B. van der Kolk on new advances in trauma treatment

I am currently studying massage at Esalen, and was fortunate to have the chance to hear Bessel van der Kolk speak on new advances in trauma treatment. Here is a summary of some of the ideas he discussed.

Bessel began his talk by making the point that people have been indifferent to the people who suffer trauma at least since the 1500s when Pieter Brueghel the Elder painted Landscape with the Fall of Icarus, and those around to witness the spectacular event went about their business and let the boy drown. He then discussed the US government’s prioritization of trauma that is worth treating. 2.5 million children are physically abused in the US each year. Changing this would require ensuring everyone has enough food and a home to feel safe in, yet the food stamp program was just revoked by congress. Conversely, there was $83 million in funding offered to help the families of the 3 people who were killed by the Boston marathon bombings.

He described the body’s fight, flight, or freeze response to trauma, and said that few of the 911 witnesses who could run over the bridge to the safety of home suffered Post-Traumatic Stress Disorder (PTSD). A boy who witnessed people jumping out of the towers to their death found the imagination to think of a solution for the future (a trampoline) while President Bush froze for 17 minutes. So being able to run or otherwise work off the adrenaline response to a dangerous situation, having a home to go to, and having people to take care of oneself until able to function again are all factors that help prevent PTSD in response to trauma. It is also helpful if someone takes charge who seems to know what they are doing—this is reassuring. Being able to speak about the trauma is the first requirement, so those suffering from secret trauma (physical or sexual abuse at home, molestation, rape, and soldiers) don’t get the help they need—a survivor can’t deal with trauma until someone is willing to listen. Survivors also must be able to cultivate their imagination in order to heal, for example by imagining an alternate outcome.

The survivors of 911 said these were the most effective ways to treat trauma, in order: acupuncture (1), massage, yoga, and EMDR (4). EMDR has been studied the most, and yoga is also an evidence-based treatment. Massage has not been studied, nor has acupuncture. But the officials in charge of funding wanted to fund psychoanalysis and cognitive behavioral therapy (CBT) as treatment modalities for the survivors. Yet during a traumatic event, the frontal lobe shuts down and the limbic brain takes over. So psychoanalysis and CBT are not effective at treating trauma—cognitive understanding has no pathways to the emotional system. But no one is doing limbic system therapy. (He did not mention all the somatic modalities of trauma-treatment therapy that are out there, such as somatic experiencing. And actually EMDR is somatic as well.) Bessel said Internal Family Systems (IFS) therapy is very effective for treating chronic trauma, while EMDR is effective for single events. Neurofeedback is a new trauma-treatment method that changes how the brain processes information. It involves expensive equipment and is mechanical. The Boston school system is experimenting with theatre for traumatized kids; taking a different role than the person they usually feel like has been very effective for some children.

People who have PTSD can be triggered by the most innocuous event that others would not find traumatic at all. For example, being touched during child’s pose in a yoga class could re-trigger a traumatic event. Those with PTSD perceive the world as a dangerous place. The brain is actually changed by chronic danger, so that the survivor can’t accurately perceive what is going on in the present. The brain waves produced from different parts of the brain in response to stimulus are altered. The chronic arousal (hyperalertness) caused by PTSD also reduces the body’s immune system’s ability to fight disease. They need to find ways to calm their bodies and reclaim ownership of their bodies. Feldenkrais can help people feel safe some of the time. Yoga is as helpful as most psychological treatments; people with PTSD feel uncomfortable in their bodies, and a trauma-sensitive yoga class can help people learn to feel a sense of safety and ownership (control) of their bodies, and connection to their breath is calming. Massage can be boundary-violating, but if it is gentle, thoughtful, and responsive to the client’s agreement of where they can be touched, it can be very powerful. People are not healed from PTSD until they can be safely touched.

Bessel’s new book, The Body Keeps the Score: Brain, Mind, and Body in the Healing of Trauma, will be coming out in June 2014. It describes the impact of trauma on brain chemistry, and the studies that have been done with neurofeedback, in greater detail.