Keep Pain in the Past. Dr. Chris Cortman

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СКАЧАТЬ that there is no longer a threat (or that it is manageable) and that all is “okay.” It’s that simple. And yet meeting this condition is imperative for turning off the stress response. In reality, there are a thousand ways to get to “okay.” For instance, the surgeon looks down at you in the recovery room, smiles, and says, “We got it all, you will recover completely,” and you believe her. Likewise, the insurance guy calls and says, “We’ve reviewed your case, and we are going to pay for 100 percent of the flood damage,” and you believe him. Your wife says the affair is over and she only wants to be with you, and you believe her. The nanny says she will forgive your children for tying her up in the playroom and will not resign after all, and you believe her.

      Again, the mind must conclude that somehow all is okay once again for the stress response to be shut down. So you, the trauma sufferer, need to believe that whatever the trauma—rape, betrayal, financial loss, death of a loved one, abandonment, the sounds and images that form the experience of combat, etc.—there is hope, and you and it will be okay. For Jim to resolve his issue, he will have to believe that despite the loss of his two sons, he can recover and live a meaningful life. All will be okay.

      Neuroscience

      Trauma can quite literally change your brain7. Various neurological studies and research conducted since Selye’s discovery of the stress response have further illuminated the impact that trauma can have on brain structure.8 9 Thanks to modern neuroimaging, we can now observe some of the fascinating complexities of the brain. For instance, the hippocampus is the structure responsible for memory. More specifically, it creates new memories, storing them away for later, and also retrieves memories in the brain. If I ask you to recall the name of your third-grade teacher, more than likely, you would be calling upon your hippocampus to do the dirty work. But as Bremner (2006) notes, it appears trauma is responsible for reducing the volume or size of the hippocampus.7

      Why does size matter? Since we routinely call upon our memory center thousands of times in the course of a day, shrinkage would create confusion and compromise your capacity for recall. Additionally, a smaller hippocampal unit would make it more difficult to decipher which things were threatening to you and which not. Your judgment would also be reduced, and the stress response would be triggered far too often by non-threatening stimuli.

      After a particularly bad auto accident, the hippocampus may be impacted. As such, deciphering what driving conditions are normal and which ones are dangerous may be extremely difficult. Hence, all driving on crowded roads and highways might be perceived as very threatening and compromise the driver’s willingness or confidence in his/her ability to drive. Again, this may contribute to your stress response being left in the “on” position for no good reason.

      The limbic system, the area of the brain most responsible for emotions, contains the amygdala, which is thought to be responsible for emotional processing and the acquisition of fear responses. Your amygdala attempts to determine what a given stimulus is and whether or not to react emotionally to the stimulus. When adversely impacted by trauma, this structure in the brain is thought to become “hyper-responsive” in trauma clients. This means that not only does your brain react too strongly to trauma, but also to ANY emotional stimuli; this overreaction can be measured in cortisol levels in your blood plasma and saliva.10 11 You might find yourself crying uncontrollably during a sad part in a movie, or overreacting in fear to a bathroom spider with a handlebar mustache. This would mean that your emotional reactions to items NOT associated with the trauma would be far greater than would otherwise be anticipated. You can imagine how exhausting life would be if everything felt frightening and required you to be on high alert. This is the experience of many combat veterans, including those I have known who have kept watch throughout the night, checking and rechecking the locks on the door and the safety of their children.

      As you may know, the brain is divided into four lobes: frontal, parietal, temporal, and occipital. The frontal lobe is responsible for things like personality, decision-making, initiation of activity, emotional reactivity (how one responds to emotions), motivation, social interactions, and even judgment. Evolutionarily speaking, this is the last part of your brain to develop, and it does not stop growing until your early twenties. It is this very same frontal lobe that scientists claim separates us as humans from all other creatures on the planet.

      Any trauma that occurs can impact your brain functioning. Within the frontal lobe is the medial prefrontal cortex (mPFC). The mPFC is responsible for inhibiting the stress response, which is housed in the amygdala. Koenigs and Grafman (2009) noted that people exposed to trauma had a decreased activity volume in their frontal cortex, more specifically in the mPFC.12 Why is this decreased activity important to PTSD? If the area of the brain responsible for shutting off the stress response is left on, the stress response continues. Continued stress can then lead to more unhealthy responses to difficult and stressful situations, including drinking alcohol to excess, angry responses, and even social isolation.

      The bottom line is this: trauma impacts the structures of the brain, making life considerably more difficult for the survivor. Healing from the traumatic event(s) becomes that much more necessary.

      Consider how Jim’s brain may have responded to his trauma. With traumatic impairment of his hippocampus, he reportedly perceived two young boys in the barbershop as too closely resembling his deceased boys, which therefore launched his body into a full-blown panic attack. His under-responsive prefrontal cortex (PFC) didn’t properly regulate his over-reactive amygdala and may have made normal challenges during his work at the auto shop feel overwhelming to him. Fortunately, these changes in the brain can be addressed with good treatment and healing.

      Cognitive Behavioral Therapy

      Cognitive Behavioral Therapy, usually just called CBT, was developed by Albert Ellis in the 1960s and Aaron Beck in the 1970s.13 CBT holds that our thoughts and beliefs influence how we behave and feel. Such beliefs include how we view ourselves, how we view others, and how we view the world. One person sees himself as inferior, while another sees himself as superior. You perceive your mother as supportive, your sister sees her as critical. One person sees the world as warm and welcoming, the other sees the world as cold and harsh. And as your therapist will tell you is true, how you perceive something is more important than reality when it comes to your feelings and emotions. Said simply, when it comes to your emotions, perception trumps reality (and that is not a political statement).

      How Beliefs about Self, Others, and the World Are Developed

      Self-views relate heavily to concepts like self-esteem, self-worth, and self-confidence. All of this supports a concept that psychologists call “self-efficacy.”14 When good things happen, it is either because “I worked for it” or because “I got lucky.” Views of self are influenced heavily by parental praise and punishment. Were your parents highly critical of you? If so, then you may think, “I’m not good enough,” and that “No one will ever love me.” On the other hand, if your parents affirmed not only your success, but also your efforts, you may “try and try again.”

      Views of others play out heavily in relationships. Was your trust betrayed by someone important to you? Maybe your father said he would show up at your baseball games, but never did. When the people you love let you down, trust becomes an issue.

      Views of the world come into play in the work environment, in the community, in government, and for the world as a whole. Is work a competitive place where coworkers backstab each other for promotions? Or is it a place where people cooperate to get the job done? What about government? Are politicians motivated to do good, or are they inherently corrupt?

      Cognitive Beliefs or Schemas

      The cognitive perspective on human behavior is especially important in explaining how pathological behavior endures over time. Beck (2011) explained СКАЧАТЬ