Advanced Understanding and Treatments for Trauma.

PTSD Awareness Day

27th June 2021

‘Frightening battle dreams’

Hippocrates, The Father of Modern Medicine (c. 400 BC) - more than 2,000 years ago.

‘And many wrestle on and groan with pains,

and fill all regions round with mighty cries and wild,

as if then gnawed by fangs of panther or of lion fierce.’

Lucretius, De Rerum Natura (c. 60 BC) – still more than 2,000 years ago.

‘[They are] suffering from memories.’

Sigmund Freud (1895) – more than 100 years ago.

‘The nucleus of the neurosis is a physioneurosis [it is in the body and in the brain].’

Abram Kardiner, Psychiatrist (1941) – 80 years ago.

‘While we all want to move beyond trauma, the part of our brain that is devoted to ensuring our survival (deep below our rational brain) is not very good at denial.’

Bessel A. van der Kolk, MD (2014) – a few years ago.

‘There is a wisdom in trauma. When we realise that our traumatic experiences and imprints are not ourselves and that we can work them through, and thus become ourselves.’

Dr Gabor Maté, MD (2021) – today.

The experience of trauma is as ancient as the human experience itself. We know it.

Why then has it taken so long to talk about it?

Because, at the soul of it, perhaps we don’t want to know it. It can feel horrible and impossible to talk about devastating things that have happened to people, it is overwhelmingly hard to trust enough to ‘find the words’. It could also be that too many people have experienced it. Perhaps we identify so closely with it because it is standing there in the room with us. If we think deeply about it, we know trauma is not alone with the threatening long echo of war, it is in how families might battle through the challenges of life every day. There is an unquantifiable range in the trauma experience. The immenseness of trauma may immediately feel as though it is already ‘too much’. And it is exactly this potentiality that is key.

As outstanding experts like Paediatrician Nadine Bourke Harris in the field agree, this could be the greatest power to turn the assessment of and treatments for trauma, and the innumerable chronic diseases that extend from the heart of toxic stress, on its head. With enough devoted energy and a critical mass of humans on board, a new paradigm emerges, and we all move forward on the new wave.

Well, the swell has reached the shore, it is here, and it is connecting knowledge to the extent of creating entirely new branches of science. As Dr Daniel Amen puts it ‘the brain is ‘in’ at the moment and this is a very exciting thing’. Behavioural, cellular, social, and developmental neurosciences (including neuroplasticity), along with neuropsychology - give us advanced ways of looking at the damage trauma has inflicted, and pathways to repair the damage done.

All of these branches of science help us understand what it is to be human, and what happens as we live the full human experience. Through hard-core evidence, it is reuniting the mind, body, and spirit through the bio-psycho-social model. We are seeing it more in the treatment of many complex phenomena, not just trauma, also with things like pain, depression and addiction.

Modern neuroscience is reshaping clinical practice - knowing fully that you cannot treat a human enduring anything without recognising that it impacts the entire person. When emerging scientists tune into the origin the most profound change is possible.

So, what does reflection back to ancient knowledge combined with emerging new science tell us about trauma?

Trauma is incredibly complex, the complexities we are only beginning to detangle. Similar traumatic experiences can impact individuals, and their brains, very differently.

Your trauma does not define you. What is going on inside you is the result of what has happened to you. You grapple every day with the changes experiencing trauma has evoked.

The changes are possibly too deep in your brain for you to just ‘talk yourself out of it’.

The brain and nervous systems of sufferers of PTSD and cPTSD are disorganised.

The brain reorganises itself around the trauma in every effort to protect you and help you survive. Even long after the threat has passed - it is like the lion is still close by, hiding, and attacking unpredictably.

Your brain, in turn, trains your nervous system and therefore the way you breathe, move, think, feel, see, perceive, and interact with others and your world.

Brain wave production or activity in the brain may appear reversed, where the brain produces slow, sleepy activity when it is meant to be alert; and fast, excited, and hypervigilant activity when it is trying to relax or sleep.

Circadian rhythm is then disrupted. When our wake/sleep cycle, our master clock, is off, so is our hormone production, our digestion and our brain cleaning functions.

Pleasure and reward centres can be altered. Some brains, that may have changed in response to trauma, may not be able to ‘see the positive’, or hold onto the good feeling of enjoyable moments.

The brains fear centres, for detecting threats and initiating action, can be over-activated. There are several brain areas and networks that can be involved. Many people already know about their amygdala (areas for the feeling of fear) and how much they talk to the insula (the areas for finding meaning and predicting the consequences).

When these areas are always ‘on-line’ the thinking brain gets put ‘on-hold’. The brain simply cannot do both properly at the same time. That is why it is hard to manage emotions, pay attention to what you want to, and be motivated for the future.

As Dr Janet Seahorn, co-author of Tears of a Warrior, informs us - when these, and other deep changes, go on for too long, your brain and your body start to wear out. Chronic disease risk can multiply, but we know by doing something it can help us move forward.

What do we take from this knowledge and put it into practice when we develop treatments for the individual whose brain and nervous system has changed in response to trauma?

We cannot go back and change the traumatic events. What you can do is get to know every part of yourself deeply, learn more about what trauma has done to the way you function, and set about reorganising your own change. Every day your brain is changing anyway. Why not learn how to drive that change in the most positive way possible. After all, you are renewable too.

Many people trying to make sense of their trauma experiences, and the therapists helping people with PTSD and cPTSD, have found Doctor Bessel A. van der Kolk’s book The Body Keeps the Score (2015) a supportive start. It describes in detail what happens in the brain, mind and body in response to trauma, and explores possible paths to recovery. Talking treatments; emotional regulation techniques; yoga; mindfulness; neurofeedback; somatic therapies (those that importantly include the body); even the use of the arts, theatre and music are explored for their value in this multifaceted space, where positive change can be safely activated by things so intensely unique to the individual.

In the ABC series Searching for Superhuman, over monochrome footage of the war, we hear the narrator ‘when it comes to messing with the brain, prolonged exposure to psychological trauma is one of the most severe disturbances an individual can experience’. Senior Psychologist Mirjana Askovic, a leader at Services for the Treatment and Rehabilitation of Torture and Trauma Survivors (STARTTS) in NSW, goes on to speak about how the brain becomes disorganised as a result of trauma, and how in severe cases, where people do not want to talk about their experiences of trauma, highly specific neurofeedback treatments tailored to these individuals can work wonders.

Let’s explore further three brain-based options touched on in both The Body Keeps the Score and Searching for Superhuman:

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 its high performance self-management and resilience training.

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 change things for the better. Our team of experienced Health Professionals respect the courage it takes to trust another with your trauma. You can find out more in any way you are comfortable - watch, read, call or email - any time that feels right.