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Nurse Linda Grabbe extends the gift of resiliency to the homeless, her peers and herself

Linda Grabbe, Nell Hodgson Woodruff School of Nursing - Emory University
Linda Grabbe, Nell Hodgson Woodruff School of Nursing - Emory University

Credit: Contributed

Credit: Contributed

Linda Grabbe is the type of nurse, and the type of person, who found something wonderful that works and won't rest until she's shared it with all in her sphere who could benefit. As a trainer and researcher, she's expanded the reach of a mental health strategy called the Community Resilience Model, blending it with Dialectical Behavior Therapy (DBT) Skills training for homeless youth in the Atlanta area. She also uses the healing properties of CRM in her work as a board-certified Family Nurse Practitioner, psychiatric/mental health nurse practitioner, and as a clinical assistant professor at Emory University's Nell Hodgson Woodruff School of Nursing.

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The basic CRM idea is this: "It explains trauma and human responses to trauma as autonomic nervous system events," says Grabbe, who earned a doctor of nursing in TK and has published studies of trauma response in publications like the Journal of the American Psychiatric Nurses Association. "The response can be understood through the lens of brain functions and the concept of the 'Resilient Zone' each person has."

As an example, Grabbe tells of encountering an acquaintance who had recently suffered two severe losses. "I acknowledged his grief but asked him a question that prompted him to go into a reverie about someone he loved and had recently lost," she remembers. "For the several minutes, as he talked he was beaming, relaxed, and expansive. It's at moments like that that people sense they can feel better again someday. Hope is awakened."

She herself may be one of the most visible success stories of CRM, employing its tactics to be able to continue her work in the high-burnout arena of homeless care and to cope with the rigors of academia. "I do all of the self-care essentials -- family, friends, fun, nature, exercise, healthy eating, at least most of the time," she explains. "But I also meditate and with the Community Resiliency Model, I actually listen to my body carefully. Every time I 'sense-in' and notice body sensations, I am expanding my 'Resiliency Zone.'"

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Grabbe is no stranger to PTSD, first displaying the symptoms in her years as an ICU nurse. Part of the work she lives for, providing mental and primary care to Atlanta's homeless population for the past 20 years, makes her as vulnerable as they are. "My PTSD came from the painful things they recounted," she says. "I think most had never told anyone about their trauma, and when a nurse listens in an accepting way, the patient is validated as a human being in a way they may never have experienced."

She could not, would not, give up this important work, which she began as a volunteer at Community Advanced Practice Nurses fresh out of the Emory FNP program. This clinic operates from homeless shelters, with satellites throughout Atlanta.

And it was almost as if she had no choice but to lend her services, and her ears. "I found the women, children, and young adults compelling and never looked back," Grabbe recalls. "We could provide holistic, humanistic care and treat our patients with a respectfulness that they deserve. I had excellent mentorship from Connie Buchanan, the clinic director. She taught me to be trauma-informed before the term existed. We knew about the ubiquity of childhood trauma before the Adverse Childhood Experiences study connected the dots."

The clinic patients have opened her eyes, too, says Grabbe. "What I have seen is that people are eager to understand why they might engage in unhealthy, self-destructive behaviors, and willing to try to use their own bodies to promote their well-being and resilience."

Grabbe earned her doctor of Family and Community Nursing from Georgia State University in 1992, and part of her life’s work since then has always involved demystifying neurobiology concepts so that ordinary people can employ them in an everyday fashion. "Neurobiology informs the Community Resiliency Model, which many of us teach at Emory School of Nursing," she explains. "Deep brain imaging is unlocking secrets which explain many of our stress and trauma responses, and I expect will unveil some of the mechanisms of psychiatric disorders. If we understand how stress affects us, we can begin to be truly self-compassionate, which translates then into compassion for others."

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Nurses are prime candidates to reap the benefits of resiliency models, for themselves and their patients, Grabbe insists. "We can use our own biology to prevent burnout so we can stay in the profession we chose, but we need health care organizations to do their part to create compassionate working environments -- systemic empathy. In addition, if nurses teach resiliency skills to our patients, there will be improved outcomes. Someone needs to do that research, but it makes intuitive sense."

Grabbe would like to see research like hers institutionalized in nursing education, to have nurses become agents of change as the paradigm shifts to body-based approaches to healing from trauma and coping with stress. "Nursing students all need education on ACEs (Adverse Childhood Experiences)," she says. "When they have that knowledge, many are galvanized to commit to working to undo the harms of family and community trauma that over 80% of us experience before adulthood."

Lest her life sound entirely earnest and a little bleak, Grabbe is quick to point out that she finds lighthearted joy, too, especially with her husband Terry. "He makes me laugh," she says simply.

Like his wife, Terry has causes he's passionate about, including social justice and health care for all. "He was hospitalized in Ireland for a syncopal episode and received a bill for $230 for an ambulance, ER, hospitalization, a brain scan, and excellent medical care," Grabbe shares.

For her part, Grabbe looks out for her fellow nurses and promotes nurse wellness, including current ongoing research on how CRM impacts burnout and secondary traumatic stress in nurses and first responders. Even without formal training in CRM, she urges nurses to "start paying attention to body sensations. Learn to notice sensations of distress, localize and maybe describe it (if you name it, you can tame it!). When you notice body sensations that are pleasant or neutral, lean in to them and experience them fully. If you localize and characterize these body-based sensations and hang in there for about 15 seconds, you are creating resilient neuro-circuitry in your brain."

She says she will continue to teach CRM where she can. "Teaching CRM is like giving a gift," she says. "I see incarcerated or homeless teens learn to track their internal sensations of well-being. And I see them develop a CRM 'resource,' for example, a memory that brings a sense of calm and safety. They are basically producing their own 'best medicine.' I've also been witness to the magic nursing students have made when they teach CRM to psychiatric or substance use disorder patients."

From patients to fellow nurses to students to her family members, Grabbe has the same message for all who have experienced trauma. "It is never too late to heal," she says. "My heartbreak is that the most traumatized members of our society are the least likely to get therapy and mental health care."