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The Body Keeps the Score is the inspiring story of how a group of therapists and scientists— together with their courageous and memorable patients—has struggled to integrate recent advances in brain science, attachment research, and body awareness into treatments that can free trauma survivors from the tyranny of the past. These new paths to recovery activate the brain’s natural neuroplasticity to rewire disturbed functioning and rebuild step by step the ability to “know what you know and feel what you feel.” They also offer experiences that directly counteract the helplessness and invisibility associated with trauma, enabling both adults and children to reclaim ownership of their bodies and their lives.
Drawing on more than thirty years at the forefront of research and clinical practice, Bessel van der Kolk shows that the terror and isolation at the core of trauma literally reshape both brain and body. New insights into our survival instincts explain why traumatized people experience incomprehensible anxiety and numbing and intolerable rage, and how trauma affects their capacity to concentrate, to remember, to form trusting relationships, and even to feel at home in their own bodies. Having lost the sense of control of themselves and frustrated by failed therapies, they often fear that they are damaged beyond repair.
What distinguishes THE BODY KEEPS THE SCORE is that the author is both a scientific researcher with a long history of measuring the effect of trauma on brain function, memory, and treatment outcomes, and an active therapist who keeps learning from his patients what benefits them most. This makes for deeply personal, analytic, and highly readable (not to mention incredibly moving) approach to the topic of trauma recovery.
The title underscores the book’s central idea: Exposure the abuse and violence fosters the development of a hyperactive alarm system and molds a body that gets stuck in fight/flight, and freeze. Trauma interferes with the brain circuits that involve focusing, flexibility, and being able to stay in emotional control. A constant sense of danger and helplessness promotes the continuous secretion of stress hormones, which wreaks havoc with the immune system and the functioning of the body’s organs. Only making it safe for trauma victims to inhabit their bodies, and to tolerate feeling what they feel, and knowing what they know, can lead to lasting healing. This may involve a range of therapeutic interventions (one size never fits all), including various forms of trauma processing, neurofeedback, theater, meditation, play, and yoga.
Readers will come away from this book with awe at human resilience and at the power of our relationships—whether in the intimacy of home or in our wider communities—to both hurt and heal.
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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 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 illness. 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 a 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, nonthreatening 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 threat, 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 a cooperative and enjoyable member of the tribe.
Q. You have worked with war veterans and at the beginning of your career worked with Vietnam vets before PTSD was an official diagnosis. What do you think of the current prescribed treatment by the Veteran Affairs office for trauma?
A. I currently treat only a few veterans and I am not intimately familiar with what is happening at the Veterans Administration. The VA is a pretty closed system—people who work at the VA rarely attend my workshops or lectures, or those of my close colleagues.
I hear that their main focus is on cognitive behavioral treatments, and on desensitizing people to their memories. These treatments, research shows, are not particularly effective. That is not surprising, given that being traumatized is not an issue of faulty cognition—the problems emanate from parts of the brain that have little to do with cognition.
The biggest problem for veterans is to fully engage in their current lives. The Body Keeps the Score provides a number of ways to reengage — some are ancient, like yoga, theater, and martial arts, while others, like neurofeedback, are based on the latest advances in neuroscience.
Doctors at the VA and the DoD prescribe vast amounts of drugs, even though there is scant evidence that drugs significantly help traumatic stress. Drugs can obscure posttraumatic symptoms but not resolve them.
This issue is even more concerning in the treatment of traumatized children. The poorer you are the more likely it is that you will be given psychiatric drugs to control your behavior. These drugs can have devastating effects on children’s capacity to learn, engage and feel good in their bodies.
Q. What benefits does yoga offer patients in treatment? Are they universal?
A. Yoga is just one of many time-honored ways to help people experience ownership of their bodies and to feel safe and in control. Our most recent research study on this subject showed that yoga had better results than any drug studies so far for PTSD. That is not to say that everybody should practice yoga—one size never fits all—but every trauma survivor would do well to engage in practices that increases their inner bodily sense of control, safety, and flexibility.
In order to overcome trauma we have to befriend and be in touch with ourselves—our sensations and our emotions. Neuroscience research has shown that the only way we can consciously access that disturbed survival brain is through our interoceptive pathways — through the part of the brain that helps us to feel what is going on deep inside of ourselves.
Q. What do you hope to accomplish with The Body Keeps the Score? What do you want readers to take away from it?
A. I hope that all traumatized individuals, and their loved ones, will find this book helpful for comfort, understanding, and guidance. That politicians and policy makers will read this book to help them understand the devastating effects of early deprivation and punitive school systems on the health and welfare of our country, as well as the predictable consequences of putting our young men and women in harm’s way.
That parents of adopted kids will understand what their children are dealing with, and serve as a guide to solutions.
