Understanding PTSD: Why Do Trauma Memories Feel Dangerous?
Many of my patients who have been diagnosed with PTSD describe their traumatic memory as if the event just happened yesterday. They tell me it feels dangerous to examine the memory and to allow it into their minds. They tell me that any reminder of the memory also feels dangerous. This makes sense for a variety of reasons.
First, thinking about the worst day or days of your life will understandably feel awful. Second, one component of PTSD is experiencing intrusive thoughts about the traumatic experience and other symptoms related to feelings of re-living the trauma, otherwise known as re-experiencing symptoms (American Psychiatric Association, 2013). Intrusive symptoms reflect the nature of PTSD as a recovery disorder (Resick et al., 2017). Although most people experience PTSD symptoms after a traumatic event, most people recover in a month or less. What does recovery mean? In part, it means that these individuals are able to think of the traumatic experience without feeling significant anxiety or distress. However, if the memory continues intruding into your conscious awareness and causing significant distress, it generally is a sign that the brain did not properly process the memory and place it into long term memory storage (Foa & Kozak, 1985). The brain thereafter keeps prompting intrusive thoughts about the traumatic memory in order to remind the individual to process and properly store the memory. Unfortunately, this means that the memory continues feeling very fresh, in a way that some patients describe as ‘hot.’
These intrusive memories provoke anxiety symptoms because the brain continues believing this event to be a recent occurrence that we must be vigilant of and prevent from happening again. In addition, without proper processing and storage, the brain will continue forcing the memory into awareness but instead of allowing the memory to be present, individuals with PTSD push the memory away. The longer we try to avoid something, the harder it becomes to face and the more anxiety one will experience when the intrusion comes to mind. Therefore, from a psychological perspective, avoidance is one of the main reasons memories continue feeling dangerous. When we tell our brains, “hey, don’t think about that, it’s scary,” we develop a stronger fear response if we do not look.
From a biological perspective, memories feel dangerous because they are activating the part of our brain that detects danger, the amygdala (Resick et al., 2017). Specifically, experts have explained this activation as part of the neurocircuitry model of PTSD (Rauch et al., 2006; Hughes & Shin, 2011) which suggests that three areas of the brain contribute to an extreme fear response to traumatic memories when an individual has PTSD. While the amygdala is over-reactive to the memory, creating a fear response to the memory, various regions in the part of our brain involved in rational processing, known as the prefrontal cortex, is under-reactive (Hughes & Shin, 2011). Therefore, the prefrontal cortex fails to remind individuals with PTSD that they are not rationally in any danger when they experience the memory (Rauch et al., 2006; Hughes & Shin, 2011). In addition, the part of our brain responsible for long-term memory storage, the hippocampus, functions abnormally in individuals with PTSD (the exact nature of these abnormalities are still being examined by researchers; Hughes & Shin, 2011). The abnormal functioning in these three regions interfere with fear extinction (Hughes & Shin, 2011). For these reasons, when I ask my patients with PTSD if it feels like the event is still happening, they often say yes, even if the event or events took place a decade or decades ago.
Many of my patients feel like these memories will always feel dangerous. This is a fair assumption because, since the event or events occurred, the memories have likely triggered. The good news is, the memories are not actually dangerous and they do not need to be avoided. In fact, one major aspect of PTSD treatment is reducing and eventually eliminating avoidance of traumatic memories so that your brain can properly process and store these memories. We will eventually even help you process what are known as, hotspots, or the aspect of the traumatic memory that triggers the highest levels of anxiety or distress when re-experienced (Nijdam et al., 2013); oftentimes, hot spots represent the most terrifying aspects of a memory. Your provider will help you do so by using treatments and techniques that challenge avoidance of memories. One technique is called an imaginal exposure, in which processing takes place by imagining the event. By doing so, the brain will learn that the memory is actually not dangerous and is not still happening. The memory is in the past and we are here to help your brain recover from the past.
Please call 630-570-0050 or email us at Contact.OH@OakHeartCenter.com to get started with your healing process.
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). https://doi.org/10.1176/appi.books.9780890425596
Foa, E. B., Hembree, E. A., & Rothbaum, B. O. (2007) Prolonged Exposure for PTSD: Emotional Processing of Traumatic Experiences: Therapist Guide. Oxford University Press.
Foa, E. B., & Kozak, M. J. (1985). Treatment of anxiety disorders: Implications for
psychopathology. In A. H. Tuma & J. D. Maser (Eds.), Anxiety and the anxiety
disorders (pp. 421–452). Erlbaum.
Hughes, K.C., & Shin, L. M. (2011). Functional neuroimaging studies of post-traumatic stress disorder. Expert Rev Neurother, 11(2), 275-285. https://doi.org/10.1586/ern.10.198
Nijdam, M. J., Baas, M. A. M., Olff, M., & Gersons, B. P. R. (2013). Hotspots in Trauma Memories and Their Relationship to Successful Trauma-Focused Psychotherapy: A Pilot Study. Journal of Traumatic Stress, 26(1), 38-44. https://doi.org/10.1002/jts.21771
Rauch, S. L., Shin, L. M., & Phelps, E. A. (2006). Neurocircuitry models of posttraumatic stress disorder and extinction: human neuroimaging research – past, present, and future. Biol Psychiatry, 60(4), 376-382. https://doi.org/10.1016/j.biopsych.2006.06.004
Resick, P. A., Monson, C. M., & Chard, K. M. (2017). Cognitive Processing Therapy for PTSD. The Guilford Press.
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