This blog post emerged as I saw that it's not always clear what can be done to heal from the effects of trauma. I'd never heard of any of these approaches when I was a family physician and have discovered others over time. The tools I introduce here include books and therapies for healing the effects of many different kinds of trauma. While I focus specifically on chronic illness, these books and approaches are also helpful for mental health conditions and other symptoms including PTSD, depression, anxiety and other effects of trauma.
Trauma and subtle perceptions of threat influence risk for chronic illness and other problems because life experiences interact with our genes to shape long-term health. Therapies for chronic illness and other symptoms work with brain plasticity and these changes in how our genes express themselves can sometimes be reversed (1). The approaches support a nervous system that operates from subtle perceptions of threat and are helpful whether or not you have a known history of trauma.
The modalities introduced below can be used in combination with other tools (medical treatment, medication, complementary and alternative health care, diet, mindfulness, meditation, vagal stimulation etc). They can help you make sense of why one thing works and another does not, why sometimes an approach works for a while and later does not and more. These therapies for chronic illness can also make other modalities more effective. And they support healing when nothing else works.
This page gives you a sense of how to make sense of trauma, what you can do on your own, and what kind of therapies might be a good fit for you. It also offers tips on how to find and choose a therapist and gives you insights to help you find other approaches that appeal to you even if they aren’t listed here (and there are many).
The list comes from research I never learned as a medical doctor. I have tested and used most of the ones described here and they have helped me make sense of – and begin to recover – from my own chronic illness, including understanding flares and decreasing their frequency. Clients and colleagues have made gains using them as well.
Addressing the 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
- childhood trauma such as adverse childhood experiences (ACEs)
- 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
- trauma in your parents’, grandparents’ or other ancestors’ lives
- an infection, which is a common trigger for the onset of all kinds of chronic illnesse
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, therapies for chronic illness can focus or start with a subtle lack of safety or trust; or by identifiying and working with a feeling, such as one 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.
Go Slowly, Gently and Include Your Body I
There are many approaches for healing and working with bodily responses to the perception of threat. The therapies for chronic illness 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.
Books for Working on Your Own
There are many activities that support nervous system regulation that you can start on your own or inexpensively with CDs, videos or online. These are helpful for working with chronic illness as well as mental health conditions and do not imply your symptoms are “all in your head.”
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. I find two of his books to be among the most helpful to learn more about trauma. These are Waking the Tiger (2) and In an Unspoken Voice, which gives an example of how he experienced and worked directly with a recent traumatic event in his own life (3).
It Didn’t Start with You: How Inherited Family Trauma Shapes Who We Are and How to End the Cycle, by Mark Wolynn (4). This is a powerful book that includes some of the science of how trauma in our parents’ and grandparents’ and other relatives’ lives can affect our health. Mark shares stories of unexplained symptoms that were successfully addressed when understood from this context. His book also provides guidance and very specific steps for working with symptoms of all kinds even if you have no sense of trauma in your ancestors’ lives.
Childhood Disrupted is Donna Jackson Nakazawa’s description of the research on adverse childhood experiences (ACEs) and the story of how learning about this set of studies helped her begin to heal (5). She has a number of serious autoimmune diseases that run in the family. Donna shares links between stress, toxic stress and chronic illness, which are slightly different from the trauma perspective, but many similarities exist. Her approaches support nervous system patterns of regulation and include yoga, meditation and mindfulness practice as well as Somatic Experiencing (Peter Levine’s approach, briefly described late in the book).
CFS Unravelled (Rewiring the Nervous System, by Dan Neuffer (6). While this book is about one particular illness, the research I suggests similar patterns drive many other chronic diseases, including type 1 diabetes, multiple sclerosis, rheumatoid arthritis / disease and others. Dan Neuffer recovered from chronic fatigue syndrome (ME/CFS) by supporting nervous system patterns of regulation through many means, including diet, pacing and going slowly, and other mind body practices. These are sometimes sufficient to recover from some chronic diseases. It has not been enough for me, but it’s a valid, inexpensive, empowering place to start. Here’s a video of Peter’s story of recovery and an intro to Dan’s work. I’ve only read his book (first edition) and have not participated in his online program given that I have my own comprehensive and similar set of tools. I’d love your feedback about this and other resources.
Books for Inspiration
The Brain’s Way of Healing by Dr. Norman Doidge (7) 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 (8). 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.
Poetry and Stories About Our Human Journeys. David Whyte talks about self-compassion in this DVD (9)and about the road we travel as humans that includes suffering in so many different guises. His description of The Three Marriages – self, relationship and work – applies to living with chronic illness and how we find our way through acceptance, courage, internal explorations and following that which calls to us most deeply (10).
Free Downloadable Ebooks
Book 1 provides an Overview of the links between chronic illness and trauma, including citations from the research. It describes stories of healing and recovery in asthma, inflammatory bowel disease, chronic fatigue (ME/CFS), autoimmune and other diseases. It also introduces the different types of trauma that affect risk for chronic illness and other health conditions and describes the differences between stress and trauma. Book 2 explains symptoms commonly seen in both trauma and chronic illness. This can make it easier to recognize whether and how adverse events may be affecting you. Book 3 introduces research explaining how the effects of trauma in chronic illness are not psychological.
Therapies for Chronic Illness
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 nervous 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. There are many therapies for chronic illness and therapists who have a well developed set of skills that are also valuable for helping us heal.
