In Our Shoes: Sexual assault’s effects on the nervous system
STEAMBOAT SPRINGS — When a person is sexually assaulted, he or she might remember the color of the walls, the smell of room or the texture of the sheets.
But the painted picture of the story is unfinished. The brain’s protective responses are meant to help cope, but can do more harm than good.
“Following the event itself, the brain converts that trauma into a body awareness,” UCHealth Behavioral Health Counselor Amy Goodwin said. “The body is asked to remember the event, so that sets us up for the long-term challenges of being a survivor of assault.”
Understanding how sexual assault affects the nervous system is one of the most important steps to healing. Healing is more important than people realize since trauma can cause a lifetime of anxiety, problems with internal organ functioning and, even, chronic pain.
Normal versus trauma brain
Creating a normal memory involves the prefrontal cortex, or front, of the brain. In a calm, relaxed state, information comes in from the outside world and is sent to the amygdala, a set of neurons that process emotion, which determines whether or not there is a threat.
The amygdala is a member of the limbic system inside the brain. The limbic system includes the thalamus, amygdala, hippocampus among other components involved in learning, memory and the processing of emotions.
If there is no threat, the amygdala sends information to the hippocampus, a curved part of the brain involved in forming memories and learning, which encodes the information and sends it to the left front part of the brain called the Broca’s area, which processes language and records the memory as a narrative.
In contrast, when the amygdala senses a threat, it turns on the fight or flight response, preparing the victim to get out of harm’s way. This involves diverting blood away from the brain and more to the limbs to maximize an opportunity to physically escape. The problem is that hinders the process of creating memories. When there’s no escape, the body does the opposite. It freezes.
“Trauma is the ultimate experience of powerlessness,” Chief Clinical Officer of The Foundry Treatment Center Dr. Michael Barnes said. “If we could’ve stopped it, we would’ve.”
In a freeze response, the blood pressure decreases, decreasing blood flow to the limbs. This often diminishes physical pain, so the victim can make it through the traumatic event.
“It’s the oldest defense system in the body,” Barnes said. “From a purely evolutionary standpoint, when the Sabertooth tiger rips our arm off, there’s a chance we might survive it.”
Victims of sexual assault most often enter the freeze response.
“The first symptom when somebody goes into a freeze response is their hands get cold, or they get sleepy,” Barnes said. “It’s a period of being depersonalized. Many people describe it as, ‘I’m watching a movie I happen to be also starring in, I’m not feeling it.’”
Goodwin adds that there’s another element to going into the freeze response.
“A lot of our training says there’s a ‘please’ response as well,” Goodwin said. “How do we please people? If we please them, then threat goes down, even if we are compromising ourselves.”
Culturally, Goodwin says women are specifically trained to appease. It’s not as commonly accepted for a woman to punch someone in the face, even in defense.
While both the fight or flight and freeze responses are ways for the body to protect itself from harm, sexual assault survivors tend to get stuck in these response states or are easily triggered into these states by their sensory memories.
Living in fear
The few memories that remain from traumatic events are sensory — sounds, smells, touch, sights and taste — since the hippocampus does not function during a traumatic event.
This is because the thalamus, a part of the limbic system, still carries on its function of relaying sensory signals to the front of the brain to the prefrontal cortex during trauma. Later, this sensory information can trigger a fight or flight response.
“I work with a lot of sexual abuse clients,” Angela Melzer, a therapist and owner of Minds in Motion, a psychiatry medical clinic, said. “There’s a lot of curling in shoulders or hands anytime there’s a trigger that happens in their life now, even if perpetrator is decades gone.”
The nervous system of a trauma survivor becomes hyper vigilant, leading to a life in an almost constant state of fight or flight response, causing physical health problems.
Some of these physical responses are controlled by the Vagus nerve, a cranial nerve that controls bodily functions in the heart, lungs and digestive tract. It’s the largest nerve in the body after the spinal cord, touching every single organ in the body.
“Information can go from body to brain or brain into body,” Melzer said. “Someone has a history of sexual abuse and men make them uncomfortable, their stomach tighten up or shoulders hunch down. That information, starting from body going up, putting in fight or flight response.”
After a while, these responses are unhealthy.
“We’re only supposed to be in there for a short time,” Goodwin said. “So these muscles break down. That’s been linked to fibromyalgia, chronic pain or hypertension. If our blood vessels are tight, we don’t get nutrients and muscle tissue loses elasticity and hardens and pinches around the nerves.”
The external or conscious response can be a person avoiding contact with certain sensory signs of their trauma. Barnes said he worked with a patient who was sexually assaulted in a park in Pennsylvania, where she only remembered the bright blue sky peaking through the trees.
As a result, she avoided daylight and social interaction, working a night job from home. This was a way she could feel in control because the assault made her feel powerless. While the methods worked, she was incredibly lonely.
Trauma also leads to forms of addiction, notably drug or alcohol abuse. While these are coping mechanisms that seemingly provide relief to victims, they’re not a healthy way to treat trauma.
There are a variety of different approaches to therapy, and they often work best in combination with each other.
Barnes specializes in addiction counseling and family therapy. Goodwin helps patients with chronic pain management from trauma, while Melzer is licensed in social work and occupational therapy
All three use somatic approaches to therapy, meaning they focus on the body’s behavior first, rather than asking the victim to talk through their trauma.
Before therapy begins, all three agree that they must help the victim establish their office as a safe place. Melzer can see when her patients are in a fight or flight response. She assesses their nervous system’s response when they walk into the room and asks what they are feeling as they look around.
Rationally, the patient knows he or she is safe, but the body is telling them something different. To teach the body to orient to safety, she asks them to use methods like finding comforting things to look at in the room, speaking in slower tones and exhaling longer with each breath. This helps calm the Vagus nerve, which triggers bodily fight or flight responses.
One form of somatic therapy is called Eye Movement Densensitization and Reprocessing, or EMDR. The idea formed in 1987 after American psychologist Francine Shapiro realized her eye movements while walking in a park decreased negative emotion associated with her distressing memories. The idea was the foundation for something greater.
“It allows us to build connections between the left and right hemisphere, using tones that alternate with the left and right ear and or vibrations in your left and right hands,” Goodwin said. “It allows our whole brain to make sense of the experience, instead of being stuck in the emotional cycling.”
Barnes also focuses on the symptoms first by teaching coping skills to reduce the nervous system reaction. The use of mindfulness, meditation or yoga can reduce the distressed state.
Somatic therapy is referred to as a bottom-up therapy approach, while talk therapy is a top-down. Talk therapy is effective but isn’t for everyone. Sometimes, it’s used after somatic therapy.
The hope is that through education and personalized therapy, survivors of sexual assault can improve their quality of life.
“We need to educate them about trauma: your brain is changed in this way and here’s what we’re going to try to do,” Barnes said. “I don’t want them telling stories about what happened, don’t sit around and ruminate on these stories. Let’s work on symptoms, reduce those, reduce fight flight and freeze response, once I am sure you can come in and walk out of my office and be safe, then we can work on what actually happened.”
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