Research shows a staggering prevalence of trauma, with roughly 70% of adults globally [Benjet et al, 2016] and 75% of Australians [AIHW, 2024] experiencing at least one traumatic event. This prevalence underscores a crucial point: if we work with people, we’re likely interacting with individuals who carry the potential consequences of trauma. For instance, research suggests a connection between childhood adversity and increased risk factors for poor physical and mental health, unhealthy behaviours like smoking, and obesity [Loxton, 2021]. As a holistic nutrition practice, understanding how trauma can impact our client's health is paramount for building supportive and effective therapeutic relationships. This knowledge allows us to tailor our approach to create a safe space for healing and empower clients to reclaim their well-being.

The Devastating Impact of Trauma

Traumatic experiences leave a profound mark. The Adverse Childhood Experiences (ACE) score, which measures the number of traumatic events experienced in childhood, has been linked to a significant increase in the risk of various chronic diseases.  Individuals with an ACE score of 4 or higher face a dramatically increased risk for heart disease, alcoholism, lung disease, depression, and suicide [Felitti, 1998]. Trauma can also accelerate aging, shorten telomeres (the protective caps on chromosomes), and disrupt the Hypothalamic-Pituitary-Adrenal (HPA) axis, the body's stress response system [Burgin et al, 2022].

The Biology of Trauma

Trauma alters the way our brains function. It can affect the limbic system, responsible for processing emotions and memories, leading to heightened arousal and changes in the opioid system. The body also experiences a primed inflammatory response, leaving individuals more susceptible to illness [Poletti et al, 2022]. Neuroplasticity, the brain's ability to adapt, plays a role in these changes. Traumatic experiences can cause dose-dependent changes in the amygdala (fear centre) and hippocampus (memory centre). [Kearney et al, 2021]. The possibility of epigenetic changes – where trauma leaves its mark on gene expression across generations – further underscores the far-reaching effects of trauma [Jiang et al, 2019].

Polyvagal Theory, which explores the connection between the nervous system and social engagement, sheds light on how trauma disrupts our ability to feel safe and connected. As Bessel van der Kolk, a leading trauma expert, states, "After trauma, the world is experienced with a different nervous system. The survivor’s energy now becomes focused on suppressing inner chaos, at the expense of spontaneous involvement in their life” [Van der Kolk, 2014]. Clients with a trauma history may struggle to engage fully in their health journey due to a nervous system primed for survival rather than thriving.

Trauma History and Clinical Practice: Bridging the Gap

Individuals with trauma histories often exhibit specific characteristics that can impact the therapeutic relationship:

• Difficulty recounting past experiences

• Difficulty following detailed treatment plans

• Self-sabotage

• Increased stress, impatience, or hostility

Utilising tools like brief trauma questionnaires can help identify the presence of trauma and we can tailor our therapeutic approach accordingly [Tomaz, 2020].

Trauma-Informed Care: A Foundation for Healing

Trauma-informed care (TIC) acknowledges the potential impact of trauma and integrates this awareness into the therapeutic approach. TIC prioritises safety, trust, and patient empowerment.  The three E's model (Events, Experience, and Effects) and the four R's model (Realise, Recognise, Respond, Resist re-traumatisation) offer frameworks for understanding and responding to trauma [SAMHSA (2014)].  Six guiding principles offer a roadmap for implementing TIC:

1. Safety: Ensuring physical and emotional safety in all interactions.

2. Trustworthiness/Transparency: Building trust through open communication and shared decision-making.

3. Peer Support: Acknowledging the power of shared experiences and support networks.

4. Collaboration/Mutuality: Working with clients to create a treatment plan that feels empowering and respectful.

5. Empowerment, Voice, and Choice: Putting clients in control of their healing journey.

6. Cultural, Historical, and Gender Issues: Recognising how cultural background, historical context, and gender identity can influence experiences with trauma.

