Can a game trigger post-traumatic growth?

This TED Talk by game designer Jane McGonigal is worth 20 minutes of your time. As she says, "A traumatic event doesn't doom us to suffer indefinitely. Instead, we can use it as a springboard to unleash our best qualities and lead happier lives."

Delayed trauma: PTSD decades later

Stars and Stripes reports that a major life event like retirement can cause decades-old traumas to come to the surface, creating anxiety, anger and other PTSD-related symptoms. In particular, this is starting to affect some Vietnam vets who did not get proper treatment when they returned from war.

Mental health experts say...delayed trauma isn’t unusual. Major life events such as retirement often trigger personal reassessment and forgotten memories.

But for Vietnam veterans who returned decades ago to a harsh reception and limited mental health options, that could mean a new wave of stress and serious psychological issues as their generation enters retirement age.

Many of these Vietnam veterans (who are now approaching retirement age en masse) threw themselves into their work when they returned from the war as their way of coping with their trauma. As their work lives end, the untreated trauma is now becoming an issue.

Stars and Stripes reports that the VA is not yet prepared to deal with the thousands of new requests for treatment they could receive in the next few years.

Read more:

Retirement might unleash PTSD symptoms in Vietnam veterans

60% of Egyptians suffering from PTSD

A survey has shown that 60% of Egyptians are suffering from PTSD following 18 months of political turmoil. Of that 60%, nearly half witnessed violence in the streets. 

Digital Journal has the story:

Video: 60% of Egyptians suffering from PTSD

1 in 8 heart patients suffer PTSD

Any life-threatening event can leave a person with symptoms of PTSD. Now a new study finds not only that a heart attack can lead to PTSD but PTSD can double a person's risk of future cardiac events and death. Read on...

One in eight people who suffer a heart attack or other acute coronary event experience clinically significant symptoms of post-traumatic stress disorder (PTSD), according to a meta-analysis of 24 studies led by Columbia University Medical Center researchers. The study also shows that heart patients who suffer PTSD face twice the risk of having another cardiac event or of dying within one to three years, compared with those without PTSD. The findings were published today in the online edition of PLoS ONE: http://dx.plos.org/10.1371/journal.pone.0038915.

"While most people think of PTSD as a disorder of combat veterans and sexual assault survivors, it is also quite common among patients who have had a severe coronary event," said lead author Donald Edmondson, PhD, assistant professor of behavioral medicine at CUMC. "Not only are such events life-threatening, but their psychological impact can be devastating and long lasting."

PTSD is an anxiety disorder initiated by exposure to a traumatic event such as combat, disaster, or sexual assault. Common symptoms include nightmares, avoidance of reminders of the event, and elevated heart rate and blood pressure.

Each year, about 1.4 million people in the United States experience an acute coronary syndrome (ACS), a term used to describe any condition brought about by sudden reduced blood flow to the heart. Numerous small studies have suggested that ACS-induced PTSD is common and can have serious health consequences, but its prevalence is not known.

To get a better idea of the scope of the problem, Dr. Edmondson and his colleagues performed the first combined review, or meta-analysis, of clinical studies of ACS-induced PTSD. The 24 studies in the meta-analysis included a total of 2,383 ACS patients from around the globe.

The study found that overall 12 percent, or one in eight, of the patients developed clinically significant PTSD symptoms, with four percent meeting full diagnostic criteria for the disorder.

"Given that some 1.4 million ACS patients are discharged from U.S. hospitals each year, our results suggest that 168,000 patients will develop clinically significant PTSD symptoms. That is quite substantial. However, there is abundant evidence that psychological disorders in heart patients are underrecognized and undertreated. In fact, underdiagnosis may be even more pronounced in cardiac practices than in other types of medical practices," said Dr. Edmondson.

"This is a serious problem for individual patients, as well as for the healthcare system as a whole," he said. "PTSD appears to double a heart patient's risk for a second cardiac event and for death, which adds hundreds of millions of dollars to annual health expenditures."

"Fortunately, there are good treatments for people with PTSD," Dr. Edmondson said. "But first, physicians and patients have to be aware that this is a problem. Family members can also help. We know that social support is a good protective factor against PTSD due to any type of traumatic event."

