Practical Application in the Treatment of Trauma
By Diane Poole Heller, Ph.D. Revised August, 2006
“For I can see that
in the midst of death, life persists
in the midst of untruth, truth persists
in the midst of darkness, light persists.”
Recent developments in trauma resolution have enormous implications for the spiritual quest, offering a new paradigm for the expansion of consciousness. In this article we will be exploring the link between Somatic Experiencing®, a trauma resolution therapy, gradual ego dis-identification and spiritual transformation.
From a clinical standpoint, how do we enhance our support to trauma survivors and help them heal from symptoms such as dissociation, disrupted relationships, grief and loss, chronic fatigue, tension, pain, hyper-vigilance and the overall emotional, cognitive and physical distress that so often becomes lodged in body and soul?
First, let’s explore the advantages of body-oriented psychotherapy in clearing fear from the physiology and how to practically apply the more recent brain and nervous system research in clinical practice. Clearing fear also supports a more relaxed capacity for ego strengthening and eventual dis-identification. This work sets the stage for experiencing expanded spiritual states in an embodied and integrated way.
Cognitive treatments, in part, may aim to help clients develop practical coping skills that are often based in the body, such as breathing and relaxation techniques. However, the body-oriented psychotherapy approach, Somatic Experiencing® (SE), developed by Dr. Peter A. Levine, teaches clients how to track sensation in the body through sensate focus to elicit the intrinsic healing capacity for self-regulation and healing that all humans share. Connecting the client to the experience of their innate healing wisdom supports mastery and restores self-confidence and the inner experience of core intactness regardless of previous experiences.
For example, therapists using some cognitive methods, may tell clients to take several deep breaths. This activity accesses voluntary brain function from the top (neocortex) down. Conversely in SE® , working from the bottom (brain stem) up, it is a more common practice that the practitioner will work with the client to help them use a sensate focus guiding their awareness between what has been distressing, how it feels in the body now, and then shift focus to what resources they might access that have a calming effect. This “pendulation” back and forth is one technique among many to help the over-activation discharge through accessing the parasympathetic relaxation response. Deeper abdominal breathing returns naturally without the therapist’s overt suggestion and is a signal of successful creative self-regulation.
The SE® practitioner also directs the clients’ attention toward completing self-protective responses to threat and guides them to follow the body’s instinctive “felt sense”. This process allows highly charged survival energies to be slowly and safely discharged, often alleviating arousal-induced trauma symptoms.
Exploring Somatic Experiencing®
“Trauma is in the nervous system, not in the event.”
We now understand more fully that long-term stress causes deeper and deeper somatization meaning that trauma is stored in the body. It makes sense then that our treatment effectiveness might be enhanced if we were to emphasize and include a body orientation. Somatic Experiencing® was developed by Dr. Peter Levine in Lyons, CO in the early 1970’s and has proven highly effective in resolving symptoms of post traumatic stress disorder, (PTSD) and in overcoming extreme life events. This model emphasizes tools to help clinicians help traumatized clients discharge bound survival energies including immobility or freeze responses so they can become more active in self-protection as well as initiating what they need in their lives. Completion of self-protective responses (fight/flight) related to the original threats facilitates discharge of arousal in the autonomic nervous system (ANS) resulting in a return to relaxation.
This strategy can also be used to help heal the deep “trust in humanity” wounds left after the breakdown of relationship, with oneself, others, family and/or the community.
Broken connection is a hallmark of trauma. SE® and the transformational process can support survivors as they create new lives out of shattered ones.
Thirty-five years ago, Peter Levine began to apply his deep understanding of brain and ANS function to the treatment of post-traumatic stress disorder, (PTSD).
Levine studied how animals recover from the constant threat of life threatening prey and predator dynamics in the wild. He recognized how these instinctive reactions in the human animal brain and nervous system are very important physiological resources for the healing of traumatic stress.
An instructive element is our understanding of the reciprocal regulatory function of the two branches of the ANS. One branch is called the sympathetic nervous system, (SNS) and it mobilizes energy to take action while the other, the parasympathetic branch, (PNS) initiates the rest and rebuild cycle. When triggered to respond to danger by the amygdala, which is the part of the limbic brain that alerts us to possible danger, the SNS attempts to meet and defeat threat through action oriented fight/flight responses. If these actions are blocked or unsuccessful, the SNS may continue to flood with residual anger and panic and/or the PNS may initiate a shutdown response. A client may experience high oscillation shifts between the SNS and the PNS resulting in flooding that alternates with over-constriction leading to disconnectedness and fragmentation.