Building Resilience: A Path to Better Health

Resilience, the ability to bounce back from adversity, plays a crucial role in navigating the challenges of trauma.  The six domains of resilience – Vision, Composure, Reasoning, Health, Tenacity, and Collaboration – offer a framework for supporting clients in cultivating resilience [Driven, 2018]. Models like the Salutogenesis Model and the Coherence Model emphasise how fostering a sense of meaning, purpose, and social connection can promote overall health and wellbeing [Mittelmark et al, 2013].

As natural medicine practitioners, our unique skillset positions us to address the physical and emotional consequences of trauma on multiple levels. Through a client-centred therapeutic relationship, we can create a safe space for healing, explore dietary and lifestyle changes that support nervous system regulation, and empower clients to reclaim their health and well-being. It's important to recognise that some clients may benefit from additional support beyond the scope of our practice. In such cases, we can collaborate with and refer clients to behavioural medicine specialists or other mental health professionals for comprehensive trauma treatment. By integrating trauma-informed practices with our natural healing expertise and collaborating with other providers when needed, we can become a powerful catalyst for transformation, helping clients move from a place of surviving to thriving.

References

Benjet C, et al. The epidemiology of traumatic event exposure worldwide: results from the World Mental Health Survey Consortium. Psychol Med. 2016 Jan;46(2):327-43. doi: 10.1017/S0033291715001981. Epub 2015 Oct 29. PMID: 26511595; PMCID: PMC4869975.

AIHW, 2024. Stress and Trauma. AIHW, Australian Government, accessed 20 April 2024.

Loxton D, et al. The impact of adverse childhood experiences on the health and health behaviours of young Australian women. Child Abuse Negl. 2021 Jan;111:104771. doi: 10.1016/j.chiabu.2020.104771. Epub 2020 Nov 5. PMID: 33160649.

Felitti VJ, et al. Relationship of childhood abuse and household dysfunction to many of the leading causes of death in adults. The Adverse Childhood Experiences (ACE) Study. Am J Prev Med. 1998 May;14(4):245-58. doi: 10.1016/s0749-3797(98)00017-8. PMID: 9635069.

Bürgin D, et al. Adverse and traumatic exposures, posttraumatic stress disorder, telomere length, and hair cortisol – Exploring associations in a high-risk sample of young adult residential care leavers. Brain, Behaviour, & Immunity. https://doi.org/10.1016/j.bbih.2022.100524.

Poletti S, et al. Long-term effect of childhood trauma: Role of inflammation and white matter in mood disorders. Brain Behav Immun Health. 2022 Oct 3;26:100529. doi: 10.1016/j.bbih.2022.100529. PMID: 36237478; PMCID: PMC9550612.

Kearney B E, et al, 2021. How the body remembers: Examining the default mode and sensorimotor networks during moral injury autobiographical memory retrieval in PTSD. NeuroImage: Clinical, accessed 22 April 2024.

Jiang S, et al. Epigenetic Modifications in Stress Response Genes Associated With Childhood Trauma. Front Psychiatry. 2019 Nov 8;10:808. doi: 10.3389/fpsyt.2019.00808. PMID: 31780969; PMCID: PMC6857662.

Bessel van der Kolk, M. (2015). The Body Keeps the Score: Brain, Mind, and Body in the Healing of Trauma. Penguin Books. 

Tomaz T, Castro-Vale I. (2020). Trauma-Informed Care in Primary Health Settings-Which Is Even More Needed in Times of COVID-19. Healthcare (Basel). 2020 Sep 14;8(3):340. doi: 10.3390/healthcare8030340. PMID: 32937966; PMCID: PMC7551418.

SAMHSA. (2014) SAMHSA's Concept of Trauma and Guidance for a Trauma-Informed Approach, SAMHSA, accessed online 22 April 2024.

Driven, 2018. The 6 Domains Of Resilience, accessed online 22 April 2024

Mittelmark MB, et al. The Handbook of Salutogenesis [Internet]. Cham (CH): Springer; 2017. PMID: 28590610.

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