An in-depth exploration of how somatic awareness, interoception, and relational neuroscience can support nervous system regulation, authenticity, and healing in clinical practice.
Allison Creech, M.Ed., ND
Abstract
This article examines mind-body medicine as a clinical framework that bridges physical symptoms with lived experience through somatic awareness, interoception, and compassionate presence. Using theory, case illustration, and relational neuroscience, it highlights how nervous system regulation and authentic connection can facilitate deep, lasting healing.
Introduction
As a clinical perspective, mind-body medicine provides a bridge between presenting symptomology and underlying experience. It helps to create a context that acknowledges what it means to be alive as a human on the planet at this moment in time, recognizing the impact of collective trauma as well as the power of collective engagement. A mind-body approach reminds us that healing ultimately comes from within, and how we show up as practitioners matter. In a world where disconnection is rampant, we as practitioners can be a connecting point, inviting patients back into a more authentic and embodied relationship with themselves.
As a long-time advocate for mind-body medicine, Dr. Gabor Mate, MD teaches that “people heal when met with compassion.”1 Naturopathic doctors can utilize this principle to create safe spaces where our patients are seen, understood, and held without judgment. With compassion, we can be open to seeing how and where old survival patterns may be contributing to current health issues; healing simply does not happen in a state of physiological survival. Compassion also invites practitioners to lean into relational neuroscience, resourcing social engagement and present-moment connection as neuromodulators.2 The relationship itself helps patients to release conditioned states of survival and lean into more fluid states of autonomic responsiveness. The moments we spend in authentic connection with patients are truly therapeutic.
The autonomic state of the practitioner also has a direct impact on care. When grounded in the ventral vagal and embodied in the present moment, practitioners can become a resource for co-regulation. As practitioners are present with attuned compassion, patients may subconsciously begin to shift to autonomic states of safety and connection. The relationship itself supports wellbeing and facilitates the patient to see themselves in a more compassionate way. With increased capacity in these states, subconscious patterns of sensation and emotion can move through conscious awareness and towards integration. It is important to note that we are simply observing and being with these movements, noticing subtle shifts in physiology. We are not trying to change or influence what is happening but are simply bringing a compassionate and present curiosity to observe and track somatic information as it arises. By expanding the capacity for conscious and compassionate witnessing of our experience, we support a physiological return to safety, restore flexibility within the nervous system, and allow for the expression of vitality. All treatment options improve when built on this foundation.
Interoception, Authenticity, and the Wisdom of the Body
Interoception, the capacity to consciously attend to somatic experience, is essential to a compassionate witnessing of self. Physiologically, this process is related to the insula, which “centralizes a wide range of information, from the most internal bodily states, such as interoception, to high-order processes, such as knowledge about oneself.”3 From a phenomenology perspective, interoception is the awareness of somatic experience as it arises in the moment, also described as the ‘felt-sense.’ Different from a cognitive knowing or a conceptual appraisal, the felt-sense provides a direct expression of our authentic experience. If we are to be authentic, we must be connected to our bodies and emotions and be in touch with our experience at the level of sensation. Practitioners can provide co-regulation and support for patients as they invite them to be more present with bodily sensations, improving interoception and teaching mindful witnessing of physiologic activity in real-time. Somatic awareness also includes interoceptive processing, which attends to how the nervous system anticipates, senses, and integrates signals originating from the body.4
Our body is constantly generating somatic information, but many people ignore or subconsciously dampen the afferent flow of information, thereby diminishing their felt-sense experience of the present moment. This process is what Dr. Gabor Mate, MD refers to when he describes trauma as a disconnection from self. In his words, “Trauma is not what happens to you. Trauma is what happens inside you as a result of what happened to you.”5 Dr. Peter Levine, PhD teaches the same principle, adding that trauma is “what we hold inside in the absence of an empathetic witness.”6 As we develop our own capacity for somatic awareness and interoceptive integration, we are better able to be an empathetic witness with our patients, supporting them in accessing the wisdom of their bodies. As expressed by Dr. Bessel Van der Kolk, MD “Mindfulness not only makes it possible to survey our internal landscape with compassion and curiosity but can also actively steer us in the right direction for self-care… In order to change, people need to become aware of their sensations and the way that their bodies interact with the world around them. Physical self-awareness is the first step in releasing the tyranny of the past.”7
Sasha’s story
Sasha is a woman in her early 40’s who presents with inflammatory symptoms that had become progressively worse over the last year. She studies Ayurveda and botanical medicine and implemented botanical strategies and dietary changes before our consultation. She had seen some improvement in her symptoms, however a recent experience with bilateral epicondylitis brought her to seek additional support. The pain was intense and interrupted both her ability to work (she has a computer-based job) as well as play (she is an avid pickleball player who plays in a competitive league). She had seen her MD before we met and had also changed her office set-up in an attempt to maintain her ability to work online. In our consultation, she mentioned an awareness that the pain had an emotional component.
