Somatic therapy works from the body up: it uses sensation, breath, posture and movement to change arousal first. Talk therapy works mainly through language, meaning and the relationship. The trials do not show that somatic methods beat good talk therapy across the board. Both help. Several of the best-supported treatments mix the two, and some nervous systems need the body route before words can do much.

An earlier version of this post argued that somatic and brain-based therapies outperform talk therapy because of anatomy: most fibers in the vagus nerve carry signals up from the body, so the body must be in charge. The anatomy is real. The conclusion does not follow from it. My argument here is narrower and more useful. Emotional dysregulation runs on a loop between bodily signals and the brain’s predictions about them. When arousal is high, the verbal end of that loop is the first to go offline, so a bottom-up method is often the only door that opens. That is a case for sequencing and integration, and it has to be argued from trials, not from fiber counts.

What the body sends up

The idea that feeling follows the body is older than psychotherapy. In 1884 William James argued that “we feel sorry because we cry, angry because we strike, afraid because we tremble,” and that without the bodily changes, the perception that sets off an emotion would be “purely cognitive in form, pale, colourless.”¹ Modern anatomy gives that intuition some support.

Nerves carry traffic in two directions. Efferent fibers carry commands from the brain and spinal cord out to muscles, glands and organs. Afferent fibers carry information back in. The vagus nerve, the main parasympathetic link between the brainstem and the heart, lungs and gut, is mostly afferent: a 2018 review in Frontiers in Psychiatry puts vagal afferents at 80 to 90 percent of its fibers.² Those afferents carry mechanical, chemical, temperature and immune signals from the organs to the nucleus tractus solitarius in the brainstem, and some, such as pain signals, feed reflexes that run through the amygdala and other limbic structures.³ The same review calls the clinical evidence for vagus nerve stimulation in depression and PTSD preliminary.²

Much of that signal seems to become feeling in the insula. A. D. Craig’s 2002 review described an afferent system that maps the physiological condition of the whole body and proposed it as a foundation for subjective feeling and self-awareness.⁴ Hugo Critchley’s team then showed that right anterior insula activity predicted how accurately people sensed their own heartbeats, and that better heartbeat perception went with higher scores on measures of negative emotional experience.⁵ Lesion evidence is thinner than it is often presented. One study described three patients with right insular damage who read high-arousal emotions such as anger as lower-arousal ones such as sadness; one of them also had very poor heartbeat perception.⁶ Three cases point in a direction. They do not prove that sensing the body is a prerequisite for emotion.

The amygdala also listens below awareness. A 2017 review of imaging and lesion studies concluded that the evidence for amygdala responses to emotional stimuli people never consciously register is solid, though those responses run through more complex networks than commonly assumed.⁷ Depth psychology noticed the body’s head start early. In 1907 Frederick Peterson and Carl Jung published a study in Brain that recorded skin conductance with a galvanometer and breathing with a pneumograph during word-association experiments, using the body’s reactions to flag which words carried an emotional charge.⁸

The earlier version of this post went further, claiming that because afferent fibers outnumber efferent ones, the body “shouts” while the brain “whispers.” Fiber counts measure bandwidth, not authority; the outnumbered vagal efferents can still slow the heart within a beat or two. The better question is what the brain does with the signals it receives.

The brain predicts the body, too

The most influential current models of interoception, the sensing of the body’s internal state, run partly the other way. Lisa Feldman Barrett and W. Kyle Simmons proposed in 2015 that interoceptive experience “may largely reflect limbic predictions about the expected state of the body that are constrained by ascending visceral sensations.”⁹ In their Embodied Predictive Interoception Coding model, regions of cortex that also drive the viscera issue predictions about the body, and signals rising from the body constrain and correct those predictions. Anil Seth and Karl Friston go further: in their account, autonomic reflexes themselves are driven by descending predictions from the brain’s models of the body and the world.¹⁰

This matters clinically because it turns a one-way story into a loop. A brain that predicts danger prepares the body for it: muscles brace, breathing shortens, the gut tightens. Those changes travel back up as evidence the prediction was right. A 2016 summit of interoception researchers listed problems with interoception in anxiety, mood, eating, addictive and somatic symptom disorders, while noting conceptual and measurement problems that have slowed the idea’s use in treatment.¹¹ A dysregulated state, on this view, is a prediction that keeps confirming itself. It can be interrupted from either end: by changing what the body reports, or by changing what the brain expects.

