How Movement Therapy Can Heal Traumatic Stress

It may sound like child’s play: I’m walking barefoot, balancing two Jenga pieces in my hand. I squeeze one wooden block between my right thumb and pointer finger while the other block rides on top. It takes focus to balance the two pieces when I stand still. As I move, the challenge increases exponentially.

This deceptively simple “game” can have a profound effect. I’m playing it in the name of trauma-informed movement, a burgeoning subset of fitness aiming to complement traditional trauma therapy.

I’m part of a certification-workshop group in New York City that includes personal trainers and athletic coaches, social workers, and other mental-health professionals. The leader is Jane Clapp, a Toronto-based trauma-recovery specialist and strength-and-movement coach who has developed courses for practitioners and survivors alike, helping them learn to use the body to support healing.

Clapp’s demeanor is kind and calm. Maintain focus and balance the blocks while walking, she advises. Maintain focus and balance while switching hands. While lowering to sit on the floor and coming back to standing. While lying down and rising back up. While making figure eights with our hips. While swirling our upper bodies as though they are windmills. All the while, don’t let the wooden blocks topple to the floor.

Oh, and don’t forget to breathe.

“This is dual awareness, the ability to maintain awareness of two, or more, aspects of experience,” she explains. In this case, the two aspects are balancing the blocks and moving through space.

Dual awareness is one of several techniques used for treating trauma. The required focus plants participants squarely in the here and now rather than in the past or future. It can help draw their attention outside of themselves when internal stimuli, such as a speedy heart rate or shallow breathing, are overwhelming.

Ultimately, dual awareness is a tool designed to establish that the present is safe and trauma-free — a time when success (balancing the blocks) is possible and failure (dropping the blocks) is not the end of the world.

“Trauma changes the brain. It primes survivors to perceive threats everywhere and respond as if they are in constant danger,” Clapp says. “If you feel frightened or unsafe, your brain will specialize in feelings of fear. If you feel safe and loved, your brain becomes specialized in exploration, play, and cooperation.

“The good news is the brain is plastic, meaning it can be changed. Learning new ways of being and new adaptive coping skills is one way to change the brain.”

Balance exercises, she explains, can be a form of self-regulation, “a way to tether ourselves back” by triggering the nervous system’s righting reflex.

As I bob and weave across the floor with my wooden blocks, I begin to find a balance between tension and relaxation — too much of either and the blocks tumble.

Tending to trauma is serious work, but there is solace in knowing that a path to relief exists through play. There’s also an opportunity to regain a sense of agency and self-confidence by moving the body.

The Anatomy of Trauma

Traumatic stress is a consequence of a traumatic experience. These experiences can be physical, mental, emotional, generational, and institutional. They can be acute, happening only once, or chronic, as in the case of prolonged abuse.

Causes include (but are not limited to) illness, accident, assault, neglect, natural disaster, torture, war, and even otherwise welcome occurrences like childbirth. It can happen to us as children or adults, and although some demographic groups have a higher prevalence, no one is immune.

“Unlike commonplace misfortunes, traumatic events generally involve threats to life or bodily integrity or a close personal encounter with violence or death,” writes Judith Lewis Herman, MD, in her seminal book Trauma and Recovery.

Whether that traumatic event gets stored in the mind and body as trauma for the long term depends on a variety of factors, including resiliency, support networks, social and familial stigma, and access to resources.

It may be surprising to hear that trauma gets stored in the mind and body, yet that’s exactly what happens, and it has significant effects.

It may be surprising to hear that trauma gets stored in the mind and body, yet that’s exactly what happens, and it has significant effects.

Our autonomic nervous system (ANS) acts largely independent of our conscious awareness. It influences the function of internal organs and regulates heart rate, digestion, respiration, pupillary response, urination, and sexual arousal. This system is the primary mechanism in control of our stress responses.

