The Body Keeps the Score: Key Insights & Takeaways

What if the key to healing trauma isn't talking about it, but working with the body that still carries it? Bessel van der Kolk's The Body Keeps the Score revolutionizes our understanding of trauma by revealing that traumatic experiences don't just affect the mind—they literally reshape the brain and become embedded in muscles, immune systems, and neural pathways. This is why talk therapy alone so often fails, and why effective treatment must address the whole person.

This guide breaks down van der Kolk's decades of clinical research and the breakthrough therapies—EMDR, yoga, neurofeedback, and more—that help trauma survivors reclaim their lives. Whether you've experienced trauma yourself, support someone who has, or work in mental health, you'll understand not just what trauma does, but why certain approaches work when others don't.

Start practicing these concepts for free ▸

Why does trauma live in the body, not just the mind?

Trauma creates physiological changes that persist long after the traumatic event ends. When someone experiences overwhelming threat, the body mobilizes massive survival energy—stress hormones flood the system, muscles tense for fight or flight, and the nervous system shifts into high alert. If this energy can't be discharged through action (running, fighting, completing the defensive response), it becomes trapped in the body.

This trapped energy doesn't simply dissipate over time. It creates chronic patterns of tension, altered immune function, and a nervous system stuck on high alert. Van der Kolk's research shows that trauma survivors carry their experiences in their posture, their muscle tone, their heart rate variability, and their hormonal rhythms. The body keeps the score of what happened, even when the conscious mind tries to move on.

This explains why telling someone to "just get over it" fundamentally misunderstands what trauma is. You can't think your way out of a physiological state. The body needs its own form of resolution. Loxie helps you internalize these crucial distinctions—the difference between psychological and physiological trauma responses—so you can recognize them in yourself and others and choose appropriate paths to healing.

How did Vietnam veterans change our understanding of PTSD?

Before Vietnam, post-traumatic stress was often dismissed as cowardice or moral weakness. Veterans who returned with nightmares, flashbacks, and emotional numbness were told to pull themselves together. Van der Kolk's work with these veterans transformed this understanding by revealing that PTSD fundamentally rewires the brain's alarm system.

Brain imaging showed that veterans' fear centers (the amygdala) had become hyperactive, firing at the slightest reminder of combat. Meanwhile, the rational brain regions that could provide context—"that was then, this is now"—went offline during triggers. Their bodies were reacting to present situations as if the threat was still happening, because neurologically, it was.

This discovery shifted PTSD from a character flaw to a biological condition. The brain had adapted to survive extreme threat, but those adaptations became maladaptive in peacetime. Understanding this mechanism opened the door to treatments that could address the underlying neural dysregulation rather than simply expecting veterans to will their way to recovery.

What happens in the brain during a flashback?

Van der Kolk's brain scan research revealed something remarkable: during flashbacks, Broca's area—the brain's speech center—literally goes offline while the amygdala lights up as if the trauma is occurring in real time. This creates what he calls "speechless terror." Survivors experience overwhelming emotion without the ability to put their experience into words.

This neurological reality explains why trauma survivors often struggle to describe what happened to them. It's not avoidance or unwillingness—the verbal processing centers simply weren't active when the memory was encoded, and they shut down again when the memory is triggered. Traditional talk therapy, which relies entirely on verbal processing, runs directly into this limitation.

Learn these brain mechanisms for good ▸

Why are traumatic memories stored differently than normal memories?

Normal memories are processed by the hippocampus, which consolidates experiences into coherent narratives with clear timestamps—this happened in the past, in a specific place, under particular circumstances. Traumatic memories bypass this system entirely. They're stored as fragments: disconnected sensations, emotions, body responses, and images that exist outside of time.

This fragmented storage explains why trauma doesn't fade like ordinary memories. A smell, a sound, or a physical sensation can trigger the full emotional and physiological response as if the trauma is happening now, because the memory lacks the contextual information that would mark it as "past." The survivor isn't just remembering—they're reliving.

Van der Kolk emphasizes that these aren't memories in the traditional sense but intrusions of raw, unprocessed experience. They exist in what he calls a "timeless present" where past and now collapse together. This is why therapy that focuses on creating a coherent narrative can be helpful—it engages the hippocampus to finally process and contextualize what the trauma response prevented it from processing originally.

How does trauma change the brain's physical structure?

