A person who has survived a lifetime of trauma has shown to have diminished (or completely shut down) areas of the brain, including the amygdala (the alarm system of the brain that interprets whether or not a stimulus is dangerous), anterior cingulate cortex (which plays a part in empathy, impulse control, emotion, and decision making), hippocampus (a part of the brain involved with memory formation), the prefrontal cortex (where logistic, analytical decision making takes place), and the insula.
The insula is an area of the brain where interoception (the process by which afferent, visceral stimuli is received and processed in the brain) takes place. Practicing interoception allows the participant to have an increased ability to consciously become aware, acknowledge, and respond to an aversive experience instead of automatically reacting with adverse behavior (consider that a person who uses substances is doing so to avoid or numb uncomfortable feelings and sensations). Practicing interoception allows time for autonomic processes in the brain to restore homeostasis, rather than perpetuating inefficient or maladaptive regulatory habits that rely on behavioral intervention (such as using drugs). Interoception is one of the major components of Trauma Center, Trauma Sensitive Yoga (TCTSY).
A complex pattern among regions of the brain that become activated during intoxication and drug craving include the prefrontal cortex, the amygdala, hippocampus, and many others. This pattern can explain how the drug seeking becomes compulsive and the seeker experiences loss of control. These changes in brain functioning last for months or even years after detoxification (Cadet, Bisagno, Milroy, 2014, Volkow, Fowler, Wang, 2015). It has been proposed through clinical research that chronic stress (such as that experienced in complex trauma) affects regions of the brain that may make a person more vulnerable to drug addiction. (Lee, Oswald, and Wand, 2018., Volkow, Fowler, Wang, 2015).
Decreases in gray matter of the brain around the regions of the hippocampus, amygdala, the prefrontal cortex, thalamus, nucleus accumbens, insula, anterior cingulate cortex, the central nervous system, and several others, were found in brain imaging studies of drug abusers (Cadet, Bisagno, Milroy, 2014). Drug use has shown to produce anxiety and depression. Serious cognitive functioning, decision making, verbal learning, problems with memory, and executive functioning are all impacted by long-term use of drugs. Movement, neurological disorders, insomnia, convulsions, confusion, and paranoia are also evidenced with long-term drug use. Of specific note here is that verbal instruction (such as that involved with talk therapy, psychoeducation, or education regarding substance abuse) might not be appropriately received and can negatively impact a person’s ability to follow instruction (Cadet, Bisango, Milroy, 2014).
We can see that many of the same parts of the brain are damaged as a result of chronic stress (complex trauma) and drug and alcohol abuse. It would be reasonable, then, to seek treatment that involved revitalization of those same parts of the brain, as well as treatments that attend to the many behavioral, emotional, and physiological disruptions that have resulted from the lifetime trauma exposure and the sustained drug use. Body-based, bottom up approaches may be necessary to be implemented in the treatment process, and we will see how body-based modalities have shown to complement the top-down processes (such as psychotherapy and education) well. Providing an opportunity for the regions of the brain involved in language, executive functioning, decision making, emotional regulation, memory, and impulse control to heal and regain functioning before talk therapy and education is implemented may be far more more effective than relying on talk-based therapy alone, and could be more effective than attempting to combine the modalities at the same time, especially in early recovery.
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