Dr Peter Levine Ph D
Somatic Experiencing®, enhanced by NARM, The NeuroAffective Relational Model™, are the shock and developmental trauma therapies used as a point of reference in this field.
This is not intended to be an exhaustive report on Somatic Experiencing® and NARM; for detailed examinations of these approaches, readers can refer to books and training courses. Moreover, the intention is in no way to provide a guide to self-therapy, as proper therapeutic treatment requires considerable experience and ability.
Trauma according to Somatic Experiencing®
In recent years, Dr. Peter Levine, creator of Somatic Experiencing® (SE), has provided a relatively simple and effective definition and scientific explanation for trauma that facilitates our understanding of how it occurs but also how to prevent and treat it. This is done in a way that, albeit scientific, is congruent with the tradition of meditation.
Levine studied medical biophysics and psychology and was a consultant for NASA in the development of the Space Shuttle. His intuition in the 1970s led him to develop a method of trauma therapy. He observed that wild mammals, when they are the prey of other carnivores, for example, possess what he defines as “built-in immunity” to trauma, without which they could not survive. Humans, also mammalian, have instinctive reactions when faced with danger that are fundamentally identical to those of any other mammal. Levine asked himself why humans are so easily traumatized in comparison to all of the other mammals in nature. In his work with traumatized patients, he reached the conclusion that human cerebral cortex (neocortex), whose rational function supersedes that of other mammals, makes the natural process of instinctive (reptilian) and emotional (limbic) brain function more difficult. The result is that it is more difficult for humans to heal their traumas.
When the individual experiences an event, a great amount of energy from the vagal neurovegetative system or the sympathetic neurovegetative system may be required in order to manage the situation. When this large amount of energy is released, the event can be integrated as a learning experience. On the other hand, when this energy becomes trapped in the neurovegetative system and is not discharged, numerous physical, emotional, and psychological complications that are considered traumas may ensue. This entrapment of energy happens more frequently in humans than in other mammals because of the existence of a predominantly rational brain function. The cause of the trauma is therefore the excess of energy that remains trapped within the neurovegetative system and not the event itself, which may be a normal experience for one person and a traumatic one for another.
Levine not only explains the genesis of the trauma response, he also describes a way to avoid traumatization and to resolve pre-established traumas by facilitating self-regulation of the neurovegetative system.
The Neurovegetative Nervous System
The neurovegetative nervous system regulates the autonomous functions of the body. These functions—circulatory and visceral functions, for example—are independent of thought, are involuntary, and continue even when an individual is in a coma.
These are part of the parasympathetic neurovegetative system, where the vagus also plays an important part, and the sympathetic system. The neurovegetative vagal system and the sympathetic system have antagonistic functions. The vagal system helps the body to conserve energy by slowing down the heartbeat, for example, or by lowering arterial blood pressure, anesthetizing the person, causing the person to faint, and, if necessary in extreme cases, inducing a coma. The sympathetic system, on the other hand, activates the fight or flight response by accelerating the heartbeat, increasing arterial blood pressure, increasing the quantity of glucose in the blood, increasing blood circulation in muscles, and reducing circulation in the digestive system. The continuous alternation of these two systems, which determines the prevalence of one as opposed to the other, is a fundamental operation at the base of human existence.
When faced with an engaging event of particular significance, one of these two systems is activated: the sympathetic when fight or flight is involved or the vagal system if there is a necessity to decelerate, anesthetize, or cause a fainting spell in order to conserve energy and reduce suffering. Once the event has passed, the neurovegetative system that has been activated must now discharge or break down the remainder of the large quantity of energy produced. There are ideally two ways in which this can occur. The first is facing the event at hand well prepared, meaning with the experience of already having dealt with similar events of lesser significance that did not lead to a traumatic condition. The second option is to seek the intervention of someone to guide the individual through the processing of the experience. Whether on our own, thanks to prior life experience, or with the help of another, the point is to learn how to deactivate the neurovegetative system that has been activated, slowly acquiring the capacity to break down the large amount of energy produced in that system so that it can then return to its neutral state.
