Bessel van der Kolk: how trauma lives in the body

Bessel van der Kolk's research demonstrates that trauma lives physically in the body through altered nervous system patterns and muscle memory, requiring evidence-based therapeutic approaches like EMDR, somatic experiencing, and trauma-sensitive yoga to heal beyond traditional talk therapy alone.

For decades, mental health treatment assumed trauma lived in your thoughts - something you could talk through and intellectualize away. Bessel van der Kolk's groundbreaking research shattered this belief, proving that trauma actually lives in your body and requires healing approaches that go far beyond traditional talk therapy.

Who is Bessel van der Kolk?

When it comes to understanding how trauma affects the human body, few names carry as much weight as Bessel van der Kolk. This Dutch-born psychiatrist has dedicated over 50 years to researching trauma, fundamentally changing how mental health professionals think about its lasting effects. His work bridges the gap between what happens in the brain and what people feel in their bodies, offering new hope for those living with the aftermath of overwhelming experiences.

Van der Kolk’s path into trauma research began in the 1970s when he started working with Vietnam War veterans at the Boston VA Clinic. What he observed in those early years shaped the direction of his entire career. These veterans weren’t just haunted by memories. Their bodies seemed to hold onto the war in ways that traditional talk therapy couldn’t fully address. This observation became the foundation for decades of groundbreaking research.

As founder of the Bessel van der Kolk Trauma Center in Brookline, Massachusetts, he created one of the most respected treatment and research facilities dedicated to traumatic disorders in the world. The center has become a hub for developing innovative approaches that go beyond conventional methods, integrating body-based treatments with traditional psychiatric care. His role as professor of psychiatry at Boston University School of Medicine has allowed him to train generations of clinicians in these approaches.

What sets van der Kolk apart is his willingness to look beyond standard treatments. While many psychiatrists focused solely on medication or talk therapy, he explored how practices like yoga, EMDR (eye movement desensitization and reprocessing), and neurofeedback could help people with trauma. His research helped legitimize these approaches within mainstream psychiatry, opening doors for people who hadn’t found relief through conventional methods alone.

The Bessel van der Kolk TED talk brought his ideas to millions of viewers worldwide, making complex neuroscience accessible to everyday people. In it, he explains how trauma reshapes the brain and why healing often requires more than just talking about what happened. This talk, along with his bestselling book, helped spark a broader cultural shift toward trauma-informed care in schools, healthcare settings, and workplaces.

Van der Kolk has also been a persistent advocate for recognizing developmental trauma disorder as a distinct diagnosis. This proposed category would acknowledge that children who experience chronic abuse or neglect often develop a specific pattern of symptoms different from traditional PTSD. While the diagnosis hasn’t yet been added to official diagnostic manuals, his advocacy has raised awareness about how early trauma affects development in unique ways.

His influence extends far beyond academic circles. Therapists, educators, parents, and people with lived experience of trauma have found validation in his work. By connecting PTSD research to neuroscience and body-based treatments, van der Kolk has helped countless individuals understand that their symptoms aren’t signs of weakness or personal failure. They’re the body’s natural response to overwhelming experiences.

Overview of ‘The Body Keeps the Score’

When Bessel van der Kolk published The Body Keeps the Score in 2014, it changed how millions of people understood their own suffering. The book spent years on the New York Times bestseller list, a rare feat for a work rooted in neuroscience and clinical research. Its success reflected something profound: readers finally felt seen. Van der Kolk had put words to experiences that many people with trauma had long felt but couldn’t explain.

The book’s power lies in its accessibility. Van der Kolk translated decades of complex research into language that anyone could understand. He wove together case studies from his clinical practice, cutting-edge brain imaging findings, and historical context about how our understanding of trauma has evolved. For many readers, it was the first time they encountered the idea that their bodies might hold memories their minds couldn’t fully access.

What is Bessel van der Kolk’s theory on trauma?

The Bessel van der Kolk theory on trauma challenges a fundamental assumption that shaped mental health treatment for decades. Traditional approaches often treated trauma as a psychological problem, something to be processed through talking and thinking. Van der Kolk argued this was incomplete at best.

His central thesis is elegantly simple: trauma lives in the body. When something overwhelming happens, especially when escape isn’t possible, the experience doesn’t just create painful memories. It reshapes your nervous system, alters your stress responses, and changes how your body feels to inhabit. You might intellectually understand that a traumatic event is over, yet your body continues responding as if danger is still present.

