How PTSD Creates Differences in Brain Function . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .	3
How Trauma Changes Perception . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .	5
How the Flashback of PTSD Affects the Brain. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .	6
Three Brain Systems: Smoke Detector, Cook, and Watchtower . . . . . . . . . . . . . . . . . . . . . . .	8
The Importance of the Vagus Nerve in Treating Trauma . . . . . . . . . . . . . . . . . . . . . . . . . . . . .	10
The Same Experience with Two Different Responses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .	11
How a Predisposition to PTSD Is an Attachment Issue . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .	13
Limbic System Therapy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .	14
Neurofeedback as PTSD Therapy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .	16
EMDR and PTSD . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .	17
About the Speaker . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .	21

Dr. Buczynski: Hello everyone and welcome. I am Dr. Ruth Buczynski, a licensed psychologist in the State of Connecticut and the President of the National Institute for the Clinical Application of Behavioral Medicine. Welcome back to this series on the treatment of trauma.

We have the world’s leading expert with us today on the treatment of trauma, especially when it comes to how trauma and PTSD affect the brain – and that is Bessel van der Kolk.

He is a neuroscientist and a professor of psychiatry at Boston University’s medical school, and he is also the medical director of the Trauma Center there.

He is the author of a book that came out last year, so we are going to explore some of the new ideas that he wrote about in this book. The book is called The Body Keeps the Score: Brain, Mind and Body in the Healing of Trauma.

So, Bessel, welcome. It’s great to see you. Thanks for coming back again.

Dr. van der Kolk:It’s great to see you.

Dr. Buczynski:I am going to jump right in because we have so much that we want to talk about today.

I would like to start by talking about how traumatic experience changes the way people perceive the world – you talk about this in your new book.

Actually, you focus on how the body, mind and brain come into play when treating PTSD.

How PTSD Creates Differences in Brain Function

Let’s start with the brain: how is the brain different in a person with PTSD as compared to a person who doesn’t have PTSD.

Dr. van der Kolk: There a three big differences. One is that the threat perception system is enhanced in those with PTSD. These people see danger where other people see what is manageable.

This perception is not in the cognitive part of the brain – this is in the core perceptual part, a very primitive part of the brain.

Basically, this primitive part of the brain is in charge of making sure that your body is okay – it is the fear-driven part of the brain. So threat perception is enhanced – that is number one.

Number two is that your filtering system, which is a little higher up in your brain that helps you to distinguish between what is relevant right now and what you can dismiss gets messed up.

What other people sort of ignore or don’t pay attention to, the PTSD brain starts to pay attention to, and this makes it very hard to focus on what is going on right now. The filtering system does not function efficiently, and it’s difficult to fully engage with ordinary situations.

The third difference is with the self-sensing system, which runs through the midline structures of the brain and various people probably have talked about on your program already.

The self-sensing system that is devoted to your experience of yourself gets blunt. This is probably a defensive response – when you are in a state of terror, you feel it in your body: you feel it in terms of heartache and gut-wrenching feelings – your body feels bad, and as a way of coping with that, people start taking drugs, to dampen that system, and other people naturally find a way of dampening that internal response.

But when you start dampening your response to yourself, you also dampen the response to pleasure, sensuality, excitement, and connection – all the deep feelings that are at our core as human
beings.

Dr. Buczynski: That is very interesting, and you can see how that would affect the feeling of aliveness in a person with PTSD, or even their motivation to do anything.

Dr. van der Kolk: Right, and paradoxically, they may feel alive when they are involved in dangerous situations.

Dr. Buczynski: Say more about that

Dr. van der Kolk: The very first thing that struck me, working with traumatized patients many years ago is that, while they hated what they had gone through, they felt a natural attraction to it at the same time.

They felt alive when they were in situations similar to being beaten up or being molested or being back at war.

The feelings of pleasure and pain got confused with each other – while they were horrified by what had been traumatic they felt alive at the same time.

Dr. Buczynski: Bessel, is that because the brain has to pay so much closer attention when a person is in a dangerous situation?

Dr. van der Kolk: I think something happens to the traumatized brain that makes it hard to just take pleasure in a raindrop falling on a leaf, or light coming through a window, or seeing two kids play – just the little things that give color and texture to our lives.

Traumatized people tend to feel numb and not alive, and they can make themselves feel alive by exposing themselves to the same situations that caused their terror.

Dr. Buczynski: It is almost as if they have an on/off switch and no rheostat.

Dr. van der Kolk: That’s right – they have no rheostat.

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