What Are the Effects of PTSD on the Brain?

Migration, breakup, divorce, serious illness or death of loved ones; long-term abuse or neglect of caregivers during the growth process; major car accidents, violent injuries, sexual assaults, medical accidents; Wenchuan earthquake, Tianjin explosion, Malaysia Airlines ...

The body never forgets: the brain, mind, and body in healing

Migration, breakup, divorce, serious illness or death of loved ones; long-term abuse or neglect of caregivers during the growth process; major car accidents, violent injuries, sexual assaults, medical accidents; Wenchuan earthquake, Tianjin explosion, Malaysia Airlines ...
Everyone may suffer from large and small psychological traumas, which may turn us into another person: often feel anxious, numb and furious, unable to concentrate, memory loss, difficult to build trustful relationships ...
This is because, although you really want to forget, the brain and the body never forget the fear of the event. Even after a long time, it will still cause too severe negative reactions due to the small danger signals and disrupt our normal lives.
In addition to traditional medicine and talk therapy, this book proposes a number of innovative and proven therapies (including neurofeedback, mindfulness, games, yoga, eye movement desensitization and reprocessing, etc.) that can activate the brain's natural Neural plasticity reconnects brain circuits that are distorted and damaged by trauma (especially those related to happiness, commitment, and trust), and rebuilds the ability to "perceive the present" step by step. These treatments can also provide new physical experiences, eliminating the feelings of weakness, anger, and breakdown left by trauma, and allowing people to regain self-control.
The author Basel van der Cork has more than 30 years of cutting-edge research and clinical practice experience in the field of psychological trauma, treating thousands of traumatized children and adults. He personally used all the treatments introduced in the book, which makes the book more credible and practical.
The author straddles the book with many moving and true stories: psychotherapists, scientists, patients, how they work together to help people with trauma recover. This makes the book fascinating and truly touching. [1]
Praise
Recommended order
Translator order
Preface Facing Trauma
Part One Rediscovery of Trauma
Chapter 1
Vietnam soldier experience
Lessons from trauma and self-control 7
Emotional Numbness 9
Reforming Perception 10
Trapped in trauma 13
chapter 2
Understanding the mind and brain
The trauma of the revolution before dawn 16
The meaning of pain 19
Inescapable Electric Shock 22
Traumatic Addiction: Painful Pleasure and Pleasant Pain 25
Calming the brain 27 The triumph of the pharmaceutical industry 29
Is it a form of adaptation or a disease? 32
Chapter 3
Peeps into the brain: nerves
The terror that the scientific revolution cannot describe 37
Go to the side of the brain 38
Stuck in a fight or flight response 39
The second part of the brain in trauma
Chapter 4
Escape: Survival
Anatomy student storage system 46 from lower brain to upper brain 48
Learn from each other: Interpersonal Neurobiology 51
Identifying hazards: kitchens and smoke detectors 53
Controlling Stress Response: Watchtower 54 Rider and Horse 56
Stan and Ute's brains 57 dissociate and reproduce 59
Oversensitive Smoke Detector 60 Timer Crash 61
Impaired thalamus function 62 Disintegration of personality: separation from self 63
Live in the moment 65
Chapter 5
Body and brain
Neural Code for Love 70
Security and reciprocity 71 Three levels of security 72
Fight or flee, or crash 74 What do we think of people 75
Self-defense or relaxation 76 New treatments 77
Chapter 6
Lose body
Losing Your Body Self 81 How Do We Know We Are Alive 82
Self-perception system 84 Self in crisis 87
Possessing self-motivation 87 alexithymia: unable to describe feelings of 90 personality disintegration 92 and physical friend 93
Connect with yourself and others 94
Part III Children's Mind
Chapter 7
Harmonic Wavelength: Attachment
And emotionally tune people without a mother 101 a safe base 102
Emotional Coordination Dance 103 Photorealistic 105
Getting with Existing Parents 107 Inherent Chaos 109
Long-term consequences of chaotic attachment 112
Personality dissociation: know or do not know 113 restore emotional coordination 114
Chapter 8
Stuck in a relationship:
The cost of neglect and abuse Terror and numbness 117 Broken world map 120
Learn to remember 123 hate your family 125
Repeated Trauma 127
Chapter 9
What to do with love, how do you consider trauma history 131 self-harm 134
Power and power of diagnosis 135 Hidden epidemiology 136
When Problem Behavior Becomes Solution 140
Child abuse: the country's worst public health problem 141
Chapter 10
Developmental trauma:
Hidden spread of bad genes? 144
Monkey clarifies the classic question of "native or acquired" 146
National Child Trauma Stress Network 148
Diagnostic Power 149
Social relations shape individual development 153
The long-term effects of incest 155
DSM-5: A Veritable Diagnostic Buffet 157
How Developmental Trauma Disorders (DTD) can affect 160
The fourth part of the mark of trauma
Chapter 11
Discovering the Secret: Trauma
Problems with Sexual Memory Tide-like Feelings and Images 165
Ordinary and traumatic memory 168
Amnesia, dissociation and reappearance 172
The Origin of "Talk Therapy" 174
Traumatic memory in court 176
Chapter 12
New Faces of Unbearable Memory Trauma 180 Trauma Rediscovery 182
The Science of Inhibitory Memory 184
Normal and traumatic memory 186
Hear Survivor 188 Nancy's Story 189
Part 5. The road to recovery
Chapter 13
Heal wounds and embrace
New Focus on Self Therapy 197 Limb System Treatment 198
Get emotionally and brain-friendly 199 Choose a professional therapist 205
Integrated Traumatic Memory 212 Cognitive Behavioral Therapy (CBT) 214
Desensitization treatment 216 drugs keep us safe from trauma 217
How the drug works 218 The road to recovery is the road to life 221
Chapter 14
The wonder of language and
The truth that tyranny cannot tell 225 breaks the silence 226
The miracle of self-discovery 228
Know yourself or tell your story? Our dual consciousness system 230
The body is the bridge 232 write to yourself 232 art, music and dance 236
Limitations of Language 237 Handling Reality 239 Reconnecting with the Body 240
Chapter 15
Let go of the past: eye movement
Desensitization and reprocessing