Include the Body II
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 therapies for chronic illness 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 (11) and Getting Our Bodies Back (12).
In this kind of work, slower is faster.
Types of Therapies for Chronic Illness
Treating chronic illness using the types of approaches described in this post – 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 who works specifically with chronic illness or who has experience in this area. If that is the case, look for someone with a significant amount of experience working with trauma. This might include
- more years in practice
- extra training in trauma in addition to a degree in counseling or psychotherapy
- trusts or uses the language or intelligence of the body (sometimes called a “somatic” psychotherapist” or “body psychotherapist”)
- who trusts you and your body to have answers rather than having all the answers themselves
- who supports going slowly, gently and at the pace that works for YOU
Ultimately, a place to start is with someone who you feel comfortable with.
Below are highly regarded approaches for healing effects of trauma that are also powerful tools for working with survival reactions, stress responses and a heightened perception of threat. I see them as extremely relevant therapies for chronic illness as well.
There are many other approaches, these are simply the ones I’ve been drawn to and used myself on my own journey and as a therapist.
I have grouped these into approaches for working with different types of trauma. You’ll find an example of what this kind of approach can look like and how it approaches healing and the nervous system in this post.
If you have a chronic illness and no obvious or known trauma history consider starting with therapists who work with general trauma or developmental wounds from childhood. These are helpful approaches for working with subtle nervous system patterns that can help with symptoms of chronic illness:
- General Trauma occurring at any age, including accidents, surgery, loss, abuse, assault, the trauma of having a chronic illness or getting a diagnosis of a life-threatening disease, etc
- Childhood Events, such as loss of a parent, abuse, exposure to domestic violence, having been bullied. This includes but is not limited to the 10 adverse childhood experiences (ACEs), which you can learn about in this blog post.
- Childhood Relationships ie: Developmental Wounds or Complex Trauma, such as 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…
- Pregnancy, Birth and Infancy Events such as 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. These include 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
You can get a sense of the research summarizing general trauma and how it looks in chronic illness in this blog post or in this review of how serious life events increase risk for type 1 diabetes (it will give you examples of types of events that affect risk and an idea of how much research is being done if you don’t have diabetes). This area of trauma includes childhood experiences of abuse, loss of a parent to divorce or death or for some other reason as a child, having parents with issues of substance abuse and more. You can learn about the 10 adverse childhood experiences (ACEs) research in this post.
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 (13).
Therapies for Parent-Child Relationships (Attachment / Developmental Work / Complex Trauma)
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. Here’s an introductory blog post on this topic.
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, IPNB practitioners and Prenatal and Perinatal Therapies (see below) are especially helpful for the healing the effects of experiences such as those described above.
Their book is called Trauma and the Body
Therapies for Multigenerational Events
These therapies for chronic illness 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 (14). This blog post introduces some of my multigenerational history of trauma.
It Didn’t Start with You: How Inherited Family Trauma Shapes Who We Are and How to End the Cycle, by Mark Wolyn is a powerful book that includes some of the science, shares stories, and provides guidance and very specific steps for working with the effects of multigenerational trauma. His work draws from Hellinger’s approach (see below).
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 (15).
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.
Therapies for Events from Pregnancy, Birth and Infancy
These approaches work with trauma from prenatal life, birth, infancy, and very early childhood. Learn more in two blog posts: an introduction to early risk factors in type 1 diabetes followed by more detail and an example of how these therapies work for kids with asthma who have the same risk factors. This will give you insights into how similar approaches can work for adults. Both posts are relevant regardless of the kind of chronic illness you have, since the research is similar for chronic disease and mental health conditions.
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.
Myrna Martin supports adults in the process of healing from perinatal events in a small group formats. She brings her experiences as a nurse, child and family therapist, mother of premature babies, and craniosacral therapist to this work. Her birth process workshops include 6 to 8 individuals and take place in supportive, safe settings over 3 or 4 days. I’ve done 6 or 7 (or more?) of these workshops as well as a 2.5-year training with Myrna and it has been among the most life transforming for me – both in terms of symptoms of fatigue and back pain, as well as in my relationship life, among other areas.
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
Other Approaches & Resources
There are many ways of beginning to heal the effects of trauma. Most of them work with the nervous system in some way rather than purely through talking or cognition or will power. There is no particular one that is the best fit for everyone. You’ll find a number of approaches for healing the brain whether or not you have a history of trauma, such as described in The Brain’s Way of Healing.
Some people, such as holistic therapist Aoife Brown, have had great success in reducing symptoms using energy healing such as sound, emotional freedom technique (EFT), the Emotion Code and others. Many people incorporate movement practices such as yoga, tai chi, chi kung and other practices that inherently support nervous system states that help create greater calm and groundedness. I’ve greatly appreciated other tools as well, including art therapy, for example, with someone who is “trauma-informed” and familiar with how trauma can show up in subtle ways as well as who is familiar with working with the nervous system from their modality.
Other places to look include browsing through the over 1600 comments left on this post from the ACEs Too High website, which focuses on adverse childhood experiences (ACE). Many readers describe modalities they have found very helpful. You’ll also find a list of therapies and supportive resources on David Baldwin’s Trauma Pages, along with a lot more information about trauma.
The important thing to note is that symptoms are not always as solid or fixed as we think. And there are many ways of supporting change and bringing more options and ease into our lives. Follow your intuition and look for resources and therapies that feel like a good fit for you.
I wish you all the best on your journey of healing.