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.

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 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.

Women’s Health History

Early History

In the early history of health sciences, the philosopher Aristotle believed that the women were the inverse of men and had suggested the superiority versus inferiority between the sexes. This hypothesis had influenced the ideology of women’s place in society as well as their health. It wasn’t until the mid 1980s that women were beginning to be seen as an independent group as opposed to a “sub-group” of men (King & Paul, 1996).

Another concept that influenced women’s healthcare was the diagnosis of hysteria. In its early conception, hysteria was defined as the idea of a woman’s uterus would wonder throughout her body causing mental and physical dysregulation. This idea continued to morph through the ages, from hysteria being define as “melancholic uterus” to the “workings of the devil” or other forms of demonization. The treatment for hysteria also morphed with the definition of the diagnosis, such as fumigating the uterus, expelling “semen” from the uterus by utilizing fingers to stimulate the internal organ. The concept of women being a sub-group of men had led philosophers and early physicians to believe that the cause of disease. However, at one point in the 18th century the concept of hysteria was separated from disease of the uterus and was suggested it had actually neurological origins and can impact any person (Tasca, Rapetti, Carta, & Fadda, 2012).

In the Victorian Era, Dr. Sigmund Freud had also studied the concept of hysteria and its relation to libidinal evolution. This lead him to the early theory of psychoanalysis with the concept of male and female hysteria involving stages of sexual conflict and fixations. Hysterical neurosis had remained in the Diagnostic and Statistical Manual until 1980 ((Tasca, Rapetti, Carta, & Fadda, 2012) however the ideology and the origination of the concept of hysteria and its relation to the “inferiority” of women still impact our health care systems and cultures.

Leading up to that ideology of woman being an independent group and other components of the Feminist Movement, the Women’s Health Movement (WHM) began to develop in the 1960s with the intention to “…improve health care for all women.” (Nichols, 2000).

Women’s Health Movement

In the Journal of Obstetric, Gynecologic, & Neonatal Nursing (JOGNN) Dr. Nichols, RNC, PhD, FAAN outlined the significant events in the WHM (adapted from Table 1, History of the Women’s Health Movement in the 20th Century; 2000).


The Doctors’ Case Against the Pill by Barbara Seaman was published. It brought the severity of the side effects of the birth control into awareness, resulting in the 1970 federal hearing on birth control pill safety.


Our Bodies, Ourselves was published.


The National Women’s Health Network was established to advocate women across the US. The network continues their efforts for advocacy of all women.

The first International Conference on Women was held in Mexico City, Mexico.


The Commonwealth Fund conducted the first national survey of women’s health. Their latest survey was conducted in 1993.


“Rehabilitation of the female patient after myocardial infarction” (Boogaard) was published, suggesting that women have differing experiences than men and are not a subgroup of men.


The Congressional Caucus for Women’s Issues (CCWI) put into view the serious lack of research on women in the National Institutes of Health (NIH).


The Jacobs Institute of Women’s Health was founded to “…improve women’s health through research, dialogue, teaching, and information dissemination.”

The Office of Research on Women’s Health (ORWH) within NIH was established “… to ensure that women’s health research is part of the scientific framework at the NIH- and throughout the scientific community.”

The national nonprofit, Society for the Advancement of Women’s Health Research (SWHR) was founded to “…[address] unmet needs and research gaps in women’s health.”

Women’s Health Equity Act (WHEA) was introduced and later passed in 1991 increased awareness in women’s health issues.


Women’s Health Initiative (WHI) began the project of long-term studies on several chronic diseases in women of all backgrounds. It continues to provide research in other areas of women’s health.


The FDA pulled back the federal ban of women of childbearing years in Phase 1 and 2 drug trials from 1977 and developed new gender guidelines.

The NIH Revitalization Act was signed into law which “…directed the NIH to establish guidelines for inclusion of women and minorities in clinical research.”


The New Mothers’ Breastfeeding Promotion and Protection Act was introduced to amend the Civil Rights Act of 1964 to include breast feeding as an activity that cannot be discriminated against. This bill still remains in the House of Representatives and has been passed along through several subcommittees, last action was on April 17, 1998 in which it was referred to subcommittee on Early Childhood, Youth and Families.

