September 23, 2024 • 2hr 26min

Dr. Victor Carrión: How to Heal From Post-Traumatic Stress Disorder (PTSD)

Huberman Lab

In this episode, Dr. Andrew Huberman interviews Dr. Victor Carrión, Professor and Vice Chair of Psychiatry and Behavioral Sciences at Stanford University School of Medicine. Dr. Carrión is a world-renowned expert on post-traumatic stress disorder (PTSD), particularly in children and adolescents. The discussion covers the psychological and neurobiological underpinnings of PTSD, effective treatments, and ongoing research into stress resilience.

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Key Takeaways

Post-traumatic stress disorder (PTSD) is part of a spectrum of stress responses ranging from beneficial to traumatic. Stress operates on an inverted U-shaped curve - some stress improves performance, but too much becomes harmful.
Children are more vulnerable to developing PTSD than adults due to their developing brains, but they also have more neuroplasticity which allows for better recovery with proper treatment.
PTSD symptoms in children are often misdiagnosed as ADHD. Hypervigilance can be mistaken for hyperactivity, and dissociation for inattentiveness.
Elevated evening cortisol levels are associated with PTSD symptoms in children, which can disrupt sleep and brain development.
Cue-centered therapy (CCT) is an effective treatment for childhood PTSD that focuses on identifying triggers, building coping tools, and empowering children.
A yoga and mindfulness curriculum implemented in schools showed significant benefits, including a 73-minute increase in sleep duration on average.
Resilience is not an innate trait in children but can be developed through learning coping skills and having supportive relationships.
Ongoing research using brain organoids and epigenetics aims to uncover the biological basis of resilience and stress vulnerability.

Introduction

In this episode, Dr. Andrew Huberman interviews Dr. Victor Carrión, Professor and Vice Chair of Psychiatry and Behavioral Sciences at Stanford University School of Medicine. Dr. Carrión is a world-renowned expert on post-traumatic stress disorder (PTSD), particularly in children and adolescents. The discussion covers the psychological and neurobiological underpinnings of PTSD, effective treatments, and ongoing research into stress resilience.

Topics Discussed

Understanding Stress and PTSD (6:19)

Dr. Carrión explains that stress exists on a spectrum from beneficial to traumatic. Some stress is necessary for optimal performance and development of coping skills. However, when stress exceeds our ability to cope, it can lead to allostasis - a physiological cost to the body.

PTSD develops when a person experiences traumatic stress that threatens their physical integrity. Dr. Carrión emphasizes that PTSD often results from an accumulation of stressors rather than a single traumatic event.

PTSD feeds on avoidance - pretending trauma didn't happen or that treatment isn't necessary can lead to complications like substance abuse
Children are more vulnerable to developing PTSD than adults due to their developing brains
However, children's neuroplasticity also allows for better recovery with proper treatment

PTSD vs ADHD in Children (33:19)

Dr. Carrión discusses how PTSD symptoms in children are often misdiagnosed as ADHD:

Hypervigilance can be mistaken for hyperactivity
Dissociation can be mistaken for inattentiveness
In genuine ADHD, hyperactivity tends to be persistent across environments
In PTSD, hyperarousal and hypervigilance are triggered by specific cues

He emphasizes the importance of correctly identifying PTSD in children to provide appropriate treatment, as stimulant medications for ADHD can exacerbate PTSD symptoms.

Cortisol and Brain Development in PTSD (27:17)

Dr. Carrión's research has shown that children with PTSD symptoms have elevated cortisol levels in the evening, which can disrupt sleep and brain development:

Higher evening cortisol correlated with smaller hippocampal volume over time
Functional brain imaging showed reduced activation in the hippocampus and prefrontal cortex during memory and executive function tasks
These brain changes can affect memory, emotional regulation, and attention

Cue-Centered Therapy for PTSD (53:11)

Dr. Carrión developed Cue-Centered Therapy (CCT) to address the unique needs of children with PTSD:

Focuses on identifying triggers (cues) that lead to PTSD symptoms
Teaches children about classical conditioning and how trauma affects the brain
Empowers children to develop their own coping tools
Can be done without parental involvement if necessary
Shown to decrease symptoms of anxiety, depression, and PTSD

The Four-Corner Square Response (1:26:32)

Dr. Carrión describes a technique used in CCT to help children understand and manage their responses to triggers:

A square with four corners: thoughts, emotions, physical sensations, and actions
Children identify what's happening in each corner when triggered
Changing one corner can lead to changes in the others, creating new response patterns
This technique helps children develop cognitive flexibility and multiple coping strategies

Yoga and Mindfulness in Schools (1:46:07)

Dr. Carrión discusses a study implementing a yoga and mindfulness curriculum in schools:

Partnered with Pure Power to develop the curriculum
Taught to teachers who then instructed students 2-3 times per week for 15-50 minutes
Results showed:
- Increased sleep duration by an average of 73 minutes
- Improved depth of sleep
- Decreased amygdala activity (preliminary data)
Highlights the potential for school-based interventions to improve mental health and resilience

Biology of Resilience Research (2:10:33)

Dr. Carrión describes ongoing research to understand the biological basis of resilience:

Using brain organoids to study the effects of cortisol on neural development
Identified novel genes related to collagen formation, potentially linked to accelerated aging in PTSD
Conducting epigenetic analysis of children in Puerto Rico undergoing yoga/mindfulness and CCT interventions
Aims to identify genetic factors associated with resilience and treatment response

Redefining Success and Building Resilience (2:06:08)

Dr. Carrión emphasizes the need to redefine success beyond extreme achievements:

Current definitions of success can harm individuals who don't reach exceptional levels
Importance of belonging to multiple facets of life (sports, community, family, etc.)
Resilience involves not just bouncing back, but adapting to be in a better place
Key factors in resilience: sense of humor, perseverance, supportive relationships

Conclusion

Dr. Carrión's work highlights the importance of understanding and treating PTSD in children, as well as implementing preventive measures to build resilience. His research bridges multiple levels of analysis, from molecular genetics to school-based interventions, offering a comprehensive approach to addressing trauma and stress-related disorders.

The development of targeted therapies like Cue-Centered Therapy and the implementation of yoga and mindfulness programs in schools show promising results in helping children cope with stress and trauma. Ongoing research into the biological basis of resilience may lead to more personalized and effective treatments in the future.

Dr. Carrión emphasizes the importance of listening to children and adults about their experiences with trauma and stress, creating supportive environments, and empowering individuals to identify their own strengths and capabilities for healing and growth.