War. Rape. Fear. Violence. Molestation. Sexual assault. According to Bessel van der Kolk, MD, incidents involving emotional trauma and toxic stress are far more common than people generally understand.
Since 2001, he says, far more Americans died due to family violence than in the wars in Iraq and Afghanistan. Women are twice as likely to endure domestic violence than breast cancer. Firearms kill two times as many children as does cancer.
Yet Van der Kolk says that until recently, we haven’t had an effective way to treat the aftereffects of trauma. That’s largely because trauma isn’t just an event that took place sometime in the past, explains Van der Kolk, who is the author of The Body Keeps the Score.
Instead, trauma changes not only how we think and what we think about, but also our very capacity to think. People with post-traumatic stress disorder (PTSD) lose their way in the world, he says. Time stops because the body keeps replaying the past. That makes it hard to take pleasure in the present.
Van der Kolk explains that trauma is often re-experienced in the present, not just as a memory or a story, but as deeply disturbing physical sensations and emotions that may not be consciously linked to past memories of trauma. Victims feel and relive terror, helplessness and rage with physical symptoms such as a pounding heart, rigidity, rage, or nausea.
Over time, the trauma is no longer what happened years before; it becomes the fact that you’ve been robbed of feeling fully alive and in charge of yourself, he explains.
Van der Kolk says the challenge for trauma victims is to learn to experience their feelings without being overwhelmed: learning to sit quietly, noticing what they’re feeling and understand that those feelings will not last forever.
He explains that the function of emotion is actually motion, engaging in action. Emotion propels people toward doing something, whether it is engagement, as in fighting, running away from someone, as in fear, or moving toward someone, as in love, for example. But when you experience trauma, you become emotionally paralyzed. Our brains are designed to engage in the world, not to abolish emotions. The challenge is to learn techniques to calm ourselves.
For real change to take place, the body must learn that the danger has passed and live in the reality of the present. To do that, Van der Kolk says the challenge is to reestablish ownership of your body and mind, your “self.” He suggests eight approaches that can and should overlap. Some may be more difficult than others. He says that while some people get better using just one method, most people need different approaches at different stages of recovery:
Healing from trauma: revisiting the trauma, confronting what has happened, only after you feel safe and won’t be further traumatized by thinking about it. Techniques include developing a good support network, working with a professional therapist, cognitive behavioral therapy, desensitization, and sometimes medications, among others.
Language: Because trauma makes people feel that they are no longer themselves, strategies to overcome that include writing to yourself to access your inner world of feelings, art, music and dance, among others.
Letting go of the past: EMDR, or eye movement desensitization and deprocessing, which gives people rapid access to loosely associated memories and images from the past. It sometimes allows people to heal without talking about the trauma, and can be effective even when the patient doesn’t have a trusting relationship with a therapist.
Learning to inhabit your body with yoga:People with PTSD have trouble appreciating pleasure because the body keeps replaying the past. Yoga can help develop a strong body and can help avoid being stuck in the past.
Putting the pieces together: Tapping the internal family systems model (IFS) to help put yourself back in charge and learn self-compassion.
Creating structures:Filling the inner void, the holes of not feeling love, with approaches including rescripting your life, psychomotor therapy and eliminating secrets.
Rewiring the brain:Using neurofeedback. Patients can see patterns of brain activity that seem to be responsible for their difficulty focusing or their lack of emotional control. That can help them shift from self-blaming and learn to process information differently.
Finding your void with dance, improv and theater:Participating in these activities may help patients feel in control and more comfortable in their bodies.
Learn more: The Body Keeps the Score: Brain, Mind and Body in the Healing of Trauma, by Bessel van der Kolk, MD, The Penguin Group, 2014.