The Body Keeps the Score: A Comprehensive Exploration of Trauma and Healing
The Body Keeps the Score: Brain, Mind, and Body in the Healing of Trauma by Dr. Bessel van der Kolk, published in 2014, has become a seminal work in understanding the profound impact of trauma on the human psyche and body. Dr. van der Kolk, a Dutch-born psychiatrist, has dedicated over four decades to studying trauma, its effects, and potential pathways to healing. His extensive experience includes pioneering research on post-traumatic stress disorder (PTSD), neuroimaging studies, and innovative therapeutic approaches.
The book has achieved remarkable success, spending over 328 weeks on The New York Times bestseller list and being translated into 43 languages. It has been lauded by professionals and lay readers alike for its insightful exploration of trauma and its accessible presentation of complex scientific concepts. Notably, Alexander McFarlane, Director of the Centre for Traumatic Stress Studies, described it as
“essential reading for anyone interested in understanding and treating traumatic stress”
.
Part I: The Rediscovery of Trauma
Trauma, in the classical sense, has long been understood as the consequence of horrific events—war, natural disasters, sexual assault, or violent accidents. However, as Dr. Bessel van der Kolk illustrates in the opening section of The Body Keeps the Score, this traditional definition barely scratches the surface of trauma’s reach and impact.
Van der Kolk begins with a critical reflection on his early work at the Veterans Administration clinic in the 1970s, where he encountered Vietnam War veterans suffering from what would later be labeled PTSD. These men were haunted by nightmares, plagued by flashbacks, and increasingly alienated from society. Many found themselves unable to reintegrate into everyday life, forming the “walking wounded” of a war that had ended for everyone else but not for them.
“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.”
This powerful insight sets the tone for the book’s thesis: trauma is not just a psychological phenomenon but one that is deeply embodied, reshaping how individuals experience the world, often beyond conscious control.
Trauma Beyond the Battlefield
Dr. van der Kolk broadens the lens, challenging the idea that trauma is limited to war veterans. In his clinical practice, he began to observe striking similarities between the symptoms of soldiers and those of people who had experienced childhood neglect, sexual abuse, or growing up in unstable or violent households. For example, the story of a woman named Marilyn illustrates this overlap vividly. As a survivor of childhood sexual abuse, she suffered from the same dissociative episodes and emotional numbness that the Vietnam veterans described.
This expansion of the trauma narrative was not immediately accepted within the psychiatric establishment. Much of the resistance stemmed from the prevailing frameworks of the time, particularly the Diagnostic and Statistical Manual of Mental Disorders (DSM), which attempted to box human suffering into narrowly defined criteria. Van der Kolk critiques this reductionist approach:
“The diagnosis of PTSD… fails to capture the essence of what trauma is all about: the residue of imprints left behind in people’s sensory and hormonal systems.”
In essence, trauma is not just a disorder of memory or emotion—it becomes embedded in the body’s stress response systems. Survivors aren’t simply remembering the past; their bodies are re-living it, again and again.
The Limits of Language and Talk Therapy
Van der Kolk explores a critical concept here: that trauma can exist without narrative memory. Many survivors, especially children, lack the language to articulate what happened to them. Some may have dissociated so thoroughly that their memories are fragmented or stored in non-verbal parts of the brain.
“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.”
This insight is more than theoretical—it has real implications for treatment. Traditional talk therapies often falter because they assume that healing occurs through verbal articulation. But if trauma is held in the body and expressed through visceral responses rather than coherent stories, then treatment must go beyond talk.
Revolutionizing Psychiatry with PTSD
A key historical moment described in this section is the inclusion of Post-Traumatic Stress Disorder (PTSD) in the DSM-III in 1980, a landmark recognition that psychological trauma could have long-lasting mental health consequences. Van der Kolk was part of the team that helped push for its inclusion, driven by the observable suffering of Vietnam veterans and by research revealing physiological correlates of trauma.
He notes the pioneering research of his colleague, psychiatrist Mardi Horowitz, who described trauma as
“an experience that overwhelms the ordinary human adaptations to life.”
This gave scientific grounding to what was previously seen as weakness or malingering.
