September 2024, Issue 3

CrossFit Medical Society™ Newsletter

Trauma and Grief: The Aftermath of the 2024 CrossFit Games

Through a Mental Health Professional’s Lens

Dr. Christina Migliara,

PhD, LMFT, CCTP, MAC, CAP, CASAC, L2, USAW level 1 Coach

It’s hard to believe it has been almost a month since the 2024 CrossFit Games in Fort Worth, Texas. The anticipation of new possibilities to find the fittest on earth filled the air, but no one was prepared for what was to come. As a Mental Health Professional and Mental Coach specializing in high performance, trauma, systems theory, and addiction, I work with athletes to sharpen their mental game—focusing on mindset skills, the mind-body connection, and overcoming mental blocks to optimize performance. While my role is to prepare the athlete for a number of scenarios and train to be ready for anything mentally, the last thing a coach anticipates is how to respond in the face of the unthinkable: an unforeseen traumatic loss. No one watching or participating in Event 1 of the Games was prepared for this tragic turn of events.

The tragic loss of Lazar Dukic cast a dark shadow over the Games, and as I looked around, I saw a variety of trauma responses unfolding. I vividly remember witnessing the different reactions, and a chilling realization hit me—I don't think anyone truly grasped the gravity of what was happening. It was like watching icebergs floating around on the competition floor, you could only see what they were presenting to the crowd but you had no idea the turmoil they were going through underneath it all. Having a trained eye and understanding of the psychology of humans was like a blessing and a curse in these moments as I, like many, felt powerless.

Trauma is fickle, and so is its companion, grief. When a traumatic event occurs, our bodies and minds react in complex and automatic ways. These are not conscious decisions but primal, innate responses aimed at survival. During a traumatic experience, the reptilian part of the brain takes over, and the body shifts into survival mode. The sympathetic nervous system is activated, releasing stress hormones throughout the body, shutting down all non-essential functions, and pushing individuals into fight, flight, freeze, flop, or fawn responses (Levine, 1997). We witnessed these responses among the athletes as they faced the choice to continue competing or not. Some chose to "fight" by staying in the competition, others "fled" because they couldn’t cope with their bodies, unable to perform no matter how hard they tried (flight). Some followed a routine to just get through the event (flop), while others sought to not let Lazar down and honor him (fawn). 

These varied responses depend on many factors, including an individual's foundational mental health, coping mechanisms, and influences like culture, age, and beliefs to name a few. The challenge arises when the body perceives ongoing threats, pushing it back into fight, flight, freeze, flop, or fawn mode, leading to an overwhelming sense of paralysis or emotional flooding. This is extremely taxing emotionally and physically. It is crucial to avoid making major decisions and to actively manage stress to reduce the risk of developing PTSD symptoms (van der Kolk, 2014). Given the circumstances, the athletes simply responded the best way they knew how and what would make them feel “safest” at the time when asked to make the decision.

The community also responded from a different layer of trauma and loss, displaying a mix of sadness, admiration, empathy, and a protective instinct toward the athletes. It felt as though a comforting blanket of support had wrapped the arena. You could see the collective grieving process beginning as athletes completed events and approached young attendees taking pictures, signing autographs, and giving out memorabilia to fans. You could feel these moments of connection and relief throughout the weekend that brought temporary comfort.

When experiencing a loss, it's also important to be mindful of the grief process, as many of its symptoms can mimic those of PTSD. Symptoms such as anger, irritability, depression, flashbacks, intrusive thoughts, and dreams are common. These can also lead to feelings of bargaining, shame, and guilt, among others. Now that the athletes and community have returned home, the greatest challenge is how to create a safe and calm environment where their bodies can process what they feel, and their minds can come to terms with what they know (van der Kolk, 2014). 