(EMDR) Therapeutic Learning EMDR 244 EMDR: Original Origins 245
Study EMDR 248 Is EMDR another exposure therapy 250
Treating wounds with EMDR 251
The link between EMDR and sleep 255 Association and integration 257
Chapter 16
Yoga: in the body
The sequelae of inescapable electric shock 260 numb inner 260
Therapeutic Effects of Yoga: Top-Down Regulation 261
Explore in Yoga 264 Learn Self-Regulation 265
Knowing Yourself: Developing Interoception 267
Yoga and Self-Aware Neuroscience 269 Learn to Communicate 269
Chapter 17
Self leadership:
Desperate means need to be taken when desperately put together 272 Thinking is a mosaic 274 Self-leadership 277 Understanding the inner landscape 279
Living with self 280 Meetings with managers 282
Extinguish fire 283 burden of toxicity 284 unlock past 285
The Power of Self-Compassion: Using IFS 287 in the Treatment of Rheumatoid Arthritis to Free the Exile Self 288
Chapter 18
Filling the void: creating
Structural Reconstruction Inner Map 296 Seek Past 298
Retell your life 302 Dare to tell the truth 304
Antidote to painful memories 306
Chapter 19
Reconnect the brain:
Neurofeedback therapy mapping brain circuit diagram 308 Symphony of the brain 311
The birth of neurofeedback 313 from homeless shelters to nurse stations 314
Introduction to Neurofeedback 317 Basics of Brain Waves: From Slow to Fast 319
Helps the brain to focus 320
Where Is My Brain Wrong? 321
How Brain Trauma Changes Brain Waves 322 Neurofeedback and Learning Disabilities 324 Alpha-Theta (-) Training 324
Neurofeedback, post-traumatic stress disorder and substance addiction326
The future of neurofeedback therapy 327
Chapter 20
Find your heart
Voice: Internal
Rhythm and drama War drama 330 When concerted 332
Treating trauma through drama 334 Making investment safe 335
Urban Improvisation (UI) Theatre Company 337 Possibility Theatre Company 340
Shakespeare's Verdict 343 Treatment and Drama 346
Postscript choices 348
Addendum Opinion on the addition of "developmental trauma disorder" 359
Source 363
Further reading
Comments [1]
Psychological trauma is an eternal topic in the psychological field. It involves not only the development and operation of the individual's body and soul, but also the social, economic, and cultural aspects. At the same time, it is a difficult topic. Psychological trauma is often filled with shame, shame, anger, grief, and all the strong emotions that human beings do not want to touch. When people evade, the trauma is further fermented, bringing profound negative effects on the injured person's own, family, community and the entire culture, until people wake up and resolve to face it.
Due to the Vietnam War in the United States, the "September 11th" incident, and the recent war in Afghanistan, extensive psychological trauma has been caused among the people and soldier groups. These psychological traumas have caused severe injuries to patients and their families, and caused by psychological trauma Both health and social issues place a huge burden on government finances. Therefore, in the past 20 years, the U.S. government and social groups have greatly increased their investment in psychological trauma research and treatment, coupled with new research data brought about by the technological revolution in neuroscience and brain science research methods in recent years, In recent years, psychiatrists and psychologists have made a lot of breakthroughs in understanding the physiological mechanism of psychological trauma and the development of related clinical interventions.
Today, we can get rid of many ambiguous psychological etiology and symptom theories of the 20th century. It is relatively clear which brain structures have been physically or functionally altered after the parties have experienced psychological trauma, and these brains can The changes are directly related to the difficulties encountered by the parties in their thinking, emotions, and social life. Based on this, they develop and practice clinically targeted drugs and psychological interventions. This book is these modern psychological trauma research and research A masterpiece of development.
This book is one of the best-selling trauma healing books in the United States. It comprehensively introduces the main research results in the field of trauma therapy in the United States so far. This book gives a detailed introduction to the situations that may cause trauma, the performance of different types of trauma, the reasons behind trauma problems, common self-care and clinical intervention methods, and the mechanisms of these methods. What's more valuable is that it is still a book for the public compared to other obscure books on neuroscience and psychopathology. Through various vivid metaphors and clinical cases, the author intuitively brings the complex traumatic neural mechanisms to the reader, so that even people without a psychological background can glimpse the clues of psychological trauma. Since then, the author has given many clinical and personal opinions and guidance worthy of reference.
The author of this book is both familiar with drug therapy and psychotherapy, and has in-depth exchanges and cooperation with the founders of all major psychological trauma therapies in the United States. It can be said that it is one of the authority in the field of psychological trauma therapy in the United States. The public is the perfect candidate to introduce psychological trauma and healing methods. Maybe at first you will be scared by the author's extensive clinical knowledge and complex brain science explanations, but after a few chapters you will gradually get used to them and be able to establish a new understanding of psychological trauma through the author's introduction and learn more Effective and effective wound healing methods also bring more possibilities and hopes for your own psychological career or your growth.
In fact, whether you are a psychologist, enthusiast, or a traumatized client, I highly recommend reading this book. For clinical psychology and social workers, this book is almost comparable to the introductory textbook of psychological trauma treatment, from pathology to therapy. Although the author's subjective preferences are revealed from time to time, the clinical guidance is also quite selective, but The principles and data listed in the book are almost the golden rules and research essence of contemporary psychological trauma intervention. It can be said that it is the basis of modern psychological trauma intervention.
