Somatic experiencing how does it work

Unlike most forms of psychotherapy, SE focuses on physical responses that occur when someone experiences trauma. What qualifies as trauma exactly? This dysfunction can prevent someone from living in the present and can contribute to a number of symptoms and unhealthy defense mechanisms. A somatic therapist or coach educates patients about how their autonomic nervous systems work and helps them increase their awareness of their own bodily sensations.

The therapist also acts as a trusted partner and calm presence during sessions, which can feel stressful and overwhelming for the patient at times. The goal of SE therapy sessions is to release traumatic activation through increased tolerance of bodily sensations and related emotions.

SE integrates body awareness into the psychotherapeutic process, which is what makes it unique. Sessions focus on creating awareness of inner physical sensations, which are seen as the carriers of the traumatic memory. Unlike other approaches, such as exposure therapy , SE does not require reliving the traumatic events and discussing them in detail. Instead, patients learn to monitor their own arousal through body awareness and relaxation techniques.

SE therapists help their clients move between aroused states and calmer states. SE therapy was created by Dr. Peter Levine, Ph. He helped develop SE therapy based on multidisciplinary studies of stress physiology, psychology, ethology, biology, neuroscience and indigenous healing practices. One way he apparently came up with the somatic experiencing approach was by observing how animals handle stress.

He realized that animals typically complete a full sequence of a response to danger, unlike most humans. Animals usually notice danger, react by fighting or fleeing, and then recover, often with help from physical movement that releases energy. But, I certainly felt a lot better. Me: Alright, that makes sense; tell me, what were the good feelings like after the session? Simon: Oh, I felt really relaxed, all that tension dropped away; it felt like such a relief.

He sighs and settles into the chair. Me: And what are you noticing in your body while we are sitting here talking right now? Simon: I feel good—must be this chair! Smiles mischievously and laughs. Me: So… let's come back to that morning, remembering how that was…what do you notice happening in your body as you recall that morning?

Simon: I feel fine, no problem, I can remember that scene fine. Me: So, where was the car? At this point I observe Simon carefully for the first signs of activation; I want to elicit some activation to work with, but not so much as to lead down the slippery slope toward overwhelm. Simon: calmly In the garage. Me: OK, so, do you remember how you got to it? Simon: Yes, I went and lifted the garage door. Me: OK, simply remember doing that, and notice how you feel as you explore that image.

Simon: still appearing relaxed Well, I see myself opening the garage door…I am going to the car door…I am getting in…. Me: noticing Simon's shoulders come up, his breathing getting more rapid OK, let's pause for a moment.

What do you notice? Simon: suddenly closing his eyes, sitting forwards in the chair, twisting his body a bit to the left, hunching his head down; his voice sounds tight Oh Jesus that was so scary, I really thought I was going to die! Me: firmly OK Simon, slowly begin to open your eyes…Simon, look at me, right here. Simon slowly opens his eyes, at first he looks at me vacantly, his breath rapid You're fine Simon, you are right here, it's OK.

Just see me, right here. Simon's eyes come back into focus, his breath slows. Simon: Oh damn, what happened? Me: in a calm voice It's fine, we just went a bit too quickly. Look around the room a bit, tell me three things that you see. Simon: focusing on the room, his voice calmer and slower OK…I see the walls…your picture there…the window…. Me: Can you feel the chair? Simon: Yes—the magic chair!

Chuckles That's better! In SE one is walking the tightrope between not enough activation, in which case there is no discharge because there is no activation to discharge; and full-blown reactivation of the trauma memory, in which aspects of the trauma are relived and the person again experiences overwhelm. This can actually be harmful, and can compound the original trauma. One of the tasks of SE is to interrupt this destructive loop.

To this end, SE uses concurrent evocation of positive interoceptive experiences, which may help alter the valence of the disturbing memories Quirin et al. In the rest of session 2, Simon has been able to return to the memories of getting into the car, driving to the location of the accident, and seeing the first signs of the accident about to happen the truck ahead of him starting to lose control.

At each step he has experienced discharge of various kinds, including shaking, crying, and angry gestures, each time successfully returning to balance with an increasing sense of well-being and capacity. His phobia of driving has diminished considerably but he still has tension in his arms.

Two nights ago he woke from a nightmare drenched in cold sweat. After an initial greeting and check-in, we begin where we had left off the previous session. Me: OK Simon, if you feel ready: let's come back again to the moment you first saw the wheels of the truck scoot out sideways. Can you get there? Simon: Yes, OK, I can see that, a puff of smoke at the wheels and they kick sideways. Me: Noticing a slight twisting of his body to the left and a hunching of his shoulders forward And what else do you notice?