Antonio Damasio’s somatic marker hypothesis is the classic version of the argument that the body biases thought. In the 1997 Iowa Gambling Task study, healthy participants produced anticipatory skin-conductance responses before risky choices, and began choosing well, before they could say which decks were better; patients with ventromedial prefrontal damage never developed those responses.¹² A 2006 critical review countered that participants understand more of the task than assumed, that the physiological data are ambiguous, and that causal evidence is scarce.¹³ The hypothesis describes how gut reactions color judgment. It does not show that the body decides.

The loop also gives a sober meaning to the phrase “the body remembers.” Taken literally, it is wrong: there is no known mechanism for storing autobiographical memories in muscle or fascia. Memory research separates memory that can be consciously recalled from memory that cannot, and the second kind depends on systems that include the amygdala, striatum and cerebellum.¹⁴ Bracing, startle, a habitual hunch of the shoulders and a racing heart at a certain tone of voice are learned and expressed through the body, but they are stored in the brain. Breanne Kearney and Ruth Lanius have proposed that trauma-related symptoms are grounded partly in brainstem-level problems with somatic sensory processing, vestibular and somatosensory, which cascade into arousal, emotion and sense of self.¹⁵ It is a model, not a finding. On it, somatic methods do not release memories from tissue; they give a sensory system that learned to expect danger new experience to learn from.

Why insight stalls when arousal is high

The original’s best argument concerned the limits of cognitive control, and it holds up with the right studies. Cognitive reappraisal, reinterpreting a situation to change how it feels, works. A meta-analysis of 306 experimental comparisons found a small-to-medium effect for cognitive change strategies (d = 0.36), with perspective taking somewhat stronger.¹⁶ A meta-analysis of 48 imaging studies found that reappraisal recruits frontal and parietal control regions and modulates activity in the amygdala.¹⁷ Talking yourself down is a real neural event.

It is also fragile under exactly the conditions that bring people to therapy. Amy Arnsten’s review describes how even mild, uncontrollable stress can rapidly impair prefrontal function.¹⁸ Candace Raio, Elizabeth Phelps and colleagues taught people a regulation strategy for a conditioned fear; the next day, participants who had not been stressed used it to reduce their fear, while participants put through a stress induction showed no reduction.¹⁹ People seem to know this about themselves. In experiments by Gal Sheppes, James Gross and colleagues, participants leaned toward reappraisal for low-intensity negative material and toward distraction for high-intensity material.²⁰ Nor is reappraisal always helpful: in one study of 170 people, stronger reappraisal ability went with less depression under uncontrollable stress and more depression when the stressor could have been changed.²¹

Together these findings support a sequencing argument. Words work best inside a certain range of arousal; above it, the prefrontal tools that conversation relies on are partly offline. Many people know this from the inside. They can explain their panic in detail and still cannot stop their hands from shaking, which is the experience behind our post on why insight alone often does not stop a trauma response. Bringing arousal down through the body can be what lets reflection start working again. That is different from saying the body route is better. It says the order of operations matters.

Posture, breath and polyvagal theory: what holds up

If the body feeds the brain, changing the body should change mood. Sometimes it does, by modest amounts. In one experiment, 74 people had their backs taped into either a slumped or an upright seated posture for a stressful speech task; the upright group reported higher self-esteem, better mood and lower fear.²² A later study of 61 people who screened positive for mild to moderate depression found that upright posture increased high-arousal positive affect and reduced fatigue during the same task.²³ Both were single-session studies, and the second used a non-clinical sample. A meta-analysis of 138 facial-feedback studies found a real but small and variable effect of facial movement on emotional experience.²⁴ And the popular claim that “power posing” shifts hormones did not survive a larger test, which found no effect on hormones or risk tolerance.²⁵

Breathing has better support as a lever. A systematic review of 15 studies in healthy adults found that slow breathing, under ten breaths a minute, increases heart rate variability and is associated with more relaxation and less anxiety, anger and depressive symptoms.²⁶ A month-long randomized study compared three five-minute daily breathing practices with mindfulness meditation; exhale-focused “cyclic sighing” produced greater improvement in mood and a larger drop in respiratory rate than meditation did.²⁷ These are tools for shifting a state, not treatments for a disorder, and our guide to somatic brakes for panic, including the physiological sigh treats them that way.

