Trauma is the condition of being overwhelmed by threatening and chaotic events over which you have no control. A trauma from outside the body (an infection, an assault, ongoing work stress, exposure to an environmental toxin, warfare, etc.) creates a reaction in the body (behaviors like fight, flight or freeze, alterations in gut function, cortisol and other hormones that alter metabolism, immune system response, etc.). The body will keep reacting in these ways - a primitive and essential survival response -- so long as it perceives the threat.
Here's the problem: We may not be aware that our body responses to threat remain activated even after the threat has vanished. This is because the threat pulls our attention toward it and away from the body. In a survival situation, you may not even notice the pain and fatigue from exertion, wounds, etc. until you reach relative safety.
The amygdala and related fear perception neural networks create a state of vigilance that last well beyond the actual traumatic events. Over a long period of time the threat, in addition to coming from the external sources, may also begin to come from within the body, showing up as chronic pain and illness. People with chronic musculoskeletal pain, fibromyalgia, migraine, asthma, and cardiovascular disease, for example, are more likely to have a history of psychosocial or tissue trauma than people without these disorders. They are, in a real sense, living in a body that threatens them.
If this underlying body state deterioration is not treated, it can lead to post traumatic stress disorder (PTSD), a condition that is characterized in the DSM-IV as having persistently high arousal, flashbacks of parts of the trauma event, memory loss for other parts of that event, lack of ability to concentrate, and impairment of social functioning. Note, however, that these diagnostic criteria are primarily psychological. Nothing is mentioned about the body: the chronic pain, muscle tension, movement limitations, outbursts of energy followed by listlessness, not to mention consequent illnesses of the cellular pathways in the neuromuscular, digestive, cardiovascular, hormonal, and immune systems.
All forms of psychotherapy for trauma, in some form, involve re-experiencing the trauma memories in the context of a safe and supportive therapeutic environment. As we begin to feel, in our body sense, the trauma-related fear, we can better manage it.
Psychotherapy clients learn to gain a sense of control over the negative arousal and feelings of being overwhelmed by those memories using various psychological strategies including emotional sharing, cognitive restructuring, and lessons in anger and stress management. In experiments in which individuals are allowed to become aware of a fearful stimulus (the subjects are given time to consider how they might respond), the ventromedial prefrontal cortex (VMPFC, body sense) becomes activated while amygdala activity (sense of immediate fear) is lessened. This suggests that psychotherapy has effects on the brain and body.
If psychotherapy affects the body, it is likely that explicit incorporation of body sense training into treatment would also be effective. Many psychotherapists have begun to do just this. Among the methods employed are relaxation techniques and mindfulness meditation, both of which access the parasympathetic nervous system as an antidote to the continuously high sympathetic arousal that leaves the body depleted of its metabolic resources. Sensorimotor psychotherapy, somatic psychotherapy and somatic experiencing take these approaches even further by directly incorporating awareness of body sensations -- including breathing, muscle tension, posture, and habitual movement patterns - thus re-training the body sense.
Certain trauma survivors, however, may not respond to traditional or to somatic approaches to psychotherapy. They may need a more body-centered approach to treatment. Many of the clients I have seen in my Rosen Method Bodywork (RMB) practice have a long history of unsuccessful attempts to treat their trauma with psychotherapy or medicine. This is likely true because RMB has a very unique type of touch. RMB touch is supportive, non-manipulative, non-demanding, and "listening," designed to help people feel their muscle tension, and related physical and emotional pain.
Therapist talk in RMB is also non-evaluative and has the same function, to enhance body sense awareness, to stay in the present moment with feelings and sensations related to the trauma and its memory, and to distinguish conceptual self-awareness with its expectations and judgments as distinct from the direct body sense awareness of self. RMB practitioners do little more with conceptual thought than to point out that a person is thinking rather than feeling. Our goal is to heighten and educate the body sense. People who want to do more processing of their conceptual self-awareness get referred to psychotherapists.
What might it feel like to be touched by a RMB practitioner? As in any relationship, it depends on the two people involved. If the client feels safe with the practitioner's touch, it may feel like the following. Imagine you've had a rough day or week with lots of compounding stresses coming from work or family or both. You do your best to hold yourself together until the weekend, and the effort to contain it all adds to and amplifies the stress. You finally get some alone time with a loved one who sees your pain, doesn't ask any questions, but just reaches out and holds you in their arms. Now your feelings can come through, your tears arise both from the grief and pain you've been suppressing and also from the relief of having someone to just be with you. If you are the kind of person who needs the support of physical contact in order to let yourself feel, you may respond better to a treatment approach like RMB.
I once worked with a man who had chronic neck and shoulder pain from whiplash in an automobile accident 20 years earlier. He had tried massage, meditation, pain medication, physical therapy, and endless scans and negative medical diagnoses. He was beset by the pain and plagued by the never-ending question of why his pain would persist for so long after his body had apparently healed. Within 15 minutes after I began to touch those affected areas, his muscles relaxed and his breathing became easier, all indices of a parasympathetic response. It was almost as if his body was hungry for that type of touch. He was astounded by this since he had not experienced any relief since the accident. As soon as he began talking about it, however, his muscles tensed up again. I guided him back to just feeling my hand on his shoulder and the relaxation returned, only to vanish again.
Across sessions this pattern of shifting between feeling and thinking was repeated. As he became more aware of this shifting, he could stay in his body sense for longer periods, and even experience his body sense for a short while outside of our sessions. As I felt the growth of trust in me as well as the increasingly longer islands of relaxation that seemed more real to him, we began to explore the trauma memories. This, as in psychotherapy, is done slowly and with a focus on re-living the sensory and emotional experiences (not the conceptual story about the trauma). The difference here is that the practitioner's touch can help both the client and the practitioner be aware of when the body tenses with remembered threat or relaxes with newfound body sense awareness.
