Dale Johnson: I’ve been looking forward to today and the release of this particular podcast as we think about neuroscience and trauma. We’re moving forward in May, Mental Health Awareness Month, and it’s important for us to always address these types of issues and to give a biblical background. And today, we want to demonstrate that we’re not afraid of science. We want to make sure that we understand science and understand it well. And particularly as it relates to this issue of trauma, we definitely need to understand what’s happening and what we can know relative to neuroscience and the brain and that sort of thing.
And today with me, I have two guests: Ernie Baker, who most of our listeners are very familiar with, and I’m so grateful for Ernie. Thank you for being here. But I want to introduce another brother here with us as well, Dr. Eric Everhart. He’s a practicing clinical neuropsychologist and licensed psychologist. He’s a professor and Director of the Cognitive Neuroscience Laboratory at East Carolina University. His clinical and research expertise includes electrophysiology, emotion processing, and behavioral sleep medicine. Erik, I’m so grateful that you would be willing to join us and to help us to think through these areas that aren’t our everyday study. So thank you for working through this and helping us to do the same. Thank you for being with us.
Erik Everhart: It is my pleasure to be here today. So hopefully I can help out.
Dale Johnson: Now for our listeners, what I just described about you and what you do every day, that’s in a different universe for many people and so, I’m sure, intriguing and interesting. So just to explain, Eric, if you can a little bit about what you do and some of your research interests, particularly.
Erik Everhart: Sure, on a day-to-day basis, I am in the classroom, so I teach, and I train undergraduates and doctoral students in clinical psychology and neuropsychology. As part of that I see patients, so I have patient care, both inpatient and outpatient, where I will often provide a diagnosis for various conditions like Alzheimer’s disease or traumatic brain injuries, various neurodevelopmental disorders, and so forth. And then I also have a research lab that I work in with my doctoral students and some undergraduates, where we examine things like electrophysiological processing during various emotions and how it might relate to sleep and sleep disorders. And so, a typical day is pretty busy but very enjoyable.
Dale Johnson: It sounds quite intriguing. Maybe I should come visit. I’d like to love to watch all that unfold, and that’s so intriguing to me. Now, we’re going to talk a little bit about trauma today, and Ernie and I’ve spoken in the weeks preceding about trauma-informed therapy and a very popular book, The Body Keeps the Score by Bessel van der Kolk. This is a very popular book, and people have different opinions about it. But I want to ask you about it, Eric, because I think this is sort of the framework of the discussion for a lot of people downstream as we think about the issue of trauma, the body itself, and how trauma impacts the body. So, just raise some of your concerns or give some of your perspective on this very popular book, The Body Keeps the Score.
Erik Everhart: Sure, happy to do so. To start, I would say that the science behind trauma is exceedingly complicated and every individual who has experienced trauma is unique. However, books like this, well, they attempt to simplify terms to make it relatable. And when we do so, we often lose critical information and gain misinformation. It’s very similar to, I guess maybe, one example is sort of the “chemical imbalance” phrase that was pretty common 20 or 30 years ago where patients would say I have a chemical imbalance. And that was used to account for a wide range of mood and affect-related behaviors and symptoms, but yet really provides no explanation of what’s going on. And the book is impressive, and has some merit and relevance to those who study and treat trauma. And so, that’s all good. It’s a vast amount of information to try to present and unpack the neurophysiological pieces of trauma. But the concern for me, professionally, is that the work is in a variety of information. Some of its anecdotal, some of it is what we would call pseudoscience, and then it’s blended in with science and that’s not uncommon for books like this. They’re written for similar populations. I would make the assumption maybe that this is done to help the layperson understand, maybe a person, with trauma history or perhaps some practitioners that don’t have a neuroscience background. But the result can be misleading, and sort of the hype that’s raised based on a case study that’s not able to be replicated or some type of anecdotal, personal experience with an intervention, and that can result in ineffective techniques and inefficiency. And there are some examples of that if you’d like for me to provide some of those, I’d be happy to.
Dale Johnson: Yeah, I think the people listening would be somewhat familiar. I think maybe a couple of those examples would be helpful.
