People living with PTSD can be particularly prone to sensory overload, which can have a major impact on the normal functioning of brain processes if not identified and treated. The impact on a happy, healthy life is the same, regardless of the original trigger for the anxiety or sensory overload, and there are strategies to help restore equilibrium and quality of life.

As with so many mental health conditions, sensory overload is related to the reptilian brain and the fight, flight or freeze (FFF) responses to calamity or what we perceive as a calamity. When we are overwhelmed, our five senses (sight, sound, smell, touch, and taste) tend to become over-sensitised, which causes our brain to become overwhelmed or overloaded by the amount of data being submitted. This is a bit like trying to stuff more clothes into a trunk than it can physically handle until something has to give, or to use a more 21^st Century analogy, running out of RAM, which makes everything just seize up. When this happens, it causes a sense of anxiety, panic, and a general feeling of being unsafe, and during sleep can give rise to nightmares which then exacerbates problems in waking hours.^[1]

Regardless of whether the anxiety or the sensory overload has come first, the outcome is the same; the sufferer will frequently find themselves in situations and settings that will trigger their symptoms or an episode. Several conditions are linked with sensory overload, but it is highly common for people with Post-traumatic Stress Disorder (PTSD); for instance, soldiers who are easily tripped into FFF responses by, for example, loud noises, strobe lighting, or fireworks, which can cause a meltdown. People who have suffered sexual or other forms of physical abuse and violence, accident survivors, or even people who have lived through natural disasters can all develop PTSD ^[2].

Brought about by a traumatic event that the person has associated with the possibility of death or grave injury at the very least, the condition can become highly debilitating, quickly sparking an episode and triggering the preferred coping mechanism of the sufferer. It’s worth noting that the event may not be traumatic for someone else, so it’s about perception and context. The problem with this is that it becomes exhausting as this hypervigilance is based on a faulty detection system which causes the sufferer to feel worried or frightened when there is no actual threat to life and limb. To use another analogy, it’s like that annoying alarm on your neighbour’s car that is frequently set off by another vehicle just driving by (usually at 2am!) or someone bumping the car as they walk past.

The Brain and Trauma

Trauma experts like Dr. Bessel van der Kolk and Professor Stephen Porges describe the brain actually being altered as a coping response to traumatic events, especially those that are sustained or repeated in nature, which is a neurobiological, chemical response and nothing to do with personal resilience or fortitude.^[3] Due to the trauma, future events are responded to in a similar way, in the form of a variation on a theme (different triggers but a standard response) because it is comfortable for the brain, which has, in effect, become stuck in a loop.

Signs and Triggers

Like most things, the signs of sensory overload can span the spectrum from the very obvious to the more subtle or less easy to correlate. For instance, someone placing their hands over their ears, attempting to flee or fainting at the sight of fireworks might be pretty obvious, whereas a general inability to relax or being highly restless might not. In children, this might spark a tantrum which may be misinterpreted as receiving a simple shock when it is, in fact, sensory overload. In general, witnessing a hyper response or high levels of anxiety or, at worst, panic, which is quite different to the normal reaction in others, is usually a pretty good indication. However, some symptoms such as a racing pulse and pounding heart or dizziness won’t be visible to others. In general, symptoms fall into four categories:

• intrusion
• arousal
• avoidance
• thoughts and feelings, which are usually negative

Triggers can vary depending on the way the PTSD presents and whether the sensory overload is also related to another condition such as autism or ADHD, but common triggers include:

• being caught in a crowd.
• loud and/or shocking noises such as fireworks or helicopters.
• strong scents which can remind the sufferer or people or situations they identify as stress-inducing.
• inappropriate or unwanted physical contact or proximity.
• restrictive or otherwise uncomfortable clothing.
• flashing lights such as strobe lights or fireworks.
• extreme temperatures, especially sudden in nature.
• certain individuals or groups.

How Do We Clear the Cache and Delete the Trauma Cookies?

Obviously, the easiest route to avoiding a stress-induced episode is to avoid it, but unless we resign ourselves to a solitary life, living indoors with limited stimuli, the chances are that we are going to encounter new and stressful situations – and your sensitivities could actually increase. While this is a challenge even for non-PTSD sufferers, for those with PTSD, it can be debilitating and can prevent them from living full lives and even precipitate comorbidities such as substance abuse. Mastering breathing techniques for relaxation and learning to meditate can be invaluable in situations where you feel your pulse rate start to increase.

Sleep also plays an integral part in the body’s capacity for resilience (the more tired you are, the more sensitive you will be), as does eating healthily, cutting down on salt, exercising, and drinking plenty of water.^[4] Avoiding stimulants like nicotine, coffee, alcohol, and illegal drugs is also recommended. In some cases, medication can be helpful though all the factors in your condition need to be considered and viewed holistically and empathetically by a healthcare specialist who can take all of the elements into account.

