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Is Neuropsychiatry the solution to Bipolar Disorder and Risk Taking?

Advances in Neuropsychiatry Regarding Bipolar Disorder and Risk Taking

This interesting article explores the links between Bipolar Disorder, Neuropsychiatry and Risk Taking (which likely include compulsive gambling, severe substance use and other addictive disorders.




Researchers are beginning to discover some of the reasons why bipolar disorder can cause people to engage in risky behavior. The condition involves fluctuating depression and mania.

In the manic stage, the patient often feels intense excitement and irritability, which can trigger unpredictable risky behavior. Work, family, and social life all can be impaired by this risk-taking.

Professor Wael El-Deredy of Manchester University, UK, and colleagues investigated the neuroscience behind this risky behavior. They engaged 20 individuals with bipolar disorder but not taking anti-psychotic medication and 20 without bipolar disorder.

They measured with fMRI these individuals’ brain activity while playing a game of roulette. Participants were encouraged to make both safe and risky gambles in the game.

This showed “a dominance of the brain’s pleasure center” among those with bipolar disorder, say the team. This area, the nucleus accumbens, drives us to seek out and pursue rewards, they explain, and is not under conscious control. Healthy participants had a less strongly activated nucleus accumbens than those with bipolar disorder.

There were also differences in the prefrontal cortex, a more recently developed part of the brain which allows us to make conscious decisions. The team describe the prefrontal cortex as “much like the conductor of an orchestra.”

They say it gives us the ability to coordinate our various drives and impulses, such as quelling our urges when faced with risky decisions, allowing people to make decisions that are less immediately rewarding but better in the long run.
Participants with bipolar disorder showed greater neural activity for risky gambles, whereas the non-bipolar roulette players were guided by their prefrontal cortex toward safer gambles.

The study is published in the journal Brain. These findings will help to design, evaluate, and monitor therapies for bipolar disorder, the team believes. They now plan to work on psychological therapies that help people engage with their value systems and have greater regulation over their pursuit of goals.

“The greater buzz that people with bipolar disorder get from reward is a double-edged sword,” said El-Deredy.
“On the one hand, it helps people strive toward their goals and ambitions, which may contribute to the success enjoyed by many people with this diagnosis. However, it comes at a cost: these same people may be swayed more by immediate rewards when making decisions and less by the long-term consequences of these actions.”

Co-author Professor Richard Bentall pointed out that this study shows how the new tools of neuroscience, such as advances in fMRI, can be used to better understand the psychological mechanisms that lead to a psychiatric disorder.
Impulsivity and risky decision-making is also characteristic of some other disorders including substance dependence, attention deficit hyperactivity disorder, and pathological gambling.

The team say their findings suggest that in bipolar disorder, and potentially other disorders characterized by impulsivity, the weighting of signals in an area called the ventromedial prefrontal cortex “may be biased towards the ventral striatal contribution, and away from the dorsolateral signal.”

The outcome of this bias is that “lower-order, strongly desired outcomes are favoured above and beyond those that fit with the long-term goal.”

A tendency toward hyperactivation of ventral striatum appears to take place both during anticipation and experience of rewards, among participants with bipolar disorder.

“When immediate rewards are likely to be available, this group have a greater drive to obtain them,” the researchers explain, because rewards have “a greater hedonic impact” and are “more enticing.”

This process may be part of the link between mania and increases in impulsive and unrestrained reward-seeking behavior. Hence, “bipolar disorder cannot be reduced to affective instability alone,” believes the team.

“Our findings have implications for clinical intervention,” they add. For example, psychotherapeutic interventions might be aided by specifically focusing on problems with goal regulation.

In addition, the brain pathways involved could suggest targets for new pharmacological treatments. “In particular, interventions that bolster dorsolateral prefrontal cortex-mediated cognitive control may be an important direction for future research,” they conclude.

Commenting on the study, Professor Peter Kinderman of Liverpool University said, “This excellent study is yet another example of how psychologists are piecing together the picture of why people experience mental health problems.

