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Can You Heal From Trauma? with Dr. JoAnn Difede

A psychologist describes the medical approach to trauma and effective treatments for PTSD.

This week, Faith is joined by Dr. JoAnn Difede, a psychologist at NewYork-Presbyterian and Weill Cornell Medicine and a specialist in the treatment of post traumatic stress disorder. “Trauma” is a term that we use every day, but most of us aren’t talking about trauma in the strictly medical sense. Dr. Difede explained how trauma forms when we respond to threats that provoke us to fight, flee, or freeze, and described the difference between trauma and PTSD. Despite the challenging nature of a conversation that covers examples of traumatic events, we end this episode on a hopeful note: effective treatments exist for people with PTSD.

Episode Transcript

Welcome to Health Matters, your weekly dose of the latest in health and wellness from New York Presbyterian. I’m Faith Salie. 

Trauma is an emotional response to a distressing event that can have a serious impact on our mental and physical health. It’s also become part of our vernacular. To understand how mental health professionals define trauma, I talked to Dr. JoAnn Difede, a psychologist at NewYork-Presbyterian and Weill Cornell Medicine and a specialist in the treatment of post traumatic stress disorder. She explained how we are hardwired to fight, flee, or freeze and the difference between trauma and PTSD. 

Before I share our fascinating conversation, I want to let you know that we discuss examples of traumatic events, including war, 9/11, sexual assault, and the COVID-19 pandemic, so please listen with care. 

Faith: Dr. JoAnn Difede, thank you so much for joining us.

Dr. Difede: Thank you for inviting me. It’s a pleasure to be here.

Faith: Let’s start by talking about how to understand some of the main ideas in your work, because it seems like people use the terms trauma and PTSD very freely these days. Can you tell us: What does trauma mean in a medical context — and how does trauma differ from PTSD?

Dr. Difede: First, there’s the broad definition of trauma: when a human being is faced with a situation where they perceive a threat to their life, they witness something like that happening to another person, we are all hardwired to fight, to flee, and to freeze. In our body, there’s a whole psychobiological cascade of events that occurs the moment that you decide that you’re threatened. 

We use “trauma” now, um, more commonly in everyday life to mean almost any event where a person feels like it’s might change their life. So for example, losing a job or, which is a very big event in a person’s life. I don’t mean to in any way minimize it, right? Or a divorce, which can be horrible. It’s pain and suffering. It’s a different kind of pain and suffering. 

PTSD is a psychiatric condition that develops following the kind of trauma where your body prepares to fight, flee, or freeze, and your body pumps out all these neurochemicals and your autonomic nervous system goes into hyperdrive, if you will, to live and survive.

But just because you would experience an event where your life might be threatened, say you’re a firefighter that runs into a burning building and you get burned, doesn’t mean you will develop PTSD. You did experience a trauma, according to the narrow medical definition, because your life was at risk, and there was a threat to your bodily integrity. You got burned. You don’t necessarily develop PTSD. Less than half of people do.

Studies done on psychiatric disorders showed that in an urban area, adults were likely to have two to three traumas in their lifetime, whether that’s being held up at gunpoint, in a car accident, natural disaster, sexual assault. However, most of those people didn’t develop post traumatic stress disorder. Rates of PTSD are quite high in certain populations that have, say occupational exposure like firefighters, cops, combat, exposed soldiers, healthcare workers these days after the pandemic. 

Faith: You’ve done um, so much work with, with burn victims, emergency crews after 9/11, the medical staff who worked through the worst of the COVID pandemic in New York. Would you say a little about how this work has helped you understand what trauma is?

Dr. Difede: The one thing I want to make really clear is no one should ever feel bad if they’re the person whose life has been transformed and they’re having a hard time moving forward without a lot of support. There should be no shame in getting treatment. Unfortunately, there often still is, particularly among our healthcare workers who are highly trained and our soldiers and firefighters and cops and EMTs and people who are trained to serve other people. 

I’ve developed a profound respect for how severely PTSD can negatively affect a person’s life. You know, the adage cancer affects the whole family? Well, there’s a way in which trauma does too, right? Because if you become vigilant and can’t concentrate, can’t sleep, a perfectly good marriage and relationship with kids can get really strained because your partner and spouse doesn’t completely understand what’s happening to you. 

