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

[00:41] Dr. Linda Bluestein: 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 going to 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. 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-identity, and it really was just such a contributing factor to my suffering.
[01:29] 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 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.
[02:20] As always, this information is for educational purposes only and is 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. I am 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. Can you start out by telling us why people living with these conditions should be aware of grief and how it can play a role?

[02:57] Natasha Trujillo, PhD: Oh my gosh, yes, 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, anytime you lose something significant — and with chronic illness and disabilities, there are a slew of losses, right? You have primary losses, secondary losses, cumulative losses. So you are grieving. 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 live the life that you have more holistically.

[03:42] Dr. Linda Bluestein: Yeah, I know when I was going through my own process, when I had terrible pain over a decade ago, it is like you lose the ability to do certain things. You lose something of yourself that maybe 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.

[04:07] Natasha Trujillo, PhD: Yeah. I don't think it gets talked about enough, so I'm very excited for the opportunity.

[04:12] Dr. Linda Bluestein: And so in terms of moving towards acceptance and healthy coping — because most of us don't want to accept what is out of our control — how can we move towards acceptance? I get asked often from people whether they should accept what is or if they should keep trying, kind of like it's an either/or type of scenario.

[04:33] Natasha Trujillo, PhD: Oh my goodness, 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 with 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 I'm never going to like this or want this, so I just can't get there.
[05:01] 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 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 complex than just accepting and giving in and loving every part of it, because that often doesn't happen.

[05:25] 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?

[05:41] Natasha Trujillo, PhD: Yeah, so it really depends on the person, right? I have conversations a lot with people about introversion and 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.
[06:05] 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. I try to help people spark that balance between what do you need to do and how do you need to be? And then how does that play into your relationship with yourself and your relationship with other people?
[06:29] Because socially, we do need connection, we do need validation and support, and to 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. But some of that work has to come from ourselves and our relationship with ourselves too.

[06:50] Dr. Linda Bluestein: And I'm sure, like you just said, 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 work on their mindset, you know, that could really help people because they might get some ideas of different things that they could try.

[06:53] Natasha Trujillo, PhD: Yes.

[07:22] Dr. Linda Bluestein: So if someone's really struggling, they've had a really challenging time, they're physically disabled, they can't do the things that they want to do, what are some of the things that they can do, especially if they're lacking in resources?

[07:35] Natasha Trujillo, PhD: 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.
[07:49] An example here would be an athlete who has a career-ending injury. Maybe their identity is very wrapped up in being an athlete and they're no longer able to participate in sport in that way. We do usually go back to the drawing board and say, what came from sports? What did it provide? Why was it helpful? How did you integrate it into your life? And how can we recreate that in other areas?
[08:24] I think I'm also pretty real with people, though, that oftentimes you're not going to be able to completely recreate something. And when you lose mobility, for example, or 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 coming to terms with that.

[08:44] Dr. Linda Bluestein: And is it the same or very similar stages of grief as the typical stages that we tend to think of when we are dealing with a death? Is that kind of how we process?

[08:57] Natasha Trujillo, PhD: I'm so glad you asked this question. 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 said, hey, this is not the whole story. And so I think with that, allowing yourself flexibility and knowing that you might experience some of those things — anger, denial, bargaining, acceptance, those pieces — however, you might not, and they might not come in a gradual order. 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 quite unique ways for each individual person.
[09:52] As far as death loss or non-death loss, anything is on the table. Again, it's such a unique experience for each person. 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 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. Expectations are kind of off the table as you get to know yourself while going through something.

[10:23] Dr. Linda Bluestein: And do you have some practical tips for how people can get to that stage of acceptance and work through the stages in whatever sequence they might come in? Like you said, you might feel like you've accepted things and you're in a pretty good place, but then something happens that triggers those feelings all over again. Are there some specific things that work for enough people that it'd be worth talking about?

[10:54] Natasha Trujillo, PhD: 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, having people spend some time really thinking about 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 physical activity, maybe it's through art or music or whatever that medium is. I think that is crucial.
[11:23] 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 — okay, what is the data?
[11:51] I think there's something to be said about confidence building in that too. 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. I think helping people understand that with all the information that you have at this time, are you making the decision that best fits? And then helping people understand that tomorrow or next week or next month maybe you get new information and that changes the course of things. But helping people be more present and in the moment cognitively, I think, can really help with moving towards that acceptance and just being more realistic about what options are and what choices they do have.