“Researchers here found that some people are more strongly motivated to take risks to pursue their goals, feel somewhat more of an emotional ‘high,’ but are also somewhat more likely to experience the distressing mood swings that lead to a diagnosis of bipolar disorder.

“That makes a lot of sense, could point the way to effective therapies, but also helps to make sense of mental health problems; too often seen as inexplicable ‘illnesses.’”


APA Reference 
Collingwood, J. (2014). Study Probes Neuroscience of Bipolar Risk-Taking.Psych Central. Retrieved on November 12, 2014, from http://psychcentral.com/news/2014/11/10/bipolar-risk-taking-explained/77165.html


"Do 12 Steps Cause Suicide?" / Response From A Harm Reduction Advocate


The question of whether 12 step programs "cure" or "cause" anything is a misrepresentation of 12 step doctrine, and, thus, misleading.




12 step doctrine says addiction is a chronic disease that cannot be cured; rather, it is a disease that can be "arrested" so that the disease goes into a full remission, optimally for the rest of one's life.

So to clarify, 12 step programs neither claim to "cause" or "cure" anything.

The research on suicide and other co-occurring mental health issues of a significant number of substance abusers is true, without question. But there are no studies on rates of suicide by 12 steppers to build this argument upon.

Robin Williams' suicide may not have been prevented by his 12 step work, but I don't know that this proves AA caused him harm. There are too many unknown variables to prove his 12 step work encouraged him to end his life. The variables disclosed about Robin included his just having been diagnosed with Parkinson's disease and bipolar disorder.  Other variables we know nothing about include the suicide history within his family or origin, the stability of his home life, work life, and PTSD going back to childhood and more.  An autopsy confirmed that there were no addictive substance in Robin's body following his death.  And had Robin had a drink or cocaine, who is to say he would not have taken his life anyway.  

Although I advocate for harm reduction, I believe Robin Williams' death was sensationalized and exploited to argue that AA was to blame. This, to me, is irresponsible and hurts the evidence-based movement that is the foundation harm reduction.

But what, exactly, is harm reduction? During the past 20 years I've been in practice, I have found that all addiction treatments are, in fact, some form of harm reduction. We've yet to find an infallible treatment for addictions and substance use disorders. However, the change in the DSM terminology is very significant. It differentiates diagnoses of substance abuse and chemical dependency from it's evolved diagnosis of substance use disorder - mild, moderate or severe. 

Those with severe diagnoses (co-morbidity involving diabetes, liver damage, severe psychiatric conditions, dementia, legal, etc) would certainly be appropriate candidates for abstinence over moderation. But as I see it, at the end of the day, from moderation to abstinence it's all harm reduction.

For any patient who repeatedly relapses and is referred to the "higher level of care," this, too, is a form of harm reduction. We've learned how poor the success rates are at inpatient facilities that practice abstinence-only 12-step model approaches. Without guarantees, this too is a harm reduction approach.

In this regard, I believe the term "harm reduction" is obsolete. It is a "given" in any treatment to practice some form of harm reduction. The professional who believes relapse prevention techniques and behavior modification are not a form of harm reduction is terribly misinformed.

But I will state for the record, I believe more substance users will be attracted to treatment facilities that are not abstinence-only, where clients' lives will be saved by being medically monitored by trained professionals. Once stabilized, every patient--regardless of their clinical needs, has the right to have reasonable access and education regarding current evidence-based treatment. Ultimately, it is the patient's right to be empowered to make choices regarding his or her own health and treatment.

Unfortunately, the polarization of professionals who see harm reduction and abstinence as opposing treatment models often do not empower clients with education of all current treatment and self help options accessible for substance use disorders.

This is a serious bias in our field that dis-empowers patients ("knowledge is power"),  with potential to cause more harm to those substance users at risk out there.


Response to "12 Steps Are Anti-Medication and Anti-Psychiatry"

I've heard  some 12 Step members at some meetings discourage the use of any medications for psychiatric disorders. But which ones do and which ones do not is another variable that must be considered before lumping ALL 12 step meetings together.

