Just a decade ago, Dr. Bessel van der Kolk published his best-selling book, The Body Keeps the Score: Brain, Mind, and Body in the Healing of Trauma [1].
It is a groundbreaking exploration of how trauma affects the brain, body, and psyche, and how survivors can recover. His main idea is that exposure to abuse and violence fosters the development of a hyperactive alarm system and molds a body that gets stuck in fight/flight, and freeze. In this video, he explains many of the aspects of the book [2].
His work draws on years of research by Dr. Steven Porges developing Polyvagal Theory and by Deb Dana who later developed many clinical applications [3][4]. Simply put, Porges defined trauma as a chronic disruption of connectedness.
Since then there has been extensive continued research and the broad development of clinical practice around the concept of embodied therapy and healing from Post-Traumatic Stress Disorder (PTSD).
The Science: How Trauma Damages Physical Health
According to Porges and van der Kolk, trauma reshapes the brain and body. The body retains traumatic memories, leading to chronic stress responses even when the danger has passed.
Common Physical Symptoms of Trauma
In addition to changes in thoughts, feelings, and behaviors, people with PTSD may also experience either acute or chronic physical problems.
Acute physical symptoms typically last for a short time in reaction to reminders of trauma. These could include [5]:
- Increased heart rate
- Sweating
- Trembling
- Muscle tension
- Nausea, pain (e.g., back, joints, headaches)
- Trouble breathing
- Dizziness
Chronic physical problems include:
- High blood pressure
- High cholesterol
- Obesity
- Heart disease
- Chronic pain
- Fatigue
- Decreased life expectancy
It’s not uncommon that a person does not realize the relationship between their physical symptoms and a traumatic event. For those with chronic pain, the pain may be a reminder of the trauma, causing or worsening other symptoms of PTSD, depression, or alcohol or prescription medication misuse [5].
The Nervous System’s Role
The nervous system plays a central role in how individuals experience, process, and recover from trauma. Traumatic events can fundamentally disrupt the normal regulatory mechanisms of the nervous system, leading to a range of physical, emotional, and psychological symptoms. This short video is a helpful explanation of the basics [6].
Fight-or-Flight Activation (Sympathetic Nervous System)
During a traumatic event, the sympathetic branch of the autonomic nervous system is activated. This triggers the “fight or flight” response, releasing stress hormones such as cortisol and adrenaline, which increase heart rate, blood pressure, and respiration to prepare the body for immediate action [7].
If trauma is ongoing or severe, this system can become chronically overactive, leading to persistent states of hyperarousal, anxiety, irritability, hypervigilance, and sleep disturbances.
Freeze and Shutdown (Parasympathetic Nervous System)
In some cases, the nervous system may respond to overwhelming trauma by engaging the parasympathetic branch, leading to a “freeze” or shutdown response. This can manifest as numbness, disconnection, fatigue, depression, and lethargy.
People may alternate between hyperarousal (sympathetic dominance) and hypoarousal (parasympathetic dominance), struggling to return to a balanced state.
Window of Tolerance
The “window of tolerance” refers to the zone in which a person can function optimally, experiencing and processing emotions without becoming overwhelmed. Trauma can push individuals outside this window, making it difficult to self-regulate emotions and bodily responses.
Neurobiological and Brain Changes
Brain Structure and Function
Trauma can alter key brain regions involved in emotion, memory, and decision-making, including the amygdala (fear processing), hippocampus (memory), and prefrontal cortex (executive functioning).
These changes can result in flashbacks, emotional dysregulation, avoidance behaviors, and difficulties with memory and concentration [8].
Neurochemical Imbalances
Traumatic stress can disrupt neurotransmitter systems, leading to increased norepinephrine (heightened arousal and startle response), decreased serotonin and GABA (reduced calming effects), and changes in stress hormone regulation.
Such imbalances contribute to symptoms like hypervigilance, anxiety, impulsivity, and dissociation.
Van der Kolk says trauma interferes with the brain circuits that involve focusing, mental flexibility, and being able to stay in emotional control. A constant sense of danger and helplessness promotes the continuous secretion of stress hormones, which wreaks havoc with the immune system and the functioning of the body’s organs.
Only making it safe for trauma victims to inhabit their bodies, and to tolerate feeling what they feel, and knowing what they know, can lead to lasting healing.
The Role of Dissociation and Fragmented Memory
Many trauma survivors dissociate, detaching from their bodies or emotions as a survival mechanism. Traumatic memories are often stored non-verbally, emerging as flashbacks, physical pain, or emotional outbursts.
Long-Term Effects of Untreated Trauma
Chronic Dysregulation
In conditions like PTSD, the nervous system remains in a state of chronic dysregulation. This is marked by sustained sympathetic hyperactivity, abnormal stress hormone levels, and persistent changes in brain function.
