Introduction 

Trauma is an umbrella term defined by the effects from experiencing a distressing and emotionally threatening event, either on a single or repeated occasion. When an individual experiences trauma, it is marked by their physical and emotional safety being under threat; this can have a deeply ingrained effect on the brain and body connectivity impacting how they make sense of and percieve themselves, others, and the external world.¹ 

In the process of healing, therapies that integrate the mind and body can empower individuals to reclaim their emotional safety.² Eye movement desensitization and reprocessing (EMDR) and psychosomatic therapy are two distinct forms of psychotherapies. EMDR focusses on particular distressing events or experiences and works to reprocess them.³ Psychosomatic therapies largely rely on reshaping experiences with our body to address the physical manifestations of trauma.⁴ Both therapies provide a foundation to address distress associated with psychological trauma and acknowledge the imprint trauma can leave on the brain and body. 

Understanding trauma: a mind-body perspective

The nature and severity of trauma can vary for every person and can stem from an acute, complex, or developmental trauma. An acute trauma is the immediate response to a single isolated distressing event or experience that has occurred to an individual.⁵ A complex trauma is when an individual has been subjected to a repeated series of traumatic events over a prolonged period of time, often affecting their emotional regulation and interpersonal effectiveness.⁶ A developmental trauma refers to adverse events during critical periods of childhood development that can impact later social, cognitive, and emotional abilities in adulthood.⁷ 

A traumatic event can keep the brain and body trapped in the experience, keeping the trauma stored. This can be viewed as the ‘aftermath’ to what has happened, rather than it being the event itself. Therefore, after the event itself has occurred, the body continues to react as if it was still in danger. Traumatic experiences can lead to symptoms of anxiety, flashbacks, nightmares, intrusive thoughts, hyperarousal, changes in memory, and startle responses. The effects of trauma can overwhelm an individual's emotional and sensory ability to cope, being stored in the nervous system. 

Trauma can influence several brain structures and their neural connections.⁸ The amygdala plays a vital role in our emotional processing and regulation, which helps to process fears and threats in our fight-or-flight response. When experiencing a traumatic event, the amygdala can become overstimulated and perceive your surroundings as threatening and, therefore, cause hypervigilance and alertness. The hippocampus is responsible for mediating our learning and memory consolidation. When affected by trauma, the hippocampus can become less active and decrease in size, leading to difficulties distinguishing the past and present, and the ability to create new memories. Together, these consequences can lead to experiences of fashbacks. The prefrontal cortex can be considered as the ‘central hub’ in driving our thought processes and rationality. The activity within this structure can decrease when affected by trauma, inhibiting our decision making processes and attention.^9,10 

Traumatic memories are stored somatically, in that they carry the physical impact and bodily sensations that are associated with the traumatic event. Therefore, when treating trauma, it is suggested to take steps allowing individuals to feel safe in their body again.¹¹

What is EMDR therapy?

Eye movement desensitization and reprocessing (EMDR) was originally introduced based on observations of using bilateral eye movements leading to reduced levels of distress. It is based on the adaptive information processing (AIP) model, suggesting the brain is naturally wired to process experiences and, therefore, can be reprocessed in our memory network.¹² EMDR is a frontline psychotherapy option in trauma treatment based on the principles that experiencing trauma disrupts memory formation, allowing traumatic experiences to get ‘stuck’ in the nervous system. The ‘stuck’ memories contain an overwhelming amount of sensory, emotional, somatic, and cognitive information that are not fully integrated. EMDR involves recalling traumatic memories while simultaneously ulitising bilateral stimulation, such as eye movements, taps, or sounds. EMDR aims to allow the memory to become ‘unstuck’ through mental shifts and reduce the ‘emotional hold’ it has on the individual.¹³

Method 

EMDR follows an 8-phase protocol, where the primary focus is often targeting specific traumatic events and distressing memories. This structure includes:¹⁴

1. History taking aims to understand the client’s background and the nature of their current presenting difficulties. The therapist works with the client to gather information to formulate which traumatic events to target for reprocessing. Additionally, it acts as a starting point in establishing a supportive and trusting therapeutic relationship between the client and therapist, allowing the client to feel safe in exploring these memories
2. Preparation/ stabilisation is about understanding the client’s readiness to engage in the therapy, where questions are addressed and psychoeducation on the approach is discussed. Furthermore, this stage provides the foundation in beginning to teach and practice some of the low-level bilateral stimulation techniques
3. Assessment involves identifying target memories and gaining a baseline measurement of how the memory is presently being experienced in its sensory components and current associated distress levels

Stages 4-6 are phrases of reprocessing the target memory

4. Desensitization is achieved with the repeated use of bilateral stimulation. The client and therapist work on bringing the memory to mind while working on reprocessing it
5. Installation involves the client and therapist continuing to repeat these steps to reinforce new desired positive connections to the memory, reducing its emotional load, and creating new insights of the event that occurred
6. Body scan checks in with the client to assess whether there is any remaining tension or distress persisting in the body
7. Closure is used at the end of every reprocessing session, aiming to return and ground the client back into the room
8. Re-evaluation is completed by the therapist at the start of every session to review and re-examining the changes that have been made; the aim is to gain feedback to ensure that changes are sustained

Often, this therapeutic work can be short-term and effective given its structured nature. While the memory is still present, the emotional hold and demand it has on the individual lessens as it is adequately restored.¹⁵ 

What is psychosomatic therapy?

Psychosomatic therapy focuses on understanding how body-held, unprocessed emotions are implicated in physical health symptoms, such as those that consequently appear from trauma. When feelings like fear, anger, or sadness are not expressed in an adaptive manner, they can contribute to chronic physical tension or emotional dysregulation.^16,17 The approach combines body awareness, movement, breathwork, and emotional processing to help clients relieve physical symptoms. Psychosomatic therapy helps clients tune in and uncover bodily sensations without judgement and release stored emotional stress from the nervous system.¹⁸ Psychosomatic therapy is a fluid approach to restore balance and can involve techniques including psychoeducation on the mind and body connection, guided imagery, and progressive paired muscle relaxation, all of which aim to reduce bodily tension.¹⁹ 

Which therapy approach is best for me?

Knowing which therapeutic approach to explore is dependent on a range of factors surrounding individual needs. It could be that you are struggling with specific traumatic events where EMDR can provide a structured time efficient way of identifying these as targets to reprocess the memory. In comparison, if you are experiencing physical symptoms of conditions with emotional bodily tension then psychosomatic exploratory work could be the best option. 

Summary

Trauma affects every individual differently and healing takes courage to address difficult experiences and the implications this has had on their life. Understanding the connections between the brain and body in trauma recovery go hand in hand in helping individuals make sense of their experiences. Eye movement desensitization and reprocessing (EMDR) and psychosomatic therapies are complementary approaches in treating trauma that aim to understand the root of the body and mind connections. It is important for people to explore integrated therapeutic options when feeling comfortable and ready to make an informed decision. Through the commitment and patience in collaboratively working in therapy, it is important to recognise that healing is not linear, and there is no right or wrong pathway to recovery. Ultimately, the therapy approach depends on what resonates with the client and their needs.