Recent History

Whi Studies

The WHI studies continue to expand upon the original data collected along with newer cohorts. In the most recent WHI Annual Progress Report (February 28, 2020), of the number of women that remain in the studies have shown that:

  • More women develop cardiovascular disease that can lead to death
  • The older the women who are studied, the high percentages of developing cardiovascular disease, cancer, and hip fractures.
  • American Indian/ Alaskan Natives have the highest percentage of cardiovascular disease.
  • Asian/ Pacific Islanders and Non-Hispanic Whites have the highest percentage of cancer.
  • American Indian/Alaskan Natives have a higher percentage of deaths from cardiovascular disease, cancer, or other known causes.
  • There are higher incidences of breast cancer (invasive) in comparison to ovarian, endometrial, colorectal, leukemia, lung, Non-Hodgkin’s lymphoma, melanoma of the skin, and pancreas cancers.
  • There are higher incidences of Coronary-Artery Bypass Grafting (CABTG) and Percutaneous Transluminal Coronary Angioplasty (PTCA) in comparison to other cardiovascular issues.

What are the implication of these studies?

From the WHI study we can learn about how women’s heart attack symptoms may differ from men’s symptoms:


according to the Mayo Clinic

  • neck, jaw, shoulder, upper back or upper abdomen discomfort
  • shortness of breath
  • pain in one or both arms
  • nausea or vomiting
  • sweating
  • lightheadedness or dizziness
  • unusual fatigue
  • heartburn
  • sudden cold sweat
  • discomfort or tingling in the back, shoulder, arms, neck, or jaw
  • chest pain or pressure
  • shortness of breath
  • nausea

Prior to this information, women were often misdiagnosed or disregarded as being “hysterical” leading to health complications or premature death. We’re also finding the severity of the lack of health care resources that plague the American Indian/ Alaskan Native populations to the point that it impacts their life expectancy through disease.

Global focus on Women’s health and gender equality

In 2021 the World Health Organization (WHO) are turning to the future to set their sights on women’s health and gender equality. They stated that the agenda will revolve around these key areas:

“Bodily autonomy — enabling women and girls to make informed sexual, reproductive, and healthcare decisions—a human right for all.

Promoting equitable gender norms, including those that make violence against women and girls, including harmful practices such as early/forced marriage and female genital mutilation, unacceptable.

Financing universal health coverage and social protection to cover health costs, child care, paid parental, sick and family care leave and old age pension.

Valuing paid employment and unpaid care work equally and enabling men to share care work with women.

Addressing male bias in the development of vaccines, drugs, and diagnostics. 

Strengthening health systems to include safe, decent working conditions for the majority female health workforce including eliminating sexual harassment and violence.

Investing in feminist movements, which have been instrumental in fostering progressive changes towards gender equality.

Ensuring women’s and feminist leadership in governments, health and development agencies, and other global organizations.”

The Future we Expect: Women’s Health and Gender Equality; Joint News Release; June 28, 2021

Women’s health has come a long way from it origins, however it has a lot further to go. Newer research and the understanding of all women can provide insights in the hopes to expand upon the Women’s Health Movement and affect our laws to create equality and the availability of resources in health care.


UnWell Women: Misdiagnosis and Myth in a Man Made World by Elinor Cleghorn

The Future we Expect: Women’s Health and Gender Equality, the WHO Joint News Release, it also has other resources such as podcasts and videos

National Women’s Health Network

Women’s Health Initiative

Women and Hysteria in the History of Mental Health, Tasca et al., 2012.

The Doctors’ Case Against the Pill by Barbara Seaman

Our Bodies, Ourselves

The Jacobs Institute of Women’s Health

The Office of Research on Women’s Health

Society for the Advancement of Women’s Health Research

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

Mental Health in the hospitality industry

“We’ve got to have a delicate balance of carefully and prudently going towards normality and opening up at the same time that we contain and allow these surges. Staying shut down has economic, employment, health and other negative consequences…”

– Dr. Anthony Fauci


Covid-19 is one of the most potent and aggressive ailments our society has seen in a long time. It’s initial spread, to its mutations, have all led to where we are now. In the United States, we’ve had lockdowns, and still have mask mandates, and vaccine boosters coming out to try and stem the tide of this ever-present threat. 

