Download Caroline F. Meyer, ND

Presented by: Caroline Meyer, ND
At the OAND Annual Convention
On 18 November 2014
The Impact of Trauma
 “When you're born a light is switched on, a light which shines
up through your life. As you get older the light still reaches
you, sparkling as it comes up through your memories. And if
you're lucky as you travel forward through time, you'll bring the
whole of yourself along with you, gathering your skirts and
leaving nothing behind, nothing to obscure the light. But if a
Bad Thing happens part of you is seared into place, and
trapped for ever at that time. The rest of you moves onward,
dealing with all the todays and tomorrows, but something,
some part of you, is left behind. That part blocks the light,
colours the rest of your life, but worse than that, it's alive.
Trapped for ever at that moment, and alone in the dark, that
part of you is still alive.”
 ― Michael Marshall Smith, Only Forward
Learning Objectives:
 Understand the prevalence of trauma in the general
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female population
Learn how to recognize the features of trauma in
women in the clinical setting
Review recent research on the impact of trauma to
the CNS and hormonal system
Review conventional medical treatment of trauma
Explore naturopathic approaches in the treatment of
trauma, including dietary, nutraceutical, lifestyle,
counselling,botanical and homeopathic prescriptions
First, Some Definitions
 Trauma: any experience that interferes with normal
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physiological, mental-emotional, social functioning
PTSD, according to new DSM V criteria (1), includes:
1) Experience of a stressor (acute, chronic, witnessing,
and/or indirect)
2) Intrusive symptoms (1)
3) Avoidance symptoms (1)
4) Negative changes in mood & cognition (2)
5) Changes in reactivity & arousal (2)
6) Duration of sx last more than 1 month
Patient also can have dissociative sx and may have
delayed onset of sx
Prevalence of Trauma
 According to Stats Can, it is estimated that 50% of
Canadian women and 1/3 of men have survived at
least one incidence of sexual or physical abuse (2)
 Even though boys and girls are equally likely to be
exposed to family violence, 4 out of 5 victims of
family-related sexual violence are girls (2)
 Similar findings in US studies
Health Impacts of Trauma
 From the ACE (Adverse Childhood Events) study
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involving 17 000 respondents (3):
Having 4 or more indices of childhood trauma
significantly increases risk of:
Depression
Suicide attempt
COPD
Addiction, including risk of becoming a smoker and/or
alcohol dependent
Liver disease,
Early death and more medical conditions
More Health Impacts
 People with PTSD have increased self-reported
experience of pain and increased impairment in daily
activities to pain (4)
Trauma Changes The Brain
 Lang, a leader in neurobiology of trauma, proposed that
emotionally-charged memories are held in ‘associative
networks’ that impact many different structures and
functions in the brain (5)
 Trauma appears to negatively impact the functioning of
the brain’s cortex as well as brain stem
 In people with PTSD, the prefrontal cortex & particularly
the anterior cingulate (which governs rationality/reason)
is smaller along with shrinking of hippocampus (6)
 Emotionally based memories are stored, too, in the
amygdala and trauma can increase the sensitivity of the
amygdala to non-threatening stimuli (6)
Trauma Destabilizes the
Autonomic Nervous System
 PTSD associated with impaired
parasympathetic control (as measured by
low respiratory sinus arrhythmia) along
with increased sympathetic sensitivity (7 )
 Clinically, this presents as overstimulationbased symptoms (eg. anxiety) along with
under-arousal symptoms (eg. depressed
mood)
Trauma and Neurotransmitters
 Trauma has been associated with lowered GABA
levels especially in the anterior cingulate and this
corresponds with increased insomnia severity
(measured by ISI scores) (8)
 Again, Lang has shown that trauma often induces
dysregulation of serotonin and dopamine pathways
in the CNS (5)
Hormonal Effects of Chronic Stress
vs. PTSD in Adults (6,9,10)
Chronic Stress
PTSD
 Increased cortisol
 Lowered or normal cortisol
 Increased CRF (ie.
