~ Dr. Robert Sapolsky
When we experience trauma, we see it, smell it, taste it, feel it on our skin, and the stress hormones released into the body under the negative stress of trauma, feed our entire system with chemistry that creates an over-all experience for us that is super-learned. The Diagnostic and Statistical Manual of Mental Disorder, Fifth Edition (DSM-V) specifies this symptom of PTSD as, intrusive memories.
Every sensory cell, organ and system, plays an integral part in holding the memory of our traumatic experience. This is part of the human body's natural defense system. We learn, through traumatic experience, an emblazoned set of sensory memories in order to protect ourselves from experiencing such trauma again. One could argue that every cell in the human body, remembers the moment of trauma.
Therefore with a traumatic experience, sensory input is hyper-imposed into memory, and is therefore stored as such in the human brain and throughout the human body, preparing a traumatized human to avoid a similar fate in the future.
Ultimately, one could further propose, with PTSD it is the memories themselves, once the traumatic event has passed, that causes us further harm over time. We recollect upon the trauma, when we've not yet found way to resolve the psychological harm and intrusive memories the trauma has left behind. Recollection, reignites the dump of stress hormones into our systems, further reinforcing the trauma experience for us as a strong memory of danger for future consideration and action.
It would be nice, if all this took place within our conscious awareness. However, the nervous system dictates for us this fight-or-flight response. Our survival as human beings, depends on the instinctual nature of fight-or-flight for protection. The negative feelings and emotions that come up for us as we are reminded (often-times incessantly) of the psychological trauma we've lived through, are actually caused not by the memories themselves, but by the re-releasing of the stress hormones as part of re-experiencing the fight-or-flight, traumatic stress response.
According to science, we are mammalian creatures. We share fight-or-flight reactions with all other mammals, the closest in relationship to us being primates. One person who studies stress in the animal kingdom, is Dr. Robert Sapolsky, of Stanford University.
A professor of biological sciences, neurology and the neurological sciences, Sapolsky has spent more than three decades studying the physiological effects of stress on health. His pioneering work includes ongoing studies of wild baboons in the African Savanna, highlighted in the National Geographic Special: Stress, Portrait of a Killer. As well, he is the author of the best-selling book, Why Zebras Don't Get Ulcers: The Acclaimed Guide to Stress, Stress-Related Diseases, and Coping(2004).
In a 2007 interview with Stanford Report, Dr. Sapolsky states that all invertebrates share the same brain and body-chemistry, associated with the stress response:
"The stress response is incredibly ancient evolutionarily." . . . "Fish, birds and reptiles secrete the same stress hormones we do, yet their metabolism doesn't get messed up the way it does in people and other primates." (Stanford Report, 2007).
Sapolsky goes on to further state that the metabolic responses we often feel in situations of stress, comes to us through our nature as humans as sociable, highly-intelligent creatures in the animal kingdom. Our intelligence, our ability to reason and to think through our traumatic experience, accents in us the metabolic flooding of stress-hormones, released through psychological, intellectual attempts to make sense of something tragic having happened in our lives.
In other words, Sapolsky suggests, it is our ability of intelligence and inner story-telling, that then becomes our nemesis in recovery. The traumatic event for us has passed. Memory recollection is responsible for the ultimate damage in our lives associated with PTSD. The feelings associated with our traumatic memories result when our brain signals a flood to our systems again with hormones. What we experience as feelings, is the doping of our body with naturally produced stress hormones, now automatically engaged through thought, triggered by memory: the fight-or-flight, stress response.
There are three identified hormones that are released in the stress response, each triggering specific functions in the body necessary for surviving any threat.
Adrenaline, produced by the adrenal glands, floods into our system after receiving a message from the brain that a stressful situation has presented itself. Adrenaline acts to increase heart rate, breathing rate and muscular readiness, granting us the surge of energy we might need to run away from a dangerous situation.
Adrenaline also serves to ignite and place our immediate attention upon the threat itself, enabling us to better fight in response to perceived or actual danger. We feel adrenaline when we are startled. The butterflies we feel in the stomach with even a simple fright, is actually due to adrenaline release, pouring into our bloodstream from the adrenal glands.
Norepinephrine, a hormone similar to adrenaline, is released from both the adrenal glands and also from the brain. Like adrenaline, the primary function of norepinephrine is arousal. It also helps to shift blood flow away from areas where it might not be so crucial, like the skin, and toward more essential areas of the body, including the areas of the primitive brain used for processing information for survival.
