A systematic review of somatic intervention treatments in PTSD: Does Somatic Experiencing® (SE®) have the potential to be a suitable choice?

Abstract

The psychophysiological substrate of Post-traumatic stress disorder (PTSD) is associated with deregulation of neural networks involving mind-body interaction and is the subject of considerable research. It has been managed using pharmacological treatment associated or not with complementary treatments. The aim of this study was to systematize the knowledge about the types and effectiveness of complementary treatments using somatic interventions in the PTSD setting. According to the revised literature, the complementary approaches are based on Somatic Experiencing®, meditation and brainspotting techniques, and are anchored in the search for regulating the underlying neural mechanisms. However, there is little scientific production on these treatments, despite the positive clinical impact of their results, particularly for Somatic Experiencing®, which has presented good results. For the authors, further controlled trials involving improvement of symptoms and their association with possible biological markers are necessary to corroborate the efficacy of this therapy.

Full text

Estudos de Psicologia
DOI: 10.22491/1678-4669.20190025 ISSN (versão eletrônica): 1678-4669 Acervo disponível em http://pepsic.bvsalud.org
A systematic review of somatic intervention treatments in PTSD:
Does Somatic Experiencing® (SE®) have the potential to be a
suitable choice?
Ana Kelly Almeida. Universidade Federal do Rio Grande do Norte
Sayonara Christiane Gomes de Melo Macêdo. Universidade Potiguar
Maria Bernardete Cordeiro de Sousa. Universidade Federal do Rio Grande do Norte
Abstract
The psychophysiological substrate of Post-traumatic stress disorder (PTSD) is associated with deregulation of neural networks
involving mind-body interaction and is the subject of considerable research. It has been managed using pharmacological
treatment associated or not with complementary treatments. The aim of this study was to systematize the knowledge about the
types and effectiveness of complementary treatments using somatic interventions in the PTSD setting. According to the revised
literature, the complementary approaches are based on Somatic Experiencing®, meditation and brainspotting techniques, and
are anchored in the search for regulating the underlying neural mechanisms. However, there is little scientific production on
these treatments, despite the positive clinical impact of their results, particularly for Somatic Experiencing®, which has presented
good results. For the authors, further controlled trials involving improvement of symptoms and their association with possible
biological markers are necessary to corroborate the efficacy of this therapy.
Keywords: post-traumatic stress disorder; complementary treatments; somatic interventions; Somatic Experiencing®.
Resumo
Uma revisão sistemática de tratamentos de intervenção somática em PTSD: a Experiência Somática® tem o potencial para ser uma
escolha adequada? O transtorno de estresse pós-traumático (TEPT),cujo substrato psicofisiológico é associado à desregulação de
redes neurais que envolvem a interação mente-corpo, é objeto de muitas pesquisas e vem sendo manejado usando tratamento
farmacológico associado ou não a tratamentos complementares.O objetivo desse estudo foi sistematizar o conhecimento
sobre os tipos e eficácia de tratamentos complementares que utilizam intervenções somáticas no quadro do TEPT. Segundo a
literatura revisada, as intervenções somáticas são baseadas em técnicas de experiência somática, meditação, brainspotting e
estão ancoradas na busca da regulação dos mecanismos neurais subjacentes. Todavia, constatou-se baixa produção científica
destes tratamentos, apesar do impacto clínico positivo de seus resultados, particularmente para experiência somática® que
apresentou bons resultados. Para os autores, mais estudos controlados envolvendo melhora dos sintomas e sua associação a
possíveis marcadores biológicos são necessários para corroborar a eficácia desta terapia.
Palavras-chave: transtorno de estresse pós-traumático; tratamentos complementares; intervenções somáticas; experiência somática®.
Resumen
Una revisión sistemática de tratamientos de intervención somática en el trastorno de estrés postraumático: ¿tiene la experiencia
somática® el potencial de ser una opción adecuada? El trastorno de estrés postraumático (TEPT), cuyo sustrato psicofisiológico está
asociado a la desregulación de redes neuronal que involucran la interacción mente-cuerpo, es objeto de muchas investigaciones y viene
siendo manejado usando tratamiento farmacológico asociado o no a tratamientos complementarios. El objetivo de este estudio fue
sistematizar el conocimiento sobre los tipos y la eficacia de los tratamientos complementarios que utilizan intervenciones somáticas
en el trastorno de estrés postraumático. De acuerdo con la literatura revisada, las intervenciones somáticas se basan en técnicas de
experiencia somática, meditación, braquines y están ancladas en la búsqueda de la regulación de los mecanismos neurales subyacentes.
