The Underlying Effects of Trauma

Traumatic experiences can come in many forms: emotional, physical, sexual, and even witnessing trauma in others can affect you. Whether in childhood or as an adult, the way this changes your brain can impact your mental health and underlying trauma can be mistaken for, or worsen, anxiety, depression and even ADHD. Finding the right mental health provider can also be challenging in Alaska. Join host Dr. Justin Clark as he discusses how trauma impacts mental health and how to navigate mental health services to find the right provider for you.

There are both immediate and delayed reactions to trauma and these can be emotional like numbness, detachment, and anxiety, or physical like sweating, nausea, rapid heartbeat cognitive like memory problems or difficulty concentrating and behavioral like sleep disturbances or substance use. In addition, the need for mental health services has greatly increased in the last few years, perhaps as a result of the pandemic but also because of increased awareness and acceptance as well as less stigma surrounding seeking care. However, the supply of providers has not kept up with the demand for services and this is particularly true in Alaska. Not only can it be challenging to find a mental health provider, but it can be challenging to find the right provider for you, which is just as important.

After that, in about 2005, I became the director of a mental health program that was on a campus of a school for kids with special needs and we contract with LA County Department of Mental Health. So, I worked in that sector for quite a while for about 10 years, mostly doing administrative but also a lot of clinical work and working a lot with kids with developmental delays as well as severe emotional issues. Then after that, I got a little burned out dealing with the Department of Mental Health and moved into private practice. I did that for quite a while. Then about two and a half years ago, my wife and I decided we wanted to move out of LA and she’s from up here originally, so we came up to Alaska. When we first got here, I started working at Providence. I was working in primary care doing integrated behavioral health. I did that for a couple years and then a couple months ago, came over to Psychology Services of Alaska, and so doing evaluations for bariatric surgery, Department of Labor work comp cases and then also a lot of individual therapy.

Dr. Seth Bricklin: Sure. As far as my approach with therapy and how I like to work with patients, I always like to think of therapy as a joint venture and different from a lot of medical treatments, especially like surgeries, therapy is something we do with the patient, not to the patient. They are very actively involved in that entire process. I sometimes think of my role as almost like a personal trainer. A patient client comes in, here’s my goals, here’s what I want to achieve – and I will work with them and give recommendations and suggestions and help map out a plan for how we’re going to get there. The patient has to still do the heavy lifting. They’re the ones that are doing a lot of the work and I feel I’m more of a guide. I really like to let them lead.

In terms of my philosophy in what I think people often come and need help for, there’s an old Buddhist saying, which I think really encapsulates it very well, which is, “pain is inevitable, suffering is optional”. It basically means that painful things are going to happen to all of us in life and if we’re suffering because of them, it’s often because of our own processes, whether we’re thinking too much or have a hard time letting go or feeling stuck. But often, there’s a lot of things that we’re doing to contribute to that. The good news is if we’re contributing to it, then it’s also in our power to fix it and to change it.

Dr. Seth Bricklin: I think that the same “pain is inevitable, suffering is optional”, has become kind of adopted by the mindfulness folks and people who believe in that. The idea there is, one of the other principles in mindfulness is this idea of radical acceptance. Acceptance doesn’t mean we have to like something, it just means we accept that it’s happening. I believe suffering comes really from two places – It’s either when we refuse to accept that something is what it is, or when we believe that something is what it is, when it isn’t. Meaning, we do have the power to change a situation. People will say, well, I have this job and I’m stuck and I can’t leave and it’s like, well, you could leave. It might be difficult and maybe challenging, but you could do it. So it’s either we refuse to accept something that we cannot change, or we believe that we can’t change something that we actually could.

Dr. Justin Clark: Thank you, Amelia. That’s a good point. We’ll chat about that here. I’m really sorry for your experience and hopefully, now that you’ve returned to Alaska, you’re with someone that can help you work through this process and encourage you. Make sure you listen to the rest of the show as well as we talk more about trauma. Dr. Bricklin, I know you’re strictly outpatient and outpatient therapy. I know Alaska does have a lack of services for the inpatient side. Any thoughts on what Amelia had to say?

