Imagine that a survivor of sexual assault comes into your therapy office overwhelmed by shame and self-blame. Through tears, they recount a traumatic event where they found themselves unable to scream, run, or fight back. “Why didn’t I do anything?” they ask. “I was completely paralyzed.” This is a critical therapeutic moment where a therapist’s knowledge of traumatic responses—specifically the intersection of tonic immobility (TI) and shame—can support the survivor as they navigate the integration of their trauma.
Tonic immobility is the body’s way of protecting itself when flight or fight are not viable options. This phenomenon can often conjure overwhelming feelings of shame in survivors who aren’t familiar with this survival response. For trauma therapists, providing psychoeducation about TI and shame is essential in supporting survivors.
Drawing from the research of Rubin and Bell (2024) and the broader trauma literature, this article explores how TI surfaces in response to trauma, how it interacts with shame, and how therapists can support survivors as they move forward.
The Neuroscience of Tonic Immobility: Why We Freeze in the Face of Threat
When faced with trauma, the body mobilizes an arsenal of defenses: fight, flight, freeze, or faint. Tonic immobility is an automatic, phylogenetically conserved (i.e., preserved through evolution) component of this defensive process designed to switch on when more active defenses fail.
Tonic immobility is the body’s way of protecting itself when flight or fight are not viable options. This phenomenon can often conjure overwhelming feelings of shame in survivors who aren’t familiar with this survival response.
Research shows that TI is characterized by a loss of voluntary motor control, including speech and movement, leaving the individual “paralyzed” in the presence of life-threatening danger. This state is distinct from fainting in that the individual remains conscious, continuing to process the event cognitively. Rubin and Bell (2024) wrote, “TI causes a loss of intentional motor control, including speech…when escape and resistance fail in life-threatening situations.”
A common example of TI is when survivors of sexual assault report feeling as though their body “betrayed” them by freezing or becoming very still. This perception stems from a misunderstanding of the evolutionary purpose of TI. By rendering the victim motionless, TI may have historically helped humans and animals avoid detection or aggression from predators. While effective in an evolutionary context, this response can leave modern survivors with lingering feelings of helplessness and self-blame.
Clinical studies reinforce the role of biology in TI. A 2017 study by Kalaf et al. demonstrated that survivors of sexual violence who experienced TI reported higher rates of post-traumatic stress disorder (PTSD) symptoms. Similarly, Kozlowska et al. (2015) explored how TI involves coordinated activation of the skeletal muscles, autonomic nervous system, and pain modulation systems—making it a physiologically embedded, involuntary process.
Understanding shame in the face of tonic immobility
Shame, another phylogenetically conserved (i.e., preserved through evolution) survival mechanism, frequently co-occurs with TI, amplifying trauma’s painful legacy. While TI is rooted in the nervous system, shame operates in the mind and the body, surfacing when individuals perceive they have failed societal or personal expectations. This emotional state often lingers long after the traumatic event, feeding cycles of avoidance, withdrawal, and low self-loathing.
Rubin and Bell (2024) emphasize that “both [TI and shame] engage without conscious awareness, leaving victims blaming themselves for their inaction and emotions.” Survivors may internalize their inability to act during TI as a personal failing, believing they are “weak” or “cowardly.” This misunderstanding leads to a compounding effect: the shame of the trauma itself, coupled with the shame of experiencing TI.
Take the example of a young woman who freezes during an armed robbery at her workplace. Despite having undergone workplace safety training, she cannot move or speak as the gunman points a weapon at her. While the freeze response likely increased her physical safety in the moment, she later struggles with self-recrimination. “Why didn’t I press the panic button? Why didn’t I yell for help?” These thoughts, stoked by shame, obscure the reality that her body acted precisely as it was biologically designed to.
Shame also has significant physiological consequences. Chronic activation of shame-related processes, such as cortisol production and proinflammatory cytokines, has been linked to depression, anxiety, and even cardiovascular issues (Kemeny et al., 2004). In therapy, it is crucial to untangle these feelings and reframe TI as a survival mechanism, not a moral failing.
The intersection of TI and shame in sexual assault survivors
Nowhere is the interplay between TI and shame more evident than in cases of sexual assault. In Rubin and Bell’s 2024 study, sexual assaults were identified as a distinct outlier in their analysis of traumatic events. Survivors of sexual assault not only experienced the highest levels of TI but also reported event-specific shame at unprecedented levels.
Rubin and Bell (2024) emphasize that “both [TI and shame] engage without conscious awareness, leaving victims blaming themselves for their inaction and emotions.”
This combination can leave survivors with PTSD symptoms that rival the psychological toll of the assault itself. The narrative structure of sexual assault, as Rubin and Bell describe, often includes “an aggressor violating the body and trust of the participant–victim, without providing a warning or chance of escape.” This structure inherently heightens feelings of helplessness and shame.
Consider the case of a college student who experiences “rape-induced paralysis” during an assault at a party. Her inability to resist leads to profound feelings of guilt and self-blame, especially as peers or authority figures question why she “didn’t fight back.” These external pressures can exacerbate internal shame, making it more difficult for her to disclose the assault or seek help.
How therapists can help
As therapists, we are uniquely positioned to help survivors make sense of their experiences and renegotiate the narratives they tell themselves about their trauma. Here are three practical strategies to address TI and shame in therapy:
- Educate survivors about tonic immobility:
Begin by explaining the biological basis of TI. Normalize the freeze response as an adaptive survival mechanism that helped ensure safety in a life-threatening situation. Use accessible metaphors, such as comparing TI to a computer entering “safe mode” when overwhelmed. - Reframe shame as a natural response:
Help survivors separate their actions (or perceived inactions) from their intrinsic value. Remind them that shame is not evidence of failure but a universal, evolved mechanism designed to maintain social bonds and protect against rejection. - Encourage narrative reconstruction:
Survivors often focus on the parts of their trauma that feel unresolved or incomplete, such as “I should have screamed.” Encourage them to tell their story with a focus on survival. Highlight moments of strength and resourcing, such as their decision to seek help or attend therapy.
Through these interventions, therapists can help survivors understand that their responses—both TI and shame—are natural, protective, and not a reflection of personal failure. As Rubin and Bell aptly summarize, “We introduce a theoretical framework for TI, shame, and their interaction…to clarify how both increase symptoms and why both are so prevalent in sexual assaults.” Armed with this knowledge, we can work to shift the focus from “Why didn’t you fight back?” to “You survived.”
References
- Rubin, D. C., & Bell, C. F. (2024). Tonic immobility is engaged in most highly stressful and traumatic events: Insights into the relationship of freezing, shame, and sexual assault. Traumatology.
- Kalaf, J. et al. (2017). Tonic immobility and PTSD in survivors of sexual violence. Journal of Traumatic Stress.
- Kozlowska, K. et al. (2015). The neurobiological mechanisms of tonic immobility: Implications for trauma therapy. Frontiers in Psychology.
- Kemeny, M. E., et al. (2004). Chronic shame and its impact on health. Journal of Behavioral Medicine.
