This is just a brief little article from Psych Central's World of Psychology blog, but it offers some nice introductory information on the benefits of somatic psychotherapies for trauma.

The two main models I like are Somatic Experiencing, developed by Peter Levine, and Sensorimotor Psychotherapy, developed by Pat Ogden. Both of these cost three arms and a leg to get trained in, but there are useful books.

Recommended Reading:

• Trauma and the Body: A Sensorimotor Approach to Psychotherapy by Pat Ogden (part of the Norton series in Interpersonal Neurobiology)
• Sensorimotor Psychotherapy: Interventions for Trauma and Attachment by Pat Ogden (also part of the Norton series) - Due out December 15, 2014
• Waking the Tiger: Healing Trauma by Peter Levine
• Trauma Through a Child's Eyes: Awakening the Ordinary Miracle of Healing by Peter Levine
• In an Unspoken Voice: How the Body Releases Trauma and Restores Goodness by Peter Levine

Somatic approaches can be very helpful, especially for preverbal trauma.

How Somatic Therapy Can Help Patients Suffering from Psychological Trauma

By Kay Khan
September 12, 2014

Whatever happens in our lives impacts our mind either consciously or unconsciously. Sometimes events — such as the unexpected death of a loved one, illness, fearful thoughts, near-death accidents or experiences — result in traumas. Psychological trauma causes damage to the psyche that occurs as a result of a severely distressing event.

How Somatic Psychotherapy Helps

Somatic psychotherapy is one of the best ways to help patients suffering from psychological traumas cope, recover and live a normal life. The word somatic is derived from the Greek word “soma” which means living body. Somatic therapy is a holistic therapy that studies the relationship between the mind and body in regard to psychological past. The theory behind somatic therapy is that trauma symptoms are the effects of instability of the ANS (autonomic nervous system). Past traumas disrupt the ANS.

According to somatic psychologists, our bodies hold on to past traumas which are reflected in our body language, posture and also expressions. In some cases past traumas may manifest physical symptoms like pain, digestive issues, hormonal imbalances, sexual dysfunction and immune system dysfunction, medical issues, depression, anxiety and addiction.

However, through somatic psychotherapy the ANS can again return to homeostasis. This therapy has been found to be quite useful in providing relief to disturbed patients and treating many physical and mental symptoms resulting from past traumas.

Somatic psychology confirms that the mind and body connection is deeply rooted. In recent years neuroscience has emerged with evidence that supports somatic psychology, showing how the mind influences the body and how the body influences the mind.

How it Works

The main goal of somatic therapy is recognition and release of physical tension that may remain in the body in the aftermath of a traumatic event. The therapy sessions typically involves the patient tracking his or her experience of sensations throughout the body. Depending on the form of somatic psychology used, sessions may include awareness of bodily sensations, dance, breathing techniques, voice work, physical exercise, movement and healing touch.

Somatic therapy offers a variety of benefits. It reframes and transforms current or past negative experiences, inculcates greater sense of oneself, confidence, resilience and hope. It reduces discomfort, strain and stress while developing a heightened ability to concentrate.

Some of the somatic methods that therapists use are titration and pendulated method. Titration uses a resource state, a place of safety. The patient is guided through traumatic memories and then the therapist asks the patient if he or she notices any change in the way they feel when the memory is revived. The physical stimulus is usually gentle and small. However, if physical symptoms occur, they are then attended to at length.

On the other hand, pendulated method refers to the movement between homeostasis and instability. Unlike titration, in this type of method, the patient is moved from a state of homeostasis to a state where physical symptoms are present. Then the patient is helped to return to the state of stability. In this method, discharge occurs. Discharge is stress that is stored by the nervous system. It can include discomforting experiences, nausea, twitching and flushing of the skin.

When somatic therapy sessions are completed, the patient often reports a feeling of being free, less stressful and more engaged with life. It decreases the level of physical pain and mental stress, too.

