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5 More Nuts and Bolts of the Traumatized Train (Part 3)

9/25/2018

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"Although the world is full of suffering, it is also full of the overcoming of it." - Helen Keller


**This article is Part 3 of 4 in a series entitled The Nuts and Bolts of the Traumatized Brain - See Part 1 here, Part 2 here**

Continuing the discussion of the human brain and the subsequent impact of trauma exposure, today's article will focus upon five additional tidbits of information. Prior articles (see above) have addressed the role of the amygdala and hippocampus in trauma and trauma recovery. Moving forward in learning about the neurobiology of our miraculous cerebrums, we know that the body interprets trauma as a life-threatening event(s). Therefore, different parts of the brain fire up to respond to the perceived threat (real or imagined).

11) The HPA Axis is a hormonal/nervous system connection in the brain that lights up when the saber-toothed tiger is attacking (i.e. a present day trigger or perceived/real threat like a car accident, rape, abuse, reminder of prior trauma, etc.). The aforementioned HPA Axis is activated by stress and trauma and consists of the hypothalamus, the pituitary gland, and the adrenal glands.  

12) The hypothalamus acts as a Command Center of the brain, communicating with the pituitary gland to release hormones, which in turn activate the adrenal glands to release hormones. These hormones include cortisol, opiates, oxytocin, and catecholamines, and they are released in varying amounts to ready the body to respond to trauma in "fight, flight, or freeze" response. Cortisol works to ready the body to have the energy to respond to the perceived threat; opiates reduce physical pain; and oxytocin reduces psychological pain. 

13) As mentioned in the prior articles in this series, the hippocampus and amygala work together to process the trauma. However, with the HPA Axis producing the "neurological soup" described above, encoding, processing and storing information goes haywire during a traumatic event. The amygdala remains activated while the hippocampus goes "offline" and stores traumatic material in scattered "file cabinets" of the brain, rendering processing of the traumatic event, at best, difficult and memory consolidation impaired. 

14) The area of the brain associated with language in the left frontal region, Broca's Area, gets shut down during trauma. A flashback or trigger shuts down this part of the brain, rendering the survivor incapable or at minimum, very impaired, with their ability to assign words to the experience of trauma (van der Kolk, 2015).  Brain-wise psychotherapeutic interventions (like EMDR) help the brain to synthesize and organize the traumatic material in such a way that the brain is able to store the traumatic material in an adaptive fashion, whereby the "charge" of the limbic system lowers. In turn, the higher order executive functioning skills of language, focus and concentration go back "online" to assist the survivor with narration of the story and thereby mastering the traumatic experience (Herman, 1992). 

15) "Bottom-up" processing of the trauma(s) involves helping the brain move into the action of recovery and getting unstuck from looping back to the state of being viscerally frozen in trauma (van der Kolk, 2015). Such interventions are designed to soothe and calm the limbic system and can include EMDR, sensori-motor therapy (i.e. somatic experiencing), expressive arts, music, meditation, trauma-informed yoga, prayer and mindfulness based practices, among others. Talk therapy (which requires a functioning prefrontal cortex that is back "online") comes only after addressing the somatic components of trauma recovery.

The last article in this four part series will address interventions that help with healing the traumatized brain. 


Retrieved from : https://sapac.umich.edu/article/neurobiology-trauma September 25, 2018

Herman, Judith (1992). Trauma and recovery: The aftermath of violence from domestic abuse to political terror; Basic Books.

van der Kolk, Bessel (2015). The body keeps the score: The brain, mind and body in the healing of trauma, Penguin Books.



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5 More Nuts and Bolts of the Traumatized Brain (Part 2)

9/15/2018

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"Trauma victims cannot recover until they become familiar with and befriend the sensations in their bodies. Being frightened means that you live in a body that is always on guard...." Bessel van der Kolk


In last week's blog post on the 5 Nuts and Bolts of the Traumatized Brain (Part 1), I talked about the role of the amygdala in the stress response of individual's with Post Traumatic Stress Disorder (PTSD). One in four survivors of trauma will develop PTSD (van der Kolk, 2015). Our brain's amygdala runs in overdrive like a fire alarm gone awry when triggered by trauma.  Other parts of the brain are also impacted by trauma in the delicate orchestra of cerebral neurocircuitry.

​6) The hippocampus is akin to the brain's librarian, holding the responsibility of storing and retrieving memories. Located in the limbic (emotional) part of the brain, the hippocampus reduces in size in individuals with PTSD and gets confused with interpreting past and present memories (Wlassoff, 2015). For example, a rape victim may not be able to distinguish between a past trauma (the rape) and a rape scene in a movie (present) because of the re-wiring that occurred in the hippocampus during the traumatic event (Shin et al., 2006).

7) The prefrontal cortex is the higher reasoning area of the brain where processing, consciousness, language meaning, and logic are located. When a trauma occurs, this part of the brain goes "offline." Many survivors of trauma report not being able to access language because the brain goes into "fight or flight mode,"(amygdala fire alarm) and the language center shuts down.

8) Neuroplasticity is a key component of healing in the aftermath of trauma, meaning that the brain has the capacity to form new neural networks throughout the lifespan and heal. The brain has an innate capacity to mend itself and is remarkably resilient even in the adult years, moreso than was previously thought. (van der Kolk, 2015).

9) Survivors of PTSD can be hopeful that their brains can heal by engaging in trauma-informed and brain-wise therapeutic interventions like EMDR (Eye Movement Desensitization and Reprocessing). Studies show that the hippocampus can regain its normal size after trauma-informed interventions (Shapiro, 2017). 

