Trauma

Body psychotherapy has a very specific interest in trauma. We know that painful or difficult experiences can trigger a shock response which remains frozen in the body. In a dangerous situation, the bodymind system will split (fragmentation or dissociation) to protect itself from overwhelm. This is a normal reaction to dealing with danger, and normally the system returns to equilibrium as the fear is released or discharged. Trauma is created when fear is experienced without the possibility of escape – because of immobilising terror (scared stiff), physical restraint (e.g. a seat-belt or assailant), or lack of agency (e.g. under anaesthetic, or a helpless child).

 

Modern neuroscience research now explains the mechanisms by which this happens, and the way in which the body ‘remembers’ past traumas. Much of the trauma literature is focused on treating Post-Traumatic Stress Disorder (PTSD) and other anxiety states. Usually this is related to specific, and remembered, traumatic events such as abuse, accidents or dangerous experiences. However body psychotherapy applies the trauma model more widely, in two important respects:

 

  1. Most bodies carry some degree of trauma. We have all had scary experiences which may or may not be remembered, for which the body memory remains to be released or completed. In particular, early pre-verbal or pre-egoic experiences tend to be held in the body. As a child develops, later wounds to the sense of self will also become embodied if they are not processed at the time. Long-term low-level abuse can be as traumatising as a single traumatic event. The trauma model explains how problems ranging from difficult birth, insecure attachment, inappropriate sexual contact or early invasive surgery become ‘somatised’ – held out of awareness in the body memory. What is now becoming known as developmental trauma can present as chronic holding of anxiety, or acute panic reactions to specific triggers. You may also see this described as Complex PTSD .

 

  1. Where trauma is held in the unconscious it can be awakened by body-centred techniques such as massage, yoga, dance, breathwork, etc. Used in small steps (titrated), these feelings and memories can be allowed to emerge and be expressed as part of the healing process. If they erupt too quickly, the overwhelm will be reinforced (retraumatisation).

 

So we can work actively to help the body release trauma at a rate which feels safe. We also need to be aware of the possibility – or inevitability – that as we explore the bodymind system, trauma will be reawakened, and we need to handle it before it goes into overwhelm.

 

How does trauma therapy work?

 

The basic neuroscience of trauma is now well understood. In a traumatic situation, the cognitive brain shuts down. Survival comes first – we react instinctively, too quickly for rational thought. Trauma is remembered emotionally and bodily so that we can react quickly again in similar threatening situations. The ability to split off cognition from emotion and sensation makes sense on an evolutionary basis, but the lower brains don’t carry an episodic ‘time code’ in the same way the cognitive brain does. When the traumatic memory is retriggered it feels like the trauma is happening again now, rather than being understood as something which happened in the past. The body reacts as though it is still under threat, and the rational mind doesn’t understand why.

 

So instead of addressing trauma ‘top-down’ through the mind, we address it bottom-up, through the body, by paying attention to what is happening in the here and now on the level of sensation and movement, then linking to emotion, and only later to understanding and meaning. This is where mindfulness becomes a useful skill, borrowing from meditation practice which encourages a compassionate and non-judgemental attitude of curiosity to what is happening in the present moment, rather than interpreting and analysing.

 

As the body ‘remembers’ the trauma, there is often a physical release or movement which discharges the impulses which were not allowed or available at the time – for instance fighting off the surgeon, screaming for attention, or clinging to the longed-for contact. We’re often looking for small ‘micromovements’. These can have two meanings – first, a trembling or shaking which is simply the body releasing fear. Second, the beginning of repressed action (‘attenuated response’) waiting for a safe opportunity to complete. It’s important to appreciate the original traumatic reaction as an appropriate, or adaptive, survival response. It made sense at the time.

 

Responding to overwhelm

 

As developing children we learn to regulate our feelings (“affect regulation”) in relationship with others. Where we don’t get appropriate feedback we can respond by getting hyperaroused (frantic, anxious…) or hypoaroused (depressed , withdrawn…). The same is true of the traumatic response – if we can’t go into fight or flight, we freeze (hyper) and eventually flop (hypo). Trauma therapy works by getting us to expand the middle range between hyper and hypo, in a process called self-regulation. Too much arousal will retraumatise, too little and we stay stuck. Hence the need to work slowly, gently, and mindfully in the middle ground, sometimes called the window of tolerance (where we can tolerate our emotions, thinking and feeling).

 

Trauma provides a really useful model for explaining our response to any overwhelming situation. When our rational (adult) self is overwhelmed, our emotional (child) self takes over and reacts as if under threat. As well as the four classic fight/flight/freeze/flop responses I would add another two ‘F’s – flap and fawn. Both are taken from animal behaviour – flap is to behave chaotically or distract, fawn is to ‘roll over’ and display submission. Say you’re having a heated argument with your partner and feeling overwhelmed. Do you attack (fight), leave the room (flight), dissociate (freeze), collapse (flop), try and change the subject (flap) or say ‘it’s all my fault, sorry’ (fawn)? A lot of relational difficulties can be explained by understanding our differing responses to overwhelm.

Some sources

It's only in the last ten years or so that the overlapping disciplines of body psychotherapy, neuroscience, and trauma treatment have really crystallised into a coherent field. Three pioneering books are by Babette Rothschild (The Body Remembers),  Peter Levine (Waking the Tiger) and Pat Ogden  (Trauma and the Body). There is now a lot more recent literature, of which Bessel Van Der Kolks's The Body Keeps the Score is essential reading. I also like Mark Epstein's The Trauma of Everyday Life (which covers the unlikely-sounding overlap between Buddhist Psychology, object relations and trauma theory), and Janina Fisher's Healing the Fragmented Selves of Trauma Survivors (which is very clear about working with different parts of the self). They all have websites!