“Change begins when we learn to ‘own’ our emotional brains.”
—Bessel van der Kolk, MD
Trauma, in greater and lesser forms, is one of the most challenging aspects of the human experience. It could be a once-in-a-lifetime tragedy, like experiencing a devastating earthquake. Or, it could be the gradual accumulation of negative emotional experiences, such as enduring a decade in a hostile work environment.
According to clinical social worker J. Kellie Evans, LCSW, CSOTP, “A traumatic event can involve interpersonal events such as physical, emotional, or sexual abuse; war; community violence; neglect; maltreatment; loss of a caregiver/loved one; natural disasters; terrorism; witnessing violence or experiencing trauma vicariously; it can also result from chronic adversity; chronic, severe, or life-threatening injuries; illness; and accidents. Trauma interferes with one’s ability to cope.”
Trauma—whether it belongs to us alone, a loved one, our family line, or even the global community—touches all people. Luckily, significant advances have been made in trauma treatment, and several sophisticated therapeutic modalities such as eye movement desensitization and reprocessing (EMDR) and sensorimotor psychotherapy have been developed to address it directly. Many of these advances have resulted from research on the neurobiology of trauma—that is, how trauma affects the nervous system, and what is needed in order to adequately recover.
In this article, I’ll give a brief overview of what exactly trauma is, including the different types of trauma, and how it affects the mind, body, and behavior. Then, I’ll take a closer look at one of the most promising developments in neurobiology that is having a powerful effect on the way that therapists work with trauma. This development can also extend to life outside the therapy room, as I’ll show how it can be applied to everyday life to create a deeper sense of safety and contentment.
Types of Trauma
There are two primary types of trauma. The first is relational trauma, such as that caused by feeling emotionally neglected by a caregiver early in life (or the hostile work environment example from above). The second type is shock trauma, such as that caused by being in a car accident (or the earthquake example from above). According to Canadian colleague Swarn Hardy, RCC, a psychotherapist, teacher, and certified Somatic Transformation practitioner, past exposure to one type of trauma can have a direct impact on our resilience in coping with another type. This is why people can have very different responses to similar events. Complex trauma is a term used to describe the layering of both relational and shock trauma.
How Trauma Affects the Mind, Body, and Behavior
The five survival responses
When we experience trauma, our nervous system kicks into high gear and activates specific responses to preserve our survival. Comprised of the brain, spinal cord, and nerves, the nervous system is the body’s “mission control” center for taking in information from the external world and coordinating responses to it, such as fight, flight, attach, submit, or freeze. According to British psychotherapist and sexual trauma specialist Zoe Lodrick, the amygdala in the brain decides which response is most likely to ensure survival.
“Fight or flight” is probably the best-known response—think of being startled by the cat knocking over a vase in the middle of the night and feeling your heart pound. That’s your nervous system preparing you to either fight off a possible intruder or to flee the scene. The freeze response is easily observed in nature—when certain animals such as opossums and snakes are provoked, their nervous systems take over and cause a protective shutdown reaction, which gives the appearance of being dead, thus making them less appealing to predators. This response also occurs in humans in varying degrees of severity. If you’ve ever felt nervous and developed shallow breath and a rigid body, this is an example of the freeze response.
The attach response is lesser known, but it is very prevalent. We are wired to prioritize attachment, as it is interpreted by the brain as a route to safety. An example of this is someone who is in a physically abusive relationship who continues to return to the abuser, and even seeks comfort from that person after an episode of abuse. According to Ms. Lodrick, “When confronted with a significant threat from someone depended upon, most people respond in a way that best ensures continued attachment to that person.”
The submit response, also known as the “flop” response, occurs when all of the other responses have failed. When this response is activated, people become passive, compliant, and submissive in the face of a threat. An example of this is someone who has been brainwashed into submission by a dangerous cult.
The role of the nervous system
Specifically, a part of the autonomic nervous system (or ANS) called the sympathetic nervous system is responsible for activating the “fight or flight” response when we are under duress or feel we are in danger. Conversely, when we do not perceive danger and feel safe, another part of the ANS called the parasympathetic nervous system is in control, as it promotes responses that engender relaxation and the stimulation of digestion (i.e., “rest and digest”).
