How Does Somatic Experiencing Therapy Work?

Somatic experiencing therapy is a type of alternative therapy geared towards helping people find healing from trauma. Created by Peter Levine, PhD, this therapy works on the principle that trauma gets trapped in the body, leading to some of the symptoms people with PTSD or people who have experienced trauma might experience. Through this method, practitioners work on releasing this stress from the body.

Many people who have experienced trauma, especially those who have experienced physical trauma such as domestic violence or sexual assault, can dissociate or disconnect from their bodies. Somatic experiencing helps them increase awareness of their internal experience (interoceptive, proprioceptive, and kinesthetic sensations).

Techniques in Somatic Experiencing Therapy

Somatic experiencing practitioners use a framework known as SIBAM (Sensation, Imagery, Behavior, Affect, and Meaning) to help clients incorporate their bodies in processing trauma.

Typically, most therapy uses our cognitive skills to access our memories or traumas via "top-down" methods. However, somatic experiencing uses a "bottom-up" approach, which starts with bodily sensations before returning to our thoughts.

Sensation

You may not be used to sitting with the sensations that are constantly coursing through your body, or you may not have previously realized how they were linked with your emotions. You will begin with simply noting what you are feeling in your body.

Imagery

This part of the framework uses guided imagery (where the practitioner leads you through imagining a scene while you listen) or interactive guided imagery. The latter is an ongoing conversation between you and the practitioner where you share what’s coming up as you are being led through this exercise.  

Behavior

While much of this therapy consists of you reporting your internal experiences, the behavior part of Levine's model involves the therapist observing your behavioral responses, such as your body language or posture.

Affect

This is how you display your emotions to the outside world, such as through your word choices, tone, and speed.

Meaning

Finally, this part of the model looks at how you perceive the therapy and what your experiences mean to you.

What Somatic Experiencing Therapy Can Help With

Somatic experiencing therapy may be helpful with aspects of:

• Trauma
• Anxiety
• Grief 
• Substance use disorders
• PTSD
• Chronic pain

Trauma can have debilitating effects on the body. Somatic experiencing therapy can help by relieving the emotions, stress, and pain that have detrimental effects. For example, it can help relieve stress and pain associated with muscle tension.

Benefits of Somatic Experiencing Therapy

The trauma that is held within the body may lead to emotional dysregulation. It is believed that somatic experiencing therapy works by releasing the trauma that becomes "trapped" in the body. One aspect of this dysregulation is the freeze response, our body’s primitive defense against danger. This response would activate if someone were being chased by a tiger.

Unlike the "fight or flight" response that takes place in response to an acute threat, which causes the sympathetic nervous system to increase heart rate, breathing, and focus, the "freeze" response can cause the opposite.

It is said that the body doesn’t know how to distinguish physical trauma from mental trauma. If the danger is life-threatening, like that tiger, you may be able to physically shake off that fear once the tiger is no longer around. With emotional trauma, however, the brain can get stuck believing that you are still in a state of danger.

The freeze response may manifest in both cognitive and physical symptoms such as:

Effectiveness of Somatic Experiencing Therapy 

While not much research has been published on somatic experiencing, one study, a randomized controlled trial, showed that 44% of the participants no longer met the criteria for a diagnosis of PTSD after treatment. 

A 2018 study looked at the effects of somatic experiencing therapy to build resilience in health professionals at risk of vicarious trauma. The results indicated that a three-year somatic experiencing training course significantly improved quality of life and psychological symptoms.

A 2021 scoping literature review found that the current research on somatic experiencing therapy shows promise. However, more research using randomized controlled trials is needed further to assess its effectiveness and use for mental health conditions.

Things to Consider

While somatic experiencing therapy does not involve a complete retelling and processing of your past trauma like some other trauma therapies might, you will be asked to bring up some of these painful memories. Doing so may result in you feeling "activated" or feeling a high level of energetic arousal in your body. This may also be known as feeling triggered.

This may feel uncomfortable, but that is the point. Before reaching this stage, your therapist will work with you on "resourcing," or finding tools that will help you self-soothe when you are feeling emotionally overloaded so that you can handle working with these memories when they come up in therapy.

How to Get Started With Somatic Experiencing Therapy

If you're interested in this type of therapy, below is actionable advice that you can use to begin your search for this kind of care.

How to Find a Therapist

There are many therapists who may call themselves somatic therapists, but somatic experiencing therapy is a particular method, developed by Dr. Peter Levine. His organization offers training in this particular approach. You can find a list of practitioners on their website. 

What to Expect

Be prepared for your practitioner to ask you about your trauma history. Remember, this is your therapy, so you can only answer as much as you feel comfortable with. A good practitioner should recognize and respect that and work with you to feel safe as you disclose more. 

What Does a Session Look Like?

First, the practitioner or therapist will do a pre-interview to learn about your trauma and overall health history and answer any questions about your expectations. They will then ask questions centered around assessing how your body is responding to your trauma and stress.

This is practiced in the safety of your therapy so that you become familiar with these sensations and once learned you will hopefully be able to down-regulate on your own. Because of how our bodies hold and express trauma primitively, your therapist may see small movements that indicate your body moving into flight mode. You will learn to safely ride these somatic experiences out as you begin to heal.