Simon: My shoulders are killing me! Me: What is that like? Simon: They're on fire, they feel like they are being twisted off! Me: And then … what happens now? Simon: Oh, it's like I have to turn the damn wheel! I can't turn the wheel! I'm going to die! Me: OK Simon, just feel yourself trying to turn the wheel! Slow it way down! You can give yourself all the time you need, feel what your shoulders are wanting to do!

Simon: grimaces, groans; very slowly his arms start to move But I couldn't do it! Me: But now can you let yourself do what you couldn't do then; give yourself all the time you need…that's it, keep it slow, really feel it—what you couldn't do then, but now you can… that's it, take your time….

Simon: slowly, with the appearance of a sustained effort, completes the gesture of turning the wheel, then slowly relaxes and heaves a huge sigh. I did it! Me: What happened, what did you do? Simon: I turned the wheel even though I was afraid I couldn't. I got out of the way! I went right past, I could see him behind me crashing but I was free!

Me: Great! How does all that power feel? Simon: It feels fantastic, I feel free, my shoulders feel so light, I don't think I have ever felt like this! Indeed Panksepp's candidate for the neural substrate of core self Panksepp, , the PAG, is principally recognized as a nucleus involved in the preparation of instinctive defensive responses. Via the reticular formation, the ANS and associated affective and motoric structures change the gamma efferent supply to the muscles, altering the spinal reflexes, muscle tone, and posture in preparation for the movements of fight or flight appropriate to the situation Bosma and Gellhorn, ; Loofbourrow and Gellhorn, ; Gellhorn, b.

These instinctive affective-motoric Boadella, patterned responses have developed to ensure survival; they therefore have an extremely powerful drive to completion. Their organizing nuclei depend partly on proprioceptive feedback from the somatic system to confirm successful completion of the response Loofbourrow and Gellhorn, ; Gellhorn and Hyde, This is closely related to the phenomena observed by Gellhorn that, absent proprioceptive feedback, the ANS does not reset to baseline Gellhorn, b.

When the survival response is incomplete, ineffective, or prevented, the preparation for the response may persist indefinitely unabated, resulting in continued sympathetic, and in extreme cases concurrent parasympathetic, activation Gellhorn, b , This results in a maladaptive organization of the CRN, as the precipitating situation in fact no longer exists.

The organism is no longer actually responding to present conditions, challenging or not, but is locked into an unresolved state of persistent inappropriate activation. The view of SE is that it is possible to facilitate the completion of this biological defensive response see Figure 7. In other words, this is NOT re-exposure to memory of the original trauma; nor is it a suppression of those memories and feelings.

Instead it is a re-working, on a felt subcortical level, which enables the person to have, for the first time, an experience of successful completion of the subcortical instinctive defensive response Quirin et al. Figure 7. De-potentiation of positive feedback loop by SE. The procedures of SE can de-potentiate the disturbing trauma-linked implicit and procedural memories. Titration and the co-evocation of supportive and empowering interoceptive experiences calm the extreme arousal and facilitate accurate awareness of the interoceptive and proprioceptive cues.

The client becomes able to identify the urge toward completion of the biological defensive response; and, in the safe and supportive context created by the therapist, is able to complete the blocked defensive response, through imagery and subtle movement. This will often be accompanied by autonomic discharge in the form of heat, trembling, tears, and so on. Once the proprioceptive experience of biological completion has occurred, the memories lose their intense charge, and may now integrate into the hippocampal autobiographical timeline like ordinary memories.

Now that the client's nervous system is in a more functional state, the client has more resilience and a greater capacity to tackle any remaining trauma-related memories.

The canonical animal model for PTSD is threat coupled with restraint. Restraint alone, without threat, does not induce trauma; nor does threat without restraint Philbert et al. The defensive escape response has to be prevented; only then do trauma symptoms develop Shors et al.

Tellingly, Ledoux found that in rats conditioned through such a procedure to a trauma-like fear response, if they were placed in the same experimental situation and allowed to complete an escape response, the fear conditioning immediately disappeared Amorapanth et al. When the person is finally able to stay fully present to their interoceptive and proprioceptive experience, the interrupted movement incomplete at the time of the trauma can then fulfill its meaningful course of action.

This gives rise to proprioceptive feedback in the nervous system that tells the ANS that the necessary action has finally taken place, so that the sympathetic system can stand down Gellhorn, b ; LeDoux and Gorman, Careful visual attention, on the part of the therapist, can often detect the interrupted movement behind chronic muscular tension as revealed in very small spontaneous motions; guiding the client to slow things down and take the time they need is essential in order that they can bring these subtle sensations to consciousness.

