How to read and interpret the alternative health science for wellness professionals
In the trauma-informed space where movement, mental health and western medicine overlap, there is an expectation that as a wellness professional we are up to date on the latest science and most effective ways to help people optimize their health. There’s an assumption in the US that we have proof of efficacy for all of our favorite mind body modalities through double blind controlled studies. The truth is the space between eastern and western medicine is filled with hope and unanswered questions. Today on the work IN we’re discussing some of the difficulties with getting hard science when it comes to mind body modalities and what we do with answers that aren’t what we hope for.
As a part of my mission to bring a legacy of resilience through movement, each month you can join me for a hike on the bike trail followed by a free trauma informed vinyasa class back at the studio on Main Street. Go to savagegracecoaching.com to see the calendar and join my newsletter, Yoga Life on Main Street, to stay up to date on all the latest studio news, events and gossip. And now… on to this week’s episode.
It’s time to stop working out and start working IN. You found the Work IN podcast for fit-preneurs and their health conscious clients. This podcast is for resilient wellness professionals who want to expand their professional credibility, shake off stress and thrive in a burnout-proof career with conversations on the fitness industry, movement, nutrition, sleep, mindset, nervous system health, yoga, business and so much more.
I’m your host Ericka Thomas. I'm a resilience coach and fit-preneur offering an authentic, actionable realistic approach to personal and professional balance for coaches in any format.
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How to read and interpret the alternative health science for wellness professionals
In the trauma-informed space where movement, mental health and western medicine overlap, there is an expectation that as a wellness professional we are up to date on the latest science and most effective ways to help people optimize their health. There’s an assumption in the US that we have proof of efficacy for all of our favorite mind body modalities through double blind controlled studies. The truth is the space between eastern and western medicine is filled with hope and unanswered questions. Today on the work IN we’re discussing some of the difficulties with getting hard science when it comes to mind body modalities and what we do with answers that aren’t what we hope for.
I heard about trauma release a long time ago. I didn’t start my training as a TRE provider until 2019. TRE, as we've discussed many times on this podcast, was developed by David Berceli. It’s a series of simple movement exercises that open the way for natural neurogenic tremors in the body. Those self induced tremors are thought to give the body a way to release the physical, mental and emotional stress and tension. It was hoped (hypothesized) that TRE might be a way that individuals who didn’t have access to mental health support could prevent or relieve symptoms of ptsd on their own. Kind of like trauma first aid.
When I first started my training in TRE it was only about 20 years old. And I did wonder if there were any studies to back up the theory. The physical movements themselves are so simple that I bet most of us do some everyday. So I was curious if they had really been put to the test in any meaningful way. Turns out they were.
Now before I tell more of this story, I’d like to point out that doing controlled double blind studies on anything is challenging for many reasons. They’re expensive and time consuming. The take a lot of human capital. That’s why drugs are so expensive. When creating a study they try to control variables in order to answer a single question. For example, does this drug lower blood pressure? In that case you are studying the physical changes in an animal first then person and you are measuring a placebo, and a control group and following only blood pressure. Noting any side effects along the way.
So as a review of jr high biology. The test group is the group that gets the intervention. The thing you are studying or asking the question about. The control is a group that doesn’t get anything. And your placebo group receives some kind of intervention that is similar to the test but isn’t. So for example a sugar pill. It needs to be so similar that the group believes it’s receiving the treatment. Or at least can’t tell it’s not getting it, in the case of humans.
When studying people there are an innumerable list of variables, not the least of which is the placebo effect which can be upwards of 60% in some cases of antidepressant and other mental health drugs.
So you can imagine trying to control for something as subjective as stress and ptsd symptoms in a trial to test any kind of movement modality.
There have been a lot of studies that have looked at specific breathing techniques that are based on yoga meditations, mantra and pranayama that have proved to be significant. As well as yoga itself for PTSD in veterans, incarcerated people and for chronic pain and more.
Of course you and I know yoga works for these things. Especially when we’re intentional about it. We might not have needed a study to prove it. But some people do. For western medicine it isn't enough to know something works. Nature isn’t enough. We must also know how it works. Because otherwise how will we monetize it? That’s part of the truth of science these days.
EMDR for example was discovered by Dr. Francis Shapiro on a walk in the park. Is EMDR a walk in the park? No. or at least it isn’t only that. Dr Shapiro added other treatment elements, including a cognitive component, and developed a standard procedure called EMD.
You can’t patent things that grow naturally or an innate mechanism in the human body. I suspect that’s why there’s a lack of funding for some of these things. And it’s a part of why David Berceli created TRE. He wanted to give people something they could do themselves. Something that didn’t require a prescription or visit to an expensive therapist.
But people want proof. I wanted proof. I wanted science at my back when I told people about trauma release exercise.
I remember asking if there were any studies on TRE in my training. I think the answer came back that they were working on it. And I supposed that was true at the time.
Now it’s 2024 and here’s what I found.
On Pub med I found one exploratory study on TRE for people with MS from 2021 and a report of another study called Neurogenic Tremors Training (TRE) for Stress and PTSD: A Controlled Clinical Trial completed in 2018 and prepared for the U.S. Army Medical Research and Materiel Command Fort Detrick, Maryland.The second was not on pub med it was on the TRE website.
Then outside the US…A paper on the use of TRE for African refugees. And Case Report of a Former Soldier Using TRE (Tension/Trauma Releasing Exercises) For PostTraumatic Stress Disorder Self-Care
Some of these are easier to read than others. I was most interested in the controlled trial. Partly because controlled trials are always the gold standard and partly because I was curious as to how they were going to control for so many variables.
