Erasing fear and traumas.

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We cannot have fear without having most or all the elements of a stress response – but we can have stress without fear.

We can inherit a predisposition to fear and trauma from our parents, with a stronger association shown from father.

Amygdala is a critical component of threat reflex, which involves activation of some systems and suppression of the parasympathetic system.

Changing the narrative is one of the most potent ways we can rewire fear circuitry.

Detailed recounting or retelling or fearful or traumatic event is key to unpairing threat reflex and changing the narrative, which will diminish stress response over time.

Eye movement desensitization and reprocessing (EMDR) has been shown beneficial for acute, single event experiences (e.g., car accident) by reducing activation of amygdala and amplitude of threat reflex – but might be incomplete treatment because it doesn’t change the narrative of the event.

Social connection is beneficial for relief of fear and trauma by diminishing tachykinin.

Taking a self-directed approach and inducing stress through breathing can mitigate stress – best results if incorporated with narrative therapy.

Breathing approaches to mitigate stress:
(1) Try 5 minutes of physiologic sigh (double inhale through the nose followed by long exhale through mouth);
(2) Try 5 minutes of cyclic hyperventilation (deep inhale through nose immediately following by deep exhale through mouth x 25-30 then fully exhaling until lungs are empty and repeating).

Defining Fear, Trauma & Related Topics.

Fear is an emotion, a physiological and cognitive response.
Fear is not stress but is built from stress and anxiety.
We cannot have fear without having most or all the elements of a stress response – but we can have stress without fear.

Operational definition of trauma: some fear took place and is embedded in the nervous system which shows up when it’s maladaptive and does not serve us.

Panic attacks: experience of extreme fear but without fear-inducing stimulus.

Phobia: extreme fear of something specific
One of the hallmarks of fear and trauma is that it is long-lasting even if the triggering event is short.

Branches & Functions Of The Autonomic Nervous System.

The autonomic nervous system controls things like digestion, urination, sleep, wake.

Sympathetic nervous system: alertness nervous system, ramps up acceleration on alertness and attention.

Parasympathetic nervous system: cells, neurons, chemicals of brain and body in9volved in calming.

Hypothalamic Pituitary Adrenal (HPA) Axis: the nexus of the hypothalamus, pituitary, and adrenal systems which uses the brain to wake up the body and prepare it for action in short term and long term.

HPA can actually alter genes and embed fear in the brain and body.

Neural Circuits & Biology Of Fear.

Amygdala is an area of the brain that integrates information.

Amygdala is part of the “threat reflex” in the brain, responsible for threat response.

The threat reflex can be activated at any time, and quite easily depending on two factors:

(1) prior memories;

(2) immediate experiences.

Threat reflex has two major circuits – one area involved in pain management, freezing, alertness, and the other area involved in reward, motivation, and reinforcement.

Much of fear system is a memory system designed to embed a particular experience in us so the threat reflex is activated in anticipation of what might happen.

Fear response takes place because of the threat reflex that occurs and sets off a cascade of responses.

The fear system is generalizable and not designed for all people to be afraid of the same things.

We can become afraid of anything as long as we have an external experience.

Understanding & Overcoming Fear.

Fear contains a historical component, protecting us for the future.

Fear is an adaptive response – we don’t want to eliminate fear the response to things that can get us injured or killed.

One-trial learning: unlike other elements of neuroplasticity and the need for multiple exposures and reinforcements, fear can be embedded after one intense experience.

We can override the threat reflex by giving a new narrative to the stimulus but you cannot just extinguish a fear – you have to extinguish fear and replace it with a positive response.

Amygdala is a critical component of threat reflex, which involves activation of some systems and suppression of the parasympathetic system.

Pharmaceuticals like SSRIs and benzodiazepines address fear indirectly but don’t tap into fear circuits and threat reflex response.

Behavioral therapies:
(1) prolonged exposure therapy,
(2) cognitive-behavioral therapy (CBT),
(3) cognitive processing therapy (CPT)

Over time, the experience of fear and trauma becomes diminished with retelling.

A detailed recounting of fear or traumatic event is essential to get positive effects of any behavioral therapy modality.

The retelling of the event starts to uncouple threat reflex from the narrative until it becomes dull.

Overcoming fear is not about forgetting what happened, it’s about attaching new positive memory to circuitry.

Eye movement desensitization and reprocessing (EMDR): reduces activation of the amygdala and associated anxiety and reduces the amplitude of threat reflex.

EMDR has been shown beneficial for acute, single-event experiences (e.g., car accident) – not lengthier experiences with trauma (e.g., difficult childhood).

You have control over the calibration of what you are feeling versus the reality of external events.

Daily short bouts of controlled intense stress through breathing can mitigate stress, try:
(1) 5 minutes of physiologic sigh (double inhale through the nose followed by long exhale through mouth);
(2) 5 minutes of cyclic hyperventilation (deep inhale through nose immediately following by deep exhale through mouth x 25-30 then fully exhaling until lungs are empty and repeating).

Transgenerational Passage Of Trauma.

We have the capacity to inherit a predisposition to trauma and fear.

An abused father can experience genetic mutations in sperm that can be passed on to offspring and reduce their threshold to trauma.

There is a stronger tendency to inherit polymorphism from father than mother.

Threat reflex is part of a larger sensory system
Drug Therapeutics.

Ketamine-assisted psychotherapy is approved for clinical use in the U.S.

MDMA-assisted psychotherapy is in clinical trials in the U.S..

Ketamine is a dissociative anesthetic that creates a state of dissociation within the body by changing the rhythm of activity in the cortex.

Ketamine allows a patient to recount trauma while feeling none of the emotional experiences, remapping new feelings onto old feelings.

Weaves in all three components of overcoming fear:
(1) diminish the intensity of experience;
(2) extinction of trauma or fear;
(3) relearning new experiences.

Data on ketamine and depression is strong.

MDMA is a powerful synthetic drug that creates a state in the brain and body unlike any other, increasing both dopamine and serotonin simultaneously.

People on MDMA experience intense euphoria and connection or resonance with people or things (because of a release of oxytocin).

MDMA allows fast relearning or new association of traumatic experience.

Lifestyle & Behavioral Factors To Mitigate Fear.

As always, get your sleep dialed in so systems function properly without dysregulation.

Maintain deep social connections to create physiological and perceived support.

Saffron has antidepressant effects
Inositol at 18g daily for one month has had outcomes similar to pharmaceutical antianxiety and antidepressants.

Kava has an MDMA contour (without the same physical and mental effects) and seems to produce improvements in generalized anxiety and depressive symptoms.

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