Healing Combat Trauma

A Nutritional Clue Offers Hope for Military Suicides

It's not often enough that we get to report some good news about suicide and the military -- for months now, the numbers have been climbing in the wrong direction, with few notable exceptions to the trend.

However, just recently, a development from a most unusual quarter shows some true promise for the future. And for those unfamiliar with the effect that nutrition has on brain and emotional health, the results may truly surprise.

Maybe you've never associated C-RATs, MREs, or even meals served in base dining halls, in the U.S. and in the war zone, with impressive nutritional credentials -- but that may be the wave of the future if the military takes steps to improve servicemembers' mental health through a closer attention to nutrition's effect on the brain and the emotions.

A study published in the August 23, 2011 issue of Journal of Clinical Psychiatry online links military suicides to a low level of docosahexaenoic acid (DHA), an Omega-3 essential fatty acid found in fish and flax seed, but which the body doesn't manufacture -- in other words, which needs to be supplemented through diet.

According to the press relase about the study from the Uniformed Services University of the Health Sciences:

"Scientists at the National Institute on Alcohol Abuse and Alcoholism (NIAAA) led by Capt. Joseph R. Hibbeln, M.D., teamed with researchers at the Uniformed Services University of the Health Sciences (USUHS) in Bethesda, Md., to analyze a sample of suicide deaths among U.S. military personnel on active duty between 2002 and 2008. The researchers compared levels of omega-3 fatty acids of 800 individuals who committed suicide with those of 800 randomly selected controls — service members who were matched with the suicide cases by age, sex, and rank. They found that all the service members had low omega-3 levels, and that suicide risk was greatest among individuals with the lowest levels of docosahexaenoic acid (DHA), the major omega-3 fatty acid concentrated in the brain. The new study is reported online in the Journal of Clinical Psychiatry." 

The study, entitled "Suicide Deaths of Active-Duty US Military and Omega-3 Fatty-Acid Status: A Case-Control Comparison," "found that service personnel with higher levels of DHA in their blood were less likely to take their own lives," according to Military.com, continuing "Servicemen whose medical records showed they had low levels of DHA in their blood were 62% more likely to have been suicide victims than those with the highest levels."

The background -- a fish story

An earlier study, from 2004, sets the stage for our understanding:

"Even though the brain is materially an organ like any other, that is to say elaborated from substances present in the diet (sometimes exclusively), for long it was not accepted that food can have an influence on brain structure, and thus on its function. Lipids, and especially omega-3 fatty acids, provided the first coherent experimental demonstration of the effect of diet (nutrients) on the structure and function of the brain."

Quickly, omega-3 fatty acids, in particular DHA from fish oil, swept the nutritional world with promise of their remarkable benefits. According to one expert, quoted in an article called "Omega Medicine," from "Nutrition Action," the newsletter for the Center for Science in the Public Interest, in October, 2007, "it's one of the biggest success stories in decades," with "downsides ... so minimal that the burden of proof for a benefit doesn't have to be that high." 

Familiar television personality and heart doctor Mehmet Oz, M.D., calls Omega-3 one of the five critical nutrients to take, and says that "It's good for your joints, skin, vision, brain, heart, helps lower bad cholesterol levels and even boosts fertility. It's ... good for just about every single part of your body."

With this kind of versatility -- and publicity -- suddenly DHA the superstar food additive started being introduced to many items on grocery store shelves, from bread to milk to cereal. Then there were the nutritional supplements as well (e.g., fish oil capsules) which were sold over-the-counter in health food stores, probably gratifying the generations of mothers who attempted to push daily spoonfuls of cod liver oil on their unsuspecting, and frequently ungrateful children :-). 

But DHA has always been in its most effective form, apparently, when sourced directly from food itself -- primarily fatty fish from cold-water regions -- so Atlantic salmon, mackerel, and sardines are frequently mentioned as particularly good sources. Omega-3s are also found in flax seed, nuts and even certain kinds of algae, but DHA is sourced predominantly from fish and fish oil.

Science takes a closer look

A study published in the Journal of Nutritional Health and Aging in 2004 stated that "dietary omega-3 fatty acids are certainly involved in the prevention of some aspects of cardiovascular disease...and in some neuropsychiatric disorders, particularly depression."

An earlier French study from 2003 on lipids, depression and suicide reports as part of its literature review that "Some epidemiological data support the hypothesis of a relation between lower depression and/or suicide rates and a higher consumption of fish." While focusing on the ratio of fatty acids to one another in the blood, it reported, "In major depression, all studies revealed a significant decrease of the polyunsaturated omega 3 fatty acids ... In addition, two studies found a higher severity of depression when the level of polyunsaturated omega 3 fatty acids or the ratio omega 3/omega 6 was low." 

The findings of the current study, according to one of its authors, "add to an extensive body of research that points to a fundamental role for DHA and other omega-3 fatty acids in protecting against mental health problems and suicide risks." As the press release regarding this study notes:

"Previous studies have associated low levels of omega-3 fats or low dietary intake of seafood, with suicide, thoughts of suicide, and depression. Many, but not all, treatment studies also have reported mental health benefits of supplemental DHA, including reduced anxiety, depression and risk of psychosis."  

The benefits conceivably extend beyond suicide to general emotional wellness. Capt. Joseph R. Hibbeln, M.D., acting chief, Section of Nutritional Neurosciences, NIAAA Laboratory of Membrane Biochemistry and Biophysics remarks,

"... a previous placebo-controlled trial demonstrated that 2 grams of omega-3 fatty acids per day reduced suicidal thinking by 45 percent as well as depression and anxiety scores among individuals with recurrent self-harm. In a prior study we found that low blood levels of DHA correlated with hyperactivity of brain regions in a pattern that closely resembles the pathology of major depression and suicide risk. While omega-3 fatty acids are generally recommended by the American Psychiatric Association as an adjunctive therapy for mood disorders, more research is needed to establish a definitive role for their use in the stand alone treatment of depression."

With suicides up, the military looking for reversible risk factors

Generally speaking, DHA levels seem low in servicemembers, if this study is any indication -- which points to a deficiency of fish in their diet, and little supplementation in the form of fish oil capsules, for instance. From Army Col. (Dr.) Michael D. Lewis, lead author on the study, and assistant professor in the Department of Preventive Medicine and Biometrics at the UHSU:

“We were surprised to find just how low the levels of omega-3 fatty acids were in the entire sample. There still was a significant suicide risk when we stratified the population. When we compared the 1,400 samples with the lowest levels of DHA to the remaining 200, there was a 62 percent increased risk that the samples were from a documented suicide. We need to continue to evaluate these results with a well-designed interventional study, but this represents a potential simple nutritional intervention that warrants further investigation.” 

The takeaway for us from this study is that if supplementing with DHA -- in the form of an increased amount of dietary fish, of the right kind -- improves the situation for depression and suicide -- it sounds like it's a change very worth making. The upside is so large, and the downside so low that truly, what's the risk? (And the rest of the literature on omega-3 fatty acids and DHA suggest so many other phsyiological positives -- from heart health to joint pain -- that it only adds to the attractiveness of this option.)

Again from Capt. Hibbeln:

"The U.S. military invests a great deal of funds and effort to ensure that its troops receive optimal nutrition, especially in combat and deployment situations. This study presents new information on the potential usefulness of omega-3 fats in reducing risk for suicide and optimizing mental health, which can be taken into account when designing U.S. military diets." 

Anything that improves the situation with mental health and combats suicide -- even if it makes only a fraction of a difference -- seems to be worth doing. Let's hope the military tests this as an intervention to see how well it works, and ends up making a "dietary difference" in the ongoing fight against suicide.

Traumatic War Experiences Predict Future Health Woes, Study of Civil War Vets Shows

In some medical news that you might have missed, a study came out that was published in the February, 2006 issue of the Archives of General Psychiatry that studied historical records pertaining to Civil War veterans, the amount of trauma they experienced in combat, and what the after-effects were in later years to their health.  Fascinating stuff, of course.

According to the article, "An archival examination of military and medical records of Civil War veterans was conducted. Degree of trauma experienced (prisoner-of-war experience, percentage of company killed, being wounded, and early age at enlistment), signs of lifetime physician-diagnosed disease, and age at death were recorded." Additionally, "The US Pension Board surgeons conducted standardized medical examinations of Civil War veterans over their postwar lifetimes. Military records of 17,700 Civil War veterans were matched to postwar medical records."

The conclusion?  "Greater exposure to death of military comrades and younger exposure to war trauma were associated with increased signs of physician-diagnosed cardiac, gastrointestinal, and nervous disease and more unique disease ailments across the life of Civil War veterans." In other words, younger soldiers were at greater risk; and the more brother (or today, also sister) soldiers who died, the harder it was for the combat veterans.  Makes sense, doesn't it?

Editor's note: The study's citation is: Arch Gen Psychiatry. 2006 Feb;63(2):127-8, and it's linked here. 

The Dept. of "No Real Surprises Here": Chiropractic Doesn't Help Veterans Suffering from PTSD

An article in the current issue -- June, 2009 -- of Military Medicine takes a look at the effects of chiropractic on veterans with PTSD, and finds the results lacking.  The study is called "A cross-sectional analysis of clinical outcomes following chiropractic care in veterans with and without post-traumatic stress disorder,” and it was authored by Drs. Andrew Dunn, Steven Passmore, Jeanmarie Burke and New York Chiropractic College student David Chicoine.

According to an article in trade publication ChiroEco.com, that study "investigates clinical outcomes for 130 veteran patients with neck or low back complaints at the VA of Western New York. This study found that patients with post-traumatic stress disorder had significantly lower lower levels of improvement than those without post-traumatic stress disorder on self-reported outcome measures of neck and low back disability."

These results are not really surprising, because -- unlike another form of bodywork, massage therapy, which does have proven results for helping PTSD symptoms -- there's nothing about chiropractic per se that indicates it would be helpful. Spinal subluxations, while combat veterans may be experiencing them, aren't really part of the PTSD profile, and relieving them wouldn't necessarily have any effect whatsoever on reducing PTSD symptoms.  They're just not related. That said, it's progress that chiropractic is offered in military health care settings, and we're sure it brings combat veterans some relief -- in the appropriate context, which PTSD is not.

For a look at complementary and alternative medicine therapies ("CAM") that have shown benefit in treating PTSD, click here.  For a look at bodywork therapies, click here.  For a look at mind-body medicine approaches, click here.  To read the article in ChiroEco.com, click here.

Let's Hope This Isn't More "Blame the Victim" Thinking on Combat Veterans with PTSD, But...

A recent medical study, published in the British Medical Journal and reported on Friday, suggests that "the risk of combat-related post-traumatic stress disorder (PTSD) increased by two- to threefold in military personnel who had significant mental or physical problems before deployment, according to a study of 5,400 veterans."  In other words, those who were vulnerable beforehand, were even more susceptible to PTSD than their peers.  Hmmmn.

It's always interesting, and is going to stay interesting, to contemplate what, if any, predictive or predisposing factors there are for who develops later develops combat-based PTSD and why.  At the very least, this study throws yet more analysis into the mix, in a story that will continue developing for years.

According to the BMJ, the conclusion of the study was that:

"Low mental or physical health status before combat exposure significantly increases the risk of symptoms or diagnosis of post-traumatic stress disorder after deployment. More vulnerable members of a population could be identified and benefit from interventions targeted to prevent new onset post-traumatic stress disorder."

The study, which was supported by the U.S. Department of Defense, reported that:

"More than half of post-combat PTSD diagnoses involved veterans who ranked below the 15th percentile in mental or physical health at baseline, Cynthia LeardMann, of the Naval Health Research Center in San Diego, and colleagues reported online in BMJ.

"We have identified an at-risk population whose functional health seems to predict vulnerability to PTSD after combat deployment," the authors said. "In theory, such a population could be targeted for PTSD prevention programs, early intervention after exposures to stress, or even protection from stressful exposures, when possible."

The findings came from the Millennium Cohort Study, which has accumulated data on military personnel since 2001, before the wars in Afghanistan and Iraq. Investigators collected follow-up data from June 2004 to February 2006.

A previous report based on the study suggested that combat exposure -- as opposed to deployment -- significantly increased the risk of new-onset PTSD. Building on that observation, the authors examined the association between baseline mental and physical health and the risk of new symptoms or a diagnosis of PTSD.

The current analysis involved 5,410 combat veterans who completed baseline and follow-up questionnaires. The questionnaire includes a 17-item self-report measure of PTSD symptoms.

Baseline health status was determined by participants' scores on the mental and physical summaries of the SF-36V (veterans) health survey. A new PTSD diagnosis was based on DSM-IV criteria (derived from the questionnaires) or self-reported physician diagnosis.

The analysis showed that 7.3% of the participants had new-onset symptoms or a diagnosis of PTSD at follow-up by DSM-IV criteria. When self-reported physician diagnosis was included, the rate increased to 8.6%.

The authors stratified the participants into three groups according to mental and health status scores: below the 15th percentile, 15th to 85th percentile, and above the 85th percentile.

Combat veterans who scored below the 15th percentile of the mental summary had a relative risk of PTSD of 3.51 compared with those in the 15th to 85th percentile.

A score below the 15th percentile of the physical summary more than doubled the risk of PTSD (RR 2.22).

Overall, 58% of new PTSD diagnoses involved combat veterans who were below the 15th percentile for either summary.

Subgroups at increased risk for new PTSD symptoms or diagnosis included:

• ≥3 combat exposures during deployment, 2.60
• Women, 2.33
• Current smokers, 1.56
• Non-officers, 1.77
• Reserve/National Guard members, 1.85
• Army veterans, 2.04"

Editor's Note: The full reference is: LeardMann CA, et al "Baseline self reported functional health and vulnerability to post-traumatic stress disorder after combat deployment: Prospective U.S. military cohort study."  The full citation is: BMJ 2009; 339: DOI:10.1136/bmj.b1273. For the link to the full article, click here.

Suicide Predictors in Young Men -- Combat Trauma Not Included

We've talked on the blog before about "suicide maps" and various predictors of suicide, however imperfect they may be.  Today there's an item from a medical journal that details a Finnish study -- aka, a medical study performed in Finland -- which essentially says, adolescent boys and young men who committed suicide frequently also showed some form of psychiatric illness at age 8 -- which happened to be the age where they were first evaluated, in the study.  Young women who killed themselves, didn't show this particular trend. Now, not to say that this study is in any way conclusive about PTSD -- since obviously it didn't even touch on that as a topic -- but it is interesting, since some of the research indicates that PTSD can be particularly difficult if it is "laid on top of" a previous, significant traumatic experience (often in childhood). In some ways, this study may not be all that germane to our topic, but it's interesting to note, in any case, since there are obviously a number of young men (and women) who commit suicide in the armed forces, and as veterans -- and it's always worthwhile to comb the scientific literature for any other reasons, or contributing factors into, why this might actually be.  Here's the info from the study:

Childhood Psychiatric Problems May Predict Suicide Attempts in Males

Most males who commit suicide or need hospital care for suicide attempts during their teen or early adult years appear to have high levels of psychiatric problems at the age of 8, according to a report in the Archives of General Psychiatry. However, later suicide attempts in females are not predicted by mental health issues at this age.
 
Andre Sourander, MD, of Turku University Hospital in Finland, and colleagues studied 5,302 Finnish individuals born in 1981. Eight years later, information about psychiatric conditions, school performance, and family demographics was gathered from children, parents, and teachers. Participants were then tracked through national registers through 2005.
 
Between the ages of 8 and 24, 40 participants died, including 24 males and 16 females. Of those, 13 males and two females died from suicide. A total of 54 males and females (1%) either completed suicide or made a suicide attempt serious enough to result in hospitalization.
 
