Overview to Trauma-Informed Practice 

As exercise physiologists, we often work with clients who have experienced trauma. Understanding the impact of trauma on the brain is crucial for providing effective and trauma-informed care. In this blog, we’ll explore how trauma affects the brain, and how exercise physiologists can adapt their approach to support clients who have experienced trauma.

The Brain’s Response to Trauma

Multiple systems and regions of the brain are impacted by trauma, including:

Limbic system: The limbic system, responsible for emotions, motivation, and memory, is activated during traumatic events. This leads to the release of stress hormones, such as cortisol and adrenaline, which can alter brain function and structure.

Amygdala: The amygdala, located in the temporal lobe, is the primary structure responsible for processing fear and anxiety. During trauma, the amygdala is overactive, leading to increased fear and anxiety responses.

Hippocampus: The hippocampus, responsible for memory formation and consolidation, is impaired during traumatic events. This can lead to difficulties in recalling past experiences and forming new memories.

Prefrontal cortex: The prefrontal cortex, responsible for executive function, decision-making, and problem-solving, is “shut down” during traumatic events. This can lead to difficulties in cognitive function, attention, and emotional regulation.

Sympathetic nervous system (SNS): The SNS, responsible for the “fight or flight” response, is activated during traumatic events. This leads to increased heart rate, blood pressure, and other physiological responses.

Parasympathetic nervous system (PNS): The PNS, responsible for relaxation and restoration, is suppressed during traumatic events. This can lead to difficulties in regulating emotional responses and promoting recovery.

Anterior cingulate cortex: This region is involved in error detection, conflict monitoring, and emotion regulation. It is often overactive in individuals with PTSD.

Insula: The insula is involved in interoception (the sense of internal bodily sensations) and is often altered in individuals with PTSD.

Prefrontal-striatal-thalamo-cortical (PSTC) circuit: This circuit is responsible for motor control and habit formation. It is often disrupted in individuals with PTSD.

In summary, trauma affects multiple systems and regions in the brain, including the limbic system, amygdala, hippocampus, prefrontal cortex, SNS, PNS, anterior cingulate cortex, insula, and PSTC circuit. These changes can lead to difficulties in emotional regulation, memory formation, cognitive function, and motor control.

The Role of Exercise Physiology

Exercise physiology can play a crucial role in helping clients who have experienced trauma. By desensitizing clients to their internal arousal cues, improving cognitive function, and promoting physical activity, exercise physiologists can help clients navigate the physical and emotional impacts of trauma.

Common Barriers to Trauma-Informed Practice

When working with clients who have experienced trauma, it’s essential to be aware of common barriers that can prevent effective treatment. These include:

• Sensitivity to physiological arousal: Clients may be sensitive to internal cues of threat, such as rapid heartbeat or sweating. 
  • Exercise physiologists can use invitational language to help clients feel more comfortable and in control.
• Hypersensitivity to touch: Some clients may be highly reactive to touch or physical contact.
  • Exercise physiologists should prioritize client comfort and consent when providing physical demonstrations or assistance.
• Dissociation: Clients may appear disconnected or non-responsive during sessions. 
  • Exercise physiologists can use questions of inquiry to help clients feel more present and engaged.
• Disrupted interoception: A common result of trauma, referring to the altered processing of internal bodily sensations such as accelerated heart rate, difficulty recognizing bodily sensations, sensory overload, increased awareness of bodily sensations, and dissociation from bodily sensations. These disruptions can lead to increased anxiety and fear, avoidance behaviours, increased stress and arousal, and difficulty with self-regulation, including emotional regulation, impulse control, and decision-making.
  • Exercise physiologists should identify additional skills to ground and regulate the client (e.g. breathing retraining, grounding, cold water) 
  • Celebrate the wins: Highlight if the client was able to notice that the activation of their heart and breathing changes were not catastrophic.

Trauma has a profound impact on the brain, affecting cognitive function, emotional regulation, and physical response. As exercise physiologists, it’s essential to understand these effects and adapt our approach to support clients who have experienced trauma. By being aware of common barriers and using trauma-informed techniques, we can help clients recover from the physical and emotional impacts of trauma.

How do we utilise this information as Exercise Physiologists?

• Review the impact of trauma on the brain and its effects on cognitive function and emotional regulation.
• Reflect on our own experiences and biases when working with clients who have experienced trauma.
• Consider attending training sessions or workshops on trauma-informed practice.
• Develop a plan for implementing trauma-informed practice in your work with clients.