Healing Combat Trauma

Learning to Bounce Back: Helpful Hints for Increasing Personal Resilience

"Resilience" or the concept of "increasing personal resilience" is something we're hearing about more and more in connection with PTSD.  For combat veterans and their families, the greater the amount of personal resilience, the more fully they'll be able to "bounce back" from trauma (hence the image of the boomerang, which quickly returns to its source.)

 

According to the dictionary, "resilience" is "The ability to recover quickly from illness, change, or misfortune; buoyancy;" and the intrinisic "property of a material that enables it to resume its original shape or position after being bent, stretched, or compressed; elasticity."

According to the National Center for PTSD, and its PowerPoint presentation on PTSD 101, presented by Fred Gusman, M.S.W. and colleagues, three keys to resilience are the "ABC's" of "awareness" (of one's limits, emotions and resources); "balance") among personal and professional activities [their presentation was to clinical caregivers, so that's explains the inclusion of that sentence]; and "connection" (to one's inner self; to others, and to something "larger" (typically spiritual).) A connection with others, in particular, "breaks the silence of unacknowledged pain; offsets isolation; and increases validation and hope."

 

The short, pithy presentation also offers these

 

Helpful Hints for Personal Resilience:

• Make connections/relationships;
• Avoid seeing crises as insurmountable problems;
• Accept that change is inevitable;
• Set goals and actively move toward them;
• Take decisive actions;
• Look at problems as triggers for personal growth;
• Don’t blow things out of proportion;
• Remember and use past coping, success, strengths. 

-- Source: APA Task Force on Resilience, 2002, quoted in National Center for PTSD’s "PTSD 101," linked here.

"Purple Mountains' Majesty and PTSD": Colorado VA Hospital Hosts Three-Part Series on PTSD

According to an article in today's Grand Junction (Colo.) Free Press, the local Veterans Affairs hospital is sponsoring a three-part series for veterans, their families, and the community on PTSD.  The series apparently started yesterday (Wednesday) and will continue on the following two Wednesdays, July 16 and July 23.  According to the article, session was led by social workers Gerry Mitchell and Austin Sorensen and "educated the group on the symptoms, perceptions and impacts of PTSD on the soldier and his or her family."  Next session will discuss "veterans’ family members coping with PTSD." (Hey, I hope they see our blog entry from yesterday on that exact subject -- "Home Sweet Home -- After Deployment, What? Support for Returning Veterans and Families," -- linked here!)  The third week's session will let veterans discuss their own experiences with PTSD. (My buddy, Kathie Costos, over at "Wounded Times," mentioned this upcoming series with great excitement the other day.  As she knows, veterans are often not that eager to seek help, but this series looks like a very positive development.)

Editor's Note: The article, by Marija B. Vader, called "PTSD attracts crowd at VA hospital," is linked here. The main website of the VA Hospital in Grand Junction, Colorado, is linked here.  (That site also includes driving directions.)  The hospital is located at 2121 North Avenue, in Grand Junction, CO 81501, and the phone number is (local) (970) 241-0731 and Toll Free:(866) 206-6415.  The sessions apparently start on Wednesdays at 5:30 p.m. in Building 6 on North Avenue.

PTSD Drugs: Better Living through Chemistry, or Purely Popping Pills for PTSD's Psychological Ills?

There was a story in the news recently about four young combat veterans in West Virginia, all seemingly in decent physical condition beforehand, who nevertheless all died in their sleep recently.  Besides combat PTSD, one thing the vets all had in common was the cocktail of drugs they were taking: Paxil, Klonopin and Seroquel.  (The Charleston, West Virginia Gazette-Mail reported this story on May 24, 2008 - it's linked here.)  An investigation is pending, but the story obviously raises the question: what are vets with PTSD being prescribed, and is it really working, or what's best?  (Continue reading, and you'll learn more about those specific medications as well.)

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Where to go for information about PTSD medications?  Here are a few, carefully-chosen selections, and their pros and cons - as appropriate:

Jonathan Shay, M.D., Ph.D., well-known VA psychiatrist and outstanding veterans advocate, has written before about medications used to treat combat PTSD, and his impressions of them.  He wrote the material for a lay audience, in the version that's kicking around on the Web, in several different locations, and although it has been quoted by many as gospel, it's more than 12 years old by now (first published in 1995), and that's much too much time that's elapsed to consider that information really current. (The Dr. Shay list, "About Medications for Combat PTSD,"  is linked here.)  So that information is interesting for background -- and particularly for Dr. Shay's explanation of how things work and/or what makes a good PTSD medication, and what doesn't -- it out of date and should not be considered current. 