Yet even this formal recognition came with limitations. PTSD, as defined in the DSM, often emphasizes a single traumatic event, like a car crash or a combat experience. But as van der Kolk repeatedly demonstrates, many individuals suffer from complex trauma—the cumulative effect of repeated, often interpersonal, trauma over time. This form of trauma is especially common among people who experienced prolonged abuse, neglect, or domestic violence.
The Body Remembers
One of the central tenets emerging from Part I is that trauma imprints itself on the body in visceral, unconscious ways. This concept, first coined by psychiatrist Pierre Janet in the late 1800s and rediscovered by van der Kolk and his contemporaries, shifts the therapeutic approach from a purely cognitive one to a somatic one.
In one poignant example, van der Kolk recounts a therapy session with a patient who, while discussing a past trauma, began to shake uncontrollably, her body responding as though the event were happening in real-time. No amount of rational reassurance could stop her shaking. Only later, through movement and breathwork, could she begin to feel grounded.
This underscores a central point:
“The body keeps the score: the memory of trauma is stored not only in the mind but in the body itself.”
Trauma in the Broader Social Fabric
Van der Kolk also points out how trauma isn’t isolated to individual stories—it ripples through families, communities, and even institutions. One sobering example he gives is of inner-city youth exposed to constant violence. These children, like war veterans, develop hyper-vigilant stress responses and can become emotionally numb, aggressive, or dissociative.
In a study conducted by van der Kolk and his colleagues, over 75% of the children in a Boston juvenile detention center met the criteria for PTSD, yet the vast majority had never been diagnosed or treated. Their behavior—often labeled as delinquent or oppositional—was, in fact, a response to untreated trauma.
Part III: The Minds of Children
In Part III, Dr. van der Kolk shifts his focus to childhood trauma, exploring how adverse experiences during formative years impact brain development, emotional regulation, behavior, and the capacity for connection. While previous sections deal with trauma’s neurological imprint, this part zooms in on Developmental Trauma—trauma that is experienced in the context of primary caregiving relationships, often repeatedly and over long periods.
“Being able to feel safe with other people is probably the single most important aspect of mental health.”
This quote sets the stage for a sobering truth: when a child’s first lessons about human interaction are dominated by fear, rejection, or violence, the consequences reach deep into every aspect of their being.
Childhood Trauma is Not Just a Smaller Version of Adult Trauma
One of the central arguments in this section is that childhood trauma is qualitatively different from trauma experienced in adulthood. Children are still in the process of developing their brain, identity, and coping strategies. When trauma occurs during these critical years—especially without the buffer of a supportive adult—the child’s very sense of self becomes entangled with the traumatic experience.
“Trauma almost invariably involves not being seen, not being mirrored, and not being taken into account.”
Unlike a single-incident trauma, developmental trauma is complex and cumulative. A child who is consistently neglected, ignored, or abused does not simply suffer from an episodic injury but grows into a self that is shaped around those experiences. Their stress-response systems stay activated, and their neural architecture becomes adapted to danger, rather than safety and learning.
Attachment and Attunement: The Need for Safe Caregivers
Van der Kolk emphasizes the role of attachment in a child’s development. Secure attachment—when a caregiver reliably soothes, mirrors, and protects the child—helps regulate the child’s stress systems and lays the foundation for emotional and social health.
“The more responsive the parent is to the baby’s signals, the more the baby’s brain can develop a normal stress-response system.”
But when caregivers are unpredictable, abusive, or absent, children are forced to adapt to an unsafe world. This adaptation often includes dissociation, aggression, hypervigilance, or emotional shutdown.
In one heartbreaking clinical case, van der Kolk describes a boy named Brian who had been sexually abused by his father and ignored by his mother. He exhibited violent outbursts in foster care, was unresponsive to rewards or punishments, and seemed “out of control.” But when his trauma history was uncovered and his therapy focused on building trust and safety rather than punishment, his behavior began to shift.
Developmental Trauma Disorder (DTD): A New Framework
Dr. van der Kolk makes a compelling case for a diagnosis he calls Developmental Trauma Disorder (DTD). This concept emerged from his work with thousands of traumatized children and aimed to capture the broad spectrum of symptoms that these children display—many of which don’t fit neatly into existing DSM categories.
