Episode 45: Trauma, Memory, and the Mind: How PTSD Forms and How It Can Be Treated

Show Notes

PTSD is often misunderstood as something that is broken inside a person. In reality, it is a survival system that worked exactly as it was designed to in one environment and then refused to turn off when the environment changed. In this episode, Dr. Ravi Kumar sits down with Dr. Trey Tippens, a clinical psychologist and former Army Sergeant who spent years at Walter Reed Medical Center treating some of the most severe trauma cases in the country.

Dr. Tippens enlisted in the field artillery in 2003 and watched the war in Iraq begin from inside basic training. When members of his cohort came back from deployment changed, he made a decision that would shape his career: get out of the army, earn a doctorate in clinical psychology, and come back to help. He brings that lived perspective to a conversation that strips PTSD down to its mechanics. Hypervigilance, scanning, sleeping with one eye open, these are not pathology in a war zone. They are how you stay alive. The disorder begins when the brain can no longer distinguish the dangerous environment that taught those behaviors from the safe one a person has returned to.

The conversation walks through the Shattered Assumptions model, which helps explain why two people in the exact same foxhole can come home with very different responses. It is the delta between the world someone believes they live in and the world a traumatic event reveals. When that gap is too wide to integrate, the result is a worldview where nothing feels safe.

From there, Dr. Tippens lays out the gold standard treatments and why each one is really a variation on the same principle: habituation. Prolonged Exposure (PE) asks patients to tell their story over and over until the emotional charge wears down. Cognitive Processing Therapy (CPT) maps the loops a person gets stuck in and breaks them with rational analysis. EMDR adds bilateral stimulation, which feels like voodoo to many patients but has now reached gold standard status. The common thread is tolerability: PE works, but it is brutal, so newer modalities exist to give patients something they can actually stick with.

The episode then moves into the more interventional and chemical frontier. The stellate ganglion block, a temporary anesthetic injection at the base of the neck that interrupts the sympathetic nervous system, has become a mainstay in the military. Dr. Kumar, as a neurosurgeon, breaks down the anatomy of why this works and why it took guts to develop. Then they get into psychedelic assisted therapy, where MDMA trials have shown 69% of participants no longer meet PTSD criteria after just three sessions, a result no traditional therapy comes close to. The catch is the blinding problem: when the participants in the active arm are visibly tripping, you cannot run a clean placebo controlled trial.

Finally, the conversation turns to generational trauma, the biological transmission through cortisol exposure in utero, and the psychological transmission through modeled behavior. Dr. Tippens closes on post traumatic growth, the idea that some survivors come out of recovery with what one of his patients called “steel in my soul,” no longer defined by what happened to them but by how they choose to engage with the world afterward.

In this episode, you will discover:

• PTSD as a learned survival process, not a malfunction: Why hypervigilance, scanning, and sleeping with one eye open are exactly the right behaviors in a war zone, and why the disorder is actually a mismatch between learned environment and current environment
• The Shattered Assumptions model: Why two people in the same foxhole can have completely different outcomes, and how the delta between expected and actual reality determines who gets stuck
• How childhood trauma is structurally different from adult onset trauma: Why combat PTSD is a disintegration of an existing self, while childhood trauma is a self that gets built around neglect and danger from the start
• Why treatment cannot start with the trauma story: Dr. Tippens explains why the first session is about building trust and motivation, not asking a patient to relive the worst moment of their life and then come back next week with a smile
• Prolonged Exposure (PE): The gold standard of habituation, telling the story until you are bored of it, until the emotional charge no longer fires
• Cognitive Processing Therapy (CPT): Mapping the loops a patient gets stuck in (such as a veteran patrolling the perimeter of his own house at night) and breaking them by making the unconscious behavior pattern visible on paper
• EMDR and the bilateral stimulation question: Why the eye movement may not even be the active ingredient, and why what really matters is whatever lets the patient tolerate revisiting the memory
• The stellate ganglion block: A temporary anesthetic injection at the base of the cervical spine that disrupts the sympathetic chain, breaking hyperarousal long enough for the habituation work to actually land. Dr. Kumar walks through the anatomy of how it works and the risk of Horner syndrome if it is done wrong
• MDMA assisted therapy and the blinding problem: Why a 69% remission rate after three sessions is staggering, and why the inability to blind a study where the active arm is visibly tripping is the central regulatory hurdle
• Psilocybin and openness: Why the increase in psychological openness and brain plasticity may be exactly what allows trauma survivors to integrate their stories into a new worldview
• Generational trauma, biological and behavioral: How a mother’s cortisol and adrenaline during pregnancy can change a baby’s chemical receptors, and how children of traumatized parents learn that the world is dangerous through modeled behavior
• Post traumatic growth: Why some survivors come out stronger, with what one patient called “steel in my soul,” no longer victims of the event but the authors of how they choose to interact with the world afterward
• The first step: Dr. Tippens’ practical advice for someone who suspects they have PTSD, including why isolation and feedback from loved ones are the two earliest signals worth listening to

