Cognition and Post-Traumatic Stress Disorder
Metamorphic stages of psychiatric and psychological disorders and ailments have their roots in traumatic events in most cases. However, not all individuals are mentally capable to cope with traumas when they experience or witness them. The ability to have a right mind or proper emotion functionality depends on quite a few factors, including both external and internal ones.
Current essay will further discuss fear, anxiety, and brain parts they activate. The paper would also discuss flashbulb memories, a brief history of PTSD, types of PTSD, brain areas and cognitive processes associated with PTSD, as well as treatment theories related to brain functioning.
An Overview of Fear, Anxiety, and Brain Areas They Activate
In his article “The Biology of Fear and Anxiety Related Behaviors”, Steimer (2002) defined anxiety as a behavioral, psychological, and physiological state induced in humans and animals resulting from a threat to well-being or survival, whether potential or actual. Characteristics of anxiety include: neuro-endocrine instigated, autonomic, arousal, expectancy, and other specific behavioral patterns. Anxiety is a reflex action or reaction directly prompted to initiate the ability of a human or animal to cope during unexpected situations. The study of fear and anxiety can be evaluated systematically based on neuro-anatomic functionality, brain relationships and behaviors, neuronal circuitry, neurotransmitters, and biochemical and hormonal factors.
According to etiologists, fear is described as a stimulus that signals a defensive instinct against or escape from danger. Fear and anxiety function together as a danger, threat, and motivated conflict triggered by adaptive reflexes. Some scholars believe that fear and anxiety represent the same phenomenon and some believe they can be distinguished (Steimer, 2002). It is possible that anxiety and fear are two different emotional expressions, but the fact remains that brain activity and behavioral mechanisms may also overlap. Avoidance behavioral patterns towards similar situations or events that resulted in pain or stress can be noticed in humans and animals as a result of fear. Another important observation made by etiologists about fear is that it can be mixed -up with certain aspects of motivation. The difference between fear and anxiety is simple: fear is based on familiarity with external danger, while anxiety is considered to be a generalized response to an unfamiliar threat or thought/mind conflict.
In order to understand anxiety, it is necessary to properly consider its cognitive aspects because it is affiliated with uncertainty. The difference lies in time courses, response patterns, and intensity among others. The object or subject or fear is real, known, and objective and usually comes from an external source. Sources of anxiety are usually unclear or uncertain.
Parts of the brain involved in response to stress include the prefrontal cortex, amygdale, and the hippocampus (Bremner, 2006). These parts of the brain can undergo permanent changes as a result of the traumatic stress experienced. The increase in cortisol and norepinephrine are the usual response associated with traumatic stress and concerned stressors. When a stressed or depressed person takes antidepressant pills, the effect of the antidepressants focuses on the hippocampus. The hippocampus is the part of the brain that counteracts stress (Bremner, 2006). The results of some animal studies have been relatively concurrent in the studies of human PTSD patients with lower hippocampus and anterior cingulated activities, a higher amygdale function, as well as lower medial prefrontal/anterior cingulated functionality.
Furthermore, the analysis shows that patients with PTSD have a higher cortisol level and stress responses are instigated by norepinephrine responses to stress (Bremner, 2006). Effective post-traumatic stress disorder treatments relating to animal studies have exhibited visible improvement in neurogenesis, memory capabilities, and a higher volume of hippocampus in PTSD patients.
A Look at Flashbulb Memories
According to a brief discussion made on the University of Illinois' website, flashbulb memories are memories that are very distinct, vivid, concrete, precise, as well as last for a very long time in the memory of a witness. Such memories are usually associated with shocking events experienced or witnessed by someone. Such events are remembered with a vivid clarity and might range from natural disasters, terrorist attacks, and unusual events to other pleasant and sometimes unpleasant things. The accuracy of flashbulb memories are not as accurate or permanent as photographic memories, but shockingly are minutely affected by time. Memories such as flashbulbs are collected on specific occasions and retained for a lifetime. The emotion arousal connected to flashbulb memories is the reason why they are precisely saved in individual memories. The same emotional amusement is responsible for the high level of accuracy with which the event is being recalled and/or retold. Although not always collectively of individually accurate, there is a chance that the memory is reactivated when details of involved events are often retold. This in turn makes the accuracy of a flashbulb memory reduce gradually.
A History of PTSD, Types of PTSD
Humans have been prone to trauma long before the emergence of civilization. Early people sustained injuries and trauma from wild animals and other physically devised and natural sources. In other words, trauma has been a part of human natural existence long before it was given a name or studied. However, types of trauma experienced have varied from generation to generation and continue varying. Long ago, most traumas experienced by the human species were not human-induced. Such trauma ranged from wild animal attacks to falling off a tree or cliff and volcanic eruptions among others. However, Post-Traumatic Stress Disorder (PTSD) deals with psychological aspects of traumatic effects and events.