This explains why someone with PTSD might know they’re safe while still feeling their heart race at certain sounds or smells. The thinking brain and the survival brain aren’t always in agreement. Van der Kolk’s trauma research showed that healing requires addressing both.

He didn’t dismiss talk therapy entirely. Understanding your story matters. But he argued that insight alone often isn’t enough to release trauma’s grip on the body. You can spend years analyzing why you feel the way you do without ever feeling fundamentally different.

What are the main concepts in Bessel van der Kolk’s work?

Van der Kolk’s framework draws from multiple disciplines, creating a more complete picture of how trauma affects people.

Neuroscience and brain changes: He explains how trauma alters brain function, particularly in areas responsible for detecting danger, regulating emotions, and maintaining a sense of self. Brain scans of people with trauma histories often show distinct patterns in how these regions communicate.

Attachment and relationships: Early experiences with caregivers shape how your nervous system develops. When those relationships are frightening or unpredictable, it affects your capacity to feel safe with others throughout life. Van der Kolk emphasizes that healing often happens within relationships, not in isolation.

The body as a resource: Perhaps most revolutionary was his emphasis on somatic, or body-based, approaches to healing. Practices like yoga, EMDR (eye movement desensitization and reprocessing), and other methods that engage the body directly can help release trauma in ways that talking cannot.

Integration over insight: Van der Kolk stresses that recovery isn’t about achieving perfect understanding of your past. It’s about helping all parts of your brain and body work together again. This means learning to tolerate sensations, stay present in your body, and gradually expand your capacity to feel safe.

These concepts represented a significant shift in trauma treatment. They validated what many people intuitively knew: that their struggles weren’t just “in their head” and that healing might require more than words alone.

How trauma affects the brain

Understanding why trauma gets stuck in the body requires looking at what happens inside the brain during and after overwhelming experiences. Bessel van der Kolk’s theory draws heavily on neuroscience to explain why traditional talk therapy often falls short, and why the body must be part of healing. The brain’s response to trauma isn’t a character flaw or weakness. It’s biology doing exactly what it evolved to do: keep you alive.

The alarm system goes haywire

Deep within your brain sits the amygdala, an almond-shaped structure that acts as your internal smoke detector. Its job is to scan for danger and sound the alarm when threats appear. In a person with unresolved trauma, this alarm system becomes hypersensitive. It starts detecting threats everywhere, even in safe situations.

A car backfiring sounds like gunfire. A raised voice triggers panic. A certain smell brings waves of dread. The amygdala doesn’t distinguish between real danger and reminders of past danger. It simply reacts, flooding your body with stress hormones and preparing you to fight, flee, or freeze. This hyperactivity explains why people with trauma histories often experience persistent anxiety symptoms that seem to come out of nowhere.

The thinking brain goes offline

When the amygdala sounds its alarm, something critical happens in the prefrontal cortex, the part of your brain responsible for rational thinking, planning, and decision-making. It essentially goes offline. Blood flow shifts away from this region and toward the survival-focused parts of the brain.

This is why you can’t simply think your way out of a trauma response. In those moments, the logical part of your brain isn’t running the show. You might know intellectually that you’re safe, but your body doesn’t believe it. Van der Kolk emphasizes that this disconnect between knowing and feeling is central to understanding trauma’s grip.

Memories without timestamps

The hippocampus normally processes experiences and files them away as memories with clear beginnings, middles, and ends. It stamps them with context: this happened in the past, it’s over now, you survived. But during traumatic events, the hippocampus struggles to do its job properly.

Research shows that traumatic memories are fragmented, stored as disconnected sensory pieces rather than coherent narratives. This fragmentation explains flashbacks. Without proper timestamps, the brain can’t distinguish between remembering something and reliving it. A trigger activates these memory fragments, and suddenly your nervous system responds as if the trauma is happening right now.

When words fail

One of van der Kolk’s most significant observations involves Broca’s area, the brain region responsible for speech and language. Brain imaging studies show that this area often shuts down during trauma responses. This finding explains something many people with trauma know intimately: the experience is literally unspeakable.

Trauma lives in sensations, images, and body states that exist below the level of language. This is why someone might struggle to describe what happened to them, even years later. The words simply aren’t there because the verbal brain wasn’t online when the memory was encoded.

The brain stuck in survival mode

Perhaps most troubling is that these changes don’t automatically reverse when danger passes. The brain remains on high alert, scanning for threats, ready to react. Months or years later, the nervous system still operates as if the trauma is ongoing. This persistent survival mode drains energy, disrupts sleep, strains relationships, and keeps people disconnected from the present moment.

