The Neuroscience of Trauma and Addiction | PTSD & cPTSD Interventions

Foreign.

I'd like to welcome everybody to today's presentation on the neurobiological impact of trauma and addiction.

I am your host, Dr. Donnelly Snipes.

Now, you may wonder, why am I.

Putting trauma and addiction together? Well, both of them have similar impacts on the brain. So we're really going to talk about what happens when that HPA axis is really turned on, is really ramped up and becomes dysregulated. And we're going to talk about how both trauma and addiction can cause those brain changes and that HPA axis dysregulation.

Now, if you want to know more.

About HPA axis dysregulation in its most, you know, clinical terms, this is an excellent article. The Post Traumatic Stress Disorder, the Neurobiological Impact of Psychological Trauma. The authors go through in detail all of the or most of the physiological changes that occur as a result of trauma to the brain and HPA axis dysregulation. Now, it does take a couple of minutes to read because it is written at a very high level, but it is worth, if you're interested in this topic, topic, it is definitely worth taking your time and sifting through it because they do do a great job of pulling everything together and helping you really see the bigger picture as clinicians. Awareness of the changes that happen in the body and in the brain as the result of what, what I'm just going to generally call stress can help us educate patients about their symptoms and ways of adapting to improve their quality of life. We want to help them understand why.

Some of their symptoms are kind of.

Expected and what they may be able to do in order to, you know, help heal their brain or to hedge against the damage that's been done. For example, you know, you may have an accident and lose the function or as much of function because you hurt your lower back.

All right, well, does that mean you.

Can'T do anything anymore? No, it means you may not be able to do it the same way. You may need to use assistive devices or something.

When we're talking about the brain, there.

May be some areas of the brain, like the hippocampus, we're going to talk about extensively, that shows damage and shrinkage as the result of repetitive assault from either trauma or addiction.

That's probably not coming back. But the great thing with our brain.

Is with a lot of humans, I think the last study I read that says we only use 10 to 15% of our brain, that means we got a lot of room to, you know, form new pathways and to form workarounds. There's also a lot of things we can do to help the body recover instead of continuing to stress it. And you all know that I, I harp on the aspects of nutrition, sleep and stress management in order to help regulate that HPA axis. Because when we're not getting those things, when those things that are controllable are stressing our HPA axis, we're not doing ourselves any favors. We want to do everything we can to sort of, if you want to think of it this way, baby, our stress response system, when it's been taxed too much in order to help it have the energy to do what it needs to do.

Neurobiological abnormalities result from trauma and, and addictive behaviors. If you want to think of addictions.

Think of those as physical assaults on the brain. You're basically introducing a poison to the brain. And, and that's grossly oversimplified. We're going to talk more in depth about it later. But you want to think about the fact that when these things happen, when people are exposed to psychological trauma, when they regularly engage in addictive behaviors, it can cause HPA axis dysregulation, which results.

In changes in the brain that are very common in, when we look at.

People who've had physical traumatic brain injury. So that's kind of interesting.

The response of an individual to trauma depends not only on stressor characteristics, but.

Also on factors specific to the individual. Now we're going to talk a lot in, in this class about how the. When people are regularly abusing substances or engaging in addictive behaviors or exposed to chronic stress or trauma, their HPA axis becomes dysregulated, which means they're more sensitive, they're more hyper vigilant, they're more aware of traumas in the, that are around them. They are scanning for things. So they are more sensitive to what may be going on.

We do need to remember that.

So with typical stressors and traumas, the impact or the level of HPA axis activation, the level of threat perceived from people by people, relates to how close it occurred to their safe zone. And I know we've talked about this some in the, in the past few weeks. So if it occurs to them, obviously that's their safe zone. If it occurs in their neighborhood, that's their safe zone. With the riots that are going on right now, unfortunately, we can, you know, look at this. How close is it occurring to where you are? And you know, it was kind of interesting for me to note that my daughter, while she's an older Teenager really doesn't have a great conceptualization of how far away Nashville is from where we live because we live kind of in the suburbs of the suburbs. And seeing all of the news about the protests and the clashing with police and all that kind of stuff on the news, she suddenly became very worried about me even coming to work. And you know, I had to show her on Google Maps, you know, how far away that is, and talk about, you know, how likely they are to come out here into rural middle Tennessee because there's just not that kind of population out here in terms of, you know, population density. There's not enough people to really get a crowd together in, in the city of Lebanon. So recognizing that, I thought it was interesting because I felt very safe.

It was.

I was very saddened and very disheartened and very angry about some of the things that are going on. However, I did not feel unsafe in our house. And that was, you know, just kind of interesting for me to note from someone else's perspective. Granted she's, you know, almost 17, but so I think of her as a little adult and in reality she just doesn't have the experiences and the grasp of, you know, some of the nuances that may help you recognize how close that stuff is.

