Compassionate trauma-informed healthcare does not emerge from policies, training sessions or good intentions alone.  It is created through the everyday actions, relationships, practices, self-compassion, understanding of trauma and cultures that shape how we meet ourselves and one another.  While this blog is focusing on healthcare the principles apply to social care and other sectors.

There are many factors that support compassionate, trauma-informed working including:

• Presence and awareness
• Understanding trauma and embodying trauma-informed principles
• Nervous system awareness and regulation
• Self-compassion
• Somatic and embodiment practices
• Compassionate leadership
• Effective team working, psychological safety and safeness
• Reflection and shared learning

These elements are deeply interconnected, and together support compassionate trauma-informed ways of working, relating and being.

Presence and Awareness

Presence and awareness are foundational in compassionate healthcare.  Compassion begins with noticing suffering and being willing to turn towards it.  Presence is not passive, it invites awareness and inquiry.

When we aren’t aware of suffering, we can’t take action to try and alleviate it and when we can’t tolerate discomfort, we will either avoid it, jump into trying to fix it, or become overwhelmed by it.

This can be supported by mindfulness-based practices, which trains awareness and attention — learning to notice experience moment by moment with greater clarity, steadiness, and openness.  Supporting presence, listening, and the ability to respond rather than react.

Everything is relational, compassionate healthcare is not simply about what we do, but about how we are with ourselves and others.  Presence supports us in listening deeply, understanding experiences, building trust, and responding wisely rather than automatically.

Empathy helps us understand and resonate with the experiences of others, while compassion adds the motivation and courage to respond wisely to suffering.

Professor Michael West describes the first behaviour needed in compassion as attending — being fully present with another person and listening with fascination.  This is something that resonates with me perhaps it does with you too.

Compassionate Questions

Compassionate healthcare is supported by simple but powerful questions that help us remain connected to ourselves and others.  Questions that support compassionate awareness, understanding and wise action, include:

• What is needed right now?
• What would be supportive right now?
• How can I help you? (something Professor Michael West often highlights the importance of asking)
• What matters most right now?

These questions shift us away from assumptions, fixing and rushing, and towards understanding, collaboration and more trauma-informed compassionate responses.

Presence alone is not enough.  Compassionate presence also requires care, curiosity, courage, humility and enough regulation to remain open to another person’s experience rather than making assumptions, or controlling the conversation.  Like compassion, presence is a lifelong practice.

Understanding Trauma and Embodying Trauma-Informed Principles

As discussed in part one of this blog, compassion and trauma-informed practice are deeply interconnected.  Alongside the elements that support compassionate heathcare, trauma-informed healthcare is also supported by understanding the wide-reaching impact that adversity and trauma can have on individuals, relationships, organisations and systems and society.

This includes understanding the different types of trauma and how trauma can affect the brain, body, nervous system and whole person.  It is also helpful to consider how trauma has shaped communities, systems and society.  It’s important to recognise that there will be people who have experienced trauma within healthcare teams, as well as among those using healthcare services.

Being trauma-informed is not simply about having knowledge of trauma or embedding trauma-informed principles into policies and procedures.  It involves embodying the principles of safety, trustworthiness, choice, collaboration, empowerment, and cultural, historical and gender awareness in everyday interactions, leadership and organisational culture.  Like compassion, trauma-informed practice is something that needs to be lived and embodied, not simply understood intellectually.

Trauma-informed working recognises that experiences throughout life can influence many things, including: health and wellbeing, behaviour, our ability to be present for ourselves and others, how we experience healthcare, connection, relationships, and stress.

Together with compassion, these principles shape how people communicate, how decisions are made, how conflict is managed, and how individuals and teams respond when people are distressed or struggling.  They invite us to ask not “What’s wrong with you?” but “What has happened to you?”, “What is happening for you?”, and “What is needed right now?”

Compassion, presence, nervous system awareness, self-compassion, effective team working and compassionate leadership all help create the conditions in which trauma-informed principles can be embodied and sustained.  Together, they support environments where people feel safer, more valued and respected, more able to heal, collaborate, learn and flourish with greater connection and shared wisdom.

Nervous System Regulation

Nervous system awareness and regulation are essential components of compassionate trauma-informed healthcare.

When we are overwhelmed, stressed or operating beyond our capacity, it becomes more difficult to stay present, think clearly, listen deeply and respond wisely.  We may become reactive, defensive, controlling, avoidant, or rush into trying to fix problems before fully understanding them.

Regulation does not mean remaining calm all of the time.  It means developing enough awareness and capacity to stay present with difficulty, respond rather than react, and reconnect and settle enough when we become activated.   We need enough capacity to stay present with suffering without becoming overwhelmed by it.  We need to understand our own nervous systems and how to stay regulated enough in the face of suffering, along with the challenges of lack of time and resources that are so often present.

When we can remain regulated enough in the face of suffering and challenge, we also support others in regulating.  This process of co-regulation has ripple effects within teams, services and organisations.  Also, beyond this as people carry the compassion out into their world.  In the same way that stress and threat can spread through systems, compassion, steadiness and connection can also spread.

Self Compassion

Compassionate healthcare requires self-compassion as well as compassion for others, it’s something that is essential.

Many healthcare professionals are highly skilled at caring for others whilst finding it difficult to extend the same understanding, care and kindness towards themselves.

Self-compassion supports awareness of our own suffering, helps us recognise our limits, and encourages us to respond wisely rather than pushing endlessly through exhaustion and distress.

Far from being self-indulgent, self-compassion supports our ability to be present with our own suffering and challenges and to take wise action, along with remaining present and compassionate with others over time.  It is a foundation for sustainable healthcare.

Self-compassion can be supported in a number of ways, including through gentle inquiry.  In moments of stress, overwhelm or self-criticism, we might pause and ask:

• What is needed right now?
• What is helpful right now?
• What can I do for myself out of kindness in this moment?

These questions are not about avoiding difficulty, they help us respond to ourselves with the same care, understanding and wisdom that we would offer to someone else who was struggling.

Somatic and Embodiment Practices

Compassion is more than an idea or intention, or something to be ticked off a list, it is something to embody and to make away of being over time.

Somatic and embodiment practices help us develop awareness of our internal experience, recognise signs of activation earlier, strengthen our capacity for presence, support nervous system regulation, and choose what to embody.

They can help move compassion from something we understand intellectually into something we genuinely embody and enact in our relationships, leadership and everyday life.

Embodiment also helps us recognise when our words, actions, values and organisational practices are aligned — and when they are not.

Compassionate Leadership

Compassionate leadership is essential for creating compassionate trauma-informed cultures.

Research has consistently demonstrated the importance of compassionate leadership in staff engagement, wellbeing, team performance and quality of care.

Compassionate leadership is not soft, passive or about avoiding difficult conversations.  It requires the courage to lean into suffering, challenge and uncertainty, and act with wisdom and care.

It involves creating conditions where people can flourish, removing obstacles that prevent people from doing their jobs effectively, listening deeply, valuing diverse perspectives, and supporting people to contribute their skills and ideas.

Compassionate leadership is not only the responsibility of formal leaders.  Everyone working within healthcare influences others and the culture around them.  We are all leaders in how we show up, relate to others and contribute to the environments we work within.

Self-compassion is an important foundation of compassionate leadership, along with awareness, presence and nervous system regulation.  Compassion needs to be practiced in all areas of life and embodied over time to become genuine compassionate leadership.

Compassionate leadership is not soft; it takes great courage to lean into the suffering, challenge, and uncertainty.  It includes advocating for the resources, time and conditions people need to do their work safely and effectively.  It also includes addressing conflict and unacceptable behaviour with courage, care and clarity.  Ultimately it can help to create environments where people can flourish rather than merely survive.

Reflective Practice and Learning

Teams need time and space to reflect, share experiences, learn together and discuss challenges openly.  This requires environments that support psychological safety and safeness, compassionate challenge and genuine collaboration.  Research has shown that teams who take regular time to reflect together are significantly more productive than those who do not.  Reflection is important both within and between teams to help create a more effective, compassionate and sustainable healthcare system.

When people feel safe enough to contribute ideas, raise concerns and learn from mistakes, organisations become more adaptive, innovative and effective.

Collective intelligence is one of the most underused resources in healthcare systems.  The solutions to some of the challenges facing healthcare already exist within the collective wisdom of the workforce.  Creating opportunities to access this wisdom is a vital part of compassionate leadership and culture change.

Compassionate Trauma-Informed Communication

Communication is one of the primary ways the principles of compassionate trauma-informed healthcare are lived and embodied in everyday practice.

Compassionate trauma-informed communication is not only about what we say. It is about how we are in relationship with ourselves and others.  Before we choose our words, our presence, nervous system state, tone of voice and capacity for compassion are already shaping the interaction.  The way we speak, listen, create choice, respond to uncertainty and relate to one another helps shape the culture of healthcare.

I’ve explored this in more depth in my blog, Understanding Compassionate Trauma-Informed Communication, which you can read here:

https://unityphysio.co.uk/compassionate-trauma-informed-communication/

Creating Compassionate Trauma-Informed Cultures

When compassion and trauma-informed principles are not embodied throughout an organisation and woven into leadership, policies, procedures and everyday practice, they risk becoming a tick-box exercise.

Culture is not only reflected in leadership teams, organisational documents and strategies, it’s shaped moment by moment through how we meet ourselves, how we relate to one another, how decisions are made, and how people are treated when they are struggling.

Creating compassionate trauma-informed healthcare requires commitment at every level of an organisation and the wider system.  It involves individuals, teams, leaders and organisations working together to create environments where people feel safe and have a sense of safeness — where they feel valued, respected, supported, and able to contribute.  It requires compassion and trauma-informed principles to be woven into leadership, team working, reflective practice, policies, procedures and everyday interactions.

This is not only beneficial for healthcare professionals and service users, it contributes to healthier workplaces, stronger communities and, ultimately, a more compassionate, trauma-informed society.  Compassionate cultures are created collectively through the relationships, behaviours and systems that shape how people experience work and care.

Summary

Compassionate trauma-informed healthcare is more than words or isolated practices; it is an integrated way of being and working.  It is supported by many interconnected elements, including: presence, awareness, understanding trauma and embodying trauma-informed principles, nervous system regulation, self-compassion, mindfulness-based practices, somatic and embodiment practices, compassionate leadership, effective team working, psychological safety and safeness, and reflection and shared learning.  When these are woven into individual ways of being, teams and systems, they help create cultures where people can meet challenge with greater steadiness, connection, shared wisdom and compassion.  This supports environments where staff and services users feel heard, valued and supported, contributing to more compassionate, effective and sustainable healthcare and, ultimately, a more compassionate society.

