Trauma in the Brain Series: PTSD and C-PTSD
- Katya Bownas RN, PMH-BC
- Feb 5
- 3 min read
Post-traumatic stress disorder (PTSD) and related conditions impact millions of Americans, and can be difficult to treat using conventional methods. PTSD, complex PTSD (c-PTSD), and post-traumatic stress injury (PTSI) are all conditions that arise as a result of experiencing trauma. Many people with PTSD experience symptoms such as flashbacks, intrusive thoughts, sleep disturbance, hyperarousal, and other distressing symptoms that impact their ability to function in their day-to-day lives. Looking at PTSD and related conditions through the lens of neurobiology, it is clear that trauma causes marked changes in essential structures and systems in the brain that contribute to this symptomology.
PTSD, PTSI, and c-PTSD impact brain structures that are responsible for emotional regulation, our body’s “alert system”; this causes certain areas of the brain to become hyperactive while others become hypoactive. Systems that are believed to be the most impacted in these conditions are the hippocampus, the amygdala, and the prefrontal cortex. Getting into specifics, the amygdala’s overactivity as a result of trauma or stressors leads to hyperarousal, or having a disproportionately intense response to stimuli that would otherwise not cause alarm. Inversely, the underactivity of the prefrontal cortex, which serves as the “rational” portion of our stress response, results in an inability to calm or regulate when the amygdala fires.
Treatment modalities that have been shown to be effective in treating PTSD include EMDR therapy, medications such as SSRIs, and cognitive processing therapy (CPT). Unfortunately, for a significant percentage of the population of PTSD sufferers, these treatments do not adequately relieve symptoms. This is, in part, due to the structural changes that have occurred in the brain and the need for a treatment that can actually help “heal” the underlying structural changes. While therapy has been shown to affect underlying brain function, the changes are incremental and may be very slow. And medications, while sometimes helping with symptoms, do not produce the underlying brain changes that help the brain heal.
This is where brain stimulation techniques come in. Deep brain stimulation (the implantation of a stimulating device, like a pacemaker, in certain areas of the brain) has been shown to effectively treat conditions like PTSD, but it is a highly invasive treatment that most people do not want to undertake. Transcranial magnetic stimulation (TMS), a non-invasive brain stimulation technique has also been found to be effective in the treatment of PTSD as well as depression and other anxiety-related conditions. TMS works by stimulating underlying brain networks that are involved in mood regulation, allowing for better neural communication, synchronization and efficiency.
More recently, Magnetic E-Resonance Therapy (MeRT), obtained breakthrough status from the FDA as a novel and effective treatment of PTSD. MeRT is a TMS protocol that uses brain imaging (EEGs) to measure a patient’s brainwaves, which allows the treatment team to create an individualized treatment protocol. Research shows that many patients with PTSD have dysfunction in the propagation of brain waves that are involved in positive mood states. MeRT stimulates the brain in such a way as to help regulate alpha waves, a brain wave that is highly correlated with positive mood, brain synchrony and emotional regulation. In addition to effectively treating PTSD, MeRT has also shown effectiveness in treating conditions such as anxiety, depression, ADHD, ASD, and post-COVID symptoms. With its recent breakthrough status from the FDA, it is clear that it is being recognized as a promising up-and-coming treatment modality.
Due to the complexity of these conditions, the most effective treatments are those that are multimodal, utilizing a variety of different treatment methods and therapies to provide those who live with PTSD the relief that they need. Any treatment modality, be it medication, TMS, or EMDR should be performed by a competent care team that understands the importance of socioemotional supports, lifestyle factors, and wraparound care in obtaining the best possible treatment outcomes for patients.
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