{"id":151683,"date":"2023-10-31T22:35:10","date_gmt":"2023-11-01T02:35:10","guid":{"rendered":"https:\/\/effectsofanxiety.net\/?p=151683"},"modified":"2023-10-31T14:18:44","modified_gmt":"2023-10-31T18:18:44","slug":"neurobiological-impact-of-psychological-trauma-on-the-hpa-axis","status":"publish","type":"post","link":"https:\/\/effectsofanxiety.net\/archives\/151683","title":{"rendered":"Neurobiological Impact of Psychological Trauma on the HPA Axis"},"content":{"rendered":"<div class=\"jetpack-video-wrapper\"><iframe loading=\"lazy\" title=\"Neurobiological Impact of Psychological Trauma on the HPA Axis\" width=\"660\" height=\"371\" src=\"https:\/\/www.youtube.com\/embed\/qLxgQdxedL4?feature=oembed\" frameborder=\"0\" allow=\"accelerometer; autoplay; clipboard-write; encrypted-media; gyroscope; picture-in-picture; web-share\" referrerpolicy=\"strict-origin-when-cross-origin\" allowfullscreen><\/iframe><\/div>\r\n\r\n&nbsp;\r\n\r\nUnlimited CEUs for $59 are available at AllCEUs.com\/Trauma-CEU this episode was pre-recorded\r\nas part of a live continuing education webinar. CEUs are\r\nstill available at AllCEUs.com\/Trauma-CEU welcome to today’s presentation on the\r\nneurobiological impact of psychological trauma\u00a0\u00a0 on the HPA axis we’re going to define and explain\r\nthe HPA axis which we’ve talked about before is a response system so it’s not\r\nanything to get to you know overly concerned about\u00a0\u00a0 that it’s going to be super dry well identify the\r\nimpact of trauma on this axis and on basically\u00a0\u00a0 your whole nervous system in your brain identify\r\nthe impact of chronic stress and cumulative trauma\u00a0\u00a0 on the HPA axis because a lot of times when\r\nwe talk about PTSD we think only about some\u00a0\u00a0 particular acute event and that’s not necessarily\r\ntrue there are a lot of people with PTSD who have\u00a0\u00a0 basically what I call cumulative trauma and they\r\nwere exposed to extensive child neglect they were\u00a0\u00a0 in domestically violent relationships they were\r\nin a situation where they were exposed to trauma\u00a0\u00a0 over and above what a normal person would think lawfully\u00a0think of law enforcement military personnel think first responders I mean\r\nthey see stuff that no human should have to see\u00a0\u00a0 and they see it not only once but you know once\r\na week or once a month depending on kind of where\u00a0\u00a0 you are so it’s important to understand well\r\none thing may not be so traumatic to create\u00a0\u00a0 post-traumatic stress we’re going to look at some\r\nof the reasons that PTSD symptoms may develop as\u00a0\u00a0 a cumulative sort of thing which I found this\r\nto be interesting anyway we’ll identify\u00a0\u00a0 symptoms of dysfunction and we’ll talk about some\r\ninterventions that are useful for this population\u00a0\u00a0 now my guess is none of you are prescribing\r\nphysicians so when we’re going through this you’re\u00a0\u00a0 going to be going yeah that’s all well and good\r\nwhat’s the exact point of thinking about\u00a0\u00a0 exactly what this information is telling\r\nme on each slide show used to be the hat to help my\u00a0\u00a0 clients who have been annoyed by trauma and\r\nhave not yet developed any sort of PTSD symptoms\u00a0\u00a0 or who have PTSD symptoms and how can I use this\r\ninformation to better tailor my treatment plan to\u00a0\u00a0 help them become more effective in managing their\r\nsymptoms this is kind of a unique presentation\u00a0\u00a0 because it was based on only one article this\r\nwas a meta-analysis so it’s a long article\u00a0\u00a0 and it’s a really good article that I would\r\nstrongly suggest looking at it in your resources\u00a0\u00a0 section in the class it lays out the many changes\r\nand\/or conditions that are seamed in the brain and\u00a0\u00a0 nervous system of people with PTSD so they really\r\nlooked at a lot of research longitudinally to see\u00a0\u00a0 what we know and what we don’t know as clinicians\r\nawareness that these changes can help us educate\u00a0\u00a0 patients about their symptoms why do you feel this\r\nway and find ways of adapting to improve quality\u00a0\u00a0 of life so neurobiological abnormalities in PTSD\r\noverlap with features found in traumatic brain\u00a0\u00a0 injury so that started making a lot of researchers\r\ngo hmm you know traumatic brain injury there is\u00a0\u00a0 something or again of course hurting part of\r\nthe brain so why are the symptoms similar in\u00a0\u00a0 PTSD you’re going to find out pretty\r\nsoon is that PTSD does cause damage\u00a0\u00a0 actual physical damage in the brain the response\r\nof an individual to trauma depends not only on\u00a0\u00a0 the stressor characteristics but also on factors\r\nspecific to the individual so somebody can see a\u00a0\u00a0 trauma and not be as traumatized if you will as\r\nsomeone else and part of these factors and\u00a0\u00a0 there was a study done by Pi Newson Nader back\r\nI believe the early 80s looked at triage\u00a0\u00a0 factors for PTSD and some of the factors that\r\nthey found why certain traumas may be more\u00a0\u00a0 traumatic than certain people versus others have to do\r\nwith this particular trauma, you’re experiencing\u00a0\u00a0 it close to one of your safe zones where you\r\nlive where you work somewhere where you’re not\u00a0\u00a0 where you’re supposed to be feel safe and if\r\nso then it’s probably going to be perceived as\u00a0\u00a0 more traumatic now again think about the survival\r\ncapacity or the survival function of this behavior\u00a0\u00a0 when your brain says this is supposed to be a safe\r\nzone and it’s not so I need to respond in kind\u00a0\u00a0 you’re trying to protect yourself make sense the\r\nsimilarity to the victim if it could happen to her\u00a0\u00a0 if it could happen to him they’re like me it could\r\nhappen to me that makes me feel scared because we\u00a0\u00a0 like to categorize the world in terms of using them\r\nbad things happen to those people not to us people\u00a0\u00a0 but if you’re looking at a victim who’s liked you\r\nand you say well I am and us people then you’re\u00a0 \u00a0going to have more difficulty separating it and\r\nfeeling safe and going well that couldn’t happen\u00a0\u00a0 to me and the degree of helplessness you know if\r\nyou saw something and you were just like there\u00a0\u00a0 was nothing I could do there’s a greater sense of\r\nhelplessness and horror then if you didn’t have\u00a0\u00a0 that necessarily that same experience so those\r\nare a couple of things as far as the prestress or\u00a0\u00a0 perception that we want to consider when we’re\r\ntalking to our patients even if you’re not a\u00a0\u00a0 therapist that works with the trauma specifically\r\nsome people refer out for that some people are\u00a0\u00a0 working with an EMDR therapist and you know cool\r\nbut as important to understand and if you happen\u00a0\u00a0 to go down this road with your clients help them\r\nunderstand why they perceived that particular\u00a0\u00a0 stressor so intensely versus some other stressor\r\nthat they think may have good English there\u00a0\u00a0 oh well sorry they think should have stretched\r\nthem out more so their perception of the stressor\u00a0\u00a0 prior traumatic experiences and we’re going to\r\nlearn that prior traumas do cause changes\u00a0\u00a0 in the brain to prepare you basically\r\nTherese bond more quickly when there’s a threat\u00a0\u00a0 so prior traumatic experiences can send you from\r\nzero to 100 a lot faster which means it’s going\u00a0\u00a0 to be or