PTSD's Impact on the Brain

Post traumatic stress disorder is a neurobiological disorder. All of the symptoms are a reflection of a brain that has been changed.
 
Research in neuroscience suggests impaired functioning in brain areas responsible for threat detection/response and emotion regulation account for many PTSD symptoms.

 PTSD FROM NARC ABUSE   —    COMPLEX PTSD    —   TREATMENT 

The Brain’s Response to Trauma

Trauma can impact people in a variety of ways and can even have a lasting impact on the brain. In some cases, it can lead to post-traumatic stress disorder (PTSD), a trauma- and stressor-related disorder that results in improper processing and storage of traumatic memories.
 

Because of the way these memories are stored, people with PTSD exhibit symptoms such as recurrent memories regarding the event; traumatic nightmares; dissociative flashbacks; hypervigilance; engaging in risk-taking behavior; and an exaggerated startle response.
  

Not all people with PTSD experience the same symptoms or have the exact same pattern of brain changes. However, researchers have been able to use neuroimaging techniques to look at some of the different areas of the brain that play a role in the development of the condition.
 

When your brain identifies some type of threat, the amygdala is responsible for initiating a fast, automatic reaction known as the fight-or-flight response.
  

Think of the amygdala as the alarm that sounds when something poses a danger. This alarm prepares your body to respond, either by dealing with or getting away from the threat.
 

The amygdala also communicates with other areas of the brain, including the hypothalamus, which then releases the stress hormone cortisol.
 

It is the brain's prefrontal cortex that must then assess the source of the threat and determine if the body needs to stay on high alert to deal with the threat or if the brain needs to begin calming down the body.
  

The prefrontal cortex acts as a braking system that helps return your body to a normal state when you realize that the threat doesn't pose a danger or after the threat has passed.
 

When people have symptoms of post-traumatic stress disorder, the amygdala becomes hyperactive while the medial prefrontal cortex becomes hypoactive.
 

In other words, the part of the brain that triggers a fight-or-flight response responds too strongly, often in a way that is disproportionate to the danger posed by the threat.
 

At the same time, the part of the brain responsible for calming this reaction does not work well enough.

How Trauma Changes the Brain

by Carrie Baatz
 

Many of us experience trauma at some point in our lives. Traumas are deeply distressing events that threaten our life, safety and well-being. They can be terrible events like natural disasters, shootings, rape, accidents, combat, or the loss of a loved one. They can also be ongoing, like the experience of abuse, extreme poverty or homelessness.
 

The impact is profound. Trauma elicits a sense of helplessness that may stay with a person for a long time. Some people carry a weight of shame or guilt from their experience and suffer from an eroded self-worth. Some survivors say that they have experienced what feels like emotional or spiritual death. Chronic health problems can occur as a result of extreme stress on the body.
 

Traumas can cause physical or psychological disabilities. Post-traumatic stress disorder (PTSD) is a mental health disability. It develops in people who experience symptoms with extreme intensity over a long time. Symptoms usually include flashbacks, nightmares and severe anxiety, as well as uncontrollable thoughts about the trauma.
  

Everyone responds to trauma differently. Having support in the aftermath of trauma is one of the most important factors in determining the impact trauma will have on a person. A lack of support after trauma is often more damaging than the trauma itself.
 

How the Brain Adapts in Response to Trauma

Human beings are master adapters. Our biological systems are designed to change in response to whatever life throws at us. Research in neuroscience shows that if we witness or experience trauma, our brains can actually take on a different structure.
 

For people who develop PTSD, trauma causes a psychological injury. Certain areas of the brain become hyperactive, while others are less active, creating an imbalance.

The Amygdala enlarges, stimulating "fight or flight mode."

Our emotional center in the brain, the amygdala "sounds the alarm" to the rest of the body when a threat is detected. When the amygdala is hyperactive, people may have a lower tolerance for stress and harder time controlling their emotions.
 

The Hippocampus, responsible for short-term memories, shrinks.