Hope through neuroplasticity

The same brain science that explains trauma’s lasting effects also points toward recovery. Neuroplasticity, the brain’s ability to form new neural connections and reorganize itself, means that these patterns aren’t permanent. With the right interventions, the brain can learn to calm its alarm system, bring the thinking brain back online, and process fragmented memories into coherent narratives.

This is the foundation of Bessel van der Kolk’s theory: because trauma changes the brain, healing must also change the brain. And because so much of trauma’s impact bypasses language and lives in the body, effective treatment must engage the body directly.

Understanding polyvagal theory: the science behind van der Kolk’s approach

When Bessel van der Kolk discusses how trauma lives in the body, he frequently draws on the groundbreaking work of neuroscientist Stephen Porges. Polyvagal theory provides the scientific framework that explains why body-based approaches to trauma work. It reveals that your nervous system isn’t simply switching between “stressed” and “relaxed.” Instead, it operates through three distinct states, each with its own physical sensations, behaviors, and survival functions.

The vagus nerve sits at the center of this theory. This long, wandering nerve connects your brain to your heart, lungs, and digestive system. Think of it as your body’s brake pedal for stress responses. When functioning well, it helps you slow down after danger passes. But for people with unresolved trauma, this braking system often malfunctions, leaving them stuck in states of high alert or complete shutdown.

Understanding these nervous system states gives you a roadmap for healing. Rather than asking “What’s wrong with me?” you can start asking “What state is my nervous system in right now?” This shift in perspective is central to Bessel van der Kolk’s trauma treatment philosophy.

The three nervous system states

Your autonomic nervous system cycles through three primary states, each designed to help you survive different situations.

Ventral vagal state: safe and social

This is your optimal state. When your ventral vagal system is active, you feel calm, connected, and capable of engaging with others. Your heart rate is steady, your breathing is relaxed, and you can think clearly. You make eye contact easily, your voice has natural melody, and you feel present in your body. This state allows for intimacy, creativity, and genuine rest.

Sympathetic state: fight or flight

When your brain perceives danger, your sympathetic nervous system mobilizes energy for action. Your heart pounds, muscles tense, and breathing becomes shallow and rapid. You might feel restless, irritable, or anxious. This state prepares you to fight off a threat or run from it. In short bursts, it’s protective. But chronic activation leads to exhaustion, anxiety disorders, and physical health problems.

Dorsal vagal state: freeze and shutdown

When fighting or fleeing seems impossible, your nervous system has one more option: shutdown. The dorsal vagal state causes you to freeze, dissociate, or collapse. You might feel numb, disconnected from your body, foggy, or profoundly exhausted. Your heart rate and blood pressure drop. This ancient survival mechanism helped our ancestors survive attacks by predators. Today, it shows up as depression, chronic fatigue, or feeling “checked out” from life.

People with trauma often get stuck cycling between sympathetic activation and dorsal shutdown, rarely experiencing the ventral vagal state where healing happens. This explains why traditional talk therapy sometimes falls short: you can’t think your way out of a nervous system state.

Identifying your default survival state

Your body constantly sends signals about which nervous system state you’re in. Learning to read these signals is the first step toward regulation. Trauma-informed care approaches emphasize this body awareness as foundational to recovery.

Signs you’re in sympathetic activation:

• Racing or pounding heart
• Tight jaw, neck, or shoulders
• Difficulty sitting still
• Scanning the environment for threats
• Snapping at small annoyances
• Trouble falling asleep despite exhaustion

Signs you’re in dorsal vagal shutdown:

• Feeling heavy or weighted down
• Difficulty getting out of bed
• Numbness or disconnection from emotions
• Brain fog or difficulty concentrating
• Monotone voice or flat facial expression
• Wanting to hide or withdraw completely

Signs you’re in ventral vagal safety:

• Relaxed muscles, especially in face and shoulders
• Steady, comfortable breathing
• Feeling curious and open
• Enjoying connection with others
• Ability to be playful
• Feeling grounded in your body

Notice which state feels most familiar to you. Many people discover they’ve been living in survival mode so long they’ve forgotten what safety feels like in their body.

Vagal toning exercises by state

Just like you can strengthen a muscle, you can tone your vagus nerve to improve its flexibility. The goal isn’t to eliminate stress responses but to move more fluidly between states. Different exercises work better depending on where you’re starting.

