Grief, Healing, and Mental Health Strategies for Chronic Illness with Natasha Trujillo, PhD

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Dr. Linda Bluestein: [00:00:00] Welcome back every bendy body to the Bendy Bodies podcast with your host and founder, Dr. Linda Bluestein, the Hypermobility MD. Today my guest is Dr. Natasha Trujillo, and we're gonna be talking about grief and loss. And this topic is really, really personal to me because when I started having health problems back over a decade ago, it was really.

So hard for me to understand that processing grief was such an important part of the healing process. But so much of my identity was tied up in my perception of myself as an athlete, in my job as an anesthesiologist. And as I was not able to do those things, I really found myself struggling with my self [00:01:00] identity and it really was just such a contributing factor to my suffering.

So this is a really, really important conversation for all of us who have dealt with chronic pain, chronic illness, and I think you're really going to find it really, really helpful. Dr. Natasha Trujillo is a licensed sports psychologist specializing in grief and loss, self injury and eating disorders. She has worked to destigmatize mental health distress and increase access to services, especially for student athletes.

She recently released her first book, and she was never the same again, which focuses on the nuances of grief and loss, especially pertaining to life's events. Dr. Trujillo is also the psychologist for the Colorado Ballet, the University of Denver Women's Basketball Program, and Wilhelmina, Denver. She works with current and former collegiate, professional Olympic and Paralympic athletes in over 40 states throughout the United States.

As always, this information is for educational purposes only, and it's [00:02:00] not a substitute for personalized medical advice. Be sure to stick around until the very end so you don't miss any of our special hypermobility hacks. Well, let's get started talking to Dr. Trujillo.

All right, well, let's jump in and start talking to Dr. Trujillo. I'm so excited to chat with you about grief because I know this is a really important topic for people living with chronic illnesses and disabilities, but can you start out by telling us why? Why should people? Living with these conditions, be aware of grief and how it can play a role.

Dr. Natasha Trujillo: Oh my gosh. Yeah, absolutely. And this is such a good question to start with. I think that oftentimes people don't feel like they are grieving or that they can grieve or even think about grief in the lens of their own experiences if death is not involved. But truly, any time you lose something significant, and with chronic illness and disabilities, there are a slew of losses, right?

You have primary losses, secondary losses, [00:03:00] cumulative losses. And so it's, you are grieving. And so I think just opening up that awareness and giving people some language and different ideas and ways to process it allows you to kind of integrate these changes into your life and, and live the life that you have.

More holistically,

Dr. Linda Bluestein: yeah. I know when I was going through my own process, when I had terrible pain over a decade ago. Yeah, it is. It's like you lose, you lose the ability to do certain things, you lose something of yourself that maybe it was a significant part of your identity. And so I think, it is really important for people to get better ideas as to certain skills and things that they can do.

So I really appreciate you coming on to talk about this.

Dr. Natasha Trujillo: Yeah. Yeah. I don't think it gets talked about enough. So I'm very excited for the opportunity.

Dr. Linda Bluestein: And so in terms of moving towards acceptance and healthy coping, Um, because we obviously, most of us don't want to accept what is out of our control. How can we move towards [00:04:00] acceptance?

And I ask, I get asked often from people, I don't know if I should accept what is, or if I should keep trying kind of like it's an either or type of scenario.

Dr. Natasha Trujillo: Oh my goodness. Yes. Yes. So my first thought on that is that it's often both and instead of either or. And I also usually start this type of conversation with helping people understand that you don't have to agree or like something in order to accept it.

Because sometimes people feel like, well, I can't accept it because that's giving up or that's giving in or, you know, I'm never going to like this or I'm never going to want this. So I just can't get there. And I do think there is a difference between being able to accept and know what is what is. But still own and have those feelings of like, yeah, but I, I would choose something different.

And this is really hard and really frustrating and I don't like it and I don't agree with it. So I think that can be a game changer for people when they recognize. It's a lot more [00:05:00] complex than just accepting and giving in and loving every part of it because that often doesn't happen.

Dr. Linda Bluestein: And in terms of ways that we can navigate these transitions or losses, especially when we feel like others misunderstand us, what are some of the things that we can be doing?

Dr. Natasha Trujillo: Yeah. So it really depends on the person, right? I have conversations a lot with people about kind of introversion, extroversion. Are they someone who likes to process and needs more time independently and by themselves versus are they someone who really derives a lot of energy from other people? And I usually try to help them craft that balance because I do think you need a little bit of both.

I think one of the biggest things with grief that is so powerful Is that you often can't do your way out of it. You have to be with it and you have to go through it. So that difference between doing and being. So I try to help people spark that balance between. What do you need to do and how do you [00:06:00] need to be and then how does that play into Your relationship with yourself and your relationship with other people because socially we do need connection.

We do need validation and support and to you know Feel like we are not alone and have a circle of people who can be alongside us Even if they don't fully get it And if they can't fully help, that is really important, but some of that work has to come from ourselves and our relationship with, with ourself too.

Dr. Linda Bluestein: And I'm sure, like you just said, that, you know, what works for one person is not going to be the same thing that works for another person, of course, but we also know that not everyone can. Afford or access one on one counseling, so I think conversations like this are so important because by you sharing a variety of ways that people might be able to build resilience and, uh, work on their mindset and things like that, you know, could really help people because they might get some ideas of some different things that they could try.

Yes. So if someone's really struggling, they've [00:07:00] had a really challenging time, they, they're physically disabled, they can't do the things that they want to do. Um, what are some of the things that they can do, especially if they're lacking with resources?

Dr. Natasha Trujillo: Yeah, I think that starts with a little bit of exploration about their values and about what is important to them, what gives them a sense of meaning and purpose.

I also think that has to coexist with. an understanding and an acceptance of being willing to change your own mind. Uh, an example here would be an athlete who has a career ending injury, right? And so maybe their identity is very wrapped up in being an athlete and they're no longer able to participate in sport in that way for whatever We do usually go back to the drawing board and say, what came from sport?

