Traumatic experiences can mould and shape us in surprising ways as we try to control our bodies, our beliefs, and our environment in order to recreate a sense of safety. Yet, the after-effects of trauma often hide in plain sight. We often do not realise that the behaviours of those around us are shaped by their own trauma histories. For instance, we might interpret our friend Justin’s need to always drive his car as a love for his new vehicle. We do not realise that since his car accident, Justin experiences shortness of breath and a racing heart if he attempts to ride in the passenger seat. Similarly everyone in the office views Carlos as continually tired. What we do not see is that Carlos wakes up every night screaming from nightmares that put him back on the battlefield. In cases such as these, we encounter common, everyday behaviours by friends, family members and acquaintances that we do not recognise as developed responses to manage painful symptoms stemming from prior traumas.
While many people will not develop post-traumatic stress disorder (PTSD) after a traumatic event, for those that do, living with debilitating psychological and physical symptoms can be life altering. For years, there was little hope for individuals who entered therapy to try to alleviate their PTSD symptoms. Many left therapy feeling worse than when they started. The good news is that we now have a number of effective treatment protocols for PTSD that alleviate suffering by utilising integrated body-focused treatment interventions.
This is where embodied cognition enters the picture. I maintain that the effectiveness of these body-based interventions is better understood if we apply an embodied cognition analysis to both the traumatic event itself and the patient-therapist interaction needed to process the event. There are two key questions that emerge. First, how might research in embodied cognition help us to better understand how to treat complex trauma? And, can embodied cognition research help to further isolate the psychological mechanisms and strengthen the theoretical foundations that would explain more fully why these somatic-oriented treatments are so successful in treating PTSD, especially when compared to talk therapy alone?
My hope is that by pointing out these shared connections, embodied cognition theorists can partner with trauma researchers who are working to refine new treatment protocols to treat post-traumatic stress disorder (PTSD). This partnering and joint awareness of one another’s research programmes might lead to swifter progress in both fields so that overall suffering can be diminished. In addition, it is important that trauma survivors are aware of effective treatment options.
In order to see these shared connections more clearly, let’s first consider what is commonly meant by embodied cognition.
Embodied cognition, as I have argued, is a growing research programme in cognitive science that emphasises the formative role the environment plays in the development of cognitive processes. The general theory contends that cognitive processes develop when a tightly coupled system emerges from real-time, goal-directed interactions between organisms and their environment; the nature of these interactions influences the formation and further specifies the nature of the cognitive capacities.
Since the specific ways in which an organism is embodied in its environment directly impact its cognitive processing, its movements and its understanding of the world, all of these factors become central when applying this framework to determine how an individual experiences a traumatic event.
For instance, since an organism’s available sensorimotor capacities partly determine the options that emerge for it to successfully navigate its environment, then not having access to certain capacities (e.g. hands and feet are bound to a chair during a robbery vs free to run) will impact the sensorimotor traces that endure from the event.
Embodied cognition theories are viewed in contrast to cognitivist/classicist theories that advance a rule-based, information-processing view of cognition. Cognitivist/classicist theories employ a computer metaphor of the mind and assume 1) problem solving occurs in terms of inputs and outputs, 2) symbolic, encoded representations facilitate computational solutions, and 3) cognition can be properly understood by attending to an organism’s internal processes, with an emphasis on those involving computation and representation. This would imply that classicist accounts would not view body-based trauma interventions as central since any relevant bodily features could be imported via a representational mapping and processed through talk therapy. On a classicist model of trauma, the importance and perhaps even the existence of the sensorimotor traces (e.g. the smell of coffee) would be viewed as symbolic encoding.
Since classicist/cognitivist accounts focus solely on an organism’s internal cognitive processes, some claim this results in an isolationist flaw since the organism’s environment and its bodily instantiation are viewed as an afterthought when explaining cognitive development. To avoid this isolationist error, embodied cognition theorists favour a relational analysis. This more holistic approach helps to explain why the body-based trauma interventions are more successful. In general, Embodied cognition researchers seek to construct cognitive explanations that capture the complexity of the ways in which mind, body and world mutually influence one another to promote the adaptive success of the organism.
