Trauma Triggers

June 12, 2015 | Comments Off on Trauma Triggers | Uncategorized

When Rain is Triggering


Remember when rain was just…well, rain?


I know for many who lived through the 2013 Colorado flood, a rainstorm will never again be the brief interlude between days and days of sunshine. Instead, rain has become a threat, a taunt, “This might be only the beginning of the devastation.”


Unfortunately, (or fortunately, as the case may be), our brains are designed to go into a state of high alert whenever we re-experience anything that happened as part of a trauma. A small structure, buried deep in our emotional brain called the amygdala records a Technicolor-like record of every sense, thought, feeling, or event that we experienced shortly before or after the trauma. Later, when we experience a similar sense, thought, feeling, or event our brain starts its warning sirens, “DANGER, DANGER, DANGER! DO SOMETHING TO SAVE YOUR LIFE.” Our bodies shift into a fight, flight, or freeze mode. That is a great survival mechanism if there is really a threat.


The trouble is that 99% of the time, rain is likely… just rain. Rain that will fill our reservoirs, nurture our gardens and bring life. There are long-term solutions to this amygdala-triggering response, namely trauma-specific therapy. For those of us who did not receive this type of treatment after the flood, here are some short-term ways to cope.


  • Remind yourself that the flood was a very, very, unusual occurrence.
  • Anxiety, at its best, is a signal system. Use that signal to reassure yourself you are prepared. If you are not prepared do one or two small things that make you feel prepared.
  • Don’t give in to the fear. Remind yourself, it is your amygdala talking. Not the rational part of your brain.
  • Indulge in a dose of reality. Remind yourself of all the differences between this rainstorm and the ones during the flood. For example, the forecast is different. It only rained buckets for a few minutes and then stopped.
  • Use the rain as an excuse to do something that makes you feel cozy. Make some tea or hot chocolate and snuggle up with a book and a blanket.
  • You are shut in the house, you may as well tackle one of those projects you have been avoiding. You will end up feeling productive instead of frozen.
  • Music can be very powerful in helping your change your emotional state. Play some of your favorite music or something that makes you want to sing aloud or dance.
  • Do not allow yourself to brood about the what-ifs. Absolutely DO NOT try to convince yourself that with global warming anything is possible. Global climate change is real but this is not the moment to be thinking about it.
  • Reassure yourself that you are strong and adaptable. After all, you survived the flood of 2013. If we do have another one, you will find the strength to cope and thrive.


Good Luck! We are all in this together!



Cynthia Divino, Ph.D.

Executive Director, InReach

Member Long Term Flood Recovery Group


InReach (formerly BIPR) offers affordable counseling for children, adolescents, and adults, parenting help and resources and professional trainings for early childhood and mental health professionals.  Contact InReach at 303-442-4562.

Training for Mental Health Professionals

June 11, 2015 | Comments Off on Training for Mental Health Professionals | Uncategorized

Fellowships and Internships

Fellowships and Internships

Bright by Three

June 11, 2015 | Comments Off on Bright by Three | Uncategorized

Bright by Three

Bright by Three

Counseling for Adults, Teens, and Children

June 11, 2015 | Comments Off on Counseling for Adults, Teens, and Children | Uncategorized

Depressed Young Woman Talking To Counsellor

Experts in Trauma and Attachment

June 11, 2015 | Comments Off on Experts in Trauma and Attachment | Uncategorized

Expertise in Trauma and Attachment

[Question]  My four year old has started having temper tantrums again.   He hasn’t had any since he was about two years old.  Is this normal?  When should I seek help? What should I do about them?

[Answer] Dear A.,

thescream2Temper tantrums are most common in toddlers but do occur in children up to about age 5. 

In two year olds, temper tantrums usually occur due to “system overload.”  Frustration, extreme emotions, and the dawning understanding that all there “wants” will not fulfilled are major causes of temper tantrums.  Coupled by the fact that they do not have the language to express their needs and wants means they will often have meltdowns.  This is especially true when they are physically disregulated because of lack of sleep, hunger, or illness.