So what you're no longer able to do, what, what came from it? Why was it helpful? How did you integrate it into your life? And how can we re recreate that in other areas? [00:08:00] I think I'm also pretty real with people though, too, that you're oftentimes you're not going to be able to completely recreate something.

And, you know, when you lose mobility, for example, or right, like functioning in some way, you're not going to be able to fully recreate that. And that is grief. So I think that also coexists alongside the grief processing and kind of coming to terms with that.

Dr. Linda Bluestein: And is it the same or very similar stages of grief as we, as the typical stages that we tend to think of when we are dealing with a death?

Is that kind of how we process?

Dr. Natasha Trujillo: Okay. I'm so glad you asked this question. So I like the stages because they provide a general framework that I think is easy for people to understand. and wrap their head around, but it is not all inclusive, right? Those stages are fairly outdated. Even the person who created the stages since came out and, and said, Hey, you know, that's it.

This is not the whole story. And so I think with [00:09:00] that, allowing yourself flexibility and knowing that, okay, you might experience some of those things. You might experience anger, denial, bargaining, acceptance, right? Those pieces. However, you might not and they might not come in a gradual order and they might kind of be, you know, maybe one day you're sad and then you feel like you've accepted it, but now you're angry all of a sudden.

So they come and go in, in quite unique ways for each individual person. So I think that is education. That's really, really important as far as death loss or non death loss. Yeah. Right. Anything is on the table. Again, it's such a unique experience for each person. Yeah. And maybe you lose a job in your 20s, and you grieve that one way, and then maybe you lose a job in your 40s, and you grieve that a completely different way, so that is one of the biggest messages, I think, is that there is not one way to do it, and It can be quite complex and nuanced and expectations are kind of off the table as you get to know yourself

Dr. Linda Bluestein: as you're going through something.

[00:10:00] And do you have some practical tips for how people can get to that stage of acceptance and work through the stages of whatever sequence they might come in or like you said, you kind of maybe feel like you're, you know, You've accepted things and you're actually in a pretty good place. But then something happens.

And I imagine something could happen. It could trigger those feelings all over again. So what are some other things? Are there some specific things that work for enough people that we would be worth talking about?

Dr. Natasha Trujillo: Yeah. Yeah, a couple things come to mind. I think one is being able to identify and express your emotions.

whatever they are. And so that self awareness piece is big and, and having people spend some time really thinking about, you know, how am I being affected and what emotions are coming up? And then being able to express that, whether it's through talking to another person, maybe it's through some sort of, uh, physical activity, maybe it's through art or music or whatever that medium is.

I think that is crucial [00:11:00] on the cognitive side of things. I really encourage people to check the facts, and what I mean by that is sometimes we can have a feeling that is very strong and very powerful, but it can make us believe things that don't necessarily fit the facts of the situation. And so I think that sort of reality check can be really helpful with moving closer towards acceptance, where it's like, okay, what is the data?

What is the data? I think there's something to be said about confidence building in that too. Um, we are all faced with decisions that we have to make. And in the case of some sort of chronic illness or whatnot, there's a lot of questions that are asked and a lot of decisions that need to be made. And I think helping people understand that with all the information that you have at this time, are you making the decision that, that best fits and then helping people understand that tomorrow or next week or next month.

Maybe you get new information and that kind of changes the course of things, but helping people be more present and [00:12:00] in the moment cognitively, I think, can really help with, again, moving towards that acceptance and just being more realistic with what options are. Uh, what choices they do have.

Dr. Linda Bluestein: That's uh, very interesting about being present and being in the moment because I feel like it is harder than ever before between, you know, pretty much everyone having a smartphone in their pocket, which of course can do so many things and take our attention in so many different directions.

So what tips do you have for people for being present? Present in the moment because I do think from the standpoint of anxiety and for a lot of us that, you know, I've struggled with that, uh, that's forward focused, right? So if we can bring ourselves into the present, that can help with anxiety as well.

Dr. Natasha Trujillo: Oh, for sure. Yes. Well, and a lot of people will talk about on the flip side, depression, right? Where you're kind of stuck in the past and replaying things that have already happened and then anxiety is very future oriented. And so, yeah, the present kind of allows you to, to put both sets of symptoms aside and really just be to your point.

I do think stepping [00:13:00] away from social media a little bit and distractions is really, really important. One of my favorite tools that I give, uh, the folks that I work with a lot is sensory grounding. And that really is just paying attention to what is around you. So it is stopping. It is putting your phone down.

It is, turning off any outside noises, and it is using your senses to truly bring you into the moment. And I usually take that at like a 1 sort of thing, so I'll encourage people, look around in your space right now and find five things that you can see. And I encourage people, look for things that aren't just the biggest, most flashy items in the room.

Look for things that really are bringing you into the moment. You kind of have to dig around your space a little bit to see. And then I encourage four things you can touch, and I often suggest touching different things with different textures and touching them long enough that you can kind of describe them a little bit, you know, as if you were describing to a friend what it feels like.

Three things you can hear. With that one, I often suggest [00:14:00] that people tune into the little things that we so easily tune out. So examples of that could be, you know, you can sometimes hear a fan going in your home or hard drive of a computer or even the buzzing in your own ears sometimes. Uh, and then two things you can smell.

I will often encourage people, you can smell hair, clothes, if you've got something around you, some sort of like lotion or candle, that sort of thing. And then one thing you can taste. So I think those sorts of interventions, just to kind of turn down all the outside toys, give you something specific to focus on.

And help you be more in your body and in your physical space can be good strategies to assist with that.

Dr. Linda Bluestein: I like that. I've tried to do meditation before and I have a really hard time shutting off my brain. Yes. But by doing meditation Doing what you're describing, instead of just saying, don't do something, right?

It gives us something positive to do. [00:15:00]

Dr. Natasha Trujillo: Yes. Yes. And there are two reasons why I like that. Similar to you, I have always really struggled with, with meditation. And then I get quite frustrated because I'm like, ah, I got to bring myself to the moment. And that's what I'm spending this whole time doing. I also think with Oftentimes with chronic illness, for example, there's a lot of pain going on, and so it can be really hard to just focus on nothing, and so I think still giving something that you can engage your brain with, but it is with that focus of being more in right now, Can be a game changer for people because it still gives a little bit of strategy and a little bit of detachment as you are working to bring yourself more into the moment.

