Book Summary (2 of 2): The Body Keeps the Score by Bessel Van der Kolk
by Jerry Wu
The summary of the book is divided into two parts: Go to Part 1 if you want to learn about trauma and how it affects our physical brain and cognitive functioning.
Part 2 of the summary will focus on various healing techniques mentioned in the book. It covers a variety of methods, including writing, EMDR (Eye Movement Desensitization and Reprocessing), breathwork, yoga, IFS (Internal Family Systems), PBSP (Pesso Boyden System Psychomotor), MDMA (commonly known as ecstasy or molly), neurofeedback, theater, responsive community, medication, writing, and more.
But why do we need these methods? Why not just think harder and reason your way out of trouble? Many people approach psychological issues with the mindset of negotiating with or controlling their emotions through sheer willpower and rational thinking.
However, psychological troubles often run deeper than logic alone can address. Trauma and emotional wounds can create deeply ingrained patterns in the brain that simple reasoning cannot easily undo. These healing methods provide various pathways to healing by addressing the neurological, physiological, and psychological aspects of trauma. They help rewire the brain, release stored emotions, and foster a holistic recovery process that thinking alone cannot achieve.
The rational, executive brain is good at helping us understand where feelings come from (as in: “I get scared when I get close to a guy because my father molested me” or “I have trouble expressing my love toward my son because I feel guilty about having killed a child in Iraq”). However, the rational brain cannot abolish emotions, sensations, or thoughts (such as living with a low-level sense of threat or feeling that you are fundamentally a terrible person, even though you rationally know that you are not to blame for having been raped). Understanding why you feel a certain way does not change how you feel. But it can keep you from surrendering to intense reactions (for example, assaulting a boss who reminds you of a perpetrator, breaking up with a lover at your first disagreement, or jumping into the arms of a stranger).
This is why talk or verbal therapies can only take you so far on the healing journey. While these therapies may provide a better understanding of the overall issues, they often fall short in addressing the deep-seated wounds hidden within your brain and body.
In contrast to its effectiveness for irrational fears such as spiders, CBT has not done so well for traumatized individuals, particularly those with histories of childhood abuse. Only about one in three participants with PTSD who finish research studies 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.
The “cognitive” part of cognitive behavioral therapy focuses on changing such “dysfunctional thinking.” This is a top-down approach to change in which the therapist challenges or “reframes” negative cognitions.
This principle applies not only to trauma but to healing in general. Healing is not about positive thinking or altering thoughts with statements like "I'm already lucky. It could be worse." While positive thinking, gratitude, and compassion can shift our mindset at the cognitive level, they do not necessarily heal the deep-seated wounds within. Similarly, pleasure is a way to temporarily cease the pain, but pleasure does not cure the underlying wounds. Without addressing the root cause, this leads to a never-ending chase for pleasure without achieving true healing.
Almost every brain-imaging study of trauma patients finds abnormal activation of the insula. This part of the brain integrates and interprets the input from the internal organs—including our muscles, joints, and balance (proprioceptive) system—to generate the sense of being embodied. The insula can transmit signals to the amygdala that trigger fight/flight responses. This does not require any cognitive input or any conscious recognition that something has gone awry—you just feel on edge and unable to focus or, at worst, have a sense of imminent doom. These powerful feelings are generated deep inside the brain and cannot be eliminated by reason or understanding.
The only way to change the way we feel is to become aware of our inner experiences and recognize and accept what is going on inside ourselves. This doesn't mean we have to befriend our painful memories or negative feelings, but we must acknowledge our feelings without denying, withdrawing, or avoiding them. Healing is only possible when we see ourselves as whole and complete, recognizing that both positive and negative feelings are part of us.
We might not like negative feelings, but to heal is to address them rather than avoid them and pretend that they don’t exist. Healing takes a lot of willpower and courage to revisit what happened, gain a good understanding of the issue, and leverage healing methods to resolve the troubling feelings lingering in your mind and body.
EMDR (Eye Movement Desensitization and Reprocessing)
The beauty of EMDR lies in its ability to facilitate healing without requiring you to disclose the specific details of your trauma, which you may or may not feel comfortable sharing. This is completely okay. However, EMDR does require you to recall the imagery of the traumatic event during the eye movement process.