could be more traumatic the amount of\r\nstress in the preceding months if you’re already\u00a0\u00a0 worn down and your body has already said I can’t\r\nfight anymore it’s not doing any good then when\u00a0\u00a0 it encounters PTSD and when it encounters a\r\ntrauma the body might be going I just can’t\u00a0\u00a0 take another thing please just I can’t do it which\r\nis why we see in people with PTSD chronic stress\u00a0\u00a0 burnout and chronic fatigue this inability to\r\ntolerate stress because the body’s just already\u00a0\u00a0 waived them that white flag going I can’t do it\r\ncurrent mental health or addiction issues again\u00a0\u00a0 that’s your body’s way of saying something in\r\nthe neurotransmitter something in the system\u00a0\u00a0 is a little bit wonky and that means I’m not\r\ngoing to be able to respond a hundred percent\u00a0\u00a0 healthy and functionally to whatever’s going\r\non and the availability of social support now\u00a0\u00a0 a lot of the research especially with emergency\r\nservice personnel points to the availability of\u00a0\u00a0 social support within 24 hours of the trauma\r\nso when there’s an officer-involved shooting\u00a0\u00a0 when there’s something that they encounter on\r\nthe duty that’s trauma the ability to have social\u00a0\u00a0 support within that first 24 hours preferably first\r\ntwo-hour period to at least touch base with a\u00a0\u00a0 social positive social support is vital to\r\nhelping somebody process the memories instead of\u00a0\u00a0 just kind of them disappearing into never-never\r\nland and getting solidified in an unhelpful way for the vast majority of the population though\r\npsychological trauma is limited to an acute\u00a0\u00a0 transient disturbance you see something that’s\r\ntraumatic you’re like oh my gosh Wow it is\u00a0\u00a0 devastating and yeah is going to affect you for\r\na little while but in a week or two you’re kind\u00a0\u00a0 of feeling like you got your land legs again so\r\nthere’s this subpopulation of the population\u00a0\u00a0 there’s a small group that ends up developing\r\nPTSD the signs and symptoms of PTSD reflect\u00a0\u00a0 a persistent adaptation of the neurobiological\r\nsymptoms to witnessed trauma and I crossed out\u00a0\u00a0 abnormal in the article it says abnormal and\r\nI look at it as a perfectly normal adaptation\u00a0\u00a0 because the body is either going with the reserves\r\nI have right now I can’t deal or you know whatever\u00a0\u00a0 it’s doing it’s trying to protect itself now it\r\nmay not be helpful but from a survival\u00a0\u00a0 perspective it generally makes sense so I try\r\nwhen I’m working with clients to help\u00a0\u00a0 them see the functional nature of their symptoms\r\ngiven the knowledge they had or the state they\u00a0\u00a0 were in at the time so now to the HPA axis the\r\nThe hypothalamic-pituitary-adrenal axis aka your\u00a0\u00a0 threat response system controls reactions\r\nto stress and regulates many body processes\u00a0\u00a0 including digestion the immune system mood and\r\nemotions sexuality energy storage and expenditure\u00a0\u00a0 so let’s think about this real quick when you’re\r\nunder stress, your body feels threatened I needs to survive so it sends out excitatory\r\nneurotransmitters that get you wired up which\u00a0\u00a0 kind of makes your digestion speed up\r\nit can cause some cramping in the abdominal area\u00a0\u00a0 your immune system is not really important\r\nright now threat we’re not worried\u00a0\u00a0 about the flu mood and emotions you tend to\r\nbe hyper-vigilant and more easily startled threat\u00a0\u00a0 means fight or flee which means anger or anxiety\r\nso you’ve got some stress emotions and I don’t\u00a0\u00a0 want to say dysfunctional because they’re very\r\nfunctional your body perceives a threat and it’s\u00a0\u00a0 saying you need to do something sexually well if\r\nthere’s a threat this is no time to procreate so\u00a0\u00a0 your body says let’s turn off those sex hormones\r\nright now, because we need to use us for fighting\u00a0\u00a0 and fleeing not procreating which is all well\r\nand good but when we have reduced sex hormones\u00a0\u00a0 it also reduces our serotonin availability which\r\nserotonin is one of those calming chemicals\u00a0\u00a0 which help us calm down the excitatory neurons\r\nso without them, you stay revved up which brings\u00a0\u00a0 us to energy storage and expenditure you’re\r\nrevved up you’re on high alert you’re staying\u00a0\u00a0 up here and your body says you know what if\r\nI’m going to survive this fight or flight I\u00a0\u00a0 need fuel which means you need to eat preferably\r\nhigh-fat high-sugar foods that give us instant\u00a0\u00a0 energy and sustained energy we want calorie defense\r\nstuff now thinking about it from that perspective\u00a0\u00a0 you can see how when you’re under chronic stress\r\nor a big stressor you know some of your symptoms\u00a0\u00a0 make sense why do you want to go eat chocolate\r\nor do whatever you do that’s my go-to pizza and\u00a0\u00a0 chocolate when I’m stressed is generally what I\r\ncrave not what I need but what I crave so we want\u00a0\u00a0 to help people understand that there’s a reason\r\nit makes sense now we just have to figure out\u00a0\u00a0 how to deal with it differently the ultimate\r\nresult of HPA axis activation is to increase\u00a0\u00a0 levels of cortisol in the blood during times of\r\nstress now cortisol is the hormone that goes out\u00a0\u00a0 and sets off kind of this whole well there are\r\na couple before it but it sets off this whole\u00a0\u00a0 event cortisol is your stress hormone cortisol\r\nis the one who says no sex hormones right now\u00a0\u00a0 you know and it monkeys with all your different\r\nhormones to make sure and your energy storage to\u00a0\u00a0 make sure that you’re ready for this fight or\r\nflee its main role is to release glucose into\u00a0\u00a0 the bloodstream in order to facilitate the fight\r\nor flight now glucose is sugar is raising your\u00a0\u00a0 blood sugar so you’ve got energy now we’re going\r\nto talk regularly about glucocorticoids which are glucose hormones that make your body release\r\nglucose which is mainly cortisol and that\u00a0\u00a0 term is going to become important later I’m just\r\nkind of throwing it out there right now cortisol\u00a0\u00a0 also suppresses and modulates the immune system\r\ndigestive system and reproductive system so again\u00a0\u00a0 cortisol is saying we’ve got this energy we’ve got\r\nthis threat let me figure out how to sort of dole\u00a0\u00a0 out our resources right now for survival in the\r\nnow it’s cortisol is very present focused\u00a0\u00a0 it’s not looking at you know the long-term and\r\ngoing well this will pass cortisol is very right\u00a0\u00a0 now HPA axis dysfunction the body reduces HPA axis\r\nactivation when it appears further fight-or-flight\u00a0\u00a0 may not be beneficial and they call this hypo\r\ncortisol ism so basically a threat response system\u00a0\u00a0 is you know warning the alarm in\r\nmy dorm when I was in college used to have these\u00a0\u00a0 really annoying blinking lights I because why I do\r\nthis all the time sorry the hypercritical ism is\u00a0\u00a0 your body’s response to going if I keep fighting I\r\nam just throwing good energy after bad there is no\u00a0\u00a0 sense in surrendering so it turns down the system\r\nand it stops producing as much cortisol that way\u00a0\u00a0 it has cortisol your stress hormone for when there\r\nis a bigger more threatening threat well what does\u00a0\u00a0 that mean