Sin embargo, se constató baja producción científica de estos tratamientos, a pesar del impacto clínico positivo de sus resultados,
particularmente para la experiencia somática®, que presentó buenos resultados. Para los autores, más ensayos controlados involucran
la mejora de los síntomas y su asociación a posibles marcadores biológicos son necesarios para corroborar la eficacia de esta terapia.
Palabras clave: trastorno de estrés postraumático, tratamientos complementarios, intervenciones somáticas; experiencia somática®.
Estudos de Psicologia, 24(3), julho a setembro de 2019, 237-246
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A systemac review of somac intervenon treatments in PTSD
Estudos de Psicologia, 24(3), julho a setembro de 2019, 237-246
Post-traumac stress disorder (PTSD) has been
extensively studied since the conrmaon of its diagno-
sis in DSM-III in 1980. Research on PTSD broadened its
diagnosc criteria aer the DSM-IV and DSM-5 revisions
in 1994 and 2013, respecvely. PTSD is characterized
by the development of symptoms aer exposure to
one or more traumac events, and can be classied
as developmental trauma directly related to the life
history of an individual, or the shock trauma caused
by an isolated threatening event easily encountered in
one’s everyday environment. PTSD has three classica-
ons regarding its onset: acute onset, chronic onset,
and late onset. Symptoms in the acute form of PTSD last
less than 3 months. Chronic PTSD is characterized when
symptoms last for a minimum of 3 and a maximum of 6
months, while symptoms in delayed-onset PTSD appear
only aer at least 6 months aer the traumac event
(American Psychiatry Associaon [DSM-5], 2013).
Both drug and psychological treatments have
been used aer the 2013 revision of PTSD diagno-
sis (Reis, Motoki, & Neto, 2013). However, there are a
number of lile-known somac intervenon approaches
that can mitigate PTSD symptoms (Barnes, Rigg,
& Williams, 2013; Corrigan & Grand, 2013; Dahm, et al.,
2015; Fuzikawa, 2015; Payne, Levine, & Crane-Godreau,
2015; Polusny et al., 2015; van der Kolk et al., 2014).
Psychological vulnerability before any traumac event
is as important as the related trauma. Family history of
child abuse, substance abuse, and traumac exposure
to war and urban violence are social factors which
contribute to the development of PTSD. Considerable
evidence also demonstrates that men and women
respond dierently to stressors in terms of behav-
ioral outcomes by the acvaon of the Hypothalamic-
Pituitary Adrenal (HPA) axis and the sympathetic
nervous system (McEwen, Gray, & Nasca, 2015).
This revision has the aims to present current scien-
tific knowledge on the efficacy of as yet comple-
mentary treatments using somac intervenons to
combat post-traumac stress disorder and the respec-
ve impacts on the clinical evoluon of PTSD. These
studies provide updated informaon on the use of
these complementary therapies applied to treat PTSD.
Moreover, to characterize them in terms of the respec-
ve clinical picture and types of somac approaches
which aim at body awareness. The somac techniques
associate sensive, cognive, motor and aeconal
factors, recruing the main brain areas involved with
the neural circuitries of PTSD. The aenon toward
sensaons enables beer connecon and understand-
ing in the direcon of interocepve processes and their
relaonships with the external environment. These are
usually experienced through muscular and breathing
movements (Haase et al., 2015).
This review started with the hypothesis that the
combined applicaon of drug and psychological thera-
pies is not a common pracce, since most paents
are prescribed drugs alone (Druss, 2010), indicang
a predominance of these types of intervenons over
their psychological counterparts. As such, applying
both therapies could be more ecient in paents who
are exhibing severe and persistent symptoms. In this
context, somac experience® emerges as an important
tool to be explored in relaon to increasing the use of
mind-body approaches to balance the neural mecha-
nisms involved in PTSD symptoms improvement.
