My name is Lisa Danilchuk and I'm a psychotherapist specializing in trauma treatment.

I created this podcast because I'm surrounded by people who have dedicated their lives to navigating healing.

There is so much wisdom in each guest this season and my hope is that this show makes their important ideas and experiences available to you in a way that uplifts and inspires you.

These guests and I have committed our lives to fostering health and joy in the world even as we work through the impacts of trauma and face deep challenges.

Let's dive into season four and let's keep talking about how we can heal.

I want to give a big shout out and extend a huge thank you to the International Society for the Study of Trauma and Dissociation, the ISSTD, for sponsoring this episode.

If you've been listening to this podcast for any amount of time, you've heard me talk about the ISSTD and the incredible researchers, clinicians, and advocates I've met during my time as a member and a volunteer there.

This group is made up of some of the kindest, most inspiring, intelligent people and I'm happy to be able to share just a few of them here on the show.

This organization has been delving into the science and best practice of treating trauma and dissociation for over 40 years now and they have a rich catalog of educational offerings for both professionals and non-professionals on their website.

That's cfas.isst-d.org.

If you're a mental health professional, I highly recommend you consider becoming a member of ISSTD.

I'd love to see you during their live educational offerings and at the annual conference in

Boston in March of 2025.

Go to isst-d.org to learn more.

Welcome back to the How We Can Heal podcast.

Today our guest is Dr. Lauren LeBlois.

Dr. Lauren LeBlois is a cognitive neuroscientist who is passionate about understanding how the mind, brain, and body adapt in the aftermath of trauma.

Her National Institute of Mental Health funded research program focuses on the neurobiology of dissociation in trauma spectrum disorders.

She prioritizes translating scientific breakthroughs in accessible, compelling, and clinically relevant ways.

Dr. LeBlois serves as the chair of the Scientific Committee of the International Society for the Study of Trauma and Dissociation, or ISSTD.

She's also the operations co-director of the Initiative for Integrated Trauma Research,

Care, and Training at McLean Hospital in Belmont, Massachusetts.

Recently she was awarded the Alfred Pope Award for Young Investigators from McLean and the

Pierre Genet Writing Award and the Morton Prince Award from the ISSTD.

Dr. LeBlois is deeply committed to using her advances in neurobiology, behavior, and treatments to reduce stigma and improve care for individuals living with PTSD and dissociative identity disorder.

Lauren and I connected some years ago through the ISSTD.

I have always appreciated her thoughtful and thorough presentations, and I'm thrilled to share her with you today.

Let's welcome Lauren to the show.

Well, welcome, Lauren LeBlois.

It's so good to have you here.

I've been to a bunch of your presentations and I'm always like, everyone needs to hear this.

Everyone needs to know this.

So I'm excited to share a little bit of your background, your experience, and hopefully connect people to your work a little bit more.

Thank you.

That's very kind, Lisa.

So I have to ask first, how's everything going with the babes?

Because you and I had kids right around the same time, so it's kind of a miracle that we're both here.

It's been quite a journey.

Yes.

I feel like you captured it right there.

Yeah, but things are going really well.

It does feel like a lot, and it's pretty intense, but it's more just like the extremes, just a moment of joy, and instantly, three seconds later, the pits of despair kick off.

You had twins, too, and then you already have one?

Do you have one before that, too?

Yes.

Okay.

I just have the one.

I'm already like, oh my goodness gracious, it's a lot.

This is how humanity continues.

Wow.

Okay.

There's a lot that goes into it.

I thought I was aware.

I'm not that aware.

Now I'm learning.

So I'm curious, just to start, I always love to just go to a little bit of your background.

How did you come to learn about trauma and dissociation?

How did this become such a big part of your world?

Yeah.

I guess I feel like I've learned the most from our research participants.

They've been the best teachers for me.

