“The Body Keeps the Score” by Bessel Van Der Kolk is the go-to book for understanding and healing trauma. Highly recommend for anyone in therapeutic professions or for those looking to discover deeper levels of healing and wholeness in their lives.
Chapter 1 – Lessons from Vietnam Veterans
-Trauma, whether it is the result of something done to you or something you yourself have done, almost always makes it difficult to engage in intimate relationships.
-Traumatized people have a tendency to superimpose their trauma on everything around them and have trouble deciphering whatever is going on around them.
-Trauma can prevent people from using imagination as they just replay the same old images
-Whether the trauma had occurred ten years in the past or more than forty, my patients could not bridge the gap between their wartime experiences and their current lives. Somehow the very extent that caused them so much pain had also become their sole source of meaning. They felt fully alive only when they were revisiting their traumatic past.
Chapter 2 – Revolutions in Understanding Mind and Brain
-Antipsychotic drugs were a major factor in reducing the number of people living in mental hospitals in the United States, from over 500,000 in 1955 to fewer than 100,000 in 1996.
-In PTSD patients Cortisol levels fail to balance out wreaking havoc on their health
-Strong emotions can block pain
-Higher levels of serotonin dampen the fear system
-While antipsychotic drugs can calm children they often interfere with motivation, play and curiosity. They can also lead to obesity and diabetes.
-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.
-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.
-We have the ability to regulate our own physiology, including some of the so-called involuntary functions of the body and the brain, through such basic activities as breathing, moving, and touching.
-We can change social conditions to create environments in which children and adults can feel safe and where they can thrive.
Chapter 3 – Looking into the brain: The Neuroscience Revolution
-Trauma flashbacks often turn off the part of your brain which helps put your thoughts and feelings into words
-It is much easier for trauma victims to talk about what has been done to them — to tell a story of victimization and revenge — than to notice, feel, and put into words the reality of their internal experience.
Part 2 – This is Your Brain on Trauma
Chapter 4 – Running for your life: The Anatomy of Survival
-During disasters young children usually take their cues from their parents. As long as their caregivers remain calm and responsive to their needs, they often survive terrible incidents without serious psychological scars.
-After trauma, the world is experienced with a different nervous system. The survivor’s energy now becomes focused on suppressing inner chaos, at the expense of spontaneous involvement in their life.
-Trauma can shut down certain areas of the brain responsible for a sense of time which makes it seem like we are stuck in this experience
-Depersonalization is one symptom of the massive dissociation created by trauma.
Chapter 5 – Body-Brain Connections
-The purpose of emotions is to initiate a movement that will restore the organism to safety and physical equilibrium
-If an organism is stuck in survival mode, its energies are focused on fighting off unseen enemies, which leaves no room for nurture, care, and love.
-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?
-Physical immobility and loss of curiosity is typical of frightened, traumatized children and adults
-“inescapable shock” is a physical condition in which the organism cannot do anything to affect the inevitable.
-All creatures need a purpose but trauma often damage the “reflex of purpose”
-HRV measures the flexibility of the sympathetic nervous system and the parasympathetic nervous system …the more fluctuation, the better your system is functioning.
-Our culture teaches us to focus on personal uniqueness but our brains are built to help us function as members of a tribe
-Most of our energy is devoted to connecting with others
-Almost all mental suffering involves either trouble in creating workable and satisfying relationships or difficulties in regulating arousal
-Being able to feel safe with other people is probably the single most important aspect of mental health
-Many traumatized people find themselves chronically out of sync with the people around them
-Dogs and horses and even dolphins offer less complicated companionship while providing the necessary sense of safety.
-The autonomic nervous system regulates three fundamental physiological states. The level of safety determines which one of these is activated at any particular time.
3 levels of safety :
1. social engagement – whenever we feel threatened we call out for help, support, and comfort from the people around us.
2. Fight or flight – If no one comes to our aid, or we’re in immediate danger, the organism reverts to a more primitive way to survive. We fight off our attacker, or we run to a safe place.
3. Freeze or collapse – If we can’t get away, we’re held down or trapped – the organism tries to preserve itself by shutting down and expending as little energy as possible.
-The Vagus nerve registers heartbreak and gut-wrenching feelings. When a person becomes upset, the throat gets dry, the voice becomes tense, the heart speeds up, and respiration becomes rapid and shallow.
