Shadowboxing: The Neurological Implications of Post-Traumatic Stress Disorder

by Sarah Von Hoene

 “I have acid rain in my brain,

and it’s killing the flowers in my heart.”

       - Marianna Paige

                                                                       

            It was only her second time entering a police station. The first time, it had been easy. Her heart raced as she pulled open the door to the building, her sweaty hands struggling to grasp the metal door handle. The station’s interior seemed darker and more intimidating than she remembered. This time, the woman at the front desk was much younger. Her nerves increased as she approached the glass blockade dividing her and the desk. She struggled to explain why she had come to the station, speaking quietly and unable to finish her sentences. Her boyfriend explained, and the secretary quickly nodded and gestured to a couch that looked so uncomfortable that one might prefer to sit on the floor. “I’ll have someone out in a moment,” the woman assured. The waiting was unbearable. She sat on the couch, cold, nervous, and uncomfortable. In an effort to ease her mind, she got up to look at cliché brochures on the wall, covering every topic from fire safety to how to register a new family pet. Time passed slowly. She wondered which door the detective would emerge from, glancing quickly between the four possible entrances. Would they be a man or a woman? She hoped for the latter. Even more, she wished she could walk back outside, bask in the warm sunshine, and drive home. A dark-haired man eventually appeared and she was ushered into a tiny room with drab beige walls, three chairs, and a small table. The detective pulled out a notebook and pen and began asking questions. He wanted to know what she could remember. What evidence did she have? She answered the best she could, hoping that by speaking out there would be a light at the end of what was an incredibly dark tunnel.

                                                           

According to the American Psychological Association (APA), trauma is simply defined as, “an emotional response to a terrible event like an accident, rape, or natural disaster”.  With such a general definition comes a plethora of possible traumatic events. Generally, the most common traumatic experiences involve combat, abuse, assault, or a loved one’s death. In any situation where an individual’s physical body, mind, or integrity feels dangerously threatened, there is a chance that the experience could result in trauma. While some types of trauma are discussed more openly than others, any traumatic event can leave lasting marks on an individual’s mind, body, and overall life.

            In severe cases, an individual who has experienced a traumatic event may develop Post-Traumatic Stress Disorder (PTSD). The symptoms of PTSD often include flashbacks of the traumatic experience, depression, elevated responses (particularly when startled), and persistent anxiety. Unfortunately, these are just a handful of the many ways in which PTSD can seep into one’s daily life. For those who suffer from PTSD, the intense mental and physical reactions to traumatic experiences of the past can become so engrained in their daily lives that it feels like they are no longer the same person they once were. Life feels different, and for many people with PTSD, their mind is consumed by a constant fear that something may trigger an unbelievably intense, painful, seemingly unstoppable reaction. The fact that PTSD is not a visible health condition often makes it even more difficult to manage and treat. There is no way for friends or family to physically see the way a person’s brain transforms after they’ve experienced trauma. Regardless of what can be seen by the human eye, the impact of trauma certainly leads to circuit-level brain remodeling. The precise details of this process, however, are yet to be completely understood.

Significant progress has been made towards understanding the effects of adverse experiences on the brain in the last 10 years. Thanks to advancements in technology, such as fMRI brain scanning and the expansion of many scientific fields of study, researchers have been able to narrow in on the underlying processes at play when an individual experiences trauma. Specifically, there are three particular areas of scientific study that correspond with trauma research. Neurobiology studies how an individual’s behavior affects their emotional and mental state, while neuroscience analyzes how mental processes occur within the brain.  Lastly, psychopathology studies the manner in which traumatic events affect the brain’s overall development. It wasn’t until the 20th century that these areas of study began to earn recognition as their own distinct disciplines rather than minute, amorphous parts of the general neuroscientific field. As they have developed into their own unique areas of expertise, neuroscientists have come to the conclusion that the human brain is ever changing, just like the majority of the human body. This concept, known as neuroplasticity, suggests that when the brain encounters a traumatic event, it undergoes changes that allow us to adapt and survive the situation.