Hearing them talk about their experiences, what it's like inside their mind, has been so fascinating, and then I think at the same time, I had the great fortune of getting connected with Dr. Melissa Kaufman, who I now jointly direct the Dissociative Disorders and Trauma

Research Program with, but learning from her throughout my training, and she's one of those people who, well, she's an amazing psychiatrist and clinician, and she's just one of those people who asks really beautiful questions of people that they just reveal the most amazing things with the way, just her presence and how she asks questions.

And so I think both from watching her and how she asks questions and hearing how people reply about these things has been where I've learned the most.

And I think I'm someone who's always been fascinated ever since I was little by people's stories, and that moment where you're in conversation with someone and you can see or feel that they feel seen, it's just so thrilling to me.

I love those little micro moments.

And so this is a place where I feel like I kind of fell into it by a chance of opportunities.

It was like, oh, this is home.

This is where I can hear the most amazing stories and help in some way by kind of putting a quantitative data point to it.

And I think your work does that.

It helps people feel seen because it describes something that can be difficult to encapsulate or to validate.

Right.

And when you come at it from that quantitative or very tangible standpoint, it's like, ah, okay.

Yeah, that's me.

Or, oh, that's how that works.

And naming it and just letting that land instead of being up in the land of what's happening here.

Yeah, exactly.

That's the hope.

That's what I'm hoping.

So what is your day to day work look like?

Are you just like, I just imagine you around fMRI machines all the time.

Is that what it's like?

Yeah, I feel like at this point, my position is much more administrative.

So it's a lot of writing, analyzing data, writing grants, writing papers, managing the lab, mentoring trainees.

I get less face-to-face time with research participants and like sitting at the imaging center.

But I get over there once in a while.

I don't know if I told you this, but I actually, when I first got to Harvard, I volunteered for a study at McLean.

It was about yoga and GABA levels.

So I think maybe that's why I just really put you like right in those.

I was in an fMRI machine.

I went in before.

I did an hour of yoga while they watched me and then I went back in after and I just really put you in right there.

And maybe that's near where you've worked and maybe it's not, but yeah.

Well, there's one imaging center, so it's, yeah, it's right there.

That's probably, probably where you and Melissa hang out quite a bit, even though you're doing a lot of other stuff now too.

So I want to try to translate, and I know we're not going to like go through a PowerPoint here, but I, you know, I've seen you present also, I think it was the grand rounds at Harvard.

You had a presentation at some point that you sort of opened up access to.

I want to like help people listen in on that.

So rather than going into like explaining all of like what trauma is and what dissociation is, we've talked a lot about that in other podcasts.

So I'm just wondering if you can start to speak to some of the things you've seen as you've taken in this fMRI data, as you've worked with people around like changes in the brain with post-traumatic stress, with PTSD, and I think we can kind of tease that out.

So is there anywhere you'd want to start in like the overview of what you've learned about post-traumatic stress from looking more closely at the brain?

That's a great question.

I think it does, the context of it depends so much or matters so much rather.

So what we ask someone to do in the scanner will really dictate what looks different in their brain if they have PTSD versus not, or have a more complex post-traumatic adaptation like DID.

So I think a good place to start would be what it looks like, what's different when someone is feeling really activated and symptomatic or triggered.

And maybe just briefly, we could touch on different types of post-traumatic adaptations.

So we've got PTSD, subsystem subtype of PTSD, and dissociative identity disorder.

And I'm just going to repeat those, PTSD, post-traumatic stress disorder, dissociative subtype of PTSD, and DID or dissociative identity disorder.

Yeah.

And I, there's a woman, Sachi Nakajima, who has this, I love her metaphor of a rollercoaster for how to describe the differences between those three different conditions.

Talks about like, imagine you're on a rollercoaster.

So I guess first I should say Sachi is a nonprofit founder and she's a lecturer and an author, and she's also open about being a survivor of domestic violence herself, but she talks about for PTSD, imagine you're on a rollercoaster and you're feeling that really intense adrenaline rush, and it's a frightening experience for you to be on this rollercoaster versus the dissociative subtype of PTSD, where imagine if somehow in your mind, you can make it feel like you were standing on the ground, watching yourself be on the rollercoaster provides that level of detachment.