well we need cortisol is what\r\nhelps us get up in the morning our cortisol goes\u00a0\u00a0 up and down throughout the day which helps us\r\nhave the energy to get up go to work do those\u00a0\u00a0 sorts of things it’s a normal hormone when it’s\r\nin the right balance hypo cortical cortisol ISM\u00a0\u00a0 seen in stress-related disorders such as chronic\r\nfatigue syndrome burnout and PTSD is actually a\u00a0\u00a0 protective mechanism designed to conserve energy\r\nduring threats that are beyond the organism with\u00a0\u00a0 us ability to cope so dysfunction in the axis\r\ncauses abnormal immune system activation so\u00a0\u00a0 you have increased inflammation and allergic\r\nreactions cortisol is also related to\u00a0\u00a0 cortisone your body does not release its\r\nnatural antihistamines when you are pardon me\u00a0\u00a0 under stress which is why your allergies seem to\r\nbother you more which when your allergies bother\u00a0\u00a0 you more you’re probably not sleeping as well at\r\nnight and we know that not sleeping as well at night keeps your HPA axis activated so you’re\r\nfighting this battle you’re trying to squeeze\u00a0\u00a0 blood out of a turnip basically because your body\r\nsaid we’re not releasing any more cortisol I don’t\u00a0\u00a0 care what you say but everything else you’re not\r\nsleeping as well you’re still kind of revved up\u00a0\u00a0 you’re fatigued and your body is going but there’s\r\na threat and back in your brain they’re going yep\u00a0\u00a0 but it’s not a big enough threat yet so you can\r\nsee where this cascade you’re fighting inside your\u00a0\u00a0 own body and all your systems are kind of arguing\r\nirritable bowel syndrome such as constipation and\u00a0\u00a0 diarrhea because cortisol speeds things up and if\r\nyou don’t have enough cortisol you know what might\u00a0\u00a0 happen reduce tolerance to physical and mental\r\nstresses including pain remember I said that sex\u00a0\u00a0 hormones go down which means that the availability of\r\nserotonin goes down we know that serotonin is not\u00a0\u00a0 only involved somehow in mood it’s involved\r\nwith some level of anxiety reduction but we\u00a0\u00a0 also know it’s involved in pain perception\r\nso when serotonin goes down we perceive pain\u00a0\u00a0 more acutely and altered levels of sex hormones\r\nso fatigue and you’re like where did that\u00a0\u00a0 come from well the HPA axis is activated see how\r\nmany times I can say that without tripping on my\u00a0\u00a0 tongue when it’s activated it sends out these you\r\nknow excitatory neurotransmitters when\u00a0\u00a0 you’re excited for too long you get fatigued\r\nwell interesting little caveat or thing here\u00a0\u00a0 fatigue is actually an emotion generated in the\r\nbrain you know we’ve learned to label it which\u00a0\u00a0 prevents damage to the body when the brain perceives\r\nthat further exertion could be harmful sounds\u00a0\u00a0 similar to hypo cortisol ISM it is so what do\r\nwe know from athletes we know that fatigue and\u00a0\u00a0 sports is largely independent of the state of\r\nthe muscles themselves so fatigued you know your\u00a0\u00a0 muscles usually only work up to about 60% of\r\ntheir ability to work and then fatigue starts to\u00a0\u00a0 set in so there was still a big margin that you\r\ncould work before your muscles finally gave out\u00a0\u00a0 and said hold no more I’ve got jelly legs but\r\nyour muscles quit you start feeling tired you\u00a0\u00a0 start feeling exhausted so this is a protective\r\nmechanism the body’s gone we need to conserve a\u00a0\u00a0 little bit of energy because you have to get home\r\nand shower and you know prepare to run in case\u00a0\u00a0 the tiger chases you but what factors is your body\r\npaying attention to but tells it OK whoa we need\u00a0\u00a0 to stop so we’ve got enough reserve in the event\r\nof a problem core temperature, you’re working out\u00a0\u00a0 your core temperature goes up at a certain point\r\nit goes that’s high enough your glycogen your\u00a0\u00a0 blood sugar levels your oxygen levels in the brain\r\nhow thirsty you are whether you’re sleep-deprived, to begin with, it’s going to mean that you fatigue\r\na lot easier and the level of muscle soreness and\u00a0\u00a0 fatigue going into that exercise session the\r\nbrain kind of takes all these factors into\u00a0\u00a0 effect and goes okay I can unless you work out\r\nthis much and then I’m going to shut you down I’m\u00a0\u00a0 wrong it’s off what they have found though\r\nis we can override this so when clients come into\u00a0\u00a0 our office, they’re fatigued they are they’re off\r\nthey’re just like I’m exhausted I’m agitated I’m\u00a0\u00a0 irritable I’m not sleeping well I just uh okay so\r\nwith athletes, we know that psychological factors\u00a0\u00a0 can be used to reduce fatigue such as their\r\nemotional state if they go in in a positive\u00a0\u00a0 emotional state or a hyped up energized emotional\r\nstate if they’re listening to really energizing\u00a0\u00a0 music it can help them push past that fatigue\r\npoint a little bit if they know the endpoint\u00a0\u00a0 maybe they know they’re doing three sets of ten\r\nreps they’re going to push through faster or more\u00a0\u00a0 effectively than if they’re working with the coach\r\nand they have no idea how many sets they’ve got or\u00a0\u00a0 how many reps they’ve got to do they’re just like\r\nare you going to make a stop to other competitors that\u00a0\u00a0 service motivation they’re looking around they’re\r\nseeing other people doing it they’re going okay\u00a0\u00a0 I got this and in the case of athletes visual\r\nfeedback you know they’re seeing growth in their\u00a0\u00a0 muscles they’re seeing positive changes so they\r\ncan push through that fatigue a little bit more\u00a0\u00a0 they’re like okay this is worth it so fatigue\r\nis one sign that the body is getting ready to down-regulate that HPA axis and go conservation\r\nin practice and counseling practice how can we\u00a0\u00a0 help reduce mental fatigue and help clients\r\nrestore their age PA access functioning and\u00a0\u00a0 one of the things I would challenge you to think\r\nabout is how can we increase their self-efficacy and their high ductless if you will in their\r\nthe emotional state that a can-do attitude increases their hardiness and resilience you know we talk\r\nabout those, a lot man make sure they know their\u00a0\u00a0 endpoint where are they going what does their\r\nwhat do their symptoms look like what is it\u00a0\u00a0 going to look like in three weeks in three months\r\nand what can we reasonably think will change you\u00a0\u00a0 know let’s give them some tangible goals that\r\nthey can look at other competitors or motivational group therapy can be very helpful in dealing\r\nwith some of this stuff obviously, you’re not going\u00a0\u00a0 to do a lot of trauma work in the group most of the\r\ntime but having other people around knowing that\u00a0\u00a0 there are other people who are dealing with\r\nPTSD and having support groups can be really\u00a0\u00a0 helpful because they can cheer each other on and\r\ngo come on John you got this you just need to push\u00a0\u00a0 I know this is a really tough week for you and\r\nthat can help people push through that fatigue and feedback now in the case of psychological\r\nissues we’re not talking about visual feedback but\u00a0\u00a0 we’re talking about looking at that treatment\r\nplan or looking at their symptoms and being able\u00a0\u00a0 to say you know what I have made progress I’m not\r\nhaving nightmares as much