"The next step is further research to assess whether treatment can reduce ACS-induced PTSD symptoms and reduce the associated risk for ACS recurrence and mortality," said Dr. Edmondson.

Brain shrinkage in Japanese tsunami survivors with PTSD

Survivors of last year's Japanese tsunami who have PTSD from the disaster experienced a shrinking of their orbitofrontal cortex -- that's the part of the brain that is involved in decision-making and the regulation of emotion.

Brain shrinkage seen in Tohoku PTSD cases | The Japan Times Online

This is just the most recent evidence that shows PTSD is a very real, physical injury.

Today's must-read: Connecticut Paves New Path In Treating Traumatized Children

Connecticut is changing the way it treats kids in the child-welfare system: "the state Department of Children and Families, working with experts in childhood trauma, is using a multi-million dollar federal grant to increase from 16 to about 26 the number of outpatient community clinics that practice trauma-focused therapy, and to put it in play at DCF's most difficult facilities, the former Riverview Children's Hospital, reorganized as the Albert J. Solnit Psychiatric Center, and the Connecticut Juvenile Training School."

Read more:

Traumatized Children Treated For PTSD - Courant.com

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Traumatic Stress Linked to Heightened Inflammation; Possible Link to Heart Disease

Greater lifetime exposure to the stress of traumatic events was linked to higher levels of inflammation in a study of almost 1,000 patients with cardiovascular disease led by researchers at the San Francisco VA Medical Center and the University of California, San Francisco.

In the first study to examine the relationship between cumulative traumatic stress exposure and inflammation, the scientists found that the more traumatic stress a patient was exposed to over the course of a lifetime, the greater the chances the patient would have elevated levels of inflammatory markers in his or her bloodstream.

“This may be significant for people with cardiovascular disease, because we know that heart disease patients with higher levels of inflammation tend to have worse outcomes,” said lead author Aoife O’Donovan, a Society in Science: Branco Weiss Fellow in psychiatry at SFVAMC and UCSF.

The study was published electronically in February in Brain, Behavior and Immunity.

The authors looked at exposures to 18 different types of traumatic events, all of which involved either experiencing or witnessing a direct a threat to life or physical integrity, in 979 patients age 45 to 90 with stable heart disease. They then measured a number of clinical markers of inflammation that circulate in the bloodstream, and found a direct correlation between degree of lifetime stress exposure and levels of inflammation.

Five years later, they measured the surviving patients’ inflammation markers again, and found that the patients who had originally reported the highest levels of trauma at the beginning of the study still had the highest levels of inflammation.

“Even though we lost some study participants because they died, we still observed the same relationship in those who remained,” O’Donovan said. “This suggests that it wasn’t just the people who were the most sick at the outset who were driving this effect.”

Senior investigator Dr. Beth Cohen, a physician at SFVAMC, emphasized that the effect remained even after the researchers adjusted for psychiatric diagnoses such as post-traumatic stress disorder (PTSD), anxiety and depression.

“Not everyone who is exposed to trauma develops PTSD,” said Cohen, who also is an assistant professor of medicine at UCSF. “This study emphasizes that traumatic stress can have a long-term negative impact on your health even if you don’t go on to develop PTSD. It also tells us that, as clinicians, we need to think about not just which diagnostic box someone might fit into, but what their lifetime trauma exposure has been.”

Although the study did not probe the potential causes for the link between lifetime stress and inflammation, O’Donovan offered one possible explanation.

“We know that in the aftermath of traumatic stress, people become more sensitive to threats,” she said. “This is actually pro-survival, because if you’re in a dangerous environment, that alertness can help you avoid future harm.”

However, she explained, people with heightened threat sensitivity may also show increased inflammatory responses. “What we think is happening is that people with a history of multiple traumatic stress exposures have increased inflammatory response more often and for longer periods, and so inflammation becomes chronically high,” she said.

Cohen noted that “this is a study of older people, and the cumulative effects that decades of traumatic experiences have on their bodies. If we could intervene with young people,” she said, “using techniques that we know help fight stress, such as exercise, yoga and other integrative health techniques, it would be interesting to know if we might be able to prevent some of this.”

The study subjects were all participants in the Heart and Soul Study, an ongoing investigation into the link between psychological factors and the risk of heart events and mortality in patients with stable heart disease. The Heart and Soul study is directed by Dr. Mary Whooley, a physician at SFVAMC and a professor of medicine at UCSF.