Key Takeaways

• PTSD is a survival system that worked correctly in a dangerous environment and then failed to switch off when the environment became safe. It is not weakness, and it is not brokenness
• The Shattered Assumptions model frames PTSD as the failure to integrate an experience that contradicts your fundamental beliefs about how the world works. The size of that delta is one of the strongest predictors of who gets stuck
• Every gold standard treatment for PTSD (PE, CPT, EMDR) is ultimately a variation on habituation. The differences are mostly about what the patient can actually tolerate
• The stellate ganglion block is not curative on its own, but it lowers hyperarousal enough that the cognitive work of habituation becomes possible. It is an enabler, not a fix
• MDMA assisted therapy has shown roughly 69% of participants no longer meet PTSD criteria after three sessions. The blinding problem is the regulatory bottleneck, not the efficacy
• Psilocybin’s effect on openness and brain plasticity may explain why psychedelic assisted therapy helps trauma survivors reintegrate their stories rather than just suppress them
• Generational trauma is real and has both biological pathways (cortisol exposure in utero altering receptor function) and behavioral pathways (children learning the world is unsafe from the way their parents move through it)
• Children’s brains are dramatically more plastic than adult brains, so early intervention for trauma exposed kids has outsized leverage
• Post traumatic growth is achievable. The goal of treatment is not to forget the event but to assimilate it into a self that no longer reacts to it as an active threat
• The earliest practical signal that someone needs help is often external: feedback from a spouse or close friend, or the noticeable urge to isolate

Transcript

[00:00 –> 03:08] Dr. Ravi Kumar: Welcome to the Dr Kumar Discovery. I’m Dr. Ravi Kumar. On this episode, we’re sitting down with Dr. Trey Tippens, a clinical psychologist and former army sergeant who went back to school, earned his doctorate, and spent years at Walter Reed Medical Center treating some of the most severe trauma cases in the country. He’s lived inside military culture and then trained to heal people coming out of it. Now post traumatic stress disorder, or PTSD, affects a massive number of people. And it’s not just the person suffering who’s hurt. It’s the people around them, the spouses, the children, the friends. It ripples outward. And what makes it so tricky is that PTSD isn’t a sign that something is broken inside you. It’s actually a survival mechanism. Your brain learned how to keep you alive in a dangerous environment, and now it can’t turn off. So today, we’re going to unpack all of it. What PTSD actually is, how it rewires your brain, what the Shattered Assumptions model tells us about why some people develop it, and others don’t. We’ll get into the gold standard treatments like prolonged exposure therapy, cognitive processing therapy, and EMDR. And then we’ll talk about some newer, more innovative approaches, including the stellate ganglion block, and even the potential role of psychedelics like MDMA and psilocybin. We’ll also talk about something a lot of people don’t realize, how trauma can be passed from one generation to the next. If you or anyone you know has PTSD or even suspects they might, this is going to be a very important episode, and you should definitely share it with them. Because understanding what’s happening in the brain is the first step towards getting out of the cycle. One quick note before we jump in. Both Dr. Tippens and I are clinicians, but this show is for informational purposes only. We’re not giving medical advice. What we are giving you is knowledge, and knowledge is the kind of power that helps you climb out of difficult health situations. So take what you learn here, bring it to your physician or your clinician, and use it to work towards your health goals. Also, this podcast is separate from my role as assistant professor at UNC. Okay. Let’s get into it. My name is Dr. Ravi Kumar. I’m a neurosurgeon in search of the causes of human illness and the solutions that help us heal and thrive. I want you to join me on a journey of discovery as I turn over every stone in search of the roots of disease and the mysteries of our resilience. The human body is a mysterious and miraculous machine with an amazing ability to self heal. Let us question everything and discover our true potentials. Welcome to the Dr Kumar Discovery. So can you just start off with telling us a little bit about yourself and how you got involved in patients with PTSD?

[03:08 –> 05:11] Dr. Trey Tippens: So I’m a prior enlisted soldier, initially joined in 2003 in the field artillery, went to basic training in AIT with the same cohort of people. Uh, we came back from a mission one day, and the drill sergeant sat us all down, and, uh, they pulled a TV up to the front, which I had not seen a TV in base training up to that point, uh, and they cut it on, and, and it was bombs over bad debt. So that was the first day of the war in Iraq, and the drill sergeant looked at us and said, you know, some of you guys, if you have not been taking it seriously, this might be the only training that you get before you go overseas. So, uh, it was about halfway through basic training. Half of my cohort ended up going to The States, and the other half went to Korea. So I went to Korea. The other half that went to The States ended up deploying straight to either Iraq or Afghanistan. So I had known these guys prior to, you know, basic training. When they came back, I noticed that they were having some difficulties. I was a sergeant at the time, and I didn’t feel qualified to be able to help them. So I said, you know what? I’m gonna get out, and I’m gonna be a psychologist, um, I’m gonna go to school, get my psych degree, and I’m gonna come back into the army to help support these people. My own personal reasoning was it could have been me, right? And it would have been nice to have someone who had shared a similar experience or at least knew about the military culture that could then speak to it in a real meaningful way. So I went to school, got into a grad program, I was working at the VA as a practicum student, I was working at local community health centers, I was working at substance abuse clinics, just getting a real exposure to to working with trauma. Now, I was working with trauma in some of those places back to back to back to back back. So one hour sessions, trauma for six to eight sessions a day. So different trauma stories over the course of the day. Uh, did my internship at Walter Reed Medical Center, which is generally the first stop for people who have had adverse events happen overseas, and then they come straight to the Walter Reed. My thinking was that as a former enlisted person, that I could speak to some of the militarisms and help at least lower the barrier to care for people to come in and see me.

