Bessel van der Kolk

Utilize Non-Verbal Therapies

Explore non-verbal therapies such as EMDR, psychomotor therapy, and animal-assisted therapy. These methods can help reprocess traumatic memories and address physical manifestations of trauma.

For abused children, the whole world is filled with triggers. As long as they can imagine only disastrous outcomes to relatively benign situations, anybody walking into a room, any stranger, any image, on a screen or on a billboard might be perceived as a harbinger of catastrophe.

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.

Focus on Early Intervention

Recognize the signs of trauma in children early on and seek professional support to mitigate long-term adverse effects. Early attachment and relational experiences are crucial.

Practice Expressive Writing

Set aside time each day to write about your deepest thoughts and feelings related to traumatic events. This practice can help integrate disjointed emotional experiences and promote healing.

The fundamental issue in resolving traumatic stress is to restore the proper balance between the rational and emotional brains.

Trauma isn’t 'all in one’s head,' as some people supposed, but has a physiological basis.

Trauma results in a fundamental reorganization of the way mind and brain manage perceptions. It changes not only how we think and what we think about, but also our very capacity to think.

Being traumatized means continuing to organize your life as if the trauma were still going on—unchanged and immutable—as every new encounter or event is contaminated by the past.

For real change to take place, the body needs to learn that the danger has passed and to live in the reality of the present.

After trauma, the world becomes sharply divided between those who know and those who don’t.

Repetition leads only to further pain and self-hatred. In fact, even reliving the trauma repeatedly in therapy may reinforce preoccupation and fixation.

The brain-disease model takes control over people’s fate out of their own hands and puts doctors and insurance companies in charge of fixing their problems.

If the amygdala senses a threat—a potential collision with an oncoming vehicle, a person on the street who looks threatening—it sends an instant message down to the hypothalamus and the brain stem, recruiting the stress-hormone system and the autonomic nervous system (ANS) to orchestrate a whole-body response.

Knowing the difference between top-down and bottom-up regulation is central for understanding and treating traumatic stress.

The challenge is not so much learning to accept the terrible things that have happened but learning how to gain mastery over one’s internal sensations and emotions.

Being able to feel safe with other people is probably the single most important aspect of mental health; safe connections are fundamental to meaningful and satisfying lives.

Traumatized people chronically feel unsafe inside their bodies: The past is alive in the form of gnawing interior discomfort.

The body keeps the score: If trauma is encoded in heartbreaking and gut-wrenching sensations, then our first priority is to help people move out of fight-or-flight states, reorganize their perception of danger, and manage relationships.

Once you start approaching your body with curiosity rather than with fear, everything shifts.

Trauma robs you of the feeling that you are in charge of yourself.

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.

Trauma produces actual physiological changes, including a recalibration of the brain’s alarm system, an increase in stress hormone activity, and alterations in the system that filters relevant information from irrelevant.

While we all want to move beyond trauma, the part of our brain that is devoted to ensuring our survival (deep below our rational brain) is not very good at denial.

The challenge of recovery is to reestablish ownership of your body and your mind—of your self.

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.

Trauma robs you of the feeling that you are in charge of yourself, of what I will call self-leadership.

Traumatized human beings recover in the context of relationships with families, loved ones, AA meetings, veterans’ organizations, religious communities, or professional therapists.

We have learned that 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.

Trauma results in a fundamental reorganization of the way mind and brain manage perceptions.

EMDR proved to be a more effective antidepressant than Prozac.

One system creates a story for public consumption, and if we tell that story often enough, we are likely to start believing that it contains the whole truth. But the other system registers a different truth: how we experience the situation deep inside.

When you activate your gut feelings and listen to your heartbreak—when you follow the interoceptive pathways to your innermost recesses—things begin to change.

Drugs cannot ‘cure’ trauma; they can only dampen the expressions of a disturbed physiology.

Trauma, by definition, is unbearable and intolerable.

We now know that their behaviors are not the result of moral failings or signs of lack of willpower or bad character—they are caused by actual changes in the brain.

