Your body remembers trauma. The brain and body are one, and the central nervous system will continue to sound the alarm well after the threat is gone, especially with complex trauma. This trauma is chronic (repetitive), interpersonal, and happens in childhood. Complex trauma can cause havoc to the developing brain and CNS, effects that last a lifetime if not properly healed. This is why trauma survivors often have shorter lifespans. The overactive nervous system will end up on overdrive and continue to release stress hormones that damage the body over time.
It doesn’t have to be a death sentence though. There are ways to heal your mind and body. I think a lot of therapy misses the core issue if it’s targeting negative beliefs and thoughts only. Cognitive therapy is still important because trauma will absolutely cause negative beliefs about the world, shame, low self esteem, and disconnection from others. However, top down approaches are lacking in healing the damage to the CNS. Top down treatments refer to approaches targeted at the top of the brain, like the Prefontal cortex. The PFC is the part of the brain that deals with critical thinking, impulse control, and executive functions.
The problem with complex trauma is it affects the lower parts of the brain significantly, like the amygdala and insula. These areas of the brain focus on emotional reactions, stress response, and body awareness. In complex trauma, the amygdala (the fear center) often becomes enlarged and overactive due to excessive stressful events. Also the hippocampus, the main structure involved in memory, becomes under-activated. The amygdala consults with the hippocampus to see if a situation is dangerous. Since the hippocampus is often shrunk or under-activated by chronic trauma, it provides inaccurate information and sees threat where there isn’t any. It sets off an alarm that alerts the amygdala to react to threat. This is what causes hypervigilance in PTSD, and it’s why hypervigilance symptoms last long after the trauma has ended.
So how does a complex trauma survivor calm and regulate their brain and CNS if it’s been wired to overreact? Bottom up approaches are critical to healing. These treatments are ways to regulate the bottom parts of the brain like the amygdala and include body work, exercise, breathing, meditation, etc. If complex trauma treatment doesn’t include these interventions, it will not be effective.
My experience with bottom up techniques began with intuition. Ever since I was a kid, being active made me happy. I felt empowered playing soccer, other sports, and climbing trees. I’d hang out with the boys who wanted to ride bikes and play soccer with me. In high school I lost this natural way of managing my stress and instead began to use drugs which made me unmotivated and depressed. As an adult I began to do High Intensity Interval Training because I noticed that strenuous exercise worked better than any prescribed medicine. Then pregnancy and motherhood derailed me for a while. Two years after the birth of my daughter, I got back into my exercise routine, and it has helped tremendously.
I exercise because I have an overactive nervous system that makes me experience fear and adrenaline a lot, and it calms my body. It alters my biochemistry and releases endorphins and endocannabinoids. Hours after strenuous exercise I still feel happy and calm. On the worst days of my depression, I can elevate my mood from severely depressed to neutral. It may not seem like a big deal, but I’m very grateful for a neutral emotional state. When I’m agitated and feel like negative energy is coursing through my body (the uncomfortable feeling of cortisol and adrenaline), exercise channels that energy so that it dissipates.
I also have to be careful when I exercise because of my dissociation. Trauma affected the insula in my brain, which makes interoception more difficult. Interoception is being aware of internal body states like pain, hunger, and other physical sensations. Dissociation can numb my body so that I barely feel pain. This can be dangerous if I push myself too hard, I could injure myself and not notice until afterwards. The flipside to this is that dissociation can help me attain my fitness and endurance goals because I’m able to push myself through the pain. Anyone who works on fitness goals knows that there is a point where you have to push through discomfort to attain a higher level of endurance or performance. I’m a master at this, which is why it is fairly easy for me to swim and run for long periods of time. As long as I’m careful and mindful about exercise, I can use this to my advantage.
