When Talk Therapy Isn't Enough: Why Trauma Lives in the Body
When Talk Therapy Isn't Enough: Why Trauma Lives in the Body
By Dr. Matt McKeithan, Psychologist
Throughout my years in clinical practice, I've encountered a pattern that both humbled and puzzled me: some patients simply don't get better with traditional psychotherapy. Despite my training in evidence-based modalities like Dialectical Behavior Therapy (DBT), Cognitive Behavioral Therapy (CBT), and even Eye Movement Desensitization and Reprocessing (EMDR), I watched certain clients—particularly those with complex trauma—remain stuck in their suffering.
These weren't cases of poor therapeutic rapport or lack of effort. These were intelligent, motivated individuals who showed up week after week, engaged deeply in therapy, and genuinely wanted to heal. Yet the needle barely moved.
The realization that eventually changed my entire clinical approach was this: we were trying to fix bottom-up problems with top-down solutions.
Understanding Top-Down vs. Bottom-Up Processing
Top-down approaches work through the conscious mind—our thoughts, beliefs, and cognitive processes. CBT helps us challenge distorted thinking patterns. DBT teaches emotional regulation skills. Even EMDR, while incorporating bilateral stimulation, still requires cognitive processing of traumatic memories.
These approaches assume that if we can change how we think about our trauma, we can change how we feel and behave.
But trauma doesn't live primarily in our thoughts. Trauma lives in the body.
Bottom-up processing recognizes that trauma is fundamentally a physiological experience. When we experience overwhelming stress or danger, our nervous system responds automatically—our heart races, muscles tense, breathing becomes shallow, and stress hormones flood our system. If that energy isn't discharged, it becomes trapped in the body's tissues, creating chronic patterns of tension, dysregulation, and disease.
No amount of cognitive reframing can release tension that's been held in your shoulders for twenty years. No thought exercise can discharge the fight-or-flight energy still trapped in your nervous system from childhood.
This is why some patients don't improve with talk therapy alone. We're trying to think our way out of a problem that exists below the level of conscious thought.
Why Trauma Gets Stored in the Body
When we experience trauma, our autonomic nervous system activates to protect us. This happens instantaneously, without conscious thought. Our body prepares to fight, flee, or freeze.
In a healthy stress response, once the threat passes, the nervous system completes this cycle. Animals in the wild demonstrate this perfectly—after escaping a predator, a gazelle will literally shake and tremble, discharging the accumulated stress energy before returning to calm grazing.
Humans, however, often don't complete this cycle. We're told to "calm down," to "get over it," to "be strong." We suppress the shaking, the crying, the anger. We hold our breath. We tighten our muscles to contain overwhelming emotions.
That survival energy doesn't disappear—it gets trapped. The body continues to hold the muscular tension, the shallow breathing patterns, the biochemical state of high alert. We develop what Alexander Lowen called "character armor"—chronic patterns of muscular tension that form to contain suppressed emotions and traumatic energy.
Over time, this creates a feedback loop. The body signals danger to the brain through its state of chronic tension. The brain interprets this as ongoing threat. More stress hormones are released. The cycle perpetuates itself, sometimes for decades.
My Personal Journey into Somatic Work
My understanding of this shifted from intellectual to visceral when I discovered my own patterns. Reading Alexander Lowen's The Voice of the Body was nothing short of revolutionary for my practice—and my personal healing.
For years, I struggled with chronic gastric issues, food intolerances, and severe GERD. I'd seen gastroenterologists, tried elimination diets, taken various medications. Nothing provided lasting relief. The traditional medical route couldn't answer a fundamental question: Why was my body having so much trouble in this area?
Through somatic work, I learned that my trauma was stored primarily in my diaphragm and solar plexus region. According to Lowen's interpretation, this represents an energetic block that prevents the free flow of energy between the upper body (emotion, expression, connection) and the lower body (grounding, instinct, vitality).
Psychologically, this pattern often relates to fear of expressing oneself or fear of punishment for doing so. It's common in individuals who had to suppress spontaneous emotional or physical expression as children to maintain safety or approval. The person literally "holds their feelings in the gut."
For me, this was devastatingly accurate. I had learned early to be the "good kid," to not make waves, to keep my authentic reactions contained. My belly became a storage vault for unexpressed anger, fear, and grief.
The chronic gastric issues weren't just digestive problems—they were somatic symptoms of unresolved trauma. Floods of cortisol linked to stored trauma were the answer. My body was in a constant state of threat response, particularly concentrated in the area where I held my most suppressed emotions.
Traditional psychotherapy had never touched this. But somatic work did.
Practical Bioenergetic Exercises for Trauma Release
Based on Lowen's work and my own clinical experience, here are key exercises that can help release stored trauma from the body:
1. Grounding
Purpose: Restores contact with the body and the earth, discharging excess energy downward and helping you feel safe in the present moment.