Of the 27 males who either seriously attempted or completed suicide, 78% screened positive for psychiatric conditions at the age of 8, compared with 11% of 27 females who had serious or completed suicide attempts. In addition, males who would go on to make life-threatening or completed suicide attempts were more likely at the age of 8 to live in a family that did not consist of two biological parents, have psychological problems as reported by a teacher or have conduct, hyperactive, or emotional problems. However, none of these factors at 8 predicted later suicidal behavior in females, and depression at age 8 was not associated with suicide attempts for either sex.
 
Previous research has shown that in females, suicide is associated with depression and other affective disorders, which increase sharply after the beginning of puberty. This may explain why childhood psychiatric conditions do not predict later suicidal behavior in girls, the authors noted.
 

— Source: American Medical Association

Ethnic Disparities in Incidence of PTSD and Suicide among Combat Veterans

The topic of "culture, race, ethnicity and PTSD" is a complicated subject, with great potential to offend, so it has to be covered delicately, and slowly, over time.

There is a concern that ethnic minorities or non-white populations experience PTSD at greater rates than whites, but this concept is not without its detractors, who frankly disagree. 

It would be interesting to learn more about this phenomenon, and learn if the data really supports it, or if it's just an assumption.  If it turns out to be true, then it might be useful to map it against the prevalence of ethnic minorities who serve in the armed forces, in order to guesstimate more accurately future numbers of veterans who are likely to be affected by PTSD, and predict the resources that will be needed for their effective care in their home communities.  On the one hand, you would hope that these estimates were already being made; on the other hand, it doesn't seem that they are. Consequently, in this post we're unfortunately raising more questions than answers.

To narrow the focus here enough for discussion, let's take a look at just one ethnicity among many from which we could choose -- one that's on the rise in the United States (and in the U.S. military) -- Hispanics (aka Latinos). Observe how cultural issues may come into play with their incidence of PTSD, as the study indicates. (The same questions that are raised here could apply, in turn, to other ethnic minorities, and ideally, all should be studied.)

Re: Hispanics/Latinos:

"Several studies have found that Hispanic Americans have higher rates of post-traumatic stress disorder (PTSD) than non-Hispanic Caucasian and Black Americans. The authors identified predictors of PTSD symptom severity that distinguished Hispanic police officers (n=189) from their non-Hispanic Caucasian (n=317) and Black (n=162) counterparts and modeled them to explain the elevated Hispanic risk for PTSD. The authors found that greater peri-traumatic dissociation, greater wishful thinking and self-blame coping, lower social support, and greater perceived racism were important variables in explaining the elevated PTSD symptoms among Hispanics. Results are discussed in the context of Hispanic culture and may be important for prevention of mental illness in the fastest growing ethnic group in the United States." (Source.)

Hispanics/Latinos in the military. Do figures exist for how many Hispanics/Latinos are currently serving in the military; and/or are veterans of the Vietnam war, the Gulf war, the Iraq war, or Afghanistan? Are more Hispanics/Latinos joining the military?

I've seen a copy of a report that the state of Massachusetts has for number of veterans by zip code across the state.  Not surprisingly, a quick glance through that report impresses the casual reader that numbers of veterans are highest in poorer communities than wealthier communities. (You'd have to know Massachusetts for the examples to make sense, but say, the difference between Brockton or Fall River, MA and Wellesley or Osterville, MA.) A similar trend may also exist for communities with higher concentrations of ethnic minorities.

Hispanic/Latinos military suicides. Similarly, do figures exist that break out the ethnicity of active duty servicemembers or veterans who have committed suicide? Seemingly, the data to this point has not been this specific, but it needs to be.

Ironically, an unrelated study (circa 2002) done at the VA showed that with regard to being misdiagnosed with a particular mental illness (in this case, schizophrenia), you were more likely to be misdiagnosed if you were black or Hispanic than if you were white.  Also, if you were single, male, and lived in a rural area.

A study published in the American Journal of Public Health, Dec. 2007, Vol. 97, No. 12 offered some conflicting findings.  Their study, done with the VA system in the Ann Arbor, Michigan area, suggested that suicide rates for Hispanic veterans were actually LOWER than those of whites.  According to the study's authors:

"When the researchers calculated suicide rates over the entire 5.5 year study period, they were much higher for men (89.5 per 100,000 person-years) than for women (28.9), and higher for whites (95 per 100,000 PY) than for African Americans (27) and veterans of other races (56.1). Veterans of Hispanic origin had a lower rate (46.28 per 100,000 PY) of suicide than those not of Hispanic origin (86.8)."

The study had other unusual findings, including that vets with service-connected disabilities committed suicide less frequently than those without, and, most interestingly, that veterans with PTSD diagnoses committed suicide less frequently than those without such diagnoses(!).

However, the study's methodology was such that "the researchers analyzed comprehensive data from 807,694 veterans of all ages diagnosed with depression and treated at any Veterans Affairs facility nationwide between 1999 and 2004." In other words, before any significant number of OEF/OIF vets could be included in the study, a group whose rate of suicide is markedly higher than expected. In fact, during the course of the study, only "1,683 of the [over 800,000] depressed veterans committed suicide," a figure which represents "0.21 percent of the depressed veterans studied." Clearly, suicide figures among veterans today are higher than this study indicated, and it would be worthwhile redoing the study with a more current population of veterans.

Study Shows Young Adults with PTSD More Likely to Commit Suicide

On the one hand, this sounds like fairly self-explanatory science.  So why the inclusion on this blog?  Because of the (young) age of many active duty military, and even recent veterans -- news like this is relevant.

Young Adults With PTSD May Be More Likely to Attempt Suicide

"Posttraumatic stress disorder (PTSD)—but not exposure to traumatic events without the development of PTSD—may be associated with subsequent attempted suicide in young adults, according to a report in Archives of General Psychiatry.

Approximately 421,200 to 842,400 Americans aged 15 to 24 attempt suicide every year, according to background information in the article. Holly C. Wilcox, PhD, of Johns Hopkins Children’s Center, Baltimore, and colleagues studied 1,698 young adults of a group of 2,311 who had been tracked since entering the first grade in Baltimore public schools. Fifteen years later, 90-minute interviews were conducted with the participants (average age of 21) to assess the occurrence of traumatic experiences, suicide attempts, and the development of PTSD.

Of the participants interviewed, 1,273 (81%) had been exposed to a traumatic event and 100 (6%, or 8% of those exposed to trauma) developed PTSD. Suicide had been attempted by 10% of those with PTSD, compared with 2% of those who were exposed to trauma but did not develop PTSD and 5% of those who had never been exposed to traumatic events.

“The mechanisms involved in the association between PTSD and suicide attempts are not known,” the authors wrote. “There could be a common pre-existing predisposition to PTSD and suicide attempts that was present before the trauma occurred. Studies of early trauma and suicidal behaviors have implicated depression and impulsivity as possible mediators or possible pre-existing susceptibility traits.”

— Source: American Medical Association

Veterans Sought for National Clinical Study on EFT and Combat Trauma

Veterans sought for combat stress study

Veterans from wars in Vietnam, Iraq and Afghanistan may be eligible to participate in a clinical study investigating the effectiveness of Emotional Freedom Technique (EFT) at releasing combat-related stress, trauma and memories.

Qualifying veterans will receive six free private sessions of EFT with a professionally trained coach, including follow-up assessments after 3-6 months.

Combat-related conditions include insomnia and/or nightmares, drug and/or alcohol dependencies, anger, anxiety, depression, paranoia, obsessive compulsive behavior, panic attacks, phobias, rage, grief, survivor’s guilt, feelings of isolation or jumpiness around people.

The study is organized and sponsored by the Iraq Vets Stress Project (http://www.StressProject.org), a project of Soul Medicine Institute, a nonprofit research corporation.

For more information contact Susan Maloney, an integral life coach and EFT practitioner, at (707) 888-0246 or [email protected].

What Would Hope Regained Do for Combat Veterans?

I was in a conversation the other day with a Vietnam era psychologist, who I respect and admire a great deal, but who was nonetheless giving me static for the way I talked about "hope" in a previous blog post, as it concerned combat veterans.  "You talk about it as though it's an abstract, but then immediately move into talking about its RESULTS," he said (I'm paraphrasing.)  Rrrright.  And that would be exactly the point.  Hope is a great and a necessary thing -- but our goal here is to find ways to get over combat trauma, to the extent possible -- at least to reduce its effects on veterans -- and in that regard, yes, we're all about the results.  Are there any?  And what can those be?  Because if they're legitimate at all, in the vacuum of hope-lessness and despair created by a complete lack of reasonable solutions, let's figure out what those are, and let's try them out.  Are combat veterans game?  Many are.

Here's something I ran across the other day, in the middle of a [draft] journal article.  The author was talking about a type of therapy he used -- a therapy he's famous for developing, and which has been around and in use for decades -- on combat veterans, mostly from the Vietnam era, and the results he was able to achieve with them.  I have some inside knowledge of his program, but this was the first time I'd read something in print about it.  In the middle of quite an extensive article, charting this result and that, he happened to mention the results of one of the tests he did on the 22 vets, both before and after the two weeks of treatment.  This is what he wrote:

"Scores on the Beck Hopelessness Scale fell from an average of 11 before treatment to 3 following treatment.  In clinical practice, scores of 9 or more are used to indicate serious hopelessness.  A score of 4 is expected in the general population.  The veterans went from having pre-test scores characteristic of hopelessness, suicidal ideation and predictive of suicide attempts, to having scores typical of the general population.  Thirteen veterans had scores above 9 before treatment, one had a score above 9 after treatment. (That individual's score had dropped from 17 to 10.)  Nineteen out of 22 scores dropped; two remained the same (scores of 1 and 2); and one score increased [negligibly] (from 4 5o 5).  Marked decreases in pessimism are indicated, and it seems safe to conclude that the treatment group felt considerably more hopeful at the program's conclusion."

Do you see what's embedded in that, if true?  In two weeks of treatment, combat veterans with PTSD that went back decades started feeling better to a degree, on average, better than the general population?  That's remarkable...

---

So I ask you, what would HOPE do for veterans today, and their families?  It's pretty clear that when it comes to suicide, people are able to go forward with the act because they've given UP hope.  (That's why the Beck test, for example, is able to link the two: hopelessness and suicide, both ideation and attempts.)  We've seen in previous blog posts how the "focus" of a suicidal person becomes narrower -- it's not that they "don't love their family" or "aren't thinking about the consequences to others," they simply have narrowed their focus down to an either/or choice, and the rest of the considerations, no matter how otherwise dear, are simply "not in the picture." 

---

Now it's entirely possible that the veterans in the above-mentioned program didn't functionally "stay" that perky and optimistic, and that's why more follow-up studies, such as retests at longer intervals, would have contributed more information worth knowing.  Many times, at the end of a program, irrespective of what type of program it is, participants feel most buoyed and optimistic about future performance, lighter about their burdens, and more likely to discount the negative effect of future obstacles they may encounter.  However, even so it's significant to note how good those scores seemed to be, given the great degree of difficulty the same participants had having hope beforehand.

It's not just veterans -- it's also their families.  How often do family members say things like, "But you were only in the war for two years...how can you let it affect you for the whole rest of your life?"

If combat veterans are able to access health care that adequately deals with their symptoms, and reduces their symptom load to a manageable extent, and gives them back HOPE -- they will have the ability to resume their lives with some degree of normality, and prevent any number of negative consequences that come from NOT having hope, from having given up.  The tremendous societal costs from combat trauma we have to start understanding not only affect the veterans involved -- they affect their families, the communities in which they live, future generations, etc.  Veterans with hope -- who get their hope back -- will be functional and integrated into all aspects of their lives, and actively participate in their various roles as spouses, parents, employees, citizens, etc.  Veterans who lose hope, and who we do not help to regain hope, will lose out.  And this loss will affect them first, and then like the ripple effect of a pebble thrown into a pond, concentric circles of effect will spread out from them to others in their lives: their immediate families, their workplaces, their schools, their communities, even future generations in their families.

Far from being an abstraction, I believe HOPE is pretty central to the whole concept of "healing combat trauma."  We've got to help combat veterans to hang on and have some, and they themselves have to believe it's possible to get better.  Then we have to make sure we're connecting them with the very resources that can deliver the results.

Chronic Life Stress as a Predictor of Illness: How Much is Too Much?

In the annals of stress management studies is a particular test called the Holmes and Rahe Social Readjustment Scale.  It assigns "points" to major and minor life stressors a person may have experienced over the past year, and then has you total up the points at the end of the test to get a "total score." That total score can be used to predict the likelihood of illness, whether mild or severe, because chronic stress is well known to reduce immune function.

(Of course, stress management skills, such as what we've been discussing on this blog for a while, in the "mind-body medicine" category, linked here, are very helpful in reducing symptoms of stress.  But conscious awareness and the willingness to make life changes are also crucial.)

Veterans may be under chronic stress; but their families -- partners, significant others, children -- may also be under chronic stress.  Partners and children of deployed servicemembers may also have very high scores.  And care-givers for injured veterans (combat trauma, TBI, PTSD, amputations -- veterans suffer any number of serious injuries) are also at increased risk for stress-related illness.

Ideally this is a case where "knowledge is power" -- being able to quantify the stress you're under could help you to ask for help, make better choices, and prioritize self care.  Let's hope so... In the meantime, here's the test:

In the past 12 months, which of the following major life events have taken place in your life?

1. Print out this form

2. Make a mark next to each event that you have experienced this year.

3. When you're done, add up the points for each event.

4. Check your score at the bottom.

_____ Death of Spouse 100
_____ Divorce 73
_____ Marital Separation 65
_____ Jail Term 63
_____ Death of close family member 63
_____ Personal injury or illness 53
_____ Marriage 50
_____ Fired from work 47
_____ Marital reconciliation 45
_____ Retirement 45
_____ Change in family member's health 44
_____ Pregnancy 40
_____ Sex difficulties 39
_____ Addition to family 39
_____ Business readjustment 39
_____ Change in financial status 38
_____ Death of close friend 37
_____ Change to a different line of work 36
_____ Change in number of marital arguments 35
_____ Mortgage or loan over $10,000 31
_____ Foreclosure of mortgage or loan 30
_____ Change in work responsibilities 29
_____ Trouble with in-laws 29
_____ Outstanding personal achievement 28
_____ Spouse begins or stops work 26
_____ Starting or finishing school 26
_____ Change in living conditions 25
_____ Revision of personal habits 24
_____ Trouble with boss 23
_____ Change in work hours, conditions 20
_____ Change in residence 20
_____ Change in schools 20
_____ Change in recreational habits 19
_____ Change in church activities 19
_____ Change in social activities 18
_____ Mortgage or loan under $10,000 17
_____ Change in sleeping habits 16
_____ Change in number of family gatherings 15
_____ Change in eating habits 15
_____ Vacation 13
_____ Christmas season 12
_____ Minor violations of the law 11

______ Your Total Score

Now, take the total score and look at the following key:

LIFE STRESS SCORES

0-149 Low susceptibility to stress-related illness.

150-299 Medium susceptibility to stress-related illness.

300 and over High susceptibility to stress-related illness.

Now is the time to look into techniques to reduce stress loads, and to practice better self-care (to the extent possible.)

Pilot Study on Mind-Body Medicine Intervention Techniques Looking for Oregon Veterans

A study of mind-body medicine getting underway in Portland, Oregon will test whether veterans with post-traumatic stress disorder can benefit from meditation, neurofeedback and other healing alternatives.

Researchers at Oregon Health & Science University are seeking 45 volunteers, including combat veterans troubled by PTSD and veterans who lack combat experience or have never suffered from PTSD.  They are accepting veterans between the ages of 18 and 70 who are in good health.

The pilot study, which could lead to a larger clinical trial, will measure how stressful and relaxing situations change a subject's hormone levels, heart rate, brain activity, and immune system functioning.  Helané Wahbeh, a naturopathic doctor and postdoctoral fellow at OHSU, is leading the study with funding from OHSU's department of neurology as well as the National Institutes of Health (NIH).

