Healing Trauma: Reuniting Body and Mind

Katherine Gotis

Abstract

This paper explores the impact of trauma and some of the treatments available to assist a person in the process of recovering from traumatic experience. The use of 3,4-methylenedioxy-N-methamphetamine (MDMA)-assisted psychotherapy and somatic psychotherapy has shown the most promise in the healing of trauma. The fields of neurobiology, psychiatry, psychology, and physiology have discovered that trauma can be accessed and healed through the vehicle of the body, which contains the painful and unconscious memories that were too overwhelming for the body to integrate at the time of the trauma. MDMA-assisted psychotherapy along with sensorimotor psychotherapy, allow a person access to the traumatic psychological and somatic memories without overwhelming them. This paper elaborates on what is currently known about how trauma impacts the brain, the process of integrating traumatic memories using a phase-based approach and how mental health professionals can assist their clients by utilizing the somatic tools available today, as well as the pharmacological tool that may become available in the very near future.  

Keywords: trauma, somatic psychotherapy, MDMA-assisted psychotherapy

Healing Trauma:

Reuniting Body and Mind

Trauma is an event that a person experiences as “unbearable and intolerable” (Van der kolk, 2014, p.1), and that keeps them stuck in the past reliving the trauma in both conscious and unconscious ways. Human beings are resilient and capable of surviving great physical, psychological, and emotional traumas, but experiences of helplessness in the face of traumatic and often life threatening situations leave lasting impressions that affect a person’s ability to feel safe in their bodies, to create loving sustainable relationships, and to find satisfaction and joy in their lives. People who experience trauma may be trapped in the past, reliving the events that are often buried beyond their conscious awareness.

 Trauma may be re-experienced and replayed as uncomfortable physical sensations and emotions, nightmares and flashbacks, and body movements (Levine, 2015). The body is a truth-telling living testament to the life it has lived. What a person cannot recall with linear language, the body has packaged as evidence kept in various non-verbal compartments. When trauma is visited upon a person, their nervous system is modified in a way that directs their life force towards managing unbearable internal sensations at the expense of spontaneously engaging with life and integrating new experiences (Van Der Kolk, 2014).

The goal of somatic psychotherapy and MDMA-assisted psychotherapy is to facilitate the integration of that which has been disintegrated by trauma by restoring a felt sense of physical safety, allowing the traumatic memories to be felt and processed, and finally to emerge into the world more empowered, resourced, and able to enjoy life from an embodiment that is no longer bound up defending against the past.

             Impacts of Trauma on the Brain

Ensuring survival is the brain’s primary function (Van Der Kolk, 2014). Trauma affects a person’s organism in ways that change their brain, the way it processes stimuli, and thus the way they experience the world. When a person is traumatized, they dissociate to survive, and their body holds onto the past in ways that limit their fluency to meet life’s opportunities and challenges. Psychological trauma creates fragmented memories related to the overwhelming experience, these memories are often non-verbal and encountered by individuals as bodily sensations, smells, numbing, pain, tension, and images which can be intrusive and often unconscious (Ogden, Minton, & Pain, 2006). The past can influence the present by interrupting reality with these intrusions, and coloring the now with the traumatic shades of the past.  

Trauma compromises the integrative capacity of the thalamus, a structure located within the limbic system which receives the sensory stimulation from the eyes, nose, skin, and ears and organizes them to create a coherent story of what is being experienced by the self, and then relays this sensory information to the reptilian brain, limbic brain, and to the neocortex, collectively known as the triune brain (Van Der Kolk, 2014).

The route from the thalamus to the emotional brain is much faster than the route from thalamus to the thinking brain, which gives the emotions a head start on interpreting the significance of the thalamus’ messages (Van Der Kolk, 2014).  The thalamus can break down in relation to trauma and this is what creates the fragmented autobiographical memories that arrive as somatic imprints, sounds, smells, and images that come with emotions such as extreme fear and hopelessness (Van Der Kolk, 2014). When presented with stimuli similar to that of the original trauma, an individual may have trouble controlling emotions and impulses (Ogden, Minton, & Pain, 2006). The thalamus is also in charge of sifting through sensory information and weeding out that which is irrelevant; trauma derails this filtering process and the individual may be overloaded with sensory stimuli, unable to concentrate or to distinguish the relevant from the irrelevant (Van Der Kolk, 2014).

