When Mindfulness Works Van Der Kolk

○
When Mindfulness Will

(and Won’t) Work for
Treating Trauma, and One
Technique That Can Be
○ Effective
with Bessel van der Kolk, MD
nicabm
N a t i o n al I n s t i t u t e f o r
○ the Clinical Application

of Behavioral Medicine
When Mindfulness Will (and Won’t) Work for Treating Trauma, and One Technique That Can Be Effective 2
When Mindfulness Will (and Won’t) Work for Treating Trauma,
○ and One Technique That Can Be Effective

with Bessel van der Kolk, MD
The research shows that meditation – mindfulness meditation – changes the brain and changes the areas of the
brain that are most affected by trauma.
So, it’s key that mindfulness meditation-type practices are very good “Mindfulness
for traumatized people.
meditation changes
The downside is that, in practice, the better off you are, the more the brain and
composed you are and the easier it is to meditate.
changes the areas
If you’re a very frightened, traumatized person, trying to do meditation of the brain that are
is likely to drive you nuts. People think about trauma as something that
was out there and something from the past that comes into you – that most affected by
is a fundamental misunderstanding. trauma. ”
Trauma is about the residues
that are left inside of you. Trauma is about having physical sensations,
emotions, and feelings that are happening right now that don’t belong
“The past is here.
the past – but
○
The past is the past – but trauma is about the residues of the past in your
trauma is about current system.
the residues of
Traumatized people try not to feel those things – by drinking, by running,
by numbing themselves out.
The moment you start allowing yourself to become calm, the toxins of
the past will start coming up. So it’s very easy to become overwhelmed “The moment you
by what comes up as you do mindfulness meditation. start allowing
Jon Kabat-Zinn taught me this – I was very surprised by it because it yourself to become
sounded so intense to me, but he said, “I think it is malpractice to do calm, the toxins of
meditation without doing yoga with traumatized people.”
Now, why do we do yoga with
traumatized people instead of doing meditation?
“Why do we
do yoga with When you do yoga, you can concentrate your mind on touching that toe
or keeping your breathing going while you have one foot in the air.
traumatized people
instead of doing In some ways, yoga organizes your attentional system into very specific
movements and postures and keeps you away from the free-floating
meditation?” (residue) that comes up when you do meditation.
So, yoga is a much easier way of becoming mindful than meditation is –
and they probably have similar effects.
○ The benefit from yoga over meditation is that, for one, yoga very specifically does focus on breathing, and by
focusing on breathing, which many yoga teachers tend to neglect, you can train people to develop good heart
rate variability.
The National Institute for the Clinical Application of Behavioral Medicine

www.nicabm.com
When Mindfulness Will (and Won’t) Work for Treating Trauma, and One Technique That Can Be Effective 3
In our study of yoga in PTSD, we found that people develop better
○
heart rate variability, which means that their overall capacity to
become calm increases. “By focusing on
breathing, which
But equally – if not more – important is that the triggers for your
trauma are not primarily outside of oneself. many yoga teachers
tend to neglect, you
Most people like to talk about, “Oh, that horrible person there / the
terrible car out there / the firecrackers caused me to feel this way.” can train people to
develop good heart
But the triggers are more often interoceptive triggers – feelings that
you have inside of your body. rate variability.”
For example, if somebody

“The triggers are more touches you or if you start
having sexual feelings or you start having sensitizations, that becomes
often interoceptive a reminder of your trauma and you start going nuts!
triggers – feelings
that you have inside The big benefit of yoga is that you learn to breathe yourself into
body positions that are potentially very triggering, but by having the
of your body. ” voice of your yoga teacher and having that deep attention to trying
to breathe while you do the posture, you can detoxify that particular
interoceptive awareness into a piece of safety.
Now, maybe, it becomes safe to take a deep breath.
With yoga, you can begin to pay attention to parts of your body that are internal triggers for you to go into the
traumatized state.
○ For example, the most flagrant example is doing the “happy baby posture.”
People, who have been sexually abused and hear this, say, “Oh, no. That’s impossible. The happy baby posture is
a posture in which you lie on the floor on your back, you put your legs straight up in the air, you hold your toes
with your hands and you spread your legs as wide as you can.
It doesn’t take a lot of imagination to understand that this might be hard if you have a sexual abuse history – and
certainly, if you have
You need to very slowly – and that is what our trauma program does with activity – very slowly educate, help,
and guide people into ever-more-complex areas of their internal worlds and to make them tolerable.
What keeps coming up is that when traumatized people start doing yoga, they often encounter contrary
sensations and feelings in their bodies that are terrifying.
That’s where the sound of the voice of the yoga teacher becomes extraordinarily important.
The sound of voice becomes very important to help people regulate their arousal.
Then there’s the power of breath at this point – you hear the yoga teacher talk about focusing your breath,
“Notice your out breath. See what happens. Slow it down.”
So, you get an organism that learns how to tolerate feeling those sensations. Once that sensation is no longer a
trigger – once that part of your body becomes a safe part – you’re liberated. It’s over!
This is an alternative to telling the story – and as a therapist you know that oftentimes telling the story is just
○
that – it’s telling the story, but it doesn’t make the trauma go away.
But once the sensation becomes a safe sensation, the trauma is gone.
The National Institute for the Clinical Application of Behavioral Medicine

www.nicabm.com

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○

When Mindfulness Will

with Bessel van der Kolk, MD

○ the Clinical Application

When Mindfulness Will (and Won’t) Work for Treating Trauma,

○ and One Technique That Can Be Effective

The National Institute for the Clinical Application of Behavioral Medicine

In our study of yoga in PTSD, we found that people develop better

For example, if somebody

The National Institute for the Clinical Application of Behavioral Medicine

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