as I actually slept through\u00a0\u00a0 the night last night who knew and finding those\r\nthings that they can latch on to and go things\u00a0\u00a0 are getting better you know they’re not going to get\r\nexponentially better overnight likely but they are\u00a0\u00a0 getting better and I can see this incremental\r\nprogress and in doing that we can help people\u00a0\u00a0 get a sense increase that those dopamine levels\r\nincrease that learning and go okay I can do this\u00a0\u00a0 we want to make sure that we are considering\r\ntheir fatigue level though and not putting too\u00a0\u00a0 much on them at once let’s look at really\r\nsmall steps and then solidifying those steps not\u00a0\u00a0 taking one step after another but taking one step\r\nand then taking a breather for some of our clients\u00a0\u00a0 helping them identify how they’re feeling and\r\nbe aware of their own fatigue level low cortisol\u00a0\u00a0 has been found to relate to more severe PTSD\r\nhyperarousal symptoms and you’re like yeah it\u00a0\u00a0 took me quite a while to wrap my head around this\r\nwhole concept but it makes sense now so when you\u00a0\u00a0 have low cortisol your body is conserving all\r\nits energy can in case it needs to respond\u00a0\u00a0 to an extreme threat the sensitized negative\r\nfeedback loop in veterans diagnosed with PTSD\u00a0\u00a0 have they’ve shown that they’ve got greater ludic\r\ncorticoid responsiveness now remember I talked\u00a0\u00a0 about cortisol being a glue to co-corticoids and\r\nthere’s just no nice way to talk about\u00a0\u00a0 this without using really obnoxiously clinical\r\nterms anyhow which means that the body is holding\u00a0\u00a0 on and it’s going you’re not going to have cortisol\r\nto just get irritable or happy or excited about\u00a0\u00a0 just anything but if there’s a threat I’ll let you\r\nhave it unfortunately in patients with cortisol\u00a0\u00a0 ISM when there’s a threat they have an exaggerated\r\nresponse thank hyper-vigilance and I call it the\u00a0\u00a0 flatter the Furious so their mood is either kind\r\nof flat and they’re not really responsive too much\u00a0\u00a0 but when there is something that startles them or\r\ntheir body perceives as a threat all of a sudden\u00a0\u00a0 their body dumps cortisol and dumps glucose into\r\nthe system which floods the system and if you’ve\u00a0\u00a0 ever flooded your engine you know what happens\r\ndoesn’t respond quite as well but there are even\u00a0\u00a0 more problems with this so evidence says that the\r\nrole of trauma experienced in sensitizing the HPA\u00a0\u00a0 axis regulation is independent of PTSD development\r\nokay so what does that mean that means even if\u00a0\u00a0 somebody doesn’t develop PTSD clinical diagnosis\r\nif they’ve had trauma HPA access is going to\u00a0\u00a0 sensitize them a little bit and hold them back a little bit\r\nmore cortisol and be a little bit more reactive\u00a0\u00a0 when there is trauma which means successive\r\ntraumas could produce success successively\u00a0\u00a0 significant reactions in those with prior trauma\r\nmaybe more at risk of PTSD for later traumas\u00a0\u00a0 so again as a clinician what does this mean for\r\nme this means that if I’m working with a client\u00a0\u00a0 who comes from a troubled childhood there were\r\nadverse childhood events or you know whatever\u00a0\u00a0 you want to label it they had chronic stress they\r\nhad trauma in their childhood even in the prenatal\u00a0\u00a0 period they found I wanted to educate them about the\r\nthe fact that they are at a greater risk of developing\u00a0\u00a0 PTSD if they’re exposed to more trauma so they\r\ncan learn how to keep their stress levels under control because it’s more important for\r\nthem according to this research because of some\u00a0\u00a0 persistent brain changes that we’re going to see\r\ncore endocrine factors of PTSD include abnormal\u00a0\u00a0 regulation of cortisol and thyroid hormones okay\r\nso we’ve already talked about cortisol our stress\u00a0\u00a0 hormone and you’re probably familiar with thyroid\r\nhormones being sort of your metabolism hormone but\u00a0\u00a0 what happens when cortisol goes down in the body\r\nstarting to rein in the energy thyroid hormones\u00a0\u00a0 also go down hypo cortisol ism and PTSD occurs\r\ndue to increased negative feedback sensitivity\u00a0\u00a0 of the HPA axis okay studies suggest that low\r\ncortisol levels at the time of exposure to trauma\u00a0\u00a0 may predict the development of PTSD so if their\r\ncortisol levels were already low they were already\u00a0\u00a0 suffering if you will from hypercortisolism and\r\nremember we’ve seen hypercortisolism in burnout\u00a0\u00a0 and you know regular old burnout chronic fatigue\r\nsyndrome as well as PTSD so we’re not just talking\u00a0\u00a0 about veterans here if the cortisol levels are\r\nalready abnormally low and the body’s already\u00a0\u00a0 started conserving cortisol when they’re\r\nexposed to a trauma we can with more certainty\u00a0\u00a0 predict which people are going to develop PTSD\r\nsymptoms back to those gluteal corticoids they\u00a0\u00a0 interfere with the retrieval of traumatic memories\r\nan effect that may independently prevent or reduce\u00a0\u00a0 symptoms of PTSD so when cortisol is in\r\nthe system and it’s causing all the blood\u00a0\u00a0 sugar to develop we’re not forming lots of\r\nmemories right now we’re just surviving which they\u00a0\u00a0 hypothesize could prevent or reduce the symptoms\r\nif those memories aren’t consolidated and they\u00a0\u00a0 go away, or it could contribute to difficulty\r\nin treating PTSD why well let’s think about\u00a0\u00a0 it if people who’ve been exposed to trauma you\r\nknow hypercortisolism they respond to threats by\u00a0\u00a0 increasing the amount of cortisol and political\r\ncorticoids exponentially have an exaggerated\u00a0\u00a0 response than when they’re in our off and\r\nwe’re talking to them about their trauma, and they\u00a0\u00a0 start to get upset they start to get excited there\r\nthe body’s going to start dumping all these gluten coke\u00a0\u00a0 or turquoise and guess what it’s going to make it\r\nmore difficult for them to retrieve those memories\u00a0\u00a0 potentially so it’s kind of an interesting thing\r\nto look at because a lot of clients that I\u00a0\u00a0 worked with PTSD have been like I can’t\r\nremember why can I not remember and my very\u00a0\u00a0 general response because they don’t want to know\r\nabout all this stuff generally is it’s your brain’s way of protecting you it’s your brain’s way of\r\nsaying there’s a threat right now and you need\u00a0\u00a0 to protect yourself from the threat we don’t need\r\nto be worrying about all those memories back there\u00a0\u00a0 so we do some you know relaxation activities and\r\nthose sorts of things to help them you know get\u00a0\u00a0 back down to baseline so we’re not continuing to\r\nfight against those gluten Co corticoids and thus\u00a0\u00a0 cortisol because when you fight with that what\r\nhappens the client generally gets progressively\u00a0\u00a0 frustrated progressively upset and progressively\r\nunable to think clearly and access those memories\u00a0\u00a0 neurochemical factors corner or chemical\r\nfactors of PTSD include abnormal regulation\u00a0\u00a0 of catecholamines serotonin amino acid peptide and\r\nopioid neurotransmitters each of which is found in\u00a0\u00a0 brain circuits that regulate and integrate the\r\nstress and fear response now again if you’re\u00a0\u00a0 thinking I’m never going to remember this for