So these are folks who report feelings of depersonalization and derealization where they feel a sense of detachment from their body or their sense of self or their surroundings, where it feels like they're watching themselves from above or they're in a movie or in a dream, something like that.

Yeah.

And then add another layer on with conditions like DID, where not only can you make it feel like you're standing on the ground, watching yourself on the rollercoaster, but it feels like someone else is on the rollercoaster and you're watching from afar.

So that's where you get this added layer of dissociation where people lose a sense of agency and ownership over some feelings or memories or actions or the sense of their body to the point where sometimes it can feel like it's someone else living in their mind.

I thought you were going to go to like passed out on the rollercoaster, right?

Like that's like a meme, probably somewhere you can get someone who just got so afraid on the rollercoaster that they just passed out.

And then they come to the end.

They're like, are we starting yet?

And you're like, oh, it already happened.

Yeah.

Yeah.

I like that, Lisa.

I think maybe that that could be like certain experiences in DID where it feels like you weren't there for, um, or you're like have that, that full amnesia of a fully dissociated experience.

I guess.

It happens.

Maybe someone else is there and has a full narrative of it, but you're just like, what, where was I?

Yeah.

Yeah.

But I think as you know, the more common experiences that you have some, like you're kind of an observer while someone else takes the wheel and drives on.

Yeah.

So I think setting the stage with those different types of post-traumatic adaptation, and then as far as what's going on in the brain, when someone's feeling symptomatic, um, the way researchers typically study this, they're called symptom provocation paradigms.

Yeah.

They, um, have folks come in and narrate a traumatic experience they've had.

They play this recording back to them while they're in a scanner.

Um, the idea being that while someone's feeling triggered or symptomatic, then they can capture what's happening in the brain at those moments while they're getting immersed in this traumatic experience that they had in the past.

So this is the functional changes, like as it's happening, this is the different activity in the moment.

Exactly.

Yes.

Okay.

Great.

And so typically what happens in this paradigm for someone without PTSD, uh, is that, well, actually I should first talk about two key brain regions that often come up in this paradigm and have been studied a lot in the trauma literature, the prefrontal cortex and the amygdala.

And there's a particular region of the prefrontal cortex, right in the middle, in the front called the ventromedial prefrontal cortex.

It's involved in lots of different functions, but kind of as a shorthand, we can think of it as an executive controller helping to regulate our emotional and physical reactions to things.

So that's a key region.

And then also the amygdala, which again, involved in lots of different things.

As a shorthand, we kind of think of it as a salience detector helping to alert us really quickly to things that would be important to pay attention to for our survival.

And one example of something that's important to pay attention to are potential threats.

And so for someone in this symptom provocation paradigm who doesn't have PTSD, typically what you'd see is a rapid activation of amygdala to help mount a full body stress response to deal with this threatening information.

And then once that threat has passed, you see activation of ventromedial prefrontal cortex kind of helping to dam things down, regulate things, because that threat isn't actually there.

You're just listening to a narrative about what's happened to you.

So that's how it typically works in PTSD and classic PTSD.

So that where you're on the roller coaster, you're feeling that big hyper arousal response.

We see activation in the amygdala, but less activation in the ventromedial prefrontal cortex.

So it's as if the brakes are off in a way, and your body's kind of constantly mounting the stress response to deal with threats, even when they're not there anymore.

So that's classic PTSD.

The dissociative subtype where you've got that more detachment from the experience with the use of dissociation, we see the opposite pattern.

So more activity in the ventromedial prefrontal cortex, less activity in regions like the amygdala.

So it's kind of like the brakes are on too tightly.

They're almost like too good at dampening things down, and that matches what people say about their experience, that they feel numb and detached in those triggered moments.

And then for folks with DID, Simone Reinders has done a lot of this work in this paradigm where she has folks, she and her team have folks listen to the trauma narrative in two different self-states.

So one that feels more hyper-aroused, emotionally flooded, and has some ownership over the trauma memory, feels that it happened to them personally.