Creating Safe Spaces for Trauma Survivors - how to support lifestyle, fitness and habit changes

As a follow-on from the previous blog Trauma Response & Lifestyle Change - how the four Fs can show up as barriers.acknowledging how the different trauma responses might show up for someone who has been through trauma when it comes to health, fitness and habit change, we will look at some ways that situations and spaces can provide safety.

This information is for those who have experienced trauma, and for coaches, preventative healthcare professionals, instructors and other fitness professionals.

Please note, the suggestions in this blog post are by no means exhaustive. Please keep in mind that the responses described can be related to human behaviour in general, not necessarily trauma.

It should also be kept in mind that as professionals, it is not within our scope to diagnose trauma nor to 'cure' trauma. In any situation, it is worth remembering our scope of practice as professionals and where mental health support is needed, always refer or signpost back to the GP or healthcare provider. What we can do, however, as a minimum, is to avoid known situations that might re-trigger the trauma, to assist people to feel safe in the spaces that we provide, and to support and encourage habit change, keeping in mind some considerations.

Whilst it is never advisable to ask a person whether they have experienced life trauma (based on the behaviour you observe or otherwise), it is possible that a client (especially in an initial consultation or during subsequent 1:1 sessions) might disclose to you that they have been through a traumatic life event which continues to have an impact.

In this case, it can be helpful to simply ask the client how they would like you to work with them. You might wish to have a list to use as a prompt in case a person might be unaccustomed to identifying such options. After all, we live in a world which is broadly uninformed when it comes to trauma so people might not be accustomed to being asked.

As an individual who has experienced trauma (and if it continues to impact on your life) you might want to look for an instructor who is trauma-informed and trauma-aware (and find out a bit more about their experience and qualifications to work with trauma survivors. Social media doesn't always tell the whole story and sometimes service labels / claims can sadly be used inaccurately or out of context so it's a good idea to meet with or speak to the professional to have the chance to ask questions and get a feel for how they will work with you).

It is also essential to consider the following (with every client, whether trauma is a factor in their history or not).

Consent

Consent is 'what is ok and what is not ok' for an individual (and for a professional). We must always seek consent when any physical contact is involved for example with adjusting an exercise or taking a measurement. I will ask someone each time to ensure that they are happy for me to do so and that they realise they have the option to say no. If a client would prefer not to have a physical adjustment, there are many ways to work around this as it often not necessary anyway. It is also useful to understand, where possible, how a client would like to receive feedback and to explain the importance of offering constructive advice (to ensure exercises are performed correctly, to avoid injury, to assist with reaching goals, to ensure someone has correct, evidence-based guidance, to assist them in their choices etc).

Having a good working relationship with a client is about understanding how they would like to work with you. It is also reciprocal and the client must be made aware of your policies and what your expectations are of the working relationship. This helps to clarify boundaries from the beginning and avoid conflict or confusion.

Safeguarding, Confidentiality, GDPR

In terms of creating safe spaces, t is also vital to have a good, up-to-date understanding of safeguarding and to ensure that safeguarding, confidentiality and GDPR data protection policies are not only written but actually adhered to. Undertake regular training and ensure that you have the relevant certifications to work with your client base.

To recap, in the last blog post we looked at the four Fs of trauma response (Fight, Flight, Fawn and Freeze) and some examples of some ways that these responses might show up in an individual, class or gym setting. Of course, there may be no visible or verbal clues that the responses are taking place and the trauma survivor might completely internalise the feelings.

I have copied the problems raised in the previous blog post (white italics), with suggested approaches in yellow text in the section below.

This might create a combative response physically or verbally.

Perhaps it might be someone slamming the equipment down or being confrontational when they feel they are under threat or perceived threat such as humiliation or criticism.

Whilst of course aggressive behaviour is unacceptable, a major factor that underpins any relationship with a client is trust. As a client, if you trust your instructor and feel safe with them you will be more open to being able to receive constructive advice.

It is a bugbear of mine when instructors mock or speak down to participants or create humiliating scenarios (yes it happens and no, it's not 'banter'). As professionals it is vital that we measure the impact of our communications and also that we are able to have a reciprocal relationship, meaning we ourselves are as willing and able to accept feedback from our clients as we are to provide it.

It might be a case of being angry and upset with a situation or person, but feeling unable to articulate this for fear of being disbelieved or silenced, or seem as ‘out of control’ or a ‘troublemaker’. They therefore internalise the anger which can lead to a person adopting unhealthy coping mechanisms which have an impact on their long term health.  

