The Body Keeps the Score Book Summary
Brain, Mind, and Body in the Healing of Trauma
Book by Bessel van der Kolk
Summary
The Body Keeps the Score revolutionizes our understanding of trauma's impact and offers a science-backed roadmap to healing the mind, brain and body.
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1. The Rediscovery of Trauma
Lifelong Impact of Trauma on War Victims
Many Vietnam war veterans continued to be haunted by their traumatic combat experiences years or decades later, unable to move on with their lives. Their trauma infiltrated every aspect of their lives, making it difficult to maintain relationships, find satisfaction in work, and control intense emotions like rage. Trauma leaves an imprint on mind, brain, and body that persists long after the original event. Healing requires finding ways to come fully alive in the present rather than remaining stuck in the past.
Section: 1, Chapter: 1
The Source of Our Suffering
"The greatest sources of our suffering are the lies we tell ourselves" - Elvin Semrad
Van der Kolk's teacher Elvin Semrad taught that the biggest obstacles to healing are the denial, lies and self-deceptions trauma survivors tell themselves to avoid the painful truth of their past. Being honest with oneself about one's experience and feelings is an essential first step in recovery.
Section: 1, Chapter: 1
Helping Patients Feel Real Again
Many traumatized people feel numb, shut down, and "not fully alive." Effective treatment must help them regain a visceral feeling of safety and aliveness. Therapists should focus not just on changing thoughts and behaviors, but on helping patients truly feel safe, powerful, and connected to their bodies again.Activities that promote physical mastery, social connection, creativity and play can help restore a sense of agency, engagement and pleasure.
Section: 1, Chapter: 1
How Childhood Shapes the Mind
The brain develops sequentially "from the bottom up", starting with the brainstem that controls basic survival functions, then the emotional brain or limbic system, and finally the rational brain or neocortex. Emotional and relational patterns learned in childhood become deeply ingrained in the limbic system and shape our expectations and behaviors in relationships throughout life. When early attachment relationships are disrupted by abuse or neglect, the emotional brain becomes hyperreactive to threat and the rational brain loses its ability to effectively regulate emotions and impulses. This sets the stage for psychological problems later in life.
Section: 1, Chapter: 2
"Use-Dependent" Brain Development
"The brain is formed in a 'use-dependent manner.' This is another way of describing neuroplasticity, the relatively recent discovery that neurons that 'fire together, wire together.' When a circuit fires repeatedly, it can become a default setting—the response most likely to occur. If you feel safe and loved, your brain becomes specialized in exploration, play, and cooperation; if you are frightened and unwanted, it specializes in managing feelings of fear and abandonment."
Section: 1, Chapter: 2
The Limits of Talk Therapy
Conventional talk therapy relies on the rational brain to try to control the emotional brain through insight and understanding. But when people are triggered into trauma responses, the rational brain goes "offline" and loses its ability to override the emotional brain.
- Therapists must help patients learn to regulate their physiological arousal and feel safe and grounded in their bodies, not just understand their issues intellectually. Mindfulness practices, yoga, and other body-based techniques can be valuable tools for this.
- Medication can help dampen hyperreactivity in the emotional brain, but is not enough for full recovery. Therapy must engage the whole organism and promote actual experiences of safety and mastery.
Section: 1, Chapter: 2
Trauma's Lasting Imprint
Brain scans of trauma survivors in the throes of a flashback show that the amygdala, the brain's "smoke detector" for threat, remains highly activated as if the trauma were happening in the present. This occurs even decades after the original event. At the same time, Broca's area, the part of the brain responsible for putting feelings into words, goes "offline," making it difficult for trauma survivors to articulate what they are experiencing. Trauma also appears to affect the brain in a highly lateralized fashion, shutting down the left hemisphere responsible for language and sequential ordering, while the right hemisphere responsible for emotional and sensory experience goes into overdrive. This results in the fragmentation of traumatic memories into sensory "splinter skills" without a coherent narrative.
Section: 1, Chapter: 3
Harnessing Brain Science in Trauma Therapy
Understanding how trauma affects the brain can guide therapists in choosing effective interventions. Since trauma disrupts left-brain functions like language and sequential processing, therapeutic methods that rely solely on talking things through are likely to fall short.
