Julio F. P. Peres

Spirituality and Resilience in Trauma Victims

The way people process stressors is critical in determining whether or not trauma will be experienced. Some clinical and neuroimaging findings suggest that posttraumatic stress disorder patients experience difficulty in synthesizing the traumatic experience in a comprehensive narrative. Religiousness and spirituality are strongly based on a personal quest for understanding of questions about life and meaning. Building narratives based on healthy perspectives may facilitate the integration of traumatic sensorial fragments in a new cognitive synthesis, thus working to decrease post-traumatic symptoms. Given the potential effects of spiritual and religious beliefs on coping with traumatic events, the study of the role of spirituality in fostering resilience in trauma survivors may advance our understanding of human adaptation to trauma.

Cerebral blood flow changes during retrieval of traumatic memories before and after psychotherapy: a SPECT study

BACKGROUND Traumatic memory is a key symptom in psychological trauma victims and may remain vivid for several years. Psychotherapy has shown that neither the psychopathological signs of trauma nor the expression of traumatic memories are static over time. However, few studies have investigated the neural substrates of psychotherapy-related symptom changes. METHOD We studied 16 subthreshold post-traumatic stress disorder (PTSD) subjects by using a script-driven symptom provocation paradigm adapted for single photon emission computed tomography (SPECT) that was read aloud during traumatic memory retrieval both before and after exposure-based and cognitive restructuring therapy. Their neural activity levels were compared with a control group comprising 11 waiting-list subthreshold PTSD patients, who were age- and profile-matched with the psychotherapy group. RESULTS Significantly higher activity was observed in the parietal lobes, left hippocampus, thalamus and left prefrontal cortex during memory retrieval after psychotherapy. Positive correlations were found between activity changes in the left prefrontal cortex and left thalamus, and also between the left prefrontal cortex and left parietal lobe. CONCLUSIONS Neural mechanisms involved in subthreshold PTSD may share neural similarities with those underlying the fragmented and non-verbal nature of traumatic memories in full PTSD. Moreover, psychotherapy may influence the development of a narrative pattern overlaying the declarative memory neural substrates.

Police officers under attack: Resilience implications of an fMRI study

OBJECTIVE Crime is now a top-priority public-health issue in many urban areas. Sao Paulos state police force was the target of gunfire attack on an unprecedented scale. Several officers were killed or wounded, and many more were affected by psychological trauma. We investigated the brain activity underlying trauma, the coping effect of psychotherapy, and resilience in a highly homogenous sample that experienced the same traumatic event. The design applied was a between-group comparison of cerebral blood-oxygenation-level-dependent signals and symptom scores of police officers with and without partial Posttraumatic Stress Disorder (pPTSD). METHOD We used functional magnetic resonance imaging (fMRI) to investigate the retrieval of traumatic memories of 36 volunteers divided in three groups: (1) pPTSD policemen submitted to psychotherapy; (2) pPTSD policemen on the wait list; and (3) symptom-free (resilient) policemen. All participants were given a baseline fMRI scan and a follow-up scan some 40 days later. Not given psychotherapy, groups 2 and 3 were controls. RESULTS Group 1 showed 37% fewer PTSD symptoms post-psychotherapy and their scores and neural expressions were comparable to Group 3 resilient policemen. A marked increased in medial prefrontal cortex (mPFC) activity was concomitant with decreased amygdala activity during traumatic memory retrieval in both resilient and pPTSD participants (after psychotherapy) and these findings were associated with symptom attenuation. CONCLUSIONS Our results provide neurophysiological evidence of resilience in a high-risk group for PTSD. Psychotherapy may help to build narratives and resilient integrated translations of fragmented traumatic memories via mPFC, and thus weaken their sensory content while strengthening them cognitively.

Espiritualidade, religiosidade e psicoterapia

Crencas e praticas religiosas/espirituais constituem uma parte importante da cultura e dos principios utilizados para dar forma a julgamentos e ao processamento de informacoes. O conhecimento e a valorizacao de tais sistemas de crencas colaboram com a aderencia do individuo a psicoterapia e promovem melhores resultados. Contudo, nem todas as abordagens encontraram um ajuste desse tema em suas intervencoes e os diversos conceitos sobre religiosidade/espiritualidade dificultam essa importante interface. Neste artigo, trazemos os conceitos mais coerentes e acessiveis para facilitar o dialogo profissional no âmbito terapeutico. Discutimos o impacto da subjetividade, dos estados de consciencia e das percepcoes influenciadas pela religiosidade/espiritualidade na saude mental e a importância de a psicoterapia voltar-se a clientes e respectivos sistemas de crencas, desenvolvendo modelos que mobilizem esperanca e potencializem suas capacidades de superacao. A despeito da atual distância entre estudos controlados e praticas clinicas, discutimos a integracao das dimensoes espirituais/religiosas na psicoterapia com profissionalismo etico, conhecimento e habilidades para alinhar as informacoes coletadas ao beneficio do cliente. Considerando que apenas 7,3% da populacao brasileira nao tem religiao e a escassez de abordagens e psicoterapeutas que contemplem a religiosidade/espiritualidade, apontamos a relevância de investigacoes sobre o tema e que as propostas psicoterapicas sejam testadas em ensaios clinicos.

Psychological dynamics affecting traumatic memories: Implications in psychotherapy

The search to understand response to trauma has turned to the contribution of personality factors. The way people process the stressor event is critical in determining whether a trauma will be configured or not. Neuroscience shows that the brain does not store memories, but traces of information that are later used to create memories, which do not always express a completely factual picture of the past experience. Whenever an event is retrieved, it may undergo a cognitive and emotional change. Psychological dynamics--emotional interpretative tendency that affects the internal dialogue related to a meaningful event--may influence the development of positive or negative outcomes after stressor events. We postulate that therapists must see beyond the traumatic event itself and work with the internal dialogues that maintain the pathological relationship with the past episode. Thus, they may better treat traumatized patients by therapeutically rebuilding the memory. A brief clinical case is presented to show how exposure-based and cognitive restructuring therapy may help trauma victims experience psychological growth from their negative experiences, by fostering healthy psychological dynamics.