When stimulus is too great and the activation from the threat exceeds or breaks what Freud long ago described as the “stimulus barrier”, often the SNS and the PNS activate simultaneously and the highly charged freeze response results. At this point clients report feeling immobilized, frozen and often become dissociated.
Usually the freeze response is short-lived and time-limited. When it continues to be stimulated by associated triggers to the stressful event or is held by the body too long, problems arise. Often the release of the freeze response results in exposing the flooding of emotions such as panic, anxiety, rage, helplessness and many physical manifestations as well such as chronic fatigue, pain and tension, headaches, irregular heart rate, etc.
Understanding the significance of this dilemma in the treatment of trauma, Levine designed highly effective physiologically based clinical strategies that support the nervous system in its attempts to “renegotiate” or discharge the residual over-activation originally mobilized in response to threat.
Somatic Experiencing® , (SE) is an involved treatment strategy and I will only discuss a few of the highlights in this article.
Tools related to a basic SE® approach that the therapist
can use include:
- a) Resources: Discovering what’s right with the client and using that information to develop an inventory of resources to help them access a sense of safety or support that can help neutralize over-arousal, etc.
- b) Felt Sense/ Sensate Focus: Helping the client develop a sensate focus and ability to track their experiences in the body.
- c) Pendulation and Modulation: Pendulation is defined as the body’s natural rhythm supporting the basic process of contraction and expansion, i.e., the movement between tension and relaxation or inhalation and exhalation. Guiding the client to shift their attention back and forth between the calming effect of resources and the high activation of traumatic material in a manageable, balanced way to help them digest overwhelming material without becoming overwhelmed in the process helps to facilitate the pendulation.
- d) Pacing: Learning the slower pace and rhythm needed to integrate traumatic material when including the physiological reorganization. “Slow is fast and less is more” in the service of effective integration. Note: It has been suggested that the reptilian brain processes much more slowly than the neocortex.
- e) Titration: Breaking the activation down into small enough pieces to be integrated easily so that a client can process overwhelming material in a non-overwhelming way. EX: Adding drops of HCL into caustic soda until the liquid gradually transforms into water and salt, the building blocks of life.
- f) Biological Sequencing: Learning to work with the biological sequences innate in the body in terms of how it deals with threat. i.e. the threat response sequence, the brace-collapse-rebound sequence, and the Dorsal Vagal (driving the PNS response), sympathetic, Ventral Vagal (driving the PNS) sequencing studied by Porges.
- g) Discharge: Supporting discharge of residual arousal in the ANS including completion of defensive orienting responses.
In SE® , there is the understanding from Levine that “trauma is in the nervous system not in the event.” Content related to what actually happened is used to understand the situation but reviewing the details mostly defines where the activation is still interfering with resolution of distress. Therefore treatment is not memory or content dependent. We can focus on treating symptoms such as migraines or chronic pain without knowing the initial cause.
Symptoms develop when the massive energy that became mobilized to meet real or perceived threat is left undischarged in the body. As I mentioned before, when under extreme stress, both branches of the ANS, sympathetic and parasympathetic, over-activate, and often the immobility/freeze response results. The body compartmentalizes the undischarged activation and binds that residual arousal into symptoms. At a certain threshold of stress, the threat response becomes internalized and our own undischarged arousal can trigger the threat response. We lose our capacity to discharge the excess energy and symptoms can worsen and become progressively debilitating. This is why re-establishing clients’ ability to discharge and to re-regulate is so important.
Often during threat, the ANS deregulates so that the SNS over-activates causing flooding and the PNS over-activates causing hyper-constriction. Many of the PTSD symptoms a client experiences derive from the alternating dominance of either one or the other branches of the ANS while over-activating. We see symptoms as markers for where the somatic work can be applied to help alleviate this painful vacillation between the out of balance workings of the SNS and PNS. As the nervous system re-regulates and symptoms resolve, the person begins to heal and to return to a more balanced functioning which results in increased well being.
Threat Response Sequence
All humans react to perceived danger in essentially the same way according to the biological design of the threat response. The threat response, which is stimulated by novelty or threat in the environment, basically includes the following sequence if it is allowed to complete.
1) Arrest Response stops you from what you are doing to alert to novelty or possible danger. Something’s different…I instinctively stop to check.
2) Startle Response involves a surprise expression in the eyes and face and a shivery jolt to attentiveness throughout the body closely related to the Arrest response in time sequence.
3) Orienting to Locate the threat or novelty usually through scanning visually by extending the neck, turning the head toward sounds or pivoting the body looking for movement or identifiable threat. “Where is it?”
4) Evaluating (primarily a non-conscious process) the novelty to determine if dangerous. “What is it?”
