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ALTERED DEFAULT MODE NETWORK (DMN) RESTING STATE FUNCTIONAL CONNECTIVITY FOLLOWING A MINDFULNESS-BASED EXPOSURE THERAPY FOR POSTTRAUMATIC STRESS DISORDER (PTSD) IN COMBAT VETERANS OF AFGHANISTAN AND IRAQ.

ALTERED DEFAULT MODE NETWORK (DMN) RESTING STATE FUNCTIONAL CONNECTIVITY FOLLOWING A MINDFULNESS-BASED EXPOSURE THERAPY FOR POSTTRAUMATIC STRESS DISORDER (PTSD) IN COMBAT VETERANS OF AFGHANISTAN AND IRAQ.

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ALTERED DEFAULT MODE NETWORK (DMN) RESTING STATE FUNCTIONAL CONNECTIVITY FOLLOWING A MINDFULNESS-BASED EXPOSURE THERAPY FOR POSTTRAUMATIC STRESS DISORDER (PTSD) IN COMBAT VETERANS OF AFGHANISTAN AND IRAQ.

Depress Anxiety. 2016 Apr;33(4):289-99

Authors: King AP, Block SR, Sripada RK, Rauch S, Giardino N, Favorite T, Angstadt M, Kessler D, Welsh R, Liberzon I

Abstract

BACKGROUND: Recent studies suggest that mindfulness may be an effective component for posttraumatic stress disorder (PTSD) treatment. Mindfulness involves practice in volitional shifting of attention from “mind wandering” to present-moment attention to sensations, and cultivating acceptance. We examined potential neural correlates of mindfulness training using a novel group therapy (mindfulness-based exposure therapy (MBET)) in combat veterans with PTSD deployed to Afghanistan (OEF) and/or Iraq (OIF).

METHODS: Twenty-three male OEF/OIF combat veterans with PTSD were treated with a mindfulness-based intervention (N = 14) or an active control group therapy (present-centered group therapy (PCGT), N = 9). Pre-post therapy functional magnetic resonance imaging (fMRI, 3 T) examined resting-state functional connectivity (rsFC) in default mode network (DMN) using posterior cingulate cortex (PCC) and ventral medial prefrontal cortex (vmPFC) seeds, and salience network (SN) with anatomical amygdala seeds. PTSD symptoms were assessed at pre- and posttherapy with Clinician Administered PTSD Scale (CAPS).

RESULTS: Patients treated with MBET had reduced PTSD symptoms (effect size d = 0.92) but effect was not significantly different from PCGT (d = 0.46). Increased DMN rsFC (PCC seed) with dorsolateral dorsolateral prefrontal cortex (DLPFC) regions and dorsal anterior cingulate cortex (ACC) regions associated with executive control was seen following MBET. A group × time interaction found MBET showed increased connectivity with DLPFC and dorsal ACC following therapy; PCC-DLPFC connectivity was correlated with improvement in PTSD avoidant and hyperarousal symptoms.

CONCLUSIONS: Increased connectivity between DMN and executive control regions following mindfulness training could underlie increased capacity for volitional shifting of attention. The increased PCC-DLPFC rsFC following MBET was related to PTSD symptom improvement, pointing to a potential therapeutic mechanism of mindfulness-based therapies.

PMID: 27038410 [PubMed – in process]

Observational evidence for buprenorphine’s impact on posttraumatic stress symptoms in veterans with chronic pain and opioid use disorder.

Observational evidence for buprenorphine’s impact on posttraumatic stress symptoms in veterans with chronic pain and opioid use disorder.

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Observational evidence for buprenorphine’s impact on posttraumatic stress symptoms in veterans with chronic pain and opioid use disorder.

J Clin Psychiatry. 2016 Mar 1;

Authors: Seal KH, Maguen S, Bertenthal D, Batki SL, Striebel J, Stein MB, Madden E, Neylan TC

Abstract

OBJECTIVE: Posttraumatic stress disorder (PTSD), chronic pain, and substance use disorders are prevalent co-occurring conditions that are challenging to treat individually, and there is no evidence-based treatment for all 3. Buprenorphine, used to treat opioid use disorder and chronic pain, is a partial nociceptin opioid receptor agonist. In preclinical studies, a nociceptin opioid receptor agonist was shown to mitigate PTSD symptoms in acute trauma. We compared buprenorphine to other opioid medications in its impact on PTSD symptoms in patients with chronic pain and opioid and/or other substance use disorders.

METHOD: We assembled a retrospective cohort of 382 Iraq and Afghanistan veterans in US Department of Veterans Affairs health care from October 1, 2007, to July 29, 2013, with ICD-9-CM diagnoses of PTSD, chronic pain, and substance use disorders. We used time-varying general estimating equation models to assess the primary outcome, which was change in PTSD symptoms (measured using the PTSD Checklist and the Primary Care PTSD Screen) among veterans initiated on sublingual buprenorphine versus those maintained on moderately high-dose opioid therapy.

