How Trauma Impacts Your Physical Health & How To Heal From It with Dr Bessel van der Kolk #336
Dr. Bessel van der Kolk, a professor of psychiatry, discusses how traumatic experiences leave physical imprints, leading to mental and physical health issues. He explores body-oriented therapies like yoga, movement, and theatre, alongside EMDR, neurofeedback, and psychedelics, emphasizing social connection for healing.
Deep Dive Analysis
16 Topic Outline
Defining Trauma: Not the Event, But Your Reaction
Distinguishing Trauma from Stress Responses
Prevalence, Secrecy, and Shame of Trauma
Factors Influencing Trauma Imprint: Temperament and Social Support
Trauma's Impact on Physical and Mental Health
Fibromyalgia and its Connection to Trauma
Medical System's Potential to Re-Traumatize Patients
The Body Keeps the Score: Feeling Safe in Your Body
Yoga as a Body-Oriented Therapy for Trauma
Movement and Agency in Trauma Recovery
Theatre and Shakespeare for Trauma Healing
EMDR: Eye Movement Desensitization and Reprocessing
Neurofeedback for Brain Organization and Regulation
The Importance of Community and Group Healing
Psychedelic Therapy for Trauma and Mental Health
Societal Lessons from Trauma and Post-Traumatic Growth
5 Key Concepts
Trauma
Trauma is defined not by the external event itself, but by an individual's inability to cope with that event, leading to persistent reactions as if the catastrophe is still ongoing. This changes one's nervous system and how the brain's salience network reacts to minor issues as if they are major threats.
Stress
Stress is a response to adverse circumstances that, once the challenging situation is over, allows the body to reset, calm down, and stop being hyper-focused. Unlike trauma, stress is a temporary state from which the body can recover to baseline.
Salience Network
This brain network is responsible for selecting what is important and unimportant in our environment. After trauma, the salience network can become dysregulated, causing individuals to react to minor issues with the intensity and alarm typically reserved for catastrophes.
The Body Keeps the Score
This concept highlights that traumatic psychological experiences leave a physical imprint within us, affecting the immune system, stress responses, and manifesting as persistent physical sensations like 'gut-wrench' or 'heartbreak.' The goal of healing is to help individuals feel safe and at home within their own bodies again.
Emotional Isolation / God Forsaken
A significant and painful aspect of trauma, characterized by a profound feeling of being disconnected from other people, abandoned, or utterly alone. Group therapies and community engagement are crucial in counteracting this isolation by fostering connection and shared understanding.
9 Questions Answered
The main difference is that when stress is over, the body resets and calms down, whereas with trauma, the intense reactions do not stop, leading to chronic changes in the nervous system and reactivity.
Trauma is extremely common; statistics suggest at least one in four women and one in five or six men experience sexual abuse before adulthood, and many are involved in domestic violence situations.
Factors include individual temperament and, crucially, the social environment; having supportive people who acknowledge the reality of what one went through and are deeply present makes a significant difference in resilience.
Due to a lack of understanding, time, and training, the medical system can inadvertently re-traumatize patients, especially those with complex, diffuse conditions like fibromyalgia, making them feel unheard or dismissed.
It means transforming the persistent physical sensations of fear, heartbreak, or gut-wrenching feelings that remain after trauma into a sense of calm and openness, often achieved by reconnecting with and regulating bodily sensations.
EMDR helps to neutralize traumatic memories by activating specific brain circuitry, particularly the salience network, allowing individuals to reorganize their perception of past events so they are no longer relived as current catastrophes but are instead processed as memories belonging to the past.
Neurofeedback is a method that uses electrodes on the skull to monitor brainwave activity, allowing individuals to play computer games with their own brainwaves to subtly train the brain to create optimal connections and calm down overactive or disconnected circuits, improving focus and self-regulation.
Psychedelics can open the mind to new possibilities, make individuals aware that their perceived reality is a small part of a larger one, and lead to a dramatic increase in self-compassion, allowing them to visit traumatic memories without being engulfed by them and to reorganize their perception of these events.
Yes, psychedelics are powerful substances, and if not administered with extraordinary care, proper setting, and a strong therapeutic relationship, they can lead to very painful and potentially dangerous experiences, causing overwhelming and horrible manifestations.
19 Actionable Insights
1. Shift Blame to Self-Management
Recognize that trauma’s difficulty stems from one’s own reactions, not solely external events or other people. Focus on managing personal arousal and reactivity to regain control over your life.
2. Practice Compassion & Understanding
Extend compassion and understanding to others, recognizing that people generally do their best to survive. Avoid punitive or judgmental responses, as connection and being heard are crucial for healing.
3. Prioritize Human Connection
Actively foster and re-establish human connection with loved ones and within communities. This is a main source of comfort, protection, and resilience against trauma’s chronic imprints.
4. Adopt Trauma-Informed Systems
Advocate for and implement trauma-informed approaches in schools, workplaces, and hospitals, focusing on individual safety and agency. This shifts from treating trauma as purely an individual problem to a systemic one.
5. Caregiver Self-Awareness & Reassessment
Caregivers should recognize their own frustration or anger towards a patient as a signal to step back and reassess the situation with colleagues. This helps avoid re-traumatizing the patient and ensures better care.
6. Experiment with Healing Modalities
Maintain an open mind and actively experiment with different healing modalities, as there is no one-size-fits-all solution. Explore what helps you feel alive in your body, as different approaches work for different people.
7. Engage Body-Oriented Therapies
Explore body-oriented therapies like yoga, Qigong, Tai Chi, martial arts, or massages to gently reconnect with bodily sensations. These practices can calm the nervous system and open pathways of self-experience.
