Can't read as i don't have a subscription with new York times.  Do you have a pdf of this?

By Ellen Barry
Nov. 30, 2023

At the root of post-traumatic stress disorder, or PTSD, is a memory that cannot be
controlled. It may intrude on everyday activity, thrusting a person into the middle of a
horrifying event, or surface as night terrors or flashbacks.

Decades of treatment of military veterans and sexual assault survivors have left little
doubt that traumatic memories function differently from other memories. A group of
researchers at Yale University and the Icahn School of Medicine at Mount Sinai set out
to find empirical evidence of those differences.

The team conducted brain scans of 28 people with PTSD while they listened to recorded
narrations of their own memories. Some of the recorded memories were neutral, some
were simply “sad,” and some were traumatic.

The brain scans found clear differences, the researchers reported in a paper published
on Thursday in the journal Nature Neuroscience. The people listening to the sad
memories, which often involved the death of a family member, showed consistently high
engagement of the hippocampus, part of the brain that organizes and contextualizes
memories.

When the same people listened to their traumatic memories — of sexual assaults, fires,
school shootings and terrorist attacks — the hippocampus was not involved.

“What it tells us is that the brain is in a different state in the two memories,” said
Daniela Schiller, a neuroscientist at the Icahn School of Medicine at Mount Sinai and
one of the authors of the study. She noted that therapies for PTSD often sought to help
people organize their memory so they can view it as distant from the present.

Understand Post-Traumatic Stress Disorder
The invasive symptoms of PTSD can affect combat veterans and civilians
alike. Early intervention is critical for managing the condition.

• Understanding the Brain: Decades of treatment of military veterans and sexual assault
survivors have left little doubt that traumatic memories work differently from other
memories. A group of researchers set out to find empirical evidence of what makes them
stand them apart.

• E.M.D.R.: The once-experimental trauma treatment might look bizarre, but some
clinicians say it’s highly effective against PTSD. Here’s how the therapy works.

• Removing the Stigma: Misconceptions about how PTSD develops and its
symptoms, can prevent people from seeking treatment.

• Psychedelic Drugs: As studies continue to point to the therapeutic value of substances
like MDMA, veterans are becoming unlikely advocates for their decriminalization.

“Now we find something that potentially can explain it in the brain,” she said. “The
brain doesn’t look like it’s in a state of memory; it looks like it is a state of present
experience.”

Indeed, the authors conclude in the paper, “traumatic memories are not experienced as
memories as such,” but as “fragments of prior events, subjugating the present moment.”

The traumatic memories appeared to engage a different area of the brain — the posterior
cingulate cortex, or P.C.C., which is usually involved in internally directed thought, like
introspection or daydreaming. The more severe the person’s PTSD symptoms were, the
more activity appeared in the P.C.C.

What is striking about this finding is that the P.C.C. is not known as a memory region,
but one that is engaged with “processing of internal experience,” Dr. Schiller said.

The findings feed into a much debated question in the field of trauma: Should clinicians
encourage people with PTSD to expose themselves to their most traumatic memories?

In recent years, many Americans have embraced treatments such as prolonged exposure
therapy and eye movement reprocessing and desensitization, or EMDR, which revisit
traumatic memories in hopes of draining them of their destructive force. Ilan HarpazRotem,
an author of the paper, said the new findings suggested that revisiting the
memory was a critical element of treatment.

“You are helping the patient to construct a memory that can be organized and
consolidated into the hippocampus,” said Dr. Harpaz-Rotem, a professor of psychiatry
and psychology at Yale University.

He described a case from his clinic: An Army medic was haunted by a fragmentary
image from his past, of frantically bandaging a solder’s wound while under fire. In
therapy, trying to “build a story, a coherent memory,” the clinician helped the medic fill
in details around the edges of that scene, including a dead soldier who lay nearby,
shooting in the background, and his own panicked use of too many bandages.

Ideally, such treatments can help transform the traumatic memory into one that more
closely resembles ordinary sad memories. “It’s like having a block in the right place,” he
said. “If I can access a memory, I know it’s a memory. I know it’s not happening to me
now.”

Dr. Ruth Lanius, the director of PTSD research at the University of Western Ontario
who was not involved in the study, described its findings as “seminal,” both because it
establishes that traumatic memories have distinct pathways and because it indicates
that key mechanisms for traumatic memory may involve less-examined areas of the
brain. Much research into PTSD has focused on the amygdala, the stress detection
center of the brain, and the hippocampus, she said. The posterior cingulate cortex is
“really involved in the reliving of memories,” and in seeking self-relevance, which may
explain why a sensory reminder may cause overwhelming fear or panic.

“A soldier, if they hear fireworks, they may run and take cover,” Dr. Lanius said.
“Traumatic memories are not remembered, they are relived and re-experienced.”

Clinicians, she said, can use these findings to treat patients who “don’t feel that the
trauma is over,” employing therapies that “bring on line context, so you know, ‘Oh, that
happened in the past.’” She said researchers should explore therapies, like mindfulness,
which are known to activate the parts of the brain known to provide context.

If biological markers for PTSD can eventually be identified, it would be “a major
scientific contribution,” settling differences within the field about what experiences
constitute a trauma, said Brian Marx, deputy director of the Behavioral Science Division
of the National Center for PTSD, who was not involved in the study.

While most experts agree that motor vehicle accidents, sexual assaults or military
combat are traumatic events, there is disagreement about whether experiences like
racism or pandemic stress should be viewed as the basis for a PTSD diagnosis, he said.

“It is one of the foundational questions of the field,” he said. “It is a debate we still
wrestle with, because we don’t have an answer for it.”

Dr. Marx called the new research “intriguing,” but not conclusive, noting that it did not
include a comparison group of subjects without a PTSD diagnosis, specify how long ago
the traumatic events took place, or specify whether the subjects had already received
psychotherapy.

And he said it was not likely to settle debates over whether PTSD treatments should
include exposure to traumatic memories, since literature on treatment outcomes show
that responses are highly individualized.

“To say this is proof positive really ignores the reality that our treatments are imperfect,”
he said. “They don't work for everyone in the same way.”

Ellen Barry covers mental health. She has served as The Times’s Boston bureau chief,
London-based chief international correspondent and bureau chief in Moscow and New
Delhi. She was part of a team that won the 2011 Pulitzer Prize for International
Reporting. 

Last edited by M-Kate (December 15, 2023 8:51 am)