Therapist

New treatment for post traumatic stress disorder

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SGB was found to be effective, and represents another treatment option for people suffering from PTSD.

Study participants received either the SGB injection or an injection of saline near the stellate ganglion instead of the SGB medication.

Determine whether the stellate ganglion block (SGB) procedure can decrease the severity of PTSD symptoms and whether it affects other conditions such as anxiety, suicidal thoughts, pain, and alcohol use.

More than 7 million adults throughout the United States suffer from posttraumatic stress disorder (PTSD). Most commonly thought of as associated with military combat, PTSD can occur following any traumatic event—including natural disasters, terrorist incidents, serious accidents, or physical or sexual assault. The disorder is often compounded by depression and substance abuse. Those who suffer from PTSD can also experience interpersonal and relationship difficulties as well as problems at work.

The U.S. Department of Veterans Affairs estimates that PTSD affects or has affected as much as 20 percent of those who served in the Vietnam War, Desert Storm, and Operations Iraqi Freedom and Enduring Freedom. Recent evidence suggests that PTSD is increasing among service members—rising from 7 percent of active duty service members in 2005 to 11 percent in 2008.

The Search for Effective Therapies for PTSD

The ideal PTSD treatment—safe, effective, and fast-acting, with few side effects—has been elusive. And as with many mental-health issues, patients sometimes have trouble accepting or adhering to some of the options that are available. The Department of Defense and healthcare researchers have pursued a variety of solutions for years.

In the early 2010s, some military medical centers began offering patients with PTSD a procedure that had been used for decades to relieve pain. The procedure, called stellate ganglion block, or SGB, involves injecting a local anesthetic into the stellate ganglion. This group of nerve cells and nerves in the neck helps regulate the body’s “fight or flight” mechanism.

As more and more patients tried the stellate ganglion block, the reports seemed promising. But the medical community still needed evidence of its effectiveness. RTI in 2014 launched a randomized, controlled trial of SGB, and in fall 2019, we found that it is indeed effective.

Combining Clinical Data with Patient-Centered Perspectives

Our study was the first multi-site randomized controlled trial of SGB for treatment of PTSD. The trial determined that the SGB procedure decreases the severity of PTSD symptoms. Our researchers are still evaluating whether it affects other conditions such as anxiety, suicidal thoughts, pain, and alcohol use.

RTI coordinated all aspects of the study at three U.S. military facilities:

  • Womack Army Medical Center in North Carolina
  • Tripler Army Medical Center in Hawaii
  • Landstuhl Regional Medical Center in Germany.

This included developing the study protocol and monitoring its execution to measure patient health outcomes for 8 weeks after injections.

Study participants received either the SGB injection or what’s referred to as a sham procedure (akin to a placebo), during which the patient received an injection of saline near the stellate ganglion instead of the SGB medication.

We also conducted focus groups and interviews with service members, spouses, and healthcare providers to explore how SGB is perceived in comparison to other treatments for PTSD, which should predict whether SGB could be widely accepted as an option for the many service members, veterans, and civilians who suffer from PTSD.

Expanding Treatment Options and Addressing the Stigma of PTSD

The study ran through 2018, and gathered and analyzed clinical and qualitative data to inform recommendations for U.S. military medical centers and private practitioners who treat patients with PTSD symptoms.

SGB is a true breakthrough in PTSD treatment. It is a powerful new option for people suffering from PTSD—one that may be more readily accepted by military service members and veterans, for whom the stigma associated with mental healthcare is often a deterrent to seeking treatment. We hope that our study is the first step to healing for millions of veterans and others for whom PTSD symptoms have long been a barrier to a better life.

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Diagnosis

To diagnose post-traumatic stress disorder, your doctor will likely:

  • Perform a physical exam to check for medical problems that may be causing your symptoms
  • Do a psychological evaluation that includes a discussion of your signs and symptoms and the event or events that led up to them
  • Use the criteria in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), published by the American Psychiatric Association

Diagnosis of PTSD requires exposure to an event that involved the actual or possible threat of death, violence or serious injury. Your exposure can happen in one or more of these ways:

  • You directly experienced the traumatic event
  • You witnessed, in person, the traumatic event occurring to others
  • You learned someone close to you experienced or was threatened by the traumatic event
  • You are repeatedly exposed to graphic details of traumatic events (for example, if you are a first responder to the scene of traumatic events)

You may have PTSD if the problems you experience after this exposure continue for more than a month and cause significant problems in your ability to function in social and work settings and negatively impact relationships.

