As you may recall, the emotional brain communicates with the body by releasing stress hormones and other messengers that produce visceral sensations in the body. You might be wondering what are these visceral sensations? Visceral sensations are those shock waves you feel throughout your body when something fearful or threatening occurs. For instance driving in your car and the person in front of you slams on his or her brakes. Your body is rushed with these intense sensations that surge through your body rapidly in order to get you to react.
Usually these stress hormones dissipate to their normal state relatively quickly. In individuals with PTSD, however, researchers have found they secrete stress hormones on a continuous basis long after the actual danger has passed. The balancing system fails and they get stuck with their fight/flight/freeze chemicals continuing to release. Further, since the stress hormones do not dissipate completely, they spike more rapidly and disproportionately in response to less stressful situations. The effects of this constant elevation of stress hormones can lead to problems with memory, attention, irritability, and sleep. It can also lead to long term health issues. This is major stuff. The effects of these stress hormones are profound. How people react to this constant release of stress hormones can go one of two ways. The first way is they become extremely jumpy, react quickly, and intensely, and over time, start avoiding a lot of situations over fear of being triggered. The other way people react is that they cut themselves off from their emotions and the visceral sensations. They ignore and push it away so much that they stop feeling emotions all together. Both avenues are devastating. I will go more into the two main ways that I have seen people react and what that looks like in my next two posts. For now, cosy up, breathe, and take care of yourself. With great care and compassion… Until next time.- Dr. B References Heck, S. (2013). Healthing and Resilience After Trauma. Home Study. heiselandassoc.com. Levine, P. (2015). Peter Levine Ph.D. on Trauma: How the body releases trauma and restores goodness. Online Training. catalog.pesi.com Van Der Kolk, B. (2014). The Body Keeps the Score: Brain, mind, and body in the healing of trauma. New York, NY: Penguin Books.
1 Comment
Ok, so we covered how the brain forms and how it is related to PTSD in terms of our reactions, but lets now turn our attention to what exactly is happening in the brain structures during the symptoms of PTSD. Part of the picture of living with PTSD is re-experiencing the sensations and images of the trauma when you are not in a dangerous or traumatic situation. As you can imagine this is very difficult to manage, and it often leads to many disruptions in a person’s daily life.
To gain perspective on what occurs in the brains of people with PTSD researchers have performed brain scans while having a traumatized person listen to a recorded script of their traumatic experience. These brain scans show a large area of activation in the limbic region of the brain (aka the emotional brain). The intense emotions activate the lower right limbic area, and in particular, the amygdala. The amygdala’s job, as we learned in my last post, is to warn us of impending danger and to activate our stress response. Studies show that when traumatized people come in contact with images, sounds, or thoughts related to their trauma experience, their amygdala reacts with alarm even if the actual threat is no where near them in either space or time. Activation of the amygdala sets into motion a multitude of stress hormones and nerve impulses that drive up blood pressure, heart rate, and oxygen intake in preparation for fight or flight. We can see how this intense activation can be troubling and interfere with daily functioning if this is occurring in seemingly innocuous situations such as at work or your kid’s soccer game. Another finding from the brain scans of traumatized people was that there was an area in the left frontal lobe that showed a significant decrease in activation. This area of the frontal lobe is known as Broca’s area, which is one of the speech centers of the brain. When this area is cut off people have tremendous difficulty putting their thoughts and feelings into words. In traumatized people, the scans showed that their Broca’s areas went offline whenever a flashback was triggered. Even years after a trauma, people have tremendous difficulty articulating what exactly happened to them. Their bodies will re-experience the terror, rage, and helplessness along with the urge to fight or flee, but these feelings are nearly impossible to put into words. This is not to say that survivors cannot talk about the tragedy at all, eventually traumatized people come up with a story that explains their symptoms, but these stories often fail to represent the true inner experience of what they went through, or what their symptoms continue to be. When words cannot be found, images capture the experience and return to the person in the form of nightmares and flashbacks. In the brain scans, the region of the brain known as Brodmann’s area 19 was activated. Brodmann’s area 