Therapies must also target physiological hyperarousal, using techniques like breath work, mindfulness, or yoga to help patients feel safe and grounded in their bodies.
Integrating traumatic memories requires activating both right-brain sensory experience and left-brain narrative processing. Treatments like EMDR that bilaterally stimulate both sides of the brain may help with this integration process.
Section: 1, Chapter: 3
2. This is Your Brain on Trauma
The Fight-or-Flight Mode
Faced with overwhelming threat, the brain triggers preprogrammed physical escape plans: fight, flight, or freeze. This happens automatically, before the thinking brain has time to process what's happening.
When these survival responses succeed in getting a person out of danger, the nervous system is able to return to baseline once the threat has passed. But if escape is thwarted, the brain and body keep sounding the alarm, leading to chronic hyperarousal and vigilance.
Section: 2, Chapter: 4
Immobilization: The Root of Most Traumas
"Immobilization is at the root of most traumas. When fight and flight are thwarted, the human organism has a third, even more primitive, way to save itself: total paralysis, like an animal playing dead. This reaction is controlled by the most ancient reptilian part of our brain. When that reptilian brain takes over, the bodies of traumatized people re-enact the dynamics of the original trauma, collapsing, getting stuck in (often maladaptive) patterns of behavior and movement. Feeling 'scared stiff' and 'frozen in fear' (collapsing and going numb) describe precisely what terror and trauma feel like."
Section: 2, Chapter: 4
Restoring Safety and Connection to the Body
Since trauma leaves people stuck in fight/flight/freeze mode, recovery requires helping them shift out of hypervigilance and chronic tension and return to a baseline sense of safety and connection to their bodies.
- Therapists can teach techniques like deep breathing, grounding exercises, yoga and movement to release chronic muscle tension, regulate arousal, and restore a felt sense of safety and control.
- Mindfulness practices that cultivate the ability to track sensations in the body with curiosity rather than fear can be an antidote to the constant vigilance of trauma. They help people "befriend" rather than avoid their physical experience.
- Anything that gets people to shift their perspective from "imminent danger" to "safety" in the present, whether it's playing with pets, walking in nature, receiving a massage or simply feeling supported by a therapist's calm presence, can be deeply reparative.
Section: 2, Chapter: 4
Body-Brain Connections
According to pioneer Charles Darwin, emotions are fundamentally rooted in the body and give shape and direction to behavior:
- The autonomic nervous system (ANS) is key in regulating emotions and arousal through the sympathetic (accelerator) and parasympathetic (brake) branches
- Trauma upsets the balance between the sympathetic and parasympathetic nervous systems, leading to issues like hyperarousal, numbing, and dissociation
- The body continues to react as if the trauma is ongoing, even after the threat has passed
Section: 2, Chapter: 5
Trauma as an Imprint
"Trauma is not just an event that took place sometime in the past; it is also the imprint left by that experience on mind, brain, and body."
Section: 2, Chapter: 5
Polyvagal Theory
Polyvagal Theory, developed by Stephen Porges, explains how the autonomic nervous system regulates emotions and social connection in response to cues of safety or danger:
- The vagus nerve connects the brain to the heart, lungs and gut
- The ventral vagal complex (VVC) promotes social engagement when safety is detected
- The sympathetic nervous system activates fight-or-flight in the face of danger
- The dorsal vagal complex (DVC) triggers shutdown and collapse if danger is extreme
- Many trauma symptoms reflect a loss of the VVC's ability to promote feelings of safety
In summary, Polyvagal Theory shows how the nervous system mediates between safety and survival, and how trauma can disrupt this delicate balance. It provides a framework for understanding and treating trauma by working with the body's autonomic responses.
