Mind and Body in Psychotherapy
*Diane is not an actual person, but a composite of several clients Dr. Schwartz has seen over the past several years. Identifying details have been changed to protect their privacy. The treatments and outcomes are real.
By the time Diane came into my office her suffering had become unbearable. Migraines, chronic pain, and insomnia were interfering with her ability to simply live her life. Knowing that psychotherapy can improve health outcomes, her doctor referred her for treatment. Together we began to discuss her symptoms and unpack her history. Diane revealed her ongoing struggles with depression, fatigue, weight gain, and risk for diabetes. I learned of her frightening childhood exposure to domestic violence. She spoke of her father’s alcoholism and that her mother was never involved in her life. With tears streaming down her cheeks she said, “They never should have had children; I should have never been born.”
Unresolved trauma takes a significant toll on the mind and body. Unresolved childhood trauma is particularly insidious and is now considered to be a leading cause of heart disease, lung disease, and a contributor to the development of auto-immune illnesses. If you see yourself in Diane’s story there is good news…
Mind-body medicine reminds us that health promoting behaviors such as exercise, healthy diet, and positive social connections strengthen your resilience mentally, emotionally, and physically. New research reveals that psychotherapy has the potential to heal the body and the mind; reversing the physiological impact of trauma and improving your mental outlook on life.
“Trauma leaves wounds on the body, imprints in the psyche, and markers on our DNA. You feel broken. You can heal. You believe you are damaged. Believe you can be repaired. Relationships hurt you. Healthy relationships help you heal. Attending to the wounds of trauma is not easy. It is worthwhile.”
-Dr. Arielle Schwartz
Childhood Trauma and Your Health
Diane began to process her history of exposure to domestic violence and alcoholism and as she did so she had an A-Ha moment “My parents neglected me, and now I neglect myself by not taking care of my body as an adult. They were not loving parents but I can become good at loving myself.” Realizing she had no models for healthy diet and exercise as a child she developed greater self-compassion regarding her struggles with diet and exercise.
The psychological and medical fields are now recognizing that children exposed to trauma are significantly more likely to have physical health risk factors later in life. The Adverse Childhood Experiences (ACE) study conducted through Kaiser Permanente, assessed 17,000 patients experiences of 7 domains of childhood trauma: physical, verbal, or sexual abuse, exposure to domestic violence, or living with household with addictions, mental illness or imprisonment.
The study revealed that ACE factors were greater predictors of poor health than diet, smoking, and exercise factors combined. There were significantly increased mental health risks for depression and suicide and significantly increased physical health risks for cancer, heart disease, chronic lung disease, liver disease.
Healing from Adverse Childhood Experiences involves recognizing that while the past leaves a mark on us we cannot allow our past to define us. Once you can feel your pain you can free yourself from pain. When you recognize limiting beliefs that are running your life you can take charge of your mind and reclaim a positive outlook on life.
Trauma and Telomere
Step by step, Diane took her body and mind back from the costs of trauma. She committed herself to therapy. With her commitment to loving herself she gave herself permission to rest and slowly her sleep improved. When her fatigue improved she developed an exercise routine; initially walking around the block but as she felt stronger her walks grew longer. She became inspired to focus on a healthier diet of protein, fiber, fruits, and vegetables.
What is the physiological bridge between trauma and your health? To answer this question researchers have turned their attention to tiny structures within your DNA called telomeres. Telomeres act as caps on the end of our chromosomes that act as protectors. You can think of these like the plastic tips on shoelaces that keep them from fraying. Telomeres naturally shorten with age leaving chromosomes exposed and more likely to get damaged. Without telomeres cells cannot replicate themselves and die off as a result.
Shortened telomeres are associated with increased risks for physical health and mental health problems. Importantly, stress and trauma prematurely shorten telomeres. Research by Shaley et al. (2012)1 looked at the impact on telomere erosion in children exposed to violence. Children exposed to multiple forms of violence (domestic violence, frequent bullying, or physical abuse by an adult) had significantly shorter telomeres than children who had not been abused. These results suggest that shortened telomeres may be one link between early-life stress and later life disease. You can read more in my blog about the connection between chronic trauma and health.
