Trauma is any unhealed psychological wound. It’s the response our nervous system has to a frightening and distressing experience. This could be a single event, such as a violent incident, or the culmination of long-term stress, such as from abuse.
Trauma-informed UKCP psychotherapists, such as Lorna Evans, work with people to process unresolved trauma that can get ‘stuck’ in the body. Here, Lorna, also a trauma-informed yoga teacher, illuminates current research on this issue and explains how integrating the body into therapy can help us heal.
How did you become interested in trauma and the body?
I was working in the stressful entertainment industry which was making me unwell. Practising yoga made me feel better. I became a yoga teacher to find out why it helped. To understand more about the clinical benefits, I began training to be a psychotherapist and became really interested in neuroscience and movement. Now, I integrate the body into all of my work with therapy clients.
I believe that our whole body is our unconscious and a reflection of our past, present and perceived future.
How have therapists come to understand that trauma is stored in the body?
There’s been a split between body and mind in psychotherapy for years. But even Freud talked about the existence of a body energy. In 1945, Wilhelm Reich spoke about “character armour”. When someone “develops a blocking against his [or her] emotional excitations, resulting in rigidity of the body, lack of emotional contact, and deadness”. This was picked up in the work of psychotherapist Laura Perls and gestalt therapy which believes we are cut off from our bodies. But by noticing and bringing awareness of the body into the present moment in therapy, we begin to dissolve this character armour.
What about more recent thinking on trauma and the body?
The catalyst moment for this way of understanding trauma came with the publication of Bessel Van Der Kolk’s bestselling book The Body Keeps the Score in 2015. But other body psychotherapists, including Babette Rothchild, Gabor Mate, Nick Totton, Dan Siegel, Pat Ogden and Peter Levine, have built momentum for ideas around how trauma manifests in our body.
In 2011, Steven Porges developed “polyvagal theory”. His research found that the vagus nerve [which connects organs between the brain and colon] plays an important role in regulating the body and that trauma can keep our defences constantly engaged.
Now, more and more people in popular culture are talking openly about trauma.
What scientific evidence is there?
Neuroscience shows us that practices such as yoga, breath and movement impact the amygdala and insula in the brain and calm our nervous system. The amygdala is responsible for the fight, flight or freeze response that can get stuck when people experience trauma. And the insula is responsible for our ability to control our emotional responses and immune system.
People who are traumatised are frequently highly anxious or ‘hyperaroused’. They need tools to help them regulate and access their ‘window of tolerance’. This is a state, where you can tolerate emotions and integrate information, often associated with being engaged when you are with others.
How can working with the body in therapy help someone to process trauma?
The body is another tool therapists can use to help someone experiencing emotional distress, just as we use journaling, using sand trays or creative writing. We begin with ‘noticing’ the body. This supports the client to make the unconscious, conscious. Both the client and therapist notice what is happening in their bodies.
This process gives people choice. It’s the difference between “I am broke, and I have a diagnosis” and “How do my trauma symptoms affect my body and how can I bring back choice into my life?” People who come to therapy want change. Noticing and raising awareness of the phenomenological reactions in the body can change behaviour.
How would you bring the body into therapy with people who have experienced trauma?
Slowly. It’s about bringing them back into the present moment so they can feel steady and safe and not hijacked by their bodies.
At the beginning of the session, I might ask someone to consider what changes they can make to feel more comfortable and steady. For example, taking their shoes off to feel the floor, or sitting on the ground, for example.
I would offer a calm, containing presence so that my client’s nervous system syncs with mine and they feel more regulated. This brings them into their window of tolerance.
I would invite them to notice the sensations in their body to help them out of feeling frozen and numb. We’d think about how and why the sensations, and feelings they bring up, may have started. This helps us recognise triggers and their early warning signs.
I would invite a client to notice their breath. I’d explain the science behind how the breath impacts our nervous system. For example, when we inhale for the count of four and exhale for six, we will activate our parasympathetic nervous system (the part of the nervous system which helps the body calm down). This is a great tool to manage anxiety. With a longer exhalation, we calm our nervous system and have an impact on the part of the brain that controls fear.
This noticing of the body, energy and breath, for both client and therapist, is a very powerful tool to activate self-care. We begin to notice what we need to be well.
How would you use movement in therapy?
I give clients the choice to use movement or exercise, such as using seated yoga, to burn off the stress hormones adrenaline and cortisol. This helps to manage anxiety, panic and low mood.
I would invite my client to experiment with movement between sessions, noticing the impact on their mind and body.
Visit the UKCP Find a Therapist directory to search for someone who’s right for you. Create a shortlist and arrange a call with the ones you like and see how it feels. Don't agree to anything straight away. Go with your gut instinct and who you feel more connected with.
What reading and resources would you recommend for people interested in trauma-informed work with the body?
The Body Keeps the Score is very popular. Pat Ogden reviews neuroscience and trauma research in her book,Trauma and the Body. Other recommended books are New Dimensions in Body Psychotherapy and The Present Moment in Psychotherapy and Everyday Life.
Peter Levine has done a lot of work around trauma and the body, based on observing the way animals in the wild recover from stress by physically releasing energy.
The Headspace app has a partnership with Netflix which has videos explaining the benefits of meditation and is very accessible.
Dutch athlete Vim Hoff focuses on the power of the breath and is also accessible.
I also have a series of YouTube videos where I talk more about this work, including this one on yoga and movement.