-The more efficiently the VVC (ventral vagal complex) synchronizes the activity of the sympathetic and parasympathetic nervous systems, the better the physiology of each individual will be attuned to that of other members of the tribe.
-Being in tune with other members of our species via the VVC is enormously rewarding. What begins as the attuned play of the mother and child continues with the rhythmicity of a good basketball game, the synchrony of tango dancing, and the harmony of choral singing or playing a piece of jazz or chamber music – all of which foster a deep sense of pleasure and connection.
-The natural state of mammals is to be somewhat on guard. However, in order to feel emotionally close to another human being, our defensive system must temporarily shut down.
-Many traumatized individuals are too hypervigilant to enjoy the ordinary pleasures that life has to offer, while others are too numb to absorb new experiences — or to be alert to signs of real danger.
-Many people feel safe as long as they can limit their social contact to superficial conversations, but actual physical contact can trigger intense reactions.
-Small rhythmically attuned movements such as throwing a ball around can create a safe place where the social-engagement system could reemerge.
-Immobilization is at the root of most traumas
-Women who had an early history of abuse and neglect were seven times more likely to be raped in adulthood.
Chapter 6 – Losing Your Body, Losing Your Self
-If you have a comfortable connection with your inner sensations — if you can trust them to give you accurate information — you will feel in charge of your body, your feelings, and yourself.
-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 experts at ignoring their gut feelings and in numbing awareness of what we played out inside. They learn to hide from their selves.
-Trauma victims cannot recover until they become familiar with and befriend the sensations in their bodies.
Part 3 – The Minds of Children
Chapter 7 – Getting on the Same Wavelength: Attachment and Attunement
-For abused children, the whole world is filled with triggers
-When infants and young children notice that their mothers are not fully engaged with them, they become nervous. When their mothers disappear from sight, they may cry and become inconsolable, but as soon as their mothers return, they quiet down and resume their play.
-Attachment styles include secure, avoidant, anxious, and disorganized
Chapter 8 – Trapped in Relationships: The Cost of Abuse and Neglect
-It’s not important to know every detail of a patient’s trauma. What is critical is that the patients themselves learn to tolerate feeling what they feel and knowing what they know.
-When we are unconditionally loved as children then we expect similar treatment in our relationships but when we are neglected or mistreated as children we tend to think that is the treatment we deserve
-A therapist should never tell a client how they should feel
-Trauma is not stored as an orderly narrative… flashbacks arise as fragments of experience, isolated images, sounds, and body sensations that initially have no context other than fear and panic.
Chapter 9 – What’s Love Got to do With it?
-Understanding what is “wrong” with people currently is more a question of the mindset of the practitioner (and if what insurance companies will pay) than of verifiable, objective facts.
-81 % of the patients diagnosed with Borderline Personality Disorder at Cambridge Hospital reported severe histories of child abuse and/or neglect.
-The ACE Study revealed that traumatic life experiences during childhood and adolescence are far more common than expected. Only one-third of the respondents reported no adverse childhood experiences.
-Incidents of abuse are never stand-alone events. And for each additional adverse experience reported the toll in later damage increases.
Chapter 10 – Developmental Trauma: The Hidden Epidemic
-After thirty years and millions of dollars of research, we have failed to find consistent genetic patterns for schizophrenia — of for any other psychiatric illness, for that matter.
-Monkeys and humans share the same two variants of the serotonin gene (known as the short and long serotonin transporter alleles). In humans, the short allele has been associated with impulsivity, aggression, sensation seeking, suicide attempts, and severe depression.
-Humans with the short allele had higher rates of depression than those with the long version but this was true only if they also had a childhood history of abuse or neglect. Children who are fortunate enough to have an attuned and attentive parent are not going to develop this genetically related problem.
-PTSD: A person is exposed to a horrendous event “that involved actual or threatened death or serious injury, or a threat to the physical integrity of self or others,” causing “intense fear, helplessness, or horror,” which results in a variety of manifestations: intrusive reexperiencing of the event (flashbacks, bad dreams, feeling as if the event were occurring), persistent and crippling avoidance (of people, places, thoughts, or feelings associated with the trauma, sometimes with amnesia for important parts of it), and increased arousal (insomnia, hypervigilance, or irritability).
