Author: Leaman Ralph

 Unlimited CEUs for $59 are available at AllCEUs.com/Trauma-CEU this episode was pre-recorded as part of a live continuing education webinar. CEUs are still available at AllCEUs.com/Trauma-CEU welcome to today’s presentation on the neurobiological impact of psychological trauma   on the HPA axis we’re going to define and explain the HPA axis which we’ve talked about before is a response system so it’s not anything to get to you know overly concerned about   that it’s going to be super dry well identify the impact of trauma on this axis and on basically   your whole nervous system in your brain identify the impact of chronic stress and cumulative trauma   on the HPA axis because a lot of times when we talk about PTSD we think only about some   particular acute event and that’s not necessarily true there are a lot of people with PTSD who have   basically what I call cumulative trauma and they were exposed to extensive child neglect they were   in domestically violent relationships they were in a situation where they were exposed to trauma   over and above what a normal person would think lawfully think of law enforcement military personnel think first responders I mean they see stuff that no human should have to see   and they see it not only once but you know once a week or once a month depending on kind of where   you are so it’s important to understand well one thing may not be so traumatic to create   post-traumatic stress we’re going to look at some of the reasons that PTSD symptoms may develop as   a cumulative sort of thing which I found this to be interesting anyway we’ll identify   symptoms of dysfunction and we’ll talk about some interventions that are useful for this population   now my guess is none of you are prescribing physicians so when we’re going through this you’re   going to be going yeah that’s all well and good what’s the exact point of thinking about   exactly what this information is telling me on each slide show used to be the hat to help my   clients who have been annoyed by trauma and have not yet developed any sort of PTSD symptoms   or who have PTSD symptoms and how can I use this information to better tailor my treatment plan to   help them become more effective in managing their symptoms this is kind of a unique presentation   because it was based on only one article this was a meta-analysis so it’s a long article   and it’s a really good article that I would strongly suggest looking at it in your resources   section in the class it lays out the many changes and/or conditions that are seamed in the brain and   nervous system of people with PTSD so they really looked at a lot of research longitudinally to see   what we know and what we don’t know as clinicians awareness that these changes can help us educate   patients about their symptoms why do you feel this way and find ways of adapting to improve quality   of life so neurobiological abnormalities in PTSD overlap with features found in traumatic brain   injury so that started making a lot of researchers go hmm you know traumatic brain injury there is   something or again of course hurting part of the brain so why are the symptoms similar in   PTSD you’re going to find out pretty soon is that PTSD does cause damage   actual physical damage in the brain the response of an individual to trauma depends not only on   the stressor characteristics but also on factors specific to the individual so somebody can see a   trauma and not be as traumatized if you will as someone else and part of these factors and   there was a study done by Pi Newson Nader back I believe the early 80s looked at triage   factors for PTSD and some of the factors that they found why certain traumas may be more   traumatic than certain people versus others have to do with this particular trauma, you’re experiencing   it close to one of your safe zones where you live where you work somewhere where you’re not   where you’re supposed to be feel safe and if so then it’s probably going to be perceived as   more traumatic now again think about the survival capacity or the survival function of this behavior   when your brain says this is supposed to be a safe zone and it’s not so I need to respond in kind   you’re trying to protect yourself make sense the similarity to the victim if it could happen to her   if it could happen to him they’re like me it could happen to me that makes me feel scared because we   like to categorize the world in terms of using them bad things happen to those people not to us people   but if you’re looking at a victim who’s liked you and you say well I am and us people then you’re   going to have more difficulty separating it and feeling safe and going well that couldn’t happen   to me and the degree of helplessness you know if you saw something and you were just like there   was nothing I could do there’s a greater sense of helplessness and horror then if you didn’t have   that necessarily that same experience so those are a couple of things as far as the prestress or   perception that we want to consider when we’re talking to our patients even if you’re not a   therapist that works with the trauma specifically some people refer out for that some people are   working with an EMDR therapist and you know cool but as important to understand and if you happen   to go down this road with your clients help them understand why they perceived that particular   stressor so intensely versus some other stressor that they think may have good English there   oh well sorry they think should have stretched them out more so their perception of the stressor   prior traumatic experiences and we’re going to learn that prior traumas do cause changes   in the brain to prepare you basically Therese bond more quickly when there’s a threat   so prior traumatic experiences can send you from zero to 100 a lot faster which means it’s going   to be or could be more traumatic the amount of stress in the preceding months if you’re already   worn down and your body has already said I can’t fight anymore it’s not doing any good then when   it encounters PTSD and when it encounters a trauma the body might be going I just can’t   