The NeuroPhysiological Response to Trauma

Trauma, a deeply disturbing or distressing experience, can rattle the foundations of our reality, leaving profound imprints on both our psyche and body. It extends beyond the boundaries of our minds and permeates the very fabric of our being, echoing within our nervous system. This article aims to provide a comprehensive exploration of the physiological repercussions of trauma, catering to a broad audience that includes the general public, trauma survivors, and researchers.
The human nervous system, the body’s intricate communication network, bridges our external and internal environments. This dynamic system includes the central nervous system (comprising the brain and spinal cord) and the peripheral nervous system (consisting of sensory and motor neurons). When we experience trauma, this system is fundamentally disrupted.
Typically, when we encounter a threat, our body triggers an automatic “fight, flight, or freeze” response, orchestrated primarily by the amygdala. Our bodies flood with stress hormones like adrenaline and cortisol, our heart rate increases, and we find ourselves in a heightened state of alertness. This is our built-in survival mechanism, preparing us to confront danger or evade it.
However, trauma can distort this acute stress response, transforming it into a chronic condition with lasting effects on brain structure and function. Key regions such as the amygdala, hippocampus, and prefrontal cortex – involved in memory processing, emotional regulation, and executive functioning – undergo significant changes.
Post-trauma, the amygdala, our emotional alert system, may become hyperactive, escalating anxiety and fear responses. The hippocampus, which facilitates memory and learning, might shrink, leading to memory consolidation issues and an inability to differentiate between past and present experiences. The prefrontal cortex, which manages planning, decision-making, and impulse control, may function less efficiently, impairing these cognitive processes.
The continuous activation of the stress response can disrupt the neuroendocrine system, especially the Hypothalamic-Pituitary-Adrenal (HPA) axis. This disruption can lead to a hormonal imbalance, with possible physical health implications, such as cardiovascular disease, gastrointestinal issues, and chronic pain.
For trauma survivors, it’s vital to remember that these physiological alterations have profound societal implications, affecting relationships, self-perception, and societal interactions. Yet, these effects also create a window of opportunity.
Various therapies such as Trauma-Focused Cognitive Behavioral Therapy (TF-CBT), Neurofeedback, Biofeedback, and Eye Movement Desensitization and Reprocessing (EMDR) are designed to address the neurobiological effects of trauma. They provide strategies to process traumatic memories, manage emotions, and rewire the neural pathways associated with the traumatic response, offering potential paths to healing.

Pari Shah

Pari is our newest multilingual clinician who specializes in adult psychotherapy.

Black/African Americans and Mental Health

Why is it that members of the black community are less likely to seek services for mental health? Is it the mistrust in healthcare professionals? Stigma? Cultural barriers? Lack of access? Or is it the safety nest of relying on family, friends and the religious community? Whatever it may be how do we fix it? What other mental hurdles keep black people from seeking assistance? Believe it or not, the list continues. Many will seek help for physical concerns, but not mental disorders. 

The Centers for Disease Control and Prevention’s National Health and Nutrition Examination Survey found that Black and Hispanic respondents had equal or higher rates of depression than Whites. According to The US Department of Health and Human Services (OMH), in 2019, suicide was the second leading cause of death for blacks or African Americans, ages 15 to 24. Black or African Americans living below the poverty level, as compared to those over twice the poverty level, are twice as likely to report serious psychological distress. National Alliance on Mental Illness (NAMI) reports only 1 and 3 black adults with mental illness received treatment.

Stigma comes from the lack of understanding and fear that leads to the reluctance to seek help. It is time to eliminate negative stigmas like only crazy people see shrinks, therapy and sharing your feelings make you weak, it’s a waste of money and the “I can handle it myself” approach. What other negative stigmas associated with black therapy come to mind? Let’s not forget the stigma behind the journey in itself of finding a therapist that can relate culturally. As some stigmas may be more discouraging than others, the time to eliminate them is now.

Knowledge is power. First step to seeking help is to know the signs. Let’s take a stroke episode for an example: You have to know the signs and quickly seek help when the signs first present itself. Signs such as facial droop, one sided weakness and trouble speaking. While mental illness has signs that impact our daily functioning such as poor appetite, loss of interest, feelings of sadness, hopelessness, worthlessness, irritability, increase in risk taking behaviors, racing thoughts and so much more. It is so very important to know the signs.

Let’s change the perspective and encourage ourselves and others to live a happy, positive and successful life. Many black success stories include battles with mental health. Celebrities such as actresses Taraji P. Henson, Jennifer Lewis, hip hop artists Jay Z, Kid Cudi and first lady Michelle Obama – all detailed times in their lives where they sought the help needed and continued to thrive as individuals. 

Treatment is available. Please do not suffer in silence. Acting as if the signs/symptoms are not there will not make it go away. Face the fears and push forward. 

Seek help and reach out to a well-trained mental health professional. Encourage other loved ones to do the same. 

Team work makes the dream work! Each one, teach one! Greatness awaits!


National Institute of Minorities Health and Health Disparities

Constance White, MA, LPC

Constance White, MA, LPC is brilliant clinician who assist clients experiencing general mental health challenges reach their full potential

Finding an Approach in Coping with Trauma

There are many symptoms of trauma. It can be seen as a constant search for a threat that cannot be found, difficulty sleeping, hyperarousal, constriction in the physical body, flashbacks, and disassociation. some individuals experience reduced ability to cope with stress and mood swings.

What is trauma?

The Diagnostic and Statistical Manual Fifth edition – Text Revision (DSM 5-TR), which psychotherapists and psychiatrists use as a diagnostic tool, would suggest that trauma,

“is caused by a stressful occurrence, which is outside the range of usual human experience, and that would be markedly distressing to almost anyone.”

It is a

“serious threat to one’s life or physical integrity serious threat or harm to one’s children, spouse, or other close relatives or friends; sudden destruction of one’s home or community seeing another person who is or has recently been seriously injured or killed as the result of an accident or physical violence.”

