PTSD Awareness Day - 27th June 2023

Every moment presented to us throughout our entire lives is a moment of learning for our brains. The way our brains learn things, and change as a result, is neuroplasticity in action. It is happening every moment of every day. Our brains respond to the information we receive through our experience of life and the output of this learning we see in our behaviours, thoughts, feelings, perceptions, physiology, memories, dreams, imagination, visions…

We see this learning in who we think we are, and this learning changes us every day.

Photo by Ramiro Pianarosa on Unsplash

National Centres for Post-traumatic Mental Health this year - pose the question – 

Can you see PTSD?

In attempting to answer this loaded question we must recognise how incredible our ability to ‘see’ is in this age of technology. We can see and analyse brain waves, brain activity and blood flow in our brains in real time. We can see the way our heart-rate variability and our nervous systems change under stress with sophisticated biofeedback technologies. We can even see the things we have learned right down in our DNA, this kind of deep learning that can get passed to the next generations. 

However, the real enquiry sparked by this first question goes more deeply than this. Trauma is about what we can see, and about what we can’t see - the highly specific and individual parts that are the experience of trauma and its afterlife in the lived experience of each individual that we may never see. So, the answer is complex, the answer is yes, and it is no.

Photo by Nathan DeFiesta on Unsplash

PTSD and cPTSD are disorders specifically associated with STRESS. Stress is so broadly used as a term, and its meaning applied as a word so diversely, that it may be useful to be clearer here. 

The International Classification of Diseases (the ICD 11) from the World Health Organisation (WHO) provide first a brief description of each disease, of which there are around 17,000 unique codes. PTSD has a code within this classification, it is 6B40, and it is outlined as this: Following exposure to an extremely threatening or horrific event or series of events. PTSD is characterised by ALL of the following:

• Re-experiencing the traumatic event in the present

• Avoidance of traumatic reminders

• A sense of current threat
  

cPTSD (complex PTSD)is now listed, with code 6B41, and with additional criteria. Where, as well at the 3 characteristics of PTSD, requires also:

• A negative self-concept

• Emotional dysregulation

• Interpersonal difficulties

With our capacity to look inwardly, to see our inner workings, as we can with sophisticated brain-based technologies, we understand the characteristics described are impactful on almost innumerable brain regions, and networks of the brain that work together for specific functions. The brain regions including (but never limited to) the hippocampus; amygdalae; insulae; anterior cingulate cortex; orbitofrontal; and pre-frontal regions. Brain networks including the Central Executive Network; the Salience Network; the Default Mode Network, that are large scale networks (that are also connected to each other), that can be impacted with the experience of trauma. As well as the fronto-parietal, cingulo-opercular, and occipital subnetworks. There can be changes in some of these areas of the brain both structurally and functionally. 

As we learn and understand more about PTSD and how to provide individuals with the best opportunity, available at the time, to make informed decisions about their own treatment options - it may be empowering to know that we stand in a place where seeing the brain is really possible, and our ability to do this and respond to what we learn is only improving exponentially with time and research. The Black Dog Institute and other leading mental health change makers agree that a combination of treatments often works best for PTSD.

So, what brain-based treatment options do we have available?

There are many, here we outline one option for functional neuroimaging and two brain based treatment options. 

• QEEG Brain Scans
  

QEEG Brain Scans are safe well-known assessments used in scientific research and clinical practice. Unlike standard CT and MRI scans which provide information about brain structure, QEEG Brain Scans provide information about how the brain is working by directly measuring the electrical activity of the brain, known as ‘brain waves’. Specialised software is used to analyse an individual’s brain waves and produces detailed ‘brain maps’. These highly specific maps help us understand how the brain is working showing precise areas of under-activity or over-activity. These brain maps can show us how the brain may have changed the way it is functioning every day in response to the experience of trauma.

• Neurofeedback
  

Using the highly specific information from a QEEG brain scan about how your brain is functioning you can then start to retrain brain areas that may have been impacted by trauma through neurofeedback training. Neurofeedback training is a proven, targeted and effective way to retrain specific areas of your brain and change how these areas are then communicating and acting on other parts of your brain. For example, neurofeedback training might work on ‘calming down’ over-active survival areas and change the way these zones are talking to the areas for emotion and thinking. 

Neurofeedback is one of the treatments used in clinics with a specific interest in the care of trauma survivors, including STARTTS, The Salvation Army, and (in combination with biofeedback) as part of recent powerful resilience and recouperation programs in the Dutch Defence Forces and the US Department of Veterans Affairs. Neurofeedback as a potential treatment option for PTSD was a prizewinning presentation at the Australasian Military Medicine Conference in 2017. 

• Biofeedback
  

Biofeedback technology has been developed over more than 60 years. Over this time research has been done into its use to prepare military personnel for highly stressful situations and into the effectiveness of biofeedback as a treatment specifically for trauma, along with the disorders an individual who has endured trauma may also be diagnosed with (things like anxiety, depression, and dissociation). 

Biofeedback training teaches you how to rebalance your body and brain by showing you how your own nervous system is working. Biofeedback training actively works through the communication between your body and brain - improving resilience to stress, reducing muscle tension and putting your nervous system back in balance. Leading PTSD organisations are recommending further research into the benefits of biofeedback treatments. The Australian Army BattleSMART program uses biofeedback as part of their high performance self-management and resilience training.

Photo by Austin Neill on Unsplash

The Perth Brain Centre offers a range of services, including those above, that can help inform your decision making when you are trying to work out how to gradually, and in an informed way, build the dirt tracks, footpaths, roads and highways toward trauma recovery. Our Team of experienced Health Professionals include those specifically trained in Trauma Informed Practice. You can find out more in any way you are comfortable - watch, read, call or email - any time that feels right.

About the author - Ms. Emily Goss (Occupational Therapist, Senior Clinician, The Perth Brain Centre).