You can find part-one of this blog here, which explores what compassionate trauma-informed working is and why it matters: https://unityphysio.co.uk/?p=8390&preview=true

You can find out more about my work in this area here https://unityphysio.co.uk/services/compassionate-trauma-informed-working/

The post Creating Compassionate Trauma-Informed Healthcare appeared first on Unity Physiotherapy and Wellbeing.

Compassionate trauma-informed healthcare brings together compassionate care with trauma-informed principles.   It has compassion at the heart, which changes how individuals, teams, leaders and systems operate.  It’s about creating healthcare systems that support staff and service users, recognise that anyone can be affected by trauma, and support more sustainable healthcare.  While this blog focuses on healthcare, a lot of what’s shared here is equally relevant to social care and other sectors.

In compassionate, trauma-informed working, compassion is not only an individual skill – it’s embodied and enacted at every level of the organisation.  This requires shared responsibility, awareness, and practice, across leadership, teams, and systems.

Compassionate trauma-informed healthcare recognises that both service users and healthcare professionals are human beings with needs, vulnerabilities, strengths and life experiences that shape how they experience healthcare.

It supports us in being present with suffering, understanding people’s experiences and responding wisely.  As relational beings, connection, belonging, and compassionate relationships are fundamental to our health, wellbeing, and collective flourishing.  Trauma-informed principles help ensure this care is delivered in ways that promote safety, trust, collaboration, choice and empowerment.

Together they create conditions where people are more likely to feel heard, respected and supported.  They help to cultivate conditions of safety, trust, collaboration and compassionate care, along with reducing the risk of retraumatisation.

What is Compassion?

To understand compassionate healthcare it’s important to understand what compassion is.  Through the lens of compassion focused therapy (CFT), compassion is the recognition of suffering and the desire or motivation to try and alleviate or prevent it.  It is something we can train and it is innate within us.

In CFT compassion has three core qualities: a caring commitment to engage with suffering and try and alleviate it, the courage to turn towards difficulty, and wisdom which involves recognising the complexities of being human, understanding the root causes of suffering, and responding in ways that are wise and with the intention of being helpful.

CFT also describes a number of attributes and skills that support compassion.  Attributes include sensitivity to suffering, distress tolerance, and care for wellbeing.  Skills include compassionate attention and compassionate behaviour.  Other qualities often associated with compassion include patience, kindness, humility, non-judgement and curiosity.

Compassion can flow in three directions: towards others, from others, and towards ourselves (from ourselves).  Many people find self-compassion the most difficult of these.  Compassion directed towards ourselves is essential in healthcare, and in life more generally.   Without self-compassion, it becomes harder to sustain compassionate attention, behaviour and care over time.

Compassion is both a motivation and an experience.  We can feel compassion, cultivate it intentionally, and strengthen the qualities and skills that support it.  Through practice and embodiment, compassion becomes more than something we do occasionally — it becomes a way of being that influences how we relate to ourselves, others and the wider world.

Compassion is commonly misunderstood as soft and fluffy.  Whilst compassion can have a gentle and nurturing quality, it also requires great courage.  It supports us in leaning into suffering, conflict, challenge and difficulty, rather than turning away or rushing to try and ‘fix’ things.  This includes navigating difficult behaviour and conversations.

Compassion in Healthcare

Compassion in healthcare is more than being kind.  It is reflected in how we listen, relate, communicate and respond to suffering, and how compassion is embodied within teams, organisations and systems.

Compassionate care is a whole person approach to care and involves a variety of aspects like curiosity, non-judgmental listening, presence and being with the person and all of what’s present, awareness of ourselves and others, awareness of what is happening relationally, effective communication, clarity, and respect for individual experiences and values.

I like a term that Professor Michael West uses around presence and being with the other person and their experience, which is attending.  This refers to presence and deep listening and Michael says listening with fascination.

Before trying to help, we first need to attend and be with the person and their challenges or suffering, listening deeply with curiosity and a genuine desire to understand.  We need to acknowledge and validate what is present before moving towards wise action.

What Does Being Trauma-Informed Mean?

Trauma-informed working is not the same as trauma-sensitive or trauma aware, all of these matter.  Trauma-informed working recognises the profound and wide-reaching impact of trauma on individual lives and collectively.   There needs to be an understanding of trauma, the many ways it can present, and the need to prevent retraumatisation or further trauma.  There are 6 key principles of trauma-informed practice:

• Safety
• Trustworthiness and Transparency
• Choice
• Collaboration
• Empowerment
• Cultural, Historical and Gender Awareness

You can read more about Trauma-Informed Practice here: https://unityphysio.co.uk/services/trauma-informed-practice/

Trauma-informed principles are naturally supported when compassion is embodied at individual, team and organisational levels.  Safety, trust, collaboration, empowerment and choice are not separate from compassion; they are expressions of compassion in practice.

Why Does it Matter? 

We face significant challenges across health and social care, including workforce pressures, chronic work overload, high levels of stress and burnout, increasing demand and inequities in access and outcomes; and waiting lists in healthcare are long.  We need to address a variety of issues and better meet the core human needs of staff and the people using healthcare services.  There are some pockets of good compassionate healthcare, within individual practice, teams, and whole organisations and trusts.  This needs to be more the norm than the exception.

Compassionate healthcare has been shown to help decrease the risk of burnout, improve team working, improve job satisfaction, improve service user engagement and outcomes.  It’s also important for sustainability. It values diversity, supports inclusion, and enables organisations to benefit from the collective wisdom, experience and perspectives of their teams.  Compassionate trauma-informed healthcare recognises that sustainable wellbeing requires attention to both individuals and the systems in which they work.

“Compassion is the single most important intervention we have in healthcare” Professor Michael West

The potential benefits for staff include:

• Supports nervous system regulation, trust and a sense of belonging
• Enhances therapeutic relationship and professional relationships
• Improves wellbeing including mental health and overall wellbeing
• Reduces work-related stress
• Lowers the risk of burnout and vicarious trauma
• Increases work satisfaction

Burnout is often framed as an individual problem requiring individual solutions.  While personal wellbeing practices can help, they cannot compensate for systems that repeatedly fail to meet core human needs.  It is not a resilience issue of individuals, it’s largely a systemic issue.

When people have little autonomy, feel disconnected from others, experience chronic overload, lack resources, or feel unable to influence change, stress and burnout rise.   Part of this is core human needs not being met, this increases threat system activation.

It’s also wider than this — it’s a societal issue too.  We have a society that encourages over doing, striving, not resting, and feeling like nothings enough.

It is essential that staff feel understood, valued, trusted, and cared about.  Working within a compassionate culture supports this and creating well structured teams.

There are also a number of potential benefits for the organisation, including:

• Improved effectiveness and sustainability
• Reduced sickness absence and staff turnover
• Supports healthy boundaries and sustainable workloads
• Stronger team dynamics, communication, and collaboration
• Enhances service user experiences and outcomes

It also has a number of potential benefits for service users including:

• Supports nervous system regulation
• Decreases the risk of retraumatisation
• Improves engagement with services
• Enhances satisfaction and care outcomes
• Promotes healing and recovery

When healthcare is not compassionate and trauma-informed, people can leave encounters feeling dismissed, invalidated or blamed. Some avoid seeking support in the future, others disengage from treatment or lose trust in healthcare services altogether.

Creating compassionate, trauma-informed healthcare is about more than improving individual interactions.  It helps create cultures where staff can flourish, service users feel heard and supported, and compassion ripples out into families, communities and wider society.

Summary

Compassionate trauma-informed healthcare is not only about reducing harm and improving service user outcomes.  It’s about creating conditions where people, teams and organisations can work, heal and thrive sustainably over time.

When people feel heard, understood and supported, they are more likely to engage with care, communicate openly, and participate in decision-making.  This can contribute to improved experiences, more effective care and better outcomes.

Creating compassionate, trauma-informed healthcare is about more than improving individual interactions.   It helps create cultures where staff can flourish, service users feel heard and supported, and compassion ripples out into families, communities and wider society.

Part two of this blog explores what can support the cultivation of compassionate trauma-informed healthcare, including compassionate leadership, nervous system regulation, self-compassion, embodiment, reflective practice and collective wisdom.  You can read part two here: https://unityphysio.co.uk/?p=8420&preview=true

You can find out more about my work in this area here: https://unityphysio.co.uk/services/compassionate-trauma-informed-working/

The post Understanding Compassionate Trauma-Informed Healthcare appeared first on Unity Physiotherapy and Wellbeing.

What is a Word of the Year?

I see a word of the year as a quality, a felt sense of something, or a way of being that you’d like to invite more of in the coming year.  It can act as a gentle guide — something to orient towards, return to, and weave into reflections throughout the year.

Choosing a word can be a gentle mindbodyspirit practice (no spaces intentionally here) — a way to invite deeper alignment, inner guidance, coherence, and attunement into your life.  It becomes a thread through your days, helping you notice where you are in relation to your intentions, values, presence, and the rhythms of life within and around you.

I’ve chosen a word of the year for many years now, and I’ve found it especially supportive when combined with my way of living –in a mindful, compassionate & values-aligned way.

In 2025 I also began choosing a word of the month – each connected to my main word of the year.  Having both has felt nourishing and grounding, and has been helpful on a variety of ways.

Part of the how I choose my yearly word is by reflecting on the year that’s coming to a close.  This often includes exploring:

• What felt supportive?
• What went well?
• What was challenging?
• What do I want to invite more of
• What could I let go of?

Reflecting on the Year & Choosing Your Word

For me, this process begins mid-autumn and completes around the winter solstice – although my word often arrives earlier.  I reflect in a compassionate, somatic way: combing body wisdom with cognitive understanding, embodying my compassionate self.

Reflection can reveal what you would like to carry forward into the coming year — strengths, qualities, practices — and what may be helpful to let go of.  This can naturally lead into choosing a yearly word, a seasonal word, or words of the month.

End-of-year reflection can be really grounding and clarifying, though only if it feels okay for you.  Some people find it supportive; others may feel overwhelmed, partly depending on what is currently happening in life.

