Published: June 2026 | Last updated: June 2026
Somatic therapy treats addiction and trauma by working with the body’s stored physiological responses — not just the mind’s narrative about them. Instead of only talking through what happened, body-based approaches like Somatic Experiencing, EMDR, and Mindful Awareness in Body-oriented Therapy (MABT) help regulate the nervous system dysregulation that drives cravings, emotional flooding, and relapse. The clinical evidence is building. And for people whose trauma runs deep, this approach often reaches places talk therapy can’t.
What is somatic therapy, and how does it differ from traditional talk therapy?
Somatic therapy is a category of body-based therapeutic approaches that treat psychological distress — including trauma and addiction — by working directly with physical sensation, movement, breath, and nervous system states. The word “somatic” simply means “of the body.”
Traditional talk therapy — CBT, psychodynamic therapy, motivational interviewing — engages the brain’s cortical, language-based systems. It works through meaning-making, narrative restructuring, and conscious insight. Those approaches are valuable and, in the right context, effective.
Somatic therapy starts somewhere else. Rather than leading with the story of what happened, it works with how the body is responding right now: the tightness in the chest, the hypervigilance that reads every room as a threat, the freeze response that shuts someone down when emotions get intense. The idea, grounded in neuroscience, is that trauma and chronic stress aren’t just memories — they’re physiological states that get embedded in the autonomic nervous system and shape behavior from below the level of conscious thought.
For people in addiction recovery, this matters because craving is fundamentally a somatic event. The body initiates it before the mind catches up.
Why does the body “keep score” in addiction and trauma?
The phrase “the body keeps the score” comes from psychiatrist Bessel van der Kolk’s landmark book of the same name, published in 2014. It describes something clinicians have long observed: that trauma doesn’t live only in the mind as a bad memory. It lives in the body as a pattern of activation — a chronically dysregulated nervous system that behaves as if the original threat is still present.
The neurobiology of stored trauma and addiction
When someone encounters an overwhelming experience, the brain’s threat detection system (centered in the amygdala) floods the body with stress hormones and activates a survival response: fight, flight, or freeze. In animals, this response typically completes — a deer that outrunns a predator will literally shake and tremble to discharge the physiological activation before returning to grazing.
Humans often don’t do this. Dr. Peter Levine, who developed Somatic Experiencing, observed that our higher cognitive functions frequently override the body’s natural discharge process. The result is that survival energy stays trapped in the nervous system — expressing as hypervigilance, chronic tension, emotional dysregulation, sleep disruption, and dissociation.
Substance use enters this picture cleanly: alcohol and drugs are extremely effective, in the short term, at suppressing the physiological discomfort of unprocessed trauma. They quiet the hyperarousal. They blunt the intrusive memories. They interrupt the freeze. The nervous system learns quickly that substances work — and that’s a large part of what makes addiction so difficult to untangle from trauma.
According to research published by Relias, 70% of adults in the U.S. have experienced at least one traumatic event in their lives. Trauma is recognized as a risk factor in nearly all substance use disorders. And among people already in treatment for addiction, estimates of co-occurring PTSD range from 25% to 49%, depending on the population and study methodology.
That isn’t incidental. For a significant portion of people seeking recovery, untreated trauma is the engine underneath the substance use. If treatment doesn’t address it, the cycle continues.
What are the main types of somatic therapy used in addiction treatment?
There’s no single protocol. Somatic therapy is more of an orientation than a single technique — a way of understanding and approaching healing that centers the body’s experience. Several distinct modalities fall under this umbrella.
Somatic Experiencing (SE)
Developed by Dr. Peter Levine over more than 50 years, Somatic Experiencing is probably the most widely known body-based trauma therapy. It uses two core techniques: titration (approaching trauma material in small, manageable doses rather than full immersion) and pendulation (gently guiding attention between states of activation and states of relative calm, to build nervous system flexibility).
SE doesn’t ask clients to retell their trauma story at length. In fact, extended narrative re-exposure without adequate nervous system support can be re-traumatizing. Instead, it tracks physical sensation — what the client notices in their body as they approach the edge of trauma material — and works to complete the biological responses that got frozen in place. Levine’s approach has been taught to over 30,000 therapists in 42 countries.
EMDR (Eye Movement Desensitization and Reprocessing)
EMDR, developed by Francine Shapiro in the late 1980s, involves processing traumatic memories while engaging in bilateral stimulation — typically tracking side-to-side eye movements. It’s now recommended for PTSD by multiple government and medical bodies, including the VA and WHO. In addiction treatment contexts, it’s used to reduce the emotional charge of trauma memories that function as relapse triggers.
