Treatments for PTSD

Posttraumatic stress disorder (PTSD) is a psychiatric disorder that can develop in certain individuals after exposure to traumatic events, such as combat and sexual assault. PTSD is commonly treated with various types of psychotherapy and pharmacotherapy.

Psychotherapy

Prolonged exposure therapy (PE)

This type of therapy involves exposing the patient to traumatic or scary memories. In this treatment, there will most likely be from 8 to 15 sessions of this exposure. Patients will first be exposed to a past traumatic memory; following is an immediate discussion about the traumatic memory and, "in vivo exposure to safe, but trauma-related, situations that the client fears and avoids".[1] The goal of this therapy is "to reduce their emotional impact in terms of cognitive (thoughts), behavioral (behavior), or physiological effects (physical)".[2] Slowed breathing techniques and educational information is also touched on in these sessions.

Eye movement desensitization and reprocessing (EMDR)

There are eight phases of EMDR treatment. The therapy involves clients or patients to think of upsetting images while they track the therapist moves her fingers back and forth in front of the patient. Adding to that, the client is asked to think of positive thoughts while they follow the fingers back and forth, then they write down what they are thinking.[1] This treatment is found to be similarly effective as exposure therapy.

EMDR is successful because of its neurophysiological basis. The development of PTSD is related to an error in the storage of the memory of the event. This dysfunction is often caused by the memory of the trauma being stored with the same emotionally arousing state that it was encoded in. Because of this, the information does not progress through the normal steps of integration and instead results in "continual activation" of the information by certain stimuli.[3] This manifests itself in the common symptoms of flashbacks, nightmares, etc. It has also been hypothesized that these symptoms are the result of "repeated unsuccessful attempts of the information-processing mechanism to complete its own processing."[3]

The processing of emotionally arousing information results in an earlier activation of the amygdala and subsequently disrupts integration. This arousal causes the information from the trauma to be "stored as sensory fragments, with emotions experienced as physical states rather than verbally coded experiences free of excessive affective load."[3] There is also evidence that PTSD symptoms correlate with neurobiological changes in the brain.

A proposed neurophysiological basis behind EMDR is that it mimics REM sleep, which plays a vital role in memory consolidation. Imaging studies suggest that "eye movements in both REM sleep and wakefulness activate similar cortical areas."[4] Thus, the reorientation facilitated by EMDR "shifts the brain into a memory processing mode" without "integration of traumatic memories into associative cortical networks without interference from hippocampally mediated episodic recall."[4] The information can then be integrated completely, which consequently weakens the episodic memory of the event and the associations it produced. The restoration of the pathway can lead to recovery from PTSD.

Some other theories are similar in that they propose a physiological component of PTSD, whether it be specific structures or hormones or a combination. It is an area that is still not fully understood.

Cognitive processing therapy (CPT)

Cognitive Processing Therapy is a type of manualized therapy that was originally developed by Patricia Resick and Monica Schnicke to treat Post-Traumatic Stress Disorder in rape victims, using Information Processing Theory and Cognitive Behavioral Therapy.[5] This involves both cognitive (thinking) and exposure elements. It is a type of cognitive behavioral therapy that focuses on cognitive (thinking) interventions. There are usually 12 sessions of the treatment that involve writing and reading activities. In short, activities involved with this therapy include the clients being asked to write about their traumatic or scary memories in detail, and then read these memories to themselves daily and aloud in therapy sessions.[1]

Pharmacotherapy

Drug therapy, known as pharmacotherapy, is widely used as a treatment for PTSD. Drug therapy is considered less time consuming and easier to continue than psychotherapy (talk therapy). The only two medications for PTSD that are approved by the FDA are sertraline and paroxetine, both antidepressants of the selective serotonin reuptake inhibitors (SSRI) class.[6]

