The Body Keeps The Score Summary and Infographic | Bessel van der Kolk

Brain, Mind, and Body in the Healing of Trauma

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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. 

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Introduction

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:

1. The belief that we can heal each other in the same way we can destroy each other
2. Language that is critical to providing us with the power to change circumstances
3. Controlling our physiology by using breathing, moving, and touching techniques, rather than by resorting to medication
4. 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.  

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:

1. Mindfulness meditation
2. Yoga

Ways to recalibrate bottom-up mental regulation are:

1. Breathing
2. Movement
3. Touch

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:

1. Help clients to reactivate a sense of self in the physical body. Mindfulness helps to do exactly that.
2. Draw out blocked sensory information and help the client to befriend, not suppress, bodily responses.
3. Complete the self-preserving physical actions that were thwarted when the survivor was restrained or immobilized by terror.
4. 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:

1. Find a way to be calm in all moments. Learn to maintain your calmness and focus even when triggered by past thoughts or emotions.
2. Learn to be fully alive in the present. Remain engaged with others and with the present moment.
3. 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:

• Yoga
• EMDR
• Schwartz’s Internal Family Systems
• Pesso PBSP psychomotor therapy
• Neurofeedback
• Movement 
• Theater
• Dance

Yoga

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. 

Mindfulness

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. 

Rating

We rate The Body Keeps the Score 4.6/5.

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Editor’s Note

First published in March 2021. Updated in March 2022.

Disclaimer

This is an unofficial summary and analysis.

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