We tend to think of PTSD as a mental illness when really a huge part of it is physical. It is not just our world view, the patterns in our thinking and our relationships that make up PTSD, it is also hyper/hypoarousal, hypervigilance, flight/fight response, chronic stress and intense emotions, all physical experiences.
We can approach PTSD from different directions.
One approach is to work top-down and use our thinking, which involves newer parts of our brain like the prefrontal cortex. We learn to reflect, recognize patterns, learn coping strategies and regulate our emotions by using skills or distractions. We try to exchange beliefs that don’t serve us anymore and to make sense of our emotions. This approach uses talk therapy. Especially with severely traumatized people talk therapy has its limits. Some things are impossible to believe without experiencing them. Some things cannot be expressed with words.
The second approach is bottom-up, to work with the body, sometimes without using words at all. This involves older parts of our brain; older because they historically developed earlier but we also use them first when we are children, before we manage logical thinking. This includes our sense of touch, physical actions and movement. They become an entrance gate to our emotions and memories. Sometimes things are easier to reach that way than through our thinking.
I believe that it is wise to use both approaches. For some patients body work is the key to getting unstuck in their healing process.
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When the body becomes a trigger
Many survivors find themselves in a terrible cycle of avoidance and re-experiencing. We learned early on that feeling the body is not safe and a source of pain, so we avoid or dissociate it. But physical experiences get through and remind us of our violated body. That throws us from not experiencing enough right into experiencing too much, a flashback. As a response we avoid/dissociate even harder, distancing us from our body even more. It can be automatic behavior that keeps us from realizing that we respond to a physical experience that isn’t actually happening anymore. It also means that we condemn our bodies to keep secrets for and from us: the trauma information that is not processed enough to be verbal memory, that is stored as a body memory. Without this information we might get stuck in our healing.
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Safety within our bodies
The first goal in trauma therapy is establishing a sense of safety. It is impossible to create a sense of safety within this cycle. We can only reduce the impact by reducing the avoidance of our physical experience and allowing ourselves to have new, safe experiences with our body. That can help us to find middle ground where our experience is connected to the here and now instead of the then and there. As the body experiences that it is save we will be able to calm down. We cannot create a sense of safety in our minds that is independent from the body.
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Grounding
When we work with the body it means being present and engaged instead of dissociated or stuck in memories. It becomes a here-and-now-therapy that helps to deal with current symptoms without the need to look back at traumatic experiences. Some patients are simply not stable enough for that, but they are well able to improve their experiences today.
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Self-regulation
Arousal states as well as intense emotions are physical experiences. We can approach them by working with the body to help us regulate ourselves. This could include movement to release stress and find balance but also touch for comfort and relational regulation. Slowing our breath will help the whole body to calm down.
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Self-esteem & agency
When we work with our bodies, we can have the physical experience that we are in control of our body today. We feel that we can make a choice and act on it to create change. It makes a difference if we know this with our mind or with our body. This will increase our sense of safety today and improve the way we see ourselves in this world.
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Thoughts and beliefs
It is hard work to change our thoughts and to think ourselves into a new belief. Body work might reveal a truth to us that we were not able to grasp in our minds but our body helps us to feel it and that can change the way we think. Even just one experience that proves our belief wrong is powerful enough to change it.
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When we stay with our safe body, we can learn to own it, to live in it, even to love it and take good care of it. It is part of who we were. We won’t have to fight it anymore, we are a team. It means that we can learn to listen to our body and become more aware of our needs.
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Overcoming defenses
In talk therapy we sometimes face mental barriers and defense strategies like intellectualizing to avoid painful emotions. A non-verbal body-focussed approach could help to overcome these defenses.
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Unspeakable
And some things concerning trauma simply cannot be put into words. They are experiences that are hard to express and sometimes the memory wasn’t processed enough and it leaves us with a sensation instead of a situation we could describe. This can be approached through body work though and result in a relief.
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Body work can support our preparation for trauma work, as it helps us to stay with ourselves, which influences our ability to integrate a memory and to regulate ourselves, which keeps us from getting re-traumatized during exposure.
But even if exposure is not for you, body work might be able to reduce your symptoms significantly. It can help to over-write some of your physical memories with layers and layers of new memories, to the point that your awareness of the present is a strong counterbalance to any flashback you experience. You need to be present for this to happen, because our brain can’t create proper memories while we are dissociated. It might not stop the flashbacks, but it can reduce the impact and help you to recover a lot faster.
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I have put together a list of different kinds of unspecific body work that have been helpful to survivors in the past.
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Movement
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Qigong
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Martial arts (not as preparation for fight but because of the focus on self-control)
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dance therapy
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self-defense, model mugging program
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kinaestetics
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Sensory integration
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therapeutic massage
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craniosacral therapy
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feldenkrais
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acupuncture
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functional relaxation
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Other
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drama
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rhythm and drumming
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choir/ gospel/choral singing
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breathing therapy
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I will add articles about some of these over time. Please be patient.
More about trauma-specific body work (coming soon)
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