Somatic Therapy for ADHD and Trauma: A New Holistic Treatment Option
Unraveling the complexities of ADHD and trauma can help you live with less fear and more stability. Learn how an emerging natural treatment called somatic therapy can help patients listen to the “stories” deep in their tissues, and heal psychological wounds by reconnecting the body and the brain.
Imagine the intricate complexities of a spider’s web — one thread attaches to dozens of others; pull just one of those silky strands and the entire web collapses. Living with attention deficit hyperactivity disorder (ADHD) and trauma can feel similar — the symptoms are so intertwined a single tug may cause the whole tangled web to cave in.
Studies show that experiencing trauma increases a patient’s chances of being diagnosed with ADHD.1 What’s more, teasing out the origins of a patient’s trauma — and assessing its impact on the brain and body — can be complicated since many symptoms of trauma overlap with those of ADHD.1 These symptoms include:
- Difficulty concentrating
- Poor memory
- Emotional dysregulation
- Interrupted sleep
- Impulsivity and/or restlessness
- Problems connecting with others
- Substance abuse
ADHD or Trauma? It’s Complicated
Typically present in early childhood, ADHD is a brain-based disorder often diagnosed after a child struggles in school, or even later in life. Trauma is the result of exposure to stressful events or experiences that can occur at anytime during a person’s life. If trauma occurs during childhood, when the brain is developing, it can lead to cognitive and emotional changes that may resemble ADHD.
According to the most recent statistics from the Centers for Disease Control and Prevention (CDC), ADHD impacts 9.4 percent of children and about 4.4 percent of adults in the United States. Around 64 percent of children with ADHD also have at least one additional mental health diagnosis, such as post-traumatic stress disorder (PTSD), anxiety, or mood disorder.2
Trauma is also prevalent in the U.S., where up to 70 percent of adults report experiencing at least one traumatic event in their lifetime.3 The death of a loved one, divorce, car accidents, caregiver abuse or neglect, living through a natural disaster, experiencing racism, being the victim of a crime or witnessing one — these can all impact the way a person thinks or feels. If left untreated, the problem may become debilitating.
Each person has a unique response to trauma; what’s traumatic for one person may not be for another. Although not all trauma has lasting effects, some trauma becomes chronic with persistent symptoms. Nightmares, frightening flashbacks, intrusive thoughts, avoidance of things associated with the trauma (traveling in a car, for example, if trauma was triggered by a car crash), emotional dysregulation, and hypervigilance are all associated with PTSD.
However, a patient may have trauma-based nervous system dysregulation and not have PTSD. Other trauma-spectrum symptoms (which are also common in PTSD) include anxiety, low mood, difficulty concentrating, numbing (lack of emotion), and feelings of shame and guilt. Trauma symptoms also include physical manifestations, such as headaches, nausea, shaking, chest tightness, shallow breathing, and lightheadedness. 3,4
Because symptoms of ADHD and trauma present similarly, accurately assessing and treating them requires skill and experience. Here’s an example to illustrate the complexity: Poor working memory is associated with ADHD, but consider how the mind can avoid thinking about a distressing experience. Practitioners must determine whether poor memory stems from ADHD or trauma, and treat accordingly.
When the Body Carries Emotional Stress
The chronic stress response is commonly referred to as the “fight or flight” response. Another name for it is “sympathetic arousal,” because it is an activation of the sympathetic nervous system. Sympathetic arousal is the body’s involuntary response to danger and causes adrenaline and cortisol to rush through the body, heart rate to increase, muscles to become tense.
If this response happens repeatedly — on a less intense level — for many months or years, the body learns to treat everything it encounters as a dangerous threat. Over time, it creates fixed action patterns in the body’s tissues, such as habitual muscle tension (clenching jaw or raised shoulders), digestive distress, and neurons that fire the same way repeatedly (defensive behavior patterns). All of these are signs of dysregulation. The nervous system has learned to respond to past events as if they are happening in the present.
How Growing Up with ADHD Causes Trauma
Co-occurring ADHD and trauma are more common than previously thought. People with ADHD are often bullied, feel that they don’t fit in, struggle academically and socially in school, and are admonished by adults for behaviors over which they have little control. It’s easy to see how this adds up to trauma for some people and how the two disorders may become entangled.
Think of the nervous system as our body’s version of a building’s electrical wiring. The brain is the fuse box. The nerves are the wires that extend throughout the body. Our wires contain billions of neurons that communicate via neurotransmitters much like electricity — jumping from one neuron to the next.