For those who have experienced psychological trauma (such as a major car accident, violent assault, sexual assault, medical accident, natural disaster, etc.) or developmental trauma (such as long-term physical, emotional, verbal or sexual abuse during growth, or long-term neglect by a caregiver Etc.), I will sincerely recommend you to read this book. This book will give you an idea of what happened to you, what the trauma changed, and at least in principle what kind of treatment or intervention can really help you heal these traumas. The only thing to note is that due to the susceptibility of the trauma to the person concerned, some of the descriptions in the book may stimulate your memories and emotions in a short time, so you must respect your inner pace and take care of your body when reading And mind.
Our country has experienced countless traumas, our people have also experienced many traumas, and these traumas are still passed on from generation to generation in some form, and until we can face them and take the initiative to heal them, we can finally get rid of the repeated destruction of trauma. curse. The gradual rise of psychological counseling and treatment, the introduction of excellent books and research on trauma healing such as this book, are in response to the needs of this era. When someone needs help, there is always someone fighting for it. These healing efforts are not only for ourselves, but also for our children and grandchildren to live in a healthy and harmonious society.
Clear stream
2015.10.3 [1]
When I first started my clinical internship, I did an epidemiological investigation in a prison. During the day, I talked to every prisoner in the prison to conduct a psychiatric diagnosis and investigation of physical diseases; at night, I compiled the interview materials into notes and data, talked to colleagues, and thought about the meaning of these stories. Most of them live in poverty, isolation, and violence that I cannot imagine. Even though I have read these experiences in the literature to some extent, talking and contacting these people in person is a completely different feeling than reading the literature. In conversations with them, I am often surprised and confused by the question: How did these people survive these unimaginable burdens? What kind of resilience and determination do these people rely on in the extremely harsh living environment of prisons?
Although the internship ended, these curiosities did not end. Because of work, I still keep in touch with many people who have experienced traumatic experiences. There was an opportunity for me to take over the translation of this book. It turns out that translating this book is a journey full of meaning and gain.
The author of this book, Dr. Basel Vandercock, has creative insights into trauma, and his theory has greatly influenced the mainstream theories of trauma today. At the same time, because of his support for non-talk therapy, he was full of controversy in the academic world. In this book, his understanding of trauma comes from borrowing from the theory of attachment, as well as new theories (cognitive neuroscience, interpersonal neuroscience) and new treatments (neural feedback therapy, EMDR, yoga, and art therapy) Open acceptance and scientific exploration. His greatest contribution to the current theory of clinical treatment of trauma lies in his understanding of developmental trauma (that is, the effect of early traumatic experiences in children on adulthood) and dissociation.
Psychological trauma is widely known in China. It started in the Wenchuan earthquake in 2008. The disaster situation has led to a wave of "psychological reconstruction assistance". For a while, it seemed that everyone knew that there was a need to provide care and help to those who had experienced major natural disasters and lost loved ones; people could become psychological counselors through a certain degree of training to alleviate people's psychological pain. However, it is not clear what we mean by what kind of psychological trauma, traumatic experience and traumatic memory will affect people and how to help them.
The understanding and treatment of psychological trauma in the last decade of the 20th century, especially after entering the 21st century, have made rapid progress. This book provides the most advanced interpretation of how to understand traumatic experiences and how to treat psychological trauma. The author of this book, psychiatrist Basel Vandercock, is one of the pioneers in studying traumatic experiences and treatments. His interest in trauma came directly from his own experience: his father and uncle were survivors of World War II (hereinafter referred to as World War II) concentration camps. When his career at the Veterans Affairs Clinic just started in 1978, his first patient was a typical Post-traumatic Stress Disorder (PTSD) patient. The trauma is almost unknown and can do nothing.
Therefore, he devoted himself to the study of the treatment of psychological trauma and its influence on psychological development. Over the next 20 years, he continued to publish research results in this field-how psychological trauma is related to dissociation, borderline personality disorder, and self-harm behavior; how psychological trauma affects brain and mental development. He pioneered the scientific paradigm to study the effects of PTSD drug therapy and non-drug therapy (especially yoga and neurofeedback). In addition, he also led a group of colleagues to conduct clinical studies related to PTSD diagnostic standards for the preparation of the fourth and fifth editions of The Diagnostic and Statistical Manual of Mental Disorders (DSM) The trial has had a profound impact on the clinical field of psychological trauma.
This book is not only a handbook for Dr. Van Der Cock to summarize and share treatment experience, but also an fascinating humane work. It records the traumatic experience and its impact on human beings and society as a whole from the perspective of history, society and culture. . Dr. Van Der Cock started with the traumatic war wounds of veterans of World War II and the Vietnam War, going back to the end of the 19th century in psychoanalytic understanding of psychological trauma, a record of "cannonball shock" around 1920, and a lifetime of humans that began to rise in the 1940s Surveys, revolution in psychiatric pharmacology in the late 1970s, modern understanding of attachment theory in the 1980s and 1990s, and large discussions on "traumatic memory suppression (recovery)", child (sexual) abuse around 2000 Attention, new interpretation of post-traumatic stress disorder with neuroimaging in 2005 and later, and various new non-pharmacological and oriental therapies after the new millennium. After reading the whole book, it is enough to leave a vivid impression on the history of the development of the treatment of psychological trauma.
