PTSD occurs when the brain has lowered its setpoint for alarm due to traumatic experiences, making emergencies out of anything remotely resembling either a single, impactful traumatic event or prolonged periods of suffering cruelties.
PTSD also generally stems from traumatic events in which the victim felt helpless. The helplessness is part of what makes the initial traumatic event so overwhelming to the limbic system -- it increases the strength of the emotion because the brain feels like there’s no action to take.
Here’s how PTSD affects the brain:
- Key changes in a brain affected by PTSD happen in a structure that regulates adrenaline and noradrenaline, which are emergency hormones. This system turns hyperactive in PTSD, releasing extremely large doses of those hormones in situations that pose little to no threat to the person but resemble the traumatic event.
- But not only does the brain go into hyperactive threat mode as a result of PTSD, the opioid system in the brain also becomes hyperactive. In a healthy brain, the opioid system secretes endorphins to dull any feelings of pain. When this system goes into overdrive, not only does it dull feelings of pain, but also of pleasure, and emotion in general. This creates the numbness and emotional distance that many PTSD victims feel.
- These two changes together seem to increase the likelihood that a person will be further traumatized, since the changes increase the number of emergency alerts while decreasing any positive feeling or connection to the outside world that might offset the emergency.
Recovery from Trauma
But we can learn to handle our emotions better, as we already know, and PTSD victims can, with treatment, relearn a different, more normal response to their specific triggers. The amygdala will always retain its response to that initial emergency alert, but victims can work on developing an ability to suppress the emergency alert through their rational mind.
Trauma sticks on an unconscious level, so a great way to work through trauma is through art, which also deals with the unconscious. (Shortform note: Goleman does not go into detail as to how art can be used in therapy for this purpose, but there are plenty of good books out there on art and drama as therapeutic techniques.)
Children have an easier time relearning responses to traumatic events. Because their brains are still forming, they can use a wider variety of tools to relearn responses -- tools like games, dreams, fantasy, and play.
- In 1989, Patrick Purdy, a white supremacist with a criminal record, opened fire with an automatic weapon on Cleveland Elementary School in Stockton, CA. He killed 5 children and wounded 30 others, then shot himself in the head. Children who had survived the attack began playing a recess game called “Purdy,” where one student would be Purdy and try to kill the other students. Sometimes “Purdy” would kill everybody; sometimes the others would kill “Purdy.”
- This game allowed the survivors to replay the event safely, repeating the traumatic event in a low-anxiety setting and desensitizing themselves to it. It also allowed them to change the outcome of the tragedy, giving them a sense of control over the event instead of the helplessness they felt at the time.
There are 3 stages of recovering from trauma:
- Regaining a sense of safety.
- This stage is about calming the triggered emotional circuits enough to be able to relearn a response.
- PTSD victims, during the traumatic event and in the episodes after, feel as though they are not in control of their emotions or bodies -- so ideally, patients would find a way to regain a sense of control over what is currently happening to them. Medication can help in this arena -- antidepressants help control the activation of the sympathetic nervous system.
- Relaxation techniques are another good tactic, allowing patients to counter the anxiety and agitation of triggered emotional circuits and find a sense of safety.
- Reviewing the details of the trauma and mourning the loss it resulted in.
- Retelling or revisiting the traumatic event in great detail in a safe environment allows patients to come to a more realistic understanding of the memory, as well as their response to it. Therapy helps them do this.
- Putting memories into words is, in a sense, gaining control over them and transferring them from the feeling system to the thinking system.
- Mentally reliving the traumatic event in a safe environment can teach the brain that those two things -- safety and the traumatic event -- can happen at the same time.
- Trauma always results in loss, so mourning is necessary. Mourning any loss is about acknowledging why that person or thing was important, and beginning to let go of the lost thing. Mourning in relation to a traumatic event can help to let go of the trauma itself.
- Reestablishing a more normal life.
- Once a patient has reduced their physiological symptoms, feels more in control of how they respond to it, and can revisit the traumatic memory voluntarily or put it aside if they choose to, then the patient can start to rebuild their life and reinvest in strong relationships built on trust.
Once we’ve learned an emotional response to something, the emotion hardly ever changes or goes away -- but we can learn to control that emotion and how we let it affect our actions.
This is why people have patterns that show up regardless of the situation -- for instance, if we feel emotionally neglected by our parents and learn to hide our emotions to avoid the feeling of rejection, then as adults we will respond to any perceived neglect by hiding our emotions, whether the person neglecting our feelings is our boss, our spouse, or our children.
If PTSD patients can relearn their responses to traumatic events, than people with less intense but still impactful negative memories can also relearn how to respond. Psychotherapy can help in both instances.
- In one study, psychotherapy was just as effective as Prozac in treating patients with obsessive compulsive disorders -- both sets of PET scans showed a significant decrease in activity in the emotional center of the brain.