Psychological Trauma and Brain- Part 1

Bessel van der Kolk is a name that most professionals working with psychological trauma recognise. Recently attended his webinar and was re- assured to hear that the things that I have seen in my practice as a private psychiatrist and my conceptualisation of trauma and it’s consequences are similar to his.

Whilst writing about the full description is for a scientific journal, I thought it may be useful to put things in a simple way. So here is a simple explanation- there are some inherent stress action systems in human beings that make us function as a ‘whole organism’-

1. The Freeze system
2. The Flight system
3. The Fight system

These help us in situations of danger and being ‘primitive systems’ get modulated by the ‘Neocortex’ (Newer developed parts of brain), so that the person in a stressful situation such as trauma, eventually derives a ‘context’ and puts a meaning to the stressful or traumatic life event in the wider context of his/her life, the ‘primitive systems’ are reset and life moves on.

What happens in PTSD or in people suffering with consequences of trauma is that the ‘primitive systems’ remain active for a longer period of time than what is necessary for adaptation and the individuals are in a state of ‘Chronic Hyperarousal’ leading to living life in a sense of fear with constant alertness or hyper vigilance to ensure their safety and experience symptoms of anxiety.

At the same time the memories of the event are laid down in a disjointed manner. More on memory in trauma in my next post.

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EMDR for Travel Anxiety after RTA

Eye Movement Desensitisation and Reprocessing (EMDR) is a psychological treatment used for improving symptoms of post trauma sequeale. Whilst NICE recommends its treatment for PTSD, newer indications and it’s application as a treatment have increased over the years. Working as a Consultant Psychiatrist in Wales and as part of my medico-legal practice in Personal Injury, recently I have treated someone for Travel Anxiety following a RTA who had been struggling to pass a particular point on the road and had anxiety symptoms when on the road in general. The outcomes were very good as the EMDR phases were very useful and all the symptoms improved within 6 sessions. The desensitisation phase was one phase that was very useful to get past the particular point on the road for the patient and by the end of sessions, the patient had commenced driving, had gone past the struggling point, felt more relaxed on the road in general and scored 0 on all scales used in the therapy.

The crucial element was the use of ‘Eclectic’ tools to help the individual to regain control over the situation and in Neuroanatomical terms, what we now know in Trauma work is that once the ‘Chronic Hyperarousal’ is modulated and regulated, the symptoms begin to improve.

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