[LUM#6] After the trauma
Life sometimes inflicts us with brutal events... Far from being harmless, they can leave traumatic scars in the brain. Fortunately, there are ways to heal.
Attack, assault, combat, serious accident... These experiences have one thing in common: they bring us face to face 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 in our lifetime. A psychic injury that often leads to symptoms. During the day, flashbacks or hallucinations. At night, nightmares... The scene reappears without us even 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 blunted, leading to indifference towards those around you. In a state of alert, you become irritable, jumping at the slightest noise.
Memory disease
If these stigmata last for more than a month after the event, we speak of post-traumatic stress disorder (PTSD). According to the World Health Organization, an estimated 3.9% of the world's population have suffered from PTSD in their lifetime. Half of those sexually assaulted suffer from it, or one in five combatants. For a third of all sufferers, the disorder will last more than six months, and potentially years.
" The disease is linked to a traumatic memory that we can't metabolize," explains Isabelle Chaudieu, a neurobiologist at Inserm. When our memories are normally archived, they form part of our autobiographical memory. In people suffering from PTSD, the memory remains blocked in the emotional memory. To cure this memory disease, there's only one solution: "The patient must be deconditioned to allow the fear to be extinguished ", explains Isabelle Chaudieu.
Progressive bearings
Cognitive-behavioral therapies (CBT) have proven their worth. " In CBT, we act on erroneous thoughts, such as guilt, which is very common in traumatized people, but also on maladaptive behaviors," explains Nadia Sourdril, psychiatrist at CHU Lapeyronie. To return to a normal life, the patient will gradually expose himself to the situation that is causing him anxiety.
After the Nice attack in 2016, some people didn't go out for a week. " The principle of CBT is to work out step-by-step exercise programs together. For example, someone unable to leave their home would start by walking downstairs in the company of someone else, then alone. The second step would be to go to the bakery accompanied, then alone, and so on, until they could walk back into a crowd," explains Nadia Sourdril. We see with him what he feels capable of ". In twelve or fifteen sessions, it's possible to get out of 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 to treat post-traumatic stress, really? Inserm).
Benzodiazepines contraindicated
But these sessions come at a cost... which dissuades many traumatized people. Indeed, many don't want to talk about what they've been through. " Forcing unwilling patients to talk is counter-productive: it traumatizes them a second time," reports 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 an attitude of denial that doesn't help healing either...",says the head of the regional medical-psychological emergency unit (CUMP).
If we hope to heal, we'll one day have to verbalize our emotions. Until that happens, medication can help. " Benzodiazepines are contraindicated following a traumatic event: they increase the risk of developing PTSD. Antidepressants, on the other hand, are relatively effective over the long term. Some anxiolytics and antihistamines reduce anxiety," explains Nadia Sourdril.
And when things finally get better? Of course, the memory of the traumatic event doesn't disappear. " All you can do is superimpose an emotionally neutral memory, created in therapy, on a traumatic memory, " explains Isabelle Chaudieu. The trace of the trauma remains in the brain. " The risk of relapse therefore exists ", moderates the neurobiologist (Biological and psychological predictors of the onset and chronicity of post-traumatic stress disorder. A one-year prospective studyin Neurobiology of Stress, 2016). The aim, in any case, is not to forget. Rather, it's to reduce the emotional burden and repercussions of the event. So that the patient can integrate his or her own story. And get back into the flow of life.
EMDR: Eye therapy
Developed in 1987, EMDR (eye movement desensitization and reprocessing) is a psychotherapy with a proven track record for treating trauma. "The patient begins by recounting the scene, and the thoughts, emotions and sensations associated with it. They then follow the therapist's fingers as they move from right to left - or the therapist alternately taps their knees. The patient then expresses himself again," explains Nadia Sourdril.
Over a period of around six sessions, the traumatic memory is reworked so that it can be unblocked and metabolized. The emotional charge associated with the memory rapidly diminishes.
While the workings of EMDR remain somewhat mysterious, the eye movements from right to left are reminiscent of those that occur during REM sleep, when we dream and memories are stored in the brain.
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