Topic: Traumatic experiences and Repressed memory management
Course: FF:PSX_006 Psychotherapy
Student: Cecília Nagy 443205
Teacher: PhDr. Pavel Humpolíček
April, 2015
Psychotherapy
Traumatic experiences and Repressed memory management
1.
Psychological & Emotional Trauma
• The word “trauma” is rooted in a Greek word meaning: “wound – injury - damage“
• Traumatic experiences often involve a threat to life or safety, but any situation that
leaves you feeling overwhelmed and alone can be traumatic, even if it doesn’t involve
physical harm. It’s not the objective facts that determine whether an event is traumatic,
but your subjective emotional experience of the event.
1.1.
2 main types of trauma:
-single event trauma-Emotional and psychological trauma can be caused by singleblow,
one-time event, such as a horrible accident, a natural disaster, or a violent attack
-repeated trauma-Trauma can also stem from ongoing, relentless stress, such as living
in a crime-ridden neighborhood or struggling with cancer. People are more likely to be
traumatized by a stressful experience if they’re already under a heavy stress load or
have recently suffered a series of losses.
1.2.
Symptoms of trauma
• Nightmares
• Edginess
• Agitation
• Muscle tension
• Withdrawing from others, feeling disconnected, numb
• Mood swings
• Guilt, shame, self-blame
• Being startled easily
Childhood trauma results from anything that disrupts a child’s sense of safety and
security, including:
• Seperation from the parent
• Sexual, physical, verbal abuse, violence
• Neglect
• Bullying
• Serious illness
• Natural disaster, war
• Horrible accident
Traumas and adversities in childhood may leave scars that last into adulthood and put a
person at risk for a variety of difficulties. This is true for all kinds of early traumas,
including accidents, disasters, and witnessing violence directed at others, but it is
especially true for child abuse and neglect, the victims of which have been studied
extensively. Not all childhood trauma survivors experience difficulties in adulthood.
However, for many people, it may be important to come to terms with past traumatic
events. People who have been in treatment can gain relief from anxiety and depression
and are able to stop focusing on the disturbing memories and feelings associated with
traumatic childhood events.
1.3.
Prenatal traumatic experiences
The effects of prenatal traumatization cannot be predicted without knowledge of other factors,
and prenatal experiences are likely to have lifelong impact when they are followed by
reinforcing conditions or interactional trauma.
There is a growing number of studies that foetuses are vulnerable to traumatic stress felt by
the pregnant woman. In fact, research shows that pre-natal exposure to natural disasters and
other life-or-death situations can have a lasting effect on offspring. Studies have shown earlier
births among pregnant women who experienced an earthquake in California; delayed
development among children whose pregnant mothers suffered through an ice storm in
Canada; and early signs of post-traumatic stress syndrome in babies whose pregnant mothers
experienced the 9/11 terrorist attacks. I.Q. of such children are also found to be lower.
Maternal stress is also linked with imperfections in the developing nervous system
1.4.
Trauma and amnezia
For more than a hundred years, doctors, scientists, and other observers have reported the
connection between trauma and forgetting. But only in the past 10 years have scientific
studies demonstrated a connection between childhood trauma and amnesia. Most scientists
agree that memories from infancy and early childhood - under the age of two or three - are
unlikely to be remembered. Research shows that many adults who remember being sexually
abused as children experienced a period when they did not remember the abuse. Scientists
also have studied child victims at the time of a documented traumatic event, such as sexual
abuse, and then measured how often the victims forget these events as they become adults.
They discovered that some people do forget the traumatic experiences they had in childhood,
even though it was established fact that the traumatic events occurred.
Theories why they are forgotten:
• Forgetting becomes an adaptive response important for survival to avoid stress.
• Stress levels, emotional arousal and altered attention focusing during the experience
prevent proper encoding.
• The traumatic experience sometimes causes global impairment that is people fail to
construct an accurate memory of their present and past events.
False memories
• Misremembering may result from confusion of memories of perceived and imagined
events, as there may be overlap between features of the stored information comprising
memories for perceived and imagined events - incidents that had not occurred
• One could experience intense emotions but without the thoughts or actual memories
• Distortions such as switching the roles of people in one's memory are quite common
• Adults can have vivid memories, of which they are extremely confident, that are
nevertheless wrong. Once those false memories have been established, they are not
easily changed by contrary evidence
How might false memories develop?
