Stress-linked mental disorders, systemic inflammation, and Brainspotting

Stress-linked disorders, including anxiety and depression, are associated with systemic inflammation. Brainspotting can calm the adverse somatic activation loop.

Traumatic or emotionally charged experiences can get ‘stored’ in our nervous system, leading to emotional distress and physical symptoms. When physiological or emotional issues remain unprocessed, we can become stuck in a maladaptive biological and/or cognitive-emotional homeostasis. Brainspotting activates the trauma or stress-related emotions, and memories that persist in the deeper, subcortical brain in a way that permits spontaneous processing and resolution.

An insightful paper, Central regulation of stress-evoked peripheral immune responses, just published in the respected journal Nature Reviews Neuroscience (Volume 24 | October 2023 | 591–604) is an excellent introduction to how Brainspotting works within the functional medicine model to ameliorate the stress-driven biological dysfunction resulting from unprocessed trauma and other chronic stress. The authors note:

“Contemporary neuroscientists now have a growing understanding that psychological states can indeed impact physiological processes in the periphery such as metabolism, host defence and cardiovascular function . In turn, somatic states are sensed by the CNS to shape and guide behaviour . Underlying many of these processes are cells of the immune system, which have diverse inflammatory and regulatory roles and are embedded in all tissues throughout the body.”

They add specific detail to how the specific neuronal populations involved in the brain-to-body circuits regulate immune system responses.

“Here, we review the current literature to discuss how a negative affective state brought upon by psychological stress can control peripheral immunity. Specifically, we highlight stress-responsive brain regions that innervate immunologically relevant tissues, such as the bone marrow, spleen, gastrointestinal tract, adipose tissue and liver, largely through the autonomic nervous system and hypothalamic-pituitary–adrenal (HPA) axis.”

The immune cells distributed throughout the body respond in ways that contribute to the stress-relevant disorders such as anxiety and depression in a mutually interacting feedback loop:

“In addition, we address how immune cells in these tissues respond to stress and how these responses contribute to physiological and behavioural changes associated with stress-relevant psychiatric disorders such as anxiety and depressive disorders. These studies reveal a feedback loop between the nervous and immune systems that becomes hijacked during chronic stress to propagate psychiatric illness and inflammatory co-morbidities.

The link between chronic stress and inflammation

It’s become increasingly recognized that individuals with trauma or stress-related disorders show signs of chronic, non-resolving inflammation, the common denominator of most chronic diseases. This can show up in ways that include elevated pro-inflammatory cytokines, dysregulated myelopoiesis and lymphopoiesis (immune cell formation), and disruption of the body barrier systems including the gut epithelium and blood–brain barrier; and more.

“A pivotal study in 1987 reported that a subpopulation of people with viral hepatitis treated with interferon-α (IFNα; a pro-inflammatory anti-viral cytokine) developed depression, demonstrating that a pro-inflammatory molecule in the periphery could directly influence mood. Consistent with this finding, individuals with prior hospitalizations for infections or autoimmune diseases display greater odds of subsequently developing depression, with multiple infections having additive effects.”

“…animals that are exposed to chronic stress are predisposed to the development of inflammatory conditions such as experimental autoimmune encephalitis, colitis, atherosclerosis and diabetes. Thus, the experience of psychological stress — independent from any prior or concurrent immune challenge — exerts whole-body immunomodulatory activity, provoking inflammation and vulnerability to inflammatory diseas..”

Brain-to-body neurocircuits

The authors detail brain-body regulating loops including brain-to-bone marrow, brain-to-spleen, and brain-to-gut neurocircuits that have substantial effects on inflammation and mood. The first two directly influence the formation and type of white blood cells produced, while it’s hard to think of anything that brain-gut dysregulation doesn’t potentially affect.

“Our systematic review and meta-analysis suggests that phototherapy is a promising intervention, as it can improve cognitive function in older patients with dementia…further well-designed studies are needed to explore the most effective clinical implementation conditions, including device type, duration, frequency, and time.”

Breakdown of body barriers during stress

“Chronic stress or stress-relevant disorders, such as anxiety and depression, compromise the blood–brain barrier and gut epithelial barrier…inflammatory monocytes…and neutrophils…can enter the brain parenchyma through the damaged blood–brain barrier to directly influence neuronal excitability. In the intestine, stress increases IL-17 + T cell and mast cell accumulation…allowing lipopolysaccharide (LPS) to enter circulation from the gut lumen to activate pro-inflammatory signalling pathways.

Special role of the gut

It’s well-known that the gastrointestinal system with its bulk of immune tissue and the enteric nervous system (the “gut brain”) has a tremendous influence on other systems in the body and a big impact on the brain, including mood, and inflammation.

