Monday, February 6, 2017

Trauma and Recovery

Maureen Mason MS PT, WCS, CCI, PYT

Self check:
Are you suffering from trauma? Trauma can be experienced from verbal, physical, or sexual abuse. We often think of trauma from sudden experiences like falls, car accidents, fights, or other dramatic events. Infants may be traumatized by difficulties at childbirth. Women may experience trauma with childbirth and unexpected difficulties with bodily changes, and loss of function. Military service is recognized as inherently life and safety–stressing, so as to have the effects linger after exposure to conflict, as in “post traumatic stress disorder (PTSD). First responders such as police, paramedic and firefighters may experience trauma in the line of duty, which may entail life threatening situations, or exposure to social conflict and crime.

Trauma may slowly occur with exposure to suffering for an extended time, such as hospice workers, or parents caretaking disabled children, or being a caretaker for someone in chronic poor health. Medical professionals often suffer from “vicarious trauma” as they are exposed to patient populations that are challenging, and they may take on the concerns and suffering of clients. There is an institutional as well as financial challenge medical staff face whether to be a medical problem solver, providing a treatment, or intervention vs. simply “being” present with clients, and in some scenarios MD’s only have 7 minutes scheduled per patient. This may be associated with medial provider “burn out” or “compassion fatigue” and you may unfortunately have experienced a medical provider interaction where the professional seemed dis interested, uncaring, or even dismissive.

Emotional loss as in broken relationships, and losing a loved one in death, are also significant traumas to the heart and soul, and there are physical stress reactions to emotional trauma. In looking at all these sources of trauma, most people have some elements of trauma exposure, and bounce back, whereas others may develop poor health from the trauma.

Our primal body:
Our brains are programmed for survival, and safety seeking, so we have primal mechanisms that help us to react to dangers, to threats to our safety and well being. This is the sympathetic nervous system, our protector. In response to a stressor, either physical or mental, the heart rate speeds up, blood pressure rises, and we become on alert for danger and threats. But with sympathetic nervous over-activation from prolonged or intense trauma, we may be stuck in the primal reactions once danger has passed, in physiologic processes involving the entire system. Initially termed the “fight or flight response”, we now recognize we may “freeze” to protect ourselves. We may state, “I’m ok” while holding rigid and breathing shallowly. Also we may be stuck in excess activity to soothe the body such as compelling interest in fornication, and or feeding. Drug and alcohol addictions are frequently developed in individuals seeking self calming, soothing, and escape from the monster of chronic unresolved stress. Consider if you have signs of unresolved trauma in your life. Chronic anxiety, depression, anger, sleep difficulties, and other mood imbalances are increased in individuals that have experienced significant trauma. Chronic pain is often associated with a history of trauma, and unresolved pain is on ongoing health challenge.

There is a protective nature of the stress response, to get out away from danger, or to fight to survive, or hide so as to be unseen (freezing), yet when it is constantly turned on, it is not adaptive, it is interfering with health, homeostasis, self -care, connection, and enjoyment of life, of work and play. Cortisol levels gradually rise, sleep difficulties worsen, blood sugar may be elevated, and inflammation increases in the body in a chronic stress response. Several practices can help reboot and recharge the body towards a calm, more contented state, with improvement in health and well -being. Consider trauma self care as essential as plugging in a battery that is blinking amber, or red.

Trauma Recovery Toolkits:
Trauma recovery is a process that is multidisciplinary and it can have profound improvement in an individual’s sense of wellness, health, and well -being. Trauma recovery starts with an individual, and often-social groups, such as the military health system care system, recognizing the presence of unresolved trauma. Trauma recovery entails a plan, a daily practice, a guide, or coach, or therapist, and the encouragement towards hope and resiliency. The best results are produced with a caring practitioner, and social support system. Successful programs may include mindfulness/meditation, walking meditation, yoga, exercise and massage therapy, sound/color therapy, acupuncture, aromatherapy, hypnosis, individual/group-cognitive behavioral therapy, and nutritional approaches. At CTS we have therapists that can provide mind-body spirit care with Medical Yoga, Pilates, and training in breathing exercises, and direction to healing resources such as sleep hygiene, stress management and trauma resolution. Also locally in San Diego, veterans may participate in horseback riding, kayaking, and other activities such as pet care and training. With current overloads in our veterans health care system, some are offered only pharmaceutical approaches.

