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October 23, 2014

The impact of the brain’s survival ‘wiring’

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Because EMDR can get through to the limbic brain, Dr Uram estimated that approximately 85 per cent of people show a marked improvement, with many recovering completely

Delegates at an upcoming conference will hear about how childhood traumas can affect us years later and even determine addiction patterns.

Dr Shelley Uram – a Harvard-trained, triple board-certified psychiatrist, who is a Senior Fellow at the Meadows in the US – is set to speak at the forthcoming NEAR Conference about how the human brain’s survival ‘wiring’ impacts, and often interferes, with the ability to thrive in our lives.

The NEAR Conference is being hosted by Toranfield House, the addiction and behavioural health centre based in Enniskerry in Co Wicklow, and is taking place from 10-12 November at the Ritz Carlton Powerscourt Hotel in Enniskerry.

The backdrop for Dr Uram’s presentation is the recent announcement by the American Society of Addiction Medicine (ASAM) of its new definition of addiction – that it is a chronic brain disorder, not just a behavioural problem. The ASAM has concluded that when people see compulsive or damaging behaviours in friends or family, these behaviours are actually a manifestation of an underlying disease that involves various brain parts. At its core, addiction is not just a social, moral or criminal problem; it is a brain problem whose behaviours are manifest in all these other areas.

In her presentation, Dr Uram will assert that psychological trauma is the genesis of most addictions. Very often, relational traumas sustained during childhood may ultimately lead to uncomfortable feelings, urges and compulsions, which may lead to self-medicating (with food, drink, drugs, gambling, sex, et cetera).

Dr Uram’s skill is taking this complex information about how the brain works and turning it into easy-to-understand concepts. She will explain about the three different levels of the brain. The top level is the cortex (the outer layer), which contains the pre-frontal cortex. This deals with understanding, thinking, analysing and planning. Our personalities are mostly located in this area. The second level, the limbic brain, contains much of our ‘survival’ wiring and fight/flight/freeze responses. The oldest part of the brain in terms of evolution, which is the brainstem, maintains much of the homeostasis of the body and integrates trauma responses within the body with sensations and feelings.

Reaction to traumas
In the brain, obvious traumas – such as natural disasters, wars, murder or terrorist attacks – can register in the same way as relational traumas, such as how a parent relates to a child, child neglect or abuse. These are held in the unconscious, limbic area of the brain. These memories can become imprinted into the evolutionarily ancient limbic brain, which is a part of the brain that does not understand thought or language.

The primary modality of dealing with psychological trauma in Ireland and the UK is CBT (cognitive behavioural therapy), or similar therapies. When people are traumatised, they have a ‘story’ about the trauma and what happened, which is stored in the pre-frontal cortex. So, when people try to deal with these traumas through CBT, they actually work on their story of the trauma.

This is in contrast to how the limbic brain encodes the traumas as the emotional and physical symptoms of fight/flight/freeze response. It is these repeated responses that give chronic post-traumatic stress disorder (PTSD) symptoms. Experiences that are encoded as fight/flight/freeze responses can be triggered and re-triggered  for  many  years after the initial trauma.

“Say, for example, you have a three-year-old girl. Her mum goes through a mild depression for about 6-8 weeks and is perhaps 20 per cent less emotionally available than usual. In the child’s brain, at that age it would trigger a fight/flight/freeze response, which in turn is stored in the limbic brain.”

Dr Uram continued: “Fast forward to when her first boyfriend leaves her at 18. She’ll most likely re-experience the fight/flight/freeze response. Her pre-frontal cortex will make up a story about what has just happened, but the reality is that her anxiety is coming from the ‘old part’ of the brain – from the initial trauma when her mother was mildly depressed.

“Move forward another 30 years to when she’s 48: her children have left the nest and she finds herself very anxious again. The chances are that this is, again, coming from the limbic brain from the original trauma, as opposed to the conscious ‘story’ about her children leaving home, which comes from the pre-frontal cortex.”

Dr Uram said that as a result of this kind of childhood relational trauma, coupled with many other relational traumas that are similarly processed, people become quite stressed and “may resort to self medicating – with drink, drugs, food, gambling, sex or whatever – to help them cope”.

Unravelling the brain
The good news is that treatments are available, according to Dr Uram, as there is a way to get in touch with the limbic, unconscious part of the brain and unravel what happened there. This is done through ‘bottom up’ therapies, such as EMDR (eye-movement desensitisation reprocessing), somatic experiencing and other treatments.

EMDR is a psychological therapy founded by Dr Francine Shapiro. She discovered that disturbing thoughts seemed to disappear as she moved her eyes in rapid sideways movements. EMDR was developed initially for PTSD and was found to be successful with Vietnam veterans and rape survivors. In 2000, it was recognised as an effective PTSD treatment by the International Society for Traumatic Stress.

Because EMDR can get through to  the  limbic  brain,  Dr  Uram estimated  that  approximately  85 per cent of people show a marked improvement, with many recovering completely.

She cited studies where some patients were on anti-depressants while others underwent EMDR. For the patients on anti-depressants, all symptoms returned after they were stopped – because, Dr Uram said, their brains were “bathed in serotonin”. For those who underwent EMDR, their symptoms got better while in treatment and continued to improve after EMDR was stopped.

The reason for this, according to Dr Uram, was that their chronic anxiety or depression was dealt with effectively, through EMDR in the limbic part of the brain – the right level in the brain to actually generate a response.