Dr. Linda Bluestein: So bringing yourself into the moment could be more traditional sitting, meditating, or doing some kind of guided imagery. It could be sitting and doing the, this five, four, three, two, one that you just mentioned. Um, there's other like walking meditation and other ways that you can try [00:16:00] to be in the moment, right?

That are maybe some would work for some people and others would work for other people. Um, do you have other ideas?

Dr. Natasha Trujillo: What just popped into my mind was the importance of setting intentions too. And this is a little bit more cognitive. Um, I've been talking with a few athletes recently who have been participating in the Olympic trials.

And setting intentions is something that we have been focused on in the sense of, okay, you're going to have so much stimuli and so much external noise going on. What do you really want to get out of this experience? And I think that can be said for even everyday events. If you're going to a Uh, I often work with eating disorders, and there are a lot of exposures where I will encourage my clients to go to a new restaurant, right, or maybe they're going out to eat with someone that they don't typically eat with, and so I think that idea of setting intentions and kind of putting yourself in this place where you can prime them.

Your mind and prime your motivation to figure out what you want to get out of an experience can help you go into that a [00:17:00] little bit more focused and a little bit more able to stay intent on whatever goals or intentions you set.

Dr. Linda Bluestein: That's, that's a great idea. I feel like so often we can be very reactive and I think social media maybe also contributes to that.

You know, I don't know about you, but I pick up my phone to do one thing and next thing I know I'm doing something completely different. And so I'm reacting to what it was that, um, I saw when I picked up my phone rather than I intended to do something different. So I think, uh, setting intentions could probably help us in a lot of spheres of our life.

Dr. Natasha Trujillo: Yes. Yeah, absolutely. The example that comes to mind, I was working with an athlete who definitely struggles with social media and then can get a little bit. Anxiety just rises, you know, and, and she really needed to be locked in for trials. And so we kind of talked about, you can't stay away from your phone completely for two weeks.

But when you do, can you set some intentions so you know exactly what you're doing when you're on it and really hold yourself [00:18:00] accountable to, to stick to that. So, you know, that your anxiety stays manageable for one of the biggest competitions you'll ever compete in.

Dr. Linda Bluestein: Yeah. I think for some of us having that much discipline around that would be really hard.

And as you're saying that I'm thinking if that was me, of course, I've never been in the Olympic trials, that would be really cool, but never had that. Um, but I'm wondering almost if Removing those apps off your phone because you could download them again, right afterwards. But I think setting ourselves up for success, um, might also be important.

Dr. Natasha Trujillo: Yes. Yes. And that's what I love about setting intentions. You do have to be honest with yourself and you have to be pretty self aware, but if you know that, right, then, then you can be more proactive and say, yeah, I'm just going to eliminate the app altogether. So that in the moment when, you know, when my automatic thought is to open that, it isn't there.

And I've set the intention and I can hold myself more accountable because I've taken those steps beforehand.

Dr. Linda Bluestein: I'm glad you mentioned about automatic thoughts [00:19:00] because I think a lot of people who have chronic illness, or at least in my observation, a lot of us tend to have a lot of automatic negative thoughts and we say things to ourselves, right?

That we would never say to other people. Well, how can we change that pattern?

Dr. Natasha Trujillo: Oh my gosh. Yeah. Yeah. There's so many layers to this. I do, again, think it starts with awareness. We have to recognize how automatic our thoughts are. And the problem with automatic thoughts is that they happen so effortlessly that they lead to these, these beliefs that we don't question.

Because we don't have to slow ourself down to look at it from another angle. And so, a couple strategies that I frequently encourage people is, Are you confusing something that is possible with something that is likely? Because sometimes with automatic thoughts, it's like, Oh, this always happens, or, Oh, this never happens, right?

Something like that. And it's typically not that black and white. Boys are never white. We want to kind of [00:20:00] move away from those extremes and look at some probabilities. Uh, and I think that can be quite useful. I think another thing that comes to mind is, are you only focusing on one part of the story?

What pieces are you not paying attention to? What pieces are not getting stage time when they really do need it? Uh, even for myself and my own experience with chronic illness, I think as soon as I feel my lungs start to Start to go and I'm like, oh man. Yep. Here we go. I will have these sort of automatic thoughts that are futuristic and right I'm predicting the future and I'm assuming I know exactly what's going to happen and something that's really helpful for me is like, okay What parts of the story am I not paying attention to?

I'm only focusing on this one symptom. I'm not paying attention to any of the other things that I'm doing to be proactive and prevent some sort of episode from happening. I haven't actually been [00:21:00] checked out yet, so there's that. Because sometimes with chronic illness, right, as soon as we feel something, we we just know, and we don't always just know.

So I like to kind of challenge myself to think through what else is missing, or what am I giving too much attention to? Yeah,

Dr. Linda Bluestein: and when I first learned about, oh, it probably wasn't the first time I learned about catastrophic thinking, but when I was having chronic pain and I learned about catastrophic thinking and I immediately realized, oh my gosh, that is absolutely what I'm doing.

Thinking that the worst is going to happen, right? And that can really make our suffering so much worse, because that's the other thing is pain and suffering are two different things, right? So, I tell my patients all the time, the goal is to, well of course, it would be great to alleviate 100 percent of your pain.

I would love that, but that's often not a realistic goal. if we can remove the layers and layers of suffering, um, you might still have some pain, but if you're not suffering like you were, you [00:22:00] know, instead of being pain with all capital letters, it's like pain like this, you know? So, um, I think that catastrophic thinking is that, is that something that you see a lot of people, um, experiencing?

Dr. Natasha Trujillo: Oh my gosh. All the time. Yes. Yes. Well, and to your point about suffering, I think the lack of acceptance sometimes can really make suffering a lot worse. Because you're, we're so resistant, we're so avoidant, we're trying to fight what is in a way that just intensifies our situation. And I think in some cases, recognizing what we can and can't control is really powerful.