There’s no right or wrong way to reflect, and there’s no pressure to do it at all.  There’s also no set timing.

This time of year naturally calls us towards slowing down and turn inwards — especially when we tune into the seasonal rhythm of winter.  The commercial pace of Christmas can pull us in the opposite direction, but reflecting (in whatever form) can be an invitation to gently pause.

As we reflect it can be helpful to remember our shared humanity – every year contains challenge and difficulty, and also moments of things like joy, connection, love, wonder and support; each in varying amounts.  All of this is part of being human.

Somatic ways to reflect:

As you reflect, notice:

• What sensations are present
• What feelings and thoughts
• What your breaths like

You might explore by:

Travelling back through the year & noticing what events arise naturally — and how they show up in your body.

Exploring the strengths and resources that supported you in challenging times & what helped you to thrive.  Maybe also noticing what else could have been supportive, or what strengths it could be helpful to build upon

Consider which practices, strategies or resources were helpful — and what might support you in the future.

Look at the year as a whole, or in quarters, noticing: what was nurturing, what supported your energy & what drained it; and whether a word, image, colour, or piece of music captures your year.

Reflecting on your values — how they guided your choices, how have they been present, and where you’d like more alignment

Journalling in whatever way feels supportive

You can find more journalling ideas in my blog:  https://unityphysio.co.uk/end-of-year-journalling/

How to Explore Your Word of the Year

There are many ways to approach this. You might reflect first, or go straight to exploring possible words. There’s no right way.  Choose whatever feels right for you — there’s no rule.

Here are some steps you can use as a guide:

Reflect on the year

If it feels supportive, you might use journalling or the practices above.

Consider what you’d like to invite more of into your life

Write down any words that come to mind — qualities, feelings, ways of being.  Questions you could explore:

• What would support me?
• What would I like to cultivate or build upon?
• What does next year call me towards?

(The word cloud image below might give inspiration — there are many more word possibilities, including flourish, thrive, confidence & flow)

Notice how each word feels in your body

Pause with each one:

•  What sensations arise?
• What is your breath like?
• What thoughts and feelings show up?
• How do you experience this word?

Circle up to five words that feel most alive

Spend time with each one.  Sense and imagine how how each word might support you over the coming year.  Sit with them a little while and then let them be — often a word will make itself known.

If you haven’t chosen a word yet, give it space

Return to your list of narrowed down words over the coming days or weeks.  You might explore:

• How does each word align with my values?
• How would each word support the way I would like to show up for myself and others?
• How might they have supported me this year?
• How could it help having more of this?
• What small daily intentions could each one encourage?

Check in again

Sit with the word you’ve chosen, or the few you’ve narrowed it down to (if it hasn’t quite landed yet).  Notice:

• How do you experience this word, what do you notice as you focus on it?
• What sensations. emotions, or thoughts arise?
• Does it feel aligned with your values and your heart?
• Is it resonating with you?
• Is it a gentle yes, or a clear no?
• Does it feel like a warm, welcoming invitation to explore the coming year with?

It Doesn’t Have to Be a Whole Year

You might choose:

• A word for the first quarter
• A seasonal word
• A monthly word
• Or a yearly word supported by monthly ones

All of these can be equally supportive.  The invitation is simply to choose what feels nourishing, grounding, and helpful for you.

Summary

There isn’t a right or a wrong way to do this.  It’s about intention, compassionate awareness, curiosity, orientation, gentle guidance; and a way of listening inwardly as you approach the coming year.

If you choose to explore a word this year, I hope the process feels spacious, compassionate and rooted in your own wisdom.

The post A Somatic & Compassionate Guide to Choosing a Word of the Year appeared first on Unity Physiotherapy and Wellbeing.

The Window of Tolerance is a model of nervous system regulation developed by Dr. Dan Siegel.  It describes the optimal zone of arousal – the state where our physiology is balanced, we feel settled enough to connect with others, we can explore, learn and grow.  Inside the window emotions and challenges are tolerable, and we can respond rather than react – we can cope with life stressors.

Either side of the window are two dysregulated states — hyperarousal and hypoarousal.

• Hyperarousal is the fight or flight response, driven by the sympathetic nervous system.  Here we may feel, for example, anxious or agitated, or on high alert – our physiology is dialled up
• Hypoarousal happens when something is too much for too long, it’s the parasympathetic nervous system without the “vagal brake”, and we lack the enough mobilisation of the sympathetic nervous system that we need to function effectively day to day (this is not the same as the fight or flight response which of course we need too!).

Each of the three zones is associated with different emotions, thoughts, feelings, behaviours and physiology.  The window isn’t only about our emotions, it’s about the body and behaviour too – it’s about the whole person and being able to function in a balanced, or efficient, way aS much as possible.

The aim isn’t to stay in our window all of the time – that’s not realistic.  Instead, we can over time learn to spend more time there, gently expand the window and recognise its edges (a place of growth).  These edges are sometimes called our stretch zone: where we are challenged but not overwhelmed.  I’ve created an infographic below which illustrates these states.

(You’re welcome to use & share this infographic – please keep the copyright & logo visible so the work is credited)

(You’re welcome to use & share this infographic – please keep the copyright and logo visible so the work is credited)

Returning to Regulation

To return to regulation we first need to notice:

• What’s present and what the nervous system state is (hyperarousal, hypoarousal or in our window)
• The signs that we are moving beyond the edge of our window into dysregulation.

There are some suggested practices for hyperarousal and hypoarousal below:

Practices for Hyperarousal

• Compassionate awareness of what’s present
• Somatic tracking (either with a sense of safety noticing and tracking an unpleasant sensation, or leaning into a pleasant of neutral sensation)
• Breath practices, for example diaphragmatic soft slow nose breathing (normal breathing), Buteyko recovery breathing, extended exhale, coherent breathing, bee breath
• Grounding practices, for example the 5-4-3-2-1 practice, or noticing your feet on the floor and gently swaying if gentle movement feels accessible
• Connection with others
• Time in nature in a way that feels soothing or settling
• Soothing self-touch
• Soothing music or nature sounds
• Rhythmic movement, for example somatic shaking, walking, dancing, jogging, or swimming.  Other movement for example stretching
• Humming
• Sensory stimulation, for example a soothing essential oil, listening to soothing music or nature sounds, touching objects with a soothing texture or temperature, looking around and naming objects
• Self compassion practices
• Let be, let go let in (I’ve written more about this here: https://unityphysio.co.uk/the-mindful-compassion-based-5-steps-stress-awareness-management-model
  

Practices for Hypoarousal

• Mindfulness and somatic techniques, for example tapping, squeezing, or self-massage
• Energising movement, for example walking, stretching, jumping, somatic shaking, swimming, anything to energise the body that feels accessible and within tolerance levels
• Sensory stimulation, for example the smell of coffee, an essential oil, or another strong scent, touching objects with different textures or temperatures, looking around and naming objects, uplifting sounds, eating something salty/cold/crunchy, drinking a cold drink with a straw
• Cold shower or splashing cold water on face
• Stimulating breath practices
• Time in nature, gently connecting with energising elements
• Walking barefoot on a safe surface (grass is one option)
• Grounding practices. for example the 5-4-3-2-1 practice
• Self-compassion practices

Expanding the Window

We can expand our window by understanding and noticing the early signs from our body of being at the edge of our window and gently working here in a way that feels safe enough.  I often describe it as having one foot (or even a toe) outside the window and the other in regulation.  This supports nudging the window in a way that feels possible.

“Expanding the window isn’t about staying regulated all the time – it’s about awareness and finding enough safety at the edges, and returning from dysregulation with more ease”

Some ways I support people in expanding their window includes:

• Awareness of the edge of the window
• Somatic and embodiment practices (e.g. somatic tracking, somatic check-in)
• Meditationand mindfulness-based practices
• Compassion practices
• Mindful language and reframing
• Downregulation practices to support regulation after nudging hyperarousal
• Learning to trust the body
• Holding outcomes lightly
• Supporting connection with others
• Lifestyle changes, such as pacing of activities, including some restorative rest each day, good quality sleep and a healthy balanced diet.

In Summary

There are many things that support regulation — awareness, compassion, and regular practice are key. Expanding the window also takes gentleness, patience and time: finding what’s best for you, listening to your body’s signals, and trusting the wisdom within.  Remember, the aim isn’t to stay in the window all of the time – over time, we want to be able to return to it with greater ease, and to gently expand it.

You might like to reflect on:

• What are the signs of being in each of the three zones of the Window of Tolerance?
• What are the signs of being at the edge of your window, and what helps you to keep a foot in regulation?
• What supports you in returning to your window from hyperarousal or hypoarousal?
• What helps you expand your window over time?

The post The Window of Tolerance and Chronic Illness appeared first on Unity Physiotherapy and Wellbeing.

This blog offers a compassionate trauma-informed introduction to nervous system regulation – what it is, why it matters, and how trauma and chronic stress can impact it.  We explore protective responses like fight, flight, freeze, and fawn, and share trauma-informed nervous system regulation frameworks such as Polyvagal Theory and the Window of Tolerance.  You’ll also be introduced to my own Compassionate Nervous System Regulation Framework, Polyvagal Theory infographics, and further resources that can support the journey back to balance, safety, and connection.

What Is Nervous System Regulation?

Nervous system regulation often refers to the state and balance of the autonomic nervous system (ANS).  This system controls automatic bodily functions like heart rate, breathing, digestion, and our stress responses.  Of these, breath is unique, as we can also influence it consciously.

The ANS is a network of nerves that extend throughout the body, with neurons originating in both the brain and spinal cord.  Two key brain regions involved in its function are the hypothalamus and the brainstem.  The ANS has two main branches: the sympathetic nervous system (SNS), which activates the fight-or-flight response, and the parasympathetic nervous system (PNS), which supports rest, digestion and restoration.

There’s also a third division: the enteric nervous system (ENS).  While it’s technically part of the ANS, it can also function independently and is often referred to as our “second brain.”  It governs digestion and communicates with the rest of the ANS, especially via the vagus nerve – the main part of the PNS, making up about 75% of it’s nerve fibres.  Like the rest of the nervous system, the ANS communicates through a complex network of electrical signals and chemical messengers.

The ANS is a functional division of the peripheral nervous system, which connects to the central nervous system (the brain and spinal cord).   When we talk about nervous system regulation, it’s broader than the ANS alone – everything in the body is deeply interconnected.

