Thursday, December 21, 2006

Cognitive Effects of Trauma and PTSD

Typical cognitive effects after a traumatic experience:
-Recurring intrusive thoughts
-Memory lapses
-Difficulty with focus, concentration and sustained attention

It is difficult for a person who is traumatized to learn new things. There is a sense of being scattered, distracted and unable to focus on work or daily activities. Making even simple decisions might seem overwelming.

Feeling overwhelmed: It can be difficult to sort out relevant matters from the daily bombardment of information.

Negative perceptions: The world seems threatening after a traumatizing experience. Partly this is due to flashbacks and environmental triggers. There is also a bias toward noticing things that are worrisome or frightening.

Recurring memories and nightmares replay the same experience, over and over again. Research by Bessel van der Kolk observed that the content of the nightmares of veterans with PTSD stayed the same for 15 years.

Unlike normal, narrative memories, which fade over time, traumatic memories remain fixed, timeless and contemporary, delivering the same dramatic punch every time.

Why do our brains work this way? The flood of hormones in response to trauma both gives us the energy to fight/flee danger and imprints the memory of that trauma in order to create a once-and-forver learning experience. It is a survival mechanism, so that if a similar danger comes again, we will be wired to instantly react.

Traumatic memories are processed and stored differently than memories of ordinary events. "Normal" memories are encoded verbally, and thereby can be verbally communicated to others afterwards. But traumatic memories are experienced as emotions, sensations and physical states.

The trauma survivor faces an odd contradiction. The memories are so vivid, rich with emotional and sensory details. Yet it's difficult to put words to these experiences, to make cognitive sense out of them.

The phrase "speechless terror" is not a hyperbole; people literally cannot talk when affected in this way. PET scans demonstrate the physiological basis of this phenomenon: during flashbacks, oxygen levels and the verbal centers of the brain are affected.

Naparstek, Belleruth. Invisible Heroes. NY: Bantam Bell, 2004.

Wednesday, December 20, 2006

Physical effects of PTSD

In post-traumatic stress disorder, the cycling back between fight/flight and freezing continues and becames a self-sustaining feedback circuit. The cycle takes on a life of its own.

This pattern becomes imprinted in the neural networks, initially underground but eventually as a self-perpetuating system. If left unchecked, symptoms become increasingly entrenched, and often worsen.

PTSD can be immediately triggered by:
-Spontaneous memories

PSTD might become activated from even vaguely related cues of the initial threat, such as a loud noise, a reminiscent smell, a movement from the corner of the eye, a familiar building or the shadow of a person approaching from behind.

Constant activation of the body's alarm system can lead to several physical complaints. Because these conditions are generated in the brain stem, peripheral forms of treatment provide only temporary relief.

This is why, for the PTSD victim, it's difficult to distinguish between physical compaints and their psychological underpinnings.

Naparstek, Belleruth. Invisible Heroes. NY: Bantam Bell, 2004.

Tuesday, December 19, 2006

Physical Effects of Trauma

Bear with me here... In my next series of blog entries, I will explore the physical, cognitive, emotional and behavioral effects of trauma and PTSD, one by one. Then, I will share some helpful techniques.

Physical effects of trauma:
1.) Immediate response: Restlessness, hypervigilance, sleep issues, generalized anxiety, inability to relax, shallow breathing, fatigue and an exaggerated startle response at trigger events, sudden noises and/or unexpected touch.

Can also include headaches, backaches, TMJ, skin complaints such as itching or rashes and unintentional weigh loss.

2.) Weeks following a traumatic experience: Body remains on alert, reacting to neutral cues in the environment as if they are dire warnings, threats of annihilation.

3.) If chronic post-traumatic stress sets in: Survivors often manifest functional diseases such as chronic fatigue syndrome, irritable bowel syndrome, fibromyalgia, interstitial cystitis, and myofacial, lower back and pelvic pain.

What happens to the body during a traumatic event?
1.) Blasted by biochemicals: The body has a built-in reaction to physical threat.

A small structure within the brain called the amygdala is the storehouse of emotional memory, and it is instantly activated when we sense danger. Interestingly enough, laboratory rats with surgically-removed amygdala are fearless. They are also vulnerable and reckless, with very short life spans.

The amygdala does not wait for instructions from the conscious, thinking portions of the brain to act. It has an enormous capacity to commander our brains, and override the neocortex (which is designed to analyze detailed information and formulate an apporopriate response).

The amygdala jolts the hypthalmus, which produces a hormone called CRF, which signals the pituitary and adrenal glands to flood the bloodstream with stress hormones: epinephrine, norepinephrine and cortisol.

This results in hyperalertness, a flood of energy and the "fight or flight response."

Endorphins are released as well. These are our body's pain-killing neurotransmitters. They ensure our physical survival by making sure that pain doesn't interfere with our ability to act immediately.

2.) Freeze response: This is the immobility response. When an animal is overtaken in the wild, fight-or-flight seems pointless and there is nothing proactive that can be done to save the day. So, the animal collapses and becomes limp, even before it is seized.

At this point, the body receives even more pain-killing endorphins to inhibit wound-licking and other behaviors that could interfere with one last-ditch, life-saving effort on the animal's part.

The body has rebounded from the tension of alarm to its polar opposite: the state of near-paralysis. Tense muscles relax, blood pressure takes a step dive and the racing heart slows down to a crawl.

In the wild, this can help the animal by "playing possum" or by preventing a painful death. If the animal (or person) survives, this biochemical overload has an aftereffect. Almost all animals start to shudder and tremble, to perspire for several minutes and then to take a series of short deep breaths.

Rabbits can do this several times in one day, and shake it off afterwards. People differ from animals in that we don't automatically discharge the biochemicals. It's been hypothesized that we humans don't shake, perspire or take enough deep breaths afterward.

3.) Disassociation: When people freeze, they also disassociate. They "flee the scene" psychically by becoming emotionally disconnected from what is happening.

Afterwards, people tend to blame themselves for their detachment, and assign a negative meaning to it.

Naparstek, Belleruth. Invisible Heroes. NY: Bantam Bell, 2004.

Saturday, December 16, 2006

Lack of predictability and loss of control

We all structure our lives based on certain assumptions. When children enter foster care, this creates a sense of loss of safety, where "nothing makes sense anymore."

Consciously or unconsciously, a child might cling to ideas like, "If I do A, then B will happen." For me, it was, "If I am smart enough, pretty enough, talented enough, then maybe my father will come back for me."

This makes sense, because our self esteem is bound up in our belief that we can impact the world. Watch an 18-month old child knock over a tower of blocks; he will be compelled to do it again and again, because he's discovering that he is prime mover; he can make things happen.

Because it is built into our hard wiring to love ourselves for being able to make things happen, the converse is also true; we lose self-regard when things happen that are out of our control.

Rational or not, we can't help but feel it's a reflection on our worthiness when a terrifying event comes, and we are unable to prevent it, escape it or fix it. If the trauma is somehow our fault, then the world still makes sense. As a result, we feel guilty and ashamed.

Trauma creates a sense of helplessness, powerlessness and inadequacy.

Left unchecked, that sense of inadequacy can haunt a person (off and on, at intervals) for the rest of their lives.

Naparstek, Belleruth. Invisible Heroes: Survivors of Trauma and How They Heal. NY: Bantam Bell, 2004.