[05:11 –> 05:21] Dr. Ravi Kumar: Very cool. So just for the listeners, how would you define PTSD? This doesn’t have to be a military person to have PTSD. Correct? Uh, so like what is the general definition here?

[05:21 –> 06:38] Dr. Trey Tippens: So I think PTSD in the in the wrong context is a pathology where people, it causes them immense stress, it causes families immense stress. But I think it’s a learned process that people have developed in adverse threatening environments that then they can’t let go of and then they bring home with them into non adverse non threatening environments and it’s the same mechanism, it’s the same hyperarousal. So, I always think, you know, in the right context, scanning rooms for danger and sitting with your back to the wall wall, and seeing who’s coming into the building, and looking around for bags on the side of the road that in the right context could be an IED, that in a war environment is what keeps you alive. Right? Your awareness, your hyperarousal, your ability to look and recognize danger is what keeps you alive. You then get out of that environment, you put it in a home environment, and it’s no longer fitting within the social construct of of being back home with your family, or being back home at a restaurant, or being back home and driving, you know, down a down a two lane road. So part of it is a is a mismatch between our learned experience of of being in threatening environments that then causes us to have these type of behavioral cues and types of hyperarousal activation that we then have hard time letting go of when we get back to a place that’s nonthreatening.

[06:38 –> 06:57] Dr. Ravi Kumar: Okay. So people put in dangerous or scary situations, learn how to survive, essentially. It’s a natural mechanism. And come out of that situation, you have to essentially unlearn. And if you don’t, you have what’s called post traumatic stress disorder. Is that correct?

[06:57 –> 07:32] Dr. Trey Tippens: That’s right. Yeah. So there’s several different mechanisms that go into that. So post traumatic stress disorder is the inability to dislocate the experience from the reality. It’s auto thinking, it’s the danger activation process on on high alert. And then you get into like the the reliving, and the re experiencing, it’s all happening now. And when you get into like the actual disorder component of it, you’re you’re talking about like sleep disruption, you’re talking about nightmares, you’re talking about other reliving and re experiencing situations, and it’s part of why it’s so difficult to get rid of some of the symptoms of PTSD.

[07:32 –> 07:49] Dr. Ravi Kumar: So in PTSD, people will relive the traumatic experience. They hear that knock on the door, and even though they’re in a safe neighborhood in their house, they will relive the fear that happened when they were in a dangerous situation where that knock on the door meant a possible person trying to hurt them. Is that right?

[07:49 –> 08:15] Dr. Trey Tippens: Yeah. Or you hear people sometimes who it doesn’t even take a knock at the door. They wake up and they they feel unsafe. I would have people track what they do when they wake up, and what they were doing was patrolling around their their house. Right? And some of them will say, you know, they want to go back to combat. They want to go back to war. In that environment, these behaviors and these thought patterns make sense to them that these behaviors and the way that we’re approaching the world is not pathological in that in that context.

[08:15 –> 08:33] Dr. Ravi Kumar: So they have a set of behaviors that essentially does better in a war zone than it does at home. And so they wanna go back to that place where they essentially fit in from a behavioral standpoint. Right. So what about other types of trauma? Sexual, uh, child abuse, spousal abuse. Can these cause post traumatic stress disorder?

[08:33 –> 10:37] Dr. Trey Tippens: You know, I guess we can start with childhood trauma because it matters whether or not it was prolonged. Right? It matters whether or not it was recurring. It matters whether or not it was a single incident versus multiple incidents over a period of time. One of the the theoretical models of why is that there’s some disintegration of the sense of self, right? Like the sense of security and safety, there’s some disintegration of that, right? Where people who’ve gone to combat have created a full identity of who they are prior to going to war. So, you know, we can look at kind of a disrupted assumption where some people think that the world is a certain way, and then they discover that the world isn’t, and then they they overreact. But childhood trauma specifically, their sense of identity and sense of self is not fully formed. So they don’t have a disintegration of self. They have a building of the sense of self, which includes neglect, that includes abuse, and that includes general lack of care. Right? And that goes into the way that you see the world, that goes into the way that you view yourself within the world, and how you interact with other people. That becomes kind of a modus operandi of how do we see other people, how do we trust other people, how do we recognize where we are. And it it’s a much longer, much more complex way of thinking about PTSD. Um, sexual trauma can also happen over multiple events. Right? You can have a single incident, you can have multiple incidents of sexual trauma. So, with sexual trauma, you know there’s there’s shame and guilt, and victim blaming, they blame themselves. Right? And there’s also a sense of helplessness associated with it, where you’re not in control of the situation, which makes it very, very difficult to then understand how I can now regain control of my life when I know that people can take the control away from me. But it again, when you go back into, well, what are the behaviors, or you start getting into distrust of other people. You start getting into poor interpersonal relationships are dangerous, people are dangerous, so you start putting up protective barriers around yourself to make sure that you don’t make yourself vulnerable to being a victim again.

[10:37 –> 10:57] Dr. Ravi Kumar: So explain to us a little bit more this dissolution of self. So, basically, someone goes into a traumatic event. They have a certain perception or view of the world, and that’s how they fit into it, and that’s how they work in it. And this traumatic event breaks that perception of the world, and now they don’t know who they are. Is that what you’re describing here?

