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when your anxiety lives in your body, talk therapy isn't enough

the somatic connection in psychotherapy

I'm a big supporter of psychotherapy. In fact, I just started my Master's Degree in Clinical Mental Health Counseling! I'm looking forward to being able to offer licensed mental health support to folks that integrates my existing knowledge of the body and mindful practices.

It felt important to me to pursue more training because in my current practice, I see so many somatic (body-based) connections to mental health that are commonly missed in traditional talk therapy. Talking can only take us so far. While terms like "somatic" and "embodiment" have become more and more common in the psychotherapy field, I still find that many therapists are still missing the crucial element of somatic understanding.

“For a hundred years or more, every textbook of psychology and psychotherapy has advised that some method of talking about distressing feelings can resolve them. However, as we’ve seen, the experience of trauma itself gets in the way of being able to do that. No matter how much insight and understanding we develop, the rational brain is basically impotent to talk the emotional brain out of its own reality." --Bessel van der Kolk, The Body Keeps the Score

our bodies need to feel safe

Our mental health isn't simply something that exists in our brains. Each of us is a complex system that consists of many interrelated systems, and which is affected by our history, culture, and other factors. There is no central command unit; each of the many parts of this constellation has the capacity to affect the others. This is the primary concept of The Murmuration Model of Adaptive Behaviors, which Jennifer Snowdon and I talk about in our upcoming course on Traumatic Stress and the Breath.

What this means is that when one part of our system feels unstable or unsafe, all of the other parts are affected. We might experience this as anxiety, stress, hyper-vigilance, or other symptomology (for example, we might experience compensatory tightness or stress in our muscles). It doesn't matter what our brain"tells"us; there's no manual override here. A lack of stability or safety in the body means that our entire system is going to compensate to create a greater sense of safety or containment.

One example of this occurs in folks living with Hypermobility Syndromes. For folks who live in hypermobile bodies, it can be more difficult to feel stable or grounded. Their proprioception ability is different; the system has a harder time understanding where it is in space. Many other parts of the system can be affected as well. It's common for these individuals to experience muscle tightness, feel achy, and get fatigued more easily than someone who is not hypermobile. There are many studies correlating hypermobility and anxiety disorders (like this one by Jessica Eccles and team, quoted below).

Individuals with hypermobility are (up to 16 times) overrepresented among those with panic or anxiety disorders. Hypermobility is also linked to stress-sensitive psychosomatic disorders including irritable bowel syndrome, fibromyalgia and chronic fatigue and is associated with hypersensitivity to nociceptive stimuli. Additionally, individuals with hypermobility often exhibit autonomic abnormalities, typically postural tachycardia syndrome, where there is enhanced cardiovascular reactivity and a phenomenological overlap with anxiety disorders.

If a hypermobile client is experiencing anxiety and their therapist fails to recognize that this symptom is part of a complex system of interrelated, physiological phenomena, they miss an opportunity to help the individual feel supported and more stable. For example, strength training can be quite beneficial for these folks, as can movement activity that helps stimulate proprioception in their bodies. Finding comfortable ways to feel supported (and normalizing these), like sitting with their legs curled up, or shifting position frequently, is important. Perhaps more importantly, simply validating the experience and understanding that these are natural and normal responses can in itself be healing. In some cases, diagnosing JH can explain other serious "mystery" symptoms that have eluded diagnosis-- so finding a medical professional that understands these disorders is key. You can read more about JH here.

Other sources of instability

In addition to joint hypermobility, there are other reasons that people may feel existential instability and insecurity in their system. One common (and commonly missed!) reason is poor dental occlusion-- that is, if someone is unable to get good molar contact, where their back teeth touch. Feeling this bite is important to our brain's sense of safety. If we can't achieve this, we will feel less stable overall, and compensate in other ways (neck tightness, systemic bracing, tension, anxiety). This is the case in my body, where my inability to touch my back teeth naturally means that my neck and hips "lock up" to try to help support me. When I am able to achieve occlusion (with a dental splint, or even chewing gum) I breathe more easily and have more range of motion. I'm working with an orthodontist now to correct my bite, and simply understanding why this is the case for me helps me to recognize that I will feel more anxiety and less stability when I am not able to make that connection. If you think this may be the case for you, I recommend working with a Postural Restoration provider who can assess and support you.

Of course, other parts of our system can contribute in similar ways. Brain injuries; hearing or visual imbalances have an enormous effect on how we function. Heart irregularities-- not an uncommon issue-- replicate the feeling of a threat response in our bodies! Undiagnosed or unsupported physiological issues like these can leave us feeling anxious-- so we seek out therapy, which cannot "fix" the experience our system is having of being unsafe. If we are then made to feel that we should try to control their anxiety from the "top-down", by working on our thought patterns alone, we are more likely to feel as though we are failing at managing our mental health.

Breathing is a big one

Perhaps the most common source of embodied anxiety that I see in folks is a generalized pattern of stress breathing. This presents differently in each individual, but will often look like shallow breathing; accessory (neck/shoulder/chest) or belly breathing. The person may have over-active spinal extensors that won't shut off, or over-active neck muscles, or a nose that always feels clogged.

All breathing patterns are adaptive, and not inherently problematic. However, if we get "stuck" in a defensive pattern, it reinforces the feeling that something is wrong for our system. We're breathing like we're anxious, so we feel anxious. Being unable to get a breath that feels easy, calm, relaxed, or nourishing, can feel pretty bad. And when our therapist tells us to "take a deep breath" and we CAN'T, or it increases our stress level-- that can feel much worse.

The good news is that these things are quite easily addressed, when we recognize them. (Did I mention that we'll cover all of this in next month's Traumatic Stress and the Breath course with Integrative Breathing Therapist Jennifer Snowdon? You can read more and register here).

Of course, it would be unreasonable for all psychotherapists to also be anatomical experts, or breathing therapists, or physical therapists, etc.! What we can work toward is a greater understanding of our mental health as part of a system that includes not just our brains but our embodied experience. If talking doesn't seem to be working to alleviate anxiety, or we feel "stuck", it may be helpful to consider addressing other potential parts of the system as part of our therapeutic approach.

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Your passion and strength will make such a difference in yourself and many. Proud to know you

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