Sensorimotor Psychotherapy

Sensorimotor Psychotherapy (SP) is a somatic psychotherapy specifically designed to treat trauma and attachment issues. Somatic psychotherapy focuses on relating and connecting to the body, rather than the mind.

Developed by Pat Ogden, Ph.D., and her colleagues in the 1980s, SP combines principles from various therapeutic disciplines, including psychodynamic therapy, Cognitive Behaviour Therapy (CBT), and body-oriented therapies.

What separate SP from other therapies is that it is focuses on the crucial role of the body in mental health disorders and aims to incorporate the body's innate ability to adapt, heal, and develop new capacities.

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How Sensorimotor Psychotherapy was Developed

Pat Ogden, a pioneer in somatic psychology, developed Sensorimotor Psychotherapy in response to the observation that traditional talk therapies often failed to address the impact of trauma on the body. For example, one challenge with trauma focused talk therapies is that the individual can intellectualise while doing the therapy work - discussing their trauma in great detail all while being detached from the body.

Pat noticed that many clients who had experienced trauma exhibited physical symptoms and body memories that were not being addressed through verbal therapy alone. Ogden and her colleagues combined elements from various therapeutic models, such as attachment theory, neuroscience, and mindfulness, to create a unique and holistic approach to treating trauma and its related symptoms.

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Who Can Benefit from Sensorimotor Psychotherapy?

SP has been shown to be beneficial for:

• cPTSD and PTSD
• Attachment trauma
• Anxiety disorders
• Mood disorders
• Borderline Personality Disorder (BPD)
• Substance Use Disorder (SUD)
• Self-harm and suicidal behaviours
• Dissociation

Principles of Sensorimotor Psychotherapy

There are several core principles underpinning the practice of SP, which include:

1. The mind-body connection: SP recognises that mental and emotional experiences are intrinsically linked with the body. The therapy focuses on the interplay between the mind and the body and aims to address the physical manifestations of psychological distress.
2. The role of the body in trauma: Traumatic experiences often get stored in the body, manifesting as physical sensations, habitual postures, and movement patterns. SP seeks to address these manifestations and facilitate the release of stored trauma through body-oriented interventions.
3. The importance of mindfulness: SP places a strong emphasis on cultivating mindfulness in clients, encouraging them to develop greater self-awareness, non-judgmental curiosity, and acceptance of their internal experiences.
4. An integrative approach: SP is an integrative therapy that combines elements from various therapeutic models, allowing therapists to tailor the treatment to the unique needs of each client.

Techniques in Sensorimotor Psychotherapy

Sensorimotor Psychotherapy employs a range of techniques to help clients address the physical and emotional aspects of their mental health disorders. Some of these techniques include:

1. Body awareness: Clients are encouraged to develop a heightened awareness of their bodily sensations and to track the physical manifestations of their emotions and thoughts.
2. Mindfulness: Therapists guide clients through mindfulness exercises to help them cultivate self-awareness, acceptance, and non-judgmental curiosity about their experiences.
3. Movement and posture: SP therapists work with clients to explore movement patterns and postures that may be contributing to their symptoms, and collaboratively develop new, more adaptive patterns.
4. Emotional processing: SP therapists help clients identify and process emotions that may have been suppressed or dysregulated as a result of trauma.
5. Integration: The ultimate goal of SP is to help clients integrate their physical, emotional, and cognitive experiences, promoting a sense of wholeness and healing.

Effectiveness of Sensorimotor Psychotherapy

There is a growing body of evidence supporting the effectiveness of Sensorimotor Psychotherapy in treating various mental health disorders, particularly those related to trauma. Research has shown that SP can lead to significant reductions in symptoms of post-traumatic stress disorder (PTSD), anxiety, depression, and dissociation. Moreover, SP has been found to improve clients' overall quality of life, self-esteem, and interpersonal relationships.