If the temper tantrums have just sprung up again after disappearing for a year or two, I would ask yourself some questions:

– Is my child behaving this way to get out of something? (Like throwing tantrums in the grocery store because he hates going shopping; before daycare because he wants to delay a separation; or because he doesn’t want to do something you have told him to do.)

– Is my child trying to get something I have already denied him. (For example, if you said “no” to a cookie or extra time playing before bedtime.

– When do these temper tantrums usually occur?

The answers to these questions will help you understand the reason your child is having a tantrum. If your child is successful in getting what he or she wants because of the tantrums, they will continue because your child’s strategy has worked.

What do I do when my child is having a tantrum?

If it is possible, ignore it.  If your child is at risk of hurting himself or of breaking things with his flailing arms and legs, move him to a place where it is safe.  If your child is throwing a tantrum in a public place, you can pick him up and move him to a less conspicuous spot or to the car.  (Yes, you should just abandon your cart in the grocery store and go to the car.  It will be likely to still be there when you return.)  Then make sure you return to the activity your child may have wanted to avoid so that he gets the message that temper tantrums do not work. 

What you will have to do to get the tantrums to stop is to consistently NOT give in to your child’s demands. If you give in just once, your child will keep doing it and the tantrums will be more prolonged because your child will be exploring whether THIS is the time you will give in. 

If you can honestly say that you do not give in to your child’s wish to avoid an activity or demand, then it is important to question yourself about other possibilities. 

Are there any new challenges my child is facing that may be more than he can handle? (For example, a move, starting a new daycare situation, marital strife that leads to arguments the child witnesses, other traumas or big changes for the family)

Does my child have sensitivities to sound, light, items touching his body, or sensory over-load.

Is there a family history of  mental or emotional problems which may be inherited? Depression, anxiety, bipolar disorder, ADHD, and many other disorders that run in the family can predispose a child to these disorders.

Is this normal?  When should I seek help?

The length of temper tantrum is important.  If they are brief (5-10 minutes) I wouldn’t worry too much about them.  If they last longer than 30 minutes on a regular basis, it is time to seek help.  If the temper tantrums are frequent 1-2/ day for over 3 or 4 months, it is very important to seek an evaluation.

Where can I go for help?

You can certainly call us!  We have a sliding scale and can and do help people in any socioeconomic range.  You can also contact a licensed therapist who has experience working with children as young as yours. Contact us at info (at) or call us at 303-442-4562

By Cynthia Divino, Ph.D.

Licensed Psychologist


* This information is intended for educational purposes only.  It is not intended to serve as or substitute for psychotherapy.

5 Steps to a Happier, Less Stressful Holiday Season

November 14, 2014 | Comments Off on 5 Steps to a Happier, Less Stressful Holiday Season | Uncategorized

holidayseasonThis is not going to be the typical suggestions of take care of yourself, cut out unnecessary activities, get things done early, etc.  Those might be useful practical suggestions but I have never thought they got to the core of what causes stress around the holidays.  You probably know by now that my philosophy is:  if you don’t know the cause of the problem, it is very difficult to resolve it.  So this holiday season, let’s take a look at the some of these root issues together.

Thanksgiving, Christmas, Hanukah, and New Years are imbued with memories. Typically these memories are of family get-togethers, pressures of gift-giving, and often tumultuous emotions.  Whether we have conscious childhood memories of this time or not, the change in weather, in light, and the appearance of thanksgiving and holiday decorations can kindle some of these memoirs. While we may not have actual thoughts about the events at that time, the emotions and feelings in our bodies are solidly present. This five-step guide will guide you through some steps to be more conscious of your expectations and concerns so that you will be able to choose what type of holiday season you will have.


Having a Conscious Holiday

xmas photoStep 1:

Think about what you really wanted most around the holidays as a child.  (For example:  “ I wanted my family to be happy.  I just wanted everyone to have fun and be together.  I wanted cool gifts.)  Write down or type up three quick things that come to mind as you picture yourself as a child heading into this season.