 “Mind-body medicine appears to be an ideal way to help people with PTSD because the disorder affects the body’s immune system, hormone system and nervous system,” says Helané Wahbeh, N.D., a naturopathic physician researcher at OHSU. “I don’t believe you can effectively treat PTSD by only focusing on one aspect of the illness. For example, if we only give people suffering from PTSD anti-depressants, we may only be treating one aspect of the illness.”

The first phase of the OHSU study will measure changes in hormones, heart rate, brain activity and the immune system in both relaxing and stressful situations. Mary Lu, M.D., a psychiatrist with the Portland VA Medical Center, will provide PTSD screening.

Veterans interested in volunteering for the study, which will take up to about six hours of their time (probably broken up over time) can call (503) 494-3528 for more information.

Editor's note: If the study will measure hormone levels, undoubtedly it will measure cortisol levels -- and we've talked about cortisol, stress and sleep quite a bit previously on this blog. Unfortunately, good luck to the study's researchers on finding older vets who are also in "good health," especially ones who suffer from combat-based PTSD. Typically this creates a cascade of other physiological problems as veterans age -- however, on the plus side, mind-body relaxation techniques ideally will help even older veterans with health problems to achieve greater quality of life.  Either way it's an interesting study.

---

Additionally, here's a little more about the study from OHSU's own site, including some goals and a short video, linked here. And here's a description of the study (confusingly saying that it's not yet open for participation yet -- call the phone number instead to be sure) from the NIH's own Clinical Trials site, linked here.

Center for Mind-Body Medicine Wins DOD Grant to Study Methods for Treating PTSD, Depression in Returning Veterans

DEPARTMENT OF DEFENSE AWARDS GRANT TO THE CENTER FOR MIND-BODY MEDICINE

Date: October 22, 2008

The Washington, DC based Center for Mind-Body Medicine (CMBM) announced today that it has been awarded a $411,000, two-year grant from the newly formed Defense Center of Excellence for Psychological Health and Traumatic Brain Injury, for a randomized controlled trial (RCT) to study the effectiveness of the CMBM’s comprehensive, non-drug approach to treating post-traumatic stress disorder and major depression with troops returning from Iraq and Afghanistan, and their families. This study, whose principal investigator is the CMBM founder and director, James S. Gordon, MD, will be undertaken at the Southeast Louisiana Veterans Healthcare System, and is entitled “A Randomized Controlled Study of Mind-Body Skills Groups for Treatment of War-Zone Stress in Military and Veteran Populations.”

The study will test the effectiveness of CMBM’s model, which includes mind-body approaches (meditation, guided imagery, biofeedback, and yoga) and self-expression in words, drawings, and movement, in supportive, educational small groups. The groups will be led by VA clinicians who have been trained by Dr. Gordon and his CMBM faculty and will be offered to veterans and their families on weekends over the course of three months.

Dr. Gordon’s model is widely used with anxious and depressed people and those with chronic illness in the US, and has already been incorporated as a stress reduction program for students in a dozen US medical schools. Dr. Gordon describes his groundbreaking approach in detail in his new book, Unstuck: Your Guide to the Seven Stage Journey Out of Depression (published by The Penguin Press; June 2008). “This model is educational, non-stigmatizing, and powerfully effective. It can be easily taught and can be used by people of all ages on their own,” Dr. Gordon explains. “Veterans and their families will have the opportunity to share their experiences and challenges in a supportive group and learn techniques which have proved swiftly effective in reducing symptoms of stress and improving mood. They will, often quickly, experience a sense of control and calm and feelings of hope that many of them felt they might never again have.”

The study made possible by the Department of Defense’s grant will further demonstrate that the Center’s model can be used to produce significant and lasting changes in levels of anxiety, agitation, and anger, in flashbacks and nightmares, and in symptoms of withdrawal and numbing in highly traumatized soldiers and their families.

This model, which Dr. Gordon presents in a step-by-step self-help format in Unstuck, is currently being used by CMBM with war traumatized populations in Kosovo, Israel and Gaza as well as in post-Katrina southern Louisiana. In August 2008, CMBM published a landmark study on the use of its model to treat posttraumatic stress disorder in war-traumatized children in Kosovo. The study, which was published online in the Journal of Clinical Psychiatry, is the first RCT ever of any intervention with war-traumatized children, and is also the first RCT of a successful, comprehensive mind-body approach with any traumatized population.

From October 25 - 29, 2008, Dr. Gordon and his CMBM colleagues will begin training more than 100 active duty and VA clinicians from across the country in the CMBM model. These men and women will then be able to incorporate the CMBM approach in their work with US Veterans returning from Iraq and Afghanistan.

Getting Stuck to Get Unstuck: Army Studies Acupuncture for PTSD

An article from March 6, 2008 talks about the "Army PTSD Study on Track to Present Findings This Year."

Findings from a study on the effectiveness of acupuncture as a treatment for PTSD among military personnel may be reported later this year, according to research officials at the US Army’s prestigious Walter Reed Medical Center in Washington, DC.

According to the government web site www.clinicaltrials.gov initial report on the study, untreated PTSD “leads to decreased force readiness and increased health care utilization. Yet, service members with the disorder may be resistant to traditional treatments or find them undesirable because of side-effects, stigma, and long-term commitment.

“Acupuncture, which has few known side effects, holds promise as an effective treatment option for PTSD. Acupuncture has been shown to improve well-being and has been successfully used to treat stress, anxiety and pain conditions.”

Col. Charles C. Engel , principal investigator of the project, reports that data collection and primary statistical analysis have been completed and secondary analysis is currently underway. He says that the project intends to report data at upcoming professional conferences. These include the Force Health Protection conference in Albuquerque and the International Society for Trauma Stress Studies (ISTSS) in Chicago.

According to the web site, the project was intended to enroll up to 75 subjects, all active duty personnel. Researchers were to gauge the subjects’ PTSD status and response to treatment with the PTSD Checklist during a 12-week, randomized, waitlist-controlled trial. Participants were to receive an eight-session course of acupuncture treatment, and were to be evaluated throughout the study by way of clinical assessments and an independent assessing acupuncturist.

According to the study staff, all subjects were to receive a standardized protocol, based on Chinese medicine principles, for “clearing and calming” during the first four treatment sessions. During the fifth through eighth sessions, individualized treatments were to be given according to Chinese medicine diagnosis. All acupuncture services were to be performed by licensed acupuncturists who were graduates of the TAI Sophia Institute located in nearby Laurel, Maryland.

Marjorie Shovlin, a licensed acupuncturist in Washington, DC, was one of the acupuncturists providing treatment during the 18-month study period. She gave a presentation on the study methods and goals at the 18th annual NADA conference in May of last year.

Trauma Appears to Shrink the Brain's Hippocampus, Research Shows

An extremely recent article in the journal, Hippocampus, makes the simple observation that, according to recent medical research, trauma appears to shrink the size of the brain's hippocampus, a center linked (not surprisingly) to emotions and memory, thought to be part of the limbic system. This is good news, because it's always helpful if psychological topics such as trauma and PTSD can be shown to correspond to organic changes in phyisology: it gives them more credibility to the nay-sayers, of whom there are far too many.  The article itself is linked here.

According to MedicineNet.com, "The hippocampus is an area buried deep in the forebrain that helps regulate emotion and memory. Functionally, the hippocampus is part of the olfactory cortex, that part of the cerebral cortex essential to the sense of smell. Certain antidepressants (such as fluoxetine, or Prozac) influence the birth of new neurons in the hippocampus. The hippocampus is so-called because its shape suggests that of a seahorse. From the Greek hippos (horse) = kampos (a sea monster)."

The full citation of the journal article, for further study, is this:

AU: Fu L. Woon, Dawson W. Hedges
TI: Hippocampal and amygdala volumes in children and adults with childhood maltreatment-related posttraumatic stress disorder: A meta-analysis
SO: Hippocampus
VL: 18
NO: 8
PG: 729-736
YR: 2008
CP: Copyright © 2008 Wiley-Liss, Inc.
ON: 1098-1063
PN: 1050-9631
AD: Department of Psychology, 1001 SWKT, Brigham Young University, Provo, UT 84602; Neuroscience Center, 1001 SWKT, Brigham Young University, Provo, UT 84602
DOI: 10.1002/hipo.20437
US: http://dx.doi.org/10.1002/hipo.20437

The Carrot or the Stick: A Specialized "Cocktail" for PTSD?

Carrot of Hope is a nonprofit organization on the Web of individuals with PTSD, who are trying to pool their experiential knowledge base in order to create a better future for those with PTSD.  It's hard to figure out much from their website about what they're about, but perhaps that's just because they're a work in progress. 

However, much of the group's enthusiasm seems to center around a "PTSD cocktail," using various chemicals, that they feel -- from their members' accumulated experience with it -- has some beneficial effect on PTSD.  Apparently they are both trying to raise money to study the effects of this cocktail on PTSD, and also provide resources so that those with PTSD can take the information to their doctors and/or health care providers, and initiate a dialogue about whether this treatment might be beneficial.  Worth checking out -- especially worth sharing with your health care provider, to see if it might have promise in your particular case.

They say that they are "currently taking donations to fund a research project studying the role of the MAO-A enzyme in post-traumatic stress."  According to them, "the Monoamineoxidase-A (MAO-A) removes catecholamines (fight or flight chemicals) from the body," and that "studying MAO-A levels in PTSD patients could be a major key in curing" and possibly even "preventing PTSD in the future.

The article on their website about understanding catecholamines is linked here, and th material about the "PTSD cocktail," which contains three ingredients -- Geodon [Zeldox, Ziprasidone] (20 mg); Propranolol [Inderal] (10-20 mg); and Vistaril (25 mg) -- is linked here.  The main website is linked here.

The Cortisol Connection: Sex and Sleep, Stress and Survival

An amusing quote from two women health experts on Oprah, back in February of 2001: "Sleep is the sex of the next century," (meaning this one that we're in, now), by Laura Berman, Ph.D. and Jennifer Berman, M.D.

Good sleep being equated in importance to good sex?  Ahhh, that's not just humorous, that's interesting!  And both topics are recent focuses of this blog, so we've got to dig in and discuss.

Recently, we've talking about sleep AND sex (though not necessarily at the same time, for obvious reasons ;-).  However, both are important to maintaining good psychological health and happiness -- and the reality is, they both have something to do with a topic we've recently mentioned: cortisol. 

According to one expert, "Elevated cortisol levels resulting from chronic stress" [PTSD is a chronic stress] have been associated with the following conditions: increased appetite and food cravings; increased body fat; decreased muscle mass; decreased bone density; increased anxiety; increased depression; mood swings (anger and irritability); reduced libido (sex drive); impaired immune response; memory and learning impairment; increased symptoms of PMS (cramps, appetite); and increased menopausal side effects (hot flashes, night sweats)." Oh, my goodness!  Is there anything that ISN'T on that list?

Remember, too, that increased cortisol levels such as exist in veterans with PTSD are also implicated in risk for heart disease, as we blogged about here, recently.

---

Shawn Talbott, Ph.D., who has an interesting book called The Cortisol Connection: Why Stress Makes You Fat and Ruins Your Health -- And What You Can Do about It, has several pages devoted to the all-important topic of how cortisol from stress -- which veterans with PTSD have -- wrecks people's sex lives.  Since we've been discussing healthy sex and the combat veteran lately, it seems tailor-made to discuss what Talbott finds.  As he writes:

“You don’t need to read a book about the relationship between stress and disease to know that when we’re stressed out, we also have problems in the intimacy department.  For starters, menstrual cycles get all out of whack, erections are more difficult to achieve and maintain, and overall libido (sex drive) plummets.  Stress simply makes us lose interest in sex.  In males, this is due primarily to a dramatic fall in testosterone levels during stressful times.  In females, the stress-induced loss of sex drive is a bit more complicated, involving disruption in levels not only of testosterone, but also of estrogen, progesterone and prolactin.

 

(We're skipping over the part where he goes into biology class level details about how cortisol levels affect men's and women's sex drives, and going straight to his conclusion.  His book, which is worth getting, goes into details about what you can to do affect your own cortisol levels, apparently for better health.)

“So what to do?  Quit your job, move to the islands, and open a surf shop!  Your sex drive is guaranteed to increase.  (Ever wonder why you feel friskier when you’re on vacation? – Less stress!)  Not practical to move your family to Tahiti?  Okay, then at least do something about your cortisol levels…”

 

---

Another part of Talbott's book I found interesting was when he talks about the three main factors that make a huge difference in stress levels of individuals.  Take a look at these and think about combat trauma in the lives of veterans you know, and wonder about these factors continue to play into their lives, from remembered combat:

 

“We know from studies of both animals and humans that at least three factors can make a huge difference in how the body responds to a given stressor: whether there is any outlet for the stress, whether the stressor is predictable, and whether the human or animal thinks they have any control over the stressor.  These three factors – outlet, predictability and control – emerge as modulating factors again and again in research studies of stress.”

It's safe to say, healthy sex could be an outlet for stress, intrustive memories of PTSD are relatively un-predictable; and veterans' ability to "control" their stressors, many of which arrive unbidden, is fairly sketchy.

 

Another aspect of Talbott's work I found interesting was when he talked about how even potentially stressful sitautions can eventually lose their "charge" over time, if only they become "expected" or "predictable."  Unfortunately, there's pretty much nothing about combat that's "predictable" (except that it will be unpredictable!) so it stands to reason why combat veterans struggle with both stress and high cortisol levels, implicated in various illnesses including heart disease.  This scenario, below, shows a great "de-fanging" of a potentially large trigger: but because it becomes "predictable" over time, it loses its intensity.  Unfortunately, probably VERY little of what combat veterans experienced fell in this category: 

"The scenario [of predictability] has been studied in Army rangers training at jump school to become paratroopers.  At the start of the training, the soldiers underwent enormous increases in cortisol levels during each jump, but by the end of the course, their stress responses were virtually nonexistent.  By making the stressor more predictable, the stress response of each soldier was controlled to a much greater degree (though skydiving will probably never become a completely stress-free activity)."

 

At the very least, Talbott's book is worth picking up because it gives many practical ideas (including exercise, relaxation and diet) for reducing cortisol levels, which ultimately should result in better health.  Since cortisol is implicated negatively in sleep and sex, as well as many other important categories, it's worth knowing more about how to modulate your own levels, to optimize your experience.

Racktime, Sacktime: The Importance of a Good Night's Sleep for Brain and Heart Health

Trying to pull together two seemingly unrelated concepts lately: the importance of a good night's sleep (heck, any decent sleep would be a good idea) and heart health, let's look at this longish quote from an interesting and worthwhile book, The Cortisol Connection: Why Stress Makes You Fact and Ruins Your Health -- and What You Can Do About It, by Shawn Talbott, Ph.D. 

 

Essentially the background here is that high cortisol levels are both common in veterans with PTSD, and implicated in the literature with increased risk of death from heart disease.  It's also thought that cortisol causes other problems, including weight gain, diminished libido, increased blood pressure, and other topics of interest to veterans and their families, some of whom struggle with all these issues.

 

By writing a whole book about cortisol levels and their effect on health, Talbott is able to isolate the importance of some things we might not ordinarily think about (as well as suggest improvements). Says Talbott on cortisol levels and sleep:

 

"If you’re like most people, you understand that stress management can be used effectively to help with stressful events.  After reading the previous chapters, you now know that effectively managing your stress response will help you maintain your cortisol levels within a more normal range.  What you may not know, however, is that as little as a night or two of good, sound, restful sleep may do more for controlling your cortisol levels and reducing your long-term risk for many chronic diseases than a whole lifetime of stress-management classes.  Here’s why:

 

When you were just a few months old, a mere babe, your brain had you programmed to sleep about 18 hours a day – not a very stressful existence.  Upon reaching adulthood – say, about 20 years of age – your nightly allotment of sleep had been slashed to less than seven hours (six hours and 54 minutes, according to the National Sleep Foundation.)  That’s around two hours less than the eight to nine hours recommended by sleep experts for optimal physical and mental health. 

