I stopped seeing my therapist two years ago, but not because I didn’t like her. After several months of cognitive behavioral therapy, or CBT, I felt like I wasn’t getting anywhere. In fact, my physical anxiety symptoms got worse every time I talked through my feelings on my therapist’s loveseat. “I don’t know if this makes sense,” I told a new therapist during a consultation call. “But my anxious feelings aren’t really in my mind; they’re in my body.”
Turns out, it did make sense. The new therapist believed the constant heart-racing, muscle tension and stomach pain I’d been experiencing were a result of childhood trauma. She recommended a therapeutic approach developed specifically for trauma survivors, and we began meeting weekly, just as I’d done for years with other therapists. But our sessions were different in one major way: I wasn’t asked to explore my emotions or challenge my beliefs. In body-focused therapy, it was matter over mind.
The goal of all psychotherapy is to treat mental health issues, but treatment approaches differ. The right approach for a patient depends on the problem a patient is dealing with and how it’s affecting them. Cognitive behavioral therapy, which helps people identify and change unhelpful emotions and behaviors, is commonly used to treat generalized anxiety and depression. To work through trauma, however, some therapists believe body-focused therapies, like somatic experiencing and sensorimotor psychotherapy, are more effective.
“Threats don’t go through the thinking brain,” says Pat Ogden, the psychologist who created sensorimotor psychotherapy, a body-focused and trauma-informed therapy approach. “When you’re threatened, your instincts take over, so to try to address it cognitively isn’t efficient.”
A body-focused approach might be particularly helpful right now. According to Portland-based therapist Heather Fairlee Denbrough, COVID-19 and systemic racism are both enormous stressors that can elicit trauma-like responses.
Trauma survivors often develop overactive stress responses. Having a stress response is the same thing as going into fight, flight or freeze mode: The brain reacts to a perceived threat by telling the nervous system to release adrenaline into the bloodstream, prompting a series of physiological changes including an increased heart rate and sharpened senses.
Those changes are immensely helpful if you’re trying to outrun a sabertooth tiger. But if you’re in therapy trying to sort through a painful memory, a pounding heart can be distracting or overwhelming.
Stress also inhibits learning, an important part of CBT. Studies show the thinking brain (the prefrontal cortex) goes “offline” when people are exposed to stressors they feel they can’t control. Somatic therapists focus on calming down the body before addressing thoughts and helping patients self-soothe, a method called “bottom-up regulation.”
“CBT is great when your ‘top’ is still on, but if you work from the bottom up — starting with a bodily sensation and working your way up to the brain — you can work through it, even in moments of stress,” says Ashley Eder, a therapist in Folsom, California.
That’s the goal of somatic therapy: To identify how the response affects you physically and try new strategies for managing it. For example, let’s say you go to therapy feeling stressed over a recent breakup. In the safety of your therapist’s office (or your own living room), you could pinpoint the accompanying physical sensation without being overwhelmed by it.
Once you figure out that stress made your chest feel tight, you can practice taking deep breaths until you feel calm again. “When you understand what’s going on in your body, you can try new ways of coping both in and out of therapy,” says Denbrough.
All these things help turn off the stress response so that you can eventually process the thoughts you have in response to stress, on your own or alongside a therapist. “Body-centered therapy can permanently shift the way we have automatic responses to stressors, not just the way we talk to ourselves,” says Eder. “We can change the default as opposed to constantly having to talk ourselves out of the default.”
Focusing on your body while staring at a screen
If you’re used to working through issues on your therapist’s couch, telehealth might come with a learning curve. But Eder, who’s been offering body-centered telehealth since 2015, says remote therapy can sometimes be better than in-office appointments for patients with trauma.
People are generally more relaxed in their own space, which often means more productive therapy. And it can be helpful to learn new coping skills in the place you’ll actually be using them. Plus, having a glimpse of the home environment also gives therapists insight into patients’ daily lives, potentially allowing for more specific treatment recommendations.
Telehealth also encourages more direct eye contact, which Eder says can foster a connection between a therapist and patient. Staring directly at someone might feel weird when you’re talking face to face, but it’s normal when you’re interacting through a screen. “People who struggle with eye contact or feeling like they need a little space can relax and connect with the therapist more,” she says. “There’s a built-in distance, so you get to stare at them without breaking a social contract.”
Virtual care doesn’t always cut it; some health issues need to be addressed in person. But distance can actually benefit somatic therapy, Denbrough says. One goal of body-centered therapy is mindfulness, which patients learn by actively noticing and describing their physical sensations. In an in-person session, a therapist might play a supporting role in this exercise by making observations about, say, a patient’s body posture. But in teletherapy, a therapist usually doesn’t have a clear view of a patient’s whole body, and thus can’t make the same kind of observations. In the long term, patients can benefit from being forced to develop and hone bodily awareness without any assistance.
Ogden, who offered webinars for clinicians who want to offer body-oriented approaches through telehealth, says she hopes they become more prominent and available to the growing number of patients who need help managing trauma symptoms.
“It’s hard for me to imagine how just talking about something will effect lasting change,” she says. “Unless physical patterns can shift alongside with cognitive and emotional patterns, I don’t think someone’s change will be as far-reaching as it could be.”