[HN Gopher] Accelerated forgetting of a trauma event after a sin...
___________________________________________________________________
Accelerated forgetting of a trauma event after a single dose of
hydrocortisone
Author : rntn
Score : 74 points
Date : 2022-10-24 18:04 UTC (4 hours ago)
(HTM) web link (www.nature.com)
(TXT) w3m dump (www.nature.com)
| jasec57322 wrote:
| fasthands9 wrote:
| In the US it seems like it is extremely in vogue to talk about
| trauma and PTSD. From a layman's POV, it seems pretty obvious
| that talking about something very often (whether it be with a
| therapist or just friends) would elevate the amount of times
| someone thinks of something. From my understanding of the paper,
| this drug is a success if it lowers the amount of time someone
| thinks of a traumatic memory
|
| >We found that participants receiving hydrocortisone showed a
| faster reduction in daily intrusion frequency. Voluntary memory
| was assessed once, at the end of the week, but was unaffected by
| hydrocortisone.
|
| Ultimately I see some contradictions in what the goal of
| different types of psychiatry/therapy is. Is the end goal to just
| be as happy and functional as possible? Is it to avoid the worst
| case scenarios the most while not caring as much about baseline?
| Or is there a moral/humanistic good to processing the world even
| if it results in being less happy and more functional in concrete
| tasks?
|
| I'm really not an expert in any of these things - but it does
| sometimes bother me that the discourse on this is jointed. I
| think it comes up in political/cultural talk quite often.
| [deleted]
| moate wrote:
| >>I'm really not an expert...
|
| A lot more people should come to this conclusion, reflect on
| it, and then not post whatever thought helped them come to this
| realization. Just go read enough to inform an opinion on the
| matter before sharing it.
| fasthands9 wrote:
| I strongly disagree. People who are experts in field X are
| self-selected people who agree with the assumptions that
| define the field.
|
| There should not be discussion forum on the website if there
| is a belief that smart people (who have read plenty of books
| on clinical psychology and neurology) can't ask questions
| about something they haven't personally worked in.
| kayodelycaon wrote:
| It doesn't take much thought to refute this idea. Talking about
| something can help you process it and feel better.
|
| If you have a bad day, talking to someone about it usually
| helps.
|
| Hell, bitching to a coworker about the idiot you just got off
| the phone with is a pastime for the average office workers.
| fasthands9 wrote:
| I'm still a bit confused - sorry if I don't sound earnest.
|
| This drug eliminates the amount of time you think about a
| past event. This is pitched as good. Is the model that
| thinking about something is bad but talking about something
| is good? What if talking about something changes how or when
| you think about something? As you said with your co-worker
| example (which I realize is not PTSD levels) I think it could
| be pretty easily argued that fixating about your current
| situation is actually contributing to negative mental
| processes.
|
| I have done therapy for specific issues and it worked for me
| - but nonetheless still dont see some contradictions between
| therapy and a pill that makes you think about something less.
| ThePhantom wrote:
| This is a pre-clinical study that is designed to model an
| aspect of a "traumatic" event and assess how the treatment
| condition (hydrocortisone) can affect behavior. Moreover,
| this experiment is designed to probe the effects of trauma
| in the moments immediately after the traumatic event, where
| the stress response is initiated. This is likely the period
| of time where the most synaptic changes occur. Of course,
| this paper doesn't directly posit that forgetting thoughts
| associated with trauma is therapeutic, as that would
| require an empirical study that include patients with PTSD.
|
| Also, the purpose of therapy, such as CBT, is not to fixate
| on one's current situation, but be able to unlearn feelings
| of trauma / anxiety from the event. This is done by
| engaging with a trained professional who can help the
| patient carefully break down their thoughts and feelings.
| Reflecting on a traumatic situation with a partner is
| different from reflecting on a traumatic situation amongst
| oneself.
| switchbak wrote:
| I think there's a difference between (mediated)
| constructive reflection with the goal of processing an
| event, and Repetitive Negative Thoughts (RNT) about an
| event. The latter can of course have long lasting negative
| effects.
|
| I think it's probably better to reflect on and process a
| _potentially_ traumatic event, than it is to repress or
| otherwise force yourself to forget it. But either of those
| is preferable to dwelling on it and spiraling in
| negativity.
