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The Neuronal Circuit of PTSD

If we were to look at the PTSD activation process through an fMRI, specific areas deep within the limbic system of the brain such as the amygdala would appear to be activated (flared). Other brain areas such as the speech center located in the left hemisphere would be shut down, going off line when the trauma is triggered. The area that is associated with making complex decisions in the prefrontal lobes referred to as "executive functioning" also goes off line when the trauma is reactivated.

Perhaps this pattern is the reason that talking to someone in the depths of their PTSD despair hardly ever does anything but frustrate the speaker, whose words can’t be fully received by the supposed listener. On the other hand, the individual inflicted with this condition has difficulty articulating what is occurring within, due to the overwhelming instinctive reaction to protect and defend the self. Also, perhaps this is why the person with PTSD seems dumfounded by tasks that he/she was previously well able to manage. With this chain of events in mind, I wonder why those with PTSD are frequently placed in group therapy often as a primary treatment modality?

Another area located in the visual cortex is called Brodmann’s Area 19, or peristriate area 19. This part of the brain receives images conveyed from the eyes and supports feature extraction, shape recognition, visual attention, and multimodal integration. This part of the brain helps rekindle visual aspects of trauma, often referred to as flashbacks. Other senses such as smell, sound and visceral sensations also are likely to be reactivated in flashbacks.

Consequently, I have come to refer to the pattern of limbic system activation, speech and cognitive inhibition, and in some cases, flashbacks as the Neuronal Model of PTSD. To reiterate, when an individual is traumatized the following events occur. The connection to the prefrontal cortex shuts down leading to a decline in the ability to execute executive functions that previously existed.

Second, the speech centers located in the left hemisphere of the brain suffers the same fate, with the PTSD sufferer being left with an ability to address only fragments of the trauma. This makes it difficult for him/her to fully articulate what happened in the first place. It also filters the ability to hear from others in a complete and meaningful way. The person becomes unable to fully express what has occurred. Furthermore, he/she becomes unable to benefit from what others say. Next, the Limbic System becomes over activated perpetuating the "fight, flight or freeze" instinctual response. Finally, Brodmann’s Area 19 rekindles visual and other sensory aspects of trauma referred to as flashbacks and nightmares.

‘Gold Standard’ treatments are not holding up to meta-analytical scrutiny in regards to the full and complete elimination of PTSD symptomatology. The emergence of Delayed Onset Post-Traumatic Stress Disorder (DO-PTSD) in our aging Veteran population suggests that our customary interventions are missing the mark. I have earlier proposed that we are dealing with a neuronal circuitry problem rather than just the presence of psychological symptoms. The results of RESET Therapy are apparently validating this hypothesis within the context of our first six of thirty-six combat Veterans provided with up to four treatment sessions.

Over the summer, I will be writing up these findings with the intent of submitting these six case studies to a peer reviewed journal as our first step to scientifically document the findings. The study will continue over the next year as we proceed with the formalized IRB approved treatment of an additional thirty Veterans from the Vietnam; Gulf War and Afghanistan/Iraq eras. Perhaps neuroscientific advances are shedding light on the means through which we can finally return those who have served to defend and protect us to a full and meaningful life. Perhaps we are on the brink of finally being able to end the continual nightmare of PTSD.

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