Dr. Seth Bricklin: It’s actually unfortunately common throughout the country. There are many places I worked and I lived in LA for a couple of decades and there are very few really good accessible programs for just mental health. So many of the residential programs down there will say we treat mental health issues, depression, anxiety and they end up being very much substance abuse. There’s always a strong component. They will advertise to try to draw inpatients but that’s really not their specialty, so it really is true what Amelia is saying and it’s not unique to Alaska. I’m glad that you were able to find that program. It does take some work to find the right place. You know, when patients need a higher level of care and they feel like outpatient isn’t doing it, I really encourage them to call places and make sure they’re asking them what’s your programming like, how many of your patients are struggling with trauma versus substance abuse? So you get a feel to make sure that the program really is geared towards what you need.

Dr. Seth Bricklin: Yes. Usually patients coming out of a residential program are going to do what we call step down, so they’ll go from residential, maybe to an outpatient program where they would go a few days a week, and then ultimately into just regular outpatient therapy where they might see the therapist once or twice a week for an hour. Unfortunately too, these programs, some do a really good job with aftercare and some don’t do the best job so a lot of times as is the case nowadays with a lot of healthcare is, you really have to be an advocate. You really have to keep asking questions and keep searching until you find the right care.

Dr. Bricklin, let’s go into a little bit of trauma. There’s a lot of different types of trauma that can happen to people. Some people think when they say trauma, it’s necessarily, “Oh, like I was attacked or I had a physical trauma”, but there are many different types of trauma that affect people. Even seeing somebody or knowing about trauma, like these wars that are going on on the other side of the world, thinking about it can have an impact on you. So, what are some of the examples of trauma?

Dr. Seth Bricklin: Well, you gave several of them. But that is true – trauma is one of those words that has become a very broad term. You’re right and when I meet patients, I’ve learned you don’t simply say, “Have you ever experienced any trauma?” because that definition means so many things to different people. Often, it’s associated with victims of violence. Usually, abuse is what people think of. Many times patients will tell me “no, I’ve never had any trauma” and then when we ask about their childhood or upbringing, you know, “my parent yelled a lot, they scream, they were physically abusive.” Even though they’ve said they have no trauma.

One thing to point out is that trauma is very much in the eye of the beholder. It’s how the person perceives the event or the situation that really determines whether it’s traumatic. So, it can be an actual victim of violence or abuse, sexual abuse, physical abuse, ongoing verbal abuse. It can be an acute incident, something that happened one time, involved in a car accident or witnessing some kind of event or ongoing abuse where somebody grows up in an abusive household or is in an abusive relationship – all of those things can be considered traumatic and affect us in similar ways.

Dr. Seth Bricklin: Well, it’s again, their perception. How did they feel? The key element really is a person experiencing an intense sense of fear. They were in fear for their life or their safety or the life or safety of somebody else. That would certainly qualify. That’s an element of it, which is, how was it for you? What were you feeling and experiencing during that time? But, many many people, in fact most people might experience something that could be considered objectively traumatic, and not have PTSD. It can still have an effect on us and affects our brain in certain ways.

When I was in LA practicing, there was a train derailment nearby where my office was and I had somebody come in and he was having a lot of PTSD symptoms. He was on the train with friends and family and none of them had the same symptoms. So, people in the same exact event, some people go on to develop symptoms, some don’t. The other thing with trauma of course is you can have a delayed onset. So, sometimes people will have immediate symptoms related to the trauma and other times, they may not get PTSD symptoms for months or years, so they don’t think of it and they don’t make the connection. For example, there was a study done after 9/11 where people witnessed it, but didn’t really have a traumatic PTSD-like response. And then a couple years later, they got fired from their job and all of a sudden have these flashbacks and started to develop these PTSD symptoms. So, stressors later in life can bring forth trauma from earlier.

For example, somebody is involved in a car accident, that’s not their fault. Somebody ran a red light and hit them. There’s no part of them that thinks they are to blame. It’s very clear that it’s not their fault. They don’t feel bad about themselves and it doesn’t really affect their esteem, but if somebody is in a long term abusive relationship or as a child was abused, that affects their sense of self, their self esteem, they may start to ask themselves why is this happening to me? What am I doing wrong? And so because of that, PTSD in patients who have that kind of history can be more complex and more difficult to treat.

