks and calm down, you may need other people to help distract you. That is totally okay, and a good way to learn to calm yourself. If you can, seek help from others with regulating your feelings until you can manage this yourself.

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Nightmares

The hot memories and trauma albums are not only triggered when we are awake; they can also be triggered in our sleep. It is common for people who have experienced traumatic situations to have nightmares about the situation they were in, or other similar situations. You may experience nightmares about being abandoned by the people you love, about being chased or about being trapped. You may also have nightmares about specific traumatic episodes that you have lived through yourself. Sometimes when you wake up from a nightmare, your brain may have trouble separating between reality and the bad dream you just had. Your body might still be “in” the dream; your heart is racing; your muscles are tense, and the sweat is pouring. Your body is in “fight-or-flight” mode as though there were real danger. You need to remind yourself that you are safe in the present, and to do this you can use some of the techniques below.

F OR F R EEDOM | C H AP TE R 3

SELF -H ELP

If you have trouble calming down after having a flashback or after waking up from a nightmare, here are some helpful methods from Modum Bad (2013) you can try to calm down. Be aware that you might have to practice them a few times before they help:

Anchoring When you are in â&#x20AC;&#x153;fight-or-flightâ&#x20AC;?-mode and your brain is still partly in the nightmare, it can be helpful to remind yourself where and when you really are. Simply put, remind yourself that you are in a safe place and that the trauma is now over. You can do this by turning on the light and describing to yourself where you are and what you see around you. Use your senses to find different anchors to reality; a smell, a sound, an object to see and touch. You can for example keep a picture next to your bed that helps you feel safe when you look at it, or an object that helps you feel safe when you touch it.

F OR F R E E DOM | C H AP T ER 3

Distraction It might help you to calm down if you simply get out of bed and do something else for a little while. Drink some milk or eat a banana â&#x20AC;&#x201C; these are foods that will also help you feel sleepy again. You can also put on some music, read or do something else that takes your mind off the nightmare.

The superhero method This method involves a bit of imagination. If you are having trouble distracting yourself from thinking about the nightmare, you can try to reimagine the nightmare with an ending where you are in control. Like if you got superhero powers and could do whatever you wanted in the dream. It does not matter if this is unrealistic, the point is to get back the feeling of control and power. What would you do if you could fly, if you were super strong or could become invisible?

Safe place This method also involves a bit of imagination. Instead of imagining superhero powers, you imagine going to a place where you feel completely safe and at peace. This can be a real place where you have been, or it can be completely imaginary. You can choose to keep your eyes open or closed, and you can describe this place to yourself in your thoughts or out loud. This place must be somewhere that only you know about. Keep this place to yourself and do not tell anyone about it, and this way it remains a place where you can go when you need to feel safe. Picture this place in your mind; the colors, the smells, the sounds. Imagine the temperature, the weather (if it is outside), and if there is somewhere you can sit down and rest. Your safe place should be exactly how you want it â&#x20AC;&#x201C; the way you like it. How does your safe place make you feel?

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Triggers

Flashbacks and nightmares are often activated by cues that remind us of our trauma. These cues are triggers that cause the feeling and memory brain to open the trauma album. Triggers can be different from person to person, depending on what you have experienced, but usually the triggers are: • • • • • •

a noise a scent an object or image you see a physical sensation in your body – like increased heart rate a reduction in consciousness – like falling asleep a feeling or a thought you suddenly get in your mind

•

a situation you experience with other people

A trigger can be anything that reminds you of past trauma (your hot memories). Knowing what triggers can open your trauma album can help you deal with your post-traumatic reactions and anxiety. Often, the connection between the trigger and the trauma memory is clear. The scent you smell is the same as the scent of the abuser in the trauma situation, the feeling you get is the same as the feeling you had when the trauma occurred, or an increased heart rate reminds you of how frightened you were. Other times the connection between the trigger and the trauma is not so clear. This might be explained by the fact that your freeze-faint reaction during the trauma protected you from the sensory impressions in the situation, and the memory is therefore unclear and fuzzy. It is still laced with fear and terror, but the details are hard to recall. This might cause you to panic at a sound or smell that you don’t recognize. You do not know why, but your trauma album is open and you feel terrified. This fear causes you to go into the fight-flight mode or the freeze-faint mode. Mapping your triggers might therefore help you to gain some control of your reactions, even if you don’t know why they trigger your fear.

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SELF -H ELP

•

First, you need to map the triggers you know. What triggers do you recognize that open your trauma album?

•

You can also ask the people around you if they have noticed that you react with fear to certain cues or situations in ways that seem exaggerated to them.

•

When you have mapped your triggers, you need to learn that your reactions to these triggers are exaggerated, too strong or not helpful in the reality of your present situation. This might be difficult at first, and it requires that you evaluate your reaction pattern after an event where a trigger and flashback caused you to react. If it helps you, you can do this evaluation with a person you trust.

•

Next, you need to practice the ability to not react instantly to the trigger when it occurs. It might help to decide on and practice an alternative reaction pattern in a time and place where you feel safe. This will help you to react differently when the trigger occurs.

Avoidance

Because flashbacks make us scared, angry and maybe even ashamed, it is natural to want to avoid the trauma album and the triggers that open it up. This might work well for a while, but this fear of triggers might expand and lead you to start fearing things that have only a slight connection to the triggers and trauma. Over time, avoidance will maintain the trauma, because instead of working to resolve your trauma, you adapt to its existence by working around it. This can make you scared of many things that are not dangerous, and you end up living a very limited life, while still living with a lot of fear of the trauma album. If you avoid the triggers and the trauma album for a long time, it can make it hard to remember what really happened. Hot memories are more feelings than facts. So, when a hot memory is triggered, not only do you get scared, you also find it hard to remember what happened. This avoidance and difficulty with remembering what happened is your brain’s way of protecting you against the trauma. But sometimes this can make you wonder if it really happened at all. You might question y our own experiences, and wonder if you are making things up and if you are losing your mind. Let me reassure you: you are not losing your mind. It is merely your brain trying to protect you from the trauma album with its hot memories and feelings of fear and anxiety.

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Dealing with emotional reactions

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Feelings are a natural part of life. So-called “bad feelings”, such as fear, anxiety, sadness and loneliness, are actually not inherently bad. Both good and bad feelings are there for a reason: they are information – signals that the brain uses to communicate with itself. Feelings are the signals that help you understand if things are okay or not. Further, feelings tell you something about what you think you need. Feeling lonely? That’s a signal that you need more human connection in your life. Feeling sad? That’s a signal that something is not okay and you need to change it. Feeling scared? That’s a signal that you feel a threat in your surroundings, and you need to remove it or recognize that that threat has passed. It is the same with good feelings. Feeling happy? That’s a signal that things are okay, so keep doing what you are doing. Feeling safe? That’s a signal that the people you are with are good for you; keep them close. In conclusion; feelings are not “good” or “bad”, they are just feelings. Also, sometimes feelings do not tell the truth about what is going on. Feelings can trick us because feelings are a result of how we think. And sometimes, what we think is not really the right reflection of our situation. We will consider this topic later in this book.

SELF -H ELP

When we feel overwhelmed by difficult feelings like sadness, loneliness, shame or fear, it can be hard to deal with them in a way that is helpful for us. We easily focus too much on the bad feelings, or we ignore them too much. Dealing with difficult feelings is hard, but necessary to feel better and more balanced over time. Take the time to address the feelings you focus on too much, and which feelings you may be ignoring. Try to recognize these feelings with patience and compassion towards yourself. Later in this book, I explain how self-compassion can help you work on painful feelings that you find it difficult to deal with.

