Neuropsychology and post traumatic stress disorder
Neuropsychology is scientific, objective and organized discipline for looking at person’s brain by properly observing their behaviors (Swiercinsky, 2001). It uses investigational and objective measures to evaluate the action among individuals with identified disparity in their natural brain structure and to look for for countless sources of brain variances that produces differences in the behavior of each person. Contributing factors comprises biological, social and psychological factors (Swiercinsky, 2001).
The clinical neuropsychology studies how injury or disease affects the brain structures and changes the behavior and meddle with the cognitive and mental functions of an individual (Swiercinsky, 2001). In its application it investigates the biological sources of differences of individuals. Clinical neuropsychology helps in the identification of brain disorders in memory, cognition, self-awareness, emotional expression and personality (Swiercinsky, 2001). Understanding the neurofunctional abnormalities as an effect of brain injury or damage identifies the limitations for present and future behavioral expectations in the daily life of a person (Swiercinsky, 2001).
Post Traumatic Stress Disorder
Post traumatic stress disorder (PSTD) is a very common kind of anxiety disorder that develops after experiencing an extremely event that caused harm or death (“Post-traumatic stress disorder (PTSD)”, 2007). The signs and symptoms of post-traumatic stress disorders develop within three months of seeing or living with the traumatic event wherein some cases, the symptoms may occur few years after that traumatic event (“Post-traumatic stress disorder (PTSD)”, 2007). A person with post traumatic stress disorder may experience the following symptoms: problems with their memory, feeling of emotional numbness, poor concentration, flashback of traumatic events for minutes or even days, difficulty in sleeping, feeling of guilt or shame, visual or auditory hallucinations, irritable mood, easily frightened, having dreams of the traumatic event, difficulty in handling or engaging in relationships and having self destructive behavior (“Post-traumatic stress disorder (PTSD)”, 2007).
Although not yet fully understand, researchers believe that the possible causes of post traumatic stress disorder are the following: first is the life experiences of an individual in which they would encounter different traumatic events; secondly is genetics wherein there’s a possibility that post traumatic stress disorder is hereditary; third is the personality or character of a person wherein their coping skills are high enough to surpass this kind of anxiety disorder; and lastly is the changes in chemicals in the brain wherein there are changes in the amount of different chemicals needed by the brain structures to function very well (“Post-traumatic stress disorder (PTSD)”, 2007).
Post traumatic stress disorder can affect people of all ages but it is comparatively common in adults especially women which has a double prevalence than men. There’s also a large number of soldiers with PSTD especially those who have served in combat (“Post-traumatic stress disorder (PTSD)”, 2007). Most people with PSTD experience one or more of the following distressing events: have been in combat, living through a natural disaster, robbery, kidnapping, plane crash, living through an accident, rape, torture, have seen someone or a relative being killed, terrorist attack, child abuse and has been diagnosed with life threatening disease (“Post-traumatic stress disorder (PTSD)”, 2007). Not all people can develop PSTD especially those who have strong personality or character or have good coping skills. But they can still be at risk if they experience or have the following: the person has a relative who has PSTD; the intensity of the traumatic event is very strong that the person cannot tolerate it; having relatives with depression; the traumatic event has been experienced for a long period; there is no or less support from the family members or circle of friends; and the person has already have a mental illness (“Post-traumatic stress disorder (PTSD)”, 2007).
Post traumatic stress disorder is not just psychological but also has a physical effect on the brain. There are different parts of the brain that is directly affected by the PSTD. Studying the different parts of the brain that involves in emotions and memory helps the researchers identify the probable reasons of PSTD (J. D. Bremner, 2000). The first brain structure that is related with the function of memory is the hippocampus that appears to be very perceptive to stress. This part of the brain has a significant role in the connection and organization of different pieces of a memory and it is thought to be accountable for tracing the memory of an event in its place, time and context (J. D. Bremner, 2000). Damage or injury caused by the stress to the hippocampus may cause problems with memories and impairs the process of learning (J. D. Bremner, 2000). According to some recent research, hippocampus has the ability to regenerate neurons, which is a part of the normal operation of the brain and stress slows down or stops the regeneration of the neurons (J. D. Bremner, 2000).