Method
A systematic review was conducted between
January 2010 and June 2018 in a number of databases,
including Google Scholar, SciELO, Web of Science and
Pubmed/Medline regarding the types and ecacy of
treatments for post-traumac stress disorder that use
complementary conducts. The search was directed using
the following keywords: post-traumac stress disorder
and treatments, psychotherapeuc treatments and PTSD,
PTSD and complementary treatments for arcles publi-
shed between 2010 and 2018, as well as any updated
data since the last revision found in the literature.
The review was performed by three researchers.
The rst and third authors were in charge of searching,
analyzing and summarizing the arcles. The third author
guided and revised all the text. Arcles in Portuguese,
Spanish and English were included. Arcles containing
only convenonal psychotherapeuc treatments such as
those using Cognive-behavioral therapy and Dynamic
psychotherapy were excluded. There was no randomi-
zed data due to the small number of arcles which met
the criteria. The arcles were similar at baseline regar-
ding the most important prognosc indicators and the
eligibility criteria. Thus, the number of eligible arcles
was insucient to perform a meta-analysis.
Results
According to the arcles analyzed and summa-
rized in the present revision, somatic intervention
approaches have seldom been used in clinical medicine

M. B. C. Souza, A. K. Almeida, S. C. G. M. Macêdo
despite their important ecacy in treang war veterans
and civilians diagnosed with PTSD. Psychological therapy
studies are primarily conducted on men, despite the fact
that PTSD is twice as prevalent in women. Moreover,
evidence indicates that men and women respond
dierently to stressors in terms of behavioral outcomes,
acvaon of the HPA axis and the sympathec nervous
system (Larsen, 2016).
Data on study selecon, classicaon and criteria
are presented in the owchart (Figure 1).
Eletronic search:
Google Scholar, SciELO, Web of Science and Pubmed/Medline
(N= references)
Arcles selected
(n=102)
Arcles not related to the
proposed issue (n = 57)
Studies selected for evaluaon
of the complete text
(n=45)
Studies excluded aer reading
(n=22)
Studies included in the review
(n=23)
Studies included in the
quantave synthesis (reviews)
(n=6)
Studies included in the
quantave synthesis
(n=17)
Included
Eligibility
Screening
Idenficaon
Other sources (books)
(n=3)
Figure 1. Flowchart: Study Selecon. Registraons Idened between 2010 and 2018.
Six systemac reviews were found between 2012
and 2018, one in Portuguese and ve in English. The
rst was conducted by Libby, Pilver and Desai (2012)
and aimed at somatic intervention treatments for
PTSD, suggesng the combined use of somac and
drug therapies. The second was by Reis et al. (2013)
and limited to Brazilian studies, discussed the types
of somac intervenons and the importance of provi-
ding more ecient treatment to paents with PTSD.
As such, the authors underscore the need for both
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A systemac review of somac intervenon treatments in PTSD
Estudos de Psicologia, 24(3), julho a setembro de 2019, 237-246
somac intervenon and drug follow-up. This review
demonstrated that 20% of follow-ups contained combi-
ned therapy, 25% somac intervenons and the remai-
ning 55% were not specic. The review also highlights
the scarcity of studies in Brazil.
The third review was by Fodor et al. (2014)
and discussed the extent of research on the issue.
Corroborang the previous arcle, it described the lack
of studies in Brazil, accounng for only 1% of scienc
producon, and the fact that research is more concen-
trated in North America (50%) and Europe (20%).
The three other reviews showed that Yoga
contributed to a signicant overall reducon in PTSD
symptoms by about 60%. The ndings suggest that
meditaon and yoga are promising complementary
approaches in treang PTSD among adults and warrant
further study, although many studies are limited by
methodological weaknesses. Recent publicaons have
evidenced increasing rigor and treatment combinaon,
with the results for mindfulness, yoga, and relaxaon
looking promising.
For instance, in the fourth revision, the efcacy
of a yoga intervenon employing yoga postures in a
variety of traumazed populaons (e.g., veterans, survi-
vors of childhood abuse and interpersonal violence, and
survivors of natural disasters) was examined in relaon
to improving PTSD symptomatology ulizing a valida-
ted PTSD assessment. Yoga could potenally be a viable
alternave treatment for PTSD for several reasons such
as benets of behavioral and cognive performance,
causing a decrease of intrusive symptoms (Sciarrino,
DeLucia, O’Brien, & McAdams, 2017).
