BOOK SUMMARY: THE BODY KEEPS THE SCORE
This was our first book for our now disbanded “Trauma Book Club”. We had a wonderful and relaxing time with the few who attended and plan to continue in future with book reviews. Bessel Van der Kolk, MD's “The Body Keeps the Score” remains one of the best books out there for both clinicians and clients. This book is a primer on trauma and the body and is invaluable to any of us in trauma focused work.
Bessel Van der Kolk is the preeminant neuroscientist most influencing our understanding of trauma as the cause of so many mental health issues. For that reason alone, the book is worth reading but there is so much more. This book has the most understandable explanation of the brain and trauma's impact on it of any we've read. Van der Kolk's extensive use of case examples from his therapy experiences powerfully expand this understanding. He uses simple terminology, such as calling the primitive brain the 'fire alarm', which can help our clients understand the brain impact of adverse experiences, particularly childhood abuse and neglect.
This book is a history of his career as a psychiatrist, researcher and therapist and as such, becomes a history of the mental health field over the last 30+ years. I (Bonnie) began practice over 40 years ago so remember many of the changes and their impact on our the field. I recall the same excitement he shares at being able to use medications early such as the early antidepressants to help people. I also agree about what we as a field have lost with the reductionist view of mental illness as a brain disease. This led to primarily treatment by drugs to fix a chemical imbalance, now debunked, but still a part of our culture. Here’s what he lists as losses from this paradigm shift (p. 38):
a) We have the capacity to heal each other that is equal to our capacity to destroy
b) Language does give us the power to change
c) We can regulate our own physiology [without drugs] through breathing, moving, touching.
d) We can change social conditions to help people feel safe and be able to thrive.
I learned more about the history of the DSM, its profit-rather than research-driven impetus, and why he was not successful in getting Child Developmental Trauma in the DSM V, after overwhelming research showing child mental illness has adverse experiences as its cause along with strong national support from child clinicians. Other child specialists share his helpful explanation of the loss of identity of self through trauma. Van der Kolk recognizes the value of language but emphasizes the greater importance of action that connects to the powerless, trapped, or frozen condition that is trauma's imprint on the brain.
More than all of this, however, we read about a man working and sharing from his heart, one who exemplifies a deep respect for suffering people and a commitment to healing the whole person in front of him. He is able to admit mistakes which often then result in further learning, showing himself curious and continually searching for new and better ways to assist others. He writes with openness about his own personal experiences with EMDR and other therapies, often leading to his next research and therapeutic interventions. We are all impressed with his passionate and heartfelt dedication to healing.
Part 1: The Rediscovery of Trauma
The title of this section is significant, underlying the knowledge about trauma and mental health being discovered by Janet and others in the late 1800's. Van der Kolk's early research on veterans is impactful, particularly the case example of the trauma-distorted perceptions found in Rorschach tests. Since EMDR deals with perception, this was a concrete example of how trauma distorts the brain's 'reality'. These early experiences later helped him to have a 'trauma lens' when he began working with survivors of incest. He saw their experiences very differently than the prevailing dismissive approach of the mental health field at the time. " Most human suffering relates to love and loss so the therapist's job is to help people acknowledge, experience, and bear the reality of life, with all its pleasures and heartbreak ." (p. 26) He goes on to say that we can't get better until we ' know what we know and feel what we feel ," recognizing the tremendous courage and strength it takes to remember.
Part 2: This is Your Brain on Trauma
Here he shares that our brain's adaptive response to stress leads to action and how trauma can overwhelm this healthy adaptive response. This supports Francine Shapiro's Adaptive Information Processing (AIP) theory of EMDR therapy that the brain moves toward health just like the rest of the body, unless blocked or hindered. His example of the child who survived 9/11 and drew a picture (p. 52), seen around the world, of people jumping from the Towers, shows the healthy result of taking action while being in the secure presence of caregivers.
In contrast, traumatized people often get stuck in powerlessness, either by being prevented or unable to take action. Robbie Adler-Tapia, EMDR author, trainer, and child welfare expert, told us in her specialty workshop, that the key Negative Cognition for children is powerlessness. Peter Levine, (Waking the Tiger) furthers our understanding of how trauma gets stuck in the body by clarifying how we differ from the animal kingdom in our response to stress. Animals who survive an attack by predators will get up, physically shake it off, and run away, something that is difficult for humans whose threats are not as obvious as a tiger nor frequently not as short lived as a predator attack. Action is key to healing as it shuts down the 'fight or flight' survival mechanism, signaling safety.
Our primitive brain, shared with other mammals, is geared toward survival. If our normal response is blocked (trapped, held down, prevented, frozen out) from action, our brain keeps secreting stress hormones. This limits our PFC activity–keeping our thinking brain off-line– while our amygdala and limbic system emotional (survival) brain remains in charge. Thus, " PTSD is the body continuing to defend against a threat that belongs in the past. " (p. 60). Well said! " Knowing the difference between top down and bottom up regulation is central for understanding and treating traumatic stress ." (p, 63) Van der Kolk states that top down regulation is strengthened with activities such as mindfulness meditation and yoga to 'recalibrate' the nervous system so the brain's 'watchtower' (PFC) more effectively monitors our body's reactions. Bottom up regulation happens through breath (one of the few body functions that is automatic and self regulatory), movement or touch. Therapeutic interventions need to do both as self regulation requires connection with the body.
He bluntly states that dissociation is the essence of trauma (p.66) because overwhelming adverse experiences cause a split-off and fragmentation of experiences. The survival brain, which he labeled the 'smoke detector,' loses the capacity to evaluate danger and safety in the environment. Lanius' research particularly shows how the body is lost through disconnection, explaining how severe early trauma leads to missing self awareness. When the brain shuts off this awareness to survive terrifying and overwhelming emotions, the person's capacity to feel fully alive is also deadened. A key to trauma treatment is helping clients to 'reactivate' a sense of self, ' the core of which is our physical body.' (p. 89) Recovering this requires a sense of agency, of being in charge of one's life. This is why mindfulness–knowing what you feel and understanding why–is so helpful in strengthening the PFC.
Van der Kolk also points out that this also lends support to Peter Levine's Somatic Therapy and Pat Ogden's Sensorimotor Psychotherapy approaches to the healing of trauma. In therapy, we need to a) draw out blocked sensory information b) help clients befriend, not suppress, body energies needing to be released and c) complete the self preserving physical actions that were thwarted when the survivor was restrained or immobilized by terror. (p. 96). Trauma survivors cannot recover 'until they become familiar with and befriend the sensations in their bodies." (p. 100) The wonderful thing about our brain is it does not know the difference between imagination and reality. Thus, we can assist our clients to imagine things as part of the change process. We do not rewrite history, but we can imagine present and future actions that will empower individuals who feel helpless and shameful due to their past adverse experiences.
Part 3: The Minds of Children
In this section, Bessel Van der Kolk covers the impact of adverse childhood experiences, notably child abuse and neglect, on the developing brain. Self regulation is learned from early caregivers through mirror neurons, empathy, and imitation. Early trauma changes the way the brain is wired and 'neither drugs nor conventional therapy' has show the necessary ability to change the brain. We have the evidence through neuroscience and most powerfully gathered by the author, to show that the majority of child mental health issues stem from trauma. Through his study of abused children and those who were not, he profoundly concludes "…for abused children, the whole world is filled with triggers." (p. 108) Think about children dealing with daily life while trying to manage these triggers, with elevated, hyper-alert physiology stemming from early caregiver deprivation, abuse or neglect and other adverse childhood experiences.
He advocated for and lost the battle to have the diagnosis of child Developmental Trauma Disorder replace most childhood diagnoses in the DSM V. He again bluntly states that the APA makes far too much money on the mandated use of the DSM to be open to change even with overwhelming research evidence, including the ACE Study. It made me think of Upton Sinclair's 1994 statement that I recently tweeted: “It is difficult to get a man to understand something, when his salary depends on his not understanding it.” (I, Candidate for Governor and How I Got Licked, 1994)
Diagnoses should lead us to interventions, and he asserts that our current child diagnoses describe behavioral and emotional symptoms that are the result of trauma. A similar disconnect comes with Shapiro's theoretical view that negative cognitions are a symptom of unprocessed memories, rather than the cause of dysfunction as cognitive approaches assert.
Part 4: The Imprint of Trauma
Here is a very useful description of the normal vs. traumatic brain. Both have perceptions of experience stored in neuro networks but the key difference is in the level of arousal determined by how personally meaningful and emotional we felt during the experience. He goes back to very early research by Charcot and Pierre Janet's on the root of hysteria (now PTSD) characterized by intense emotional arousal. He discusses Freud's 'talking cure' involving an 'energetic reaction connected to the memory' being released' for resolution. (p. 182).
Dissociation is the splitting off and isolation of memory so the person remains ‘stuck in trauma time’. Shapiro outlines how unprocessed memories are the basis of pathology, preventing the brain from adaptively updating our neuropathways developed through distressing past adverse experiences. Processing, per Shapiro, is accelerated learning, leading to assimilation of new information, which cannot take place if a person is not in their ‘window of tolerance.’ It is both sad and encouraging to realize that these keys to mental health treatment have been there but are only recently being ‘rediscovered’ as Van der Kolk states. The advances in neuroscience and the neuroplasticity of the brain are significant leaps in our understanding of how to assist and heal others through mental health treatment interventions.
Most interesting are the results he summarizes of his own research into traumatic memories. They differ from positive memories in how they are organized and in their physical reactions. Positive memories have a beginning, a middle, and an end. Traumatic memories, however, are disorganized, fragmented, with blank periods, presenting as images, physical sensations and intense emotions (does this remind you of EMDR's Phase 3?). He learned that ' remembering the trauma with associated affects doesn't necessarily resolve it and language cannot substitute for action’. We have all experienced or witnessed deeper healing with actual or imaginative action completing what the client was unable to do in the past.
Part 5: Paths to Recovery
Van der Kolk's directive to an effective trauma therapy involves the following steps (not in order and overlapping) for clients to achieve (p. 203-204):
1) finding a way to become calm
2) learning to maintain that calm and focus when triggered with past thoughts, emotions, reminders, etc.
3) finding a way to be fully alive, in the present, and engaged with others
4) not having to keep secrets from self including the ways the person has managed to survive.
His position is clear that the trauma has to be revisited in more than the logical brain " The fundamental issue in resolving traumatic stress is to restore the proper balance between the rational and emotional part of the brain. " (p. 205) Breathing for hyper-arousal, mindfulness to strengthen core of self awareness, relationships through good support networks and other ways of recovery through social connection are all important approaches. Thus he recommends clients choose a trauma therapist who is educated about the impact of child abuse and neglect and has a variety of techniques to stabilize and calm, help lay the trauma to rest, and reconnect people to others, not advocating just one treatment of choice.
This chapter continues with the variety of approaches on his 'menu' of healing, including the body as the bridge to language, putting words to nonverbal experiences, as well as yoga, EMDR, Schwartz's Internal Family Systems, Pesso's PBSP psychomotor therapy, neurofeedback, movement, theater, and dance. While we may not have the resources that Van der Kolk has, we can incorporate what we can as we continue to learn how to most effectively treat our clients.
We remain passionate about EMDR because of the powerful healing it provides. We know that the most effective EMDR treatment is provided by an innovative and attuned therapist willing to use all at his or her disposal to effect healing. Mindfulness has proven benefits and is particularly useful in the Preparation Phase of EMDR. Neurofeedback is foundational for resetting the brain to calmness and many EMDR therapists use HeartMath for this purpose. Trauma sensitive yoga works on reconnecting the body to address helplessness and awareness of body sensations needing release as critical for healing. Self leadership through integration of self through IFS, ego state therapy, structural dissociation or DNMS is foundational for our clients with dissociation and fragmentation. Adding movement, particularly for children with traumatic stress, is also powerful. The use of activity (rolling a ball, play) is as essential to healing as well as engagement. As my mentor and Director of EMDR Consulting, Roy Kiessling LISW would say, "if you can think it, do it' with creative ways of working with those who have had adverse childhood experiences. The multitude of specialty approaches and protocols came from just such innovation.
We strongly urge you to read the book, as there is so much that cannot be reflected here. This is just a taste of what Bessel Van der Kolk so clearly, powerfully, and eloquently teaches us in his book, The Body Keeps the Score .
Bonnie Mikelson, LISW Director, EMDR & Beyond
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The Body Keeps The Score Summary
1-Sentence-Summary: The Body Keeps The Score teaches you how to get through the difficulties that arise from your traumatic past by revealing the psychology behind them and revealing some of the techniques therapists use to help victims recover.
Favorite quote from the author:
Table of Contents
The body keeps the score review, audio summary, who would i recommend the body keeps the score summary to.
It’s easy to see the trauma that war causes. Too many veterans come home with PTSD and suffer from a range of difficulties because of it. But more and more people are experiencing their own ordeals that leave scars on their minds that are tough to heal.
Chances are you’ve had a traumatic event or two in your own life. Whether you realize it or not these do affect you, and in some cases a lot. You’re probably wondering about the impact that these tragic memories have on your mind and body. And why is it so difficult to get free of the pain they cause?
Finding relief from trauma is what Bessel van der Kolk’s The Body Keeps the Score: Brain, Mind, and Body in the Healing of Trauma is all about. This will help you see the effects of it on your life. But more importantly, you’ll discover a few techniques that can free you of it’s torment.
Here are the 3 most helpful lessons this book teaches about trauma and recovery:
- EMDR is a slightly mysterious technique that the author uses to help trauma patients recover, and with wonderfully positive results.
- You can connect your body and mind through yoga to help you deal with your troubling past.
- Having a network of supportive people and practicing mindfulness are two more ways that bring healing.
Ready to find out how to recover from your most difficult experiences that still haunt you? Let’s dive right in!
If you want to save this summary for later, download the free PDF and read it whenever you want.
Lesson 1: Trauma patients who go through the EMDR technique have seen incredible results in recovery.
Difficult events can have a long-lasting negative effect. Just remembering them can raise blood pressure and deactivate rational thinking parts of a victim’s brain. Many of these experiences came from childhood and have been around for a long time. But there is hope for even the nastiest of demons you face.
One technique is as simple as moving a finger across a patient’s vision. As they follow the finger with their eyes, audio cues from the medical professional help them make new associations. EMDR, or eye movement desensitization and reprocessing might sound crazy, but it’s wildly effective at helping people recover from trauma.
The reason it’s so helpful is because of the way it allows victims to integrate their traumatic memories. Part of the problem with these events is that their memory can play out as if it’s happening in the present. Integration allows for them to simply add these events to a memory bank instead of thinking they’re real.