The relationship between the sympathetic and parasympathetic nervous systems is of specific interest in the study of how we experience and recover from trauma. Originally, it was thought that these two systems had an inverse, reciprocal relationship—more activation in the sympathetic signals less calming in the parasympathetic, and more calming in the parasympathetic signals less activation in the sympathetic. However, in 1994, behavioral neuroscientist Stephen Porges, Ph.D., expanded the original understanding of the sympathetic and parasympathetic nervous systems and pioneered the discovery of a third nervous system response, governed by what he called the social engagement system (SES). Instead of working reciprocally, it is thought that these three systems work hierarchically, with the SES being used first, as it is the most recent system to biologically evolve in humans.
The Social Engagement System
The SES response is activated when we feel safe in our environment, helping us to feel soothed and connected to other people. This system also activates the parasympathetic nervous system response, bringing on feelings of peace and contentment. Further, the SES helps us to be more flexible in how we cope with trauma, and it also helps us to maneuver our way through relationships, according to clinical counselor and dance therapist Dee Wagner, LPCC.
“The aim of trauma therapy informed by Dr. Porges’ research is to help restore a client’s instinct to reach out to others when they need help, rather than trying to manage dysregulation (or difficulty regulating emotions) on one’s own by relying on behaviors such as withdrawal, aggression, dissociation, or substance abuse,” says Ms. Hardy. “And the way that therapists do that is to create a lot of attuned, resonant responses to the client. The embodied empathy of the therapist co-regulates the client’s nervous system, and the client eventually learns to self-regulate. So the initial impulse to manage oneself in a way that’s ultimately harmful, such as binge drinking, becomes replaced by more optimal ways.” In other words, trauma therapy makes use of the SES and parasympathetic nervous system responses to help people to feel calmer, less alone, more resourced with tools and options for coping, and more empowered to reach out for help when necessary.
In addition to developing the concept of the SES, what was also groundbreaking about Dr. Porges’ work was that he identified a physiological component of the SES. Dr. Porges homed in on the tenth cranial nerve (out of a total of 12), better known as the vagus nerve, which has already been known to be key in initiating the parasympathetic nervous system response. The longest cranial nerve, the vagus starts in the brainstem and extends nerve fibers to the visceral organs. Dr. Porges identified the relationship between the three distinct branches of the vagus nerve, hence the term polyvagal theory.
The ventral vagal branch is the “star” branch in psychotherapy, as it is responsible for the SES. This branch extends to the face, pharynx, larynx, heart, lungs, and stomach. When the sympathetic nervous system and ventral vagal branch are both active, this results in a response of playfulness, notes Ms. Hardy.
The dorsal vagal branch travels down to the intestines (and also connects to the lungs and heart). It is responsible for two effects—on one hand, it assists the nervous system with gracefully moving between stimulation and relaxation, helping to restore balance. On the other hand, when the sympathetic nervous system is in overdrive, it can cause the dorsal vagal branch to instigate the freeze response, which, in severe cases, can render us immobile.
Dr. Porges first noticed this effect when he studied the incidence of mortality in premature infants. He concluded that their combined sympathetic nervous system and dorsal vagal activation put them in a physiological state of preparation for death, according to Ms. Hardy. The dorsal vagal shutdown response is also associated with shame and sensitivity to rejection. Last but not least, the caudal vagal branch travels to the genitals.
Polyvagal Theory in Action
How does this sophisticated model of the vagus nerve and its relationship to the nervous system inform the work that therapists do with clients, especially when it comes to helping them to recover from trauma? “I use polyvagal theory in many different ways with clients,” says Ms. Hardy. “I’ll explain it in simple terms so that clients have a sense of their nervous system, as well as their different responses. It’s also important to help clients to be in a ventral vagal—or calm and regulated—state as much as possible in therapy, especially before exploring traumatic experiences from the client’s life. I also learned from my teacher, Sharon Stanley, how to combine polyvagal theory with interpersonal neurobiology, attachment theory, affect regulation, and embodiment in my work.”
This idea of prioritizing regulation and calm in therapy is quite different from modalities from a few decades ago such as primal scream therapy (now known as “primal therapy”), which emphasized having the client enact repressed rage and frustration through screaming and other behaviors. According to Ms. Hardy, techniques such as this “may actually reinforce maladaptive circuits in the nervous system.”