While these methods of containment and trying to fight back against the virus are surely justified, they do have their implications. One major implication is economically, with many businesses having to adapt to the ever-shifting changes and government mandates or be crushed underneath them.

No other type of business is impacted more by this than small businesses. Small businesses within the service industry are even more impacted by this virus, as government mandates often limit how many people can be within the store at one time, on top of the recent staff shortages, it makes for a challenging time to operate, and work for one of these businesses.

For the most part, this economic impact has been looked at by most news outlets and reported fairly well. However, while economics are important, the spotlight is not often shone on those working and operating these businesses. How these turbulent times have not just impacted the people in these businesses financially, but on their health, especially their mental health.

In this article, we will be exploring the perspectives and stories of those working within these businesses. 


The Small Business Owner

Small businesses were once considered the backbone of America, where anyone who put their mind to it could reach their goal of financial independence and a decent way of life. During the age of Covid-19, that dream is hampered substantially. 

Trying to entice customers into the store, while offering a decent wage against larger corporate competitors is no easy task. With so many odds stacked against them, it is no wonder many small businesses have had to close their doors. That being said, not all small businesses have become dust in the wind. 

Within the Lincoln Park area, there lies a bakery and café that has stood its ground during this turbulent time. We at TriWellness were fortunate enough to be able to get to talk to the business owners who operate the establishment, to get a glimpse into how it is running a small operation in the midst of a global pandemic, and the tole it takes on their mental fortitude.

The first topic we discussed was how covid-19 impacted their mental health. The owners talked about how it has forced them to become more resilient mentally, that they recently had a baby girl, and they need to not just be strong for themselves, but for their child as well.

The owners also spoke about the hiring difficulties, that trying to hire, and retain workers during this time has been more difficult than it has ever been. One of the owners even spoke to working over a hundred days straight, day and night, because no night cooks would be willing to come in and take a shift.

While we were on the topic of working long hours, the question was asked if the owners felt they can even relax when they are not in the store? The owners said that they had to adapt to the added strain, and that they have to often force themselves to take breaks and relax, just so they can keep functioning.

Now, this added strain and strife was not exclusive to the owners of this small business, but also the people who staffed it as well, who we were fortunately able to talk to some of the people who staffed this small café. 

We started by asking the same question, “how has Covid-19 impacted your mental health?” The worker described that it has fluctuated, that every day brings a different feeling. The worker described the turbulence that working in the food industry has caused, being laid off from one food service job, and leading them to where they are now. The worker described this process as stressful, on top of the ambient threat of the virus in the back of their mind, worrying not so much for themselves, but their partner and coworkers as well. 

This added stress and anxiety has even impacted this person’s ability to work as well, with dealing with customers, and the world around them, harder. The worker described this added weight when having a negative interaction with a customer, even as something small as a customer complaining that “you put onions on my sandwich when I asked for none.” The worker went on to state that working during this period has “made hard things harder.”

The worker was then asked as a follow up to the concept of working during this time, “is feeling safe at work a luxury?” To which the worker then said, with a definitive, “Yes!” The luxury of some people having the ability to feel safe by working from home is not available to someone who works in the service industry, and that as difficult as it can be, the worker must take the feelings of safety where they can get it.

The worker then reflected, and stated they have this dreadful feeling, that during this time, working and interacting with people who are not taking this pandemic seriously, and act so callously towards people just trying to work. The worker described this lack of common humanity, when customers refuse to wear masks, or when customers complain about just wanting things to go back to normal, all things that impact their ability to work, and their feelings of burnout.

The worker elaborated on this feeling of burnout, that they often feel that they go in this cycle of feeling better about working, then over time and so many negative interactions, it brings them back around to feeling burnt out, not just with work, but with everyday tasks as a whole.

We then switched gears a bit, and started talking about self-care, and being able to relax outside of work. The worker then chuckled slightly and stated, “I am good at relaxing.” The worker then went on to say that now more than ever, they take the time outside of work to relax, they take bubble baths, read, and do fun projects with their partner. All that to the goal of being able to keep functioning in the world they find themselves in.

