Rest After Trauma May Help Decrease PTSD Symptoms

New research suggests a period of rest following a traumatic event can help reduce the subsequent development of involuntary “memory intrusions,” a frequent symptom of post-traumatic stress disorder. Memory intrusions can be both visual or non-visual and are often referred to as flashbacks.

The study, published in Scientific Reports, discovered memory disturbances in PTSD may be mitigated by a process that occurs in the brain that can be facilitated by rest and sleep. Specifically, investigators discovered increased consolidation — storage and contextualization of memories in the brain — helps to alleviate memory intrusions. Experts believe this finding could shed new light on treatment and prevention.

Lead author Dr. Lone Hørlyck, from the Institute of Cognitive Neuroscience at University College London, said, “Over a lifetime, many people experience traumatic events, but most people do not develop persistent trauma symptoms.

“Identifying which mechanisms might contribute to memory intrusions in PTSD is important, as these disturbances comprise an important maintaining factor in the disorder.”

For the study, researchers presented 85 participants with emotionally negative videos, followed by either a period of wakeful rest or a simple control task, where participants were required to pay attention to numbers on a screen.

The videos comprised highly emotional content, such as badly injured people or serious accidents.

Researchers found that participants who had a period of rest following the viewing of negative videos reported fewer memory intrusions related to the videos over the following week.

In contrast, there was no difference between rest and the simple control task on a follow-up memory test assessing how much participants remembered when they wanted to.

Rest and certain phases of sleep are known to increase processing in the hippocampus, a key region of the brain that helps put memory in context.

According to the investigators, the results suggest that a strengthening of this contextual memory system is beneficial in preventing memory intrusions following trauma.

Senior author Professor Neil Burgess, of the Institute of Cognitive Neuroscience, said, “The coherence of memories is often compromised when people are exposed to psychological trauma, resulting in emotional memories popping up involuntarily and out of context.

“However, the binding of an event memory with its context may be partly restored with rest, facilitating deliberate control of the memory.

“The results show that specific brain systems could be targeted to reduce development of PTSD and may explain why treatments that focus on re-exposure and integrating the trauma with other information are beneficial.”

Hørlyck added, “Our findings contribute to a better understanding of the mechanisms that are at play when some people develop memory disturbances following trauma while others do not.”

Source: University College London/EurekAlert

From Combat to Counseling: Comprehensive mental health in the military-affiliated population

It is important to understand what we are talking about when we discuss mental health in the military-affiliated population. As mental health professionals, it is equally important to understand the potential psychological impacts that our clients have experienced.

The post From Combat to Counseling: Comprehensive mental health in the military-affiliated population appeared first on Counseling Today.

Thrashing Sleep More Common Among Veterans With PTSD

Military veterans with post-traumatic stress disorder (PTSD) or concussion are much more likely to develop REM sleep behavior disorder (RBD) — a thrashing form of sleep behavior — compared to the general population, according to a new study published in the journal SLEEP.

Next, the researchers from the VA Portland Health Care System and Oregon Health & Science University (OHSU) want to investigate whether RBD might provide an early signal of neurodegenerative conditions such as Parkinson’s disease.

Typically, during REM (rapid eye movement) sleep, a person’s muscles are effectively paralyzed. In cases of RBD, however, the brain’s control of muscle paralysis is impaired, resulting in people acting out their dreams, sometimes causing injuries to themselves or their partners.

RBD is estimated to affect less than 1% of the general population. However, the researchers found that 9% of the 394 veterans in this study had RBD, and this number increased to 21% among those with PTSD.

“This is important because, in the general population, RBD has been linked to Parkinson’s disease, and RBD often precedes classic symptoms of Parkinson’s by years,” said senior author Miranda Lim, M.D., Ph.D., a staff physician at the VA and assistant professor of neurology, medicine and behavioral neuroscience in the OHSU School of Medicine.

“We don’t know whether veterans who have PTSD and higher rates of RBD will go on to develop Parkinson’s, but it is an important question we need to answer.”

Researchers suspect chronic stress on the brain may play a role in causing the sleep disorder in veterans with PTSD, as many veterans have been exposed to concussion which potentially accelerates neurodegenerative processes.

Each participant underwent an overnight sleep study at the VA Portland Health Care System between 2015 and 2017 to determine the presence of dream enactment during episodes of REM sleep. Muscle activity was monitored constantly during the 8 hours of the study in order to diagnose RBD. The findings show that participants with PTSD had over 2-fold increased odds of RBD compared to veterans without PTSD.