 

Progressive changes in your body’s internal clock (the suprachiasmatic nucleus), combined with alterations in your patterns of hormone secretion, have you going to bed later, and waking up earlier with each successive decade, resulting in nearly 30 minutes less sleep per night with each passing decade. 

 

By the time we reach our thirties and forties, we’re getting 80% less time in the most restful “slow-wave” period of sleep (as compared to our teenage years), and by the time we hit our 50s and 60s, we get almost no uninterrupted deep sleep.  (We still get some deep sleep, but it tends to come in short fragments that do little in terms of recovery and repair for mind and body.)

 

What does this lack of sleep mean for your cortisol levels?  It means that the average 50-year-old has nighttime cortisol levels more than 12 times higher than the average 30-year-old – yikes!  Perhaps the worst piece of news is that not only will an inadequate quality or quantity of sleep result in elevated cortisol levels, but high cortisol will also limit both your ability to fall asleep – and the amount of time that your mind spends in the most restful stages of deep sleep.  This sets you up for a vicious cycle of poor sleep, elevated cortisol, and subtle changes in metabolism that lead you down the path toward chronic diseases.  So get some sleep!"

 

-- Source: The Cortisol Connection: Why Stress Makes You Fact and Ruins Your Health -- and What You Can Do About It, by Shawn Talbott, Ph.D.

You'd have to read Talbott's book -- and you should -- to learn more about the relationship between high stress, cortisol levels and disease (as well as his recommendations for what to do about it).  However, even several items we've got linked to this blog are possible suggestions, among others, for getting a better night's sleep.  Not to pun, but most experts' recommendations on this topic often sound like a "real snore," they're so basic (practice sleep 'hygiene,' set a regular bedtime, warm milk for tryptophan, don't exercise within several hours of bedtime, etc.)  What's of greater interest to me at least is what items can we use to de-stress or relax more completely so that we can sleep.  Some suggestions:

 

Sleep Soundly CDs, by Steven Halpern; The Delta Sleep SystemDVD, by Dr. Jeffrey Thompson; and, of course, the highly-recommended Pacific Light DVD, by Thomas Day Oates, Jr.  And of course the restful, soothing lavender sleep pillow, which you can make yourself; or if you're really lucky, a massage.

 

Happy Zzs...

Study Shows Mind-Body Medicine Works on PTSD

(Just what we've been talking about, and who we've just been talking about as well.  Heh.  Love that.  So confirming...)

Read down and see how therapeutic this would be for people in rural communities, with little or no access to the VA, who are in therapy or not, for DIY types and those who prefer to access healthcare through a practitioner of one kind or another.  Just wonderful... and we knew it all along :-)

---

The Washington, DC based Center for Mind-Body Medicine (CMBM) announced today the publication of a landmark study on the use of its comprehensive, non-drug model to treat posttraumatic stress disorder (PTSD) in war traumatized children. The study, “Treatment of Posttraumatic Stress Disorder in Post-War Kosovar Adolescents Using Mind-Body Skills Groups: A Randomized Controlled Trial,” which was published today online in the Journal of Clinical Psychiatry is the first randomized controlled trial (RCT) ever of any intervention with war traumatized children. It is also the first RCT of a successful, comprehensive mind-body approach with any traumatized population.

The study demonstrates that the Center’s groundbreaking model can be used to produce highly significant and lasting changes in levels of stress, flashbacks, nightmares, and symptoms of withdrawal and numbing in highly traumatized children – those who lived in an area of Kosovo where in 1999 90% of the homes were burned and bombed and 20% of the children lost one or both parents.

 The CMBM approach includes self-expression and mind-body techniques and was offered to these children over 12 sessions in an educational, supportive small group setting. Eighty-two high school students in Kosovo participated in the study. The program was conducted by teachers and included meditation, guided imagery, breathing techniques, and biofeedback as well as self-expression through words, drawings, and movement. All the students met the criteria for posttraumatic stress disorder (PTSD) which was measured using the Harvard Trauma Questionnaire. Following the program, the number of students having symptoms indicating PTSD was significantly reduced from 100% to 18%. The reduction in symptoms was maintained at a 3 month follow-up. The improvement in PTSD symptoms was significantly greater compared to a similar group of students who did not participate in the mind-body skills program. This is the same model that CMBM’s founder and director, James S. Gordon, M.D., describes in detail in his new book, Unstuck: Your Guide to the Seven Stage Journey Out of Depression.

“This RCT,” Dr. Gordon, the lead author, says, “is important because it provides scientific evidence for the efficacy of a model that has been taught to almost 3,000 health and mental health professionals and educators worldwide. We’ve used this small group model to give tens of thousands of children and adults practical tools that help them to feel better quickly, and we’ve taught them to use their intuition and imagination to solve problems that had seemed overwhelming. We help traumatized people around the world to draw on strengths they may have forgotten they have, and we offer them a ‘safe place’ in which they can share their pain with others who have suffered as they have.”

“This model is educational, non-stigmatizing, and powerfully effective. It can be easily taught and can be used by people of all ages on their own,” Dr. Gordon explains. “It’s highly acceptable to populations which do not want to be given medication, those with no access to a doctor or therapist, and those who are in psychotherapy.”

This model, which Dr. Gordon presents in a step-by-step self-help format in Unstuck, is currently being used by CMBM with war traumatized populations in Israel and Gaza as well as in post-Katrina southern Louisiana. It is widely used with anxious and depressed people and those with chronic illness in the US, and has already been incorporated as a stress reduction program for students in a dozen US medical schools.

The CMBM model is also of increasing interest to the US Department of Defense and the Veterans Administration. “The military,” Dr. Gordon says, “understands the breadth and depth of the psychological crisis (as many as 300,000 returning veterans are expected to have posttraumatic stress disorder or major depressive disorder, and another 320,000 will have been made vulnerable to these conditions by traumatic brain injury). The military’s leadership is committed to finding evidence-based approaches, like the one taught by The Center for Mind-Body Medicine, that can make a difference for the individual veteran and his/her family, an approach that can be taught to the large numbers of professionals and peer counselors who serve them.” More than 100 health and mental health professionals who work with the military are expected at the next CMBM training in mind-body medicine on October 25-29 in Minneapolis, and many more are expressing interest in learning and using the CMBM model.

For more information about the upcoming training, click here,  or to order Unstuck: Your Guide to the Seven-Stage Journey Out of Depression", please email The Center for Mind-Body Medicine (CMBM) at [email protected] or visit www.cmbm.org.

Heart Un-Healthy: Study Shows PTSD Bad for Combat Veterans' Hearts

A Reuters story on Wednesday, citing a study in the July/August issue of Psychosomatic Medicine, raised PTSD as a risk factor for cardiac disease.   (That story is linked here.)

The study was done with Vietnam veterans, and it showed that once other factors were accounted for, PTSD caused twice as many study deaths from heart disease as researchers  expected.  The upshot of the study is that veterans with PTSD should try to overcome their PTSD as early as possible, through counseling and whatever other means prove effective (that wasn't really part of the study), because otherwise, PTSD continues to raise health risks decades after it first shows up, as it has with these Vietnam veterans, who are now in middle age.

PTSD: it's not good for your psyche, and it's not good for your body either.  The best thing you can do, if at all humanly possible, is find ways to move through it, so it harms you as little as possible. WAY easier said than done, we realize.  This study, however, is just another reminder -- not that we needed one -- that combat trauma/PTSD are not good for human beings to suffer: not at first, and not later.

But you know... if there were ever (another) good reason to check into something like "Mind Body Medicine," which we've talked about on the blog here recently, this is one of those opportunities.  Even hearing something like "PTSD [which you couldn't avoid; you were in combat] raises your risk of heart disease [which by implication you can't avoid, now that you involuntarily have PTSD] -- or the even cheerier "raises your risk of early death!" [lovely...] is plenty stressful.  And chronically elevated stress levels, don'tchaknow, aren't good for your heart (or your health in general.)  The good news is, there are things you can do for yourself, in addition to whatever your doctor prescribes, that are low-tech, sometimes even high-touch solutions, that can create more peace and calm in your life with which to face whatever crises you may have, including health ones.  Don't just let this news discourage you: let it prompt you to look into all of what your options are, for a healthier, and ideally longer life.

Murder, They Wrote: Statistics on Recent Combat Veterans and Homicides

The Spring/Summer 2008 issue of the American Psychological Associations' Section VII newsletter contains an interesting article on the "postdeployment homicide" statistics of combat veterans, that basically follows up on the study published in the New York Times in January of 2008, which we blogged about, here, while expanding on it and doing additional research.  The findings are quite worth reading.

(The study's authors are Kyle Burchett, David Ferreira and Glenn Sullivan, all from the Virginia Military Institute.)

They write:

A relationship between criminal behavior and Posttraumatic Stress Disorder in combat veterans has been hypothesized almost since the inclusion of PTSD in DSM-III (e.g. Wilson & Zigelbaum, 1983). Some researchers (e.g. Chemtob, Novaco, Hamada, Gross, & Smith, 1997) have posited that combat veterans may be more prone to entering a cognitive, behavioral, and physiological “survival mode” when confronted with threats in civilian environments, and may be more likely to respond to perceived threats with overwhelming aggression. Multiple studies, beginning with the National Vietnam Veterans Readjustment Study (NVVRS; Kulka et al., 1990), have shown dramatically higher rates of violence among combat veterans with PTSD compared to combat veterans without PTSD. Beckham and colleagues (Beckham, Feldman, Kirby, Hertzberg, & Moore, 1997), for example, found rates of 22 violent acts in the past year for help-seeking combat veterans with PTSD, versus 0.2 violent acts for combat veterans without PTSD. One implication of the extant research is that combat exposure per se does not appear to increase violence risk, although the severity and quality of an individual’s combat experiences (e.g. participation in atrocities) may effect postdeployment violent behavior insofar as these factors mediate he development of PTSD.

In January 2008 the New York Times published a list of 121 U.S. veterans who had been charged with homicide after returning from deployments in Iraq or Afghanistan (Sontag & Alvarez, 2008). This list, and the series of articles that followed it, provoked strong reactions from some veterans’ advocates. Many expressed concern that the nation’s most recent veterans were being portrayed as “ticking time bombs” who pose a risk to civilian society. The authors of the present article examined the 121 homicide cases presented in the Times’ study from a clinical perspective, with the intent of clarifying the association between combat exposure and postdeployment violence in the dataset.

In addition to the information on each case available on the Times’ website, we gathered corroborative data from independent media outlets -- most commonly online versions of newspapers serving the localities where the crimes had occurred. In more than 80% of the cases, we gathered significantly more information about the perpetrator than was available in the original Times article. In fewer than 10% of the cases, we were unable to find any additional information about the case and relied solely on the account provided by the Times.

All but one of the 121 offenders were male (99.2%). The majority of the offenders (53.7%) were between 18 and 24 years old, and 85% were under age 30. Of the cases in which race/ethnicity was known, Caucasians represented the majority (54.4%), followed by Hispanics (23.5%) and African-Americans (22.1%). The most represented service branches were Army (62.8%) and Marine Corps (30.6%). Over 90% of the charged offenders had served in Iraq, and 10.7% had served in Afghanistan; two of the 121 has served in both countries. Eleven offenders (9.1%) had deployed overseas twice during the current hostilities and five (4.1%) had deployed three times.

The homicide victims included strangers (35.2%), friends/acquaintances (23.0%), spouses/girlfriends (18.8%), children (8.3%), and Other/Unknown (14.7%). As in the general population, handguns were the most frequently employed murder weapon. The most common criminal charge was first-degree (i.e. willful and premeditated) murder (55.7%). At the time of this study (April 2008), nearly 30% of the cases were still pending (i.e. th veterans had been charged but not convicted). Seven of the veterans on the Times’ list (5.8%) had been acquitted of the homicide charges against them. None of the veterans received a Not Guilty by Reason of Insanity acquittal, although considerations related to combat-exposure and self-defense appear to have influenced prosecutors in at least one case (e.g. Matthew Sepi). More than one-fifth of the cases (20.5%) involved vehicular manslaughter or homicide. All but one of these vehicular cases were primarily substance-related – the prototypical homicide victim in these cases was the passenger in a vehicle driven by an intoxicated veteran.

We reviewed the compiled case material for evidence of combat exposure. In the vast majority of cases (92%), some evidence of combat exposure was provided in media accounts of the criminal proceedings. In 40% of the cases, combat exposure appeared certain: news reports included details regarding combat decorations, injuries sustained by the accused in battle, or testimony by commanding officers or multiple fellow unit members regarding IEDs, mortar attacks, clearing buildings, etc. In an additional 52% of the cases, combat exposure appeared probable: friends or family members of the accused veteran referred to combat exposure, the veteran’s unit was known to have engaged in combat during the veteran’s deployment, the area in which the veteran operated (e.g. Fallujah) was known for intense combat, etc.

We also evaluated the case files for evidence of psychiatric symptoms. Due to the nature of our data, we could not achieve anything resembling a formal diagnosis, but we reliably detected significant psychiatric symptoms related to PTSD, Antisocial Personality Disorder, Substance Abuse, or psychosis in 114 of the 121 cases (94.2%). Only four (3.5%) of the veterans demonstrated psychotic symptoms.

Significant symptoms related to PTSD were reported in 85 of the 121 cases we examined (70.2%). Family members, friends, judges, defense attorneys (and even prosecutors) referred to veterans’ nightmares, insomnia, intrusive thoughts, survivor guilt, hyperarousal, hypervigiliance, intense anger, depressed mood, and suicidal ideation. In general, we searched for evidence that the veteran had returned from combat somehow “changed” or disturbed. Approximately 34% of the veterans in this sample demonstrated PTSD symptoms only, an additional 19% exhibited PTSD and comorbid Substance Abuse, and almost 17% appeared to display symptoms of both PTSD and Antisocial Personality Disorder.

We identified 39 cases that appeared to involve significant symptoms associated with Antisocial Perrsonality Disorder (ASPD; 32.2%). Evidence for ASPD included committing violence for material gain (e.g. killing a spouse for the insurance money), killing during the commission of a felony (e.g. shooting a gas station attendant during the course of a robbery), evidence of substantial criminal activity prior to the instant offense, callous disregard for others, lack of remorse, etc. In general, we searched for evidence of pre-deployment antisocial behavior or instrumental (versus expressive) aggression. Almost 17% of the veterans in this sample (n=19) demonstrated ASPD symptoms only, an equal number exhibited comorbid ASPD and PTSD, and one displayed comorbid ASPD and Substance Abuse.

Finally, each judge rated the strength of the association between the violent act reported in each case and the combat experiences of the accused veteran. We used a seven-point scale in which “1” indicated no relationship and “7” indicated the strongest possible linkage (i.e. the crime would not have been committed “but for” the combat exposure). The mean rating for the entire sample was 5.2 (standard deviation = 1.9). Over 50% of the sample was rated “6” or higher and less than 5% received ratings of “0.” This approach requires further validation but a similar procedure may prove useful in assessing public attitudes toward hypothetical criminal cases in which combat-related PTSD is presented as a mitigating factor.

The prevalence of PTSD symptoms in this sample of combat veterans charged with homicide (70.2%) is much greater than has been found in other samples of returning veterans. This finding appears to be consistent with prior research that suggests that PTSD mediates the frequency and severity of violent behavior among combat veterans. However, it is also extremely important to note that a substantial minority of veterans in this sample (n=20; 16.5%) exhibited no symptoms of PTSD and appeared rather to demonstrate behaviors associated with habitual criminality. Criminal cases involving recent veterans, like those of Vietnam veterans before them, are likely to be marked by either legitimate claims of diminished culpability or cynical attempts to malinger the effects of trauma.

