Reframing and Reconsidering the Brain-Body Impact of Trauma:
A Response to Bessel Van Der Kolk’s “The Body Keeps the Score”
A 21-year-old college student named Kathy had been used by her father for child prostitution for many years in her youth, and had experienced intense physical, emotional, and sexual abuse. When she was studying, she could focus all of her attention on her work, but her traumatic experiences made it nearly impossible for her to create a healthy relationship with herself or others. She had attempted psychotherapy for years, but after her third suicide attempt, she was referred to Dr. Bessel Van Der Kolk. After only eight sessions with him using a unique treatment strategy many psychologists were unfamiliar with at the time, she had made extreme progress and Van Der Kolk reported her as completely recovered. For decades, psychologists across the globe have made attempts at understanding trauma. Most have tried to find one root cause or one effective solution. In Dr. Bessel Van Der Kolk’s book The Body Keeps the Score: Brain, Mind, and Body in the Healing of Trauma he shares the broad effects of trauma and provides different techniques to help patients heal.
Van Der Kolk first began working with patients who had suffered from traumatic experiences in 1975. His first patients were with veterans from Vietnam. At this point, there was not much, if any, research on the impacts of trauma, let alone how to treat it. Post Traumatic Stress Disorder became a diagnosis in the DSM-III in 1980. This reframed the understanding of trauma, and Van Der Kolk was at the beginning of this development. The diagnosis was created after many psychologists worked with veterans, and observed the way they changed when they came back from combat. The understanding of the disorder continued to evolve, and now can be applied to those who have suffered trauma of any kind, like physical, sexual, and emotional abuse. But the key idea still remains: experiencing traumatic events causes a, “chronic vigilance for and sensitivity to threat,” (Van Der Kolk, 2015). Van Der Kolk expands on the definition of vigilance and sensitivity. He writes that there is a fundamental change in the way PTSD patients’ brains and bodies function. After experiencing trauma, people are expected to go on with their lives, and although they wish to, they are unable.
Many psychologists and psychiatrists consider mental illness as if it is a physical illness, as if it can be simply healed with one specific treatment or medication. During the early parts of his career, Van Der Kolk observed the way psychiatrists spoke about their patients. He saw that they focused on the symptoms of their patient’s illnesses, like their suicidal thoughts or self destructive behavior, but didn’t consider the root causes of these symptoms. The practitioners also were not attentive to other details of their patient’s lives, like people they cared about and who they had problems with, their motivations, or their interests. Van Der Kolk argues that this model of thinking overlooks key ideas that can assist in helping patients cope with trauma. The first idea in Van Der Kolk’s model is reconstructing relationships and support systems. The second is using language as a tool to figure out what the patient knows and what it means. The third is regulating the patient’s physical functions, like breathing, moving, and touching. The fourth is that social environments need to be changed so people who have experienced trauma can feel safe. He writes that ignoring these strategies is a disservice to patients in their healing process. If practitioners can consider these ideas when working with their patients, they can better understand their patients and their needs. Physicians need to broaden their outlooks and not solely focus on treating the symptoms of trauma, but work to find the root of the issues as well as develop a recovery plan that best fits the individual. Once doctors see the brain-body connection, they can see how traumatic experiences rupture the way people are able to fully function, and create a treatment plan that is best suited for that specific patient. Van Der Kolk’s work synthesizes emerging developments in a lively field of PTSD treatment and theory — including treatments like eye movement desensitization and reprocessing and yoga, that other practitioners have also applied and validated. Although these treatments are so promising, they are not widely accessible to people of all socioeconomic levels, even though vulnerable people are often at greater risk of trauma exposure.
The human brain is responsible for detecting threats, establishing connections with other humans, understanding sensory information, and holding memories, among many other functions. Patients who have experienced trauma have memories that inform them about what situations have caused them threats. These memories result in difficulties understanding what situations are actually threatening for the rest of their lives. Patients with PTSD see certain situations that appear everyday, common, and safe for most, as dangerous for them. This causes them to enter a stressful fight or flight response long after the traumatic situation has ended. Trauma can also interrupt the capability of sensory integration, which is the process by which our brain interprets sensory information, like vision, hearing, touch, and balance. People with PTSD often do not feel connected to their bodies or that they are in the present. Van Der Kolk’s takeaway is that trauma rewires the brain, and physicians need to figure out how to rewire it back to help patients heal.
One treatment therapy Van Der Kolk mentions was extremely helpful for many of his patients was eye movement desensitization and reprocessing (EMDR). It involves the patient bringing up memories from their traumatic experiences while the therapist instructs them to move their eyes back and forth, notice the sensations they are experiencing, and breathe deeply. The technique is believed to mimic Rapid Eye Movement (REM) sleep, which helps the brain process and reshape memories. EMDR is believed to help patients revisit troubling or lost memories of traumatic experiences in a way where they can see them in a larger context and perspective. They can revisit the experiences without entering a fight or flight status, and reshape the way the memories affect them. A study done by researchers in the Netherlands and Belgium found that EMDR was found to help improve quality of life for elderly people with PTSD, including those who have endured childhood trauma (Gielkens et al, 2022).