The American Psychiatric Association (APA) noted Post-Traumatic Stress Disorder (PTSD) as a mental disorder or ailment when it added PTSD to its statistical and diagnostics manual in the year 1980 (Friedman, 2014). There were several controversies about PTSD when it was first discussed and introduced, but it has since made a great impact on psychiatric studies and practices. The PTSD concept, with respect to a historical point of view, insinuates that during a traumatic event there is always an etiological agent outside the individual suffering from PTSD other than individual weakness. It is necessary to understand the nature of trauma in other to apply scientific or clinical solutions. The etiological agent, also known as the traumatic stressor, makes PTSD a unique aspect of psychiatric diagnosis. According to Friedman (2014), the APA's Diagnostic and Statistics Manual of Mental Disorders, a traumatic event is defined as the catastrophic stressor that exists outside the bounds of usual human experience.
A few traumatic events suggested by the first PTSD psychiatrists were mostly war-affiliated. Events such as rape, torture, starvation, atomic bombings, the Nazi holocaust, natural disasters, human-influenced accidents, and incidents among others were a part of their suggestions. The then psychiatrists did not agree that traumatic events included stressors such as rejection, divorce, financial loss, death of the loved ones, life-threatening illnesses, and failure among others (Friedman, 2014). These were regarded to be "ordinary stressors" by the APA during the first few years of PTSD diagnosis and as such were characterized as adjustment disorders, not PTSD (Friedman, 2014). Clinical studies and evaluations of PTSD diagnosis have shown that the individual capacity to cope with catastrophic/traumatic stress varies from person to person. This simply means that not all those exposed to traumatic events would later develop a post-traumatic stress disorder. Meanwhile, some people gradually or instantly develop the syndrome with respect to the results of such observations, while a trauma such as pain was not initially considered to be an external phenomenon that could be objectified.
According to Grohol (2013), there are currently five types of post-traumatic stress disorder and they are listed as follows:
Comorbid PTSD: This is a psychiatric disorder commonly affiliated with another or several other psychiatric disorders such as alcoholism, drug abuse, panic disorder, and depression among other anxiety disorders.
Acute stress disorder: This type of disorder is usually characterized by existence of constant mental confusion, panic reactions, dissociation, insomnia, and inability to practice basic self-care and manage work and personal relationships.
Complex PTSD: This type of disorder is noticed in persons who have suffered from a prolonged exposure to traumatic stress events such as childhood sex abuse, childhood battery witnesses, or/and victims. The persons affected by such disorders are usually diagnosed with antisocial personality disorders or other behavioral disorders like eating disorders, sexual disorders, and self-destructive actions among others.
Uncomplicated PSTD: This type of PSTD is associated with re-experiencing of a traumatic event, boycotting of stimuli related to a traumatic event, numbing of personal emotions, and increased arousal.
Normal stress response: This occurs mostly in healthy adults and adolescents who had traumatic experience during adulthood associated with bad memories, emotion numbing, relationship, and unreal feelings among others.
Currently, there is no specific definition of PTSD by the American Psychological Association in the fifth edition of Diagnosis and Statistics Manual, but there are several and recently updated criteria meant for determining if and when a person can be considered as a PTSD patient. Abnormal information processing could also facilitate PTSD in affected persons.
Brain Areas and Cognitive Processes Associated with PTSD, Treatment Theories Related to Brain Functioning
Cognitive processes associated with PTSD involve two specific control mechanisms, namely cognitive control of working memory and cognitive control of emotional information. These two control mechanisms are responsible for the kind of reactions and reflexes observed in persons during or after reception of emotional and /or non-emotional information (Banich et al., 2009). The dorsal lateral cortex and a portion of the inferior frontal cortex are partly responsible for processing information related to working memory.
The concept of emotion regulation is a very vital aspect of healthy emotion functionality. This process could be disturbed or disrupted by a vast variety of psychopathologic disorders, which may arise from post-traumatic disorders (Banich et al., 2009). Medial and lateral prefrontal parts of the brain are associated with cognitive control of emotions like suppression and processing of emotional information or emotional expressions. Researchers are currently working on determining if there is an interface between working and emotional information without the interference of cognitive control (Banich et al., 2009).
According to Friedman (2014), there are many therapeutic propositions from different psychiatrists, scholars, and practitioners of psychology, but the most effective post-traumatic stress disorder treatment ever proposed is the Cognitive Behavioral Therapy (CBT). Other methods that have yielded outstanding results include the Prolonged Exposure Therapy (PE) and the Cognitive Processing Therapy (CPT). These therapies are effective and recommended, especially to females who were victims of adult or childhood sexual traumas, war veterans, and military persons who suffer from war-related traumas. Group therapy is also recommended to patients who were fairly affected by PTSD. During group therapy, a patient discusses memories of personal traumatic events, functional deficits, and symptoms experienced. Therapists try as much as possible to implement realistic therapeutic ideologies and goals for obtaining better results. This is a very important aspect to therapists and therapeutic processes as post-traumatic stress disorders can be very complex and difficult to treat.
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Traumatic events will continue to occur and if they do, there is always a possibility/probability that some people would suffer from traumatic events. However, some people might possess the ability to cope with traumatic events, but it is important that those who end up with post-traumatic disorders are well-looked after before they lose their sanity and their loved ones or cause harm to themselves or others. Helpful and effective treatment therapies have been developed and made available for affected persons by psychiatrists and psychologists. Healthy mental stability, brain functionality, and rehabilitation of PTSD-affected citizens would facilitate healthy relationships and lifestyle and, in turn, would have a positive effect on crime rates. It is know that almost all criminals suffer from one or several PTSD types.
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