How somatic experiencing can help treat post-traumatic stress disorder

Photo Cred: Gustavo Fring/Pexels

By Brittany Vargas

You can’t think your way out of trauma. It affects you at an embodied level, which means body-based techniques like somatic experiencing (SE) can be especially helpful for treating post-traumatic stress disorder (PTSD), said Michele DeMarco, MTS, MSC, integrated therapist, clinical ethicist, and trauma researcher specializing in somatic experiencing in San Francisco, California.

This is all the more important because trauma doesn’t just haunt the mind — it haunts the body in very real ways, according to the Adverse Childhood Experiences (ACE) study published in the American Journal of Preventive Medicine, which was conducted by Kaiser Permanente and the Centers for Disease Control and Prevention (CDC) in 1998.

The study found “a strong dose response relationship between the breadth of exposure to abuse or household dysfunction during childhood and multiple risk factors for several of the leading causes of death in adults.” These include ischemic heart disease, cancer, chronic lung disease, skeletal fractures, and liver disease.

SE was developed by Peter Levine, PhD, and is rooted in hard science — physiology, biology, neuroscience, medical biophysics, and psychology — along with Indigenous healing practices, according to the SE website. 

According to Levine, when faced with a threat, our bodies generate an immense amount of energy preparing to fight or flee. If the threat passes and we’re unable to discharge that survival energy, our bodies become locked in physiological states of over or under arousal, which can lead to symptoms like insomnia, rage, depression, or numbness. It also leads to dysregulation, the inability to manage difficult emotions like anger or depression.

Clinical research demonstrating SE’s efficacy is promising. A 2017 study in the Journal of Traumatic Stress found it to be effective in treating PTSD and said it’s unique in that it facilitates healing without requiring the patient to give a full, explicit retelling of events.

“It’s looking more at the body’s story of trauma than it is the mind’s memory of trauma,” said DeMarco.

SE practitioners guide patients to resolve incomplete processes and work through ways in which the body retains unconscious traumatic memories, said Michael Shiffman, PhD, somatic psychotherapist in Los Angeles, California.

Incomplete processes might be grabbing a handrail that wasn’t there as you fell down the stairs or being able to cry when crying would have made you too vulnerable to do so in the moment, he explained.

SE is often used in the context of somatic psychotherapy, a body-centered therapy that has its origins in the 1920s and has experienced peaks and dips in popularity, Shiffman said. When using SE in his somatic psychotherapy practice, he’s not only helping people release traumatic shock, but also reading the language of the body.

“You’re getting people to be able to pay attention to their somatic patterning — the way in which they hold their body, what they do with their body, how they walk, how they stand. That changes the way one’s emotions work and that begins to change the way one thinks,” said Shiffman.

Changing the body in order to affect thinking and emotions is working in the exact opposite direction of cognitive-behavioral therapists, who target the mind first. Shiffman said that while working with the body deals with the unconscious memory process, working with the mind deals with the identity the person has developed as a result of those processes. He added that SE is now beginning to incorporate both of these approaches.

Helping patients with overwhelm and establishing safety

One primary goal of SE is to help patients more effectively tolerate overwhelming emotions such as rage or shame. Sessions start off by establishing baseline feelings of safety before moving into challenging emotions.

“It starts from a place of calm, safety, and connection, as opposed to, ‘Let’s just launch into the story and what happened,’” said DeMarco. “In a sense, it’s letting people know what it’s like to feel safe and secure, even when they don’t feel safe and secure,” she said.

Patients also establish safety in a process called orienting, which means getting into a state of deep comfort and settling down the nervous system. That might mean sitting in a soft chair, being outside, or touching a beloved object, said DeMarco.

Moving gently and slowly is key. Shiffman described how he used touch — an aspect of SE that allows practitioners to intervene with the client’s nervous system more directly — to help a patient who had been repeatedly assaulted during childhood. After each traumatic incident, she would curl up in a fetal position.

As an adult patient, it took a year before she was able to lay on the treatment table without curling up, but by working through her body’s constriction, she had a much-needed release.

“When she was just beginning to constrict her muscles, I would draw attention to it, so she could let go of it,” he said. “By bringing awareness to the part of her body that was reacting in this manner, she was able to open it up, and when she would do that, she could breathe more fully. When you breathe more fully, you cry. And then she would get scared. And we would work through the fear of crying.”

Shiffman’s example brings up an important point about how traumatic experiences affect our body systems.

“When you [curl up in the fetal position], you collapse your lungs, constrict your diaphragm, and contract your stomach. That leads to all sorts of muscular, digestive, and cardiovascular problems,” he said.

He added that over a dozen of his patients with complex trauma also have irritable bowel syndrome (IBS), while DeMarco said insomnia, IBS, and muscle tension are “part and parcel” of having a trauma history.

This link between PTSD and physical complaints is supported by research. A 2017 study in Pain Medicine on refugees and asylum seekers found that “somatic symptoms are of considerable concern among traumatized refugees” and highlighted the “importance of screening for PTSD in refugees presenting with pain and somatic symptoms.”

Chronic health issues that appear to have no physical origin may very well indicate unprocessed trauma, DeMarco said, making it important for practitioners to understand the impact of trauma on the body.