Healing the Mind Through the Body - Rethinking How We Treat PTSD

According to one estimate, nearly 70 percent of us will live through a traumatic event at some point in our lives — and a fifth will go on to develop PTSD. For those suffering the worst effects of trauma, talk therapy isn’t always effective. Now, new therapies are emerging to help treat trauma survivors who are unable to move past a painful event.

Bessel Van Der Kolk is an internationally recognized leader in the field of trauma research. For more than a decade he’s been championing a technique know as “eye movement desensitization and reprocessing therapy,” or EMDR, as an alternative to traditional talk therapy. Instead of just talking, EMDR aims to reduce psychological stress through physical movement. Critics of EMDR have called its effectiveness into question, but it also has many adherents: more than 60,000 therapists around the world are certified in it. Steve Paulson caught up with van der Kolk to learn more about this new approach to trauma.

So how does trauma affect our senses, how we respond to the world?

Trauma causes our senses to become hyperacute, very reactive to sound and lights and touch. As this goes on, the body desperately tries to calm that down. Many people use drugs or alcohol to try to do that. [Trauma is] probably the single most important cause of drug addiction and alcoholism. Many people manage to do that without alcohol or drugs, and they just shut off their relationship to their body. One of the effects of trauma, maybe, is that you go through life feeling like a zombie.

You tell a fascinating story in your book about a patient you call Cheri, who was getting a foot massage and apparently had some startled reaction when she realized the therapist had her hands on her feet.

It’s really very startling to me to also discover the degree to which traumatized people have a very distorted relationship to their bodies. There’s whole parts of their bodies that basically are missing. Or they feel too much. They’re hyper-reactive to stuff nobody could find an origin of.

If someone is massaging your feet, how could you not feel that?

All you need is to shut down the perceptual system in your brain. And your brain just learns how to shut down those sensations. All these strange reactions start off as ways in which people try to defend themselves and deal with the horror that’s happening to them. But if it continues, then it makes you very ill equipped to deal with daily life. That is very much what happens to soldiers, for example. Your brain gets reorganized to deal with threat, but you become very oblivious to anything else. Nothing means anything to you except the very thing that has caused you pain. And so you get this strange paradox. .

You’ve also done a lot of work with EMDR (eye movement and desensitization and reprocessing). Could you explain how that works?

It’s a very strange technique. About 25 years ago, Francine Shapiro discovered that if you move your eyes back and forth while you think about a very bad event, that event calms itself down. And eventually that became EMDR. I actually did some National Institutes of Health funded research on that method, and was quite skeptical of it initially. And we had fantastic results.

Just moving your eyes back and forth as you’re thinking about this traumatic thing is enough?

As you call up the memories – what you saw, what you heard, what you smelled, what you felt in your body, what you were thinking – and you move your eyes from side to side, something starts shifting. And what happens looks like what happens when you dream, when you also move your eyes back and forth. It consolidates memories and attaches it to other things that are happening in your life. When you get traumatized, a number of different brain circuits and brain regions that you need in order to put an event behind you go offline…It seems like EMDR is one method by which you can bring those brain regions online that you need in order to make a differentiation between things happening now and things having happened a long time ago.

If I were to come into your office, what would you do? How would you do that with me sitting right there?

I’d become very quiet and say, “Just sit in your chair and evoke the scene of what happened back then.” I don’t ask you to talk about it. One of the great problems with verbal therapy is that the moment you start talking about these terrible things, your body tends to get hijacked and it feels like it’s happening all over again….And then we ask people to go into these eye movements. My hunch is that with hypnosis you can do the same thing, but very few people are doing hypnosis anymore.

You sort of go into a trance state. And in the trance state you can sort of rework that memory. In our culture people talk about trauma as an event that happened a long time ago. But in fact trauma is the imprint that event left on your mind and in your sensations. It’s the discomfort you feel and the agitation, rage, and helplessness that’s happening right now. And so it’s all located in the landscape of your body.

That’s remarkable.

It is remarkable!

Are you saying that after one session of EMDR this can happen?

It depends on many different things. The more acute the trauma is, the more efficiently this works. For example, a number of my colleagues saw people who were affected by the Boston Marathon [bombing]. And within one or two sessions, [they said things like] “I’ve been through a really bad experience, but I’m safe now.” And I see this in my office quite a bit. It’s very gratifying to see people come to life and say, “Hey, I’m alive. Thank you very much.” They shake your hand and walk off…

Have you tried EMDR yourself?

I’ve tried everything I do, so I do many different methods [like] EMDR. I’m a great advocate and researcher of yoga. Yoga is a great way to help people get in touch with their bodies, feel alive in their bodies, and regulate physiological arousal. I just published a research study that showed that in our particular population people had a better response to yoga than any pharmacological drug that had ever been studied. And I’ve done a few of the drug studies myself, so I could compare the two.

Are these kinds of practices good for everyone?

If you don’t have PTSD, I see no reason to do EMDR. But yoga – I think I’m a better person for doing it. I think I’m quieter, more mindful, more tolerant. It’s very interesting that the whole culture…the Western tradition is [all about] yakking and drugs.

Well the Western tradition has sort of cut the mind off from the body, right?

There’s also a deep belief that as long as you can talk, things will get better. Talking could be enormously important, but it’s very interesting to go to places like China, India and Japan, and see they have long traditions doing qigong, tai chi, yoga, etc. And it’s very clear to me that those methods were all invented in those cultures to help people with trauma.

It’s kind of amusing to hear a psychiatrist talk about the limits of yakking, of talk therapy.

Well of course there’s much more extreme people in my profession who believe you should only give people drugs. Talking is important, but most importantly befriending yourself, allowing yourself to feel what you feel, and becoming safe in your body is the most important thing in overcoming trauma.

Feeling Through Trauma

Psychiatrist Bessel van der Kolk is studying the healing power of helping people with post traumatic stress disorder focus less on telling their stories, and more on how their stories feel — how they sound, look, or smell.

You can also hear van der Kolk's extended interview, including more on yoga and the neuroscience of trauma.

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