From Freeze to Thaw: How Therapists Help Trauma Survivors with Hypoarousal

Mar 03, 2023

 Just because no one else can heal or do your inner work for you,
doesn't mean you can, should or need to do it alone.
- Lisa Olivera

Hypoarousal is a common trauma response that can lead to a dissociative state, sometimes known as “flop and drop.” It occurs when the nervous system is overwhelmed and the body goes into survival mode. The person experiencing hypoarousal may feel paralyzed, numb, or disconnected from reality. They are not able to respond or react in the moment, instead entering into a defensive state of being—similar to the way possums respond to stress by playing dead. In this article, we will look at hypoarousal in more detail, exploring its link to the dorsal vagal response and how therapists help clients/patients move out of hypoarousal with somatic techniques such as orienting, grounding, centering and connecting.


What Is Hypoarousal?

Hypoarousal is a defense mechanism that is triggered when the body senses danger. It is related to what is known as the dorsal vagal response which is an evolutionary adaptation designed for survival purposes—it helps us shut down so that we don’t have to confront threats in our environment. When someone experiences hypoarousal they enter into a dissociative state where they become unresponsive and unable to act on their own behalf. They may also experience physical paralysis or numbness in addition to mental disconnection from reality. This reaction can be seen in animals too–when possums sense danger they will often go into a “flop and drop” response where they literally play dead until the threat passes.


Therapists Help Clients Move Out of Hypoarousal with Somatic Techniques

Therapists work with clients who suffer from hypoarousal by helping them reconnect with their bodies and break free from traumatic responses like flop and drop. To do this, therapists use somatic techniques such as orienting (focusing on something tangible such as one’s physical body), grounding (connecting sensations within one's body), centering (bringing awareness back to one's center) and connecting (cultivating relationships between oneself and others). These techniques can help clients/patients move out of hypoarousal by calming their nervous systems and allowing them access to their resources once again.

Photo credit: Toa Heftiba @Unsplash


Case Study Vignette: A Therapist Working With a Client

Let’s take a look at how these techniques might be used in practice through a case study vignette featuring Jane, a trauma survivor who has experienced prolonged periods of hypoarousal throughout her life due to traumatic events she has endured. Jane’s therapist begins by asking her if she would like some help calming down her nervous system before they continue talking about her traumatic experiences further: 

Therapist: "I'm noticing that your breathing has become quite shallow lately; would you like some help calming your nervous system?"

Jane: “Yes…I just feel so overwhelmed right now."

Therapist: "That's understandable! Let's start off by orienting ourselves--can you tell me what your feet are feeling right now? We'll work our way up slowly until you feel more connected with your body."

Jane begins slowly describing what her feet are feeling while her therapist guides her through each step of orienting, grounding, centering, and connecting until Jane finally feels connected with herself again. Through this process Jane was able to extricate herself from the dissociative state she had been stuck in for so long without having to confront any of her painful memories directly--a wonderful example of how therapy can be used effectively for trauma survivors suffering from hypoarousal!

Hypoarousal is an instinctual defense mechanism designed for survival purposes but it can lead people into states of dissociation if left unchecked over time. By utilizing somatic techniques such as orienting, grounding, centering and connecting therapists can help clients/patients move out of states of hypoarousal so that they can begin processing their traumatic experiences again in healthier ways. It takes patience but it can be done with the right guidance! If you are struggling with trauma induced hypoarousal or know someone who is please seek professional help today–you don't have to go through it alone!

Photo credit: Kelly Sikkema @Unsplash

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