Trauma: the Inevitable Condition

The word 'trauma' originates from the Greek 'wound', and it is commonly defined as being of psychological or physical nature. Trauma occurs as a result of an event, and it has deep roots in various levels of the human mind and behaviour. In a world with excessive reasons to experience a traumatic event, understanding this condition may be the key approach to combat its symptoms.

The Causality of Trauma

Psychological trauma is a broad concept, and its origins are co-related with two well-know mechanisms of the human mind: stress and memory. In order to fully understand this relationship, we'll briefly explain these two processes:

Stress

Albeit commonly associated with negativeness, stress is an evolutionary advantage. The stress triggering mechanism allows most people to react to dangerous situations prior to consciously detecting it. The level of a stress response generally dictates the intensity of psychological trauma in an individual.

Primarily, the Hypothalamus (region of the brain responsible for controlling the Autonomic Nervous System) identifies a stressor (an event which triggers stress) and automatically prepares the body to react to that event. This is done through sending signals to both the ANS and the Pituitary Gland (limbic system) - which in turn, activate a 'response mechanism' by stimulating body organs to change their regular activity.

This response mechanism is identified by: increase of blood pressure, heart rate, sugar levels and re-direction of blood flow to major organs. The body also improves respiration by dilating air passages, stopping digestion in order to direct focus (energy) to other parts of the body and increasingly producing adrenaline (epinephrine).

All these processes transpire in a few seconds - and they were particularly 'designed' to increase survival chances either by challenging a situation, or by escaping from it.

Memory

Memory and trauma are interrelated processes - without the memory of a traumatic event, psychological trauma is inexistent. In addition, memory also plays an active role in the incidence and intensity of stressful responses.

Once stress is triggered by an event (a stressor), the prefrontal cortex (region of the brain responsible for decision-making) promptly receives a message from the limbic system. This process instigates the assessment of the situation by higher functions of the mind.

If the situation does not constitute danger, the stressing mechanism will gradually shut down and the body will return to normal functioning.

If the situation reflects danger, the individual will need to decide what to do - and in that process - the amygdala (a part of the limbic system which plays a key role in human emotions, particularly fear) directs the hippocampus (a central region of human memory) to imprint that information differently from other events. This long-term storage of the memory is explained by its emotionally attached significance.

Such mechanism is another 'smart' human feature. Next time the same stressor (or similar) is identified, that memory will be instantly retrieved in order to assist in the individual's reaction. At a subconscious level, there will be an overstressed response to the event. At a conscious level, comparison and previous experience will induce better decision making.

The Effects of Trauma

Trauma is inevitable in our lives. From the birth of a child, to all stages of its development - traumatic events are common and also part of the 'human experience'. However, the level of trauma caused by an event dictates the short and long-term effects of that occurrence.

For instance, trauma can be related to several mental illnesses. Conditions such as Schizophrenia, Depression, and Bipolar Disease can be triggered by traumatic events. One condition in particular, is directly related to trauma: Post Traumatic Stress Disorder (PTSD).

Post Traumatic Stress Disorder

PTSD occurs when an individual develops a set of behaviours and reactions based on a traumatic event. The traumatic experience interferes with normal functioning, causing the affected person to present avoidance behaviour (avoid activities, people, context, or other things that can associate with the trauma).

This condition can occur at any age and traumatic stress can be cumulative over a lifetime. Responses to trauma include feelings of intense fear, helplessness, and/or horror. This condition has roots in the relationship between stress, trauma and memory.

It is perceived that PTSDs are originated from a 'defect' in the brain memory processing functions. As previously described, emotionally attached events are stored differently (at a 'deeper' level). These memories include stressful and traumatic events, particularly those which resulted in some kind of harm and emotional distress to the person.

Upon the identification of the same stressor (or similar) that caused a reaction for the previous situation, the body would instantly trigger an overstressed response. However, in most cases, the new event will not constitute a threat. For instance, a noise could be a stressor from a situation in which a person ended up being assaulted. The same noise, or something similar, could occur in other situations which are harmless. Unless that stressor is reinforced (results in danger overtime), your brain will adapt to the stimulus and gradually reduce the stressful response. This process is called 'extinction' (Pavlov's theory).

