Mind-body and expressive therapy for embodied stress, trauma and physical symptoms

The festive season is supposed to be joyful and relaxing, but for many it is the opposite. The various celebrations as the year draws to a close can be a time of chronic stress and a never-ending to-do lists; physical illness, general malaise associated with the seemingly never-ending darkness, or revisited psychological trauma such as painful memories or emotions associated with family or Christmas.

Add to this the physical and mental toil as the days and weeks fly past driving to work in the dark, going home in the dark, bracing the bad weather, perhaps caring for family members, all the while squeezing in those long-overdue catch-ups (“yay!”) and it's hardly surprising that many of us start to experience stress as physical symptoms.

Do any of these sound familiar at the moment?

• Headaches
• Palpitations or breathlessness
• Sleep problems, tiredness
• Eating problems
• Digestive issues like IBS or gastric reflux
• Musculoskeletal problems
• Skin issues, acne or eczema
• Chronic low-grade infections
• Clumsiness or tearfulness.

While many of these symptoms have a clear biological origin (and should always be checked out by a medical doctor), they can also be signs of embodied stress or embodied trauma and unfortunately, they are often treated as ‘medically unexplained’ symptoms. If you’ve been to your GP and feel like you’re getting nowhere with chronic symptoms like these, it’s time to take a closer look at how your body and mind interact.

The autonomic nervous system - mind-body signalling

Some classic features of individuals who carry trauma or high levels of stress in the body are a disrupted autonomic nervous system (ANS) and a lack of connection to – and healthy expression of bodily sensations and emotions.

In response to triggering emotional states or external events, the ANS can quickly ‘ramp up’ causing panic, anger or other strong urges to fight or flee the situation. Alternatively, the stressful situation or emotion can provoke the opposite reaction, experienced as shutting down, hiding or becoming completely disconnected from the self as the instinct to ‘freeze’ (like a rabbit in headlights) in response to danger kicks in.

These examples can be quite extreme in the case of embodied trauma, but for embodied stress similar processes do occur, albeit less sudden and intense than with trauma. In response to triggering emotional states or external events, the ANS is also at work ‘ramping up’ our responses to stress perhaps by working harder, trying to control situations or people, engaging in arguments, or filling up our diaries - leaving no time to stop, feel our emotions or ‘be’ in our bodies. Alternatively, we may collapse in response to the pressure, using isolation, social media, oversleep, food or other substances to ‘numb out’ and press pause in response to the threat of stress.

How is it that both trauma and stress become embodied as symptoms?

If you are one of the many people who find it impossible to find time for self-care, rarely express how you really feel and run around doing all the things you feel you ‘should’ be doing for others to have a ‘good’ festive break, then it’s time to acknowledge the truth:

Your lack of healthy boundaries, repressed self-expression or avoidance of personal processing means the body has to speak for you.

Unacknowledged emotions, unconscious conflicts between what we really want and what we feel obliged to do, unprocessed traumatic mental and physical experiences and unattended somatic sensations can all-present as symptoms in the physical body. Therapy which addresses these unmet needs and unprocessed experiences is needed to bring the ANS back into a state of healthy regulation within a more manageable ‘window’ of variation.

Expressive therapy for mind-body symptoms

It is helpful to recognise, acknowledge and express mind-body symptoms through careful attention to the whole person. Psychotherapy to address embodied symptoms needs to take place, not just at the level of talking, but at the level of the mind, body and wider system. This is known as a holistic, embodied approach – we listen to the body-mind and its inherent impulses as well as your rational thoughts on things. In the absence of physical processing and personal expression, the body will continue to send physical messages to draw your attention to the stress and unmet need for self-care.

While discussing things verbally as you might expect from talking therapies like counselling, in mind-body and expressive therapies clients are encouraged to practice body-awareness and healthy expression. We can ask clients to recall the stressful or traumatic ‘trigger(s)’ and listen into the body until physical sensations are felt. If a therapist has specialist training in body or movement-oriented therapy (such as dance/movement psychotherapy), they can also observe and evaluate how people ‘are’ in their bodies – how they walk, sits, hold themselves, interact, move – and this reveals a lot of useful information.

These physical states and feelings can then be processed at the level of the body and its somatic sensations. This can be especially effective when done creatively, as the ‘creative impulse’ can be used as a signpost to begin expression, and the expression itself can present both a multi sensory (involving multiple senses) representation of what perceives unconsciously or taking place at the level of the body and a means of processing, expressing and transforming what is taking place within the body.

Tools used for this could be imagination, drawing, writing, moving, sculpting or something else, and clients will often give some verbal clues as to which aesthetic tools might be useful. For example, they might say that they feel a knot in the stomach. The therapist might then ask them to represent how the knot might look or how it feels with their hands or with clay and see what else comes to mind when they ‘recreate’ this with their hands. Or they might describe a ‘red mist’ descending over their head when angry. The therapist might then ask them to draw this red mist and follow the creative impulse further to see what else emerges.

Arriving at a balanced ending and new trajectory

The client can then be helped to re-integrate the stress or trauma by making sense of it, arriving at a new, much less threatening meaning or relationship to the trigger based in the here and now. The end goal of therapy is to be able to maintain healthy, mindful awareness of one’s whole experience, and then process any internal signals effectively – before they become chronic physical symptoms. Clients can be encouraged to recognise when their body starts to exhibit signs of emotional imbalance, and use self-care and grounding techniques to process them when they show up instead of when they ‘blow up’ as symptoms.

Going forwards, it can be useful to encourage clients to develop active and creative hobbies as a means of maintaining their connection to hidden aspects of self and to the body. Just like that which is now being recognised in the NHS with the new ‘social prescribing’ initiative, it is expected that these physical and artistic pursuits will help to carry on the progress and development achieved in therapy. This way, clients may be less likely to relapse and can continue their journey towards deepened self-understanding and self-care, without the need for therapy.