Section: 2, Chapter: 5
Applying the Polyvagal Theory in Therapy
Polyvagal Theory can help therapists make traumatized clients feel safe and in control
- Encourage bottom-up regulation through breath, movement, touch and rhythm to calm the autonomic nervous system
- Promote top-down regulation through social engagement - attuned human contact
- Use playful and soothing tones of voice to activate the social engagement system
- Help people focus on bodily sensations to regain ownership over their inner experience
Section: 2, Chapter: 5
Losing Your Body, Losing Your Self
Children who grow up with abuse and neglect lack a stable, cohesive sense of self. Traumatized children have trouble sensing what is going on inside their bodies and cannot describe their feelings. This impairs their ability to know what they want or to protect themselves from danger
Abused children often blame themselves and feel defective, developing a deep sense of inner badness. In adulthood, child abuse survivors continue to struggle with self-loathing, emptiness and feeling unreal
Section: 2, Chapter: 6
3. The Minds of Children
How Babies Learn to Regulate Emotions
Infants learn to regulate their arousal and emotions through attunement with caregiversWhen a caregiver is responsive and attuned, the child feels soothed and connected. Misattunement, as when a caregiver doesn't respond, is overwhelming for babies. Repeated attunement builds secure attachment, allowing optimal child development. Disrupted attunement, as in abuse and neglect, leads to emotional dysregulation
Section: 3, Chapter: 7
Inner Maps
"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 your self."
Section: 3, Chapter: 7
Trapped in Relationships: The Cost of Abuse and Neglect
Sexual abuse has profound negative impacts on child development. Sexually abused girls show cognitive deficits, depression, dissociation, eating issues, self-harm, substance abuse and sexual problems. They have difficulty forming healthy peer relationships, especially in adolescence. Abuse speeds up biological development, with early puberty and sexual development.
Section: 3, Chapter: 8
The Adverse Childhood Experiences (ACE) Study
The ACE (Adverse Childhood Experiences) study looked at effects of childhood trauma in 17,000 adults:
- 2/3 of participants reported at least one adverse childhood experience
- 1 in 5 were sexually abused; 1 in 4 beaten or witnessed domestic violence
- More ACEs led to more mental health issues, addiction, health problems and early death. The ACE study showed that childhood trauma is far more common and damaging than previously recognized
Section: 3, Chapter: 8
The Inadequacies of Current Psychiatric Diagnoses
Patients with histories of abuse and neglect often receive many different psychiatric diagnoses over time, like depression, bipolar disorder, ADHD, borderline personality, etc.
- However, none of these diagnoses adequately capture what these patients are truly suffering from or point to effective treatments
- The current diagnostic system fails to recognize the profound impact of abuse, neglect and abandonment in childhood
- As a result, treatment ends up focusing narrowly on managing symptoms with drugs rather than addressing the underlying trauma and attachment disruptions
Section: 3, Chapter: 9
The Inescapable Impact of Early Caregiving Relationships
Two landmark prospective studies, by Sroufe and colleagues and by Putnam and Trickett, definitively showed:
- The quality of early caregiving relationships, not temperament or IQ, was the most powerful predictor of mental health outcomes
- Abuse and neglect led to a host of cognitive, emotional, behavioral and health problems that often persisted into adulthood
- Supportive, consistent early caregiving relationships provided a buffer against adversity and promoted resilience
Section: 2, Chapter: 10
The Societal Costs of Failing to Prevent and Treat Childhood Trauma
Children with histories of trauma, abuse and neglect absorb massive societal resources in health care, education, social services and criminal justice costs
- Economists estimate the cost-benefit of prevention programs: every $1 invested yields $7 in savings down the line
- A public health approach providing universal supports to families, quality childcare, parental leave, home visitation, etc. promotes healthy development and averts immense suffering and expense
- Countries that have made these social investments have drastically lower crime and incarceration rates than the U.S.
Section: 3, Chapter: 10
4. The Imprint of Trauma
The Complexities of Traumatic Memory
- Traumatic memories are often stored as fragmented sensations, images and emotions rather than as a coherent narrative. They persist with "astonishing freshness" and can be triggered involuntarily
- This is in contrast to ordinary memories which evolve and change over time
- Traumatized individuals simultaneously remember "too little and too much" - explicit memory may be impaired while implicit trauma memories intrude. Recovery involves putting the trauma in the past and regaining ownership of body and mind
Section: 4, Chapter: 11
Writing About Trauma Improves Mental Health
Van der Kolk describes a landmark study by James Pennebaker testing the impact of writing about trauma:
- College students wrote about either a traumatic experience or a superficial topic for 15 minutes on 4 consecutive days
- In the months after the study, those who wrote about both the facts and emotions of their trauma had a 50% drop in doctor visits compared to the other groups
- They reported that the writing helped them gain a new perspective - "It helped me think about what I felt during those times. I never realized how it affected me before."