Anxiety and stress

It is important to understand that acute anxiety and stress in itself is not bad for you. Your body is designed to use the stress response to cope with challenges and dangers in your environment. A certain amount of stress may even increase focus and achievement, as long as you feel like you have control of the situation. The stress response will continue in your body until your mind no longer perceives any threat. If you feel threatened and not in control over a longer period of time, like in a trafficking situation, the prolonged stress activation can become unhealthy. Prolonged stress can negatively affect your immune system and make you vulnerable to infections and illness, concentration difficulties and memory problems, and it can make you vulnerable to mental health issues.

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The window of tolerance

“The window of tolerance” (Siegel, 1999) is a metaphor used to describe the optimal zone of activation where you are attentive, present, able to concentrate, and ready to play and learn. “Activation” means the way your body and mind responds to your surroundings. Inside the window of tolerance, you are relaxed and what you experience is within what you can cope with; you are not overwhelmed or stressed. The window of tolerance is a comfortable place to be. As described before, when you are overwhelmed by a traumatic situation, by a flashback or nightmare, your body reacts with a fight-or-flight response, or by a freeze-or-faint response. These two reactions happen when what you’re experiencing is too much for you to handle. In the “window of tolerance” - model, we also call the fight-flight response over-activation, and the freeze-faint response under-activation. This model can help you understand why you sometimes feel fine, like you are in control of your feelings and reactions, and why you feel like you lose control or freeze when something triggers a flashback. Learning to identify what triggers you to go outside the window of tolerance can help you to deal with these triggers. It can also teach you something about what type of help you might need to stay inside the window, or to get back inside the window if you are pushed outside it by a trigger. Maybe you need someone to help you calm down when you are over-activated and in fight-flight mode, or maybe you need someone to help you wake up when you are under-activated in freezefaint mode.

OVER-ACT I VAT IO N

F LIG H T F IG H T

OP TI M AL AC TI VATI O N

F R EE Z E

U NDER-ACT I VAT I ON

FAIN T

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Allowing a person you trust to comfort you is a good way to calm down when you are overwhelmed and your body is in fight-flight mode. The comfort of a hug or an arm around your shoulders can help you feel safe and will help you back into the window of tolerance. If you have a hard time trusting another person to come physically close to you in this way, you can practice comforting yourself by using mindfulness techniques. The essence of mindfulness is to be focused on the “here and now”, without judging your own presence as “good” or “bad”. It just “is”. Mindfulness has been shown to increase energy, self-confidence and self-esteem, and reduce depression, pain, stress and anxiety. Mindfulness teaches “inward acceptance – and outward focus”, which means accepting the presence of pain and difficulties in your body, but focusing on what is happening around you. What do you see, hear, smell? What are you doing, and who are you with? Mindfulness can help you anchor yourself in the present if something triggers your trauma album and makes you anxious. It may take some practice, but accepting the presence of the traumatic memories, while using your senses to focus on the moment you are in, can help you deal with your trauma reactions. Flashbacks trick your brain and body into thinking that you are back in the traumatic situation, so using mindfulness can help you anchor yourself in the present. Using your senses: One simple way to be mindful and present in the moment, is by using your senses to identify things around you that help ground you and calm you down: •

Use your hearing to identify the sound of three things in your environment.

•

Use your eyes to identify three objects in your surroundings.

•

Use your sense of smell to identify three scents in your environment.

•

Use your hands to feel the surface of three objects.

The purpose of this exercise is to practice being attentive towards your physical and mental presence in the moment.

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Feeling numb or without energy is common in freeze-or-faint mode. It can make you want to hide under the covers in your bed, or leave you feeling powerless. Giving in to this can feel like the only comfortable option, but the best thing is to activate yourself in a way that you like and where you feel safe. Go for a walk, do some stretching, do a chore or be creative. The point is to stop the numbing by being active and get inside the window of tolerance again. Write a list of things you can do when you feel numb and powerless: Things to do when I feel numb and have little energy:

01.

02.

03.

04.

05.

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The importance of social support

More than anything, we humans need each other. We are hard wired for community and connection. This is especially true when we are afraid and have problems with trusting others. The most powerful weapon against fear and anxiety is community – being in the presence of good people who want the best for you. The best protection against overactivation and under activation is human connection and social support. Our need for connection and community is instinctive and is meant to push us towards fellowship, support, encouragement and comfort, so that we can feel loved, protected and valued. This helps to ensure our survival. Social support is known to be essential for preventing anxiety and depression. However, it is common for a traumatized person to avoid other people. This is an attempt to protect oneself from more harm. This is right and good when the people around you don’t mean you well, but when the community is loving and protective, avoidance will only make things worse. Seeking out this kind of loving and helpful community is a key to healing from the consequences of trauma.

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So, what kind of community should you look for? This will depend on the culture in the country you live in, the religious practices that are common in your community, and your personal needs. What kind of community you need will depend on you and your ability to trust others. When trying to figure out how to connect with others in your community, these questions may be helpful in guiding your choices:

•

What kind of people do I trust more than others? (In terms of gender, age, religious identification, culture, etc.)

•

Who do I know in my community that selflessly help others with no personal motive?

•

What organizations or religious groups do I know that are focused on helping people?

•

How can I meet these people, and how can I tell if I can trust them?

•

Are there any programs in my community for people in my situation that I can seek out?

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Stopping anxious thoughts

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Worrying is thinking about things you fear might happen in the future – having thoughts that begin with “What if…”. Anxiety is often connected with worrying. In a way, you can call worrying “anxious thinking”. We all worry sometimes. Usually, people worry about their finances, their kids, their sick relatives, or about school or work. Worrying can bother you a little in your everyday life, but it can also get so bad that it paralyzes you and stops you from living your life as you wish. Survivors of human trafficking have experienced the worst that life has to offer. What most of us just see in movies, you have lived through, in some way or another. This may fuel your anxious thinking, and make you worry that these things might happen again. Maybe you worry that you will never heal from your trauma; that you will never feel whole again. If you do not take control of your anxious thinking, you may end up spending too much time and energy worrying instead of trying to focus on what you can control and doing something about that. Most of what you worry about will probably never happen, and you will have to wait until the future to know for sure. Worried thoughts are not a true reflection of reality, and they are just thoughts. You don’t have to give them attention. Instead of being paralyzed by worry and waiting for the future to prove you wrong or right, try to let go of your worrying and focus on what is really happening around you. You cannot control the future by worrying; you can only control how you deal with what is happening around you right now.

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The cloud Imagine that you put the worry-thought on a cloud and let the wind carry it away. It may sound too easy, but it can be quite effective. The goal of this exercise is to remind you that thoughts are not a true reflection of reality, and they are just thoughts. You don’t need to give them attention. Putting your worries on a cloud is both a reminder to ignore them, and an exercise in doing just that; ignoring them.

Stop! This is also an exercise by Dyregrov (2019) that might seem too simple, but it may be more effective than you think. When your worries come, imagine yourself seeing your thought coming towards you like a moving car. Put up your hand, and tell it to “STOP!”. Saying “stop” out loud works as a reminder to yourself to not allow these thoughts to take control of you, and for you to take control of them.

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Time to worry (Dyregrov, 2019) If you find it hard to not think through your worries at all, try to set a time during your day when you allow yourself to worry. I would suggest some time in the early evening. Do not worry for more than 30 minutes and try to keep worrying solution-focused. Ask yourself: “What if this happened? What can I do to prevent it, or deal with it if it happens?”. If you cannot find an answer within the 30 minutes you have allowed yourself to worry, leave the worries until next day.

