Magazine article Clinical Psychiatry News

Sensory-Based PTSD Therapy May Prove More Calming Than Words: Alternative Coping Strategies

Magazine article Clinical Psychiatry News

Sensory-Based PTSD Therapy May Prove More Calming Than Words: Alternative Coping Strategies

Article excerpt

VANCOUVER, B.C. -- Terror registers most sharply in the subcortical brain, not the prefrontal cortex, explaining why talk-based therapies for posttraumatic stress disorder often have limited success, Dr. Bessel van der Kolk said at a meeting on Posttraumatic Stress Disorder sponsored by Vancouver General Hospital.

"Underneath what people talk about is another layer of disorganization," he said.

To illustrate his point, Dr. van der Kolk showed a videotape of a woman with PTSD describing a terrifying motor vehicle accident she witnessed. As she got to the most frightening part of her story, she tightly gripped the arms of her chair, physically pulled back toward the wall, and breathed rapidly, her words drifting off.

"Words after 1-2 seconds don't mean much," he said of the session. "Her brain is somewhere else, experiencing another time."

Verbal therapies target the prefrontal cortex, the region of the brain responsible for cognitive analysis, planning, and processing of sequences of events. However, this area is not powerfully activated during initial trauma or the reliving of traumatic situations.

In fact, PET scans of PTSD patients show inactivation of Broca's area, the brain's speech center that translates internal experiences into verbal communication. The hippocampus, which generally evokes clear, declarative memories, is similarly under-activated. This may be why some trauma victims experience what Dr. van der Kolk described as "speechless terror," unable, even in retrospect, to explain exactly what happened.

In contrast, neuroimaging shows that the amygdala, brain stem, and cerebellum "light up" on brain scans of people recalling very traumatic events.

These are not areas of the brain that are sensitive to overt intellectual control. The amygdala, for example, serves as a storage area for indelible memories. If it is on heightened alert after trauma, no amount of logical analysis will help calm a patient's "fight or flight" response to ordinary stress.

"Core dysregulation [typical of PTSD] is only marginally impacted by thinking," argued Dr. van der Kolk, professor of psychiatry and clinical director of the trauma center at Boston University.

For PTSD healing to occur, he believes patients really need to reexperience the feelings and sensations that left them unable to react, but with enough emotional distance that they can devise strategies for confronting such situations differently in the future. …

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