If you've ever tried to remain logical and rational under threat, in panic or when angry, think for a moment how clearly you were able to think and process information during these times of intense stress. When we are traumatized, we are in shock. The response of the body in shock is to create an environment in the body, solely concerned with the bodily functions necessary for survival. It is our primitive brain that deals with survival, not the per-frontal cortex and other brain regions responsible for reason and logic.
Although norepinephrine might seem redundant, given that adrenaline (also called epinephrine) fuels the same needs in the body, theory suggests that we may have both hormones as a type of backup system. Nature, some would argue, makes no mistakes, therefore nature provides for us, this back-up system of care. Should our adrenal glands not be working well, norepinephrine release from the brain takes care of the same needs for protective response in the body.
The third stress hormone associated with fight-or-flight is cortisol. In survival mode, optimal amounts of cortisol are necessary to save our lives. Cortisol helps to maintain fluid balance and blood pressure, while regulating other body functions that aren't crucial in the moment of threat. These functions include reproductive drive, immunity, digestion and growth, to name a few.
Many studies now suggest that too much cortisol can suppress the immune system, increase blood pressure and blood-sugar levels, often requiring medication to correct these issues in the human body. High levels of cortisol in the system can decrease libido, produce acne, and is recognized as a contributor to obesity. Cortisol is continually flushed into our systems when we are under threat, and studies also suggest a direct co-relationship between levels of cortisol in the system and the development of physical diseases such as diabetes and even cancer.(The Cortisol Connection, Shawn Talbot, PhD: 2002).
Dr. Sapolsky's work in the wilderness of Africa, supports that high-levels of cortisol is present in the most stressed members of the baboon populations he studies. This directly mimics similar levels of cortisol found in highly stressed human populations. (Stress: Portrait of a Killer, National Geographic: 2010).
These are powerful chemicals. More powerful, some would argue, then any street drug available to man. I'll stress again, when we feel the emotions of trauma, it is the surge of this chemistry that is actually felt.
Our bodies are amazing machines. With it now understood that PTSD is the result of our survival-mode in the body being stuck in an open position, what we feel in response to memories of trauma, are these hormones, racing through our systems, often on a constant basis. We feel this chemistry as anxiety.
This is a very unhealthy situation for our bodies, to be constantly emotionally engaged for battle like this, with memories producing such powerful chemistry in response to a threat that is no longer before us. As stated in the beginning of this article, it is these three hormones, along with others in the stress response, that fuels emblazoned memories of trauma in a misinterpreted effort to protect us from future harm.
If we learn anything while under the spell this chemically induced emotional attachment drives with it into memory, the lesson in the threat, will be super-learned, as identified in the PTSD diagnostic literature as intrusive memory. With the amazing power of our bodies to provide for us when we are under threat, it's reasonable to accept that the body would produce a countering action to the chemistry of the stress response.
Dopamine, serotonin and oxytocin, are three such chemicals now identified as producing feelings of happiness and well-being in humans, that counter the more negative effects of stress hormones in human body. We call these counter-chemicals, (neurotransmitters) endorphins.
How do we naturally counter stress hormones in the body with endorphins? We do so by learning to practice wellness. Recovery efforts, therefore, must contain components of practice that focuses our attention on reducing stress hormones, while at the same time, making way for natural endorphins to do their work towards assisting our bodies in a return to balance, or homeostasis.
As I hope by now is evident, trauma-induced PTSD is a complex disorder, requiring complex and blended interventions to ensure such a return to balance. The first order of business, is to apply treatments to help us restore balance by resetting our nervous system from the open mode of survival, created with our stuck mechanisms of fight-or-flight. One of the most powerful and now accepted treatments in recovery from trauma, is EMDR.
Eye-Movement, Desensitization and Reprocessing, is a technique pioneered by American psychologist and educator, Francine Shapiro. In 1987, she made the chance observation that moving her eyes from side to side appeared to reduce the disturbance of negative thoughts and memories she was having at the time. This experience led her to examine this phenomenon more systematically, leading ultimately to the EMDR technique.