With gradual life experience, the neurovegetative system acquires flexibility and the capacity to regulate itself: it can undergo total activation and then return to the neutral state it maintained initially. A neurovegetative system that is capable of managing a high level of activation while remaining within its capacity of self-regulation is called resilient. This term was originally used to describe the ability of a metallic structure to absorb impact without damaging itself or that of an elastic material returning to its original form after being bent or stretched.
If, however, the event activates the vagal or sympathetic system beyond its self-regulatory capacity, the neurovegetative system remains active, unable to break down the large quantity of energy produced. This means that the alternation between the two neurovegetative systems cannot be carried out as usual, causing trauma.
The Three Excesses
According to Levine, the event that triggers the vagal and sympathetic systems beyond their autoregulatory capacities, or resilience, is characterized by “excess”: too soon, too fast, too much.
Too soon: the event has occurred too soon in life at a time when an individual does not yet possess the maturity necessary to sustain certain experiences: a sexual encounter, for example, experienced prematurely at an early age. Additionally, this could be an episode that has occurred too soon within the routine of daily life when the organism is not yet physiologically prepared. For example, this would be like one person eating an entire Christmas lunch at seven o’clock in the morning after waking up, as opposed to having his usual cup of coffee. With “too soon” cases, the neurovegetative system has not yet reached a sufficient level of resilience and is unable to regulate itself following the event.
Too fast: the event that has occurred with an abrupt intensity, almost to the point of leaving a person out of breath. Let us refer once again to the Christmas lunch metaphor: devouring the entire feast in just ten minutes. Similarly, in this case, the neurovegetative system cannot regulate itself because it has surpassed its resilience level.
Too much: the event that has occurred sets off one of neurovegetative systems beyond its capacity to regulate itself. Returning again to the Christmas metaphor: this would be comparable to an individual unaccustomed to binge eating who literally eats for four people. The event is considered a traumatic one because it is “too much” when all three excesses are combined, or only two of these concomitant excesses, or even in the instance that just one exists.
When one of the neurovegetative systems remains holds large quantities of unassimilated energy, it reaches a higher level in relation to the other inactive system. Between the two systems there is a reciprocal imbalance that renders oscillation (a continuous and balanced alternation between one system and the other contingent on the situation that presents itself) impossible. Life’s course, however, continues as the vagal and sympathetic system engage in their rotation. Each comes into play in turn depending on specific necessities, like two cyclists alternating the role of pack leader.
The Development of Trauma: Addiction and Stress
If the neurovegetative system is unable to regulate itself and there is an imbalance between the vagal and sympathetic systems as a result, normal life cannot continue. The two systems must be at the same level to properly take turns as the dominant force. There are three possibilities that can bring the two neurovegetative systems back to the same level so that life can resume normally:
- The overcharged neurovegetative system that is unable to regulate itself is partly controlled by external factors on which the individual, in order to survive in these situations, becomes dependent. These factors may be substances, such as anxiolytic medications or drugs, or these may be behaviors that become all-out addicitions: for example, overworking oneself, too much sex, fatigue as a result of excessive physical exercise, or maintaining relationships in order to feel stimulated.
- The other neurovegetative system—the one left in a state of rest—is activated through the production of a large amount of energy comparable to that of the operational neurovegetative system. In this way the two systems find themselves at the same level once again, but both are activated instead of neutralized.
- The trauma is treated, which is certainly the best option. Using therapy to help the overly active neurovegetative system slow down allows it to learn to regulate itself. In this way the traumatic event is transformed itself into an episode that enriches one’s life experience.
Through any one of these three options, the two neurovegetative systems will establish themselves once again at the same level, making alternation possible. However, it is the third option—treating the trauma—that is the ideal solution in maintaining the natural flow of life, whereas the first and second options are detrimental to this endeavor.
In the first case, in order to neutralize the neurovegetative system left active, an addiction to a behavior or a substance is necessary. In the second case, the organism exhausts itself in an effort to activate the neurovegetative system that was not stimulated by the event at hand. Now, instead of remaining inactive, it must work to compensate for the other neurovegetative system that is unable to neutralize itself. In this case the activation of both neurovegetative systems consumes an enormous amount of energy. This dual activation of both neurovegetative systems is called stress.