This vast increase in our knowledge about the basic processes that underlie trauma has also opened up new possibilities to palliate or even reverse the damage.

The theory that mental illness is caused primarily by chemical imbalances in the brain that can be corrected by specific drugs has become broadly accepted, by the media and the public as well as by the medical profession.

The brain-disease model takes control over people’ s fate out of their own hands and puts doctors and insurance companies in charge of fixing their problems.

The right is intuitive, emotional, visual, spatial, and tactual, and the left is linguistic, sequential, and analytical. While the left half of the brain does all the talking, the right half of the brain carries the music of experience.

The frontal lobes are responsible for the qualities that make us unique within the animal kingdom. They enable us to use language and abstract thought. They give us our ability to absorb and integrate vast amounts of information and attach meaning to it.

We have discovered that helping victims of trauma find the words to describe what has happened to them is profoundly meaningful, but usually it is not enough.

The mere opportunity to escape does not necessarily make traumatized animals, or people, take the road to freedom. Like Maier and Seligman’s dogs, many traumatized people simply give up.

Scared animals return home, regardless of whether home is safe or frightening. I thought about my patients with abusive families who kept going back to be hurt again.

When words fail, haunting images capture the experience and return as nightmares and flashbacks.

When something reminds traumatized people of the past, their right brain reacts as if the traumatic event were happening in the present. But because their left brain is not working very well, they may not be aware that they are reexperiencing and reenacting the past—they are just furious, terrified, enraged, ashamed, or frozen.

The most important job of the brain is to ensure our survival, even under the most miserable conditions. Everything else is secondary.

The central function of the amygdala, which I call the brain’s smoke detector, is to identify whether incoming input is relevant for our survival.

Emotion is not opposed to reason; our emotions assign value to experiences and thus are the foundation of reason.

Dissociation is the essence of trauma. The overwhelming experience is split off and fragmented, so that the emotions, sounds, images, thoughts, and physical sensations related to the trauma take on a life of their own.

The challenge is not so much learning to accept the terrible things that have happened but learning how to gain mastery over one’s internal sensations and emotions. Sensing, naming, and identifying what is going on inside is the first step to recovery.

If you do something to a patient that you would not do to your friends or children, consider whether you are unwittingly replicating a trauma from the patient’s past.

The challenge of trauma treatment is not only dealing with the past but, even more, enhancing the quality of day-to-day experience.

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.

People with alexithymia can get better only by learning to recognize the relationship between their physical sensations and their emotions.

Secure attachment develops when caregiving includes emotional attunement.

Infants with seriously disrupted emotional communication patterns with their mothers at eighteen months grew up to become young adults with an unstable sense of self, self-damaging impulsivity, inappropriate and intense anger, and recurrent suicidal behavior.

Emotional withdrawal had the most profound and long-lasting impact. Emotional distance and role reversal were specifically linked to aggressive behavior against self and others in the young adults.

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?

After trauma the world is experienced with a different nervous system that has an altered perception of risk and safety.

When children are oppositional, defensive, numbed out, or enraged, it’s also important to recognize that such “bad behavior” may repeat action patterns that were established to survive serious threats.

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.

Agency starts with what scientists call interoception, our awareness of our subtle sensory , body-based feelings: the greater that awareness, the greater our potential to control our lives.

Our gut feelings signal what is safe, life sustaining, or threatening, even if we cannot quite explain why we feel a particular way.

The price for ignoring or distorting the body’ s messages is being unable to detect what is truly dangerous or harmful for you and, just as bad, what is safe or nourishing.

Many traumatized children and adults simply cannot describe what they are feeling because they cannot identify what their physical sensations mean.

In order to change, people need to become aware of their sensations and the way that their bodies interact with the world around them.

Mastering the skill of self-regulation depends to a large degree on how harmonious our early interactions with our caregivers are.

From the intimate give-and-take of the attachment bond children learn that other people have feelings and thoughts that are both similar to and different from theirs.

A secure attachment combined with the cultivation of competency builds an internal locus of control, the key factor in healthy coping throughout life.