take another thing please just I can’t do it which is why we see in people with PTSD chronic stress   burnout and chronic fatigue this inability to tolerate stress because the body’s just already   waived them that white flag going I can’t do it current mental health or addiction issues again   that’s your body’s way of saying something in the neurotransmitter something in the system   is a little bit wonky and that means I’m not going to be able to respond a hundred percent   healthy and functionally to whatever’s going on and the availability of social support now   a lot of the research especially with emergency service personnel points to the availability of   social support within 24 hours of the trauma so when there’s an officer-involved shooting   when there’s something that they encounter on the duty that’s trauma the ability to have social   support within that first 24 hours preferably first two-hour period to at least touch base with a   social positive social support is vital to helping somebody process the memories instead of   just kind of them disappearing into never-never land and getting solidified in an unhelpful way for the vast majority of the population though psychological trauma is limited to an acute   transient disturbance you see something that’s traumatic you’re like oh my gosh Wow it is   devastating and yeah is going to affect you for a little while but in a week or two you’re kind   of feeling like you got your land legs again so there’s this subpopulation of the population   there’s a small group that ends up developing PTSD the signs and symptoms of PTSD reflect   a persistent adaptation of the neurobiological symptoms to witnessed trauma and I crossed out   abnormal in the article it says abnormal and I look at it as a perfectly normal adaptation   because the body is either going with the reserves I have right now I can’t deal or you know whatever   it’s doing it’s trying to protect itself now it may not be helpful but from a survival   perspective it generally makes sense so I try when I’m working with clients to help   them see the functional nature of their symptoms given the knowledge they had or the state they   were in at the time so now to the HPA axis the The hypothalamic-pituitary-adrenal axis aka your   threat response system controls reactions to stress and regulates many body processes   including digestion the immune system mood and emotions sexuality energy storage and expenditure   so let’s think about this real quick when you’re under stress, your body feels threatened I needs to survive so it sends out excitatory neurotransmitters that get you wired up which   kind of makes your digestion speed up it can cause some cramping in the abdominal area   your immune system is not really important right now threat we’re not worried   about the flu mood and emotions you tend to be hyper-vigilant and more easily startled threat   means fight or flee which means anger or anxiety so you’ve got some stress emotions and I don’t   want to say dysfunctional because they’re very functional your body perceives a threat and it’s   saying you need to do something sexually well if there’s a threat this is no time to procreate so   your body says let’s turn off those sex hormones right now, because we need to use us for fighting   and fleeing not procreating which is all well and good but when we have reduced sex hormones   it also reduces our serotonin availability which serotonin is one of those calming chemicals   which help us calm down the excitatory neurons so without them, you stay revved up which brings   us to energy storage and expenditure you’re revved up you’re on high alert you’re staying   up here and your body says you know what if I’m going to survive this fight or flight I   need fuel which means you need to eat preferably high-fat high-sugar foods that give us instant   energy and sustained energy we want calorie defense stuff now thinking about it from that perspective   you can see how when you’re under chronic stress or a big stressor you know some of your symptoms   make sense why do you want to go eat chocolate or do whatever you do that’s my go-to pizza and   chocolate when I’m stressed is generally what I crave not what I need but what I crave so we want   to help people understand that there’s a reason it makes sense now we just have to figure out   how to deal with it differently the ultimate result of HPA axis activation is to increase   levels of cortisol in the blood during times of stress now cortisol is the hormone that goes out   and sets off kind of this whole well there are a couple before it but it sets off this whole   event cortisol is your stress hormone cortisol is the one who says no sex hormones right now   you know and it monkeys with all your different hormones to make sure and your energy storage to   make sure that you’re ready for this fight or flee its main role is to release glucose into   the bloodstream in order to facilitate the fight or flight now glucose is sugar is raising your   blood sugar so you’ve got energy now we’re going to talk regularly about glucocorticoids which are glucose hormones that make your body release glucose which is mainly cortisol and that   term is going to become important later I’m just kind of throwing it out there right now cortisol   also suppresses and modulates the immune system digestive system and reproductive system so again   cortisol is saying we’ve got this energy we’ve got this threat let me figure out how to sort of dole   out our resources right now for survival in the now it’s cortisol is very present focused   it’s not looking at you know the long-term and going well this will pass cortisol is very right   now HPA axis dysfunction the body reduces HPA axis activation when it appears further fight-or-flight   may not be beneficial and they call this hypo cortisol ism so basically a threat response system   is you know warning the alarm in my dorm when I was in college used to have these   really annoying blinking lights I because why I do this all the time sorry the hypercritical ism is   your body’s response to going if I keep fighting I am just throwing good energy