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PTSD And Decision-Making Anxiety

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QuietNow

Learning
Grandma-Herc brought up an interesting topic in a prior post about indecision and anxiety.

One of the perks of working for higher education is free access to the research journals.

There are very concrete reasons why PTSD affects decision-making. In survival terms, if you step into a street with an on-rushing car, you don't have time to weigh decisions. Your body reacts in flight panic.

Once a body has been subjected to the fight/flight adrenalin overload for too long, there are physical changes that occur to make it easier on the body. One of those changes appears to turn down the decision-making capability. After all, if you ruminated about that on-rushing car and how heavy it was and how fast it was going and whether it was going to turn and BAM!!! it hits you.

The hypothalmus, which is the seat of memory, shrinks. The amygdala, which is the source of the fight/flight response, increases. Over time, with reduced stress, these changes may shift back to a normal size --but they also might not. The fight/flight stress response shuts down the cognitive sections of your brain so that you can handle reflex actions without that pesky thinking getting in the way.

That doesn't mean that you can't make decisions. Or that your decisions are bad. It just means that sometimes a decision can enter a feedback loop of ...uh, I can't decide....WAIT, NO, ACK! I have to pick SOMETHING....(and the panic immediately shuts down the cognitive side of your brain)...Uh, I CAN'T Decide!....WAIT, NO!!!.....

ya see?

There have been moments where I completely lose all ability to decide anything for myself. Just tell me to do it and I'm fine. Make me work at a decision, and, well, I'm lost. (This becomes a lot worse when I'm tired.) I've mentioned in another post on the board that I've actually gone to bed hungry with a full refrigerator of food simply because I couldn't decide what to cook. Actually, if my loving husband didn't feed me once a day, I'd probably get really really skinny. (Hmmmm, maybe a weight-loss technique? ;-) ) Really, it's rather scary that rather than face a decision on what to make to feed myself I'll just go hungry. From an evolutionary standpoint, that's probably right up there with platform shoes.

There's a lot more interest being given to PTSD and the physical changes in the brain and how they affect a person. Lemme source a couple, for those individuals that can get access to articles (sorry for the less-than-perfect attributions. No style guide, so I'm doing the source etiquette from memory instead of from...um...I forget...that book we used in college when working on our papers):
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Attentional biases in PTSD: More evidence for interference. Pineles, S., Shipherd, J., et al; Behavior Research and Therapy, Vol 47(12), Dec, 2009. pp. 1050-1057.
- Abstract basically boils down to took high PTSD and low PTSD participants and made them search for something and then make a lexical decision (probably a multiple choice question, though I didn't read the full experiment write-up). High PTSD participants had a much harder time making that decision when a trauma-related word was thrown in. Indicates that intrusive thoughts are shutting down the cognitive functions.

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Altered reward processing in the nucleus accumbens and mesial prefrontal cortex of patients with posttraumatic stress disorder. Sailer, U., Robinson, S., et al; Neuropsychologia, Vol 46(11), Sep, 2008. pp. 2836-2844.
- The abstract here describes a win-lose game that was designed with a set of controls and PTSD patients. The controls learned faster than the PTSD patients. The interesting part of the study came when both sets were hooked up to brain monitoring. Both sets had equivalent reactions to a loss. ("the agony of defeat..") But when the participant *won*, the reactions differed. The controls had the elation/reward response, but the PTSD patients had a much lowered elation/reward response. There's a description in the beginning about the lowered prefrontal brain functions in PTSD on working memory and attention.

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Traces of fear in the neural web — magnetoencephalographic responding to arousing pictorial stimuli. Rockstroh, B. and Elbert, T. International Journal of Psychophysiology, Feb 11, 2010.
- Abstract excerpt: "Consequently, the fear network undergoes neuroplastic modifications, for instance, incremental enlargements with repeated exposure to threat and danger. This will in turn modify future processing of sensory stimuli and ultimately lead to an altered architecture of the brain's processing machinery and information processing modes." ..."As a result, the brain's architecture is changed from a careful analyzer of the environment to a rapid threat detector with a low threshold to engage in costly defense."
 