In people with ADHD and trauma, the neurological functioning becomes altered and dysregulated, causing the wiring to fire differently. This begs the question, what is the cause of impaired neurological functioning? ADHD and trauma are so interrelated, we may never be able to tease them apart. So how do we move forward? We treat both.
Untangling the Web: Treating Both Conditions
If we only treat one condition or the other, the untreated condition will mask any significant progress in the treatment of the other. People with both ADHD and trauma need strategies for executive functioning, but in order to regulate the nervous system, they must also process the trauma.
Medication is a good place to start because it is a well-researched treatment for both disorders. If pharmacological interventions are successful, life becomes more manageable, and therapy more effective. True healing can begin.
For example, when a stimulant medication improves sustained focus, behavior treatment can center around regulating the nervous system, rather than managing the disorganization. Antidepressants, like selective serotonin reuptake inhibitors (SSRIs), can help lessen emotional extremes, so that the difficult work of processing trauma is more accessible.
What is Somatic Therapy?
Somatic therapy (or somatic psychotherapy) is an emerging, holistic treatment modality that can be used to simultaneously treat comorbid ADHD and trauma. It is the umbrella term for a group of body-based or body-mind therapies. Not to be confused with bodywork involving physical touch, somatic therapy is conducted by licensed mental health practitioners typically trained in both traditional talk therapy and somatic therapy. Their focus is on treating the whole person and fostering reconnection between the brain and body.
Somatic psychotherapy has evolved over the past 50 years as different practitioners observed how the body responds to trauma — as a chronic stress response in the nervous system and fixed action patterns in the tissues.
These practitioners observed that if therapy engaged with the physical sensations of the trauma, rather than the narrative “story” of the trauma, the thought patterns associated with the trauma would eventually shift and in some cases resolve. These observations led to the research and development of multiple therapeutic modalities.
The central objective of somatic therapy is healing or regulating, the nervous system. If the nervous system is stuck in survival mode, the symptoms of ADHD become intensified. Regulating the nervous system may not eradicate symptoms of ADHD, but improving the function of the nervous system (the mastermind of the body) can have ripple effects in every aspect of life.
Somatic therapy increases awareness of the sensations in the body to give the patient a roadmap to understand what they mean. It has been studied as a treatment for trauma, but not as a treatment for comorbid trauma and ADHD. The cousin of somatic therapy, eye movement desensitization and reprocessing (EMDR), has been studied as a treatment for both with promising results, though further research is needed.5 There is some evidence that treating both trauma and ADHD improves the symptoms of both.6,7,8,9,10,11
Somatic therapists are trained to work with the sensations of the body in the same way that talk therapists are trained to work with thoughts or cognitions. I’ve been treating clients using this technique for two years. Here’s a basic overview of how it works.
First, I ask the client to take note of any sensations in their body (tightness, tingling, or nausea, for example). Next, I ask questions to deepen my understanding of the sensation and we pay careful attention to how the sensation shifts in the body. From there, we work with the sensation in different ways to transform it from fear to safety.
Focusing on the body’s response to the trauma — instead of the trauma itself — reduces the possibility of re-traumatizing the individual and starts the healing process. Through the body, we have more access to the traumatic residue, which may not be available in memories.
This is a process that needs to be guided by a trained somatic therapist. I consistently remind my clients: We do not process trauma alone. It is important to process trauma in a trusting, therapeutic relationship. We must co-regulate with another person before we can self-regulate.
Finding Acceptance in Both ADHD and Trauma
Shame is a pervasive component of both ADHD and trauma; recognizing this is key to effective treatment. Somatic therapy can help patients to understand that neither is their fault and, eventually, to find acceptance.
A patient who develops a highly-attuned awareness of their body may be able to discern which symptoms are manifesting from a stress response and which symptoms are more rooted in the neurology of ADHD. For example, somatic therapy can help a patient determine whether they are distracted because of a stress trigger or because of something new and interesting in their environment. A therapist can apply traditional ADHD treatment therapies, such as executive functioning skills training, to help a patient who is experiencing the latter.
Somatic therapy is a long-term treatment (lasting a year or more) that requires a licensed mental health practitioner trained in somatic therapy who also has experience treating people with ADHD. Since somatic therapy is a modality used by licensed therapists, most insurance policies that cover traditional talk therapy will cover somatic therapy as well.
5 Ways A Patient Can Help Him or Herself
Though working with a trained therapist is the best treatment, patients with trauma and ADHD can follow these simple rules to increase awareness of the nervous system.
