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Q1ABSTRACT: The research showing how exposure to extreme stress affectsbrain function is making important contributions to understanding thenature of traumatic stress.Reminders of traumatic experiences activate brain regions thatsupport intense emotions, and decrease activation in the central nervoussystem (CNS) regions involved in (a) the integration of sensory inputwith motor output, (b) the modulation of physiological arousal, and (c)the capacity to communicate experience in words.This includes the notion that traumatizedindividuals are vulnerable to react to sensory information with subcor-tically initiated responses that are irrelevant, and often harmful, in thepresent.

Q1ABSTRACT: The research showing how exposure to extreme stress affectsbrain function is making important contributions to understanding thenature of traumatic stress. This includes the notion that traumatizedindividuals are vulnerable to react to sensory information with subcor-tically initiated responses that are irrelevant, and often harmful, in thepresent. Reminders of traumatic experiences activate brain regions thatsupport intense emotions, and decrease activation in the central nervoussystem (CNS) regions involved in (a) the integration of sensory inputwith motor output, (b) the modulation of physiological arousal, and (c)the capacity to communicate experience in words. Failures of attentionand memory in posttraumatic stress disorder (PTSD) interfere with thecapacity to engage in the present: traumatized individuals “lose their wayin the world.” This article discusses the implications of this research bysuggesting that effective treatment needs to involve (1) learning to toler-ate feelings and sensations by increasing the capacity for interoception,(2) learning to modulate arousal, and (3) learning that after confronta-tion with physical helplessness it is essential to engage in taking effectiveaction.KEYWORDS: PTSD; affect regulation; neuroimaging; meditation; yoga;HRV; introspection; movement; action; medial prefrontal cortex; auto-nomic nervous systemThe discovery that sensory input can automatically stimulate hormonal secre-tions and influence the activation of brain regions involved in attention andmemory once again confronts psychology with the limitations of consciouscontrol over our actions and emotions. This is particularly relevant for un-derstanding and treating traumatized individuals. The fact that reminders ofthe past automatically activate certain neurobiological responses explains whytrauma survivors are vulnerable to react with irrational-–subcortically initiatedAddress for correspondence: B.A. van der Kolk, M.D., Boston University School of Medicine, 1269Beacon Street, Brookline MA 02446. Voice: 617-247-3918; fax: 617-859-