Treatment

Post-traumatic stress disorder treatment can help you regain a sense of control over your life. The primary treatment is psychotherapy, but can also include medication. Combining these treatments can help improve your symptoms by:

  • Teaching you skills to address your symptoms
  • Helping you think better about yourself, others and the world
  • Learning ways to cope if any symptoms arise again
  • Treating other problems often related to traumatic experiences, such as depression, anxiety, or misuse of alcohol or drugs

You don’t have to try to handle the burden of PTSD on your own.

Psychotherapy

Several types of psychotherapy, also called talk therapy, may be used to treat children and adults with PTSD. Some types of psychotherapy used in PTSD treatment include:

  • Cognitive therapy. This type of talk therapy helps you recognize the ways of thinking (cognitive patterns) that are keeping you stuck — for example, negative beliefs about yourself and the risk of traumatic things happening again. For PTSD, cognitive therapy often is used along with exposure therapy.
  • Exposure therapy. This behavioral therapy helps you safely face both situations and memories that you find frightening so that you can learn to cope with them effectively. Exposure therapy can be particularly helpful for flashbacks and nightmares. One approach uses virtual reality programs that allow you to re-enter the setting in which you experienced trauma.
  • Eye movement desensitization and reprocessing (EMDR). EMDR combines exposure therapy with a series of guided eye movements that help you process traumatic memories and change how you react to them.

Your therapist can help you develop stress management skills to help you better handle stressful situations and cope with stress in your life.

All these approaches can help you gain control of lasting fear after a traumatic event. You and your mental health professional can discuss what type of therapy or combination of therapies may best meet your needs.

You may try individual therapy, group therapy or both. Group therapy can offer a way to connect with others going through similar experiences.

Medications

Several types of medications can help improve symptoms of PTSD:

  • Antidepressants. These medications can help symptoms of depression and anxiety. They can also help improve sleep problems and concentration. The selective serotonin reuptake inhibitor (SSRI) medications sertraline (Zoloft) and paroxetine (Paxil) are approved by the Food and Drug Administration (FDA) for PTSD treatment.
  • Anti-anxiety medications. These drugs can relieve severe anxiety and related problems. Some anti-anxiety medications have the potential for abuse, so they are generally used only for a short time.
  • Prazosin. While several studies indicated that prazosin (Minipress) may reduce or suppress nightmares in some people with PTSD, a more recent study showed no benefit over placebo. But participants in the recent study differed from others in ways that potentially could impact the results. Individuals who are considering prazosin should speak with a doctor to determine whether or not their particular situation might merit a trial of this drug.

You and your doctor can work together to figure out the best medication, with the fewest side effects, for your symptoms and situation. You may see an improvement in your mood and other symptoms within a few weeks.

Tell your doctor about any side effects or problems with medications. You may need to try more than one or a combination of medications, or your doctor may need to adjust your dosage or medication schedule before finding the right fit for you.

Coping and support

If stress and other problems caused by a traumatic event affect your life, see your doctor or mental health professional. You can also take these actions as you continue with treatment for post-traumatic stress disorder:

  • Follow your treatment plan. Although it may take a while to feel benefits from therapy or medications, treatment can be effective, and most people do recover. Remind yourself that it takes time. Following your treatment plan and routinely communicating with your mental health professional will help move you forward.
  • Learn about PTSD. This knowledge can help you understand what you’re feeling, and then you can develop coping strategies to help you respond effectively.
  • Take care of yourself. Get enough rest, eat a healthy diet, exercise and take time to relax. Try to reduce or avoid caffeine and nicotine, which can worsen anxiety.
  • Don’t self-medicate. Turning to alcohol or drugs to numb your feelings isn’t healthy, even though it may be a tempting way to cope. It can lead to more problems down the road, interfere with effective treatments and prevent real healing.
  • Break the cycle. When you feel anxious, take a brisk walk or jump into a hobby to re-focus.
  • Stay connected. Spend time with supportive and caring people — family, friends, faith leaders or others. You don’t have to talk about what happened if you don’t want to. Just sharing time with loved ones can offer healing and comfort.
  • Consider a support group. Ask your mental health professional for help finding a support group, or contact veterans’ organizations or your community’s social services system. Or look for local support groups in an online directory.

