Salutogenic approach in trauma therapy

As a certified specialist in clinical trauma and integrative coaching, I have studied numerous intervention methods, starting from short courses in CBT (cognitive behavioral therapy), EMDR (Eye Movement Desensitization and Reprocessing), NET (narrative exposure therapy) to short-term certifications (3-6 months) in schematic therapy, emotion-focused therapy or the salutogenic approach in dealing with trauma. (Salutogenesis)

The salutogenic approach is the one that drew my attention for exploration and use in personal practice, being a combination of coaching approaches based on strengthening competencies (strengths-based approach), neuroscience and understanding the nervous and sensory system (polyvagal theory and sensory interventions) and elements of narration (narrative exposure therapy) in a relaxed and centered body (grounding). I found myself in this model both as a profession and skills (integrative coach – cognitive, emotional, somatic, behavioral, spiritual, integrative) but also as a personal life philosophy, especially bearing in mind a quote from Dr. Robert Macy, who trying to define trauma, he said it is ”An overwhelming demand imposed on the human physiological system”.

The author of Salutogenesis is Aaron Antonovsky, a medical sociologist who lived between 1923-1994 and who created the term in 1968 to capture a developing concept: that some people manage to avoid illness and manage well even in conditions of extreme stress or trauma.

Some key elements in salutogenesis show that although stress is omnipresent, salutogenesis opens the possibility for the client undergoing transformation to use stress management as a rehabilitation factor, developing active adaptation capacities and focusing attention on the history of a person’s movement through their trauma.          

The salutogenic approach is therefore based on Franke’s (2014) types of stress:· 

–positive stress (normal, rare and of short duration, essential for personal growth, motivation and resilience)·     

–tolerable (More severe or sustained, greater biochemical response)·     

–toxic (Prolonged activation of the stress response, failure of the body to fully recover and return to baseline, lack of caregiver response, reassurance or emotional response), and trauma is seen as complex, developmental and chronic , with the following specifications and causes: o   Complex trauma (complex PTSD) – Severe, prolonged and repeated trauma

o   Traumatic Developmental Disorder – The impact of prolonged trauma and heightened arousal on a child’s development.

o   Chronic trauma – Prolonged and repeated. The cumulative effect prolonged exposure to adversity and insecurity has on a person’s physiology.

      The salutogenic approach is focused on:

1) understanding the changes that occur at the biological level with a direct impact on thinking and emotional behavior (Biochemical and hormonal changes occur in the brain and nervous system that throw the body out of balance, with the repeated activation of the threat, key structures and areas of the brain change over time, close or become hyperactive) and later

2) the client’s assets and the strengthening of self-regulation capacities (self-regulation = interoception and relaxation by observing in real time the physiological processes that take place when perceiving danger and consciously interrupting this reaction and replacing it with relaxation through different methods and techniques)

3) dis-synthesizing by narrating in a relaxed body

Source: http://natureswaycounselling.co.uk/

As we showed above, the central element in the salutogenic approach to trauma is the capacity for self-regulation. Most of the symptoms of complex trauma, toxic stress, and adversity that we encounter have a sensory component, part of the nervous system responsible for processing information. Sensory integration theory states that the brain develops from the bottom up with most basic sensory functions (thalamus, cerebellum, brainstem) being located mainly in the lower CNS. (stimuli → sensory system → CNS processing, the 8 senses: visual, auditory, tactile, olfactory, gustatory, vestibular, proprioception, interoception)

Practically, in stabilizing the client and his body (stage 3 in the salutogenic approach after establishing the relationship and carrying out psychoeducation) we use techniques such as: body scanning and active identification of tense muscles – respectively their relaxation and centering, progressive relaxation, diaphragmatic breathing, pelvic relaxation, vision peripheral (similar to EMDR), safe space visualization. The purpose of the techniques is to familiarize the client with a relaxed body and a state of safety.

Among the sensory therapies with potential, we mention:

• Propioceptive: Engaging in activities by using resistance to generate pressure in joints and muscles. Increasing awareness of self and boundaries.

• Vestibular: Focus on movement, balance and grounding improving grounding, body awareness, muscle tone, level of alertness.

• Tactile: Using touch, pressure, temperature, vibration to self-nourish or self-regulate and become more grounded.

 In Stage 4, integration and desensitization, we try to use some elements to reduce anxiety, namely the use of drawings (the graphic line of life, 4 symbols of a memory in one minute, draw in 2 minutes what is happening in your body) and narration the event in a relaxed body (activating the elements from stage 3). In stage 5 we talk about growth and post-traumatic resistance and here, as throughout the entire process, salutogenic assets such as:

• Self-adjustment; Strengthening strong capacities; Meeting primary social/emotional needs.

• Increasing the voice and the ability to choose; Developing a long-term vision of positive expectations; Consolidation of interpersonal resources; Consolidation of personal resistance    

         

As in several methods, there are recommended scales to be used, respectively: the ACE score, the Resilience Scale or questionnaire, the trauma symptom checklist, the Devereux Adult Resilience Scale.

Unlike the pathological approach that is focused on disease, deficiency and the absence of pain, the salutogenic approach to patient care does not look at health as the absence of disease, but rather as a global and coherent orientation to life.

The advantages of the method are found in the integrative approach. People come from dark times in their lives and need help, a direction to move forward and live better. As they seek professional help, they deserve the quality of care anchored in them, their strength and their ability to cope, rather than being bogged down with routine trials and diagnoses.

The salutogenic approach focuses on identifying the strengths and assets of a situation or person that can contribute to or enhance their well-being. When assets are identified, the necessary interventions are made to match the psychological needs of a person exposed to stressors such as traumatic experiences.

Applying a salutogenic approach to trauma treatment helps clinicians track their clients’ progress without overlooking important details such as the client’s coping mechanisms. When their resistance is acknowledged, clients can feel “heard,” which can ignite their motivation to find purpose in life.           

Salutogenesis focuses on the origins of health, as opposed to pathogenesis which focuses on the development of disease. Most often, clinicians focus on the effects of developing posttraumatic stress disorder (PTSD), rather than the factors that led to its development and the factors that helped clients overcome their traumatic experiences.

The pathogenic approach to PTSD focuses primarily on prevention and avoidance of stressors. A salutogenic approach focuses on promoting and acting toward health. A pathogenic approach is not ineffective, but it is not as client-centered as salutogenic models. Clinicians serve primarily as mediators in dealing with trauma while clients go through a rigorous psychological process.

Using an asset-centric approach can help humanize the psychological process customers must experience.

Bibliography:    

Antonovsky, A. (1979) Health, Stress, and Coping. Jossey-Bass

Antonovsky A. (1987) Unraveling the Mystery of Health. How People Manage Stress and Stay Well. Jossey-Bass, San Francisco, London.

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Burkhart H., Debra G., Owens E.W. (2020) “Salutogenesis: Using Clients’ Strengths in the Treatment of Trauma.” Counseling Today: https://ct.counseling.org/2016/04/salutogenesis-using-clients-strengths-in-the-treatment-of-trauma/

Mittelmark, M.B (2017), The Handbook of Salutogenesis. Switzerland: Springer, 2017

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“SALUTOGENIC Approach to Wellness.” Physiopedia. Accessed November 14, 2021. https://www.physio-pedia.com/Salutogenic_Approach_to_Wellness

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