Practice gratitude When you worry, you focus on what could go wrong, instead of focusing on what has gone right. By shifting your focus to the things you appreciate and are grateful for, your anxious thinking will seem less important. Regularly practicing gratitude can lead to reduced stress and a more optimistic view on life. Try to set aside some time in your day to write down 3-5 things you are grateful for. These can be simple things like good weather, a meal you liked, a person greeting you, sleep, exercise, or deeper things like friendship, work, family, or daring to challenge yourself and your fears. Big and small, they all count! I would recommend you do this every day, or at least once a week. But it’s better and easier to remember to do it more than once a week.

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Depression and rumination

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Depression

Feeling depressed after experiencing trauma is common. As described earlier, under-activation can be an instinctual reaction to trauma – a way to survive. Depression can be seen as a form of under-activation; a way to stay invisible to avoid further trauma. Feeling sad is not the same as depression. Being sad is a common human feeling and something we all experience from time to time.

Depression is: •

Low mood and lack of interest in life almost all day, every day, for at least two weeks.

•

Change in appetite; eating too little or too much.

•

Disturbed sleep; sleeping too little or too much.

•

Feeling restless or without energy.

•

Thinking that you are worthless and/or feeling guilty or shameful.

•

Feeling tired without having done much.

•

Feeling numb or empty.

•

Trouble concentrating and keeping focus.

•

Trouble making decisions and starting things.

•

Thinking about death or suicide.

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We separate between mild, moderate and severe depression depending on how many symptoms you experience and the severity of the symptoms. For most people, depression includes symptoms that affect feelings, thinking and physical function. If the depression is moderate to severe, it may also affect your behavior, in that you may: •

...withdraw from, or actively avoid family and friends.

•

...avoid activities; even enjoyable activities.

•

...not take good care of yourself.

Dealing with people when you are depressed

If you feel depressed, you may not want to meet people because you do not want to answer questions like “How are you doing?” The paradox is that the more you avoid people, the lonelier you will feel. This may fuel your depression further. Social isolation takes away the support and connection that we all need, and may lead to a feeling that life is meaningless and not worth living. Try to meet with people as much as you can manage. Maybe your answer could be; “I´m not doing great, but I am doing the best I can. Thank you for asking, but I would rather we talk about or do something else.” Most people will understand that you have a need to talk about something else, or maybe not talk at all. And if they don´t, maybe they are not the people you should spend time with. Find the friends that understand, and stick with them. Talking with someone that cares about you is always a good thing to do. They can help you figure out solutions to your problems, and it can be helpful just to know that someone knows what is going on with you.

Being active when you feel depressed

When you feel depressed you might stop doing things you normally enjoy doing, like exercising, shopping for food, being creative, reading and more. Not doing the things you normally enjoy doing may fuel your depression further. Your life becomes dull and discouraging without the activities you like. Depression leads to inactivity; and inactivity leads to more depression. It is a vicious cycle. So doing activities you like may help you out of depression again. Maybe you are thinking “I will start doing that activity again when I feel better”. However, I think you must do that activity so that you can start feeling better. Waiting to feel better may make it less likely that you will start doing that activity again.

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Ask yourself; “What did I enjoy doing before I started to feel depressed?” Maybe this question will be hard to answer because you have been depressed for years, or in a trafficking situation for years. Try to ask yourself; “What do I see people doing, on TV, movies or in real life, that I would like to try?”. It is easiest if these activities are simple, everyday activities that will be easy to try out. Like having picnic in a park, going for a walk, watching a fun movie, reading, painting or drawing, learning to cook, meeting a friend for coffee, doing charity work. It would be even better if the activities you choose to try are activities you can do with other people.

To start, choose three activities: •

One where you are physically active.

•

One where you do something with other people.

•

One where you do something to help you relax.

Taking care of yourself when you feel depressed

When you feel depressed, the need to take care of yourself seems unimportant, and you may also feel like you don’t have the energy to shower, exercise, eat properly, shave, or put on makeup. For trauma victims, not taking care of yourself and your body may be a way of protecting yourself from unwanted attention. Especially for victims of sexual abuse, not taking care of your body feels like a protest or protection against the abuse. If you have been exposed to sexual abuse or commercial sexual exploitation, you may have been told to look and dress a certain way, to do your hair a certain way, or use makeup. It is understandable that you want to distance yourself from doing anything that may remind you of this. However, if it leads you to not take care of your body in a way that might be bad for your health, like not eating or eating too much, you may want to reconsider who you are damaging by making these choices. The best way to resist those who showed you hostility and neglect is to show yourself love. Try to make new habits of taking care of yourself; habits that do not remind you of your trauma but are still good for your health.

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Depressive thinking

If depression goes on for a long time, it can become permanent and it may not stop when you are free from the trauma. This may also be because the trafficking situation leads to some unhealthy thinking patterns that maintain the depression. When you go through complex trauma, it is normal that this will affect the way you think about yourself, your possibilities and your future. Being controlled, trapped and abused for a long time can steal your belief in yourself, your trust in other people, and your feeling of being safe in the world. This will affect your thinking in a negative way, and may both trigger and maintain depression. Some common negative thinking patterns that may develop after prolonged trauma are rumination, catastrophizing (expecting the worst to happen), focusing on the negative and ignoring the positive, “black and white” thinking, self-blame, and over-generalizing.

Rumination

Rumination is a common sign of depression. Rumination means to repeatedly think about your trauma, and to constantly question why this happened to you. Rumination is the opposite of being solution focused. After experiencing trauma, it is not uncommon to ruminate on questions like: •

“Why did this happen to me?”

•

“Why did they do this to me?”

•

“What did I do wrong?”

Often, it is impossible to find helpful answers to these questions, and continued rumination will lead you into a never-ending circle.

Catastrophizing and expecting the worst

Rumination and lack of solution-focus may lead to a feeling that nothing good will ever happen again, and it may lead you to always expect the worst. We call this catastrophizing and this thinking pattern will maintain a feeling of hopelessness. On some level, catastrophizing may also be a way to protect yourself from being hurt and disappointed in the future. This way of thinking can take the form of thoughts like: •

“The world is dangerous, unpredictable and threatening”.

•

“People cannot be trusted; they will hurt me and take advantage of me”.

This way of thinking may stop you from recognizing the good in other people, your own strength, and the positive possibilities you may encounter in the future.

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Focusing on the negative and ignoring the positive

Living through trauma like human trafficking can direct your mind to focus on possible threats and at the same time shut out positive signals from the environment. This is a survival strategy, and has probably helped you survive by staying alert to signals of threats and danger around you. When you are safe, this ability to detect danger is no longer needed in the same way, and may even distract you from signals of good and positive change in your environment. We call this a “bias”, meaning that your mind is skewed towards recognizing negative signals, which will make you unable to recognize positive signals. This bias may feed your interpretation of what happens to you and around you and lead to thinking like this: •

“This is so typical, bad things always happen to me”.

•

“People never help me, I am always left alone”.

•

“I can never get it right, I always fail at everything”.

This bias may trick your brain into thinking that things are worse, people are worse, and you are worse than is actually true. At one point, when you were trafficked, things were very bad. But now that you are free, this thinking pattern may directly feed your feelings of hopelessness and depression, and training to recognize what is good and helpful in your surroundings is an important tool to prevent further depression.