That educators and school systems will implement trauma-based interventions for children who come from abuse and neglect, and thereby become agents of change to help all children become productive members of society. My greatest hope is that all school systems will teach the four R’s: reading, writing, rhythmatic, and self-regulation. That from K to 12 all kids will be taught to experience how they can regulate themselves though their breath, movements, and synchronized interactions with others, and learn how their bodies, brains, and minds react to overwhelming stress with recognizable patterns that can be managed through self-regulation practices, more than with drugs or alcohol.
That it will inspire our armed forces to become as expert in helping returning warriors to once again become peaceful and productive civilians, as they are in transforming adolescents into members of magnificent fighting units.
That physicians will appreciate the role of trauma in the disintegration of bodily systems, and learn what they can do about it.
That mental health professionals will acknowledge the relationship between trauma, drug addiction, and numerous psychiatric “disorders” and incorporate effective trauma treatments in their practice.
That law enforcement and criminal justice personnel will read it to understand their own responses, and that of the people they are dealing with.
That psychiatrists will integrate the scientific knowledge that our brains are meant to help us cooperate and thrive in a community, and realize that their job is to help patients deal with the devastating effects of trauma on mind, brain, and body.
I hope that this book will help us all acknowledge the fact that our zip code has a more profound effect on health and well-being then our genetic code. In short, the goal of this book is to help us to become a trauma-informed society that will confront and deal with our largest public health issue: psychological trauma.
Every once in a while, a book comes along that fundamentally changes the way we look at the world. Bessel VanderKolk has written such a book. Having read “The Body Keeps the Score”, it will be impossible for us any longer to deny the profound extent of trauma and its impact on our lives. VanderKolk writes in the humanitarian tradition of his great Harvard mentor, Elvin Semrad, and his book is a worthy testament to the tutelage of this great man, and the beautiful maturation of his pupil. The arc of VanderKolk’s story is vast and comprehensive—but Vanderkolk is such a skillful storyteller that he keeps us riveted to the page. I simply could not put this book down. It is, simply put, a great work.
- Stephen Cope, Founder and Director, Kripalu Institute for Extraordinary Living; Author, Yoga and the Quest for the True Self.
In this magnificent book, Bessel van der Kolk takes the reader on a captivating journey that is chock full of riveting stories of patients and their struggles interpreted through history, research, and neuroscience made accessible in the words of a gifted storyteller. We are privy to the author’s own courageous efforts to understand and treat trauma over the past 40 years, the results of which have broken new ground and challenged the status quo of psychiatry and psychotherapy. The Body Keeps the Score leaves us with both a profound appreciation for and a felt sense of, the debilitating effects of trauma, along with hope for the future through fascinating descriptions of novel approaches to treatment. This outstanding volume is absolutely essential reading not only for therapists but for all who seek to understand, prevent, or treat the immense suffering caused by trauma.
- Pat Ogden PhD, Founder/Educational Director of the Sensorimotor Psychotherapy Institute; Author, Sensorimotor Psychotherapy: Interventions for Trauma and Attachment
This is masterpiece of powerful understanding and brave heartedness, one of the most intelligent and helpful works on trauma I have ever read. Dr. Van der Kolk offer a brilliant synthesis of clinical cases, neuroscience, powerful tools and caring humanity, offering a whole new level of healing for the traumas carried by so many.
- Jack Kornfield Author, A Path work Heart
The Body Keeps the Score articulates new and better therapies for toxic stress based on a deep understanding of the effects of trauma on brain development and attachment systems. This volume provides a moving summary of what is currently known about the effects of trauma on individuals and societies, and introduces the healing potential of both age-old and novel approaches to help traumatized children and adults fully engage in the present.
- Jessica Stern, Policy consultant on terrorism; Author, Denial: A Memoir of Terror
This is an amazing accomplishment from the neuroscientist most responsible for the contemporary revolution in mental health toward the recognition that so many mental problems are the product of trauma. With the compelling writing of a good novelist, van der Kolk revisits his fascinating journey of discovery that has challenged established wisdom in psychiatry. Interspersed with that narrative are clear and understandable: descriptions of the neurobiology of trauma; explanations of the ineffectiveness of traditional approaches to treating trauma; and introductions to the approaches that take patients beneath their cognitive minds to heal the parts of them that remained frozen in the past. All this is illustrated vividly with dramatic case histories and substantiated with convincing research. This is a watershed book that will be remembered as tipping the scales within psychiatry and the culture at large toward the recognition of the toll traumatic events and our attempts to deny their impact take on us all.
