Measuring Fear:Measuring Fear:
Strategies for Gauging School Climate and 
Implementing Mental Health Recovery 

Presenters:
Richard van den Pol, Ph.D.Richard van den Pol, Ph.D.
Director  Division of Educational Research and Service (DERS)

Matthew Taylor, M.A.
Associate Director  DERS

Aaron Morsette, M.A.
Trauma Intervention Specialist 
Montana Center for the Investigation and Treatment of Childhood Trauma 

This presentation is supported, in part, by the Montana Safe Schools 
Project and the Montana Center for the Investigation and Treatment of 
Childhood Trauma, both at the Division of Educational Research and 
Service at The University of Montana. These projects are funded by a 
U.S. Department of Justice Grant at the Community Oriented Policing 
Services Office (Grant # 2004CKWX0377), and through the U.S. Substance 
Abuse and Mental Health Services Administration (SAMHSA) and its National 
Childhood Traumatic Stress Initiative. However, no official university 
or federal endorsement should be inferred. 



Division of Educational Research and Service
Strengthening Schools and Communities Since 1957 


The Division of Educational Research and Service at the 
University of Montana (www.dersum.org) 

.Partnerships with: 
. National Childhood Traumatic Stress Network 
. SAMHSA, OSDFS, ACA, Department of Justice and others 

.Topic Areas: 
. School & Community Safety 
. Mental Health 
. Technology Integration 
. Early Intervention 


Presentation Agenda 

International Perspectives: Efforts to manage school and community fear 

.Historical overview of traumatic stress research  defining fear 
. Physiological correlates 

.Warning signs for school counselors 

.Emergency management cycle and relation to traumatic stress in schools 
. Prevention/Mitigation strategies for schools 
. Strategies for measuring fear - Safe Schools Assessment and Resource Bank (SSARB) 
. Preparedness / Response stages overviewed 
. Recovery stage overview -Psychological first aid summary 

.School based interventions for mental health recovery 
. Overcoming the challenges of serving need of diverse clients in rural settings 
. Cultural Differences Influencing Trauma Treatment in Native American Populations 
. Cognitive Behavioral Intervention for Trauma in Schools (CBITS) 

.Questions 


Multi-national Perspectives 

. The SSARB survey confirms other findings that bullying is the #1
threat to health, a source of fear, and a barrier to school success. 

. Bullying is considered a public health threat in Canada: 

. 41% of students reported being involved in social bullying. 

. 32% of students reported being involved in physical bullying. 

. 18% reported they had called other students racist names. 

. 16% reported unwanted touching, in a sexual way. 

. 13% reported being victims of electronic bullying and/or electronic bullying others. 

. 10% reported being victimized by homophobic harassment. 

. Time frame: monthly 


Defining and Measuring FearDefining and Measuring Fear

. We all have experienced fear.We all have experienced fear.
. We have a range of fear responses, both withinWe have a range 
of fear responses, both within our self and between our self and others.
. Temperament (a tendency to activate or not) helps to explain the range 
of emotion, but does not define the nature of what fear is. 


Historical overview of traumatic stress research: 
Toward a definition of fear 

. Germinal research in defining human emotion examined fear using 
clinical, epidemiological, experimental, and technological methodologies. 

. Pioneering work of Stanley Schachter and Phil Zimbardo created current foundation. 


Historical overview of traumatic stress research: 
Toward a definition of fear 

. Schacter used experimental methods to induce activation through IM 
injections of epinephrine. 

. Participants were told a lie about the research and placed in waiting rooms. 

. Environmental events were contrived to produce anger, levity and anxiety. 


Historical overview of traumatic stress research: 
Toward a definition of fear 

. Participants endorsed verbally that they variously reported being mad, 
finding situations funny, and feeling fearful. 


Historical overview of traumatic stress research: 
Toward a definition of fear 
. Zimbardo induced anxiety via post-hypnotic orders.

. Subjects would feel strong fear when his phone light 
illuminated during the post interview.

. Subjects self-rated fear intensity and reported reductions 
once they hypothesized the cause. 


Historical overview of traumatic stress research:
Toward a definition of fear

. Schachter also worked with polygraph equipment (lie detectors) to 
biologically define human emotional states, whether created experimentally or naturally. 

. He concluded that we can confidently determine level of activation with 
technology, but that human physiology does not differentiate by emotion type 
at a level detectable by technology. 


Historical overview of traumatic stress research: 
Toward a definition of fear 

. Schachter and Zimbardo provided numerous contributions to our 
understanding of the nature of human fear: 

. Intero-receptive behaviors reflect activation: HR, BP, GSR, gastric 
motility, pupillary dilation, EEG, respiration rate, blood chemistry, etc. 

. Activation is largely undifferentiated by emotional state whether 
produced exogenously or endogenously. 

