Trauma Related Brain Damage: Neurotoxicity of Stress

Foreign. I'd like to welcome everybody. Today's presentation on trauma related brain damage, glutamate and neurotoxicity. I am your host, Dr. Donnelly Snipes. Now, I know this sounds like potentially a dreadfully boring class, but we're really only going to talk about the mechanics of it for a couple of slides, and then we're going to start talking about what you can do about it. So we're going to explore the effect of trauma on glutamate levels and in the body, especially the brain. We'll learn about the effects of glutamate and cortisol on the brain and explore symptoms of glutamate imbalance. Finally, we'll identify interventions to assist in the recovery of the HPA axis, which is when glutamate levels are imbalanced. That means the HPA axis is not functioning optimally. Remember, the HPA axis is your threat response system. And we'll also talk about ways to assist in the recovery of neurotransmitter balance and just overall brain functioning. Moderate activation of the glutamatergic neurons plays an important role in learning in synaptic plasticity. So we do want a little bit of excitement. Think about when you were trying to learn something. It, if you think it's something that you already know, if you're really not motivated, if there's not much excitement about it, you probably have a harder time committing it to memory because you just don't care. You know, we need to care about it. We need to have a little excitement. And glutamate is our main excitatory neurochemical. So when we're a little bit excited, when we're a little bit anxious, it prompts that HPA axis to turn on just a little bit. Give us some norepinephrine to focus, give us some dopamine to, you know, persevere, and give us some glutamate to be enthusiastic. So a little bit of glutamate, just like a little bit of cortisol, is necessary for motivation and energy and things like that. Unfortunately, glutamate also enhances inflammation. Too much of it can be a problem. One of the things we talk about a lot in terms of neurotransmitters is called the Goldilocks principle. Too little of a neurotransmitter can cause problems, and too much can cause problems. So we want it to be just right. Too little glutamate can result in difficulty concentrating, mental exhaustion, fatigue, apathy. A lot of those feelings that we associate with depression, too much can result in excitotoxicity, which can damage the nerve cells in the brain. It also contributes to feelings of that we would associate with anx. Excess glutamate is thought to contribute to cell degeneration in hunting Huntington's disease, and lead to acute movement disorders such as tremor, gait disturbances, parkinsonism, dyskinesias, dystonias, myoclonus and restless legs. Now I know that dopamine is also involved in a lot of these things, but you're going to learn in a minute that glutamate and dopamine are interrelated. And dopamine actually potentiates, makes glutamate more powerful. Dopamine receptors located on the glutamatergic terminals enhance glutamate release in the presence of stimulants. And that can be caffeine, that can be nicotine, that can be adhd, medications can be cocaine. You know, anything that's a stimulant. And it can even be excitement that comes from when that HPA axis, you know, ramps up it. Your body secretes cortisol, which triggers the release of glutamate and dopamine. And when that dopamine is, is secreted, it enhances the effectiveness or the potency of the glutamate. Dopamine, unfortunately, because it enhances this potency, may also increase the excitatory neurotoxicity of glutamate. When we talk about excitatory neuro, neurotoxic, the analogy I make is cooking. I, I go back to a lot of things for cooking, but when we are overly excited, when we are overly stressed, when we have too much glutamate going through our body, we are running too hot. And if you want to think about it that way, and, and even Eastern medicine, traditional Chinese medicine, talks about, you know, the difference between yin and yang or yang and yin, I guess hot and cold. Yin is your cold, yang is your hot. And when we've got too much glutamate coursing through our system, we're running too hot. And too hot causes cell death. You know, that's overly, overly simplified, but kind of gives you a better frame of reference. Instead of talking about all of those big ex neurotoxicity and all those other things, we're just running too hot and we're making it so the cells actually start to decay and decline. Normally when the HPA axis is doing what it's supposed to do, a stressor evokes a stress response and causes the Release of hormones including cortisol, norepinephrine, adrenaline, which helps us adapt to the situation to protect ourself. When the threat is gone, then our system is supposed to re regulate itself or go back into the rest and digest place when the response is overused or dysregulated. And when I say overused, that can refer to chronic stress or dysregulated can even refer to a single acute stressor that is particularly intense. But for a lot of our clients, what we're talking about is chronic stress and it can be chronic stress from lifestyle factors, chronic stress from uncontrolled PTSD, or all of the above. So there are a lot of things that we want to consider. But when our HPA axis is over activated or activated for too long, it leads to quote pathophysiological