after bad there is no   sense in surrendering so it turns down the system and it stops producing as much cortisol that way   it has cortisol your stress hormone for when there is a bigger more threatening threat well what does   that mean well we need cortisol is what helps us get up in the morning our cortisol goes   up and down throughout the day which helps us have the energy to get up go to work do those   sorts of things it’s a normal hormone when it’s in the right balance hypo cortical cortisol ISM   seen in stress-related disorders such as chronic fatigue syndrome burnout and PTSD is actually a   protective mechanism designed to conserve energy during threats that are beyond the organism with   us ability to cope so dysfunction in the axis causes abnormal immune system activation so   you have increased inflammation and allergic reactions cortisol is also related to   cortisone your body does not release its natural antihistamines when you are pardon me   under stress which is why your allergies seem to bother you more which when your allergies bother   you more you’re probably not sleeping as well at night and we know that not sleeping as well at night keeps your HPA axis activated so you’re fighting this battle you’re trying to squeeze   blood out of a turnip basically because your body said we’re not releasing any more cortisol I don’t   care what you say but everything else you’re not sleeping as well you’re still kind of revved up   you’re fatigued and your body is going but there’s a threat and back in your brain they’re going yep   but it’s not a big enough threat yet so you can see where this cascade you’re fighting inside your   own body and all your systems are kind of arguing irritable bowel syndrome such as constipation and   diarrhea because cortisol speeds things up and if you don’t have enough cortisol you know what might   happen reduce tolerance to physical and mental stresses including pain remember I said that sex   hormones go down which means that the availability of serotonin goes down we know that serotonin is not   only involved somehow in mood it’s involved with some level of anxiety reduction but we   also know it’s involved in pain perception so when serotonin goes down we perceive pain   more acutely and altered levels of sex hormones so fatigue and you’re like where did that   come from well the HPA axis is activated see how many times I can say that without tripping on my   tongue when it’s activated it sends out these you know excitatory neurotransmitters when   you’re excited for too long you get fatigued well interesting little caveat or thing here   fatigue is actually an emotion generated in the brain you know we’ve learned to label it which   prevents damage to the body when the brain perceives that further exertion could be harmful sounds   similar to hypo cortisol ISM it is so what do we know from athletes we know that fatigue and   sports is largely independent of the state of the muscles themselves so fatigued you know your   muscles usually only work up to about 60% of their ability to work and then fatigue starts to   set in so there was still a big margin that you could work before your muscles finally gave out   and said hold no more I’ve got jelly legs but your muscles quit you start feeling tired you   start feeling exhausted so this is a protective mechanism the body’s gone we need to conserve a   little bit of energy because you have to get home and shower and you know prepare to run in case   the tiger chases you but what factors is your body paying attention to but tells it OK whoa we need   to stop so we’ve got enough reserve in the event of a problem core temperature, you’re working out   your core temperature goes up at a certain point it goes that’s high enough your glycogen your   blood sugar levels your oxygen levels in the brain how thirsty you are whether you’re sleep-deprived, to begin with, it’s going to mean that you fatigue a lot easier and the level of muscle soreness and   fatigue going into that exercise session the brain kind of takes all these factors into   effect and goes okay I can unless you work out this much and then I’m going to shut you down I’m   wrong it’s off what they have found though is we can override this so when clients come into   our office, they’re fatigued they are they’re off they’re just like I’m exhausted I’m agitated I’m   irritable I’m not sleeping well I just uh okay so with athletes, we know that psychological factors   can be used to reduce fatigue such as their emotional state if they go in in a positive   emotional state or a hyped up energized emotional state if they’re listening to really energizing   music it can help them push past that fatigue point a little bit if they know the endpoint   maybe they know they’re doing three sets of ten reps they’re going to push through faster or more   effectively than if they’re working with the coach and they have no idea how many sets they’ve got or   how many reps they’ve got to do they’re just like are you going to make a stop to other competitors that   service motivation they’re looking around they’re seeing other people doing it they’re going okay   I got this and in the case of athletes visual feedback you know they’re seeing growth in their   muscles they’re seeing positive changes so they can push through that fatigue a little bit more   they’re like okay this is worth it so fatigue is one sign that the body is getting ready to down-regulate that HPA axis and go conservation in practice and counseling practice how can we   help reduce mental fatigue and help clients restore their age PA access functioning and   one of the things I would challenge you to think about is how can we increase their self-efficacy and their high ductless if you will in their the emotional state that a can-do attitude increases their hardiness and resilience you know we talk about those, a lot man make sure they know their   endpoint where are they going what does their what do their symptoms look like what is it   going to look like in three weeks in three months and what can we reasonably think will change you   know let’s give them some tangible goals