“Black and white” – thinking

Living in an extreme environment, like a trafficking situation, may lead you to experience the world in black and white. Dividing experiences and other people into different categories make them easier to deal with. Categorizing other people as “good” or “bad” can make it easier to know what to expect from them, if you can trust them or not, and if you should run away from them or not. This may be a helpful survival strategy in a trafficking situation. But in general society, most people are good but may sometimes do bad things. Just think of a good person you know – does this person always do the right thing? Can you think of other examples of good people who may have messed up and done something they should not? Being good, but sometimes doing something bad, does not mean that they are not trustworthy. Learning to see that most people are good people, but that they may still disappoint you from time to time, is a step towards integrating your experience of the world into a meaningful story again.

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Self-blame

Humans are meaning-seeking creatures: we want the world to make sense, we want there to be a reason that things happen, and we want to believe that we can control what happens to us. When we cannot make sense of the bad things that happened to us, it is common to turn to self-blame. If you cannot find a good reason for why you ended up being trafficked, why this happened to you, you may start to blame yourself for what happened: •

“I am not smart enough and I don’t know how to protect myself”.

•

“I am to blame for what happened; I am helpless and too weak to defend myself”.

•

“I should have realized that they wanted to take advantage of me”.

•

“I should have been able to see that the job offer was false and too good to be true”.

Please believe me when I say that you are not to blame! Maybe you walked into the trafficking situation voluntarily because you did not know how bad it would become, or you were simply tricked into it. Either way, the blame belongs to the people who took advantage of and abused you. Fight the urge to blame yourself; it is neither helpful nor will it build faith in yourself. Instead, when you think self-blaming thoughts, try to look for the strengths you recognize in yourself that helped you survive and get out of the trafficking situation.

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The way you think about yourself, the world and the future affect your feelings and bodily reactions. If your thinking has become increasingly depressive, ruminative and focused on negative aspects about yourself and your situation, this will impact your motivations, reactions, hopes and plans. Rumination can cause you to lose sight of the possible solutions to your problems. Some of these depressive thoughts happen outside of your control, and are therefore difficult to put into words. Others of these thoughts are easier to express and work on. It is easy to believe in your own thoughts, simply because you think it. It is your perspective and reality. But it may be helpful for you to know that what you think is not always a true reflection of reality, and that what you feel might be distorted by your thoughts. If you see now that you have developed some unhelpful thinking patterns, you can start making changes to this. The goal should not be “to think more positive”, but instead to simply “think more realistically and supportively”. This can help you feel better about yourself, others and the world. Remind yourself that thoughts are not reflections of reality, but your perceptions filtered through your experiences and expectations. One way to help you work with your rumination, self-blame or negative expectation is by using the ABC model.

The ABC-model The ABC model (Ellis, 1974) comes from the field of cognitive therapy. It assumes that you can change your thinking by identifying the thoughts that make you feel bad. The ABC-model is short for Activating event – Belief – Consequence. In this model, we also add a D; which stand for Discussion. The A may also represent a trigger that opens the trauma album. That is why this model may be helpful not only with your depression, but also with dealing with your other trauma reactions.

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It may be difficult to identify an unhelpful thought. Working to change your thoughts works best if you first recognize a negative change in your mood or emotions: 1. If you feel sad, irritated, ashamed, or have other negative feelings, try asking yourself what happened before you started feeling this way? Was there a trigger or a trauma memory? 2. What depressive belief (thought) did the memory or situation activate? 3. When you can identify a thought or memory, try to understand how your emotional reaction is linked to this thought. 4. Then ask yourself if there is any other, more neutral or positive way to view the situation: Would changing how you think help you to feel or react differently? You can use the ABC-model by putting it in a form, like this:

AC T I VAT I N G E VEN T

BELIEF / THOUGHT

CO NSE QU ENCE /R E ACT IO N

DISCUS SIO N

I heard someone talk about the city where I was trafficked.

I am weak and helpless; I should have been able to stop the abuse. I am to blame for what happened to me.

I feel ashamed, sad and angry with myself. I want to hide in my room, and not talk to anyone.

I was threatened and controlled; I was not free to come and go as I wanted. I was not weak, but did the best I could to survive.

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The last section in the model, the D-section, is meant to help you find more helpful and supportive ways to think about what happened to you. It can be difficult to work on alone, and it may help to use some of the following questions: •

Can you find any evidence to contradict the B-thought?

•

Do you recognize any of the depressive thinking patterns mentioned earlier: o Rumination o Catastrophizing o

Focusing on the negative and ignoring the positive

“Black and white” thinking

o Self-blame •

What would you say to a friend who had this thought in a similar situation?

•

What are the costs of thinking this way?

•

What are the benefits of thinking in a more helpful way?

•

How will you feel about this in 5 years?

•

Is there any other way to look at this situation?

It takes practice to master the ABC-model. I recommend that you practice it every day for at least two weeks before you tell yourself that it does not work. Good luck!

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Difficulty with concentration, learning and memory

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The brain in danger and the brain at rest

When you are in danger, or think you are in danger, you are not able to focus on learning. When you are outside your window of tolerance, your senses, perception and body are focused on survival instead. In simple terms, we could say that a brain in danger does not learn well. After trauma, this stress response may continue because the alarm system in your brain may not have adapted to being safe. Even though you know you are safe, your brain still doesnÂ´t believe it, and your body follows where your mind goes. So, your brain is still focused on looking for signs of danger around you: listening for sounds of people approaching, looking for movement or situations where you need to be ready to protect yourself. Therefore, you may experience concentration difficulties for some time even after your trauma is over. For some people, this may continue for several years until they learn to relax and trust that they are safe.

Concentration and learning difficulties

Your ability to concentrate and focus on work, school or even everyday tasks can be affected by reactions to trauma. Difficulty with concentration, learning and memory are not uncommon for trauma survivors. The reason can be that it is a lot of work to avoid thinking about what happened to you. It may feel like your brain is working overtime trying not to think about the trauma. You can get distracted by triggers and flashbacks. You may be tired from sleep deprivation because of nightmares. Or the tasks you are trying to focus on seem trivial compared to what you have been through. There may also be other reasons, like physical stress or depression, that make it hard to focus. Being able to work, study or just do everyday chores is important for you to have a sense of normality and control after trauma. Basic constructive activity can also boost self-esteem and self-confidence, and it builds your future. Therefore, it is important to take concentration difficulties seriously. A step in the right direction may be to acknowledge that there is a reason you have trouble concentrating (post-traumatic reactions), and try to adapt your tasks and chores to this limitation until it gets better. Because it will get better with time! Be patient with yourself, and ask others to be patient as well.

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Here are some tips you can use to make it easier to concentrate when you work or study: •

Work and study in quiet and calm surroundings where you feel safe.

•

Try to figure out if it is easiest to concentrate when you work alone, or with others, and do whichever works best.

•

Have reasonable expectations of how much you are going to get done. Be kind to yourself; self-blame and self-criticism are not going to help.

•

Have shorter work-sessions, and take breaks – for example, 20 minutes’ work + 10 minutes’ break. I recommend doing a breathing or mindfulness exercise in your break.

•

Try to make plans and lists of what you need to get done, so you can check it off and track your progress.

•

Try to do some physical activity in between working or studying. Go for a walk and get some fresh air, even if it is just for 10 minutes.

•

If you are distracted by worries and rumination, set a time for later when you are going to think about those things. It may help you concentrate when you know that you will be able to think about your worries and concerns later.