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Benefits and Limitations

SP offers a holistic and integrative approach to therapy that addresses the mind-body connection in a way that many traditional therapies do not. This allows clients to access and process deeply held emotions and experiences that may be difficult to access through talk therapy alone.

While SP has been shown to be effective in treating trauma-related disorders, it may not be the best fit for all clients. Some individuals may find the body-oriented techniques uncomfortable or triggering, and may benefit more from other therapeutic approaches.

Trauma being Stored in the Body, Polyvagal Theory, and the Triune Brain

SP is in part founded on the idea that trauma is stored in the body, polyvagal theory, and the triune brain theory.

The Body Keeps the Score
‍The concept of trauma being stored in the body came into popular culture with Besser van der Kolk’s 2015 book the Body Keeps the Score. Kolk posits that unprocessed trauma is stored in the memory and emotional centres of the brain, such as the hippocampus and amygdala, activating the body when exposed to triggers. According to this idea, trauma may show up in the body as:

• Feeling easily overwhelmed
• Feeling on edge
• Muscle tension
• Chest tightness
• Sleep difficulties
• Nightmares
• Memory difficulties
• Poor concentration
• Anxiety
• Avoidance
• Depression
• Dissociation
• Chronic pain
• Headaches

Kolk sees these symptoms as potential indicators and posits that trauma therapy is appropriate when the body is showing signs of trauma (even when there is no memory or awareness of trauma in the individual).

Polyvagal Theory (PVT)
Similar to the concept of the body keeping the score, polyvagal theory proposes that trauma isn't just in your head or in your memories; it actually gets stored as a habitual reflexive state of your nervous system. Now, your nervous system is designed to protect you and keep you safe by reacting very quickly and intensely to threats.

PVT views the parasympathetic nervous system as being split into two distinct branches: a "ventral vagal system" which supports social engagement, and a "dorsal vagal system" which supports immobilisation behaviours, both "rest and digest" and defensive immobilisation or “shutdown"

The Triune Brain
The triune brain theory views the brain as having evolved to make up three parts:

1. The lizard or primitive brain (aka the reptile brain made up of the basal ganglia) - responsible for survival instincts and at times a freeze/shut down response
2. The emotional brain (aka the paleomammalian complex or the limbic system made up of the septum, amygdalae, hypothalamus, hippocampal complex, and cingulate cortex) - responsible for emotions and the fight or fight response
3. The cognitive or smart brain (aka the neomammalian complex made up of the prefrontal cortex) - responsible for complex decision making, creativity, imagination, abstract thought etc.
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Limitations and Controversy of Trauma Being Stored in the Body, PVT, and the Triune Brain

All three of the theories have been widely adopted and shared in both thee theory and practice psychology and in popular culture. These theories often resonate with people with trauma in a powerful and meaningful way, and many with trauma report the theories to “make intuitive sense” and to be incredibly validating.

Unfortunately, all three theories are not backed by science, and in many cases the science we have available contradicts the theories.

When it comes to the body keeping the score, there is no doubt that trauma results in real changes to the brain and body. However, these ‘symptoms' of trauma can also be attributed to mental or physical illness. It is important to take all claims of trauma seriously, but it is extremely dangerous to work backwards by looking at such symptoms in a person (such as poor concentration, headaches, anxiety etc.) and inferring trauma based on them alone.

The Polyvagal Theory, often taught as fact by therapists, is not currently endorsed by social neuroscience, and the evidence we have contradicts the theory. PVT incorrectly portrays the role of the different vagal nuclei in mediating the freeze response. The current evidence does not support a role of the dorsal vagal complex in freezing as proposed by the PVT and the dorsal vagal complex should not be linked to passive defensive behaviour. Regarding the proposed ventral vagal complex, PVT posits new ventral vagal complex encompassing the entire branchiomotor column, ascribing to the vagus much more than it actually can serve. This terminology insinuates that the vagus is a prime mover when this not the case.  (1) (2)