“With constant exposure to pathogenic and food-related antigens and as the home of many lymphoid follicles, the gastrointestinal tract represents another immunologically relevant tissue that is sensitive to stress. Substantial research has investigated the communication between the central and enteric nervous systems (also known as the gut–brain axis) and its impact on local and systemic inflammation…

Growing evidence suggests that chronic stress impairs healthy gastrointestinal function presenting as dysregulated intestinal motility, dysbiosis of the microbiota and initiation of low-grade inflammation.”

Clinicians and the informed public will recognize the vital role of the vagus nerve in regulating these systems.

The brain and immunometabolism

Insulin resistance, hyperglycemia, weight gain and aberrant appetite are all susceptible to the effects of stress and unprocessed trauma.

“Metabolic dysfunction is another common consequence of chronic stress in both humans and animals, with significant co-morbidity existing between MDD and metabolic syndrome . Moreover, metabolic inflammation — leukocyte infiltration and pro-inflammatory signalling in insulin-responsive tissues — promotes systemic hyperglycaemia…

Both chronic stress and metabolic syndrome have also been associated with hepatic steatosis and markers of liver inflammation such as macrophage infiltration and expression of stress-relevant brain regions…chronic psychosocial stress dampens orexin signalling in the brain, leading to hepatic inflammation, macrophage infiltration, hyperglycaemia, and depression-like and anxiety-like behaviour. From the LH [lateral nucleus of the hypothalamus], these effects may be exerted through parasympathetic neurons in the DMV [dorsal motor nucleus of the vagus] as LH orexin neurons project to the DMV and parasympathetic input from the vagus nerve dampen hepatic inflammation.”

Unresolved stress and immunosuppression

Chronic, unresolved stress due to trauma or other factors renders us more susceptible to opportunistic and chronic infections.

“While acute stressors or infections activate the HPA axis, which stimulates the immune system to facilitate the clearance of pathogens, chronic stress has immunosuppressive effects. This exemplifies how stress is a context-dependent adaptation that is necessary for the body to appropriately respond to threats but becomes maladaptive and pathological when left unresolved…It is hypothesized that chronic stress leads to persistent activation of the HPA axis, resulting in glucocorticoid resistance and subsequent over-production of pro-inflammatory cytokines and impairment in adaptive immune responses. Together, these maladaptations worsen the outcomes of infectious disease.”

“These studies demonstrate bi-directional communication between the brain and body, whereby chronic stress suppresses host defence against pathogens and these infections subsequently activate brain regions that promote anxiety-like or depression-like behaviour.”

Brainspotting and its profound value in Functional Medicine

Our bodies and brains are trying the best they can to keep functioning in the face of a multitude of adversities. Homeostasis is the biological drive to maintain a stable equilibrium. When physiological or emotional issues are unable to be fully resolved, we can become stuck in an adaptation that entrenches unresolved issues—a maladaptive biological and/or cognitive-emotional homeostasis. The intent in functional medicine is to migrate the system from this entrenched, maladaptive biology to a healthier one. It entails recognizing the strong bidirectional relationship between the emotional and physical systems in the body. Emotional distress can manifest as physical symptoms and physical symptoms can exacerbate emotional distress. This interplay can create a cycle of symptoms that is difficult to break without addressing unprocessed trauma.

Trauma can have profound and lasting effects on both the brain and the body, and caring for these mechanisms can be necessary for a comprehensive approach to patient care, especially in the bioconscious functional medicine model.

Biological effects of unprocessed trauma

1. Stress Response and the HPA Axis: Trauma can trigger the body's stress response, leading to the dysregulation of the Hypothalamic-Pituitary-Adrenal (HPA) axis and a chronic stress response. This results in the release of stress hormones like cortisol. Chronic activation of the HPA axis due to unresolved trauma can drive stress chemistry with widespread biological consequences including immune disorders, hormonal imbalances, muscle tension, pain, and gastrointestinal disturbances.

2. Dysregulation of the Autonomic Nervous System (ANS): Traumatic experiences can lead to a dysregulation of the autonomic nervous system (ANS), which controls all involuntary bodily functions such as heart rate, digestion, and breathing. When someone experiences trauma, the ANS can become overactive or underactive, leading to a range of physical symptoms.

3. Inflammatory Response: Unprocessed trauma can promote chronic inflammation in the body. The continuous activation of the stress response system can increase the production of pro-inflammatory cytokines. Prolonged inflammation is associated with various biological disorders, including cardiovascular disease, metabolic disorders like diabetes, and autoimmune conditions.

