Dr. Keira Barr discusses the relationship of the nervous system and the skin as well as the benefits of somatic practice, including grounding, vocalization, and breathwork, to manage stress and transform trauma to improve skin health.
Keira L. Barr, MD, dual board-certified integrative dermatologist, certified somatic trauma therapy practitioner, Somatic Skin Science, Seattle, Washington.
“It all boils down to stress,” said Keira Barr, MD, who presented “Beauty & The Beast: Stress, Trauma, Skin Disease & A Somatic Approach to Healing,” during the “Mind Body Therapies as Treatment Strategy in Dermatology: What is the Evidence?” session at the 2023 AAD Innovation Academy in Tampa, Florida.
“I say this not just from an academic lens, but also from a very personal place. I was not aware of how profound the impact of stress could be on our bodies and our skin until about a decade ago when my own health started falling apart,” she said.
At the time, Dr. Barr said she thought she was doing all the right things. She was running ultramarathons and wearing sunscreen and sun protective clothing.
“But my skin was telling a very different story. It was incredibly dry and irritated. My pigmented lesions were growing and changing, and I was getting new ones. Ultimately, I was diagnosed with melanoma.”
Dr. Barr said she also suffered with gut issues, hormonal issues, and burnout.
“It was a wakeup call that the roles of unmanaged stress and unresolved trauma play in our overall health and wellbeing—especially in our skin health—can’t be ignored.”
Not all stress is negative, but chronic stress can have important negative effects, she said.
“It’s because our skin is embryologically linked to our brain and is a window to the state of our nervous system. There’s bidirectional communication that’s happening all the time. ”
The DNA Connection
Deep in our DNA, there’s a primordial theme of slowing down, connection, and safety, said Dr. Barr.
“We’re always looking for ways to feel safe in our own bodies, in our environments, and in our relationships with others.”
The autonomic nervous system is like a personal safety surveillance system on the lookout for cues of safety and danger, and it’s always ready to activate, said Dr. Barr.
Stephen W. Porges, PhD, coined this as “neuroception,” according to Dr. Barr.
“… this wordless expression of neuroception is created without the thinking parts of our brain, and we need to create meaning from it. The issue and why this is so important is, when your autonomic nervous system is regulated and balanced, [we] can respond to these neuroceptive cues with ease. You can be activated…like falling behind in the clinic or navigating a challenging patient interaction and you can ride the wave of your stress response and stay within what we call ‘the window of capacity.’”
You might be a little agitated or nervous but remain present and clear-headed, completing the stress response and can move onto the next thing, said Dr. Barr.
“The challenge that arises for so many of our patients and for ourselves is that it can feel like our circumstances or situations are too much for our nervous systems to handle. We sense this as a threat of danger. It doesn’t just have to be physical danger…it can be a threat to our mental and emotional wellbeing.”
That’s when a person crosses the threshold of that window of capacity. There’s mobilization of the sympathetic stress response, also called the fight-or-flight response. Cortisol and adrenaline increase. Blood pressure and heart rate increase, said Dr. Barr.
“What happens with the skin is stimulation of inflammatory cytokines and neuropeptides, which can create a lot of changes on the skin’s surface.”
If stress is ongoing and the fight or flight response is ineffective for resolution, the stress response can make one freeze, shutdown, or collapse, said Dr. Barr.
“It’s where you see so many of your patients struggling with chronic fatigue, fibromyalgia, autoimmune conditions, and they’re not getting better despite their best treatment plans.”
When circumstances or life events overwhelm our nervous system’s capacity to handle it, this is where trauma happens. Trauma happens when there is not enough time, space, support, or permission for the stress response cycle to complete itself, and people get stuck in a vicious cycle in which there’s activation of the stress response, release of stress hormones, and body and skin inflammation, said Dr. Barr.
“This [can trigger] or exacerbate conditions like psoriasis, acne, and eczema. Then, because of the physical manifestations and inflammation happening in the body and skin, it can shape what I call our ‘skin story,’ the perception of how one sees themselves, which creates a lot of shame, self-loathing, and discomfort, which creates more stress.”
“I’m sure you’ve experienced this in your clinic. People are so overwhelmed. They identify with their skin disease and make it all-encompassing. They are really struggling with emotions of fear and shame. It really impacts how they move about their lives, personally and professionally,” she said.
To cope with that discomfort, some turn to overeating, over-drinking, scrolling social media—lifestyle habits which can compound the inflammation that is driving their skin condition, according to Dr. Barr.
Mind-Body Medicine Techniques
This is where somatic and mind-body medicine techniques come into play. While there are many different types of somatic and mind-body skills, all center on attuning to the present moment which can help manage stress and transform trauma, said Dr. Barr.
“All of these practices are very simple, very powerful, and very effective. But it is a practice. It is a practice that is worth investing your time and energy in, because it will not only help you, as the practitioner, regulate your own nervous system, but it will support your patients as well.”
Resourcing
Resourcing is the first phase of trauma healing, said Dr. Barr.
“Essentially a resource is anything that helps you and your patients feel a sense of safety and support. Places like the ocean, the mountains, anywhere in nature; patient advocacy and support groups; activities like art, journaling, movements of all kinds; breathwork; and positive memories that evoke a pleasant feeling or delight.”
All of these resources can help shift people into more of a rest and relaxation state, said Dr. Barr.
Somatic Awareness
“Soma is Greek for the living body known from within—our soma is the home in which we live.” Somatic awareness is bringing our attention with intention to our soma and is an experiential approach towards mind/body integration.
Cognitive therapy has its place, but sometimes talk therapy leaves people disconnected, said Dr. Barr.
“But when we bring awareness to how and where the stress is stored in our body and we are attuned to our primal language of touch, sound, and movement, we increase our somatic awareness. By increasing our somatic awareness, we can tap into our primal language to help metabolize and process unresolved trauma that had been stored in our body because it wasn’t able to complete that stress response cycle. We’re able to discharge that stuck energy and bring our nervous system back into regulation. We’re able to handle situations with less overwhelm, and more ease. Through doing somatic work, patients can actually enjoy their lives more even if their skin is not completely clear.”
Grounding
Grounding simply is feeling a physical connection to the ground, said Dr. Barr.
“What happens in trauma is that we get caught in events in the past or worry that it’s going to happen again in the future. When you feel a physical connection to the ground—to the surface beneath you—you’re back in the present moment. In the present moment, you can reassure yourself those events are not happening and that you’re safe. When you feel safe, you can heal trauma.”
Orienting
Orienting is the practice of looking around your space (in front, to the sides and especially behind you), she said.
“Oftentimes we feel like something is coming at us. When you look around at your space, taking in the colors, textures, and sounds, you get that reassurance and create a felt sense of safety which is fundamental to our thriving.”
Vocalization
People experiencing trauma often feel like they can’t or shouldn’t use their voices, said Dr. Barr.
“Encouraging singing or humming can be empowering and healing.”
Movement of many types can help a person feel more in the present, as can techniques like progressive muscle relaxation and breath work, said Dr. Barr.
“Breath work is probably the [simplest], most powerful somatic practice that you can use because it is with you at all times. Our breath is under our subconscious control, but you can bring it under your conscious control by simply noticing your breathing. If we’re breathing fast, shallow, from our belly, from our chest. How we breathe can signal that our nervous system is dysregulated, and it can also be a resource to bring our nervous system back into balance. ”
Inviting the patient who is sitting in front of you and seems activated, overwhelmed, or checked out to breathe with you can help anchor them in the present moment and create a safe space for them during the office visit, said Dr. Barr.