processes, which means the body, physiologically we actually have changes that are pathological, including stress induced remodeling of the brain and neuronal death. This is not something that we want. We don't want neurons dying on us at a faster rate than they need to. When people experience a trauma, it disrupts their sense of safety and can contribute to the development of hyper vigilance. We've seen this and this is true immediately after a trauma acutely and can remain through that acute stress period. It can also for some people who go on to develop ptsd, often remains as a symptom of ptsd. So we want to recognize that hypervigilance is a very normal reaction. It's the body going crap, I don't want to do that again. So I need to be aware, I need to be alert. So it makes sense that we may experience that. However, persistent hypervigilance results in persistently elevated levels of cortisol, our stress hormone and glutamate, our excitatory neurotransmitter. And this is what we don't want because then it starts, starts when it's constantly there, it starts becoming toxic to the cells. Acute and chronic stress induced release of glucocortic glucocorticoids, cortisol, cause changes in glutamate neurotransmission in the prefrontal cortex, which, remember that's where we do all of our executive functioning, our planning and stuff and the hippocampus, which impact cognitive processing. So these changes that happen, especially with regard to glutamate transmission start impacting us up in that prefrontal cortex in the hippocampus and it causes problems with goal setting and execution, attention, impulse control and Even fear extinction. So thinking about our clients, thinking about the people that we work with who have had trauma, who in their past, or who may be struggling with things like goal setting and execution, attention and impulse control, we really need to screen for traumatic stress and HPA axis dysregulation, because there may be something underneath. You know, they're just general presenting symptoms that is contributing to the dysfunction in glutamate neurotransmission and causing problems in prefrontal cortex functioning. Dysfunction of glutamatergic neurotransmission and prefrontal cortex functioning is increasingly considered to be a core feature of most stress related mental and physical illnesses. You know, kind of let that sit in for a while. Physical illnesses like autoimmune diseases. Remember I said on the first slide, glutamate increases inflammation. HPA axis over activation contributes to systemic inflammation. Inflammation is strongly related to. Drumroll, please. Depression and anxiety. So we can see how these physiological symptoms also interact with mental health symptoms. But inflammation is also related to autoimmune diseases, including, you know, fibromyalgia. They found that a lot of. There's a lot of evidence pointing to the fact that diabetes may be at least partially an autoimmune disorder. Lupus, eczema. There are a lot of different autoimmune disorders that may be caused and definitely can be exacerbated by problems with HPA axis dysregulation, specifically glutamatergic neurotransmission. And. And. Exactly right. Working in a jail. I think that's probably Jennifer. Yeah, Jennifer. Working in a jail. The majority of people that are in jail, according to a survey that we did in the Alacha county jail some years ago, the vast majority have experienced trauma. So not only do they have, you know, ish stuff that impacts their perception of the present, but they also may be more hyper vigilant when they're in jail. They're typically, you know, also hyper vigilant because a lot of times it doesn't feel like a safe place. Now, I'm not going to knock every jail, but, you know, I've heard that jail is not a walk in a park. So definitely repeated trauma and then continued chronic stress and a chronic feeling of unsafeness will certainly cause sustained levels of glutamate, high levels of glutamate, Gl. And that's a wonderful question, Patricia, whether there's a higher frequency of dementia in people with ptsd. And I don't know the answer to that, but I do know that people who have high levels of Depression also evidence high, higher levels of dementia. And they're associating the connection there with systemic inflammation. Alzheimer's is also associated in many cases with a inflammation and a neurotoxic environment. So it's possible that PTSD prompted systemic inflammation could lead to that. You know, obviously if somebody has PTSD and they, you know, get it treated quickly and get it under control, then, and they're not having the hyper vigilance and the persistent sense of unsafeness and persistent level of stress, then it may not be a risk factor. But it certainly can be a motivator when we help people start understanding that stress leads to inflammation and inflammation is a bugaboo. I've talked before about the Flat and the Furious, and this is basically what happens when the the receptors become tolerant to excessive levels of cortisol and glutamate in the system. Just like an alcoholic or a person with alcohol dependence needs more alcohol in order to get the same effect, get the same high over time because their body adapts to it and becomes tolerant. The same thing is true with our receptors to glutamate and cortisol. When they are persistently exposed to those excitatory neurotransmitters, they become tolerant. Somewhere