Welcome back to the Healing Pain Podcast with Dr. Peter Levine, PhD
PTSD can happen to anyone. It’s not a sign of weakness. In many ways, it’s a normal part of the traumatic healing process. Post-traumatic stress disorder can occur after you’ve experienced any type of trauma. A trauma is defined by a shocking or a dangerous event that you see or experience. Depending on which study you read, approximately 15% to 35% of patients with PTSD also suffer from chronic pain. Is there a link between trauma, PTSD, and chronic pain? Dr. Peter Levine, author of “Waking the Tiger: Healing Trauma” think so, and offers ironclad research to support his claim. Dr. Levine received his PhD in medical biophysics from the University of California at Berkeley, and also holds a Doctorate in Psychology from International University. For over 40 years, Dr. Levine has worked in fields of stress and trauma, leading to his development of the Somatic Experiencing Method, giving a new lease in life for PSTD survivors.
We’re going to speak with a true pioneer regarding the topic of trauma, PTSD, and chronic pain. There are many topics in the fields of chronic pain that do not receive the attention they deserve, but PTSD or posttraumatic stress disorder is perhaps at the top of the list. Depending on which study you read, approximately 15% to 35% of patients with chronic pain also suffer from PTSD. Survivors of physical, psychological or sexual abuse tends to be more at risk for developing certain types of chronic pain conditions later in life. Posttraumatic stress disorder can occur after you’ve experienced any type of trauma. A trauma is defined by a shocking or a dangerous event that you see or experience. During this event, you think that your life or the life of others close to you is in danger or threatened. Living through or experiencing a trauma is not a rare occurrence. Approximately 60% of all men and 50% of all women experience at least one trauma during their lifetime, but the type of trauma they experience can be different. Women are more likely to experience sexual assault or child sexual abuse, while men are more likely to experience accidents, physical assault, combat, disaster, or to witness death or a serious injury.
PTSD can happen to anyone. It’s not a sign of weakness. In many ways, it’s a normal part of the traumatic healing process. Here’s some facts based on the US population regarding PTSD. About eight out of every 100 people will have PTSD at least once in their life. Approximately a million adults suffer from PTSD during any given year, and about ten out of every 100 women will develop PTSD sometime in their life, compared to four out of every 100 men. PTSD is a big topic in our military and especially for the men and women who serve our country. During Operation Iraqi Freedom or what is known as Enduring Freedom, about twenty out of every 100 veterans or 20% who serves had PTSD. During the Gulf war or what’s known as Desert Storm, about twelve out of every 100 Gulf War veterans had PTSD in any given year. During the Vietnam War, of which we don’t have great data, it’s estimated that approximately 30% of every Vietnam veteran has suffered with PTSD at least once during their lifetime.
Here to speak with us now about trauma, PTSD and its link to chronic pain is Dr. Peter Levine. Dr. Levine received his PhD in medical biophysics from the University of California at Berkeley. He also holds a Doctorate in Psychology from International University. He has worked in the field of stress and trauma for over 40 years and is the developer of the Somatic Experiencing Method. Pete’s original contribution to the fields of body psychotherapy was honored in 2010 when he received the Lifetime Achievement Award from the United States Association for Body Psychotherapy. Peter’s the author of over ten books as well as his bestselling book called Waking the Tiger: Healing Trauma which has been published in 24 languages and has sold over 250,000 copies. Before you listen to this podcast or as you’re listening to this podcast, if you feel that trauma or PTSD may be a contributing factor to your chronic pain, I’ve included a brief self-test for you. This test will provide a general assessment of where you might be emotionally and can help you decide whether you could benefit from treatment. To receive this free self-test, all you have to do is go to www.DrJoeTatta.com/88Download or if you’re on your cell phone, you can text the word 88Download to the number 44222. This is an important topic for those living with chronic pain. Let’s begin with Dr. Peter Levine.
Connections Between Trauma, PTSD And Chronic Pain With Peter Levine, PhD
Peter, welcome to the podcast. It’s great to have you.
I’m looking forward to it.
Peter, I get a lot of questions about how trauma is related to chronic pain. You spent most of your life studying trauma patients and how trauma affects the human body. You have a technique called somatic experiencing and it emphasizes the physiology and what’s happening in the body on a physiologic level. Before we dive into that specifically, can you tell me how you started to explore this many years ago?