The need for attachment never lessens. Most human beings simply cannot tolerate being disengaged from others for any length of time.

Infants who are not truly seen and known by their mothers are at high risk to grow into adolescents who are unable to know and to see.

Traumatized people often have trouble sensing what is going on in their bodies, they lack a nuanced response to frustration.

Trauma victims cannot recover until they become familiar with and befriend the sensations in their bodies.

Change begins when we learn to “own” our emotional brains. That means learning to observe and tolerate the heartbreaking and gut-wrenching sensations that register misery and humiliation.

Rage that has nowhere to go is redirected against the self, in the form of depression, self-hatred, and self-destructive actions.

One out of four patients we interviewed could not recall anyone they had felt safe with as a child. We checked “nobody” on our work sheets and did not comment, but we were stunned. Imagine being a child and not having a source of safety, making your way into the world unprotected and unseen.

Our study clearly supported the conclusions of John Bowlby. When children feel pervasively angry or guilty or are chronically frightened about being abandoned, they have come by such feelings honestly; that is because of experience.

The challenge is to find ways to help them lead productive lives and, in so doing, save hundreds of millions of dollars of taxpayers’ money. That process starts with facing the facts.

Children who develop in the context of ongoing danger, maltreatment and disrupted caregiving systems are being ill served by the current diagnostic systems that lead to an emphasis on behavioral control with no recognition of interpersonal trauma.

Mental illness, however, is not at all like cancer: 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.

To fully understand how we become the persons we are requires an understanding of the process of development, how all of these factors work together in an ongoing way over time.

Janet coined the term 'dissociation' to describe the splitting off and isolation of memory imprints that he saw in his patients.

Janet discovered that, while it is normal to change and distort one’s memories, people with PTSD are unable to put the actual event, the source of those memories, behind them.

Events that take place in the laboratory cannot be considered equivalent to the conditions under which traumatic memories are created. The terror and helplessness associated with PTSD simply can’t be induced de novo in such a setting.

Nobody wants to remember trauma. In that regard society is no different from the victims themselves. We all want to live in a world that is safe, manageable, and predictable, and victims remind us that this is not always the case.

Having a biological system that keeps pumping out stress hormones to deal with real or imagined threats leads to physical problems: sleep disturbances, headaches, unexplained pain, oversensitivity to touch or sound.

Social support is a biological necessity, not an option, and this reality should be the backbone of all prevention and treatment.

Recognizing the profound effects of trauma and deprivation on child development need not lead to blaming parents.

The imprints of traumatic experiences are organized not as coherent logical narratives but in fragmented sensory and emotional traces: images, sounds, and physical sensations.

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.

Traumatic memories are fundamentally different from the stories we tell about the past. They are dissociated: The different sensations that entered the brain at the time of the trauma are not properly assembled into a story, a piece of autobiography.

When people are chronically angry or scared, constant muscle tension ultimately leads to spasms, back pain, migraine headaches, fibromyalgia, and other forms of chronic pain.

Our maps of the world are encoded in the emotional brain, and changing them means having to reorganize that part of the central nervous system.

Study after study shows that having a good support network constitutes the single most powerful protection against becoming traumatized.

Recovery from trauma involves (re)connecting with our fellow human beings.

The most natural way that we humans calm down our distress is by being touched, hugged, and rocked. This helps with excessive arousal and makes us feel intact, safe, protected, and in charge.

Communicating fully is the opposite of being traumatized.

Trauma stories lessen the isolation of trauma, and they provide an explanation for why people suffer the way they do.

We can get past the slipperiness of words by engaging the self-observing, body-based self system, which speaks through sensations, tone of voice, and body tensions.

Only by getting in touch with your body , by connecting viscerally with your self, can you regain a sense of who you are, your priorities and values.

EMDR loosens up something in the mind/brain that gives people rapid access to loosely associated memories and images from their past.

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.

The trauma had lost its immediacy and become a story about something that happened a long time ago.

