'Tis the season of intense emotions and evoked memories.
For some, however, the holiday time can generate feelings of grief, anxiety, loss and pain. Articles in journals and magazines talk about seasonal pathology: holiday blues, "Christmas Neurosis," seasonal mood disorders. We even hear about "Holiday Heart," a form of cardiac abnormality, or worse, the "Merry Christmas Coronary."
Holiday stress is well-documented in the mental health community as well. Dec. 25 and many other holiday or "anniversary" dates can be highly significant. These include birthdays, marital anniversaries and days when loved ones died. Such memorial events often trigger a powerful emotional and physical remembrance of a loved one or event, and the various feelings that attend a significant personal loss. This phenomenon, often deeply painful, is called an "Anniversary Reaction." Unless it is understood, the anniversary reaction can strike without warning, making its effects all the more disturbing.
Anniversary reactions are considered the re-experience of a prior traumatic event -- a death, a disaster or an individual tragedy. They are triggered by a specific date or event that strikes a chord deep inside our minds, which can be a traumatic portal to the past. A birthday, a notable date or a holiday can link to an earlier moment in our lives that was full of trouble, hurt or conflict. When they do occur, a person who may be highly functioning can be overcome and feel powerlessness, even immobilized.
Painful memories, unfortunately, cannot be simply deleted from the brain. The mind, after all, is a dedicated timekeeper and diarist. "Nothing improves the memory more than trying to forget," as the old saying goes.
Not all traumas elicit an anniversary reaction. But for those vulnerable, a memorial day or event can produce responses as varied as sadness, anger, anxiety, nightmares, difficulty concentrating, poor eating and despair. Bodily disturbances, such as headaches, back pain, gastrointestinal distress or numbness can also occur.
The specific time or date might seem obvious, like a known anniversary date of a loss or an important calendar date. But sometimes the trigger is elusive -- even hidden from awareness. Freud recognized that painful memorials could be unconscious or entirely beyond a person's awareness. He wrote about the case of Fraulein Elisabeth von R who experienced grief upon the anniversaries of the deaths of close relatives she had nursed. Clinical examples familiar to these authors include a 45-year-old man's anniversary reaction upon reaching the age that his father died, a patient who annually became overwhelmed with grief upon the anniversary of her brother's death, and holiday depressive states in a person who lost his spouse during the holidays. These reawakened traumas struck predictably as if without warning.
Anniversary reactions can also be experienced culturally. The assassination of a great leader, a plane crash, terrorist acts (like 9/11) and natural disasters can be profoundly distressing to survivors and witnesses alike. These memorial events are shared in a society; there can be solace among those who lived through the traumatic event.
The brain pays mind to all things and is a bottomless drop box. Memories can be classified: declarative (explicit "facts" that you can recall into consciousness), procedural (implicit learning whereby your writing hand knows how to manipulate a pencil), topographical (your brain's GPS system), and emotional memory (your feelings associated with an event). Neurotransmitters -- such as dopamine, norepinephrine and serotonin -- carry messages across neurons, thereby sending signals to the brain's memory coding structures. These centers include: the hippocampus (the recordable hard-drive), the amygdala (the brain's walnut-sized emotional diarist), and the hypothalamus (the nerve center that regulates the body's hormones).
The neuroscience of creating a traumatic memory is quite complex. As much as we might want to forget a trauma or loss, the hyper-activated (traumatically overwhelmed) brain takes snapshots -- the date of the event, the clock on the wall, the smell of an apple, the angle of the sun, and other cues -- and imprints them into the brain's fear circuit.
Scientists are certain that the amygdala is the powerful processor that records the emotional memories associated with a trauma. Trauma also puts the hypothalamus on high alert and mobilizes the body's stress responses, including the fight-or-flight reaction that increases heart rate and blood pressure and causes sweating and greater blood flow to the muscles. Like a well-conducted orchestra, the mind harmonizes the cues of the trauma with intense feelings and bodily responses.
Later, a specific event date triggers the memory, which in turn unleashes a traumatic response in mind and body. The anniversary reaction occurs. It is unclear how vulnerable each individual person may be to anniversary reactions. Is there an anniversary-prone amygdala? That remains unknown.
Anniversary events are not protracted. Nor are they characterized by the extended emotional downs associated with Seasonal Affective Disorder (SAD). They also are different from what is called survivor's guilt, a paradoxical phenomenon where someone who survives a horrific experience feels worse, not better. Anniversary reactions are more potent and disruptive than "déjà vu," the odd feeling of having been there before. Anniversary reactions are common. They are quite a normal human reaction to moments in time that carry significant meaning in our lives.
How you can master the anniversary reaction:
1. Foresight. Anticipating an anniversary event can be as good as 20/20 hindsight, maybe better. By considering when you are vulnerable to a traumatic memory, you can be on the lookout for its triggers and expect -- and thereby diminish -- their impact. Awareness of an anniversary reaction means knowing what moments are important to you. With foresight you can eliminate the unexpected and take actions (see below) to minimize your response. Time will take you the rest of the way.
2. Rituals. Coping strategies to control the psychological and somatic responses to a troubling anniversary are ancient. Rituals to commemorate a loss, support mourning and affirm life abound in organized religions. Ceremonies to work through and strengthen coping during anniversary reactions can be extremely beneficial: in Judaism there is the Yarzheit to commemorate an annual mourning, Hindus practice Shraaddha, and the Day of the Dead helps many Catholics dissipate painful grief. Visiting a grave, sharing the event with others impacted or attending a religious service can dissipate the pain. Spiritual support groups, individual or group prayer and meditation can also provide great comfort.
3. People. Our family and friends are often the best medicine. An important element of self-care is maintaining strong social bonds, talking to people as much as fits your needs, and spending time with others. Reaching out to friends and families, engaging in enjoyable activities, and seeking out those you like and trust all can be terrific antidotes during a vulnerable time. Tolerating an anniversary reaction is best done when you are not all by yourself.
Is it possible to erase a bad memory? Scientists are working on isolating the chemicals of the anniversary reaction and other traumas. Recently, a group at the SUNY Downstate Medical Center isolated a molecule in animals called PKMzeta, which is involved in the imprinting of negative memories. This protein appears between neurons when memories are created and likely enhances memory formation. When the drug ZIP -- a PKMzeta blocker -- was given to animals it seemed to inactivate traumatic recollections.
While ZIP is not ready to be a stocking stuffer this season, let's hope that the anniversary reaction is something we will all be able to forget about someday in the future.
Stein DJ, Rauch SL. (2010). "Neuropsychiatric Aspects of Anxiety Disorders" in Essentials of Neuropsychiatry and Behavioral Neurosciences. Eds. SC Yudofsky, RE Hales. Virginia: American Psychiatric Publishing.
Shin LM, Liberzon, I. (2010). The Neurocircuitry of Fear, Stress, and Anxiety Disorders. Neuropsychopharmacology, 35, 169-191.
Phan KL, Wager TD, Taylor SF, Liberzon I. (2004b). Functional Neuroimaging Studies of Human Emotions. CNS Spectrums, 9, 258-266.
The opinions expressed here are solely those of Drs. Erlich and Sederer, as physicians and public health advocates. Neither receives support from any pharmaceutical or medical device company.
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