Trauma and the Body

1. Trauma fragments the mind and body, disrupting hierarchical information processing.

The complexity and variety of symptoms affecting both mind and body are perplexing to therapists and clients alike.

Disrupted integration. Trauma profoundly affects the body and nervous system, leading to somatically driven symptoms and a fragmented sense of self. Processes normally unified—emotions, thoughts, identity, memory, and sensorimotor elements—become separated, a phenomenon Pierre Janet termed "integrative failure." This results in a chronic physiological arousal that replays endlessly, creating a "speechless terror" and hindering the assimilation of traumatic experience into a coherent life narrative.

Triune brain's role. The human mind operates through a hierarchical relationship between three evolutionary brain levels: the reptilian brain (sensorimotor, instinctual arousal), the limbic brain (emotional, memory, social behavior), and the neocortex (cognitive, self-awareness, thought). Trauma compromises the integration of these levels, causing dysregulated arousal to drive emotional and cognitive processing, leading to misinterpretations of present cues as past threats. This "bottom-up" hijacking means the body's primitive responses override rational thought.

Bidirectional influence. Cognitive and emotional processing significantly affect the body, and vice versa. Maladaptive interpretations like "I am bad" or "I am never safe" are reflected in posture, breathing, and movement, which in turn reinforce these beliefs. Sensorimotor psychotherapy addresses this by integrating "bottom-up" interventions—working directly with sensations and movements—with "top-down" cognitive and emotional approaches, aiming for a unified mind-body approach to healing.

2. The "Window of Tolerance" is essential for regulating trauma-induced arousal.

Within this window, “various intensities of emotional and physiological arousal can be processed without disrupting the functioning of the system.”

Optimal arousal zone. Traumatized individuals often struggle with dysregulated arousal, oscillating between hyperarousal (too much activation) and hypoarousal (too little activation). Effective trauma processing requires maintaining arousal within an "optimal arousal zone," or "window of tolerance," where information can be integrated without overwhelming the system. Outside this window, cortical functioning is compromised, hindering cognitive, emotional, and sensorimotor integration.

Polyvagal hierarchy. Stephen Porges's polyvagal theory describes three hierarchical autonomic subsystems:

• Ventral vagal complex (social engagement): Correlates with the optimal arousal zone, enabling flexible communication and social interaction.
• Sympathetic system (mobilization): Correlates with hyperarousal, activating fight/flight responses to threat.
• Dorsal vagal complex (immobilization): Correlates with hypoarousal, leading to shutdown, numbing, or feigned death when other defenses fail.
  Trauma often leads to a functional narrowing of this window, making individuals more vulnerable to perceived threats.

Restoring balance. Chronic trauma can diminish the social engagement system's ability to regulate arousal, leaving individuals stuck in sympathetic or dorsal vagal dominance. Treatment aims to expand the window of tolerance by:

• Helping clients identify somatic signs of dysregulation.
• Utilizing physical actions (e.g., measured breathing, grounding) to return to the optimal zone.
• Strengthening the social engagement system through attuned therapeutic interaction.
  This allows for gradual integration of traumatic experiences and adaptive self-regulation.

3. Early attachment experiences profoundly shape lifelong self-regulation and social engagement.

Early disruptions in attachment have enduring detrimental effects, diminishing the capacity to modulate arousal, develop healthy relationships, and cope with stress.

Dyadic regulation. Infants, born with limited self-regulation, depend on primary caregivers for "interactive regulation" to maintain arousal within the window of tolerance. Consistent, attuned interactions build the social engagement system and the orbital prefrontal cortex, crucial for self-regulation. This body-to-body dialogue, or "affect synchrony," forms the basis for a functional sense of self and future relational capacities.

Attachment patterns embodied. Attachment patterns (secure, insecure-avoidant, insecure-ambivalent, disorganized/disoriented) are not just psychological but are encoded as procedural memory, manifesting in chronic physical tendencies.