-Insensitive, pushy, and intrusive behavior on the part of the parents at six months predicted hyperactivity and attention problems in kindergarten and beyond
-By far the most important predictor of how well his subjects coped with life’s inevitable disappointments was the level of security established with their primary caregiver during the first two years of life.
-Resilience in adulthood could be predicted by how lovable mothers rated their kids at age Two
-Over time the body adjusts to chronic trauma by numbing out
-The abused, isolated girls with incest histories mature sexually a year and a half earlier than non-abused girls. Sexual abuse speeds up their biological clocks and the secretion of sex hormones.
-Humans are social animals, and mental problems involve not being able to get along with other people, not fitting in, not belonging, and in general not being able to get on the same wavelength.
-70% of prisoners in California spent time in foster care while growing up
-The United States spends $84 billion per year to incarcerate people at approximately $44,000 per prisoner; they invest in helping parents to raise their children in safe and predictable surroundings. Their academic test scores and crime rates seem to reflect the success of those investments.
Part 4 – The Imprint of Trauma
Chapter 11 – Uncovering Secrets: The problem of Traumatic Memory
-While memories are usually altered over time, those who had been traumatized and subsequently developed PTSD did not modify their accounts; their memories were preserved essentially intact forty-five years after the war ended.
-When something terrifying happens, like seeing a child or a friend hurt in an accident, we will retain an intense and largely accurate memory of the event for a long time. The more adrenaline you secrete, the more precise your memory will be. But that is true only up to a certain point.
-unlike Traumatic memory Ordinary memory is adaptive; our stories are flexible and can be modified to fit the circumstances.
-Ordinary memory is social, it’s a story we tell for a purpose. But there is nothing social about traumatic memory.
-When patients dissociate their traumatic memories they lose their capacity to assimilate new experiences
-If the problem with PTSD is dissociation, the goal of treatment would be association: integrating the cut-off elements of the trauma into the ongoing narrative of life, so that the brain can recognize that “that was then, and this is now.”
Chapter 12 – The Unbearable Heaviness of Remembering
-Denial of the consequences of trauma can wreak havoc with the social fabric of society. The refusal to face the damage caused by the war and the intolerance of “weakness” played an important role in the rise of fascism and militarism around the world in the 1930s.
-Culture shapes the expression of traumatic stress
-Doctors shape how their patients communicate their distress: When a patient complains about terrifying nightmares and his doctor orders a chest X-ray, the patient realizes that he’ll get better care if he focuses on his physical problems.
-In comparison with the women who had always remembered their molestation, those with a prior period of forgetting were younger at the time of their abuse and were less likely to have received support from their mothers. The recovered memories were just as accurate as those that never were lost.
-As long as memory is inaccessible, the mind is unable to change it. But as soon as a story starts being told, particularly if it is told repeatedly, it changes — the act of telling itself changes the tale.
-In contrast to normal memories, traumatic memories were disorganized. Some details are remembered all too clearly while a cohesive sequence of events is often not recalled.
-Finding words to describe what has happened to you can be transformative, but it does not always abolish flashbacks or improve concentration, stimulate vital involvement in your life or reduce hypersensitivity to disappointments and perceived injuries.
-The essence of trauma is that it is overwhelming, unbelievable, and unbearable. Each patient demands that we suspend our sense of what is normal and accept that we are dealing with a dual reality: the reality of a relatively secure and predictable present that lives side by side with a ruinous, ever-present past.
Part 5 – Paths to Recovery
Chapter 13 – Healing from Trauma: Owning Your Self
-Trauma robs you of the feeling that you are in charge of yourself (self-leadership)
-Understanding why you feel a certain way does not change how you feel. But it can keep you from surrendering to intense reactions.
-As long as people are either hyperaroused or shut down, they cannot learn from experience.
-To change post-traumatic reactions, we have to access the emotional brain and do “limbic system therapy”
-Neuroscience 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.
-Learning how to breathe calmly and remaining in a state of relative physical relaxation, even while accessing painful and horrifying memories, is an essential tool for recovery.
-When you deliberately take a few slow, deep breaths, you will notice the effects of the parasympathetic brake on your arousal. The more you stay focused on your breathing, the more you will benefit, particularly if you pay attention until the very end of the outbreathe and notice the air moving in and out of your lungs.
-At the core of recovery is self-awareness
-Learning to observe and tolerate your physical reactions is a prerequisite for safely revisiting the past.
