Somatic Experiencing: Therapy Overview and Effectiveness

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Somatic Experiencing: Therapy Overview and Effectiveness

THC Editorial Team October 8, 2021
Under the Wave off Kanagawa, ca. 1830–32, Katsushika Hokusai, The Metropolitan Museum of Art (article on Somatic Experiencing)
Under the Wave off Kanagawa, ca. 1830–32, Katsushika Hokusai, The Metropolitan Museum of Art

Contents

People who have posttraumatic stress disorder (PTSD) often experience psychological symptoms that can be debilitating, including persistent nightmares and flashbacks, anxiety, and depression. In addition, many people with PTSD are affected by negative physical symptoms such as a racing heartbeat and chronic panic attacks.1

Somatic Experiencing (also called SE), a body-centered approach to psychotherapy, was created to bridge mind-body connections to holistically treat PTSD and other mental health conditions, including grief, anxietytrauma, and depression.

What Is Somatic Experiencing?

Somatic Experiencing is a specific type of somatic psychotherapy that helps practitioners treat both psychological and physical symptoms in people who have experienced some form of trauma. Premised on the idea that trauma can cause dysfunction within the nervous system and prevent people from fully processing their experiences, Somatic Experiencing was created to help people recognize the connections between their bodily sensations and mental health concerns and then process their distressing or painful experiences.2

Various practitioners, including psychotherapists, physical therapists, medical doctors, and others who have undergone specialized training and certification, use Somatic Experiencing to help people heal from trauma by focusing holistically on their proprioceptivekinesthetic, and interoceptive experiences, instead of prioritizing only their emotional or cognitive responses.3 Proprioception and kinesthesia are very similar; proprioception is the inherent sense of the positioning of one’s body and the strength needed for a movement, whereas kinesthesia is the awareness of the body’s position as told through sensory organs, such as the eyes.4 Interoception is the ability to access and feel bodily sensations.2

What Is the History of Somatic Experiencing?

Somatic Experiencing was developed in the 1970s by trauma therapist Dr. Peter Levine, who conducted research on animals’ reactions as they recovered from traumatic experiences. Levine noticed that after the threat diminished, animals released physical energy generated by the threatening encounters through running, trembling, or shaking. Further, the physical release allowed the animals to return to their normal state quickly.5

Levine hypothesized that humans also possess a natural mechanism to release pent-up physical energy created by trauma but commonly suppress it through their efforts to maintain their composure after traumatic events. He suggested that such attempts to maintain composure can prevent people from processing their experiences, exiting fight-or-flight states, and returning to their baseline adrenaline levels.2

Later, Levine worked with a client who experienced PTSD related to a traumatic event from her childhood. During a particular session, the client relived the traumatic experience and grew agitated. Levine instructed her to flee from the threat, and she responded by physically kicking her feet to simulate her escape. According to the client, this action helped her release pent-up energy from the traumatic experience, and she reported both immediate and lasting relief from her symptoms. Levine used insights from this case to create Somatic Experiencing, developing the approach through his work with patients over more than 45 years. Since then, more than 12,000 practitioners globally have trained in Somatic Experiencing techniques, and it has become a common therapy to treat people with PTSD.6

How Does Somatic Experiencing Work?

Somatic Experiencing seeks to uncover and address somatic sensations linked to traumatic emotions and memories. This therapy approach primarily addresses the physiological outcomes of humans’ fight, flight, and freeze responses to perceived danger. During this common, well-documented response to threat, people experience muscle tension and increased breathing and heart rates due to the stimulation of their sympathetic nervous system (SNS) in preparation to fight or flee. However, some people instead experience a freeze response. In this case, the dorsal vagal complex is stimulated rather than the SNS, resulting in the person’s inability to feel pleasure or recognize their own emotions.2 This is similar to the phenomenon of certain animals “playing dead” in response to actual or perceived threats.7

Practitioners often use Somatic Experiencing to address this freeze response; when people experience such an urge, they risk physically retaining any accumulated energy generated during the natural fight-or-flight response.8 According to the tenets of Somatic Experiencing, any lingering unspent energy and adrenaline may prevent people from fully recovering from the experience. Instead, the “trapped” experience may cause the person to develop trauma-related symptoms.8