The author used this technique to help a woman named Kathy who had just attempted suicide for the third time. At a young age, she’d been raped, assaulted, and abused by her father.
Using EMDR, van der Kolk helped Kathy re-imagine these memories in a helpful way. She imagined a bulldozer destroying her childhood home and the memories that came with it. Another visualization had her thinking about locking her dad out of a cafe. She progressed well and 15 years later the author reconnected with her to discover she was happy and healthy.
Lesson 2: Dealing with your troubling past is easier when you practice yoga to help you connect your mind and body.
Your body and mind are more connected than you might think. Figuring out how your emotions work and impact your body is essential for balance and stability in life.
Trauma makes this really hard because of the way it puts a sort of alarm system in our bodies. A child who was sexually abused, for example, might feel panic when doing something as simple as cuddling with their significant other.
People usually try to numb these feelings with drug or alcohol abuse, or by overworking themselves. But these temporary fixes only put a bandage on rather than getting to the root of the issue. That’s where unifying the body and mind with yoga comes in handy.
Yoga allows trauma victims a way to understand emotions and how their body handles them. The author had a patient named Annie who had been raped and suffered from PTSD that decided to give it a try. It was tough at first because just a simple pat on the back triggered her alarm system.
But refusing to give up, Annie persevered and began to notice how her body was giving her information about her emotional state. Some of the positions made her feel sadness, pain, and vulnerability. Instead of pushing them away, she began to explore and accept them. This let Annie come to terms with these difficult feelings and deal with them instead of trying to bury them.
Lesson 3: Mindfulness and a support network of friends and family who care are also great ways to experience healing.
The aim of mindfulness is to mentally connect with and become aware of your body and emotions instead of just denying them. It’s difficult to do this after adversity because we don’t like to deal with painful emotions like sadness or anger. But suppressing them, as many victims do, just leads to more problems.
Only by confronting your demons can you begin to heal from them. Meditation techniques help you reconnect with the way you really feel so that you can start this process.
This unique tool can calm the impacts of trauma on the mind and body. Whether it’s depression or chronic pain, mindfulness can help. It’s also known to strengthen your immune system, help you regulate emotions, and get your hormones in better balance.
Relationships are another vital component of the recovery process. Your network of family, friends, and medical professionals can help you always have someone to turn to for help. You can connect with other helpful people through local AA meetings, religious groups, and veterans’ organizations.
The Body Keeps The Score is a powerful book especially at a time when too many have to deal with trauma. I’ve got family members who have been through some pretty difficult things that I know the techniques in this book could help. If you’ve been through traumatic events this book will give you hope to recover.
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The 33-year-old who was abused by her father as a child and is now dealing with mental illness because of it, the 56-year-old who has chronic pain and wants to find ways to deal with it, and anyone who has been through trauma or suffers from depression or anxiety.
Last Updated on August 30, 2022
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The Body Keeps The Score Summary | Bessel van der Kolk
posted on March 25, 2022
Summary and Analysis of The Body Keeps The Score: Brain, Mind, and Body in the Healing of Trauma
Life gets busy. Has The Body Keeps The Score been gathering dust on your bookshelf? Instead, pick up the key ideas now.
We’re scratching the surface here. If you don’t already have the book, order it here or get the audiobook for free on Amazon to learn the juicy details.
Bessel Van der Kolk’s Perspective
Bessell Van der Kolk , MD, is a qualified psychiatrist. He specializes in the field of post-traumatic stress, which led him to write over 150 peer-reviewed scientific articles, the majority of them about post-traumatic stress. Van der Kolk, originally from the Netherlands, has also served as president of the International Society for Traumatic Stress Studies. He is currently a professor of psychiatry at Boston University School of Medicine.
The Body Keeps the Score is an innovative book by psychiatrist and trauma expert Van der Kolk. We all understand the effect that psychological trauma can have on individuals. Trauma can impact the way people perceive themselves and the world around them. Psychological trauma can have a lasting impact on the individual’s loved ones as well. In this book, Van der Kolk covers the intricacies of how trauma produces these effects by considering the neuroscience involved. Van der Kolk also presents ways neuroscience allows us to produce new, effective treatments for psychological trauma survivors. Examples of these approaches include eye movement desensitization and reprocessing, yoga, and limbic system therapy. Van der Kolk guides us through these modern therapies by recalling his career and the patients he has seen. So this book also serves as a history of the mental health field of the last 30 years.
After learning these storyshots, you will better understand how our brains react to and deal with psychological trauma. What Van der Kolk recommends is helping survivors of psychological trauma to recover.
StoryShot #1: Antidepressants Ruined Mental Health Support
Van der Kolk describes how he and other researchers/therapists were so excited when antidepressants were first introduced. He now believes that our overuse of these medications has led us to treat mental illness as a disease. Unfortunately, this approach means that the following things have been removed from mental health support:
- The belief that we can heal each other in the same way we can destroy each other
- Language that is critical to providing us with the power to change circumstances
- Controlling our physiology by using breathing, moving, and touching techniques, rather than by resorting to medication
- An inclination to change social conditions so that people feel safer and are then able to thrive
StoryShot #2: The Development of Our Understanding of Trauma
Van der Kolk’s early research played a massive part in reigniting ideas surrounding trauma.
Trauma and its association with mental health were supposedly first discovered by Pierre Janet in the late 1800s. Janet is one of the founding fathers of psychology. He was also one of the first to identify how previous events in a person’s life can lead to present-day trauma. He defined the terms dissociation and subconscious , both of which are still used today in conversations surrounding trauma.
Van der Kolk describes his early research on veterans. Rorschach tests found that trauma can distort the brain’s perceptions of reality. These tests were integral to the way Van der Kolk later approached his therapy sessions with survivors of incest. That’s when he began treating patients through a ‘trauma lens.’ Working with veterans allowed him to understand the remarkable courage that it takes for trauma victims to recall their trauma.
Van der Kolk also applied this trauma lens to a broader range of individuals, revealing that trauma was far more widespread. Trauma can result from any experience of extreme stress or pain that leaves the individual with feelings of helplessness.
StoryShot #3: Trauma Influences Relationships
Van der Kolk also acknowledged that trauma has a significant impact on the people around the survivor. Traumatized individuals often have Post-Traumatic Stress Disorder (PTSD), leading to depression and substance abuse. Traumatized individuals can struggle to trust others. They assume nobody can understand what happened to them and why they keep reliving it.
Van der Kolk gave an example of this phenomenon by writing about a group therapy session he provided for war veterans. The group also helped veterans find new friends to share their experiences with. That said, those who weren’t traumatized were considered outsiders by those who were. This prejudice meant Van der Kolk was also an outsider in the traumatized group’s eyes. To overcome this hurdle, Van der Kolk had to provide weeks of listening, empathizing, and building trust. This story shows that we must build rapport with the traumatized before we can expect any trust from them. Often trauma is caused by trusted people in the first place. So it is essential to understand that regaining trust is difficult for traumatized people.
StoryShot #4: Therapy Can Treat Trauma
Van der Kolk described how the brain’s health and adaptive responses to stressors are key to producing action. Think of the “fight or flight” responses. Both require action to end the stress. Issues arise when stress is overwhelming, such as with a traumatic event that can block the body’s adaptive response and prevent the required action. This suggests why eye movement desensitization and reprocessing (EMDR) is vital. This therapy helps the traumatized person to process information adaptively.
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Storyshot #5: brain scanning suggests you should take action.
Treating hopelessness or inertia is extremely important. Hopelessness has been described as the most impactful feature of trauma. Action is key to healing because it shuts down the fight or flight survival mechanism, signaling safety. As this survival response can be blocked by trauma, our brain continues to secrete stress hormones. Van der Kolk likens this to a smoke detector always going off. So, even when you are not currently experiencing this stressor, your body is still reacting as if you are. Stress hormones are particularly impactful because they limit the activity of the brain in an area called the prefrontal cortex . The prefrontal cortex is arguably the most crucial part of the brain, as it is involved in all decision making. While reliving the trauma, the amygdala and the limbic system run at maximum speed. This overdrive means the part of the brain and the system associated with emotions are always overactivated.
This reaction can be described as ‘bottom-up’ processing. Van der Kolk explains that we should develop therapies that encourage the recalibration of both ‘top-down’ and ‘bottom-up’ processing. The brain’s watchtower (prefrontal cortex) should then be better able to monitor our body’s reactions.
Ways to strengthen top-down mental regulation are:
- Mindfulness meditation
Ways to recalibrate bottom-up mental regulation are:
StoryShot #6: How Therapists Should Approach Treating Trauma
Therapy for traumatized individuals needs to leverage both top-down and bottom-up mental regulation techniques, including mindfulness, yoga, breathing, movement and touch. . Dissociation is the essence of trauma, as adverse experiences fragment our everyday lives. Here is a summary of how therapists should approach treating trauma:
- Help clients to reactivate a sense of self in the physical body. Mindfulness helps to do exactly that.
- Draw out blocked sensory information and help the client to befriend, not suppress, bodily responses.
- Complete the self-preserving physical actions that were thwarted when the survivor was restrained or immobilized by terror.
- Assist clients through imagination . Our brain does not know the difference between real life and imagination, as evidenced by dreams. This means imagination is fundamental to helping the traumatized heal.
StoryShot #7: Early Trauma Changes Neuroanatomy
Self-regulation is learned from early caregivers through mirror neurons, empathy, and imitation. Early trauma changes how the brain is wired, and neither drugs nor conventional therapy can erase those changes in the brain. Van der Kolk cites his research to show that the vast majority of children’s mental health issues are due to trauma.
Sadly, despite this fact, Van der Kolk has lost his battle to have the diagnosis of child Developmental Trauma Disorder added to the DSM-5 (Diagnostic Statistical Manual of Mental Disorders). He wanted it included as a replacement for the majority of childhood diagnoses. Van der Kolk attributes the rejection to the substantial monetary value derived from the DSM.
Diagnoses should lead us to interventions. Van der Kolk asserts that our current child diagnoses describe behavioral and emotional symptoms resulting from trauma.
StoryShot #8: Traumatic Memories Are Disorganized
Healthy and traumatic brains both store perceptions of experience in neural networks. That said, the critical difference between them is their level of arousal. Charcot and Pierre Janet were the first to talk about PTSD as being characterized by intense emotional arousal. Freud also provided talking cures that focused on an energetic reaction being connected to the memory, and the resolution is to release or sever this connection. Van der Kolk explained that this dissociation involves isolating oneself with this memory and its emotional connection.
Van der Kolk explains that research shows that positive and traumatic memories differ in structure. Positive memories have a beginning, a middle, and an end. Traumatic memories are disorganized, fragmented, and appear as images, physical sensations, and intense emotions.
The American psychologist, Francine Shapiro, believed that unprocessed memories are the basis of pathologies. These memories prevent our brain from adaptively updating our neural pathways. But our brains are neuroplastic, so developments in neuroscience and knowledge of how our brains can be changed provide great hope for our ability to assist others toward mental health and well-being.
StoryShot #9: Restore the Balance Between Your Emotional and Rational Brain
Van der Kolk’s directive to effective trauma therapy includes the following tips:
- Find a way to be calm in all moments. Learn to maintain your calmness and focus even when triggered by past thoughts or emotions.
- Learn to be fully alive in the present. Remain engaged with others and with the present moment.
- Try to remain truthful to yourself. Remaining truthful includes how you managed to survive the trauma.
In summary, overcoming trauma is about restoring the balance between the rational (prefrontal cortex) and emotional (amygdala) parts of the brain. You should use breathing techniques (also known as breathwork) to manage hyperarousal, mindfulness to strengthen your self-awareness, and strong relationships and support networks developed to help you move towards recovery.
Beyond this basic foundation, Van der Kolk provides many suggestions for therapy options, including:
- Schwartz’s Internal Family Systems
- Pesso PBSP psychomotor therapy
One of the most effective therapies for trauma is yoga. Van der Kolk explains that your body and mind have a close relationship. So a balanced life depends on understanding how your emotions work and how these emotions impact your body. Trauma can make this relationship between your body and mind particularly hard to understand. For example, traumatized individuals have a hypersensitive alarm system.
To tackle this disconnect between body and mind, post-traumatic people will turn to things that will numb their feelings. But this tends to do more harm than good. An alternative that aims to help you get in touch with your emotions is yoga. Van der Kolk explains that he has had many patients successfully encourage signals about their emotional state by using yoga. Yoga allows traumatized individuals to adopt stereotypically vulnerable positions within a safe environment.
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Mindfulness has a similar potential for allowing traumatized individuals to get in touch with their emotions. Mindfulness’ primary goal is to help people maintain a conscious awareness of their bodies and emotions rather than denying them. Trauma is often associated with denial of emotions as a way of repressing difficult memories. This denial prevents traumatized individuals from starting the healing process.
Mindfulness has consistently been able to alleviate some of the psychological and physiological effects of trauma. Research also suggests that mindfulness can improve biological immune responses and activate the regions of the brain that regulate emotions.
StoryShot #10: Try to Process Traumatic Experiences Like Other Experiences
There are clear differences between the ways we remember traumatic memories and non-traumatic memories. Traumatic memories are heavily reliant on sensory and emotional fragments. This is because our brains are overwhelmed by the shock of traumatic events and so we struggle to process all the information. A vital part of overcoming trauma is trying to remember the details of these experiences. If a person can process this information, they will be better equipped to put the structures in place to start overcoming trauma.
Final Summary and Review of The Body Keeps The Score
The Body Keeps the Score is an overview of the relationship between our bodies and minds. Van Der Kolk uses his years of experience researching, diagnosing and treating PTSD to offer guidance on the strong relationship between trauma and our bodies. He challenges the common view that drugs are the cure for traumatic experiences. The alternative is to better understand how trauma affects our mind and body, and how we can change the way we process this information.
We rate this book 4.6/5.
The Body Keeps The Score PDF, Free Audiobook, and Animation
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First published in March 2021. Updated in March 2022.
This is an unofficial summary and analysis.
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Director, behavioral associates, ny, usa.
Myndlift provides a powerful solution to some of the major barriers we see in neurofeedback. It allows patients to train in an affordable and convenient way that increases treatment compliance and consistency, resulting in great outcomes.
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Big news myndlift publishes a peer-reviewed study on its efficacy for improving mental health in jmir.
- Aug 15, 2022
5 Lessons We Learned From The Body Keeps The Score
Updated: Feb 17
✎ Written by: Dubravka Reb ic ✓ Fact-checked by: Dr. Nathan Brown , Ph.D.
There aren't many books containing dense and scientific material that also manage to top the New York Times best-seller list for 150 weeks – that's almost three years – and counting. The Body Keeps the Score by psychiatrist and author Bessel van der Kolk is quite possibly one of the most popular mental health books in the last decade. The numbers speak for themselves; it has sold nearly two million copies worldwide !