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Pain and fatigue

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Pain

Pain is an uncomfortable sensation and feeling in your body that is caused by actual or possible tissue damage. Pain is subjective, which means that sometimes there is an injury or illness, and sometimes there are other reasons for your pain. For example, psychological stress can cause tension and physical pain without tissue damage. In other words; pain is what you sense as pain. Your thinking can affect the pain signals in your body, which means that pain is not imaginary just because there is no injury; you can have physical pain from psychological stress. Your thoughts, worries, expectations and attention can influence the pain signals in your body and make the pain worse. Your body also remembers pain and becomes more sensitive to it each time you feel the same kind of pain. This means that your nervous system (the brain and nerves in your body) has lowered the threshold for sensing pain. You may sense the pain as stronger than it really is, because your mind senses “new” pain stronger when it has a memory of “old” pain. Stress and anxiety can also increase the sensation of pain. Using techniques described in this book to reduce stress and anxiety can alleviate the extra pain caused by this. You can also use mindfulness techniques to cope with pain and reduce the impact that other psychological factors have on your pain.

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Physical tension and pain

Prolonged stress and overactivation can cause your muscles to hurt. This is because the stress response produces tension in your body so that you are ready to fight or flee if needed. Being scared and having to defend yourself often will cause your muscles to tense. Over time this may cause pain, especially in the head, neck and shoulder area, but it can also spread to the whole body. You may also suffer pain from injuries from your trafficking trauma. First of all, I encourage you to see a medical doctor for these injuries. If you do not have money for a doctor, try to find an organization in your community that offers free health care services. Do not attempt to diagnose yourself or treat your injuries without the opinion of a healthcare professional. That also includes self-medicating with alcohol or illegal drugs. This may develop into an addiction which may increase your pain and suffering over time. It can also cause you to develop a tolerance for the drugs which can cause more psychological, social and financial problems. Please see a doctor or health care professional if you need pain relief.

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There are some techniques you can use to help yourself deal with pain and the physical symptoms of anxiety. You can use your own body to ease the pain by learning to breathe better, relax in an active way, and increase heart rate and muscle tension in a good way by exercising. Try the techniques described below. Breathing exercise Breathing is an automatic function, but you can still consciously control it. Stress and trauma disturb calm breathing by triggering the fight-flight response and making you breathe faster. After the trauma is over, the body may still breathe like it is in danger. So, you may need to learn to breathe properly again. We can all benefit from a good breathing exercise! When you are stressed, your breathing is too fast and too deep, and you breathe in too much oxygen. This can make you dizzy and increase your feeling of danger. When you are relaxed, your breathing is calmer and you get the right amount of oxygen. Stress is like a gas pedal for your body, so if you learn to breathe in a more relaxed way, you can use this breathing technique to calm down when you feel anxiety and stress coming. Slow and controlled breathing can work like a brake pedal for stress.

Try to follow these instructions for a more relaxed breathing: 1.

Find a room or place where you can do this exercise undisturbed.

2. Close your eyes if you feel comfortable doing so. 3. Make sure youâ&#x20AC;&#x2122;re sitting comfortably. 4. Let your shoulders fall down as far as possible. 5. Focus your attention towards your stomach and chest, and try to feel the air going in and out. 6. Breathe slowly in through your nose while you count to three seconds. 7. Feel how the air fills your stomach. Put your hands on your stomach if this helps you feel whether the air is going all the way down or not. 8. Breathe calmly out through your mouth while you count to three seconds. 9. Repeat this ten times while counting down 10-1 between each breath. If you still feel some tension or stress after ten times, just continue until you feel calm.

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Active relaxation One way to help yourself relax and ease the tension that causes pain in your body is called “active relaxation” or “progressive muscle relaxation”. This method simply focuses on flexing your muscles and then relaxing them in a predictable pattern, while you breathe slowly in through your nose and out through your mouth. Try to pull the air down into your stomach. Follow these instructions from Modum Bad (2013): • Begin by finding a comfortable and undisturbed place to sit or lie down. If it helps you relax and concentrate. You can close your eyes if that helps, but it is not necessary.

•

You will then relax all the parts of your body step by step, by flexing and relaxing for 5 seconds each, two times for each muscle group. Try to focus on how it feels in your muscles when you flex them, and then how this feeling changes when you relax. If it hurts too much, you can skip that muscle group, or try to just focus on relaxing that part of your body.

•

Start with your hands; tighten your fists for 5 seconds, and then relax for 5 seconds. Repeat.

•

Move to your arms; put your hand on your shoulder and tighten your muscles for 5 seconds, then relax with your arms hanging down. Repeat.

•

Focus on your triceps (back of your upper arm) by stretching your arms out in front of you for 5 seconds, and then relax with your arms hanging down. Repeat. Remember to focus on your muscles; feel when they are tense and when they are relaxed.

•

Move your attention to your face; Tighten the muscles in your forehead by raising your eyebrows up as high as you can, while pulling your jaw down. Relax, and repeat.

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•

Focus on the neck; bow your head down towards your chest, then slowly turn your head to the right for 5 seconds, and then slowly to the left for 5 seconds. Repeat this at least one time, but you can repeat several times as there is often a lot of tension around the neck and shoulder areas.

•

Move to the shoulders; raise them up to your ears and hold for 5 seconds, relax by letting them drop and trying to pull them down. There is often a lot of tension in the shoulders. When we are stressed, we automatically raise our shoulders a little, so by pulling them down you may help yourselves to relax more. Repeat, and make sure to notice the difference in how your muscles feel when they are tense and when they are relaxed.

•

Focus on your upper back by pulling your shoulders back against each other while you sit up straight. Hold for 5 seconds and then relax. Repeat.

•

Move your attention to your legs; stretch them out while you point your toes like a ballerina. Relax with your feet on the floor. Repeat.

•

Now stretch your legs again with your toes back towards yourself. Relax with your feet on the floor. Repeat.

•

Curl your toes for 5 seconds, and then relax. Repeat.

•

Finally; scan through your body. Are there areas where you still feel tension? Repeat the exercise for that part 1-2 more times.

•

Now, imagine that a feeling of relaxation and comfort spreads through your body. You may feel warm, heavier, safe and relaxed. Stay this way as long as you need to.

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Physical activity Physical activity and exercise can reduce stress and tension and help with pain and fatigue. By building your physical strength, you also build your mental strength. Exercise is also a great way to take back control of your body and build a sense of agency after trauma. I would recommend that you try an exercise that leads to an increased heart rate, like jogging, walking fast, swimming, or bicycling; and also, an exercise that builds muscle strength, like Pilates, weight training or simple training where you use your own body as the weight. You can also combine your exercise with social support. By exercising with other people, you get exercise and friendship and fun. You can try team sports such as soccer, handball, volleyball, cricket, American football, softball, baseball, or simply go for a walk together.

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Fatigue

Fatigue is a common symptom after prolonged stress and trauma. Fatigue means feeling tired or exhausted no matter how much you rest and sleep. Prolonged trauma can cause fatigue because of the continuous stress activation in your body. The fight-flight stress response causes strain to your body if it continues for months and years. When the trauma is over and you can relax and rest again, the stress level in your body will go down and you may feel continuously exhausted. Fatigue is not the same as the ordinary tiredness that we all experience sometimes from working too much, sleeping too little, or not eating enough. Fatigue can steal your motivation, concentration and interest in everyday activities. It can also affect your mood and relationship with other people. Fatigue can also be unpredictable; you may feel better in the morning, and then totally exhausted a few hours later. For some people, the fatigue is more intense in certain situations.