It’s important to understand: it’s normal to move in and out of regulation throughout the day.  No one lives in a perfectly regulated state all the time, and that’s not the goal.   Life includes challenges, and our nervous system is designed to respond.  Sometimes it may over-respond, but that’s still it doing its job based on previous experiences.  With time and support, the system can learn when we are safe, helping the threat response settle more easily, when the environment is actually safe.  The aim isn’t to avoid dysregulation, but to notice when it happens and gently support ourselves in returning to balance, again and again.  This helps build nervous system efficiency, capacity, and resilience.

Understanding our nervous system, gently coming home to a regulated place, and befriending the body can support many things including healing & thriving.

My Working Definition of Nervous System Regulation

When I talk about nervous system regulation, I’m not referring to being calm all of the time or never getting dysregulated – this is normal and part of being human (though when we are dsyregulated too often/too much, and struggle to return to regulation, is when it’s problematic).  Regulation isn’t a fixed state – it’s a dynamic process.

To me, helpful nervous system regulation means having the ability to move flexibly between different states, in response to life’s demands and stressors. It’s about matching the level of arousal to what’s needed in the moment – and being able to return to a more regulated state with some degree of ease when dysregulation happens.  This supports a sense of safeness, connection, optimal functioning, growth, and healing.

Understanding Dysregulation: The 5 F’s

When we experience threat/stress in general, chronic stress or trauma our nervous system shifts into protective states that help us survive.   These protective states are referred in different ways, one is the 5 F’s:

• Fight – activation of the SNS (mobilised)
• Flight – activation of the SNS (mobilised)
• Freeze –blends SNS activation (mobilised) with the PNS (immobilised), initially this is state is SNS driven – we are mobilised with physiological changes that are needed to flee or fight e.g. an increased heart rate and muscle tension.  It’s a brief pause whilst the options to get to safety are assessed automatically and quickly, if there is no escape we begin to shift into a state of dysregulated immobility (flop).  Freeze can be understood as part of a spectrum – with a more activated freeze at one end and flop (shutdown) at the other
• Flop – this is a shutdown state, it is the body’s last resort for protection when there is perceived to be no escape
• Fawn – this is also referred to as appeasing, the protection response is to please and pacify the threat for safety.  It’s a complex blended state of fight/flight and freeze

At its core, nervous system regulation is about returning to a place of balanced physiology and a sense of safeness after being in one of the dysregulated states.  It’s important for us all to be able to re-regulate quickly and efficiently, with some level of ease.  This can be challenging for people who have experienced chronic stress or trauma, and/or are struggling with chronic health conditions such as ME/CFS, PoTS, fibromyalgia, or Long Covid – dysregulating more easily, taking longer to return to regulation and getting stuck in dysregualtion, over time this can be changed.

Why Regulation Matters

The good news is that your body knows how to come back to regulation – it knows the way home.  Sometimes, it simply needs compassionate, trauma-informed support, this is part of my role in my work – to walk alongside people in the journey to remembering the innate state of regulation and connection.

Nervous system regulation is a foundational aspect of how we feel, think, move, and relate to others.  For example, when we are in a fight or flight state (SNS) our experience may include anxiety, restlessness, difficult concentrating and a racing mind, we may be impatient, there may be insomnia, stillness may be difficult and movements are likely to be quick.  When your nervous system is dysregulated, it can affect everything, including:

• Sleep and rest
• Pain and fatigue management
• Emotional resilience
• Concentration and memory
• Your ability to connect with others

Nervous system dysregulation is not a sign of weakness—these responses are wise protective responses, however, when they persist beyond the original threat, they affect our health and wellbeing and limit our ability to thrive – we can move from surviving to thriving.

What Regulation Isn’t

Nervous system regulation isn’t about pushing through, ignoring or fixing symptoms. It’s about learning to:

• Feel safer in your body
• Gently restoring balance
• Expanding capacity to be present and grounded even when life is challenging

Various things support nervous system regulation including understanding it, along with  trauma-informed, compassionate, and somatic approaches – to support shifting out of survival mode and into a state where healing, connection, and thriving become possible.

We are social beings, nervous system regulation enables us to co-regulate—to be present, steady and attuned with others, both in our work and with the children and loved ones in our lives.   It’s especially important with children as initially they can’t regulate themselves initially and then they learn to self-regulate from co-regulation.

The Nervous System Regulation Tools and Models I Use

The tools I use are grounded in compassionate trauma-informed care, compassion and mindfulness-based practices, somatic and embodiment practices, and clear frameworks that help to understand and support the nervous system with compassion and clarity in sustainable ways.  The main frameworks I use are:

Window of Tolerance

This was developed by Dr. Dan Siegel, this model describes the optimal nervous system state (the Window of Tolerance) which is sometimes referred to as the optimal zone of arousal, where we are settled/safe, alert and engaged, and the two dysregulated states either side of it (hyperarousal and hypoarousal).  Hyperarousal is the fight or flight response and hypoarousal is dorsal vagal in Polyvagal Theory – the parasympatehtic nervous system without the vagal brake and without the mobilisation of the SNS that we need to function day to day (this is not the same as the fight or flight responses of the SNS, which of course we also need!).  The aim isn’t to be within our window all of the time, instead to know how to stay there as much as possible and keep gently expanding the window over time.  The edges of the optimal zone are our stretch zone, here we can learn and grow.

There is a Window of Tolerance infographic I created below and a few links to more information on this model.

A helpful short video about the Window of Tolerance by Lewis Psychology https://m.youtube.com/watch?v=TNVlppGz0zM

A helpful Window of Tolerance blog by Dr Sarah Davies https://www.drsarahdavies.com/post/what-is-window-of-tolerance-emotional-regulation-model-explained

Polyvagal Theory

Developed by Dr. Stephen Porges, this theory explains how the autonomic nervous system moves between:

•  Ventral vagal (safety, connection & social engagement)
•  Sympathetic (fight/flight, mobilisation)
•  Dorsal vagal (shutdown, immobilisation)

Understanding and mapping these states helps us better understand our nervous system and gently support return to regulation.  The three main states are shown in the first infographic below and the two blended ventral vagal ones are shown in the second infographic (please feel free to share these infographics, kindly ensure the credit is visible).

A helpful blog about what Polyvagal theory is by the Polyvagal Theory institute https://www.polyvagalinstitute.org/whatispolyvagaltheory

A useful video on Polyvagal Theory by Lewis Psychology https://m.youtube.com/watch?v=SlhFrBoEnxU

The Three Circles Model (The Three Emotional Systems Model)

This is part of Compassion Focused Therapy and was developed by Professor Paul Gilbert.  The three emotional systems in this model are:

• • Threat (protection and safety seeking system, activating/inhibiting)
  • Drive (incentive/resourced focused system, pursuing and achieving, activating)
  • Soothing (connection, safeness & care, non-wanting/affiliative)

No one of these systems is good or bad, we need them all, the aim is for them to be in balance.  Many people I work with have overactive threat systems and underactive soothing systems, which is a very common pattern partly due to the way our society is in general.  One of the ways I use this model is to support people in growing the green (the soothing system) with practices and strategies that feel safe, nourishing and sustainable.

Trauma-Sensitive Mindfulness (TSM)

TSM was developed by David Treleaven, and I have completed his Advanced Trauma-Sensitive Practitioner training.   It’s grounded in the 4R’s of trauma informed practice:

• Realising the widespread impact of trauma
• Recognising the signs and symptoms of trauma
• Responding with informed, supportive practices
• Resisting (or avoiding) Retraumatisation

You can read more about the 4 R’s on my Trauma Informed Practice page: https://unityphysio.co.uk/services/trauma-informed-practice/

Mindfulness can be a powerful tool for nervous system regulation—when it’s offered safely. I use mindfulness in a trauma-sensitive way: the practices are choice-based, gentle, and paced to meet each person’s needs.  Regulation, choice, and empowerment are central to this approach.

My Framework: A Compassionate Path to Regulation

In both my workshops and 1:1 sessions, I use a visual framework that I developed to support regulation through compassionate awareness and curiosity.  It’s non-linear – each element is interconnected, and many experiences may sit in more than one circle at a time.

The process usually begins with noticing your internal state through compassionate awareness with a gentle curiosity.  From there, you might explore settling, grounding, letting go, or receiving what feels nurturing and supportive.  Each part of the framework reinforces the others, helping you reconnect with safety, presence, compassion and self-trust at your own pace.  Over time, this helps build your capacity for regulation, connection, and thriving.

There’s no one right way to move through this—it’s a path of compassionate awareness and curiosity that you can return to again and again.

Summary

Nervous system regulation is a vital, ongoing process of gently returning balance for us all, and is especially important with chronic health conditions, or healing from chronic stress or trauma.  It isn’t about fixing ourselves (we are all already whole)—it’s about gently understanding our bodies, restoring balance, and reconnecting with a felt sense of safety and compassion towards ourselves, others, and the world around us.

Understanding protective responses and using compassionate, trauma-informed frameworks, supports us in reconnecting with safety, regulating and building nervous system capacity, and moving from surviving towards thriving.  This journey is unique for each of us, and it’s important that it’s grounded in curiosity, patience, compassion and kindness toward ourselves and others.

Would You Like to Explore More?

If you would like to explore nervous system regulation more take a look at:

Nervous System Regulation https://unityphysio.co.uk/services/nervous-system-regulation/

You can also book a free 15 minute discovery call to see if this work feels like a good fit for you 1:1, alternatively you are invited to take a look at my 4-week nervous system regulation workshop series on:

The Awakening The Body’s Wisdom: A Somatic Workshop Series https://unityphysio.co.uk/services/awakening-the-bodys-wisdom-somatic-workshops/

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Stress often gets a bad press, which is because it negatively affects our health and wellbeing when it’s certain types of stress, prolonged and repetitive.   Stress is part of our daily life in many ways and some of it we need for adapting including the stress from exercise.  Chronic, or ongoing stress, also impacts chronic health conditions, it amplifies pain, fatigue, gut issues, anxiety and other symptoms.

Many things contribute to stress, including health inequalities, which I’m not going to go into in this blog.  There is also often a negative perception of stress and a stigma associated with it which isn’t needed or helpful.  I’m not going to go into this because it would be a whole other blog, however it’s important to mention that being stressed isn’t a weakness and recognising it and taking action is a strength.