Furthermore, NA, another 12 step program, does not advise its members to discontinue any medications.  

So, I find many generalizations and misinformation in the argument that these programs cause suicides (show me the data--I love research!). 


There is no uniformity in 12 step meetings town to town, city to city, state to state, country to country (planet to planet).  No two AA meetings are exactly alike or conducted the exact same way. Sponsors vary is how they coach, train or work with sponsees and without uniformity, the variables between meetings and protocols are too great to reach an evidence-based conclusion that "12 step programs cause suicide."

Besides location (NY meetings are run differently from Alabama meetings) other variables include gender, political ideals--there are always politics, even at 12 step meetings, age, sexual orientation, socio-economic backgrounds of members, etc.   Furthermore, OA (Overeaters Anonymous), DA (Debtors Anonymous), SA (Sex Anonymous), SCA (Sexual Compulsives Anonymous) and SLA (Sex and Love Anonymous) are also 12-step programs that work with both moderation and abstinence.  Again, there is no uniformity within the scope of the 12 steps. It is simply impossible to draw conclusions about all 12 step programs the same way.

Thus, with so many different variables, how can one conclude anything about 12 step meetings as a whole? Too many assumptions are based on opinion or anecdotes without evidence to back them up.

In Response to 12 step programs "playing doctor or psychiatrist"

Regarding physicians and medication, the 3rd Edition of the AA Big Book reads:

 "God has abundantly supplied this world with fine doctors, psychologists, and practitioners of various kinds. Do not hesitate to take your health problems to such persons. Most of them give freely of themselves, that their fellows may enjoy sound minds and bodies. Try to remember that though God has wrought miracles among us, we should never belittle a good doctor or psychiatrist. Their services are often indispensable in treating a newcomer and in following his case afterward." (AA Big Book, 3rd Edition p.133.)

I know of no where in the Big Book to support any 12 step member who tries to "play doctor." 

Summary


I am neither defending nor attacking AA, but I am being objective.  And many claims are made with bias instead of research, which is the foundation of evidence-based movement for harm reduction and abstinence treatment models.




    Integrated Pain Management and Addiction Prevention







    Pain Management practices would benefit by having an addiction professional as part of their interdisciplinary team just as addiction treatment centers would benefit from a pain management professional educating and monitoring their clients. I would be very interested in working with a pain management practice for the benefit of clients, staff, and the organization as a whole. 

    Opiate addiction has sky rocketed among the elderly, adolescents, young adults and mid-life adults. Since the cost of heroin is cheaper than the cost of prescription pain killers, I have treated many clients for severe opioid use disorders.

    The challenge of pain management and addiction is great. We need more training and research to assist those substance users in chronic pain. No faith-based approach I am aware of addresses this important issue. 

    Successful pain management in the recovering addict provides primary care physicians with unique challenges. Pain control can be achieved in these individuals if physicians follow basic guidelines such as those put forward by the Joint Commission on Accreditation of Healthcare Organizations in their standards for pain management as well as by the World Health Organization in their stepladder approach to pain treatment.

    Legal concerns with using pain medications in addicted patients can be dealt with by clear documentation of indication for the medication, dose, dosing interval, and amount provided. Terms physicians need to be familiar with include physical dependence, tolerance, substance abuse, and active versus recovering addiction. Treatment is unique for 3 different types of pain: acute, chronic, and end of life. Acute pain is treated in a similar fashion for all patients regardless of addiction history.

    However, follow-up is important to prevent relapse. The goal of chronic pain treatment in addicted patients is the same as individuals without addictive disorders—to maximize functional level while providing pain relief. 

    "To minimize abuse potential, it is important to have 1 physician provide all pain medication prescriptions as well as reduce the opioid dose to a minimum effective dose, be aware of tolerance potential, wean periodically to reassess pain control, and use non-psychotropic pain medications when possible.

