Dr. Victor Carrión: How to Heal From Post-Traumatic Stress Disorder (PTSD)
23 Sep 2024 (1 day ago)
Dr. Victor Carrión
- Dr. Victor Carrion is a professor and the vice chair of Psychiatry and Behavioral Sciences at Stanford University School of Medicine.
- Dr. Carrion is considered a leading expert on PTSD, particularly in children and adolescents, and is the director of the Stanford Early Life Stress and Resilience Program.
- Dr. Carrion's research combines psychological, neurobiological, and practical approaches, including mindfulness and cognitive behavioral therapy, to address PTSD.
Sponsors: Eight Sleep, BetterHelp & Waking Up
- The speaker has been sleeping on an Eight Sleep mattress cover for nearly four years and believes it has improved their sleep quality.
- BetterHelp offers professional therapy with a licensed therapist carried out entirely online.
- The Waking Up app is a meditation app that offers hundreds of guided meditation programs, mindfulness trainings, yoga needra sessions, and more.
Stress, Post-Traumatic Stress Disorder (PTSD), Avoidance
- Stress is a spectrum that ranges from beneficial to traumatic.
- Traumatic stress can lead to post-traumatic stress disorder (PTSD), but individuals can recover from PTSD with treatment.
- Avoiding treatment for PTSD can lead to complications such as substance abuse and self-injurious behaviors, making it harder to treat.
Stressors, Perseverate; Children & PTSD
- When children experience trauma, it can disrupt their ability to engage in play, which is crucial for their development. Instead of joyful play, they may exhibit repetitive and non-joyful play as they try to make sense of the trauma.
- PTSD is often not caused by a single traumatic event but rather by an accumulation of stressors over time. While everyone carries a burden of stressors, children are more vulnerable as they lack the tools and resources to cope with excessive stress.
- Children are more vulnerable to PTSD than adults, potentially due to their brain's increased plasticity. While neuroplasticity makes them susceptible to the negative impacts of trauma, it also presents an opportunity for recovery with appropriate support and therapy.
Transgenerational Trauma
- There are two forms of transgenerational trauma: one where trauma experienced by older generations is discussed and impacts later generations, and another where trauma is believed to modify the genome, impacting descendants even without direct contact.
- While it is uncertain if stress-induced genomic changes can be inherited, genes that contribute to vulnerability are passed down through generations.
- Children can exhibit PTSD symptoms without experiencing direct trauma, potentially due to learned behaviors from parents with PTSD, highlighting the influence of both nature and nurture on vulnerability.
Post-Traumatic Stress Injury (PTSI); Children, Dissociation & Cortisol
- Post-traumatic stress disorder (PTSD) is often referred to as post-traumatic stress injury (PTSI) by many people who view it as an injury to the autonomic nervous system rather than a disorder.
- Children, due to their dependence and inability to fight or flee from traumatic situations, often freeze, leading to dissociation as a coping mechanism.
- Studies on children with PTSD symptoms revealed that while their cortisol levels followed a normal circadian rhythm, their pre-bedtime cortisol levels remained elevated compared to healthy controls, potentially contributing to sleep disturbances and nighttime fears.
Cortisol & Brain, Post-Traumatic Stress Symptoms
- Cortisol levels typically rise in the morning, peak within 90 minutes of waking, and gradually decrease throughout the day, reaching their lowest point in the evening.
- In children with PTSD, cortisol levels do not decrease as much in the evening as they do in healthy individuals, potentially contributing to difficulty sleeping and increased focus on stressors.
- High levels of cortisol can impact brain development, particularly in areas like the hippocampus and prefrontal cortex, which are associated with memory, problem-solving, and attention, and are more sensitive to glucocorticoids like cortisol.
Sponsor: AG1
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PTSD, Attention Deficit Hyperactivity Disorder (ADHD)
- Children are being overmedicated for mental health issues, but those who have attention-deficit/hyperactivity disorder (ADHD) are being undermedicated.
- While ADHD exists and stimulant medication is an effective treatment, the first line of intervention for children with post-traumatic stress disorder (PTSD) should be psychosocial.
- Hyperarousal in children with PTSD can be mistaken for hyperactivity in children with ADHD, but clinicians can differentiate between the two; hyperactivity is more constant, while hyperarousal is usually triggered by cues that remind the child of a traumatic event.
PTSD & ADHD; Identifying Cues, Triggers & Interventions
- Children and adults with ADHD can focus intently on engaging activities, but struggle to direct and maintain attention in other necessary settings.
- Identifying cues, which are often neutral sensory experiences associated with a traumatic event, is crucial for understanding and managing PTSD symptoms.
- Recognizing cues helps individuals understand their reactions as learned responses to specific triggers, promoting self-compassion and reducing feelings of being "crazy" or "bad."
PTSI, Autonomic Nervous System Seesaw; Sleep
- Post-traumatic stress injury (PTSI) can be understood as a disruption of the autonomic nervous system, which regulates the balance between the sympathetic and parasympathetic nervous systems.
- PTSI can manifest as either a hyperaroused state, where the sympathetic nervous system is dominant, or a dissociative state, where the parasympathetic nervous system is dominant.
- A good night's sleep can help to recalibrate the autonomic nervous system and improve psychological well-being.