If you’re stuck in sympathetic activation:

Your system needs help completing the stress cycle and discharging excess energy.

• Shake it out: Stand and let your body shake naturally for two to three minutes, starting with your hands and letting the movement spread
• Cold water on your face: Splash cold water on your cheeks and around your eyes to activate the dive reflex, which slows heart rate
• Vigorous movement: Run in place, do jumping jacks, or push against a wall to use up the mobilized energy
• Extended exhales: Breathe in for four counts, out for eight counts, repeating for several minutes

If you’re stuck in dorsal vagal shutdown:

Your system needs gentle activation before it can access calm. Pushing too hard backfires.

• Orienting: Slowly look around the room, naming five things you see, bringing awareness to the present moment
• Gentle rocking: Rock side to side or forward and back while seated, stimulating your vestibular system
• Humming or singing: The vibration stimulates the vagus nerve where it passes through your throat
• Small movements: Wiggle your fingers and toes, gradually increasing movement as tolerated

For building ventral vagal capacity:

These practices help you spend more time in the safe, social state.

• Social engagement: Make eye contact with someone you trust, have a genuine conversation, or share a meal together
• Laughter: Watch something funny or spend time with people who make you laugh
• Gargling: Gargling water vigorously activates muscles connected to the vagus nerve
• Breathing practices: Slow, rhythmic breathing with slightly longer exhales signals safety to your nervous system

Consistency matters more than intensity. Brief daily practice builds nervous system flexibility over time, gradually expanding your capacity to return to safety after stress.

How trauma manifests in the body

Understanding trauma intellectually is one thing. Feeling it locked in your muscles, gut, and breath is another experience entirely. The body doesn’t just remember traumatic events; it continues responding to them long after the danger has passed. This physical dimension of trauma explains why talking about painful experiences sometimes isn’t enough to heal them.

How does trauma live in the body according to Bessel van der Kolk?

Bessel van der Kolk’s trauma research reveals that traumatic experiences fundamentally alter how the body functions. When you experience overwhelming stress, your nervous system launches survival responses: fight, flight, or freeze. Under normal circumstances, these responses complete themselves. You fight off the threat, run to safety, or the danger passes and your body returns to baseline.

But trauma interrupts this cycle. The survival energy gets stuck, frozen in time within your tissues. Your muscles remain braced for impact. Your breath stays shallow, ready for the next blow. Your gut clenches in perpetual anticipation of threat.

This isn’t metaphorical. Childhood trauma studies show measurable changes in how the body operates after traumatic experiences. Heart rate variability decreases. Stress hormone patterns shift. The immune system becomes dysregulated. Your body essentially stays trapped in a moment that has long since passed, continuing to protect you from a danger that no longer exists.

One of the most significant impacts involves interoception, your ability to sense what’s happening inside your body. Trauma often impairs this internal awareness. You might struggle to recognize hunger, fatigue, or emotional states. Some people feel disconnected from their bodies entirely, as if watching themselves from a distance. Others become hyperaware of every sensation, interpreting normal body signals as threats.

Common physical symptoms of stored trauma

Trauma doesn’t announce itself with a clear label. Instead, it often shows up as mysterious physical symptoms that don’t respond to conventional medical treatment.

Chronic muscle tension is one of the most common manifestations. Your body holds incomplete fight or flight responses in contracted muscles, particularly in areas you would use to defend yourself or run away. This tension can persist for years, creating pain patterns that seem to have no clear origin.

Digestive issues frequently accompany trauma histories. The gut contains millions of nerve cells and maintains constant communication with the brain. When your nervous system stays dysregulated, your digestion suffers. Irritable bowel syndrome, chronic nausea, and appetite changes are common among people with unresolved trauma.

Chronic pain without clear medical cause often has roots in traumatic stress. Fibromyalgia, chronic headaches, and persistent back pain can all be connected to how the nervous system processes threat. When doctors can’t find a structural explanation for ongoing pain, trauma may be playing a role.

Autoimmune conditions have been linked to prolonged stress responses. When the body stays in survival mode, inflammation becomes chronic. Over time, this can contribute to conditions where the immune system attacks healthy tissue.

Breathing patterns shift after trauma, often becoming shallow and restricted. Deep belly breathing feels vulnerable when your body believes danger is near. Many people with trauma histories breathe primarily into their upper chest, never fully exhaling or allowing their diaphragm to move freely.

