Feeling rough after therapy? It's not (all) in your head. Turns out, working through all that mental and emotional trauma can absolutely take a physical toll.
Therapy, particularly trauma therapy, always gets worse before it gets better. If you've ever done trauma therapy — or just intensive therapy work — you know this already: it's not easy. This is not the "believe and achieve," positive affirmation, discovering your inner power kind of therapy, but rather the "everything hurts" kind.
Digging into past traumas and traumatic events, experiences from childhood, and other similarly deep, fraught memories can take a toll on you — not just mentally, but physically. It's something that been termed "the treatment effect."
The increased awareness from the work you're doing on your thoughts (which is very challenging, to say the least), increases your sense of autonomy. This can also increase your stress levels and anxiety because you're starting to become more aware of what you're going through, how you've handled your stress and trauma, and why you'll have to face some deep, internal issues."
In turn, you might feel pretty beat up post-therapy. This is a very real phenomenon that you may have experienced without even noticing. Was your last migraine on the same day as your last psychotherapy visit? Did you see your therapist and feel completely depleted for the rest of the day? You're not alone. Experts from all areas of the mental health field have verified that post-therapy fatigue, aches, and even physical symptoms of illness are not just real, but extremely common.
This is why it's so important for therapists to be upfront about the therapeutic process with their clients. [These symptoms are] very normal and natural, and a perfect example of the mind-body connection. Wellness isn't just our physical being, but our mental being — it's all connected.
First, What Is Trauma Therapy?
Because this phenomenon is especially relevant when undergoing trauma therapy, it pays to explain what it is, exactly.
Many people experience some form of trauma, whether they realise it or not. Trauma involves something that happened to us that was out of our control, and often results in a pervasive feeling of threat. This includes things like adverse childhood experiences, traumatic experiences at any age, war trauma, and all forms of abuse, including racial aggression and socioeconomic oppression. It's involuntary and has been inflicted on a person, which often leaves them feeling emotionally and physically exposed, worn out, and fearful.
What differentiates trauma therapy from other types is somewhat nuanced, but:
It can be therapy you receive after a distressing event and you notice changes in your behaviour. (i.e. when PTSD or anxiety is impacting your day to day life.)
It can be ordinary therapy in which a past trauma comes up through the work with your therapist.
It can be a specific therapy you seek out in the wake of a traumatic event.
Trauma in the realm of psychology is when a distressing event takes place, and as a result of that distressing event, a person becomes exceedingly stressed and unable to properly cope, or come to terms with their feelings regarding the event.
Trauma therapy — whether intended or accidental — isn't the only instance in which you'll experience a "therapy hangover" of sorts. All of the feelings that come up throughout the therapeutic process can leave you feeling fatigued or with other physical symptoms. This is why it is important to note that this is a very normal part of the process, and should eventually subside as the therapeutic process ensues.
Physical Symptoms from Therapy Work
If you're not doing trauma work, therapy might actually leave you feeling more relaxed, confident, or energised. The most common physiological reactions I've seen in my practice are leaving therapy in a more relaxed state, or with increased energy; however, changes in a person's physiological state are common after more intense psychotherapy meetings. Here's why.
The Brain-Body Connection
Because of the intimate connection between the brain and body, it would be odd for emotional therapy to not have an impact. The more emotionally intense the work, the more likely it is to find some expression in a physical reaction.
Stress can be used as an everyday example to better contextualise and understand this. Stress is one of the most common feelings in our daily lives. Whether you're studying for an exam, prepping for a presentation, or going out on a date for the first time with someone new, you might feel anxious and excited. Some people would say they have a 'pit in their stomach,' while others say they 'have butterflies,' — and some people say they're 'going to sh*t themselves.' And sometimes they actually do!
This is magnified in trauma therapy. With trauma therapy, symptoms are significantly present, and in a much bigger way. There's a wide variety of physical symptoms that can occur from breaking down issues and breaking through during trauma therapy. For anyone who has foam rolled, you know how much it hurts before it gets better — think of it like foam rolling some super tight fascia, but for your brain.
