Trauma——how do we understand it
Trauma is due to the overactivation of fear, necessary for surviving, but unnecessary for living.
It’s extremely hard to tell your brain it’s safe because it’s not easy to be convinced, it needs to witness.
It happened, and you know it happened in the past, but its influences are still present.
Fear & Not Fear ——Two Circuits and one treatment
Mind & Body——From your brain to your muscle
Shame & Guilt——From hiding to avoiding
Past & Now——From hurting to healing
Areas of the brain that are affected by Traumas, PTSD, Complex Traumas, and why you feel certain ways
The hippocampus: This area of the brain is responsible for forming and consolidating memories, and it can be particularly vulnerable to trauma. Damage to the hippocampus can lead to memory problems, including difficulty forming new memories and recalling past experiences.
The amygdala: This area of the brain is responsible for processing emotions, and it can become overactive in response to trauma. This can lead to symptoms such as anxiety, fear, and a heightened startle response.
The prefrontal cortex: This area of the brain is responsible for decision-making, planning, and regulating emotions. Trauma can lead to changes in the activity of the prefrontal cortex, which can contribute to symptoms such as impulsivity, difficulty with decision-making, and problems regulating emotions.
The hypothalamic-pituitary-adrenal (HPA) axis: This is a complex system that controls the body's response to stress. Trauma can lead to changes in the HPA axis, which can contribute to symptoms such as depression, anxiety, and sleep disturbances.
The cingulate cortex: This area of the brain is involved in regulating emotions and controlling pain. Trauma can lead to changes in the cingulate cortex, which can contribute to symptoms such as chronic pain, irritability, and difficulty regulating emotions.
The insula: This area of the brain is involved in the perception of emotions and physical sensations. Trauma can lead to changes in the insula, which can contribute to symptoms such as dissociation, depersonalization, and heightened sensitivity to physical sensations.
The ventromedial prefrontal cortex: This area of the brain is involved in regulating emotions and social interactions. Trauma can lead to changes in the ventromedial prefrontal cortex, which can contribute to symptoms such as difficulty forming attachments and trust, social isolation, and difficulty regulating emotions.
The brainstem: This area of the brain is responsible for basic life-sustaining functions such as heart rate and breathing. Trauma can lead to changes in the brainstem, which can contribute to symptoms such as sleep disturbances, changes in appetite, and a heightened startle response.
Therapies I use accordingly:
Cognitive Behavioral Therapy (CBT): This approach focuses on identifying and changing negative thoughts and behaviors that are associated with the trauma. CBT can help individuals understand how their thoughts and behaviors are impacting their mental health, and teach them new ways of coping with their trauma.
Trauma-Focused Cognitive Behavioral Therapy (TF-CBT): This is a type of CBT that specifically targets the emotional and behavioral problems that can result from trauma. It often includes a parent/caregiver component, teaching them how to support the child, and a family therapy component.
Cognitive Processing Therapy (CPT) is a form of cognitive behavioral therapy that is specifically designed to treat trauma and post-traumatic stress disorder (PTSD). CPT helps individuals understand and process their traumatic experiences in a way that allows them to integrate their traumatic memories into their overall life story, rather than continuing to be dominated by them.
Supportive therapy: This approach provides individuals with a safe, non-judgmental space to talk about their trauma and receive emotional support. This type of therapy can be particularly helpful for people who are not ready to delve into the trauma itself but need to build trust and a sense of safety to be able to engage in other types of therapy.
Prolonged Exposure (PE): This approach helps individuals confront and work through their traumatic memories in a safe and controlled environment. PE can help individuals reduce their fear and anxiety related to their trauma.
Somatic Experiencing (SE): This approach focuses on addressing the physiological effects of trauma on the body. SE can help individuals learn how to self-regulate their nervous system and reduce the chronic stress response that can result from trauma.
Medications (not provided): Certain medications, such as antidepressants and alpha or beta blockers, can be helpful in treating trauma symptoms, particularly symptoms of depression, anxiety, and insomnia.
DSM-5 Core Symptoms for PTSD (accidents/family/relationship)
Criterion A (one required): The person was exposed to: death, threatened death, actual or threatened serious injury, or actual or threatened sexual violence, in the following way(s):
Direct exposure
Witnessing the trauma
Learning that a relative or close friend was exposed to a trauma
Indirect exposure to aversive details of the trauma, usually in the course of professional duties (e.g., first responders, medics)
Criterion B (one required): The traumatic event is persistently re-experienced, in the following way(s):
Unwanted upsetting memories
Nightmares
Flashbacks
Emotional distress after exposure to traumatic reminders
Physical reactivity after exposure to traumatic reminders
Criterion C (one required): Avoidance of trauma-related stimuli after the trauma, in the following way(s):
Trauma-related thoughts or feelings
Trauma-related reminders
Criterion D (two required): Negative thoughts or feelings that began or worsened after the trauma, in the following way(s):
Inability to recall key features of the trauma
Overly negative thoughts and assumptions about oneself or the world
Exaggerated blame of self or others for causing the trauma
Negative affect
Decreased interest in activities
Feeling isolated
Difficulty experiencing positive affect
Criterion E (two required): Trauma-related arousal and reactivity that began or worsened after the trauma, in the following way(s):
Irritability or aggression
Risky or destructive behavior
Hypervigilance
Heightened startle reaction
Difficulty concentrating
Difficulty sleeping
Avoidance, avoidance, and avoidance
Three things can both cause & result from the avoidance: Fear, Shame & Guilt, and Disassociation
Trauma and Fear
How so
Fear is a common factor that drives trauma-related avoidance behaviors. When an individual experiences a traumatic event, they may develop a sense of fear and danger in response to the trauma. This fear can be associated with particular stimuli, such as places, people, or activities that remind the individual of the trauma. As a result, the individual may develop avoidance behaviors in an effort to avoid these triggers and the associated feelings of fear and distress.