A great deal of laboratory research involving normal people in everyday situations
demonstrates that memory is not perfect. Evidence shows that memory can be
influenced by other people and situations; that people can make up stories to fill in
memory gaps, and that people can be persuaded to believe they heard, saw or
experienced events that did not really happen. Studies also reveal that people who
have inaccurate memories can strongly believe they are true.
2.
Post Traumatic Stress Disorder (PTSD)
• It was first described by Jacob Mendes Da Costa, a doctor during the American Civil
War. Marked by chronic tachycardia (high heart rate), and reactivity (increase in heart
rate due to a stressor), it looked very much like cardiac disease, but Da Costa
recognized the possibility that it was brought on by wartime trauma. PTSD was first
noticed on a massive scale during World War I.
• PTSD can develop in people who have never set foot on a battlefield. The disorder
occurs in men, women and children, as a result of a number of traumatic experiences.
• PTSD - the continuation of disturbing thoughts, emotions, and feelings that persist
even after the trauma is over
Post-traumatic stress disorder is a term used to explain mental health condition marked by
severe anxiety, flashbacks and uncontrollable thoughts about a terrifying event.
2.1.
Symptoms of PTSD
Post-traumatic stress disorder symptoms typically surface within three months of a traumatic
event; however, in some people, they may not appear until years after the event
The National Institute of Mental Health (NIMH) notes that PTSD symptoms are generally
grouped into three types:
• Re-experiencing symptoms-flashbacks, or reliving the event, with physical reactions
such as sweating and a racing heart; nightmares; and frightening thoughts. These
symptoms can intrude on a person's everyday life. People, places and activities can
remind the person of the event and trigger the reactions
• Avoidance symptoms-include trying to avoid thinking or talking about the event.
People with PTSD will often steer clear of places, events or situations that remind
them of the experience for fear of having a flashback and being unable to control their
actions. They may also feel emotionally numb
• Hyperarousal symptoms-include feelings of stress, and being "on edge" and easily
startled. These symptoms are usually constant rather than being triggered by reminders
of the event. These symptoms may make it hard to eat, sleep or concentrate.
A family or personal history of mental health risks, such as an increased risk of
anxiety and depression, can affect the likelihood of experiencing a PTSD episode.
Another factor is the way that the brain regulates the chemicals and hormones that the
body produces in response to stress. Temperament also plays a role, according to the
NIMH.
Children can exhibit different symptoms than adults do. Some children who are
suffering from PTSD will regress, sometimes wetting the bed or being unable to talk,
although they had mastered these tasks prior to the event.
3.
The brain function and the traumatic experience
The impact of trauma on the brain
All trauma effects the physical body, consequently the traumatized people have alterations
in their brain. Memory is affected by lapses-there are deficits in verbal recall. The frontal
cortex ability is decreased. Less ability to do left-brain functions--it can’t distinguish a
real threat from a false threat. Intense stress or trauma is accompanied by the release of
hormones. A nerve running out of the brain to the adrenal glands triggers adrenaline and
noradrenaline secretions. Adrenaline and noradrenaline surge through the blood stream
causing the heart to beat faster and prime the body for an emergency. Then these
hormones activate receptors on the vagus nerve running back to the brain. This causes the
heart to continue to beat faster, but also signals various parts of the brain to supercharge
that intense emotional memory. These hormones assist the individual to mobilize in the
event of emergency. They also sweep through the body, return to the brain, and trigger the
release of more equally powerful hormones (cortisol, epinephrine and norepinephrine,
oxytocin, vasopressin and opioids
Trauma researchers have looked inside the brains of people who have suffered serious
emotional trauma. The first scan was while they remembered neutral events in their lives.
The second scan was taken as they were exposed to scripted versions of their traumatic
memories. During the scanning, the images actually showed dissociation happen in the
brains of these PTSD patients. When they remembered a traumatic event, the left frontal
cortex shut down, particularly Broca's area (the center for speech). But areas of the right
hemisphere, associated with emotional states and autonomic arousal, lit up, particularly
the area around the amygdala. This suggests that when people relive their traumatic
experiences, the frontal lobes become impaired and, as a result, they have trouble thinking
and speaking.