And yeah, some of that catastrophic thinking, some of the lack of acceptance, some of the fighting to, to try to change or control things that we can't control, that does intensify suffering in a way that, that isn't, Is it necessary and isn't really adaptive or all that helpful? And of course, this is much easier said than done, but I do think that that focus and energy being put into recognizing [00:23:00] that and doing your part to kind of unlearn some of your atom automatic and catastrophic thoughts can be a game changer.

Dr. Linda Bluestein: And when it comes to these kinds of things, it's such a delicate balance to write with self blame or shame. So how do we, how do we try not to? You know, because, because then once you kind of know about these things and then you can blame yourself for, Oh, I shouldn't be, I shouldn't be thinking this way. I shouldn't be feeling this way.

And then, and then sometimes that can make that even worse. Yes. So how do you stay away from that as much as is feasible?

Dr. Natasha Trujillo: Yes. Yes. So I think sometimes with self blame, we do that as a control seeking measure, because if we blame ourselves, or if we, If we make ourselves responsible and it's like, okay, well then there's this perceived sense of control and sometimes blaming yourself, but having that sense of control feels a whole lot better than, wow, I have no control over this and this just [00:24:00] happened and it's very uncertain and that feels terrible too.

So I think some people use the blame as a control strategy a little bit. I also think disentangling intention versus responsibility. Versus blame is really important. This idea comes from the type of therapy called cognitive processing therapy. And it is a PTSD treatment that I use. It's like a 12 week protocol that I use with people, uh, recovering from trauma.

And this idea of intention versus responsibility allows people to think through, you know, with blame, it's like, okay, we feel like we have done something wrong. So the first thing that we do is look at, have you actually violated one of your own values or principles? And as we uncover that, then it's kind of like, okay, what was your intention with this behavior?

What were you hoping was going to come out of this decision that you made? And how much responsibility can you truly take for that? And so when [00:25:00] we kind of pull all of those things apart, It allows us, again, to look at some of those things I brought up earlier. Are you only focusing on one detail and maybe neglecting all these other facts from the story that play a really big role?

Are you allowing your emotions to reason for you more than the facts of the situation? And so when we pull those things apart, it just gives us more context to really analyze our thinking patterns and figure out what's going on. What fits and what doesn't, and then adapt and adjust what we need to, to cope more effectively.

Dr. Linda Bluestein: So right when you started saying that, I started thinking about forgiveness and how it seems like we can forgive, often forgive others more easily than we can forgive ourselves and, uh, self compassion and how important those things are when it comes to chronic illness and, um, any suggestions for people surrounding that?

Dr. Natasha Trujillo: Yeah, the first thought that comes to mind is Perfectionistic thinking too. So I don't know if that's something that you were [00:26:00] kind of thinking about or kind of woven into that question. But yeah, we often have very different expectations and standards for ourselves than we do other people. The easiest strategy, I think, but people do get frustrated with this one too, is, okay, would you say this to other people?

And even if you can readily say, no, I would never say what I tell myself to other people. I think just recognizing that dissonance, it's really important. And then I think kind of leaning into your own humanity a little bit. And I think this is very woven into perfectionism, uh, in my book, I write about perfectionism.

Um, and one of the things that I delve into is this idea that. To be perfect, you really can't be human because it doesn't exist, right? And so that's part of what drives perfectionism is like, no, I want to be a robot. I want to work my way out of emotion. I want to work my way out of being human and just be this like perfect [00:27:00] specimen in every area of my life.

And so I think shattering the illusion around some of that can be really, really helpful to not placing as much blame on ourselves and finding more compassion when we, again, accept you don't have to like it. I don't love that I'm a human all the time, but when I accept and say like, this is what is and I'm not going to be able to change that.

So how do I want to approach that and truly is it, is it helping me or is it harming me? Is the lack of compassion moving me closer to my goals and what I'd like for myself? Or is it helping me or is it harming me and pushing me farther away? And so some of those questions I think can be catalysts for building a little bit more trust and support of ourselves.

Dr. Linda Bluestein: Okay. We are going to take a quick break. And when we come back, I want to dig into trauma. Cause I know that is an area of expertise of yours. And I also want to talk more about your book, of course. And so we will be right [00:28:00] back with Dr. Shahil.

Okay, we're back with Dr. Trujillo, and I want to talk about trauma because this is something that, you know, before I opened my practice, I did have a number of people tell me probably a lot of your patients will have suffered some pretty significant traumas in their lifetime. And as I talked to people, I realized how significant a role this seems to play so commonly.

So what should we know about trauma? Uh, what are some of the techniques that you feel are beneficial. And let's just talk about that for a while. And, and what, uh, what you think people should know.

Dr. Natasha Trujillo: I think the biggest piece, I get asked a lot, what separates someone? Like, how do you know if someone is going to develop PTSD or not after some sort of traumatic event?

And the way that I like to explain that, because I can't predict the future, I don't know for certain, but one of the kind of telltale signs is how, how apt someone is to lean [00:29:00] into avoidance, to lean into distress, to confront what they've been through versus how much is someone, gosh, just trying to, again, avoid and, and check out as much as possible.

That is a huge, difference in people who do and do not go on to develop PTSD. Uh, and not every traumatic event, right, is going to lead to PTSD. So I think that that's really important to know as well. But that avoidance and that exposure, I think those are two key concepts really impact how people move through and process trauma or Or they don't.

Dr. Linda Bluestein: So something could be very traumatic for one person, but the exact same thing could happen to another person. And how they respond to that could be completely different, right?

Dr. Natasha Trujillo: Yes. Yeah. And I, There's also a lot of questions about how soon do you intervene, right? After some sort of traumatic experience, how soon do they need to get into therapy?

And, you know, do you need to initiate all these things right [00:30:00] away? And my answer truly is always, it depends. It really depends on the person and how they are processing and making sense of things. How much avoidance are you seeing? What else is going on in their life? So, it's really hard to know we're certain, and I default back to this idea of awareness.

