Personalized PTSD Treatment- Pan's Labyrinth

INTRODUCTION:

Life is hard, and it is normal for human beings to have upsetting memories, feel on edge, or have trouble sleeping after this type of event. It may even affect daily life and function as effectively during normal daily activities such as attending school, performing at work, or spending quality time with people. With majority of cases, time heals these bruises within a few weeks or months. However, whenever these symptoms persist for longer than a few months, it is possible to have PTSD.

Whenever a disturbing life event occurs to a person, ‘Post Traumatic Stress Disorder’ or ‘PTSD’ can develop. Individuals with PTSD find themselves continuously re-living these traumatic memories forcing them to avoid people, places, or situations that can trigger symptoms of PTSD. These triggers can change the mood and thinking pattern of the individual. At some point or another in their lifetime, up to 7% of Americans find themselves struggling with PTSD. [C]

For some, PTSD symptoms may appear in different period of one’s life different from the traumatic event and may even come and go over time. Although symptoms of PTSD usually begin soon after the traumatic event, there are cases where symptoms do not appear until months or even years later. It is also very common to see these symptoms appear and disappear on their own. [A]

Stanford University Medical Center conducted studies that focused on predicting, with high accuracy, which individuals with PTSD will benefit the most from psychotherapy (a common treatment option for PTSD). Brain imaging was key to making this discovery. Although psychotherapy is the only effective treatment available for PTSD, not much is understood on why and how this type of therapy works as well as who benefits the most from it. [C]

BACKGROUND INFORMATION:

PTSD (posttraumatic stress disorder) is a mental health problem that some people develop after experiencing or witnessing a life-threatening event, like combat, a natural disaster, a car accident, or sexual assault. [A] In instances where individual’s memory is triggered of the trauma it is typical for him or her to have intense emotional and physical reactions accompanying the trigger. [B]

In some cases, even getting injured during an event can make it more likely to develop PTSD. Combat and sexual assault are the most commonly associated forms of trauma found in individuals suffering with PTSD. The number of traumatic experiences, age at exposure, and gender are just some personal factors contributing to an individual’s development of PTSD. The life events after these events are also key as exposure to stress or lack of social support afterwards can contribute also. [A]

It is extremely important to remember that PTSD is NOT a sign of weakness, but that one has overcome great although painful life experience(s). PTSD can happen to anyone and several factors can increase the chances that a certain individual will have PTSD. The many variables and/or factors that contribute to one having PTSD is out of the person’s control in that they have experienced a very intense or long-lasting traumatic event. [A]

Other problems that manifest from traumatic experiences into chronic physical pain, employment difficulties, and trouble in maintaining or forming relationships are common in individuals struggling with PTSD. Behaviorally, individuals experience heightened reactivity to stimuli (hypervigilant), become hostile, practice self-destructive behavior, social isolation due to overwhelming anxiety and depression.

Symptoms include nightmares and flashbacks which lead to insomnia, avoidance of situations that could trigger memories of the trauma drastically affecting the quality of ones’ life, and sever mistrust of people around them. In addition, emotional detachment and/or unwanted thoughts are also common.

Specifically speaking there are 4 types of PTSD symptoms (although each varies from person to person).

The first type of PTSD symptom is known as, “Re-living the event” or “re-experiencing symptoms” where unpleasant memories and nightmares make the individual relive the event similar a flashback.

The second type is whenever the individual “Avoids situations” that could trigger memories of the traumatic event. This causes the person to avoid conversations on this specific topic, having thoughts related to the event, and avoiding activities.

The third type includes the perception the individual has of themselves but also the perception of the world and people around them. This PTSD symptom is called, “Excessive/more negative beliefs and feelings” and it causes a loss of interest in activities one enjoys, feels guilty or shame along with the overwhelming feeling of the world as being a dangerous and frightful place. Subsequently, individuals suffering with PTSD have difficulty trusting others. In addition, they feel numb or find it hard to feel happiness.

State of being on constant alert of surroundings is the fourth type of symptom, “hyperarousal” causing the individual to always be looking out of danger affecting the ability to sleep and/or concentrate. Feelings of anger can arise suddenly, are easily startled, or have unhealthy habits such as drug usage, alcohol, smoking, or reckless driving.