RESULTS: Twice as many veterans in the buprenorphine group (23.7%) compared to those in the opioid therapy group (11.7%) experienced improvement in PTSD symptoms (P = .001). Compared to veterans in the opioid therapy group, veterans receiving buprenorphine showed significant improvement in PTSD symptoms after 8 months, with increasing improvement up to 24 months (incidence rate ratio = 1.79; 95% CI, 1.16-2.77; P = .009). There were no differences in the longitudinal course of pain ratings between groups.

CONCLUSIONS: This observational study is the first to report an incidental effect of buprenorphine compared to opioid therapy in improving PTSD symptoms in veterans.

PMID: 27035058 [PubMed – as supplied by publisher]

Psychological therapies for chronic post‐traumatic stress disorder (PTSD) in adults

Psychological therapies for chronic post‐traumatic stress disorder (PTSD) in adults Background: Post‐traumatic stress disorder (PTSD) can occur following a traumatic event. It is characterised by symptoms of re‐experiencing the trauma (in the form of nightmares, flashbacks and distressing thoughts), avoiding reminders of the traumatic event, negative alterations in thoughts and mood, and symptoms of hyper‐arousal (feeling on edge, being easily startled, feeling angry, having difficulties sleeping, and problems concentrating).

Mindfulness Training May Ease PTSD

Mindfulness Training May Ease PTSD

Study of war veterans shows the therapy triggers brain changes that seem to help manage thoughts, memories

HealthDay news image

Source: HealthDay

Mindfulness Training Leads to Brain Changes in Vets With PTSD

Mindfulness Training Leads to Brain Changes in Vets With PTSD

Mindfulness Training Leads to Brain Changes in Vets With PTSD

New research shows the promise of mindfulness training for helping veterans with Post-Traumatic Stress Disorder (PTSD) manage the memories and thoughts that keep playing over and over in their minds in an endless loop.

Even more surprising, according to researchers, is that the veterans’ brains actually changed in ways that may help them find their own off switch for that endless loop.

The findings, published in Depression and Anxiety by a team from the University of Michigan Medical School and VA Ann Arbor Healthcare System, come from a study of 23 veterans of Iraq and Afghanistan.

All of the vets got some form of group therapy. After four months of weekly sessions, many reported that their PTSD symptoms eased up.

But only in those who got mindfulness training — a mind-body technique that focuses on in-the-moment attention and awareness — did the researchers see the brain changes.

The changes showed up on functional MRI, or fMRI, brain scans that can visualize brain activity as different areas of the brain “talk” to one another through networks of connections between brain cells, according to the researchers.

Before the mindfulness training, when the veterans were resting quietly, their brains had extra activity in regions involved in responding to threats or other outside problems. This is a sign of that endless loop of hypervigilance often seen in PTSD, researchers noted.

But after learning mindfulness, they developed stronger connections between two other brain networks: The one involved in our inner, sometimes meandering, thoughts, and the one involved in shifting and directing attention.

“The brain findings suggest that mindfulness training may have helped the veterans develop more capacity to shift their attention and get themselves out of being ‘stuck’ in painful cycles of thoughts,” said Anthony King, Ph.D., a University of Michigan Department of Psychiatry researcher who led the new study in collaboration with VA psychologists.

“We’re hopeful that this brain signature shows the potential of mindfulness to be helpful for managing PTSD for people who might initially decline therapy involving trauma processing,” he said. “We hope it may provide emotional regulation skills to help bring them to a place where they feel better able to process their traumas.”

In all, 14 of the veterans finished the mindfulness sessions and completed follow-up fMRI scans, and nine finished the comparison sessions and had scans. The small size of the group means the new results are only the start of an exploration of this issue, King said.

Source: University of Michigan Medical School and VA Ann Arbor

 

PHOTO: The colorful areas show the two brain regions where veterans trained in mindfulness saw the biggest increases in connections, using powerful fMRI scanners.Credit: University of Michigan/VA Ann Arbor.

PTSD May Hike Risk of Heart Attack, Stroke

PTSD May Hike Risk of Heart Attack, Stroke

PTSD May Hike Risk of Heart Attack, Stroke

Post-traumatic stress disorder (PTSD) may reduce the ability of blood vessels to fully dilate, which may raise the risk of heart attack and stroke, according to a new study of veterans published in the Journal of the American Heart Association.

The findings showed that the blood vessels of veterans with PTSD were less reactive and did not expand normally in response to stimuli compared to veterans without PTSD. Less reactive blood vessels are associated with the development of heart disease and other serious conditions.

“Traditional risk factors such as high blood pressure, diabetes, high cholesterol and smoking, have not fully explained why people with PTSD seem to be at higher heart disease risk. Our study suggests that chronic stress may directly impact the health of the blood vessels,” said lead author Marlene Grenon, M.D., associate professor of surgery at the University of California San Francisco and vascular surgeon at the Veterans Affairs Medical Center San Francisco /Veterans Affairs Medical Center-Surgical Services.