Mindful Awareness in Body-oriented Therapy (MABT)
MABT, developed by researcher Cynthia Price at the University of Washington, teaches interoceptive awareness — the ability to notice and interpret internal bodily signals — as a skill for self-regulation and emotion management. It combines mindfulness instruction, psychoeducation, and gentle touch-based guidance to develop body awareness.
The research on MABT in substance use disorder treatment is worth knowing. A randomized controlled trial published in Drug and Alcohol Dependence (Price et al., 2019) followed 187 women in intensive outpatient SUD treatment over 12 months. Participants who received MABT alongside standard treatment showed significant reductions in substance use at both 6- and 12-month follow-up compared to treatment-as-usual alone. Additional findings included reduced craving, improved emotion regulation, and decreased psychological distress. That’s not anecdote. That’s a year-long RCT.
Sensorimotor Psychotherapy
Sensorimotor Psychotherapy, developed by Pat Ogden, integrates body-centered techniques with psychotherapeutic theory. It pays close attention to posture, movement impulses, and gesture as windows into emotional and trauma states — working with what the body “wants to do” as a way to complete interrupted survival responses.
Trauma-Sensitive Yoga
Trauma-sensitive yoga adapts traditional yoga practices specifically for people who have experienced trauma. It emphasizes choice, agency, and noticing rather than performance. Multiple studies have examined its effects on PTSD symptoms; van der Kolk’s own research found significant reductions in PTSD scores compared to a dialectical behavioral therapy control group. In recovery settings, it’s often used as an adjunct to individual therapy rather than a primary treatment.
What does the evidence say about somatic therapy for addiction recovery?
I’ll be direct: the body of evidence is growing but still younger than the evidence base for CBT. Anyone claiming somatic therapy is comprehensively proven to the same standard as first-line treatments is overstating. Anyone dismissing it as unscientific is also wrong.
What we have is a credible and accumulating evidence base, particularly for trauma-informed approaches applied alongside standard SUD treatment.
The MABT RCT referenced above is one of the more rigorous studies in this space. The University of Houston research published in the Harm Reduction Journal (2024) established what clinicians already knew practically: nearly all participants with OUD (96.4%) reported financial and emotional barriers tied to unaddressed trauma that led to disrupted or delayed treatment. Treating the trauma matters for treatment engagement, not just downstream outcomes.
In the MABT pilot study published by NCBI, participants who received body-based mindfulness training described a common theme: they hadn’t been able to access emotional awareness or connect emotions to bodily experience through prior therapeutic approaches. That’s not a failure of those clients. It’s a signal that some people need a different entry point into healing.
A systematic review in the Journal of Traumatic Stress found robust evidence that somatic therapy effectively reduces PTSD symptoms, including meaningful reductions in flashbacks and hyperarousal that persisted at one-year follow-up. Given the 25–49% co-occurrence rate of PTSD and SUD, this matters directly for addiction treatment outcomes.
What the evidence doesn’t yet fully resolve: ideal dosing, which subpopulations benefit most, how somatic approaches compare head-to-head with established treatments at scale. In my observation, the most effective programs treat this as an integration question rather than an either/or — somatic methods alongside CBT and medication-assisted treatment, not instead of them.
How does somatic therapy specifically help with cravings and relapse prevention?
This is the practical question. Understanding the theory is useful. Understanding what it does in the moment a craving hits is more useful.
Interoception and craving recognition. Many people in early recovery have a dulled or dysregulated ability to read their own body’s signals — in part because chronic substance use disrupts interoceptive processing. MABT research has shown that training interoceptive awareness improves the ability to notice emotional states before they escalate into crisis or craving. Catching the body’s early warning signals — the stomach tightening, the throat constricting, the particular quality of restlessness — gives someone a window to respond rather than react.
Nervous system regulation. Cravings spike when the nervous system is activated. Somatic practices — whether breathing techniques, grounding exercises, or movement — provide tools to down-regulate the stress response in real time. Techniques like diaphragmatic breathing directly influence the vagus nerve and parasympathetic nervous system, shifting the body from threat response toward rest and safety.
Processing triggers without re-traumatizing. Environmental cues — a smell, a sound, a neighborhood, a person’s face — can activate trauma responses that immediately drive craving. Standard relapse prevention focuses on cognitive strategies for these moments. Somatic approaches work with the physiological activation directly, using pendulation and titration to help the nervous system process these triggers without becoming overwhelmed by them.