Disclaimer:

Unanihealth has provided this material for your information. It is not intended as a substitute for medical expertise and advice of your primary health care provider. We encourage you to discuss any decisions about treatment or care with your health care provider. The mention of any product, service, or therapy is not an endorsement by Unanihealth or its writers.

Sources:

• http://www.recoveryranch.com/articles/trauma-and-ptsd-articles/somatic-experiencing-therapy/
• http://www.treatment4addiction.com/treatment/types/somatictherapy/
• http://www.somatictherapy.net/content/why-somatic-psychotherapy

A Trauma-Based Model of Mental Illness (preliminary thoughts)

Here is another section (still in the process of being written) from the paper I have been working on for a couple of months now - or maybe it will be a monograph, since it keeps getting longer and longer.

This section (much of which is still missing citations) proposes a new model of mental illness that does away with many of the diagnoses we now find in the DSM. Rather, it proposes a trauma-based model that sees symptoms as adaptations to the traumatic experience.

As I said, this is VERY preliminary - just began writing it yesterday. Any feedback is welcome.

A Trauma-Based Model of Mental Illness

It is my belief, based on years of reading the trauma literature and working with sexual trauma clients in therapy, that nearly all the traits we label as mental illness are more accurately understood as adaptations (or clusters of adaptations) to traumatic experience, either interpersonal or "shock."

Interpersonal traumas are those occurring between people in relationship, such as neglect, abuse, bullying, and attachment failures. The younger one is when these traumas occur, the more profound their impact on brain development.

"Shock" traumas are those single frightening events that can seriously disrupt our lives and our basic understanding of the world. These may include natural disasters, accidents, stranger rape, muggings, and other unexpected, unpredictable violent disruptions of our lives.

The greater the severity of the trauma, the more extreme the adaptations a survivor makes to cope with the experience. Early interpersonal trauma tends to be more difficult to treat than shock traumas, unless the person experiencing the shock trauma has also experienced adverse child events. I propose that we can create a spectrum of how these adaptations are generated and how they function, ranging from less extreme to more extreme.

At one end we might have the adaptation cluster often labeled as an adjustment disorder, with anxiety or depression being common expressions. Addictions and other forms of self-numbing behavior would also likely be in the first half of the spectrum.

An issue with some of the adaptations, particularly addictions, is that they generally co-occur with other adaptations. For example, post-traumatic stress disorder (PTSD) often co-occurs with mood symptoms, addictions, or disordered personality structures.

PTSD would be somewhere near the middle, although its manifestation can be mild to severe. Further down the spectrum would be dissociative disorders, the most extreme form of PTSD, with the most extreme adaptation being dissociative identity disorder (DID).

At the far end would be full-blown psychosis, representing a cumulative experience so awful and unbearable that reality become intolerable, necessitating a retreat into an alternate reality often imbued with a sense of importance or specialness, which is even true in paranoid iterations of psychosis.

It's important to keep in mind that when these interpersonal traumas occur during development, they create changes in the way the brain is wired, particularly the right hemisphere, the source of affect regulation, interpersonal skills, and body-mind integration.

Likewise, many of the adaptations noted here will manifest in the brain as shrinkage of one set of circuits or enlargement of another. For example, PTSD can produce an enlarged amygdala and a smaller hippocampus. Prolonged environmental stress also generates excessive levels of cortisol and other stress hormones that can damage brain function and leave the survivor in a near constant state of hypervigilance.

How Trauma Changes the Brain

When confronted with a stressor, a series of events occurs in the body that generates what we now call the “fight or flight response.” This process evolved early in the history of life on Earth to allow organisms to act in a situation where their life was in danger. In response, the body generates the energy for either a “fight” or a “flight” through activation of the nervous system and the endocrine system in order to maximize resources for surviving the threat (the stressor).

The following is paraphrased from Neigh, Gillespie, and Nemeroff (2009).

