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Sensory Motor Arousal Regulation Treatment (SMART)


Delivery Approach:
  • Individual
  • Group
  • Individual & Group
  • Dyadic
Delivery Format:
  • In-person
Provider Requirements:
  • Licensed/Certified Professional Led
Type of Experience Addressed:
  • Neglect
  • Mental Health Issues/Concerns
  • Other Types of Experiences Addressed
Engagement Methods:
  • Somatic
  • Experiential
  • Play-based
  • Other Engagement Methods (see Program Details)
Level of Intervention:
  • Intervention
  • Greater than 12 weeks
  • Headstart and Early Education Programs
  • Home
  • Residential
  • School
  • Mental Health Settings
  • Health Services
  • Community-based Agencies
  • Other Settings
Program Details:
Type of services provided:

Sensory Motor Arousal Regulation Treatment (SMART) is a somatic and attachment-based treatment for children and adolescents experiencing complex trauma and neglect. SMART addresses three key processes that are commonly impacted by developmental trauma:

  • Somatic regulation
  • Trauma processing
  • Attachment-building

Using movement and sensation to target neurological structures that support emotional and behavioral regulation, SMART teaches seven regulation tools that help children and adolescents to manage feelings, learn to play with others, fully participate in school and develop a sense of self that isn’t defined by trauma.

SMART utilizes sensory motor stimulation such as bouncing, balancing, spinning, rolling, jumping, snuggling into a body sock and building a protective fort. SMART creates “sensory rooms,” a safe and structured environment where clients can practice skills to use when they become highly aroused. Sensory rooms have athletic floor mats and contain sensory motor and sensory integration equipment that engage the five senses. When a dedicated room isn’t available, then space in a classroom or other area may be designated at the “the comfort zone” or “cozy corner” with a sensory cart and variety of sensory-based pieces of equipment to choose from. Items found in sensory rooms, zones and carts may include large fitness balls, weighted blankets, wrist and ankle weights, a mini-trampoline, a balance beam, large crash pillows, body socks, bottles of scents to engage smell, baskets of tactile items, puzzles, lotions to rub on skin, items for chewing and taste, a surround sound system with relaxation CDs, and different types of lighting that can be moved around.

Program setting:

Outpatient clinics, schools and early childhood education settings, home, residential treatment settings

Length of program/number of sessions:

Average length of weekly treatment was 9 months in residential treatment settings with a range of 6 to 12 months

Type(s) of trauma/concerns addressed:

Complex trauma and neglect

Education level of providers:


Unique/Innovative Characteristics:
  • SMART, a nonverbal, somatic intervention, addresses a gap in the treatment of childhood trauma by using sensory motor approaches to address the affect and behavioral dysregulation frequently experienced by traumatized children and youth
  • SMART was co-developed by trauma-focused child psychotherapists, occupational therapists and experts on sensory motor approaches in clinical settings
  • The SMART model has been implemented in adolescent residential settings in Massachusetts and therapeutic schools for children and young adolescents in Maryland and Kansas

Date Added/Updated:


Population Served

  • 0-5 (Early Childhood)
  • 6-12 (Childhood)
  • 13-17 (Adolescent)
Population Language:
  • English
Ethnic Racial Group:
  • Child
  • Family
Population Adaptations:
Age range of children served:

Children and adolescents (adolescents in an evaluation of SMART in residential treatment settings were 13 to 20 years old)

Are parent/adult caregiver(s) included in intervention?

Yes, SMART does family sessions and provides in-home therapy

Ethnic/racial and other groups served:

In the residential treatment evaluation study by Warner et al (2014), 20% of the adolescents were Hispanic/Latino, 16% were African American and 7% were biracial.

Specific cultural adaptations:

Not indicated.

Languages that service/resource is available:



Goals of the program/services:
  • Strengthen trauma psychotherapy by more effectively addressing the problems of affect and behavioral dysregulation
  • Enhance sensory motor engagement and promote affective, behavioral and physiological regulation using somatic regulation and sensory integration techniques
Evaluation Studies:
Has there been any evaluation?


Key evaluation results:

A quasi-experimental pilot study using a matched control design was conducted to evaluate SMART with adolescents (ages 13 to 20 years old; 90% female) with histories of complex trauma in two residential treatment centers. The intervention group received SMART once a week and the control group received treatment as usual. From pre- to post-treatment (average 9 months; range 6-12 months), the SMART group had significantly greater reductions in internalizing symptoms, somatic complaints, and anxiety and depressive symptoms compared to the treatment as usual (control) group. In a secondary analysis, a trend approaching significance was found on the Overarousal subscale of the Posttraumatic Stress Disorder-Reaction Index.

Warner, E., Spinazzola J., Westcott A., Gunn C., Hodgdon H. (2014). The body can change the score: empirical support for somatic regulation in the treatment of traumatized adolescents. Journal of Child and Adolescent Trauma. DOI 10.1007/s40653-014-0030-z

A case study analysis of a latency-age child with history of exposure to complex and preverbal traumatic experiences describes how enhancing somatic regulation in traumatized children can improve relational engagement, behavioral and emotional regulation and trauma processing.

Finn H., Warner E., Price M. & Spinazzola J. (2018). The boy who was hit in the face: somatic regulation and processing of preverbal complex trauma. Journal of Child and Adolescent Trauma. 11(3): 277-288.

Other publications:

Transforming Trauma in Children and Adolescents: An Embodied Approach to Somatic Regulation, Trauma Processing, and Attachment-Building. Elizabeth Warner, Heather Finn, Alexandra Cook & Ann Wescott. 2020. North Atlantic Books.

Warner E., Koomar J. & Lary B. (2013). Can the body change the score? Application of sensory modulation principles in the treatment of traumatized adolescents in residential settings. Journal of Family Violence. DOI 10.1007/s10896-013-9535-8.

Rated/Reviewed by Evidence Based Registries:

SMART was added to the National Registry of Evidence-Based and Promising Practices (NREPP) in 2016. SAMHSA’s National Evidence Based Practice Resource Center 

Training & Resources

Training Language:
  • Not indicated
Training Available:
  • Yes
Training Details:
Training manuals/protocols:


Availability of Training:

Yes, in the United States, Canada and overseas

Training Costs:

Not indicated

Training Contact:

Program Contact