Citizens In Recovery

Posttraumatic stress disorder

Posttraumatic stress disorder (PTSD) has been in literature since Homer wrote about Achilles from Iliad. Achilles described of characteristics posttraumatic stress after killing Hector and dragging his body in front of Troy. Achilles described having nightmares and reoccurring thoughts that were triggered by the traumatic event of losing a close comrade. According to Murray Stein (2012) approximately two to three percent of American citizens have posttraumatic stress disorder. According to the Diagnostic Statistics Manual of Mental Disorders PTSD can result if the person was in danger, witnessed the danger, learned that a family member or close friend was exposed to violent or accidental trauma. Most common causes of PTSD are war, severe childhood emotional, physical, or sexual abuse, neglect, betrayal, experiencing or witnessing violence, rape, catastrophic injuries or illnesses, and natural disasters (Levine, 2008). PTSD contains specific criteria in order to be considered a mental disorder.

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Posttraumatic stress disorder (PTSD) has been in literature since Homer wrote about Achilles from Iliad. Achilles described of characteristics posttraumatic stress after killing Hector and dragging his body in front of Troy. Achilles described having nightmares and reoccurring thoughts that were triggered by the traumatic event of losing a close comrade. The strongest link between substance use disorder and any other mental health diagnoses is PTSD. So much so, there is a stronger correlation between trauma and substance use disorder than between obesity and diabetes.

Symptoms are congruent among most people with PTSD regardless of the type of trauma they were exposed to. Repeated compulsive and interfering stressful memories of the distressing occurrence is common among those with PTSD (APA, 2012). Repeated nightmares or disturbing dreams that reflect the traumatic event are reported to occur frequently (APA, 2012). Flashbacks or disassociation is often triggered in which the affected person presents as the event was reoccurring (APA, 2012). According to O’Brien (2012), triggers that bring about internal or external cues can startle the individual generate fear and helplessness surrounding the event or qualities of the traumatic event (Bloomberg, 2012).

Because of the occurrence of flashbacks, nightmares, and compulsive memories people with PTSD struggle with day-to-day life. Further symptoms such as anger, hyper arousal, avoidance, guilt, emotional numbing, and dysphoria are all symptoms of PTSD (Bloomberg, 2012). Cognitive irregularities are common with PTSD. The inability to remember an important aspect of the traumatic event is the result of way the brain perceives the threat. Beginning with the thalamus the brain decides whether or not the perceived threat is dangerous. If the thalamus determines it is safe, the brain will transfer the perception to the visual cortex to be sorted appropriately. However, if the thalamus decides that the perception is determined to be dangerous the visual cortex will be bypassed and the amygdala will be activated to produce a flight, fight, or freeze response (Bloomberg, 2012). PTSD affects memory, the amygdala, the prefrontal cortex and the hippocampus.

The activation of the amygdala will produce an influx of hormones and changes in body that will supersede memory-producing chemicals, which will produce temporary amnesia from specific details about the event. PTSD occurs when the amygdala may respond when it is not needed or responds to the wrong situation e.g. a car backfiring (Bloomberg, 2012). Also, the Medial prefrontal cortex is affected. This is the part of the brain in between the two hemispheres involved in regulating emotions and involved in remembering and learning. The process of extinction doesn’t occur normally with some of the PTSD. Less activation implies difficulty with emotional regulation (Bloomberg, 2012). Ivan Pavlov described this process as fear conditioning which corresponds to classical conditioning (Broomberg, 2003). Fear conditioning is associated to the amygdala. When the amygdala sends signals to the hippocampus, which then creates spatial memory. If this process is bypassed and the hippocampus does not create meaning behind the event then extinction is unable to occur, because the traumatic event then becomes somatic (Bloomberg, 2003).