 Increased CRF (ie. normal
Abnormal negative feedback
loop)
 Tendency for insensitivity of
glucocorticoid receptors
negative feedback loop)
 Tendency for heightened
sensitivity of glucocorticoid
receptors
Hormonal Impact of PTSD in
Children
PTSD appears to affect children differently:
 Initially (shortly after traumatizing event), high
evening cortisol and elevated IL-6 are predictive of
developing PTSD within six months of event (11)
 Six months after trauma event, cortisol levels return
to normal but catecholamines levels higher (11)
Generational Impact of PTSD
 Adults with PTSD may confer alterations of stress
hormone responses in their children
 Children of Holocaust survivors with PTSD as well as
mothers pregnant during 9/11 who reported
symptoms of PTSD had:
 Lower urinary excretion of cortisol and lower salivary
cortisol levels (compared to children of parents who
experienced these traumatic events but didn’t have
PTSD) (12,13)
Conventional Treatment of
Trauma: Therapy
 Usually involves combination of trauma-specific
therapy and psychoactive medications (14)
 Main therapeutic approaches include:
 EMDR (Eye Movement Desensitization &
Reprocessing)
 CBT, has been shown to be effective in both adults
and particularly with children and adolescents (15)
 Exposure therapy (a form of behaviour therapy)
Therapeutic Approach: Judith
Herman
 Judith Herman published Trauma and Recovery
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(16), a classic book on the healing of trauma
Her approach includes the following steps:
Developing A Healing Relationship
Creating Therapeutic Safety
Remembrance and Mourning
Reconnection
Commonality
Therapeutic Approach: Peter
Levine
 Another classic approach developed by Peter Levin
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takes its inspiration from observations in the animal
world; that is, observing how animals in the wild
respond to acute trauma(17)
Levine’s key elements of trauma therapy include:
Establishing sense of relative safety
Encouraging patient’s self-awareness of body
sensations
Decoupling & discharging body sensations from the
memories of trauma
Conventional Treatment of
Trauma: Medication
 First-line medications include SSRIs and SNRIs (eg.
Venlafaxine/Effexor) (14)
 Second-line medications include tricyclic
antidepressants, mirtazapine/Remeron,
anticonvulsants, and MAO inhibitors
 Adjunct treatment can involve antipsychotic meds,
benzopdiazapines, and Prasozin/Alpha-adrenergic
blocker (15)
Novel Conventional Treatment
of Trauma: Cortisol
 Low dose oral cortisol tx for 4 weeks significantly
reduced the recall of traumatic memories for people
with PTSD (18) without major adverse effects
Novel Conventional Treatment of
Trauma: MDMA & Cannabinoids
 These psychoactive components appear to positively
impact the process of fear conditioning and reduce
anxiety (15, 19)
 This research is in its first stages, and the long-term
effects of MDMA and cannabinoids are unclear
 Nevertheless, these findings may explain in part why
people with PTSD often use psychoactive drugs to
self-medicate
Recognizing Trauma in Clinical
Practice: ‘Red Flags’
 Beyond the typical clinical symptoms of PTSD, look
for:
 “Never Well Since ….”
 Unexplained physical symptoms that do not fit neatly
into diagnostic categories, including recurrent
abdominal pain, idiopathic infertility
 I have found that people with certain medical
conditions are more likely to have a traumatic past,
including endometriosis, fibromyalgia, and BPD
(borderline personality disorder)
Naturopathic Treatment of
Trauma: Initial Steps (20)
 1) Ensure that patient is safe and not at immediate
risk of harming self or others
 2) Where PTSD and/or trauma is significantly
impacting your patient and you determine it is
beyond your scope of practice, refer patient for care
with psychologist, psychiatrist, psychotherapist, or
another practitioner with experience in trauma
 3) Even if referral is made, naturopathic medicine
has much to offer patients in supporting them in
healing from trauma and co-managed care is often
optimal
Naturopathic Treatment of
Trauma: Ongoing Steps
 4) As you continue to work with a patient undergoing
treatment for trauma, it is important to ensure patient
has a crisis management plan. The healing path is
circuitous especially with trauma, and acute distress
can occur.
 5) May be obvious but ongoing self-care for you as
the practitioner is essential because treating patients
with trauma histories can be emotionally intense and
draining
Naturopathic Treatment of Trauma:
Creating Safety in the Clinical Setting
When a patient has disclosed a history of trauma, I
always take care to:
 Clarify what feels safe in terms of physical touch for
physical exams, acupuncture, etc.