Stress has two separate origins and two completely different consequences depending on which neurovegetative system has remained active following a significant event:
1) The first case involves a fully activated vagal system that is unable to neutralize itself following a traumatic event, causing an anesthetic reaction or loss of senses that may be life-threatening. There is then a compensatory activation of the sympathetic system, which may give the initial impression of sympathetic hypertonia at first glance: the manifestation of combative, aggressive behavior or great fear and the desire to flee. Heller’s NARM indicates that this situation is typical of individuals who have suffered premature trauma at the very beginning of their lives. In fact, a fetus or newborn, when faced with an event of particular intensity, can neither fight nor escape, only tolerate the situation and try to survive by activating the vagal system. This, in turn, gradually causes an anesthetic effect and helps to conserve energy. The compensatory activation of the sympathetic system then “kicks in” to attempt to rebalance the organism. As we discussed with regard to female adolescent anorexia that is associated with the connection survival style, the traumatic experience takes place during the period that extends from conception to birth. Anorexia independent of age and sex, on the other hand, is associated with the attunement survival style and stems from trauma that occurs in the early stages of a child’s life. In both cases, however, the event experienced as a trauma leads to the maximum activation of the vagal system, which is then unable to return to its neutral state, in addition to the subsequent compensatory activation of the sympathetic system.
2) The second case involves the maximum activation of the sympathetic system as a result of a traumatic event, wherein energy was produced for a “fight or flight” response that was not undertaken. To compensate, the vagal system is activated, giving an individual an abnormally calm appearance. A wise, popular term, “false calm,” describes this sort of person. Behind the calm facade there is a bubbling fury that can explode suddenly at any moment.
If events similar to those that were experienced as traumas in the past should occur again in the future, the trauma intensifies because the neurovegetative system’s operational method is the same and, as a result, this method is enforced. In the end, even seemingly insignificant events can echo an old trauma and the survival style develops inevitably and with greater intensity.
Treating the trauma, according to SE, means neutralizing the excessive activation of the neurovegetative vagal or sympathetic systems provoked in response to an event. In this way the traumatic event can be transformed into a simple episode that serves to enrich one’s experience by removing any negative connotations that may be associated with it.
SE and NARM are not regressive approaches because they do not go back to previous phases of psychological development. The point is not to dwell on traumas of the past because such a focus may instead reinforce them. With these approaches, an individual is well rooted in the present. In effect, the therapy bases itself on feeling the movement of one’s own breath and concentrating on present-moment bodily sensations. This connection with one’s own sensations enables the overactive neurovegetative system to slow down, allowing both vagal and sympathetic systems to regulate themselves. Through this acquired self-regulation, which prevents the two neurovegetative systems from becoming overactive, the events of the past experienced as traumas are gradually integrated into the present.
The aim of all trauma therapies is the same: to teach the overactive neurovegetative system to slow down or regulate itself. If this is the general rule, however, it must also be noted that every trauma presents unique peculiarities that require appropriate strategies. Trauma causes the neurovegetative systems to lose the fluidity of passing from one (e.g., vagal) system to the other (e.g., sympathetic), and vice versa. Instead, one of the two, either the vagal or sympathetic system, remains in such a completely overactive state in response to an event that it is unable to neutralize itself. Helping the neurovegetative system neutralize itself means increasing its resilience, increasing the elasticity with which it activates itself and then returns to a state of rest, just like an elastic band returns to its original form after being stretched.
It may be useful to identify a situation that could be a resource for the individual. In this context, resource refers to a situation in which it is easier for the active neurovegetative system to return to its neutral state so that both systems are once again in equilibrium. Each individual has his or her own personal resources: this might be a sunset, a mother’s embrace, immersing oneself in nature, etc. Enabling a person to recall this resource may help the active neurovegetative system to return to a neutral state of rest and break down the large amount of excess energy.