As they revisit the traumatic experience, they show sharp increases in their heart rate, blood pressure, and stress hormones. But if they manage to stay with the treatment and keep reliving their trauma, they slowly become less reactive and less prone to disintegrate when they recall the event.

The lives of many trauma survivors come to revolve around bracing against and neutralizing unwanted sensory experiences, and most people I see in my practice have become experts in such self-numbing.

Somatic therapies can help patients to relocate themselves in the present by experiencing that it is safe to move. Feeling the pleasure of taking effective action restores a sense of agency and a sense of being able to actively defend and protect themselves.

Being traumatized is not just an issue of being stuck in the past; it is just as much a problem of not being fully alive in the present.

Drugs cannot “cure” trauma; they can only dampen the expressions of a disturbed physiology.

Being able to say aloud to another human being, 'I was raped' or 'I was battered by my husband' or 'My parents called it discipline, but it was abuse' or 'I’m not making it since I got back from Iraq,' is a sign that healing can begin.

The road of recovery is the road of life. This helped him to refocus on taking care of his family and on finishing his training as a minister.

Only after you identify the source of these responses can you start using your feelings as signals of problems that require your urgent attention.

Getting perspective on your terror and sharing it with others can reestablish the feeling that you are a member of the human race.

Writing about their deepest thoughts and feelings about traumas had improved their mood and resulted in a more optimistic attitude and better physical health.

In yoga you focus your attention on your breathing and on your sensations moment to moment. You begin to notice the connection between your emotions and your body.

People who feel safe in their bodies can begin to translate the memories that previously overwhelmed them into language.

The first step in this collaboration is to assure the internal system that all parts are welcome and that all of them—even those that are suicidal or destructive —were formed in an attempt to protect the self-system, no matter how much they now seem to threaten it.

The task of the therapist is to help patients separate this confusing blend into separate entities, so that they are able to say: 'This part of me is like a little child, and that part of me is more mature but feels like a victim.

Firefighters will do anything to make emotional pain go away . Aside from sharing the task of keeping the exiles locked up, they are the opposite of managers: Managers are all about staying in control, while firefighters will destroy the house in order to extinguish the fire.

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.

People process spatial relations with the right hemisphere of the brain, and our neuroimaging research had shown that the imprint of trauma is principally on the right hemisphere as well.

Physically reexperiencing the past in the present and then reworking it in a safe and supportive 'container' can be powerful enough to create new, supplemental memories: simulated experiences of growing up in an attuned, affectionate setting where you are protected from harm.

Structures do not erase bad memories, or even neutralize them the way EMDR 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.

Feeling safe means you can say things to your father (or, rather, the placeholder who represents him) that you wish you could have said as a five-year-old.

Our relationships will suffer as well. The more early pain and deprivation we have experienced, the more likely we are to interpret other people’s actions as being directed against us and the less understanding we will be of their struggles, insecurities, and concerns.

When we cannot rely on our body to signal safety or warning and instead feel chronically overwhelmed by physical stirrings, we lose the capacity to feel at home in our own skin and, by extension, in the world.

The healing tableaus of structures offer an experience that many participants have never believed was possible for them: to be welcomed into a world where people delight in them, protect them, meet their needs, and make you feel at home.

Neurofeedback nudges the brain to make more of some frequencies and less of others, creating new patterns that enhance its natural complexity and its bias toward self-regulation.

In effect, we may be freeing up innate but stuck oscillatory properties in the brain and allowing new ones to develop.

W ith neurofeedback we hope to intervene in the circuitry that promotes and sustains states of fear and traits of fearfulness, shame, and rage. It is the repetitive firing of these circuits that defines trauma.

When the fear patterns relax, the brain becomes less susceptible to automatic stress reactions and better able to focus on ordinary events. After all, stress is not an inherent property of events themselves—it is a function of how we label and react to them.

I now can actually talk about things like my childhood. For the first time I started being able to do therapy . Up till then I didn’ t have enough distance and I couldn’ t calm down enough. If you’re still in it, it’ s hard to talk about it.

