Why The Body Keeps the Score Changed How I Work With Clients

Van der Kolk's central argument is straightforward, even if the implications are enormous: trauma is not just something that happens in the mind. It lives in the body. It reshapes the brain, disrupts the nervous system, and leaves physical imprints that no amount of talking, on its own, can fully resolve. 

The body, as the title says, keeps the score. That idea sits at the heart of everything I do at Low Tide Calm. Every session I offer, whether it is breathwork, mindfulness, reflexology, or Indian head massage, works with the same principle: if the body is where stress and trauma get stuck, then the body is where the work of regulation has to happen too.

What the book actually says
The Body Keeps the Score was published in 2014 and has spent years on bestseller lists for good reason. Van der Kolk draws on decades of clinical work with trauma survivors, from Vietnam veterans to children who experienced abuse and neglect, to make a case that traditional talk therapy has serious limitations when it comes to trauma recovery.His argument is rooted in neuroscience. 

Trauma disrupts the balance between three key brain regions: the amygdala (threat detection), the prefrontal cortex (rational thought), and the insula (body awareness). When someone is stuck in a trauma response, the amygdala fires constantly, the prefrontal cortex goes quiet, and the person loses connection with what their body is actually feeling in the present moment.Van der Kolk calls this a loss of interoception: the ability to sense and interpret internal body signals. And he argues that restoring interoception, through what he calls "bottom-up" or body-based approaches, is essential for recovery. Not instead of talk therapy. Alongside it.

The body-based approaches he highlights include yoga, EMDR, neurofeedback, somatic experiencing, and therapeutic touch. He also discusses breathwork and mindfulness at length. He does not name reflexology or Indian head massage specifically. But the mechanisms he describes, autonomic nervous system regulation, vagal tone, safe structured touch, and the re-establishment of body awareness, are exactly what those modalities deliver.

Breathwork: the vagus nerve connection
Van Der Kolk is explicit about the role of breath in trauma recovery. He describes how traumatic experiences fundamentally alter breathing patterns, often leaving people stuck in shallow, rapid chest breathing that keeps the sympathetic nervous system (fight or flight) permanently switched on

This is where the vagus nerve comes in. The vagus nerve is the longest cranial nerve in the body, running from the brainstem to the gut, with branches touching the heart, lungs, and digestive organs along the way. It is the primary pathway of the parasympathetic nervous system, which governs rest, recovery, and social connection.

Slow, controlled breathing, particularly with an extended exhale, directly stimulates vagal activity. Research published in Psychiatric Times confirms that voluntarily regulated breathing practices significantly improve symptoms across anxiety, trauma-related, and depressive disorders by restoring what researchers call sympatho-vagal balance.

This is precisely what functional breathwork does in practice. The Buteyko method, which I use in my sessions, focuses on gentle nasal breathing with a light, barely perceptible breath and deliberate breath holds. It is not dramatic or hyperventilation-based. It trains the nervous system to tolerate stillness, to sit with the discomfort of a pause, and to shift from sympathetic dominance back toward parasympathetic calm.

Dr Arielle Schwartz, a psychologist specialising in complex trauma, specifically references Buteyko alongside other pranayama practices as a tool for vagal stimulation and trauma recovery. The connection between van der Kolk's argument and what happens on the mat during a breathwork session is not a stretch. It is the same science, applied.

Mindfulness: rebuilding interoception
Van der Kolk views mindfulness as a valuable tool for trauma recovery because of its ability to help people reconnect with their bodies, regulate their nervous system, and develop greater awareness of internal experience. That description could have come straight from any mindfulness facilitator's notes.But here is where it gets interesting, and where I think a lot of generic mindfulness programmes miss the point. Van der Kolk emphasises that for people with trauma histories, mindfulness can be difficult or even distressing. Asking someone to close their eyes, sit still, and turn inward when their body feels unsafe is not always helpful. Sometimes it is actively harmful.

This is why the mindfulness work I do at Low Tide Calm is built around external sensory anchors rather than traditional eyes-closed, inward-focused meditation. For neurodivergent clients and those with trauma backgrounds, grounding techniques that use sound, texture, temperature, and movement tend to be far more accessible than sitting with your thoughts in silence.

The goal is the same one van der Kolk describes: restoring the capacity to notice what your body is feeling, right now, without being overwhelmed by it. That is interoception. And interoception is, in many ways, the foundation that everything else in trauma recovery is built on.Reflexology: the autonomic nervous system in the feetVan der Kolk does not discuss reflexology by name in The Body Keeps the Score. What he does discuss, extensively, is the role of the autonomic nervous system in trauma, the importance of safe therapeutic touch, and the need for bottom-up interventions that bypass cognitive processing and work directly with the body's physiology.

Reflexology fits that description cleanly.
A systematic review published in Evidence-Based Complementary and Alternative Medicine (McCullough et al., 2014, University of Ulster) examined the physiological outcomes of reflexology treatments across multiple randomised controlled trials. The review found that the most promising explanation for reflexology's effects on the autonomic nervous system, the exact system van der Kolk identifies as being disrupted by trauma. The research showed reductions in blood pressure, cardiac index, and salivary amylase (a stress biomarker) following reflexology treatment. A separate feasibility study from the University of Ulster found significant reductions in blood pressure during mental stress following reflexology compared to pre-intervention levels

More recently, a 2023 fMRI study (Descamps et al.) demonstrated measurable changes in brain functional connectivity following reflexology, including changes in the default mode network and pain-related neural networks, confirming the therapy can safely induce well-being responses at a neurological level.