Polyvagal theory is where the earlier post went furthest past the evidence. Stephen Porges introduced it in 1995, proposing that two brainstem sources of the vagus produce different autonomic states, with a mammal-specific ventral vagal system tied to attention, emotion and communication.²⁸ Clinicians took up its three-state picture of social engagement, fight-or-flight and shutdown, and Porges’s 2025 overview extends it to trauma, chronic pain, autism and mood disorders.²⁹ Physiologists have not followed. Paul Grossman’s 2023 review argued that each of the theory’s five basic premises is either untenable or highly implausible, including its treatment of respiratory sinus arrhythmia as a measure of vagal tone.³⁰ In 2026, Grossman and 38 co-authors, many of them vagal physiologists and evolutionary biologists whose work polyvagal writings had cited, concluded that the theory is untenable “because it is not defensible based on existing neurophysiological and evolutionary evidence.”³¹ Porges has published a reply.³² The earlier claim here, that a slumped posture is a “dorsal vagal” shutdown, had no study behind it.

None of that makes the states clinicians describe imaginary. People do mobilize, freeze and go numb. What is contested is the anatomy and the evolutionary story, so polyvagal language belongs in therapy as a useful map, not settled biology, which is the spirit of our piece on polyvagal theory read through myth.

What the trials show for somatic methods

Superiority is a claim about trials, so here are the trials. The comparison point is strong: for adults with PTSD, a 2016 systematic review of 64 trials rated the evidence high for exposure therapy, moderate for cognitive processing therapy, cognitive therapy and mixed CBT, and low to moderate for EMDR and narrative exposure therapy. It found too few head-to-head trials to rank them.³³

Somatic Experiencing. Peter Levine’s method guides attention to interoceptive, kinesthetic and proprioceptive sensation, aiming to complete thwarted defensive responses and discharge excess arousal.³⁴ Its first randomized trial assigned 63 people with PTSD to 15 weekly sessions or a waitlist and found large effects on PTSD symptoms (d = 0.94 to 1.26).³⁵ A waitlist is a weak comparison. Two Danish trials in people with low back pain and post-traumatic stress symptoms say more. In the first (91 participants), adding SE to usual care reduced PTSD symptoms more than usual care alone, though the authors wrote that the clinical importance of the effect “can be questioned.”³⁶ In the second (114 participants), adding up to 12 SE sessions to physiotherapy produced no additional benefit on any outcome.³⁷ A 2021 scoping review called the evidence preliminary and of mixed quality.³⁸ Newer work includes a 2026 experiment in which one 60-minute SE-based session raised momentary feelings of safety more than psychoeducation did,³⁹ and a randomized trial comparing SE with prolonged exposure in veterans; the report I could find describes participants’ experiences rather than outcomes.⁴⁰ To see what the method involves, read how Somatic Experiencing sessions work at Taproot.

Body psychotherapy as a family. A 2021 meta-analysis pooled 18 randomized trials and found medium effects on psychopathology (g = 0.56) and distress (g = 0.52), with moderate to high heterogeneity. The advantage shrank when the control group did something physical, such as Pilates or massage, and two trials against an equal dose of physical activity found no advantage at all.⁴¹

Trauma-informed yoga. In a trial of 64 women with treatment-resistant PTSD, 52 percent of the yoga group no longer met PTSD criteria after ten weeks, against 21 percent after health education.⁴² A meta-analysis of seven trials found low-quality evidence of benefit against no treatment and no clear difference from attention-control conditions.⁴³

EMDR. EMDR is the brain-based method with the largest trial base. A 2020 meta-analysis of 76 trials found a large effect against control conditions (g = 0.93), but only four of 27 assessed studies had low risk of bias, and EMDR’s advantage over other therapies did not hold in the low-risk studies.⁴⁴ Its mechanism is also less “bottom-up” than the earlier post claimed. Eye movements do add something, an effect of d = 0.41 within EMDR treatment in one meta-analysis.⁴⁵ But Marcel van den Hout and Iris Engelhard’s experiments found that vertical eye movements, and tasks with no eye movement at all, work as well as side-to-side ones, as long as they tax working memory. Bilateral stimulation is not required.⁴⁶ An fMRI study found that goal-directed eye movements briefly deactivate the amygdala, possibly through a ventromedial prefrontal pathway involved in the cognitive regulation of emotion, and that another working-memory task did the same.⁴⁷ The authors liken this to the circuitry of cognitive emotion control, which puts it closer to top-down regulation than to a bottom-up route. Our post on “purple hat” therapies and their theories takes up the general problem: a technique can help for reasons other than the one its founders give.