Neuroimaging during Trance State: A Contribution to the Study of Dissociation.

Despite increasing interest in pathological and non-pathological dissociation, few researchers have focused on the spiritual experiences involving dissociative states such as mediumship, in which an individual (the medium) claims to be in communication with, or under the control of, the mind of a deceased person. Our preliminary study investigated psychography – in which allegedly “the spirit writes through the mediums hand” – for potential associations with specific alterations in cerebral activity. We examined ten healthy psychographers – five less expert mediums and five with substantial experience, ranging from 15 to 47 years of automatic writing and 2 to 18 psychographies per month – using single photon emission computed tomography to scan activity as subjects were writing, in both dissociative trance and non-trance states. The complexity of the original written content they produced was analyzed for each individual and for the sample as a whole. The experienced psychographers showed lower levels of activity in the left culmen, left hippocampus, left inferior occipital gyrus, left anterior cingulate, right superior temporal gyrus and right precentral gyrus during psychography compared to their normal (non-trance) writing. The average complexity scores for psychographed content were higher than those for control writing, for both the whole sample and for experienced mediums. The fact that subjects produced complex content in a trance dissociative state suggests they were not merely relaxed, and relaxation seems an unlikely explanation for the underactivation of brain areas specifically related to the cognitive processing being carried out. This finding deserves further investigation both in terms of replication and explanatory hypotheses.

Traumatic memories: bridging the gap between functional neuroimaging and psychotherapy.

Objective: Neuroimaging studies have highlighted important issues related to structural and functional brain changes found in sufferers of psychological trauma that may influence their ability to synthesize, categorize, and integrate traumatic memories. Methods: Literature review and critical analysis and synthesis. Results: Traumatic memories are diagnostic symptoms of post-traumatic stress disorder (PTSD), and the dual representation theory posits separate memory systems subserving vivid re-experiencing (non-hippocampally dependent) versus declarative autobiographical memories of trauma (hippocampally dependent). But the psychopathological signs of trauma are not static over time, nor is the expression of traumatic memories. Multiple memory systems are activated simultaneously and in parallel on various occasions. Neural circuitry interaction is a crucial aspect in the development of a psychotherapeutic approach that may favour an integrative translation of the sensory fragments of the traumatic memory into a declarative memory system. Conclusion: The relationship between neuroimaging findings and psychological approaches is discussed for greater efficacy in the treatment of psychologically traumatized patients.

Promovendo resiliência em vítimas de trauma psicológico

Exposure to life-threatening and violent events is relatively common in a significant portion of the population. Efforts aimed at understanding responses to traumas have also focused on the contribution of personality factors. The way people process the stressful event is of paramount importance for the determination of trauma. The brain does not store records of facts; rather, it keeps traces of information that are later used to recreate memories, which do not always express a completely faithful picture of the past experience. Whenever a traumatic event is retrieved, it may undergo cognitive and emotional changes. We postulate that therapists must go beyond the traumatic event itself and work with the internal dialogs that maintain the pathological relationship with the past episode. Therapy based on exposure and cognitive restructuring may help trauma victims experience psychological growth from their negative experiences, by fostering resilient internal dialogues.La exposicion a eventos estresores y violentos ocurre con relativa frecuencia en grande parte de la poblacion. La busqueda por la comprension de las respuestas al trauma tambien esta dirigida a la contribucion de los factores de la personalidad. La manera como los individuos procesan el evento estresor es critica para la determinacion o no del trauma. El encefalo no almacena propiamente registros factuales, sino rasgos de informaciones que seran usados para recrear memorias, las que no siempre expresan un retrato completamente fidedigno de la experiencia pasada. Siempre que se recuerda un evento traumatico, este puede ser sometido a cambios cognitivos y emocionales. Postulamos que los psicoterapeutas deben trabajar, ademas del evento traumatico mismo, los dialogos internos que mantienen la relacion patologica con el episodio del pasado. La exposicion imaginaria y la reestructuracion cognitiva pueden ayudar a las victimas de experiencias traumaticas a evolucionar a partir de sus experiencias negativas, con el desarrollo de dialogos internos saludable y resilientes.

Achados da neuroimagem em transtorno de estresse pós-traumático e suas implicações clínicas

Neuroimaging findings have been replicating some findings important to understanding structural and functional abnormalities associated with posttraumatic stress disorder (PTSD). The impairment in synthesizing,

Sensitivity to aversive stimulation, posttraumatic symptoms and migraines: What do they have in common?

Studies have suggested that the high comorbidity observed between chronic migraine and anxiety disorders can be mediated through a third factor namely increased sensitivity to aversive stimulation. This trait may predispose for both chronic migraines, through medication overuse as an avoidance response, and anxiety disorders. Additional studies have shown that hyper sensitivity to aversive stimulation, migraine chronification and anxiety disorders share other characteristics such as serotonergic mediation and personality traits. Preliminary analysis of empirical data comparing the frequency the impact of traumatic events over chronic [CM] and episodic migraine [EM] patients gives further support to this hypothesis. In spite of CM and EM did not differ in terms of the occurrence of traumatic events, CM patients that had experienced at least one traumatic event during their lives had higher scores in re-experiencing and avoidance (but not in hyperarousal) symptoms than CM patients. These observations suggest that traumatic events have greater impact over CM than over EM patients.