So proximity to safe zones does it.

If it happens to you, then obviously that's going to be more prominent or more meaningful in the term.

In terms of addictions, if you are.

Engaging in an addictive behavior, you are assaulting yourself. So that is, you know, really close to home.

The similarity to the victim, if you.

Are the victim, if you are the one abusing substances or you are the one that's victimized, then it's going to hit you harder than if it is somebody who is not similar to you at all. And the degree of helplessness felt.

Prior traumatic experiences also impact our ability.

To handle the stressor. And we're going to talk about the physiological reasons for that, you know, towards the end of this presentation.

But it's important to remember that if.

You'Ve had prior traumatic experiences, then your amygdala and several in your HPA axis and stuff is probably more primed, more hyper vigilant to be aware of potential dangers or, or potential threats to your physical or psychological safety.

Now think about, remember we're thinking about.

Addiction in terms of trauma.

It is addictive behaviors are a physiological.

Assault on the brain, which means that the brain is sort of in that revved up state that may make it more vulnerable to perceiving stressors and More vulnerable to the stressor. We. We've talked about flat or furious a couple classes ago, and we're going to go into that again.

The amount of stress in the preceding.

Months that the person has experienced. And again, when people abuse substances, they are stressing their body. The influx or the surge of neurochemicals as a result of the addictive behavior or the addictive substance is stressful to the body. The withdrawal or the sobering up from those substances or those behaviors is stressful to the body. We also want to, of course, remember psychological stresses. And a lot of people, you know, right now are just overwhelmed with the number and intensity of stressors in their life.

And we do want to recognize that.

Because I would go out on a limb and say the majority of people right now have an HPA axis that is pretty dagum worn out because it has been revved up for so long. It has been stressed for so long because of COVID because of tornadoes, because of, you know, the problems in feeling safe in your environment or being locked down.

And for some people, they've been locked.

Down in very unhealthy environments. So we do want to remember that too.

Current mental health or addiction issues obviously.

Make people more susceptible to the impact of additional stressors. So if somebody already has some issues going on, then when they add on another physical or psychological assault, it's not one plus one equals two. It's more like one plus one equals five.

And the availability of social support to.

Help people cope with life on life's terms and after a trauma or during stress, obviously social support can help sort of blunt that.

When we're talking about addiction, we need to recognize that people who are engaging.

In addictive behaviors are often doing the best they can with the tools they have.

And when they start to sober up.

The cravings, the withdrawal symptoms, and facing, you know, the devastation, facing what, you know, the fallout from their addictive behaviors may be so overwhelming or. And whatever they've initially started using to get away from is probably still there.

So we need to make sure that people have social support because when they're.

Trying to sober up and they, you know, they start recognizing what's going on, they may have this just wave of overwhelmedness. I know it's not a word, but whatever that triggers them to want to use again. Because remember, their HPA axis is dysregulated. So they see this stuff and instead of reacting to it with a, you know, oh, crap, this is going to be really tough to get through like a three in terms of Stress, they see it and they go from flat, being just kind of eeyore, like blah to furious. They get totally overwhelmed. They, they are just, they have an exaggerated stress response when they sober up and kind of look around and go, oh crap. We do want to recognize the impact that stressors have. The more stressed people become, the more stressful things become. So, you know, things that would normally be a 1 or a 2, maybe more like a 4 or a 5 at a certain point.

For the vast majority of the population, the psychological trauma is limited to an acute transient disturbance. So when somebody experiences some kind of.

Trauma, most of the time it doesn't result in ptsd. When people are recreationally using substances or engaging in behaviors that could be addictive, like watching porn, most of the time.

That is a transient change in their.

Neurochemical balance as a result of engaging in that behavior. And you know, it quickly resolves. It doesn't result in long term. Disruption to the health of their brain. And, and kind of going back to something that Melissa pointed out, social media playing a part in bringing people's, bringing stressors, bringing these things into people's safe zones is definitely an issue. And, and we've talked about that a.

Little bit with kids, but with adults too, it's so important to disconnect.

And it's not just social media, it's media media bringing these things in to our presence. And it could be the current news, it could be movies about death and destruction.

There's a lot of different ways that.

Potential stressors can come into what we thought was our safe zone.

So it's important to recognize. And I was talking with somebody, I.

Don'T remember if it was with y' all or in a consultation that I did.

But for clinicians who are working from.

Home right now, it can be very overwhelming because when you work at work then you can.

The bad things that you hear, the.

You know, stuff that you hear from clients, you know, it's devastating, but you're hearing it there and you're not associating it with environmental stimuli in your home when you are doing counseling from home.

A lot of the clinicians that I've.

Talked to recently have reported that it.

Is harder to kind of feel safe.

In their own home.

It's harder for them to feel less.