the\r\nquiz don’t get too stressed out about it because\u00a0\u00a0 I want you to take home the overarching concepts\r\nI’m not going to ask you really nitpicky questions\u00a0\u00a0 about stuff that you have absolutely no control\r\nover or at least that’s what I tried to do that\u00a0\u00a0 being said I want I think it’s important that you\r\nknow that all of these neurochemicals including opioids are involved in the regulation and\r\nintegration of stress and fear responses it’s not\u00a0\u00a0 just serotonin or two dopamine the catecholamine\r\nfamily including dopamine and norepinephrine are\u00a0\u00a0 derived from the amino acid tyrosine now it’s\r\nnot really all that important but an interesting\u00a0\u00a0 little aside is that norepinephrine is made from\r\nthe breakdown of dopamine so your focus and get\u00a0\u00a0 up and go chemical is made from your pleasure\r\nchemical interesting little concept there when\u00a0\u00a0 a stressor is perceived the HPA axis releases\r\ncorticotropin-releasing hormone which interacts\u00a0\u00a0 with norepinephrine to increase fear conditioning\r\nand encoding of emotional memories enhance arousal\u00a0\u00a0 and vigilant vigilance and increase endocrine\r\nand autonomic responses to stress so when the\u00a0\u00a0 threat response system is turned on it releases\r\ncortisol which interacts with norepinephrine the stress hormone and they get up and go hormone\r\nsay there’s some really bad mojo brewing here\u00a0\u00a0 which increases fear conditioning because the\r\nheart rates go in and everything and the response\u00a0\u00a0 is stress there’s an abundance of evidence\r\nthat norepinephrine accounts for certain classic\u00a0\u00a0 aspects of PTSD including hyperarousal heightened\r\nstartle and increased encoding of fear memories so\u00a0\u00a0 what about serotonin you know that’s supposed to\r\nbe one of our calming chemicals it where\u00a0\u00a0 did it go poor serotonin transmission and PTSD\r\nmaybe may cause impulsivity hostility aggression\u00a0\u00a0 depression and suicidality remember you’ve got\r\nthe downregulation of the sex hormones so less\u00a0\u00a0 availability of serotonin and there are other\r\nthings that cause the serotonin to not be as\u00a0\u00a0 available but they found that serotonin binding\r\nto 5h t1a receptors and this is just a little\u00a0\u00a0 soapbox I’m going to go on don’t differ between\r\npatients with PTSD and controls so what does that tell us that’s the only way we can really\r\nTo figure out what’s going on in the brain in a live\u00a0\u00a0 subject look at PET scans what we have figured\r\nout or they’ve hypothesized is the fact that the\u00a0\u00a0 serotonin may not transmit as effectively as it may\r\nbe a really weak connection it’s connecting but\u00a0\u00a0 it’s you know it’s kind of like having a rabbit\r\nears you got to twist it to get the signal to\u00a0\u00a0 come in correctly all right this is another one\r\njust a concept I want you to think about all\u00a0\u00a0 they’re looking at in the research is the 5-hit\r\n1a receptor there are a ton of 5-ht serotonin\u00a0\u00a0 5-ht receptors and each one of these receptors is\r\ninvolved in some aspect of addiction anxiety mood\u00a0\u00a0 sexual behavior mood sleep so when we’re talking\r\nabout why SSRIs don’t work well SSRIs only bind\u00a0\u00a0 to certain receptors and if we’re not picking\r\nthe right receptor if it is the serotonin at\u00a0\u00a0 all then we’re probably barking up the wrong tree\r\nI educate my patients about this if they decide\u00a0\u00a0 they need to go on antidepressants just so they\r\ndon’t get frustrated as easily I mean it’s still\u00a0\u00a0 frustrating but so they don’t feel hopeless if\r\nthe first medication they start taking doesn’t\u00a0\u00a0 seem to work or makes it worse we talked about why\r\nthat might be because there are so many different\u00a0\u00a0 receptors for each one of the neurotransmitters\r\nthere is a really cool table if you’re into this\u00a0\u00a0 stuff it’s actually on Wikipedia and it talks\r\nalso about not only what these receptors do\u00a0\u00a0 but also what chemicals and medicines act on\r\nthese receptors and how Food for Thought\u00a0\u00a0 GABA has profound anxiolytic effects in part by\r\ninhibiting the cortisol norepinephrine\u00a0\u00a0 circuits so it turns down the excitatory circuits\r\npatients with PTSD exhibit decreased peripheral\u00a0\u00a0 benzodiazepine binding sites well we know that\r\nwhen the body secretes a neurotransmitter goes\u00a0\u00a0 to the other end and it binds like a lock-and-key\r\nif you will or it knocks on the door and the door\u00a0\u00a0 gets opened and it goes through however you want\r\nto think about it basically what they found is\u00a0\u00a0 in patients with PTSD the Kem GABA goes through\r\nand the GABA levels are okay but then it knocks\u00a0\u00a0 on the door to get let in or it tries to put its\r\nkey in the lock and there’s something wrong at\u00a0\u00a0 the binding sites or the binding sites you know\r\nsomebody’s super glued them shut and they’re just\u00a0\u00a0 not there which is why patients with PTSD tend\r\nto have a harder time de-escalating when their\u00a0\u00a0 anxiety and stuff gets up because the GABA is\r\nthere but it’s got no doors to go through no\u00a0\u00a0 locks to bind with however you want to whatever\r\nmetaphor you want to use this may indicate the\u00a0\u00a0 usefulness of emotion regulation and distress\r\ntolerance skills due to the potential emotional\u00a0\u00a0 dysregulation of these clients so remember we\r\ntalked about them having a more exaggerated\u00a0\u00a0 get-up-and-go response to a perceived threat and\r\nthey also have a harder time calming down which is\u00a0\u00a0 basically one of your primary tenants of emotional\r\ndysregulation so one thing clinicians can\u00a0\u00a0 do is help patients learn that okay their body\r\nresponds differently to stress than other people\u00a0\u00a0 at least for right now so it’s important for\r\nthem to understand what emotional dysregulation\u00a0\u00a0 is emotional regulation strategies as well as\r\ndistress tolerance skills to help them until they\u00a0\u00a0 can calm down to baseline because it sometimes\r\ntakes them longer than other people as clinicians\u00a0\u00a0 we also can help reduce excitotoxin in order to\r\nreduce stress improve stress tolerance and enable\u00a0\u00a0 the acquisition of new skills when the brain gets\r\nreally going when the cortisol is out there and\u00a0\u00a0 the glucocorticoids are in there it’s actually\r\ntoxic and starts causing neurons to disappear which we’re going to talk about in a second it’s\r\nkind of scary NMDA receptors have been implicated in synaptic plasticity.