The triune brain is composed of the three main parts of the brain utilized to process information, all of them are intertwined, functionally dependent upon each other, and hierarchically and developmentally organized (Ogden, Minton, & Pain, 2006). The brain evolved and develops from the bottom up (Van Der Kolk, 2014). The reptilian brain is the deepest and most primitive level of the brain and is in charge of heart rate, breathing, body temperature, arousal, sexual drive, and the processing of some sensorimotor experience, such as sensation and the non-conscious drive for movement (Ogden, Minton, & Pain, 2006).

The processing of memory, emotions, learning, and part of social behavior happens in the limbic region of the brain, which surrounds the reptilian brain from above (Ogden, Minton, & Pain, 2006). The neocortex caps the other two systems, and is responsible for empathy, cognitive processing, awareness of self, language, and contains a significant amount of the corpus callosum, a membrane that allows the communication between the right and left hemispheres of the brain (Ogden, Minton, & Pain, 2006).

Each part of the brain sees and reacts to the world in a different way, and one level may override the others depending on the circumstances (Ogden, Minton, & Pain, 2006). The reptilian brain tends to be rigid, reactive, compulsive, and focused on survival and eliminating threats, the limbic brain remembers the past and judges situations (often unconsciously) based on what came before, while the neocortex is flexible and capable of abstract thought and reasoning (Ogden, Minton, & Pain, 2006). Regardless of which level of processing is dominant, this trifecta is always communicating and functioning as a cohesive whole, with the processing abilities of the lower levels impacting those of the higher levels. (Ogden, Minton, & Pain, 2006).

                     Emotional Regulation

            People who have experienced trauma often feel too little or too much; they may become flooded with various internal and external stimuli that makes it hard for them to focus, or they may feel numb and not notice or respond to what is happening in and around them (Boon, Steele, & Van Der Hart, 2011). One of the goals of trauma therapy is for a person to learn how to self regulate and stay within their window of tolerance, a place of optimal arousal where they are not hyper aroused and feeling too much, or hypo aroused and feeling too little (Boon, Steele & Van Der Hart, 2011). Ideally, people learn how to self regulate through receiving emotional and physical support from their caregivers early in life, this lays a foundation that fosters feeling safe, supported, and empowered to care for oneself emotionally and physically as they develop and grow throughout life (Boon, Steele & Van Der Hart, 2011).

Hyper and Hypo arousal

Emotional dysregulation, when it is experienced as hyper arousal is a sense of being overwhelmed by fear, shame, anger, pain, etc., as well as an edginess and an increase in sensitivity to situations that may not normally be upsetting (Boon, Steele & Van Der Hart, 2011). Hypo arousal is emotional dysregulation that moves in the direction of avoidance and numbing as a way to cope with situations that inspire discomfort and overwhelm (Boon, Steele & Van Der Hart, 2011). Because both hyper and hypo arousal are dysregulated emotional responses to internal and external stimuli that is reminiscent of past trauma, and therefore encountered as overwhelming and unsafe, learning to notice and tolerate what is happening inside the body is essential for learning how to self regulate.

                      Two Kinds of Awareness

Recent neuroscience studies have proven that the brain is capable of two kinds of awareness, one that measures experience through time and one that perceives the self in the present moment (Van Der Kolk, 2014). The awareness that creates an autobiographical self tells a story that is based in language is connected, coherent, rooted in time, and changes as new insights and experiences are added to the mix (Van Der Kolk, 2014). The other awareness is connected to moment-to-moment experience and is grounded in physical sensations (Van Der Kolk, 2014). The two kinds of self-awareness tell two different stories, one that is made to share with the world through language and another other that is made by how we actually feel about the story in our bodies (Van Der Kolk, 2014).

Top Down and Bottom Up Processing

This understanding describes why somatic psychotherapies, (which are also known as bottom up approaches, because they work on the lower levels of the brain), are so effective when treating trauma survivors. It is only by accessing the self-awareness that is based in present-tense bodily sensations that the emotional brain can change

Traditional talk therapy is known as a top down approach to psychotherapy because it utilizes the awareness that is language based and depends on a story told through time (Van Der Kolk, 2014).  When not combined with somatic therapy, this kind of cognitive processing is limiting when used with trauma survivors, as it inhibits access to the reptilian and limbic brains, the non-verbal realms where trauma is stored (Ogden, Minton, & Pain, 2006).

