Sober Synthesis

“Once you start to approach your body with curiosity, rather than fear, everything shifts”. Besser van der Kolk, MD (The Body Keeps The Score)

What are Sources of Trauma?

General Definition: Any disturbing experience that results in significant fear, helplessness, dissociation, confusion, or other disruptive feelings intense enough to have a long-lasting negative effect on a person’s attitudes, behavior, and other aspects of functioning.

Abuse: Physical, emotional, or sexual harm.

Neglect: Failure to meet a child’s basic physical and emotional needs.

In-Utero Trauma: Adverse experiences that a fetus undergoes while developing before birth.

What Can Be the Neurobiological Consequences of Life Event Trauma and/or Abuse?

• The intensity of “fight or flight” hormones and neurochemicals can result in emotional center (amygdala) functioning that remains on “high alert”.
• Language and logic centers in the brain can be impaired during trauma resulting in decreased ability to process the experience(s).
• Sensory integration functioning (insula) can be impaired. Can reduce ability to interpret and integrate feelings, actions, and physical sensations (interoception and neuroception). 
• Memory (hippocampus) functioning can be impaired resulting in fragmented memories that often occur in “flashbacks”, the experience that the event(s) are happening right now.
• Heart rate variability is often decreased.
  • Heart rate can become rigid and excessively steady leading to much greater susceptibility to stress to a state of chronic hyperarousal.

Feature	Change	Effect
A. Neuroendocrine
Hypothalamic-pituitary-adrenal axis	Hypocortisolism	Disinhibits CRH/NE and upregulates response to stress
		Drives abnormal stress encoding and fear processing
	Sustained, increased level of CRH	Blunts ACTH response to CRH stimulation
		Promotes hippocampal atrophy
Hypothalamic-pituitary-thyroid axis	Abnormal T3: T4 ratio	Increases subjective anxiety
B. Neurochemical
Catecholamines	Increased dopamine levels	Interferes with fear conditioning by mesolimbic system
	Increased norepinephrine levels/activity	Increases arousal, startle response, encoding of fear memories
		Increases pulse, blood pressure, and response to memories
Serotonin	Decreased concentrations of 5 HT in:Dorsal raphéMedian raphéDorsal/median raphé	Disturbs dynamic between amygdala and hippocambus
		Compromises anxiolytic effects
		Increases vigilance, startle, impulsivity, and memory intrusions
Amino acids	Decreased GABA activity	Compromises anxiolytic effects
	Increased glutamate	Fosters derealization and dissociation
peptides	Decreased plasma NPY concentrations	Leaves CRH/NE unopposed and upregulates response to stress
	Increased CSF b-endorphin levels	Fosters numbing, stress-induced analgesia, and dissociation
C. Neuroanatomic
Hippocampus	Reduced volume and activity	Alters stress responses and extinction
Amygdala	Increased activity	Promotes hypervigilance and impairs discrimination of threat
Cortex	Reduced prefrontal volume	Dysregulates executive functions
	Reduced anterior cingulate volume	Impairs the extinction of fear responses
	Decreased medial prefrontal activation	Unclear

https://pmc.ncbi.nlm.nih.gov/articles/PMC3182008/

What are Possible Neurobiological Consequences of Childhood Neglect?

• Impaired development of brain valuation systems (estimating the value of alternative options).
  • Impacting ability to assess and respond to risky situations 
• Disruptions in brain areas (prefrontal cortex) responsible for executive functions like planning, decision-making, and working memory.
• Brain network maladaptations that are responsible for emotional regulation and social interactions.
  • Could lead to difficulties discriminating between emotions

https://www.sciencedirect.com/science/article/pii/S187892932100030X

https://pmc.ncbi.nlm.nih.gov/articles/PMC4760853/#S20

Why is Addiction a Common Consequence of Trauma?

• Research shows that approximately 46% of individuals diagnosed with PTSD also meet the criteria for a substance use disorder.
• There are estimates that adults with a history of childhood abuse and/or neglect have a 4.3 (430%) higher likelihood of developing a SUD.
  • People often initially use alcohol or drugs to alleviate the anxiety, hyperarousal, and other distressing symptoms (self medicating).
  • The neurobiological changes associated with trauma may enhance the rewarding effects of substances increasing vulnerability for addiction.

Summary

• Trauma often results in both conscious and unconscious states of high arousal and hypervigilance, disconnection from our senses and executive functioning, and disconnection from the experience of safety with others.
  • When most significantly impacted, one can feel like nothing and nobody can be trusted.

Interventions:

1. Breathing exercises
2. Trauma therapies (EMDR, Neurofeedback are often lesser known)
3. Activities that involve movement (e.g. yoga, dance)
4. Music, drumming, art, tapping
5. Massage
6. Mindfulness/meditation 
7. Supportive/safe interaction with people (connection)

Proposed Questions for Thought/Discussion:

1. Did this information spark any curiosity and how?

Disclaimer

This summary is for general informational purposes only and does not constitute the practice of medicine or other professional health care services, including the giving of medical advice, and no doctor/patient relationship is formed.