\r\n\r\n<img decoding=\"async\" src=\"https:\/\/images.pexels.com\/photos\/6624299\/pexels-photo-6624299.jpeg?auto=compress&amp;cs=tinysrgb&amp;h=650&amp;w=940\" \/>\r\n\r\nWhich means the brain’s\r\nability to adjust and adapt as well as learning\u00a0\u00a0 and memory so these are good receptors I like\r\nthem glutamate binds with these receptors and high\u00a0\u00a0 levels of glutamate are secreted during high\r\nlevels of stress glutamate remember is what\u00a0\u00a0 GABA is made from but high levels of glutamate\r\nit’s an excitatory neural net in the brain and\u00a0\u00a0 overexposure of neurons to this glutamate can be\r\nexcited toxic and may contribute to the loss of\u00a0\u00a0 neurons in the hippocampus of patients with PTSD\r\nso we’re actually seeing brain volume decrease as\u00a0\u00a0 a result of exposure to certain chemicals elevated\r\ngluten core glucocorticoid and yeah glucocorticoids\u00a0\u00a0 increases the sensitivity of these receptors so\r\nyou’ve got a bunch of glutamate being dumped and\u00a0\u00a0 you’ve got a bunch of glucocorticoid you’ve got\r\ncortisol in there making these receptors more\u00a0\u00a0 sensitive so it’s got they’re more sensitive and\r\nthey’ve got more coming in which makes it a whole\u00a0\u00a0 lot easier to become toxic and start causing\r\nneuronal degradation what does that mean why do\u00a0\u00a0 we care it may take clients with PTSD more time to\r\nmaster new skills because of emotional reactivity\u00a0\u00a0 but also because some of their synaptic plasticity\r\nmay be damaged so it may take them a little bit\u00a0\u00a0 longer to actually acquire and integrate these\r\nnew skills it’s not saying they’re stupid they\u00a0\u00a0 can remember it just fine however when they’re\r\nan emotionally charged state and helping their\u00a0\u00a0 brain learn that okay this isn’t a threat that’s one\r\nof those sort of subconscious things that has to\u00a0\u00a0 happen that can take longer if the brain becomes\r\nexcited toxic during stress inhibited learning\u00a0\u00a0 and memory then it becomes excited toxic during\r\nstress which inhibits learning and memory so it’s\u00a0\u00a0 under stress things are excited toxic neurons\r\nare starting to disappear so I’m wondering and\u00a0\u00a0 I’m just hypothesizing here I don’t know the\r\nanswers obviously or I wouldn’t be practicing\u00a0\u00a0 it but what happens during the exposure therapies\r\nbecause that’s exactly what we’re doing is we are\u00a0\u00a0 flooding the brain with all of these chemicals\r\nand creating basically an excitotoxin now they\u00a0\u00a0 found some evidence that exposure therapies can\r\nbe helpful according to the DOJ website but or\u00a0\u00a0 not the DOJ I can’t even think of it right\r\nnow the VA website but you know I’m wondering\u00a0\u00a0 long-term what the impact is endogenous opioids\r\nnatural painkillers act upon the same receptors\u00a0\u00a0 activated by exogenous opioids like morphine and\r\nheroin exerts an inhibitory influence on the\u00a0\u00a0 HPA axis well we know that people take opiates\r\nand it has depressant effects on them it slows\u00a0\u00a0 them down and calms them down alterations in our\r\nnatural opioids may be involved in certain PTSD\u00a0\u00a0 symptoms such as numbing stress-induced analgesia\r\nand dissociation again think of any clients you’ve\u00a0\u00a0 had who have been abused or even taken and not like\r\nthe side effects of opiates are what opiates do to\u00a0\u00a0 some people make them feel more relaxed stress\r\ninduced and analgesia they don’t have as much\u00a0\u00a0 physical pain sometimes they just it’s there\r\nI don’t care pill another interesting factor\u00a0\u00a0 is now truck zone which is used to oppose opiate\r\nappears to be effective in treating symptoms of\u00a0\u00a0 dissociation flashbacks in traumatized persons so\r\nbasically, they’re saying if we undo the endogenous\u00a0\u00a0 opioids we can treat these symptoms it highlights\r\nthe risk of opiate abuse for persons with PTSD\u00a0\u00a0 though because if endogenous opioids produce\r\nsome of these numbing symptoms and dissociative\u00a0\u00a0 symptoms so they can get away from the pain and\r\nthe flashbacks then if they add to that you know\u00a0\u00a0 oral opioids it could prove to be a very tempting\r\ncocktail we do want to as clinicians figure out\u00a0\u00a0 how we can assist them with their physical and\r\nemotional distress tolerance so they don’t feel\u00a0\u00a0 the need to numb and escape and you know I\r\ncan’t imagine what some people have seen have\u00a0\u00a0 gone through and I’m not trying to take that away\r\nfrom them, I’m trying to help them figure out how\u00a0\u00a0 they can stay present and learn to integrate it\r\nchanges question marks in brain structure and one\u00a0\u00a0 of the questions that’s come up in the research is\r\nbecause there aren’t any longitudinal studies that\u00a0\u00a0 looked at it was the hippocampal volume as low to\r\nbegin with which created a predisposition for PTSD\u00a0\u00a0 or did PTSD create the smaller hippocampal volume\r\ninteresting hippocampus is implicated in the\u00a0\u00a0 control of stress responses memory and contextual\r\naspects of fear conditioning so it helps you to find these triggers in the environment that\r\nhelp you become aware with your senses about when\u00a0\u00a0 there might be a trauma prolonged exposure\r\nto stress and high levels of glucocorticoids damage the hippocampus we’ve talked about that\r\nhippocampal volume reduction in PTSD may reflect\u00a0\u00a0 the accumulated toxic effects of repeated exposure\r\nto increased cortisol levels what I called earlier\u00a0\u00a0 the flatter the Furious having you know your body\r\nholding on to cortisol for this extreme stress\u00a0\u00a0 and then when it perceives stress it’s either\r\nnothing or it’s extreme there are no kind sort\u00a0\u00a0 of mild stressors out there that decrease hippocampal\r\nvolumes might also be a pre-existing vulnerability\u00a0\u00a0 factor for developing PTSD the amygdala yet\r\nanother brain structure is the Olympic structure\u00a0\u00a0 involved in the emotional process and it’s\r\ncritical for the acquisition of fear responses\u00a0\u00a0 functional imaging of studies has revealed hyper\r\nresponsiveness and PTSD during the presentation of\u00a0\u00a0 stressful script cues or trauma reminders but\r\nalso patients show increased amygdala responses\u00a0\u00a0 to general emotional stimuli that are not trauma\r\nassociated such as emotional faces so they show an\u00a0\u00a0 increased responsivity to things they see on the\r\nTV that aren’t trauma-related to people crying\u00a0\u00a0 to people showing anger’s going to have a\r\nstronger emotional amygdala response than people\u00a0\u00a0 without PTSD so clients with PTSD may be more\r\nemotionally responsive across the board leading\u00a0\u00a0 to more emotional dysregulation again an area that\r\nwe can help provide them with tools for early adverse\u00a0\u00a0 experiences including prenatal stress and stress\r\nthroughout childhood has profound and long-lasting\u00a0\u00a0 effects on the development of neurobiological\r\nsymptoms the brain is developing and if is exposed\u00a0\u00a0 to a lot of stress and some of these excited toxic\r\nsituations how does that differ in the amount of\u00a0\u00a0 damage caused versus a brain that’s already kind\r\nof pretty much-formed programming may change for\u00a0\u00a0 subsequent stress reactivity and vulnerability\r\nto develop PTSD so if these happen during\u00a0\u00a0 childhood or at any time the brain can\r\nbasically reprogram and go that it’s a really\u00a0\u00a0 dangerous place out there so I need to hold\r\non to cortisol and I need to hold on to these\u00a0\u00a0 stress hormones because every time I turn around\r\nit seems like there’s a threat so I am going to be hyper-vigilant and respond in an exaggerated way\r\nto protect you from the outside world adult women\u00a0\u00a0 with childhood trauma histories have been shown\r\nto exhibit sensitization of both neuroendocrine and Audino stress responses so basically they’re\r\nshowing hypo cortisol ISM a variety of changes\u00a0\u00a0 take place in the brains and nervous systems of\r\npeople with PTSD and we talked about a lot of\u00a0\u00a0 those the key take-home point is stress can\r\nactually get toxic in the brain and cause physical\u00a0\u00a0 changes not just