Aside from the hippocampus, prefrontal cortex is also affected by the post traumatic stress disorder. This area of the brain controls the judgment, decision making and problem solving of a person (J. D. Bremner, 2000). Different areas of the prefrontal cortex play different roles. The medial prefrontal cortex is the part of the brain that controls the fear and emotional reactions and it also restrain the action of amygdala as an alarm center placed deep in the brainstem (J. D. Bremner, 2000). While the ventromedial prefrontal cortex maintains the long period of extinction of fearful memories (J. D. Bremner, 2000).
Another affected brain structure is the amygdala that controls the memory, learning ability and the emotion of a person. Amygdala shows an active participation or has the control in the acquisition of fear and as well as the first stage of extinction of fear (J. D. Bremner, 2000).
Treatment of Post Traumatic Stress Disorder
In the past, dealing with post traumatic stress disorder was very hard because instead of talking to others, people tend to hide their feelings from others. But now, there are good quality interventions available for post traumatic stress disorder like talking to a therapist, which helps a person overcome their problem, or anxiety disorder.
There are different kinds of therapy used in the treatment of post traumatic stress disorder. One of it is the cognitive behavioral therapy (CBT) which is the most effective type of counseling for post traumatic stress disorder patients (“Treatment of PTSD”, 2007). Cognitive behavioral therapy comprises of cognitive therapy and exposure therapy. There are also other intervention used for patients with PSTD like eye movement desensitization and reprocessing (EMDR), medications, group therapy, psychodynamic psychotherapy, and family therapy (“Treatment of PTSD”, 2007).
Cognitive therapy is a type of psychotherapy that highlights the significant role of thoughts in how we feel and what we do. It implies that emotional pain is due to vague thoughts about stimuli giving rise to troubled emotions (“Treatment of PTSD”, 2007). The mission of cognitive therapy is somewhat understand the relation of the three components namely the emotions, thoughts and behaviors and how they are being affected by the external stimuli (“Treatment of PTSD”, 2007). In the process of cognitive therapy, the client or patient will learn, explore and test, and will develop the coping skills including their ability for evaluation, self-consciousness and introspection. When they acquire and develop these skills, they will be able to handle the process on their own and reducing their reliance to all the people around them especially their therapist and also reducing the chances of having relapses (“Treatment of PTSD”, 2007).
Another intervention is the exposure therapy wherein the patients face up a feared situation, memory, thought or object (“Treatment of PTSD”, 2007). This is used to deal with phobias, anxiety and post traumatic stress. The goal of the exposure therapy is to lessen the physical or emotional pain brought up by certain situations (“Treatment of PTSD”, 2007). Hypnosis and virtual reality techniques are sometimes use for this kind of approach (“Treatment of PTSD”, 2007). Furthermore, this type of therapy also causes anxiety to the patient but this is made on purpose so that they will be able to learn coping skill thus reducing or eliminating the symptoms (“Treatment of PTSD”, 2007).
The eye movement desensitization and reprocessing (EMDR) is a new and fairly complex therapy for post traumatic stress disorder. There are several steps in this technique and all of this has different approach and direction (“Treatment of PTSD”, 2007). The unusual part if this intervention is the movement or waving of the fingers of the therapist in a back and forth motion in front of the patient’s eye. The patient must track this finger(s) while reminiscing the traumatic event (“Treatment of PTSD”, 2007). This approach seems to be effective since the patient was able to evaluate the traumatic event calmly. Despite the fact that this approach is just new in this field, studies shows that it helps lessen the symptoms of PSTD. Although some researches suggest that eye movements are not essential in the treatment of PSTD (“Treatment of PTSD”, 2007).