. Other contributions of these researchers. 


Physiological reactions to traumatic stress

. The last 100 years, psychologists have offered a variety of
definitions, each focussing on different manifestations or components 
of the emotion. As there seems to be no empirical solution to the debate 
on which component is sufficient or necessary to define emotions, at present 
the most favouredsolutions is to say that emotions are best treated as a
multifaceted phenomenon consisting of the following components: behavioural 
reactions (e.g. approaching), expressivereactions (e.g. smiling), physiological 
reactions (e.g. heartpounding), and subjective feelings (e.g. feeling amused). 
Each instrument that is claimed to measure emotions in fact measures 
one of these components. 

. P.M.A. Desmet (in press) Measuring Emotions Delft University of 
Technology; Department of Industrial Design 


Historical overview of traumatic stress research: 
Toward a definition of fear 

. Biologically, psychologically and medically, our best efforts to measure 
fear depend on the individuals verbal description of what the emotion is. 

. Verbal report is the essence of formal assessment, counselor interview, 
and system wide assessment (SSARB, YRBS, CPHA). 


A footnote to Schacter and Zimbardo* 
Vicarious trauma & Caring for the caregiver 

. Humans cannot easily perceive  or control - those phenomena measured by lie detectors. 

. Blood pressure is the best known example of medical significance  the silent killer. 

. Other killers exist, and all are exacerbated by temperament, family history and job stress. 


Fear, Anxiety and Traumatic Stress 
. While fear has a physiological component we only can confirm empirically the amount of
activation, and we cannot differentiate types of activation, and we cannot differentiate 
types of activation: We must rely on verbal report activation: We must rely on verbal report
through interviews, formal assessment tools, and through interviews, formal assessment tools, 
and less formal methods.less formal methods.


Fear, Anxiety and Traumatic Stress 
. We propose a hierarchy of mild fear (anxiety),significant fear 
(feeling really afraid) and debilitating fear (traumatic stress).

. While chronic fear may induce life threatening disease, traumatic 
stress per se may produce increased morbidity and mortality. 


Fear, Anxiety and Traumatic Stress 
. Historically traumatic stress and post traumatic stress disorder (PTSD)
symptoms were stress disorder (PTSD) symptoms were presumed to be exclusively adult phenomena.

. We now know trauma and PTSD present in children, manifest somewhat differently than
adult counterparts, and are readily treatable. 


Fear, Anxiety and Traumatic Stress 
. That which does not kill us makes us stronger.
- Friedrich Nietzsche, c. 1860- Friedrich Nietzsche, c. 1860

. but, sometimes we do, in fact die, and sometimes that makes us 
weaker via traumatic stress/PTSD

. Science does not yet let us predict who will be sensitized and who will be inoculated. 


Fear, Anxiety and Traumatic Stress 
..Traditionally, psychological trauma was defined as a near death experience where
the individual believed they were about to die.

. We now understand that trauma is a kind of disabling fear resulting from many 
etiologies including near death, vicarious exposure, bereavement, medical procedures,
war, terrorism, and intergenerational influences. 


National Child Traumatic Stress Network (www.nctsn.org)
. 25 % of children experience a traumatic event by age 16

. Many develop childhood symptoms of PTSD or Childhood Traumatic Stress (CTS)

. Incidence estimates range up to 22% 


National Child Traumatic Stress Network (www.nctsn.org) 

We live with dangers every day. They can become 
traumatic when they threaten serious injury or death or 
when they include physical or sexual violation. The 
witnessing of violence, serious injury, or grotesque 
death can be equally traumatic. 

Developmental implications (Stolle, 2004): 
. the world is not safe, 
. my parents cannot keep me safe, and 
. bad things will happen to me again. 


National Child Traumatic Stress Network (www.nctsn.org)
.Child Traumatic Stress  3 main features:
. 1 Re-experiencing via intrusive thoughts, dreams
. 2 Avoidance of school, community, & life
. 3 Chronic activation (per Schachter) leading to leading to symptoms 
like headache, stomachache, insomnia and long term morbidity
. the implications for school and life success are significant and multi-dimensional 


Foregoing help can have long-lasting consequences,
and fortunately, entering treatment can have concrete
beneficial results. (NCTSN, no date)

. Teaching children stress management and relaxation skills 

. Creating a coherent narrative or story of what happened 

. Correcting distorted ideas about what happened and why 

. Changing unhealthy views that have resulted from the trauma 

. Involving parents in creating optimal recovery environments 


Emergency Management Cycle

Decrease the need 
for response 

Plan for a rapid, coordinated, 
effective response 

Restore the learning 
environment; Monitor
and assist the healing  

Execute the plan 


Mitigation and Prevention
.Connect with county emergency management and first 
responders to identify local hazards. 

