A little over a year ago, I wrote a post about trauma “not just in your head.” Here I follow it up with supporting evidence. I have devoted most of my life to emotionally focused and assisted trauma healing EMDR treatment methods. And I was constantly wondering how and why it works.
I also see versions of brain diagrams social networks constant; A colorful infographic illustrating how trauma affects key areas of the brain. And I cringe at oversimplified mental health memesthis is actually about something very important. The neurology of trauma is well documented, illuminating and validating for survivors and their loved ones. I think it is deeply comforting and humanizing for anyone who has suffered emotional trauma: What is wrong with me? Or, why can’t I do it?!
Here I summarize the four most affected areas of the brain and how they relate to people trying to heal from real pain (as I said in a previous post, “trauma” comes from the Latin word for “wound”).
1. An overstimulated amygdala: Your brain’s malfunctioning signaling system
For me, the most useful way to think about the amygdala is as your brain’s primary threat detection system. Ideally, it will light up when there is real danger, help you respond effectively, and resume once the threat is gone. With trauma (defined by someone’s reaction to the event, not the event itself) this system is not only turned “on”, but I would argue that the brain handle that keeps it “on” metaphorically rusts and turns it “on”. Functional imaging studies consistently show this PTSD Patients show increased amygdala activation in response to threatening cues, which is associated with decreased activity in prefrontal regions that normally feed it (Kredlow et al., 2022; Etkin & Wager, 2007). As a result a nervous system constantly scanning for risk (and, e.g confirmation biasit looks for information that confirms existing beliefs). He takes the risk and therefore finds it even when no one is around or the risk is minimal.
Therefore, trauma survivors do not appear to be startled by a light knock on the door, freeze at an unexpected touch, or relax in an objectively safe environment. As we said, their brains are strongly neurobiologically trained to stay awake (even when they don’t need to be awake). As I have written before, this defect in the brain is not a defect in character; it’s a sensitive alarm system that has saved their life one or more times and they don’t get a reminder (and/or don’t trust the reminder) that the threat has passed.
2. Affected Prefrontal Cortex: When rationality goes offline
For me, the most useful way to think about the prefrontal cortex (PFC) is as the conductor or CEO of your brain. Its function is rational thinking, decision makingstrategy, tact, and most importantly, evaluation and regulation of emotional responses from the amygdala. This control is disrupted in trauma survivors. A study published in Neuropsychopharmacology A well-supported model describes a well-supported model in which the ventromedial (“ventro” refers to the front and “medial” refers to the middle in brain anatomy) PFC, which normally controls and inhibits the amygdala, becomes hypoactive when the aforementioned amygdala is present. hyperactive. This imbalance makes it much more difficult to regulate fear. (Credlow et al., 2022).
That’s why trauma healing isn’t just different thinking, it’s a common misconception that I often hear even from health and mental health professionals. I repeat: you can’t rationalize your way out of your nervous system in extremes. When going offline under PFC stressability to think rationally, to gain perspectiveand emotional management all take a significant hit. It also helps to explain why the traditional discourse –therapy alone, while valuable, may ultimately prove insufficient for many trauma survivors because it fails to respond adequately to direct body and brain signaling systems.
3. Inactive Broca’s Area: Why It Can Feel Impossible to “Put It Into Words”
Have you ever had the experience of knowing exactly what you’re feeling, but not being able to find the right or appropriate words? I know there is. It’s neurobiology, not weakness or avoidance. The intensity and richness of our experience and emotional life can transcend the boundaries of language, especially for trauma survivors.
Broca’s area, located in the left inferior (inferior) frontal gyrus (one of the main communication centers of the brain), is central to language production and labeling experience (especially perceived language). Neuroimaging studies have consistently replicated decreased Broca’s area activity in PTSD when trauma symptoms occur (Hull, 2002), particularly when the amygdala is hyperactivated (Rauch et al., 2006; Hull, 2002). One review has described this erasure as an explanation that trauma survivors may have difficulty putting words to their feelings and experiences, which remain unspoken when trauma memories are activated (Hull, 2002). That’s why in EMDR therapy we often ask the person what they’re experiencing verbally from time to time because there’s trauma in the background of attention while they’re making rapid eye movements.
For me, this has profound clinical implications. This helps explain why asking someone to talk about their trauma can feel so activated and almost neurologically impossible. This is also a compelling argument for body-based and emotional techniques such as EMDR (and somatic experiential therapy) that do not require the client to verbalize what they are feeling while focusing on the trauma in order for healing to occur (Shapiro, 2017). The brain can’t always verbalize this literally, from compression caused by trauma, and thus often shuts down frequently, like a computer with too many programs running at once (or overheating from hot air), until it eventually has to be restarted or shut down.
4. Shrunken hippocampus: when the past and present collapse
The hippocampus is essential for contextualization and shaping memoryhelps us to fit experiences into a coherent timeline with clear markers of then and now. If you have a MacBook, you can think of it as the “Finder” of chronological folders. Reduced hippocampal volume in PTSD is one of the most consistently reproducible neurobiological findings in the literature that I have seen. Indeed, hippocampal volume best discriminates PTSD patients from trauma-exposed and non-traumatic controls (Zilcha-mano et al., 2023).
This means traumatic memories are often lost anchor in time. They don’t remember what happened in the past, but something is happening now. The unique quality of smell, sound, light can bring a trauma survivor into a whole-body re-experience that feels present. This is not a hallucination; This means that the hippocampus cannot seal the memory with “past” and “safe”. Fortunately, research shows that hippocampal volume can increase with successful treatment, providing real hope/evidence that these changes are not permanent (Zilcha-mano et al., 2023).
Combine it
These findings are why I gently but firmly push back when someone says that trauma is “in your head” or that survivors need to heal on their own. These four brain regions: the amygdala, the prefrontal cortex, Broca’s area, and the hippocampus are measurably altered when damaged. Suffering is not only mental but also biological, somatic, physiological and emotional. Some of the most effective treatments for trauma, such as EMDR, somatic experiential therapy, and emotion-focused therapy, work because they address these neurobiological realities, rather than trying to talk around them.
Understanding brain changes after injury is not only intellectual but also affirming. He asked, “What’s wrong with me?” repeats the experience of “It happened to my brain.” For me, this change itself is essential to healing.
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