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The Body Keeps the Score

The Body Keeps the Score

Brain, Mind, and Body in the Healing of Trauma
by Bessel van der Kolk 2014 464 pages
Psychology
Self Help
Mental Health
Listen
11 minutes

Key Takeaways

1. Trauma disrupts the body's natural equilibrium, leaving an imprint on body, mind, and brain

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

Trauma's far-reaching impact. Trauma affects not just the mind, but the entire human organism. It alters how people process sensory information, often leaving them hypervigilant to potential threats. This state of constant arousal can lead to:

  • Difficulty distinguishing between past and present dangers
  • Impaired ability to engage fully in the present moment
  • Physical symptoms like chronic pain, fatigue, and digestive issues

Neurobiological changes. Trauma can rewire the brain, particularly affecting areas responsible for:

  • Emotion regulation
  • Memory processing
  • Stress response

These changes explain why traumatized individuals often struggle with emotional volatility, fragmented memories, and a persistent sense of being unsafe.

2. PTSD involves reliving the past in the present, affecting the entire human organism

"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."

Stuck in survival mode. People with PTSD remain physiologically primed to face the original threat, even long after the danger has passed. This state of constant alertness manifests as:

  • Intrusive memories or flashbacks
  • Nightmares and sleep disturbances
  • Heightened startle response
  • Emotional numbing or dissociation

Whole-body impact. PTSD affects not just the mind, but the entire body. Sufferers often experience:

  • Chronic muscle tension
  • Digestive issues
  • Immune system dysfunction
  • Cardiovascular problems

These physical symptoms reinforce the psychological sense of ongoing danger, creating a vicious cycle that can be difficult to break without targeted interventions.

3. Early relationships shape brain development and future stress responses

"Trauma in childhood becomes the child's default state of existence, a lens through which they view all future experiences."

Attachment patterns. Early caregiver relationships profoundly influence a child's developing brain, particularly in areas responsible for:

  • Emotion regulation
  • Stress response
  • Social bonding

Children who experience consistent, attuned caregiving develop resilience and the ability to self-soothe. In contrast, those with neglectful or abusive caregivers may struggle with:

  • Emotional dysregulation
  • Difficulty forming healthy relationships
  • Heightened vulnerability to future trauma

Long-term consequences. Early trauma can lead to lifelong difficulties in:

  • Trust and intimacy
  • Self-worth and identity
  • Ability to cope with stress

These early experiences create a template for how individuals perceive and interact with the world, often persisting into adulthood unless addressed through targeted interventions.

4. Childhood trauma can lead to lifelong struggles with physical and mental health

"Child abuse is our nation's largest public health problem."

The ACE study. The Adverse Childhood Experiences (ACE) study revealed the profound impact of childhood trauma on adult health. Key findings include:

  • Higher ACE scores correlate with increased risk of:

    • Chronic diseases (heart disease, cancer, etc.)
    • Mental health disorders
    • Substance abuse
    • Early death
  • Even in the absence of high-risk behaviors, childhood trauma can lead to poor health outcomes

Intergenerational transmission. Trauma's effects can be passed down through generations via:

  • Epigenetic changes
  • Parenting styles shaped by unresolved trauma
  • Social and environmental factors

Addressing childhood trauma is crucial not only for individual healing but for breaking cycles of intergenerational trauma and improving public health outcomes.

5. The body keeps the score: trauma is remembered as physical sensations

"The body keeps the score: If the memory of trauma is encoded in the viscera, in heartbreaking and gut-wrenching emotions, in autoimmune disorders and skeletal/muscular problems, this demands a radical shift in our therapeutic assumptions."

Somatic memory. Trauma is not just stored in the mind, but in the body itself. This manifests as:

  • Chronic pain
  • Unexplained medical symptoms
  • Heightened physiological arousal

Traumatized individuals often struggle to verbalize their experiences, but their bodies tell the story through:

  • Muscle tension
  • Breathing patterns
  • Posture and movement

Mind-body disconnection. Many trauma survivors experience:

  • Difficulty identifying and expressing emotions (alexithymia)
  • Dissociation or feeling "out of body"
  • Inability to feel safe in their own skin

Effective trauma treatment must address both the psychological and physiological aspects of trauma, helping individuals reconnect with and feel safe in their bodies.

6. Traditional talk therapy may not be enough to heal trauma's deep-rooted effects

"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."

Limitations of cognitive approaches. While talk therapy can be helpful, it often falls short in addressing trauma because:

  • Trauma affects areas of the brain not accessible through language alone
  • Reliving traumatic memories verbally can be retraumatizing
  • Many trauma survivors struggle to put their experiences into words

Need for bottom-up approaches. Effective trauma treatment often requires:

  • Body-based interventions to address physical manifestations of trauma
  • Techniques that directly target the autonomic nervous system
  • Methods that help individuals feel safe in their bodies

Integrative approach. A comprehensive trauma treatment plan may include:

  • Traditional psychotherapy
  • Somatic therapies (yoga, body awareness exercises)
  • Neurofeedback or other brain-based interventions
  • Pharmacological support when necessary

By addressing trauma's impact on multiple levels, individuals have a better chance of achieving true healing and integration.

