Somatic Therapy: Letting Go of Stress

Stress in the Body

It’s often said that the body stores stress, but what does that actually mean?

When faced with a challenge, your sympathetic nervous system releases norepinephrine, setting off a chain of physiological responses, including a spike of epinephrine from the adrenal gland. Your airways dilate, your blood vessels constrict, your liver releases glucose, and your heart starts racing. 

This sudden spike in cortisol is what’s called the fight, flight, freeze, or fawn response. Essentially, you’ve encountered a threat or an obstacle, and your body rallies to beat it, escape it, hide from it, or appease it. When the stressful event is over, your parasympathetic nervous system releases acetylcholine, relaxing the airways, increasing gastrointestinal functions, and lowering the heart rate. This is why the parasympathetic nervous system is called the rest and relax response.

From an evolutionary standpoint, this dynamic response system helped us survive as a species, so what’s the problem? Our prefrontal cortex allows us to have many complex thoughts, yet we respond to stressors in the past, present, and future via the same nervous system. Whether you’re reliving past traumas, or dealing with stress in your day-to-day life, or anticipating the next problem coming down the pipeline, your body reacts the same way. If you have ever had an intense anxiety, then you may know from first-hand experience how you can panic about the past, the present, and the future, individually and simultaneously.  

Not only this, but stress becomes an ouroboros, a snake biting its own tail! The head of the snake begins to stress about stress itself, falling into metacognitions, worrying about worry, being angry about being angry, and being depressed about being depressed. This sensitizes your awareness and therefore your responsiveness to stress itself. If you have felt overwhelmed by a relatively simple task like going to the grocery store, then you know what it’s like to be sensitized to your own stress response. Indeed, those who struggle with anxiety or PTSD often report a level of hypervigilance—on edge and on the lookout for the next stressful thing, even when there is no present threat.

When the major stress becomes the prospect of stress itself, the snake has bitten its own tail, and round and round we go until the snake can’t eat itself anymore. And when that happens, you may suffer from adrenal fatigue, as the pituitary gland struggles to keep up with this constant level of stress. This is why people who live in stressful environments may not describe a state of alarm or panic, instead reporting a level of lethargy, exhaustion, depression, low libido, or dissociation.

Beyond the racing heart rate and the overall exhaustion that follows, there are many other ways stress is physically experienced. Increased muscle tension can lead to chronic pain in various parts of the body, like your legs, arms, neck, jaw, shoulders, and back. As the respiratory system constricts, your chest may feel tight like you’re holding your breath, or like you’re losing your voice. 

Unable to engage the parasympathetic nervous system without interruption, your digestive system can also go haywire. Abdominal pain, bloating, constipation, diarrhea, nausea, and irritable bowel syndrome (IBS) are just some of the problems that occur. 

On top of this, cortisol inhibits the production of immune cells, suppressing your immune system. So during periods of prolonged stress, you may find yourself more susceptible to illness, or you may notice old injuries and chronic conditions flaring up.

What is Somatic Therapy?

Somatic therapy was developed to help people navigate and heal their mind-body relationship. Drawing from a long history of meditation and yoga, this practice of reconnecting with one’s physical experience is found in ancient cultures throughout the world. Unfortunately, its introduction to Western psychology began with a lot of controversy.

It was first integrated into Western psychology in the 1930s by the communist sexologist Wilhelm Reich, who promoted body-oriented psychotherapy. Reich observed how repressed emotions manifested as tension in the body and how pressure on these areas could elicit an emotional response. He also promoted orgone energy, an aether he believed he could harness with his invention, the orgone accumulator. 

After the FDA took him to court for distributing “quack cures,” he wound up in the Lewisburg Federal Penitentiary, where he died of a heart attack only a few months later. Not only this, but the FDA burned his books. For more on this tumultuous history, read Voices: A History of Body Psychotherapy by Barbara Goodrich-Dunn and Elliot Greene.

This public reprimand cast a dark shadow on body-oriented psychotherapy, until the counterculture movement of the 1970s. During this experimental era, there were a lot of ideas flying around, with two notable factions that certainly intermingled. 

On one side, there were psycho-spiritualists like Illan Rubenfeld, who developed the Rubenfeld Synergy Method, as well as the growing movement of Transpersonal Psychologists. 

On the other side, there were psycho-physiologists like Moshe Feldenkrais, who developed the Feldenkrais Method, Alexander Lowen and John Pierrakos’ who developed Bioenergetic Analysis, and Peter Levine, who developed Somatic Experiencing.  

