Embodied psychotherapy techniques such as Gestalt Therapy created in the 1940s, Dance/Movement Therapy in the 50s, and Somatic Psychotherapy techniques including Focusing (Gendlin,1984), Somatic Experiencing (Peter Levine, 2015), Sensorimotor integration (Pat Ogden, 2015), family constellations created in the 90s (Hellinger, 1996; Kampenhout, 2001) and more recently coming from a neurobiology perspective Stephan Porges (2011) and van der Kolk (2014) are bringing the body to the forefront in psychotherapy and trauma treatment. Van der Kolk (2014) has advocated for the integration of the body in trauma treatment, endorsing yoga as an effective complementary treatment for PTSD and chronic PTSD (C-PTSD). Even though research on embodied techniques for trauma treatment is in its beginning stages, many researchers have accepted the following premise: “The high rates of somatic complaints among traumatized individuals indicate that a trauma is remembered in the body” (West et al., 2017, p. 174).
Greenberg and Malcolm (2002) studied the use of the Gestalt Therapy technique of the empty chair dialogue as an embodied technique to heal one’s relationship with parental shortcomings. Participants (N = 26; Mage = 42, SD = 8.95, range = 27 to 68 yrs) reported being maltreated and suffered relational problems throughout childhood participated in 12 to 14 weekly individual sessions (1 hr. each) using the empty chair dialogue, where present moment expression is given to emotions about things that happened in the past and needs that were not met. Each session was led individually by a therapist from a group of eight advanced doctoral students of psychology, who had a minimum of 3 years of clinical experience and a minimum of 1 year of training in the empty chair technique. Participants were then asked to sit in another chair in the role of the parent. This role reversal and full embodied emotional engagement, according to the authors, facilitated an embodied sense of resolution. According to a Chi-square analysis, there was no statistically significant difference between “groups on sex, level of education, and marital status, whereas a t test showed no significance at the .05 level on age” (p. 412). Ten Likert scales were developed to analyze the videotaped sessions, which were each coded by two raters from the group of doctoral students and clinical psychologists trained for the task. Greenberg and Malcolm (2002) verified the coded sessions and analyzed the data to determine which elements were present when the method worked. Based on results, the researchers separated the participants into two groups, one set of participants who showed complete resolution (N = 13) and the other group who were randomly selected from among those who didn’t completely resolve their unfinished business (N = 19); four did not complete the trial. The researchers concluded that the empty chair technique was effective only when there was a presence of embodied emotional expression for completing unfinished business with the parent.
Rae Johnson (2009) conducting two sets of 60 to 90 minutes interviews on the topic of personal experiences on embodied oppression. During the interviews one or two embodied techniques included “focusing” as described by Eugene Gendlin (1982) and boundary exercises in order to explore issues and patterns in one’s personal space. Two main themes held the focus of the researcher: embodied response to oppression and somatic impact of trauma; the body as a place of wisdom and a place for social and personal power as resistance towards oppression. When it came to embodied response and somatic response to trauma, Johnson (2009) found three main experiences: body memory, somatic vigilance and withdrawal or alienation from the body. When it came to embodied power, participants reported using arts, dance, yoga and using education and safe forums to reclaim one’s body. Johnson (2009) concludes that although more studies linking trauma and oppression still needs to be made, the body can offer a place of hope: “Although the stories they tell offer examples of the trauma and disconnection that result from the misuse of interpersonal and social power, they also offer the promise of hope and change” (p. 14).