.Assess physical hazards of school environment. 

.Collect data on the safety perceptions of students, staff, and 
parents. 

.Implement prevention programs: substance abuse, bullying, 
suicide, positive behavioral supports etc. 

. Collect incident report data from SROs, SEAs, YRBS etc., 

 its about the process, more than its about the plan 


Measuring fear as a prevention strategy 

. Safety is key to learning. 

. School safety is a NCLB priority and a priority of every Ministry of 
Education in Canada. 

. Most provinces require school climate assessments. 

. Aggression in young children is rising. 

. Most school violence is hidden. 

. Perceptions are measurable and can drive program initiatives. 

. Recovery begins with student and teacher perceptions of renewed 
security. 


Measuring fear as a prevention strategy
.Incident data only goes so far.
.Experiencing trauma affects students
. Ability to learn
. Ability to make friends, social skills
. Behavior in classroom
.Behaviors may be similar to ADHD.
.Careful consideration of intrusive questions.
.Helps keep the hardening of the school in check while other prevention/mitigation steps are taken.


Safe Schools Assessment and Resource Bank (SSARB) 

.Based on 32 key factors of school safety which statistically group to create 
the following major areas of focus: 

. Community Involvement 

. Discipline 

. Perceptions of Safety 

. School Services 

. Staff Preparedness 

. Violence and Victimization 


Features of SSARB 

. A proactive, cost effective tool to assess student, staff, and parent perceptions on school safety 

. Helps schools make informed decisions about important safety improvements over time 

. Ability to add custom questions to better fit individual school needs 

. Online access makes it quick to administer and results are accessible immediately 

. Reports and charts display results by gender, school, district, state, and respondent groups 

. Research-based questions and resources as well as connections with school safety and mental health experts. 

. For more information visit www.ssarb.com or www.dersum.org 


SSARB exampleSSARB example

Image of SSARB questionnaire


Graphical results
Image of scores and bar graph


Preparedness & Response Stages 

.Preparedness : .plan for the consequences, not for the crisis 
. Identify all stakeholders. 
. Gather information about the school facility, such as maps and the
location of utility shutoffs.
. Develop Incident Command System (ICS) and procedures for
communications.
. Practice, practice, practice.

.Response : .manage the crisis, dont let the crisis manage you 
. Determine if a crisis is occurring. 
. Initiate the appropriate emergency procedure. 
. Activate the ICS and be prepared to hand off control of certain aspects of
an crisis when emergency response agencies come on scene. 
. Maintain communications and initiate parent-child reunification plan. 
. Keep records of decisions and secure school data --and dont forget to 
secure the crime scene. 


Recovery Stage 

. Recovery involves medical, psychological, infrastructure, legal,
insurance, and documentation issues 

. Strive to return to teaching and learning as quickly as possible 
but understand what type of learning is going on and dont rush this critical process 

. Conduct after action reviews with staff and first responders 

. Recovery will not happen quickly 

. Psychological First Aid 

. System of follow up (mid & long term) 


Psychological First Aid 

.Psychological First Aid (PFA) is an evidence-informed modular 
approach for assisting children, adolescents, adults, and families 
in the immediate aftermath of disaster and terrorism. 

.Designed to:
. reduce the initial distress
. foster short- and long-term adaptive functioning.

.PFA meets four basic standards 

.consistent with research evidence on risk and resilience following 
trauma;

.Applicable & practical in field settings;

.Developmentally appropriate across the lifespan; and

.culturally informed and adaptable.

PFA information citation: 
Brymer, M., Lane, C., Pynoos, R., Ruzek, J., Steinberg, A., Vernberg, E., 
and Watson, P. (2005): Psychological First Aid: Field 
Operations Guide. National Child Traumatic Stress Network and National Center for PTSD. 


Psychological First Aid Strategies in School Settings 

.Immediate Steps for Emotional Triage and PFA 

. Ensure safety and comfort 

. Stabilization 

. Information gathering: current needs, concerns, history 

. Practical assistance (immediate needs, action plan, sense of control) 

. Connection with social supports 

. Education / normal range of emotions and physiological 
reactions . Linkages with collaborative services & client/guardians 


Psychological First Aid Strategies in School Settings 

.Pre-School 
. Allow expression, reassure adult control 

. Clarification that the danger is past (tv/radio) 

. Use social stories, dont minimize but also dont encourage magical thinking 

.School age 

. Productively channel feelings of responsibility, fear of reoccurrence, and retelling 

. Clarify somatic complaints 

. Monitor tendencies to minimize - when intended to protect adults and friends. 

.High School age 

. Excessive self blame 

. Acting out behavior  particularly when oriented to regaining control 

. Awareness of tendencies toward emotional detachment 

.Post PFA 

. School base mental health response team focus on classifying students by: 

. Emotional and physical proximity 

. Vulnerabilities 

. PTSD awareness training / information sharing with teachers, coaches etc,. 