    Patients who are at the end of their life need to receive aggressive management of pain regardless of addiction history. This management includes developing a therapeutic relationship with patients and their families so that pain medications can be used without abuse concerns. By following these strategies, physicians can successfully provide adequate pain control for individuals with histories of addiction."


     

    Treatment is unique for 3 different types of pain: acute, chronic, and end of life. Acute pain is treated in a similar fashion for all patients regardless of addiction history. However, follow-up is important to prevent relapse. The goal of chronic pain treatment in addicted patients is the same as individuals without addictive disorders—to maximize functional level while providing pain relief. 

    However, to minimize abuse potential, it is important to have 1 physician provide all pain medication prescriptions as well as reduce the opiate dose to a minimum effective dose, be aware of tolerance potential, wean periodically to reassess pain control, and use non-psychotropic pain medications when possible. Patients who are at the end of their life need to receive aggressive management of pain regardless of addiction history.
     
    This management includes developing a therapeutic relationship with patients and their families so that pain medications can be used without abuse concerns. By following these strategies, physicians can successfully provide adequate pain control for individuals with histories of addiction."




    Pain Management practices would benefit by having an addiction professional as part of their interdisciplinary team. I would be very interested in working with a pain management practice for the benefit of clients, staff, and the organization as a whole. 

    Risk Factors of Suicide in Military Life

    RISK FACTORS

    "Risk factors" refers to an individual's characteristics, circumstances, history and experiences that raise the risk for suicide.

    HOW TO READ THE 'NEGATIVE LIFE EVENTS THAT INCREASE SUICIDE RISK' LIST: Having experienced any one (or even several) of the items listed in the Negative Life Events list does not necessarily mean that a person is suicidal or contemplating self-harm. However, these negative experiences do increase the risk of suicidal behavior when compared with individuals who have not experienced such events.

    INCREASED DISPOSITION TO ENGAGE IN SELF-HARM: When compared with individuals who have not experienced these events, the occurrence of an immediate "precipitating event" such as a personal crisis may increase the suicide risk for people who have previously encountered the life events noted in the Negative Life Events list.

    NEGATIVE LIFE EVENTS THAT INCREASE SUICIDE RISK:

    • History of one or more prior suicide attempts.
    • Family history of suicide.
    • Exposure to the suicidal behavior of others.
    • History of violence or hostility.
    • History of family violence.
    • History of physical or sexual abuse.
    • Psychiatric illness.
    • Family history of mental disorder or substance abuse.
    • Chronic physical illness, including chronic pain.
    • Loss of health (real or imaginary).
    • Recent, severe loss (especially a marriage or relationship), or threat of significant loss.
    • Being faced with a situation of humiliation or failure.
    • Recent or impending incarceration.
    • Difficult times: holidays, anniversaries, and the first week after discharge from a hospital; just before and after diagnosis of a major illness; just before and during disciplinary proceedings.
    • Assignment or placement into a new and/or unfamiliar environment.
    • Difficulty adjusting to new demands and different workloads.
    • Lack of adequate social and coping skills.
    • Academic, occupational, or social pressures.
    • Loss of job, home, money, status, self-esteem, personal security.


    OTHER RISK FACTORS RELEVANT TO MILITARY LIFE:

    • Male gender.
    • Caucasian race.
    • E-1 to E-2 rank.
    • Younger than 25 years of age.
    • GED/less than high-school education.
    • Divorce or recent relationship failure.
    • Regular component.
    • Drug and Alcohol Abuse.
    • Relationship Problems.
    • Legal, administrative, and financial problems.


    PROTECTIVE FACTORS

    Protective factors are skills, strengths, or resources that help people deal more effectively with stressful events. Protective factors enhance resilience and help to counterbalance risk factors (negative life events such as academic, occupational, or social pressures). Protective factors may be personal, external, or environmental. A protective factor reduces the likelihood of attempting or completing a suicide. Increasing protective factors can decrease suicide risk. Strengthening protective factors should be an ongoing process to increase resiliency when increased risk factors or other stressful situations occur. Positive resistance to suicide is not necessarily permanent; programs that support and maintain protection against suicide should be ongoing.

