Somatic Experiencing Therapy: Healing the Physical Symptoms of Alcoholism

Somatic experiencing therapy is a specific therapeutic approach for the treatment of trauma. Somatic experiencing therapy is a body-focused therapy that releases the biologically stored traumatic shock in the body that accumulates after a stressful event.1 This approach to healing is indirect and subtle, keeping your nervous system from becoming overwhelmed during the process of healing from painful and traumatic events.2

Where Somatic Experiencing Therapy Is Practiced

Somatic experiencing (SE) therapy is one type of somatic—or body-based—therapy. Providers who offer SE must undergo training to obtain Somatic Experiencing Practitioner (SEP) certification. When seeing a clinician who uses SE to address trauma and closely related health conditions, including addiction, this professional will be a licensed therapist who may also use other therapy techniques.

Clinicians utilize SE in multiple environments, such as:

SE combines the knowledge of physiology, biology, evolutionary psychology, neuroscience, and traditional Indigenous healing practices into a modality of treatment that supports you in managing physical symptoms related to trauma.1

How Trauma Relates to Addiction

Trauma is stress that is significant and enduring enough that it has generated changes in your nervous system.2 Ideally, your nervous system oscillates between a mild to moderate fight-flight state and then back into a calm, relaxed state. You need your nervous system to be activated in fight-or-flight to react appropriately in interactions you have and events you encounter on a daily basis, such as voicing your position in a work meeting and driving defensively. In a regulated fight-flight state, the experience is pleasant or neutral, and you feel productive, creative, and focused.3

The fight-flight state is also necessary when confronted with a threat. For example, fighting or fleeing may save your life and protect your loved ones if attacked. You also experience the biological processes of intense fight-or-flight in response to non-life-threatening threats such as verbal arguments.

However, when your fight or flight response does not resolve the presence of the threat, you may enter a frozen state, in which you experience immobilization.1

When you cannot return to a calm state after being in a fight, flight, or freeze, you begin to experience trauma symptoms.4

Definitions of Trauma

The Diagnostic and Statistical Manual of Mental Disorders (DSM-5) defines trauma as “actual or threatened death, serious injury, or sexual violence.”5 Many behavioral health professionals believe trauma includes less apparent stressors that accumulate over time as well.6 These stressors are less identifiable since no specific event directly led to the sense of being overwhelmed. These traumas include: 7

  • Neglect or engulfment by a caregiver
  • Non-life-threatening injuries
  • Medical procedures
  • Bullying and harassment
  • Psychological abuse, especially when subtle and indirect

How Trauma Contributes to Addiction

When your body continues to have a fight or flight response when a threat is not present, you may experience physical or mental symptoms, such as: 2

  • Restlessness or startling easily
  • Anger or frustration
  • Fear, anxiety, or dread

If the stress intensifies without regulation, your nervous system will go into a state of freeze, also known as depression.2 These symptoms can be associated with certain mental health conditions, such as post-traumatic stress disorder (PTSD).

Substance misuse and other coping behaviors can start as a means to help your system regulate itself.8 A substance, like alcohol, that temporarily alters your brain chemistry can change how you experience trauma-related symptoms.

When you reach a state where you cannot perform daily living tasks without the aid of a substance like alcohol, this is known as dependence. Chronic substance misuse and physical dependence are risk factors for developing addiction.8

Additionally, when you experience a regular flight, flight, or freeze state, the feeling is so uncomfortable that you may experience disconnections from reality called dissociation. Mind-altering substances can trigger or extend dissociation and are sometimes used to induce dissociation when mental health symptoms become overwhelming.9

The paradox is that while an addictive substance or behavior is initially an adaptive response to trauma, the addiction’s side effects and harmful consequences can become a source of traumatic stress itself, and your efforts to seek balance may leave you more dysregulated than before.8

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Somatic Psychotherapy in Addiction Treatment

One of the reasons that awareness of your flight-fight-freeze response is helpful in addiction treatment is that treatment is stressful. In recovery, you may temporarily feel worse before you feel better.9

This is a natural part of healing and may indicate that the healing process has begun. Seeking treatment for addiction involves detoxification and withdrawal, which is a form of physical stress on the body.8 Additionally, treatment consists of a period in which you no longer use the coping mechanism you’ve developed to regulate your symptoms, which is a form of mental and emotional stress. Therefore, stress is often experienced more significantly in early treatment.9 Because of this, you may enter into a state of fight, flight, or freeze, which could manifest as feeling argumentative with treatment professionals (fight), a desire to leave treatment (flight), or dissociation when attempting certain therapies (freeze).

When in a state of stress, you may perceive a situation as dire and catastrophic.10 There is a sense of urgency. When you expect these mind and body states to arise, you recognize that you’re having a natural reaction to treatment and recovery. This awareness can stop you from engaging in-flight behaviors that can affect recovery outcomes, such as leaving treatment prematurely.

Somatic therapies are beneficial in addiction recovery because they gently address the stress involved in early treatment. Additionally, somatic therapists understand that body-based experiences may be a causal factor in your addiction.11

Somatic Experiencing Exercises

Somatic experiencing therapy is practiced one-on-one with a specialist.2 Most treatment centers incorporate SE in combination with group therapies, psychoeducational classes, and other styles of individual treatments such as cognitive-behavioral therapy or motivational interviewing.