While the diagnostic criteria in the DSM 5-TR may not be wrong, some experts would argue that it is vague and that there is more to consider what is trauma. Like any definition, this is subjective to a person’s experience. Several experts would argue that surgeries, falls, a diagnosis, abuse, and shootings are outside the realm of usual human experience. This would suggest that a traumatic event may be more than a feeling than a mere subjective definition on paper. 

Clinicians who use the Trauma Resiliency Model may argue that symptoms of trauma stems from the frozen residue of energy that has not been resolved and discharged. The natural autonomic, defensive, response could be a stuck response. This stuck residue of energy can pop up when a person has a memory of what has happened, leading to a reaction, to a triggering event. In turn, this energy remains trapped in the nervous system if not managed or released. Furthermore, this frozen energy, such as a tight feeling in the chest, a feeling frozen when triggered, or the need to fight or run away from the triggering situation.

What physiologically happens in someone who has experienced trauma?

Research has shown that an excess of cortisol and adrenaline is released into the body. An individual who has experienced trauma takes the excess of cortisol and adrenaline and automatically fights, flights, freezes, or fawns. Furthermore, memories, triggers, or stressful events can create havoc on our minds, bodies, and souls. Due to the resulting release of excess cortisol and adrenaline, it mobilizes resources from the gut, immune system, elimination system, and parts of the brain responsible for cognition, decision-making, and other higher functions. This energy gets placed into muscles to fight or run for one’s life. Other negative impacts of the stress response can be seen in memory, digestion, concentration, as well as the elimination of toxins.

A study conducted at UCLA suggests that when someone is triggered less, it slows the aging process in their brain. Therefore, being triggered more creates more aging in the brain and can compromise the immune system, as stress hormones inhibit the immune system. All of the above can happen when a triggering memory has been brought to the present. Rosenfield concludes that the memory can be misleading, “it is not fixed images that we rely on, but recreations, imaginations, the past remolded in ways appropriate for the present.” 

Consequently, if in a traumatic situation a maladaptive response (fight, flight, freeze, fawn) is never completed in a threatening situation, the nervous system is trying to search for an appropriate response to an inappropriate situation. According to Peter Levine, as we become more desperate to find an appropriate response, we begin to select any image around us at the time of the traumatic situation, which becomes a memory. These images then become related to similar future emotional state but are not useful to one’s survival.

Therefore, a past memory in a current situation can seem more real than life itself. This has been referred to as a trigger, which can cause flashbacks. In healing work, “the relationship that we have with our memories” may be a key to change. Becoming unattached to symptoms, and “release[ing] them from our minds and hearts along with the energy that is locked in our nervous systems” describes the healing process.

When an individual experiences a traumatic or difficult situation, the body releases an excess of stress hormone and reaches for anything as an appropriate response to feel safe, which creates a memory. In turn, the memory creates the future physiological responses that experts call trauma responses.

How do we heal and feel better to deal with these trauma responses?

There are various types of therapies proven to assist in trauma. It is up to the client to do what feels like the right fit for them, while remembering there is no “right” way to heal. Yoga or breath work can slow down the nervous system. Emotional Freedom Technique requires one to tap, access, and release emotions, while speaking the truth. Eye Movement Desensitizing and Reprocessing (EMDR) is used to process the past through the use of techniques to heal the physical and mental state of trauma.

Meditation is just as powerful through the discovery of inner peace. While also, belief can shift biology as in Cognitive Behavioral Therapy (CBT). Neurofeedback and Biofeedback is also another efficacious therapeutic strategy, with the focus on neurological origins of trauma and Heart Rate Variability. Some would go to a shaman or other holistic healers and use energy work or herbal-based medicine. Science continues to explore the aforementioned therapies and healing practices; some practices have more data to support the efficacy while others are emerging in science to determine why these therapies are successful. 

The use of Yoga in Trauma Therapy

In the traumatic state, which has been activated in amygdala and the prefrontal cortex and is inhibited by stress, asking somebody to rationalize or think through their response when they are (in an acute) state is asking them to do something of which they are temporarily, neurologically incapable. Therefore, for some, focusing on breath and movement of the physical body awareness is a way to shift active stress.

One study suggests in an active state of stress, one can learn to calm down by learning a set of skills including Tracking, Resourcing, Grounding and Gesturing, Help Now and Shift and Stay. This study mentions something akin to what in Buddhist terms would be described as mindfulness of the body. This state of mindfulness can help calm and stabilize the nervous system. Yoga Nidra is a specific (still and gentle) type of yoga, which has been used to treat PTSD symptoms such as anxiety, insomnia, and depression.

Programming the autonomic nervous system, changing beliefs, and thus neuropathways in the brain can shift biology to feel better. It is proven that releasing emotional and physical blockages leads to healing. There are many treatments, it is the preference and which therapeutic style fits with the needs of the client. Whether it is practicing yoga, lifting weights, attending counseling, burning old letters, or throwing eggs at trees to release energy, is up to to the client. Finding the approach to healing and coping with the memories, felt-sense, reactions, and held emotion is key to healing and the understanding and releasing the trauma. The client is not the emotion or feelings, trauma is not a life sentence. With the correct tools and support one can feel better and live a life of wellness past the trauma.


Compson, J. (2014). Meditation, Trauma and Suffering in Silence: Raising Questions about How Meditation is Taught and Practiced in Western Contexts in the Light of a Contemporary Trauma Resiliency Model. Contemporary Buddhism15(2), 274–297.

Diagnostic and statistical manual of mental disorders : DSM-5-TR (5th edition, text revision.). (2022). American Psychiatric Association Publishing.

            Levine, P. A., & Frederick, A. (1997). Waking the tiger : healing trauma : the innate capacity to transform overwhelming experiences. North Atlantic Books.

Merriam-Webster’s collegiate dictionary. (Eleventh edition.). (2003). Merriam-Webster, Incorporated.

