Understanding the body is key to understanding the mind in treating trauma.
Post-Traumatic Stress Disorder (PTSD) is a long lasting anxiety response to a developing three to six months after a traumatic event. An acute stress disorder is similar to PTSD, but symptoms are experienced immediately after the trauma. A person with PTSD has either experienced or witnessed a traumatic incident that is dangerous or life threatening. Sometimes an injury is sustained, you have witnessed someone else being seriously injured, or your personal integrity is threatened. Traumatic events include sexual or physical assault, mugging, torture, kidnapping, terrorist attacks, car accidents, natural disasters, being diagnosed with a life threatening illness, witnessing or discovering the unexpected death or injury of another person.
You feel helplessness, intense fear or horror at the time of the trauma. These feelings can be re-experienced repeatedly as symptoms of PTSD when triggered by environmental cues that are reminiscent of the trauma. Trauma clients often look fine on the surface, but experience nightmares, insomnia, flashbacks, feelings of numbness, are easily startled by noise or touch, experience depressed or irritable moods, social withdrawal, concentration and memory difficulties, and dissociation. Dissociation means being unable to experience the present moment as a body-mind felt experience (Management of Mental Disorders Treatment Protocol Project; 2004).
Effective treatment of PTSD involves helping a person to bite size memories or aspects of a traumatic event until the body lets go of the trauma, and calms itself. Sensorimotor psychotherapy is specifically geared towards treating trauma as it is a gentle and safe method. This method integrates sensorimotor processing, which is exploring body movements, sensations, gestures and postures of the body, together with integrating cognitive and emotional processing in the treatment of trauma. Psychotherapist and author Dr Peter Levine, confirms that trauma is a physiological reaction to danger, and is best treated from the body first and then the mind. Levine writes that “we are like animals as our response to fear is hard wired in our bodies. Humans are similar to animals in the wild because we too have the ability to discharge fully the highly activated energies mobilized for survival, and then resume normal functioning.” People therefore have an innate capacity in their bodies to resolve trauma (traumahealing.com).
A person develops PTSD when trauma is lodged in the body after attempts to run away or fight back from dangerous, or life threatening situations are thwarted. The body-mind changes abruptly into a fixated emotional state of anxiety after responding with frenzied flight, freezing on the spot or collapsed body posture. Levine says that “we really only have one fear, and that is the fear of not being able to cope” (traumahealing.com).
Overcome Post Traumatic Stress Disorder
Levine maintains that to repair traumatic injury we need to progressively and precisely restore the underlying flight or fight, and other defensive responses in the body that kick in at the moment before one’s escape is thwarted. Psychiatrist Bessel van der Kolk says that “preventing people from moving when something terrible happens is what makes trauma a trauma” (Wylie, M.S.). Van der Kolk explains that “the brain is an action organ it is characterized by the formation of patterns and schemas geared to promoting action.
People are physically organized to respond to things that happen to them with actions that change the situation” (Wylie, M.S.). As such, working with the body, not just the mind through talking, is essential in integrating disorganized sensations and action patterns that form the core imprint of the trauma in the body. Mary Sykes Wylie agrees that treatment needs to integrate sensations and actions that have become stuck for people to regain a sense of safety and efficacy (Wylie, M. S.). Van der Kolk discovered that traumatic memories remain stuck in the brain’s non-verbal and unconscious regions of the brain stem, where they are not accessible to the neo cortex which is the brain’s center of understanding, thinking and reasoning. This again confirms that it is our bodies not our minds that control how we respond to trauma. It is our bodies that know how to heal the trauma. Van der Kolk said that studies revealed that “people process their trauma from the bottom up, body to mind, and not mind to body” (Wylie, M. S.).
He understood this when his trauma patients found it difficult to talk about their trauma. Van der Kolk noticed his patients’ verbal understanding part of their brains switched off when they tried to access their trauma and couldn’t effectively think or speak, whereas areas of the autonomic nervous system (ANS) in the brain stem lit up. Trauma memories ignite ANS activation such as sweating, trembling or increased heart rate. The person senses their physical body and becomes aware of implicit physical actions they need to take to protect themselves (Wylie, M. S.).
Experiential body-mind psychotherapy teaches clients how to become mindful and turn their attention inwards to witness body-mind experiences. They can include spontaneous body sensations, patterns, movements, postures, and corresponding images or memories, emotions and thoughts emerging. The work becomes experimental and mindful bringing what is unconscious to consciousness where learning and change both physical and psychological can happen. Rather than focusing on the client’s story, the story-teller becomes the main focus, as this is where the healing happens.
When an early sign of ANS activation is noticed the therapist can help the client to make a mobilizing defensive response like kicking, pushing, standing, walking or running. The ANS increases activity in respiratory, cardiovascular and muscular systems in the body signaling that the person is preparing to fight or flee from a dangerous situation. Following these sensations the client can naturally bring on mobilizing defensive responses that they could not do at the time of the trauma, but that they now can do, and this becomes very healing for the client.