The body also has the capacity to produce telomerase, a protective substance that lengthens telomeres. Health promoting behaviors have been shown to reverse DNA breakage. The science of telomeres is still young and holds some unresolved contradictions. Too much telomerase interferes with necessary, healthy levels of cell death and has been associated with the development of cancer. As with many things in the body, there seems to be a delicate balance of telomere activity that facilitates health.
The Good News
You can take back your mind and body from the costs of trauma. Mind-body medicine reminds us that health promoting behaviors strengthen your resilience mentally, emotionally, and physiologically. Recent research takes a look at the role of psychotherapy in reversing trauma’s impact on the body. Results reveal that therapy for PTSD in war trauma and torture survivors returned telomeres to normal levels. Morath et al. (2014)2write, “The reversibility of DNA breakage in individuals with PTSD via psychotherapy described here clearly indicates that there is indeed a possibility not only to reduce the psychological burden of PTSD but also the long-term, and potentially lethal, somatic effects of this mental disorder.”
5 Keys to Mind-Body Health:
- Exercise: Mental health professionals have long known that exercise is of upmost importance in the treatment of depression and anxiety. However, recent research has focused on changes in telomere length associated with how much you exercise. Again, moderation is the key. A sedentary lifestyle and engaging excessive exercise are both associated with shorter telomeres. Perhaps this involves training for a 10K, developing a yoga practice, or walking over your lunch hour; however the goal is to sit less and discover a “sweet spot” that you are motivated to continue.
- Rest and Relaxation: We all know what it feels like when we are sleep deprived. Our thinking deteriorates, our body feels heavy, our energy reserves deplete. Chronic poor sleep is associated with shortened telomeres. Learning to rest and relax is an important practice for mind-body health and longevity. Cultivate experiences that allow you to feel peaceful and uplifted such as time in nature, meditating, or listening to music. You can find more ideas in my Top 40 resilience practices blog post.
- Healthy Nutrition and Lifestyle: A diet high in processed meats, polyunsaturated fats, and refined sugar is linked to shortened telomeres. Smoking and excessive alcohol consumption are no good either. According to Shaley et al. (2013)1 eating a balanced, nutritious diet is associated with greater health; however, it is important to note that women preoccupied with restraining their food intake showed both higher cortisol and shorter telomeres. Again, moderation appears to be the key. When both physical and mental health is compromised developing collaborative relationships between psychotherapists, medical providers, and nutritionists can often facilitate optimal health outcomes.
- Learned Optimism: When there is no way to stop the abuse, end the domestic violence, or convince a parent to stop drinking a child feels powerless. Persistent childhood trauma is characterized by a state of learned helplessness. Martin Seligman describes the 3 P’s of pessimism or helplessness as: personalizing, pervasiveness, and permanence. In other words, “It’s my fault, I mess everything up, and it will always be this way. When healing from chronic we must recognize that we are safe now and are no longer stuck or powerless in the past. Seligman calls this “learned optimism,” a process of cultivating positivity by consciously challenging negative self-talk.
- Insight and Understanding: We develop insight when we have the opportunity to process the events of our lives. You might find this journaling, during an intimate conversation with a friend, or in the more structured environment of psychotherapy. When sharing your experience with another it is important to feel heard and validated in your story. Psychotherapy takes this process further by helping to identify ways of thinking and behaving that may perpetuate difficult feelings or painful patterns of relating with others. Psychotherapy for PTSD, such as Somatic and EMDR Therapies, work with the cognitive and body-centered impact of traumatic events. Most importantly when working with a therapist is that you feel a sense of trust and hope.
Trauma leaves wounds on the body, imprints in the psyche, and markers on our DNA. You feel broken. You can heal. You believe you are damaged. Believe you can be repaired. Relationships can hurt. Healthy relationships help you heal. Attending to the wounds of trauma is not easy. It is worthwhile.
1Shaley et al. (2013) Stress and telomere biology: A lifespan perspective, Psychoneuroendocrinology, 38(9), 1835-1842
2Morath et al. (2014) Effects of Psychotherapy on DNA Strand Break Accumulation Originating from Traumatic Stress. Psychotherapy and Psychosomatics, 89, 289-197.