After severe trauma and the development of post-traumatic stress disorder (PTSD), one of the main symptoms the sufferer has to contend with often things which, in themselves, are not at all threatening can strike terror into the heart of the individual as, in his/her own mind, they are connected to, and re-trigger responses to, the original trauma. Psychologists often refer to this process as fear conditioning.
In normal circumstances, when a person learns to be afraid of something through the process of fear conditions, as time goes on the fear will become less intense and fade away. In psychological terminology, the fear gradually becomes extinguished. However, research by the psychologist Charney reveals that in those affected by PTSD, the necessary learning process required to extinguish the fear does not occur. This results in disturbing memories relating to the trauma persisting, in the absence of treatment for many, many years.
However, if the person affected by PTSD undergoes the right experiences in a treatment program, these disturbing memories CAN be made to loosen their grip upon the individual and become manageable, as, indeed, can the thought processes and reactions that these memories trigger.
In terms of brain activity, the fear generated by the brain structure known as the AMYGDALA can be suppressed by greater activity being generated in another brain structure known as the PREFRONTAL CORTEX. How therapy makes this happen I describe below :
Even the symptoms caused by the most severe trauma imaginable can be overcome (incredibly, studies have revealed even Holocaust survivors have recovered from the PTSD caused by their horrific experiences). The key to recovery appears to be by undergoing a process of relearning.
Dr Judith Herman, an expert in the field of trauma recovery, from Harvard University in the USA, suggests that there are three key phases of recovery. These are ;
1) attaining a sense of safety
2) remembering the details of the trauma and mourning the losses that have occurred because of it
3) re-establishing a normal life
Let’s look at each of these steps in turn :
STEP 1 – ATTAINING A SENSE OF SAFETY : this involves aiding the patient in the understanding that his/her feelings of intense anxiety, fear, nightmares, panic, terror etc are due to the condition s/he is suffering, namely PTSD, and are occurring due to brain dysfunction (which can be treated) rather than because there is any real, present threat or danger. By getting the PTSD sufferer to view his/her symptoms from this angle, these symptoms become less frightening.
Also during this initial step, the therapist can help the PTSD sufferer see that although s/he feels helpless (feeling helpless is one of the main symptoms of PTSD), this is not the case (for example, s/he has already started to take control by seeking therapy for the PTSD).
Furthermore, during this first stage of attaining a greater sense of safety and calm, there is the option of medication for symptoms such as intense anxiety and nightmares. Antidepressants which act on the neurotransmitter serotonin in the brain are one option. A second option is the beta-blocker PROPRANOPOL (I was prescribed this drug and still take it; I have definitely found it to be helpful) which reduces activity in the sympathetic nervous system and reduces agitation; new research on the latter drug is giving very encouraging results.
There is also the option of teaching the PTSD sufferer relaxation techniques such as meditation and self-hypnosis.
STEP 2 – REMEMBERING THE DETAILS OF THE TRAUMA AND MOURNING THE LOSSES WHICH HAVE OCCURRED BECAUSE OF IT : once a relatively calm state and greater sense of safety and security has been attained by the individual suffering from PTSD, the second stage of the therapy can be implemented; this involves RETELLING and RESTRUCTURING the story of the trauma in a SAFE and SUPPORTIVE ENVIRONMENT. In this way, the brain’s emotional circuits develop a more realistic comprehension and response to the traumatic memory, and, also, those things that trigger the traumatic memory.
Indeed, the retelling of the trauma in a safe environment when the PTSD sufferer is relatively calm starts to change the memory itself in terms of both its emotional meaning, and, also, therefore, in terms of its effects upon the emotional brain (ie it starts to give rise to LESS distress and anxiety).
In essence, the emotional response to the trauma is RELEARNED.
The therapist encourages the PTSD sufferer to describe the traumatic memory, however horrible, in as much detail as possible and also to describe in detail the feelings that the trauma evoked. The aim is to is to encapsulate, as far as possible, the whole traumatic episode/s in words.
Why is this important? It is thought that this process of capturing what happened in words places the memory more under control of a brain structure called the NEOCORTEX; this makes the reactions the memories lead to more manageable.
Because this all takes place in a safe environment, the PTSD sufferer is able to start to associate the traumatic memory with feelings of safety and relative calm as opposed to terror.
Once this has been achieved the therapist encourages the individual to mourn what the trauma and resultant PTSD caused him/her to lose. This mourning of what has been lost marks the ability to start to let go of the trauma itself.
– STEP 3 RE-ETABLISHING A NORMAL LIFE : this final stage can now take place, in which the individual can begin to rebuild his/her life. Physiological symptoms drop to a manageable level as do feelings connected with the memory of the trauma.
I hope you have found this post helpful.
Best wishes, David Hosier BSc Hons; MSc; PGDE(FAHE).