Trauma and Emotional Relearning

The title of this post is identical to the title of a chapter in Daniel Goleman’s book “Emotional Intelligence.” The primary topic of this chapter is the frequently discussed and written about Post Traumatic Stress Disorder (PTSD). PTSD is a disorder of the limbic system. The main symptoms of such learned fearfulness, including the most intense kind, can be accounted for by changes in the limbic circuitry focusing on the amygdala. Some key changes are in the locus ceruleus, a structure that regulates the brain’s secretion of two substances called catecholamines: adrenaline and noradrenaline. The neurochemicals mobilize the body for any emergency; the same catecholamine surge stamps memories with special strength. This system becomes hyperactive in PTSD, secreting extra-large doses of these brain chemicals in response to situations that hold little or no threats, but somehow are reminders of the original trauma.

The locus ceruleus and the amygdala are closely linked, along with other limbic structures such as the hippocampus and hypothalamus; the circuitry for the catecholamines extends into the cortex. Changes in the circuits are thought to underlie PTSD symptoms, which include anxiety, fear, hyper vigilance, being easily upset and aroused, readiness for fight or flight, and the indelible encoding of intense emotional memories. One study found that Vietnam vets with PTSD had 40% fewer catecholamine-stopping receptors than did men without the symptoms, suggesting that their brains had undergone a lasting change, with their catecholamine secretion poorly controlled.

Other changes occur in the circuit linking the limbic brain with the pituitary gland, which regulates the release of CRF, the main stress hormone the body secretes to mobilize the emergency fight-or-flight response. The changes lead this hormone to be overselected—particularly in the amygdala, hippocampus and locus ceruleus—alerting the body for an emergency that is not there in reality.

A third set of changes occurs in the brain’s opiod system, which secretes endorphins to blunt the feeling of pain. It also becomes hyperactive. This neural circuit again involves the amygdala, this time in concert with a region in the cerebral cortex. The opioids are powerful numbing agents, like opium and other narcotics that are chemical cousins. When experiencing high levels of opioids, people have a heightened tolerance for pain.

Something similar seems to occur in PTSD. Endorphin changes add a new dimension to the neural mix triggered by preexposure to trauma: a numbing of certain feelings. This seems to explain a set of “negative” psychological symptoms long noted in PTSD: anhedonia and a general emotional numbness, a sense of being cut off from life or from concern about others’ feelings. Those close to such people may experience this indifference as a lack of empathy. Another possible effect may be dissociation, which includes the inability to remember crucial minutes, hours, or even days of the traumatic event.

The neural changes of PTSD also seem to make a person more susceptible to further traumatizing. A number of studies with animals have found that when they were exposed even to mild stress when young, they were far more vulnerable than unstressed animals to trauma -induced brain changes later in life. This seems to be a reason that, exposed to the same catastrophe, one person goes on to develop PTSD, and another does not: the amygdala is primed to find danger, and when life presents it once again wth real danger, the alarm rises to a higher pitch.

All these neural changes offer short-term advantages for dealing with the the grim and dire angers that prompt them. However, these short-term advantages become a lasting problem when the brain changes so that they become predispositions, like a car stuck in high gear. The amygdala and its connected brain regions take on a new set point during a moment of intense trauma.

Dr. Judith Lewis Herman is a Harvard psychiatrist whose groundbreaking work outlines the steps to recovery from trauma. The first step is regaining a sense of safety, presumably translates to finding ways to calm the too-fearful, too easily triggered emotions circuits enough to allow relearning. Typically this begins with helping parties understand that their jumpiness and nightmares, hyper vigilance and panics, are part of the symptoms of PTSD. The understanding makes the symptoms themselves less frightening.

The sense in which PTSD patients feel “unsafe” goes beyond fears that dangers lurk all around them: their insecurity begins more intimately in the feeling that they have no control over what is happening in their body and to their emotions. This is understandable, given the hair-trigger for emotional hijacking that PTSD creates by hyper sensitizing the amygdala circuitry.

Medication offers some way to restore patients’ sense that they need not be so at the mercy of the emotional alarms that flood them with anxiety, keep them sleepless, or pepper their sleep with nightmares. Unfortunately, today’s medications preclude doing exactly what they would like to achieve. For now, there are medications that counter only some of the needed changes, notably the antidepressants that act on the serotonin system and beta-blockers like propanol, which block the activation of the sympathetic nervous system.

Patients also may learn relaxation techniques that give them the ability to counter their edginess and nervousness. A physiological calm opens a window for helping the brutalized emotional circuitry rediscover that life is not a threat and for giving back to patients some of the sense of security they had in their lives before the trauma occurred.

Another step in healing involves retelling and reconstructing the story of the trauma in the harbor of that safety, allowing the emotional circuitry to acquire a new, more realistic understanding of and response to the traumatic memory and its triggers. As patients retell the horrific details of the trauma, the memory starts to be transformed, both in its emotional meaning and in its effects on the emotional brain. The pace of this retelling is delicate; ideally it mimics the pace that occurs naturally in those people who are able to recover from trauma without suffering PTSD. In these cases there often seems to be an inner close that “doses” people with intrusive memories that relive the trauma, intercut with weeks or months when they remember hardly anything of the horrible events.

To summarize, psychotherapy serves as an emotion tutorial.

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