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Post-Traumatic Stress Disorder

Long-Standing PTSD: Two Treatments May Renew Hope

Neuropsychology research is exploring alternative pathways to brain healing.

Key points

  • Surviving life-threatening events, including events that just momentarily appeared life-threatening, can trigger long-term brain changes.
  • A traumatized brain may become emotionally hyper-reactive, seeing danger in places where others see none.
  • New treatment methods may soon be able to treat long-standing PTSD—or, if used shortly after a trauma, to prevent PTSD altogether.
 Bialasiewicz/fotosearch.
PTSD sufferers now have new treatment options. Too few sufferers know about them.
Source: Bialasiewicz/fotosearch.

Manny had been one of those fellows whom everyone loved. He was fun, smart, a loving husband, a great dad, and super-competent at work.

Then came the war. While fighting as a soldier has many challenges, one episode, in particular, proved too potent for Manny's brain. When his unit suddenly found themselves surrounded and cut off from communications with their support network, Manny was the one who volunteered to brave enemy fire, crawl out from their bunker, rescue their radio equipment, and signal for help.

While he saved the lives of his fellow soldiers, and at first seemed fine himself, several years later the impacts of that event resulted in a total inability to function. The smallest movement, sound, commotion of any sort, or everyday stress would set him off into a rage state. Now, fortunately, two new treatment methods are emerging from research that hopefully will enable Manny to return to normal functioning: hyperbaric oxygen therapy and stellate ganglion block.

Hyperbaric Oxygen Therapy

Hyperbaric oxygen therapy utilizes pure oxygen to speed healing, and is most often used to treat conditions like decompression sickness or gangrene. Is it possible that oxygen treatment could help with PTSD?

Researchers at Israel's Tel Aviv University and the Shamir Medical Center studied brain scans of Israeli soldiers whose wartime traumas had left them with long-term PTSD. As they reported in the scientific journal PLOS One, the scans showed physical damage in the hippocampus and frontal lobe regions.

Because of this organic brain damage, talk therapies have often been insufficiently effective. PTSD brain damage likely needed physical healing for the emotional wounds to heal, they argued.

In the initial round of testing, which involved 65 war veterans with major PTSD, before and after brain scans showed major improvements in both the hippocampus and the frontal lobes. The study was small, and more research is needed to confirm the therapy's effectiveness, but the results are promising.

Hyperbaric treatment increases the supply of oxygen to the brain to activate the creation of new blood vessels and neurons. The oxygen infusion reactivates stem cells and causes them to proliferate (grow more). The oxygen also stimulates the production of new blood vessels, thought to result in increased brain activity and restore wounded tissues to normal functioning.

Treatments are conducted in a hyperbaric oxygen chamber, where atmospheric pressure is higher than sea-level pressure and the air is rich with oxygen.

Stellate Ganglion Block

Stellate ganglion block treatment consists of an injection into an individual's neck that results in calming the parts of the brain system that the trauma has caused to become over-reactive.

The results have been impressive enough that there are now over 50 stellate ganglion block treatment centers across the U.S. where this treatment is being done. (I have listed a number of the published studies in the reference section below.)

Note that a number of the articles have been published in journals associated with the military. PTSD is a serious physical and mental injury, The military has taken seriously its responsibility to find effective treatments for its wounded soldiers.

Some PTSD sufferers who have received this treatment have reported:

The Still-Vital Role of Conventional Psychotherapy

Both during and after the two treatments above, traditional psychotherapy methods enhance treatment success.

Individual therapy is vital. Habits generated by PTSD do not necessarily disappear on their own. Understanding what has happened to them helps PTSD sufferers to digest their painful experiences so that the shame and guilt associated with them can dissipate. CBT treatment, in addition, can accelerate the change back from PTSD beliefs and reactions to normal, functional, and healthy responses to life's stresses.

Family therapy also can be vital for managing the secondary PTSD suffering of family members, including the children. Understanding the symptoms, causes, and hopeful cure of PTSD can decrease the negative impacts that the tension and emotional outbursts from PTSD will have on others in the family.

Couples therapy can be pivotal for healing romantic relationships that may have been harmed by PTSD-related anger outbursts. Couples need strong skills for handling difficult conversations such as cleaning up the resentments generated by PTSD's impacts on irritability and quickness to anger. (I clarify these skills in my book The Power of Two.) Guidance from an effective couples therapist can speed up the healing of the attachment between a husband and wife, Otherwise any irritated or outright angry outbursts of someone with PTSD can do significant harm to the marital bond.

The Bottom Line for PTSD Sufferers

Manny is currently participating in a further study of the effectiveness of hyperbaric oxygen treatment. If he continues to struggle with PTSD symptoms after this treatment, he hopes to receive the stellate ganglion block.

While hyperbaric oxygen treatment is still in a research phase with regard to treatment of PTSD (though it is widely used to treat other conditions), stellate ganglion block may be available for many right now. If you or a family member are struggling with PTSD, know that there is hope.

References

Hanling, S.R., Hickey, A., Lesnik, I., Hackworth, R.J., Stedje-Larsen, E., Drastal, C.A., & McLay, R.N. (2016). Stellate ganglion block for the treatment of posttraumatic stress disorder: A randomized, double-blind, controlled trial. Regional Anesthesia & Pain Medicine, 41(4), 494-500.

Lipov, E.G., Navaie, M., Brown, P.R., Hickey, A.H., Stedje-Larsen, E.T., & McLay, R.N. (2013). Stellate ganglion block improves refractory post-traumatic stress disorder and associated memory dysfunction: A case report and systematic literature review. Military medicine, 178(2), e260– e264. https://doi.org/10.7205/MILMED-D-12-00290.

Lynch, J. (2020). Stellate ganglion block treats posttraumatic stress: An example of precision mental health. Brain and Behavior, 10(11):e01807. https://doi.org/10.1002/brb3.1807

Lynch, J.H., Muench, P.D., Okiishi, J.C., Means, G.E., & Mulvaney, S.W. (2021). Behavioral health clinicians endorse stellate ganglion block as a valuable intervention in the treatment of trauma-related disorders. Journal of Investigative Medicine: The Official Publication of the American Federation for Clinical Research, 69(5), 989–993. https://doi.org/10.1136/jim-2020-001693

Lynch, J.H., Mulvaney, S.W., Kim, E.H., de Leeuw, J.B., Schroeder, M.J., & Kane, S. (2016). Effect of stellate ganglion block on specific symptom clusters for treatment of post-traumatic stress disorder. Military medicine, 181(9), 1135-1141.

Mulvaney, S.W., Lynch, J.H., Curtis, K.E., & Ibrahim, T.S. (2021). The successful use of left-sided stellate ganglion block in patients that fail to respond to right-sided stellate ganglion block for the treatment of post-traumatic stress disorder symptoms: A retrospective analysis of 205 Patients. Military medicine, usab056. Advance online publication. https://doi.org/10.1093/milmed/usab056

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