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--:-- Bessel van der Kolk: How many people do you think—I mean, this is maybe a ridiculous question—but how many people, what percentage of people do you think have trauma in some form? How you define it, uh, you know, the figures are a quarter of people get physically abused, one out of five people get sexually abused, one of eight kids witness violence between their parents, etc., etc. So, you know, if I sit in a room, you know, it's not a binary issue. It's not either you were traumatized or you didn't get traumatized. But when I talk to a room of professionals, which I do a lot, I assume that at least half the group viscerally knows what trauma means and what it does to your brain.
--:-- Steven Bartlett: You said you've done a lot of neuroimaging scans. Um, if I was traumatized and you scanned my brain, is there something you could see? Not necessarily. I can see how your brain may be different from other people's brains. I may take a particular population, average it out, and say, "Oh, there's a little more activation of the periaqueductal gray, a little bit less of the insula." So you see certain patterns of connectivity in the brain. But to some degree, you know, I think we learn a lot about the brain, but we don't know much about the brain. And I think people tend to overstate how much brain pictures can teach us.
--:-- Bessel van der Kolk: You know, I love the Hubble telescope or the Webb telescope. You know, our brain is like a universe, and our technology is very inadequate to really know about all the unbelievably complex connections in the brain. But we have learned a few things in the last 20 years. So, how does trauma affect the brain? It affects the brain in that... There's one part of your brain that I call the cockroach center of your brain, the periaqueductal gray, that lights up. It's sort of underneath the amygdala. Everybody knows the word amygdala these days, I guess. So, the part of your brain that tells you that you're in danger. When you're traumatized, you're likely that that little part of your brain, way back in your brainstem, is firing all the time. All the time, you go like, "I'm in danger, I'm in danger, I'm in danger." And that's where it starts, in a very elementary sensory level. You don't know what the danger is, but you just feel that you should be scared.
--:-- Steven Bartlett: And then there's certain other parts of your brain, for example, your insula, which makes the connection with your physical sensations and your body awareness, that for many people get shut down. Because the experience of trauma is a visceral experience of heartbreak and gut wrenching. And if you have a lot of that, you can learn to shut that part of your brain down so you don't feel your body so much anymore. Or you don't feel your body so much. You don't feel very alive either, but you don't feel so scared all the time. But it's likely that you will want to take some drugs to make yourself feel alive sometimes. Stuff like that, yeah.
--:-- Bessel van der Kolk: So, the part of my brain, you said just around the amygdala? Below the amygdala. People that are traumatized, they have some kind of dysfunction in that, typically? The dysfunction is that it keeps firing. Keeps firing. And how does that make you feel? And then the amygdala—so there's a constant sense of subliminal dread. Is that anxiety? Anxiety is already too high, mental functioning. Okay. It's more elementary. It's like your dog shaking. My dog has adopted a dog three years ago, and two years later, the dog still walks from my house. You've adopted a dog, and it shakes in your house still? Yeah, but still never quite comfortable. And that's how many times you meet are never quite comfortable.
--:-- Steven Bartlett: So when someone says they're triggered? No, trigger is in the higher level thing. Okay. So then the next level is indeed the trigger that is in part mediated by the amygdala. If your amygdala is your smoke detector, that tends to become hypersensitive so that minor things get blown up. And a minor thing that you may say to me, I take as the most insulting thing in the world, and so you constantly triggered by things. And that makes you feel like you are doing terrible things to me. And it's not like I'm hypersensitive, and when you have an off day, that is your issue and not my issue. No, when you have an off day, I feel your off day, and we start getting into trouble together.
--:-- Bessel van der Kolk: I've got a picture here of what the brain looks like when the brain smoke detector goes off. Is that what it looks like on the brain? That is one particular guy. Nobody is exactly the same as everybody else. Can you explain this to me? But basically, what you see here is, this is a guy who is reliving a terrible car accident he was involved in. What you see here is that the right posterior part of the brain, this temporal parietal junction on the right side of the brain, fires, and that's the feeling part of your brain. So you go, "Oh, my God, oh, my God, I'm terrified." But there's no cognition. Basically, the left side of the brain shuts down. So when you're in your trauma, you're not a reasonable person. You actually become a little bit of a blubbering idiot. All of us, when we really are angry, upset, are not very articulate, but we have a lot of feelings.
--:-- Steven Bartlett: And then the piece that I showed us is that as he is reliving his trauma, these two parts of the brain go offline. This is the dorsolateral prefrontal cortex. That's the part of the brain that's the timekeeper of your brain. So if something unpleasant happens between us, let's say, I'll go, "Oh, it's not a half hour, and I'll be okay," so let me just sort of put up with this. But when you get traumatized, the timekeeper disappears, and this is all there is. You lose your sense of perspective, and that is what happens when you're in your trauma—you don't know the difference between the past and the present because the timekeeper of your brain goes offline, and whatever you're feeling is real as opposed to being a memory.
