Treatments for combat-related PTSD

Posttraumatic stress disorder (PTSD) is a very broad category involved in psychological disorders. PTSD is "consequence of terrifying occurrences, both natural and manmade, which shock the psychological system and violate core assumptions that life is predictable, safe, and secure" (Sharpless). Combat PTSD is common in soldiers that have experienced time in combat on the battlefield where they were exposed to many different traumatic scenes and situations. In the United States, the people that are involved with the treatment of combat PTSD are most likely employed by Veteran Affairs (VA). The treatments and therapies discussed will be prolonged exposure therapy, eye movement desensitization and reprocessing, cognitive processing therapy, drug therapy, and a few other therapies that are less practiced.

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. They 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 traumarelated 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)

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]

Experimental treatment

Alternative medicine is any practice that is put forward as having the healing effects of medicine.[5][6] 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.[5][6] 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.[7] 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.[7] It was later made illegal and was not used in the medical community.[7] In 2015, despite being a schedule 1 drug, the FDA approved four clinical studies on its effectiveness to treat PTSD.[7] It was later reported from the study that 83 percent of veterans claimed to be cured of PTSD.[8] These results are considered to be promising especially considering only 25 percent of veterans were cured from talk therapy.[8] However, many people in the medical community are still skeptical. The Veterans Administration is strongly opposed to the use of MDMA. Since it is a schedule one drug, the number of participants in the clinical trials are very small.[8] It is also believed that long term use has a negative effect on the brain. Many of the veterans who are treated with MDMA use it as a last resort after all other treatment has failed.

Magnetic resonance therapy

Magnetic resonance therapy (MRT) is one of the leading forms of alternative treatment for Post traumatic stress disorder. It works by sending magnetic and radio waves in the body. The powerful magnets pull on the protons of the hydrogen atoms in the body so that they line up in the directions of the magnetic field.[9] When the scanner switches the magnetic waves on and off, the protons move. The procedure pulses energy from magnetic coils into the cortex.[10] This is known as brain zapping.[10] It is highly controversial and is not used by the veterans administration. Two of the only places that perform this form of treatment is the Brain Treatment Center in California and Johns Hopkins Medical Center in Baltimore.[10] All veterans receive the treatment free of charge. It has been used ever since it was approved by the FDA in 2008. Since its approval there have been an increased number of studies. Over 100 veterans have taken advantage of this new treatment. Many of the veterans who are treated report having a decreased number of symptoms, and in some cases are cured. One of the leading doctors in this treatment is Yi Jin. He is the medical director at the brain treatment center. He believes that with an increase in medical research, it will gain acceptance within the medical community.[10]

Tapas Acupressure Technique

The Tapas Acupressure Technique or TAT is an alternative energy therapy that claims to remove negative emotions and past traumas. It was started in 1993 by Tapas Fleming.[11] The roots of TAT treatment are derived from acupuncture. It is a pose that involves putting pressure on the area between your eyes with one hand, and putting pressure on the back of your head with the other hand.[11] While it is not considered a solution for treating PTSD, many patients will use it as a way to complement more conventional treatment. Even though there is no scientific evidence that it works, many veterans will use it as a way to help them relax.[12]

Thought Field Therapy

Thought Field Therapy or TFT is a fringe psychological treatment that was developed by American psychologist Roger Callahan. He believes that mental illness is "the product of disturbances", what is referred to as "thought fields". The idea behind TFT is that by tapping acupuncture points in the body, it will relieve the sufferer from emotional pain.[13] While these acupuncture points are being tapped on, there are 9 things that the patient is instructed to do. Some of these things include having the patient move their eyes in a circular motion and counting numbers.[14] Callahan claims that post-traumatic stress disorder symptoms can be easily relieved in 15 minutes.[14] However, many mental health doctors dispute TFT. James Herbert, a psychology professor at Drexel University said that the "scientific status of thought field therapy is basically nonexistent and there is no evidence it does that it claims to do."[14] While it is not widely used among veterans, many have used it as a way to complement more conventional treatment. Callahan teaches classes on TFT throughout the country, and also allows people to purchase his program through his website. Since it is a fringe treatment, there have not been any studies done on the benefits that it has for veterans.

Emotional Freedom Technique

The Emotional Freedom Technique or EFT is a form of psychological acupuncture that is very similar to TFT. The treatment begins by first having the patient select a problem that is causing them distress.[15][16] Then they name the emotion that they are feeling at the current time and identify the body part where they are feeling the emotion.[15][16] For example, a patient may be feeling sadness in the pit of their stomach. The whole point is to have the patient overcome this emotion by accepting themselves. They do this by placing pressure on certain points in the body, while verbally stating that they accept themselves for who they are. While all of this is going on, they also will perform other tasks such as rolling their eyes from side to side. The technique combines exposure, cognitive resurrecting, waking hypnosis, and physical relaxation while tapping on a sequence of pressure points and repeating key phrases out loud.[15] It is believed that the physical stimulation of certain pressure points during exposure to an emotional trauma may send deactivating signals directly to the amygdala, also known as the fear center of the brain.[15]