19 is located in the visual cortex and registers images when they first enter the brain. Normally, raw images registered in this area are rapidly sent to other brain areas for interpretation, and to make meaning of what has been seen. The activation of this area when participants listened to their trauma scripts once again indicates that the brain area was activated as if the participant was in the actual trauma scenario, even though the trauma could have occurred long ago. The scans also revealed that during flashbacks the participants brains only lit up on the right side, while the left side seemed deactivated. Do you recall the differences between the right and left side of the brain? Well, the left side of the brain is associated with rational, linguistic, logical thinking while the right is more intuitive and artistic. When the left side of the brain goes offline, it has the direct impact on one’s ability to organize experience into sequences, and to put one’s feelings and perceptions into words. As you might of guessed, Broca’s area is on the left side. When a traumatized person is reminded of their trauma, their right hemisphere brain lights up and reacts as if the traumatic event is happening in the present. The right side of the brain appears to be more connected to our emotions, and thus, gets taken over during reminders of the trauma. Getting familiar with what specific brain structures are impacted during activation of trauma symptoms helps us gain a better understanding of why individuals feel and experience what they do with PTSD. Education on how the brain reacts during PTSD can help individuals feel less confused and out of control, and in a sense normalize what they are going through. I have seen a true look of relief on my client’s faces when I can explain to them the reasons they are experiencing what they are experiencing. It helps set the stage for moving forward to calming self-love and self-acceptance. The suffering experienced with PTSD is profound. It is my hope that by sharing these tid bits of information, it may help someone who does not walk through my door to find some peace amongst the turmoil. With care and compassion… Until next time. - Dr. B References Heck, S. (2013). Healthing and Resilience After Trauma. Home Study. heiselandassoc.com. Levine, P. (2015). Peter Levine Ph.D. on Trauma: How the body releases trauma and restores goodness. Online Training. catalog.pesi.com Van Der Kolk, B. (2014). The Body Keeps the Score: Brain, mind, and body in the healing of trauma. New York, NY: Penguin Books. At least a few times a month I have a client come in and describe a situation in which they had a very strong, intense, quick reaction over which it seemed they had no control. The reason for this has to do with how our brains are formed and how we process information. I want to talk about how the brain is formed because it is relevant to PTSD and how the symptoms of PTSD manifest.
The brain is formed from the back to the front, or bottom to top depending on which way you want to think about it. Our ancient animal brain, or reptilian brain- the parts of our brain that we have in common with most other animals- is located in the brain stem just above where the spinal cord enters the skull. The reptilian brain is in charge of basic survival including eating, sleeping, and breathing. This is the part of the brain that is online and working when an infant is born. Above the reptilian brain we find the rest of the brain stem and the hypothalamus. Together these structures dictate our energy levels and regulate the heart, lungs, endocrine, and immune systems. Again our basic systems that keep us alive. Just above the the brain stem and reptilian brain is the limbic system. The limbic system houses our emotions. It helps us recognize danger, tells us what is desirable or scary, and indicates what is needed or not needed for survival. It also helps us navigate our social environments. Our limbic system is shaped based on our experiences, along with our genetics and temperament. Together the reptilian brain and the limbic system comprise the “emotional brain.” The job of the emotional brain is to look out for our well-being. It monitors and communicates by releasing hormones and other messengers that yield visceral sensations. These visceral sensations get our attention and possibly change our course. The emotional brain takes in a lot of information and assesses this information broadly. This means that it may jump to react based on generalizations versus taking in the details of a situation. The emotional brain starts us on our biological instincts to escape. These reactions are automatic and start without our conscious awareness. Sometimes we do not catch up and realize what is going on until after the threat is over. The top layer of the brain is the neocortex. This layer of the brain starts to develop rapidly around the age of 2 when the child starts to develop language. The neocortex houses our frontal lobes which allow us to integrate and give meaning to information. The more intense the visceral/sensory messages from the emotional brain, the more difficult for the rational brain to override it. As we take in information