When you’re not afraid of being hurt, you can know people differently .

Once the brain has been trained to produce different patterns of electrical communication, no further treatment is necessary, in contrast to drugs, which do not change fundamental brain activity and work only as long as the patient keeps taking them.

Since time immemorial human beings have used communal rituals to cope with their most powerful and terrifying feelings.

Collective movement and music create a larger context for our lives, a meaning beyond our individual fate.

Love and hate, aggression and surrender, loyalty and betrayal are the stuff of theater and the stuff of trauma.

The essence of trauma is feeling godforsaken, cut off from the human race. Theater involves a collective confrontation with the realities of the human condition.

The idea that we’re asking our young people to go out in the world completely alone and call themselves independent is crazy. We need to teach them how to be interdependent, which means teaching them how to have relationships.

Learning to experience and tolerate deep emotions is essential for recovery from trauma.

In today’s world your ZIP code, even more than your genetic code, determines whether you will lead a safe and healthy life.

All of us, but especially children, need such confidence— confidence that others will know, affirm, and cherish us. Without that we can’t develop a sense of agency that will enable us to assert: “This is what I believe in; this is what I stand for; this is what I will devote myself to.

In order to have a healthy society we must raise children who can safely play and learn. There can be no growth without curiosity and no adaptability without being able to explore, through trial and error, who you are and what matters to you.

The greatest hope for traumatized, abused, and neglected children is to receive a good education in schools where they are seen and known, where they learn to regulate themselves, and where they can develop a sense of agency.

Resilience is the product of agency: knowing that what you do can make a difference.

Trauma is now our most urgent public health issue, and we have the knowledge necessary to respond effectively. The choice is ours to act on what we know.

The child or adolescent has experienced or witnessed multiple or prolonged adverse events over a period of at least one year beginning in childhood or early adolescence.

A felt sense is not a mental experience but a physical one. A bodily awareness of a situation or person or event.

When an adult uses a child for sexual gratification, the child invariably is caught in a confusing situation and a conflict of loyalties.

Every single scientific study of memory of childhood sexual abuse, whether prospective or retrospective, whether studying clinical samples or general population samples, finds that a certain percentage of sexually abused individuals forget, and later remember, their abuse.

The main brain structure involved in body awareness is the anterior insula.

They appeared to have activated the vestibule-cerebellar system in the brain, which seems to be involved in self-regulation and can be damaged by early neglect.

There are several studies on how eye movements help to process and transform traumatic memories.

Greek drama may have served as a ritual reintegration for combat veterans.

We learned from these Rorschach tests that traumatized people have a tendency to superimpose their trauma on everything around them and have trouble deciphering whatever is going on around them.

Many traumatized people find themselves chronically out of sync with the people around them.

In an effort to shut of f terrifying sensations, they also deadened their capacity to feel fully alive.

Our relationship maps are implicit, etched into the emotional brain and not reversible simply by understanding how they were created.

Erasing awareness and cultivating denial are often essential to survival, but the price is that you lose track of who you are, of what you are feeling, and of what and whom you can trust.

People cannot put traumatic events behind until they are able to acknowledge what has happened and start to recognize the invisible demons they’re struggling with.

The capacity of art, music, and dance to circumvent the speechlessness that comes with terror may be one reason they are used as trauma treatments in cultures around the world.

One of the clearest lessons from contemporary neuroscience is that our sense of ourselves is anchored in a vital connection with our bodies.

The sense of being inhabited by warring impulses or parts is common to all of us but particularly to traumatized people who had to resort to extreme measures in order to survive. Exploring—even befriending—those parts is an important component of healing.

In alpha-theta training these frequencies are alternately rewarded. The challenge in PTSD is to open the mind to new possibilities, so that the present is no longer interpreted as a continuous reliving of the past.

Just as we teach history and geography, we need to teach children how their brains and bodies work. For adults and children alike, being in control of ourselves requires becoming familiar with our inner world and accurately identifying what scares, upsets, or delights us.

