Does the body really keep the score? Sort of, but not really.

The body “keeping score” of traumatic reactions has become a popular idea. The idea is that reactions to traumatic events get physically stored in different parts of the body. However, this idea was not quite born out of research. Even the popular book The Body Keeps the Score never really intended for people to think about it this way. 

Technically, it is not incorrect to say that the body keeps the score, insofar as the brain is inside the body. That is, the brain activates trauma-related triggers and responses. They are not stored in other body parts or even throughout the body. For example, a leg that was injured in an auto-accident; or parts of the body that experienced sexual assault, or in an excited heart during a battle.

What the research says

What really happens: the brain keeps the score. This involves an interaction of memory and emotion centers in the brain. Research finds the brain to interpret reminders of a traumatic events as threatening or indicative of a similar event about to occur. These brain centers then send messages to the rest of the body to jump into fight, flight, or freeze reactions in order to mobilize and be ready for that threat. Individuals experience this “reactivation” in the body as it occurs, but the body does not store it.

The problem arises when individuals interpret objectively non-threatening or mildly threatening triggers as threats, thereby activating this entire process. This constant state of alert is highly distressing and taxes the body. It also leads the individual to behave in ways that are not congruent with a situation.

For example, a combat veteran with PTSD may interpret an individual walking behind them as a threat. They then yell at the individual and risk physical altercation or ostracization. Or, the veteran avoids going outside the house altogether and reinforces the need to avoid many things in their world. These reactions are understandable, given what the veteran has experienced, but they can also disrupt daily life and emotional health in many ways.

Even Bessel van der Kolk (the author of the The Body Keeps the Score) talks about how traumatic triggers and memories are first misinterpreted as threats by the brain before triggering a fight or flight response, not as the body storing trauma. He actually tends to emphasize approaching this process for clients with self-compassion and acceptance of one’s reactions than he does somatic experiences and somatic regulation (e.g., breathing techniques). Watch an interview with van der Kolk here to hear his take. 

What this mean for therapy.

For some reason, van der Kolk’s book came to be viewed as evidence for approaches meant to relieve the body (e.g., somatic experiencing, tapping treatments). Many even argue that clinicians should prioritize these treatments over more structured psychotherapies. However, these alternative approaches do not have much research support. Some argue that the research still “needs to catch up”, but the research conducted thus far shows minimal results. 

Some somatic strategies (e.g., breathing techniques) may help as a tool in the moment. However, they do not prevent trauma reactions from occurring whenever a traumatized individual encounters a reminder. On the other hand, we have approaches that help retrain the brain to more accurately interpret whether a reminder or a memory of trauma is truly threatening. These evidence-based approaches decrease fight-flight-freeze reactions over time in the face of traumatic reminders, until those reminders are no longer distressing. 

Cognitive processing therapy (CPT), cognitive behavioral therapy (CBT), and Prolonged Exposure Therapy (PE) constitute those approaches. These approaches demonstrate very robust effects in extensive research from the last 40 years. And contrary to some claims, these approaches do not retraumatize people. The approaches can be legitimately difficult for clients. We as therapists can provide a safe place and guidance for clients to learn these approaches though. They can then effectively bring skills learned into the real world. After all, they only see us for a very small portion of their entire week.

There are plenty of trainings (see links) for Cognitive processing therapy (CPT), cognitive behavioral therapy (CBT), and Prolonged Exposure Therapy (PE). EMDR also proves effective, but research finds that bilateral stimulation is not necessary for healing. This research shows that the exposure and memory work are really what make EMDR work (which are keep components of cognitive and exposure approaches). Trauma-focused cognitive behavioral therapy (TF-CBT) effectively helps children and families who experience trauma, according to extensive research.

How clients understand trauma is actually very important to inform how they approach and work with their own traumatic reactions. Therefore, we as a field should be very careful in how we disseminate these ideas about trauma. Therapists on social media should work to differentiate the benefits of our approaches for trauma. For example, discussions about how breathwork may be helpful in the moment. While exposure and cognitive approaches help modify the brain’s interpretation of traumatic events and decrease traumatic reactions overtime. After all, we want our clients to truly have less distress.

Popularity and appeal does not always mean most effective. Body-based approaches may help in some ways. But focus on the brain’s tendency to activate the rest of the body, not how trauma is stored in certain locations in the body, is what leads to the most robust long-term change. And is what Bessel van der Kolk intended in The Body Keeps the Score.