[10:57 –> 11:51] Dr. Trey Tippens: Yeah. So there’s a model that’s called the Shattered Assumptions Model of PTSD, which is you can have two people in the exact same foxhole. One develops some level of post traumatic stress where they’re not able to let it go, I guess, for lack of a better word. And then you have someone who goes on and, it’s not that they’re not affected, but they’re not affected on a longer term to the point where it impacts their ability to live a functional life, right? There’s all sorts of reasons why would one person get it and not the other. One of the models is a shattered assumption, which is the delta, or the difference between the way that I think that the world is, and the way that I suddenly discover that it is. If that difference is so much that you can’t integrate this new information into your world view, that that actually creates so much ambiguity in the world that you stop seeing the world as safe. You now don’t know how to understand and experience the world because it’s so different from the way that you had initially thought that it was.

[11:51 –> 12:32] Dr. Ravi Kumar: Hey, guys. If you’re enjoying this podcast or it’s helping you, please help me get it out to the rest of the world. All you need to do is rate and review it on Apple Podcasts. Share it with a friend, post it on Facebook, and that’s basically it. The algorithm rewards engagement. Every review, every mention puts this show in front of someone who’s looking for clear, no nonsense health information, the type of information that I’m putting in these podcasts. So thanks so much, and let’s get back to it. So Dr. Tippens, what is life look like for someone with PTSD? Are there varying degrees of it? And can it be all the way from just minor to something that’s completely destroying someone’s life?

[12:32 –> 13:12] Dr. Trey Tippens: People can have PTSD around specific triggers. So if you hear people who have been in large scale attacks, right, they don’t like crowds anymore. Right? Like for them, there are specific triggers that that cause them to not feel safe in those specific events. So they avoid them. Right? When they just avoid the things that give them that experience, and they just kinda go on. It’s not holistic. It’s specific to a type of experience. And really, what you get is avoidance in that case. Right? They just avoid. They don’t go to the supermarket, as opposed to where you get kind of this multi trauma events where everything becomes not safe. Everything is a cause for hyperarousal. They’re always on edge.

[13:12 –> 13:26] Dr. Ravi Kumar: Tell me about this now. I mean, so you’ve identified, uh, patient. They’ve got PTSD. How do you start off by addressing it and treating it, especially if they’re really functionally hurt by this, uh, trauma?

[13:26 –> 15:35] Dr. Trey Tippens: I guess it depends where along the process you get them. So if you if you get them had an event happen, you know, there’s a bit of a gap, you know, between event and time, which means that they’ve had some kind of manifestation of symptoms. The first step really is to see where are the behaviors manifesting. Because what we’re trying to do is create some kind of level of motivation for treatment. Right? We need to help them understand that that you’re not always in control of these things. This is the system of fight or flight going off, and how is that manifesting? And if you could fix those things, what would that mean for you in your life? Treatment for PTSD does not start with story of exploration. Right? Like, the very first day of treatment is not the time to to say, tell me what happened. Lay it out for me, especially if it’s someone who’s lived with it for years. If they’ve lived with it for years, it’s who they are. Right? And if you want somebody to come back to the next appointment, you don’t have them start with their most terrifying story that they’ve ever experienced, and then expect them to come back with a smile the next time. Right? You need to build relationship, you need to build trust, you need to build safety, and you need to let them know the benefits of the treatment that we’re gonna go down. And then you give them a list of options. So these are the gold standard treatment options for PTSD. You know, you got prolonged exposure, you got cognitive processing therapy, you got, you know, EMDR. EMDR is kinda newish when I was coming up as a as a psych at the at Walter Reed. It wasn’t quite gold level, but it’s now moved, I think, at the gold level status for treatment. What are the medication protocols that can maybe help mitigate some of the experience? And you have them make a choice, and you explain it to them. Here’s PE, prolonged exposure. You’re gonna tell your story over, and over, and over, and over, and over, and over, and over. You’re gonna tell your story, and then as soon as you’re done telling your story, uh, we’re gonna say tell it again. Right? And you’re gonna tell it over and over and over. And the point is habituation. That’s a hard sell. That is a hard sell, uh, for people for people to do. So you lay out other options. Right? Some people just want, you know, they just want a fix. Right? Like, I can’t go to the grocery store. Okay. Why can’t you go to the grocery store? And it always goes back to the trauma story. Right?

[15:35 –> 15:50] Dr. Ravi Kumar: So if we’re looking at these gold standard treatments that you’re talking about, these are the standard treatments, the first things that are offered to your patients. Prolonged exposure is basically having them relive their experience over and over again until they realize that nothing bad is happening.

[15:50 –> 16:18] Dr. Trey Tippens: Why we have these reimaginings and these nightmares is because it’s never adequately filed into the long term memory. We need it to stop being so present for you. We need it to stop being so right underneath the surface. We need to move this into long term memory. One of the ways to do that is to get bored of it. It’s just to tell it over and over and over again until you’re bored of it, until you’re sick of telling the story, until it doesn’t elicit the emotional experience that it does right now. Yeah. But that’s a process.

[16:18 –> 16:30] Dr. Ravi Kumar: So what about cognitive processing therapy? That centers around finding a place where people get stuck in this default mode network where it just rotates over and over in their mind and sticks them in life. Right?

