Somatic Integration Practices

Body scan (start-here practice)

Lie down or sit. Eyes closed. Move attention slowly from crown to feet, pausing 10-20 seconds at each region: top of head, forehead, jaw, throat, shoulders, chest, upper belly, lower belly, hips, thighs, knees, calves, feet. At each region, just notice — temperature, tension, sensation, absence. No fixing. The point is awareness, not change. 8-12 minutes. Most patients find one or two regions where attention sticks; those are the regions asking for more time.

Orienting (return-to-here practice)

Slowly turn your head from one side to the other, letting your eyes lead. Notice 5 specific things you can see in your environment — the corner of a window, a plant, the texture of a wall. Notice their colors and shapes specifically. This activates the social-engagement system (Porges polyvagal framing) and pulls awareness back into present-time when integration material has carried you elsewhere. 2-3 minutes. Useful when post-session emotional surfacing becomes overwhelming.

Butterfly tap (self-soothing bilateral)

Cross your arms over your chest, hands resting on opposite shoulders. Alternate gentle taps — left shoulder, right shoulder, left, right — at the pace of a slow heartbeat. 30-60 seconds per round, 3-5 rounds. Bilateral self-tapping is a self-administered version of techniques used in EMDR and trauma-focused therapy. Calms the autonomic nervous system; many patients find it more accessible than breath-based practices when distressed.

Grounding through feet

Stand barefoot on a hard floor. Press through the soles of your feet — really feel them. Rock weight from heels to toes, side to side. Notice the contact, the temperature, the texture. Add a slow breath. 2-3 minutes. This is the most accessible grounding exercise; it works through the proprioceptive system without requiring closed-eyes work that can sometimes amplify dissociation.

Vagal toning (vocal exercises)

Polyvagal-informed practice. Hum, gargle, sing, or chant for 2-5 minutes. The vagus nerve innervates the vocal apparatus; sustained vocalization tones the ventral vagal complex (Porges framing). Many patients find humming the most accessible — try 3-5 minutes of slow, low humming with a long exhale. Sustained tone, not melody. Notice the vibration in your chest and throat.

TRE basics — IMPORTANT SAFETY NOTE

TRE (Trauma Release Exercises) is a structured sequence of muscle-fatigue movements designed to trigger involuntary tremors that release held tension. DIY TRE is contraindicated for patients with significant trauma, dissociative tendencies, cardiovascular issues, or seizure history — the tremor response can be destabilizing without qualified support. If TRE interests you, work with a certified TRE Provider (not a video). For most patients, gentler somatic practices (body scan, butterfly tap, orienting) produce equivalent benefit with less risk.

Self-massage / pressure-point work

Use a tennis ball or massage ball against a wall to apply slow pressure to held tension — between shoulder blades, along the spine, on the soles of feet. Move slowly. Pause where pressure feels meaningful. This is somatic permission for the body to be touched and witnessed — many patients carry tension in regions they no longer notice consciously.

Polyvagal-informed pacing (when to slow down)

After sessions, the autonomic nervous system is more reactive than usual. Notice when you're moving too fast — walking quickly, scrolling, multi-tasking. Deliberately slow your pace by 30% for 24-72 hours after sessions. Walk slower. Eat slower. Speak slower. This protects the regulatory capacity the session opened up. Not glamorous; structural.

Yoga + coherent breathing (Streeter protocol)

Streeter and colleagues' published protocol pairs Iyengar yoga (90 minutes, 3x/week initially) with coherent breathing (5.5 breaths per minute). Both individually have evidence for mood improvement; the combination produced larger effects in their MDD RCT. The accessible version: 20 minutes of gentle yoga (no inversion, no demand poses) followed by 5 minutes of coherent breathing daily. Yoga apps like Down Dog can substitute for in-person classes.

I feel disconnected from my body. I don't notice sensations.

Common and meaningful. Chronic disconnection from the body is a depression / trauma pattern. Start with the most accessible practices (grounding through feet, orienting) rather than body scan. Body scan asks for interoception that may not be online yet; orienting works through exteroception which is more accessible. Build sensation-noticing capacity slowly.

Body practices make me anxious.

Sometimes happens, particularly with closed-eye work for patients with trauma history. Switch to eyes-open practices (orienting, walking, grounding). Avoid TRE without practitioner support. If body work consistently produces high anxiety, that's diagnostic — work with a somatic-experiencing or sensorimotor therapist alongside the integration practices.

I tried yoga and hated it.

Yoga as practiced in many studios isn't the same as therapeutic yoga. Gentle, restorative, Iyengar-style yoga (no fast flow, no demanding poses) is the version with the depression-treatment evidence base. Down Dog's "Gentle" setting, Yin yoga videos, or a restorative class often work for patients who hated power yoga.

I don't have time for daily practice.

5 minutes is plenty. The body-scan above takes 8-12; you can do a shortened version in 5. Grounding takes 2-3. Vagal toning takes 3-5. The sustainable practice is the one you actually do — 5 minutes daily beats 60 minutes weekly. Aim for consistency over duration.

These feel silly. Like I'm doing nothing.

Polyvagal-informed practices are subtle; they don't feel like work. That's part of the design. The autonomic nervous system doesn't respond to effort; it responds to repeated regulatory inputs. The "feeling silly" is often the cognitive mind objecting to a practice that operates below cognition. Stay with the practice; the effects are measurable in HRV data even when patients say they don't feel much.

Do I need to do all of these practices?

No. Pick 2-3 that resonate. Body scan and grounding cover most patients' baseline needs. Add orienting and butterfly tap as situational tools. Yoga + coherent breathing if you want a longer daily practice. TRE only with a qualified practitioner.

Is somatic work the same as exercise?

Different. Exercise is cardiovascular and musculoskeletal — important for mood but it operates through different mechanisms. Somatic practices target the autonomic nervous system specifically: vagal tone, interoception, regulatory capacity. Most patients benefit from both; they're not interchangeable.

Should I do somatic work during a ketamine session itself?

Most patients find sessions are interior — eyes closed, body still. Active somatic work fits before sessions (grounding, breath) and after sessions (body scan during recovery). Mid-session somatic work is usually a distraction from the inward experience.

What if I have a panic-like reaction during body scan?

Stop. Open your eyes. Do orienting (5 things you can see). Do butterfly tap. The body scan asked for more interoception than the system could safely hold; back off and try again with a shorter scan, eyes open, in a different setting. If consistent panic-like reactions, work with a somatic-experiencing therapist who can guide pacing.

Can I do these practices with my partner?

Yes for some (orienting, vagal toning, slow walking together), not for others (body scan and breath work are usually solo). Practicing alongside someone you co-regulate with adds a co-regulation dimension that many patients find supportive. Discuss with your partner; experiment.