Radix InstituteScience and the Resurgence of Somatic Approaches
Somatic Work and Neuroscience
The Touch Taboo by Deb Dana, LCSW
Today, most people come into therapy with a general understanding of the concept of “body-mind,” the notion that their physical and emotional selves work in concert. But I’ve found that relatively few people understand the precise ways in which the body creates emotional experience, in turn prompting individuals to behave in predictable ways that create and perpetuate a story about themselves and the world they inhabit. That’s why, well before bringing touch into the equation, I help clients create a clear map of their own autonomic nervous systems, so they become aware of their patterns of response to ease and distress.
Following some brief psycho-education about the three parts of the ANS, I ask my clients to create a personal profile of their own. I suggest that they imagine their nervous system as a ladder, with ventral vagal at the top, sympathetic in the middle, and dorsal vagal at the bottom. (Here, I provide a worksheet with an image of a ladder.) Clients start by writing down their typical feelings and behaviors when they’re in a sympathetic state, often using words and phrases like out of control, angry, confrontational, fearful, and desperately seeking. They do the same for their experiences of being in dorsal vagal, which may include silent, out of focus, numb, hopeless, helpless, shut down, and feeling abandoned and unwanted. Finally, they recall times of being firmly planted at the top of the ladder-the ventral vagal zone. These typically include such descriptors as openhearted, engaged, curious, and playful.
I then ask my clients to complete their personal profiles by finishing two sentences for each state: “I am . . .” and “The world is . . .” Most clients are astonished by the dramatic difference in their core narratives, depending on the zone they inhabit. In a ventral state, people typically characterize their story as something like “I belong” and “the world is welcoming and filled with opportunity.” In sympathetic, they may say, “I feel crazy, panicked. I’m trapped in a world that’s unfriendly and scary.” When in dorsal, the response is something like: “I’m invisible, unlovable, lost, alone. The world is cold and empty.”
Now clients have both a mental picture and a language for their “ladder” of ANS activation at any given moment. Importantly, client and therapist now share this language, so that during a session they have a useful shorthand for noticing, naming, and addressing these ever-changing states of arousal. Over time, we want to help clients shift their default ANS setting from a place of danger and distrust to a state of openhearted safety.
Yet before going further, I want to emphasize that the polyvagal perspective is by no means a replacement for any particular model of therapy. Rather, it’s a way of looking at the nervous system, one that can inform and deepen any clinical approach. I think of it as a kind of moment-to-moment awareness of the ongoing biological reactions of self and others that deeply infuence the quality of the therapist-client relationship and, ultimately, a client’s fundamental sense of safety in the world. It’s an element of mindfulness; ideally, it’s a tool for healing.
Deb Dana, LCSW, specializes in treating complex traumatic stress and lectures internationally on the ways Polyvagal Theory informs clinical interactions with trauma survivors. She is the Coordinator of the Traumatic Stress Research Consortium in the Kinsey Institute at Indiana University and the developer of the Rhythm of Regulation clinical training series. She is trained in Internal Family Systems and Sensorimotor Psychotherapy and completed the Certificate Program in Traumatic Stress Studies at the Trauma Center. Deb is the author of The Polyvagal Theory in Therapy (Norton, 2018), co-editor with Stephen Porges, of Clinical Applications of the Polyvagal Theory (Norton, 2018), and is currently writing Polyvagal Exercises for Therapists and Clients(forthcoming from Norton). The Touch Taboo – Complete PDF
Published July 2019.
Somatic Experiencing and Resilience
Somatic Experiencing® works with what Payne et al. (2015) paper call the Core Response Network (CRN). The CRN includes subcortical, limbic system, motoric pathways, interoceptive cues, and basic arousal systems [i.e., the autonomic nervous system (ANS), the hypothalamic-pituitary-adrenal axis and the reticular activating system]. Dysregulation in these protective systems leads to the development of symptoms of trauma and other negative health outcomes. The SE® modality works by supporting the re-establishment of the innate regulatory capacity of the CRN via interoception (a core component of mindfulness), self-protection, emotion regulation, and self-awareness (Payne et al., 2015). To support the goal of re-establishing innate regulatory capacity (e.g., resilience), interventions are conducted in a client-centered, titrated manner.