With Sasha’s permission, we brought curiosity to her emotions and explored her feelings as they related to the pain she was experiencing. We allocated time in our appointments to focus on Sasha’s present moment experience, and as she developed her capacity for somatic awareness, she became more able to identify and describe what was happening within her. We focused on breathing with sensations as they arose, learning to observe what was happening, and inviting attention to her emotions and perceptions about herself. Over time, this allowed Sasha to have powerful moments of clarity. For example, Sasha became aware of a pattern of overextending herself. For the last few years, she had been in a high-profile management role in her workplace that came with interpersonal challenges and many hours of computer-based administration. She also described how her preoccupation with work protected her from having to address difficult emotions that were present in her long-term relationship. In her words, the demanding nature of her work made it easy to ignore the sadness and fear that she felt in relation to her partner’s health. As we visited these emotions and explored how they showed up as sensations in her body, she became more adept at noticing and describing them and was better able to relax into the emotional energy as it moved through her body. Rather than ignoring and resisting her experience, she began to open into it. She did this incrementally over a period of months, resourcing my nervous system to offer her co-regulation and support as she developed her own capacity for being with her experience. As Dr. Bessel van der Kolk, MD explains, “Neuroscience research shows that the only way we can change the way we feel is by becoming aware of our inner experience and learning to befriend what is going on inside ourselves.”8
As Sasha developed a more inclusive relationship with herself, she began to access the deeper wisdom of her body. When she tuned in to the pain in her elbows with curiosity and compassion, she heard the message “let go.” As she connected more deeply with her authentic experience, she came to an awareness that she had been “holding on to things that I need to let go of.” Over the next few months, Sasha got more clear within herself and ultimately decided to step out of the management role she had been holding, allowing her to focus on different aspects of her profession that she more genuinely enjoyed. She was also able to initiate conversations with her partner where she expressed her fears around their health, and together they agreed to no longer ignore certain issues but to turn towards them as a couple. She was more attuned to her experience and was able to give any sensations her attention as they arose. As she met herself in this way, she noticed that the pain in her elbows began to subside. With attention to self-care, she was able to return to work and described a “huge sense of relief” after letting go of the role she had been in, noting that new opportunities were opening up that were more in line with her current professional focus. She was also able to gradually resume playing pickleball, shifting to a recreational rather than competitive focus and again making her self-care a priority. She reported a decreased level of stress in her body and mind and felt more comfortable being with her emotions as they arose. She continued with anti-inflammatory therapeutic strategies, noting that she had more enthusiasm for giving her body the care it needs. In her own words, “the emotions that had been hidden and activated pain no longer have to hide. I can be with them.”
Reclaiming the wisdom of the body
When we work with the body, in the present tense and in the present moment, we access the innate wisdom that guides us back into authenticity and vitality. Dr. Gabor Mate, MD explains that “The natural impulse when pain arises is to try and get rid of it somehow. All of western medicine is built on the goal to get rid of pain. But getting rid of pain is not the same as healing. Healing is actually the capacity to hold pain.”9 When we are grounded, present, and embodied in our experience, we create a secure relational container that holds the patient in their experience. This is not just an intellectual exploration; the resolution comes through the actual felt-sense experience as the body metabolizes old emotional energies and releases survival-based patterns of somatic organization. Our ability to co-regulate is significant – we must stay attuned to the patient and be aware of when their nervous system starts to go into protection so that we can titrate between their somatic awareness and their connection with us. Over time, the patient will learn to titrate for themselves and it becomes reliably safe for them to feel their feelings and connect with their bodies. Healing happens as emotional energy that has been held in implicit memory arises and is experienced through the felt-sense, while also being held within a regulated nervous system. By holding a secure relational container, we can be that for our patients until they have the capacity to do it for themselves. As Dr. Stephen Porges, PhD shares, “An optimally resilient individual has opportunities to co-regulate physiological state with a safe and trusted other.”10
We are the medicine
While I utilize Compassionate Inquiry as a method, the general principles of somatic awareness are similar across approaches. Most important is the ability to tune in to what is happening in the body and to be curious as to where it is happening. As attuned clinicians, we learn to recognize the somatic experience that is happening below our patients’ words and gestures. Nonverbal cues show us there’s something going on at a deeper level; we can pause and draw it out to be safely witnessed and held. As Dr. Bessel Van der Kolk, MD writes, “In my practice I begin the process by helping my patients to first notice and then describe the feelings in their bodies—not emotions such as anger or anxiety or fear but the physical sensations beneath the emotions: pressure, heat, muscular tension, tingling, caving in, feeling hollow, and so on. I also work on identifying the sensations associated with relaxation or pleasure. I help them become aware of their breath, their gestures and movements.”11
With compassion, curiosity, and presence, we can support patients as they learn to trust their own process of inner healing. We can help them to see the adaptations that they assumed in order to survive, and how that limits their ability to live wholeheartedly in the present moment. We can use the relational container to co-regulate and support the autonomic nervous system into a new physiologic setpoint, disrupting old neurobiological patterns and re-establishing a connection with the authentic self. Rather than trying to make a part of our experience go away or bypass around it, we learn to get curious about it and be with it.