Sometime just imagining performing the movements brings relief. Studies have shown that imagined movement activates very wide areas of the brain, especially the pre-motor areas which are strongly linked to the autonomic and emotional centers Decety, ; Fadiga et al. Procedural memory as distinct from declarative and episodic memory is the memory of how to do things Squire, , such as riding a bicycle. It is believed to be encoded in the neostriatum rather than the hippocampus Mishkin et al. SE suggests that in a highly stressful situation, vivid procedural memories of the incomplete innate survival actions are laid down, which later intrude and interfere with normal functioning.

The intensity of the intrusion is due to the powerful survival imperative embedded in the intrinsically affective content of these defensive reactions; as long as the system does not experience completion, the survival imperative continues to operate, and the person feels as if the situation is still happening; this of course is a well-recognized aspect of PTSD.

The SE interventions described enable the procedural memories to complete their biological imperative and therefore cease to intrude.

Our clinical experience seems to indicate, however, that not just any muscular activity will do: profound shifts seem to occur when the activity corresponds to the movement that was interrupted in the precipitating event. I was able to notice subtle hints of the movement of trying to turn the wheel manifesting in Simon's body.

Once I drew his attention to these, he was able to become aware of the incomplete impulse; the completion of this very specific impulse was crucial in enabling the release of the chronic muscular, autonomic and neuroendocrine activation. It is very unlikely that ordinary voluntary vigorous exercise, even if it had used those same muscles, would have brought about comparable results.

By now, Simon has completed a lot of work. He has revisited most of the traumatic memories, has experienced considerable autonomic and somatic discharge, and is feeling a great deal better. He sleeps well, is able to concentrate and drives without anxiety.

I suspect the remaining slight dissociation is related to this, and I judge him sufficiently resilient to be able to comfortably handle this last step. At this point, I ask Simon to recall the first time after the accident at which he really took in that he was OK.

He recalled his first interaction with his wife at the hospital, immediately after the accident, recounting a tearful reunion. Then I ask him to return to the memory of the moment before the car spun out of control. Simon: I can feel the steering wheel like iron in my hands—I can see the truck's trailer ahead start to slide sideways—oh God— I notice his face get pale. Me: Let's slow down Simon. Feel the chair underneath you….

Simon: orienting to me a bit OK…. Me: OK Simon, I'm going to ask you to do something here to help slow things down—it may seem a little strange. Simon: still tense, but clearly curious OK…. Me: We're going to make a sound together, like this: Voooooo very deep and resonant. Simon: smiles a little. You want me to…. Me: Together now: Vooo….

Simon: Simultaneously Voooo.. Me: And again, feel it in your belly: Voooo…. Simon: noticeably more relaxed Vooo…. Me: And what do you notice? Simon: takes a deep breath I can feel my legs, my lower body…. Simon: It feels good, solid… I can feel warmth in my legs. Me: Good, let yourself feel that, take some time… now very gently, touch on that memory again, nice and slow. Simon: Yes… I can see the trailer ahead…. Me: And what else do you notice? Simon: I'm gripping the wheel—the lights are so close….

Me: The brake lights? Simon: Yes… my jaw is so tight, there's nothing I can do, I'm so scared…. Me: Notice your jaw—what is your jaw doing? Simon: It's shaking, my teeth are chattering. Me: Ok just let that happen, let your teeth chatter… and what else are you noticing? Simon: I'm shaking all over, I can't breathe, I feel really scared.

Me: You're doing fine, just let it happen, you are OK, it's your fear and all those pent up tears. Simon: shakes and trembles violently, breathes deeply Oh God, I don't want to die!

Oh my Lord… I just saw a picture! When I was 7 I fell off my bike, I couldn't breathe. My dad got mad and made me get back on the bike and told me he was proud I didn't cry. I so much wanted to please him, even though I was just a little kid. Tears start to flow freely down Simon's cheeks as he sobs gently. I was so scared, so scared…. I think he was scared too; my dad.

I think I never really cried after that, not till just now. Me: You're doing great, let the shaking and tears happen, just feel it… they've been there for such a long time…. Things settle over a few minutes. Then I notice Simon's body starts to gently jerk in the chair. Me: What happens now? Simon: I'm losing control! It's spinning! The car is spinning. Me: Slow it down, let's see if you can slow it down like you did before. Feel it, stay with it, it's OK. Simon: Gradually his body slows down, comes to rest.