Something I seek frequently in my work is feedback. This could be a form or post-it note at the front of the room that can be filled out at the end of a session or an anonymous Google Form sent after the class (or both). The option to be able to speak up is empowering to a person and also helps to minimise the fawn response (someone telling us everything is great because they are scared to raise an issue, more about this later in the blog).

As professionals, we must be willing to receive feedback and to understand how we can make relevant changes as a result of what our clients are telling us. Collecting group feedback is also a really good way to spot trends - and to hone in on what common themes might be appearing. Of course, we can't please everyone but in terms of ongoing development, we must understand the impact that we are having.

It might also show up as a person trying to ‘control’ their environment or control others in order to minimise the perceived ‘threat’ to feel safe.

There is a quite a lot here to unpick so to begin with, acknowledge, as objectively as possible, what is going on. It could be that the combination of people working together is not effective, so a simple change of partner, seating location or group can alleviate some of the pressure. As long as the threat is not immediate to others, you can wait for some time to pass and then take the chance to speak to the individual, asking them how they found the session today and using open questions to establish the issue.

It could also be that a person will reject instructions, become easily angered or combative in response to a suggestion of change, not follow rules or seem to be unaware of the needs of others in the group.

This can be more challenging, especially in a group situation. One way to assist is for the group to help to draw up their own rules about engagement in the session. This can happen in the first session and be periodically reviewed. You can go through the class expectations with new members and check their understanding before they participate. Of course, in the moment and when someone is angry, it is easy for them to forget and it is not advisable in the height of anger to be trying to remind someone of rules. If the tension in the room is raised, it might be an idea to implement a quick break, a change of task to burn some energy for a few minutes. You might want to ask the person to help you, take them off task and invite them to focus on something else, or in the worst case, offer the individual the chance to take a break from the room (this is a last resort as excluding a person can make them feel ostracised, thus having the whole group take a couple of minutes to grab a drink and take a breath can be more effective). One thing not to do is to meet anger with anger. It is really important that we aim to remain calm in the face of confrontation. I will look more closely at something called co-regulation in a later blog post.

A person might feel a strong desire to leave the situation. They might physically leave the space or perhaps they might become disconnected.

It could be that someone needs to near to an exit or a window space or perhaps they need to be in the same space within the room each time.

Ensure that there are clear instructions about accessing the space. Perhaps having the opportunity to visit the location first would be helpful. It might be necessary for a trauma survivor to know what else is happening in the building at the same time. Details such as parking, public transport links and a map can be additionally useful.

When participants enter a room, trust them to choose where they would like to sit or stand. Sometimes moving positions is part of the session or is unavoidable, but it is worth knowing that people might choose a particular destination for reasons of safety. Observe your clients, get to know their preferences. Remaining engaged with a class is key - make eye contact with people as they arrive, say hello, welcome new members. Say goodbye when people leave. It may sound basic, but sadly I have witnessed a lack of this occurring in many spaces. Yes, of course the coach or instructor may be busy enrolling people, sorting out the music, setting out the equipment. Nonetheless, there is always scope to acknowledge participants.

They might work too hard, overexerting their body, not understanding their physical boundaries.

This one is not a quick fix. I will talk about safety within the body (which is vital) in a separate post because it is a big topic. There are of course scales of exertion that can be used in the fitness sphere (RPE, The Borg Scale), but in my view, these can fall short for trauma survivors, for a few reasons including the flight and fawn responses. That is not to say we must assume these scales to be unhelpful - every trauma survivor is different and it is not useful to label someone.

It might drive a person to feel they have to be the best or it's not worth doing.

This is similar to the fawn response. One way to assist with this is to give small, manageable goals and to emphasise the importance of working on small goals. Also, make sure that people do not feel pressurised to demonstrate an exercise in front of a class. If necessary, you could break the class down into smaller groups or pairs, and visit each group to check form or understanding with the individuals. If you are working 1:1, perhaps find a quiet corner or space in the gym. When it comes to habit change and lifestyle advice, the small goals principle also applies. Try to avoid guilt or shame inducing language, try to create safety for clients to made mistakes, as it is part of the learning process. Talk about your own mistakes and times you have struggled, if relevant. If clients see humanity in the instructor or coach, they are more likely to understand that it's ok to try things.