[16:30 –> 17:31] Dr. Trey Tippens: Yeah. So it’s exactly like you said. It it looks at stuck points, so it identifies where people are getting these loops that are occurring. So, you know, going back to to my person earlier who gets out of bed and starts roving around, you know, the interior of the house like they’re doing patrols. Right? Like what is the catalyst for you activating in that way? And then, let’s look at actually the behavior that’s associated with that, which is, you’re back on patrol. Right? I know you’re not rationally thinking about that, but you’re back on patrol. So it’s all about these loops that people get into of hyperarousal or avoidance. And maybe that’s that’s part of it too, where people avoid the diff having these conversations or avoid the things that give them these kind of poor behavioral manifestations and poor thoughts and, you know, the all of these things that they begin to avoid and their world starts to shrink. Right? We need them to not avoid. We need them to address the cognitive processing therapies getting into that that loop cycle that people get into, and how do you how do you recognize the triggers for that?

[17:31 –> 17:42] Dr. Ravi Kumar: Give me a, like, a discreet example of how you would do CPT on a on a patient who is walking around their house, checking the doors constantly to make sure things are locked. What would you, like, actually do with them?

[17:42 –> 19:00] Dr. Trey Tippens: I’ve actually sat down and drawn out maps of their house with them, and said, okay. So we actually looked through the behavioral patterns that they’re getting into, the the looping pattern. What occurred before, right? What’s the catalyst? What’s the trigger? Now that we have identified the trigger, what is it doing for you internally? What’s the immediate thought? Maybe there is one, maybe there’s not. Sometimes it’s just I gotta go, I gotta go look. So then, I would actually have them draw their house and what they do. So, you they will go outside, and they’ll look around their backyard, and they’ll come back inside, and they’ll look around the house, right? And you know, we are all on the way, we’re trying to figure out why are you activating into this cycle, right? What are you thinking? What are you trying to accomplish? When do you know you’re done? Maybe you’re never done, right? Maybe this now becomes what you do the rest of the night, and for some people that is, right? But we need to recognize the thought pattern, we need to recognize the behavior associated with that thought, and then what the outcome of that behavior is. And when you lay it all out for people, again, when they’re in that loop, they don’t really recognize that they’re doing something that’s related. They just need to feel safe. But when you remove them from the event, and you actually paint it out for them on a piece of paper and say, here’s what you’re doing. And then that kinda looks like you’re on a patrol. It helps them tie what they’re doing now into what they’ve experienced before and why they’re doing it.

[19:00 –> 19:34] Dr. Ravi Kumar: Yeah. In the end, it’s just you using your cognitive, rational mind to objectively look at what your behaviors are and try to change them. Basically, that that’s kinda what you’re describing. And and that goes along with behavioral activation. And for depression, it works very well. Tell me about EMDR because this is something that’s very interesting. And, honestly, when EMDR is described to anyone, pretty much they think that sounds like voodoo because, you know, you’re looking at a light, you’re moving your eyes, and somehow that’s gonna make your PTSD better. What is EMDR, and how does it work?

[19:34 –> 20:30] Dr. Trey Tippens: So when I was at Walter Reed, it was not a gold standard. And there was a lot of conversation for a period of time that it was just exposure done in a different way. It’s now moved into gold standard, and it’s still not clear what the mechanism of change is with EMDR. PE is very difficult, but exposure and habituation is the best treatment. So, CPT, you know, EMDR, all of these other, you know, written exposure therapy, they’re all variations of the same model and it’s more about, I I think, it’s more about what people can tolerate. There’s a tolerability component to it where EMDR you don’t share a story. You don’t you don’t verbalize a story. You sit in silence and you do a bilateral stimulation, and a stimulation where you go back and forth with the the eye movement. And the desensitization part is you’re telling the story in your head while you’re doing this bilateral stimulation. It would seem to be supposed to habituate you to it.

[20:30 –> 20:35] Dr. Ravi Kumar: And so for someone who’s never seen EMDR, what does it look like and what is bilateral stimulation?

[20:35 –> 21:16] Dr. Trey Tippens: Yeah. So, and again, the mechanism of change it’s still not clear, right? You would sit down in front of somebody, and you have a therapist in front of you, and they would tell you to relive a moment in your trauma story. So EMDR stands for Eye Movement Desensitization. So what you’re doing is desensitizing someone to their story internally, and the thought is is that the eye movement is someone waves something in front of your face and you’re supposed to follow it with your eyes. So that’s the bilateral, you’re bilaterally stimulating both sides of of your brain. And the thought is is that there’s some kind of mechanism inside of your your mind that is able to then move it into longer store memory. You’re habituating yourself to the story internally.

[21:16 –> 21:40] Dr. Ravi Kumar: Very interesting. Yeah. The brain’s fascinating, and there’s so much we still don’t know about it. I’d be curious to know at some point who came up with that. Look to the left. Think about your trauma. And like you said, maybe the eye movement has nothing to do with it. Maybe it’s just this, you know, reliving and habituating, basically normalizing this memory, moving it into long term storage, and moving on with your life is is the key to EMDR. Right.

[21:40 –> 21:50] Dr. Trey Tippens: That and that’s the goal. Right? And I think anything that helps people tolerate it, we should hold on to it as as hard as we can. Right? Because that’s the trick with PTSD treatment, is tolerate.

[21:50 –> 21:59] Dr. Ravi Kumar: So let’s talk about some of these innovative therapies out there, and I know the military is really focused on this one. It’s a stellate ganglion block. Tell me about that.