He is gently trembling. I'm alive! He takes deep spontaneous breaths. Me: How does that feel, to be alive? Simon: Continuing to sob, though now they appear to be tears of relief and joy. It's wonderful! I'm alive, I can feel. I thought I was dead, I'm alive! Gradually the tears subside, his breathing slowly returns to normal, he opens his eyes.

He has a quality of intense vitality in his gaze, a softness and aliveness through his body; he looks at me more directly and openly than he has since he started sessions. Me: Yes, you are alive.

You can feel the joy of being alive through your whole body. Really feel that! I tell him this is the natural state of his being that becomes available when there are no obstructions. I also explain to him that we all carry many layers of obstruction from past trauma that we may not even remember, that this opening-up is an ongoing process.

I suggest that he come in for one more appointment in a month, so we can follow up if there are any remaining issues. All the key elements of SE are demonstrated here: presence, embodied resource, titration, pendulation, discharge, and biological completion.

Simon is now sufficiently resourced, as a result of the increased resilience of his nervous system gained through the previous work, that he is able to tolerate, befriend and stay fully present to the great fear of dying and the disorienting experiences of being jerked around in the car.

Mechanisms involved may include Jerath et al. The deep pitch of the sound may also play a role. Due to Simon's increased resilience, he does not need nearly as much titration at this stage as he needed at the beginning. Not until he has been able to digest the experiences and experience biological completion is he able fully to recognize that he has survived. In normal experience, the brain lays down a narrative of life experiences in memory, which can be recalled in sequence and are experienced as belonging to a specific time in the past.

This happens in the hippocampus. It has been shown that stress interferes with explicit, autobiographical memory, but not with implicit memory Luethi et al. This is believed to be at the root of the pervasive, timeless quality of trauma-related memories Stolorow, In this session, Simon's recovery of the memory of his father making him get back on the bike is pivotal. Although the memory may have been accessible to him prior to the session as a normal autobiographical memory, aspects of the experience the fear of not being able to breathe, the pushing down of his tears in order to please his father were encoded as implicit and procedural traumatic memory.

The conscious visual and interoceptive-proprioceptive-kinesthetic recall of this memory facilitated completion of the interrupted discharge, and enabled a spontaneous cognitive re-evaluation of the past event recognizing his father's fear and the role it played in his actions. Clinical experience in SE shows that such cognitive re-evaluations often emerge spontaneously during or shortly after the autonomic and kinesthetic discharges take place. We believe that the subcortical state plays a very significant role in creating and maintaining the faulty cognitive structures, and that cognitive restructuring happens much more easily as the CRN is restored to normal functioning.

When a person is exposed to overwhelming stress, threat or injury, they develop a fixed and maladaptive procedural memory that interferes with the capacity of the nervous system to respond flexibly and appropriately.

Trauma occurs when these implicit memories are not neutralized. The failure to restore flexible responsiveness is the basis for many of the dysfunctional and debilitating symptoms of trauma. In response to threat and injury animals, including humans, execute biologically based, non-conscious action patterns that prepare them to meet the threat by defending themselves.

The very structure of trauma, including activation , freezing , dissociation , and collapse , is based on the evolution of survival behaviors Bolles, ; Nijenhuis et al.

We orient, dodge, duck, stiffen, brace, retract, fight, flee, freeze, collapse, etc. All of these coordinated responses are somatically based—they are things that the body does to protect and defend itself. Animals in the wild recover spontaneously from this state; involuntary movements, changes in breathing patterns, yawning, shaking, and trembling, release or discharge the intense biological arousal; these phenomena have been observed repeatedly by one of the authors PAL over 45 years of clinical experience, and confirmed through numerous anecdotal accounts by those who work professionally with wild animals; however we have not been able to find any significant treatment of these phenomena in the peer-reviewed literature.

This failure to reset leaves the nervous system stuck in a dysregulated state. Trauma is a highly activated incomplete biological response to threat, frozen in time. The treatment of posttraumatic stress disorder PTSD has been the topic of much research. The focus of the therapy is on creating awareness of inner physical sensations, which are seen as the carriers of the traumatic memory.

In the theory behind SE Levine, , posttraumatic stress symptoms are considered an expression of stress activation and an incomplete defensive reaction to a traumatic event.

From this theoretical perspective, the goal of the therapy is to release the traumatic activation through an increased tolerance of bodily sensations and related emotions, inviting a discharge process to let the activation dissipate. SE differs from exposure therapy methods used for treating PTSD in that it does not require extensive nor full retelling of the traumatic events. It does require the client to engage with traumatic memories that cause high arousal.

To date, the literature on the effectiveness of SE is scarce and scientifically insufficient. Acknowledging the lack of a control group, Parker et al. Results, based on a symptom tracking form developed by the research team, demonstrated that immediately after the SE session One year later, Although other methods have become common practice after clinical trials proved their effectiveness Foa et al.