-Traumatized human beings recover in the context of relationships: with families, loved ones, AA meetings, veterans organizations, religious communities, or professional therapists. The role of those relationships is to provide physical and emotional safety, including safety from feeling shamed, admonished, or judged, and to bolster the courage to tolerate, face, and process the reality of what has happened.
-When we play together, we feel physically attuned and experience a sense of connection and joy. Improvisation exercises also are a marvelous way to help people connect in joy and exploration.
-The hand and the forearm is the safest place to touch somebody because that is the place from where they can touch you back.
-“Just like you can thirst for water, you can thirst for touch.”
-Pendulation is the process of gently moving in and out of accessing internal sensations and traumatic memories.
-Telling a story about the event does not guarantee that the traumatic memories will be laid to rest.
-The idea behind CBT is that when patients are repeatedly exposed to the stimulus/fear without bad things actually happening, they gradually will become less upset; the bad memories will have become associated with “corrective” information of being safe.
-Exposure sometimes helps to deal with fear and anxiety, but it has not been proven to help with guilt or other complex emotions.
-CBT does not work so well for traumatized individuals
-Desensitization to our own or to other people’s pain tends to lead to an overall blunting of emotional sensitivity.
-Drugs cannot “cure” trauma; they can only dampen the expressions of a disturbed physiology and they do not teach the lasting lessons of self-regulation.
Chapter 14 – Language: Miracle and Tyranny
-9/11 survivors were asked what helped them deal with their trauma ….they said acupuncture, massage, yoga, and EDMR in that order.
-If you’ve been hurt you need to acknowledge what happened to you
-As long as you hold secrets and suppress information, you are fundamentally at war with yourself.
-Hiding core feelings takes an enormous amount of energy and saps your motivation
-Communicating fully is the opposite of being traumatized
-We possess two forms of self-awareness:
1. The autobiographical self creates connections between experiences to create a coherent narrative
2. Moment-to-moment self-awareness is based on physical sensations
-The second system must be accessed to heal trauma
-The language center is as far removed from the center for experiencing one’s self as is geographically possible that’s why most of us are better at describing someone else than we are at describing ourselves.
-Being able to perceive visceral sensations is the foundation of emotional awareness
-Talking about painful events doesn’t necessarily establish community — often quite the contrary.
-Trauma makes people feel like either somebody else or like nobody. In order to overcome trauma, you need help to get back in touch with your body, with yourself.
-Our sense of self depends on being able to organize our memories into a coherent whole.
Chapter 15 – Letting Go of the Past: EMDR
-Eye movement desensitization reprocessing (EDMR)
-EDMR loosens up something in the mind/brain that gives people rapid access to loosely associated memories and images from their past this seems to help them put traumatic experiences into a larger context or perspective.
-People may be able to heal from Trauma without talking about it. EMDR enables them to observe their experiences in a new way, without verbal give-and-take with another person.
-EMDR can help even if the patient and the therapist do not have a trusting relationship.
-Chronic childhood abuse causes very different mental and biological adaptations than discrete traumatic events in adulthood.
-EDMR 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.
-Increasing our time in REM sleep reduces depression while the less REM sleep we get, the more likely we are to become depressed
-PTSD is associated with disturbed sleep and self-medication with alcohol or drugs further disrupts REM sleep.
-Dreams help forge novel connections which are an important feature of creativity and healing
-Drugs like Prozac can blunt the images and sensations of terror, but they remain embedded in the mind and body.
Chapter 16 – Learning to Inhabit Your Body: Yoga
-Memory of helplessness is stored as muscle tension or feelings of disintegration in the affected body areas
-Traumatized people become experts at self-numbing
-The flip side of numbing is sensation seeking
-The Sympathetic nervous system (SNS) uses chemicals like adrenaline to fuel the body and brain to take action
-The parasympathetic nervous system (PNS) uses acetylcholine to help regulate basic bodily functions like digestion, wound healing, and sleep and dream cycle.
-We are at our best when these two systems work closely together to keep us in an optimal state of engagement with our environment and with ourselves.