Erik Everhart: Yeah, and here’s one great example, when the book discusses EMDR, which is a widely used and popular intervention these days for trauma. Part of the description of that technique involves a person that he came into contact with, who I guess eventually became a healthcare professional. But this person, she introduced EMDR to van der Kolk and she described how she was able to vividly remember a trauma that occurred to her when she was going through this. And I think maybe as a result she became a practitioner in this. But then, van der Kolk also describes his own experience with EMDR as provided by one of his colleagues. So apparently, he and one of his colleagues were testing this out and, you know, there might be some concerns with that. But the fact is that the claims aren’t testable from a scientific perspective, and so they may have some inherent emotional and intellectual value to a lay person or practitioner interested in administering the technique, but that’s not really a testable claim.
And it’s interesting, I found when I was sort of doing background research, van der Kolk said in an interview about this book and EMDR right about the same time it came out, he said he “would never say that EMDR is the treatment of choice because we haven’t studied every possibility. But EMDR is a treatment, a very good treatment for one-time trauma and also a very useful adjunct for more chronic trauma.” So, that’s sort of a separation from what people bring out of his book. You know, he’s even being cautionary on it. And granted, this was nine years ago, and there’s a lot of other research that has come out that is still cautionary. And it’s one of these reasons that, and I’ll avoid getting into the weeds, but I would encourage listeners to go out and look at the controversy with this technique and go to source articles. I can’t stress that enough so you can make some educated decisions. But most of the science and research came from one person, and we can talk about hype and some of the things to watch out for. But the American Psychological Association currently recommends this as conditional, which means they don’t have strong evidence to recommend it. So that it’s not top-tier on their list.
Dale Johnson: I think those are very significant points that you’re making it. And I would dare say if you and I are looking at some similar research, van der Kolk, at different levels of education, has been sort of cast out of favor with some of the newer research that you’re seeing appear. And then yeah, the cautionary tales relative to the EMDR approach, I think I would reiterate in some of the things that I’ve been reading and researching as well. You talked about hype, and I think this is a really important key. I mean, you probably studied this way more in-depth than even what I have relative to the history of psychiatry and the history of psychology. And what we see here are the theoretical approaches that are hypothesized and then people work through different means and methods, trying to understand how things happen and implement methods and so on.
Psychiatry and psychology has a sordid past, a really interesting past, as you see it cycle back from what several historians call romantic versus biological psychiatry. And you see these moments of hype; you mentioned the chemical imbalance theory, for example. And there are moments where, man, we’re really excited, we see how this could possibly be the thing that’s that gives explanatory value to certain things. And then we see sort of a crash and burn. And then we see new things pop up, right? Well, we’re still a young science, give us a little bit longer, we’ll figure this out, kind of thing. Help us to discern between hype and legitimate science. Because listen, we in the biblical counseling world, even from the beginning, we’re not afraid of real science. We want to embrace legitimate science. But there’s always this battle back and forth between what is hype and what is legitimate. Help us to have some categories to think through that.
Eric Everhart: I think the warning signs, and there’s always warning signs. We have to be really careful. But I’ll start out with, go to source articles. I would say I’m weary of anything with Google searches or news or media or social media. And even popular books, even if they’re written by professionals because they’re going to do exactly what we’re talking about, sort of reduced information to make it understandable. So I would recommend the things like PubMed and NIH if you’re going to the source articles, they have lists that are pretty good. But beyond that, sort of the warning signs are when someone uses primarily sort of anecdotal, personalized experiences as evidence. Those things are, again, not testable with science. In science, we like to be able to falsify our claims so that we can test things and either say this supports it or it doesn’t. And if there’s no way to do that, then I would be very wary of that. For instance, if it’s not connected to other research or peer review from established professionals, I’m wary of that. If there’s no sort of self-correction. So, for instance, if there some journal articles it suggests the opposite, and nobody ever goes back to sort of revise a theory, those are things to be wary of. One of my favorites is, I got this quote from a colleague of mine, but “extraordinary claims without extraordinary evidence,” right?