Thinking about this made me question whether I am just reenacting my trauma by putting my body through pain and discomfort. I think that it is actually a reenactment but in a powerfully healing way. Therapists who understand bottom up interventions realize that a trauma survivor needs their body to complete an action it was not able to. Dissociation occurs when the body’s sympathetic nervous system activates the flight or fight response, but the person is unable to actually fight or run away. The body will then freeze or collapse, and the mind turns to dissociation to manage pain and numb emotional distress. It is the last line of defense before death. If an animal is cornered by a predator, it will freeze and collapse in a way to manage terror and pain. It’s pretty much all that can be done in those dire circumstances. If an attack is inevitable, it makes sense that the body would try to numb the effects of pain and fear. Unfortunately there are many kids who’s bodies have to resort to this last line of defense when being abused. Children usually can’t fight off their attacker or run away. They grow up with this trauma stored in their bodies, which makes them tense, avoidant, and dissociative.
Running is completing the action of running away, something I couldn’t do as a kid. It’s empowering beyond words to be able to run now, especially for long distances. It releases so much tension in my body. Also, because I have DID, these flight or fight responses are stored in different parts that dealt with the trauma. I have child and teen parts who get a lot of relief from running, dancing, and swimming. The movement helps parts who were frozen, tied up, and unable to move for long periods of time. We had to dissociate to escape the inability to fight or flee, but now we can complete those actions. We also used to enjoy wrestling and martial arts as a child, I think because we couldn’t fight our abusers, so it was an instinctual way to complete those actions stored in our CNS. Now we’re learning to do Tai Chi because it’s calming and based in martial arts techniques. For example, we recognize that some moves feel like a slow moving block technique used in karate. Some people like yoga, but we prefer a bit more movement. Despite being bored by yoga, we still do certain basic poses amongst our daily strength training. We do child’s pose and upward facing dog to stretch our back which is susceptible to tension and muscle spasms. We also really like warrior pose to help ourselves feel grounded and empowered.
I think the piece I was missing despite the exercise was being more aware of my body, or paying attention to interoception and improving these abilities. This basically means I have to train myself to listen to my body. A lot of childhood trauma survivors, like me, are body phobic or avoidant. We’ve learned to disconnect from our bodies, and for good reason. The way to heal from trauma is to slowly unlearn the numbing response, both physically and emotionally. I used to think it was impossible to shut this off, but I’m starting to see that slowly bringing awareness to body states can help.
My therapist often asks me what I feel in my body while talking, which teaches me to stop and pay attention. I’m often tense without noticing, or I’m spacey and numb. If I’m tense or hyperventilating, I need to do breathing techniques or tensing and releasing my muscles. Progressive muscle relaxation is also helpful for survivors, although it triggers me because my abuser used that technique against me.
Complex trauma survivors will often switch between the two extremes of spacey dissociation and hyperarousal (agitation and activation). It’s important for a therapist to check in often with a trauma survivor as they’re talking, so that they can learn to do the same for themselves in daily life. At first this didn’t seem important to me, but it’s slowly helping me to bring awareness to physical sensations in my body. If I can learn to listen to my body in a safe space, I can begin to do this more on my own.
A final word about bottom up approaches: do what is fun and empowering for you. Everyone is different. Swimming and running is exhilarating for me. Strength training also makes me feel empowered. I generally hate yoga, but others love it. Other people hate running, and that’s fine. Go for a walk if you can’t run, and notice how your body and mind feel afterwards. Due to my DID, classic meditation is challenging for me, but when I swim I focus on only the technique. My mind is clear, and that feels like my meditation. Walking meditation is another one that I like. Find what works for you, what makes your body feel strong. When your body feels empowered, your mind follows. Even breathing techniques can differ in their effectiveness. I used to hate them, because focusing on my breathing was triggering for me due to my past. I found a way to visualize an upside down triangle that I draw in my mind as I inhale, hold, and exhale. The visual piece allows me to focus on something other than just breathing. There are also power breaths to energize if you feel slow and tired. To calm down, exhaling slightly longer than you inhale will activate the parasympathetic nervous system, or relaxation response.
These are just a few ideas, if you search bottom up trauma interventions, there are many more to try. The key is to keep trying until you find something that works for you. If you just tell your brain to calm down or stop being anxious, it won’t work. If you train your body and alter the CNS response, your mind will follow.