A second-year medical student at the Ohio University Heritage College of Osteopathic Medicine is adding an important voice to the national discourse about sexual assault and abuse as the lead author of a paper about how physicians can better care for survivors of sexual trauma.
Kristen Cuevas worked with Heritage College faculty members Jane Balbo, D.O. (’07); Krista Duval, D.O. (’08); and Elizabeth Beverly, Ph.D., on the article, “ Neurobiology of Sexual Assault and Osteopathic Considerations for Trauma-Informed Care and Practice,” which was published online in December, and then in the February issue of the Journal of the American Osteopathic Association.
Cuevas’ interest in the subject matter dates from her undergraduate days at Ohio State University, where she worked with the Sexual Civility and Empowerment program, teaching students about things like healthy sex, consent and how alcohol can complicate sexual encounters. During that time, she learned from a survivor advocate about research being conducted on how the brain responds to trauma, but didn’t have time to dive into the research as much as she wanted to.
That opportunity came at the Heritage College, where she worked with Balbo, assistant professor of family medicine and director of the family medicine associateship; Duval, assistant clinical professor of family medicine; and Beverly, assistant professor of family medicine, to produce the JAOA-published study. Cuevas spent five months on the project, reviewing more than 50 studies to cull information on how the brain reacts long-term to trauma from sexual assault or abuse and how doctors can avoid re-traumatizing patients who have survived such experiences.
“I think the most important thing for a physician is to remember that when any patient walks in the room, they’re more than just the reason for their visit,” Cuevas said. “You have to always pay attention to the patient’s full body, mind and spirit. Second, it’s important to practice trauma-informed care with all of your patients.”
Trauma-informed care can include intake forms that let patients share such information as whether they are trauma survivors and whether they wish to discuss this. It also requires a caregiver’s being sensitive to whether an exam procedure might be a trigger.
“It’s things like the way you ask questions, or the way you do a physical exam on your patient,” Cuevas explained. “You’re always asking permission, and you’re always making sure that the patient knows that it’s OK for them to tell you that they don’t want this exam performed on them today.”
The study summarizes neurological and hormonal changes that occur when a person undergoes a traumatic episode of sexual violence or threat. Such a frightening situation can set off a series of “defense states” as danger escalates. A person having undergone these states may show lasting effects, which can be triggered if something causes the person to flash back to the original trauma.
For example, one of the defense states, the “freeze alert” state, can leave someone prone to exaggerated fear responses when faced later with triggering stimuli. Defense states also affect memory, so that someone who has been traumatized may have fragmented memories of the event right afterwards, but later, remember salient details quite accurately. Caregivers should be aware that this process requires time and a safe space for healing.
The paper offers recommendations for physicians to ensure they are offering the best care to patients who have survived abuse or assault – whether or not the patient discloses this. These include specific questions to ask on patient intake forms, and advice on handling different scenarios of doctor-patient interaction, contributed by authors Duval and Balbo.
Practicing trauma-informed care, Beverly suggested, includes assuming that patients have experienced all kinds of traumas, taking pre-emptive action to avoid possible triggers, making clear that you’re a safe person to talk to if the patient chooses to disclose, and having resource information at the ready if a referral is needed.
She also notes that physicians should extend this awareness to themselves. “As a provider, you have to know what are your triggers and trauma you’ve had,” Beverly said. “You have to be aware of your own history.”
Cuevas, who aims to become a family medicine physician and plans to teach college undergraduates about sexual abuse and assault, will be teaching some of what she’s learned from the study to other Heritage College students; she has a lecture scheduled for Feb. 23, which is open to students, faculty and staff on all three campuses. She said she welcomes the media coverage the study has attracted – including stories in The D.O. magazine and Newsweek – as it helps spread the word about a subject she’s passionate about.
“We’re so proud of our students’ contributions to research projects like this one,” said Heritage College Executive Dean Ken Johnson, D.O. “Osteopathic physicians should be leading the way in making trauma-informed care the norm for every doctor visit. Student Doctor Cuevas and her faculty colleagues have offered practical steps in this article to help make that happen.”