By Mary Carpenter
Since My Little Bird’s 2017 post reported on Bessel van der Kolk’s book The Body Keeps The Score—about body-focused therapies like yoga for treating mental health issues—the 2015 book has been on the New York Times Paperback Nonfiction Bestsellers List for the past 140 weeks and on the (all) Nonfiction Bestsellers list for 44 weeks; and is number one on both lists —as of Sunday July 11. And therapists who specify the kinds and combinations of therapies they use often include “somatic” therapies, alongside others that incorporate physical components, such as touch.
Last year in Los Angeles, 30-something entrepreneur T.J. found a new therapist, who told him her practice included Cognitive Behavior Therapy (CBT)—along with somatic and IFS (internal family systems) therapies, both of which incorporate physical components, including movement, touch and breath work. Somatic therapy is “based on the idea that traumatic experiences cause dysfunction in a person’s nervous system [that] prevents them from processing” talk-therapy sessions, writes Jessica DuBois-Maahs on Talkspace .
Somatic therapy aims to “help individuals develop new thinking patterns and behavior to better respond to various experiences or emotions as they come up,” writes Dubois-Maahs—by making them “notice physical sensations stemming from their mental health issues and use that awareness to work through painful feelings and emotions.” (For some patients, especially those who have suffered physical abuse, physical contact can be triggering or uncomfortable.)
In the 1990s, Antonio Damasio’s “somatic marker hypothesis” pointed to the role of the insula, located in the brain’s cerebral cortex, in processing bodily sensations that influence decision making—for example, queasiness in the stomach when deciding not to walk down a dark side street at night, or not to move to a different state—although much about the insula remains unknown.
“When you get to the point in struggling with a problem that you think, ‘I’m sick of talking about this,’” then it’s time to focus on your body, said Jonathan Foust, senior teacher at the Insight Meditation Community of Washington (IMCW). In a DC day-long workshop on “Body-Centered Inquiry: Mindfulness, Focusing and the Power of Questions,” Foust was only partly joking as he quipped: “Your issues are in your tissues.”
According to Bessel van der Kolk, when a child’s needs have been ignored by caretakers, their body remains in a state of high alert: brain imaging studies show effects in the insula, deep in the brain “where they cannot be eliminated by reason or understanding”—hence the need for work with the body along with cognitive therapies.
“Dr. van der Kolk writes that there are three avenues for recovery: ‘top down, by talking, (re-) connecting with others and allowing ourselves to know and understand what is going on with us’; ‘taking medicines that shut down inappropriate alarm reactions’; and ‘bottom up, by allowing the body to have experiences that deeply and viscerally contradict the helplessness, rage or collapse that result from trauma,’” according to the New York Times review. “Survivors usually need some combination of the three methods, writes Dr. van der Kolk, but the latter— the mind-body connection—is most neglected.”
As a researcher at Harvard and Boston University for more than four decades, van der Kolk studied the impact of childhood trauma on brain development and emotional regulation, as well as the effectiveness of yoga, theater, the drug MDMA “and other methods for treating trauma,” writes productivity consultant Tiago Forte.
Another of T.J.’s therapies, IFS, divides consciousness into distinct “parts” —one being “firefighters” that offer protection from depression and pain by redirecting the sufferer’s attention to work, sex, alcohol or drugs —for example, to the part of the brain that wants to stay out drinking vs. another part that’s aware such behavior will make tomorrow’s workday more difficult.
The goal of IFS is to access the wounded parts—from childhood or other trauma—to better balance consciousness, for example, to obviate the need for such firefighters. In particular with therapy called “Somatic IFS,” learning to use more effective breathing techniques can lead to relaxation and eventual mental clarity, along with the ability to sense which of your parts wants to keep drinking and try to understand the negative emotions involved.
While the goal of mindfulness exercises involving breath and body awareness focus on “being,” CBT uses the mind to reframe negative, anxious or obsessive thoughts with the goal of “doing,” or acting, differently.
Self-talk: to “approach, personify, exaggerate and talk directly” to their anxiety — to ask yourself, how can I create some anxiety here; how can I practice being willing to be anxious?—is the first homework UNC psychiatry professor Reid Wilson gives his patients. Worrying and avoiding stress heighten physical reactions by raising adrenaline levels, Wilson explains; whereas looking directly at and moving toward fears can be calming.
For the 2020s, CBT is also the therapy offered by Woebot, an app that relies on algorithms to “take someone through a standard CBT process,” according to University of Louisville psychiatrist Jesse Wright. But MIT clinical psychologist Sherry Turkle, who writes about technology and relationships, is skeptical—pointing out that, for therapy to heal, the therapist must empathize with a patient’s pain: “An app cannot do that.”
In fact, for most people, the best therapy occurs when they can form a relationship with the therapist—which happened for T.J. And the most effective therapists —whether or not they specify which therapies they are using—employ a variety of techniques with the goal of responding differently to the needs of each individual patient.
—Mary Carpenter regularly reports on topical issues in health and medicine.