Learn more about formal EMDR therapy APA
The group on Prozac did slightly better than the placebo group, but barely so. This is typical of most studies of drugs for PTSD: Simply showing up brings about a 30 percent to 42 percent improvement; when drugs work, they add an additional 5 percent to 15 percent. However, the patients on EMDR did substantially better than those on either Prozac or the placebo: After eight EMDR sessions one in four were completely cured (their PTSD scores had dropped to negligible levels), compared with one in ten of the Prozac group. But the real difference occurred over time: When we interviewed our subjects eight months later, 60 percent of those who had received EMDR scored as being completely cured. As the great psychiatrist Milton Erickson said, once you kick the log, the river will start flowing. Once people started to integrate their traumatic memories, they spontaneously continued to improve. In contrast, all those who had taken Prozac relapsed when they went off the drug.
EMDR puts the brain into a meditative or hypnotic trance state.
Theta frequencies (5–8 Hz) predominate at the edge of sleep, as in the floating “hypnopompic” state I described in chapter 15 on EMDR; they are also characteristic of hypnotic trance states. Theta waves create a frame of mind unconstrained by logic or by the ordinary demands of life and thus open the potential for making novel connections and associations. One of the most promising EEG neurofeedback treatments for PTSD, alpha/theta training, makes use of that quality to loosen frozen associations and facilitate new learning.
The “desensitization” aspect of EMDR, Eye Movement Desensitization and Reprocessing, can be misleading. EMDR doesn't desensitize emotions or feelings in the sense of making you insensitive or dulling your emotional responses. The act of moving the eyes introduces a distraction to the brain, changes the routine thinking pattern, and loosens the association between the traumatic event and the intense emotions.
From my personal experience, after a few rounds of eye movement, EMDR put me into a deep meditative or trance state, making it easier to receive hypnotic suggestions. The process helps the brain unstuck from trapped trauma mode, allowing it to reinterpret the event. The effect is somewhat similar to the methods used by Milton Erickson, who employed unconventional actions like odd handshakes or utter hard-to-understand sentences to create confusion and induce a light trance in patients.
However, EMDR is not a silver bullet. While it is highly effective for many situations, particularly incident-based trauma, some issues require significantly more effort to resolve. For example, individuals with abusive childhoods develop different mental and biological adaptations compared to those who have experienced discrete traumatic events in adulthood. Regardless, eye movement is a great way to reduce the impact of negative emotions. Here are the 3 simple steps if you would like to try it yourself.
Adults with histories of childhood trauma responded very differently to EMDR from those who were traumatized as adults. At the end of eight weeks, almost half of the adult-onset group that received EMDR scored as completely cured, while only 9 percent of the child-abuse group showed such pronounced improvement.
EMDR is a powerful treatment for stuck traumatic memories, but it doesn’t necessarily resolve the effects of the betrayal and abandonment that accompany physical or sexual abuse in childhood.
Dealing with event-based trauma is very different from addressing long-standing trauma. Event-based trauma is a single-line broken software function, while childhood trauma often results in incoherent programs running in confusion. In my experience, helping individuals with troubled childhoods requires an extra action: reorienting the person's thinking framework to heal the trauma. During this process, the person might feel disoriented, dreadful, and fearful as the old framework is being dismantled— long-held beliefs, habits, or “common sense” fall apart. Realizing that much of what you've learned over the past few decades is defective, necessitating a relearning process from scratch, much like learning to walk again.
During the eye movement, the person is asked to recall and exposed to the traumatic memory. However, EMDR differs significantly from exposure therapy, which desensitizes emotions or feelings by flooding a person with traumatic materials and hoping the brain can cope. Instead, EMDR has a distinct effect on the operation of the brain, helps mitigate the intensity of the emotion, and allows the brain to reprocess the event or memory without overwhelming emotions. Individuals process and integrate their memories in a healthy way, allowing them to move forward without the emotional burden.
A more accurate description would be that it integrates the traumatic material. As our research showed, after EMDR people thought of the trauma as a coherent event in the past, instead of experiencing sensations and images divorced from any context.
Memories evolve and change. Immediately after a memory is laid down, it undergoes a lengthy process of integration and reinterpretation—a process that automatically happens in the mind/brain without any input from the conscious self. When the process is complete, the experience is integrated with other life events and stops having a life of its own. As we have seen, in PTSD this process fails and the memory remains stuck—undigested and raw.