Brainspotting. David Grand’s method holds the eyes at positions that client and therapist link to a felt sense of activation. Its proposed mechanism, recruiting the midbrain to reach sensorimotor traces of trauma, was published as a hypothesis in Medical Hypotheses in 2013.⁴⁸ The main clinical comparison gave 76 adults three sessions of EMDR or Brainspotting. Both groups improved, and EMDR’s effect sizes were larger (d = 1.19 to 1.76 against 0.74 to 1.04); the group sizes were uneven (23 and 53), and the published abstract does not describe randomization.⁴⁹ In a 2022 study of 40 psychologists and physicians, single sessions of EMDR and Brainspotting lowered distress about a memory more than body-scan meditation or reading did.⁵⁰ Taproot offers Brainspotting therapy, and its research base is still small, the subject of our post on why Brainspotting spread faster than its research.

Emotional Transformation Therapy and bodywork. ETT, developed by Steven Vazquez, pairs psychotherapy with colored light and eye-movement work. Its main text is Vazquez’s own 2012 book, and I know of no independent randomized trials.⁵¹ I am certified in ETT and use it, so it is worth saying plainly: the earlier claim that it produces “unprecedentedly fast emotional healing” was marketing, not evidence. Our ETT page describes it with more care. Rolfing and myofascial release are bodywork, not psychotherapy. One physiological study from 1988, co-authored by Porges, found that a Rolfing pelvic lift increased respiratory sinus arrhythmia, a rough index of parasympathetic activity, in 20 younger men but not in 10 older ones.⁵² That is a short-term reflex, not evidence of lasting emotional change.

Talk therapy already works through the body

The weakest part of the “somatic versus talk” framing is the word talk. Several of the best-supported treatments for dysregulated states already work partly through the body. A component network meta-analysis of 72 trials of CBT for panic disorder found that interoceptive exposure, deliberately bringing on feared sensations such as a racing heart or dizziness, was associated with better outcomes. Muscle relaxation, the most obviously somatic calming technique in the package, was associated with lower efficacy.⁵³ The body ingredient that helped was meeting sensation, not soothing it.

Borderline personality disorder is the textbook disorder of emotional dysregulation, and its most-studied treatment is dialectical behavior therapy. In a 2020 Cochrane review of 75 trials, DBT was the subject of about a third of them and reduced BPD severity and self-harm compared with treatment as usual, on low-quality evidence.⁵⁴ DBT is a talk therapy built on skills training in mindfulness, emotion regulation, distress tolerance and interpersonal effectiveness.⁵⁵ Whether that counts as top-down or bottom-up is hard to say, which is the point.

A 2026 theoretical paper makes a similar point from the trauma side: its Exposure Continuum Model rates trauma therapies by how direct and how cumulative their exposure is, and places Somatic Experiencing alongside prolonged exposure, cognitive processing therapy and EMDR.⁵⁶ SE’s own developers describe it as offering “a supplement to cognitive and exposure therapies.”³⁴

So the honest answer to “somatic therapy vs talk therapy” is that the line is blurry and the trials do not crown a winner. Somatic methods have promising but thin evidence. Established therapies have more evidence and already contain bodily components that do some of the work. What the neuroscience adds is a reason to start with the body when arousal is too high for words to land.

What this looks like in therapy

In practice the question is less “somatic or talk” than “which door is open today.” Integrated work tends to move through a few phases, rarely in a straight line.

Reading the state first. The therapist tracks arousal as it happens: breath, posture, skin color, where the eyes go, the moment speech speeds up or goes flat. If someone is flooded or numb, interpretation tends to slide off, and the first job is to bring arousal into a range where reflection can work. Attention to the body is not automatically calming. For people with panic or dissociation, early body focus can raise alarm, so pacing matters more than technique.

Building interoceptive awareness. People with long histories of dysregulation often feel little in their bodies, or only alarm. Mindful Awareness in Body-oriented Therapy, for example, teaches identifying, accessing and appraising internal signals as separate skills, on the reasoning that better awareness supports better regulation.⁵⁷ In the studies the 2021 scoping review gathered, practitioners and clients named resource orientation, deliberately finding and returning to what feels steady, as a specific ingredient of Somatic Experiencing.³⁸

Approaching the hard material in doses. Once someone can notice activation without being swallowed by it, the work turns toward what drives it: a memory, a relationship, a part of the self that learned to brace. This is where EMDR, Brainspotting or exposure-based work fits. A plausible shared ingredient, best supported in the panic research, is contact with the feared sensation or memory, with enough safety to learn something new.^{53, 56}

Making meaning afterward. Words come back in. A calmer nervous system still has to make sense of what happened, and that is where depth and existential work earn their place: what the symptom was protecting, what a life organized around danger has cost, what now seems possible. Peterson and Jung’s galvanometer could show where an emotional charge sat. It could not say what the charge meant. That part still takes conversation.

