November 25 was the international day against violence against women.

In Italy 11.3 percent of women between 16 and 70 years of age reported cases of physical or sexual violence occurred in the five years preceding 2014.

The latest Istat data say that in our country about 7 million women have undergone some form of violence, physical or psychological, in their lives. Relevant data followed by the inevitable psychological consequences.

The Stories of physical violence and abusein fact, they are just some of the scenarios that can evolve into a post-traumatic stress disorder (PTSD).

The PTSD, in the new psychiatric nosography, is no longer a category of anxiety disorders, but constitutes a distinct entity within “disorders related to traumatic or stressful events”.

Once a traumatic event occurs in an individual’s life, a watershed is created: there is a before and there is an after. Nothing remains more the same and the brain reorganizes to adapt to the new situation.

A peculiar feature in patients with PTSD is a marked alteration of arousal and reactivity associated with thetraumatic event same.

Typically, these patients have difficulty regulating and modulating their emotional states and the somatic responses of hyper and/or hypothesis, showing irritable behaviors and explosions of anger, hypervigilance, concentration problems, exaggerated alarm responses, as well as a tendency to impulsive and self -elevative behaviors.

The failure in manifesting appropriate emotional responses is the consequence of the fact that all that the patient perceives tends to be decoded in the light oftraumatic experience lived, leading him to react as if the event was recurring in the present moment.

The space-time orientation in the present is lost: the person remains ‘frozen’ at the time of trauma and lacks the ability to recognize when his emotional responses are appropriate to current circumstances and when instead they represent a dysfunctional reactivation of theirs traumatic event needed in the past.

The integration into the CBT of body -oriented therapies

In a randomized and controlled clinical trial on the effectiveness of cognitive-behavioral therapy for PTSD in a sample of women (Schnurr et al., 2007), 59% of patients still had PSD symptoms after 12 weeks of treatment and 78% of women remained symptomatic at 6 months of follow-up.

A possible explanation of this result was provided by Bessel Van Der Kolk, professor of Psychiatry at the Boston University Medical School and founder of the Trauma Center in Brookline (Massachusetts).

In his clinical experience with hundreds of victims of abuses the Standard cognitive therapy It was not resolved because, as Van der Kolk says, what triggers the discomfort is the somatic component in the present, that is to say the body sensations associated with the memory.

We think about how much events such as a physical and/or sexual abuse can leave a mark, a trace in the body and is therefore The body that accuses the blow (Van der Kolk, 2015).

In recent years, forms of psychotherapy have been developed precisely on the sensorial aspects of the psychic distress, on the mind-body integration and on the ability to observe the bodily experience even unpleasant, without judging it negatively, in order to intervene on the bottom-up mechanisms, or starting right from Somatic components of trauma.

Body -oriented therapies affixed to MindFulness, EMDR approach and sensomotor psychotherapy use precisely body experience as a privileged access point for thetrauma processing.

According to these approaches, the emotional discomfort, which we have seen being a typical characteristic of traumatized patients, could be precisely the evolutionary consequence of activation, even in non -dangerous situations, of the sensomotor experience lived at the time of trauma.

In these cases, cortical structures have no influence on subcortical ones such as amygdala and the body does not allow top-down regulation.

For example, the adult who suffered one sexual violence In childhood, it can immobilize instead of refusing an unwelcome sexual surplus. It is therefore necessary to act on the body to intervene on the somatic component at the basis of emotional discomfort.

The practice of yoga as an additional treatment for the PTSD

It is precisely starting from these premises that Van der Kolk and coll. (2014) published the results of a controlled and randomized trial aimed at evaluating the effectiveness of the Yoga as a treatment for PTSD.

A sample of 64 women with chronic PTSD, refractory to treatment (the participants had in fact undergone at least 3 years of therapy aimed at the treatment of PTSD disorder), was randomly assigned to two groups (Yoga group VS. Health education group), each of which included a meeting per week for 10 weeks.

The hypotheses of the researchers were that traumatized women, assigned to the yoga condition, would have shown a significant clinical improvement in terms of reducing PTSD symptoms to post-treatment, as well as an increase in emotional regulation capabilities.

The results of the study found that 52% of patients in the Yoga group, compared to 21% of those in the control group, no longer satisfied the criteria of the DSM for the PTSD.

Both groups of patients showed significant changes in the post-traumatic symptoms During the first half of the treatment, but these improvements were maintained only in the yoga group.

The conclusion of the authors is that the practice of yoga, focusing on breath and physical exercises that combine movement, muscle relaxation and meditation, can increase the ability to accept and tolerate the physical and sensory experiences associated with emotions, improving their regulation.

The purpose of treatment of traumatic memories It is reconstituted the entirety of the events lived, associating the different fragmented components (emotional, sensory, motor, kinesthetic, cognitive) and allowing its integration into the patient’s autobiographical narrative.

Since traumatic memories cause emotions overwhelming the individual’s ability to face it, this integration work must be preceded by that on the regulation of emotions.

The mind-body interventions, such as Mindfulness and Yoga, encourage a position as an observer in the patient, aimed at maintaining attention on what happens in the present moment, without judgment, with opening, acceptance and curiosity. These practices that stimulate awareness increase the acceptance and tolerance of emotions, effectively improving emotional regulation.

In addition, the orientation towards the experience of the here and now stimulates presentation (Janet, 1928), that is to say the mental action of being firmly rooted in the present, integrating one’s past, present and future.

Clinical work with this type of patient cannot therefore ignore taking into consideration the body sizeespecially as regards connections with the effects of trauma.

As Van der Kolk wrote even if the mind does not remember abuse, the body has memory of it. And we cannot forget about this memory.

Bibliography

Janet P. (1928). The Évolution de la Mémoire et de la notion du temps. A. Chahine, Paris. Liotti G., Farina B. (2011).
Traumatic developments. Raffaello Cortina Editore, Milan.
Onofri A., La Rosa C. (2015). Mourning. Evolutionist cognitive psychotherapy and EMDR. Giovanni Fioriti publisher.
Van der Kolk Ba et al. (2014). Yoga as an Adjunctive Treatment for Postraumatic Stress Disorder: A Randomized Controlled Trial. Journal of Clinical Psychiatry; 75 (6): E559-65.
Van der Kolk Ba (2015). The body accuses the blow. Mind, body and brain in the elaboration of traumatic memories. Raffaello Cortina Editore, Milan.