A racing heart and a roiling stomach. Panic attacks, nightmares, or fatigue. The body has myriad ways to manifest the many faces of trauma and fear. And for many people, getting help to cope with the symptoms of emotional distress means going through “talk therapy”—a kind of psychotherapy based on verbally processing thoughts, feelings, and experiences.

Now, though, the rapidly growing field of somatic psychotherapy is shifting the paradigm from talking to feeling—and this approach is offering new promise for healing trauma through body-centered techniques, such as Somatic Experiencing.

Somatic Psychotherapy Is Body-Centered Psychotherapy

Somatic psychotherapy—also called body psychotherapy—focuses on the complex and profoundly powerful connections between body and mind and how those connections affect how we process and recover from trauma and other emotional distress. Somatic psychotherapy arises from the premise that, along with thinking about the world and how to respond to it, humans engage with others and the world through sensations, movement, and expression.

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In response to situations and stimuli of all kinds, the body’s core response network, or CRN, is activated. This network, which is made up of the autonomic nervous system, the limbic system, and other regulatory functions, is responsible for organizing and generating an immediate response to challenges presented by a person’s environment, such as the well-known “fight, flight, or freeze” response to stressors and perceived dangers.

In that kind of situation, the CRN signals the body to release a flood of stimulant chemicals, such as adrenaline and cortisol, creating a surge of energy that throws the system temporarily out of balance.

When animals are faced with threats—say, from predators—they experience those responses too. But once the threat has passed, they typically discharge that “survival” energy with movements such as shaking, sighing, or stretching before returning to normal behavior. For them, that kind of event is generally experienced as an isolated incident and causes no lingering symptoms.

But for humans, returning to “normal” after a traumatic experience is not so simple. People who experience sudden or ongoing trauma or other kinds of distressing events typically don’t have ways to clear their systems of the survival, or arousal, energy produced in response to those situations. That energy lingers in the body, and if unresolved, may result in conditions including posttraumatic stress (PTSD), depression, phobias, muscle aches and pains, irritable bowel syndrome and other digestive issues, insomnia, and autoimmune disorders.

Somatic Therapy Is Not “Talk Therapy”

The goal of psychotherapy is to help people resolve issues that trigger emotional and physical distress. With approaches such as cognitive behavioral therapy, people seeking help are encouraged to talk about their experiences in order to gain insights into patterns of negative thinking, identify harmful behavior patterns, or learn new ways to cope with triggers for stress. This kind of “talk therapy” might also include activities such as journaling, poetry, and other kinds of writing, and even art and drama therapy.

But these approaches place heavy emphasis on cognitive functioning and verbal expression—and while a person in this kind of therapy might talk about physical symptoms of trauma or distress, engaging the responses of the body itself might play a fairly limited role in the therapeutic process.

Somatic Experiencing Brings Completion

Somatic psychotherapy begins with the body, working to discover how and where trauma is being physically experienced—and finding ways to safely “discharge” the energy related to that trauma.

Somatic psychotherapy begins with the body, working to discover how and where trauma is being physically experienced—and finding ways to safely “discharge” the energy related to that trauma.

While traditional “talk therapy” encourages people to think about traumatic experiences and express their feelings in words, the somatic approach focuses instead on fully feeling the body’s sensations and the emotions that accompany them. People are encouraged to engage with the body’s responses to memories, experiences, and surroundings. Somatic Experiencing, created by Dr. Peter Levine, is one somatic psychotherapy modality.

In recent work published in Frontiers in Psychology, Levine, in collaboration with Somatic Experiencing practitioners Peter Payne and Mardi A. Crane-Godreau, reviews the broad range of applications for this approach and its potential for supporting recovery from trauma caused by combat, earthquakes, and other natural disasters.

Somatic Experiencing employs three core strategies for resolving trauma-related energies:

• Resourcing helps a person experiencing the effects of trauma to create resources for feeling safe and secure while working to resolve the trauma. These might include memories of good times or loved ones or thinking about a valued object or activity. One goal of therapy is to help people discover and build a supply of resources for support.
• Titration exposes a person to small amounts of trauma-related distress at a time in order to build up tolerance and avoid becoming overwhelmed by traumatic memories. In therapy, people pay close attention to the sensations they experience when revisiting a traumatic event and gradually become less affected by them.
• Pendulation, also called “looping,” involves switching between resourcing and titration, allowing a person to move between a state of arousal triggered by a traumatic event and a state of calm. This helps the body to regain homeostasis—a state in which the body’s systems are regulated and working in balance.