- a) If harmless, a return to activity and relaxation or, if desirable, a possible joining in the source of perceived pleasure.
- b) If deemed dangerous, defensive orienting or self-protective responses are triggered including Fight, Flight and/or Freeze responses. The question here is, “How does the body try to defend?”
5) Completion of self-protective responses of Fight, Flight and/or Freeze
6) Discharge of energy mobilized to meet threat through completion. How to let go.
7) Relaxation Response returns.
8) Sense of Mastery or the exhilaration of success in defeating threat referred to as “Pronking” in animal studies, the thrill of successful escape, a return of confidence and empowerment.
If any one of these natural biological sequences is thwarted before the relaxation response is attained, a person may remain locked into the threat response in a way that remains uncomfortable. The amygdala is in the central part of the limbic brain and modulates arousal of pleasurable states as well as alerting us to possible threat, much like a smoke alarm in your home. When the amygdala triggers the threat response, a vast amount of energy is mobilized to be used by the body to survive the danger. If the organism is unable to eventually discharge the energy and return to a relaxation response, we remain in a highly charged state referred to as “tuning”. SE® attempts to interrupt tuning related to threat and help the system complete the threat sequence toward relaxation and empowerment. I will describe this process as it might show itself in the body and include some possible symptoms if the sequence is interrupted or defeated.
For example, when you hear a loud banging noise, you instinctively stop doing whatever you are doing and startle to attentiveness. Any novel sound or change in the environment will cause this arrest/startle response until the novelty is deemed harmless or neutral. If the environment is safe or neutral, you return to your normal activities undisturbed and soon become relaxed again. If you decide that an event is indeed threatening, you proceed along another predefined biological path.
Naturally you turn your head to listen for the direction of the strange noise to locate the threat. Your neck elongates to get a better view and your eyes scan to see where it comes from. “Where is it?” is the internal question your body is trying to answer. If you encounter the impact of the threat before finishing the goal of locating it, afterward you will be left with a feeling that threat can come from anywhere, can catch you off-guard, and that there won’t be time to protect yourself. It makes sense biologically to stay hyper-vigilant and on the lookout if this “mission has not been accomplished”.
A client may demonstrate this unfinished business by darting their eyes around the room, being unable to focus, or have difficulty making good eye contact with another. Clinically we can insert time into the threat sequence in the present and help a client locate threat now. “Take all the time you need to turn your head and look directly at the threat as you feel ready.” might be an intervention to support completion of locating threat. The client has already done the hard work of surviving whatever happened so that this response can conclude its’ function and relax into the next step of the natural sequence.
Processing an Incomplete Orienting Response from an Attack
For example, I was treating an attorney I will call, Linda, who had been raped from behind at the law library during her education and had never seen her attacker. She suffered from many symptoms of extreme hyper-vigilance and described the feeling of always being followed from behind for thirty years after the attack. As she described this “being stalked” feeling, her head and neck kept slightly rotating to the left. Because she was unaware of this small orienting response (most likely an attempt to see and locate the threat posed by her unseen attacker), I pointed this involuntary movement out to her. Linda was surprised.
As she continued the movement slowly to the left, she experienced terror leftover and held in the neck muscles from the original attack. I suggested she move back toward the front where she felt safer. This way we could slow the pace of dealing with the fear and to give her time to discharge some of the high activation. As she was ready, Linda continued to move more to the left. She again encountered terror and then modulated it by opening her eyes and moving back to center. This modulation helped her stay in contact with the experience and not dissociate which then served to help her integrate the difficult experience step by step within her range of readiness and resiliency.
We must stay connected to our experience in order to integrate what happened and to literally digest it. We can’t change what happened in the past but can greatly change how it affects us in the present. We find relief in the future as well because we are projecting less of the pain of the past into it.
“Trauma may be a fact of life. It doesn’t have to be a life sentence.”
Anngwyn St. Just, Ph.D
It is important to help the energy discharge and not to push through the fear, pain, or over-activation. Each time Linda, the attorney, rested in the neutral position she could move a bit further to the left until she eventually could see over her shoulder and she then suddenly exclaimed, “He’s not there!” The fear drained from her and she no longer had the feeling of someone dangerous behind her because she had successfully located the area of the previous threat triggered from so many years earlier and completed her orientation to it. Biologically she had to look at the threat to finish that stage of the threat response so she could literally move on. Linda had known cognitively that the attack was over but as she “looked at” the threat now in the present, she realized physiologically that the rapist was truly gone.