So, it’s a good time to mention maybe another one of those interventions, like neurofeedback, which is mentioned in that book. And it can be useful. I understand the technology really well. For many years, the American Academy of Neuropsychology said it was investigational, so they’ve retired that, by the way, because it was so long ago. But there was a publication that came out a couple of years ago, and I think it is the Journal of Clinical Neurophysiology; they came to the same conclusion with regard to diagnostics. I’m not talking about intervention now. But this is a great example for diagnosing traumatic brain injury, sort of mild, so far we haven’t been able to demonstrate the difference between that and, say, depression or anxiety. So, for a variety of reasons, it doesn’t mean it doesn’t hold promise, but we’re just not there yet. But I see extraordinary claims among practitioners who go into neurofeedback where they claim it can cure whatever ails you: depression, anxiety, brain, autism. We can go down the list and I’m always wary of that because I know that there are enormous fees for that type of intervention and so people can be really taking advantage of, not to mention poorly-trained. So I’ve seen a number of people just open up the shop after a weekend workshop for that. So I’m weary of if you’re seeking that kind of intervention, I’d say, you really, really have to investigate the credentials in that person.
Dale Johnson: Erik, what you just gave us is priceless. Honestly, you know, and this is the type of language that I try and help my students to discern when they’re reading some of these books early on: “it seems like” or “it may be” and “could be that this is possible.” And people read that as if we’re talking about exact science. That’s more philosophical, and to understand and interpret it as it’s being written, not in the extraordinary claims that you’re describing, which I think is helpful.
Ernie, I want to get you in here in just a second. I’m going to ask one more question, and then you guys have had lots of conversations, Ernie, you, and Erik. And he’s been a helpful resource to you even over the years just batting back and forth things that will come out in literature and that sort of stuff. And I want you guys to discuss some of that literature. But Erik, before I let you guys jump into that, what I’d love to get a little bit more detail on, because we’re talking about this issue of trauma itself, give us some of the explanation of the preciseness with which we can tell in neuroscience, whether an individual is anxious by doing some sort of basic brain scan, which is what many will claim on some level here.
Erik Everhart: There are many, many different types of brain scans available, but I’ll kind of stick with the couple. You know, when we’re just doing a structural brain scan like an MRI, that just looks at parts of the brain. You know, it’s really difficult to say that there are any differences unless you have some really extreme groups that are sort of developmental in nature. But the more sort of recent technology with FMRI that sort of looks at blood volume differences and so forth are more sensitive. And these types of technologies can often identify group-related differences in various regions of the brain. So, for instance, you have a group of highly anxious individuals and a group of individuals who aren’t, and there’s typically some type of task in that study where they’re viewing something, listening to something, that is designed to elicit a response. So you can find these groups-related differences in places like the amygdala or prefrontal cortex and connections. And there’s some scientific value in that because we often want to understand the science behind anxiety and what’s going on, and other disorders, so to speak.
But there are three things to consider. The differences are correlations. So it doesn’t determine cause and effect. So causal agents could be other parts of anatomy, environmental, long-term influences, those kinds of things. So in those types of studies, someone has to interpret the findings, and you can interpret those in several different ways. So that’s one thing. Another sort of cautionary note is that these are lab-based paradigms. And so, in the real world, some of these may have limited generalizability to real-time phenomena that someone is experiencing. Looking at pictures of faces that are angry or pictures that might induce anxiety is a fantastic tool in the lab, but how does that correspond? I’d say the last thing is it’s difficult to take that group study and extrapolate it and apply it to a single individual in the course of time. Sure there is a science behind it, and it’s got merit and value, and it’s really important for us to understand, but the biggest caution is trying to then reduce that to a single person.
Dale Johnson: And I’ve heard you say that number of times, the caution of reductionism. And that has really been a thorn in the side of the history of psychiatry, if we’re honest, the wanting to have explanatory power, and it leads us to reductionism. And that’s a human issue. I think we do that in theology as well at times where we want to reduce something down into its simplest parts and it doesn’t give it proper explanatory power. This has been helpful.
Ernie, I want to give you an opportunity to discuss some of the things that you guys have been talking about, even some of the quotes and different things that you guys have talked through. So help lead us here.
Ernie Baker: I’m having fun just listening. So this is great. These are the types of conversations that Erik and I have been having for years. So I’m thankful that other listeners are getting to listen in now. So, a couple of quotes, people talk about amygdalas being hijacked, and I won’t go into all the details of things. I’ve been listening to a lot of trauma-informed presentations and that gets talked about a lot, about the amygdala being hijacked.