Researchers have identified two phases to this process. When the stressor is detected, the initial phase of the stress response begins. The sympathetic nervous system (associated with action, the "fight or flight" response) releases norepinephrine from nerve terminals and epinephrine from the adrenal medulla into the general circulation. Both of these neurochemicals and stimulants in their effects on the body.

In the secondary phase, moments later, corticotropin releasing factor (CRF) is released by “parvocellular neurons of the hypothalamic paraventricular nucleus into the hypothalamo-hypophyseal portal system for transport to the anterior pituitary gland where it stimulates the release of adrenocorticotropic hormone (ACTH) into the general circulation” (Swanson, Sawchenko, Rivier, & Vale, 1983; cited in Neigh, Gillespie, and Nemeroff, 2009). The ACTH travels to the adrenal cortex where it stimulates the release of glucocorticoids (cortisol is the primary stress hormone in primates). It generally takes several minutes for these processes, which are characteristic of the hypothalamic-pituitary-adrenal (HPA) axis stress response, to become fully activated.

Following the crisis, activity in the HPA axis is dampened through negative feedback (the parasympathetic nervous system, associated with "recuperation") via stimulation of glucocorticoid receptors within the hippocampus, hypothalamus, and anterior pituitary (Jacobson & Sapolsky, 1991). When there is a crisis, this stress response allows an organism to shift biological resources away from whatever activity was the focus and engages physiological functions that promote survival.

However, if the stress response becomes chronic due to repeated exposure to stressors, or a physiological deficit in the negative feedback system (or both), the organism experiences an on-going excess in stress hormone levels, which can trigger pathological changes in a variety of physiological systems, leading to stress-related diseases (McEwen, 2008).

This near-constant state of "activation" also leads to many of the symptoms of PTSD, including anxiety, memory deficits, hypervigilance, and the exaggerated startle response. The inability or failure of the body to metabolize the stress hormones, representing in essence that the situation cannot be escaped, results in the third and fourth of the Four F's - fight, flight, freeze, and fold. The freeze response is the most common experience for those who experienced on-going trauma, and the fold represents complete surrender, a profound state of "giving up."   

Whitehouse and Heller explains it this way:

Part of the problem is that when these states occur, discharge of the intense energies mobilized to meet threat often becomes thwarted. Often we just don't have the time necessary to complete them. Nevertheless, the survival energy has mobilized for fight or flight, but literally has no place to go and ends being converted into symptoms. (Whitehouse & Heller, 2008)

The freeze response (fold is very rare, so it will not be discussed here) is characterized by a simultaneous activation of the sympathetic and parasympathetic nervous systems. According to Peter Levine, the creator of Somatic Experiencing:

We have several synonyms for freeze, including dissociation, immobility, spacing out, deer in the headlights look. In the healthy nervous system it still serves and protects us humans, but often freeze is associated with the residual crippling effects of trauma. Here's what happens that causes humans to get stuck in trauma. (Levine, 1992)

References (partial)

• Neigh, GN, Gillespie, CF, and Nemeroff, CB. (2009, Aug 6). The Neurobiological Toll of Child Abuse and Neglect. Trauma Violence Abuse; 10: 389-410. DOI: 10.1177/1524838009339758
• Jacobson, L., & Sapolsky, R. (1991). The role of the hippocampus in feedback regulation of the hypothalamic-pituitary-adrenocortical axis. Endocrine Reviews, 12, 118-134.
• McEwen, BS. (2008). Central effects of stress hormones in health and disease: Understanding the protective and damaging effects of stress and stress mediators. European Journal of Pharmacology, 583, 174-185.
• Whitehouse, B., & Heller, DP. (2008). Heart Rate in Trauma: Patterns Found in Somatic Experiencing and Trauma Resolution. Biofeedback, 36(1).
• Levine, P. (1992). Somatic Experiencing. The Foundation for Human Enrichment. http://www. traumahealing. com/index. html.