When we’re talking about any mind-body intervention there’s a lot going on. Not only is it important to try to get participants who are similar but the trainers who are delivering the intervention also need to be controlled. As a TRE provider and yoga instructor I know how critical the inter personal connection between instructor and student is. It can make a world of difference in outcome for the student. So in this study they used trained people to deliver either TRE with tremors, a placebo intervention that they called a yoga-sham or TRE without tremors and a waitlist control. In other words there was a group who was told they were on a waitlist and did not participate in either. It was 2x per week for 4 weeks and there was 2 weeks of pre testing and 2 weeks post. Then they followed up at 3 months and 6 months.
It was interesting what variables they chose to follow. Assessments included mental health symptoms, well-being and physical health, and neuropsychological tests of attention, memory, and executive functions. In my opinion, just reading the study it seemed like they were trying to compare too much. ANd while there were some areas where the TRE group did better than the placebo or control the entire sample did better over time. There was a lot of “contrary to the hypothesis”. In other words it didn’t meet expectations. Which In my mind is probably why it isn’t being shouted from a mountain top. It’s hard to get definitive results when you’re asking so many questions.
To get those results I go straight to the summary and conclusion sections of any study.
“ It should be noted that gains in working memory are also found with yoga interventions (Brunner, Abramovic, & Etherton, 2017) but they are significantly greater in the TRE group here in comparison to the Placebo group. It should be noted that list learning is a more complex memory and attention measure in comparison to working memory, as it tests immediate recall, delayed recall, and recognition memory. Another notable finding is the improved sleep, perhaps reflecting improved breathing, a rhythmic activity associated with CPG and, thus, with TRE training. The gains shown by all three groups call for additional analyses that examine mediators and moderators. All groups improved on the PTSD measure across time, with no between group differences.
Translation there wasn’t a big significant difference between the TRE group and the others. There were some differences in certain categories but they couldn’t definitively say that yes TRE by far helps PTSD symptoms more than any other thing.
And because all groups improved over time it may be as simple as the healing affect of time and that simply taking some action to get help can start the healing process.
Reading the report further it was acknowledged that…quote
“Our findings point to TRE as a potentially useful approach for not only affecting physical functions, such as sleep, but cortical functions associated with trauma. The participants in this study were complex: had multiple psychiatric and medical diagnoses, had received a variety of therapies for some time, had been and were on numerous medications.”
As we know here on The Work IN, everything we do has an effect. How we eat, sleep, move, connect, our past present and future experience, what we believe, all of it counts.
So perhaps it isn’t possible to control for all the variables. In the TRE for MS study they were looking at over 40 symptoms of PTSD. And that right there illustrates the complexity of the question itself because not only do individuals differ, both the providers and participants in these studies but the symptoms differ.
Experience also may have played a role as the principal investigator, study coordinators and psychology technicians had never been involved in a study like this before. The intervention providers themselves were trained and experienced in TRE prior to the study though so were able to deliver both the placebo and TRE intervention.
All this to say that studies like this one that are looking at mind-body interventions for complex mental, physical and emotional states like ptsd are difficult to simplify for the sake of a blind control.
That complexity is part of the reason it takes years for exercise science to get done first of all and then get distilled down to common knowledge and even longer to correct that knowledge as our understanding of the mind body evolves.
Because evolve, it does.
People want hard proof (I would love hard proof) but there is a lot of softness when it comes to the network of body and mind. And because we’re talking about human behavior no matter how hard we try there’s always some confirmation bias. That’s what a hypothesis is. We think we’ve got something that will do x,y or z and we are brave enough to test it.
I will admit to that in fact I was disappointed when I read this particular study and a little put out because it seemed like they were keeping the lack of definitive results hush hush. But actually I think the results do point the direction for new questions to be asked and maybe new ways to limit (control) the study.
So what can I do with this study? As a fit pro I can share it as information. I want my students to understand the possible benefits and to get the chance to learn and have another tool to use in their toolbox. Sleep and cognition are 2 areas of concern for many people and this study should TRE helps with those things. And everything is connected.
Sometimes in science we get a clear yes or a no to our question. But with human minds and human bodies and complex questions of our natural stress response perhaps we should be also willing to look for another maybe. Just like other interventions for physical health like running for weight loss or particular diets, if there were one thing that worked for everyone there would only be one thing. The same may be true for stress related mental health interventions. Meaning it’s not top down OR bottom up, it’s not this OR that, but maybe we can look for the AND.
Take antidepressants. Exercise statistically works just as well. But that doesn’t mean both together for a time can’t work better. If we want to find interventions that help us become more connected and resilient, more self aware and integrated then maybe studies like this one need to be shared and translated for the general public.
I look for these because a lot of my students come to me for an extra understanding of the mind-body connection. They know there’s more to it than calories in calories out and no pain no gain. There’s more to them than what the eyes can see. Fitness and wellness professionals can take an extra step in the experience they bring to clients and students. There’s no shame in saying “Back in the day we thought this…but now we think it’s actually this…and the science is evolving.” Because guess what? That’s what good science does.
Thanks for listening ! If you like what you heard and you want to know more head over to savagegracecoaching.com/theworkin for all the show notes from this episode and others. If you haven’t already, be sure to like, follow and leave a 5 star review on apple podcasts and subscribe on spotify it helps other folks find us. Until next time stop working out, start working in.