Post-Traumatic Stress Disorder (PTSD) can occur after experiencing or witnessing a traumatic event or events, or through early neglect which can lead to attachment trauma. Typical traumatic experiences are childhood sexual abuse, childhood neglect, emotional and physical abuse, domestic violence, rape, military combat, accidents, acts of terrorism, illness and complex grief.
Symptoms of Post-Traumatic Stress Disorder
Some symptoms of PTSD are:
- Emotional instability
- Flashbacks or reliving the trauma
- Avoidance of anything that reminds the person of the trauma
- Anxiety and sleep disturbance
- Mood swings between hyperarousal and hypervigilance.
Alcohol and drug use may be used to cope with the psychological symptoms of trauma. PTSD may be a cause of relapse if left untreated.
Trauma Therapy in Group Sessions
All patients at Castle Craig are screened for Post Traumatic Stress Disorder using the PTSD questionnaire and a full psychiatric assessment by our Consultant Psychiatrist.
Trauma Therapy at Castle Craig Hospital is undertaken by experienced, qualified trauma therapists. There is a trauma group in which participants learn ways of dealing with the psychological and physical effects of the trauma. Some patients may require individual trauma therapy. The therapies of choice are Eye Movement Desensitisation and Reprocessing (EMDR) and Cognitive Behavioural Therapy (CBT).
Both therapies are recognised as the gold standard by the National Institute of Clinical Excellence. As trauma memories are often held in the body, Sensorimotor Psychotherapy may also be used. Mindfulness is also practiced as this can teach people ways to regulate their arousal levels. Complementary therapies such as acupuncture and aromatherapy can be used to help the person relax.
The trauma treatment is holistic and helps the person re-process the trauma so that memories which are being re-experienced are processed into narrative, explicit memory rather than implicit and somatic memory. This means that these memories no longer intrude on daily life nor interfere with addiction treatment.
Using EMDR in PTSD Therapy (Transcription)
Linda Hill, Specialist in Trauma Therapy:
EMDR is eye movement desensitisation and reprocessing. It was discovered kind of accidentally by a psychologist in New York who was working primarily with Vietnam war veterans…
What is her name?
Her name is Francine Shapiro. She was working with Vietnam war veterans and with women who have been raped. She was working with people with PTSD, with people with flashbacks, nightmares, classic symptoms of PTSD. And around that time, she was doing research and she also had a diagnosis herself of cancer, I think. The story goes… she was walking through Central Park thinking about her own personal trauma and noticed that her eyes were moving from side-to-side, kind of spontaneously, I think, and that started to reduce the level of distress she was feeling. So she did research on using eye movement with the population she was doing research with – the patient population. And so EMDR developed.
There are various explanations for why it works, none of which I think people are satisfied with at the moment. Initially, it was thought that it linked to the rapid eye movement you get during dreaming sleep. Because when you do eye movement in therapy, its rapid, short bursts. And it was thought that the rapid eye movement you get during dreaming sleep links to processing memory and that you were stimulating that artificially in the therapy session to begin to move people forward. Other explanations would be that it is connecting the right and left half of the brain, as you do some kind of bilateral stimulation, because you can also use headphones with alternate taps, just in each ear, or tap the backs of people’s hands to create a left-right connection across the halves of the brain. It also, if you do it with a brain scan, it shows that you begin to change the activity in the brain, and there is increased activity in the frontal lobes. If you look at a brain scan of someone that is extremely traumatised, there is very little brain activity and most of it is in very specific areas of the brain and in the limbic system and the brain stem. And the frontal lobes have almost completely shut down.
So what’s the kind of physical reaction to…?
Well, it’s functional. If you think about the brain, the brain stem comes up the back of your neck into a ball, and that’s the reptilian brain at the back of your head. It’s the brain any reptile has. It’s designed to keep you alive: to keep your heart beating, to keep your lungs flowing, keep vital functions going. When you’re in danger, it will flood adrenaline through your body so that you can fight or run away. Next to that or around that, you’ve got the limbic system, which is about emotional memory, emotional stuff, and around that, the big frontal lobes.
