Written by Elizabeth Dartnall (SVRI), Abbie Shepard Fields (Universidad Centroamericana, Nicaragua), Sophie Namy (HaRT), Dan Lakin (JHBSPH), Hope Chigudu (Feminist Activist), Niyati Shah (World Bank Group), Anne Eckman (Consultant and Mental Health Practitioner), Claudia García-Moreno (WHO)
The SVRI in partnership with experts on mental health and violence against women (VAW) held a webinar to launch SVRI’s Knowledge Exchange on Healing from Sexual Violence: Body-focused mental health approaches. This Knowledge Exchange was motivated by a desire to understand better why and how many survivors of sexual violence manage and try to cope with the impacts of sexual violence for years; not only psychological problems, but also challenges and difficulties in their intimate relationships, in their ability to regulate emotions, in their connection with their own bodies, and with a range of physical problems. This blog shares findings of the Knowledge Exchange along with discussions and resources shared during the webinar.
Key messages from the Knowledge Exchange - Abbie Shepard Fields
Different conceptualisation of the ongoing impacts of sexual violence
The field of mental health has increasingly recognised the limits of the Post-Traumatic Stress Disorder (PTSD) formulation, a one-size-fits-all diagnosis that supposedly captures the impact of all traumatic experiences, across all cultures. By the early 1990s, alternative conceptualisations to PTSD were being proposed in response to these limitations. Judith Herman used the term “Complex Trauma” to describe a broader range of impacts including: problems regulating emotions and impulses; difficulties with attention and memory; shame, guilt and self-blame; problems with trust and intimacy in relationships; a sense of hopelessness; and physical difficulties and pain. These symptoms are often accompanied by a negative body image. Sexual violence survivors may feel disconnected from their bodies, which they sense as unsafe, damaged, uncontrollable, or confusing. Such symptoms can recur for years and years. The survivor often has no idea that these sensations/perceptions may be linked to a prior trauma.
How we process traumatic experiences
When trauma occurs, the thalamus—located in the executive part of the brain, the frontal cortex—completely shuts down, so although an imprint of the experience is left behind in the brain, it lacks a corresponding story. Because of the state of activation during trauma, the experience is recorded in a more primitive part of the brain, the limbic area, whose functions include perceptions and emotions. Unlike memories processed in the frontal cortex, feelings associated with traumatic experiences are stored as a series of separate sensations, rather than part of a coherent and accessible story. The lack of cognitive access to such non-narrative memories can limit the ability to heal.
The mind-body connection
Not all human beings respond in the same way to traumatic events, and not everyone exposed to sexual violence requires psychological attention. Similarly, not all survivors of trauma respond by “working through” their experiences as suggested by the Western model of psychotherapy. A growing body of evidence points to the importance of engaging the body in trauma healing.
Being traumatized, whether due to exposure to war, torture or sexual violence, means people can find themselves out of sync with their own bodies and what is going on around them. Trauma can get locked in the body, leaving many victims feeling immobilized and helpless, or in a continuous state of alert, never able to calm. To control the response, the body memory also needs to be attenuated. And this is not a cognitive process; it is somatic.
Emerging new evidence on what works
Despite its documented usefulness in many therapeutic settings, the benefits of cognitive-based therapy—particularly talk therapy—in treating the long-lasting symptoms associated with trauma are not clear. In contrast, a range of techniques focused on both the body and the mind are demonstrating new and effective ways of accessing traumatic memories without provoking the painful re-experiencing often triggered when verbally recounting traumatic events. These techniques include EMDR, somatic experiencing, neurofeedback, meditation, yoga, and others.
Some of these programs and techniques were shared during the webinar.
Trauma-informed yoga: An experience from Nicaragua – Abbie Shepard Fields
In a study about the mind-body relationship in healing from trauma conducted in Nicaragua in 2017, adult female survivors of CSA who took part in a trauma-informed yoga program underwent dramatic, life-altering changes that included notable reductions in physical, psychological and emotional symptoms, and positive growth in the form of greater tolerance of sensations, reconnection with their bodies, increased self-acceptance/self-awareness, and improved intimate relationships.
The outcome of the yoga practice that seemed to resonate most strongly with the women was their sense of reconnection with their bodies. The alienation they had experienced from their bodies as adolescents and young women had given rise to numerous physical and psychological symptoms; thus, connecting again, beginning to accept and love their bodies, was a central component of healing and growth.