Medication is also an essential part of the treatment of posttraumatic stress disorder. Chemicals in the brain affects it function especially when there are changes in its normal level. Reduction of serotonin level causes depression to a person (“Treatment of PTSD”, 2007). The condition may improve if the patient takes a prescribe medicine or the SSRIs. SSRIs is also called as the selective serotonin reuptake inhibitors which is an antidepressant medicine that increases the level of serotonin in the brain (“Treatment of PTSD”, 2007). The SSRIs comprises of the following: fluoxetine (Prozac), sertraline (Zoloft), citalopram (Celexa), and paraxetine (Paxil) (“Treatment of PTSD”, 2007).
Group therapy is also considered as an intervention for posttraumatic stress disorder. In this type of therapy, patient is placed in a group of people who have experienced a traumatic event in their life or those who have PSTD. The group therapy will help the patients rebuild their self-confidence and trust and also their relationship towards other people especially those people who have the same situation with them (“Treatment of PTSD”, 2007).
Another approach for the treatment of PSTD is the psychodynamic psychotherapy, which is the process or verbal communication used to find relief from emotional distress. The goal of psychodynamic psychotherapy depends on the process of treatment which is either supportive or expressive (“Treatment of PTSD”, 2007). Expressive therapy finds a relief of the symptoms through the development of a person’s insight. In contrast with this, the supportive therapy is used to relieve pain, helps the patient to get back to his level of functioning and strengthen his coping skills so that they will be able to face up their problems and anxieties (“Treatment of PTSD”, 2007).
REVIEW OF RELATED LITERATURE
There have been extensive studies on the effects of posttraumatic stress disorder on the brain arising from chemical and brain structure changes. The investigation was published in the Dialogues of Clinical Neuroscience in 2006, which has started on animals and extended to humans. One of these clinical studies was about the effect of traumatic stress to the brain structures like decrease in size of the hippocampus and anterior cingulated volumes, increase amygdala function, and reduce function of the medial prefrontal/anterior cingulated (J. Bremner, 2006b). Researchers believe that higher amount of cortisol and norepinephrine in the brain causes post traumatic stress disorder (J. Bremner, 2006b). They used antidepressants to counteract the effects of traumatic stress on the brain. Treatment done on this study showed positive results like improvement in memory and had an increased volume of the hippocampus (J. Bremner, 2006b).
Another study was made regarding the effects of major life trauma the functions of amygdala and medial prefrontal cortex (LM et al., 2006). Researches believe that the processing of fear happens in the amygdala and medial prefrontal cortex (MPFC). And to further investigate their theory, they conducted a study on the impact of fear on the amygdala and medial prefrontal cortex using functional MRI and fear perception tasks (LM et al., 2006). The result of this study reveals that PSTD subjects has bilateral reduction of the activity of the medial prefrontal cortex compared to the non traumatized subjects (LM et al., 2006). PSTD subject also has major development in the activity of the left amygdala most evident during the late phase and the right amygdala has less response in the early phase (LM et al., 2006).
The relationship between cognitive function and changes in the brain structures regarding the effects of posttraumatic stress disorder has also been stress out. According to some pre-clinical studies, hippocampus changes its figures and functions along with the stress encountered by the subject or patient (J. Bremner, 2006a). A study included in this investigation shows that selective serotonin reuptake inhibitors (SSRIs) and the phenytoin (dilantin), which is a medication for epilepsy can obstruct the effects of stress on the hippocampus(J. Bremner, 2006a). Imaging studies on posttraumatic stress disorder (PSTD) reveals that patients who have serve or experience war and those children that had been abuse have lesser hippocampal volume (J. Bremner, 2006a). A functional imaging studies using the positron emission tomography (PET) shows a decrease activity of the hippocampus with the memory task (J. Bremner, 2006a). The result of the first year of study of paroxetine treatment shows an increase in the volume of the hippocampus by 5% and an increase in the memory function by 35%(J. Bremner, 2006a). In the second study made, the result reveals that phenytoin was effective to use against the symptoms of PTSD and guide to a major increase of 6% in the hippocampal and brain volume with no changes in the memory functions (J. Bremner, 2006a).