It’s a good one. I’m not sure that I would say hey, if I see this pattern of symptoms, that’s a cue that there is some kind of repressed trauma. You know, I might expect that, if somebody presents having all of these symptoms and are having these intrusive thoughts, they’re hyper vigilant, which means they’re always on the lookout for danger, they get startled very easily, like they’re having all of the PTSD symptoms, but they can’t identify any kind of trauma, maybe that would be some indication of it. So I guess if somebody’s having PTSD symptoms, and they’re not identifying a trauma, that might be an indication that something like that could be occurring. But I honestly haven’t run into that situation where I’ve had that experience with a patient where they have been presenting all the symptoms, but no, they’ve never had any trauma. I haven’t seen that. So that would be, I think, unusual, at least in my experience.

Those two structures in the brain are important. Example on how this happens in trauma: So during a trauma or some kind of life threatening experience, the amygdala starts firing. That floods the brain with cortisol and adrenaline. At the same time, the hippocampus starts to shut down. Think of it like the amygdala sort of drawing energy, because what your brain is saying is hey, this is a fight or flight situation we need all the energy we can for survival. What happens is the amygdala will take over memory during those circumstances, but the amygdala really only stores emotional memories.

Those are intense emotions during the trauma right? Fear, anger, rage, and so traumatic memories because of that, they lack context – the Who, what, where when. So let’s say for a combat veteran, for example, rather than understanding that angry people waving guns during Desert Storm in Iraq equals danger, the brain simply remembers that angry people and loud noises equal danger. So, something as mundane as somebody aggravated in line at the DMV and raising their voice might trigger that trauma response because all the brain remembers is loud people and angry people is danger. That’s why you can see how the structures sort of interact with each other so each time that person gets triggered, the brain is flooded with more adrenaline and more cortisol and the more this happens the more easily they can get triggered. So eventually, people can become stuck in this hyper-aroused state.

Dr. Seth Bricklin: So other parts of the brain, the insula, is responsible for what we call interoception and proprioception. So proprioception is like how you know where your body is in space. Like how you can touch your finger to your nose with your eyes closed. That’s proprioception. Interoception is how you feel into your body. How do you know when you’re hungry, you feel butterflies in your stomach, you feel warm, you feel cold. This part of the brain becomes dysregulated during trauma.

People with trauma could also be very sensitive. They feel one little twinge in their body and they become very reactive. Then you start to move up the brain and I say up so the amygdala is kind of the base of the brain – this is like parts of the brain that are responsible for survival. When you move up in the brain, you get to more consciousness, cognition, and these types of things. So when we move up here, we’re talking about the prefrontal cortex and this is the thinking center of the brain responsible for executive functioning, so decision making, concentration, impulse control, self control, and with trauma, this is underactivated.

The last part of the brain that we’ll touch on is called the cingulate and this is responsible for self regulation. So when you’re angry or scared, this is what helps calm the amygdala. That’s because the amygdala is firing and is responsible for anger and fear. And when you say to yourself, “Okay, that person just bumped into me, it was an accident, take a breath, let’s calm down” – that’s your self regulation part of the brain. That becomes underactivated, so it also becomes difficult to manage conflicting emotions. I’m really frustrated with somebody who I love deeply – our cingulate allows us to make sense out of that.

A good example of this kind of dissociation that is sort of benign, not very, and actually sometimes helpful would be, you’re driving home from work and your mind is sort of occupied. You’re thinking through a problem or chewing on some issue from work, and all of a sudden you get home and in your driveway, you’re like, how did I get here? You know, you’re almost – you stopped at all the lights, you were paying attention – but this part of you is kind of disconnected and dissociated.

Dissociation can come in all forms. So to the person’s question, first, you really have to assess what level of dissociation is occurring. Are they really experiencing a dissociative identity disorder, which means they have really distinct personalities that will come out under times of stress? It’s fairly rare. I have treated a couple patients who had that issue and generally it stems from really severe, severe abuse, long-term severe abuse that is usually seen as a precursor of something like that. Many people with trauma that’s maybe not as severe will have some dissociation. And in that regard, you see people, they go numb, they just disconnect, they withdraw. The treatment for that, we’ll talk about, but the part of the brain that is responsible for that, the insula is a part of that right? So we disconnected our body so there are some things and even things like yoga, breathing exercises, ways to try to begin to reconnect with your body. These are obviously done very carefully with the therapist because you don’t want to overwhelm the system and get too connected, because that could then just be retriggering.

