How to Heal From Post-Traumatic Stress Disorder (PTSD): Neurobiology, Symptoms, and Effective Treatments in Children and Adults

This episode features Dr. Victor Carrion, a leading expert on post-traumatic stress disorder, particularly in children and adolescents, discussing its psychological and neurobiological underpinnings and effective treatments. Dr. Carrion introduces his "Q-centered therapy," designed to mitigate triggers from words, events, or memories, proving effective in both youth and adults. The discussion begins by distinguishing stress, anxiety, and trauma, framing stress as an inverted U-shaped curve where optimal performance occurs at a moderate level, but beyond a certain point, it leads to allostasis and physiological cost, eventually becoming traumatic stress when physical integrity is threatened. He emphasizes that PTSD often stems from an accumulation of stressors rather than a single event, highlighting the vulnerability of children who, despite popular belief, are not inherently resilient but can become so with proper support. A critical insight is that "PTSD feeds on avoidance," meaning pretending trauma didn't happen or isn't serious exacerbates the condition, potentially leading to substance abuse or self-injurious behaviors. Dr. Carrion also addresses transgenerational trauma, noting that while direct genomic changes passed down are still debated, genetic vulnerabilities and learned behaviors (like avoidance or hypervigilance) from traumatized parents are certainly transmitted. He re-frames PTSD as a "post-traumatic stress injury" (PTSI), suggesting a desensitized autonomic nervous system that requires painful but curative re-regulation. A key distinction is made between the sympathetic (fight/flight) and parasympathetic (rest/digest) responses, explaining how children, unable to fight or flee, often resort to freezing and dissociation as a defense mechanism, which, if overused, can lead to dissociative disorders. Dr. Carrion details his research on cortisol levels in children with PTSD, finding that while their general circadian rhythm is intact, pre-bedtime cortisol levels remain abnormally high. This elevation correlates with nocturnal symptoms like nightmares and bedwetting, and raises concerns about the neurotoxic effects of glucocorticoids on brain areas like the hippocampus and prefrontal cortex, which are crucial for memory, problem-solving, and context-dependent processing. He also highlights the frequent misdiagnosis of PTSD symptoms in children as ADHD, where hypervigilance is mistaken for hyperactivity and dissociation for inattentiveness, underscoring the need for greater understanding of pediatric PTSD. The episode underscores the profound impact of environment on biology, noting that just as negative stressors can cause PTSD, positive interventions like supportive systems and psychotherapy can facilitate recovery, especially given the neuroplasticity of the developing brain. The discussion sets the stage for exploring therapeutic interventions that leverage this understanding to help individuals return to an optimal state of stress management and well-being.

The experience of stress as we now know is a spectrum from beneficial to not beneficial to traumatic.

Stress operates in our lives as an inverted U-shaped curve. The more stress we have, the better we perform, the better we do.

After that optimal point, all of those outcomes, health, performance, start to decline, happiness starts to decline, and it is in that second part of the curve where we find traumatic stress.

PTSD feeds on avoidance. If we pretend that something didn't happen, if we pretend that it will go away, if we pretend that treatment is not necessary, then and that that's when it gets complicated.

When play becomes traumatic play, it becomes non- joyful but it becomes perseverative and repetitive. This is the attempt of the individual to try to make sense of what happened.

Children are really not [resilient], they're more vulnerable. They have the opportunity to become resilient if we help them and we tell them what tools to use.

If PTSD is teaching us that the environment can have an impact on biology, that's the only lesson, right? Environment can have an impact in biology.

That hypervigilance that you're talking about was being misinterpreted as hyperactivity and the dissociation was being misinterpreted as inattentiveness.

It was the bedtime level that wouldn't come as low as the healthy controls. It would remain high.