Other recommended strategies include:

• When out and about, choose more quiet periods and less buzzy environments such as restaurants if eating out.
• If holding a meeting, try to choose a quiet venue and ask people to speak slowly and in turn. If you don’t feel comfortable explaining the real reason, tell them that you have a hearing issue.
• If you feel one sense overloading, try some distraction tactics like relaxing music or eating something with a strong flavour like chilli or peppermint. Experimenting with smell in the form of aromatherapy (including candles) can also be helpful, and there are a multitude of essential oils to choose from.
• Deep pressure can remove the focus and place it somewhere else, for instance, on the steering wheel of your car by squeezing some wrist grips, or the most fun way, giving yourself a hug.
• Embrace your inner Marie Kondo by living minimally, which not only helps with mental clarity but also reduces the risk of injury if overstimulated.
• Invest in some earplugs and/or headphones, so you choose what and when you listen to something.
• Have some white noise like a fan or something on quietly in the background like a radio or TV.
• Sunglasses or tinted glasses depending on the stimulant can aid with visual over-stimulus.
• If you find travelling stressful and you are not the driver, take the opportunity to nap.

Seeking support from your friends, family, and colleagues can also play a crucial part in helping you to circumnavigate triggers where possible. Choosing quiet activities in calmer settings instead of crowded restaurants, concerts, theatres (where you might also be trapped in a row of people) would be preferable alternatives, and they need to know this. Securing appropriate advice and treatment for accompanying conditions is also key to avoiding one condition feeding off another. Again, a trusted medical or mental health professional can be invaluable in helping you to manage this very fine balance to live a full and satisfying life.

If you have a client or know of someone struggling to heal from psychological trauma, reach out to us at Khiron Clinics. We believe that we can improve therapeutic outcomes and avoid misdiagnosis by providing an effective residential program and outpatient therapies addressing underlying psychological trauma. Allow us to help you find the path to realistic, long-lasting recovery. For more information, call us today. UK: 020 3811 2575 (24 hours). USA: (866) 801 6184 (24 hours).

Sources:

[1] Tanev, Kaloyan S. et al. “Positive Association Between Nightmares And Heart Rate Response To Loud Tones”. Journal Of Nervous & Mental Disease, vol 205, no. 4, 2017, pp. 308-312. Ovid Technologies (Wolters Kluwer Health), doi:10.1097/nmd.0000000000000641. Accessed 18 July 2021.

[2] Clancy, Kevin et al. “Restless ‘Rest’: Intrinsic Sensory Hyperactivity And Disinhibition In Post-Traumatic Stress Disorder”. Brain, vol 140, no. 7, 2017, pp. 2041-2050. Oxford University Press (OUP), doi:10.1093/brain/awx116. Accessed 18 July 2021.

[3] van der Kolk, Bessel A. “The Body Keeps The Score: Memory And The Evolving Psychobiology Of Posttraumatic Stress”. Harvard Review Of Psychiatry, vol 1, no. 5, 1994, pp. 253-265. Ovid Technologies (Wolters Kluwer Health), doi:10.3109/10673229409017088. Accessed 18 July 2021.

[4] Baglioni, Chiara et al. “Sleep And Mental Disorders: A Meta-Analysis Of Polysomnographic Research.”. Psychological Bulletin, vol 142, no. 9, 2016, pp. 969-990. American Psychological Association (APA), doi:10.1037/bul0000053. Accessed 18 July 2021.

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Pat Ogden, developer of SP and founder of the Sensorimotor Psychotherapy Institute, first began to develop her innovative treatment approach while working in a psychiatric clinic in California in the 1970s. As a dance and yoga teacher, Ogden observed that many of the patients in the clinic appeared to be deeply disconnected from their bodies, and this disconnection prevented resolution of their psychological issues. Missing from traditional talk therapies, Ogden noticed, was attention to the body.

The concept

The theory behind the approach is that traumatic threat stimulates the body’s emergency stress response. Release of adrenaline results in an increase in heart rate and breathing along with instinctive animal defense responses that compel us to automatically fight, freeze in terror, flee, or collapse in total submission (the ‘feigned death’ response seen in animals).  To allow these instinctive responses to be successful, the prefrontal cortex or ‘thinking brain’ is inhibited.  We sense what to do rather than decide what to do. But with an inhibited prefrontal cortex, we can’t put the experience into words.

Following the traumatic experience, the brain does not encode a chronological verbal memory of the event but instead stores the ‘memory’ of the trauma in the form of nonverbal physical and emotional memories. These implicit unresolved memories cannot be recalled, but they are continuously stimulated by even very subtle cues connected in some way to the event or events. These triggers evoke the same threat responses to danger, and our bodies respond as if we were.

