Wie sich Trauma neurobiologisch auswirkt / Text ist in Arbeit

Excerpts of / Auszüge aus "Narrative Exposure Therapy" (Maggie Schauer, Frank Neuner, Thomas Elbert)
(Text ist in Arbeit / under construction):

Sprachlosigkeit / Speechlessness

Mangelndes chronologisches Erinnern / Lack of explicit memory

Fühllosigkeit / Non-Feeling

"The ordinary response to atrocities is to banish them vorm consciousness. Denial, repression, and dissociation pberate on a social as well as an individual level... Far too often secrecy prevails, and te story of the traumatic event surfaces not as a verbal narrative but a a smptom. Remembering and tellling the truth about terrible events are prerequisites both for the restoration of the social order an for the healin of individual victims." (Judith L. Herman, 1992b)

"Only through an externalizaation of the feelings, abuse and distrust, will true healing occur.

NET works at the level of the individual by encouraging the telling of the trauma story and by reliving the past traumatic sceneries within an imaginative exposure design. ... Thus NET weaves hot implicit memories into the story unfoldet by cool declarative memories.

Riggs et a. found that 70% of veterans who had been diagnosed with PTSD wer in relationships characterized by clinically significant levels of relationsship destress; this rate was much lower among veterans without PTSD (30%). In paricular, veterans with PTSD presented more aggression toward thier inimate partners and were at increased risk for perpetratin domestic violence.

Epidemiological studies have found that one or more comorbid psychiatric disorders diagnosed in additon to PTSD occur in 80% of cases (Kessler, Sonnega, Bromet, Hughes, & Nelson 1995)

In accordance with this finding, our group found that experiencing traumatic events leads to severe immunologial alterations, e.g., a reduction in naive cytotoxic and regulatory T-cells, which can explain the increase risk for infections and autoimmune diseases, respectively (Sommershof et al. 2009)

The numer of traumatic experiences is the main predictor for PTSD...
Pretrauma vulnerability factors such as education, previous trauma, childhood adversity, psychiatric history, and family psychiatric history predicted PTSD consistently in several studies, bu only to a surprisingly small extent.
We carried out as study that showed that the cumulative number of traumatic events experienced was the main predictor of PTSD among the war-affected Sudaniese and Ugandan West-Nile populations. In the studied population, we found that every person who reported more than some 25 trumatic events in their lifetime met the criteria for PTSD. Nobody seems to be sesilient at such a level of repeated threat. (Neuner et al 2004a; Schauer et al. 2003)

There is no evidence for the hypothesis that the prevalence and validity of PTSD depends on cultural factors.
Obviously, this possibility to break the mind is an integral part of being human.

Other than accidental single traumata, these repeated and overwhelming experiences, especially during childhood, modify the brain in structure and function.

In these cases victims could foresee the next traumatic experience but could not influence the timing and had no way of escaping other than through dissociation of consciousness.

The fact that victims with poor social support followin a traumatic event are at an increased risk for developing PTSD might be explained by the lack of opportunity or encouragement to talk about the event.

Summary - Emotiona processint of the fear/trauma structure:

Emotional processing enables the reconstruction of the auobiographical representation of the event. The explicit (declarative) autobiographical representation is needed to regulate the activation of the original fear/trauma structure. This will modify the connections withi the fear/trauma structure. People naturally seem to try to heal themselves by narrating their experinces. In many cases this is helpful, because this process naturally helps building up cool memory context information. Because thinking about the traumatic event automatically causes painful emotions, people avoid this process (despite the fact that it may prove helpful) and try to terminate recollection as soon as possible. By avoiding the memories, they are inhibiting the habitual processing of the experimence and as a result the fear / trauma structure seems to consolidate itself, and chronic PTSD can develop. When however, a patient thinks and talks about the event in chronological order and includes the stimuli presented by intrusive memories, autobiographical knowledge about the traumatic episode can be reconstructed and the victim can learn to distinguish between past and urrent threats. The construction of a narration enforces the activation and consequently the habituation of the fear. This exposure ist the most powerful means to tearing down the fear / trauma network. In this process, the pationt is learning that sensory and emotional memory can be activated without fear.

Foa and colleagues systematically developed exposure therapy for PTSD. This technique has proven to be one of the most successful treatment approaches for this disorder.

In particular, Foa demonstrated that those patients who manage to construct a coherent narrative of the event during exposure therapy profit most from treatment.

Because the sensory-perceptual representations of the memoriein the brain provoke intense emotional reactions, successful therapy cannot proceed without a high level of emotional involvement.

Consistent with this view Jaycox, Foa and Morral (1998) showed that tratment success in exposure therapy is positively correlated with the level of fear initially experienced in treatment - that is the higher the level of fear experience initially, the greater the success of the treatment.

Note that putting feeling into words regulates negative emotional responses. Linguistic processing such as affect labeling and naming of emotions contro amygdala activity.

The majority of survivors of organized violence of war and torture, are unable to safely escape their countries, forced instead to flee to insecure places within their home country or in adjacent regions that are often equally affected by war and  terror. In additon to living with violence many of these refugees are also living in poverty, suffering from malnourishment, and are dependent on humanitarian aid. It seems plausible that these living conditions would question the applicability of any psychotherapeutic treatment. However experience shows that this is not the case. Contrary to Maslow's hierarchy of needs, suggesting that treatment for psychological problems cannot be addressed as long as the basic needs of nutrition and safety are pressing, our investigations show that survivors see their mental health as having the highest priority and theat mental functioning is the prerequisite for self-efficacy and meeting one's basic needs.

Note that the effectiveness of narrative procedures can be explained by the construction of an explicit, semantic representation of the events, coupled with a defractionation of the fear/trauma network and by habituation and inhibition of fear and helplessness. As pointed out by Kaminer (20016) in her literature review, three additional factors max also contribute: 1. emotional catharsis, 2. developing an explanation of the traumatic incidence, and 3. identification of the causes of and responsibilities for, the horror.

Indeed these factors are an integral par of NET.

What we know today is that catharsis as solely abreaction (in sense of "letting off steam" through the expression or the reactivation of previously suppressed trauma related feelings) is not enough as a cure for trauma symptoms.

The therapist must never work on the incident as a fragment of the persons's life. (47)

Support the processing of the material by following the emotional reactivity. Generate the physiology of that emotion: Pursue memorial association of the affect and generate memorial cues that elicit the physiological responsiveness.

The essence of NET is to connect the hot memory - i.e. sensations, feelings, and thoughts - to the coresponding sequences in the autobiography by putting all memory fragments into words and thus into declarative memory.

This is what you are here for: To accompany the person, side by side, back to the most horrifiying moments of their past life.

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