To be clear about the evidence: reflexology research is still limited in scale, and the exact mechanisms are not fully settled. But the direction of the evidence, autonomic regulation, parasympathetic activation, and stress reduction, aligns directly with what van der Kolk argues the body needs in order to heal.In a reflexology session, the client is still. They are receiving safe, structured, intentional touch. Their nervous system has the opportunity to shift from sympathetic overdrive into a parasympathetic state. That is not a vague wellness claim. That is what the research consistently points toward.Indian head massage: touch, safety, and the vagus nerve.

Van der Kolk acknowledges the therapeutic role of safe, structured touch in trauma recovery. He also cautions, rightly, that it must be client-led and trauma-informed, particularly for people whose trauma involved physical contact.Indian head massage works with the head, neck, and shoulders, areas where the body tends to accumulate tension from stress and postural strain. But what makes it relevant to van der Kolk's framework is not just the muscle release. It is what happens underneath.

A study published in the Journal of Physical Therapy Science (2016) found that scalp massage over a 10-week period produced significant reductions in cortisol and norepinephrine levels, alongside measurable drops in blood pressure. The researchers attributed these changes to decreased sympathetic nerve activity and increased parasympathetic activation.

A separate study published in the Journal of Physical Therapy Science (Hatanaka et al.) found that parasympathetic nerve activity increased immediately after Ayurveda-based head treatment, with accompanying reductions in depression, boredom, and anxiety, and a notable increase in liveliness. The study concluded that head treatment has both relaxing and refreshing effects.

The occipital region and temples, both key areas in Indian head massage, are linked to vagus nerve pathways. Gentle pressure in these areas has been associated with parasympathetic activation, lower heart rate, and a shift away from fight-or-flight states. This is the same vagal stimulation that van der Kolk highlights as central to trauma recovery.

The thread that connects them all.
Is why I keep coming back to this book. It is not because van der Kolk has all the answers. The book has its critics, and some of the science, particularly around recovered memory, has been legitimately challenged. Polyvagal theory itself, which underpins much of the framework, has faced scrutiny from comparative neuroanatomists. I am not pretending any of this is settled science wrapped in a neat bow. But the core insight holds up: the nervous system is not separate from mental health. The body is not separate from the mind. And approaches that work directly with the body, through breath, through awareness, through safe touch, have a legitimate and increasingly well-evidenced role in helping people regulate, recover, and feel at home in themselves again.

That is the thread that runs through everything I offer at Low Tide Calm. Breathwork targets the vagus nerve and restores healthy breathing patterns. Mindfulness rebuilds interoception and present-moment awareness. Reflexology modulates the autonomic nervous system through structured touch. Indian head massage activates parasympathetic pathways and releases the physical tension that stress leaves behind.

None of these modalities are a replacement for professional mental health support. I am not a psychotherapist and I do not treat trauma clinically. But for people who are looking for practical, body-based tools to support nervous system regulation, whether they are dealing with burnout, chronic stress, neurodivergence, or just the accumulated weight of a life that has not slowed down, this work can make a real difference.here

If you have read The Body Keeps the Score and found yourself thinking, "Alright, but what do I actually do with this?" that is exactly where we start.

Cian O'Driscoll is a breathwork and mindfulness facilitator, reflexologist, and complementary therapist based in Wicklow, Ireland. He works with neurodivergent adults and burned-out professionals through Low Tide Calm. Sessions are available in person and online.

To book a session or find out more, visit lowtidecalm.ie

References and further reading:

• Van der Kolk, B. (2014). The Body Keeps the Score: Brain, Mind, and Body in the Healing of Trauma. Penguin Books.

• McCullough, J.E.M., Liddle, S.D., & Close, C.M. (2014). The Physiological and Biochemical Outcomes Associated with a Reflexology Treatment: A Systematic Review. Evidence-Based Complementary and Alternative Medicine. PMC4026838

• Hatanaka, M. et al. (2016). Physical and Psychological Effects of Head Treatment in the Supine Position Using Specialized Ayurveda-Based Techniques. Journal of Physical Therapy Science. PMC4939366

• Kim, I.H. et al. (2016). The effect of a scalp massage on stress hormone, blood pressure, and heart rate of healthy female. Journal of Physical Therapy Science. PMC5088109

• Gerbarg, P.L. & Brown, R.P. (2016). Neurobiology and Neurophysiology of Breath Practices in Psychiatric Care. Psychiatric Times.

• Schwartz, A. (2024). Conscious Breathing and the Vagus Nerve. drarielleschwartz.com

• Porges, S.W. (2011). The Polyvagal Theory: Neurophysiological Foundations of Emotions, Attachment, Communication, Self-Regulation. W.W. Norton.

• Descamps, M. et al. (2023). Effect of reflexology on the brain (fMRI study). Referenced in Preprints.org review of reflexology mechanisms (2025)