that they can look at other competitors or motivational group therapy can be very helpful in dealing with some of this stuff obviously, you’re not going   to do a lot of trauma work in the group most of the time but having other people around knowing that   there are other people who are dealing with PTSD and having support groups can be really   helpful because they can cheer each other on and go come on John you got this you just need to push   I know this is a really tough week for you and that can help people push through that fatigue and feedback now in the case of psychological issues we’re not talking about visual feedback but   we’re talking about looking at that treatment plan or looking at their symptoms and being able   to say you know what I have made progress I’m not having nightmares as much as I actually slept through   the night last night who knew and finding those things that they can latch on to and go things   are getting better you know they’re not going to get exponentially better overnight likely but they are   getting better and I can see this incremental progress and in doing that we can help people   get a sense increase that those dopamine levels increase that learning and go okay I can do this   we want to make sure that we are considering their fatigue level though and not putting too   much on them at once let’s look at really small steps and then solidifying those steps not   taking one step after another but taking one step and then taking a breather for some of our clients   helping them identify how they’re feeling and be aware of their own fatigue level low cortisol   has been found to relate to more severe PTSD hyperarousal symptoms and you’re like yeah it   took me quite a while to wrap my head around this whole concept but it makes sense now so when you   have low cortisol your body is conserving all its energy can in case it needs to respond   to an extreme threat the sensitized negative feedback loop in veterans diagnosed with PTSD   have they’ve shown that they’ve got greater ludic corticoid responsiveness now remember I talked   about cortisol being a glue to co-corticoids and there’s just no nice way to talk about   this without using really obnoxiously clinical terms anyhow which means that the body is holding   on and it’s going you’re not going to have cortisol to just get irritable or happy or excited about   just anything but if there’s a threat I’ll let you have it unfortunately in patients with cortisol   ISM when there’s a threat they have an exaggerated response thank hyper-vigilance and I call it the   flatter the Furious so their mood is either kind of flat and they’re not really responsive too much   but when there is something that startles them or their body perceives as a threat all of a sudden   their body dumps cortisol and dumps glucose into the system which floods the system and if you’ve   ever flooded your engine you know what happens doesn’t respond quite as well but there are even   more problems with this so evidence says that the role of trauma experienced in sensitizing the HPA   axis regulation is independent of PTSD development okay so what does that mean that means even if   somebody doesn’t develop PTSD clinical diagnosis if they’ve had trauma HPA access is going to   sensitize them a little bit and hold them back a little bit more cortisol and be a little bit more reactive   when there is trauma which means successive traumas could produce success successively   significant reactions in those with prior trauma maybe more at risk of PTSD for later traumas   so again as a clinician what does this mean for me this means that if I’m working with a client   who comes from a troubled childhood there were adverse childhood events or you know whatever   you want to label it they had chronic stress they had trauma in their childhood even in the prenatal   period they found I wanted to educate them about the the fact that they are at a greater risk of developing   PTSD if they’re exposed to more trauma so they can learn how to keep their stress levels under control because it’s more important for them according to this research because of some   persistent brain changes that we’re going to see core endocrine factors of PTSD include abnormal   regulation of cortisol and thyroid hormones okay so we’ve already talked about cortisol our stress   hormone and you’re probably familiar with thyroid hormones being sort of your metabolism hormone but   what happens when cortisol goes down in the body starting to rein in the energy thyroid hormones   also go down hypo cortisol ism and PTSD occurs due to increased negative feedback sensitivity   of the HPA axis okay studies suggest that low cortisol levels at the time of exposure to trauma   may predict the development of PTSD so if their cortisol levels were already low they were already   suffering if you will from hypercortisolism and remember we’ve seen hypercortisolism in burnout   and you know regular old burnout chronic fatigue syndrome as well as PTSD so we’re not just talking   about veterans here if the cortisol levels are already abnormally low and the body’s already   started conserving cortisol when they’re exposed to a trauma we can with more certainty   predict which people are going to develop PTSD symptoms back to those gluteal corticoids they   interfere with the retrieval of traumatic memories an effect that may independently prevent or reduce   symptoms of PTSD so when cortisol is in the system and it’s causing all the blood   sugar to develop we’re not forming lots of memories right now we’re just surviving which they   hypothesize could prevent or reduce the symptoms if those memories aren’t consolidated and they   go away, or it could contribute to difficulty in treating PTSD why well let’s think about   it if people who’ve been exposed to trauma you know hypercortisolism they respond to threats by   increasing the amount of cortisol and political corticoids exponentially have an exaggerated   response than when they’re in our off and we’re talking to them about their trauma, and they   start to get upset they start to get excited there the body’s going to start