For the study, the researchers used a standard test known as flow-mediated dilation (FMD) to gauge how well an artery in the arm relaxes and expands in response to the squeezing of a blood-pressure cuff.

They compared the FMD scores of 67 veterans (average age 68, 99 percent male) with PTSD and 147 veterans (average age 69, 91 percent male) without PTSD. The presence of PTSD was defined as a score of 40 or higher on the PTSD Symptom Checklist.

The findings showed that veterans with PTSD had significantly lower FMD scores; that is, their blood vessels expanded only 5.8 percent compared to 7.5 percent among non-PTSD veterans, indicating a less-healthy response in the lining of their blood vessels.

Veterans with PTSD were more likely to be male and to have a diagnosis of depression, but less likely to be taking ace-inhibitors or beta-blockers to treat high blood pressure. Aside from PTSD, lower scores on the FMD test were also linked to increasing age, worse renal function, and high blood pressure.

After adjusting for differences in age and the presence of other conditions and treatments, PTSD itself was still very strongly linked to reduced blood vessel dilation.

While the current study only included veterans, PTSD can also occur in non-veterans as a result of experiencing or observing a terrifying event, such as warfare, natural disasters, sexual assault, other physical violence, or trauma.

People with PTSD may experience prolonged anxiety, flashbacks, nightmares and many other severe symptoms. The disorder is estimated to affect 7.7 million people in the United States according to the U.S. Department of Health and Human Services National Institutes of Health.

Source: American Heart Association

 
Heart and cardiovascular system photo by shutterstock.

Vets Receive Care for Sub-Clinical PTSD

Vets Receive Care for Sub-Clinical PTSD

Vets Receive Care for Sub-Clinical PTSD

A new study reports that veterans who fall just below the threshold for a diagnosis of post-traumatic stress disorder (PTSD) respond to a psychotherapy regimen better than those with full PTSD.

Investigators believe the study highlights the need to recognize veterans suffering from an overlooked condition called subclinical PTSD.

Researchers from the Department of Psychiatry and Behavioral Sciences at the Medical University of South Carolina (MUSC) discuss their findings in the Journal of Anxiety Disorders.

“The study shows not only that we can treat those experiencing subclinical presentations of PTSD, but also that those with subclinical PTSD may actually respond better to treatment than those with more severe forms of the disease,” says MUSC investigator Kristina Korte, Ph.D.

Researchers explain that just like patients with full PTSD, those with subclinical PTSD have experienced a traumatic event and are regularly re-experiencing it, often in nightmares or flashbacks.

Patients with full PTSD also experience hyperarousal (i.e., they are easily startled) and avoid reminders of the event, for example by withdrawing from social interaction or turning to substance abuse.

In addition re-experiencing the event, patients with subclinical PTSD may exhibit either hyperarousal or avoidance, but not both.

Psychologists began noticing this pattern more frequently in the nineties in veterans returning from the first Iraq War, and even more frequently in veterans returning from Iraq and Afghanistan in the last decade.

As researchers have learned more about these patients over time, varying and sometimes conflicting symptoms have provided an incomplete picture of the disorder and how to treat it.

The issue is complicated as those with subclinical PTSD are often excluded from clinical trials testing treatments for PTSD. That is, patients with only some symptoms of PTSD commonly aren’t included in the healthy control group or in the group with full PTSD.

As a result, there is still no standard psychotherapy for treating subclinical PTSD as there is for full PTSD.

According, the researchers devised an intuitive approach — Why not treat subclinical PTSD patients with one of the standard evidence-based psychotherapy tools already being used in PTSD patients?

To do this, they enrolled 200 patients with combat-related PTSD symptoms, identifying those with either subclinical or full PTSD.

For eight weeks, patients received intensive weekly sessions of behavioral activation and therapeutic exposure therapy, designed to lessen their PTSD symptoms by helping them safely re-experience and resolve elements of the original trauma.

Psychologists rated the patients’ PTSD symptoms and had patients rate their own symptoms before, during, and after the eight weeks.

The results were encouraging. Those with subclinical or full PTSD each experienced a real drop in PTSD symptoms after treatment. The striking result was in how much those symptoms dropped: 29 percent in those with subclinical PTSD as compared to 14 percent with full PTSD.

It may seem obvious that patients with a less severe form of PTSD would respond better to standard psychotherapy, but the implications for treatment are far-reaching.

That is, PTSD symptoms often worsen over time; as they do, treatments become less effective at reducing symptoms. In this context, subclinical PTSD could be seen as “early-stage” PTSD, in that treatment might be more effective when the disorder is caught early.

Researchers hope these early studies can move beyond men in combat to civilians of both sexes.

“It is our hope that providing treatment for subclinical PTSD could have a significant impact on the cost-effectiveness of treating this common disorder,” says Korte.

“It could lead to the prevention of more intractable forms of PTSD that can occur when subclinical PTSD goes untreated.”

Source: Medical University of South Carolina/EurekAlert

 
Veteran in counseling photo by shutterstock.