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PTSD IN THE CROSS HAIRS: MENDING A SHATTERED SOUL --

Doctors nationwide are testing experimental and conventional

treatments to cure a growing number of afflicted veterans.

 

Veterans practice tai chi at the VA Mare Island Outpatient Clinic.
(photo: Herman Bustamante Jr./Contra Costa Times)

 

Story here... http://www.contracostatimes.com/
news/ci_5622055

Story below:

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Post-traumatic stress disorder in the cross hairs: Mending a shattered soul

Doctors nationwide are testing experimental and conventional treatments to cure a growing number of afflicted veterans

By Dogen Hannah
CONTRA COSTA TIMES

In Iraq, disturbing dreams awakened Christian Valenti in the dead of night, leaving him panicked and drenched in cold sweat.

From the moment his eyelids snapped open, the Army specialist couldn't recall the sights and sounds that had interrupted his sleep. He suspected that they were drawn from his day-to-day experiences as a soldier.

The East Bay native had been bombarded by mortars and been shot at by gunmen. He had seen the bodies of U.S. troops and Iraqi civilians. He had fired his rifle at people and killed some of them.

But he recalled nothing of his dreams.

"I would just wake up and would have no idea what had happened," said Valenti, who spent 14 months in Iraq. "I was terrified."

What was happening, he later learned, was that post-traumatic stress disorder was taking a toll. Only after he began receiving mental health care, including medication and psychotherapy, did the symptoms recede.

"I kind of feel like my old self again," said the 23-year-old Danville resident, retired from the Army and in school. "I sleep pretty well now."

A search for treatment

Valenti's experience is far from unusual, and the potential for hundreds of thousands of Afghanistan and Iraq veterans to develop PTSD has spurred the search for new treatments.

Long and, in many cases, repeated tours of duty have put troops at ever greater risk of developing the disabling disorder. The condition is expected to beset 15 percent to 30 percent of the more than 1.4 million members of the U.S. military who have served in the wars.

"PTSD research is huge because the problem is much larger than it ever was," said Joan Walter, vice president for military medical research at the Samueli Institute in Virginia, which supports PTSD research.

"We have lots of troops being deployed. ... This is a condition that is going to be around for decades."

The scope of the research is broad. It spans the nation and runs from cutting-edge drugs and state-of-the-art technology to centuries-old health practices and communitywide efforts to help veterans.

Success would benefit not just Afghanistan and Iraq veterans. Even today, veterans of previous conflicts are being diagnosed with PTSD for the first time or still are searching for an effective treatment.

Therapies being studied could complement proven treatments. Some researchers are testing drugs that could boost the effectiveness of psychotherapy, for example, while others are studying whether meditation could do the same thing.

"There's a lot of research going into this field," said Jeffrey Matloff, a senior PTSD clinician for the U.S. Department of Veterans Affairs' San Diego Medical Center. "There is no panacea. There's no one single treatment that will work for everyone."

Experimental therapies

In San Francisco, scientists have been enrolling Iraq and Afghanistan veterans in a study that combines psychotherapy with a drug usually used to treat tuberculosis. The drug might boost the effectiveness of psychotherapy.

Scientists in Atlanta have been returning traumatized Iraq and Afghanistan veterans to the battlefield in virtual reality, hoping repeated yet safe and controlled exposure to a simulated traumatic event might ease lingering anxiety caused by the real event.

In Philadelphia, scientists are teaching mindfulness meditation to Iraq veterans. Rooted in Buddhist traditions, the technique might help veterans with PTSD to sleep better and to improve their overall well-being.

The proliferation of research and application of novel therapies is cause for optimism, said PTSD experts. Yet they cautioned that new therapies might not benefit everyone, might be entirely ineffective and might even harm some people.

"My concern ... is that individuals do not become disappointed by therapies that offer a quick cure-all to what can be a very complex disorder," said Gregory Leskin, acting assistant director of the VA's National Center for PTSD in Palo Alto.

A conventional cure

Jeremy Williams doesn't expect to be cured of PTSD. Still, conventional therapy has helped the former Marine come a long way since the disorder fueled his rage and drinking and tore apart his relationship with his wife and two young sons.

The Texas native spent about 16 months at war during three tours in Iraq.

He guarded prisoners of war and insurgent detainees. He patrolled restive cities on foot and in Humvees under constant threat of ambush. He cleared buildings of militants and searched roads for homemade bombs. He was shot at and fired back on countless occasions.

Williams was diagnosed with PTSD symptoms after his first tour. The PTSD became chronic by the end of his second tour, and he was prescribed drugs for nightmares, depression and insomnia.

"It got progressively worse after each deployment," he said. "The thing is, I didn't talk about it because I was afraid I'd get kicked out of the Marine Corps. I decided to swallow it and hide it from everyone the best I could."

Back from the war after his second deployment and living in Southern California, Williams began to isolate himself and to drink heavily, to the point of blacking out. Rage and resentment spurred him to lash out at people, including his wife.

