Somatic therapies

Somatic therapies as part of complex trauma treatment

Somatic therapies as part of complex trauma treatment

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Complex trauma (C-PTSD) treatment is different from general therapy or single event (PTSD) treatment and therefore follows a treatment protocol that is also different. Generally the "gold standard" is the 3-stage or 3-phase method which progresses the client through stabilisation, processing and then post traumatic growth. NICE guidelines are clear that you should only consult a therapist with specialist training who uses a trauma specific protocol.

Somatic therapy has become more and more well known as the evidence has grown of the need to address trauma that appears to be "held in the body". This concept used to be viewed with scepticism, but now with the discovery of neurons in both the gut and the heart areas, we are gaining more and more evidence of the diffuse nature of the "mind" as apposed to just the "brain".

Trauma memory itself is now known to be divided into two types - explicit (similar to factual diary entries that you can recall and talk about) and implicit (emotional, feeling based and very embodied). It is the latter where the real pain of trauma is held, and it is somatic processing and somatic therapy that accesses it. To be clear, talking therapy is very inefficient at addressing this kind of memory, which is why talking therapy often fails to help trauma recovery.

Talking therapies alone often do not lead to trauma recovery, and in some cases talking about trauma over and over again makes it worse!

HOW CAN SOMATIC THERAPY HELP?

Firstly is is useful just to split somatic therapy into two parts for a moment, even though these two parts are often applied together by the trained therapist.

  1. Finding the emotion or memory to process using brainspotting, sensorimotor psychotherapy, NLP or other detection methods where the therapist observes physical reactions that the client may not even be aware of.
  2. Following the physical feelings and sensations in the client's body, in this case the client is aware of some feeling and is following it in a way that leads to discovery and processing. This is what is more often known as somatic work and is often used in groups as well as private therapy.

In practice therapists will often use methods like somatic experiencing, sensorimotor psychotherapy and TIST to combine these two elements in a single combined process.


How does somatic therapy get used in complex trauma therapy

Somatic therapy is mainly a stage / phase 2 process. By this time the client has used phase 1 to learn to remain in a calm and relaxed body while carrying out therapy exercises - so called stabilisation. This is vital because if you launch into somatic work or memory processing without being able to self regulate and remain emotionally calm you instead experience trauma triggering.

Therapeutic use of somatic processing at the right time allows the client to rediscover the fragments of memory that have yet to be processed. These are often themes and meanings rather than memories of events. It is NOT necessary to remember everything about your traumas in order to heal, that was a mistake invented by Freud. In reality it is the meaning and theme or narrative that we are left with that continues to effect us, and thus it is this we need to process.

The exception is the physiological effect of trauma where it can be useful to discover and process the tendency for a client to remain in a physically altered base state of "brace" or "collapse" (think brace, brace in aircraft safety drills versus collapse in exhaustion after a crisis). Here the somatic therapy can be helpful in identifying key times and themes to unlock the ability to let go of these "stuck" responses.

Stuart is trained in multiple methods of somatic therapy including Hakomi, Mindfulness, Body and movement work, Somatic Experiencing, Brainspotting, Sensorimotor psychotherapy, NLP and combined integrative somatic processes. He has trained with leading experts including David Grand, Peter Levine and Janina Fischer.

The Evidence

Somatic therapies address complex trauma (C-PTSD) by targeting the subcortical and autonomic nervous system responses that traditional top-down cognitive therapies may leave unaddressed. Complex trauma often manifests as chronic physiological dysregulation, somatic dissociation, hyperarousal, and hypoarousal (collapse or numbing).

Evidence evaluating key somatic modalities for complex trauma highlights their clinical efficacy.

Key Somatic Therapies & Their Evidence Base

1. Somatic Experiencing (SE)

Developed by Peter Levine, Somatic Experiencing focuses on tracking body sensations to complete interrupted, trapped physiological survival responses (fight, flight, freeze) without requiring detailed narrative re-telling of traumatic events.

