Prior imaging studies of people with PTSD have shown that these brain regions can over- or underreact in response to stressful tasks, such as recalling a traumatic event or reacting to a photo of a threatening face.

Researchers now believe chronic trauma can inflict lasting damage to brain regions associated with fear and anxiety.

In the new study, researchers at New York University School of Medicine explored for the first time what happens in the brains of combat veterans with PTSD in the absence of external triggers.

Investigators say the findings, published in Neuroscience Letters, show that the effects of trauma persist in certain brain regions even when combat veterans are not engaged in cognitive or emotional tasks, and face no immediate external threats.

Experts believe this knowledge is a critical step toward better diagnostics and treatments for PTSD as it shows which areas of the brain provoke traumatic symptoms.

PTSD can plague victims with disturbing memories, flashbacks, nightmares and emotional instability. Among the 1.7 million men and women who have served in the wars in Iraq and Afghanistan, an estimated 20 percent have PTSD. Research shows that suicide risk is higher in veterans with PTSD.

Tragically, more soldiers committed suicide in 2012 than the number of soldiers who were killed in combat in Afghanistan that year.

“It is critical to have an objective test to confirm PTSD diagnosis as self-reports can be unreliable,” said co-author Charles Marmar, M.D.

The study, led by Xiaodan Yan, a research fellow at NYU School of Medicine, examined “spontaneous” or “resting” brain activity in 104 veterans of combat from the Iraq and Afghanistan wars using functional MRI, which measures blood-oxygen levels in the brain.

The researchers found that spontaneous brain activity in the amygdala, a key structure in the brain’s “fear circuitry” that processes fearful and anxious emotions, was significantly higher in the 52 combat veterans with PTSD than in the 52 combat veterans without PTSD.

The PTSD group also showed elevated brain activity in the anterior insula, a brain region that regulates sensitivity to pain and negative emotions.

Moreover, the PTSD group had lower activity in the precuneus, a structure tucked between the brain’s two hemispheres that helps integrate information from the past and future, especially when the mind is wandering or disengaged from active thought.

Decreased activity in the precuneus correlates with more severe “re-experiencing” symptoms—that is, when victims re-experience trauma over and over again through flashbacks, nightmares and frightening thoughts.

Source: NYU Langone Medical Center / New York University School of Medicine

Abstract of a person’s brain photo by shutterstock.

Experts say the study is the first to look at the effects of smoking and age on neurocognition in people seeking treatment for alcohol dependency.

Researchers say the findings are important because treatment for alcohol use disorders is more effective if a person actively understands and adopts the interventions. Multiple factors may impede cognition during early abstinence including chronic cigarette smoking and increasing age.

In the study, researchers discovered alcohol dependent (AD) individuals who currently smoke show more problems with memory, ability to think quickly and efficiently, and problem-solving skills than those who don’t smoke, effects which seem to become exacerbated with age.

Study results will be published in Alcoholism: Clinical & Experimental Research and are currently available at Early View.

“Several factors — nutrition, exercise, comorbid medical conditions such as hypertension and diabetes, psychiatric conditions such as depressive disorders and post-traumatic stress disorder, and genetic predispositions — may also influence cognitive functioning during early abstinence,” explained Timothy C. Durazzo, Ph.D., corresponding author for the study.

“We focused on the effects of chronic cigarette smoking and increasing age on cognition because previous research suggested that each has independent, adverse affects on multiple aspects of cognition and brain biology in people with and without alcohol use disorders.

“This previous research also indicated that the adverse effects of smoking on the brain accumulate over time. Therefore, we predicted that AD, active chronic smokers would show the greatest decline in cognitive abilities with increasing age.”

The interactive effects of smoking and other drug use on cognitive functioning among those with alcohol dependence are largely unknown.

“This is problematic because many heavy drinkers also smoke. Furthermore, in treatment programs for alcoholism, the issue of smoking may be largely ignored,” said Alecia Dager, Ph.D., associate research scientist in the department of psychiatry at Yale University.

Experts believe the current study provides important insights for treatment programs.

First, individuals with AD who also smoke may have more difficulty remembering, integrating and implementing treatment strategies. Second, there are clear benefits for thinking skills as a result of quitting both substances.

Durazzo and his colleagues compared the neurocognitive functioning of four groups of participants, all between the ages of 26 and 71 years of age: never-smoking healthy individuals as controls (n=39); and one-month abstinent, treatment-seeking AD individuals, who were never-smokers (n = 30), former-smokers (n = 21) and active-smokers (n = 68).

Researchers assessed cognitive efficiency, executive functions, fine motor skills, general intelligence, learning and memory, processing speed, visuospatial functions, and working memory.

