First, get your bearings…
A patient of ours who was involved in a car accident suffered from symptoms of PTSD as a result. PTSD is basically a disorder marked by brain and hormonal hyperarousal in response to triggers one faces. This gentleman would get very anxious when driving and would make bad decisions rooted in fear of the worst – even if very improbable – possible outcome when driving. He had taken to yelling, cursing a lot and panicking, and he felt like he had no control over it. The sight of ambulances, police and firetrucks reminded him of his injury. Cars near him, especially BMWs, would make him very upset. Now, there are many treatment options for PTSD but we will show you how quickly results can be had by shedding more light on the mechanism of this patient’s PTSD and it’s consequences.
Clinically, the patient’s history and physical exams showed significant deficits in attention, the ability to shift attention and difficulty with being immersed in an environment that provided a lot of information for processing (sounds, traffic, pedestrians, traffic lights, sounds, lanes, street signs, etc.). He also had severe challenges with balance. He commented that he had gotten lost a few times even in areas with which he had been familiar for years. On further questioning he had difficulty orienting himself to a map. Cognitive testing corroborated this by showing deficits in visual attention, visual and spatial reasoning, spatial memory and visual memory among other things.
Now, the patient was asked if perhaps his anxiety was trying to tell him something?
Up until now, he had felt like a victim and that his body had betrayed him and was punishing him with anxiety. But upon revealing that he likely suffered from right parietal lobe dysfunction, his general symptoms made more sense to him. Then upon revealing that people with parietal lobe problems may have more car accidents because they are not able to pay attention to both sides of the visual field as efficiently (Demos, John N. Getting Started with EEG Neurofeedback. W.W. Norton & Company; 2nd Edition (2019)), his anxiety made immediate sense.
It became clear that his nervous system was telling him to be more cautious because he is driving ‘short-handed’. Rather than worrying about worrying, and when it will strike, and that the worst possible thing would happen – well, because he felt anxious so something bad was sure to happen (also known as emotional reasoning, a maladaptive [incorrect] cognition) – he could now accept the worry as a sign that his nervous system was doing its job; kind of like a crash-detection feature in a car, and that he should listen to it without getting upset; just as when you are backing up and your car starts beeping, you don’t get upset, you just push on the brakes.
He was then able to focus on parietal lobe rehabilitation with more purpose as he could not ‘connect the dots’. Nothing eliminates fear of the unknown as knowledge, literally, the involving the frontal lobe of the brain (knowledge and reasoning) can inhibit the seat of emotion (the limbic system) from running a muck. Think about when you thought you saw a snake late at night and panicked (fear) and then when you saw it in a better light, it turned out just to be a rope (knowledge), and your hyper-aroused system was then able to immediately settle down. This form of rehabilitation employed many vestibular therapy drills, cognitive rehabilitation and combining the two together. It also consisted of learning to regulate his fight-or-flight system with heart rate variability training and cognitive behavioural therapy to better understand (and change) the connection between some of his newly formed, maladaptive thoughts and correlated dysfunctional emotions and behaviours.
Written by: Dr. Taher Chugh
Last update: August 2019