So what’s all the fuss about? For one thing, The Body Keeps the Score is a hopeful book. Although it emphasizes the broad scope of traumatic experiences and the profound, often devastating impact they can have on an individual, it also makes the case that therapy is effective and that post-traumatic distress need not be a permanent condition.
Furthermore, Bessel van der Kolk summarized his four decades of experience studying the impact of trauma on the brain. He synthesized the most important breakthroughs in neuroscience, psychology, and body-centered therapies and created a coherent blueprint for understanding and treating trauma.
But he also made us realize how common trauma is. According to Dr. Van der Kolk, even if we haven't experienced it first-hand, there's a good chance that we know someone with a history of trauma, such as neglect or abuse. And that’s what makes the knowledge from this book so widely applicable.
The Body Keeps the Score is not only considered a life-changing read for trauma survivors; this book can also help our society become better friends, parents, and partners. It can support us on a journey to becoming kinder and more empathetic versions of ourselves.
According to Dr. Van der Kolk, the journey starts with a deeper understanding of trauma.
Lesson 1: The Brain-Body Connection Is Real
When we experience a real or perceived threat, our brain's alarm system gets triggered. This alarm system involves a region of the brain called the amygdala , which Dr. Van der Kolk refers to as the brain's smoke detector.
When the amygdala senses a threat (for example, a person on the street who looks threatening), it recruits the stress hormones and autonomic nervous system to orchestrate a whole-body response that propels us to run, hide, fight, or, on occasion, freeze in order to confront the threat. In these moments, we might notice a quicker heart rate, shallow breathing, sweating, and an inability to think clearly.
Simultaneously, our frontal lobes , which Dr. Van der Kolk refers to as the "watchtower," offer a view of the scene from above. In many cases, they can help us respond to a false alarm and turn off the brain's smoke detector. With PTSD (post-traumatic stress disorder) , however, the balance between the amygdala and the frontal lobes shifts radically, which makes it much harder for the brain to recognize that the alarm is likely unwarranted.
As a result, the parts of our brains that are on the lookout for danger are always on alert, and even the slightest sign of a threat can trigger the amygdala. It’s this overactivity that might keep us trapped in a prolonged state of emotional reactivity that can take its toll on the body. In fact, according to Dr. Van der Kolk, there are many examples where trauma is connected to physical symptoms.
Lesson 2: Trauma Causes Physical Symptoms
Being trapped in a prolonged state of emotional reactivity might change the way our body functions. According to The Body Keeps the Score , when we are chronically angry or scared, constant muscle tension might lead to spasms, back pain, migraine headaches, fibromyalgia (widespread musculoskeletal pain), and other forms of chronic pain.
As a remedy, Dr. Van der Kolk mentions that learning to observe and tolerate our physical reactions by practicing mindfulness can calm down our nervous system, making us less likely to be thrown into fight-or-flight mode.
Practicing mindfulness means striving to be present and involved in whatever we are doing at the time. Some of the examples of mindfulness practice described in the book are yoga and meditation.
Mindfulness practice has been shown to positively affect numerous psychiatric, psychosomatic, and stress-related symptoms, including depression and chronic pain. It broadly impacts physical health, including improvements in immune response , blood pressure, and cortisol levels .
Lesson 3: The Mind Is Not Tending To The Present Moment
Being traumatized is not simply a problem of being stuck in the past; it is also a problem of not being fully present in the here and now.
According to Dr. Van der Kolk, as long as we don't resolve the trauma, the stress hormones that the body secretes to protect itself from danger keep circulating, and the defensive movements and emotional responses that belong to the past traumatic event keep getting replayed in the present.
For example, we might react intensely to some minor irritation as if the world were ending. Upon taking a step back, we may realize that these strong emotions are actually stemming from a traumatic event that occurred in the past.
Another reaction to these stress hormones being released is to freeze and numb us down, which might make our day-to-day events less compelling. For instance, we could feel emotionally detached during birthday parties for our kids or in response to the death of a loved one.
As a result of not being able to fully take in what's going on around us, we might feel ashamed, alienated, and disconnected from our community. Dr. Van der Kolk states that the solution to this problem is learning to gain mastery over our internal sensations and emotions, which brings us to the next lesson.
Lesson 4: We Have the Power to Regulate Our Physiology
If our brain activity has been impacted by trauma, our brainwaves are likely less coordinated than they should be. However, dysregulated brainwave patterns are not irreparable: they can be rewired and transformed thanks to a process called neuroplasticity.
Neuroplasticity allows neurons (nerve cells in the brain) and the connections they form with each other to compensate for injury and adjust their activities in response to learning or changes in the environment. Brain training technologies such as neurofeedback can promote neuroplasticity and train our brain to regulate our brainwaves to achieve the desired brainwave state, allowing us to be focused or calm.
When doing neurofeedback training with Myndlift , for example, you would play a video game or watch a video while EEG technology measures your brainwave activity. Every time your brain reaches its optimal brainwave state, you receive positive feedback, and that feedback not only earns you points, but it gives you insight into your brain function – when it’s in its optimal state and when it isn’t.
Eventually, after consistent training, your brain learns to regulate itself and reach its optimal brainwave state without that immediate reward. As a result , you may find it easier to stay calm in stressful situations, like when you're struggling with difficult emotions and traumatic memories.
It’s important to note that this type of brain training doesn't require deliberate control. All you have to do is to be mentally focused and physically relaxed, allowing your brain to follow the feedback.
Lesson 5: Positive Relationships Are Fundamental To Our Well-Being
As Dr. Van der Kolk states in The Body Keeps the Score , our attachment bonds are our greatest protection against threats. Nothing soothes our fear like a soothing voice or a solid hug from a trusted person.
For instance, children who experience a traumatic event and are not immediately soothed by their parents or receive other forms of emotional support may suffer the effects of said trauma long-term .
Indeed, traumatized human beings recover in the context of relationships: with families, loved ones, Alcoholics Anonymous meetings, veterans’ organizations, religious communities, or professional therapists.
The purpose of these relationships is to foster the bravery to accept, face, and process the reality of what has happened while also offering physical and psychological protection, especially safety from feeling shamed, admonished, or judged.
According to Dr. Van der Kolk, our most pressing public health problem today is trauma, and we are well-equipped to deal with it. The choice is ours to act on what we know!
Multiple Myndlift users report monthly changes in their behavior and lifestyle. Get matched with a Myndlift Provider by finding one in your area or enrolling in our Total Remote program .
About the author:
To help create awareness and positive change in the mental health space, Dubravka Rebic puts a lot of time and energy into researching and writing. From poring over scientific studies to reading entire books in order to write a single content piece, she puts in the hard work to ensure her content is of the highest quality and provides maximum value.
About the reviewer:
Dr. Brown is a clinical psychologist with over 35 years of experience using biofeedback and neurofeedback techniques. His clients include people dealing with depression, anxiety, ADHD, PTSD, and other stress-related conditions. He also helps those who seek to simply "raise their game" in their personal lives as well as their careers.
Van der Kolk, B. A. (2014). The body keeps the score: Brain, mind, and body in the healing of trauma . Viking.
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Alexandra Kredlow, M., Fenster, R.J., Laurent, E.S. et al. Prefrontal cortex, amygdala, and threat processing: implications for PTSD . Neuropsychopharmacol. 47 , 247–259 (2022). https://doi.org/10.1038/s41386-021-01155-7
Keng SL, Smoski MJ, Robins CJ. Effects of mindfulness on psychological health: a review of empirical studies . Clin Psychol Rev. 2011 Aug;31(6):1041-56. doi: 10.1016/j.cpr.2011.04.006. Epub 2011 May 13. PMID: 21802619; PMCID: PMC3679190.
Creswell JD, Lindsay EK, Villalba DK, Chin B. Mindfulness Training and Physical Health: Mechanisms and Outcomes. Psychosom Med. 2019 Apr;81(3):224-232. doi: 10.1097/PSY.0000000000000675. PMID: 30806634; PMCID: PMC6613793.
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Dutra L, Bureau JF, Holmes B, Lyubchik A, Lyons-Ruth K. Quality of early care and childhood trauma: a prospective study of developmental pathways to dissociation. J Nerv Ment Dis. 2009 Jun;197(6):383-90. doi: 10.1097/NMD.0b013e3181a653b7. PMID: 19525736; PMCID: PMC2697443.
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Coach | Teacher | Advisor
- Toby Sinclair
- Jun 26, 2021
The Body Keeps The Score Summary By Bessel Van Der Kolk
Updated: Jul 6, 2021
Buy The Body Keeps The Score on Amazon
⭐ Toby's Rating: 6/10 - Recommended For: Coaches
A fascinating exploration of a wide range of therapeutic treatments shows readers how to take charge of the healing process, gain a sense of safety, and find their way out of the morass of suffering.
— Francine Shapiro, PhD, originator of EMDR therapy
3 Big Ideas 💡
The three big ideas in this The Body Keeps The Score Summary:
For real change to take place, the body needs to learn that the danger has passed and to live in the reality of the present.
Being traumatized is not just an issue of being stuck in the past; it is just as much a problem of not being fully alive in the present.
Nobody can “treat” a war, or abuse, rape, molestation, or any other horrendous event, for that matter; what has happened cannot be undone. But what can be dealt with are the imprints of the trauma on the body, mind, and soul.
2 Best Quotes 💬
The Body Keeps The Score Quotes
Learning how to breathe calmly and remaining in a state of relative physical relaxation, even while accessing painful and horrifying memories, is an essential tool for recovery.
Traumatized children have fifty times the rate of asthma as their non-traumatized peers.
Tobys Top Takeaway ✅
The Body Keeps The Score summary is a fascinating exploration of trauma. I particularly enjoyed the analysis of different approaches such as talk therapy. The Body Keeps The Score shares that talk therapy, although widely used, often does not lead to long term improvement. Instead, a range of other techniques has been proven to make a lasting change. These include mindfulness, relationships and human touch.
Highly recommended for people in helping professions such as coaches, mentors and therapists.
Big Idea Expanded 💡
The Body Keeps The Score Summary expanded for each of the big ideas.
What is trauma and its effects?
Whats the best approach to trauma?
How is trauma and the body connected?
Importance of safety and attachment
The Path To Recovery
Handling the emotional brain.
“The task of describing most private experiences can be likened to reaching down to a deep well to pick up small fragile crystal figures while you are wearing thick leather mittens."
- Harvard psychologist Jerome Kagan
Research from these new disciplines has revealed that trauma produces actual physiological changes, including a recalibration of the brain’s alarm system, an increase in stress hormone activity, and alterations in the system that filters relevant information from irrelevant
For a hundred years or more, every textbook of psychology and psychotherapy has advised that some method of talking about distressing feelings can resolve them. However, as we’ve seen, the experience of trauma itself gets in the way of being able to do that. No matter how much insight and understanding we develop, the rational brain is basically impotent to talk the emotional brain out of its own reality.
Traumatized people become stuck, stopped in their growth because they can’t integrate new experiences into their lives.
If an organism is stuck in survival mode, its energies are focused on fighting off unseen enemies, which leaves no room for nurture, care, and love. This reduces our ability to imagine, plan, play, learn and pay attention to other people’s needs.
Typical Responses to Trauma:
One of the hardest things for traumatized people is to confront their shame about the way they behaved during a traumatic episode, whether it is objectively warranted (as in the commission of atrocities) or not (as in the case of a child who tries to placate her abuser)
It can feel as if you are floating in space, lacking any sense of purpose or direction.
Traumatized people look at the world in a fundamentally different way from other people. For most of us, a man coming down the street is just someone taking a walk. A rape victim, however, may see a person who is about to molest her and go into a panic.
The very event that caused so much pain can also become their sole source of meaning. They feel fully alive only when they revisiting the traumatic past
What's the best approach to trauma?
The challenge: How can people gain control over the residues of past trauma and return to being masters of their own?
Three typical approaches to resolving trauma:
Talk therapy , (re-) connecting with others, and allowing ourselves to know and understand what is going on with us, while processing the memories of the trauma;
Medication - To shut down inappropriate alarm reactions, or by utilizing other technologies that change the way the brain organizes information.
Connecting with the Body - by allowing the body to have experiences that deeply and viscerally contradict the helplessness, rage, or collapse that result from trauma.
Here is an example of how play can be used in therapy:
Steve Gross used to run the play program at the Trauma Center. Steve often walked around the clinic with a brightly colored beach ball, and when he saw angry or frozen kids in the waiting room, he would flash them a big smile. The kids rarely responded. Then, a little later, he would return and “accidentally” drop his ball close to where a kid was sitting. As Steve leaned over to pick it up, he’d nudge it gently toward the kid, who’d usually give a halfhearted push in return. Gradually Steve got a back-and-forth going, and before long you’d see smiles on both faces. From simple, rhythmically attuned movements, Steve had created a small, safe place where the social-engagement system could begin to reemerge.
Other examples demonstrate this approach to recovery. Severely traumatized people may get more out of simply helping to arrange chairs before a meeting or joining others in tapping out a musical rhythm on the chair seats than they would from sitting in those same chairs and discussing the failures in their life.
Sadly, our educational system, as well as many of the methods that profess to treat trauma, tend to bypass this emotional engagement system and focus instead on recruiting the cognitive capacities of the mind
Be patient toward all that is unsolved in your heart and try to love the questions themselves.... Live the questions now. Perhaps you will gradually, without noticing it, live along some distant day into the answer.
—Rainer Maria Rilke, Letters to a Young Poet
The body keeps the score: Memory of trauma is encoded in the viscera, in heartbreaking and gut-wrenching emotions, in autoimmune disorders and skeletal/muscular problems. This demands a radical shift in our therapeutic assumptions.
There are many examples of where trauma connects to physical symptoms. They can include chronic back and neck pain, fibromyalgia, migraines, digestive problems, spastic colon/irritable bowel syndrome, chronic fatigue, and some forms of asthma. Traumatized children have fifty times the rate of asthma as their non-traumatized peers. Studies have shown that many children and adults with fatal asthma attacks were not aware of having breathing problems before the attacks.
Many traumatized children and adults simply cannot describe what they are feeling because they cannot identify what their physical sensations mean. Psychiatrists call this phenomenon alexithymia—Greek for not having words for feelings.
Bessel Van Der Kolk describes a body led approach to explore trauma:
In my practice I begin the process by helping my patients to first notice and then describe the feelings in their bodies—not emotions such as anger or anxiety or fear but the physical sensations beneath the emotions: pressure, heat, muscular tension, tingling, caving in, feeling hollow, and so on. I also work on identifying the sensations associated with relaxation or pleasure. I help them become aware of their breath, their gestures and movements. I ask them to pay attention to subtle shifts in their bodies, such as tightness in their chests or gnawing in their bellies, when they talk about negative events that they claim
What is the role of safety and attachment?