As seen in early attachment research, community support can play an important role in overcoming complex post-traumatic stress disorder (C-PTSD). Broadening the embodied relational aspect of trauma treatment to a community, three interns, Silva et al. (2015), two dancers and one psychologist, came together to study the intersection of dance and psychology while working with 12 youth at risk in a community in Rio de Janeiro for a year. Following a phenomenological theory by Merleau-Ponty and Gestalt Therapy, and the dance foundation as defined by Helenita de Sa Earp, the group of three found important similarities in their ontology, epistemology, concept and methodology during the workshops. The researchers had a dance and a psychology supervisor and searched for understanding the experience of the participants from an interdisciplinary approach while facilitating a dance, with music and video. One of the common goals that served to create dance and therapy was that Laura Perls as a dancer and musician, often used coordination, posture and breath, voice and body awareness. In this, the idea of having a body versus being a body was illuminated through the process. Other similar findings were that the body would hold tension in the tissues of the person in the present from events that were traumatizing in the past. Through dance, there was a spontaneous expression and relief of what felt habituated coping into creative embodiment. The embodied awareness, with expression and dialogue were important affinities found in the disciplines of Gestalt and Dance.
Despite the difficulties in creating valid and trustworthy dance/movement therapy (DMT) research, over the years, there have been several studies using DMT to treat trauma. Levine and Land (2015) completed a meta-synthesis of nine qualitative studies on dance/movement therapy, a treatment for individuals with PTSD. The findings included themes of increased awareness of the body-mind connection, reclaiming trust and empowerment in the body through increased range of movement, and creating healthier relationships with others in the group, themselves, and therapists. The authors emphasized that only one study was conducted in Israel, while the other eight were conducted in African countries where dance is a common vehicle for communication and community building, limiting transferability to other cultures (Levine & Land, 2015). The findings from this meta-analysis on dance/movement therapy also supported findings in neurobiology research, which suggested movement-based treatment to be helpful in treating trauma.
In another study, Levine and Land together with Lizano (2015) conduct 15 semi-structured interviews with dance/movement therapists in The United States who worked with women with a history of PTSD. This study intended as a first step towards understanding what are the elements present when practitioners that use Dance/Movement Therapy work with a population diagnosed with PTSD. Interviews ranged from 30 to 75 minutes in length and the material was condensed into themes on how the participants work with this population. Results included working in groups, and having a movement based warm up for assessment and facilitating participants to get in touch with their authentic self, that assisted the facilitator to see what needed to be developed. Once the therapeutic rapport was developed, participants talked about the use of metaphor, music and props, body awareness, mirroring, empowerment, trust and self-care as part of the middle of the session. The end of the session themes included processing, and integrating other therapeutic modalities such as expressive arts and verbal therapy. Researchers created a platform of interventions that could further be studied as possible important elements in effectively treating women with trauma. Nevertheless, the use of the body in treating PTSD is still elusive and needs further understanding.
Following an embodied inquiry approach, Federman et al. (2016) correlated verbal life stories and body movement expressions among 16 Holocaust survivors aged 73 to 93 (nmale = 7, nfemale = 9) who were part of building the world’s first Holocaust Museum in Israel. The qualitative open and unstructured interviews were videotaped and analyzed for major themes in correlation to movement analysis. Interviewers began with open questions, such as, “Please tell me the story of your life.” And then added additional questions as the interview went on, such as, “What are the most important memories that you have from your Holocaust experience?” and, “What bodily sensations do you remember from moments of distress, relief, horror?” (p. 19). The data analysis had four stages, observing movement expressions, coding verbal content, cross checking between both, and finally organizing data. Observing movement was done from a videotape and nonverbal analysis was based on “on movement dimensions such as use of space, mobility, sensory and body arousal, flow of movement, direction, and typical body expressions” (p. 20). The verbal coding was done looking for meaning, and after the cross check the data was organized in six clusters: “activity, passivity, arousal, self-reassurance, deadlock, and suffocation (p. 16). Authors concluded that the interviews showed verbal and emotional non-verbal expressions were congruent and both told important parts of the same story. The trauma embodiment showed up after many years still present in the survivors' embodied expression as they told the story, even though each person integrated the story with the bodily expression in an individual way. One common consequence of carrying traumatic memories leads to difficulty in telling a coherent story of what happened and expressing a “sense of integrated identity” (p. 16). By paying attention not only to the content of the narrative but to nonverbal actions, in facial expressions and gestures, communication became clearer and understood. Although this research filled a gap in embodied knowledge, the expertise of movement observation created difficulty for this study to be recreated. Nevertheless, this study is crucial in the premise of integrating the body in treating the trauma.