Mindful Movement Supports Somatic Therapy

Somatic psychotherapy often incorporates movement to help regulate the autonomic nervous system and bring about a state of “biological completion” in which trapped arousal energy has been resolved and the system is restored to balance. Breathwork and “moving meditations,” such as qigong, yoga, and tai chi, can help to engage the vagus nerve and ease bodily symptoms of trauma, such as muscle pain and headache.

Somatic psychology draws from ancient mind-body practices as well as ongoing research in psychology, biology, and the neurosciences. With the support of new insights into the intimate and profoundly powerful connections between the body and brain, the field of somatic psychotherapy continues to grow, creating more opportunities to help the body heal itself from trauma—one step at a time.

June is National PTSD Awareness Month. For help with trauma and related issues, contact a therapist in your area.

References:

1. Barratt, B. B. (2013, January 10). The emergence of somatic psychology and bodymind therapy. London: Palgrave McMillan.
2. Gold, P. (2014, November 1). Somatic psychology: The complementary nature of qigong and counseling. Retrieved from http://www.portlandtherapycenter.com/blog/somatic-psychotherapy-the-complementary-nature-of-qigong-and-counseling
3. Ogden, P., Pain, C., Kekuni, M., & Fisher, J. Including the body in mainstream psychotherapy for traumatized individuals. Retrieved from https://www.sensorimotorpsychotherapy.org/article%20APA.html
4. Payne, P., Levine, P. A., & Crane-Godreau, M. A. (2015, February 4). Somatic experiencing: Using interoception and proprioception as core elements of trauma therapy. Frontiers in Psychology. Retrieved from http://journal.frontiersin.org/article/10.3389/fpsyg.2015.00093/full
5. Payne, P., Levine, P. A., & Crane-Godreau, M. A. (2015, April 14). Corrigendum: Somatic experiencing: Using interoception and proprioception as core elements of trauma therapy. Frontiers in Psychology. Retrieved from http://journal.frontiersin.org/article/10.3389/fpsyg.2015.00423/full
6. Somatic Psychology – Body Psychology. Retrieved from http://usabp.org/somatic-psychology-body-psychotherapy/
7. What Is Somatic Psychotherapy? Retrieved from https://www.ciis.edu/academics/graduate-programs/somatic-psychology

“It feels heavy right here,” Rebecca* said, crying and touching her chest, “like a huge rock is sitting on me. It’s like that old cartoon, where a boulder would fall off a cliff and pin the roadrunner to the ground—it feels like I can’t move.”  Rebecca, a 32 year-old successful marketing professional whose older sister had recently been diagnosed with a psychotic condition, had come to see me last year. She seemed lost in grief. Fluctuating bewilderment, sadness, fear, anger, tenderness, and love were tying knots in every part of her.

I thought that untying some of the knots in her body, with the help of mindfulness practices, might help her begin to lift the boulder.

Growing up, Rebecca’s sister had provided unconditional loving support which protected Rebecca from demanding, neglectful, and painfully critical parents. She had always relied on her sister to guide and comfort her; they had always been best friends. She said that now it felt like she was standing at the edge of the ocean, watching her sister sit on a raft drifting out to sea. She had been crying uncontrollably off and on for days. What made things even harder was that her sister sometimes acted like her old self, then became delusional again. Rebecca’s emotions were rising and crashing along with her sister’s state of mind.

Mindfulness of the Body: Body Scanning and Stretching

The first foundation of mindfulness is mindfulness of the body. It is cultivated with body scanning and movement practices, like yoga and walking meditation, anchored in feeling the sensations of breathing. A body scan involves directing one’s attention to different areas, one at a time, and focusing on the sensations in each place. A scan can begin with feeling the moisture on one’s skin, sensations of warmth or coolness, pressure or tingling. Then we scan the interior of the body, noting muscle tightness or ease near the surface and going deeper, where emotions express themselves as inner physical sensations.

Building brief body scans into a sustained stretch can begin to soften tight muscles—created from strong emotions—and release the mind from thinking for a while.

Prior to entering therapy, Rebecca had taken an 8-week course in Mindfulness-Based Stress Reduction (MBSR) from me. MBSR is based on the work of Jon Kabat-Zinn at the University of Massachusetts, and is taught in hundreds of hospitals, corporations, and schools in the US and around the world. Rebecca had done many body scans as part of the course. She knew how to locate and identify the physical sensations accompanying her emotional states. The following intervention was natural to offer, and easy to do with her.