In my experience, the clients who describe somatic work as transformative are often the ones who had been through multiple rounds of talk-based treatment without sustained success. Not because CBT failed them — but because the trauma driving their use hadn’t been addressed at the level where it was actually operating.
What should someone look for in a somatic therapist for addiction recovery?
This is where I’ll add an honest caution: the word “somatic” has gotten popular enough that it gets applied loosely. Not every provider describing themselves as a somatic therapist has the same training, and the quality of care varies significantly.
When evaluating a provider, look for:
- Specific credential in an established modality. SE practitioners are trained and certified through Somatic Experiencing International. EMDR practitioners should be certified through EMDRIA. These aren’t optional details.
- Dual competency in trauma and addiction. Someone skilled in trauma therapy but unfamiliar with addiction dynamics — or vice versa — may miss important clinical considerations. Ask directly about their experience treating co-occurring SUD and trauma.
- A clear integration model. Somatic therapy is rarely most effective in isolation. A thoughtful provider will explain how their approach integrates with your overall treatment plan, including medication if applicable.
- Pace and safety. One marker of a skilled somatic therapist is that they don’t push you into activating trauma material faster than your nervous system can tolerate. Titration — that gradual approach — is intentional clinical technique, not timidity.
Frequently asked questions
Is somatic therapy the same as the book “The Body Keeps the Score”?
Not exactly. The Body Keeps the Score is Bessel van der Kolk’s 2014 book about trauma’s impact on the brain and body — it draws on somatic approaches as part of a broader argument for body-inclusive trauma treatment. Somatic therapy refers to actual therapeutic modalities like Somatic Experiencing, EMDR, and MABT. Van der Kolk’s work is frequently cited in support of somatic approaches, but the book itself isn’t a therapy protocol.
Can somatic therapy replace medication-assisted treatment for opioid use disorder?
No. Medication-assisted treatment (MAT) — buprenorphine, methadone, naltrexone — is the evidence-based standard of care for opioid use disorder and significantly reduces overdose mortality. Somatic therapy is best understood as a complement to MAT and other evidence-based treatments, particularly for individuals with co-occurring trauma. It addresses underlying physiological patterns that medication alone doesn’t target.
How do I find a qualified somatic therapist who works with addiction?
Start with credentialing bodies: the Somatic Experiencing International directory for SE practitioners, and EMDRIAfor EMDR therapists. When contacting potential providers, ask specifically about their experience treating co-occurring substance use and trauma. SAMHSA’s treatment locator can also help identify integrated behavioral health programs in your area.
How long does somatic therapy take to work for addiction recovery?
This varies considerably by individual, trauma history, and the specific approach used. Randomized controlled trial data on MABT showed significant improvements in substance use outcomes at 6 and 12 months. Somatic Experiencing research has demonstrated effects that remain stable up to one year post-treatment. Most practitioners caution against expecting rapid resolution — particularly with complex or developmental trauma — and frame this as one part of a longer recovery process.
Is somatic therapy covered by insurance?
It depends on the modality and the provider’s licensure. EMDR, when delivered by a licensed therapist, is increasingly covered by major insurers. Somatic Experiencing and other body-based therapies may be billed under psychotherapy codes depending on the provider’s credentials and the payer. Ask providers specifically how they bill and whether they verify benefits before committing to a treatment plan.
How All The Way Well Supports Recovery Through a Whole-Person Lens
Recovery that works long-term addresses more than the substance use. The financial pressure, the housing instability, the loss of employment, the absence of community — these aren’t peripheral to recovery outcomes. They’re central to them.
All The Way Well is a Denver-based nonprofit built around that understanding. Our peer recovery coaches bring lived experience in recovery — they’ve been through it, not just studied it. Coaching is personalized and one-on-one, focused on goal setting, navigating the practical barriers that most clinical treatment programs don’t address, and providing consistent accountability as people build a life in recovery.
Beyond coaching, All The Way Well offers recovery housing scholarships for individuals who need financial support to access safe, sober living environments. Our Start Strong Workforce Program addresses employment readiness — one of the most evidence-supported predictors of sustained sobriety. And our Active Recovery Community builds physical and mental resilience through structured activity alongside others who understand what recovery actually requires.
The somatic dimension of recovery — regulating the nervous system, learning to tolerate emotions without substances, reconnecting with the body as a source of information rather than a source of threat — takes place most durably when it’s nested inside a stable life. All The Way Well works to build that stability.