Here’s a quote from a journal article. I just want to read part of it and then, like, what are you hearing as someone who does neuroscience with what’s being said in this journal article? So it says, “In addition, research has found that the brain is most malleable to rewire when in an anxious state. In other words, in order for neurogenesis to occur, it’s essential for the amygdala to be activated when applying methods designed to impact thoughts and beliefs. This is important since it’s not unusual that those seeking counseling for anxiety are also taking drugs such as Xanax designed to sedate the amygdala, therefore impeding the neurological processes necessary for neuroplasticity to occur.” So, that’s just stated as a fact, as if that’s a fact. What are you hearing?
Erik Everhart: Yeah, I’ll kind of stick to sort of the statement, I think where that came from and sort of my background research, that’s not a peer-reviewed article. So it’s more of a general statement that someone made and so the scientific background for such a statement is difficult to determine. But I’ll say like I say for many things, activity in the amygdala is not an all-or-none event. If that were the case then we would be in a lot of trouble as humans, I think. It’s always sort of continuous. And so, I have questions like, how much activity would one need to rewire thinking or memories and so forth? And we don’t have the answer to that. So it’s a rather extreme statement to say that, you know, neurogenesis won’t occur unless you have this, which we don’t know how much of this is. So again, sort of cautionary and how one might interpret that.
It makes sense that benzodiazepines, by the way, would inhibit the amygdala for, you know, people who are experiencing anxiety. I’ll say that it’s typically not the first-line medication treatment for anxiety disorders, by the way. But there are lots of patients who are on it. In terms of what I’m hearing in science and the community, it’s sort of what I said. This is a simplification of a process that is much more complicated and involves more brain regions than just the amygdala.
Ernie Baker: So here’s another quote, and I think my concern is when someone claiming to be a biblical counselor states something like this as fact, we’re asking our counselees to put their hope in this. It is stated as if, “Okay, here’s your problem, and this is part of the solution then.” This is the hope that we’re giving people, so that’s why I think it’s great that we have you here, just giving us some insight and just being a bit cautionary. Okay, what are we asking people to put their hope in? So here’s the other statement, and this is out of a book that came out maybe a year or so ago: “Brain scans of people experiencing flashbacks show that trauma pushes the Broca’s area, the speech center of the brain, offline. A person with a deactivated Broca’s area cannot put thoughts and feelings into words. It’s difficult to change a thought you can’t fully articulate.” What are you hearing?
Erik Everhart: Okay, so with that particular quote and reference, that’s actually, I think they’re referencing van der Kolk’s book in a specific section where van der Kolk talks about a single patient who they observed an imaging study. The Broca’s area was deactivated, that’s the reference. I could not find a journal article that was published with regard to that, but I sure did find that quote in other places, and so it’s being used, it’s out there. This becomes almost like pseudo-science because it’s not replicated; I couldn’t find it, I was looking for more data. But beyond that, if it were true that in all cases, trauma, experiencing flashbacks, and so forth, deactivated Broca’s area, then all of our patients experiencing that wouldn’t be able to talk. And that’s certainly not the case, which goes back to, we don’t live in a dichotomous world. All of these symptoms are on a continuum, and it’s true that maybe you can get disturbed enough, aroused enough, or panicky enough, where you’re not articulating like you should, and you can see some changes in Broca’s area. But again, it’s a continuum, and it doesn’t mean that just because I’m experiencing something that’s traumatizing or reliving something, it doesn’t mean I’m not going to be able to talk at all. Again, if that were the case, none of our patients will be able to do so during that time.
Ernie Baker: Let me give you another quote. This is from a blog article, and this is about amygdala hijacking. And I’m not going to read the whole quote but just some segments. It says this, “This data from our senses—eyes, ears, touch, etc.—enters the brain through the thalamus, which relays impulses to other parts of the brain, including the amygdala, which is like a filing cabinet that stores our memories of emotional experiences in life and triggers our flight, fight, or freeze responses to new life experiences. Due to small differences in the distances to be traveled, impulses arrive at the amygdala a few nanoseconds before they get to the neocortex. If the sensory data triggers an intense, emotional memory in the amygdala, those emotions can trigger an impulsive reaction, essentially hijacking our mouth or body before we are able to rationally process the information.” Then the end of the blog post says, “They found that when the amygdala is highly stimulated with intense emotions, it utilizes more blood and oxygen than normal, leaving less of both for the neocortex. This deficit causes a corresponding decrease in our capacity for reasoning, problem-solving, and impulse control. This can lead to a temporary loss of 10 to 15 IQ points.” What do you think?