We cannot change stress if we aren’t aware of feeling stressed, or we don’t notice when stress is increasing and/or are not aware of the factors that we can influence.  The rest of this blog will focus on my compassionate mindful 5 steps stress awareness and management model which can support stress awareness and management, and optimising health & wellbeing, alongside lifestyle factors, including: exercise/movement, diet, sleep, time outside, and connecting with others and nature.

The 5 steps stress awareness & management model

1. Slow down & pause

2. Awareness – Notice what’s present in the body (somatic check-in) with compassion & curiosity

3. Let Be –  allow what’s present as it is without judgement as best you can, noting how things ebb & flow

4. Let go – let go of what does not serve

5 Let in – choose what’s helpful, what you would like to invite more of.  Connect to what’s nurturing & supportive, and focus on this.

Using this model we start by slowing down and pausing, perhaps noticing the feet on the floor and the position of the body (eg sitting or standing).  It can also be helpful to connect to an intention to notice how we are and what’s present with a compassion and curiosity.

Step 2 is noticing what’s present in the body (a somatic check-in), this includes how the external environment is impacting our physiology, for example the nervous system state.  Doing a somatic check in creates an embodied awareness of what’s present.   A somatic check-in can include noticing what sensations are present where, what the breath is like, what energy levels are like, what thoughts & feelings are present and how they show up in the body.

Step 3 is letting what’s present be, allowing it to be as it is as best you can with compassion and curiosity, and also noticing how things ebb and flow.   Acceptance of what is present is part of this, there are many misconceptions about acceptance, it doesn’t mean liking or wanting something, nor does it mean something won’t change, and it’s not a one off thing (it’s an ongoing relational process).  Alongside allowing and accepting we can also notice how what we are paying attention to changes moment by moment, everything’s always changing.   To be with what’s present and allow it we need to have a wide enough window of tolerance, this could be seen as nervous system capacity to maintain some regulation with the impact of stressors, this is something that we can expand over time.  We also need to know what helps us keep a foot or at least a toe in some regulation whilst we are being with what’s present when it includes suffering or things that are challenging.  If our window of tolerance is narrow and we don’t know what anchors us in regulation, what supports us to stay settled and grounded enough (regulated enough) we will become too dysregulated to be with what’s present, mixed with previous experiences, and can become overwhelmed.  We need a number of things to support being with suffering especially compassion, courage, nervous system regulation and a sense of safety in the body.  The being with what’s present and listening to the body often holds much wisdom, this can guide us towards what’s helpful.

Step 4 is letting go of what does not serve us.  This is not always an easy process and can take some time, it’s not necessarily a one off in the moment thing, nor a do one practice and we have magically let go of something, although sometimes it can be like this (usually when there has been prior work with something).  Letting go can be related to a variety of things including worry, self-criticism, impatience, unhelpful beliefs, unsupportive/unhealthy habits and excess tension in the body.  Things that support letting go include the wisdom from within the letting be step, embodied movement, other somatic and embodiment practices, breath practices, compassion practices, compassionate phrases/mantras, meditations, visualisations, and other things like journalling.  As well as needing some nervous system regulation to be with and let go of what does not serve us the process of letting go usually creates more nervous system regulation.  We can also purposely use practices to support regulation as part of letting go which can support the process.

Step 5 is letting in what supports our health & wellbeing and being able to thrive.  Letting in what’s nurturing or supportive can include many things, for example: noticing a sense of ease, spaciousness, or freedom from letting go of tension in the body, or through connecting to a slow soft smooth breath; noticing a sense of being cared for/loved; recalling a sense of being appreciated; noticing kindness and being kind to others; connecting to a sense of what you can do being enough; and moments of joy.  In this step we aim to take in the nurturing moments as they happen and/or recall them, letting them soak in and noticing how this impacts us, for example a change in breathing or nervous system state.  This is what Dr Rick Hanson calls ‘Taking in the good.’  One of the things you can do here is consider what you would like to invite more of into your life, for example more connection, more kindness, or more strength.  We can choose to embody what’s helpful here, for example self-compassion, a gentle strength, a sense of ease, or feeling cared for.  With regular practice of letting in what’s nurturing and supportive, letting in the ‘good’, it changes our whole being.  It impacts our physiology, how we relate to ourselves, others and the world and we are training our brain to take in what’s helpful, positive and nurturing.  This supports our health and wellbeing, whilst not pushing things away or ignoring them (the noticing and allowing steps) – there’s much wisdom held within these steps.  This letting in step could also including letting in the changes that with repetition become helpful habits.

This 5 steps mindful compassion based stress awareness and management model is really about connecting to the body, awareness, compassion, being with, letting go and letting in/bringing in what’s helpful/supportive/positive.  Compassionate awareness is foundational to this, and I think in many things if not in all things.  If we pay attention to what’s present with self-criticism, blame, or frustration it increases the stress, one of many reasons why compassion and awareness are like two wings of a bird, we need both to fly.  The model isn’t 1-5 steps that we rigidity stick to, we move back and forth between different stages, there’s a flow and flexibility within it.  For example, we might be working with letting go and then go back to noticing and letting be before going back to letting go again, or we might be working with letting in and go back to awareness and noticing and even more letting go, and there might not be a clear distinction between the steps always.

As mentioned at the start of this blog there are various lifestyle factors which support optimising our health and wellbeing and stress management.  Developing helpful habits by focusing one habit and one step at a time can be a helpful starting point, over time habits become a way of being.  You could also use this model to support developing habits that support health and wellbeing, I could write how but then this blog would be even longer!  Do let me know if you would like a blog with some tips for this.

If you would like to learn more about these steps in relation to the frame of compassion and compassionate mind training check out the ‘Compassion Focused Approach to Stress Management’ blog which I wrote for Balanced Minds https://balancedminds.com/a-compassion-focused-approach-to-stress-management/

Letting be, letting go and letting in has been a practice for me for some time, it will always be ongoing as part of a way of living and being, and I use it in my work.  I’m not sure if I developed this practice fully myself or if it’s something I picked up and from Dr Ricki Hanson’s work and modified in my own way based on all my learning and personal practices.  I always acknowledge other people’s work and where I get ideas from, in this instance I’m unclear if one of Dr Rick Hanson’s books or attending one of his workshops inspired this model and my work with ‘Let Be, Let Go, Let In’ so I’m mentioning it in case it did.

What do you think? Could this be a helpful model/practice for you for you? Maybe something like this is a practice, or part of a way of being for you already.

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Some people like to use end of year journalling as part of reflecting on the year as it draws to a close.  Journalling can be helpful as part of reflecting on the year and see what’s gone well, what’s not been easy or challenging and what helped navigate these times, what’s been meaningful and other aspects too.   Some people like to reflect on the year and journal and others don’t, either way is ok.

As we reflect it is important that we notice what has been helpful, supportive or ‘positive’ as well as the more tricky and challenging times.  Our brains have a ‘negativity’ bias, this means that we will naturally remember the challenges and focus here if we don’t intentionally explore the ‘positives’ too.

This time of year is often a reflective time and when we align with nature seasons it’s a time for slowing down.  Our society and the commercialisation around Christmas tends to make people busier which can take us away for our natural need to slow down, turn a little inward, to rest and restore.

Before we look at different types of journaling and some tips I feel that it’s important to mention a few things:

• We all struggle and suffer sometimes and these will be part of everyone’s years to varying degrees, this is part of being human.  There will also be joy, connection, love, wonder and other nurturing emotions and feelings to varying degrees too
• There isn’t a right or wrong way to reflect or journal
• It can feel too much to reflect on the year, this is normal and it’s ok not to do it.  We can reflect and journal if it feels ok to do so and like it might be helpful for us and if not we don’t have to do it.

Types of Journalling

There are many types of journalling I have listed some of them below along with examples of how they can be used as part of end of year reflections:

• Free flow journalling/stream of consciousness journalling – this basically means writing whatever comes into your head even if it doesn’t seem to make sense.  Instead of choosing one focus like gratitude or feelings as journal prompts free flow journalling doesn’t have a focus and it is writing without editing
• Gratitude journalling – this is basically noticing and focusing on what you are grateful for.   For end of year journalling you could notice a few things that you are grateful for each month of the year as you explore the year that’s gone by and simply list them and/or use one, or a few of them as journalling prompts
• Art journalling – this type of journalling uses visual representations of things like your thoughts and feelings.  You could draw or find illustrations/visuals that you feel reflect your year as you review it
• Nature journalling – this type of journalling relates to what you are noticing in nature.  It can be combined with other types of journalling like art journaling.  One way this can be used is to gather nature pictures that you have from throughout the year and then journal with what arises through connecting with the picture memories, this may also lead into other types of journalling like what you are grateful for within the year
• Yoga journalling – this type of journalling is where people write in their journal after a yoga practice.  An example for end of year reflections could be to hold the intention to reflect and review the year, take this onto the yoga mat and then journal with any thoughts, feelings and insights that may have come up
• Strength based journalling – this journalling focuses on your strengths and exploring these through journalling.  For example, see if you can notice something that has helped you to thrive and/or manage the challenges this year and journal about this
• Values based journalling – this uses your values as a prompt for your writing.  One way to do this is to note down your core values and then journal with each value and how you brought it to life this year.  If you’re unsure of your values do a values exploration exercise first, there are some in my book, linked at the end of this blog
• Bullet journalling – this can be any sort of bullet point list.  For an end of year review you could list the things that you are grateful for, the values in your year, the strengths that helped you navigate challenges and helped you to thrive, and/or inspirational quotes that reflect your year.

There are many more types and you can blend different ones together and of course create your own journalling style

Questions for journalling:

Questions can be used as journal prompts, some examples for end of year reflections/journalling:

• What has gone well the last month/last few months/this year and why?
• What are 1-5 things that I am most proud of this year and why?
• What has been tricky or challenging & what have I learnt from this/what am I taking from it?
• What helped me navigate the challenges?
• What strengths helped me this year?
• What’s been supportive for me this year?
• What 1-5 things am I grateful for right now/over the last few months/this year?
• Did I set boundaries, did I stick to them and were they helpful?
• What’s created some balance, some ease, some stability this year?
• How have I related to myself most often this year? (For example, with self-criticism or self-compassion)
• Is my daily routine supportive of my wellbeing?
• What 1-2 things could I keep doing or start doing regularly that would make a difference to my wellbeing?
• What are my core values (3-5 values) and how have they been part of this year?
• What is most important to me & why?
• What do I want to take into the new year?  What feels welcome to have more of? (This ties in with word of the year if you do this)
• What would I like to explore more of, what qualities do I want to embody next year?
• What could it be helpful to let go of?