There is no evidence that the dorsal motor nucleus (DMN) is an evolutionarily more primitive center of the brainstem parasympathetic system than the nucleus ambiguus (NA), and evidence we have is to the contrary. (3)

Research has found that myelinated vagus nerve fibres in lungfish leading from the nucleus ambiguus to the heart, indicating that the PVT hypothesis that the nucleus ambiguus is unique to mammals is incorrect. (4)

The dichotomy between asocial reptiles and social mammals assumed by PVL is incorrect, with evidence for the presence of cardio-respiratory interactions similar to respiratory sinus arrhythmia (RSA) and their potential purpose in blood oxygenation in many vertebrate species (both air- and water-breathing) indicating that RSA may be a relic of older cardio-respiratory systems, contrary to PVT assumptions. (5)

PVL also proposes a relationship between RSA responses and forms of psychopathology, but a meta-analysis finds the empirical evidence to be inconclusive. (6)

The existing research indicates that respiratory sinus arrhythmia is not a reliable marker of vagal tone, since it is subject to both respiratory variables and sympathetic (beta-adrenergic) influences in addition to vagal influences. There is also no evidence to support the effects upon mammalian vagally mediated (heart rate) during any conditions other than severe experimental irritation of the airways, extreme hypoxia, or lung congestion.

The concept of the triune brain has been rejected by the majority of neuroscientists due to its lack of evidence (7) (8). The triune brain theory does not accurately explain how the brain functions in everyday life or during the stress response. Evidence indicates that emotion and cognition are seperate structures but are heavily interdependent and work together. Additionally, evidence indicates that the limbic system is not a purely emotional centre nor are there purely emotional circuits in the brain, and the cortex is not a purely cognitive centre nor are there purely cognitive circuits in the brain. Furthermore, there is no evidence of a fear brain circuit that turns on during a fear response but otherwise lies dormant.  (9) (10)

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1. Neuhuber, W.& Berthoud, HR. (2022). Functional anatomy of the vagus system: How does the polyvagal theory comply?". Biological Psychology. 174: 108425

2. Taylor, E. Wang, T., & Leite, C. (2022). An overview of the phylogeny of cardiorespiratory control in vertebrates with some reflections on the 'Polyvagal Theory'. Biological Psychology. 172

3. Grossman, P.& Taylor, E.W. (2007). Toward understanding respiratory sinus arrhythmia: Relations to cardiac vagal tone, evolution and biobehavioral functions. Biological Psychology. 74 (2): 263–285

4. Monteiro, D. (2018). Cardiorespiratory interactions previously identified as mammalian are present in the primitive lungfish. Science Advances. 4 (2).

5. Doody, B.& Dinets. (2013). Breaking the Social–Non-social Dichotomy: A Role for Reptiles in Vertebrate Social Behaviour Research?. Ethology. 119 (2): 95–103.

6. Beauchaine, T.P., Bell, Z., Knapton, E., McDonough‐Caplan, H., Shader, T.,& Zisner, A. (2019). Respiratory sinus arrhythmia reactivity across empirically based structural dimensions of psychopathology: A meta-analysis. Psychophysiology. 56 (5): e13329

7. Kiverstein, J., Miller, M (2015). The embodied brain: towards a radical embodied cognitive neuroscience. Frontiers in Human Neuroscience. 9: 237.

8. Reiner, A. (1990). The triune brain in evolution: Role in paleocerebral functions. Science, 250(4978), 303-306

9. Steffen, P.R., Hedges, D.,& Matheson, R. (2022). The Brain Is Adaptive Not Triune: How the Brain Responds to Threat, Challenge, and Change. Frontiers in Psychiatry. 13. 802606.

10. Shackman, A.J., Salomons, T.V., Slagter H.A., Fox, A.S., Winter, J.J.&, Davidson, R.J. (2011). The integration of negative affect, pain and cognitive control in the cingulate cortex. Nat Rev Neurosci. 12: 154–67.

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