Miller, R. C. (2015). The iRest program for healing PTSD : a proven-effective approach to using Yoga Nidra meditation & deep relaxation techniques to overcome trauma. New Harbinger Publications, Inc.

Rosenfield, I., & Rosenfeld, A. H. (1988). Rosenfield, Israel. The Invention Of Memory: A New View Of The Brain // Review [Review of Rosenfield, Israel. The Invention Of Memory: A New View Of The Brain // Review]. Psychology Today22(5), 68–. Sussex Publishers, LLC.

Schalinski, I., Elbert, T., Steudte-Schmiedgen, S., & Kirschbaum, C. (2015). The Cortisol Paradox of Trauma-Related Disorders: Lower Phasic Responses but Higher Tonic Levels of Cortisol Are Associated with Sexual Abuse in Childhood. PloS One10(8), e0136921–e0136921.

Van der Kolk, B. A. (2015). The body keeps the score : brain, mind, and body in the healing of trauma. Penguin Books.

<a href="">Rebecca Caliendo, MM</a>
Rebecca Caliendo, MM

Rebecca is a senior clinical intern at TriWellness and has been teaching yoga and mediation for six years. Her clinical focus is on using yoga and evidence-based clinical therapies in her work with clients.

Seasonal Affective Disorder

December is Seasonal Affective Disorder (SAD) Awareness month, and we want to bring more awareness to this aspect of depression. Seasonal Affective Disorder is a type of depression where significant mood and behavior changes happen with the changes in the seasons, usually late fall or early winter and improve in the spring and summer, or vice versa. The seasonal changes in mood are not a full diagnosis, it is s specifier for depressive disorders and it is important to be aware of those changes. Here are some symptoms of depression to watch out for: 

Symptoms of major depression may include:

  • Feeling depressed most of the day, nearly every day
  • Lack of interest in activities you once enjoyed
  • Experiencing changes in appetite or weight
  • Having problems with sleep (too much or too little)
  • Feeling sluggish or agitated
  • Having low energy
  • Feeling hopeless or worthless
  • Having difficulty concentrating
  • Having frequent thoughts of death or suicide

In order for SAD to be diagnosed, the above depressive symptoms have to have a noted relationship with a particular the time of the year for at least 2 years and be more of a presence during that time of the year than any other times of the year. Here are some depressive symptoms that are often characteristic of SAD:

  • Loss of energy
  • Over-sleeping
  • Overeating
  • Weight gain
  • A craving for carbohydrates

An important distinction in the diagnosis of SAD is whether there are external factors that are impacting the change in mood, such as changes in school or seasonal employment status. It has also been noted that winter-type seasonal pattern occurs more in women than in men, in younger people more than older people, and with people who live in higher altitudes; having another mental health condition also increases the likelihood of developing SAD. Treatment for SAD often includes 

  • Antidepressant medication
  • Vitamin D
  • Light therapy
  • Psychotherapy


American Psychiatric Association. (2022). Diagnostic and statistical manual of mental disorders (5th ed., text rev.).

During this time of year there can be an increase in depressive symptoms which can greatly impact your ability to function, here at TriWellness we can help you develop the skills to manage this low mood. 

This month’s blog post was written by our Chronic Illness Specialist Jessie Duncan, MA, LPC, NCC.

Native americans and HealthCare

Traditional Medicine

Throughout history, different tribes have different rituals for healing following what is called the bio-psycho-social-spiritual model. Tranditional healing practices involve the balance of the physical, mental, social, and spiritual factors in life. Ceremony is an important part of healing as it incorporates the Spirit, Creator, and the Universe. Alaskan Native, Hawaiian Native, and Native American healers utilize indigenous plants to heal conditions from muscle aches to diabetes. Healers of the Nation utilize their tribal Medicine Wheel that represents the four directions along with Father Sky, Mother Earth, and the Spirit Tree. The Medicine Wheel’s four directions connect the life stages (birth, youth, adulthood, and death), life aspects (physical, intellectual, emotional, and spiritual), the seasons (spring, summer, autumn, and winter), along with other factors connecting one to nature. Movement along the Medicine Wheel also is a reflection of one’s connection to nature, as one moves along withe Medicine Wheel in the same direction the Sun moves across the sky, East-West, in a clockwise direction (Native Voice: Healing Ways).

History of American Indigenous People and Healthcare

Native Americans healers would utilize the aforementioned healing practices, however once the western people arrived to the American shores, they also brought diseases that the Natives were not immune. As a result of the lack of immunity, an estimate of 90% of the population, prior to colonization, perished.

The Indian Health Service (IHS) was established on July 1, 1955 under the Public Health Service for the betterment of healthcare for Native Americans. The IHS was responsible for providing healthcare to Native Americans in accordance to the Synder Act of 1921 and the later Indian Healthcare Improvement Act (IHCIA) of 1976 (Baciu et al, 2017). However, the IHS mission was not always realized and had a documented unethical practice. In 1976 the General Accounting Office (GAO) found that in a span of three years, Native women ages 15-44 years old were subjected to involuntary forced sterilizations. This unethical practice and several other clinical misconducts along with genocide, ethnocide, and trauma has fostered mistrust in the American healthcare system (Pacheco, et al, 2013).

Native American Healthcare Today

Despite the advancement and access to healthcare, Native Americans continue to experience disparities. Their average lifespan is 73 years in comparison to the 78.5 years for the rest of Americans. Indigenous people in the US also have higher rates of impact from liver disease, chronic respiratory diseases, and the recent Covid-19 pandemic (Stanley, 2020).

However due to the mistrust in the American healthcare system, the improvement of these disparities are challenging to say the least. The Indian Self-Determination and Education Assistance Act (ISDEAA) of 1976 and the subsequent amendments place the power back to the Native Americans. They have the option to receive or decline healthcare services from the IHS. By placing the power with the people, the leaders of each tribe can determine their need or even desire to contract with IHS. However a factor that continues to impact the efficacy of the IHS is insufficient funds (Baciu et al, 2017).