Stressed because they're constantly thinking about the clients that they're seeing and they're hearing about things that, you know, they don't really want to be thinking about at 8 o', clock, 10 o', clock, 12 o' clock at night. But they're hearing about those in their home environment. So the brain is associating these stress messages with. With that environment. So that invite that environment inadvertently becomes.

A little less safe, which is why.

It'S important if you are working from home and, you know, seeing clients virtually that you have, if you're going to do that, you have like a home office where you can shut that door and you're not, and you're able to somehow create some sort of a barrier, so it's not infiltrating your entire safe space.

And it can also apply to clients.

As Denise points out, and I hadn't.

Thought of this, but you're right. When clients are in their homes, they're.

In their place that is now safe, and they start talking to you virtually about, you know, the worst day in their life, a trauma that happened six years ago. Well, all of a sudden, now that memory has invaded their new safe space, so it's going to be important to talk about ways for them to continue to feel safe in, in their home.

So that.

That's a great point, Denise. And I've kind of gotten way off track here, but that's okay. Those are really, really awesome important points that I think we need to remember. Another thing that I have noticed in talking to people and reading social media is during this whole Covid loc, I've.

Heard a lot of people.

Glorify drinking. And it seems like, and I have no data on this, but it seems like people are drinking a lot more and people are using substances and engaging in addictive behaviors a lot more, whether it's gaming or watching porn or drinking alcohol or smoking cigarettes. Those are the four big ones that I've heard a lot of. But we do want to recognize that right now, people, since they're not feeling safe, they may be engaging in some escape behaviors, which unfortunately, as we're going to learn in a few minutes, makes.

Them more vulnerable to additional stressors.

So they're already feeling worn down.

Abusive.

Okay.

The sign, signs and symptoms of PTSD.

Or HPA axis dysregulation reflect a persistent adaptation of neurobiological symptoms to the. To the trauma, whether it is to.

A psychological trauma or to repetitive physiological assaults from the use of substances or.

Engaging in process addictions that just flood the brain with dup. Wow, can't talk today. Flood the brain with dopamine, dopamine and glutamate.

Abusive stimulants. Alcohol and process addictions increase excitotoxicity in the brain, which is a really shorthand way of saying when people engage in.

Pleasurable behaviors and use, especially using stimulants or alcohol, but also to a certain extent, process addictions. The excitement part, the stress part, in if you're thinking about like gambling, the tension and release, the tension part causes the HPA axis to go into overdrive. Secrete cortisol, norepinephrine and glutamate, all of those ex excitatory neurotransmitters. Makes the brain more susceptible to excitotoxicity, which means it basically gets, if you want to think of it this way, it gets too hot and burns up brain cells. And that's obviously it's not actually getting hot, but it becomes toxic and you start having neuronal death.

Excessive use of depressants and opioids can.

Cause respiration to be impaired, causing hypoxia, which also can cause brain damage as well as the increased sensation of stress. Because when the brain is not getting enough oxygen, that kicks off the HPA axis because it says breathe, damn it. And, and the, the person's stress response kicks in to try to get their respiration up. The body doesn't want to die, which again, even though it's a depressant, if.

It gets a little bit too low.

If it gets below normal, that will trigger that HPA axis to respond to try to keep the brains and body systems going.

During alcohol withdrawal, blood pressure increases and can cause a stroke. Blood pressure increase is a symptom of that HPA axis activation.

And I don't know why I always do this. I guess it's because it's when our HPA axis gets activated, it kind of.

Goes over the top, but whatever. When people's blood pressure goes up, that HPA axis is activated.

That's a sign that it is. The excitatory neurochemicals are winning out. Remember, I've used the analogy before of a bath between we want a warm bath, we want some, you know, calming.

Chemicals, but we also want a little.

Bit of excitatory chemicals so we're not feeling depressed. That's warm. When the HPA axis is over activated, when our blood pressure is increasing, that means that hot water is turned up too much, we're getting too much hot in there.

Alcohol use specifically can also cause Wernicke.

Korsakoff syndrome, also known, I think it's kind of derogatory as wet brain because alcohol reduces the levels of thiamine in the brain.

Now if you are working with somebody.

Who drinks alcohol, and even if they're not quote unquote an alcoholic. If they start exhibiting signs of dementia or cognitive impairment, it could indicate that they do have reduced levels of thiamine. That's a medical emergency. If those thiamine levels are not restored, the brain damage can become permanent. So if you notice a client that, you know, maybe they decided they were going to self detox or over the weekend they went on a bender and, you know, binge drank all weekend, and now they're exhibiting some symptoms of cognitive dysfunction. Really important to get them evaluated by a physician asap.

I've been talking a lot about the.

HPA axis, but what exactly is it?

For those of you who haven't been.

In my other classes where we've talked.

