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.
Sign up for the free broadcasts here.
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.
We all seem to carry shame and targeting the defense system and become aware of our body response are key. I have been attending your free broadcasting courses and learn much about your model. Very grateful for all what you do to improve the life of the PTSG trauma survivors
This was very helpful thank you
Your “micro-movement” response makes me think of The Tuning Board, a very subtle somatic therapy tool/balance board that can help people access a flow of movement through their bodies. (www.tuningboard.org). It helps self-regulation in either direction; for someone who is collapsed, they inherently summon energy to engage in the gentle balance task. Someone with a high sympathetic charge will amp down to be able to do it. And someone in freeze will begin to feel the return of micro-mobility through their system.
These videos are fantastic, thank you so much for your contribution to our skills. I am beginning to realise that non-verbal interventions are so important for trauma survivors. With the benefit of all this information, we providers are paying it forward and improving our service to our clients.
Thanks
Diana
thanks for the wonderful learning sessions , Deep massages and oil baths have been part ayurvedic treatments and also cultural practices in India specially during transitions like marriage , childbirth and also regular festival occasions , I feel these practices are meant to release cumulative trauma in a universal and non stigmatising ways , When every one in the family has access to such practices then the person with particular trauma experinces would have access to it . The sense of being cared for and interpersonal aspects of such rituals are therapeutic , Unfortunately a more MOdern Lifestyles has decreased regular practices allowing trauma to become more embodied
How would you work with a seizure disorder rooted in trauma? The last thing I want to do is retraumatize and put the nervous system into overwhelm, retriggering things, ab reactions etc. It gets tricky with seizures not knowing my window of tolerance and what activates this stress response . As you know, In those with trauma histories, engaging in exercises designed to induce parasympathetic rest and digest (breathwork, orienting etc.) without a sufficient sense of safety in the setting can induce vulnerability as, for these people, calm can be associated with lack of vigilance and subsequent danger.
I am so sensitive that Modalities such as neurofeedback, vagus nerve toning , exceeded my window of tolerance
Trauma experts Advise that if the Trauma is still happening because I’m still living in a relationship that where I don’t feel safe then it is not time to open and take the lid off the historical events /face fears until we have enough sense of stability and safety
Please let me know if anyone has had experience working with seizure disorders rooted in unconscious trauma
As a complex trauma survivor who has experience with both chronic freeze and shutdown, this was extremely informative and practical and resonated deeply. I especially appreciated the mention of the “dorsal meniscal system” and the use of light/deep pressure, as that gives me direction for research into my own recovery.
Thank you very much for presenting this very important issue. In addition to your great team of experts, your clarifications between each presentation are very useful. It is very important to address the differences between “shut down” and “freeze.”
Simple, doable, and aligned with knowledge and experience. I greatly value Dr. Lanius’ participation in the NICABM videos.
Learning to tease apart nuances to deepen one’s own awareness of these two neurological states is so important. But it’s also worth noting that for a client it may not be an “either/or” experience but rather a “both/and.” I personally experience both collapse and tonic immobility together. But differentiating them for myself and working with each one in the ways Ruth does is so helpful. This is where the concept of co-consciousness also comes into play. I’ve been following these trauma programs for the past decade and this is the best one yet. Thank you!
Thank you for sharing these techniques and experience with us.
Very informative and much appreciated.
Molly Chatalic (PhD, University of Western Brittany, France)
I am interested in the ways you help people to cope with the symptoms of high nervous anxiety and stress. It will be helpful to put in place the most helpful response to an episode if it occurs in a study/public environment.
Hopefully it will help calm the individual and aid their recovery.
As usual I love the science and specifics on how to work with that system from Ruth. She is always enlightening, so patient and soothing in her own voice techniques. I like the idea of enlightenment as they recover to identify the sympathetic ner
ve as they pull out of the freeze response. I would imagine that would be a wealth of information in moments reactivation skills, information so helpul to the organism.
Informative. Thank you