Step 2:

Think about what your experience actually was.  (For example: “My parents would always start out so excited but there was constant criticisms about how each of them was arranging the decoration, arguments about how much money was being spent, inevitably one parent would storm out and we wouldn’t be together on Christmas Day. I received fun toys but it wasn’t’ the same without my parents being happy.”  Or “In my family, everything was perfect, though I think my mom paid a price n making it that way.”  Write down or type up three quick things that come to mind as you picture yourself as a child watching the events unfold.

lessstressflholidayStep 3: 

Think about your last two holiday seasons as an adult.  Are there ways in which you might be perpetuating the experiences you had as a child?  If so write down a few ways you think you might be contributing to negative aspects of the experience or parts of the experience that are stressful.  (For example: “I want it to be a great holiday for my spouse and my children so I really stress myself out running around to make it perfect, spending too much money.  The added extended family exposures and all of those complex relationships puts a lot of pressure on me.)


Step 4:

Think about the aspects of the entire situation you described above that you do have control over.  Write down those things as well as what you can do differently this year.  (For example:  “I don’t have to make things perfect.  Everyone is responsible for his or her own happiness.  I am only going to make fewer dishes for Thanksgiving and ask people to bring a dish.  I am going to set a budget with my spouse for holiday gifts and give my children a few, well-chosen gifts rather than spending too much. My children and family don’t care if every inch of the house is decorated.  I will put up the decorations that are the most important to us and not put pressure on us to impress the neighbors with our glorious yard decorations.  I will sit down and talk with family members about my expectations and get a clear idea of their expectations so we can come up with some compromises before then.)  Write these down and then follow through.

Step 5:

Think about aspects of the holiday season that you have no control over and figure out if you have control over some aspect of the situation. (I can’t control how my father-in-law’s excess drinking makes him obnoxious but I can talk to my spouse about leaving early if he does. I can’t control my insane family but I can limit the time there.)


Write these down and make different plans.

Don’t be discouraged if despite all your best efforts, some things remained the same.  It takes a very conscious effort to not slip into old patterns.  Be encouraged by the few things you were able to do differently and build on those next year.


Please add your comments about what you have done to make things different or what seem like insurmountable challenges in your family.  Perhaps our online community can be helpful to each other by sharing what has worked for you.



Children’s Fear and Anxiety

October 30, 2014 | Comments Off on Children’s Fear and Anxiety | Uncategorized

‘Tis the season.  With Halloween rapidly approaching the appearance of ghosts, goblins, witches, and werewolves pervades the senses.  Images of these scary figures are everywhere from the grocery store to TV and even in the classroom.  For adults, this is all in good fun. For children, however, the idea of all of these scary specters can be terrifying.  For children who have a tendency toward anxieties and fears, it can quickly overtake a child’s imagination, interfering with sleep and their ability to cope away from their parents.  This blog, a continuation of our discussion about anxiety disorders will focus on helping parents manage fears and anxieties in their children. 

Here are some simple steps to manage smaller anxieties in children:

Mother comforting ChildTalk about it with your child.

Help your child articulate how the fear began.  For example, if your child is suddenly scared of ghosts and can’t sleep at night because he is afraid a ghost will get him, ask him. What have you heard about ghosts?  What do ghosts do?  Chances are you child has all sorts of confusing information from their friends, their siblings or even a storybook.  This will at least help you understand what you are up against and will give you some clues about what is so frightening to your child. Most parents will first try to explan that these things really do not exist. They are just make believe or pretend.  Unfortunately, in my experience, because of children’s tendency to use magical thinking, this plan does not usually work well with most children. 

Have your child draw about it or make the scary figure out of clay. 

This step is designed to help children further articulate the issue.  You will often get much more information about your child’s fear from their drawing and their explanation about the drawing.  To the extent you can, correct any misconceptions.

Use your child’s magical thinking to help resolve the problem

Ask your child what they think could defeat the scary figure (the ghost, goblin, witch, etc.)  Then ask them to draw about that.  Ask them what else they think would help and to the extent possible help them do those things for a period of time until the fear abates.  For example, if your child thinks that ghosts are afraid of the night lights, allow them to have a night light for a period of time. 

Help your child use relaxation techniques to decrease their anxiety.  Most of these involve having your child take deep breaths that brings air into their diaphragm. For younger children I use the following exercises. 

Nearly all of the issues that are true of adult anxiety are true for children but the presentation can look a bit different.  (The previous newsletter can be viewed here.) 

