Erasing Fear & Traumas Based On The Modern Neuroscience Of Fear


Key Takeaways

  • 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 involved 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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