Treating the Whole Person: Trauma-Informed Care Part 1

In pelvic floor physical therapy by Emily SchwerdtfegerLeave a Comment

By Jillian Giannini, DPT, PHRC Westlake Village

Whether you are a clinician, a patient, or someone who wants to learn more about the concept of trauma, learning more about trauma can be beneficial for your life and for others that you encounter in your life. Trauma often plays a role in our lives, even if we are not fully aware of how. However, not everyone is currently equipped to engage in conversations about trauma, which often includes acknowledging their own experiences with trauma. If you are reading this and notice unpleasant feelings, please feel free to not continue reading; there is absolutely no judgement. You can skip to the bottom for supportive resources.  

 

One note to remember is that everyone is in different stages in their lives and it is important to listen to your body and what it is telling you. For instance, if you are engaging in a mindfulness practice (e.g. grounding or a guided meditation) and rather than feeling relaxed you feel the opposite (e.g. increased heart rate, uneasiness), bring yourself out of the mindfulness practice. If you continue even though you feel uncomfortable, this well-intended exercise may be more harmful than beneficial. 

 It is okay if a certain practice isn’t the best choice for you right now. 

What do you think of when you hear the word trauma? Are you someone that has experienced it? Or, perhaps you’re not sure if you have. A common thought that pops up for people when they think about trauma is “a war veteran and PTSD,” but this stressor can occur for anyone; you, a family member, or a friend. 

 

Over the years, the Substance Abuse and Mental Health Services Administration (SAMHSA) developed their own concept of trauma through existing definitions and discussions with expert panelists. Their understandings are that “individual trauma results from an event, series of events, or set of circumstances that is experienced by an individual as physically or emotionally harmful or life threatening, and that has lasting adverse effects on the individual’s functioning and mental, physical, social, emotional or spiritual well-being.”¹

 

Some examples of a traumatic event include:

  • Psychological, physical, or sexual abuse
  • Witnessing or experiencing domestic violence
  • National disaster 
  • Grief or loss 
  • Neglect 
  • Accidents or illness 
  • Medical interventions 
  • Cultural, intergenerational, and historical trauma 

 

After reading this definition of trauma and the examples of traumatic events, how common do you think it is in all of our lives? 

  • About 70% of adults in the U.S. have experienced at least one traumatic event in their life.²  
  • Two thirds of children have experienced at least one traumatic event by 16 years old.³ 
  • The Centers of Disease Control and Prevention (CDC) research has shown that “one in five Americans was sexually molested as a child; one in four was beaten by a parent to the point of a mark being left on their body; and one in three couples engages in physical violence.”⁴ 

 

With these statistics you may think that U.S. society would be more educated about trauma, or aware of it. It’s unfortunate because side effects can then develop. With a spectrum of stressful events, your experience is uniquely perceived, processed and manifested. These effects can occur immediately after or have a delayed onset and sometimes you may not even correlate the event with the effects it may have caused. Some side effects include, but are not limited to:

  • Numbing
  • Avoidance
  • Hypervigilance or constant state of arousal 
  • Inability to cope with normal stressors of daily living
  • Lack of trust and benefit from relationships 
  • Difficulties with managing cognitive processes 
  • Inability to regulate behavior or control the expression of one’s emotions¹ 

 

To better understand how these stressors can affect someone it’s important to know what happens to your mind, body, and brain due to trauma. In Bessel A. van der Kolk, M.D.‘s The Body Keeps The Score it is so well put that “trauma affects the entire human organism– body, mind, and brain. In PTSD the body continues to defend against a threat that belongs to the past. Healing from PTSD means being able to terminate this continued stress mobilization and restore the entire organism to safety.” 

So what does it mean when your body continues to defend itself? Well, there is a part of our peripheral nervous system called the autonomic nervous system (ANS), which controls the involuntary physiological functions like:

  • Heart rate
  • Respiration 
  • Sexual arousal 
  • Blood pressure
  • Digestion⁵

Some pretty crucial processes, right? 

