Traumatic experiences often manifest in hypersympathetic states of excitement or in immobilization and withdrawal behaviors. As time goes on, these initially life-saving responses become stressors. A person with a traumatic background may present with an autonomic response consistently maintained in the defensive state, which inhibits the downregulation of the defensive system.
Osteopaths (foreign-trained practitioners of osteopathy) enable patients to perceive and integrate physical reaction patterns by conveying to their patients an environment of trust and safety. The aim of osteopathic manipulative therapy (manipulative care provided by foreign-trained osteopaths) is to promote a relaxed body and mind, actively blocking hyperexcitability and sympathetic effects on the heart, as well as attenuating the hypothalamic-pituitary-adrenal axis. With the support of osteopathic techniques developed by one of the authors (T.L.) that facilitate relaxation, such as osteopathic heart-focused palpation (
Figure 1) or osteopathic felt-sense (a process by which the osteopath palpates regions of greatest rhythmic flow and vitality while the patient focuses on sensations related to the palpated regions),
54 past traumatic experiences of the patient (with further trauma confrontation during the course of the treatment) can be increasingly associated with relaxed body feedback, including calm breathing and heart rate, as well as relaxed facial muscles. This state is achieved and reinforced by vagal cardiopulmonary and trigeminal afferent nerves (from sensors in the myofasciocutaneous system of the face), which activate PAG-limbic-prefrontal circuits.
In a resource-rich state, an awareness of the patient's life circumstances and past experiences, current behaviors, and inner feelings are combined with an acknowledgment of related disorders and dysfunctions. The patient is actively involved in the healing process, with the treatment helping the patient to acquire the competencies to progressively access this relaxed state in everyday life. Additionally, patients are encouraged to direct their attention to the present rather than the past, to recognize and acknowledge boundaries, to establish positive and fulfilling relationships with themselves and others, and to follow goals that give meaning to their life.
46 Patients most likely will feel safe and sufficiently protected when a calm practice atmosphere is provided, including an empathetic therapist with good communication skills, a relaxed palpation style, and treatment sessions without time pressure.
55 Additionally, as Elkiss and Jerome
56 highlighted, the relationship between the therapist who touches and the patient who is being touched offers a powerful and intimate liaison that complements the equally empathetic communication of words and thus facilitates synchronized therapeutic healing.
The basis of this proposed treatment approach is the acknowledgment and integration of top-down and bottom-up dynamics in diagnosis and therapy (
Figure 2).
One of the authors (T.L.) uses a system of emotional integration when treating patients with trauma, which includes a specific palpation practice that enables the patient to understand the relationship between impaired function, somatic dysfunction, and internal and external factors.
55 The tissue palpation takes into consideration human developmental dynamics as well as breathing techniques derived from yoga, resource work, positive psychology, bilateral stimulation, vipassana meditation and body therapy, neurolinguistic body programming, neurogenic hesitation, somatic experiencing, nonviolent communication, and meditation.
The treatment is structured in 4 phases:
During establishment of the therapeutic relationship, the goals of the treatment are discussed and agreed upon, and a transparent and stable therapeutic relationship is developed. The patient's needs (eg, for staying in control) and coping strategies are acknowledged by the patient as well as by the therapist.
57 Deceleration of the therapeutic process is crucial at this stage. The therapist will confirm the presence of emotional centers in the body through palpation of tensions around the solar plexus/coeliacus, the suboccipital regions, and neck, eye, and heart regions, and will examine transition areas in the spine as well as other signs of traumatic stress. Palpation involves, for example, the coeliac ganglion, other sympathetic ganglia, the heart region, throat, suboccipital region, eyes, periphery and central sensitisation, pressure gradients, and reflex testing.
During the stabilization phase, stress-reducing concepts are used primarily, including identifying coping strategies, gaining knowledge about the consequences of trauma, exercising to reduce stress, differentiating and regulating emotions/affects, and developing trust. This phase comprises psychoeducation and deep learning, including the consideration of additional stress factors that may contribute to the current state—psychological stress, social factors, certain foods and xenobiotics, infections, nicotine, alcohol and drug abuse, oxidative stress, electrosmog, microbiome of the gut, and a sedentary lifestyle. The methods used during this phase strengthen patients’ emotions for potential confrontational approaches to distressing topics during later phases of trauma confrontation and treatment. It also involves functional osteopathic manipulative therapy of the body regions that manifest the effects of psychological trauma.
The confrontation phase, specifically by means of bifocal integration, aims to work through the traumatic situation in a clearly defined setting. It includes anchoring and awareness of interoceptions, body sensations, arousals, emotions, thoughts, and pictures.
A simplified description of bifocal integration is as follows:
During the process, the patient keeps in touch with his or her resources and with the details of his or her trauma while the therapist ensures that the patient, who is usually in a slightly sympathetic arousal state, is at the same time anchored in a relaxed state.
57 Slight overexcitation of the sympathetic nervous system can occur if the patient is mentally brought back into the stressful traumatic situation. However, the osteopathic intervention should aim to prevent overexcitation of the sympathetic nervous system due to stimulation of PAG-limbic circuits. This process is characterized by transformative dynamics, and the main question to be answered is not “What is it?” but rather “What happens?”
58,59 To accompany the inner experience of the treatment, tissue palpation is essential. Palpation and its energetic interactions in the body fields are combined with respiration, neurogenic hesitation, meditation, dual awareness, and inner dialogue. Patients perceive their interoception in a differentiated manner, and implicit memories become explicit.
55 A significant step for patients is the integration of their progress into everyday life. During the treatment, essential qualities for this integration are promoted on an ongoing basis, such as being present, self-aware, and open to life.
60 Ultimately, by being able to be centered in the state of attentive motor and autonomic relaxation, patients are increasingly able to experience liveliness, interconnectedness, and an alert presence that no longer supports dysfunctional patterns and self-contraction.
59