  • Evidence Base: A growing body of randomized controlled trials (RCTs) and systematic reviews supports SE for post-traumatic stress and associated somatic symptoms. Findings demonstrate significant reductions in PTSD severity, anxiety, and depression, along with marked improvements in interoceptive awareness and autonomic regulation (Kuhfuß et al., 2021).
  • Effectiveness for C-PTSD: Particularly effective for individuals prone to severe emotional flooding or somatic shutdown, as its emphasis on titration (processing trauma in tiny micro-doses) and pendulation prevents re-traumatization and expands the window of tolerance.

2. Sensorimotor Psychotherapy (SP)

Founded by Pat Ogden, Sensorimotor Psychotherapy integrates body-oriented techniques with somatic mindfulness and principles from attachment theory. It directly addresses the somatic components of implicit memory, procedural habit patterns, and developmental trauma.

  • Evidence Base: Clinical trials evaluating SP protocols (such as phase-1 stabilization groups for C-PTSD) show statistically significant reductions in PTSD symptoms, depressive symptoms, and overall functional impairment, alongside improved emotional regulation (Fisher, 2011; Langmuir et al., 2012).
  • Effectiveness for C-PTSD: Excellent for resolving early developmental/attachment trauma, somatic dissociation, and non-verbal relational wounds by reprogramming physical postures, defenses, and boundary-setting movements.

3. Trauma-Informed Somatic Yoga / Trauma-Sensitive Yoga (TSY)

Developed at the Trauma Center (often studied as Center-Trauma Sensitive Yoga or TSY), this approach utilizes gentle movement, interoceptive choices, and dual awareness to rebuild a safe connection to the physical self.

  • Evidence Base: Extensive empirical support, including multiple RCTs funded by the NIH. Studies demonstrate that TSY leads to significant reductions in treatment-resistant complex PTSD symptoms and dissociation, with outcomes comparable to standard evidence-based psychotherapy modalities (van der Kolk et al., 2014).
  • Effectiveness for C-PTSD: Directly targets body alienation, depersonalization, and alexithymia by restoring agency and interoceptive awareness without forced physical adjustments.

4. Eye Movement Desensitization and Reprocessing (EMDR)

While categorized as an integrative therapy, EMDR heavily relies on somatic tracking, body scans, and bilateral stimulation to process traumatic memories stored in subcortical neural networks.

  • Evidence Base: Recommended globally as a first-line trauma treatment by organizations such as the WHO and APA. Meta-analyses demonstrate its high efficacy in reducing both psychological trauma and associated somatic/behavioral distress (Yunitri et al., 2020).
  • Effectiveness for C-PTSD: When adapted into phase-oriented models, EMDR systematically desensitizes lingering bodily tension and somatic triggers tied to complex developmental trauma.


References

  • Fisher, J. (2011) 'Sensorimotor approaches to trauma treatment', Advances in Psychiatric Treatment, 17(3), pp. 171–177. doi: 10.1192/apt.bp.109.007054.
  • Kuhfuß, M., Maldei, T., Hetmanek, A. and 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), p. 1929023. doi: 10.1080/20008198.2021.1929023.
  • Langmuir, J.I., Kirsh, S.G. and Classen, C.C. (2012) 'A randomized controlled trial of Sensorimotor Psychotherapy for women with childhood abuse histories', Journal of Trauma & Dissociation, 13(2), pp. 213–231. doi: 10.1080/15299732.2012.640222.
  • van der Kolk, B.A., Stone, L., West, J., Gaurino, A., Rhodes, A., Emerson, D. and Spinazzola, J. (2014) 'Yoga as an adjunct treatment for posttraumatic stress disorder: a randomized controlled trial', Journal of Clinical Psychiatry, 75(6), pp. e559–e565. doi: 10.4088/JCP.13m08561.
  • Yunitri, N., Kao, C.C., Chu, H., Voss, J., Chiu, H.L., Liu, D., Shen, S.T.H., Chang, P.C., Kang, X.L. and Chou, K.R. (2020) 'The effectiveness of eye movement desensitization and reprocessing toward anxiety disorder: A meta-analysis of randomized controlled trials', Journal of Psychiatric Research, 123, pp. 102–113. doi: 10.1016/j.jpsychires.2020.01.005.


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