[LUM#6] After the trauma
Life sometimes inflicts brutal events on us... Far from being harmless, they cause traumatic damage to the brain. Fortunately, there are ways to heal.
Attacks, assaults, combat, serious accidents... These experiences have one thing in common: they confront us with death. Suddenly, in the flow of life, a traumatic event occurs, and we are faced with our own destruction or that of another person.
Half of us will experience trauma at some point in our lives. Psychological wounds that often cause symptoms. During the day, flashbacks or hallucinations. At night, nightmares... The scene resurfaces without us trying to remember it. To avoid being plunged back into the horror, we avoid certain situations: driving or going out at night, for example. Emotions become dulled, which can lead to indifference towards those around us. In a state of alertness, we become irritable, jumping at the slightest noise.
Memory disorder
If these symptoms last more than a month after the event, it is referred to as post-traumatic stress disorder (PTSD). According to the World Health Organization, an estimated 3.9% of the global population has suffered from PTSD at some point in their lives. Half of all victims of sexual assault suffer from it, as do one in five combatants. For one-third of all sufferers, the disorder will last more than six months, and potentially years.
"The disorder is linked to traumatic memories that we are unable to process," explains Isabelle Chaudieu, a neurobiologist at Inserm. When our memories are stored normally, they become part of our autobiographical memory. In people suffering from PTSD, the memory remains stuck in the emotional memory. It resurfaces without us seeking it out... There is only one solution to cure this memory disorder: "We need to decondition the patient to allow the fear to be extinguished , " explains Isabelle Chaudieu.
Progressive bearings
Cognitive behavioral therapy (CBT) has proven effective in treating this condition. "In CBT, we work on erroneous thoughts, such as guilt, which is very common in traumatized individuals, but also on inappropriate behaviors," explains Nadia Sourdril, a psychiatrist at Lapeyronie University Hospital. To return to a normal life, patients are gradually exposed to the situation that causes them anxiety.
After the Nice attack in 2016, some people didn't leave their homes for a week. "The principle of CBT is to work together to develop step-by-step exercise programs. For example, someone who can't leave their home would start by going downstairs accompanied by someone else, then alone. The second step would be to go to the bakery accompanied by someone else, then alone, and so on until they can return to a crowd," explains Nadia Sourdril. "We work with them to see what they feel capable of." In twelve to fifteen sessions, it is possible to overcome PTSD. Another type of psychotherapy with proven effectiveness is EMDR, based on eye movements or bilateral tapping (see box). The recovery rate after psychotherapy is around 75% (EMDR for treating post-traumatic stress, really? Inserm).
Benzodiazepines contraindicated
But these sessions come at a cost... which deters many trauma victims. In fact, many people do not want to talk about what they have been through. "Forcing patients who do not want to talk to do so is counterproductive: it traumatizes them a second time," says Nadia Sourdril. Those who say, "I don't want to talk about it, I don't want to think about it, I'm pretending it never happened," are in a state of denial that also prevents healing,"says the head of the regional medical-psychological emergency unit (CUMP).
To hope for a cure, one day you will have to verbalize your emotions. Until that is possible, medication offers relief. "Benzodiazepines are contraindicated following a traumatic event: they increase the risk of developing PTSD. On the other hand, antidepressants are relatively effective in the long term. Certain anxiolytics and antihistamines reduce anxiety," explains Nadia Sourdril.
And when, finally, does it get better? Of course, the memory of the traumatic event does not disappear. "All we can do is superimpose an emotionally neutral memory, which we may have created in therapy, onto a traumatic memory," explains Isabelle Chaudieu. The trace of the trauma always remains in the brain. "So there is a risk of relapse, "cautions the neurobiologist (Biological and psychological predictors of the onset and chronicity of post-traumatic stress disorder. A one-year prospective study, in Neurobiology of Stress, 2016). In any case, the goal is not to forget, but rather to reduce the emotional burden and repercussions of the event so that patients can integrate their own history and get back into the flow of life.
EMDR: Eye Movement Desensitization and Reprocessing Therapy
Developed in 1987, EMDR (eye movement desensitization and reprocessing) is a form of psychotherapy that has been widely proven effective in treating trauma. "The patient begins by recounting the scene and the thoughts, emotions, and sensations associated with it. Then they follow the therapist's fingers as they move from right to left—or the therapist taps their knees alternately. The patient then speaks again," explains Nadia Sourdril.
Over the course of about six sessions, the traumatic memory is reworked so that it can be unblocked and metabolized. The emotional charge associated with the memory quickly diminishes.
While the functioning of EMDR remains somewhat mysterious, the right-to-left eye movements are reminiscent of those that occur during REM sleep, when we dream and memories are archived in the brain.
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