thought changes in the brain\r\npreexisting issues causing hypo cortisol ism where\u00a0\u00a0 the brain has already downregulated whether it’s\r\ndue to chronic illness or chronic psychological\u00a0\u00a0 stress increases the likelihood of the development\r\nof PTSD this points to the importance of\u00a0\u00a0 prevention and early intervention of adverse\r\nchildhood experiences we really need to get\u00a0\u00a0 in there and help these people develop distress\r\ntolerance skills understanding of vulnerabilities\u00a0\u00a0 so they’re not going from flat to furious all\r\nthe time and so that they can understand why\u00a0\u00a0 their body kind of responds and why they respond\r\ndifferently than others and you know as we talk\u00a0\u00a0 about this and of course I’m regularly bringing up\r\nDBT buzzwords if you will think about your clients\u00a0\u00a0 if you’ve worked with any who’ve had borderline\r\npersonality disorder what kind of history do they\u00a0\u00a0 have did they have just a great childhood no we\r\nknow that people with BPD generally had pretty\u00a0\u00a0 chaotic childhoods so this research is also\r\nkind of underscoring why they may react and act\u00a0\u00a0 the way they do that flat to furious people with\r\nhypo cortical ism may or may not have PTSD so we\u00a0\u00a0 don’t want to say well you’re fine if you don’t\r\nhave PTSD symptoms we do know that every trauma\u00a0\u00a0 potentially can cause the body to down-regulate\r\nand I kind of look at it as conserving a little\u00a0\u00a0 bit more of the energy that it needs each time so\r\ninstead of conserving 60% now it’s conserving 65\u00a0\u00a0 and 66 each time it encounters a stressor in order\r\nto prepare for potential ongoing threats in the\u00a0\u00a0 environment hypercortisolism sets the stage for\r\nthe flattened the furious leading to toxic levels\u00a0\u00a0 of glutamate upon exposure to stressors which\r\ncan cause the theorized reduction in hippocampal\u00a0\u00a0 volume and persistent negative brain changes now I\r\nalways say the brain can you know rebalance itself\u00a0\u00a0 and all well that’s part of the plasticity that is\r\nthe really cool thing about our brain however as\u00a0\u00a0 far as regenerating those neurons I haven’t found\r\nany evidence in the research that we found a way\u00a0\u00a0 to help people regenerate once we’ve already those\r\nneurons are gone they’ve been killed off the brain\u00a0\u00a0 has to find a workaround so it does take time\r\nbut I do believe people can minimize some of the\u00a0\u00a0 impact of the trauma they may have experienced\r\npeople with PTSD are more reactive to emotional\u00a0\u00a0 stimuli even stimuli unrelated to trauma again\r\nthink about some of your clients especially\u00a0\u00a0 if you work in a residential situation where you’re\r\naround on 24\/7, you know for 30 or 60 days, and\u00a0\u00a0 you may see some clients that seem to get upset\r\nover everything and you’re like ah such a drama\u00a0\u00a0 queen or such a drama king and to yourself not\r\nto anybody else but when you think about it from\u00a0\u00a0 this perspective it gives you a different\r\nperspective and you might say oh maybe their body\u00a0\u00a0 responds differently they’ve got more emotional\r\ndysregulation because of prior trauma they’re not\u00a0\u00a0 trying to overreact this is their body’s response\r\nbecause it’s perceived threat so many times it gives me a different approach to working\r\nwith that client hypercortisolism results when the\u00a0\u00a0 brain perceives that continued effort is futile\r\nfeelings of fatigue set in akin to reduced stress\u00a0\u00a0 tolerance so think about you know when you’ve had\r\na really long stressful period you know weeks or\u00a0\u00a0 months maybe you’re dealing with an ailing family\r\nmember or something it’s just a lot of stress and\u00a0\u00a0 you start getting really tired and when you’re\r\nreally tired and you’re worn down and somebody\u00a0\u00a0 gives you one more thing it’s that one more thing\r\nnormally wouldn’t bother you but right now you\u00a0\u00a0 just can’t take it so we can see how there’s a\r\nreduced stress tolerance when somebody’s already\u00a0\u00a0 at this stage reducing fatigue in our clients can\r\nbe accomplished in part with psychological factors\u00a0\u00a0 including motivation or knowledge of other people\r\nwho are dealing with similar things support groups\u00a0\u00a0 feedback about their and making sure they have\r\nfrequent successes not once a week but I want to\u00a0\u00a0 have them keep a journal every day of something\r\ngood that happened or something positive that\u00a0\u00a0 may indicate they’re moving forward in their\r\ntreatment goals and knowledge of an endpoint.\r\n\r\n<a href=\"https:\/\/shopzpresso-computer-software-store.business.site\/\" target=\"_blank\" rel=\"noopener\"><img decoding=\"async\" src=\"https:\/\/i.ibb.co\/VDycpgj\/OIP-6.jpg\" alt=\"OIP-6\" border=\"0\" \/><\/a>\r\n\r\nWhere are we going with this when is the treatment\r\ngoing to end I don’t want most clients don’t\u00a0\u00a0 want to be with us forever no matter how lovable\r\nwe are do you want to feel better and be done\u00a0\u00a0 with us so having to help them see that there\r\nis an endpoint we’re going to accomplish this\u00a0\u00a0 goal this month and then we can reassess 46% of\r\npeople in the US are exposed to adverse childhood\u00a0\u00a0 experiences so like I said this is a huge area\r\nfor early intervention where we can prevent people\u00a0\u00a0 from developing PTSD later in life how awesome\r\nwould that be instruction and skills to handle\u00a0\u00a0 emotional dysregulation including mindfulness\r\nvulnerability prevention and awareness emotion\u00a0\u00a0 regulation distress tolerance and problem-solving\r\ncould be wonderful additions to health curriculums\u00a0\u00a0 anything any skills groups you do with children\r\nor adolescents or even adults I mean just because\u00a0\u00a0 they’re adults doesn’t mean that they’re safe\r\nfrom PTSD or that they’ve crossed any threshold\u00a0\u00a0 where they’re too old to learn we’re never too\r\nold to learn of those exposed to trauma education\u00a0\u00a0 about and normalization of their heightened\r\nemotional reactivity and susceptibility to PTSD\u00a0\u00a0 in the future may be helpful in increasing their\r\nmotivation for their current treatment protocol\u00a0\u00a0 whatever it is but it also just normalizes things\r\nso they don’t feel like they’re overreacting or\u00a0\u00a0 they don’t feel guilty for being so tired\r\nor whatever they’re experiencing right now are there any questions I know I went through\r\na lot of really complicated stuff but I thought\u00a0\u00a0 it was really interesting not only the way\r\nour brain reacts in order to protect us\u00a0\u00a0 but how cross-cutting a lot of this stuff\r\nwas it not just PTSD we’re talking about\u00a0\u00a0 necessarily but a lot of this information\r\napplies to our clients with chronic fatigue burnout and chronic stress and we can\r\nsee that those people also are at risk at\u00a0\u00a0 higher risk of PTSD should they be exposed\r\nto trauma and none of us is immune I mean\u00a0\u00a0 there are tornadoes there are hurricanes\r\nthere are you know things that happen that\u00a0\u00a0 really stink so the more we can help clients\r\nbe aware of things develop skills and tools to prevent as much harm as possible I\r\nthink the more effective we are as clinicians depending on the client and I can do some\r\nmore research on the VA website because\u00a0\u00a0 they’re really