in there, your brain recognizes that you can't, quote, run that hot for that long. So the brain says, you know what? No, we're not passing that along right now. So in order to get those receptors to activate, we need a stronger flood of cortisol and glutamate in order to get a reaction. So under persistent stress, glutamate response is blunted in the prefrontal cortex. So it's harder to potentiate that glutamate release, it's harder to get that HPA axis to even activate. But when it does, look out. During conditions of chronic stress, acute stressors, something that is potent enough to actually move somebody to distress may prompt an exaggerated release of glutamate, that glutamate and those and cortisol levels remain elevated for significantly longer. Now, if you've read any of Linehan's work, this is going to sound really familiar to you because one of the key features of people with emotional dysregulation is they have an exaggerated stress response when presented with a stressor and it takes them a lot longer to return to baseline. Well, this is the physiological reason why. And this is one of those things that can be helpful, I find, when working with clients because it helps them understand that it's not all, I hate to say it's not all in their head, because it is, you know, the neurons are in their head, but it's not something with willpower. It's not something that they're doing intentionally. There's a physiological reason to. To why they may disregulate strongly and then take longer to get calmed down. And Jennifer, you may see this in your inmates as well. They may, you know, go from 0 to 220 like that, and then it takes them a minute. They, they can't just, you know, take a few deep breaths and it's all good. It takes them a minute to get re regulated. Now, there's a lot of reasons for that. There's a lot of cognitions that go along with that. But, um, and we're going to talk about some of those interventions in a few minutes. But, you know, the point being, the dysregulation experience comes from a physiological reaction that is due to a dysfunction in the glutamatergic system in the HPA axis, or at least that's one of the reasons for it. Low to moderate levels of cortisol and glutamate enhance synaptic function. Now, this isn't, you know, too low. What this, what I was trying to say here is that we need a little bit of cortisol and glutamate to be motivated, to be interested, to be intrigued. So a little bit helps enhance our memory and helps us commit things to memory. But if you get too anxious or too stressed or too much cortisol and glutamate, then it becomes harder to remember things and it becomes harder to learn over days or weeks or after a sudden insult like a seizure or a stroke. Excessively high levels of cortisol and glutamate cause neuronal, neuronal death and suppress neurogenesis in the prefrontal cortex and hippocampus and cause neurons in the amygdala and orbitofrontal cortex to grow. So those areas in our brain that are more primitive, more associated with fear conditioning, those get bigger. And the areas in our brain that are associated with impulse control, goal setting, attention planning, you know, all of that stuff, those get smaller. So you can see where this is a problem. And they've done brain scans. I mean, there are actually changes to the weight to the density of those areas of the brain. And this happens quickly, days or weeks. It's not something that takes, you know, it's not something that has to go on for years and years before it causes a problem. You know, it happens relatively quickly. However, the good news is with reductions in stress and that's physiological and cognitive. These changes may be reversible, but Recovery often takes 30 or more days. It takes the brain a while to get the message that, okay, hey, we're safe now. I don't need to keep the glutamate levels high. I don't need to stay on this level of, you know, constant alert and then start actually rebuilding itself. So what do we do? You know, I, I think most of us have worked with clients and probably known people who've had some level of HPA axis dysfunction. I would venture to say that, you know, better than 50% of the population has some level. But the question is, what do we do about it? Glutamate antagonists, now these are substances that actually suppress glutamate. Not recommending them, just pointing them out. Barbiturates and benzodiazepines, your anti anxiety medications and your sedatives obviously increase GABA levels, decrease glutamate levels, by the way, glutamate, well, glutamine is an amino acid. Glutamine is turned into glutamate. Glutamate is broken down into gaba. So if there's not enough glutamate in the system, there's not enough, not enough raw material, so to speak, to make gaba. So that's kind of an interesting little thing there. But when glutamate starts to get broken down, it can be made into gaba, which helps us calm down. Dextromethorphan, which is a common cough medicine and unfortunately it's a common over the counter drug of abuse, can also be a glutamate antagonist. Dextromethorphan not only reduces glutamate levels, but it also increases serotonin levels. So just be aware that that is a drug of abuse by people and was a popular one for a little while with young people. Alcohol. Now alcohol has two little asterisks by it because it's both an antagonist and an agonist. When people first drink alcohol, when it's