from our environment it first registers in the thalamus which is located in the limbic system (emotional brain). Messages about what is happening are then sent in two directions, down to the amygdala and up to the frontal lobe. The path down to the amygdala is much faster than the path up to the frontal lobe. The job of the amygdala is to tell us if incoming information is relevant to our survival. It does this extremely fast and automatically with the help of the hippocampus which is in charge of memory and relates the new information to past experiences. This explains how we get triggered by stimuli that are similar to stimuli we have encountered before even if the current stimuli is not dangerous. Since the amygdala processes information much faster than the frontal lobe it could set into action a stress response and cause us to be on the move before we are even aware of what is happening. To sum it up, information comes in, it gets skimmed over by the emotional brain, then it is sent both down to the amygdala, and up to the neocortex… our brain wants us to survive, so the route down to the amygdala is much faster (remember our amygdala assesses for danger), if the amygdala senses danger it puts in motion a survival response. This explains the experience of reacting so quickly and intensely that you do not feel you have control over your actions. Think of walking along a trail and seeing something move out of the corner of your eye, you jump and start to move in the opposite direction before realizing it was just the wind blowing a twig. This is an example of how the message got down to the amygdala faster than it got to the neocortex where you could have determined that it was a twig versus a snake or crocodile. Having experienced trauma makes misinterpreting a situation even more likely. It can lead to, put simply, a wacky alarm system (more on this later), that can cause a person to explode or shutdown to seemingly neutral comments, movements, or facial expressions. If the incoming information is not too threatening, and the message is able to get to the frontal lobe before our amygdala sets in motion the stress response, then our frontal lobes can help us recognize the twig versus the faux snake. The executive functioning of the frontal lobe helps us observe the situation and predict what will occur based on what action we choose to take. As long as our frontal lobes are functioning properly we can most likely control our reactions. In PTSD, however, the relationship between the amygdala and frontal lobes changes- putting the amygdala on much higher alert- making it more difficult to control emotions and impulses. In a sense, PTSD disrupts the balance and ability to assess incoming information and causes the person to stay in a heightened state of detection to threat without the ability to properly assess what is going on. To be able to manage stress properly it depends on having a balance between the amygdala and frontal lobes. Having this balance can be achieved by either a top down or bottom up approach. Top down meaning using your frontal lobes to pay attention and improve your ability to monitor your body’s sensations via mindfulness and yoga. Bottom up involves resetting the autonomic nervous system through breath, movement, and touch (soothing activities). Again think of soothing an infant. Rocking, swaying, being held, and being able to calm and slow down our breathing will help bring the overactive amygdala into more balance. To sum it up and make this easier to digest. Think about how we are all animals. Our sole purpose on this earth is to survive, and multiply. These are strong biological drives. Our brains are wired to help us survive. This is the reason we may jump to react even if the situation is not dangerous, but reminds us of something dangerous we may (or may not of) encountered before. The path to reacting is much quicker than the path to assessing the situation logically, especially in PTSD. In PTSD the path to reaction is primed and ready to fire. In order to help calm down the kindling that is ready to ignite, we need to work on bringing our systems into a calmer more mindful state. With much care and compassion… Until next time. - Dr. B References Heck, S. (2013). Healthing and Resilience After Trauma. Home Study. heiselandassoc.com. Levine, P. (2015). Peter Levine Ph.D. on Trauma: How the body releases trauma and restores goodness. Online Training. catalog.pesi.com Van Der Kolk, B. (2014). The Body Keeps the Score: Brain, mind, and body in the healing of trauma. New York, NY: Penguin Books. Ok, now that you know what PTSD is (if you read my last post, if not go back and read it) you may be wondering who gets PTSD, or maybe even do I have PTSD? When traumatized individuals come into my practice seeking care, some have a sense of what they might be dealing with, but others just feel as if they are out of control and do not know what is happening. We will get more into the feeling out of control part of living with PTSD and why a person might experience that, but for today, I want to educate on the factors that contribute to some developing PTSD, while others who may have experienced a similar situation do not.