If extinction fails to take place, the individual will continue to react (stressfully) to the original stimulus, or similar ones. This is the case for PTSD sufferers. Because the human body is not prepared to maintain stressful status continually, side effects will appear. These effects are both physiological (Coronary Heart Disease, ageing acceleration, etc) and psychological (fear, avoidance, etc).

This explains the occurrence of PTSD in war veterans (individuals who were exposed to stress over a long period of time) and accident survivors (individuals who were exposed to a highly stressful and traumatic situation).

Combating Trauma: Current Treatments

The effects of trauma may vary greatly among people. The extent, frequency and intensity of each event are presented according to each person's mind frame and previous experiences - and because traumatic events are cumulative over life, it can be quite difficult to provide a treatment that comprises all problems derived from separate traumas.

Most people adapt to trauma in their lives, and through the extinction process, do not experience much psychological harm derived from past events. However, for patients with PTSD, and other stress-triggered conditions, the situation requires further attention.

Currently, most treatments for PTSD are based in psychotherapy, introspection and conditioning. These treatments attempt to identify the major traumatic events or associations which are predominant in the individual's life:

Cognitive Behaviour Therapy

CBT is a form of psychotherapy which works in the perspective of the individual towards a memory and traumatic event. By working the way the person perceives that event, therapists believe that the trauma can be coped with. This form of treatment is recommended by the World Health Organisation and it is widely used to combat PTSD symptoms.

Debriefing

A single section-based treatment which occurs shortly after the traumatic event. The debriefing process evolves on the 'traumatized' individual's verbal expression of the event. It is suggested that by 'letting out' those memories and feelings, the person is more unlikely develop suppressed emotions, which reduces the effects of trauma. Debriefing is widely used for professionals that deal with traumatic events on a daily basis (e.g. paramedics).

Eye Movement Desensitisation and Reprocessing

This treatment is based in a psychophysiological approach. According to the theory, the overload of emotions derived from traumatic events interferes with the individual's information processing episode. That interference, in a physiological level, produces 'flawed' pathways of memory retrieval, which in turn, results in the non-logical perception of the event. For instance, a victim of rape, albeit aware that the fault was of the perpetrator, continually invokes self-blame for the incident. The process of desensitisation and reprocessing would serve to reprogram those pathways, resulting in the extinction or partial extinction of negative symptoms.

Combating Trauma: A New Approach

The issue of trauma has generated several different treatment approaches. While some researchers focus in the psychological processes, such as psychotherapy and conditioning, others are studying the possibility of tackling the problem at a physiological level. This division of focus has caused much discussion in this field, and each individual's pool of experience complicates the process of targeting the causes of a trauma, and particularly to define the extent of one single event.

A new proposition attempts to provide the solution at a molecular level. Increased research in the field of memory, particularly the formation and storage processes, is instigating scientists to develop this new approach. This time, instead of taking a passive stance towards the development of a trauma, researchers are intending to eliminate the most prominent element of the trauma: the event itself.

The idea is to administer beta-blockers to act in the molecular level of memory formation. Beta-Blockers are commonly used drugs to control blood pressure (hypertension). They block the action of epinephrine (adrenaline) and norepinephrine, which slows the heart rate. This effect seems to dissociate stress with traumatic memories by 'reducing' that memory to a regular response level.

This 'reduction' would result in a varied pathway to access a particular memory, invoking altered production of substances such as epinephrine and, in the end, a memory which does not cause overstressed responses in an individual suffering from PTSD.

However, this research, along with other similar methods of combating PTSD at a molecular level, is still in its infant stages. It has been suggested that this procedure could affect other memories or memory retrieving processes and scientists have not been able to deny that possibility.

Much discussion is expected for the next few months. According to Richard Glen Boire from the Center for Cognitive Liberty and Ethics (New Scientist - 03/12/2005), these kind of drugs should be available within 5 to 10 years. Further research in the field of memory and general neuropsychiatry should also play a major role in refining and expanding current evaluation of beta-blockers and their effects in the human mind. The "Human Connectome" project - a worldwide project which aims to create a 4-dimensional map of neuronal connections in our brain - is an example of those.

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