Trauma and The Body

Excerpts from: Trauma and the Body: A Sensorimotor Approach to Psychotherapy, Pat Ogden, Kekuni Minton, Clare Pain, W.W. Norton & Company, Inc. New York NY 2006.

Therapy needs to help them develop a deep curiosity about their internal experience.

Once people realize that their internal sensations continuously shift and change, that they have considerable control over their physiological states, and that remembering the past does not inevitably result in overwhelming emotions, they can start to explore ways to actively influence the organization of their internal landscape.  As patients learn to tolerate being aware of their physical experience, they discover physical impulses and options that they had abandoned for the sake of survival during the trauma.

These impulses and options manifest themselves in subtle body movements such as twisting, turning, or backing away.  Amplifying these physical impulses and experimenting with ways to modify them ultimately bring the incomplete trauma-related action tendencies to completion.

Sensorimotor psychotherapy helps them reorient to the present by leaning to attend to nontraumatic stimuli.  This focus opens them up to learning from new experiences, rather than reliving the past over and over again, without modification by subsequent information.

1) become aware of old automatic maladaptive action tendencies

2) learn to inhibit the initial impulses

3) experiment with various alternatives to bring to completion the incomplete, frozen actions that proved to be futile at the moment of the trauma

4) practice ways to execute alternative, effective actions

…integrate our knowledge of body-oriented therapy, neuroscience, and attachment theory into a composite treatment method….therapy for traumatized individuals will take a giant leap forward and never be the same.

Working directly with the client’s embodied experience is largely viewed as peripheral to traditional therapeutic formulation, treatment plan, and interventions.

…helping clients become aware of their bodies, track bodily sensations, and implement physical actions that promote empowerment and competency.

…a self-representation uttered in a here-and-now therapy moment, such as “I’m a bad person,” affects physical sensation, posture, autonomic arousal, and movement. …physical sensations, postures, and movements affect their emotional state and influence the words and content they describe in therapy.

…traumatized individuals tend to interpret these reactivated sensorimotor responses as data about their identity or selfhood:  “I am never safe,” “I am a marked woman,” “I am worthless and unlovable.”  These beliefs are reflected in the body and affect posture, breathing, freedom of movement, even heart rate and respiration.

Attempting to describe traumatic events thus brings the past suddenly into the present, and orientation to current reality may be partially or temporarily lost.

“Remembering” the trauma is experienced as “It’s happening again—I’m still not safe.”  At those moments of feeling under threat, the “thinking” mind—the frontal cortex—is compromised.

…alternate between 1) emotional and bodily numbing and avoidance of cues reminiscent of the trauma and 2) intrusive reliving of the trauma via flashbacks, dreams, thoughts, and somatic symptoms…dissociation: traumatic events are distanced and dissociated from usual conscious awareness in the numbing phase, only to return in the intrusive phase”

Reptilian Brain: first to develop from an evolutionary perspective, governs arousal, homeostasis of the organism, and reproductive drives, and loosely relates to the sensorimotor level of information processing including sensation and programmed movement impulses.

Limbic Brain: correlates with emotional processing, the paleomammalian brain, found in all mammals, surrounds the reptilian brain and mediates emotions, memory, some social behavior, and learning.

Neocortex: last to develop. Enables cognitive information processing, such as self-awareness and conscious thought, and includes large portions of the corpus callosum, which bridges the right and left hemispheres of the brain and helps consolidate information.

…the fixed action patterns seen in defenses; changes in breathing and muscular tone; and autonomic nervous system activation.

…traumatized people typically form inflexible, maladaptive interpretations of the trauma or other life experience.  Such interpretations take the form of inadvertent, generalized thoughts that are negatively biased and erroneous, such as “I am bad,” “It was my fault,” “All men are dangerous,” and so on.

Each thought is an action—that is, a mental action—that generates not only more negative cognitions but also corresponding emotions and sensorimotor reactions.  These thoughts play a part in the way traumatized people continue to organize their experience, which is shaped by pervasive patterns of cognitive distortions; these distortions result in persistent experiences of low self-esteem and defeat, as well as chronic perception of a lack of safety.

Cognitive processing is inextricably linked with our bodies.  Bodily feelings, or “somatic markers,” influence cognitie decision making, logic, speed, and context of thought.  The background body sensations that arise during cognitive processing form a biasing substratusm that influences thefunctioning of the individual in all decision-making processes and self-experiences.  The “very structure of reason itself comes fromt eh details of our embodiment.  The same neural and cognitive mechanisms that allow us to perceive and move around also create our conceptual systems and modes of reason”  The circuits of the brain that are used for mental action are the same ones that are used for physical action.  The movement of the body as a child matures is essential for the optimal development of memory, language, and learning.  Ratey speculated that motor neurons may even drive our sense of self-awareness.  Thus, how we think and what we think are literally shaped by the bo0dy, and vice versa.