sedating to them, then it is antagonizing that glutamate. But it leaves the body faster than the body can replace it with gaba. And so people experience when they're detoxing or when the alcohol is leaving their system, people experience increases in blood pressure, increases in anxiety, increases in heart rate and respiration, and that is due to that increase in unopposed glutamate in the system. So alcohol is kind of a sticky wicket. Ketamine has been studied a lot recently. For people with resistant severe major depressive disorder, especially ones who are suicidal. And they have found that nasally administered ketamine has a rapid, rapid and potent antidepressant effect in treatment resistant major depressive disorder and bipolar depression. Now, interestingly enough, one of the main effects of ketamine is to antagonize the glutamate. So people who are agitated, who are suicidal, the, the, the thought is, and they're not exactly sure how it all works yet, the thought is that they have high levels of anxiety and glutamate that are contributing to exhaustion and that the ketamine actually calms their system down for a minute. So nitrous oxide and phencyclidine are also glutamate antagonists. So thinking about people that we've worked with, people that we know, how might abuse of any of these substances because they're all abusable, be triggered by PTSD or chronic stress? And you know, that kind of answered our own questions here. We already talked about how PTSD and chronic stress increase. Glutamate may keep it increased and lead to that dysregulation, that excessive glutamate secretion and, and then longer time to return to baseline. So the use of these substances is potentially one way people might be self medicating to try to suppress that glutamate level faster than what their body can actually do. Normalizing glutamate levels, there are a lot of nutrients that are necessary in order order to keep the body going. Vitamin B3 or niacinamide is a coenzyme in glutamate dehydrogenase. This is the substance that breaks down glutamate. So when glutamate is in the synapse, it either has to be reabsorbed or metabolized, broken down. And if people don't have enough glutamate dehydrogenase and in their system, then they don't have their, their body isn't as efficient at breaking down the glutamate either to make it into GABA or to, you know, dispose of it. Carnitine may also support and protect glutamate receptors, which can be really important because we talked about how over stimulation of those neurons can cause neuronal death. Well, carnitine theoretically goes in there and kind of protects against those things. So think of it kind of like when you wear sunscreen, when you go outside, it protects you from those nasty old UV light rays. Same sort of thing. You know, again, way oversimplified, but same sort of thing with Carnitine protecting the neurons from the heat, quote unquote of the glutamate neuroadaptogens, including ginkgo and rhodiola rosea may protect neurons from excessive glutamate excitation as well. I am not underscore, bold italicize, not recommending that anybody start taking supplements without consulting first with their physician because a lot of these substances, with the exception of B3, may interact with medications. So it is important to make sure because that people are, you know, doing things safely. If they want to try it, they should get it cleared with their medical professional. Neurolipid compounds like DHA, which is an omega 3, are used in cell membranes and may support balanced glutamate receptor signaling and functioning. Again, a really oversimplified analogy would be, you know, thinking like omega 3s are fatty acids, think about sort of greasing the system to make sure everything flows smoothly. Magnesium, vitamin D and taurine are also important nutrients for normalizing glutamate levels. Most people get most of these things in their diet without any problem at all, with the exception of omega 3s. Most Americans can benefit from enhancing their omega 3 intake, but, you know, they need to figure out how to do that in a sensible way. Ashwagandha is another neuro, neuroadaptive herb, and it has also been shown or thought to protect against glutamate damage. Another one that I found really interesting was bee pollen. Bee pollen has been demonstrated to ameliorate effects of glutamate excitotoxicity on the impaired glutamine glutamate GABA circuit. So basically, bee pollen can go in there and help that circuit heal, which I thought was really neat. Now, I don't know how much or, you know, ingestion, you know, anything like that, but I thought it was interesting that something as natural as bee pollen is helpful at ameliorating the effects of excitotoxicity. It's neuroprotective. Gonadal hormone balancing is also important. If you've watched the videos that I've done on our gonadal hormones, estrogen is actually, for example, a neuroprotective substance. So if people's estrogen levels or testosterone levels or progesterone levels are out of balance, then that may contribute to those neurons in the brain being more susceptible to glutamate excitotoxicity. And that's one we don't think about a lot. But remember, as we age, our gonadal hormones naturally decline and some People's decline more than others. Stress also impacts the level of gonadal hormones. Chronic stress suppresses gonadal hormones, thereby making the brain more