• Secure: Integrated, tempered movements of approach, able to seek comfort and self-regulate.
• Insecure-avoidant: Withdraws under stress, prefers autoregulation, often low muscular tonicity or rigidity, avoids eye contact.
• Insecure-ambivalent: Preoccupied with attachment, hyperaroused, uncontained movements, difficulty modulating distress.
• Disorganized/disoriented: Contradictory behaviors (e.g., seeking proximity then freezing), reflecting simultaneous activation of attachment and defense systems.

Therapeutic re-patterning. The therapeutic relationship serves as a "secure base" to re-pattern these early attachment dynamics. The therapist, acting as an attuned regulator, helps clients:

• Recognize nonverbal cues of safety or danger.
• Develop both autoregulatory (e.g., grounding) and interactive regulatory (e.g., reaching out) capacities.
• Challenge maladaptive physical tendencies (e.g., armoring, withdrawal) that interfere with social engagement.
  This process strengthens the social engagement system, expanding the client's window of tolerance for relational intimacy and positive affect.

4. Trauma distorts orienting and perpetuates maladaptive defensive responses.

Long after the original traumatic events are over, many individuals find themselves compelled to anticipate, orient to, and react to stimuli that directly or indirectly resemble the original traumatic experience or its context.

Compromised orienting. Orienting, the fundamental process of directing attention to stimuli, is severely impaired by trauma. Traumatized individuals reflexively narrow their field of consciousness to trauma reminders, overlooking safety cues, or experience hypoarousal that dulls their perception of both pleasure and danger. This maladaptive orienting, whether hyper-focused or under-responsive, maintains an internal sense of threat and hinders adaptive information processing.

Defensive cascade. When a stimulus is perceived as threatening, a cascade of instinctive defensive reactions is triggered, ranging from social engagement to mobilizing (fight/flight) and immobilizing (freeze, collapse, feigned death) responses. These are fixed sequential sensorimotor reactions, often occurring faster than conscious thought. In trauma, these responses become "stuck" or "incomplete," leading to repetitive reenactments long after the actual danger has passed.

Reenactment of defenses. Traumatized individuals often repeat the defensive actions that were evoked during the original trauma, even if unsuccessful. For example:

• A survivor of childhood beatings may react with uncontrolled aggression.
• An incest survivor may freeze instead of refusing an unwanted advance.
• A war veteran may feel the urge to run when slightly anxious.
  These "everlasting recommencements" prevent adaptive responses to present, non-threatening situations, causing feelings of helplessness and shame.

Restoring adaptive action. Sensorimotor psychotherapy aims to restore adaptive and flexible defensive functioning. Clients learn to:

• Mindfully observe their defensive tendencies (e.g., tension, immobility).
• Recognize them as survival resources, not personal defects.
• Discover and complete abandoned empowering defenses (e.g., the impulse to fight or flee) that were thwarted during the trauma.
  This process helps dismantle chronic defensive engagement and reestablishes a sense of mastery and competence.

5. Unresolved trauma hijacks daily life action systems, limiting fulfillment and well-being.

The dominance of the defense action system in people with trauma-related disorders is a central theme in the treatment of these individuals.

Compromised daily life. Beyond defense, humans possess action systems for attachment, exploration, energy regulation, caregiving, sociability, play, and sexuality. These systems are interdependent and crucial for optimal adaptation and well-being. However, in traumatized individuals, the defense system often becomes overactivated and takes precedence, hijacking the functioning of these other vital systems.

Impact on action systems:

• Energy regulation: Disrupted, leading to sleep/eating difficulties, insensitivity to pain, chronic dysregulation.
• Exploration: Inhibited, as curiosity is perceived as dangerous, leading to avoidance of new experiences.
• Play: Often lost, as safety is a prerequisite for play, leading to an inability to experience pleasure, exuberance, or joy.
• Sociability/Attachment: Impaired, leading to isolation, social phobias, or difficulty forming healthy bonds.
• Caregiving/Sexuality: Distorted or avoided, due to fear of intimacy, vulnerability, or reenactment of past trauma.

