By Heather Hamilton, PhD. | ©2023BreakThrough!
Mental Health Care Supports Recovery from Obesity
When legacy trauma is a factor for patient care, sometimes behavioral health efforts (nutrition, exercise, activities) need to be supplemented with mental health support. This support can help our patients address long-standing conditions and disorders that lead to impulsive/emotional eating and the development of health problems such as type 2 diabetes and obesity. In this article we review the “freeze” response to trauma, it relationship to weight gain, and how we help participants in the BreakThrough! program recover from the past.
Working with Adult Survivors of Abuse to Treat the FREEZE Response
We talk often enough about “fight” or “flight” reactions to trauma, but not enough about the FREEZE response. In this post we discuss how we work with adults suffering with a legacy of abuse that has deeply and negatively affected how they feel about themselves.
Certain elements of personality and life experience typically predict responses to stress and there’s great literature that discusses “fight and flight” behaviors. But many participants in the BreakThrough! obesity recovery program talk about feeling like they freeze; paralyzed in place, uncertain about what to think or feel, how to act, who to trust and more. Through their stories common elements surface that polarize on a history of abuse, rejection, instability, toxic family environments, and more. The following narrative is directly from the BreakThrough! course text & workbook.
Abuse & Identity
We know from the cognitive and emotional perspectives, that early childhood influences the following:
- How we see ourselves
- Our relationships with others
- How we think we’re viewed by others
- Whether we believe we can do anything to change these conditions
Up to a certain age we simply believe and take to heart, that what our parents (or other authority figures) tell us, is true. We do this without significant resistance, misgivings, or uncertainty. We accept other people’s perceptions and opinions as ‟fact”. As we mature, we assimilate these “facts” and begin to turn to them as the guide for how we think about ourselves and our choices. Over time our thoughts (based on other’s people’s perceptions) solidify into beliefs. These beliefs start defining our identity (self-view), our place in the world, and our sense of efficacy. For those who experience emotional, and physical abuse it’s difficult to develop a positive sense of identity.
Some of us grew up with extremely inconsistent parenting influences and “mixed” messages. This environment can be as damaging to developing our sense of identity than one of purely negative messages. Say for example a parent presents the image of success, confidence and charm outside the home, but turns into a demanding, vicious and abusive alcoholic behind closed doors. As a child we lack the experience and wisdom to distinguish between the two extremes.
The message in public might be “Oh yes, my daughter Mary is a wonderful young girl.” Hours later with no provocation, the message being screamed at Mary is “I wish you were never born!” There’s no way Mary knows which message is accurate. Is she wonderful or a mistake? Is she loved or unwanted? Does she live with the kind, caring person or its evil twin? Which one should she be most like when she grows up? Supposing we inherit 50% of how we feel about ourselves; which message will Mary take to heart? That she’s loved, or that she’s a burden? That it’s safe to love, or that rejection or betrayal is to be expected? That it’s okay to relax, or that she has to remain hyper-vigilant?
Recovering from Freeze.
With conflicting internal messages it’s easy to see how decision making processes can be compromised or hijacked in times of uncertainty. The effect of intimidation, threats and exposure to violence in childhood can produce paralyzing internal conflict. Do I stand my ground? Do I run? This challenge can feel so overwhelming for some, freeze sets in. Participants who freeze describe re-actively curling up on the floor, a corner or couch, to protect themselves. Moments, even hours pass feeling as though they can’t move, can’t think, and are afraid to feel. Some dissociate, some recover by turning to mood altering substances and comfort food.
Recognition is the first chance we have to assess whether we are truly in danger or if our present has been hijacked by our learned fears. Automatic behavioral responses to fears begin with a flood of hormones and chemical activity in the brain. This flood in turn engages survival responses. It’s a natural protective and avoidant behavior to avoid physical pain and the act of curling up protects most of our vital and vulnerable areas. Once this has happened we have to work to move ourselves out of the fear and into our thinking brain. As soon as we can tell ourselves we’re safe then the initial flood of emotions has a chance to recede. Next we have to objectively assess what’s happening.
- What do we need to do to be safe?
- Who do we need to reach out to?
- What are we reacting to?
- Are we looking at this situation in the present or through our past experience?
Uncurling and stretching, massaging tension from our muscles is a good place to start. When you know you’re safe, it’s time to down-regulate cortisol (stress hormone) to reset the body and brain. Know your “go-to” soothing activities that help you relax and pick one! These may include some form of meditation, listening to music, fresh air, a warm bath, time at the park, playing with a pet, or visiting a friend. We aren’t distracting ourselves; we’re consciously choosing to relax; to let go and recover.
In the aftermath of panic and these types of automatic responses, it’s hard not to give in to self-indulgent mood-altering (comfort food, wine etc.,) because intense stress responses deplete energy and stimulate our appetite for carbohydrates. Mindful eating is always possible and it’s really important to drink water to prevent dehydration. If possible, schedule a massage to release deep muscle tension and memory. It may feel embarrassing if you unexpectedly had a freeze or “turtle” response in front of others. A true friend will offer empathy, concern and support. Remember, the judgement or negativity of anyone who doesn’t know us is meaningless. They don’t know us so nothing they think has any context or truth.
The takeaway here: know your go-to activities for reducing stress and reach out for support when necessary.
We hope you’ve enjoyed this article from the BreakThrough! program. This course is designed to support the mental health recovery for patients suffering with obesity & type 2 diabetes.