Even if the reader reads this book as a documentary literature, it is not bad. The cases described in the book span multiple types of trauma, including the well-known phenomenon of "splitting personality" (which should actually be called "personal dissociation") in popular cultural works, and psychological trauma caused by accidents such as car accidents , Psychological trauma caused by (experienced or witnessed) (sexual) abuse and violence, psychological trauma of war and terrorist attacks, and psychological trauma caused by the lesser-known "interoperative sobriety". In the process of translating, I followed Dr. Van Dercock's wonderful pen, feeling the fate of the protagonist of the story, sometimes excited and tense, and sometimes sighed.
Psychological traumatic events generally refer to external or sudden extreme or abnormal events that cause great mental stress. DSM-5 believes that traumatic stressors refer to events that may cause life or sexual threats to themselves or their relatives and friends. These events can be serious events such as war, natural disasters, plane crashes, traffic accidents, or family members. Personal experience such as death, end of intimacy, illness or surgery. However, recent research on child trauma has found that for children, long-term neglect, emotional abuse, sexual abuse and physical abuse are also traumatic experiences. These findings apply exactly to Lindemann's definition of psychological trauma in 1944: "a sudden, uncontrollable disruption of the original attachment relationship."
Traumatic experiences are not necessarily personal or witnessed. Just listening to similar experiences. For example, a police officer investigating child abuse or a professional psychological counselor may have symptoms similar to PTSD because they know the traumatic experience. In addition, severe traumatic experiences are not as rare as we think. In the materials cited in this book, approximately one in five U.S. women has experienced sexual violence; in the ACE study, 28% of respondents had been physically abused during childhood and only 36% There were no bad experiences in childhood, and up to 12.5% of the respondents encountered more than 4 bad experiences in childhood.
In another of his books, Trauma Stress, Dr. Van Dercock said that people are reluctant to talk about trauma because trauma reveals the "evil" prevalent in human nature-our friends, neighbors, Family, superiors, and ourselves. Many people prefer to believe that trauma is extremely rare, and they want to forget that there is suffering in the world.
The human central nervous system can be divided into two parts if divided according to function: one part is responsible for basic physiological functions and detecting dangers, this part develops earlier; the cerebral cortex responsible for understanding develops later. The part of the brain responsible for basic physiological functions is also closely related to human emotions, so it is also called "emotional brain". In the emotional brain, the amygdala is the center of fear, and it acts like a siren, and when it encounters danger (and seems to be a dangerous stimulus), the siren sounds loud. Maybe the emotional cortex passes through two autonomic nerves before we understand the cerebral cortex (called "watch tower" in the book, mainly the medial prefrontal cortex, which is responsible for explaining the situation). System that stimulates or slows our body's response. By using different vagus nerve pathways, we will act differently to deal with dangers (such as seeking social help around us, fighting or escaping, and reducing the consumption of internal organs that are not related to escape. See Chapter 3 in the book "Three levels of security ").
The most basic fighting or flight response described above is often used to deal with accidents that are ubiquitous in daily life. Traumatic events can also trigger our stress response. However, not everyone will develop further symptoms of PTSD after a traumatic event. According to a random sample survey, more than 60% of people in the United States have experienced a traumatic event (Kessler et al., 1995; quoted from McNally, 2003). However, only 20% of women and 8% of men PTSD symptoms after traumatic experience. In daily life, people mostly use language and imagination to relieve the stress and pain caused by traumatic experiences.
Chapter 4 of this book refers to the story of a little boy, Nome, who experienced the "September 11th" incident. Five-year-old Nome attended school in downtown Manhattan. That morning, he saw the plane crash into the World Trade Building through the classroom window, and people kept jumping from the building window. He ran downstairs with his brother, classmates, and teachers in the next class, and saw his father who had just sent him to school at the door. Then, he followed his family and other panicked people to escape in the rubble, dust and smoke. Fortunately, he did not lose any loved ones in this disaster. He described the scene of the "September 11" incident with pictures the day after the incident. However, unlike the fact, he drew a trampoline under the building to catch the people who kept jumping.
Dr. Van Dercock uses this story to illustrate two skills that are vital to human survival: positive action and an imaginative brain. Unlike Nome, people with PTSD may not be able to break through the predicament with their actions during traumatic experiences, and lose the ability to calm their pain with imagination. The metaphor in the book is used to describe that "the siren" controls the entire human brain and body and mind, and the "watch tower" has lost its explanatory power.
In general textbooks, the core symptom of PTSD is invasive memory-flashback of traumatic memory anytime, anywhere, nightmares, or sudden reproduction of memory details in daily life. This is because the storage method of traumatic memory is different from that of daily memory: people who have suffered psychological trauma may not remember their past experiences, but they have abnormally clear memories of some details (such as touch and smell) (see this Chapter 12).
However, traumatized people do not always come for help because of invasive memory problems. Most of them ask the therapist the same problem as ordinary people: they are out of control and have problems with their friends and relatives. , Attention deficits, substance abuse, and more. Many parties themselves cannot express the impact of trauma on them in words. They just feel strong negative emotions that are not consistent with the actual situation, such as anxiety, fear, anger, shame, guilt, or feel numb, empty, or even unconscious. Medium reenactment of traumatic experience. Prior to Dr. Van Der Cock, few people had linked emotional instability, substance abuse and dissociation symptoms to traumatic experiences.
A typical person "trapped in trauma" loses his psychological flexibility, and is always in the same panic as the traumatic experience. He maintains daily life with full spirit, enduring tension, fear, or as if living in a fiction. In the world. They avoid all circumstances related to trauma. For example, veterans will hide in the office on National Day (because fireworks explode outside like gunfire), and patients who are traumatized because they are awake during surgery will quit their job in the hospital (because See people wearing surgical gowns). Many of them also paralyze themselves by overwork, alcohol abuse or other self-harm. Being on the verge of collapse at this moment makes them emotionally out of control. Many of them struggle to maintain good interpersonal relationships because they cannot control their emotions; accordingly, their lack of social support makes their symptoms worse.