Over the course of 3 years, 63 participants meeting eligibility criteria were included in the study, 32 women Participants presented with a wide variety of traumatic events triggering PTSD including 28 vehicle accidents No significant differences were found in group allocation. The study, including procedure, expected outcomes, benefits, and potential risks, was presented to Herzog Hospital's Institutional Review Board Jerusalem, Israel by the principal investigator and research coordinator, and received the board's written approval.

In the time period during which the study took place, several highly stressful national events also occurred. In both and , wars took place between Israel and the Palestinian factions in Gaza. In addition, there were many terrorist attacks in the Jerusalem area, and all the participants were exposed to this directly or indirectly.

We have not included the measurement of this exposure in this study. The participants were referred to ICTP for the purpose of the study via Israeli medical and mental health clinics and practitioners.

Short lectures about SE and the study were held during staff meetings at the respective clinics; recruitment brochures were distributed; and ads were placed in local newspapers. Applicants participated in a brief initial phone screening conducted by the research coordinator that consisted of questions about the traumatic events, psychiatric history, and prior traumatic experiences.

In the first session, held with the research coordinator, applicants received a detailed explanation of the study's course, and gave written consent followed by an open interview of the traumatic events and sequelae. At the end of the interview, applicants were asked to complete a set of questionnaires. Applicants were excluded from the study if during the course of the evaluation one of the following conditions arose: a history of psychosis, brain damage, active suicidal tendencies, substance use, psychiatric comorbidity apart from depression, or complex traumatic situations that are characterized by prolonged situations of extreme stress.

Participants who were taking psychiatric medication for over 2 months were included, with the stipulation that any changes made during the course of the study would be made known to the research coordinator.

This occurred in two such instances among the waitlist group: one participant stopped taking a selective serotonin reuptake inhibitor antidepressive medication during therapy and a second increased the dosage of an selective serotonin reuptake inhibitor. Applicants who did not meet study criteria were referred by the coordinator back to their health insurance outpatient clinics for therapeutic intervention.

There were applicants enrolled in the study, out of which 30 applicants were excluded after the initial phone screening, and an additional 11 applicants were excluded during the course of the first evaluation.

At the conclusion of the evaluation process, 63 applicants who continued to meet inclusion criteria were accepted to the study and assigned by the research coordinator to one of two groups intervention or waitlist , based on a predetermined list created prior to the beginning of the study by a flip of a coin, the research coordinator created a list of places, assigning each of them to either "intervention" or "waitlist".

Each participant accepted to the study was assigned the next free spot on the list. The list was only accessed after the participant was accepted, by the research coordinator alone, insuring that all clinical examiners and therapists remained blinded to group allocation, and that the randomization process was not contaminated.

At the end of the SE treatment, the intervention group participants met with a clinical examiner for a second assessment T2 using the same clinical interviews and questionnaires as the initial assessment T1.

The clinical examiners performing the assessments were trained and supervised by highly experienced trainers in the use of CAPS and SCID, and were blind to the group allocation of the participants.

Additionally, participants were asked not to talk about their group allocation and whether they had already received therapy. A third and final evaluation T3 took place 15 weeks after the second evaluation.

In the intervention group, four participants decided not to seek therapy after one or two SE therapy sessions, and one patient experienced a recurrence of physical illness between T1 and T2. In the waitlist group, three participants chose to leave the study and not begin therapy, and two additional participants left during their therapy sessions.

All participants reached the decision on their own accord and were then contacted by the research coordinator.

To the best of our knowledge, all decisions were made for various personal reasons e. While the nervous system is designed to be self-regulating, it has its limitations around trauma. Unresolved trauma, especially when trauma is chronic and accumulated, can lead to more extensive mental and physical health symptoms. The long term effect of SE treatment is a restored sense of healthy functioning, which includes reduction in maladaptive coping skills, resolved sleep issues, and mood stabilization — to name a few.

When the body gains the capacity to self-regulate, it restores its sense of safety and balance. As an SE practitioner, I have the privilege of helping individuals restore their sense of safety and gaining a new lease on life. I witness clients experience a renewed sense of safety and ability to experience a more joyful and connected life filled with deep, meaningful relationships.

I see incredible openings of creativity and productivity, all of which are possible when one is able to change their relationship with their traumas and leave them in the past where they belong. Somatic experiencing may help you treat trauma-related symptoms. Although working with a therapist is recommended, you could also practice these 4….

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Uncertainty is the reigning emotion during critical times. The response to our feelings may depend on our phys.