Videogame Treatment for PTSD?

A little fluff I chanced upon over at the Mind Hacks website, regarding the “psychology of Tetris.” It even includes a link to a Psychology Today article about the possibility of using video games such as Tetris to prevent flashbacks in people suffering with PTSD. Here’s the quote from Mind Hacks:

The writer Jeffrey Goldsmith was so obsessed with Tetris that he wrote a famous article asking if the game’s creator Alexey Pajitnov had invented “a pharmatronic?” – a video game with the potency of an addictive drug. Some people say that after playing the game for hours they see falling blocks in their dreams or buildings move together in the street – a phenomenon known as the Tetris Effect. Such is its mental pull, there’s even been the suggestion that the game might be able to prevent flashbacks in people with PTSD.

The theory, as noted in the Psychology Today article, is that an “intensive mental task” might actually be able to “compete successfully” with the development of flashbacks. From that article, which you might find interesting:

In their experiment, volunteers were shown a brief video with traumatic scenes of violence and death, and half of them were then assigned to play Tetris for 10 minutes, the other half (the controls) were told to sit quietly, doing nothing. At followup a week later, the Tetris players had fewer flashbacks and lower scores on measures of trauma impact. Holmes concluded, “strategic, selective interference with the consolidation of recently triggered visual memories occurs via the demand on the player’s limited visuospatial working memory resources.”

Informative New York Times Piece on Trauma

This clip, from yesterday’s New York Times. The piece was sent my way, and I wanted to pass it on: “For Veterans, a Surge of New Treatments for Trauma.” It’s a rich article that covers a lot of ground in a short space. It might serve either as a primer on trauma or an update on recent treatments for the otherwise informed. It roams from the causes of trauma, to the rash of suicides the army is currently experiencing and their campaign to end the stigma of traumatic stress, to a recent wave of mind-body treatments now being successfully employed, and touches upon the prevalence of traumatic brain injury among those with traumatic stress, mentions the Center for Mind-Body Medicine — in other words, it’s a cornucopia of useful and interesting information.

Here’s a quote:

You name it, and it’s being used somewhere in the veterans’ health system: The National Intrepid Center in Washington is one of many places using acupuncture to treat stress-related anxiety and sleep disorders; it has been shown to be effective against PTSD. At the New Orleans V.A., the same clinicians who ran Trin’s group also did a small study using yoga. They found vets liked it and attendance was excellent. The yoga reduced the veterans’ hyperarousal and helped them sleep. There is even a group in the Puget Sound V.A. Hospital in Seattle that treats PTSD — including among Navy Seals — using the Buddhist practice of “loving kindness meditation.” (“We had a little bit of debate about changing the name,” said Dr. David Kearney, who led the group. “But we decided to keep it, and it worked out just fine.”)

Questions and Answers: Trauma

Q. What Causes Psychological Trauma?

A. Trauma is the result of being exposed to extreme, often life-threatening stress that is accompanied by a an overwhelming feeling of helplessness. Examples of incidents that might lead to trauma include:

• rape
• sexual abuse
• domestic violence
• military combat

Q. Are there any other causes of trauma?

A. Yes. Because what causes something to be traumatic is partly related to perception, many events can cause traumatic stress. Some less obvious examples include:

• sports injury
• life threatening illness
• invasive surgery
• car accident
• bullying
• sudden death of a loved one
• ongoing, relentless stress
• earthquake or flood
• neglect

Q. Okay, what are some signs that someone has traumatic stress?

A. There are a number of flags that might indicate trauma, such as:

• difficulty functioning at work
• terrifying nightmares or flashbacks
• avoidant behavior (often related to the circumstances of the trauma)
• difficulty with relationships
• severe anxiety or depression
• abuse of alcohol or drugs

Q. Any specific symptoms?

A. Yes, while many symptoms of traumatic stress overlap with depression and anxiety, there are a few key signs to look for. When such symptoms occur in clusters there is a likelihood of trauma. Such symptoms include:

• shock
• numbness
• social withdrawal
• confusion
• fearfulness
• panic attacks
• recurrent nightmares
• flashbacks
• self-blame

Q. Can trauma really affect my health?

A. Yes, there are two medical outcomes related to trauma:

• Higher rates of health problems
• Higher rates of unhealthy behavior

Q. What health problems are associated with psychological trauma?

A. Research has linked trauma to increased rates of:

• cardiovascular disease
• diabetes
• gastrointestinal disorders
• poor immune function

Q.  What about unhealthy behaviors?

A.  People suffering with the after effects of trauma tend to have:

• poor dietary habits
• obesity
• abuse of tobacco, alcohol, drugs

Q. Any other problems associated with trauma?

A. Yes, because unhealthy behaviors and health problems tend to reinforce one another, trauma patients tend to end up in the doctor’s office more frequently:

• have higher rates of outpatient visits to ER
• have higher rates of primary care visits
• have higher rates of surgery procedures
• they also have higher rates of depression
• tend to cope by avoiding things which leads to greater cardiovascular reactivity, and impaired immune function

Q. Is there an effective treatment for trauma?

A. Yes! If trauma is properly diagnosed it can be treated effectively. But trauma is best treated by a mental health professional with a specialty in treating trauma.