As early relational dynamics with primary caregivers, traumatic or non-traumatic, serve as blueprints for the child’s developing cognition and belief systems, and these belief systems influence the posture, structure, and movement of the body, and vice versa.  If a child grows up in a family that values high achievement and encourages the child to “try harder” at everything she undertakes, her posture, gesture, and movement will be shaped by this influence.  If this value is held at the expense of other values, such as “You are loved for yourself, not for what you do,” the child’s musculature will probably be toned and tense; her body will be mobilized to “try harder.”  In contrast, a child who grows up in an environment where trying hard is either discouraged or seen as maladaptive and where everything he achieves is undervalued, might have a sunken chest, limp arms, and shallow breath; his body will reflect a childhood experience of not feeling assertive and confident, of “giving up.”  It may be difficult for this child to mobilize consistent energy or sufficient self-confidence to complete a difficult task.  Chronic postural and movement tendencies serve to sustain certain beliefs and cognitive distortions, and the physical patterns, in turn, contribute to these same beliefs.

If the body shapes reason and beliefs—and vice versa—then the capacity for insight and self-reflection—our ability to “know our own minds—will be correspondingly limited by the body’s influence….Reflecting on, exploring, and changing the posture and movement of the body may be as valuable.  For example, Terry came to therapy with a body “filled with fear”: His shoulders were hiked up, his head was retracted, his chest was tight with held breath, his eyes darted around, and he had an exaggerated startle reflex.  His chronic experience of his body did not support the “reasonable” belief that his past trauma was over and he was not currently in danger.  Terry reported that he knew he was safe, but he felt as if he were unsafe.  In therapy, the sensations and movements of his body were addressed in order to reveal their impact on his beliefs as well as to change both his body and beliefs.  In the course of therapy, Terry became aware of this mind-body interface; he worked both cognitively and physically to change his embodied belief by relaxing his shoulders, deepening his breathing, and feeling his legs as firmly grounded and supporting his upper body.  During this exploration, memories of his trauma emerged and were dealt with and resolved.  After several sessions, Terry described a shift in his body and his beliefs: “Now my body feels like it supports me!  I feel safer when my shoulders are more relaxed and my breathing is not so shallow and tense.”

Emotions add motivational coloring to cognitive processing and act as signals that direct us to notice and attend to particular cues.  Emotions help us take adaptive action by calling attention to significant environmental events and stimuli.  The “emotional brain directs us toward experiences we seek and the cognitive brain tries to help us get there as intelligently as possible.  According to Llinas, “As with muscle tone that serves as the basic platform for the execution of our movements, emotions represent the premotor platform as either drives or deterrents for most of our actions.”

Traumatized people characteristically lose the capacity to draw upon emotions as guides for action.  They might suffer from alexithymia, a disturbance in the ability to recognize and find words for emotions.  They may be detached from their emotions, presenting with flat affect and complaining of a lack of interest and motivation in life and an inability to take action.  Or their emotions may be experienced as urgent and immediate calls to action; the capacity to reflect on an emotion and allow it to be part of the data that guides action is lost and its expression becomes explosive and uncontrolled.  Through nonverbal remembering triggered by reminders of the event, traumatized individuals relive the emotional tenor of previous traumatic experiences, finding themselves at the mercy of intense trauma-related emotions.  These emotions can lead to impulsive, ineffective, conflicting, and irrational actions, such as lashing out physically or verbally, or feeling helpless, frozen, and numb.  Emotional arousal in an individual with unresolved trauma thus often provokes action that is not an adaptive response to the present (nontraumatic) environment, but is more likely a version of an adaptive response to the original trauma.

Emotions usually follow a phasic pattern with a beginning, middle, and an end.  However, for many traumatized individuals, the end never arrives.  Emotional responses to very strong stimuli, such as trauma, do not appear to extinguish—a phenomenon that has been demonstrated in animal research by LeDoux, who noted that emotional memory may be forever.  Traumatized individuals are often fixated on trauma-related emotions of grief, fear, terror, or anger.  There might be a variety of reasons for this fixation; denial or lack of awareness of the connection between current emotions and past trauma; attempts to avoid more painful emotions; the inability to “think clearly”; or the inability to distinguish emotions from bodily sensations. Moreover, the emotions may relate to a variety of past events rather than only one.  All these elements contribute to a circular, apparently never-ending reexperiencing of trauma-related emotions.

