Understanding Trauma Through the Body: Integrating Somatic Awareness in Clinical Practice

Introduction

Trauma leaves lasting imprints not just in the mind but deeply within the body. Over the last few decades, neuroscience and somatic psychology have increasingly illuminated how traumatic experiences alter the body's physiological, neurological, and emotional systems. Traditional "talk therapy" often fails to reach these embodied dimensions, leaving survivors struggling with symptoms such as chronic tension, dissociation, emotional numbing, and hyperarousal. As clinicians shift toward more integrative and body-centered approaches, understanding the body's role in trauma becomes not only beneficial but essential.

This article explores five critical aspects of working with trauma through somatic awareness. First, we will examine the latest research on what happens in the body during trauma. Then, we will explore how to help clients notice what's going on in their bodies and why that can be so difficult for trauma survivors. We will also discuss dissociation as a common coping mechanism in childhood trauma, explore strategies to help clients become more comfortable focusing inward, and finally, learn how to work with the story the client's body is telling. Throughout, real-world clinical vignettes and cutting-edge research will provide practical insights for therapists supporting clients on the path to healing.

What’s Happening in the Body During Trauma

The Neurobiology of Trauma

When a person experiences trauma, the body's autonomic nervous system (ANS) becomes highly activated. The sympathetic nervous system (SNS) is responsible for the classic "fight or flight" response, releasing adrenaline and cortisol to prepare the body to respond to danger (Porges, 2021). If escape or defense is impossible, the parasympathetic nervous system (PNS) may initiate a "freeze" or shutdown response to minimize further harm. This autonomic cycling—between arousal and shutdown—is a central feature of trauma's physiological impact.

Polyvagal Theory, developed by Stephen Porges, explains how the vagus nerve mediates these survival responses. Porges (2021) identifies three primary states: social engagement (safe and connected), mobilization (fight/flight), and immobilization (freeze/collapse). Trauma often disrupts a person's ability to access the social engagement system, leaving them stuck in cycles of hyperarousal or dissociation.

HPA Axis Dysregulation

The hypothalamic-pituitary-adrenal (HPA) axis is another system profoundly affected by trauma. Chronic activation of this stress response system leads to elevated cortisol levels, immune suppression, and increased inflammation, contributing to long-term physical health issues such as cardiovascular disease and autoimmune conditions (Khoury et al., 2019).

Body Memory and Somatic Storage

Trauma is not only stored cognitively but somatically. According to Van der Kolk (2015), the body retains implicit memories of traumatic events. These can manifest as chronic tension, pain, gastrointestinal disturbances, and other psychosomatic symptoms without conscious recollection of the original trauma. These "body memories" often surface during moments of safety, such as in therapy or during mindfulness practices.

Case Example: Maria

Maria, a 34-year-old woman, sought therapy for persistent gastrointestinal issues. Despite numerous medical evaluations, no clear diagnosis was found. Through body-oriented therapy, Maria connected her abdominal tension and pain with early childhood experiences of sexual abuse. Gradually, her physical symptoms diminished as she processed these memories somatically through grounding and gentle movement.

How to Help Clients Begin to Notice What’s Going On In Their Body

The Role of Interoception

Interoception, the ability to perceive internal bodily sensations, is often diminished in trauma survivors (Khalsa et al., 2018). Research shows that early trauma disrupts the development of accurate interoceptive awareness, leading to difficulties recognizing hunger, fatigue, and emotional states (Mehling et al., 2022).

Mindfulness and Somatic Practices

Mindfulness-based interventions can rebuild interoceptive accuracy. Farb et al. (2015) demonstrated that contemplative practices like body scans and mindful breathing enhance somatic awareness and emotional regulation. However, for trauma survivors, these practices must be carefully titrated to avoid overwhelming sensations that may trigger flashbacks or dissociation.

Practical Techniques

• Grounding exercises: Feeling the feet on the floor, noticing contact with a chair.
• Breath awareness: Tracking the inhale and exhale without forcing change.
• Titration: Encouraging clients to notice sensations for brief periods, then shift attention outward.

Case Example: James

James, a 42-year-old veteran with PTSD, initially struggled with body awareness. He described feeling "numb from the neck down." Using short, guided grounding exercises, James gradually noticed tension in his chest. Naming this sensation allowed him to stay present during therapy rather than dissociating.

One Common Coping Mechanism for Childhood Trauma

Dissociation as Survival

Dissociation is one of the most common adaptive responses to early trauma. It allows individuals to psychologically "escape" unbearable situations by detaching from reality. Lanius et al. (2020) found that dissociation involves neural disconnections between regions responsible for memory, emotion, and body awareness.

Signs of Dissociation

• Emotional numbing.
• Depersonalization (feeling detached from the self).
• Derealization (feeling the world is unreal).
• Time loss or memory gaps.

While dissociation is protective in childhood, it can impede adult functioning, making relationships, work, and self-awareness difficult.

Case Example: Sophie

A 28-year-old teacher, Sophie reported "going blank" during arguments with her partner. Through psychoeducation and body tracking, Sophie recognized these episodes as dissociation. Developing grounding rituals, such as pressing her hands together or feeling her pulse, helped her stay engaged during conflict.