While increased awareness and tolerance for affective states is a core outcome of SE® therapy, it is not primarily an exposure therapy. Rather than evoking intense traumatic memories directly, SE® works indirectly and gradually with these memories, identifying resources and corrective shifts in states that lead to new interoceptive experiences that in turn lead to changes in the felt experience of safety, power, and competence. While SE® shares many components with traditions such as meditation, Qigong, and yoga, it also has a specific set of tools that help clinicians and clients address the fundamental dysregulation of the CRN that underlies trauma (Payne et al., 2015). Parker et al. (2008) showed that tsunami victims in southern India showed 90% improvement in symptoms even at eight month follow up to short 75 minute treatment sessions using SER skills.
While the most traditional definition of resilience is the ability to withstand and rebound from adversity, in a study involving human subjects it would be unethical to create severe adversity in subjects lives in order to study their immunity to adversity. We therefore looked at secondary indicators of resilience in this study, which can be measured on self-report psychological measurement instruments.
The purpose of this study was to test the effect of Somatic Experiencing® Training on measures of resiliency by assessing changes in clinician resilience longitudinally over the 3 year SE® training course. Clinician quality of life, psychological symptoms and degree of early life trauma were measured. We used the World Health Organization Quality of Life-Brief (WHOQOL-BREF) to assess changes in well-being in four domains: psychological quality of life (mental wellness), health related quality of life (overall physical well-being), social quality of life (quality of social relationships), and environmental quality of life (measure of wellness on community and access to housing etc.,). Changes in psychological symptoms was measured using the Patient Health Questionnaire (PHQ-SADS), which includes three subscales for anxiety (GAD-7), somatic symptoms (PHQ-15), and depression (PHQ-9). In order to assess the early life adversity on changes in resilience, early life adversity was measured using the CDC/Kaiser Permanente ACE1 Score Calculator Questionnaire.
Pioneers of Neuroscience
Dr. Levine’s Approach to Trauma Resolution
“Somatic Experiencing” is a body-oriented therapy designed to treat trauma and PTSD patients. Levine’s approach concentrates
on our instinctual biology and physiology – what happens in our bodies when we’re exposed to extreme threat. At the core of the approach is the assumption that trauma and PTSD symptoms are most often the result of the nervous system being overwhelmed by
the intensity and speed of a violent and threatening event, which may be a single incident or involve chronic exposure. The nervous system simply cannot process the experience and gets “stuck” in two possible patterns: hyper-arousal (fight or flight response), or immobility response. When the stuck energy does not get released, the traumatized person may experience all kinds of symptoms—not only the classic symptoms of PTSD such as ashbacks and nightmares, but also physical symptoms, including chronic pain, stiffness, or tension in different parts of the body.
Because of the neurological impact of trauma, Peter Levine states that resolving trauma must first happen at the physiological level before the person can begin to process emotions or thoughts about the event. One reason for this is that a traumatized person’s ability to read people’s emotions is compromised, making it difficult for them to interact at an emotional level, or even benefit from the empathy of a therapist, until they have regained some self-regulation in their nervous system.
“Somatic Experiencing” focuses on facilitating this re-regulation of the nervous system by guiding clients to become aware of and experience their bodily sensations. Levine asserts that a traumatic event triggers self-protective mechanisms in the body, such as attempting to orient toward the source of the threat to identify it and at the same time wanting to run away from it to protect oneself. However, the trauma, such as a car accident, attack, or in the case on this video, an IED explosion, interrupts the completion of these self-protective mechanisms, leading to a destabilization of the nervous system. By using various body-oriented techniques that encourage the client to very slowly complete these self-defensive orienting responses, Levine enables the client to regain pleasure in his body, reach various stages of relaxation, and allow for progressive gentle releases of energy that induce a greater self-regulation of the nervous system. As you will see in this video, sensations of goodness are triggered in the client’s body, which in turn allows him to re-connect with the outside world, regain a sense of independence in his life and reach stages where he can process the trauma at an emotional and cognitive level.