Pat Ogden and Kekuni Minton state that ‘trauma calls forth physical defenses’ that are firstly active fight/flight defenses. If this is not possible then the second line of defense is a passive defense that is submissive, automatic obedience, numbing and freezing, and requires extreme dissociation from core organizers (Ogden & Minton, Vol. 7, May 2001). Transforming the dissociation can be a large part of trauma recovery for clients. The client and therapist work together to observe both voluntary and involuntary body movements and sensations. These include the client’s body postures, gestures and facial expressions, and sensations like tingling, trembling, tightness or body heat or coldness which can be used to reduce ANS arousal and heal the trauma. It is also a process that enables the client to re-associate back into their whole body-mind.
Telling the trauma story can often be difficult and overwhelming for the client. This over arousal can be avoided by bringing the client’s attention to their internal sensations and involuntary movements which temporarily inhibit thinking and feeling. This helps the client to stay with body sensations and movements, and increases their ability to stay with the pain and experience present reality, rather than reacting as if the trauma was still happening.
A significant aspect of therapy involves helping the client modulate their arousal levels so they cease to feel overwhelmed by the intensity of their own physical and emotional activation (Ogden, P. Hands on Therapy). Once this arousal is within the window of tolerance for the client, they can begin thinking and speaking about the meaning they make through the sensorimotor processing completed in their bodies. As Ogden writes, “the therapeutic key becomes one of helping this critical information from within become accessible to the conscious body-mind, where it can become examined, understood and resolved” (Ogden, P. Hands On Therapy).
Conversely, when a person experiences a traumatic event during a vulnerable period such as childhood, the mind struggles to make sense of the experience and fit it into a secure and meaningful whole. As such this emotional experience floats unassimilated in our unconscious and jams the gears of our mind (Kurtz, R.). The pain of the emotional event can turn into PTSD symptoms where the body-mind continues to feel frustrated and exhausted in trying to make sense of the original experience. A stable and positive mood is only possible once we have successfully understood and integrated these emotionally overwhelming experiences (Kurtz, R.).
The client learns through experience how to process core beliefs in present moment mindfulness, while having a direct dialogue with their unconscious. This enables the client’s trauma memory to be integrated and their core beliefs to be reorganized, allowing for a greater range of mental, emotional, physical and behavioral coherence to occur. This results in the client having a far greater capacity to respond in any given situation from a mature adult place. As mentioned early a useful map for the therapist to deepen the client’s experience involves applying the five core organizers. These core organizers are body sensations, movements, images or memories, emotions and cognitions. This enables the client to get in touch with early memories that facilitates transformation. For example when a client talks about a memory they can begin to gain a picture of the memory through these core organizers.
The therapist may ask the client, ‘as you talk about this memory what happens inside your body as you remember the event?’ The client may respond with the words, ‘I see myself at school in the playground’. They can begin to understand what happened to them and to finally speak up if they were not listened to or believed. This can be profoundly healing for the client. As their thinking and rational mind comes on line they can decipher and separate emotions from thoughts, body sensations from body movements and make sense of why they feel scared, have a stomach ache, and believe they are undervalued. This is how the client gains clarity in knowing how they feel, sense and think. With this clarity the client is surprised to find the trauma memory linked to a long ago forgotten memory.
Ogden, writes, “when we work to integrate the raw data from the sensational level of our experience with other aspects of our overall reality, we develop a strong resource for knowing and expressing who we are, and for healing” (Ogden, Hands on Psychotherapy). As therapists we look at the body as having integrated actions, and where emotions have calmed and the body reflects that as well. When clients are able to re-center and refocus themselves on a deep level their trauma becomes uninteresting and they can move on with their lives to a greater fulfillment.
References
1. Allen, J.G., Coping with Trauma Hope Through Understanding 2005.
2. Barrett, M.J., Addressing PTSD: How to Treat the Patient Without Further Trauma, www.nicabm.com.
3. Kurtz, R., Five Recent Essays, 16-17, Summer 2006.
4. Levine, P., traumahealing.com.
5. Management of Mental Disorders Treatment Protocol Project (2004); World Health Organization Collaborating Centre for Evidence in Mental Health Policy, 2010.
6. Ogden, P. & Minton, K., Sensorimotor Processing for Trauma Recovery, Psychotherapy in Australia, Vol. 7. 3 May 2001.
7. Ogden, P., & Peters, A., Translating the Body’s Language.
8. Ogden, P., Body-Mind-Spirit Integration: Sensorimotor. Psychotherapy for Treating Trauma, www.nicabm.com.
9. Ogden, P., Hands-On Psychotherapy.
10. Wylie, M.S., Limits of Talk, in Psychotherapy Networker Magazine.