Stress Protocol
Working with patients' stress management is crucial to reversing hypertension and heart disease. While nutrition is often seen as the foundation for heart health, research shows that stress is often an overlooked aspect of treatment that has only recently come into the mainstream. For Oben patients, providing trauma-focused stress management techniques is crucial considering the high prevalence of trauma in communities of color.
Our stress protocols are based on the understanding of our patient’s lived experience. This includes the patient’s past and daily exposure to stressors; externally - systemic racism, low-income economic status, and other forms of oppression, as well as internally - their own personal struggles and traumas that cause prolonged stress activation and high blood pressure, leading to increase susceptibility to Heart disease and mental illness (13).
Our trauma-informed treatment protocols are based on Somatic Experiencing (SE), a trauma modality originating from the work of Peter Levine, Phd. Dr. Levine is an internationally renowned trauma expert who studied the effects of trauma on the nervous system, and its correlating effects on mental and physical health. This treatment protocol helps to address underlying nervous system dysregulation that may be contributing to high blood pressure. This is done by trauma-specific exercises that involve elements of mindfulness and tracking of the physiological states. Our director of clinical operations, Meaghan McVeigh, has utilized this trauma focused treatment approach over the past decade in her work with patients in low-income neighborhoods in Oakland, CA. She has found it to be particularly effective in helping patients manage underlying stress associated with socioeconomic and systemic stressors. When patients have experienced trauma, often the nervous system becomes stuck in a pattern of survival. It is difficult for patients to feel calm or take action towards their health when their body is in a constant state of fight, flight, freeze, or shutdown as a result of trauma (16). Thus, simply directing a user to do mindfulness or meditation, an intervention often used for stress reduction in heart patients, is likely to be ineffective if it does not address underlying nervous system states. SE helps patients move through flight, fight and freeze, and enables the body to come into a state of rest in the parasympathetic nervous system. This state lowers blood pressure and transitions the body out of a stress response (16).
One crucial component of stress is emotional health. Our program teaches users to build emotional awareness by introducing how to understand their emotions, as well as how to express and move through them. Low income communities of color often report struggling with feelings of grief and anger due to systemic stressors such as violence and racism. Thus it is crucial to work specifically with grief, anger, and other difficult emotions. In addressing anger, we lead patients through exercises like wall pushes, leg pushes, as well as allowing and tolerating sensations of anger in their body. This allows their physiology to discharge patterns of fight that occur in the limbs (arms/legs) that often get stuck. These exercises help patients safely express titrate patterns of emotional stress out of their body in a trauma-informed way. Over time, patients will notice a decrease in stress levels associated with anger, and ultimately a drop in blood pressure.
When people experience high levels of trauma, a common reaction is to disassociate. When a person dissociates, they are no longer connected to their physical bodies, often do not notice the level of stress in their bodies, and thus do not recognize the connection to poor health as a result. The skill taught in our program, building body awareness, helps patients come back into their bodies using simple exercises to connect and bring awareness to each body part, using mindfulness, tapping, chanting, and massage.
Spirituality is an integral part of the black community, incorporating it into treatment is vital to engagement. Prayer, church, and religious gatherings are often a primary means to self care in the black community. We empower users to utilize their spirituality and/or religious beliefs as a way of connecting to themselves and thus their overall health. Spirituality is recognized as a motivator for our users to continue with treatment. We also introduce users to nature as a spiritual healer and a means to help calm their bodies and lower blood pressure. We recognize that many of our users may not have access to nature, and thus have created options for users to incorporate nature already present in their home.
Teaching the body to wind down is the first skill in the stress section, as it teaches users basic, beginning ways to regulate. In order to work on managing stress in communities of color, we have to consider how trauma has impacted each user's ability to regulate. We need to first teach the patient how to calm their body and find “resourcing” - safety inside themselves and/or in their environment. We do this by teaching exercises like belly breathing, box breathing, dealing with overwhelm through mindfulness and tracking, as well as understanding what’s happening in their body when they become stressed, dysregulated and overwhelmed. These exercises are the foundation for progressing into the rest of the stress program, where patients will be able to regulate and calm themselves while working through more specific stressors like anger, grief, and self esteem.
In considering motivators for preserving heart health in Black and Brown communities, sexual activity is a key component. Sexual activity can help preserve heart health and lower blood pressure. We offer content specific to educating users around the effects of high blood pressure on sexual performance i.e. lowering of libido, erectile dysfunction, lack of stamina/ability to physically perform. This can be highly detrimental to self-esteem. There is an emphasis on empowering users to improve their overall self-esteem and self-love. By doing so, we are creating a space that encourages users to love and cherish themselves, a message these communities have historically not received.
Self-care is often overlooked in Black and Brown communities, and is sometimes written off as a luxury they do not feel they have time for. Our program challenges this misconception, and teaches users different skills/ways to implement self-care into their everyday lives and routines. There is an overwhelming connection between emotional and physical self-care, and improvement in overall health and blood pressure. Creating a stress-free environment is one way we help our patients begin this self-care practice. To do this we teach patients ways to improve how their home makes their body feel. While patients don't always have control over aspects of their environment like noise or safety in their neighborhoods, there are ways to create moments of relaxation and respite that they can have control over. For example, lowering lights, using white noise to drown out sounds, or watching shows that increase relaxation rather than increase anxiety, aids in decreasing the stress response. Napping is another component of self-care that may be overlooked by our patient population. There is often a stigma around napping, as if that time could be better spent doing something more meaningful. We challenge this misconception in the program as well, encouraging patients to listen to their bodies, and inviting naps when their bodies are seeking rest, and teaching them how this benefits blood pressure (15).