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

Janis Joplin

"As good as you've been to this world, is as good as it's gonna be right back at you," Janis Joplin. (1943-1970) 

Janis Lyn Joplin was an American rock singer and songwriter. She was one of the biggest female rock stars of her era. After releasing three albums, she died of a heroin overdose at age 27.

Matthew Mcconaughey

 

"...at the end of your life, all the things you thought were periods, they turn out to be commas. There was never a full stop to any of it," Matthew Mcconaughey (1969) 

American actor, voice actor, director, producer, and writer. He first gained notice for his breakout role in the coming-of-age comedy Dazed and Confused.

Stranger Than Fiction: Breakthrough in OCD Treatment

INTRODUCTION:

An unstable IRS auditor (Will Ferrell) who displays similar symptoms to individuals with OCD disorder in which his cycle of obsessions and compulsions are fixated on numbers (i.e. the number of steps he takes to the bus stop to work in the morning, the number of strokes he uses to brush his teeth, how much time it takes him to accomplish tasks which he depends on his wrist watch to give him these numbers such as times).

In the film, "Stranger than Fiction", he hears an author's (Emma Thompson) voice in his head as she narrates every move he makes and thoughts. He soon discovers that he is in fact the ill-fated protagonist of her latest piece of work. While a book-company employee (Queen Latifah) tries to cure the author's case of writer's block, the auditor and a professor (Dustin Hoffman) set out to find the woman and make her change her story.

In a small, preliminary clinical study, the experimental drug rapastinel rapidly reduced symptoms of OCD, although the effect was not long-lasting. The drug was well tolerated, causing none of the dissociative side effects associated with ketamine.

BACKGROUND INFORMATION:

Research has shown that most people have unwanted “intrusive thoughts” from time to time, but in the context of OCD, these intrusive thoughts come frequently and trigger extreme anxiety that gets in the way of day-to-day functioning. Obsessive Compulsive Disorder (OCD) is a mental health disorder that affects people of all ages and walks of life, and occurs when a person gets caught in a cycle of both obsessions and compulsions. Obsessions are unwanted, intrusive thoughts, images, or impulses that occur in a continuous loop causing the individual to experience intensified feelings of distress and overall a lack of control. These obsessions are then followed with feelings of fear, disgust, doubt, and the strong urge to do things the ‘just right’ way.

Subsequently, these behaviors, and thoughts interfere if not consume a majority of these individuals lives. They are aware that these thoughts do not make sense but the psychological disorder determines if a person has OCD or simply an obsessive personality trait. The words “obsessing” or “being obsessed” are causally used in the day-to-day life to describe someone who is pre-occupied with a topic, idea, or person. However, being “obsessed” with something does not interfere with living a normal functional life and often times people find pleasure in it. An example would be if a new song came on the radio and you describe yourself to be "obsessed" with it to friends and family, however you continue to function despite this "obsession". 

*Individuals with OCD have a hard time hearing this usage of “obsession” as it feels as though it diminishes their struggle with OCD symptoms*

Compulsions, the second part of obsessive compulsive disorder, are the repetitive behaviors or thoughts a person uses to neutralize, counteract, or make their obsessions disappear. People with OCD realize that their compulsions are only a temporary solution to cope with the distress they feel and rely on the compulsions as a temporary escape. Compulsions can also include avoiding situations that trigger obsessions.

Not all repetitive behaviors or 'rituals' are compulsions. It is important to look at the function and context of this behavior. [For example, bedtime routines, religious practices, and learning a new skill all involve some level of repeating an activity over and over but are positive and functional part of daily life.] Behaviors depend on the context. Arranging and ordering books for eight hours a day isn’t a compulsion if the person works in a library. Compulsions are time consuming and get in the way of important activities the person values. 

Most people have obsessive thoughts and/or compulsive behaviors at some point in their lives, but that does not mean that we all have “some OCD.” People tend to have 'compulsive' behaviors, where this type of 'compulsive' refers to a personality trait that a person enjoys whereas individuals with OCD feel driven to engage in compulsive behavior and would rather not have to do these time consuming and many times torturous acts.