Dr. van der Cork borrowed Peter Levine's trauma theory and Pat Ogden's body therapy theory to point out that people's psychological trauma is because they have encountered difficulties but can't resist. The resistance will turn into a so-called "unfinished action", and eventually "solidify" in people's physical feelings or unexplainable symptoms, such as migraine, asthma, instead of feeling angry or sad, they feel muscle soreness , Intestinal abnormalities, or other unexplained symptoms. About three-quarters of patients with anorexia nervosa and more than half of those with bulimia have difficulty describing their emotional feelings. They may repeat certain incomprehensible behaviors in the unconscious, and repeatedly fall into the same trouble. People who have witnessed domestic violence between parents often fall into relationship violence as adults.
Dr. van der Cork cited an example of a replay of traumatic memory in the book. He reported a case in 1989: a veteran soldier "robbed with a gun" every year when his comrades died, he ran to a convenience store and threatened the clerk that he had a gun in his hand and let the clerk hand over the money But enough time was allowed to call the clerk and let him be arrested by the police. After the soldier repeated several times, the judge eventually sent the man to a psychiatrist. After Dr. Van Dercock and his colleagues helped him overcome his guilt over the sacrifice of his comrades-in-arms, he no longer staged this kind of "suicide by police" every year.
The book mentioned Sandy, a middle-aged visiting nurse, who was neglected by alcohol-addicted parents in her childhood and was very lonely. She responded by obeying everyone she depended on. Whenever her husband says something ruthless, she will have an asthma attack and fall down, and can only be taken to the emergency room immediately. Although Sandy learned to ignore her intimacy issues, these stresses eventually turned into symptoms of asthma to get her attention. Her treatment focused on discovering the relationship between physical feelings and emotions. Within three years of her treatment, she had never been in the emergency room.
This is the mark of trauma on action or physical symptoms. Dr. Van Der Cock cites neuroimaging research, stating that strong, repetitive experiences may change the way we receive and understand stimuli. Traumatic people are less likely to capture environmental information than traumatic stimuli than non-traumatic people. Studies have also found that children who are traumatized have a harder time recognizing the positive expressions of others than those who have not been traumatized, and it is easier to recognize external expression stimuli as "dangerous" signals. People who have been traumatized may not have obvious symptoms of PTSD, but they may continue to fall into the same situation unintentionally. They may feel understood and comforted in gangs or extreme organizations, but these organizations are difficult for them to learn enough psychological flexibility, reduce the sensitivity of the nervous system, and allow them to adapt to changing interpersonal and daily life. The "mark of trauma" is an important reason why we cannot go out of the past and experience similar trauma repeatedly.
Talk therapy is the most mainstream form of psychotherapy. Talk therapy attempts to evoke insights to understand and control their behavior. However, this insight is difficult to stop our amygdala from sending red flags constantly, and it is difficult to stop the body's escape status, especially when people close to us make us feel fear or anger. The neuroimaging studies described in the book found that when people enter a flashback or numb state, the language center is inhibited.
On the one hand, such excessive arousal may make ordinary conversation therapy very difficult; on the other hand, a dissociated visitor who cannot feel and think, may also make treatment difficult. People who are accustomed to responding to trauma with numb self-awareness, because it does not disturb anyone, but it is more difficult to access the treatment needed. For these people, conversation therapy is only meaningful if the physical discomfort is overcome during treatment. And from the bottom to the top-from the body to the consciousness of treatment, it is more likely to break the stagnation of treatment and overcome the mark of trauma.
Effective treatment does not necessarily require language, but the mark of healing must be able to establish effective interpersonal relationships. Dr. Vandercock pointed out that the key to trauma treatment is to reduce people's discomfort when recalling / replaying trauma. In the treatment of psychological trauma, effective treatment can be non-verbal; improving physical awareness and allowing visitors to experience safe interpersonal communication outside the treatment room may fundamentally bring about breakthroughs in treatment.
In the book, Dr. Van Der Cock cited his experience while studying EMDR treatment as an example. EMDR treatment is very controversial. However, empirical studies have found that EMDR treatment is currently one of the most effective treatments for psychological trauma. In the treatment, the therapist almost completely does not need to establish any linguistic trust and understanding with the visitor. The therapist relies on a simple password and asks the person to observe the therapist's finger movements while recalling traumatic memories in the brain , But the therapist does not need to know what the person is thinking of. While learning about EMDR, Dr. Van Dercock's practice partner told him, "I don't trust you at all. I won't tell you any trauma from my childhood." Dr. Van Dercock felt extremely frustrated. However, after the treatment, his Partners seem to be more relaxed.
In his book, Dr. Van Dercock wrote: "The ability to feel secure in social interactions is the most important aspect of mental health." Among the many diagnostic criteria for mental illness, most include the inability to establish satisfactory interpersonal relationships, Or difficulty controlling emotions. Almost all studies on mental health have also pointed out that social support (ie, interpersonal connection) is an important factor in the prevention and rehabilitation of mental illness; interpersonal connection, in addition to companionship, also means being able to communicate with each other and feel in interpersonal connections stable. This is the so-called "security". Many people can engage in superficial interpersonal relationships, however, in intimate behaviors (such as sex) where they need to be completely vigilant, they can feel intensely nervous or upset.