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.[17][18] The needles are extremely thin and are placed at strategic points throughout the body.[17] Acupuncture has long been part of traditional Chinese medicine. The Chinese explain acupuncture as "as 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.[17] The military first started using acupuncture in 1864 as a way to treat wounded Civil War veterans.[19] 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.[18] A German study looked at over 2 million acupuncture patients, and found that 8.6 percent suffered from at least one side effect.[19] 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.[19] 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.[19] 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.[20] 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."[20] Many yoga instructors are offering their services to veterans who need them. While it hasn't always been accepted by the medical community, many doctors are now starting to see its benefits. The Veterans Administration offers a wide range of yoga and meditation to treat PTSD.

Music therapy

Music therapy has a long history of helping U.S. veterans. Early on musicians would perform for the veterans who returned from Europe in the World Wars.[21] Doctors began to notice the positive emotional response that many of the veterans had.[21] It is currently one of the few types of alternative treatment that is funded by the veteran's administration. Walter Reed Medical Center has the first treatment program to test out the effectiveness of music therapy. There are currently 50 licensed music therapists that work for the VA.[21] Some of the things that may take place during a therapy session include matching the rhythm placed on the therapists instrument and listening for changes in the therapists rhythm.

Various forms of music therapy are an effective and powerful healing resource for the treatment of combat veterans suffering from anxiety, depression, and Post-Traumatic Stress Disorder or PTSD. 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 pilot study showed remarkable results in terms of measurable positive outcomes. The veterans reported improvement in skill levels, but they also reported improvement in their emotional and psychological characteristics. This study has provided a solid foundation for further research into music therapy practices and it strongly advocates for more academic investigation (Dillingham and Zablocki).



Dillinger, Timothy and Clement Zablocki. “Guitars for Vets: Evaluating psychological outcome of a novel music therapy.” va.gov. September 2011. Web. 31 October 2016.

Other therapies

Nightmare therapy

Many veterans that suffer from combat-related PTSD sometimes suffer from reoccurring nightmares from past traumatic or scary experiences. The positive outcomes from this type of therapy suggest that it is highly effective. For this type of therapy, the therapist needs to select techniques for treatment that will help increase the understanding of the anxiety-producing features of the nightmares. These techniques should be based on the likely chance of getting rid of the nightmare or decreasing the anxiety-producing features of the nightmare.[22] One form of treatment for nightmares is through learned lucid dreaming, causing one to become aware they are dreaming enabling a sense of control.[23]

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.[24]

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 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 major reduction in PTSD symptoms. Positive results are being shown using VR for treating people suffering from PTSD after a traumatic event.[25]

Soul- and energy-based healing methods

Psychotherapy, translated from the original Greek, means therapy of the psyche, or the soul. As part of the healing process, PTSD sufferers need to make peace with their dead friends, relatives, ancestors, and others that they had a relationship with. Accepting their presence is critical in healing the trauma of death and pain for the survivors. Allowing themselves to feel the pain, to grieve and forgive, re-humanizing and honoring the other, makes the soul return to its initial healed state. Alternative PTSD treatment, such as shamanic healing, Emotional Freedom Techniques (EFT), BodyTalk and others, address the necessary elements to heal the psyche in its core.

Transcendental Meditation technique

The David Lynch Foundation works with the US Department of Veterans Affairs to give the Transcendental Meditation technique to veterans.[26] Foundation launches in 2006 "Operation Warrior Wellness".[27] Recent research shows that regular practice of Transcendental Meditation enables some active duty service members battling post-traumatic stress disorder to reduce or even eliminate their psychotropic medication and get better control of their often-debilitating symptoms, researchers report in the journal Military Medicine.[28] Transcendental Meditation technique shows marked efficacy in treating anxiety disorders says a meta-analysis of randomized controlled trials, "TM practice is more effective than treatment as usual and most alternative treatments, with greatest effects observed in individuals with high anxiety."[29] And a meta-analysis says: "Differential effects of relaxation techniques on trait anxiety: a meta-analysis. Effect sizes for the different treatments (e.g., Progressive Relaxation, EMG Biofeedback, various forms of meditation, etc.) were calculated. Most of the treatments produced similar effect sizes except that Transcendental Meditation had significantly larger effect size (p less than .005)"[30]

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) but it is encouraged for patients who participate in pharmacotherapy to also participate in psychotherapy (talk therapy) simultaneously. The key to successful medication treatment is matching the medicine to the patient. In particular, antidepressants are highly used in the treatment of PTSD because of the likelihood of depression involved with PTSD patients. The most popular types of medications for drug therapies are monoamine oxidase inhibitors (MAO), tricyclic antidepressants (TCAs), selective serotonin reuptake inhibitors (SSRIs), mostly focusing on SSRIs because MAOIs and tricyclics have more harmful side effects.[31]

Selective seretonin reuptake inhibitors (SSRIs)