dumping all these gluten coke   or turquoise and guess what it’s going to make it more difficult for them to retrieve those memories   potentially so it’s kind of an interesting thing to look at because a lot of clients that I   worked with PTSD have been like I can’t remember why can I not remember and my very   general response because they don’t want to know about all this stuff generally is it’s your brain’s way of protecting you it’s your brain’s way of saying there’s a threat right now and you need   to protect yourself from the threat we don’t need to be worrying about all those memories back there   so we do some you know relaxation activities and those sorts of things to help them you know get   back down to baseline so we’re not continuing to fight against those gluten Co corticoids and thus   cortisol because when you fight with that what happens the client generally gets progressively   frustrated progressively upset and progressively unable to think clearly and access those memories   neurochemical factors corner or chemical factors of PTSD include abnormal regulation   of catecholamines serotonin amino acid peptide and opioid neurotransmitters each of which is found in   brain circuits that regulate and integrate the stress and fear response now again if you’re   thinking I’m never going to remember this for the quiz don’t get too stressed out about it because   I want you to take home the overarching concepts I’m not going to ask you really nitpicky questions   about stuff that you have absolutely no control over or at least that’s what I tried to do that   being said I want I think it’s important that you know that all of these neurochemicals including opioids are involved in the regulation and integration of stress and fear responses it’s not   just serotonin or two dopamine the catecholamine family including dopamine and norepinephrine are   derived from the amino acid tyrosine now it’s not really all that important but an interesting   little aside is that norepinephrine is made from the breakdown of dopamine so your focus and get   up and go chemical is made from your pleasure chemical interesting little concept there when   a stressor is perceived the HPA axis releases corticotropin-releasing hormone which interacts   with norepinephrine to increase fear conditioning and encoding of emotional memories enhance arousal   and vigilant vigilance and increase endocrine and autonomic responses to stress so when the   threat response system is turned on it releases cortisol which interacts with norepinephrine the stress hormone and they get up and go hormone say there’s some really bad mojo brewing here   which increases fear conditioning because the heart rates go in and everything and the response   is stress there’s an abundance of evidence that norepinephrine accounts for certain classic   aspects of PTSD including hyperarousal heightened startle and increased encoding of fear memories so   what about serotonin you know that’s supposed to be one of our calming chemicals it where   did it go poor serotonin transmission and PTSD maybe may cause impulsivity hostility aggression   depression and suicidality remember you’ve got the downregulation of the sex hormones so less   availability of serotonin and there are other things that cause the serotonin to not be as   available but they found that serotonin binding to 5h t1a receptors and this is just a little   soapbox I’m going to go on don’t differ between patients with PTSD and controls so what does that tell us that’s the only way we can really To figure out what’s going on in the brain in a live   subject look at PET scans what we have figured out or they’ve hypothesized is the fact that the   serotonin may not transmit as effectively as it may be a really weak connection it’s connecting but   it’s you know it’s kind of like having a rabbit ears you got to twist it to get the signal to   come in correctly all right this is another one just a concept I want you to think about all   they’re looking at in the research is the 5-hit 1a receptor there are a ton of 5-ht serotonin   5-ht receptors and each one of these receptors is involved in some aspect of addiction anxiety mood   sexual behavior mood sleep so when we’re talking about why SSRIs don’t work well SSRIs only bind   to certain receptors and if we’re not picking the right receptor if it is the serotonin at   all then we’re probably barking up the wrong tree I educate my patients about this if they decide   they need to go on antidepressants just so they don’t get frustrated as easily I mean it’s still   frustrating but so they don’t feel hopeless if the first medication they start taking doesn’t   seem to work or makes it worse we talked about why that might be because there are so many different   receptors for each one of the neurotransmitters there is a really cool table if you’re into this   stuff it’s actually on Wikipedia and it talks also about not only what these receptors do   but also what chemicals and medicines act on these receptors and how Food for Thought   GABA has profound anxiolytic effects in part by inhibiting the cortisol norepinephrine   circuits so it turns down the excitatory circuits patients with PTSD exhibit decreased peripheral   benzodiazepine binding sites well we know that when the body secretes a neurotransmitter goes   to the other end and it binds like a lock-and-key if you will or it knocks on the door and the door   gets opened and it goes through however you want to think about it basically what they found is   in patients with PTSD the Kem GABA goes through and the GABA levels are okay but then it knocks   on the door to get let in or it tries to put its key in the lock and there’s something wrong at   the binding sites or the binding sites you know somebody’s super glued them shut and they’re just   not there which is why patients with PTSD tend to have a harder time de-escalating when their   anxiety and stuff gets up because the GABA is there but it’s got no doors to go through no   locks to bind with however you want to whatever metaphor you want to use this may indicate the   usefulness of emotion regulation and distress