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

KEYPOINTS

• 01

  Stress follows an inverted U; trauma sits past the peak

  Carrión, a Stanford child psychiatrist, describes stress as helpful up to an optimal point — caring about tomorrow's exam, or a vaccine challenging the immune system — beyond which it carries a physiological cost (allostasis). Traumatic stress threatens your physical integrity. Resilience and post-traumatic symptoms are both possible outcomes, and recovery means returning to that optimal point, not eliminating stress. He worries that overprotecting kids from all stress robs them of chances to build coping skills.

• 02

  'PTSD feeds on avoidance'

  That is his team's slogan. Pretending nothing happened, or that treatment isn't needed, lets symptoms deepen and become complicated by substance use and self-injury, which makes treatment harder. Ruminating alone doesn't help either: in children, trauma turns play into joyless, repetitive play, and people usually fixate on the wrong event.

• 03

  PTSD is usually a backpack, not a single event

  Most people carry an accumulation of stressors (allostatic load). Most existing trauma treatments targeted one event and required parent participation, which fails when a parent is the source of trauma, is avoidant, or would lose their job for missing work. That gap is why Carrión developed his own treatment.

• 04

  Many kids have impairing symptoms without a formal diagnosis

  Children struggling in school and relationships often fall short of the behavioral criteria for PTSD. Carrión therefore studied stress symptoms across a spectrum. He firmly believes ADHD exists, but he saw children sent to him with ready-made ADHD diagnoses and stimulant plans whose problems were trauma. The two can also coexist, and ADHD inattention can raise the risk of PTSD.

• 05

  Children with PTSD symptoms keep bedtime cortisol high

  Measured before breakfast, lunch, dinner and bed, these children showed a normal daily cortisol rhythm except at bedtime, when levels stayed above those of healthy controls. That fits their night-time symptoms: bedwetting, nightmares, and short or shallow sleep.

• 06

  Higher cortisol tracked with hippocampal changes over time

  A cross-sectional MRI study found no hippocampal volume difference, which Carrión saw as a window to intervene. In a small longitudinal sample, though, higher pre-bedtime cortisol correlated with smaller hippocampal volume. On memory tasks, children with symptoms activated fewer hippocampal voxels and showed weaker ventromedial prefrontal activity, consistent with a quick-firing amygdala lacking its prefrontal 'brake'.

• 07

  Transgenerational trauma: genes and learned behavior, epigenetics unproven

  Carrión says the jury is still out on whether stress-induced genomic changes pass to offspring, though vulnerability genes clearly do. He has treated children with full PTSD symptoms and no identifiable trauma, where the trauma surfaced in a parent's history. Avoidance, hypervigilance and mistrust had been learned across generations.

• 08

  Cue-Centered Therapy is multimodal and child-led

  It combines CBT with psychoeducation (what cues and classical conditioning are, that recovery is possible), self-efficacy, empowerment and insight work, and it can be done without parents. In trials it reduced anxiety, depression and PTSD symptoms as rated by both children and observers, and untreated parents' anxiety also fell. It is published as an Oxford therapist manual, and an adult adaptation is underway.

• 09

  Self-chosen tools work best

  Children start with an empty toolbox. They are taught breathing, muscle relaxation, positive thinking, mindfulness and simple yoga poses such as mountain pose, but they decide which cues matter and which tools to keep. Tools they invent themselves work best; teammates and sports come up often. The underlying message is that the most portable tool is yourself.