Talking About Anxiety: PTSD, Mindfulness and Exposure Therapy

Post-Traumatic Stress Disorder is really no disorder at all. It is a very reasonable response to life at its most unreasonable. When one is subjected to an experience too excruciating and extreme to internalize, it gets stuck like a bite that’s too big; it can’t be “swallowed.” Typically, the experience plays and replays obsessively in the victim’s mind, producing severe anxiety. In addition, all situations that even begin to evoke memories of the incident are avoided at all costs.

Unfortunately, one of the things many of us who suffer from PTSD do to avoid the extreme pain and anxiety is to deny ourselves psychotherapy. The mistaken belief is that therapy will increase awareness of trauma and will thus make us feel worse. So, if thoughts of what happened can be avoided, symptoms will supposedly be minimized.

But it isn’t that simple.

PTSD predominantly affects and changes three areas of the brain. One area, the amygdala, is a part of the brain’s limbic system, which is the seat of emotion. The amygdala is responsible for determining whether or not a threat is approaching. When we perceive danger, it is in the amygdala that the fight-or-flight response, discussed in my last anxiety article, is initiated. If we go through a significant trauma, the amygdala stays hypervigilant even when no threat is present. The fight-or-flight response is triggered without the presence of real danger. We tend to seek it out and find it everywhere.

Another part of the brain, the hippocampus, which is associated with memory, actually becomes smaller after severe trauma. The hyperactive PTSD amygdala communicates frequently with the hippocampus, trying to connect memory and perceived threat. Since the amygdala is in a hypervigilant state and the hippocampus is at reduced effectiveness, this communication is significantly inaccurate.

The prefrontal cortex (PFC) is the third area of the brain involved in PTSD. Normally involved in regulating behaviors, emotions, impulses and fear, the PTSD PFC is much less active and efficient, less able to override the inaccurate flashes of memory produced by the hippocampus or let the hyperactive amygdala know that the “danger” is not really dangerous.

These are neurological, “hard wired” changes to the brain and together, as you now see, they create the familiar PTSD symptoms – overreaction, avoidance and frequent, panicky anxiety.

The good news is that research indicates that mindfulness, both as a meditation practice and an ongoing state of mind, quiets down the amygdala and improves performance of the PFC and hippocampus. So, meditation can actually undo the physiological changes caused by the exposure to extreme stress.

An additional way of improving symptoms of PTSD is known as exposure therapy. It involves increasing the patient’s ability to bring the traumatic events to mind in a very gradual and controlled manner. It is done slowly so the patient can feel as in control of the process as possible. So, a combination of doing meditation to restore the brain to “default settings” and the rehearsed and supervised exposure to the traumatic events can take the person with PTSD back into a reasonable, more comfortable world.

Before concluding, I want to specifically address anyone who was involved in the Parkland shootings, since this article is coming out of and being read to a great extent in South Florida. If you’re thinking it’s better to avoid what happened to you, you’re trying to regulate your PTSD in a way that will not work, as the above pointed out. I suggest that if you see a psychotherapist familiar with both techniques, you stand an excellent chance of getting past what happened. It is possible!

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