Now Linda could feel the attack was “behind her” in the past, rather than having the feeling that someone was still lurking there ready to attack in the immediate future. The sense of being attacked had felt like it was in front of her in time so she remained tensely alert. With the completion of the locating part of the threat sequence, the attack experience moved into the past where it belongs. Understandably, her body relaxed and much of her hyper-vigilance began to resolve.
To continue our explanation of the sequencing of the threat response, once you locate threat, you evaluate it. If the noise was fireworks from a party nearby you may go back to your previous project knowing there is no danger or decide to join in the fun. You would relax and feel at choice about what to do next.
If you see that the noise was an explosion, you react very differently and immediately decide whether or not to run away and in what direction for the best chance of survival. If you want of confront the threat by mobilizing into a fight response, you may try to attack the bomber. Often your body instinctively responds without much time to analyze the situation cognitively. If overwhelmed and under resourced you may freeze or become immobile, perhaps feeling cold and paralyzed.
Note: Not every overwhelming event results in traumatic stress. Many challenges will not disturb a person beyond a short time after the event if that person has an adequate support system, enough internal strengths to rely on and/or if they were sufficiently able to discharge the survival energies generated by the threat.
Organization of Intentional Movements
What happens if these important survival responses are interrupted? The energy mobilized to defend against threat will be stored in the body often causing familiar PTSD symptoms. In session, you may find the client is prone to panic as a symptom of incomplete flight responses. Observing the body, you may see a client tapping their foot or moving their leg. These, often unconscious, movements may be the beginnings of a flight response that needs to be completed. Clinically we would evoke the running response related to the original threat, not by having the client actually run around, but by having the client feel the impulse to run and work with that organizing impulse toward completing the running movement.
This initiation of a defensive orienting response is called “intentional”, “preparatory” or “micro/rehearsal” movement and helping the client become more aware of it allows the flight impulse complete and the held energy discharge much more effectively that gross motor movement. The client may be encouraged to imagine a safe destination and to use arousal of the running energy originally activated in response to threat to move toward the safe place as a resource to lessen the panic of the flight response still associated with the threatening situation.
If the fight response is blocked, clinically we might notice the client cycle in and out of unresolved anger that is commonly over-associated with helplessness and is left over from the experience of defeat or incompletion in the dangerous circumstance. Again the thwarted fight response is supported to surface in the session in a safe way. A client is encouraged to feel the impulse to fight, or to make fighting sounds or movements slowly while focusing on the bodily sensations, words, or images that may accompany the response as it completes and discharges slowly. Done properly a sense of strength and power usually returns.
In all cases, the emphasis is on completion of survival strategies in the body versus reliving the event. Remember, in SE® , we use the content of the event to understand the lay of the land and, predominantly, to discover where activation remains mobilized and needs to be creatively worked with in order to discharge.
It is important to note that the client’s body knows how to do this on it’s own with the proper support and treatment. The client experiences a renewed trust in his or her body as they can feel their body regaining power, strength, and well being as relaxed alertness returns and symptoms decrease.
The Freeze or Immobility Response
The freeze response demonstrates the highest level of over-activation in the ANS. It may be a primary defense strategy in that the body reads the situation in such a way as to determine that freezing is the safest response because many predators cannot perceive non-moving prey. As we discussed earlier, the tonic immobility response is also caused by an activation of the sympathetic nervous system to fight or flee, but then is overcome by a stronger impulse for the parasympathetic to literally put the brakes on to stop any action from taking place. As a secondary default reaction, sometimes we find ourselves in freeze when the activation level is very high and our resources are insufficiently available to the extent that the system jams and becomes blocked into paralysis.
It is important to understand that even though this frozen response looks passive, the autonomic nervous system is highly activated with both ANS branches, SNS and PNS over-activated. It would be as if you had your feet pushed down on both the accelerator and the brakes of your car at the same time with the engine running. If you lifted the brakes too fast the car would accelerate out of control. This is not the way you want to drive your car or run your engine for long. Obviously, this is not a desirable state for your nervous system for any length of time either.
You can see why trauma survivors are so exhausted. Many traumatized individuals are in this dilemma of constantly being overwhelmed and flooded, or overly constricted and frozen in the body and in time. As the freeze response is allowed or supported to thaw, a client often experiences involuntary trembling and shaking as the nervous system slowly relieves the brakes and the stuck mobilized energy begins to discharge out of the system.
We often show a demo DVD of Peter Levine working with Ron, a Dutch gentleman, releasing the freeze response after surviving a childhood in a Japanese concentration camp that demonstrates this phenomenon. When watching this DVD, you can see that when the intrinsic movements arise, or the natural gentle shaking discharge begins involuntarily, Ron has the tendency to try to control the physical expression. This attempt to control movement will override the subtle intentional movements with larger gross motor ones. This trembling out of the freeze response happens when we feel safe enough to surrender our volitional control.