If you have spent years understanding your reactions without being able to change them, a therapist who works with both the body and the story may suit you better than one who works with only one. Our somatic therapy practice in Hoover combines these approaches, in person near Birmingham and by teletherapy across Alabama. If you want to talk about whether it fits what you are dealing with, contact us.

References

1. James, W. (1884). What is an emotion? Mind, 9(34), 188–205. https://doi.org/10.1093/mind/os-IX.34.188
2. Breit, S., Kupferberg, A., Rogler, G., & Hasler, G. (2018). Vagus nerve as modulator of the brain–gut axis in psychiatric and inflammatory disorders. Frontiers in Psychiatry, 9, Article 44. https://doi.org/10.3389/fpsyt.2018.00044
3. Berthoud, H.-R., & Neuhuber, W. L. (2000). Functional and chemical anatomy of the afferent vagal system. Autonomic Neuroscience, 85(1–3), 1–17. https://doi.org/10.1016/S1566-0702(00)00215-0
4. Craig, A. D. (2002). How do you feel? Interoception: The sense of the physiological condition of the body. Nature Reviews Neuroscience, 3(8), 655–666. https://doi.org/10.1038/nrn894
5. Critchley, H. D., Wiens, S., Rotshtein, P., Öhman, A., & Dolan, R. J. (2004). Neural systems supporting interoceptive awareness. Nature Neuroscience, 7(2), 189–195. https://doi.org/10.1038/nn1176
6. Terasawa, Y., Kurosaki, Y., Ibata, Y., Moriguchi, Y., & Umeda, S. (2015). Attenuated sensitivity to the emotions of others by insular lesion. Frontiers in Psychology, 6, Article 1314. https://doi.org/10.3389/fpsyg.2015.01314
7. Diano, M., Celeghin, A., Bagnis, A., & Tamietto, M. (2017). Amygdala response to emotional stimuli without awareness: Facts and interpretations. Frontiers in Psychology, 7, Article 2029. https://doi.org/10.3389/fpsyg.2016.02029
8. Peterson, F., & Jung, C. G. (1907). Psycho-physical investigations with the galvanometer and pneumograph in normal and insane individuals. Brain, 30(2), 153–218. https://doi.org/10.1093/brain/30.2.153
9. Barrett, L. F., & Simmons, W. K. (2015). Interoceptive predictions in the brain. Nature Reviews Neuroscience, 16(7), 419–429. https://doi.org/10.1038/nrn3950
10. Seth, A. K., & Friston, K. J. (2016). Active interoceptive inference and the emotional brain. Philosophical Transactions of the Royal Society B: Biological Sciences, 371(1708), Article 20160007. https://doi.org/10.1098/rstb.2016.0007
11. Khalsa, S. S., Adolphs, R., Cameron, O. G., Critchley, H. D., Davenport, P. W., Feinstein, J. S., Feusner, J. D., Garfinkel, S. N., Lane, R. D., Mehling, W. E., Meuret, A. E., Nemeroff, C. B., Oppenheimer, S., Petzschner, F. H., Pollatos, O., Rhudy, J. L., Schramm, L. P., Simmons, W. K., Stein, M. B., . . . Interoception Summit 2016 participants. (2018). Interoception and mental health: A roadmap. Biological Psychiatry: Cognitive Neuroscience and Neuroimaging, 3(6), 501–513. https://doi.org/10.1016/j.bpsc.2017.12.004
12. Bechara, A., Damasio, H., Tranel, D., & Damasio, A. R. (1997). Deciding advantageously before knowing the advantageous strategy. Science, 275(5304), 1293–1295. https://doi.org/10.1126/science.275.5304.1293
13. Dunn, B. D., Dalgleish, T., & Lawrence, A. D. (2006). The somatic marker hypothesis: A critical evaluation. Neuroscience & Biobehavioral Reviews, 30(2), 239–271. https://doi.org/10.1016/j.neubiorev.2005.07.001
14. Squire, L. R. (2004). Memory systems of the brain: A brief history and current perspective. Neurobiology of Learning and Memory, 82(3), 171–177. https://doi.org/10.1016/j.nlm.2004.06.005
15. Kearney, B. E., & Lanius, R. A. (2022). The brain-body disconnect: A somatic sensory basis for trauma-related disorders. Frontiers in Neuroscience, 16, Article 1015749. https://doi.org/10.3389/fnins.2022.1015749
