For Health Professionals and Organisations

For Reflection

Do the women who you are supporting struggle with:

  • pain, discomfort, muscle tension?

  • low energy?

  • weight management issues?

  • managing co-existing chronic conditions such as diabetes, arthritis, osteoporosis?

  • a lack of confidence?

  • poor emotional regulation?

Could these health challenges be negatively impacting each woman’s ability to:

  • focus on and participate in the work you are doing with her? 

  • function well at work, parent her children, and build healthy relationships with herself and others?

Health Impacts of Complex Trauma

Intimate partner abuse is the third highest health risk factor for women aged between 25 – 44.[1] Physical and mental health consequences can be acute, and/or chronic (such as gastrointestinal, gynaecological conditions; chronic pain syndromes; depression; stress, anxiety, sleeping, and eating disorders; poor self-esteem).[2] Bessel Van Der Kolk refers to multiple chronic health conditions resulting from complex trauma due to the continual release of inflammatory cytokines over months and years. Consequently, people with trauma histories can be at increased risk of developing chronic pain, fibromyalgia, chronic fatigue, migraines, arthritis, lower back pain, psoriasis, eczema, heart disease, asthma, irritable bowel syndrome and insulin resistance.[3]

Importantly, studies have revealed that women with trauma histories have an unusually low heart rate variability (HRV), meaning that their autonomic nervous system (parasympathetic and sympathetic systems) is out of balance.[4] This is due to prolonged and chronic activation of the stress response, causing the sympathetic nervous system to be repeatedly activated to prepare to fight or flee, without adequate activation of the parasympathetic nervous system to bring about physiological recovery from stress. A low HRV reflects poorer resilience to stress and lower levels of physical and psychological wellbeing, leading to increased vulnerability to illness such as heart disease, cancer and depression.[5]

Impact of Complex Trauma on the Brain

 

The Amygdala.

The “threat detector”:[6] The amygdala becomes hypersensitive and hyperactive in trauma, causing an increased risk of misinterpreting whether a particular situation is dangerous or safe. This can lead to painful misunderstandings in relationships at home or at work. When the amygdala senses a threat (in the information received from the thalamus) it sends a message down to the hypothalamus and brain stem to trigger stress hormones (cortisol and adrenaline) and a sympathetic nervous system response (increased heart rate, blood pressure and breathing rate) to prepare to fight, flee or freeze. A hypersensitive and hyperactive amygdala causes increased arousal and agitation, leading to blow-ups or shutdowns often in response to unexceptional occurrences such as innocuous comments or facial expressions.[7]

Medial Prefrontal Cortex.

The self-experience – “interoceptive”- part of the brain: The more trauma an individual experiences, the greater the reduction in the functioning of the Medial Prefrontal Cortex (MPFC).[8] The MPFC helps us to observe ourselves; be aware of what our body is telling us moment to moment; calmly and objectively observe our thoughts, emotions and feelings; and then take time to respond with a conscious choice. This interoceptive ability of the MPFC allows other parts of the pre-frontal cortex and frontal lobes (the executive brain) to filter (i.e. inhibit, organise and modulate) the hardwired automatic reactions pre-programmed into the emotional brain.[9] This capacity is crucial for self-care and body awareness (e.g. recognising pain signals, identifying when sleepy, maintaining health), emotional regulation (e.g. identifying emotions in ourselves and being prompted to use coping strategies), social participation (e.g. recognising emotions in others and being able to communicate and offer empathy).[10]

How I Offer Help to the Women You Support

Based on the physical and brain health impacts outlined above, it is clear that body awareness programs have a vital role to play in inviting women living with complex trauma to support their own physical and emotional healing. My mindful exercise programs work powerfully in collaboration with counselling and other therapies by creating a context which is welcoming, non-judgemental and respectful, cultivating calm and choice-making. Through individual and small group sessions, I work alongside each woman as part of her larger network of support, offering her the opportunity to build a sense of agency in relation to her body and her emotional and physical healing.

Care of Physical Health:

Depending on each woman’s specific hopes for her physical healing, sessions involve a variety of mindful exercises and stretches to:

  • activate and improve the endurance of postural muscles, and ease stiff joints in order to better manage and reduce muscle tension and pain throughout the body.

  • improve the strength of global muscles and increase cardiovascular fitness in order to enhance energy levels, promote better sleep, support weight management, and prevent and manage other chronic illnesses.

Care of Emotional Health:

The key to managing the increased reactivity, stress and heightened arousal that occurs in complex trauma is to achieve a balance between the MPFC and the amygdala.

Body/postural awareness practices, mindful exercise and movement, breathing, and mindfulness meditation are incorporated into all sessions in order to facilitate improved emotional regulation by using the “top-down” approach (i.e. by strengthening the MPFC) as well as the “bottom-up” approach (i.e. by recalibrating the autonomic nervous system through better balance between the parasympathetic and sympathetic nervous systems).[11]


A customised collection of management strategies will be developed in consultation with each woman. Each woman will gradually become familiar with which strategies are of benefit to her, and will be equipped with the knowledge and the skills to enable her to practise them each day to assist her to better regulate and nurture her physical and emotional health.

All sessions are offered using trauma-sensitive principles,[12] involving the use of invitational language; offering women choice; providing opportunities for women to bring awareness and sensation to the present moment; supporting each woman to discover her own empowerment and voice; authentically sharing in the experience of each session together; and cultivating safety in all aspects of the sessions and in my communication with each woman.