Basics of Trauma and the Brain

My first co-authored publication was on a rare case involving a male who lost all his autobiographical information. He did not know who he was or where he was from and was found lying intoxicated in the middle of the road. It was a bit unnerving as the city where we lived was on high alert for a man accused of assaulting others and there was some early thinking on the part of police that this was their guy. Several sessions of hypnosis revealed he was a veteran who was assaulted and a victim of trauma himself. The hypnosis helped him recover his identity but unleashed a wave of emotions nearly too difficult for him to manage. This taught me an early lesson on the power of the mind to protect our brains from processing experiences that can be too difficult or painful. It was a clear example of the damaging effects trauma can play on our mind, brain, and body.

Trauma is defined by the American Psychological Association as an emotional response to a terrible event like an accident, combat, crime, or natural disaster. Immediate and short-term reactions include shock and even denial. Longer term reactions can result in post-traumatic stress disorder (PTSD), and it is estimated that 20% of people who experience a traumatic event will develop PTSD and many others subclinical symptoms of PTSD. It remains unclear why some people who are exposed to the same trauma as others get PTSD and some do not.

Examples of trauma include physical or sexual abuse, victim or witness to violence, accidents, natural tragedies such as fire, flood, or storms, and war and combat. The trauma occurs when the person experiencing it perceives their situation as life threatening. The brain has a remarkable built-in process that emphasizes the importance of survival. Our ability to survive over thousands of years is due in large part to our brains being vigilant, processing quickly, and understanding threats to our very existence. We have developed primitive and more elegant defenses to survive over the years. While we are no longer chased by animals wishing to eat us, we do experience life-threatening challenges in our lives, and our brains also can perceive something as life threatening which really is not. We can fall prey to “catastrophizing” things and experiencing chronic anxiety and panic as a result. Either way, our brains will react to help us survive and when this protective system does not shut off, we experience the long-term and uncomfortable effects of trauma.

What happens in the brain when we are confronted with a life-threatening trauma and what happens if we cannot shut the systems off once the trauma is removed? Deep inside your brain is a collection of small but critical structures known as the Limbic System. It helps regulate your emotions, behavior, motivation, and memory. It works in a harmonious way with other parts of the brain to help you process thoughts and motivations and to tell your body how to respond.

Some of the critical structures (one on each side of the brain) in the limbic system include the hippocampus, which is critical to learning, memory, and spatial processing. The next-door neighbor of the hippocampus is the amygdala, which is responsible for processing our emotional response to a given stimulus. It is the structure that can trigger panic, fear, and sense of doom creating the perception that “my life is in danger.” When you put these two structures together, you can appreciate how emotion is connected to memory and how it can be especially difficult to forget negative or traumatic experiences. The amygdala and hippocampus can set off our endocrine-hormonal-brain-neurochemical reaction via the hypothalamus-pituitary-adrenal axis (HPA), causing cortisol (stress hormone) to flood our brain and body and norepinephrine (adrenaline) where our glands, brain, and body coordinate the well-known “fight or flight” response. An overactive amygdala will also limit the functioning of the hippocampus, which is why we are more forgetful and less able to learn when we are anxious or under stress. The final critical region of the brain to get activated is your prefrontal cortex (most anterior part of your brain) that facilitates decision making and execution of behavior that enhances safety. This complicated set of reactions is good and helps us to avoid danger, but if it does not shut off once the situation is clearly safe, a long-term clinical condition like PTSD can occur.

The typical fight or flight reaction sets off a cascade of bodily reactions and interactions that causes rapid breathing, fast heartbeat, expansion of the lungs, dry mouth, sense of time slowing, increased blood flow to the biceps (fight) and quads (flee), hypervigilance, dissociation and cognitive impairment. These are the typical symptoms and signs of a panic attack and anxiety, which are unpleasant. In the immediate phase, when reacting to a dangerous stressor, this reaction helps us survive. When the stressor is no longer present, this reaction should shut off or the body will suffer the long-term negative effects noted above.

Unfortunately, this article seems timely as we recently all took moments of silence to recall the horrendous and traumatic events of September 11, 2001. Many people died, and many more continue to suffer the consequences of that day. Trauma can have a lasting effect that requires intensive therapy and behavioral interventions to help a person regain function. Many of you recall the details of your day on 9/11 even though that terrible day was 25 years ago. Those closer to the incidents of direct impact are more likely to have experienced the negative and long-term effects, but even someone thousands of miles away who watched the trauma unfold on television may have had difficulty boarding an airplane or going into a city, etc., for a period. Witness of a particular trauma can also trigger a past trauma that may have been hidden out of consciousness.

Individuals and society at large, with groups supporting one another, help to spark the healing process. Our nation held many vigils and continues to do so; we have concerts and pray together to heal. There is no medication to make the pain go away or to remove the negative impact of 9/11 or other traumas. The healing comes from a slow but deliberate approach to teach the brain you are safe and capable of living a normal or almost normal life again. It requires time, patience, heavy doses of love and support, and professional skill to help. Many times, the powerful therapeutic effect of healing does not take place in an office, but in the actual environment where the target of fear is greatest. Each of us has fears and if the fears paralyze us, it will be good for us to work on the thinking that promotes the fear, but to slowly and successively approximate to that which causes us the fear reaction. This is best done under professional guidance, but the brain essentially relearns and reinforces the idea that you are safe again and capable of living a strong and independent life.

It is important to have empathy and tolerance for those who have experienced any level of trauma and to be a kind neighbor, family member, and friend. Often, persons who are suffering the effects of trauma are hidden and do not appear to be suffering. It is always a good idea to recall we do not know another person’s journey and that everyone typically is doing the best they can. It is never comfortable to be afraid, fearful, or limited by our emotional dyscontrol. The good news is that our brains can heal and there is nothing stronger than the human spirit guided by faith and love from others.

If you or a family member is struggling with trauma, I encourage you to seek help from others you trust and to speak to your doctor who can help create a plan of therapeutic healing for you. Trauma does not define anyone, and each of you is more than any given challenge, regardless of its possible current hold on you. You can overcome and live your life to the fullest!