The only two medications for PTSD that are approved by the FDA and have the strongest empirical evidence of being safe and well tolerated are SSRIs called Paxil and Zoloft. Paxil and Zoloft are ranked as the first-line (first choice) treatments for PTSD. These medications focus on the neurotransmitter serotonin and are helpful in regulating mood, anxiety, appetite, and sleep.[32] They increase the amount of serotonin, contributing to a more positive mood. To achieve maximum benefits from SSRIs, treatment focuses on the correct dosages and duration of treatment. According to the APA Practice Guidelines, "SSRIs have proven efficacy for PTSD symptoms and related functional problems".[33]

Tricyclic antidepressants

There is not as much research to support TCAs' effectiveness as there is for SSRIs. If a patient did not respond to or tolerate SSRIs, the therapist might move on to prescribing a TCA. Some studies have shown them to be more effective than the placebo which allows them to still have a role in the treatment of PTSD.[33]

Monoamine oxidase inhibitors (MAOIs)

MAOIs are a third-line medication if other medications like SSRIs and TCAs proved ineffective for a patient. They are third-line due to the possible side effects and the strict diet (minimizing dietary intake of the amino acid tyramine) patients have to adopt while taking this type of medication. If patients observe the dietary restrictions, MAOIs can be clinically effective in reducing PTSD symptoms.[33]

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.
  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. 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.
  6. 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.
  7. 1 2 3 4 "From Club To Clinic: How MDMA Could Help Some Cope With Trauma". NPR.org. Retrieved 2016-05-07.
  8. 1 2 3 Chabrol, Henri (2013). "MDMA Assisted Psychotherapy Found To Have A Large Effect For Chronic Post-Traumatic Stress Disorder" (PDF). Journal Of Psychopharmacology.
  9. ↑ "Overview - Transcranial magnetic stimulation - Mayo Clinic". www.mayoclinic.org. Retrieved 2016-05-07.
  10. 1 2 3 4 Leiby, Richard (2015-01-12). "'Brain zapping': Veterans say experimental PTSD treatment has changed their lives". The Washington Post. ISSN 0190-8286. Retrieved 2016-05-07.
  11. 1 2 Porpiglia, Tom. "Tapas Acupressure Technique". www.lifescriptcounseling.com. Retrieved 2016-05-07.
  12. ↑ McCaslin, Danny. "A Review Of Efficacy Claims In Energy Psychology".
  13. ↑ "Founder of Tapping | TFT Thought Field Therapy | Roger Callahan". tfttapping.com. Retrieved 2016-05-07.
  14. 1 2 3 "Unorthodox Therapy in New Orleans Raises Concern". NPR.org. Retrieved 2016-05-07.
  15. 1 2 3 4 "How Tapping Can Help You Zap Your Anxiety". The Huffington Post. 2014-10-27. Retrieved 2016-05-07.
  16. 1 2 Lynch, Elizabeth (2007). "Emotional Acupuncture". Royal College of Nursing.
  17. 1 2 3 "Acupuncture - Mayo Clinic". www.mayoclinic.org. Retrieved 2016-05-07.
  18. 1 2 "Acupuncture for PTSD | Pacific College". www.pacificcollege.edu. Retrieved 2016-05-07.
  19. 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.
  20. 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.
  21. 1 2 3 "Music Therapy and the Military". The Huffington Post. 2013-01-02. Retrieved 2016-05-07.
  22. ↑ Coalson B (1995). "Nightmare help: Treatment of trauma survivors with PTSD". Psychotherapy: Theory, Research, Practice, Training. 32 (3): 381–388. doi:10.1037/0033-3204.32.3.381.
  23. ↑ Imants, Baruss (2003). Alterations of Consciousness. Washington, DC: American Psychological Association.
  24. ↑ 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.
  25. ↑ 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
  26. ↑ Office of Public and Intergovernmental Affairs - David Lynch Foundation
  27. ↑ Operation Warrior Wellness official website. Retrieved 17 February 2013
  28. ↑ PTSD Symptoms May Be Reduced With Transcendental Meditation - Neuroscience News January 11, 2016
  29. ↑ David W. Orme-Johnson, Vernon A. Barnes (2014). "Effects of the Transcendental Meditation Technique on Trait Anxiety: A Meta-Analysis of Randomized Controlled Trials". THE JOURNAL OF ALTERNATIVE AND COMPLEMENTARY MEDICINE. 20 (5): 330–341. doi:10.1089/acm.2013.0204.
  30. ↑ Eppley K, et al. (1989). "Differential effects of relaxation techniques on trait anxiety: a meta-analysis". Journal of Clinical Psychology (45): 957–974. PMID 2693491.
  31. ↑ Giller, EL (ed.) (1990). Biological Assessment and Treatment of Posttraumatic Stress Disorder. Washington DC: American Psychiatric Press, Inc.
  32. ↑ "Clinician's Guide to Medications for PTSD". U.S. Department of Veterans Affairs. 2009.
  33. 1 2 3 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

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