Combining somatic elements or mindfulness with psychotherapeutic approaches has become more popular in recent years, but can sometimes seem a little mysterious. I am going to take a tour of some of the neuroscience at work here, and give some insights into the world of physical sensations, including how to move with and through them to change our emotional responses.
Bodies can seem like strange, unfamiliar places at times. They can be sources of long-term pain and discomfort, or just cumbersome things that we lump around with us, which don’t seem to do everything we want from them. But our psychological experience exists in a complex system with physiology of our bodies. That’s why practices that focus us on the body can help us feel more calm – like yoga, tai chi, and mindfulness meditation. They activate the parasympathetic nervous system, which is our natural relaxation response. For some people though, tapping into the body through mindfulness can bring up difficult and overwhelming sensations or emotions that they aren’t equipped to deal with on their own. It can even lead to a kind of contemplative dissociation or freeze response. These reactions are often linked to old or unconscious trauma that hasn’t been fully processed. Working with various kinds of body psychology is a way to navigate these waters, and to use the resource of your body and its nervous system to alter your emotional responses and belief systems.
Bodies and psychology
Most of us have had headaches or neck pain when we’ve been under stress or in a challenging emotional period, or have wondered if there’s more to those stomach aches and that back pain than just food and posture. Our experiences of states like anxiety or depression are extremely physical, with sensations like tightness in the chest or throat and difficulty breathing, heaviness, numbness, or emptiness. Although we might focus more on our thoughts and feelings then, the physical sensations are a big part of what is so unbearable and drives us to distraction.
There is a huge amount of feedback from the body level to the brain informing how we feel. In this “bottom-up processing”, unconscious parts of the brain monitor sensory factors such as blood vessel constriction, muscle tension, and joint position, and that information is a large part of what creates our sense of well-being: the feeling that things are okay. That means that when the body is in alarm-mode, for whatever reason, you will feel uneasy – even if you can’t explain why. What’s more, if those brain areas register things like braced shoulders and shallow, rapid breathing, then they trigger the body’s fear response, thus maintaining the physical state of alarm.
A key part of our emotional processing also happens in the unconscious area of the limbic system, particularly the amygdala, and the areas it is in close and complex connection to: the hypothalamus, the cingulate gyrus (emotion processing and communication), and the insula (connected to feeling internal sensations or “gut” feelings). The limbic system also drives and regulates our fear and stress responses (via the hypothalamus) by stimulating the sympathetic nervous system (SNS) and the release of adrenaline and cortisol, which kick us into active mode and power the fight-or-flight response.
Many of our emotional response patterns become established in those brain areas in our very early years, including our reactions to conflict and emotional pain. They determine whether we calmly and resiliently experience various emotions, or whether emotions like anger, sadness, or shame push us into a frightened state of alarm, anxiety, and panic: over-activation of the SNS.
Conversely, if we have established passive emotional patterns when we are afraid, then experiencing those emotions might cause us to shut down and withdraw, going into a collapsed state of lethargy, numbness, and depression. Usually, the parasympathetic nervous system (PNS) should come into play when we are in safety, allowing us to calm down again. But there is also an aspect of our fear systems that switches us into a freeze or flop mode, particularly when we perceive we are helpless. This system is designed to protect us, but being stuck in it for a prolonged period can be considered an over-activation of the PNS.
These kind of dysregulated patterns could have been set through deficits of attachment and bonding, or traumatic experiences. If we conceptualize trauma in terms of a break in the regulation of the nervous system’s response to threat, then we could talk of it becoming effectively stuck “on” or “off”. Our bodies are built to be continually shifting between the SNS and PNS systems, which don’t only regulate the fear response, but also all of our basic organ functions: the activity levels of the digestive and immune systems, heart and breathing rate, blood vessel constriction and muscle tension. This is why psychological imbalances are so often connected with physical symptoms.
Crucially, the patterns in those unconscious areas feed into our conscious, thinking brain, and inform our rational thought. Although there are excellent strategies for “top-down” regulation of emotion, sometimes we can’t shift those body-mind states. If our body-systems are effectively programmed to slip quickly into a fear response, then we will keep coming back to anxious or shut-down feelings, and think in ways that are colored by those feelings.
Re-programming the nervous system
This is why it is often useful to supplement therapy with some kind of somatic approach, working with body sensations to effectively re-program the nervous system. In body-oriented approaches, you learn to notice how you experience emotions in your body, and how they are connected with thoughts or beliefs about yourself and the world. Most importantly, you learn how to move with and through various sensations and emotions. This effectively teaches your nervous system to regulate itself differently, without getting stuck in over-activated (anxious, hyper-vigilant) or under-active (depressed, frozen) states.
