Body Awareness in Survivors of Trauma

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Introduction[edit | edit source]

Body awareness is an approach often used within rehabilitation for individuals with persistent / complex pain [1][2] and / or psychosomatic / psychiatric conditions,[3][4][5][6] that explores and uses the mind-body-(spirit) connection to develop a more positive experience of the body and self through reflection of our bodily experiences.[7][8]

Body awareness has been defined as a treatment directed towards an awareness of how the body is used in terms of body function, behaviour, and interaction with self and others,[9] and can be influenced by both our emotional regulation, which is is our ability to exert control over our emotional state and interoception, which is the perception of sensations from inside the body and includes the perception of physical sensations related to internal organ function such as heart beat, respiration, satiety, as well as the autonomic nervous system activity related to our emotions.[10]

Body awareness therapies aim to normalise and restore breathing, posture, balance, and muscular tension, which are commonly experienced and visible in the movement behavior of individuals who have experienced trauma or displacement.[9][11]

Role of the Limbic System[edit | edit source]

LimbicSystem.png

The limbic system is a set of structures of the brain. These structures cover both sides of the thalamus, right under the cerebrum. It is not a separate system, but a collection of structures from the cerebrum, diencephalon, and midbrain. It supports many different functions, including emotion, behaviour, motivation, long-term memory, and olfaction.[12] It is the part of the brain involved when it comes to behaviours we need for survival: feeding, reproduction and caring for our young, and fight or flight responses.

The limbic system is a system that helps us to process emotions such as fear, pleasure, and anger, and also helps to control our drives, whether a hunger drive, sexual drive, or a need for sleep. It also combines higher mental functions and primitive emotion into a single system often referred to as the emotional nervous system. It is not only responsible for our emotional lives but also our higher mental functions, such as learning and formation of memories. Subparts of the limbic system ultimately regulate important aspects of our conscious and unconscious patterns (including our emotions, perceptions, relationships, behaviors and motor control).

Barriers to Care[edit | edit source]

Language Barriers[edit | edit source]

Research suggests that communication difficulties with service providers act as a critical barrier for displaced persons seeking health and social services.[13] The majority of displaced persons may not speak the language of the host country and have fear of and difficulty in expressing their medical symptoms in a second language.[14] Therefore, people with a language barrier are often unable to seek adequate medical attention without an interpreter or translator, which are not always widely available depending on the language of the person. An interpreter helps in transferring the message from the health provider to the displaced person and vice-versa. The role of interpreter is to hear concerns from both sides and provide accurate interpretation.[15] Even with interpreters, miscommunication can occur between doctors and patients due to the lack of proficient medical interpreters. This leads to inappropriate diagnosis, and devastating outcomes such as adverse drug effects, permanent disability, or even death.[13] Confusion might arise during a medical consultation with the use of complex medical terms providing information.[13] The feelings of alienation and mistrust may continue to grow and may prevent the patient from seeking out future medical care.[16]

Cultural Barriers[edit | edit source]

Cultural competence is a defined as a set of congruent behaviors, attitudes and policies that come together in a group of people to work effectively in cross-cultural situations such as an evaluation of programs and services provided to immigrants and refugees. [17] The word 'culture' is the integrated pattern of learned human behavior that includes thoughts, communications, actions, customs, beliefs, values and institutions of a social group. The word 'competence' implies having the capacity to function effectively as an individual and as an organization with the context of cultural beliefs and behaviours.[17]

Unfortunately, there is evidence to suggest that race / ethnicity can affect the way patients report pain and also the way in which rehabilitation professionals interpret a patient’s pain. In a study by Staton et al (2007)[18] it was found that clinician’s generally under-rated their patient’s pain, regardless of race, in agreement with Modanloo M. et al (2011)[19]. However, physicians were twice as likely to under-estimate a patient with black ethnicity’s pain in comparison to those patients of white ethnicity. Ultimately this study was unable to conclude the reasons behind this difference in pain assessment – further research has been suggested to combat this disparity in pain assessment.

Rehabilitation professionals should be aware of their own cultural identity. They should have cultural knowledge of common health beliefs and behaviours and should display culturally-sensitive behaviours (e.g., empathy, trust, acceptance, respect). They are required to use this knowledge and skills to modify their approach to meet the culturally-diverse needs of their clientele. Therefore, the ability to work with clients from diverse cultures is considered as a skill for improving clinical outcomes.[20]

Understanding of Healthcare System[edit | edit source]

Lack of knowledge about how to navigate the complex health care system results in poor access to healthcare services. The limited information on accessing primary health care services and not knowing whom to ask or where to go for health care, can result in frustration. It can also prompt to seek help from inappropriate sources. The displaced persons may experience difficulties; for example, immediate access to GP (General Practitioner) in the host countries follows a protocol that involves an appointment and wait-listed approach. It is contrasting to their homeland, where they get to see the GP immediately. It can be confusing as the displaced persons may think condition might resolve by the time, they get an appointment. The problem with this approach is that it may prevent individuals with more severe illnesses from acquiring medical attention early in the disease process5.