Faith: When we talk about PTSD, just in case anyone doesn’t know what that acronym stands for, it is …

Dr. Difede: Post Traumatic Stress Disorder. It’s become so common now that everyone refers to it as PTSD and no one spells it out anymore.

Faith: We often hear about something triggering trauma. Is that just a kind of popular rhetoric, or is that something real from a medical perspective?

Dr. Difede: It’s both. For people who develop PTSD, your nervous system ratchets up and your body’s going to continue to pump out chemicals saying, Oh. That building over there, that’s just like the World Trade Center. I better run. Or That plane, Oh gosh, another plane’s going to come in and crash in the building over there. And, and so you’re constantly pumping out the stress hormones. 

Faith: That sounds relentlessly unnerving and exhausting.

Dr. Difede: It can be. It really can be. People talk about being exhausted a lot, feeling like they’re losing their mind because images pop into it of whatever their trauma was. PTSD is very commonly associated with a whole host of medical conditions that are related to this autonomic dysregulation. Cluster headaches, tension headaches, migraine headaches, grinding one’s teeth, pain syndromes, and cardiovascular disease, from this constant stress reaction that the body is experiencing.

Faith: If someone is triggered with PTSD, what is happening in their body then? 

Dr. Difede: Well, it could be confined, if you will, to the emotional experience of distress, right? And just sad, maybe a little bit anxious, a little bit upset, where it could be the full on fight, flight, freeze response. And that varies a lot by the person. And that’s where treatment comes in.

One of the goals of the major treatments for PTSD, which is known as exposure therapy, is going over the trauma memory in such a way that your brain basically at a pre conscious level kind of resets. And and you might remember and just have a brief momentary memory and then you can refocus your concentration to the present. And then your body wouldn’t be having that response, if you will, of preparing to fight, flee, or freeze. 

Faith: How much of treating trauma requires a mental health perspective versus a physical health perspective?

Dr. Difede: Well, I’m a big fan of integrated treatment approaches. In fact, after the World Trade Center, I brought in a yoga expert to teach all of us, meaning my clinical staff, how to do one of the yoga breathing techniques, ujjayi breathing, and we started to teach our patients that. And we offered yoga classes to our health care workers who were, um, taking care of all the burn patients and really couldn’t leave the hospital. And for years before yoga became very popular and before evidence developed that it was possibly an effective intervention for some people with some sorts of trauma, we were doing that kind of work. So I’m a fan and I would say you need both, that you need the psychological treatment for sure. If you’re having the symptoms of intrusive images and nightmares or bad dreams and avoiding and becoming numb and then having that manifest as hyper vigilance where you’re constantly scared scanning your environment, and your body is overly alert to signals to danger and so you overreact like a car backfiring for someone who was in a war zone might trigger a memory of being in Iraq. Where I’m going with this is so then if by doing an exercise program, whatever might, might appeal to the individual in which your body is, say, producing those happy hormones and neurochemicals, like endorphins, should very much be part of a program of intervention for PTSD. 

Faith: If someone has experienced a trauma, does someone really only need to seek help once it’s clear that that trauma has created PTSD for them?

Dr. Difede: Right, so we’re the last to know that we have PTSD. What I would say is if you feel different, if you feel like you’re out of sorts, you’re not yourself, and certainly at the extreme, if you feel like you’re losing your mind, which is something people say a lot, and if a loved one or a friend or a, a close colleague is saying, “Hey, you just don’t seem like yourself,” I would do what we do for our physical health and, and go and see a person who’s qualified to assess trauma and treat trauma. And let them collaborate with you and, and help you figure out how it’s affecting your life and whether it requires intervention. 

Faith: Many of us have heard this phrase, the body keeps the score. Is that true?

Dr. Difede: If you experience a trauma that puts you at risk for PTSD, in which you are at much greater risk for a whole host of medical conditions that are associated with the autonomic dysregulation, from problems in your gut, your heart, your jaw, your, your brain, right? With the, with headaches. So in a very narrow and specific sense, the answer is yes. It has an effect on the entire human being.