Where trauma hides: body mapping guide

Trauma tends to accumulate in predictable areas of the body. Understanding these common holding patterns can help you recognize where your own body might be storing unresolved stress.

The jaw holds unexpressed words, clenched against things you couldn’t say. Teeth grinding, TMJ pain, and chronic jaw tension often connect to silenced emotions or suppressed screams.

The shoulders carry the weight of hypervigilance. They rise toward the ears in a protective posture, guarding the vulnerable neck. Chronic shoulder pain and tension headaches often originate here.

The chest tightens around grief, fear, and heartbreak. Shallow breathing, chest pressure, and the sensation of a heavy heart can indicate stored emotional pain in this area.

The gut responds to threat with clenching and churning. Butterflies, nausea, and digestive distress often reflect anxiety and unprocessed fear held in the belly.

The hips store survival instincts, particularly the urge to run or kick. Many people experience emotional releases during hip-opening exercises, as this area holds deep-seated fight and flight energy.

Recognizing where your body holds tension is the first step toward releasing it. This awareness creates the foundation for body-based healing approaches that can help complete the interrupted survival responses still living in your tissues.

Treatment approaches for trauma recovery

Understanding that trauma lives in the body naturally leads to a crucial question: what actually helps? Bessel van der Kolk’s decades of research point toward treatments that engage the body directly, not just the thinking mind. These approaches work with the nervous system’s own healing capacities, helping people move from survival mode back into full, present-moment living.

Body-based modalities van der Kolk recommends

EMDR (Eye Movement Desensitization and Reprocessing) uses bilateral stimulation, typically eye movements following a therapist’s finger, while a person recalls traumatic memories. This might sound unusual, but research shows it helps the brain reprocess stuck memories so they lose their emotional charge. Van der Kolk describes watching patients who had been frozen in trauma for years finally experience relief after EMDR sessions. The memory remains, but the body no longer reacts as if the danger is happening now.

Trauma-sensitive yoga differs significantly from a typical yoga class. It focuses on rebuilding interoception, that internal body awareness trauma often destroys. Instructors offer choices rather than commands, using language like “you might try” instead of “do this now.” This approach helps people with trauma histories reclaim a sense of agency over their own bodies. Van der Kolk’s research at the Trauma Center found that yoga reduced PTSD symptoms in ways that talk therapy alone could not achieve.

Neurofeedback trains the brain to produce healthier patterns of electrical activity. Sensors placed on the scalp measure brainwaves while a person watches a screen or plays a simple game. When the brain produces desired patterns, they receive positive feedback. Over time, the brain learns to regulate itself more effectively. Van der Kolk has called neurofeedback one of the most promising developments in trauma treatment because it addresses the dysregulated brain directly.

Somatic Experiencing, developed by Peter Levine, works with the body’s incomplete defensive responses. Remember how trauma can leave the body stuck in fight, flight, or freeze? This approach helps people safely complete those interrupted survival actions. A therapist might guide someone to notice physical sensations, allow trembling or movement, and gradually discharge the energy that got trapped during the traumatic event.

Internal Family Systems (IFS) works with what founder Richard Schwartz calls “parts”: the protective strategies we develop to cope with overwhelming experiences. Some parts might numb us out, others might drive perfectionism, and still others might hold the pain of past trauma. IFS helps people develop compassion for these protective parts while accessing their core, undamaged self. Van der Kolk appreciates this approach because it honors how the mind naturally organizes itself around traumatic experiences.

Theater and movement therapies might seem unconventional, but van der Kolk has seen remarkable results. Programs that involve acting, drumming, or martial arts help people inhabit their bodies in new ways. These activities require being present, coordinating with others, and experiencing the body as capable rather than damaged. For some people with trauma, especially those who dissociate, embodied creative expression offers a path back to feeling alive.

The science behind why talk therapy isn’t enough

Traditional psychotherapy typically engages the prefrontal cortex, the brain’s rational, language-based center. You talk about what happened, gain insight into patterns, and develop new ways of thinking. This approach works well for many psychological concerns.

But Bessel van der Kolk’s theory explains why trauma often requires something different. When someone experiences a traumatic memory or trigger, brain scans show decreased activity in Broca’s area, the region responsible for putting experiences into words. Simultaneously, the limbic system, especially the amygdala, becomes hyperactive. The body is responding to perceived danger while the verbal brain goes offline.

