Bessel van der Kolk on Trauma

Rerunning a post from quite some time ago, 2007. Some new posts in the not-too-distant future!

Renowned trauma expert.
Bessel van der Kolk, M.D., internationally renowned trauma expert, spoke at the Los Angeles County Psychological Association (LACPA) convention this past Saturday. It was an engaging and thought provoking presentation. His seminal article “The Body Keeps the Score: Memory and the Evolving Psychobiology of Post-Traumatic Stress“(1994) caught the attention of both clinicians and researchers alike — appropriate, as van der Kolk has a foot in each camp.

Psychobiology, psychotherapy.
With a solid background in neuroscience and physiology, one of van der Kolk’s basic assertions is that traumatic memories are hard wired into somatic (body) memory. As such, these “memories” are associated with primitive areas of the brain, inaccessible to talk therapies. The speech centers of the brain are located in the left hemisphere, in the cerebral cortex, on the very surface of the brain. It is generally believed that the cerebral cortex is the most recent product of human evolution. In contrast, the parts of the brain that regulate bodily sensations, temperature, respiration, and so on, are in the primitive, reptilian lower brain. Inaccessible to talk therapies.

Clinicians and researchers: Debate over EMDR.
That simple assertion, that traumatic memories rest in a part of the brain unaffected by talk therapies, causes a stir, among both researchers and clinicians. Both find van der Kolk’s espousal of Eye Movement Desensitization and Reprocessing (EMDR) as trauma treatment provocative, for different reasons.

Is talk therapy effective?
Clinicians bridle at the idea that traditional talk therapies might be ineffective, or at least less effective, than a therapy that involves waving one’s fingers in front of the patient’s face. But van der Kolk’s assertions relate chiefly to the treatment of trauma, usually under the diagnosis of what is known as post-traumatic stress disorder (PTSD). Nevertheless, drawing inferences from van der Kolk’s statements would give any clinician pause for reflection: Just how effective is talk therapy?

How to establish “treatment of choice.”
Researchers have disputed whether the finger waving has anything to do with the outcome of EMDR, though it seems at this point it has been established that EMDR has outcomes as good, if not better than, the “standard” or “evidence-based” treatment. (Controversy has been good to EMDR — it is perhaps the most researched therapy in history.) Cognitive-behavioral “exposure” therapy is conventionally supposed to be the “treatment of choice” for PTSD. (An exposure treatment involves gradually introducing an unpleasant stimulus — a spider for instance — until it can be tolerated more easily.)

Is trauma in a category of its own?
Even a cursory look at van der Kolk’s presentation and his work raises many questions: What is trauma? Is talk therapy appropriate for treating trauma? Who decides on the evidence in “evidence-based” treatment? What makes good research — and who funds it? What makes an effective psychotherapy?