The neurobiological changes in PTSD reflect an enduring adaptation to trauma, often resulting in a heightened response to reminders of the traumatic event and impaired ability to distinguish between real threats and safe situations.
Accelerated Aging and Cellular Damage
Studies show that PTSD symptoms, such as sleep disturbance and emotional arousal, are expected to most strongly contribute to cellular aging.
Research is investigating the suggested mechanisms, such as epigenetics (the study of changes in gene expression that occur without changing DNA, primarily from environmental factors), and biological systems such as oxidative stress and HPA axis dysfunction, that might contribute to this. Epigenetic markers of cellular aging have been shown to be strongly influenced by groundbreaking discoveries in understanding the genetics of aging,
As well, aspects of the intra-individual environment, such as psychiatric symptoms, may impact physiology directly and be as important as the external environment, if not more so, in predicting subsequent health outcomes [9].
Healing the Body After Trauma
Trauma is not just a psychological issue but a physiological one, requiring holistic treatment that integrates mind, body, and community. Healing involves rebuilding safety, processing memories, and restoring bodily awareness.
Van der Kolk says that traditional talk therapy alone is often insufficient. Trauma survivors may struggle to verbalize their experiences because trauma disrupts language centers in the brain.
Van der Kolk argues for somatic (body-based) therapies (e.g., yoga, EMDR, sensorimotor psychotherapy) alongside talk therapy.
Holistic Embodied Approaches to Recovery
While drugs like SSRIs (used for depression) can help manage symptoms, they don’t address the root causes of trauma. van der Kolk advocates for integrative approaches over purely pharmacological solutions.
Evidence-based Therapy
Several therapies have proven effective in treating trauma and PTSD.
- Eye Movement Desensitization and Reprocessing (EMDR) is a psychotherapy technique that helps process traumatic memories by using guided eye movements. It reduces distress by stimulating the brain’s natural healing, often in 8-12 sessions.
- Accelerated Resolution Therapy is a brief psychotherapy that uses eye movements to reprogram traumatic memories, reducing emotional distress in 1-5 sessions. It combines elements of EMDR and guided imagery.
- Trauma-focused Cognitive Behavioral Therapy is a short-term therapy for trauma survivors, especially children. It combines cognitive restructuring with exposure techniques to reduce PTSD symptoms and improve coping skills in 12-16 sessions.
- Dialectical Behavior Therapy is a cognitive-behavioral approach that teaches mindfulness, emotion regulation, distress tolerance, and interpersonal skills to help manage intense emotions, self-harm, and Borderline Personality Disorder.
Embodied Healing
Van der Kolk stresses the importance of embodied healing, in which recovery requires reconnecting with the body through a variety of approaches including:
- Movement (yoga, walking, exercise)
- Breathwork
- Touch (such as neurofeedback, theater, and dance)
- Mindfulness and meditation to help regulate the nervous system
Social Relationships Are Key to Recovery
Trauma isolates people; safe, trusting relationships (therapy, support groups, community) are crucial for healing. Attachment theory explains how early trauma disrupts relationships, requiring reparative experiences.
Trauma’s Impact on Society
Unresolved trauma contributes to cycles of violence, addiction, and mental illness. Trauma-informed care is required in education, healthcare, and the criminal justice systems.
Why Choose Corner Canyon Health Centers?
Treatment for mental health conditions and trauma is available in Utah. Are you or a loved one looking for a compassionate space to heal from anxiety, trauma, PTSD, other mental health conditions, or addictions? Our licensed trauma-informed professional therapists and counselors at Corner Canyon Health Centers can provide compassionate help using a range of therapeutic and holistic techniques.
Reach out to our Admissions team now at Corner Canyon. We’re in a peaceful setting bordered by the beautiful Wasatch Mountains.
Sources
[1] Bessel van der Kolk. 2014. The Body Keeps the Score: Brain, Mind, and Body in the Healing of Trauma.
[2] Bessel van der Kolk. Video. The Body Keeps the Score: Brain, Mind, and Body in the Healing of Trauma.
[3] Porges, S. 2011. The Polyvagal Theory: Neurophysiological Foundations Of Emotions, Attachment, Communication, Self-Regulation.
[4] Deb Dana. Polyvagal Theory and Trauma. Youtube.
[5] Guina J. n.d. Expert Q&A: Posttraumatic Stress Disorder (PTSD). American Psychiatric Association.
[6] Trauma and the Nervous System: A Polyvagal Perspective. The Trauma Foundation. Youtube.
[7] Sherin, J. E., & Nemeroff, C. B. (2011). Post-traumatic stress disorder: the neurobiological impact of psychological trauma. Dialogues in clinical neuroscience, 13(3), 263–278
[8] Bremner J. D. (2006). Traumatic stress: effects on the brain. Dialogues in clinical neuroscience, 8(4), 445–461.
[9] Wolff, E. 2016. PTSD and Accelerated Aging. PTSD Research Quarterly. Volume 27/No. 3.