- Subsequent studies showed that writing about trauma improves immune function and physical health across diverse populations
This demonstrates the power of putting one's traumatic experiences into words in a safe, controlled way. The act of writing allows integration of the traumatic memory.
Section: 4, Chapter: 11
The Unbearable Heaviness of Remembering
When working with trauma survivors to process traumatic memories, it's important to:
- Go slowly and use pendulation - gently moving in and out of accessing traumatic memories
- First establish "islands of safety" in the body where they can retreat if overwhelmed
- Have them focus on bodily sensations as an anchor to the present
- Gradually build their capacity to tolerate the sensations and emotions linked to the trauma
- Aim for titration of experience, not flooding or catharsis which can be destabilizing
- Respect the wisdom of defenses and work with them, not try to override them
By pendulating between safety and traumatic memory, between language and body, patients can integrate traumatic memories at a tolerable pace.
Section: 4, Chapter: 12
5. Paths to Recovery
The Fundamentals of Trauma Recovery
According to van der Kolk, the essential elements of recovering from trauma are:
- Finding a way to be calm and focused
- Learning to maintain that calm in response to images, thoughts, sounds or physical sensations that remind you of the past
- Finding a way to be fully alive in the present and engaged with the people around you
- Not having to keep secrets from yourself, including how you have managed to survive
He emphasizes that trauma recovery is not a step-by-step process but an individualized journey that may draw upon various approaches at different stages. Therapy is about providing guidance and support as the trauma survivor reestablishes ownership of their inner world.
Section: 5, Chapter: 13
The Critical Role of Social Support
Van der Kolk describes the powerful role of social support in a group for rape survivors in a South African township:
The women initially appeared defeated and frozen. But then, "one of the women started to hum, while gently swaying back and forth. Slowly a rhythm emerged; bit by bit other women joined in. Soon the whole group was singing, moving, and getting up to dance. It was an astounding transformation: people coming back to life, faces becoming attuned, vitality returning to bodies."
This illustrates how participation in communal rhythms can help trauma survivors resurface from shutdown and isolation. Engaging in music and movement with others restores a visceral sense of connection and being part of the human community. We heal in relationships.
Section: 5, Chapter: 13
Language: Miracle and Tyranny
While language is crucial for processing traumatic experiences, it also has constraints:
- Traumatized individuals often struggle to put their experiences into words - the default is speechless terror
- Trauma is registered in the body and right brain, while language is the province of the left brain
- Focusing exclusively on creating a narrative can keep one stuck in trauma - it needs to be balanced with accessing sensations and emotions
- Therapists must be able to tolerate patients' intense affects and sensory experiences without fleeing into intellectualization
Section: 5, Chapter: 14
Facing Yourself
“As long as you keep secrets and suppress information, you are fundamentally at war with yourself…The critical issue is allowing yourself to know what you know. That takes an enormous amount of courage.”
Section: 5, Chapter: 14
Describing Private Experiences
"The task of describing most private experiences can be likened to reaching down to a deep well to pick up small fragile crystal figures while you are wearing thick leather mittens." - Jerome Kagan
Section: 5, Chapter: 14
Writing Allows Unspoken Truths to Surface
Van der Kolk suggests that writing is a potent way to access one's inner truths, especially parts that feel too vulnerable or shameful to share with another:
- When you write to yourself, you don't have to worry about others' judgment
- You can temporarily suspend your internal censor and allow unspoken parts of yourself to have a voice
- Spontaneous free writing can put you in touch with implicit memories and emotions
- You may be surprised by what emerges when you give yourself permission to write uncensored
- You don't have to share your writing with anyone - the act of self-expression is therapeutic in itself
Writing accesses the timeless place within us that exists beyond fear and shame. Giving voice to our authentic inner reality, even if only for our own eyes, is an act of integration and self-validation.
Section: 5, Chapter: 14
Unleashing the Power of the Imagination with EMDR
Van der Kolk describes a powerful EMDR session with his patient Kathy, a survivor of incest. During the session, a cascade of images, sensations, and emotions surfaced:
Kathy recalled vivid memories of her abuse, including specific details. As the memories emerged, Kathy spontaneously accessed new, healing images, like "I'm picturing my life now—my big me holding my little me—saying, 'You are safe now.'" She envisioned "a bulldozer flattening the house I grew up in" and imagined confronting her abuser.
