Science can help reduce stress following traumatic events, breakups

Montreal-based clinical psychologist reprograms memories

A Montreal-based clinical psychologist expanded his treatment from PTSD patients to those who have experienced terrible betrayals in romantic relationships. The innovative treatment can reprogram traumatic memories with the help of a beta blocker drug and therapy.

In 2008, Dr. Alain Brunet created a treatment called the “reconsolidation therapy,” or the “Brunet Method,” which treats patients with PTSD or victims of crime or terror attacks, such as the one in Paris in 2016.

In short, reconsolidation therapy involves therapy sessions in conjunction with a blood pressure drug that alleviates the negative surge of emotions when remembering a traumatic memory.

Brunet was a student at the University of Montreal in 1989, when the Polytechnique shooting occurred. What he interpreted as a lack of care for those affected with psychotraumatic disorders after the attack inspired him to find a cure for people suffering from PTSD.

In 2015, Brunet turned to treating romantic heartbreaks and betrayals, with one of his former graduate students, Michelle Lonergan. Lonergan worked on the project as her PhD at McGill University. She said this method is “based on this idea that the trauma memory was really at the root of the disorder.”

For six weeks, participants in the study took propranolol––a drug normally used for treating high blood pressure––one hour before a weekly therapy session, where they read their personal handwritten account of the traumatic event. They would re-read the account every session and speak about the event itself with Brunet. Lonergan said at the end of the study, two-thirds of the participants experienced an overall reduction “in the severity of people’s symptoms and reactions.”

While the method may be reminiscent of Eternal Sunshine of the Spotless Mind for some––a movie where a couple erases the memory of their terrible relationship together. Lonergan said no memory is lost, only updated––comparing the process to editing an essay.“Let’s say we have an essay on a computer and the essay is written, it’s saved to our hard drive, well when we open the essay and make changes to it and re-save it, then it’s updated with that new information,” Lonergan said.

The memory we store is saved in two different parts of the brain: the dry element––the factual, visual occurrence––in the hippocampus, and the emotional portion of the experience in the amygdala. When a traumatic event occurs, it activates the adrenergic system––our stress system––pumping adrenaline into our brain, and the memory registers with a stressful, heightened emotional response.

When an affected individual recollects the event, or experiences a trigger, such as what they ate, saw, were wearing, or even smelled in those moments, it activates their adrenaline to the amygdala and the memory re-creates a surge of uncontrollable negative emotions. This tolls the person’s mental health and wellbeing.

“For some people, that system can become overactivated, and that would result in putting an emotional stance on the

memory that is just extremely powerful,” Lonergan said.

The drug for the treatment isn’t new. Propranolol is popularly used to reduce high blood pressure and heart rhythm disorders, but it has another quality that makes the treatment possible. It’s an adrenergic beta-blocker, meaning that it works by blocking the surge of adrenaline to the amygdala when re

membering the traumatic memory.

According to testimonials on Brunet’s website, patients described the initial version of their traumatic memory as so emotionally discharged, it feels like someone else wrote it.

Kanica Saphan, a sexologist counsellor who works with individuals and couples in Montreal, said that a lot of the baggage people carry from bad breakups is from negative stories they create from their experience. “It will become like a story of how we were either ugly, unworthy or valuable, that we had something to do with it,” she said, adding that such stories are created for many reasons, including misunderstanding the causes of a breakup.

For her counselling, Saphan works by developing a therapeutic relationship with her clients. She

uses “talk therapy,” meaning she develops a human connection with clients to work through issues and heal over time. She said she does not prescribe medication, and that while reconsolidation therapy can work for traumatic experiences, she suggested that using propranolol pills could restrain people from learning to use their own internal coping tools.

While Saphan hopes the treatment will not add to “pill culture,” where medication is used to treat an excessive range of emotional afflictions, Lonergan said the pill does not mask symp

toms. It can provide a significant change, and the treatment is short––roughly four to six weeks. Patients are not medicated long term, Lonergan said.

Lonergan suggested that the treatment could be expanded in the future, to other areas where people suffer psychological strain from emotionally-charged events.

Graphic by Jad Abukasm

Student Life

Can trauma be transmitted intergenerationally?

Dr. Rachel Yehuda reveals groundbreaking research on trauma and its biological risk factors

Before post-traumatic stress disorder (PTSD) was officially identified in 1980, little was known about the repercussions of a traumatic incident. “In general, when we talk about the effects of trauma, we are talking about a moving target,” said Dr. Rachel Yehuda. “We are talking about a dynamic process that moves and develops and changes. We are not talking about something that is static.”  

Yehuda’s focus on PTSD is part of her broader research in epigenetics—the study of changes in gene expression rather than alterations to the genetic code. “Some of the epigenetic changes are inheritable, but others can occur in development in response to environmental influences and particularly in uterine influences,” Yehuda explained to an audience at Dawson College on Oct. 16.

