In terms of treatment, memory dysfunction is one of the most difficult aspects of PTSD. For most people there is some memory, but it is fragmented and confusing. It is difficult to think about because of the anxiety that arises, as these memories often feel as if they are happening right now (implicit). In order to achieve some degree of integration, what needs to be built are coherent narratives of the event/s, one’s personal part in it, and a sense of meaning around this life event. In order to do that, two things are necessary : 1/ to be able to tolerate the discomfort and panic involved in thinking about it, and 2/ to be able to sort through the debris of memory and feeling and make some sense of it all.
The solution to lack of memory integration lies in the left-right hemisphere system of the brain. It needs to be stressed again and again that the key to the development of PTSD and treatment for it, lies in the organization of one’s MEMORY and attention to the damage done to the Central Nervous System.
Memory is encoded using the left hemisphere, but is retrieved using the right hemisphere. During REM sleep, the left side of the orbitofrontal cortex encodes relevant information into long-term memory by registering important events, linking them together and reorganizing them with neural linkages to networks about similar issues. These representations of recent experiences have been retrieved from the right side of the orbitofrontal cortex where they exist in a more global, autobiographical, emotional form. It is believed that the two sides of the brain are activated in a rhythmical, alternating sequence, back and forth from right to left. The eye movements that are seen during REM sleep reflect this alternating activation.
The consolidated memories are ‘episodic’ in nature, ie, can be retrieved and remembered as conventional story-like memory, with images and attached emotional content. These memories are now stored in the cortex and are free from the influence of the hippocampus.
Traumatic memory, however, fails to be correctly reorganized by right-left networking and remains implicit and connected to the lower pathways of the limbic system. To resolve the trauma at the level of memory and sense-making, it is necessary to help the trapped material to be integrated into normal memory. Therapy strategies that activate right to left brain processing are important. Some of these treatment options include relationship-based talking-therapy, EMDR therapy, creative arts therapy, emotional release therapy and some aspects of cognitive-behavioural therapy. (1) A further level of healing is important for those whose trauma involved overwhelming shock, fear, rage, physical danger or loss of freedom. These states push the nervous system into the freeze response, which can leave the survivor with an (often buried) emotional paralysis. Body-centred strategies are most effective in helping the frozen shock to be released.
The damage to the Central Nervous System is best addressed using Mindfulness training, meditation techniques, relaxation and stress-reduction exercises, activities that foster feelings of peacefulness and pleasure (being near animals, in nature settings, eating well), combined with cognitive-behavioural techniques.(2) But where the trauma is based in childhood trauma and/or abuse, further therapeutic techniques are essential. Therapy choices are dealt with under the menu tab “The Healing Journey“. Be aware, however, that the most important element in choosing a treatment option is to work with someone who feels like a good ‘fit’, with whom you feel comfortable.
Neural integration is discussed under the menu tab “Neurobiology – Integration“.
(1) EMDR references: Picture and article – eSkeptic, Wednesday May 21st 2014. Rosen, G.M., McNally, R.J. and Lilienfeld, S.O., Eye Movement Magic: Eye movement desensitisation and reprocessing.
CBT references: Pictures – http://balancepsychology.com.au/what-is-cbt/;
(2) CBT references: STOPP worksheet – http://www.getselfhelp.co.uk
Distinguishing ‘MORAL INJURY’ from PTSD ~ Article
This article joins a discussion about the effect of ‘moral injury’ – injury to a person’s sense of their own moral and ethical foundation, when their behaviour under dire stress goes against their own principles. I feel this is a very important area which deserves careful thought as to how the survivor can be assisted towards integration of their experience.
More on PTSD