tolerance skills due to the potential emotional   dysregulation of these clients so remember we talked about them having a more exaggerated   get-up-and-go response to a perceived threat and they also have a harder time calming down which is   basically one of your primary tenants of emotional dysregulation so one thing clinicians can   do is help patients learn that okay their body responds differently to stress than other people   at least for right now so it’s important for them to understand what emotional dysregulation   is emotional regulation strategies as well as distress tolerance skills to help them until they   can calm down to baseline because it sometimes takes them longer than other people as clinicians   we also can help reduce excitotoxin in order to reduce stress improve stress tolerance and enable   the acquisition of new skills when the brain gets really going when the cortisol is out there and   the glucocorticoids are in there it’s actually toxic and starts causing neurons to disappear which we’re going to talk about in a second it’s kind of scary NMDA receptors have been implicated in synaptic plasticity.Which means the brain’s ability to adjust and adapt as well as learning   and memory so these are good receptors I like them glutamate binds with these receptors and high   levels of glutamate are secreted during high levels of stress glutamate remember is what   GABA is made from but high levels of glutamate it’s an excitatory neural net in the brain and   overexposure of neurons to this glutamate can be excited toxic and may contribute to the loss of   neurons in the hippocampus of patients with PTSD so we’re actually seeing brain volume decrease as   a result of exposure to certain chemicals elevated gluten core glucocorticoid and yeah glucocorticoids   increases the sensitivity of these receptors so you’ve got a bunch of glutamate being dumped and   you’ve got a bunch of glucocorticoid you’ve got cortisol in there making these receptors more   sensitive so it’s got they’re more sensitive and they’ve got more coming in which makes it a whole   lot easier to become toxic and start causing neuronal degradation what does that mean why do   we care it may take clients with PTSD more time to master new skills because of emotional reactivity   but also because some of their synaptic plasticity may be damaged so it may take them a little bit   longer to actually acquire and integrate these new skills it’s not saying they’re stupid they   can remember it just fine however when they’re an emotionally charged state and helping their   brain learn that okay this isn’t a threat that’s one of those sort of subconscious things that has to   happen that can take longer if the brain becomes excited toxic during stress inhibited learning   and memory then it becomes excited toxic during stress which inhibits learning and memory so it’s   under stress things are excited toxic neurons are starting to disappear so I’m wondering and   I’m just hypothesizing here I don’t know the answers obviously or I wouldn’t be practicing   it but what happens during the exposure therapies because that’s exactly what we’re doing is we are   flooding the brain with all of these chemicals and creating basically an excitotoxin now they   found some evidence that exposure therapies can be helpful according to the DOJ website but or   not the DOJ I can’t even think of it right now the VA website but you know I’m wondering   long-term what the impact is endogenous opioids natural painkillers act upon the same receptors   activated by exogenous opioids like morphine and heroin exerts an inhibitory influence on the   HPA axis well we know that people take opiates and it has depressant effects on them it slows   them down and calms them down alterations in our natural opioids may be involved in certain PTSD   symptoms such as numbing stress-induced analgesia and dissociation again think of any clients you’ve   had who have been abused or even taken and not like the side effects of opiates are what opiates do to   some people make them feel more relaxed stress induced and analgesia they don’t have as much   physical pain sometimes they just it’s there I don’t care pill another interesting factor   is now truck zone which is used to oppose opiate appears to be effective in treating symptoms of   dissociation flashbacks in traumatized persons so basically, they’re saying if we undo the endogenous   opioids we can treat these symptoms it highlights the risk of opiate abuse for persons with PTSD   though because if endogenous opioids produce some of these numbing symptoms and dissociative   symptoms so they can get away from the pain and the flashbacks then if they add to that you know   oral opioids it could prove to be a very tempting cocktail we do want to as clinicians figure out   how we can assist them with their physical and emotional distress tolerance so they don’t feel   the need to numb and escape and you know I can’t imagine what some people have seen have   gone through and I’m not trying to take that away from them, I’m trying to help them figure out how   they can stay present and learn to integrate it changes question marks in brain structure and one   of the questions that’s come up in the research is because there aren’t any longitudinal studies that   looked at it was the hippocampal volume as low to begin with which created a predisposition for PTSD   or did PTSD create the smaller hippocampal volume interesting hippocampus is implicated in the   control of stress responses memory and contextual aspects of fear conditioning so it helps you to find these triggers in the environment that help you become aware with your senses about when   there might be a trauma prolonged exposure to stress and high levels of glucocorticoids damage the hippocampus we’ve talked about that hippocampal volume reduction in PTSD may reflect   the accumulated toxic effects of repeated exposure to increased cortisol levels what I called earlier   the flatter the Furious having you know your body holding on to cortisol for this extreme stress   and then when it perceives stress it’s either nothing or it’s extreme there