Social support is a strong protective factor against PTSD. To date, the over 1.4 million American soldiers that have been deployed to Iraq or Afghanistan have received generally positive reactions to their homecoming.

Unfortunately, this public support is not guaranteed and might be negatively affected by misinterpretation of news reports regarding violent combat veterans. Should public support for veterans deteriorate for any reason, an already immense public health problem could become even less manageable. It would be terrible for the public to conclude erroneously that returning veterans are inherently dangerous. This is why the Veterans of Foreign Wars and other veterans’ advocacy groups have taken pains to point out that the murders in the Times’ dataset yield an estimated 8.6/100,000 homicide rate in the veteran population, which they contrast to the 29.3/100,000 rate among American men aged 18 to 24.

References

Beckham, J.C., Feldman, M.E., Kirby, A.C., Hertzberg, M.A., & Moore, S.D. (1997). Interpersonal violence and its correlates in Vietnam veterans with chronic Posttraumatic Stress Disorder. Journal of Clinical Psychology , 53(8), 859-869.

Chemtob, C.M., Novaco, R.W., Hamada, R.S., Gross, D.M., & Smith, G. (1997). Cognitive-behavioral treatment for severe anger in post-traumatic stress disorder. Journal of Consulting and Clinical Psychology, 62, 827-832.

Kulka, R. A., Schlenger, W. E., Fairbank, J. A., Hough, R. L., Jordan, B. K., Marmar, C. R., et al. (1990). Trauma and the Vietnam War generation: Report of findings from the National Vietnam Veterans Readjustment Study. New York: Brunner/Mazel.

Sontag, D., & Alvarez, L. (2008). Across America, deadly echoes of foreign battles. Retrieved January 15, 2008, from http://www.nytimes.com/2008/01/13/us/13vets.html

Wilson, J.P., & Zigelbaum, S.D. (1983). The Vietnam veteran on trial: The relation of Post-Traumatic Stresss Disorder to criminal behavior. Behavioral Sciences and the Law, 1(3), 69-83.

Editor's note: Thanks to psychology graduate student, Melanie Goodman, for pointing out this article!

Mind Body Medicine: Healing the Wounds of War

When I started this blog over two years ago now, I was hoping that somehow James S. Gordon, M.D., and the Center for Mind-Body Medicine which he founded in Washington, DC, would somehow get involved in the prospect of bringing mind-body medicine to the troops.  Gordon is a Harvard-trained psychiatrist, with impeccable credentials, who has a lifetime interest in expanding patient care into new areas, particularly Complementary and Alternative Medicine (CAM), and mind-body medicine in particular.  (Mind-body medicine is a shorthand way of re-combining the two "halves" of medicine perhaps unjustly sundered in an arbitrary Cartesian mind-body split.  Much of Eastern thought, rather than Western, never saw them divided at all.)  In a previous lifetime, where I interviewed luminaries in the natural medicine field, Gordon was a favorite interviewee - smart, genial and with a very forward-thinking grasp of what mind-body medicine could accomplish.  Gordon, who was featured in the Bill Moyers series on PBS, Healing and the Mind, was a frequent lecturer at the Smithsonian Institution in Washington, DC, and for years had served as the head of the White House Commission on Complementary and Alternative Medicine.  He is also a Clinical Professor in the Departments of Psychiatry and Family Medicine at Georgetown University Medical School.

But more to our purposes, when war broke out in Kosovo, he and the Center for Mind-Body Medicine (CMBM) took their methods into the region, creating a program called "Healing the Wounds of War," to help war-torn schoolchildren and their caregivers manage the trauma they had undergone, through a sustained, devastating conflict.  What I was hoping -- and I kept checking the CMBM website periodically to find out -- was that they would leapfrog off their successes with PTSD in Bosnia and Kosovo, and Israel and the Middle East, and develop something geared to PTSD in servicemembers, and the conflicts in Afghanistan and Iraq.  For years, nothing was obvious (yet), but here's some of their success with children in Kosovo.  Notice what symptoms the program helped with, how impressive the statistics are, and make the conceptual leap to how this might help with combat veterans and/or their families:

The clinical efficacy of the CMBM program with traumatized children has been repeatedly demonstrated. In a pilot study in which high school teachers in the Suhareka region of Kosovo used the CMBM model, levels of posttraumatic stress disorder in high school students were reduced from an average of 88% to 38% in only six weeks (read the research, published in Journal of Traumatic Stress, April 2004, linked here). Participants have also reported the following documented effects of CMBM trainings, including: the alleviation of their own stress and trauma; decreases in anxiety and depression; increased optimism; decreased anger; and increased capacity to help others.

You can read more about the program's specific successes, here.  Or, you can read a general overview of the program and what's involved, here.  You can also read Dr. Gordon's bio, here.

The Dose-Response Relationship with PTSD: More Combat = More PTSD, Earlier Study Shows

"If you aim for simplicity, you must first master complexity" -- said the 17th century Chinese painter, Wang Kai. Almost 400 posts in on this blog, I still enjoy the moments when something profoundly complex like combat trauma is nevertheless reduced to something quite simple to understand.  Here's one such observation: the more combat one is exposed to, the greater the chances of experiencing PTSD.  Makes sense, doesn't it?  Although we've talked about that concept recently on this blog -- with a great graphic that shows the linear relationship quite profoundly, that entry linked here -- here's another, earlier study that says the same thing, in an article linked here.

Researchers who went back and analyzed two conflicting, large-scale studies of PTSD -- one done by the Centers for Disease Control (CDC), the other the National Vietnam Veterans' Readjustment Study -- found, among other things, that although "most veterans who experienced very highly traumatic events did not develop PTSD," still, the more war trauma a veteran experienced, the higher a veteran's odds of developing PTSD.  Researchers called this the "dose-response relationship," and said their work, going back over the two major studies and attempting to reconcile their findings, found that it was "even stronger than previously reported."

SOURCES: Dohrenwend, B.P. Science, Aug. 18, 2006; Vol. 313: pp. 979-982. McNally, R.J. Science, Aug. 18, 2006; Vol. 313: pp. 923-924.

Army Broadens View of Possible PTSD Therapies, Includes Complementary and Alternative Medicine

A Military.com article published on May 29th reports on the U.S. Army's increasing openness to non-traditional therapies to treat PTSD.  The article by Bryant Jordan is called, "East Meets West in Army Mental Therapy," and it quotes Col. Elspeth Ritchie on the Army's increasing openness to options beyond traditional counseling and medication, to include items like yoga, acupuncture, meditation, and of course, virtual reality. The headline is positive, but in truth, the Army may be taking only baby steps towards including nontraditional therapies, often known as Complementary and Alternative Medicine (CAM).

(Some "definition of terms" is in order.  "Alternative medicine" means treatment choices other than conventional medicine, to be used instead of conventional medicine; "complementary medicine" means treatment choices to be used in addition to conventional medicine -- so the term "CAM," or "Complementary AND Alternative Medicine" is meant to be inclusive of both approaches.  This ends up being an important distinction, because responsible M.D.s are often more in favor of patients adding complementary therapies in to their treatment protocol, rather than replacing a conventional treatment protocol with fully alternative therapies. "Complementary" is misspelled in the Military.com article as "complimentary," which further confuses the terminology.) 

The article states that "Therapies that are "kind of tried and true" remain at the forefront of treating Soldiers with behavioral problems, [Col.] Ritchie said. These include behavioral therapy and exposure therapy -- where patients are "exposed" by degrees to scenarios that may be at the core of the problem -- and medication."  And it further quotes Col. Ritchie as saying that although CAM therapies "are interesting, we don't have the hard data to show which therapies are useful for what population. So we're really in the research phase of this for yoga, acupuncture and some other therapies."

The Military.com article is linked here.  A previous article by Noah Shactman in Wired magazine on March 25 discussed similar material, and mentions a Department of Defense grant opportunity with a closing date of May 15, providing $4 million in funds to study therapies with possible benefits for PTSD and/or TBI, including but not limited to "music, animal-facilitated therapy, art, dance/movement, massage therapy, EMDR program evaluation, virtual reality, acupuncture, spiritual ministry, transcendental meditation, yoga and other novel approaches."  (The grant opportunity announcement is linked here.)  According to the Wired article, reading from the grant application, the Army is willing to contemplate as well the potential effectiveness of "biologically-based treatments, botanicals, and nutritional supplements for enhancing cognitive function and mood in patients with trauma spectrum disorders, including TBI and/or PTSD, depression, anxiety, and/or substance dependence/abuse," and adds, "Even proposals for wild-sounding "therapies using bioenergies such as Qi gong, Reiki, distant healing and acupuncture" would be accepted."  The Wired article is linked here.

I'm unclear whether the Army is leading the way of all the military branches in considering the potential of CAM for PTSD; but whether it is or isn't, kudos to it for being reasonably open-minded.  One of the problems that seems to keep coming up with PTSD is that no one obvious choice comes up in treating it, that works every time.  There are a variety of pharmaceutical drugs that are prescribed, but no one remedy in particular appears to be the wonder drug, or cure-all.  (You hear the frustration about this when you listen to the stories of combat veterans who are taking a handful of pills to combat PTSD, sometimes as many as 20 or 30 separate medications - a scary cocktail, indeed.)  Other approaches for PTSD, such as talk therapy, cognitive therapy, EMDR, etc., all have their place in the pantheon of treatments, and each has their adherents/proponents, but again, there doesn't seem to be a one-size-fits-all, cure-all for PTSD.  In the absence of the medicinal "silver bullet" that cures all PTSD, it's great that the Army is at least embracing the concept of possible adjunct therapies, while asking them to prove themselves clinically, as much as possible.

In the following weeks, we will report on complementary and alternative therapies that appear to have some benefit in treating PTSD; in addition to the more mainstream approaches that are already in use.  (Virtual reality is another type of treatment entirely: dependent on technology, it doesn't fit the typical rubric of CAM, nor should it.)

More Combat = More Trauma, and More Chance of Developing PTSD, Study Shows

For anyone who's every wondered about whether troops' increased exposure to combat trauma results in greater chances of their developing PTSD, the answer is a definite "yes," according to a study released in the February issue of the Psychiatric Times, linked here.  The article from which excellent graphic (left) is taken is entitled, "Posttraumatic Stress Disorder in Veterans," and it makes the point that cumulative exposure to combat trauma predicts PTSD in a linear fashion.  Less exposure (fewer firefights) -- lower rates of PTSD; higher exposure (greater number of firefights) -- higher rates of PTSD.  According to the article, it really is that simple.

The article's authors cite an earlier published report of OIF (Iraq) and OEF (Afghanistan) servicemembers, and found high rates of exposure to both "traumatic situations and combat."  "According to the study, about 33% of soldiers in Afghanistan and 71% to 86% of soldiers in Iraq experienced a firefight. PTSD rates ranged from 6.2% for veterans of Afghanistan's OEF to more than 12% for OIF veterans. The risk of PTSD was found to increase linearly with the number of firefights (see graphic, above). Having been wounded, a condition previously found to be predictive of PTSD, was also significantly associated with PTSD. As is commonly found in patients with PTSD, rates of depression and alcohol use also increased following combat exposure."

When we think of tragic stories of what we can only assume to be PTSD-fueled incidents in the news -- the recent suicide of Marine SSgt. Travis Twiggs, the arrest of Marine LCpl. Eric Acevedo for murder, and others like them -- we should really stop to pause and wonder, how many times have these servicemembers been deployed, for how long have they been in combat, and to what have they been exposed (meaning, how many firefights)?  Twiggs, it turns out, had done four(!) tours of Iraq, and one of Afghanistan (earlier reports mentioned four total, but they were wrong); Acevedo had done three tours of Iraq by the time he was 22, including one that involved a horrific battle, where 10 members of his battalion died on a single day, and several others were wounded.  To not take the effects of their cumulative exposure -- what they saw, did, were witness to -- is just unconscionable.  We have a very love-hate relationship with the glory of serving in this country: we glorify our military heroes for their astounding feats of endurance (Brad Kasal, the Marlboro Marine, etc.), but we also equally unreasonably vilify them when they crack under the all-too-obvious strain.  It seems like what we need most of all is just the sober estimation: the more servicemembers have gone through -- and suffered -- the more we can expect them to have problems later on, with developing PTSD.  As noted Australian Vietnam War researcher Hedley Peach said in a slightly different context, what we're really looking at here is not something unusual -- it's the generic effect of combat.

The Killer Headache: Migraines, PTSD and Increased Risk of Suicide among Veterans, Teens

Remarkable scientific data first reported over a year ago -- which seems to have created nary a flicker of interest in the media, though it absolutely should have -- links veterans' experience of migraine headaches with likelihood of experiencing PTSD, depression and anxiety.  Similar research in teens -- and many combat veterans, after all, are barely out of their teens -- indicates that those who suffer migraine headaches most frequently are also at greatest risk for suicide.

In soldiers:

Soldiers returning from combat in Iraq who have migraine headaches are more than twice as likely to also have symptoms of post-traumatic stress, depression or anxiety than soldiers who do not have migraines, The study involved 3,621 United States Army soldiers who were given a health screening questionnaire within 90 days after returning from one year of combat duty in Iraq. A total of 2,167 of the soldiers, or 60 percent, completed the questionnaire. Of those, 19 percent screened positive for migraine headaches, 32 percent screened positive for depression, 22 percent screened positive for post-traumatic stress disorder, and 13 percent screened positive for anxiety.

The researchers found that 50 percent of those with migraine also had depression, compared to 27 percent of those without migraine. A total of 39 percent of those with migraine also had post-traumatic stress disorder, compared to 18 percent of those without migraine. And 22 percent of those with migraine also had anxiety, compared to 10 percent of those without migraine.

"Previous studies in non-military populations had revealed a higher prevalence of certain psychiatric conditions, such as depression and anxiety, among people with migraine," said study author Maj. Jay C. Erickson, MD, PhD, of Madigan Army Medical Center in Tacoma, WA. "We hypothesized that there would be a similar relationship between migraine and psychiatric conditions in soldiers. The precise reasons for such an association are not fully understood, but may be related to similarities in the mechanisms underlying migraines and some psychiatric disorders."

The study also found that those with migraine and depression also had more frequent headaches than those who had migraine with no depression -- an average of 3.5 headache days per month for those with depression compared to 2.5 days per month for those with no depression. The findings were similar for those with migraine and post-traumatic stress disorder.

"These findings should alert health care providers, especially those affiliated with the military or veteran health care systems, about the frequent association of migraine headaches and psychiatric conditions in soldiers returning from deployment," Erickson said. "We recommend that health care providers who evaluate combat veterans for headaches perform mental health screening in order to ensure that psychiatric disorders are identified and properly treated. All soldiers returning from deployment presently undergo mental health screening."

This research was presented at the American Academy of Neurology's 59th Annual Meeting in Boston, April 28 -- May 5, 2007. Full citation: American Academy of Neurology (2007, May 4). For Iraq Veterans, Migraines May Be Sign Of Other Problems. ScienceDaily. Retrieved May 30, 2008, from http://www.sciencedaily.com­ /releases/2007/05/070503075228.htm

For teens:

Teens who have chronic daily headache, especially those with migraine headaches, are at greater risk for suicide than teens who don't have migraines, according to a study published in the May 1, 2007, issue of Neurology®, the scientific journal of the American Academy of Neurology. Teens with migraine are also more likely to have other psychiatric disorders such as depression and panic disorder.

Reported in ScienceDaily, May 1, 2007.  Full citation: American Academy of Neurology (2007, May 1). Teens With Migraine At Greater Risk Of Suicide. ScienceDaily. Retrieved May 30, 2008, from http://www.sciencedaily.com­ /releases/2007/04/070430181213.htm

Professor Hedley G. Peach (Australia)

BSc(Hons) (Wales), MBBCh (Wales) PhD(London), FFPH(UK)
University of Melbourne

(Retired) Professor, School of Public Health, Queensland University of Technology, Kelvin Grove, Queensland, AUSTRALIA.