“RBD seems to be highly prevalent in veterans with a history of trauma,” said lead author Jonathan Elliott, Ph.D., a research physiologist at the Portland VA and assistant professor of neurology in the OHSU School of Medicine.

Doctors involved in the study, including co-authors Kristianna Weymann, Ph.D., R.N., a clinical assistant professor in the OHSU School of Nursing, and Dennis Pleshakov, a student at the OHSU School of Medicine, will continue to track research participants with RBD, looking for early signs of Parkinson’s or other neurodegenerative conditions.

Although there are several approaches to ease certain Parkinson’s symptoms, including tremor and fatigue, there is no definitive therapy to prevent the condition.

Clinical trials for promising therapies are usually conducted well after patients have been diagnosed with Parkinson’s, at a stage which may be too late to reverse the symptoms. Lim said that identifying patients with RBD presents an opportunity to identify people earlier in the disease course, and potentially provides a more viable window to test promising interventions.

“By the time a patient shows classic symptoms of Parkinson’s, it may be too late,” Lim said. “If you could intervene when people first start to show RBD, maybe you could prevent later symptoms of Parkinson’s.”

Source: Oregon Health & Science University

 

Large Study Shows PTSD Has Strong Genetic Component

In the largest and most diverse genetic study to date of post-traumatic stress disorder (PTSD), scientists reveal that PTSD has a strong genetic component similar to other psychiatric disorders.

The findings are published in the journal Nature Communications.

Despite much research, it has remained unclear why some people go on to develop PTSD after a traumatic event while others do not. Some researchers suggest that the disorder is only a social construct, but other studies point to the fact that genetics may be involved.

In the new study, researchers from the University of California (UC) San Diego School of Medicine and more than 130 additional institutions participating in the Psychiatric Genomics Consortium suggest that genetics may account for between five and 20 percent of the variability in PTSD risk following exposure to a traumatic event.

“Our long-term goal is to develop tools that might help clinicians predict who is at greatest risk for PTSD and personalize their treatment approaches,” said the study’s first and corresponding author Caroline Nievergelt, Ph.D., associate professor of psychiatry at UC San Diego School of Medicine and associate director of neuroscience in the Center of Excellence for Stress and Mental Health at the Veterans Affairs San Diego Healthcare System.

“We can’t always protect people from trauma. But we can treat them in the best ways possible, at the best time.”

The findings show that, like other psychiatric disorders and many other human traits, PTSD is highly polygenic, meaning it is associated with thousands of genetic variants throughout the genome, each making a small contribution to the disorder.

According to the findings, six genomic regions called “loci” contain variants strongly associated with disease risk, providing some clues about the biological pathways involved in PTSD.

“Based on these findings, we can say with certainty that there is just as much of a genetic component to PTSD risk as major depression and other mental illnesses,” said senior author Dr. Karestan Koenen, associate member of the Stanley Center for Psychiatric Research at the Broad Institute of MIT and Harvard.

“Our limited ability to study the living human brain and uncover the biological roots of PTSD has contributed to the lack of treatments and the stigma around this debilitating condition. Genetics helps us make new discoveries, find opportunities for new therapies, and counter that stigma,” she said.

Since many behavioral traits and psychiatric disorders have some shared genetic factors, the researchers also looked for genetic correlations between PTSD and 235 other disorders, behaviors and physical traits. They discovered significant overlap with 21, including depression, schizophrenia, neuroticism, insomnia, asthma and coronary artery disease.

“Similar to other mental disorders, the genetic contribution to PTSD correlates with that for many other traits,” said Koenen, who is also professor of psychiatric epidemiology in the Harvard T.H. Chan School of Public Health. “Further research is needed to determine what this means — whether some of the same genes that influence risk for PTSD also influence risk for other diseases like, for example, depression.”

To conduct the study, the team collaborated with the Psychiatric Genomics Consortium’s PTSD working group and Cohen Veterans Bioscience, a non-profit organization dedicated to accelerating PTSD and traumatic brain injury research.

The team built an international network of more than 200 researchers, assembling data and DNA samples from more than 60 groups of people with PTSD and control subjects, including the UK Biobank.

The data included more than 200,000 people, which is 10 times larger than the first Psychiatric Genomics Consortium PTSD study, published in 2017. The study group is also the most ancestrally diverse for any psychiatric genetics study to date, with more than 23,000 people with PTSD of European ancestry and more than 4,000 of African ancestry. It also included both civilians and members of the military.

