By Iraimer Ruiz Lopez and Alicia Martin, LMSW
Introduction
There are moments in trauma recovery where what feels most distressing is not only the memory itself, but the loss of control that can accompany it.
Emotions may arise suddenly and intensely. The body may tighten, become restless, or shut down. Thoughts can feel overwhelming or difficult to organize. In these moments, many individuals describe a sense that their experience is happening to them, rather than something they can meet with choice or direction.
This loss of agency, which is the feeling of being carried by internal reactions rather than guided by intention, is one of the most disorienting aspects of trauma.
Healing, in part, involves restoring that sense of agency. Not through force or override, but through the re-establishment of safety within the nervous system.
As our understanding of trauma evolves, there is growing recognition that healing often benefits from integrative approaches that support both physiology and meaning-making. Within this framework, modalities such as somatic breathwork and Ketamine-Assisted Psychotherapy (KAP) are increasingly explored as complementary pathways for regulation, insight, and lasting change.
The Nervous System After Trauma
Trauma and chronic stress shape the autonomic nervous system in adaptive ways during threat, but these patterns can persist after danger has passed.
Some individuals experience hyperarousal: anxiety, hypervigilance, irritability, or emotional intensity. Others experience hypoarousal: numbness, collapse, disconnection, or dissociation. Many move between both.
These states reflect the nervous system’s ongoing attempt to organize around safety. When safety feels uncertain, protection takes priority.
In these conditions, access to reflection, emotional processing, and insight may be reduced. This is not resistance; it is physiology.
A trauma-informed, polyvagal-informed lens emphasizes that therapeutic work depends on the nervous system’s capacity to access relative safety, where regulation, connection, and integration become possible.
Agency as a Relational and Bodily Experience
Agency is not only psychological, it is embodied.
It is the felt capacity to:
- Notice internal experience
- Stay present with it
- Respond with some degree of choice
Trauma can disrupt this sequence, creating patterns where reaction precedes awareness.
Restoring agency is not about controlling internal states, but about increasing the capacity to remain in contact with experience without overwhelm or shutdown.
This capacity is built gradually through repeated experiences of regulation, safety, and choice within the body.
Breath as a Foundation for Regulation
Conscious breathing offers a direct pathway into nervous system regulation.
Because breath is both automatic and voluntary, it bridges physiology and conscious awareness.
In trauma-informed practice, breath is not used to override experience, but to support a more regulated relationship to it. This may include:
- Observing natural breath rhythm
- Gently lengthening the exhale
- Noticing bodily sensation without judgment
These practices can support shifts toward ventral vagal states associated with regulation, connection, and cognitive flexibility.
The emphasis remains on choice and pacing. The goal is capacity, not control.
Somatic Breathwork as an Adjunctive Pathway
Once stability and internal safety are established, some individuals may benefit from more active somatic breathwork.
Approaches such as holotropic-style breathwork use sustained breathing patterns that can influence arousal and emotional processing. In clinical settings, they may support access to deeper emotional and embodied experience.
Within a trauma-informed framework, sequencing and readiness are essential. Stabilization must precede intensive experiential work, and individuals must have sufficient capacity to engage internal experience without losing regulation or integration.
When appropriately facilitated, somatic breathwork may support:
- Access to implicit emotional material
- Increased interoceptive awareness
- Processing beyond cognitive insight
- Strengthened embodied agency
Somatic breathwork is not a replacement for regulation-based practices, but an extension of them, requiring grounding, pacing, and integration support.
Safety first, followed by guided expansion, allows these experiences to become meaningful rather than overwhelming. This sequencing is also central to integrative approaches such as Ketamine-Assisted Psychotherapy.
Understanding Ketamine-Assisted Psychotherapy (KAP)
Ketamine-Assisted Psychotherapy (KAP) is a structured treatment that combines psychotherapy with carefully supervised ketamine sessions in a supportive clinical setting. Rather than serving as a standalone intervention, KAP is grounded in thoughtful preparation, the medicine experience itself, and ongoing integration afterward. Within a trauma-informed framework, ketamine may create a temporary state of increased openness and flexibility, allowing therapeutic work to deepen when paired with skilled clinical support.
Integration in Therapeutic Contexts, Including KAP
Preparation involves more than intention-setting; it includes strengthening the nervous system’s capacity for presence and regulation. Breath-based practices can support this foundation by helping individuals access a stable internal reference point before treatment.
During and after ketamine sessions, when emotional or sensory material may feel intensified, breath can serve as an anchor, supporting continuity of awareness and connection to the body.
When appropriately sequenced and supported, somatic breathwork may also aid integration by supporting deeper emotional processing and embodiment. Its effectiveness, however, depends on prior stabilization and clinical attunement.
Within this framework, insight alone is not the goal. What matters is whether the experience can be safely processed, integrated, and translated into lasting change.
A Gradual Return to Choice
Restoring agency after trauma is not a single intervention, but a gradual reorganization of experience.
It develops through moments of:
- noticing rather than reacting
- staying rather than leaving
- sensing rather than disconnecting
Breath often becomes an entry point, not because it resolves trauma directly, but because it reintroduces choice within the body.
Over time, what once felt overwhelming or fragmented can become something that can be met, felt, and integrated. And within that shift, something essential returns: Not control in a rigid sense, but agency. A quiet, embodied capacity not only to survive experience, but to remain present with it.
Closing
When combined with somatic practices such as conscious breathing, KAP can become part of a more comprehensive approach to trauma recovery, one that honors both the body’s need for safety and the mind’s capacity for meaning-making.
At Acheron Psychiatry, our trauma services may include individual psychotherapy, EMDR, Ketamine-Assisted Psychotherapy (KAP), and trauma-focused group therapy, depending on each person’s needs, goals, and stage of healing. We view KAP not as a standalone solution, but as one component of an integrative treatment model designed to support regulation, insight, and the gradual restoration of agency over time.
Alicia Martin, LMSW is a trauma-focused psychotherapist at Acheron Psychiatry who specializes in relational trauma, C-PTSD, emotional neglect, narcissistic abuse, and codependency. She integrates EMDR, Internal Family Systems (IFS), trauma-informed psychotherapy, and holistic approaches to help clients reconnect with themselves, restore a sense of safety, and reclaim agency in the aftermath of trauma.
Iraimer Ruiz is a longevity-focused health practitioner, somatic breathwork facilitator, Ayurvedic chef, and founder of The Sacred Movement Method. Through her private practice and The Sacred Movement Academy, she integrates Somatic breathwork, nervous system regulation, functional movement, Ayurveda, and longevity-based nutrition to help individuals cultivate resilience, emotional regulation, and sustainable well-being through an embodied, whole-person approach.
