Solving the mysteries of PTSD
Do patients have the power to reorganize their own brain activity?
After spending 13 years in and out of hospitals, Teresa Kinney had given up hope. She did not expect to get well.
Teresa experienced extended trauma at a young age in the form of repeated sexual assaults.
In the years that followed, she experienced an array of symptoms including flashbacks, light trances that left her unaware of her surroundings and even suicide attempts. It was difficult to understand the symptoms and she was diagnosed with a number of illnesses.
It was not until she met Dr. Ruth Lanius that her illness was diagnosed as post-traumatic stress disorder (PTSD). Dr. Lanius is a psychiatrist at London Health Sciences Centre and a clinician-researcher at Lawson, specializing in PTSD. Teresa met Dr. Lanius in the emergency department following a suicide attempt. Dr. Lanius began working with Teresa in one-on-one and group therapies.
“I was struggling on a day-to-day basis when I met Dr. Lanius,” says Teresa. “I knew immediately that she was the right person for me to work with. She had a different approach and was the first to offer me hope for recovery.”
Dr. Lanius’ research combines imaging and psychiatry to understand the mechanisms of the human brain that produce symptoms. She then uses this knowledge to develop and test new therapies.
A common symptom of PTSD is defensive responses to stress or triggers. Triggers include sights, sounds, smells or feelings that bring back vivid memories of an individual’s trauma.
By collaborating with Lawson’s Imaging scientists, Dr. Lanius and her PhD student, Sherain Harricharan, were the first to show that people experiencing PTSD are constantly on edge or prepared for defense, even when they seem to be at rest.
There are two kinds of PTSD, each with different defensive responses. Individuals with the more common type of PTSD experience active defensive responses like irritability or even aggression. The other 15 to 30 per cent have more passive defensive responses like shutting down, freezing or out-of-body experiences.
Dr. Lanius and Harricharan wanted to unlock the mechanisms behind the defensive responses. “We knew from existing research that an area deep in the brain called the periaqueductal gray (PAG) plays a key role,” says Dr. Lanius.
Post-traumatic stress disorder
PTSD is a mental illness that some people develop after experiencing or witnessing traumatic events like combat, a natural disaster, a car accident, childhood abuse or sexual assault.
It can result from a single event or develop after ongoing trauma.
Anyone can develop PTSD at any age.
According to the National Centre for PTSD about seven or eight out of every 100 people will experience PTSD at some point in their lives.
PTSD symptoms vary from person to person.
The team conducted a seven-year study to examine both types of defensive responses by comparing the brains of participants with PTSD to those without. They used fMRI (functional magnetic resonance imaging) to scan participants’ brains while at rest, capturing brain activity by detecting changes in blood flow.
Participants with PTSD had extensive connections between the PAG and other areas of the brain associated with defensive action. Only those with passive defensive responses had unique connections between the PAG and regions of the brain associated with passive coping strategies.
“This study suggests that patients with PTSD are always on edge and ready for defense, even when they seem to be at rest,” says Dr. Lanius. “This is an important finding that could be a first step towards identifying neural and behavioural targets for therapies that address both kinds of defensive strategies.”
Harnessing the power of brain training
Dr. Lanius’ work also includes testing the amazing potential of ‘brain training’ exercises that give people the power to regulate their own brain activity, emotions and PTSD symptoms.
Individuals with PTSD tend to have more random patterns of brain activity. Brain activity involves different parts of your brain communicating with each other, and helps to regulate states of consciousness, thought, mood and emotion.
Her research suggests that those with PTSD can exercise their own brains to restore these patterns to a healthy balance and reduce their defensive responses.
The process is called neurofeedback - training or exercise for the brain.
A neurofeedback loop acts as a mirror that visually displays a patient’s brain activity to them. This is done through a computer interface that records brain signals through sensors on the patient’s scalp. Since the person can see their brain activity, they can complete exercises in ways similar to a gym workout and see the results.
In one study, participants were asked to reduce the intensity of the brain’s dominant brain wave – the alpha rhythm. Brain activity was visualized as a computer game with a space ship flying through a starry background. If patients maintained a heightened alpha rhythm, the space ship remained still. When the alpha rhythm was successfully reduced, the space ship moved forward.
“No further instructions were given,” explains Dr. Lanius. “Each individual figured out his or her own way to reduce the alpha rhythm. Some let their mind wander or thought about positive things, while others reported concentrating their attention.”
The team of researchers, which included post-doctoral student Tomas Ros and collaborators at the University of Geneva, were surprised by the results.
Images were captured both before and after the brain training, which uncovered lasting changes to brain activity. The alpha rhythm rebounded to levels consistent with healthy individuals and patterns of brain activity were much less random.
The participants experienced a decrease in defensive response following the sessions.
“These results are very exciting,” says Dr. Lanius. “Neurofeedback is showing that patients have the power to regulate their own brain activity. As more tools become available, people can take control of their illness and its resulting symptoms.”
Moving forward with hope
Over the years and in working with Dr. Lanius, Teresa was able to acknowledge her trauma and develop strategies for coping.
She participated in neurofeedback studies at Lawson and found that actually seeing the images captured was extremely validating.
“When it comes to mental illness, some people don’t believe it unless they can see it. This research shows that PTSD symptoms are caused by real changes to the brain. Hearing the results and breakthroughs in Dr. Lanius’ research adds to a personal sense of validation.”
Today, Teresa is doing well and has been teaching English as a second language (ESL) for over seven years. She credits Dr. Lanius with giving her the tools to turn her life around.
Dr. Ruth Lanius is a part of the Imaging research program at Lawson. She holds the Harris-Woodman Chair in Mind-Body Medicine and is a Professor in the Department of Psychiatry, Schulich School of Medicine & Dentistry at Western University.