Yehuda is a professor of neuroscience and the vice-chair of psychiatry at the Icahn School of Medicine at Mount Sinai in New York City. She is also the mental healthcare patient director at the Veteran Affairs Medical Center in Bronx, N.Y. She has authored more than 250 published papers, chapters and books in the field of traumatic stress and the neurobiology of PTSD. Her epigenetics research led her to studying the children of Holocaust survivors and pregnant women who survived the 9/11 attacks. The purpose was to demonstrate how traumatic stress can be transmitted biologically to the next generation.

“I was studying the effects of stress and learning something that I thought was quite fascinating which was how stress hormones affect the brain and brain development in particular,” she said. Yehuda received her PhD in psychology and neurochemistry and her master of science in biological psychology from the University of Massachusetts Amherst, which allowed her to pursue the study of stress psychology further. While she was earning her PhD, PTSD was a relatively new diagnosis. “This was the first recognition by psychiatry that the effects of a traumatic stressor could be long-lasting,” she said. “It was a very brave thing to do because stress research didn’t really offer a paradigm for understanding this.”

In 1991, Yehuda became an assistant professor of psychiatry at the Icahn School of Medicine at Mount Sinai. “I became very fascinated with some questions after I became acquainted with the concept of PTSD,” she said. According to Yehuda, the main question on her mind was why the effects of trauma endure once a traumatic event is over. She also studied the factors that cause people to react differently to trauma “because, surely, we don’t all respond the same way,” she said. “Why do survivors feel transformed by traumatic experiences?”

According to Yehuda, when a person experiences fear, their fight-or-flight response is activated. “The startle response orients you to danger. All the things that your body might have been doing at the time of trauma—like ovulation or digesting your lunch—all these things had to slow down so that all your energy could be preserved […] to increase your heart rate, blood pressure and cause the release of adrenaline,” she said.

When the brain senses the immediate danger has passed, it sends a signal to the adrenal glands to release cortisol. This hormone has the effect of reducing the amount of adrenaline circulating in a person’s system. According to Yehuda, the more severe the stressor, the more cortisol is secreted to bring the body back to normal.

“It’s a really well-balanced system that is designed to activate and calm itself down,” she said.

What Yehuda discovered during a clinical study in 1991, however, was that Vietnam war veterans with PTSD had lower levels of cortisol in their systems at the time compared to Vietnam veterans who didn’t have the disorder. “I couldn’t understand what would explain why a trauma survivor would have low cortisol,” she said.

In an attempt to understand these results, Yehuda spoke with her postdoctoral advisor. “It can’t be the war in Vietnam,” she told him. “I grew up in a Jewish community full of Holocaust survivors, and you don’t see Holocaust survivors in mental hospitals. You don’t see Holocaust survivors being so disabled.”

His response: “Rachel, that is a testable hypothesis.”

At the beginning of her research, Yehuda came across a Holocaust survivor who had many symptoms common with PTSD. “I couldn’t help but ask her: how did you live with your symptoms for so long? Why didn’t you ever seek treatment?,” she said. According to Yehuda, only three per cent the people she studied had ever been to a mental health professional in their lives. “Her response to me was: where am I supposed to go?”

It was then that Yehuda decided to open the first clinic for Holocaust survivors at Mount Sinai with a program dedicated to their treatment. She has spent more than 30 years conducting extensive research and interviewing Holocaust survivors and their children.

“What blew me away even more was the Holocaust survivors with PTSD also had lower cortisol levels,” she said.

During this first part of her research, Yehuda found that changes in DNA function, gene expression, brain structure and function, neurochemistry, metabolism, hormone regulation and immune function are all possible effects of trauma. “All these things can persist well beyond the effects of the fight-or-flight response,” she said.

Further on in her studies, Yehuda came across literature that disputed the myth of traumatic damage to the second generation. “Interestingly, that literature came from Montreal. A lot of that literature was written by second-generation Holocaust survivors,” she said. This inspired Yehuda to ask more questions and develop hypotheses. “Do Holocaust offspring have more mental health problems? Do they show biologic alterations that reflect psychiatric vulnerability? If so, do these biological alterations transmit somehow through the experience of being raised by Holocaust survivors?,” she said.

To test her hypotheses, Yehuda decided to ask the Holocaust survivors she had initially studied if she could interview their children. What she learned from this research was that the higher levels of mental illness and low levels of cortisol in these children were caused by a biological change in their parent which occurred in response to surviving the Holocaust.

According to Yehuda, parental trauma can affect the next generation in many different ways including in utero and postnatally. Another conclusion drawn from her epigenetics study was that, when exposed to something traumatic during pregnancy, as many as three generations can be affected.

“The mother is affected, her fetus is affected and the fetuses gametes are affected. That is one way in which this exposure [to trauma] and pregnancy might have effects,” she said.

Through her research, the conclusion that trauma can be transmitted intergenerationally led Yehuda to form a new hypothesis: what gets transmitted to the offspring of trauma survivors isn’t the trauma itself, but rather the body’s solution for dealing with trauma. “I can’t prove this yet, but I think it is true,” Yehuda said. “Maybe someone in this room will prove it, because you are young and science is a great field, and we now have the tools and techniques to be able to do so.”

Photo by Sandra Hercegova

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