People just have to be able to be brutally honest with themselves and aware of what's going on and, you know, reach out if they need to or utilize whatever sort of resources are at their disposal. if they feel like they are avoiding or distracting too much or have checked out in some way or struggling with intrusive thoughts or, you know, flashbacks or whatever it might be.

Dr. Linda Bluestein: And in terms of processing trauma, what, what is the goal there? What, what would be like the ideal outcome, I guess?

Dr. Natasha Trujillo: So when I'm working with someone from a trauma lens, I want to know how the traumatic [00:31:00] experience or experiences. have impacted their functioning. And when we can get at that and we can really get into how has this changed your identity and how you show up and what is not working about that, that kind of becomes our goals.

And so the intention is not necessarily to relive every moment of the traumatic experience. In fact, with cognitive processing therapy, That, that's not part of our protocol. We're not, I'm not asking them to replay scene by scene every single thing that happened. Rather, we're talking impact. And when we kind of look at trauma and start to break it down, when the event happens to you, how does that change what you believe about yourself, about other people, and about the world?

And again, what is adaptive and healthy and what is maladaptive and not working for you? So the goal with processing trauma is often to help people restore functioning and to look at which of their [00:32:00] beliefs are adaptive and working for them and which might be maladaptive and leading to emotions or thoughts or behaviors or relationships that are not serving them.

Dr. Linda Bluestein: I know that you've mentioned one method that you use, and of course we know that there's an alphabet soup out there probably. I know for sure EMDR is one that gets talked about a lot. How do you decide which method to recommend to someone? And again, if someone's listening to this and they say, gosh, I wish I could come see Dr.

Trujillo, but I you know, can't afford one on one care. Um, how do you think people can find the method that might work best for them? And are there any online tools?

Dr. Natasha Trujillo: Yeah. Yeah. I know CPT, I believe it's CPT4PTSD, which is a lot of letters dot, dot com, but I know CPT has a bunch of different resources and things like that on their website.

Um, I often encourage people, so I think buy in is really, really important, [00:33:00] and so if someone is in a place where they have the resources and are willing and able and wanting to meet with someone and talk to someone, I think connection with a therapist is huge, or, or with whatever medium you're going to pursue, do you feel like you can truly be brave in this space with your provider?

Does, does it feel safe, does it feel like a good connection in that way? So that's kind of the foundation that things are built on. But buying is super important. So as you are listening to the explanation of CPT or EMDR or some sort of somatic therapy or whatever it is, What are you thinking? It does come back to that awareness.

Are you like, Oh, absolutely not. Or like, Oh, wow, this is really interesting. So how open to, how open are you to the idea and how much buy in do you have? Because I do think that that really can impact outcomes. with something like cognitive processing therapy, which is what I can speak to the [00:34:00] best because that's, that's what I have been trained in.

I wanted to pursue CPT because above other types of trauma therapy, A, it had the most evidence backing. So that was very important to me, but B, I work with so many people who are so cognitively oriented, right? There are very, just a lot of high performers. Um, high thinkers, overachievers, and so this act of doing and this act of being able to analyze thoughts and think critically and kind of delve into some of that, I think the skill set just blends really nicely.

And of course, we're doing work with emotions and things like that, but it is kind of under this umbrella of this kind of protocol with, with homework and with all these cognitive flexibility and interventions that I just think that the population really nicely, which is why I chose to pursue it. And I've seen good things so far, but those are also things that I really encourage people to think [00:35:00] about is what do you connect with?

What do you bought into? Um,

Dr. Linda Bluestein: and so whether they have medically induced trauma, because unfortunately we know that that does happen a lot, especially in the population that listens to this podcast, people that have symptomatic joint hypermobility, but they could have joint hypermobility and not be symptomatic also, but a lot of them are symptomatic of course, or I know a lot of people when I throw out questions, uh, for you for today, I asked some people to submit questions, or I asked people to submit questions.

And, uh, people commented on things like, you know, how do I get over the trauma of not being believed by my family?

Dr. Natasha Trujillo: Yes. Yes. To me, that takes it right back to the beliefs, right? So what do you believe that experience of not being believed? How has that impacted your belief system? What do you believe about yourself?

What do you believe about other people and, and what of those beliefs, what is adaptively helping you integrate your experiences into your life and continue to move forward? Versus what might be [00:36:00] holding you back, what makes you feel stuck, what makes you feel avoidant, what makes you feel like, yeah, you know, I, I'm not building relationships with other people very well, or I'm so weary of what other people might think that I really struggle with being vulnerable.

And so in that way, that that's part of doing the work is just disentangling what's working and what isn't. Oftentimes, of course, you know, trusted supports are huge to be able to take down some of those walls of social constraint and let people talk some of this out.

Dr. Linda Bluestein: I know another area that, uh, was mentioned on your, in your bio, I should say, was working with people who have experienced self harm and self harm I imagine can take a lot of different forms.

And so can you talk a little bit about how that might show up in a person's life? What can be done about it?

Dr. Natasha Trujillo: Oh my gosh, for sure. Yeah. Thank you for this question. Uh, self-harm was my first clinical interest area. All of my research as [00:37:00] an undergrad, my dissertation, everything was very focused on self-harm or, or self-injury.

So, uh, thank you for bringing light to it, first and foremost. It can look a lot of different ways. One of the biggest definition pieces that I like people to understand is that when we're talking self injury, we're often talking non suicidal self injury. So self harm that is not with the intent to die, but is to relieve Or alleviate some sort of negative affect.

And it's purposeful in intention, right? So things like cutting yourself, burning yourself, scratching yourself, et cetera. But there are also, sometimes eating disorders are grouped into self-harm. Sometimes substance use disorders are grouped into self harm. So some of these other self-destructive behaviors can kind of be grouped in.

But when we're really talking true, like non-suicidal self-injury, or N ssis, we shorthand it. We're talking about that purposeful intention of, of [00:38:00] harming your body in the moment. That can manifest a lot of different ways for a lot of different people. And I actually see it quite a bit in populations with chronic illness or with disabilities because there's, it's a conflicted and challenging relationship that that individual has with, with their own body.