Recognition of the healing power within us is a unifying feature of mind-body medicine. When we attune to the body and bring acceptance to our experience, it will guide us back into connection with ourselves. As Thicht Nacht Hahn so powerfully offered, “Go back and take care of yourself. Your body needs you, your feelings need you, your perceptions need you. Your suffering needs you to acknowledge it. Go home and be there for all these things.”12 This is the essence of healing.
Allison Creech is a licensed naturopathic doctor and professor at the Canadian College of Naturopathic Medicine. She has an academic focus on mind-body medicine, trauma, and relational neuroscience. Her clinical work emphasizes authenticity and embodiment, facilitating a healing-centered process that restores a deep sense of connection and well being. Allison has a Masters degree and PhD training in clinical psychology and advanced training in both somatic and psychedelic-assisted therapy. She has been a part of Compassionate Inquiry since 2019, and is honoured to support others as a CI Practitioner, Facilitator, and Mentor.
References
- Compassionate Inquiry [Web page]. https://compassionateinquiry.com. Accessed October 2, 2024.
- Porges SW. Polyvagal Theory: A Science of Safety. Front Integr Neurosci. 2022 May 10;16:871227. doi: 10.3389/fnint.2022.871227. PMID: 35645742; PMCID: PMC9131189.
- Tisserand A, Philippi N, Botzung A, Blanc F. Me, Myself and My Insula: An Oasis in the Forefront of Self-Consciousness. Biology. 2023; 12(4):599. https://doi.org/10.3390/biology12040599
- Chen WG, Schloesser D, Arensdorf AM, Simmons JM, Cui C, Valentino R, Gnadt JW, Nielsen L, Hillaire-Clarke CS, Spruance V, Horowitz TS, Vallejo YF, Langevin HM. The Emerging Science of Interoception: Sensing, Integrating, Interpreting, and Regulating Signals within the Self. Trends Neurosci. 2021 Jan;44(1):3-16. doi: 10.1016/j.tins.2020.10.007. PMID: 33378655; PMCID: PMC7780231.
- Mate, Gabor. Trauma Is Not What Happens to You, It Is What Happens Inside You, July 22, 2021 [Web page]. https://www.youtube.com/watch?v=nmJOuTAk09g. Accessed October 2, 2024.
- Levine, Peter A. About Peter. [Web page] Ergos Institute. https://www.somaticexperiencing.com/about-peter. Accessed October 2, 2024.
- Van der Kolk, Bessel A. The Body Keeps the Score: Brain, Mind, and Body in the Healing of Trauma. New York, New York, Penguin Books, 2015.
- Van der Kolk, Bessel A. The Body Keeps the Score: Brain, Mind, and Body in the Healing of Trauma. New York, New York, Penguin Books, 2015.
- Maté, G., & Maté, D. The myth of normal: trauma, illness & healing in a toxic culture. New York, Penguin Publishing Group; 2022.
- Porges SW. Polyvagal Theory: A Science of Safety. Front Integr Neurosci. 2022 May 10;16:871227. doi: 10.3389/fnint.2022.871227. PMID: 35645742; PMCID: PMC9131189.
- Van der Kolk, Bessel A. The Body Keeps the Score: Brain, Mind, and Body in the Healing of Trauma. New York, New York, Penguin Books, 2015.
- Thich Nhat Hanh, post from Dec 01, 2016 [Web page] Facebook. https://www.facebook.com/thichnhathanh/posts/10154349910279635. Accessed October 2, 2024.