According to the theory of Interpersonal Neurobiology, the reason why interpersonal relationships can be therapeutic is because the connections between neurons are constantly adjusted according to external environmental stimuli. The "mirror neurons" in the brain will always capture the social responses around us (smile, frown, angled mouth, face angle), and affect our heartbeat and muscle tension through three layers of vagus nerve pathways, determining whether we are To relax or escape. Psychotherapy is also a type of treatment using interpersonal relationships. Half of its effectiveness comes from the stable and safe therapeutic interpersonal relationship between the visitor and the therapist. The experience experienced in EMDR is also a kind of memory that is physically safe.
This is "the body will remember". The body remembers traumatic experiences as well as safe experiences.
Although Dr. Van Dercock's own clinical theory has changed the landscape of clinical treatment of trauma, these non-traditional treatments he advocates in this book are undoubtedly controversial. Dr. Vandercock himself is also controversial for advocating innovative therapies. These disputes are actually the difference between drug treatment (or empirical treatment) and non-empirical treatment, and they are the epitome of the dispute between researchers and clinicians.
The so-called "innovative therapy", in the eyes of many researchers, is "therapeutic method without empirical research". There is nothing wrong with this understanding. Of the many treatments mentioned in this book, only drug therapy and cognitive behavioral therapy (flood method / systemic desensitization method) have been proven by the most empirical studies; in the past decade, EMDR and neurofeedback therapy have also been gradually demonstrated Research accepted. The rest of the therapies: yoga, martial arts, Internal Family System Therapy (IFS), Pesso Boyden System Psychomotor Therapy, and drama have not been as empirical as the previous treatments. stand by.
Therefore, in this book, Dr. Van Der Cock has spent some time explaining the controversy between innovative and traditional therapies and the differences in empirical evidence. He pointed out that because of the lack of empirical evidence, or the long distance from the traditional method of "talk therapy" in psychotherapy, and the length of treatment, the innovative therapy lacks sufficient funds for empirical research. And before some topics have received enough attention (such as war trauma, child developmental trauma), Dr. Van Dercock and his colleagues had to pay for their own clinical and empirical research. In an interview, Dr. van der Cork pointed out bluntly that the research fund's non-investment in treatment methods that are not supported by evidence is a "final clinical exploration" approach.
In his book, Dr. van der Cork repeatedly emphasized that when he was at Harvard Medical School, his teacher Elvin Samrad taught him that he should learn treatment from patients and rely on his perception of reality rather than listening to books. Speaking diagnostic criteria. When a therapist is facing a patient, the healer is facing a "person" with various life needs and development potentials, not a disease term. In the book, Dr. Van Dercock wrote several points of change in his own thoughts: Because of the development of antipsychotics, patients have achieved an unimaginable recovery on the one hand, and can leave the long-term ward and return to relatives and friends; however, the hospital has gradually Become a "repair station", doctors become a "repairman" to eliminate symptoms, rush to prescribe medicines to patients within 15 minutes, eliminate their anxiety or depression, or happily accept themselves as a "real scientist" , Returned to his laboratory, thinking that all the human problems (anger, desire, arrogance, greed, laziness) that are struggling to overcome are just "obstacles", as long as the appropriate chemical drugs are found, "the cure will be cured." However, Dr. Van Dercock also found that although sedatives, antidepressants, and treatment groups targeted at veterans were almost ineffective, yoga saved some of his worst patients. In the treatment of traumatic children with behavioral problems, animal-assisted therapy, sensory stimulation therapy, drama-assisted and play therapy (and preventive group), and neurofeedback therapy have all achieved undeniable effects. . These children not only restored their trust and ability to interact with others, but also achieved achievements that cannot be ignored in their profession.
This book has a deeper meaning in China. In China, many people still think that the understanding of psychotherapy is "accompaniment" and that the most scientific and effective way to treat mental illness is to take medicine. This view is also welcomed by many psychiatrists: on the one hand, non-drug treatment Mystification, on the one hand, sanctifies drug treatment. This situation of rupture of psychology and drug therapy is also a concrete manifestation of the long-term barriers between education and professionalism between psychiatry and psychotherapy. China's "Mental Health Law" stipulates that psychological counselors cannot diagnose and treat people with mental illness, and only allow psychotherapists and psychiatrists to perform diagnosis and treatment. In fact, China's psychological counselors assume almost all the functions of psychotherapy; at the same time, in the existing system, only those who have graduated from medical colleges can become psychotherapists through the title system in each hospital.
In the United States, similar barriers are the debate between medical evidence-based therapy (drug and cognitive behavioral therapy) and innovative treatments. Clinical psychology researchers and doctors conducting mental / psychological clinical treatment often attack each other: one side condemns the other for arbitrary treatments, does not limit the treatment to only empirical research, and uses some lack of empirical evidence. The treatment method is irresponsible to the patient; the other side condemns that the other party has not been exposed to complex clinical diagnosis and comorbidities at all, and the empirical research has limited interpretation of complex clinical phenomena. In clinical practice, in the face of a patient who does not respond well to traditional therapies, the most natural way for clinicians is to adopt some treatment methods that have heard good results but lack empirical evidence for the time being.
As an early supporter of non-empirical and body-psychotherapy, Dr. Van Dercock naturally caused panic in the psychology and psychiatry. However, Dr. Van Dercock called for more research funding for unproven treatments and urged clinicians to face up to their experience in clinical work and conduct empirical research on unproven treatments.
