Tag: PTSD

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Post Traumatic Stress Disorder Uncategorized

Interpersonal Therapy and PTSD

Anxious. Nauseous. The only thing on your mind is what shouldn’t be. The only thing you can feel is the sound of your heart, breaking away.

 

PTSD stands for post-traumatic disorder, an anxiety disorder that develops from experiencing or witnessing difficult trauma. People with PTSD live with nightmares, flashbacks, and overwhelming anxiety. Contrary to popular belief, signs and experiences of PTSD can occur years and decades after a traumatic event. At any point in their lives, those with PTSD relive the fear and panic of that moment over and over again.

 

PTSD is a disabling disorder that impacts 7.7 million Americans, and even more worldwide. Thankfully, there are psychological solutions to help cope and recover from PTSD. The current choice for treating PTSD is exposure therapy. Since remembering events that you don’t want to is deeply upsetting, many of those with PTSD protect themselves by avoiding triggers such as situations and places that remind them of their trauma. This not only obstructs them from daily tasks, but it also isolates them and deteriorates their mental wellbeing. Exposure therapy tackles avoidance behavior by assisting those with PTSD to confront their fears in a safe, controlled manner. Trust is vital here, as exposure therapy requires clients to put themselves in situations and places they have been avoiding. When done right, clients with PTSD build up the comfort level with facing what they had been avoiding and acknowledge that they are a no longer threat to them. While exposure therapy has shown great success in reducing the symptoms of PTSD, it is intimidating and painful for many PTSD patients.

 

“Exposure Therapy was just awful, but I did persist, where I believe many do give up because it’s just too hard. My therapist is a very good one, and I trust her. Although even during the therapy I was still not able to vocalize what had happened. I would just clam up, shake, cry and freeze.”

 

Across platforms, the common voice amongst online discussions of PTSD is the emotional exhaustion of going through exposure therapy. Processing one’s trauma is a difficult task, and doing so deliberately in the presence of someone else is mentally taxing. It has turned many of those with PTSD from seeking treatment, reclusing them from the help they need. Thus, researchers have looked for alternative methods of treating PTSD. With some recent results, psychologists may have found a new alternative to exposure therapy.

 

Having PTSD often means feeling a loss of control, whether if its the ugly anxiety that keeps coming back, or not being able to go out with friends because you no longer feel safe in the places you used to. Understandably, this can cause anyone to feel at lost with their emotions and to isolate themselves from more hurt. Originally developed for treating depression, interpersonal therapy (IPT) sets to improve the difficulties experienced by PTSD patients by focusing on repairing what trauma does to trust and relationships. IPT focuses on affective attunement and helps clients recognize their emotions not as threats, but as ways and reasons for connecting with others. IPT aims to mend disruptive relationship patterns associated with PTSD. This allows patients to develop close, meaningful relationships and allows to cope better with a strong support network that the patient themselves have chosen to trust. It is through the support of these relationships and fulfilling social interactions that allow PTSD patients to finally open up facing their trauma, on their own accord.

 

For its distinctly different approach from exposure therapy, IPT has shown similar clinical effectiveness to exposure therapy. In addition, research examining IPT and exposure therapy has proved that IPT was more accommodating. IPT has had a lower dropout rate, and patients showed a preference to IPT over exposure therapy. As the importance of therapy is persistence and consistency, a lower dropout rate is a huge part of giving patients more effective treatment.

 

While exposure therapy is a time tested and important part of PTSD treatment, IPT takes a successful social and personal perspective on treating PTSD. PTSD is a hollowing condition and its consequences impact on the lives of millions every day. Thus, new insights into improving and providing treatments are going to help ease the lives of so many.

 

References

IPT for PTSD. (n.d.). Retrieved from https://www.interpersonalpsychotherapy.org/ipt-basics/adaptations-of-ipt-what-works-for-whom/ipt-for-ptsd/

Levin, A. (n.d.). Trial of Interpersonal therapy may open new door to treat PTSD. Retrieved from https://psychnews.psychiatryonline.org/doi/full/10.1176/appi.pn.2015.4b1

Living with PTSD (Potentially Triggering Material) [Online forum post]. (n.d.). Retrieved from Lifeline website: https://lifeline.saneforums.org/t5/Our-stories/Living-with-PTSD-Potentially-Triggering-Material/td-p/114515

Post-traumatic stress disorder (PTSD). (n.d.). Retrieved from Mayo Clinic website: https://www.mayoclinic.org/diseases-conditions/post-traumatic-stress-disorder/symptoms-causes/syc-20355967

Post-traumatic stress disorder (PTSD). (n.d.). Retrieved from https://report.nih.gov/NIHfactsheets/ViewFactSheet.aspx?csid=58

Rafaeli, A., & Markowitz, J. (n.d.). Interpersonal psychotherapy (IPT) for PTSD: a case study. Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/22032045

Tull, M. (n.d.). How exposure therapy can treat PTSD. Retrieved from https://www.verywellmind.com/exposure-therapy-for-ptsd-2797654

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Uncategorized

A Brush With Death: Near Death Experiences

Not many return from the dead. However, sometimes people are fully submerged in temporary moments of death, before returning back to the living. Researchers call this phenomenon the Near Death Experience.