The beauty of EMDR lies in its potential for permanent healing, unlike temporary relief found by repeatedly sharing a traumatic story and crying on someone’s shoulder. Often, this method only ends up retelling the same stories over and over again without truly curing the wound.
As our Prozac/EMDR study showed, drugs can blunt the images and sensations of terror, but they remain embedded in the mind and body. In contrast with the subjects who improved on Prozac—whose memories were merely blunted, not integrated as an event that happened in the past, and still caused considerable anxiety—those who received EMDR no longer experienced the distinct imprints of the trauma: It had become a story of a terrible event that had happened a long time ago. As one of my patients said, making a dismissive hand gesture: “It’s over.”
During exposure patients initially become extremely upset. As they revisit the traumatic experience, they show sharp increases in their heart rate, blood pressure, and stress hormones. But if they manage to stay with the treatment and keep reliving their trauma, they slowly become less reactive and less prone to disintegrate when they recall the event.
When an event memory is successfully processed through EMDR, it transforms into a distant memory, much like listening to someone else’s story. The memory remains intact, but the intense emotions associated with it dissipate.
In my experience, many people have no intention to let go or forgive others initially. However, as the intensity of the emotion fades away, they often come to a sudden realization. One might say, “The memory is painful, but I am not angry anymore. I now feel my parents do love me—it’s just their way of expressing it or their actions that upset me. Understanding their situations and upbringing has helped me make peace with the past.” As a result, relationships are being mended, and internal conflicts are being resolved. There’s no forced compassion or forgiveness, but they come to you naturally as you heal. Here’re more ideas on Eye Movement (EMDR): How Does Moving Your Eyes Heal You?
Over the past two decades the prevailing treatment taught to psychology students has been some form of systematic desensitization: helping patients become less reactive to certain emotions and sensations. But is this the correct goal? Maybe the issue is not desensitization but integration: putting the traumatic event into its proper place in the overall arc of one’s life. Desensitization makes me think of the small boy—he must have been about five—I saw in front of my house recently. His hulking father was yelling at him at the top of his voice as the boy rode his tricycle down my street. The kid was unfazed, while my heart was racing and I felt an impulse to deck the guy. How much brutality had it taken to numb a child this young to his father’s brutality? His indifference to his father’s yelling must have been the result of prolonged exposure, but, I wondered, at what price?
In my view, while mindfulness is beneficial for observing our feelings without judgment and understanding them with raw, unfiltered senses, many people misunderstand the concepts of non-judgmental and non-dual awareness. Overly practiced mindfulness meditation can become a form of desensitization and reach the bottlenecks of the mindful practice. This happens when individuals spend countless hours trying to achieve a state of mindlessness or thoughtlessness or seeing everything as “non-dual” or “non-differentiation” by trying to eliminate distinctions between good and bad, beauty and ugliness, or pleasure and pain. Particularly within Buddhist teachings, the belief that the world is full of suffering and that everything is a grand illusion can lead to maintaining a state of non-differentiation. This approach can become a form of desensitization and withdrawal from reality.
Yoga
The lives of many trauma survivors come to revolve around bracing against and neutralizing unwanted sensory experiences, and most people I see in my practice have become experts in such self-numbing. They may become serially obese or anorexic or addicted to exercise or work. At least half of all traumatized people try to dull their intolerable inner world with drugs or alcohol. The flip side of numbing is sensation seeking. Many people cut themselves to make the numbing go away, while others try bungee jumping or high-risk activities like prostitution and gambling.
Yoga is a process of learning to listen to our body and being mindful of the different parts of the body as we move from pose to pose, noticing subtle changes. It helps reconnect the mind and body by identifying the relationships between emotions and bodily sensations. As many practitioners probably noticed, “I can express my feelings more because I can recognize them more. I feel them in my body, recognize them, and address them.”
When people are chronically angry or scared, constant muscle tension ultimately leads to spasms, back pain, migraine headaches, fibromyalgia, and other forms of chronic pain.
During practice, you might notice painful memories or emotions stored in the body, such as pain in the chest, abdomen, or various other areas. Once these areas are identified, you can progressively relax the tension or discomfort.