Journalling tips

Some people like to reflect prior to journalling and then deepen the reflection through journalling and other people prefer to journal first and then reflect more in some way, for example through a yoga or other somatic movement practice, and others prefer to do something like a yoga practice first and then journal.  There isn’t a right or a wrong with journalling or reflecting, it is simply what feels ok for you and what’s helpful.

Before starting reflection and/or journalling I suggest people do a somatic (body) check-in and notice how they are.  The way I guide a somatic check-in is by encouraging connection to the body with compassion and curiosity to notice what’s present, for example noticing sensations, energy levels, the breath (if it’s ok to notice this), what thoughts are present and how they show up in the body.  I also encourage people to reflect and journal in a somatic way, this basically means noticing the bodies reactions, the body’s wisdom as you reflect, for example, what sensations do you notice, what’s your breath like, is there a temperature change, how are you feeling, what do you notice where in your body?  Without doing this we are only reflecting on a head level and this means we are missing important information and the body’s wisdom.   It is important to slow down and pause regularly, this can help us to notice what’s present in the body and increases our awareness and understanding

I encourage people to journal and reflect with compassion and curiosity, holding the intention to be curious and compassionate can be part of this.  As well as holding this intention you can connect to your compassionate self to support with journalling in a compassionate way, there are various exercise available that can guide with this.  There are a few in my book and there are some audios freely available like this one by Dr Shelley Kerr: https://on.soundcloud.com/kSyVQUZu923v9HYz7

It can also be helpful to use soothing rhythm breathing from compassionate mind training, this can be used as part of connecting to your compassionate self or simply to connect to your body, settle and slow down.  I have an audio freely available for this here: https://on.soundcloud.com/kqJdxtjerKGMUHBq6  There are a number of other soothing rhythm breathing practices freely available, you can find a few of them here: https://www.compassionatemind.co.uk/resource/audio

If reflecting on the whole year feels overwhelming consider what feels ok, perhaps exploring the last month or last few months, or something else that feels better to you.  If nothing feels ok and it feels too much don’t do it and perhaps reach out for some support instead.

One way you can reflect using end of year journalling is by reflecting back on the year by moving back through time from now and noticing what events/memories come to mind and what is present in your body, noting feelings or something else down in your journal.  Once you have reviewed the whole year you could choose a common feeling to journal with, or use some things that you are grateful for that have come to mind.  If journalling on the whole year feels too much you can split it into chunks, maybe quarters.

When you have finished your reflection one of the things you may wish to explore may be what would it be helpful to have more of in the following year, what would support you and what may you wish to let go of.   You can journal with these as prompts as well.  What you wish to have more of can be used as a word of the year (or words) for the following year, something I see as a kind of gentle guide.

Summary

• There are many types of journalling and you can blend different types together
• You don’t have to use a specific journalling type you can create your own approach
• You can review the whole year working backwards from now or split it into chunks, for example review each quarter
• Do a somatic check-in before beginning and during the journalling
• Slow down, this helps you to notice what’s present in the body
• Go at your own pace and take breaks as needed
• Use the body’s wisdom along with the minds understanding in your journalling
• Hold the intention to be curious and compassionate
• Connect to your compassionate self and use soothing rhythm breathing if these feel helpful for you
• Journalling can be combined with yoga and other somatic practices
• You could explore what it would be helpful to invite more of in the following year, what would build on your strengths & resources and support your wellbeing
• There isn’t a right or wrong way to journal or reflect.

In this blog I mentioned that there are some values exercises in my book you can find the book here: https://www.amazon.co.uk/Dancing-through-Life-Guide-Living/ dp/B08P1CFDNW/ref=mp_s_a_1_4? crid=3EHSYPASVND90&keywords=ann+parkinson+book&gid=1671047573&sprefix=ann+patkinson+ %2Caps%2C65&sr=8-4

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Aligning mind, body & heart

Terms like aligning mind, body and heart can seem a bit abstract so I’m going to define this in the way I see it before we explore connectedness more.  To me aligning mind, body and heart means living in a loving and embodied way aligned with our purpose and what’s meaningful, living from a place of love, compassion & connectedness.  By living in a loving and embodied way I mean noticing how, for example, our thoughts and feelings, are showing up in the body in a compassionate and non-judgemental way.  Part of healing is awakening our senses and being able to fully be in the present moment in an embodied and loving way.  We can’t do this if we are stuck in hyperarousal or hypoarousal, where we are stuck in our heads or rushing around all the time, disconnected from ourselves and the world around us, and not feeling safe/settled and secure.  Aligning body, mind and heart helps us regulate our nervous system, awaken to a deeper way of being and reconnect to the connectedness of everything.

Living in an embodied and open hearted way can also help us see that the obstacles and challenges that appear as part of life can help us awaken and grow.  We can ask questions that support with this like how can this help me grow? How can this help me serve myself and others?  How might this help serve my heartfelt intentions or aspirations?  Sometimes things are overwhelming, these times we won’t know the answers to these questions and we will struggle to connect to our bodies, these times we may need to find a suitable therapist to support us.

Love & connectedness in healing

One of the things that is really important in healing is that our suffering is witnessed and acknowledged in a compassionate and non-judgemental way.  Suffering that is not witnessed and acknowledged, or done so in a critical way, often causes more trauma.   Love, compassion & connection are needed here because when we aren’t fully present and connected we can’t truly notice our suffering, or that of another, and without love and compassion there is judgement and criticism.

Acceptance is important in healing, it isn’t a one off thing, instead it’s ongoing and it can be said to be a moment by moment process.   Acceptance isn’t passive, it doesn’t mean putting up with something, or that things won’t change (things are always changing right down to each moment).  A great strength or courage is needed to be able to let go and trust in our inner wisdom and the process.  With curiosity, openness, courage and a compassionate loving presence (a heartfelt presence) we can notice and allow what’s present in the moment to be exactly as it is, even if it’s not how we would ideally choose it to be.  Being present with love & compassion helps us accept and allow what’s present to be without, for example, self-blame or self-criticism, and when these do appear they can be met with compassion and love too.   Allowing what’s present to be needs a sense of safety, or feeling safe enough in the present moment.  This means that we need the nervous system to be balanced or close to balance (where we are within our window of tolerance/ventral vagal system).

From a place of noticing what’s present in the body we can increase our understanding, connect to our inner wisdom and discern what’s supportive for us.  Any action comes from our inner wisdom rather than from a threat based reaction, for example a pushing away, trying to get rid of something, or avoiding.  It’s important for us to stop over controlling and resisting, this is part of being in a regulated nervous system (resistance & over control are part of our threat system and protection mechanisms), as it calms our nervous system and allows new possibilities to begin to surface.  Allowing what’s present to be with an acceptance or openness is a place where fear softens and we can start to see what’s resting underneath.  Holding whatever is present, in love compassion isn’t always easy and this is part of the practice and the healing.  Things can reappear that we thought we had dealt with once, that we had healed, new layers surface for healing, here again we practice acceptance and compassion.

We need trust to allow the healing process to unfold in its own time without wanting it to be a certain way or create a certain outcome, without pushing or resisting, easier said than done I know (that’s part of the practice too).  We naturally push away or resist what causes suffering and grasp what creates joy and the things we want more of.  Part of suffering is in the pushing away and grasping, we can learn to allow things to flow through (an ever ongoing practice).  We can, for example, notice that pain is present and allow it to be in the background as best we can, rather than trying to get rid of it and getting frustrated, angry or self-critical when nothing works.  This doesn’t mean we don’t take action to try and alleviate the suffering, instead it comes from a different place and we take wise action.  This may be no action sometimes, or something simple like after noticing what’s present and allowing it to be, offering ourselves some soothing words or soothing touch (this could be part of Tara Brach’s R.A.I.N practice or Kritsin Neff’s self-compassion break, for example).  We also need to learn to hold the outcome lightly, we cannot control this as there are many variable (some we don’t see) we can influence the outcome and control how we relate to it.

Often when we are suffering we lose trust in ourselves, I have seen this time and time again working with people with persistent pain, other long-term conditions and felt it myself.  The decreased trust, or the loss of trust, brings an opportunity to connect more deeply to it and develop more of a kind of unshakeable trust.  Part of trust is trusting that we have the skills, knowledge, resources/practices to manage, or if we don’t then believing that with support we can develop them.  Learning to trust the healing process is important and it means we need to trust in uncertainty too.  Trusting in uncertainty isn’t easy, it’s important because so much is uncertain in life, this means we need to let go of over control.  Being safely grounded in compassion and love links with trust in holding us steady enough within the uncertainty, within what feels like a vulnerable place.

Reconnecting to our inner wisdom is so important in healing, it supports and guides us.  Terms like inner wisdom and our true nature or essence, can seem a bit abstract, they aren’t tangible things we can see.  Our inner wisdom and true nature both hold love & compassion and connecting to them is important in healing.  Connecting to our inner wisdom through our body guides us in many ways, for example it can guide us when to explore something to deepen understanding and when to allow something to be in the background for the time being.  Sometimes we need help to access our inner wisdom especially if there is unprocessed trauma, the light of compassion and love can be hidden under layers.

Feeling the connectedness to love, nature and the wider whole is also important in healing and our overall wellbeing.  Research is showing us that it is not necessarily the amount of time that we spend in nature that is significant for our wellbeing, except in terms of physical wellbeing, there needs to be a sense of connectedness too (physical wellbeing needs this too, so again it’s not just the time in nature that’s important).  Sometimes we have disconnected from the interconnectedness of nature, reconnecting to this is part of our healing and it’s needed for natures healing.  Nature’s wisdom combines with our inner wisdom and can guide us when we listen.  If we haven’t lost the connection to the connectedness with nature then the sense of connectedness with this tends to deepen as part of healing.  Nature is part of us and we are part of nature, our wellbeing and natures wellbeing are inextricably interlinked, connecting to this helps our healing and also the healing that nature is desperately calling out for.