1) Bubbles.  Get a small jar of bubbles and see if she can blow the biggest bubble she can.  Tell her the trick is to take a deep breath in and blow it out slowly and carefully.  Oooh and Ahhh over her great accomplishments.

2)  The Marker Blowing Game.  Get a marker that is completely symmetrical and can roll across a table easily.  Put two of them on a table so that the long side is pointed toward you and your daughter (who are standing side-by-side).  Tell her to take a really, really deep breath in and then blow out slowly to see how far she can make the marker go.  You get to blow your marker too.

3) The Tummy Elevator.  When she is laying down, put a loved stuffed animal on her tummy.  The game is to see if she can breath in deeply enough to get her stuffed animal to go up and stay up until the animal counts to three.  Then as she blows out the air, her stuffed animal gets a ride down the Tummy Elevator.  You should do it too.  Before you know it, you will be giggling and having fun.

Read or tell stories that contradict the child’s fears.

For example, if a child is afraid of ghosts, telling stories about a nice ghost or a silly ghost that can be a friend to children may help your child have another point of view and can take the place of the frightening images.

If the fears persist, seek professional help. 

Just like with adults, if anxiety is not dealt with it can grow to unmanageable proportions. 

If you have any further questions, please feel free to comment or ask the question with our Ask A Psychologist feature

Managing Panic Attacks

October 20, 2014 | Comments Off on Managing Panic Attacks | Uncategorized

Panic attacks can consume a person’s life. They are like a virus: they start as tiny invaders that can quickly grow to infiltrate every waking moment of a person’s existence if they are not stopped in their tracks. Unlike a virus, that our body’s defense system fights off and usually conquers, our mind’s most common mechanisms for fighting off panic attacks–avoidance, tends to make things much worse.


This is how it usually begins:


An individual may have a fear or a thought that seems particularly threatening. Often these thoughts are notions that threaten our view of ourselves or how we fear others may perceive us (usually both). Amanda* is a great example. Amanda, an excited college freshman, top of her high school class, received a C on her first college chemistry exam. She suddenly became very fearful that she was not as smart as others have always viewed her. A small fear is planted. Every time she studied, she found herself consumed by the shame of getting a C and suddenly started fearing that she would fail in college and be exposed as a fraud. Fantasies took hold. She imagined the look of disappointment on her parents’ faces, the surprise of her friends, and the glee of her enemies if she flunked out of college. As the next test approached, she became even more frightened as study sessions became hijacked by these thoughts and she couldn’t learn the material. Finally on the day of the exam, Amanda’s fears took over she had a terrifying panic attack. Of course, Amanda didn’t know that is what it was. All she knew is that she had all the symptoms common in panic attacks:


  • Shortness of breath or a feeling of not being about to breathe
  • Racing heart
  • Chest discomfort or chest pain
  • Trembling or shaking
  • Feeling unreal or detached
  • A feeling of impending doom
  • Fear of dying, losing control


Amanda, thought she was dying. As soon as she convinced herself she was too sick to take her test, would notify her professor and ask for a retake, and stay in bed, the symptoms mysteriously disappeared. She felt an amazing sense of relief and started feeling herself again.


That was the first big step in avoidance. After that, Amanda found that just thinking about Chemistry brought on feelings of fear. Only now, Amanda was not just afraid of failing, she was afraid she would have another episode of the crippling feelings she had on the day of the test. Anxiety experts call this, “the fear of the fear”. Amanda decided to drop the class. Consumed by shame because the word “Withdraw” now tarnished her transcript, she found she could not share this decision with anyone. Far from resolving the issue, this avoidance and resulting shame, bled into Amanda’s view of herself. Soon, she feared she would fail her other classes despite evidence to the contrary. Her life became a living hell as she started avoiding her other classes and started spending more and more time in her dorm room. Soon, her fears became a self-fulfilling prophecy since she could not do well if she didn’t go to class.


This is a typical story of how a small fear can blossom into a severe anxiety disorder. The lessons are:


  • Panic Attacks need immediate attention to stop them in their tracks.
  • One has to combat the fear rather than giving in to it.
  • Avoidance of feared activities makes panic attacks much worse.