This is why many people with trauma can describe what happened to them in detail yet still experience nightmares, flashbacks, and physical symptoms. Knowing the story doesn’t automatically calm the body’s alarm system. The survival brain doesn’t respond to logic or insight; it responds to safety signals, physical experiences, and nervous system regulation.

Bessel van der Kolk’s trauma research suggests that effective treatment must involve the body because that’s where trauma is stored. Talk therapy can be a valuable component, helping people make meaning of their experiences and develop coping strategies. But for many people with trauma, adding body-based approaches makes the difference between managing symptoms and truly healing.

Choosing the right approach for your trauma type

Selecting evidence-based PTSD treatments depends on several factors: the nature of your trauma, your current symptoms, and your personal preferences. There’s no single best approach for everyone.

Single-incident traumas, like a car accident or assault, often respond well to EMDR. The memory is discrete, and bilateral stimulation can help reprocess it efficiently. Many people see significant improvement in eight to twelve sessions.

Complex or developmental trauma, the kind that results from ongoing childhood abuse or neglect, typically requires longer-term treatment. Approaches like IFS and somatic experiencing may be particularly helpful because they address the layered protective strategies that developed over years. Trauma-sensitive yoga can rebuild the body awareness that early trauma disrupts.

For people who experience significant dissociation, feeling disconnected from their bodies or emotions, grounding approaches are essential. Movement therapies, yoga, and somatic work help reestablish the body-mind connection before processing specific memories.

Neurofeedback can benefit people whose nervous systems remain highly dysregulated despite other treatments. It’s also useful for those who find talking about trauma overwhelming, since it works directly with brain patterns without requiring verbal processing.

Your preferences matter too. Some people feel drawn to yoga’s gentle, self-directed quality. Others prefer the structured protocol of EMDR. Still others connect with the creative expression of theater or movement work. The best treatment is one you’ll actually engage with.

If you’re unsure which approach might work for you, a free assessment can help you understand your needs and connect with trauma-informed therapists at your own pace. Many therapists integrate multiple modalities, tailoring treatment to your specific situation.

What matters most is finding a therapist who understands that healing trauma means working with the body, not just the mind. Look for someone trained in at least one body-based approach who can help you move from surviving to thriving.

Rebuilding interoception: learning to feel your body again

There’s a word that sits at the heart of Bessel van der Kolk’s theory, one that rarely makes headlines but changes everything about how we understand trauma recovery: interoception. This is your ability to sense what’s happening inside your body. Hunger, thirst, a racing heart, tension in your shoulders, the flutter of anxiety in your stomach. These internal signals form the foundation of emotional awareness.

For most people, interoception operates quietly in the background. You notice when you’re tired, recognize when stress is building, feel the warmth of connection with someone you love. But trauma can fundamentally disrupt this internal sensing system.

Why trauma dims your internal signals

When the body becomes a site of overwhelming experience, numbing those signals makes sense. If your nervous system was flooded with terror, pain, or helplessness, learning not to feel became a survival strategy. The problem is that this protective mechanism doesn’t turn off when the danger passes.

Many people with trauma describe feeling disconnected from their bodies, as though they’re observing themselves from a distance. Some struggle to recognize basic needs like hunger or exhaustion until they become extreme. Others feel a constant, undifferentiated sense of discomfort without being able to pinpoint what’s wrong.

This disconnection creates a significant barrier to emotional regulation. Your emotions don’t just happen in your mind. They register first as physical sensations. Anxiety might start as chest tightness. Sadness might begin as heaviness in your limbs. Anger often shows up as heat or jaw tension. Without access to these bodily cues, you lose the early warning system that helps you manage your emotional states.

The link between body awareness and emotional vocabulary

Researchers have found that many people with trauma experience alexithymia, a condition where identifying and describing emotions becomes genuinely difficult. This isn’t about being emotionally unintelligent or avoidant. When interoception is impaired, the raw data needed to recognize emotions simply isn’t available.

You might know something feels wrong without being able to say whether you’re anxious, angry, sad, or just tired. This ambiguity makes it harder to respond effectively to your own needs or communicate them to others.

Restoring your internal compass

The encouraging news is that interoceptive capacity can be rebuilt. This restoration happens gradually, through practices that gently invite attention back into the body without overwhelming the nervous system.

Simple exercises form the starting point. Noticing the sensation of your feet on the floor. Paying attention to your breath without trying to change it. Observing where you feel temperature differences in your body. These may seem basic, but for someone whose survival depended on not feeling, they represent significant steps.