In the modality of another ancient, embodied method, Ashtanga yoga was studied in a mixed-method on regulating the intensity of implicit traumatic memory felt in one’s body when engaged in conscious movement. LaChiusa (2016) described Ashtanga yoga practice as it related to trauma, dreams, images, and the unconscious. By explaining implicit memory as encoded emotions and sensations, the author argued that body sensations and movement trigger traumatic memories that are stored in the body and stimulate the amygdala. The author’s hypothesis was that embodied practices could support complex trauma survivors in working through trauma and, as a result, increase their sense of body acceptance and affect regulation. The first part of the study was quantitative and served as a foundation for the qualitative part, where six participants were chosen based on their questionnaire responses. All participants chosen for the qualitative portion of this study scored moderate to severe levels of abuse or neglect on the short version of the Childhood Trauma Questionnaire. In the quantitative portion (n = 31), 90% reported yoga helped with emotions and 96.8% reported it helped with body awareness tolerance, which supported the decision for a qualitative portion for the study, where participants could discuss their experience of using yoga to help with trauma. Through a thematic analysis of a 60-min, semi-structured interview with each participant, LaChiusa (2016) identified the following themes: being ‘at home’, connecting with the present moment, starting slowly, holding difficult emotions in specific sites, and healing the body to transform the psyche. These themes are important elements for creating resilience and embodiment, and the thick description showed trustworthiness, but the small sample of the quantitative part of the study limited external validity.
According to West et al. (2017), trauma in childhood can present as C-PTSD that lasts into adulthood and is resistant to trauma-processing treatments that do not emphasize self-regulation. Treatment that does not address somatic symptoms and heightened physiological states is considered to be ineffectively meeting the need for clients to be able to focus on the present moment and tolerate triggers without avoiding body awareness and therefore dissociating. In order to investigate how yoga could aid the treatment of women (N = 31) with C- PTSD, West et al. (2017) conducted a qualitative study focused on a 10-week trauma-sensitive yoga program. According to the authors, “the intention of hatha yoga (commonly referred to simply as ‘yoga’ in the Western world) is to cultivate mindfulness through a combination of physical movement, breathing exercises and intentional relaxation” (p. 175). Findings supported PTSD symptom reduction as well as themes of developing gratitude, relatedness, acceptance, centering and empowerment (West et al., 2017). There was no member checking, and participants were 74% Caucasian, which impacted both trustworthiness and transferability.
Levine (1997) pioneered Somatic Experiencing (SE), a body-centered technique that teaches clients to use body awareness of traumatic memory while regulating it with a body sensation of a pleasant or positive memory. Brom et al. (2017) studied the effectiveness of SE to treat post-traumatic stress disorder (PTSD) in Israel. The researchers randomly assigned 63 participants, who through initial interview and Clinician-Administered PTSD Scale, met the criteria for PTSD into two groups. The experimental and control group had 33 and 30 participants, respectively, and both groups were about 50% female. The experimental group received 15 weekly SE sessions, while the control group remained on the waitlist during the same period of time. The statistical results reflected a moderate effect, with 44.1% of experimental group participants no longer meeting the criteria for a PTSD diagnosis following intervention; however, the effect size was large for both PTSD and depression symptoms (Cohen’s d > 0.8). These results were promising, considering that researchers reported the sample was exposed to local war and terrorist attacks during the course of the study, but still showed improvement (Brom et al., 2017). Further research with other populations and locations would strengthen the study’s external validity. Also, further studies to determine what part of this embodied inquiry technique is effective might yield a universal understanding of the importance of movement in trauma treatment.
Recently, there was enough research using yoga in trauma treatment to conduct a meta-analysis of 15 studies using seated or gentle yoga that included breath, meditation, and mantra repetition, 70% of participants maintained their improvements in PTSD symptoms (Cushing & Braun, 2018). Although a meta-analysis was helpful, a comparison research study might help solidify this conclusion. Nevertheless, research supports mind-body approaches to treating trauma-related disorders and trauma symptoms and might be helpful in the treatment of TGT.
