The Body Keeps the Score : Recovering from Trauma

Wedding Day. By Della Chen. 

Wedding Day. By Della Chen. 

When a person experiences traumatic events, the aftermath can be extremely debilitating. Trauma not only affects the mind, but can have lifelong effects on the body. Trauma is an experience that overwhelms your capacity to cope. People feel helpless, overwhelmed, scared, horrified. 

For trauma survivors, their bodies feel deeply unsafe, so the enemy that was once living outside is now living within. They need to befriend their bodies, they need to calm their bodies down. Yoga is more effective than medication; medication can be nice to dampen some of the symptoms. But in the end, people need to own their bodies, they need to own their physical experiences. And, in order to overcome your trauma, it needs to be safe to go inside and to experience yourself. 

There is too much emphasis on the capacity of the cognitive rational brain to conquer our irrational survival brain. Neuroscience has really helped us understand that you can't talk yourself out of being in love, or being angry, or hating particular people because these are not rational processes. Reason has only very limited capacities to override these more primitive survival issues. And so, you need to not rely on reason, you need rely on mastery of your body, safety of your body, finding peace in your body. You need to find some way where your body once again feels like "I am in control of myself." 

- From Bessel Van der Kolk, author of The Body Keeps the Score: Brain, Mind, and Body in the Healing of Trauma.

The following is an excerpt from the book: 

Mindfulness

At the core of recovery is self-awareness. The most important phrases in trauma therapy are “Notice that” and “What happens next?” Traumatized people live with seemingly unbearable sensations: They feel heartbroken and suffer from intolerable sensations in the pit of their stomach or tightness in their chest. Yet avoiding feeling these sensations in our bodies increases our vulnerability to being overwhelmed by them. Body awareness puts us in touch with our inner world, the landscape of our organism. Simply noticing our annoyance, nervousness, or anxiety immediately helps us shift our perspective and opens up new options other than our automatic, habitual reactions. Mindfulness puts us in touch with the transitory nature of our feelings and perceptions. When we pay focused attention to our bodily sensations, we can recognize the ebb and flow of our emotions and, with that, increase our control over them.

Traumatized people are often afraid of feeling. It is not so much the perpetrators (who, hopefully, are no longer around to hurt them) but their own physical sensations that now are the enemy. Apprehension about being hijacked by uncomfortable sensations keeps the body frozen and the mind shut. Even though the trauma is a thing of the past, the emotional brain keeps generating sensations that make the sufferer feel scared and helpless. It’s not surprising that so many trauma survivors are compulsive eaters and drinkers, shun making love, and avoid many social activities: Their sensory world is largely off limits.

In order to change you need to open yourself to your inner experience. The first step is to allow your mind to focus on your sensations and notice how, in contrast to the timeless, ever-present experience of trauma, physical sensations are transient and respond to slight shifts in body position, changes in breathing, and shifts in thinking. Once you pay attention to your physical sensations, the next step is to label them, as in “When I feel anxious, I feel a crushing sensation in my chest.” And you can begin to notice how these sensations constantly shift and change.

Practicing mindfulness calms down the sympathetic nervous system, so that you are less likely to be thrown into fight‑or‑flight. Learning to observe and tolerate your physical reactions is a prerequisite for safely revisiting the past. If you cannot tolerate what you are feeling right now, opening up the past will only compound the misery and retraumatize you further.

Once we are fully aware that the commotions in our bodies are in a constant state of flux we can tolerate whatever discomfort comes up. One moment your chest tightens, but after you take a deep breath and exhale, that feeling softens and you may observe something else, perhaps a tension in your shoulder. Now you can start exploring what happens when you take a deeper breath and notice how your rib cage expands. Once you feel calmer and more curious, you can go back to that sensation in your shoulder. You should not be surprised if a memory spontaneously arises in which that shoulder was somehow involved.

A further step is to observe the interplay between your thoughts and your physical sensations. How are particular thoughts registered in your body? (Do thoughts like “My father loves me” or “my girlfriend dumped me” produce different sensations?) Becoming aware of how your body organizes particular emotions or memories opens up the possibility of releasing sensations and impulses that you may have learned to block in order to survive. 

Relationships

Study after study shows that having a good support network constitutes the single most powerful protection against becoming traumatized. Safety and terror are incompatible. When we are terrified, nothing calms us down like the reassuring voice or the firm embrace of someone we trust. Frightened adults respond to the same comforts as terrified children: gentle holding and rocking and the assurance that somebody bigger and stronger is taking care of things, so you can safely go to sleep. In order to recover, mind, body, and brain need to be convinced that it is safe to let go. That happens only when you feel safe at a visceral level and allow yourself to connect that sense of safety with memories of past helplessness.

After an acute trauma, like an assault, accident, or natural disaster, survivors require the presence of familiar people, faces, and voices; physical contact; food; shelter and a safe place; and time to sleep. It is critical to communicate with loved ones close and far and to reunite as soon as possible with family and friends in a place that feels safe. Our attachment bonds are our greatest protection against threat. For example, children who are separated from their parents after a traumatic event are likely to suffer serious negative long- term effects. Studies conducted during World War II in England showed that children who lived in London during the Blitz and were sent away to the countryside for protection against German bombing raids fared much worse than children who remained with their parents and endured nights in bomb shelters and frightening images of destroyed buildings and dead people.

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.

As we have seen, much of the wiring of our brain circuits is devoted to being in tune with others. Recovery from trauma involves (re)connecting with our fellow human beings. This is why trauma that has occurred within relationships is generally more difficult to treat than trauma resulting from traffic accidents or natural disasters. In our society the most common traumas in women and children occur at the hands of their parents or intimate partners. Child abuse, molestation, and domestic violence all are inflicted by people who are supposed to love you. That knocks out the most important protection against being traumatized: being sheltered by the people you love.

If the people whom you naturally turn to for care and protection terrify or reject you, you learn to shut down and to ignore what you feel. When your caregivers turn on you, you have to find alternative ways to deal with feeling scared, angry, or frustrated. Managing your terror all by yourself gives rise to another set of problems: dissociation, despair, addictions, a chronic sense of panic, and relationships that are marked by alienation, disconnection, and explosions.

Patients with these histories rarely make the connection between what happened to them long ago and how they currently feel and behave. Everything just seems unmanageable. Relief does not come until they are able to acknowledge what has happened and recognize the invisible demons they’re struggling with. 

While human contact and attunement are the wellspring of physiological self-regulation, the promise of closeness often evokes fear of getting hurt, betrayed, and abandoned. Shame plays an important role in this: “You will find out how rotten and disgusting I am and dump me as soon as you really get to know me.” Unresolved trauma can take a terrible toll on relationships. If your heart is still broken because you were assaulted by someone you loved, you are likely to be preoccupied with not getting hurt again and fear opening your heart to someone new. In fact, you may unwittingly try to hurt them before they have a chance to hurt you.

This poses a real challenge for recovery. Once you recognize that post-traumatic reactions started off as efforts to save your life, you may gather the courage to face your inner music (or cacophony), but you will need help to do so. You have to find someone you can trust enough to accompany you, someone who can safely hold your feelings and help you listen to the painful messages from your emotional brain. You need a guide who is not afraid of your terror and who can contain your darkest rage, someone who can safeguard the wholeness of you while you explore the fragmented experiences that you had to keep secret from yourself for so long. Most traumatized individuals need an anchor and a great deal of coaching to do this work.