The Importance of Early Intervention and Secure Attachments

Early intervention and secure attachments are critical in mitigating the long-term effects of trauma. Van der Kolk discusses how early relationships with caregivers shape a child's emotional and mental development. 'Disorganized attachment, role reversal, and lack of maternal communication at age three were the greatest predictors of children being part of the mental health or social service system at age eighteen,' he writes. This underscores the need for stable, nurturing environments to foster healthy development and resilience.

The Malleability of Memory and the Role of Dissociation

Traumatic memories are often fragmented and can be altered when recalled, making them difficult to integrate into a coherent narrative. Van der Kolk explains, 'When memory traces of the original sounds, images, and sensations are reactivated... the frontal lobe shuts down.' Dissociation, a common response to trauma, further complicates this process by creating a 'dual memory system' where traumatic memories are split off from normal consciousness. Understanding these mechanisms is essential for effective trauma therapy.

The Impact of Trauma on Physical Health

Trauma can manifest in various physical symptoms, such as chronic pain, increased heart rate, and gastrointestinal issues. Van der Kolk highlights the connection between trauma and physical health, noting that 'trauma is not just a psychological issue but also manifests in physical symptoms.' Addressing these physical manifestations is crucial for comprehensive trauma recovery, as traditional medicine often struggles to treat these symptoms effectively.

Trauma's Enduring Impact on Mind and Body

Trauma leaves a lasting imprint on both the mind and body, fundamentally altering how individuals perceive and react to the world. Bessel van der Kolk explains that trauma is not just an event from the past but an ongoing experience that affects the brain's ability to manage perceptions. This is evident in the stories of veterans who, long after their service, continue to experience flashbacks and nightmares. 'Trauma results in a fundamental reorganization of the way mind and brain manage perceptions,' van der Kolk writes, highlighting the pervasive nature of trauma.

The Disconnect Between Body and Emotion

Trauma often leads to a profound disconnect between one's physical sensations and emotions, making it difficult for individuals to recognize and respond to their own needs. Van der Kolk notes, 'Traumatized people often have trouble sensing what is going on in their bodies; they lack a nuanced response to frustration.' This disconnect can result in emotional numbing and a lack of self-awareness, as seen in patients who struggle to identify their feelings and bodily sensations.

The Role of Safe Relationships in Healing

Safe, supportive relationships are crucial for trauma recovery. Van der Kolk emphasizes that 'traumatized human beings recover in the context of relationships.' These relationships provide a sense of safety and stability, allowing individuals to explore and process their traumatic experiences without fear of re-traumatization. Group therapy and communal activities, such as theater and music, offer valuable opportunities for shared understanding and emotional support.

The Power of Non-Verbal Therapies

Non-verbal therapies, such as EMDR, yoga, and psychomotor therapy, play a significant role in trauma recovery by addressing the physical and emotional aspects of trauma. Van der Kolk highlights the effectiveness of these therapies in helping individuals reprocess traumatic memories and reconnect with their bodies. For example, EMDR has been shown to reduce PTSD symptoms by enabling patients to observe their experiences in a new way. 'EMDR proved to be a more effective antidepressant than Prozac,' van der Kolk notes.

Engage in Mindfulness Practices

Incorporate mindfulness and yoga into daily routines to help maintain emotional balance and reconnect with your body. These practices can reduce stress and improve self-regulation.

Join Support Groups

Participate in support groups, particularly those that focus on shared traumatic experiences. This communal experience can provide validation and an opportunity to process emotions in a supportive environment.

The greatest sources of our suffering are the lies we tell ourselves.

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.

The fundamental issue in resolving traumatic stress is to restore the proper balance between the rational and emotional brains.

Trauma isn’t 'all in one’s head,' as some people supposed, but has a physiological basis.

Trauma results in a fundamental reorganization of the way mind and brain manage perceptions. It changes not only how we think and what we think about, but also our very capacity to think.

Being traumatized means continuing to organize your life as if the trauma were still going on—unchanged and immutable—as every new encounter or event is contaminated by the past.

For real change to take place, the body needs to learn that the danger has passed and to live in the reality of the present.