“Our study is distinguished by the fact that it’s international and is highly diverse,” Nievergelt said. “There’s greater representation here than in most studies to date.”

The team used the data to conduct a genome-wide association study (GWAS), using statistical tests to measure the effect of common genetic variants at millions of points across the genome on someone’s likelihood of developing PTSD.

The study uncovered DNA variants at six loci that were significantly tied to PTSD risk. Three of the six loci were specific to certain ancestral backgrounds — two European and one African — and three were only detected in men.

The six loci hint that inflammatory and immune mechanisms may be at play in the disorder, which is consistent with findings from previous research.

Overall, the researchers conclude that PTSD’s heritability — the level of influence genetics has on the variability of PTSD risk in the population — is between five and 20 percent, with some variability by gender. These findings were similar across different ancestral groups.

The research team also developed a polygenic score that could potentially predict one’s risk of developing PTSD following a traumatic event. Polygenic scores take into account the effects of millions of genetic variations and create a measure that can predict a person’s risk of developing a certain trait or disorder.

The team tested their scores on data from men in the UK Biobank dataset, finding that those with the highest scores had 0.4-fold greater odds of developing than those with the lowest scores.

Similarly, when applied to data from the Million Veterans Program — a study of how genes, lifestyle and military exposures impact health and illness — individuals with the highest scores had a significant increase in re-experiencing traumatic memories — a key PTSD symptom.

The researchers assert that polygenic scores are not ready for clinical use. Even larger studies with more diverse datasets are needed to improve the accuracy of PTSD prediction and confirm the genetic findings.

Source: University of California- San Diego

 

Exposure to Violence Tied to Loneliness, Hypervigilance, Health Issues

Exposure to community and police violence can negatively impact a person’s physical and psychosocial health, according to new research published in the journal Health Affairs.

The research involved two studies based on in-person surveys of more than 500 adults living in Chicago neighborhoods with high rates of violent crime, and mostly comprising racial and ethnic minority groups. Of the study participants, 77% were age 50 and up.

Elizabeth L. Tung, M.D., a social epidemiologist from the University of Chicago Medicine and coauthor of both studies, was inspired to conduct this research after she noticed that more of her patients from violent neighborhoods were struggling to follow their prescribed health regimens.

“They would be hesitant to join walking groups because they were afraid to walk in their neighborhoods. Or I’d ask, ‘Why didn’t you get your medications on time?’ And they’d say, ‘Well, I could only get a ride at night, and I don’t want to leave the house at night.’ That kind of thing was coming up a lot more,” Tung said.

In the first report, researchers found that social isolation and loneliness were linked to limited physical activity, not taking medication properly, poor nutrition, binge drinking and smoking.

The results reveal that the more violence people experienced in their own community, the lonelier they were likely to be. The greatest risk for loneliness was found among those who were exposed to community violence and screened positive for post-traumatic stress disorder (PTSD).

The findings are particularly troublesome for older adults who live in violent neighborhoods, who are more prone to loneliness and might already have chronic health issues like diabetes, obesity or heart disease. Loneliness is a growing health concern, and a key predictor of mortality in the U.S.

“The association between violence exposure and loneliness is a really interesting one, because there’s such a strong link,” said Tung. “The pervasiveness of violence seems to be more evident now than ever. What does that sense of violence in our culture do more broadly to loneliness?”

Social withdrawal might be a survival strategy in violent neighborhoods, but it’s not a good long-term option, said study coauthor Monica E. Peek, M.D., an associate professor at the University of Chicago and the associate director of the Chicago Center of Diabetes Translation Research.

“Someone who is socially isolated and lonely has a higher risk for cardiovascular disease, just like someone who has a history of smoking. Loneliness is a public health issue with real health implications,” Peek said.

“Violence impacts more than just the victims, but the whole community. Everyone’s health is potentially affected.”

The new findings tie into a bigger conversation happening nationwide about how issues like loneliness, food insecurity and housing impact a person’s physical and psychological health, Peek added.

“Our health care system is changing and evolving, and we’re starting to think not just about medical care but the social needs of our patients, and trying to use the medical system as a way to integrate those needs. Having a more holistic approach will better help our health outcomes,” she said.

The second report, led by Nichole A. Smith, a medical student at the University of Chicago Pritzker School of Medicine, quantified a connection between exposure to community and police violence and hypervigilance.

