Keep Pain in the Past. Dr. Chris Cortman

too strongly to trauma, but also to ANY emotional stimuli; this overreaction can be measured in cortisol levels in your blood plasma and saliva.10 11 You might find yourself crying uncontrollably during a sad part in a movie, or overreacting in fear to a bathroom spider with a handlebar mustache. This would mean that your emotional reactions to items NOT associated with the trauma would be far greater than would otherwise be anticipated. You can imagine how exhausting life would be if everything felt frightening and required you to be on high alert. This is the experience of many combat veterans, including those I have known who have kept watch throughout the night, checking and rechecking the locks on the door and the safety of their children.

      As you may know, the brain is divided into four lobes: frontal, parietal, temporal, and occipital. The frontal lobe is responsible for things like personality, decision-making, initiation of activity, emotional reactivity (how one responds to emotions), motivation, social interactions, and even judgment. Evolutionarily speaking, this is the last part of your brain to develop, and it does not stop growing until your early twenties. It is this very same frontal lobe that scientists claim separates us as humans from all other creatures on the planet.

      Any trauma that occurs can impact your brain functioning. Within the frontal lobe is the medial prefrontal cortex (mPFC). The mPFC is responsible for inhibiting the stress response, which is housed in the amygdala. Koenigs and Grafman (2009) noted that people exposed to trauma had a decreased activity volume in their frontal cortex, more specifically in the mPFC.12 Why is this decreased activity important to PTSD? If the area of the brain responsible for shutting off the stress response is left on, the stress response continues. Continued stress can then lead to more unhealthy responses to difficult and stressful situations, including drinking alcohol to excess, angry responses, and even social isolation.

      The bottom line is this: trauma impacts the structures of the brain, making life considerably more difficult for the survivor. Healing from the traumatic event(s) becomes that much more necessary.

      Consider how Jim’s brain may have responded to his trauma. With traumatic impairment of his hippocampus, he reportedly perceived two young boys in the barbershop as too closely resembling his deceased boys, which therefore launched his body into a full-blown panic attack. His under-responsive prefrontal cortex (PFC) didn’t properly regulate his over-reactive amygdala and may have made normal challenges during his work at the auto shop feel overwhelming to him. Fortunately, these changes in the brain can be addressed with good treatment and healing.

      Cognitive Behavioral Therapy

      Cognitive Behavioral Therapy, usually just called CBT, was developed by Albert Ellis in the 1960s and Aaron Beck in the 1970s.13 CBT holds that our thoughts and beliefs influence how we behave and feel. Such beliefs include how we view ourselves, how we view others, and how we view the world. One person sees himself as inferior, while another sees himself as superior. You perceive your mother as supportive, your sister sees her as critical. One person sees the world as warm and welcoming, the other sees the world as cold and harsh. And as your therapist will tell you is true, how you perceive something is more important than reality when it comes to your feelings and emotions. Said simply, when it comes to your emotions, perception trumps reality (and that is not a political statement).

      How Beliefs about Self, Others, and the World Are Developed

      Self-views relate heavily to concepts like self-esteem, self-worth, and self-confidence. All of this supports a concept that psychologists call “self-efficacy.”14 When good things happen, it is either because “I worked for it” or because “I got lucky.” Views of self are influenced heavily by parental praise and punishment. Were your parents highly critical of you? If so, then you may think, “I’m not good enough,” and that “No one will ever love me.” On the other hand, if your parents affirmed not only your success, but also your efforts, you may “try and try again.”

      Views of others play out heavily in relationships. Was your trust betrayed by someone important to you? Maybe your father said he would show up at your baseball games, but never did. When the people you love let you down, trust becomes an issue.

      Views of the world come into play in the work environment, in the community, in government, and for the world as a whole. Is work a competitive place where coworkers backstab each other for promotions? Or is it a place where people cooperate to get the job done? What about government? Are politicians motivated to do good, or are they inherently corrupt?

      Cognitive Beliefs or Schemas

      The cognitive perspective on human behavior is especially important in explaining how pathological behavior endures over time. Beck (2011) explained that in psychology, views of self, others, and the world go by a technical name; they are called cognitive beliefs or schemas.13 Your beliefs provide a readymade mold into which your experiences are poured. We’ve all had the experience of responding in a knee-jerk fashion, in a rush to judgment that seems to ignore objective facts. This happens because your beliefs influence other interpretations of experience. People tend to fall back on pre-existing biases and prejudices (the beliefs one brings to the experience). We have to. The world is far too complex, and our cognitive abilities are far too limited, for our perspectives on life to be invented anew with each rising sun. Instead, we apply what we have been taught, usually by parents, role models, education, and other previous experiences in life. We have beliefs about ourselves, others, the world, and the future. These beliefs are usually accepted as facts because we just don’t have time to isolate and test the assumptions that underlie all of our thoughts and actions. From our belief system, certain thoughts, feelings, and behaviors arise. As an example, if you believe you are unworthy and unlovable, a friend cancelling their plans to hang out with you might invoke feelings of rejection, while at the same time your friend might have a very good reason why they had to cancel their plans.

      Cognitive Therapy and PTSD

      This is especially true with PTSD, where the very structure of memory and cognition are changed by a traumatic event. When clients tell me they “can’t remember what happened,” they are really saying that their physiological arousal at the time of the traumatic event was so intense that they cannot recall the details of their experience. This is called “state-dependent memory,”15 which means simply that the state of the body is encoded along with the objective facts of the experience. When the state of your body changes, your memory may not be easily accessible. Symptoms of numbing dampen emotions and prevent traumatic material from reaching your conscious awareness. Hypervigilance (being overly watchful) supports a sense of safety by ensuring that the individual attends to every possible threat. At the same time, it ensures that you perceive threats that don’t really exist, mobilizing your fight-or-flight system to deal with each such “emergency,” even if the loud noise was only thunder, and not enemy mortars.

      Because PTSD changes the very architecture of cognition, it is necessary for your therapist to interpret your statements liberally. Your reluctance to cooperate in therapy can mean either, “I don’t think I’m strong enough to say this out loud,” or “Talking about the traumatic event makes it real again.” When you say, “I can’t move on,” you may be referring to flashbacks or intrusive memories that suddenly return to your mind. Or alternatively, you may be saying, “I can’t move on due to guilt… What happened was my fault.” The term “survivor’s guilt” refers specifically to this phenomenon. Survivor’s guilt occurs sometimes when you survive a traumatic event where others died.16 “I should’ve died along with my mother, father, brother, sister, child, or fellow soldiers.” Survivor’s guilt may lead to “self-flagellation,” that is, punishing yourself for “letting loved ones die on my watch.” This includes any behavior with a high potential for painful consequences, such as risk-taking (e.g., excessive speeding), self-harming (e.g., cutting), self-neglect (e.g., drinking, drugs, loss of jobs and relationships), and not seeking treatment (in order to continue the misery of unresolved trauma). Careful inspection shows that self-blame is actually based on the expectation or assumption that life should be fair for everyone. Life is not fair, and the consequences can be tragic, particularly when you attempt to take responsibility for events beyond your control.

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