4. Altered Brain Structure and Function: Trauma can cause structural and functional changes in the brain, particularly in regions such as the amygdala, prefrontal cortex, hippocampus, and persistent subcortical activation. These changes can affect emotional regulation, memory processing, and the ability to cope with stress. Altered brain function can contribute to mental health disorders like depression, anxiety, and post-traumatic stress disorder (PTSD), which in turn can impact physical health through mechanisms such as sleep disturbances, appetite changes, and reduced physical activity.

5. Immune System Dysfunction: Trauma can impair the functioning of the immune system. Stress hormones like cortisol suppress innate and Th1 lymphocytes (white blood cells), making individuals more susceptible to infections, impair cancer surveillance, and promote autoimmunity and autoinflammatory disorders including chronic low-grade inflammation. It can also increase susceptibility to infections, allergies, and autoimmune diseases.

6. Somatization: What’s in the brain is in the body and vice versa. Unprocessed trauma can express as functional physical symptoms associated with a wide array of disorders and altered pain perception, often an unconscious process. These symptoms can include headaches, fatigue, and gastrointestinal issues.

7. Altered Pain Perception: Trauma can affect the perception of pain. Some individuals may have a heightened sensitivity to pain, while others may be less aware of pain. This altered pain perception can contribute to somatic symptoms and disorders.

8. Psychological Factors and Unhealthy Coping Mechanisms: Unprocessed trauma can lead to persistent psychological distress which can indirectly affect physical health by disrupting sleep patterns, appetite, and overall well-being. We may turn to unhealthy coping mechanisms, such as substance abuse or overeating, to deal with emotional distress. These behaviors can contribute to the development of biological disorders.

9. Epigenetic Changes: Emerging research suggests that trauma can alter gene expression patterns. These changes may even increase the risk of various health conditions being passed down to future generations since epigenetic modifications can be hereditary.

In summary, trauma that has not been fully processed can have deep effects on the body's biological systems. Chronic activation of the stress response, alterations in brain structure and function, immune system dysfunction, epigenetic modifications, and unhealthy coping strategies can all contribute to the development or exacerbation of biological disorders. In the functional medicine model, it's necessary to consider the impact of unresolved trauma when diagnosing and treating patients for comprehensive and effective care.

Brainspotting to resolve unprocessed trauma

Brainspotting is a therapeutic approach developed by Dr. David Grand in 2003 and has grown in resources and effectiveness since then. It has gained popularity in the field of trauma therapy and has been found effective for various psychological and brain-body connection issues.

How Does Brainspotting Work?

1. The Brain-Body Connection: Brainspotting is based on the understanding that our brains and bodies are interconnected, and that our eye positions can help access and process unprocessed trauma, emotions, and memories in the brain. Traumatic or emotionally charged experiences can get stored in our nervous system, leading to emotional distress and physical symptoms. The central concept is that there are "brainspots" in our field of vision which are connected to specific emotional or physiological experiences. These spots are activated when we focus our gaze on them.

2. The Visual System: Brainspotting recognizes the relationship between our visual system and our brain's processing of emotions and memories. The human brain has a vast network of connections between the visual cortex (responsible for processing visual information) and the limbic and subcortical systems (involved in regulating emotions, memory, and their somatic manifestations). It draws on the concept that specific eye positions can activate different neural networks and access deep emotional and traumatic material.

3. Identification of Brainspots: In a Brainspotting session, the practitioner helps you identify what are known as "brainspots." These are specific points in your visual field that are associated with your emotional or traumatic experiences, corresponding to a specific issue, trauma, or emotion. These spots are linked to the activation of subcortical neural networks related to those experiences.

4. Focused Attention: The practitioner guides you in maintaining focused attention on the brainspot while simultaneously being aware of your bodily sensations, thoughts, and emotions. This sustained focus allows for deep processing of the stored trauma or emotional distress.

5. Dual Attunement: One of the unique aspects of Brainspotting is the concept of "dual attunement." This means that both you and the practitioner are attuned to your inner experiences during the session. The practitioner observes your non-verbal cues and helps you navigate your emotions without requiring you to verbally describe them (you are free to remain silent or express whatever you wish).

6. Processing and Integration: As you maintain your focus on the brainspot, your brain is activated to process and integrate the traumatic or distressing memories, emotions, and sensations. This can lead to the release of stored tension, new insights, and a reduction in emotional distress. Brainspotting aims to promote the integration of these experiences into your psyche, fostering healing and growth.

The exact neurological mechanisms at play are still the subject of ongoing research. The field of neuropsychology is continually advancing, and our understanding of how therapies like Brainspotting affect the brain may become clearer with further research and exploration. See Brainspotting: Recruiting the midbrain for accessing and healing sensorimotor memories of traumatic activation and Brainspotting: Sustained attention, spinothalamic tracts, thalamocortical processing, and the healing of adaptive orientation truncated by traumatic experience.

