How The Body Keeps The Score: An Interview with Dr. Bessel van der Kolk


BW: How does trauma affect memory and how does that affect the learning process?

BvdK: Because people focus on the threat, it may become very difficult to take in new information. Indeed, your brain is not very available to learn new things. In fact, it may be that new information doesn’t mean much to the traumatized person. If it is not threatening, it’s not meaningful. So the world appears bland and meaningless, even though all kinds of nice things may be happening. Traumatized people tend to reiterate the same feelings and thoughts over and over again. That is why such an important part of treatment is to calm the brain down enough to focus, so new information can come in, allowing you to actually have new experiences that mean something to you.

BW: The Western world tends to separate mind and body. Can we break this preconception from a scientific standpoint?

BvdK: The core issue with trauma is that people feel unsafe in their bodies. Your body keeps reacting right now as if you’re still in danger, right now. The degree to which your body keeps reacting that way defines the depth of your trauma. So, trauma is expressed as sensations of heartbreak, gut wrench, of being irritable, being on edge, or just being numbed out.

So trauma is really a bodily state of feeling deeply uncomfortable, hyperaroused, or not feeling anything at all. There are numerous ways to approach trauma with body-based interventions. For example, we just finished a study of yoga for PTSD, where we found it worked more effectively than any medication. That doesn’t mean yoga cures PTSD, but it helps people inhabit their bodies and feel like they’re masters of their own ship again.

It also teaches people that you can actually do things to change these horrible internalizations of panic, of feelings of helplessness. And I won’t say that yoga is the end all or be all — nobody has ever studied whether Tai Chi or tango dancing would do the same thing. My suspicion is that if people studied these things, there would be interesting and productive results.

BW: How exactly does “the body keep the score”?

BvdK: The body keeps the score in every possible way. In terms of sensations of dread, collapse, and agitation, the body keeps the score by altering immune functions — after you are traumatized, you are more prone to diseases. Trauma speeds up the aging process. It makes you vulnerable to a whole range of physical illnesses, and leaves people feeling unsafe, with a loss of feelings of enjoyment, and the sense of being fully alive.

BW: How come in the same situation or context some people are traumatized and other people are not?

BvdK: Well that’s a question often raised. But in my practice, I don’t see much relevance to it. I rarely see a patient where I think: “If that happened to me, I would have been just fine.” So, I am somewhat skeptical when people talk about resilience.

On occasion, it may look like people are not traumatized because most victims have adaptive modes of survival, where they may be able to work or be creative, but in their personal lives they may be unable to tolerate intimacy or conflict. Dissociation starts off as a healthy way of coping, which allows you to go on with your life, while avoiding the impact of the trauma. People around them may think this person is resilient because he or she is so successful academically, let’s say. But then they go home and tear their hair out and scratch their skin. Before declaring somebody as resilient, I would like to get to know them really well.

BW: Based on these findings, how can we improve our education approach and policies?

BvdK: I’m glad you asked that question. I think one very important thing we can teach in our culture is that there are certain ways to regulate ourselves. One basic element is breathing. We can start simply by learning to breathe deeply and slowly, and that changes your heart rate variability. When you improve your heart rate variability, you will feel more in charge of yourself.

In school systems, instead of punishment, instead of finger-wagging, we can start teaching kids about safe places, about timeout, about organizing the day, about ways to help them feel safe. People can learn to activate their self-regulatory functions — that should be a basic element of all school curricula, from kindergarten right up to graduate school. Interspersing the day with vigorous physical activity in which you feel competent and smart. If a kid throws a tantrum, instead of screaming at the kid and frightening him, we can say here’s a soft room with pillows, just lay there for a while and feel the softness of the pillows and listen to quieting music.

I think imagination is also a pretty valuable tool when it comes to coping with trauma. One of my favorite ways to encourage this is with theater, helping patients to embody a different role. If you’re always a collapsed person, it would help to play someone like Julius Caesar. To feel what it’s like to be someone other than your current self. To experience what it’s like to feel physically and viscerally different from what you are accustomed to. Or for kids who are bullies, to be in a play and feel what it’s like to get hurt, see what it’s like to be on the receiving end. Acting out an imaginary situation can be very powerful, letting them see a drastically different solution, and to embody different options.

BW: What else can we do?

BvdK: Let them speak out. Trauma is real, and one of the hardest things about trauma is that oftentimes it’s a secret. After 9/11 in New York, there’s very little PTSD, because people could talk about it, share it and actively be there for each other. If you have a secret trauma, like domestic violence or child abuse, you can’t always talk about it, and you hold these secrets inside. Being able to say what happened, and to allow yourself, and the people around you to know what’s going on is important.

Most traumatized people tend to feel bad about this having happened to them, they tend to blame themselves: “If I had worn different clothes, I wouldn’t have been raped,” “If I hadn’t been there, I wouldn’t have been assaulted.” Trauma is very much associated with a sense of shame and self-hatred for having put yourself in a situation where you were vulnerable.

Opening up and dealing with your shame, and forgiving yourself for not always being in control becomes very important. Becoming mindful does activate the prefrontal cortex, which is part of how we consciously calm down the survival regions of the brain. But it only becomes truly helpful when we combine mindfulness with self-compassion.

This article was originally published in Brain World Magazine’s Spring 2015 issue.

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