--:-- Bessel van der Kolk: So, for people that can't see it in this brain scan, what I'm basically seeing is the right side is extremely activated, the left side looks like it's off, off. Yeah. And then there's these two blank, empty spaces that aren't activated, called the dorsolateral prefrontal cortex. Dorsolateral prefrontal cortex. So that's part of the system in the brain that gives you a sense of time. Okay. And as long as you have a sense of, it's like little babies only have a sense of time either. Whatever happens, happens totally. And you see a child slowly grow, and they get a sense of perspective. It's happening by now, but tomorrow it will be different. Okay. Okay, so that's when, I mean, presumably that's when you get anxiety, right? When you start thinking about the future. It is about having the perspective of this is happening right now. Right now I'm really scared. But the moment I go home, the moment I call my friend, I'll feel better. And so you need to have that capacity for perspective. And that perspective goes offline when you're in your trauma, and you become a trauma-desperate person.
--:-- Steven Bartlett: So, this particular person, this brain scan that I have here, this guy was in a car accident. And the triggered brain that I'm looking at here is, he was basically put in an FMRI scanner, and he was intentionally triggered to see what would happen in his brain. Exactly. So he was shown maybe a car accident or something. No, no, specifically his car accident. Oh, you showed him a picture of his car. What did you see? What did you hear? What did you smell? What were you thinking? Very specific sensory details. Not somebody else's sensory details, your sensory details. And the right side of his brain was illuminated. Yeah, the lighter brain became very active, but what got inactivated was the timekeeper of his brain. So he could not lie there and say, "Oh, I'm remembering what happened to me yesterday." He's reliving what happened yesterday. Instantly. You feel like it's happening right now. And that's the nature of trauma. Trauma is not a memory. It's a reliving.
--:-- Bessel van der Kolk: Are you consciously reliving it, or is your subconscious reliving it? You feel like it's happening right now. With all forms of trauma. But not, it's happening right now, but my feeling is happening right now. And my body. You don't know that the feelings actually belong to the time that your dad used to beat you. It is now I feel the same way because I disagree with you. So I've been triggered in the past, and I felt that sort of instant fight-or-fly response because something's happened or whatever, and it's instantaneous. So although I don't feel like I'm back there, my body does feel like it's back there. And so people are confused about it. They say, "Oh, you relive the past." No, actually, you're not aware that you relive the past because the past is the present. So you don't think, "Oh, this reminds me about a time that my dad used to beat me when I was four years old." No, it feels like you are beating me right now.
--:-- Steven Bartlett: And is there a way for this particular gentleman here who's been through that car crash to ever stop this triggering? Yeah, he's done quite well. He's done quite well. He did EMDR, actually. Yeah, eye movement desensitization. And what were his results? He's an all-right guy. He's functioning. He's fine. He's no longer a traumatized person. What's the most radical improvement you've seen in your clinical practice? Oh, really, people really coming to life. People just saying it's over. Give me the most, the best example. The good example is the videotape I showed people yesterday of a woman, again, terrible car accident, freezing, upset, freaked out. And then three sessions later, we go talk about it. She says, "Yeah, this shitty thing happened to me. I was in this car accident and I jolted for it and my head. And boy, that was terrible back then." But now I have a granddaughter, and I drive my car to my granddaughter, and I'm fine. Three sessions, yeah. And we saw it in psychedelic therapy all the time.
--:-- Bessel van der Kolk: What did you do in those three sessions? Biggle your fingers in front of people's eyes. I mean, for me, EMDR was really the gateway drug. Sorry, you know, I've written three books about PTSD. They actually wrote the very first book in which the word PTSD exists in '84 or something. But they didn't know how to treat it. So I'm a world-renowned expert, but I have no idea how to treat it because people keep reliving their trauma and they don't know how to stop that. And somebody starts telling me about EMDR, and I don't believe a word of it. And they say, "Yes, you move your fingers in front of people's eyes." I mean, you move your eye from side to side as you relive the trauma. And I go, "That's crazy." Everybody who hears it, that's crazy. And then people start doing it, and they show me how it works. I go, "Wow." And people indeed had a certain subsample of people we studied, indeed, after a few sessions of EMDR, go like, "Yeah, that really sucked. But it's over. It belongs to the past. It's not happening right now."
--:-- Steven Bartlett: You're telling me that wiggling your fingers in front of people's eyes can help heal their trauma? Well, then, of course, we had to do a little research, which took us 15 years to get enough funding to do it, to see what happens when you move your eyes back and forth. And then we discovered that if you move your eyes back and forth as you recall a traumatic experience, you activate certain pathways between the temporal parietal junction, which is your sense of self, and your insula, which is your sense of your body. So your brain is able to say, "Oh, yeah, this is what happened to me, but it happened to me in the past." So these are pathways that make it possible for your brain to make that distinction.