Causes of Trauma and PTSD: Common and Less Common

Trauma occurs when we are exposed to extremely an stressful situation accompanied by a feeling of helplessness. Common examples of experiences which cause trauma are rape, sexual abuse, domestic violence, and military combat. But not everyone exposed to trauma develops Post-Traumatic Stress Disorder (PTSD).

And trauma does not always arise from the causes mentioned above. Here’s a brief list of events that may also result in traumatic stress:

• sports injury
• car accident
• life-threatening illness
• surgery
• the sudden death of someone close
• a breakup
• ongoing relentless stress
• natural disasters such as earthquake or flood
• neglect
• bullying

Fortunately, we have some good treatments for trauma and PTSD. Talk therapy can be helpful, especially for chronic, on-going trauma such as may occur during childhood. But sometimes talk is not enough. Various exposure treatments, such as EMDR, can be effective in reducing and even eliminating some of the most bothersome symptoms of trauma such as flashbacks, panic attacks, and nightmares.

Curious about treatment for trauma or PTSD? I am trained in and practice EMDR, a well researched trauma treatment. Please click on the ‘EMDR’ link in the ‘ABOUT’ section in the right-hand column of this website for more information.

If Stress Is Bad For Your Health, Trauma Is Really Bad

Here’s the abstract from an article, “Psychological Trauma and Physical Health: A Psychoneuroimmunology Approach to Etiology of Negative Health Effects and Possible Interventions” (2009) by Kathleen Kendall-Tackett published in Psychological Trauma: Theory, Research, and Policy. Quite a mouthful! What it means is: “Trauma Is Bad For Your Health”. You could also read it as “Stress Is Bad For Your Health” — keeping in mind that trauma is an extreme form of long-term stress. Sometimes an abstract (the short version of a scientific article) says so much. I’ve put some of the key points in bold, since I know you are busy.

People who have experienced traumatic events have higher rates than the general population of a wide range of serious and life-threatening illnesses including cardiovascular disease, diabetes, gastrointestinal disorders, and cancer. An important question, for both researchers and clinicians, is why this occurs. Researchers have discovered that traumatic events dysregulate the hypothalamic pituitary-adrenal axis and sympathetic nervous system. More recently, research from the field of psychoneuroimmunology (PNI) suggests that traumatic life events can lead to health problems through dysregulation of another key system: the inflammatory response. Prior trauma “primes” the inflammatory response system so that it reacts more rapidly to subsequent life stressors. Elevated inflammation has an etiologic role in many chronic illnesses. Recent PNI studies also suggest some interventions that can serve as adjuncts to traditional trauma treatment. These treatments include long-chain omega-3 fatty acids, exercise, and sleep interventions. Each of these interventions downregulates inflammation, which will likely halt the progression to chronic disease for some trauma survivors.

The take-home point, if you will, is not just that stress is bad, but the way that it is bad. We’ve known for some time that stress activates the adrenal system, and that leads to poor health outcomes. But aggravating the inflammatory response is a new wrinkle. As I understand it, the inflammatory response is a key player in the cause of both heart disease and cancer, and a lot of research is going into understanding what makes it tick. That said, if you can head the inflammatory response off at the pass, reduce its activity before it starts — that should reduce your risk of a whole range of health conditions. Exercise and diet can reduce your risk.

And if you have traumatic stress — then potentially you open yourself up to all kinds of health problems. The good news is that traumatic stress can be treated effectively.

 

Trauma Resource

I found this guide “Healing Emotional and Psychological Trauma” that might be useful for someone who suspects the root of their problem is related to trauma. It’s nicely laid out and covers a lot of material straightforwardly. Recommended.

Here’s the link to the article at helpguide.org.

Where Are Veterans Returning to Civilian Life? Community College

Suicides of Troops Exceeding Combat Deaths.

The Huffington Post, and other sources, just reported June 7 that deaths from suicide had outpaced combat deaths in the Afghanistan war. During the first 155 days of the years the armed forces lost 154 troops to suicide — an alarming rate of nearly one suicide per day. According to the Huffington Post, who cited Pentagon statistics via the Associated Press, that’s about 50 percent more soldiers lost to suicide than soldiers killed in action. From the article:

The reasons for the increase are not fully understood. Among explanations, studies have pointed to combat exposure, post-traumatic stress, misuse of prescription medications and personal financial problems. Army data suggest soldiers with multiple combat tours are at greater risk of committing suicide, although a substantial proportion of Army suicides are committed by soldiers who never deployed….

The 2012 active-duty suicide total of 154 through June 3 compares to 130 in the same period last year, an 18 percent increase. And it’s more than the 136.2 suicides that the Pentagon had projected for this period based on the trend from 2001-2011. This year’s January-May total is up 25 percent from two years ago, and it is 16 percent ahead of the pace for 2009, which ended with the highest yearly total thus far.