- Richard Schwartz PhD Originator, Internal Family Systems Therapy
Breathtaking in its scope and breadth, The Body Keeps the Score is a seminal work by one of the preeminent pioneers in trauma research and treatment. This essential book unites the evolving neuroscience of trauma research with an emergent wave of body-oriented therapies and traditional mind/body practices. These new approaches and ancient disciplines build resilience and enhance the capacity to have new empowered bodily (interoceptive) experiences that contradict the previous traumatic ones of fear, overwhelm and helplessness. They go beyond symptom relief, and connect us with our vital energy and here-and-now presence. A must read for all therapists and for those interested in a scholarly, thoughtful, tome about the powerful forces that affect us as human beings in meeting the many challenges of life including accidents, loss and abuse.
- Peter A. Levine, PhD, Author, In an Unspoken Voice: How the Body Releases Trauma and Restores Goodness
The body keeps the score is masterful in bringing together science and humanism to clearly explain how trauma affects the whole person. Bessel van der Kolk brings deep understanding to the pain and chaos of the trauma experience. The treatment approaches he recommends heal the body and the mind, restoring hope and the possibility of joy. One reads this book with profound gratitude for its wisdom.
- Alicia F. Lieberman, Ph.D., Irving B. Harris Endowed Chair in Infant Mental Health; Vice Chair, Academic Affairs, UCSF Department; Director, Child Trauma Research Program, SF General Hospital
This book is a tour de force. Its deeply empathic, insightful, and compassionate perspective promises to further humanize the treatment of trauma victims, dramatically expand their repertoire of self-regulatory healing practices and therapeutic options, and also stimulate greater creative thinking and research on trauma and its effective treatment. The body does keep the score, and Van der Kolk’s ability to demonstrate this through compelling descriptions of the work of others, his own pioneering trajectory and experience as the field evolved and him along with it, and above all, his discovery of ways to work skillfully with people by bringing mindfulness to the body (as well as to their thoughts and emotions) through yoga, movement, and theater are a wonderful and welcome breath of fresh air and possibility in the therapy world.
- Jon Kabat-Zinn, Professor of Medicine emeritus; UMass Medical School; Author, Full Catastrophe Living
Clear, fascinating, hard to put down, filled with powerful case histories, Van der Kolk, the eminent impresario of trauma treatment who has spent a career bringing together diverse trauma scientists and clinicians, and their ideas, while making his own pivotal contributions, describes what is arguably the most important series of breakthroughs in mental health in the last thirty years. We’ve known that psychological trauma fragments the mind. Here we see not only how psychological trauma also breaks connections within the brain, and between mind and body, and learn about the exciting new approaches that allow people with the severest forms of trauma to put all the parts back together again.
- Norman Doidge, M.D., Author, The Brain That Changes Itself
This exceptional book will be a classic of modern psychiatric thought. The impact of overwhelming experience can only be truly understood when many disparate domains of knowledge, such as neuroscience, developmental psychopathology, and interpersonal neurobiology are integrated, as this work uniquely does. There is no other volume in the field of traumatic stress that has distilled these domains of science with such rich historical and clinical perspectives, and arrived at such innovative treatment approaches. The clarity of vision and breadth of wisdom of this unique but highly accessible work is remarkable. This book is essential reading for anyone interested in understanding and treating traumatic stress and the scope of its impact on society.
- Alexander McFarlane AO, MB BS (Hons) MD FRANZCP Director of the Centre for Traumatic Stress Studies; The University of Adelaide, South Australia
In The Body Keeps the Score we share the author's courageous journey into the parallel dissociative worlds of trauma victims and the medical and psychological disciplines that are meant to provide relief. In this compelling book we learn that as our minds desperately try to leave trauma behind, our bodies keep us trapped in the past with wordless emotions and feelings. These inner disconnections cascade into ruptures in social relationships with disastrous effects on marriages, families, and friendships. Van der Kolk offers hope by describing treatments and strategies that have successfully helped his patients reconnect their thoughts with their bodies. We leave this shared journey understanding that only through fostering self-awareness and gaining an inner sense of safety will we, as a species, fully experience the richness of life.
- Stephen W. Porges, PhD
Professor Department of Psychiatry University of North Carolina at Chapel Hill; Author, The Polyvagal Theory: Neurophysiological Foundations of Emotions, Attachment, Communication, and Self-Regulation
The Body Keeps the Score” eloquently articulates how overwhelming experiences affect the development of brain, mind, and body awareness, all of which are closely intertwined. The resulting derailments have a profound impact on the capacity for love and work. This rich integration of clinical case examples with ground breaking scientific studies provides us with a new understanding of trauma, which inevitably leads to the exploration of novel therapeutic approaches that allow the brain to 'rewire' itself, and help traumatized people to (re)-engage in the present. This book will provide traumatized individuals with a guide to healing and permanently change how psychologists and psychiatrists think about trauma and recovery.
