Individualized Sustainability Plan (ISP)
I’ve often asserted my conviction – based on personal experience as a trauma survivor, professional observation as a therapist, and reading of the literature as a researcher – that, to be effective, treatment strategies for dealing with stress and trauma must include cognitive, emotional, and body-focused aspects. In work with clients I help them create a set of self-care activities that they can engage in over an extended period – after, of course, we’ve done essential preliminary work on connecting to inner resources and establishing a sense of safety. This post begins a series on such self-care activities, which in the language of therapy I call Individualized Sustainability Plan (ISP).
As a general rule, in therapy I start with things I think clients can do immediately that will bring immediate results. This frees up energy for other more slowly unfolding processes that follow. This means I often start with nutrition, not because I’m a nutritionist, but because I’ve found attention to this area so fruitful in dealing with stress and trauma symptoms.
Brain Gut Axis
An intriguing phrase appearing more frequently now in the literature is “gut-brain axis”. Chris Kresser, a functional and integrative medicine practitioner, describes this as “the relationship between digestive health and cognitive function, memory, depression, anxiety and other mental and behavioral health issues”.
Painful personal experience drove me to the reading through which I encountered Kresser’s work. I lived in Africa for several years, working with survivors of severe gender-based violence and with professionals mandated to assist them. This was stressful work for me and I had minimal social or supervisory support. I was stressed for so long that I became chronically physically ill and eventually experienced advanced stages of burnout.
Burnout is well-recognized for its emotional toll, but its physical aspects get less attention. In my case, it all happened gradually and I never had an urgent life-threatening health crisis. Yet I got more and more tired and fatigued, vulnerable to constant colds and infections, reacting to many foods I had long eaten, and feeling miserable most of the time with a constant sense of brain fog.
Worried, I underwent tests. None revealed any significant underlying problems. My doctor suggested depression. But I know depression as a therapist and from my own seasons of hard times. This was not depression. Something was wrong, out of balance, in my body.
In this time I discovered writings of Kresser and others studying nutrition and health. I also located a well-trained practitioner of natural medicine who worked with me to create a path of treatment that I still follow. I have no miracle stories to tell, no surefire solutions to pass along. But I gained useful information about myself in this experience and began noticing interactions between nutrition and mental health that I am convinced get far too little attention among mental health practitioners.
Stress as a trigger
From recent findings, we know that different types of psychological stress affect the composition of the gut microbiotica (Mayer et al., 2014).
Such findings suggest that an imbalance in the gut could play a key role in many symptoms such as chronic fatigue, brain fog, low and high blood pressure, insomnia, PMS, PMDD, and other symptoms and conditions that people experience during anxiety and panic attacks or depression.
Recently, the Gut-Brain Axis has received a lot of media buzz. Here is a long article about the connection between gut bacteria and mood. Here is an article describing the connection between depression and gut inflammation; a similar article describes the link of suicide and inflammation. Here is a more controversial post about ketogenic diet and its benefit in dealing with mental health issues. Dr. Emily Deans, an evolutionary psychiatrist writes a stimulating blog on junk food, gut, and the brain.
Several of the links above indicate a complex relationship between stress/trauma and the ratio of good and bad bacteria in our gut. An increase in bad bacteria affects how we feel both physically and emotionally and increased consumption of processed foods and sugars The connection holds in the other direction as well. That is, what we eat effects how we feel, and increased consumption of processed foods and sugars is associated with greater sensitivity to stress.
Multidisciplinary approach
Medications have their place, including psychiatric ones. But when someone needs a root canal we don’t just give them pain pill, we treat the underlying cause. I think the science emerging about the brain-gut axis is pointing us towards a root cause that is largely overlooked by current mental health and medical practices.
For stress management and trauma therapy to really help survivors achieve trauma integration, we need to work with people as a complex, interacting whole. After trauma, such an approach must include working on cognitive, physical, emotional and spiritual aspects of healing.
Diet and nutrition need to be included in treatment plans. I suspect the day is not so far distant when trauma practitioners will routinely be trained in more than one modality of therapy and that psychobiology and nutrition will be recognized as key elements of trauma treatment.
Psychobiotics – first steps to feeling better
In 2013 Dinan et al., (2013) coined the phrase psychobiotics in describing emerging evidence that probiotics are useful in alleviating symptoms of depression and chronic fatigue syndrome. Even though use of probiotics should be guided by an expert in their use to avoid counterproductive results, here are suggestions drawing from several authors that I think assist many people suffering from stress and/or trauma:
1. Reduce intake of processed sugars and processed foods. Avoid artificial ingredients wherever possible, in particular, artificial sweeteners, food coloring, and monosodium glutamate.
2. Eat whole foods as much as possible, especially vegetables and fruits of diverse colors.
3. Make planning a key aspect of eating, for if you do not, you will repeatedly be at the mercy of the eating practices of businesses and people who do not take nutrition seriously. When you eat out, pay attention in advance so you can arrange healthy options. Always carry snacks with you, so you aren’t forced to eat whatever is within reach.
4. Keep a food symptoms journal to pay attention to what you body is telling you. Soon enough you will learn what foods you are reacting to, and will be able to eliminate those from your diet.
Take a look at this helpful guidance from Dr. Terry Wahls, professor of medicine at University of Iowa, about inflammation and diseases and at this link get quick ideas on foods to avoid. You can find many more online.
If you can’t make these changes right now, or if you try, and find them too hard, give yourself a break. Try again when you can. Find a Facebook support group, or if there is none, create one. Simply aim to do the best that you can now, and there is always tomorrow to try again.
Remember that YOU are the only authority on your body. If a medication or food makes you feel bad or worse, and your medical professional does not support you, find one who does.
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References:
Dinan, T. G., Stanton, C., & Cryan, J. F. (2013). Psychobiotics: a novel class of psychotropic. Biological psychiatry, 74(10), 720-726.
Mayer, E. A., Knight, R., Mazmanian, S. K., Cryan, J. F., & Tillisch, K. (2014). Gut microbes and the brain: paradigm shift in neuroscience. The Journal of Neuroscience, 34(46), 15490-15496.