Co-authors of the study are Dr. Thomas Neylan of SFVAMC and UCSF and Thomas Metzler, M.A., of SFVAMC.

The study was supported by funds from the National Institutes of Health, the U.S. Department of Defense, the Irene Perstein Foundation, the Department of Veterans Affairs and a Society in Science: Branco Weiss Fellowship. Some of the funds were administered by the Northern California Institute for Research and Education.

9 in 10 firefighters suffer PTSD

A new study out of New Ben-Gurion University in Israel shows that 9 in 10 firefighters showed symptoms of PTSD (24%) or partial PTSD (67%).

The study was conducted by Dr. Marc Lougassi, who is not just a doctoral student at the university but is also a firefighter himself. It examined 342 active Israeli firefighters who had been exposed to traumatic events since 1997. The study excluded any firefighters with histories of psychiatric treatment or chronic pain, as well as anyone who had suffered a head injury.

According to Dr. Lougassi, "Professional firefighters are frequently exposed to extreme stress during their work in emergency situations. In addition to the physical challenges of firefighting, they must evacuate burned and injured victims or bodies. Their involvement in traumatic events exposes them not only to the pressures stemming from the traumatic event itself, but also to post-traumatic emotional expressions that result in secondary traumatization."

In addition to "normal" firefighter duties, Lougassi said that firefighters in Israel are frequently "exposed to additional traumas such as war and terror strikes."

It is unclear if Lougassi's study was published in a scientific journal or if it was just announced by the university.

Read more:

Ninety Percent of Firefighters Exhibit Symptoms of Post Traumatic Stress Disorder

Time: "The Army Venn Diagram from Hell"

Yikes.

Read more:

The Army Venn Diagram from Hell | Battleland | TIME.com

PTSD recovery thickens your brain (and that's a good thing)

According to a study conducted by Kyoon Lyoo, M.D., Ph.D., a professor of psychiatry at Seoul National University in South Korea, patients with PTSD who improved their mental health also experienced a thickening of the dorsolateral prefrontal cortex, a portion of the brain that, according to our friend Wikipedia, "plays an important role in the integration of sensory and mnemonic information and the regulation of intellectual function and action."

The study followed 30 survivors of a subway fire for five years. The patients not only received psychiatric care, they were also periodically examined through neuroimaging to get a picture of what was going on inside their brains.

A control group was also followed over the course of the five years. The study found that "During the first year and a half of the study, the trauma subjects also acquired a thicker dorsolateral prefrontal cortex than controls did," according to a report at Psychiatric News.

The researchers concluded that boosting the thickening of the dorsolateral prefrontal cortex, possibly through "transcranial magnetic stimulation before and early after trauma," could be a way to help people recover from trauma.

Read more about this study here:

Why Does Brain Thickening Occur During PTSD Recovery?

The study itself can be found here. (The full article is only available to subscribers. The abstract is available to all.)

Employers' Misconceptions About PTSD

According to a survey cited by Lisa Stern of the Department of Labor’s project America’s Heroes at Work program, 46 percent of HR managers believe PTSD poses a "hiring challenge" -- namely that people with PTSD or TBI are not efficient or create a potential problem for violence in the workplace. But Stern said these assumptions are myths, and no evidence backs them up.

In His VA blog Vantage Point, Alex Horton summarizes some of the advice Stern had for hiring vets and other people with PTSD:

• Consider flexible work hours
• Put instructions in writing instead of just relying on verbal communication
  

Stern also said that the act of working can by itself help reduce PTSD symptoms.

Read more:

Debunking Employers’ Misconceptions About PTSD and TB 

What other myths about PTSD have you encountered in the workplace? Discuss them in the comments.

How to talk to someone with PTSD

From the Huffington Post:

Trauma-senstive yoga

As we've discussed on the blog several times, yoga can be a very effective source of relief for people with PTSD. But finding the right yoga teacher, who understands the needs of people with trauma, is important.

On the blog Linda's Yoga Journey, the author discusses some things yoga teachers should keep in mind for their students who are trauma survivors. Here's her introduction:

A “trauma sensitive” yoga class is taught very differently from the yoga class with which we are familiar -- soft music, altars, incense, physical adjustments. A typical yoga class may not be comfortable place for a trauma survivor and in fact may feel very dangerous. Merely saying the word "relax" can be a PTSD trigger if the person was told to relax and then was abused.