Dr. Seth Bricklin: That’s a good question. I don’t know for sure if there’s, the research has kind of parsed it out that clearly where like physical trauma tends to lead to more problems in the amygdala versus this part of the brain. I think it really has more to do with a person’s perception. So, in the state that they’re in, if somebody is already in a weakened state, for some reason, they’re compromised in some way when the trauma is happening, they might be more prone to developing those symptoms.

Dr. Seth Bricklin: Absolutely. Sometimes when I would do assessments and you would hear people say, ”Well, you know, we had a lot of arguing and fighting and screaming and yelling in our house, but she was only six months, so she doesn’t remember any of that. There was this belief that if you were so young, that you couldn’t remember, that you wouldn’t be as affected by it. The research has shown it’s actually the opposite. The younger children are actually more affected by that. The reason is they lack the language to understand what’s going on. There’s no filter. So, if I’m at home and in my room, and my parents are downstairs yelling, I can understand that. That’s not about me. If I’m six months old, and I’m in my crib and there’s yelling and screaming right next to me, I have no filter. I’m just feeling that anger, that fear, that rage and so without that filter, younger brains can be much more effectively impacted by trauma.

As children get older, they do develop the language that they’re able to then say, “Oh, mom is mad at dad. That’s why there’s yelling.” But kids at that age developmentally, are still somewhat egocentric and that they believe things are about them. Well, mom’s mad, what did I do? And so that can have a greater effect. That’s where that complex PTSD can come into play. They tend to blame themselves and take responsibility for what’s going on around them, just because developmentally they haven’t figured it out and that’s not exactly how things work. So the younger you are, for sure, the more impacted you can be partly because your brain is developing, it’s not fully developed.

I have this experience with my kids who are still three and five. Well, they will say something, and they’ll talk to you about it like it just happened yesterday and my wife and I look at each other and say that happened two years ago, how do you remember that? You think it’s like that timestamp. That context isn’t fully there. So they will really feel things, they get all mixed up about when stuff happened. So it’s a good example of how the brain sort of develops and you learn that ability to kind of have context for your memories.

Dr. Seth Bricklin: Well, that’s often how we talk about trauma and what people are struggling with is they will get stuck. But usually we’re thinking like they’re reliving the memory over and over again. They have trouble letting go of something. I mentioned I worked a lot in substance abuse, and we used to say, hey, this person stopped developing when they started using drugs, because it does sort of stall their emotional development because if you’re using a substance you’re numb to things and so you just kind of are in your own world and you’re not engaging with the rest of the world and you’re not allowing your brain to develop. I think with trauma, there is an element of that where you can get stuck to some degree. I think what happens more often is rather than necessarily being stuck in the sense that you’re talking about, they might get triggered and the amygdala fires and that traumatic memory comes back and then the person might regress. So it’s more of what I would consider to be sort of a regression where I’m at work and my boss is mad at me and she’s yelling at me and all of a sudden I feel like a seven-year-old whose mom is yelling and screaming. I don’t know if that answers your question. It’s more along with that type of process, I would think.

Dr. Justin Clark: So we’ve mentioned throughout the show some of the emotional reactions, physical, cognitive, behavioral stuff, and we can touch more on that. Maybe you can mention some of the reactions to trauma that we talked about. And then I really want to understand how those can be confused for other diagnoses because a lot of people will say yes, and especially self diagnosis. Oh, well, I’m, you know, my friends told me I’m bipolar. Yeah. Like that’s not a medical diagnosis. It might be being confused for something else. So let’s list off a few of the reactions to trauma and then let’s talk maybe about how that confuses other diagnoses.

