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 on inside ourselves, explains Dr. Bessel van der Kolk, one of the world’s foremost experts on trauma, has spent over three decades working with survivors.
“Trauma is a fact of life,” he knows. “Veterans and their families deal with the painful aftermath of combat; one in five Americans has been molested; one in four grew up with alcoholics; one in three couples have engaged in physical violence.”
In The Body Keeps the Score, Dr. van der Kolk uses recent scientific advances to show how trauma literally reshapes both body and brain, compromising sufferers’ capacities for pleasure, engagement, self-control, and trust. He explores innovative treatments—from neurofeedback and meditation to sports, drama, and yoga—that offer new paths to recovery by activating the brain’s natural neuroplasticity. Based on his own research and that of other leading specialists, the book exposes the tremendous power of our relationships both to hurt and to heal—and offers new hope for reclaiming lives.
In 1984, he set up one of the first clinical/research centers in the US dedicated to studying and treatment of traumatic stress in civilian populations, which has trained numerous researchers and clinicians specializing in the study and treatment of traumatic stress, and which has been continually funded to research the impact of traumatic stress and effective treatment interventions. He did the first studies on the effects of SSRIs on PTSD; was a member of the first neuroimaging team to investigate how trauma changes brain processes and did the first research linking BPD and deliberate self-injury to trauma and neglect in early childhood.
Much of his research has focused on how trauma has a different impact at different stages of development, and that disruptions in caregiving systems have additional deleterious effects that need to be addressed for effective intervention. In order to promote a deeper understanding of the impact of childhood trauma and to foster the development and execution of effective treatment interventions, he initiated the process that led to the establishment of the National Child Traumatic Stress Network (NCTSN), a Congressionally mandated initiative that now funds approximately 150 centers specializing in developing effective treatment interventions, and implementing them in a wide array of settings, from juvenile detention centers to tribal agencies, nationwide.
He has focused on studying treatments that stabilize physiology, increase executive functioning and help traumatized individuals to feel fully alert to the present. This has included an NIMH-funded study on EMDR and NCCAM-funded study of yoga, and, in recent years, the study of neurofeedback to investigate whether attentional and perceptual systems (and the neural tracks responsible for them) can be altered by changing EEG patterns.
His efforts resulted in the establishment of Trauma Center (now the Trauma Research Foundation) that consisted of a well-trained clinical team specializing in the treatment of children and adults with histories of child maltreatment, that applied treatment models that are widely taught and implemented nationwide, a research lab that studied the effects of neurofeedback and MDMA on behavior, mood, and executive functioning, and numerous training courses nationwide to a variety of mental health professional, educators, parent groups, policymakers, and law enforcement personnel. Click here to learn more: besselvanderkolk.com
Q. You’ve been working with traumatized children and adults for many years and have seen significant changes in how mental illness and trauma are treated. What have you learned from neuroscience, attachment research, and interpersonal neurobiology about how to help children and adults recover from toxic stress?
A. Trauma is ubiquitous in our society. Over 500,000 children are reported for abuse and neglect each year. One out of four Americans reports having been left with bruises after having been hit as a child, one out of five was sexually molested, one out of eight has witnessed severe domestic violence, and a quarter grew up with alcoholism or drug addiction. Almost every inmate in our prison system, by far the largest in the world, has a serious history of prior trauma. Half a million women are raped each year, half of them before they are adolescents.
These experiences leave traces on people’s biology and identity and have devastating social consequences–medical illnesses, problems with school and work performance, drug addiction, and a variety of psychiatric illnesses. In fact, the Centers for Disease Control and Prevention calculate that childhood trauma is our single largest public health issue—more costly than cancer or heart disease—and one that is largely preventable by early prevention and intervention.
In order to overcome trauma people need to feel safe enough to open up their hearts and minds to others and become engaged with new possibilities. This can only be done if trauma survivors, and their communities, are helped to confront and confess the reality of what has happened and are helped to feel safe again. In many non-Western cultures, this involves communal rhythmical activities, such as dancing, athletics, and collective prayer. Communal rituals of acknowledgment, support, and repentance can play a substantial role in healing from trauma.
