Post-Traumatic Stress: Psychotraumatology and Somatic Experiencing
- Arnaud
- Apr 30
- 4 min read
Post-traumatic stress (or post-traumatic stress disorder, PTSD) is an anxiety disorder that can develop after experiencing or witnessing a traumatic event, such as an accident, assault, natural disaster, armed conflict, or any other event that threatens life or physical integrity.
People with PTSD may experience symptoms such as:
Re-experiencing the trauma: flashbacks, nightmares, or intrusive memories of the event.
Avoidance: efforts to avoid situations, places, people, or activities that are reminders of the trauma.
Hypervigilance: feeling constantly on edge, difficulty relaxing, exaggerated startle response.
Mood alterations: feelings of guilt, shame, irritability, or hopelessness.
PTSD can appear shortly after the traumatic event or several months or even years later. It often requires treatment combining psychological therapies (such as cognitive behavioral therapy) and sometimes medication to help manage the symptoms.
Understanding the mechanisms of stress and post-traumatic stress leads us to address the art of psychological crisis intervention.
Who is involved?
Directly: injured individuals, witnesses, first responders, etc.
Indirectly: loved ones, people connected to the situation, etc.
Stress = an adaptive, natural, physiological, psychological, and behavioral reaction.
Psychological First Aid
Human assistance, attentive listening, providing comfort, connecting people to resources and networks, and helping them access information, services, and social support.
Progression from Acute Stress to PTSD
Post-traumatic stress disorder (PTSD) is defined by the DSM-5 (Diagnostic and Statistical Manual of Mental Disorders, 5th edition) as a set of symptoms that occur following exposure to a traumatic event. The main diagnostic criteria are:
Criterion A: Exposure to a Traumatic Event
The individual must have been exposed to death, threatened death, serious injury, or sexual violence in one (or more) of the following ways:
Direct exposure to the traumatic event.
Witnessing the event in person.
Learning that a traumatic event occurred to a close friend or family member.
Experiencing repeated or extreme exposure to aversive details of the event (e.g., first responders, military personnel).
Criterion B: Intrusive Symptoms (at least 1)
The person experiences one or more of the following:
Recurrent, involuntary, and intrusive distressing memories of the traumatic event.
Recurrent distressing dreams related to the trauma.
Dissociative reactions (e.g., flashbacks) in which the person feels or acts as if the event is recurring.
Intense psychological distress at exposure to trauma-related cues.
Physiological reactions to internal or external cues resembling aspects of the traumatic event.
Criterion C: Avoidance (at least 1)
Persistent avoidance of trauma-related stimuli, shown by one or both of the following:
Avoidance of distressing memories, thoughts, or feelings about the trauma.
Avoidance of external reminders (people, places, conversations, activities, objects) that evoke trauma memories.
Criterion D: Negative Alterations in Cognition and Mood (at least 2)
Negative changes in thoughts or mood beginning or worsening after the trauma, including:
Inability to remember important aspects of the event.
Persistent negative beliefs about oneself, others, or the world.
Persistent distorted blame of self or others about the cause or consequences of the trauma.
Persistent negative emotional state (fear, horror, anger, guilt, shame).
Marked loss of interest in significant activities.
Feelings of detachment or estrangement from others.
Persistent inability to experience positive emotions.
Criterion E: Alterations in Arousal and Reactivity (at least 2)
Irritable behavior or angry outbursts without provocation.
Reckless or self-destructive behavior.
Hypervigilance.
Exaggerated startle response.
Problems with concentration.
Sleep disturbances.
Criterion F: Duration
Symptoms must persist for more than one month.
Criterion G: Distress and Impairment
Symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.
Criterion H: Not Attributable to Substance or Medical Condition
Symptoms must not be due to the physiological effects of a substance (e.g., medication or drugs) or another medical condition.
All these criteria must be met for a diagnosis of PTSD according to the DSM-5.
Somatic Experiencing
Somatic Experiencing (SE), developed by Peter Levine, is a therapeutic approach focused on resolving trauma through the body, paying special attention to physical sensations. The central idea is that trauma becomes "stuck" in the nervous system when fight, flight, or freeze responses are not fully completed. By integrating these responses, the body can return to its natural balance.
According to Jean-Marie Kuhfuss, a practitioner and trainer in SE, this method is based on several principles and aims to support the resilience of the nervous system. Key elements include:
Regulation of the Autonomic Nervous System (ANS)
Kuhfuss emphasizes that SE seeks to restore balance to the ANS, often disrupted by trauma. The sympathetic nervous system (responsible for fight or flight) and the parasympathetic system (linked to rest and recovery) need to work in harmony. SE helps patients transition from survival states (sympathetic) to safety and restoration states (parasympathetic).
The Principle of Self-Regulation
A core aspect of SE, according to Kuhfuss, is helping individuals learn to better self-regulate. This involves regaining the ability to manage emotions and bodily responses in stressful situations. SE works with small doses of traumatic experience, allowing the nervous system to release tension slowly and in a controlled way, instead of reliving the trauma intensely.
Pendulation and Titration
SE uses pendulation, the process of moving between pleasant and unpleasant sensations in the body, helping to avoid overwhelming the patient. Titration refers to the gradual approach— engaging with trauma little by little to manage emotional intensity in manageable portions.
Importance of Bodily Sensations
A cornerstone of SE is that trauma manifests as physical sensations in the body. Kuhfuss highlights the importance of listening to and observing bodily sensations (such as tension, tingling, or trembling) as key to releasing blocked energy in the nervous system. The therapist guides the patient to become aware of these sensations and allow them to shift.
The Concept of "Charge" and "Discharge"
Building on Peter Levine's core idea, Kuhfuss explains that trauma creates an energetic "charge" in the body — a natural response to survival threats. If this energy is not discharged, it remains trapped and surfaces as traumatic symptoms. SE aims to facilitate safe, progressive discharge of this energy, often through spontaneous movements like trembling.
Creating a Sense of Safety
Kuhfuss places great importance on establishing a safe environment for the patient. This sense of safety allows the person to connect with bodily sensations without being overwhelmed by fear. The therapist plays a key role in fostering trust and security.
In summary, Jean-Marie Kuhfuss’s understanding of Somatic Experiencing emphasizes healing through the body, nervous system regulation, and working with trauma in a gradual, respectful manner, aligned with the patient’s pace and capacity for adaptation.
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