As integrative medicine continues to makes its place in the world of health care, and as research continues to reveal more nuanced knowledge of the mind-body connection and brain development, patients are reaping the benefits. Today, there is a keener awareness of the value of bodywork and movement in addressing trauma, attention deficit hyperactivity disorder (ADHD), depression, and a host of mental health issues, as well as in managing stress and chronic illness. Let’s take a look at some facilities that honor this approach.
Three centers, founded by psychiatrists, exemplify this type of holistic, integrative approach: the Wholeness Center in Fort Collins, Colorado, The Center for Mind-Body Medicine in Washington, DC, and the Child Trauma Academy in Houston, Texas. Though their models vary, each stresses the mind-body connection and a holistic, integrative approach to their patients’ problems.
“When you address mind, body, and spirit, you are going to have much better results,” says Hugh Castor, licensed acupuncturist and massage therapist with the Wholeness Center in Colorado. Castor is one of a team of practitioners at the center, which includes adult and child psychiatrists, family therapists, naturopathic doctors, counselors, psychologists, acupuncturists, a clinical social worker, nutrition specialists, a psychiatric nurse practitioner, and a massage therapist.
Founded by child psychiatrist Scott Shannon in October 2010, the center employs biomedical treatments in recognition of the fact that “neurological symptoms can be the result of, or worsened by, physical illness.”
The Wholeness Center addresses physical and mental health, as well as learning issues through several interventions: medical, which may include pharmaceuticals; individual psychotherapy or family therapy; behavioral changes, which can include nutrition and exercise; and movement and bodywork.
Years of experience working with children in institutions and private practice showed Shannon the validity of a collaborative approach. Author of Please Don’t Label My Child and an advocate of natural medicine since his student days, he sought to understand his young clients’ temperaments, needs, gifts, and struggles in a holistic way. Aware of the limitations and even dangers of psychiatric medications for children, he aimed to minimize their use and instead support children with a multipronged and more natural approach.
The Body and Brain
Shannon is just one of a number of physicians, psychiatrists, psychologists, and educators informed by research from the neurosciences on brain development and the emotional and environmental factors crucial to this development. Bruce Perry, founder of the Child Trauma Academy and author of The Boy Who was Raised as a Dog, works directly with developmental trauma and he and his staff teach practitioners and educators how to address it. Perry and his group are applying the knowledge of the neurosciences to therapy, while stressing the importance of movement and bodywork in addressing early injury.
Many experts note the importance of relationship in regulating the nervous system, and most acknowledge the role of touch or movement in addressing attachment issues, hyperarousal, and trauma. Whether an individual struggles with psychosis or ADHD, comprehensive treatment approaches can change biochemistry and even neural pathways. Many therapeutic approaches involve healing relationships, bodywork, and movement to address nervous system agitation; and nutrition, supplements, exercise, and sleep to stabilize brain chemistry and endocrine function. As practitioners across the country assimilate the knowledge and apply integrative approaches, the perspectives on mental illness, diagnoses, and prognoses are shifting.
The Wholeness Center, for example, addresses depression and anxiety, learning issues, attention deficit disorder (ADD), and autism, as well as psychosis, schizophrenia, neuroses, and violent or suicidal tendencies. Yet, as Shannon writes in Please Don’t Label My Child, the diagnosis isn’t front and center; it may take a backseat as practitioners consider temperament, environment, family, diet, and exercise. As children’s relationships, environment, diet, and exercise change, or as they receive bodywork or acupuncture, they may feel more regulated or more at ease, less stressed, and better able to concentrate.
When a client comes to the Wholeness Center, he or she is paired up with a primary practitioner, such as a social worker or psychiatrist, who can then coordinate with colleagues to best address the client’s needs. “We are trying to bring it all together and use structural, biochemical, energetic, and movement practices to best serve our clients,” Castor says. “Different combinations are often necessary to address the unique individual and their problem.”
For example, a child with autism may see a Wholeness Center social worker, as well as naturopath Steve Rondeau. Rondeau, who specializes in autism, may “prescribe” acupressure to harmonize the energy in the body and calm the nervous system. He will also address the disorder with some combination of herbs, nutrition, and exercise in a way that makes sense for the individual.
Bodywork and Emotions
For some clients, massage is a fundamental part of treatment, Castor says. Massage soothes the nervous system and can help address somaticized pain, he says. As an acupuncturist and massage therapist, he sees a connection between some physical symptoms, such as pain, and trauma or other trapped emotions. “With bodywork, we see a release of emotions that sometimes leads to a dramatic resolution of pain.”
