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Why compassion is needed for those with PTSD & Trauma - a neurobiological understanding



This article is intended to provide people suffering with PTSD ( or family who have to live with someone with PTSD) a basic understanding of the condition and why it needs to be de-shamed with compassionate understanding.



PTSD (Post Traumatic Stress disorder) is stereotypically associated with flashbacks, night terrors, prone to aggressive behaviour, using substances to cope with painful feelings, emotional insatiably and trouble with relationships. The list goes on....

These symptoms occur after a sufficiently stressful event (a trauma*) .


*"any disturbing experience that results in significant fear, helplessness, dissociation, confusion, or other disruptive feelings intense enough to have a long-lasting negative effect on a person’s attitudes, behavior, and other aspects of functioning. Traumatic events include those caused by human behavior (e.g., rape, war, industrial accidents) as well as by nature (e.g., earthquakes) and often challenge an individual’s view of the world as a just, safe, and predictable place." - (American Psychological Association 2023)



Clearly PTSD and its counter part, C-PTSD (complex post traumatic stress disorder) are really debilitating conditions that tragically in many cases the victim was the innocent party - but was the one left with the scars. Think domestic abuse, sexual violence, long-term abuse, bullying, racial discrimination or violence, returning from a war, or witnessing or being around any of the above.


The Problem - In simple terms


People with PTSD tend to have larger more sensitive amygdala's (fear center) then normal which means they will have less activation in their frontal cortex then normal, which combined with a smaller and less effective hippocampus to make healthier new memories and associations about past memories. All result in someone with Brain differences seen in PTSD will react stronger to threatening things, have less emotional control and regulation and struggle to make new memories about it all to tell themselves it's ok.


'PTSD victims describe flashbacks as powerful and multisensory, often triggered by stress, and experienced as if they were occurring in the present moment.' (Gloor, 1978; LeDoux, Van De Kolk & Greenberg, 1987 quoted in Cozolino 2017).


Working with individuals with PTSD and Complex trauma softens you greatly to sympathising with individuals who suffer greatly. It is hard to meet someone who is suffering from PTSD and not be moved by the desperation of the person who simply wants help, but often finds themselves self-sabotaging their progress due to horrific nightmares or flashbacks.

However, PTSD often goes misunderstood as solely a psychological condition. An example is Combat Veterans returning from Vietnam relieving hell on earth in flashbacks or nightmares in the 70's trying to prove they had something wrong with them (Sapolsky 2017). It took a while for PTSD to be recognised as an organic brain disorder where the symptoms are not only psychological but critically abnormalities occur within the brain structure. Namely, PTSD causes enlargement of the Amygdala (the brains centre of fear processing) and shrinking of the hippocampus (where new memories are formed) (Sapolsky 2017, Cozolino 2017). As a result, people with PTSD are hyper vigilant to threats, paranoia and are inhibited from making new memories to replace the traumatic memories, which creates a loop that people with PTSD know all too well - flashbacks are easily triggered and with little ability to form new memories to change the meaning of their past experience they relive the past in the present with little ability to change it.


Because of the misunderstanding of PTSD it is important that we de-shame victims who can be made to feel they are seeing things or make believing. Compassion and compassion focused interventions can be helpful in this de-shaming process.


The Amygdala - Hippocampus Problem: a brain set up for hyper-vigilance


In a healthy functioning brain the Amygdala processes anything to do with danger or fear amongst other things. It scans faces to detect if they are a threat or not. It tell us if we are safe or not. The amygdala is part of a neural circuit called the amygdaloid circuit, this connects the amygdala to other areas of the brain: the thalamus, hippocampus and frontal cortex. This circuit determines whether the amygdala switches on and takes over 'hijacks' the rest of the brain or not.



Source: Anthony Wright, Ph.D., Department of Neurobiology and Anatomy, McGovern Medical School https://nba.uth.tmc.edu/neuroscience/m/s4/chapter06.html


Fast processing makes mistakes


The Amygdala has two main pathways in which it activates: one that bypasses the frontal cortex receiving information straight from the Thalamus and in the other the cortex receives the information about say a loud bang first and then sends it to the Amygdala to check it out, are we safe or not?


The cortex is the part of the brain that makes good decisions and is logical, thinks things through etc (Sapolsky 2017). Having the cortex involved Information about danger takes longer to process by a fraction of a second, however it is the mediator of rational conclusions. You hear a loud bang, the sounds get sent to your cortex first and you remember your at a party with loud music - you were expecting a loud bang and therefore you decide you are safe. Bypass the cortex and just activate the Amygdala, a quicker process but it bypasses any conscious decision making process you just run, hide or cry. The most common example always used is that Amygdala see what it thinks is a snake, it runs like hell screaming. If the cortex was consulted for just a section of a fraction longer it would tell you it was a rope dropped on the floor in some sand or even a non-poisonous snake.



Compassionate conclusion


People with PTSD will tend to have larger more sensitive amygdala's then normal which means they will have less activation in their frontal cortex then normal, which combined with a smaller and less effective hippocampus to make healthier new memories and associations about past memories. All result in someone with Brain differences seen in PTSD reacting stronger to threatening things, having less emotional control and regulation and struggle to make new memories about it all to tell themselves it's ok.


Therefore, a key part of compassion focused therapy when someone is experiencing PTSD, C-PTSD, relational trauma is to help the person understand the organic element ( their brain is likely comprised) and that it is not their fault for not always being able to control it with sheer willpower. People with these types of histories often feel like failures or weak, as they cannot stop themselves from lashing out in anger at loved ones, dissociating, needing coping mechanisms such as substances or other addictions, not being able to hold down a job, or do what they used to do. The key message is it's not your fault, but it is your responsibility work with what you have got now and try to make the best of the situation.



References

American Psychological Association (2023)'Trauma', APA Dictionary of Psychology, https://dictionary.apa.org/trauma (accessed: 31st May 2023)


Anthony Wright, Ph.D., (2022) Department of Neurobiology and Anatomy, McGovern Medical School https://nba.uth.tmc.edu/neuroscience/m/s4/chapter06.html


Cozolino, L. (2017).The neuroscience of psychotherapy: Healing the social brain (3rd ed.).W W Norton & Co.


Sapolsky, R. M. (2017). Behave: the biology of humans at our best and worst.New York, New York, Penguin Press.


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