Healing Combat Trauma

Back from Hell: Treating PTSD with Massage and Other Bodywork Therapies

An interesting article recently published online talks about the therapeutic benefits of touch (massage therapy, in this case) for PTSD, without making it seem like either a panacea, or a complete walk in the park.  Kudos to the article's author for acknowledging the difficulties faced by this client population, and the special sensitivities needed.  Bodywork modalities like massage therapy, craniosacral therapy, possibly even Reiki and therapeutic touch, hold some promise for treating combat veterans, provided the practitioners are educated about the special challenges of that population, and provided the participants are willing.  (The attached photo is of a crayon drawing, done by one appreciative child patient, depicting his practitioner's healing hands.)

The article is well worth reading, and is excerpted in part below:

Traumatized in war, often faced with family and job relationship difficulties, and also frequently confronted with government bureaucracy, veterans deal with high levels of anger. One study stated, "Anger management intervention is an integral part of post-traumatic stress disorder treatment in the Department of Veterans Affairs facilities across the country."11 The presence of intense anger, along with other deep emotions, can cause a veteran -- triggered during therapy -- to undergo an explosive emotional release. "PTSD may cause a person to fly into a rage for no apparent reason or strike out in fear at inappropriate targets."12

"Vets tend to have a more violent type of reaction if a memory comes up," explained Chris Smith, director of education at the Colorado School of Healing Arts in Lakewood, Colorado. Smith, who is also a massage therapist and instructor for the school's 100-hour program in Trauma Touch Therapy, explained, "It takes a therapist who can stay grounded and isn't afraid of the intense emotional outbursts." Because of their war-time experiences, she said, veterans in therapy may tend to be "less resourced" in how to handle stress and "more hyperaroused" than other trauma clients.

According to some therapists who work closely with veterans, the VA and other group programs provide only limited help for veterans. After a certain amount of time has passed, these therapists say talking about the trauma in a group setting can become a useless "rehashing" of the horrors. To emerge from the sense of victimization may likely demand hard, individual work in therapy on the part of the patient. It generally requires facilitation by an extremely grounded and well-versed therapist. If the veteran chooses to try an alternative therapy, such as massage, the process will likely necessitate participation not only in bodywork sessions, but also in simultaneous sessions with a psychotherapist.

One massage therapist who has worked with veterans visited a VA hospital to learn more about PTSD and observed that many of the veterans were in extremely serious condition. "For many vets, the only answer is a great deal of isolation and seclusion and often medication that can have so many other side effects. They often cope by removing stimulation as much as possible," she said.

It seems like a good time to re-mention the fabulous Claude Anshin Thomas passage in his book, At Hell's Gate (see sidebar), about suffering not being the enemy.  Click this link to bring back that earlier blog entry.

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.

Canada's Only In-Patient Program for PTSD

An article from several years ago in the Psychiatric Times describes Canada's only in-patient program for PTSD sufferers.  The program, at a location called Homewood Health Centre, is located in Guelph, Ontario; and is modeled on a program in Philadelphia, PA., developed by psychiatrist Sandra L. Bloom, M.D., in the 1980s.

PTSD Symptoms Arising Sooner

A recent, likely overlooked article from US Medicine: The Voice of Federal Medicine, in September of 2005 is a good, in-depth look at one Iraq veteran's suicide and his family's interaction with veteran mental health services before, during and after.  The veteran was an Army captain, married to another Army captain, with a young baby and a brand new house.  The story is definitely one of not enough services available to be delivered in a timely manner, a horrible cost paid in human life, and some improvement after the fact, because of the brave, grieving wife's willingness to go forward and push for change.

The story makes the point that part of the reason the system is having a hard time responding to the current wave of returning veterans with PTSD is that their symptoms are coming up sooner and more severely than had been anticipated.  Hear what Dr. Matthew Friedman, executive director of VA's National Center for PTSD in White River Junction, Vt, has to say:

"Another challenge to VA clinicians is the acuteness of symptoms among veterans with adjustment reactions or PTSD, Dr. Friedman said. During the post-Vietnam era, most veterans with PTSD were considerably older and had much more chronic PTSD before they sought or received VA treatment.

"With the improvement in VA/DoD diagnosing, an increasing number of OIF/OEF returnees are requesting care at a much earlier stage in their post-traumatic clinical course.

"What's new now is that there are families [seeking help] who have returnees that came in [from deployment] one or two days ago," Dr. Friedman said.

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Importantly, there are also serious legal or insurance-related repercussions to PTSD diagnosis, or a lack thereof, which will be discussed in future posts.  The military is essentially refusing to consider a veteran's PTSD-related death from suicide to be "combat related" unless he or she has been officially diagnosed with PTSD, but making a timely appointment to be seen with symptoms arising so shortly after returning from combat has kept many veterans unable to avail themselves of the services they so desperately need.

Acupuncture and Healing Trauma

The University of New Mexico is studying acupuncture and Post-Traumatic Stress Disorder (PTSD).  An article on the ongoing study is linked here.

An excerpt from the article follows:

Researchers at the University of New Mexico are continuing work on a $250,000 two-year study of the effects of acupuncture in treating PTSD. The study, which began in May, was made possible with a grant from the National Institutes of Health. If successful, it could lay the path for larger trials that incorporate Eastern and Western approaches to treating the condition.

"This is the first study I'm aware of to look at acupuncture as a modality for PTSD," said Dr. Michael Hollifield, an associate professor of psychiatry and family medicine at the university's department of psychiatry and the study's principal investigator. "To date, our research supports using acupuncture for treating PTSD symptoms, including insomnia, anxiety and depression, in addition to some pain disorders. It may do so by stimulating the body's internal opiate system, though much more research on this issue is needed."

Aiding Dr. Hollifield in his research are Nityamo Sinclair-Lian, DOM, and Teddy Warner, Ph.D., who will serve as co-investigators. Drs. Hollifield and Sinclair-Lian collaborated previously on a study on the effects of trauma in Vietnamese and Kurdish refugees. Dr. Sinclair-Lian also runs a public health pain clinic for Vietnamese refugees, and provides acupuncture detoxification for substance users at a local outreach shelter for the homeless.

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Anecdotally, as they say in the medical biz, acupuncture and other traditional healing modalities, are known to offer comfort and relief to numerous health conditions.  We'll list individual acupuncturists here on this blog as we come to learn about ones who are interested in the topic; and in general, check out a comprehensive directory of specialized acupuncturists here, of a type that treats conditions affecting the body, mind and spirit.