PTSD And Physically Evaluating The Brain
Posttraumatic stress disorder (PTSD) and complex posttraumatic stress disorder (complex PTSD) can both be considered forms of brain INJURY even though the cause of the injury is extreme psychological trauma rather than a physical trauma such as a blow to the head with a hammer or car accident.
However, when psychiatrists treat PTSD with drugs, they do so, in the vast majority of cases, without looking at the organ they are treating (i.e. the brain), unlike, say, a cardiologist, who would not consider treating the heart without, first, physically evaluating it.
In relation to this, the psychiatrist Dr. Daniel Amen stresses the importance that, before prescribing psychoactive drugs in patients suffering from PTSD (and other disorders), it is vital that the patient’s brain is physically evaluated in order to help ascertain in what ways it may be behaving sub-optimally ; he argues that such physical evaluations of the brain would reduce the amount of guess work psychiatrists (who do not examine the brain) must currently employ when prescribing medications intended to beneficially alter brain function and thus ameliorate the patient’s particular symptoms.
The method Amen recommends for physically evaluating what is going on in the brains of patients seeking therapeutic intervention for their particular condition is called SPECT (Single Photon Emission Computed Tomography) imaging.
What Information Does SPECT Imaging Provide About The Brain?
SPECT imaging measures blood flow in the brain and, because this blood flow reflects brain activity, it provides three important preces of information about the brain’s functionality ; these are :
- Areas of the brain that are functioning well.
- Areas of the brain that are overactive.
- Areas of the brain that are underactive.
Armed with this information, Amen argues, the psychiatrist who makes use of SPECT imaging is in a much stronger position to tailor his / her treatment to the specific needs of the individual based upon the results of this imaging technique, whereas the psychiatrist who does not physically evaluate the brain in such a manner is forced to merely speculate what is happening in the patient’s brain, thus making his / her decisions about which psychoactive drugs need to be administered less informed and, potentially, therefore, less effective.
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David Hosier BSc Hons; MSc; PGDE(FAHE).
Signs Of PTSD In Very Young Children And Toddlers
What Are The Signs Of Posttraumatic Stress Disorder (PTSD) In Very Young Children And Toddlers?
Because the linguistic development of very young children and toddlers is so restricted, they are unable to articulate their distress in anything other than a very rudimentary way ; therefore, in order to infer whether they are suffering from PTSD, it is necessary to observe their behavior and emotional expression.
These behavioral and emotional reactions to trauma will, of course, vary between individuals, both in terms of the number displayed and their intensity. Clearly, all else being equal, the greater the number of symptoms and the more severe such symptoms are, the greater the imperative for therapeutic intervention.
Possible signs of PTSD in very young children and toddlers include the following :
Above : Brain scan showing difference between the brain of a ‘normal’ three-year-old and a severely traumatized (in this case, due to extreme neglect) three-year-old.
- disrupted sleep pattern
- physical symptoms such as stomach aches and headaches
- developmental regression ; the child may regress to an earlier stage of development and, as a result, lose some learned skills (e.g. toilet training).
- post-traumatic play : this can manifest itself as repetetive play that mirrors the events of the original trauma. For example, a child involved in a car crash may repetetively play with toy cars in a way that reenacts the accident. Also, traumatized children may dramatically reduce their ‘exploratory’ play.
- over-sensitive startle response ; the child may become extremely startled and fearful in response to unexpected events, including trivial ones that would not have bothered him before the trauma, especially, of course, if the unexpected event triggers memories (on either a conscious or unconscious level) of the original traumatizing experience.
- obsessive preoccupations ; the child may become obsessed by a particular toy or cartoon character, for example.
- acute separation anxiety ; represented as intense fear of being separated from the primary caregiver.
- self-blame ; this can manifest itself by the child developing a wholly irrational belief that the traumatic event or experience was his fault.
- reactions as if the traumatic experience is recurring, which, in extreme cases, can manifest itself losing awareness of present surroundings (also referred to as ‘dissociation’)
- habitual avoidance of activities, places and other reminders associated with the original traumatic experience
- loss of motivation to participate in activities that brought pleasure and captivated interest prior to the trauma (for example, loss of interest in playing games)
- mood changes, including outbursts of rage and anger, extreme tantrums, aggression, irratability, marked reduction in expression of positive emotions
- deterioration in relationships with significant others such as parents, caregivers and peers, increased wariness of strangers, ‘clingyness.’
- impaired concentration
- socially withdrawn behavior
- fears of things that might seem unconnected to the trauma but are actually representative and symbolic of it ; for example, a fear of an imaginary monster (that represents, on an unconscious level, someone who has harmed the child).
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David Hosier BSc Hons; MSc; PGDE(FAHE).