#1. Note body sensations throughout the day. Noting and amplifying good experiences can be especially helpful when treating both ADHD and trauma, both of which carry a history of negative experiences. Ask the patient to notice a flash of joy or happiness, pause and ask, “What are the sensations of feeling good in my body?” Softness in the shoulders? Heaviness in the legs? Warmth in the belly? There is no right answer. Taking an imaginary “snapshot” of this feeling shows the nervous system how to feel regulated.
#2. Find safety in structure. Structure — knowing consistently what to expect — can foster a sense of safety and decrease chronic stress-related activation or vigilance. Knowing the day will start with a shower and end with teeth brushing, for example, makes us feel safe.
#3. Build a strong foundation. Diet, exercise, and sleep are the foundations of a healthy nervous system function. Healthy habits can be challenging for those with ADHD and trauma, so it makes sense to revisit these foundational areas frequently. If a patient feels lost and overwhelmed, assess foundations, and adjust as needed.
#4. Notice agency. ADHD and trauma are the opposite of control. In somatic therapy, we start with controlling the movement of muscles in the body. Paying attention to the areas of life where there are choices brings awareness to what can be controlled, rather than what feels uncertain.
#5. Communicate with the nervous system to calm it down. One way to quiet activation in the body is the gentle reminder that this is not a survival situation. Patients may send the body an “all clear” signal by:
- Slowing down movement and speech when walking and talking quickly.
- Picking a daily action — such as walking out the door to a car. Use this as a signal to check for muscle tension in the shoulders, back, or jaw. Then, release it, even just a little, in that moment.
- Practicing intuitive movement. When there is a natural pause in the day, ask the body if it wants to move in a certain way. Perhaps the patient feels like shaking out his or her hands or stretching the neck. Asking the nervous system what it needs to feel better — and listening for the answer — is an effective way to communicate with the body and give it what it needs.
It is important to remember that slow is fast, and less is more. There is no quick fix, but as the chronic stress response heals, symptoms will improve.
1 Brown N, Brown S, Briggs R, et al. Associations Between Adverse Childhood Experiences and ADHD Diagnosis and Severity. Department of Pediatrics, Albert Einstein College of Medicine, Children’s Hospital at Montefiore. Accepted August 29, 2016.
2 Centers for Disease Control and Prevention. Data and Statistics About ADHD. Page last reviewed October 15, 2019. Accessed June 24, 2020.
3National Council for Behavioral Health. Infographic. “How to Manage Trauma”. Available at: https://www.thenationalcouncil.org/wp-content/uploads/2013/05/Trauma-infographic.pdf?daf=375ateTbd56
4 Center for Substance Abuse Treatment (US). Trauma-Informed Care in Behavioral Health Services. Rockville (MD): Substance Abuse and Mental Health Services Administration (US); 2014. (Treatment Improvement Protocol (TIP) Series, No. 57.) Available from: https://www.ncbi.nlm.nih.gov/books/NBK207201/
5Friday, S. (2003). Using eye movement desensitization and reprocessing as an intervention for trauma and behavior symptom severity in attention deficit hyperactivity disorder. Dissertation Abstracts International: Section B: The Sciences and Engineering, 64(6-B), 2901. Available at: https://emdria.omeka.net/items/show/17411/
6Shapiro F. The role of eye movement desensitization and reprocessing (EMDR) therapy in medicine: Addressing the psychological and physical symptoms stemming from adverse life experiences. Perm J. 2014;18(1):71-77. DOI:10.7812/TPP/13-098
7Ogden, P., & Minton, K. (2000). Sensorimotor psychotherapy: One method for processing traumatic memory. Traumatology, 6(3), 149–173. https://doi.org/10.1177/153476560000600302
8Brom D, Stokar Y, Lawi C, et al. Somatic Experiencing for Posttraumatic Stress Disorder: A Randomized Controlled Outcome Study. J Trauma Stress. 2017;30(3):304‐312.doi:10.1002/jts.22189
9Grabbe L, Miller-Karas E. The Trauma Resiliency Model: A “Bottom-Up” Intervention for Trauma Psychotherapy. J Am Psychiatr Nurses Assoc. 2018;24(1):76-84. doi:10.1177/1078390317745133
10Parker C, Doctor RM, & Selvam R. (2008). Somatic therapy treatment effects with tsunami survivors. Traumatology, 14(3), 103–109. https://doi.org/10.1177/1534765608319080
11Bessel A. van der Kolk (1994) The Body Keeps the Score: Memory and the Evolving Psychobiology of Posttraumatic Stress, Harvard Review of Psychiatry, 1:5, 253-265, DOI: 10.3109/10673229409017088
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Updated on June 25, 2020