Calming Trauma - How Understanding the Brain Can Help
How Understanding the Brain Can Help
By Dawn McClelland, PHD, and Chris Gilyard, MA
TRAUMA AND THE BRAIN
Joe was a welder who came into the outpatient burn clinic with burns to the back sides of both his hands. Joe had been welding in a large tank when there was an explosion and he narrowly escaped through the 2-foot hole used for entering and exiting the tank. While his burns were relatively small, the resulting trauma from his injury was significant. Joe reported regular nightmares, flashbacks, and, especially troubling, panic attacks when thinking about returning to his job. Joe’s comment to the burn clinic staff was, “My boss wants me to go back into the tank to weld, but I’m still trying to get out.”
Joe’s brain has been hijacked by trauma. As he thinks about the incident, it seems reasonable to Joe that he should be able to go back into the tank and weld. He feels crazy because he can’t make his brain do what he wants it to do, which is to forget the trauma. But despite what reason says, Joe’s body still holds on to the distress of the accident and is desperately trying to get out of the tank. This hijacking results in posttraumatic stress disorder (PTSD). Some common symptoms of PTSD include nightmares, flashbacks, panic attacks, startle response, and preoccupation with the traumatic event.
How exactly is Joe’s brain and body being hijacked by the trauma? Simply put, when a person experiences something traumatic, adrenalin and other neurochemicals rush to the brain and print the picture there. The traumatic memory loops in the emotional side of the brain, disconnecting from the part of the brain that does reasoning and cognitive processing. The reasonable part of the brain is unable to help the emotionally loaded part of the brain get away from the trauma.
THE NEED TO KNOW
Why is it important to have understanding of PTSD? It is estimated that of 100 people who have experienced trauma, 25%, or 1 in 4, will experience PTSD. That’s also 1 of every 4 burn survivors. With statistics this high, we can conclude that this is a normal response to an extreme situation and not a pathology.
Why understand PTSD? As stated in Proverbs 19:8, “He who gains wisdom loves his own soul.” When you live with PTSD, it’s hard to love anything, much less your own soul. Understanding trauma gives us back our lives.
UNDERSTANDING THE BRAIN AND BODY IN TRAUMA
Several parts of the brain are important in understanding how the brain and body function during trauma. They include the forebrain (the prefrontal cortex); the limbic system, which is located in the center of the brain; and the brain stem.
When a person experiences a traumatic event, adrenalin rushes through the body and the memory is imprinted into the amygdala, which is part of the limbic system. The amygdala holds the emotional significance of the event (the intensity and impulse of emotion). For example, if you’re on a roller coaster, your sensory information is “fear, speed, stress, excitement, not life threatening.” The amygdala can read the emotional significance of the event: “it’s a ride, it’s fun, you are done in 3 minutes.” The amygdala stores the visual images of trauma as sensory fragments, which means the trauma memory is not stored like a story, but by how our five senses were experiencing the trauma at the time it was occurring. The memories are stored through fragments of visual images, smells, sounds, tastes, or touch.
Consequently, after trauma, the brain can easily be triggered by sensory input, reading normal circumstances as dangerous. For example, a red light is no longer a red light, now it’s a possible spark. A barbecue had been just a barbecue, but now it sounds like an explosion. The sensory fragments are misinterpreted and the brain loses its ability to discriminate between what is threatening and what is normal.
The rational part of our brain is the prefrontal cortex. This is the front part of our brain, where consciousness lives, processing and reasoning occur, and we make meaning of language. When a trauma occurs, people enter into a fight, flight, or freeze state, which can result in the prefrontal cortex shutting down. The brain becomes somewhat disorganized and overwhelmed because of the trauma, while the body goes into a survival mode and shuts down the higher reasoning and language structures of the brain. The result of the metabolic shutdown is a profound imprinted stress response.
Traditional trauma therapies have been based on the belief that the best way to address and heal PTSD symptoms is to deal with it in the “thinking” part of the brain, through talk therapy. Talking through the story and making meaning was thought to help a person understand the trauma and slowly desensitize themselves to the emotional intensity of it. The goal was to try to deal with the story in the rational part of the brain and, although these therapies were helpful to a point, they did not address the sensory responses in the body.
In the last 18 years, through brain scan technology we have gained insight into the difference between what happens when people talk about past trauma and what happens when their body is re-experiencing it. We have learned that talk therapy attempts to engage parts of the brain that are “off-line” and therefore is not able to resolve the trauma when people are in hyperdistressed states.
