PTSD

Transcendental Meditation has dramatic benefits for those with PTSD

  • A month of practicing Transcendental Meditation daily resulted in 80% of military veterans with PTSD having their symptoms reduced to below the clinical level.

A pilot study involving 41 military veterans and 5 active-duty soldiers diagnosed with clinical levels of PTSD has found that one month of transcendental meditation produced dramatic benefits, with 37 (80%) having their symptoms reduced to below the clinical level, and 40 having a clinically significant decrease of more than 10 points.

A test 90 days later also showed that PTSD symptoms continued to improve, and a further three individuals had dropped to below the clinical level.

The participants learned the standard Transcendental Meditation technique, which is practiced 20 minutes twice a day. Those who practiced twice a day had greater benefits than those who practiced once a day.

The study follows on from two earlier studies involving Congolese refugees, who found a significant benefit after just 10 days of Transcendental Meditation.

Note that this is only a preliminary study, with no controls, and the participants were self-selected, responding to media advertising (89 responded — only those with clinical levels of PTSD were included in the study). However, the results certainly appear dramatic, and previous research has shown that Transcendental Meditation has a positive benefit for many of the conditions associated with PTSD, such as high anxiety, insomnia, depression, and high blood pressure.

https://www.eurekalert.org/pub_releases/2018-01/muom-vwl011018.php

Full text of the paper is available at https://academic.oup.com/milmed/article/183/1-2/e144/4781643

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Sleep helps process traumatic experiences

  • A finding that sleeping after watching a trauma event reduced emotional distress and traumatic memories is intriguing in light of the theory that PTSD occurs through a failure of contextual processing.

A laboratory study has found that sleeping after watching a trauma event reduced emotional distress and memories related to traumatic events. The laboratory study involved 65 women being shown a neutral and a traumatic video. Typically, recurring memories of certain images haunted the test subjects for a few days (these were recorded in detail in a diary). Some participants slept in the lab for a night after the video, while the other group remained awake.

Those who slept after the film had fewer and less distressing recurring emotional memories than those who were awake. This effect was particularly evident after several days.

 One of the reasons for this benefit is thought to be that the memory consolidation processes that happen during sleep help contextualize the memories. This is interesting in view of the recent theory that PTSD is associated with a deficit in contextual processing.

However, I'd note that there is conflicting evidence about the effects of sleep on negative memories (for example, see http://www.memory-key.com/research/news/sleep-preserves-your-feelings-about-traumatic-events).

https://www.eurekalert.org/pub_releases/2016-12/uoz-shp121316.php

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Individual cognitive processing therapy had better PTSD improvement

  • A large randomized study has found that cognitive processing therapy works better when administered on an individual basis, but that regardless, it is only successful about half the time.

A randomized clinical trial of 268 active-duty personnel seeking treatment for PTSD has found that individual sessions of cognitive processing therapy were twice as effective as group sessions.

Participants were assigned to CPT in either 90-minute group sessions or 60-minute individual sessions twice weekly for six weeks. PTSD severity was reduced significantly more in those receiving individual treatment, however improvements were maintained during the six-month follow-up in both groups. Depression and suicidal ideation also improved equally with both forms of CPT.

However, even among those receiving individual CPT, some 50% still had PTSD and clinically significant symptoms.

https://www.eurekalert.org/pub_releases/2016-11/tjnj-icp112116.php

Full paper available at https://jamanetwork.com/journals/jamapsychiatry/fullarticle/2587076

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Brain changes seen in veterans with PTSD after mindfulness training

  • A small study found mindfulness training had an observable effect on the brains of PTSD sufferers.

A pilot study involving 23 military veterans with PTSD found that those who received mindfulness training showed reduced PTSD symptoms, and brain changes that suggest a greater ability to shift and control attention. Mindfulness training was given to 14 veterans, while the other 9 received ‘control’ group support. Both groups were given brain scans before and after the treatment program.

