Memory And Forgetting PTSD

Forgetting PTSD: How Genes Affect Memory

Memory can be a double edged sword.  It holds our identities, our relationships, our histories.  But when memory holds our most unspeakable stories, it can become a painful burden.

Sufferers of PTSD live with this reality.  Many cannot forget.  Recent studies have found that a gene, called tet1, plays a central role in forgetting such traumatic experiences.

Massachusetts Institute of Technology researcher, Andrii Rudenko, found that when people with normal levels of this gene experience a traumatic event, the triggers to traumatic responses become extinct over time.  For example, if you were bitten by a dog after walking past a neighbour’s house, you may be reluctant to walk by that same house again.  And if you continued to walk past the house and nothing happened, eventually the association with being bitten and walking past that house would become extinct –you would no longer fear walking past the house.  However, people with PTSD do not form these new associations, and would continue to fear walking past the neighbor’s house.

DNA (Photo courtesy of Wikicommons)

Currently, one of the most effective treatments for PTSD is exposure therapy, where patients learn new associations by being exposed to the triggers of PTSD in safe environments.  This can include practicing driving on a driving simulator for someone who is afraid to drive due to a motor vehicle accident.  Over time, patients begin to learn that driving is not as dangerous as they came to believe.

The tet1 gene aids in the expression of genes in the brain that help people form new memories and cover up old ones.  However, when a person has low levels of this gene, old and traumatic memories are not masked.

In Rudenko’s study, mice were conditioned to fear a particular cage using electric shocks.  When the electric shock was taken away and the mice were placed in the cage, the mice with normal levels of the tet1 gene lost their fear of the cage, while the mice with low levels of the tet1 gene continued to fear as before.

A process called DNA methylation blocks the expression of the promoter genes that are responsible for forming new memories.  The methylation process is lowered by tet1 and other tet proteins in areas of the brain that are important for forming memories, including the hippocampus and the cortex.

Simply put, the more tet proteins, the more expression of promoter genes and memories formed. Conversely, even though low levels of the tet1 gene make learning new things difficult, it has been hypothesized that fear responses are so strong that tet2 and tet3 proteins can compensate for the demethylation processes of tet1 proteins.  Therefore, memories are formed during strong responses to fear or traumatic events, but with a lack of tet1 proteins, new memories are not formed to replace the old memories, and chronic PTSD is the result.

Li-Huei Tsai, director of MIT’s Picower Institute for Learning and Memory, told MIT news  that “if there is a way to significantly boost the expression of these genes, then extinction learning is going to be much more active.”  That is, if we can find a way to boost the expression of the tet1 gene, then people’s traumatic memories will be covered up by new memories quicker.

Memory extinction, prefrontal lobotomies, and other psychosurgeries have been a topic of popular film and literature.  It’s not surprising that questions on how these findings may be applied to PTSD treatment have raised eyebrows.

Soldiers in Afghanistan in 2009 (Photo courtesy of WILF.org) 

According to Tsai, “What happens during memory extinction is not erasure of the original memory.”  Instead, new memories and associations can be formed and old ones forgotten.  In the case of the mice, the mice with the higher levels of the tet1 gene begin to learn that the cage is safe, and forget that it was once dangerous.  In Rudneko’s view, “association with safety is rebuilt.”

Manipulating tet1 proteins in the brain and combining exposure therapy may bring new PTSD treatment possibilities.  This method might even be used to assess a person’s genetic predisposition to PTSD.  One imagines a possible screening tool for applicants to jobs with exposure to highly stressful events, like police officers.

This research is still in its infancy.  Yet it shows promise for those who, despite their best efforts, can’t find a way to forget.

Posted by: Shirley Coenen

Originally posted by Andrew McColl with The Trauma and Mental Health Report 

Mark Moore, founder of Intercultural Counseling and Consultation on therapy

Mark James Moore, founder of Intercultural Counseling and Consultation.