My goal is to take you away from commonly discussed embodied cognition experiments and into the psychotherapist’s office to consider how embodied cognition might provide helpful insights into understanding trauma. Specifically I argue that one reason these trauma protocols are more effective in alleviating symptoms than talk therapy is that they are grounded in the tenets of embodied cognition. Therapeutic interventions such as mindfulness, sensorimotor psychotherapy, and eye movement desensitisation and reprocessing (EMDR) encourage patients to process traumatic events in the here and now by paying close attention to bodily sensations and environmental cues. As the patient is taught to move away from numbing unpleasant sensations and move toward the toleration of these sensorimotor traces, the therapist responds in real time to maintain an appropriate level of hyperarousal so that the patient doesn’t become flooded during the session, but is still experiencing the emotions and sensorimotor traces that require integration. This balancing act forces the therapist to continually attend towhat the patient is reporting while also reflecting back the bodily responses that the patient may not be aware of in that moment.
This back and forth dance between patient and therapist results in a tightly coupled system that provides a safe space for processing the traumatic event. While not all therapeutic interactions create a tightly coupled system, I maintain that the somatic-based interventions I will describe can create interactions that enable the successful processing of the traumatic event. We will explore this therapeutic “dance” in more detail below, but I first will explain why there is such an urgent need for embodied cognition theorists to turn their attention toward trauma research.
Trauma directly or indirectly affects all of us. If we have not experienced a traumatic event ourselves, then typically we know of a friend or family member who has. Examples of acute traumas include car accidents, school shootings, terrorist attacks, gang violence, sexual assault, natural disasters, physical assault, and the sudden loss of a loved one. Acute traumas are defined as one-time events that can result in feelings of extreme emotional and physical stress, terror or helplessness. If a traumatic event is ongoing (e.g. abuse from a caregiver) or if an individual has experienced multiple traumatic events, then chronic trauma can result. Other examples of situations that can result in chronic trauma include domestic violence, war, neglect and ongoing sexual abuse. Some individuals who experience a traumatic event will ultimately develop symptoms that might include an inability to focus, emotional numbing, avoidance of people or places that remind them of the event, reoccurring flashbacks or a feeling of reliving the event, severe anxiety, an exaggerated startle response, dissociation, hypervigilance and difficulty experiencing pleasure engaging in activities they once enjoyed. These symptoms can become debilitating and can lead to the development of Acute Stress Disorder or Post Traumatic Stress Disorder.
According to the Center for Disease Control, “injuries and violence are a major public health issue worldwide and account for nearly 1 out of every 10 deaths every year.” Bessel Van Der Kolk, founder and medical director of the Trauma Center and professor of psychiatry at Boston University School of Medicine, explains in his recently released book, The Body Keeps the Score: Brain, Mind, and Body in the Healing of Trauma, that trauma is experienced in epidemic proportions. He further notes that in the United States, “one in five Americans was sexually molested as a child; one in four was beaten by a parent…; and one in three couples engages in physical violence.”
Van der Kolk argues that there is a great need to connect trauma survivors with treatment protocols that will enable recovery. He claims that treatment protocols that include body-based interventions are more effective in processing traumatic events than talk therapy alone. Even though van der Kolk does not refer directly to the embodied cognition research programme (aside from briefly referencing Antonio Damasio’s work), I will discuss why body-focused trauma interventions, such as EMDR somatic experiencing and mindfulness-based interventions, can be viewed as in-line with the tenets of embodied cognition.
In order to understand how the tenets associated with embodied cognition might be understood in terms of trauma theory, I offer a representative case study. The case study highlights what event-related factors are crucial to understanding why the individual began to manifest symptoms after the event. After assessing the key details in the case, I use the tenets associated with embodied cognition to demonstrate how these body-oriented therapies create a coupled system between patient and therapist that provides a safe space for healing to occur. Let’s turn to the case study.
Mary is fifteen and alone in her home. She hears her older brother’s two friends come in the front door. They are loud and they smell of alcohol. She walks into the hallway and tells them they need to leave because her brother isn’t there. One of her brother’s friends surprises her and pushes her up against the wall. She wants to scream out, but her voice won’t work. It is frozen. Her body won’t respond. She is assaulted by both men. The last thing she hears before passing out is “She must have wanted it; she didn’t even say no.” When Mary wakes up she showers and never tells anyone in her family what happened. When she enters treatment at age 18, Mary has gained a substantial amount of weight, suffers from severe anxiety, and reports that she has no self-esteem. Mary states that she cannot sleep at night and that the smell of alcohol on someone’s breath will take her back to the day of the assault.