The initial scan showed that, even during rest, veterans’ brains showed unusual activity in regions involved in responding to threats and other external dangers. After practising mindfulness, the default mode network was not only more active, but also showed stronger connections with the executive network, which is involved in controlling attention. PTSD is associated with reduced executive functioning.

Moreover, veterans responded well to the training, with more of that group sticking with the therapy, compared with the comparison psychotherapy group.

The researchers emphasize, however, that people with PTSD interested in this should seek out providers trained specifically in PTSD care, as mindfulness sessions can sometimes trigger symptoms such as intrusive thoughts to flare up.

http://www.eurekalert.org/pub_releases/2016-04/uomh-bcs033016.php

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Is PTSD a failure of context processing?

  • A new theory suggests a single dysfunction, in the processing of context, could underlie the multiple symptoms and characteristics of PTSD.

An interesting new theory for PTSD suggests that the root of the problem lies in context processing problems.

Context processing allows people and animals to recognize that a particular stimulus may require different responses depending on the context in which it is encountered. So, for example, a lion in the zoo evokes a different response than one encountered in your backyard.

Context processing involves the hippocampus, and its connections to the prefrontal cortex and the amygdala. Research has shown that activity in these brain areas is disrupted in those with PTSD.

The idea that a disruption in this circuit can interfere with context processing can explain most of the symptoms and much of the biology of PTSD. Previous models have focused on one aspect of the disorder:

  • on abnormal fear learning, which is rooted in the amygdala
  • on exaggerated threat detection, which is rooted in a network involving the amygdala, the anterior cingulate cortex and insula
  • on executive function and emotion regulation, which is mainly rooted in the prefrontal cortex.

The researchers suggest that a deficit in context processing would lead PTSD patients to feel "unmoored" from the world around them, unable to shape their responses to fit their current contexts. Instead, their brains impose an "internalized context", one that always expects danger.

This type of deficit, arising from a combination of genes and life experiences, may create vulnerability to PTSD in the first place.

The researchers are now testing their model.

https://www.eurekalert.org/pub_releases/2016-10/uomh-wrg100716.php

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Size of hippocampus associated with PTSD therapy benefits

  • Size of that key memory region, the hippocampus, appears to be not simply a risk factor for PTSD, but also key to whether sufferers will respond positively to exposure therapy.

Following previous research showing that having a smaller hippocampus is associated with increased risk of PTSD, a study involving 40 participants with PTSD and 36 trauma-exposed healthy controls has found that those PTSD patients who responded to the treatment had larger hippocampi compared to those who didn’t benefit from the therapy.

The participants were evaluated at baseline and after 10 weeks, during which time the PTSD group had prolonged exposure therapy.

The study found that both the resilient controls and the 23 patients with PTSD who responded to treatment had greater hippocampal volume at the beginning of the study than the 17 non-responders.

The findings add to growing evidence that the hippocampus is key to distinguishing between cues that signal safety and those that signal threat.

http://www.eurekalert.org/pub_releases/2016-05/cumc-sob051216.php

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Concrete thinking may reduce the power of traumatic memories

  • Focusing on concrete details when experiencing a traumatic event may, oddly enough, protect you more from the power of those memories, than if you tried to distance yourself from what you are experiencing.

Can you help protect yourself from the memory of traumatic events? A new study suggests that, by concentrating on concrete details as you live through the event, you can reduce the number of intrusive memories later experienced.

The study, aimed particularly at those who deliberately expose themselves to the risk of PTSD (e.g., emergency workers, military personnel, journalists in conflict zones), involved 50 volunteers who rated their mood before watching several films with traumatic scenes. After the first film, they rated their feelings. For the next four films, half the participants were asked to consider abstract questions, such as why such situations happened. The other half were asked to consider concrete questions, such as what they could see and hear and what needed to be done from that point. Afterward, they gave another rating on their mood. Finally, they were asked to watch a final film in the same way as they had practiced, rating feelings of distress and horror as they had for the first film.

The volunteers were then given a diary to record intrusive memories of anything they had seen in the films for the next week.

