How trauma survivors can reclaim their bodies and their lives
The terror and isolation at the core of trauma literally reshape both the brain and body. New insights into our survival instincts explain why traumatised people experience extreme anxiety and rage, and how trauma affects their capacity to concentrate, to remember, to form trusting relationships, and to feel safe in their own bodies.
Pioneers at the forefront of trauma research, such as Dr. Allan Schore and Dr. Bessel van der Kolk, have shown how advances in brain science, attachment theory and body awareness techniques can be integrated into treatments that free survivors from the oppression of the past. Only by making it safe for traumatised people to inhabit their bodies, and to tolerate feeling what they feel, and knowing what they know, can lasting healing take place.
Despite cognitive behavioural therapy (CBT) having accumulated the most research support, we now know that the whole cognitive part of the brain shuts down when people are traumatised, triggering the primitive survival part. So while CBT can give people a sense of perspective on their coping options when they’re in the right frame of mind, it has limited value in healing trauma.
Body psychotherapists have long recognised that “the body keeps the score” when it comes to trauma, and to treat it effectively we must work at the somatic sensory level with the body’s own language of sensation. Bottom-up approaches like Radix, Somatic Experiencing and Hakomi help people discharge hyperarousal and the fight-flight-freeze response.
The body’s defence response to danger
The amygdala and the hippocampus are part of the limbic system, the area of the mid-brain that initiates fight, flight or freeze responses in the face of danger. The cortex, the more rational, outermost layer of the brain, is the seat of our thinking capacity and where most memory is stored. The rational cortex is in constant communication with the amygdala and the hippocampus.
When someone is threatened, the amygdala perceives danger through the senses and sets in motion a series of hormone releases and other somatic reactions that quickly lead to the defensive responses. Adrenaline stops digestive processes and increases heart rate and respiration to quickly oxygenate the muscles necessary to meet the demands of self-defence.
The amygdala may continue to sound an alarm inappropriately, despite outward evidence that these responses are no longer needed. In fact, the amygdala’s perpetuating alarm even after the actual danger has ceased is at the core of post-traumatic stress disorder (PTSD). The amygdala continues to stimulate the same hormonal release as during the actual threat. Thus, PTSD could be said to be a healthy survival response gone awry.
A well-functioning hippocampus makes it possible for the cortex to recognise when a trauma is over. It instructs the amygdala to stop sounding an alarm, and facilitates resolution and integration of traumatic incidents and memories. However, it is highly vulnerable to stress hormones, particularly adrenaline and noradrenaline, released by the amygdala’s alarm.
When stress hormones reach a high level, they suppress the activity of the hippocampus and it loses its ability to function. Information that could make it possible to determine the difference between past danger and current safety never reaches the cortex, and a rational evaluation of the situation isn’t possible.
This has critical implications for therapy. Safe, successful trauma therapy must maintain stress hormone levels low enough to keep the hippocampus functioning so that feelings and sensations can be processed effectively without overwhelm. That’s why it’s so crucial for both client and therapist to know how to “apply the brakes” in therapy – to keep the hippocampus functioning and return it to action as promptly as possible when the system gets overloaded.
Mindfulness enables people to become attentive to their body and can help them to feel safe. Being able to be mindful is a necessary precondition for change as it facilitates the integration of trauma into overall consciousness. In this altered state, they can actually observe themselves and develop a sense of self-compassion that enables them to integrate their dissociated self from the past into in a calm state of mind in the present.
A body-centred perspective on dissociation
One of the key developments in the treatment of trauma has been the recognition of the role that dissociation plays its aftermath. The dissociative defence protects the victim from experiencing the overwhelming physical, emotional and cognitive impact of the traumatic event. Dissociation is complex and occurs across the dimensions of behaviour, affect, sensation, and knowledge. The result is a disconnection from one’s self, one’s ego identity, one’s body, one’s emotions, and one’s contact with reality. So, cognitive dissociation cannot be transformed in isolation from the concurrent physical dissociation.
A child or adult who has been traumatised or severely abused will dissociate by withdrawing energy and awareness from the parts of their body that want to fight or flee, from the parts that contain the unexpressed emotion, and from the cognitive processes that cannot acknowledge what is happening. A common phenomenon in adult survivors is a dissociation from the pelvis and legs. This lack of awareness of their legs translates in the way they interact with the world as feeling like they have no support or they are unable to stand their ground. The consequence of this detachment from the body and the deadening of feelings is that the person is frozen into unconscious, habitual patterns of thinking, feeling and behaving.
When life energy is withdrawn from the eyes, they may appear deadened, blank or lifeless. This is a clear indicator that the person is dissociated and not fully in contact with the present. Respiration is another primary way of limiting vitality. Trauma survivors restrict the breath to reduce their sense of aliveness and self-contact which makes it difficult to know what they want or need. With diminished body awareness, they also have little energy in the periphery of the body, which leads to a poor sense of physical boundaries. They aren’t sure where their body begins and ends. Without boundaries, there cannot be a sense of the body as a container for emotions. If they contact emotions, escalation and overwhelm are likely without having a way to contain the sensations and feelings.
The advantage of a body-centred approach in working with trauma and dissociation is that the physical aspects are easy to recognise, both for the therapist and client. We can see when the eyes deaden, space out or stare, stop blinking, or the pupils dilate. We can see when the breath is very shallow or stops, and when some part of the body tightens, collapses or changes colour. The client is able to report if they have no real sense of being able to feel their body or certain parts of it.
People can be shown how to stay grounded in reality by developing a body connection with the environment through their eyes, hands, legs and feet, which gives them a sense of having some control in their lives. By being grounded in the here and now, and learning how to experience the body as a container for emotions, traumatic memories and feelings can be integrated effectively, without overwhelm. Working in states of low arousal and distress meets the trauma survivor’s primary need to feel safe, especially in therapy.
Perhaps the most important contribution trauma therapy can make to society is to give people greater access to their innate systems and inner resources to self-regulate their emotions and the way that they interact with each other, especially when life gets challenging.
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