About this, the HPA axis is the hypothalamic pituitary adrenal axis, or what I.

Call the threat response system.

It controls our reactions to stress and.

Regulates many body processes including digestion, our immune system, our mood, our emotions, our sex drive, energy storage and expenditure.

When the HPA axis is dysregulated, some.

Things that we see include diabetes, metabolic syndrome, blood pressure changes, usually high blood pressure. But for people who are have hypocortisolism, you can see extra low blood pressure.

The ultimate result of the HPA axis is to increase levels of cortisol, which.

Is our stress response hormone. And it's the one that helps us fight or flee. It's there for a reason.

It's also helps us get motivated.

In the morning when we wake up is when our cortisol levels like peak and then they gradually decline throughout the day. We need cortisol just like anything else or most anything else. It's all a matter of moderation.

We don't want too much, but we.

Need enough to help us get motivated.

So in the morning that cortisol is.

Released, it helps us get motivated to get out of bed and then declines throughout the day.

Glutamate, when the cortisol is released, it.

Also causes the release of glutamate and norepinephrine. Glutamate is our main excitatory neurotransmitter and.

Norepinephrine is excitatory, but it also helps.

Us with focus and attention.

Both of those are secreted. When those are secreted, think of it.

You know, think of back to that bath as turning up the hot water.

Now it may just turn it up a little bit, but it could also.

Depending on the strength of the stressor, could turn it up a lot.

Both intoxication and withdrawal from substances trigger the stress response. Your Body wants to maintain homeostasis. It has this nice little level that's.

Really kind of narrow that it wants to stay in in terms of balance of hormones, neurotransmitters, blood pressure, respiration, all those things.

There's a happy little.

What'S the word? Avenue. Happy little place that it wants to stay.

When we use substances or engage in.

Hyper stimulating activities like gambling or day trading or watching porn or you know.

Any of those process addictions that cause.

A stress response, you know, that are exciting, that cause you to be a little bit, you know, revved up as.

Well as the use of any substances.

Not just stimulants, will get us out of that normal range of where our body wants to be. And when that happens, the HPA axis goes into overdrive. It goes, okay, I gotta do something.

Cortisol's main role in the is the.

Releasing of glucose into the bloodstream so.

We have energy to fight or flee.

Well, that's not good news for people with diabetes. It's not good news for anybody if it happens over a long period of time because that's what ends up starting to trigger metabolic disorders. But it's especially problematic for people with diabetes.

So think about when you have someone.

Who has an addict, an addiction, process or chemical doesn't matter. And they are regularly exciting that HPA axis, You're going to see that they probably have more difficulty regulating their blood sugar.

Cortisol also suppresses and modulates the immune system, digestive system and reproductive system. When we are under stress, our body.

Is worried about getting us out of there. Not our immune system, not repair of torn tissues quite yet, not digesting food, you know, that comes later, don't have.

Time for that, and certainly not reproducing.

So all of those things get altered from the norm. Glutamate, remember, is the main excitatory neurotransmitter.

Interestingly, because our body likes to protect us and it recognizes that too much.

Cortisol, too much glutamate, too much norepinephrine creates an excitotoxic environment, makes it too hot in there. It creates a reaction called hypocortisolism, where.

The body doesn't react as strongly to.

Stressors anymore because it says, you know what, we can't, we can't keep running this hot. It doesn't seem like this is getting any better. Now when we are working with people.

Who have addictions, sometimes we look at this as tolerance because what used to.

Cause and a reaction of that HPA axis system, what used to cause that reaction, that secreted dopamine and all those pleasure chemicals. And the euphoria, we don't have that as much anymore because the brain's going, you know what? No, that's that you're running too hot. Can't do that right now. Which is why people start increasing how much they're using or combining substances.

Hypocortisolism is seen in stress related disorders.

Such as chronic fatigue syndrome, burnout, PTSD and addiction.

And it's designed to conserve energy during.

Threats that are beyond the organism's ability to cope.

So we're conserving energy in addition to.

Trying to reduce the excitotoxicity in the brain.

Dysfunctional HPA axis activation.

So when the, when the HPA axis isn't responding like it wants to.

Then.

You'Re going to have abnormal immune system activation, increased inflammation and allergic reactions, irritable bowel syndromes, reduced tolerance to physical and mental stresses, and altered levels of sex hormones, often resulting in reduced sex drive.

Now, with people with addictions, we need to remember that if they're experiencing increased.

Inflammation, they may be tempted to self medicate that so they are again assaulting their body with an increased level of chemicals that it's not used to.

Low cortisol is found to relate to.

More severe PTSD hyper arousal symptoms.

A lot of clients with addictions have.

PTSD and a lot of clients with PTSD have addictions. So we do need to make sure that we understand the interaction between these two things.

