[BLANK_AUDIO]. Hey, okay so one of the really cool things about being right here at the end of the course is that you now know so much that we can take a lot of this information you know, and, you know, try to really make it make sense by applying it in some highly relevant situation. So that's really what I hope to do with this, our second-last lecture? I want to talk about a, Post-traumatic stress disorder, a very serious issue that a lot of people face. And then I'm going to highlight a recent new approach to it. I think in doing so we'll bring together some issues of therapy, some issues of effects of drugs, Conditioning and all sorts of other things. And you'll see how some of these things can all come together in what we hope will be a very helpful way. For people who are suffering from a very debilitating. I guess you could call it a mental illness. But it's not really a mental illness. Or is it? Let's explore that one, as well. Alright, so, Week 8, Lecture 7: Post-Traumatic Stress Disorder. Let's talk about PTSD. Now, there's all sorts of situations that could give rise to it. Unfortunately, the two that are probably most common are post-traumatic stress disorder that's related to serving in the military in some fashion, and that related to rape. You know, specifically, being raped. if we think about the military situation for just a moment, what we typically have in, in this situation is, is people who are in literally horrific situations where you know life and death happens everyday including the death part and including the unfair death part. You know sometimes Very young children, innocent bystanders are caught in the middle of a wartime situation. Sometimes you know, it's not innocent bystanders. Sometimes it's comrades. It's, it's a good buddy of yours that you've been serving with that gets killed in some situation. and, obviously the classic sort of. Scdnario is that the person is there somehow they're seeing terrible things they're hearing terrible things, and they survive that situation but afterwards when they, when they, atempt to go back to normal living something's happened, specifically. There's a whole area of research on what's called emotion and memory. And very often when something is a very emotional event, you know, think, think 9/11 or something like that. Most of you can probably still tell a story about where you were when the planes hit the Twin Towers and what you were doing. So that was a highly emotional event. And if we think about that for a minute, moment, it was, you know, for all of us, to some extent, there was this hint of a feeling like, our life may have just changed, and we could be in personal danger. and, and that seems enough to give us all what we call this flashbulb memory of the original event. Well, imagine, you know, literally Being in the middle of a wartime situation, where you could be killed any second. or, you know, being beat up and raped and not sure if your assailant is going to kill you. In these situations, emotions are running very high. There's a lot of hormones running through the system, and the amygdala seems to work over time in these situations, the, the current theory is that, you know, when there's a highly emotional event especially one that, that is infused with danger and risk and threat that the amygdala encodes a lot more details than it normally would, Apparently with the notion of, and even encodes the details that happen just prior to the event. Which is very important to post traumatic stress disorder. It does know what the amygdala is trying to do, is to, really learn the sequence of events that led to this high risk situation. Perhaps in hopes of averting it in the future. So let's say somebody who is a victim of rape had been followed a little bit, and then pulled into an alleyway. The amygdala seems to encode all of those sounds and feelings and impressions of being followed as well. It doesn't start when the real threat starts. It encodes stuff that happened before that thread, as well. and now, where the victim is left, afterwards. Is with A, a very vivid memory of the event. And most critically, not just you know, an, a replaying of the event itself. But also a triggering of all the emotions that are associated with the event. It's like that memory trace that's formed is extremely rich and extremely emotionally rich, and so now let's imagine the soldier that comes back from the war but perhaps, you know, just before this horrific event, let's take this soldier. so, a little boy, it looks like, got caught up in the middle of something, and got killed. Let's say, just before this event, this soldier was walking down the road, and saw this little boy playing with a ball, maybe bouncing a ball in a typical basketball kind of fashion. And then, all hell breaks loose. And he ultimately sees this child being gunned down, let's say. And so that's forever burned into his memory. Let's say he wanted to help, he wanted to get in there and do something, but he couldn't, not in time. And so he's got all those feelings of guilt and what could I have done differently and yadda, yadda, yadda. And now, maybe a year later, two years later, maybe he's in Cleveland. He's out of the war-time situation, but he can be walking down the road and the sight of a little boy bouncing a