Hi everyone, Kelly Mahler, occupational therapist. And I wanted to take the time to talk about interoception and trauma and why interoception is a must. It is a vital consideration when supporting clients that have a history of trauma. What we know from emerging research and literature is that the interoceptive system is impacted by trauma. A person’s interoception experience can be derailed as a result of trauma, whether that’s early life trauma, or perhaps even an acute trauma as an adult, either way, this trauma is impacting the body and our interoceptive experience.
For example, for some people that have a history of trauma, they report that they are completely disassociated from their body sensations.
- Their body sensations are too small
- They’re unreliable
- They’re missing out on really important clues letting them know exactly how they are feeling
This in turn makes it hard to manage the way that you feel. If you’re not clearly aware and noticing how your body is feeling, you’re missing out on vital clues to help you to be able to regulate those feelings.
On the other hand, we know that for some people that experience trauma they report the opposite experience
- they report body signals that can be too big.
- their inner experience is very intense and overwhelming.
- They feel a lot of different things happening on the inside of their body at once. It’s all encompassing.
That makes it very hard to be able to manage the way that you feel as well, because your inner experience is so overwhelming. It still is not providing very valuable clues to exactly how your body is feeling and what your body needs in order to feel comfortable and regulated.
We know that lots of people can have a mix of sometimes their body signals are too small and sometimes they can be too big.
- The strength of their body signals fluctuate depending on the day, their level of stress or the signal that they are receiving (e.g., pain signals may be too big but feelings of fullness/satiety may be too small).
Any way you look at it, trauma can be disrupting the interoception experience, causing difficulty with caring for the body’s needs, caring for emotional needs, and living a life where one feels comfortable and regulated. And because interoception is so impacted by trauma, it becomes a vital consideration in the supports that we are providing. What we see so often are professionals that are trying so hard to provide really meaningful support to their clients, but
- they are shooting way too high with their approach
- they’re using lots of cognitive based work and they’re missing the entire body piece
- they’re missing the whole interoception piece.
If you’re not clearly aware of how your body is feeling, you are not going to be at a place where cognitive strategies make sense to your neurology.
We need to consider each client and meet them where they are at, to provide support that is a best match for their current neurology. To help with this, we follow a three-level interoception approach. And this three-level interoception approach is designed to be followed in a sequential way. Starting at the beginning at level one, and then moving to level two, and then finally getting to level three. What we see so often are professionals that are trying their very best to provide meaningful support to clients with a history of trauma. And they are using supports that fall into our level three, these cognitive rational thought types of strategies, which many clients are not ready for. Read on to learn more.
So where do we start? Level one in our framework is all about co-regulation. That’s all of the things we can do to help promote those feelings of safety and regulation in our client. How we can teach those that are supporting that client, that are surrounding that client on a daily basis, what they can do to promote feelings of regulation and safety? What activities we can do together with the client to promote those feelings of safety and regulation? Also, what can we do to the environment to maximize feelings of safety and regulation? That’s all about where level one is at.
If our client is not feeling safe and regulated, their attention is going to be naturally pulled outside. They are going to most likely be hypervigilant on
- the external world
- their environment around them out of just protection for their bodies
- they are going to be watchful, waiting for that next insult
- that next thing that makes them feel unsafe
- that sets off a stress response
- their attention is going to be pulled outward, scanning the environment for the next sign of danger
So, we need to help them to feel safe and regulated in order for them to be able to move to the next level, which is all about tuning their attention within.
At this point, we move on to level two. Level two is all about connection. It’s connection:
- to their body
- to being able to playfully and safely explore the way their bodies feel during meaningful activities
- to begin connecting with those sensations
- to be able to learn about their own unique interoceptive experience and connecting with that experience, understanding that experience for them
- also connecting with other people to promote those feel-good sensations within their bodies
Then once a person is really understanding their inner sensations and what these sensations mean for them, they’re ready to move on to level three. Level three is all about the action-based interoception piece. It’s all about finding those feel-good activities that promote feelings of regulation and safety. And we’re empowering the client to be able to start to seek those strategies out on their own when they are needed. This is where the rational cognitive thought comes in.
For example, thinking about when I start to feel anxious, I can take four deep breaths…or whatever it is true for them. That requires a lot of cognition. You need to be able to sort out how you’re feeling and identify that feeling in the moment. You need to think about your feel-good strategies and what are those feel-good strategies that work for you in that moment with that and with that emotion. That’s a lot of cognitive work that’s happening.
So many times, almost in all cases, I should say, a client is not ready for that type of work, until they go through level one where they are co-regulated, promoting and maximizing feelings of regulation and safety. We’re not expecting the client at that point to care for their own regulation needs. We’re stepping in and offering support and comfort and teaching others to do the same. Then we get to level two. The person’s connecting with their body, learning about how their own inner experience, what that is and what that means for them. Then they’re ready to move on to level three and exploring different feel-good activities, and really learning to self-regulate.
Hopefully that three-level approach helps. And hopefully this also really sheds light on the value and importance of incorporating interoception into the supports that we provide for our clients that have a history of trauma.
Until next time.
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