patient population considerations

[khughes]

I’ve noticed differences in the goals/needs in clients (with neural circuit disorders) with extensive trauma/developmental challenges. Wondering what tips/advice you have on working with neural circuit disorders in different populations? I find that people with extensive trauma/developmental wounding often need more regulation skills/rapport/resources prior to focusing on the reprocessing method we are studying in this training. ALso wondering any additional information on how neural circuit training has been studied in lower socioeconomic status clients?

[hschubiner]

Great questions here. We don’t really have all the answers to them though. Alicia has done some work in lower SES populations, but most of my work has been from self-referrals of folks who are already familiar with these concepts.

We did do a pilot study of this work in Las Vegas through United health care insurance company and we did find that it was more difficult to implement these ideas right away. People had a fair amount of other issues, such as life issues that often needed addressing (low economic resources, family issues, job issues, etc.). That seemed to be the most important obstacles. The amount of trauma varies greatly from person to person and we found that we could work with the trauma over time, although we usually did not address that right away.

As far as regulation type work (what a lot of people call calming the nervous system with general approaches, such as breath work, mindfulness, PVT type of work), that can certainly be useful and is often a great way to begin the work, especially when working on explaining the concepts, getting buy in, investigating for evidence of MBS over time; before going into the PRT or EAET work.

Best, Howard

[abatson]

I agree that different people may need different approaches. This work is definitely not cookie cutter and we have to meet the patient where they are. I have worked in community mental health care settings located in underserved areas with underserved populations. Needs of safety come first, so helping a patient obtain needed resources for food, housing, transportation and personal safety usually take priority. After that, if a patient has high levels of anxiety, which often correlates with high levels of trauma (though not always), working on the skill of self-soothing and self-compassion skills comes next. Once they can bring down their anxiety levels so that they are not always in full panic, then they can better focus on how periodic shifts in anxiety and pain correlate with mental/emotional/present stressors. Then, they can begin to do the pain reprocessing therapy work and if that is not resolving everything, I will turn towards the emotional processing work. However, this is just a very general guide. I have also been known to do emotional processing work on the first visit and it has been very affective. Over time, you get a sense of where the patient is and what is driving their danger signal – in the moment. Sometimes, they just need to tell their story – it might be the very first time they have told anyone who took the time to listen. I have worked with homeless who have done well, but they had lower levels of anxiety. I don’t find lower socio-economic status to be a barrier – I really think it depends on the individual and what whether they are open to it or not. Some people associate more biomedical care with being acknowledged and affirmed and are reluctant to consider a non-biomedical approach, feeling like their needs are being ignored or diminished. This is unfortunate, because with more biomedical care and attention, in these cases, the negative outcomes are greater.

[khughes]

THank you Howard and Alicia. THis is very helpful information because there are so many presenting needs in some people. It’s nice to know what works for you all and I”m now getting some skills in co-creating goals with the client about what’s most important to them to address. I listened to the Ezra Klein interview of Rachel ZOfness and heard her quote that trauma is a co-morbidity for chronic pain 80% of the time. I would like to know more about that – it seemed important. Do either of you or any of my esteemed colleagues know more about this? Thank you! Karin

[hschubiner]

Thanks Karin.
There is a great deal of information from the past couple of decades on the relationship between chronic pain and the common mind-body conditions such as fibromyalgia, migraine, IBS, pelvic pain and trauma. This has been shown many times and a good resource for articles on this is PPDAssociation.org bibliography.

It’s often difficult to know if one needs to deal with these traumas in order to recover, as many people recover by having a good assessment, the powerful knowledge that they are not actually physically damaged and using the PRT techniques. But some people definitely need to address that trauma in order to recover. We don’t know who those people are until we get into treatment and see how they respond!

Best, Howard

[khughes]

ok thank you that is an extensive bibliography for sure!

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