The interconnectedness with nature and something bigger than us may resonate with you or it may not, either way is ok.  If these things are of interest one of the books that I would recommend is called ‘Reconnection: Fixing Our Broken Relationship With Nature’ by Miles Richardson.

Common Humanity & Healing

As human beings we all experience joys and sorrows, love and loss, easier times and tough times, suffering and healing.  This is the common humanity we all share, we share many things as part of being human and connecting to this is important in healing.  Connection to others is important in healing, we are social animals.  We self-regulate and we co-regulate, our nervous system talks to other nervous systems.

Adapting to and processing many losses is part of being human and is often part of healing too  This can be for many reason, for example, from the multiple losses related to living with a chronic health condition, from life being different from the way you wished it to be, and/or from the loss of a loved one.  There isn’t a right or wrong way to grieve.  I wrote a grief and loss in persistent pain & other long term health conditions blog which you can find this here:

Part one https://unityphysio.co.uk/grief-loss-in-persistent-pain-other-health-conditions-part-one/

Part two https://unityphysio.co.uk/grief-loss-in-persistent-pain-other-health-conditions-part-two/

It is the tough times that we learn the most from and these times that we need a toolbox of practices to draw on, these can also be referred to as strategies or resources.  The tough times strengthen our heart and allow our heart to open more fully, to be present with love, compassion and courage, connect to the depth of our strength and to connect more deeply to the connectedness of everything with a sense of spaciousness.  We cannot heal until we learn what supports our nervous system regulation and have some resources/practices to support this and healing, we create more resources along our healing journey too.

What supports healing?

There are many things that can support us each day, that can become part of a way of being and part of healing, including: embodied self-awareness practices (awareness in the body), meditation, mindfulness, breath practices, self-compassion, yoga, exercise and movement, walking, time in nature, journaling, distraction (sometimes this is needed, for example when things are over whelming) and many more things.

When I had a really tough couple of years due to some health conditions I leaned deeply into my yoga and compassion practices and drew on many other resources that I had, my gratitude for these deepened and I developed many more resources through this time too.  I also reached out for additional support, remember we can’t heal on our own.

What practices and resources/strategies do you use to support you day to day?

Summary

To heal we need many things including: to restore balance and retrain our nervous system, a sense of safety and trust, an embodied loving awareness, acceptance, a variety of resources/practices along with a daily commitment to practice, belongingness, support of others, connection and connectedness, and of course compassion and love.  Healing takes time and a toolbox of strategies and practices, it’s not one thing that helps us heal it’s many things.  We can’t heal on our own, we need the co-regulation and support of others which can take many forms.  Sometimes support needs to be in the form of a therapist, other times it could be a coach or mentor, friends, or a wider community group that we are part of.

As we heal the confusion that we had in our suffering evolves into clarity and we awaken a little more to our true selves and the interconnectedness in everything too.  There are times that we think we have healed and everything is going smoothly and then something happens that opens up new layers that are ready to be healed.   Healing is something I have come to see as being ongoing, maybe you can relate to this too.  I don’t think there is a destination unless it is to return to our true selves and wholeness, to the alignment of mind body and heart and live from this place, and return again and again.  Each time there is a challenge or an obstacle it gives us an opportunity to grow and connect to our true selves, our inner wisdom, and more deeply to the connectedness within and around us.

We all already have what’s needed for healing within us, to access and nurture this we need to be able to safely connect to our bodies and we often need to change how we are relating to ourselves, from being critical, for example, to being more compassionate.  Sometimes we need help from a psychologist, or another psychological clinician to do this, for example when there is unresolved or unprocessed trauma.  We all have within us a core essence of compassion and love, this light never goes out, sometimes it’s under layers and we need help to be able to start to see it, and the more we connect to this place the more brightly it shines.

Healing has many aspects and perhaps we could see it as being rooted in connectedness and love, and aligning mind, body and heart.  I have come to understand that our healing rests within the love that is within and around us all and the connection to the interconnectedness of everything.  Healing is a place where enougness, okness, compassion, love, trust and freedom all rest.  Connecting to the wisdom of our body, heart, inner trust, compassion and love over and over again helps us to heal & develop an unshakeable inner core, or at least a less shakeable one.  The inner wisdom that is within us all, our core of love and compassion, is a place that we can come to know more deeply with time and once we have an embodied knowing (a felt sense in our body) we can return again and again to our true selves and a balanced state (our ventral vagal system/window of tolerance) that supports healing.  As we heal we can live more fully in an open hearted presence, developing a new way to be, relating to ourselves in a more loving and compassionate way and extending this love and compassion to others and the world around us.

To finish this blog I’m sharing a poem that I wrote called ‘Healing Within’:

Many things were unknown

Couldn’t be seen

In the darkness there was always some light

Flickering gently

Leading the way

Slowly, step by step

Pauses scattered through

Compassionate awareness enveloping

Body wisdom guiding to explore

What’s resting inside, to be seen, accepted and loved

Slowly, never to be rushed

Each footstep exploring

Heart trusting

A loving presence guiding

Exploring and listening

Natures wisdom shining

Deepening a knowing

Harmony evolving

Learning a new way to be

Compassion, love and trust united

Deeply embedded within

Shining brightly

Holding the steadiness

Resting in aliveness

Connected to the unity

Being & healing

You may also like to check out the poem I wrote called The Body Remembers The Trust

https://m.youtube.com/watch?v=2pgR3COJLPk

I would love to hear your thoughts on healing and this blog, do drop me an email if you would like to (info@unityphysio.co.uk) or share some thoughts in the comments on social media where I’ve shared this blog.

The post Healing Within Connectedness & Love (part two) appeared first on Unity Physiotherapy and Wellbeing.

I’ve especially been considering healing in relation to trauma, persistent pain, ME/CFS, long covid, PoTS and other long-term conditions, which is probably because these are the areas I work within and have lived experience of some too.   Many people are healing from trauma and/or a long-term health conditions in our modern world.  Last week I read in a new report by The Health Foundation it has suggested that 9.1 million people in England are expected to live with a major illness by 2040 and that a significant proportion of this will be related to certain conditions, including anxiety, depression, chronic pain and diabetes.   In my opinion there are many factors that need consideration here including healing and the innate connectedness that we need to reconnect to and nurture.

What does healing mean?

There is no agreed definition of healing, healing in acute terms means repairing damaged tissues, or fixing an injury, for example.  Things get complex when it’s not a simple acute injury and there isn’t a specific time frame to heal or repair the wound/injury.  When there are, for example, layers of trauma, or many symptoms from fibromyalgia, or someone is living with persistent pain healing becomes trickier to define.

Before reading on I invite you to consider what healing means to you?

I think we could say that healing is always an individual experience that involves reducing or transforming suffering.   However, if we were to say healing is only a change in suffering this would be a simplistic view, especially as suffering is complex and it is always changing, everything is always changing, and because healing is about more than the suffering or struggle that is part of the picture.

Another thing to consider with what healing means is that it may or may not mean full resolution of pain, anxiety, or other symptoms.  Often people have shared with me themes around alignment with their heart and what’s meaningful, connectedness and wholeness as part of what healing means to them, and these are things I can relate to from my own healing journey too.   Some people may say that not feeling whole implies that something is broken and needs fixing.  I don’t see it this way and instead see it as a disconnection from our true selves, disconnection from nature and a disconnection from the wider whole/universe (there are different terms for this, it can essentially be seen as something bigger than ourselves).  Although we may at times feel broken we never really are, our true self is like the sky in that it is always there and can never be broken and the weathers come and go.

A journey to wholeness is something I see as a heart based connection, a connection to meaning and purpose, to a sense of belonging, and to the love, trust and compassion that’s within us all.  We could maybe say that healing is a coming home to ourselves, reconnecting to our inner wisdom and connecting to the interconnectedness of everything.  I would say healing is also an alignment of mind, body and heart, a place where we can live fully connected from an open hearted presence with a gentle strength and love.  We will explore this a little more in part two of the blog.

I think that it is helpful to consider what nervous system regulation means in the context of healing, especially because we can’t heal with a nervous system that is dysregulated too often/too much.

What is nervous system regulation?

Nervous system regulation includes the whole nervous system and is often discussed in terms of the autonomic nervous system.  Everyone’s nervous system dysregulates many times a day and then re-regulates, the problems come when the nervous system is dysregulating too often or too much relative to the context and not re-regulating well.  A well regulated nervous systems helps us to feel safe or safe enough to be fully present and to engage with others and the world in general, and it helps all of our systems to function optimally.

There isn’t an agreed definition of nervous system regulation, this is one that I created for my Creating A Healing Path workshop series:

‘Nervous system regulation can be thought of as when our nervous system is flexibly able to move between different states in response to stressors & the level of arousal matches the context/what you are required to do.  It is where it is working in a balanced way that supports optimal function & healing.’

A quick summary of the autonomic nervous system (ANS) could be helpful here.  The ANS unconsciously controls and regulates our organs and unconscious body functions, including heart rate, breathing (which we also have conscious control over), blood pressure, and temperature.  It is split into two branches, the sympathetic nervous system (SNS), fight or flight, and the parasympathetic nervous system (PNS), rest and digest.  These work together to maintain a state of balance in the body (homeostasis) and we need both branches of the ANS, neither is good or bad.  The levels of activation of the SNS and PNS are always fluctuating, our central nervous system CNS) and autonomic nervous system are constantly adjusting, along with all other systems, to try and maintain homeostasis.  Our ANS and the CNS (mainly the amygdala and hypothalamus in the limbic system in the brain) are constantly monitoring for threat/danger or safety.  The ANS and CNS are constantly surveying our internal environment (information from all systems), along with our immediate and wider external environment, including how the interactions with others feel.  Our nervous system takes a better safe than sorry approach and our previous experiences and modern society mean it is often dysregulated by things that aren’t actual threats.  Once the threat, or potential threat, has gone we need to be able to return to regulation to function optimally and feel safe and settled again.  When this doesn’t happen automatically or takes sometime we can assist this process and there are many ways in which we can do this, this is part of healing.

It is important to mention that changes in ANS activation are associated with different chemical messengers which of course impact all of our systems.  Our thoughts feelings and emotions are also in themselves associated with different chemical messengers, they are part of our biology too.

There are different models that can help us to understand the ANS and nervous system regulation, the ones I use most often are Dan Siegel’s window of tolerance and Stephen Porge’s polyvagal theory, combined with the 3 circles model by Paul Gilbert (part of Compassion Focused Therapy).  For this blog I’m going to touch on the window of tolerance model and polyvagal theory.