Many tribes within the Nation have also reintroduced the traditional healing practices their ancestors utilized. In Hawaii, some communities have adopted the Waianae Diet, or the “Pre-Captain Cook Diet”, where the focus on the reduction of preservative, fatty, and high-caloric foods to promote a healthy living. Furthermore, several tribes have also opened up their Powwow to the public and invite non-natives to healing ceremonies to engage in the aforementioned traditional healing practices.


Koithan M, Farrell C. Indigenous Native American Healing Traditions. J Nurse Pract. 2010 Jun 1;6(6):477-478. doi: 10.1016/j.nurpra.2010.03.016. PMID: 20689671; PMCID: PMC2913884.

National Academies of Sciences, Engineering, and Medicine; Health and Medicine Division; Board on Population Health and Public Health Practice; Committee on Community-Based Solutions to Promote Health Equity in the United States; Baciu A, Negussie Y, Geller A, et al., editors. Communities in Action: Pathways to Health Equity. Washington (DC): National Academies Press (US); 2017 Jan 11. Appendix A, Native American Health: Historical and Legal Context. Available from:

Native Voices: Healing Ways (Retrieved Nov. 2022).

Pacheco CM, Daley SM, Brown T, Filippi M, Greiner KA, Daley CM. Moving forward: breaking the cycle of mistrust between American Indians and researchers. Am J Public Health. 2013 Dec;103(12):2152-9. doi: 10.2105/AJPH.2013.301480. Epub 2013 Oct 17. PMID: 24134368; PMCID: PMC3828980.

Stanley, B. ‘Many Years To Overcome’: A Brief History of Native American Health Care Disparities. The Rotation. 2020 Aug.

This month’s blog post was written by our Chronic Illness specialist, Aarti S. Felder, MA, LCPC, BCN.

Breast Cancer and its Impact on Mental Health

Overview of Breast cancer

Breast cancer is a common cancer that impacts mostly women, but has a history of impacting 1% of men. Breast cancer is characterized by the formation of cancer cells in the breast tissue. Some common symptoms of breast cancer are lumps within the breast tissue, changes in size, shape, or appearance, changes in skin around the breast and nipple. Regular mammograms and self-examinations can assist in early detection and resulting better prognosis (Mayo Clinic, April 2022).

Breast surgeon, Dr. Judy C. Boughey, M.D. explains breast cancer.

Types of breast cancer

There are eight types of breast cancer.


  • Cancer cells in the lining of blood vessels and lymph vessels
  • This a a rare cancer

Ductal carcinoma in situ (DCIS)

  • Abnormal cells in the milk duct
  • Earliest type of breast cancer that is noninvasive, and has a low risk of spreading


  • A type of breast cancer that develops rapidly
  • Symptoms include red, swollen, and tender breasts
  • This is a rare cancer

invasive lobular carcinoma

  • A cancer that begins at the lobules of the breast (the milk producing glands)
  • These cancer cells have the ability to spread to the lymph nodes and other areas of the body

Lobular carcinoma in situ (LCIS)

  • Abnormal cell formation in the lobules
  • Not a cancer, however individuals with this diagnosis have an increased risk of developing breast cancer
  • This is an uncommon condition

Male Breast Cancer

  • Cancerous cells in the male breast tissue
  • This is a rare condition

Paget’s Disease of the Breast

  • The disease starts at the nipple and extends outwards to areola
  • This condition is a rare type of cancer

Recurrent Breast Cancer

  • Breast cancer that reoccurs after treatment
  • Cancerous cells evade treatment

Risk Factors that impact Breast Cancer

The following are risk factors that can affect the development of breast cancer. However, having one or more of the following factors, does not necessarily imply that one will develop breast cancer.

  • Physically a female
  • Older in age
  • Personal or family history of breast cancer
  • Genes (BRCA1 & BRCA2 are known genes that increases the risk of cancer)
  • If you have been exposed to radiation
  • Obesity
  • Start of menstruation before 12 years old
  • Starting menopause at a later age
  • Having your first child after the age 30 or not having been pregnant
  • Postmenopausal hormone therapy
  • Drinking alcohol

Prevention and treatment

Breast cancer prevention involves lifestyle changes from diet and movement, and regular self exams and breast cancer screenings. In cases of high risk, your physician may recommend preventive medications or surgery.

Despite risks and prevention, sometimes an individual may still develop breast cancer. Due to intensive research, there are several treatments available.


There are several different types of surgeries which is contingent on the severity of the breast cancer. Lumpectomy is utilized to remove the specific region around the tumor. A mastectomy is the removal of the entire breast, depending on the spread of the cancer it may involve the removal of both breasts. Another type of surgery involves the removal of certain lymph nodes; the amount of lymph nodes removed depends on the spread of the cancer. After the removal of the tissue, some patients may want to get a referral to a plastic surgeon for reconstructive surgery.

Radiation Therapy

Radiation therapy is another treatment strategy used to treat cancer. It involves x-ray or proton energy that targeted to the infected region. These beams of energy can be externally implemented or internally implemented, as in brachytherapy. Common side-effects of radiation therapy are fatigue, swollen or redness around the targeted region


Chemotherapy is a type of cancer treatment that involves utilizing medication to treat the cancerous cells. This treatment may be used prior to surgery to decrease the size of the tumors in the breast tissue. Other times, chemotherapy may be used post-surgery in high risk cases of the cancer returning. Chemotherapy is also used to treat cancer that has spread to other areas of the body. This treatment is known to have several side effects, from hair loss to vomiting, and a compromised immune system.

Hormone Therapy

Hormone therapy blocks certain hormones, mainly estrogen or progesterone, depending on the specific cancer. Much like chemotherapy, this treatment may be used before surgery (to shrink the tumor), during, or after surgery. This treatment have several side effects depending on the type of treatment received. Common side effects are hot flashes, vaginal dryness, or night sweats.