By: Anel Herrera

Mark Moore is soft-spoken, has long hair, and always greets his patients in casual jeans, a simple shirt and a smile in his office just down the street from Millennium Park.

 Each work day, the Licensed Clinical Professional Counselor sees patients of various ethnic groups for the private practice group he founded, Intercultural Counseling and Consultation. At Intercultural Counseling and Consultation, the mission is to provide the highest quality of psychological and psychiatric services to all races, cultures, nationalities and classes of patients.

The group specializes in cultural shock, cultural adjustment, depression, trauma, anxiety, addiction, and couple therapy in different ranges of immigrants. They strive for cultural sensitivity, experience and knowledge to promote self-growth through consistent clinical supervision.

Intercultural Counseling and Consultation is unique in Chicago. Each of its four therapists is multilingual and multicultural: Ayako Konno, Psy. D., Casey McNamara, MA, LPC and Ionanna Hadjicharalambous.

 "All along, even from school, I knew I wanted to work with immigrants, foreigners and people with different cultural backgrounds," Moore said.

 Moore has lived on three continents and speaks Portuguese, Spanish and Japanese. He uses his language skills to work with immigrant populations, especially Latinos. Moore's childhood was spent in Brazil where he lived until he was 11 years old. There, he became fluent in Portuguese. When he returned to the United States, he began studying Spanish because of the large Latino community.

"I came across Moore through my job," said a former Latino patient. "He taught me that if I wanted to change my life, it was great decision. If I was unwilling to do so, therapy was useless. From the first session, I knew he was going to help me and he did.

"He's a very nice person, very comprehensive. He's very special because he was very open and spoke directly."

Mark sees recurring themes in his patients, despite their varying ethnic origins.

In the Latino community, Moore notices his patients want pragmatic solutions. His patients come into his office asking for advice, which is not therapy. Moore spends time educating his patients as to what therapy actually is and sets goals for improvement.

                "It's not like going to a regular doctor and saying 'this hurts, what do I do to fix it?'" Moore said.

                This trend also applies to his Asian patients and he attributes it to the stigma in Asia. Asians tend to be more indirect, and if he is being overly direct they might see it as offensive. "Saving face" is also of upmost importance, what the community thinks is in high regards in both Asian and Latino communities.

                Eastern Europeans, specifically Yugoslavians, are a tightly-knitted community in Chicago. Similarly, they are also worried about what others are thinking. Reputations and status are important values in the group.

"You have to be highly sensitive because you can easily lose clients if you say the wrong sentence and offend them unconsciously."

            Moore has used his personal experiences abroad to help patients with all sorts of cultural adjustment issues.

                "I felt most places really are not sensitive to it [adjustment issues]," Moore said. "They're either not aware of it or don't have their own personal experience. Some therapists impose their own value system on the client without realizing it."

                Being more culturally sensitive may be an issue for therapists who have never lived abroad. Moore believes it is important for a therapist to immerse in a culture in order to effectively help patients. Too often, he sees therapists imposing their own views and values on patients without understanding their background.

Moore received his Bachelor degree in psychology from the University of Southern California in 1989 and his Master's degree in clinical psychology from Roosevelt University in 2000.

 Moore's interest in psychology started in high school when he took his first psychology class.

                "I was also interested in languages," Moore said.  "I thought about [being] an interpreter or translator. Then I found out maybe it’s not as glamorous as I originally thought. So then I started taking more undergraduate classes in psychology."

                The more classes Moore took, he realized a psychology degree would perfectly suit his interests.

                His internship in graduate school first exposed him to working with foreigners. He worked with political refugees from Bosnia after the Bosnia-Serbia civil war at the Kovler Center. The center’s work focused on highly traumatized immigrants, homeless people, and political refugees.

After completing his degree in psychology, he chose to move to Japan for two years to travel and learn Japanese. While in Japan, he taught English as a second language. Moore was then drawn to Chicago, which has been the center for most of his career.