Understandably, this letting go can be challenging if we use being in control to keep fear at bay. In the video session, Levine gently encourages Ron to allow the movement versus make the movements happen. Paradoxically, this is a therapeutic directive for the client to be non-directive and allow their body to unwind and discharge the held energy the way it needs to at its own pace. “Let your body move you without you moving your body.” might be such a suggestion.
Completion, Mastery, Empowerment and Return of Resiliency
It is important to give the body all the time it needs to fully allow this discharge. Often it is best to avoid distracting the client by talking too much or by making additional interventions. Often unfinished fight and /or flight responses will surface as the freeze lifts and then we facilitate the completion of those responses. As a point of interest, clients will often experience great relief and a sense of mastery as they complete these defensive orienting responses even if they failed in the actual event.
As completion happens, there is often a sense of winning exhilaration called ‘pronking’. Pronking is a term taken from ethnology, the study of animal behavior in the wild, where animals, after they achieve successful escape, leap high into the air with a sense of apparent joy and freedom. People, finishing fight or flight responses, experience the same expansive empowerment through completion of these built in survival plans.
This mobility can translate into having the ability to move forward in your life after severe challenges as well. This is certainly relevant for any individual who might remain dissociated or shutdown and/or stuck in an arousal pattern leading to rage outbursts, panic attacks, night terrors, insomnia, and flooding. The hyper-arousal stuck in such symptoms needs to be connected to its original purpose of self-protective defense. The release of the freeze response and completion of fight and flight energies helps clients reconnect to empowerment and resiliency. As the threat response resolves during or after engaging that threat, the system relaxes and life force is again available to use expansively and creatively versus defensively.
Porges’ Polyvagal Theory and the Social Engagement Nervous System
We have discussed briefly the view held by Levine and shared by Bessel van der Kolk, author of “Traumatic Stress” and another leading expert in somatic treatment strategies for PTSD, on the reciprocal and simultaneous activation of the parasympathetic and sympathetic branches of the Autonomic nervous system (ANS). Both Levine and van der Kolk are also enthusiastic about Stephen Porges’ recent scientific research revealing the importance of the “Social Engagement” Nervous System. I will present an oversimplification of this theory emphasizing its’ significance in clinical treatment.
Expanding the focus on how humans respond to danger, Porges emphasizes that the ANS has three sequential systems that follow brain evolution instead of only two reciprocal systems, PNS and SNS. His research relies on phylogenic development. He suggests a specific sequencing of ANS function while confronting threat. Porges believes we access our highest functioning first when confronting threat, and if the higher functions are thwarted or inadequate, we revert to the subsequent lower ones. He sees the nervous systems operating sequentially versus in a reciprocal or simultaneous fashion. Even though these two models of nervous system function differ in emphasis, both are valuable as guiding principles in treatment of PTSD or in resolving overwhelming life events.
Porges’ significant research is called Polyvagal Theory, referring to the dual role of the Vagus nerve. The Parasympathetic has two branches; the Dorsal Vagal that is more primitive in evolution and drives immobility and the Ventral Vagal that is more recent in evolution and involves higher functioning and supports social engagement. The Polyvagal nervous system includes the following (from lower to higher in order of development):
1) The Dorsal Vagal drives the PNS response that is sometimes referred to as the “primitive” parasympathetic and is unmyelinated. The Dorsal branch of the tenth cranial Vagus nerve emanates from the dorsal nucleus brain stem or reptilian brain and strongly influences digestion. It also activates the immobility response and may include a feeling of overwhelming helplessness and sometimes paralysis. It also descends to the heart and lungs, slowing heart rate and/or restricting breathing for oxygen conservation, a response we have in common with reptiles resembling the “diving reflex”.
Peter A. Levine notes that in land mammals, the archaic Dorsal Vagal system appears to have evolved with three different primary functions. “Firstly, at low to moderate levels, it modulates normal gastro-intestinal activity. Secondly, at high intensity surges, it stimulates vomiting and diarrhea associated with feelings of nausea. And thirdly, at sustained high levels, dorso-vagal stimulation results in generalized immobilization, including bradycardia and musculoskeletal paralysis.
In other words, according the polyvagal theory, based upon functional anatomical and physiological considerations, the very functions that, in the primitive aquatic environment regulated oxygen conservation, evolved in mammals to control states of paralysis (“freeze”) – as a last ditch survival response.