[12:34] Dr. Linda Bluestein: That's very interesting about being present and being in the moment, because I feel like it is harder than ever before — pretty much everyone has a smartphone in their pocket, which can take our attention in so many different directions. So what tips do you have for people for being present in the moment? I do think from the standpoint of anxiety, and for a lot of us who have struggled with that, anxiety is forward-focused. So if we can bring ourselves into the present, that can help with anxiety as well.

[13:05] Natasha Trujillo, PhD: Oh, for sure, yes. 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 anxiety is very future-oriented. So the present kind of allows you to put both sets of symptoms aside and really just be.
[13:17] To your point, I do think stepping away from social media and distractions is really, really important. One of my favorite tools that I give the folks I work with 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. I usually take that at a 5, 4, 3, 2, 1 sort of thing.
[13:48] So I'll encourage people to look around in your space right now and find 5 things that you can see. And I encourage people to look for things that aren't just the biggest, most flashy items in the room — look for things that are really bringing you into the moment, where you kind of have to dig around your space a little bit. And then I encourage 4 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, as if you were describing to a friend what it feels like.
[14:20] 3 things you can hear. With that one, I often suggest that people tune into the little things that we so easily tune out — the sound of a fan going in your home, the hard drive of a computer, or even the buzzing in your own ears sometimes. And then 2 things you can smell. You can smell hair, clothes, or if you've got something around you like a lotion or a candle, that sort of thing. And then 1 thing you can taste.
[14:52] So I think those sorts of interventions — just to turn down all the outside noise, 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.

[15:07] Dr. Linda Bluestein: I like that. I've tried to do meditation before and I have a really hard time shutting off my brain. But by doing what you're describing, instead of just saying don't do something, it gives us something positive to do.

[15:25] Natasha Trujillo, PhD: Yes. And there are two reasons why I like that. Similar to you, I have always really struggled with meditation, and then I get quite frustrated because I'm like, I've got to bring myself to the moment and that's what I'm spending this whole time doing. But I also think oftentimes with chronic illness, there's a lot of pain going on and so it can be really hard to just focus on nothing. So still giving yourself something that you can engage your brain with, but 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.

[16:05] Dr. Linda Bluestein: So bringing yourself into the moment could be more traditional sitting meditation or doing some kind of guided imagery. It could be sitting and doing this 5, 4, 3, 2, 1 that you just mentioned. There's also walking meditation and other ways that you can try to be in the moment, right? Some would work for some people and others would work for other people. Do you have other ideas?

[16:32] Natasha Trujillo, PhD: What just popped into my mind was the importance of setting intentions. And this is a little bit more cognitive. 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?
[16:57] And I think that can be said for even everyday events. 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, 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 your mind and prime your motivation to figure out what you want to get out of an experience can help you go into it a little bit more focused and a little bit more able to stay intent on whatever goals or intentions you set.

[17:30] Dr. Linda Bluestein: 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. 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 reacting to what I saw when I picked up my phone rather than what I intended to do. So I think setting intentions could probably help us in a lot of spheres of our life.

[17:58] Natasha Trujillo, PhD: Yes, absolutely. The example that comes to mind — I was working with an athlete who definitely struggles with social media and her anxiety just rises, and she really needed to be locked in for trials. And so we talked about, you can't stay away from your phone completely for 2 weeks, but when you do use it, can you set some intentions so you know exactly what you're doing when you're on it, and really hold yourself accountable to stick to that so your anxiety stays manageable for one of the biggest competitions you'll ever compete in?

[18:31] 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, I've never been in the Olympic trials, that would be really cool — almost removing those apps off your phone, because you could download them again right afterwards. I think setting ourselves up for success might also be important.

[18:56] Natasha Trujillo, PhD: 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, then you can be more proactive and say, yeah, I'm just going to eliminate the app altogether, so that in the moment when my automatic thought is to open it, it isn't there. And I've set the intention and I can hold myself more accountable because I've taken those steps beforehand.