Faith: Dr. Difede, if someone is hearing this and is like, “Oh my gosh, I get migraines and I grind my teeth. Do I have PTSD?”

Dr. Difede: Not necessarily, no. 

Faith: What do you want that person to know?

Dr. Difede: A person might be going, might be a woman who’s going in perimenopause and suddenly developing, um, migraine headaches. It might be, might be a woman or a man with, with a really tough work situation. So, no, not at all. But, if you also know that you were, you know, in a car accident or sexually assaulted, or any of the events that can happen to a person where their life was threatened, or that of a loved one, or their physical integrity was threatened, I would, a little bell should probably go off and go, “Hmm, maybe I should go to a psychologist or psychiatrist and, and talk with them about how I’m feeling.”

Faith: How does a severe trauma change someone’s relationship to their body?

Dr. Difede: Particularly for men or women or people of any gender identification who have been sexually assaulted their sense of their body changes a lot, right? They don’t often feel as comfortable in their skin anymore or as safe. And that goes with child abuse as well. If you’re, you’re abused as a child by someone you trust, um, that will change your relationship. And the other end though is people who don’t have any physical violence, but they have, they feel like they’re going crazy because their brain is constantly sending out intrusive images of their trauma, because they can’t control the images in their brain. But I do want to start emphasizing a little more is there are evidence based treatments for PTSD, and they work. The sooner you go to speak with a mental health professional who’s qualified to assess and treat trauma, the better for you. The more likely the treatment will be shorter, the more likely it won’t have as severe of an impact on your life. 

Faith: So let’s talk about how real and how effective treatment is for trauma and PTSD. To start with, what are the range of treatments available today?

Dr. Difede: The most effective treatments are that the psychological treatments, particularly trauma focused cognitive behavioral therapy and exposure therapies. There are additional emerging treatments like interpersonal therapy, where one doesn’t have to go over the trauma in great detail, that also appear to be effective.

All of these treatments that I’ve mentioned are all talk therapies. The exposure based one in which you go over the trauma memory have a more of a behavioral component where you go out in the world and you start to systematically and gradually confront what you’re afraid of, because part of PTSD is becoming avoidant. We’re wired for pleasure and to avoid pain. So it would be a natural response. It’s like, “Oh, well, I don’t have to work in lower Manhattan. Let me just quit my job,” or “I don’t have to fly. I guess I could drive or take the train,” or “I don’t really want to take that trip to Europe.” And I can tell you story after story of people who did exactly those things.

And so the treatment is talking about it, but talking about it in a way that’s systematic and goes over the memory so your brain can learn that things are safe. And then going out and doing the homework of confronting it.

Interpersonal therapy it’s still a talk therapy. But you focus on when you have PTSD and you’re vigilant, you get irritable, right? You can’t concentrate. You’re not sleeping. And so the quality of your relationships may begin to deteriorate, with your spouse, with your children, at work. And so it focuses more on the present and in the interpersonal dynamic and working on the conflicts that may develop, but they’re both psychological treatments.

Faith: What would you say success looks like when it comes to treating trauma?

Dr. Difede: Well, my favorite quote is, “Doc, I got my life back. Doc, I thought it might help me feel a little bit better, but I got my life back.” I mean, that’s, that’s, uh, you know, when you do research, um, and you’re trying to help people, that’s, that’s something that we don’t expect. But when we do, wow. That’s incredible.

There are treatments. If it were your lungs or your heart or some other body part, you’d probably go to your healthcare provider without too much hesitation. But when it comes to a brain-based psychological and psychiatric conditions, there is still that stigma associated with it, particularly among people who are so highly trained to serve other people.

Faith: Dr. JoAnn Difede, this has been fascinating, and um, I thank you so much for what you do.

Dr. Difede: Thank you. 

Faith: Our many thanks to Dr. Difede. I’m Faith Salie 

Health Matters is a production of NewYork-Presbyterian. The views shared on this podcast solely reflect the expertise and experience of our guests. NewYork-Presbyterian is here to help you stay amazing at every stage of your life. 

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