Moore considers himself a humanistic, client-centered therapist also influenced by other theorists such as Sigmund Freud. He focuses on the present time and the therapeutic relationship with his patients. He's also client directive. He lets patients choose their own direction in therapy and follows them on their path, providing more clarity.

 Moore is not confrontational, and he will not tell patients what to do or not to. He allows them to make their own decisions to learn from. He believes his methods work well with the immigrant population he helps because it is not implosive of a therapist's own values.

               Moore is constantly learning from his colleagues or patients.

"I feel like every day I come to work, you don't really know what you're going to walk into," Moore said. "It's always a surprise and challenge but there's growth."

                Twice a week, Moore and the therapists at Intercultural Counseling and Consultation hold clinical meetings to review cases more in-depth which also serve as a learning group. The goal is to keep learning and improving clinical skills.

                Twice a week, Moore and the therapists at Intercultural Counseling and Consultation hold clinical meetings to review cases more in-depth which also serve as a learning group. The goal is to keep learning and improving clinical skills.

                To people who need counseling but are afraid to seek it because of stigma and cultural reasons, Moore has these words of advice:

                "Try it, see what happens. Take a risk. You'd be surprised what you can learn about yourself in terms of improving the quality of your life and having more meaningful relationships."

 "I think what happens to a lot of people that aren't aware of what therapy is, they have the idea that it is for people who are really sick and mentally ill. Sometimes, people can benefit from it even when their life is going pretty good."

Treating Kids With Autism

Chloe Dove with writer Torey Darin

Every weekday Chloe Dove sits in her poppy red two-door Volkswagen Golf before work, doing her morning breathing exercises that she teaches in her yoga class. In with the nose, and out with the mouth. She mentally prepares for her job as Senior Behavior Instructor at Behavior Frontiers, a training and treatment program designed for children and families living with autism, located in El Segundo, Calif. 

Dove works in home and school settings, providing therapy children with autism. Dove is petite, with chestnut brown hair, a tan complexion, and a glinting smile that radiates her Mexican heritage. Her work requires a great deal of patience, because every patient can be different, ranging to either extreme on the autism spectrum.

Autism spectrum disorder (ASD), or autism, is a range of complex neurodevelopment disorders. The hallmark feature of autism is impaired social interaction, according to the National Institute of Health. As early as infancy, a baby with autism may be unresponsive to people or focus intently on one item to the exclusion of others for long periods of time. A child with autism may appear to develop normally and then withdraw and become indifferent to social engagement. Some struggle to communicate verbally.

Scientists are not sure about what causes autism, but it is likely that both genetics and environment play a role.

To help the kids develop as fully as possible, Dove uses applied behavior analysis (ABA) in her therapy sessions. ABA helps children with autism learn through repetition to interact socially. In her therapy sessions, Dove conditions children by increasing behaviors through reinforcement, on-task behavior, or social interactions. She also works to teach new skills, such as functional life skills, communication skills, or behavioral skills.

Dove said that ABA therapy is the most effective treatment option in helping children with autism.

But, Dove enjoys it. “It’s basically like working with any kids, but mine tend to have a few more behavioral issues and social deficits,” Dove said.

There are no medications specifically designed to treat autism. If a child has another mental health issue, such as ADHD or anxiety in addition to autism, they may be on medication for those conditions.

Some days can be challenging for Dove, because some children who she treats have a hard time expressing themselves verbally, especially if something is wrong. “I work with a few non-verbal children, and when their behaviors are off, it can be difficult, because I may never know why.”

Steve Sanchez, 56, is the uncle and legal guardian of Peter who is diagnosed with autism and ADHD. Sanchez said that his nephew, has benefited greatly from ABA therapy from a private psychologist in Joliet, Ill. 

“I’ve seen his attitude improve over the course of treatment," Sanchez said. "He was always a smart kid. He could count and read when he was only four or five. He seemed like a normal kid. But he had trouble talking and playing with other kids and would throw tantrums when he didn’t get his way.”