The ANS has two branches: the parasympathetic and sympathetic nervous systems. We are designed to live in our parasympathetic nervous system most of the time. It’s a sort of green zone where the body is primed to rest and digest, with intermittent interruptions by stressors, such as deadlines at work and hard workouts in the gym. These stressors may push us into the red zone by activating the sympathetic nervous system responsible for fight-or-flight reactions, but the effect is temporary and positive. The ability to respond to and reconcile stress — to toggle between sympathetic and parasympathetic activation — is what makes us resilient.

But trauma and chronic stress can dysregulate the ANS and leave us functioning full time in the red zone. And getting stuck there can damage our mental and physical health.

“A single stressful event, for a person that’s reasonably resilient, isn’t going to affect them,” says Peter A. Levine, PhD, author of Waking the Tiger: Healing Trauma. “But if people have to live in a climate of stress . . . it really erodes our sense of self and our resilience.”

“A single stressful event, for a person that’s reasonably resilient, isn’t going to affect them,” says Peter A. Levine, PhD, author of Waking the Tiger: Healing Trauma. “But if people have to live in a climate of stress . . . it really erodes our sense of self and our resilience.”

While it was once commonly accepted that the ANS comprised only the fight-or-flight response and the rest-and-digest state, it’s now become clear that it’s also responsible for trauma responses, such as freeze and collapse.

Freezing involves a highly engaged sympathetic system: The muscles stiffen, the heart rate elevates, alertness increases. You may feel panic-stricken, trapped, even paralyzed.

Collapsing refers to a state of “tonic immobility,” which is distinct from freezing and may be triggered by extreme fear, a threat of imminent death, and a sense that fleeing is not an option. In the natural world, prey animals may instinctively assume the collapsed state, unconsciously feigning death until a predator has passed.

Victims of sexual assault often collapse, which explains an inability to fight back and may create intense feelings of shame and guilt. These responses are instantaneous and not controlled by the higher-order prefrontal cortex — the part of the brain responsible for analytical planning and decision-making.

When someone experiences a traumatic event (particularly one that forces a freeze or collapse state) that isn’t conclusively resolved — by fighting off or outrunning an attacker, for instance — it can influence how trauma and traumatic memories are stored in the body and mind. The memory can be encrypted as sights, sounds, and smells that may be remembered powerfully as sensations, but not in an organized way.

The survivor of an attack, for instance, may block many details of the experience from his or her conscious memory, including the specifics of the attacker’s face. But he or she may be haunted by nightmares and waking “daymares.” For reasons that are not consciously recollected, the physicality of certain people may trigger a posttraumatic response, as may certain sounds or smells.

Traumatic memories often lack personal narrative or other verbal representation, experts say. This sensory recollection means that the body “remembers” the trauma, while the conscious mind may not. And this is key to how movement therapy can reach that trauma.

The body can respond to trauma in many ways. “Trauma continues to intrude with visual, auditory, and/or other somatic reality on the lives of [PTSD] victims. Again and again they relive the life-threatening experiences they have suffered, reacting in mind and body as though such events were still occurring.”

The body can respond to trauma in many ways. “Trauma continues to intrude with visual, auditory, and/or other somatic reality on the lives of [PTSD] victims,” explains Babette Rothschild, MSW, LCSW, author of Trauma Essentials. “Again and again they relive the life-threatening experiences they have suffered, reacting in mind and body as though such events were still occurring.”

Similarly, emotions may manifest as physical pain — sometimes in parts of the body that were not involved in the trauma.

“Traumatized people chronically feel unsafe in their bodies; the past is alive in the form of gnawing interior discomfort,” writes psychiatrist Bessel van der Kolk, MD, in The Body Keeps the Score: Brain, Mind, and Body in the Healing of Trauma. “Their bodies are constantly bombarded by visceral warning signs, and, in an attempt to control these processes, they often become expert at ignoring their gut feelings and in numbing awareness of what is played out inside. They learn to hide from themselves.”