In the h revision conducted by Gallegos, Crean,
Pigeon and Hener (2017), the eects of yoga on PTSD
had a minor impact and were comparable to mindfulness
and meditaon approaches. These results indicate that
somac approaches to treang PTSD such as meditaon
or yoga had a moderate eect on the symptoms among
veterans and non-veterans. These results indicate that
both complementary therapies increase paent availability
of opons for other complementary treatments for PTSD.
According to the authors, limitaons of the revision include
the small number of studies available to conduct some of
the moderator analyses.
Finally, in the sixth review (Niles et al., 2018), the
designated studies using mindfulness, yoga, and relaxa-
on provide support for somac treatments for PTSD.
Mind-body intervenons may give paents the opportu-
nity to manage their emoonal skills related to negave
physical and emoonal states for individuals with PTSD.
In this review, a Pilot study using completer analyses was
evaluated, in which the post treatment assessment indica-
ted that those who performed yoga had signicantly
greater reducons in self-reported PTSD than the waitlist
control, with a small to moderate eect size. Another
study showed that signicant and lasng benets were
noted following a short period of me in a small study
which examined Sudarshan Kriya yoga, a breathing-based
meditaon. A study that examined relaxaon in compari-
son to three other acve treatments (prolonged exposure,
cognive restructuring, and the two combined) found
large treatment eects on both self-reported and clinician-
-assessed PTSD for all four treatments.
Recommendaons for designing future mind-body
trials are oered by dierent authors such as randomi-
zed controlled trials (RCT) vs. uncontrolled trials. Another
important contribuon from these reviews shows that
complementary therapies using somac intervenons
are increasing in PTSD paents. Recent use esmates a
range from 26% to 39% in PTSD populaons.
The types and efficacy of somatic interven-
on treatments, sample characteriscs, and pernent
observaons regarding somac intervenons collec-
ted from the non-revision studies are shown in Table 1.
With respect to treatments aimed at somac interven-
ons processes, six techniques were idened: Somac
Experiencing
®
, mindfulness, brainspong, yoga, trans-
cendental meditaon and the use of mantras. All of
these exhibited posive results with an average of
between three and twenty sessions, and 44.1% to 90%
improvement in PTSD symptoms.

M. B. C. Souza, A. K. Almeida, S. C. G. M. Macêdo
Table 1. Types and Ecacy of Complementary Somac Treatments.
Type of
psychotherapy Type of study
Sample
characteristics:
Sample number/
nationality/sex
Positive effect (s) on
reducing symptoms Reference (s) Observations
Somatic
Experiencing®
Case studies 1. Man (n=1)
4 sessions;
2.Woman (n=1)
15 sessions
90% Payne, Levine, & Crane-
Godreau, 2015.
Bonzon, 2013
Body symptoms are understood as
a nervous system survival response
and it becomes coping strategies for
patients.
Therapy reduces medication.
Randomized
controlled
outcome study
3.Men (n=31)
Women (n=32) /
15 sessions
44.1% absence of
symptoms of PTSD
Brom, Stokar, Lawi,
Nuriel-Porat, Ziv,
Lerner,… Ross, 2017
Further studies look at SE
effectiveness on more specific groups
such as military trauma, sexual
assault, and complex trauma.
Randomized
Controlled
Trial
4.Cohort of patients
(n = 1045)
Reduction of the number
of PTSD symptoms
compared with TAU
Andersen, Lahav,
Ellegaard, & Manniche,
2017
A brief additional SE intervention
was found to have a significant effect
on PTSD and fear of movement
compared to TAU alone.
Mindfulness Study group 1.Men (n=58)
9 sessions
49% during treatment,
53% 2 months later
Polusny, et al, 2015 Study conducted with control group
(n=58).
Comparing
group
mindfulness-
based
psychotherapy
against group
present-
centered
psychotherapy
2.Groups (n=4 of 20
men) 8 sessions
75% Dahm, Meyer, Neff,
Kimbrel,Gulliver, &
Morissette, 2015
Study conducted with control group
(n=17).
3. Men (n=116)
Veteran’s
Association
participants
No difference between
the treatment and
control group
Lee & Hoge, 2017 Mindfulness may provide one
modality that supports the relaxation
component of PTSD treatment
but should remain no more than
adjunctive to established evidence-
based treatments.
