Embodied simulation in exposure-based therapies for posttraumatic stress disorder—a possible integration of cognitive behavioral theories, neuroscience, and psychoanalysis

Abstract

Exposure to the trauma memory is the common denominator of most evidence-based interventions for posttraumatic stress disorder (PTSD). Although exposure-based therapies aim to change associative learning networks and negative cognitions related to the trauma memory, emotional interactions between patient and therapist have not been thoroughly considered in past evaluations of exposure-based therapy. This work focuses on recent discoveries of the mirror-neuron system and the theory of embodied simulation (ES). These conceptualizations may add a new perspective to our understanding of change processes in exposure-based treatments for PTSD patients. It is proposed that during exposure to trauma memories, emotional responses of the patient are transferred to the therapist through ES and then mirrored back to the patient in a modulated way. This process helps to alleviate the patient's sense of loneliness and enhances his or her ability to exert control over painful, trauma-related emotional responses. ES processes may enhance the integration of clinical insights originating in psychoanalytic theories—such as holding, containment, projective identification, and emotional attunement—with cognitive behavioral theories of learning processes in the alleviation of painful emotional responses aroused by trauma memories. These processes are demonstrated through a clinical vignette from an exposure-based therapy with a trauma survivor. Possible clinical implications for the importance of face-to-face relationships during exposure-based therapy are discussed.

A randomized controlled trial of brief Somatic Experiencing for chronic low back pain and comorbid post-traumatic stress disorder symptoms

“…Recently, it has been suggested that more subtle processes related to the therapeutic relationship and embodied cognition may be common underlying mechanisms associated with emotion regulation and fear extinction across therapeutic approaches (Peri et al, 2015). Also, a number of patients have difficulties tolerating exposure in vivo or to trauma memories resulting in elevated arousal and the risk of dropping out of treatment (Wald & Taylor, 2008).…”

“…While exposure to trauma memories is one of the most common approaches to treating PTSD (Peri, Gofman, Tal, & Tuval-Mashiach, 2015 ), the so-called ‘active ingredients’ across treatments are still being debated (see Schnyder et al, 2015 ). Recently, it has been suggested that more subtle processes related to the therapeutic relationship and embodied cognition may be common underlying mechanisms associated with emotion regulation and fear extinction across therapeutic approaches (Peri et al, 2015 ). Also, a number of patients have difficulties tolerating exposure in vivo or to trauma memories resulting in elevated arousal and the risk of dropping out of treatment (Wald & Taylor, 2008 ).…”

Re-enacting the Bodily Self on Stage: Embodied Cognition Meets Psychoanalysis

“…The psychoanalyst resonates to the emotions linguistically expressed by the patient. In a recent work attempting to integrate cognitive behavioral theories, embodied simulations, and psychoanalysis for the treatment of post-traumatic stress disorder, Peri et al. (2015) emphasized the importance of having a therapist present in face-to-face contact.…”

Embodied Cognition and the Direct Induction of Affect as a Compliment to Cognitive Behavioural Therapy

“…Peri et al [142] explored the use of therapeutic embodied simulation and mirroring in helping clients with post-traumatic stress disorder to down regulate during exposure to trauma memories. In this process, the emotional responses of the client are transferred to the therapist through embodied simulation.…”