Mental Health tips: How Does trauma live in the body?
When you hear the words “trauma and the body,” it is common to think of sexual or domestic violence, military service or other violent experiences. Yet, trauma comes in many forms. According to the American Psychological Association (APA), trauma is “an emotional response to a terrible event like an accident, rape or natural disaster.” Car accidents, extreme weather events, a house fire or flood, experiences of homelessness or poverty and bearing witness to violence can all be forms of trauma.
These events and conditions cause great disruption to us on a physiological, emotional and psychospiritual level. Common physiological responses during the event include a racing heart, shaking, sweating, muscle tension and bowel disruptions. Emotionally, the person experiencing or witnessing the trauma may feel anger, powerlessness, self-blame, sadness and/or fear. Psychologically, all these different experiences are unexpected and overwhelming. They elude our comprehension and may leave us in a state of questioning and despair.
In the immediate aftermath of this emotional, physical and psychological overload, the APA says “shock and denial are typical.” If this overload goes unprocessed though, the body stores and manifests trauma in a variety of ways including insomnia, flashbacks, emotional dysregulation and isolation.
These symptoms form what the Diagnostic and Statistical Manual of Mental Disorders V (DSM-5) calls Post-Traumatic Stress Disorder. It is a disorder of disconnect between the body and mind, the memory and the story, the experience and experiencer. A skilled therapist can help you process and heal from trauma.
What is body trauma?
The word trauma is Greek for wound. The Greeks used it to refer to physical injuries only. Modern psychology has expanded our understanding and use of the word to also include psychological, emotional and vicarious wounding to our conceptualization of trauma.
The Greeks may have been on to something in their attachment of trauma to physical injury, though. Research by neuropsychologists and neurologists over the past 30 to 40 years indicates trauma, no matter what kind a person has sustained, lives in the body.
In his groundbreaking work “The Body Keeps the Score,” Dr. Bessel van der Kolk lays out the mechanisms through which trauma becomes part of our very cells.
- Our alarm system: When a person experiences a traumatic event, the brain’s alarm center – the amygdala – sends our bodies into protection mode. It activates the sympathetic nervous system and sends a cascade of stress hormones to get the heart and muscles ready for action or collapse. This protection mode is commonly called “fight, flight or freeze.”
Each individual has a different default. Some of us are wired to fight against a threat, similar to a fireperson who rushes into a burning building. Others are wired to flee as fast as possible, like a gazelle running from a lion. Some might freeze, like the classic image of a deer in the headlights.
- Reason and memory: A common thread between all three reactions is the shutdown of the prefrontal cortex and the hippocampus. The prefrontal cortex is responsible for decision-making, analysis and language. It is the part of our brain that makes us human. The hippocampus encodes memory.
Recall is interrupted during trauma. The memory of the event (instead of being stored as a coherent narrative with a beginning, middle and end) is stored as sensory fragments or “imprints”— a smell here, a sound there — that prompt the mind and body to respond as if the trauma is happening in that very moment.
When the mind is unable to make the connection between the fragment and the stress response, and the body is still holding on to undischarged energy from when the trauma originally occurred, the body returns to the state of fight, flight or freeze. Stress hormones flood the system and knock the prefrontal cortex offline. We lose reason and control, and we become fearful, angry and panicked.
How do you heal from trauma?
Think about what happens to a deer after being chased by another animal. Or what a zebra does after being attacked by a lion. They shake and tremble. When the shaking process is completed, the energy from the trauma is discharged rather than held in the animal’s body. It is able to return to living life as it had before the chase.
- Integration: Human societies could do well to take a cue from the animal kingdom. Healing from trauma means being able to find ways to discharge this energy and to build a cohesive narrative around the event. According to van der Kolk, integration is key. The survivor is able to remember the event without reliving the sensations, emotions, images, smells and sounds that occurred during it.
The body does not shut down the mind’s ability to tell a coherent story. When we integrate a traumatic memory, we pick up these pieces and fragments and gain safety and security in knowing the event happened in the past. The mind reassures the event is not happening now, and it does not have power over us anymore.
- Post-Traumatic Growth: Completion of this integration process is the hallmark of healing. It is not easy, but it is very rewarding because it promotes growth, altruism and a sense of strength and self-worth.
How do you handle trauma triggers?
The goal of handling triggers is to restore equilibrium. On the surface, this concept seems simple. We cut our finger with a kitchen knife, we walk to the bathroom, we wash and bind the finger. Our body then takes over to heal the cut. These steps restore the finger to the state it was in before the cut. In this case, we know what cut us and what actions we need to take to heal it.
The difference with healing from a trauma is, because the memory has not been properly encoded, the survivor cannot always recognize what is throwing the nervous system into overdrive. Anytime a situational or sensory fragment enters our field of experience, the body leaps into fight, flight or freeze mode. These fragments are what we know as “triggers.” They trip the body’s alarm system and send us reeling back into the moment the trauma occurred. We are living it over and over.
To handle triggers, identification is key. The process of identification may be difficult, though. The mind’s ability to analyze a situation has been knocked offline by an overactive sympathetic nervous system. Thus, first, the nervous system must be calmed.
The following three strategies work well to quickly do so:
- Breath awareness: Although deep breathing may be frightening for some survivors, simply being aware you are breathing and noting the quality of the breath can help re-establish the lost connection to the body. Describe the breath. Is it shallow, deep or rapid? How does it feel entering and exiting the body? The reconnection to breath reconnects us to the present; a time when we are most likely safe and secure.