Brainspotting Group study 1.Men and women
(n= 22 men and
women) /3 sessions
90% Reduction of
the number of PTSD
symptoms
Fuzicawa, 2015. Indicate brainspotting as promising
new approach psychotherapy for
trauma treatment
2. Total sample=76
(men and women)
Longitudinal
study (with two
comparison
groups)
2.1. *EMDR (n=23)
2.2. **BSP(n=53)
3 sessions
Both, EMDR and BSP
were successful in
treating clients with
traumatic experiences
Hildebrand, Grand, &
Stemmler, 2017.
More research is needed to replicate
the results and to evaluate effects in
different samples e.g., clients with
substance use disorders and
comorbid
Yoga Study group 1.Women (n=64)/
10 sessions;
52% van der Kolk et al., 2014. Study on interpersonal violence in
women
2. Women (n=64)/
12 sessions.
50% Mitchell et all, 2014 Holistic treatment program for
veterans
3.Couples (n=149)/
8 sessions
60% Monk, Ogolsky, &
Bruner, 2016.
Despite limitations, the results of
the study offer a number of useful
findings for both research and
practice
Qualitative
Descriptive
analysis
4.Women (n=31)/
10 sessions
Some participants
recognized a greater
ability to tolerate
trauma-related stimuli
and verbally express
themselves
West, Liang, &
Spinazzola, 2017.
Study related to chronic childhood
trauma
Transcendental
meditation
Study group Men (n=74)
Regular meditation
for one month
83.7% Barnes, Rigg, &
Williams, 2016.
Study performed with a control
group.
Therapy reduces medication use
connue...
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A systemac review of somac intervenon treatments in PTSD
Estudos de Psicologia, 24(3), julho a setembro de 2019, 237-246
Type of
psychotherapy Type of study
Sample
characteristics:
Sample number/
nationality/sex
Positive effect (s) on
reducing symptoms Reference (s) Observations
Mantra Randomized
ClinicalTrial
Men (n=173)
veterans diagnosed
with military-
related PTSD
1. The mantram
group (N=89)
2. The comparison
group (N=84)
Both treatments
were delivered
individually in eight
weekly 1-hour
sessions.
Greater reductions
in PTSD symptom
severity and insomnia
for veterans compared
with present-centered
therapy.
Bormann, Thorp, Smith,
Glickman, Beck, Plumb,
Zhao, … Elwy, 2018.
Significantly greater improvements
in CAPS**** score than the present-
centered therapy.
Note. *EMDR- Eye movements desensibilizaon and reprocessing; **BSP – Brainspong; *** (TAU) - Treatment-as-usual for paents with chronic low back pain. This treatment
consisted of supervised exercises for low back pain delivered in 4–12 sessions and performed by physiotherapists in the Centre or in primary sector clinics according to the European
guidelines for the management of chronic low back pain; **** CAPS - Clinician-Administered PTSD Sca
between 18-65 years of age (Andersen, Lahav, Ellegard,
& Manniche, 2017) (Table 1).
Three studies were found that used occidental
meditaon as mindfulness using groups of paents sugges-
ng a reducon of PTSD symptoms (Dahm et al., 2015; Lee
& Hoge, 2017; Polusny et al., 2015). One study conducted
with Afghanistan veterans at nine weekly group sessions
focused on their current life problems (Polusny et al., 2015),
in which subjects were assessed before, during and aer
two months of treatment, and around 50% of PTSD
symptoms were demonstrated to have been reduced.
In the second study, self-reports conrmed a
53% improvement in the severity of PTSD symptoms
(Dahm et al., 2015). However, no dierences between
the treated and control groups were demonstrated in
the third study (Lee & Hoge, 2017) (Table 1).
In relaon to mindfulness, this technique invol-
ves awareness, aenon and memory, and its praccal
proposal is to connuously idenfy one’s own feelings,
emoons and thoughts in an aempt to remove those
regarding the trauma. In this respect, individuals
concentrate on what they are doing or feeling and are
aware of the evoluon of their body and behaviors. This
requires them to shi from a reacve mind and from
automac and unconscious responses to conscious
ones (Vásquez-Dextre, 2016).