When he went to Iraq for the third time, he could no longer suppress his feelings. He became even more withdrawn and despondent after a couple of disturbing insurgent attacks on him and fellow Marines.

"I couldn't take it anymore," he said. "I was completely and utterly gone."

Soon after that, military doctors decided he was no longer fit for war and sent him back to Camp Pendleton. Later, he was medically discharged from the Marine Corps.

Today, Williams takes medication and sees a psychotherapist weekly. Symptoms of PTSD make life difficult at times, but he has reconciled with his wife, returned to college and is optimistic about the future.

"I'll never be cured," said Williams, who recently moved back to Texas from California. "But in the large spectrum of things, I have learned to better manage my emotions."

Spiritual pause button

At the San Diego VA Medical Center, nurse and researcher Jill Bormann is studying a therapy that could help Williams and other veterans who expect to have to cope with PTSD for the rest of their lives.

The object of Bormann's study are "mantrams," Sanskrit for a repeated word or phrase with a spiritual or religious association. In theory, repeating a mantram, or mantra, as it often is called, during times of stress focuses and calms the mind.

Veterans with PTSD often have knee-jerk, dysfunctional reactions to sights, sounds and other so-called triggers associated with traumatic events. Veterans might be able to use mantrams to short-circuit that response.

"Sometimes it's referred to as a pause button," Bormann said. "It seems to have the effect of slowing down their thinking, allowing them to have less reactivity."

Army veteran Fred Yaekle was skeptical of the therapy but was willing to try it to curb the rage and other PTSD symptoms that had undermined his life for years.

"I went with an open mind and an open heart and took it very seriously," said Yaekle, a retired 60-year-old San Diego resident who fought in the Vietnam War.

Yaekle picked the mantram "om shanti rama" -- meaning, roughly, peace and well-being -- and repeats it when he feels anxious or upset. The mantram calms him even though it has no spiritual meaning for him.

"It's working for me, and I guess that's all that really counts," Yaekle said. "I've had a real, life-changing experience."

Martial arts

In the Bay Area, veterans with PTSD have been benefiting from another ancient health practice: tai chi.

The Chinese martial art uses slow, deliberate movements and breathing to instill balance, relaxation and self-awareness. Noel O'Brien, a VA readjustment counselor, began teaching it to veterans in Oakland and Vallejo about six months ago.

Among his students is Harry Stonelake, 67, a retired Navy captain who flew 130 or so combat missions from an aircraft carrier during two Vietnam War tours.

Beginning in the war, Stonelake came to be plagued by migraines, depression, insomnia and flashbacks. He was treated for those symptoms but wasn't diagnosed with PTSD until he saw a VA physician late last year.

Not long after that, Stonelake began learning tai chi from O'Brien and, as a result, has had fewer migraines and been sleeping better. Not only does he attend O'Brien's weekly class, but he does tai chi on his own every morning for about 40 minutes.

"I am finding this class to be really amazing," the Castro Valley resident said. "The pace of the class just absolutely slows you down. You concentrate on little things, like breathing and balance."

The Oakland Vet Center is one of 207 community-based clinics established after the Vietnam War to help combat veterans readjust to civilian life. Through the years, the centers have tried a variety of alternative PTSD treatments, said Denver Mills, head of the Concord Vet Center.

"We kind of invented therapy for PTSD," said Mills. "We started doing it before they even called it PTSD."

Some of those therapies were unconventional, at least at the time. Veterans have tried sweat lodges, art therapy and "all kinds of weird things" to ease PTSD symptoms, said Mills.

"It helps," Mills said of unconventional therapies. "It really does."

Virtual reality

In addition to exploring ancient healing techniques, researchers are investigating whether some of the latest technology can help veterans struggling with PTSD to lead better lives.

At Emory University in Atlanta, traumatized Iraq veterans have been returned, in a way, to the war. By donning a head-mounted video display and earphones, veterans are immersed in a virtual representation of the battlefield.

The technology is intended to enhance a PTSD treatment called exposure therapy and to complement medications used to reduce fear or anxiety.

In theory, repeated exposure to a previously traumatic event in a safe place and in a controlled way reduces anxiety associated with the event, said assistant professor Maryrose Gerardi, one of the Emory researchers.

Virtual reality technology lets therapists present a convincing depiction, tailored to each veteran's experience, of battlefield events. That makes it harder for veterans to avoid the necessity of revisiting traumatizing events.

The technology also can produce vibrations and odors, such as that of diesel fuel. It can simulate close-quarters urban combat or an attack on a convoy, complete with blasts from roadside bombs, insurgents firing assault rifles and helicopters thudding overhead.

"We really are trying to have an experience that involves as many senses as possible," Gerardi said. "While it looks like a video game to the rest of us, those cues really help people tap into their own experience."