Dorso-vagally mediated immobility is, apparently, programmed to execute in conditions of physical restraint, inescapable threat, as well as in response to internal threats such as illness and hypoxia. Once these threats, either external or internal, are eliminated or otherwise resolved, the dorso-vagal system is meant to disengage, restoring homeostasis. In the absence of fear, the dorso-vagal induction of paralysis or energy conservation is time limited. However, when potentiated by states of fear, the duration of immobilization and energy conservation is greatly extended.
Thus it seems plausible that fear can cause these normally time-limited dorso-vagal responses to become chronic in the formation of traumatic stress symptoms. We argue, in other words, that states of chronic dysregulation can be fear-conditioned. These dysregulated states can, in turn, drive and maintain the chronic, and seemingly intractable, clinical presentation of ‘shut-down’ syndromes such as seen in certain forms of panic disorder, depression, PTSD, and chronic fatigue. Conversely, homeostatic self-regulation can be restored (and symptoms resolved) by active extinction of the fear-induced immobility.”
One of the primary goals of session working with trauma survivors is to discharge fear in order to “uncouple” fear from the immobility response.
When Dorsal Vagal influence is dominant, breathing is often restricted or shallow at best. Consider the sharp inhale we take when startled or frightened. We may become stuck on upper chest shallow breathing if we don’t shift out or hyper-vigilance to relaxation after the fright. A natural return to abdominal breathing is one of the easiest shifts to recognize toward autonomic self re-regulation after encountering stress or threat.
Activation of the Dorsal Vagal in the face of overwhelming threat refers us back phylogenically to amphibian reptilian times where the freeze response was the main response to danger. The Dorsal Vagal nerve runs down the back of the spine from the brain stem and spreads through the abdomen. Therefore, when it causes shutdown, many digestive difficulties arise including eating disorders or such disturbances as irritable bowel syndrome (IBS).
In the Dorsal Vagal state we are much less socially oriented and demonstrate much less emotional expression. Flat affect or a deathlike mask appearance is common after severe acute trauma or long-term chronic traumatic stress. This part of the nervous system has little orientation toward social or bonding behavior.
The Dorsal Vagal response may activate when we have too much stimulus to deal with during physical restraint and inescapable threat externally or in response to internal threats from illness when we have far too little resources or supports in place to help us manage it. We may collapse in a shame response when confronted with threat and default to the PNS response. We feel shutdown, disconnected and are often completely immobilized. If motor activity has been initiated in an attempt to be self-protective but has been sufficiently thwarted, there may be an underlying activation of the SNS. There can be high oscillation of the SNS and PNS at the same time but resulting in shutdown of the freeze response as well. Then it is difficult for us to focus or find realistic options or to connect to many of our higher functions.
The capacity to accurately send or receive coherent social cues is impaired. Broken connections to self, such as fragmentation and dissociation, as well as disrupted relationships abound if the dorsal dominance persists. Unfortunately anyone exposed to long term traumatic stress may experience these limiting consequences for long periods of time.
It is important to note that often the lack of cognitive functioning, the difficulty moving physically or metaphorically in one’s life or lack of social engagement can be largely due to a physiological state resulting from PTSD rather that a true deficiency. Conversely, developmental deprivation or damage can prohibit or impair certain autonomic functions.
The higher functions often begin to regain functionality as we regain the ability to become mobile instead of immobile. This can happen when activation decreases through access to resources, including our sense of self and core intactness, and/or a completion of the thwarted self-protective orienting responses. In the absence of impairment, we could consider that the wiring of the higher functions is there in the body and mind awaiting usage much like a darkened room needs the flick of a light switch to brighten again.
This Dorsal immobilization or Freeze response holds the highest charge and often results in the freeze response and dissociation. To free clients from a debilitating inability to act on their own behalf after the threat has passed, we can help them access the sympathetic responses to reconnect to greater mobility. Clinically I suggest that we reintroduce the threat at a safe distance determined by the client. Suggesting that the client give themselves plenty of time and space to respond to the previous threat can help them initiate and finish the sympathetic fight or flight responses. Typically, completion is very empowering.
2) The sympathetic branch (SNS) activates the reptilian and limbic mammalian brain to take action to defend oneself. When confronted by threat it initiates fight/flight reactions. Often these reactions are blocked or left incomplete. As clients emerge from PNS shutdown, they contact the urge to run or fight connected to the activation of the original threat. They need to find a safe way complete the impulse. As we discussed, undischarged arousal can become compartmentalized into symptoms. When the arousal is released rather than stored in the body through somatization, clients discover more resilient responses and a greater sense of well being. This supports clients to have greater access to the next higher function of social engagement.
