The body keeps the score

Psychiatrist Bessel Van Der Kolk’s book ’The Body Keeps the Score’ is an exploration into the mind-body connection of those suffering from the effects of trauma. Van Der Kolk has been working in the field of psychiatry since the Vietnam War and has tried a variety of different methods in helping those afflicted with the symptoms of PTSD. He brings a wealth of experiential knowledge into his writing.

 
Chapter 16 of the book details his work with yoga as a form of healing. Yoga has now become a mostly accepted form of exercise in the West and is synonymous with wellness and, for some, a form of spirituality.  Van Der Kolk approaches the practice as a scientist would – with quantifiable data and research. The premise of his work is that trauma breaks the alarm system of the brain and body, a.k.a. the amygdala and associated limbic system. The limbic system is responsible for our fight, flight, or freeze response that helps us to escape bodily danger. It assesses threat without reason such as a jump away from a snake-like object or a quick reaction to a loud noise. It usually keeps us safe. However, for individuals with trauma it can lead to misinterpretation of daily situations as potentially life threatening and a constant state of ‘high alert’.

A real trauma has taught those of us with PTSD that the world is a dangerous place. Often, this waking state of extreme caution is unconscious to the day-to-day self, but our bodies are aware. Van Der Kolk asserts, if we are chronically scared or afraid our bodies will respond with chronic pain, headaches, and difficulty sleeping. In fact, many with mysterious physical illnesses may seek out treatment from physicians for issues that stem from a mostly psychological event. To help cope with the uncomfortable physical sensations, we may find ways to numb ourselves: drugs, alcohol, work, exercise, over or under-eating. Van der Kolk sought to better understand the physiology of PTSD and an over-active limbic system.


In order to assess our nervous system’s health, Van Der Kolk utilized heart rate variability (HRV) to evaluate the balance between the two branches of our autonomic nervous system, the sympathetic and parasympathetic. Broadly speaking, the sympathetic nervous system (SNS) branch uses adrenaline to thrust our system into action while the parasympathetic system (PNS) activates chemicals to assist with digestion, sleep, and healing.

When we inhale we activate the SNS and our heart rate slightly accelerates. When we exhale, our PNS takes over and our heart rate slightly decreases. The difference between our heart rate on an inhalation and exhalation is our heart rate variability. Healthy individuals show a wide difference in HRV correlated with the breath. Individuals with PTSD show rapid and shallow breaths that have little relationship with the heart rate. In short, individuals with PTSD have a much harder time regulating their nervous systems during both stimulating and relaxing times.

Van Der Kolk studied the effect of yoga on HRV and discovered that as little of eight weeks of regular yoga practice helped improve variability. However, it became clear to Van Der Kolk that the value of yoga was not its effect on HRV, but the bodily awareness it provided to those that practiced. The sequences of postures activating different muscle groups combined with awareness on deep or shallow breathing allowed practitioners to become more aware and comfortable with the relaxation and tension inherent in a yoga class. They understood that sensations came and went and they could tolerate them. This awareness clued them into the tension and relaxation present in their day-to-day lives. Many found themselves listening to their body more, and that it became easier to know what they needed moment-to-moment. Yoga taught many that their fear of certain feelings and sensations (anger, shame, sadness) was usually more detrimental than the feelings themselves. Yoga shows that like postures, feelings will peak then remit. Often the anxiety about the feelings is more de-stabilizing than the feelings themselves. Yoga harnesses the body to teach us these lessons which is an experiential form of learning that cannot be learned through reading, talking, or watching a film. We must experience to learn.

Van Der Kolk ‘The Body Keeps the Score’ is a fascinating and easy read that represents some of the most fascinating integrative work in psychology. His belief (backed up by modern neuroscience) that our psychological sense of self is rooted in our physical selves is a new idea to the West, but one that is fundamental to many Eastern philosophies.

“We don’t truly know ourselves unless we can feel and interpret our physical sensations; we need to register and act on these sensations to navigate safely through life,” (Van Der Kolk, The Body Keeps the Score, p. 272)