by Jan E. Estrellado, Ph.D.
Responses to trauma can be found in both the mind and the body. In the mind, people can experience unwanted, intrusive thoughts that remind them of the traumatic event. They may feel misunderstood, isolated, and irritated with others around them. Their beliefs about the world might change from a sense of safety and stability to one of unpredictability and danger.
In the body, people can feel “on edge,” like something bad is about to happen. They may feel more anxious than usual, with symptoms of an increased heart rate, sweatiness, hyperventilating, difficulty focusing, or even a panic attack. This is more likely to be true when they are exposed to an internal or external cue reminding them of the traumatic event, but for others, it can feel like it comes out of nowhere.
Trauma Response in the Brain
For an individual with PTSD, much of the response to trauma can be found by understanding what is happening in the brain.
When something might be dangerous or threatening, it first goes to the thalamus, which is responsible for receiving sensory input (what you see, smell, taste, touch, and hear). From the thalamus, it can go in one of two directions. In the first direction, the “more sensible” direction, the sensory cortex accurately appraises the event as non-threatening and the hippocampus (responsible for memories), confirms or modifies this response. This direction, while slower than the second direction, is often more capable of accurately assessing true threat.
In the second, “less sensible” direction, the thalamus sends signals to the amygdala (the emotion and fear center of the brain), which then goes to the hypothalamus, where action is taken to get relief. This direction is often seen as tapping into the “fight or flight” response to fear. While this direction is quicker and engages our survival mechanisms, it can also get us into trouble if our response is bigger than the situation calls for.
For individuals with PTSD, their brains often go in the second direction. Their amygdala is on “over-drive” and cannot help them evaluate what is a true threat and what is not.
Re-Training Your Brain
If your brain is trained to fire its amygdala at will, what can you do about it? Enter the pre-frontal cortex. This part of the brain is responsible for planning, strategizing, executing, reasoning, and decision-making. At CSAM, we often encourage our patients with PTSD to engage their pre-frontal cortex in various ways: deep breathing, mindfulness practice, even coloring! Any grounding activity that helps you stay in the present moment will help you engage your pre-frontal cortex. These are effective short-term strategies for helping to manage an individual’s immediate PTSD-related anxiety.
Longer-term strategies include Cognitive Processing Therapy (CPT), Prolonged Exposure Therapy (PE), and Acceptance and Commitment Therapy (ACT). These interventions have strong support in the scientific literature showing their effectiveness to manage PTSD. In CPT and PE, patients “re-train their brains” to reduce their reactivity to distressing cues, often related to the traumatic event. They continually re-write or re-tell the story of their traumatic event until they make new meaning of the trauma, learn that the trauma memories are not dangerous and discover that they can handle the upsetting responses that come with remembering the traumatic event. In Acceptance and Commitment Therapy, patients practice mindfulness in order to understand what distressing thoughts they have when they recall the traumatic event. They develop a willingness to engage with the memories and feelings of the traumatic event, so that they are “freed up” to live a life based on their values and what’s important to them.
CSAM is here to help
If you or someone you love might benefit from CPT, PE, or ACT following a traumatic experience, or if you would like more information about our other therapy services, please contact us at (858) 354-4077 or at firstname.lastname@example.org.
U.S. Department of Veteran Affairs (2015). How common is PTSD?. Retrieved from http://www.ptsd.va.gov/public/PTSD-overview/basics/how-common-is-ptsd.asp