Neurobiology and Cognition of Trauma

Levels of Cognitive Processing of Trauma

From the cognitive model, PTSD is understood through the interaction of several levels. The etiological level considers prior vulnerability and severity of the event.

Automatic processing involves an attentional bias toward the threat and a fragmented trauma memory that is triggered without conscious control.

Finally, elaborative processing is where the individual attempts to make sense of what happened, often using maladaptive strategies such as rumination or thought suppression.

The disconnect between these levels prevents the traumatic memory from being integrated into the patient's normal biographical narrative.

The Role of Hypocortisolism and Energy.

Unlike the typical acute stress response where cortisol is elevated, in chronic or severe trauma a phenomenon of hypocortisolism (low cortisol levels) may be observed.

The brain, after extreme stress, reduces the responsiveness of the system to "save energy" and protect the body from total exhaustion.

This explains the emotional dullness and the inability to feel pleasure; the body avoids unnecessary "expenditures".

However, due to fear conditioning, when a real or symbolic stressor is detected, this depressed system reacts with an exaggerated and explosive stress response, going from 0 to 100 in moments, as it lacks modulated regulation.

Impact on the Fundamental Belief Systems

Trauma shakes the foundation upon which a person builds his or her reality. Five critical areas of belief are affected: safety (the world becomes unpredictable and dangerous), trust (cannot rely on anyone or one's own judgment), power/control (feeling totally helpless), esteem (feeling damaged or worthless), and intimacy (inability to connect).

The mind attempts to assimilate the traumatic event by modifying these beliefs to "prevent" future harm (e.g. "if I don't trust anyone, I won't get hurt"), but these new rigid beliefs end up imprisoning the patient in a limited and fearful life.

Summary

The cognitive model analyzes the disconnection between automatic and elaborative processing. Fragmented traumatic memory is triggered uncontrollably, and attempts to make sense often fail due to maladaptive strategies.

Neurobiologically, hypocortisolism may occur following extreme stress. The brain reduces energy to protect itself, but reacts explosively to new stressors due to lack of modulation, moving from apathy to high alert.

Trauma impacts fundamental belief systems of safety, trust and control. The mind rigidly modifies these schemas to prevent future harm, which ends up severely limiting the patient's life and relationships.