Professionals can help people learn techniques to decrease anxiety and to combat it effectively. There are also medications that can help decrease one’s level of anxiety until management techniques are well ingrained. There are also some books that are very helpful. My personal favorite is The Anxiety and Phobia Workbook by Edmund Bourne.


Amanda’s story did have a happy ending. After telling her parents, she got the psychotherapy she needed to understand her panic attacks. She learned that her fear of failing is a common one among college freshman until they prove themselves in a new setting. She also learned breathing techniques that helped activate her parasympathetic nervous system so that she could return to a state of calm. Most of all, she learned not to avoid things that were scary. She got connected with the college’s disability services so that she could get help in the future if she had continuing problems.


by Cynthia Divino, Ph.D. 

*Amanda is not a real name but a compilation of a number of similar client histories.


What is Toxic Stress

October 6, 2014 | Comments Off on What is Toxic Stress | Uncategorized

baby-in-crib3We are sponsoring a free lecture on Toxic Stress on Thursday, October 16th.  Because this is such an important issue, I wanted to give you a little bit of information about what Toxic Stress is, how it differs from a normal stress response, and why it matters.

So, what is Toxic Stress?

Toxic Stress is defined as a strong, persistent activation of the body’s stress response. It happens as a result of a child being exposed to repeated or unrelenting threats (as seen from the infant or child’s point of view) in their environment which activates their fight, flight, or freeze response. Neglect, exposure to domestic violence, physical or sexual abuse are just a few of the situations which can trigger this bodily response. In the last newsletter we discussed how the stress response returns to normal as the parasympathetic nervous system kicks in.  Because of the constant or extremely threatening nature of the dangers in the environment, the child’s stress response does not return to normal but is permanently set on “high alert” mode.

While we have known that chronic or extreme stress can cause an abnormal stress response for some time, we have not had direct evidence about the deleterious impact of this type of stress response in infants and young children.  A group of scientists at the Harvard Center for Child Development, including psychiatrist Jack Schonkoff, were interested in studying the impact of this type of stress response in young children.  They coined the term, “Toxic Stress” and theorized that a protective environment buffers the impact of toxic stress.  They have been actively studying the phenomenon.  They have developed some ingenious methods of studying the impact of toxic stress on infants, toddlers, and preschool children through a study of children in orphanages or foster care settings in Bucharest, Romania.  They succeeded in constructing a situation where they could randomly assign children to a foster care setting (previously non-existent or extremely rare in Bucharest) or the orphanage (care-as-usual) setting.  They then studied children’s brain development (using various brain scanning techniques) and other outcomes after different periods of time in these settings.  The extent of brain differences in these children is truly stunning.

Here are just a few:

If child was taken out of the institution before 24 months of age there was a good chance of a child developing a secure attachment but after 24 months, the chance of developing a secure attachment fell below 30%. After 30 months it was just slightly over 20%

IQ scores are lower in children raised in the orphanage but the score rebounds if taken out of the institution before the age of 24 months

  • Less overall brain electrical activity brain (Marshall, P.J., Fox, N.A. 2004; DeBellis, M.D. 2005)
  • Differences in neural reactions to stimuli like facial expressions or understanding emotions EEG study  (Parker, S.W., Nelson, C.A., 2005)
  • MRI studies show less volume in PFC, hippocampus, medial temporal lobe, corpus callosum
  • Poorer connectivity between brain areas that integrate complex information (Eluvathingal, T , et. al 2006)
  • This results in Difficulties with learning
  • Difficulties with emotion regulation

So what is the good news?

We now have very specific information that it is the quality of the relationship between a child and their caregiver that builds brain growth.  We also know that a caring, responsive relationship in which a parent actively talks with their child and responds sensitively to a child’s cues is key to forming these strong neural networks that buffer toxic stress.


Interested in learning more? Here are some links and references:

National Scientific Council on the Developing Child. (2012). The Science of Neglect: The Persistent Absence of Responsive Care Disrupts the Developing Brain: Working Paper 12.

Center for Developing Child at Harvard University

Experience Builds the Brain

Serve and Return Interaction