The most natural way for human beings to calm themselves when they are upset is by clinging to another person. This means that patients who have been physically or sexually violated face a dilemma: They desperately crave touch while simultaneously being terrified of body contact
Attachment is the secure base from which a child moves out into the world. Having a safe haven promotes self-reliance and instils a sense of sympathy and helpfulness to others in distress. From the intimate give-and-take of the attachment bond children learn that other people have feelings and thoughts that are both similar to and different from theirs. In other words, they get “in sync” with their environment and with the people around them and develop the self-awareness, empathy, impulse control, and self-motivation that make it possible to become contributing members of the larger social culture
A secure attachment combined with the cultivation of competency builds an internal locus of control, the key factor in healthy coping throughout
Attachment patterns often persist into adulthood. Anxious toddlers tend to grow into anxious adults, while avoidant toddlers are likely to become adults who are out of touch with their own feelings and those of others. (As in, “There’s nothing wrong with a good spanking. I got hit and it made me the success I am today.”) In school avoidant children are likely to bully other kids, while the anxious children are often their victims.
Nobody can “treat” a war, or abuse, rape, molestation, or any other horrendous event, for that matter; what has happened cannot be undone. But what can be dealt with are the imprints of the trauma on body, mind, and soul: the crushing sensations in your chest that you may label as anxiety or depression; the fear of losing control; always being on alert for danger or rejection; the self-loathing; the nightmares and flashbacks; the fog that keeps you from staying on task and from engaging fully in what you are doing; being unable to fully open your heart to another human being.
Trauma robs you of the feeling that you are in charge of yourself: The challenge of recovery is to reestablish ownership of your body and your mind—of yourself. This means feeling free to know what you know and to feel what you feel without becoming overwhelmed, enraged, ashamed, or collapsed.
This path to recovery involves:
Finding a way to become calm and focused
Learning to maintain that calm in response to images, thoughts, sounds, or physical sensations that remind you of the past
Finding a way to be fully alive in the present and engaged with the people around you
Not having to keep secrets from yourself, including secrets about the ways that you have managed to survive
In order to regain control over yourself, you need to revisit the trauma: Sooner or later you need to confront what has happened to you, but only after you feel safe and will not be retraumatized by it. The first order of business is to find ways to cope with feeling overwhelmed by the sensations and emotions associated with the past.
Understanding why you feel a certain way does not change how you feel. But it can keep you from surrendering to intense reactions.
A key skill to learn on the road to recovery is how to manage your emotional brain. Unless you learn to manage the emotional brain people remain trapped.
In this The Body Keeps the Score Summary there are 6 tactics:
In research supported by the National Institutes of Health, my colleagues and I have shown that ten weeks of yoga practice markedly reduced the PTSD symptoms of patients who had failed to respond to any medication or to any other treatment.
At the core of recovery is self-awareness. The most important phrases in trauma therapy are “Notice that” and “What happens next?”
Allow your mind to focus on your sensations and notice how, in contrast to the timeless, ever-present experience of trauma, physical sensations are transient and respond to slight shifts in body position, changes in breathing, and shifts in thinking. Once you pay attention to your physical sensations, the next step is to label them, as in “When I feel anxious, I feel a crushing sensation in my chest.” "Focus on that sensation and see how it changes when you take a deep breath out, or when you tap your chest just below your collarbone, or when you allow yourself to cry.”
Practising mindfulness calms down the sympathetic nervous system so that you are less likely to be thrown into fight-or-flight.
Study after study shows that having a good support network constitutes the single most powerful protection against becoming traumatized
After an acute trauma, like an assault, accident, or natural disaster, survivors require the presence of familiar people, faces, and voices; physical contact; food; shelter and a safe place; and time to sleep.
Finding a responsive community in which to tell your truth makes recovery possible
When we play together, we feel physically attuned and experience a sense of connection and joy. Improvisation exercises also are a marvellous way to help people connect in joy and exploration. The moment you see a group of grim-faced people break out in a giggle, you know that the spell of misery has broken.
However, the most natural way that we humans calm down our distress is by being touched, hugged, and rocked. This helps with excessive arousal and makes us feel intact, safe, protected, and in charge
People who actively do something to deal with a disaster—rescuing loved ones or strangers, transporting people to a hospital, being part of a medical team, pitching tents or cooking meals—utilize their stress hormones for their proper purpose and therefore are at much lower risk of becoming traumatized.
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Book review article, book review: the body keeps the score: brain, mind, and body in the healing of trauma.
- 1 School of Nursing, The Hong Kong Polytechnic University, Hong Kong, China
- 2 Department of Applied Social Sciences, The Hong Kong Polytechnic University, Hong Kong, China
- 3 Department of Paediatrics and Adolescent Medicine, Queen Mary Hospital, Hospital Authority, Hong Kong, China
- 4 State Key Laboratory of Translational Oncology, Department of Anatomical and Cellular Pathology, The Chinese University of Hong Kong, Hong Kong, China
A Book Review on The Body Keeps the Score: Brain, Mind, and Body in the Healing of Trauma
Bessel van der Kolk (Penguin Books), 2015, 464 pages, ISBN: 978-0143127741.
Posttraumatic stress disorder (PTSD) is defined as a psychiatric disorder in an individual who has experienced or witnessed a devastatingly traumatic event ( Bufka et al., 2020 ). These patients persistently experience overwhelming stress responses beyond the traumatic period. Fear and stress are triggered predominantly in response to a dangerous event followed by a series of bodily changes, including increased blood pressure, heart rate, and breathing due to the release of adrenaline. This biochemical reaction is termed as the “fight-or-flight” mechanism, which temporarily protects people against danger ( Kozlowska et al., 2015 ). It has been well-recognized that PTSD significantly impacts social functioning, physical well-being, and occupational ability ( Watkins et al., 2018 ).
Bessel revisits his clinical experience and reconfirms the impact of PTSD on his patients. People with PTSD experience various symptoms, including personality changes, depression, social disconnection, poor sleep hygiene, flashbacks, and nightmares. Facing recurrent episodes of disturbing symptoms, PTSD patients are prone to develop risky behaviors, including alcoholism, substance abuse, or self-injury. PTSD has many negative impacts on patients' quality of life (QoL), and poses a potential health burden to society if no prompt assessment and support is guaranteed ( Lewis et al., 2019 ).
In his work “The body keeps the score,” Bessel highlights that traumatic stress is at the root of neuroscience. Traumatic stress is associated with functional and chemical changes in the emotional part of the brain—the limbic area and brain stem. Knowing the functions of the amygdala, hippocampus, and prefrontal cortex, as the primary stress responders in the brain, can provide a new therapeutic direction for PTSD management. The hyperactive status of the amygdala triggers the release of stress hormones ( Badura-Brack et al., 2018 ) and impairs the functioning of the hippocampus, causing traumatic memories to remain vivid. In addition, the deactivation of the prefrontal cortex function and the failure to maintain a balanced stress hormone system, causes panic, agitation, and hypervigilance responses in PTSD patients ( Koenigs and Grafman, 2009 ). This hyperactive aroused emotional status can be evidenced by hyperactive brain waves over the fear center of the right temporal lobe of the brain, with suppression of electric activity over the frontal area.
Pharmacotherapy is the first-line of treatment for PTSD. Antipsychotics, anticonvulsants, and tranquilizers have been widely used to improve the QoL of PTSD patients over the past few decades. As some patients developed morbid obesity and diabetes from the medication as well as experienced drug overdoses, it alarmed the book author and pushed him to consider a much safer and natural approach to assist PTSD patients in dealing with their symptoms and responses using a self-regulation strategy. Bessel further suggests that medication cannot 'cure' trauma; it can only mediate the disruptive behavior of the sufferers.
This revolutionary treatment was enlightened by one of Bessel's patients, who could not get rid of his traumatic memory as a minister for many years after returning home from Vietnam. This memory was subconsciously imprinted in his life. Bessel continued working with this patient and explored that yoga can help him regain his sense of control and bodily pleasure. A subsequent experimental study showed that mindfulness yoga significantly reduced PTSD symptomatology and restore the homeostasis of the autonomic nervous system. With the aid of the mindfulness approach, we can raise awareness of bodily sensations, which can improve control over the flow of emotions by decreasing activity over the amygdala. Hence, individuals can have a reasonable degree of control over themselves, both physically and psychologically ( Streeter et al., 2012 ).
To restore the emotional part of the brain and repair the limbic system, Bessel explains various psychotherapies related to the brain, mind, and body of PTSD patients. He emphasized on the human body as the means of communicating with oneself and others. Expressive therapies, through language, art, music, and dance, can motivate people orientate themselves and find their own identity and a meaningful purpose in life ( Baker et al., 2018 ). Most importantly, the reconnection of attachment bonding with family and friends can help individuals feel secure in fighting against the threat ( Chan et al., 2021a , b ).
“The body keeps the score” attempts to address how PTSD patients experience trauma over the years following a traumatic exposure. From the stories of different victims introduced by the author, Bessel used both scientific and philosophical approaches to explain the complex neurobiology and connection of the human brain-mind-body, and provided useful guides for specialists and the public. An abstract or summary of each chapter can aid readers in capturing the essence of the message. As various approaches that can help people with PTSD are suggested by the author, the book would be more comprehensive if further empirical findings are provided to demonstrate their effectiveness and how readers can integrate them into practice.
JH is mainly writing this book review. CL, AC, and PT gave comment and suggestion in this manuscript. All authors contributed to the article and approved the submitted version.
The preparation of this manuscript was partially supported by funding's from School of Nursing and the Department of Applied Social Sciences, The Hong Kong Polytechnic University, Hong Kong.
Conflict of Interest
The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.
All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article, or claim that may be made by its manufacturer, is not guaranteed or endorsed by the publisher.
Badura-Brack, A., McDermott, T. J., Heinrichs-Graham, E., Ryan, T. J., Khanna, M. M., Pine, D. S., et al. (2018). Veterans with PTSD demonstrate amygdala hyperactivity while viewing threatening faces: a MEG study. Biol. Psychol. 132, 228–232. doi: 10.1016/j.biopsycho.2018.01.005
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Bufka, L. F., Wright, C. V., and Halfond, R. W. (Eds.). (2020). Casebook to the APA Clinical Practice Guideline for the Treatment of PTSD. Washington, DC: American Psychological Association.
Chan, A. S. W, Ho, J. M. C., Tam, H. L., and Tang, P. M. K. (2021a) Book review: successful aging: a neuroscientist explores the power potential of our lives. Front. Psychol. 12:705368. doi: 10.3389/fpsyg.2021.705368
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Lewis, S. J., Arseneault, L., Caspi, A., Fisher, H. L., Matthews, T., Moffitt, T. E., et al. (2019). The epidemiology of trauma and posttraumatic stress disorder in a representative cohort of young people in England and Wales. Lancet Psychiatry 6, 247–256. doi: 10.1016/S2215-0366(19)30031-8
Streeter, C. C., Gerbarg, P. L., Saper, R. B., Ciraulo, D. A., and Brown, R. P. (2012). Effects of yoga on the autonomic nervous system, gamma-aminobutyric-acid, and allostasis in epilepsy, depression, and post-traumatic stress disorder. Med. Hypotheses 78, 571–579. doi: 10.1016/j.mehy.2012.01.021
Watkins, L. E., Sprang, K. R., and Rothbaum, B. O. (2018). Treating PTSD: a review of evidence-based psychotherapy interventions. Front. Behav. Neurosci. 12:258. doi: 10.3389/fnbeh.2018.00258
Keywords: posttraumatic stress disorder, physical well-being, psychological well-being, health care, quality of life
Citation: Ho JMC, Chan ASW, Luk CY and Tang PMK (2021) Book Review: The Body Keeps the Score: Brain, Mind, and Body in the Healing of Trauma. Front. Psychol. 12:704974. doi: 10.3389/fpsyg.2021.704974
Received: 04 May 2021; Accepted: 25 May 2021; Published: 18 August 2021.
Edited and reviewed by: Hyemin Han , University of Alabama, United States
Copyright © 2021 Ho, Chan, Luk and Tang. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY) . The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
*Correspondence: Jacqueline Mei Chi Ho, firstname.lastname@example.org ; Alex Siu Wing Chan, email@example.com
The Body Keeps the Score: Brain, Mind, and Body in the Treatment of Trauma (Book Summary)
- Posted in Book summary , Books , Emotions , Habits , Personal growth
- On October 22, 2019
- BY Tiago Forte
- Last modified
- January 31, 2020
Estimated reading time: 32 minutes
This post is also available in Ukrainian
When I first picked up this book, I wasn’t quite sure what it had to do with me.
It is a book about trauma – what it is, where it comes from, and how to treat it. But I had never experienced abuse, or been caught in a natural disaster, or been attacked. I didn’t have any trauma…
As I turned the pages, slowly and then quickly, I was introduced to a completely new conception of trauma unlike anything I had ever encountered before.
I’d spent years immersed in the “personal development” world, obsessed with uncovering hidden truths and rewriting limiting beliefs. I had read countless books on positive psychology, spiritual growth, and overcoming cognitive biases. But somehow I had never taken the time to really understand what lies at the root of a disturbed psychology.
On the pages before me I saw many of the challenges I had encountered in myself, my students, and my clients for years, except this time framed as common side effects of trauma. For example:
- Difficulties with focusing and memory
- Sensory overload and filtering what matters from what doesn’t
- Difficulty sleeping and relaxing
- Learning new information and changing behavior
- Cultivating a sense of confidence and personal agency
- Fear and anxiety around taking risks
- Fully accessing imagination and creativity
- Self-doubt and perfectionism
- Chronic fatigue and exhaustion
- Maintaining motivation and a sense of purpose
I was shocked to learn that not only is attention deficit a common symptom of trauma, but so is hyperfocus. They can both be forms of dissociation – an attempt to escape from the present moment. Even those of us who find it easy to “be productive” are not immune to the impact of trauma.
I thought, could this be the key to so much that plagues us? Could it be the root cause of so many problems that keep us from achieving our most cherished goals and dreams?
I’ve summarized the book The Body Keeps the Score (affiliate link) below because I want the information it contains to spread far and wide. These findings are critically important to everything from education, to social policy, to healthcare, to law enforcement, to personal development, and far beyond. In fact, I have difficulty thinking of any domain that they won’t have an impact on.