susceptible when, when we're under stress because those gonadal hormones are suppressed, our brain is more susceptible to damage. So making sure that people go to the doctor, get a blood test for their, to measure their hormone levels, get a blood test to measure their thyroid levels, get a blood test to measure their vitamin D levels. It's all the same blood test. You're not having to get stuck to three times. But, you know, these are things that are really simple to test for and can have a significant impact on long term health and well being. Reduce stimulants, including caffeine, and that is really hard to do in our culture. I think a lot of people already drink caffeine. Whether it's green tea or black tea or coffee or soda. We are regularly ingesting caffeine and caffeine is a stimulant. Caffeine triggers the HPA axis and while it's not triggering it nearly as intensely, for example, as, you know, cocaine or something like that, it is causing an increase in levels of glutamate throughout the body and it is contributing to an increase in inflammation. Reducing nicotine is also important. Nicotine does have some stimulant effects to it. It has a myriad of effects, but it's been found that nicotine also enhances the excitotoxicity in the brain. So reducing nicotine, reducing stimulants, that also improves sleep, which, you know, sleep is when the brain repairs itself. So that's good too. Now, terpenes, these were the things I was talking about before class started. Terpenes are the aromatic compounds that are found in plants. They can be found in plants like rosemary and black pepper and oregano, sage. Any of your herbs in your, in your cabinet have terpenes in them? Cilantro has terpenes in it. So it's interesting to note that there's something called the entourage effect that makes terpenes even more effective. Terpenes by themselves can have restorative or healing properties to them, but when combined with their plant host, whatever you want to call it, the two of them work together synergistically in order to improve health and well being. So they found, like for example, they've done studies with cannabis where they've taken out the terpenes and just left the cannabinoids. And it had certain effects that we would expect, but it had much more potent effects when the terpenes were left in. Now not everybody can take CBD oil, not everybody is interested or even wants to go near cannabis. And people have a variety of reasons for this and, and that's, that's cool. It's important to remember that CBD oil, you know, even, you know, CBD oil, which, which has no THC or like only trace amounts of thc. So it doesn't have that psychoactive effect. But CBD oils and cannabis both interact along the same pathway as a lot of medications ranging from anti anxiety medications to warfarin. So taking it needs to be done very cautiously and under medical supervision if people are taking any, any other medications. But terpenes can also be found in essential oils. So people who are not interested in ingesting them at all, they just want to get the benefit by inhaling them, which, you know, is, has a lot of benefits. Can find that certain terpenes, linalool, caryophylline, limonene, beta pinene, humulene and geraniol, all have very neuroprotective effects and can normalize glutamate levels. They may ra also raise GABA levels and raise serotonin levels which act to help suppress or re regulate the HPA axis. So linalool is found in a lot of things, including lavender. Lavender is the most common one. Beta, beta caryophylline is found in cloves, black pepper and rosemary. So think about how these things smell a little bit differently. Most plants have multiple terpenes in them, which is why clove, black pepper and rosemary smell very different. But they all have caryophylline in them. Limonene is found in citrus oils and citrus foods. And spearmint. I was like really spearmint too. Limonene has been shown to produce reductions in HPA axis activation. It helps calm down that HPA axis and reduce hypervigilance in some people. That was a really cool article and I've told you all before you can order D limonene. It's D dash limonene from online and I get mine in, in from some chemical company I can't remember. But it's organic delimonene that comes super concentrated. It is a super intense degreaser, works great in the wash. But our house smells like lemon like all the time. So hopefully it's helping us relax a little bit. Beta pinene is another one and like you would think it smells like pine and it can be found mainly in rosemary and all of your different pines, your cypress, your balsam, your furs, Your, you know, whatever your pine essential oils. Humulene is also found in sage, cloves, basil and black pepper. So you see that cloves and back black pepper have both caryophylline and humulene. And geranial, like it sounds, is found in geranium, rose, geranium and interestingly enough, citronella. I know a lot of people really don't like the smell of citronella, but it is another one of those substances out there that you can find. You know, most people like the smells of smell of geraniums or roses. So you can get your geranial that way. Helping clients figure out ways to work terpenes into their life. You know, essential oils are obviously super available. You can order them offline, you can get them at health food stores. You're not ingesting them, you're just inhaling them. And