    Personal Protective Factors

    • Attitudes, values, and norms prohibiting suicide, for example strong beliefs about the meaning and value of life.
    • Positive social skills, such as decision-making, problem-solving, and anger management.
    • Good health and access to mental and physical health care.
    • Strong connections to friends, family, and supportive significant others.
    • Cultural, religious or spiritual beliefs that discourage or prohibit suicide.
    • A healthy fear of risky behaviors and pain.
    • Hope for the future; optimism.
    • Sobriety.
    • Medical compliance and a sense of the importance of health and wellness.
    • Impulse control.
    • Strong sense of self-worth or self-esteem.
    • Sense of personal control or determination.
    • Good frustration tolerance and ability to regulate emotions.
    • Positive beliefs about the future, ability to cope and life in general.
    • Access to a variety of clinical interventions and support for help-seeking.
    • Coping skills.
    • Resiliency.
    • Reasons for living.
    • Being married or a parent.


    External/Environmental Protective Factors

    • Strong relationships, particularly with family members.
    • Opportunities to participate in and contribute to school and/or community projects/activities.
    • A reasonably safe and stable environment.
    • Restricted access to lethal means.
    • Responsibilities/duties to others.
    • Pets.
    • Spirituality.
    • Sense of Belongingness.


    WARNING SIGNS

    Definition: Suicide is the deliberate taking or ending of one's own life. It is often associated with a severe crisis that does not go away, that may worsen over time, or that may appear hopeless. Friends or loved ones in crisis may show signs that indicate that they are at risk of attempting or committing suicide.Warning Signs:

    • People who are considering suicide often show signs of depression, anxiety, or some form of crisis in their overall self-esteem. Specific signs include:
    • Appearing sad or depressed most of the time.
    • Clinical depression - deep sadness, loss of interest, trouble sleeping and eating - that doesn't go away or that continues to get worse.
    • Feeling anxious, agitated, or unable to sleep, or sleeping all the time.
    • Neglecting personal welfare; deteriorating physical appearance.
    • Withdrawing from friends, family, and society.
    • Loss of interest in hobbies, work, school, or other things one used to care about.
    • Frequent and dramatic mood changes.
    • Expressing feelings of excessive guilt or shame.
    • Feelings of failure or decreased performance.


    • People who are considering suicide:

    • Feel hopeless, helpless, worthless.
    • Feel that life is not worth living or see no reason for living.
    • Have no sense of a life purpose.
    • Have feelings of desperation, and say that there's no solution to their problems.
    • Talk about feeling trapped - like there is no way out of a situation.


    • People who are thinking about ending their lives are often preoccupied with death or suicide. They may:


    • Talk of a suicide plan or making a serious attempt.
    • Frequently talk or think about death, or say things like "It would be better if I wasn't here", or "I want out".
    • Talk, write, or draw pictures about death, dying, or suicide when these actions are out of the ordinary for the person.
    • Talk about suicide in a vague or indirect way, saying things like: "I'm going away on a real long trip"; "You don't have to worry about me anymore"; "I just want to go to sleep and never wake up"; or "Don't worry if you don't see me for a while".


    • A person who is contemplating ending their life may show behavior that looks as though he or she is "getting ready", and do things like:


    • Give away prized possessions.
    • Put affairs in order, tie up loose ends, and/or make out a will.
    • Seek access to firearms, pills, or other means of harming oneself.
    • Call or visit family and/or friends as if to say goodbye.


    • People who are considering suicide may show dramatic changes in behavior, such as:


    • Performing poorly at work or school.
    • Acting recklessly or engaging in risky activities - seemingly without thinking.
    • Looking as though one has a "death wish" such as tempting fate by taking risks that could lead to death, or driving fast or running red lights.
    • Taking unnecessary risks; behaving in a reckless and/or impulsive manner.
    • Show violent behavior such as punching holes in walls, getting into fights or self-destructive violence; feeling rage or uncontrolled anger or seeking revenge.
    • Show a sudden, unexpected switch from being very sad to being very calm or appearing to be happy, as if suddenly everything is okay.