In addition, he notes, bodywork helps ground individuals when they are anxious or have ongoing nervous system agitation, it can lift spirits when someone is depressed, and it can relieve the pain that is a primary cause in some forms of depression. “Chronic pain has a real biochemical component, and it affects the whole life relationship. We try to distinguish where the depression comes from—the cause; it may be biochemical and require medications. But treating pain with bodywork and acupuncture can cure depression for some people,” he says. “Furthermore,” he notes, “if you add movement arts, like yoga and tai chi, you can influence structure and energetics in a beneficial way. You then put tools in the client’s hands so they can keep their energy flowing and open.”
Castor says the Wholeness Center practitioners also know that movement arts can help with self-esteem. Anca Niculae, a marriage and family therapist at the Wholeness Center, teaches yoga classes for teenage girls, and Carolyn Williams-Orlando, a psychologist and expressive arts therapist, does yoga and creative arts with children at the center. “This empowerment aspect is one of the most powerful parts of a holistic approach,” Castor says.
The benefits of movement and bodywork can also be far-reaching for those diagnosed with ADHD. The therapies can promote grounding, as well as sensory integration, giving clients a newly found ability to function. “The movement seats kids into their bodies and positively affects learning and attention,” Castor says.
Reorganizing the Brain
Another comprehensive treatment model that embraces bodywork and movement comes from the Child Trauma Academy. This not-for-profit organization employs a unique approach based on the sequential aspects of child development. The center was created at the University of Chicago and at Baylor College of Medicine; it became The Center for the Study of Childhood Trauma in 1990, then moved to Houston and became the Child Trauma Academy in 1998. It provides direct service to children, as well as research and education.
According to its website, the center translates emerging findings about the human brain and child development into “practical implications for the ways we nurture, protect, enrich, educate, and heal children. The ‘translational neuroscience’ work of the [Child Trauma Academy] has resulted in a range of innovative programs in therapeutic, child protection, and educational systems.”
Perry developed a Neurosequential Model of Therapeutics (NMT) for children who have experienced trauma. “Because the brain is organized in a hierarchical fashion with symptoms of fear first arising in the brain stem and then moving all the way to the cortex, the first step in therapeutic success is brain stem regulation,” Perry writes in his book on the Child Trauma Academy website. Children who have experienced trauma need “dedicated amounts of focused repetition” in order for their neural systems to change, Perry says, and he and his staff train others in how best to bring such repetition into the treatment of children.
The repetitive interventions the academy applies include approaches that regulate the brain stem, such as positive, nurturing interactions with peers, teachers, and caregivers. According to the Child Trauma Academy website, these are especially important for “neglected children who have not had enough neural stimulation to develop the capacity to bond with others.” Beyond these interactions, other interventions might include dance, music, or massage, “especially for children whose persisting fear state is so overwhelming that they cannot be expected to improve via increased positive relationships or even therapeutic relationships until their brain stem is regulated by safe, predictable, repetitive sensory input.”
To share what they’ve learned, the Child Trauma Academy provides training in NMT to clinics and mental health centers nationally. From 2007 to 2009, the academy worked with staff members from the Larimer County Children, Youth, and Families Division in Colorado, who were looking for more effective ways to help children. Director Jim Drendel hired Marcia McConnell Ranch, a clinical social worker experienced in working with trauma, to develop and implement a pilot project, and Gary Ranch, a psychologist, to assist with assessment and planning.
Larimer County Department of Human Services caseworkers, supervisors, and collateral treatment providers participated in two of Perry’s case-based training series’ via phone conferencing and Internet. They presented a case, and Perry provided impressions and recommendations. “It was all under the basics of Perry’s model, in which we looked at the earliest developmental insult children experienced and addressed that,” McConnell Ranch says.
The department set up The Trauma Impact Project and selected 20 children from 18 months to 16 years old to participate. When staff assessed them for early life trauma impact, they found that all 20 had experienced the earliest developmental insult in the first stage of life, which affects development of the brain stem. The brain stem regulates arousal, sleep cycles, and sensory input; when it has not developed in an organized way, children experience dysregulation, which can cause them to look like they have ADHD, McConnell Ranch says. “The project was designed to assess the impact of that trauma and provide nontraditional interventions at the neurodevelopmental stage of the earliest developmental insult,” she says. “Traditional psychotherapy typically doesn’t work with this population because it requires the foundation of the cognitive brain, a much higher level of development and functioning. We did age-appropriate interventions that addressed that part of the brain developing at that age—the brain stem.”