What I generally will say to folks is, generally speaking, they feel that their emotional reactions are often out of proportion. So it makes sense that they might be angry but it doesn’t make sense that they’re that angry. There’s a saying a therapist I worked with years ago, and I don’t know who actually I could credit for this saying, but “if it’s hysterical, it’s probably historical.” By hysterical meaning, if it’s an overreaction, it’s probably not about your boss getting mad. There’s probably more to it than that. These are some of the immediate responses cognitively – you have trouble concentrating, ruminating thoughts, that distortion in time and space is common. We talked about that, like you don’t know when things happen. This is why witness testimonies that…and I went and heard somebody give a lecture and she was a neuropsychologist who would go and testify, she’d have to explain to juries, this victim of this rape, their timeline is off because their memory wasn’t working right.

So, prosecutors will try to or, you know, defense attorneys will try to stump them like what you said, this happened to, you know, at two o’clock, but it’s really four o’clock and it’s not because they’re lying, it’s because their memory wasn’t working properly. You see some of these effects, sleep problems, very common, or the two main senses we often see are what we call hypervigilance. You’re always on edge, you’re looking for danger, loud noises. When you have to go to a room, you sit with your back to the wall, you’re always looking, you’re always on the lookout. And this exaggerated startle response, and many people with PTSD will tell me oh, yeah, you know, my partner touched me on the shoulder and I jumped up to the ceiling, the real overreactions.

Dr. Justin Clark: So there’s a lot of different symptoms and different parts of emotional, physical, cognitive, behavioral, and a lot of what you listed, I would say, well, that sounds like someone’s depressed right? They’re numb or they’re withdrawing, or it sounds like they have ADHD because they can’t concentrate and everything, so I can see where people might think, oh, they have these other diagnoses. As a therapist, how do you tease this out and say, oh, this patient is coming to me because they’re anxious, but when I work with them, it’s clear that they are reacting to trauma.

Dr. Seth Bricklin: It’s a good question. So the first part of whenever I meet with the patient is a really good thorough assessment. Sometimes it’s an hour, sometimes it takes several sessions to really get the full assessment, but it’s really trying to understand their whole history and a whole background. One thing I get a lot is, the two most common, self doubt… Well, now it’s sort of three that I get a lot. People come to me, just like you said, “I think I’m bipolar…I think I have ADHD…I think I might be autistic.” We hear that a lot. Now that’s becoming much more understood now that we see on a spectrum.

With bipolar disorder, 70% of the patients who tell me they have Bipolar, do not. They’ve never been diagnosed. They think they have it, but they do not. But you know, the one example of ADHD is a really good one where that can often be a result of trauma. In fact, when I do ADHD assessments, the first thing I’m thinking about is, has there been a history of trauma? Because of that effect on the prefrontal cortex – you’re not concentrating, you’re not able to focus if you’re always in this hyperaroused state, you can’t remember anything if you’re anxious. If there’s a fire alarm going off and I say here’s my phone number, you’re not gonna remember my phone number when there’s a crisis.

So, people who have trauma and are in this state will present with many symptoms of ADHD. A lot of it is just getting a history. When did it start? ADHD, you have to have had symptoms as a child. People tell me they have all these symptoms but oh no, I did great in school, no problems, got good grades. I was a good student. Then I’m thinking well, it’s probably not ADHD, it might be trauma. And you know, lack of concentration is a symptom of every one of those disorders. So teasing it out, really it’s other symptoms. So you’ve got to ask about past trauma and ask about all of those things.

Dr. Seth Bricklin: As I said, surprisingly, it’s limited. There’s waiting lists. People will tell me they’re waiting three or four or five months to get in to see somebody. So the person that Mike is talking about, usually in a case like that, the best thing I can recommend is you can start with your primary care physician. Some are very good at understanding and helping to at least get the ball rolling for mental health issues. Most of the ones that I know and I worked in primary care for a couple of years up here, you know, they’re pretty at least open about whether it’s in their wheelhouse or not. If it’s not, they’ll tell you, so you can start there and try to get a referral. But the key, as I said before, is a good assessment.

You mentioned he had had some car accidents and that’s another thing to keep in mind – head injuries. We always ask if this person had seizures, concussions. Post concussion syndrome can mimic a lot of symptoms. There’s all of these things when you do a good thorough assessment. That’s how you really tease out what’s going on and very often somebody will come to me and they’ll be diagnosed. Oh, I was diagnosed with PTSD, panic disorder, depression and bipolar disorder. Usually, it’s not gonna be all of those things. Because very often it’s just PTSD. PTSD is what could account for all of those symptoms.