into medications for PTSD I\r\nknow ketamine which is a horse tranquilizer\u00a0\u00a0 has been shown to be effective in people\r\nwith PTSD and there have been some others\u00a0\u00a0 that have kind of given me pause ketamine\r\nis a hypnotic you know most of the drugs\u00a0\u00a0 they’re trying out right now are really in my\r\nopinion they’re powerful drugs but a\u00a0\u00a0 lot of them all of them that I know of have\r\npretty high addictive potentials too so they\u00a0\u00a0 make me nervous but you know when you’re\r\nweighing the when you’re going from a harm\u00a0\u00a0 reduction model that’s not necessarily not\r\nnecessarily 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\r\nstuff that some of my clients and some people\u00a0\u00a0 have seen done experienced I couldn’t even\r\nimagine and you know sometimes for them to\u00a0\u00a0 actually survive we may need to look at some\r\nof these more intense more powerful drugs PTSD and veteran trauma is not are not my focus\r\nright now and yes marijuana is being experimented\u00a0\u00a0 with or looked at used whatever however you want\r\nto look at it for PTSD treatment with veterans\u00a0\u00a0 there’s pretty much not a drug out there they\r\nhaven’t tried to throw at it to see well what\u00a0\u00a0 will this do I believe they were even using\r\nLSD experimentally for a little while too you the VA I mean if you’re interested in this\r\ntopic let me see if I could pull that\u00a0\u00a0 down into here, we go to the National Center\r\nfor PTSD US Department of Veterans Affairs\u00a0\u00a0 has a lot of information if you go for\r\nprofessionals, it has a ton more information\u00a0\u00a0 if you can get on get some of your SI CEUs on\r\ndemand they do have some free CEUs for PTSD\u00a0\u00a0 here I’ve never taken any of them but what\r\nI’ve looked at when I’ve looked at like the\u00a0\u00a0 PowerPoints the presentations and stuff I’m\r\nsure they’re good so if you’re you do focus\u00a0\u00a0 a lot on PTSD and you can get on-demand CEUs\r\nthen this might be a place to get some good free\u00a0\u00a0 ones aside from DBT are there any other\r\nevidence-based practices for therapy that\u00a0\u00a0 you’ve seen work best in combination with the\r\nmedications cognitive processing therapy when\u00a0\u00a0 you’re working specifically with veterans\r\nand there is a free course on that too and this one I have gone through\r\nand it’s really awesome CPT dot must seed and here I’ll just put it\r\ninto that education and this is a free course oops\u00a0\u00a0 and here’s the other one ah golly everyone and\r\nembryo does have a lot of research effectiveness\u00a0\u00a0 with people with PTSD too so yes I would\r\ndefinitely encourage people to explore\u00a0\u00a0 all options alrighty everybody I really\r\nappreciate you coming today and sticking\u00a0\u00a0 with me through this topic and I will see\r\nyou on Thursday if you have any questions\u00a0\u00a0 please feel free to email me or you can\r\nalways also send it to support that all\u00a0\u00a0 CEUs com either way I get it and otherwise I\r\nwill see you on Tuesday thanks a bunch if you enjoy this podcast please like and\r\nsubscribe either in your podcast player or\u00a0\u00a0 on YouTube you can attend and participate\r\nin our live webinars with Doctor Snipes by\u00a0\u00a0 subscribing at all CEUs comm slash\r\ncounselor toolbox this episode has\u00a0\u00a0 been brought to you in part by all CEUs\r\ncom providing 24\/7 multimedia continuing\u00a0\u00a0 education and pre-certification training to\r\ncounselors therapists and nurses since 2006 used coupon code consular toolbox to get\r\na 20% discount on your order this month\r\n\r\n<a href=\"https:\/\/www.youtube.com\/watch?v=qLxgQdxedL4\" target=\"_blank\" rel=\"noopener\">As found on YouTube<\/a>\r\n\r\n15 Modules Of Intimate Video Training With <a href=\"http:\/\/flywait.awakenedm.hop.clickbank.net\/\">Dr. Joe Vitale<\/a> – You’re getting simple and proven steps to unlock the Awakened Millionaire Mindset: giving you a path to MORE money, \u2026\r\n\r\n<a href=\"http:\/\/flywait.awakenedm.hop.clickbank.net\/\" target=\"_blank\" rel=\"noopener\"><img loading=\"lazy\" decoding=\"async\" class=\"alignnone\" src=\"https:\/\/i.ibb.co\/4gfX2Qc\/download-2k.jpg\" alt=\"download-2k\" width=\"283\" height=\"180\" border=\"0\" \/><\/a>","protected":false},"excerpt":{"rendered":"<p>&nbsp; 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\u00a0\u00a0 on the HPA axis we’re going to define and explain the HPA axis which we’ve talked about &hellip; <a href=\"https:\/\/effectsofanxiety.net\/archives\/151683\" class=\"more-link\">Continue reading <span class=\"screen-reader-text\">Neurobiological Impact of Psychological Trauma on the HPA Axis<\/span><\/a><\/p>\n","protected":false},"author":3,"featured_media":151682,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"_jetpack_memberships_contains_paid_content":false,"footnotes":"","jetpack_publicize_message":"","jetpack_publicize_feature_enabled":true,"jetpack_social_post_already_shared":true,"jetpack_social_options":{"image_generator_settings":{"template":"highway","enabled":false},"version":2}},"categories":[1,6],"tags":[59800,60999,60990,39425,42324,60987,37897,42335,59801,37905,38531,60474,42336,60981,37901,61001,60985,42328,59884,59802,38533,42326,37893,37894,42329,37877,37876,60994,60472,35731,37883,37882,60997,42327,37907,42325,37926,37906,60989,60978],"class_list":["post-151683","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-anxiety","category-reducing-triggers","tag-aca-opd","tag-addiction-certification","tag-addiction-counselor-certification","tag-addictions-academy","tag-allceus","tag-aspirace","tag-cadc","tag-ccm-ceus","tag-ccmc","tag-ce4less","tag-cebynet","tag-counseling-ceus","tag-counselling-ceus","tag-counsellor-ceus","tag-counselor-education","tag-counselor-toolbox","tag-crc-ceus","tag-crcc","tag-ctrs-ceus","tag-dr-dawn-elise-snipes","tag-homestudy","tag-hpcsa","tag-ladc","tag-lcdc","tag-lcsw-ceus","tag-lmhc-ceus","tag-lpc-ceus","tag-lsw-ceus","tag-mcap","tag-mindful","tag-naadac-ceus","tag-nbcc-ceus","tag-ncac","tag-nctrc","tag-online-ceus","tag-podcast-ceus","tag-psychotherapy","tag-quantum-units","tag-relias","tag-rp-cpd"],"jetpack_publicize_connections":[],"jetpack_sharing_enabled":true,"jetpack_featured_media_url":"https:\/\/effectsofanxiety.net\/wp-content\/uploads\/2023\/10\/htmlF_IMG_654121bb324eb.jpg","_links":{"self":[{"href":"https:\/\/effectsofanxiety.net\/wp-json\/wp\/v2\/posts\/151683"}],"collection":[{"href":"https:\/\/effectsofanxiety.net\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/effectsofanxiety.net\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/effectsofanxiety.net\/wp-json\/wp\/v2\/users\/3"}],"replies":[{"embeddable":true,"href":"https:\/\/effectsofanxiety.net\/wp-json\/wp\/v2\/comments?post=151683"}],"version-history":[{"count":3,"href":"https:\/\/effectsofanxiety.net\/wp-json\/wp\/v2\/posts\/151683\/revisions"}],"predecessor-version":[{"id":151694,"href":"https:\/\/effectsofanxiety.net\/wp-json\/wp\/v2\/posts\/151683\/revisions\/151694"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/effectsofanxiety.net\/wp-json\/wp\/v2\/media\/151682"}],"wp:attachment":[{"href":"https:\/\/effectsofanxiety.net\/wp-json\/wp\/v2\/media?parent=151683"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/effectsofanxiety.net\/wp-json\/wp\/v2\/categories?post=151683"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/effectsofanxiety.net\/wp-json\/wp\/v2\/tags?post=151683"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}