Medication for post traumatic stress disorder Post traumatic stress disorder (PTSD) occurs after exposure to significant trauma and results in enormous personal and societal costs. Although traditionally treated with psychotherapy, there is increasing recognition of a theoretical basis for medication treatments. This was a systematic review of 35 short‐term randomised controlled trials of pharmacotherapy for PTSD (4597 participants). A significantly larger proportion of patients responded to medication (59.1%) than to placebo (38.5%) (13 trials, 1272 participants). Symptom severity was significantly reduced in 17 trials (2507 participants). The largest trials showing efficacy were of the selective serotonin reuptake inhibitors, with long‐term efficacy also observed for these medications.
Comparing Antidepressants How do newer antidepressants compare in depression?
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).
Upside: The New Science of Post-Traumatic Growth
“I’m reading a book about post-traumatic growth,” I told a friend who had suffered significant health-related trauma.
“Is that when post-traumatic stress grows worse over time?” she asked, worried.
Not at all, I told her, though I understood where she was coming from. It’s not easy to wrap one’s mind around the concept of an upside to trauma. But post-traumatic growth, a fledgling field of research, refers to positive changes that many people experience in the aftermath of traumatic events.
The term post-traumatic growth was coined by Richard Tedeschi and Lawrence Calhoun of the University of North Carolina, Charlotte. In 1996, Tedeschi and Calhoun published a psychological measurement tool called the Posttraumatic Growth Inventory, but the concept has been around for all of recorded history. In Upside: The New Science of Post-Traumatic Growth, journalist Jim Rendon points out that a traumatic incident, a passage through darkness, and ultimate growth are all part of mythology’s archetypal story. He cites Man’s Search for Meaning, published in 1946, in which Viktor Frankl explains what he came to understand about trauma and suffering while in a Nazi concentration camp. He reminds us of a 1936 story about a young boy who saw his parents murdered and vowed to spend his life fighting crime. That boy, of course, was Bruce Wayne, and his crime-fighting alter-ego was Batman.
So post-traumatic growth, by any name, is nothing new, and psychologists are finally taking a good, hard look at it. And while nobody suggests that trauma is a good thing, that it’s easily moved through, or that we would all be better off with some trauma in our lives (not that we have a choice), Rendon looks at what psychologists have learned about how people grow and even thrive in the aftermath of traumatic experiences.
Post-traumatic growth, Rendon writes, can manifest in many different ways. It can be a person feeling that life has more meaning and that they are closer to their loved ones, or it can be a life-altering change that sends them, as Rendon puts it, “on career and life paths they never would have considered before.” The book offers stories of people suffering all manner of almost incomprehensible traumas — a parachute that doesn’t open, a child killed by a stray bullet, a grenade explosion, a fall in front of an oncoming train — to illustrate what researchers have learned about post-traumatic growth.
Perhaps surprisingly, Rendon finds that people who experience post-traumatic growth are not outliers, either.
“In study after study, research shows that about half or more of trauma survivors report positive change as a result of their experience,” Rendon writes. “…Every time I talk to one of these people in my reporting — someone who has totally altered his life, his sense of self, someone who says he is thankful for what most of us would consider a terrible tragedy — I am thrilled and amazed,” he continues. “What an exceptional person, I think. And then I remember all of the others who have told me similar stories. This kind of miraculous transformation, it turns out, is hardly unusual. The potential for such inspiring change lives inside most people.”
In each chapter, Rendon uses stories and research to explore things like the importance of deliberate rumination, the role of social support, the power of talking or writing about your experience, where optimism fits in, how faith helps, and creativity.
Still, the people in the book don’t spring from their hospital beds full of hope and optimism. They move through anger, despair, depression — everything you would expect under the circumstances. But ultimately, they find their way to new careers that will help others, new communities, better relationships, deeper faith, creative breakthroughs. (The story of the Tutu Project, which you may have seen online, is in here. The series of photographs of Bob Carey in a pink tutu is now a successful fundraiser to help women with breast cancer, but it started as a way for Carey to deal with trauma when his wife, Linda, was diagnosed.) Each horrendous tale concludes not with pie-in-the-sky happily ever after, but with solid, sustainable, realistic transformation.
