Developmental Trauma and Breathwork
Breathwork and Developmental Trauma
The common understanding of trauma refers to a single experience of shock which was so terrible that the inner balance gets severely affected over a longer period of time – a traffic accident, the sudden death of a family member, a violent assault etc. Such events are called mono traumas and are connected to the posttraumatic stress disorder (PTSD). When working in therapy with such cases, it is important to resolve the shock state which is stored inside and to complete the fight/flight-reaction which was disrupted by the trauma.
When such traumatization happen frequently, for instance like abusive violations or aggressive attacks, we talk about sequential traumatization. In the therapy of such cases, the focus has to be on establishing a stable therapeutic relationship, connected with building up inner strength and a reliable access to resources before the resolution of the traumas can start. Then the work can focus on freeing the feelings which have been blocked around the traumatic situations.
The relatively new term of developmental trauma addresses ongoing experiences of neglect and frustration of needs in early childhood. It is closely connected to the extensively documented concept of attachment disorders. Unsecure attachment causes chronically malfunctions in the autonomic nervous system and interferes with the development of the brain, the hormonal system and the memory. These different forms of unsecure attachment (avoidant, ambivalent, disorganized) develop in an atmosphere of ongoing and repeated miscommunication between the child and its caretakers. This is exactly the atmosphere for creating developmental traumas.
There do not have to be single significant traumatic experiences but uncertainty, threat and distortion happen very often or constantly. Many studies have shown that traumatization caused by human relationships have a much deeper impact as traumatization by natural sources (like natural catastrophes). It seems that we humans are so strongly designed as social beings that our healthy emotional and physical development depends to a high degree on a loving and stable social environment, especially in the early phases of growing up. Developmental traumas can cause physiological, emotional, social and cognitive disabilities.
For the unborn and the baby are totally depended on the grownups for their survival. They have nothing to give in exchange for what they get except their love. Is the safeguard of this survival in danger, panic breaks out. And a baby does not have more that total defense, tensing up, freezing and inner withdrawal as mechanisms to survive the panic. The ultimate defensive reaction is rigor and numbness. When the traumatization has happened before birth, it is the only possibility of reaction. In this state, dissociations, splits in consciousness and loss of body perception happen easily. When someone has difficulties in gaining access to feelings and emotions up to palsies can have their origin in such early childhood grievances.
When this inner state of stress becomes chronified, it can be seen in slighter symptoms like a rigid gaze, deficits in concentration, disability to listen or different health problems. Trivial reasons can trigger a shock reaction: the breath is held, all irrelevant actions stop. The total awareness goes to the outer senses, especially to hearing and looking. Such symptoms can be active throughout a whole lifetime and intensify in situations of stress. These persons do not even realize that they have adopted this reactive behavior at one point in time for protecting themselves, but they assume that this is just the way they are.
A further result of this kind of traumatization is the delay, deceleration or even inhibition in developing the Social Engagement Systems resp. the smart vagus system according to the polyvagal theory. In these cases, even low degrees of stress in social situations can lead to intensive emotional reactions which impede any empathic clarification of the situation. When the stress mode passes another level, blocking is the only possibility. Socially compatible reactions are no longer accessible in this state. It is not possible to regulate the emotions, they flood the consciousness without any respect to the situation and the involved persons.
A nervous system which predominantly switches between sympathetic nervous system and parasympathetic nervous system without using the newer and more intelligent vagus systems comes into deregulation and overstraining. Various health problems can result from that. The sympathetic system does not know about relaxation, and the parasympathetic system can only relax in exhaustion.
Researches in the US estimate that three million newborn babies per year are affected by developmental traumas (which are 70 % !) so that this distortion is one of the most crucial health issues in the world. This category is not yet contained in the current diagnostic classifications (DMS IV, ICD 10). So symptoms with a developmental trauma background get often wrongly diagnosed, e.g. as Attention deficit-hyperactivity disorder (ADHD) or as bipolar (manic-depressive) illness. The standard treatment is medication instead of working therapeutically on the developmental deficits.
Breathwork and developmental traumas
Many elements for a successful treatment of developmental traumas are part of the basic repertoire of integrative breathwork when applied with all the skills from a profound training. These elements which will be discussed in the following sections and they can be used as a checklist if there is any need of further training to work efficiently with breathwork in cases of developmental trauma.
Developmental traumatization causes ongoing deregulations in the whole area of the vegetative nervous system. This can lead to over activity on the one side (chronic tension and nervousness) or lack of drive and motivation (passivity, depression). Sometimes there is a constant shift between these poles. These clients cannot react in a relaxed way to challenges from the environment.