According to Dr. Bart Billings, in his text “Invisible scars”, which focuses on military recovery post trauma, pharmaceutical interventions have increased 700% from 2005 to 2011, with a concomitant increase in suicide rates. Many medications for depression have a black box warning regarding suicide risks. In times before the Vietnam War, military service personnel had extended time on leave with their troops following active engagement, allowing for team caring and communication and mental and physical refreshment. Veterans stayed with their comrades and had rest and recuperation following exposure to conflict. Current practice is for many veterans to be sent home solo, with no decompression time, and then given a disability rating for PTS (D). Our veterans need encouragement for as much relational support as possible, as well as the establishment of a plan and adherence to a recovery toolkit.

Trauma Sensitive Yoga Therapy (TSY) has been developed by psychologists to help recover mind, body and spirit, for survivors of trauma. TSY, according to the author David Emerson, places the client in the driver’s seat to assume comfortable seated yoga postures. Participants are guided towards noticing breath, and sensations in a variety of modified yoga poses, and this allows a sense of control and empowerment for the client. TSY allows clients to get back into their body, in a non- judging, accepting, loving manner. And in the text Yoga Therapy, (Horovitz, Elgelid) the authors note that certain people have a positive engagement, and sense of release and recovery, from the vigorous, repetitive practice of Bikram Yoga. An idea presented in both of these yoga texts is that trauma “lives in the body” and the body has to participate in the recovery. The latter text is a comprehensive review of the history, philosophy, styles of yoga therapy, and practical applications. It may be useful for self-care for individuals, but a key is to get on a mat and engage the body, vs. just reading about stress management.

Here is a sample of daily practices for trauma recovery:
  • Journaling thought and feelings and goals.
  • Add one new healthy food item per week.
  • Attend individual or group therapy.
  • Take a yoga class that suits your style.
  • Make a place in your home or room a sanctuary, including an item from nature such as a shell, aromatherapy, and plan for sleep hygiene.
  • Listen to a 10 min mindfulness guide such as self-compassion.
  • Play with self guiding your breath on a breathing app.
  • Social: Walk with a friend, meet a friend for tea, call someone and video chat or facetime if possible.
  • Sample a meditation/mindfulness class.
  • Practice gratitude daily.
  • Nurture a mind body spirit connection with inspirational readings and time in nature.

Resources for trauma recovery:
  • A cool app developed by the military to help vets, valuable for all, nice visual guides as well, helps develop the skill of breath-awareness and control - breathe2relax

  • Proven strategies to help improve sleep -

  • Proven strategies to help reduce stress -

  • Profile of bereavement triggers, processes -

  • Risk factors for trauma, healing options -

  • Cultivate the healing power of gratitude -

  • Seven Principles for Cultivating Gratitude -

  • Audio Guides for Healing: UCSD Center for Mindfulness: Practice 6-40 minutes per day, in a seated or comfortable reclining pose. Use headphones/boundaries for family/prioritize this for self care. Choose a voice you like. The center offers 8 -week mindfulness based stress reduction classes. -

  • Specific "Body Scans" that may you may like -

  • Loving Kindness Meditation: Self care -

  • Yoga Therapy: Individualized for client needs: 11 Free Videos and links to audio guides for mediations: Focus, align breathe, be. I am certified in Medical Therapeutic Yoga through her institute -

References: Billings, Bart, Invisible Scars, How to Treat Combat Stress and PTSD Without Medication, Paradies/Inspire, Florida, 2016

Emerson, David, Trauma-Sensitive Yoga in Therapy, Bringing The body Into Treatment, Norton and Company, NY, London, 2015

Figley, C.R, Compassion Fatigue: Toward a New Understanding of the Cost of Caring. In BH Stamm (Ed) Secondary Traumatic Stress: Self care issues for clinicians, researchers, and educators, Baltimore, Sidran Press, 1995

Figley, C, Compassion Fatigue: Psychotherapists chronic lack of self-care: Journal of Clinical Psychology, 58, 2002, p 1435

Garner, Ginger, Medical Therapeutic Yoga, Biopsychosocial Rehabilitation and Wellness Care, Handspring Publishing 2016

Horovitz, Ellen, Elgelid, Staffan, Yoga Therapy, Theory and Practice, Routledge, NY, NY 2015

O'Dowd TC, Five years of heartsink patients in general practice. BMJ. 1988; 297(6647): 528-30 (ISSN: 0959-8138)

Kate Sheppard, PhD, RN, FNP, PMHNP-BC, FAANP, Compassion Fatigue: Are You at Risk? Am Nurs Today. 2016; 11(1)

Skolvt, Thomas, Trotter Mathison, Michelle, The Resilient practitioner, Routledge, NY 2016