A helping hand

Elsewhere, the search for new therapies includes a holistic approach. In the Bay Area, Zen teacher and psychologist Joseph Bobrow launched a project in January to help Afghanistan and Iraq veterans and their families adjust to life after returning from war.

The Coming Home Project gathers veterans and their relatives for a daylong series of mental health workshops. The project aims to provide a confidential and supportive environment for people to express themselves and learn coping tools, such as yoga and meditation.

Prescription drugs and other conventional therapies "may help an individual person temporarily and in a meaningful way," Bobrow said. But to treat PTSD only as a psychiatric or medical condition misses the spiritual and cultural role in healing veterans' psyches, he said.

"This is what a number of us are struggling to get across," Bobrow said. "We need to think holistically about PTSD."

Toward that goal, the project seeks to educate the public about the challenges facing veterans and military families and to spur a communitywide response to help with those challenges.

"People have drawn great strength from the greatest resource of all, which is one another," Bobrow said. "The community is the missing link in healing PTSD."

Finding comfort

Emerging alternative PTSD therapies such as mantrams, drugs, meditation and the Coming Home Project show promise. In the meantime, conventional treatments such as drugs and psychotherapy still can help. That has been the case for Valenti, the Iraq veteran with PTSD.

Even after he returned to Danville, the mysterious dreams that he had while at war disturbed his sleep. He was irritable, listless and anxious, especially when among people in public places.

At first, psychotherapy was difficult, he said, because it was hard to discuss traumatic events openly. Over time he became more comfortable with it, as the weekly discussions began to help him adjust to life after war.

"Now, I look forward to it," Valenti said. "I just feel better every time I come out."

Dogen Hannah covers the military and the home front. Reach him at 925-945-4794 or dhannah@cctimes.com.

By the numbers

More than 1.4 million members of the U.S. military have served in the Iraq and Afghanistan wars. Experts estimate that 15 percent to 30 percent of troops in those wars will develop PTSD.

What is post-traumatic stress disorder?

An anxiety disorder some people develop as a result of experiencing or witnessing a traumatic event. Such trauma include life-threatening events such as combat, natural disasters, terrorist incidents, serious accidents, or physical or sexual assault.

People with PTSD can experience three sets of symptoms:

# Reliving the trauma in some way, such as becoming upset when confronted with a traumatic reminder or thinking about the trauma when trying to do something else;

# Staying away from places or people that remind one of the trauma, isolating from other people, or feeling numb;

# Feeling on guard or irritable, or startling easily.

PTSD can be hard to diagnose because people who suffer from it often develop additional disorders such as depression, substance abuse, problems of memory and cognition, and other physical or mental health problems.

More information: www.ncptsd.va.gov/ncmain/index.jsp

Alternative PTSD therapies being studied or applied

Mindfulness Meditation: Enhances awareness of moment-to-moment experience of perceived mental processes; creates greater awareness of body sensations, feelings and thoughts.

What it does: Might improve the sleep and psychological wellness of veterans with PTSD.

Acupuncture: Component of traditional Chinese medicine; involves the insertion of small needles along body's energy pathways, or meridians, and at other points to restore energy flow.

What it does: Seeks to ease stress, anxiety and other PTSD symptoms.

Eye Movement Desensitization and Reprocessing: As patient brings traumatic events to mind, therapist facilitates "bilateral stimulation" by, for example, repeatedly moving a handheld light across the patient's field of view.

What it does: Seeks to help patients experience memories of traumatic events in new and less-disturbing ways.

Emotional Freedom Therapy: Based on acupuncture's identification of body's energy pathways, or meridians. Instead of inserting needles, therapists tap their fingers along meridians as patient relates traumatic event.

What it does: Seeks to ease fear and anxiety associated with trauma by disconnecting the triggers for those emotions from the body's energy system.

Mantram Repetition: Word or phrase with spiritual or religious associations repeated aloud or silently to focus attention and calm thoughts.

What it does: Seeks to ease feelings of anger, anxiety and stress and other PTSD symptoms.

Yoga: Centuries-old practice that uses meditation, breathing, postures and movement to attain physiological and spiritual well-being.

What it does: Deep relaxation, breathing and meditation might reduce physical, emotional, mental and subconscious tension of PTSD.

Virtual Reality Exposure: Head-mounted screen, earphones and other technology that depicts sights, sounds, smells and other battlefield sensations.

What it does: Enables people to revisit traumatic events in a safe, controlled environment; desensitizes people to traumatic events, easing PTSD symptoms.

D-cycloserine: Drug usually used to treat tuberculosis.

What it does: When combined with a form of psychotherapy for PTSD, might speed up reduction of PTSD symptoms.

Tai chi: Chinese martial art employing slow, deliberate movements and breathing.

What it does: Seeks to instill balance, relaxation and self-awareness; improves overall well-being and eases anxiety, stress, anger and other PTSD symptoms.

Sources: U.S. Department of Veterans Affairs; U.S. National Institutes of Health; psychotherapists

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Larry Scott  --