Packing Away Bad Feelings
You're likely bringing more to your therapy session than you realise. When you have stressors that build up — if you don't take care of them — they continue to build, and they sit in your body physically.
Hence, stored trauma. You don't like it, so you pack it away, like a mental junk drawer... but the junk drawer is ready to burst from being so full of your worst nightmares.
We tend to suppress things because conscious awareness of painful toxic memories brings discomfort, and we don't like being uncomfortable or feeling uncertainty and pain. As humans, we have a tendency to avoid and suppress instead of embrace, process, and re-conceptualise pain, which the brain is designed to do to keep healthy. This is in fact why suppressing our issues does not work as a sustainable solution, because our thoughts are real and dynamic; they have structure and will explode, often in a kind of volcanic mode, at some point in our lives, physically and mentally.
But don't feel bad about feeling ‘bad’ — you need to feel those feelings! We live in an age where we want to feel good all the time, and where feeling uncomfortable, sad, upset or angry are universally labelled as ‘bad’, although they are actually healthy responses to adverse circumstances. Good therapy helps you embrace, process, and re-conceptualise your past experiences, which will inevitably involve some degree of pain, but this just means the healing work has started.
Trauma In, Trauma Out
All that packed trauma? It didn't feel good when it was stored, and it's probably going to feel traumatic coming out, too. You're literally drawing up established toxic habits and trauma, with their embedded informational, emotional, and physical memories from the non-conscious mind.
Digging into this stored trauma and stress will be the most difficult in the first few weeks of treatment. This is when your thoughts, with their thousands of embedded mental and physical memories, are moving from the non-conscious mind into the conscious mind. And it makes sense that bringing painful memories and experiences into your consciousness will feel uncomfortable.
What compounds all those stored stressors is psychological distress and mental illness. Put all that together, and by the time you sit with a mental health professional and start processing, you're not just releasing the immediate thing you went in to talk about, but all the experiences, memories, habits, traumas you've stored. It makes sense that it would release in your body the same way it was stored in your body, stored in your cells, in your feelings, in your physicality.
The Physiology of Trauma Therapy
There's a physiological, scientific explanation for a lot of this too. If therapy has resulted in heightened stress, for example, reviewing traumatic memories, then there is likely to be increased levels of cortisol, and catecholamines.
In a nutshell, cortisol and catecholamines are chemical messengers your body releases during the stress response. Cortisol is a single hormone (known as the stress hormone), while catecholamines comprise several neurotransmitters, including adrenaline and noradrenaline. (Interestingly enough, catecholamines are part of the reason you might get an upset stomach after a tough workout.)
This may lead to a rapid heart rate, sweating, headaches, muscle fatigue, etc. This is not a complete list of chemical/physical responses to psychotherapy, but just intended to get the main point across. Psychotherapy affects brain chemistry, and this, in turn, is expressed through physical symptoms.
The gut-brain interaction is one of the most obvious examples of this — we often feel stress physically in our stomachs. When the body and brain are in a highly tense state, which happens during and after therapy, this can be seen as changes in activity in the brain, as well as erratic changes in our bloodwork, right down to the level of our DNA, which impacts our physical health and our mental well-being over the short and long term periods if not managed.
Most Common Post-Therapy Symptoms
Here are some examples of symptoms to look out for:
Gastrointestinal and gut issues
Headaches or migraines
Muscle aches and weakness, backaches, body aches
Flu-like symptoms, general malaise
Anxiety and panic attacks
Lack of motivation, feelings of depression
Wild, right? All from trying to feel better — but remember, it does get better.
How to Prepare for Intense Therapy Appointments
If you know you're headed for a deep dive into some of your worst memories and experiences, be strong! You can prepare for this (very necessary) work. Because everyone's brain is different, there are different approaches to this. No matter what strategy is used, it should be one that encourages you to develop a stronger mindset, to come away confident that you will prevail in your struggle.