For someone who has been abused, a physical assist can be a severe trigger for PTSD. Many teachers say, "but I always ask first." Think about that statement. For someone who has a history of abuse and was not allowed to say no (so has issues with power and control), assists are problematic.

Read more here.

Study: Living in captivity gives chimpanzees PTSD

Two new studies reveal that chimpanzees, one of our closest non-human relatives, can get post-traumatic stress disorder from living in captivity, or from the traumatic events that led to their being in captivity in the first place. Many chimpanzees in zoos are rescues of the (often illegal) animal trade, in which young chimps are often torn from their mothers and placed in restrictive cages.

Earth Times has the story:

Can Chimps Have PTSD?

PTSD affects childrens' DNA

Childhood trauma can lead to PTSD in adults, while also affecting them on a genetic level.

According to a study published in the journal Biological Psychiatry, adults with PTSD who had a history of childhood trauma had a significantly shorter region of DNA proteins known as the telomere -- a region of repetitive DNA sequence at the end of a chromosome which protects the chromosome from deterioration. Previous studies have linked short telomere length with accelerated aging and a greater risk of cardiovascular disease, cancer, and other degenerative conditions.

The study examined a total of 90 people -- 47 with PTSD and 43 without. The subjects with PTSD were found to have an average telomere length shorter than that of the non-PTSD subjects.

Read more here:

Risk of Accelerated Aging Seen in PTSD Patients with Childhood Trauma

US soldiers 7 times as likely as UK troops to develop PTSD

Does culture impact how you react to trauma? The UK newspaper The Independent examines the possibility that PTSD is not a universal response:

The invisible division: US soldiers are seven times as likely as UK troops to develop post-traumatic stress - Americas, World - The Independent

Managing Your Post-Holiday Stress

Psychology Today has a great new article about managing your holiday-induced stress: PTSD: Post-Thanksgiving Stress Disorder?

Here's a good quote from the beginning of the article:

"But time alone will not put the past behind you. Without realizing it, you may be holding onto your pain -- and often re-create it in the present -- in a misguided attempt to protect yourself from further trauma."

This is all less about PTSD than the general trauma caused by our every-day lives, but it's still worth a read.

Children Can Get PTSD from Their Parents

A Canadian study focusing on the families of returning vets indicates that parents can pass PTSD along to their children.

"Isolation, depression and trauma are among the symptoms soldiers pass on to their kids, according to preliminary results from a Canadian study," according to a report on the study at the website Parent Dish. Kids also risk "physical abuse, emotional neglect and unpredictable rage."

The study was very small -- just four teenagers whose parents, three of whom had PTSD, had served in recent conflicts, but it echoes other studies and real-world examples we've heard too much about.

Read more:

Children Getting More PTSD, Less TLC From Parents Returning From War

Childhood trauma results in adult alcohol abuse

According to a new study, women who abuse alcohol suffered a greater level of childhood trauma. The study looked at 106 men and women without PTSD (a fairly small sample group), but it's another way of disputing that old "children are resilient" saw.

The study was published in the Journal of Traumatic Stress.

How children react to parents with PTSD

One family member's PTSD can have terrible effects on the rest of the family, especially when it's a parent suffering.

According to an article from the National Center for PTSD, the symptoms of PTSD "can be frightening not only for the individual experiencing them but also for the children who witness them."

Children often react to PTSD in three common ways: by behaving like their PTSDer parent (the "over-identified child"); by trying to fill the adult's normal role in the family (the "rescuer child"); or by becoming emotionally uninvolved.

All of these responses can pose problems for a child later in life. And in fact, the children can, themselves, develop their own cases of PTSD, a condition known as "intergenerational transmission of trauma."

But that doesn't mean the situation is hopeless for families. According to the article, simply explaining to a child why a parent has been traumatized (without going in graphic detail) can go a long way toward alleviating the stress a child feels.

Treatment/therapy as a family is also often a valuable asset and tool.

If anyone in your family is suffering from PTSD, this article by Jennifer L. Price, PhD, is essential reading:

When a Child's Parent Has PTSD - National Center for PTSD