NDEs occur in life-threatening body conditions, even where the brain and heart is effectively dead but the human consciousness remains. Although there are many theories, such as undetected brain activity or cognitive compensation, the cause of NDEs are largely a mystery to the neurology and psychology community. When a dead patient’s vitals return, they remember vivid, intense experiences during their clinical death. While some describe an acute awareness of their death, others see a light at the end of the tunnel. Some even re-live a collection of their memories and see their lives flash by.

Most of the NDEs are seen as spiritual and positive, but 1-15% of documented NDEs are deeply distressing. These low numbers are not only indicative of how rare these occurrences are, but also how few people want to talk about them.

NDEs aren’t for everyone, and there are three major types of NDEs that are more than unpleasant. One category is defined retaining trauma of people’s fear and powerlessness in their last moments. Afterall, the flood of emotions and awareness of your own mortality from an NDE can be overwhelming. The second common report is a void-like feeling of darkness and total disconnection, also known as “existential hell”. Some people’s worst fear is the nothingness that comes after death, and this NDE clearly reflects it. The third type of distressing NDEs is a more clear-cut version of hell. Some have claimed to see demon like figures and descriptions befitting the fires of an inferno. While it might be easy to assume that, according to religion and our sense of justice, those who receive these more nightmare-like NDEs are unsavory people who deserve what they are seeing, Dr. Marilyn A. Mendoza’s work with inmates of the Angola State Prison show that jailmates are seen the same NDEs as non-incarcerated people.

Distressing NDEs can happen to anyone, and they can have drastic effects. The University of Virginia, the Department of Psychiatric Medicine, has recently published a paper regarding the connection of posttraumatic stress and NDEs. Researchers sampled 194 people from 18 to 65 who have nearly died about whether or not they experienced NDE, and how that has impacted their lives onwards. In their studies, more participants who have experienced NDE expressed that they still have intrusive thoughts and denial about their trauma than those without NDE. Although for most participants it had been more than 15 years since their NDE, the lingering effects of NDE changed how often and intensely they think about their near death. While staring death in the face can be a source of trauma, the participants of this experiment did not match enough symptoms to be diagnosed with PTSD.

From seeing the light at the end of the tunnel to the empty embrace of the void, NDEs are lucid reminders of human morality and how our mind transcend it. Although there is not enough knowledge and research on NDEs, the immense power these moments have on people is largely observed and understood. While some have found spirituality, others revisit the clawing of death constantly.

Works Cited:

Greyson, B. (2001). Posttraumatic stress symptoms following near-death experiences. American Journal of Orthopsychiatry, 368-373. Retrieved from http://web.b.ebscohost.com.proxy.library.stonybrook.edu/ehost/detail/detail?vid=0&sid=ce3ec1e1-dc2b-4bf8-96ec-95080d5bd0c7%40pdc-v-sessmgr06&bdata=JnNpdGU9ZWhvc3QtbGl2ZSZzY29wZT1zaXRl#AN=2001-01985-010&db=pdh

Mendoza, M. A. (n.d.). What We Know About Near Death Experiences. Retrieved from Psychology Today website: https://www.psychologytoday.com/us/blog/understanding-grief/201902/what-we-know-about-near-death-experiences

Mendoza, M. A. (2017, February 3). Prisoners working with the dying. Retrieved from Psychology Today website: https://www.psychologytoday.com/us/blog/understanding-grief/201702/prisoners-working-the-dying

Taylor, S. (n.d.). Near-death experiences and DMT. Retrieved from Psychology Today website: https://www.psychologytoday.com/us/blog/out-the-darkness/201810/near-death-experiences-and-dmt

 

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Post Traumatic Stress Disorder

Traumatic Illness: The Unlikely Relationship Between Cancer and PTSD

Posttraumatic stress disorder (PTSD) manifests as a result of experiencing traumatic events (American Psychiatric Association, 2013). It can be triggered through exposure to life or death situations, violent events such as assault, or witnessing the death of someone close to you. The faces of PTSD that include victims of abuse, rape survivors, or war veterans. However, one face that is gaining more traction is those who have developed cancer.

A recent study done by the National University of Malaysia focused on 469 adults who had been diagnosed with different types of cancer. They were interviewed 6 months (and 4 years later) following their cancer diagnosis. The study discovered that approximately 20% of their participants had developed PTSD during their 6-month visit, even after successful treatment of their cancer. For some, their PTSD symptoms worsen. In the 4-year follow-up, 6% of participants were reported to demonstrate signs of PTSD. When attempting to reason for this relationship, researcher Caryn Mei Hsien Chen said, “Many cancer patients believe they need to adopt a ‘warrior mentality,’ and remain positive and optimistic from diagnosis through treatment to stand a better chance of beating their cancer. To these patients, seeking help for the emotional issues they face is akin to admitting weakness (Cohut, 2017).”