3.1.
Effect of trauma on amygdala and hippocampus
Amygdala - It becomes highly active during and while remembering a traumatic incident.
When someone has been in trauma it’s hypersensitive-overreacts to normal stimuli.
Hippocampus- Researchers have looked at the size of the hippocampus in people with
and without PTSD. They have found that people who have severe, chronic cases of PTSD
have smaller hippocampi. The researchers have taken this to suggest that the experience of
constant stress as a result of severe and chronic PTSD may ultimately damage the
hippocampus, making it smaller. The shrinkage is induced through trauma
4.
Repressed memory therapy
Historical overview
• Freud introduced the concept of memory repression to the public and advocated that
the brain represses traumatic memories automatically
• Inspired partly by the Freudian-based concept - In his theory the mind automatically
banishes traumatic events from memory to prevent overwhelming anxiety. Freud
further theorized that repressed memories cause "neurosis," which could be cured if
the memories were made conscious. For Freud, repression was the unconscious
mechanism whereby unacceptable impulses or memories were kept hidden from
awareness, as a basic defense which the ego uses to ward off anxiety
• One of the issues Freud struggled with was the status of the childhood memories
recovered in his therapy from repression. Freud's repressed memory theory joined his
philosophy of psychoanalysis. Repressed memory has remained a heavily debated
topic inside of Freud's psychoanalysis philosophy
RMT refers to the attempts to recover long forgotten or repressed memories and is
a psychotherapy term for therapy using one or more method or technique for the purpose
of recalling memories. It does not refer to a specific, recognized treatment method, but
rather several interviewing techniques, such as hypnosis and guided-imagery. Proponents
of recovered memory therapy claim that traumatic memories can be buried in the
subconscious and affect current behavior, and that these can be recovered.
4.1.
How does trauma-focused therapy work?
The point of trauma - focused therapy is not to make people remember all the disturbing
things that ever happened to them. People do not need to remember every detail in order
to heal. Rather, the goal of psychotherapy is to help people gain authority over their
trauma - related memories and feelings so that they can get on with their lives. To do this,
people often have to talk in detail about their past experiences. Through talking, they are
able to acknowledge the trauma - remember it, feel it, think about it, share it, and put it in
perspective. At the same time, to prevent the past from continuing to influence the present
negatively, it is vital to focus on the present, since the goal of treatment is to help
individuals live healthier, more functional lives in the here and now.
4.2,
Trauma therapy treatment aproaches:
• Pharmacotherapy-Management of PTSD may involve the use of various treatment
modalities, involving both nondrug treatments and pharmacotherapy. It is an important
adjunctive treatment for trauma in conjunction with either cognitive behavior therapy
or psychoanalytic psychotherapy
The current medications of choice are the selective serotonin reuptake inhibitors
(SSRI), which are beneficial for posttraumatic reexperiencing, hyperarousal, and
avoidant symptoms. Other medication classes including non-SSRI antidepressants,
mood stabilizers, anticonvulsants, and anti-adrenergic agents have shown efficacy for
some trauma symptoms. Because beneficial responses may be slow to appear,
pharmacotherapy of trauma requires a medication trial of adequate length and dose to
determine effectiveness.
• Exposure Therapy-Exposure therapy, previously known as imaginal flooding therapy,
involves carefully exposing the patient to prolonged and repeated imagined images of
the trauma until the images no longer cause severe anxiety. In PTSD, exposure therapy
is intended to help the patient face and gain control of the fear and distress that was
overwhelming in the trauma, and must be done very carefully in order not to retraumatize
the patient
• Cognitive Behavioral Therapy (CBT)- A branch of psychotherapy which is based on
the premise that the way we think (cognitive) determines how we respond to those
thoughts (behaviour). Over years these negative thinking and behaviour patterns
become fixed, and cognitive behavioural therapy hopes to challenge those behaviours,
bringing about positive feelings and behavioural changes. CBT for PTSD is aimed at
teaching sufferers ways to help them modify negative thought patterns so they are able
to gain control of their fear. Though techniques will vary from practitioner to
practitioner, often-mental imagery is used to help individuals through their trauma
• Eye Movement Desensitization and Reprocessing (EMDR)- Eye movement
desensitisation and reprocessing (EMDR) is a form of treatment which has been found
to benefit a variety of behavioural and emotional issues in both adults and children.