As a result, trauma lives on in our minds and bodies. The conscious mind may forget the original episode, but the ANS remembers. Some sufferers live as if the pain were constantly occurring, enduring a continual cycle of emotional and physical pain. Other trauma victims may experience discomfort only under certain circumstances: The sound of fireworks might affect a veteran of wartime deployment; physical contact might scare a survivor of sexual ­assault; rolling over in bed into a position that mirrors his or her posture after a collision might traumatize someone injured in a car accident. In each instance, the body is primed to react long after the original threat has passed.

No matter the cause, once trauma occurs, processing it is critical.

Move the Body, Heal the Mind

Now more than ever, people can turn to a wide variety of resources for help. Trauma-focused cognitive-behavioral therapy, for example, addresses distorted thinking and negative reactions. Eye movement desensitization and reprocessing, or EMDR, modifies traumatic memories to ease their painful emotional charge. Somatic Experiencing, developed by Levine, can increase tolerance for difficult bodily sensations and suppressed emotions.

Recently, groundbreaking neurological and biological research suggests that mindfully integrating the body into healing practices is essential for trauma recovery. This inclusion of the body in recovery has opened a door to incorporate exercise as a complementary therapy, reestablishing trust in the body as a source of pleasure and strength rather than pain and fear.

“With any kind of trauma, trust is the biggest issue we’re working toward,” says Mark Schneider, CSCS, a Minneapolis-based strength coach and conflict mediator. “Strength is a manifestation of trust in yourself. The more you believe in what you can do, the more you can access what you can do, and the more likely you can meet and exceed limits. Trust in your own ability is paramount.”

Exercise helps the body find a healthier equilibrium, both physiologically and emotionally. It improves hormonal and nervous-system regulation, and it helps people connect with their bodies, which expands their capacity to counter dysregulation and to trust themselves.

Ultimately, movement makes people “more resilient physically and, hopefully, emotionally,” says Clapp.

Yet people experiencing traumatic stress tend to avoid exercise. “Many people with PTSD fear bodily symptoms that are associated with anxiety, such as increased heart rate and shortness of breath,” explains University of Toledo psychology professor Matthew Tull, PhD. The depression symptoms often associated with PTSD, such as low motivation and energy, may also discourage people from exercising.

People experiencing traumatic stress tend to avoid exercise. “Many people with PTSD fear bodily symptoms that are associated with anxiety, such as increased heart rate and shortness of breath.”

These are challenging obstacles. But as a growing cadre of psychiatrists, researchers, family mediators, physical therapists, fitness trainers, and health-club and gym owners advance movement therapies and create trauma-sensitive workout spaces, people in need will find more accessible and adaptable entry points.

Yoga instructor David Emerson, author of Trauma-Sensitive Yoga in Therapy, paved the way in 2001, when he launched the Black Lotus Yoga Project. The organization offers yoga classes for people suffering from complex trauma — experiences that are repetitive or cumulative, such as childhood abuse — as well as PTSD. In 2003 he partnered with the renowned Trauma Center in Brookline, Mass., to study the model. In 2018 Emerson and his colleague Jennifer Turner established the Center for Trauma and Embodiment at the Justice Resource Institute in Needham, Mass., to house the yoga program and cultivate new, body-first trauma interventions.

Meanwhile, in Toronto, Clapp was developing her own system. In 2016 she began offering workshops and a three-part Movement for Trauma (MFT) certification program to educate personal trainers and coaches, as well as social workers and mental-health professionals, in trauma-informed movement. (I completed Level 1 of the certification, MFT-1, in 2018.)

Partnering with Emerson’s team, Schneider and Boston-based researcher Mariah Rooney received a grant earlier this year to develop a trauma-sensitive weight-training program. The goal, says Schneider, is to explore “strength training as a way to process and progress through traumatic events and their aftereffects,” augmenting other therapeutic approaches. (See “How Exercise Can Help Build Physical — and Mental — Resilience” for more.)