Someone may become completely overwhelmed and unable to follow instruction or perform the exercise required.

In this situation, it is advisable to change course. Whatever has come up for that person has made them feel unsafe to continue. This is a difficult one because we don't want to push someone to have to explore what has triggered the freeze response but if possible, it can be useful to find out what could be avoided or navigated better next time. Always use open questions, listen and remain non-judgemental.

Or, freeze could manifest in being completely stuck in terms of starting to make lifestyle changes, having a sense of total overwhelm and simply not being able to engage with or begin the process.

As with the earlier advice in the flight section, suggesting small, manageable changes can be helpful. What is realistic for each individual will vary. It is no good quoting guidelines at someone without considering where they are starting from. 150 minutes of moderate cardio a week for someone who is sedentary is unrealistic. Telling a person to include resistance training 2-3 times a week when they have never done it is ridiculous. 5-a-day fruit and veg for a person who might usually manage 1-a-day is a big ask. Keep your goals realistic and in context of the person's starting point.

It could also affect someone’s ability to leave the house and participate in an activity, because they very thought of going elicits a paralysing response.

Of course, you probably won't know that this is happening as the person won't have turned up. Some ways to minimise this is taking the time to explain all about what will happen at the class, how to access the service etc. Taking the time to contact someone (if appropriate) in a non-judgmental way (avoiding blaming language - rather than saying 'you weren't there', explain it's a courtesy call to see whether there is anything you can do to support them). I also find it useful to avoid saying things like 'we haven't seen you for a while' when someone turns up who hasn't been attending, as this can be received as blaming or can make a person feel like they have to explain themselves. Simply welcoming someone in, saying hello etc is so much more empowering. It says 'welcome back, you belong here, you don't need to explain'. It is not always appropriate to contact non-attendees every time - you must gauge the situation accordingly so as to avoid placing additional pressure on someone.

This is a people-pleasing response. Someone might agree to something that they do not want to do. They may feel obliged to say yes, because the desire to please the instructor (or others) overrides their desire to protect themself. This might be agreeing to taking part in something they really don’t want to do, pushing themselves physically harder than they want to, being in a group photograph of the session that they didn’t want to feature in.  

This can be hard to identify and it is something that really begins with the trauma survivor feeling safe to express how they feel (and also identifying that they themselves are people-pleasing as a trauma response). This also goes back to the trust relationship that must be established initially. Make it clear that people have options. Celebrate the small wins and remain non-judgmental. If you are taking a photo of the class, ensure that people have the option to not be included. Remember consent is ongoing - what might be ok for someone one day might not be ok on another day. Clear, open communication and listening are essential skills for the professional.

It can also manifest as a kind of perfectionism, fear of making a mistake, fear of disappointing others or fear of being seen as ‘less than’. This might show up as defensiveness when lifestyle changes are suggested, or it might show up as a desire to ‘prove’ to the coach or instructor that they are doing everything perfectly.

As mentioned earlier, create a space where it's ok to be human. Perfectionism is not a goal. It is important for professionals, as appropriate, to show our own struggles and flaws. Avoid judging or criticising others in your narratives (highly judgmental people are often using judgement as a deflection of their own insecurities). Celebrate effort as well as achievement. Make it ok to safely make mistakes - it is after all what makes us human.

The fawn response also makes it difficult to articulate feelings and give feedback, because there is a sense of their views not being important and not wanting to be seen as fussy or causing trouble. Internalising these feelings can again lead to adopting unhealthy coping strategies.

Again providing the opportunity to feedback is key. The last thing you want is for someone to be telling others negative things about your work or service when they have not had the opportunity to comfortably address these with you. Of course, it is worth remembering, you can offer safe spaces and opportunities for feedback and personal development but you can't please everyone (and in fact we also need to be aware of our own trauma responses, which I will address in a future blog post).

You might also be interested in:

Trauma as a Barrier to Lifestyle Change. Why does trauma matter?

Trauma Response & Lifestyle Change - how the four Fs can show up as barriers.

Future Blog Posts to look out for...

Feeling safety within the body & co-regulation

Considerations for professional who have survived trauma

Follow me on social media for more (links at the top of website page)

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Tonia Dunn is a CIMSPA member, an Associate Member of the Faculty of Public Health, Advanced Personal Trainer Practitioner, Boxercise Instructor and Preventative Healthcare Coach based in Birmingham, UK.