Dr. Peter Levine's Somatic Experiencing is one of the most popular somatic psychotherapies for PTSD and survivors of trauma. Their website offers this brief definition of SE:

Somatic Experiencing® is a body-awareness approach to trauma being taught throughout the world. It is the result of over forty years of observation, research, and hands-on development by Dr. Levine. Based upon the realization that human beings have an innate ability to overcome the effects of trauma, Somatic Experiencing has touched the lives of many thousands. SE® restores self-regulation, and returns a sense of aliveness, relaxation and wholeness to traumatized individuals who have had these precious gifts taken away. Peter has applied his work to combat veterans, rape survivors, Holocaust survivors, auto accident and post surgical trauma, chronic pain sufferers, and even to infants after suffering traumatic births.

The SE models seeks to balance an unbalanced nervous system. Here are two graphics that help to explain the model.

The image above is how we are when healthy, the image below shows how trauma disrupts the system and leaves us either over-activated (anxious, restless, emotionally flooded, and so on) or under-activated (depressed, dissociated, fatigued) and quite often bouncing back and forth between these two states.

Levine has written several excellent books on SE, two of the best are Waking the Tiger: Healing Trauma: The Innate Capacity to Transform Overwhelming Experiences (1997) and In an Unspoken Voice: How the Body Releases Trauma and Restores Goodness (2010).

Shrink Rap Radio #347 – Somatic Experiencing for Trauma Work with Suzie Gruber and Jerry Allen

Posted on April 18, 2013



Suzie Gruber, M.A., SEP., holds advanced degrees in chemistry & psychology She spent 15 years in biotechnology before returning to her first love helping people transform their lives. A Somatic Experiencing Practitioner in private practice in Sebastopol, CA, Suzie assists practitioner trainings while piloting an effort to apply SE to the child welfare setting.

Jerry Allen, MFT, MPH, psychotherapist, health educator, musician, and currently in training in Somatic Experiencing®. With 23 years in child protective services helping families undergoing abuse, stress, violence and addiction, three black belts in Aikido, and a lifelong interest in resolution of stress, conflict and development of healthy families and communities.

Check out the following Psychology CE Courses based on listening to Shrink Rap Radio interviews:

• Jungian Psychotherapy Part 1 (6 CEUs)
• Jungian Psychotherapy Part 2 (7 CEUs)
• Jungian Psychotherapy Part 3 (7 CEUs)
• Jungian Psychotherapy Part 4 (6 CEUs)
• Jungian Psychotherapy Part 5 (7 CEUs)
• Jungian Psychotherapy Package of the Five Above (33 CEUs)
• Wisdom of The Dream (4 CEUs)
• Positive Psychology (6 CEUs)
• Pros and Cons of Positive Psychology (5 CEUs)
• CERTIFICATE PROGRAM IN POSITIVE PSYCHOLOGY (32 CEUs)
• Body-Mind: Goodbye to Dualism (6 CEUs)
• Brain: Insights from Neuroscience (8 CEUs)
• Meditation & Psychotherapy (8 CEUs)
• Insights from Neuroscience (8 CEUs)
• Neuroscience and Healing (8 CEUs)

A psychology podcast by David Van Nuys, Ph.D.
copyright 2013: David Van Nuys, Ph.D.

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Dr. Peter Levine - Creating Health In a Traumatized Society

For those who work with trauma or have spent time healing their own trauma, Dr. Peter Levine - founder of Somatic Experiencing - is likely to be a well-known figure. Apparently, some people in the Integral world have discovered him and his work - Terry Patton and Marilyn Hamilton.

Peter Levine is author of Waking the Tiger: Healing Trauma: The Innate Capacity to Transform Overwhelming Experiences, Trauma Through a Child's Eyes: Awakening the Ordinary Miracle of Healing, and In an Unspoken Voice: How the Body Releases Trauma and Restores Goodness, among many other fine books and audio programs (see Sounds True).

