PTSD: What is actually happening in the brain?
Post-traumatic-stress-disorder or PTSD affects more than 3 million Americans a year. The experience of PTSD will vary in terms of duration, intensity, and presentation of symptoms from person to person. Many people who experience PTSD may exhibit other comorbidities such as anxiety, insomnia, depression, high blood pressure, chronic pain syndrome, autonomic nervous system dysregulation and more.
In this article, we’ll explore the neuroscience behind PTSD and discuss how biofeedback can actually work to reduce symptoms of PTSD through neuroplasticity (don’t let this word scare you away, I promise I won’t nerd out TOO much).
Let’s start with a brief overview of how our brain and body typically processes stress. The amygdala is the region of the brain responsible for initiating a stress response. It does not interpret information, it just reacts. Dr. Van Der Kolk, author of The Body Keeps the Score, describes the amygdala as the brain’s smoke alarm. It detects danger and immediately raises the alarm. Similar to the amygdala, a smoke alarm does not know if the house is really on fire or you just overboiled pasta water, it just responds to the presence of smoke. Now, before we start to give our amygdala a hard time, let’s take a minute to express some gratitude. This automatic stress response is the reason we still exist as a species-in the presence of danger we don’t have to think, we are able to take immediate action that hopefully keeps us safe.
In order to modulate the stress response, our amygdala communicates with the intelligent part of our brain, the frontal lobe. The frontal lobe is responsible for processing and interpreting information. Imagine you are sitting on the couch curled up with a good book when all of the sudden there’s a loud BANG. Your amygdala will immediately respond as you flinch and sit up straight, alert and attentive. Your eyes scan the room for the source of the random, unexpected noise and you spot a picture frame on the floor. The frontal lobe of your brain realizes that the bang you heard was from the picture falling off the wall. While you may be wishing you used a good old-fashioned nail instead of command strips (just me?), you frontal lobe assesses the situation and realizes your not in danger. The frontal lobe communicates this to the amygdala, decreasing the stress response. You pick up the frame and place it on the table. You go back to your seat, order a picture hanging kit on amazon and return to your book, picking up exactly where you left off.
At least, this is how a healthy brain manages stressors.
When someone experiences PTSD, the neural communication between the amygdala and frontal lobe dampens. Therefore, the frontal lobe is no longer able to modulate the stress response. This change in neural pathways between the two components of the brain is an example of neuroplasticity. Your brain and body have been exposed to such intense and/or prolonged periods of stress and, as a result, the amygdala has decided in order to keep you safe, it’s going to maintain hyper-vigilant and ignore the front lobe-it doesn’t have time to “think it through”. If we consider the above scenario, someone with PTSD may experience any (or a combination) of the following:
A hyperactive stress response: Upon hearing the loud BANG, you jump up off the couch, knocking over the water cup on the end table and dropping your book into the puddle of water on the floor. “Great, just f&*$ing great”, might be what’s coming out of your mouth. As you look around and realize that the the picture frame fell off the wall, your heart continues to race. You feel a little silly for your reaction, and now you’re going to have wait for the book to dry before you find out how chapter 8 ends…
A prolonged stress response: Upon hearing the loud BANG, you jump up off the couch, ready for combat. As you look around the room, your eyes land on the picture frame on the floor. Your heart is racing, your breath is shallow and your muscles are tense. You may even notice your standing in a defensive position, legs slightly crouched, arms out protectively. It takes a few moments to make sense of the visual input of the picture frame on the floor. Eventually, you brain registers that the BANG was the picture frame falling, but you can’t shake the feeling of danger. You pick up the frame and try to return to your book, but you can no longer concentrate. You get up for a glass of water and accidentally pour milk into your glass instead. “What the hell is my problem?” might be going through your head as you dump out the glass in the sink. You realize your hands are still shaking. Good luck getting to sleep tonight…
A freeze stress response: This is an extreme response typically due to severe trauma. Upon hearing the loud BANG, you turn your head towards the sound. Your eyes are wide and your breath is extremely shallow. Your muscle tense, bracing themselves for impact and your body remain somewhat motionless. You’re looking at the picture frame on the floor, but can’t seem to make any sense of it, your thoughts have completely slowed down…your a deer in headlights. You sit there for what feels like hours staring at the picture frame on the floor when all of the sudden you hear you hear your kids calling to you. “ Dad…dad…daaaaaad! Hello, earth to Dad! Aren’t you going to pick that up?” You realize they’ve been calling your name and slowly snap out of it. Still in a daze, you walk over to the frame on the floor, pick it up and return back to your seat without speaking a word. Your kids look at each other, “What’s up with him?”.
Again, PTSD creates changes in the neural pathways of the brain. Telling someone to “relax” or “chill out” is not going to help much, the response has become automatic. The good news, is that the brain is still malleable, meaning it can unlearn this maladaptive behavior.
Biofeedback therapy is one tool that can influence positive change in neural pathways to reconnect and strengthen the relationship between our frontal lobe and amygdala. This happens through the process of balancing out your nervous system, which will reduce activity in the amygdala so that it can hear what the frontal lobe has to say. The amygdala learns to trust the frontal lobe’s judgement and begins seeking input. Slowly, your brain and body learn to live in a place of safety and balance.
Biofeedback therapy makes a great complement to traditional talk therapy, EMDR, exercise, medication, and so on in PTSD treatment.
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