they can be used. You can put it on a little cotton ball and just keep it in a Ziploc bag in your pocket or in your purse or wherever you can use it. Use them for cleaning. They have the little wax tarts that you can plug, plug in the warmer into the wall. Ways you can diffuse and use. There's also diffusers. Ways you can diffuse and use essential oils are pretty much only limited by your creativity. There are a lot of different ways to use them. They are highly, highly, highly potent and can be very toxic. It is recommended by most physicians never to ingest them. That is, you know, going to be my statement on that. You need to talk with your doctor if you have a different perspective. So these are things that clients can easily start doing to promote relaxation, to promote the release of GABA and serotonin, to help them feel calmer. And each one of these hyperlinks, as always, goes to a study in PubMed that will. That talks about the calming effects and the neuroprotective effects of these particular terpenes behaviorally. Now we can talk to them about using essential oils. We can encourage them to eat a healthy diet and talk to a nutritionist. But when it comes to what do we actually do, how can we actually help? We are able to target some of the causes of hyper vigilance. We can help them first figure out how do they create safety when they are. When we're hyper vigilant, when we are on edge, when we feel like a soldier in a foxhole, we are feeling unsafe for some reason. So first we need to figure out what is it that's triggering this sense of unsafeness and what can we do to create safety in our environment and in our own head. And in our own head is where it can become a little bit dicey sometimes because people with ptsd, people with a history of trauma may have, you know, an inner critic that is extremely harsh. They may have an inner child that is extremely scared, and they also may have be plagued by intrusive thoughts and flashbacks. So it's going to be important to help people figure out, you know, again, what are the things that are causing me to feel unsafe and triggering that stress response and what can I do about them? So with that, I'll jump down here. EMDR is, can be very helpful for people that have intrusive thoughts and traumatic memories and flashbacks. So if part of the lack of safety comes from within their own head, that might be something that they want to consider. Cognitive processing therapy and acceptance and commitment therapy for trauma can also help them cope with intrusive thoughts and reduce dirty discomfort. Basically, cognitive processing therapy walks them through examining the thoughts that they're having and encourages them to take a step back from those thoughts, examine the facts supporting and against their thought in the present context, look for extreme words and see if they're missing something, if they're only looking at one small widget, or if they're looking at the big picture. So there's a lot to cognitive processing. I don't. I'm not going to get into the whole thing here, but cognitive processing is a very practical, sort of almost linear approach to addressing intrusive thoughts and can be very helpful for some. One of the. One of my favorite tools in acceptance and commitment therapy is living in the and and helping people embrace the notion that they can have a rich and meaningful life as they define it and experience occasional intrusive thoughts. This can be really helpful because sometimes people get frustrated and they're like, I can't live a decent life when I'm having these memories. And it's important to help them recognize that those memories and those intrusive thoughts may not go away right away. You know, that's something we're going to work towards, but they may not go away right away. However, you know, they can strive to have a rich and meaningful life and learn to cope with those at the same time. So and is a big word in acceptance of commitment therapy. Hayes also talks about dirty discomfort. And basically that is the quicksand of negative emotions. When we have an initial thought, fear or anger, then that is what he calls clean discomfort. But then when we start getting angry about the fact that we're afraid or depressed about the fact that we're angry and then we start feeling guilty about the fact and you know, we have all these other ancillary dysphoric emotions that kind of jump on the dog pile. That's what he calls dirty discomfort. And one of the goals of ACT is to help people mindfully identify and non judgmentally accept their feeling as it is in the moment. If they're angry, if they're scared, if they're, you know, fill in the blank as you know, it is what it is. Now how can I improve the next moment? Or I can feel anxious and do this thing that may be prompting some anxiety or do this thing that is meaningful to me. So I do have an entire video on acceptance and commitment therapy for trauma on the YouTube channel. But I find that CPT, cognitive processing therapy, acceptance and commitment therapy and DBT skills are all extremely useful. And DBT skills are really helpful when people have that initial reaction of fear or anxiety or anger because it can help them with that dysregulation. When they have that initial flood of glutamate and cortisol going into their synapses and they become dysregulated. DBT skills, their emotion regulation skills and distress tolerance skills