--:-- Bessel van der Kolk: And in the research that's been done on this, what did the outcome, what was the conclusion in terms of its efficacy? Oh, in terms of, in our research, 78% of the people who had adult-onset trauma, so being assaulted or raped by a stranger, 78% of them were completely cured. But that's not the majority of people we see because most people we see have early childhood trauma, which is much more complicated as a treatment. Early childhood trauma is much more sort of stubborn and resistant to this treatment. Yeah, because your early childhood experiences create who you are. So if you go to a fancy college when you're 18, you do become identified with that college, but it doesn't radically change you into a new person. It becomes part of your identity. But if you grow up in a certain family early on in your life, you actually become that. That the imprint is very deep early on, yeah.
--:-- Steven Bartlett: So, it's called eye movement desensitization and reprocessing treatment. I was just looking up some stats about it. It says it's been extensively studied with evidence supporting its efficacy across various conditions. With PTSD, a 2020 meta-analysis of 26 randomized control trials found that EMDR significantly reduced PTSD symptoms with a large effect size. Depression, a 2024 systematic review and meta-analysis encompassing 25 studies and more than a thousand participants reported that it alleviated depressive symptoms. The same 2014 meta-analysis noted that EMDR led to significant reductions in anxiety symptoms among PTSD patients with a large effect. And finally, a 2024 systematic review and individual participant data meta-analysis concluded that EMDR is as effective as other psychological treatments for PTSD, achieving comparable symptom reduction and remission rates. So, can you show me how it works? Can you do it on me? I could. Can I move my chair? Of course, you can. Are you going to come closer? So, can you bring to mind a really unpleasant experience you had not too long ago? Yeah. And can you bring to mind what you saw at that point? Yeah. Can you remember what the voice sounded like at that point, or whatever it was, any sounds come to mind? Yeah. Do you remember what your body felt like back then? Yeah. Okay. Can you remember what you were thinking or bring to mind what you were thinking? Yeah. Okay. So, how vivid is your feeling right now on a scale of one to ten? It's a six, seven out of ten. Okay. So, stay there. Now, follow my finger with your eyes. So, look at me right now. [Bessel guides Steven through the EMDR process.] A deep breath. So, what comes to your mind right now as we're doing this? I feel calm. Yeah, I just don't feel calm. Okay. So, when you go back to what you were just feeling, what's it like now? It's... it's hard to recall why I was bothered. That is the weird stuff, you know why? Is that just because... why is that? No, see, that is what's so great about his work—we don't know the linearity, and we don't know where the hell the emotional imprint is gone now, but it is. And, you know, of course, if you bring up something much worse than what you had going on, it takes much longer, and a lot of other stuff comes up. But somehow, EMDR seems to do... it creates new associative processes in the brain. So, let's say, first, people did EMDR on me, something really very, very nasty had happened to me, and I started off being very upset. And then during the EMDR, I don't know if that happened to you, I had images of sitting at my dining room table as a kid and I had images of playing in a playground in primary school. It started, don't come to mind. And then we stopped it, and it needed. So, yeah, that really sucked. Time to go on. An important part of this, you did not tell me what you were going through. No. Because I'm suspicious of language because language is always an interactive process. And if I were to ask you to tell me what happened, you will filter yourself because certain things may be embarrassing or you don't want me to know about it. And so we circumvent this whole verbal process of your making meaning out of it and we organize some core ways in which your brain is perceiving this. So, you saw a little bit of this in a minor way. For me, when I first saw this, I was blown away by it and thought I need to study this. So, when they quoted studies, the main study was done by me. NIH funded it. But that was also the last time that somebody got funded for NIH for EMDR.
--:-- Steven Bartlett: What you just listened to was a most replayed moment from a previous episode. If you want to listen to that full episode, I've linked it down below. Check the description. Thank you. It takes a little bit of time to realize this as a founder, but once you do, it's something you can't unsee—that having the right systems in place with your business is critical. One that's helped me across all of my investments is NetSuite, the number one cloud financial system and sponsor of today's conversation. Through their streamlined platform, you'll find all of your accounting, finance, management, inventory, and HR in one place. And their technology has been a massive unlock for all of my companies, especially for my team at FlightStory. As over the last year, we've moved out of startup mode into scale-up mode. And that's the stage where we found it mission-critical to use NetSuite. We no longer have to juggle multiple systems, and having everything together has reduced the number of manual tasks and, of course, the number of errors. Over 42,000 businesses have chosen to future-proof their business with NetSuite. So, if you'd like to learn how it can help your business, head to NetSuite.com/Bartlett and download the CFO's Guide to AI and Machine Learning. That's NetSuite.com/Bartlett.