She says there are two main consequences of experiencing trauma from 0–9 months: “First, it disrupts development so that the brain is poorly organized and functionally impaired. Second, it causes an overdevelopment of the fight-or-flight system so that these children tend to be in a state of heightened arousal much of the time. Hyperarousal and the associated stress it produces in multiple physiological and brain functions interferes with these kids’ abilities to attend to learning and other age-appropriate tasks and activities.”
Perry’s recommended interventions correspond with the types of activities that normally occur to facilitate brain development, McConnell Ranch says. “If the earliest developmental insult occurred in the first nine months of life, then patterned, repetitive activities that help to regulate the brain stem are the appropriate interventions. This could include massage and rhythmic activities that soothe and calm. As children progress to the second stage of neurodevelopment (which involves the motor cortex and midbrain), dance, therapeutic movement, yoga, and animal therapies help to reorganize dysfunctions in these parts of the brain. And so on, hierarchically, up the brain.”
A 16-year-old boy in the study, for example, would become hyperaroused easily. He couldn’t stay calm or engage in functional activities, and he had a lot of trouble in school. His assessment revealed very early trauma that the Child Trauma Academy believes could be addressed by massage; The Trauma Impact Project engaged a massage therapist to help. He first learned to tolerate self-massage, and eventually he could accept receiving it from another person. In addition, his caseworker encouraged him to engage in patterned activities, such as bouncing a rubber ball on the wall, which he did once a day. In time, he could better tolerate being around other people enough to go to school, and he began to engage in new behaviors such as riding the bus to school and calling when he was going to be late for a meeting, McConnell Ranch says. He also began to get a new sense of reward from his tasks and accomplishments.
Another success story from the Larimer County project involved an 18-month-old boy who had been in three foster homes because of extreme tantrums. The staff identified that he needed frequent calming movement, like rocking. His caregivers rocked him at regular intervals, as well as when he began to get hyperaroused. The rocking calmed and soothed him, literally facilitating regulation of his brain stem, McConnell Ranch says. “By the time he was 2, he was sometimes requesting to be rocked; he seemed to recognize when he was becoming dysregulated and could initiate calming for himself.”
Movement was also central to the Larimer County project, especially in addressing the needs of some young girls. Arline Heaton, a therapeutic movement specialist, assisted girls in improving self-regulation, coordination, and motor planning, as well as social skills through therapeutic dance. One participant who had a reputation for frequently being out of control and aggressive became more cooperative, better coordinated, and grounded in her body with movement. She emerged as a leader in the group. Many of the girls had difficulty staying focused and on-task, tended to be clumsy and physically awkward, and failed to cooperate well at the beginning of the eight-week groups. “By the end of the groups, they were alert, grounded in their bodies, moving more fluidly, assisting one another, and taking great pride in their improvements and the joy of movement,” McConnell Ranch says.
“I think one of the most critical aspects was developing better understanding of trauma among caseworkers, parents, foster parents, and collateral providers,” McConnell Ranch says of the project. “They learned more about brain development and that children were not intentionally acting up. They came to view the kids differently and learned to deal with hyperarousal with patterned, repetitive activity.”
Perry’s work is widely known, and the Child Trauma Academy is now involved in numerous public-private partnerships in traditional mental health and medical settings, as well as in child protective services and juvenile justice systems. The academy has created assessment protocols and processes for various organizations and helps with evaluation and intervention strategies. Examples of its programs include Community Building, Violence Prevention, Safe from the Start, Keep the Cool in School, Early Childhood Development, and KidZonePhiladelphia.
The Mind-Body Approach
Psychiatrist James Gordon, a clinical professor in the Departments of Psychiatry and Family Medicine at Georgetown Medical School, promotes another integrative mental health model. His work with clients, as well as with his own physical ailments and depression, led to him founding The Center for Mind-Body Medicine in Washington, DC, in 1991. He considers the mind-body connection crucial to health and healing, and the center teaches that skills evoking this connection can be applied in a myriad of settings to address illness, as well as depression, anxiety, or trauma. Author of Manifesto for a New Medicine and Unstuck: Your Guide to the Seven-Stage Journey out of Depression, Gordon discovered the importance of movement, meditation, nutrition, bodywork, and self-expression in his own life and emphasizes it in his work with his patients and in the programming of the center.