In my experience, yoga is tremendously helpful beyond just stretching and discovering muscles I didn’t know existed. It also releases tension stored in the muscles. When I did the child's pose for the first few times, with support at the bottom, I sensed a rush of sadness. Perhaps it stretched and relaxed my lower back muscles, which used to cause me terrible pain if I sat for too long or in the wrong posture. The pain was so severe that I could barely walk. I'm not exactly sure why I felt sadness, but the stretch released the muscle tension, which improved the overall range of body movement.
The book didn't cover Qi and energy work, but bodywork like yoga often leads to exploring Qi, prana, or energy practices. Yoga is an incredible way for mind and body discovery, and Qi and energy work can help restore and smooth out the flow of energy in the body.
Breathwork
Instead of relaxation we picked up too much muscle activity to get a clear signal. Rather than going into a state of quiet repose, our students’ muscles often continue to prepare them to fight unseen enemies. A major challenge in recovering from trauma remains being able to achieve a state of total relaxation and safe surrender.
Breathwork is a technique to relax and release.
We can access the ANS (autonomic nervous system) through breath, movement, or touch. Breathing is one of the few body functions under both conscious and autonomic control…Whenever you take a deep breath, you activate the SNS (sympathetic nervous system). The resulting burst of adrenaline speeds up your heart, which explains why many athletes take a few short, deep breaths before starting competition. Exhaling, in turn, activates the PNS (parasympathetic nervous system), which slows down the heart.
When we inhale, we stimulate the SNS, which results in an increase in heart rate. Exhalations stimulate the PNS, which decreases how fast the heart beats. In healthy individuals inhalations and exhalations produce steady, rhythmical fluctuations in heart rate: Good heart rate variability (HRV) is a measure of basic well-being…Individuals with poorly modulated autonomic nervous systems are easily thrown off balance, both mentally and physically…people with PTSD have unusually low HRV. In other words, in PTSD the sympathetic and parasympathetic nervous systems are out of sync.
IFS (Internal Family Systems)
Psychology Today offers a good explanation:
Internal Family Systems (IFS) is an approach to psychotherapy that identifies and addresses multiple sub-personalities or families within each person’s mental system. These sub-personalities consist of wounded parts and painful emotions such as anger and shame, and parts that try to control and protect the person from the pain of the wounded parts. The sub-personalities are often in conflict with each other and with one’s core Self, a concept that describes the confident, compassionate, whole person that is at the core of every individual. IFS focuses on healing the wounded parts and restoring mental balance and harmony by changing the dynamics that create discord among the sub-personalities and the Self.
IFS was developed by psychologist Richard Schwartz. In his work as a family therapist, Schwartz began to observe patterns in how people described their inner lives: “What I heard repeatedly were descriptions of what they often called their "parts"—the conflicted subpersonalities that resided within them,” Schwartz says. He began to conceive of the mind as a family, and the parts as family members interacting with one another. Exploring how these components functioned with one another was the foundation for IFS and the idea of the core Self.
This approach is perhaps a great way to analyze core issues by recognizing distinct parts of the self, providing a pathway to explore our own identity and better understand ourselves. For example, if we feel, "I hate the envious part of myself," instead of forbidding or condemning these feelings, we can take a step back and ask, "Why do I feel envy?" An answer might emerge, such as, "I feel inferior or not good enough." Instead of being trapped in unresolved battles between different parts.
This approach seeks to reconcile the various parts or "small selves" within us, much like harmonizing and balancing relationships among family members. However, recognizing the issue with a particular part or member is crucial, but it doesn't guarantee the resolution of conflict. Conflicts might stem from specific beliefs, personalities, or moral dilemmas. For instance, one part of you might want to be a good person, a good spouse, a good parent, or a good child, yet striving to meet these standards could compromise your autonomy or go against your will. Especially when the notion of being "good" is based on social norms or dogmatic standards, it might clash with your personal values. In such cases, reconciliation is problematic as the different parts hold contradictory and incompatible values, leaving conflicts lingering in the air. Internal conflicts cause self-division, but fundamentally, there is only one entity.
This issue is similar in spiritual practices that divide the self into the ego and the higher Self with a capital "S." This division can overly complicate matters. For a child who needs to do homework but also wants to play. Understanding that a child naturally wants to play but is also responsible for assigned tasks, but there's no need to split the child into two separate entities—the "I want to do well in school kid" and the "I want to play kid."