“In my Somatic Transformation training, we learned how to ‘oscillate’ in therapy—spending a small time on the traumatic material and a much larger amount of time helping the client to feel calm, regulated, and resourced,” explains Ms. Hardy. “One of the goals in therapy informed by polyvagal theory is to uncouple dorsal vagal activation from sympathetic nervous system activation [which together cause the freeze response] in the container of a safe therapeutic relationship. In other words, the warmth of connection helps someone to unfreeze.”
One of the ways that therapists facilitate this “unfreezing process” is to help clients to slow down their narratives in therapy. Ms. Hardy states: “Much of conventional therapy stays only in the left hemisphere of the brain. However, trauma is a right-hemisphere injury—often, the traumatic experience didn’t have a chance to fully process through both hemispheres of the brain. Slowing down helps the client to stay in the right hemisphere and complete the processing of the event.”
It’s not only important for clients to become more aware of their shifting responses (or “neural states”) and to learn to regulate—this is also essential for therapists, in order to take care of themselves and to continue to provide quality therapy. “Anybody who works with people would benefit greatly from learning the essentials of polyvagal theory and its applications—such as educators and all healthcare practitioners. I don’t know why this hasn’t been integrated more into training for people working with students, clients, and patients. Trauma is a very vulnerable thing, and it can be retraumatizing to seek help for it or to be in a situation with someone in a position of influence who isn’t trauma informed,” says Ms. Hardy, who also offers polyvagal theory trainings to registered massage therapists with her teaching partner, massage therapist and therapeutic yoga teacher Lindsay Campa, RMT.
“The process of dissociation is an elegant mechanism built into the human psychological system as a form of escape from (sometimes literally) going crazy. The problem with checking out so thoroughly is that it can leave us feeling dead inside, with little or no ability to feel our feelings in our bodies. The process of repair demands a reassociation with the body, a commitment to dive into the body and feel today what we couldn’t feel yesterday because it was too dangerous.”
—Alexandra Katehakis, MFT
Trauma-informed Approaches Slow to Take Root Outside Psychology World
We are living in a very complex time where trauma of all kinds, including local and global acts of violence, is prevalent. We also have a growing body of knowledge and clinical evidence on the best ways to address and treat trauma. However, this is not without controversy. For example, in the academic world, there is an ongoing heated debate about whether trigger warnings (a heads up that specific materials reviewed for the class will contain potentially retraumatizing, or “triggering,” content) are appropriate for students—or if they create problems of overly censoring teachers and overprotecting students.
When asked about why trauma training isn’t more widespread for educators and healthcare practitioners, and why there is such a high degree of controversy with trigger warnings, Ms. Hardy states: “I think part of this ambivalence and controversy is the unconscious unwillingness to face our own suffering and privilege. To understand trauma, we have to understand our own trauma. We haven’t prioritized safe, human connection in our society, and therefore, practically everyone has relational trauma. Instead, we have prioritized money and power. Because of all this, my work in trauma has become increasingly political. I’m looking at both individual and collective suffering, and the ways that society helps or hinders trauma recovery and the creation of safety.”
How to Integrate Polyvagal Theory Into Everyday Life
How might awareness of polyvagal theory and nervous system responses help in everyday life, whether you want to feel better all around, or if you’re dealing with stress or trauma? Ms. Hardy recommends the following steps:
- Since trauma can take people out of their bodies, find ways to safely return to the body. One way to do this is to get curious about sensations of joy, which can bring us back into the body
- Other ways to get back into the body include grounding practices, such as yoga, meditation, and feeling the sensation of gravity on the body
- Orienting (doing a slow gaze around the room to orient yourself to your surroundings) activates the ventral vagal system and can help bring a sense of calm
- In general, directing attention to whatever brings you vitality, whether it’s dancing or photographing flowers, can be tremendously healing
About This Contributor: Chiara Viscomi, MA, LMFT (MFC #104851) is a practicing licensed marriage and family therapist in California. She received her master’s in counseling psychology with a certificate in creative expression at Sofia University (formerly known as the Institute of Transpersonal Psychology). Prior to that, Chiara received a BA in psychology and a BFA in drama at the Experimental Theatre Wing at New York University’s Tisch School of the Arts. She is passionate about expressive arts therapy, Jungian psychology, transpersonal psychology, and integrative approaches to wellness. In addition to her clinical work, Chiara is a longtime professional writer and editor in the healthcare field, as well as a musician and performing artist.
To find out more about her approach to psychotherapy, visit www.lapishealingarts.com. [Bio updated June 2018.]