Step 2: Get Educated

I will try to keep this section as easy as possible to understand as I do not want to get too technical. This may anger some pure-ists but it is best to keep things simple and understandable. However, it is really really important to get your head round what PTSD is, and how it alters how your brain works (the neurobiology is the medical or science word for this). For me, understanding this was the first step on the long road to recovery because it meant I stopped blaming myself.

I spent 20 months working with a consultant psychologist, who I thought was helping me, who did not understand the basics of PTSD. She predominantly used standard cognitive behavioural therapy (CBT) techniques which were making me worse, and I could not understand why. As a result, I blamed myself even more, and the spiral continued downwards.

Standard CBT is ineffective for PTSD because CBT needs a rational brain. PTSD involves an irrational part of the brain and you simply cannot reason with it. 

I like to think of PTSD the same as I think of other physical disorders. Even though it is considered a mental health disorder, it is associated with changes that you can see on imaging investigations (scans of the brain), so I think it should be considered a physical disorder in the same way.

This is probably quite novel and a different approach, but I think it helps enormously and makes the whole situation much less confusing. PTSD is essentially a disorder of the amygdala. This is a tiny, almond shaped structure found deep in the middle of the brain (in fact we have two, one on each side). This is a primitive structure vital to survival, meaning that it is also a structure found in animals. It is useful to think of this structure as the brain’s smoke alarm. This means it goes off in response to any ‘smoke’ or trigger in the environment and generates a response in the body known as the ‘fright, fight, freeze’ survival response. I have to admit I hate using the word trigger as it is so over-used, especially in the media which means it has lost some of its meaning.

For me, in this context the word trigger is used to mean some kind of sensory stimuli in the environment which the brain perceives as a threat to survival and as a result, sets off the survival response. It is obvious that this response is very necessary – if you see a tiger charging towards you then you need your brain to get you to run away as quickly as possible. This needs to happen super quick without any thinking as if you don’t you might find yourself tiger food! However, this highlights a key point about the amygdala that it is vital to understand. The amygdala is outside your conscious control. You cannot simply just think differently to stop it reacting. You can try, but, as I found, your physical symptoms will just escalate and it is exhausting psychologically. This is why standard CBT is of limited used in the treatment of PTSD. For me, CBT was really unhelpful – I was blaming myself when the approaches weren’t working and I just became more and more depressed. The awful situation just got worse!

Scientists have imaged the brains of PTSD sufferers when they are ‘triggered’ – what is seen on MRI scan (a specialist kind of scan known as a functional MRI) is that the amygdala is over activated in response to what would be innocuous stimuli. At the same time, because the brain has gone into survival mode, the thinking part of the brain (mainly the frontal cortex) becomes down regulated or less active. This means it is very difficult, if not impossible to think straight, to take reasoned actions or conduct any rational executive function. When it is really bad, even the speech area of the brain, known as Brocas, becomes down regulated and speech can even become difficult. I experienced this quite a few times – it was really horrible, as I felt I had words I wanted to say but just couldn’t. It felt like it must feel for people having a stroke. 

Gaining some understanding how PTSD affects the neural pathways in your brain can be really helpful. For me, it meant I stopped blaming myself and was able to understand the reasons for treatment. Because of the physical effects of PTSD, trauma specialists and scientists now understand that one of the first stages of treatment of PTSD has to be to help people to feel safe in their bodies. This is why body work of some description plays a really important part in recovery. Some people call this ‘a bottom up’ approach. For me this was a vital learning point. If you want to learn more about this, including some of the science – Professor Van der Kolk’s book, the Body Keeps the Score, is really good, although quite heavy going in parts.