Even children can have PTSD and experience symptoms which differ depending on age. Ages 6 and younger may get upset if their parents are not nearby, display trouble sleeping, or act out the trauma through their play activities. Between ages 7 to 11, the trauma may also be displayed through drawings and stories. Their nightmares can become increasingly aggressive and irritable. Children with PTSD between these ages have difficulties with school and/or friends. When a child is between ages 12 and 18 their symptoms are more like adults’ symptoms (experience depression, anxiety, withdrawal, or reckless behavior such as substance abuse, running away from home, etc.) The great news is that PTSD is curable, and the following treatments can get rid of symptoms altogether.

Treatment includes different types of psychotherapy as well as medications to manage symptoms. In most PTSD cases, treatments include both medications and talk therapy. What talk therapy (sometimes called counseling or psychotherapy) does is that it gives individuals the tools and coping skills to deal with PTSD and problems that stem from this condition. 

Trained individuals who guide patients through distressful time periods in life or mental disorders through talk therapy are known as clinical psychologists. There are different types of psychotherapy that clinical psychologists use to help individuals struggling with PTSD.

Prolonged Exposure (PE) is a form of psychotherapy where the individual talks about the trauma repeatedly until the memories are no longer upsetting. Through this process, when completed successfully, helps to get control over the thoughts, feelings, and possibly even perspective on the traumatic event.

A similar kind of therapy is called Eye Movement Desensitization and Reprocessing (EMDR), where patients focus on the sounds and/or movements when speaking of the trauma. This approach helps the brain approach and eventually work through these unpleasant memories.

However, when speaking of psychotherapy, the most effective treatment, at least for PTSD, has been cognitive behavioral therapy (CBT) including cognitive therapy and exposure therapy.

One type is Cognitive Processing Therapy (CPT) where you learn skills to understand how trauma changed your thoughts and feelings. Changing how you think about the trauma can change how you feel.

There are also psychiatrists who prescribe the medications needed in treatments of PTSD. Typically, these medicals include some type of SSRI’s which ease symptoms of depression and anxiety to help patients reach their goals of healing. SSRIs (selective serotonin reuptake inhibitors) and SNRIs (serotonin-norepinephrine reuptake inhibitors), which are also used for depression, are effective for PTSD.

Another medication called Prazosin has been found to be helpful in decreasing nightmares related to the trauma. It is incredibly important to note that benzodiazepines and atypical antipsychotics should generally be avoided for PTSD treatment because they do not treat the core PTSD symptoms and can be addictive.

*[Please note, that if you or someone you know is experiencing such symptoms for over four weeks causing great distress or interfere with daily life functioning, it is possible that he or she can have PTSD.] *

RESEARCH:

Stanford University Medical Center conducted studies that focused on predicting, with high accuracy, which individuals with PTSD will benefit the most from psychotherapy (a common treatment option for PTSD). Brain imaging was key to making this discovery. Although psychotherapy is the only effective treatment available for PTSD, not much is understood on why and how this type of therapy works as well as who benefits the most from it. [C]

The pair of studies had researchers measuring brain activity during 5 tasks assigned to participants and researchers looked for the associations key to reducing symptoms of PTSD after treatment. Studies conducted such as these help the medical field closer to giving patients personalized treatment. One of the studies focused on whether brain activity levels before treatment could help scientists predict which participants would respond well to prolonged exposure therapy.

 

 

 

The first step of the procedure involves psychotherapy where scientists had patients revisit traumatic experience(s) specific to each person. Revisiting traumatic experiences allows for decrease in emotional response. Since everyone is different, not all cases of PTSD will benefit from this treatment. Prolonged exposure therapy for PTSD consists of a series of sessions and assignments. This approach leads patients to slowly approach similar memories and situations that can trigger a reaction. Patients begin by imagining scenarios that trigger their PTSD symptoms -- such as a crowded park. Gradually these individuals progress enough to bring themselves to these very situations.

Prolonged Exposure Therapy (or ‘PET’) functioned in achieving the goal of these studies of measured brain scans of 66 individuals with PTSD as they completed 5 tasks which triggered various emotional and cognitive functions. These tasks involved showing patients images of faces or scenes to evoke either happy, neutral, or positive emotions. Such tasks can also involve responding to questions about such content. 

Prior to receiving prolonged exposure therapy, patients with both lower activity in the amygdala and higher activity in various regions of the frontal lobe while viewing faces with fearful expressions showed a larger reduction in PTSD symptoms following therapy.

The amygdala (located deep within the primitive region of the brain’s alarm system and plays a key role in emotional responses). The frontal lobe is the outer layer of the human brain in the area behind the forehead; it plays a role in complex functions such as behavior, personality and decision-making.

