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Trauma and the Body

How integrating Yoga with CBT can boost treating trauma

Recent national news stories have featured people coming forward speaking of their experiences of sexual assault, sexual abuse, and trauma. Hundreds of demonstrators filled Washington to protest the nominee to the Supreme Court. These events have sparked women’s opening up about their experiences of assault - many of whom had not spoken up before. Christine Blasey Ford, Ph.D. testified both as a victim of assault and as an expert on the effects of trauma on the brain. She spoke of how one memory had lodged itself in her brain: the sound of her assailant’s laughter.

This memory if an example of what we call “triggers.” A trigger recreates the past in present times. As we say in the EMDR community “Old Brain Cells Fire”. The emotions, thoughts and bodily sensations experienced during a traumatic or event are reactivated. These experiences – sometimes called “flashbacks” - can be as vivid, real and frightening as they were years ago. We’ve all heard of veterans reacted to the sound of a car backfiring as though they are back in a firefight that began and ended decades before. As a psychotherapist who works with trauma and uses many methods, including EMDR, I utilize therapies that include not only thought patterns and emotions but physical sensation as well. Physical experience is oftentimes part and parcel of trauma patients’ emotional suffering and the body itself offers a pathway to healing.

Daniel Mintie, LCSW, an integrative trauma expert, utilizes both cognitive behavioral therapy [CBT] and yoga therapy to help patients heal from the aftereffects of trauma. “Language differentiates ‘body’ from ‘mind,’ Mr. Mintie explains. “And while these two are distinct they are never separate. Psychological experience always has correlates throughout our physical structure. When we think a stressful thought or have a distressing memory our bodies participate in such activities every bit as much as our minds. Our emotions too occur not only in such brain structures as the amygdalae but throughout our bodies. It is impossible to experience feelings like fear, anger or joy “from the neck up.” Our psychological lives are intimately bound up with activity in our endocrine, cardiac, respiratory and immune systems.”

I distinguish trauma from and other very upsetting events, as trauma typically involves feelings of extreme and overwhelming powerlessness. And both types of experience intimately involve the body. Heartbreak can literally feel like a cardiac event. Studies have shown that unresolved grief and recurrent traumatic experiences actually weaken the heart muscle. I know of this body/mind connection first-hand after losing babies in the 6th month on two separate occasions. And the difference between my memories of these two losses is instructive, shedding light on Mr. Mintie’s statement that body and mind are always one.

The first time, hearing in the sonogram suite that my baby had died, I felt dread in the pit of my stomach and a clutching in my chest. Instantly I went from complete joy over the impending birth of my healthy daughter to complete horror at my loss. There was no hope. The doctor gave me a medication that precipitated labor. I was sent home and told to “drink vodka.” I had no idea that I was going through labor and no idea what to expect. Along with the terrible physical pain, I was terrified. The following day the doctor put me under and it was over. I woke to an empty womb and wretched grief. The memories of that loss are filled with anguish that I feel in my body to this day. I also still fear the physical and emotional anguish associated with that terrible memory.

The second time I lost a child the same experience re-occurred, with a nightmarish similarity. I couldn’t believe what was again happening. I had entered the sonogram suite completely anxious, again in the 6th month of my pregnancy, and the result of the sonogram was the same. Again, the baby was dying and there was no hope. This time the doctors recommended that I deliver my baby so that they could do a more thorough study. They found nothing abnormal; my baby’s anatomy was perfect and yielded no clue as to the cause of death.

The first time I went through my grieving process without having any tangible baby or evidence of my pregnancy, beyond shadowy sonogram pictures. Leaking breasts and all, I couldn’t memorialize and maintain a tangible visual or tactile memory of my baby. This had made grieving painful in a way that I didn’t want to repeat. I wanted to deliver and hold this baby. I agreed with the doctors.

The profound difference in how I hold these two memories in my body and mind has everything to do with the different way my body experienced the loss. Because I wasn’t able to get an epidural, my doctor ordered the nurses to give me a continual Demerol drip. This transformed the experience into one where I was able to experience everything, but with much less physical pain and some emotional distance. In fa,ct my body was completely relaxed, a state opposite my emotional state. This afforded me some physical buffer from emotions of sadness and fear. Being cared for and given an understanding of what to expect helped my fear compared to the earlier experience. And the memory of the event is profoundly different as I relive those memories years later. Fear, deep sadness and physical pain were not connected in my brain, to that actual event. While my grieving process was similar - same leaking breasts, hormone drop, grief, and fear of what this meant for my ability to have a baby – I had very different experiences of labor and delivery. My second set of memories focus on feelings of gratitude toward the small kindnesses from others: my husband bringing me a bedpan when I needed it, his rubbing my feet and holding my hand. Gratitude for the kind doctor who sat on my bed at midnight when I had been in labor for 19 hours, frightened and not knowing why this was taking so long. The extraordinary care of the nurses who were so gentle, compassionate and thoughtful, respecting the birth and death of our daughter and giving me several photos, footprints and condolence cards. I physically remember the emotions of gratitude and compassion more than the sadness and fear of that 24 hours.

The neuronal connections forged when experiencing trauma without a ‘block’ like an IV drip die hard. It is vital to honor and understand that while a patient may process and reprocess memories and diminish upsetting feelings through psychotherapy, it is absolutely vital to incorporate a somatic piece to address the physical sequelae of trauma. Yoga and other body-based therapies can have a dramatic healing effect. These complementary therapies work hand in glove with cognitive approaches like CBT. Changing our physical experience can be tremendously supportive of changing our thought patterns and emotions. Healing body and mind are like feet walking: as one moves forward it takes the other with it.

“Integrative healing is not adding one thing [yoga therapy] to something “else” [CBT],” Mr. Mintie explains. “It is, rather, skillfully utilizing both pathways to healing, with an appreciation that each offers complete access to the suffering and wellness of the whole person. Working with the body, by means of yoga, we heal the mind. Working with CBT tools we sooth and restore the body to a state of vitality, equilibrium and wellness.” In his self-help book "Reclaiming Life after Trauma: Healing PTSD with Cognitive-Behavioral Therapy and Yoga"., Mr. Mintie presents a suite of both yoga therapy and CBT tools to do precisely this.

So! You’re not just a head being carried around atop a body. You are a whole person. Let’s take care of all of you.