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Frontline Psych with Doc Bender: Promising Treatments for PTSD

Service member in Army shirt doing yoga
U.S. Army photo by Sgt. Jennifer Spradlin

Dr. James Bender is a former Army psychologist who deployed to Iraq as the brigade psychologist for the 1st Cavalry Division 4th Brigade Combat Team out of Fort Hood, Texas. During his deployment he traveled through Southern Iraq, from Basra to Baghdad. He writes a monthly post for the DCoE Blog on psychological health concerns related to deployment and being in the military.

If you keep up with the DCoE Blog or national news, it’s likely you’ve heard of posttraumatic stress disorder (PTSD), an anxiety disorder that some people develop after being exposed to a traumatic experience, like combat. If so, you might be wondering what treatments are available.

 

While evidenced-based treatments such as prolonged exposure and cognitive processing therapy have been successful in many patients with PTSD, the scientific community continues to research other helpful treatments. The Departments of Defense and Veterans Affairs, hospitals and universities are among those investigating options ranging from injections to reduce PTSD symptoms to smartphone apps developed to support those in psychological treatment.     

 

Determining if a treatment works, however, can be tricky. You need multiple studies of hundreds of people, and you have to consider that many factors may obscure results (some people improve without treatment; some treatments work better with people of a certain age or gender, etc.). It takes time and effort to sort all this out and confirm that the treatment works. 

 

Despite these challenges and the complexity of PTSD, there are promising new therapies being studied. Here are four:

 

Virtual Reality Iraq/Afghanistan

Virtual reality is a technology being used to address PTSD in returning service members and veterans and one place it’s being studied is at the Naval Medical Center-San Diego. Patients are equipped with a head-mounted visual display and exposed to a virtual world in which they experience the sights, sounds and even smells of combat in order to confront their trauma in a safe and controlled environment. By gradually exposing the patient to memories of the traumatic event, they’re able to deal with emotions that the memories bring up. A 2009 study by the center and researchers at the University of Southern California and Emory University, found that virtual reality technology yielded an 80 percent success rate in treating combat-related PTSD.         

 

Yoga Intervention for PTSD

A 10-week yoga program funded by the U.S. Army included twice-weekly yoga interventions with an assigned daily home practice. This particular program was built on considerable evidence that yoga, which focuses on calming sympathetic nervous system (SNS) activity, can be effective for PTSD. The SNS activates when someone is very stressed or fearful and is responsible for associated physical responses (increased heart rate, tense muscles, stomach churning, etc.). People with PTSD have trouble regulating these responses and yoga helps them to regain control. The yoga program was found to be as effective as medication in treating PTSD.

 

Stellate Ganglion Block

In this potential treatment, an anesthetic is administered through the neck into a collection of nerves called the stellate ganglion. These nerves are connected to the amygdala, the “fear center” of the brain, which becomes very active in many people with PTSD. The shot calms down the amygdala and other brain areas responsible for the feelings of anger and high anxiety that are core symptoms of PTSD. A small study published in 2012 of nine military patients found that seven of them saw significant reduction in PTSD symptoms after receiving the injection. There have been a few other small studies showing similar results.    

 

Fishing Therapy

In other places, some veterans are taking up fishing to ease the symptoms of PTSD. Piscatorial therapy, meaning “related to fishing,” suggests there are health benefits to fishing. Further research is needed, but findings from the University of Southern Maine, University of Utah and the Salt Lake City Veterans Affairs medical center showed significant improvement in perceptual stress, PTSD symptoms and sleep quality for veterans who took part in a two-day, three-night residential fly fishing retreat.

 

Check out the National Center for PTSD website for more information and resources. You can also request information related to PTSD or psychological health from the DCoE Outreach Center 24/7 at 866-966-1020 or resources@dcoeoutreach.org. If you think you might have PTSD, I encourage you to get checked out — contact your medical provider — or look into these resources for psychological health care.


Comments (12)

  • patrick d. murphy 29 Mar

    thanks for keeping us updated and informed. as a ptsd sufferer and one who helps out with homeless veterans; many of which also suffer from ptsd and other ailments; your resource is very helpful and appreciated.
  • DCoE Blog Editor 01 Apr

    @Patrick, Thanks for your comment. We’re glad you found this post helpful!

