From TikTok to private therapy clinics, somatic therapy is being discussed as the missing piece of mental health treatment. The science is more nuanced than the hype suggests, but also more compelling than the sceptics admit.
A body of evidence
In 2014, psychiatrist Bessel van der Kolk published The Body Keeps the Score: a dense, clinical account of trauma, memory, and the nervous system that sat, improbably, at the top of the New York Times bestseller list for over four years. The book’s central argument (that traumatic experience is stored not only in memory and narrative but in the body itself, and that effective trauma treatment must therefore engage the body as well as the mind) was not new to clinical circles. To general readers, it was revelatory.
In its wake came a cultural appetite for body-based therapeutic approaches that has not abated. Somatic therapy (a broad category of therapeutic modalities that attend to physical sensation, movement, and nervous system states as primary sites of psychological intervention) has moved from the fringe to the mainstream of mental health conversation with remarkable speed. Understanding what it actually is, and what the evidence actually says, requires working through several layers of hype.
What somatic therapy is, and is not
‘Somatic’ derives from the Greek soma, meaning body. Somatic therapies share a foundational premise: that psychological distress is not confined to the brain and mind but is expressed and maintained through patterns of physical tension, autonomic nervous system dysregulation, and embodied memory. This premise, once dismissed by mainstream psychiatry, is now substantially supported by neuroscientific research.
The category encompasses a range of distinct approaches, which should not be conflated. Somatic Experiencing (SE), developed by Peter Levine, focuses on tracking and discharging physiological stress responses, drawing on ethological observations of how animals in the wild complete threat responses and return to baseline. EMDR (Eye Movement Desensitisation and Reprocessing), developed by Francine Shapiro, uses bilateral sensory stimulation to process traumatic memories and is now one of the best-evidenced treatments for PTSD in the world. Sensorimotor Psychotherapy integrates movement and physical awareness with traditional talk therapy. Trauma-Sensitive Yoga, developed at the Trauma Centre in Massachusetts, uses adapted yoga practice within a therapeutic framework.
These are not equivalent approaches, and they do not share equivalent evidence bases. Grouping them all under the banner of ‘somatic therapy’, as social media and many wellness providers do, elides important distinctions.
‘The body is not a passive observer of psychological distress. It is an active participant, and in many cases, the place where the most important therapeutic work happens.’
What the neuroscience supports
The theoretical framework underpinning somatic approaches has been substantially advanced by research on the autonomic nervous system and its role in threat response and recovery. Stephen Porges’ Polyvagal Theory, first published in 1994, proposed that the vagus nerve, the primary nerve of the parasympathetic nervous system, operates in a hierarchical fashion, with social engagement at the apex, fight-or-flight beneath, and freeze/shutdown at the base. The theory suggests that trauma disrupts this hierarchy, leaving individuals chronically in states of either hyperarousal or dorsal shutdown.
While Polyvagal Theory remains debated at the level of specific neurological claims, its clinical utility has been widely endorsed by practitioners working with trauma, and its core insights about the relationship between autonomic nervous system states and psychological experience are broadly consistent with the neuroscientific literature on fear, safety, and social connection.
Research on interoception, the body’s ability to sense its own internal states, has also provided a neurobiological basis for somatic therapeutic approaches. Studies by Lisa Feldman Barrett, Sarah Garfinkel, and others have demonstrated that interoceptive awareness is closely linked to emotional regulation and psychological wellbeing. Practices that develop interoception (body scanning, breath awareness, mindful movement) may therefore support emotional regulation through a genuinely neurological mechanism, not merely through distraction or relaxation.
What the clinical evidence says
The evidence base for somatic approaches varies significantly by modality. EMDR has the strongest evidence among somatic-adjacent therapies, with multiple randomised controlled trials demonstrating efficacy for PTSD comparable to, and in some studies exceeding, trauma-focused CBT. It is recommended in NICE guidelines for PTSD and is available, to a limited degree, within NHS services.
Somatic Experiencing has a smaller but growing evidence base. A 2017 pilot RCT published in Psychological Trauma found significant reductions in PTSD symptoms in refugees treated with SE compared to a waiting list control. A 2022 systematic review in Frontiers in Neuroscience concluded that body-based interventions showed ‘significant promise’ for trauma, but that methodological limitations (small samples, lack of active control conditions, heterogeneous populations) precluded definitive conclusions.
Trauma-Sensitive Yoga has several RCTs supporting its efficacy as an adjunct treatment for complex PTSD, including a frequently cited trial by van der Kolk and colleagues at the Trauma Centre. Sensorimotor Psychotherapy has the weakest formal evidence base of the major approaches, relying largely on clinical case literature and practitioner experience.
The accessibility and quality problem
The mainstreaming of somatic therapy has produced both opportunity and risk. On the positive side, wider cultural awareness has reduced stigma around body-based therapeutic work, encouraged people to seek help, and created demand for training that is gradually improving clinical availability.
The risks are equally real. Somatic therapy conducted without adequate training and clinical oversight (by practitioners whose credentials are unverifiable, or who operate outside any regulatory framework) carries genuine potential for harm. Body-based work can evoke intense physiological and emotional responses. Without appropriate containment, pacing, and clinical skill, this can be destabilising rather than healing.
The UK’s regulation of therapy and counselling is, by international standards, weak. The British Association for Counselling and Psychotherapy (BACP) and the UK Council for Psychotherapy (UKCP) provide accreditation frameworks, but membership is voluntary. Nothing prevents an individual from calling themselves a somatic therapist after a weekend workshop. Consumers seeking somatic therapy are therefore well-advised to check practitioner credentials carefully, prioritise those accredited by BACP or UKCP, and treat social media recommendations with appropriate caution.
The integration question
The most significant development in somatic therapy’s clinical trajectory is its gradual integration into mainstream psychological treatment rather than its persistence as an alternative to it. A growing number of trauma-informed CBT practitioners incorporate body awareness elements into standard cognitive work. EMDR is now delivered within NHS settings, albeit with long waiting times. Trauma-sensitive approaches are being incorporated into school mental health programmes, refugee support services, and NHS primary care.
The body is not a passive observer of psychological distress. It is an active participant, and in many cases, the place where the most important therapeutic work happens. This insight, long known to experienced trauma clinicians, is now entering the scientific mainstream in a form rigorous enough to withstand scrutiny. The challenge for the field is to maintain that rigour as the modality expands, and to ensure that the people who would benefit most from body-based treatment can access it through the NHS, not only through private practitioners at rates most cannot afford.
The science is not as settled as the wellness industry implies. It is also not as thin as the sceptics suggest. For the millions of people for whom talk therapy alone has not been enough, somatic approaches, practised by qualified clinicians, offer a genuinely promising, neurologically grounded complement to the tools mainstream mental health care has long relied upon.