You want to leave a trauma therapy session firmly convinced that, “Yes, I've been there, survived, and have gone on with my life. I faced down those demons and won. The things that disturb me are in the past. My life is here in the present and in the future. What tried to beat me down failed, and I've triumphed.”
Fortunately, healthy habits you may have picked up for other reasons — eating well, getting quality movement in your day, logging good sleep — may have a significant contribution to how you feel during and following trauma therapy. This is part of stress inoculation training, which can be explained as building up your reserves and skills to have resilience against many forms of stress. All those things can help your body stay strong against mental and physical stress.
What To Do After Therapy to Feel Better
Some patients do best by having work or projects to throw themselves into after an intense therapy meeting. Others do best by having time to themselves to organise their thoughts.
Pause - Take the rest of the day off from work if you're able to. If not, take a pause; don't walk out of therapy and go straight back to work — take five minutes, don't turn anything on, don't pick up any devices, don't call anybody. That's the pause you need to reset your mind for the next activity.
Journal - Write down one or two things that you got out of your session that you can remember and have incorporated.
Recite your mantra - Reflect and remind yourself: "I'm alive, I'm breathing, I'm happy I'm here, I feel better today than I felt yesterday." And when in doubt, try the mantra: "The things that disturb me are in the past. My life is here in the present and in the future. What tried to beat me down failed, and I've triumphed."
Stimulate your mind - Engage in something new and interesting to take advantage of your brain's development. A simple way to brain-build post-therapy is to learn something new by reading an article or listening to a podcast, and understanding it to the point where you can teach it to someone else. Because your brain is already in a rewiring and rebuilding mode from therapy, you can jump in there and keep working. This is a very different approach to the suggestions above; this is where you can choose what feels right for you or for that particular day post-therapy.
It Does Get Better!
It’s hard work, and scary, (especially at first) because it will feel like things are a little bit out of your control. However, as you learn to control the process through different mind-management techniques, you can start looking at the toxic thoughts and trauma differently and see the challenges they bring as opportunities to change and grow instead of the pain that you need to ignore, suppress, or run away from.
Think of it as the anxiety before you do something really scary or daunting. Remember the stress of preparing for a test — all that intense anxiety leading up to it. It's typically worse and more intense than the test itself, right? Then you take the test, and there's this weight lifted off you once you get through the tough work; you're elated, ready to party. That's what trauma therapy can be like.
This transition from "ugh" to elated may happen gradually (think: less intense symptoms after therapeutic sessions over time) or all at once (think: one day you cry it out and have an "a ha!" moment and feel like a new person).
That said, if you seem to be in the icky part for a really long time, that's not normal. If the intense trauma work never ends, it's time to find a new therapist. Too often people with trauma enter therapy and end up getting stuck in rehashing the past without moving beyond it.
Above All, Be Kind to Yourself
If you feel like you got mono mixed with the flu with a side of migraine after you saw your therapist, be kind to yourself. You've got a therapy hangover. Go to bed. Take some ibuprofen if you've got a headache. Binge Netflix, make tea, take a bath, or call a friend. It's not frivolous or overindulgent or selfish to make sure you heal properly.
The experience of trauma is vastly different for each person, and the healing process is also different. There's no magic solution that can help everyone, and it takes time, work, and the willingness to face the uncomfortable for true healing to take place — as hard as this can be.
You're doing unimaginably difficult work. You wouldn't run a marathon and expect to function at 100% the next day (unless you're a superhuman) so give your brain that same grace.
Sally Edwards Counselling
I am a fully qualified counsellor based in Orpington, Kent
I work with clients with problems including: depression, anxiety, panic attacks, stress, low self-esteem, low self-confidence, identity issues, relationship problems, self-destructive behaviours, self-harm, childhood sexual abuse, sexual violence, domestic violence, domestic abuse, trauma, PTSD, eating disorders and body image problems.
I am easily accessible from local areas near me including Orpington, Bromley, Chislehurst, Petts Wood, Sidcup, Beckenham, Sevenoaks, Tonbridge, Knockholt, West Wickham, Chelsfield, Swanley and Bexley
Face-to-face in person or online counselling