. Detailing mid and long term follow up plans / responsibilities 


Overcoming Challenges of serving the mental health needs 
of diverse populations in rural settings 

.Rural areas (Stamm, 2003). 

. 20% of U.S population, 

. Adverse weather, 

. Distances, 

. Lack of Services, and 

. Stigmas. 

.Prevalence of PTSD 

. 8% of general population (APA, 2000). 

. 6.3-22% of adolescent populations. 


PTSD Prevalence (Robin, Chester,PTSD Prevalence (Robin, Chester,
Jaranson, & Goldman, 1997)Jaranson, & Goldman, 1997)

Trauma Exposure & PTSD Prevalence in a Southwestern 
American Indian Community 
N =247
Scale 0-100 

Trauma Exposure 80

PTSD Lifetime Prevalence 20

Men Point Prevalence less than 20

Women Point Prevalence less than 20
 

Trauma Exposure in Native Populations

.Alcohol abuse and dependence may also be related to trauma 
(N=1660, 7 reservations; Koss,2003).

. 86% abused and neglected as children.

. 9% of men and 5% of women met criteria for alcohol abuse.

. 30% of men and 18% of women met criteria for alcohol dependency. 

. Study did not assess PTSD symptomatology. 


Historical Trauma

.Historical trauma and historical unresolved grief
(Yellow Horse Brave Heart & DeBruyn, 1998).
. Genocide;
. Boarding school era;
. Assimilation policies; and

.Relocation programs. 


Cultural Differences Influencing Trauma Treatment in Native American Populations

.Rural areas
.Cultural dissimilarities
. Approaches to treatment
. Family composition
. Perceptions of elders
. Social norms
. Systemic distrust

.Provide culturally responsive services
. Integrate culture into therapy (De CoteauCoteau & Hope, 2003; Sue & Sue, 1990).
. Garrett (1994) suggests counselors:
.  Do not interject 
.  Exhibit patience 
.  Allow for silence 
.  Utilize descriptive statements 
.  Use anecdotes and metaphors for self-disclosure 


Cognitive Behavioral Intervention for Trauma In Schools (CBITS) 

.Cognitive Behavioral Intervention for Trauma in Schools 
(CBITS; Stein et al., 2003) 

. CBITS incorporates aspects of CBT. 

. 10 week treatment protocol. 

. Treats secondary-aged children. 

. Standardized on an immigrant population in the Los Angeles Unified 
School Districts (LAUSD) 

.Research indicated: 
. 86% of children exhibited significant decreases in PTSD symptomatology. 
. 67% of children exhibited significant decreases in depressive symptomatology. 

For more information see: Stein, B.D., Jaycox, L.H., Kataoka, S.H., Wong, M., 
Tu, W., Eliot, M.N., & Fink, A. (2003). A mental health intervention for school 
children exposed to violence: A randomized controlled trial. Journal of the 
American Medical Association, 290(5), 603-611.


CBITS Overview
.Ten Week Group Intervention
. Introductions
. Education & Relaxation
. Introduction to Cognitive Therapy
. Combating Negative Thoughts
. Introduction to Real Life Exposure
. Exposure to Stress or Trauma Memory (Two weeks)*
. Introduction to Social Problem Solving 
. Practice with Social Problem Solving 
. Relapse Prevention and Graduation 


CBITS results  Montana Center for the Investigation and Treatment of Childhood Trauma 

.Screening data (48 students) 
. LES 1-19,
. M = 6.85 
. CPSS 0-19, 
. M = 6.33 

.Group Analysis 
. LES 3-14, 
. M = 6.85 
. CPSS 5-18, 
. M = 8.57 


CBITS results  Montana Center for the Investigation and Treatment of Childhood Trauma 

.Group Analysis
. LES, 0-19, 
. M = 6.57 
. CPSS, 2-15, 
. M = 8.43 
. CDI, 2-23, 
. M = 14.29 

.Group Analysis 
. LES, 0-4, 
. M = 1.5 
. CPSS, 2-5, 
. M = 3.5 
. CDI, 0-11, 
. M = 4.5 


CBITS results  Montana Center for the Investigation and Treatment of Childhood Trauma

Image of Group Means chart 


CBITS results  Montana Center for the Investigation and Treatment of Childhood Trauma

Image of Treatment Completers chart


CBITS in the school setting

.CBITS effective method of treatment addressing PTSD and depressive symptoms in the schools
(Stein et al., 2003, JAMA).

.Control group did improve  but slowly.

.Treatment group improved rapidly.Treatment group improved rapidly.

. When treated, control group also improvedrapidly. 

. Sustainable.