So, what can we take from this? 

For the many people working within this industry, it can often feel that there is no room to breathe, that one has to work so much that there is no time at the end of the day to relax. 

One thing that we can glean from these interviews, is that it is important to carve out any amount of time for self-care, even if it is limited. Although this begs the question, even if we do set aside some valuable time for ourselves, how do we spend it?

A major part of self-care we can do for ourselves is to make sure that keeping on top of proper nutrition, and sleep. It can be easy to forget that our minds and bodies are so closely linked, and that they have so much influence over the other. When we stop and take the time to care for our bodies, we care for our mind as well

A tried-and-true method of self-care is exercise. Exercise is a multifaceted approach to helping our body and mind. Not only does a little bit of movement help build our muscle and endurance, but it also helps our brain as well. When we exercise, a neurotransmitter gets released, called an endorphin. Endorphins aid our brain release some stress and help us to feel a little happier. Research has also shown that exercise can be a factor to activate the parasympathetic nervous system, after stressful event or even during chronic stress (Tsatsoulis, Agathocles  & Fountoulakis, Stelios; 2006). So, be it a nice run, lifting weights at the gym, or even a long walk, a little bit of exercise goes a long way. 


Articles on Excercise!

The Protective Role of Exercise on Stress System Dysregulation and Comorbidities


Robinson, K., Jesner, L., Rapaport, L., Bedosky, L., Byrne, C., Millard, E., & Asp, K. (2022, February 18). 8 exercises that Relieve Stress – Women’s Guide to Stress Management – Everyday Health. Retrieved February 26, 2022, from

Howley, E. K. (2020, June 19). 12 Best Exercises to Ease Stress and Anxiety – US News Health. USNews. Retrieved February 26, 2022, from

Mayo Foundation for Medical Education and Research. (2020, August 18). Exercise and stress: Get moving to manage stress. Mayo Clinic. Retrieved February 26, 2022, from

Olpin M, et al. Healthy lifestyles. In: Stress Management for Life. 4th ed. Cengage Learning; 2016.

This month’s blog post was written by Christian Moresco. Christian is an intern and attends graduate school at DePaul University and aspires to be a counselor who specializes in health and wellness.

Chronic pain and mental health

It has been said that time heals all wounds. I don’t agree. The wounds remain. Time – the mind, protecting its sanity – covers them with some scar tissue and the pain lessens, but it is never gone. 

Rose Kennedy

Pain is something that everyone experiences. It is a signal that there is something wrong in the body. According to the CDC, 20.4% of adults had chronic pain and 7.4% of adults had chronic pain that frequency limited life or work activities. This data also found that chronic pain increased as people got older. And while we are still recording data, we have preliminary reports about long-term effects of Covid-19, we find that different types of pain is one of those effects.  This study found that chronic pain was highest in women at 21.7%, and that women are less likely to be believed about pain by their doctors. This is something that is also seen in physician’s responses to people of color, as they are often acting on unconscious bias about how minoritized individuals feel less pain or feel pain differently than white people. 

What is Pain?

There are many ways to define pain, and how you define it impacts how you approach it. Do we consider physical pain? What about emotional pain? Social pain? Psychological pain? Here are some common types of pain:

  • Acute pain
  • Chronic pain
  • Neuropathic pain
  • Psychogenic pain

Acute pain is a sudden pain that has a limited duration, usually a few minutes to three months, sometimes up to six months. Chronic pain is more long-term pain that can be constant or intermittent, even after healing is complete. Neuropathic pain is pain caused by nerve damage and is often described as shooting or burning pain. Nociceptive pain is pain caused by tissue damage. Psychogenic pain is pain that might have started physically, but is prolonged by fear, stress, depression, anxiety, or is caused by a psychological condition. Often psychogenic pain is a type of pain that doesn’t match the symptoms a person is experiencing, and is diagnosed after everything else has been ruled out.

How is Pain Processed

The gate-control theory of pain was developed to look at three systems involved in the perception of pain. These systems are the peripheral nerves that first receive pain signals, the spinal cord which receives the signal and sends it to different areas of the brain. In the brain there are different areas that can be impacted by pain such as the limbic system developing a memory of pain, and some emotional areas. This process can be inhibited at different points in the pathway, and through other pathways that responds to deep touch and inhibits the release of pain signals. While this is an abstract look at how pain is processed by the body, it is important to look at how pain affects everyday life. 