When viewing this situation, it is important to acknowledge that no traumatic event occurs in a vacuum and that the specifics of the event will directly impact how treatment should proceed. For instance, the specific environment in which the assault occurred (e.g. her home), her relationship to the perpetrators (e.g. her brother’s friends) as well as Mary’s inaction/immobilisation during the attack all factor into how she attaches meaning to the event today. In session, it becomes apparent that Mary blames herself for not fighting back, for not screaming, and for not having locked the front door. She feels that her body betrayed her and that she could have prevented the assault if her body would have only “let her” fight back. Mary has started drinking alcohol as a way to self soothe and numb her feelings. Even though Mary now has her own apartment, she reports never feeling completely safe within her own home. In addition she finds that it is difficult to trust others, including family members and long-time friends.
When examining the key details of Mary’s case from an embodied cognition perspective, we must pay particular attention to the environment itself, the options it presented, Mary’s thoughts as well as any actions Mary experienced during the trauma. Particular care will be devoted to tracking the exact bodily actions and responses that Mary initiated or encountered during the assault.
One factor to stress to Mary is that she experienced a freeze response during the attack instead of a fight or flight response. Individuals do not consciously choose whether a fight-flight-or freeze response will occur. As is the case with wild animals, this type of response is automatic and not chosen by the victim. Of the three possible responses, survivors often feel guilt when a freeze response occurs and they commonly blame themselves for not fighting back or attempting escape. Yet, in certain cases individuals might decrease their likelihood of surviving the event if a fight or flight response occurred instead.
It is important to note that a freeze response should be viewed as adaptive, since it enabled Mary to survive the attack. Aside from educating Mary on how a traumatic event can result in a fight, flight, or freeze response, the therapist will need to teach Mary a number of healthy coping mechanisms to help her tolerate the feelings and emotions that will surface during the processing of the event. Effective processing cannot occur if the patient does not feel a sense of safety with the therapist or if the patient lacks the tools to tolerate raw emotions that might occur outside of session.
Trauma expert Babette Rothschild uses the example of a soda bottle to explain the care the therapist must take when beginning to process a traumatic event. The traumatic event is parallel to shaking a bottle of soda in that the motion causes severe disruption to the system. If the therapist opens the bottle top quickly, then the contents will explode into the room. Instead, the therapist must make small twists to the cap so that miniscule amounts of carbonation are let out each time. This can be a time-consuming process and one must pay close attention to the carbonation levels inside. Yet, in the end, it is possible to remove the cap safely without a spill. The ultimate goal is to manage the states of hyperarousal so that the patient both feels and can tolerates the difficult emotions and bodily sensations that emerge until a state of homeostasis is achieved.
One of the reasons that processing a traumatic event can be overwhelming is that the event itself is not typically stored in a linear fashion. The patient does not have access to a narrative with a clear beginning, middle and end. Instead, there are often intense, but disjointed sensorimotor memories, such as the intense smell of bleach, the sound of crickets, or the pressure of the car door on one’s hand. Emotions, such as fear and helplessness, can accompany these memory traces and the patient can feel frustrated at their inability to link the traces into a coherent narrative. Some patients report that “time stopped” or “everything happened in slow motion, but I was apart from my body” while the traumatic event occurred. Others note that they know it happened to them, but that it felt like it happened to someone else. As one patient stated “I don’t know who the girl was that it happened to; I was not there when it happened to her… I mean me.” These comments demonstrate that individuals experience an inner struggle in which they often feel divorced from their bodies and from their very sense of self. Van der Kolk states that because individuals can dissociate during a traumatic event, the trauma is not “integrated within the conglomerated, ever-shifting stores of autobiographical memory, in essence creating a dual memory system” in which the sensorimotor traces stemming from the trauma “are stored separately as barely comprehensible fragments.” Van der Kolk notes that for patients with PTSD, the goal is to move from dissociation toward association with a focus upon “integrating the cut off elements of the trauma into the ongoing narrative of life, so that the brain can recognise that ‘that was then and this is now’”.
