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July 07 2024

June Journical Club: ART for PTSD

Author Susan Vaught Categories Blog, Current Interns 0 Comments

Journical Club- Shakeira Frye

Article: Kip, K. E., Berumen, J., Zeidan, A. R., Hernandez, D. F., & Finnegan, A. P. (2019). The emergence of accelerated resolution therapy for treatment of post‐traumatic stress disorder: A review and new subgroup analyses. Counselling and Psychotherapy Research, 19(2), 117-129.

 

Purpose: This article discussed the effectiveness of Accelerated Resolution Therapy (ART) for treating individuals with Post-traumatic Stress Disorder (PTSD), specifically among military personnel and individuals with traumatic brain injury (TBI). The article described PTSD as a chronic, disabling psychiatric disorder that is characterized by being exposed to actual or threatened death, serious injury or sexual violence that leads to persistent re-experiencing of the details associated with the traumatic event, avoiding stimuli that evoke thoughts or feelings about the event, negative changes in cognitions and mood related to traumatic event. The article emphasized ART’s potential as a reasonable, shorter alternative to traditional PTSD treatments, especially for military populations with difficult clinical presentations.

What is ART: ART therapy was described as an emerging trauma-focused psychotherapy that is brief relative to other treatments. This article aimed to describe the ART clinical protocol and the theoretical foundations. The protocol consists of four primary steps which included Relaxation and Orientation, Imaginal Exposure, Imagery Rescripting, and Assessment and Closeout. In the Relaxation and Orientation step, the client identifies and states the specific traumatic event they want to address. Next, the therapist directs the patient to focus on their bodily sensations while also performing a set of eye movements. In the Imaginal Exposure step, the client is directed to begin visualizing the traumatic event in their mind from start to finish while also performing eye movements. Again, the therapist asks the client to pay attention to any somatic, emotional, or physiological sensations that they may be experiencing. Those sensations are then processed with a set of eye movements until they are comfortable returning in their mind to the place they left off in the traumatic event. This step is completed when the client can visualize their experience from start to finish two times. The third step, Imagery Rescripting, involves the client being directed to imagine a new and preferred way of visualizing their experience while performing eye movements. The final step, Assessment and Closeout, includes reinforcing techniques which are used to assess if there are any areas of the traumatic event that still causes the client to generate visceral responses.

Study and Results: This study consisted of 291 participants who received at least one session of ART across four studies. The participants were classified based on their TBI status (no TBI, mild TBI, moderate TBI or severe TBI). The participants also had to have symptoms related to PTSD. The results of this study indicated that there were significant reductions in PTSD symptoms among participants. On average, the participants showed a 20.6-point reduction on the PTSD Checklist (PCL) after ART treatment, with 60.8% experiencing a clinically meaningful reduction of symptoms. Among the military personnel with TBI, the response rates to ART were similar regardless of TBI severity.

August 08 2017

Understanding Anxiety and Trauma

Author Susan Vaught Categories Blog, Continuing Education, Mental Health and Wellness, Resources for Interns 0 Comments

Anxiety refers to the response of the body towards a stressing, unsafe, or unfamiliar circumstance. It describes the sense of distress, nervousness, or fear that one feels before an important event. Being nervous about a job interview or terrified over an upcoming test is healthy and is commonly referred to as “normal anxiety.” Anxiety of this nature encourages people to adequately prepare for situations they are uneasy about and ensures that one stays prepared and attentive. Anxiety can develop to levels that need health or medical attention (Wu, Tang & Leung, 2011). Anxiety Disorder can be devastating. The anxiety that may require treatment is usually overwhelming, absurd, and inconsistent to the situation. People who suffer from it feel like they have no control of their sentiments, and can include severe physical symptoms such as nausea, headaches, or trembling. If normal anxiety develops to be disproportionate and starts to recur and affect one’s daily life, it is referred to as reaching clinical levels and termed a disorder.

 

Trauma refers to an emotional response to a devastating circumstance such as physical or mental abuse, rape, accident, natural disaster, etc. After an event has occurred, denial and shock are common. Unforeseen emotions, flashbacks, stressed relationships and some physical symptoms such as nausea and headaches are some of the long term responses to trauma (Baldwin & Leonard, 2013). Traumatized people have problems moving on with their lives and may sometimes require guidance and intervention help from psychologists and other health care professionals to move on.

 

Some people who experience traumatic events may develop an anxiety-linked disorder referred to as Post-traumatic stress disorder (PTSD).  Individuals who suffer from PTSD encounter a hard time in the aftermath of the traumatic event that continues to impact them even after the event has subsided (Ardino, 2011). Continuous anxiety and difficulty in concentration are some of the prevalent symptoms in people suffering from PTSD.