Patton recently interviewed Levine - the introduction is below, followed by the podcast. At the bottom, Marilyn Hamilton applies some of Levine's ideas to her "Integral City" model.

Resolving Trauma and the “4th Wave” of Psychotherapy

by Terry Patten

On Sunday, November 11th, Dr. Peter Levine joined me for a profound exploration of how trauma affects our nervous systems and society, in a dialogue entitled “Creating Health In a Traumatized Society”. Our discussion, which was at times deeply tender, explored the link between healing trauma in the individual and the transformation and flourishing of culture and society.

Peter agreed with my suggestion that his work has helped bring about what might be called “the 3^rd wave” of psychotherapy. The 1^st wave of psychotherapeutic approaches focused on helping the client become conscious of psychological patterns, primarily using the conscious mind, the primate or cortical regions of the brain. The 2^nd wave of psychotherapies focus on eliciting healing, corrective emotional experiences, experienced in the mammalian limbic regions of the brain. Now, a 3^rd wave of psychotherapeutic approaches focus on helping free up stuck patterns of chronic activation or freezing in the reptilian midbrain.

Early in Peter’s career he began studying animals because they have identical lower brain structures to those in humans. He observed that animals exhibit shaking, trembling, and temperature changes just as humans do when confronted with threatening situations such as a predator. Yet animals seem to quickly return to equilibrium after a trauma while humans can take years or even a lifetime to recover.

He also noticed that there’s a wide spectrum of trauma, ranging from disabling battlefield post-traumatic stress disorder (PTSD) to the low-level that restricts even “healthy” successful people’s freedom to respond flexibly and appropriately in triggering situations.

This exploration gave rise to the lynchpin insight underlying Peter’s work—addressing trauma as it manifests in the somatic being. In studying wild animals, Peter realized that “we must possess the same abilities to rebound from trauma as these animals. So, much of my work has been coaching clients to trust those animal instincts.” Rather than denying or suppressing them as Freud would have us do, Peter believes there is something much wiser that can come from opening to the sensations and impulses that arise out of our instincts. We can be with these “creature” reactions of fight, flight and freeze without becoming the rage, the fear, or the shock; this allows us to integrate, discharge tension, and grow.

During our dialog Peter remarked that in the same way we are programed to pick up on and experience fear and threat from each other’s nervous systems, we are also programmed to experience peace. I suggested to Peter that within the context of the driving inquiry of Beyond Awakening—that is, how can a living spiritual practice enable human beings to create more enlightened responses to the global crisis of our time—his work offers a model of how to integrate mind, emotion and instinct as a basis for a fully-embodied spirituality. This model gives us the ability to show up as a more functional being, one who is operating less as a reaction to unresolved trauma, and more able to respond appropriately to experience, even sometimes unwinding trauma in our own bodies, communities and world.

I suggested to Peter that it would be helpful to our listeners, many of whom might never have occasion to enter into trauma therapy, to hear about addressing trauma as it lives in our ordinary lives.

He shared several practical applications of his work including “titration” and “pendulation.”  First he suggested noticing that, even when we are in physical or emotional pain, there is always a place in our body or spirit that is peaceful or restful. Orienting to the space we are in, and connecting to sensations of peace, calm the nervous system and provide key resources when facing trauma.

Titration involves facing the experience of trauma gently and gradually, experiencing only what feels manageable and then backing off, never pushing to the point that we become flooded or overwhelmed. Pendulation means shifting your attention back and forth between sensations associated with activation (such as pressure in the chest) and sensations associated with peace (such as warmth and tingling in the hands and arms). By using titration and pendulation, we don’t face the trauma directly and re-traumatize the nervous system, but even so we gently expand our capacity to experience what had previously been disabling, slowly but surely experiencing greater and greater freedom.

I observed that this insight into trauma offered a basis for a much more profound and radical kind of self-compassion—not just compassion for ourselves at a mental and emotional level, but compassion for ourselves as creatures, analogous to the compassion we might extend to a suffering pet or wild animal. Peter agreed, and the mood of our dialog deepened and opened.