When I'm in front of male authority figures.......making decisions and telling what I know becomes almost impossible. My voice shakes, I get all confused....
Sucks.

I'm extremely good at making and communicating decisions on the phone, to women, to my honey (who's safe)....but get me in front of my so called Boss (I really am the one who tells him what to do) and I become a blithering idiot. I deal with an intense amount of fear that shuts down my other capabilities.

Sucks
 
When I'm in front of male authority figures.......making decisions and telling what I know becomes almost impossible. My voice shakes, I get all confused....
Sucks.
Oh yeah...I'm there, too. And yes, it does suck the big one!

Lisa
 
Here's to re-training the brain! I have to really kick in the higher cognitive functions today.......especially cause I'm going to be around a bunch of testosterone!
 
Hey TLight,
Yeah, I can't comfortably do public speaking. I actually had my upper lip dry so much that it stuck to my teeth in one speech. That really interferes with your ability to talk! I found that I can manage ok if I memorize, memorize, memorize the material, don't have hecklers in the audience, and keep a water bottle in hand. Oh, and I now put vaseline on my upper gum line under my upper lip so that if it dries up, it doesn't stick.

The worst is when you cry in a pressure situation. I'm a cryer, unfortunately. It doesn't mean anything but the people around me think it's a sign that I don't know what I'm doing. And I still haven't found a good way to shut off the anxiety so that I don't cry in public.
 
I'm taking a klonopin and letting the 'functional one' take over. I sort of feel like I might have multiples in me because someone (not sure who really) always seems to pull it off. But I don't really think it's me because by the time I'm away from the situation....I'm wondering what I even said? But I must have pulled it off cause I haven't been fired yet!

Yes, memorize, go through the scenario in my head.....then just jump in and hope for the best.

When I get home I'll be tired, tired, tired.
 
Yeah, the adrenalin surge of just coping tends to drain me down to the bottom of the well too. Often I find that I just fall asleep with my clothes on once I get home.

Good luck today!
 
Thank you for this post QuietNow. It makes so much sense! I had always wondered why I had no problem doing what needs to be done in a time of crisis and yet being simply unable to decide what to have for dinner or what to wear etc. Take out night is a pain because hubby refuses to make a decision and I simply can't so I just float ideas and see if I get any response one way or another and try and go from there...

Rell
 
With authority figures, for me it depends on my mood. If I am in a pissy ass mood, then they do not bother me, I may actually challenge them...If I'm not in a pissy ass mood, then authority figures, really bother me....But for me, it really depends on my mood, on how I react to things......

I have a hard time with decisions on the small stuff in life, the bigger things I can use logic to try and come to a decision,(takes me awhile, but I finally make one) but the small things usually just throw me....
 
Hi Rell,
There's a book called _Blink_ by Malcolm Gladwell that is fascinating. It talks about the two sides of your decision-making functions of your brain. Malcolm paraphrases the literature out there to paint a picture that laypersons can read.

Basically, when real emergency (or a perceived real emergency) strikes, the brain shuts down a lot of cognitive sections so that it can just act. You begin working in "tunnel vision." The tunnel vision is similar to the perceptions that an autistic person would have. There's a good analysis of that infamous case where the police officers shot a suspect 40+ times when he reached for his wallet to produce ID. Once I read that analysis, my stomach turned and my sympathies suddenly shifted to the police officers rather than the poor doomed suspect. I think all of them were damned.

I'm terrific to have around in a true emergency. If the house is burning down or the car blows a tire or (in an extreme case) someone is shooting in my direction, I instinctively just act. I know what to do. It's like someone deep down has this master disaster recovery plan that I just have to follow step-by-step. And I've always gotten out.

However, if you need data for a presentation right this minute and the format must be fussed with, well, notsogood.
 
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