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  • Kara Tolman, LCSW

CBT vs Somatic Therapy: When to Use Each Approach

Cognitive Behavioral Therapy, more commonly known as CBT, is an evidence-based (meaning it has been studied and tested), time sensitive (meaning it only lasts so long), structured, present-oriented type of therapy.

CBT is based on the theory that the way you perceive a situation is more closely connected to your thoughts and feelings about the situation than the facts of the situation itself. For example, when we feel distressed, our thoughts and perceptions are often distorted by that distress leading us to be more susceptible to have thoughts that only contribute to us feeling worse.

Think about a time when you have had a really bad day, and you get pulled over for speeding; that speeding ticket is going to be more upsetting than on a day where everything has gone really well, and you are in a great mood. The facts of the situation are the same, but your thoughts and feelings about the situation have been influenced by whatever else you were thinking and feeling in the moment and how you think and feel about getting speeding tickets, in general.

CBT works by helping you identify the facts of a situation and by separating your thoughts and feelings out, so you can start to evaluate how realistic the thoughts you are having truly are. CBT emphasizes using behavior change and thought strategies to better solve problems.

Because of this, CBT is considered a “top down” approach and relies heavily on cognitive processing such as learning, thinking, reasoning, problem solving and so much more. While CBT does acknowledge that you experience feelings and physical reactions in your body (for example, butterflies in response to anxiety), the focus is on changing your thoughts and behaviors.

Somatic therapy, which I have talked about before, is considered “bottom up”– reducing stress and anxiety physiologically, through changing the autonomic nervous system and discharging trauma.

Both CBT and Somatic therapy can be used to treat trauma, and we know that research shows that the result of psychological trauma can have long term cognitive effects and eventually alter our cognitive processes (memory, reasoning, problem solving). However, each approach has its own strengths and weaknesses.

For someone who has experienced preverbal trauma and/or non-verbal trauma, CBT may not be the most effective approach. Preverbal trauma and nonverbal trauma memories typically do not have associated words or a clear and coherent story. In contrast, they might come in the form of flashes of images, disconnected fragments, or uncomfortable physical sensations with no known cause.

For example, in Somatic Work, a practitioner may not ask you to talk much at all about the specific trauma you experienced, but instead will ask that you observe and “track” physical sensations in your body in the present moment and when you are recalling a specific trauma. I often use pendulation exercises in session which allows a person to move between a state of arousal triggered by a traumatic event and a state of calm. This helps the body to regain homeostasis—a state in which the body's systems are regulated and working in balance.

Similarly, I use CBT interventions to help my client understand their depression, anxiety, or trauma more clearly and to be able to connect it to their everyday thoughts, feelings, and behaviors. We might use a tool like a thought log or a behavior chain to help understand the patterns and identify coping skills to try in order to feel better in the moment and in the long-term.

As a clinician, I am able to use an integrated therapy approach to help clients achieve their goals in and out of sessions. Both researched approaches have powerful ways of helping clients with trauma while improving cognitive functioning. When fused together, it allows clients to gain perspective on how trauma not only affects their minds but their bodies as well.

To get scheduled with Kara, please email

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