PTSD can manifest in many ways for those with cancer. This can include hesitation or refusal to appear in follow-up appointments out of fear that it will trigger stressful memories. Some others will not seek mental help during their treatment because they do not want to appear weak (Kelly, 2017). The heightened stress can also lead to body aches, pain, and sickness. The increase in physical pain that results from their stress can induce fears that their cancer will return. However, counseling and support can change outcomes for any physical or mental illness. In the same study, it was found that breast cancer patients were 3.7 times less likely to have developed PTSD six months after diagnosis than patients with other types of cancers. As part of the treatment for their breast cancer, patients received support and counseling during the first year following their diagnosis.

We tend to forget about the mental stress that is often associated with physical illness, and instead focus on the physical element. It is important to remember that physical and mental illnesses go hand in hand—they affect one another. As with any illness, help, and support are essential and we have to remind ourselves of the impact that diseases, such as cancer, can have on one’s mental health.

References:

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: American Psychiatric Publishing.

Cohut, M. (2017, November 20). Many grapple with PTSD after a cancer diagnosis. https://www.medicalnewstoday.com/articles/320100.php

Kelly, L. (2017, November 22). Many cancer survivors living with PTSD: Study. Retrieved November 26, 2017, from https://www.washingtontimes.com/news/2017/nov/22/many-cancer-survivors-living-ptsd-s udy/

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Post Traumatic Stress Disorder

Traumatic Coverage: The Link Between PTSD and the Media?

In an increasingly socialized and globalized era, people are able to convey and exchange new ideas at a rapid speed. Information that would previously require hours or days to be transferred to another person is able to quickly spread across the world in seconds. Along with this is the increase in accessibility to news and the media. However, the emergence of newer media forms includes the transmission of raw, unaltered, and chilling images.

The possibility that PTSD develops as a result of watching traumatic events through social media or a television has remained a controversial topic for years. The DSM-5 states that PTSD is triggered through exposure “to actual or threatened death, serious injury, or sexual violation, exposure must result from directly one or more; experiencing the traumatic event, witnessing the traumatic event in person, learning that the traumatic event occurred to a close family member or close friend or experiences first-hand repeated or extreme exposure to aversive details of the traumatic event,” while specifically outlining that it cannot be developed through media, pictures, television or movies unless it is work related—if you work as a police officer and watch a video detailing a crime scene, you can potentially develop PTSD (American Psychiatric Association, 2013).

One of the most prominent research studies conducted regarding the link between PTSD and social media was through Pam Ramsden. In 2015, the psychology professor at the University of Bradford conducted a study that surveyed 189 men and women about their reactions and responses towards various pictures of traumatic events. She conducted a personality questionnaire and trauma assessment including videos of the 9/11 terrorist attack, suicide bombings, and school shootings. She found that over a fourth for participants met the criteria of PTSD. She suggests that this second-hand exposure, particularly through social media, to traumatic or violent events are harmful due to their raw and unedited nature. Her research adds to the growing body of concern over the impact of social media on a person’s physical and mental wellbeing.

Further research conducted by the University of California, Irvine suggested that coverage of traumatic events may exacerbate the symptoms of those who are vulnerable to PTSD, have past history of mental illness, or have a history of trauma. The researchers of this study acknowledged that their results don’t illustrate a cause-and-effect relationship between consumption of media coverage of traumatic events and PTSD. However, among their findings, they discovered that three years after those terrorist attacks, those who reported watching the most Sept. 11 coverage had the most severe case of post-traumatic stress symptoms, such as intrusive thoughts, nightmares, anxiety, insomnia, and headaches. However, researchers interpreted it as: “media coverage can be an unhelpful factor for those predisposed to PTSD in the first place” (Healy, 2013).

There is constant discussions and research being produced regarding the impact of the media on a person’s development of illnesses such as depression, OCD, or PTSD. With our world becoming more modernized and connecting constantly, it is important to discuss the impact of the media on a person’s mental health and wellbeing.

References:

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: American Psychiatric Publishing.

British Psychological Society. (2015, May 6). Viewing violent news on social media can cause trauma. ScienceDaily. Retrieved November 2, 2017 from www.sciencedaily.com/releases/2015/05/150506164240.htm

Healy, M. (2013, December 09). Can you get PTSD from watching media coverage of an event? Maybe. http://www.latimes.com/science/sciencenow/la-sci-media-coverage-trauma-stress-20131209-story.html

Holman, E. A., Garfin, D. R., & Silver, R. C. (2014). Media’s role in broadcasting acute stress following the Boston Marathon bombings. Proceedings of the National Academy of Sciences of the United States of America, 111(1), 93–98. http://doi.org/10.1073/pnas.1316265110

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Eating Disorders

Traumatic Experiences and their Relationship with Eating Disorders

We often connect eating disorders to body dissatisfaction brought on by societal standards of beauty. However, the root of eating disorder are often more tangled and complicated. In addition to body image issues, victims of eating disorders often struggle to maintain control over their lives, bodies, and diets. As a result, there exists a connection between Post Traumatic Stress Disorder and eating disorders. In other words, traumatic experiences–most often prolonged–can lead to the development of an eating disorder.Trauma victims seek to gain control over their lives and eating disorders provides a channel, through associated behaviors such as calorie counting.