When sensitized negative feedback loops in veterans.

Diagnosed with PTSD were indicated because they had a greater glutocorticoid responsiveness to stress, which is what I was talking about, the flat or the furious. So they'd be, be bopping along, doing okay, just kind of flat.

And then when they'd experience a stressor.

What when a per. A person without this condition would experience.

The same stressor, they would go to.

A 3 on a scale of 1 to 10. But a person who has hypocortisolism or.

Low cortisol levels typically goes up to.

An 8 or a 9 because they're such an exaggerated stress response.

People with hypocortisolism generally have low cortisol.

Levels, which means there's low motivation, low energy, more fatigue.

But when a threat is perceived, there's.

The exaggerated stress response.

Evidence points towards a role of trauma experience in sensitizing HPA axis regulation. Again, remember, we're not just talking about.

Psychological trauma, we're also talking about physiological trauma.

So if a person has a history of trauma. Even if they haven't met the criteria for ptsd, if they have a history.

Of the trauma, psychological or physiological, then they are at more risk of developing ptsd.

Those with prior trauma probably need to.

Be helped to regulate that HPA axis a little bit more and try to get out of that place where they're. They have hypocortisolism in order to make them less susceptible.

Core endocrine factors of PTSD and HPA axis dysregulation include abnormal regulation of cortisol.

Gonadal, and thyroid hormones. And we kind of hit those earlier.

Remember, your gonadal hormones are your testosterone.

Your estrogen, your pro, progesterone, your thyroid hormones are, you know, your T3 and your T4.

Hypocortisolism in PTSD and addiction occurs due to increased negative feedback sensitivity of the.

HPA axis, which, again, is that flat or furious. It just doesn't get as.

It doesn't get triggered as easily, but.

When it does, it's wide open.

Studies suggest that low cortisol levels at.

The time of exposure to psychological trauma may predict the development of ptsd.

If somebody has been abusing substances and.

They already have low cortisol levels because they've been on that, you know, yo, yo, for so long of intoxication and withdrawal and just chronic physiological stress as a result of the addiction, and it's gotten to the point where they're hyp. Have hypocortisolism, then they may be at greater risk of developing PTSD in the. When they're exposed to psychological trauma.

A lot of clients that I worked.

With in my almost 20 years of treatment in.

In community mental health, by the time people came into residential, most of them had experienced something that was psychologically traumatic.

Whether it was having their kids taken away from them or seeing a friend die or overdosing themselves. There are a lot of things that people see.

But because they already had low cortisol.

Levels because of their addiction use, you know, they were more susceptible to develop having a stronger reaction to that traumatic event and thus developing PTSD.

Interestingly, glucocorticoids, I.e. cortisol and glucose, interfere with the retrieval of traumatic memories, an effect that may.

Independently prevent or reduce symptoms of PTSD.

Or contribute to difficulty treating it. So if somebody's glucocorticoid levels are low.

Then they are more likely to, you know, develop symptoms. If their glucocorticoids are normal levels, then it may help prevent or reduce the development of ptsd.

Neurochemical features of PTSD and HPA axis.

Dysregulation in general include abnormal regulation of catecholamine, serotonin, glutamate amino acid peptide, and opioid neurotransmitters.

Now, catecholamines are your a lot of.

The neurotransmitters that we typically think of. We know serotonin, we know glutamate is our excitatory neurotransmitter. So that's out of whack.

Amino acids. Well, all of our neurotransmitters are made.

From breaking down amino acids. So if our body's not able to use the nutrients because it's not focused on digestion, then we're going to have a harder time helping people maintain that natural balance of neurotransmitters and then opioid neurotransmitters.

We have endogenous opioids in our body.

That help us deal with pain. And when those get out of whack, then we start to feel more pain.

All of these chemicals or things are found in brain circuits that regulate and.

Integrate with stress and fear responses.

So as stress and fear goes up.

All of those systems go wonky. For lack of a clinical term.

When a stressor is perceived, the HPA.

Axis releases corticotropin releasing hormone, or crh.

Which interacts with norepinephrine to increase fear.

Conditioning and encoding of emotional memories. So remember, norepinephrine is our one of our focus chemicals.

So when the stress response is kicked.

Off, it dumps norepinephrine and glutamate.

The norepinephrine helps us focus so we.

Can, you know, fight or flee. Which is why a lot of people, when they're really stressed out, have tunnel vision. They have difficulty when they're in their emotional mind seeing the big picture, because that norepinephrine says protect. You know, we're focused on protecting right now.

So totally makes sense why we have.

Tunnel vision and why it's important to help people relax a little bit so they can, you know, get some GABA in there, get some serotonin in there, and they can broaden their perception of the situation.

There's an abundance of evidence that norepinephrine accounts for certain classic aspects of ptsd.