As he took questions from listeners, Peter went on to address, in an increasingly tender, compassionate, and intimate way, the way trauma expresses itself and even sometimes resolves itself across a spectrum of situations, including spirituality, intimate relationships, breakups, and sexuality.

In these ways, on a moment-to-moment basis, we can learn to compassionately and skillfully react to the arising patterns of trauma, for ourselves and our world. Peter summed up his philosophy by saying that he hopes there can be a “4^th wave” of psychotherapy, in which we integrate and engage our resources on all levels, using the cortical, limbic and midbrain regions of our brains. I invite you to listen to the full dialog here.

November 11, 2012: Dr. Peter Levine: “Creating Health In a Traumatized Society”

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Compassionate Somatic Path for Healing Cities in Trauma

November 14, 2012 by Marilyn Hamilton

Terry Patten dialogues with Dr. Peter Levine about the 3rd and 4th wave of psychotherapy. (Read Terry’s blog and listen to the dialog here.)  They talk about “Creating Health In a Traumatized Society” in a way that links the insights of human brain development and compassion. 

 

This has fascinating implications for the Integral City. Dr. Levine reveals a whole new pathway to generating psychological coherence, integration and evolution in the city, by releasing the blocks and barriers that contract human potential at a somatic level – as individuals and groups. Terry describes it this way:  

In studying wild animals, Peter realized that “we must possess the same abilities to rebound from trauma as these animals. So, much of [his] work has been coaching clients to trust those animal instincts.” Rather than denying or suppressing them as Freud would have us do, Peter believes there is something much wiser that can come from opening to the sensations and impulses that arise out of our instincts. We can be with these “creature” reactions of fight, flight and freeze without becoming the rage, the fear, or the shock; this allows us to integrate, discharge tension, and grow. 

The way that Terry and Peter frame multiple waves of psychotherapy (1st, 2nd and 3rd) – through working with the somatic levels of lower-mid-and upper brain capacities – suggests a kind of nuanced stratification and layered approach that healing trauma in the city could take. They suggest that trauma needs to be addressed in our somatic being, because in studying wild animals, Peter realized that “we must possess the same abilities to rebound from trauma as these animals”. So, much of [his] work has been coaching clients to trust those animal instincts as an integral process in healing all kinds of trauma – regardless of source or manifestation ( e.g. PTSD, abuse or war).  

Rather than denying or suppressing [traumatic experiences] as Freud would have us do, Peter believes there is something much wiser that can come from opening to the sensations and impulses that arise out of our instincts. We can be with these “creature” reactions of fight, flight and freeze without becoming the rage, the fear, or the shock; this allows us to integrate, discharge tension, and grow. 

What would happen to the cities in the mid-east (or anywhere) who have found themselves immersed in the traumas of war, if we created a process for citizens to heal themselves and each other? Dr. Levine’s engagement with the somatic realities of trauma suggests how we might alleviate the pain and suffering of today’s generations so that we can create the conditions for wellbeing in future generations. Peter’s somatic healing approach even opens up a possible “4^thwave of psychotherapy” where he suggests we could “integrate and engage our resources on all levels, using the cortical, limbic and midbrain regions of our brains”.  Terry points to the importance of compassion in Levine’s approach to psychotherapy. Terry observes: 

… that this insight into trauma [offers] a basis for a much more profound and radical kind of self-compassion—not just compassion for ourselves at a mental and emotional level, but compassion for ourselves as creatures, analogous to the compassion we might extend to a suffering pet or wild animal. 

This compassionate somatic psychotherapy that has the potential to heal whole cities, affirms our proposition that compassion is embedded in the Master Code as core to our DNA and our evolution and gives us new ways that we can:

• Take care of ourselves
  
• Take care of each other 
  
• Take care of this place/planet