Erik Everhart: Okay, so it is understood in science that with recognizing sort of fear types of stimuli or experiences, it could be harmful to us that we have a sort of a fast pathway and a slow pathway. And one seems to be more instinct and goes through the amygdala. So the best example of that is you’re walking on the Appalachian Trail, and you come around the trail, and there’s a snake in front of you, and you temporarily freeze. It’s the fight, flight, or freeze. And it’s thought that that might be protective. But then the sort of the slow pathway evaluates what you see. And it turns out it was a stick that was kind of curved up and look like a rattlesnake. And so that’s sort of the slow pathway. So those are fairly well-understood scientific principles. However, to sort of temper that, the fact, in terms of where memory is actually stored or experiences, it’s not really one place as far as we understand, so it’s not just the amygdala. That’s certainly part of it, but emotion-related memories are associated with multiple anatomic structures and pathways. So again, sort of a simplification of what we understand.
The last part of that statement though that says it could lead to a temporary loss of 10 to 15 IQ points. I know of nowhere where that was tested, I couldn’t find it. I think it’s originally in Goldman’s book on emotional intelligence, emotional EQ, or something along that line. It basically says, if we lose 10 to 15 IQ points because we were thinking with less brain power and capacity, but that has not been scientifically tested. In order to test that, you’d have to give someone an IQ test while they are experiencing those things. And that’s something that I’m not sure we can do.
Dale Johnson: Erik, as we consider these things, this is the type of language that is being thrown out there, and people are responding to some of these ideas as factual. And as you mentioned, there’s just a lot more that’s complex that’s going on in this language using brain, neuroscience as sort of a platform, if you will, catapulting other ideas. And I think that’s the thing that if I were to share a concern, that’s the thing that I’m most concerned about. And as you mention, you take a person in a laboratory, studying particular things, you put them in the field, and they’re just lots of variables that, you know, it’s hard to measure some of those things distinctly. So, I appreciate your measured expression and concern for some of these things. All the while also giving proper credence to the things that we know and maybe things that we don’t know.
Now I want to give you sort of a last word because I think that would be important. Maybe some of the things that we’ve talked through and covered, you know, where we want to offer clarity or, you know, questions that maybe Ernie and I haven’t even thought of, that could be helpful a part of this discussion—so last few words.
Erik Everhart: Sure, I would sort of close by saying, you know, van der Kolk’s book is important and has value in it. But I can’t state enough to read it critically and go to source articles and pull out what can be supported versus what is just sort of anecdotal information. It’s there that we get into trouble and, you know, he’s trying to tell a story, and there’s a lot of information in there, but go to the source articles. Be really careful and critical and take what’s useful and supported. But some of these other things to be really wary of and also in terms of implementing with your clients or whoever you’re working with. So that’s the take-home message.
The other take-home message is remember all of this is continuous. Even our DSM-5 manual sort of forces a dichotomy on human behavior when we know that’s kind of artificial in a way. So we’re forced into treating everybody as an individual, which is important. I can’t recommend that enough.
Dale Johnson: Yeah, super well said, brother. And I just want to say, you know, publicly how much I appreciate you and the work that you’re doing. And, you know, as a believer, entering into that world and the research that you’re doing and your understanding here is so helpful in understanding the body that the Lord has made us to live in. But yet not losing that idea of individuals, the Lord made us as distinct individuals and how we respond to different scenarios at different times. It’s fascinating, and I’m so grateful. We have wise brothers looking into it, like you. So thanks for spending time with us today. Ernie, both you and Erik, I’m so grateful for both of you guys and your help thinking through these very complex, difficult subjects.
Ernie Baker: Thanks, Dale. Always good to be with you.
Erik Everhart: Thank you, great to meet you, and great to do this today.
Dale Johnson: Yeah, it’s been a pleasure. Thanks, guys.
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