C2. Trauma and the Body – Oral Paper Session

Friday, 31 March 2017

Physiotherapy to heal the pain of trauma stuck in the body

Traumatised clients tend to dissociate traumatic memory from feelings, as well as accompanying physiological sensations. Thus emotional trauma gets trapped in the body, often somatised in the form of chronic physical pain. The high prevalence of chronic pain among traumatized refugees is well documented. As the pain matrix involves many aspects of the central nervous system, physical pain is rarely an isolated sensation, and is almost always accompanied by emotion and meaning. Psychological distress exacerbates pain perception. Physiotherapy for survivors of torture and trauma requires an integrative approach which considers mechanical, neuro- physiological processes, as well as psychosocial variables.

This presentation will describe a bio-psycho-social model of physiotherapy used in the treatment of a middle aged female Hazara refugee. The client had chronic pain low back pain and headaches. The resulting dysfunction limited her ability to cope with daily tasks. Pain limited movement and restricted her activities. She had difficulties with resettlement, including applying for a job. Physiotherapy aimed to help the client to learn to respond constructively to pain and to facilitate the flow of movement. A comprehensive range of conventional physiotherapy techniques such as joint mobilisations, soft tissue release, stretching and strengthening exercises, coupled with acupuncture / musculoskeletal dry needling and cardio-vascular exercise were implemented over a period of time to reduce pain and improve function. Specialised skills of facilitating body- mind awareness, breathing exercises and education on pain mechanisms were used to assist the client in understanding how the body stores unhealed psychological pain and distress. This, also, provided her with tools on how to prevent and release pain and work towards her own healing. Working collaboratively with the client’s counsellor augmented the process and improved her quality of life.

Veena O’Sullivan (STARTTS)

Yoga for Refugees Healing from Torture and Trauma: A Mixed Methods Evaluation

Background: As worldwide displacement continues to increase, so too does the number of refugees experiencing torture and trauma. There is increasing recognition of the importance of the brain and body in the development and maintenance of trauma-related symptoms and increasing interest in the use of mind-body therapies such as yoga as part of multi-modal treatment. However, there has been very little published research on the use of yoga with refugees.

Aims: 1) To assess the feasibility and acceptability of a yoga group program for refugee participants. 2) To identify possible physiological, psychological and interpersonal benefits of the program. 3) To explore counsellor and participant attitudes and opinions about the program.

Methods: Following the success of a two-month pilot, The Refugee Yoga Project offered free weekly yoga classes in South Western Sydney to eight groups of refugees. They were co-led by a yoga instructor and a counsellor, with the support of an interpreter. We collected physiological and self-reported psychological data at three time-points (baseline, mid-point and follow-up), held client focus groups and conducted qualitative interviews with counsellors. Process outcomes (attendance and client satisfaction) were also measured.

Results: Preliminary data provides evidence for the acceptability and sustainability of this program for refugee clients, with benefits observed across physical, psychological and interpersonal domains. We will present both quantitative and qualitative outcomes and discuss the challenges of implementing a multi-method evaluation with this client group.

Conclusion: Weekly yoga classes show promise as an adjunct treatment for refugees who experienced torture and trauma. We will discuss our experiences with tailoring both the program and the evaluation to participants with a range of backgrounds, physical abilities and literacy levels.

Danielle Begg (STARTTS & The Vasudhara Foundation),  Helen Bibby, Tonet Ortega, David Perez, Kedar Maharjan & Mariano Coello

“In Shape – A Lifestyle Modification Program”

Congruent with STARTTS’ BioPsychoSocial approach ‘In Shape’ is a multilingual lifestyle modification program developed by Fairfield City Council. The program has been developed in accordance with the existing BHE (Bilingual Health Educators) program guidelines and provides psycho education about the benefits of good nutrition in combination with a program of functional exercise tailored to the needs of each group and based in accordance with the Australian Guidelines of recommended exercise intensity.

The ‘In Shape’ program is based on a goal setting system whereby the aim is to improve the nutritional habits and physical activity levels of the participants, in order to enhance their mental health and general wellbeing. Another important aim of the program is to learn different tools to overcome mental barriers and increase motivation with the purpose of sustaining healthy habits.

‘In Shape’ provides opportunities for social connectivity and support, and adopts a holistic approach in accordance with STARTTS’ best code of practise.

‘In Shape’ is for both men and women from a refugee background which can be adapted to various age groups and is translated into simple English with translation of (most) resources of the program that could facilitate its delivery in the following languages; Arabic, Assyrian, Karen, Vietnamese, Italian, Spanish and Khmer (Cambodian).

Participants can self-refer or be referred to the program by their counsellor.

The evaluation process includes pre and post assessment tools such as the Hopkins Symptom Checklist 25, Harvard Trauma Questionnaire, DASS-21, Generalized Self-Efficacy Questionnaire as well as a physical assessment to ascertain the positive changes in the participant’s BioPsychoSocial wellbeing.

STARTTS has implemented four ‘In shape’ programs with communities from Iraq, Afghanistan, and various South American countries. The evaluation has shown improvements in nutritional habits and overall mental and physical wellbeing.

Rocio Martinez & David Perez (STARTTS)

Reconnections- Chronic Pain Group

The prevalence and complex nature of pain amongst survivors of torture/trauma is vast and adversely impacts on their health and wellbeing in many ways. The basis of this program was to facilitate a broader understanding of chronic pain issues and management in a cross-cultural context for refugee groups with a history of torture and complex trauma. Furthermore, the program aimed to improve client’s quality of life, restore hope, confidence, trust and build upon broad social/cultural connections. The group consisted of 8 males and 4 females from various cultural backgrounds who were clients of STTARS and who had a history of unresolved chronic pain.

The sessions ran for 4 hours every fortnight for 16 weeks during 2016. Our overall approach to self-management was to explore multiple strategies for individuals living with chronic pain including nutrition and diet, exercise, sleep hygiene, medication management, mindfulness and relaxation techniques, group discussions and individual storytelling. The participants were all asked to complete a pre and post pain score evaluation and a chronic pain impact worksheet.

Upon completion of the group sessions, clients reported a decrease in their pain scores and an increase in their daily coping strategies. Interestingly, despite the cultural diversity of the participants, many shared similar cultural views of the origins and expression of their pain that conflicted with the western discourse of pain origins and management. As such, an understanding of how collective culture, trauma and grief shapes pain perception in our clients is imperative in supporting them beyond the western paradigm of pharmaceutical approaches.

Matthew Seabrook (STTARS), Ghani Nasery (Survivors of Torture and Trauma Assistance and Rehabilitation Service (STTARS, Adelaide)