Episode 011: Finally, we will discuss the mainstream treatment PTSD, effectiveness of medications and psychotherapy, and practical neuroscience you can use today. While the medical facts regarding what can be done for PTSD are still frightfully limited, I’ll highlight what I believe are the most important.
When combined, psychotherapy with medications offers synergistic improvement. Among the psychotherapies, the two at the top of the list are cognitive processing therapy (CPT), which is a subtype of cognitive behavioral therapy (CBT), and prolonged exposure (PE). My dislike of PE was outlined in its own podcast, Episode #7 The Ugly Truth about Prolonged Exposure: A Case Study in Medical Ethics.
Cognitive Processing Therapy was created by federal employees and is therefore an open, free copyright. Anyone can search online to find the exact worksheets used in this therapy. It hinges on core beliefs, automatic thoughts, and reframing just like CBT.[caption id="attachment_6803" align="aligncenter" width="540"] Cognitive Processing Therapy for PTSD: Automatic thoughts-feelings circle.[/caption]
Example of Cognitive Processing Therapy:
I believe: I can’t trust anyone.
Consequences: Decreased social life, family suffers, feel lonely.
Evidence for: I got assaulted 4 different times.
Evidence against: I’ve gone years without being assaulted.
Modified core belief: I am safe almost all the time and work to maintain.
Now, doesn’t that feel much more optimistic? It certainly puts us in a more grateful posture to set us up for growth and healing in the future. Unfortunately if this is all you do for PTSD, the body, spirit and sometimes the emotions don’t get a chance to heal.
Here are some cool whiteboard videos about CPT from the VA: https://www.ptsd.va.gov/appvid/video/index.asp
PE can help in specific behavioral circumstances when PTSD, phobia, or disabling anxiety are causing a clear behaviors that qualify as a disorder. Listen to Episode 7 to learn the ugly truth about prolonged exposure.
Eye Movement Dissociation and Reprocessing (EMDR)
A 2017 literature review of EMDR for PTSD found it to be helpful for people that have more than one diagnosis. Also, it can be help for psychotic (I have to think psychotic-like, intrusive flashbacks too) and affective (mood: anger/depression/panic) symptoms. Therefore, EMDR is definitely a mainstream treatment not to be ignored.
Neuroscience of PTSD
Neurons in the hippocampus and prefrontal cortex degrade during PTSD, sleep deprivation, head injury, and Major Depressive Disorder. Below is a picture of mouse brains with and without Brain-Derived Neurotrophic Factor, a protein that does the rebuilding. Row A are mouse brain slides without BDNF, Row B are mouse brain slides with BDNF.[caption id="attachment_6812" align="aligncenter" width="516"] Row A has low Brain-Derived Neurotrophic Factor, Row B has high amounts of BDNF.[/caption]
Figure 5. Brain-derived neurotrophic factor (BDNF) grows neurons.
(This topic is discussed in more detail in my book, Combat PTSD in America: Toward a Permanent Solution. Available at http://www.lulu.com/shop/daniel-williams/combat-ptsd-in-america/paperback/product-22601787.html)
There are only two FDA-approved medications for PTSD core symptoms: sertraline (Zoloft) and paroxetine (Paxil). From after-market trials we know that practically any SSRI, and similar medications, help about as equally as they do in other conditions, such as major depressive disorder. Evidence suggests 10% of the PTSD benefit comes from medications and 90% comes from psychotherapy. In my opinion, sleep medications are the handiest thing the psychiatrist can provide when you’re just dealing with PTSD alone.
Sleep medications commonly used in PTSD
If you can control the adrenaline at night and practicing turning off your mind at bedtime, you can usually get reasonable control of sleep after trying less than a few of the medications in Table 3.
Table 3. Common sleep medications for PTSD.
(Combat PTSD in America: Toward a Permanent Solution. Available at http://www.lulu.com/shop/daniel-williams/combat-ptsd-in-america/paperback/product-22601787.html)
Complementary and Alternative Medicine (CAM) approaches to PTSD therapy
So far, we have spent our time on mainstream approaches to PTSD, while there are a couple dozen of middle-strength of evidence approaches and literally hundreds that haven’t been tried. To highlight the organization of Episode 4 here and the courses at PTSD Academy, I’ve listed several techniques below with CAM strategies that can all be summarized and explained in an eerily similar way:
- Trauma and Tension Releasing Exercise
- Somato-Respiratory Integration
- Weight lifting
- Eating an organic diet, as close to Paleo core principles as you can get today
The next episode is #12 PTSD and the Endocannabinoid Receptor System.