basketball or even that sound of the basketball can be enough to trigger all of that. And suddenly he's reliving this horrific event all over again. And not just again seeing the sights but feeling those emotions feeling that same desperation feeling that panic feeling that desire to do something feeling that horror. that came with not being able to do anything. That's post traumatic stress disorder. And you know, for the rape victim it could very well be every time they walk down the street and now hear footsteps behind them. You know, that could be enough to trigger again that whole feeling, you know, everything that went with being Attacked and being raped, and the threat of potentially being killed and you know and being beat up, all of that. You know the simple sound of a footstep can trigger all of that. so you know given how much war goes on, unfortunately, PTSD is extremely common. Now, I, I bought that, calling it a mental disorder or a mental disease because, you know, it's really something created in a sense by the memory system. It's a memory system that, that's working well and trying to protect you from danger in the future. it, so it's a very normal function of the brain. It's just one that can be debilitating. and so in that sense it's a, it's a mental disease in the sense that it's you know, contributing to a lack of mental health. but, the way it's, it's created is a little differently a little different in that respect. Okay. So, what can we do for something like this? You know, we all feel terrible these things happen. I mean, I can say for every, for every self-respecting male, the notion that, that a male would, would rape a woman, or, or rape anybody, for that matter, I mean, boys are, are, boys and men are raped as well. It's just horrific, and, and it's just unacceptable and you know if it were possible for One man to apologize for all men. I absolutely I, I, I'm painfully aware that when I give talks like this to any large group I'm talking to a lot of, of rape victims. and, and in some cases I'm talking to military members and this case I probably am as well. There, there could be many of you out there That, that know all too well what I'm talking about. And, you know, that, that's a drag that's not, that's just not fair at all. so what I'm going to do from here, though, is talk about a new, a really new therapy that's starting, I don't even want to call it a therapy, but it's an approach that's starting to be developed That has the potential for hope, for helping these people who suffer from PTSD. So let's get into that. It's going to involve beta blockers. So I, I, I like this example because it does use drugs but it uses them in a very different way. The drug is not the cure its the path to the cure. and so. Let's get there. What are beta-blockers? Well, first of all, we have these so-called beta receptors all through our nervous system. And they're very much tied to the sympathetic nervous system. So the sympathetic nervous system, again, is that one that, you know, gets engaged, that's what I call the light switch, that's what turns you into this fight-or-flight mode you know and really gets all your, your anxieties up, your et cetera, ready to, ready to go. and it also this system also mediates responses to adrenaline. And adrenaline, Surfaces in every emotional situation. So there are these drugs called beta-blockers. They block the beta receptors. There's a lot of these actually on the heart itself, and its a lot of the sympathetic nervous system activity begins with the heart, begins with the heart beating a lot faster Pumping blood all the way through your system, etc. But, if you're on a beta blocker, that does not happen. The sympathetic nervous system does not kick in. in fact your heart rate tends to be decreased on beta blockers. your force of your contractions is lower, your blood pressure's lower. Essentially you're relaxed in a sense. Beta blockers chill you out. But they don't just chill you out. They chill you out in the face of anxiety producing situations, so, you know, just as one other example of beta blockers some of my students, there's on in particular, but I won't mention his name. But he was very anxious about public presentations, public, you know, speaking in public. But if you want to be a scientist, you have to do that and if you want to be a professor, especially, you have to do that. So he had to find a way to get over this, but he would find is, he would get in front of people, start speaking, and he would feel his sympathetic nervous system kick in. He would feel his heart beating, he would feel the sweat, he would feel the anxiety, and that would make him nervous. Just the fact that he was starting to feel nervous would make him nervous. And it would create this spiral of, of anxiety. what, he went to a doctor to talk about it, and the doctor prescribed beta blockers. And he said, just before you give a big talk take one of these. And the result is, you get up in front of people and that sympathetic response never begins, you don't feel the anxiety. And it allowed him, absolutely, to get through his first few presentations, and clinically, once he gotten through a few, once he had kind of put himself in that situtation in a way where the emotion didn't happen, the anxious emotion. He