Hypervigilance — defined as a heightened emotional state of always feeling “on guard” — can prevent people from making healthy lifestyle choices. Chronic hypervigilance can lead to hypertension, cardiovascular disease, memory impairment, anxiety disorders and difficulty regulating emotions.

“It’s a very well-studied phenomenon, mostly in veterans. But it’s so poorly studied in community-based settings where you have this chronic exposure to violence,” Tung said.

The study found a surprisingly strong link between hypervigilance and exposure to police violence more than community violence.

Exposure to community violence was linked to a 5.5% increase in the hypervigilance score, while exposure to police violence was associated with a 9.8% increase. Respondents who experienced a traumatic event during a police stop had a 20% increase in hypervigilance scores.

The findings suggest a complex association between police violence and the mental and physical health of community members. It raises the question of whether hypervigilance, both among residents and police officers, could possibly lead to harmful escalations during police stops.

The study suggests that more trauma-informed policing and opportunities for community-building activities between police and community members, such as the CAPS police baseball league with community members, could help reduce hypervigilance on both sides and prevent situations from escalating into harmful ones.

Source: University of Chicago Medical Center

New Medication May Boost Treatment for PTSD

A medication that boosts the body’s own cannabis-like substances called endocannabinoids may offer a new way to treat post-traumatic stress disorder (PTSD).

“We have used a medication that blocks the way the body breaks down its own cannabis-like substances, or endocannabinoids,” said Dr. Leah Mayo, a senior post-doctoral fellow and lead investigator on the study, which was carried out in the laboratory of Professor Markus Heilig at the Center for Social and Affective Neuroscience at Linköping University in Sweden.

“Our study shows that this class of medications, called FAAH inhibitors, may offer a new way to treat PTSD and perhaps also other stress-related psychiatric conditions,” she continued.

PTSD, arises in some people who have experienced life-threatening events. A person affected by PTSD avoids reminders of the trauma, even when the danger is long gone. Over time, these patients become tense, withdrawn, and experience sleep difficulties. This condition is particularly common among women, where it is often the result of physical or sexual abuse, the researchers noted.

PTSD is currently treated using prolonged exposure therapy (PE). In this treatment, patients are repeatedly exposed to their traumatic memory with the help of a therapist. This ultimately allows patients to learn that these memories no longer signal imminent danger.

Although clinically useful, effects of PE are limited. Many patients do not benefit, and among those who do, fears frequently return over time.

The scientists who carried out the new study examined whether fear extinction learning, the principle behind PE therapy, can be boosted by a medication.

The researchers tested a pharmaceutical that affects the endocannabinoid system, which uses the body’s cannabis-like substances to regulate fear and stress-related behaviors.

The experimental medication results in increased levels of anandamide, a key endocannabinoid, in regions of the brain that control fear and anxiety. The medication accomplishes this by blocking an enzyme, FAAH (fatty acid amide hydrolase), that normally breaks down anandamide. The FAAH inhibitor tested by the researchers was originally developed for use as a painkiller, but was not effective enough when tested clinically, they explained.

The experimental study was randomized, placebo-controlled, and double-blind, which means that neither the participants nor the scientists knew who was receiving the active drug (16 people) and who was receiving the placebo (29 people).

Participants were healthy volunteers. After taking the drug for 10 days, they underwent several psychological and physiological tests.

In one of these, participants learned to associate a highly unpleasant sound, that of fingernails scraping across a blackboard, with a specific visual cue — an image of a red or blue lamp. Once they had learned to respond with fear to the previously innocuous image of the lamp, they were repeatedly re-exposed to it, but now in the absence of the unpleasant sound. This allowed them to unlearn the fear memory, the researchers said.

The following day, the scientists measured how well participants remembered this new learning that the lamp was no longer a threat signal. This process of unlearning fear is the same principle on which PE therapy for PTSD is based, the researchers explained.

“We saw that participants who had received the FAAH inhibitor remembered the fear extinction memory much better,” Mayo said. “This is very exciting.”

“Numerous promising treatments coming out of basic research on psychiatric disorders have failed when tested in humans. This has created quite a disappointment in the field. This is the first mechanism in a long time where promising results from animal experiments seem to hold up when put to test in people. The next step, of course, is to see whether the treatment works in people with PTSD,” added Heilig.

The study was published in the scientific journal Biological Psychiatry.

Source: Linköping University

Photo: When the lamp in the figure is red, the subject hears an unpleasant sound in the earphones and learns to associate the visual signal with discomfort. Credit: Anna Nilsen/Linköping University.