8. Practice Slow, Deep Breathing
Intentionally practice slow and deep breathing to calm your nervous system and change heart rate variability. This can lead to a sense of relief and openness by calming the body’s stress response.
9. Consciously Alter Body Posture
Consciously alter your body posture to influence your emotional state. Adopt positions associated with positive emotions (e.g., joy, power) to shift your internal experience and counteract feelings of helplessness.
10. Engage in Movement & Action
Actively engage in varied movement and activities that make your body feel alive and capable. Doing something to overcome helplessness is crucial for processing stress and tapping into full human potential.
11. Consider EMDR Therapy
Explore EMDR (Eye Movement Desensitization and Reprocessing) therapy with a qualified therapist to neutralize traumatic memories. This can calm triggers and reduce the emotional impact of past events, though it may be less effective for long-standing child abuse histories.
12. Explore Neurofeedback Treatment
Investigate neurofeedback as a brain organization treatment to train your brain to make different connections. This can help calm the brain, improve focus, and regulate emotions, making it easier to learn and get along with others.
13. Engage in Group Healing
Seek out group treatment or community-based programs (like group yoga or choral singing) where others have similar experiences. This can significantly reduce shame, provide validation, and foster a crucial sense of connection and shared humanity.
14. Consider Theatre & Role-Playing
Engage in theatre or role-playing activities (e.g., Shakespeare plays, sword fighting) to viscerally experience different ways of being, moving, and feeling powerful. This can help break habitual responses of helplessness by embodying new roles.
15. Cautious Psychedelic Therapy Approach
If considering psychedelic therapy (where legal), ensure it is conducted with extreme caution, under the guidance of multiple trained therapists, in a safe and supportive setting, and within a strong therapeutic relationship. This mitigates significant risks and avoids potentially dangerous or painful experiences.
16. Parents: Be Present & Acknowledge
When a child experiences difficult events, be present for them and acknowledge their reality. This support significantly contributes to their resilience and overall well-being.
17. Take Ownership of Healing
Actively take ownership of your healing process and engage with treatments, rather than passively complying with external orders. This fosters a deeper connection with your progress and empowers your recovery.
18. De-escalate Relationship Conflicts
In intimate relationships, when a partner disproportionately reacts, practice trauma-sensitive responses by taking a step back, engaging in calming activities (e.g., a walk, playing tennis), or seeking external perspective. This helps to decrease the emotional heat of the situation and prevent re-traumatization.
19. Revisit Past Coping & Hope
If feeling stuck, revisit past coping mechanisms and moments that gave you a glimmer of hope. Reflect on what has worked or hasn’t worked for you as a survivor, and explore cultural activities that might help your body feel at home or safe.
8 Key Quotes
Trauma robs you of the feeling that you are in charge of yourself.
Dr. Bessel van der Kolk
When you get traumatized, it's not the external event, but your reaction to that external event is that you cannot cope with it, and then you're vulnerable to react to other things as if they're catastrophes.
Dr. Bessel van der Kolk
Shame and secrecy is very much part of trauma situations.
Dr. Bessel van der Kolk
The title of my book, The Body Keeps the Score, is not just a cute title. It actually, it affects your immune system, it affects your stress responses and people who have long trauma histories oftentimes have multiple medical problems which have to do with their body that gets stuck in fear, fight and flight.
Dr. Bessel van der Kolk
I think our own reactions are a very important bellwether of whether we're dealing with a traumatized person. And I think as physicians, we have an amazing capacity to help recreate trauma for our patients.
Dr. Bessel van der Kolk
Pleasure is a very somatic response, and I think people don't talk much about pleasure, but I think pleasure is a very important part of life.
Dr. Bessel van der Kolk
I think I became a good scientist because the psychedelics made me realize that the reality that we have defined for ourselves is just a small part of what there is and it made me a more open-minded and curious person.
Dr. Bessel van der Kolk
I think the big message is people generally do the best they can.
Dr. Bessel van der Kolk
4 Protocols
Four Principles for Trauma Recovery
Dr. Bessel van der Kolk- Find a way to become calm and focused.
- Be able to maintain that calm in response to things, events, and people that trigger you to the past.
- Find a way of being present in your life and with the people in your life.
- Do not keep secrets from yourself.
EMDR (Eye Movement Desensitization and Reprocessing) Session
Dr. Bessel van der Kolk- Ask the person to call up the stuff that really bothers them (what they saw, felt in their body, thought), but not to talk about it.
- Ask the person to stay in that state of awareness.
- Move fingers from side to side in front of the person's eyes and ask them to follow the fingers.
Neurofeedback Brain Training
Dr. Bessel van der Kolk- Place electrodes on the person's skull to harvest electrical brainwaves.
- Project the brain's electrical activity onto a computer screen to visualize active and inactive parts, and connections.
- Have the person play computer games using their own brainwaves, where creating optimal brain connections triggers positive sensory feedback (e.g., color changes, music changes).
- Avoid feedback for brain forms that induce anger or hyper-arousal, subtly nudging the brain towards different, more organized connections.
General Approach to Healing from Trauma (for individuals)
Dr. Bessel van der Kolk- Take careful histories about when things worked for you in the past, when you did not feel this way, and what relationships you were in.
- Help people to not only remember the horrors of the past but also to revisit themselves as a survivor, acknowledging what has worked and what hasn't, and what gave them a glimmer of hope.
- Look around in your environment for cultural activities that might help your body to feel at home, safe, or experience pleasure and engagement (e.g., singing in a choir, martial arts, yoga).