Technique:
Stand barefoot (or in socks) with feet hip-width apart
Bend knees slightly, weight evenly distributed
Breathe slowly into your belly and feel the floor "holding" you
On exhale, let the legs feel heavy and release tension down into the ground
Notice any trembling or vibration—this is energy discharging
Practice: 5-10 minutes daily, especially when feeling anxious or disconnected.
2. Deep Belly Breathing
The diaphragm is often rigid in people with chronic anxiety and stored trauma. Restoring full breathing is essential.
Technique:
Lie on your back with knees bent, hands on abdomen
Inhale through nose → feel the belly rise (not the chest)
Exhale through mouth → make a long, relaxed sigh
Let your belly be soft and round, releasing the habitual "holding"
Repeat 20-30 breaths to soften the diaphragm
This calms the vagus nerve and signals safety to your nervous system.
3. Vibratory Release (Soft Shaking)
Technique:
Stand with knees slightly bent
Gently bounce on your heels so vibration moves up the legs into the belly and chest
Allow your jaw to loosen, lips to tremble
Don't control it—allow spontaneous micro-shaking that restores flow
This mimics the natural trauma-discharge response we see in animals
The goal is not control, but allowing the body's natural release mechanisms.
4. Expressive Work for the Solar Plexus
Stomach anxiety often masks unexpressed anger or sadness. Safe expression is crucial.
"Soft Punch" Exercise:
Kneel by a bed or padded surface
Inhale deeply, exhale with a sound ("Ha!") as you strike slowly downward
Feel the tension in your belly move outward through your arms
Do not aim for aggression—aim for authenticity of feeling
This helps discharge fight energy trapped in the core
5. Body Awareness and Self-Contact
Understanding Your Stomach Anxiety:
Place one hand gently over your solar plexus (upper abdomen, just below the ribcage). Notice the sensations: Is it tight? Hollow? Fluttering? Heavy?
Speak aloud to your body: "It's okay to feel. It's safe to let go."
This gentle contact builds a felt sense of safety with your emotions. You're telling your body, through presence and touch, that it's no longer alone with what it carries.
6. Vocal Grounding
The gut and throat are directly linked through the vagus nerve. Sound can release diaphragm tension.
Technique:
Sit or stand comfortably
Place one hand on your belly
Make a deep "Ahhh" sound, feeling it vibrate from your diaphragm
Try humming or toning vowels, letting the sound resonate in your belly
This vibration literally shakes loose held tension
7. The Bioenergetic Bow
Technique:
Stand with feet hip-width apart
Lean backward with knees bent, arms slightly extended, chest open
Let your belly push forward
Hold this position and breathe
Feel the tremble, allow the vibration to move through the stomach
This opens the entire front of the body, including the solar plexus
Supporting yoga poses include cat-cow, cobra, and bridge pose—all open the diaphragm and solar plexus region.
Integration: Making the Work Sustainable
After any of these exercises, lie down for 2-3 minutes with hands on your belly and simply feel the sensations settle. Notice the difference in your body.
The goal is not dramatic catharsis but contact—staying present with the bodily experience without suppressing or escaping it.
Consider keeping an emotional body journal. Write from your body's perspective: "My stomach says..." or "When I breathe into my belly, I notice..."
This builds the crucial bridge between somatic sensation and conscious awareness.
A Daily Practice
Here's a 15-minute routine that integrates these principles: Start with three minutes of grounding stance for energy discharge and building a sense of safety. Move into four minutes of deep belly breathing to release the diaphragm and calm the vagus nerve. Spend three minutes with vibratory release or the bioenergetic bow to restore energy flow. Follow with three minutes of expressive movement to discharge stored emotions. End with two minutes of hand on belly, building internal safety through self-contact.
The Paradigm Shift
Understanding trauma as a bottom-up phenomenon fundamentally changed how I practice therapy. I still use cognitive approaches, but now I always assess: Is this person living in a dysregulated nervous system? Are they disconnected from their body? Where are they holding tension?
For many of my clients—and for myself—somatic work provided the breakthrough that years of traditional therapy couldn't achieve. Not because talk therapy is bad, but because we were trying to solve a body problem with brain solutions.
The body keeps the score, as Bessel van der Kolk famously wrote. But the body also holds the key to healing.
When we learn to listen to its voice, to release what we've held for so long, to complete the survival responses that were interrupted years or decades ago—that's when real transformation becomes possible.
My gastric issues didn't fully resolve until I addressed the trauma stored in my diaphragm. No medication could do what conscious breathing, grounding, and safe emotional expression accomplished. The relief wasn't just physical—it was a profound return to wholeness.
This is the work I now bring to my clients. Not as a replacement for traditional therapy, but as its essential complement. Because healing trauma isn't just about changing our thoughts—it's about finally letting our bodies know that the danger has passed, and it's safe to let go.
Dr. Matt McKeithan is a licensed psychologist specializing in trauma therapy, EMDR, and somatic approaches to healing. He practices at Your Kind of Happy LLC Simpsonville, South Carolina, where he integrates traditional psychotherapy with body-centered interventions for clients struggling with anxiety, PTSD, and complex trauma.