The Hippocampus helps us distinguish between past and present memories. People with PTSD can lose the ability to discriminate between past and present experience, which can result in flashbacks (re-living traumatic events). This can also cause short-term memory loss.
 

The Pre-frontal Cortex shrinks, making it harder to regulate thoughts and emotions.

Years after experiencing a trauma, a survivor may continue to feel frightened and highly alert, no matter what they are doing. They might have difficulty expressing what they are thinking and feeling, or get stuck in negative thinking patterns. They might carry extreme amounts of stress. This happens because the activity in their pre-frontal cortex has been disrupted.
 

The pre-frontal cortex is responsible for emotional regulation, rational thought, language and conscious awareness. When impacted by trauma, this part of the brain is not able to regulate fear and other negative emotions as well, which causes fear, anxiety and stress responses when anything happens resembling their original trauma.
 

Because of the way our bodies adapt to trauma, the brain learns to perceive threats everywhere. For a survivor, this can mean that the world seems like a perpetually dangerous and frightening place. It can also damage a person's ability to trust others and themselves.
 

PTSD can cause serious disruption in the ability to have healthy, satisfying relationships or tolerate life's uncertainties, failures, and rejections without excess distress.
 

It can also cause phobias, sleep disturbance, negative mood, anxiety, and attention/concentration difficulties that interfere with academic or career success.
 

The Amygdala, a small structure located deep in the middle of the temporal lobe, is designed to:

• Detect threats in the environment and activate the "fight or flight" response

• Activate the sympathetic nervous system to help you deal with the threat

• Help you store new emotional or threat-related memories
   

The Prefrontal Cortex is located in the frontal lobe just behind your forehead. The PFC is designed to:

• Regulate attention and awareness

• Make decisions about the best response to a situation

• Initiate conscious, voluntary behavior

• Determine the meaning and emotional significance of events

• Regulate emotions

• Inhibit or correct dysfunctional reactions
  

When your brain detects a threat, the amygdala initiates a quick, automatic defensive ("fight or flight") response involving the release of adrenaline, norepinephrine, and glucose to rev up your brain and body.
  

Both the amygdala and the mid-anterior cingulate cortex become over-stimulated when a person has PTSD. 

However, the hippocampus, right inferior frontal gyrus, ventromedial PFC, dorsolateral PFC, and orbitofrontal cortex all become hypoactive, some to the point of atrophy.

Consequences of Brain Dysfunctions in PTSD

Hyperarousal

Because the amygdala is overactive, more norepinephrine is released in response to threat and its release is not well-regulated by the PFC.

Effects of excess norepinephrine include:

1. Hyperarousal.
2. Hypervigilance
3. Increased wakefulness and sleep disruption

As a result of hyperarousal, people with PTSD can get emotionally triggered by anything that resembles the original trauma (e.g., a sexual assault survivor telling her story on TV, a loud noise, or passing somebody who looks like their assailant). Symptoms of hypervigilance means they are frequently keyed up and on edge, while increased wakefulness means they may have difficulty sleeping or wake up in the middle of the night.

Reactive Anger and Impulsivity

A reactive amygdala keeps people with PTSD on the alert and ready for quick action when they face a threat, leading them to be more impulsive. The orbital PFC is a part of the PFC that can inhibit motor behavior (physical action) when it is not appropriate or necessary. In people with PTSD, the orbital PFC has lower volume and is less activated. This means that people with PTSD have less control over reactive anger and impulsive behaviors when they are emotionally triggered. Reactive anger can cause damage to career success and interfere with relationship functioning.

Increased Fear and Anger and Decreased Positive Emotionality

People with PTSD often report feeling an excess of negative emotion and little positive emotion. They may have difficulty enjoying their day-to-day activities and interactions. This could be the result of a hyperactive amygdala communicating with the insula, an area of the brain associated with introspection and emotional awareness. 
 

The amygdala-insula circuit also impacts the medial PFC, an area associated with assigning meaning to events and regulating emotions. Research shows overactivity of the amygdala-amygdala-insult circuit can suppress the medial PFC, thereby interfering with the ability to regulate negative emotions and assign more positive meaning to events.
 