Immunotherapy is a type of therapy that utilizes the patient’s own immune system to attack the cancer cells. This therapy impedes the cancer from hijacking the patient’s immune system. Immunotherapy is effective in cases where the patient does not have receptors for estrogen, progesterone, or HER2.

Targeted Medications

This type of treatment strategy uses specific medications to target specific abnormalities in the infected cells. Through research, scientists have found specific abnormalities called the HER2, this is type of protein that assists the cancer cells to grow and survive. By targeting the HER2, it can attack the protein without harming the healthy cells and restricting the growth of cancer cells.

the impact of diagnosis on mental health

Receiving the diagnosis of breast cancer and the subsequent treatments can understandably impact one’s mental health. From experiencing the stages of grief of what was to the treatments’ side effects as well as the impact of the treatment on the patient, there are several areas that can influence the patient’s and their family’s mental health.

Mood changes

One’s mood can be impacted at any stage of breast cancer. In the initial stage of being diagnosed with breast cancer, it can come as a shock if it was a sudden diagnosis. Some patients and their families noted experiencing The Kübler-Ross Five Stages of Grief or anticipatory grief. Certain aforementioned treatments can impact mood by causing hormonal changes, resulting in fluctuations in mood.

Other treatment strategies can also affect mood as a result of the physical side-effects. Increased fatigue and decreased energy can result in depressed mood due the lack of engagement in previously enjoyable activities, energizing movement activities, or general functionality. Surgery can affect how one view’s themselves which impact their self-esteem and mood.


Anxiety is another common mental health condition connected to the diagnosis and treatment of breast cancer. Patients may experience concern and worry about their prognosis and the impact of treatment. Some people who have experienced recurrent breast cancer or other cancers may feel anxious about the effectiveness of treatment this time.

Some individuals who have experienced recurrent breast cancer or other cancers may also experience medical trauma. Medical trauma is an experiential response to pain, serious illness, and medical procedures. Considering that breast cancer can lead to a person feeling a sense of shock, loss of the sense of control, life-altering or even life-threatening treatments/prognoses, and conditions experienced at the hospital and with clinicians, patients develop medical trauma.

Strategies for managing mental health

As important it is to seek medical treatment for breast cancer, it is also important to take care of one’s mental health. As previously mentioned, there are several factors that can impact a patient’s and their family’s mental health. It is important to seek help.

Community support groups are a great resource for patients’ and their families to support each other and to receive support in difficult times. In the Chicagoland area, Lurie Cancer Center lists several local support groups. The National Breast Cancer Foundation also provides some resources on finding support groups nation-wide. American Society of Clinical Oncology also provides some international resources and support in several languages for several different types of cancers.

Individual or family therapy is another strategy that can assist patients and their families cope with the mental health conditions that impact them. In therapy, individuals will have a safe space to process their diagnosis, prognosis, treatment process, and other aspects that may arise during the process. Therapist also assist individuals in the development of coping strategies to manage whatever stressors may arise outside of therapy.


Breast Cancer

How Breast Cancer can Affect Mental Health

On Death & Dying: What the Dying Have to Teach Doctors, Nurses, Clergy, and Their Own Families. 50th Anniversary Ed., Dr. Elisabeth Kübler-Ross, Aug 2014.

Elisabeth Kübler-Ross Foundation

Anticipatory Grief: Mourning a Life before it’s Gone, A. Drakulich, 2021.

Public Fact Sheet for Medical Trauma Survivors

Receiving the diagnosis for Breast Cancer can be challenging, however you are not alone. Clinicians at TriWellness are trained in health psychology can provide assistance in this difficult time.

This month’s post was written by our Chronic Illness specialist, Aarti S. Felder, MA, LCPC, BCN.


“You are not lucky to be here. The world needs your perspective. They are lucky to have you.”

– Antonio Tijerino, President & CEO of the Hispanic Heritage Foundation

Each year from September 15th to October 15th, National Hispanic-Latino Heritage month is recognized. This month is to celebrate the rich histories, cultures, and contributions of people whose ancestors come from Mexico, the Caribbean, Central and South America, and Spain. This month originally started as Hispanic Heritage Week in 1968, and was expanded to a full 31-days in 1988. The month begins on September 15th because that is the anniversary of the independence of Costa Rica, El Salvador, Guatemala, Honduras, and Nicaragua; Sept 16th is the anniversary of Mexico’s independence, Sept 18th
is the anniversary of Chile’s independence, and September 21st is when Belize declared its
independence; also Día de la Raza is on Oct 12th falling within the month.

Now the terms Hispanic and Latino encompass 62.1 million people (18.7% of the population in 2020) and has been steadily increasing for the past few decades. Originally the term “Hispanic” came from United States census’s need to categorize people and the term was used for “Americans who identify themselves as being of Spanish-speaking background and trace their origin or descent from Mexico, Puerto Rico, Cuba, Central and South America, and other Spanish-speaking countries.” This excluded Brazil as it is a Portuguese-speaking country even though it is part of South America. There is a lot of discourse about the term “Hispanic” because of the fact that it highlights the colonial legacy of these diverse countries, especially with the emphasis being on Spanish-speaking. There is also discourse around the term “Latinx” when used to describe this community because of how gendered terms are in Spanish, and because Latinx came from academia and not the community; Latine or Latin are often preferred, but there is no consensus because this community is full of different people with different opinions.

It’s easy to see how this diverse group is often lumped into one by the dominant culture, because that’s easier than having to learn the histories and cultures of 45 countries in the Caribbean and Latin America. There are many cultural strengths seen in this community, but that implies that the whole community is a monolith. Each of these countries has a culture, history, and people groups that existed before colonization, was impacted by colonization in different ways, and have developed into their modern way of being in different ways.