Only two arcles were found on brainspong
(Fuzikawa, 2015; Hildebrand, Grand, & Stemmler, 2017),
an approach created by the psychotherapist David
Grand in 2011. The arcle describes its development,
principles and clinical use, in addion to neurobiological
Table 1. Connuaon
Somac Experiencing® guides the paent’s aen-
on towards an interocepve, synesthec and proprio-
cepve experience. Three studies are available in the
literature using SE®. According to Levine (2015), inwar-
dly-directed aenon, in addion to the use of synes-
thec and interocepve images, may resolve chronic
and traumac stress symptoms, thereby increasing an
individual’s resilience and well-being. Sensory experien-
cing has proven to be an eecve approach to intervene
in complex trauma (Rossi & Neto, 2013).
Two case studies, one using one man, and
the other one woman, show that praccing SE®
is an
important complement for both cognive and exposure
therapies (Payne et al., 2015) and to reduce the use of
medicaon (Bonzon, 2013), respecvely (Table 1).
In the study by Brom et al. (2017), the enrolled
parcipants presented a wide variety of traumac events
triggering PTSD in Israel, including vehicle accidents,
assault cases, and terrorist aack cases of death or
injury of a family member, cases of medical trauma, and
combat and threat cases. The intervenon was conduc-
ted during a period of ongoing collecve trauma and
unsafety due to polical unrest in Israel, which included
toward and ongoing terrorist aacks. The results presen-
ted in this study showed a large posive size eect with a
large eect size for all cases (Table 1).
A brief addional SE® intervenon was found to
have a signicant eect in paents who were under
management of chronic low back pain that met the
criteria for possible sub-clinical or clinical PTSD as
measured by the Harvard Trauma Quesonnaire part IV,

M. B. C. Souza, A. K. Almeida, S. C. G. M. Macêdo
hypotheses and a preliminary clinical study. It was
conducted with individuals diagnosed with PTSD in
order to assess the ecacy of the technique, which
seems to combine knowledge of Somac Experiencing®
and EMDR (eye movement desensizaon and repro-
cessing). Internaonal publicaons describe the therapy
as a rapid and eecve strategy (Fuzikawa, 2015).
However, there are no empirical studies on the ecacy
of brainspotting, in addition to the aforementio-
ned preliminary study since, as in SE®, these results
are generally presented in books and at congresses
(Hildebrand et al., 2017) (Table 1).
The body intervenons of these new somac
approaches also use ancient techniques such as yoga,
and have been used with a complementary treatment
for post-traumac stress disorder. It is known that
trauma aects body physiology and that its memories
are somacally stored. The authors concluded that
yoga can improve the functioning of traumatized
individuals, helping them tolerate physical and sensory
experiences of fear and associated impotence. The
studies provided insight into how parcipants felt the
pracce of yoga led to benets in their lives on and o
the yoga mat, such as the power to make choices and
determine the direcon of their lives; develop strong
connecons to others; accept and appreciate themsel-
ves and their life experiences; and culvate a sense
of calm and internal balance (Mitchell at al., 2014;
Monk et al., 2016; van der Kolk et al., 2014; West,
Liang, & Spinazzola, 2017).
One study developed by Barnes, Monto, Rigg
and Williams (2016), showed that regular transcen-
dental meditaon decreased the need for psycho-
tropic medicaons required for post-traumac stress
disorder (PTSD) management and increased psycho-
logical well-being and resilience. In a previous arcle
(Barnes et al., 2013), the researchers referred to earlier
studies including one in 1985 with Vietnam veterans,
showing that soldiers who engaged in transcendental
meditaon instead of taking medicaon exhibited signi-
cantly reduced PTSD symptoms (Table 1).
The mantra therapy program study was eec-
ve in decreasing PTSD symptoms in war veterans,
managing sleep disturbance as insomnia. However,
the results of this study cannot be generalized because
the sample size was limited to veterans who reported
substance abuse (Bormann et al., 2018) (Table 1).
Discussion
Complementary treatments seem to have
good potenal to manage PTSD. Somac intervenon
approaches share a common characterisc, namely
the use of focused aenon in cognive and physio-
logical processes to assess the pathological behavioral
changes. This indicates mind-body interacons and also
reinforces the importance of neurobiological invesga-
ons, highlighng their signicant role in idenfying
PTSD as an organic disorder, in addion to psychopatho-
logical alteraons. However, exploring the dierences
between techniques is necessary, since both Somac
Experiencing® and brainspong address traumac
memories more directly.