There are many trauma-informed approaches that can assist in the healing process, and finding the right resources is crucial. Being aware of the signs and symptoms of trauma is important for both those who experienced the event and their loved ones, who may be able to recognize these signs in them. The response to compartmentalize will be common due to the nature of the typical competitors mindset  of “pushing through” and being “mentally strong”. However, this can prolong the healing process and have other mental and physical ramifications creating the opposite of the goal to achieve awareness and capacity to improve the window of tolerance. Healing is not a linear process, and awareness is the first step. Grief will look different for everyone with random entering and exiting denial, anger, bargaining, depression, acceptance, as will the healing journey but it is a necessary part of developing mental resilience and strength. Some basic everyday steps to begin the process include:

- Moving your body

- Getting enough rest

- Nourishing your body with whole foods

- Being gentle with yourself and allowing thoughts without judgment

- Taking walks to get fresh air and sunlight

- Connecting socially with a friend or family member each day

It’s also important to recognize that delayed onset of grief is a realistic expectation. As mentioned, there is no set timeline for grieving, so it’s vital to be mindful and supportive of the professional athletes, volunteers, coaches, and the entire community, offering support when they are ready. If someone you know is struggling with symptoms and showing signs of difficulty, please reach out to the CrossFit Medical Society for assistance. Licensed Mental Health Professionals are available to help.

The 2024 CrossFit Games sheds light on opportunities for change in both mental and physical protocols and validates the reality of how crucial the mind-body connection is to our wellbeing. Furthermore, this highlights the urgent need to stop marginalizing or stigmatizing mental health particularly in CrossFit. The body functions in conjunction with our mental and emotional well-being, and I firmly believe that incorporating mental training into competition and performance routines will enhance overall performance. You cannot simply outthink the science; it is clear that as complex beings, we need both physical and psychological safety to thrive. We must take action to advocate for, educate about, and implement mental health practices within our sport and communities to ensure true well-being as mental health is an intricate part of CrossFit.


Resources:

van der Kolk, B. A. (2014). The body keeps the score: Brain, mind, and body in the healing of trauma. Viking. (For information on trauma and stress response.)

Levine, P. (1997). Waking the tiger: Healing trauma. North Atlantic Books.


Meet Christina

Dr. Christina Migliara

Provider Spotlight

Written by Dr. Tom McCoy

What really stood out to her though was [CrossFit’s] impact on her mood and mental health. With her clinical background she was able to appreciate and put what she was feeling into clinical context. This helped her understand what a powerful tool CrossFit could be to improve mental well-being.

“Well, it all started in a maximum security forensic hospital in rural Florida” Christina nonchalantly informed me. And with that, I knew this would not be a typical interview. Christina’s exposure to the field of psychology is extensive and varied. It started by shadowing providers who were assessing individuals incarcerated but deemed unfit to stand trial or not guilty by reason of insanity. This early experience gave Christina a deep understanding of the extreme manifestations of mental health disorders and the ramifications if left untreated.

She went on to get her bachelors in psychology and Masters degree in Marriage and Family Therapy. The focus of her approach was in systems theory, which essentially highlights how the structure of relationships and their environment outside of the individual can impact mental well-being. Chrisinta then went on to obtain her PhD in general psychology and additional certifications in both trauma and addiction. She worked as a clinician and educator for many years in these fields. 

After having her second child, her cousin told her about CrossFit and how it helped him lose a significant amount of weight and get healthy. Christina was all in. She loved the idea of a hard challenge and wanted someone to push her. She lived and practiced for years in New York so developed a thick skin. So in 2014 she gave it a go and just like her cousin she had an amazing response, got in shape and felt great.

What really stood out to her though was the impact on her mood and mental health. With her clinical background she was able to appreciate and put what she was feeling into clinical context. This helped her understand what a powerful tool CrossFit could be to improve mental well-being.

She began prescribing lifestyle interventions and movement to all of her patients. Often this included CrossFit. If she was going to work with you, you were not going to just take medications and come back in a month. Ultimately, this reshaped how she practiced at TheraFit where her approach includes movement such as walk and talk and ruck and talk sessions https://www.therafitworks.com/ 

Seeing the success of this approach led her to ultimately found an affiliate CrossFit Tailwinds https://www.crossfittailwinds.com/. Today CF Tailwinds is an amazing example of an integrated health home in the affiliate space. Under one roof they have not just an affiliate, but also a dietician and nutrition team, physical therapist, chiropractor and of course mental health care services. Tailwinds has mental health and mindset as the foundation of their pyramid, and six years later they continue to positively impact the lives of their members. 