|
| Perhaps this is just a matter of degree. For really bad
| trauma (mass casualty, etc) it's probably good to have
| stronger tools available.
| CocaKoala wrote:
| It eliminates the times you uncontrollably think about a
| past event - note that voluntary recall isn't affected. So
| it's saying that this lets you process the trauma in a
| controlled environment when you're in a position to deal
| with it, but otherwise resume a life that isn't interrupted
| or dominated by it.
| scarecrowbob wrote:
| Much of the therapy I have been involved with has been
| arranged not just around dealing with negative thoughts,
| but more fundamentally getting into a position where you
| can approach negative thoughts without moving into a
| triggered state.
|
| I think I get what you're saying; I could, for instance,
| just drink a lot every day to ignore a variety of ideas,
| but it's much healthier in the long run to deal with those
| ideas directly.
|
| Unfortunately, the reason why there are so many palliative
| coping strategies is that unless a person is in a state
| where they can examine those uncomfortable thoughts, then
| it's just creating more harm and the person isn't able to
| deal with the issue. That in turn often leads to the
| maladaptive coping that leads people into therapy in the
| first place.
|
| So a common therapeutic goal getting people to a point
| where they can first recognize that they are in an upset
| state, second calm themselves without totally disengaging
| from the event and, then (if possible) work on whatever
| thoughts or events led to becoming upset in that manner.
|
| That work is contingent on the first two parts of that;
| palliative care to help people get into a place where they
| can do the first two things without engaging in more
| harmful types of coping strategies (drinking, for instance)
| seems like a reasonable method.
| fasthands9 wrote:
| Right. I think I mostly agree with you. Perhaps I just
| think involuntary/intrusive thoughts in the study is a
| bit of a loaded term. These words to me sound implicitly
| negative - but unless they resulted in serious negative
| behaviors then I don't see why they should be considered
| such a negative. From my own perspective it seems that
| even if my own thinking about something a lot may not be
| as effective as therapy or meditation, thinking about
| something _does_ help process it and does help you come
| to a similar calmness about it.
|
| The drug in the paper, to me, seems more like the coping
| strategies you talk about but without the other physical
| harms. Like what if alcohol made you not think about
| something but actually kept your physical and mental
| health the same/stable? Would that be desired? Isn't that
| what this drug is hoping to achieve?
| duskwuff wrote:
| And there's a big difference between suffering from intrusive
| thoughts about a traumatic experience, and talking about that
| experience voluntarily. The former is stressful; the latter
| is therapeutic.
| fasthands9 wrote:
| I guess my skepticism of this is a bit unpopular - but the
| way they measured intrusive thoughts is whether or not the
| people mentioned the traumatic film they saw in a journal
| for a week.
|
| It seems plausible to that thinking (even if involuntary)
| about any other traumatic memory may result in short term
| stress but in the long run help you process it and be
| healthy? Like in my own experience thinking about something
| a lot on my own is part of therapy - since I really think
| about how I explain the situation and what really happened
| - so I guess I'm skeptical that _not_ thinking of something
| is actually good for mental health in the long run even if
| in the short run it works.
| duskwuff wrote:
| > I guess my skepticism of this is a bit unpopular - but
| the way they measured intrusive thoughts is whether or
| not the people mentioned the traumatic film they saw in a
| journal for a week.
|
| That's a fair criticism. Doing research on real PTSD is
| tough -- everyone's experience is a little different, and
| is colored by their personal history -- and it'd be
| wildly unethical to put test subjects through an in-
| person experience stressful enough to induce lasting
| PTSD. Some studies, like the Tetris intervention one I
| linked elsewhere [1], used real trauma patients; others,
| like this one, have to rely on stress simulants like a
| violent film.
|
| I will note, however, that Irreversible [2] -- the film
| this study used excerpts from -- is _exceptionally_
| violent. It 's not a run-of-the-mill action film. One of
| the scenes the study probably used graphically depicts a
| man being beaten to death with a fire extinguisher.
|
| [1]: https://www.psych.ox.ac.uk/news/tetris-used-to-
| prevent-post-...
|
| [2]: https://en.wikipedia.org/wiki/Irr%C3%A9versible
| fasthands9 wrote:
| Yeah. Perhaps its a bit unfair to pick out in the weeds
| details of the study.