Does EFT Help Alleviate PTSD?
EFT stands for the emotional freedom technique and is used to treat sufferers of various disorders, including PTSD (complex posttraumatic stress disorder) and complex PTSD (and, in this article, I will be looking at its effectiveness in relation to these two disorders).
‘TAPPING’ :
EFT is also sometimes referred to as tapping for the simple reason that it involves using the tips of the fingers to tap on specific acupuncture (sometimes called acupuncture points or just acupoints) on the body.
EFT is based on the same theory as acupuncture (in which the acupuncture points are punctured with needles rather than being tapped with the finger tips) ; this theory proposes that ‘meridians’ run through the body which operate as pathways for the carrying of energy.
BLOCKAGES :
It is theorized that disease is caused by the occurrence of blockages along these meridians (or pathways) and that these blockages can be unblocked by tapping on specific points on the body (in EFT, these points are referred to as acupressure points, whereas, in acupuncture, they are referred to as acupuncture points ; in both cases, these terms can be abbreviated to acupoints). This unblocking, according to the theory, alleviates the corresponding disease.
SPECIALIZED TECHNIQUES FOR WORKING WITH TRAUMA :
Within EFT, there are three specific techniques which were devised for treating trauma. These are referred to as THE GENTLE TECHNIQUES, as described in the EFT MANUAL (Church, 2013).
EVIDENCE :
RANDOM CONTROLLED STUDIES :
In terms of evidence for EFT, a random controlled study (Church et al., 2013), involving war veterans suffering from PTSD. found that 86% significantly improved after six sessions of EFT and 80% remained significantly improved after 3 and 6 month follow-ups.
This experiment was independently replicated by Geronilla et al. (2014), and this replication obtained similarly encouraging results.
TELEPHONE EFT VERSUS ‘IN PERSON’ EFT :
On further analysis of the data obtained from Church et al.’s (2013) study (see above), it was found that telephone EFT (in which the therapist talks to, and guides, the client over the telephone and the client ‘self-administers’ the taps) led to the significant improvement of 67% of the veterans with PTSD after six sessions, compared to 91% of the veterans with PTSD who significantly improved after the same number of ‘in-person’ EFT sessions. This suggests that whilst telephone EFT can be effective, it tends, overall, not to be as effective as ‘in person’ EFT.
GROUPS :
In a study by Gurret et al. (2012), seventy-seven victims of the Haiti earthquake were given a two-day training course in EFT. It was found that, before the EFT training, 62% fulfilled the criteria for having PTSD but this fell to zero per cent after the training had been administered, providing support for the effectiveness of group EFT.
META-ANALYSIS :
A meta-analysis, conducted by Sebastian and Nelms (2016), reviewed seven studies ; findings from this analysis found evidence that EFT for those suffering from the effects of trauma can :
- regulate 72 different genes
- increase the expression of immunity genes
- decrease inflammation genes
- is as effective as CBT and EMDR
and that :
- EFT has no adverse side-effects
- the number of EFT sessions required for the effective treatment of PTSD is 4 to 10 sessions
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David Hosier BSc Hons; MSc; PGDE(FAHE).
Why Complex PTSD Sufferers May Avoid Eye Contact
A study by Lanius et al. was conducted to cast light upon why many with individuals suffering from posttraumatic stress disorder (PTSD), including those suffering from complex-PTSD, often find it excruciatingly uncomfortable every time the rules of social etiquette compel them to make eye to eye contact with another human being (I, myself once attempted to circumvent this problem by deliberately buying a pair of glasses with lenses that were by far the wrong strength for me so that, whilst, to whomever it was I was required, as the law of social norms decrees, to make eye contact, I appeared to be doing so in the conventionally stipulated manner, in fact, all that my eyes were actually meeting with was a comfortingly, non-threatening blur).
Returning to Lanius’ et al.’s experiment :
The experiment consisted of two groups :
1) Survivors of chronic trauma
2) ‘Normal’ controls
What Did The Experiment Involve?
Participants from both of the above groups were subjected to brain scans whilst a making eye to eye contact with a video character in such a way as to mimic real life face to face contact.
What Were The Results Of The Experiment?
In the case of the ‘normal’ controls (i.e. those who had NOT suffered significant trauma), the simulated eye to eye contact with the video character caused the are of the brain known as the PREFRONTAL CORTEX to become ACTIVATED.
HOWEVER:
In the case of the chronic trauma survivors, the same simulated eye contact with the video character did NOT cause activation of the PREFRONTAL CORTEX. Instead, the scans revealed that, in response to the simulated eye contact, the part of the chronic trauma survivors’ brains that WAS ACTIVATED was a very primitive part (located deep inside the emotional brain) known as the PERIAQUEDUCTAL GRAY.