Maladaptive action tendencies. Trauma creates "action tendencies"—automatic physical and mental responses—that were adaptive in the past but become maladaptive in the present. These tendencies limit choices and prevent individuals from "upgrading the forecast" of outcomes. For example, a child who learned to be quiet to avoid abuse may, as an adult, struggle to assert needs, even when safe.

Reclaiming life. Therapy helps clients recognize how defensive action tendencies intrude on other life domains. By becoming aware of these patterns (e.g., physical tension, withdrawal), clients can learn to inhibit them and engage in new, more adaptive actions. This process allows them to fulfill the goals of daily life action systems, moving beyond a life constrained by past trauma.

6. Neurobiological research illuminates trauma's impact on brain integration and memory.

An understanding of the neurobiology of trauma may further enhance our conceptualization of the long-term sequelae of trauma and help to guide our therapeutic efforts toward increasing the accuracy and specificity of clinical interventions.

Brain regions affected. Neuroimaging studies (PET, fMRI) have identified several brain areas involved in traumatic stress syndromes:

• Thalamus: Key relay for sensory information; dysfunction may cause fragmented, timeless sensory flashbacks.
• Amygdala: "Alarm center" for fear; can be overactive (generalizing fear) or hypoactive (leading to unawareness of danger).
• Medial Prefrontal Cortex: Involved in fear extinction, emotion regulation, self-referential processing, and temporal segregation of memories; often shows dysfunction in PTSD.
• Anterior Cingulate Gyrus: Integrates bodily responses with behavioral demands, crucial for emotion regulation and social engagement; its maturation can be negatively impacted by early trauma.
• Hippocampus: Essential for declarative memory; often shows reduced volume in PTSD, potentially reversible with treatment.
• Insula: Involved in body perception (interoception) and emotional awareness; acts as an "internal alarm center."

Lateralization and memory. PTSD often shows increased right-hemispheric activity and decreased left-hemispheric activity during traumatic memory recall. This suggests a dominance of nonverbal, sensory-based memory (flashbacks) over verbal, narrative memory. The "subcortical bridge" between hemispheres may transmit nonverbal danger signals, influencing "response readiness."

Implications for treatment. Neurobiological insights guide somatic interventions:

• Thalamic dysfunction: Sensorimotor processing of sensory fragments may aid integration.
• Medial prefrontal cortex: Mindfulness and self-witnessing engage this area, enhancing regulation.
• Insula: Increasing awareness of body sensations and emotions may optimize insula activation.
• Right-hemispheric dominance: Working bottom-up with nonverbal body experiences may facilitate interhemispheric transfer and integration, transforming fragmented memories into coherent narratives.

7. Phase-oriented treatment prioritizes stabilization before processing traumatic memories.

In the first phase of treatment, interventions must be chosen that facilitate both physiological and psychological homeostasis and that emphasize self-regulatory skills that maintain arousal within a window of tolerance and reduce or eradicate self-destructive tendencies.

Sequential approach. Trauma treatment follows a three-phase model:

1. Stabilization: Symptom reduction, establishing safety, and self-regulatory skills.
2. Traumatic Memory Processing: Addressing and integrating dissociated memories.
3. Integration and Success in Normal Life: Self-development, adaptive relationships, and embracing life.
   This approach is cyclical; clients may return to earlier phases as new challenges or memories emerge, ensuring stability throughout the healing process.

Phase 1: Foundation of safety. The initial focus is on helping clients manage dysregulated arousal and self-destructive behaviors without directly confronting traumatic memories. The therapist acts as an "interactive psychobiological regulator," guiding clients to:

• Recognize triggers and early signs of hyper/hypoarousal.
• Implement somatic resources (e.g., grounding, breathing) to return to the window of tolerance.
• Develop coping and safety plans.
  This builds integrative capacity and a sense of control, preparing them for deeper work.

