Pathways that support health with chronic illness differ for everyone. Many that work for some of us don’t work for others. Many that work at one point, no longer work after a period of time. The following tools offer another level of support. They can be used in combination with others tools, to make other approaches more effective, and in support of healing when nothing else works. These tools are especially designed to heal from symptoms linked to the perception of threat – overt or subtle, whether or not you have a chronic illness. This page gives you a sense of which approaches might be a good fit for you and how to find, and choose, a therapist.
Whether you have a history of trauma – or not – and you have a chronic illness that is not responding to available treatments or for which no treatment approaches reduce or manage your symptoms well these tools may be of help. This is because chronic illness and symptoms are often influenced by an underlying perception of threat. Not because our diseases are psychosomatic or all in our heads, but because the perception of threat affects how our nervous systems function and how they regulate our physiologies and our bodies.
Whether your chronic illness started gradually, or following an environmental trigger such as an infection, stress or trauma, vaccination, exposure to toxins such as mold or another trigger, these approaches are valuable tools to add to your tool kit.
The support our autonomic nervous systems’ innate capacities to regulate the rest of our organ systems including our immune systems, guts, cardiovascular and energy systems and more.
These approaches are not psychotherapies even though they are commonly referred to as such. They are gentle, specialized ways of working with our nervous systems and biological responses. And they follow the innate nonverbal information conveyed through our bodies that is not accessible to conscious awareness or through talking.
These approaches can help
- make sense of symptoms,
- stabilize symptoms,
- prevent or nip flares in the bud,
- decrease the severity and duration of flares,
- manage living with a chronic illness with more ease and confidence,
- and make space for more joy in your life.
These approaches come from research that lead me to a new way of understanding chronic illnesses than I learned as a medical doctor. I have tested and used them with my own chronic illness and they are enabling me to slowly and steadily improve as well as to make sense of my symptoms and flares. Clients have made gains using them as well.
Table of Contents
- 1 Trauma and Sensitivity to Stress
- 2 Go Slowly, Gently and Include Your Body
- 3 How to Work On Your Own: Books and Exercises
- 4 Working with the Support of Others
- 5 Include the Body
- 6 Introduction to Types of Therapies
- 7 Therapies for General Trauma & Childhood Events ie: One good place to start
- 8 Working with Past or Present Parent-Child Relationships (Attachment / Developmental Work)
- 9 Working with Multigenerational Events
- 10 Therapies for Events from Pregnancy, Birth and Infancy
- 11 How to Choose a Therapist
- 12 What’s Your Experience? Has Therapy Helped?
- 13 Let me know in a comment
Addressing the Often Unconscious Perception of Threat
When you have a chronic illness it is helpful to consider the perspective that symptoms are often a body’s particular way of responding to the perception of threat.
The perception of threat is usually not conscious.
It can be so subtle that you don’t recognize it, even though your body does. And it can be as simple as not feeling safe.
This perception of threat can come from
- an infection, which is a common trigger for the onset of all kinds of chronic illnesses
- work stress
- strain in relationships or with finances
- having had a difficult surgery
- a history of a complicated birth
- the sense of not feeling safe
The perception of threat may link to something you experienced in the past but no longer exists in the present.
Rather than a particular thing or event that can be pinpointed specifically, however, these approaches can focus or start with a subtle lack of safety or trust or a feeling that something bad is going to happen even when everything seems to be going your way.
You can also work with chronic illness from such a perspective by exploring current symptoms, triggers, sensitivities to work stress or to foods or odors or places, for example. Such symptoms serve as a guide.
Having a sense of not feeling secure or of impending doom and other difficult feelings is not a sign that your illness is psychosomatic. It is not an indication that you are crazy, mentally ill or that your chronic illness represents a personality flaw. Such symptoms can be triggered by getting a diagnosis of a chronic illness, the unpredictability or severity of your symptoms, as well as by other difficult life events.
These are an indication that your nervous system may be primed to be more sensitive to stress and to other triggers.
Trauma and Sensitivity to Stress
While trauma is still commonly believed to cause only psychological symptoms such as PTSD, anxiety and depression, this information is out of date (1)Mead, V. P. (2007). Timing, Bonding, and Trauma: Applications from experience-dependent maturation and traumatic stress provide insights for understanding environmental origins of disease. Advances in Psychology Research. A. M. Columbus, Nova Science Publishers. 49: 1-80, (2)Scaer, R. (2005). The Trauma Spectrum: Hidden wounds and human resiliency. New York, W.W. Norton.
Trauma is a significant risk factor for chronic illness and other physical symptoms. It may be overt such as a car accident, abuse, loss of a loved one, surviving a natural disaster or having served in a war. Much of the time, however, trauma is unrecognized because it can be very subtle.