3) Porges’ theory suggests that, for humans and existing only in mammals, the more recently evolved social engagement, or ventral vagal system drives a parasympathetic (PNS) response. It is myelinated and originates from the ventral brain stem. Sometimes referred to as the “smart vagus”, supports face-to face communication and contact for social engagement. In the human animal, the benefits of healthy bonding are paramount for later healthy relational interaction. The devastation reaped from impaired bonding is equally as significant in the opposite direction.
The Ventral Vagal system connects to the tenth cranial nerve and along with cranial nerves V, VII, IX, X, and XI, supports the muscles of the neck, throat, mouth, ears, nose and the overall face. Working together, this allows us to perceive social cueing from others as well as send our own through facial and emotional expression. When humans developed the capacity for social cueing and emotional expression that starts in early infancy and continues to develop throughout childhood into adulthood, we found a new, more sophisticated way to negotiate threat beyond the former fight/flight and freeze responses when feasible. For example, if using the higher functions such as communicating or negotiating our way through a conflict-ridden or threatening situation won’t work, it is Porges’ idea that we revert to sympathetic fight/flight reactions. If fight/flight reactions fail us, we revert further to the most primitive, Dorsal Vagal response reflecting immobility, frozenness and/or dissociation.
For further clarification, see Peter A. Levine’s description of Stephen Porges’ Polyvagal Theory at end of this article.
Review of Somatic Treatment Strategies
Clinically, part of our task may be to help our clients become able to access different aspects of the nervous system and different areas of the brain to integrate the higher functions that may have been interrupted by trauma. With regard to tracking the physiology, a clinical intention might be to help facilitate:
- a) a release of the inhibition function of the primitive parasympathetic (driven by the Dorsal Vagal nerve emanating from the brain stem) when the immobility response is engaged, and to
- b) access the sympathetic that connects to the limbic mammilian and reptilian brain and allows the ability to move, to complete the defensive responses and discharge the excess energy.
- c) Ultimately, this shift from SNS dominance gives clients a connection with the more evolved ventral-vagal response (that drives the more recent PNS) to reestablish and broaden the capacity for social engagement and bonding behavior.
In review, the main thrust of the somatic treatment strategies that I am suggesting specialize in understanding the physiological underpinnings of the freeze response, in particular, and the threat response as well as trauma symptoms in general. Clinical applications are used that support a client to access the three-part nervous system and the reptilian, mammalian, and neo-cortex brain functions to integrate increasingly higher functioning after the event is over.
As we reclaim higher functioning, we return to a deeper sense of well being as well as the ability to connect to one’s self and others.
Biologically the client will find mobility arising out of immobility as the therapist helps them find a more effective balance between the SNS and PNS through accessing resources and corrective experiences. As stabilization occurs, the therapist can facilitate modulation of the activation by alternating sensate focus between the upsetting aspects of the event or distress localized in the body and experiences that have a calming and soothing effect. This supports a return of the basic function of pendulation restoring the body’s natural rhythm between contraction and expansion. Pendulation/modulation usually enables the distressing experience to be integrated regardless of the circumstances of the actual event. Remember, Levine emphasizes, “Trauma is in the nervous system, not the event”.
The main goal is to keep the arousal levels moderate enough so that the clients’ awareness remains intact and connected to the experience so that dissociation is unnecessary. The nervous system is designed to facilitate recovery from threat and extreme experience. Understanding how to work clinically with the physiology greatly enhances our use of all of our skills and training in a much more effective way.
Most importantly, these treatment strategies support and elicit intrinsic healing capacities and, in a way, put the client’s body in charge of the session. The therapist is in the role of facilitator and keen observer of what the body is constantly broadcasting in terms of which part of the brain or nervous system it is currently referencing. Symptoms are signposts where ANS over-activation is held in the body and causing a disturbance. When we learn how to help client discharge held mobilization the function of the symptom often evaporates. When treatment is done properly, the client experiences his or her own innate healing capacity. This experience is, in itself, extremely empowering and also acts as an antidote to the extreme helplessness encountered in the traumatic experience.
Based on a phylogenic perspective, Porges sees the nervous system as sequential in how it responses to threat meaning that when confronted by danger a person will attempt to use the highest or most evolved functioning first. His important research shows the development of the Social Engagement nervous system or the ventral vagal system, which gives us the more sophisticated ability to socially cue and negotiate, speak and listen contributing to healthy bonding, communication, and social contact.
Awareness Practice and Staying Connected to Experience
When working with extreme experience it is often suggested to work with the activation directly and not the specific memories. For example, with torture survivors, the material can overload them. Aliveness can often return without needing to delve onto the details of the actual content too deeply. In closing, I would like to tell a story reflecting a return to resiliency and contact-fullness working predominantly with awareness and image.