Benefits of Brainspotting

1. Effective for Trauma: Brainspotting has been particularly effective in treating trauma-related issues, such as post-traumatic stress disorder (PTSD), without requiring detailed verbal recounting of traumatic events.

2. Neuroplasticity: change from Brainspotting is based on the concept of neuroplasticity, which is the brain's ability to reorganize and form new neural connections throughout a person's life. The therapeutic process is believed to tap into this capacity for change by helping the brain reprocess and reframe traumatic or emotionally charged experiences through the identified brainspot, by which the brain may gradually reorganize itself, leading to symptom relief and emotional healing.

3. Deep Emotional Processing: Brainspotting can access and process emotions and memories that may be difficult to reach through traditional talk therapy because unprocessed trauma is ‘stored’ at the subcortical level, deeper than the verbal cerebral level. It allows for a deeper activation of subconscious material and allows access to early, preverbal phenomena. It taps into the brain's natural healing mechanisms.

4. Reduction in Symptoms: Many patients report a significant reduction in symptoms like anxiety, depression, and PTSD after Brainspotting sessions.

5. Reduced Re-traumatization: Because it doesn't require you to verbalize traumatic experiences, it can be less re-traumatizing compared to some other therapies.

6. Faster Results: Some individuals have reported quicker and more lasting results with Brainspotting than with traditional talk therapy, which may take longer to uncover and address underlying issues.

7. Individualized Approach: Brainspotting is highly individualized, adapting to your unique experiences and needs. The practitioner maintains a discipline of refraining from imposing interpretations or analyses.

How Brainspotting can be adjunctive to or preferable to verbal therapy

While verbal therapy, such as cognitive-behavioral therapy (CBT) or psychoanalysis, is valuable and effective for many people, Brainspotting can be superior in certain situations:

1. Limited Access to Subcortical Regions: While talk therapy can provide valuable insight and cognitive restructuring, it may have limited direct access to the subcortical regions where traumatic memories are often stored. Processing preverbal trauma through talk therapy may rely on the individual's ability to create a verbal narrative from nonverbal experiences.

2. Less Verbal Pressure: Some individuals struggle to express their emotions or find talking about their problems difficult, Brainspotting offers an alternative, non-verbal way to access and address these issues.

3. Physical Manifestations: When emotional issues manifest primarily as physical symptoms or sensations, Brainspotting can be particularly effective in addressing both the emotional and physical components simultaneously without relying on verbal communication.

4. Faster Progress: The focused approach of Brainspotting can lead to faster therapeutic progress, especially for trauma-related issues. 

5. Less Emotional Labor: For those who find it emotionally taxing to repeatedly discuss traumatic experiences in verbal therapy, Brainspotting can offer relief.

6. Unique Experience: Brainspotting offers a unique therapeutic experience that can complement traditional talk therapy or stand alone as a powerful approach when indicated.

It's essential to note that the effectiveness of Brainspotting, like any therapy, depends on the individual and their specific needs. In many cases, a combination of Brainspotting and traditional talk therapy can be desirable. The two approaches can complement each other; Brainspotting can help individuals access and process subcortical trauma, while talk therapy can provide cognitive understanding and support for integrating these experiences into one's overall narrative.

For a brief and highly digestible video introduction to Brainspotting see Brainspotting Therapy - Developed by David Grand (PhD) - A sketch animation by Dr Mark Grixti.

Brainspotting and Primal World Beliefs

Primal world beliefs, or “primals” for short, are extremely basic beliefs about the world as a whole, such as the belief that the world is dangerous. Our primal world beliefs impact us constantly and influence health, depression, success, optimism, well-being, extroversion…most life outcomes people care about. Maladaptive primal beliefs could be a consequence of trauma, but primals may be installed when there is no remembered or suspected acute trauma, elicited by experiences that are never identified. It is particularly significant to note that primals are very durable—research has shown that they tend not to be changed by dramatically negative or positive experiences.

All primal world beliefs are:

• Stable: Primals can change but in practice they are as stable across time as personality traits like extraversion. This means many people likely spend decades holding the same world beliefs.

• Hidden: Primals are not that related to demographic factors. For example, people who are rich do not see the world as more abundant than people who are poor. Men don’t see the world as safer than women. This means you can’t tell someone’s primals by looking at them.

• Correlated: Primals are correlated to how we live our lives and our mental health. For example, Safe world belief is very strongly correlated to trust and less depression. Enticing is very strongly correlated to curiosity, gratitude, and happiness. Alive is strongly correlated to spirituality and having purpose in life. This means that, across a wide range of behaviors, humans act rationally given their primals.

Primal world beliefs do not presuppose a history of traumatic events, but maladaptive primals may have negative health consequences comparable to the chronic stress of unresolved trauma and may likewise be accessible to remediation by Brainspotting.