How Somatic Therapy & CBT Work Together for Trauma Healing
There are a lot of people who might be interested in eventually doing somatic therapy work, but are hesitant to do so for various reasons. Somatic Experiencing is a very different way to do therapy, and looks different from traditional talk therapy. There are always a lot of nerves about starting with a new therapist, and trying a new modality might have some people feeling a bit skittish. For others, it is their first time with therapy and would rather enter into somatic work gently. This is why it is important to reiterate that other therapy modalities, especially Cognitive Behavioral Therapy, are very complimentary to somatic work. You don’t always have to choose one or the other!
Understanding Bottom-Up vs. Top-Down Therapy Approaches
What is a Bottom-Up Therapy Approach?
Before fully exploring how these two compliment each other, it would be helpful to identify how they are different.
Somatic therapy is known as a “bottom-up” approach to therapy. This means that instead of allowing the intellectual part of ourselves (or the cognitive part) to run the show, we allow what is naturally coming up in the body to guide the session. An example of what this looks like:
Sam is coming into therapy very overwhelmed that day. They are stressed out with school and a conflict with their partner. Because of this, they are talking a mile a minute and fidgeting a lot with their hands. Because Sam wants to do somatic work, their therapist guides them to slow down and notice what is happening in their body instead of engaging too much with the story they are telling at that moment. Sam notices that they have a lot of energy in their body related to stress, and by allowing themselves to fidget and move on purpose, they feel more calm.
How CBT Uses a Top-Down Approach
While Cognitive Behavioral Therapy certainly can include components of body-based mindfulness, it is considered a “top-down” approach. Instead of allowing the client’s body sensations to dictate how the session will go, the therapist and the client engage in thought reconstruction, dissection of beliefs, and behavioral modification. Instead of taking cues from the body, the therapist might suggest some coping skills to help the client calm down. (Examples of this include the 5-4-3-2-1 orienting method, or progressive muscle relaxation techniques.) As a therapist, I think starting with some Cognitive Behavioral Therapy in the beginning can be helpful so that the person can develop some strong coping skills before diving into somatic work.
How CBT Helps Clients Ease into Somatic Therapy
When most people think about therapy, they think of talk therapy. Telling narratives, identifying root causes of issues, identifying thoughts and feelings, and so on. A lot of the time, we as humans like to be more cognitive, or “in our heads,” as a way to distance ourselves from our feelings. Because of this, starting out with talk therapy and gradually adding in components of somatic work feels safest to a lot of people. Safety is of the utmost importance when helping clients feel into their bodies and explore their trauma histories.
It can also take some time to develop interoceptive awareness skills. Interoceptive awareness is the ability to identify how things feel within the body, or the awareness of sensation happening on a somatic level. As a therapist, it is my job to encourage curiosity within my clients in order to start to develop this ability. It is important to be able to do this as somatic therapy relies on the client’s ability to feel what is happening in their body and how emotions are held there. Again, this can feel like a tall ask at first, but it does eventually develop.
CBT & Somatic Therapy Offer Flexibility to Match Client Comfort Levels
I like to tell clients that it is important for therapists to be able to pull from different modalities such as traditional talk therapy and Somatic Therapy because all clients are different. I think of it as a recipe; add a dash of this here and a dash of that there, creating a comprehensive and tailored experience for each person depending on their needs and how they respond to different interventions.
Here is an example of how this could look:
Maria really wants to work on some childhood trauma but is worried about what will happen when she opens that “can of worms.” She has spent decades trying to repress difficult feelings related to past experiences and doesn’t feel like she will be able to survive feeling it all. Also, because of the nature of Maria’s trauma, she has little to no awareness of how she feels in her body, much less what emotion she is feeling there. By working with her therapist and developing some important skills with Cognitive Behavioral Therapy, she is able to tolerate beginning to talk about some of the trauma she wants to work on. Also, by being able to stay more in the intellectual realm, she has been able to develop her relationship with her therapist, which makes delving into a new modality more possible for her.
The Mind-Body Connection: Why CBT & Somatic Therapy Complement Each Other
Cognitive Behavioral Therapy works by helping the individual identify their thoughts, feelings, and behaviors that are creating discomfort or distress. It is based on the idea that thoughts, feelings, and behaviors are all interconnected; they all impact one another. This is good news because we know if we can work on one area, the others will undoubtedly be affected. Therefore, if you want to help shift, for example, feelings and behaviors, it would be helpful to restructure destructive thought patterns. The Beck Institute has great resources and information about what Cognitive Behavioral Therapy is.
This compliments somatic therapy because it helps to make the mind and body connection more apparent. It helps the client to understand that their body is not separate from their mind; that they both impact one another and work together as a team. By incorporating somatic therapy with CBT, people have a better awareness of how their whole system is working. In therapy, we take that information in to help the client identify their needs in a better, more efficient way.
CBT & Somatic Therapy for Trauma Treatment
Using CBT to Reframe Trauma-Related Beliefs
A hallmark symptom of trauma is a changed world belief. Because of what a person goes through, their belief about themselves, others, or the way the world works can profoundly change. Most of the time, this belief is distorted, which causes big disruptions in that person’s life. Cognitive Behavioral Therapy helps clients identify and challenge these thoughts and beliefs. A lot of the time, these beliefs are very subtle or subconscious and they are driving a lot of behaviors and feelings.
How Somatic Therapy Releases Trauma from the Body
In therapy, these identified beliefs can be used as a place to start and a marker for progress in somatic therapy for trauma. Because trauma symptoms almost always involve intense physiological responses, such as hyperarousal or complete shut down (freeze), cognitive work alone can’t address this. Somatic therapy helps clients to address this by noticing and releasing (via guided tracking and intervention from the therapist) the trauma stored in the body.
By utilizing both Cognitive Behavioral Therapy and Somatic Experiencing, the client is able to not only challenge unhelpful thoughts and beliefs related to trauma, but reduce somatic symptomatology related to it as well.
Curious about how Somatic Therapy and CBT can support your healing?
If you're curious about how Cognitive Behavioral Therapy (CBT) and Somatic Therapy can work together to support your healing journey, I’d love to help. Whether you’re looking to ease into somatic work gently or want to explore a trauma-informed approach tailored to your needs, we can create a personalized plan that aligns with your comfort level.
Not sure where to start? Let’s talk about your goals, concerns, and what feels safe for you as you begin this process.
Your healing journey is unique—let’s take the first step together.
Stevie Spiegel is a Licensed Therapist and Somatic Experiencing Practitioner located in Kansas City. She uses Somatic Experiencing as her main body-based trauma healing modality, as well as EMDR. As an Intuitive Eating Counselor, she uses these principles to help her clients challenge their relationship with their cultural misconceptions about their body and food.
