Communication Coaching

             for Better Healthcare

The META Toolkit™

A Self-Care Program for Simulators Who Portray Characters-in-Crisis
© 2017 PRN Consulting 


Healthcare providers need opportunities to practice skillful communication with people who are experiencing physical or emotional trauma. Practice is most effective if done with simulators who are skilled in portraying intense states of grief, fear, anger, pain, etc.  Simulators who portray these cases for extended periods often report emotional and physical effects lasting beyond the portrayal.

PRN Consulting trains Simulators to work with physicians and other providers on high-emotion cases including end of life conversations, domestic violence, workplace confrontations, law enforcement enactments, medical crisis simulations, psychiatric cases, etc. PRN Consulting is committed to providing support for Simulators, to help them manage the effects of traumatic portrayal.

Based on the work of specialists in neuroscience and trauma, PRN developed a process for this purpose called the META Toolkit™ (Managing Effects of Traumatic Activity.)  We define traumatic activity as voluntary engagement of mind and body in disturbing or distressing experiences, an occupational risk associated with Professional Simulators, First Responders and Trauma Care Providers.

The META Toolkit™ is a system of self-care designed to be learned in an interactive workshop and customized by each person for personal use after traumatic activity.  PRN Consulting has presented workshops on the META Toolkit™ for Trauma Nurses, Physician Coaches, Standardized Patients, Law Enforcement and other Professional Simulators.


The META Toolkit™ is taught in a workshop setting, where participants discuss personal experiences in traumatic activity, and explore how each element of the toolkit can best be adapted for their use.  We practice elements of the META Toolkit™ together, and each person then creates their own ‘customized toolkit’.

Thereafter, we encourage participants to use their personal toolkit immediately following each day’s work with traumatic activity.  If they become aware of the need for additional support, we encourage them to take advantage of resources such as literature on managing trauma and professional counseling.

Participants who’ve been trained to work with the META Toolkit™ report increased awareness of the effects of traumatic portrayal, decreased anxiety after using their personal toolkit, and deeper appreciation for the support of their peers in managing the effects that can come with this important and challenging work.


Preparing and portraying a case that involves intense distress can take a physical and emotional toll.  Research suggests that the sympathetic nervous system (responsible for the “fight or flight” response) can undergo similar responses whether a person is experiencing trauma or simulating trauma for an extended time.  Similarly, the parasympathetic nervous system (responsible for the “rest and digest” response) can be engaged through deliberate actions following traumatic portrayal.

Acting has been defined as “The ability to live truthfully under imaginary circumstances.” Simulators devote time and attention to preparing a case by focusing both on clinical facts and on the mental state of a character in distress.  We believe there is benefit in the process of deliberately disengaging from traumatic activity as thoughtfully as one prepares for it.

With this in mind, we recommend creating a process that Simulators replicate thoughtfully after each day’s work with traumatic portrayal.  This process should be undertaken in a private place, such as a quiet room (even a bathroom) or a car.  It can take as little as 5 minutes, or as long as you have time to devote to any element.  We believe it is time well spent.

Our workshop explores exercises designed to thoughtfully disengage from traumatic activity, and gain closure around the experience.  After learning the principles associated with each group of exercises, participants create a toolkit that’s customized for their needs.  Many report that the toolkit is useful in disengaging from a variety of stressful situations beyond traumatic portrayals.

The META Toolkit™ is licensed under Creative Commons for attribution and non-commercial use.  PRN Consulting offers workshops, webinars and free consultation services to organizations that want to develop their own Standardized Patient support programs.

© 2017 PRN Consulting                                                               META Toolkit™ Workshop                                              


1. Bessel van der Kolk, M.D.  (2014) The Body Keeps The Score:  Brain, Mind and Body in the Healing of Trauma.  New York, NY: Penguin

2. Fitzgibbon, Bernadette M., Jaime Ward, and Peter G. Enticott  (2014) The neural underpinnings of vicarious experience.  Frontiers in Human Neuroscience  8:384. doi: 10.3389/fnhum.2014.00384

3. Goldstein, Thalia R (2009) Psychological perspectives on acting. Psychology of Aesthetics, Creativity and the Arts Vol. 3, No. 1, 6-9  American Psychological Association  DOI: 10.1037/a0014644

4. Ohikuare, Judith (2014)  How Actors Create Emotions: A Problematic Psychology. The Atlantic, March 10, 2014

5. Bloom, Paul, Goldstein, Thalia R.  (2011) The mind on stage:  Why cognitive scientists should study acting. Trends in Cognitive Sciences, April 2011, Vol 15, No. 4

6. Meisner, S. and Longwell, D (1987). On Acting.  Vintage Books

7. Thomson, P., Jaque, S.V. (2012).  Holding a mirror up to nature:  Psychological vulnerability in actors.  Psychology of Aesthetics, Creativity and the Arts doi: 10.1037/a0028911

8. Konijn, Elly A. Translated by Barbara Leach with David Chambers (2000) Acting Emotions : Shaping Emotions On Stage Amsterdam University Press  Original title: Acteren en Emoties (Amsterdam/Meppel, Boom, 1997)

9. Kansas State University (2014) How de-roling may help actors shed intense roles.  ScienceDaily.  ScienceDaily, 5 June, 2014

