The Body Keeps the Score


By Mary Carpenter

FOR COPING with end-of-the-day fatigue, hunger or past trauma, somatic therapies or “experiences” incorporate techniques that involve the body as well as the mind. Feeling irritated when hungry, for example—known as “hangry”—may originate in childhood frustration with delays in getting fed. To return to one’s adult self in the present time, a somatic technique might be to sense the environment, such as the temperature, or to touch one hand to the other.

“I might ask a patient if her hands feel okay and, if she says yes, I’ll ask her to move them, exploring their lightness and warmth and flexibility,” writes Bessel van der Kolk in his 2015 book The Body Keeps The Score—which has remained at or near the top of the New York Times Paperback Nonfiction Bestsellers List for 284 weeks. “Later, if I see her chest tighten and her breath almost disappear, I can stop her and ask her to focus on her hands and move them, so she can feel herself as separate from the trauma.”

Daily stressors have multiplied with the explosion in social media on top of the daily roller coasters of excited highs and disappointing lows—resulting in end-of-the-day overload that may be best relieved with physical activity—a relaxing walk or gentle yoga. Reactions to both present stress and past trauma—fight and flight, along with a third, freeze—can build up in the body over time as persistent muscle tension, tightness of breath and hair-trigger startle responses, which can cause more health problems as people age.

“Typical talk therapies such as CBT engage only the mind, not the body, encouraging people to become aware of [and try to change] disturbing thoughts and behavior patterns, explained Mass General clinical psychologist Amanda Baker. “But in somatic therapy, the body is the starting point to achieve healing.” People identify tension points in their body as a way to understand and deal with past trauma—and to learn techniques for feeling safe in their bodies going forward.

Movement and touch are two pillars of somatic therapy, which is usually offered as one of several modalities by practitioners, along with talk therapies—such as CBT, and more often recently, dialectical behavior therapy (DBT) that combines movement with talk. (Practicing also increasingly popular “psychedelic therapy”—either using ketamine, the only psychedelic legal in most locations, or with patients obtaining their own drugs —therapists have learned what questions to ask and how to respond to bad experiences.)

In the trauma resilience model, practitioners use touch, such as a hand on a shoulder “to provide gentle support and endorse a feeling of safety,” according to pacesconnection. A woman who described helplessness and immobility during a traumatic event focused on creating a “strong image of running and [she] sensed strength in her legs,” leading to sensations of release and relief that provided confidence and helped prepare her for action in the future.

Decision-making offers a different use for somatic techniques. “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). Participants in a day-long workshop in DC on “Body-Centered Inquiry: Mindfulness, Focusing and the Power of Questions” practiced describing a difficult decision and seeing how their bodies reacted, first at one of the options and then with the other.

Pushing physically against a pillow or wall until you feel strength in your arms offers both an immediate experience and preparation for situations when “saying no” is difficult, according to somatic therapist Pat Ogden on IntegrativePsych. Alternatively, you can  “slowly drop into the sensation of the event [where you wanted to say no, but this time the body does what it needed to do] so you may move your feet as if you’re beginning to walk or run out.”

The person who has trouble speaking up may perform physical movements involved in “hiding” —such as crouching down or looking away—that can lead them to understand “I actually have something important to say,” notes Ogden.  The choice of which movements might be most helpful comes from an  ability to read the body’s inner state, called interoception—an important tool and often the first step in somatic therapy, but one that benefits from practice over time.

Mindfulness, with its focus on scanning the body for areas of tension and then releasing it, can be another tool of somatic therapy. According to the NewPathwaysTherapy blog,  “When you make space for sensory awareness, you may notice that you are sensing more than you think, and through that, you may experience more grounding, stability and stillness.”

But Baker disagrees, pointing out that “mindfulness meditation lets any feeling or emotion come into our mind without judgment, as opposed to [somatic therapy] homing in specifically on bodily sensations that are happening.”  Baker also notes that while, anecdotally people find “tremendous benefit” from somatic therapy, the research is lacking—compared to talk therapies such as CBT, which she “always recommends…as a starting point.”

For me, the Jonathan Foust workshop offered a refreshing alternative approach to problems after years of talking about them—and that in turn spurred my interest in somatic therapy. But while techniques of mindfulness can seem obvious, I needed the full eight-week course in Mindfulness-Based Stress Reduction (MBSR) before I could make good use of them on a daily basis. And MBSR is a standardized program that has helped large numbers and a wide range of people, whereas somatic therapy might work better for individuals working with experienced practitioners, both to help select appropriate techniques and to integrate and practice them—in conjunction with other kinds of therapy, which should probably include talking.

—Mary Carpenter regularly reports on topical subjects in health and medicine.

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