Brain imaging studies reveal that trauma creates measurable structural changes. The hippocampus—responsible for memory consolidation and distinguishing past from present—actually shrinks in trauma survivors. Meanwhile, the amygdala—the brain's fear alarm—enlarges and becomes hyperactive. This creates a brain wired for survival rather than living.

These changes explain common trauma symptoms. A shrunken hippocampus means difficulty with memory and context: survivors can't easily distinguish between a triggering stimulus and actual danger. An enlarged amygdala means hair-trigger fear responses to minimal provocation. The prefrontal cortex—the brain's "watchtower" for rational observation and self-regulation—loses connectivity, making it harder to observe reactions objectively or calm oneself down.

The hopeful news is that brains retain plasticity throughout life. Targeted interventions can help regrow hippocampal volume, calm amygdala reactivity, and strengthen prefrontal connections. But this requires treatments that directly engage these neural systems—which is why body-based approaches often succeed where talk therapy fails.

Understanding trauma neuroscience changes how you approach healing
These brain mechanisms aren't just interesting science—they're practical guides to what will and won't help recovery. Loxie helps you retain these distinctions so you can make informed decisions about trauma treatment for yourself or others.

Practice these concepts daily ▸

What is nervous system dysregulation and why does it matter?

A healthy nervous system oscillates naturally between arousal (activation for action) and calm (rest and recovery). After a stressful event, it returns to baseline. Trauma breaks this oscillation, leaving people stuck in one of two states: hypervigilance (always on high alert) or dissociation (checked out and numb). Many survivors cycle between both extremes without ever finding the middle ground of calm alertness.

This dysregulation means trauma survivors can't trust their bodies' signals. Internal sensations that should communicate basic information—hunger, fatigue, emotion—become unreliable or overwhelming. The body feels like enemy territory, a source of danger rather than information. This leads to chronic health problems as stress systems that should activate temporarily remain permanently engaged.

Van der Kolk emphasizes that healing requires restoring this natural rhythm. Survivors must learn to tolerate arousal without becoming overwhelmed and to stay present without dissociating. This is fundamentally a body skill, not a cognitive insight—which is why practices like yoga and neurofeedback, which directly train nervous system regulation, can be so effective.

How does trauma cause physical illness?

The body keeps mobilizing against threats that no longer exist. Stress hormones remain elevated, inflammation stays high, and the immune system stays on alert. When the body can't fight the original danger, this mobilized energy can turn inward—the immune system may begin attacking the body itself, creating autoimmune conditions.

Van der Kolk documents connections between trauma and conditions ranging from fibromyalgia to irritable bowel syndrome to chronic fatigue. Many patients with mysterious physical symptoms that resist medical treatment are carrying unresolved trauma. Their bodies are expressing what their minds couldn't process.

This explains why purely medical approaches to these conditions often fail. Treating the symptom without addressing the underlying trauma is like mopping a floor while the tap keeps running. Once the trauma is processed and the nervous system can stand down from high alert, many of these physical symptoms improve or resolve entirely.

What is dissociation and why does it block healing?

Dissociation is the mind's emergency escape hatch when the body can't flee. When neither fight nor flight is possible, consciousness separates from physical experience. The person "leaves" their body, observing from a distance or losing awareness entirely. This protects the psyche from unbearable experience in the moment.

The problem is that this protective strategy becomes automatic. Long after the danger has passed, the nervous system deploys dissociation at the first sign of distress. Survivors may space out during difficult conversations, lose time during the day, or feel chronically disconnected from their bodies and emotions. They can't fully inhabit their present experience.

Van der Kolk identifies this as a central barrier to healing: you can't heal what you can't feel. Trauma recovery requires gradually learning to stay present with difficult sensations and emotions rather than automatically checking out. This is why body awareness practices are so essential—they help survivors safely return to residence in their own bodies.

Download Loxie for free ▸

How do early relationships wire the brain's stress response?

The attachment relationship between infant and caregiver literally programs the developing brain's stress response system. When caregivers are attuned and responsive, the infant learns that distress is manageable—someone will help, things will get better. This creates a baseline of safety and a nervous system that can regulate itself through co-regulation with others.

When attachment is disrupted—through abuse, neglect, or caregiver unavailability—the infant's nervous system develops without this programming. The baseline becomes insecurity rather than safety. Stress responses are more easily triggered and harder to calm. The child may learn that reaching out for help brings more danger, not less.

This early wiring creates vulnerability to later trauma. A nervous system that developed without secure attachment has fewer resources for coping with overwhelming experience. It also explains why healing often requires creating new attachment experiences—safe, attuned relationships that can provide the co-regulation that was missing developmentally.