In terms of neuroscience, this means stopping the limbic system from dominating our responses, which brings our social engagement systems in the pre-frontal cortex (PFC ) back on board. The pre-frontal cortex integrates many inputs about ourselves with inputs about others’ feelings, via mirror neurons, which are part of what creates the sense that someone else “gets” us. It also regulates the amygdala’s fear systems, by integrating bottom-up processing of emotions and body sensations with the top-down processing of conscious reflection. Turning down the fear response and feeling a sense of social safety are mutually reinforcing systems centered on the PFC. That’s why a felt sense of empathetic understanding is so crucial to therapeutic sessions of all kinds. Re-activating the PFC increases resilience, allowing us to feel, recognize, and contain our emotions, without the amygdala revving up or shutting down the system.
Developing a vocabulary
So what does this re-programming actually look like? Well, it involves a lot of talking and paying attention to your body! Some bodywork practices also use touch to guide attention. I begin by talking with my clients about what bothers them, and as we talk, although I’m listening to my client’s words, I’m also watching a lot of other messages coming from them. I’m listening to what their body is saying: the way they hold themselves, the places that seem tense or stuck or absent. I’m watching the way they become animated or worked up, or shrink into the chair, for example, or the way all the energy seems to drain away to the floor. In order to read these signs, I need to be relaxed myself, as if I’m sitting back and allowing their state of being to wash over me.
At various points in our conversation, I slow down the flow by asking my client to describe what they are sensing, perhaps after reaching a particular insight, or when I see them reacting physically. This might include them noticing an emotion that they normally try to move past, but I also guide them to tune into their bodies and notice whatever sensations are present on a physical level.
It is crucial that they describe this in their own words or images, to develop this sensibility; they are learning to describe the state of their nervous system! We are generally quite poorly tuned to our bodies, lacking both attention and vocabulary. We typically tend to try to block out the sensations, or pay attention in a more cerebral way, focusing on explanations, judgments, and analyses of what we can sense. As my clients narrate their sensations, I follow their own descriptions, and use my communication to explore and work with their experience. And that’s where the magic lies.
Tuning in to discomfort
Often what people find at first are not especially pleasant experiences. Especially if you’ve been quite disconnected from your body, getting back into it usually comes with uncomfortable sensations or emotions. Shifting attention toward the inside, my clients might notice that their shoulders feel rigid and are reaching up to their ears, their chest feels narrow and tight, their breathing is shallow, and their heart is beating quicker. This is a classic anxious/SNS feeling, but it also sometimes coexists with more passive PNS feelings, even in the same area, such as the feeling of an empty void in the chest, a black hole pulling everything in, sucking all their energy out.
It tends to be easier to notice sensations in our chests, shoulders, and necks, but when we tune in further, there are often strange things lurking in our bellies: they are often very tense, or we feel flutters, nausea, or pain there, or the feeling of it being like a heavy block of concrete. Other people experience a total absence of feeling in the belly, as if it’s a gap, or not part of them at all. There can often be a sense of trying to pull away from or block out those uncomfortable belly feelings, and tuning into them can feel like risking that those feelings would rush up and overwhelm us, or strangle us at the throat. Again, not so pleasant!
As well as noticing specific areas, I encourage my clients to find words or images to describe their state of being more generally. On the more agitated side of things, someone might feel alert and ready to spring, but at the same time held in place, rigid. Someone else might feel like they’re fighting to keep their head above water, but with a knotty feeling of fear below. Or perhaps there’s a surging restless energy or aggression in the arms and legs, but with a sense of not knowing what to do with it and so feeling paralyzed, as if something might happen at any moment and you need to be prepared to defend.
You can see that common to all of these is some kind of variation of feeling activated and yet stuck. As a sensation, this feels very much like being helpless, and indeed a sense of powerlessness is often at the core of what is so disturbing about a sensation, and why those emotional patterns became lodged in the first place. More on the PNS side of things, there can often be a sense of needing to hide or disappear, or others feel small and barely attached to the ground, like being too light. Others feel totally disconnected from their body, or as if they’ve become like stone: a numb, solid wall that seems to have shut down all feeling within the skin. None of these sensations are particularly enjoyable, and to top it off, they usually feel extremely isolating.
Sensations gone awry
Focusing in on these sensations can make people feel uncomfortable and frustrated, and can bring a sense of shame or self-judgment: why is my body doing this to me?! Stronger still, focusing on them can make us panicked and overwhelmed, feeling either unconsciously or consciously somehow in danger. We’re back to the amygdala, and slipping into anxious hyper-arousal, or dissociation/shut-down. Neither of these is going to help us change, and they can even be re-traumatizing.