The author of this book, as a senior psychiatrist, personally embraced the invention and rise of psychiatric drug therapy, while maintaining a scientific tone of positivist tendency, not only continuously tracking the latest developments in the field of human psychology, Efforts have also been made to explore the possibilities of non-traditional treatments. This book connects the wisdom of exploring human spiritual suffering scattered in history, and then describes it in the language of modern psychological research that emphasizes experimental control (for example, research on recurrence of trauma, dissociation, and contemporary attachment relationships). Ancient literature and drama describe human trauma and the way to face it, and Eastern wisdom (such as mindfulness, yoga) also provides some new ideas for the treatment of trauma. In the research of various scientific frontiers, characterization genetics is changing the answer to the traditional psychological question of "congenital or acquired"; while individualized drug treatment is changing the way of medical treatment; the development of neuroscience and artificial intelligence is refreshing our self Recognition. As Keith Steinovich said in "This is Psychology": in the development of psychology, the development of theory is not realized in a leapfrog manner like physics; the new theory of psychology It is not a complete rejection of the old theory, but a theory that better summarizes different situations. In this book, Dr. Van Dercock co-ordinates various theories, and expresses experimental explorations in history in simple terms, making his trauma theory present a grand vision and grandeur.
In this book, Dr. van der Cork expresses his position with the help of the Institute of Medicine (IOM): The institute called on clinicians in 2001 to use evidence-based practice, meaning The clinical evidence should come from a combination of empirical research, clinical experience, and patient interests. Evidence-based treatment requires that clinicians not only pay attention to empirical research, but also truly perceive their own clinical experience, while paying attention to the long-term interests of each patient as an individual. In addition to the disease itself, the complex human dilemma in reality is the biggest challenge for clinicians in their daily work, and it is also the true teacher of clinicians. Dr. Van Dercock never hides his concerns: "I can't teach a full day of lectures in front of these therapists, because real learning is only in action."
Psychological trauma is not only a pathological phenomenon, but also a social phenomenon. Poverty, family incapacity, and unequal educational opportunities are all hotbeds of psychological trauma. What promotes the continuous development of human society is the resilience and agency embodied in trauma rehabilitation. In the fight against human pain and trauma, as a psychological clinician, I sincerely called on both the psychotherapist and the medical therapist to relax their prejudices and reach a settlement, in the language of Dr. van der Cork, together with the patients and their families Teachers, society, and people from all walks of life cooperate to use a variety of resources to form a true healing alliance, prevent psychological trauma, and promote the recovery of psychological trauma.
Thank you very much for the patience of the planning editor Zou Huiying and the responsible editor Feng Yuyan. Thank you editors for giving me the opportunity to translate this book has opened up a new world for me. Thanks to my mother and friends for giving me a lot of practical help in translation; the encouragement and support of my classmates and colleagues also made me feel that my translation is meaningful. Without you, this book would not have appeared. thank you all.
Li Zhi
April 1, 2016 [1]
Face trauma
A person may be traumatized without having to go to the battlefield or live in a refugee camp in Syria or the Congo. Trauma can happen to ourselves, our friends, our family or neighbors. A study by the U.S. Centers for Disease Control and Prevention shows that 1 in 5 Americans are sexually harassed during childhood; 1 in 4 people are injured after being beaten by their parents; 1 in 3 couples or couples have experienced physical violence; 1 / Four of them grew up with relatives with alcohol problems; one in eight had witnessed their mother being beaten by one.
We humans are really an adaptable species. Since historical records, we have been constantly revived by uninterrupted war, countless natural or man-made disasters, and violence and betrayal in our personal lives. But the trauma always leaves traces, larger or smaller, as large as historical or cultural scars, as small as the dark secrets of the family that have been unknowingly passed down from generation to generation. They also leave marks in our minds and emotions, our ability to experience pleasure and intimacy, and even in our bodies and immune systems.
Psychological trauma affects not only those directly exposed to the event, but also those around them. Soldiers returning from the battlefield may scare their families with anger or indifference. Husbands with post-traumatic stress disorder (PTSD), and his wife are also likely to become depressed, and the children of these depressed mothers are likely to be anxious. Children exposed to domestic violence often find it difficult to establish stable, trusting, intimate relationships as adults.
Trauma, as it is defined, is unbearable and intolerable. Most rape victims, soldiers who have experienced battlefields, and children who have been sexually harassed are extremely frustrated when they remember their past experiences. They tried to clear these memories, trying to behave as if nothing had happened, and continued to live. It will take a huge effort to live with these horrible memories and shame for your weakness and vulnerability.
Of course, we all want to get out of the trauma. However, the part of the brain responsible for our basic survival functions (behind our rational brain) is not good at denying memory.
I remember when I first germinated to study medicine, I was only 14 years old, and was attending a summer camp. My cousin Michael doesn't let me sleep, and he's been explaining to me all night how the kidneys work, how they filter body waste and reabsorb chemicals to keep the body in balance. I was completely fascinated by his wonderful description of body functions. Later, at every step of my medical training, whether I was studying surgery, cardiovascular, or pediatrics, I thought that the key to treatment was to understand how the human system works. However, when I started to rotate in psychiatry, I was fascinated by the extreme complexity of thinking and the diversity of interpersonal relationships, yet the psychiatrist knew very little about the problems they were treating, and I was shocked by this extreme contrast. Can we one day understand our brain, mind, and love just as we do our other organs?
Obviously, to obtain such a detailed understanding, we still have to conduct many years of subject research. However, the birth of three new disciplines has led to an explosive growth of knowledge about psychological trauma, abuse and neglect. The three new areas are: neuroscience, a discipline that studies how the brain supports the thinking process; development of psychopathology, the study of the effects of adversity on thinking and brain development; interpersonal neurobiology, the study of how our behavior affects those around us Emotions, physiology and ideas. Research in these three areas has revealed that trauma can have actual physiological effects, including recalibrating our brain alert system, making stress hormones more active, and letting the alert system filter out crisis-related information from irrelevant information. We now know that trauma can damage the functional areas of the brain that perceive physiological sensations, leaving us unable to feel vitality. These changes also explain why traumatized people overreact to threats and fail to experience their daily lives. This knowledge also helps us understand why people who have been traumatized always seem to face the same problem and seem to have difficulty learning from experience. We now know that their repeatedly frustrated behavior is not because they have a moral defect or weak willpower or a bad character, but because their brains have changed.
