Neurology and Trauma

Impact and Treatment

Implications

Damien Dowd & Jocelyn Proulx

HPA - Axis

Hypothalamus

Corticotropin-releasing hormone

Pituitary gland

Beta-endorphins – pain suppression

Adrenocorticotropic hormone

Adrenal gland

Cortisol

Effects of Beta Endorphins

Avoiding stimuli reminiscent of the event

Emotional numbing

Loss of interest in daily activities

Detachment from others

Effects of Cortisol

Dysregulation of cortisol levels

Low levels interfere with ability to process the event into long term memory leading to flashbacks and intrusive memories

High levels can lead to hypersensitivity to psychologically threatening stimuli

Hippocampus

Formation of

memories

Stress regulation

Medial Prefrontal Cortex

Decisions about

appropriate or required

cognitive, emotional or

behavioural responses

Suppresses or

modified emotional

responses generated

by the amygdala

Filtering of information

Genetic Markers

Family mental health

Cortical dysfunction

Smaller hippocampus

Larger cavum septum pellucidum

Serotonin and dopamine systems

Treatment Approaches

Drug Therapies

Serotonin re-uptake inhibitors

Drugs reducing corticotropin-releasing

hormone

Antidepressants

Cognitive Behaviour Therapies

Exposure therapy

Imagery rehearsal

Stress inoculation therapy

Narrative therapy

Emotion focused therapy

EMDR

Eye movement desensitization and

reprocessing

MBSR

Mindfulness based stress reduction

Meditation

Evidence and Recommendations

Eclectic approach

Therapeutic relationship

Need for evaluative research