This is where practicing mindfulness meditation on your own can lead some people down a difficult path. There, the idea would be to practice non-judgmental observation of those sensations. Although this can result in the feelings changing and easing, if it triggers our unconscious into its fear response, perhaps because of unprocessed trauma, then many people don’t have the tools to navigate this territory alone. The role of a body-oriented therapist is to guide someone through this tricky terrain.
In this journey, what I want is to dip very lightly into the stress/fear responses that are linked to my client’s emotional patterns and belief structures, and then to come back out again. And then to repeat this process many times in various ways. In order to manage this process, I first need to find ways to access my client’s own resources: their ability to regulate their nervous systems and come back from the difficult sensations. A good starting point can be to find places in the body where the sensations feel somehow positive or useful, and to focus in on those.
One way of going about this is to use touch. Being touched in a particular place – perhaps gently on your belly, or firmly and precisely on that little dense, tense area right at the top of your neck – can allow you to relax and be calm, or it can feel like the body becomes reanimated and energized. A good sign is when it feels like a relief or a release. It is important, though, that the aim of my touch and words together is to guide attention, rather than to fix something. This is more in line with approaches like the Grinberg Method than, say, massage. I have heard many wonderful descriptions for the positive experiences that ensue, like water flowing from the head down, or becoming glowing and vivid, floating peacefully, being solid and weightless at the same time, or feeling as if the whole body is connected in one piece again, or feeling like a lighthouse standing tall and shining.
We can also find these resources with just words and my client’s attention, which can even be more powerful than using touch, since there is a stronger sense that the client got there on their own. Perhaps I’ll ask them to search for the place in their body that is the least tense (or weak, or whatever the difficult sensation was), and to explore that sensation. Or I might ask them to pay attention to parts of their body that are in contact with the ground or chair, which can give a sense of containment, solidity, suggesting that there is enough body area for the difficult sensations. Communicating with my client, I can help them follow and strengthen any changes this brings in their emotional or physical experience. This is not to ignore the difficult sensation, but to turn up the volume of other experiences.
In a session with one of my clients, she was feeling strongly absent and disconnected from her entire body, with a vague sense that there were uncomfortable feelings in her belly that she didn’t want to go into. We had been talking about an upcoming operation that was triggering a lot of anxiety; just thinking of the operation brought intense nausea in her stomach, and then disconnection. She immediately mentioned that she feels this every time she’s sick, ever since a few years before, when she had passed out when she was sick. This memory seemed so integral to her current experience, that I stayed with it long enough to find out what had been so frightening there. Back then, she had been taken to hospital, and remembered feeling powerless and weak.
Bringing us back to her body in the present moment, I wondered if there was anywhere in her body that felt a little less disconnected, a little more accessible, and she realized that her face and hands did. They felt more in control. I asked her to focus there, suggesting that she even bring her hands to her face so that they were together. She put them over her cheeks and eyes, and gradually they both started to feel more full, energized and warm, which felt calming. After a while, I asked her to put her hands wherever else it might feel good. She placed them on her belly. Slowly, the warmth of her own hands seemed to calm the feeling there, and she began to feel more attached to her body again. And what did she find there? Joy! I gave her time to explore this somewhat unfamiliar experience, and both of us found ourselves chuckling as I encouraged her to put words to that body sensation, which centered on feeling light and physically able to act: the opposite of powerless!
In a third approach to resources, we could capitalize on some of our complicated brains’ other systems: movement and vision. Bizarrely enough, imagining movements or images can change our physical sensations. Mentally preparing for a movement is neurologically similar to actually doing the movement, and imagining movements or images that contrast with the ones currently lodged in our systems can start to change the patterns of neurons that fire together, which changes how they wire together. In one of my own sessions, I found that a way out of my alarm state was the image of being a huge whale! To me, the feeling of being enormous, slow moving, and unconcerned by the little things I encounter lets my body relax out of a tense, anxious state.
This kind of approach works better the more it comes from the client; I try to give suggestions that fit them in this moment, rather than a formula, and then to follow them in a quite open-ended fashion. For instance, I might ask my client to imagine the exact opposite of the difficult sensation, and then follow their descriptions, echoing back to them what I hear, and encouraging them to go with it as it changes. Continuing the session with the client facing the operation, her sense of joy also felt a bit like floating in water. Describing it as such helped her relax further, which was excellent, but I wanted to find a way to help her feel more active: to more easily access her SNS after being so disconnected. Somehow I found myself suggesting to her that she imagine swimming in that water. I invited her to make mini-micro movements, but basically just to imagine it.