During therapy, all parts of the triune brain must be actively engaged in order for traumatic memories to be successfully integrated, which is why bottom up therapies that connect a person’s awareness to the physical and emotional sensations produced by the reptilian and limbic brains are needed to achieve integration (Van Der Kolk, 2014). A connection can be made between an individual’s autobiographical story and the story that is told by their interior world, and this relationship is forged through the body (Van Der Kolk, 2014).

                    Somatic Psychotherapy

Interoception

According to Van Der Kolk, (2014) “All trauma is preverbal” (p. 43).  Interoception is an awareness of the subtle sensations that are based in the body (Van Der Kolk, 2014). Being able to feel what is going on inside the body is primary to regain control over one’s life and for the healing of trauma, but for a traumatized person, internal sensations can arise with alarm bells and terror, which serve to reinforce a person’s tendency to abandon the present moment (Van Der Kolk, 2014).

Moving away from bodily sensations by numbing out and ignoring them makes a person more vulnerable to being overwhelmed by what they perceive as intolerable and dangerous (Van der kolk, 2014). Gaining control over arousal reflexes that lead to self-destructive behaviors is born from developing an awareness of internal sensations; by noticing what happens inside, a person can interrupt the habitual action response with alternatives that help them to cope in ways that foster well-being (Ogden, Minton, & Pain, 2006).

Sensorimotor Therapy

Adhering to a phase-oriented treatment plan, which will be described later, sensorimotor therapy is a bottom up approach that focuses on the non-verbal aspects of an individual’s experience (Ogden, Minton, & Pain, 2006). With the help of a trained guide, a person is able to safely re-experience the physical sensations related to the traumatic event (Ogden, Minton, & Pain, 2006). During sensorimotor therapy, the therapist supports a client in developing self-awareness, self-regulation, and a deep curiosity about what is happening inside of them (Ogden, Minton, & Pain, 2006). Sensorimotor therapists strive to create conditions that support a client’s exploration of their inner landscapes, building confidence in their capacity to witness and feel the rise and fall of emotions and sensations and to eventually feel that their body is a safe place to be (Ogden, Minton, & Pain, 2006).

Other Somatic Therapies

            Most of the great wisdom traditions include body and breath based practices as a way to heal psychic and emotional imbalances. Yoga, meditation, tai chi, and dance, are all powerful and profound practices that heal the split between the body and psyche by connecting movement, breath, and interoceptive awareness (Van Der Kolk, 2014).

     The Gold Standard of Trauma Therapy

Phase-Oriented Treatment

The phase oriented treatment approach is the recommended system when working with trauma (Ogden, Minton, & Pain, 2006). In phase one, the goal is stabilization and reduction of distressing symptoms (Ogden, Minton, & Pain, 2006). This phase focuses on developing emotional regulation, building awareness of interoception and triggers, interrupting and working to correct reflexive, disruptive action tendencies and any other destabilizing elements that may increase trauma related affects (Ogden, Minton, & Pain, 2006). The individual’s growing capacity to self-regulate allows for the safe transition to working with their traumatic memories (Ogden, Minton, & Pain, 2006).

Phase two relies on the client being in their window of tolerance to complete the body’s stunted response to the trauma and to integrate the memories (Ogden, Minton, & Pain, 2006).  In this phase the focus shifts to the emotions, sensations, sensory intrusions and physical sensations, which are the scattered fragments of the traumatic memories (Ogden, Minton, & Pain, 2006). During this phase, clients learn how to utilize the defenses that were ineffective during the trauma; this experience decreases feelings of helplessness and shame, which often accompany trauma. (Ogden, Minton, & Pain, 2006).

In phase three, the individual is empowered with the experience of actions that keep them safe, equipped with the resources to self-regulate arousal, and there is a restored confidence in their body as a helper (Ogden, Minton, & Pain, 2006). Also explored in this phase are distorted beliefs and their somatic counterparts (Ogden, Minton, & Pain, 2006). The client is guided to change the distorted cognitions and to begin to experience more peace and satisfaction in their daily lives (Ogden, Minton, & Pain, 2006). What was learned in the previous phases is reinforced in phase three, and phase one and two may be revisited as needed to integrate more material as it arises (Ogden, Minton, & Pain, 2006).     