While there is tremendous interest in the physical components of trauma-informed training programs, just as important are the materials and supports for trainers who will implement them. “I’m working through creating training resources for coaches to work empathetically and compassionately, and to avoid burnout,” Schneider says.

An empathetic approach to therapeutic movement isn’t limited by exercise modality. Many organizations and crisis centers offer guided, trauma-informed options as varied as running, dance, boxing, and more.

Seattle’s Street Yoga, for example, brings trauma-informed yoga and mindfulness classes to young people with adverse childhood experiences. In Minnesota, Mind Body Solutions offers adaptive yoga and trauma-informed mindfulness training. Warrior Surf Foundation in South Carolina and the Jimmy Miller Foundation in California provide access to adaptive surf therapy and ocean therapy. Strength for All NYC in Brooklyn is dedicated to creating a gender-affirming workout space.

Many programs have sprouted from the needs of military veterans, including the We Defy Foundation in Texas, which teaches Brazilian jiu-jitsu to disabled military service members.

Movement therapy doesn’t diminish the importance of other approaches to healing trauma. Instead, exercise is yet one more tool to help people find relief.

The scope and availability of offerings continues to expand as our awareness and understanding of trauma grows. (For some illuminating statistics, check out “Trauma by the Numbers” below.)

Movement therapy doesn’t diminish the importance of other approaches to healing trauma. Instead, exercise is yet one more tool to help people find relief.

“Movement can be an integral resource for helping to regulate the physiological symptoms of traumatic stress,” explains Clapp.

Everyone’s path to healing is different. There’s no simple prescription for recovering through exercise, no magical movement to “fix” the mind, body, and spirit. The process can’t be rushed. But when employed alongside mental-health therapies, movement offers new hope for healing.

Embodied Movement

The goal of trauma-informed movement is not to release trauma or cure it. Instead, a targeted practice is designed to help people rebuild their body awareness, teach them that they have choices for that body, and allow them to make a choice that is right for them.

“Physical movement can activate the parts of the brain that help us be more aware of our bodies,” says Emerson. In trauma-sensitive yoga, that awareness, combined with moving experimentally and making one’s own choices, helps encourage the embodiment essential to healing.

The goal of trauma-informed movement is not to release trauma or cure it.

The ability to notice what the body is sensing internally is called interoception. A category of sensory nerves, interoceptors receive signals and sensations like hunger, a racing heart, or the need for a bio-break. The awareness of the body in space and in relation to external objects is called proprioception. Exteroception describes the category of senses that helps us perceive and navigate external stimuli: sight, hearing, smell, taste, and touch.

Trauma can compromise interoception, proprioception, and exteroception, which are essential to what psychiatrist van der Kolk describes as “being embodied.” Disembodiment leads to a sense of detachment from physical and emotional experiences.

“Only by getting in touch with your body, by connecting viscerally with your self, can you regain a sense of who you are, your priorities and values,” he writes. “Trauma makes people feel like either some body else, or like no body. In order to overcome trauma, you need help to get back in touch with your body, with your self.”

“Only by getting in touch with your body, by connecting viscerally with your self, can you regain a sense of who you are, your priorities and values.”

Exercise can play an important role in reconnecting with body and self, and in regulating the nervous system’s stress response. Sometimes people unknowingly back into this simply by starting an exercise regimen, says Schneider. He has trained clients who didn’t know they were dealing with posttraumatic effects until they began moving their bodies. “Movement and touch can draw out somatic [body-only] memories and experiences blocked by trauma,” he explains.

Movement is a way to learn to pay attention to the senses, inside and out. This “can be extremely important when endeavoring to resolve trauma,” writes body-psychotherapist Rothschild. “It is the information from the senses that the amygdala [which is responsible for emotions, survival, and memory] uses to determine whether an environment is safe or dangerous and how to respond.”

People experiencing the aftereffects of trauma may place disproportionate emphasis on their interoceptive sensations, notes Clapp, especially if their condition comes with highly uncomfortable sensations, such as pain or an increased heart rate.