Happily, this brought a sense of powerful joy and freedom in her entire body. She talked about having loved swimming in her youth. Not only had we journeyed out of a disconnected fear-state into a relaxed sense of power, but we had also broadened her self-image beyond that powerless moment to a time of feeling free. Giving her time to experience this, I brought us briefly back to paying attention to her belly, to thinking about the operation, and then back to the swimming sensations. And the operation became something matter of fact rather than disturbing.
With another client, we had encountered a strong sense of aggression, which he described as like being ready to fight. We had been talking about moments when he felt insecure and very focused on what other people were thinking about him, convinced they thought he was stupid and didn’t deserve to be there. He knows where this comes from in his past, which we sometimes focus on, but at this point I guided us to stay centered on his body. He felt extremely rigid and tense, especially across his arms and shoulders. It felt like being dried out, with a hard plate across his chest, like being a robot with no feelings. When I asked him to think of an image that would feel like the opposite of this rigidity for him, he replied straight away: water. (Not all sessions involve water!)
I asked him to picture water while still paying attention to his body, and to tell me more specific things about it, to make the image clearer. Was it the ocean, a stream? We followed this imagery, and gradually his entire state of being changed. He felt waves of energy running down from his head to his feet, and his whole body felt more vivid and alive, calm but still powerful. He described feeling much taller and wider, and more like himself: “this is how it should be”. When we talked again about the situations he’d been insecure in, they seemed almost trivial.
Gaining trust in your body
All of these strategies can feel calming, bringing the alarm systems down a notch. When we are not in perceived threat, then our sense of physical energy can shift to excitement or curiosity rather than fear, and we feel more in control and capable. Your body becomes something you could use, rather than a place you are stuck in or that you need to escape from. The breathing pattern changes to a deeper, fuller one (indicating PNS relaxation), and I will guide my client to explore that sensation too, as a way of making it more accessible in future.
Returning to the difficult sensations that we first accessed, it can then feel as if a positive sensation surrounds or holds the difficult one, helping it to subside. In terms of neuroscience, this shift is regulated through oxytocin, the “happy hormone” that is released through warmth, touch, movement, and the feeling of being loved and safe. Oxytocin reduces the level of cortisol, the hormone activated by the fear/stress systems. It also re-activates our social engagement systems and pre-frontal cortex, creating feelings of connection and belonging, and the pre-frontal cortex can quell the fear response. We can then contain the emotions we feel, resiliently letting them roll through us without being overwhelmed by them.
As shown in recent pain research, our brains do a great deal of interpreting of the signals our bodies send them, deciding how important something is, and then actually determining how sensitive the nerves should be! Collating many information sources about the context of our sensations, our brains decide whether to downgrade the signal, or to do what brains are great at: worry about a problem and anxiously focus on it, and amplify the messages from below. The outcome is that things hurt more when we’re stressed or sad, and the increase in pain will make us more stressed and sad, leading us down a vicious spiral. Conversely, we experience lower levels of pain when we feel safe.
Through strengthening the client’s ability to shift from “negative” to “positive” states, we are building their body attention and their trust in themselves. It’s useful to repeat that movement back and forth, which Peter Levine, who created Somatic Experiencing, calls “pendulation”. This gives the client the physical experience of the body regulating itself by moving between activation/SNS and relaxation/PNS, rather than getting stuck in over-agitation or numbed-out withdrawal, or a disturbing blend of the two. Importantly, I then connect this with my client to their thoughts and beliefs about themselves and the situations they are in. They start to arrive at new conclusions, which also feel right.
Completing old body stories
Gaining more of a sense of trust and ability to regulate ourselves, we can dip our toes a little deeper into the emotional patterns that we are caught in, and explore further the uncomfortable sensations and emotions that come up when we tune in to the body. Since these patterns tend to be linked to experiences in the past, I do sometimes address that directly with my clients, but I still want to follow their body now as much as possible. Physical sensations are a way to stay rooted in the present moment, and they also reveal stories of their own. In a sense, I’m looking for memories that are locked in the body. I want to do this in small steps though, without risking flooding or dissociation. This is the principle that Levine calls “titration”: mixing two fluids drop by drop makes a gentle fizzle out of what could have been a violent explosion.