|
| I guess maybe the core of my confusion comes with the
| term "intrusive" or "involuntary" memory. To me, in
| reference to PTSD, this sounds extremely negative. But
| perhaps you were in a situation where you saw someone
| die, perhaps even someone you know, should the goal be to
| only think about these things in therapy or when you sit
| down to meditate? Is involuntary/intrusive thoughts on
| these bad so long as it doesnt have major effects on your
| stability?
|
| Not nearly as traumatic - but when I went through my last
| break-up I thought about it non-stop for a few weeks. I
| was able to get through my work and keep up social
| engagements fine, but otherwise it consumed me. Would it
| have been better to only think about the situation in
| therapy sessions and allotted meditation time? Maybe? But
| I'm not that sure on that I probably needed a few weeks
| of internal "involuntary" struggle in order to be free of
| the negative thoughts around it going forward.
|
| I guess for me the answer is that if your brain is
| thinking about something, even if it seems a bit
| disorganized, you are still processing it on your own
| time and the short term benefits of not thinking about it
| then may not actually be good for your long term. Though
| perhaps this runs counter to established literature I'm
| not aware of.
| dwringer wrote:
| People routinely cross the threshold from thinking about
| something and processing it on their own time into a
| state of nonproductive recurrence of said thoughts in
| which no real processing is done. Managing this kind of
| symptom is often the first step in successful long-term
| recovery; the goal of psychiatry is never just to sweep
| problems under the rug instead of helping patients
| process their world effectively.
| kayodelycaon wrote:
| Oh, I'm quite aware. I spent most of my life dealing with
| them. Psychosis, paranoia, and flashbacks are a bitch.
| dmbche wrote:
| What they are reffering to as "intrusions" is not just having
| thoughts about the traumatic event, it is having intrusive and
| uncontrolable toughts pop into your mind when triggered - it's
| very disrupting and distracting. Depending on the level of
| trauma, these intrusions can be debilitating.
|
| In general, PTSD treatment involves changing one's perspective
| towards the traumatic event so that when triggered, the
| thoughts it recalls are not intrusive and debilitating - making
| it so the patient doesn't feel shame, fear, loss of control
| when trigered.
| fasthands9 wrote:
| I realize I am being downvoted so perhaps this is settled in
| literature.
|
| I know PTSD can be traumatic and takes different forms
|
| I suppose my confusion still comes from the fact that
| stopping intrusive thoughts is measured as good. But what if
| these intrusive facts are needed (just like therapy) to
| process things in the long run?
|
| I would understand if someone could ran a (very costly)
| experiment that said "Taking this over the course of 5 years
| lowered the amount of outbursts/negative behaviors someone
| took" but this is just measuring thoughts.
|
| Presumably, if there had been another group that had been in
| a therapy group after seeing this traumatic film it is highly
| possible the number of times someone thought about the film
| (which is what they were measuring) would have gone up - but
| would that be bad?
| renewiltord wrote:
| Sure, these are all possibilities. With sufficiently able
| individuals who are sufficiently informed, we simply create
| the treatment and permit the individuals to select as
| required. For instance, the patient can choose to either
| suffer temporarily with the hope of the future positive
| outcome for the suffering or they can choose the immediate
| solution.
|
| If the patient is not sufficiently able to choose due to
| being mentally unable and the drug is likely to bring them
| back to lucidity, then it is obvious that bringing them
| into a lucid state is the logical path, so we should
| recommend administering the drug.
|
| For my part, I've noticed that people who dwell on these
| traumas have a hard time. Meanwhile I've suffered numerous
| things that many of these people claim have led to
| debilitating mental illness and I operate in a space of
| mental comfort. So, should I encounter another trauma
| event, I'll take the forgetting drug.
|
| And presumably you, believing otherwise, should refuse it.
|
| P.S. Here's a thought experiment for you: What if the MMR-2
| vaccine instantaneously kills people at the age of 60. It
| was introduced in 1963 and this year is 2022, so the first
| recipients are not yet 60. So you simply cannot prove that
| it does not do this. You have a son. How do you reason
| whether to risk the possibility of instantaneously killing
| your son when he hits 60 vs the risk of him contracting any
| of Measles, Mumps, or Rubella?