When someone you love has PTSD

The person you love may seem like a different person than you knew before the trauma — angry and irritable, for example, or withdrawn and depressed. PTSD can significantly strain the emotional and mental health of loved ones and friends.

Hearing about the trauma that led to your loved one’s PTSD may be painful for you and even cause you to relive difficult events. You may find yourself avoiding his or her attempts to talk about the trauma or feeling hopeless that your loved one will get better. At the same time, you may feel guilty that you can’t fix your loved one or hurry up the process of healing.

Remember that you can’t change someone. However, you can:

  • Learn about PTSD. This can help you understand what your loved one is going through.
  • Recognize that avoidance and withdrawal are part of the disorder. If your loved one resists your help, allow space and let your loved one know that you’re available when he or she is ready to accept your help.
  • Offer to attend medical appointments. If your loved one is willing, attending appointments can help you understand and assist with treatment.
  • Be willing to listen. Let your loved one know you’re willing to listen, but you understand if he or she doesn’t want to talk. Try not to force your loved one to talk about the trauma until he or she is ready.
  • Encourage participation. Plan opportunities for activities with family and friends. Celebrate good events.
  • Make your own health a priority. Take care of yourself by eating healthy, being physically active and getting enough rest. Take time alone or with friends, doing activities that help you recharge.
  • Seek help if you need it. If you have difficulty coping, talk with your doctor. He or she may refer you to a therapist who can help you work through your stress.
  • Stay safe. Plan a safe place for yourself and your children if your loved one becomes violent or abusive.

Preparing for your appointment

If you think you may have post-traumatic stress disorder, make an appointment with your doctor or a mental health professional. Here’s some information to help you prepare for your appointment, and what to expect.

Take a trusted family member or friend along, if possible. Sometimes it can be difficult to remember all the information provided to you.

What you can do

Before your appointment, make a list of:

  • Any symptoms you’ve been experiencing, and for how long.
  • Key personal information, especially events or experiences — even in your distant past — that have made you feel intense fear, helplessness or horror. It will help your doctor to know if there are memories you can’t directly access without feeling an overwhelming need to push them out of your mind.
  • Things you have stopped doing or are avoiding because of your stress.
  • Your medical information, including other physical or mental health conditions with which you’ve been diagnosed. Also include any medications or supplements you’re taking, and the dosages.
  • Questions to ask so that you can make the most of your appointment.

Some basic questions to ask your doctor or mental health professional may include:

  • What do you believe is causing my symptoms?
  • Are there any other possible causes?
  • How will you determine my diagnosis?
  • Is my condition likely temporary or long term?
  • What treatments do you recommend for this disorder?
  • I have other health problems. How best can I manage these together with PTSD?
  • How soon do you expect my symptoms to improve?
  • Does PTSD increase my risk of other mental health problems?
  • Do you recommend any changes at home, work or school to encourage recovery?
  • Would it help my recovery to tell my teachers or co-workers about my diagnosis?
  • Are there any printed materials on PTSD that I can have? What websites do you recommend?

Don’t hesitate to ask any other questions during your appointment.

What to expect from your doctor

Your doctor is likely to ask you a number of questions. Be ready to answer them to reserve time to go over any points you want to focus on. Your doctor may ask:

  • What symptoms are concerning to you or your loved ones?
  • When did you or your loved ones first notice your symptoms?
  • Have you ever experienced or witnessed a traumatic event?
  • Do you have disturbing thoughts, memories or nightmares of the trauma you experienced?
  • Do you avoid certain people, places or situations that remind you of the traumatic experience?
  • Have you been having any problems at school, work or in your personal relationships?
  • Have you ever thought about harming yourself or others?
  • Do you drink alcohol or use recreational drugs? How often?
  • Have you been treated for other psychiatric symptoms or mental illness in the past? If yes, what type of therapy was most helpful?
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