Somatic experiencing therapy was developed specifically for the treatment of trauma, which is medically diagnosed as post-traumatic stress disorder (PTSD). PTSD is caused by an experience or several experiences that are so overwhelming and distressing that a person is unable to cope. The traumatic event usually triggers the stress response known as fight, flight, or freeze. The stress response causes a number of somatic reactions: hormones such as cortisol are released; cardiac, digestive, and respiratory functions are adapted; and the heart rate changes as the circulatory system prepares for action. 

With fight-or-flight responses, breathing and heart rate increase, whereas with the freeze response, they slow down. Somatic therapy uses bottom-up processing to modify the trauma-related stress response and alleviate the lasting psychophysiological effects of the traumatic event. The founders of somatic experiencing therapy consider trauma to be an interrupted natural and non-pathological response that needs to be brought to closure and feel that this should be done through embodied practice.

Understanding Trauma’s Effect on the Body 

When the autonomic nervous system (ANS) detects a threat and triggers the fight, flight, or freeze response, the functions involved in the rest-and-digest state are paused or adapted. This is an automatic reaction, meaning you cannot consciously choose whether or not to trigger the stress response or select a specific reaction. The stress response can be understood as a chain reaction that triggers certain bodily responses. When the ANS detects a threat, it causes the hormones adrenaline and cortisol to be released. This release of adrenaline causes higher-level brain functions to decrease or stop altogether. The pre-frontal cortex – the part of the brain involved in decision-making, problem-solving, emotional expression, and memory – essentially shuts down. This allows more blood, and therefore more oxygen, to be sent to the large muscle groups for fighting or fleeing. This has been a fundamental function for human survival by ensuring immediate and effective responses to threats. 

The higher-level brain is referred to as the cortex or forebrain. It is involved in complex functions like motor control and emotional expression and, perhaps most prevalent in trauma therapy, memory. When the cortex is shut off, memories cannot be stored as they usually would. Instead, the memory of the traumatic event is stored in the amygdala, leaving it disorganized and without a connection to time, reasoning, or other memories. The traumatic memory is stored in the reptilian brain, the part responsible for basic automatic functions like breathing, heart rate, and communicating sensory information to the limbic system and cortex. When the reptilian brain detects sensory information related to the traumatic memory, such as the sound of a gunshot, for example, a connection is made with the memory before the sensory information is passed to the limbic system or cortex. 

While this may be useful for human survival by ensuring the fastest possible response to a threat, it prevents the cortex from evaluating whether the sensory information is an actual threat. For example, suppose the sensory information (the sound of a gunshot) were passed to the cortex. In that case, the brain could use problem-solving and critical thinking to analyze the environment and correctly identify the sound as a firework. Unlike conventional psychotherapy, which mainly focuses on verbal cognitive processes, somatic therapy focuses on the functioning of the regulatory levels of the nervous system. It targets the area where the traumatic memory is stored and focuses on sensory information processing within the core response network (CRN).

The Core Response Network

The core response network is formed by four subcortical structures:

• The autonomic nervous system (ANS)
• The emotional motor system (EMS)
• The reticular arousal systems (RAS)
• The limbic system (LS)³ 

The CRN triggers immediate, automatic responses to environmental information before the cortex processes this data and forms a complex, active system that can trigger a variety of functional and dysfunctional states.³

In somatic experiencing, Peter Levine and Ann Frederick state, “trauma is a highly activated incomplete biological response to a threat, frozen in time.”² People experiencing trauma are caught in a dysregulated and dysfunctional state within the CRN. 

Unlike most trauma talk therapies, somatic therapy focuses on nonverbal experiences while still using words to facilitate the identification and elicitation of somatic experiences. These experiences are categorized as interoceptive, proprioceptive, and kinetic sensations and experiences.

Interoceptive, Proprioceptive, and Kinetic Sensations

In assisting clients with drawing attention to their bodies, somatic therapists describe sensations and experiences as:

• Interoceptive – a visceral internal awareness of the body
• Proprioceptive – spatial orientation of the body
• Kinesthetic – sensations of movement

In somatic experiencing, these are analyzed to bring unknown aspects of yourself and your experience into the known. 

By directing clients’ attention toward internal sensations, they are supported in gradually reducing the arousal associated with the trauma.³ As somatic experiencing, from a theoretical perspective, views trauma as an incomplete defensive reaction to a traumatic event, the goal of somatic therapy is to release the traumatic activation.² This is achieved through increased awareness and tolerance of bodily sensations and related emotions. Increasing interoceptive, kinesthetic, and proprioceptive awareness eventually triggers a discharge process that allows the activation to dissipate.

Unlike exposure therapy, clients do not need to relive the traumatic event to reduce the stress reaction.³ A direct and intense evocation of traumatic memories is carefully avoided in somatic therapy. 

Effectiveness of Somatic Therapy

There has been an increased interest in somatic therapy in recent years, which has led to a more detailed evaluation of its effectiveness. Overall, findings show that somatic therapy can effectively treat trauma in a variety of settings.³

In particular, the present body of research shows that somatic therapy improves comorbid symptoms, including pain-related symptoms and depression, as well as increasing resilience. 

Overall, there is increasing awareness of the benefits of somatic therapy, particularly in treating trauma, including complex trauma. In an increasingly stressed world in which our understanding of trauma is rapidly growing, somatic therapy represents an innovative approach to alleviating mental and physical suffering with methods that can transcend the therapy room.

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Sources

 [1] Kuhfuß, M., Maldei, T., Hetmanek, A., & Baumann, N. (2021). Somatic experiencing – effectiveness and key factors of a body-oriented trauma therapy: a scoping literature review. European journal of psychotraumatology, 12(1), 1929023. 

[2]  Levine, P. A., & Frederick, A. (1997). Walking the tiger healing trauma: The innate capacity to transform overwhelming experiences. North Atlantic Books.

[3]  Payne, P., Levine, P. A., & Crane-Godreau, M. A. (2015). Somatic experiencing: using interoception and proprioception as core elements of trauma therapy. Frontiers in psychology, 6, 93.

[4]  van der Kolk, B. A. (2015). The body keeps the score: Mind, brain and body in the transformation of trauma. Penguin Books.