Gordon’s center trains practitioners to incorporate mind-body approaches in their work. Practitioners, including physicians, nurses, psychologists, social workers, bodyworkers, and others, study a model for treatment that puts self-help first, movement and bodywork next, and surgery and medication last. They learn a new concept of care that focuses on self-care, mind-body awareness, structural and energetic adjustment, and nutrition, with medication and surgery as last resorts. They become educators of mind-body skills, such as basic meditation, movement exercises, and nutrition principles.
Kathy Farah, a family practitioner with Mayo Health Systems, Red Cedar Medical Center in Glenwood City, Wisconsin, and Children’s Integrative Medicine Clinic in Minneapolis, attended The Center for Mind-Body Medicine professional training in 1998 to learn a new approach for her work. “People kept coming back to me with a lot of the same issues, and medications weren’t always fixing things,” she says. “I felt that there had to be more; I thought we could get to the root cause. I value a holistic approach—I ask what is going on with this person. It isn’t just what is happening in the body; it is what is happening in the mind, around them, in their families, jobs or school, in their community. I found that stress—the environment and our internal stress—impacts our physical and mental well-being, and I began to explore this issue for myself, as well as [for] patients. I began to explore ways to promote health, rather than just cure disease.”
Farah learned craniosacral therapy, which gave her a sense of being “a hands-on doctor,” she says. In addition, training she received at The Center for Mind-Body Medicine taught her many other approaches, such as imagery, meditation, simple biofeedback, relaxation breathing, movement, yoga, and biofeedback. “I practice these techniques myself, which helps me to teach others.” Then she began to practice an approach embracing all these modalities.
Farah now uses craniosacral therapy for pain syndrome, headaches, or in instances when a child is not settled enough to do other techniques. She says the hands-on practice calms their nervous systems so they get to a balanced place. She uses shaking and dancing in groups for kids and adults and holds “stress-buster” workshops for patients. She recommends massage often, stressing the need for stress reduction and the importance of massage for reducing anxiety, improving sleep, helping with cancer-related symptoms, and alleviating headache and back pain.
Like Castor, Farah values the empowerment patients experience when they learn mind-body skills, such as breathing and movement. “I find that if I teach a person one thing—such as deep breathing, they can do it on their own and begin to feel the change it can make for them. People are searching for ways to feel better. It empowers them to become a partner in their health.”
Finally, Farah asks her patients what they are doing to move their body and tells them about the physiological benefits and about the stress response. “To me, movement is health—if we are ill, we don’t move. If we are depressed, it takes all our effort to walk outside our home. If we find an exercise or movement we enjoy, we feel better. I ask people what they like to do physically, and together we try to determine the best way to bring it into their lives. So, for example, I had a woman tell me she liked to dance. She reported back that she had started dancing with her granddaughter, which was good for both of them.”
The approaches of these centers represent part of a much bigger trend: greater recognition of the process of brain development and the need for neural stimulation are fueling a vast array of approaches nationally and internationally. These approaches reach into medicine, mental health, and education, spurred by the need for more effective ways to help abused children, traumatized veterans, kids with ADHD who struggle to learn, and even to address psychosis.
Other examples of centers promoting integrative approaches and mind-body skills range from the UCLA Mindful Awareness Research Center founded by Daniel Siegel to the Center for Mindfulness in Medicine, Health-care, and Society at the University of Massachusetts (home of Mindfulness-Based Stress Reduction taught by Jon Kabat-Zinn) to veterans’ administrations applying yoga and mindfulness in treatment of post-traumatic stress disorder (PTSD).
The Word is Spreading
Whether bodywork, movement, and arts are integrated into a center’s treatment approach, or are encouraged by particular practitioners working with clients, their importance is recognized, and it is spreading. This development has the potential to change the perspective of physicians and psychologists on bodywork and movement and how it can change their patients’ lives.
Lynda McCullough is a freelance health writer and yoga teacher living in Loveland, Colorado. She previously served on the staffs of Common Boundary magazine and the American Psychiatric Association, as well as two wellness centers featuring massage. Passionate about bodywork and movement arts, she enjoys teaching and writing about them whenever the opportunity arises. She can be reached at mccullo3@msn.com.