Over the past decade, our society has become more aware of trauma and its effects. Thanks in part to the popularity of books such as Bessel van der Kolk’s The Body Keeps the Score and Gabor Mate’s When the Body Says No, we are currently experiencing a cultural awakening to the impact of unprocessed and oftentimes misdiagnosed trauma.
Trauma comes in many forms, including major events like natural disasters and war, childhood abuse and neglect, and interpersonal and relational trauma. As we learn more about trauma, we are expanding our understanding of what can be classified as trauma. Using new brain-imaging techniques, we are also discovering how our brains rewire themselves in response to all kinds of trauma, whether it happens in one life-changing moment or comes in the form of chronic, subtle exposure to overwhelming circumstances.
In this article we’ll explore the many faces of trauma: we’ll discuss the consequences and symptoms of unprocessed trauma, the role brainmapping plays in identifying the effects of trauma, and how neurofeedback can help heal PTSD and developmental trauma.
Understanding Trauma: Beyond PTSD
For many of our clients, “trauma” doesn’t feel like an appropriate label for their experiences. We traditionally associate the term with experiences like combat, car accidents, or violent crimes. What research is teaching us, however, is that many common experiences, including relational difficulties, abuse and neglect (regardless of how minor or severe), pandemics, and even a mother’s stress during pregnancy can all produce trauma markers at the neurological level.
To begin healing from trauma we must start by recognizing that we don’t necessarily have to go through devastating earthquakes or incomprehensible abuse in order for our brains to function in a traumatized way. While such life-altering events are undeniably difficult and traumatic, distressing day-to-day occurrences can be as impactful in the long run. From bullying to job loss to toxic relationships, these seemingly normal experiences can all have a cumulative effect on our mental and physical well-being. While traditional trauma such as combat exposure or physical abuse is recognized as the precursor to PTSD, smaller traumas and the chronic stress that comes with it are also associated with mood disorders and impaired immune function.
Aside from shaping our behavior and causing numerous knee-jerk reactions (trauma responses, colloquially referred to as „triggers”) unprocessed trauma can lead to any of the following symptoms:
- anxiety and depression
- substance abuse
- difficulty maintaining healthy boundaries
- difficulty navigating interpersonal relationships
- social withdrawal
- poor self-esteem
Different Types of Trauma
We established that many events can be in fact traumatic and have long-lasting effects on our psyche. For the purpose of our article, we will focus on the trauma disorders we encounter most in our practice: PTSD and C-PTSD, specifically developmental trauma
- PTSD is a mental health disorder that can develop in the aftermath of witnessing or experiencing a single traumatic event, such as military combat or sexual assault.
- Complex PTSD (C-PTSD) is a PTSD subtype that involves the occurrence of multiple traumatic events. The most common type of C-PTSD we encounter is developmental – or childhood – trauma.
The journey that led to the recognition of post-traumatic stress disorder (PTSD) as a medical condition was long and tedious. Formerly known as shell-shock, combat fatigue, or war neuroses, the American Psychiatric Association introduced PTSD as an official diagnosis in the third edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-III) back in 1980. It mostly pertained to war veterans who found it increasingly difficult to adjust to regular post-war living. It was, however, not properly understood and ended up being underutilized as a diagnosis. This led to numerous individuals suffering from PTSD being misdiagnosed with mood disorders such as depression or anxiety.
According to the National Center for PTSD, nowadays 5 in every 100 Americans suffer from PTSD in any given year, with women being much more likely to be diagnosed with this condition than men (8% vs. 4%).
Understanding Childhood Trauma
Developmental trauma has become synonymous with chronic abuse or neglect, but should not be limited to these behaviors. A highly sensitive child can be traumatized by the repetitive and unintentional emotional unavailability of a parent and be as affected as a child who’s witnessed physical abuse within his household in his formative years. We often see markers for developmental trauma in adopted children, even when they were adopted within days of being born.
According to a whitepaper on complex trauma in children and adolescents, children and adult survivors of developmental trauma can be impaired in any or all of the following areas:
- attachment: can include problems with boundaries and the formation of unhealthy attachment styles.
- biology: can include asthma and autoimmune disease.