Dr. Judy Scheel, whose work focuses on the research and prevention of eating disorders, states that 30% of individuals with eating disorders have suffered sexual abuse. Scheel also summarizes the Psychiatric Times article, “The Links Between PTSD and Eating Disorders,” by Timothy D. Brewerton, in which Brewerton discusses data collected from multiple studies. In particular, Scheel cites Brewerton when he says, “74% of 293 women attending residential treatment indicated that they had experienced a significant trauma, and 52% reported symptoms consistent with a diagnosis of current PTSD based on their responses on a PTSD symptom scale.” These data points reveal the link between post-traumatic stress and eating disorders.

According to the National Eating Disorders Association (NEDA), traumatic experiences that most often lead to eating disorders are: sexual abuse at a young age, domestic abuse (victims and observers), and other experiences that cause PTSD. The article also states, “Bulimia, in particular, has been connected to trauma as a means of self-protection, because the binge/purge cycle of behaviors seem to reduce awareness of thoughts and emotions as a means of escape for several of the emotions that may accompany traumatic experiences.”

Furthermore, Scheel mentions that sexual abuse victims often project their feelings of shame attached to their experience onto their bodies. Scheel explains this by providing a hypothetical example, in which a woman associates the glance of a man with that of her abuser and projects the feelings of shame onto her body. This creates in her mind negative body image issues and causes her to binge and purge.

This occurrence is not strictly limited to victims of sexual abuse a survey of 642 male veterans revealed that there was a strong correlation between military trauma and the manifestation of eating disorder symptoms. This finding demonstrates the need for increased awareness about the demographics of individuals afflicted by eating disorders. In other words, we need to overlook common misconceptions about eating disorder patients being primarily female. This can be accomplished through further research and increased diversity in the media coverage of eating disorders.

References:

“Military-Related Trauma Associated With Eating Disorders,” (2017, October 2). Psychiatry Advisor. Retrieved November 19, 2017, from  http://www.psychiatryadvisor.com/ptsd-trauma-and-stressor-related/military-trauma-linked-to-eating-disorders/article/696877/

Scheel, J. (2016, March 29). PTSD and Its Relationship to Eating Disorders. Psychology Today. Retrieved November 14, 2017, from https://www.psychologytoday.com/blog/when-food-is-family/201603/ptsd-and-its-relationship-eating-disorders

“Trauma and Eating Disorders,” (2012). National Eating Disorders Association.  Retrieved November 14, 2017, from https://www.nationaleatingdisorders.org/sites/default/files/ResourceHandouts/TraumaandEatingDisorders.pdf

 

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Addiction

PTSD and Addiction: A Duel Diagnosis

At some point, whether in real life or Hollywood movies, you’ve probably heard someone say, “I need a drink” after dealing with a stressful situation. Many people use alcohol to help them relax and unwind.

Studies have shown that one is likely to consume more alcohol after a stressful event rather than during it. While enjoying a drink or two after elevated stress levels isn’t necessarily harmful, it’s important to consider the role alcohol and drugs play when someone is dealing with an ongoing chronic stressor or a stress-related disorder. These substances might not be used as an aid to occasionally calm down, but instead as an unhealthy (and usually unsuccessful) coping mechanism. Using alcohol to cope distracts the person from the issue at hand, but often allows the person to remain in denial or misplace blame and judgment.

One of the illnesses that addiction is commonly comorbid with is post-traumatic stress disorder, or PTSD.  Post-traumatic stress disorder refers to the avoidance of intrusive memories from a traumatic event. Symptoms like nightmares, flashbacks, and increased stress due to internal or external cues often result, making this mental illness especially intrusive and debilitating (American Psychiatric Association, 2013).

Due to its precursor of experiencing a distressing event, PTSD is common among sexual assault victims and military veterans. A study in 1997 suggested that women suffering from alcoholism were two to three times more likely to be comorbid with PTSD due to sexual and physical abuse. However, this statistic has likely changed, due to the increased awareness of PTSD among military veterans. When surveying 140,00 veterans who are incarcerated, a shocking 60 percent reported addiction and substance abuse problems. Another study found that nearly 1 out of every 10 returning veterans has experience substance use disorder.

Thomas J. Brennan, a sergeant in the Marine Corps, serving in both Afghanistan and Iraq, wrote for the New York Times about the drinking culture in the United States military.  He explains that underage drinking is common, and that not a lot of action is taken to prevent it.  He goes on to state how many soldiers diagnosed with PTSD used alcohol to self-medicate and relieve their symptoms, something he admits to doing it himself for a short period of time.

