Living in Sandy Hook, practicing medicine in Sandy Hook, my life – and the lives of all of us here – continue to be influenced by the 12/14/12 mass shooting. The day it happened, despite not losing a child in the tragedy, I was gutted, locked in grief. I also remember thinking that it couldn’t be undone. It was in my psyche – this intimate knowing of such violence – it was there, etched into the fabric of my existence. Since Sandy Hook (and before) there have been other mass shootings, of course. Here, and around the globe. Beyond shootings, trauma is happening in many forms, all of the time: the pandemic, war, racial injustice and so on. These are the traumas that make news, but in truth, trauma comes in many guises including losing a loved one, experiencing abuse or neglect, or having a chronic or terminal illness.
The trauma experience can be harmful – it can accelerate aging and promote chronic diseases of aging, like heart disease and cancer. It also promotes other conditions, like functional digestive disorders and dysautonomia. And of course, trauma precipitates the various forms of recognized PTSD. Women are more likely to experience post-traumatic stress disorder (PTSD) than men, and US Latinos, African Americans and Native Americans also have higher rates of PTSD than whites.
How do we get to the other side of trauma?
And how do we limit negative “biological embedding” of these experiences (i.e. the epigenetic marking of our DNA for deep memory of them in such a way that we’re more likely to experience a PTSD response, and later illness, as well as transmit trauma biochemistry to our offspring)? This is an aspect of PTSD prevention that particularly interests me and that I’ll circle back to below.
Humans have an amazing capacity for resilience – turns out, most of us will get to the other side of trauma relatively unscathed. Statistics show that more than 50% of us will experience a potentially traumatic event (PTE), but only about 6% of us will go on to develop PTSD around it. So, what is it that predisposes us to trauma resilience or even post-traumatic growth (PTG) – the positive life shifts that can occur after trauma, like a sense of personal growth or a devotion to being helpful to others?
Could we protect more people from the negative effects of traumatic events? I think so.
What is Post-Traumatic Growth?
Although research on PTG is paltry compared with PTSD (and illustrates the pathogenic research bias in trauma literature), some pioneering scientists have started to frame the concept and investigate it. Drs. Richard Tedeschi and Lawrence Calhoun of the Department of Psychological Science at the University of North Carolina, Charlotte, foremost thinkers in this field, have defined PTG as “the positive psychological change that is experienced as a result of the struggle with highly challenging life circumstances.” Of course, none of us would choose the potential horrors of trauma, and the shattering of the foundational structures on which we build our lives (and research still shows more benefit from positive life experience than negative ones). However, these are some of the potential growth areas that can be derived from such adversity:
- A greater appreciation for life
- A strengthening of close relationships
- Greater compassion and altruism
- Finding a purpose in life, or positive adjustment of goals
- Increased awareness of personal strengths
- Spiritual development
- Creative/artistic growth
Psychological, spiritual, and social priming for PTG
Several psychological characteristics have been associated with an increased likelihood of turning an adverse experience into a growth-fostering one:
- Openness to cognitive exploration
- A willingness to face uncomfortable emotions and thoughts head on (i.e. avoiding avoidance)
- Having an “opportunity for growth” mentality
- Positive rumination and deliberation that leads to more organized and rational thinking
A reasonable way to seek to improve the chances of achieving PTG rather than PTSD is to nurture these characteristics. The Functional Medicine toolbox has several modalities that fit here – like mindfulness, meditation, and gratitude journaling. Creative therapies such as art therapy or creative writing on a topic of deep emotion have also been shown to help improve emotional awareness and expression, and make sense of stressful experiences.
According to Dr. Tedeschi, one way clinicians can help individuals be more likely to experience PTG should trauma occur is simply to “allow people to understand that this may be a possibility for themselves.” Experts caution, however, that this is best imparted before trauma occurs, since if introduced after a traumatic experience can be perceived as minimizing suffering.
Social support structures and spiritual resources also play a role in moving more successfully through trauma. In a 2019 study of arthritis patients, for example, PTG related to the experience of having this chronic disease was more likely to occur in those patients with higher social support measures, and spiritual resources appeared to be important contributors to the benefits of the social support process.
Emerging understandings of transgenerational trauma inheritance
In addition to these strategies above, I’m particularly interested in looking at the potential to directly address epigenetic imprinting that drives the biological embedding of trauma. By this I mean changes to the epigenome (the regulatory layer that sits atop our DNA and alters gene expression) that relate to trauma and that are lasting. Early research indicates epigenetic changes related to trauma can be passed down to future generations – a fascinating concept with huge implications.