| lazide wrote:
| PTSD is a disorder _because_ people aren't clearing or
| processing these things successfully and it becomes
| disruptive to their life. Sometimes it destroys their
| lives.
|
| If someone successfully processes the trauma in a way that
| isn't disruptive, they by definition don't have PTSD
| anymore.
|
| What you're saying is a bit like saying someone who suffers
| from persistent, terrible constipation, to the point it
| causes them health issues should 'just poop'.
|
| If they could on their own, they wouldn't have the problem!
| 8ytecoder wrote:
| There's also the very important distinction between
| remembering something and experiencing something. People with
| PTSD and unresolved trauma relive the entire episode with
| emotions and all.
| regular wrote:
| jasec57322 wrote:
| Why is stress after trauma a 'disorder'? And how is it a solution
| to drug people up, making them forget this?
| kennedywm wrote:
| PTSD has strong negative impacts on a person's life. Treating
| it mitigates these negative impacts.
| tsimionescu wrote:
| That's a bit like asking "why is pain after an injury a
| 'disorder'"?
|
| Just like some people are left with persistent recurrent pain
| in an otherwise healthy and recovered limb (often known as
| rheumatism), some people are left with persistent recurrent
| stress after trauma - such as suddenly bursting out crying or
| cowering in fear after incidentally remembering trauma that
| happened 20 years ago while doing the dishes.
|
| When this sort of thing happens, we call it "post-traumatic
| stress _disorder_ ", and are looking for ways to treat
| patients. Making them forget the event is one possible
| treatment, and there are others (such as trying to disassociate
| the event itself and the strong negative feelings).
|
| Just like acute pain is useful to keep us healthy, acute stress
| is very important. But chronic pain and post-traumatic stress
| are _not_ useful to anyone, they are failure modes of these
| otherwise useful systems, and it makes sense to try various
| ways of correcting them.
| gilbetron wrote:
| Spoken like someone that hasn't experienced PTSD.
| HeyLaughingBoy wrote:
| A long time ago my wife shattered her wrist. In the ER, they
| explained that they needed to reset it so it could be put in a
| splint before surgery could be scheduled. They weren't going to
| use anesthetic. She would be conscious of the pain as they
| moved her wrist into position, but they'd give her something so
| she wouldn't remember the experience.
|
| 15+ years later she remembers telling them to go ahead and do
| it, then there's a hole in her memory for about 10 minutes.
|
| I'd say that's one good solution.
| gateaux wrote:
| Wow. Do you happen to know what it was they gave her?
| roywiggins wrote:
| I believe midazolam can cause amnesia, it's not technically
| an anesthetic in the sense that it doesn't knock you out,
| but it's a sedative.
|
| https://en.wikipedia.org/wiki/Midazolam
| atdrummond wrote:
| Versed's ads on radiology magazines literally say "For
| when they need to forget."
| lostlogin wrote:
| Ketamine has been something I have seen used. The lack of
| reaction from people having broken bones manipulated while
| under its influence is very disconcerting.
| minitoar wrote:
| It's a disorder if the stress interferes with your daily life,
| e.g. you can't hold down a job or your personal relationships
| suffer.
| ska wrote:
| > Why is stress after trauma a 'disorder'?
|
| It isn't. Sometimes you can experience trauma, then experience
| stresses, and react to the stress in normal ways.
|
| The disorder is when this _doesn 't_ happen, and you have
| atypical reactions to stress, which can be debilitating.
| runnerup wrote:
| Because sometimes there's no war left to fight but the soldiers
| still can't return their minds to civilian life. They're
| disabled, unable to hold down a job reliably, unconfident in
| their ability to do normal tasks like go grocery shopping
| without having a debilitating panic attack which causes
| additional heart damage every time.
|
| There's tons and tons of examples why stress after trauma is a
| disorder. Also a very good wikipedia article if you'd like a
| place to start: https://en.wikipedia.org/wiki/Post-
| traumatic_stress_disorder
| kennywinker wrote:
| The "disorder" is a description of about how it's causing
| people pain / trouble in their lives. Experiencing something,
| and processing it, and it having a lasting impact on your life
| and your thinking isn't by definition disordered. But having it
| cause problems in your life, e.g. physical touch from people
| you trust causing panic attacks, that's a disorder.