            Dr. Steven Maier, a distinguished professor at University of Colorado Boulder, has spent years studying the effects of stress on the brain, coping mechanisms, and resilience. When interviewed about traumatic stress research and recent findings, he brought to light an important fact: the research has only just begun. He also emphasized that many recent neuroscience findings are still very much up in the air. “After all, we’ve only had the tools to really study what goes on in the brain at a detailed level for a very small number of years,” he stated. For example, the term neuroplasticity only become a psychology buzzword when scientists recently realized that the brain is capable of changing throughout adulthood, not only during childhood development. According to Dr. Maier, “in another three years, there’ll be some new discovery that’ll everyone will be talking about. There’s still so much we don’t know.” However, there are a few safe conclusions that we can draw today. Primarily, “there certainly are changes that occur in the brain as a result of experiencing adverse events that affect the processes that underlie plasticity.” However, an important question still remains: What exactly are those changes, and more importantly, how can individuals with PTSD recover from them?

Figure 1: When an individual experiences a traumatic event, the brain reacts in a particular way. Brain scans have shown that for those with PTSD, certain brain regions have been re-wired in response to the trauma (ACEs Connection).

 

                                                                       

            “You did what you had to so that you could survive.” The therapist repeated the words once again. They were meant to provide comfort, but didn’t make it any easier to get over the deep feelings of shame and guilt that constantly filled the girl’s mind. She couldn’t get the angry, blaming voice out of her head. Why hadn’t she moved? Why hadn’t she said anything? Why had she convinced herself that it was just a bad nightmare that she kept having for nearly a decade? Why couldn’t she remember what he’d done to her? Her therapist had explanations for everything. “It’s a common misconception that humans only respond to danger with fight or flight. The body can also freeze and dissociate.” The therapist’s kind eyes and calm, nurturing voice was soothing, yet the comment still made her shudder. The memories came rushing back. She remembered waking up in the middle of the night, immediately being paralyzed in fear. Trying to get up, but not moving an inch. Screaming at the top of her lungs, but no sound coming out of her mouth. Waking up hours later and sitting on her bed, wondering why she kept having such a terrifyingly vivid nightmare over and over again. For years, she told herself it was a dream. Now, she was slowly realizing it was a reality. She had gone to the police station. She had reported what she remembered, everything she had experienced. All she wanted was for the memories to go away. Yet, that was something her mind simply wouldn’t allow.        

                                                                       

To understand brain basics and how the cerebrum responds to trauma, there are a few key concepts to learn. First, the brain is composed of billions of cells called neurons. Neurons are responsible for moving information throughout our entire body. When they function in neural networks, neurons are able to pass information to each other chemically and electronically (Freudenrich). They are our body’s circuitry, and the majority of these circuits and neuron responses are deeply engrained into the brain. Therefore, in the case of trauma response, individuals are not able to tell the brain to react in a different way. In fact, evidence shows that there are specific circuits in place to protect us from danger, some of which lead to the commonly known “fight, flight, or freeze” response (Harvard). These neural networks and complex circuitry are also responsible for other responses to trauma, such as dissociation. When dissociation occurs, the brain circuitry that allows us to recognize physical sensations is essentially shut down, so the brain is unaware of what is happening to the body. For many trauma victims, this is their mind and body’s most basic coping mechanism.

 

                       

Figure 2: The above diagram shows the primary cerebral regions that are affected by trauma and the snowball

effect that stress has on these regions. Regions that handle long-term memory storage, fear response, and emotion

are all involved in the brain’s stress responses (Bremner).

