Trauma isn't just psychological. It can impact your body too.

It may feel like you're on edge. You may start to sweat. Your heart may race, your fists may clench.

Trauma isn't only a person's emotional and psychological reaction to an intense or overwhelming event, it can lead to physical manifestations that are felt in the body too.

"Those kinds of physiological symptoms are incredibly common in PTSD (post-traumatic stress disorder), but also just a more global trauma response," explains Dr. Rubin Khoddam, clinical psychologist and founder of COPE Psychology. "And that (physical response) over time has a big impact on our body."

But emerging body-first treatments, such as trauma-informed yoga, aim to help those struggling.

"Tears can come up, emotions can come up. Sometimes memories can come up," explains Jenn Turner, clinical mental health counselor and co-director and founder of the Center for Trauma and Embodiment. She has been working with the Trauma Center Trauma Sensitive Yoga (TCTSY) approach for the last 20 years.

How can the body react to trauma?

When working with patients who have experienced trauma, Dr. Christine Gibson, author of "The Modern Trauma Toolkit," typically sees two types of physical responses.

Some may have a fight-or-flight type of response, which may include muscle tension, heart pounding and sweating because their body "believes it needs to activate," she explains. Others maybe experience a freeze response, which can look like someone who struggles to move or get out of bed.

"We are more familiar with fight-or-flight because it looks kind of like anxious energy... and all of those physical things show up in the body. But what a lot of people don't understand is that freeze response is also related to trauma," she explains.

The length of a person's physical response can differ depending on the type of trauma they're facing.

In the midst of an acute trauma (a one-time event like a car accident, for example), a physical sensation can be there in the short term, Khoddam explains. With chronic trauma, if a person is constantly experiencing hyper-arousal (a soldier in a war zone, for example) their body may stay in that state. And, for some, the body may maintain that physiological response even when the stressor is no longer there.

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Releasing trauma from the body

The best route for treating trauma depends on the severity and its impact, Khoddam says. With trauma that has progressed into PTSD symptoms, he recommends strong evidence-based practices like cognitive processing therapy or prolonged exposure.

These approaches help to "undo a lot of the learning that our body and mind did as a result of that trauma," he says, but "on the most basic level, we want to create spaces where the body is able to down regulate."

This could look like mindfulness practices such as setting time aside to not be stimulated by your surroundings or yoga and other body-first interventions, some of which have been shown to be beneficial towards treating trauma.

Gibson prefers this body-first approach over a top-down cognitive approach when it comes to treating physical trauma responses.

"The bottom-up approach is where you use the body to affect those pathways in the brain... a lot of those trauma responses are actually reflexes. And when it's a reflex, it's really hard to think your way out of it," she explains.

Turner describes the specialized yoga sessions as "a space for trauma survivors to reconnect (and) develop agency and ownership over their own body."

"What we know about trauma is that it dysregulates this internal network where we basically can feel everything within our own skin, including our own skin," she explains. "For a lot of folks who are who have had experiences of inter-relational trauma, familial trauma, it benefits them to read their surroundings, to notice mood shifts in a parent, a caregiver, a boss – whomever might be perpetrating trauma. And so oftentimes, what happens is that internal network gets dysregulated.... so our intention is to create a space where folks can reconnect to that. Reconnect to sensation, reconnect to a sense of agency over their body."

Triggers are often thought of as external things like sounds and smells, but Turner says triggers can also exist from within our body – even a body position or the rate of our breath can be a reminder of a traumatic experience.

"So a lot of times survivors will learn ways to disconnect from their body, so they don't 'bump into' memories by moving a certain way or taking a certain kind of breath," she explains.

While someone may experience a range of emotions during a yoga session, Turner says that's not the goal. 

"It's not that we're trying to push people toward experiencing intense emotions, that's really up to them," she says. "We want to support survivors in guiding them but then defer to their wisdom about their own body."

Looking ahead at trauma treatment

Turner and Gibson have seen increasing interest in body-first treatments. 

A study last year found trauma-sensitive yoga to be a “game-changer” in the treatment of sexual abuse-related PTSD in veterans.

"There's a lot of data around how talk therapy and processing only gets a fraction of the bigger picture of healing from trauma," Turner says. "I think a lot of clinicians and providers have the awareness of the body is important. But there's not a lot of access."

Gibson, on her TikTok account @tiktoktraumadoc, has also found interest is high in her videos that showcase body-based exercises, like Trauma Releasing Exercises.

While Turner doesn't see body-first treatments like yoga as a replacement for other forms of therapy, she does see it as a helpful option.

"What we have learned through the years and through research is that like, for some people, talking is actually re-traumatizing and very unhelpful. So for some people, yes, it could be the main modality that they use," she says.

No matter what treatment route is best for a trauma survivor, Khoddam says early intervention and prevention are key to managing trauma "so that chronic stress, that chronic arousal, that chronic impact on the body doesn't have to be chronic."

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