These symptoms include:
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Chronic emotional dysregulation
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Impulsivity and aggression
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Attention and concentration problems
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Difficulty with relationships and trust
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Somatic complaints (stomachaches, headaches)
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Dissociation and fragmentation of memory
“The DSM fails to capture the complexity of the developmental effects of trauma.”
Van der Kolk recounts how children with developmental trauma are often misdiagnosed with ADHD, ODD (Oppositional Defiant Disorder), bipolar disorder, or even psychosis—treating only the symptoms and often medicating children heavily without addressing the root cause.
He argues that we must stop “pathologizing” traumatized children and start creating systems that understand and accommodate their lived experiences.
The ACE Study: Trauma Predicts Health Outcomes
A turning point in the public understanding of childhood trauma came from the Adverse Childhood Experiences (ACE) Study, which van der Kolk discusses in this section. Conducted by the CDC and Kaiser Permanente, the study found a direct correlation between the number of adverse childhood experiences and negative health outcomes in adulthood.
These adverse experiences included:
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Emotional, physical, or sexual abuse
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Emotional or physical neglect
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Household dysfunction (e.g., addiction, domestic violence, parental incarceration)
The findings were staggering:
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Individuals with 4 or more ACEs were twice as likely to smoke, seven times more likely to be alcoholic, and ten times more likely to inject street drugs.
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They had significantly higher risks for diabetes, heart disease, depression, suicide attempts, and even early death.
“The greatest public health threat is not a disease, but childhood trauma.”
This research reinforced what van der Kolk had seen clinically for decades—trauma is not only a psychological issue but a major predictor of physical illness and social dysfunction.
Self-Regulation vs. Behavior Control
Traumatized children are often seen as disobedient, defiant, or inattentive. But van der Kolk reframes this: the issue is not moral or behavioral, but neurological. These children are not “choosing” to act out—they lack the brain capacity for self-regulation, the ability to manage emotions and impulses.
“You can’t reason with people who are out of control. And they can’t reason with themselves.”
One example is a child who, when placed in time-out for throwing a toy, would begin screaming and hitting his head against the wall. Traditional disciplinary techniques backfired because they relied on a child having a calm rational state—something trauma had stripped away. Recovery, in these cases, depends not on punishment but on teaching children to regulate their internal states. This often includes body-based therapies, mindfulness, rhythm (like music or drumming), and movement.
The Role of Safe Adults and Relational Healing
Perhaps one of the most hopeful threads in Part III is the transformative power of safe, attuned relationships.
“Traumatized children can grow up to become well-functioning adults—if they find someone they can attach to safely and who can help them regulate their feelings.”
Van der Kolk describes schools and programs where traumatized children thrive not through rigid rules or medication, but through relationships—with teachers, mentors, therapists—who understand them, co-regulate with them, and offer a reliable source of safety.
The therapeutic goal becomes not just “correcting behavior,” but creating the conditions where the child can feel safe enough to grow, connect, and explore.
Part II: This Is Your Brain on Trauma
In Part II of The Body Keeps the Score, Dr. Bessel van der Kolk shifts the lens inward, examining how trauma quite literally reshapes the structure and functioning of the brain. This is not metaphor or speculation—neuroscience and neuroimaging have revealed that traumatic experiences alter how people process fear, memory, emotion, and even their sense of self.
He opens this section by noting:
“The most important job of the brain is to ensure our survival.”
Yet, when trauma occurs—particularly when it’s repeated or inescapable—the brain’s survival mechanisms can become overactivated and ultimately maladaptive. Instead of keeping us safe, our brain begins to misfire, treating everyday experiences as threats and locking us into patterns of hypervigilance, dissociation, or emotional overwhelm.
The Triune Brain Model: Survival vs. Rationality
Van der Kolk introduces the Triune Brain theory, originally proposed by neuroscientist Paul MacLean. While simplified, it offers a useful framework for understanding how different brain regions respond to trauma:
- Reptilian Brain (Brainstem): Governs basic survival functions—heart rate, breathing, digestion, fight/flight/freeze responses.
- Limbic System (Mammalian Brain): Emotional brain; includes the amygdala and hippocampus; processes fear, attachment, and memory.