When someone enters Somatic Experiencing therapy, the therapist teaches the person about the autonomic nervous system and its role in the trauma response. This information may help people understand why they respond in particular ways during traumatic incidents. Next, the therapist focuses on helping the person recognize and perceive bodily sensations associated with their traumatic experience more deeply. The therapist might use a technique called resourcing to help the person access feelings of peace, strength, and resilience. This technique involves invoking a positive memory of something the individual loves when they encounter a trigger or experience distress in order to help them feel calm when memories of a traumatic event arise.9

After the person has created emotional resources to feel more secure when they encounter trauma-related sensations or memories, the therapist leads the client through a process called titration. During this stage, the therapist helps the client revisit both the trauma and related sensations by talking about the experience in greater detail to enable the client to gradually process the event and dispel the physical symptoms the event evokes.8 As the person revisits the traumatic event, the therapist draws out and notes the individual’s activation response—usually physical sensations and motion. In particular, the therapist watches for changes in breathing, voice, and muscular clenching and asks the client to report any other sensations they experience, such as dizziness, heat, or chill. According to the Somatic Experiencing framework, such sensations and others (e.g., shaking, shivering, or crying) are natural ways for the body to release trapped energy related to trauma. The therapist continues talking through the event, allowing the physical sensations to arise and dissipate until the client feels complete relief, exemplified by eased breathing and a steady heart rate.8

The therapist might also teach the client different relaxation and breathing techniques to help them process and release trauma. One of the physical signs that the client is revisiting the sensation of the traumatic experience is rapid breathing. If the client can control their breathing, they can release the trauma without further physical turmoil. When a release of the energy occurs, the Somatic Experiencing therapist will assist the individual in returning to a calm state through resourcing.

This cycle of activation (talking through the traumatic event) and deactivation (calming the client) is a hallmark of the Somatic Experiencing process, referred to as penduation.2 The goal is to help people return to a calmer state more naturally through Somatic Experiencing therapy.2

What Conditions Are Commonly Treated by Somatic Experiencing?

Although Somatic Experiencing was developed to treat PTSD, it is also commonly used to treat depression and anxiety. It can be used to address both psychological and physical conditions and symptoms such as the following:10

  • PTSD
  • depression
  • anxiety
  • substance abuse
  • digestive issues
  • sleep problems
  • chronic pain
  • stress
  • autoimmune disease
  • eating disorders
  • identity exploration

How Effective Is Somatic Experiencing?

Though scientific evidence of the effectiveness of Somatic Experiencing remains limited as the research into it is new and burgeoning,11 some studies suggest it may be effective in certain situations.

For example, in a randomized controlled study completed in 2017, researchers evaluated how effectively Somatic Experiencing treated symptoms among people with PTSD. In the study, 33 people were assigned to an experimental group and received Somatic Experiencing, and 30 were assigned to a waitlist. Using the Clinician-Administered PTSD Scale, the researchers found significant improvement in the symptoms reported by people in the Somatic Experiencing group. However, because the study’s sample size was small, further research is needed to confirm the generalizability of these results.11

In a 2018 study, researchers looked at the effectiveness of Somatic Experiencing in treating people with chronic lower back pain and comorbid PTSD. The researchers evaluated 1,045 people who were referred to a Danish spine center and screened them for PTSD. Ninety-one people met the criteria for PTSD and were randomly assigned to either a group that received 4 to 12 sessions of supervised exercises for lower back pain or a group that received both the supervised exercises and 6 to 12 hr of Somatic Experiencing. The study showed that people in the Somatic Experiencing group experienced a significant reduction in their reported PTSD symptoms and their fear of movement, compared to the control group, at a 12-month follow-up. Both groups experienced a significant reduction in their lower back pain.12

In another article published in 2021, researchers reviewed 16 peer-reviewed studies that included quantitative and qualitative analysis, and that tested Somatic Experiencing alone or in combination with another type of therapy to evaluate Somatic Experiencing’s effectiveness. Overall, the researchers found that Somatic Experiencing might be an effective approach to reducing PTSD symptoms, depression symptoms, and physical pain, and increasing resilience, though they acknowledged that more research support is required in this field.13

Finally, a 2015 review conducted by Australian researchers evaluated the effectiveness of various types of body-oriented mental health therapies, including Somatic Experiencing, sensorimotor psychotherapy, and relaxation therapies. The studies detailed the therapeutic methods’ effectiveness in treating physical issues, sexual disorders, PTSD, eating disorders, and chronic schizophrenia. The researchers found body-oriented psychotherapies to be effective for treating a variety of issues. However, they also found the field lacking the necessary research to support body-oriented approaches over more established interventions, such as eye movement desensitization and reprocessing therapy and mindfulness-based therapy.14

How Do I Find a Therapist for Somatic Experiencing?

