As new programs continue to grow in response to the huge demand of patients who believe they are victims of PTSD (Post-Traumatic Stress Disorder), I am becoming more frustrated with the mercenary trends of the professional community in trying to "catch the next wave" of fad diagnoses. Not that I am calling PTSD a fad, but practitioners are coming forth with only a modicum of understanding of what this complex is and how to treat it. This blog may be more of an editorial than educational.
The DOD fiasco of caring for these vets has led to many of these professionals losing credibility by the tons when they exclaim how "effective" they can be in dealing with the suffering veterans suffering while the number of suicides begin to stack up at their door and some estimate reaching over a million individuals are still waiting for a call back from a regional center and unknown numbers have been reclassified as "personality disorders" to rid them of being eligible for services. Personality disorders have defined the onsets as early childhood and adolescence, which obviously predates induction in the armed services and rendered "non-military status." These individuals are discharged and left without even a referral.
But my focus is that even if they got the services, what did they get? There is no established PTSD protocol in the DOD, so it is every professional to his or her own wits end as what to do. The studies I have read discuss the use of group therapy, cognitive therapy, exposure therapy and some combination of anxiety/ depressive approaches swinging a finger in front of their eyes. But no body seems to have a clue as to understanding of PTSD from a brain-based knowledge.
Normal brain development is an amazingly complex and dynamic process that is influenced by precise timing of events within critical sensitive periods, beneficial environmental influences, and optimal gene functioning. Although many types of experience have the potential to influence brain development, trauma and abuse experiences are just being studied for evidence of the profound affects that emotional trauma has on brain development.
One of the most profound findings from EEG brain maps have consistently shown is the lowering of the frontal lobe frequency (EEG), especially the left side. In clinical terms this finding would be consistent with a psychological reaction to horrific perceptions in which the individual unconsciously limits access to the make sense of these experiences ("can't get my brain around them" and develop a type of disassociation mind state. The confusion leads to lack of utilization of a person's problem-solving skills and need for authority for guidance.
Making the picture more complicated would be the agitation in the temporal lobes, containing the emotional and memory functions. These areas have been shown to have a mixture of complicated reactions, especially memory those areas of the brain designated as remembrances of affective experiences. The clinical implications have been correlated to limited memory to negative, rather than positive accounts, and leading to stress storms from the past rather than the present.
Of particular interest are the results of brain scans showing a severe lack of coherence from the frontal lobes to the temporal and other areas of the brain. The clinical interferences are that this represents the breakdown in integration of brain resources for the individual to naturally call on for mental aid in dealing oncoming stress cycles, such as creativity in problem-solving and making cognitive mistakes. Many victims resort to alcohol and pot-smoking to try to remediate the anxiety of lost of control, but actually undermine the process, making the poor coherence even worse. Bad judgment often can lead to poor choices and destructive internal dialogue.
The mixture of problem areas can lead to very negative results of treatment. Trying to resolve depression with "one-step" therapies can lead to further problems, while using anxiety treatments can aggravate the existing anxiety and frontal lobe activity. This is a complex problem that required a learning process.
Based on the scientific foundation the treatment phase can be conceived as a multiple-step program. Although most people will note lasting results in fewer steps and some steps will be more important than others, the full protocol will be described for clarity.
Step One: Control - The major complaint of individuals suffering from PTSD is lack of control from their despairing thoughts. They can't stop the memories of traumatic experiences, the nightmares, and usually can't stop feeling emotional pain. They are in what I have coined as a "stress storm" in which they feel trapped. They feel they are "going crazy" and often report demon-like forces entering and controlling their minds.
Step Two: Release of destructive thought habits - Often as the brain is vulnerable for destructive thoughts and inabilities to cope, the re is a tendency to use self dialogue, either learned from authority or from other frustrating challenges. Guilt, depression, anger and other emotions can create a trap that can only go downward in mood and self-confidence. For those reasons, these myths and internal conversations have to be confronted and dismantled. Forgiveness of self will also be addressed.
Step Three: Activation of the "Warrior Brain" - As noted in the discussion on brain function, the frontal lobe has to be stimulated in order for effective problem-solving to take place. This phase comes at a point where it can be accessed with increasing thinking patterns and extending concentration.
Step Four: Balancing and connection - This step in balancing the brain so that it can begin to coordinate within itself. In clinical terms, this is finding the "self." In essence, what is being accomplished in problem-solving terms is finding confidence in meeting challenges.
Step Five: Stepping out of depression - Although this step might have been accomplished earlier, there is the tendency to turn inward for nurturance because of guilt and shame. By trying to protect themselves, individuals often cannot "turn on" the joy centers from their vulnerable brains. It is important to learn how to energize the brain with positive therapy and create a life plan to earn pleasure and accept the privilege of life.
Step Six: Sleep and restoration - Too often the restless brain can become its own worst energy and insomnia is the chief complaint to the fatigue and depressions that occurs. It is required of the brain and body for restorative rest for healing to occur, but much of these skills were never learned in life, but now are required.
Step Seven: Reconnection with others - When a person has been traumatized, there is a state of betrayal that has to be over come, although the trauma may not even be anyone's fault. It may be of a variety of loneliness in which no one understands the emotional upheaval that has taken place or it might be that the individual feels so isolated in the experience. This step is the reentry back into the community.
The Spiritual Aspects of Challenging PTSD - How PTSD can actually serve as a spring board to higher realizations and skills. Experience can make you stronger or weaker, spiritually. It is the mark of healing when at least one positive conclusion can be made from the experience.
Home program available: If anyone is interested in a home program with these steps, I have created a CD series that I feel can be helpful, although they should not be used as a substitute for competent therapeutic care (MindBodySeries.com.) I would also caution that as these steps are needed, each should be resolved at some level before going to the next. This is not a horse race, but I can understand how impatient we are to get back to life as soon as possible.
As a special resource in the Dallas Texas region, I am working with a special grant through the Mental Health America (Operation Healthy Reunions) to develop excellence in PTSD therapy and other problems for veterans and families that are free and even have great financial support for goal-directed activities for higher education and some vocational training with possible placement opportunities. If you are interested, please call 214-871-2420.