Recovery from the Trauma of a Crash
In the case of a car accident, like so many traumatic events, the accident victims have no opportunity to complete natural instinctive survival reactions. This is how unresolved trauma leads to post-traumatic stress disorders. Somatic Experiencing, SE, a somatically based approach to the resolution of trauma, is one of the most effective tools for the healing of traumatic life events and is particularly effective in the treatment of auto accident trauma because of the special difficulties presented by high-speed, high-impact trauma and injuries.
Unless one has seen the relief that this body awareness approach can bring to a traumatized client, it is hard to believe the dramatic results these techniques can have where other treatments have failed. A therapist’s account of the treatment of a car crash survivor clearly demonstrates how SE and the creation of an “Oasis of Safety” can successfully help a client overcome a traumatic auto accident.
The patient in question was a young woman who had been treated for whiplash, severe headaches and other pain after a rear-end collision, but whose chronic pain ailments persisted. She spent years taking medications for her anxiety and sleep difficulties. In psychotherapy she was encouraged to "talk it out,” but each time the woman retold her accident story she got upset. Some of her symptoms worsened over time despite the efforts of well-meaning therapists. She thought she was going crazy because she still felt so much fear and anxiety.
A basic principle in Somatic Experiencing is that trauma is in the nervous system, not in the event. So symptoms are markers for where the body has attempted to compartmentalize leftover survival energy that has not yet been “discharged” or released. Unfortunately, the nervous system becomes increasingly closed and the threat response internalized so that eventually any “activation” causes and perpetuates mobilization of defense energy, exacerbating the symptoms over time.
Moving Past the Memory Snapshot
Rather than ask the patient to retell the story, she was asked to recall the first time she felt safe after the accident. She instantly recalled seeing her husband in the ER. Visibly the woman relaxed at that memory. There was a significant shift from shallow breathing to deeper belly breathing. All of these signs show that the parasympathetic branch of the nervous system was gently beginning to facilitate discharge.
This technique is important for two reasons. First, the client realizes that there is an "after." Traumatized people feel that the trauma will happen again because they are not really aware that it is, indeed, over. Second, the client perceives how the body itself is capable of switching to a relaxation response.
The part of the brain in charge of survival basically takes a "memory snapshot" of elements considered part of the danger of the accident, associations to the original event fuel fears, hyper-reactivity or disconnection. In this client’s case, the danger came from behind while driving, the accident occurred at an intersection, it was raining at the time, and the sound of metal on metal was terrifying. Understandably, triggers for her fears occurred when she stopped at intersections, was approached from behind by a vehicle, or when she saw wet, slick roads or heard loud noises. Extinguishing these triggers was the next task.
Finding an Oasis of Safety
Whenever memories flooded back to activate the trauma, the young woman’s attention would be immediately switched to after the accident was over, when she felt safe again. This illustrates another key concept of SE called “pendulation” or “looping.” Looping is a technique in which the therapist helps the client move back and forth between small segments of the traumatic event and a calming interlude. This helps discharge the activation in the nervous system that emerges as the person slowly works through it.
It is also beneficial if the client is allowed to discover his or her own sources of calm rather than to have the therapist suggest resources. Asking the client what has helped to get them through difficult times in the past is a good strategy. Close friends and family members are usually acknowledged, or memories of activities that are relaxing. Creating this "Oasis of Safety" for a patient allows the therapist to effectively address the traumatic moment.
Thawing the Freeze Response
Bringing the patient back to the moment before the impact is a critical next step in the final discharge. In the case of the young woman, she was asked to “freeze frame” the van before it hit her. Visualizing this in her mind gave her time and space to respond to it, like an advance warning.
The client showed immediate signs of relief as she pictured the van, fully stopped and about three blocks back. The client was now positioned to work through a series of responses, the first being the desire to accelerate (flight). At the suggestion of feeling her foot press on the accelerator, she felt energy released down her leg and through her foot.
Another survival plan response was anger. She felt that she wanted to yell at the driver and honk the horn. Again she felt a palpable discharge and a sense of calm returning. She realized that her body could design realistic survival plans when it had enough time. The patient began to trust her body again.
When something unexpected occurs in our environment that alerts us, our threat reaction is activated. When alerted, there is a “startle response.” We then orient our eyes, ears and our body position to locate the possible threat. If we determine it is dangerous, we instinctively move either toward it to confront it, as in the fight response, or away from it, as in the flight response. Later, as the freeze response literally thaws out, we tremble and shake as the nervous system releases and reorganizes.
By giving the body all the time it needs, it can relax and shake off the excess energy left from the traumatic experience. Biological completion helps unlock the jamming in the nervous system and allows the client to integrate the experience so that they can move on and be freed from the after-effects of trauma. But starting slowly from an Oasis of Safety and by directing attention to events before and after the impact, working gradually toward the center, is critical to the process.
The Return to Self
By using this method, car crash victims can gradually slow down and maintain an integrated awareness from start to finish throughout the accident, including impact. Then perceptually, the accident can move from seeming to be ever-present, or fixated in the future, back into the past where it belongs. The accident is experienced as truly over. Symptoms diminish. Triggers of fear, panic and anger are extinguished. Continuity of self is re-established.
This is good news for both therapist and client. Case in point, after six months of SE treatment, many of the woman’s phobias as well as most of her physical and emotional symptoms were resolved.
For more case histories and to learn exercises to treat the health problems and trauma brought on by car accidents and injuries, read Crash Course – A Self-Healing Guide to Auto Accident Trauma & Recovery by Diane Poole Heller, Ph.D. with Laurence S. Heller, Ph.D.
Crash Course – A Self-Healing Guide to Auto Accident Trauma & Recovery
Diane Poole Heller, Ph.D. with Laurence S. Heller, Ph.D.
North Atlantic Books, 2001