Antidepressants

Antidepressants are widely used in the treatment of PTSD and have consistently shown efficacy, though the magnitude of improvement is often modest. The most popular types of antidepressants are SSRIs, atypical antidepressants, tricyclic antidepressants (TCAs), and monoamine oxidase inhibitors (MAOs).[6] SSRI are most often used as they are considered safer than TCAs and MAOIs.[7] To date, only sertraline and paroxetine carry FDA approval for PTSD, though in general, all SSRIs seem similarly effective. These medications appear to be helpful across all PTSD symptoms.[8] According to the APA Practice Guidelines, "SSRIs have proven efficacy for PTSD symptoms and related functional problems".[9]

Other medications

Prazosin, an alpha-adrenoreceptor antagonist, is also widely prescribed, particularly for sleep-related symptoms. Early studies had shown evidence of efficacy,[6] though a recent relatively large trial failed to show a statistically significant difference between prazosin and placebo.[10] Antipsychotic medications have also been prescribed to treat PTSD, though clinical trials have not yielded consistent evidence for their efficacy.[6]

Experimental treatment

Alternative medicine is any practice that is put forward as having the healing effects of medicine.[11][12] Its characteristics are that it does not originate from evidence gathered using the scientific method, is not part of bio-medicine, and is contradicted by scientific evidence or established science.[11][12] Over the last decade, alternative treatment has become more and more common in treating veterans with post traumatic stress disorder. It is often used selectively in clinical trials. While it is not yet excepted medical treatment, there are often studies being done to test its effectiveness. Usually, it is used as a last resort due to the failure of conventional treatment.

MDMA

MDMA, known as the recreational drug Molly, has recently been seen as an alternative way of treating post traumatic stress disorder. It is used complementary to psycho-therapy. MDMA releases serotonin, dopamine, and oxytocin in the brain.[13] It creates a state where the patient feels very calm. This allows them to open up more with their therapist because they are able to trust them more. It was first used as treatment during the late '70s and early '80s.[13] It was later made illegal and was not used in the medical community.[13] In 2015, despite being a Schedule I drug, the FDA approved four clinical studies on its effectiveness to treat PTSD.[13] It was later reported from the study that 83 percent of veterans claimed to be cured of PTSD.[14] These results are considered to be promising especially considering only 25 percent of veterans were cured from talk therapy.[14] However, since it is a Schedule I drug, the number of participants in the clinical trials are very small.[14]

Acupuncture

Acupuncture is one of the most practiced forms of alternative medicine. It involves the insertion of needles into the body by a trained and licensed medical doctor.[15][16] The needles are extremely thin and are placed at strategic points throughout the body.[15] Acupuncture has long been part of traditional Chinese medicine. The Chinese explain acupuncture as "a technique for balancing the flow of energy or life force" throughout your body. However, many western doctors see acupuncture as a way to stimulate nerves, muscles, and connective tissue.[15] The military first started using acupuncture in 1864 as a way to treat wounded Civil War veterans.[17] In recent years acupuncture has been seen as an effective way of treating PTSD. Evidence on the effectiveness of using acupuncture are still being looked at by doctors. Many of the side effects of acupuncture include blood clotting, warfarin use, severe psychiatric conditions, and skin infections.[16] A German study looked at over 2 million acupuncture patients, and found that 8.6 percent suffered from at least one side effect.[17] The military stress recovery (veterans) project, which began in 2006, provides free acupuncture to veterans returning from the wars overseas. While it was started in Albuquerque, there are now locations in places like Boston, Chicago, and Seattle.[17] There are currently 20 clinics in operation, with many more clinics in the process of opening. Veterans at these clinics reported full nights' sleep, improved mental clarity, less anxiety, and reduced stress.[17] The VA hospital is currently researching the viability of using such treatment as a way of treating PTSD.

Yoga

There has been a sudden rise in the use of yoga to treat PTSD. Yoga is often used as an adjunctive form of treatment.[18] The Pentagon and the Department of Veterans Affairs researchers have found that yoga's stretching, breathing techniques, and meditation can "help calm the part of the brain that the stresses of war kicks in to state of hyper-arousal."[18]

Music therapy

A study on the positive effects of music therapy took place at the Zablocki VA Medical Center in Milwaukee, Wisconsin. The scientists conducting this study introduced 68 veterans diagnosed with PTSD to the experience and interaction with music. The veterans were given weekly private and group guitar lessons. The soldiers were either new to the instrument or had some previous experience playing the guitar or another instrument. This preliminary study showed potentially encouraging results. The veterans reported improvement in skill levels, but they also reported improvement in their emotional and psychological characteristics. Link to project abstract.