Van Der Kolk discusses stories of his experiences with patients and how EMDR was very successful for many of them. EMDR was the technique he used with Kathy, the young woman who had been used by her father for child prostitution. He wrote that patients like Kathy were able to revisit their past experiences in a unique way, including from the perspective of an adult looking down at the scene of their trauma when they were a child. This new perspective allowed Kathy to understand that she was young and vulnerable when she experienced the abuse, and allowed her to provide herself the comfort she had always needed to her younger self. Kathy was able to combine her memories with her imagination so that she now had control over the situation. She could put those memories away and was able to imagine new, positive experiences for her future. EMDR has been shown to be extremely beneficial to many, but although there are many clinics who offer EMDR therapy treatment, these sessions can be hard to access, and EMDR sessions can range from about $120-$200 per session. For EMDR, multiple sessions are usually necessary to fully recover. Kathy needed eight sessions, and this was the fewest number of sessions of any of Van Der Kolk’s patients who had experienced severe childhood abuse. Many patients do not have the financial means to afford this many sessions at that cost, even though they can be life changing in the recovery process.
Trauma also alters the way a patient’s body functions. Traumatic memories do not solely cause mental illnesses, but also can cause physical illnesses, because mental responses trigger physical responses. Entering fight or flight states results in increased heart rate, blood pressure, and breathing rate, causing muscles to tense. This is useful when experiencing a threat, but for patients with PTSD who over experience this reaction, this can be harmful. These findings led Van Der Kolk to employ treatment methods such as breathing exercises, meditation, and yoga to attempt to interrupt the stress response that PTSD patients are constantly in. A study performed at a university in Mississippi analyzed the effect of practicing yoga for a year on PTSD symptoms in college students who endured childhood trauma. They found that practicing yoga promoted mindful awareness, self compassion, psychological flexibility, as well as repairing brain systems that have been harmed by PTSD symptoms (Dunn et al, 2022). People who have experienced trauma will often enter a numb state and dissociate from the experience as a way to protect themselves. But when the traumatic experience has ended, they remain at a disconnect with their body. Some actions and an unexpected awareness of body parts can unearth past trauma and increase the stress response. Van Der Kolk writes that yoga can help PTSD patients regain healthy awareness of their body. Yoga and meditation are more accessible than many other treatment strategies, and similar exercises can be done at home with guidance from internet resources. This can be a very helpful option for many who are limited financially, but for most, yoga or meditation on their own are not enough to combat the effects of trauma.
In his book, Van Der Kolk works with many patients who have experienced severe childhood trauma. He found that childhood trauma can completely alter the way children form relationships to others and to themselves, like for Kathy, because many of these patients believe that they somehow deserved what happened to them. This belief severely impacts their self image and self compassion. Van Der Kolk also writes about how self-compassion can protect against the effects of trauma, and regaining kindness for oneself can help people heal. A study done at the University of Vermont found similar results. The researchers found that those who experienced more severe symptoms of PTSD were not shown to employ self compassion, and often experienced a lot of shame. They discussed that developing self compassion may reduce the effects of PTSD symptoms and improve negative moods (Maheux & Price, 2015). Van Der Kolk expands on this, and explains how when his patients were able to revisit their trauma, they were able to start recovering when they realized that they did not deserve the abuse they suffered and that there was nothing they could have done to prevent it from happening. Self compassion can be practiced and developed with the assistance of a psychologist, therapist, or social worker. But finding a competent therapist that a patient can feel comfortable with and connect with is not easy, especially for low income people who don’t have adequate or any health insurance. Therapy sessions can range from about $120-$200 per session and multiple sessions are necessary, like EMDR sessions, and usually occur over the course of months or even years. This is not a viable option for many.
Van Der Kolk outlines many different types of treatment, but some are more accessible than others. Although treatments such as yoga or meditation can be done at home, most patients, especially those with severe symptoms, need a combination of different types of therapy, and may need guidance from a physician to turn to yoga or meditation as a healing strategy.Van Der Kolk has great ideas for treatment strategies for patients and physicians alike, but they need to be easier to access for those who are at a lower socioeconomic status. They need to be able to prioritize their health without compromising their financial security.
This book makes great progress in the field of psychology, and provides a comprehensive analysis of PTSD. Van Der Kolk uses research findings from psychologists and psychiatrists across the world, including those who are still researching and those who have made groundbreaking discoveries and developed accepted theories. He combines these findings with his own research as well as accounts of specific patient experiences. He expands on the understanding of how PTSD affects people, and moves beyond the notion that it only affects emotions and behavior. He concluded that PTSD drastically affects the brain and the body as well. These findings then helped him test new therapy treatments that can better fit a patient’s needs.
Trauma changes the way people operate. It is not simply a bad memory or scary experience, it fundamentally alters the ability for people to function. Understanding this can encourage more compassion and understanding towards those with PTSD, which can in turn create safe and accepting environments to encourage their healing. Psychologists can better understand PTSD and adopt more treatments than solely psychotherapy, which is productive for every client. Once we can fully understand the problem, we can learn how to fix it.
References:
Dunn, N., Esplin, J.A., & Fitzgerald, M. (2022). Moving out of your mind and into your body:
Yoga buffers the effects of childhood maltreatment on PTSD symptoms. Journal of American College Health. DOI: 10.1080/07448481.2022.2066956
Gielkens, E.M.J., Turksma, K., Kranenburg, L.W., Stas, L., Sobczak, S., van Alphen, S.P.J., &
Rossi, G. (2022): Feasibility of EMDR in older adults with PTSD to reduce frailty and improve quality of life. Clinical Gerontologist. DOI:10.1080/07317115.2022.2114397
Maheux, A. & Price, M. (2015). Investigation of the relation between PTSD symptoms and self-compassion: Comparison across DSM IV and DSM 5 PTSD symptom clusters. Self and Identity, 14(6), 627–637. DOI: 10.1080/15298868.2015.1037791
Van Der Kolk, B. (2015). The Body Keeps the Score: Brain, Mind, and Body in the Healing of Trauma. Penguin Books.