Avoiding retraumatization. A major therapeutic error is to rush into memory retrieval before stabilization. Sensorimotor psychotherapy emphasizes a "slower we go, the faster we get there" approach, minimizing abreaction (uncontrolled catharsis) and ensuring arousal remains manageable. The goal is resolution, not just recollection, of traumatic events, allowing memories to be processed without causing further dysregulation or dissociation.

8. Somatic resources, rooted in the body's core and periphery, are vital for self-regulation and safety.

Somatic resources comprise the category of abilities that emerge from physical experience yet influence psychological health.

Body as a resource. Phase 1 treatment focuses on developing somatic resources—physical functions and capacities that support self-regulation, well-being, and competence. These resources are often overlooked but are crucial for stabilizing arousal and increasing daily functioning. The therapist assesses existing resources (e.g., deep breathing, aligned posture) and teaches missing ones.

Core and periphery. Somatic resources are mapped onto the body's core (pelvis, spine, ribcage) and periphery (arms, legs, head, face):

• Core resources (autoregulation): Involve awareness and movement of the core, fostering internal stability and self-connection. Examples include:
  • Vertical alignment: Erect posture, head over shoulders, balanced with gravity.
  • Centering: Focusing awareness on the body's center, often with hands on abdomen/heart.
  • Grounding: Sensing legs and feet, their weight, and connection to the earth.
  • Breathing: Deep, regular breath patterns to modulate arousal.
• Peripheral resources (interactive regulation): Involve awareness and movement of the limbs and face, facilitating social interaction and boundary setting. Examples include:
  • Pushing away: Using arms/legs to create physical distance, setting boundaries.
  • Reaching out: Movements of connection and seeking proximity.
  • Locomotion: Walking, running, moving through space with intention.

Building safety. Reconnecting with the body can be challenging for trauma survivors due to fear, numbness, or negative self-perceptions. Therapists create safety by:

• Focusing on competence and pleasure (e.g., recalling positive physical experiences).
• Using "contact statements" to gently draw attention to body sensations.
• Conducting "experiments" to explore new movements and their effects.
• Modeling and mirroring movements to facilitate learning.
  This helps clients differentiate physical sensations from trauma-based emotions and cognitions, gradually expanding their "somatic barometer" for safety and preference.

9. Processing traumatic memory involves "acts of triumph" and sensorimotor sequencing.

The patients who are affected by traumatic memories have not been able to perform any of the actions characteristic of the stage of triumph.

Beyond narrative. Traumatic "memory" often exists as nonverbal, implicit fragments (sensory intrusions, intense emotions, maladaptive physical actions) rather than a coherent narrative. Phase 2 aims to integrate these dissociated components, not just retrieve them. The goal is to resolve the effects of the past on the client's present experience, allowing them to feel the danger is past.

Acts of triumph. A core intervention is helping clients complete "acts of triumph"—mobilizing defensive responses (fight or flight) that were truncated or impossible during the original trauma. This is achieved by:

• Reactivating a "sliver" of memory: Enough to evoke mental and sensorimotor tendencies without overwhelming the client.
• Discovering "what wanted to happen": Through mindful awareness of body sensations and impulses (e.g., a hand wanting to make a fist, legs wanting to run).
• Voluntarily executing the action: Slowly and mindfully, allowing the body to complete the thwarted defense (e.g., pushing against a pillow, running in place).
  This transforms helplessness into mastery, associating the traumatic memory with empowering actions and corresponding positive emotions.