These things can lead to vastly different experiences in the United States that can impact mental health. For example, the stress and/or trauma of immigrating to the U.S. would be different for a person coming from Honduras seeking asylum at the southern border compared with someone coming from Puerto Rico which is a U.S. territory. For either of these people, if they were Spanish-speaking, wherever they ended up it would often be assumed that they are a Mexican immigrant, a common microaggression. There are also the impacts of other forms of discrimination such as colorism and racism. The stresses of these experiences can cause psychological and physical harm. This can include physical affects like headaches, muscle tension or pain, chest pain, fatigue, stomach issues, and sleep problems; mood issues like anxiety, restlessness, lack of motivation or focus, feeling overwhelmed, irritability or anger, and sadness or depression; or behavioral issues like over- or under- eating, angry outbursts, drug or alcohol misuse, and social withdrawal. There can also higher risk for issues such as diabetes, substance use, high blood pressure, cardiovascular disease, and autoimmune disorders. This can also impact interpersonal relationships and the ability to have strong social support. Often in communities of color, it is seen as a weakness to be dealing with mental health struggles which can lead to further isolation and further issues.

“Acknowledge and embrace the person you are, imperfections and all. That’s the highest service we can achieve: to give back and give to ourselves in the best way we know.”

-Dr. Paul Bonin Rodriguez

Living in a society that ignores your needs and piles stressors on makes it hard, but there are ways to approach healing despite that. First looking at the strength that is to be found within many cultural values such as family connections, community connection, respect, trust, and dignity.
Here are some suggestions to begin individual healing:

  • Take care of your physical health
    • Eat healthy and get 7-8 hours of sleep
    • Stay physically active by making space for joyous movement in your life
    • Explore relaxation techniques such as deep breathing
  • Connect with a community that will reaffirm your humanity in a society that dismisses it
  • Seek out healing practices consistent with your beliefs
  • Take breaks from technology and social media

This process can be difficult but important for one’s wellbeing and functioning. You have the skills to heal, and we can help.

Adames, H.Y., & Chavez-Dueñas, N.Y. (2017). Cultural foundations and interventions in Latino/a mental health: History, theory, and within group differences. New York, NY: Routledge Press.

This month’s blog post was written by Jessie Duncan, MA, LPC NCC, our Chronic Illness and Lantinx Mental Health Specialist.

Sleep and neurofeedback

Come Sleep! O Sleep, the certain knot of peace, 
The baiting-place of wit, the balm of woe, 
The poor man's wealth, the prisoner's release, 
Th' indifferent judge between the high and low. 
With shield of proof shield me from out the prease 
Of those fierce darts despair at me doth throw: 
O make in me those civil wars to cease; 
I will good tribute pay, if thou do so. 
Take thou of me smooth pillows, sweetest bed, 
A chamber deaf to noise and blind to light, 
A rosy garland and a weary head: 
And if these things, as being thine by right, 
Move not thy heavy grace, thou shalt in me, 
Livelier than elsewhere, Stella's image see.
-Sir Philip Sidney

The importance of sleep

Sleep is an important function of all living creatures, everyone in the animal kingdom has some variation of a sleep wake cycle. However why is sleep so important in humans? Research has shown that sleep has many functions.

Sleep helps us to consolidate what we have learned into memory through acquisition (information introduced to our brain), consolidation (the process of memorizing the information in the brain), and recall (information being brought up in any mental state). Those who have impaired sleep, can have impacts on memory and learning (Healthy Sleep, 2007).

Another example of the importance of sleep is its impact on mood. Having a good night sleep can lead to feeling energized, motivated, and content. In the reverse, impaired sleep or insomnia can lead to irritability, increased stress, or even the development of a mood disorder (Get Sleep, 2008).

Sleep also has an impact on body restoration. Certain hormones are released during sleep that is responsible for tissue repair and muscle growth. Another restorative factor sleep can assist in cognitive functioning, which may impact in learning and memory. Recent research has also found the importance of sleep on Neuroplasticity.

We previously believed in the idea that if we don’t use certain neurons through practice our brain loses the capacity to use it in the future (use or lose it principle). We now know that it isn’t true, as our brain has what is called Neuroplasticity, which the brain’s ability to form new neurological connections. We do this in everyday life, from learning something new (even if it is small), to sleep, to psychotherapy. We are making new neurological connections without realizing it! Proper sleep helps strengthen and these newer neurlogical connections.

Conditions that effect sleep

Knowing that sleep is very important and its impact that it can have on our brain, mind, and body, what happens when certain conditions impair sleep?

Mental Health CONDITIONS

There are several mental health conditions that can impact sleep. Anxiety, for example, can severely impact sleep. During the first part of the pandemic, many people were experiencing fear, uncertainty, stress, and many other emotions that naturally turned into anxiety. When one is feeling anxious their mind can race, especially while laying in bed trying to fall asleep. As a result of the anxiety, many individuals struggled to get enough sleep which could also further impact their mood.

Another symptom of anxiety that impacts sleep is hyperarousal, the state of being excessively alert. Therefore, when one is trying to sleep while also experiencing hyperarousal, they may be quick to awaken from even the smallest of stimuli (hearing a small thud from the apartment above, for example) and ready to react. 

Certain types of anxiety can also lead to nightmares. Post-Traumatic Stress Disorder and other anxiety and stress disorders can cause night terrors and nightmares that can impact a person’s relationship to sleep. Due to the fear of having night terrors or nightmares, one can also experience anticipatory anxiety.

Depression is another mental health condition that can impact sleep. Depression can impair sleep as well as sleep can impact depression. Due to this relationship, it can be difficult to know which condition caused which symptom. Depression is characterized by experiencing sleep-related symptoms of insomnia, hypersomnia, as well as having abnormal levels of Serotonin, a neurotransmitter that is important for regulation of sleep as well as other bodily functions. 

Medical conditions

There are also several medical conditions that impact sleep. In fact, there are several sleep disorders that can be treated with medication or devices, such as Sleep Apnea, a disorder that is related to breathing disruptions, and Narcolepsy, a sleep disorder related to regulation of the sleep-wake cycle. These are just a few types of sleep disorders, however there are many more conditions that fall under the umbrella of sleep disorders. There are also several chronic medical conditions that impact sleep.