This came out of an accidental cure of somebody. This was back in 1969. There wasn’t a label for this, but she was suffering from what we would now call fibromyalgia, irritable bowel, chronic fatigue, and so forth. I rather, by accident cured her of most of the symptoms. From the very beginning, it was clear to me that there was a very strong relationship between chronic pain and between different pain syndromes and trauma. At the same time, I’m having this pain that’s unremitting and being shuttled from provider to provider and often these people are given pejorative things like, “This is all in your head because we can’t find anything wrong with x-rays and so forth.” That itself becomes traumatizing. Maybe the place to start is what the body does when it’s exposed to threat. We stiffen, we can constrict, we turn away from, we brace. These are all things that the body does to protect itself from an onslaught of threat.
What happens with trauma is that these reactions get stuck. They stay contracted. They stay with the shoulders up in a protective stance. What happens is the body then sends signals back to the brain that says that the threat is persisting. Again, this is what I call a positive feedback loop with negative consequences. When we brace against the threat and that becomes chronic, then that becomes painful. The body, if it’s in this position for days, weeks, months, years, then it becomes what the person believes is how their body is. That of course causes the pain. What happens when we experience pain? Our body constricts even more, which then again signals more of the fear. The fear causes more constriction, the constriction causes more pain and fear, and you have this feedback loop. I want to get away from that that trauma is causing the pain, but it’s a big factor in the pain. Often, again, people will start some physical pain.
Our response to physical pain by and large is to become rigid, to constrict. Actually, it’s probably part of an evolutionary response that if a part of our body is injured, because this was before there were doctors that would put a cast on us, our muscles cause the casting by co-contracting one muscle group against another muscle group and stiffens the body. This stiffening also feeds into the trauma, increases the constriction, increases the pain, and so forth. I guess what I’m saying is it’s not like, “You have the pain, so you need to work on your trauma.” It’s more nuanced than that. It’s more complicated than that. The trauma and the pain had a final common pathway, which is how it plays out in the theater of the body, and that’s what needs to sit. What I discovered back in the ‘60s and ‘70s as I started to develop this work is that when people are traumatized, their body goes through all of these responses. Bracing the experience, they collapse. They experienced fight-or-flight and these things become habitual, becomes stuck. They will remain stuck and the trauma in a way is playing itself out in the present time by this reactivated trauma circuit.
What I discovered in working with trauma is that when people were able to get new experiences in their bodies, experiences that contradicted those of bracing and of helplessness, of overwhelm and helplessness, when the body had these experiences, then the trauma would recede to a degree that the people could find new experiences than the trauma itself. The pain itself was reducing. Also, the areas of the brain that are responsible for physical pain are also responsible for emotional pain. Again, you have this self-perpetuating cycle of the pain becoming emotionalized and the emotions becoming pain-ized. It’s useless trying to separate mind and body because they are in a welded, undifferentiated unity. This also gives us the idea that if we can change the body experiences, then we will also change what’s going on in the mind. Most approaches, at least when I began developing my work, was about the mind and trying to change the mind, which is okay but it’s going to be very limited in terms of trauma and of pain. If we can help a person become aware of their catastrophizing thoughts, that can be of help. There’s no question about that. By itself, it isn’t going to shift the pain because it’s a primitive response. It doesn’t have anything to do with thoughts.
People are going to want to know, “He has a history or a degree in psychology so you would think that the first place you might go might be talking about thoughts and emotions.” You’re actually saying, the first place in is actually through the body, which is so interesting because oftentimes people with pain don’t want to move or don’t want to feel the experience in their body, but the window or the door to reversing this could be through the body.
Exactly. When the body has been the source of pain and fear and helplessness, the body becomes the enemy. You want to do anything else but feel what’s going on in your body. I discovered a phenomenon that when you can help the person just touch into those sensations, not go diving into them, but just touching into them, at first the pain is very likely to feel worse because you haven’t been aware of it, aware what’s going on in the body and so there is a contraction, but then every contraction is followed by an expansion, and then another contraction and another expansion, and another contraction and other expansion. When we help people contact these sensations in a relatively safe way, they begin to change on their own. I call this phenomena pendulation and it’s a basic rhythm of all living organisms.
If you even see a video of an amoeba, it’s always contracting and expanding, contracting and expanding. It’s moving towards sources of nourishment and constricting away from sources of threat or toxicity in the water. If you put some nourishment in the water, you’ll see the amoeba moving towards the nutrient. If you put something toxic or just touch it with a sharp pipette, the whole amoeba constricts and contracts. We do the same thing. With pain, we contact. What does contraction do to pain? It makes it worse. Eventually, many people get to the point of dissociating from the pain, dissociating from the difficult emotions because they seem unmanageable. As we learn to be able to touch into them, to explore them, even eventually to embrace them, then things start to change.