Over time, the traumatic event does not resolve because it is activated over and over again by triggers. The traumatised individual still feels unsafe, frightened, and at risk or hopeless and numb. Bessel van der Kolk describes this phenomenon as “the body keeps the score.”  The trauma cannot be resolved because the body responses keep re-activating it.

Healing the body

For a long time, talk therapies have been the go-to approach for treating traumatised clients. While they can be helpful in increasing insight and self-compassion, the physical effects of trauma go unchanged or can even be exacerbated by the telling and re-telling of the events.

With a traumatised nervous system unable to effectively regulate emotions and impulses and a body easily stimulated by triggers, the individual often remains on high alert, anticipating new dangers.  The result is either emotional numbing (often labeled ‘depression’) or chronically high anxiety or impulsive and self-destructive.

A dysregulated nervous system affects all areas of life, from the ability to feel safe in the world to personal satisfaction and contentment, from the quality of our relationships to our ability to perform well at work or school.  Nervous system dysregulation is also the underlying ingredient in anxiety disorders, mood disorders and personality disorders.

How it works

‘Traditional talking therapies (including psychodynamic psychotherapy, psychoanalytic methods, cognitive-behavioural treatment, and exposure techniques) can effectively address the emotional, relational, and cognitive symptoms of trauma-related disorders and/or manage the secondary symptoms to ensure patient safety, but traditional psychotherapy models generally lack techniques that directly treat the autonomic and somatic effects perpetuating the psychological symptoms.’^[1]  – Janina Fisher

Here is where sensorimotor psychotherapy aims to intervene. Sensorimotor psychotherapy uses a somatic (body-based) and mindfulness-oriented approach in which clients are asked to become aware of the physical sensations accompanying their painful thoughts and feelings.

Each traumatised individual uniquely encodes an event or events in the form of images, smells, sounds, autonomic responses, visceral and muscular sensations, movements and impulses, emotions, and cognitive and narrative components.^[2]

By avoiding interpretation of the sensations or autonomic responses as danger signals and instead focusing on increasing the capacity to tolerate their feelings and physical reactions, most clients experience a calming effect. With practice and repetition, they begin to feel a greater sense of control over their overwhelming or numbing reactions.

In a sensorimotor psychotherapy session, the therapist focuses not on the events but on how the traumatic experiences are encoded in the client’s body. Mindful curiosity is encouraged, which itself helps with affective and autonomic regulation.

Sensorimotor Psychotherapy, Mindfulness and Dual Awareness

By cultivating their ability to be mindful, clients can foster a sense of dual awareness.  They can feel the uncomfortable or distressing feelings in their bodies while also holding awareness of present time and safety: “I feel scared though I can see that I am here with you and not in danger.” Dual awareness keeps the prefrontal cortex or ‘thinking brain’ active, allowing individuals to distinguish a threat from a trigger. In addition, the brain’s threat center (the amygdala) decreases its activity when there is increased activity in the medial prefrontal cortex. With practice, aided by increased connection to clients’ innate strengths and inner resources, the nervous system becomes more regulated. The result is the acquisition of the ability to connect to themselves without becoming numb or overwhelmed.^[3]

With a more regulated nervous system and more access to mindful curiosity, clients can then begin to transform the ways in which the trauma responses have become encoded in the body. The completion or transformation of old traumatic reactions occurs through the practice of physical interventions, such as a deep breath to expand the chest or a lengthening of the spine or the completion of defensive actions not available at the time. As traumatised individuals experience a physical sense of power, boundary, and mastery, their ability to tolerate their feelings and manage their impulses begins to grow, increasing the capacity for pleasure and connection in daily life.

In Conclusion

Sensorimotor psychotherapy addresses how traumatic memory is held in the body. Clients are supported and guided in becoming aware of how the body ‘remembers’ the trauma or communicates feelings and emotions. Focus is centred around befriending and managing trauma-related thoughts, feelings, and impulses so they are less disruptive to the client’s wellbeing.

Mindfulness and curiosity are combined with a cultivation of the client’s inner resources and strengths, along with psychoeducation, to help the client experience present moment safety, connection, and a bodily sense that ‘It’s over, and now I am safe.’

Get in touch

If you have a client, or know of someone who is struggling and could benefit from sensorimotor psychotherapy, reach out to us at Khiron Clinics. We believe that we can improve therapeutic outcomes and avoid misdiagnosis by providing an effective residential program and out-patient therapies addressing underlying psychological trauma. Allow us to help you find the path to realistic, long lasting recovery. For information, call us today. UK: 020 3811 2575 (24 hours). USA: (866) 801 6184 (24 hours).