Inflammatory chronic conditions such as, Arthritis, Fibromyalgia, and Inflammatory Bowel Diseases, can impair one’s sleep leading to the symptom of fatigue. Sleep disturbances can be a result of pain impacting one’s sleep, as pain is common in areas of inflammation. When someone is experiencing pain it can lead to mood dysregulation resulting in sleep disturbance conjointly with the the physical discomfort. Furthermore, research has shown that sleep disturbance can result in higher levels of C-Reactive Protein (CRP), a marker of inflammation, suggesting that sleep impairment and inflammation are directly correlated. 

Much like the aforementioned inflammatory conditions as well as cancer can impact one’s immunity. Our immune system is very important in our ability to fight off infections, and for those with a compromised immune system, contraction of infections can be regular occurrence or fear of contraction. Research has also found that sleep impacts immunity; when one has impaired sleep their immune system has difficulty fighting off infections. This also can further compound an already compromised immune system, leading to increased infections and overall feeling of being unwell, increased inflammation, and the cyclical nature of impaired sleep. (Simpson & Dinges, 2007).

Sleep Hygiene

Sleep hygiene is defined by the healthy habits one practices on a regular basis to promote restful sleep. The Sleep Foundation lists some great steps to improve sleep hygiene that is summarized below.

Setting a consistent sleep schedule

  • Go to bed and wake up at the same time everyday, regardless of weekend day
  • If you want to change your bedtime/wake up routine, make changes gradually
  • Try not to take as many naps; if you do take naps, have short 10-20 minute naps in the early afternoon

Have a bed time routine

  • Having a consistent bedtime routine can prep your mind for bedtime
  • Take 30 minutes to wind down before going to bed by doing something relaxing and not stimulating
  • Refrain form using electronics 30-60 minutes before bed, as the screens can be overstimulating to your brain
  • If you haven’t fallen asleep within 20 minutes of lying in your bed, get out of bed, do something relaxing, and then try again

Have healthy daily habits

  • Try and get some sunlight exposure to promote healthy circadian rhythm
  • Build a exercise/movement routine that is right for your ability
  • Limit smoking and alcohol consumption
  • Skipping on caffeinated beverages in the afternoon and evening
  • Try to eat and drink 2 hours before bed (be mindful of heaving/spicy meals); if you need to eat or drink something before bed try to make it small to not wake you up in the middle of the night
  • Regulate activity in bed to only sleep and sex

Having a restful and Relaxing environment

  • Having a bedpillow, and sheets that matches your comfort needs
  • Have a cool and dark sleeping environment
  • Have devices that block or drown out noise (i.e. ear plugs, noise cancelling machines, etc.) to not wake you in the middle of the night

Neurofeedback as a treatment strategy for sleep impairment

Now we know why sleep is important, what can affect sleep, and how we can improve sleep with proper sleep hygiene. But what if sleep hygiene isn’t enough to get a good night’s rest and there are more underlying issues that impact sleep. Therapy can be very helpful if the underlying symptom of sleep impairment originates from a mental health condition. However if there is a neurological reason for sleep challenges (either from mental health or medical conditions) a treatment strategy must address the neurological source of the disturbance. 

Neurofeedback is a form of biofeedback that encourages healthy neurological connections through the use of training one’s brain to effectively operate in specific conditions. Therefore, in regards to sleep, Neurofeedback training promotes healthy brain activity during the sleep state by regulating one’s brainwaves. 

In some cases, sleep and brain activity can be effected by the situation. In one study looking at college students with sleep onset insomnia, they found that poor sleepers had difficulty regulating their alpha brainwave. This suggested the use of neuro-regulating therapies to promote neuroflexibility (Buckelew et. al., 2013).

In another study that focused on the Central Nervous System, researchers studied the effects of electromyography tele-biofeedback versus tele-neurofeedback in subjects with insomnia. They found that not only does neurofeedback improved the amount of sleep in subjects, but also the efficacy of remote neurofeedback (Cortoos, 2010).

As previously mentioned, chronic health conditions can impact sleep, such as fibromyalgia, a condition where a patient experiences pain throughout their body and experience several other symptoms (including sleep disturbance and fatigue). In a study that researched the efficacy of neurofeedback in patients with fibromyalgia, researchers found that neurofeedback protocols that focused on alpha brainwave and sensorimotor rhythm regulation in an 8-week program produced significant results. Patients experienced sleep improvement and pain severity reduction (Wu, Fang, et al., 2021).

Neurofeedback is an evidence-based treatment strategy that does not utilize pharmaceutical intervention to treat sleep problems. In some cases, neurofeedback conjoint with behavioral modifications can drastically improve, if not alleviate, symptoms of fatigue due to sleep impairment.


Anxiety and Sleep, Suni, E., Sleep Foundation (March 2022).

Buckelew et. al, Neuroflexibility and Sleep Onset Insomnia Among College Students: Implications for Neurotherapy, Journal of Neurotherapy (2013). doi

Cortoos, A., De Valck, E., Arns, M. et al. An Exploratory Study on the Effects of Tele-neurofeedback and Tele-biofeedback on Objective and Subjective Sleep in Patients with Primary InsomniaAppl Psychophysiol Biofeedback 35, 125–134 (2010).

Get Sleep– Harvard Medical School

Gorgoni et. al., Is Sleep Essential for Neural Plasticity in Humans, and How Does It Affect Motor and Cognitive Recovery?. Hindawi, 2013. doi: 10.1155/2013/103949

Healthy Sleep– Harvard Medical School

Sleep Disorders, Rehman, A., Sleep Foundation (December 2020)

Sleep and Inflammation, Simpson & Dinges, Wiley (December 2007)

Yu-Lin Wu, Su-Chen Fang, Shih-Ching Chen, Chen-Jei Tai, Pei-Shan Tsai, Effects of Neurofeedback on Fibromyalgia: A Randomized Controlled Trial. Pain Management Nursing, Volume 22, Issue 6 (2021).