 

There are three primary cerebral regions that are greatly affected when dealing with trauma. For one, there is the hippocampus, which is primarily responsible for organizing memories within the brain. Changes in the hippocampus can result in different symptoms. For some PTSD victims, traumatic memories may become too fragmented to piece together. In other individuals, they may have an overwhelmingly clear recollection of what happened to them. When this is the case, vivid flashbacks and painful memories occur more often, leading to a hyperactive amygdala, a second component of the brain that reacts strongly to trauma. The amygdala is considered to be the brain’s early warning system. When danger approaches, it will activate and tell the brain and body how to react to the threat. When an individual develops PTSD, the amygdala is hyper-activated, telling the brain that danger is constantly nearby. Finally, there is the pre-frontal cortex, which controls emotions, attention, and decision-making. After a traumatic event, it is common for the pre-frontal cortex to become significantly less active, making it unable to gain control over the unstable hippocampus and the hyperactive amygdala. In other words, if someone experiencing PTSD has a vivid flashback, the brain is unable to assure the individual that they are safe in their current environment. Instead, they react as if they were re-experiencing the trauma, immediately feeling as if they are threatened by danger once again.

My first encounter with PTSD was when I met Kyle. He was the friend of a friend, and not an easy person to miss in a crowd. His large figure hovered over most and immediately caught the eye, while his frequent joking drew everyone into his conversations. He didn’t look like much of a joker, though. When he wasn’t telling an amusing story, Kyle’s face seemed stern, suspicious, and tense. There was a gleam in his eye that would appear when he engaged with friends, but would quickly fade when the conversation came to an end. I noticed this when I first met him, but didn’t spend too much time considering my observation. For the most part, Kyle seemed like a friendly, humorous, highly skilled musician in my friend’s band.

Kyle and I met again at a Fourth of July celebration. Everyone spent the day outside, cooking Spanish paella in the heat of the sun, drinking beers, and smoking cigars. As I noticed before, Kyle’s personality attracted people of all types and his conversations generally led to a circle of smiles and laughter. But, as the sun went down and the nighttime Fourth of July festivities began, Kyle struggled to keep himself composed. While all of our friends rushed into the front yard to light up the largest legal explosives they could find, Kyle stood in a corner of the backyard alone, nervously rocking back and forth on his feet, staring wide-eyed into nothing. The gleam in his eyes was nowhere to be seen.

It did not take long after approaching Kyle to learn that his intense response to the surrounding fireworks was not voluntary. Kyle was a Marine who had served as an instrument technician for the overseas U.S. Marine Corps Band, but was on medical leave after being bombed near base camp and shattering his knee. Although he managed to escape the war zone, the traumatic experience of being in the center of such violent conflict left his mind just as damaged as his knee, possibly more.

Kyle’s PTSD kicked in as soon as the fireworks started exploding, causing his brain to immediately shift into danger mode. Even though he knew he wasn’t back in the war zone, the rewiring his brain underwent left him mentally and emotionally unable to prevent an influx of harrowing memories and natural fear responses. Underneath his humorous personality and engaging presence, Kyle was experiencing a pervasive, often uncontrollable mind-body reaction that was, for the most part, invisible to others.

                                                           

She could feel herself cracking. She was finally alone and the torrent of emotions within her couldn’t be contained any longer. Her quiet sobs turned into chilling, agonizing screams. She felt like a feral animal, incapable of preventing the fear and rage from taking over every single cell in her body. Curled up on the cold bathroom tile, she tried to calm down. She tried to stop hyperventilating, to stop screaming at the top of her lungs, to tell herself that she wasn’t back in her childhood room. He wasn’t there. She didn’t need to protect herself; she didn’t need to keep screaming, “GET AWAY FROM ME”. But, after years of dissociating from the trauma that she’d experienced, her body and her mind were finally waking up. Remembering. Processing.

                                                           

As debilitating as PTSD can be, a variety of treatments and coping mechanisms have been developed over the years. Pharmacotherapy, often in the form of antidepressants, has been a recommended treatment for PTSD for decades. However, mounting criticism stating that antidepressants only serve to temporarily reduce symptoms rather than actually heal the individual are leading many people to shy away from pharmacotherapy. Instead, the focus has shifted to forms of psychotherapy that teach the traumatized individual to truly process their trauma. This way, they learn how to express the emotions related to the trauma effectively and re-program their mind and body in order to move on with their life and leave the trauma in the past. This treatment, known as mindfulness-based cognitive therapy, has shown immense success in sufferers of PTSD over recent years. Studies have shown that veterans with PTSD who receive mindfulness-based exposure therapy (MBET) experience changes in their brains that indicate the rewiring of networks related to the perception of external threats (Wolkin).