The ANS is usually described as being subdivided into the sympathetic (SNS) and parasympathetic nervous systems (PNS). An easy way to remember the difference between the two is when you are in the SNS you’re in a “fight or flight” state. So way back in the day when humans had to fight off lions, forage for food, and often fight for survival daily this nervous system was very helpful. Nowadays the lions you can face are a little different; it can be a stressful deadline, school, traffic, you name it. 

 

Opposite to the SNS is the PNS, or the “rest and digest” or social engagement state. This is when you are relaxed, calm, feel safe and not on high alert. However, there is much more to it. There’s actually a third state that your nervous system can fall into that is described in Stephen Porges’s Polyvagal Theory. It is described as the dorsal-vagal system, which is the most primitive of all three systems. You can think of this state as a “freeze” state or shutdown in response to a big threat, sometimes even resulting in fainting or complete shock.⁶ For more detailed descriptions of these systems check out our blog A Polyvagal Map to Pelvic Health.

 

All of these states are important and have their purpose. Some examples of what is happening in your body during each state…

Sympathetic Nervous SystemParasympathetic Nervous SystemDorsal-Vagal System 
Increased heart rateDecreased heart rateDecreased heart rate 
Increased respiratory rateDecreased respiratory rateDecreased respiratory rate
Decreased gastrointestinal activityIncreased gastrointestinal activityDecreased gastrointestinal activity
Increased musculoskeletal toneDecreased musculoskeletal toneDecreased musculoskeletal tone

 

Your body will fluctuate between states based on what is needed at that moment; however, going back to what Bessel A. van der Kolk said about your body continuing to defend against a threat, what state or states of the autonomic nervous system do you think you are stuck in with post traumatic events? Correct, the sympathetic or “fight or flight” state or even the Dorsal-Vagal System or “freeze” state. 

 

After a traumatic event that results in your body protecting you with either the sympathetic or dorsal-vagal state you should return to the state of social engagement; however, some people will stay stuck in some level of these states chronically. This is an adaptation to stress and trauma. You can begin to lack the ability to regulate the state of your nervous system throughout the day, having difficulty distinguishing, clearly when you are safe or not.⁷ Staying in this heightened state when there is no longer a threat can result in lack of productivity, clarity and joy of living until you are able to return to a social engagement state. When someone is stuck in the dorsal-vagal state they are described to have “depressive feelings”. Some of these feelings include⁶:

  • Sadness
  • Anxiousness
  • Emptiness
  • Hopelessness
  • Worthlessness 
  • Guilt
  • Irritability 
  • Feeling Ashamed 

 

These states can affect someone’s mental and physical health. 

 

You might be asking, why talk about trauma and the effects on a pelvic health physical therapy blog? We must talk about trauma and pelvic health for many reasons. Trauma plays a role in how we as physical therapists need to treat and create a safe environment for our patients to the best of our abilities. Whether or not a physical therapist specializes in pelvic health, trauma is something that can be understood to help treat the whole person. As physical therapists, it is not within our scope to treat or heal trauma; however, implementing a trauma-informed approach to healthcare will help us better serve patients by preventing re-traumatization and creating a supportive and safe environment for their healing journey. Also, with our understanding of the nervous system and how it affects pain and muscle overactivity, we can use tools in our sessions to assist with regulating the nervous system. For instance, check out our blog, What is Mindfulness and How Can it Help Pelvic Pain?. Stay tuned for part two where we will discuss ways and tips on how to implement trauma-informed care within your practice.