Mindfulness practices and body-based therapies support this rebuilding process by creating safe opportunities to reconnect with physical sensations. The goal isn’t to feel everything intensely right away. It’s to slowly widen the window of what you can notice and tolerate, restoring the internal compass that trauma disrupted.

Complex PTSD vs PTSD: why the distinction matters

One of Bessel van der Kolk’s most significant contributions to the field has been his persistent advocacy for recognizing that not all trauma is the same. A single car accident affects the mind and body differently than years of neglect or abuse during childhood. This distinction isn’t just academic. It shapes everything about how treatment should unfold.

Standard PTSD, as defined in diagnostic manuals, typically develops after a discrete traumatic event: a natural disaster, an assault, combat exposure, or witnessing violence. The person had a stable sense of self before the trauma occurred, and treatment focuses on processing that specific experience. But what happens when trauma isn’t a single event? What happens when it’s the water you grew up swimming in?

Complex PTSD emerges from prolonged, repeated trauma, often occurring during critical developmental periods. Beyond the classic PTSD symptoms of flashbacks, nightmares, and hypervigilance, people with complex PTSD frequently experience profound difficulties with emotional regulation, a fragmented or negative sense of identity, and persistent challenges in relationships. These aren’t peripheral symptoms. They’re central to the condition.

Developmental Trauma Disorder: van der Kolk’s proposed diagnosis

Bessel van der Kolk’s theory about childhood trauma led him to propose a new diagnostic category called Developmental Trauma Disorder. He argued that children who experience chronic maltreatment, neglect, or household dysfunction develop a distinct pattern of difficulties that existing diagnoses fail to capture adequately.

These children often receive multiple diagnoses throughout their lives: ADHD, oppositional defiant disorder, bipolar disorder, borderline personality disorder. Van der Kolk saw this diagnostic chaos as a sign that the mental health field was missing something fundamental. The problem wasn’t that these children had several separate conditions. The problem was that early, repeated trauma had disrupted their development across multiple domains simultaneously.

Childhood trauma research showed that developmental trauma affects the brain differently than adult-onset trauma. When trauma occurs while the brain is still forming, it doesn’t just create painful memories. It shapes the very architecture of how a person perceives themselves, relates to others, and regulates their internal states. Standard PTSD treatments, designed primarily for adults with single-incident trauma, often prove insufficient for these complex presentations.

Phase-based recovery for complex trauma

Recognizing that complex trauma requires a different approach, van der Kolk and other trauma specialists advocate for phase-based treatment. This model acknowledges that you can’t effectively process traumatic memories when your nervous system remains in constant chaos.

The first phase focuses entirely on safety and stabilization. This means developing skills to manage overwhelming emotions, creating a sense of physical safety in your body, and building enough internal resources to handle what comes next. For some people, this phase alone takes months or even years. Rushing past it typically backfires.

The second phase involves carefully processing traumatic memories and experiences. With complex trauma, this isn’t about addressing one event but rather working through layers of experience that have shaped your sense of self and your relationships. Body-based approaches often play a crucial role here, helping integrate experiences that words alone cannot reach.

The third phase centers on integration and reconnection. This is where you begin building a life that reflects who you actually are, not just who trauma forced you to become. It involves developing new relationship patterns, discovering or rediscovering meaningful activities, and consolidating the gains from earlier phases.

Timeline expectations matter enormously here. While someone with single-incident PTSD might see significant improvement in weeks or months, recovery from developmental trauma often unfolds over years. This isn’t failure. It’s reality. The trauma took years to create its effects, and healing those deep patterns requires patience and sustained effort.

Finding the right trauma therapist: a practical guide

Understanding how trauma lives in the body is powerful knowledge. But knowledge alone doesn’t heal. The next step is finding a therapist who can guide you through the process of reconnecting with your body safely. Not every licensed therapist has the specialized training that trauma work requires, so knowing what to look for makes a real difference.

Credentials and training to look for

Start by looking beyond basic licensure. A licensed therapist has completed graduate training and supervised hours, but trauma-specific work requires additional education. The Bessel van der Kolk Trauma Center and similar institutions offer specialized training programs that go deeper into body-based approaches.

When evaluating credentials, look for certifications tied to specific modalities. For EMDR therapy, the EMDR International Association (EMDRIA) certifies practitioners who have completed extensive training and supervised cases. Somatic Experiencing practitioners are certified through the Somatic Experiencing International (SEI) after a multi-year training program. Trauma-sensitive yoga instructors should have certification from programs specifically designed for working with people who have experienced trauma.