The beautiful aspect about this degree of health home integration is that referrals and new leads come from all sides. They all support and refer to each other to create a living, breathing integrated health home.

Christina has also partnered with Nicole Aucoin at HSN nutrition to create coursework and education for affiliate owners and coaches on how to teach mindset and to put mental health on the front burner. You can learn more about this program here. https://growyournutritionbusiness.com/mentalfit/

With the guidance and support of the CFMS team of mental health professionals, the CFMS put out some key considerations when processing trauma. Those sides are linked in PDF version below. Please feel free to download and share with members in your community


Biomarker HUB is Live

Central to the CFMS vision is providing tools and resources to help individuals take control of their healthcare journey. In order to make informed decisions and prioritize what is most important, ready access to biomarkers is key. Through these labs we’ll be able to understand our position on the sickness-wellness-fitness continuum.

Access to the most important lab tests should not be restricted by price or availability. That is why the CFMS is proud to announce the release of our Foundations Biomarker Panel. This is an extremely high yield lab panel at best-in-market pricing.

When CFMS members order blood work, they are advised to follow up with their physician to review the results. If they do not have a physician whom they can do this with, the CFMS Physician Directory is an alternative means to find a doctor who they can meet with to complete a virtual or in person lab review.

The Foundations Biomarker Panel is an exclusive offering to members of the CFMS. Orders can be placed from your member portal. Detailed information and FAQs can be found in the CFMS Biomarker Hub. 

We see this initiative as a key step in breaking down barriers to actionable health information for our community.  Remember, membership in the CFMS is free for community members, affiliate owners, and coaches. Share this groundbreaking initiative with your family and others in your community. Together, we can take better care of each other. 

Below is the list of biomarkers from the Foundations Panel. 


Testosterone, Free and Total

FSH & LH

Cortisol

Homocysteine

TSH Rfx on abnormal to free T4

Lipoprotein (a)

Lipid Panel

SHBG, Serum

DHEA-sulfate

Estradiol

Uric Acid

Complete Metabolic Panel 

Insulin

Hemoglobin a1c

Vitamin D, 25-hydroxy

Vitamin B12+ Folate

Ferritin

CBC with differential/platelet 


Merchandise is now available!

Shipping in the US and Canada

(with additional fee)

Noteworthy News

  • Journal articles will be posted each month along with questions to answer and submit for CME. Healthcare providers from any membership tier (Physician directory, HCP directory, or healthcare professional, and students) automatically have access to these CME courses. Once released, courses will be available on an on-going basis.

    Each article has a series of questions that must be answered to earn CME credits. Once you complete the article questionnaires, providers will be prompted to submit the SURVEY which validates the ACCME credit and will issue your CME certificate.

  • Shirts are available for purchase and can be shipped anywhere in the US and Canada (for a greater shipping fee).

    We're working on sending some bulk orders to our international members, so please stay tuned for more information.

    Purchase Shirts HERE!

  • Labs are live and available for direct to consumer order.

    Join us for a webinar, open to anyone in the CFMS, for a detailed look at how to order, how to talk to your members about the importance of tracking biomarkers included in the CFMS panel, knowing your scope practice and how to refer members to appropriate practitioners, and using this as a tool to start creating your health home.

  • This month Grand Rounds will be led by Dr. Christina Migliara.

    Join us for a case study presentation and deep dive into the implications of mental health on performance.

Podcasts and Information

Did you miss Grand Rounds? While this live webinar is attended by CFMS healthcare professionals., recordings are released and available for all members. We encourage affiliate owners and coaches to watch! CrossFit Games competitor, physician and Pursing Health creator Julie Foucher spends time with Christine Bald unpacking CrossFit and the human experience.