How pain impacts life

Pain can have a profound impact on a person’s life; from limiting the things a person can do, to decreasing the quality of sleep, to leading to mental health issues, pain can bring about a lot of changes. Chronic pain specifically can impact physical, psychological, and social functioning. Often pain management is primarily handled through pharmaceuticals, but we are now seeing how that overmedication is leading to increased substance abuse. Studies have shown that people with chronic pain are four times more likely to have depression and anxiety than those without pain. 

Common chronic pain conditions

There are many different things that can cause chronic pain, but some of the most common are: 

  • Arthritis/joint pain
  • Back pain
  • Cancer pain
  • Headaches/migraines
  • Muscle pain
  • Nerve damage

This pain can lead to what is known as the “terrible triad.” The terrible triad happens when pain interferes with the normal activity of life leading to depression and irritability, which can lead to insomnia. This state of being in pain, being depressed and being sleepless create a triad of suffering.  

Another thing that is often not considered is how pain affects younger people. In a study from 2016, it was conservatively estimated that 20-35% of children and adolescents are affected by chronic pain worldwide. In children, pain is often under-recognized and under-treated, especially when they might not have the language skills to express what they’re experiencing. Common causes of pediatric chronic pain include: 

  • Headaches
  • Recurrent abdominal pain
  • Limb pain
  • Back pain
  • Pain without any known cause

In children this pain can impact their development because it can lead to the inability to participate in age-appropriate social activities, missing school, isolation, difficulty forming interpersonal relationships, and mental health issues.

Treatment for pain

So as stated above medication the the primary treatment for pain, and should be continued but there are other treatments to keep in mind, that should be monitored by a medical professional. This includes:

  • Physical therapy
  • Acupuncture
  • Transcutaneous electrical nerve stimulation (TENS) therapy
  • Hypnotherapy
  • Behavioral Therapy
  • Biofeedback
  • Neurofeedback
  • EaseVRx virtual reality system

Some therapeutic modalities, specifically Cognitive Behavioral Therapy (CBT) and Acceptance and Commitment Therapy (ACT) have been shown to help relieve some in managing the pain and discomfort. 

Neurofeedback and pain

So what is neurofeedback. Neurofeedback is a kind of biofeedback that has been in use for decades based on direct, behavioral training of the brain using an electroencephalograph (EEG). We place electrodes on the scalp to observe the different brainwaves and learn different information based on where, the frequency of, and when certain brainwaves occur. This technique allows us to observe the brain in action as the brain learn to function more efficiently. 

For pain management, the theory is that neurofeedback works by teaching self-regulation. Studies suggest that neurofeedback can be used to affect the processing of pain perception, such as in the gate-control theory discussed above. Some chronic pain conditions neurofeedback has been used to treat before include: 

  • Trigeminal Neuralgia
  • Headache and migraines
  • Fibromyalgia 


Ibric, V. L., and Dragomirescu, L. G. (2009). “Neurofeedback in pain management,” in Introduction to Quantitative EEG and Neurofeedback. (New York, NY: Elsevier Inc.), 417–51. doi: 10.1016/B978-0-12-374534-7.00016-2

Here at TriWellness we do offer neurofeedback and a pediatric chronic illness support group.

This month’s blog post was written by Jessie Duncan, MA, LPC, one of our trained specialists in Neurofeedback and chronic illness specialist.

Neurofeedback and Tinnitus

What is tinnitus

Tinnitus is a condition characterized by ringing or other noises in one or both ears. Tinnitus can be caused by hearing loss, ear infection, head or neck injuries, certain medications, or symptoms of other health conditions. Tinnitus can also cause other complications from sleep problems, social problems, and other mental health issues.

Tinnitus effects on mental health

anxiety and Stress

Often people pondered the “chicken-or-the-egg” conundrum, does anxiety cause tinnitus or tinnitus cause anxiety? Research continues to try and answer that question. In a longitudinal study examining the correlation between anxiety and tinnitus, the researchers found that those with tinnitus had a high incident rate of anxiety. They further noted that the correlation could be due to anxiety causing tinnitus, tinnitus and anxiety effect each other equally, or that there is another factor affecting both anxiety and tinnitus. Other factors may be genetic or neurological dysfunction (Hou, Yang, Tsai, Shen, Lan, 2020).