Treatments that focus solely on decreasing a few PTSD symptoms, or on drugs to obliterate feelings, ignore the importance of integrating the traumatic experience in the overall arc of one’s life, and they fail to help survivors reconnect with their communities. The scientific evidence for the efficacy of these therapies, while widely promulgated and practiced, is, in fact, quite disappointing.
Probably the most important challenge in recovering from trauma is learning to regulate oneself. We can activate this innate capacity by utilizing breath, touch, movement, and rhythmical engagement with one’s fellow human beings, such as yoga, tai chi, and dancing, methods that are not widely utilized in medical settings or in school systems.
Q. In your book, you talk about the effect of trauma on the brain. What changes occur in the brain in response to trauma? What happens when someone experiences a flashback?
A. Neuroscience research has shown that traumatized individuals are prone to activate brain areas involved in fear perception and to have deficits in the areas involved in filtering out relevant from irrelevant information, as well as in the perception of bodily sensations. These changes do not occur in the rational part of the brain and do not really seem to benefit merely from being aware of the error of one’s ways.
The impact of trauma is located in the survival part of the brain, which does not return to baseline after the threat is over. This part of the brain is by definition unreasonable—you do not stop being hungry by reminding yourself how fat you are, and it’s pretty difficult to talk yourself out of being angry, shut down, or in love.
One of the most devastating effects of trauma is that people’s biology changes into the biology of threat; this is expressed on multiple levels, in stress hormones, immunology, and what the brain selects to pay attention to. The intrinsic reward system changes, as do “attractors”—what turns you on or leaves you cold. As a consequence, traumatized people stay on hyper-alert; they feel chronically unsafe and in danger, and they have problems feeling calm and enjoying the moment and they are out of touch with their surroundings. Trauma can make it difficult to have comfortable reciprocal relationships with one’s children, partners, and coworkers.
Through brain imaging technology, we can visualize how traumatized people even have problems processing ordinary, non-threatening information, which makes it difficult to fully engage in daily life and to learn from experience. As a result, they are frazzled, unfocused, and tend to repeat the same nonproductive behavior patterns, with the same miserable results.
Trauma affects the entire human organism–thinking, feeling, relationships, and the housekeeping of one’s body. Trauma survivors are vulnerable to a host of medical illnesses and chronic pain syndromes, insomnia, drug and alcohol addiction, depression, obesity, and other issues related to optimal functioning of the entire organism, and the capacity for self-regulation and self-care.
Q. What do you wish more people understood about trauma?
A. First of all, is important to understand is how ubiquitous trauma is in our society, what devastating effects it has on family life, workplace productivity, the facility to learn and take initiative, the ability to stay calm and focused, and the capacity to be compassionate with one’s fellow man.
As a society, we cannot afford to ignore trauma and keep our heads in the sand. There are, in fact, countries where governments have taken the science of trauma (and its prevention and treatment) seriously, with results to prove how well that works. For example, Norway has fifty-one citizens per hundred thousand in jail; the US, 951. Their students also have higher test scores and higher graduation rates from high school and college, and their society has a fraction of our crime rate.
I think that the general public tends to associate trauma with the military and terrorism, but the vast majority of traumas occur within families, schools, and neighborhoods, the very people whom they depend on for safety and security. Most traumatized women and children, for example, are traumatized by their intimates. Another important issue is that trauma has a different impact, depending on the age and relative maturity of the affected individual. The brains of traumatized kids develop in a “use-dependent” manner—they become experts in dealing with threats and have problems with self-regulation, play, and the sort of imaginative creativity that is necessary to become productive members of society.
Trauma is a deeply communal problem: we are fundamentally social animals, and trauma profoundly affects people’s capacity to get along with others and be cooperative and enjoyable members of the tribe.