Post-traumatic stress disorder is a result of psychological trauma. But not everyone who goes through severe psychological trauma ends up with PTSD. A study done at Texas A&M University looked at early identification of PTSD in trauma survivors. The hope is that by identifying those individuals at risk for long-term, virtually permanent PTSD that treatment can be begun sooner with better results. For this to work, there will need to be early identification of PTSD via targeted screening of trauma survivors as opposed to waiting until individuals present with PTSD symptoms.
How Common Is PTSD?
After traumatic experiences the majority of people come through without any long-term or even short term mental health difficulties. Symptoms of PTSD occur in roughly 40% of individuals after traumatic experiences. Most of these folks get better. Between 2% and 10% of those who experience significant psychological trauma end up with full-blown post-traumatic stress disorder. The question is, can we identify those at risk for long-term PTSD?
Altered Brain Processing in PTSD
Researchers have known for years that alterations of processing in areas of the brain responsible for emotions and emotional modulation occur in PTSD. These areas include the amygdala, insula, and prefrontal cortex. What had not been understood because it had not been studied was how quickly changes associated with PTSD begin. To help understand this, researchers studied 104 trauma survivors. Most of these were from car accidents. Studies were done at 1, 6, and 14 months post-accident. They did brain scans on all of these folks at each visit.
Post Trauma Brain Scan Findings
In this study of survivors of trauma at early stages the researchers found something that appears to be significant. Individuals who showed greater activation on scans of the right inferior frontal gyrus had significantly better recoveries without lasting PTSD than those in which this did not happen. The right inferior frontal gyrus is an area responsible for cognitive control and emotional reappraisal. The researchers say this tells us that cognitive regulation of fear is important in the development or non-development of lasting PTSD:
Progressive Brain Scan Changes in PTSD
The brain scan changes found in trauma survivors were not unchanging over time. Rather, those individuals who ended up with true PTSD had different progressions of scan results than those who got better. This is consistent with the clinical picture of PTSD in which a person essentially relives and rehearses their trauma causing negative memories to gain more power and areas like the amygdala to solidify damaging emotional feedback loops.
Why Some Folks Get Better and Others Progress to Full-blown PTSD
At the brain level as seen by repeated brain scans, researchers say this. The findings highlight the role that cognitive processing through the prefrontal cortex can play in protecting against the development of PTSD. To the degree that an individual is able to process a traumatic event and to the degree that they do so, individuals tend to recover and not end up with post-traumatic stress disorder. The researchers put this in terms of regulating emotional responses via contextual information processing. To a lay person, what this sounds like is how coaching or psychotherapy work in psychedelic medicine treatments to help a person sort out what is the past, what is the present, and how to escape from living constantly with past trauma.
The doctor who ran the study says that by understanding better the brain circuits involved in PTSD development that will lead to better understanding of this mental health condition. It will hopefully lead to treatments based on the mechanism of the disease. And it will hopefully lead to early study of trauma survivors so that those who are sliding into permanent PTSD can receive earlier and more effective treatment.
PTSD and Veteran Suicide Risk
A practical issue came to mind as we looked at this study. It is unlikely that people’s insurance is going to pay for sequential brain scans after every car accident. The situation in the military is different. We know that trauma affects service members and know the situations when trauma occurs. During military service or upon discharge service members can be screened and appropriate tests, including brain scans, be administered in order to identify those at risk of developing full-blown PTSD before the fact or before they present as a completed suicide!