 

It is important for psychologists and other professionals in the health care field to truly comprehend the relationship between trauma and anxiety (Hughes, Kinder & Cooper, 2012). Clinical Psychologists perhaps have an ethical responsibility to go beyond a mere text book understanding about this relationship if they are to become effect in their treatment approach.  In other words simply knowing what to call something by name does not terminate the treatment process. That may also be why psychology is referred to as a helping field (operative word being help) not just a naming one.    The treatment of both trauma and anxiety entails a detailed assessment and creation of a treatment plan that meets the distinct needs of the sufferer. It is essential for the health practitioners to have an in-depth understanding of both the conditions so as to be better placed to help the people suffering from these conditions. Because of the differences in experience and repercussions of the trauma, the treatment differs and is tailored to the symptoms and requirements of the person (Hyman & Pedrick, 2012). Psychologists must have a good understanding to ensure that their patients are able to lead a more balanced and functional life again. Health practitioners may have a difficult time in differentiating the symptoms of anxiety and trauma. Therefore, health practitioners must become proficient and informed on how to handle people suffering from anxiety and trauma.

 

Possessing sufficient understanding that can assist differentiate between anxiety and trauma will improve the outcomes of some of the interventions applied to assist those affected. In most cases, people suffering from anxiety disorders have previously been affected by a certain traumatic event. Thus, it is possible that these people will exhibit some symptoms that are the same during the phase they suffered from trauma. It is important for the health practitioners to understand the relationship between anxiety and trauma to ensure that they give the correct medications and that the appropriate intervention procedure is used. More importantly, we need to have in-depth knowledge and understanding so as not to re-traumatize those who are entrusted under our care. There is the high probability that many on your caseloads and even those you work around, you will have had traumatic past experiences.  Your approach in caring for these individuals can be a direct reflection of your skills and understanding about the anxiety/trauma relationship. Moral ethical rule number one: Do no (more) harm.

 

References
Ardino, V. (2011). Post-traumatic syndromes in childhood and adolescence: A handbook of research and practice. Chichester, West Sussex, UK: Wiley-Blackwell.

Hughes, R., Kinder, A., & Cooper, C. L. (2012). International handbook of workplace trauma support. Chichester, West Sussex: Wiley-Blackwell.

Hyman, B. M., &Pedrick, C. (2012). Anxiety disorders. Minneapolis: Twenty-First Century Books.

In Baldwin, D. S., & In Leonard, B. E. (2013). Anxiety disorders.

Wu, K. K., Tang, C. S., & Leung, E. Y. (2011). Healing trauma: A professional guide. Hong Kong: Hong Kong University Press.

 

Dianne Rapsey-Vanburen, MA
WKPIC Doctoral Intern

 

September 09 2015

Friday Factoids: Promising Long-Term Treatment for PTSD

Author Susan Vaught Categories Blog, Current Interns, Friday Factoids, Mental Health and Wellness, Resources for Interns 0 Comments

 

Post-traumatic stress disorder (PTSD) can result from being the victim or witness to a number of traumatic events including war, an automobile accident, physical abuse, assault, homicide, and other difficult or devastating experiences. It is an equal opportunity disorder and affects men, women, and people of all cultures similarly. In the United States, PTSD has been thrown into the limelight due to the number of service men and women who are returning from active duty with this condition. The current publicity around PTSD has left many in the medical and mental health fields looking to and for variations of treatment in hopes of finding more effective, longer-lasting methods to treat this illness.

 

One of the more promising treatments, currently in Phase 2 of 3 in testing, is MDMA-Assisted Psychotherapy. MDMA (3,4-methylenedioxymethamphetamine) is a psychedelic, synthetic substance noted for its capability to help patients delve into their excruciating memories. The drug reportedly facilitates trust and compassion between the patient and therapist, all the while greatly reducing the patient’s feelings of defensiveness and terror while in session. It is believed that MDMA is able to offer this therapeutic safe haven by stimulating the release of hormones (prolactin and oxytocin) linked to bonding and trust which comforts the patient and reduces symptoms of avoidance and panic.

 

According to the research data, an astounding 83% of participants who received the treatment no longer met the guidelines for PTSD while in Phase 2 of the study.  Additionally, many of those participants reported the results lasted 3 ½ years or longer. So, why is this treatment not already approved and readily available for those who so desperately need it?

 

One potential answer to that question could be the stigma surrounding MDMA.  Most all of you have heard it referred by it street names of “Molly” or  “ecstasy.” And given so, some will not be comfortable using it as an aid during therapy even in a controlled setting providing such positive, long-term results. Secondly, the cost and time frame for each individual trial is fairly massive.  The End of Stage 2 meeting is estimated to take an additional 3 years and $2.3 million before presenting results to the FDA. Afterwards, Stage 3 is speculated to have a price tag of $15.8 million and spanning 5 years until the treatment is fully available for use with the public.

 

References
MDMA-Assisted Psychotherapy. (n.d.). Retrieved September 9, 2015, from http://www.maps.org/research/mdma

 

Treating PTSD with MDMA-Assisted Psychotherapy – Home. (n.d.). Retrieved September 8, 2015, from http://www.mdmaptsd.org/index.html

 

Crystal K. Bray, B.S.
WKPIC Doctoral Intern

August 08 2015

Friday Factoids: Sleep and Brain Functioning

Author Susan Vaught Categories Continuing Education, Current Interns, Friday Factoids, Mental Health and Wellness, Resources for Interns 0 Comments

A Monday catch-up factoid!

