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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