[21:59 –> 22:44] Dr. Trey Tippens: Essentially, it’s a it’s like an anesthetic that basically disrupts the hyperarousal pathway. So it stops the, the neurons from firing as quickly as they normally would. So that people don’t go into this hyperactivity, hyperarousal kind of process. And I have heard people say that it is a miracle. The problem is it’s not forever. It’s not a long term thing. You have to go back and you have to get periodic shots because it’s it’s anesthesia, right? It’s not permanent. I think functions interestingly is that it actually helps with the habituation process because it lowers the hyperarousal that people have when they’re retelling their story. So the combination of this lowering of hyperarousal with the ability to then habituate, I think there’s a lot of potential. But I’ve seen people who just like, I go get them a shot, and that’s, you know, that’s kind of what I do. And You

[22:44 –> 24:47] Dr. Ravi Kumar: know, the sympathetic nervous system for the listeners is your fight or flight nervous system. So we have two autonomic nervous systems, the parasympathetic, which is your rest and digest, and the sympathetic, which is your fight or flight. Well, in these PTSD patients, these patients who are living previous traumas, whether it be sexual or combat or any kind of traumatic incident, they’re in this, like Dr. Tippens keeps saying, in this hyperarousal, hyperstimulated state. Well, that comes from the brain down to the body through the sympathetic chain, which is this chain of nerves that come down the sides of the spine and then go out to your body. Well, at the top of the spine, which is basically the base of the cervical spine, which is your neck, there’s these three ganglion there. And one of them is this stellate ganglion. And they’re kind of the master regulators or the master switches that allow sympathetic flow through the nervous system. So you block it, and as Dr. Tippens says, it’s temporary. You block it, you kinda break this hyperarousal scale. And then I guess if you combine it with this habituation where you can get through memories or thoughts without the hyperarousal, it could lead to long term healing. And I I think it’s just fascinating because someone had to think about this and have the guts to do it too because, yeah, you could go through a soft tissue here, and there’s a bunch of big, uh, important structures here. There’s the carotid artery and the jugular vein, and they use an ultrasound and they guide it all the way down to those muscles there on the sides of the spine, find the sympathetic ganglion, and inject it with the anesthetic. I mean, if you do it wrong, it gives you a droopy eye. It’s called the Horner syndrome. And so there is a bunch of risks taken there, but that just shows you how bad PTSD is that some doctor somewhere at some point was willing to go in and and try this procedure with the theoretical thought that it’s gonna help. And I I think it’s really interesting that it’s become such a mainstay and so heavily used in the military.

[24:47 –> 25:08] Dr. Trey Tippens: I think the idea that you can help people mitigate their stress enough or their their hyperarousal process enough to where that they can then do the work that’s required for them to to be able to move into habituation. I keep using that word, but that’s what it is, right? It’s like desensitization to your story. Uh, without all of the stress that goes along with that, you could have long term benefits as a result of that.

[25:08 –> 26:20] Dr. Ravi Kumar: Hey, everybody. I want you to imagine something. Someone somewhere discovered that cutting out a certain food lowered their blood pressure, or a simple daily practice eliminated their headaches, or drinking coffee two hours later helped them sleep through the night. These discoveries exist. But that knowledge is like a grain of sand on a beach halfway around the world for the rest of us. And that’s the problem I’m trying to solve with an app I’m building called sharemytrial.com. This is a platform where people share health solutions that worked for them, and then the community validates what works on a broader scale. Right now I’m looking for beta testers, so if you’re interested, go to sharemytrial.com and sign up. Help me turn that grain of sand into a pearl in your palm. So the next thing I want I wanted you to talk about is something that’s very exciting, MDMA, which most people know as ecstasy, the street drug. It’s actually clinically used in PTSD. And there’s been some really exciting results, but there’s also been some issues with blinding and how to determine whether those results are real or not. But can you kinda talk to us about MDMA and PTSD?

[26:20 –> 26:32] Dr. Trey Tippens: Yeah. I’ll I’ll just sort of listen to kind of a psychedelic treatment. MDMA is actually not FDA approved. I think it was going through a FDA process, and it was because of the blinding psilocybin I think is having the same blinding problem.

[26:32 –> 26:35] Dr. Ravi Kumar: What is the blinding problem? Tell us that, Dr. Tippens.

[26:35 –> 27:32] Dr. Trey Tippens: So, when you go and do a a study like this for for FDA approval, so you’re given two different modalities of treatment. So one of them is a placebo, it’s not, doesn’t do anything, it’s inert, doesn’t do anything. The other one is supposed to be the the treatment protocol that actually does the activation. For MDMA and psilocybin, right, you know, I I just imagine people are sitting around and saying, well, am I am I in the control group? And then they they look over and ask their hat rack, you know, if they’re in the control group or not. Like, you’re like, you know you know if you’re in an MDMA or a psilocybin process. Right? You just know. Uh, you can’t blind it. Which means that if people already believed it was gonna work, you know, if you think about like placebo, they already think that there’s some kind of mechanism of change, they’re gonna be more likely to to just generally get better anyway. So, at least report that they’re getting better. So it’s it’s really difficult to unblind those two specifically because you you know. You you know.