Sources:

^[1]  Fisher, J., n.d. Sensorimotor Approaches To Trauma Treatment. [ebook] Available at: <https://janinafisher.com/pdfs/trauma.pdf> [Accessed 5 August 2020].

^[2]  Fisher, J., n.d. Sensorimotor Approaches To Trauma Treatment. [ebook] Available at: <https://janinafisher.com/pdfs/trauma.pdf> [Accessed 5 August 2020].

^[3] Ogden P, Minton K, Pain C (2006) Trauma and the body: a sensorimotor approach to psychotherapy. W.W. Norton.

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“The body is our general medium for having a world” Merleau-Ponty (1902-1961).

Pat Ogden, the founder of a therapy that many of our therapists practice at Khiron House, Sensorimotor Psychotherapy, had the insights that led to the birth of her new therapy at a time when paradigms were shifting.

She was developing her ideas not long after the french philosopher, Maurice Merleau-Ponty (1902-1961), broke with the intellectual tradition he was part of by emphasising the body as the primary site of knowing the world. That tradition had always viewed consciousness as the source of knowledge but for Merleau-Ponty the body was completely enmeshed with ‘that which it perceived’.

He emphasised the importance of ‘experience’ :

“the world is not what I think, but what I live through”.

Merleau Ponty is now widely regarded as a hugely influential and under rated thinker, but at the time, in his philosophical and intellectual circles, this thinking was seen as far from the mainstream and as unusual. However, it would undoubtedly have made complete and utter sense to the body therapists (like Pat Ogden) who were starting to emerge around the end of Merleau-Ponty’s life.

In the early 1970’s, Pat Ogden was working as a technician and a yoga and dance teacher at a short term psychiatric unit. She started to notice a correspondence between her clients’ disconnection from their bodies, their physical patterns and their psychological issues. Dr Ogden realised that, while most of the patients with trauma were constantly at the mercy of reliving their past traumatising experiences, the treatments at the hospital were actually also triggering traumatic reminders.

For Pat Ogden it started to become very clear that “the body had been left out of the talking cure” and she then became deeply committed to working in and developing body-centred somatic psychotherapy.

She went on to co-found the Hakomi Institute with Ron Kurtz. Then, in 1981, she began her own school , the Sensorimotor Psychotherapy Institute, which pioneered a therapy that draws on somatic (‘of the body’) therapies, neuroscience, attachment theory and cognitive approaches.

The beginnings of Sensorimotor Psychotherapy in the UK

Our clinical lead, Catriona Morten, was one of the very first UK graduates in Sensorimotor Psychotherapy when training began in this country.

The very first time Catriona came across Pat Ogden’s work was at a conference, here in the UK, where leading Sensorimotor psychotherapist, Janina Fisher, from the Sensorimotor Institute in Boston, was speaking about Pat Ogden’s approach and also giving a practical presentation.

At the time of the conference, twelve years ago, Catriona Morten was a therapist at the NSPCC and she was finding that the therapies at her disposal were not answering the needs of the deeply traumatised children she was working with. She was realising that approaches that required these children to recall the events from their past, and to speak about those experiences, resulted in them completely detaching

So when Catriona Morten first saw Janina Fisher working with experiences as “felt” and processed within the body, and heard about and witnessed the powerful impact this therapy was having with traumatised people, she recalls:

“it was as though a light bulb went on, and I felt this was exactly what these children needed. It was a therapeutic approach that I just knew would work, and it did, and I also knew I had found something that could help people recover from trauma and not just learn to live with it. This had been the message we were getting from the medical profession at the time. Also I now knew that people did not have to tell me deeply painful and humiliating details in order to get better”. 

And, as they say, the rest is history – Catriona Morten and the team of therapists here at Khiron House are still finding that Sensorimotor Psychotherapy offers an approach that can transform lives. By using the body as the primary entry point in processing trauma, Sensorimotor Psychotherapy directly treats the effects on the body, which then allows us to heal emotionally and psychologically.

“Visible and mobile, my body is a thing among things; it’s caught in the fabric of the world, and its cohesion is that of a thing.But, because it moves itself and sees, it holds things in a circle around itself” Maurice Merleau-Ponty. 

Several research studies to gather data on the effectiveness of SP are underway or in the process of publication at the following institutions:

• Maudsley Hospital (London, UK)
• Womens’ College Hospital (Toronto, Ontario)
• Modum Bad Outpatient Clinic (Oslo, Norway)

This is part of our series of blogs which are telling the story of trauma treatment, how it has developed and is still developing every day. In this series our expert practitioners will be sharing their knowledge with you, we will be finding out what recent scientific breakthroughs are teaching us all about the nervous system, and we will be keeping you in touch with the latest news about the life transforming therapies that are becoming more sophisticated and responsive every day. 

If you would like a weekly email about new posts on our blog please sign up for our mailing list in the box above right. 

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