Sensorimotor sequencing. This technique facilitates the completion of involuntary bodily actions (trembling, shaking, micromovements) associated with unresolved autonomic arousal. Clients are taught to:

• Mindfully track sensations: Focusing exclusively on physical sensations and small movements as they progress through the body.
• Uncouple from emotion/content: Temporarily disregarding thoughts and emotions to prevent dysregulation.
• Allow involuntary impulses: Trusting the body to "discharge" mobilized energy until resolution.
  This process metabolizes arousal, integrates fragmented responses, and provides a powerful sense of relief and control, allowing the body to "unwind" the stifled impulse.

10. Therapy fosters a new, integrated self capable of pleasure and adaptive action.

The best indices of resolution are the survivor’s restored capacity to take pleasure in her life and to engage fully in relationship with others.

Life after trauma. Phase 3 focuses on self-development, adaptation to normal life, and relationships, moving beyond trauma's shadow. Clients apply skills from earlier phases to expand social connections, overcome fears, take appropriate risks, and explore intimacy. This involves challenging cognitive distortions and corresponding physical tendencies that hinder full engagement.

Integrating core and periphery. A key aspect is integrating the body's core (stability, self-connection) and periphery (mobility, interaction). Maladaptive beliefs (e.g., "I'm bad") often manifest as disharmony between these areas (e.g., rigid core, weak limbs). Therapy helps clients:

• Connect with their "core state" to define inner desires.
• Execute balanced actions that emanate from the core and extend through peripheral movements (e.g., reaching out with a relaxed, strong arm).
• Practice new, integrated movements to foster a stronger, embodied sense of self, replacing old patterns of constriction or disorganization.

Embracing pleasure and intimacy. Trauma often diminishes the capacity for pleasure and positive affect, associating excitement with danger. Phase 3 challenges this by:

• Encouraging awareness of pleasurable sensations and activities.
• Helping clients tolerate increasing levels of positive affect without triggering defensive responses.
• Exploring intimacy and boundaries, moving from "underboundaried" (acquiescing) or "overboundaried" (avoiding) styles to flexible, resilient boundaries.
  This leads to a renewed sense of self, capable of joy, connection, and meaningful participation in life, transforming tragedy into triumph.

11. The therapist's attuned presence and somatic interventions are crucial for healing.

The art and science of the sensorimotor psychotherapist lies in making this unconscious processes conscious, thus giving language to the non-verbal communication that is so integral to our interactions with others, including our clinical practice, that we have almost completely overlooked it as a primary object of study.

Attuned observation. The therapist's ability to "track" (moment-by-moment observation of nonverbal cues) and "bodyread" (observing persistent physical tendencies) is foundational. This meticulous attention to the client's physical organization—movements, sensations, posture, autonomic arousal—reveals trauma-related patterns and resources often outside conscious awareness. This nonverbal communication is central to understanding and intervening effectively.

Collaborative exploration. The therapist fosters a collaborative relationship, acting as an "interactive psychobiological regulator" and "auxiliary cortex." This involves:

• Contact statements: Gently verbalizing observed physical changes (e.g., "Your hand seems to be tightening") to bring awareness to the body.
• Mindfulness: Guiding clients to nonjudgmentally observe their present-moment internal experience (thoughts, emotions, sensations, movements).
• Experiments: Proposing small, precise physical or verbal "trials" to explore new responses and challenge maladaptive tendencies (e.g., experimenting with different postures or distances).
  This approach empowers clients by placing the locus of control within them, allowing them to discover and practice new, adaptive actions.

Navigating transference and countertransference. The therapeutic relationship inevitably evokes transference (client's past relational patterns projected onto the therapist) and countertransference (therapist's reactions). Somatic manifestations (e.g., client's fear-induced rigidity, therapist's unconscious mirroring) are crucial indicators. The therapist must:

• Be aware of their own somatic countertransference through self-awareness and supervision.
• Explore client's somatic reactions to interventions as expressions of transference.
• Differentiate therapeutic relationship from past trauma, preventing reenactment.
  This careful navigation ensures a safe, authentic space for healing, where physical and mental actions can be transformed, leading to a more integrated and resilient self.

Last updated: November 26, 2025