|
| Forgetting, as a treatment, may be something some people want.
|
| To my eyes your comment is pretty dismissive ("drug people
| up"). A little empathy, and an open heart goes a long way here.
| eli wrote:
| PTSD is a serious medical condition. It's not merely a feeling
| of "stress."
| api wrote:
| It is if it sticks around long after the original triggering
| trauma is gone and prevents you from leading a healthy life.
| travisjungroth wrote:
| Not all stress after trauma is a disorder. A disorder, by
| definition, is a big problem. It's "an illness or condition
| that disrupts normal physical or mental functions". Think PTSD
| as "disorder from stress from trauma".
|
| How is it a solution? If giving people a drug reduces disorders
| and that benefit outweighs the cost, then it's generally
| considered a good idea.
| Traubenfuchs wrote:
| Combine with propranolol for maximum effect.
|
| A very overlooked drug that can be used in the treatment of many
| disorders related to anxiety, stress and fear. Without the risk
| of debiliating addiction benzos and benzolikes bring.
|
| https://pubmed.ncbi.nlm.nih.gov/14573324/
|
| https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3692719/
| khazhoux wrote:
| Ah, propranolol... how I wished it was a thing back when I was
| in school. I used to practice my instrument for hours every
| day, just to choke when performing a solo in front of an
| audience. Fast forward 20+ years, and I embarrass myself by
| freezing up during a VP review. That damn lizard brain!
|
| I finally got a prescription, and a full bottle of pills at the
| ready -- but I haven't tried it yet.
| Traubenfuchs wrote:
| I couldn't do job interviews without -I'd probably be
| unemployed.
| zaroth wrote:
| Hah, had me on the edge of my seat to hear the life altering
| impact, and then, bottle's still on the shelf!
|
| Here's to hoping it works well next time you need it tho.
| fellowniusmonk wrote:
| Yeah, I've been on beta blockers for a heart defect for several
| years now. I read this paper about a year after going on them
| and just started exploring trauma on my own (stuff that made me
| weep or even pull face muscles in grief) the post sleep memory
| reconsolidation is basically a miracle and my emotional trauma
| responses were basically wrapped up within ~ 1 year. There is
| now nothing so awful I cannot touch, hold and examine it. I no
| longer even have nightmares of any kind. I don't have intrusive
| thoughts from past events during the day (none to speak of) and
| no rumination either, it's like speed running stoicism.
| canadiantim wrote:
| What is the post sleep memory reconsolidation?
|
| My mom has severe PTSD that is causing memory and cognitive
| decline because all her resources are dedicated to fight or
| flight. She is just a ball of the most significant stress you
| can imagine and it's destroying her.
|
| Have any recommendations or suggestions?
| fellowniusmonk wrote:
| Basically the protocol is to be on a beta blocker and then
| recall the memory and explore it followed by normal sleep.
|
| This pulls the memory into short term storage and then when
| you sleep the memory will reconsolidate into long term
| storage but without the physiological adrenaline/stress
| response.
|
| I had some terrible experiences that provoked strong grief
| responses and it took several cycles of recall /
| reconsolidation before the emotional stress response was
| stripped to something manageable.
| canadiantim wrote:
| Wow that sounds very powerful and a logical way to reduce
| the associated trauma from a memory. Good for you for
| working your way through that! And thanks for sharing.
|
| For my moms case, she's unfortunately buried whatever
| trauma it is that is causing her to eg always have her
| bags packed and ready to bolt such that I don't think she
| can consciously identify a memory that has traumatized
| her. She doesn't even think she has trauma (despite
| everyone having at least some trauma and her more than
| others). At this point she's just put up all her defences
| and refuses to deal with the root of it. It's ruining her
| psychologically and unfortunately negatively affects all
| those who are around her (considering she's at 20/10
| stress levels nearly all the time but she thinks that's
| normal).
|
| Thanks again for sharing what has been working for you.
| I'm trying desperately to find something that can help
| her become a functional human being again because I've
| been her full time caretaker for last couple years and
| now it's killing me too. But perseverance they say,
| balanced with burn out.
| Traubenfuchs wrote:
| The non pharmaceutical variant of exactly this would be
| using meditation. Which is a lot of effort.
