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Table 1 Overview of the SE Intervention

From: Somatic experiencing® for patients with low back pain and comorbid posttraumatic stress disorder – protocol of a randomized controlled trial

Steps Theme Therapeutic approach
1 Create a safe environment To facilitate a therapeutic environment that promotes a feeling of security. Build a therapeutic relationship with the patient. The therapist assumes an accepting stance.
2 Support initial exploration of sensations To support a mindful approach to the exploration of bodily sensations. Facilitate the experience of positive sensations.
3 Pendulation By the process of “pendulation” to encourage the patient to come in contact with bodily sensations. To help the client experience how the body alternates between pleasant and unpleasant sensations. By facilitating this awareness, the patient learns how to relax.
4 Restore active defensive responses To help the patient to restore active defensive responses that has “collapsed” because of the overwhelming nature of the trauma. Support impulses to active responses, including defensive orienting, fight and flight.
5 Titration Because the central nervous system cannot distinguish between the original trauma and being overwhelmed by the re-experience of the traumatic event in therapy, the aim is to help the patient to gradually move in and out of the trauma. This by ensuring a continuous grounding in the body with attention to the bodily responses while moving into and out of the content of the traumatic event.
6 Uncoupling fear from immobility Traumatic events activate a flight-fight response. When the traumatic event remains unresolved, the body collapse and becomes “frozen”. The aim is to help the patient to experience this response of immobility in a safe environment and enable immobility to dissolve.
7 Encouraging the discharge of energy To help the patient to discharge accumulated energy during the traumatic event. Help the client to experience and resolve hyper-arousal states in a safe environment.
8 Restore equilibrium through self-regulation Through cyclical discharges of energy to help the patient to “reset” the nervous system and feel more empowered to regulate themselves. Allowing time for integration and reverberation.
9 Restoration to the here-and-now Gently invite the patient to return to the outer world after being attentive to inner sensations and experiences.
  1. Note. The nine steps are building blocks and not linear steps. The nine steps are intertwined and may be accessed repeatedly. Adapted from (Levine [21], chapter 5)