Bessel van der Kolk: Four Concrete Steps for Working with Trauma
Wednesday, November 18, 2015
NYAPRS Note: Bessel van der Kolk is a bestselling author, and one of the foremost, cutting-edge trauma specialists in the world. Here he discusses four steps for working with trauma, and though the piece may be designed for therapists working with clients, there is a lot we can use, or at least consider for use, in our own lives. The key message is: We can each improve our ability to calm ourselves down.
Four Concrete Steps for Working with Trauma
with Bessel van der Kolk, MD and Ruth Buczynski, PhD
Step 1: Start with Self-Regulation
Dr. van der Kolk: I would say the foundation of all effective treatments involves some way for people to learn that they can change their arousal system.
Before any talking, it’s important to notice that if you get upset, taking 60 breaths, focusing on the out breaths, can calm your brain right down. Attempting some acupressure points or going for a walk can be very calming.
Dr. Buczynski: So this is learning to modulate arousal?
Dr. van der Kolk: Yes, and there’s alarmingly little in our mainstream culture to teach that. For example, this was something that kindergarten teachers used to teach, but once you enter the first grade, this whole notion that you can actually make yourself feel calm seems to disappear.
Now, there’s this kind of post-alcoholic culture where if you feel bad, you pop something into your mouth to make the feeling go away.
It’s interesting that right now there are about six to ten million people in America who practice yoga, which is sort of a bizarre thing to do - to stand on one foot and bend yourself up into a pretzel. Why do people do that? They’ve discovered that there’s something they can do to regulate their internal systems.
So the issue of self-regulation needs to become front and center in the treatment of traumatized people. That’s step number one.
Step 2: Help Your Patients Take Steps Toward Self-Empowerment
Dr. van der Kolk: The core idea here is that I am not a victim of what happens. I can do things to change my own thoughts, which is very contrary to the medical system where, if you can’t stand something, you can take a pill and make it go away.
The core of trauma treatment is something is happening to you that you interpret as being frightening, and you can change the sensation by moving, breathing, tapping, and touching (or not touching). You can use any of these processes.
It’s more than tolerating feelings and sensations. Actually, it is more about knowing that you, to some degree, are in charge of your own physiological system.
There needs to be a considerable emphasis on “cultivating in myself,” not only as a therapist, but also as a patient – this knowing that you can actually calm yourself down by talking or through one of these other processes.
So, step number two is the cultivation of being able to take effective action. Many traumatized people have been very helpless; they’ve been unable to move. They feel paralyzed, sit in front of the television, and they don’t do anything.
Programs with physical impact, like model mugging (a form of self-defense training), martial arts or kickboxing, or an activity that requires a range of physical effort where you actually learn to defend yourself, stand up for yourself, and feel power in your body, would be very, very effective treatments. Basically, they reinstate a sense that your organism is not a helpless (tool) of fate.
Step 3: Help Your Patients Learn to Express Their Inner Experience
Dr. van der Kolk: The third thing I would talk about is learning to know what you know and feel what you feel. And that’s where psychotherapy comes in: finding the language for internal experience.
The function of language is to tie us together; the function of language is communication. Without being able to communicate, you’re locked up inside of yourself.
So, learning to communicate and finding words for your internal states would be very helpful in terms of normalizing ourselves - accepting and making (the communication of internal states) a part of ourselves and part of the community. That’s the third part.
Step 4: Integrate the Senses Through Rhythm
Dr. van der Kolk: We’re physical animals, and to some level, we’re always dancing with each other. Our communication is as much through head nodding and smiles and frowns and moving as anything else. Kids, in particular, and adults, who as kids were victims of physical abuse and neglect, lose those interpersonal rhythms. “Rhythmical interaction to establish internal sensory integration is an important piece.”
So, some sort of rhythmical interaction to establish internal sensory integration is an important piece that we are working on. With kids, we work with sensory integration techniques like having them jump on trampolines and covering them with heavy blankets to have them feel how their bodies relate to the environment because that’s an area that gets very disturbed by trauma, neglect, and abuse, especially in kids.
For adults, I think we’ve resolved rhythmical issues with experiences like tango dancing, Qi Gong, drumming – any of these put one organism in rhythm with other organisms and is a way of overcoming this frozen sense of separation that traumatized people have with others.
Dr. Buczynski: These are four keystones that can make healing from trauma faster and more effective. In order to give patients the best chance for recovery, consider these steps as you plan your interventions and treatments.