[19:16] Dr. Linda Bluestein: And I'm glad you mentioned automatic thoughts because I think a lot of people who have chronic illness tend to have a lot of automatic negative thoughts. We say things to ourselves, right, that we would never say to other people. How can we change that pattern?

[19:20] Natasha Trujillo, PhD: Oh my gosh. There are so many layers to this. I do 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 beliefs that we don't question, because we don't have to slow ourselves down to look at them from another angle.
So a couple of strategies that I frequently encourage people: 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 this never happens, right? Something like that. And it's typically not that black and white — always or never. We want to kind of move away from those extremes and look at some probabilities. I think that can be quite useful.
[20:28] 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? Even for myself and my own experience with chronic illness, I think as soon as I feel my lungs start to go, I will have these automatic thoughts that are futuristic and I'm predicting and assuming I know exactly what's going to happen. And something that's really helpful for me is: 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 checked out yet. Because sometimes with chronic illness, as soon as we feel something, we just know — and we don't always just know. So I like to challenge myself to think through what else is missing, or what am I giving too much attention to and need to spread the effort a little bit.

[21:42] Dr. Linda Bluestein: Yeah, when I first learned about catastrophic thinking — when I was having chronic pain and I learned about it — I immediately realized, oh my gosh, that is absolutely what I'm doing. Thinking that the worst is going to happen. And that can really make our suffering so much worse. Because that's the other thing — pain and suffering are two different things, right? So I tell my patients all the time, of course it would be great to alleviate 100% of your pain, I would love that, but that's often not a realistic goal. But if we can remove the layers and layers of suffering, you might still have some pain, but if you're not suffering like you were, instead of pain being written in all capital letters, it's like pain in small letters. Is catastrophic thinking something that you see a lot of people experiencing?

[22:35] Natasha Trujillo, PhD: Oh my gosh, all the time. Well, and to your point about suffering, I think the lack of acceptance sometimes can really make suffering a lot worse because we're so resistant, so avoidant, 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.
[22:54] Some of that catastrophic thinking, some of the lack of acceptance, some of the fighting to try to change or control things that we can't control — that does intensify suffering in a way that isn't 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 focus and energy being put into recognizing that, and doing your part to unlearn some of your automatic and catastrophic thoughts, can be a game changer.

[23:28] Dr. Linda Bluestein: And when it comes to these kinds of things, it's such a delicate balance, right, with self-blame or shame. Once you kind of know about these things, you can blame yourself for — oh, I shouldn't be thinking this way, I shouldn't be feeling this way. And then sometimes that can make things even worse. So how do you stay away from that as much as is feasible?

[23:53] Natasha Trujillo, PhD: So I think sometimes with self-blame, we do that as a control-seeking measure, because if we blame ourselves or make ourselves responsible, 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 happened, and that uncertainty feels terrible too. So I think some people use the blame as a control strategy.
[24:28] I also think disentangling intention versus responsibility versus blame is really important. This idea comes from a type of therapy called cognitive processing therapy, which is a PTSD treatment that I use — a 12-week protocol that I use with people recovering from trauma. This idea of intention versus responsibility allows people to think through, with blame, it's like we feel like we have done something wrong. So the first thing we do is look at: have you actually violated one of your own values or principles? And as we uncover that, 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?
[25:18] And so when we pull all of those things apart, it allows us 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? When we pull those things apart, it just gives us more context to really analyze our thinking patterns and figure out what fits and what doesn't, and then adapt and adjust what we need to in order to cope more effectively.

[25:58] Dr. Linda Bluestein: Right when you started saying that, I started thinking about forgiveness and how we can often forgive others more easily than we can forgive ourselves. Self-compassion seems so important when it comes to chronic illness. Any suggestions for people surrounding that?

[26:17] Natasha Trujillo, PhD: Yeah, the first thought that comes to mind is perfectionistic thinking. We often have very different expectations and standards for ourselves than we do for other people. The easiest strategy — though people do get frustrated with this one too — is: would you say this to other people? And even if you can readily say, no, I would never say to other people what I tell myself, I think just recognizing that dissonance is really important.
[26:52] And then I think leaning into your own humanity a little bit. In my book, I write about perfectionism, and one of the things I delve into is this idea that to be perfect, you really can't be human, because perfection doesn't exist. And so part of what drives perfectionism is this desire to be a robot — to work your way out of emotion, to work your way out of being human and just be this perfect specimen in every area of life. So I think shattering the illusion around some of that can be really, really helpful in not placing as much blame on ourselves and finding more compassion.
[27:36] When we again accept — you don't have to like it — and say, this is what is and I'm not going to be able to change that, so how do I want to approach it? Is the lack of compassion moving me closer to my goals, or is it harming me and pushing me farther away? Those questions, I think, can be catalysts for building a little bit more trust and support of ourselves.