And so sometimes it's a control thing. Sometimes it's a punishment thing. Uh, so gosh, lots of different reasons or functions for the behavior too. As far as what can be done about it, it really depends on what the reason is, right? What is the function? What purpose is that serving? Because when you kind of get underneath that, you can figure out, okay, this is the need that you're trying to get met.

I often bring up the idea of unmet needs with self harm. What needs are not being met? And are there other ways that are potentially less? impactful or less harmful to get those sorts of needs met. And so we usually kind [00:39:00] of dig in that way. And that's how we figure out what. What might that look for each individual person?

Dr. Linda Bluestein: That makes sense. And kind of tying into that as well, I know some of the comments that I got had to do with how people feel towards their bodies once they have become ill. Like, how do you avoid hating your body or, you know, treating your body like the enemy?

Dr. Natasha Trujillo: Oh my gosh, such a good question. So this also kind of brings me back to acceptance because It's okay to have moments where you hate your body and where you're frustrated and really upset.

And you know, when, when your body is undergoing a lot of changes or you have received some sort of diagnosis, that's appropriate. That's an appropriate and natural reaction. That's kind of where I meet people first and foremost is, Hey, you're not crazy and you don't need to necessarily avoid hating things.

Because that's where you are in that moment. And I think that can be a game changer sometimes in and [00:40:00] of itself is just to allow people that freedom to be like, yeah, this, this sucks. This does suck. And it's okay to be there right now. Now, we don't want to stay there forever, but I think those moments are really, really important and can allow people.

The opportunity truly to sit and be with their feelings, because as I said earlier with grief, that is the only way to go through it is to figure out how to be with it. So that is kind of where I would start. I also really, and this is a very conflicting relationship, but image versus functionality can be another big concept working with body image or someone's relationship with their body.

Because, of course, when that functionality changes or decreases, there's a lot of grief in that. There can be a lot of frustration there. But I do think pulling those things apart can be really helpful as well. Um, and kind of balancing, again, accepting and grieving what you have lost. [00:41:00] Also being able to recognize and express gratitude for what you have or accommodations that you have made that have been successful.

Thank you. Again, even if you don't like them, are they helping functionality in some way? So it's trying to hold those both ends at the same time too.

Dr. Linda Bluestein: And I know you work with, uh, quite diverse populations, right? You have people that are, you know, I will say ordinary people for lack of, but you know, ordinary people that may or may not have a chronic illness, but you also work as you, as you've mentioned.

And as I've read in your bio with very, very high level athletes. And so if you are working with a really high level athlete, for example, and they're no longer able to train at the level that they had trained before, um, it seems like sometimes that might be really challenging for them and they feel like, you know, is this good enough?

And like you said, they identify so much, that's such a huge part of their identity. When you're working with that type of individual, are there certain specific things that you might be doing with them?

Dr. Natasha Trujillo: Oh yeah, [00:42:00] absolutely. Absolutely. I think part of it is bringing him back into the moment because there's a lot of catastrophic thinking that happens with that.

Um, this actually did just happen recently, about five or six weeks ago. One of The athletes that I'm working with preparing for Olympic trials kind of tweaked something and had to take a few days off. And we didn't really know what was going on. And so, right, her thought process was like, worst case scenario, this is it.

And so some of the interventions truly were just helping kind of regulate her emotions, bring her back into the moment, look at the facts that we have, help her be proactive. What is in your control? What is not in your control? And it's also beefing up other areas of the training plan. So oftentimes with elite athletes, they're so focused on their practice schedule, but it's also helping them expand that idea of, hey, you're doing so many other things that are part of your training plan.

You're meeting with me, right? You're working the mental muscles. You, uh, have a dietician, you're getting your nutrition checked. [00:43:00] You're making sure that you're sleeping enough. You're making sure that you're surrounding yourself with people that are encouraging and right. Like bringing out the best in you at this time, you are seeing your massage therapist or, you know, whoever is part of that team, uh, and helping make sure that they understand that too is part of training.

It isn't about just what's in practice. I also think managing expectations is something that I work with them on, because if there is some sort of injury or some sort of tweak, that might mean that outcomes or results have to realistically be changed a little bit. You know, what, what you should be kind of aiming for or hoping for.

And I try to do that in combination with the rest of the treatment team. So getting kind of coaches involved too, so we can have those discussions and, and put that plan together. But I think the more realistic Nuggets of information we can have and rely on that are about today and keeping them in today is, is huge.

Then you have the deeper [00:44:00] work of Again, how much are you separating your worth from your achievements and how much is your identity on that of an athlete versus the other roles that you have in your life? So, there's definitely background or deeper things that we're working on too.

Dr. Linda Bluestein: Yeah, having our identity tied up in our achievements, I think, is something that's So many of us, uh, you know, struggle with, and of course, then also comparing ourselves to other people, even if we know intellectually that that's not helpful, it can be very challenging, you know, not to do that.

Um, any other suggestions for dealing with those kinds of, uh, challenges?

Dr. Natasha Trujillo: Yeah, the comparison piece is really interesting. I think as human beings, we're not going to be able to completely turn that down, and this is a message that I often send, kind of regardless of the issue. I don't know that my goal when I'm working with someone is to completely, for example, alleviate their anxiety or make their trauma completely go away, because I just don't know how realistic that is.

Dr. Linda Bluestein: It

Dr. Natasha Trujillo: is [00:45:00] rather how much power and control are you giving the thoughts and the urges that you have? And do you feel like you are able to manage those things in a way that you continue to move towards the goals that you have and the direction that you want to go in your life? So on the comparison front, I don't know that we can completely eliminate it, but I often encourage people to turn down the outside noise.

So sometimes that's social media. Sometimes that is for my athletes. Encouraging them to please stop aggressively Googling all of your competition and all of their PRs and all of that. Like that's no, nope, we don't need to do that. That's not very helpful right now. So it's kind of turning down some of that noise and it is focusing more on the process rather than the outcome.

