1.4.4 Treatment

Topic Progress:

So what the ‘low road’ / ‘high road’ dichotomy teaches us is that there are two options for dealing with post-traumatic stress.

A top-down method which would use the high road (cortex). This would involve reasoning or words. Methods like counseling.

A bottom-up method which would use the low road (limbic brain + nervous system). This method might use things like breathing techniques to ‘ramp-down’ the nervous system directly. (Also things like yoga and meditation, or even sports, if they encourage relaxation).

Body Based Therapies

Top-down therapy (counseling) has its place, but the bottom-up method (known as body-based therapy) is fast becoming the go-to method for treating ongoing post-traumatic stress symptoms, because it works directly on the persons physiology and most especially on the nervous system. The best way to understand this is to consider the following analogy of the horse and rider.

The battle between the rational brain and emotional brain can be thought of as a horse and its rider. The horse is the emotional limbic brain and the rider is the rational human brain. They are working together, but should the horse get startled then the rider is going to have a difficult time controlling him. It can be done, but it’s not easy. Whenever this happens, even rational people can get a disconnect between their emotional brain and their frontal lobes and stop listening to reason.

Interestingly, the SNS and PNS (or adrenaline and acetylcholine, to look at it another way) are quite easily manipulated by breath. Breathing is one of the few functions that is driven by both conscious and unconscious action (cortex and limbic brain). In other words, it happens by itself but we can change how it happens.

When we breathe in, we get a burst of adrenaline. And when we breathe out we get a slug of acetylcholine. This is why we breathe in sharply before doing anything scary or taxing, and why we exhale when we are relieved or trying to calm down.

This is what lies behind the effectiveness of things like meditation, yoga and breathing exercises, and why they have been used for so long by humans to help them regulate their own nervous systems.

In addition, physical movement and physical activity in general can help to ameliorate the effects of traumatic stress.

It should be noted that modern treatment programs (like Alpha) have greatly expanded the repertoire of activities that could be considered ‘body-based’. For example, in 2019-2021, Alpha Sober Living ran a Jiu-Jitsu program for young men leaving treatment, and previously, our rehabs have used techniques like triathlon training and weight lifting to help people get back in touch with their bodies. Provided it is done within safe bounds and an understanding that the whole goal is to achieve overall relaxation, greater social interaction and an expanded sense of well-being – almost any sport could potentially be used as a body-based therapy.

Cognitive Behavioral Therapy (CBT)

CBT believes that the way people think affects their feelings. Its main goal therefore is to help people feel differently by changing the patterns of their thinking. One of the ways we do this is by using a tool called ABC, where we identify thoughts which may be irrational, and then dispute those thoughts. Group therapy can be particularly helpful in this regard.

Results from a 2018 systematic review found good evidence to support CBT as an effective treatment of PTSD as well as depression.6 Since 2016, CBT has also been considered the standard of care for PTSD by the United States Department of Defense.7 Internet-based CBT programs have also been studied and found to be as beneficial as face-to-face CBT programs.8