You mentioned there are changes in the body happening, what do you think is happening in the nervous system, in the brain, as the body begins to change? We’re learning so much through functional MRIs and through other types of imaging studies, but do you have any inkling of how our body is affecting our neuroplasticity?
One of the things that Darwin talked about is about the vagus nerve. The vagus nerve goes between the brain, the brain stem, goes to all of the organs especially the subdiaphragmatic organs, the organs of digestion, elimination, so forth, and it goes to the other organs as well. Darwin called the pneumogastric nerve. Now we call it the vagus nerve. My dear friend, Stephen Porges, looked at this and all of the information that was known at that time starting from Darwin onwards. He discovered that when we’re experiencing threat, the body mobilizes for fight-or-flight. When we’re completely overwhelmed and we’re experiencing something we perceive as life-threat, our body goes down. Instead of preparing for action, it goes into a process of inaction. It shuts down. One of the things that goes on as part of the shutdown is the gastrointestinal system gets over stimulated. We see some horrible things; our guts tighten up and they twist.
This vagus nerve that goes from the brainstem down into the viscera, it turns out as Darwin suspected, that 80% of that nerve is afferent. In other words, it’s taking information from the guts and bringing it back up to the brain. You see an accident or something like that, somebody has been injured and we go, “Ugh.” Through the sensory nerves, that signal goes back up to the brain. Then the brain says, “This is beyond horrible.” It sends again messages down through the motor part of the vagus nerve. Again, as Darwin realized back in the 1860s, you can’t separate mind and body. When you change something in these primitive circuits, the mind changes. The mind starts to relax, the mind starts to see new possibilities. Again, whether it’s fight-or-flight or life threat, this is a feedback loop. This in a way reminds us of the welded unity of mind and body. We can’t really get into the brain. The only way we get into the brain to access to these primitive circuits is through sensation and through somatic experience.
For example, I have one exercise that I do which helps people come out of shutdown and very effective with chronic pain. That’s to make a very easy soft in-breath and on the exhalation to make the sound voo as though it’s coming from the belly. It’s something like this voo and I let the breath and the air go all the way out and then just allow the next breath to come in, and again directing the voo right into the belly, into the gut, voo. I can feel the vibration there in my belly. That’s now sending a new signal back to the brain. Remember, before it was this yuck, twisted, knotted, now it’s, “It’s an interesting vibration.” Then as the person begins to befriend those sensations, lo and behold, they start coming out of shutdown, out of dissociation. The pain level very often decreases sometimes dramatically. I sometimes, not all the time of course, but I’ve often worked with people who have chronic pain and doing these awarenesscises. By just doing those things, sometimes in a matter of fifteen to twenty minutes, the pain level can shift between an eight and a three. I’m not saying that that takes care of the pain forever but I’m saying by changing that, the information that’s going not just from the brain to the body, but from the body to the brain, shift happens.
That’s a good way to put it. I liked that one little exercise you gave us because it gives us an idea of what you’re starting to talk about and what somatic experience looks like. When someone comes to you for a first session or some of the people you’ve trained, what might they experience? Let’s say someone has fibromyalgia so they have widespread back pain and neck pain and pain all over their body. What might they experience during a first session with a practitioner?
First is get to know the person to be aware of their symptoms, of how long they’ve been there in that thing. That’s essential information for any clinician. It’s also important to get the person to get something fundamental about who that person is and what might have happened to them throughout their lives. I’d say that’s the key. The idea is to not take the person into the trauma. That’s not going to be helpful. There are methods where they just have the person relive their traumas over and over again. I’m not a fan of those for sure. It has to do with touching and gradually befriending those sensations. Almost always where there’s pain, underneath the pain or around the pain, there are other sensations, some that are positive, some that are even pleasant and pleasurable. Then sometimes the person will learn that they can shift between the pain sensations and the more pleasurable sensations, shifting back and forth. In doing that, the pain sensations almost always begin to reduce.
