The Body Keeps the Score: A Revolutionary Approach to Understanding and Healing Trauma

In his groundbreaking new book The Body Keeps the Score, renowned trauma expert Bessel van der Kolk draws on decades of research and clinical experience to offer a powerful examination of how trauma impacts the brain and body, and pathways to recovery.

Van der Kolk begins by describing Stephen Porges' influential polyvagal theory, which identifies three distinct stages of response in our nervous system when we face threats. The first involves facial expressions and vocal signals calling for help from others. If that fails, the sympathetic “fight or flight” response is activated, mobilizing us for action. Finally, when fighting or fleeing is impossible, the parasympathetic “freeze” response takes over, shutting down metabolic processes to conserve energy and minimize pain. This sequence matches the evolution of our nervous system’s reactions to danger.

To illustrate the brain functions disrupted by trauma, van der Kolk uses vivid metaphors for key structures. The thalamus, which filters sensory input, is the “cook” creating a “soup” of information. The amygdala is the “smoke detector” that raises the alarm for potential threats. The medial prefrontal cortex acts as the “watchtower,” assessing context and regulating alarm responses. And the dorsolateral prefrontal cortex serves as the “stopwatch,” linking past, present and future experience so we can understand timeframes. Trauma impairs these processes, overwhelming the cook, triggering the smoke detector, blinding the watchtower, and stopping the stopwatch.
A major theme of the book is the need to integrate top-down and bottom-up approaches to trauma recovery. Bottom-up therapies like yoga, breathing exercises, theater improvisation and rhythmic drumming help regulate the nervous system and rebuild neural pathways from the body up. Top-down methods like mindfulness meditation, expressive writing, and talk therapy engage higher cognitive capacities to make sense of experiences. Van der Kolk stresses that both levels are essential to comprehensive healing.

At its core, he argues, trauma recovery is about reconnecting—with ourselves, our bodies, other people, and meaning itself. Safety and secure attachment lay the foundation. Befriending our physical sensations and gaining self-awareness helps overcome dissociation. Finding community and purpose counteracts isolation and numbness. While long and challenging, van der Kolk insists this journey is possible through understanding trauma’s biological impact and using scientifically-validated integrative therapies.

Written with deep compassion and hope, The Body Keeps the Score offers profound insights into trauma’s roots while lighting a path forward. Van der Kolk makes a persuasive case that by heeding trauma’s biological and psychological lessons, we can help sufferers regain security and live fully. For researchers, clinicians and survivors alike, this book provides an invaluable roadmap to healing unspoken pain