You can often find information about a therapist’s specialized training on their website or professional profile. The Bessel van der Kolk website and affiliated organizations also maintain directories of trained practitioners. Don’t hesitate to ask directly about training background during your initial consultation.

Questions to ask potential therapists

A good trauma therapist will welcome your questions. Consider asking: “What is your approach to trauma treatment?” and “How do you incorporate the body into your work?” Their answers should reflect an understanding that trauma affects both mind and body.

Other helpful questions include: “How do you help clients stay grounded during difficult moments?” and “What does a typical session look like with you?” A skilled trauma therapist will describe techniques for managing overwhelm and explain how they pace the work to avoid retraumatization.

Watch for red flags. A therapist who wants to dive into traumatic memories in the first few sessions may not understand the importance of building safety first. Anyone who dismisses physical symptoms as “just anxiety” or seems impatient with your pace isn’t the right fit. Trust your gut: if something feels off, it probably is.

Your first session should focus on assessment, not processing trauma. Expect questions about your history, current symptoms, and goals. The therapist should explain their approach and give you space to ask questions. This is a chance to see if you feel comfortable with them before committing to ongoing work.

Online therapy has made trauma-informed care more accessible than ever. You can work with specialists who might not practice in your area, attend sessions from the comfort of your own space, and build safety in an environment you control. ReachLink connects you with licensed therapists trained in trauma-informed approaches, and you can start with a free assessment to explore your options with no commitment.

Finding the right therapist takes time, and that’s okay. The relationship between you and your therapist matters as much as their credentials. When you find someone who understands that healing happens in the body as well as the mind, you’ve found a partner who can support real, lasting change.

Moving from understanding to healing

Bessel van der Kolk’s work has fundamentally changed how we understand trauma’s impact on both mind and body. His research reveals that healing isn’t just about processing memories or gaining insight. It requires working directly with the nervous system, rebuilding body awareness, and finding safety in your own skin again. Whether through EMDR, trauma-sensitive yoga, or other body-based approaches, recovery becomes possible when treatment addresses where trauma actually lives.

If you recognize yourself in these patterns and feel ready to explore support, ReachLink’s free assessment can help you understand your needs and connect with trauma-informed therapists at your own pace. You can also access support wherever you are by downloading the app on iOS or Android.

FAQ

• How does trauma affect the body according to van der Kolk's research?

  Van der Kolk's research shows that trauma creates lasting changes in the body's stress response systems, muscle tension patterns, and nervous system functioning. Traumatic experiences can become "stuck" in the body, manifesting as chronic pain, digestive issues, sleep problems, and hypervigilance. His work demonstrates that the body holds trauma memories even when the mind tries to forget, which is why traditional talk therapy alone may not fully address trauma's impact.

• What are body-based therapeutic approaches for trauma healing?

  Body-based trauma therapies include somatic experiencing, which helps release trapped trauma energy through gentle body awareness exercises. Other approaches include trauma-informed yoga, breathwork techniques, and movement therapies that help reconnect the mind and body. These methods work alongside traditional therapies like EMDR and trauma-focused CBT to address both the psychological and physical aspects of trauma recovery.

• How do I know if I need trauma therapy?

  Signs you might benefit from trauma therapy include persistent anxiety, panic attacks, nightmares, or flashbacks related to past experiences. Physical symptoms like chronic tension, unexplained pain, or feeling disconnected from your body can also indicate trauma. If you have difficulty trusting others, feel emotionally numb, or struggle with relationships due to past experiences, trauma-informed therapy can help you process these experiences and develop healthier coping strategies.

• What should I expect from body-based trauma therapy?

  Body-based trauma therapy typically begins with learning to recognize bodily sensations and building a sense of safety in your body. Your therapist will guide you through gentle exercises to increase body awareness and help you notice patterns of tension or disconnection. The process is gradual and client-paced, focusing on building resilience and helping your nervous system learn new, healthier responses to stress and triggers.

• Can online therapy effectively address trauma that affects the body?

  Online trauma therapy can be highly effective, especially when therapists are trained in body-based approaches that can be adapted for virtual sessions. Many somatic techniques, breathing exercises, and mindfulness practices translate well to telehealth platforms. The comfort and safety of your own environment can actually enhance the therapeutic process for some trauma survivors, while still allowing for the body awareness work that's essential to trauma healing.