How to Help Traumatized Clients Become More Comfortable Focusing Inward

The Fear of Internal Experience

For trauma survivors, the body can feel like an unsafe place. Hypervigilance, chronic pain, and intrusive memories make inward attention threatening (Siegel, 2020). Safety and co-regulation with the therapist are critical to rebuilding this internal connection.

Research on Co-Regulation

Dana (2021) emphasizes the importance of "ventral vagal" activation—states of safety and connection—facilitated through the therapeutic relationship. Clients are more able to explore internal sensations when they feel attuned to a calm, regulated therapist.

Techniques to Increase Comfort

• Co-regulated breathing: Synchronizing breath with the therapist.
• Imagery: Visualizing safe spaces or protective figures before body-focused work.
• Window of Tolerance: Helping clients identify and remain within their optimal arousal zone.

Case Example: Alex

Alex, a 35-year-old man, used humor and distraction to avoid body awareness. Over months, with gentle encouragement and validation, Alex explored his physical sensations, eventually identifying a tightness in his throat during stressful moments. Naming this helped him process underlying grief.

Working with the Story the Client’s Body Is Telling

Somatic Narratives

The body communicates trauma through posture, movement, and chronic tension patterns. Ogden (2021) describes "somatic narratives" as implicit, nonverbal stories encoded in the body that reflect past experiences.

Research on Embodied Processing

Sensorimotor Psychotherapy and EMDR both utilize body-based cues to access and process trauma (Shapiro, 2018). Movement, gesture, and physical expression become avenues for healing when verbal storytelling feels insufficient.

Practical Approaches

• Tracking micro-movements: Noticing subtle shifts like fidgeting or jaw clenching.
• Reflecting posture: Asking clients what emotions arise when they notice slumped shoulders or guarded arms.
• Rewriting body stories: Exploring new movements, such as standing tall or pushing hands outward, to embody empowerment.

Case Example: Liam

Liam, a 40-year-old man with a history of neglect, presented with a collapsed posture and quiet voice. Through posture work, movement exercises, and breath support, Liam gradually embodied a more confident, upright stance, which paralleled increased assertiveness in his personal life.

Conclusion

Trauma is fundamentally a bodily experience. Effective trauma therapy requires more than cognitive insight—it demands compassionate attention to the body's wisdom. Therapists can support profound healing by helping clients notice, tolerate, and eventually transform their somatic experiences. As research continues to validate these approaches, integrating body awareness into trauma work becomes not just an option but a necessity.

References

Dana, D. (2021). Polyvagal practices: Anchoring the self in safety. W. W. Norton & Company.

Farb, N. A., Daubenmier, J., Price, C. J., Gard, T., Kerr, C., Dunn, B. D., ... & Mehling, W. E. (2015). Interoception, contemplative practice, and health. Frontiers in Psychology, 6, 763. https://doi.org/10.3389/fpsyg.2015.00763

Khalsa, S. S., Adolphs, R., Cameron, O. G., Critchley, H. D., Davenport, P. W., Feinstein, J. S., ... & Paulus, M. P. (2018). Interoception and mental health: A roadmap. Biological Psychiatry: Cognitive Neuroscience and Neuroimaging, 3(6), 501-513. https://doi.org/10.1016/j.bpsc.2017.12.004

Khoury, J. E., Bosquet Enlow, M., Plamondon, A., Lyons-Ruth, K., & Madigan, S. (2019). The association between adversity and hair cortisol levels in humans: A meta-analysis. Psychoneuroendocrinology, 103, 104-117. https://doi.org/10.1016/j.psyneuen.2018.12.017

Lanius, R. A., Terpou, B. A., & McKinnon, M. C. (2020). The neurobiology of dissociation: Implications for treatment. Journal of Trauma & Dissociation, 21(3), 197-210. https://doi.org/10.1080/15299732.2020.1725057

Levine, P. A. (2015). Trauma and memory: Brain and body in a search for the living past. North Atlantic Books.

Mehling, W. E., Price, C., Daubenmier, J. J., Acree, M., Bartmess, E., & Stewart, A. (2022). The Multidimensional Assessment of Interoceptive Awareness (MAIA). PLoS ONE, 17(5), e0268329. https://doi.org/10.1371/journal.pone.0268329

Ogden, P. (2021). Sensorimotor psychotherapy: Interventions for trauma and attachment. W. W. Norton & Company.

Porges, S. W. (2021). Polyvagal safety: Attachment, communication, self-regulation. W. W. Norton & Company.

Schore, A. N. (2012). The science of the art of psychotherapy. W. W. Norton & Company.

Shapiro, F. (2018). Eye movement desensitization and reprocessing (EMDR) therapy: Basic principles, protocols, and procedures (3rd ed.). Guilford Press.

Siegel, D. J. (2020). The developing mind: How relationships and the brain interact to shape who we are (3rd ed.). Guilford Press.

Van der Kolk, B. A. (2015). The body keeps the score: Brain, mind, and body in the healing of trauma. Penguin Books.