How Treatments Affect the Brains of People with PTSD

Some studies show that psychotherapies which include repeated exposure to trauma cues can enhance the ability of the PFC to assign less threatening or more positive meanings to trauma-related events.
   

Antidepressants seem to have a similar effect. Mindfulness interventions lasting 10 to 12 weeks have been shown to decrease amygdala volume and increase the connectivity between the amygdala and PFC.
 

Mindfulness seems to make the amygdala less reactive and the PFC more able to calm down the threat response. But some people with PTSD may have difficulty tolerating being mindful or confronting their trauma actively.
 

Avoidance is a hallmark of PTSD and some patients may need more support and relationship-building before they are ready to face their distressing feelings.
 

Summary

Research suggests that the brains of people with PTSD differ from brains of those without PTSD in two main ways:

• They are hyperactive to threat (amygdala).

• They have difficulty regulating or damping down anxiety and anger (medial PFC).
   

Effective treatments for PTSD seem to address these brain dysfunctions by either decreasing the reactivity of the amygdala or increasing the ability of the PFC to calm it down. 
 

Therapists who are trained to recognize and treat the signs of PTSD can be much more effective in reducing the considerable suffering associated with their trauma experience.
 

Educating patients about their symptoms and the neurobiology of PTSD can be de-shaming and increase their self-compassion and sense of control.

Source: https://www.psychologytoday.com/us/blog/the-mindful-self-express/201809/how-ptsd-and-trauma-affect-your-brain-functioning

The Consequences of Trauma

When examining the functions of the various structures of the brain, the correlation between a change in those structures' activity levels and some PTSD symptoms becomes clearer.
 

Hypervigilance

The over-activity of the amygdala presents as symptoms of hypervigilance and the exaggerated startle response.
 

Because the amygdala overreacts, norepinephrine is released but then not adequately controlled or dealt with by the prefrontal cortex.
 

As a result, people with PTSD experience symptoms of hypervigilance. They become overly aroused and are on high alert, which can make it hard to relax and to sleep. A person may feel that they are always tense and even small triggers can lead to react as if they are facing or re-experiencing their original trauma.

Distorted Recall

The hippocampus is involved in explicit memory processes and in the encoding of context during fear conditioning. When the hippocampus fails to function optimally, it impacts the way a person remembers and recalls memories, especially memories that contain a fear element-such as those related to trauma.
 

In terms of PTSD symptoms, this results in:

• Recurrent memories regarding the event
• Distorted negative beliefs
• Dissociative flashbacks
    

Impulsive Behavior

Changes to the right inferior frontal gyrus help to explain why people with PTSD may suddenly engage in high-risk activities.
 

Research has found that reduced cortical thickness in certain areas of the brain associated with emotional regulation and response inhibition, including the right frontal gyrus, is linked to impulse control problems in PTSD.
 

When thoroughly examining the relationship between brain function and a person's symptoms, it becomes easier to understand many of the complex manifestations of PTSD. Although understanding the brain in this way may not provide direct symptomatic relief to someone living with PTSD, it can be helpful in understanding why the symptoms are happening and, in turn, help the medical community continue to develop more effective interventions.

Source: https://www.verywellmind.com/what-exactly-does-ptsd-do-to-the-brain

Avoidance Behavior: Examples, Impacts, & How to Overcome

Written by: Silvi Saxena MBA, MSW, LSW, CCTP, OSW-C
 Reviewed by: Rajy Abulhosn MD 

• Definition
• 13 Examples
• Impacts
• 4 Tips
• How Therapy Helps
  

Avoidance refers to specific behaviors that people use to ensure they're not involved in a specific situation, or that they can leave a situation they've already entered. These behaviors also refer to individuals who actively avoid difficult feelings. Avoidance behaviors can be a sign of underlying mental health issues.
 

What Is Avoidance Behavior?