Embodied cognition helps to further explain why the environment and the bodily movements of the trauma survivor are so central in understanding how and why the survivor still suffers from the event even years after it has occurred.
The trauma has impacted the survivor on multiple sensory levels (e.g., auditory, tactile) and each of these levels must be addressed individually and holistically before the traumatic imprint can be fully released. One might imagine that the traumatic event caused the individual to go “off-line” which resulted in them disconnecting from their body, their narrative and their overall sense of self. Sometimes dissociation is said to occur when it is too much for the survivor to be part of their own body so the perceived separation is viewed as an adaptive mechanism that kept them safe and seemingly elsewhere while the event occurred. Yet now that the event is over and part of the past, the work is for the therapist to unite with the patient in a manner that enables both to re-visit the event in a way that the sensorimotor traces, the emotions, and the cognitive beliefs can be safely integrated into the present narrative. The frozen memory traces must be safely joined with the autobiographical narrative.
In Mary’s case, her system seemingly went “off-line” when her body froze during the assault. Since her body did not feel as if it was her own, the therapeutic work is to reunite her with her body by integrating the memory traces from the assault. Let’s consider interventions that facilitate a reintegration.
Clinical interventions, such as Francine Shapiro’s eye movement desensitisation reprocessing (EMDR), Jon Kabat-Zinn’s mindfulness-based protocols and Peter Levine’s somatic experiencing all employ techniques that utilise an integrated body-focused approach to promote healing. These techniques require patients to develop a dual awareness of attending to the past trauma while tracking sensorimotor sensations in the present. While the techniques differ in the degree to which bodily experiences are prioritised in the process, each technique requires a degree of mindful awareness in order to observe the sensorimotor states that surface.
For instance, Peter Levine maintains that trauma symptoms continue to manifest if the individuals is not able to befriend, rather than suppress, their bodily sensations and ultimately discharge any unresolved actions from the time of the event. His somatic experiencing technique places an emphasis on moment-to-moment sensorimotor experiences that are then carefully tracked before any attention is given to the processing of emotional or cognitive content. To do this, the therapist must actively listen as well as attend to any changes in bodily movements, including posture. The smallest shift in movement, if tracked and labelled by both the patient and therapist, can result in dramatic re-integrations between body and self.
Similarly, EMDRenables the processing of traumatic memories that are not capable of being activated or accessed through talk therapy by the patient. This activation occurs because EMDR uses body-based techniques, including bilateral stimulation involving eye movements, body scans and cognitive interweaves that employ embodied metaphors. This clinical protocol requires the patient to hold the primary negative cognition or self-belief they associate with the event (e.g. I am worthless), their emotions, their bodily responses and any images depicting the event. All of these event-related sensorimotor elements are processed together through a form of bilateral stimulation (e.g. back and forth eye movements, tapping) until the heightened response associated with the event is diminished.
David Grand, EMDR trainer and author of Emotional Healing at Warp Speed: The Power of EMDR, maintains that EMDR employs a “bottom up” approach that is capable of activating body memories traveling through the primitive parts of the brain while talk therapy employs a “top down” approach that processes information through the cortical brain which limits access to the emotional brain, hindbrain and body. Grand maintains that EMDR is more effective than talk therapy because trauma deeply affects these regions of the brain that talk therapy cannot easily access.
EMDR is also a clinical technique that requires patient and therapist to create a tightly coupled system in which the sensorimotor traces can be processed on multiple levels. A unique characteristic of EMDR is that processing the current traumatic event will often involve processing a number of earlier memories that share the same negative cognition or negative self-belief that one holds (e.g. I am unlovable). Often times these seemingly unrelated older memories will surprise the patient, but the clearing of all of the memories that share the same negative cognition or negative self-belief as well as the clearing of any bodily sensations that accompany these memories will release the initial trauma.
Typically individuals do not think of trauma theory or PTSD protocols when they think of embodied cognition. While I have only been able to point to potentially fruitful places where researchers should turn their attention, I maintain that the stakes are too high to not fully explore the ways in which these two research programmes might inform one another in hopes that these collaborations will isolate psychological mechanisms, enrich coupling explanations, and possibly even result in further protocols that will reduce human suffering.