[27:32 –> 27:42] Dr. Ravi Kumar: And you essentially can’t determine the difference between treatment effect and placebo because everyone who’s getting the actual real treatment and not the placebo, they’re all tripping. [27:42 –> 27:43] Dr. Trey Tippens: That’s right. That’s exactly right. [27:43 –> 28:27] Dr. Ravi Kumar: And placebo is surprisingly powerful. I mean, there’s people who just study how can we use the placebo as medicine because it’s better than most drugs, honestly. And, but here, so we don’t know. We were seeing huge benefits with the MDMA trials, but everyone who takes MDMA is feeling this, this totally abnormal, different feeling, and they think, this must be doing me some good. And so you don’t know, is that placebo or is it actual MDMA? The results are pretty exciting. I mean, there’s like 69% of people with three treatments of MDMA no longer have that diagnosis of PTSD, which I think is way better than any treatment you can do otherwise. Correct?

[28:27 –> 29:17] Dr. Trey Tippens: For sure. And I believe pretty well tolerated. But you know whether you took the sugar pill or whether you took MDMA. Right? You you you know. And I think, you know, again, that was for FDA approval, right? What I found, there’s been studies where psilocybin has actually increased openness in people who’ve taken it. That it actually increases brain plasticity, increases openness, and it creates an opportunity for expansion of a worldview, which is an interesting thought. Could explain part of why people experience better integration of their stories after they’ve gone through a process like this. But psilocybin specifically has been found to increase openness to experience, openness to to shaping world views, openness to new information, then that also should lead to some level of of reintegration of world views and reintegration of stories, which I think is really

[29:17 –> 30:40] Dr. Ravi Kumar: And, with psilocybin, especially, I mean, there’s been so much research, and it’s absolutely has a clinical effect. It’s effective for depression, trauma, basically reevaluating your perspective in the world when it gets in the way of you living a happy, functional life, I think it’s really fascinating. The problem is that these drugs have been highly regulated for a long time. And it’s not the case with MDMA, but with psilocybin, it is extraordinarily safe. It’s non addictive. I’m glad that we’re getting back into this world where we’re open to these, basically, it’s a plant medicine or it’s a fungal medicine, you know, that comes from nature, grows out of the ground, and it’s given to us. And because it was used used by alternative culture for some time, like, you know, Timothy Leary and these guys back in the seventies, it kind of just got pushed out to the side when it’s this amazing potential for human health improvement. And so I’m really excited to see that it’s being used and looked at for things like PTSD. You know, the MDMA research, I mean, that’s fascinating too. MDMA, you can overdose on and get really hurt. But MDMA, three doses, three sessions, and 69% no longer have PTSD. Whereas you guys are doing this, uh, CPT, I mean, for a long, long time, sometimes years. Correct?

[30:40 –> 30:48] Dr. Trey Tippens: Yeah. They’re protocols. Yeah. They’re protocols. Yeah. Yeah. I mean, you can do discrete sessions, and you can time them out, but you can then reset those the sessions. Right? Like, it it can go on for a while.

[30:48 –> 31:31] Dr. Ravi Kumar: So that’s I mean, that’s fascinating. And the fact that something like that exists in nature, and we can’t we can’t match it is is pretty cool. There’s something that I think is very fascinating that I wanna talk about. It’s this idea of generational trauma. And you hear this, you know, people talk about this and it and it sounds a little woo woo. You know? Like, how how is that how is trauma that your grandparents have now affecting you? But don’t be so skeptical because there is some biological basis for it, and there is some, um, psychological explanations for how trauma that affected your mother, um, could actually affect or your your family could affect you. Can you talk about that a little bit?

[31:31 –> 33:00] Dr. Trey Tippens: There’s really two models of transmission that I’m aware of. So one of them is if the mother has PTSD or has experienced some level of trauma either prior or during, the unborn child is exposed to large doses of very strong chemicals related to fight or flight, right? So, you know, all of the different things that go along with that. It changes the chemical receptors in the baby’s brain, which then makes it more susceptible to experiencing trauma in the future. Or even coming out with some level of anxiety. Uh, the other way is once the baby’s born, and you hear about like the cycle of abuse all the time or the cycle of substance use, where where you have intergenerational transmission of abuse. And and you hear about people all the time breaking the cycle because they don’t drink, or they decided to to act differently towards their children. Again, if we’re thinking that trauma responses are protective factors, then it’s done out of love and care. But what ends up happening is you have parent or parents who who have experienced some level of trauma, which then have developed these behavioral patterns and and ways of experiencing the world, which then the child learns that the world’s dangerous. Right? The child then learns that the world isn’t safe, and then they become hyper aroused around the things that are occurring in their environment. You know, is it nature nurture? Right? Is it it can be both, Where you can transmit through bio means, where you’re just giving them doses of adrenaline and cortisol. But it can also be nurture, where you you model and shape the world view that the child has, which then becomes that the world is a dangerous place.

[33:00 –> 33:16] Dr. Ravi Kumar: And so, let’s say, you you know, you’re talking to a mother and she’s had trauma in the past. It’s creating a functional problem for her. How does she not model that to her children? Are there ways to cope with that and to try to keep your kids growing up with healthy coping mechanisms?

[33:16 –> 33:52] Dr. Trey Tippens: Some people just could they just create for themselves a worldview that the world isn’t safe, and that’s just the way that they interact with the world. But if they recognize that it’s a problem or that it could potentially cause problems, right, they will have already gotten into some kind of framework of help seeking. So whether that’s through some kind of primary care support, or through therapy, or to learn ways to better cope. And you can also put children in early therapies so that they can also learn different ways to cope. Uh, I am not a developmental psychologist. I never worked with kids, but but that is a whole line of effort in and of itself where you can help shape the way that kids learn about and engage with the world and help the mother, really.