The book is written by Dr. Bessel van der Kolk , summarizing his four decades of experience studying the impact of trauma on childhood brain development and emotion regulation. As a clinician and researcher at Harvard University and Boston University, he has published more than 150 academic papers and led studies on the effectiveness of yoga, Eye Movement Desensitization and Reprocessing, neurofeedback, MDMA, theatre, and other methods for treating trauma.
In other words, there is no one more qualified to speak on both the scientific and personal impact of trauma in a wide variety of contexts.
I’ll focus on what I think are the most important, unusual, and powerful points from Dr. Van der Kolk’s message. All research and conclusions come from the book. Any errors or omissions are mine.
Trauma is universal
Trauma is an almost universal part of the human experience, the book establishes early on.
We usually think of trauma as a thing that happens in very extreme circumstances – rape, molestation, physical abuse, extreme neglect, assault, domestic violence, or natural disasters. But this is acute trauma, which is not the only kind.
Even acute trauma is common. Research from the Centers for Disease Control (CDC) found that one in five Americans has been sexually molested as a child; one in four has been beaten by a parent; one in four of us grew up with alcoholic relatives; and one out of eight has witnessed their mother being beaten or hit.
These are appalling numbers, far beyond what even most practitioners expect. Childhood trauma is a silent epidemic, with only one-third of respondents in the landmark ACE study (from which these findings are drawn) reporting no such experiences.
The CDC estimates that overall costs for childhood and adolescent trauma exceed those of cancer or heart disease, and that eradicating child abuse in America would reduce the overall rate of depression by more than half, alcoholism by two-thirds, and suicide, IV drug use, and domestic violence by three-quarters.
But even for those of us who experienced no such incidents, there remains a subtler and less graphic source of trauma: chronic emotional abuse and neglect. Incredibly, Van der Kolk’s research has shown that such abuse and neglect can be just as devastating as physical abuse and sexual molestation.
He cites the research on childhood attachment by his Harvard colleague Karlen Lyons-Ruth, who in the 1980s conducted an influential study that followed children from birth to 20 years old. Their hypothesis was that hostile or intrusive behavior on the part of mothers would be the strongest indicator of mental instability in their adult children.
Instead, they found that a mother’s emotional withdrawal had the most profound and long-lasting impact.
If your caregivers regularly ignore your needs, you learn to anticipate rejection and withdrawal. You cope by blocking out their hostility or neglect and acting as if it doesn’t matter. But the body keeps the score : it remains in a state of high alert, prepared to ward off blows, deprivation, or abandonment.
One of the most devastating effects of this, Van der Kolk found, is “not feeling real inside.” When you don’t feel real, nothing matters. It’s impossible to protect yourself from danger or attend to your own needs. You may resort to extremes in an effort to feel something – even cutting yourself with razor blades or getting into fights with strangers.
And all of this carries into adulthood. It doesn’t just go away on its own. A child who has been ignored or chronically humiliated is likely to lack self-respect. Children who have not been allowed to assert themselves will have trouble standing up for themselves. And many adults who were brutalized as children carry a smoldering rage they can barely contain.
As psychologists have observed all the way back to Freud and Breuer, “the psychical trauma—or more precisely the memory of the trauma—acts like a foreign body which long after its entry must continue to be regarded as an agent that still is at work.”
In other words, the memory of the trauma acts like a splinter in the mind – it is the body’s response to the foreign object that becomes the problem rather than the object itself.
From a neuroscience lens, brain-imaging studies of trauma patients usually find abnormal activation of the insula. The insula integrates and interprets information from sensory organs, and transmits fight-or-flight signals to the amygdala when necessary.
In people with trauma, these signals are firing all the time . It doesn’t require any conscious influence – you just constantly feel on edge, for no apparent reason. You may have a sense that something has gone wrong, or of imminent doom. These powerful feelings are generated deep inside the brain and cannot be eliminated by reason or understanding.
Van der Kolk tells the story of a high-powered trial lawyer he had once worked with. He was driven, successful, and well-respected for his achievements. But he found that he was unable to enjoy them. He would pretend to feel gratified when he won a case, and when he lost it was as though he had seen it coming and was resigned to defeat before it even happened.
The lawyer would get totally absorbed in devising a strategy for winning a case, and would stay up all night enmeshed in the details. “It was like being in combat,” he said. He felt fully alive, and like nothing else mattered. But when the case finished, win or lose, he would lose his energy and sense of purpose.
This story describes a common experience among survivors of trauma: they only feel fully alive when they are totally absorbed, allowing them to escape their current reality, but at the cost of aliveness, motivation, excitement, and purpose in the rest of their lives.
Trauma becomes physical symptoms
When people are chronically angry or scared, constant muscle tension ultimately leads to spasms, back pain, migraine headaches, fibromyalgia, and other kinds of pain.
Other common conditions which often have no clear physical cause include chronic neck pain, digestive problems, spastic colon/irritable bowel syndrome, chronic fatigue, and some forms of asthma. Traumatized children have fifty times the rate of asthma as their non-traumatized peers.
These individuals may visit multiple specialists, undergo extensive diagnostic tests, and be prescribed medications. These measures may provide temporary relief, but none of them address the underlying cause.
Another common symptom is alexithymia, in which a person reports feeling physically uncomfortable without being able to describe exactly what the problem is. This comes from self-numbing, which keeps them from responding to the ordinary needs of their bodies in quiet, mindful ways – shifting in their chair, stretching, drinking water, or going for a walk, for example.
If you’re not aware of what your body needs, you’re unable to take care of it. If you don’t feel hunger, you can’t nourish yourself. If you mistake anxiety for hunger, you may eat too much. And if you can’t feel satiated, you’ll keep eating.
The impact of trauma
The overall effect of trauma can be described as a “loss in the feeling of aliveness, motivation, excitement, and purpose.”
In brain scans of 18 chronic PTSD (Post-Traumatic Stress Disorder) patients, researchers discovered something startling: there was almost no activation of the “self-sensing” areas of the brain when compared to non-traumatized subjects: the medial prefrontal cortex, the anterior cingulate, the parietal cortex, and the insula were dark.
Their conclusion was that “in response to their trauma, and in coping with the dread that persisted long afterward, these patients had learned to shut down the brain areas that transmit the visceral feelings and emotions that accompany and define terror .”
Here’s the problem: those very same areas are also responsible for registering the entire range of emotions and sensations that form the foundation of our self-awareness. What the researchers were witnessing was a terrible tradeoff: in an effort to shut off terrifying sensations, they had also deadened their capacity to feel fully alive.
Traumatized people often lose their sense of purpose and direction, because they cannot check in with themselves about what they truly want, as defined by the most basic sensations in their bodies, which are the basis of emotions like desire and passion. In some cases, the loss of self-awareness is so profound that subjects cannot even recognize themselves in the mirror.
Suppressing one’s core feelings takes a tremendous amount of energy. This leaves less energy for pursuing meaningful goals, making you feel bored and shut down. But at the same time, stress hormones are flooding your body, leading to headaches, muscle aches, bowel problems, sexual dysfunction, or aggressive behavior toward people around you.
This quote powerfully sums up what is missing:
“All of us, but especially children, need such confidence— confidence that others will know, affirm, and cherish us . Without that we can’t develop a sense of agency that will enable us to assert: “This is what I believe in; this is what I stand for; this is what I will devote myself to.” As long as we feel safely held in the hearts and minds of the people who love us, we will climb mountains and cross deserts and stay up all night to finish projects . Children and adults will do anything for people they trust and whose opinion they value.”
With a map of the world based on trauma, abuse, and neglect, traumatized people often seek shortcuts to oblivion. Anticipating rejection, ridicule, and deprivation, they are reluctant to try new options, certain that they will lead to failure. This lack of experimentation traps them in a world of fear, isolation, and scarcity where it is impossible to welcome the very experiences that might change their basic perspective.
A distinct lack of imagination has been noted among traumatized subjects. When they are compulsively and constantly being pulled into the past, they cannot envision a different future.
But imagination is essential to the quality of our lives. It fires our creativity, relieves our boredom, alleviates our pain, enhances our pleasure, and enriches our most intimate relationships. Without it, there is no hope, no chance to envision a better future, no place to go, no goal to reach.
Other common symptoms or effects of trauma include:
Flashbacks and projection
The traumatic event had a beginning, middle, and end. But flashbacks can be even worse: you never know when they will strike, or how long they will last. Traumatized people often “project” their trauma onto people and everyday situations, seeing risks and dangers where there are none.
Othering of self and others
After trauma the world becomes sharply divided – between those who know and those who don’t. People who have not shared the traumatic experience cannot be trusted, because they can’t understand it. Sadly, this often includes their spouse, children, and close friends.
Feeling numb during children’s birthday parties or at weddings makes people feel like monsters, like they are not a part of the human race. As a result, shame becomes the dominant emotion and hiding the truth the central preoccupation.
Van der Kolk and his colleagues often noted a distinct lack of physical coordination among their subjects: they had trouble playing sports, pitching tents, righting a boat, and even seemed stilted in casual conversation.
He eventually came to understand these as symptoms of a profound disembodiment. Their bodies constantly bombarded by visceral warning signs, they become experts at ignoring their gut feelings and numbing awareness of what’s going on inside.
People who cannot comfortably notice what is going on within them become vulnerable to any sensory shift, and respond either by shutting down or going into a panic. It is now understood that what drives panic attacks is not the initial trigger, but an escalating fear of the bodily sensations that accompany the panic attack itself.
Chronically elevated stress hormones
Embedded trauma can easily be reactivated at the slightest trigger. Massive amounts of stress hormones flood the system, and take much longer to return to baseline than normal. The insidious effects include memory and attention problems, irritability, and sleep disorders.
Overcontrol and hypervigilance
Being traumatized means continuing to organize your life as if the trauma is still going on. Every new encounter and event is continuously contaminated by the past in an endless loop. A survivor of trauma will devote their entire energy to suppressing inner chaos, leading to a withdrawal from life and a range of conditions such as fibromyalgia, chronic fatigue, and other autoimmune diseases.
In a study on people with PTSD, researchers found that there was no activation in the frontal lobe when they encountered strangers. Instead of experiencing curiosity, there was intense activation in a primitive area known as the Periaqueductal Gray, which generates startle, hypervigilance, cowering, and other self-protective behaviors. In response to being looked at they simply went into survival mode.
Dissociation and avoidance
Dissociation is the essence of trauma. The traumatic experience is split off and fragmented, so that the emotions, sounds, images, thoughts, and physical sensations intrude into the present and are relived. These people respond to even the smallest of irritations as if they are going to be annihilated, and can’t understand why. A common response is to reorganize their lives around trying to avoid these memories. But constantly fighting unseen dangers is exhausting and leaves them fatigued, depressed, and weary.
While reliving trauma can be terrifying and even self-destructive, over time a lack of presence can be even more damaging. The kids who act out are at least given time and attention. But the ones who are simply blanked out don’t bother anybody and are left alone to lose their future bit by bit.
Difficulty integrating traumatic memories
Under ordinary conditions, our emotional and rational memory systems work together to integrate new experiences into a continuous flow. But in traumatic events, many regions shut down: linguistic areas, areas responsible for creating our sense of time and space, and the thalamus, which integrates raw sensory data.
This results in a memory that is not cohesive and organized in a logical narrative, but stored as disorganized “fragments” of images, sounds, and chaotic physical sensations. In effect, a wall is erected between the two parts of a dual memory system. The traumatic memory isn’t integrated into the combined, ever-shifting sense of who we know ourselves to be.
Ordinary memory is social and adaptive – it can be reorganized, condensed down for quicker retelling, or expanded into its full detail depending on the needs of the moment. But the fragmentation and chaos of traumatic memory makes it inflexible – the reenactment is frozen in time, unchanging and always lonely, humiliating, and alienating.
In normal circumstances, the thalamus serves as a filter or “gatekeeper” for incoming information. This makes it a central component of attention, concentration, and learning, all of which are known to be compromised by trauma.
People with PTSD have the sensory floodgates wide open. Lacking a filter, they are on constant sensory overload. In order to cope, they try to shut themselves down and develop tunnel vision and hyperfocus. If they can’t do this naturally, they may turn to drugs or alcohol to block out the world. The tragedy is that by closing down they are also filtering out pleasure and joy as well.
Addiction to trauma
Van der Kolk noted a common phenomenon among his patients, which he calls “addiction to trauma.”
Many traumatized people seem to seek experiences that would repel most of us, and even sometimes the very experience that traumatized them in the first place. They report a vague sense of emptiness and boredom when they are not angry, under duress, or involved in some dangerous activity.
In an experiment with eight veterans, they were asked to keep their hand in painfully cold water for as long as possible. One group watched the graphic war movie Platoon – and were able to keep their hand in the water 30% longer than a control group.
Reexposure to memories of war-time stress functioned as a relief from pain and anxiety. The researchers calculated that the pain relief they experienced was equivalent to eight milligrams of morphine, about the same dose a person would receive in an emergency room for crushing chest pain.
This could explain why people with trauma paradoxically seek injury or are only attracted to people who hurt them. If you have no internal sense of security, it is difficult to distinguish between safety and danger. If you feel chronically numbed out, potentially dangerous situations may make you feel alive.
Pathways for treatment
The Body Keeps the Score summarizes several decades of research into the nature of trauma. Drawing on Van der Kolk’s work and those of many others, it reveals the discoveries of a new generation of disciplines, including:
- Neuroscience , the study of how the brain supports mental processes.
- Developmental psychopathology , the study of the impact of adverse experiences on the development of mind and brain.
- Interpersonal neurobiology , the study of how our behavior influences the emotions, biology, and mind-sets of those around us.
What these disciplines have revealed is that trauma causes actual physiological changes in the brain. This includes a recalibration of the brain’s alarm system, an increase in stress hormone activity, and alterations in the system that filters relevant information from irrelevant.
Trauma results in a fundamental reorganization of the way the mind and body manage perceptions, plunging people into a perceived world full of risks and threats.
The book presents three pathways by which we can use the brain’s natural neuroplasticity to undo the effects of trauma:
- Top down , by talking, (re-)connecting with others, and allowing ourselves to know and understand what is going on within us, while processing the memories of the trauma.
- By taking medicines that shut down inappropriate alarm reactions, or by utilizing other technologies that change the way the brain organizes information.
- Bottom up , by allowing the body to have experiences that deeply and viscerally contradict the helplessness, rage, or collapse that result from trauma.
Top down, by talking
Although psychoanalysis has fallen out of favor in recent years, the “talking cure” remains one of the most established and popular ways of addressing trauma.
Top-down regulation involves strengthening the capacity of the mind’s “inner manager” to monitor your body’s sensations. Its basic premise is that recounting the traumatic incident in great detail and processing it through language will help the mind to leave it behind.