16. Webb, T. L., Miles, E., & Sheeran, P. (2012). Dealing with feeling: A meta-analysis of the effectiveness of strategies derived from the process model of emotion regulation. Psychological Bulletin, 138(4), 775–808. https://doi.org/10.1037/a0027600
17. Buhle, J. T., Silvers, J. A., Wager, T. D., Lopez, R., Onyemekwu, C., Kober, H., Weber, J., & Ochsner, K. N. (2014). Cognitive reappraisal of emotion: A meta-analysis of human neuroimaging studies. Cerebral Cortex, 24(11), 2981–2990. https://doi.org/10.1093/cercor/bht154
18. Arnsten, A. F. T. (2009). Stress signalling pathways that impair prefrontal cortex structure and function. Nature Reviews Neuroscience, 10(6), 410–422. https://doi.org/10.1038/nrn2648
19. Raio, C. M., Orederu, T. A., Palazzolo, L., Shurick, A. A., & Phelps, E. A. (2013). Cognitive emotion regulation fails the stress test. Proceedings of the National Academy of Sciences, 110(37), 15139–15144. https://doi.org/10.1073/pnas.1305706110
20. Sheppes, G., Scheibe, S., Suri, G., & Gross, J. J. (2011). Emotion-regulation choice. Psychological Science, 22(11), 1391–1396. https://doi.org/10.1177/0956797611418350
21. Troy, A. S., Shallcross, A. J., & Mauss, I. B. (2013). A person-by-situation approach to emotion regulation: Cognitive reappraisal can either help or hurt, depending on the context. Psychological Science, 24(12), 2505–2514. https://doi.org/10.1177/0956797613496434 (Corrigendum published 2016, Psychological Science, 27(3), 428–431.)
22. Nair, S., Sagar, M., Sollers, J., Consedine, N., & Broadbent, E. (2015). Do slumped and upright postures affect stress responses? A randomized trial. Health Psychology, 34(6), 632–641. https://doi.org/10.1037/hea0000146
23. Wilkes, C., Kydd, R., Sagar, M., & Broadbent, E. (2017). Upright posture improves affect and fatigue in people with depressive symptoms. Journal of Behavior Therapy and Experimental Psychiatry, 54, 143–149. https://doi.org/10.1016/j.jbtep.2016.07.015
24. Coles, N. A., Larsen, J. T., & Lench, H. C. (2019). A meta-analysis of the facial feedback literature: Effects of facial feedback on emotional experience are small and variable. Psychological Bulletin, 145(6), 610–651. https://doi.org/10.1037/bul0000194
25. Ranehill, E., Dreber, A., Johannesson, M., Leiberg, S., Sul, S., & Weber, R. A. (2015). Assessing the robustness of power posing: No effect on hormones and risk tolerance in a large sample of men and women. Psychological Science, 26(5), 653–656. https://doi.org/10.1177/0956797614553946
26. Zaccaro, A., Piarulli, A., Laurino, M., Garbella, E., Menicucci, D., Neri, B., & Gemignani, A. (2018). How breath-control can change your life: A systematic review on psycho-physiological correlates of slow breathing. Frontiers in Human Neuroscience, 12, Article 353. https://doi.org/10.3389/fnhum.2018.00353
27. Balban, M. Y., Neri, E., Kogon, M. M., Weed, L., Nouriani, B., Jo, B., Holl, G., Zeitzer, J. M., Spiegel, D., & Huberman, A. D. (2023). Brief structured respiration practices enhance mood and reduce physiological arousal. Cell Reports Medicine, 4(1), Article 100895. https://doi.org/10.1016/j.xcrm.2022.100895
28. Porges, S. W. (1995). Orienting in a defensive world: Mammalian modifications of our evolutionary heritage. A polyvagal theory. Psychophysiology, 32(4), 301–318. https://doi.org/10.1111/j.1469-8986.1995.tb01213.x
29. Porges, S. W. (2025). Polyvagal theory: Current status, clinical applications, and future directions. Clinical Neuropsychiatry, 22(3), 169–184. https://doi.org/10.36131/cnfioritieditore20250301
30. Grossman, P. (2023). Fundamental challenges and likely refutations of the five basic premises of the polyvagal theory. Biological Psychology, 180, Article 108589. https://doi.org/10.1016/j.biopsycho.2023.108589