                 MDMA-Assisted Psychotherapy

There are currently only two drugs approved by the Food and Drug Administration (FDA) for the treatment of Post-Traumatic Stress Disorder (PTSD), but this may be changing in the near future as 3,4-methylenedioxy-N- methamphetamine (MDMA)-assisted psychotherapy makes its way into phase three clinical trials after showing great promise in Phases one and two as a breakthrough treatment for PTSD. The current pharmaceutical interventions used to treat PTSD work to decrease awareness of distressing symptoms and to slow down the damaging physiological effects of chronic stress, but they do not heal the psychological, emotional, and physical impacts of the traumatic event (Mithoefer, 2015).

MDMA greatly reduces activity in the limbic brain, specifically the amygdala, which is the brain’s alarm system and warns of the body of danger, preventing access to the trauma as a survival mechanism (Mithoefer, 2015; Van Der Kolk, 2014). When used alongside psychotherapy, MDMA catalyzes the therapeutic process by decreasing reflexive fear and defensiveness associated with traumatic memories without blocking access to the memories or the authentic and profound experience of the emotions associated with the event (Mithoefer, 2015). In MDMA-assisted psychotherapy, somatic, biological, and non-directive psychotherapeutic approaches are utilized to help a client process and integrate traumatic memories (Mithoefer, 2015). This approach seeks to decrease emotional dysregulation and stress responses instead of working to eliminate or suppress these symptoms (Mithoefer, 2015).

T he benefits of MDMA-assisted psychotherapy come not only from MDMA’s physiological effects, but also from the therapeutic setting, and the mindsets of client and therapist alike (Mithoefer, 2015). The client experiences increased feelings of love, trust, empathy, and many report insights into a clearer awareness of the trauma as a past event as well as the understanding of the safety and support available to them in the present (Mithoefer, 2015). During the session, there may also be a non-verbal processing as chronic somatic holding patterns are released as well as other transpersonal experiences that are of great significance to the client, but not completely understood (Mithoefer, 2015).

Somatic interventions that directly address the relationship between psychological material and physical sensations such as Sensorimotor Psychotherapy are very helpful during the medicine phase and throughout the treatment process (Mithoefer, 2015). Mindfulness-based interventions such as Hakomi and focused bodywork may also be utilized during the medicine session to help the client move through bodily tensions and to facilitate energetic movement (Mithoefer, 2015).

Prior to the medicine session, the client will meet with the therapist several times, and there will be at least one integration session after, and more if necessary (Mithoefer, 2015).

Therapists are licensed and have previous experience working with trauma, but they must also be trained in the MDMA-assisted therapy protocol, which teaches empathic presence and listening, non-directive communication, and the concept of the inner healing intelligence of a human to move towards health and integration (Mithoefer, 2015).   MDMA-assisted psychotherapy, when implemented as the treatment protocol states, shows tremendous hope for not only lessening the impacts of traumatic stress, but in some cases, it even curing people of their PTSD symptoms (Mithoefer, 2015).

The research on the brain and its relationship to the body in the wake of trauma has resulted in an increased interest in embodiment and body-based therapies. The future holds great hope for the healing of trauma, and this healing is steeped in somatic psychotherapies with the possible addition of radical yet safe pharmacological assistance.

References

Boon, S., Steele, K., & Van Der Hart, O. (2011). Coping with trauma related dissociation: Skills training for patients and therapists. New York, NY: W.W. Norton & Company

Levine, P. (2015). Trauma and the body: Brain and body in a search for the living past. Berkeley, CA: North Atlantic Books

Mithoefer, M. (2015). A manual for mdma-assisted psychotherapy in the treatment of posttraumatic stress disorder. Santa Cruz, CA: Multidisciplinary association for psychedelic studies.

Ogden, P., Minton, K., & Pain, C.  (2010). Trauma and the body: A sensorimotor approach to psychotherapy. New York, NY: W.W. Norton & Company

Van der kolk, B. (2014). The body keeps the score: Brain, mind, and body in the healing of trauma. New York, NY: Penguin Books.