This demonstrates EMDR's capacity to activate a free-associative process, linking traumatic memories with reparative images and sensations. By following the thread of her own inner experience in a state of open awareness, Kathy could metabolize the frozen trauma and restore a sense of agency and safety.
Section: 5, Chapter: 15
Yoga as a Pathway to Embodied Self-Awareness
Van der Kolk outlines several key elements that make yoga a potent practice for trauma recovery:
- Yoga cultivates interoception, the sense of the body's interior landscape. Traumatized individuals often disconnect from their bodies as a survival strategy. Yoga helps them to safely tune in to physical sensations, rebuilding a foundation of inner attunement.
- Yoga balances the autonomic nervous system. Trauma disrupts the body's natural equilibrium, leading to states of hyperarousal or dissociation. Yoga practices like deep breathing, mindful movement, and relaxation activate the parasympathetic "rest and digest" response, promoting self-regulation.
- Yoga fosters self-acceptance and self-control. Trauma shatters one's sense of control and ownership of one's body. In yoga, students are invited to notice sensations without judgment and to move in ways that feel safe and nourishing. This supports a gradual reclaiming of one's body as a source of pleasure, vitality and agency.
Section: 5, Chapter: 16
Healing the Traumatized Self through Inner Dialogue
Van der Kolk presents the Internal Family Systems (IFS) model as a paradigm for restoring inner harmony after trauma. In IFS, the psyche is viewed as a system of interacting "parts" with different roles and agendas. Trauma disrupts this inner ecology, causing parts to become polarized and disconnected from the core Self.
The goal of IFS therapy is to reestablish the Self's innate leadership and compassion. The Self is the seat of clarity, confidence and curiosity - it is not identified with any one part but can create space for all. From this empowered center, the individual can open a dialogue with the protective parts that carry trauma burdens.
Exiles are the wounded parts that become frozen in time, bearing the pain, terror and shame of trauma. Managers are the preemptively controlling parts that try to safeguard against further wounding. Firefighters are the impulsive, self-destructive parts that try to extinguish overwhelming emotions.
IFS teaches people to embrace all their parts with understanding and empathy. As the Self grows more robust, it can help exiles to heal, managers to relax, and firefighters to discover new roles. By honoring each part's positive intention and releasing it from extremes, the system moves toward balance and wholeness.
Section: 5, Chapter: 17
Feeling the Hole Where Love Never Was
Many traumatized children grow up with an aching void - the absence of feeling loved, seen, soothed or safe. These deficits in early nurturance create "holes in the soul" that continue to undermine adult functioning, even after considerable therapeutic work.
Van der Kolk poses the question: How can we help people acquire an embodied sense of security when it was missing from the start? How can the brain and nervous system belatedly experience the warmth, resonance and regulation that are essential for healthy development?
While therapists can provide a reparative attachment experience to some degree, van der Kolk suggests that somatic practices may offer a more direct route to filling developmental gaps. By engaging in powerful physical experiences of attunement and protection, patients can viscerally encode new possibilities of comfort and connection.
Section: 5, Chapter: 18
Retraining the Traumatized Brain with Neurofeedback
Neurofeedback is a technology that allows individuals to directly reshape their brain wave patterns through real-time feedback. By targeting areas of dysregulation associated with trauma, such as the fear center in the temporal lobe, neurofeedback can help restore neural integration and flexibility. As patients learn to consciously shift their brain activity, they develop a greater capacity for self-regulation and emotional balance. Neurofeedback capitalizes on the brain's neuroplasticity to gradually rewire the patterns that keep traumatized people stuck in cycles of hyperarousal and dissociation.
Section: 5, Chapter: 19
Rekindling Aliveness through Rhythm and Theater
Communal rhythmic activities and theater can serve as powerful tools for trauma recovery. Moving together to a shared beat fosters a sense of attunement, connection, and empowerment - experiences often shattered by trauma. Theater allows survivors to safely express and transform their stories through embodied role-play and collective creation. By physically experimenting with new possibilities, they can reclaim a sense of agency and spontaneity. These expressive arts tap into the emotional brain and invite the whole self into a space of witnessed authenticity. They remind trauma survivors of their capacity to create beauty and meaning from the fragments of pain.
Section: 5, Chapter: 20
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