Peter is now 9 years old, and loves the treatment that he has received since he was 6. “I like my counselor. She helps me. She helps me do things, and calms me down,” Peter said, sitting on his uncle’s lap.

Peter is currently in a developmental learning school in the Chicago suburbs, but Sanchez said that he has high hopes for Peter to integrate into mainstream public school in the near future. . 

“He will never be fully cured, but I have seen him improve so much since he began treatment," Sanchez said. "Just in the little things.”

For instance, Sanchez remembered when Peter would not eat dinner and instead wanted ice cream. “He would throw tantrums on the floor, pounding his fists at the ground and crying,” Sanchez said.

Now, Peter knows that if he cries, he will not get ice cream, but if he eats his dinner, he will get rewarded with dessert.

Dove said that a large portion of her time is devoted to trying to figure out why a certain behavior occurred. There was one child who flapped his hands constantly. Through ABA therapy Dove was able to diagnose that the flapping was caused when the child was nervous. After the problem is identified, Dove goes about trying to stop it from happening.

Sometimes children come to the center. Other times, the child struggles with social interactions, so their needs are best met with private interactions in the home. Each child's needs are met based on what they need the most, and what the family would like. Each child has a "team" consisting of a clinical director to oversee the process, a Board Certified Behavior Analyst (BCBA), a case supervisor, and therapists.

Depending on the child, the family and the family’s financial situation, the supervisor and BCBA discuss with the family what the child needs most to function properly in society, and from there the therapists enforce it. Dove said that sometimes it can take years to really get used to a child and his or her family and to see what works best for them. 

The hard work, however, seems to pay off. Dove has seen tremendous changes in children in the last two years. Several of children that she has worked closely with have become able to both communicate with others verbally, and express their emotions in controlled ways. Dove indicated that while this may not seem like a spectacular improvement, but any increase in social interaction is a tremendous victory for a child with autism.

Dove went on to say that the best part about working with these children through Behavior Frontiers is the relationships she develops with the kids and their families. 

“I’m basically an extra member of all my client’s families and it feels nice knowing that they’re helping their children and are open to change," Dove said. "It’s definitely not easy for them. Seeing my kids grow and change is really special.”

The first child that Dove worked with is graduating from ABA services at the end of March. In the time the child has been getting treatment, he is already comfortable around his peers and has grown drastically since beginning treatment a year ago.

The stigma surrounds autism is similar to many mental illnesses and neurological disorders, a lack of education. 

“Like anything challenging, unless you've seen it yourself you really have no idea," Dove said. "Part of my whole job is often trying to figure out why a certain behavior occurred and it isn't always black and white.”

If people were more aware about people living with autism, and why they interact the way that they do, it could help shine a new light on autism.  

“It's a very frustrating disorder because it doesn't always make sense to most people,” Dove said.

Posted By: Torey Darin

Seeds of Hope

What happens when memories disappear? How does a person deal with forgetting things that they once knew?  Words. Names. Events. All lost in some sort of neurological trashcan. A landfill of memories, buried deep in the soil of the mind. Living with diagnosed dementia can be terrifying, but there are ways to plant new seeds of hope.

Dr. Darby Morhardt is a clinical social worker at Northwestern’s Cognitive Neurology and Alzheimer’s Disease Research Center . It is one of the twenty-six existing Alzheimer’s research centers in the country.

Dr. Morhardt specializes with people experiencing memory loss and dementia. Lewy Body disease (LBD) patient, Natalie Ross was diagnosed with LBD years ago when she noticed she wasn’t driving as fast as she thought.

“I drove slow. My friends said I drove slow. Before, when I was younger, I drove fast.  I started to drive the limit. I remember my right turns were off too, I veered over the right curb every time. That is when I knew something was off.”

Lewy Body Disease (LBD) is not a rare disease. According to the Lewy Body Disease Association it affects an estimated 1.3 million individuals and their families in the United States. 