- Neocortex (Rational Brain): Responsible for thinking, language, planning, and self-awareness.
In moments of threat, the lower (primitive) parts of the brain take over. The rational brain gets overridden:
“When the alarm bell of the emotional brain keeps signaling that you are in danger, no amount of insight will silence it.”
This concept is crucial: trauma lives in the body and the primitive brain. It bypasses logic. This is why traumatized individuals often know rationally that they are safe, but still feel like they’re in danger.
The Amygdala and the Smoke Detector
The amygdala, a tiny almond-shaped structure in the limbic system, plays a central role in trauma. It’s the brain’s “smoke detector,” constantly scanning the environment for danger. In trauma survivors, the amygdala becomes hyperreactive, constantly sounding the alarm even when no threat is present.
Functional MRI studies cited in the book show that:
- Trauma survivors have heightened amygdala activation when exposed to reminders of trauma.
- This leads to exaggerated emotional reactions, hypervigilance, and even panic attacks without clear cause.
“Traumatized people become stuck in a state of fight or flight, even long after the threat has passed.”
For example, a veteran might hear a car backfire and instinctively dive for cover. Their amygdala reacts before their rational brain can assess the situation.
The Prefrontal Cortex: The Watchtower
In contrast, the prefrontal cortex—the brain’s “watchtower”—helps interpret and regulate emotional responses. It’s where we make sense of what we’re experiencing. In healthy brains, it assesses whether a perceived threat is real or imagined.
However, trauma deactivates the prefrontal cortex.
Van der Kolk describes how, in brain scans, survivors of PTSD show reduced activity in the prefrontal cortex when recalling traumatic events. This explains why trauma survivors often have difficulty concentrating, making decisions, or managing their impulses.
“The more intense the trauma, the less access people have to the brain areas that enable them to register, process, and understand what is going on.”
This neurological shutdown is not a failure of will—it’s a biological fact. The brain is quite literally unable to process new information rationally while it’s being flooded with stress signals.
The Hippocampus: Distorting Time
Another key player is the hippocampus, the brain’s memory processing center. It helps us differentiate between past and present.
Trauma can shrink the hippocampus—a phenomenon confirmed in numerous studies. This has devastating consequences. Memories of trauma may be stored as disjointed fragments rather than coherent narratives. This is why many trauma survivors experience flashbacks, where the traumatic event feels as if it’s happening now.
“Because trauma memories are stored in the emotional brain, they continue to feel current even years later.”
Van der Kolk gives the example of a woman who, upon smelling aftershave similar to her abuser’s, had a full-blown panic attack. Her brain could not distinguish between past and present; the smell acted as a trigger, catapulting her into a state of terror as if the abuse were occurring again.
Broca’s Area: Silencing the Voice
Another fascinating and troubling discovery involves Broca’s area, the region of the brain responsible for speech production.
In trauma survivors, brain imaging shows that Broca’s area goes offline during flashbacks or emotional overwhelm. This explains why people often struggle to talk about what happened. It’s not that they’re withholding information—it’s that the part of the brain needed to describe it is literally deactivated.
“When people are reliving their trauma, Broca’s area shuts down, making it nearly impossible to put their thoughts and feelings into words.”
This is why talk therapy, particularly in the early stages of trauma recovery, can be limited or even retraumatizing. For healing to occur, therapy must first engage the parts of the brain that are still functioning—and help reactivate those that are not.
Neuroscience in Action: Studies and Clinical Observations
Throughout Part II, van der Kolk backs his arguments with real-world research:
- In one study, when PTSD sufferers were shown pictures related to their trauma, the amygdala lit up while their prefrontal cortex shut down.
- Another study showed that yoga and breath-based practices can increase activity in the insula (the brain’s center for body awareness) and calm the amygdala, helping trauma survivors regain emotional control.
- A 1995 study by Bremner and colleagues demonstrated reduced hippocampal volume in trauma survivors, correlating with fragmented and intrusive memories.
These are not abstract findings—they’re maps of suffering. They show us where trauma lives in the brain and guide us toward what might help.