Somatic Experiencing
®
offers an intervention
pathway in non-completed neuromuscular paerns
of traumac responses by screening body feelings
and anchoring images related to traumac events,
enabling patients to describe a stress pattern as
if their bodies were about to do something. Thus,
the traumac responses gradually decline and are
completed, as non-declarave memory becomes a
declarave memory. On the other hand, smulaon of
a brainspot makes it possible to observe whether there
are traumac experiences underlying the complaints or
symptoms shared by the paent. To that end, associa-
ons with prior disturbing experiences which contribu-
ted to shaping their self-image are analyzed. As with
Somac Experiencing®, brainspong ensures that the
blocked orientaon response in the nervous system due
to a traumac event is completely concluded.
The somac approaches presented in this review
showed a posive impact of the complementary treat-
ments, associated or not with convenonal pharmaco-
logical approaches, producing percepble physiological,
psychological and behavioral results. In some cases, the
eects were beer with SE® and brainspong (between
80% and 90%), yoga (60%), as well as a combinaon of
mindfulness and transcendental meditaon (83,7%).
Thus, both SE
®
and brainspong techniques have the
greater potenal to be an important tool to help in the
PTSD treatment.
It is important to menon that in the rst arcle
published in 2008 about Somac Experiencing®, its
ecacy was demonstrated in 150 vicms of Tsunami with
only three intervenons (Parker, Ronald, & Selvam, 2008).
The authors used three instruments to monitor their
study (17-item Post-Tsunami Symptom Checklist and the
243
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244
A systemac review of somac intervenon treatments in PTSD
Estudos de Psicologia, 24(3), julho a setembro de 2019, 237-246
Impact of Events Scale–Revised–Abbreviated (IES–R–A),
Subjecve Units of Distress (SUD), before and aer the
treatment using SE®. Improvement in symptoms reached
75% (somewhat beer) and 85% (completely well) at
4-week and 8-month follow-ups, respecvely.
Regarding Somac intervenons, we were unable
to analyze the use of Somac Experience® or brainspot-
ng in this review, or conrm how they are being
applied, whether alone or associated with conven-
onal treatments. Although 80% of the arcles show
a signicant decline in PTSD symptoms with a combi-
naon of somac intervenons and medicaon, we
found no studies where this interacon was sasfacto-
rily explored, although they can decrease drug doses.
Given the improvement in symptoms with the use of
SE® and brainspong, these should be thoroughly
invesgated in news studies, as well the combinaon of
somac approaches and medicaon to treat PTSD. This
is indicated in order to broaden the choice of treatment
or combined therapies, and in the laer case, review
the types of drugs and their respecve doses.
Another important nding of this systemac review
is related to intervenon programs used by the United
States Defense Department for returning war veterans and
their families. These programs are oen in the form of a
retreat, and are used to avoid the development of PTSD or
diagnosis or treat it when necessary. Combined therapies
programs open a range of opportunies for using somac
intervenons and measuring instruments to monitor the
progress of each paent and tailor treatments to individual
paents (Libby et al., 2012). The intervenon programs for
war veterans deserve aenon, and can serve as models
to provide new treatment facilies within communies
and university hospitals. These include the formaon
of therapeuc groups with well-dened goals, couples
counseling and relaxaon acvies.
PTSD can be characterized by two extremes of
emoonal dysregulaon as hyperarousal and hypoarousal.
The complexity of these symptoms appears to be repre-
sented in the neural network related to the emoonal
motor system underlying PTSD involving the insula, the
medial prefrontal cortex, the anterior rostral cingulate
cortex and the amygdala (Payne et al., 2015; Yehuda et
al., 2015). For this reason, it is known that the response
to PTSD treatment diers substanally between paents.
However, the implementaon of complementary inter-
venons used in the therapeuc process has proved to be
successful through signicant evidence, thus broadening
scienc research and mainly contribung to the debate
of clinical pracce. Nevertheless, much more empirical
studies are required to establish their ecacy.
As aforemenoned, the body-brain connecon is
valued by somac intervenons. The techniques presented
in this arcle provide an array of opportunies for empiri-
cal studies with men and women. However, it is impor-
tant to underscore that studies on women with PTSD are
scarce, even though they are twice as likely to develop this
disorder (Yehuda et al., 2015). Thus, new invesgaons
are needed to conrm the ecacy of these treatments
and the neurobiological and physiopathological mecha-
nisms and interacons associated with each, including sex
dierences. It has become increasingly evident that the
exclusive use of medicaon is not enough to improve the
symptoms of individuals diagnosed with PTSD.
