Why Body-Centered Therapies Help Heal Post-Traumatic Stress
About one-half of adults in the U.S. experience at least one traumatic event during their lives. It might be a violent attack, accident, military combat, natural or human-caused disaster, or physical, verbal, or sexual abuse.
People who have experienced trauma, whether or not they get diagnosed with post-traumatic stress disorder (PTSD), may suffer from long-term symptoms like anxiety, fear, flashbacks, insomnia, self-destructive behaviors, irritability, hostility, emotional detachment, or social isolation. Until recent years, the medical community in the U.S. has not been aware of the prevalence of PTSD—it was only recognized in 1980—nor successful in helping trauma survivors work through their experiences in a constructive way.
Treatment for PTSD typically involves psychotherapy and pharmaceuticals. While both of these approaches can be very helpful for some people, they don’t address fundamental aspects of post-traumatic stress: the ways we hold on to and adapt to trauma throughout our body, and the ways in which psychological and physical tension are inextricably connected.
Traumatized people tend to either shut down and become unaware of their physical sensations, or become overwhelmed by them. Their nervous systems are stuck in the past and unable to accurately sense what is happening within their minds and bodies in the present moment. Memories of past events constantly activate their stress response, keeping their blood pressure high, their breathing shallow, and their muscles tense. They commonly experience either chronic muscle tension or numbness in certain parts of their body, leading to muscle spasms, fibromyalgia, migraine headaches, and other types of chronic pain.
Fortunately, body-centered therapies are becoming more widely used in treatment for post-traumatic stress, and they are proving to be highly successful. In this post I’ll discuss four important ways in which body-centered therapies are helpful in treating trauma.
Movement increases sensation and reduces over-reactivity to internal sensations
There is a network of structures in the brain referred to as the “default mode network” (DMN) or “default state network.” The DMN gives you an internal sense of your self: it processes sensations that you feel in your body, coordinates emotions and thinking, and allows you to reflect on your own emotional and physical state.
As renowned psychiatrist Bessel van der Kolk describes in his landmark book The Body Keeps the Score, brain scans of patients suffering from PTSD show startlingly low activation of these self-sensing areas of the brain. In response to the trauma they experienced, people learn to shut down the areas of their brain that sense their internal state and emotions so that they can avoid feeling the terror of past events.
Sadly, shutting down the DMN in order to avoid feeling emotions also results in not being able to sense the body accurately, sometimes to the point of not being able to feel entire areas of the body. Stress and emotions don’t exist only in the mind; they involve the release of hormones, contraction of muscles throughout the body, changes in heart rate and breathing, and how we sense and react to these internal changes. Babette Rothschild eloquently sums it up in The Body Remembers: “Each emotion is the result of interplay between the sensory, autonomic, and somatic nervous systems interpreted within the brain’s cortex.” When PTSD patients shut down their emotional processing to avoid reliving their trauma, they also shut down their ability to sense their bodies.
Another adaptation of the sensory system in response to trauma is becoming over-reactive to internal physical sensations. A slight speeding up of the pulse or shallowing of the breath in response to a mild stressor can quickly escalate into a full-blown panic attack or asthma attack. People with PTSD sense their physiological stress response kicking in, and feel as though they are experiencing the traumatic event all over again.
Learning how to sense the body internally, and learning how to correctly interpret those sensations, is a critical part of recovery from trauma. Recognizing what we feel and why we feel that way gives us the ability to regulate our emotions and control our lives. Having conscious awareness of what’s going on in our minds and bodies allows us to choose something other than our habitual reactions; we can notice our physiological sensations for what they are and allow ourselves to calm down instead of becoming overwhelmed. And being in tune with our interoception (our sense of the internal state of our body) allows us to know what we need and to take care of ourselves.
Sensory neurons in our body respond to stimuli, like changes in heart rate or breathing, damage to cells, movement in our joints, and contraction or stretching of our muscles. These sensory receptors then send information about the change in our internal state to our brain for processing. If I ask you to notice how your second and third toes feel, can you? Did you instinctively move your toes in order to feel them?