PBSP Psychomotor Therapy
This approach is to reconstruct and reshape the internal reality within one’s self.
Although the structures involve dialogue, psychomotor therapy does not explain or interpret the past. Instead, it allows you to feel what you felt back then, to visualize what you saw, and to say what you could not say when it actually happened. It’s as if you could go back into the movie of your life and rewrite the crucial scenes. You can direct the role-players to do things they failed to do in the past, such as keeping your father from beating up your mom. These tableaus can stimulate powerful emotions. For example, as you place your “real mother” in the corner, cowering in terror, you may feel a deep longing to protect her and realize how powerless you felt as a child. But if you then create an ideal mother, who stands up to your father and who knows how to avoid getting trapped in abusive relationships, you may experience a visceral sense of relief and an unburdening of that old guilt and helplessness. Or you might confront the brother who brutalized you as a child and then create an ideal brother who protects you and becomes your role model.
As you position placeholders for the important people in your life, you may be surprised by the unexpected memories, thoughts, and emotions that come up.
Structures do not erase bad memories, or even neutralize them the way EMDR does. Instead, a structure offers fresh options—an alternative memory in which your basic human needs are met and your longings for love and protection are fulfilled.
It also surprises me, again and again, how the placeholders representing the significant people in the protagonist’s past almost immediately assume a virtual reality: The people who enroll seem to become the people he or she had to deal with back then—not only to the protagonist but often to the other participants as well.
Structures promote one of the essential conditions for deep therapeutic change: a trancelike state in which multiple realities can live side by side—past and present.”
This approach bears a close resemblance to Bert Hellinger's "Family Constellation," which aims to uncover unrecognized family dynamics. However, Hellinger's method delves into mystical aspects, reaching far into the past to reveal patterns and traumas passed down through generations. This taps into the more enigmatic parts of the human experience, uncovering hidden stories of relationships and interactions. Mystery aside, this type of therapy is immensely helpful for bringing unconscious aspects of life to the surface, resolving internal conflicts, and rewriting one's inner narrative.
Highly structured experiences of psychomotor therapy are so valuable. Participants can safely project their inner reality into a space filled with real people, where they can explore the cacophony and confusion of the past. This leads to concrete aha moments: “Yes, that is what it was like. That is what I had to deal with. And that is what it would have felt like back then if I had been cherished and cradled.”
It gives you permission to feel what you feel and know what you know—one of the essential foundations of recovery.
Touching
The book also briefly touches upon other methods of trauma healing, such as touching.
Touch, the most elementary tool that we have to calm down, is proscribed from most therapeutic practices. Yet you can’t fully recover if you don’t feel safe in your skin. Therefore, I encourage all my patients to engage in some sort of bodywork, be it therapeutic massage, Feldenkrais, or craniosacral therapy.
Writing
Writing is another great way of self-discovery and accessing your inner world of feelings. In a study, “The group that had written about both the facts and the emotions related to their trauma clearly benefited the most: They had a 50 percent drop in doctor visits compared with the other two groups.”
One of the most effective is through writing. Most of us have poured out our hearts in angry, accusatory, plaintive, or sad letters after people have betrayed or abandoned us. Doing so almost always makes us feel better, even if we never send them. When you write to yourself, you don’t have to worry about other people’s judgment—you just listen to your own thoughts and let their flow take over. Later, when you reread what you wrote, you often discover surprising truths.
We also place great emphasis on self-analysis through writing and journaling. Based on my personal experience, dedicating time and effort to three years of book writing has been one of the most rewarding endeavors I have undertaken. It has stretched my thinking and perception, propelling them to a new level of depth and understanding.
When we talk with someone with whom we don’t feel completely safe, our social editor jumps in on full alert and our guard is up. Writing is different. If you ask your editor to leave you alone for a while, things will come out that you had no idea were there. You are free to go into a sort of a trance state in which your pen (or keyboard) seems to channel whatever bubbles up from inside. You can connect those self-observing and narrative parts of your brain without worrying about the reception you’ll get.
Trauma, whether large or small, shares striking similarities in how it affects the mind and body. Healing techniques aim to mitigate or eliminate the negative effects associated with traumatic memories or conditioning. This process helps restore equilibrium and balance within us.
Reading the Part 1 of The Summary of Body Keeps the Score.