This is not to say that these psych-physiologists were not inspired by spirituality, only that their publications focused on anatomic function. For example, Feldenkrais wasn’t even a mental health professional, he was a physicist and engineer intrigued by how self-awareness impacts body posture and movement.  

In particular, Levine’s Somatic Experiencing brought the concept of mind-body relationship back to academia, though many researchers place it in the category of alternative psychology. Levine presented the acronym SIBAM to account for the five channels of experience: Sensation, Image, Behavior, Affect, and Meaning. By incorporating concepts of exposure therapy with the growing research around the autonomic nervous system, Levine developed a treatment plan based on somatic awareness, titration, pendulation, and resourcing.

1. Somatic Awareness: Since traumatic experiences and prolonged stress can dysregulate the autonomic nervous system, somatic experiencing helps clients re-attune themselves. By tracking sensations and movements, clients begin to recognize when their stress response is activated, and how it presents in their body. For some, it’s quite apparent, but for others, there are subtle shifts, like their blood pressure increasing, or their foot tapping, or their eyes looking away. At the same time, the client also tracks moments of expression and release when they engage in activities that alleviate these points of stress.
2. Titration: Clients are often worried that they’ll be flooded or overwhelmed by the process. Recognizing this, somatic experiencing helps clients break their trauma response into smaller, manageable sensations, focusing on their heart rate or their breathing. This titration allows the therapist to guide the client slowly and gently through their activation state while monitoring their stress response. By experiencing stress within a range of tolerance, the client builds a level of resilience, allowing sessions to gradually explore the complex depth of their stress or trauma, including their emotional process, residual pain, or attachment wounds.
3. Pendulation: Somatic experiencing draws the client’s physical, emotional, and mental awareness back to safety. Moving back and forth between discomfort and comfort, tension and relaxation, allows for a sense of release. This can be quite emotional since the stress stored in the body often results from the client’s fight, flight, freeze, and fawn response being interrupted by the original trauma. They could not fight their way out of the situation, or run, or hide, or appease— keeping them on edge, indefinitely. When the body is finally allowed to let go, many emotions are forthcoming, including anger, fear, sadness, regret, shame, joy, release, and surprise.
4. Resourcing: To help clients increase their internal resources, somatic experiencing helps clients self-regulate and self-soothe via breathing, stretching and sensory exercises. To help clients increase their external resources, they’re also encouraged to connect with a network of people who can provide safety and comfort.

This eclectic, alternative history, incorporating Somatic Experiencing, meditation, and Yoga, as well as the growing field of neuroscience and biofeedback, all contribute to what is known today as Somatic Therapy.

Research pertaining to the efficacy of Somatic Therapy has demonstrated a significant reduction of PTSD symptoms. For more on this, see Andersen, Lahav, Ellegaard, and Manniche (2017), Brom et al. (2017), Leitch, Vanslyke, and Allen (2009), Parker, Doctor, and Selvam (2008), and Winbald, Changaris, and Stein (2018). These data points are also worth pairing with the reduction of PTSD symptoms correlated with meditation and Yoga,  as reported by Gallegos, Crean, Pigeon, and Heffner (2017), Hilton et al. (2017), and Sciarrino, Delucia, O’Brien, and McAdams (2017).

Somatic Wellness Teams

While trauma-informed mental health counselors are trained to help clients navigate the full complexity of a client’s trauma and trauma response, it’s important to provide as many resources to the client as possible. This is why somatic therapists often take a holistic wellness approach, collaborating and networking with other Somatic workers in their area, like the aforementioned sex therapists, massage therapists, and Watsu practitioners.    

Not only do collaborations of this kind increase the clients’ support network, they can also help navigate some ethical concerns, especially regarding physical contact. A simple touch on the shoulder can deeply humanize a person, cutting through defense mechanisms to allow for emotional release. Yet a simple touch on the shoulder can also be incredibly alarming, engaging their defense mechanisms and increasing their distress. For this reason, mental health counselors must always consider the therapeutic relevance of touch, the client’s individual and cultural boundaries, as well as the inherent power dynamics inherent in sexuality and gender identity.

Balancing all this, it can help to refer a client to a trauma-informed massage therapist who can work out the stress in their muscles or a Watsu professional who can physically hold them in water to practice trust, relaxation, and release. 

Likewise, there are many ways stress can impact a client’s relationship with their body and their libido that a certified sex therapist may better address. It’s important to remember how stress and trauma are multidimensional, so the more comprehensive a client’s support network is, the more opportunities they have to explore their multifaceted relationship with their nervous system and engage their rest and relax response.