[LUM#6] After the Trauma
Life sometimes throws brutal events our way… Far from being trivial, these events leave traumatic scars on the brain. Fortunately, there are ways to heal.
Terrorist attacks, assaults, combat, serious accidents… These experiences have one thing in common: they confront us with death. Suddenly, in the midst of everyday life, a traumatic event strikes, and we find ourselves facing our own destruction or that of another person.
Half of us will experience trauma at some point in our lives. A psychological wound that often leads to symptoms. During the day, flashbacks or hallucinations. At night, nightmares… The scene resurfaces without us even trying to recall it. To avoid being plunged back into the horror, we avoid certain situations: driving, going out at night, for example. Emotions become dulled, which can lead to indifference toward those around us. In a state of alert, we become irritable, jumping at the slightest noise.
Memory disorder
If these symptoms persist for 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 experienced PTSD at some point in their lives. Half of all victims of sexual assault suffer from it, as does one in five combatants. For one-third of all those affected, the disorder will last more than six months—and potentially for years.
“The condition is linked to a traumatic memory 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… To cure this memory disorder, there is only one solution: “We must decondition the patient to allow the fear to be extinguished , ” explains Isabelle Chaudieu.
Progressive levels
Cognitive-behavioral therapy (CBT) has proven effective in this regard.“In CBT, we address distorted thoughts—such as guilt, which is very common among traumatized individuals—as well as maladaptive behaviors,” explains Nadia Sourdril, a psychiatrist at Lapeyronie University Hospital. To return to a normal life, the patient will gradually expose themselves to the situation that causes them anxiety.
After the attack in Nice in 2016, some people didn’t go outside 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 in their building with support, then alone. The second step: walking to the bakery with support, 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 thus possible to overcome PTSD. Another type of psychotherapy with widely demonstrated effectiveness is EMDR, based on eye movements or bilateral tapping (see box). The recovery rate after psychotherapy is approximately 75% (EMDR for treating post-traumatic stress—really? Inserm).
Benzodiazepines that are contraindicated
But these sessions come at a cost… which deters many trauma survivors. In fact, many people don’t want to talk about what they’ve been through.“Forcing patients who don’t want to talk to do so is counterproductive: it traumatizes them all over again,” 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…,”notes the head of the regional medical-psychological emergency unit (CUMP).
To have any hope of recovery, one day we’ll need to put our emotions into words. Until that becomes possible, medication offers relief.“Benzodiazepines are contraindicated following a traumatic event: they increase the risk of developing PTSD. Antidepressants, on the other hand, are relatively effective in the long term. Certain anxiolytics and antihistamines reduce anxiety,” explains Nadia Sourdril.
And when, finally, things start to get better? Of course, the memory of the traumatic event doesn’t disappear.“All we can do is overlay a neutral emotional memory—one we’ve created in therapy—onto the traumatic memory,” explains Isabelle Chaudieu. The trace of the trauma 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). The goal, in any case, is not to forget. Rather, it is to reduce the emotional burden and the repercussions of the event. So that the patient can come to terms with their own history. And get back into the flow of life.
EMDR: Eye Movement Desensitization and Reprocessing
Developed in 1987, EMDR (Eye Movement Desensitization and Reprocessing) is a form of psychotherapy with a proven track record of effectiveness in treating trauma. “The patient begins by recounting the scene, along with the thoughts, emotions, and sensations associated with it. Then they follow the therapist’s fingers with their eyes 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 reprocessed in this way so that it can be released and integrated. The emotional burden associated with the memory quickly diminishes.
While the mechanism behind EMDR remains somewhat mysterious, the right-to-left eye movements resemble those that occur during REM sleep, the stage when we dream and memories are archived in the brain.
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