Chronic pain in these conditions, fibromyalgia and so forth, are the conditions that most somatic experiencing practitioners treat routinely. If I’m doing a class particularly on working with these syndromes and I ask how many people treat people who also have fibromyalgia and so forth, two-thirds of the people raise their hands. I say, “How many of you also work with people who have different pains symptoms that don’t make sense? Then again, we’re getting close to 80%. It’s very common. Back in the day, trauma was seen in terms of intrusion, in terms of hypervigilance, flashbacks, and so forth. I discovered over the years that the majority of symptoms are not those, but they’re actually things that are going on in the body in terms of symptoms that are playing out in the body. Again, they’re so common. It’s one of the things that I’m working with right now with a colleague, a couple of MIT people, setting up a web-based program to help these people because it’s so common. Even though somatic experiencing is very helpful for this, even though there are 30,000 practitioners worldwide, there’s just a grip for the need of people with these conditions. I know other people have done work with chronic pain that also was helpful. As I said, I’ve read some of your work and it’s spot on. If we look at the different approaches, we’ll see more similarity than differences. It may appear to be different, but if they work, they’re going to be similar.
Knowing that you’ve been doing this for a number of decades, when you look back on your experience through this, how has it informed your life and the person you are? You have seen thousands and thousands of people who have experienced horrific traumas as well as the practitioners who often come to you as the expert and say, “I have a vet or I have someone who’s been sexually abused or I have someone who’s got chronic pain.” That must have an impact on your nervous system after a while.
It does. Sometimes, I say I’m an unrepentant trauma monomaniac. I have such a curiosity that in some ways buffers me against the horrific things that do happen with people. Also, being able to make a difference in people’s lives buoys me up very much. There are times, quite frankly, this is when I was living in Colorado when I was still having a private practice and I would just be working with one horrific thing after another for the whole day. I lived right out of a river. I’d walk out and I’d put my feet in the river, take my hands, and splash the water in my face. That really helps. Sometimes if I’m just so angry at the world for inflicting this kind of pain, I would keep a bunch of empty cans and I’d go on the road where my house was called Apple Valley Road and I would just start kicking cans down the road. My neighbors would say, “There’s Dr. Levine. He must have had a difficult day.” I don’t let it get stuck. You’re talking about vets. Back in ‘70s, I started working with people that were coming back from the Vietnam War. They had these groups where they would be together and talk. They called them Rap Groups. As they got to know me a little bit and trust me little, I said, “If any of you want to come on Thursdays, I’ll just leave my office schedule open. Anybody who wants to come in, we can sit down together.”
The first Thursday, one person came. His name is Bill. He started by telling me the most horrific things that he did and he was made to do that he experienced. I felt myself feeling nauseous, dizzy, light-headed. I said, “Bill, when you told me those things, this is what I was experiencing. It’s not because I was judging you, because I know enough about war to know that it’s horrible. Any war is horrible. When I had these things happen to me, I knew what to do. I knew how to let them move through my body and out of my body, so I’m not going to be carrying it with me. I imagine those are some skills that might be helpful for you.” Next week, I came back to my office and there was a line down one street, the other street and another street. I asked the people whose house that I had the office of if I could use their living room. I brought everybody together and that was when we did our first group work. By the way, if you want to see, a short documentary was made about the work I did with an Afghan-Iraq vet named Ray. It’s available on YouTube. You just go to Ray’s Story, Somatic Experiencing with Peter Levine or something like that. He was also suffering from tremendous chronic pain, depression, PTSD, traumatic brain injury, and so forth, which would seem like hopeless. After the first session, he reports that 80% of it was gone.
I did four sessions and then we were together. Actually, I gave him a scholarship to be there. I used to do a workshop there called the Ordinary Miracle of Healing, so the four sessions plus that. He is interviewed after these different sessions. You see how he goes from being totally disabled and shutdown to coming back into life and being a compassionate, reflecting young man who becomes a husband and a father. Again, when you are getting back to having trauma as your daily diet, trauma is a fact of life, but it also doesn’t have to be a life sentence. That’s the message that I would want to convey more than anything else, just simply that. We’re all experiencing trauma, whether it’s an enormous big T traumas or so-called little t traumas that add up. This affects all of our lives, sometimes in very subtle ways, sometimes in very abrupt ways, in ways that interfere with our lives. That’s the takeaway message that I would want to give to people that yes, it happens to all of us to some degree, but it doesn’t have to rob us of our lives.
It’s a similar message to what we tell people about chronic pain. Chronic pain does not have to let rob you of leading a rich, fulfilled and meaningful life. There are ways to move beyond and out of it, just like you mentioned, moving trauma out of your body. Knowing that it takes a lot of empathy to work with people who have chronic pain and trauma, where is empathy built into some of the somatic experiencing framework or training? To a certain extent, some practitioners have that naturally and some practitioners needs to be gently paddled along behind to move forward toward that.
