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Chapter 13: Healing from Trauma: Owning Yourself

Chapter 13 details some general strategies for treating trauma. Van der Kolk states that the overall goal is to take ownership of one’s self again, both in body and mind, which goes hand in hand with findings way to become calm, to maintain that calm, to be fully present in one’s life, and to be open and honest with one’s self. Most importantly in treatment, one must find a way to integrate the traumatic memory into the past where it belongs.

One method of therapy is limbic system therapy, which restores the balance between the rational and the emotional brain. It attempts to do so by dealing with hyperarousal, learning mindfulness, finding a good support system in steady relationships, engaging in physically in community through dance or theater, getting in touch with one’s body, and taking action.

Other therapy methods include cognitive behavioral therapy (CBT), which challenges negative thought patterns, desensitization, which works via exposure to distressing stimuli, the use of psychedelics in order to calmly access traumatic memories, and medications, such as selective serotonin reuptake inhibitors (SSRIs) or tranquilizing drugs such as benzodiazepines. However, van der Kolk cautions against solely relying on medicine for treatment, and to be wary of its negative side effects. Instead, he advocates for a combination of therapies.

Chapter 14: Language: Miracle and Tyranny

Chapter 14 discusses the pros and cons of talk therapy. Language can be a powerful way in which to deal with trauma, as one cannot begin to understand and heal from their trauma without having named it. Honesty with one’s self is key in ensuring that the talking cure will do any good. Words can also lessen isolation as traumatic stories are shared. Other forms of language, such as written language and art, can also help process these traumatic memories. However, language can sometimes limit the patient’s depth of emotion when relating memories to another person, and may become overwhelming for the speaker as well as alienating for the listener. It also requires a safe place in which to express themselves, which not all patients may have.

Chapter 15: Letting Go of the Past: EMDR

This chapter discusses eye movement desensitization and reprocessing (EMDR) therapy. During EMDR, a therapist guides a patient’s eyes movements as the patient silently embarks on a journey through a flow of associated mental images surrounding their trauma. Van der Kolk and some colleagues at the Brookline Trauma Center performed a study in which they used EMDR to treat several PTSD patients to positive results, showing a greater effectiveness than medication. One of Van der Kolk’s patients, Kathy, was able to use EMDR to help her resolve memories of sexual abuse and child prostitution at the hands of her father.

Chapter 16: Learning to Inhabit Your Body: Yoga 

Chapter 16 discusses the benefits of yoga. In seeking to find better treatments for patients who had difficulty connecting to their bodies and physiology, he and his colleagues at the Trauma Center began studying heart rate variability (HRV), for which a good score could indicate a well-functioning nervous system. One of the candidates for improving HRV was yoga, which was studied both with traumatized civilians and veterans. Annie, a survivor of childhood abuse, was recommended to try yoga, which she found helpful in getting back in touch with her body and having an awareness of where she carried her emotional pain and trauma. Overall, most participants in yoga classes at the Trauma Center later reported a greater sense of self-awareness and confidence.

Chapter 17: Putting the Pieces Together: Self-Leadership 

This chapter explains how internal family systems (IFS) therapy works. Developed by Richard Schwartz, IFS divides the mind into different parts that form a family, or system, that affect each other. These parts include the mangers, exiles, firefighters, and Self. Managers are protectors that are responsible for safety, organization, and securing connections. Firefighters are protectors that will take extreme measures to guard against or stop emotional pain. Exiles contain elements of traumatic memories, such as emotions and sensations, and are often locked away or ignored. The Self is the distilled core of a person, protected by the managers and firefighters and separate from the exiles. Only the Self can manage all of the parts of the system, and being able to find the Self and learn to control all of the parts through mindfulness is the goal of IFS. Van der Kolk used IFS therapy in the case of Joan and her husband Brian. Joan, a survivor of childhood molestation, had a manager that manifested itself as overtly critical and a manager that was self-loathing. Her firefighters spurred her into drinking and cheating on her husband after an upsetting therapy session, in a last-ditch attempt to protect her from hurt. Her exiles were her childhood selves, abused and afraid. Van der Kolk was also able to successfully use IFS with Brian, as well as another patient, Peter, who was a survivor of childhood abuse and neglect.

Chapter 18: Filling in the Holes: Creating Structures

Chapter 18 discusses PBSP psychomotor therapy. Developed by Alfred Pesso, van der Kolk was introduced to the method at a workshop. In the method, the patient, called the protagonist, is able to create a 3D reconstruction of their past, or a structure, in the area surrounding them, using other people or objects as stand-ins for important figures in their lives. A person selected as a witness will also recognize and repeat the protagonist’s emotional state back to them, giving validation and companionship.  One of van der Kolk’s patients, Maria, used structures to process memories of her abusive father and loving mother who still failed to protect Maria from her father’s violence. In her structure, Maria chose other participants to be stand-ins for her real mother and father, as well as her ideal mother and father, and processed her emotions through conversations with them. Another patient, Mark, explored his memories of accidentally overhearing his father having phone sex with his aunt and then being accused by his father of lying when he confronted him about it. Mark chose stand-ins for his real father, his ideal father, and his aunt in order to process his memories and emotions.

Chapter 19: Applied Neuroscience: Rewiring the Fear-Driven Mind with Brain/Computer Interface Technology

Chapter 19 explains the technology of neurofeedback. Electrical brain waves can be captured via electroencephalograms, or EEGs, and with neurofeedback, electrical impulses can be used to nudge the brain waves into the desired frequencies. Different wave patterns and frequences correspond to different emotions, with delta waves corresponding to sleep, theta waves corresponding to the edge of sleep, alpha waves, corresponding to peace and calm, and beta waves corresponding to focused attention. Van der Kolk was first introduced to neurofeedback in 2007 by Sebern Fisher. One of Sebern’s patients, Lisa, had endured severe child abuse at the hands of her mother before running away from home and then unsteadily alternating between homelessness and the foster system. Lisa had experienced dissociation prior to treatment with neurofeedback, but several sessions of neurofeedback resolved that issue. However, as promising as neurofeedback seems, more research is necessary.

Chapter 20: Finding Your Voice: Communal Rhythms and Theater

The final chapter describes the benefits of participation in theater and community. Van der Kolk’s own son Nick spurred his interested in theater, as enrollment in a theater group had vastly improved his mental health. The main thrust behind theatrical therapy is its ability to create a sense of purpose and meaning in one’s life by moving collectively within a community and engaging in communal ceremonies, while simultaneously allowing participants to get in touch with their bodies and giving them a greater sense of agency. Van der Kolk studied three different theater programs: Urban Improv and Trauma Drama, Possibility Project (headed by Paul Griffin), and Shakespeare and Company. Urban Improv focused on working with children from local schools by performing relatable skits, and showed great success with younger students. Older students benefited more from the offshoot program Trauma Drama, which was more intensive. Possibility Project served several groups, including foster-care youth, via a nine-month program in which participants would write and perform their own full-length musical with the assistance of professionals. Shakespeare and Company served juvenile delinquents and guided them in a performance of a Shakespeare play.

Epilogue

In the Epilogue, van der Kolk states that trauma is both one of the largest and the most ignored public health issues. He asks the reader to consider both the societal causes of trauma and the societal damage that trauma causes, and to help cultivate safe spaces that will both help prevent and heal trauma. He especially emphasizes creating safe environments in schools for children to both learn the curriculum and learn to process their emotions in a healthy and safe way, as well as places to engage in communal activity and to get in touch with their bodies. In the final lines, van der Kolk encourages the reader to act now to change the world for the better, now armed with their knowledge of trauma.

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