Sensory Modulation and Developmental Trauma (Part 2)
Last week in the clinic I evaluated a 3-year-old who so clearly validated, in my opinion, the strong links between sensory processing difficulties and trauma. Sensory processing and sensory integrative challenges are now being recognized in children who have developmental trauma- both from an overt traumatic experience and in children whose difficulties with sensory processing and sensory integration impact their overall perception of safety in the world. My journey to better understand trauma and its impact on the body has broadened my view of sensory processing and greatly expanded my tool box for treating individuals, especially those who present with sensory defensiveness.
“Josh”, an otherwise typical little boy, was being seen for difficulties with overt defensive reactions to sound. His strong responses to sensation were accompanied by distinct emotional negativity and subsequent behavioral difficulties that were beginning to disrupt every aspect of his and his family’s life.
His body instantaneously became tense, his breath stilted, and his eyes were wide open as he sought comfort and safety on his mother’s lap.
When Josh entered the clinic, which was filled with large crash pillows, colorful balls, a loft for climbing and jumping, and multiple choices of swings (a delight for any typical three-year-old) his sole attention was immediately fixated on the smoke alarm. His body instantaneously became tense, his breath stilted, and his eyes were wide open as he sought comfort and safety on his mother’s lap. It took quite sometime before he could be wooed away form his mothers lap to play in the clinic space. Even though he appeared to relax a little once he climbed into the Lycra hammock, the tension in his body, and the frequent halting of his breath reflected his persistent state of anxiety and fear.
Mom was very tuned in to the trigger for this behavior and the story behind it. She recalled an experience “Josh” had, a year earlier, when he was extremely startled by a fire alarm at the neighborhood school. He continues to talk about this experience every time he see a smoke alarm or anything that reminds him of one. As “Josh” recites the story, he recalls every detail of that experience which he delivers in a script like fashion.
As each moment within an evaluation offers insight, I immediately began to ponder the previous event, how “Josh” processes sensation, and how this impacts daily life and participation. My previous experience and clinical reasoning led me to suspect sensory defensiveness, accompanied by an increase in arousal with a lack of recovery. The strong increase in physiological arousal is part of the brains inborn defense mechanism of fight, flight, and freeze which is ignited when faced with perceived danger. These preprogrammed defensive strategies not only increase arousal they trigger a strong response in the body.
During fight or flight the sympathetic nervous system is activated and the body is flooded with adrenaline to increase heart rate and blood pressure. Simultaneously one experiences an increase in tension and activation of the muscles in the limbs, which would allow you to flee from or fight off an attacker. The freeze response is called into action when fighting or fleeing is not possible due to the individual’s lack of resources in the context of the threat.
An overwhelming event becomes traumatic when an individual’s typical coping strategies are ineffective or when they are unable to overcome their attacker/threat.
When these defense patterns are triggered and left unresolved they lend themselves to a clinical presentation that is similar to post-traumatic stress disorder. An overwhelming event becomes traumatic when an individual’s typical coping strategies are ineffective or when they are unable to overcome their attacker/threat.
For “Josh” since he could not successfully run from or fight off the fire alarm he was left in freeze. This inability to discharge the chemistry and the tension patterns that build when faced with threat forms the bodily imprint of trauma. Now every time he sees a fire alarm his body goes back into the elements of a freeze response.
Treatment of these issues is multi-faceted
Treatment of these issues for “Josh” is multi-faceted. First we must use sensory integrative strategies to address and restore his particularly reactive auditory system to a state where he can modulate the input. Secondly use body-based strategies to help him to release the tension patterns held his body, along with regulate his breath to support arousal regulation. Finally using typical development as framework, facilitate and strengthen the developmental movement patterns (DMP) that would build resiliency (dynamic stability) and adaptability when faced with stress or perceived threat.
“Josh” started on a regime of listening to modulated albums from the Therapeutic Listening™ library to help him modulate his responses to loud low frequency sounds. Since Mom was very concerned about his behavior, which became particularly unmanageable during unstructured parts of the day, a Regulation 2 Quickshift (clinically has been show to assist in regulation arousal and decreasing reactions to sounds) was recommended prior to those periods in the day.
To begin to decrease the resultant muscle tension and breath holding that accompanied his unresolved fight, flight, and freeze patterns, I taught Mom a strategy to incorporate whole body oscillations while lying supine on caregiver (Mom). Further session will focus on working with the basic developmental movement patterns that allow us to be upright and dynamically stable for orienting in an ever changing world.
Whether the event is an overt trauma as in the case with “Kylie” or a subjective trauma as in the case of “Josh” treatment needs to include:
- effective strategies to regulate arousal
- restore the postural tone and breath back to its natural rhythm
- evaluate available DMP and develop a precise plan to ignite and build body resources
- strengthen one’s dynamic embodied sense of power and stability to face challenges within the inanimate as well as animate environment (sensory, motor, affect, and relationship based)
If you’d like more in-depth information on trauma and regulation, I recommend our course Trauma Informed Approach to Sensory Processing Disorder and Arousal Regulation.
Bainbridge Cohen, B. (1994). Sensing, Feeling, and Action. US; North Atlantic Books.
Levine, P. (2014). Getting to the Root of Trauma: Why It’s Critical to Understand the Role of Memory in Trauma Therapy [Webinar]. In NICABM Rethinking Trauma Webinar Series. Retrieved from http://www.nicabm.com
Ogden, P., Minton,K., & Pain,C. (2006). Trauma and the Body: A sensorimotor approach to psychotherapy, NY: W.W. Norton.
van der Kolk, B. (2003). The neurobiology of childhood trauma and abuse. Child & Adolescent Psychiatric Clinics of North America, 12, 293-317.
van der Kolk, B. (2014). The Body Keeps the Score: Brain, Mind and the Body in Healing Trauma, NY: Viking