In the face of a traumatic experience, some clients become unable to move. This can sometimes indicate that a client is experiencing either a freeze response or a shutdown response to trauma.
And according to Ruth Lanius, MD, PhD, there are key neurological differences that can help us distinguish between the two . . .
. . . so that we can better target our interventions to help patients find relief.
In the clip below, Ruth gets into the neurobiology of both freeze and shutdown – and walks us through her approach with each.
And always lets me remember one of my clients who had a severe trauma history as a child. And he would go into these collapsed states very easily. But as way of compensating, he was doing about four to 500 pushups a day. And this prevented him from going into this collapsed state. And when I saw him, he just suffered from a shoulder injury. And of course, having had this shoulder injury, prevented him from doing those pushups. And so he was referred to me because he frequently found in a fetal collapsed position. And so what we had to do was we had to help him despite his shoulder injury, to really activate his sympathetic or fight flight nervous system. And as we did that, and as we helped him to engage in exercises that he could engage in despite his shoulder injury and activate a sympathetic nervous system, those collapsed responses subsided. So I think that’s how I would work with a collapsed state.
In a child, the way to work with a collapsed state, of course, it’s also to increase arousal. And often kids who go into this collapsed state, they benefit from going into these rooms where they have these light balls, these colorful light balls, and it’s known actually that light pressure can really help to enhance arousal. And so, yeah, that’s another way, especially in kids, how to work with a low arousal collapsed states. When we work with tonic immobility and freezing, I think this is very different.
Deep pressure may be helpful in a freeze response because it activates a certain part of the spinal cord called the dorsal meniscal system. And this actually connects in the brain with areas that help us to know where we are, that help us to integrate sensory information. And so that may be very helpful to then start to engage in movements again. This is, again, something we still need to study, but we know that the system is involved in deep pressure. And so I think this is something we need to explore further.
Another way I often work with people with tonic immobility responses, is to use micro-movements. And often people go into freezing responses because being seen and having moved in the past was incredibly dangerous. And so having had that tonic immobility response was very adaptive at the time of the trauma. And of course now, we want them to come out of this frozen tonic immobility state. And so we have to do that at a pace that feels safe for the client. And so sometimes I use micro-movements. I tell individuals just to move your finger or your toe, whatever part of your body feels safest, just a micro meter. And often this allows people to then slowly engage in movement again, and then, over time, as they feel safe enlarge that movement until they can move their limbs fully.
So when I work with a freezing or tonic immobility response, my goal is to get the individual moving. Either the whole body, if the whole body is frozen or part of the body or the intercostal muscles, if the breath is frozen and very shallow or the gaze, if the gaze is frozen. So yeah, the whole goal with tonic immobility is to get that part of the body moving again. When you work with a collapse or shut down, the goal is to activate. To activate the nervous system to activate the sympathetic, the fight flight nervous system.
For more strategies that can help you work with a patient who’s in shutdown, please join us for the Advanced Master Program on the Treatment of Trauma. This week, we’ll dive into three emerging defensive responses to trauma (beyond the fight-flight-freeze model) and share strategies for working with each.
Now we’d like to hear from you. How do you plan to use Ruth’s strategies in your sessions? Please let us know by leaving a comment below.