Working with volunteers, she developed standardized procedures to maximize therapeutic outcomes. Shapiro then conducted additional research and published a randomized controlled study with trauma victims. After further research and development of most effective methods, she went on to publish a textbook on the subject. EMDR is now recommended as one of the most effective treatments for trauma. It is accepted as the go-to treatment by the American and Canadian psychiatric communities, as well as by the Canadian and U.S. departments of National Defense.
EMDR, along with other, less-studied treatments (such as Trauma Release Exercise, pioneered by Dr. David Berceli, and Somatic Experiencing, developed by Dr. Peter Levine) assumes that the human body has an innate knowledge of healing from trauma. A forth technique, Self-Regulation Therapy, also understands the bodies own abilities in naturally resolving traumatic experience in resetting our nervous system.
Although some who suffer trauma will resolve trauma on their own, many of us with PTSD will need to rely on such treatments as these to assist us in resetting our nervous systems. To burn-off stress hormones and to release endorphins, physical exercise is another key component we must consider applying to our recovery efforts. Nutrition as well, is key to establishing well-being in life. As discussed in previous blog entries, meditation, specifically working towards practices of mindfulness, is another key application to apply to trauma recovery efforts. Meditation can teach us about any attitudes, perceptions or beliefs that may be negatively impacting our treatment and recovery plans.
An acronym recently passed the desk, W.E.L.L.N.E.S.S.
- W=Way of Thinking: In order to heal, we must learn of any problem beliefs we may hold, clouding our filters of perception. It's only through learning to observe our thoughts, without judgement, that we can foster a relationship with our belief system. Mindfulness can help us in getting there. Journalling can can also provide a means for us to hear the words we dictate in our inner life. Caution is necessary here. Story-telling, repeating our trauma stories, over-and-over again, can groove memories deeper into our sub-conscious. Be sure to involve professionals, when story-telling is necessary to learn how to challenge problem beliefs.
- E=Exercise: Twenty minutes of exercise that works on increasing heart-rate (aerobic exercise) is all we need to burn of stress hormones and elevate endorphins.
- L=Laughter: Laughter and tears are the bodies own healing. Laugh often and cry when you must. Don't deny yourself this healing balm. In spite of what we may have learned, it's healthy for big-boys to cry.
- L=Let It Go: By engaging in therapy, the techniques described above (EMDR and Others) will reset the nervous systems, and help to restore homeostasis (balance) in the body.
- N=Involvement: Isolation, is deadly sometimes. Being alone with untreated thoughts of trauma, can take us places we might not well manage on our own. Engaging socially with others, whether an effort for us to do or otherwise, keeps us connected to the people we love and who are there to love us back from our trauma experience.
- E=Eat a Balanced Diet: As is practiced in treatments for diabetic conditions, consistent meals, supplemented with healthy snacks throughout the day, will help maintain the fuel we need to progress in recovery. Supplements can help to replace lost vitamins and minerals, exhausted often during recovery. Recovery is hard work. We need all the help we can get.
- S=Set Personal Priorities: We all need goals in life. Recovery efforts can be broken down into bite-size, meaningful tasks. Prioritizing responsibilities and incorporating time-management skills into our life, will help to reduce the unnecessary additional stressful triggers, time pressures can create for us. Recall your dreams in life and find ways to work towards achieving them. Remember, it's about the journey, not the destination.
- S=Sleep: The most important and often difficult to receive component in any recovery effort, is sleep. Quality sleep, with active periods of REM sleep in the cycle, is natures way of effectively sorting out the days events, and works well to reset the nervous system while we rest. Sleep is recovery time at it's best, both physically and psychologically. EMDR is thought to create the same brain-wave patterns of REM sleep, pointing further to the merits of including EMDR as part of our over-all recovery plan.
As always, please ensure to involve your physician and other care providers, before engaging in any self-help recovery efforts. There is no substitute, for professionally trained, trauma-informed care.
- Sapolsky, Robert: Why Zebras Don't Get Ulcers: The Acclaimed Guide to Stress, Stress-Related Diseases, and Coping: Holt Paperbacks, 2004.
- Shapiro, Francine: Getting Past Your Past: Take Control of Your Life with Self-Help Techniques from EMDR Therapy: Rodale Books, 2013.
- Schwartz, Mark: Robert Sapolsky discusses physiological effects of stress: Stanford Report, 2007.
- National Geographic Society: Stress, Portrait of a Killer: DVD, 2010.