Trauma group therapy

In trauma group therapy, the groups range from 12 to 18 members and are completed over a 10- to 12-week period. The goal of the group therapy is help the patients remember and examine their war experiences so that they can work them in with the rest of their lives. They are encouraged to remember their experiences as clear as possible without hiding or omitting details. The group part of this therapy helps the veterans develop the feeling that they belong because of the other veterans that are experiencing the same problems. This allows them to establish positive relationships with other group therapy members. It provides a sort of safe and supportive peer group.[19]

Virtual reality therapy

Virtual reality or VR technology is now being introduced to help treat patients with PTSD. Researchers began experimenting with VR in 1997 with the advent of the "Virtual Vietnam" scenario. Virtual Vietnam was used as a graduated exposure therapy treatment for Vietnam veterans meeting the qualification criteria for PTSD. A 50-year-old Caucasian male was the first veteran studied. The preliminary results concluded improvement post-treatment across all measures of PTSD and maintenance of the gains at the 6-month follow up. Subsequent open clinical trial of Virtual Vietnam using 16 veterans, showed a reduction in PTSD symptoms.[20]

Transcendental Meditation technique

Preliminary research shows that regular practice of Transcendental Meditation may benefit some active duty service members battling post-traumatic stress disorder.[21]

References

  1. 1 2 3 Sharpless BA Barber JP (2011). "A clinician's guide to PTSD treatments for returning veterans". Professional Psychology: Research and Practice. 42 (1): 8–15. doi:10.1037/a0022351. PMC 3070301.
  2. ↑ Carlson JG Chemtob CM Rusnak K Hedlund NL (1996). "Eye movement desensitization and reprocessing treatment for combat PTSD". Psychotherapy: Theory, Research, Practice, Training. 33 (1): 104–113. doi:10.1037/0033-3204.33.1.104.
  3. 1 2 3 Isabel Fernandez; Roger Solomon. "Neurophysiological Components of EMDR Treatment" (PDF).
  4. 1 2 Stickgold, Roger (January 2002). "EMDR: A putative neurobiological mechanism of action". Journal of Clinical Psychology. 58 (1): 61–75. doi:10.1002/jclp.1129. PMID 11748597.
  5. ↑ Resick, Patricia A.; Schnicke, Monica (1993). Cognitive Processing Therapy for Rape Victims: A Treatment Manual. Sage Publications. ISBN 0-8039-4902-2.
  6. 1 2 3 4 Abdallah, Chadi G.; Averill, Lynnette A.; Akiki, Teddy J.; Raza, Mohsin; Averill, Christopher L.; Gomaa, Hassaan; Adikey, Archana; Krystal, John H. (14 September 2018). "The Neurobiology and Pharmacotherapy of Posttraumatic Stress Disorder". Annual Review of Pharmacology and Toxicology. 59 (1). doi:10.1146/annurev-pharmtox-010818-021701.
  7. ↑ Giller, EL (ed.) (1990). Biological Assessment and Treatment of Posttraumatic Stress Disorder. Washington DC: American Psychiatric Press, Inc.
  8. ↑ "Clinician's Guide to Medications for PTSD". U.S. Department of Veterans Affairs. 2009.
  9. ↑ American Psychiatric Association. Practice Guideline for the Treatment of Patients With Acute Stress Disorder and Posttraumatic Stress Disorder. doi:10.1176/appi.books.9780890423363.52257