While in an SE therapy session, you can expect to engage in several guided exercises. The theory of SE suggests that talking about your traumatic experience might reactivate your trauma in a harmful way; therefore, you won’t dive deeply into the details of your traumatic experience.2 Instead, you will share what happened to you at a high level and your specialist will help you connect these memories to reactions in your body.2 During a session, you will focus on several important steps.

Connecting With Your Body

It is common to disconnect from your body when you have experienced trauma.11 The use of addictive substances or behaviors becomes a method to stay disconnected when your body is experiencing intense physical pain, you feel overwhelming emotions, or you feel unsafe. As you embark on recovery, you begin to re-experience your body as a safe place again. To connect to your body, your therapist may ask you to orient yourself to your senses by asking questions such as:

  1. Share five things you see that are the color blue.
  2. Share four things you hear.
  3. Share three sensations you feel (e.g., the soft couch, the cloth of your scarf, etc.).
  4. Share two things you smell.
  5. Share one thing you taste.

Additionally, you may be guided to engage in gentle body-tapping activities. These exercises are meant to help you identify your physical boundaries and evoke a sense of groundedness.2

Tracking Your Experience

When you have experienced trauma, your mind naturally scans for threats to protect you from harm.3 As a result, your mind might begin to see threats where they do not exist.

While in a somatic experiencing therapy session, your therapist encourages you to think of safe people and pleasant situations, such as people you have felt support from or times you felt most like yourself.

Your therapist guides you to notice your body’s responses to these pleasant thoughts. You will notice how your body expands or contracts related to your thoughts, memories, and environment. This awareness of your body can help you to identify more quickly if you are feeling stressed.2 This awareness enables you to take constructive action to tend to the stress before it becomes so overwhelming that you use an addictive substance or behavior to cope.

Identifying Somatic Triggers

During an SE session, your therapist may ask you to engage in mild physical exercises that mirror or reverse actual physical motions related to how you remember your trauma or react to it when you think about it.

For example, if you instinctively cross your arms protectively when you talk about the experience, your therapist may help you identify which other situations trigger this physical response. Your therapist may also ask you to focus on a body part that does not feel involved in this protective motion to help you feel more safe and grounded so that you are gradually able to unclench your muscles, relax your arms, and sit in an open posture.

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How to Know if Somatic Experience Therapy Is Right for You

If you want to explore if SE therapy is right for you, you can ask yourself the following questions:

  • Do you dissociate when discussing or remembering traumatic memories?
  • Have you experienced benefits in other body-based healing modalities, such as yoga?
  • Do you experience analysis paralysis, in which you aim to solve a problem logically, only to feel as though you haven’t made progress?
  • Do you find that your body is tense more often than it’s relaxed?
  • Have you received a diagnosis of PTSD or a related mental health condition in addition to a co-occurring alcohol use disorder diagnosis?

Somatic therapies are considered to be a bottom-up approach to healing. Cognitive therapies are considered a top-down approach. Evidence supports both styles of therapy.12 However, for a treatment to be effective, you need to feel comfortable with its philosophy. Your care team may help you participate in multiple treatment methods to address trauma and addiction, including other methods to treat trauma like exposure therapies.

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Resources

  1. Somatic Experiencing® International. (2021, June 18). Somatic Experiencing 101.
  2. Levine, P.A. (2005). Healing Trauma, A Pioneering Program for Restoring the Wisdom of Your Body. Sounds True, Inc.
  3. Aschbacher, K., O’Donovan, A., Wolkowitz, O. M., Dhabhar, F. S., Su, Y., & Epel, E. (2013). Good stress, bad stress and oxidative stress: insights from anticipatory cortisol reactivity. Psychoneuroendocrinology, 38(9), 1698–1708.
  4. Sapolsky, R. M., (2004). Why zebras don’t get ulcers: A guide to stress, stress-related diseases, and coping 3rd Holt, Henry, & Company, Inc.
  5. American Psychiatric Association. (2013). Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition. American Psychiatric Association Publishing.
  6. The University of New York, University at Buffalo Social Work. (2013, December 04). EMDR Rapid Healing of small “t” and big “T” trauma.
  7. Mellody, P., Miller, A. W., & Miller, K. (1989). Facing codependence: What it is, Where it Comes From, How it Sabotages our Lives. New York: Harper San Francisco.
  8. Miller, W.R., Forcehimes, A.A., Zweben, A. (2011). Treating Addiction: A Guide for Professionals. The Gilford Press.
  9. Schmelzer, G.L. (2018). Journey Through Trauma, A Trail Guide to the 5-Phase Cycle of Healing Repeated Trauma. Penguin Random House, LLC.
  10. Stahl, B. & Goldstein, E. (2010). A Mindfulness-Based Stress Reduction Workbook. New Harbinger Publications.
  11. Mate, G. (2008). In the realm of hungry ghosts: Close encounters with addiction. Toronto: Knopf Canada.
  12. Taylor, A. G., Goehler, L. E., Galper, D. I., Innes, K. E., & Bourguignon, C. (2010). Top-down and bottom-up mechanisms in mind-body medicine: development of an integrative framework for psychophysiological research. Explore (New York, N.Y.), 6(1), 29–41.

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