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When you feel exhausted it is natural to want to rest as much as possible. Many people think that by just resting enough they will feel better. Unfortunately, you cannot rest yourself better from fatigue or depression. You need to be active so that your muscles do not diminish and your breathing does not slow down. The more you rest, the harder it will be to get going again. At the same time, it is important to have an activity level that is not too demanding. You need enough rest, so that you do not overexert yourself. Both too much rest and too little rest can maintain your fatigue. This means that you need to find the optimal balance between enough activity, and enough rest. Just a reminder: rest is not just sleeping. It can also be activities that help you relax, like reading, watching TV, doing puzzles, drawing or painting, or listening to music.

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Dealing with your trafficking story

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When a person has been injured physically, like a broken arm, the doctors call it a “trauma”. Going through traumatic experiences such as human trafficking leaves an injury on your soul, also called a “trauma”. Some people who live through traumatic experiences want to forget what happened and leave it in the past. Many people live in cultures that believe this is a good way of dealing with bad experiences. But it may also be because thinking about what happened is painful and may bring feelings of shame or anxiety. It is understandable that you would want to just forget it. However, your trafficking experience will always be a part of your life story. If the injury on your soul is just covered up, by clothes and makeup, or by staying busy and by pretending it didn’t happen, it becomes like an infected wound. It will hurt until it is opened, cleaned and treated with care. Then it can heal and close. There will probably always be a scar there, but with time it may not hurt as much because it has healed properly. I highly recommend that you to see a trained therapist (a clinical psychologist or psychiatrist) to work on the story of your trauma. However, you may not be able to see a therapist because of your financial situation, or because there are none where you live. You may have a social worker, a nurse or a good friend you can talk with instead. Make sure you do it in portions you can handle. It is possible to talk about your story in a way that helps you heal, without getting into all the explicit details of what happened. And make sure to talk about what helped you survive, not just what was painful.

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If you do not have someone to talk to about your trafficking story, I suggest that you try therapeutic writing. One way to stop fearing your trauma album and make more sense of everything in it is by making a timeline. A timeline is your own story written down on paper in the right order. You can start with the day you were born and end on today. It is important to put both your hot AND your cold memories in your timeline, so that you can feel more like a whole person again. Put happy events and memories that are important to you in your timeline along with the painful memories. Making your timeline can take a lot of time, both because there are a lot of memories to write down, but also because remembering traumatic memories might be difficult and fear-provoking. Give it the time it requires, take some breaks, and leave it for a while and then come back to it if you need to! Make sure to use the self-helping techniques you have learned so far from this book if writing about your memories triggers flashbacks, pain or other symptoms. Write in your own language, and avoid details if it is too painful to think about.

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YOU CAN MAK E YOU R TI M ELI NE LI K E TH IS: CO LD MEMOR Y

DATE

I was born

03.11.1987

I started school. I made two friends in class.

AUG , 1993

H OT M E M OR Y

There was one boy in class who bullied me.

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Emotional bonding

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I don’t know how you ended up in the trafficking situation. Different survivors tell different stories. Some are tricked by fake job offers, some are kidnapped, and some are lured by promises of love and marriage from the trafficker. We call the person that exploited you and let others exploit you a “trafficker”. It is not uncommon that survivors were in love with the person that betrayed them and exploited them. This love made them trust and believe their traffickers promises of a better life in a new place or country. For some survivors, this love passes when they see that they have been tricked and taken advantage of. But for some, this love continues despite the exploitation. There are several reasons why someone would love or care for their trafficker. It could be a family member; a father, sister, cousin, or a trusted family friend. It could also be your husband, or longtime boyfriend. Maybe you have a child with this person. For some survivors, abuse during their childhood has desensitized them to abuse, and exploitation in a loving relationship is not something that would prevent them from loving the person. For other survivors, the trafficker may be the only person they knew or had a relationship to in the place where they were exploited. Maybe you were trafficked to a country where you did not know the language or culture, and did not know who to trust? Maybe you are wondering now why you let this happen? Do you ask yourself why you loved or cared for someone that abused and exploited you? Forming a bond, or even a romantic relationship, with your trafficker may have been the only way to feel some safety or to survive. This is not uncommon, and some survivors don’t even see their trafficker as the bad guy, as others do. This is okay, and I encourage you not to spend time ruminating over this; it is completely natural to form relationships to people that take care of you, even if they also hurt you. It happens in many different types of situations, with children of abusive parents, hostage situations, in human trafficking and in other traumatic circumstances. However, if you feel shame or self-criticism for the relationship you had with your trafficker and the things that happened to you in this relationship, please read the following sections on shame and self-compassion.

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Shame

Shame is an uncomfortable feeling. Shame is different from guilt, which is the feeling you get when you have done something wrong, like tell a lie to someone you care about. The moral feeling of guilt is like a compass in that it helps us to do what is right and treat each other morally. Guilt is triggered by our inner critic that reminds us when we have done something wrong, and that we need to make it right. So, guilt can be a good thing, but shame is not. Shame is the feeling that you are something wrong. Shame is the feeling you get when your inner critic tells you; “There is something wrong with you.” Shame is a liar that tells you that you are not worthy; not worthy of acceptance, of attention, or love. Shame is also expressed through body language, and it looks like hiding. You make yourselves small, because that’s how a person full of shame feels inside – small and insignificant. Shame makes us want to hide to avoid being noticed because we don´t want others to see what is wrong with us and reject us; so we look down, turn our heads, and maybe we even blush. Being trafficked and abused can induce the feeling of shame in you. As we described in a previous chapter, rumination and self-blame are common after trauma because a traumatized person will always try to make sense of what happened. However, when you (or rather your inner critic) tell yourself that “I am to blame for what happened,” you are basically telling yourself that “There is something wrong with me.” Maybe you don’t believe what happened to you was your fault, but instead you believe that the abuse you have gone through has ruined you and stolen your value, and that you are now a lesser person. Thoughts like this will always be followed by shame, because this brokenness and “otherness” brings more shame and strengthens the idea that there is something wrong with you and that you don’t belong anymore. If you believe the lie that shame tells you, that there is something wrong with you, then the next thought comes naturally; “I deserved what happened to me”. This is also a lie. No one deserves to go through what you have gone through. No one deserves to be abused, trapped and treated as a slave. Breaking the cycle of self-blame and shame can take time, but it is a personal fight that you need to get working on. Because you are worthy of acceptance, attention and love. We all are, and “we” includes “you”.

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If you believe the lies your inner critic tells you, that “there is something wrong with you”, then this exercise may be a helpful tool to change your negative thinking patterns about yourself. This exercise by Binder (2017) is meant to help you examine the self-blame and shame that you have, and help you look for alternative ways of thinking. Follow the steps below. If it helps you to keep track, you can write down your answers to the questions: 1.

What critical thoughts or self-blame do you tell yourself? What thoughts do you have that fuel your shame? It could be thoughts like; “I am weak. I am not smart enough. I am to blame for what happened to me.” Or it could be thoughts like; “I am broken. No one can love me after what I have been through.” What selfcritical thoughts – what lies – do you regularly tell yourself?