  10. ↑ Raskind, Murray A.; Peskind, Elaine R.; Chow, Bruce; Harris, Crystal; Davis-Karim, Anne; Holmes, Hollie A.; Hart, Kimberly L.; McFall, Miles; Mellman, Thomas A.; Reist, Christopher; Romesser, Jennifer; Rosenheck, Robert; Shih, Mei-Chiung; Stein, Murray B.; Swift, Robert; Gleason, Theresa; Lu, Ying; Huang, Grant D. (8 February 2018). "Trial of Prazosin for Post-Traumatic Stress Disorder in Military Veterans". New England Journal of Medicine. 378 (6): 507–517. doi:10.1056/NEJMoa1507598.
  11. 1 2 Marcinko, David Edward; Hetico, Hope Rachel (2016-01-06). Risk Management, Liability Insurance, and Asset Protection Strategies for Doctors and Advisors: Best Practices from Leading Consultants and Certified Medical PlannersTM. CRC Press. ISBN 9781498725996.
  12. 1 2 Coulter, Ian D.; Willis, Evan M. (2004-01-01). "The rise and rise of complementary and alternative medicine: a sociological perspective". Medical Journal of Australia. 180 (11). ISSN 0025-729X.
  13. 1 2 3 4 "From Club To Clinic: How MDMA Could Help Some Cope With Trauma". NPR.org. Retrieved 2016-05-07.
  14. 1 2 3 Chabrol, Henri (2013). "MDMA Assisted Psychotherapy Found To Have A Large Effect For Chronic Post-Traumatic Stress Disorder". Journal of Psychopharmacology. doi:10.1177/0269881113495119.
  15. 1 2 3 "Acupuncture - Mayo Clinic". www.mayoclinic.org. Retrieved 2016-05-07.
  16. 1 2 "Acupuncture for PTSD | Pacific College". www.pacificcollege.edu. Retrieved 2016-05-07.
  17. 1 2 3 4 Interlandi, Jeneen (2014-05-22). "A Revolutionary Approach to Treating PTSD". The New York Times. ISSN 0362-4331. Retrieved 2016-05-07.
  18. 1 2 Officer, Department of Veterans Affairs, Veterans Health Administration, Chief Communications. "Veterans Find Contemporary Relief in Ancient Discipline - Health Care". www.va.gov. Retrieved 2016-05-07.
  19. ↑ Rozynko V Dondershine HE (1991). "Trauma focus group therapy for Vietnam veterans with PTSD". Psychotherapy: Theory, Research, Practice, Training. 28 (1): 157–161. doi:10.1037/0033-3204.28.1.157.
  20. ↑ Rizzo AA, Rothbaum BO, Graap K. Virtual reality applications for combat-related posttraumatic stress disorder. In: Figley CR, Nash WP, editors. Combat stress injury: Theory, research and management. New York: Routledge; 2007. pp. 420-425
  21. ↑ PTSD Symptoms May Be Reduced With Transcendental Meditation - Neuroscience News January 11, 2016

Further reading

Non-fiction

  • Coleman, P. (2006). Flashback: posttraumatic stress disorder, suicide, and the lessons of war. Boston: Beacon Press.
  • Esposito, M. (2008). PTSD: Get a Better understanding. Chicago, United States. (Electronic resource).
  • Graff, J. (2008). The Powerful Patient: After the battle post-traumatic stress. Chicago, United States. (Electronic resource).
  • Hoge, C. (2010). Once a warrior- always a warrior: navigating the transition from combat to home - including combat stress, PTSD, and mTBI. Guilford, Conn: GPP Life.
  • Jasper, M. (2009). Veterans' rights and benefits. New York: Oceana.
  • Lawhorne, C. P. (2010). Combat-related traumatic brain injury and PTSD: a resource and recovery guide. Lanham: Government Institutes.
  • Lawlis, G. F. (2010). The PTSD breakthrough: the revolutionary science-based compass reset program. Naperville: Sourcebooks.
  • Paulson, D. S. (2010). Haunted by combat: understanding PTSD in war veterans.

Fiction

  • Abbott, J. (2006). Fear. New York: Dutton.
  • Ellis, D. (2012). The wrong man. New York: G. P. Putnam's Sons.
  • Woolston, B. (2010). The freak observer. Minneapolis: Carolrhoda Lab.
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