    • People who are considering suicide may be experiencing severe loss or potential future lossthat may intensify suicidal thoughts, such as:


    • Real or potential loss or break-up of marriage or important relationship.
    • Combat-related losses.
    • Loss of one's health.
    • Loss of job, home, money, status, self-esteem, personal security.
    • Being faced with a situation of humiliation or failure, such as loss of status or position due to injury or impending disciplinary actions.


    • Other warning signs of suicide risk may include:

    • Increasing tobacco, alcohol or drug use.
    • Signs of self-inflicted injuries, such as cuts, burns, or head banging.
    • May be unwilling to "connect" with potential helpers, i.e., counselor, chaplain, etc.


     COPING

    WHAT IF I LOSE SOMEONE TO A SUICIDE?

    Individuals experience grief uniquely and at their own pace. For some, the experience of grief following a loss can be intense, complex, and long term, while others are able to more readily ‘move on’. The grieving process varies from individual to the next because of many factors: having coped with prior losses; the quality of the relationship with the deceased; the availability of a support system, and so on. What is certain is that the lives of the survivors will be different. At first, and periodically during the next days and months following the loss, survivors may feel an array of sometimes overwhelming emotions. The expression of varying emotions, sometimes accompanied by tears, is a natural part of grieving. Common feelings experienced during grieving include: abandonment, depression, hopelessness, sadness, anger, despair, loneliness, self-blame, anxiety, disbelief, numbness, shame, confusion, guilt, pain, shock, denial, helplessness, rejection, and, of course, general life stress.

    WITH SO MANY FEELINGS TO MANAGE, HOW CAN I COPE?

    1. Take things one day at a time.
    2. Know you can survive; you may not think so, but you can.
    3. Consider getting professional help.
    4. It is okay to not understand "why" it happened; suicide may be difficult to understand and we often are left with unanswered questions.
    5. Know you may feel overwhelmed by the intensity of your feelings but that all your feelings are normal.
    6. Contact a support group or organization for survivors such as TAPS. TAPS is the 24/7 tragedy assistance resource for anyone who has suffered the loss of a military loved one. Their toll-free hotline number is 1-800-959-TAPS (8277).
    7. Find a good listener with whom to share. Call someone if you need to talk.
    8. Don't be afraid to cry. Tears are healing.
    9. Give yourself time to heal.
    10. Remember, the choice was not yours. No one is the sole influence on another's life.
    11. Expect setbacks. If emotions return like a tidal wave, you may only be experiencing a remnant of grief, an unfinished piece.
    12. If possible, delay major decisions.
    13. Be aware of the pain your family and friends may be feeling too. Talking about the person and grieving together can be healing.
    14. Be patient with yourself and others who may not understand.
    15. Set limits and learn to say no.
    16. Avoid people who want to tell you what or how to feel.
    17. Call on your personal faith to help you through.
    18. It is common to experience physical reaction to your grief, e.g. headaches, loss of appetite, inability to sleep.
    19. It is okay to laugh; it may even be healing.
    20. Accept your questions, anger, guilt or other feelings until you can let them go.
    21. Letting go doesn't mean forgetting.
    22. Know that you will never be the same again, but that you can survive and even go beyond just surviving.


    FAMILY AND FRIENDS
    • Trust your instincts that the person may be in trouble.
    • Communication needs to include mostly listening.
    • Talk with the person about your concerns.
    • Ask direct questions without being judgmental, such as:


    • "Are you thinking about killing yourself?"
    • "Have you ever tried to end your life?"
    • "Do you think you might try to kill yourself today?"


    • Determine if the person has a specific plan to carry out the suicide. The more detailed the plan, the greater the risk:


    • "Die by suicide?"
    • "Have you thought about ways that you might kill yourself?"
    • "Do you have pills/weapons in the house?"


