Somatic experiencing and medical trauma
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Traumatic experiences can take a heavy toll — not just in the moment. Symptoms of post-traumatic stress disorder (PTSD) or complex PTSD (CPTSD) can last for weeks, months, even years after the event.
You might be familiar with some psychological symptoms of PTSD, such as flashbacks and nightmares. Trauma and other mental health concerns like anxiety and depression often cause physical symptoms, too.
That’s where somatic (meaning “of the body”) therapy comes in. This approach prioritizes the mind-body connection in treatment to help address both physical and psychological symptoms of certain mental health concerns, including:
Somatic experiencing (SE), a specific approach to somatic therapy developed by Dr. Peter Levine, is based on the idea that traumatic experiences can lead to dysfunction in your nervous system, which can keep you from fully processing the experience.
The goal of SE is to help you notice bodily sensations stemming from mental health issues and use this awareness to acknowledge and work through painful or distressing sensations.
Understanding the freeze response
SE is based largely around the idea of a freeze response.
You’ve probably heard of the fight-or-flight response. When you encounter some type of physical threat or anything that causes fear or anxiety, your body typically responds by preparing you to either fight the (real or perceived) threat or flee from it.
This makes your:
- muscles tense up
- heart rate speed up
- breathing rate increase
- glands flood your body with extra hormones
These changes better equip you for confrontation or escape.
However, there’s another response that isn’t talked about as much: the freeze response. People, especially children, typically freeze when they recognize they don’t have a good chance of escaping by either flight or fight.
The problem is that you can stay trapped in this freeze response long after the threat disappears. You’re no longer in danger, but your body still holds the energy built up from the fight-or-flight response. Because you froze, the energy wasn’t used, so it lingers in your body and prevents you from completely recovering from the experience.
In other words, your body doesn’t “reset” to get ready for the next potential threat. It continues to repeat bits and pieces of the trapped experience, which you experience as trauma symptoms.
What it can help with
SE helps you access and address this trauma that lingers in your body, allowing you to work through emotional symptoms, including feelings of anger, guilt, or shame.
This approach uses a body-first method to address symptoms, with the idea that healing or freeing this felt experience of trauma can also help heal the emotional experience.
It can be particularly helpful for physical symptoms related to trauma, abuse, and other emotional distress, including:
- chronic pain
- digestive concerns
- muscle tension and pain
- sleep problems
- respiratory issues
Once these physical symptoms are resolved, most people find that it’s much easier to focus on addressing the psychological symptoms.
How it’s done
Somatic experiencing is a “bottom-up” approach, explains Andrea Bell, an ecotherapist and certified SE practitioner in Long Beach, California.
Its primary goal isn’t to help you examine the memories or emotions associated with a traumatic event, but to uncover the bodily sensations linked to those feelings.
Recognizing bodily sensations
When you enter therapy, you’ll start by learning more about your autonomic nervous system and the part it plays in your trauma response. This knowledge helps many people who feel confused about their response during a traumatic event or believe they should have reacted differently.
From there, your therapist will help you begin increasing your awareness of bodily sensations and physical symptoms.
SE therapists use a tool called resourcing to help you access your innate strength, resilience, and a sense of peace.
It involves drawing on positive memories of a place, person, or something you love when you feel distressed or encounter something triggering. Resourcing, which is not unlike grounding, can help you stay calm and present as you encounter felt trauma sensations or memories of the event.
Once you’ve got resourcing down, your therapist will begin slowly revisiting the trauma and related sensations. This is called titration. It’s a gradual process that allows you to come to terms with and integrate each aspect of the event, as you feel ready to do so. It slows down the trauma to allow you to handle it.
As you begin slowly revisiting the trauma, your therapist will track your response and the bodily sensations the trauma brings up.
They do this both by watching your response, which might involve breathing changes, clenched hands, or a shift in tone of voice. They’ll also check in with you about anything you feel that they might not see, such as:
- hot or cold sensations
- a sense of weightiness
In somatic therapy, these sensations, along with things like crying, shaking, or shivering, are considered to be a discharge of the energy trapped in your body.
Your therapist might also help you use specific breathing or relaxation techniques to help you process and release the trauma.
When this release happens, your therapist will help you move from this aroused state to a calmer one using resourcing or other techniques. Eventually, this swinging back to a calmer state will start to feel more natural.
Things to consider
If you’re interested in trying SE, there are a few things to consider first.
Lack of evidence
While plenty of people have reported good results from SE, scientific evidence around this approach is still limited.
In 2017, the first randomized controlled study looking at the effectiveness of this approach for PTSD symptoms was published. The study had some limitations, including small sample size, but the results suggest SE does have benefits as a treatment for PTSD.
Other types of research, including case studies, also show support for the potential benefits of SE.
One 2015 review looking at the effectiveness of different types of body-oriented therapies suggest these approaches can help treat a range of issues, with few to no negative side effects.
Still, more high-quality studies are needed to fully understand SE’s effectiveness.
Use of touch
A final consideration: SE sometimes involves touch, which most therapists avoid. Body-oriented therapies hold that therapeutic touch can be immensely helpful for many people, and SE therapists typically receive training in how to use therapeutic touch effectively and ethically.
If you have any reservations about the use of touch, or just don’t feel comfortable with the idea, make sure to mention this to your therapist.
Finding a provider
Only certified Somatic Experiencing Practitioners (SEP) have specific training in this type of somatic therapy. If you’re considering giving SE a try, look for a therapist with the SEP credential.
Because touch generally occurs as part of the process, you may feel more comfortable with a therapist of a certain gender, so keep this in mind when reviewing potential therapists.
Revisiting trauma, even indirectly, can be difficult. Even when you don’t spend each session talking about the event, therapy may involve some re-experiencing.
It’s important to choose a therapist you feel comfortable with to more easily share any difficult or painful feelings or memories that come up.
The bottom line
The mind-body connection is likely stronger than we think, which opens up new potential treatments, including SE.
While evidence is still lacking, the research that does exist suggests it can be beneficial. Consider giving it a shot if you’re looking for an approach that addresses both the psychological and physical symptoms of trauma.
Crystal Raypole has previously worked as a writer and editor for GoodTherapy. Her fields of interest include Asian languages and literature, Japanese translation, cooking, natural sciences, sex positivity, and mental health. In particular, she’s committed to helping decrease stigma around mental health issues.
HOW IT WORKS
The Somatic Experiencing approach facilitates the completion of self-protective motor responses and the release of thwarted survival energy bound in the body, thus addressing the root cause of trauma symptoms. This is approached by gently guiding clients to develop increasing tolerance for difficult bodily sensations and suppressed emotions.
Dr. Levine was inspired to study stress on the animal nervous system when he realized that animals are constantly under threat of death, yet show no symptoms of trauma. What he discovered was that trauma has to do with the third survival response to perceived life threat, which is freeze. When fight and flight are not options, we freeze and immobilize, like “playing dead.” This makes us less of a target. However, this reaction is time-sensitive, in other words, it needs to run its course, and the massive energy that was prepared for fight or flight gets discharged, through shakes and trembling. If the immobility phase doesn’t complete, then that charge stays trapped, and, from the body’s perspective, it is still under threat. The Somatic Experiencing method works to release this stored energy and turn off this threat alarm that causes severe dysregulation and dissociation. SE helps people understand this body response to trauma and work through a “body first” approach to healing.