Impacts of Trauma[edit | edit source]

People affected by trauma or displacement frequently experience persistent or complex pain with wide ranging bodily symptoms including but not limited to altered breathing, posture and resting muscle tone with a lack of trust or confidence in their body with some feeling unsafe in their bodies and in their relationships with others.[9]

  1. Sense of Loss of Voice and Sense of Powerlessness
  2. Difficulty Expressing Thoughts and Feelings

Resources[edit | edit source]

Emotions Wheel by Abby Vanmunijen [21]
Body Needs Mapping Worksheet by Abby Vanmunijen [22]

References[edit | edit source]

  1. ↑ Gard G. Body awareness therapy for patients with fibromyalgia and chronic pain. Disability and rehabilitation. 2005 Jun 17;27(12):725-8.
  2. ↑ Ferro Moura Franco K, Lenoir D, dos Santos Franco YR, Jandre Reis FJ, Nunes Cabral CM, Meeus M. Prescription of exercises for the treatment of chronic pain along the continuum of nociplastic pain: A systematic review with meta‐analysis. European Journal of Pain. 2021 Jan;25(1):51-70.
  3. ↑ Gyllensten AL, Ekdahl C, Hansson L. Long-term effectiveness of basic body awareness therapy in psychiatric out-patient care. A randomised controlled study. Adv Physiother. 2009;11:2–12.
  4. ↑ Gyllensten AL, Ekdahl C, Hansson L 2009 Long-term effectiveness of Basic Body Awareness Therapy in psychiatric outpatient care. A randomized controlled study. Advances in Physiotherapy 11: 2–12
  5. ↑ Gyllensten AL, Jacobsen LN, Gard G. Clinician perspectives of Basic Body Awareness Therapy (BBAT) in mental health physical therapy: An international qualitative study. Journal of Bodywork and movement therapies. 2019 Oct 1;23(4):746-51.
  6. ↑ Solano Lopez AL, Moore S. Dimensions of body-awareness and depressed mood and anxiety. Western journal of nursing research. 2019 Jun;41(6):834-53.
  7. ↑ Mehling W, Wrubel J, Daubenmier J. Body awareness: a phenomenological inquiry into the common ground of mind-body therapies. Philos Ethics Humanit Med. 2011;6:6.
  8. ↑ Gyllensten AL, Hansson L, Ekdahl C 2003a Patient experiences of basic body awareness therapy and the relationship with the physiotherapist. Journal of Bodywork and Movement Therapies 7: 173–183
  9. ↑ 9.0 9.1 9.2 Gard G, Nyboe L, Gyllensten AL. Clinical reasoning and clinical use of basic body awareness therapy in physiotherapy–a qualitative study?. European Journal of Physiotherapy. 2020 Jan 2;22(1):29-35.
  10. ↑ Barrett L. F., Quigley K., Bliss-Moreau E., Aronson K. (2004). Interoceptive sensitivity and self-reports of emotional experience. J. Pers. Soc. Psychol. 87 684–697. 10.1037/0022-3514.87.5.684
  11. ↑ Solano Lopez AL, Moore S. Dimensions of body-awareness and depressed mood and anxiety. Western journal of nursing research. 2019 Jun;41(6):834-53.
  12. ↑ Kiddle Limbic system facts for kids Available from: https://kids.kiddle.co/Limbic_system (accessed 28.12.2020)
  13. ↑ 13.0 13.1 13.2 Cite error: Invalid <ref> tag; no text was provided for refs named :3
  14. ↑ Carta MG, Bernal M, Hardoy MC, Haro-Abad JM. Migration and mental health in Europe (the state of the mental health in Europe working group: appendix 1). Clinical practice and epidemiology in mental health. 2005 Dec 1;1(1):13. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1236945/
  15. ↑ Quickfall J. Cross-cultural promotion of health: a partnership process? Principles and factors involved in the culturally competent community based nursing care of asylum applicants in Scotland.https://era.ed.ac.uk/handle/1842/4466
  16. ↑ Health Challenges for Refugees and Immigrants by Ariel Burgess, VOLUME 25, NUMBER 2 https://reliefweb.int/sites/reliefweb.int/files/resources/ACB7A9B4B95ED39A8525723D006D6047-irsa-refugee-health-apr04.pdf
  17. ↑ 17.0 17.1 Keys to Cultural Competency: A Literature Review for Evaluators of Recent Immigrant and Refugee Service Programs in Colorado, REFT Institute, Inc. March 2002. https://www.racialequitytools.org/resourcefiles/KeystoCulturalCompetency04.pdf
  18. ↑ Staton LJ. Panda M. Chen I. Genao I. Kurz J. Pasanen M. Mechaber AJ. Menon M. O’Rorke J. Wood J. Rosenberg E. Faeslis C. Carey T. Calleson D. Cykert S. When race matters: disagreement in pain perception between patients and their physicians in primary care. J Natl Med Assoc 2007: 99: 532–538.
  19. ↑ Cite error: Invalid <ref> tag; no text was provided for refs named Modanloo M.
  20. ↑ Bialocerkowski A, Wells C, Grimmer-Somers K. Teaching physiotherapy skills in culturally-diverse classes. BMC medical education. 2011 Dec;11(1):34. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3146421/
  21. ↑ Abby Vanmunijen. Emotions Wheel. Available from: https://www.avanmuijen.com/watercolor-emotion-wheel (accessed 2 March 2023).
  22. ↑ Body Needs Mapping Worksheet. Available from: https://www.avanmuijen.com/watercolor-emotion-wheel (accessed 2 March 2023).
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