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Are some predisposed to develop ...

Posted Sep 29 2008 6:24pm

Are some predisposed to develop trauma symptoms?
Why is it that some people are traumatized, others not? Is it genetic? Biological? These are the conventional questions. It turns out that many of the subjective experiences associated with Post-Traumatic Stress Disorder (PTSD) appear to be linked with an autonomic nervous system that has been thrown into overdrive. What does that mean? It means, as a result of some trauma, that nature’s get-up-and-go mechanism is both on high alert and also disinclined to step down from that alert. A constant state of agitation described as “hypervigilance.” Those with PTSD know that state well. Strange faces emerge from a crowd and take on a menacing aspect. The unexpected slam of a door sends the shoulders up around the ears where they hover in tension. The traumatized are ever ready with the potent shot of adrenaline.

The role of temperament.
Some of this is temperamental. Some people are wound tighter than others. It is easy to observe this in infants. Here is a baby that sleeps easily, is comforted after feeding, while another wails uncomforted by sleep, diaper change, breast. Intuitively this seems obvious. Put one of these high strung babies, these first violinists, in a traumatic situation and they might be more apt to emerge traumatized. Possibly.

The role of previous experience.
There is another level, another tier in the selection process. You could think of it as pre-selection. It appears that adults subjected to trauma early on are more prone to develop clinical trauma symptoms. Research has found much higher rates of adverse experiences (sexual abuse, domestic violence, parental drug abuse) in childhood, than among those that do not develop symptoms. The inference usually drawn is that something in the early experience leads to greater susceptibility. Note that the earlier event may not necessarily result in traumatic symptoms.

Neural networks and “kindling”.
In neuroscience there is a phenomenon known as “kindling”. Just as small twigs and dry grass help to start a wildfire. Many functions carried out in the brain are the result of complex systems. Millions of neurons joined together perform specific tasks — this group of neurons are collectively known as neural networks. As the theory has it, the more often a network is used, the more reinforced its connections, the more efficient it is in executing its function. Neuroscientists believe that neural networks are involved in depression. With each episode of depression, particularly major depression, the more intractable that state becomes. Each episode serves to further establish and strengthen the neural network for depression. Subsequent episodes occur more readily, take hold more rapidly. They also become more difficult to treat. Thus the kindling metaphor — a spark leads to a flame leads to a fire, a fire that can take on a life of its own.

Kindling in trauma.
Examples of a kindling mechanism in trauma are well established. In place of the melancholic vegetative states and mood symptoms characteristic of depression one finds heightened autonomic response — chronic anxiety, an exaggerated startle reflex. It appears that the mechanism that makes emotionally meaningful events memorable goes into overdrive. Traumatic memories are both burned into consciousness and replay over and over again, both in wakefulness and sleep.

Anything to be done?
Other than pre-screening those that might be subjected to potentially traumatic situations (soldiers, for instance) it is not clear that anything can be done to prevent the development of traumatic symptoms. Post-event counseling, embraced at one time, is now widely believed to be useless or even harmful. Certainly there is no support for imposing counseling on people that haven’t asked for it.

Focus on bodily processes.
Bessel van der Kolk, trauma expert, suggests that bodily processes, physical responses, are more relevant in dealing with trauma. At his presentation to the Los Angeles Psychological Association (LACPA) he showed slides of crowded teaming over the Brooklyn bridge. He noted that this was purposeful behavior rather than a chaotic response. Those that went over the Brooklyn Bridge lived in Brooklyn. Those that lived in New Jersey headed for the George Washington Bridge. Van der Kolk believes that after a profoundly disorganizing event such as 9/11 people instinctively go home. He sees return home as a kind of re-set mechanism for the organism. He notes that the behavior is found throughout the animal kingdom. He notes that without this mechanism things may go poorly.

Yakking on a couch.
In commenting on research methods, Van der Kolk recalled badgering a colleague, “If I did your study I would have included a hugging and holding treatment to compare with the psychotherapy and drug therapy groups.” Van der Kolk believes that physical soothing is at least as effective as current “treatments of choice” — Cognitive Behavioral Therapy (CBT) or use of an SSRI such as Prozac. In his work with traumatized youth he often refers his patients to join drama groups, re-enactments of traumatic events that involve a martial arts component. The premise behind recommending these activities is that it is crucial that the person feel that they are taking control of the meaning of the trauma, are defining it, taking control of it. Van der Kolk believes that too often talking about trauma — he calls is “yakking on a couch” — is too passive, encourages a victim mentality.

Kalea Chapman, Psy.D.

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