[33:52 –> 34:47] Dr. Ravi Kumar: And children are incredibly plastic, their brains. I mean, plastic means they can be molded. You can reshape neural pathways very easily. It’s much harder to do as an adult. But as a kid, even if they’re starting to model these unhealthy behaviors, it’s not too late to reshape their brains. It’s it’s very possible. And so I would, you know, urge parents who think that maybe their trauma has rubbed off on their children to have their children see a developmental psychologist or a psychiatrist and figure out a plan to help that child develop healthy coping mechanisms. The same thing happens for children who have been exposed to trauma, which, you know, we talked about at the beginning of this episode. It can totally shape their future life. But if you deal with it early, there’s a significant benefit for that person as they go on through life. So I think that’s something that important to think about.

[34:47 –> 34:56] Dr. Trey Tippens: Yeah. No. You’re exactly right. It goes from being an incident that occurred when I was young versus a lifelong pattern of abuse that never gets resolved.

[34:56 –> 35:13] Dr. Ravi Kumar: So talking about, you know, we’ve we’ve spent this whole episode talking about people who have PTSD, have trauma, whether it’s from combat, sexual assault, traumatic incidents. Is this curable? Can they find their way out of PTSD?

[35:13 –> 36:35] Dr. Trey Tippens: Yes, they absolutely can. I’ve seen people kinda walk through the process, and you’re not gonna go back to the person that you were prior. Right? You had these new experiences that are now shaping the way that you that you think about the world. But what you are gonna be able to do is you’re gonna be better equipped to be able to manage them. Right? You’re not gonna be overwhelmed and feeling out of control and revictimizing yourself in those experiences. Right? What what we wanna do is help you into this new stage of life. And and anything that occurs to us is gonna change us in some way, right? Go graduating college or, you know, going off to the army or, you know, work at working here. It changes you in some way and this event changed you. It did as things do in life, it’s causing some carryover effects and we just need to kinda know what that is. But the goal isn’t for you to to just forget what happened. The goal is for you to be able to assimilate that into into now the way that you see yourself and see the world in a way that doesn’t create such a stress reaction for you. Um, but yes, I’ve seen people come out, And actually, there’s a term for it called post traumatic growth where, you know, some people actually grow stronger. I had someone say it’s almost like it’s put steel in my soul, right? Where now, I’ve come out and I’m I’m now stronger as a result of this event, and I’m no longer a victim to it. Right? They talk about, like, transcending the event. I’m no longer defined by the thing that occurred to me. I am now defining the way that I want to interact with the world. So

[36:35 –> 36:44] Dr. Ravi Kumar: So if someone were to come to you and ask you, Dr. Tippens, I’m really struggling, what’s the first thing you recommend they do?

[36:44 –> 37:47] Dr. Trey Tippens: Um, the first thing that I would recommend is get an appointment and talk to a professional about what your symptoms are, what your experiences are. Some people have done it for so long, have lived in these experiences for so long that it’s hard for them to remember what it was like before, so it just becomes a normal way of operating in the world. You know, if you’re getting feedback from friends and family that that maybe, you know, something isn’t working in the way that they need it to, that might be a catalyst for you. We used to joke in the army, the only way people came into treatment was if their commander escorted them to behavioral health, or if their spouse escorted them to behavioral health. Right? Nobody came on their own. Right? So pay attention to, you know, the feedback that you’re getting from the people that you love. Right? And also recognize if you’re starting to isolate. Right? If you’re starting to isolate from people, that is a red flag for all sorts of different things. I think the human body is designed in a way that it wants to be well, but I think sometimes the chemicals and the the conscious and the workings of our mind keep us from being able to function that way because we feel like it’s safer Yeah. Not to be well.

[37:47 –> 38:08] Dr. Ravi Kumar: Well, thank you so much, Dr. Tippens. This was a fascinating conversation. The mind is extraordinarily complex, and I think the message that I’ve really gotten from you is that there are ways to manipulate our consciousness in the way we perceive the world in order to live better even in the face of traumatic events.

[38:08 –> 38:21] Dr. Trey Tippens: Yeah. Well, thank you for inviting me. I hope I hope it helps, uh, somebody at least inject a thought of, uh, maybe this is something I can I can actually overcome as opposed to just feeling defined by the things that occurred to you? So

[38:21 –> 39:50] Dr. Ravi Kumar: Okay. Well, thanks so much, and cheers. Alright. I hope you got as much out of that conversation as I did. Dr. Tippens has a truly extraordinary depth of knowledge about post traumatic stress disorder, and, more importantly, about the people behind it. What stood out most to me is how malleable the brain is. Even when you’re in your deepest, darkest place, the brain can be changed. We can use cognitive capacity as human beings to rewrite the perspectives and patterns that are causing us the most harm. And there are so many tools being developed and refined right now that can help people along this path, from traditional talk therapies to nerve blocks to brain stimulation to psychedelic assisted protocols. The science is moving fast, and there is real reason for hope. If you or someone you love is dealing with trauma, please share this episode with them. Information is a weapon in this fight. And sometimes just knowing that recovery is possible, that you’re not broken, that the brain can adapt again, that’s literally enough to take the first step towards healing. So thank you for being here. And until next time, stay curious, stay skeptical, and stay healthy.