There's another list on the Web -- a table, really -- that's much more current (2006), and it lists the drug names, brand names, and how the drugs are thought to work with PTSD.  That list is linked here.  It may be a little difficult to read if you're coming to the topic cold, but perhaps not.

Some other suggestions:

If you have access to a public library or academic library, you can check out the PDR -- the Physician's Desk Reference -- and read up on a drug's profile, side effects, warnings, etc.  But since you're already on the Web, we can assume, reading this -- try going to PDRHealth.com, linked here-- and read up on the prescription drugs prescribed for PTSD.  Of the three drugs mentioned earlier, Paxil is linked here; Klonopin is linked here; and Seroquel is linked here.  You can also do a straight search for any OTHER drug used in PTSD treatment, or one with possible interactions with a drug used for PTSD, at the same site, by searching within prescription drugs by name (e.g., Zoloft, Chantix, etc.), at the general search interface, linked here.

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But the information in the PDR, whether on the Web or in the desk reference, is going to dry and technical, though worth reading -- pretty much exactly like the fine print that's packaged with the medications themselves. What you're probably going to want to know more about is what in software is called "the user experience" -- how other patients like you have experienced the medications.  For that you will need to turn to some other sources.

For what amount to "user reviews," try PsychCentral, or Revolution Health, both of which have increasingly robust user communities who will comment on their own experiences of the medications.  (Of course, not all their users taking medications for PTSD have PTSD from combat trauma, so be aware that their cases may be substantially different.)  Combined with the technical information about the drug's effects, side-effects and warnings (see links, above), it might be helpful in creating a broader picture of what the user experience is like:

Dr. John Grohol's PsychCentral website:  Paxil (Paroxetene) is linked here; Klonopin (Clonazapam) is linked here; and Seroquel (Quetiapine fumarate) is linked here. A general search through the medication library is linked here.

AOL Founder Steve Case's Revolution Health:  Users in the "User Community" provide "Community Ratings" on various medications.  The items on Paxil, Klonopin, and Seroquel are linked here (click on any of those hyperlinks to take you to the community ratings), or, use a more generic search here, and look for the tab beneath that says "Community Ratings." (We will be blogging more about Revolution Health shortly.)

Don't forget books as well.  Mark Goulston, M.D.'s Post-Traumatic Stress Disorder for Dummies (2007), linked here, is very recent, and contains a whole chapter entitled, "The Role of Medication in Treating PTSD".

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You'll also want to learn as much as you can -- though this is primarily your healthcare provider's reponsibility, yet it's in your best interests to care about this as well -- about possible interactions, if you're taking a number of medications; as well as thinking through carefully whether the risks involved are ones you want to agree to, such as the potential that a medication -- bizarrely enough, prescribed for PTSD or depression -- may actually increase risk of suicide. (An example of news coverage about this is linked, here.)  Strange, and perhaps unavoidable, but true.

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Use caution whenever evaluating information about medications, especially as a non-professional, but at the same time, don't "just" believe what a healthcare provider tells you: be sure to check it out for yourself or your family member, at reputable sites like the ones mentioned above.  Your health is in your hands, so while you want and should actively solicit the expert advice of healthcare providers familiar with PTSD -- and don't settle for less :-), at the same time, YOU are the one who's going to be bearing the brunt of anything that goes wrong, so be sure to do your own due diligence and figure out what the possible side-effects, interactions, and unpleasant experiences might be for you, before you commit to a course of treatment.  You and your healthcare provider can be partners -- that's the new model -- not just "master" and "servant," or "priest" and "parishioner."  Take an active, informed role in your own healthcare, particularly where medications are concerned. 