Before she fell in front of an oncoming train as the result of an overenthusiastic hug (the unfortunate hugger was killed), Mariam Davies lived a life of partying and dead-end jobs. After the accident — and a predictable period of anger and depression — Davies went on to become a therapist, providing low-cost counseling in her South London neighborhood. Although she can walk, she’ll never run again, and she has to wear a colostomy bag.
“I still get down about things,” she says. “I still get upset that I have to wear crap knickers that aren’t sexy because they have to hold my bag in. This is horrible, I hate it. But it’s not the end of the world.” In fact, Davies says that before the accident she knew something had to change. And after the accident she remembers waking up in her hospital bed, “having a really powerful sense that this is what I’ve been waiting for.”
Davies’s is only one of many moving, inspiring, and enlightening stories in the book, and each person changes and grows in individual ways, although helping others is a recurring theme. Upside is a well-researched, well organized, informative, and eminently readable introduction to the science behind something we’ve all been aware of on some level, but haven’t before put a name to.
Sophia Dembling is author of Introverts in Love: The Quiet Way to Happily Ever After.
Upside: The New Science of Post-Traumatic Growth
Touchstone, August 2015
Hardcover, 288 pages
Mindfulness Training May Ease PTSD
Study of war veterans shows the therapy triggers brain changes that seem to help manage thoughts, memories
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 Stiffen Veterans’ Arteries, Boosting Heart Risks
Reducing stress may help blood vessels function normally, expert says
Transgender Veterans Face High Risk of Mental Health Problems
Among military veterans who identify as transgender, nearly 50 percent have been hospitalized due to a suicide attempt or suicidal thoughts, and 90 percent have at least one mental health diagnosis, such as depression or posttraumatic stress disorder (PTSD), according to a new study whose findings will be presented at The Endocrine Society’s 98th annual meeting in Boston.
The military population, including both active members and veterans, has a fourfold higher rate of gender dysphoria compared to the general U.S. population. Formerly known as gender identity disorder, gender dysphoria is the experience of significant distress associated with nonconformity to one’s birth gender.
“As more of our active military returns from deployment and transitions to veteran status, the health care system will be faced with treating more transgender veterans who have mental health issues,” said principal investigator Marissa Grotzke, M.D., an endocrinologist at Salt Lake City Veterans Affairs Medical Center (VAMC), Salt Lake City.
It is already known that non-veterans with gender dysphoria have distinct health care concerns and much higher rates of mental health problems, such as depression, anxiety, and suicidal thoughts. Previous studies have also shown that military veterans suffer from higher rates of mental health disorders as well, including PTSD and depression. Less is known, however, about the double mental health impact of veterans with gender dysphoria.
By examining 2014-2015 medical records at Salt Lake City VAMC, Grotzke and her team found 39 patients who had a diagnosis of gender dysphoria. Eight transgender patients were transitioning from female to male, and the other 39 were male-to-female. They included both combat and noncombat veterans and ranged in age from 21 to 68 years.
The researchers then looked for mental health conditions that coexisted with the gender dysphoria. They found that PTSD was the most commonly identified mental health diagnosis, affecting 46 percent of these veterans, followed by depression in 41 percent. Tobacco use occurred in one-third, and anxiety was present in 15 percent. Nine patients (23 percent) had other substance abuse, bipolar disorder, or schizotypal personality disorder.
Eighteen patients (46 percent) carried two or more mental health diagnoses, according to the researchers. Only four patients (10 percent) with gender dysphoria had no additional mental health problem.
“These findings highlight the need to improve the quality of care for our transgender veterans,” Grotzke said.
To address these issues, the Salt Lake City VAMC formed a multidisciplinary gender dysphoria team composed of an endocrinologist, mental health professional, pharmacist, speech therapist and vocational rehabilitation providers. Team members meet together twice a month to discuss patients and treatment plans, which Grotzke said already has been “very beneficial” for patients.
There are most likely several reasons behind the increased rates of mental health disorders found in transgender veterans. Grotzke said that traumatic brain injuries sustained in combat, military sexual abuse, and stigma related to gender struggles are common in this population.
Source: The Endocrine Society