7. Effective trauma treatment involves regaining a sense of safety in one's body

"The critical issue is allowing yourself to know what you know. That takes an enormous amount of courage."

Restoring physiological balance. A key goal of trauma treatment is helping individuals:

  • Regulate their autonomic nervous system
  • Distinguish between past and present threats
  • Feel safe in their own bodies

This often involves:

  • Mindfulness practices
  • Body awareness exercises
  • Breathing techniques

Reclaiming agency. Trauma often leaves individuals feeling helpless. Effective treatment helps them:

  • Recognize and respond to their body's signals
  • Make choices that support their well-being
  • Take effective action in the face of triggers

Gradual exposure. Treatment must balance:

  • Processing traumatic memories
  • Building resources and coping skills
  • Avoiding retraumatization

This often involves a pendulum-like approach, alternating between confronting difficult material and returning to a place of safety and regulation.

8. EMDR, yoga, and neurofeedback offer promising approaches to rewiring trauma responses

"EMDR loosens up something in the mind/brain that gives people rapid access to loosely associated memories and images from their past. This seems to help them put the traumatic experience into a larger context or perspective."

Innovative therapies. These approaches target trauma's neurobiological underpinnings:

EMDR (Eye Movement Desensitization and Reprocessing):

  • Facilitates processing of traumatic memories
  • Helps integrate fragmented sensory experiences
  • Can lead to rapid symptom relief

Yoga:

  • Increases body awareness and interoception
  • Promotes nervous system regulation
  • Helps individuals feel safe in their bodies

Neurofeedback:

  • Directly targets dysregulated brain patterns
  • Can improve attention, emotional regulation, and stress resilience
  • Offers a non-invasive way to "retrain" the brain

These methods often work synergistically with traditional psychotherapy, offering a more comprehensive approach to healing trauma.

9. Internal Family Systems therapy helps integrate fragmented aspects of self

"All parts have a function: to protect the self from feeling the full terror of annihilation."

Understanding parts. IFS views the psyche as composed of various "parts" or subpersonalities:

  • Exiles: carry the burden of trauma
  • Managers: try to keep the system functioning
  • Firefighters: engage in impulsive behaviors to numb pain

Self-leadership. The goal of IFS is to help individuals:

  • Identify and understand their various parts
  • Access their core "Self" – the compassionate, curious essence of who they are
  • Heal wounded parts and create internal harmony

Integration process. IFS helps trauma survivors:

  • Recognize how different parts were created to cope with trauma
  • Develop compassion for all aspects of themselves
  • Create new, healthier ways of responding to triggers and stress

This approach can be particularly helpful for those with complex trauma histories, offering a non-pathologizing way to understand and heal fragmented aspects of self.

10. Communal rhythms and theater can play a powerful role in trauma recovery

"Music binds together people who might individually be terrified but who collectively become powerful advocates for themselves and others."

Power of collective experience. Group activities like theater and music can:

  • Counter the isolation often experienced by trauma survivors
  • Provide a sense of belonging and shared purpose
  • Offer opportunities for emotional expression and catharsis

Embodied healing. Theatrical techniques help trauma survivors:

  • Reconnect with their bodies in a safe, playful context
  • Explore different ways of being and responding
  • Practice emotional regulation and social skills

Cultural and historical context. Throughout history, communal rituals have helped societies process collective trauma. Examples include:

  • Ancient Greek theater addressing the impact of war
  • Civil rights movement songs fostering courage and unity
  • "Singing Revolution" in Estonia leading to independence

These approaches tap into fundamental human needs for connection, expression, and meaning-making, offering powerful complements to individual therapy in trauma recovery.

<words>1996</words>

Last updated:

Review Summary

4.39 out of 5
Average of 100k+ ratings from Goodreads and Amazon.

The Body Keeps the Score receives mixed reviews. Many praise its comprehensive exploration of trauma, innovative treatments, and the author's expertise. Readers find it insightful, compassionate, and potentially life-changing. However, some criticize the author's writing style, graphic descriptions, and perceived bias. Critics note the book's length, academic tone, and potential to be triggering. Despite controversies, many readers appreciate the book's contribution to understanding trauma and its effects on the body and mind.

About the Author

Bessel van der Kolk MD is a renowned expert in traumatic stress, dedicating his career to studying how individuals adapt to traumatic experiences. He established one of the first clinical research centers in the US focused on civilian traumatic stress in 1984. Van der Kolk has conducted pioneering research on PTSD treatments, neuroimaging of trauma's effects on the brain, and the link between early childhood trauma and borderline personality disorder. His work has significantly contributed to the understanding and treatment of traumatic stress in both children and adults.

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