While society is becoming more aware of the issues that post-traumatic stress disorder can cause, particularly for military personnel, the US still struggles to treat addiction.  Medication can help reduce the effects of PTSD, while Cognitive Behavioral Therapy can help both PTSD and addiction (“PTSD: National,” 2015).  It is critical for society to recognize the comorbidity between PTSD and substance abuse in order to allow for the creation of more effective treatments and resources.  Because while drinking to relieve stress may be seen as a common part of culture in the United States, heavy substance use can increase complications and negative effects, especially when paired with other illnesses such as PTSD.

References:

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: American Psychiatric Publishing.

Brennan, T. J. (2013, October 1). In the military, the drinking can start on day 1. Retrieved February 26, 2017, from https://atwar.blogs.nytimes.com/2012/10/01/in-the-military-the-drinking-can-start-on-day-1/?_r=0

Newman, L. (2013, August 1). Break the silence: The reality of alcohol in military life. Retrieved February 26, 2017, from https://www.veteransunited.com/network/break-the-silence-the-reality-of-alcohol-in-military-life/

PTSD: National center for PTSD. (2015, August 13). Retrieved February 26, 2017, from http://www.ptsd.va.gov/public/problems/ptsd_substance_abuse_veterans.asp

Volpicelli, J., Balaraman, G., Hahn, J., Wallace, H., & Bux, D. (1999). The role of uncontrollable trauma in the development of PTSD and alcohol addiction. Alcohol Research and Health, 23(4), 256-262.

Categories
Post Traumatic Stress Disorder

Gaming, Virtual Reality, and PTSD

Video games, spanning from the early days of Tetris and Super Mario Brothers, to Minecraft, Grand Theft Auto and Call of Duty, have been a part of almost everyone’s attempts at unwinding after a long day, actively avoiding homework, or housework. Video games are currently spanning to more active games. These games encourage you to get up and dance-battle your friends. There are even role-playing games that involve headset communication. Video games are the ultimate leisure time activity that allows us to take ourselves out of the day’s worries. It allows us to focus on something out of this world; but what if we could use gaming as a means for something beyond just enjoyment?

Video games, or “Electronic Games” have been used for psychotherapy (EGP), these games, referred to as “serious games” developed for therapeutic purposes. There are also electronic games for entertainment (EGE) which are “off the shelf” games available at retail stores to the general public. These EGE’s were at first built for leisure, but have recently been used as a therapeutic tool; both EGE’s and EGP’s have shown potential to be applied to a variety of health and mental health matters and settings.

In psychotherapy, therapists will often used electronic games as “computer-assisted cognitive behavior therapy” which includes computer-delivered information and interventions for client-specific models. In some cases, a specific game is created; these games can also include video demonstrations of relaxation inductions. In a review that looked at the impact of treating anxiety and depression symptoms, comorbid to PTSD, computer-assisted cognitive therapy (cCBT) has shown to be effective overall and can be “maximized through therapeutic exposure”. This exposure through EGP games specifically positively impacts symptoms of depression, while also being cost-effective for therapists.

In addition to improving the symptoms of anxiety and depression disorders, EGP have been developed to also enhance psycho-education, attitude change, relaxation and pain management, social skills, problem-solving skills, emotional modulation, self-control skills, motivation, as well as therapist-client interactions.

 

Virtual-Reality Exposure Therapy (VRET) has also been used to expose clients to sources of anxiety and stress, within the safety and control of the therapist’s office. VRET has shown significant improvement for cognitive behavior therapy, as well as behavior therapy. In regards to PTSD, in research surrounding VRET in combination with cognitive behavior therapy, VRET was found to be “at least as useful as traditional exposure therapy”. Authors who published the research suggested that patients who respond better to prolonged experience to virtual reality may have a better impact from the VRET. Though not proven experimentally, the authors of the same study suggest that VRET may provide a more “robust positive effect” similar to other exposure-based treatments for PTSD, while providing treatment in a less stigmatized manner, in a more controlled; yet immersive way than traditional exposure therapy (Horne-Moyer 2014).

Clinical psychologist Dr. Kathleen M. Chard, who works at the PTSD and Anxiety Disorder’s division at the Cincinnati VA medical center, who has over 20 years in treating mental health disorders, claims that VRET is helpful among the Veteran population. Dr. Chard explains that the goal of this kind of therapy is applied to veterans with an end goal of processing their traumatic memories so that it no longer controls their life. Patients are given a control stick, which is attached to a weapon, as well as a pair of virtual reality glasses and headphones. Machines that can replicate smells are also used in this process. The goal is to recreate traumatic scenes in  “vividly” accurate detail and change their perception of what happened.

“The VRE[T] treatment allows us to trigger memories about the event to obtain the full story…ones these memories are triggered, we can challenge those misperceptions in the veteran’s mind, including areas where they may be blaming themselves for things they could not have controlled or predicted” explains Dr. Chard. One symptom of PTSD is avoidance of thinking about the event, and emotional avoidance; resulting in an ultimate shut-down emotionally as to avoid reliving the event (Prine, 2016). However, experiencing those emotions, and being able to move forward is a natural part of life. The virtual-reality technology allows therapists to help challenge individuals about the event, and helps them process their emotions.