So in order to improve internal awareness, it is most effective to create change within the body, because change stimulates the sensory system; this is one reason why movement helps in trauma recovery. Slow, conscious movement that creates gentle change within the body and gives you time to process the sensations you feel is best. Fast or intense movement can be overwhelming and stress-inducing, and does not allow the time for noticing and processing internal sensations. Van der Kolk notes that in his studies using yoga for trauma therapy, a yoga program involving intense movements had a high dropout rate, while the program that moved very slowly was far more successful.
Dual awareness brings trauma sufferers into the present
When someone has experienced trauma, two areas in the front of the brain called the right and left dorsolateral prefrontal cortex (DLPFC) may shut down. The DLPFC gives us a sense of time, and when it is deactivated we can become trapped in past trauma, feeling as through it will last forever. As Pierre Janet, a pioneer in the field of dissociation and traumatic memory, said in 1889: “Traumatic stress is an illness of not being able to be fully alive in the present.”
Therapies involving dual awareness are used in trauma therapy in order to reactivate the DLPFC and bring trauma sufferers into the present. Dual awareness is the ability to maintain awareness of two or more aspects of experience simultaneously. One example of dual awareness is paying attention to both internal and external senses at the same time; activities involving balancing and moving through space use dual awareness.
Another example of dual awareness is focusing on present internal sensations and external environment (noticing the tension in your shoulders, how your bottom feels in your chair, the light in the room, and any background noise) while talking about past events with a therapist. This helps you to feel safe in your present environment, and recognize that past events happened in the past and are not occurring right now. Practicing dual awareness allows people to understand that the present is safe and to live in the present moment.
Body-centered practices recalibrate the threat detection system from the top-down and bottom-up
The amygdala is a part of our brain central to our stress response. Our amygdala automatically decides whether or not a current event is a threat to our safety or survival. It does so with the help of the hippocampus, a brain structure that compares current input to past experiences. If the amygdala detects a threat, it triggers a full-body stress response. All of this occurs immediately and without our conscious awareness. Once our brain’s frontal lobes become aware of the situation, we can decide how we want to react. But by that time, our physiological stress response is already in full swing.
Van der Kolk cites the research of neuroscientist Joseph LeDoux, which shows that the rational part of our brain has no conscious connection with the emotional part of our brain (the limbic system, which includes the amygdala and hippocampus). This means that we can’t sit around and think our way out of deep-seated emotional memories and habitual stress reactions. There are two ways we can access the emotional, threat-detecting part of our brain: from the top-down through the medial prefrontal cortex, or from the bottom-up through the autonomic nervous system.
The medial prefrontal cortex (MPFC) is part of the default mode network that we discussed earlier, and it is located in the frontal lobes of the brain—the areas that give us the ability to choose how we react to a situation. As part of the default mode network, the MPFC also monitors our body’s internal sensations. In PTSD the balance between the rational and emotional parts of the brain is off, but recalibrating the MPFC helps bring these parts of the brain back into balance. We can improve the ability of our MPFC to monitor our internal sensations with practices like somatic exercises, meditation, and yoga.
The autonomic nervous system (ANS) regulates functions of the body including heart rate and breathing, and it carries out our physiological stress response. We can recalibrate the ANS using conscious breathing, movement, and touch.
If thinking about all of these parts of the brain is too confusing, the simplest way to think about it is this: mindfulness, movement, and touch recalibrate our sensory and emotional processing systems, bringing the rational and emotional parts of our brain back into balance and allowing us to perceive stressors more accurately.
Body-centered practices give trauma sufferers control of their healing
In his book In An Unspoken Voice, psychologist and trauma expert Peter Levine describes pendulation, our innate rhythm of moving alternately through contraction and expansion, stress and relaxation, bad and good sensations. Being aware of our internal rhythm of pendulation allows us to know that what we are feeling will not last forever.