INTERPRETATION OF THESE RESULTS :
The prefrontal cortex helps us judge and assess a person when we make eye contact, so we can determine whether their intentions seem good or ill.
However, the periaqueductal gray region is associated with SELF-PROTECTIVE RESPONSES such as hypervigilance, submission and cowering.
Therefore, we can infer that those with PTSD / complex PTSD may find it hard to make eye contact because their brains have been adversely affected, as a result of their traumatic experiences, in such a way that, when they make eye contact with another person, the ‘appraisal’ stage of the interaction (normally carried out by the prefrontal cortex) is missed out and, instead, their brains, due to activation of the periqueductal region, cause an intensely fearful response.
This constitutes yet another example of how severe and protracted childhood trauma can damage the physical development of the brain.
Link : Lanius et al’s study.
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RESOURCE :
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David Hosier BSc Hons; MSc; PGDE(FAHE).
Can New Drug Treatment Induce Memories And Feelings Of Safety In PTSD Sufferers?
An experiment carried out at the University of Puerto Rico (Quirk et al.) on rats has shown that administering a drug directly into their brains can induce in them a sense of safety in a situation in which they were previously fearful.
Brief Summary If Experiment :
Rats can be conditioned to fear the sound of a particular tone (the fearful response takes the form of the rats ‘freezing’ )if, each time the tone is sounded, the experimenter administers to them an electric shock (this works through technique known as classical conditioning).
However, this conditioned, fearful response to the same tone can be extinguished / eliminated if it is then sounded a sufficient number of times during which, now, when the rats hear it, they are NOT administered with an electric shock (this is known as ‘extinguishing training’).
It was also found that the extinguishing of the rats’ fear response to the sound of the tone is NOT due to their fear memory / memory of the electric shocks being wiped out, but, instead, due to a NEW MEMORY OF THE SOUND’S (NOW) SIGNALLING OF SAFETY (i.e. NO ELECTRIC SHOCK ADMINISTERED WHEN TONE IS HEARD) BEING CREATED.
DRUG MIMICS EXTINGUISHING EFFECT :
Crucially, the researchers involved in the study found that, instead of the rats needing to go through this extinguishing process / training to stop them feeling fearful (freezing) in response to the tone being sounded, but, instead, feeling safe in response to it, the same effect can be obtained by administering a drug (the drug used was a protein, brain-derived neurotrophic that helps the brain’s neurons to grow) directly into the rats’ brains.
In other words, it seems that the researchers involved in the experiment have found a way to pharmacologically (i.e. through the use of a drug), CREATE IN THE RATS’ BRAINS A MEMORY OF SAFETY.
IMPLICATIONS OF THE ABOVE FINDINGS :
The hope is that research like the above will help with the development of drugs which can be given to humans in order to help create feelings and memories of safety in individuals who are suffering from PTSD, a condition which, in the absence of effective treatment, can completely incapacitate and ‘paralyze’ sufferers with unremitting, intense feelings of fear and terror.
RESOURCE :
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David Hosier BSc Hons; MSc; PGDE(FAHE).
Factors That Make Complex PTSD More Severe
What Factors Make The Symptoms Of Complex PTSD Even More Serious?
We have seen from several other articles that I have published on this site that the experience of a traumatic childhood is linked to the development of complex PTSD later on in life.Whilst all cases of complex PTSD are extremely serious, certain factors are thought to increase the risk that we will develop an especially severe form of the disorder. These are as follows :
- the person responsible for causing the trauma was a parent / primary carer (this worsens the effect of the trauma because of the emotional devastation caused by being harmed and betrayed by the very person whose responsibility it was to care for us and protect us)
- how protracted the experience of the trauma was (on average, the longer the trauma lasts, the worse the effect will be ; tragically, some people experience pretty much ongoing trauma of one form or another (some of which may overlap and occur simultaneously) from birth to eighteen years which may, potentially, have a particularly adverse affect upon multiple stages of brain development and upon the young person’s development in general.
- the individual is isolated during the period of trauma (this worsens the effect of the trauma due to the fact that emotional support from significant others (such as members of the wider family, teachers, therapists etc) have a protective effect on mental health ; this protective effect is unavailable to those who experience their trauma in isolation.
- the earlier in life the traumatic experience occurs, the more psychological harm it is likely to do. This is because the young brain is especially ‘plastic’ / malleable and, therefore, more vulnerable to being damaged by the experience of protracted, high levels of stress / fear / anxiety.
- the person responsible for causing the trauma is still in contact with the traumatized individual.
RELATED ARTICLES :
David Hosier BSc Hons; MSc; PGDE(FAHE).