 Set very clear professional boundaries
 Remain mindful that it is not always necessary (or
therapeutic) for the patient to divulge details of her
trauma history
 Ensure that the patient feels grounded at the end of
the visit, and leaving adequate time for closure
Naturopathic Treatment:
Adrenal Support
Regular Daily Routine
 Most effective adrenal support is the cultivation of
daily habits done at regular times of the day (ie. Meal
times, sleeping & waking times, time for physical
exercise, etc)
 The mind-body responds positively to the regularity
of routine
 Use Adrenal Tonics over adrenal stimulants in most
cases (21)
Naturopathic Treatment:
Neurotransmitter Support
 Given that trauma appears to disrupt
neurotransmitter function in CNS, replenishing
neurotransmitters can be effective therapeutic
approach (22)
 Also consider use of precursors to neurotransmitters,
including 5-HTP, Tryptophan, P5P, magnesium,
phenylalanine, tyrosine
Naturopathic Treatment:
Mind-Body Approaches
Loving Kindness/Metta Meditation
 Pilot study published in 2013 on lovingkindness/metta meditation sessions lasting over 12
weeks showed significant improvement in PTSD
symptoms immediately at the end of the program
and at the 3-month follow-up (23, 24)
Naturopathic Treatment:
Mind-Body Approaches
Yoga
 Again, small studies involving yoga has shown
moderate positive effect on PTSD symptoms (25,26)
 A pilot study involving women found that women with
PTSD in the yoga group had lowered suppression of
emotional expression and increased psychological
flexibility by the end of the program compared to the
control group, resulting in reduction of intensity of
PTSD symptoms (25)
Naturopathic Treatment:
Body-Focused Therapy
Emotional Freedom Technique (EFT)/ Tapping
 Tapping, or Emotional Freedom Technique/EFT, has
shown promising results for treating trauma in
several small pilot studies (27,28)
 One study done in Rwanda with 50 orphaned
adolescent genocide survivors showed a dramatic
reduction in self-reported and caretaker ratings of
trauma-induced symptoms, including flashbacks,
depression, enuresis, nightmares, and impaired
concentration (27)
Naturopathic Treatment:
Meditation
 A small pilot study (only involving 9 participants)
found that after an 8-week mindfulness-based stress
reduction (MBSR) program, people with PTSD
experienced a significant reduction in PTSD &
depression symptoms, as well as ‘shame-based
trauma appraisals’ (29)
 Also, acceptance of the emotional impact of trauma
was increased over the course of the program
Naturopathic Treatment:
Acupuncture
 Again, some promising results for constitutional
acupuncture in reducing the intensity of PTSD
symptoms (30)
 Range of different protocols have been shown to be
effective, including constitutional acupuncture with or
without electrostim; with or without moxa
 Auricular acupuncture also effective
Naturopathic Treatment:
Acupuncture
 Clinically, I have seen positive impact of NADA
auricular protocol for managing symptoms of PTSD
 NADA protocol includes: Shen Men, Autonomic
point, C. Kidney, Lungs, Liver
 I often add in Point Zero, Brain & Limbic System
 Trauma can clearly damage Kidneys, grief can drain
Lung qi and suppression of emotions and/or anger
can stagnate Liver qi
Naturopathic Treatment:
Flower Essences
Clinically, I have found that flower essences can powerfully
facilitate the healing of trauma
Bach Flower Essences
 Star of Bethlehem – releases shock, useful for acute trauma
 Aspen – removes fears that are not clearly defined
 White Chestnut – heals recurrent upsetting & intrusive
thoughts
 Elm – transforms sense of overwhelm
 Rock Rose – helps to resolve fears that keep patient frozen,
unable to react
 Sweet Chestnut – restores faith/hope that all will be okay
Naturopathic Treatment:
Constitutional Homeopathy
One of my favorite and most effective ways to fortify
and balance the vis, thus helpful in healing trauma
Case #1: 35 year old woman presenting with social
anxiety and dysmenorrhea
 Started in early 20s while in undergrad
 More problematic now that she is in relationship and
has a young daughter; wants to be present and
supportive in her family relationships
 Feels better when doing intense physical exercise;
has recently discovered Crossfit
Naturopathic Treatment:
Constitutional Homeopathy
 Desires to feel strong, powerful and in control, but