Including hyper arousal, heightened startle, and increased encoding of fear memories. We do want to be aware of the impact of norepinephrine. We also want to be aware of the fact that, you know, when people use, especially when they use stimulants, they are artificially increasing levels of glutamate, norepinephrine, by artificially turning on that HPA axis. So they may be more susceptible to. To encoding fear and stress and trauma memories when they are under the influence.

Serotonin transmission. Poor serotonin transmission may cause impulsivity, hostility.

Aggression, depression, and suicidality. Now, I'll go in my little soapbox really briefly here.

We tend to think of serotonin as.

A single chemical, like milk is a single drink.

And it is so not true.

There are so many different kinds. You want to think of it more.

Like cheese, and you're going to be.

Hungry by the end of this class.

There are multiple different kinds of cheeses.

And they are all.

They all have similarities.

They're all made with certain chemicals. The 5ht, but you have 5ht 1a, 1b, 1c 1d, 5ht 3, 5ht 4. You can see all of them up here.

And our antidepressants are our chemical. Chemical psychotropics typically react only on the 5ht1a receptor. So if somebody's serotonin issues are with.

Their 5ht2a or their 5ht3, then Zoloft or Prozac or Lexapro are probably not going to do a whole lot of good for them.

So it's important to help them understand.

Why, you know, not all medications are going to work for all people.

But it's also important for us to.

Understand, just to generally understand that there are multiple types of serotonin receptors.

And serotonin, when it's out of whack, affects everything.

Addiction, aggression, anxiety, appetite, blood pressure, heart rate, impulsivity, memory, mood, respiration, libido, sleep, sociability, and the list goes on. So we do want to recognize, you know, thinking backwards, what's causing the serotonin to be out of balance. If it is a dysfunctional HPA axis, what is causing that HPA axis to be out of whack? What is causing the stress that, you know, the body is trying to respond to so chronically, and how can we eliminate that? So we really need to backward chain.

If you will, to figure out what.

Is causing the imbalance in the neurotransmitters. And, you know, a lot of times it does go back to that HPA axis and very basic things like sleep.

Nutrition, cognitive stress that we can help.

People start to address.

GABA is our main calming neurotransmitter, and.

It is actually made from glutamate. Breaking down glutamate produces gaba who knew?

It has profound anxiolytic effects, in part.

By inhibiting the cortisol and norepinephrine circuits.

It is basically the cold water to.

Turn down the HPA axis. Again, grossly oversimplified. So if you are a biochemist, I am sorry, but recognizing that GABA is our calming chemical, Patients with PTSD and HPA axis dysregulation, either one, exhibit decreased peripheral benzodiazepine binding sites. Which means, you know, when the, when the GABA is excreted, you know, the.

Body'S making plenty and it secretes plenty.

Of it, but because of stress, for.

Some reason, the body has actually shut.

Off some of those binding sites.

So it's not that there's not enough.

It's that there's not enough places for it to connect to in order to get the message out, to keep it going along.

This may indicate the usefulness of emotion.

Regulation and distress tolerance skills.

Because people with HPA axis dysregulation typically.

Do have a significant symptom of emotional dysregulation. We need to help them figure out how to reduce the excitotoxicity in order to reduce stress and improve stress tolerance so they can acquire new skills. They're not doing a whole lot of new learning if they're in their. In that fight ORF flight mode. We need to help them figure out how.

How many different ways can we take.

Some of the load off your HPA axis? How many different ways can we help you be kinder and more compassionate to your body while it heals?

NMDA receptors are implicated in synaptic plasticity.

As well as learning and memory. Now, you don't need to know all these different receptors, but if you want to do further research, these are the keywords that you would look for in PubMed. Glutamate. That excitatory neurotransmitter binds with NMDA receptors.

High levels of glutamate are secreted during.

High levels of stress. We already talked about that.

Overexposure of neurons to that glutamate creates.

That excitotoxic environment and contributes to the.

Loss of neurons in the hippocampus.

In people who have those excitotoxic environments, not only patients with ptsd, but also in patients with substance use disorders who are regularly hyperactivating that HPA axis, elevated.

Glucocorticoids or cortisol increases the sensitivity of.

These NMDA receptors, rendering the brain more vulnerable to excitotoxic insults at times of stress. And you know that Is the technical.

Term, but basically it means the brain.

Is more vulnerable to the increase in excitatory neurotransmitters that when the. The neurons are more likely to die in the presence of too much, too much glutamate points to think about.

It may take clients with brain damage.

That result from PTSD or addiction more time to master new skills. Clients with hypocortisolism with a reduced hippocampal volume may need more time to master new skills.

So we may need to slow down.

A little bit in our group counseling. We may need to write things down more and give them a little bit more time to ensure that they're mastering those skills. If the brain becomes excitotoxic during stress, which we know it does, inhibiting learning and memory, then exposure therapies may also be dangerous.