are no kind sort   of mild stressors out there that decrease hippocampal volumes might also be a pre-existing vulnerability   factor for developing PTSD the amygdala yet another brain structure is the Olympic structure   involved in the emotional process and it’s critical for the acquisition of fear responses   functional imaging of studies has revealed hyper responsiveness and PTSD during the presentation of   stressful script cues or trauma reminders but also patients show increased amygdala responses   to general emotional stimuli that are not trauma associated such as emotional faces so they show an   increased responsivity to things they see on the TV that aren’t trauma-related to people crying   to people showing anger’s going to have a stronger emotional amygdala response than people   without PTSD so clients with PTSD may be more emotionally responsive across the board leading   to more emotional dysregulation again an area that we can help provide them with tools for early adverse   experiences including prenatal stress and stress throughout childhood has profound and long-lasting   effects on the development of neurobiological symptoms the brain is developing and if is exposed   to a lot of stress and some of these excited toxic situations how does that differ in the amount of   damage caused versus a brain that’s already kind of pretty much-formed programming may change for   subsequent stress reactivity and vulnerability to develop PTSD so if these happen during   childhood or at any time the brain can basically reprogram and go that it’s a really   dangerous place out there so I need to hold on to cortisol and I need to hold on to these   stress hormones because every time I turn around it seems like there’s a threat so I am going to be hyper-vigilant and respond in an exaggerated way to protect you from the outside world adult women   with childhood trauma histories have been shown to exhibit sensitization of both neuroendocrine and Audino stress responses so basically they’re showing hypo cortisol ISM a variety of changes   take place in the brains and nervous systems of people with PTSD and we talked about a lot of   those the key take-home point is stress can actually get toxic in the brain and cause physical   changes not just thought changes in the brain preexisting issues causing hypo cortisol ism where   the brain has already downregulated whether it’s due to chronic illness or chronic psychological   stress increases the likelihood of the development of PTSD this points to the importance of   prevention and early intervention of adverse childhood experiences we really need to get   in there and help these people develop distress tolerance skills understanding of vulnerabilities   so they’re not going from flat to furious all the time and so that they can understand why   their body kind of responds and why they respond differently than others and you know as we talk   about this and of course I’m regularly bringing up DBT buzzwords if you will think about your clients   if you’ve worked with any who’ve had borderline personality disorder what kind of history do they   have did they have just a great childhood no we know that people with BPD generally had pretty   chaotic childhoods so this research is also kind of underscoring why they may react and act   the way they do that flat to furious people with hypo cortical ism may or may not have PTSD so we   don’t want to say well you’re fine if you don’t have PTSD symptoms we do know that every trauma   potentially can cause the body to down-regulate and I kind of look at it as conserving a little   bit more of the energy that it needs each time so instead of conserving 60% now it’s conserving 65   and 66 each time it encounters a stressor in order to prepare for potential ongoing threats in the   environment hypercortisolism sets the stage for the flattened the furious leading to toxic levels   of glutamate upon exposure to stressors which can cause the theorized reduction in hippocampal   volume and persistent negative brain changes now I always say the brain can you know rebalance itself   and all well that’s part of the plasticity that is the really cool thing about our brain however as   far as regenerating those neurons I haven’t found any evidence in the research that we found a way   to help people regenerate once we’ve already those neurons are gone they’ve been killed off the brain   has to find a workaround so it does take time but I do believe people can minimize some of the   impact of the trauma they may have experienced people with PTSD are more reactive to emotional   stimuli even stimuli unrelated to trauma again think about some of your clients especially   if you work in a residential situation where you’re around on 24/7, you know for 30 or 60 days, and   you may see some clients that seem to get upset over everything and you’re like ah such a drama   queen or such a drama king and to yourself not to anybody else but when you think about it from   this perspective it gives you a different perspective and you might say oh maybe their body   responds differently they’ve got more emotional dysregulation because of prior trauma they’re not   trying to overreact this is their body’s response because it’s perceived threat so many times it gives me a different approach to working with that client hypercortisolism results when the   brain perceives that continued effort is futile feelings of fatigue set in akin to reduced stress   tolerance so think about you know when you’ve had a really long stressful period you know weeks or   months maybe you’re dealing with an ailing family member or something it’s just a lot of stress and   you start getting really tired and when you’re really tired and you’re worn down and somebody   gives you one more thing it’s that one more thing normally wouldn’t bother you but right now you   just can’t take it so we can see how there’s a reduced stress tolerance when somebody’s already   at this stage reducing fatigue in our clients can be accomplished in part with psychological factors   including motivation or knowledge of other people who are dealing with similar things support