Trauma is a risk factor not because our chronic illnesses are psychosomatic or all in our heads. But because trauma affects our nervous systems, how our bodies learn to respond to stress and the perception of threat, and how our immune and other organ systems are regulated.
Many people with chronic illness have experienced one or more traumatic events in their lifetimes.
A traumatic event may have been the trigger for the onset of your chronic illness. Or you may have had one or more difficult experiences that happened earlier in your life, such as in childhood (see my post on adverse childhood experiences (ACEs)) or trauma that happened even before that during your birth, or multigenerational trauma that has occurred in your family lineage.
There are actually many effective ways of healing trauma that are not familiar in medical practice.
These approaches are designed for working with our nervous systems whether we have histories of overt trauma or experience a subtle perception of threat.
Go Slowly, Gently and Include Your Body
There are many approaches for healing and working with bodily responses to the perception of threat. The ones I list here work specifically with nervous system survival responses while being slow, gentle and emphasizing the importance of going at your own pace.
For those of you who have experienced trauma, it’s not about reliving past events but about finding the health and wisdom that already exists in your body and nervous system. For those of you with no history of trauma these approaches offer a way of unwinding and softening our intelligent survival responses that have become overactive.
How to Work On Your Own: Books and Exercises
The following 3 books offer different ways of healing and working with heightened sensitivity to stress.
Healing Trauma: Restoring the Wisdom of Your Body was written by trauma expert Dr. Peter Levine, who developed the treatment approach called Somatic Experiencing (more below). It includes an introduction to trauma and a series of gentle exercises to start on your own or with a friend or partner. It comes in paperbook and kindle formats as well in audio download formats with a CD and can be taken as an online course. You can also find it at Sounds True.
The Brain’s Way of Healing by Dr. Norman Doidge offers a series of surprising and inspiring stories of people who have improved, stabilized and / or fully recovered from chronic illnesses and physical symptoms. These include blindness caused by an autoimmune disease, MS, Parkinson’s, chronic pain, traumatic brain injuries and others. Most of the approaches described are not specifically oriented to healing from trauma but address nervous system changes by working with the ability of our brains and neurons to heal and recover, even years or decades after an event. This is known as brain plasticity. Some of these changes appear to be linked to patterns of survival and Doidge has compiled a fascinating theory in Chapter 3 that is consistent with what I’ve learned about trauma and how our bodies learn to perceive threat.
Kitchen Table Wisdom, by Dr. Rachel Naomi Remen is one of my all-time favorite books. Rachel was diagnosed with severe inflammatory bowel disease (IBD) in her teens and is a story-teller extraordinaire who communicates and educates in the most connecting and moving ways. Each chapter tells a story and offers a pearl of wisdom from experiences she’s had in her own life or that she’s witnessed with patients as a pediatrician and with clients when she became a counselor. Her stories offer insights into the subtle and profound effects of how life experiences can influence our health and help us on our journeys of healing.
Working with the Support of Others
I have incorporated a number of practices and tools into my daily routine following years of working with my chronic illness. These have helped improve my symptoms of chronic fatigue, IBS, and asthma as a result of healing old patterns and reducing the perception of threat in my own system.
Working on your own can be really helpful. It’s also free, can be done in your timing and in the place of your choosing.
For some, myself included, it can also be challenging. This is in part because the perception of threat can be quite significant once we delve into it. It’s also because living with a chronic illness can be an intense, scary, stressful and overwhelming experience in and of itself. I have thus found that working with someone who can stay regulated and in the present moment, who can remain calm, curious and mindful, and who is connecting can be of great value in this type of work.
Include the Body
Symptoms of all kinds represent our body’s intelligent attempts to maximize our survival, so this work is not about getting rid of symptoms as quickly as we can. Rather, it’s about gently finding other and better ways to defuse and unwind these stress responses as well as to develop resources and other, more effective, coping strategies.
Many symptoms are used by the body as a defense mechanism or physiological attempt to keep a lid on things that are or have been overwhelming. This is not because it’s psychosomatic but because symptoms are driven by our nervous systems.
This can look like a prolonged experience of muscle tension that leads to chronic pain or problems with digestion, for example. Or it may also be the way our blood pressures (or blood sugar levels, or heart rates or energy levels) change as they would in states of fight or flight or freeze.
Working with physical symptoms involves listening to the language of our bodies. It’s about learning to listen with curiosity, self-compassion and nonjudgment.
The following approaches access unconscious nervous system patterns that affect symptoms and operate outside of our consciousness. They do this by bringing awareness to the body and its messages, which includes making room for feelings and thoughts. You can learn more about these types of body-based therapies in The Guide to New Body-Centered Therapies (3)Caldwell, C., Ed. (1997). Getting in Touch: The Guide to New Body-Centered Therapies, Quest and Getting Our Bodies Back (4)Caldwell, C. (1996). Getting Our Bodies Back: Recovery, healing, and transformation through body-centered psychotherapy, Shambhala.