Just because you experience a traumatic event does not necessarily mean that you will develop PTSD. Like I explained in my last post, symptoms after a traumatic event are not uncommon, but it is when the symptoms hang around longer than a month that we start to get concerned. So the question is what factors contribute to the reason that some people go on to develop PTSD while others go on unscathed? The first factor is how frequent and intense the trauma was. If the trauma was a one time occurrence and the person felt supported and able to seek out help, then the likelihood is lower for developing PTSD. If the person was repeatedly traumatized starting as a young child, then the odds for developing PTSD grow substantially. Individuals with a history of prior traumas or other comorbid disorders such as depression or anxiety are also at higher risk of developing PTSD. The type of traumatic event also influences the adjustment after the trauma. If the traumatic event was a natural disaster, then the development of PTSD is less likely than if it is a combat event or the experience of being attacked or violated by a trusted partner or family member. The manner in which a person copes is also a factor in developing PTSD. Resilience is the ability to cope with tough times and bounce back from trauma. Some things that contribute to resilience is having a strong support system, being flexible in your thinking and the way you see things, seeing the cup as half full, having problem-solving abilities, spiritual beliefs, and a sense of humor. A regular exercise routine does not hurt either as it enhances a sense of well-being. To sum it up, having healthy outlets, outlooks, and habits can help protect you against the development of PTSD. Social support, in particular, is the most powerful protector against overwhelming stress and trauma. We as humans are social creatures. We need one another to live and thrive. After a trauma if an individual does not feel they can go to others to get support and care, then it makes coping with the trauma much more difficult. After a traumatic event our physiology is on overdrive (I will go into this more in a later post) and we need people close to us to help us feel cared for, seen, and heard. In order for the physiology to calm down we need a visceral feeling of safety. Think of an infant who needs touch and holding to calm down- those needs for us do not go away as we grow. Again, we are social beings and we need others to help us feel soothed and safe. In our brains we have mirror neurons that allow us to take in another person’s movements, and emotional states so that we can be in sync with others. These mirror neurons make possible the feeling of empathy and being in tune with someone else. This feeling of being understood and supported can mean a complete world of difference to the traumatized person. To think of an example to tie this all in, when I first moved back to the area after about 13 years of living and working in other cities, there was a noticeable difference in the clients I first started to see here. When I moved back in 2015, before I opened my private practice I was doing telemedicine. I had a few clients from along the coast, north of us, and there was a subtle/understood manner in which they talked that implicated a pre and post Hurricane Sandy world. We live in an area that has a shared trauma of a natural disaster. Hurricane Sandy was devastating and it is felt in the stories that I hear from my clients and friends when they talk about life and how things changed so drastically from destruction to rebuild. Organizations such as Jetty and others that stopped everything to rebuild and bring people together are prime examples of how social support heals people after trauma. Those people who did not have access to support may not have fared as well. So like I said trauma is a broad subject that can show up in many different ways in our lives. It is important to keep in mind these factors that can help protect against more intrusive and prolonged symptoms of PTSD…. Until next time. -Dr. B References Heck, S. (2013). Healthing and Resilience After Trauma. Home Study. heiselandassoc.com. Levine, P. (2015). Peter Levine Ph.D. on Trauma: How the body releases trauma and restores goodness. Online Training. catalog.pesi.com Van Der Kolk, B. (2014). The Body Keeps the Score: Brain, mind, and body in the healing of trauma. New York, NY: Penguin Books. |
Archives
May 2019
Categories |