How is developmental trauma different from single-incident trauma?

A single traumatic event—a car accident, an assault, a natural disaster—can be devastating, but it occurs against a background of normal development. The person has a pre-trauma self to return to. Developmental trauma from chronic childhood abuse or neglect is fundamentally different. It doesn't just disrupt the self—it shapes how the self forms in the first place.

Children who grow up in chronically unsafe environments develop fragmented identities. Different situations call forth different survival strategies, and these crystallize into what feel like separate parts of the self. One part may be hypervigilant and controlling, another may be shut down and compliant, another may hold rage that couldn't be safely expressed. These parts developed to survive specific situations and may not integrate smoothly.

This fragmentation explains why people with developmental trauma often feel like different people in different contexts. They're not being fake—they're shifting between parts that developed to handle different threats. Healing requires recognizing and working with these parts rather than trying to suppress them.

What did the ACE study reveal about childhood trauma?

The Adverse Childhood Experiences (ACE) study surveyed over 17,000 people about childhood experiences of abuse, neglect, and household dysfunction. The findings were startling: two-thirds of participants reported at least one adverse experience, and one in eight reported four or more. Childhood trauma isn't rare—it's epidemic.

Even more striking were the health correlations. Each additional ACE increased the risk of depression, addiction, heart disease, autoimmune conditions, and early death. Someone with four or more ACEs was 4-12 times more likely to have these outcomes than someone with none. The effects weren't linear but exponential—trauma compounds.

Van der Kolk calls this the most important public health issue of our time, yet it remains largely unaddressed. Medical systems treat symptoms without asking about underlying trauma. Schools punish traumatized children's behavior without understanding its roots. The cost exceeds that of cancer and heart disease combined, but resources flow to treating consequences rather than causes.

Remember these crucial statistics ▸

Why does talk therapy often fail for trauma—and sometimes make it worse?

Traditional talk therapy asks clients to verbally recall and process traumatic experiences. The problem is that this activates the amygdala (triggering the trauma response) without effectively engaging the brain regions that can actually integrate the experience. The survivor relives the trauma emotionally while the rational brain remains offline.

Endlessly retelling trauma stories can actually reinforce the neural pathways of traumatic memory rather than resolving them. Each retelling without physiological resolution can deepen the groove. Van der Kolk observed patients who had been in talk therapy for years with little improvement—or who had gotten worse.

Effective trauma therapy must either prevent the amygdala from hijacking the system (staying below the threshold of activation while processing) or engage body-based and visual-spatial brain regions that can integrate what verbal processing cannot. This is why approaches like EMDR and somatic therapies often achieve in months what talk therapy couldn't accomplish in years.

How does EMDR work to heal trauma?

Eye Movement Desensitization and Reprocessing (EMDR) uses bilateral stimulation—usually eye movements following a therapist's finger—while the client recalls traumatic memories. This dual activation engages both brain hemispheres simultaneously, allowing the logical left brain to integrate experiences stuck in the emotional right brain.

The process seems to mimic what happens during REM sleep, when the brain naturally processes and consolidates memories. Bilateral eye movements during dreaming may serve this integrative function, and EMDR artificially recreates it. The traumatic memory gets "filed" as a past event rather than remaining as an ongoing threat.

What makes EMDR particularly powerful is that it creates "dual awareness"—the client can remember the trauma while simultaneously staying grounded in present safety. This breaks the collapse between then and now that defines traumatic memory. Many survivors report that EMDR doesn't erase memories but removes their emotional charge, so they can recall what happened without being overwhelmed.

What does EMDR reveal about what trauma healing actually requires?

Van der Kolk notes that EMDR challenges assumptions about what's necessary for healing. It doesn't require understanding why the trauma happened or finding meaning in suffering. Clients don't need extensive verbal processing or insight into their patterns. What's needed is for the nervous system to recognize that the threat is over.

This has profound implications. Healing may be more about physiological resolution than cognitive understanding. The body needs to complete its interrupted response, discharge trapped energy, and update its assessment of danger—none of which require talking about what happened.

How does yoga help heal trauma?

Van der Kolk's research on trauma-sensitive yoga demonstrates that it heals by teaching interoception—awareness of internal bodily sensations. Trauma survivors often lose connection to their bodies because internal sensations became associated with danger. Yoga provides a controlled, safe environment for gradually reclaiming the body as a source of information rather than threat.