The frequent use of medicaon cannot disregard
the fact that individuals are shaped by their life experi-
ences and social history, with somac and psychologi-
cal components acting in conjunction: psychological,
biological and social expressions should be considered
together when selecng a treatment. With respect to
intervenon programs, we recommend coordinated and
comprehensive strategies for complementary interven-
ons using somac intervenon treatments in order to
signicantly expand their combined use. For instance, SE®
and brainspong that direct the somac intervenon to
the cause of the symptoms of the traumac event. In a
broader sense, the focus of SE® is directed to the deeper
levels and regulators of the autonomic nervous system
(SNA), motor emoonal system (EMS), recular acva-
on system (RAS) and limbic system, the so-called nuclear
response network (CRN) by Payne et al. (2015). Thus, the
possibilies involved in acve and structured aenon
focused on the interocepve and propriocepve experi-
ence performed in the SE® sessions point to the need for
more research to beer understand the dysregulaon
of the neural networks involved in PTSD, as well as their
physiological correlates. According to Taylor and Saint-
Laurent (2017), SE® also has the potenal to be used in
groups, especially for collecve trauma. Although gender
dierences in acute PTSD cases show higher prevalence
in women, the use of somac therapies may be sucient
for both men and women. Moreover, increasing research
using the specic somac experience approach deserves
much broader implementaon, as it has the potenal to
benet those aected by PTSD. Addionally, the invesga-
on of possible biological markers associated to SE® inter-
venons also seems to be important, as demonstrated in
relaon to other neuropsychiatric disorders.

M. B. C. Souza, A. K. Almeida, S. C. G. M. Macêdo
Limitaons
Somatic intervention approaches have the
potenal to be very helpful to paents, either isolated
or when combined with complementary drug treat-
ment, but must be conducted in a safe and scien-
cally rigorous manner. However, in the case of Somac
Experiencing® regarding the actual context where the
number of publicaons is sll small and limited to speci-
c clinical condions or case studies presented at SE®
seminars and training, and therefore the current results
should be analyzed with cauon. In fact, most of the
analyzed arcles had a small sample size without a
control group, and did not report follow-ups. Thus, a
stronger investment based on clinical trials, including
controlled and/or randomized clinical trials, is needed
to measure the ecacy of SE® in short- and long-term
prospects, and using specic groups related to trauma-
c events.
Conict of interest
The authors declare that there is no nancial
involvement that could lead to a conict of interest.
Acknowledgement
We are grateful to professors Priscila Fernandes
(UFRN), Dina Azevedo (UFRN) and Denis Donald
Moorman (Somac Experiencing® Trauma Instute) for
their comments and assistance.
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Ana Kelly Almeida, Mestre em Filosofia pela Universidade Federal
do Rio Grande do Norte - UFRN, doutoranda em Psicobiologia na
Universidade Federal do Rio Grande do Norte - UFRN. Endereço
para correspondência: Av. Antônio Basílio, 3006, Shopping Lagoa
Center Business, sala 602, Lagoa Nova, Natal – RN, CEP 59.056-500.
Telefone: +55(84)988170858. Email: anakelly.almeida@gmail.com
Sayonara Christiane Gomes de Melo Macêdo, Especialista em Língua
Inglesa (Educação) pela Universidade Potiguar – UNP,
é Professora do Programa saúde e qualidade de vida no CEMURE
(Centro Municipal de Referência em Educação Aluísio Alves) na
secretaria Municipal de Natal. Email: sayonaramacedopsi@gmail.com
Maria Bernardete Cordeiro de Sousa, Doutora em Neurofisiologia
pela Faculdade de Medicina de Ribeirão Preto – Universidade
de São Paulo (USP), Pós-Doutora em Physiological Ethology pela
Wisconsin National Primate Research Center - University of
Wisconsin (UW), USA, é Professora Titular do Instituto do Cérebro
da Universidade Federal do Rio Grande do Norte (UFRN).
Email: mbcsousa@neuro.ufrn.br
Received in 28.jan.19
Revised in 08.aug.19
Accepted in 16.oct.19