In this kind of work, slower is faster.
Introduction to Types of Therapies
The approaches listed below often focus on trauma. These therapists often specialize in a few areas:
- particular ages & groups such as adults, teens, and children; individuals or families
- types of trauma (PTSD, developmental wounds or attachment wounds from childhood relationships, surgery, anesthesia, childhood sexual abuse, addictions, and others ).
Treating chronic illness using these types of approaches – whether to work specifically with trauma or because you have a sense that your symptoms are linked to a perception of threat – is a pretty new concept.
As a result, you may not be able to find a therapist with a specialty of working specifically with chronic illness or experience in this area. If that is the case, look for someone with a significant amount of experience, who you feel comfortable with and / or who is skilled at helping you go slowly and stay present during the process.
Below are highly regarded approaches for healing from trauma that are also powerful tools for working with survival reactions, stress responses and a heightened perception of threat.
I have grouped these into approaches for working with different types of trauma. If you have no trauma history consider therapists who work with general trauma or developmental wounds from childhood:
- general trauma occurring at any age (accidents, surgery, loss, abuse, assault, the trauma of having a chronic illness or getting a diagnosis of a life-threatening disease, etc)
- trauma in childhood ( loss of a parent, abuse, exposure to domestic violence, having been bullied, …)
- developmental wounds from childhood relationships (growing up with a parent with a mental illness or who is subtly shaming / judging / or simply emotionally unavailable; abuse; loss of a parent or sibling; foster care or adoption, …)
- trauma during pregnancy, birth and infancy (premature or complicated birth, maternal illness during pregnancy, maternal depression in your early life, …)
- mutigenerational trauma, which may have affected parents, grandparents and other family members, even if they have passed (stressful events such as The Great Depression and war, bankruptcy, mental illness, chronic illness, accidents, being threatened due to race, religion, beliefs etc, and more).
Explore approaches that draw or feel appealing to you.
*Note: If getting out of the house is difficult because of limitations due to your health, or if there is no one in your area to work with, you may be able to find a therapist who works by phone or internet. When treating chronic illness from a body-based perspective there are actually many ways a therapist can pay attention to what is happening in the moment and still be highly attuning, connecting and present.
Ultimately, the best guidance on how to choose an approach among those listed below comes from listening to yourself – to your heart, your gut, your intuition. What appeals to you? What draws you or excites you or makes the most sense to you? You’ll know more as you listen and follow your impulses.
Therapies for General Trauma & Childhood Events ie: One good place to start
Somatic Experiencing (SE)
The founder of SE, Peter Levine Ph.D, has two excellent books in addition to the one mentioned above. Both introduce the concept of trauma in a very gentle way as well as how to work with it. These are Waking the Tiger and In an Unspoken Voice. His second book describes how he worked with his own symptoms after an accident.
Their book is called Trauma and the Body.
EMDR (Eye Movement Desensitization and Reprocessing)
EMDR is described on wikipedia; here are lists of practitioners with the EMDR Institute and practitioners with the EMDR International Association.
Brain Spotting (BSP)
I loved Brain Spotting but found that, with this approach in particular, I needed to work especially slowly and with small increments of time and issues.
Internal Family Systems (IFS)
Biodynamic Craniosacral Therapy
There are many other approaches for working with trauma and perception that can be helpful. The key is to find a therapist with an approach for working with trauma that helps you pay attention to sensations or experiences generally outside of awareness that are not in everyday consciousness. While cognitive behavioral therapy (CBT) can be very helpful with managing a chronic illness and coping with symptoms, it works with thoughts and behaviors and is not designed to address underlying trauma and survival patterns held in the autonomic nervous system (5)psychologists and psychiatrists in the field of trauma are finding this based on their studies; see article by prominent researcher Rachel Yehuda, Ph.D. et al. (2016). “What I have changed my mind about and why.” Eur J Psychotraumatol 7: 33768.
Working with Past or Present Parent-Child Relationships (Attachment / Developmental Work)
Experiences that fit into this category include some of the most subtle types of trauma, which often get normalized and overlooked. They can be extremely subtle and shape the way our nervous systems learn to perceive threat and respond to stress. Consider this approach if:
- you felt alone, unseen, or unheard as a child,
- you did not feel a sense of connection or a loving, nurturing, supportive environment in childhood (even if you were well fed and clothed and cared for in material ways),
- you had to take care of your parent(s) or sibling(s) emotionally, physically or in other ways,
- the way to connect with your parent(s) was to suppress your own needs, opinions or feelings,
- there was no one you could talk to and share your deepest feelings when you were growing up,
- there was rarely or never any repair after a parental outburst or verbal attack,
- your relationship with your parents is strained or stressful,
- you have had difficulty in your relationships as an adult (lack of closeness; multiple marriages, separations or divorces …),
- you have strong negative beliefs such as feeling unlovable / unworthy / to blame / overly responsible / a failure / unsafe, …
These examples are indications that early relationships have had some impact on you, whether in a way that was traumatizing or that affected your perception of threat. Learn more about relational trauma in a blog post, “When your ACE score is Zero”.