Trauma-sensitive yoga emphasizes choice and agency in every moment. Instructions like "notice your arm, and if you like, raise it" may seem unnecessarily gentle, but they're specifically designed to restore the sense of control that trauma destroyed. Every movement is voluntary. The practitioner is never forced or trapped.

Over time, survivors learn to tolerate physical sensations they previously avoided. They discover they can feel discomfort without being overwhelmed, that difficult sensations pass, that their bodies can be safe. This builds the interoceptive capacity that makes emotional regulation possible—you can't regulate what you can't feel.

Try Loxie for free ▸

What is Internal Family Systems therapy and how does it help?

Internal Family Systems (IFS) therapy recognizes that trauma creates distinct internal "parts"—subpersonalities that developed to handle specific situations and protect against specific threats. There are exiles (young parts holding pain and vulnerability), managers (parts that try to control life to prevent further trauma), and firefighters (parts that provide escape through numbing, addiction, or dissociation).

Rather than trying to eliminate or suppress these parts, IFS works with them. Each part developed for good reasons and is trying to help in its own way. The goal is to develop relationships between these parts and the "Self"—a calm, compassionate core that trauma couldn't destroy.

This approach normalizes the experience of internal multiplicity that many trauma survivors find confusing or shameful. The contradictory impulses—wanting connection while pushing people away, seeking success while sabotaging it—make sense as different parts with different agendas. Healing comes from Self-led integration, not from parts defeating other parts.

How does neurofeedback help retrain the traumatized brain?

Neurofeedback shows people their own brainwave patterns in real time and rewards them for producing healthier patterns. The brain learns to regulate itself through this feedback loop, gradually shifting away from trauma-altered rhythms toward more balanced activation.

Van der Kolk documents how different trauma symptoms correlate with specific brainwave dysregulations. Too much slow-wave activity may produce dissociation and foggy thinking; excessive fast waves create anxiety and hypervigilance. Neurofeedback can target these specific patterns, offering precision treatment based on individual brain signatures.

What makes neurofeedback particularly valuable is that it bypasses conscious effort. The brain learns new patterns through direct conditioning, not through willpower or insight. For survivors whose prefrontal cortex—the seat of conscious control—has been compromised by trauma, this direct brain training can be more effective than therapies that rely on cognitive engagement.

Why are rhythm and community essential to trauma healing?

Van der Kolk explores how rhythmic group activities—drumming circles, choral singing, communal dancing—engage ancient healing mechanisms. These practices activate the social engagement system, creating safety through shared rhythm. When bodies synchronize in movement or sound, mirror neurons fire together, and isolated survivors reconnect to the human community.

This collective healing provides something individual therapy cannot: witnessing and validation from a community. Trauma isolates; it makes survivors feel alone in their experience and separate from others. Group rituals say "this happened, it mattered, and you belong." This communal acknowledgment addresses trauma's destruction of social bonds at the deepest level.

Throughout human history, cultures have used rhythm, movement, and ceremony to heal collective wounds and reintegrate survivors of trauma. Van der Kolk argues that modern individualized treatment, while valuable, has lost something important. The most severely traumatized may need not just therapy but community—belonging to something larger than their individual suffering.

The real challenge with The Body Keeps the Score

This book contains potentially life-changing information about how trauma works and how to heal. But like all complex knowledge, reading it once means forgetting most of it. Within weeks, you might remember that "trauma lives in the body" but lose the specific mechanisms—why the hippocampus matters, what makes EMDR work, how nervous system dysregulation creates physical symptoms.

How many books have felt transformative while you were reading them, only to fade into vague impressions? The insights from The Body Keeps the Score are too important to let slip away. Whether you're healing yourself, supporting a loved one, or working with trauma professionally, you need this information accessible when you need it—not as a fuzzy memory but as clear, usable knowledge.

How Loxie helps you actually remember what you learn

Loxie uses spaced repetition and active recall—the same evidence-based techniques that make Anki effective for medical students—to help you retain complex information like the concepts in The Body Keeps the Score. Instead of passively rereading, you actively practice retrieving the information, which strengthens memory far more effectively.

The science is clear: we forget roughly 70% of new information within 24 hours unless we actively reinforce it. Loxie's algorithm resurfaces concepts right before you'd naturally forget them, so a few minutes of daily practice keeps crucial knowledge fresh and accessible. The free version includes The Body Keeps the Score in its complete topic library.

Sign up free and start retaining ▸