Perhaps no form of personal trauma is as painful and nefarious in its impact as sexual trauma. I have written extensively on this topic before, and my research in the area of impact of childhood sexual trauma on adult sexuality has won an award and been published in a peer reviewed academic journal. For those interested, you can read the journal article here- Pathways.

In my work with adult survivors of sexual trauma, I invariably encounter a cluster of difficulties that must be worked through. Specifically, the trauma is often internalized, which means that the affected individual may often place blame on themselves or make generalized assumptions about their own sexuality or identity. A boy, for example who has been assaulted may question his own orientation, wondering what made him vulnerable to attack. Of course, orientation never has anything to do with it, as violent hands-on sexual offenses are an indicator of sociopathy, which is marked by a lack of empathy and remorse. Or the survivor may often develop a phobia of sex, and a negative body image to boot.

It’s this phobia, this specific fear response that I want to focus in on in this article. After working with countless trauma survivors, I have found that at the root of their sexual difficulties, which may run the gamut from performance difficulties to pain syndromes to the inability to experience pleasure, is that an automatic fear response has become associated with their natural sexual response. In other words, fear and arousal become co-mingled. And as a result, one of our most important tasks is to create some separation of the fear from arousal.

Often, folks may talk about starting to feel overwhelmed when they experience sexual pleasure or arousal. Not only do they start to feel apprehensive, but they report feeling over-stimulated as well, as if the feelings generated threaten to sweep them away with their intensity. I suggest that a large part of this overstimulation has to do with the complexity of the feelings generated. In other words, it’s not just that the feelings generated are intense, it’s the variety and discord between the emotions. Specifically, as arousal rises, so does fear, which is often experienced as antithetical to and overpowering of the arousal. It is this messy mix of fear and arousal which results in the intensity of the overwhelm.

One of the first things we want to start to do in this case isolate the fear from arousal. For many, this coupled emotional cocktail has become reinforced so often that it feels indivisible. As a result, anything that leads directly to sex must be explicitly avoided. Instead, what the dynamic actually looks like resembles something more like a column graph. In this case, as arousal starts to inch up, the fear column is still nonexistent. It is only when arousal reaches a certain threshold (that is often reminiscent of past trauma, emotional or physical) that fear starts to kick in. This may often be accompanied by an automatic “oh no, not again” thought process. At this point, the fear surges forth, rising more rapidly than the arousal until it matches and then surpasses it. This is where the individual most often may feel the sense of flooding, of being overwhelmed and over-stimulated and lead to shut down. Any possibility of sexual joy and pleasure becomes prohibited at that point.

What I encourage (and I provide my clients with exercises to help them do so), is to start changing this pattern by re-introducing arousal, but much more slowly. In other words, whether partnered or solo (and sometimes solo may be the first and easiest inroad towards this kind of work), I want my clients to start to notice and chart the progression of these two distinct feeling states. I want them to ask themselves, how much of what I’m currently feeling is arousal, and how much is fear? As I mentioned, sometimes these feeling states may feel indistinguishable.

So, let’s say my client starts an exercise at home involving self-stimulation. I want this individual to stay in a state of physical feeling and emotional awareness. More on staying present here and here. Stay present with a curious and open mind. We know we are in a state of curiosity when we can ask ourselves the following question, “I wonder..” So, an open and curious mind would ask “I wonder what it would feel like to touch myself here,” or “I wonder which part of my body feels more sensitive to this kind of feeling.” I think you get the point.

At this point, I just want the individual to stay with their feelings, no expectations. If they start to feel arousal, just stay with it. Keep doing more of the same. Maybe they experience fear at the very thought of being aroused. And that’s ok. In those cases, we can jump right to down regulating the fear. In other words, we may use numerous techniques to calm down, such as grounding, mindfulness, deep breathing, and so on. I’ve written about these interventions in numerous places elsewhere in this blog. What we want to accomplish is for the individual to see that the fear in and of itself is not harmful or dangerous. Once they experience the fear, they can down regulate it, and try going back to the arousal. In this way, they “titrate” the fear– they diminish it through repeated, safe, and gradual exposure.

If the individual starts feeling aroused without initial fear, it is important for he or she to notice when they start to experience the introduction of fear. How can they distinguish fear from arousal. What does it feel like and how does it differ in the body? Stay with the arousal, while noticing the fear. If the fear rises, slow down and breath deeper. Notice where fear and arousal are situated on the graph. If fear continues to rise, stop. And down regulate using the techniques that have been learned.

What we want to accomplish is two fold.  First, we want to externalize the fear by separating it from its coupling with arousal. Second, we want to utilize specific skills and interventions to progressively diminish the escalation of fear, to give us a sense of mastery and control over it, rather than feel paralyzed and helpless in the face of appearance. In this way, we uncouple fear from arousal and provide ourselves with the opportunity to be finally be free to be our true sexual selves. Without the unnecessary layer of fear that has been added on by the experience of trauma.