So if you've got somebody who has.

That hypocortisolism and reacts with emotional dysregulation and, you know, going from flat to furious, which creates a excitotoxic environment in their brain, then those people may not be, and I'm not saying they're not. I'm saying there's may not be the best choices for exposure therapies because the exposure therapy is actually throwing them into that excitotoxic state.

People with active addictions or PTSD are.

More vulnerable to the impact of any stressors.

And we want to help them recognize.

That until their HPA axis is rebalanced, that they may be more likely to emotionally dysregulate, which is why distress tolerance skills are going to be so important, which is why sleep and nutrition and.

Taking as much stress and as much.

You know, whatever off the HPA axis is possible is going to be important in, in the recovery process.

A hallmark feature of brain damage from excitotoxicity is that reduced hippocampal volume. The hippocampus is that part of our.

Brain that's implicated in the control of stress responses, memory and contextual aspects of fear conditioning.

So if you take that part of your brain and you actually shrink it.

Down, then you're reducing your ability to respond as effectively.

Prolonged exposure to stress and high levels.

Of glucocorticoids damages the hippocampus, which may.

Reflect the accumulated toxic effects of repeated.

Exposure to increased glucocorticoid levels caused by whatever physiological stress, psychological stress, you know, any of those decreased hippocampal volumes may.

Be a pre existing vulnerability factor for developing ptsd.

So, you know, not that we're going to have every client Go in and do a PET scan or whatever to see what their hippocampal volume is. But that would be a study that would probably be interesting if you're, you know, working on your dissertation.

Early adverse experiences, including prenatal stress. The baby, even as a fetus is.

Can be exposed to excitotoxic insults.

You know, wow, think of that little.

Tiny brain being exposed to, you know, enough stress that is actually damaging the brain.

And that stress can come from maternal.

Psychological or physiological stress.

And psychological and physiological stress throughout childhood.

Including adverse childhood experiences, has profound and long lasting effects on the development of neurobiological systems, thereby thereby programming subsequent stress, reactivity and vulnerability to developing ptsd.

One of the things that's so important.

To emphasize to young adults and to parents, or not to young people and.

Parents is the impact of addictive behaviors.

On the adolescent brain is exaggerated in comparison to that of adults.

So the excitotoxic stress is greater in.

Adolescents who are engaging in addictive behaviors, watching porn, doing those sorts of things. And it can cause more damage than because the brain is more susceptible to injury when it's still developing, which, remember, is up to the age of about 24.

A variety of changes take place in the brains and nervous systems of people.

With PTSD and hpa. Axis dysregulation.

Pre existing issues causing hypocortisolism increase the.

Likelihood of the development of ptsd.

This points to the importance of prevention.

And early intervention of adverse childhood experiences and addiction.

People with hypocortisolism may or may not have ptsd. So you can't just say, well you.

Don'T, you have ptsd so you have hypocortisolism and vice versa. There's not a one to one correlation. Most people with PTSD have hypocortisolism, but you can't say that everyone with hypocortal hypocortisolism has PTSD because that PTSD is often caused more by psychological stressors than physiological stressors, I. E. You know, using a whole lot of cocaine for many, many years may cause hypocortisolism in the brain, but that in and of itself may not cause ptsd.

Hypocortisolism sets the stage for the Flat and the furious, which leads to toxic.

Levels of glutamate upon exposure to stressors, reduction of hippocampal volume, which is persistent and causes, you know, negative brain changes.

So I see that there are a.

Lot of questions and discussion here.

Yes, it is easy to forget about how much cortisol really affects our functioning.

It does so much and that HPA axis does so much to control our moods, the levels of inflammation, autoimmune disorders. There's just so much that happens that we really do need to pay attention to what's going on but also to.

Remember that it gets a bad rap.

As being the bad neuro bad hormone. But we need it. We need a little bit of cortisol to keep us going throughout the day. When we drink coffee, we are actually.

Increasing our cortisol levels.

We're trying to get that energy going, get that glutamate to go into our system.

Marcela notes that with some teens it's easier to talk if they're engaging in.

Some activity like art or a project.

And that is definitely true because they're.

Sort of distracting themselves from, from what's going on and they're not having to sit in the moment. They can be much more separated from what they're talking about if they're focusing on what they're, what they're doing. So they, they're able to distance themselves from the emotional impact of those thoughts.

There are a lot of people, and.

I've got several classes on trauma and.

And the level of the number of.

People that have psychological trauma, that have traumatic experiences in their life ranges anywhere from, the estimates range anywhere from 50% all the way up to 98% depending on the cohort and depending on who did the, who did the study.

And it is definitely important to remember.

That trauma from the past, you know.

Could have created a situation where the.