After trauma, the world becomes sharply divided between those who know and those who don’t.

Repetition leads only to further pain and self-hatred. In fact, even reliving the trauma repeatedly in therapy may reinforce preoccupation and fixation.

The brain-disease model takes control over people’s fate out of their own hands and puts doctors and insurance companies in charge of fixing their problems.

If the amygdala senses a threat—a potential collision with an oncoming vehicle, a person on the street who looks threatening—it sends an instant message down to the hypothalamus and the brain stem, recruiting the stress-hormone system and the autonomic nervous system (ANS) to orchestrate a whole-body response.

Knowing the difference between top-down and bottom-up regulation is central for understanding and treating traumatic stress.

The challenge is not so much learning to accept the terrible things that have happened but learning how to gain mastery over one’s internal sensations and emotions.

Being able to feel safe with other people is probably the single most important aspect of mental health; safe connections are fundamental to meaningful and satisfying lives.

Traumatized people chronically feel unsafe inside their bodies: The past is alive in the form of gnawing interior discomfort.

The body keeps the score: If trauma is encoded in heartbreaking and gut-wrenching sensations, then our first priority is to help people move out of fight-or-flight states, reorganize their perception of danger, and manage relationships.

Once you start approaching your body with curiosity rather than with fear, everything shifts.

Trauma robs you of the feeling that you are in charge of yourself.

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.

Trauma produces actual physiological changes, including a recalibration of the brain’s alarm system, an increase in stress hormone activity, and alterations in the system that filters relevant information from irrelevant.

While we all want to move beyond trauma, the part of our brain that is devoted to ensuring our survival (deep below our rational brain) is not very good at denial.

The challenge of recovery is to reestablish ownership of your body and your mind—of your self.

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.

Trauma robs you of the feeling that you are in charge of yourself, of what I will call self-leadership.

Traumatized human beings recover in the context of relationships with families, loved ones, AA meetings, veterans’ organizations, religious communities, or professional therapists.

We have learned that 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.

Trauma results in a fundamental reorganization of the way mind and brain manage perceptions.

EMDR proved to be a more effective antidepressant than Prozac.

One system creates a story for public consumption, and if we tell that story often enough, we are likely to start believing that it contains the whole truth. But the other system registers a different truth: how we experience the situation deep inside.

When you activate your gut feelings and listen to your heartbreak—when you follow the interoceptive pathways to your innermost recesses—things begin to change.

Drugs cannot ‘cure’ trauma; they can only dampen the expressions of a disturbed physiology.

Trauma, by definition, is unbearable and intolerable.

We now know that their behaviors are not the result of moral failings or signs of lack of willpower or bad character—they are caused by actual changes in the brain.

This vast increase in our knowledge about the basic processes that underlie trauma has also opened up new possibilities to palliate or even reverse the damage.

We have discovered that helping victims of trauma find the words to describe what has happened to them is profoundly meaningful, but usually it is not enough.

The mere opportunity to escape does not necessarily make traumatized animals, or people, take the road to freedom. Like Maier and Seligman’s dogs, many traumatized people simply give up.

Scared animals return home, regardless of whether home is safe or frightening. I thought about my patients with abusive families who kept going back to be hurt again.

When words fail, haunting images capture the experience and return as nightmares and flashbacks.

When something reminds traumatized people of the past, their right brain reacts as if the traumatic event were happening in the present. But because their left brain is not working very well, they may not be aware that they are reexperiencing and reenacting the past—they are just furious, terrified, enraged, ashamed, or frozen.

The most important job of the brain is to ensure our survival, even under the most miserable conditions. Everything else is secondary.

The central function of the amygdala, which I call the brain’s smoke detector, is to identify whether incoming input is relevant for our survival.

Emotion is not opposed to reason; our emotions assign value to experiences and thus are the foundation of reason.

Dissociation is the essence of trauma. The overwhelming experience is split off and fragmented, so that the emotions, sounds, images, thoughts, and physical sensations related to the trauma take on a life of their own.

