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Healing Power of Physical Health

Posted on August 6, 2014

Early on in my study of trauma, I asked myself a simple question: “What makes a stress event traumatizing?”  There seemed to be this invisible line that, if crossed, overwhelmed and traumatized people.  Through my experience, I also realized that if two people went through the same event, one could recover psychologically moments afterwards, while the other would be traumatized for years.  So I dove into books and studies looking for this answer.
One insight I gained from this research was the importance of physical health in both robustness, which is the capacity to perform with success under a wide range of conditions, and resiliency, the ability to recover readily from adversity.  As I put the pieces of the research together, it become clear that physical health is the foundation for social, cognitive, and psychological health.  I also realized that, as a therapist and program director, I paid little or no attention to this critical aspect of healing.  Over the next few weeks, I will present some of my conclusions from this research, starting with this week’s post on exercise. 
Exercise is an interesting subject for me to contemplate.  On one hand, it is one of the most powerful interventions I have found for combating stress (remember trauma is intense stress), improving cognitive functioning, and regulating emotions.  On the other hand, I have to admit that not one client that I ever saw in therapy or in the programs I ran was on an exercise plan.  My focus was always on social or psychological health, spending little or no time on my clients’ physical health.
Why is exercise so important for traumatized or highly stressed individuals, as well as those doing the difficult work of helping others?  Stress is designed to move a person to action.  For most of human history, stress was caused by either the need to secure food or threats to our well-being from predators or other humans.  When we are stressed, our bodies release cortisol and, in intense situations, epinephrine (also known as adrenaline).  These chemicals are designed to shift energy and information from our higher level cognitive functions in the brain to our limbs and other organs needed for surviving threats. 
Most of us have had the experience of driving down the highway and someone swerving into our lane of traffic.  Within a fraction of a second, the brain floods the body with cortisol and epinephrine, allowing you to react immediately to get out of danger.  Once safety is restored, there is usually a moment where you become conscious of these chemicals rushing through your body before your hippocampus signals to your amygdala that the threat has passed, and that higher cognitive functions can retake control. 
During most traumatic events, the amygdala signals for the release of massive amounts of cortisol and epinephrine, creating a hyperaroused state and providing energy for the flight or fight response.  In some instances, usually with repeated childhood sexual or physical abuse, the dorsal branch of the vagus nerve can take over and create a hypoaroused or freeze response, where the body enters a state close to biological death. Hypoarousal could sometimes fool a predator into thinking we were dead and potentially rotting, increasing our chance for survival.  Today, we see this manifest in people who as children had little to no power to stop the abuse they experienced.
When people with Post-Traumatic Stress Disorder (PTSD) re-experience their traumatic memories, the chemicals released during the trauma flood the body once again.  This is why traumatic memories and PTSD can be so devastating – the client must relive the nightmare of their trauma, both psychologically and physically, oftentimes making the memory as powerful as the actual event.  When someone is hyperaroused, this response becomes physical, with the person either attacking or running away from the thing that triggered the traumatic memory.
While exercise alone will not heal trauma, it is becoming an important part of many trauma treatments.  For all of us, exercise can have both cognitive and emotional benefits.  These are achieved by counteracting the cortisol and epinephrine released during a stressful event with the endorphins that are released during physical activity.  Few things I’ve found better cancel out the impact of stress than vigorous activity. 
We are designed to move, and when we do, we can better fulfill our potential as a human.  Those that exercise regularly have improved learning and memory, and their brains are more resilient to the effects of aging and injury.  When we exercise, it boosts the brain’s neurogenesis, or creation of new neurons or brain cells.  Neurogenesis is critical in maintaining a healthy brain and ensuring that our cognitive functioning remains sharp throughout life.  Exercise also gets the cortisol out of our system.  This is important because studies are showing that if cortisol stays in our systems for long periods, it becomes toxic to our brain, leading to all sort of cognitive problems, including Alzheimer’s disease.
Stress can also wreak havoc on our emotional functioning.  Being stressed out over long periods keeps us in the hyperaroused/hypoaroused states.  Feeling a sense of constant threat leads to all sorts of anxiety and mood problems, making it difficult to focus on anything else but the stress.  Exercise again can counteract this by releasing endorphins, which is an opioid and can elicit positive mood states.  One study that really opened my eyes found that 30-45 minutes of vigorous exercise, up to 6 days a week, worked just as well as psychotropic medication for treating depression. 
Exercise helps clients release stress associated with both traumatic memories and the stress of everyday life.  This increased both robustness and resiliency by giving the client more energy to bring to the challenges of their life, while also improving cognitive and emotional functioning.  Potential side effects include looking better and increased self-esteem.  I have yet to find a medication that comes close to the benefits of an exercise program, and yet little funding seems available to explore this option for clients.
Let’s now shift to some recent findings coming out of the trauma research.  There are some promising studies that are showing the power of using exercise to supplement traditional talk therapy approaches.  Trauma can impact the entire body, not just the mind and brain.  The trauma informed movement is demonstrating the power of interventions such as yoga and running as effective treatments for PTSD.
Although studies are still being conducted, it seems that vigorous exercise, such as running, is effective in treating clients whose traumatic memories trigger the fight or flight response.  One study had veterans with PTSD think about the trauma they experienced in battle while running.  This was followed by a session of talk therapy to process the experience.  Initial findings seem to indicate that remembering painful memories while intentionally creating a hyperaroused state (running) takes the power away from the memory.  When we strategically match the natural response (flight) with the stimulus (the memory), the negative energy is released, especially when i
t is processed afterwards with a therapist. 
The second study that I found fascinating relates to those whose default response is hypoarousal.  There is some great research showing that yoga can recreate the freeze response and lessen PTSD symptoms.  Similar to the running example, when clients were asked to hold a yoga pose and recall a traumatic memory, the memory seemed to lose some of its power.  Here, the yoga pose takes the place of the freeze response, and if the person can control the pose, they gain power over the memory.
Other studies have shown that the benefits of running and yoga are good for traumatized clients, regardless of their default response.  Just the general benefit of exercise alone can promote emotional and cognitive healing.  Add to that professionals who are trained in both physical and psychological healing methods, and great strides are being made that are revolutionizing the field of psychology.  Just a note: make sure you are trained in the interventions above before attempting them with clients.  Suggesting general exercise, with a doctor’s approval, is appropriate for most clients.
Finally there is implementation.  “Great, Matt, so now I need to be an expert on physical fitness on top of everything else.”  I get it.  Most helping organizations don’t have the funds or space to create physical activities for their client. 
I thought the integration of physical activity into medical and psychological care was a nice dream, until I got a tour of La Perla de Gran Precioas while I was conducting an HIV Medical Case Management Certificate Program in San Juan Puerto Rico.  At the end of my tour of this community health center, I walked by a beautiful workout room!  It was like the clouds parted, angels sang, and I had found the Promised Land! The staff giving the tour wasn’t even going to mention it, but soon realized that in awe of their facility and how amazing it was that their clients were (most from highly impoverished backgrounds and many who were HIV positive) working out.
It makes logical sense.  A center dedicated to the health of their clients, many of whom might not have the resource for a gym membership or a pair of running shoes, providing an opportunity to improve their health and feel better about themselves.  Their clients also had access to a locker room with showers (my friends who are homeless providers know how important access to showers are for clients).  I imagine the person giving the tour might have thought I was a little crazy with my fascination with free weights and showers, but I know many of you understand this excitement. 