Professor Hedley Peach is a Visiting Consultant at the Ballarat Base Hospital, and Professional Fellow at the University of Melbourne.

Professor Hedley Peach qualified as a doctor in Wales where he became interested in the social causes of illness. This interest led him to train in community medicine at the renowned St. Thomas's Hospital in London where he worked for seven years as a lecturer/senior lecturer. In 1985 he migrated to Australia where he was Foundation Professor of Tropical Health at James Cook University for three years and, subsequently, Professor of Community Medicine at Melbourne University for fourteen years. He retired earlier this year but continues as an honorary Professorial Fellow of Melbourne University. He has been interested in the nexus between religion, spirituality and health for a number of years. In 2002, he wrote the first article on this topic to appear in the Medical Journal of Australia to stimulate debate on how the medical profession should respond to research and recommendations from the USA. He has authored book chapters and papers on spirituality and women's health, the religions of rural Australians, and other topics. He has given many radio and newspaper interviews on spirituality and health. He is the author of several books, including The Epidemiology of Common Diseases and Disablement in the Community, as well as the leading author of more than 100 articles in scientific journals. He is a member of the National Heart Foundation's expert group on psychosocial causes of heart disease.

Dr. Ecstasy Will See You Now

An article in yesterday's Sunday Times (London, UK) talks about the drug, Ecstasy, as having therapeutic potential for treating severe, unremitting PTSD.  The article, which is titled "Ecstasy is the Key to Treating PTSD," by Amy Turner, is linked here.  The drug in question is more properly known as MDMA, or 3,4-methylenedioxy-N-methylamphetamine, pictured here.

The article says that MDMA's potential therapeutically wasn't noticed until 1976, "when the American chemist Alexander Shulgin tried it on himself. He noted that its effect, “an easily controlled altered state of consciousness with emotional and sensual overtones”, could be ideal for psychotherapy, as it induced a state of openness and trust without hallucination or paranoia. It quickly became known as a wonder drug, and began to be used widely in couples therapy and for treating anxiety disorders. None of these tests was “empirical” in the scientific sense – no placebos, no follow-up testing – but anecdotally the results were almost entirely positive."

The therapeutic potential for treating PTSD is apparently to be found, according to the article, "in the trust it establishes."  One researcher familiar with the drug, quoted in the article, states:

“Many people with PTSD have a great deal of trouble trusting anybody, especially if they’ve been betrayed by someone who abused their trust, like a parent or a caregiver,” he says. “MDMA has this effect of lowering fear and defenses. It also allows more compassion for oneself and for others. People can revisit the trauma, feel the original feelings but not be retraumatized, not feel overwhelmed or have to numb out to cope with it.”

This is obviously good news for PTSD sufferers.  The study is still in its early phases, and the reality is, that if PTSD is able to be treated with one or just a few doses of MDMA, versus potentially years of psychotherapy and/or lengthy courses of pharmaceutical antidepressants, etc., this news is likely to be welcomed more warmly by patients eager to get well than by healthcare providers who previously expected to be providing maintenance doses of psychotherapy and/or pharmaceutical care for years to come.

----

The formal study analyzing MDMA's therapeutic effects on PSTD is being conduced by Michael and Annie Mithoefer, under the auspices of MAPS, the Multidisciplinary Association for Psychedelic Studies, linked here.  While this might sound like a highly "hippy dippy" research project, the reality is, the other day I called a research group at the University of Arizona's Department of Psychiatry, and listened to a recorded message about a trial of psilocybin and OCD.  (See article, linked here.)  Mainstream medicine is apparently, if only slightly, open to studying the therapeutic uses of controlled substances.  In the meantime it's important to note that the street drug, Ecstasy, which may or may not be based on MDMA, depending on the purity, is not a substitute for taking part in a clinical trial like the Mithoefers', and there is always considerable risk in attempting to self-medicate any serious health condition, especially with illicit drugs.  Read the Sunday Times article, linked here -- it's quite informative.  And keep track of this ongoing research, which looks promising for some sufferers.

Editor's Note: In a feeble attempt at true-to-life humor, this was the license plate I saw recently on a very nice, late model Acura, parked in the driveway at a state veteran's home.  Perhaps it was just a visiting DJ.

Acupuncture May Help PTSD Sufferers

Acupuncture May Help Symptoms of Posttraumatic Stress Disorder

A pilot study by researchers at the University of Arizona's Department of Psychiatry shows that acupuncture may help people with posttraumatic stress disorder. Posttraumatic stress disorder (PTSD) is an anxiety disorder that can develop after exposure to a terrifying event or ordeal in which grave physical harm occurred or was threatened. Traumatic events that may trigger PTSD include violent personal assaults, natural or human-caused disasters, accidents, or military combat.

Michael Hollifield, M.D., and colleagues conducted a clinical trial examining the effect of acupuncture on the symptoms of PTSD. The researchers analyzed depression, anxiety, and impairment in 73 people with a diagnosis of PTSD. The participants were assigned to receive either acupuncture or group cognitive-behavioral therapy over 12 weeks, or were assigned to a wait-list as part of the control group. The people in the control group were offered treatment or referral for treatment at the end of their participation.

The researchers found that acupuncture provided treatment effects similar to group cognitive-behavioral therapy; both interventions were superior to the control group. Additionally, treatment effects of both the acupuncture and the group therapy were maintained for 3 months after the end of treatment.

The limitations of the study are consistent with preliminary research. For example, this study had a small group of participants that lacked diversity, and the results do not account for outside factors that may have affected the treatments' results.

Michael Hollifield, Nityamo Sinclair-Lian, Teddy D. Warner, and Richard Hammerschlag, "Acupuncture for Posttraumatic Stress Disorder: A Randomized Controlled Pilot Trial." The Journal of Nervous and Mental Disease, June 2007.

PTSD Complicates Healthcare, Increases Utilization and Costs

PTSD ASSOCIATED WITH MORE, LONGER HOSPITALIZATIONS AND GREATER MENTAL HEALTH USE

Boston, MA—Researchers from Boston University School of Medicine (BUSM) and Boston Medical Center (BMC) have found post-traumatic stress disorder (PTSD) is associated with more hospitalizations, longer hospitalizations and greater mental healthcare utilization in urban primary care patients. These findings appear in the current issue of Medical Care.

Prior studies suggest that trauma exposure and PTSD have considerable impact on health care use and costs. Most of this research, however, has focused on male veterans and female sexual assault victims but the impact on healthcare use in other populations is uncertain.

The researchers interviewed a sample of primary care patients to examine overall prevalence of traumatic exposure and select behavioral health outcomes in addition to PTSD, including major depression, substance dependence and chronic pain. The interview included demographic questions, the Composite International Diagnostic Interview (version 2.1 PTSD module), the Chronic Pain Definitional Questionnaire, the Patient Health Questionnaire (to measure depression) and the Composite International Diagnostic Interview-Short Form (for drug and alcohol dependence).

Among the participants, the researchers found that 80 percent had one or more trauma exposures. Compared to participants with no trauma exposure, subjects exposed to trauma were significantly more likely to be males, unmarried, have substance dependence and depression. They also had more mental health visits than those with no trauma exposure.

Among the participants, 22 percent had current PTSD. Compared to participants without PTSD, those with PTSD were significantly more likely to be female, to have an annual income of less than or equal to $20,000, have substance dependence and depression. PTSD participants also had more hospitalizations and mental health visits.

According to the researchers, among urban primary care patients PTSD is associated with greater health care use: both mental health visits and hospitalizations. “Unexpectedly, trauma exposure by itself was not associated with increased healthcare utilization apart from mental health visits, a finding which was attenuated after adjusting for PTSD,” said lead author Anand Kartha, MD, an assistant professor of medicine at BUSM. “This may be due to the fact that the non-traumatized to whom we are comparing the traumatized patients, have complex social milieu leading to high utilization,” added Kartha.

“PTSD has a cost beyond the specific mental health symptoms,” said senior author Jane Liebschutz, MD, an associate professor of medicine and social and behavioral sciences at BUSM and a primary care physician at BMC. “PTSD may be on the causal pathway between trauma experiences and negative health consequences. These findings are relevant in light of the PTSD prevalence not only in our returning veterans, but in areas of urban poor,” she added.

This study was supported in part by the Robert Wood Johnson Foundation and by the National Institute on Drug Abuse.

---

Editor's Note: Anand Kartha, M.D., the study's main author, served a two year fellowship (2003-2005) at then Veterans Admininstration Hospital in Boston, Massachusetts, where his healthcare systems area of focus was "predictors of re-hospitalization/Utilization of health care resources in post-traumatic stress disorder."

Women Veterans and Military Sexual Trauma

A study reported in the Journal of General Internal Medicine in 2006 compared rates of Post-Traumatic Stress Disorder (PTSD) in female veterans who had Military Sexual Trauma (MST) with rates of PTSD in women veterans with all other types of trauma.  (The full title of the article is "DSM-IV Diagnosed Posttraumatic Stress Disorder in Women Veterans With and Without Military Sexual Trauma.")

Women subjects were recruited via health appointments and/or a mailing, and completed questionairres about their military service and their health and trauma history.  The results were shocking: Ninety-two percent (92%) reported at least one (1) trauma. Forty-one percent (41%) had experienced MST, either alone or with other trauma, and 90% had other trauma, with or without MST. Overall, 43% of subjects with trauma had PTSD. And most importantly, those women veterans who had endured military sexual trauma had higher rates of PTSD.  Sixty percent (60%) of those with MST had PTSD; 43% of subjects with other traumas (with or without MST) had PTSD. Military sexual trauma and other trauma both significantly predicted PTSD in regression analyses (P = .0001 and .02, respectively) but MST predicted it more strongly. Prior trauma did not contribute to the relationship between MST and PTSD.

The study concluded, "Findings suggest that Military Sexual Trauma (MST) is common and that it is a trauma especially associated with PTSD."  To read the article itself, click here.  (The citation for the study is: J Gen Intern Med.  2006;21(S3):S65-S69.)

---

(Quoting from the study):

Rape is a violent crime with long-lasting consequences that is often perpetrated against women. At particular risk are women working within male-dominated environments such as the Armed Services, which, despite a recent influx of women, continue to be composed mainly of men.

National surveys found 13% to 30% of women veterans experienced rape during their military service. What is only beginning to be understood is the long-term impact that military sexual trauma (MST), such as rape, has on the lives of women veterans.

Posttraumatic stress disorder (PTSD) is one of the known consequences of rape. In fact, rape is the trauma most highly correlated with the development of this disorder. Posttraumatic stress disorder associated with rape is long lasting. Further, PTSD itself can cause impaired physical and social functioning. Most of what is known about rape and PTSD comes from the literature on civilian sexual trauma. Much less is known about the relationship between PTSD and MST. Previous studies examining the link between PTSD and MST have identified symptoms suggestive of PTSD or have created models connecting MST with the development of PTSD.

There is only one (1) study, to our knowledge, that examined rates of DSM-IV PTSD diagnoses in women veterans with MST. Suris et al., using a sample of female Veterans Administration (VA) patients, compared rates of PTSD related to 2 types of civilian sexual trauma with PTSD rates related to MST. They found that MST was more frequently traumatizing than civilian assault. Thus, the literature indicates that MST is more predictive of PTSD than are other types of military trauma or civilian sexual trauma.

Words of Wisdom for Veterans from Down Under

The Vietnam Veterans Association of Australia -- whose excellent motto, "Honour Those Who Died, But Fight Like Hell for the Living," we strongly agree with -- is a good source of information on the Australian government studies on the health of Vietnam veterans and their families.  These are important studies for any number of reasons, but for our purposes, because they make the point that combat trauma affects not just the veteran but also his or her family, and transfers effects into the next generation.  Their extensive information about the original Australian study, first published in 1998, is linked here.  They comment: "The responses themselves tend to support the hypothesis that the health status of the veteran has an effect on the health status of his immediate family."

Here are some specifics: "36% of veterans report that service in Vietnam, or health problems arising as a consequence of their service in Vietnam, have had a serious adverse effect on current or past partners.  Some 40% report physical or psychological health problems in their partners that they feel may be related to the veterans' Vietnam service.  Stress (40%), anxiety (34%), and depression in partners are the most commonly cited conditions.  Thirty nine percent (39%) of all veterans with partners report that treatment has been required for these conditions.  Those with greater length of service in Vietnam report higher levels of problems."

Though they noted that "the report notes difficulties that may have affected the accuracy of reporting and the accuracy of the comparison data" regarding the children of veterans, they found that settling those difficulties and verifying the results was an urgent matter, because the study concluded that, besides physical consequences to veterans' children (e.g., birth defects, etc.), that "deaths from suicide of children were reported at three times the expected rate, and deaths from accident or other causes were reported at twice the expected rate."

---

The Australian Broadcasting Corporation did a news segment on "The 7:30 Report" on June 1, 2006, about these studies, called "Veterans Fear War's Impact on New Generations."  The main reporter was Natasha Johnson, and a key interviewee was Melbourne University professor Hedley Peach, an Australian public health researcher, and adviser to their government's Department of Veterans Affairs, who had spent two years evaluating the study.  Professor Peach remarked, "there's absolutely no doubt that the effects of war [are] not going to be confined just to the person who went to war."  The Australian study showed "significant mental illness among veterans also showed their children had a high rate of accidental death and a suicide rate three times that of their peers in the general community."  The problem with studies, Peach pointed out, is if they serve to simply describe the problem accurately.  It's the government who should "develop strategies in the meantime to promote resilience and break the cycle of mental illness."  The interesting transcript of that short program is linked here.  One result of the studies is that the Australian government has made counseling services available to all veterans and their families. The U.S. House Veteran Affairs subcommittee on health is contemplating expanding veterans' mental health care to families as well.  Read more about the Australian counseling decision in the PDF linked here.

Alcohol No Cure for Painful Memories, Study Finds

Many people, including combat veterans, say they turn to drink to "drown their sorrows," or attempt to "wash all their troubles away," however momentarily.  The idea of turning to alcohol consumption, even alcohol abuse, to deal with stress and trauma is a common one in today's society, not just among injured combat veterans and other trauma survivors.  People typically believe that alcohol numbs painful experiences, and veterans often turn to alcohol to deal with sleep disturbances and insomnia. 

Now there's scientific evidence that says alcohol may actually be having the opposite effect.  A recent study in the medical journal, Neuropsychopharmacology, says that, in layman's terms, drinking actually increases sorrow, not minimizes it.  The study, which was done with rats, indicates that the ethanol in alcohol is apparently able to block painful memories from being acquired,; but for painful memories we've already acquired, it has the opposite effect - it locks them into our minds, or reactivates them.  Yikes.  Yet another reason to not look for a best friend, or a therapist, at the bottom of a glass.

---

Additionally, as the U.S. Department of Health and Human Services - Substance Abuse and Mental Health Services Administration points out, alcohol addiction prevents larger healing from taking place.  They state, "Many victims turn to alcohol or other substances in an attempt to get some relief from their emotional turmoil and suffering. All trauma survivors manage their experiences in different ways. However, substance abuse is not only ineffective in healing from trauma, but it also can present a host of additional problems that make the healing process even more difficult."

Upcoming PTSD Conference on Care of Rural Veterans and Their Families

Geisinger Health Systems of Danville, PA, is planning a national conference for May 13, 2008 on "Combat Stress Injuries (PTSD): Care of Rural Veterans and Their Families" Click here for more information about that conference.  The conference is designed for health and allied health providers, social workers, mental health counselors, veteran advocates, educators, researchers and policy makers. There are no prerequisites.  The registration fee is extraordinarily in-expensive ($85), and the list of speakers and their bios follows: 

Faculty
Guest Faculty

Charles Figley BS, MS, Ph.D.