[28:10] Dr. Linda Bluestein: Okay, we are going to take a quick break, and when we come back, I want to dig into trauma because I know that is an area of expertise of yours. And I also want to talk more about your book, of course. So we will be right back with Dr. Trujillo.
[28:28] Okay, we're back with Dr. Trujillo, and I want to talk about trauma because before I opened my practice, I did have a number of people tell me that probably a lot of your patients will have suffered some pretty significant traumas in their lifetime. And as I talk to people, I realize how significant a role this seems to play so commonly. So what should we know about trauma? What are some of the techniques that you feel are beneficial?

[29:00] Natasha Trujillo, PhD: I think the biggest piece — I get asked a lot, what separates someone, 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 is that one of the telltale signs is how apt someone is to lean into avoidance versus how much someone is trying to confront what they've been through versus just trying to avoid and check out as much as possible. That is a huge difference in people who do and do not go on to develop PTSD.
[29:40] And not every traumatic event is going to lead to PTSD. So I think that's really important to know as well. But that avoidance and that exposure, I think those are two key concepts that really impact how people move through and process trauma — or don't.

[30:00] 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?

[30:09] Natasha Trujillo, PhD: Yes. And 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 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 for certain.
[30:40] 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 reach out if they need to, or utilize whatever resources are at their disposal if they feel like they are avoiding or distracting too much, or have checked out in some way, or are struggling with intrusive thoughts or flashbacks or whatever it might be.

[31:10] Dr. Linda Bluestein: And in terms of processing trauma, what is the goal there? What would be the ideal outcome?

[31:17] Natasha Trujillo, PhD: So when I'm working with someone from a trauma lens, I want to know how the traumatic experience or experiences have impacted their functioning. And when we can get at that and 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's not part of our protocol. I'm not asking them to replay scene by scene every single thing that happened. Rather, we're talking impact.
[31:59] And when we 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 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.

[32:34] 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. 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 see Dr. Trujillo, but I can't afford one-on-one care," how do you think people can find the method that might work best for them? And are there any online tools?

[33:05] Natasha Trujillo, PhD: Yeah. I know CPT — I believe it's cpt4ptsd.com, which is a lot of letters — but CPT has a bunch of different resources and things like that on their website. I often encourage people — so I think buy-in is really, really important. 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. Do you feel like you can truly be brave in that space with your provider? Does it feel safe? Does it feel like a good connection? So that's kind of the foundation that things are built on.
But buy-in 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, oh, wow, this is really interesting? 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.
[34:20] With cognitive processing therapy specifically, which is what I can speak to the best because that's what I have been trained in — I wanted to pursue CPT because, above other types of trauma therapy, it had the most evidence backing. That was very important to me. But also, I work with so many people who are so cognitively oriented — very high performers, high thinkers, overachievers. And so this act of doing, this act of being able to analyze thoughts and think critically and 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 under this umbrella of a kind of protocol with homework and with all these cognitive flexibility interventions that I just think fit the population really nicely. And I've seen good things so far. But those are also things that I really encourage people to think about — what do you connect with? What do you buy into?

[35:26] Dr. Linda Bluestein: And so whether they have medically induced trauma — because unfortunately we know that does happen a lot, especially in the population that listens to this podcast, people that have symptomatic joint hypermobility — or I know a lot of people, when I put out a call for questions for today, commented on things like, how do I get over the trauma of not being believed by my family?

[36:00] Natasha Trujillo, PhD: Yes. To me, that takes it right back to the beliefs, right? So what do you believe from 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 of those beliefs, what is adaptively helping you integrate your experiences into your life and continue to move forward, versus what might be holding you back? What makes you feel stuck? What makes you feel avoidant? What makes you feel like you're not building relationships with other people very well, or you're so wary of what other people might think that you really struggle with being vulnerable?
[36:39] And so in that way, that's part of doing the work — just disentangling what's working and what isn't. And oftentimes, of course, trusted supports are huge in being able to take down some of those walls of social constraint and let people talk some of this out.