By relaxing the exhale and by strengthening the inbreath, improved vegetative regulations can be built up and trained. The breath “education” which means the restoration of the original breathing functions on the level of the vegetative nervous system consists in opening the space for the new, smart vagus when the rhythmical and regular change between sympathetic nervous system and parasympathetic nervous system on a low level of arousal is established. When the breath is flowing deeply and relaxed, this is an indication of a well regulated nervous system. In this state, the skills for social engagement and the openness for inner feeling are accessible. Additionally, self-confidence and self-esteem are strengthened on the organismic level.
When we breathe consciously, we open the way for inner perception, for strengthening the inner sense and for feeling body sensations. As breathworkers, we guide the client to feel the body all the time during the breathing process, to feel sensations and emotions. With eyes closed, the attention can easily stay with the inner universe.
Dissociation is a central mechanism of traumatization which is the splitting off of the awareness from the physical level. It is as if the consciousness would emigrate to a secure place so that the threating situation to which the body is exposed can be observed from a safe distance. When the traumatization goes on, the ability to feel the body and its signals can get lost totally.
The simplest way to reconnect body and consciousness is by giving the attention to the breathing. By this, one can dive consciously into the permanent stream of the organismic process in which a lot of information comes up from the inner world and its memory. The therapeutic value lies in establishing the trust in this channel of information and to help to relieve the dissociation, the split between body and consciousness. Thus, the tendency to step out of the present experience is reduced and the awareness for the demands of the momentary situation is strengthened. To feel the breath consciously and to connect to the body by doing this is a practice which can be done anytime and everywhere.
Yet we have to be aware of dissociative flashbacks which can happen during a breathing process when it becomes difficult for the breather to keep the attention with the breathing and to slip into unconsciousness. Although this state of unconsciousness can have different reasons it is important to clear whether it has to do with tiredness or exhaustion so that the body reacts with a need for sleep to the lying position or whether it is an unconsciously directed evasion into a parasympathetic state which can be the result of an early traumatization. Especially when this drifting off happens at the point of entering a deeper level of inner experience the assumption is close at hand that it is a protective reaction to safeguard the original traumatizing experience.
Bottom-Up and Top-Down
We work „bottom-up“, when we aim at the root of the distortion and let the healing happen until it can be experienced on the “upper” level. When we work with conscious breathing, we reach deeply into the preverbal area. As soon as we focus on our breathing, we access realms of experience which took place beyond or long before the cognitive processing was possible, and which have left their traces way under the regions of language.
Working top down is secondary, yet equally important. It is less represented in breathwork. The rule is often told: Let the breath do its work, that is enough. Talking during or after the process is unnecessary and can disturb the inner process. Still, the rise of deep emotions must be balanced with the ability to integrate them. We should not neglect this aspect. Working top down means to provide a frame of understanding for what happens or what has happened. When the client is able to understand the inner experience she can relax on the cognitive level as well. It is also important to stabilize healing which has happened on the physical and emotional level by changing cognitive patterns which could inhibit the integration and consolidation of what has been healed.
Filling Up the Container
Developmental traumatization causes a permanent alert state in the organism which has to run on an emergency program. There is a lack of time and space for regeneration for mending the damages and for filling up the resources. Often not even sleep provides this function of regeneration as it is restless and disrupted. This leads to irritability, hypersensitivity and lack in stress resistance. Small incidents can cause strong emotional reactions and alterations in the mood.
Breathwork sessions should ideally lead towards a state of deep relaxation either after processes of intensive emotional discharge or after a calm and smooth course. Clients often report after a session that they never before felt as relaxed as now. This is the state in which the depleted energy containers get replenished.
To be able to relax better also in daily life with the help of mindful breathing is one of the pleasant side effects of breath therapy as well as the use of conscious breathing for coping with sleep disorders. This helps to improve the energy balance sustainably because the body gets the required amount of regenerative phases.
Anchoring in the Present
Traumatization is an experience in the past with impacts on the present moment. In the present we know that we have survived the trauma and that we are stronger and more capable than we were as children. So it is important that we keep the consciousness in the present moment when elements of the trauma experience emerge. So the original experience can be relived in a secure framework.
The breath offers an excellent way to return to the present moment again and again. As therapists, we encourage the breather to notice the flow of the breath in every moment, even when tough and dreadful memories and intense feelings come up. The breath acts as safe fundament of the re-experience of the trauma situation. We help the client to establish a bridge between the bad experience of the past and the safety in the present. This way, a new imprint in the brain is established.
Conscious breathing can easily be connected with grounding exercises which play an important role in anchoring in the present. The energetic contact to the floor strengthens the internal safety, the feeling of being carried by the huge mother earth.
Working with Catharsis
Developmental traumas create complex patterns which go back to unfinished fight-flight-reactions. When a baby is frustrated in its needs it starts to react with irritation, then with anger and with aggression and finally, when there is still no adequate response from outside, with resignation, withdrawal and blocking. In these cases, the potential of activation of the sympathetic branch cannot be completed in its natural course. It is halfway stuck. Before the aggressive energies can be expressed and outlived, they meet a massive barrier which turns into a prohibition: I am not allowed to be angry because I would lose the love of the people who care for my survival.
