Outlook: Newsletter of the Society of Behavorial Medicine

Winter 2021

Addressing Trauma-Related Multimorbidity: Opportunities for Behavioral Scientists to Integrate Trauma-Informed Lifestyle-Based Interventions into Treatment Plans

Michelle M. Pebole, MA and Katherine S. Hall, PhD; Violence & Trauma SIG

Experiencing trauma is linked to a myriad of psychosomatic disorders including post-traumatic stress disorder (PTSD), diabetes, obesity, chronic pain, and cardiovascular disease.1-3 These trauma-related symptoms contribute to poor lifestyle behaviors, including low physical activity, alcohol abuse, increased sedentary behavior, and unhealthy diet.4,5 Individuals who experience high rates of violence and trauma often experience personal and systemic barriers such as stigma, weight prejudice, racism, misogyny, and homophobia when accessing healthcare services.6,7 These considerations make non-pharmacological behavioral interventions a valuable treatment option in this population. Yet, exercise, diet, and other lifestyle-related interventions have yet to be recognized as first-line treatments for PTSD and other trauma-related conditions.

Lifestyle-based interventions for trauma-related conditions enhance mental health outcomes while also improving complementary factors not directly targeted in gold standard treatment approaches. For instance, diet, exercise, and mindfulness-based interventions have been repeatedly shown to improve mental and physical health and improve health-related indicators of chronic disease among people with PTSD.8-11 These lifestyle-based treatments have also been shown to improve social health and wellbeing, strengthen community ties, and encourage participants to become more actively engaged in their own healthcare and seek out other appropriate clinical services. Despite the evidence indicating the efficacy of these interventions, current treatment schemes for trauma-related disorders focus primarily on psychotherapy and often ignore these holistic behavioral treatments.

Integrating lifestyle-based interventions into treatment for trauma-related conditions necessitates interdisciplinary collaboration between healthcare providers and behavioral scientists. Widespread adoption of interdisciplinary teams consisting of diet, exercise, and other lifestyle related professionals into first-line treatments for individuals with PTSD is needed to enhance the wellbeing of those exposed to trauma and violence. Identifying best practices for integration of behavioral services into primary mental healthcare is a necessary first step which requires coordination across medical departments and represents a key gap in medical practice that behavioral scientists are qualified to fill.

A key element of creating accessible behavioral healthcare services for this population is employing trauma-informed practice. Although research into trauma-informed practice is growing in the medical field, understanding trauma informed practices and for implementing lifestyle related interventions for groups at highest risk of trauma like women, gender, racial, and ethnic minorities, and incarcerated persons who have experienced sexual trauma, physical abuse, and psychological abuse is still a significant gap in the behavioral medicine field.

In sum, lifestyle-based interventions represent a low-threat avenue for trauma survivors to improve health and wellbeing. These health promoting interventions may be a necessary first step for trauma survivors to take charge of and advocate for their health. There is substantial opportunity for behavioral scientists to partner with mental health providers to improve health among diverse violence-exposed populations. This necessitates a systemic shift towards a whole-body treatment approach which recognizes the widespread effect of trauma on survivors’ physical and mental health and overall wellbeing. Behavioral scientists working in lifestyle related fields are well suited to help fill these gaps. Future work should identify best practices for integrating these interdisciplinary collaborations in healthcare contexts.



  1. Brewerton TD. Eating disorders, trauma, and comorbidity: focus on PTSD. Eat Disord. 2007 Sep;15(4):285–304.
  2. Heim C, Nater UM, Maloney E, Boneva R, Jones JF, Reeves WC. Childhood trauma and risk for chronic fatigue syndrome: association with neuroendocrine dysfunction. Arch Gen Psychiatry. 2009 Jan;66(1):72–80.
  3. Dichter ME, Cerulli C, Bossarte RM. Intimate partner violence victimization among women veterans and associated heart health risks. Womens Health Issues. 2011 Aug;21(4 Suppl):S190–4.
  4. van den Berk-Clark C, Secrest S, Walls J, Hallberg E, Lustman PJ, Schneider FD, et al. Association between posttraumatic stress disorder and lack of exercise, poor diet, obesity, and co-occuring smoking: A systematic review and meta-analysis. Health Psychol. 2018;37(5):407–416.
  5. Hall KS, Hoerster KD, Yancy WS. Post-traumatic stress disorder, physical activity, and eating behaviors. Epidemiol Rev. 2015 Jan 16;37:103–115.
  6. Substance Abuse and Mental Health Services Administration. SAMHSA’s Conceptof Trauma and Guidance for a Trauma-Informed Approach. HHS. 2014 Jul;14-4884:2–18.
  7. Pebole MM, Gobin RL, Hall KS. Trauma-informed exercise for women survivors of sexual violence. Transl Behav Med. 2020 Jun 14;11(2):686–691.
  8. Rosenbaum S, Vancampfort D, Steel Z, Newby J, Ward PB, Stubbs B. Physical activity in the treatment of Post-traumatic stress disorder: A systematic review and meta-analysis. Psychiatry Res. 2015 Dec 15;230(2):130–136.
  9. Pebole MM, Hall KS, Gobin RL. Physical Activity to Address Multimorbidity among Survivors of Sexual Violence: A Comprehensive Narrative Review. Psychol Sport Exerc. 2021 May;101962.
  10. Taylor J, McLean L, Korner A, Stratton E, Glozier N. Mindfulness and yoga for psychological trauma: systematic review and meta-analysis. J Trauma Dissociation. 2020 Dec;21(5):536–573.
  11. Firth J, Marx W, Dash S, Carney R, Teasdale SB, Solmi M, et al. The Effects of Dietary Improvement on Symptoms of Depression and Anxiety: A Meta-Analysis of Randomized Controlled Trials. Psychosom Med. 2019 Apr;81(3):265–280.