[36:55] Dr. Linda Bluestein: I know another area that was mentioned in your bio was working with people who have experienced self-harm. And self-harm, I imagine, can take a lot of different forms. So can you talk a little bit about how that might show up in a person's life and what can be done about it?

[37:15] Natasha Trujillo, PhD: Oh my gosh, for sure. Thank you for this question. Self-harm was my first clinical interest area. All of my research as an undergrad, my dissertation, everything was very focused on self-harm or self-injury. So thank you for bringing light to it.
[37:32] 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 — 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, etc. But there are also sometimes eating disorders grouped into self-harm, sometimes substance use disorders 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 non-suicidal self-injury, or NSSI as we shorthand it, we're talking about that purposeful intention of harming your body in the moment.
[38:21] 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 of the conflicted and challenging relationship that individual has with their own body. So sometimes it's a control thing, sometimes it's a punishment thing — lots of different reasons or functions for the behavior.
[38:53] As far as what can be done about it, it really depends on what the reason is. What is the function? What purpose is that serving? Because when you 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? So we usually dig in that way and that's how we figure out what that might look like for each individual person.

[39:27] 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 treating your body like the enemy?

[39:48] Natasha Trujillo, PhD: 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. When your body is undergoing a lot of changes or you have received some sort of diagnosis, that's an appropriate and natural reaction. So that's kind of where I meet people first and foremost — 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 of itself, just to allow people that freedom to be like, yeah, this sucks. This does suck, and it's okay to be there right now. We don't want to stay there forever, but I think those moments are really, really important and can allow people the opportunity to truly sit and be with their feelings. Because as I said earlier, with grief, that is the only way to go through it — you have to figure out how to be with it.
[40:49] I also really — and this is a very conflicting relationship — but image versus functionality can be another big concept when 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 as balancing — again, accepting and grieving what you have lost, but also being able to recognize and express gratitude for what you have, or accommodations that you have made that have been successful. Even if you don't like them, are they helping functionality in some way? So it's trying to hold those both-ands at the same time too.

[41:41] Dr. Linda Bluestein: And I know you work with quite diverse populations, right? You have what I will call ordinary people for lack of a better term — who may or may not have a chronic illness — but you also work with very high-level athletes. And so if you are working with a really high-level athlete who is no longer able to train at the level they had before, it seems like that might be really challenging for them and they feel like, is this good enough? And like you said, 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?

[42:22] Natasha Trujillo, PhD: Oh yeah, absolutely. I think part of it is bringing them back into the moment because there's a lot of catastrophic thinking that happens with that. This actually did just happen recently, about 5 or 6 weeks ago — one of the athletes 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 her thought process was like, worst case scenario, this is it. And so some of the interventions truly were just helping 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?
[43:03] And it's also beefing up other areas of the training plan. Oftentimes with elite athletes, they're so focused on their practice schedule. So it's 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 — you're working the mental muscles. You have a dietitian. You're getting your nutrition in check. You're making sure that you're sleeping enough. You're surrounding yourself with people that are encouraging and bringing out the best in you. You are seeing your massage therapist or whoever is part of that team. Helping them understand that all of that is part of training — it isn't just about what happens in practice.
[43:46] I also think managing expectations is something that I work with them on, because if there is some sort of injury or tweak, that might mean that outcomes or results have to realistically be adjusted. What you should be aiming for or hoping for. And I try to do that in combination with the rest of the treatment team, getting coaches involved so we can have those discussions and put that plan together. But keeping them in today with the most realistic nuggets of information we can rely on is huge.
Then there's also the deeper work of, again, how much are you separating your worth from your achievements, and how much is your identity that of an athlete versus the other roles that you have in your life? So there are definitely deeper things that we're working on too.

[44:38] Dr. Linda Bluestein: Yeah, having our identity tied up in our achievements is something that so many of us struggle with. And of course, comparing ourselves to other people — even if we know intellectually that that's not helpful, it can be very challenging not to do that. Any other suggestions for dealing with those kinds of challenges?