Why
Avoidance behaviors can provide temporary relief from the distress associated with the trauma, but they also reinforce the individual's sense of fear and vulnerability, making it more difficult for them to recover from the trauma in the long term. The more individuals avoid their fears, the more powerful and persistent those fears become, making it harder for the individual to face their fears and overcome them.
The periaqueductal gray (PAG) is a region of the brain that plays a role in the regulation of fear and avoidance behaviors. The PAG is a complex network of neurons that is involved in the processing of pain, anxiety, and stress responses and is thought to play a key role in the development of trauma-related avoidance behaviors.
Studies have shown that the PAG is activated in response to traumatic or stressful events and that this activation can lead to the development of fear-based avoidance behaviors. When the PAG is activated, it sends signals to other brain regions, such as the amygdala, that play a role in the regulation of fear and emotional responses. This can result in the development of fear memories and avoidance behaviors that are associated with the traumatic event.
Research has also shown that the PAG is involved in the regulation of defensive behaviors, such as freezing and fight or flight responses, which are often seen in individuals who have experienced trauma. In some cases, the PAG can become over-activated in response to trauma, leading to an increase in fear and avoidance behaviors.
Trauma and Shame & Guilt
How so
Relationship trauma can cause feelings of shame and guilt because it often involves experiences of hurt, betrayal, or abandonment by someone significant in one's life, such as a partner, family member, or friend. This can leave an individual feeling that they were at fault for the trauma, or that they should have been able to prevent it from happening.
For example, if someone experiences abuse or neglect from a partner, they may feel shame and guilt for staying in the relationship, or for not leaving sooner. If someone experiences abandonment or rejection by a family member or friend, they may feel shame and guilt for not being good enough or for doing something to cause the rejection.
These feelings of shame and guilt can have long-lasting effects, impacting an individual's self-esteem and relationships. They may also interfere with an individual's ability to heal from the trauma and move on, leading to persistent feelings of distress and vulnerability.
Why
Shame is a complex emotion that has both biological and psychological roots. It is a basic human emotion that is evolutionarily wired into our nervous system as a way of regulating social behavior and promoting social cohesion.
At a biological level, the experience of shame is thought to be related to the activation of the "social pain" circuitry in the brain. This circuitry, which includes the anterior cingulate cortex and the insula, is also activated in response to physical pain and social rejection. The activation of this circuitry leads to feelings of discomfort and a desire to hide or withdraw from others.
At a psychological level, shame arises from our internal sense of self and our social relationships. It is often triggered by experiences or beliefs that we have failed to meet our own standards or the standards of others. For example, if someone feels that they have made a mistake or failed to meet a personal or societal expectation, they may feel ashamed.
Culture, family, and personal experiences also play a role in shaping our sense of shame and the situations that trigger it. Some individuals are more prone to experiencing shame than others, based on their personality and upbringing, and may feel shame more easily or in response to a wider range of situations.
It's important to note that shame is a normal and sometimes useful emotion, but excessive or persistent feelings of shame can have negative impacts on an individual's well-being, self-esteem, and relationships.
Trauma and Disassociation
How so
Disassociation is a defense mechanism that can occur in response to traumatic events. It is a process by which the individual disconnects from their thoughts, emotions, memories, or sense of identity, in order to avoid overwhelming feelings of distress. Disassociation can manifest in a variety of ways, including feeling detached from one's body or surroundings, having memory lapses or gaps in time, or feeling as though one is observing oneself from a distance.
Why
In the context of trauma, disassociation can be understood as a coping strategy that helps the individual to tolerate and survive traumatic experiences. The process of disassociation is thought to be related to changes in the activity of specific brain regions, including the amygdala and the hippocampus, which play a key role in the regulation of emotions and the formation of memories. When a person is exposed to a traumatic event, the amygdala is activated, triggering the release of stress hormones, such as cortisol and adrenaline. If the traumatic event is perceived as particularly threatening, the amygdala may become over-activated, leading to an increase in feelings of distress and anxiety. In this situation, disassociation can occur as a way of reducing the impact of the trauma on the individual's emotional state.
While disassociation can be a useful coping mechanism in the short term, it can also have negative effects if it persists for a long period of time. Chronic disassociation can interfere with the individual's ability to form and maintain relationships, as well as to cope with everyday stressors. It can also increase the risk of developing mental health conditions, such as depression, anxiety, and post-traumatic stress disorder (PTSD).
What can I do
Since disassociation is your mind disconnecting from your body, the solution is to reconnect. Reconnect your mind with your body senses, the present senses, not the past, not the future. Senses can only happen right now. Trauma-focused therapies aim to help you process and integrate your traumatic experiences, reducing the severity and frequency of disassociative symptoms. Other strategies that can be helpful in reducing disassociation include mindfulness practices, such as meditation and yoga, and self-care activities, such as getting regular exercise and sleep.
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References:
Stahl, S. M. (2021). Stahl's essential psychopharmacology: neuroscientific basis and practical applications. Cambridge university press.
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.).