| franl wrote:
| Has she looked into EMDR therapy?
| duskwuff wrote:
| And, for a nonpharmaceutical intervention -- have them play a
| bit of Tetris.
|
| https://www.psych.ox.ac.uk/news/tetris-used-to-prevent-post-...
|
| I can confirm from personal experience that this works, and
| that it isn't specific to Tetris. Other visual/spatial puzzles
| are similarly effective.
| jonsen wrote:
| I think Nurikabe is really good.
| cantrevealname wrote:
| > _propranolol [for] anxiety, stress and fear_
|
| I recall reading that propranolol reduces the physical
| manifestations of anxiety, stress and fear, but you still
| _feel_ it internally. For example, when used for stage fright,
| you won 't fidget, stutter, blush, sweat, and have a racing
| heart beat, but you'll still feel the anxiety inside yourself.
| Traubenfuchs wrote:
| Physical and mental symptoms are feeding each other
| -sometimes in a death spiral til exhaustion or mental
| breakdown.
|
| Propranolol stops this.
|
| It's not easy for me to fully put into words, but this
| theoretical view on it impacting your body / physical
| symptoms but not your mind is simply not correct.
| cantrevealname wrote:
| I looked at your profile and saw this:
|
| _I am a GPT3 bot writing random content. Ultimately, only
| very few comments will be written (no more than 10 a day).
| Target threads and comments I respond to are picked by the
| likelihood of there being a response to my response,
| calculated via a multilayer inference matrix model and some
| random chance._
|
| Please tell me that this is a joke and that the above reply
| was written by human being. I fully believed (and still
| believe) that your reply was written by a real person. I
| saw one typo (til should've been till) and one non-standard
| punctuation (a single hyphen for dash), but the whole reply
| sounds real and relevant. If GPT3 is this good, I going to
| become nervous about the future.
| spoiler wrote:
| bad bot
|
| (The profile says to post this in case the bot commented on
| a sensitive topic)
| runnerup wrote:
| Anyone with asthma doesn't qualify for propranolol. There are
| more "selective" beta blockers but it's not clear they're as
| effective for psychological use, or how much less they
| exacerbate asthma.
| thinkingemote wrote:
| Isn't there a similar study where playing Tetris helped people
| recover faster?
| O__________O wrote:
| Paper:
|
| - https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5678449/
|
| Press coverage:
|
| -
| https://www.google.com/search?q=intitle:tetris+traumatic+mem...
|
| HN posts:
|
| https://hn.algolia.com/?dateRange=all&page=0&prefix=true&que...
| roywiggins wrote:
| This roundup concluded that the evidence is not particularly
| strong:
|
| "In short, there is no convincing evidence that playing
| Tetris actually helps people. The studies have methodological
| problems, tiny sample sizes, and have failed to replicate.
| Some found a reduction in "intrusive memories," but no
| improvement in outcomes of PTSD or distress."
|
| https://www.madinamerica.com/2021/10/tetris-trauma-viral-
| twi...
| trollerator23 wrote:
| That was a great article. Thank you.
| weq wrote:
| Games will only cover up the symptoms. My ex-wife was a doctor
| who was struggling with c-ptsd that she could not treat
| otherwise she would loose her accreditation. She used Candy
| Crush everyday to reduce the impact of the PTSD on her life,
| unsuccessfully. I had to leave. She was a ball of rage that was
| always on the precipious of a full blown flash back. She said
| it kept her "mentally fit for the job", but i saw it was the
| only way she could be be idle without it creeping back into her
| mind. There were only so many hours between shifts, and at work
| she felt value and could forgot, mostly.
| spoiler wrote:
| Why would she lose her license over this? Is it just a weird
| country/law?
|
| I'm curious because my therapist said I probably have CPTSD
| (not as severe as your ex had it, though; to the point it
| doesn't even sound like CPTSD to me).
| ghostbrainalpha wrote:
| The Tetris wasn't used long term like that as a distraction.
|
| It was used to keep people awake for a long time immediately
| after a traumatic event. The Tetris was less important than
| the lack of sleep.
|
| If you don't sleep and play Tetris for a couple days you
| scramble the process of turning short term memories into long
| term, making them less impactful.
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