The Body Keeps the Score

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.