10. Maxwell, Seton and Szabo (2013) The Australian Actors’ Wellbeing Study:  A Preliminary Report.  Equity Foundation, University of Sydney

11. Batson, C.Daniel., Fultz, J., Schoenrade, Patricia A. (1984) Distress and empathy:  two qualitatively distinct vicarious emotions with different motivational consequences. Symposium on the Construct and Assessment of Empathy, American Psychological Association Convention, Toronto, Canada, August 1984

12. Davis, Mark; Conklin, Laura; Smith, Amy (1996) Effect of perspective taking on the cognitive representation of persons: A merging of self and other.  Journal of Personality and Social Psychology Vol. 70, No 4 713-726

13. Levine, Peter A. (2008).  Healing Trauma.  Boulder, Colorado: Sounds True

14. Marco L. Loggia, Mogil, Jeffrey S., Bushnell, M. Catherine (2007) Empathy hurts:  Compassion for another increases both sensory and affective components of pain perception.  International Association for the Study of Pain.  doi:10.1016/j.pain.2007.07.017

15. Meyer, Meghan L., Masten, Carrie L., Ma, Yina, Wang, Chenbo, Shi, Zhenhao, Eisenberger, Naomi I.  Han, Shihui (2013) Empathy for the social suffering of friends and strangers recruits distinct patterns of brain activation.  Social Cognitive and Affective Neuroscience. 2013 Apr; 8(4): 446-454  Oxford University Press

16. Sherin, Jonathan E., Nemeroff, Charles B.  (2011) Post traumatic stress disorder:  the neurobiological impact of psychological trauma. Dialogues in Clinical Neuroscience 2011 Sep; 13(3); 263-278

17. Metcalfe, Janet, Schwartz, Bennett L.  (2016)  Ghost in the machine:  Self-reflective consciousness and the neuroscience of metagognition.  Oxford Handbook of Metamemory, Oxford University Press

18. Davis, Mark H.; Conklin, Laura; Smith, Amy; Luce, Carol (1996) Effect on Perspective Taking on the Cognitive Representation of Persons:  A Merging of Self and Other.  Journal of Personality and Social Psychology 1996, Vol. 70, No.4, 713-726 American Psychological Association, Inc.

19. Modinos, Gemma; Ormel, Johan; Aleman, Andre (2009) Activation of Anterior Insula during Self-Reflection.  Public Library of Science 4(2): e4618. Doi 10.1371/journal pone.0004618

20. Martarelli, Daniele; Cocchioni, Mario; Scuri, Stefania; Pompei, Pierluigi (2011) Diaphragmatic breathing reduces exercise induced oxidative stress.  Evidence-Based Complementary and Alternative Medicine, doi:10.1093/ecam/nep169

21. Goldfried & Davison, Cleveland Clinic Wellness (1997) Diaphragmatic Breathing in Clinical Behavior Therapy. Cleveland Clinic Wellness Program

22. Billman, G.E. (2011) Heart rate variability - a historical perspective. Frontiers in Physiology. 2011;2:86.

23. Hansen AL, Johnsen BH, Sollers JJ, 3rd, Stenvik K, et al. Heart rate variability and its relation to prefrontal cognitive function: the effects of training and detraining. European journal of applied physiology. 2004;93(3):263-72.

24. Payne, Peter; Levine, Peter A.; Crane-Godreau, Mardi A. (2015) Somatic experiencing: using interoception and proprioception as core elements of trauma therapy.  Frontiers in Psychology 2015; 6:93.  Doi:10:3389/fpsyg.2015.00093

25. Varela, Reynold P. (2014) Emotional healing through induced therapeutic crying.  International Journal of Social Science and Humanities Research Vol.2, Issue 4, 10-17

26. Schwarzer, Ralf; Knoll, Nina (2003) Positive coping:  Mastering demands and searching for meaning.  Positive psychological assessment:  A handbook of models and measures (393-409)  American Psychological Association doi:  10.1037/10612-025

27. Ozbay, Faith; Johnson, Douglas C.; Dimoulas, Eleni; Morgan, C.A.; Charney, Dennis, Southwick, Steven (2007) Social Support and Resilience to Stress.  Psychiatry, 2007 May; 4(5): 35-40

28. Kalyani, Bangalore G.; Venkatasubramanian, Ganesan; Arasappa, Rashmi; Rao, Naren P.; (2011) Neurohemodynamic correlates of “OM” chanting:  A pilot functional magnetic resonance imaging study.  National Center for Biotechnology Information, International Journal of Yoga 2011 Jan-Jun; 4(1) 3-6 doi 10.4103/0973-6131.78171

29. Ellis, Robert J.; Thayer, Julian F. (2010) Music and Autonomic Nervous System (Dys)function.  Music Perception 2010 Apr; 27(4): 317-326 doi: 10.1525/mp.2010.27.4.317

30. Sakuragi, Sokichi; Sugiyama, Yoshiki; Takeuchi, Kiyomi (2002) Effects of laughing and weeping on mood and heart rate variability.  Journal of Physiological Anthropology and Applied Human Science 21(3):159-65

31. Norton, Michael I., and Francesca Gino. (2014) "Rituals Alleviate Grieving for Loved Ones, Lovers, and Lotteries." Journal of Experimental Psychology 2014 Feb;143(1):266-72. doi: 10.1037/a0031772

© 2017 PRN Consulting                                                               META Toolkit™ Workshop