The effectiveness of using games as therapy has shown some inconsistencies in regards to results of improved symptoms across various studies, though a high number of investigations have shown electronic games to have positive effects on psychosocial functioning, including stress management, self-confidence, socialization, and quality of life. Virtual Reality Exposure Therapy may not always successful, but there is solid evidence of VRET and gaming having a positive impact in helping patients. VRET and video games, however, can be used as a means of helping patients in a new inventive way that cuts away some of the stigma or impact of seeking treatment. As studies have shown it to have similar levels of success with cognitive behavior therapy, it is clearly beneficial to allow new, innovative processes for treatment to come about in the clinical world.

References:

Horne-Moyer, H. L., Moyer, B. H., Messer, D. C., & Messer, E. S. (2014, October 14). The Use of Electronic Games in Therapy: A Review with Clinical Implications. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4196027/

Moore, B. A. (2010, May 10). Video Game or Treatment for PTSD? Retrieved from https://www.psychologytoday.com/blog/the-camouflage-couch/201005/video-game-or-treatment-ptsd

Prine, B. C., Seck, B. H., & Mcdermott, B. J. (2016). Video Games Show Promise as Therapy. Retrieved from http://www.military.com/benefits/2014/04/09/video-games-show-promise-as-therapy.html

Categories
Post Traumatic Stress Disorder

PTSD, Stigma, and Treatment; the Clinical Perspective.

Nicholas Eaton, Ph.D. is an assistant professor of psychology at Stony Brook University.  As someone who has experience with both the clinical side of psychology as well as research, Professor Eaton has valuable insight into the workings and treatment of various mental health conditions, as well as the numerous factors that influence treatment and willingness to seek professional assistance. Professor Eaton…  

The Humanology Project: Can you give me a little summary about your educational background and experience with mental health?
Nicholas Eaton received his PhD clinical psychology from University of Minnesota (2012)

Nicholas Eaton: Then I moved to NY started research on psychopathology, which has mostly been focused on classification. In recent years my focus has been applying this to different groups and trying to understand how oppressive influence may influence mental health.

THP: Do you have experience with PTSD clients?
NE: Yes, both research and clinically.

THP: What did your PTSD research focus on?
NE: My research looks at how PTSD relates to mental disorders and to what extent it’s a unique thing vs. a mixture of things like depression and anxiety. The treatment for PTSD largely looks like anxiety treatment, so cognitive vs. exposure based treatment as well both work.

THP: Can you tell me about any unique experiences with your clients who had PTSD?

NE: Well PTSD can occur in many different ways and manifestations.
One client in particular I remember had a traumatic work accident. So he came in thinking he had panic disorder. After we talked it, actually turned out he had PTSD. After explaining to him why I thought this was the case, and showed him that his presentation of symptoms, he himself agreed that this seemed to explain why he tried many different things to get over his symptoms, as he thought it was the result of a panic disorder rather than trauma, and therefore why his personality was changing. In that we kind of saw this misconception that PTSD is a disease for Veterans, but after showing them the diagnostic chart it clicked, his personality changed based on an accident, and he kept reliving the incident.

THP: Treatments in PTSD/other groups:

NE: With Veterans, you gradually get them thinking about service and things that remind them that provoke anxiety of service, and retrain their brain such that they can have a more balanced view of their service. So it’s not like every time they see a uniform or flag they’ll have strong negative reactions, they can tolerate the anxiety and over time it has less pull, and their reactions are less strong, so it becomes livable.

Working with different groups (ethnic minorities, non-gender binary, etc.):
In terms of treatment it doesn’t impact the treatment so long as you take unique factors into consideration. If it is PTSD resulting from someone being assaulted in transphobic attack it behooves the therapist to have knowledge of trans issues as to not miss important complexities.  Particularly when we see people traumatized more vicariously through hate crimes, which are layered in social, cultural, and political impact.  For others outside that attack, when we see our own communities being impacted it makes up worries.  However, regardless of individual circumstance it becomes exposure-based treatment.

THP: How does stigma affect the treatment of patients?

NE: So within certain communities, there certainly are stigmas about mental disorder. So for example, in some communities people may feel as though someone with a mental disorder doesn’t have enough willpower, or within other communities, they say within some military context people might view PTSD (historically at least) with some sort of weakness that someone who’s strong enough would be able to overcome or not be affected by. Whereas in other communities there’s actually a reduced stigma. I remember one client I met, a kid who was Hmong and the kid had psychosis; so hallucinations, and normally we would treat the kid with antipsychotic medication but in this case the family really viewed [his illness] as a benefit. That the kid had this kind of extrasensory perception and would be able to serve an important role in the community because of this, so kind of an anti-stigma as well, like quite accepting of these experiences.

THP: So this impacted their willingness to get treatment?

NE: Yeah, and they didn’t want treatment.

THP: How was that perceived by professionals?

NE: Certainly within the clinic, there was a diversity of opinions. With some people feeling like it was an important cultural difference that must be respected and other people feeling like it was just really almost child abuse.

THP: If it’s something that’s seen as potentially harmful to the patient, at what point does a professional step in?

