“The brave men and women, who serve their country and as a result, live constantly with the war inside them, exist in a world of chaos. But the turmoil they experience isn’t who they are; the PTSD invades their minds and bodies.”  – Robert Koger

“You can’t patch a wounded soul with a Band-Aid.” –  Michael Connelly

“Always remember, if you have been diagnosed with PTSD, it is not a sign of weakness; rather, it is proof of your strength, because you have survived!” –  Michel Templet

One of the important things about an election years is that it brings light to topics that rarely see the light of day under normal circumstances. That happened this week as Donald Trump spoke about the need for more mental health resources to help veterans afflicted with PTSD.

“When you talk about the mental health problems, when people come back from war and combat, and they see things that maybe a lot of the folks in this room have seen many times over – and you’re strong and you can handle it – but a lot of people can’t handle it,” The quote ended up getting taken WAY out of context over the past few days with media outlets saying that “Donald Trump calls soldiers with PTSD weak”. Trump says a lot of things that are polarizing, but I don’t think this was said with an inflammatory intent. It does however highlight the power that words have when discussing health conditions.

Here is the part that I care about: Is PTSD just a matter of mental toughness, or is there something happening physiologically where we can intervene and help make the brain more resilient?

What Happens in the Brain in People with PTSD?

PTSD is a diagnosis with strict criteria, but it’s mainly classified by a patient who routinely relives a traumatic event to the point where it disrupts their normal behavior. This could mean that you have flashbacks, nightmares, or hallucinations from the traumatic episodes. This reliving of an event can lead to avoidance, erratic behavior, depression, and anxiety.

Historically, PTSD has been considered a psychological disorder and despite the mounting evidence to the contrary, psychological disorders carry a stigma of being weak minded.

In more recent years, scientists have been able to identify some real changes in the physical and functional features of the brain. Here’s what we know so far.

1. Shrinkage….of the Hippocampus – MRI studies of patients with PTSD compared to control showed that the memory storing region of the brain is physically smaller. Previous studies have shown that high exposure to the stress hormone cortisol can injure brain cells in the hippocampus.Loss of hippocampal function affects your ability to differentiate between memories and present time events.
2. Hyperactive Amygdala – the amygdala is the seat of emotions in the brain. It is particularly active with intense feelings like fear and sadness. Patients with PTSD have been shown to have increased blood flow to this particular part of the brain
3. Cutting the Breaks – the ventromedial prefrontal cortex is a part of the brain that acts as the CEO of the brain’s emotional response. It serves as the break system to make sure that parts of the brain like the amygdala don’t dominate our experience with purely emotional behavior. In PTSD this part of the brain loses some of the capacity to control the amygdala which allows the Amygdala to become hyperactive.

Heart Rate Variability and the Resilient Body

I love talking about resiliency. It represents our ability to meet a challenge, survive it, and come out stronger than before. I’ve always seen the body as a resilient structure. When you are in constant pain or always sick, it’s easy to forget that our bodies are exposed to an insane amount of stress, but it still finds a way to keep us above ground.

One of the most sought after metrics to measure resiliency is a test called Heart Rate Variability or HRV for short. By measuring small differences in the rhythm of your heart beat, HRV gives us an idea of how well your brain controls your organ systems like your heart and intestines.

But that stuff isn’t really that important for your purposes. What you need to know about HRV is that it is an excellent predictor for how resilient your body is to stress and illness.

 PTSD, HRV, and the Brain

We’ve known for a long time and in a lot of studies that people with PTSD have lower HRV. However, we didn’t know if people with lower HRV led to PTSD or if someone getting PTSD led to a lower HRV.

A 2015 study in the prestigious journal JAMA Psychiatry looked to provide some evidence. They studied over 2,000 marines getting deployed into combat. All of the marines had their HRV measured before deployment, and when the marines returned home they were evaluated for PTSD.

The study showed that soldiers with lower HRV had a significantly higher risk of developing PTSD Now here’s where things get interesting. Remember that part of the brain that acts like the brakes on the brain’s emotional response in PTSD? It’s called the ventromedial prefrontal cortex. As it turns out, this part of the brain is also a big part in the regulation of HRV!

In a 2011 study in the journal Neuroscience and Behavioral Reviews, the authors looked at brain imaging studies and found that HRV is tied to blood flow in the brain in that very same area. When that part of the brain is activated, people have a stronger ability to remain calm and control their emotional responses to stress.

When you have better control over your stress response, you gain control over the health of your body.

Best of All, HRV is Under Your Control We think about someone’s health and their risk of getting disease, we often associate it to bad luck and bad genes.

The beautiful thing about HRV is that we can readily change our HRV. Things like meditation sleep, biofeedback, exercise, and even chiropractic can stimulate the right part of our brains that can improve our HRV! The reason these things seem to have such an big role in stress management might be because they improve blood flow and activation to the brakes in our brains.

In fact, we have been working with some patients on programming ways for people to improve their HRV and seeing how this improves their performance in exercise and overall health. The results so far have been promising.

Now it’s still way too early to say that we should put all of our eggs in the HRV basket. Most studies have identified correlation, and causation is still up in the air. But if we can reliably measure stress using HRV and use these inexpensive, safe, and simple ways to improve your brain’s response to stress, then there’s greater chance that we can help these soldiers start to kick out of the suffering of PTSD.