Because LBD symptoms closely resemble other cognitive impairments such as Parkinson’s or Alzheimer’s it is currently widely under diagnosed. The symptoms of those diagnosed with LBD can range and vary from day to day. The latest clinical diagnostic criteria for LBD include dementia and a diagnosis of Parkinson’s disease.

Ross reacted to her diagnosis with disbelief. “I was filled with pure utter, rage, and terror,” she said. “After the initial shock I wanted to address the stigma. We need people to understand and be able to talk. People don’t want to hear about mental illness or that you’re sick.”

“There are no cultural norms that address these diseases. [There are] No normative ways of talking about dementia, no way of understanding,” she stressed.

Since diagnosis, Ross has had a difficult time coping with LBD.

Natalie Ross in front center, Torey Darin and Shirley Coenen. Photo by: Julianne Hill

“It’s one thing asking for help, and another to be perceived as needing help,” she said.

Living with LBD, or any form of dementia can come along with so many other difficulties, besides just memory loss. “I can’t read or write due to my tremor in my hand and my cataracts,” Ross said.

She focuses her energy on reducing stigma and spending time with her close network of friends and professional caregivers.

Ross’ family lives in Detroit. She has one daughter and a granddaughter. “My granddaughter said the saddest thing to me the other night. I was reading her a bedtime story and I came across a word,” she explained. “She asked me about the word, and I had a hard time remembering. Sometimes I have a hard time remembering the meaning of words. And do you know what she said? She said 'Baba can’t even read.'”

Ross said she wouldn’t be here without her family, friends and professional caregivers. “There are four or five people who’ve been in on this since the beginning. They’ve been critical to my survival. Going to the grocery store, driving me to places, and my friends are my therapy,” Ross said.

Ross got her Doctorate in Social Work at University of Chicago and has worked as a professional for most of her life. 

“For me it’s quality of life, just because I’m sick doesn’t mean I’ll stop living,” she stated.

Ross co-leads a support group with mild cognitive impairment at Northwestern.“Who I am is a social worker, it’s in my blood. I can use this attention in my support group.”

When asked about the future, Ross responded hesitantly. “It’s scary. You imagine the old woman sitting by the window, looking out alone. Not knowing what is going on or remembering anything,” she said. After pausing for a few moments she continued, “I don’t want this to be me.”

She copes by using humor to try and stay positive and this can clash with certain doctors she said. “Many doctors lack personal skills. I’d talk with them for hours about my disorder with no eye contact, they’d just be staring at a computer screen.”

“I’ve met friends in my support group so it’s not all bleak. There are positives,” Ross assured. “Would I prefer we had a chance at going back to normal? That we had never met?” she pondered before saying, “Yes I’d give up these friendships in a heartbeat to have my health. Yes but we don’t have a choice.”

Research isn’t the only thing that gives people with cognitive disease hope. 

There are many support groups that patients rely on and are without funding or financial support. “The memory ensemble is definitely my favorite group,” Ross said with a smile. “As we learn things about improv. we learn things about each other. There is vitality in it, energy, and caring. It is powerful.”

The memory ensemble is a support group with the Looking Glass Theater and Northwestern Feinberg School of Medicine.

Ross celebrated her 70th birthday last November.  “I didn’t need anything for my birthday because everyone already gave me so much,” she said.

“I asked friends to contribute to the Theater. They all contributed enough to run the theater twice. The ceremony was wonderful. Staff did improv. with guests. It was about celebrating life, even when it is bleak. We also addressed stigma. Many of my friends knew [about Lewy Body] but many others didn’t.”

By: Shirley Coenen and Torey Darin

Our Best Defense

“The time is right for yoga teachers as well as yoga therapists to see themselves as part of the healthcare system.”

 -Dr. Jim Gordon, leading doctor on former President Clinton’s White House Commission on Complementary and Alternative Medicine Policy in 2010.

On Monday nights, Alissa Catiis runs a yoga group at the Womencare Counseling center in Chicago for trauma survivors.  Through stretching movements and calming poses like child’s pose and mountain pose, the four women in the 60 minute class practice mindfulness techniques together, and find relief.