With one client, we had been focusing on her nervousness about upcoming work projects, working with the fluttery, upwards-moving excitement that came with that. As we talked more, we found that she was particularly nervous about working with new and potentially difficult people: something she’d encountered many times before. Checking in with her body, she noticed herself becoming shy and inward, as if disappearing and losing power. Her chest was closing in, and her belly was tense. In order to find way to re-access her power and connect it to present situations, I tried to make our conversation gradually more specific. I asked what “difficult” meant for her, and she described having felt unable to hold her own boundaries in the past. Again, I searched for something more concrete, and so she began telling a story about a choreographer – she was a dancer –, who had physically forced her body into a particular position, twice, in which she had both felt and heard a ripping sound in her left hip. Although churning inside with a mixture of anger, fear and shame, in front of the other dancers, she had still held the position. As she talked, her body visibly twisted into an awkward position, all pulled together on her left side, and she described a burning sensation at her hip.
Since we had already done good work with resources, I asked her to stay for a few moments in this position and really pay attention to how it felt in her body. I made sure to tell her that I knew it didn’t feel good, and that I could see she felt stuck; I wanted to make sure she knew I was with her, and not replicating the choreographer. After a few seconds, I asked her to notice something else: that in this moment, she does not have to stay in this position. I invited her to try to sense how her tightened left hip and shoulder want to move right now, and to try to follow that impulse, and move very slowly, paying attention all the time to how those places felt. Moving a little hesitantly, she gradually uncurled. I then gently directed her to slowly go back into the stuck position, and come out again, two more times. The third time it was noticeably difficult to even find the stuck place.
Afterwards, she felt her legs planted very firmly on the ground, her belly relaxed and open. She looked radiant, and described a sense of a kinetic energy moving through her legs and from there up through her whole body. She also related the relief she’d felt in the simple moment of me pointing out she was now was free to move, and that it became progressively easier and more fluid each time to move out of the position.
We can think of this body journey as completing something that had been stuck. The movements her body would instinctively have made in that moment (“get me out of this!”) had been stopped short, combined with a strong charge of fear and powerlessness. The memory of that moment remained a kind of broken fragment that could jerk her system into the position and emotions of that day. Revisiting that position with a lot of body attention enabled her to change the way her unconscious fear and memory systems store that moment, and to change the way they communicate with her muscles. The waves of kinetic energy that she felt through her body are part of this completion process. Sometimes referred to as neurogenic tremors, they are what methods like the Tension/Trauma Releasing Exercises (TRE) deliberately try to stimulate. As well as tremors, clients often encounter waves of heat, cold, or tingling as the SNS/PNS systems change their levels of activation.
Bringing her back to the topic of the upcoming work projects, I asked her to include that kinetic energy in her attention as she thought of them. She felt a physical sense of wanting to run forwards in happy, curious excitement, so I encouraged to her imagine doing this for a few minutes. Since she’s often experienced restless legs at night, when she wants to rest, this was a wonderful way to include her legs in the experience of feeling energetic when she actually wants to be active. What began as nervousness had changed into excitement. I am sure there will be other moments to explore connected to that nervousness, but this was more than enough for one session.
Following the body
In contrast to using a verbal story as the starting point, the body often provides its own narrative. When we tune into our bodies, we might uncover a sense of being stuck in a position that is a bit like a movement frozen in place. This could be from a one-off event, but it could also be an accumulation over many years. If we try to follow the body’s impulse to move or unblock itself, sometimes memories suddenly appear or emotions well up, seemingly out of nowhere. The physical state is linked not only to memories, but also to a person’s conclusions about themselves and the world from such times.
In a session with yet another client, the kind of tension they felt in their upper body felt distinctly like the alert state in which they used to monitor their father’s mood. This ready/alert state is familiar to many people who grew up in homes where there was a lot of unpredictability – a parent who would suddenly become angry, an alcoholic parent, or one who had little attention for them and they were attentively waiting for a moment to try to get it. The sense of anxious physical tension is all bound up with the beliefs rooted in those experiences: I am not worthy of attention/love; the world is an unstable, unsafe place. Working in parallel with these different levels can be a powerful way to reconfigure those beliefs.
Shifting back to the neuroscience level, alternating between negative memories and the felt sense in the body, and positive memories, means the brain is literally changing; the negative and positive memory circuitry start to become more connected. When we unlock memories from their more unprocessed/unconscious states we are again activating the prefrontal cortex. In addition to the functions mentioned above, the prefrontal cortex is also where our brains create a sense of self-identity out of our memories and the different parts of ourselves.
Of course, our brains are so wonderfully complicated that the current state of neuroscientific research has undoubtedly only scratched the surface of how working with the body can help people heal from traumas, and shift how they respond to the world and their own emotions. Nevertheless, I hope this article has given a window into both what is happening on a neuroscientific level, and what a body-oriented approach can actually look like on a practical level.