It takes time for a traumatic event to be assimilated into an individual’s experience as an enriching part of life because it takes time to slow down the neurovegetative system and prevent the occurrence of “excesses,” as we previously discussed. This process happens in a titrated pace; in the language spoken by chemists, titration means to slowly add a solute to a solvent, one drop at a time, so that it can dissolve without causing a dangerous reaction. In trauma therapy, the elements that an individual has not yet assimilated into his or her experience (which is what causes the trauma) must be gradually integrated, one drop at a time, into what this person has already absorbed.
To elucidate the titration procedure, I would use making mayonnaise as an analogy. Let’s imagine that the oil is the traumatic experience that must be assimilated. This oil is mixed into the other ingredients one drop at a time, only after the previous drop of oil has been blended in, otherwise the mayonnaise curdles. This analogy conveys how trauma therapy should never espouse a method that causes the individual to dwell on the trauma and thereby reinforce it. The point is to slowly integrate what was left unassimilated (thereby becoming traumatic) into one’s pre-existing experience. When mayonnaise is made, the oil must be slowly integrated into the previously prepared mix. If too much oil is added all at once, however, the pre-existing amalgamation of mayonnaise would disintegrate—like a traumatic experience that occurs in an individual or what happens if one were to dwell regressively on the trauma.
Titration should be carried out while an individual concentrates on his or her breathing rhythm and the sensations produced naturally in the body, without need for stimulation or repression. Once solidly embedded within his or her own physical sensations and mindfully aware of respiration, an individual enables the free flow of emotions and thoughts, without having to induce them or fight them—temptations that may originate from our rational mind.
This free flow is called “felt sense”. When this felt sense is engaged, feelings emerge in the space and time they require; they are not rejected, modified, or induced—only welcomed. An individual may feel as if the sensation itself were evolving because it is allowed to flow freely and no longer crystalizes the energy in the body. In doing so, the excess energy that is produced as a result of a traumatic event and trapped within one of the two neurovegetative systems is gradually released. Similarly, the compensatory energy produced by the other neurovegetative system, activated due to stress, is also released.
Especially after experiencing trauma, the individual tends to be rather detached from his or her own body, distracted by false thoughts and induced emotions. In these circumstances the human brain, compared to that of other mammals, is prone to rational functions of thought in an attempt to cope. It is the individual’s own body that has the ability to neutralize the excess activity of one of the neurovegetative systems, transforming the traumatic event into simple experience. Animals, compared to humans, are much more aware of their own sensations, which explains how they are usually more capable of assimilating intense events without experiencing trauma. Additionally, if they become traumatized, they are better able to take care of themselves, gradually transforming the traumatic event into life experience, without traumatic or self-destructive connotations.
In certain ways, Levine’s trauma therapy method resembles meditation. In effect, the fundamental premise of meditation is becoming your own witness, similar to certain aspects of trauma therapy.
Meditation is the royal road to physical, emotional, and spiritual human evolution. SE, compared to meditation, is easier to adapt to Western world lifestyle: people always on the go, stressed and searching for reasons why. SE provides these individuals with neurological explanations that are easily put into practice—something that individuals in Western society require—and gives them the possibility of working with a therapist who can guide them, step by step. A therapist can help these individuals to stay well rooted in their own physical sensations, giving them the time and space required so that they can evolve. In such a context, it is possible for the neurovegetative system to neutralize itself. Without the presence of a therapist, a person risks becoming distracted by thoughts as opposed to concentrating on his or her own physical sensations—a difficult task for a traumatized individual. One may become lost in thoughts of revenge that tend to reinforce the activation of the traumatic episode itself and the neurovegetative system.