 

We all recognize the importance of sleep, but there is emerging evidence that describes a causal relationship between sleep and emotional brain function (Goldstein & Walker, 2014).  The literature indicates that sleep abnormalities are involved in nearly all mood and anxiety disorders.  For example, as in Posttraumatic Stress Disorder (PTSD), Rapid Eye Movement (REM) sleep is diminished and disrupted. Goldstein and Walker (2014) propose that after a traumatic experience, REM sleep helps to decouple emotion from memory, and if this is not achieved, the process will be repeated in subsequent nights.  What is experienced is a hallmark symptom of PTSD, nightmares.

 

Further, Major Depression is associated with exaggerated REM sleep, which includes faster entrance into REM sleep, increased intensity of REM, and longer duration of REM sleep (Goldstein & Walker, 2014).  With this underlying disruption of REM sleep, individuals with Major Depression are noted to experience next-day blunting due to excess amounts of REM sleep, which alters PFC-amygdala sensitivity and specificity to emotional stimuli (Goldstein & Walker, 2014).

 

Overall, without sleep, the regulation and expression of emotions is compromised (Goldstein & Walker, 2014).  Goldstein and Walker (2014) argue that REM sleep provides a restoration of “appropriate next-day emotional reactivity and salience discrimination” (p. 702).  Consequently, emotional responsiveness, sleep, and consistent REM sleep promote the processing of emotional memories.  REM sleep provides not only a therapeutic depotentiation of emotion from affective experiences, but also provides a re-calibration that restores emotional sensitivity and specificity.  Thus, rather than being a symptom of a psychiatric disorders, the relationship between sleep and psychiatric disorders is now considered to be more causal and bidirectional (Krystal, 2012).  In short, given this intimate and causal relationship highlights the importance of assessing for sleep disturbance, as well as informing intervention.

 

Goldstein, A. N., & Walker, M. P. (2014). The role of sleep in emotional brain function. Annual Review of Clinical Psychology, 10, 679-708.

 

Krystal, A. D. (2012). Psychiatric disorders and sleep. Neurologic Clinics, 30(4), 1389-1413.

 

Dannie S. Harris, M.A., M.A., M.A.Ed., Ed.S.
Psychology Practicum Student

January 01 2015

Friday Factoids: Study Identifies Two Genes that Boost the Risk for Post-Traumatic Stress Disorder

Author Susan Vaught Categories Blog, Continuing Education, Current Interns, Friday Factoids, Resources for Interns 0 Comments

 

How much do you know about Post-Traumatic Stress Disorder? By now, it would appear that the general population has heard of this disorder and are aware of what it is at least on a fairly rudimentary level.

 

PTSD currently affects approximately 7 % of the population of the United States and has become a pressing health issue for veterans of war. Have you ever wondered about such variables as the threshold for what will cause PTSD? For instance, two people could experience the same motor vehicle collision, yet only one of them may develop PTSD symptoms. Why is that? Researchers from the University of California, Los Angeles (UCLA) have recently linked two gene variants to PTSD. This suggests that hereditary factors can influence an individual’s risk of developing PTSD. These new findings could provide a biologically based approach for diagnosing and treating PTSD more effectively. 

 

Dr. Armen Goenjian and his team discovered two genes, COMT and TPH-2, which are linked to PTSD. These two genes play important roles in brain function. COMT is an enzyme that degrades dopamine, a neurotransmitter that assists in regulating thinking, mood, attention, and behavior, as well as controlling the brain’s pleasure and reward centers. TPH-2 controls the production of serotonin, a brain hormone that regulates mood, alertness, and sleep–all areas that are disrupted by PTSD. Dr. Goenjian and his team found significant associations between variants of COMT and TPH-2 with symptoms of PTSD. This may be indicative that these genes contribute to both the onset and the persistence of PTSD.

 

The results yielded from the study suggest that individuals that carry the genetic variants of COMT and TPH-2 may be at a higher risk of developing PTSD after a traumatic event. Now that scientists have begun to develop new ways of assessing risk factors for PTSD, what benefits do you believe can come from it? Would examination of these two genes play a role in recruitment criteria for the armed forces? Let me know what you think.

 

References
Goenijian, A., Noble, E., Stenberg, A., Walling, D., Stepanyan, S., Dandekar, S., and Bailey, J. (2015). Association of COMT and TPH-2 genes with DSM-5 based PTSD symptoms. Journal of Affective Disorders, 172.

 

University of California, Los Angeles (UCLA), Health Sciences. (2015, January 9). Study identifies two genes that boost risk for post-traumatic stress disorder. ScienceDaily. Retrieved January 12, 2015 from www.sciencedaily.com/releases/2015/01/150109123321.htm

 

Faisal Roberts, MA
WKPIC Doctoral Intern

 

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