A leading psychiatrist in the trauma field, Bessel Van Der Kolk, MD, says, “Traditionally we’ve tried to heal PTSD through talking and making meaning of the event, but treatment methods that help calm arousal systems in the deeper regions of the brain have been helpful in calming PTSD more than those that try to do so through talking and reasoning.” He calls this “bottom-up processing.”
Today we have begun to recognize that the frontal part of the brain has limited ability to change the deeper parts of the brain, especially when the body is in a trauma response or distress. Talk therapy works when the brain is on-line and functioning, but when the rational part of the brain is off-line, hijacked by the trauma memory, people may not hear words or reasoning or make meaning of events or experiences. When the deeper regions of the brain are in this state of distress, they are back in the trauma and their brain and body seems to be in a time warp.
CALMING THE DEEPER REGIONS OF THE BRAIN
To calm those deeper regions of the brain, we start with “bottom-up processing,” utilizing the kinds of treatment that will soothe and calm the body. When someone is in an activated or hyperarousal state, we do not want to ask them trauma questions that can escalate distress and further imprint the trauma into the limbic system, strengthening the trauma. The goal for therapeutic interventions is to bring oxygen and blood flow back to the brain, so we can start calming the body and accessing the higher regions of the brain.
Van Der Kolk addresses this issue, stating, “Taking action is the core issue… It’s in action that people take back their power and create healing, and words cannot substitute for action. (This is one of the great benefits of the child life specialist—they help get a child’s brain online, engaging, and taking action, which helps prevent the freeze state.)
There are a number of ways to bring action to the body and brain. One treatment option today that utilizes action to immobilize the body and brain is eye movement desensitization and reprocessing, or EMDR. EMDR uses bilateral stimulation to alternately engage both sides of the brain in action. Originally this was done by having a person follow a therapist’s finger back and forth, in front of his or her vision field.
This back and forth, bilateral movement causes the traumatic memory that is looping in the emotional side of the brain to integrate with the cognitive part of the brain. The eye and brain movement increases the ability of the prefrontal cortex to “get online” or find the rationality in the traumatic event. (More information on EMDR can be found on the EMDRIA website, http://www.emdria.org.)
Sensorimotor techniques are also useful in limbic calming. In sensorimotor therapy, the therapist helps a person to notice sensory body responses and be in-tune with their body’s messages as a means to address healing. It is a means of engaging the body and the mind in the recovery process. Through his neuro-imaging studies, Daniel Amen has documented that people experience calming in their limbic structures following EMDR treatment. Other venues for limbic calming include soothing music, prayer and meditation, mindful breathing, yoga, and exercise. Therefore, the following simple activities can encourage limbic calming:
- Take 5 minutes in the morning and evening to rock back and forth, or side to side, just noticing and relaxing the body.
- Find music or tones of music, with or without words, that bring you into a state of calmness.
- Practice deep breathing in sequences of three. For example, breathe, breathe, breathe. Rest. Breathe, breathe, breathe. Rest.…
- Participate in some form of exercise for 12-15 minutes per day to increase the serotonin and dopamine.
- Participate in 5-10 minutes per day of prayer or meditation, as the spiritual center of the brain is an area that is able to influence and calm the deeper regions of the brain.
In conclusion, if you’re being hijacked by trauma, please know that there are people and places who can help your brain find ways to get unstuck and back into motion. There are therapists who know how to help you out of the looping cycle of PTSD and into the circle of life.
The EMDRIA website, which can be accessed through a link on http://www.phoenix-society.org, provides a list of EMDRIA-approved therapists by state.
Explore our Resource Library for more resources on the physical, social, and emotional aspects of burn recovery.
Dawn McClelland is a doctoral-level licensed psychologist with Anderson, McClelland, and Associates in St. Louis Park, MN. She has 19 years’ experience collaboratively working with people dealing with a variety of issues and has extensive training in understanding post-traumatic stress, dissociative abilities, and other complex trauma issues. She has worked with burn survivors and their families in both the aftercare and acute hospitalization phases of recovery.
Chris Gilyard is the burn support representative on staff at Regions Hospital Burn Center in St. Paul, MN, where she offers support, coaching, education, and support groups for survivors and family members. Chris is a burn survivor of 28 years.
This story is an excerpt from The Phoenix Society’s® Burn Support News, Fall Edition 2008. Burn Support News is a tri-annual publication that contains articles on the emotional, psychological, and social aspects of burn recovery. All Rights Reserved.