Trauma Research: Changing Paradigms

by Penny Boreham

The treatments we practice here at Khiron House are the result of ground-breaking and paradigm shifting new research. In fact in the last forty years or so many of the biggest advances in our knowledge about the interaction of the body and mind have actually come about because of research into trauma.

Bessel van der Kolk

One individual who has been at the forefront of this research is the psychiatrist Dr Bessel van der Kolk, who is also director of the Trauma Centre in Boston, USA. He’s both a clinician and a researcher and has played a big part in introducing neurobiology (the scientific study of the nervous system) into the trauma field.

What the vets taught van der Kolk

Van der Kolk first became aware of the world of trauma in 1978 when he went to work for the Veterans Administration in the USA.

At that point there was no formal diagnosis of PTSD (post traumatic stress disorder) but there were countless clinicians who were fascinated by a phenomenon starting to become very evident, as van der Kolk observed:-

“At that time, tens of thousands of men who’d served in Vietnam suddenly seemed to come out of the woodwork, (they were) suffering from flashbacks, beating their wives, drinking and drugging to suppress their feelings, closing down emotionally”

And the psychiatrist van der Kolk became increasingly intrigued by the mental and emotional paralysis that afflicted these traumatised veterans. He wanted to find out why many of the patients he saw seemed so completely stuck in their horror and were forced to relive it over and over again in flashbacks and nightmares.

Trauma’s impact had not been acknowledged

Even though trauma has been causing untold damage to people from the beginning of time it is only relatively recently (the latter part of the twentieth century) that mental health professionals have really acknowledged it. Often a failure to “get over” a trauma was put down to personal weakness or even an unconscious desire not to recover.

And when van der Kolk started working at the Veterans Administration in 1978 he remembers “there wasn’t a single book in the library (at the VA) on war neurosis”. In fact Bessel van der Kolk also recalled that any psychiatric problems occurring more than one year after discharge couldn’t be related to military service so this affected the veterans ability to seek compensation and of course also made research deeply problematic

Tolerating the Therapy

By the late 1980’s van der Kolk had extensive experience of working with war vets and was becoming a well known figure among PTSD researchers but he was starting to be deeply concerned about the apparent lack of success of the methods he himself was using – he felt that his talk therapy wasn’t working.

“I very quickly went to people’s trauma, and many of my patients actually got worse rather than better… There was an increase in suicide attempts. Some of my colleagues even told me that they didn’t trust me as a therapist. It seemed to me that we needed to find some way to access their trauma, but help them stay physiologically quiet enough to tolerate it, so they didn’t freak out or shut down in treatment. It was pretty obvious that as long as people just sat and moved their tongues around, there wasn’t enough real change

The Body Keeps the Score

Over the next decade van der Kolk started to radically change his views about the way our systems get stuck with trauma. He started to research the brain in detail (using scans) while it was in a state of trauma. In 1994 he published a paper: “The Body Keeps the Score”and it marked a turning point for van der Kolk and also for the field of trauma research

In this important paper he writes about how trauma stays “stuck” in the brain’s nether regions – the non verbal, non conscious, subcortical regions – the amygdala, thalamus, hippocampus, hypothalamus and the brain stem – where they are not accessible to the frontal lobes, and the frontal lobes are the understanding, thinking, reasoning parts of the brain.

He also describes how trauma disrupts the stress-hormone system, causes huge disruption to the entire nervous system, and keeps people from processing and integrating trauma memories into conscious mental frameworks.

In essence, he was saying that it is our bodies that control how we respond to trauma, what we do and don’t consciously remember, and whether we recover from it or get stuck with it. As van der Kolk put it: “We’re much less controlled by our conscious, cognitive appraisal than our psychological theories give us credit for being.” 

This is certainly something that the treatments we offer here at Khiron House echo. Both Sensorimotor psychotherapy and Somatic Experiencing offer a body up approach and have grown out of the realisation that until you treat the nervous system that has become dysregulated by traumatic experiences you cannot begin to appraise or consciously understand what is going on.

Mutual learning

Many who had been working in the body therapy field for a long time saw this paper as something of a breakthrough. After all, van der Kolk represented traditional, mainstream medicine. Here was a mainstream psychiatrist and neurobiology researcher finally writing about the importance of the effects on the body of psychological disturbance and recognising the existence of somatic memory.

Van der Kolk was equally grateful to start learning from the body therapists who embraced his publication. He says that from that point, with the guidance of those steeped in knowledge of working with the body, he started to see things differently. The body therapists made him see that healing trauma is about:-

rearranging your relationship to your physical self… if you really want to help a traumatised person you have to work with core physiological states and then the mind will start changing”

He started then to understand for the first time that “if clinicians can help people not become so aroused that they shut down physiologically, they’ll be able to process the trauma themselves”.

Integrating Mind and Body

And for van der Kolk it is not that this means discounting talking. He says it is still vitally important and that his own therapy is still very “talky”. It’s important for traumatised patients who were too young to understand what was happening, who weren’t listened to or believed, or who still can’t make sense of what happened. However he says that: “fundamentally words can’t integrate the disorganized sensations and action patterns that form the core imprint of the trauma… Treatment needs to integrate the sensations and actions that have become stuck, so that people can regain a sense of familiarity and efficacy in their ‘organism'”.

Van der Kolk’s research marked something of a catalyst for a new relationship between academics in mainstream science and those clinicians who were trying to develop new treatments for people suffering from the impact of trauma in their systems. This synthesis between academia and body psychotherapy continues to grow and develop and we reflect that in our treatment here at Khiron House.

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