Suicide totals have exceeded U.S. combat deaths in Afghanistan in earlier periods, including for the full years 2008 and 2009….

The numbers are rising among the 1.4 million active-duty military personnel despite years of effort to encourage troops to seek help with mental health problems. Many in the military believe that going for help is seen as a sign of weakness and thus a potential threat to advancement.

One Response: The Soldier’s Project

The announcement was an uncanny reminder of the plight troops face, coming the day before The Soldier’s Project‘s third annual conference. The project is a non-profit group providing free resources to veterans who may otherwise not seek treatment. The tag on their website (a good resource, if you’re interested in learning more) reads: “Free, confidential psychological counseling for military service members and their loved ones.”  I had the pleasure of attending conference, just held at USC on June 8-10, which highlighted the experiences of veterans, not just from Iraq and Afghanistan, but from conflicts as far back as Korea and Viet Nam.

A frontline of Veterans Returning to Civilian Life — Community College

One interesting facet of veterans returning to civilian life is the number of them going back to school, largely in community college settings. Service members from all over the country are discharged in California. Many of them, rather than return to areas where the economy is depressed, or wary of returning home, choose to stay in California. Many service members originally enrolled as a way of financing their education. So, faced with limited options, many do just that. Patricia D’Orange-Martin, the coordinator the Pasadena City College Veterans Resource Center, stated that a full 20% of veterans in community college have been discharged within the last 30 days. In other words, community college is one of the front lines of where returning service members meet civilian life. These are veterans who are still grappling to find their place in civilian life.

Another interesting aspect of treating this group is the difficulty in getting service members to seek services. It’s a complicated problem. First off, a significant number of veterans simply don’t identify as veterans. They never expected to do a tour of duty. When they cast off their uniform they left the service behind. As one participant stated, “I used to think of a veteran as an old guy in a baseball cap with a bunch of medals that he wears all the time — it’s not something I wanted to be a part of.” Added to that, many are concerned about how seeking services may adversely affect their benefits or the stigma of mental illness. [Apparently the next revision of DSM-V may have a new name for PTSD, rather than Post-Traumatic Stress Disorder, it may become Post Traumatic Injury.] Moreover, coming from a culture where you simply “get the job done” and “achieve your mission no matter what” it can be very difficult to accept the idea that you might need help.

One clinician in the audience contributed: You’d be more likely to get veterans to attend an event if you advertise something related to learning difficulties. Many vets have Traumatic Brain Injuries (TBI) that mean they process information at a slower rate and have memory problems. Many of them don’t even realize this is related to a TBI.

One participant at the conference shared his experience on returning from several tours of duty. His grandfather had served in the National Guard. So had his father. It was a natural thing for him to do. He never expected to do a tour of duty. He had three days to get his things together. When he returned home the storage unit where all his belongings were packed away had been damaged by flooding.

I was so sick of all the ‘we’re so proud of you bullshit’ and my stuff was destroyed. But I had no ‘Rambo moment.’ I had late onset PTSD and I had no idea what it was. ‘I’m an Army of One. I can’t have PTSD.’  After five nights of not being able to sleep I would miss a class or a show [he is a musician]. And I would say, that’s never going to happen again. But it would happen again. To cope I’d get a case of beer and a bottle of wine. I became good at avoidance and numbing. I made a suicide attempt.

He said he’d been diagnosed with an adjustment disorder. Clearly, some military returning from duty are not aware of the scope of the problems they are facing. Let alone resources they might avail themselves of. Clearly they are doing important, valuable work at the Pasadena City College Veterans Resource Center. (Click on the link, if you’re interested in more information.)

The Trauma of Bessel van der Kolk

Renowned trauma expert.
Bessel van der Kolk, M.D., internationally renowned trauma expert, spoke at the Los Angeles County Psychological Association (LACPA) convention this past Saturday. It was an engaging and thought provoking presentation. His seminal article “The Body Keeps the Score: Memory and the Evolving Psychobiology of Post-Traumatic Stress“(1994) caught the attention of both clinicians and researchers alike — appropriate, as van der Kolk has a foot in each camp.

Psychobiology, psychotherapy.
With a solid background in neuroscience and physiology, one of van der Kolk’s basic assertions is that traumatic memories are hard wired into somatic (body) memory. As such, these “memories” are associated with primitive areas of the brain, inaccessible to talk therapies. The speech centers of the brain are located in the left hemisphere, in the cerebral cortex, on the very surface of the brain. It is generally believed that the cerebral cortex is the most recent product of human evolution. In contrast, the parts of the brain that regulate bodily sensations, temperature, respiration, and so on, are in the primitive, reptilian lower brain. Inaccessible to talk therapies.

Clinicians and researchers: Debate over EMDR.
That simple assertion, that traumatic memories rest in a part of the brain unaffected by talk therapies, causes a stir, among both researchers and clinicians. Both find van der Kolk’s espousal of Eye Movement Desensitization and Reprocessing (EMDR) as trauma treatment provocative, for different reasons.