The growth of our trauma knowledge also opens up new possibilities, allowing us to mitigate or even restore the damage caused by trauma. Now, the treatment of trauma can take advantage of the brain's own neural plasticity, develop new methods and experiences, and help survivors feel vigor in real life and continue to live. These methods can be summarized in three ways in essence: from top to bottom, re-establishing contact with others through conversations, so as to understand themselves and deal with trauma-related memories; take drugs, turn off inappropriate alarms in the brain, or Use other methods to change the way the brain organizes information; Bottom-up, let the body deeply experience the experience completely opposite to the helplessness, anger or collapse caused by trauma. For each particular post-traumatic survivor, which approach is best is an empirical question. As far as the patients I've met, most people need a combination of the above approaches.
This is a career in my life. I founded the Trauma Center 30 years ago and have always been supported by my colleagues and students at the Trauma Center. We have treated thousands of traumatized children and adults together: among them are victims of child abuse, natural disasters, war, accidents and human trafficking, as well as those who have been hurt by acquaintances or strangers. We have been discussing the condition with all our patients and treatment teams on a weekly basis, and carefully track the effects of different treatments on different individuals.
Our main task is to take care of children and adults who seek treatment, but we have also been working from the beginning to study the impact of post-traumatic stress in different populations and the most suitable counterparts for each treatment. We have been funded by the National Institute of Mental Health and its Centers for Complementary Therapy and Alternative Medicine, the National Centers for Disease Control and Prevention, and some private funds, and we explore a variety of different treatments, including medications, talk therapy, Yoga Therapy, Eye Movement Desensitization and Reprocessing Therapy (EMDR), Drama Therapy and Neuro Feedback Treatment.
The challenge for treatment is how to let people learn to control the traces of past trauma and regain control of their lives. Dialogue, understanding, and interpersonal relationships are all helpful. Drugs can also suppress overactive alarm systems. But we will also see that the traces of trauma can also be transformed into experiences that are completely opposite to the traumatic experience of weakness, anger and collapse through new physical experiences, allowing people to regain self-control. I don't have a preference for treatment, because no one treatment is suitable for everyone, but I have used all the treatments described in the book. Each type of treatment can bring profound changes to patients, but the effectiveness of these treatment techniques depends on specific problems and different people.
This book is both a guide and an invitation. Let us face up to the reality of trauma, explore together how to better treat trauma, and make a commitment as a society as a whole: make every effort to prevent trauma. [1]
Bessel van der Kolk
World-renowned master of trauma therapy, founder and medical director of Brooklyn Trauma Center. He is also a professor of psychiatry at Boston University School of Medicine and director of the National Complex Trauma Treatment Network. He often teaches around the world, mainly working and living in Boston.
Translator profile
Li Zhi,
Clinical apprentice. Scrambled at the intersection of legal and mental health issues. He currently resides in the Netherlands. Curiosity, transcultural, social equality, medical and mental health issues. [1]
This book is a masterpiece. The author, Van Dercock, confirms that the body can record traumatic experiences by presenting convincing evidence of the work of others, along with his own pioneering exploration and experience gained in the process. In addition, he developed a set of methods that use yoga, sports and theatrical performances to cleverly connect people's bodies and minds.
-Jon Kabat-Zinn
Founder of Mindfulness Relief Therapy, Emeritus Professor at the University of Massachusetts Medical School, and author of Mindfulness: A Flower At The Moment
This masterpiece is the wisest and most useful of the traumatic works I have read. Dr. Van Der Cock's genius lies in the combination of clinical cases, neuroscience, powerful treatment tools and humane care, which has taken the treatment of trauma to a new level.
-Jack Kornfield
Master of mindfulness meditation, author of "Going to the Soul Path"
This masterpiece by Dr. Van Dercock combines the boundless curiosity of scientists, the erudition of scholars and the passion of truth tellers.
-Judith Herman
Clinical Professor of Psychiatry, Harvard Medical School, Author of Trauma and Recovery
This book is a book for general readers. It is at the forefront of science and provides a large number of scientific ways to help people understand the complex effects of trauma, reduce pain, and surpass survival and flourish.
-Daniel J. Siegel
Clinical Professor, UCLA School of Medicine,
Author of "Whole Brain Training Method" "De-Emotional Discipline"
This book is a clear, fascinating book that is difficult to put down once picked up, and is full of stunning medical records and historical background. This book describes a series of breakthroughs in the most important and controversial mental health of the past 30 years.
-Norman Doidge
Famous science writer, author of "Reshape the Brain, Reshape Life"
The author has studied a large number of treatments, showing readers how to control the treatment process, regain a sense of security, and find their own way out of the painful quagmire.
-Francine Shapiro Founder of EMDR Therapy, Honorary Senior Fellow, California Institute of Psychology,
Author of "Let the past go with the wind"
This important book combines developing traumatic neuroscience research, an emerging body-oriented therapeutic boom, and traditional psychosomatic healing practices that go beyond relieving the symptoms themselves, bringing us and our vitality, and our existence at this moment Reconnected.
-Peter A. Levine
Founder of Body Experience Therapy and author of Awakening the Tiger
The principles and data listed in the book are almost the golden rules and research essence of contemporary psychological trauma intervention. For those who have experienced psychological trauma or developmental trauma, I will sincerely recommend you to read this book. This book will give you an idea of what happened to you, what the trauma changed, and at least in principle what kind of treatment or intervention can really help you heal these traumas.
-Clear stream
Psychologists studying in the United States, knowing the big V [1]

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