Dr. Justin Clark: Dr. Bricklin, before we unfortunately have to wrap up, I do want to talk a little bit about traditional therapy versus new therapies for trauma. But we did start the discussion on sort of the different types of providers out there and I know there are a lot of different types of therapists and credentials. There are licensed clinical social workers, there are nurse practitioners, SDs, PhDs, MDs, a lot of different initials. So if you could maybe tell our listeners what these are and more specifically, does it matter?

If you’re looking for a really good diagnosis, you’ve been given three or four different diagnoses by different therapists, you’re not really sure what’s going on. Well, you probably want a clinical psychologist, which is what my background is. We get a lot more training in differential diagnosis, diagnosing more severe persistent mental illness, training and psychological testing, which is not always necessary. In fact, most of the time it is not necessary to diagnose a lot of these issues. But a psychologist would know when it would be necessary, they can help guide you into that, and psychologists are going to be doctorate level PhD or my degree is in society. So it’s just a more clinically focused degree, whereas PhD typically traditionally, it was more research-based.

And then you’re going to have master level clinicians and master level clinicians would include marriage and family therapists, licensed clinical social workers. LPC is licensed professional counselors, I believe they’re now licensing up here. Each of those disciplines has a slightly different focus in their training, but all of them can be psychotherapists. And as I said before, if you’re just looking for therapy, the main thing is, do you feel like it’s a good connection? And do they have experience treating the issues that you’re struggling with? That’s the primary question.

But what I often will tell people is anytime you meet with a new therapist, try to give it two or three sessions. The first session is always going to be a bit of an anomaly because they’re usually going to be doing a little bit more of an assessment, unless there’s something that really just made you completely uncomfortable. Usually I encourage, you know, friends or family, give it two or three sessions, maybe four. If you really aren’t feeling like it’s helpful, try talking to the therapist letting them know and if that still doesn’t work, yeah, then go look for somebody else.

I don’t recommend having like six appointments and going to six first appointments with therapists in a few weeks, you’re gonna get burned out. Imagine having to tell your story over and over again to new therapists. It generally can be sort of overwhelming, actually. So I usually say pick one, try it for a month or two and if that’s really not working, try talking to that therapist. We’re really trained to want to hear that kind feedback. I really appreciate feedback from patients. If something I’m doing isn’t working, let me know. As I said, this is something we do together. And if you’ve tried that, and that’s still not working, then yeah, find somebody else.

Caller Tiffany: Well, thank you for taking my call. I have a question about racialized trauma. I’m Alaska native and so there was an incredible amount of trauma that was experienced. Like all that was and how that gets passed down inter-generationally. It’s really interesting. I feel like it’s a little bit different and individually impacts people a little bit differently and it also impacts families a little bit differently because of the severity of it, I guess. And then, the social dynamics are really complex and like the experiences that we have outside of that trauma kind of reinforced, I guess a feeling of being less but I was wondering if you know anybody who specializes in trauma…

Dr. Seth Bricklin: I don’t know anybody out here who would advertise that as an expertise, but I’m still new to the area to some degree, but I do think that’s a really good point. Cultural influences play a big part in that generational trauma. How people view mental health, how people view the system with a capital S, you know, all of these things are important. Generally, things that I will talk about in my assessment. So I think, one, you can certainly look and when you’re interviewing for a therapist, ask, you know, have you worked with many Native Alaskans? What’s your experience of PTSD with this population? Is that something they really consider themselves an expert in? And then if you’re struggling to find somebody who’s an expert in that, you still might find somebody who’s an expert in trauma, and then just meet with them and see how it goes.

My belief is there are so many ways in which I’m going to be different than all of my patients. I can’t possibly have shared experiences with every patient. So, I always look to my patients to educate me about their experience. I don’t know what it’s like to grow up as a native Alaskan, so I will ask them to share what their experience was. On that same note, just because I’ve done research about Native Alaskan culture, let’s say, and I have one patient who grew up that way, I don’t know that my next patient who’s native Alaskan is going to have the same experience. So it’s always about – what is your experience? What was your experience with that? I think it’s something I’m always going to be asking my patient.