This month’s blog post was written by Aarti S. Felder, MA, LCPC, BCN, our Chronic Illness Specialist and Board Certified in Neurofeedback Therapist.

Benefits of Breathing and Laughing

Over the years, I have seen an increase of individuals burdened with symptoms of anxiety. The feeling of being overwhelmed, hopeless, helpless, with excessive worrying, restlessness, and fearful. These days, we are being met with the daily hustles of balancing work, family/friends and home. We are dealing with the inflation of gas, food and cost of living. Many of us are constantly trying to please others, stay on top of our bills and avoid work burnout. We forget about ourselves. The importance of self-care and taking the time to breathe. Stopping for a few minutes just to take a deep breath can be the most beneficial thing you can do for yourself. You are giving yourself the time to gather thoughts, regain your sanity and relieve stress. The continued overwhelming feeling of anxiety and stress can impact your health, your daily functioning, performance at work and your social interactions in a negative way. That is not what we deserve or want. Take the time, breathe and focus on positivity. 

Think about all those times you had a good laugh to the point you had tears in your eyes. When you were sitting with family and friends, reminiscing about the good old times. Or even spending the night at a comedy show. How did you feel after that? Did it change your mood in a positive way? Were you more relaxed? Laughing is the best natural medicine available. Laughter reduces anxiety, relieves stress, relaxes muscles, improves mood and it is an immune system booster. We are all human and we make mistakes. Avoid feeling down about those mistakes, instead laugh and learn from them. Do not dwell on the little things, life is too short.

If you find yourself feeling overwhelmed; like the walls are closing in on you, your heart is racing, you’re sweating, unable to concentrate, just STOP and if you are able walk away to a quiet room. Close your eyes, inhale deeply through your nostrils, hold for a couple of seconds and slowly exhale through your mouth. Repeat this as long as needed, inhaling the positivity and exhaling the negativity. Afterwards, try to think of something funny, look at a funny video on your phone, check out memes or simply fake laugh. Believe it or not, but fake laughter has the same benefits as real laughter. The body does not know the difference. Like the saying goes, “fake it until you make it!” 

So, the next time you are feeling anxious remember you have the tools to alleviate the situation. Daily self-care is important, do not cheat yourself of it. Utilizing deep breathing and laughter will also provide you with inner peace. The best part about breathing and laughing is that it is FREE at no cost. Remember, you are only one person. Know your limitations, take time for yourself and think positive. At least once a day, set aside a few minutes to take a deep breath and laugh. You would be so thankful that you did. You are worth it. Love yourself.

This month’s blog post was written by Constance White, MA, LPC.

Benefits of Yoga and Movement to Mental health

Close your eyes and notice if you are carrying any stress in your body in this moment. Maybe in the jaw or stomach? Now, try to create space around the tension or stress by sending the energy of the breath around the tension. Breath regulation is beneficial in allowing people to slow down into what is happening right now.

When we experience stress or trauma, it can live in the body and can create a stress response in people of all ages. The stress response may be varying in levels such as clenching your jaw, tensing your body, needing to leave the room, or having a panic attack. 

While it is happening, it can seem scary. There is some good news. Stress response can be controlled using modalities such as mindfulness, yoga, as well as therapeutic touch such as acupuncture or massage along with therapy. 

This gives us the ability to regulate and recalibrate the autonomic nervous system, to control a stress response. In children, similar activity to assist in this release of stress include needing movement, play, and joyful engagement. These are all considered bottom-up methods, which calm physical tensions in the body, and shifts people out of flight/fight to reorganize people’s perception of danger. Basically, it can help you feel better.

Memories of trauma can but not always, lead to physiological symptoms such as autoimmune disorders, or skeletal muscular problems. Why? Because there is a proven mind, brain, and body connection to stress. 

“So how can we help that? I am a busy person and life is hard.” When we practice asana (yoga movements) no matter how modified, gentle, or vigorous, a reconnection and ability to warmly love self exists. This then shifts to other areas of life including but not limited to diet, relationships, energy, etc, which helps us to feel better.

Proven studies exist to show the physiological benefits and shifts in breathing exercises which change when a person becomes upset, is having a trauma memory, or is well regulated. Interpreting physical sensations is called interoreception, which allows people to have a relationship with their interior world and self. To be able to understand what the body needs, allows people the ability to tune into nourishing and healing the self.

Studies exist that show after twenty weeks of one weekly yoga class in people who have experienced stress and trauma, there are increases in activation of brain structures involved in stress regulation. These brain structures include the insula, and medial prefrontal cortex. Does this have to be only yoga? No! For some it could be running, reiki, massage, or even gardening.

Feeling safe in our bodies allows people to communicate previously overwhelmed situations that were not easily felt or talked about.

Children and adults can be taught self-regulation skills. The act of educating about physical sensations and becoming friends with our bodies, can assist in healing. Yoga, therapeutic touch such as acupuncture or massage, and breath work in addition to talk therapy may help you feel better. Contact us to start your journey to wellness.


Chirokas, Dennis, C., & Bradshaw, M. (2021). Phenomenological Reflections of Trauma Survivors on Healing Through Yoga. The American Journal of Occupational Therapy75(S2), 7512505186–7512505186p1.

Gulden, & Jennings, L. (2016). How Yoga Helps Heal Interpersonal Trauma: Perspectives and Themes from 11 Interpersonal Trauma Survivors. International Journal of Yoga Therapy26(1), 21–.

Van der Kolk. (2014). The Body Keeps the Score: Brain, Mind, and Body in the Healing of Trauma. Penguin Publishing Group.

This month’s blog post was written by TriWellness’s newest counseling intern, Rebecca Caliendo, MM, who has been teaching yoga from 2016.