- Ruth A. Lanius, M.D., Ph.D., Harris-Woodman Chair in Psyche and Soma; Professor of Psychiatry, and director PTSD research at the University of Western Ontario; Author, The Impact of Early Life Trauma on Health and Disease
In this inspirational work which seamlessly weaves keen clinical observation, neuroscience, historical analysis, the arts, and personal narrative, Dr. van der Kolk has created an authoritative guide to the effects of trauma, and a revolutionary approach to its treatment, including pathways to recovery. The book is full of wisdom, humanity, compassion and scientific insight, gleaned from a lifetime of clinical service, research and scholarship in the field of traumatic stress. A must read for mental health and other health care professionals, trauma survivors, their loved ones, and those who seek clinical, social, or political solutions to the cycle of trauma and violence in our society.
- Rachel Yehuda, PhD, Professor of Psychiatry and Neuroscience; Director of the Traumatic Stress Studies Division at the Mount Sinai School of Medicine New York NY
With his comprehensive knowledge, clinical courage, and creative strategies Bessel van der Kolk leads the way in understanding the impact of trauma and helping people heal from overwhelming life experiences. The Body Keeps the Score is a cutting-edge offering for the general reader to comprehend the complex effects of trauma, and a guide to a wide array of scientifically informed approaches to not only reduce suffering, but to move beyond mere survival-- and to thrive.
- Daniel J. Siegel, M.D., Clinical Professor, UCLA School of Medicine; Author, Brainstorm: The Power and Purpose of the Teenage Brain; Mindsight: The New Science of Personal Transformation
This is an absolutely fascinating and clearly written book by one of the nation’s most experienced physicians in the field of emotional trauma. Equally suitable for primary care doctors and psychotherapists wishing to broaden their range of helpfulness, or for those trapped in their memories, “The Body Keeps the Score” helps us understand how life experiences play out in the function and the malfunction of our bodies, years later.
- Vincent J. Felitti, MD
Chief of Preventative Medicine Emeritus, Kaiser Permanente San Diego; Co-Principal Investigator, ACE study
“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.”
"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."
“Eighty two percent of the traumatized children seen in the National Child Traumatic Stress Network do not meet diagnostic criteria for PTSD. Because they often are shut down, suspicious, or aggressive they now receive pseudoscientific diagnoses such as “oppositional defiant disorder,” meaning: “This kid hates my guts” or “disruptive mood dysregulation disorder,” meaning he has temper tantrums. These kids accumulate numerous diagnoses over time. Before they reach their twenties, many patients have been given four, five, six, or more of these impressive but meaningless labels. If they receive treatment at all, they get whatever is being promulgated as the method of management du jour: medications, behavioral modification, or exposure therapy. These rarely work and often cause more damage.”
“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.”
“Mindfulness not only makes it possible to survey our internal landscape with compassion and curiosity but can also actively steer us in the right direction for self-care.”
“As the ACE study has shown, 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.”
“Imagination is absolutely critical to the quality of our lives. Our imagination enables us to leave our routine everyday existence by fantasizing about travel, food, sex, falling in love, or having the last word—all the things that make life interesting. Imagination gives us the opportunity to envision new possibilities—it is an essential launchpad for making our hopes come true. It fires our creativity, relieves our boredom, alleviates our pain, enhances our pleasure, and enriches our most intimate relationships.”
“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."
“How many mental health problems, from drug addiction to self-injurious behavior, start as attempts to cope with the unbearable physical pain of our emotions? If Darwin was right, the solution requires finding ways to help people alter the inner sensory landscape of their bodies. Until recently, this bidirectional communication between body and mind was largely ignored by Western science, even as it had long been central to traditional healing practices in many other parts of the world, notably in India and China. Today it is transforming our understanding of trauma and recovery.”
“The prevailing brain-disease model overlooks four fundamental truths: (1) our capacity to destroy one another is matched by our capacity to heal one another. Restoring relationships and community is central to restoring well-being; (2) language gives us the power to change ourselves and others by communicating our experiences, helping us to define what we know, and finding a common sense of meaning; (3) we have the ability to regulate our own physiology, including some of the so-called involuntary functions of the body and brain, through such basic activities as breathing, moving, and touching; and (4) we can change social conditions to create environments in which children and adults can feel safe and where they can thrive.”
“Psychologists usually try to help people use insight and understanding to manage their behavior. However, neuroscience research shows that very few psychological problems are the result of defects in understanding; most originate in pressures from deeper regions in the brain that drive our perception and attention. When the alarm bell of the emotional brain keeps signaling that you are in danger, no amount of insight will silence it.”
“Self-regulation can be taught to many kids who cycle between frantic activity and immobility. In addition to reading, writing, and arithmetic, all kids need to learn self-awareness, self-regulation, and communication as part of their core curriculum. Just as we teach history and geography, we need to teach children how their brains and bodies work. For adults and children alike, being in control of ourselves requires becoming familiar with our inner world and accurately identifying what scares, upsets, or delights us.”
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