Dr. Figley directs the award-winning Florida State University FSU Traumatology Institute and Psychosocial Stress Research and Development Program. The Institute was recognized in 2000 as the best program of its kind by the University Continuing Education Association. He is a Fulbright Fellow and Professor, College of Social Work at FSU. He is also a psychologist and family therapist. Professor Figley received both graduate degrees from the Pennsylvania State University and his undergraduate degree from the University of Hawaii, all in the interdisciplinary field of human development. He has been editor of a number of journals (e.g., the Founding editor of the Journal of Traumatic Stress) and book series (e.g., the Innovations in Psychology Book Series with Taylor & Francis. His current editorships include Editor (founder), Traumatology, the International Journal, 1995-present and Editor (founder), Routledge ( formerly Brunner/Mazel ) Psychosocial Stress Book Series, 1983-present. He has written more than 200 scholarly works including 19 books mostly on stress.  (Editor's Note: Figley is the editor of Mapping Trauma and Its Wake: Autobiographic Essays by Pioneer Trauma Scholars.)

Michael Hwang MD

Associate Chief of Staff, Mental Health VA Medical Center Wilkes Barre, PA and Associate Professor of Psychiatry Robert Wood Johnson Medical School University of Medicine and Dentistry of New Jersey

Evelyn Llewellyn Psy.D.

Co-Founder Executive Director Director of Family and Youth Programs Life Matters New York, NY

Michael Lonski Ph.D.

Chief of Mental Health Clinical Services 244th Medical Services New York State Division of Military and Naval Affairs Captain, New York State Guard New York, NY

Keith Martin

WBRE Veteran TV Anchor Retired National Guard Brigadier General Former Pennsylvania Director of Homeland Security Wilkes Barre, PA

William Nash MD

William P. Nash, M.D., is an active duty Captain in the U.S. Navy Medical Corps, with nearly thirty years of active military service. He is a graduate of the University of Illinois, College of Medicine, in Chicago, and of psychiatry residency training at Naval Medical Center, San Diego. In addition to leading two Navy SPRINT crisis response teams, he has directed two Navy psychiatry residency training programs, and has served as the Director of Clinical Services of the hospital ship USNS MERCY. CAPT Nash has been stationed with the Marine Corps since 2000, including deploying to Iraq in 2004 with the 1st Marine Division as a psychiatrist embedded with ground combat forces. He was awarded a bronze star medal for his service in Iraq in support of combat operations there. Since October, 2005, CAPT Nash has been stationed at Headquarters, Marine Corps, in Quantico, Virginia, where he directs and coordinates combat/operational stress control policies and programs for the United States Marine Corps. He is an Assistant Clinical Professor of Psychiatry at the University of California, San Diego, and has co-edited a book on combat stress injuries released in late 2006.

Edward Rendell BA, JD

He is an Army Veteran and Pennsylvanias 45th Governor who began a second term of office on January 16, 2007, following a landslide re-election victory. As Governor, he serves as chief executive of the nations 6th-most-populous state and oversees a $27.5 billion budget. He is building on his efforts to make government more responsible to the public, and more responsive to the publics needs. He has cut wasteful spending and improved efficiency to save more than $1 billion and is pursuing a legislative agenda that includes commonsense political reforms to put progress ahead of partisanship.

Steven Silver Ph.D.

PA Army National Guard Former Director, PTSD Treatment Program VA Medical Center, Coatesville, PA

Jessica Wright BA, MA

Major General Jessica L. Wright is the Adjutant General of Pennsylvania. In this State cabinet-level position, General Wright, headquartered at Fort Indiantown Gap, is responsible for command, control, and supervision of all Air and Army National Guard units allocated to the State of Pennsylvania. She is also responsible for six (6) state-owned veterans' homes, Scotland School for Veterans' Children, and programs for Pennsylvanias 1.3 million veterans. --- The objectives of the conference are that -- at the completion of this course, the participant should be able to: define the necessary components of a comprehensive assessment of combat stress injuries and the importance of each in a multimodal approach to patient care; discuss degrees of success attained by treatment in terms of effect on function and quality of life; cite key evidence, including peer-reviewed medical literature that can help the practitioner get the veteran the right care at the right; identify and manage association events related to combat stress injuries. To register for the conference, please click this link.

PTSD Elevates Risk of Other, Chronic Health Problems

Geisinger research finds that veterans suffering from posttraumatic stress disorder (PTSD) are as likely to have long-term health problems as people with chronic disease risk factors such as an elevated white blood cell counts and biological signs and symptoms.

However, few healthcare providers screen for PTSD in the same way as they screen for other chronic disease risk factors. “Exposure to trauma has not only psychological effects, but can take a serious toll on a person’s health status and biological functions as well,” Geisinger Senior Investigator Joseph Boscarino, PhD, MPH says. “PTSD is a risk factor for disease that doctors should put on their radar screens.”  (Click here to listen to a podcast of Dr. Boscarino discussing the study.)

For this study, Dr. Boscarino examined the health status of 4,462 male Vietnam-era veterans 30 years after their military service. Results are being published in the current edition of the Journal of Nervous and Mental Disease. The study finds that having PTSD was just as good an indicator of a person’s long-term health status as having an elevated white blood cell count. An elevated white blood cell count can indicate a major infection or a serious blood disorder such as leukemia.

The study also found that veterans with high erythrocyte sedimentation rate (ESR), which indicates inflammation, were also at risk. There was a similar finding for a possible indicator of serious neuroendocrine problems. While these disease markers are measured with a blood test, PTSD is commonly measured with a psychological test or a mental health examination.

This research comes as Geisinger is organizing a national conference on May 13 to address PTSD in combat veterans from rural parts of the country. Boscarino says that almost anyone who experiences a traumatic event can experience PTSD, meaning accident and disaster victims are also predisposed to the biological risk factors associated with PTSD. (Click here for the link to that conference.)

Although therapy doesn't necessarily have to be extensive, Boscarino says it should occur shortly after a person has experienced a traumatic event. Early treatment may be critical to avoiding depression, PTSD and substance abuse-related problems following trauma. “As the conflicts in the Middle East continue, we’re seeing a new wave of our service members who have posttraumatic stress,” says Boscarino, a Vietnam veteran. “If we don’t get these personnel help earlier, our research shows that they may experience more serious health problems down the road.”

Dr. Boscarino is one of the country’s leading authorities on PTSD and has published extensively on the topic. His prior research has established links between PTSD and the increased likelihood of death by unnatural causes and between PTSD and individual soldiers’ dexterity levels.

Founded in 1915, Geisinger Health System (Danville, PA) is one of the nation’s largest integrated health services organizations. Serving more than two million residents throughout central and northeastern Pennsylvania, the physician-led organization is at the forefront of the country's rapidly emerging electronic health records movement. Geisinger is comprised of three medical center campuses, a 700-member group practice, a not-for-profit health insurance company and the Center for Health Research—dedicated to creating innovative new models for patient care, satisfaction and clinical outcomes.

---

Editor's Note: the figured featured in the statue is Asclepius, the ancient demi-god of medicine and healing.

Study Suggests Some Brain Injuries Reduce the Likelihood of Post-Traumatic Stress Disorder

A new study of combat-exposed Vietnam War veterans shows that those with injuries to certain parts of the brain were less likely to develop post-traumatic stress disorder (PTSD). The findings, from the National Institutes of Health (NIH) and the National Naval Medical Center, suggest that drugs or pacemaker-like devices aimed at dampening activity in these brain regions might be effective treatments for PTSD.

PTSD involves the persistent reliving of a traumatic experience through nightmares and flashbacks that may seem real. Twenty percent to 30 percent of Vietnam vets (more than 1 million) have been diagnosed with PTSD, and a similar rate has been reported among Hurricane Katrina survivors in New Orleans. Public health officials are currently tracking the disorder among soldiers returning from Iraq. Yet, while war and natural disasters tend to call the greatest attention to PTSD, it's estimated that millions of Americans suffer from it as a result of assault, rape, child abuse, car accidents, and other traumatic events.

Previous studies have shown that PTSD is associated with changes in brain activity, but those studies couldn't determine whether the changes were contributing to the disorder or merely occurring because of it.

Jordan Grafman, Ph.D., a senior investigator at the National Institute of Neurological Disorders and Stroke (NINDS), part of NIH, turned to the Vietnam Head Injury Study (VHIS) to make that distinction. The VHIS is a registry of Vietnam veterans who sustained penetrating brain injuries (which are less common in Iraq compared to concussion brain injuries). It has received support from the Department of Defense, the Department of Veterans of Affairs and NIH, and is currently supported by NINDS.

"If we could show that lesions in a specific brain region eliminated PTSD, we knew we could say that the region is critical to developing the disorder," says Dr. Grafman. The results of his study appear online today in Nature Neuroscience.

Dr. Grafman and members of his lab, including neuropsychiatrist Vanessa Raymont and postdoctoral fellow Michael Koenigs, studied 193 veterans registered with VHIS and 52 veterans with combat exposure but no head injury. The participants were classified as either having developed PTSD at some point in their lifetime or having never developed PTSD. CT (computerized tomography) scans were used to map their brain injuries.

By comparing the distribution of brain injuries between the PTSD group and the non-PTSD group, the researchers found two regions where damage was rarely associated with PTSD: the amygdala, a structure important in fear and anxiety, and the ventromedial prefrontal cortex (vmPFC), an area involved in higher mental functions and planning.

In another level of analysis, the researchers compared the prevalence of PTSD in subjects who had damage to either the amygdala or vmPFC, subjects who had damage to other parts of the brain and non-head-injured subjects. PTSD occurred in a similar fraction of subjects in the last two groups — 40 percent and 48 percent, respectively. In contrast, PTSD occurred in only 18 percent of subjects with damage to the vmPFC and zero (out of 50) subjects with damage to the amygdala. The occurrence of other anxiety disorders was not affected by damage to the amygdala or vmPFC.

"It appears that if you have damage to either of those areas, you're not likely to develop PTSD," says Dr. Grafman. The scientists hypothesize that drugs designed to inhibit the activity of the two structures might provide relief from PTSD. Deep brain stimulation, a technique used to treat Parkinson's disease by modifying the brain's electrical activity, might also prove useful against PTSD if targeted to the amygdala or vmPFC.

Current treatments for PTSD include medications for anxiety and depression, and therapy to help the person confront and deal with traumatic memories. But these treatments vary in effectiveness, a point underscored by the fact that many of the Vietnam veterans in Dr. Grafman's study are still dealing with PTSD some 40 years after the war.

Since the study examined only young men who served in Vietnam, one question is whether the results will extend to women, children, or people exposed to traumatic situations besides wartime combat. Dr. Grafman says similar results probably will be found in those other populations, given that previous studies had connected PTSD to changes in the amygdala and vmPFC, and only some of those studies involved war veterans.

NINDS (www.ninds.nih.gov) is a component of the National Institutes of Health (NIH), and is the nation's primary supporter of biomedical research on the brain and nervous system.

The National Institutes of Health (NIH) — The Nation's Medical Research Agency — includes 27 Institutes and Centers and is a component of the U.S. Department of Health and Human Services. It is the primary federal agency for conducting and supporting basic, clinical and translational medical research, and it investigates the causes, treatments, and cures for both common and rare diseases. For more information about NIH and its programs, visit www.nih.gov.

---

Reference:
Koenigs M, Huey ED, Raymont V, Cheon B, Solomon J, Wasserman EM and Grafman J. "Focal Brain Damage Protects Against Post-Traumatic Stress Disorder in Combat Veterans." Nature Neuroscience, published on-line December 23, 2007.

Upcoming Medical Conference on PTSD for Military Healthcare Providers

The fourth annual "Amygdala, Stress and PTSD Conference" will be held Tuesday, April 29, 2008, from 8:00 a.m. to 6:00 p.m., in the Sanford Auditorium at the Uniformed Services University, in Bethesda, Maryland.  The conference, which is co-sponsored by the Center for the Study of Traumatic Stress, and the Graduate Program in Neuroscience at the Uniformed Services University, is part of a series of conferences that "have brought together scientists and clinicians working towards solving the biologcal basis of post traumatic stress disorder. The conferences have focused on the neurobiology of the amygdala and stress and ptsd and have included speakers at the forefront of their fields," according to conference material.  To learn more about who's speaking at the conference, and their topics, click here.  To register for the conference, click here.

Editor's Note: the amygdala is a portion of the brain defined this way: "The amygdala is located in the middle of the brain, this almond shaped complex of related nuclei is a critical processor area for the senses. Connected to the hippocampus, it plays a role in emotionally laden memories. It contains a huge number of opiate receptor sites implicated in rage, fear and sexual feelings. It is part of the limbic system." (Source: "The Glossary of Brain Terminology.")

This year's conference topics and speakers will include:

• "Mechanism of Lasting Change in Anxiety Produced by Severe Stress in Animals" -- Robert Adamec - Memorial University - Canada;
• "Role of NMDA Receptors in Fear Extinction: Implications for PTSD Therapy" -- Michael Davis - Emory University, GA;
• "Neurotrophic Actions of Stress and Antidepressant Treatment" -- Ron Duman, Yale University;
• 'Amygdala, Stress and the Pathophysiology of Psychiatric Disorders -- Anthony Grace -- University of Pittsburgh, PA
• "Different Effects of Early Exposure and Cognitive Therapies on Fear and Avoidance" -- Arieh Shalev - Hadassah University - Israel
• "The Ontogeny of Fear and the Amygdala" -- Regina Sullivan - University of Oklahoma, OK

Further information may be obtained by contacting the Conference directly:

The Amygdala Conference
4301 Jones Bridge Rd
Bethesda, MD 20814
Info@AmygdalaConference.org

Where to Find Recent Medical Studies on PTSD and Combat Trauma

Well, the Inner Librarian got a little, er hem, carried away in that last blog post on how to search online databases effectively for articles on PTSD and combat trauma -- and where those articles are to be found -- but, we didn't really get around to telling you WHAT you could find in those searches.  Of course, it's better to do them yourself, but here's just a taste of what you can find by doing a search at the ...

In PubMed, if you do a search for "PTSD combat trauma" -- to pull in articles that talk about both -- important because not all PTSD is combat-related, as of today's date you can find articles such as the sample dozen that follow, all very recent -- in other words, published in the current year.  Many also have "related links" in a sidebar to additionally interesting studies, which are also worth investigating.  Here's a "random sample," no pun intended, of current research, published in medical journals in the U.S. and abroad.  As you can see, the studies cover aspects of health, disease, family relationships, which drugs do or dont show promise, social skills for adapting to PTSD, whether group therapy is effective or not, etc.  Recent articles include:

• Posttraumatic stress disorder, anger, and partner abuse among Vietnam combat veterans.
• Cardiovascular manifestations of posttraumatic stress disorder.
• Vicarious resilience: a new concept in work with those who survive trauma.
• Healing trauma: finding treatments that work. 
• The psychological consequences of combat exposure: the importance of appraisals and post-traumatic stress disorder symptomatology in the occurrence of delusional-like ideas.
• Randomized, double-blind comparison of sertraline and placebo for posttraumatic stress disorder in a Department of Veterans Affairs setting.
• Contemporary group treatment of combat-related posttraumatic stress disorder.
• Assessing late-onset stress symptomatology among aging male combat veterans.
• Psychotic symptoms in combat-related post-traumatic stress disorder.
• Quality of parental relationships among persons with a lifetime history of posttraumatic stress disorder.
• The use of prazosin for the treatment of trauma nightmares and sleep disturbance in combat veterans with post-traumatic stress disorder.
• Interpersonal trauma, war zone exposure, and posttraumatic stress disorder among veterans with schizophrenia.

(Editor's note: we're not dispensing medical advice here.  Use common sense.  Educate yourself and your caregivers if need be about PTSD and combat trauma.  Know where to look to learn more: to share information with your healthcare providers, social workers, family members, combat buddies, co-workers, etc.)

