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a Boston University School of Medicine, The Trauma Center, Brookline, Massachusetts 02446, USA
Key Words: PTSD • affect regulation • neuroimaging • meditation • yoga • HRV • introspection • movement • action • medial prefrontal cortex • autonomic nervous system
Address for correspondence: B.A. van der Kolk, M.D., Boston University School of Medicine, 1269 Beacon Street, Brookline, MA 02446. Voice: 617-247-3918; fax: 617-859-9805. e-mail: bvanderk{at}traumacenter.org
The research showing how exposure to extreme stress affects brain function is making important contributions to understanding the nature of traumatic stress. This includes the notion that traumatized individuals are vulnerable to react to sensory information with subcortically initiated responses that are irrelevant, and often harmful, in the present. Reminders of traumatic experiences activate brain regions that support intense emotions, and decrease activation in the central nervous system (CNS) regions involved in (a) the integration of sensory input with motor output, (b) the modulation of physiological arousal, and (c) the capacity to communicate experience in words. Failures of attention and memory in posttraumatic stress disorder (PTSD) interfere with the capacity to engage in the present: traumatized individuals "lose their way in the world." This article discusses the implications of this research by suggesting that effective treatment needs to involve (a) learning to tolerate feelings and sensations by increasing the capacity for interoception, (b) learning to modulate arousal, and (c) learning that after confrontation with physical helplessness it is essential to engage in taking effective action.
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