Dr. Seth Bricklin: When we say traditional therapies, I think we still do all those traditional therapies for trauma, but what we talked about now is trauma-informed therapy, so I might do talk therapy or cognitive behavioral therapy, but it’s trauma-informed, meaning I understand how trauma affects the brain. Traditional cognitive behavioral therapy deals just with that prefrontal cortex, right? How do you think about the problem? What are the thoughts you have about that situation? Let’s identify the irrational thoughts and let’s change them. Self regulation – do some deep breathing, do some meditation. These are things that we use.

The other thing we recognize on the brain, it has two hemispheres. Each one of those structures I talked about has a left and a right side. And so a therapy like EMDR, which is eye movement, desensitization and reprocessing involves bilateral stimulation. What that is, is you might move your eyes from one direction to another, left or right. What I’m doing is, I’m stimulating both sides of the brain. The left side of the brain controls the right side of the body, the right side of the brain controls the left side. So you might alternate flashing lights on different sides, I might hold something in my both hands that vibrates alternately. And by doing this bilateral stimulation, you help process your memories more effectively and it helps the brain communicate more efficiently.

Also when you do this bilateral stimulation it actually helps inhibit the amygdala. So it doesn’t get as activated when you’re processing memories. And then the key to the new therapies is eventually what you want to do and something like EMDR and other therapies as you are reprocessing those traumatic memories. Well, why are we doing that? To give them that context. So now I’m going to teach you how to relax, disinhibit your amygdala so it’s not reacting as much and allow you to talk through the trauma in more of a relaxed state so that now I know if I’m enlightened, if somebody’s yelling at the DMV, it’s 2024, I’m in the DMV. I’m saying, you know, your brain starts to make that connection. And then when you talk about the trauma, and traumatic memories, your brain knows this was 30 years ago. My father is no longer here. I’m no longer in danger. And that’s how we reprocess the memories. So the newer therapies and the trauma informed therapies really focus on that aspect of it.

Caller Marvin: Thank you. I just have a comment. I used to be an emergency responder and for years, we would be on scene called out to help people. Sometimes, in many cases there would be some people that didn’t survive. One of the things that we initially were not trained, but eventually we got to look at the situation is that trauma occurs in a place and at a time and it affects everybody in that place at that time. Those that haven’t had any experience previously, would sometimes take that trauma and I almost want to say hide that from themselves and go away and think, Oh, thank God it wasn’t me, but it was them. And sooner or later, their brain is gonna remember that and they’ll start having problems. So what we started doing in our unit was we looked at people that were bystanders and we gave them cards and have them call us individuals in our unit if they started having problems, and we could refer them to professional help. We also asked them to discuss it with their pastor, with their spouse. At least to talk about it. The earlier you start, the better off you’re gonna end up being, as far as I’m concerned.

Dr. Seth Bricklin: Sure, you can reach me at Psychology Services of Alaska. Our website is psychak.com. Our phone number is 907-290-7250. So any questions, I hope people will reach out if you do have questions or need some assistance with anything. In closing I just really appreciate the opportunity to be here and to share some of these things with some folks. It’s an important topic really and the best advice I give people is, if you’re not sure, to get assessed. That self diagnosis piece we didn’t cover quite as much but be very careful with self diagnosis because some primary care docs might just say “Oh, you have ADHD, here’s the medication.” If you don’t get the right medication, the right treatment, you can make things worse. If somebody doesn’t know there’s trauma and they start doing this, you can get really aggravated. So, really get that diagnosis and assessment.

Dr. Justin Clark: Well, special thanks to our guest for being with us today, Psychologist Dr. Bricklin from Psychology Services of Alaska. Thanks to our audio engineer Chris Hyde and our producer Madeline Rose. You can find more information on this and previous programs on our website at alaskapublic.org. Let us know your thoughts or suggestions by emailing us at lineone@alaskapublic.org This has been Line One, your health connection. I’m your host Dr. Justin Clark. Stay healthy Alaska.

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