And you can infuse a little bit of comparison in there, right? You can appraise and you can compare how is my effort in practice today versus yesterday? How do I want my effort in practice to be next week? or when I'm [00:46:00] tapering or, you know, my last hard session before a big competition. So I think if you can kind of chunk it down and look at your process and what are you doing, what is in your control and how are you comparing those things within yourself, not necessarily with other athletes, you're going to be in a much better position to have a stable sense of, uh, confidence and, and security to carry you through those challenging moments.

Dr. Linda Bluestein: You mentioned safety a while back and actually just said security and I wanted to circle back to that because people who have connective tissue disorders are much more at increased, you know, they're greatly increased risk of having dysautonomia or conditions specifically like postural orthostatic tachycardia syndrome where the sympathetic nervous system is often, you know, very, um, very much in control and might have difficulty activating their parasympathetic nervous system.

And I think that that feeling of You know, do you feel safe or do you feel [00:47:00] unsafe? Does your nervous system feel safe or does it feel unsafe, whether it be from trauma or you know, uh, knowing that, that the uncertainty of your body, like at any point you could wake up the next day and not feel great. So I think that causes a lot of people, a lot of that feeling of not feeling safe.

Do you have any suggestions for people who, who struggle with that?

Dr. Natasha Trujillo: Oh, for sure. That brings me back to uncertainty too, right? Because with something like that, you do live in this almost chronic state of uncertainty where you, you never know what's going to happen day to day. But if we really look at life, that, that is true at all times.

We just simply don't know. And so that, I think that gives a little bit more fuel and motivation to bring us back to today and to be more intentional, to try to be more present focused and to recognize, okay, What is each morning when you wake up? What is the information that I have right now? How am I feeling?

Uh, and and working towards that. Okay. What are my intentions [00:48:00] for today? How does that align with my values for today? So when you chunk that time down and not kind of allow your mind to wander too far into the future I think that can be really really important and if it's not a good day I think it is managing the distress around that.

I think it's having some compassion for yourself and recognizing Okay, these are the challenges that I have today. What is within my control and how do I want to go about executing those? What are my resources that are going to be useful for, for me? So it is a little bit of kind of game planning, right?

Problem solving to, to figure out what that's going to look like day to day. Flexibility, I think is, is huge for that as well. Not being too rigid, not sticking to plans too much. And I think that can be really hard, especially for a lot of the populations that I work with. Plans are great and you kind of want to know what's coming and there's definitely a balance between.

Okay. Yeah, I can have some idea. I can have this plan, but I can also trust myself to adapt in the moment and be [00:49:00] flexible. Should I wake up and something totally unexpected or out of my control be what I have to face and deal with today?

Dr. Linda Bluestein: And if a person is feeling particularly distressed, like even more than, you know, they, they normally do.

Do you have any particular breathing strategies that you recommend or? Um, other, other types of skills that you might, uh, teach them in order to manage that distress.

Dr. Natasha Trujillo: Yeah, for sure. I really like diaphragmatic breathing and I always encourage people to, and you probably know more about this than me, but I always encourage people to hold their breath for a few seconds.

Cause we know that that kind of presses down on that vagus nerve and can activate that Um, uh, a sense of relaxation. So I will very much encourage people to focus on holding that count a little bit too, when they're doing any sort of breathing exercise, I will often encourage people, especially people like you and I, who struggle a bit with meditation, start with something like sensory grounding, start with something that is a bit more physical or a bit more [00:50:00] cognitive to pull you into the moment.

And then maybe use a strategy like breathing. I also really like. There are some quite cool body chemistry changes that I like to be able to give people. So this also connects with what you had asked about self harm earlier. Sometimes it is that sensation of pain that can be really comforting to some people.

And so with something like self injury, I will encourage, go grab some ice cubes or freeze some oranges, right? Freeze something so that you can have something really, really cold in your hands or splash really cold water on your face. Or, right, so we want something that can just pretty instantly change your body chemistry and almost shock you a little bit.

Because that does, it brings your attention to a different area and it's like, oh, okay, okay, what, now, now what, right, now what do I want to do in this moment? So I really like some good body chemistry. work to, to, to play with that.

Dr. Linda Bluestein: Okay. [00:51:00] I love, I love those ideas and sticking an orange in the freezer. Uh, that seems like a pretty, especially now in the summer, that seems like a pretty good idea.

Dr. Natasha Trujillo: Oh my gosh, absolutely. I used to, I'm not doing this in my private practice now, but in previous facilities where I've worked, Ran a lot of group therapy and groups can be really tough, right? Really, really triggering at times, really activating for people. And so that was always something where it was like, yep, go, go grab, go grab an orange if you need to.

And that was something that they could kind of fidget with, have while they were talking and processing things. And they could either hold it in their hand or I know for my athletes, a lot of times they'll just. Rub it on their injuries a little bit, you know, that sort of thing. So it can be quite useful in staying regulated while you're also getting into the work and processing some hard stuff.

Dr. Linda Bluestein: And for someone, uh, as young as you are, you've already done so many different, interesting things. Um, cause I know you, you have worked in a PHP, which is partial [00:52:00] hospitalization program, right? And you've also worked in IHP.

Dr. Natasha Trujillo: IOP, intensive outpatient,

Dr. Linda Bluestein: IOP, IOP, intensive outpatient therapy. Okay. And, um, no way the P should stand for not for therapy, IOP, intensive outpatient program maybe.

Dr. Natasha Trujillo: Yeah. Yeah. Program.

Dr. Linda Bluestein: Okay. Um, in any event. Uh, is that what you were referring to when you were talking about the group sessions? And you were talking about how this could be triggering for some people. A lot of my patients have been through those kinds of programs with varying results. So, um, would you briefly be able to share with us kind of what people can look for in those kinds of programs and how they can get the most out of them?

Dr. Natasha Trujillo: Oh, man, yes. Gosh, this could be a very long conversation. Uh, yeah, so I've worked inpatient, like full acute inpatient, all the way through outpatient, and I've worked across truly every mental health setting except for a VA. I've never done a VA. any, uh, VA specific work. [00:53:00] In those settings, what I encourage people to look for is what is the program structure?

Well, first and foremost, what are the credentials of the providers who are there? You are looking for licensed professionals. You are looking for a team of professionals, uh, right? Multiple specialties. So you want people who have the training and the experience to provide the care that you are signing up for.