A recent study regarding the possible effects of age as well as psychiatric diseases such as depression, schizophrenia or post traumatic stress disorder in which there is a reduction of hippocampal volume was conducted to further investigate this theory (SJ et al., 2007). According to the result of the study, there is no difference in the volume of the hippocampus of healthy young and older adults (SJ et al., 2007). This study also illustrates that the idea of atrophy of the hippocampus in humans and increases the possibility that pre-determined inter-individual disparity in the volume of the hippocampus may conclude the susceptibility of age related cognitive problems throughout the life span (SJ et al., 2007).
Another follow up investigation using the functional neuroimaging was made to look for the other possible effects of traumatic stress on the brain structures (J. Bremner, 2007). The brain areas such as the hippocampus, medial prefrontal cortex and amygdala are the areas that are responsible or that control the memory and stress response. The study that was conducted recently suggested for further investigation or researches to evaluate the relationship between the changes in the function of the brain and recovery from the traumatic stress caused by the traumatic event that the patient has experienced (J. Bremner, 2007).
Post Traumatic Stress Disorder is proven to have a significant effect not only on the psychological well being of the individual who suffers from the malady but also on the physical attributes of the victims brain.
Based on clinical studies, the part of the brain affected by the disorder is the Prefrontal Cortex. This region controls the thoughts processes related to memory retention and extinction. Stress has an atrophic effects on the hippocampus, limiting the regeneration of neurons and causing a slight reduction in size.
The reduction in the size of hippocampus clearly indicates the effect of stress on the human brain. Proper treatment has shown an increase in the volume of hippocampus, which is a clear indicator of the effect of the therapy conducted on the patient. The amygdala area, the part of the brain processing thoughts related to fear acquisition, is also highly affected by stress disorders.
Neuro-imaging has provided a enormous contribution in the study of the effects of stress and trauma to the human brain. Quantifying the physical effect that the disorder has on the individual has provided researchers and medical practitioners a view on the processes involved in the human brain processes affected by the disorder. Treatment using various techniques has been developed to provide specific treatment of Post Traumatic Stress Disorder. Neuro-imaging provides a gauge for checking the development of the patient based on the extent of the changes in the brain structures.
Although treatment and therapy is still not yet perfected, researches are still being conducted in finding other means and methods to effectively address the Post Traumatic Stress Disorder. There are still other areas that may possibly be affected by the malady and is currently being looked upon.
Bremner, J. (2006a). The relationship between cognitive and brain changes in posttraumatic stress disorder. Annals of the New York Academy of Sciences, 1071, 80-86.
Bremner, J. (2006b). Traumatic stress: effects on the brain. Dialogues of Clinical Neuroscience, 8(4), 445-461.
Bremner, J. (2007). Functional neuroimaging in post-traumatic stress disorder. Expert Review of Neurotherapeutics, 7(4), 393-405.
Bremner, J. D. (2000). The Invisible Epidemic: Post-Traumatic Stress Disorder, Memory and the Brain. Retrieved 29 )ctober, 2007, from http://www.thedoctorwillseeyounow.com/articles/behavior/ptsd_4/
LM, W., AH, K., K, F., M, B., G, O., A, P., et al. (2006). Trauma modulates amygdala and medial prefrontal responses to consciously attended fear. Neuroimage, 29(2), 347-357.
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SJ, L., A, E., C, L., J, M., M, P., B, P., et al. (2007). Hippocampal volume is as variable in young as in older adults: implications for the notion of hippocampal atrophy in humans. Neuroimage, 34(2), 479-485.
Swiercinsky, D. P. (2001, 07 November). Clinical Neuropsychology 101 (An Introduction). Retrieved 29 October, 2007, from http://www.brainsource.com/NP101.htm
Treatment of PTSD. (2007, 31 May). Retrieved 29 October, 2007, from http://ncptsd.va.gov/ncmain/ncdocs/fact_shts/fs_treatmentforptsd.html