The window of tolerance model was developed by Dan Siegel to describe the optimal level of arousal, it has three parts:

• Hyperarousal (too much SNS – fight or flight)
• Window of tolerance – optimal zone of arousal (balanced ANS)
• Hypoarousal (not enough SNS & PNS without the vagal brake)

In this model a dysregulated nervous system is one that is too often, or too much for the context, in hyperarousal or hypoarousal, and/or takes longer to regulate from these states back to regulation, and sometimes gets stuck for a while in one of these threat/protection based states.  When the nervous system is dysregulated in the direction of hyperarousal a variety of things associated with this can be present including: fear, panic, initial freeze (deer in headlights) emotional overwhelm, anxiety, irritability, anger, over-activity, lack of clarity, worry, gut issues, increased muscle tension, pain, insomnia, a tired and wired feeling.  When the nervous system is dysregulated in the direction of hypoarousal a variety of things associated with this can be present including: disconnection, dissociation, low mood, depression, decreased muscle tone, shame, guilt, feeling numb, fatigue, shut down.

(infographic by Dr Sarah Davies, the link to the blog that this is in is below)

Through the lens of the polyvagal theory by Stephen Porges we see the ANS protection responses as:

• SNS (fight or flight, includes the initial freeze response)
• Shut down or collapse (PNS minus vagal brake, termed dorsal vagal in this model)

Porges suggests that there are three pathways in the ANS, being the sympathetic nervous system (SNS) (mobilised/activated, protect/survival mode, unsafe), the ventral vagal circuit (safe, regulated, sympathetic and parasympathetic activity balanced with the vagal brake, and able to be socially engaged) and the dorsal vagal circuit (unsafe, protect/survival mode, shut down).   These three systems/states are also included on the above infographic).  The SNS part is where there is increased SNS activation (hyperarousal in window of tolerance).  The initial freeze response (deer in headlight type response) is SNS dominant, this is where we freeze whilst a decision is automatically made as to whether we can fight or flee, if neither are possible and this response continues eventually the SNS is overwhelmed by the PNS (we lose the ventral vagal regulation, the vagal brake – the rest and digest part of the PNS).  Here we go into a primitive survival response of shutdown or collapse, this is termed dorsal vagal in this model (it’s where there is increased hypoarousal in the window of tolerance model).  The ventral vagal system is where we are said to be safely activated, in other words the SNS is balanced by the PNS with the vagal brake.  Here all systems can function optimally, the ANS is in balance, the limbic system in the brain is settled and the frontal lobe is online.  When we are in the ventral vagal system we feel safe and secure, this supports social connection and full engagement in a heartfelt presence with ourselves and the world.

The wider our window of tolerance, the more frequently we can be in the ventral vagal system and the more easily we can return to this place again and again.  This helps systems function optimally and we can, for example, find ease within challenges.  Being in our ventral vagal system or window of tolerance helps create the conditions that support healing.  Also with a wider window of tolerance we can more often be in a full heart felt presence and have a greater tolerance to be with our own and others suffering, along with being able to access the wisdom to discern what may be helpful in alleviating or decreasing the suffering.

There is a lot of information on the window of tolerance model and polyvagal theory available, like this blog on the window of tolerance model:

https://www.drsarahdavies.com/post/what-is-window-of-tolerance-emotional-regulation-model-explained

You can find a free beginners guide to polyvagal theory on Deb Dana’s website here:

https://www.rhythmofregulation.com/resources

Considering nervous system regulation alone would be a reductionist way of looking at things, it needs to be considered as part of the whole picture.  This includes considering all systems, what is happening in our body, the thoughts and memories that are present, our behaviour, previous experiences, essentially the whole of our experience and the connectedness of everything.

Summary

Healing doesn’t have an agreed definition except in acute injury.  Healing involves changing or transforming suffering and creates a new way of being through reconnection to our true self and living aligned with our mind, body and heart.

When our nervous system is not well regulated, we don’t feel safe, we can’t see the bigger picture and are disconnected from ourselves, others and the wider whole, and we can’t heal from this place.  It is important we remember that we don’t control any of our nervous systems threat/protection responses (hyperarousal/hypoarousal), they are quickly automatically activated when protection is deemed as needed.  When we are within our window of tolerance or ventral vagal system enough (a regulated and balanced nervous system state) we are safely able to fully connect to ourselves and others, have a more expansive view, and conditions are optimised for healing.  A healing state is one that rests in safety and connection, a place where strength & gentleness are balanced, a place where the seeds of change can be planted, begin to grow and later flourish and these are all part of having a well-balanced regulated nervous system.

Perhaps we could see healing as a return to wholeness, or an alignment of mind, body & heart.  An alignment and wholeness that means that we can live a life full of meaning, with a sense of purpose, fully connected to ourselves, others & to something bigger than ourselves (the wider whole) in an open hearted and grounded way.  These will be explored a little in  part two of this blog.

What do you think, does this way of seeing healing resonate with you?

Link to part two of the blog https://unityphysio.co.uk/healing-within-connectedness-love-part-two/

(brain in hands image with this blog is from Shutterstock by Sergey Nivens, all others are owned by Ann Parkinson at Unity Physiotherapy & Wellbeing)

The post Healing Within Connectedness & Love (part one) appeared first on Unity Physiotherapy and Wellbeing.

What Can Help

We need resources to help us in the grief process, resources help balance the challenges & vulnerabilities that arise.  Two really important inner resources are compassion & being able to regulate the nervous system, I think these are foundational in many things including in grief & loss.  Other resources include the process of learning itself, the support of others, perspective taking, being able to connect to safety and trust, and awareness (mindfulness).  If someone is under-resourced they are more likely to need some support from a counsellor or psychologist.  Also this can be needed, for example, if the grief triggers into previous traumatic experiences, which I think it often does, especially if someone is under-resourced and it’s still needed sometimes even if someone is well resourced too.  It’s important to recognise when help is needed and also remember that there is no right or wrong way to grieve.

One way to identify what could be supportive for you to nurture is to ask yourself:

What’s challenging for you?

What would help if it was more present in your mind? (for example, compassion, love)

What would it help to connect to in your body? (for example, love, kindness)

You can then nurture what you identify would be helpful, the more we practice and work with something the easier to is to access as it becomes more hard wired.  There may be a time when growing what’s nurturing creates more sadness, it’s important we listen to the not yet and reassure ourselves it’s ok to feel these things and see if it feels ok to continue the practice.  A practice where you can nurture what you identify as supportive could be one like this one, to nurture what’s supportive in the body:

https://soundcloud.com/user-103516027/nurturing-whats-supportive?si=2ef7028b5d334d2e8f6860c9cbfcfebf&utm_source=clipboard&utm_medium=text&utm_campaign=social_sharing

Our self-talk matters, as mentioned in part one of the blog our self-critic can get over active and we take the losses and grief and turn them into a big stick to beat ourselves up with, when this happens the compassionate self can help.  Let’s look at a couple of examples and some compassionate reframes: “I need to stop wallowing and get on with living life”, perhaps you could notice how this statement lands in your body and what state of mind it’s associated with?  The self-critic’s view is not very helpful and doesn’t acknowledge the impact, that it’s normal to not feel ok and settled after a loss/losses for a while (how ever long that while is).  Here’s a compassionate reframe example, “my grief reminds me of how much I’ve lost, it’s completely understandable that I’ve been struggling and how I’m feeling is normal, everyone grieves and experiences losses and it’s not easy to navigate this.”  How does that land with you?  Here’s an example that combines guilt with the self-critic, “if I had worked harder to get rid of this pain I wouldn’t have lost my ability to walk further than I can, do the garden and the housework, I really should have stopped it happening, I just wasn’t strong enough to do it.”  Wow that’s harsh isn’t it, how does this land with you?  Let’s look at a compassionate reframe here, “this has been really hard to manage and I did my best to maintain my function and do what I needed to.  I had no control over how things have turned out and I’m doing my best to find what’s helpful for me.”  How does this land in your body, what about your mind?

Being aware of where our attention is automatically resting is helpful, pain and losses take our attention automatically and become a default until we become aware and start to change this habit (it doesn’t mean ignoring the pain and losses).  We have tricky brains in that they are wired for protection and survival and so have a bias towards things that are perceived as a threat.  If, for example, we have our attention in anger, anxiety, fatigue or pain all the time it becomes a habit and what we are growing.  Also, when we do this we are functioning from our sympathetic nervous system way too much which impacts us in many ways.  Being mindful of where our attention is, acknowledging what is present and learning about it, then unhooking from this and choosing a more helpful place for our attention is part of creating space around pain, fatigue and associated losses.  In this way we can learn from what’s showing up and deepen our awareness without being hijacked by it.

When I did Rick Hanson’s Grief and Loss course recently (linked at the end of this blog) he mentioned that Peter Levine talks about being like a pendulum swinging into the intensity and discomfort and back out.  The rhythm of the pendulum and how long it stays with the discomfort can be whatever is right for you, perhaps this could be helpful in being with the losses and grief and how it’s showing up without feeling overwhelmed.  Over time we can swing into the grief and discomfort and stay a little longer if it’s helpful.  If someone can’t create space in their pain and time and time again they get pulled into it, or maybe even are stuck in it, reaching out for help may be needed.

Dr Rick Hanson also talks about even as the storm passes through the mind for your own grieving there is a place inside, a knowing that a small part isn’t swept away and is alright, even if it’s a tenth of 1%.  Can you notice this?  This basic alrightness as he calls it can be a place of refuge, a soothing place to rest and grow.  Keeping returning to it and building this indestructible, trustworthy, reliable, unshakable core, as Rick says, is helpful.

It’s important to acknowledge the losses through pain, fatigue and various long-term health conditions, honour them and when we are ready create something meaningful, something that’s helpful for ourselves and others.  A ritual can be part of this, for example, drawing something, creating a memory scrapbox or memory box, lighting a candle, planting a tree or other plant, writing a letter, getting a group of people together to acknowledge & honour the person that once was with compassion and love.

Here’s a list of other things that help, I’m not talking about them all else this blog will be way too long (this is not an exhaustive list, there are many more things):

The post Grief & Loss in Persistent Pain & Other Health Conditions (Part Two) appeared first on Unity Physiotherapy and Wellbeing.