2. Try to imagine your inner critic as a person. What does he/she look like? What does his/her voice sound like? What facial expressions does he/she have when speaking these words to you? 3. How does it make you feel to listen to the words this inner critic tells you? 4. What would you say or do if your inner critic said the same words to someone you care about? How would it make you feel to listen to someone say the exact same words to a person you love? 5. Allow yourself permission to feel the same for yourself. Allow yourself support and comfort when you acknowledge that it is painful to hear these words, and painful to feel this way when these words are spoken to you. 6. Try to find a more compassionate and caring way to talk to yourself about what happened to you. For example, you could tell yourself; “I did the best I could to survive. I am strong because I survived – I am a survivor”. What would a person you trust tell you about yourself? What would this person choose to focus on? What supportive words would this person tell you?

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Self-compassion

Compassion means to care about the wellbeing of others. The ability to feel compassion is a basic human capacity. It helps us take care of each other, especially when someone is hurting and needs help. Usually, we are better at being compassionate towards others than towards ourselves. But the ability to be self-compassionate is also necessary; it is a protection against our inner critic and self-blame, and it is also a way to help yourself deal with the psychological pain you carry. Compassion for others and self-compassion are things we are taught by our caregivers when we are young. When they show compassion and comfort us when we are hurt or afraid, it teaches us that it is possible to understand and feel the pain of other people, and that responding in a kind and loving way makes the pain weaker and the fear smaller. This is compassion, and we can comfort ourselves in the same way. Self-compassion makes it safe to face the difficult feelings and thoughts you have about yourself. Compassion only makes sense when it makes pain and fear smaller; when it makes the burden easier to carry. Just understanding that someone else is in pain is not being compassionate. In the same way, understanding that you are in pain is not the same as being self-compassionate. Self-compassion is to also allow yourself to accept, understand, and be kind towards yourself and your pain.

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How can you help yourself and give yourself kindness when no one is around to help you, or when you donâ&#x20AC;&#x2122;t feel like asking for help? When you face something difficult, when you feel ashamed or when pain surrounds you, you can use the following exercise (Binder, 2017) to practice self-compassion: 1.

Turn your attention towards the pain or fear that you feel. This might be easy or difficult, depending on how much time you spend thinking about this in your daily life. a. Picture in your mind the situation that is causing your pain. b. How does it feel in your body? How does it feel emotionally?

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2. Accept that this pain or fear is real in your life right now. Here, I don´t mean accept as in “approving” the pain, I just mean to choose to deal with the fact that the pain is present. a. Try to allow the feelings and pain you may feel to be present, and don’t push it away. Maybe just tell yourself; “I am hurting”. 3. Acknowledge that pain and fear is something all humans feel. Having these feelings does not make you weak or broken, it makes you human. a. Remind yourself that pain is something we all feel, both physically and psychologically. Remind yourself that this pain is what makes you like other people, not different from others. b. Tell yourself; “I am human”. 4. Meet your pain with kindness and tell yourself what you would like someone else to tell you. a. Ask yourself; “What do I need when I feel like this?” b. Can you meet your own feelings and reactions with kindness and care? c. Can you meet yourself with a kind voice and patient eyes? d. Imagine that you give yourself the comfort and love that you need right now. e. How does it feel to give yourself this kindness? Maybe this exercise gives you what you need. Maybe through this exercise you will discover that you need something more; connection with others, help with something, a break from things, or attention to physical needs. Maybe you will discover that you can be friendly and compassionate towards yourself; and maybe even a friend to yourself.

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Connection, support and community

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Understanding and expressing your needs and boundaries

When you are ready to step out into the world again and try to interact with other people, you may experience some reactions and needs that are difficult for you and others to understand. Please remember that your reactions and behavior may have been helpful when you were trafficked, and you should not feel ashamed if you react the same way now. By using the ABC model, you can practice new ways of experiencing and reacting to the world. You may feel that your needs and boundaries are different from before you were trafficked. Maybe you feel like a different person. Maybe you have a hard time trusting people again. You may need to practice being more social and at the same time take care of your need to protect yourself. It may take some time to learn how to deal with this, and that is okay!

The “window of tolerance” in relationships

Do you find yourself reacting in ways you don´t understand when others are acting in ways that you find kind, confusing, mean or demanding? Do you freeze when someone smells like the trauma? Or do you find yourself doing things you don´t want, because someone you care about wants you to do it? Remember the window of tolerance? It can help you understand why navigating relationships with others after trauma can be so difficult. People sometimes do or say things that may remind you in some way of what you have been through. They may not know it, and maybe you don´t either, but you find yourself overreacting or responding in ways that can be confusing to others and scary for you. If you are triggered, you may become over-activated or under-activated, and this can affect how you react.

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Over-activation

If you become over-activated, you are in the state of “fight-or-flight”. “Fighting” in response to other people may look like anger, yelling or physical violence. The fear you feel when someone triggers you may result in you losing control of your emotions and reactions, and you may do or say things you regret afterwards. The anger you feel is a secondary emotion covering up your fear. While you were trafficked, this probably helped you survive in some situations, but now it may cause you to have problems with the people you care about. If you feel yourself getting angry at people around you, try to take a break. Count backwards from 20 to 0 while breathing calmly between each number. Then use the ABCD-model to look for other ways of understanding the situation. Maybe you can identify the trigger that made you afraid and angry? Over-activation also includes “flight”, which in response to other people can look like turning or walking away, shutting people out or even avoiding and ignoring people. This can be quite confusing and hurtful for the people who love you, and you may lose out on relationships that are supportive and good for you. When other people say or do things that scare or hurt you, and you feel like you want to run or avoid them. Try to use the ABCD-model to look for triggers; what did they say or do? Maybe it´s what they didn´t say or do? Maybe you feel ignored or forgotten? How is this connected to your trauma, and is there any way you can talk with the person about it and explain how their behavior is hurting you? Maybe they mean well, but your fear of getting close to others is activating your need to run? In that case, try to talk with your friends and family about how they can help you stay close and connected.

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Under-activation:

If you become under-activated, you are in the state of “freeze-or-faint”. This is often difficult for yourself and others to notice and understand. If something or someone triggers your trauma memories, “freeze-or-faint” can make your mind go blank; you don´t remember what to say or do. You may also physically freeze up, or become paralyzed. “Faint” may look like physical or emotional numbing. This can result in you not reacting at all to other people’s words or actions. There may be a lot of strong emotions and chaos going on inside you, but on the outside you may look calm and quiet, or even uninterested in what is going on. So, others may not even notice that you are frozen or numb. This may cause them to think that you are okay, when you are not. And they may continue to talk or do what triggered you in the first place. If this happens to you, try to focus on your breathing while awakening your body by using your senses. Look for a safe object, listen for a calming sound. Try clenching your fists and opening your hands. When you feel ready, try to say something simple that makes the other person aware that you are not okay; like “stop” or “no”. Then try to explain what is going on with you, if you feel comfortable.

PR E V EN TI ON

A good way to avoid situations like the ones described above from happening is by talking with your family and friends about your typical reaction patterns when you are triggered. Do this when you feel safe and calm; this way it is easier for you to explain and answer their questions. Try to explain what words and actions trigger you. You don’t have to explain why, just that they somehow make you feel unsafe and when that happens, you may get afraid, angry, want to run, become paralyzed or go numb. Let them know that this can make it hard for you to feel safe in the relationship or even treat the other person the way you would like to. If you can have this conversation with the people you care about, you can prevent some difficult situations from happening, and you can build safe and strong relationships to the people you surround yourself with. In the long run this will be important for your recovery.