    • Do not leave the person alone.
    • Do not swear to secrecy.
    • Do not act shocked or judgmental.
    • Do not counsel the person yourself .
    • Get professional help, even if the person resists.

     
     
    SERVICE MEMBERS AND VETERANS

    • Calling old friends, particularly military friends, to say goodbye.
    • Cleaning a weapon that they may have as a souvenir.
    • Visits to graveyards.
    • Obsessed with news coverage of the war, or the military channel.
    • Wearing the military uniform or part of the uniform, boots, etc., when such dress is not indicated.
    • Talking about how honorable it is to be a soldier.
    • Sleeping more (sometimes the decision to commit suicide brings a sense of peace of mind, and sleep is used as a means of withdrawing).
    • Becoming overprotective of children.
    • Standing guard of the house, perhaps while everyone is asleep; staying up to "watch over" the house; obsessively locking doors, windows.
    • Stopping and/or hording medication.
    • Hording alcohol (not necessarily hard alcohol, could be wine).
    • Spending spree, buying gifts for family members and friends "to remember by."
    • Defensive speech, for example: "You wouldn't understand."
    • Stop making eye contact or speaking with others.

     
     
     

    How PTSD Therapy Works


    PTSD therapies focus on concentrating on 
    the thoughts and cues that trigger stress.



    “We see it all the time and since the wars in Iraq and Afghanistan, we have seen an increase,” said Dr. Ronald Johnson, clinical psychologist at the Lebanon VA Medical Center. “We’ve increased our staff and tried to become more efficient in our therapies in response. We take the safety of our veterans very seriously.”

    Returning soldiers are given a medical and mental health assessment twice within the first 90 days after they leave active duty, Johnson said.

    “Part of why we do this is to identify what needs they have and get them the services they need right away,” he said.

    For a true PTSD diagnosis, in addition to the stressor, there must be intrusive symptoms, said Dr. Scott Bunce, clinical psychologist at Penn State Milton S. Hershey Medical Center.

    "Some people with PTSD can get better and function well, but some never do get over it,'' said clinical psychologist Scott Bunce.

    Bunce said symptoms may include:

    • Involuntary thoughts
    • Nightmares or flashbacks
    • Avoidance symptoms, such as avoiding places or people that bring back reminders
    • Persistent negative beliefs about oneself, which could manifest as “survivor guilt”
    • Hyper-reactivity, such as being hypervigilant, self-destructive
    • Trouble concentrating or sleeping

    “You’ve learned that certain cues are signals for traumatic events that mean the world is not safe for you and so when you hear or see these cues in the future, you will experience stress whether it’s safe or not,” Bunce explained.

    Learning to deal with the memories

    Treatment often includes different types of psychotherapy in conjunction with medications such as anti-depressants and mood stabilizers.

    Prolonged exposure therapy helps by repeatedly exposing the person to the trauma-related thoughts and situations they have been avoiding, but without experiencing the trauma. This lessens the power of the memories.

    Cognitive processing therapy involves the veteran looking at what incorrect thoughts they may have about their role in the trauma and replacing them with accurate, less distressing thoughts, Johnson said.

    “For instance, a patient may say, ‘I should’ve seen that roadside bomb up there so it’s my fault what happened.’ The reality is that it’s difficult to see and so they shouldn’t take that responsibility upon themselves,” he said. “You help them discover their thoughts and come to new conclusions.”

    Relaxation therapy – learning to relax the body through breathing exercises or muscle relaxing techniques – can also help, Bunce said.

    Research into causes and treatments of PTSD is ongoing. One treatment on the horizon is a medication called D-cycloserine, which seems to increase the effectiveness of psychotherapy in helping people process their memories, Bunce said.

    “Some people with PTSD can get better and function well, but some never do get over it,’’ Bunce said. “It depends on the situation that created it, [the individual’s] biological constitution, how much support they get and what kind of help they get.”