Part IV: The Imprint of Trauma
By the time readers reach Part IV of The Body Keeps the Score, it’s clear that trauma does not merely reside in memories or mood—it lives in the nervous system, muscles, breath, immune response, and the very fabric of how a person experiences life. In this section, Dr. van der Kolk deepens his examination of how trauma is embodied, meaning it is physically remembered and re-enacted, often outside of conscious awareness.
“The body keeps the score: If the memory of trauma is encoded in the viscera, in heartbreaking and gut-wrenching sensations, in the dread of collapse, and in the tightness of the throat, then what needs to be healed is the body.”
From Words to the Body: When Talk Therapy Isn’t Enough
Van der Kolk begins this section by emphasizing the limitations of language-based therapies in resolving trauma. As he explained earlier, Broca’s area (the speech center of the brain) shuts down during flashbacks or intense distress. This neurological phenomenon means many trauma survivors cannot fully articulate what happened to them—because their trauma is nonverbal.
“Traumatized people often are out of touch with their bodies. They may not recognize what they’re feeling or be able to identify the sensations that signal their emotions.”
Rather than viewing this disconnection as resistance or avoidance, van der Kolk urges clinicians and society to recognize it as a survival strategy. The body’s alarm systems were so overwhelmed during trauma that it had to dissociate—cut off from sensation, emotion, and awareness.
The Legacy of Fear: Hyperarousal and Numbing
Two common bodily imprints of trauma are hyperarousal and emotional numbing.
- In hyperarousal, the body is always on guard. Heart rate is elevated, muscles tense, digestion disrupted. The individual startles easily and has difficulty sleeping or relaxing.
- In emotional numbing, the body goes in the opposite direction: shutting down. Survivors may feel foggy, detached, physically frozen, or empty. This is the freeze part of the fight/flight/freeze response.
Van der Kolk writes:
“Trauma victims cannot recover until they become familiar with and befriend the sensations in their bodies.”
This quote reveals the essential therapeutic goal of recovery—not just remembering or narrating the trauma, but learning to inhabit the body again, safely and without fear.
The Vagus Nerve and the Social Nervous System
A major conceptual contribution in this section is the role of the vagus nerve, which van der Kolk explores through the lens of Dr. Stephen Porges’ Polyvagal Theory. The vagus nerve is the main conduit of the parasympathetic nervous system and connects the brain to almost every major organ—heart, lungs, intestines, and more.
Van der Kolk explains that this nerve governs our social engagement system—the ability to connect with others, regulate heart rate and breath, and recover from stress. When functioning well, the vagus nerve helps us feel calm, safe, and socially connected.
However, trauma dysregulates this system.
“If your nervous system is stuck in a defensive mode, you will not be able to feel calm or engaged, no matter how safe your environment is.”
When the vagus nerve is dysregulated, individuals may alternate between sympathetic arousal (fight/flight) and parasympathetic collapse (freeze/shutdown). Trauma traps the body in these states, making relaxation or intimacy feel unsafe or even unbearable.
Van der Kolk stresses that to recover from trauma, survivors must regain control over their autonomic nervous system. This involves retraining the body, not just the mind.
The Body Remembers: Physical Manifestations of Trauma
Another key theme is that trauma often emerges through physical symptoms, even when the mind cannot consciously recall the traumatic event. Survivors may present with:
- Chronic pain
- Gastrointestinal issues
- Migraines
- Fibromyalgia
- Asthma or autoimmune problems
Van der Kolk shares several clinical cases where patients had no verbal memory of abuse or trauma, but their bodies expressed it in vivid, distressing ways. For instance, a woman with unexplained seizures eventually uncovered, through body-oriented therapy, that her episodes corresponded with flashbacks of childhood abuse.
“Traumatized people are terrified of the sensations in their own bodies… they will do anything to avoid feeling them.”
To cope, many turn to addiction, self-harm, or dissociation, seeking to numb themselves from these sensations. But van der Kolk emphasizes that true healing requires survivors to safely reconnect with their bodies, rather than suppress them.
Reclaiming the Body: Somatic Approaches to Trauma Healing
Part IV introduces a variety of somatic (body-based) therapeutic approaches, reflecting van der Kolk’s belief that trauma healing must involve bottom-up processing—starting with physical sensations rather than thoughts.