Here’s the limitation with the talking cure: trauma is preverbal. Neuroscience research shows that very few psychological problems are the result of defects in understanding. Therefore improving one’s understanding doesn’t help. Most psychological problems originate in deeper regions of the brain that drive our perception and action.
A surprising finding of Van der Kolk’s research was that a region in the left frontal lobe called Broca’s area went offline when traumatized subjects experienced flashbacks. Broca’s area is a speech center, and is similarly affected during a stroke. Reliving trauma shuts down people’s ability to express what they are experiencing in words, just as in a stroke.
At the same time, another region of the brain called Brodman’s area lit up. This is a region in our visual cortex that registers images when they first enter the brain. Flashbacks of trauma deactivate the left hemisphere – responsible for words, logic, and facts – and activates the right hemisphere, which is responsible for memories of sound, touch, smell, and the emotions they evoke. These memories bypass the executive functions of the brain, making them feel like intuitive truth – the way things are.
Trauma by its nature drives people to the edge of comprehension. It cuts us off from language based on common experience or an imaginable past.
Van der Kolk summarizes, “Our research did not support the idea that language can substitute for action.” Most subjects could tell a coherent story and experience the pain associated with what happened to them. Yet they continued to be haunted by unbearable images and physical sensations.
No matter how much insight or understanding people develop, the rational brain is basically impotent to talk the emotional brain out of its own reality. When our emotional and rational brains are in conflict (as when we’re enraged by someone we love, frightened by someone we depend on, or lust after someone who is off limits) a tug-of-war ensues. But this battle is largely played out in the theatre of visceral experience – in our gut, our heart, our lungs – and not in the world of ideas.
Cognitive behavioral therapy (CBT), a more modern incarnation of the talking cure, nevertheless suffers from many of the same drawbacks.
CBT has been used very successfully for irrational fears such as spiders, but has been much less successful for treating trauma, particularly those with histories of childhood abuse. Only about one in three participants with PTSD (post-traumatic stress disorder) who finish research studies in CBT show some improvement. Those who complete CBT treatment usually have fewer PTSD symptoms, but they rarely recover completely. Most continue to have substantial problems with their health, work, or mental well-being.
Finding words to describe what has happened to you can be transformative, but it does not always abolish flashbacks or improve concentration, stimulate vital involvement in your life, or reduce hypersensitivity to disappointments and perceived injuries.
Antipsychotic medicines have transformed the psychiatric profession in recent decades. They were largely responsible for reducing the number of people living in mental hospitals in the United States, from over 500,000 in 1955 to fewer than 100,000 in 1996.
Van der Kolk describes the pharmacological revolution as “unimaginable” and “miraculous.” Nearly overnight, he witnessed patients who had spent much of their lives locked in their own separate, terrifying realities suddenly able to return to their families and communities. Patients mired in darkness and despair started to respond to the beauty of human contact and the pleasures of work and play.
Yet as transformative as these substances have been, we are starting to run up against their limits. Studies of Prozac found that it had no effect on combat veterans with PTSD. These results have held true for most subsequent pharmacological studies on veterans: while a few have shown modest improvements, most have not benefited at all.
Van der Kolk has come to the conclusion that psychiatric medications have a downside: they may deflect attention from dealing with underlying issues. The diagnoses that people receive can take control of their fate out of their own hands, and put doctors and insurance companies in charge of fixing their problems.
Consider the case of antidepressants. If they were indeed a permanent, long-term solution, depression should by now have become a minor issue in society. Yet it has not made a dent in hospital admissions. The number of people treated for depression has tripled over the past two decades, and one in ten Americans now take antidepressants.
There is also a dramatically uneven socioeconomic impact. Children from low-income families are four times more likely than privately insured children to receive antipsychotic medicines. These medications are often used to make abused and neglected children easier to deal with. But they also interfere with motivation, play, and curiosity, which are indispensable for maturing into well-functioning and contributing members of society. Children who take them are also at risk of becoming morbidly obese and developing diabetes.
Based on these and other findings, Van der Kolk concludes that “…drugs cannot ‘cure’ trauma; they can only dampen the expressions of a disturbed psychology.” They do not teach the lasting lessons of self-regulation. They can help to control feelings and behavior, but at the price of blocking the chemical systems that regulate engagement, motivation, pain, and pleasure.
The most controversial medications, the so-called “second-generation antipsychotic agents” such as Risperdal and Seroquel, are the best-selling psychiatric drugs in the United States. More than half a million children and adolescents are now taking them.
These antipsychotic drugs are widely used to treat abused children who are inappropriately diagnosed with bipolar disorder or mood dysregulation disorder. And yet for the most severe symptoms – dissociation, self-mutilation, fragmented memories, and amnesia – they generally have no effect.
Meanwhile, there have been no studies on the effects of psychotropic medications on the developing brain. These medications dampen the emotional brain and thus make children less skittish or enraged, but may also interfere with being able to appreciate subtle signals of pleasure, danger, or satisfaction. They can also make them physically inert, further increasing their sense of alienation. They may work in calming them down, but by blocking the dopamine reward centers, may interfere in learning age-appropriate skills and developing friendships with other children.
Bottom up, through experiences
Bottom-up regulation involves recalibrating the autonomic nervous system (ANS), which originates in the brain stem. We can access the ANS through breath, movement, or touch.
In psychomotor and somatic therapy, one of the treatment methods that fall into this category, the goal is to form new memories that live side by side with the painful realities of the past. These new memories provide sensory experiences of feeling seen, cradled, and supported in ways that can serve as antidotes to memories of hurt and betrayal.
In order to change, people need to become viscerally familiar with realities that directly contradict the feelings of being frozen or panicked. They need to replace them with sensations rooted in safety, mastery, delight, and connection. A bottom-up approach trains people in reactivating the brain structures that were knocked out during the original experience of trauma.
Before we examine the bottom-up pathway in more detail, we’ll need to take a detour into biology – specifically, the crucial role played by the vagus nerve.
The vagus nerve
Our social engagement system depends on nerves that have their origin in the brain stem regulatory centers, primarily the vagus nerve.
Together with adjoining nerves it activates the muscles of the face, throat, middle ear, and voice box or larynx. When this nerve complex is working properly, we are able to empathize and synchronize with others. These nerves send signals down to our heart and lungs, slowing down our heart rate and increasing the depth of our breathing. As a result, we feel calm and relaxed, centered, or pleasurably aroused.
Any threat to our safety or social connections triggers changes in the vagus nerve. The throat gets dry, the voice becomes tense, the heart speeds up, and respiration becomes rapid and shallow. These changes are partially meant to signal others to come to our aide.
But if no one comes, the older limbic brain takes over. The sympathetic nervous system mobilizes muscles, heart, and lungs for fight or flight. Our voice becomes faster and more strident and our heart starts beating faster.
Finally, if the threat continues and there is still no way out, the ultimate emergency system is activated: the dorsal vagal complex (DVC). This system reaches down deep below the diaphragm to the stomach, kidneys, and intestines.
Our heart rate plunges (our heart “drops”), we can’t breathe, and our guts stop working or empty. Metabolism is drastically reduced throughout the body. This is the point at which we disengage, collapse, or freeze. Once this system takes over, both ourselves and other people cease to matter. We may not even register physical pain. This level of immobilization is at the root of most traumas.
Bottom-up treatment of trauma
Of the three pathways for trauma treatment, bottom-up approaches like somatic and psychomotor therapies are the least used and appreciated.
Their aim is three-fold:
- To draw out the sensory information that is blocked and frozen by trauma
- To help patients befriend (rather than suppress) the energies released by that inner experience
- To complete the self-preserving physical actions that were thwarted when they were trapped, restrained, or immobilized by terror
Talking and understanding help, and drugs can dampen hyperactive alarm systems. But research and practice have shown that imprints from the past can also be transformed by having physical experiences that directly contradict the helplessness, rage, and collapse that are part of trauma. And by doing so, regaining self-mastery.
In the mid-1980s, Steven Maier and Martin Seligman performed experiments in “learned helplessness” with dogs. They repeatedly administered painful shocks to dogs who were trapped in locked cages, triggering a condition called “inescapable shock.” After the cages were opened, dogs who had been previously shocked didn’t run away. They simply laid there, whimpering and defecating.
This famous experiment sheds light on what happens with trauma in humans: opening the pathway to freedom doesn’t necessarily mean they take it. Rather, they often just give up rather than experimenting with unknowns.
The scientists found that the only way to teach the traumatized dogs to get off the electric grids when the doors were open was to repeatedly drag them out of their cages so they could physically experience how they could get away. Thus began Van der Kolk’s exploration into how these findings could be applied to humans.
What he found was that the opposite of immobilization is effective action . Immobilization keeps the body in a state of inescapable shock and learned helplessness. If a person is held down, trapped, or otherwise prevented from taking effective action – such as in a war zone, car accident, domestic violence, or rape – the brain keeps secreting stress chemicals, and the brain’s electrical circuits continue to fire in vain. But if they can effectively fight or flee, the threat ends and the body returns to normalcy.
Being able to move and do something to protect yourself is a critical factor in whether an experience ends up being traumatic in the first place. Survivors of Hurricane Katrina who were strapped down and airlifted out of dangerous areas suffered worse trauma than those who stayed, for example. The best way to overcome ingrained patterns of submission is to restore a physical capacity to engage and defend.
Before beginning somatic and psychomotor therapies, patients are supported in building up a feeling of internal safety. Body-based therapist Peter Levine calls this “pendulation” – gently moving in and out of accessing internal sensations and traumatic memories. Once they can tolerate being aware of their trauma-based physical experiences, they are likely to discover powerful physical impulses – like hitting, pushing, or running – that were originally suppressed in order to survive.
Somatic therapies create a safe space for these acts to be expressed, amplifying the movements and experimenting with ways to modify them to bring the incomplete actions of the past to completion. These therapies can help patients relocate themselves in the present by experiencing that it is safe to move. Feeling the pleasure of taking effective action restores a sense of agency and a sense of being able to actively defend and protect oneself. This can eventually lead to the resolution of the trauma.
Essential steps for recovery
All these findings and therapies point to a series of essential steps that help people heal their trauma.
You can only be fully in charge of your body if you can acknowledge the reality of your body, in all its visceral dimensions. At some point, we need to feel at home and safe with the full range of sensations available to us.
This can happen through rhythmic interactions with other people – such as in sports, music, dancing, or play. All these activities rely on interpersonal rhythms, visceral awareness, and vocal and facial communication. These help lift people out of fight/flight states, reorganize their perception of danger, and increase their capacity for relationship.
This can happen through developing somatic awareness – by naming what one is feeling. Not the surface emotions like anger, fear, or anxiety, but underlying sensations such as pressure, heat, tension, tingling, caving in, feeling hollow, etc. These physical sensations are transient and respond to slight shifts in body position, changes in breathing, and shifts in thinking. Becoming aware of how your body organizes these feelings opens up the possibility of safely revisiting the past, where you can release impulses that were once blocked in order to survive.
Van der Kolk describes their work helping patients create “islands of safety” within the body. These are parts of the body, postures, or movements they can use to “ground” themselves whenever they feel stuck, terrified, or enraged. These body parts usually lie outside the reach of the vagus nerve, which carries messages of panic to the chest, abdomen, and throat. They can serve as allies in reintegrating the trauma.
Communicating and experiencing fully
At some point in their treatment, victims of trauma must learn to communicate the full extent of their experience.
Often their story has become a rote narrative over time, edited into the form least likely to provoke rejection. But through talking, writing, art, music, dance, and other forms of self-expression, they can begin to tell the real story. That may be one reason these artforms have been practiced in cultures around the world for millennia, helping individuals and communities come to terms with what has happened to them.
In journaling, for example, things will come out that you didn’t even know were there. The inner critic quiets down as words spill out onto the page, as the pen or keyboard seems to channel whatever bubbles up from inside. Through writing, we can connect parts of the brain that don’t normally speak to each other, without worrying about what anyone will say.
In a study by James Pennebaker and Anne Krantz, a San Francisco-based dance and movement instructor, non-verbal artistic expression was compared to writing in its ability to process trauma. One group was asked to disclose a personal traumatic experience through expressive body movements for at least ten minutes per day for three consecutive days and then to write about it for another ten minutes. A second group danced but did not write about their trauma, and a third group engaged in a routine exercise program.
Over three months members of all three groups reported feeling happier and healthier. But only the expressive movement group who also wrote showed objective evidence: better physical health and improved grade point averages.
In a subsequent study by Pennebaker, participants were asked to recount their traumatic experiences into a tape recorder. They found that those who allowed themselves to feel their emotions showed significant physiological changes, both immediate and long term. The drop in blood pressure could still be measured six weeks after the experiment ended.
Learning to trust others again
One of the most devastating effects of trauma is the loss of the ability to trust others. How can you surrender to an intimate relationship after you’ve been brutalized or violated?
Everything about us – our brains, our minds, our bodies – is geared toward collaboration in social systems. It is our most powerful survival strategy. The key to our survival as a species. And it is precisely this that breaks down in most forms of mental suffering. If you look beyond the formal symptoms, almost all forms of mental suffering involve either trouble creating workable and satisfying relationships, or difficulties in regulating arousal (becoming habitually enraged, shut down, overexcited, or disorganized). All of these interfere with our basic social support machinery.
Many traumatized people feel chronically out of sync with other people around them. They often seek out others with similar experiences, who “get it.” This alleviates their sense of isolation, but sometimes at the price of having to deny their individual differences. Isolating oneself into a narrowly defined victim group promotes a view of others as irrelevant at best and dangerous at worst, leading to further alienation. Gangs, extremist political parties, and religious cults may provide solace, but don’t usually offer the mental flexibility needed to be fully open to what life has to offer.
Social support is not merely just being in the presence of other people. The key issue is reciprocity: being truly seen and heard by the people around us, and feeling that we are held in someone else’s mind and heart. For such reciprocity to be possible, our defensive system must temporarily shut down. Intimacy requires us to be able to experience vulnerability without fear.
Being able to feel safe with other people is probably the single most important aspect of mental health. Trusted, intimate connections are fundamental to meaningful and satisfying lives. Because trauma almost always involves not being seen, not being mirrored, or not being taken into account, treatment needs to restore the capacity to mirror and be mirrored by others, without being hijacked by others’ negative emotions.
Traumatized people recover in the context of relationships: with families, loved ones, AA meetings, veterans’ groups, religious communities, or professional therapists.
Letting go of shame
Deep down, many traumatized people are haunted by shame over what they did or didn’t do during their experience. They despise themselves for how terrified, dependent, excited, or enraged they felt.