People who are interested in Somatic Experiencing should look for a therapist who is certified in this approach. Resources including the Somatic Experiencing International Practitioner Directory can help potential clients connect with Somatic Experiencing practitioners in any area.

References

  1. THC Editorial Team. (2021, March 30). Posttraumatic stress disorder (PTSD). The Human Condition.
    https://thehumancondition.com/posttraumatic-stress-disorder-ptsd/
  2. Levine, P. A., Blakeslee, A., & Sylvae, J. (2018). Reintegrating fragmentation of the primitive self: Discussion of “somatic experiencing.” Psychoanalytic Dialogues—The International Journal of Relational Perspectives, 28(5), 620–628.
    https://doi.org/10.1080/10481885.2018.1506216
  3. Payne, P., Levine, P. A., & Crane-Godreau, M. A. (2015, February 4). Somatic experiencing: Using interoception and proprioception as core elements of trauma therapy. Frontiers in Psychology, 6, Article 93.
    https://doi.org/10.3389/fpsyg.2015.00093
  4. Students of PSY 3031. (2020). Introduction to sensation and perception: 21. Kinesthesia and proprioception. University of Minnesota.
    https://pressbooks.umn.edu/sensationandperception/chapter/kinesthesia-and-prorioception-draft/
  5. Levine, P. A. (1976). Accumulated stress, reserve capacity, and disease (Publication No. 7715760) [Doctoral dissertation, University of California, Berkeley]. ProQuest Dissertations Publishing.
    https://www.proquest.com/openview/2053221d99c777fd00349ce1963b4b60/1?pq-origsite=gscholar&cbl=18750&diss=y
  6. Somatic Experiencing Trauma Institute. (n.d.). Transforming lives through healing trauma. Somatic Experiencing International.
    https://mma.prnewswire.com/media/1174559/SETI_Media_Kit.pdf?p=original
  7. Maner, J. K., Schmidt, N. B., Richey, J. A., & Zvolensky, M. J. (2007). Exploring human freeze responses to a threat stressor. Journal of Behavior Therapy and Experimental Psychiatry, 39(3), 292–304.
    https://doi.org/10.1016/j.jbtep.2007.08.002
  8. Levine, P. A. (1997). Waking the tiger: Healing trauma. North Atlantic Books.
  9. Ross, S. (2018, January 3). Resourcing, pendulation and titration: Practices from somatic experiencing.
    https://sarahrossphd.com/resourcing-pendulation-titration-practices-somatic-experiencing/
  10. North Carolina Center for Resiliency. (n.d.). Somatic experiencing.
    https://www.nccenterforresiliency.com/somatic-experiencing/
  11. Brom, D., Stokar, Y., Lawi, C., Nuriel-Porat, V., Ziv, Y., Lerner, K., & Ross, G. (2017). Somatic experiencing for posttraumatic stress disorder: A randomized controlled outcome study. Journal of Traumatic Stress, 30(3), 304–312.
    https://doi.org/10.1002/jts.22189
  12. Andersen, T. E., Lahav, Y., Ellegaard, H., & Manniche, C. (2018). A randomized controlled trial of brief somatic experiencing for chronic low back pain and comorbid post-traumatic stress disorder symptoms. European Journal of Psychotraumatology, 8(1), Article 1331108.
    https://doi.org/10.1080/20008198.2017.1331108
  13. Kuhfuß, M., Maldei, T., Hetmanek, A., & Baumann, N. (2021). Somatic experiencing—Effectiveness and key factors of a body-oriented trauma therapy: A scoping literature review. European Journal of Psychotraumatology, 12(1).
    https://doi.org/10.1080/20008198.2021.1929023
  14. Bloch-Atefi, A., & Smith, J. (2015). The effectiveness of body-oriented psychotherapy: A review of the literature. Psychotherapy and Counseling Journal of Australia, 3(1).
    https://pacja.org.au/2015/07/the-effectiveness-of-body-oriented-psychotherapy-a-review-of-the-literature/

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