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Understanding and Implementing Trauma-Informed Care for Clients in Pain: Summary 43
How Do We Autonomically Assess Safety? • Neuroception : A neural process to distinguish whether our environment is safe, dangerous, or life- threatening. • Black and White Thinking : One autonomic nervous system recognizing another autonomic nervous system. • Co-regulation : ○ Mutual adaptation is between partners in response to their biology and behavior ○ Co-regulation is critical to self-regulation ○ We see changes in autonomic function
| HEALTHCARE CONSIDERATION By recognizing whether a patient is in a defensive state (fight, flight, or freeze) or a state of safety, providers can tailor their approach to promote a therapeutic environment. This might include slow breathing techniques, grounding exercises, and fostering a supportive environment to help down- regulate the nervous system, thereby reducing pain and enhancing healing.
CASE STUDY 1: JILL
You are an occupational therapist. Jill comes into your clinic and starts sharing a traumatizing event in her life. Jill is visibly upset about it and can’t seem to focus on the treatment plan because she is distracted by her experience. What is a trauma-informed approach to handling a client who is verbalizing a lot of unprocessed trauma? • Acknowledge her distress and inquire whether she has a safe, qualified mental health professional to help process what’s happened to her. • You are acknowledging what she’s going through, but you are not trying to “process” it with her or dig into private details, which can be retraumatizing, make her feel unsafe, or take you away from what she is seeing you for. You are supporting her by giving her a resource while still staying within your scope (as an occupational therapist, for example).
CASE STUDY 2: KIMI
Kimi is a 35-year-old Native American woman who was raped at the age of 16 on her walk home from a suburban high school. She recounts how her whole life changed on that day. She states “I never felt safe being alone after the rape. I used to enjoy walking everywhere. Afterward, I couldn’t tolerate the fear that would arise when I walked in the neighborhood. It didn’t matter whether I was alone or with friends, every sound that I heard would throw me into a state of fear. I felt like the same thing was going to happen again. It’s gotten better with time, but I often feel as if I’m sitting on a tree limb waiting for it to break. I have a hard time relaxing. I can easily get startled if a leaf blows across my path or if my children scream while playing in the yard. The best way I can describe how I experience life is by comparing it to watching a scary, suspenseful movie, anxiously waiting for something to happen, palms sweating, heart pounding, on the edge of your chair.” H ow can I create a therapeutic environment that acknowledges the lasting impacts of trauma, such as hypervigilance and anxiety, in a way that fosters safety, trust, and healing for patients like Kimi? • I can use trauma-informed care principles, such as actively listening to Kimi's concerns, validating her experiences, and ensuring that she feels safe and in control during her treatment process. • Regardless of our scope of practice, implementing trauma-informed principles will always be appropriate, such as supporting our client’s autonomy (empowerment, voice, and choice), active listening (trustworthiness), and validating her experiences (safety). • Traumatic stress tends to evoke two emotional extremes: feeling either too much (overwhelmed) or too little (numb) emotion.
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