The therapist makes fundamental use of resonance, which is established between his or her own neurovegetative system and that of the client. In this way as the client’s system is coming out of resilience, the therapist is able to regulate titration, thanks to the resonance he or she feels within his or her own neurovegetative system. In this case, the client is brought back in to touch with bodily sensations, becoming embedded firmly within them, such that the or she may eventually appeal to this personal “resource” memory and thereby facilitate the self-regulation of his or her own neurovegetative system. Only after all of this preliminary work takes place, the therapist can help the client slowly titrate the original experience of the trauma, carefully integrating it one “drop” at a time. Returning to our mayonnaise metaphor, when you realize that the oil is not integrating properly, you keep stirring until everything is properly amalgamated. Only afterwards can other drops of oil be added, one at a time. The resonance of the client’s neurovegetative system with that of the therapist has a second significant aspect: to be sure that the event is monitored suitably so that the therapist is able to go through it without becoming traumatized him- or herself. This means that the therapist’s neurovegetative system must be fully capable of regulating itself in order to encourage, through resonance, the client’s neurovegetative system to do the same.
Conducting trauma therapy requires competence and expertise, using a relaxed and fluid approach, like an experienced painter who is capable of designing a perfect circle freehand. With trauma therapy, the individual’s vagal and sympathetic neurovegetative systems can return to a state of neutrality and gradually learn how to regulate themselves.
When the neurovegetative systems are self-regulated, there are beneficial physiological effects on the brain and body. This benefit derives from the activation of the extrapyramidal system, a neural network forming part of the motor system that controls and modulates movement (so that it is carried out in a correct, harmonious way) as well as instinctive reactions and voluntary movements. In relation to this topic, Peter Levine refers to Stephen Porges’s polyvagal theory, which takes the various neurological systems’ interactions into consideration and the evolution of the nervous system from reptiles to mammals. We will discuss this subject a little bit later.
A stressful situation increases brain activity in the two hemispheres, the motor cortex in particular, and is likely to cause a disconnection in the activity of one hemisphere in relation to the other. Additionally, stress inhibits proper instinctive (reptilian) brain function and emotional (limbic) brain function. Self-regulated neurovegetative systems enable better coordination of activity between the two cerebral hemispheres and better functionality with regard to the deepest parts of the brain that influence instinctive and emotional life. These mechanisms enable life to develop in a more fluid and gratifying way. These beneficial effects are not only attainable through trauma therapy, but also through properly managed meditation. In these conditions of self-regulation, a person can regain control of mind and body by concentrating on existing sensations, as opposed to feeding off of thoughts of revenge in the cerebral cortex. This shift works in favor of the individual’s well-being and in the best interests of everything that surrounds him or her.
No longer using the cerebral cortex to intervene in the deepest part of the brain, which is part reptilian, in charge of instincts, and part limbic, which controls emotions, means allowing instincts and emotions to freely flow. Furthermore, this shift enables the extrapyramidal system, whose nuclei originate from the base of the brain, to function more smoothly.
Healthy extrapyramidal movements are involuntary, automatic movements that determine good coordination of body movement. These movements make swallowing possible, coordination in ambulation (e.g., the swinging of the arms when walking), and facial expressions (which are extremely important during interpersonal communication). These movements characterize a state of relaxation and well-being that is manifested by, for example, stretching, a healthy yawn, or hearty laugh. As we have said, SE and NARM use Stephen Porges’s polyvagal theory as useful when managing therapeutic intervention with a traumatized individual. This is because the theory not only takes into consideration the interactions of the various neurological systems , but also the evolution of the nervous systems of reptiles and mammals, human included. When the two neurovegetative systems regulate themselves, what Porges calls the “ventral vagal complex” is activated, which is characterized by these involuntary movements such as facial expressions and relaxation-related behaviors. The frontal cortex is also activated, including the mirror neurons that mediate interest and involvement in relation to the external world. This book’s intention is to provide a simple presentation of trauma therapy with regard to anorexia and eating disorders. Therefore, we will not delve any further into Porges’s polyvagal theory, which is a topic of great interest better left to specific texts on the subject.
Allowing these movements to manifest helps the neurovegetative system to regulate itself and prevents the transformation of simple events into traumas. Inhibiting the expression of these movements (e.g., for social reasons, in the case of laughing or yawning) may lead to an increase in stress and traumatization.
From “ANOREXIA The Real Causes: Blood Types and Trauma”, by Lorenzo Bracco.