A few years ago, I worked with an Israeli gentleman who has spent a large part of his childhood in a concentration camp during the Holocaust in Germany. He was curious about a recurring intrusive image he had had almost daily since that time. He continued to see the totally white image of a mummy tightly bound in white linen strips lying on top of a polar ice cap. I gave no interpretation, as I believe the realizations are more significant when coming from his own experience. I felt this image was a dramatic and accurate example of deep freeze and unresolved shock from those early experiences. In this example, we are working primarily with the image as it evolves by maintaining awareness and connection to it, as he was only minimally able to sense his body and emotions due to dissociation.
I simply invited him to look at the image and to stay curious. Time passed and eventually a dark black hole opened up where the face would have been. Appearing worried, he said he was afraid to look in for fear of what he would see. I encouraged him to take his time and wait until he felt an internal sense of readiness. I reassured him that there are always options, including not looking there at all. There was no agenda.
Eventually he looked and saw a horrible emptiness and deadness that shocked him. He was able to stay focused and feel the state. His awareness became more intact and less disconnected. I encouraged him to remain curious. Slowly, the emptiness began to pass. Later, to his amazement, (and I believe, in response to his innate self–regulation beginning to surface), a green sprout started to grow out of the black hole. Vibrant color returned with these tender, fragile shoots. New life emerging, the vine grew longer and fuller as we stayed connected and present with the once frozen, now unfolding image. Smiling, he made eye contact with me and I felt his personal presence return more fully, signs that social engagement was strengthening. Perhaps another Phoenix was beginning to arise from the fire of earlier ashes.
Peter Levine writes, “Because traumatic events often involve encounters with death, they evoke extraordinary responses. The transformation process can allow people to deepen their sense of self and others. The healing journey can be an “awakening” to untapped resources and feelings of empowerment. With the help of these new allies, people can open portals to rebirth and achieve and increased sense of aliveness and flow. The experience can be a genuine spiritual awakening, one that allows people to re-connect with world.”
“If you bring forth what is inside of you,
What you bring forth will save you.
If you don’t bring forth what is inside you,
What you don’t bring forth will destroy you.”
American Psychiatric Association. (1994). Diagnostic and statistical manual of mental disorders (4th ed.) (DSM-IV). Washington, D.C: Author.
Chilton, Pearce, J. 2002) The Biology of Transcendence: A Blueprint of the Human Spirit. Rochester, VT: Park Street Press.
Chitty, J. (2001). Polyvagal Theory, The Triune Autonomic Nervous System, and Therapeutic Applications. http//www.energyschool.com
Cherokee Studios. (1999).Surviving Columbine [Videotape]. Denver, CO: Author.
Figley, C. (1995). Compassion fatigue: Coping with secondary traumatic stress disorder in those who treat the traumatized. New York: Brunner-Routledge.
Gendlin, E. (1981). Focusing. New York: Bantam Books.
Herman, J.L. (1992). Trauma and recovery. Basic Books, a division of Harper-Collins Publishers, USA.
Levine, P. (1999). Healing Trauma: restoring the wisdom of the body. Boulder, CO: Sounds True
Levine, P. (1997). Waking the Tiger: Healing Trauma. Berkeley, CA: North Atlantic Books.
Levine, P, Scaer, R., and Whitehouse, R. (2006), An Innovative Psychophysiological Treatment of Chronic Fatigue Syndrome Subsequent to Acute Altitude Sickness.
Newber, A. (2002). Why God Won’t Go Away: Brain Science and the Biology of Belief. New York, NY: Ballantine Books.
Poole Heller, D. (1999). Enhancing Resiliency in the Treatment of Extreme Life Events. Dissertation.
Poole Heller, D. (2000). Speaking the Unspeakable: An Expensive Truth. Dissertation.
Poole Heller, D. (2002). Rising From the Ashes. Caring For the Caregiver: The Use of Music and Music Therapy in Grief and Trauma. Silver Spring, MD: The American Music Therapy Association.
Porges, S.W. (1997). Emotion: An Evolutionary By-Product of the Neural Regulation of the Autonomic Nervous System. Carter, C.S., Kirkpatrick, B., & Lederhendler I.I (Eds.) The Integrative Neurobiology of Affiliation. Annual of the New York Academy of Science. Volume 807.
Salter, A. (1995).Transforming Trauma. California, London: New Delhi, Sage Publication, Inc
van der Kolk, B. (1987). Psychological Trauma. Boston, Massachusetts: American Psychiatric Press.
van der Kolk, V. (1999). Unpublished manuscript.
van der Kolk, V. (1993). http//www.trauma-pages.com/venderk4.htm/