Cognitive Impairment and the Neurological Basis for PTSD

This post is an original article written by Dr. Blair Cano. Blair is a United States Navy veteran and licesned psychologist working in Colorado Springs, Colorado. She specializes in adult and pediatric neuropsychology and neurofeedback. 

When confronted with a life-threatening event, the body reacts with a state of hyperarousal, designed to ‘protect’ humans against the threat. This response increases the release of stress-related neurotransmitters and hormones such as corticotrophin releasing factor (CRF) norepinephrine, serotonin, dopamine, endogenous benzodiazepines, and endogenous opiates. This response has been found in numerous studies dating back to the late 1990s, including this one from Bremner, Staib, Kaloupek, Southwick, Soufer, & Charney. These neurotransmitters and hormones are part of a complex feedback loop in the body and brain that controls our reaction to stress. The release of these neurotransmitters, and their effect on the amygdala (brain structure associated with fear and memory) initiates the fight, flight, and/or freeze response. While this response is a natural and protective response that is typically time limited with a relatively quick recovery and stabilization; people who develop PTSD have an exaggerated and perpetual response. What this means is that the level of hyperarousal becomes continual and maladaptive. Essentially, persons with PTSD remain in a hyper-alert state most of the time, rather than experiencing a recovery period where the central nervous system returns to baseline. The anxiety not only associated with PTSD, but anxiety disorders in general, impacts cognitive processing in the brain so that even benign environmental cues are interpreted as threatening, which results in an exaggerated neurobiological and psychological response; thus, maintaining PTSD. Here are some specific elements of the neurological impact of PTSD:

PTSD RESULTS IN PHYSICAL CHANGES TO THE BRAIN

Over time, with chronic emotional stress and skewed cognitive perception, structural changes occur in the brain. These changes include a reduction in the volume of the amygdala (limbic structure associated with fear based emotions) and hippocampus (memory formation and storage). In addition, there are changes in the prefrontal and orbital frontal cortex. The prefrontal cortex is responsible for cognitive functions such as planning, organizing, attention, task management, the ability to multi-task, perception of intention, personality characteristics, etc. The changes in the pre-frontal and orbital frontal cortex contribute to the cognitive impairment that many soldiers with PTSD suffer from.

PTSD IS RECOGNIZED AS A NEUROPSYCHOLOGICAL CONDITION

Historically, PTSD was thought to be a purely psychological or emotional disorder. It is now understood that there are neuropsychological underpinnings of this disorder as well, which contribute to the impairment people experience. When a person experiences a state of heightened emotional reactivity (even more so than the chronic baseline heightened reactivity, i.e.; being triggered) their cognitive abilities are even further impaired. This is true for everyone, not just people who suffer with PTSD; however, it impacts those with PTSD more profoundly because their cognitive abilities are already impaired. The emotional reactions that are associated with the amygdala are directly linked to the medial prefrontal cortex and the prefrontal cortex. Essentially, hyperactivation of the amygdala dampens cognitive abilities, which are already vulnerable to the elevation of stress neurotransmitters referenced above, in those with PTSD.

THE NEUROLOGICAL IMPACT OF PTSD AFFECTS INDIVIDUALS AND FAMILIES

It is important that society is aware of the cognitive impact PTSD has on individuals and families. It is more than a psychological disorder; it fundamentally changes the structure of the brain in ways that can impact a person’s ability to work and function socially. There are various options to treat the emotional and cognitive impairment associated with PTSD; however, it needs to be a two-pronged approach. Treatment needs to be directed toward reducing the emotional dysregulation of the amygdala and HPA axis (hypothalamic-pituitary-adrenal) (stress related neurotransmitter and hormones) as well as rehabilitating cognitive abilities. There are both medication and psychological options to accomplish this goal. While medications are useful for some, they are primarily used to treat various symptoms associated with PTSD such as nightmares, anger, depression, anxiety, sluggish cognitive tempo, etc. These symptoms however are not just biologically driven by excessive or dysregulated neurotransmitters. They are also a function of changes that have occurred in the prefrontal cortex; changes that have altered the way a person assesses/evaluates a situation or person.

PSYCHOTHERAPY IS EFFECTIVE IN TREATING THE COGNITIVE IMPACT OF PTSD

Psychotherapy and trauma therapy are often more effective overall for treatment of PTSD, as these treatments are designed not only to reduce emotional dysregulation, but also to help the client rehabilitate their ability to interpret stimuli so that they are better able to distinguish what is threatening and what is not. These types of cognitive changes have a synergistic effect on brain structures; meaning, the brain can regenerate neurons and initiate regrowth of brain structures (plasticity) as a result of individual attunement within the context of psychotherapy.

It is important for society to realize that the model of care for PTSD is not curative, rather it is rehabilitative. PTSD leaves an indelible mark upon the biological, psychological, and moral fabric of a person. Treatment should be aimed toward initial rehabilitation and then supportive maintenance.

Dr. Blair Cano is a Navy veteran and licensed psychologist in Colorado and Hawaii. She serves as the founder and clinical director of Neurofeedback Colorado Springs. In the Navy, she served with VF-101, a fighter squadron based in Virginia Beach, VA. She received her Bachelor’s in Sociology/Criminology from CSU-Pueblo, holds a certificate in Forensic Criminology, and obtained her Master’s and Doctorate are in Clinical Psychology from the University of the Rockies. She developed significant experience in neuropsychological assessment and rehabilitation of highly complex children and adults, most of whom suffered from an array of diagnoses. As a retired Navy veteran, I work extensively with the veteran population and their families, advocating for a holistic assessment and treatment approach for our veteran population.

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