Originally posted March 27, 2018.
Sarah was the witness of an accident where a car struck and instantly killed two pedestrians. She had seen the car hit the girls and had seen the bodies fly and hit the ground. She thought that she had handled the situation as best as she could. She went to a therapist to talk about the incident and she also talked about it with close friends. But, as time went on, Sarah’s emotional and physical state was deteriorating. She felt sick often and was generally experiencing a lack of well-being. Two years later, she was having intrusive thoughts about the scene and was feeling physically nauseated often and also anxious and depressed, and sometimes panicky for no apparent reason.
One of the symptoms that came on gradually yet bothered her alot was that she felt disconnected from her body. She felt like she couldn’t distinguish feeling her emotions from feeling pain in her body. When she got emotionally stressed, her stomach hurt. And the pain was causing her to detach from her body feelings in order to function in normal life. Feelings of being disconnected from your body are one of the common symptoms of post-traumatic stress disorder. These symptoms are listed in the DSM-5 as “depersonalization” and “derealization.” Depersonalization is when you feel outside of what’s happening around your or when you feel outside your body. Derealization is a persistent sense that what is happening around you isn’t real or is dream-like.
All of these feelings, more precisely, lack of feelings, scared Sarah alot. She said that she felt numb and disconnected often. Of course, when Sarah numbed herself from the bad feelings, the good feelings were numbed out as well.
To heal from the trauma, Sarah needed to let down the part of her that was the protector and allow herself to feel the strong emotions and feel her body once again. Her protector part was trying to help out by walling off her scary emotions, but they’d get subverted into body symptoms. And then, she tried to suppress the body symptoms as well. Sarah just wasn’t feeling well on multiple levels.
Sarah had approached the trauma from a mind and verbal level, but it seems that she needed to allow herself to really feel and express the emotions on a deeper somatic level as well.
Skill One: (re) Learning to embrace your body feelings
Sarah was an emotionally balanced, fairly upbeat person before she witnessed the accident. She thought she was managing her feelings about it. She went to a therapist to talk about the incident, she talked about it with some close friends. But she found that she was beginning to be afraid to be alone with her thoughts, When she closed her eyes the images from the incident would intrude on her and replay in her mind, especially at night before she went to sleep. She found she became afraid of going to sleep and began to listen to music with her ear buds in to fall asleep; the music kept out the din of her internal scary thoughts and feelings.
As the nausea and pain in her body worsened, it scared her. She tried to suppress it. She contracted her diaphragm and stomach muscles all the time, as she tried to prevent feeling pain and nausea. The emotions of the trauma and the discomfort in her abdomen became intertwined. She didn’t know where the emotional pain began and where the body pain began, they became one. It was unbearable to have both.
Sarah’s therapist urged her to do some somatic work to complement the talk therapy. She referred her to a craniosacral bodyworker.
In the craniosacral sessions, Sarah slowly and gently allowed herself to feel the pain in her body without judgement. She allowed the imagery of emotion and pain spontaneously arise from the areas of tension in her body. She felt the emotional pain and talked about the trauma as the tension was genial released from her body.
She re-befriended her body.
Over time, Sarah, compassionately thanked her body for holding the pain as she slowly released the tension that she’d been holding in her stomach and diaphragm.
Skill Two: (Re) Developing your inner body map
As Sarah dissociated parts of her body in order to mask the pain, she lost touch with her own body. Current neuroscience attributes the insula, a part of the brain located underneath the neocortex, and considered part of the limbic system, as having a role in a person’s internal body representation and emotional experience. As Bessel van der Kolk describes in his amazing book on trauma and its somatic effects, The Body Keeps the Score, extensive research indicates that the insula shrinks in persons who experience chronic trauma. Sarah had a subjective map of her body that was beginning to ignore the parts she was partitioning off. Another exercise that Sarah’s therapist introduced her to was called Body Mapping.
Body Mapping is fun and easy and relaxing.
Take a big piece of paper and create a body outline
Make list of the worst to describe emotions and thoughts associated with the trauma
Use colorful pencils to draw where these emotions and thoughts are located
Realize those areas needs compassion and understanding
Use guided imagery to go through all the parts of the body with your mind, lingering on each part, calling the parts back into the self-concept
Breathe and meditate and bring healing energy to those areas
Skill Three: DBT Skill of STOP
Even though Sarah was a well-balanced, optimistic person before the trauma she needed to improve her self-soothing skill set in order to cope with the enormity of what she had experienced.
The Dialectical Behavioral Therapy (DBT) skill set has some great easy skills that many of us use unconsciously. Explicitly learning some DBT skills helped Sarah cope with her emotions when she felt overwhelmed, instead of withdrawing. McKay, Wood and Brantley’s The Dialectical Skills Self-Help Workbook is a good, short guide to DBT coping skills.
The DBT STOP Skill helped Sarah get some perspective when her emotions swirled.
S – Stop and step back (Picture a big red STOP sign)
T – Take a breath
O – Observe what is going on internally and externally ..do not ignore, observe and detach
P – Proceed mindfully
Skill Four: Journaling and Healing
And Sarah found another way to self-soothe once again. She read online about how journaling has a broad therapeutic effect and how there’s lots of research to support this. James Pennebaker of the University of Austin has dedicated his life to the study of expressive writing and healing. She picked up one of his books, Expressive Writing: Words That Heal that helped her understand this phenomena.
An easy guideline as a springboard to begin journaling from Dr. Pennebaker’s book is this:
For at least 5 days
For personal exploration ONLY
Not ot be shared! This is NOT a letter writing exercise!
No worries about grammar or content..only for YOU!
Pick a traumatic incident, or everyday stressors or conflicts
Explore your deepest feelings and fears
Tie this trauma to other parts of your childhood, if it comes up
Relate this to your relationships with others, the people important to you
Perhaps link the writing to your present self and then imagine who you’d like to become in the future
Journal for 15 minutes in the morning and at night.
If it feels right, cut out pictures from magazines and old greeting cards and paste them into your journal or draw with colored pencils as a way to express non-verbally as well as verbally
After five days, reflect on the writing and see if there have been internal shifts
Appreciate the Experience of Post-Traumatic Growth
Going through this experience challenged Sarah’s long held belief that bad things didn’t happen to good people. She found that trauma happens in life and it was up to her to develop strength and coping skills to adapt to what is actually reality, rather than what she thought it should be.
Over time, with support, Sarah healed and grew as a person. She learned new self-help skills and the ability to experience a wider range of emotions deeply. Sarah developed a more mature and realistic perspective on life. She developed a deeper appreciation for the nuances of emotional strength and how important a foundation of internal emotional strength is as the basis of maintaining an external “normal” life.
Sarah learned to that she had a tendency to want to avoid painful feelings, but that, in the long run, this subverted into her body. She learned to stay with her emotions and with her body feelings.