“However, problems arise when the individual uses those discomforting internal sensations to judge the safety or danger of the external environment,” she adds. Otherwise-safe spaces can feel dangerous.

“The way out of this dilemma is to develop a dual awareness that will make paying attention to both internal and external senses simultaneously possible,” Rothschild explains.

That’s why activities that demand focus on something within and something outside — such as Clapp’s simple balance exercise with Jenga blocks — can be tremendously useful.

In addition to repairing the effects of trauma, exercise gradually builds physical resilience. And that strength can help us feel safe and able to hold our own in the world.

In addition to repairing the effects of trauma, exercise gradually builds physical resilience, says Schneider. And that strength can help us feel safe and able to hold our own in the world.

Just as there are many different types of trauma and ways they are ­expressed, there is no magic prescription to overcome its lingering, sometimes-debilitating effects. A therapeutic tool may work for one person and not another, and multiple techniques may be best used in tandem — for instance, pairing talk therapy with a mindful-movement practice. Likewise, there is no exercise prescription for trauma; each successful protocol is as unique as the person being treated.

That said, a mindful and trauma-sensitive movement practice might include the following, which Clapp includes in her MFT program:

• Balancing activities, such as training on one leg, with your arms at chest level or above (possibly holding extra weight), or even with closed eyes.
• Contralateral movements, like crawling or single-leg deadlifts, that require opposite sides of the body (left arm and right leg, for example) to work simultaneously.
• Activities that involve crossing over the midline of the body, such as Russian twists and curtsy lunges.
• Strength and mobility work that targets the posterior chain and core, such as rowing and deadlifting.
• Primal- and functional-movement patterns, including squatting, lunging, pushing, pulling, twisting, bending, walking, crawling, and running.

Consider this a progression. Begin with balancing exercises and advance to more complex movements, adding difficulty and weight gradually.

Moving through trauma takes work, and that work may present a lifetime of challenges. But there is also hope. It is possible for every person to regain resilience and confidence. It is possible to feel good again.

The Benefits of Gentle Movement

Psychologist Christina Hibbert, PhD, discovered the impact of movement on her own mental health when she suffered postpartum depression following the birth of her first son. Cooped up for 45 days while taking care of him, Hibbert experienced a revelation when she was finally able to take him outside for a walk.

“I felt like I’d broken out of jail,” she recalls. The sun on her face and the movement of her body helped her realize that she needed regular exercise to be strong and healthy. She later became a certified fitness instructor, and she relied on walking, jogging, and other movement to get her through the depression and anxiety that followed the labor and birth of her next two children.

“Exercise works as medicine,” says Hibbert, author of 8 Keys to Mental Health Through Exercise and founder of the Arizona Postpartum Wellness Coalition. “It changes our brain chemistry.”

Research has shown that aerobic exercise helps balance neurotransmitters, such as serotonin, norepinephrine, and dopamine, which regulate mood and combat the effects of stress and anxiety on the brain. It also releases the body’s natural opioids and endocannabinoids, which reinforce a sense of well-being.

The most traumatic period of Hibbert’s life, however, began when she was four weeks from delivering her fourth baby. Her brother died of skin cancer. Two months later, her sister-in-law died of an overdose of painkillers and alcohol.

Hibbert, by then in the midst of postpartum depression and experiencing anxiety, knew right away that she and her husband would become parents to their nephews, ages 10 and 6. They quickly went from a family of four kids to six.

“I was in shock for the first two months,” she says. “I was so busy taking care of the children that I didn’t feel anything yet. I was on autopilot. And then I was completely overwhelmed by grief.”

Hibbert began enduring nightmares, brain fog, fear of what was going to happen next, bitterness, and self-loathing. She felt hopeless and worthless. And she remembers feeling one day like the bottom dropped out.

“I thought all moms with big families could do this better than I could,” she says. “I felt like a failure. Because I felt grief stricken, I felt like a terrible mom, a terrible person.”