 

Hopefully after reading this blog you have a better understanding about what trauma is, how it can affect someone, and why it is so important in our lives. If you or someone you know has been affected by a traumatic event and needs support here are some resources: 

 

  • RAINN (National Sexual Assault Hotline): 800-656-HOPE (4673)
  • National Suicide Prevention Lifeline: 800-273-8255
  • National Domestic Violence Hotline: 800-799-7233 or https://www.thehotline.org
  • National Human Trafficking Hotline: 888-373-7888
  • Strength United Support and Referral Lines: 818-886-0453; 661-253-0258 / https://www.csun.edu/eisner-education/strength-united/services
    • “Strength United is honored to be an important part of making the world a safer place for all. Our work supports families, prevents sexual and domestic violence, and provides healing and support for those who have survived abuse. We aim to take a traumatic event in an individual or family’s life and turn it into a point of strength.”
  • 211: vital service that connects people with help. https://www.211.org
  • Department of Mental Health (https://dmh.lacounty.gov/get-help-now/) : Help Line 800-854-7771
  • Lumos Transforms 
    • “Lumos Transforms is a social enterprise founded in 2015 to shepherd individuals, communities, and organizations through positive change. Whether people are dealing with unpleasant symptoms, overwhelming stress, difficult past experiences, or unjust circumstances, we meet clients exactly where they are– providing responsive solutions that help people feel better, prepare for change, and unlock their inner potential. By empowering individuals to access wellness, grow resilience, and cultivate beneficial behaviors, we initiate a transformation process that ripples outward. The ultimate goal? Creating socio-cultural systems that are healthy, balanced, interdependent, sustainable, and equitable.”(https://lumostransforms.com/about/

 

References:

  1. SAMHSA’s Concept of Trauma and Guidance for a Trauma … (2014). Retrieved August 26, 2020, from https://ncsacw.samhsa.gov/userfiles/files/SAMHSA_Trauma.pdf
  2. National Council for Behavioral Health – Homepage. (2020, July 17). Retrieved August 26, 2020, from https://www.thenationalcouncil.org/
  3. Understanding Child Trauma. (2020, April 29). Retrieved August 26, 2020, from https://www.samhsa.gov/child-trauma/understanding-child-trauma
  4. A., V. D. (2015). The body keeps the score: Brain, mind, and body in the healing of trauma. New York: Penguin Books.
  5. Waxenbaum JA, Reddy V, Varacallo M. Anatomy, Autonomic Nervous System. [Updated 2020 Aug 10]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2020 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK539845/
  6. ROSENBERG, S. (2017). ACCESSING THE HEALING POWER OF THE VAGUS NERVE: Self-exercises for anxiety, depression, trauma, … and autism. Berkeley, CA: North Atlantic Books.
  7. PARKER, G. (2020). Restorative yoga for ethnic and race-based stress and trauma. London, UK: SINGING DRAGON.

______________________________________________________________________________________________________________________________________

Are you unable to come see us in person? We offer virtual physical therapy appointments too!

Due to COVID-19, we understand people may prefer to utilize our services from their homes. We also understand that many people do not have access to pelvic floor physical therapy and we are here to help! The Pelvic Health and Rehabilitation Center is a multi-city company of highly trained and specialized pelvic floor physical therapists committed to helping people optimize their pelvic health and eliminate pelvic pain and dysfunction. We are here for you and ready to help, whether it is in-person or online. 

Virtual sessions are available with PHRC pelvic floor physical therapists via our video platform, Zoom, or via phone. The cost for this service is $75.00 per 30 minutes. For more information and to schedule, please visit our digital healthcare page.

In addition to virtual consultation with our physical therapists, we also offer integrative health services with Jandra Mueller, DPT, MS. Jandra is a pelvic floor physical therapist who also has her Master’s degree in Integrative Health and Nutrition. She offers services such as hormone testing via the DUTCH test, comprehensive stool testing for gastrointestinal health concerns, and integrative health coaching and meal planning. For more information about her services and to schedule, please visit our Integrative Health website page

PHRC is also offering individualized movement sessions, hosted by Karah Charette, DPT. Karah is a pelvic floor physical therapist at the Berkeley and San Francisco locations. She is certified in classical mat and reformer Pilates, as well as a registered 200 hour Ashtanga Vinyasa yoga teacher. There are 30 min and 60 min sessions options where you can: (1) Consult on what type of Pilates or yoga class would be appropriate to participate in (2) Review ways to modify poses to fit your individual needs and (3) Create a synthesis of your home exercise program into a movement flow. To schedule a 1-on-1 appointment call us at (510) 922-9836

Leave a Comment