groups   feedback about their and making sure they have frequent successes not once a week but I want to   have them keep a journal every day of something good that happened or something positive that   may indicate they’re moving forward in their treatment goals and knowledge of an endpoint.Where are we going with this when is the treatment going to end I don’t want most clients don’t   want to be with us forever no matter how lovable we are do you want to feel better and be done   with us so having to help them see that there is an endpoint we’re going to accomplish this   goal this month and then we can reassess 46% of people in the US are exposed to adverse childhood   experiences so like I said this is a huge area for early intervention where we can prevent people   from developing PTSD later in life how awesome would that be instruction and skills to handle   emotional dysregulation including mindfulness vulnerability prevention and awareness emotion   regulation distress tolerance and problem-solving could be wonderful additions to health curriculums   anything any skills groups you do with children or adolescents or even adults I mean just because   they’re adults doesn’t mean that they’re safe from PTSD or that they’ve crossed any threshold   where they’re too old to learn we’re never too old to learn of those exposed to trauma education   about and normalization of their heightened emotional reactivity and susceptibility to PTSD   in the future may be helpful in increasing their motivation for their current treatment protocol   whatever it is but it also just normalizes things so they don’t feel like they’re overreacting or   they don’t feel guilty for being so tired or whatever they’re experiencing right now are there any questions I know I went through a lot of really complicated stuff but I thought   it was really interesting not only the way our brain reacts in order to protect us   but how cross-cutting a lot of this stuff was it not just PTSD we’re talking about   necessarily but a lot of this information applies to our clients with chronic fatigue burnout and chronic stress and we can see that those people also are at risk at   higher risk of PTSD should they be exposed to trauma and none of us is immune I mean   there are tornadoes there are hurricanes there are you know things that happen that   really stink so the more we can help clients be aware of things develop skills and tools to prevent as much harm as possible I think the more effective we are as clinicians depending on the client and I can do some more research on the VA website because   they’re really into medications for PTSD I know ketamine which is a horse tranquilizer   has been shown to be effective in people with PTSD and there have been some others   that have kind of given me pause ketamine is a hypnotic you know most of the drugs   they’re trying out right now are really in my opinion they’re powerful drugs but a   lot of them all of them that I know of have pretty high addictive potentials too so they   make me nervous but you know when you’re weighing the when you’re going from a harm   reduction model that’s not necessarily not necessarily such the be-all-end-all I guess that’s interesting that you use ketamine in the ER it’s definitely powerful effective stuff and like I said earlier some of the stuff that some of my clients and some people   have seen done experienced I couldn’t even imagine and you know sometimes for them to   actually survive we may need to look at some of these more intense more powerful drugs PTSD and veteran trauma is not are not my focus right now and yes marijuana is being experimented   with or looked at used whatever however you want to look at it for PTSD treatment with veterans   there’s pretty much not a drug out there they haven’t tried to throw at it to see well what   will this do I believe they were even using LSD experimentally for a little while too you the VA I mean if you’re interested in this topic let me see if I could pull that   down into here, we go to the National Center for PTSD US Department of Veterans Affairs   has a lot of information if you go for professionals, it has a ton more information   if you can get on get some of your SI CEUs on demand they do have some free CEUs for PTSD   here I’ve never taken any of them but what I’ve looked at when I’ve looked at like the   PowerPoints the presentations and stuff I’m sure they’re good so if you’re you do focus   a lot on PTSD and you can get on-demand CEUs then this might be a place to get some good free   ones aside from DBT are there any other evidence-based practices for therapy that   you’ve seen work best in combination with the medications cognitive processing therapy when   you’re working specifically with veterans and there is a free course on that too and this one I have gone through and it’s really awesome CPT dot must seed and here I’ll just put it into that education and this is a free course oops   and here’s the other one ah golly everyone and embryo does have a lot of research effectiveness   with people with PTSD too so yes I would definitely encourage people to explore   all options alrighty everybody I really appreciate you coming today and sticking   with me through this topic and I will see you on Thursday if you have any questions   please feel free to email me or you can always also send it to support that all   CEUs com either way I get it and otherwise I will see you on Tuesday thanks a bunch if you enjoy this podcast please like and subscribe either in your podcast player or   on YouTube you can attend and participate in our live webinars with Doctor Snipes by   subscribing at all CEUs comm slash counselor toolbox this episode has   been brought to you in part by all CEUs com providing 24/7 multimedia continuing   education and pre-certification training to counselors therapists and nurses since 2006 used coupon code consular toolbox to get a 20% discount on your order this monthAs found on YouTube15 Modules Of Intimate Video Training With Dr. Joe Vitale – You’re getting simple and proven steps to unlock the Awakened Millionaire Mindset: giving you a path to MORE money, …