By intensifying and deepening the breathing, often body impulses arise to the surface which urge towards expression in order to complete unfinished cycles of aggression. So it is helpful to trust these impulses and express them so that the blocked energy can be set free. This can be connected with screaming, kicking, pushing etc. and has to take place in a very safe environment, including the therapist. She needs a deep rooted trust in the power of the feelings so she can give all the safe holding the client needs in this process. She has to act like a parent who holds the helplessly angry child with the message: Yes, you are allowed to be angry now and you are allowed to express this feeling with all its strength, and I love you with all of this feeling.
But we have to be cautious to force the breath, because accessing the sensitive trauma moments to quickly can overwhelm the client and cause retraumatization. It is crucial in time to slow down the breathing when the root of the problem is approaching so that the experience can be integrated carefully step by step.
Healing and invasive body contact
A form of traumatizing neglect can be found in the lack of body contact between the baby and its caretakers. Newborns feel contact and love mainly via the body. They perceive on this channel what a relationship they have to their most important contact persons. When this channel is not used they lack of indispensable information and they do not know whether they are wanted or not, whether they are accepted or rejected. So they feel totally unsecure in a no man’s land where there is threat and danger any time possible. This is the cause for developing a constantly active vigilance and sensitivity for the smallest sparks of contact which often get charged up with unconscious interpretations like: When I smile, my mother takes notice of me.
Breathwork is a form of body therapy, so it provides different forms of body contact. As proven scientifically already, empathic touch can ease pain, relieve stress and release happiness and attachment hormones. Touch is one of the most important ways of communication for empathy and acceptance.
When working with clients with developmental trauma who suffer from lack of touch, it is crucial to be aware of the enormous importance and significance of body contact as well as of the huge insecurity connected with it. Touching in a tiny way can have a big impact which should be perceived clearly and exactly and processed verbally. So it should be clarified again and again how the body contact is received so that any overflow or invasion of contact signals is omitted.
Mindfulness therapy is gaining positive recognition as helpful tool with different problems, mainly stress disorders and diseases related to that. It is based on the Buddhist meditation practice which, of course, uses the awareness of the breath as one of its key methods. This is an assignment from mindfulness therapy: When learning mindfulness skills, it is usually recommended that we start practicing mindfulness of the breath, then mindfulness of the body, before moving on to mindfulness of thoughts.
When we work with the conscious breath, we practice mindfulness therapy. We keep our attention on the breath (as therapists and as clients), observe the inflow and the outflow, whatever sensations and impulses come from inside. Thus we connect to the experience of the present moment and pay less attention to the thoughts. The world of mental constructions withdraws to the background. This is a valuable tool to be able to cope with the challenges of life more calmly and even-tempered. For someone suffering from developmental trauma, this is a considerable aid for improving one’s quality of life.
The Therapeutic Relationship
As mentioned above, developmental traumatization predominantly results from an atmosphere of unsecure attachment. So the relationship between breathworker and client has a crucial role in healing. As a client with this burden comes with an unsecure attachment pattern, it is important that the therapist can offer the specific remedy in a new form of relationship with consistency and safety which the client missed during childhood. The therapist should be able to cope with typical pendulum movements in opening and closing, in trusting and mistrusting which are common for unsecure attached clients. As soon as they notice that they are accept whether they are open or withdrawn, they can relax more in contact and start to build up a new internal model of relationship step by step.
As congruent relationship experiences have occurred very rarely in the history of these clients, they have a high expectancy in the therapist. They notice immediately when something is wrong and they react highly sensitively to that, often without mentioning. When e.g. the therapist answers the client’s question that she is not tired (because she wants to be an attentive and present companion), although she is tired, it creates mistrust in the client, which can be so subtle that not even the client is aware of it. So there is no possibility of clearing it up unless the therapist becomes aware of the change in the relationship atmosphere.
Many of the elements which are needed by clients with developmental traumas for an effective healing process are part of the basic repertoire in breath therapy. And a lot of additional learning can take place to improve the professional skill by looking more accurately at the backgrounds of the distortions and problems with which the clients come to the session. We can trust the merits and healing power of the breath and we can work together in enlarging its possibilities. For this it is important that we encounter new concepts and insights.
Laurence Heller: Healing Developmental Trauma. How Early Trauma Affects Self-Regulation, Self-Image, and the Capacity for Relationship. Berkeley: North Atlantic Books 2012
Bessel van der Kolk: Developmental trauma disorder: Towards a rational diagnosis for children with complex trauma histories. http://www.traumacenter.org/products/pdf_files/preprint_dev_trauma_disorder.pdf 10.12.2012
Wilfried Ehrmann: Entwicklungstraumen und Atemtherapie. In: ATMAN Zeitung 1/2013
 http://www.getselfhelp.co.uk/stream.htm, 8.1.2013