There are neurological networks that share commonalities between anxiety and tinnitus. The Limbic System and the Dorsal Cochlear Nucleus (DCN) are thought to be neurological contributors to anxiety and tinnitus. One of the functions of the Limbic System is to manage emotional states. While one of the functions of the DCN converting auditory stimuli in the brain. The proximity of these two neurological networks can possibly affect each other in times of stress.

Regardless of the correlation of anxiety and tinnitus, the end result is still feeling a sense of anxiety and stress. Individuals have noted that they feel more stressed and anxious when they experience increasingly louder ringing in their ears (due to the tinnitus) and in a cyclical fashion they find that the symptoms of tinnitus are further exacerbated, creating significant distress.


Similarly to anxiety, depression and tinnitus correlation is still being researched. In a scientific review, the researchers arrived to a similar conclusion: depression affects tinnitus, tinnitus causes depression, or depression and tinnitus are symptoms of another condition (Geocze, Mucci, Abranches, de Marco, Penido, 2015). Furthermore, depression and tinnitus can be correlated due to the the neurological proximity and the functionality of the Limbic System and the DCN.

Due to the symptoms of tinnitus being unrelenting, individuals may feel hopeless in achieving relief. These symptoms may also affect sleep, causing fatigue and low energy. Furthermore, it may impact people’s motivation to engage in social activities, resulting in social isolation. All of these secondary symptoms can cause one to become depressed.

Neurofeedback As a treatment for Tinnitus

As previously established, tinnitus has neurological origins. With that understanding, researchers have studied using Neurofeedback as a treatment strategy for tinnitus. In a study, researchers found that Neurofeedback training can assist individuals in controlling their attention to the auditory stimuli, and thusly experienced a reduction in symptoms (Busse, Low, Corona-Strauss, Delb, Strauss, 2008). In another study, researchers found that utilizing Neurofeedback training to modify specific brainwaves, patients with tinnitus has experienced major to complete symptom relief (Dohrmann, Weisz, Schlee, Hartmann, Elbert, 2007).

Neurofeedback is also an affective non-pharmaceutical treatment strategy to treat the aforementioned complications of tinnitus. Studies have shown that Neurofeedback training can reduce anxiety through brainwave regulation. Studies have also shown that Neurofeedback training can assist in establishing normalized neurological activity in individuals experiencing depression.



Tinnitus Among Patients With Anxiety Disorder: A Nationwide Longitudinal Study

Systematic Review on the Evidences of an Association between Tinnitus and Depression

Depression in Patients with Tinnitus: A Systematic Review

Tinnitus and Hearing Loss in 15–16-Year-Old Students: Mental Health Symptoms, Substance Use, and Exposure in School

Neurofeedback by Neural Correlates of Auditory Selective Attention as Possible Application for Tinnitus Therapies

Neurofeedback for Treating Tinnitus

Alpha Suppression and Symmetry Training for Generalized Anxiety Symptoms

A Review of EEG Biofeedback Treatment of Anxiety Disorders

Clinical Use of an Alpha Asymmetry Neurofeedback Protocol in the Treatment of Mood Disorders: Follow-Up Study One to Five Years Post Therapy

Neurofeedback with anxiety and affective disorders

This month’s post was written by Aarti S. Felder, MA, LCPC, BCN. Aarti is our chronic illness specialist and is a Board Certified Neurofeedback practitioner.

Attention Deficit Hyperactivity Disorder

What is Adhd?

