A Sensorimotor Approach to Trauma

by Starr Denison, MS, LPC, NCC

The sensorimotor approach to trauma resolution identifies and uses mental, emotional, and physical states to relieve and manage sensations associated with trauma. It is widely understood trauma is held in the body. Trauma leaves behind intense symptoms causing uncertainty, bewilderment, reactivity, and debilitating changes in identity. Using this approach, you are gently helped toward healing in a holistic and mindful way. The sensorimotor approach helps to identify the array of physiological responses for survival in order to help you move beyond the sensations and into a healthy awareness and understanding of your reactions, thereby reducing the symptoms effectively.

Here are some key points to this approach:

1. When the “thinking brain” goes offline after trauma: Our instincts are very bodily based and the mammalian response is fight/flight/freeze/submit/comply when faced with danger. Our brainstem goes into action, without being able to connect enough to allow for abstract thinking in the moment. We go into a state of high physiological arousal. With PTSD, the instinctive responses do not complete themselves, like they would with an animal such as a gazelle who has gotten attacked by a cheetah yet was able to get away when it seemed completely hopeless. The animal releases the energy, often through shaking, and returns to a “window of tolerance” state in order to function normally, without the effects of long lasting trauma.
   1. In terms of treatment, a clinician watches for the remnants of trauma – the aftermath which may or may not be remembered. We watch for clues from the body and identify levels of arousal.
2. Helping you quiet anxiety within your body: Sometimes, people are fearful of becoming aware of their body, in order to avoid feeling re-traumatized. They may start to shake or have symptoms of high anxiety. Through physical action and re-engaging the brain with the action, you might be able to re-focus in the present moment, and feel sensation without being triggered back into the anxiety response.
3. Reframing the trauma response to help you heal: it is important not to get stuck in any of the response modes of fight/flight/freeze/submit/comply but learn to develop “flexibility” in your response while handling defense reactions (cry for help, fight response, flight response, freeze response, feigned-death response). With trauma survivors, the defenses tend to repeat over and over because they were effective when dealing with the event in the moment which is nature’s way of keeping us alive.
   1. You might not understand that your instinctive responses are constantly in action, they are responding without you actually wanting to respond.
   1. In sensorimotor psychotherapy, the theory is that these responses are not wrong or bad, they are all adaptive within context which might offer you some relief. The goal of this approach is to develop flexibility in your responses. In other words “we want people to be able to fight back – if that is what is called for, to be able to get away, or to be able to call for help – to reach out for help” (Ogden, 2014, p. 4).
4. Reading the somatic narrative: Be curious about what your body is saying. Ask yourself how you are moving, walking, what your typical facial expression is, are your arms pinned or do they move, what are the little movements that occur (finger movements or twists in the body). These movements provide insight into actions that might want to happen – that are not complete.
   1. Educate yourself about somatic clues – what do you move like?
5. Is working with memory imperative in trauma? Dr. Ogden believes the effects of a traumatic experience are independent of the memory of that experience. Therefore, you don’t necessarily need to remember what happened.
   1. In therapy, working with the memory is not what needs to happen – working with the effects of the memory or how it is still alive and limiting you is what therapists work with while using this approach. The importance is remaining in the here-and-now. Memory is not perfect! We adjust our memories, never really knowing if they are factual.
6. Five basic movements that open a window to procedural memory: Procedural memory is about HOW we do things rather than WHAT we do. How do you instinctively move your body?  Procedural memory is not conscious but has a very high influence on our lives.
   1. Five moments: yield (letting go), push, reach, grasp, and pull. Asking a variety of people to push, we will see everyone does it a little differently (weak vs. strong, push/pull back, etc.)
   1. Helping you make these movements and working through what keeps you from doing any of these actions effectively is part of the sensorimotor approach.
7. How mindfulness is an integral part of trauma therapy: A fundamental element in practice is developing a mindful relationship between you and your therapist. The term “embedded relational mindfulness” is used in sensorimotor psychotherapy where both you and your practitioner are becoming mindful of the your internal experience rather than getting invested in the story of what happened. Listening to the story is ok however wanting to know how the body sensation is changing, shifting, and what feelings, thoughts or actions are coming up are important. Turning awareness inward and allowing you to take your therapist into their inner world with you is the relational aspect. In other words, you are not going there alone.
8. Strategies for working with the body in trauma: Sometimes, according to Dr. Ruth Lanius, the chronically traumatized person may look and appear completely defeated and it can be extremely painful sometimes to go to the body, therefore psychoeducation is a good place to start – making sense of the effects of posture on emotional experience and the connection between the mind, brain, and body. The therapist can explain the importance of connection and what is happening within. How difficult is it for you to focus into what is happening in your body? Slowly work through these fears by asking what is most frightening about it, and how can we help you feel comfortable or safe while working through the sensation? After these initial steps, experimentation with body motion is the next step. Perhaps asking yourself to try to sit up and just notice what is happening in your experience.
   1. It is very important not to assume that you may feel good at first, it may be uncomfortable, or not feel good, or may be very unfamiliar. It is important to have an open mind, non-judgmental, and curious about what is happening.
9. Changing your negative beliefs: Many trauma survivors believe intrinsically that the world is not safe to live in. In therapy we help you to notice how your body is responding to the environment and help you to ask yourself “what is my body doing, am I holding my breath, tensing up…? Teaching awareness that this isn’t the only way you can feel in the moment. Every time judgment occurs, negative beliefs might rise to the surface up which may or may not be identifiable.
   1. A breathing exercise done in a slow, mindful breathing pattern – up through the nose, exhaling while pursing the lips (like breathing out through a straw), until the breath is all gone. This is a very slow breath. Breathing then naturally quiets.
   1. Look at where the belief is coming from and dispute it, are you really threatened based on what is happening right in this moment? It is important to only dispute the negative belief when the pre-frontal cortex is online. Breathing helps to make this connection happen.
10. Change established routines to become more adaptable: If you are stuck, do small experiments such as asking someone for directions (especially if you never normally ask for help), or something else that has no significant consequences is a start. If you are a perfectionist, try making a few mistakes on purpose will help you get out of your normal pattern and comfort zone.  
11. Using physical activity in trauma treatment: Dr. Joan Borysenko suggests doing some physical activities can help you change the way you notice your own body. Do something physical when you begin to feel stuck or start to over-think problems. It is a strong way to bring in the sensorimotor approach. Taking a mindful walk is even more helpful. Noticing how weight is shifting, noticing how you are moving with each footfall. Imagine walking in a different setting somewhere, noticing postures. Change your posture and how you walk to help yourself remain in the present moment.

References

Ogden, P. (2014) Rethinking trauma 2014: Quick start guide #4 with Ruth Buczynski. National Institute for the Clinical Application of Behavioral Medicine. [Webinar].

Ogden, P., Minton, K., and Pain, C. (2006). Trauma and the body: A sensorimotor approach to psychotherapy. New York, NY: W. W. Norton & Company, Inc.