473 - The Neurobiological Impact of Psychological Trauma:

The HPA-Axis

Objectives

• Define and explain the HPA-Axis

• Identify the impact of trauma on the HPA Axis

• Identify the impact of chronic stress/cumulative trauma on the HPA-Axis

• Identify symptoms of HPA-Axis dysfunction

• Identify interventions useful for this population

Based on

• Post-traumatic stress disorder: the neurobiological impact of psychological trauma

Dialogues Clin Neurosci. 2011 Sep; 13(3): 263–278.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3182008/

• This article lays out the many changes and/or conditions seen in the brain of people with PTSD.

• As clinicians, awareness of these changes can help us educate patients about their symptoms and find ways of adapting to improve quality of life.

Introduction

• Neurobiological abnormalities in PTSD overlap with features found in traumatic brain injury

• The response of an individual to trauma depends not only on stressor characteristics, but also on factors specific to the individual.

• Perception of stressor

• Proximity to safe zones

• Similarity to victim

• Degree of helplessness

• Prior traumatic experiences

• Amount of stress in the preceding months

• Current mental health or addiction issues

• Availability of social support

Introduction

• For the vast majority of the population, the psychological trauma is limited to an acute, transient disturbance.

• The signs and symptoms of PTSD reflect a persistent, abnormal adaptation of neurobiological systems to the witnessed trauma.

What is the HPA Axis

• Hypothalamic-Pituitary-Adrenal Axis AKA the Threat Response System

• Controls reactions to stress and regulates many body processes, including digestion, the immune system, mood and emotions, sexuality, and energy storage and expenditure

• The ultimate result of the HPA axis activation is to increase levels of cortisol in the blood during times of stress.

• Cortisol's main role is in releasing glucose into the bloodstream in order to facilitate the "flight or fight" response. It also suppresses and modulates the immune system, digestive system and reproductive system.

HPA-Axis Dysfunction

• The body reduces its HPA axis activation when it appears that further fight/flight may not be beneficial. (Hypocortisolism)

• Hypocortisolism seen in stress-related disorders such as CFS, burnout and PTSD is actually a protective mechanism designed to conserve energy during threats that are beyond the organism's ability to cope.

• Dysfunctional HPA axis activation will result in

• Abnormal immune system activation

• Increased inflammation and allergic reactions

• IBS symptoms such as constipation and diarrhea,

• Reduced tolerance to physical and mental stresses (including pain)

• Altered levels of sex hormones

Fatigue

• Fatigue is actually an emotion generated in the brain, which prevents damage to the body when the brain perceives that further exertion could be harmful.

• Fatigue in sports is largely independent of the state of the muscles themselves and is more related to:

• Physical factors

• Core temperature

• Glycogen levels

• Oxygen levels in the brain

• Thirst

• Sleep deprivation

• Levels of muscle soreness/fatigue

Fatigue

• Fatigue cont…

• Psychological factors reducing fatigue

• Emotional state

• Knowledge of the endpoint

• Other competitors/motivation

• Visual feedback

• Fatigue is one sign that the body is getting ready to downregulate the HPA-Axis

• In counseling practice, how can we reduce fatigue and help clients restore HPA-Axis functioning?

Low Cortisol and PTSD

• Low cortisol has been found to relate to more severe PTSD hyperarousal symptoms.

• Sensitised negative feedback loop in veterans diagnosed with PTSD by means of a greater