Attention Deficit Hyperactivity Disorder is a complex neurodevelopmental disorder that is characterized by low production of dopamine in the prefrontal cortex.  The prefrontal cortex is in charge of what we call executive functions; planning, organizing, decision-making–all of the directing parts of the brain. Emotional regulation and reward pathways in the brain are also affected by individuals with ADHD. The diagnosis is further broken down into three different presentations: primarily inattentive, primarily hyperactive, or the combined type. Here’s a list of some of the symptoms to look for:

The inattentive symptoms (previously referred to as ADD) in the Diagnostic and Statistical Manual 5th edition (DSM-5) are:

  • Often fails to pay close attention to details or makes careless mistakes in schoolwork, at work, etc.
  • Often has trouble holding attention on tasks or activities (e.g., easily distracted)
  • Often does not seem to listen when spoken to directly
  • Often does not follow through on instructions and fails to finish schoolwork, chores, or duties in the workplace (e.g., loses focus, gets side-tracked)
  • Often has trouble organizing tasks and activities; has trouble finishing tasks
  • Often avoids, dislikes, or is reluctant to do tasks that require mental effort over a long period of time
  • Often loses things necessary for tasks and activities (e.g., school materials, wallet, phone, keys).
  • Often forgetful in daily activities
  • Often distracted by stimuli (e.g., sounds, movement)

The hyperactive/impulsive symptoms in the DSM-5 are:

  • Often fidgets with or taps hands/feet or squirms in seat
  • Often leaves seat in situations when remaining seated is expected (e.g., leaves place in the classroom, in meetings, etc.).
  • Often runs about or climbs in situations where it is inappropriate. In adolescents or adults, this may manifest as feeling restless
  • Often unable to play or engage in leisure activities quietly
  • Is often “on the go,” acting as if “driven by a motor” (e.g., is unable to remain still for any extended time without significant discomfort; others may say that the person is restless, fidgety, or difficult to keep up with).
  • Often talks excessively
  • Often completes other people’s sentences or blurts out an answer before a question has been completed
  • Often has difficulty waiting for their turn (e.g., while waiting in line, while speaking in conversations).
  • Often interrupts or intrudes on others. For adolescents and adults, may intrude into or take over what others are doing (e.g., butts into conversations, games, or activities; may start using other people’s things without asking or receiving permission)

The combined type is diagnosed by the presence of an even mix of the symptoms. There are other criteria for this diagnosis which include symptoms lasting for a specific duration and having an impact on various domains of an individual’s life.

What are the Statistics

Approximately 5% of children and adolescents are affected by ADHD globally. In the U.S. 6.1 million children (9.4%) between the ages of 2 and 17 are estimated to be diagnosed with ADHD, with boys more likely to be diagnosed than girls (11.7% compared to 5.7%). The difference in the diagnosis of girls and boys is often due to the presenting symptoms and socialization of children. Girls are more often diagnosed with the inattentive presentation which is often missed in a classroom setting where most referrals for ADHD testing occur. 

While ADHD is considered a childhood disorder, 139.84 million adults have persistent ADHD with childhood onset (2.58% of the global population) and 366.33 million adults have symptomatic ADHD regardless of onset (6.76% of the global population) as of 2020. Because ADHD affects brain development, it manifests in all aspects of life and can significantly impair educational achievement, relationships (romantic, familial, friendships), employment, finances, etc. There are many common symptoms of ADHD (inattention, inability to focus, poor time management, weak impulse control, exaggerated emotions, hyperfocus) which are often seen as character flaws or bad parenting when the underlying cause is due to an individual’s specific brain functioning. This is also seen in difficulty with emotional processing.

Emotional dysregulation

One aspect of ADHD that has been recognized as a symptom for diagnosis in Europe and noted in research for at least two decades but is still not considered in the Diagnostic and Statistical Manual version 5, has been the emotional component of ADHD. About 70% of adults with ADHD report emotional dysregulation (ED), which has led to the term, DESR, or deficient emotional self-regulation, popping up in ADHD research, and other mental health conditions in which emotional dysfunction is a major component. This refers to a deficiency in the four components of self-regulation. These four components are the ability to inhibit behavior triggered by strong emotions, the ability to self-soothe and regulate strong emotions, the ability to refocus from events that cause strong emotion, and the ability to organize emotional responses. This emotional dysregulation greatly impacts a person’s ability to recognize and control the emotions that they are feeling which can lead to issues connecting with others, putting feelings aside to focus on something, and processing a difficult situation. This can be seen in rejection sensitive dysphoria. 