To understand how these coping mechanisms and healing treatments are used in practice, I reached out to Dr. Shawna Roberts. As a practicing psychologist, Dr. Roberts is an expert in mindfulness-based cognitive therapy, cognitive behavioral therapy, and quite a few other forms of trauma treatment. She thoroughly explained the gradual shift in therapeutic treatments over time; from antidepressants to cognitive therapy to mindfulness therapy. “Medication doesn’t treat the problem, it just treats some symptoms,” she reaffirmed. She also explained the phasing out of cognitive therapy and the evolution of mindfulness therapy, a practice that supports the idea that the mind and body are a connected system. “We aren’t just floating heads,” she pointed out. Cognitive therapy is considered a “top-down approach”, meaning that it is an attempt to teach change by inputting information into the frontal lobe. The brain simply doesn’t work this way. Alternatively, mindfulness therapy is considered more of a “bottom-up” approach. This treatment addresses the mind’s wounds from the brain stem up, “a more psychoanalytic method,” Dr. Roberts stated. By emphasizing the connection between our minds and bodies, trauma can be addressed directly and the wounds can heal completely over time.

                                                           

It had been months since the interview at the police station. She thought back to that day, shocked at how she felt like a different person now. Her life was still far from the “normal” one she’d known before, but there was no doubt that she was improving, slowly but surely. Therapy helped more than she initially expected. The panic attacks weren’t as frequent, nor was she triggered as easily as before. Some days were worse than others, but with time she was learning to express the pain, the frustration, the anger. Her mind and body were healing. Before all of this, the emotions had been buried. Her brain had protected her and hidden the trauma. Before all of this, she wouldn’t have gotten angry. She didn’t know how. But now, she was finding her voice. Day by day, she was learning to speak up. She was learning how to tell her story.

                                               

While some define PTSD as a mental disorder, it has become quite evident that it is simply a result of an altered brain state that evolves after a traumatic event. There is nothing disordered about having an understandable, natural reaction to obscenities that our minds aren’t capable of recognizing or processing. This reaction is certainly difficult to endure, but with advancements in technology and treatment, things are looking up for those with PTSD. Thanks to mindfulness therapy and a continually deepened understanding of how the brain functions under times of traumatic stress, the possibility of treatment and healing is far more attainable than it has ever been. With further research, an increased awareness of PTSD, and the continued practice of mindfulness therapy, we can give those around us who suffer from PTSD the best chance of recovery. In the words of Dr. Shawna Roberts, “You have to truly understand the science, then the treatment can become an art form. The brain can be re-wired, the body can heal, and you can learn to leave the trauma in the past.”

 

Works Cited

 

Fig. 1. Bremner, J. Douglas. “Traumatic Stress: Effects on the Brain.” Dialogues in Clinical Neuroscience 8.4 (2006): 445–461. Digital Image.

 

Fig. 2. The Signature of Stress.” ACEs Connection, 21 Oct. 2012, www.acesconnection.com/blog/the-signature-of-stress-infographic.

 

Harvard Health Publishing. “Understanding the Stress Response.” Harvard Health Publishing, Harvard Medical School, 18 Mar. 2016, www.health.harvard.edu/staying-healthy/understanding-the-stress-response.

 

Freudenrich, Craig, and Robynne Boyd. “How Your Brain Works.” HowStuffWorks Science, HowStuffWorks, 6 June 2001, science.howstuffworks.com/life/inside-the-mind/human-brain/brain1.htm.

 

“Trauma.” Psychology Topics, American Psychological Association, www.apa.org/topics/trauma/.

 

Wolkin, Jennifer. “The Science of Trauma, Mindfulness, and PTSD.” Mindful: Healthy Mind, Healthy Life, Mindful, 16 June 2016, www.mindful.org/the-science-of-trauma-mindfulness-ptsd/.