This is particularly true if the abuser was someone close to them as a child, or someone they depended on, as is so often the case. The result is confusion about whether one was a victim or a willing participant, which in turn leads to bewilderment about the difference between love and terror, pain and pleasure.
Part of recovery is letting go of these feelings of guilt and shame. Forgiving oneself for what happened or didn’t happen. Or realizing that there is nothing to forgive.
Reintegrating memories and changing their meaning
As we saw before, traumatic memories often exist in a separate, walled off part of the mind. An essential part of trauma treatment is reintegrating those memories back into your sense of self, where they often take on new meanings.
Van der Kolk describes his experience working with Albert Pesso, a former dancer who had developed a new kind of treatment for trauma called Pesso Boyden System Psychomotor (PBSP) therapy. It involved creating “structures” or scenarios where subjects recreated scenes from their past. Through an interview format, the main participant (called the “protagonist”) would direct people to sit or stand in positions around the room that represented their role or relationship toward them.
The human brain processes spatial movements with the right hemisphere of the brain, which is the same area that is most affected by trauma. Through creating and then manipulating these structures, the protagonist is able to replay and change scenes from their past. For example, by having someone “play” their mother or father and expressing anger, disappointment, or unexpressed love toward them. Protagonists became like the directors of their own play, enlisting others to provide the love, support, and protection that had been lacking at those critical moments.
These innovative treatment methods don’t erase bad memories, or even neutralize them. They provide fresh options – an alternative memory where your basic human needs were met and your longings for love were fulfilled. Structures promote one of the essential conditions for deep therapeutic change: a trance-like state in which multiple realities can live side by side. In that state you can simultaneously experience the complex emotions of loyalty and tenderness mixed with rage and longing.
The possibility of self-leadership
Trauma robs people of self-leadership – the feeling that you are in charge of yourself. A challenge of recovery is reestablishing ownership of your body and mind.
For most people this involves:
- Finding a way to become calm and focused
- Learning to maintain that calm in response to images, thoughts, sounds, or physical experiences that remind you of the past
- Finding a way to be fully alive in the present and engaged with the people around you
- Not having to keep secrets from yourself, including secrets about the ways that you have managed to survive
As long as people are either hyperaroused or shut down, they cannot learn from experience. Even if they manage to stay in control, they can remain inflexible, stubborn, and depressed. Recovery from trauma involves the restoration of executive functioning, and with it, self-confidence and the capacity for playfulness and creativity.
As our visceral connection to our bodies is reestablished, there is a brand new capacity to warmly love the self. We begin to care for our health, our diet, our energy, and our time. This caring arises spontaneously and naturally, not in response to a “should.” This sets the stage for developing our internal leadership skills – how well we listen to our different parts, make sure they feel taken care of, and keep them from sabotaging one another. Instead of any one part of ourselves dominating the conversation, we can treat them all as important elements in a complex constellation of thoughts and emotions.
Pioneering neuroscience research by scientists like Michael Gazzaniga, combined with work in IFS (Internal Family Systems), has given us a model of the human mind as consisting of multiple distinct subsystems. Each one operates semi-autonomously, with its own needs, skills, and history. They also have different levels of maturity, excitability, wisdom, and pain.
In trauma, the relationship between these subsystems breaks down and they go to war with one another. Self-loathing fights with grandiosity, loving care with hatred, numbing and passivity with rage and aggression. Trauma hijacks these feelings out of their natural, valuable states. For example, we all have parts of ourselves that are childlike and fun. When we are abused, these are the parts that hurt the most, and they become frozen with the pain, terror, and betrayal of abuse. This burden makes them toxic, and the other parts rally to shield themselves from its pain.
In so doing, these “internal managers” take on some aspects of the abuser. Hypercritical and perfectionistic internal voices make sure we never get close to anyone, or drive us to be relentlessly productive, or throw us into a rage at the slightest provocation. They are trying to protect us from the feeling of annihilation, but in the process are making us miserable.
Every complex system requires competent leadership, and this internal system is no different. Treatment involves assuring all parts that they are welcome and valued, even those that are suicidal or destructive. It involves calling on one’s internal leader to wisely distribute the available resources and supply a vision for the whole that takes all parts into account. This “leader self” does not need to be cultivated or trained. It is always there beneath the surface, ready to take charge once the protective mechanisms that have arisen to protect it from destruction step back.
In a nine-month study, a group of IFS subjects showed measurable improvements in self-assessed joint pain, physical function, self-compassion, and overall pain relative to a control group. They also showed significant improvements in depression and self-efficacy. The subjective improvements were maintained one year later, but not the objectively measured ones , indicating that what had improved was their ability to live with their pain.
Traumatic adaptations continue until the entire human organism feels safe and integrates all the parts of itself that are stuck fighting or warding off trauma. If you were abused or neglected as a child, you likely still have a childlike part living inside you that is frozen in time, still holding fast to self-loathing and denial. Pushing these feelings away can be highly adaptive in the short run, helping you preserve your dignity, or focus on critical tasks like caring for your family or rebuilding a house.
But it requires an enormous amount of energy to keep the system under control. A single comment may trigger several parts simultaneously: one that becomes intensely angry, another filled with self-loathing, and a third that tries to calm things down with coping habits. The internal manager we enlist to manage this situation can become a problem unto itself – creating obsessions, seeking distractions, imposing control, thirsting for power, suppressing emotions, or denying reality altogether. Eventually, the powerful managers that we created to protect against the feeling of helplessness need to be put to rest.
The future of trauma
Currently more than 50% of the children served by Head Start have had three or more “adverse childhood experiences” as defined by the ACE study, such as incarcerated family members, depression, violence, abuse, drug use in the home, or periods of homelessness.
This is an absolutely staggering number. It defies our understanding of trauma as something uncommon, that only affects a small minority of people.
Meanwhile, child abuse and neglect is the single most preventable cause of mental illness, the single most common cause of drug and alcohol abuse, and a significant contributor to leading causes of death such as diabetes, heart disease, cancer, stroke, and suicide.
We are slowly moving toward becoming a trauma-aware society, as the research and clinical practice outlined in this book spread into the medical establishment and therapeutic culture. But as Van der Kolk documents in detail, there have been backlashes against acknowledging the reality of trauma before.
This book is a landmark achievement in the history of trauma awareness and treatment. It threads scientific research together with clinical practice and new treatment methods. It calls attention to the horrific impact of trauma and individuals and on society, while suggesting numerous practical ways it can be treated, including ones not included in this summary such as EMDR (Eye Movement Desensitization and Reprocessing), neurofeedback training, and theatre.
Click here to visit the Amazon book page (affiliate link), where it is available in multiple formats.
Take the Posttraumatic Cognitions Inventory developed by clinical psychologist Edna Foa to measure the factors that commonly characterize PTSD.
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The Body Keeps The Score Summary – Bessel van der Kolk
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The Body Keeps the Score is a fascinating dive into the hidden epidemic of trauma, what we've learned about it in the last 30 years and how to better diagnose, face and heal it - by psychiatrist, author and post-traumatic stress researcher, Bessel van der Kolk. ( 443 pages )
Note: This The Body Keeps The Score summary is part of an ongoing project to summarise the Best Emotional Intelligence Books and Best Self Help Books of all time.
Note: This The Body Keeps The Score summary is a stub. I'll write a full summary later. For now, you'll find enough meta-data here to help you decide if it's worth reading the book.
The Body Keeps The Score Review
I spent just a few hours with van der Kolk’s excellent The Body Keeps The Score .
But in that short time it taught me three things:
- That trauma is a more important and widespread problem than I realised;
- That I need and want to get much more sensitive and informed about it; and
- That to get there, I’ll have to spend A LOT more time with this book.
Van der Kolk opens chapter one with a handful of shocking CDC statistics :
- One in five Americans was molested as a child;
- One in four was beaten by a parent;
- One in four grew up with alcoholic relatives (🙋♂️); and
- And one in three couples engages in physical violence.
Conclusion? No matter who you are, where you are or what your background, there’s a good chance, even if you haven’t experienced it first-hand, that someone you know well is at least partly defined by a history of trauma, neglect or abuse.
The short story? The Body Keeps The Score is a must-read. It’ll open your eyes to a hidden epidemic all around us. It’ll make you a better friend, parent and partner. It’ll help you on your journey to becoming kinder and more empathetic self.
I’ll be back for a full The Body Keeps The Score summary later.
But in the meantime, here are some quick, high-level notes below that, quite frankly, fall embarrassingly short of conveying the breadth, depth and power of the insights you’ll find on every page of the original book.
The Body Keeps The Score Summary
The devastating effects of post-traumatic stress disorders (PTSD) caused by violence, abuse and neglect are felt by many more people than just returning veterans and survivors of major accidents.
And yet our standardized go-to tools for diagnosing and treating children, teen and adult sufferers of PTSD in the general population remain woefully blunt and inadequate.
The Body Keeps The Score explores what’s changed in the last 30 years, why those things matter and sets out bold, effective and accessible new strategies for individuals, carers and medical practitioners to diagnose, face and heal from unresolved trauma.
We’ve Learned a Lot About Trauma
We have learned a lot about trauma in the last 30 years, from:
- Traumatic events transcend the self as our main lens of seeing the world;
- We often resort to coping mechanisms that add deep shame to the problem;
- Numbness becomes the only way to deal with the trauma and shame;
- We often mistakenly diagnose and try to treat symptoms (alcoholism, substance abuse, schizophrenia) instead of the trauma that fuels them;
- Removing coping strategies without addressing root causes solves nothing, leads to abandoned treatment and can even worsen psychiatric conditions;
- The same phenomena are seen in and the same lessons can be applied to victims of domestic violence, abuse and neglect.
- The triggers (e.g., hypersensitivity to memory cues and their unintended activation during treatment) for psychiatric problems;
- The symptoms and characteristics of psychiatric problems (e.g., flashbacks, dissociation, depersonalisation, hallucinations, learned helplessness);
- The secondary effects (e.g., distorted memories, coping mechanisms, compulsions, shame, self-harm, loss of agency, distorted cognition) that can complicate and prevent psychiatric problems from resolving themselves;
- The diagnosis and classification of psychiatric problems (i.e., the DSM – the Diagnostic and Statistical Manual of Mental Disorders);
- The neural and hormonal imbalances (e.g., adrenaline, dopamine, serotonin, cortisol) in psychiatric problems and their effects (e.g., memory and attention problems, irritability, sleep disorders); and
- The treatment of psychiatric problems (e.g., drugs, the placebo effect, EMDR, group therapy, experiential healing and others).
- Activation of the right (intuitive, emotional, visual, sensory) side of the brain;
- Activation of the limbic system (emotional centre) and especially the amygdala (fear centre) within it;
- Activation of visual cortex (visual area);
- Deactivation of the left (facts, statistics, logic) side of the brain;
- Deactivation of Broca’s area (speech centre); and
- Deactivation of the thalamus (sensory filtering, integration, sequencing).
Trauma Impacts Both Brain AND Body
We know that trauma significantly impacts both the brain and the body:
- Pay attention to, decipher and enjoy signals in and around us (dissociation);
- Synchronise with, mirror and engage socially with the people around us;
- Detect, interpret and respond to possible danger (fight/flight/freeze) signals;
- Restore “normal” function once a perceived threat has passed;
- Recognize, engage with or describe emotional states (alexithymia); and
- Learn and adapt effectively to new information.
- Manage/recover from adrenal/stress responses to fight/flight/freeze signals;
- Breathe properly due to hyperactivity of the fight/flight/freeze state;
- Manage basic (e.g., sleep, immune) functions due to prolonged stress;
- Digest food properly due to interference with the function of the viscera.
- A numbed inability to connect physical sensations with emotions or thoughts;
- A lack of sense of responsibility or agency; and
- A lack of a sense of self or of being fully alive.
Trauma’s Effects Are Worse for Children
We know that trauma’s effects are often worse for and underreported in children:
- Attachment – Forming healthy relationships with others; and
- Attunement – Adapting our behaviour based on cues from other people.
- They are rarely able to physically escape from abusive caregivers;
- They often feel a strong loyalty to their caregivers, regardless of abuse; and
- They can’t mentally rationalise/separate their abuser’s behaviour.
- Children don’t know how to give words to their suffering; and
- Adults are rarely trained to recognise warning signs and symptoms.
Trauma Is Hard to Resurface
And we know that trauma is difficult to surface:
- It’s hard to recall old, repressed memories accurately ; and
- Doing so is itself a traumatic experience .
There Are 3 Possible Pathways to Recovery
The good news? Once surfaced, there are three possible pathways to recovery:
- Understanding what’s happening in our brains and our bodies;
- Learn to acknowledge, experience and bear what we’ve been through;
- Reconnecting and talking about those experiences with others; and
- Expressing trauma, emotions and ourselves more positively and skilfully through e.g., changing the words we use and theatre.
- Strengthen top-down monitoring of signals through e.g., meditation, yoga;
- Change how we organise information through e.g., EMDR, neurofeedback; and
- Using drugs to dampen hyperactive internal alarm systems.
- Reconnecting mindfully and fully with the body (sensations, heart rate, breathing) through e.g., meditation, yoga;
- Learning to connect sensations with emotions with words so we can detect and process them;
- Learning to control “involuntary” responses through breath, movement and touch; and
- Seeking physical experiences that contradict helplessness, rage and collapse.
Trauma isn’t something you have to put up with or numb into submission.
There ARE strategies you can use to get through it.
The Body Keeps The Score Contents
The Body Keeps the Score contains 20 main chapters split over 5 parts…
Prologue : Facing Trauma
Part One: The Rediscovery of Trauma
- Lessons From Vietnam Veterans
- Revolutions in Understanding Mind and Brain
- Looking Into the Brain: The Neuroscience Revolution
Part Two: This Is Your Brain on Trauma
- Running for Your Life: The Anatomy of Survival
- Body-Brain Connections
- Losing Your Body, Losing Your Self
Part Three: The Minds of Children
- Getting on the Same Wavelength: Attachment and Attunement
- Trapped in Relationships: The Cost of Abuse and Neglect
- What’s Love Got to Do With It?
- Developmental Trauma: The Hidden Epidemic
Part Four: The Imprint of Trauma
- Uncovering Secrets: The Problem of Traumatic Memory
- The Unbearable Heaviness of Remembering
Part Five: Paths to Recovery
- Healing From Trauma: Owning Your Self
- Language: Miracle and Tyranny
- Letting Go of the Past: EMDR
- Learning to Inhabit Your Body: Yoga
- Putting the Pieces Together: Self-Leadership
- Filling in the Holes: Creating Structures
- Rewiring the Brain: Neurofeedback
- Finding Your Voice: Communal Rhythms and Theater
Epilogue : Choices to Be Made
Appendix : Consensus Proposed Criteria for Developmental Trauma Disorder
Best The Body Keeps The Score Quotes
These The Body Keeps The Score quotes come from The Art of Living 's ever-growing central library of thoughts, anecdotes, notes, and inspirational quotes .
