Despite the myth that post-traumatic stress disorder (PTSD) is a lifelong condition, there are effective treatments that have helped trauma survivors including veterans, researchers said at a AAAS briefing on Capitol Hill in Washington, D.C.
"A lot of us go through traumas throughout our lives whether it be horrible car accidents or a sudden death of a loved one and we don't expect to be miserable for our entire life about the event. But there's some bad messaging to our warriors that makes them think that this is something that they will suffer with permanently," said Kathleen Chard, professor of psychiatry and behavioral neuroscience at the University of Cincinnati. "PTSD is a life-debilitating event only if we allow it to be."
"Treating Post-Traumatic Stress," a 9 May briefing in Rayburn House Office Building on Capitol Hill, was the first of three 2014 neuroscience briefings on Capitol Hill hosted by AAAS in conjunction with Rep. Chaka Fattah and through the support of the Dana Foundation.
Having visited several labs that study brain disorders around the United States, Fattah said that the research appears to be at a tipping point where real progress can be made. "We have to make spending and investment decisions to help advance the science, but in order to do that, the Congress has to understand more about the state of the science and where the opportunities are," he said. "This briefing, like the others, is about having us build a currency for knowledge so that we can help move this bipartisan consensus forward in the way in which we can really make a contribution."
"PTSD has probably been a phenomenon that's been around for decades but was ignored for decades," said Alan Leshner, AAAS chief executive officer and executive publisher of the journal Science. "It has received more and more attention over time and is a major issue about which we need good policy."
The speakers agreed that post-traumatic stress is not a new condition. "Anybody who believes that it is just this generation of warriors that has this problem is really, really mistaken," said Gen. Peter Chiarelli, U.S. Army (retired) and chief executive officer of One Mind for Research. "Post-traumatic stress and traumatic brain injury have been around since mankind created war."
Moreover, veterans aren't the only individuals suffering from post-traumatic stress. Eight percent of Americans will suffer from PTSD at some point in their lifetimes, Chard said. Motor vehicle accidents, crime, and natural disasters are just a few of the scenarios that can lead to post-traumatic stress and have nothing to do with the military. "These are huge problems, not just for the military for but civilian society as a whole," Chiarelli said.
After a traumatic experience, survivors frequently link the trauma to neutral elements that were present during the experience. For example, it's not uncommon for those who escaped the World Trade Center on 9/11 to have fears linked to stairwells. "We learn to fear what our traumatic event was and we generalize it," said JoAnn Difede, director of the Program for Anxiety and Traumatic Stress Studies at Weill Cornell Medical College. "We come back from whatever our situation was and we're likely to be afraid of flying, we're likely to be afraid of going in bridges and tunnels, we're likely to not want to listen about bad things, because we have now generalized those cues to whatever the particular trauma was."
In prolonged exposure therapy, an evidence-based treatment for PTSD, patients talk about the trauma with a therapist over several sessions until the cues no longer create fear. "We help our patients process their memories in such a way that they can reorganize it and understand that it is something that happened in the past that is not happening again, and that frees them up to go on and go forward," Difede said.
While observers mistakenly believe that encouraging trauma survivors to directly engage with their memories is cruel, Difede disagreed, explaining that PTSD is characterized by intrusive thoughts that force survivors to relive their trauma. "We are not asking people to do something that their brain already isn't doing," she said. "In fact, we're introducing a sense of mastery."
Cognitive processing therapy is also an evidence-based treatment for PTSD, but unlike prolonged exposure therapy, it does not require that patients tell the full story of their trauma "There is no excuse for not getting help if the reason is that you don't want to tell your story," Chard said. "Because you can still get better by focusing on what it means to you that it happened, not discussing what happened."
Trauma often upsets an individual's belief in a just world where those who commit good or evil acts will be rewarded or punished accordingly, leading trauma survivors to conclude that they must have done something wrong. In cognitive processing therapy, patients start by learning about PTSD and talking about how the trauma has affected them and their beliefs about the world. They then may choose to write about the trauma and discuss what they tell themselves about the experience. Finally, patients learn to deal with trauma going forward by identifying and evaluating their related cognitive distortions, irrational negative thoughts that compound PTSD symptoms.
Chiarelli encouraged policymakers and researchers to decrease their use of the term PTSD because a lot of soldiers don't want to be told that they have disorder, making the term an unnecessary barrier to treatment.
"I think that before too long, we're going to be able to understand the biology and understand what happens in the brain and it will no longer be a disorder," Chiarelli said. "It will be an injury that occurs to the brain. Injuries can be healed."
Much more research on post-traumatic stress is needed and many in the field of psychiatry hesitate to use the word "cure" but Difede said that it may not be that far away. "We talk about cures for cancer," she said. "We should talk about cures for post-traumatic stress as well." Evidence emerging from pre-clinical studies suggests that this possibility may become real "sooner than we think," she said.
"A cure does not mean not caring that the trauma happened," Chard said. "A cure just means that it doesn't control your life anymore."