Fibromyalgia Syndrome (FMS) and Chronic Fatigue Syndrome (CFS) present a complex and medically unexplained cluster of symptoms that impact an individual's ability to function in most daily tasks and sustain fulfilling relationships with family and friends. High pain sensitivity sidetracks nurturing and pleasurable experiences as the individual spends time managing fatigue and regulating anxiety.
The American College of Rheumatology recognizes that many people with Fibromyalgia Syndrome (FMS) and Chronic Fatigue Syndrome (CFS) experience Post Traumatic Stress Disorder symptoms such as gastro-intestinal instability, pain in the body and the survival response of fight/flight and dissociation.
Somatic Experiencing (SE) therapy views the pain, fatigue, and other symptoms that FMS & CFS patients experience as the result of a fast cycling of arousal and avoidance patterns. This is caused by a stuck Autonomic Nervous System (ANS) response to a perceived threat - an ongoing response to overwhelming trauma or traumas.
The ANS modulates heart rate, digestion, and breath, keeping these body systems in a natural equilibrium. It also regulates physical and emotional reactions to perceived threat. It is composed of parallel systems called Sympathetic (accelerator - fight/flight) and Parasympathetic (the brake - rest/recuperation).
When this reciprocal relationship is working well, the body responds to stress or a threat by increasing heart rate and breath and tensioning the muscles for action. When the threat has been dealt with, it signals the body to rest and clear the activation from the nervous system. In animals and humans, the ANS has an innate capacity for restoring itself to balance, as long as the self-regulating function is not disturbed.
The Sympathetic or fight/flight response to threat is an automatic response of the ANS and is not mediated by conscious self-control or avoidance strategies. We believe that what we see in patients with FMS and CFS is actually a stuck fight/flight activation response in the body, which allows the tension to accumulate causing extended pain and fatigue.
For Fibromyalgia and CFS patients, this function became disrupted because overwhelming experiences, such as birth trauma, accidents, surgeries, sickness, infections, and emotional/physical abuse or neglect. Chronic stress can build up in the body for years, eventually upsetting the normal self-restoration of the autonomic nervous system.
Somatic Experiencing therapy works directly with the Autonomic Nervous System to discover where the activation responses have become stuck and cannot release their tension in a normal way. SE therapy gently and carefully works with these incomplete motor responses by allowing them to complete and then discharge and be safely neutralized. When this tension is released, accumulated stress is removed from the system and the body begins to calm down, move out of its reactive state, and be more flexible, more adaptive and able to handle new stressors in a healthier way.
As an initial step in SE therapy, the patient is asked to pay attention to sensations in the body as they describe something they experience as pleasurable. As the work progresses and the patient becomes skilled at staying with sensations that are more troublesome without disappearing or disconnecting, they begin to build the container within themselves to tolerate greater amounts of stress without the need to internalize it. This can help to release the high activation states (and related pain) of the nervous system, which allows the body to tolerate new stressors without pushing the nervous system into a FMS or CFS flare-up. In this way the therapy supports a gentle return of the natural nervous system regulation that was lost to the overload of stress and bracing.
This can allow for great benefits for people with FMS and CFS, who can experience a resurgence of energy and a resilience to stress that was once debilitating.
1. What kind of threat would trigger a fight/flight response and activate the central nervous system?
The triggering event is different for each person. It could be a physical response to a virus, injury or surgery. Or it could be an emotional response such as witnessing or experiencing the violent atmosphere in a broken home, a series of vehicle accidents or falls, or birth trauma. Any overwhelming experience that caused an activation of the survival fight/flight response that later clustered with other experiences can contribute to the onset of FMS/CFS.
This is especially true for individuals who, of necessity, had to suffer silently and keep their experiences to themselves. They internalized their pain and stress trying to control it, but this never allows the discharge of the tension, which can eventually overwhelm and disrupt the normal nervous system functions.
As much as we wish to deny or ignore something hoping it won't have an affect on us, the body can only hold so much stress before things start to break down. Just like a car that you are driving at high speed without putting oil in it, eventually that will create problems that will damage the car and require some help to fix it so it will run well again. The body is no different, and when stress and trauma have thrown off the nervous system, it needs help to discharge this energy so it to can run well again.
2. What if the individual has no memory of traumatic events?
What I see with most individuals that present with FMS or CFS is that the survival response was initially triggered before the cortical regions of the brain started to develop at age two. Most individuals never get a memory of the initial triggering event, nor do they need to. SE works with the activation cycles that are present in the here and now and assisting to bring them to completion in the present, allowing the FMS/CFS symptoms to diminish.
Remember, you do not have to experience an overwhelming event again with SE. You do NOT have to experience a violent event again to discharge the activation in the system related to that event. In this work, the discharge is brought about in a gentle way through the natural re-organization of the body and the nervous system that is present in this moment. The past remains the past. Having said that, some people later become aware of events that may have triggered the activation but it no longer has a strong charge for them.
3. How long does it take to see results with SE?
Each person is different. Most people report noticing feeling different right away with more pronounced shifts by the third session. Typically, a course of therapy lasts for twelve to twenty sessions with periodic two session follow-ups. Completion of therapy is indicated by an experience of a release of old tension, a new connection to oneself, and the experience of resiliency when new stresses are met and resolved.
If you have any questions on Somatic Experiencing, or how it might be of benefit to you, please feel free to contact me at (805) 964-2707.
Yuri Zelez, MFT, is a Somatic Experiencing Practitioner in private practice in Santa Barbara, CA. He has done presentations on SE internationally and also helps facilitate trainings in the US and Canada.