Now here, between the limbic system and the reptilian brain, you’ve got the amygdala, which detects danger. It’s not sophisticated – it recognises patterns. So the lizard walking around, sees a long shape… it doesn’t go and say, “Is that a stick or a snake?” It goes… fast. It might run away from a lot of sticks, but it won’t get eaten by a snake. So it’s patterns that are recognised. So a woman that is raped by a man wearing a red shirt may catch the colour red out of the corner of her eye and her body will start to flood adrenaline. Because this part of the brain is saying, “Red means danger” after that event. And she may not even be aware of it.
You’ve also got here the hippocampus, which lays down memory. So the hippocampus will tell you roughly how long events lasted, how far back in time they are. That switch is off during a traumatic event. If you’re in a life-threatening situation, because it’s too slow. So trauma memories are fragmented. An image here, a gut-feeling there, a sound… and you don’t get a sense of time. People often don’t know how long a trauma lasted. So you say, after a car accident, “It seemed like time had slowed down.” I thought that lasted for an hour, when in fact it was maybe 30 seconds. So this part of the brain reacts in… I think it’s seven-thousandths of a second. If this part of the brain this there’s danger, it will flood adrenaline though. The front of your brain takes half-a-second to react. So it just switches off in trauma, almost totally. And you react from here.
You don’t want to stop and think, if the boss is coming towards you, “Shall I go this way or that way?” You want to go, the way the lizard goes – fast. So it lays down memory differently and it shuts down the rational part of the brain.
Now, if you’re then left with the patterns here, you keep reacting to them. The smell of lavender, the sound of a guy whistling because your step-father whistled as he came up the stairs and you knew what was going to happen next. And you often don’t even realise that those patterns are triggering. So you start: the panic comes, the hyper-arousal, the heart-beating. And you think you’re going mad. Because you always even know what’s triggered. So why would you not have a drink to calm that down? You know? If you find that alcohol calms that down, great! If you find a joint calms it down, you go for that. Because you don’t even understand why your body is reacting that way. And that then becomes something you depend on, so you get into that cycle.
So when you come off of rehab, all those trauma things surface again. If they’re not dealt with…. Rational therapy won’t deal with it. The rational part of the brain is the front, language develops on the left, rational thinking is mostly on the left side of the brain. The right side of the brain controls this reaction. And if you’ve been neglected as a baby, the right side of the brain hasn’t properly developed. The amygdala, you can calm it from the front, from the right.
A baby learns to regulate its emotions if its mother is saying, “Oh, there there there… you’re upset. Oh, you’re crass because you haven’t been fed.” It starts to learn what emotions are and the mother, with her soothing, helps it to regulate, which develops the right side of the cortex. There’s more detailed explanations in Neurobiology, but basically… it develops on the right. If a baby doesn’t get that early on, to regulate its anger and distress, from the mother, that part doesn’t develop.
Talking therapy develops insight – that’s on the left. It doesn’t connect here. So you can begin to understand why your body is going into panic, but you can’t stop it with talking therapy only. What you can learn to do, and this is why mindfulness is developing, is develop the front of, the central part… And mindfulness and awareness of what’s going on in your body will develop. This part of the brain can develop throughout your life. If you can develop that, you can learn to come.
EMDR makes connections. It makes connections here and here, and begins to develop new neural pathways so that you can overcome, to some extent, the damage here. If you don’t have early damage here, then the EMDR can really make the connections front to back, left to right, and calm things down. But within EMDR, you’re focusing on the thought, which is in the front of the brain, the emotion, which is in the middle here, and the body sensation. Because if you think, the reptilian brain, brainstem [and] spinal cord links to every organ. So your gut memory in here, is as important, if not more important, than your thoughts here. EMDR works with all three levels of the brain and helps you to being to connect, to increase activity in the brain, and to file the memories here into long-term memory, where you can move forward and begin to say, “That happened, but it’s over. I have survived and I can learn to be different. I was powerless then; I don’t have to be powerless now.”
The brain is remarkable – it can recover from a lot. Although the analogy I use often is… if people come to me with unresolved trauma issues, because they’re still having nightmares, or flashbacks, or panic attacks, or they’re still having bouts of depression that just don’t go away with antidepressants or with anything else. What we do is like cleaning out a wound that’s infected and cleaning out is gonna hurt. And then, if you clean it out, it’s going to heal over but it’s always gonna leave a scar. And scars you need to be careful with. You need not to pick at them, you need not to do things that are likely to rip them open again.