PTSD, Brain Development & Kids; Cue-Centered Therapy
- Researchers conducted studies using magnetic resonance imaging (MRI) to examine the impact of cortisol levels on brain development in children with post-traumatic stress disorder (PTSD).
- Studies revealed that children with higher cortisol levels exhibited reduced volume in the hippocampus, a brain region crucial for memory processing and emotional regulation.
- Functional MRI scans demonstrated that children with PTSD displayed less activation in the hippocampus and prefrontal cortex during memory and executive function tasks compared to healthy children, suggesting potential disruptions in brain plasticity and development.
Sponsor: Function
- Function is a company that provides in-depth analysis of blood, urine, and saliva to provide a comprehensive picture of overall health and vitality.
- Function provides testing of over 100 biomarkers, analyzes the results, and provides doctor-informed insights.
- Function is currently offering early access to Hubreman Lab listeners due to a long waitlist.
Limbic Pathway, Inner Dialogue, Therapy Toolbox
- The frontolimbic pathway, which includes the amygdala, is responsible for creating states of alertness and relaxation, and translating information into levels of reactivity.
- The frontal cortex plays a crucial role in regulating the limbic system by providing context and facilitating internal dialogue to manage stress responses.
- Practicing positive self-talk and developing personalized coping mechanisms, like drinking orange juice, can empower individuals to manage their anxiety and stress responses effectively.
Agency & Control, Deliberate Cold Exposure, Narrative
- A sense of agency and control over stressful situations is important, as it allows individuals to regulate their responses.
- Deliberate cold exposure, such as taking cold showers, can serve as a tool for individuals to safely explore and manage their stress responses.
- Constructing a narrative that encompasses negative, neutral, and positive events is crucial for recovery, as it helps individuals understand their experiences and develop coping mechanisms.
Custom Toolbox Development; Energy
- Children can experience discomfort due to increased energy, and using tools from a personalized toolbox can provide them with a sense of control.
- Physical activities like sports, talking to friends, and playing music are examples of coping mechanisms children use to manage their energy levels.
- Adults can exhibit high energy levels through work or other activities, and physical movements like bouncing a knee can be an outlet for excess energy rather than nervous energy.
Tool: 4-Corner Square Response, Understanding Cues
- The four corners of the square are: thoughts (cognitive), emotions, physical feelings (somatic), and actions.
- The square model can be used to understand and change a child's response to a trigger.
- Working with one corner of the square can lead to changes in the other corners, resulting in a new response.
Tool: “Creating Space,” Feelings Thermometer, Analyzing 4-Corners
- The four corner system is a tool that can be used to help people understand and manage their stress response.
- The four corners represent the four components of the stress response: body, thoughts, emotions, and actions.
- The emotional thermometer is a tool that can be used to measure the intensity of a child's stress response.
Social Media, Boundaries
- Many adults would benefit from tools that help regulate the autonomic nervous system.
- Social media can be a helpful tool, but it can also be harmful if it's not used in moderation.
- Social media should be used to enhance real life, not replace it.
School, Yoga & Mindfulness Curriculum
- A yoga and mindfulness curriculum was developed for students after observing the positive effects of these practices on staff members who were exposed to trauma regularly.
- The curriculum, tested in East Palo Alto schools, involved teaching teachers to lead students in yoga and mindfulness exercises.
- A randomized controlled trial was conducted to evaluate the curriculum's effectiveness, comparing its implementation in East Palo Alto schools to a control group of schools in San Jose.
Implementing School Mindfulness Programs, Sleep
- Students used mats provided to them and participated in the program in their normal clothes while in the classroom.
- The program, which included yoga and mindfulness, was shown to increase sleep duration in students by an average of 73 minutes and also increased sleep depth.
- Preliminary data from the program suggests that it also decreased activity in the amygdala, the part of the brain associated with fear and stress.
Barriers to School Programs
- There is a need to prioritize education and mental health, allocating resources and support for these areas, particularly within the Department of Education.
- Teachers are overburdened and under-resourced, highlighting the need for increased support, time, and resources to effectively implement programs.
- Public engagement, such as contacting elected officials to express support for specific programs, can influence policy decisions and resource allocation.
Redefining Success, Identity
- The current societal definition of success primarily revolves around extreme achievements in fields like sports, technology, and entrepreneurship.
- This narrow definition of success can be detrimental to individuals' mental health, especially for those who may not achieve such extraordinary levels of success.
- A broader definition of success should encompass a sense of belonging, diverse roles and interests, and contributions to the well-being of oneself and others.
Resilience & Adaptation; Organoids, Epigenetic Treatment Response
- Resilience is the ability to bounce back from adversity, while adaptation implies bouncing back to a better place.
- Organoids, or "mini brains," are three-dimensional clusters of neurons grown from stem cells that can be used to study the effects of trauma and stress.
- A study is being conducted that bridges molecular genetics and social interventions, exposing organoids to cortisol to identify genes associated with PTSD and comparing these findings to the genomes of children in Puerto Rico undergoing stress-related interventions.
Listening to Kids & Adults
- It is important to listen to what children and adults have to say about their experiences and create a space where they feel supported and not isolated.
- It is important to help people identify their own strengths and capabilities to make themselves better.
- The best psychiatrists listen to the experiences of their patients.
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