Rejection sensitive dysphoria (RSD) is a common manifestation of emotional dysregulation that is defined by an extreme emotional sensitivity and pain that is triggered by the idea that someone is being rejected or criticized by important people in their life or by the idea of failing to meet an expectation. While RSD is not caused by a trauma, the pain from it can be felt as a traumatic experience. When these feelings are internalized, they can imitate a mood disorder, and often leads to misdiagnosis of a major mood disorder. When these feelings are externalized, they can be like a sudden rage at the person or situation causing the pain. This can be a devastating ordeal that can lead to feelings of alienation. 

Comorbidities with adhd

People with ADHD often have other co-occurring mental health conditions. According to the CDC almost 64% of children with ADHD have at least one other mental health condition: 52% have behavioral health or conduct problems, 33% have anxiety disorders, 17% have depression, 14% have been diagnosed with autism spectrum disorder, and 1% have Tourette syndrome. 

In adults as many as 80% of people with ADHD have at least one co-occurring mental health condition. It is estimated that rates of comorbid bipolar disorder in adults with ADHD are between 5.1% and 47.1%, about one-fifth to one-half of adults with ADHD have major depressive disorder/dysthymia, about 50% of individuals with ADHD have some type of anxiety disorder, personality disorders are present in more than 50% of adults with ADHD, and research shows that 25% to 40% of adults with substance use disorder also have ADHD. Having multiple mental health conditions can make it harder to identify the source of a condition and the best way to approach treatment. When talking about ADHD, we expect it to present as primarily hyperactive/impulsive and this can also lead to issues in beginning treatment. Women and girls are often misdiagnosed or underdiagnosed in ADHD because they primarily present in the inattentive type. The classroom setting is most often where ADHD is first noticed, but with the inattentive type it is often less disruptive to the classroom so is less likely to get someone referred for treatment. Also in female students the behaviors that would often get male students categorized as ADHD get labeled as “airheaded” or a “chatterbox” or “flighty.”  They also are socialized to behave in ways that more easily mask their symptoms, such as spending more time on school work, which can lead to other problems when they are unable to manage emotionally or socially in the ways they are expected to. This can be stigmatizing when they are unable to perform the way they are expected to and can lead to perfectionism, social withdrawal, low self-esteem, and negative self-talk. 

The future of adhd

In current ADHD research there is looking into changing the name to better reflect the complex of the condition. One proposed future name is variable attention stimulus trait (VAST). This name comes from Edward Hallowell, M.D., John Ratey, M.D. who are leading researchers and wrote the book ADHD 2.0. Other areas of research are looking into better understanding the emotional aspects of the condition.

Treatment for adhd

When approaching treatment for ADHD, medication is the most well known and most stigmatized. It is an important treatment approach, because when people are on the right dosage of medication it greatly improves their lives. RSD can be greatly improved by medication management. 

Another treatment approach is ADHD/executive functioning coaching. This is a behavioral training that focuses on finding ways to deal with/externalize the executive functioning skills that are lacking. 

Therapy is another approach that helps build coping strategies, builds greater understanding of the areas in which a person is struggling, and can help a person learn ways of dealing with the emotional issues of ADHD.

Neurofeedback is another treatment that has been proven effective for ADHD. Neurofeedback, or EEG Biofeedback, is a technique that uses operant conditioning to train the brain to be more efficient (and is a service that we provide).

As we continue to learn more about ADHD and how to improve the quality of life of people who have the condition, we will continue to approach it by looking at the strengths that can be found in it. Here at TriWellness we can help. 


The Prevalence of Adult Attention-Deficit Hyperactivity Disorder: A Global Systematic Review and Meta-Analysis

Emotion Dysregulation in Attention Deficit Hyperactivity Disorder

Emotion Dysregulation in Adults with Attention Deficit Hyperactivity Disorder: a Meta-Analysis

Attention Deficit Hyperactivity Disorder (ADHD)

Data and Statistics About ADHD

Adult ADHD and Comorbid Disorders: Clinical Implications of a Dimensional Approach

Does the Continuous Performance Test Predict ADHD Symptoms Severity and ADHD Presentation in Adults?


This month’s blog post was written Jessie Duncan, MA, LPC, a specialist in Chronic Illness and Neurological Treatment modalities.