Untying Knots in the Body

As Rebecca continued to cry, we talked about the benefits of recognizing and allowing her grief. But after 20 minutes of repeated bouts of intense sobbing, she asked me to help her stop. I asked if she would like me to guide her through some breathing and mindful stretching; she immediately said yes. We did a four- or five-minute sequence of stretches, while she remained seated on the couch. I guided her to stretch gently, to her limit, with each pose, holding it for 20+ seconds, and remembering to breathe. While holding each stretch, she scanned, place by place throughout her entire body, for unnecessary tension—inviting it to soften (without insisting) wherever she found it.

“Psychotherapeutic approaches that utilize mindfulness offer well-developed non-verbal exercises that enable the individual to dip into direct sensation beneath the veil of words that may often conceal the mind’s pain. This sensory immersion enables the individual to disengage from those bottom-up enslavements at the root of suffering….” (Siegel, 2007)

“Our poses can strongly influence our emotional states. For instance, because of the expansive inhalation and opening of the chest, backbending, traditionally a stimulating practice, can elevate a low mood. Exhale-intensive poses such as forward bends tend to calm an agitated mind. In any balance practice, both inhale-oriented and exhale-oriented postures are executed in order to create equilibrium in the body and breath and to gain emotional
harmony.” (Gerstein)

Untying Knots in the Mind and Heart

This practice creates a state of non-thinking in the midst of strong feelings. Non-thinking helps release habitual, reactive thought patterns as attention is redirected to the body—what is called the neutral ground of attention. If, in the heat of raw emotion, we give free rein to thinking or emotions, our familiar and deeply grooved cascades of mental and emotional activity take their usual course, often intensifying the emotions, or cordoning them off from awareness. Instead, if we direct ourselves to notice “what am I feeling in my big toe right now?” the cascade slows, or even stops, for a while. Awareness remains intact, and new, more balanced, and less distorted thoughts have a chance to arise.

When she sat up again after her last slow, deep forward bend, Rebecca’s face had softened, her breathing was quiet, and she said “it’s gone, the heaviness is gone.” She said she felt sad, but less afraid and overwhelmed. She began to speak with compassion for herself and her sister, while remaining more relaxed for the duration of the session.

Before ending, we rehearsed the practice again: she brought the feelings back into her awareness on purpose, then, increasingly independently, guided herself through stopping, breathing consciously, body scanning, and stretching/releasing tension.

Rehearsal increased the chances that she would remember to use breathing and stretching in the days ahead. Later, she reported with some relief that she had remembered and been able to stop and practice, and that it had helped sometimes. Directing focus away from thinking, and into the body, gave her a sense of independence in calming herself, and also helped her to use her considerable intelligence to understand her sister’s situation, and to face the frightening challenge of becoming independent of her sister for the first time in her life.

Practices like these are not intended to offer an easy fix for difficult emotions or life experiences. Mindfulness, at its core, involves observing things as they are and not fighting them. One formula used is Pain x Resistance = Suffering (PxR=S). Paradoxically, allowing ourselves to be with our pain, sadness, fear, or anger, frees us to go beyond them for a while. And, according to Daniel Siegel, when practiced enough, “… an intentionally and repeatedly created state can become an effortless trait of our being.”

Is prior training required for this intervention to be effective?

A person must be open to locating and feeling different body sensations. Not having this training is a limiting factor. In my experience, however, the breathing, stretching and scanning practice can lead to a similar shift in people who are receptive, regardless of having prior training in mindfulness.

*Names and identifying information have been changed for privacy

Resources:
Center for Mindfulness—Stress Reduction Program
Jon Kabat-Zinn’s Guided Mindfulness Meditations site

http://drdansiegel.com/

References:

1. Gerstein, Nancy. (n.d.). How Yoga Affects Emotions. OmPlace.com. Retrieved from http://www.omplace.com/articles/Yoga_Emotion.html
2. Siegel, Daniel J., M.D. (2007). Reflections on the Mindful Brain. New York: W. W. Norton & Company
3. Siegel, Daniel J., MD. (2010). The Mindful Therapist: A Clinician’s Guide to Mindsight and Neural Integration. New York: W. W. Norton & Company