The lesson from La Perla de Gran Precio, who got a grant to build out this facility, is that if we prioritize exercise, there are funders out there.  I’m wondering if anyone in the community has had any success in integrating physical exercise into their programming?  If so please share in the comment section.

2 responses to “Healing Power of Physical Health”

  1. Jake Finger says:

    Loved this post! Any type of physical exertion is often times overlooked. It took me a while to figure out the benefit of exercise during my 15 year tenure in the military. Physical fitness was done daily, and once the country plunged into war, the benefit became apparent. After every hostile contact, without even realizing it, the squad or platoon would choose to either hit the gym or do some other physical activity. Stress levels were reduced and cohesion/morale was reestablished. The orignal question concerning what makes an event traumatizing is the holy grail of trauma it seems. While in combat situations, leaders are charged with knowing their Soldiers-in an effort to know how certain individuals may be able to handle potentially traumatic situations.
    Exercise is truly an asset I believe to management and MH recovery; although finding the availability in a program is difficult. If you have a Peer Support on your program, they are a perfect conduit for an exercise program. I have implemented physical activity with a number of my more severe trauma suffers, and it paves the way for clinical therapy.

  2. Matt Bennett says:

    Also check out a great program at Safe Haven in Nashville called SHINE3: http://safehaven.org/2014/news/shine/

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