- affect regulation: can include temper tantrums and difficulty communicating feelings.
- dissociation: can include amnesia of traumatic events and depersonalization.
- behavioral control: can include poor impulse control, and eating and substance use disorders.
- cognition: can include learning difficulties.
- self-concept: can include low self-esteem and feelings of guilt.
Affect Dysregulation in PTSD and Developmental Trauma
A hallmark of PTSD and developmental trauma is affect dysregulation. This refers to an individual’s inability to properly regulate their affective response in stressful situations. In children, affect dysregulation can present as temper tantrums and defiant behavior, while in adults it can show itself as substance abuse, self-harm, and interpersonal aggression.
When we collect a brainmap, we can identify the areas of the brain that have been dysregulated by trauma of any kind. With this information, we can assess how a person is likely responding to their environment day-to-day. Our brains have many strategies for coping with trauma, including withdrawing, dissociating, staying locked in fight or flight, or experiencing emotional flooding. With this knowledge, we can begin building new options for the brain from the cellular level, so that it has more flexibility and can maintain a calmer, less vigilant state.
Neurofeedback as a Tool to Heal Trauma
The standard course of treatment for trauma disorders is a combination of cognitive behavioral therapy (CBT) and medication, particularly selective serotonin inhibitors (SSRIs). A number of brain-based techniques and treatment protocols for trauma processing like EMDR and Brainspotting have emerged in the past few decades. The combination of these techniques with neurofeedback has emerged as a reliable and effective course that shows promising results.
Neurofeedback is a form of biofeedback that allows us to regulate specific areas of the brain by using positive visual and auditory feedback. In plain English, we monitor brainwave activity using an encephalogram (by placing a cap with electrodes on your scalp) and identify problematic patterns of brainwave activity. In the case of PTSD, for example, we usually find increased beta wave activity in the frontal regions of the brain, which leads to hypervigilance. We also tend to observe decreased alpha activity in the parietal regions of the brain, which makes it difficult to relax and increases symptoms of stress and anxiety.
To regulate brainwave activity, we use pleasant tones and screen brightness to reinforce healthy patterns and diminish negative ones. Referencing the same example we used earlier, we would use pleasant screen brightness whenever we’d notice a decrease in beta wave activity in the frontal region of the brain or increased alpha activity in the parietal regions of the brain. Over time, this form of operant conditioning would lead to improved brain function and fewer symptoms of trauma and stress-related disorders.
Neurofeedback Studies for Trauma and PTSD
Numerous studies demonstrate neurofeedback effectiveness in healing trauma:
- When compared to a group of Vietnam combat veterans with PTSD who only received traditional treatment, a group who also received neurofeedback therapy saw a significant decrease in relapse: all 14 traditional treatment patients have relapsed after 30 months, compared to 3 of the 15 treated with neurofeedback (Peniston and Kulkosky, 1991).
- In adopted children with histories of abuse and neglect, neurofeedback therapy produced significant improvements in both externalizing and internalizing problems, aggressive behaviors, anxiety, depression, and attentional problems (Huang-Storms, Bodenhamer-Davis, Davis, & Dunn, 2006).
- A pilot study revealed that undergoing 24 sessions of neurofeedback therapy led to a significant decrease in symptoms of PTSD, a reduction of emotional and behavioral symptoms, and improved executive functioning in a group of children aged 6-13 with severe developmental trauma who had not experienced significant improvement with other previous therapies (Rogel, Hamlin, Spinazzola, Loomis, Hodgonm & van der Kolk, 2020).
- A pilot study of neurofeedback for chronic PTSD revealed that neurofeedback significantly reduced PTSD symptoms and anticipated improvements in affect regulation (Gaspen, van der Kolk, Hamlin, Hirshberg, Suvak, & Spinazzola, 2016).
Trauma, whether it’s PTSD, developmental trauma, or the small repetitive frictions of a toxic work environment, can significantly impact our quality of life. Fortunately, trauma therapy has gained notoriety in recent years, and more people are beginning their journey toward healing. To this end, neurofeedback is one of the greatest tools in our arsenal.
To learn more about how Tennessee Neurofeedback can help you process and heal from traumatic events, get in touch. We’d love to help.