The challenge is not so much learning to accept the terrible things that have happened but learning how to gain mastery over one’s internal sensations and emotions. Sensing, naming, and identifying what is going on inside is the first step to recovery.

The challenge of trauma treatment is not only dealing with the past but, even more, enhancing the quality of day-to-day experience.

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?

After trauma the world is experienced with a different nervous system that has an altered perception of risk and safety.

When children are oppositional, defensive, numbed out, or enraged, it’s also important to recognize that such “bad behavior” may repeat action patterns that were established to survive serious threats.

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.

Agency starts with what scientists call interoception, our awareness of our subtle sensory , body-based feelings: the greater that awareness, the greater our potential to control our lives.

Our gut feelings signal what is safe, life sustaining, or threatening, even if we cannot quite explain why we feel a particular way.

The price for ignoring or distorting the body’ s messages is being unable to detect what is truly dangerous or harmful for you and, just as bad, what is safe or nourishing.

Many traumatized children and adults simply cannot describe what they are feeling because they cannot identify what their physical sensations mean.

In order to change, people need to become aware of their sensations and the way that their bodies interact with the world around them.

Mastering the skill of self-regulation depends to a large degree on how harmonious our early interactions with our caregivers are.

From the intimate give-and-take of the attachment bond children learn that other people have feelings and thoughts that are both similar to and different from theirs.

A secure attachment combined with the cultivation of competency builds an internal locus of control, the key factor in healthy coping throughout life.

The need for attachment never lessens. Most human beings simply cannot tolerate being disengaged from others for any length of time.

Infants who are not truly seen and known by their mothers are at high risk to grow into adolescents who are unable to know and to see.

Trauma victims cannot recover until they become familiar with and befriend the sensations in their bodies.

Change begins when we learn to “own” our emotional brains. That means learning to observe and tolerate the heartbreaking and gut-wrenching sensations that register misery and humiliation.

Rage that has nowhere to go is redirected against the self, in the form of depression, self-hatred, and self-destructive actions.

One out of four patients we interviewed could not recall anyone they had felt safe with as a child. We checked “nobody” on our work sheets and did not comment, but we were stunned. Imagine being a child and not having a source of safety, making your way into the world unprotected and unseen.

Having a biological system that keeps pumping out stress hormones to deal with real or imagined threats leads to physical problems: sleep disturbances, headaches, unexplained pain, oversensitivity to touch or sound.

Social support is a biological necessity, not an option, and this reality should be the backbone of all prevention and treatment.

Recognizing the profound effects of trauma and deprivation on child development need not lead to blaming parents.

The imprints of traumatic experiences are organized not as coherent logical narratives but in fragmented sensory and emotional traces: images, sounds, and physical sensations.

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.

Traumatic memories are fundamentally different from the stories we tell about the past. They are dissociated: The different sensations that entered the brain at the time of the trauma are not properly assembled into a story, a piece of autobiography.

When people are chronically angry or scared, constant muscle tension ultimately leads to spasms, back pain, migraine headaches, fibromyalgia, and other forms of chronic pain.

Study after study shows that having a good support network constitutes the single most powerful protection against becoming traumatized.

Recovery from trauma involves (re)connecting with our fellow human beings.

The most natural way that we humans calm down our distress is by being touched, hugged, and rocked. This helps with excessive arousal and makes us feel intact, safe, protected, and in charge.

Somatic therapies can help patients to relocate themselves in the present by experiencing that it is safe to move. Feeling the pleasure of taking effective action restores a sense of agency and a sense of being able to actively defend and protect themselves.

Being traumatized is not just an issue of being stuck in the past; it is just as much a problem of not being fully alive in the present.

Drugs cannot “cure” trauma; they can only dampen the expressions of a disturbed physiology.

Being able to say aloud to another human being, 'I was raped' or 'I was battered by my husband' or 'My parents called it discipline, but it was abuse' or 'I’m not making it since I got back from Iraq,' is a sign that healing can begin.

The greatest sources of our suffering are the lies we tell ourselves.