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November 06, 2008

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

OregonA 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.

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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.

October 23, 2008

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.

September 07, 2008

Getting Stuck to Get Unstuck: Army Studies Acupuncture for PTSD

Acupuncture and 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.

August 29, 2008

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

Hippocampus PTSD 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 and 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.

August 24, 2008

The Cortisol Connection: Sex and Sleep, Stress and Survival

Cortisol and PTSDAn 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.

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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…”

 

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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.

August 23, 2008

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

Good Nights Sleep

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 red