The principle of pendulation is important in healing from trauma because it allows the trauma sufferer to gradually adapt to new internal states and sensations, and to not be out of their comfort zone for too long. The process of healing from trauma is not a straight forward line. Continually moving in a straight line with any type of therapy will likely result in hyperarousal and a dramatic step backward. People need periodic breaks from working through trauma; they need to pendulate forward and backward, forward and backward, with an overall gradual movement forward over time.
If you suffer from post-traumatic stress, body-centered practices like yoga, meditation, and somatic exercises are tools you can use to work through your trauma at your own pace. You can practice when you want to, stay within your comfort zone, and put on the brakes when you need to. As your internal awareness and control improves, you’ll know when you can safely move forward, and you can make your own decision to do so. Body-centered practices give you control over your healing, and give you the immediate experience that what you’re feeling won’t last forever.
EMDR, Yoga, and other mind-body practices
Yoga and other mindful movement practices are becoming widely used in trauma treatment. However, one of the most extensively studied therapies for trauma involves movement of the eyes.
In eye movement desensitization and reprocessing (EMDR), the therapist slowly moves their finger back and forth from right to left in the patient’s field of vision. The patient is instructed to think about the traumatic incident and how the experience felt while at the same time following the therapist’s finger movements with their eyes. As memories and sensations come up, the patient is told to notice them, and then to resume following the finger movements. EMDR is typically carried out in weekly sessions over the course of approximately three months.
If you’ve never heard of EMDR before, it may sound odd. Researchers still don’t know exactly why it works, but it is thought that the therapy integrates traumatic memories that were previously inadequately processed. As van der Kolk describes in his book, EMDR may reproduce what happens in REM sleep, when our eyes move rapidly and we process memories. No matter how it works, it works; meta-analyses show that EMDR has moderate to strong effects in reduction of PTSD symptoms and depressive symptoms, and can result in loss of PTSD diagnosis.
Yoga is now used in many PTSD treatment programs for U.S. veterans, and for good reason. Yoga is shown to improve sleep and resilience and reduce stress and anxiety among PTSD sufferers. A 2013 study of 64 women with chronic, treatment-unresponsive PTSD found that after a 10-week trauma-informed yoga program, 52% of participants no longer met criteria for PTSD.
A 2013 review looked at studies of yoga, tai chi, qigong, mindfulness-based stress reduction, meditation, and deep breathing, and found that these practices successfully reduced symptoms of PTSD. The mind-body practices reduced anxiety, depression, and anger, and increased pain tolerance, self-esteem, energy, ability to cope with stress, and ability to relax.
Since using body-centered therapies in trauma treatment is relatively new, research is still accumulating—but the research that has been done makes it quite clear that mindful movement practices should be included in trauma recovery programs.
Using Clinical Somatics to help heal trauma
Clinical Somatics exercises are an empowering tool for trauma sufferers. The exercises are extremely slow and require constant focus on the internal sensations of muscles gently contracting and releasing. Regular practice creates a high level of awareness and conscious control of the body. And since the slow speed of the movements demands 100% of mental focus, they keep you in the present moment.
When you practice Clinical Somatics exercises on your own at home, you can take them at your own pace and stay within your comfort zone. You can lie down and do one or two exercises for just a few minutes. You can increase the length of your practice or the number of exercises you do whenever you want to, and it is always up to you.
The pandiculations involved in Clinical Somatics exercises release subconsciously held muscle contraction, which directly reduces anxiety. Working with certain areas of your body may bring up difficult emotions, and it is up to you to decide which exercises you want to do. You can begin by working with parts of your body that feel safe and comfortable, and gradually begin moving tighter or more emotional areas of your body as you feel ready.
As you go through the process of healing from trauma, always remember that it is normal to have ups and downs. Take the process at your own pace, and put on the brakes whenever you need to. Know that when you’re experiencing stress, it is only temporary.
If you want to learn more about this topic, I highly recommend Bessel van der Kolk’s book The Body Keeps the Score. If you’re a health professional, it will make you more aware of the ways in which your patients may be suffering from post-traumatic stress and how it could be affecting their overall health. If you have experienced trauma, the book will give you deep insight into how you may have adapted to the trauma, and shed light on how to move forward in your recovery.