10) When working with deeper regions of the brain where trauma is buried and utilizing "bottom-up" strategies for accessing and healing trauma, the brain can be re-wired to store memories in a more adaptive, less activating fashion (van der Kolk, 2015). Traditional talk therapies are helpful when the prefrontal cortext is back "on-line," but first the brain heals by addressing calming the nervous system and approaching the interventions on the level of the somatic and emotional brain.

*Stay tuned for more blog posts about the Nuts and Bolts of the Traumatized Brain*


​



Retrieved from: September 16, 2018: http://brainblogger.com/2015/01/24/how-does-post-traumatic-stress-disorder-change-the-brain/

Schneider, Andrea (2018). 5 Nuts and Bolts of the Traumatized Brain, Psych Central.

Shapiro, Francine (2017). Eye movement, desensitization and reprocessing (emdr) therapy, third edition : basic principles, protocols, and procedures, The Guilford Press.

Shin LM, Rauch SL, & Pitman RK (2006). Amygdala, medial prefrontal cortex, and hippocampal function in PTSD. Annals of the New York Academy of Sciences, 1071, 67-79 PMID: 16891563

van der Kolk (2015). The body keeps the score: brain, mind, and body and the healing of trauma, Penguin Books.

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Nuts and Bolts of the Traumatized Brain (Part 1)

9/12/2018

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"The paradox of trauma is that it has both the power to destroy and the power to transform and resurrect." - Peter A. Levine

The field of psychology has grown by leaps and bounds in terms of its understanding of the nuances of brain psycho-biology. Fortunately we are living in a time where cutting edge brain research is happening as we speak, and we learn something new about our grey matter on a daily basis.

1) For those impacted by trauma, we now know that the brain rewires itself in such a way that those with PTSD (Post Traumatic Stress Disorder) experience flashbacks, hyperviligance, avoidance behaviors, panic attacks, somatic tension/aches and other symptoms (DSM-5). A little organ deep within the limbic (emotional) portion of the brain, entitled the amgydala acts as the brain's "fire alarm." Unfortunately, for survivors of trauma, the amygdala is working in overdrive and is firing off when it's not needed, resulting in the above symptoms.

2) Trauma work with a competent and compassionate psychotherapist addresses the need to calm the amydala down via brain-wise and trauma-informed modalities, such as EMDR (Eye Movement Desensitization and Reprocessing), expressive arts interventions, mindfulness-based cognitive behavioral work, somatic experiencing, and other approaches. It is possible to rewire the brain to a state of calm and self-soothing, essentially desensitizing targeted traumatic event so that it can be tucked away in the proper "file cabinet" of the brain.

3) Traumatic memories are held in a scattered fashion within the brain (akin to several chapters of a book placed in different file cabinets in a disorganized fashion), which makes it difficult for survivors of trauma to generate a cohesive narrative of their experience. When a trauma occurs, the cognitive and verbal brain go "offline" so to speak, and memories are stored in the somatic/sensory part of the brain. Bilateral and trauma-informed interventions such as EMDR can be utilized so that the scattered memories are reassembled into one tightly organized "file cabinet" in the brain, to be tucked away in a less activating manner, so that the amygdala can calm down.

4) We know that physical sensations (muscle tension, headaches, nausea, etc) can be remembered before emotions or cognitions (intellect) help to bring understanding of the trauma (van der Kolk, 2015) because of the way the triune brain holds memory.  Thus the importance of trauma-informed clinicians utitilizing brain-wise interventions which allow the synthesis of somatic/emotional/cognitive recollections of the traumatic event (Perry, 2005). Once coherent and synthesized, the client can then bring together a cohesive narrative of their experience, thus mastering the traumatic material and generating the ability to calm the amydala (Shapiro, 2017).

5) Restoration of brain health following trauma involves daily self care and self compassion, accessing the body's innate ability to flip the switch to the relaxation response (Benson, 2000). Various ways to calm an activated and traumatized nervous system (which sends the amydala in over-drive ) can include trauma-informed approaches to wellness such as yoga, deep breathing exercises, hiking in nature, mindfulness based meditation, progressive muscle relaxation, massage, reflexology, creative visualization, and mindfulness based cognitive restructuring.
(Part 2 of this series will elaborate further on the Care of the Traumatized Brain)

Benson, Herbert (2000). The relaxation response. Harper Collins.

Levine, Peter A. (2012). In an unspoken voice: how the body releases trauma and restores goodness, North Atlantic Books.

Perry, B.D.  Maltreatment and the developing child: How early childhood experience shapes child and culture.  The Inaugural Margaret McCain lecture (abstracted); McCain Lecture series, The Centre for Children and Families in the Justice System, London, ON, 2005

Shapiro, Francine (2017). Eye movement, desensitization and reprocessing (emdr) therapy, third edition : basic principles, protocols, and procedures, The Guilford Press.

Van der Kolk (2015). The body keeps the score: brain, mind, and body and the healing of trauma, Penguin Books. )

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September 04th, 2018

9/4/2018

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Hello and Happy September...

I hope this finds you well. I am reaching out to share with you my latest practice offerings...I continue to see clients in my private practice who are impacted by trauma in its many forms. The clinical approach I take is trauma-informed and strengths-focused, utilizing a variety of techniques to resolve trauma, including EMDR and mindfulness-based approaches.  

​For my latest podcasts, check out The Savvy Shrink here.   To learn more about my weekly blog posts for Psych Central, check it out here.   In addition, I am developing an online program for clients to assist in their trauma recovery. Stay tuned for more details about that and also a workbook I am designing as a second edition to my ebook, Soul Vampires: Reclaiming Your LifeBlood After Narcissistic Abuse (2015). 

Thanks for following along, and I hope you have a great fall. I will check back in soon!

Andrea :)

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    Andrea Schneider, MSW, LCSW

    Psychotherapist

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