NE: Well professionals are required legally to step in when there’s imminent threat of harm to the patient or to someone else by the patient or when you know someone is being harmed, who’s vulnerable like a kid or an older adult who can’t take care of themself.  But so in general outside of those requirements, the clinician has no authority to do anything unless the person wants treatment.

THP: Even in the case of children?

NE: In the case of children who are being abused, as in actual abuse defined by law, than no. In similar cases (Hmong) the courts will side with the parents, due to First Amendment issues.

THP: How have you found that families typically react to members of their family seeking treatment in terms of misunderstandings, or stigmas? Especially in the case of it being “the first” family member to seek treatment?

NE: It varies quite widely. By the time someone seeks treatment, often the family has really wanted them to make some sort of change because they see that they’re in pain; so they’re excited because the person has chosen to seek treatment. But sometimes the family does stigmatize, typically in more traditional settings. But in my experience people are, if they are not leery of psychotherapy or medication, they’re usually pretty happy that someone they care about is pursuing something that may help them.

THP: Have you found that patients coming in have preconceived notions of illness? Especially if they came seeking treatment believing they had one illness and they got diagnosed with something different?

NE: Most people, in my experience, don’t really know enough about these things to have much of a preconception unless they’ve tried researching on their own or have some sort of specialized education. Some people though will definitely disagree with the diagnosis and you really need to clarify for them why you think the diagnosis is appropriate and how that diagnosis fits better than the other diagnosis but in a lot of situations you don’t even talk about the diagnosis. I often don’t. I don’t think it’s necessary for most clients.

Diagnosis to me doesn’t really do very much. It puts a label on something, which for some people is very important, but for some people is very stigmatizing. So for me, I don’t usually find it profitable to do a lot of diagnosis unless a person really needs one, or really wants a name for things. Ultimately I feel like making that careful differential diagnosis is usually not a very good use of time and because most of the similar things wind up being treated similarly anyway, I’m really going to target it to their presentation and their symptoms rather than to a particular diagnosis 

Categories
Post Traumatic Stress Disorder

PTSD and Cannabis; Conflicts Between Research and Implementation

“Imagine knowing something about yourself more than you know anything, and at the same time knowing how unreal it is. This part of you has such a hold on you, that you cannot for the life of yourself feel its grasp until it is too late, then it has you and you are no longer yourself. Imagine a watery consciousness slipping away and thinking who was that? And, you already know the answer, as it dissipates like smoke on the wind. In that moment of realization comes the instantaneous realization of your being, slipping away” (Lee, 2008).

 The DSM-5 states that Post Traumatic Stress Disorder is triggered by exposure “to actual or threatened death, serious injury, or sexual violation, exposure must result from directly one or more; experiencing the traumatic event, witnessing the traumatic event in person, learning that the traumatic event occurred to a close family member or close friend (with the actual or threatened death being either violent or accidental) or experiences first-hand repeated or extreme exposure to aversive details of the traumatic event (not through media, pictures, television or movies unless work-related)” (American Psychiatric Association, 2013). Those impacted by PTSD continue to relive disruptive thoughts, feelings, and sensations related to their experiences long after the event has ended. This can leave individuals feeling isolated, estranged from family, friends, and peers, and individuals may have strong, negative reactions to sounds, sights, and touch.

According to the U.S. Department of Veterans Affairs, the estimates surrounding PTSD diagnosis in the military are; about 31% of Vietnam veterans, 20% of Iraqi war veterans, 11% of veterans of the war in Afghanistan and as much as 10% of the Gulf War (Desert Storm) veterans. (MedlinePlus, 2009).

“Sometimes I need to share with someone who will listen and validate what happened to me was real. If I do not do this I might convince myself, again, that I made it all up, that it just did not happen. I do not need solutions, I do not need answers. I just need to be heard to know what I am feeling matters, that it is real” (Lee, 2008)

 Post-traumatic stress disorder (PTSD) has more often been brought into the public eye by discussion of its effects on war veterans, but deeper discussion surrounding medical treatment and side effects of medicine is often neglected. War Veterans who suffer from PTSD often take antidepressants and sleep-aids. These medications often come with a well-documented list of risks and side effects, such as high rates of abuse of medication, as well as withdrawal symptoms if the medication is stopped. Though these antidepressants and sleep-aids will treat symptoms of PTSD, many will require additional medication to combat their side-effects, even when “these pills are paired with talk therapy, more than 60% of patients continue to maintain a PTSD diagnosis”(Ansari, 2016). The neglect towards finding better, and updated treatment for PTSD has caused many patients to suffer even more with what should be minimal impact from current medication; as the point of medication is to ease the symptoms, rather than create more difficulty for patients.

