About this Research Topic
The link between physical and emotional symptoms has been understood for over a century. Psychiatrist Abram Kardiner studied "shell shock" for the US Army after WWI. In his book 'The Traumatic Neuroses of War' he wrote that the “nucleus,” or center of traumatic stress was a “physioneurosis” rooted in the body. Though science in Kardiner’s time knew little about stress hormones, gene regulation, brainwaves, or heart rate variability, and the diagnosis of PTSD was half a century in the future, he and many of his contemporaries understood the physical impact of traumatic events. In 1977, Hochberg mentioned that in the 1920s, Freud's colleague psychiatrist Wilhelm Reich coined the term “muscular armor” based on his observations that emotional trauma can result in rigidity in certain regions of the body, and that when resolution was found, those areas of the body relaxed.
After WWII, leading psychiatrist and psychoanalyst Joseph Wolpe worked with combat veterans. He tried many different treatment methods, rigorously documenting whether or not they resulted in a reduction in the distress experienced by patients when recounting traumatic memories. Wolpe (1969) found "the talking cure" in which he had previously believed was "not ineffective, but actually harmful" to his patients. Wolpe observed that recounting painful memories often made them more intense, which may have coined the term "retraumatization" decades later. The one method Wolpe found effective was diaphragmatic breathing, which kept patients "in the body" and resulted in the attenuation of psychological distress. This reinforced the idea that somatic stimulation, addressing psychological distress using physiological means, had a role in the treatment of trauma.
Early pioneers also sought an anatomical basis of this interplay between body and emotions. Charles Darwin (1882) believed that the “pneumogastric nerve,” which we now call the vagus nerve, played a role in emotional regulation. He hypothesized that, “Heart, guts and brain communicate intimately via the ‘pneumogastric’ nerve, the critical nerve involved in the expression and management of emotions in both humans and animals. When the mind is strongly excited, it instantly affects the state of the viscera, so that under excitement there will be much mutual action and reaction between these, the two most important organs of the body”.
The Adverse Childhood Experiences (ACE) studies showed us that this relationship scales. The greater the number of childhood insults, the greater the risk for diseases such as cancer, cardiac events, COPD, diabetes, and hepatitis (Felitti et al., 1996). This relationship is, however, complex and influenced by various factors. Psychiatrist Bessel van der Kolk reminds the conceptual idea of the complex interactions between physical and emotional well-being in his book, ‘The body keeps the score’; the best-selling medical book of the past decade.
In the past three decades this has led to increasing research into somatic treatments for PTSD. Supplementing established psychological techniques (such as exposure and cognitive processing) with physiological interventions (such as yoga, eye movements, diaphragmatic breathing, massage, neurofeedback, nutrition and acupressure) which has been shown to enhance therapeutic outcomes. Some methods such as EMDR (Eye Movement Desensitization and Reprocessing), yoga therapy and Clinical EFT (Emotional Freedom Techniques) have established a research literature comprising hundreds of clinical trials, including dozens of randomized controlled studies and meta-analyses.
The complexity of somatic interventions and their outcomes means that firm conclusions cannot be drawn. However, a growing body of evidence suggests that we can change the score the body keeps. For this reason somatic interventions have been recognized as efficacious by various official bodies, including the US Veterans Administration, the US National Registry of Evidence-Based Programs and Practices, the UKs National Institute for Clinical Excellence, and the World Health Organization. In addition, the mechanisms of action of somatic therapies such as vagal regulation, stress hormone reduction, epigenetic gene regulation, the alteration of neural signaling evident in EEG, MRI and MEG scans, increased heart rate variability, and neurogenesis, have now been mapped.
This Research Topic has four primary objectives. The first is to report current studies of these methods. The second is to further illuminate the physiological mechanisms of action of somatic therapies. The third is to review the research literature and derive lessons for the translation of these findings into effective patient care. The final objective is to project the future trajectory of research and implementation and hypothesize about the contribution that the widespread adoption of these therapies might make to alleviating the burden of disease. Changing the score the body keeps in millions of people has the potential to make a significant contribution to public health.
After WWII, leading psychiatrist and psychoanalyst Joseph Wolpe worked with combat veterans. He tried many different treatment methods, rigorously documenting whether or not they resulted in a reduction in the distress experienced by patients when recounting traumatic memories. Wolpe (1969) found "the talking cure" in which he had previously believed was "not ineffective, but actually harmful" to his patients. Wolpe observed that recounting painful memories often made them more intense, which may have coined the term "retraumatization" decades later. The one method Wolpe found effective was diaphragmatic breathing, which kept patients "in the body" and resulted in the attenuation of psychological distress. This reinforced the idea that somatic stimulation, addressing psychological distress using physiological means, had a role in the treatment of trauma.
Early pioneers also sought an anatomical basis of this interplay between body and emotions. Charles Darwin (1882) believed that the “pneumogastric nerve,” which we now call the vagus nerve, played a role in emotional regulation. He hypothesized that, “Heart, guts and brain communicate intimately via the ‘pneumogastric’ nerve, the critical nerve involved in the expression and management of emotions in both humans and animals. When the mind is strongly excited, it instantly affects the state of the viscera, so that under excitement there will be much mutual action and reaction between these, the two most important organs of the body”.
The Adverse Childhood Experiences (ACE) studies showed us that this relationship scales. The greater the number of childhood insults, the greater the risk for diseases such as cancer, cardiac events, COPD, diabetes, and hepatitis (Felitti et al., 1996). This relationship is, however, complex and influenced by various factors. Psychiatrist Bessel van der Kolk reminds the conceptual idea of the complex interactions between physical and emotional well-being in his book, ‘The body keeps the score’; the best-selling medical book of the past decade.
In the past three decades this has led to increasing research into somatic treatments for PTSD. Supplementing established psychological techniques (such as exposure and cognitive processing) with physiological interventions (such as yoga, eye movements, diaphragmatic breathing, massage, neurofeedback, nutrition and acupressure) which has been shown to enhance therapeutic outcomes. Some methods such as EMDR (Eye Movement Desensitization and Reprocessing), yoga therapy and Clinical EFT (Emotional Freedom Techniques) have established a research literature comprising hundreds of clinical trials, including dozens of randomized controlled studies and meta-analyses.
The complexity of somatic interventions and their outcomes means that firm conclusions cannot be drawn. However, a growing body of evidence suggests that we can change the score the body keeps. For this reason somatic interventions have been recognized as efficacious by various official bodies, including the US Veterans Administration, the US National Registry of Evidence-Based Programs and Practices, the UKs National Institute for Clinical Excellence, and the World Health Organization. In addition, the mechanisms of action of somatic therapies such as vagal regulation, stress hormone reduction, epigenetic gene regulation, the alteration of neural signaling evident in EEG, MRI and MEG scans, increased heart rate variability, and neurogenesis, have now been mapped.
This Research Topic has four primary objectives. The first is to report current studies of these methods. The second is to further illuminate the physiological mechanisms of action of somatic therapies. The third is to review the research literature and derive lessons for the translation of these findings into effective patient care. The final objective is to project the future trajectory of research and implementation and hypothesize about the contribution that the widespread adoption of these therapies might make to alleviating the burden of disease. Changing the score the body keeps in millions of people has the potential to make a significant contribution to public health.
Keywords: PTSD, somatic therapy, emotion, physiology, trauma, Adverse Childhood Experiences
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