Zaccari et al. (2020) researched the impact of yoga on symptoms related to cognitive function, PTSD, and cortisol levels. Pre-tests and post-tests were administered within two weeks of a 10-week yoga protocol intervention. All participants were measured with The Delis-Kaplan Executive Function System, Color-Word Interference Test, Digit Span from the Wechsler Adult Intelligence Scale, and the Trail Making Test A & B (for cognitive performance), self-report symptom questionnaires, the PTSD Checklist for DSM–5, the Beck Depression Inventory, the Multiple Sclerosis, Neuropsychological Questionnaire, the Pittsburgh Sleep Quality Index, and the Satisfaction with Life Scale (to measure mental health symptoms and quality of life). Twenty-seven veterans with PTSD who had trauma treatment previously were recruited from a mental health clinic and separated by gender for the sessions. Even though Cortisol levels that were measured through saliva samples were not statistically significant, yoga did impact and improve cognitive function, PTSD symptoms including better sleep and quality of life. This research has very small samples for a good quantitative research with good validity, therefore, like many studies in the area of body and trauma treatment, it suggests the need for further research.
Beyond qualitative and quantitative research, Turner (2017) reported developing a paralyzing somatic memory that only healed after she began to investigate her ancestral connection to the Holocaust. Buonagurio (2020) reviews a literature supporting the use of dance/movement therapy to heal TGT. Other authors, such as Wolynn (2017), have described many case studies, including his own, in which healing happened through investigating embodied ancestry. Peter Levine (2015)shows through case studies the mysteries of ancestral embodied memory. Furthermore, techniques such as well as research on post-traumatic slave syndrome conducted by Dr. Joy DeGruy (2005) demonstrates how the body holds the memory of one's ancestors and their traumas in one’s family dynamics. Some experts of dance/movement therapy have described transgenerational trauma as a dissociation of body and mind and the need to assist the client in returning to the body and the aspect of time difference in their understanding of transgenerational trauma (Baum, 2013). Baum (2013) proposed that TGT had to be acknowledged by listening to the body: “The trauma event can then be brought out consciously and with mindfulness – ideally through a psychotherapeutic process, particularly one that acknowledges the role of the body in carrying trauma” (p. 40). Plenty of publications suggest ways to incorporate dance to treat TGT (Dieterich-Hartwell, 2017; Stanek, 2015), self-reported DMT techniques used with trauma (Levine et al., 2015), case studies showing how to modify techniques for extreme levels PTSD (Gray, 2001) have been documented and are helpful as a background for further studies. Lastly, post-traumatic slave syndrome as defined by Dr. Joy DeGruy (2005) as an embodiment of one's ancestral traumas, is another area of study that shows promise in helping advance the understanding of collective trauma. Through case studies and historical research, Dr. DeGruy shows how slavery still affects communities that continue to experience the cruelty that happened with one’s ancestors.
In summary, research has shown that embodiment of emotion helps heal issues with parents and youth at risk in a poor community (Greenberg & Malcolm, 2002; Silva et al., 2015). Despite the difficulties in creating valid and reliable research, there is enough research for a meta-analysis showing DMT in trauma treatment (Levine & Land, 2015). Oppression shows as embodied chronic trauma (Johnson, 2009). Furthermore, recent research using yoga as a complementary technique in treating yoga has shown positive results (Cushing & Braun, 2018; LaChiusa, 2016; West et al., 2017; Zaccari et al., 2020), trauma in childhood can present as C-PTSD that lasts into adulthood and is resistant to trauma-processing treatments that do not emphasize self-regulation. Furthermore, somatic experiences are shown to be effective in treating PTSD. Many leaders in the field have also reported in detail how they work through the body and trauma through case studies (Levine, 2015; Ogden, 2015). Nevertheless, further research in this area is needed.