We all need to do our own personal work. That’s what I say to all of my trainees, “Do your own work.” If you don’t do that, then you’re going to be very limited in what you can do with people, with clients. Therapists generally tend to be empathic. Empathy probably has something to do with what are called mirror neuron systems where when you see somebody in pain, we will actually experience something similar to that pain. That’s how empathy is built especially around issues of pain. We have to not only have empathy but the tools so that we’re not absorbing the pain because we are mirroring the pain. We use that to help us guide the clients with the pain. We have to make sure that we are resourced, that we have the tools that we need in our training program.
By the way, the people that want to learn more about that or find practitioners, they can go to TraumaHealing.org. If they’re interested in some of the events that I’m doing for the next month or so in the United States, they can go to SomaticExperiencing.com. It has a list of that. In the training program, the trainees get to practice with each other literally hundreds of times in working with these different issues and learning how to access the body in a safe way. I’m thinking about the story about the guy who arrives in Grand Central Station and he goes up and he asked a taxi driver, “How do I get to Carnegie Hall?” The taxi driver looks up at him and says, “Practice, practice, practice.” Really developing these skills so that they become second nature, and that’s really an important part of training. Sometimes, therapists neglect doing their own work, which is absolutely necessary.
When we talk about trauma, we should definitely touch on and give some attention to those who’ve been sexually abused or sexually traumatized. So often, those with chronic pain or chronic pelvic pain or problems around that part of the body, what would you say, especially in this era when it’s on all of our minds?
Just very recently, I worked with a young woman, a gymnastics person, who was abused by this monster. The effects of this are profound. If it hasn’t happened to you, most of us don’t get how deeply impacting and confusing these things are. Because sexuality is so sacred, the wounding is in our most sacred parts of ourselves. We need to have the compassion so that we can get what that experience has been for with the clients that we work with. It’s so prevalent. The current statistic is something like 40% of people have had experience of sexual abuse, sexual trauma. It’s probably going to be more for women. I came across this study that 60% of people have trauma history that was never brought up in therapy or came up in therapy. I thought, “How is that possible? How could that be missed?” Again, it’s because many therapists, because of our own woundings, we don’t want to go there. In a way we prevent our clients from going there. It gets back to the need to do our own work, deal with our own issues, whatever they are, so that we’re free with our own central awareness, with our own sexual health. It’s such a relief that the #MeToo movement has occurred because it has brought this into the foreground. These things occur in almost every profession and among people who are supposed to nurture and take care of us as little children, doing things that are harming us and profoundly confusing us.
I have been talking with Dr. Peter Levine. He’s the Founder and Creator of a world-renowned method called Somatic Experiencing. You can learn more about him by visiting TraumaHealing.org or SomaticExperiencing.com. You can go there to find out about where to find about chronic pain or to find a practitioner who specializes in somatic experiencing for the treatment of trauma. Peter, thank you for being here. Where would you like to see somatic experiencing go over the next one to two decades?
Over the past 45 years, we’ve been training individual therapists by and large. I would like to see this work go out to the general public. I’d like to see it go out to community mental health. The state of community mental health in the United States is really poor. I’ve been doing some things for these organizations. These people are overworked, they’re underpaid, and they are dealing with very difficult clients with very difficult symptoms. I’m hoping to be able to more and more provide those therapists with at least simple tools that they can use that can help both their clients and also themselves. That’s an area that I would like to see continuing. I’ve written a number of books and I’m probably going to write a couple more at least. The books are listed on at least one of the websites. I’m interested in helping adolescents find healthy sexuality. Basically, there is next to zero sex education in our schools. Where do kids go to get sex education? With the devices that they have, and so they’re learning from pornography and this is horrible. I can’t believe something like this can go on. That’s another area I’d like to try to impart some of this health to adolescents.
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About Peter Levine
Peter A. Levine, Ph.D., is the founder of the Somatic Experiencing Trauma Institute. In addition to a doctorate in psychology from International University, Levine holds a Ph.D. in medical biophysics from the University of California, Berkeley. Levine has specialized in trauma and stress for over 40 years, and is the developer of Somatic Experiencing, a treatment approach that attempts to heal trauma and other stress disorders. Levine is also the author of “Waking the Tiger: Healing Trauma,” a best-selling book published in over 20 languages. In 2010, he received the Lifetime Achievement Award from the United States Association for Body Psychotherapy.
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