Sensorimotor Psychotherapy and Prenatal and Perinatal Therapy (#4) are especially helpful for the healing the effects of experiences such as those described above:
Working with Multigenerational Events
These approaches address the effects of trauma or hardship that occurred in your ancestor’s lives, which can be transmitted epigenetically to affect your health even if you never experienced trauma yourself (6)Yehuda, R., et al. (1998). “Relationship between posttraumatic stress disorder characteristics of Holocaust survivors and their adult offspring.” Am J Psychiatry 155(6): 841-843. Full Text..
The Ancestor Syndrome, by offers remarkable information and stories that helped me identify some of my own multigenerational trauma that I hadn’t recognized. As with other trauma work, it is helpful to go slowly and to read it in small doses. You can also read a description of the author’s work in transgenerational psychotherapy.
Family Constellations is an approach to working with multigenerational trauma developed by German psychotherapist Bert Hellinger, who was forced to serve in the German army during World War II, was captured and made a POW in Belgium, and escaped. His approach often uses a small group format and can also be done individually. I have found this work to be very body based and therefore amazing at accessing information that is outside of your awareness.
Hellinger’s website (which I can no longer find) recommends you do a Google search for Hellinger work, Family Constellations or Systemic Constellations to find a practitioner in your area.
Therapies for Events from Pregnancy, Birth and Infancy
These approaches work with trauma from prenatal life, birth, infancy, and very early childhood.
The Association for Prenatal and Perinatal Psychology and Health holds regular conferences, has lots of information on its website and a list of practitioners from around the world who specialize in this area.
Many therapists will have a specific focus in this field, such as working primarily with children and families, or working mostly with babies or adults around their prenatal experiences. Many also work with subtle patterns people develop from early relationships with parents and other adult caregivers.
How to Choose a Therapist
Just as it can take time to find a doctor who specializes in your chronic illness, who treats you with respect and who is also knowledgeable and nonjudgmental, it can take time to find a therapist who is a good fit for you.
Give yourself that time.
Interview or simply talk with a few therapists before deciding (many offer a free initial consultation by phone or in person).
Some ideas of what to aim for when looking for a therapist include the following:
- has many years of experience in working with trauma
- has completed the full training in their specialty
- has done and / or is still doing personal work with their own issues, trauma, perceptions of threat
- has good boundaries
- feels like someone you can trust and feel safe with (this can take time to figure out but should seem possible at first blush)
- is responsive if you need to talk about your experiences of therapy, such as if you have symptoms or side effects after sessions etc
- is flexible, nonjudgmental and committed to helping you hear your own voice (rather than having all the answers themselves about what you should or shouldn’t do)
- is attuning to you and your needs as well as to your pace, rather than theirs etc
What’s Your Experience? Has Therapy Helped?
Have you had any successes with therapy?
Has any particular approach been helpful for you?
Have you discovered ways to decrease your symptoms or sensitivities to stress and triggers (or other chronic illness-related experiences)?
I’d love to hear about it.
Let me know in a comment
References [ + ]
|1.||↑||Mead, V. P. (2007). Timing, Bonding, and Trauma: Applications from experience-dependent maturation and traumatic stress provide insights for understanding environmental origins of disease. Advances in Psychology Research. A. M. Columbus, Nova Science Publishers. 49: 1-80|
|2.||↑||Scaer, R. (2005). The Trauma Spectrum: Hidden wounds and human resiliency. New York, W.W. Norton|
|3.||↑||Caldwell, C., Ed. (1997). Getting in Touch: The Guide to New Body-Centered Therapies, Quest|
|4.||↑||Caldwell, C. (1996). Getting Our Bodies Back: Recovery, healing, and transformation through body-centered psychotherapy, Shambhala|
|5.||↑||psychologists and psychiatrists in the field of trauma are finding this based on their studies; see article by prominent researcher Rachel Yehuda, Ph.D. et al. (2016). “What I have changed my mind about and why.” Eur J Psychotraumatol 7: 33768|
|6.||↑||Yehuda, R., et al. (1998). “Relationship between posttraumatic stress disorder characteristics of Holocaust survivors and their adult offspring.” Am J Psychiatry 155(6): 841-843. Full Text.|