Cognitive Processing Therapy

Trauma and Trauma Recovery

Under stressful conditions, the body's fight-flight-freeze response is a naturally occurring, adaptive means of defense and self-preservation. When operating properly, the brain's amygdala responds to incoming threat stimuli (e.g., person approaching with a weapon) by initiating a fear response and releasing chemical signals, or neurotransmitters, to engage the brain stem. The brain stem in turn triggers the release of additional chemicals (e.g., adrenaline, cortisol) enabling the individual to react to the threat. In order to conserve resources, these chemical signals also temporarily suppress or deactivate various brain regions and body systems, such as the digestive system that are nonessential in dealing with the current threat. One of these suppressed regions is the prefrontal cortex, the brain's higher thought center. Once the threat is no longer present, the pre-frontal cortex comes back fully online and signals the amygdala to disengage the fear response. In most cases, this system functions as designed, and although the event may be quite traumatic, the individual will fully process the event and recover in a reasonably short period of time.

However, in the case of PTSD, the body's fight-flight-freeze response is properly engaged in order to deal with a current threat but fails to fully disengage when the initial threat is no longer present. External factors, such as locations, sights, sounds, and situations, become coded in the brain and attached to the memory of the initial threatening event as conditioned stimuli; when reencountered (i.e., hearing a car backfire; seeing a knife or pistol), these conditioned stimuli can reengage the fear response. Under these conditions, the amygdala floods the brain stem, which in turn takes the prefrontal cortex completely offline, hindering its ability for rational thought. Preexisting and or posttrauma disruptive cognitions (i.e., thoughts and beliefs) about the event and the world in general (e.g., “the world is unsafe” or “I cannot trust anyone”) may also stifle an individual's ability to effectively accommodate the new experience into an adaptive outlook and worldview (e.g., “although dangers do exist, I am not always unsafe”). Additionally, PTSD sufferers often actively avoid engaging the thoughts, feelings, and memories surrounding the event altogether. This combination of avoidance, disruptive cognitions, and the continuous deactivation of the brain's higher thought center interferes with an individual's ability to process the event in a productive manner and can result in the development of a fear-based schema that is often so strong that the PTSD sufferer remains in a near constant state of high-alert and hypervigilance. The individual is essentially always on the lookout for the next threat.

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