Though marijuana legalization spreads, there is still a stigma attached to cannabis use for medicinal purposes. In the early 20th century, cannabis was made illegal due to discussion around its potential for addiction, but also cultural ties in various minority groups that had newly immigrated to the United States. Laws surrounding its restriction stem from the science surrounding its potentially addictive properties, but are also deeply embedded in sociocultural disparities and issues surrounding the early 20th century. However, over time, discussion surrounding the use of marijuana in medicinal settings has opened up and allowed for progression and testing (Burnett, 2014). Research approved by the Drug Enforcement Administration (DEA) has been done in small populations of diagnosed veterans in order to assess how medical marijuana can impact, and lessen symptoms, while simultaneously eliminating concerns about side-effects of pre-existing medication. Currently, only 6 states allow for citizens suffering from the disorder to obtain medical marijuana, while as of June 2016, 25 states and The District of Columbia allow for medical marijuana usage. One study claims the perks of medical marijuana as “versatile and fast acting, less addiction and withdrawal, and affordable trauma treatment” (Ansari, 2016). These claims are based on high success rates seen from prescribing medical marijuana to help patients overcome addiction and the flexibility of choosing from “hundreds of cannabis strains…each possessing unique medical benefits…users are in complete control of their dosage…patients can start and stop (medical marijuana usage) as they please without any noteworthy repercussions” (Ansari, 2016). The fewer risks associated with using medical marijuana are apparent with its use for other illnesses, but have also been shown in PTSD research done with our Veterans.

 “By working with chronic treatment-resistant veterans, we address a national emergency and limit variability at the potential expense of generalizability,” Rebecca Matthews, a  clinical trial leader at Multidisciplinary Association for Psychedelic Studies in Colorado claims. “Further research will be needed to determine if these results will apply to other groups of PTSD sufferers.” (Burke, 2016). Even within the scope of PTSD among Veterans, the levels of anxiety and depression associated with PTSD vary. There is also a variance in how intrusive memories, flashbacks, nightmares are, and what exactly reminds individuals of the trauma. The trauma involved within individuals of the military varies, and therefore prolonged and careful research must be funded and focused on, so we can properly assess the variance of PTSD and its impact on non-military individuals.

“The sad truth is that the American Public has become blinded to the plight of our vets and this has become evident of the ease to condemn those that commit crimes, and vilify them rather than to actually solve the dilemmas we face. We have become accustomed to ignoring our veterans who have defended our nation, since after WWII we have become your person you love to hate. This is who we are, we who do what you do not want to do and wear the emotional scars and bear your shame” (Lee, 2008).

Although there may be progression in supporting research, there are still hoops to jump when starting dialogue with the public, lobbying for support, drafting bills, and ultimately progressing the state and status of medical treatment for those who suffer from PTSD. The federal government’s position still holds that marijuana has no accepted medical use for treatment, and has a high potential of abuse. In our communities, even gaining support for medical marijuana for general treatment is difficult, let alone using it for PTSD. We need to be able to open dialogue and share current, accurate research data in regards to the effectiveness of medical marijuana in treatment.

Perception of medical marijuana as a stigmatized medicine creates difficulty in conversations progressing cannabis forward as legitimate, and assessable medication for those in need. Patients will feel the brunt of stereotypes surrounding the use of marijuana for recreational use rather than medical use, as well as the belief that marijuana will take a toll on their mental cognition. This leads into issues beyond peers, and progresses into issues in local, state, and federal government that inhibit proper growth, and distribution of medical marijuana. Use of medical cannabis can also impact the ability to get housing, child custody in a court of law.

In the process of obtaining grants, and continuing approval for research; subsequent steps need to be made in understanding PTSD. We must understand how it is treated, and break down preconceived notions of the use of cannabis for medical purposes. In creating dialogue between individuals, and communicating scientifically correct findings, we can not only progress legal processes and ideas surrounding treatment methods for mental disorders, as well as show support to those unaffected by current treatment; if already treatment-resistant patients are responding to cannabis, and have fewer concerns with side-effects compared to current medication, than we need to be able to implement further steps without fear of reproach or discrimination of their disorder or their treatment.

References:

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: American Psychiatric Publishing.

Ansari, F. (2016, September 06). Medical Marijuana Can Help Veterans Battle PTSD. Retrieved from http://observer.com/2016/09/medical-marijuana-can-help-veterans-battle-ptsd/

Burke, M. (2016, September 5). Study: Can marijuana improve PTSD symptoms for veterans? Retrieved from http://www.stripes.com/news/study-can-marijuana-improve-ptsd-symptoms-for-veterans-1.427271

Burnett, Dr M. Reiman A, PhD, MSW. (2014, October 9). How Did Marijuana Become Illegal in the First Place? Retrieved from http://www.drugpolicy.org/blog/how-did-marijuana-become-illegal-first-place

Feature: Post Traumatic Stress Disorder PTSD: A Growing Epidemic / Neuroscience and PTSD Treatments | NIH MedlinePlus the Magazine. (2009). Retrieved from https://medlineplus.gov/magazine/issues/winter09/articles/winter09pg10-14.html

Lee, S. (2008, October 24) Combat PTSD and Memory; Would You Want to Forget the Biggest Most Influential Part of Your Life? Retrieved from http://ptsdasoldiersperspective.blogspot.com/2008/10/would-you-want-to-forget-biggest-most_24.html