PTSD is a chronic impairment of the body sense: Why we need embodied approaches to treat trauma
Why we need embodied approaches to treat trauma
Posted Jun 04, 2010
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.
We finally (after several months of treatment) discovered a crucial moment when, in re-living the experience of cars in erratic motion on slick roads, he felt he could have done something different; he could maybe have avoided getting hit, and when he did get hit it shattered his notions about the regularity of the universe and his sense of being the master of his own fate. All the grief, all the helplessness, all the dread, all the body tension and high arousal, all the high speed g-forces of the accident situation were now available for him to feel. There were still many months of treatment required to work through these feelings and re-build a more functional and self-regulating body sense that would allow him to track his everyday feelings and sensations in the present moment.
In a US sample of 34 married couples aged 20 to 39 years, half the couples were trained to give each other 15 minutes per day of Rosen Method listening touch. Compared to a behavioral intervention control group, the Rosen touch group increased oxytocin and decreased stress hormones in both males and females, and also reduced blood pressure in males. Out of a sample of 53 Swedish RMB clients, 48 described enhanced physical health, body awareness, reduction in depressed feelings, anxiety and stress, support for personal growth, and ability to self-initiate life changes as a result of RMB. Additional information and case study reports can be found on the Rosen Method International Journal website. You can find RMB practitioners and training centers in growing number of locations in the US and in other countries. Contact the training centers in countries outside the US for a list of practitioners.
It's not easy, this diving into the dark pools of body sense. People cry, go limp, protest, or move as if they were re-living the event, what I call participatory memories. I want to be clear: These emotional behaviors are not a releasing of those feelings. Such feelings may never go away for a trauma survivor. They are locked into the neuromotor cellular structures that grew in response to the event. Rather, this therapeutic process involves a recognition of the presence of those feelings in the body, a body sense awareness that is now more tolerable and thus able to be brought into the realm of a re-organizing self who can regain a sense of purpose and control.
This can only occur, however, because alongside the pain is the relief of knowing one is no longer alone in the nightmare, alongside the despair is the new possibility of hope, alongside the helplessness there is a glimmer of a more complete self. We cannot really feel and name the living hell of 20 years of suffering until we can feel the possibility of a safer, more loving, more accepting way of being that comes from an awareness of safety and support in the therapeutic encounter. This is the case for any type of successful trauma treatment. Getting to a point of being able to simply feel the experience directly in the body sense, without mediating thought, is all that is needed to activate the body's natural relaxation and restoration functions.
We most likely can never let go of those fearful moments. We can, however, let go of the expectations and judgments we had about ourselves, replacing them with an honoring of our unique history and an acceptance of who we are and how we came to be. I suspect that for those most hurt by life, recovering their body sense is the surest pathway to renewal of the self.