Healing Hands: Cranio-Sacral Therapy, Veterans and PTSD

Before we leave off talking about Complementary and Alternative Medicine (CAM) therapeutic strategies for dealing with PTSD (usually, in addition to other approaches, not instead of other approaches) -- as we have been discussing lately on this blog, an index to which is linked, here -- it's important to mention one other therapeutic technique: Cranio-Sacral Therapy, developed by Dr. John Upledger (pictured at left).  You'll have to go elswhere -- like the Upledger Institute's website, linked here -- to learn more about the practice -- it would take too long to explain here, because there are several schools of thought on why it might work, and it's a fairly esoteric practice to begin with.  But...an important but...it is a bodywork therapy, akin to massage but not the same as massage, which has shown some effectiveness in improving the symptoms of PTSD.   Digging around on the Upledger Institute's site may help you learn about who practices it in your area of the country, but that is unlikely to be a completely comprehensive list.

For those who believe -- and it surely isn't everyone who does, but many do -- that the physical body "stores" trauma, craniosacral therapy attempts to "release" the stored trauma through the very light, deft touch of the craniosacral therapist.  Not everyone who's been through trauma wants to "talk about it," or "take medications for it" -- for those who are comfortable with a massage-like experience, craniosacral therapy is an opportunity to see if trauma can be cleared, lightly or substantially, using a different method.  (Rumor has it that the Navy and/or the Marine Corps, on the West Coast, is experimenting with using craniosacral therapy to treat PTSD -- more news as that develops.)

Dr. Upledger, and another West Palm Beach, FL-area craniosacral therapist, who I have known for years, and who used to practice together, worked in a novel program years ago to treat Vietnam veterans who were struggling with the effects of PTSD.  In their program were a handful of veterans and at least one medical nurse who had served during Vietnam.  The treatment program allegedly helped some, didn't help some others, and had at least one anomaly as a result: a patient who died in an unrelated car accident, soon after he reported to his family, unfortunately, how much relief he was gaining from the program.  So the results were mixed, but in general, more positive than negative.  (There was even some interest from a famous Hollywood filmmaker, who shall remain anonymous, but who's a big fan of veterans and the Vietnam experience, in filming the experience of veterans undergoing the treatments, but that created controversy for the program, and the idea was eventually dropped.)

Years later, Dr. Upledger did more work with other veterans, and at least one of them, Steve Shumelda, LMT, an ex-military guy with injuries of his own, including PTSD -- was so impressed by the treatments that he gave up whatever he was doing for a living before, and studied craniosacral therapy instead.  He has a practice in South Florida now, and has written about his experience with craniosacral therapy.  You can read more about the Upledger Institute's work with veterans and PTSD, here.

Dr. Upledger has apparently done a video that is available via his Institute on PTSD and veterans and craniosacral therapy.  You can contact their office to see about purchasing a copy.  For additional resources to read up on the topic of craniosacral therapy, veterans and PTSD, click here for a separate blog entry we did recently that consolidates a few in one place.  To read about Vietnam veteran and former Navy corpsman Steve Shumelda, LMT's experience with PTSD and craniosacral therapy, click here.

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.

Mind Body Medicine: Healing the Troops

We've talked about James S. Gordon, M.D.'s Center for Mind-Body Medicine and their successes in "Healing the Wounds of War" recently on this blog, and the wait to see if they would revamp this program to address the needs of PTSD and the troops.  Finally, at long last...The Center for Mind-Body Medicine's program for Healing the Troops, informational material linked here.

From their website:

The Center has created a program of training in mind-body medicine and on-going support for physicians and mental health professionals working with veterans returning from Iraq and Afghanistan as a first step to providing veterans with a powerful and healthy approach to dealing with the stress of war and to enhancing their resiliency.

This program will be a significant focus at our Fall 2008 Mind-Body Medicine training, for which we have received funding to bring 20 military healthcare professionals on scholarship. We are seeking additional funding for this important effort.

Also from their website:

The Center for Mind-Body Medicine has developed a trauma relief program utilizing mind-body skills including biofeedback, relaxation, guided imagery, meditation, drawing, and breathing exercises that has been used successfully around the world.

This program, which is presented in small educational groups, has the advantage of enhancing veterans’ capacity to help themselves while mobilizing social support crucial to full recovery. The Center has used this program to assist in population-wide healing efforts in war-torn and traumatized regions around the world, including Bosnia, Kosovo, Macedonia, Israel and Gaza , and in the United States with NYC firefighters post-9/11 and in post-Katrina Louisiana.

Further information about the 2008 conference is linked here. Dr. Gordon's bio is linked here.