-HRV is heart rate variability and is a measure of basic well-being
-When our autonomic nervous system is well balanced, we have a reasonable degree of control over our response to minor frustrations and disappointments
-People with PTSD have unusually low HRV
-Changing the way one breathes can improve problems with anger, depression, and anxiety
-Yoga can improve HRV
-After twenty weeks of Yoga, chronically traumatized women developed increased activation of critical brain structures involved in self-regulation
Chapter 17 – Putting the pieces together: Self-Leadership
-Many behaviors that are classified as psychiatric problems, including some obsessions, compulsions, and panic attacks, as well as most self-destructive behaviors, started out as strategies for self-protection
-At the core of Internal family systems therapy (IFS) is the notion the mind of each of us is like a family in which the members have different levels of maturity, excitability, wisdom, and pain.
-In trauma the self-system breaks down, and the parts of the self become polarized and go to war with one another.
-When we are abused, there are parts that get hurt & frozen become toxic…these are the exiles
-The protectors keep the exiles away
-Critical and perfectionistic managers make sure we never get close to anyone or drive us to be relentlessly productive.
-another group of protectors – Firefighters are emergency responders acting impulsively whenever an experience triggers an exiled emotion
-Each split-off part holds different memories, beliefs, and physical sensations; some hold the shame, others the rage, some the pleasure and excitement, another the intense loneliness or the abject compliance.
-IFS recognizes that the cultivation of mindful self-leadership is the foundation for healing from trauma.
-Blending in ISF is a condition in which the self identifies with a part, as in “I want to kill myself” or “I hate you”
-ISF seeks to identify the exiles (hurt parts) by asking the protectors to stand back temporarily
-Firefighters will do anything to make the emotional pain go away
-Managers are all about staying in control, while firefighters will destroy the house in order to extinguish the fire
-The struggle between uptight managers and out-of-control firefighters will continue until the exiles, which carry the burden of the trauma, are allowed to come home and be cared for.
-Exiles are the toxic waste dump of the system. Because they hold the memories, sensations, beliefs, and emotions associated with trauma, it is hazardous to release them.
-Unburdening corresponds to nursing the exiled parts back to Health
Chapter 18 – Filling in the Holes: Creating Structures
-People who felt unwanted as children, and those who did not remember feeling safe with anyone while growing up, did not fully benefit from conventional psychotherapy
-90% of human communication occurs in the nonverbal, right-hemisphere realm.
-Structures do not erase bad memories or even neutralize them the way EDMR 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
-In Psychomotor therapy people can safely project their inner reality into a space filled with real people, where they can explore the cacophony and confusion of the past.
-The Scene you re-create in a structure may or may not be precisely what happened, but it represents the structure of your inner world: your internal map and the hidden rules that you have been living by.
Chapter 19 – Applied Neuroscience: Rewiring The Fear-Driven Mind with Brain/Computer Interface Technology
-People with PTSD have trouble learning because their brain struggles to filter out irrelevant information
-Traumatic stress is an illness of not being to be fully alive in the present.
-Neurofeedback nudges the brain to make more of the same frequencies and less of others, creating new patterns that enhance its natural complexity and its bias toward self-regulation.
-Neurofeedback has not garnered enough research funding to become more mainstream
-Theta waves produce hypnotic trance states in which the mind is unconstrained by ordinary logic and can create new novel connections
-Alpha waves are accompanied by a sense of peace and calm. What you experience in mindfulness meditation.
-Beta waves are the fastest frequencies and enable us to focus attention while performing a task. However, high beta can cause agitation, anxiety, and body tenseness
-Neurofeedback training can improve creativity, athletic control, and inner awareness, even in people who already are highly accomplished.
-A panel of judges from Britain’s Royal College of Music found that students who were trained with ten sessions of neurofeedback had a 10% improvement in the performance of a piece of music, compared to students who had not received neurofeedback.
-At least thirty-six studies have shown that neurofeedback can be an effective and time-limited treatment for ADHD
-Quantitative EEG can convert brain activity into a color map that shows which frequencies are highest or lowest in key areas of the brain.
-Mental states that are common to many diagnoses, such as confusion, agitation, or feeling disembodied, are associated with specific patterns on the qEEG
-The people who respond best to neurofeedback training are those who can see how the feedback is related to something that they are doing
-Approximately one-third to one-half of severely traumatized people develop substance abuse problems.
-Alcohol abuse makes people careless and thus increases their chances of being traumatized again (although being drunk during an assault actually decreases the likelihood of developing PTSD)