31. Grossman, P., Ackland, G. L., Allen, A. M., Berntson, G. G., Booth, L. C., Burghardt, G. M., Buron, J., Dinets, V., Doody, J. S., Dutschmann, M., Farmer, D. G. S., Fisher, J. P., Gourine, A. V., Joyner, M. J., Karemaker, J. M., Khalsa, S. S., Lakatta, E. G., Leite, C. A. C., Macefield, V. G., . . . Zucker, I. H. (2026). Why the polyvagal theory is untenable: An international expert evaluation of the polyvagal theory and commentary upon Porges, S.W. (2025). Clinical Neuropsychiatry, 23(1), 100–112. https://doi.org/10.36131/cnfioritieditore20260110
32. Porges, S. W. (2026). When a critique becomes untenable: A scholarly response to Grossman et al.’s evaluation of polyvagal theory. Clinical Neuropsychiatry, 23(1), 113–128. https://doi.org/10.36131/cnfioritieditore20260111
33. Cusack, K., Jonas, D. E., Forneris, C. A., Wines, C., Sonis, J., Middleton, J. C., Feltner, C., Brownley, K. A., Olmsted, K. R., Greenblatt, A., Weil, A., & Gaynes, B. N. (2016). Psychological treatments for adults with posttraumatic stress disorder: A systematic review and meta-analysis. Clinical Psychology Review, 43, 128–141. https://doi.org/10.1016/j.cpr.2015.10.003
34. Payne, P., Levine, P. A., & Crane-Godreau, M. A. (2015). Somatic experiencing: Using interoception and proprioception as core elements of trauma therapy. Frontiers in Psychology, 6, Article 93. https://doi.org/10.3389/fpsyg.2015.00093
35. Brom, D., Stokar, Y., Lawi, C., Nuriel-Porat, V., Ziv, Y., Lerner, K., & Ross, G. (2017). Somatic Experiencing for posttraumatic stress disorder: A randomized controlled outcome study. Journal of Traumatic Stress, 30(3), 304–312. https://doi.org/10.1002/jts.22189
36. Andersen, T. E., Lahav, Y., Ellegaard, H., & Manniche, C. (2017). A randomized controlled trial of brief Somatic Experiencing for chronic low back pain and comorbid post-traumatic stress disorder symptoms. European Journal of Psychotraumatology, 8(1), Article 1331108. https://doi.org/10.1080/20008198.2017.1331108
37. Andersen, T. E., Ellegaard, H., Schiøttz-Christensen, B., Mejldal, A., & Manniche, C. (2020). Somatic Experiencing for patients with low back pain and comorbid posttraumatic stress symptoms: A randomised controlled trial. European Journal of Psychotraumatology, 11(1), Article 1797306. https://doi.org/10.1080/20008198.2020.1797306
38. Kuhfuß, M., Maldei, T., Hetmanek, A., & Baumann, N. (2021). Somatic experiencing: Effectiveness and key factors of a body-oriented trauma therapy: A scoping literature review. European Journal of Psychotraumatology, 12(1), Article 1929023. https://doi.org/10.1080/20008198.2021.1929023
39. Lehmivaara, J., Jansson, B., Bernhardsson, J., Cloitre, M., & Pfaltz, M. C. (2026). From Somatic Experiencing to felt safety: Assessing the effects of a body-oriented intervention in adults with various degrees of child maltreatment. European Journal of Psychotraumatology, 17(1), Article 2613544. https://doi.org/10.1080/20008066.2026.2613544
40. Harwood-Gross, A., Elias, S., Lerner, K., Nacasch, N., Lawi, C., Brom, D., & Barak, A. (2025). Veterans’ experiences of somatic experiencing and prolonged exposure therapies for post-traumatic stress disorder: A qualitative analysis. Psychology and Psychotherapy: Theory, Research and Practice, 98(1), 175–192. https://doi.org/10.1111/papt.12570
41. Rosendahl, S., Sattel, H., & Lahmann, C. (2021). Effectiveness of body psychotherapy: A systematic review and meta-analysis. Frontiers in Psychiatry, 12, Article 709798. https://doi.org/10.3389/fpsyt.2021.709798
42. van der Kolk, B. A., Stone, L., West, J., Rhodes, A., Emerson, D., Suvak, M., & Spinazzola, J. (2014). Yoga as an adjunctive treatment for posttraumatic stress disorder: A randomized controlled trial. The Journal of Clinical Psychiatry, 75(6), e559–e565. https://doi.org/10.4088/JCP.13m08561