Hyperarousal is found in bodily responses when the amygdala is responding when it is not necessary (Hermann, 1997). The bodily responses are an increase in heart rate, sweating, difficulty breathing (rapid, shallow, panting, etc.), cold sweats, tingling, and muscular tension. It can also manifest as a mental process in the form of increased repetitious thoughts, racing mind, and worry (Levine, 2008). Constriction is when the person’s nervous system shuts down to preserve energy and Blood vessels in the skin, extremities, and organs constrict so that more blood is offered to the muscles, which are tensed and equipped to yield protecting action (Levine, 2008). This is often referred to the fight / flight / freeze / submit mechanism of survival. When the body doesn’t have an opportunity to execute the neurological reponse of flight or flight, physiological saturation of cortisol can have a devastating impact on the individual. Contemporary understanding of PTSD has now begun to validate the claims of psychologists of the nineteenth century.
PTSD is one of the better-understood mental disorders because of the advances in medical imaging. Three tools that are used are functional magnetic residence imaging, PET SCANNING, topography. Treatment for PTSD has found some success in anti-depressants and SSRI’s while placebo is still a factor. Exposure therapy and virtual reality have been used to provide behavioral therapy. Exposure therapy is learning the cues to fear and learning to reframe the brain to induce extinction and resilience. The process of extinction doesn’t occur normally with someone with PTSD (Bloomberg, 2012). Less activation implies difficulty with emotional regulation. They have been proven to be effective treatments for desensitization individuals from external cues and re-strategizing how to manage internal cues. The closer to the traumatic event that the individual receives treatment, the more quickly they are to have reduced symptoms (Herman, 1997).

Individuals in recovery will often recognize that stress is one of the strongest indicators of stress. Unless someone addresses childhood their likelihood of relapse is higher. Approximately 67% of individuals that identify as addicts/ alcoholics report some form of trauma. Trauma isn’t limited to physical violence, sexual abuse or natural disasters; trauma is exposure to any condition that overwhelms our coping capacity. Therapies such as equine-assisted therapy, existential adventure therapy, music/ art therapy, therapeutic letters/ journaling, breath workand trauma eggs have been extremely beneficial for me personally. In addition to exposure and cognitive therapy, eye movement desensitization and reprocessing (EMDR), somatic experiencing (SE) and psychodrama (group work) seem to be the most effective ways of bypassing the psyche’s protective barriers and reaching the subcortical imprints of trauma. Trauma is preverbal, which is indicative more experimental therapies will be more effective in treating trauma as the language center of the brain shuts down (left side) creating disorganized sequences with an inability to interpret feelings into words (Van Der Kolk, 2015). As Judy Crane, co-owner and founder of The Guest House says “ We Are Not Bad People Trying to Be Good, We Are Wounded People Trying to Heal.” Creating a safe space is the first step of recovery for trauma. From there the goal is to acknowledge, experience and normalize the emotions and cognitions associated with the trauma at a pace that is safe and manageable(Luxenberg, Spinazzola, Hildago, Hunt and van der Kolk, 2001). Reconnection and resiliency training allow for post traumatic growth. Survivors of trauma will transition from surviving to thriving.

Going into the innermost cave of trauma can be daunting. You don’t have to go it alone.

References:

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington, DC: Author.

Bloomberg. (2012) Brain series 2: post-traumatic stress disorder. http://www.bloomberg.com/. Retrieved October 13, 2014, from http://www.bloomberg.com/video/brain-series-2-post-traumatic-stress-disorder-gYkw_DaiTDOOYnroPZGATQ.html (Links to an external site.)

Bromberg, Philip M. (2003). “Something wicked this way comes: Trauma, dissociation, and conflict: The space where psychoanalysis, cognitive science, and neuroscience overlap”. Psychoanalytic Psychology20 (3): 558–74. doi:10.1037/0736-9735.20.3.558

Corsini & Wedding, R. J. (Eds.) (2014). Current psychotherapies. (10th ed). Belmont, CA: Brooks/Cole.

Herman, J. L. (1997). Trauma and recovery (Rev. ed.). New York: BasicBooks.

Garami, J., Valikhani, A., Parkes, D., Haber, P., Mahlberg, J., Misiak, B., … &Moustafa, A. A. (2019). Examining perceived stress, childhood trauma and interpersonal trauma in individuals with drug addiction. Psychological reports, 122(2), 433-450.

Levine, P. A. (2008). Healing trauma: a pioneering program for restoring the wisdom of your body. Boulder, Colo.: Sounds True ;.

Luxenberg, T., Spinazzola, J., Hidalgo, J., Hunt, C., & van der Kolk, B. A. (2001). Complex Trauma and Disorders of Extreme Stress (DESNOS) Diagnosis, Part I: Assessment. Directions in Psychiatry, 21, (395-415).

Minchin, E. (2001). Homer and the resources of memory: some applications of cognitive theory to the Iliad and the Odyssey (p. x). Oxford: Oxford University Press.

Van der Kolk, B. A. (2015). The body keeps the score: Brain, mind, and body in the healing of trauma. Penguin Books.

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