In my last blog, I highlighted the symptom and emotional state of PTSD known as hypervigilance. To go a step deeper into understanding this emotional state, I’d like to present some recent science that helps us understand how the brain works and to present some recent discoveries that may shed some light on future and promising non-drug related solutions. I believe that non-drug solutions and processes are even more important in treating stress related emotional states than drug therapies, as these modalities focus on the problem and not on the symptoms. To put it another way, think about our Boiling Frog analogy from our last post. If we were treating a frog in boiling water, we would use drugs to help the frog fight fever he is feeling, the blisters he would be developing, and the pain he would be experiencing from being in the boiling water. Non-drug therapy would equate to “turning off the gas” to the flame that boils the water. So ask yourself this question: If you were the frog, which level of therapy do you think is going to help you in the long term?
The Science of Fear
Several survivors of traumatic events that I have worked with, say the trauma itself is only the beginning, as the problems are like a snowball rolling down a hill. While some people are relatively unaffected, many others will develop post-traumatic stress disorder. In many treatment strategies today, multi-drug therapies, or cocktails, as they are commonly referred to, are the cornerstone of treating PTSD. While medication may treat co-occurring depression, anxiety, or insomnia; the magic bullet or pharmacological agent that specifically targets PTSD remains undiscovered. In part, this is because researchers have only begun to describe the underlying neurobiology or science behind our grey matter. Several recent studies have pointed to the brain structure known as the amygdala (pronounced uh-mig-duh-luh) as a central player. Shown in research to perform a primary role in the processing and memory of emotional reactions, the amygdalae (amygdala plural, as we have a pair of these structures) are considered a part of the limbic system, or commonly this system is referred to as the mammalian brain.
Big Things Come In Small Packages
First off, I’d like you to know where both of your amygdala are located in your body. The best explanation would go like this: Take both of your index fingers and touch them to the sides of your head about an inch back from the edge of your eyebrows, right on your temples. Inside your skull from these two points, about 2 inches in, are the 2 almond shaped structures that make up your amygdalae. In complex vertebrates, including humans, the amygdalae perform the primary roles in the formation and storage of memories associated with emotional events. Common questions about these structures include “How does this small structure "recognize" danger? How does it create emotional memories? What causes recurrence of these memories and emotional states? Yes, the questions are straight-forward and simple. The answers, however, are complex and incomplete.
As an anxiety disorder, PTSD has its foundations in fear and "emotional memory." Like factual memory, emotional memory also involves the storage and recall of events and details; this has been termed the explicit or conscious memory. Emotional memory, though, has a second, distinct component. This facet, commonly called the implicit or subconscious memory, is the memory of the physiological or body’s response, such as increased blood pressure, a higher respiratory rate, and muscle tensing, and is responsible for the emotional impairment that PTSD causes.
The distinction between conscious and unconscious memory suggests - and it is generally accepted - that our memory involves two brain systems. While conscious memory is mediated by one part of the brain (the hippocampus), the other part, the amygdala, is the control center in emotional memory. In general, the amygdala controls the fear response once information in the form of sight, sound, smell, or touch is received into the brain. If the input is sufficiently intense to initiate a stronger electrical impulse, the amygdala triggers other areas of the brain that create this cascade of fear-related consequence. More importantly, the amygdala, is involved in the memory of fear. In one test, researchers used functional MRI scans to measure amygdala activity while showing subjects a number of frightening and neutral images. They found that the degree of amygdala activity was a good predictor of both fear level (as reported by the subject) and of the ability several weeks later to recall having seen (evidence of memory) the image. This evidence, along with other studies with similar findings, has made the amygdala the target of much anxiety-disorder research.
LTP in PTSD?
One of the more promising theories in understanding the amygdala appears to lie in classic fear-conditioning and in the brain cell property called long-term potentiation or LTP, for short. In experiments performed by Joseph LeDoux at New York University, laboratory subjects were administered a mild electric shock in conjunction with an auditory tone. The subjects soon responded to the tone alone with a fearful response: increased blood pressure, faster breathing, and motionlessness, according to the monitoring devices that were used in this experiment. This may explain the recurrence of emotional responses in PTSD. Just as a non-threatening stimulus (the tone) that had been associated with a threatening one (the shock) could trigger the same emotional response in the conditioned subjects, so can an innocuous sound or sight or person associated with a trauma, trigger the intense emotions of PTSD. Another way to think of LTP is muscle memory; the longer or more frequent your repeat a physical movement, the more ingrained it becomes in your coordination.
But how, science continues to ask, does this association get created? How does the amygdala learn to recognize and remember danger, even if it does so erroneously sometimes? Long-term potentiation, it is believed, is the cellular mechanism of learning and memory. When a brain cell (or neuron) receives frequent stimulation, a stronger neuronal connection is formed. Since LTP has been shown to occur in the amygdala, it would seem that this explanation could be easily extended to PTSD. If an amygdala pathway is sufficiently stimulated, it will become more receptive to stimulus, in effect remembering the frightening input and easily reproducing the cascade of fear-triggering brain cell activity that was necessary to respond to the original trauma.
Taking our boiling frog as an example again, it is easy to understand long-term potentiation. If we have been immersed in boiling water (combat) for extended periods of time, all of the neural pathways (the electrical circuits that connect from our senses) become heightened and more sensitive. So, if the frog from our original example were removed from the boiling pot, but in the future was exposed to pot and pans, stoves, and the sights and sounds of the kitchen, how do you think it would respond?
Take Away
A wise man once said ”you cannot fix something, if you don’t know how it works.” This blog post was written with that statement in mind. I want those of you who may be suffering from the symptom of combat related stress to understand how this manifests inside of you. This conditioning does not imply you are weak. I would say the opposite is true.
If you lifted weights for 8-9 months with great intensity would you consider yourself weak? Of course not! So why would you consider yourself weak after being subjected to a hypervigilant environment where your brain and natural alert system have been "working out" around the clock for close to a year? Take it from this Airborne Ranger, brothers and sisters...you are not weak, but you do need a chance to recover. World-class athletes that train to the highest standards always incorporate a recovery phase as part of a long work out program. These recovery phases use different exercises and training from the main focus of their conditioning. You are a member of the finest military on the planet and you have returned from the ultimate test; ground combat. Doesn't it make sense to try something different to aid in your recovery?
Your recovery however; cannot be accomplished by drug therapy alone. The talk therapy that exists all around you is designed to address the "conditioned state" your body has adapted to. If anything your are strongest when you are the most aware of hypervigilance and other symptoms of PTSD. Ignoring these symptoms or denying you are affecting others or possibly harming yourself are not even considered failure, but they are results! You need to ask yourself..."Do you like the results you are getting from ignoring your conditioned state?" If not, might I suggest a different course of action? Seek asistance if you or someone you know is affected by hypervigilance. If you would feel safer going outside your chain of command, my services are completely confidential. You can find my contact information at www.warriorlifecoach.com.