“We focus on being aware of our own body. For example in forward fold, we try to focus on how the body feels, the hamstrings for instance. This can be very difficult for trauma survivors because they are disconnected from their body,” she said.

People with Post Traumatic Stress Syndrome are frustrated that conventional medicine doesn’t bring about the relief they hoped, but are finding benefits of yoga therapy.

 Francine Kelley, a psychotherapist at the Center for Contextual Change in Chicago, specializes in working with trauma survivors, says yoga is becoming an important treatment for trauma survivors. 

“It’s really useful to understand, no matter what symptoms PTSD or trauma causes, bringing mindfulness into the present, having them in their body right now, right here is tremendously helpful, ” she said. “They get nervous really easily and are hyper vigilant. Yoga helps with this.”

PTSD can develop in anyone after a terrifying or life-threatening event, whether it’s a physical or sexual assault, war, natural disaster, or even car accident.  PTSD is a complex anxiety disorder that displays myriad symptoms of depression, aggression and emotional detachment. 

Often, doctors prescribe various antidepressant medications, including Paxil, Seroquel, and Klonopin. 

According to Paul Huljich, a psychological researcher and author, "Taking of these drugs without exploring other healthier, more holistic alternatives is extremely dangerous in the long term.  These drugs only offer a band aid to the time bomb waiting to go off at any second."

Yoga can make a big difference, recent research suggests. A study published last year with the Trauma Center in Brookline, Mass. found that a group of patients who completed a 10-week yoga program showed significantly more improvement in PTSD symptoms than a similar group who had the same number of group therapy sessions. The study reported that yoga can improve heart-rate variability and tension reduction, key indicators of a person’s ability to calm oneself.

The physical activeness of yoga and connection between the breath and mind can be a powerful tool. “When people can access their core strength and body strength this can create sense of psychological strength,” Kelley says.

Corinne Peterson is a registered yoga therapist in Evanston, Ill. “So much of trauma is about reliving the past and the fear of the future,” says Peterson.  “One of the things yoga does is really ground people in their bodies. When you’re in the body you aren’t dwelling in the past or the future.”

This is key because our bodies remember trauma—it’s not just a brain thing, says Dr. Bezel Van der Kolk, an internationally recognized leader in the field of psychological trauma and medical director of the Trauma Center. 

After a traumatic event, the small almond-shaped amygdala in the back of the brain controls our fight or flight response. This survival structure activates to get us to safety.

“It’s suppose to calm down afterwards, but in situations of trauma [PTSD] it’s always active. Everything is scary all the time. You [believe that you] could get attacked at anytime,” explains Peterson.

“Yoga is a mindful practice, the body and the mind and breath together. It rewires the brain and calms the fight or flight response,” she added.

Corinne Peterson utilizes breath work as a successful tool for her patients. Sitting cross-legged on a yoga mat in her office, she explains one success story.

Corinne Peterson's office in Evanston, Ill. Photo by Shirley Coenen

Corinne Peterson's certified yoga therapist, in her office. Photo by Shirley Coenen

Sign in Corinne Peterson's office. Photo by Shirley Coenen

“One thing that was really helpful for a trauma patient of mine was recording some mindful breathing practices for him on his long train rides to work,” the therapist said.  “Things such as, feel the sensations, where are your hands, where are you feet, notice your breath. That really made the difference for him.”

Catiss, who is both a psychotherapist and a yoga teacher says her class is “an addition, it’s not a replacement for talk therapy. “So all the women in my group has a primary therapist as well.”

She also says that the yoga therapy has been successful in helping heal her patients. She measures the success with a feedback survey and speaks with their main talk therapist about their experience.

“I honestly can’t see a future without it [Yoga therapy]. Therapists need tools that can empower clients,” states Kelley.

“Yoga does this, gives them something to deal with their issues. They are no longer victims of their trauma. They have agency.”

By: Shirley Coenen