It’s common, she explains, for people to question whether they’re good enough after they experience trauma. So again, she turned toward moving her body — gently.

“When you’re traumatized, you shrink,” she explains. So she started stretching in her bed when she woke up in the morning. She also took walks in nice weather, and put a treadmill in front of a window in winter months. “It was a way for me to process grief. When I moved, I could feel things. It was the only thing I could count on to change the way I felt.”

Gentle movement can also help improve proprioception, the ability to know where your body is in space, something that can be challenging for people dealing with trauma.

Hibbert cautions against pushing too hard. She recommends learning how to use movement as a way to love yourself instead of a way to punish yourself.

“When you’re going through trauma, you’re already going through so much. You don’t have to force yourself to do exercise that makes you feel worn out when you’re already exhausted.”

Trauma by the Numbers

70%

Percentage of American adults who have experienced a traumatic event, according to the Sidran Foundation, which provides traumatic-stress education and advocacy. Some 20 percent of these people eventually develop PTSD.

16 million

Number of Americans currently suffering from PTSD — 5 percent of the population.

1 in 13

Estimated number of Americans who will develop PTSD during their lifetime — 8 percent of the population.

Flipping Your Lid

One way to understand how the brain functions under stress is explained by Daniel Siegel, MD, a clinical professor of psychiatry at the UCLA School of Medicine and executive director of the Mindsight Institute, a mental-health educational organization. Siegel’s model, described in his book The Whole Brain Child, divides the brain into the “upstairs brain” and “downstairs brain.”

“Downstairs brain” refers to the lower limbic, more primitive part of the brain that acts out of instinct. This is the area of the brain responsible for breathing, blinking, big emotions like anger and fear, and reactions of fight, flight, collapse, or freeze.

“Upstairs brain” refers to the part of the brain responsible for higher-order thinking, such as imagining, planning, decision-making, and analytical thinking. When the upstairs brain is functioning well, one can regulate emotions, think before reacting, and exhibit empathy, morality, and self-understanding.

To comprehend this, Siegel suggests making a fist with one hand, closing the fingers around your thumb. If your fist represents your brain, the hidden thumb represents the downstairs brain, the amygdala that serves as the alarm and emotional center. The fingers that close over the thumb represent the upstairs, thinking part of the brain, the prefrontal cortex.

When we are upset, we can still express our feelings rationally, but only if the thinking, upstairs part of the brain is still connected with the downstairs, emotion-and-instinct area. When we get really upset we might “flip our lid.”

Now lift your four fingers to expose your thumb: The upstairs brain is no longer in connection with the downstairs. Engaging in nervous-system-regulation techniques can help bring the upstairs and downstairs brains back together, reentering the “window of tolerance” — the zone of arousal that is optimal for well-being and effective functioning.

Traumatic and chronic stress can force us out of this window of tolerance, pushing us into a hyperaroused (fight-or-flight) state or a hypo-aroused (freeze-or-collapse) state. Although these are not inherently “bad” states, staying in one or the other — or bouncing between the two — for a prolonged period of time can damage our overall health and create dysfunction in our lives.

A chronically hyperaroused state includes feeling overwhelm, anxiety, rage, and aggression; obsessive-compulsive or addictive tendencies; rigidity; and impulsivity.

A chronically hypo-aroused state may feature dissociation; memory loss; the sense of being disconnected, shut down, or running on auto-pilot; and a lack of emotional display or expression.

While there are multiple models to help practitioners guide clients back to an optimal level of tolerance, trauma-informed movement emphasizes self-regulation tools and techniques to return people to an optimal window of tolerance and build flexibility in their stress response.

It’s worth noting that living within your window of tolerance at every moment is not the goal. Stress is a necessary part of life; resolving it and returning to your window of tolerance is critical.

This originally appeared as “Moving Toward Healing” in the September 2019 print issue of Experience Life.