"You can be fully in charge of your life only if you can acknowledge the reality of your body, in all its visceral dimensions."
"Being able to feel safe with other people is probably the single most important aspect of mental health; safe connections are fundamental to meaningful and satisfying lives."
"Most bullies have themselves been bullied, and they despise kids who remind them of their own vulnerability."
"Traumatized people chronically feel unsafe inside their bodies: The past is alive in the form of gnawing interior discomfort. Their bodies are constantly bombarded by visceral warning signs, and, in an attempt to control these processes, they often become expert at ignoring their gut feelings and in numbing awareness of what is played out inside. They learn to hide from their selves."
"As long as you keep secrets and suppress information, you are fundamentally at war with yourself… The critical issue is allowing yourself to know what you know. That takes an enormous amount of courage."
"As I often tell my students, the two most important phrases in therapy, as in yoga, are “Notice that” and “What happens next?” Once you start approaching your body with curiosity rather than with fear, everything shifts."
"Trauma is not just an event that took place sometime in the past; it is also the imprint left by that experience on mind, brain, and body. This imprint has ongoing consequences for how the human organism manages to survive in the present. Trauma results in a fundamental reorganization of the way mind and brain manage perceptions. It changes not only how we think and what we think about, but also our very capacity to think."
"Neuroscience research shows that the only way we can change the way we feel is by becoming aware of our inner experience and learning to befriend what is going inside ourselves."
"Beneath the surface of the protective parts of trauma survivors there exists an undamaged essence, a Self that is confident, curious, and calm, a Self that has been sheltered from destruction by the various protectors that have emerged in their efforts to ensure survival. Once those protectors trust that it is safe to separate, the Self will spontaneously emerge, and the parts can be enlisted in the healing process."
"The greatest sources of our suffering are the lies we tell ourselves."
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The Body Keeps the Score Summary and Review
By bessel van der kolk.
Has The Body Keeps the Score by Bessel van der Kolk been sitting on your reading list? Pick up the key ideas in the book with this quick summary.
We’re all familiar with stories of traumatized war veterans who have experienced cruelty and pain, who have killed other people during combat or who have witnessed the death of a fellow soldier. Often, traumatized soldiers cannot find their way back into society. They struggle with their memories, develop hypersensitive reactions and become strangers to themselves and their loved ones.
What happens in the body and mind of people who have experienced trauma? And why is it so difficult to find relief from it?
In this book summary, you’ll learn why traumatic experiences haunt us. You’ll learn how trauma patients perceive their environment. Finally, you’ll learn why there’s hope for traumatized people and how trauma can be healed.
In this summary of The Body Keeps the Score by Bessel van der Kolk,You’ll also find out
- why war veterans only trust other war veterans;
- why an ordinary picture in a magazine can trigger horrifying thoughts; and
- how yoga relieves trauma patients of their pain.
The Body Keeps the Score Key Idea #1: Trauma is incredibly common in our society.
Trauma isn’t just something faced by war veterans – it’s far more prevalent in our society than we realize. The truth is that trauma can happen to anyone, and it’s time we found out what this really means.
Traumas result from an experience of extreme stress or pain that leaves an individual feeling helpless, or too overwhelmed, to cope with adversity. Experiences involving war typically result in traumas, but violent crimes and accidents cause them too.
Rape and child abuse are terrible events, and they are also unfortunately more common than you might think. Reports reveal that 12 million women were victims of rape in the United States in 2014 alone, and that more than 50 percent of those women were under the age of 15 at the time of the assault. Every year in the United States, there are 3 million cases of child abuse.
These traumatic experiences can change the lives of those affected, as well as the lives of their friends and family. Traumatized people often suffer from post-traumatic stress disorder (PTSD), which can lead to depression and substance abuse.
In addition, traumatized people tend to mistrust anyone who hasn’t experienced the same suffering they have, and assume that nobody can understand them. This was illustrated in one of the therapy groups the author set up for Vietnam veterans.
While the group helped the veterans find friends and share their experiences, those who weren’t traumatized by the war were considered outsiders by the group – including the author. It took weeks of listening, empathizing and building trust with the veterans for them to accept him.
Establishing a rapport with someone suffering from PTSD is a challenge on its own, so just imagine trying to maintain a marriage, a close friendship or a stable parent-child relationship. Traumatized people find it difficult to trust even those who love them most, including partners and kids. This can be very tough on friends and families, often leading to estrangement or divorce.
The Body Keeps the Score Key Idea #2: Flashbacks cause people to relive the mental and physical experience of trauma when they’re reminded of it.
Do you ever remember something embarrassing you did and feel yourself squirm or blush? Then you’ve got a tiny insight into how memories of trauma can impact the body.
When a PTSD sufferer is reminded of their trauma, their body and brain enter a high-stress mode, since they experience the memory as if it were real. This is called a flashback, an impact of trauma that the author studied in an experiment he carried out with his patients.
Each patient agreed to listen to a recording of a script that recreated their traumatic experience. As the script played, participants inhaled air with a tiny concentration of radioactive particles. This air would be visible in a brain scan, allowing the author to see which areas of the brain were active when patients remembered their trauma.
Marsha, a 40-year-old teacher, was first up for the experiment. Her script took her back to the tragic accident that caused her to lose both her five-year-old daughter and the unborn child she was pregnant with at the time.
As Marsha listened to the script, her blood pressure and heart rate rose sharply. Activity in the left half of her brain, the side responsible for rational thinking, slowed down and effectively “deactivated.” A deactivation like this makes it difficult for PTSD sufferers to realize that the things they hear, see and feel during a flashback aren’t real.
In Marsha’s brain, the Broca’s area , the area responsible responsible for speaking, showed a significant decrease in activity, leaving her unable to speak. Her stress hormone levels shot up and stayed high. For the mentally healthy, stress hormones will spike and then decrease as soon as a threat has passed. But for those with trauma in their past, these hormones take much longer to return to normal levels.
This goes to show that being reminded of trauma can be almost as horrifying as experiencing the traumatic situation itself.
The Body Keeps the Score Key Idea #3: Childhood trauma has negative impacts, not just in a person’s youth but well into adulthood, too.
Traumatic experiences are hard enough to deal with as an adult, but there is nothing more difficult than facing trauma as a young child. With brains that aren’t even fully developed, children who undergo a trauma are at greater risk to experience a wide range of negative consequences. These consequences surface in the years immediately following their experiences and later in adulthood.
Traumatized children often expect bad things to happen. The author demonstrated this in an experiment in which cards with pictures from magazines were shown to children who had experienced trauma, and to those who hadn’t.
One of the cards showed two children watching their father fix a car as he lay underneath it. While children without trauma imagined a story based on the image where the father successfully repaired the car and took his kids to McDonald’s, the traumatized children imagined much darker scenarios.
One girl said that one of the children in the images would smash the father’s head with the hammer he was holding. Another child said the car would fall, crushing the father’s body. For these children, the pictures contained a number of triggers that led them to imagine the scene ending violently.
These thinking patterns often persist into adulthood.
Take Marilyn, one of the author’s patients and a former nurse. She told the author she had a happy childhood, but this wasn’t true. Marilyn was sexually abused as a child, a traumatic experience that shaped her life as an adult.
She was prone to lashing out when men touched her, even in her sleep. She also developed an autoimmune disease that damaged her vision, which likely emerged as a result of the stress her trauma caused on her body.
Marilyn’s case may sound extreme, but she isn’t alone. Many others who were traumatized as children continue to suffer in their adult lives.
The Body Keeps the Score Key Idea #4: While normal memories fade and change, traumatic memories are vivid, unchanging and easily triggered.
When we tell stories, we tend to embellish, exaggerate or omit parts of our experiences. By the fifth time you’ve told a story, chances are it’ll be quite different from the first version. We even remember things differently over time. Why is this?
In general, we don’t tend to memorize the sensory details of events. Most of us remember what we did or how we felt in general, but don’t store vivid memories about the smell of the room we were in or the exact details of someone’s face. But it’s a different story when it comes to traumatic memories – we remember these situations vividly, and the memories don’t change over time.
The author demonstrated the difference between these two ways of remembering by asking participants to recall important but nontraumatic events in their lives, like the birth of their child or their wedding day. In these cases, participants could recall their general feelings, like happiness or nervousness, but they didn’t have a detailed image of how their partner’s hair looked at their marriage, for instance.
However, when participants were asked to recall traumatic memories, smell, taste, touch and hearing played a far more important role. One participant who was raped said that a specific smell of alcohol reminded her instantly of her trauma, so much so that she couldn’t go to parties anymore.
We also recall traumatic memories consistently, without changes or revision. In a study conducted at Harvard Medical School, 200 men were tested on a regular basis from their first joining the experiment, which they did between 1939 and 1945, up until the present day. The subject of these tests were their memories, and how trauma, or lack thereof, shaped them.
Many participants were World War II veterans and subsequent PTSD sufferers. While the memories of participants who weren’t traumatized by the war changed over time, the veterans’ memories didn’t change at all. They remained consistent for well over 45 years after the war ended.
Trauma stays with you, both in your body and your brain. So how do people learn to live with it?
The Body Keeps the Score Key Idea #5: Yoga offers trauma sufferers a safe way to explore the relationship between their body and mind.
Our body and mind share a close relationship. In order to live a balanced, stable life, we need to understand how our emotions work, and how they impact our bodies. Unfortunately, trauma can make this very difficult.
Trauma often leaves people with a hypersensitive alarm system in their bodies. Those who suffered sexual abuse as children, for example, find that they experience crippling panic in harmless situations, such as cuddling with their partner.
To avoid this, traumatized people often attempt to numb their own feelings by drinking too much, taking drugs and even by overloading themselves with work. These provide a temporary solution, but tend to do more damage than good to a person’s mental health. Thankfully, there’s a healthy way to cope with overwhelming emotions in the aftermath of trauma: yoga.
For trauma sufferers, yoga offers a safe way to get in touch with their emotions and understand how the body experiences them. Annie, one of the author’s patients, decided to give it a try. As a rape victim and PTSD sufferer, the first yoga classes were incredibly difficult for her. Even a gentle pat on the back could trigger her brain’s alarm system.
Despite this, Annie stuck with yoga, refusing to give up. Soon enough, she noticed that her body was constantly sending her signals about her emotional state. In particular, Annie struggled with the yoga position of the “happy baby,” which requires you to lie on your back with your knees bent and your feet up in the air.
Though Annie felt incredible pain, vulnerability and sadness in positions like these, she didn’t push those feelings away, choosing to explore and accept them instead. Yoga helped Annie come to terms with negative sensations like these, and helped her realize that she could deal with them head-on, rather than repressing them.
The Body Keeps the Score Key Idea #6: Mindfulness and supportive relationships are essential to trauma recovery.
Mindfulness is a pretty trendy concept right now, but it’s not just a fad – it’s an incredibly effective lifestyle choice. It also constitutes a powerful tool for trauma recovery, but how does it work?
Mindfulness is all about maintaining a conscious awareness of your body and your emotions, rather than denying them. This is especially tough after trauma, as painful memories cause us to repress our emotions rather than address them.
None of us like to feel sad, angry or broken, especially when these feelings are triggered by memories of trauma. But by pushing these feelings away, you also lose the opportunity to confront your trauma and start the healing process.
Mindfulness can alleviate the psychological and physiological impacts of trauma, from depression to stress to psychosomatic conditions like chronic pain. It can also improve immune responses, activate regions of the brain that help regulate emotions and balance out stress hormone levels.
Aside from mindfulness, supportive personal relationships are indispensable on the road to recovery from trauma. By building a network of family members, friends and mental health professionals, patients can ensure they always have someone to turn to when they need help. These networks can be formed through AA meetings, religious congregations and veterans’ organizations, to name a few.
The Body Keeps the Score Key Idea #7: Neurofeedback helps trauma sufferers rewire their brains.
Did you know that electrical signals are responsible for just about everything that goes on in your brain? These brain waves govern our thought processes, so they’re quite important. Unfortunately, they can also be damaged by trauma. Let’s find out how.
There are many different types of brain waves, one of these being alpha waves, which are triggered when we feel calm and relaxed. A recent study at the University of Adelaide in Australia examined soldiers who served in Iraq or Afghanistan, and revealed that the longer they spent in the war zone, the fewer alpha waves their brains produced. Instead, soldiers produced brain waves similar to those of children diagnosed with ADHD, hampering their ability to relax, stay calm and focus.
Fortunately, the brain has the potential to recover. How? Through a process called neurofeedback .
Neurofeedback allows traumatized people to change the brain waves they produce, and encourage the production of alpha waves to help them relax and keep calm. By displaying the patient’s brainwaves to them in real-time on a screen, they can see when they need to make a conscious effort to relax. Once they do, they’ll see their alpha waves being produced and even be rewarded through an interface that can feel like a video game.
Take Lisa, a 27-year-old woman and one of the author’s patients. Lisa’s father abandoned the family when she was three, and her mother was abusive and cruel. Lisa ran away from home twice and passed through several foster homes, mental hospitals and even spent time living on the street.
Years of trauma left Lisa with strong self-destructive urges. She’d hurt herself and destroy the things around her, with little ability to regulate her emotions. But once she began neurofeedback treatment, things changed dramatically. With her newfound ability to produce alpha waves and consciously make herself relax, Lisa was able to talk about and work through the traumatic events from her childhood.
Though neurofeedback has proven extremely effective, it’s still rarely applied. Overall, our society has a long way to go when it comes to understanding and dealing with trauma. But with a broader acceptance of mindfulness and improved knowledge about mental illnesses in recent years, there is good reason to be optimistic about the future of mental health treatment.
In Review: The Body Keeps the Score Book Summary
The key message in this book:
Although trauma can happen to anyone, not many of us know how traumatic experiences impact our mental and physical health, even decades after the event. Mindfulness, support networks, yoga and new techniques like neurofeedback are all essential tools for trauma sufferers as they learn to accept, cope with and recover from their trauma.
You may have heard someone refer to a score as a quantity and wondered what it means. A score is 20. Although people don’t use the term much anymore, you can find examples of it in literature and history.
“The Body” is a Stephen King novella set during the 1960s a few short weeks before summer vacation ends for the four protagonists, a group of young boys in rural America who set out to find and recover the corpse of another 12-year old boy.
A statutory body is an organization with the authority to check that another organization’s actions are legal. It is typically set up by a government or parliament.
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