PTSD, once a word that was only associated with combat, is found to be increasingly more commonplace. Is this because we live in a more traumatising world today? I believe there has always been “trauma” in lives, but we are only now becoming more aware of it, addressing it, and looking at ways to heal what we cannot see.
We are the sum of our parts, our life experiences and it makes complete sense that our minds and our bodies hold and store memories, both good and bad. The ancient yogis spoke about samskaras, “impressions” or memories, which they say you are able to release “when you succeed in going within and realising the peace and joy of your own Self” (Sutras, I-16). The eight limbs of yoga take the body and mind through a process of peeling back the layers to our inner core, to the point that you become liberated and at one with the nature and universe around us. How we look to process and move through trauma today is not so dissimilar — we just use slightly different language.
In today’s world, PTSD (post traumatic stress disorder) is understood as experience(s) that biologically change an individual’s basic orientation to its environment:
- Difficulty distinguishing relevant from irrelevant stimuli;
- Problems with arousal modulation and attention;
- Impairment in the capacity to plan and execute actions relevant to the present;
- Difficulties peacefully negotiating interpersonal needs;
- Problems experiencing playfulness and pleasure.
In simple terms, the world of a traumatised individual becomes unsafe, their trust is broken. Imagine a world where you are seeing things as a threat when they are not a threat — this is possibly something you can relate to, now or in the past. We each one of us manage and are confronted by a certain degree of stress and trauma in our lives. As concerns stress, this can be a daily occurrence. Now, not all stress is bad. Eustress is positive stress. It “helps us stay motivated, work toward goals, and feel good about life.” Our bodies need a certain level of cortisol, one of the hormones released during times of stress. Cortisol supports our body during times of stress, reduces inflammation and helps us adapt to stress by sensitising our tissues towards noradrenalin and adrenaline. It also help us to fight or flee — which is a basic essential survival mechanism. Exposure to certain levels of stress and trauma can build resilience. However, when we are faced with a severely traumatic event or experience high levels of repeated stress, it is then that our bodies and minds start to dysfunction and our normal stress responses start misfiring.
There is increased recognition by some trauma researchers that there are two subtypes of PTSD, one characterized predominantly by hyperarousal and intrusions, and the other characterized by dissociative symptoms (a symptom of the freeze response, and an absence of hyperarousal). Historically the autonomic nervous system has been depicted as having two opposing branches, the sympathetic (SNS) and the parasympathetic (PNS). During a normal “flight-fight” response, the hypothalamus activates a chain of hormonal responses called the “H-P-A axis” which ultimately results in the secretion of cortisol by the adrenal glands. Cortisol raises blood sugar (among other functions) to provide a quick burst of energy to deal with the stress. Normally, when the cortisol reaches a certain threshold in the brain, it turns off the “fight-flight” response. This is called a “negative feedback loop.” Glucocorticoids (i.e cortisol) do this by binding to receptors in the hippocampus and hypothalamus.
In PTSD characterised by hyperarousal and intrusions, this negative feedback loop fails: the pituitary gland is releasing an insufficient amount of ACTH (which triggers the release of cortisol in the adrenals), resulting in lower levels of cortisol in the bloodstream, so the corticotrophin releasing factor continues to be released in the brain, reinforcing the hyperarousal and causing damage to brain structures. This results in chronic activation of the amygdala, which builds more neural connections, thus further reinforcing the arousal. When the amygdala is chronically activated, its neurons grow and become adapted to constant stress. Brain regions become damaged, resulting in abnormal neuronal activity. The limbic system is shaped in response to experience — neurons that “fire together, wire together.” When a circuit fires repeatedly, it can become a default setting. If you feel safe and loved, your brain becomes sensitised to engagement and balanced moods. If you are frightened, it becomes a specialist in, and highly sensitised to fear and anxiety. The other real challenge with PTSD is that individuals become trapped in the past, both mentally by constantly re-living the traumatic experience or memory, and physically through stuck energy and stored memory.
Alongside the sympathetic spinal chain which coordinates the sympathetic response, there is the vagus nerve, the 10th cranial nerve that “wanders” from the brain stem through the organs of our body. It has become more widely known recently for it’s healing qualities thanks to the attention given to it by Stephen Porges Ph.D, and the unveiling of a new theory around the make up of the ANS.
Polyvagal theory presents a paradigm shift in our understanding of the autonomic nervous system: that there are actually three divisions to the ANS, one sympathetic and two parasympathetic. Porges divides the parasympathetic system into two completely separate divisions, a primitive unmyelinated (dorsal) vagus which is responsible for the freeze response, and one newer myelinated (ventral) vagus that has evolved in mammals which is responsible for the rest and digest functions and controls the cranial nerves, that are responsible for activating the “social engagement” system, which in turn have a direct role in modulating hyperarousal.
In event of severe trauma, the individual feels there is no way out, the initial “fight-flight” response is replaced by the activation of the ultimate emergency system: the dorsal vagal complex. This system reaches down below the diaphragm to the stomach, kidneys, and intestines. We disengage, collapse and freeze. This can result in a dysfunctioning vagus nerve and long term dissociation.
Changes in brain structure of a traumatized individual:
- Increased activation and size of the amygdala (the alarm centre of our limbic system);
- Decreased hippocampal volumes (responsible for storing, and creating appropriate context for memories);
- Reduced size of anterior cingulated cortex (relating to self awareness).
Moving through trauma:
We must help individuals to live fully and securely in the present, which is known as building interoception. The greater the awareness, the greater our potential to control our lives. “Knowing what we feel is the first step to knowing why we feel that way.” We need to help restore the proper balance between the rational and emotional brains, so individuals can feel in charge of how they respond.
How can yoga help to process and heal trauma:
- Yoga helps to foster emotional regulation through the building of the vital connection between our minds and our bodies — interoception. “By anchoring our minds to our bodies, individuals can learn to befriend their inner experiences, and cultivate new actions patterns.” Approaching sensations with curiosity with fear, helps to re-frame the experience.
- Yoga allows individuals to feel safe in their bodies again. This enables the processing of traumatic memories in a safe space, and the creation of new positive memories.
- Yoga strengthens the connection between the PFC and the amygdala. The PFC has the ability to moderate emotional responses. It therefore helps us to distinguish between a perceived and real threat.
- In seasoned yogis, the amygdala reduces in size and, connections to other primal parts of the brain are lowered — which helps to build patience, calmness and resilience.
- Yoga increases the size of the hippocampus.
- Yoga also, and importantly, helps to regulate our ANS, increasing our ability to recover more quickly from stress, by increasing our heart rate variability — which is a measure of healthy vagal tone (the higher the vagal tone and the higher the HRV. Higher vagal tone, reflected in higher heart rate variability, means the body is in an optimal state to recover more quickly from stressors).
Dr Bessel Van Der Kolk, The Body Keeps the Score
Stanley Rosenberg, The Healing Power of the Vagus Nerve
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