[45:00] Natasha Trujillo, PhD: 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 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. It is 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 you have and in the direction that you want to go in your life?
[45:38] 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. 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 — no, we don't need to do that. That's not very helpful right now. So it's turning down some of that noise and focusing more on the process rather than the outcome.
[46:06] And you can infuse a little bit of comparison in there — you can appraise and 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 tapering, or my last hard session before a big competition? So I think if you can chunk it down and look at your process and what is in your control, and how you are comparing those things within yourself rather than with other athletes, you're going to be in a much better position to have a stable sense of confidence and security to carry you through those challenging moments.

[46:49] 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 at greatly increased risk of having dysautonomia or conditions specifically like postural orthostatic tachycardia syndrome, where the sympathetic nervous system is often very much in control and they may have difficulty activating their parasympathetic nervous system. And I think that feeling of do you feel safe or do you feel unsafe — does your nervous system feel safe or does it feel unsafe, whether it be from trauma or the uncertainty of your body, where at any point you could wake up the next day and not feel great — I think that causes a lot of people that sense of not feeling safe. Do you have any suggestions for people who struggle with that?

[47:46] Natasha Trujillo, PhD: 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 never know what's going to happen day to day. But if we really look at life, that is true at all times. We just simply don't know. And so 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 the information that I have right now each morning when I wake up? How am I feeling? And working towards that. What are my intentions for today? How does that align with my values for today? So when you chunk that time down and don't allow your mind to wander too far into the future, I think that can be really, really important.
[48:34] And if it's not a good day, I think it is managing the distress around that. 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 me? So it is a little bit of game planning and problem solving to figure out what that's going to look like day to day.
[49:00] Flexibility, I think, 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 flexible should I wake up and something totally unexpected or out of my control be what I have to face and deal with today.

[49:29] Dr. Linda Bluestein: And if a person is feeling particularly distressed — even more than they normally do — do you have any particular breathing strategies that you recommend or other types of skills that you might teach them in order to manage that distress?

[49:48] Natasha Trujillo, PhD: Yeah, for sure. I really like diaphragmatic breathing, and you probably know more about this than me, but I always encourage people to hold their breath for a few seconds because we know that that kind of presses down on that vagus nerve and can activate 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.
[50:14] I will often encourage people, especially people like you and I who struggle a bit with meditation, to start with something like sensory grounding. Start with something that is a bit more physical or a bit more cognitive to pull you into the moment, and then maybe use a strategy like breathing.
[50:29] I also really like — there are some quite cool body chemistry changes that I like to be able to give people. And this also connects with what you asked about self-harm earlier. Sometimes it is that sensation that can be really sought-after for some people. And so with something like self-injury, I will encourage people to 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. We want something that can pretty instantly change your body chemistry and almost shock you a little bit, because it brings your attention to a different area, and it's like, oh, okay — now what? Right now, what do I want to do in this moment? So I really like some good body chemistry work too.

[51:18] Dr. Linda Bluestein: I love those ideas. And sticking an orange in the freezer — especially now in the summer, that seems like a pretty good idea.

[51:31] Natasha Trujillo, PhD: Oh my gosh, absolutely. I'm not doing this in my private practice now, but in previous facilities where I've worked, I ran a lot of group therapy. And groups can be really tough, right? Really triggering at times, really activating for people. And so that was always something where it was like, yep, go grab an orange if you need to. And that was something that they could fidget with or hold 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. So it can be quite useful in staying regulated while you're also getting into the work and processing some hard stuff.

[52:11] Dr. Linda Bluestein: And for someone as young as you are, you've already done so many different interesting things. I know you have worked in PHP, which is partial hospitalization program, right? And you've also worked in IOP.

[52:27] Natasha Trujillo, PhD: IOP, intensive outpatient.

[52:37] Dr. Linda Bluestein: IOP — intensive outpatient program, maybe.

[52:41] Natasha Trujillo, PhD: Yeah, program. Okay.

[52:44] Dr. Linda Bluestein: In any event, is that what you were referring to when you were talking about the group sessions and how this could be triggering for some people? A lot of my patients have been through those kinds of programs with varying results. Would you briefly be able to share with us what people can look for in those kinds of programs and how they can get the most out of them?