started to be able to do this without the beta blockers. Okay, he was able to just get up in front of people and give presentations because he had done it successfully before. And nothing horrific had happened before, and that's kind of like what the brain has to learn at some point. Is I can be in this situation, I can do what I have to do, and everythings going to be alright. and as the brain starts to do that, then it stops kicking in the sympathetic nervous system activity, okay. So people have been using beta blockers, usually it's used for heart patients to keep their heart rate low heart attack patients and such. But its started to be used as an anxiety treatment for things like a, a, that I told you about. And most interestingly, and perhaps the most potential, is it's potential use for post traumatic stress disorder. So, I hear about this experiment, or these experiments now because they're starting to propagate, are sometimes billed as A way to erase bad memories. If any of you guys saw" Eternal Sunshine on the Spotless Mind", I think that's what it's called, a Jim Carrey movie. The notion being that a couple were together, they break up in some nasty way but the woman decides to this special doctor who can now erase all memories of her ex-boyfriend. So she's going to go through this treatment that's going to make all of the, every memory of him disappear. Like she'd never met him, which he gets quite offended by, and decides he's going to do the same thing, and then the movie gets really weird. it's Jim Carrey. [LAUGH] But, the idea there that you could potentially erase unwanted memories, this is sometimes billed as that. But it's not really that. That's what I want to be clear about. Well, let me tell you about the experiment. So, we, you see somebody with little things on their fingers. These experiments, the ones I know of, were initially performed in Holland, which is important because they involved the use of electric shock. most places do not allow psychology researchers to use electric shock anymore. Holland, as you may know, tends to be a little more liberal. so they're kind of cool with it. That's alright. So if you have good reason, you can use it. and so, imagine that a person was wired up, a, so that they could receive electric shocks. But also, what this really is here is something that measures what's called the galvanic. Skin response. It's a very sensitive indicator of sympathetic nervous system activity. What it really is doing is measuring by sending little tiny currents through your, your, finger. It measures the electrical conductivity of your skin. the galvanic skin. Remember Lu-, Luigi Galvani with his electric frog leg? Galvanic skin response. So the more wet, the more sweaty. Your skin is, the better it conducts electricity. So by measuring the conduction of electricity, we can know how sweaty your fingertip is, and it turns out this is very sensitive. And of course when the sympathetic nervous system kicks in you begin to sweat a little. So you can literally measure the sympathetic nervous system kicking in. Alright, so now this experiment had 3 parts. Let's do the first part. First part, people were hooked up to a GSR and also to an electric shock apparatus and they were shown pictures. a lot of the pictures were benign things, tables. Clouds, cars, guitars, I don't know, whatever you want to imagine but intermixed among those pictures were pictures of spiders, and every time a picture of a spider was shown the person got an electric shock zzzzz. Okay, so they would go through this experiment Okay, guitar. Okay, class. Okay whatever, table. Spider [SOUND] spider [LAUGH]. So they went through and they got zapped every time a spider picture was shown. Nasty. But that's the, what we call the conditioning phase. Right? We're conditioning an emotional responses and sure enough, people were sweating when they saw spider pictures. That's phase one. So we train people up. Now this isn't post-traumatic stress disorder. Right? This is not on the level of, of being raped or, or seeing something horrific in battle. Let's, let's be clear about that. but we are in a laboratory kind of way building up an anxiety related to a specific stimulus. All right, so we do that. Phase 1. Now, phase 2 is the critical phase. So phase 2, well no, actually, phase 3 is probably the critical phase but phase 2, here's what we do. We, we take our participants, we split them in two groups. One group, we're going to give beta blockers. Another group, we're going to give placebo. And we're not going to tell them, obviously, we're going to do the full double blind thing, if we can. so that nobody knows what they've been given. they're shown pictures again. This time, we're not going to shock them. We're just going to measure their gal, galvanic skin response. So we show them pictures again. now, for the group that has the placebo, what you see is for the beni-, for the neutral pictures, they're just fine. But when you show them a spider, even though you're not shocking them anymore, you show them a spider, and you see the emotional response. You see the sympathetic nervous system kick in. Okay. Now, for the beta blocker group, same procedure, but you don't see the sympathetic nervous system kick in, which of course, you shouldn't, because that's