In OCD, compulsive behavior is done with the intention of trying to escape or reduce anxiety or the presence of obsessions. To be diagnosed with OCD, the cycle of obsessions and compulsions has to be so extreme that it consumes a lot of time and gets in the way of important activities that the person values. [A]

RESEARCH:

Rapastinel, an experimental drug currently being evaluated for the treatment for major depression and may relieve the symptoms in individuals who struggle with obsessive-compulsive disorder [aka: OCD] quickly and with few side effects allowing for an overall effective viable treatment option/ manner.

NARSAD 2009 and Young Investigator, Carolyn I. Rodriguez, M.D., Ph.D., (2014) from Stanford University School of Medicine reported in ‘The American Journal of Psychiatry’ in December of 2016 their observations in their small proof-of-concept study. A Young Investigator, Helen Simpson, M.D., Ph.D., and Independent Investigator 2010 from Columbia University College of Physicians and Surgeons, was also members of the research team.

Investigating rapastinel has been a primary focus of their studies because it was previously discovered that some OCD patients received rapid relief from their symptoms when they were treated with Ketamine (an anesthetic used to rapidly reduce symptoms of depression). Like other drugs, it has its own side effects which for Ketamine a feeling of detachment from one’s self or patients have reported having an ‘out-of-body’ experience. This brings challenges for use in the general clinics and the board spectrum of psychiatric disorders.

Rapastinel functions in a similar way that ketamine does in that the drug modulates the action of NMDA receptors found in the brain. By docking the ports for the neurotransmitter glutamate (an important region that allows for humans to learn, contain memories, in addition to keeping the synaptic plasticity) has been thought to play a large role in OCD. However, there is a difference between rapastinel and ketamine’s modes of function in that rapastinel was discovered to have a lower risk of dissociative side effects.

It is no surprise that Rodriguez and her colleagues turned to rapastinel in the hopes of finding more effective and fast acting treatment in reducing patients’ obsessions and compulsions without dissociative side effects.

RESULTS:

Each participant was given a single dose of the drug rapastinel. The drug was well tolerated as none of the patients reported dissociative side effects and within hours of treatment the severity of patients’ symptoms declined significantly.

Results of the team’s initial clinical study included 7 participants who have OCD, revealed much promise as the drug reduced obsessions, compulsions, as well as the anxiety and depression that is often paired with OCD patients. Although the effects on these symptoms were fast-acting, they did not last for long periods of time.

When the research team evaluated patients one week after treatment, symptoms were about as severe as they had been prior to treatment. The scientists say important next steps will be testing the effects of repeated dosing and working to develop related drugs that reduce OCD symptoms over a sustained period.

Links:

[A] https://iocdf.org/about-ocd/

[B] https://www.bbrfoundation.org/content/early-test-shows-experimental-drug-may-have-potential-relieve-ocd-symptoms-quickly-and-few

[C] http://psychnews.psychiatryonline.org/doi/full/10.1176/appi.pn.2017.pp4a2

*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: https://www.rottentomatoes.com/m/stranger_than_fiction/quotes/

*Screen caps by: google images

When Hip Hop Meets Ballet

G. K. Chesterton

"Fairy tales are more than true: not because they tell us that dragons exist, but because they tell us that dragons can be beaten," G. K. Chesterton.

(1874-1936)Gilbert Keith Chesterton, KC*SG, was an English writer, poet, philosopher, dramatist, journalist, orator, lay theologian, biographer, and literary and art critic.

Tom Waits

 

"Don't plant your bad days. They grow into weeks. The weeks grow into months. Before you know it, you got yourself a bad year. Take it from me. Choke those little bad days. Choke 'em down to nothin'. They're your days. Choke 'em!" Tom Waits (1949-present) American singer-songwriter, composer, and actor. Waits is also known for his distinctive voice.