Um, I also encourage people to look at how they structure the program and does it actually fit? What, what is the criteria to go into the program? Unfortunately, I have seen a lot of times where a PHP program, for example, that is partial hospitalization. So that is not residential, that is not inpatient. So 24 seven.

And sometimes those PHP programs will have criteria. Where they take really sick people who need higher levels of care [00:54:00] than is appropriate for PHP. And so I'm very big and quite a stickler on what is their criteria and what do you actually fit criteria for. Because you want to make sure that you are entering a program that can take care of your needs and is meeting your needs.

So that's also really something that I look for. And then I also encourage, it comes back to intentions, right? What are, what is each individual struggling with the most? What are they hoping to get out of a program? And during the admissions process, ask those questions, make sure that you are very clear in getting the information you need to see if that facility can provide what you need and what you are hoping to get.

Dr. Linda Bluestein: Thank you for that. And your book, and she was never the same again, just came out very recently within the last couple of months. Who is this book for and what can people expect to get out of the book?

Dr. Natasha Trujillo: Yes. Yeah. Thank you. So the book is I wanted to write a [00:55:00] book that really got into the nuances of grief and loss, but was not pitched as a how to book.

And that is very important to me with grief and loss, because I do not believe that there is a how to. Sure, I feel like there are clusters of strategies that work for a lot of people, but it is such an individualized process. And so I wanted to be sure that readers can kind of take some of the lessons and the ideas and really think through, how does this apply to me?

What can I take? And what does not work for me? And what can I disregard? So it is not a how to book, but there are a whole lot of ideas that help you understand first and foremost, the complexity of grief and loss. Each chapter is focused on a different type of loss. And the way that I've structured it is I've said several times with you today, the only way to, to deal with grief is to be with it and go through it.

So the first part of each chapter is kind of like the raw emotional [00:56:00] narrative of what happened, what the event is. So there are some topics, there are near death experiences. Um, there are, uh, childhood medical trauma, there is death, chronic illness, sudden death, there is perfectionism, there is athletics, there is first loves, right?

And there are loss of significant relationships in that way. So I tried to pull out a lot of different types of semi universal experiences. Everyone can see themselves in some way in these characters stories. So the beginning is kind of that raw narrative where you really have to be with it and you have to feel all the feels and just sit with what happens.

And then the second part of each chapter is kind of a synthesis. So I weave in, you know, research and education. I don't cite research. It's not written like an academic textbook because I wanted it to be for people who are curious about [00:57:00] their own experience of grief. Or maybe they don't feel like they're doing it right.

Or maybe they feel like, oh, well, I'm still, I'm still here because of something like grief. Like, yeah, yeah. It never really goes away, especially with significant losses. So normalizing that. And just helping people see things from different vantage points. and learn more about grief and integrate what that has looked like in their own life.

Um, those, those are the types of populations who I think would connect the most with the book.

Dr. Linda Bluestein: Fabulous. And that is available, I imagine, on Amazon, uh, you directly through your website as well, or?

Dr. Natasha Trujillo: Yes. Yeah. So Amazon is probably the best way or directly through my website, either my practice website or the book website, which is just, and she was never the same again, And then the audio book was also just released about two weeks ago now, uh, and that's on Audible, Amazon, and Apple iTunes.

Dr. Linda Bluestein: Okay. Yeah. [00:58:00] And we always end every episode with a hypermobility hack. Um, so if you could let us know if you have a hypermobility hack for our listeners.

Dr. Natasha Trujillo: Okay. Yes. I was thinking about this and I was like, how can I, with my expertise, right, like how can I kind of weave this in? And I, I alluded to this earlier, but I think the big takeaway is as psychologists, psychiatrists, we often get the nickname shrink, and it's so fun to talk to people who are a little weary of mental health or a little like, yeah, I don't know about you.

And I don't know that I want to do that because one of the main things that I tell people is that I'm not here to shrink you. I'm here to make you stretch. I want to help you stretch. And so if we're talking hypomobility, that idea of stretching the mind, right? And like using the mind as a muscle. That piece is so key.

And I said a couple times today, being willing to change your own mind, that has been a game changer for me. When I was younger, I was very perfectionistic and very rigid and like, this is the way it's going to be. And I think being [00:59:00] open to, Hey, I'm not right all the time. I don't know everything. And I, I need to be willing to think this through a different way.

I think that would be what I would leave as the hypermobility hack, got to be willing to change your own mind and stretch those muscles in different ways.

Dr. Linda Bluestein: I love that. That's fabulous. Um, and it was been, it's been so great chatting with you. I've learned a lot and I know our listeners will as well. Um, before we go, can you let us know where we can find you, how people can learn more about you?

Dr. Natasha Trujillo: Yeah, absolutely. So I'm located in Denver, Colorado. Um, I am licensed in like 40 states though. So I'm able to work with, with people all over the country. Website is npttherapy. com. The book website is, and she was never the same again, dot com. Um, and that is the best way to kind of get connected with me.

I'm also on Instagram at NPT Therapy. And then just my name Natasha Trujillo on both LinkedIn and Facebook. [01:00:00]

Dr. Linda Bluestein: Fantastic. Well, thank you so much Dr. Trujillo for coming on the Bendy Bodies podcast today and sharing your vast expertise with, with my audience. Um, this is such an important topic and affects so many people, so.

Just thrilled to get the chance to talk to you.

Dr. Natasha Trujillo: Yeah. Thank you so much for having me on. It was awesome.

Dr. Linda Bluestein: Well, that was such a great conversation with Dr. Trujillo. Grief and loss is such an important topic for anyone who is suffering from a chronic or complex illness. And so it was just an important conversation to have. And so we could all learn some additional mindset tools and some special skills that we could maybe work on in order to live our best quality of life.

And I want to thank you so much for listening to this week's episode of the Bendy Bodies with the Hypermobility MD podcast. You can help us spread the word about joint hypermobility and related conditions by leaving us a review and sharing this podcast. Please also follow the podcast on your favorite [01:01:00] podcast player.

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