- Grounding: Grounding is a process that brings us into the physical reality of our current moment. One technique often used is to have your feet touch the floor and then track that feeling of connection up through the body. Focusing on a favorite object in the room is another way to ground, as is biting into a peppermint or a lemon. These sensory experiences bring us out of the past and into the present.
- Naming: Look around the room and name each object you see. For example, if I’m having a flashback, I might scan the room and say out loud: “This is my coffee table. These are my keys. This is my bookshelf. That is my favorite book. I am in my own home. I am grown up, and I am safe here.”
Once the trigger response is calm, we can then reflect (perhaps in a journal) on what brought it on. Keeping a record of the context surrounding a trigger can help us see it before we are drowning in it. When we know what is coming, we can use a calming technique before our amygdala gets the chance to hijack our capacity for rational thought and deliberate action.
How do therapists treat trauma?
Trauma best responds to an integrated approach bringing together the mind, body and inner resources that have split off from each other in an effort to protect the person. Van der Kolk asserts a good trauma therapist has been on the receiving end of any recommended therapies.
- Trauma-Focused Cognitive Behavioral Therapy (TF-CBT): Trauma-Focused CBT is an exposure-based intervention helping us use our inner resources to target the relationship between thoughts, feelings and behaviors. Over the course of 8 to 25 sessions, the TF-CBT clinician encourages clients to make connections between the thoughts, feelings, actions and natural consequences. The client is exposed to the narrative of the trauma (the memory) and the sensory reminders of it in the controlled environment of the clinician’s office. The client is encouraged to explore how certain thoughts and feelings bring on the maladaptive symptoms disrupting their life. Worksheets, journaling and homework are part of this exploration and connection process.This therapy comes highly recommended by the APA for the treatment of PTSD in children and adults.
- Mindfulness and Yoga: Psychologist Dr. Jon Kabat-Zinn developed Mindfulness-Based Stress Reduction (MBSR), an eight-week group program that began at the University of Massachusetts Memorial Medical Center. MBSR promotes mediation, mindfulness and yoga to promote stabilization and calmness. MBSR helps us to inhabit the body that trauma has cut us off from understanding. In addition to personal completion of an MBSR course, certified MBSR teachers have a least 15 hours of silent mediation retreats, three teacher intensives and many hours of teacher practice and mentoring.Yoga is another excellent complement to mental health therapy. Try looking for a yoga teacher who is trained in trauma-sensitive yoga (TCTSY).
- Somatic Experiencing: Developed by Dr. Peter Levine, Somatic Experiencing (SE) is based on the idea that we can release trauma locked in the body. This method is the result of a combination of stress physiology, psychology, neuroscience, medical biophysics and indigenous healing practices.
Dr. Levine’s research is based on ways in which animals process trauma through shaking and trembling. Staying immobile after trauma, instead of shaking it off, traps the trauma in the body. The body’s alarm stays on perpetually and prompts hypervigilance, dissociation and emotional dysregulation.
Clients can expect SE facilitators to come from a medical or helping profession. They undergo a rigorous two-year training process.
- Eye Movement Desensitization and Reprocessing (EMDR): EMDR, developed by psychologist Dr. Francine Shapiro, is an eight-phase treatment addressing traumatic memories and reenactments.
Under the guidance of a licensed mental health clinician, EMDR develops and strengthens the connections between the right and left sides of the brain using eye movement (tracking). The clinician helps the client identify a memory to address in the session. The client holds the memory in their mind and then tracks the therapist’s hand or a light as it moves back and forth in the field of vision. The internal associations made during the session help the client process the memory and work through difficult or disturbing feelings around it.
Body awareness is also part of EMDR. Clients are encouraged to notice what occurs in the body and with memories as part of reprocessing. During the course of treatment, a client may experience positive changes in thoughts and feelings about the event(s).
Van de Kolk says EMDR is most effective for adult-onset or single-event trauma.
- Neurofeedback: Neurofeedback stabilizes the brain by interfering with the circuitry created by the trauma and the survivor’s pattern of fear, shame and rage. In this treatment, three electrodes are pasted to each side of the head and to the right ear. These electrodes are then hooked to a computer displaying the client’s brain waves. This allows the client to watch their brain waves change.Van der Kolk explains neurofeedback encourages some brain wave patterns while deterring others. It encourages us to harness our inherent power to control our brain waves. We can see in real time on the screen how we are in the driver’s seat; not our overactive amygdala. It relaxes the fear patterns and stabilizes the nervous system, so we can choose how to respond to a situation rather than having our nervous system make choices for us.
There are many ways to integrate trauma and heal. Our capacity to change and grow from these experiences is limited only by our willingness to acknowledge we need help and to seek it out. As a trauma survivor, I can attest to the power of laying down my armor and asking for help. It has changed my life, and as a counselor-in-training, I can only hope to meet clients with a listening heart and a deep empathy for the path that brought them to me. In this relationship, I can help them regain, rebuild and inspire others to do the same.
We are here to help during this difficult time. If you or someone you know is struggling with loneliness, anxiety, depression or other struggles, give us a call at (412) 366-1300 or use our Digital Intake Form to schedule an appointment today. Hope is only a phone call away.
By Jessica Nowacki, Clinical Intern