43. Cramer, H., Anheyer, D., Saha, F. J., & Dobos, G. (2018). Yoga for posttraumatic stress disorder: A systematic review and meta-analysis. BMC Psychiatry, 18, Article 72. https://doi.org/10.1186/s12888-018-1650-x
44. Cuijpers, P., van Veen, S. C., Sijbrandij, M., Yoder, W., & Cristea, I. A. (2020). Eye movement desensitization and reprocessing for mental health problems: A systematic review and meta-analysis. Cognitive Behaviour Therapy, 49(3), 165–180. https://doi.org/10.1080/16506073.2019.1703801
45. Lee, C. W., & Cuijpers, P. (2013). A meta-analysis of the contribution of eye movements in processing emotional memories. Journal of Behavior Therapy and Experimental Psychiatry, 44(2), 231–239. https://doi.org/10.1016/j.jbtep.2012.11.001
46. van den Hout, M. A., & Engelhard, I. M. (2012). How does EMDR work? Journal of Experimental Psychopathology, 3(5), 724–738. https://doi.org/10.5127/jep.028212
47. de Voogd, L. D., Kanen, J. W., Neville, D. A., Roelofs, K., Fernández, G., & Hermans, E. J. (2018). Eye-movement intervention enhances extinction via amygdala deactivation. The Journal of Neuroscience, 38(40), 8694–8706. https://doi.org/10.1523/JNEUROSCI.0703-18.2018
48. Corrigan, F., & Grand, D. (2013). Brainspotting: Recruiting the midbrain for accessing and healing sensorimotor memories of traumatic activation. Medical Hypotheses, 80(6), 759–766. https://doi.org/10.1016/j.mehy.2013.03.005
49. Hildebrand, A., Grand, D., & Stemmler, M. (2017). Brainspotting: The efficacy of a new therapy approach for the treatment of posttraumatic stress disorder in comparison to eye movement desensitization and reprocessing. Mediterranean Journal of Clinical Psychology, 5(1). https://doi.org/10.6092/2282-1619/2017.5.1376
50. D’Antoni, F., Matiz, A., Fabbro, F., & Crescentini, C. (2022). Psychotherapeutic techniques for distressing memories: A comparative study between EMDR, Brainspotting, and body scan meditation. International Journal of Environmental Research and Public Health, 19(3), Article 1142. https://doi.org/10.3390/ijerph19031142
51. Vazquez, S. R. (2012). Emotional transformation therapy: An interactive ecological psychotherapy. Jason Aronson. https://doi.org/10.5040/9798216510253
52. Cottingham, J. T., Porges, S. W., & Lyon, T. (1988). Effects of soft tissue mobilization (Rolfing pelvic lift) on parasympathetic tone in two age groups. Physical Therapy, 68(3), 352–356. https://doi.org/10.1093/ptj/68.3.352
53. Pompoli, A., Furukawa, T. A., Efthimiou, O., Imai, H., Tajika, A., & Salanti, G. (2018). Dismantling cognitive-behaviour therapy for panic disorder: A systematic review and component network meta-analysis. Psychological Medicine, 48(12), 1945–1953. https://doi.org/10.1017/S0033291717003919
54. Storebø, O. J., Stoffers-Winterling, J. M., Völlm, B. A., Kongerslev, M. T., Mattivi, J. T., Jørgensen, M. S., Faltinsen, E., Todorovac, A., Sales, C. P., Callesen, H. E., Lieb, K., & Simonsen, E. (2020). Psychological therapies for people with borderline personality disorder. Cochrane Database of Systematic Reviews, 2020(5), Article CD012955. https://doi.org/10.1002/14651858.CD012955.pub2
55. Linehan, M. M. (2025). DBT skills training manual (Rev. ed.). Guilford Press.
56. Rubinstein, D., Korem, N., Bullard, D. G., & Harpaz-Rotem, I. (2026). The exposure continuum model: A theoretical framework for understanding exposure across trauma-centered psychotherapies. Journal of Anxiety Disorders, 117, Article 103107. https://doi.org/10.1016/j.janxdis.2025.103107
57. Price, C. J., & Hooven, C. (2018). Interoceptive awareness skills for emotion regulation: Theory and approach of mindful awareness in body-oriented therapy (MABT). Frontiers in Psychology, 9, Article 798. https://doi.org/10.3389/fpsyg.2018.00798