are super helpful to give people tools so they don't feel completely overwhelmed or powerless to these waves of emotion and they start feeling like they've got some personal agency when they feel this way. Identifying it, accepting it, and figuring out what to do. Kind of like the sump pump of emotions. And I never knew what a sump pump was until I moved to Tennessee, but it's one of those pumps when the basement starts to flood, you know, you can drain it out really quick and, and that's kind of what we might be talking about here. Meditation has also been found to increase glutamate metabolism and GABA levels. So when people engage in mindfulness meditation specifically, they become aware of the moment, they become aware of their situation. So they're stepping out of that flashback and they're getting, helping themselves get grounded. It increases the, their sense of relaxation, the glutamate metabolism. Remember the dehydrogenase breaks down that glutamate and makes GABA more available. So meditation can be super helpful. Remember that there are tons of different ways to meditate. Not everybody is good with meditating with their eyes closed. Not everybody is good with having to sit still to meditate because they feel like they're going to crawl out of their skin. So helping them explore different types of meditation and that can include forest bathing and, you know, walking in nature. That can include tai chi, it can include, you know, yoga, any form of meditation. I obviously, I tend to be more of a mobile meditator. I have difficulty sitting still. I know that shocks you, but helping them find a form of meditation that helps them get grounded, the goal is to get grounded and help them feel like they are not spinning out of control. Exercise also increases neurogenesis. So when we are overly stressed and we have too much glutamate, it contributes to neuron death. When we exercise, it contributes to neuro neuron growth. So that's a good thing. Part of that is because it increases blood flow throughout the body, brings more oxygen to the brain, and at a low intensity, 40 to 50% of your target heart rate, it reduces cortisol. Now, 40 to 50% is a moderate walk. It's not even a power walk. It's a moderate walk where you're still just talking like, nope, nothing's going on. If you're starting to breathe heavy, you're probably, or, you know, notice that you're breathing heavy, you're probably higher than that 50%. Forest bathing is, is kind of interesting because it combines the benefits of meditation with terpenes. And they found that forest bathing actually in nature, you know, go, go figure. Going into a wooded area where there are plants, where there's pine trees and oak trees and whatever kind of plants are around is more effective at helping people relax than even being in a situation, maybe with a VR headset where they are visually and maybe even auditorily immersed in nature, but they don't have the terpenes that they're smelling. They found that the terpenes from the plants can be, be beneficial. They've also found in some other studies that having plants in your recovery room can be very beneficial. Actually live, you know, live plants that are growing roses, you know, get the geraniol in there. The terpenes from them can actually reduce pain levels. And they did one study and they showed a significant reduction in opioid use in inpatients when they had access to live plants in their room. Other ways that you might be able to do this, if, you know, the hospital or place you work doesn't have that many windows, you can't have plants inside or something, you know, a VR headset or a really one of those really spiffy new TVs that looks like what you're looking at is real plus diffused essential oils with the terpenes in them can, you know, be a compromise if you can't get out to do that. But they have found a lot of benefits in that. I did a video on that, I did a class on that on forest bathing and feng shui. Again, the videos on the YouTube channel if you're interested in learning more about that particular technique. So there are a lot of neat things that we can do to help people feel safer and learn to regulate their HPA axis and cope with the intrusive thoughts and the intrusive memories when they happen. Glutamate is our main excitatory neurotransmitter. Like all other substances, when exposed to glutamate for an extended period, receptors become tolerant and require more to elicit excitation. Under chronic stress, it takes the body longer to reduce glutamate levels, which leads to a longer exposure of, to of the neurons to the glutamate. Activities and substances that help create safety, reduce stress and HPA axis activation and those that enhance neuroprotection are all helpful for recovery. And you're exactly right. Our olfactory sense is our strongest memory trigger. So that is certainly something to know. That's one of the reasons that not every essential oil works for everybody. In the same way, it's. It's important for people to try different forms or different formulas to find what works for them because they may have a negative association with one or more essential oils. But the terpenes in the essential oils actually do go into our brain, go into our hypothalamus via our, our sense of smell, and it does actually trigger physiological reactions. So it is. Yeah, I think it's really cool, but I kind of like it. Kind of like the brain stuff.