Avoidance behaviors are any behavior people use to escape or distract themselves from difficult thoughts, feelings, and situations. This can look like avoiding new job opportunities, career advancements, relationships, social situations, recreational activities, and family get-togethers. People use avoidance as a natural coping mechanism for pain, trauma, and other mental health issues.

It can be understandable to avoid dangerous situations or avoid peer pressure, but avoidance is more than just feeling uncomfortable. Avoiding something can make you feel in control; however, depending on what you are avoiding, it doesn't always signify true control. Long-term, these behaviors can exacerbate other issues going on in your life.
 

Avoidant behavior can be a symptom of the following mental health issues:

• Social anxiety disorder
• Panic disorder
• Avoidant personality disorder
• PTSD
• Avoidant attachment
• Abandonment issues
• Toxic shame
• Depression
• Anxiety
• Toxic relationships
• Disorganized attachment

13 Examples of Avoidance Behavior

Avoidance behaviors can present in several different ways, including escapism, drug and alcohol use, day-dreaming, and burying your emotions.

Here are thirteen examples of avoidance behaviors:

1. Escapism
2. Drug/alcohol use
3. Wishful thinking/day dreaming
4. Burying one's emotions
5. Self-isolation
6. Avoiding eye contact
7. Lowering voice when speaking
8. Leaving gatherings early
9. Making up excuses to avoid attending a party/social gathering
10. Procrastination
11. Cancelling plans last minute
12. Not answering calls or texts
13. Avoiding certain places and at certain times

Impacts of Avoidance Behavior

When you try to prevent stress instead of allowing yourself to feel the emotions that come up for you, you give yourself a false sense of control. In reality, you hand over control to the thing you are trying to avoid, which does more long-term harm than good, even if it feels better in that moment. This can become a cycle that's hard to break, leaving you more anxious, triggered, and/or depressed.

Avoidance behaviors can also wreak havoc on your day-to-day life, forcing you to engage in other negative or maladaptive behaviors.

Here are examples of impacts from avoidance behavior:

• If you're avoiding a route in your car, it may make you late or cause you to spend more money
   
• Anxiety-related avoidance may make you lose professional opportunities
   
• If you're avoiding certain feelings or conversations, it could hurt your personal relationships

4 Ways to Overcome Avoidance Behavior

Here are four strategies to overcome avoidance behavior:

1. Journaling

Try writing things down to get them out of your head, so to speak. Sometimes, when we write down our feelings and read them aloud, it helps us process differently. This can help us identify negative thought patterns and explore where they come from and why. Once we're able to sort through some of that, we can start to do the work to heal.
 

2. Utilize Stress Management Techniques

Stress management techniques can help people manage and move on from avoidance behaviors. Given that stress can sometimes mask itself as anxiety or depression, identifying the root cause of an issue or feeling is the first step towards recovery. Stress management provides many ways to deal with stress, no matter its cause, instead of avoiding the issues.

3. Develop Coping Skills

It's important to develop healthy, positive coping strategies. Think about your day-to-day routine and imagine what a life without avoidance would look like. Ask yourself this: How do I feel? Can I get past this feeling? Could this have been prevented? Is there something I can do to fix this now? These questions will allow you to tap into your emotion-focused and problem-focused coping mechanisms.

4. Seek Professional Help

If you're avoiding situations or people and not really able to cope well or consistently, seek professional help. Due to the complex nature of how avoidance behaviors impact and trigger other mental health issues, it's safer to find help at the first sign of struggle and get the support right away.

When & How Can Therapy Help With Avoidant Behavior

If your avoidance behaviors are getting in the way of you living a full life, it may be time to consider therapy. All licensed therapists are equipped to help people with avoidance behaviors and feelings, but having a strong therapeutic relationship is more important than the specific type of therapy they provide. Consider family therapy or couples therapy if the avoidance is impacting your relationships.
 

Once you have found a therapist, the two of you will create a treatment plan that could involve other types of therapy, such as group therapy. Depending on the underlying issues, marital or family therapy may also be recommended after a few sessions. It's important to go in with an open mind and strive to address the underlying reason why you feel a need to engage in avoidance behaviors.