Person, you know, was trying, struggling, trying to deal with whatever that trauma was in their own way, whether it was through addiction or other behaviors and developed hypocortisolism when they were arrested. As Amanda points out, she works with people who are in the criminal justice system when they're arrested. That can be traumatic which if they're already have high, if they already have hypocortisolism, they're going to do that flat to furious, become excitotoxic, be more vulnerable to developing PTSD and recurrent hyper vigilance and other issues, you know, as a result of the present traumas, which you know, had they been, you know, perfectly fine and dandy and healthy going into it, they may not have had as strong or as dramatic of a reaction. We don't want to minimize people's experiences even if it seems like they're overreacting. We want to remember what Linehan talks a lot about in terms of people's reactions are their own and if they emotionally dysregulate, it's even more traumatizing to them. If we invalidate their reactions and tell them they're overreacting, if they're going from flat to furious, we want to recognize.

That that's their HPA axis just dumping.

Cortisol and glutamate and glucose, trying to help them fight or flee to protect them from whatever threat that they're, that they're perceiving.

And Britney points out that I talk a lot about fight or flight in, in this class and that's true because.

The HPA axis controls our fight or flight. It's the one that excites us.

But there's also two other F' freeze.

Is one that a lot of us know when people just feel completely paralyzed by the stressor, they don't know what to do. They don't know which way to go. And you know, that happens a lot with psychological stressors.

And then the fourth one is.

And, and I'm using cleaner language because YouTube doesn't like me to swear is.

The forget about it. And sometimes people just get to the.

Point where so much has happened. You get to that learned helplessness point and it's just like a stressor happens and they're just like, I can't deal with it. I just, I can't deal with one more thing. And they withdraw. If you want to think about that experiment that you learned about in Psych 101 with the poor doggy and the electrified fence in learned helplessness.

That'S kind.

Of the, the, the fourth F now with those. The HPA axis is in freeze. The HPA axis doesn't really know what it's doing. And a lot of that is the cognitive stuff kind of getting jumbled up in the.

Forget about it.

The cortisol and everything else just isn't even there anymore. And the person's just like, I don't, I, I don't care. I can't mess with it. So.

And Christina points out something that I.

Hadn'T ever heard of before. So I'm learning something today. Fawn can be, I'll say as a fifth response to stress when the person gives in or people pleases to avoid, to avoid conflict or danger.

So yeah, I mean, I can certainly.

See that if you just succumb to it. I mean, think about Stockholm syndrome. That would be more of a fawn than anything else.

With a child who's experienced trauma at school. What are some ways to educate future teachers about what the child may be experiencing?

And how she might deal with it. Okay, so I'm assuming, I'm hoping I read that correctly, sadly, that the child actually experienced the traumatic event at school. School.

So it's going to be important for.

Teachers to be aware of triggers in the environment that might prompt that child to have a stress related reaction. If she was assaulted in the bathroom, for example, then going to the bathroom may be a very stressful place. Even if it's not the same bathroom. Even if that happened in elementary school and now she's in high school, going to the bathroom may always feel like a dangerous place to be. So she may need to figure out.

Ways to feel safe. Remember to turn down the heat, to.

Turn, turn down that HPA axis.

People need to feel safe.

HPA axis is activated when the brain thinks it's unsafe, either because of a.

Physical stressor or a psychological stressor. So to help the person feel safe.

Is what you're going to need to do. Figuring out the again, the environmental triggers for that child's stress reactions.

There also may be, you know, certain.

Times of day that are more likely to trigger stress for, for that child or certain things that people say or ways people behave.

We really want to go back to.

That original trauma if, if the child is able to do that or if you know about it and think about what was going on and what might happen in her current situation and then.

Develop tools to help her deal with that.

Distress tolerance skills are excellent. Being aware of triggers and preparing for them if she can't avoid them completely, those are important things to do.

Helping teachers be aware of what it.

Looks like when she starts becoming stressed out, whether she acts out or she withdraws. If she dissociates, what does that look like?

And have her develop a plan that.

She can share with them for what they can do to help her out. And it's going to be really individual for each person.

But it is important to help teachers.

Recognize that.

Just because somebody is in.

A different class or older or in a different place, it doesn't mean that that trauma is gone from their mind. And so it's important for us to help them learn how to adapt and live their and into their new normal.

Are there any other questions? Alrighty. As always, y', all, the PDF of this slide is in your classroom.

So when you go in and you.

Take your quiz, you can download the.

PDF if you want to take a look at that.

And as I said, if you're interested in the HPA axis, going to PubMed.

And reading that article would be enlightening if nothing else. Like I said it was, it's one of my favorite articles, but you know, I have weird taste, so all right.

Everybody, have an awesome day. Have an awesome week.

If you're not planning on being here.

On Thursday and I will see you.

Next time.

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