The researchers discovered that patients with greater activation in a deep region of the frontal lobe when ignoring the distracting effects of conflicting emotional information -- such as a picture of a scared face with the word "happy" written across it -- responded better to exposure therapy. The better able the brain is at deploying attention- and emotion-controlling processes, the better you respond to treatment.

The way the human brain responds to emotional regulation and processing tasks gives scientists and researchers the ability to predict the effectiveness of PET with up to 95.5 percent accuracy. This kind of screening approach (using the less expensive and more widely available electroencephalogram rather than fMRI) could help doctors determine the best course of PTSD therapy in the future, the researchers said.

RESULTS:

Therapy has been found to change connectivity in the brain between the frontopolar cortex and regions of the brain located closer to emotional processing areas. Using a non-invasive method for stimulating brain activity known as ‘transcranial magnetic stimulation’ or ‘TMS’, researchers worked to activate the frontopolar cortex in ‘healthy’ individuals. At the same time, they recorded brain activity with fMRI and confirmed that the frontopolar cortex modulated downstream activity in lower cortical regions closer to emotion-processing parts of the brain. This process can confirm whether the frontopolar cortex is important in processing emotions. 

PET led to lasting changes in participants' brains associated with the improvement in PTSD symptoms by better understanding the ways in which PTSD brains function and how linking brain activity patterns determine how well patients responded to treatment. Such personalized treatments for PTSD individuals could be pivotal in helping many struggling to live normal, functioning lives. [The concluding results of these studies have been published online in The American Journal of Psychiatry.]

When participants were instructed to regulate their emotional response to an image of a negative or stressful scenario, noticeable changes were observed in frontopolar cortex activity. Changes in frontopolar cortex activity were also detected when participants were resting or in a non-focused state. It was surprising for researchers to discover that the frontopolar cortex plays such a key role in prolonged exposure therapy. Typically, and for majority of scientific studies, the primary focus has been the emotional processes that occur in PTSD through the functioning of the amygdala.

By the fourth week, fMRI scans revealed elevated activity in the front-most region of the frontal lobe known as the frontopolar cortex. This area of the brain, the most recently evolved region, balances both the internal and external attention spans of individuals as well as aiding in coordination of multiple processes such as multitasking and remembering future ‘to-do’ list items. 

Greater frontal lobe activity and less amygdala activation predicts better treatment outcomes. Based on these findings, researchers activated an area of frontal cortex with TMS probes while imaging the brain. These explorations allowed for the researchers to determine whether TMS helped individuals with PTSD better respond to ‘prolonged exposure treatment’.

They found that doing so inhibited activity in the amygdala, and the degree to which that happened also predicted the degree to which a patient's symptoms improved. In the future, stimulating this region may help increase patients' responsiveness to psychotherapy. Indeed, some small-scale studies in which therapeutic TMS was used daily on the same region of the frontal cortex, without the addition of psychotherapy, have already shown promising results.

CONCLUSION:

These results help to better understand psychotherapy and psychiatric disorders which will help fight negative stigmas surrounding these illnesses and their treatments. Such studies give hope to people struggling with PTSD as they undergo treatment laying the foundation for new treatments based on our understandings of brain circuitry.

Psychotherapy function will be to amplify the attention towards an internal regulatory process that mediates ones’ emotions. Alterations in the activity produced at the frontopolar cortex indicates a shift in frontopolar function. Using psychotherapy as a tool to train this region of the brain for successful regulation of emotions can improve overall symptoms of PTSD individuals and emotional well-being.

Therefore, psychotherapy can be used as a tool in training the frontopolar cortex region of the brain to amplify attention toward an internal regulatory process that mediates successful emotion regulation. The degree to which activity in the frontopolar cortex increased following therapy was associated with the degree of improvement in PTSD symptoms and emotional well-being.

Links:

[A] https://www.ptsd.va.gov/public/ptsd-overview/basics/what-is-ptsd.asp

[B] http://www.mayoclinic.org/diseases-conditions/post-traumatic-stress-disorder/home/ovc-20308548

[C] https://www.sciencedaily.com/releases/2017/07/170711141402.htm

[D] http://screencapped.org/movie/p/thumbnails.php?album=1

[E] http://www.imdb.com/title/tt0253474/plotsummary

*Please note! These images are not mine. They were found on various tumblr, pinterest, google image sites! If any are yours please let me know so that I can give you credit for them! Also the people in the images have no relation to the diseases, illnesses, or cancers I write about. Thanks so much & enjoy~

*Quotes by:  http://www.imdb.com/title/tt0253474/quotes

*Screen caps by: http://screencapped.org/movie/p/thumbnails.php?album=1