Medical Research Available Free Online

If you're interested in delving deeper into what recent medical research has indicated, however provisionally, about PTSD and combat trauma, you might do well to visit this one catcha-all site on the Web, PubMed.  PubMed is more tax dollars at work: it's a service of the U.S. National Library of Medicine ("NLM"), and the National Institutes of Health ("NIH"), both part of the U.S. Department of Health and Human Services.  (PubMed includes over 17 million citations from MEDLINE and other life science journals for biomedical articles back to the 1950s, often with links to full text articles and other related resources.)

As of just today, searching just got easier -- with the introduction of new technology, that allows for better, more optimized searching of MedLine Plus, an enormous database of medical and health-related articles, MedlinePlus en Espanol, and the entire NLM Library system, referred to above.  (Click here to find out more about the new search engine.)  In other words, good news for searchers, librarians, and even common folk with access to the Web. 

Try doing a search on any of those sites for "PTSD" and/or "combat trauma."  Learn a few simple search techniques for better results, too -- most people seem relatively clueless on how to search (and results are only as good and relevant as the way you looked for them.)  Here's a "How To" article from WikiHow about "How to Get the Most Accurate Results on Search Engines."  It's basic but good.  Click here for that link.  Here's another one to read after you're done with that.  Slightly more in-depth.  Between the two, you'll have a better handle on searching.  That article is entitled, ""How to Search for Expressions and Phrases in Search Engines."  Click here for that link.

(And if you want even simpler suggestions on search -- really basic and foundational -- try these: "How to Search the Internet" and "How to Search Google.")  Don't laugh.  Many don't know, and the rest of us can always learn more.  A good search = good results.  Go forth and search!

Clinical Trials Underway on PTSD

Here's a list from the National Institutes of Mental Health ("NIMH"), government recipient of our tax dollars at work, of the clinical trials presently underway that are studying aspects of PTSD.  Not many of the studies having much to do with combat trauma (yet), it would seem.  In any case, here's a link to them: there are fourteen (14) clinical trials, total, including one with the somewhat rosy title of, "Using Affectionate Communication as a Response to Acute Stress."  Mmmmn, sign me up! :-) We can never have enough of that...  One or two do relate specifically to PTSD and combat trauma, including

• Effectiveness of Virtual Reality Exposure Therapy and D-Cycloserine to Treat Iraq War Veterans With Post-Traumatic Stress Disorder.
  Interventional study. This study will determine whether a combination of virtual reality exposure therapy and D-cycloserine will reduce post-traumatic stress disorder symptoms in Iraq war veterans. Ages 21-65. Location in Atlanta, GA.

Here's a link to a page of worthwhile information about PTSD on the NIMH's website, with links to other information worth reviewing, or keeping on hand to share with others.  One is, "Post-Traumatic Stress Disorder: A Real Illness" -- click here for that; and "Post Traumatic Stress Disorder Research Fact Sheet" -- click here for that.  (Lack of continuity in hyphenating style thanks to the NIMH, not this blogger.)

And, finally, If you're in the Bethesda, MD area, and you'd like to participate in an NIMH study (not necessarily the one above), click this link to learn more about how to participate.  Not all studies looking for participants take place in the D.C. area, though -- many are in other large metropolitan areas such as Atlanta and Boston -- so check the main site above for clinical trial topics and locations.

Gimme Five: Can EMDR Work in as Few as Five (5) Sessions?!

Here's an interesting concept or challenge: what if something like EMDR ("Eye Movement De-Sensitization and Reprocessing" therapy, to the uninitiated) were able to improve symptoms of PTSD / combat trauma within as few as five (5) sessions?  What if, even further, the benefits of treatment continued, even after treatment was discontinued?  Those are two pretty heady claims -- but one researcher says they're actually both true.  And cites two internationally-published studies that support those assertions.  Click here for the link to discussion of the studies.  Hmmmn.  At the very least, what a good way to improve people's baseline level of health, while they're continuing to recover from trauma.  Worth a look...

Another Good Read...

Lori Sekela, a librarian at the U.S. Army War College Library in Carlisle Barrracks, PA, produced in 2005 a PDF entitled, "Post-Traumatic Stress Disorder and the Military: A Selected Bibliography."  You can find Ms. Sekela's excellent PDF here.  She seems to have done quite a comprehensive job at listing resources to date (meaning, through 2005).  No idea whether there are plans to bring the bibliography current, but we will keep an eye on this in case it does get updated.

Read All About It: Helping Healthcare Providers Recognize PTSD

The Department of Veteran Affairs has made available something called the Iraq War Clinicians Guide, 2nd Edition, intended to help healthcare practitioners recognize and diagnose Post-Traumatic Stress Disorder ("PTSD") in their patients.  Although the material is intended for mental health care providers, in reality, it's probably useful information for most clinicians to have handy.  A link to the guide's contents is here.

(The Iraq War Clinicians Guide was developed by members of the National Center for PTSD and the Department of Defense, and it was developed specifically for clinicians and addresses the unique needs of veterans of the Iraq war.) 

If you have the latest version of Adobe Acrobat Reader, you can download the entire guide, or you can download specific chapters of interest.  Kudos to the VA for making this information available on the Web. 

Heads Up: Traumatic Brain Injury ("TBI") and PTSD

There's a really excellent -- as in relatively comprehensive, considering -- article in today's USA Today called "Doctors Face Rash of Brain-Damaged Vets."  Unfortunately, what doctors are finding is that the two "signature wounds" of the current wars -- traumatic brain injury ("TBI") and post-traumatic stress disorder ("PTSD") can often occur together.  And even more unfortunately, the presence of both in the same person can complicate matters quite a bit.

As the article states, "Odd as it may seem, brain injury can protect against PTSD by blurring awareness of what happened.  But as memory improves, emotional problems can emerge..."

Certain symptoms that show up initially, such as headache, dizziness and balance problems -- perhaps more due to the TBI -- actually subside over time; whereas other symptoms -- including memory problems and 'irritability' -- probably more part of the PTSD complex of symptoms -- actually increase over time, according to data cited in the article, from a study conducted by Walter Reed Army Medical Center.

Current -- and future -- treatment programs are going to need to be able to effectively treat combat veterans who have undergone TBIs in such a way that they can also catch emerging PTSD, even if it comes out after the brain injury has optimistically "resolved."  Also dangerous: the fact that overall, occupational therapy needed to treat brain injury has been downgraded at many private hospitals and outsourced to nursing homes, according to an insider in the field.  With a growing number of combat veterans who've been exposed to TBIs now returning to civilian life, it's going to be important to care for them both within the VA system and also within the private hospital setting.  Affording treatment is going to be another ballooning cost of the war effort, but one that's crucial for us to get behind, in order to ensure that veterans are treated effectively.

Another issue that the article brings up is the number of times deployed military have been exposed to TBIs.  The article mentions vets experiencing at least "an explosion a month."  A few years back, doctors found that high school and college football players who experienced two or more concussions on the field in succession -- separated by days or even weeks -- were at much greater risk from serious injury, including death -- than had ever been thought.  And they started to talk about the cumulative effect of concussions, and how difficult it is for the body to heal from that.  Essentially, what combat veterans are going through now is the same thing: exposure to explosions, that causes an underlying stress on the brain, followed up sometimes by direct injury, such as TBIs.  Now we need to add into the mix PTSD as well, which can show up later, thanks to the body's own capacity to focus first on the TBI. 

Unraveling the complexities of this increasingly all-too-common scenario is going to take a lot of work, and patience, on everyone's part.  Even physicians in private practice are not used to seeing the level of TBIs that returning vets will be bringing into their practices.  The Centers for Disease Control ("CDC") even has an article on its website for doctors about recognizing and treating TBIs, but it doesn't yet reference the combat connection...Their handout, which might be worth vets and their families reading to familiarize themselves better with the subject, is called "Heads Up: Brain Injury in Your Practice - A Tool Kit for Physicians."

When Pharmaceuticals Fail - PTSD Drug Treatment Termed Ineffective or Worthless

"Common PTSD Drug No More Effective Than a Placebo" reads the title of an article published recently in Medical News Today.  It details the results of a study published in the December 1, 2006 issue of the American Journal of Psychiatry.  Not to sound like a Scientologist here, ooh no, but it's interesting to read that a common pharmaceutical approach to an illness like PTSD may have little or no value, according to psychiatristric researchers.  The question is: is anyone still being prescribed it?  And the guess is, yes, despite what this study indicates.

Says the article, in part, "Guanfacine, a medication commonly prescribed to alleviate symptoms of post-traumatic stress disorder, is no more effective than a placebo, according to a study led by researchers at the San Francisco VA Medical Center.

"There was no benefit at all, and there were several adverse side effects," says lead author Thomas Neylan, MD, medical director of the PTSD treatment program at SFVAMC."People with symptoms of PTSD should probably stay away from this drug and others of its type."  Interesting...

EMDR for Trauma: The Eyes Might Have It

The military-oriented news site, the Stars and Stripes, has an article today about how EMDR is becoming a treatment of choice at Landstuhl Regional Medical Center.  Hmmmn.  It's a little disappointing that the military is just now hearing about EMDR, which has been around since the late 1980s, and initially came into prominence as a way to treat Vietnam veterans and other trauma survivors, to lessen the impact of their violent memories.  EMDR, or Eye Movement De-sensitization and Reprocessing therapy, was developed by Francine Shapiro, Ph.D.  If you would like to read more about Francine Shapiro, Ph.D., EMDR, find out more about the history of EMDR, learn whether or not EMDR works for PTSD, or how to find a clinician trained in EMDR in your geographical area, click the hyperlinks for more information.  There are also a number of books published about EMDR, by Shapiro and others, and they're listed in the sidebar, about halfway down.  If you're a clinician and you'd like to find out more about being trained in EMDR, visit Dr. Shapiro's website for more information.

Editor's note: EMDR shows much promise for treating PTSD and symptoms of combat trauma.  It is not talk therapy, nor is it a pharmaceutical-based approach.  It is, however, not the only treatment low-tech, high-touch therapy that shows promise for treating combat trauma.  However, with almost 30,000 troops injured in Iraq and Afghanistan, plus affected family members -- because not only servicepeople suffer from trauma's effects, but also their family members can -- it's very much a significant step in the right direction.

Brain Enzyme Targets PTSD Memories

(We're catching up on some recent news here.)  An article published in the BBC online a few days ago mentioned the success of researchers at MIT in isolating a single enzyme in the brain that may hold promise for PTSD research.  The research is still a long way off from being tested with human beings, but it's of interest to anyone following PTSD in the news, particularly as it relates to healthcare.  The only concern is, the "single bullet" theory (no pun intended) in medicine often turns out to be hype.  For complex, multifactorial illnesses, of which combat trauma may turn out to be one, pinning hopes on a single brain enzyme and a strictly biochemical solution may be a bit much.  That said, if it works, bring it on!  The number of untreated PTSD sufferers continues to grow.

Want To Be in a PTSD Study?

An interesting article in the St. Louis Post-Dispatch describes the work of a Washington University (St. Louis, MO) researcher who's looking for subjects for a study she's conducting on PTSD.  Her ideal subjects would be military being deployed to Afghanistan or Iraq for their first time.  Her contact information is below, but frankly, the article is well worth reading, to get a picture of where her research is headed.  Interesting and promising research...two thumbs up :-)

Rumi Kato Price, Ph.D.
Age: 54
Education: B.A. in philosophy, Ochanomize University in Tokyo; master's and Ph.D. in sociology, University of California at Berkeley.
Residence: Clayton
Family: Daughter, 21
E-mail contact: [email protected]
Web site: http:///www.rkp.wustl.edu

A description of the study, from her department's website:

Description of project:
The Soldier's Young Legacy (SYL) Registry is a project to archive information from military personel being deployed in Operation Iraqi Freedom and Operation Enduring Freedom in Afghanistan, to help improve treatment for war veterans upon returning to the United States. Currently, we are designing a study to interview military and contractor personnel who are scheduled to be deployed to Iraq and Afghanistan to examine types of biological changes due to traumatic experience that may affect their well-being when returning to civilian life. We would like to obtain biological measures shown to be associated with acute or chronic psychological stress and of post-traumatic stress disorder (PTSD) prior to deployment and to conduct follow-up examinations after return to the United States. The contribution of providing biological and life history information to the archive is YOUR YOUNG LEGACY for aiding FUTURE veterans.

Eligibility for the study

• Men and women in the U. S. Military who will be deployed to Iraq or Afghanistan
• Men and women with no prior combat exposure.

What does participation involve before deployment?

• A magnetic resonance imaging (MRI) of the brain to obtain baseline estimates of brain structure
• Collection of blood and saliva
• Memory, learning, and personality tests
• An in-person interview.

You will be paid for your time and effort.

If you would like more information about joining their study click here.

Possible Genetic Link to PTSD?

A potentially overlooked article from August, 2005's Psychiatric Times takes a look at the link, if any, between genetics and PTSD.  The introductory paragraph provides some key facts about PTSD, and reminds us that not everyone who has been exposed to the same triggers will develop symptoms.  Says the article, "Over 50% of U.S. women and 60% of men report having experienced a traumatic event at some point in their lives. However, only a minority (approximately 10% of women and 5% of men) report having ever developed posttraumatic stress disorder, the most prominent psychiatric disorder associated with traumatic events (Kessler et al., 1995). This disparity between the prevalence of exposure to traumatic events and the development of PTSD has driven research to determine the etiology of PTSD and identify factors that increase risk for the disorder. One area of research that has received relatively little attention is genetics."

The article, which to some extent is a literature review (much like this blog!), contends that further study of the possible genetic link to PTSD might be worthwhile in isolating which drugs PTSD sufferers respond to and why.  In other words, pursuing the "better health through chemistry" approach by using pharmaceuticals to target psychological trauma.  Certainly an effective way, but not necessarily the only way, to approach the problem, one might think.  (And we're not talking Tom Cruise here, either -- just to be clear.)

Metrics of War: The Psychological Body Count

A flurry of postings today while we attempt to catch up summarizing reading we've done over the last several weeks, with no time to post the results, as it were.

An interesting article from the Iowa City, IA's Press-Citizen, that's a Q&A session with Dr. Maureen McCue, coordinator of the Iowa chapter of the progessive and esteemed "Physicians for Social Responsiblity."  McCue is talking about PTSD and the trauma of war, and she recently organized a conference entitled, "The Medical Consequences of War."

Two good quotes from the article:

"The reported rate of PTSD, post-traumatic stress disorder, is markedly higher than in recent wars because of the nature of the fighting within the population centers. The soldiers have no way of knowing where or who the enemy is. They feel surrounded by danger and are being told to suspect anyone and everyone. Thus, they have even been forced to kill women and children at close range. This is extremely disturbing and has very long-lasting effects."

Also,

In response to a question about whether psychological problems are more prevalent than physical problems for vets upon homecoming, McCue gives us the first practical metric on the topic.  She says that they are, by far.  "For every soldier killed, almost 10 times as many are wounded and 10 times that many come home with mental health problems."  As of tonight, more than 2300 troops have been killed.  If what McCue postulates is even generally true, that's some pretty frightening math we're contemplating...

How Trauma Affects the Brain

Another article you might have missed from last summer, available online now through "Health on the Net Foundation" (a reputable source, we might add, for those who wouldn't otherwise know; they're endorsed by the United Nations and the World Health Organization), talks about recent medical research into the effects of trauma on the brain.  The article is entitled, "Brain Region May Govern Resilience to Trauma," and subtitled, "Study could explain why some people react severely to emotional stress."   The article, which is mercifully short, for those whose attention span is short where science is concerned, talks about how people respond differently to fear, and process memories differently as well -- and science has been looking into why that is, and what can be done to improve physiological functioning, where trauma is concerned.  Very interesting article, and worth reading to keep up to date on where medical research is going with this all-important topic.