The treatment itself involves performing a series of right to left eye movements whilst
simultaneously recalling a traumatic event. Though it is not known exactly how the
treatment works, it is thought that it may be linked to the left and right stimulation of
the brain whilst we are in REM (rapid eye movement) sleep, during which our eyes
rapidly move from one side to another. The eye movements are designed to help the
brain process unconscious material and flashbacks so that in due course, sufferers are
able to come to terms with the harrowing event they experienced and are able to adopt
a more positive thinking approach moving forward.
• Hypnotherapy- The aim of hypnotherapy is to unlock stored emotion so that the
trauma can be revisited and explored from a different perspective. Work with the
unconscious mind so that negative beliefs which were built up during the trauma can
be explored and alleviated. Hypnosis and other techniques that ply upon a person’s
suggestibility must be used with great caution
• Psychodynamic Therapy- Psychodynamic approaches to PTSD focus on a number of
different factors that may influence or cause PTSD symptoms, such as early childhood
experiences (particularly our level of attachment to our parents), current relationships.
Psychodynamic psychotherapy places a large emphasis on the unsconscious mind.
Bringing about change in symptoms or behavior requires getting in touch with and
"working through" those painful unconscious feelings. To do this, the psychodynamic
therapist will assist the patient in recognizing the defense mechanisms being used,
what they are being used for (to avoid painful feelings in the unconscious mind
stemming from a traumatic experience) and connecting with and appropriately
releasing those feelings and thoughts that were previously being avoided.
• Group Therapy-Because isolation is such a powerful effect of trauma, the ability of
groups to provide support and reconnections for members is particularly important for
trauma treatment.. The appeal of group interventions for trauma survivors rests, to a
large extent, on the clear relevance of joining with others in therapeutic work when
coping with victimization consequences such as isolation, alienation, and diminished
feelings. Bonding with similar others in a supportive environment can be a critical step
toward regaining trust
References & Literature
• Source from: Stanford Report, Jan., 2004, by Lisa Trei - Psychologists offer proof of
brain’s ability to suppress memories -
http://news.stanford.edu/news/2004/january14/memory-114.html
• source from: http://www.guidetopsychology.com/repressn.htm written by Raymond
Lloyd Richmond, Ph.D
• http://www.victorianweb.org/science/freud/repression.html written by David B.
Stevenson, 1996, Brown University
• Renee Fredrickson, Ph.D, 1992– Repressed memories-A Journey to recovery from
sexual abuse-A dawning reality- 25-30 p. ISBN 0-671-76716-X
• http://www.caic.org.au/fms-sra/rmt.htm written by Jan Groenveld
• http://faculty.washington.edu/eloftus/Articles/lof93.htm written by Elizabeth Loftus
• Trauma statistics:
http://www.bercelifoundation.org/s/1340/aff_2_interior.aspx?sid=1340&gid=1&pgid=
391
• Sources - Trauma Releasing Exercises Pamphlet - Dr. David Berceli, Ph.D
http://www.bercelifoundation.org/s/1340/aff_2_interior.aspx?sid=1340&gid=1&pgid=
403
• Source of the article: http://www.ncbi.nlm.nih.gov/pm c/articles/PMC3181836/ J.
Douglas BremnerMD - 2006 Dec. 8 Traumatic stress: effects on the brain
• Source: http://www.fenichel.com/repression.shtml - written by Michael Fenichel,
Ph.D. - Repression: Anxiety Filter for the Ego
• http://www.rachelsvineyard.org/Downloads/Canada%20Conference%2008/TextOfBra
inPP.pdf - written by -Theresa Burke, Ph.D. - How Trauma Impacts the Brain
• Source: http://www.trauma-pages.com/a/vanderk.php Approaches to the Treatment of
PTSD - Bessel A. van der Kolk, M.D.
Onno van der Hart, Ph.D.
Jennifer Burbridge, M.A.
• 2004, Group interventions for treatment of psychological trauma, p. 25-27. -By
Kathleen Hubbs Ulman, Ph.D-http://www.agpa.org/docs/default-source/practice-
resources/group-interventions-for-treatment-of-trauma-in-adults.pdf?sfvrsn=2