1. Yoga
Van der Kolk is a strong advocate for yoga, citing both personal clinical experience and neuroscience research showing that yoga:
- Activates the insula (brain’s center for self-awareness)
- Improves heart-rate variability (a marker of vagal tone and emotional regulation)
- Helps patients notice and tolerate physical sensations
“In our yoga study, we found that ten weeks of yoga practice markedly reduced PTSD symptoms.”
Yoga works by helping trauma survivors observe their bodies without being overwhelmed by them—a key step in learning to regulate physiological responses.
2. Somatic Experiencing
Developed by Peter Levine, this method focuses on tracking internal sensations (like tightness, breath, heat) and releasing stuck survival energy through small, controlled movements.
Van der Kolk explains that animals in the wild often “shake off” trauma after a narrow escape. Humans, in contrast, suppress these natural impulses. Somatic Experiencing aims to complete those unfinished fight/flight responses and discharge the trauma held in the nervous system.
3. Touch and Body Work
Van der Kolk also acknowledges the therapeutic role of safe, structured touch, though he cautions that it must always be patient-led and trauma-informed. Some trauma, especially developmental trauma, is rooted in neglect or abuse involving touch. Reintroducing safe physical contact, even in the form of massage or sensorimotor therapy, can help repair the body’s sense of trust and connection.
The Hidden Costs of Trauma in Society
Before closing this section, van der Kolk returns to the societal implications of trauma’s imprint.
“Trauma robs you of the feeling that you are in charge of yourself.”
This loss of agency—over one’s body, choices, and emotions—can drive people into homelessness, incarceration, addiction, or abusive relationships. Society often responds with punishment, when what’s truly needed is compassion and trauma-informed care.
Van der Kolk discusses his work with juvenile justice systems and psychiatric hospitals, advocating for institutional changes that recognize trauma’s role in behavioral problems. One striking example involves a locked-down adolescent ward where violence decreased dramatically after the staff adopted trauma-sensitive practices, such as non-coercive language and daily mindfulness.
Part V: Paths to Recovery
Dr. van der Kolk opens Part V with an unflinching truth:
“Trauma destroys the social fabric of the community. But recovery can only take place within the context of relationships; it cannot occur in isolation.”
Healing from trauma is not a solitary act of willpower or insight. It is a relational and embodied process, grounded in safety, connection, and sensory integration. This part of the book is organized around different modalities of treatment that help survivors regulate their nervous systems, process traumatic memories, and re-engage with life and relationships.
1. Talking Isn’t Enough: The Limits of Traditional Therapy
Though talk therapy has long been the standard treatment for trauma, van der Kolk is clear about its limitations:
- It often fails to access non-verbal memories and body-based trauma.
- Many patients become stuck in their stories, intellectually understanding what happened but unable to feel differently.
- For severely traumatized individuals, talking about their trauma too soon can re-traumatize them.
“Being able to articulate the experience does not necessarily alter the automatic physical and hormonal responses of bodies that remain hypervigilant, prepared to be assaulted or violated at any time.”
This doesn’t mean talk therapy has no value—but it’s insufficient on its own for deep trauma healing.
2. EMDR (Eye Movement Desensitization and Reprocessing)
One of the most rigorously studied and effective treatments for trauma that van der Kolk champions is EMDR, developed by Francine Shapiro. The technique involves bilateral stimulation (typically eye movements) while the patient focuses on traumatic memories.
“EMDR loosens the sealed-over memories and helps patients integrate them into a larger context.”
In clinical trials and van der Kolk’s own practice, EMDR has shown dramatic results. One study with rape survivors found that 90% had a complete cessation of PTSD symptoms after just three sessions. EMDR helps the brain reprocess traumatic memories so that they are no longer overwhelming.
Van der Kolk describes how EMDR activates the brain’s natural healing process, similar to REM sleep. The bilateral stimulation appears to allow the brain to file traumatic memories away properly, rather than leaving them stuck in the amygdala.
3. Neurofeedback: Training the Brain
Van der Kolk devotes an entire chapter to neurofeedback, a technology-driven therapy that uses real-time brainwave monitoring to teach people how to regulate their own brain activity.
“The brain is a learning machine. With the right feedback, it can change.”