…emotions are inseparable from the body; “Emotions are …matters of the body: of the heart, the stomach, the flesh.  Also, they are of the brain and the veins.”  Whether we are aware of these internal sensations or not, they both contribute to, and are the result of, emotions.  Butterflies in the stomach tell us we are excited, a heavy feeling in the chest speaks of grief, tension in the jaw informs us we are angry, an all-over tingling feeling indicates fear

….emotions have two features: first, the internals sensation, which is “inwardly directed and private,” and second, visible feature, which is “outwardly directed and public”  Internal emotional states are thus experienced as subjective bodily sensations and are reflected in our outward presentation, giving signals to others around us about how we feel.  Anger might be visible in the purse of the mouth, clenched fists, narrowed eyes, and general bodily tension.  Fear may be communicated in hunched shoulders, held breath, and a pleading look in the eyes or in a bracing or moving away from the frightening stimulus.  These bodily stances might be an immediate response to a current situation or a chronic, pervasive emotional state….In therapy we can utilize the outwardly directed physical manifestations to clarify, work with, and resolve trauma-related emotions.  One client who presented with visible tension across her shoulders was directed to notice this tension and explore it for meaning.  She reported that it felt like the tension was holding back anger—an insight gleaned from awareness of her body rather than from cognition.  This insight led to the realization of an erroneous belief that she had no right to be angry at her abusive father.  Working with the anger through the tension itself (slowly executing the movement the tension “wanted” to make, processing the associated memories, beliefs, and emotions, and learning to relax the tension) assisted this client on her road to fuller self-expression and resolution of the emotions related to her past traumatic events.

…when trauma-related emotions such as terror are coupled with body sensation, such as trembling, the client is encouraged to distinguish body sensations and movements from emotions.  In these instances, we help clients differentiate emotional processing from sensorimotor processing.  In our vernacular, emotional processing pertains to experiencing, articulating, and integrating emotions, whereas sensorimotor processing refers to experiencing, articulating, and integrating physical/sensory perception, body sensation, physiological arousal, and motor functioning.  This differentiation between these two levels of processing is important in trauma therapy because clients often fail to discriminate between body sensations of arousal or movement and emotional feeling, which can lead to the escalation of both.  This lack of discrimination is partly due to the fact that sensation and emotions occur simultaneously and suddenly, and partly because affect dysregulation and degrees of functional alexithymia are characteristic of posttrauma symptoms.  Clients often find themselves struggling with the effects of overwhelming emotions, with little awareness of how the body participates in creating and sustaining these emotions.

If body sensations (e.g., trembling, rapid heart rate) are interpreted as an emotions (e.g., panic), each level of experience—sensorimotor and emotional—inflates and compounds the other….By working with the client to differentiate the sensation of physiological arousal from emotional arousal, the amount and kind of information are reduced and more ably processed by the client.  Physiological arousal can be addressed, and often diminished, by uncoupling trauma-related emotion from body sensation through attending exclusively to the physical sensations of the arousal (without attributing meaning or emotion to them).  Then, after the physiological  arousal returns to a tolerable level, the client can look at the emotional contents of the traumatic experience and integrate both.

…traumatized people frequently experience themselves as being at the mercy of their sensations, physical and sensory reactions, as well as emotions, having lost the capacity to effectively regulate these functions.  In the clinical practice of sensorimotor psychotherapy, we identify three general components of sensorimotor processing: inner-body sensation, five-sense perception, and movement.

Inner-Body Sensation:  refers to the myriad of physical feelings that are continually created by movement of all sorts within the body.  When a change occurs in the body, such as a hormonal shift or a muscular spasm, this change may be felt as an inner-body sensation.  The contraction of the intestines, circulation of fluids, biochemical changes, the movements of breathing, or the movements of muscles, ligaments, or bones all cuse inner-body sensations.

…movements occurring within our internal organs, such as racing of the heart, butterflies in the stomach, nausea, hunger, or that “gut feeling.”  We have a variety of nociceptors, most numerous in the skin and less numerous in tendons, joints, and organs, which relay various kinds of physical pain.

Five-Sense Perception:

All learnng depends on our ability to:

1) receive sensory information from the environment

2) synthesize this information

3) organize subsequent behavior

Because this process is influenced by our individual associations with what we sense, it overlaps with the other levels of processing…

Once this unconscious comparison has taken place, movement is planned and executed…

Our beliefs and emotional reactions to previous similar sensory stimuli condition our relationship with current stimuli.  Without the expectations that influence perceptual priming, each sensory experience would be novel, and we would quickly be overwhelmed.  Instead, we fit sensory input into learned categories…

This priming function becomes maladaptive for traumatized individuals, who repeatedly notice and take in sensory cues that are reminiscent of past trauma, often failing to notice concomitant sensory cues indicating that current reality is not dangerous.

Movement:

…frontal lobes of the cortex – home to the motor cortex…responsible for many forms of movement.  (same part of the brain as reasoning, problem-solving)

Movement has shaped, and continues to shape our minds, and vice versa.

Movement:  gross motor movement: crawling, walking

Fine motor movement: picking up objects, wiggling toes

Non-verbal interpersonal communication: facial expression, changes in posture, tilt of the head, gestures of hands, arms.

Involuntary fixed action patterns (acute traumatic situations)

We react automatically, only to feel an emotional response some time later.

Sudden intake of breath, widening of eyes, gripping of steering wheel, slamming on the breaks, turning car to avoid collision

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