Further reading here.
Healing and Resilience after Trauma – Sophie Namy
Since 2016, Healing and Resilience after Trauma (HaRT) has created a feminist space for women and girls who have experienced violence to connect with their inner resilience, build a supportive community, and collectively heal from the lingering impacts of trauma. HaRT focuses on mind-body approaches to healing and recovery, informed by trauma theory and evidence suggesting that trauma impacts the body’s physiological and neurological functioning. Consideration is also given to the structural roots of collective trauma—including the systemic oppression of women and girls—and seeks to address these dynamics through three themes: ‘safety in the body;’ ‘radical self-love’; and ‘compassion in action.’ The core methodology—HaRT Yoga—is group based and evolves over 12-weeks, with trauma-informed practices interwoven throughout (e.g., positive affirmations, group discussions, breath practice, dynamic yoga movements, guided visualizations, etc.)
Findings from a mixed method study conducted during the COVID-19 lockdown in Uganda demonstrated statistically significant reductions in symptoms of PTSD, depression, and anxiety among HaRT Yoga participants (compared to a group that did not participate in HaRT Yoga). Qualitative data substantiated these results and highlighted additional shifts such as feeling a sense of belonging and connection to peers, greater self-compassion, and increased ease and relaxation in the body. Participants also emphasized the importance of the ‘Closing Circle,’ included at the end of each session as a space for participants to share experiences, deepen reflection on the theme for the practice, and provide input for future sessions.
[From HaRT yoga] I have learned that having a good relationship with other people starts with loving myself. I cannot love other people if I do not love myself.
Further reading here.
Populations affected by violence in humanitarian context – Dan Lakin
There is a well-documented bidirectional relationship between violence against women (VAW) and mental health problems, in that experiencing VAW increases the likelihood of developing mental health problems, while mental health problems increase the risk of experiencing VAW. The negative mental health effects of VAW can be exacerbated in humanitarian contexts, where people experience multiple traumas, resources are limited, and support services are frequently unavailable. Despite the considerable associations between VAW and mental health, research has only recently started to identify mental health interventions that address the specific needs of survivors of VAW in humanitarian contexts. Dialogue between researchers and practitioners in both the VAW and mental health spheres can promote access to the full range of psychological interventions that have demonstrated efficacy in addressing mental health needs for VAW survivors in low-income and humanitarian settings.
Research is moving towards a less medicalized approach to mental health, with less emphasis on the notion of “one treatment, one problem.” By improving scalability, i.e., making it easier to implement mental health/VAW programming at larger scales, we can avoid building entirely new infrastructures that address a single mental health diagnosis. Practitioners are looking more towards broader social interventions that can be readily integrated into existing program initiatives, such as incorporating mental health-oriented programming into violence prevention or poverty alleviation programs. Similarly, organizations should consider integrating violence prevention into mental health interventions given the prevalence of VAW and its association with mental health problems. Beyond mutual collaboration between fields, contemporary research must actively develop and promote preventative interventions that include men. Many trials of mental health and psychosocial programming among traumatized populations focus predominantly on women, the notable exception being work among former combatants. Men have a pivotal role to play in violence cessation and psychosocial wellbeing, and both research and practice can benefit by focusing on strategies to improve men’s engagement with mental health services.
What is the importance of creating supportive and healing circles? – Hope Chigudu
Healing circles are safe spaces where survivors can share experiences, learn collectively, provide support. They are spaces where together survivors move, cry, and feel true compassion for other people and for self and explore healing.
Further reading here.
Mind-body techniques – Niyati Shah and Anne Eckman
Mind-body techniques including mindfulness and somatic exercises were shared at the webinar with a focus on creating a collective space to embody gratitude and an invitation to discover and experience comfort and ease in our bodies and surroundings. Experience them for yourself by watching the webinar online here.
Recognition of the strengths and limitations of existing interventions, including somatic and mindfulness based approaches, is an important step to build up our menu for addressing trauma as a result of sexual and other forms of violence against women. This must be underpinned by continuing research to document the efficacy and effectiveness of different therapeutic modalities alongside the development and evaluation of programmes that move beyond reducing PTSD to include sustained health and wellbeing for sexual violence victims and survivors and that address the diverse needs of survivors.
Find out more
To find out more about the webinar, the discussion, question and answer session and tools shared please visit the webpage here.