what the beta blocker prevents. Right? So, for these group, they are able to see the spider pictures with the other ones, but the beta blocker is preventing that anxiety based response. Okay, cool. We go through that, a number of times. Letting them see a bunch of different pictures including lots of different spiders. And now in a third phase, we repeat the second phase but we don't give anybody beta blockers. Okay, so people are just seeing pictures .Now for the group that never had the beta blockers, they've only ever had placebos, they are still showing a very strong galvanic skin response when the spiders are shown. They, it hasn't gone away, it's still there. But for the ones that had the beta blockers, in step two. Now in step 3 they no longer have the beta blockers. But when the spider pictures are shown, their galvanic skin response is much lower. It's not the same as neutral, but much lower from where it was. What's going on? Well the claim is. And lemme just do it here. The claim is. What was going on? What we built in that first phase was a link, between a memory, spider pictures, and an emotional response, the amygdala. What the beta-blockers did is came and severed this link, 'kay? The beta-blockers allowed people to experience the stimulus without The emotional response. And it seems if you allow them to do that enough, something really important happens. They, they seem to almost like my student whose able to public speak, they seem to realize I can experience that memory, I don't have the strong emotional response. And it almost allows a sort of distance to come, where they can Be much more analytic about the memory, where they can look at it, think about it, and without the sympathetic nervous system getting them anxious, they can kind of analyze the situation a little bit more. now, I don't know if that's true with the spider. I've already kind of gone the extension, because what they're starting to do now is use this therapeutically. They're literally, having, say, rape victims, or military victims, and Saying, we're going to having a therapy session where we talk about the situation you went through. Now of course, that's normally what happens in therapy. But if you do that without beta blockers, the moment you start talking about it the person's going to feel all that emotion. But if you give them the beta blockers, now They can talk about it in a much more sort of clinical way, so you know, let's imagine a rape victim. A rape victim can actually recount the event that happened, but they're not feeling the fear, they're not feeling the anxiety, almost like they're able to step back and see the it, see the wrongness of it, see the unfairness of it, the un-justness of it. but do that kind of divorced from the emotionality of it. And early results seem to suggest that if you do that a few times. If you're able to go through the experience and experience any of the stimuli. So, what triggers this in your real life. So, you expose people to those triggering stimuli. but under beta blockers. and f you do that enough now even when they're no longer on beta blockers they can somehow retain that benefit. and so they can now experience those stimuli without the emotional response. Very new, very young therapy. The reason I wanted to highlight it for you is you know, notice how it's really, it's not Freudian, at all. its much more neuroscientific and I think thats where theraputic, approaches may go at least some. And there may be these new theories that really are not about pschological trauma or anything like that theyre about the process that caused this situation and is it possible to somehow to undo it. And if the situation caused by conditioning or something like that. Then maybe it is possible to uncondition. and, and so there is a lot of hope for these sorts of very scientific-based therapeutic approaches. And I think this is a great example. And if any of you are suffering from PTSD, I would look into this. and I would make any therapists you know aware of this. Because beta blockers are not. Dangerous drugs. They're pretty benign, by enlarge. The only problem that you can have with a beta blocker, is if you try to jog, or something like that, you're muscles will seize up because your heart will not speed up and pump them more oxygen. So at some point, you'll just cramp right up. [NOISE] That's about as bad as it gets. I think. Alright, so, more stuff. This first one is a documentary on PTSD. Watch it to really understand why this is such a crippling disorder. And it really is. This is a little discussion on beta-blockers in general. And then then this is this whole erasing memories theme, so you'll see a newscast with an over-bubbly woman talking to you about memories and maybe it's now possible, yeah. I put that on to give you the sense of the hype Because sometimes there's some really cool psychological results that are hyped in a weird way in the public media, and so I just wanted you to kind of see that now that you're a little savvy to the reality. and now, here's some more, two more specific stories dedicated specifically to this PTSD and beta blockers link that you can check out. All right? So that's what I have for lecture seven, next lecture will be da dum the final lecture. I will see you there have a good day bye, bye.