knows that this also results in her feeling emotionally
shut down and isolated from others
 During treatment, patient develops an acute
hamstring injury (from overtraining at Crossfit)
 I prescribe acutely Arnica 1M once per day for three
days (31)
 Patient returns with revelation of sexual abuse as
child and sexual assault in undergrad; feels ‘free and
more emotionally open’ in sharing her experience
with her partner and close friends
Naturopathic Treatment:
Constitutional Homeopathy
 Patient continues to respond well to Arnica but I
eventually prescribe a single dose of 10M
 After the 10M dose, the patient’s dysmenorrhea
significantly reduces
 18 months after first taking Arnica 1M (and with
follow-up remedy of Lac-maternum 200C(32), patient
has a child of her own; something she never thought
possible physically or emotionally
Naturopathic Treatment:
Constitutional Homeopathy
Case # 2: 56 year old patient presents with HTN,
obesity, hypothyroidism and FM of 10+ years’ duration
 When I asked for a medical timeline, patient returns with
a chronological history of severe physical and sexual
abuse from ages 3 to 45
 She has several other medical supports including weekly
psychiatrist appointments, reiki practitioner, and First
Nations elder
 Patient also experiences dissociative symptoms in which
she can lose several hours of a day; happens a few times
per month
 Has intense dreams of flying quickly, being at height
Naturopathic Treatment:
Constitutional Homeopathy
 Patient describes FM pain as heavy, constricted
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around muscles and when BP is high, she feels
constricted feeling in chest with palpitations
Patient’s weight has fluctuated greatly in past 10
years, gaining and losing and then gaining 100lbs.
She has had several drug experiences earlier in life
but has been sober for over 10 years
Has intense dreams of flying quickly, being at height
Often has headaches with dissociative episodes
characterized by ‘crushing, constrictive’ pain that is
worse with closing eyes
Naturopathic Treatment:
Constitutional Homeopathy
 I prescribe patient Anhalonium LM4 once per day
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for 7 days in a row (LM because I was concerned
about possible aggravation)
Commonly known as Peyote, member of Cactaceae
family (31)
Keynote sensations: Constrictive, oppressive, heavy
Some keynote rubrics for Anhalonium:
Generalities; pain; crushing, as if
Mind; delusions; enlarged
Naturopathic Treatment:
Constitutional Homeopathy
 In first & second follow-ups (4 & 8 weeks later), she
reports having intense dreams on the first 3 nights of
taking the remedy; all involve her totem animal
showing her book of wisdom and various crystals
 Feels grounded and no dissociative symptoms since
taking the remedy
 FM pain has improved and she is able to exercise
daily
 Reduced appetite and has lost 10 pounds since
taking remedy
Prevention:
Building Trauma Resilience
Key components of preventing traumatic experience
from developing into PTSD/chronic trauma symptoms
(16):
 Access to social support networks
 Placing traumatic event in broader context, giving
the experience a deeper meaning
 Healing by helping others
Prevention: Building Trauma
Resilience
• Interesting genetic research on
neuropeptide Y whose presence
seems to confer a protective benefit
for prevention of chronic trauma(33)
• Mixed results in the research for
traditional talk therapy and
debriefing sessions after traumatic
event as effective means for primary
prevention of PTSD(34)
Spiritual Journey of Trauma
 Intense life experiences, whether positive or
negative, have the potential to transform our lives
 The suppression of traumatic memories and
emotions consumes an enormous amount of energy;
as trauma heals, that well of energy is available for
patient to use
 Levine has observed that when trauma is healed,
patients often have intense spiritual experiences not
unlike the generation of Kundalini energy or Satori
within meditative practices (17)
The Promise of Healing Trauma
“The wound is the place where the Light enters you.”
― Rumi
References
 1. American Psychiatric Association. DSM-V. Arlington, VA;
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American Psychiatric Assoc; 2013.
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