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Others may not understand you

Trauma is not supposed to happen, and it is life-changing when it does. For people who have not experienced trauma the way you have, or worked closely with people who have been through something similar, it can be difficult to understand how life-changing it can be. It is not lack of love, compassion or patience that stops them from really understanding; it is the lack of experience. Since they have not experienced the same type of trauma themselves, it is hard for them to understand why you have the reactions and difficulties that you have. No one can really understand what you have been through, because the experience is yours and yours alone. Give your family and friends the grace of not expecting them to understand everything. Instead, try to just explain the things you think they will be able to understand, like how you feel right now and what you need to feel better.

Social support from others who do understand

All humans need to feel support, understanding and care. We need to feel like someone understands how we feel and what we have lived through. In many communities there are support groups or organizations for people who have been through difficult situations – for example, groups for people who grieve over lost loved ones, groups for people who battle drug addiction, or groups for people who have been through trauma. Maybe there are groups or organizations in your community for people who have gone through experiences similar to yours? When we receive support from people who really understand what we have been through, we feel safe and like we belong, and this drives away shame and loneliness. Look for groups or organizations in your community that may offer you this type of support.

Making decisions and forming new habits

Being trapped and controlled for a long time can steal your sense of free will. This means that you might feel like you don’t know how to make decisions anymore. Your belief in your right to decide for yourself what you want or don’t want to do may be gone. This can make you feel helpless, and maybe even hopeless. When we feel helpless, we become passive. We wait for something to happen, or for someone else to make decisions for us. In turn, this might reinforce your feeling of not being in control. To rebuild your sense of free will again, start by making decisions that seem within your reach. For example, decisions you were not allowed to make when you were trafficked; like what to wear, what to eat, who to talk to, where to go for a walk, and when to do activities. You can ask a person you trust to support you in making the bigger decisions, and to also slowly help you to start making the bigger decisions all alone.

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Habits and routines are positive things; they free our minds from having to consider every day what to eat, when to eat, how to dress, what bus to ride to work, where to shop, when to sleep and so forth. Habits save our minds from a lot of work, and at the same time free time and energy for more creative and problem-solving thinking. After some time in a situation where choices have been made for you, your habits may have been lost or forgotten. After prolonged trauma, these everyday habits may feel trivial. And you may question the point of it all? Why should you bother to make dinner? Or wash your clothes? Or meet a friend for coffee? Habit and routines save us time and energy, but they also give us a feeling of safety and predictability.

Meaningful living

Living can be hard. Finding a way to live meaningfully can be even harder. Modern culture is very focused on â&#x20AC;&#x153;the good lifeâ&#x20AC;? and on chasing happiness. However, few of us take the time to understand, or decide for ourselves, what happiness and living a good life really means. We easily buy into the story of the good life that the media constantly tries to sell us; that owning things and achieving certain goals is what will make us happy. Some of the things money can buy, and some of the goals we can achieve, can give us a good feeling for some time. But true meaning and happiness cannot be found in dead objects. Learning to make decisions for yourself again, and living life from the values that are important to you, may guide you toward a life of meaning and happiness. Personally, I think the importance of happiness is exaggerated; it does not give our life meaning to chase happiness. Instead, I think living life meaningfully has the feeling of joy as a nice side effect. When we live our lives in line with our values and what is important to us, then we live meaningful lives. And I think we would all experience more joy if we lived more of our lives with the goal of making each other happy, instead of focusing only on our own happiness. I think this effect comes from our basic human need for connection and community. When we are truly a part of a community; a friendship, a marriage, a volunteer group, a class, a family; we feel more meaning and joy than when we are chasing our own happiness. Living a meaningful life means living in a way that builds connection and relationships with other people; with our community. We need to believe in something bigger than ourselves; we need something other than ourselves to live for. For some people this means to live for family and friends; for others it means to live for a greater mission. Meaning gives our lives direction. Happiness plays an important part, but only when it is connected to meaning. Joy opens us up to connect with other people, and this connection stimulates more joy.

Are you still living in exploitation?

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Maybe someone gave you this book, or maybe you found this book by searching the internet for help, because you are still living in a situation where you are abused and exploited. If so, please seek out a local shelter, organization, church, the police, or someone you think will be able to help you! Here are some tips for what you can do to find help. In most countries in the world, there are several non-governmental organizations (NGOs) that work to help people who have been victims of human trafficking. If you have internet available, please use the following search words on google to find an NGO that can help you: •

Human trafficking + Hotline number + (your country)

•

Human trafficking + NGO + (your city)

If you do not have internet available, please seek out the police or a medical aid facility. If for some reason you are afraid to trust the police or government where you are, try to find a local church or other religious house of worship. Religious groups have always been on the forefront of the fight against human trafficking.

Try to best of your ability to explain what is happening to you, and why you need help. Recommended world-wide organizations that work to help victims of human trafficking: •

Hope for Justice (www.hopeforjustice.org) Present in United Kingdom, United States of America, Norway, Cambodia, Zimbabwe, Uganda, Ethiopia and Vietnam.

•

Free The Slaves (www.freetheslaves.net) Present in India, Nepal, Congo, Ghana, Senegal, and Haiti.

•

A21 (www.a21.org) Present in United states of America, United Kingdom, Netherlands, Spain, Bulgaria, Ukraine, Greece, Norway, South Africa, Thailand, and Australia.

•

International Justice Mission (www.ijm.org) Offices in Australia, Canada, Germany, the Netherlands and the UK.

•

Polaris project. Present in the USA. National Human Trafficking Hotline USA: 1 (888) 373-7888 Text “BeFree” to 233733

About Benedicte Ekman is a clinical psychologist, trained at the University of Bergen, Norway. She has experience from the fields of community psychology, trauma therapy, and addiction treatment. Ekman is the leader of For Freedom, an NGO fighting human trafficking in Norway. For Freedom offers support for survivors of human trafficking as an addition to the aftercare programs provided by the Norwegian government. For Freedom also works to prevent human trafficking in Norway through information programs in schools, public awareness and political campaigning. See www.forfreedom.no for more information. Kristin Huang is a clinical psychologist and illustrator. She has experience with trauma and addiction treatment and is a freelance illustrator for several magazines. Opplett is a Norwegian media and advertisement company based in Bergen. See www.opplett.no for more information.

Thank you

To the amazing survivors I have had the privilege to know and care for. You have taught me what survival and strength really means. Thank you. I also want to thank everyone who helped make this manual and everyone who supported the project financially. Benedicte

References Binder, P. E. (2017). Ikke vær så slem mot deg selv: En veiviser i det ufullkomne livet. Oslo: J.M. Stenersens Forlag AS. Brewin, C. R. (2003). Posttraumatic stress disorder: Malay or myth? New Have, CT: Yale University Press. Courtois, C. A., & Ford, J. D. (Eds.). (2009). Treating Complex Traumatic Stress Disorder: An Evidence-Based Guide. New York: The Guilford Press. Dyregrov, A. (2019, April 3). Håndtering av påtrengende minner og tanker. Klinikk for Krisepsykologi. Ellis, A. (1974). Humanistic psychotherapy: The Rational-Emotive Approach. New York: Three Rivers Press. MacLean, P. D. (1985). Brain evolution relating to Family, Play, and the Separation Call. Archives of General Psychiatry, 42(4), 405–417. https://doi.org/10.1001/archpsyc.1985.01790270095011 Modum Bad. (2013). Manual for stabilisering og ferdighetstrening etter traumatiske hendelser. Oslo: Modum Bad and Regionsenter for barn og unges psykiske helse. Schauer, M., Neuner, F., & Elbert, T. (2011). Narrative Exposure Therapy (2nd ed.). Cambridge: Hogrefe Publishing. Siegel, D. J. (1999). The developing mind. New York: The Guilford Press.

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