In a neurofeedback session, sensors are attached to the scalp to read electrical activity. Patients receive auditory or visual feedback that rewards specific brainwave patterns. For example, someone with PTSD might be trained to enhance alpha waves (associated with calm) and reduce high beta activity (linked to anxiety).
Van der Kolk’s research found that neurofeedback significantly improved emotional regulation, attention, and interpersonal functioning in traumatized individuals, especially those who had not responded to medication or therapy.
4. Yoga and Mindfulness: Reconnecting with the Body
Yoga holds a special place in van der Kolk’s trauma treatment approach. He describes a major NIH-funded study his team conducted, in which yoga outperformed traditional therapy in reducing PTSD symptoms.
Why is yoga so effective?
- It helps people become attuned to their bodies.
- It teaches breath regulation, which calms the nervous system.
- It offers safe structure and rhythm, helping re-establish a sense of control and grounding.
“The body becomes a source of strength rather than a source of terror.”
Mindfulness meditation, though sometimes too abstract or dissociative for early-stage trauma survivors, is also shown to reduce activity in the amygdala and enhance emotional awareness. These practices cultivate interoception—the ability to feel and name what’s happening inside.
5. Theater and Movement: Expressive Therapies
Van der Kolk emphasizes that creative and expressive therapies—such as theater, dance, and psychodrama—can be uniquely healing, especially for those who cannot yet articulate their trauma verbally.
“Trauma is preverbal. So recovery requires experiences that bypass the tyranny of language.”
One of the most compelling stories is his work with a group of young men in a high-crime Boston neighborhood who participated in a trauma-informed theater group. Performing roles, reenacting stories, and embodying emotions allowed them to explore their trauma in a safe, structured, and collective way.
Dance and movement therapy can also help release stored trauma and restore agency over the body. For many trauma survivors, especially those with histories of sexual or physical abuse, this reconnection is profoundly transformative.
6. Internal Family Systems (IFS) Therapy
IFS, developed by Richard Schwartz, posits that the mind is made up of multiple parts—like an internal family of sub-personalities. In trauma survivors, some parts carry pain (exiles), while others try to manage or suppress that pain (protectors and firefighters).
“In trauma, some parts of us are frozen in time, and others are trying to shield us from ever going there again.”
Van der Kolk describes how IFS helps patients befriend and integrate these parts, rather than suppress or reject them. This aligns with his broader theme: healing requires reintegration, not just symptom control.
IFS avoids pathologizing dissociation—instead, it honors the protective roles these internal parts have played, and helps create a compassionate, observing Self that can lead healing.
7. Community and Connection: The Social Cure
At every turn, van der Kolk reminds us that trauma recovery requires relationships—safe, consistent, and attuned. Isolation intensifies trauma, while connection restores safety.
“Being able to feel safe with other people is probably the single most important aspect of mental health.”
Whether through group therapy, peer support, creative collaboration, or family healing, recovery is accelerated when survivors feel seen, heard, and held in community.
He also urges public institutions—schools, prisons, hospitals—to adopt trauma-informed practices that acknowledge, rather than punish, dysregulated behavior.
Medication: Useful but Limited
Van der Kolk is not anti-medication, but he is cautious. He acknowledges that SSRIs and antipsychotics can sometimes help stabilize symptoms, but they do not address the root causes of trauma and often come with side effects.
“Drugs cannot ‘cure’ trauma; they can only dampen its expressions.”
He advocates using medication judiciously and temporarily, in conjunction with therapy—not as a stand-alone solution.
Conclusion: Healing Is Possible
The Body Keeps the Score is not just a book about trauma—it is a manifesto for healing. Dr. Bessel van der Kolk invites us to look beyond symptoms and labels and to understand trauma as a deeply embodied and relational experience. With clarity, compassion, and scientific rigor, he charts a path forward—one that is grounded in the body, enriched by neuroscience, and sustained through connection.
As he writes:
“Recovery doesn’t mean that you forget about the traumatic event. It means that you live a life in which the trauma doesn’t own you.”
This book reminds us that while trauma may leave lasting imprints, with the right support, tools, and relationships, we can reclaim our bodies, minds, and futures.