[53:05] Natasha Trujillo, PhD: Oh man, yes. Gosh, this could be a very long conversation. I've worked inpatient — 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 any VA-specific work.
[53:24] In those settings, what I encourage people to look for is the program structure, and 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, multiple specialties. So you want people who have the training and the experience to provide the care that you are signing up for.
[53:51] I also encourage people to look at how they structure the program and whether it actually fits the criteria for why someone would go into the program. Unfortunately, I have seen a lot of times where a PHP program — partial hospitalization — will have criteria where they take really sick people who need higher levels of care than is appropriate for PHP. And so I am very much 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 then it also comes back to intentions, right? 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 from it.

[55:05] 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 it?

[55:17] Natasha Trujillo, PhD: Yes. Thank you. So the book — I wanted to write something 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. 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 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.
[56:05] Each chapter is focused on a different type of loss. And the way that I've structured it — I've said a couple of times today, the only way to deal with grief is to be with it and go through it. So the first part of each chapter is kind of the raw emotional narrative of what happened, what the event is. There are near-death experiences, childhood medical trauma, death, chronic illness, sudden death, perfectionism, athletics, first loves, and loss of significant relationships. So I tried to pull out a lot of different types of semi-universal experiences so everyone can see themselves in some way in these characters' stories.
[57:00] The beginning is that raw narrative where you really have to be with it and feel all the feels and just sit with what happens. And then the second part of each chapter is kind of a synthesis, where I weave in 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 their own experience of grief, or maybe they don't feel like they're doing it right, or maybe they feel like they're still stuck. Because with grief, 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 — those are the types of readers who I think would connect the most with the book.

[57:54] Dr. Linda Bluestein: Fabulous. And that is available on Amazon or directly through your website?

[58:02] Natasha Trujillo, PhD: Yes. Amazon is probably the best way, or directly through my website — either my practice website or the book website, which is andshewasneverthesameagain.com. And the audiobook was also just released about 2 weeks ago, and that's on Audible, Amazon, and Apple iTunes.

[58:22] Dr. Linda Bluestein: Okay. And we always end every episode with a hypermobility hack. So if you could share one with our listeners?

[58:32] Natasha Trujillo, PhD: Okay. Yes. I was thinking about this and I was like, how can I, with my expertise, weave this in? And 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 wary of mental health, 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 hypermobility, that idea of stretching the mind — using the mind as a muscle — that piece is so key.
[59:07] And I said a couple of times today: being willing to change your own mind has been a game changer for me. When I was younger, I was very perfectionistic and very rigid — this is the way it's going to be. And I think being open to, hey, I'm not right all the time, I don't know everything, and 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. You've got to be willing to change your own mind and stretch those muscles in different ways.

[59:42] Dr. Linda Bluestein: I love that. That's fabulous. And it's been so great chatting with you. I've learned a lot and I know our listeners will as well. Before we go, can you let us know where we can find you and how people can learn more about you?

[59:56] Natasha Trujillo, PhD: Yeah, absolutely. I'm located in Denver, Colorado. I am licensed in about 40 states though, so I'm able to work with people all over the country. The website is npttherapy.com. The book website is andshewasneverthesameagain.com. And that is the best way to get connected with me. I'm also on Instagram @npttherapy, and then just my name, Natasha Trujillo, on both LinkedIn and Facebook.

[1:00:24] 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 my audience. This is such an important topic and affects so many people, so I'm just thrilled to have had the chance to talk to you.

[1:00:40] Natasha Trujillo, PhD: Thank you so much for having me on. It was awesome.

[1:00:45] 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, 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.
[1:01:07] 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 podcast player. You can find me, Dr. Linda Bluestein, on multiple social media platforms including Instagram, Facebook, TikTok, Twitter, and LinkedIn @HypermobilityMD. You can find Human Content, my producing team, @HumanContentPods on TikTok and Instagram. You can also find full video episodes up each week on YouTube at Bendy Bodies Podcast. To learn about the Bendy Bodies Program Disclaimer and Ethics Policy, Submission Verification and Licensing Terms, and HIPAA Release Terms, or to reach out with any questions, please visit bendybodiespodcast.com. Bendy Bodies Podcast is a Human Content production. Thank you for being a part of the community, and we'll catch you next time on the Bendy Bodies Podcast.