Both groups, unsurprisingly, saw their mood decline after the films, but those who had been practicing concrete thinking were less affected, and also experienced less intense feelings of distress and horror when watching the final film. Abstract thinkers experienced nearly twice as many intrusive memories in the following week.

The study follows previous findings that emergency workers who adopted an abstract processing approach showed poorer coping, and that those who processed negative events using abstract thinking experienced a longer period of low mood, compared to those using concrete thinking.

Further study to confirm this finding is of course needed in real-life situations, but this does suggest a strategy that people who regularly experience trauma could try. It is particularly intriguing because, on the face of it, it would seem like quite the wrong strategy. Distancing yourself from the trauma you're experiencing, trying to see it as something less real, seems a more obvious coping strategy. This study suggests it is exactly the wrong thing to do.

It also seems likely that this tendency to use concrete or abstract processing may reflect a more general trait. Self-reported proneness to intrusive memories in everyday life was significantly correlated with intrusive memories of the films. Perhaps we should all think about the way we view the world, and those of us who tend to take a more abstract approach should try paying more attention to concrete details. This is, after all, something I've been recommending in the context of fighting sensory impairment and age-related cognitive decline!

Abstract thinking certainly has its place, but as I've said before, we need flexibility. Effective cognitive management is about tailoring your style of thinking to the task's demands.

http://www.eurekalert.org/pub_releases/2016-05/uoo-tdc050516.php

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Trauma changes the brain even in those without PTSD

  • A review of previous research has compared brain activity in those with PTSD who experienced trauma, those who experienced trauma but didn't develop PTSD, and those who never experienced trauma.
  • Those who had PTSD had differential activity in two brain regions.
  • Those who had experienced trauma had differential activity in several brain regions associated with emotional regulation, regardless of whether they'd developed PTSD.

A meta-analysis of studies reporting brain activity in individuals with a diagnosis of PTSD has revealed differences between the brain activity of individuals with PTSD and that of groups of both trauma-exposed (those who had experienced trauma but didn't have a diagnosis of PTSD) and trauma-naïve (those who hadn't experienced trauma) participants.

The critical difference between those who developed PTSD and those who experienced trauma but didn't develop PTSD lay in the basal ganglia. Specifically:

  • PTSD brains compared with trauma-exposed controls showed differentially active regions of the basal ganglia
  • trauma-exposed brains compared with trauma-naïve controls revealed differences in the right anterior insula, precuneus, cingulate and orbitofrontal cortices, all known to be involved in emotional regulation
  • PTSD brains compared with both control groups showed differences in activity in the amygdala and parahippocampal cortex.

The finding is consistent with other new evidence from the researchers, that other neuropsychiatric disorders were also associated with specific imbalances in specific brain networks.

The findings suggest that, while people who have experienced trauma may not meet the threshold for a diagnosis of PTSD, they may have similar changes within the brain, which might make them more vulnerable to PTSD if they experience a subsequent trauma.

The finding also suggests a different perspective on PTSD — that it “may not actually be abnormal or a 'disorder' but the brain's natural reaction to events and experiences that are abnormal”.

http://www.eurekalert.org/pub_releases/2015-08/uoo-tec080315.php

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PTSD for many ventilated during intensive care

A study involving 520 intensive care patients who had been put on ventilators for acute lung injury (ALI), of whom 186 patients of the 275 survivors were followed up over the next two years, found that 35% of them had clinically significant symptoms of PTSD. Nearly two-thirds of these (62%) still had symptoms at two years.

ICU survivors with PTSD are unusual in that they often experience flashbacks to delusions or hallucinations they had in the hospital, rather than events that actually occurred

03/2013

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Eye movement therapy helps PTSD

It certainly sounds like pseudo-science, but that's why we do science - because the weirdness of something is not a particularly good reason to dismiss it (quantum! many-universes!). Sometimes we don't understand enough about how things work to know why they work, but finding out whether or not they work is a good place to start.

Tori Rodriguez at Scientific American:

03/2013

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