THE POLYVAGAL THEORY: THREE PHYLOGENETIC RESPONSE SYSTEMS
Investigation of the phylogeny of the vertebrate autonomic nervous system provides an answer to the vagal paradox. Research in comparative neuroanatomy and neurophysiology has identified two branches of the vagus, with each branch supporting different adaptive functions and behavioral strategies. The vagal output to the heart from one branch is manifested in respiratory sinus arrhythmia, and the output from the other branch is manifested in bradycardia and possibly the slower rhythms in heart rate variability. Although the slower rhythms have been assumed to have a sympathetic influence, they are blocked by atropine.7
The polyvagal theory7,11–15 articulates how each of three phylogenetic stages in the development of the vertebrate autonomic nervous system is associated with a distinct autonomic subsystem that is retained and expressed in mammals. These autonomic subsystems are phylogenetically ordered and behaviorally linked to social communication (eg, facial expression, vocalization, listening), mobilization (eg, fight–flight behaviors), and immobilization (eg, feigning death, vasovagal syncope, and behavioral shutdown).
The social communication system (ie, social engagement system; see below) involves the myelinated vagus, which serves to foster calm behavioral states by inhibiting sympathetic influences to the heart and dampening the hypothalamic-pituitary-adrenal (HPA) axis.16 The mobilization system is dependent on the functioning of the sympathetic nervous system. The most phylo-genetically primitive component, the immobilization system, is dependent on the unmyelinated vagus, which is shared with most vertebrates. With increased neural complexity resulting from phylogenetic development, the organism’s behavioral and affective repertoire is enriched. The three circuits can be conceptualized as dynamic, providing adaptive responses to safe, dangerous, and life-threatening events and contexts.
Only mammals have a myelinated vagus. Unlike the unmyelinated vagus, originating in the dorsal motor nucleus of the vagus with pre- and postganglionic muscarinic receptors, the mammalian myelinated vagus originates in the nucleus ambiguus and has preganglionic nicotinic receptors and postganglionic muscarinic receptors. The unmyelinated vagus is shared with other vertebrates, including reptiles, amphibians, teleosts, and elasmobranchs.
Bodily state is regulated in an efficient manner to promote growth and restoration
Investigation of the phylogeny of regulation of the vertebrate heart11,12,19,20 has led to extraction of four principles that provide a basis for testing of hypotheses relating specifi c neural mechanisms to social engagement, fight–flight, and death-feigning behaviors:
There is a phylogenetic shift in the regulation of the heart from endocrine communication to unmyelinated nerves and finally to myelinated nerves.
There is a development of opposing neural mechanisms of excitation and inhibition to provide rapid regulation of graded metabolic output.
A face–heart connection evolved as source nuclei of vagal pathways shifted ventrally from the older dorsal motor nucleus to the nucleus ambiguus. This resulted in an anatomical and neurophysiological linkage between neural regulation of the heart via the myelinated vagus and the special visceral efferent pathways that regulate the striated muscles of the face and head, forming an integrated social engagement system (Figure 1; for more details, see Porges7,15).
With increased cortical development, the cortex exhibits greater control over the brainstem via direct (eg, corticobulbar) and indirect (eg, corticoreticular) neural pathways originating in motor cortex and terminating in the source nuclei of the myelinated motor nerves emerging from the brainstem (eg, specifi c neural pathways embedded within cranial nerves V, VII, IX, X, and XI), controlling visceromotor structures (ie, heart, bronchi) as well as somatomotor structures (muscles of the face and head).