In Project Ice Storm, Moshe Szyf, PhD, and his colleagues evaluated the epigenetic mechanism of DNA methylation of children born to mothers who were pregnant in Montreal during a severe ice storm in 1998. On the scale of trauma, it may seem like a relatively minor event, but even so, the children born to these mothers were more likely to develop a different DNA methylation pattern and were more prone to symptoms of asthma and autism years later.
Another recent study investigated the effect of sexual violence against women and girls during the later part of the 20th century in Kosovo at the time of the conflict between Serbian and Albanian people. In it, scientists observed that among women who were sexually assaulted during the Kosovo war, 72 percent had PTSD symptoms during pregnancy and that their offspring had altered DNA methylation at specific genes related to glucocorticoid and neurotransmitter activity, and higher levels of cortisol. The authors suggest that their findings support the concept of biological embedding of trauma and PTSD, and that research in this area is important to breaking the intergenerational transmission of the effects of trauma.
So, what else can we do? This is where our Functional Medicine lens, coupled with the research my team and I have been working on related to epigenetic (DNA methylation) health, offers perhaps even more insights…
Inflammation Primes for PTSD, Anti-Inflammation Primes for Resilience
An interesting 2020 review paper looking at DNA methylation patterns in PTSD, resilience, and PTG suggests, for one, an inflammatory environment BEFORE trauma might “lock-in” a PTSD response, whereas an anti-inflammatory environment appears to promote resilience. The genes that are involved in trauma responses are also consistently associated with stress glucocorticoid (stress hormone) activation (FKBP5, NR3C1, BDNF), inflammation/immune activation (IL2RA, IL18) and DNA methylation (DNMT3B) itself (i.e. DNA methyltransferase genes). That means trauma experiences “light up” genes related to the stress response, inflammation, and DNA methylation. This seems a straightforward target for potential interventions (and certainly dialing down inflammation wherever it exists in the body is a sweet spot for Functional Medicine practitioners), and it also gives us potential avenues for researching how to disrupt the development of PTSD and encourage resilience.
Trauma will also push us toward inflammation, hypothalamus-pituitary-adrenal axis activation (a stress response), and hypomethylation. This understanding indicates a post-trauma methylation diet would be smart. Maybe even short-term methyl donor supplementation or adaptogen supplementation will prove useful in minimizing negative biological embedding.
Eventually, we will be able to dissect epigenetic patterns early on and develop treatment strategies that are powerful, directed, and effective, as Dr. Moshe Szyf, from Project Ice Storm and our biological aging study scientific advisor, discussed in our 2017 podcast. I highly recommend a listen/read. In addition, these were the illuminating thoughts he shared most recently when I questioned him for this article:
“We didn’t study this in humans, but we did in animal models of PTSD. Only a fraction of animals exposed to trauma develop PTSD. When we compared animals exposed to trauma who did and didn’t develop PTSD, we identified a different methylation profile in the nucleus accumbens region of the brain in resilient animals. Based on analysis of gene pathways we arrived at the conclusion that increasing DNA methylation and activating retinoic acid pathways might help. We found that treatment with SAMe and retinoic acid converts PTSD animals to resilient. This paper will be published soon in Molecular Psychiatry. We are thinking about applying similar treatment to humans.” – Dr. Moshe Szyf, PhD
SAMe supplementation isn’t something I’d recommend for everyone, though careful, supervised and short-term use may be appropriate for some. Vitamin A (retinoic acid) is an acceptable and important nutrient that can be supplemented within RDA levels (or more under qualified guidance).
The above thoughts are pretty intuitive, I think. And safe. But much more research is needed. I think we’ve encountered enough trauma. We get it. It exists. It is lasting and potentially harmful and heritable across generations. Instead, it’s time to start studying PTG and resilience – what it is, how to grow it, and how to “turn it on” in these times of hardship because knowing how to build capabilities and structures we can lean on, as well as influence epigenetic patterns through DNA methylation, can help us make mindful choices that optimize the genetic and life events hand we’ve been dealt.
Here’s a summary of considerations for PTG:
- Dial down inflammation wherever it grows
- Methylation-supportive diet (pre-order my book or sign up to our Pioneer 100 study for more details)
- Short-term methyl donor or adaptogen supplementation (as above)
- Selective use of SAMe and vitamin A
- Mind-body practice, social support networks, and spiritual resources
- Development of psychological resilience characteristics and openness to PTG possibilities
- Support research on PTG as well as pathogenic PTSD
A *big* thank you to Romilly Hodges for her contributions to this article.