  • Greg Jacobs 01 Apr

    What about neurofeedback? http://www.isnr.org/resources/comprehensive-bibliography.cfm I am aware that is has been supported empirically for P.T.S.D. and T.B.I. I am also aware of a handful of people within the military who swear by it, Maj. Michael Villanueva at California Camp Pendelton, Marine Corps. Base, Dr. Jerry Wesch Ft. Hood TX, Dr. Austin Gomez Ft. Benning GA, Gerald Gluck Ph.D. Memorial Hospital, Hollywood FL, Dr. Joel Lubal (noted researcher) Southeastern Biofeedback Institute Knoxville TN and Pompano Beach FL, also Dr. John Carmichael  http://www.amazon.com/Multi-Component-Treatment-Manual-Post-Traumatic-Disorder/dp/0984608524. Just my .02 I am a big supporter of this noninvasive treatment. I believe it can help many of our Vets!
  • kat 03 Apr

    My husband had the injection twice and it was indeed helpful. It just didn't last as long as we hoped. But it gave him a glimmer of hope. I would say the benefits out weigh the risks.
  • Dr. James Bender 04 Apr

    @Greg, A 2005 study in the Journal of Adult Development showed that neurofeedback can be useful in calming the "fight or flight" response that is a major symptom of anxiety associated with PTSD. There have also been a few small studies saying it can help with memory problems associated with TBI. I chose a few good treatments for the blog based on the level of evidence, the feasibility of their implementation, and my personal experience with them. I'm sure there are several treatments that I left out that people have found to be helpful.

  • Dr. Diego Hernandez 04 Apr

    I would like to add two publications from 1 of 2 DOD funded studies of Accelerated Resolution Therapy (ART) which shows tremendous promise for the symptoms of PTSD in 4-5 sessions.

    Brief Treatment of Symptoms of Post-Traumatic Stress Disorder (PTSD) by Use of Accelerated Resolution Therapy (ART®) http://www.mdpi.com/2076-328X/2/2/115

     

    Brief treatment of co-occurring post-traumatic stress and depressive symptoms by use of accelerated resolution therapy® http://www.frontiersin.org/affective_disorders_and_psychosomatic_research/10.3389/fpsyt.2013.00011/abstract

     

    Diego Hernandez Psy.D

    Clinical Director of Military Trial of A.R.T. for PTSD University of South Florida College of Nursing

  • Dr. James Bender 05 Apr

    @Dr. Diego Hernandez, Thank you for identifying this experimental therapy.

  • Dr. James Bender 05 Apr

    @Kat, I'm glad your husband experienced some relief. Sometimes treatments are combined (like medication and therapy), and sometimes you have to try a few different kinds of treatment before finding the one that works for you. DCoE recommends that patients ensure they find providers who have been trained in the most evidence-based methods of care and ensure their treatment plan meets their individual needs.

  • Susan Battle 08 Jul

    Dr. Bender: I saw no mention of EMDR (Eye Movement Desensitization and Reprocessing) in your list of evidence-based treatments. I have worked with hundreds of active-duty, reserve, guard and retired service members with PTSD and know that this treatment is effective and efficient for this issue. The dropout rate in my experience is extremely low, outcome measures are very positive, and effects appear to be long-lasting. This form of therapy has been approved by the DoD and V.A. (I was trained by the military), but it seems to be mentioned less and less often in articles relating to service members.
  • Dr. James Bender 09 Jul

    @Susan, There is a lot of evidence showing EMDR’s effectiveness.  EMDR has gained widespread acceptance as an effective treatment for PTSD in the VA and other facilities.  Because it has moved beyond the "promising" category into a more established treatment, I didn't include it.

  • Smithd273 05 May

    Thank you for the sensible critique. Me & my neighbor were just preparing to do a little research about this. We got a book from our local library but I think I learned more from this post. I am very glad to see such excellent info being shared freely out there.
  • DCoE Public Affairs 06 May

    @Smithd, We're glad you found this article helpful and thanks for sharing.


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