“We found that, at one month of abstinence, actively smoking AD [individuals] had greater-than-normal age effects on measures of learning, memory, processing speed, reasoning and problem-solving, and fine motor skills,” said Durazzo.

“AD never-smokers and former-smokers showed equivalent changes on all measures with increasing age as the never-smoking controls. These results indicate the combination of alcohol dependence and active chronic smoking was related to an abnormal decline in multiple cognitive functions with increasing age.”

“These results indicate the combined effects of these drugs are especially harmful and become even more apparent in older age,” said Dager.

“In general, people show cognitive decline in older age. However, it seems that years of combined alcohol and cigarette use exacerbate this process, contributing to an even greater decline in thinking skills in later years.”

Source: Alcoholism: Clinical & Experimental Research

Abstract of the human brain photo by shutterstock.

Researchers from the National Center for Veterans Studies at the University of Utah also found that the risk for suicidal behaviors and thoughts increased not only in the short term, but during the soldier’s entire life.

“Up to now, no one has been able to say if multiple TBIs, which are common among combat veterans, are associated with higher suicide risk or not,” said the study’s lead author, Craig J. Bryan, Ph.D., assistant professor of psychology at the University of Utah and associate director of the National Center for Veterans Studies.

“This study suggests they are, and it provides valuable information for professionals treating wounded combat servicemen and women to help manage the risk of suicide.”

During a six-month period in 2009, 161 patients who received a suspected brain injury while on duty in Iraq were referred to an outpatient TBI clinic at a combat support hospital.

The researchers found that one in five (21.7 percent) who had sustained more than one TBI reported suicidal ideation, described as thoughts about or preoccupation with suicide.

For those who had received one TBI, 6.9 percent reported having suicidal thoughts. Zero percent of those with no TBIs reported suicidal thoughts.

In evaluating the lifetime risk, researchers asked patients if they had ever experienced suicidal thoughts and behaviors up to the point they were assessed.

The increases were similar for suicidal thoughts during the previous year rather than at any time, according to the researchers. They found that 12 percent of those with multiple TBIs had entertained suicidal ideas during the past year, compared with 3.4 percent with one TBI, and 0 percent for no TBIs.

The researchers explained that they used suicidal ideation as the indicator of suicide risk because too few patients reported a history of making a suicide plan or had made a suicide attempt for statistically valid conclusions to be made.

Researchers also found that multiple TBIs were associated with a significant increase in other psychological symptoms, including depression and post-traumatic stress disorder (PTSD). However, only the increase in depression severity predicted an increased suicide risk, they noted.

“That head injury and resulting psychological effects increase the risk of suicide is not new,” Bryan said. “But knowing that repetitive TBIs may make patients even more vulnerable provides new insight for attending to military personnel over the long-term, particularly when they are experiencing added emotional distress in their lives.”

Because researchers were in Iraq, they were able to compile “a unique data set on active military personnel and head injury,” Bryan said. “We collected data on a large number of service members within two days of impact.”

He noted that researchers assessed only patients with mild or no TBI at the combat hospital. Those with moderate to severe TBI were immediately evacuated from Iraq.

The patients remaining in the study were divided into three groups based the total number of TBIs during their entire lives — zero, one, and two or more. The most recent TBI was typically within the days immediately preceding their evaluation and inclusion in the study.

Each soldier was also surveyed about their symptoms of depression, PTSD and concussions, and their suicidal thoughts and behaviors.

TBI is considered a “signature injury” of the Iraq and Afghanistan conflicts, according to the researchers. They note it is of particular concern because of the frequency of concussive injuries from explosions and other combat-related incidents. Estimated prevalence of TBI for those deployed in these two countries ranges from 8 percent to 20 percent, according to a 2008 study.

Additionally, past studies have found that suicide is the second-leading cause of death among U.S. military personnel, with the rate rising steadily since the conflicts began in Iraq and Afghanistan.

Prevalence of PTSD, depression and substance abuse have risen as well, especially among those in combat, and each has been shown to increase risk for suicidal behaviors, researchers noted.

“Being aware of the number of a patient’s head injuries and the interrelation with depression and other psychological symptoms may help us better understand, and thus moderate, the risk of suicide over time,” Bryan said. “Ultimately, we would like to know why people do not kill themselves. Despite facing similar issues and circumstances, some people recover. Understanding that is the real goal.”

The study was published in JAMA Psychiatry.

Source: University of Utah

Soldier holding his head photo by shutterstock.

“I think [health care] providers are more aware of the common occurrence of depression in patients with chronic pain, and there has been less of an emphasis on anxiety,” said lead author Kurt Kroenke, M.D., professor of medicine at Indiana University in Indianapolis.

The study involved 250 patients who were being treated at a veterans’ medical center in the Midwest. All patients suffered from moderate to severe chronic joint or back pain that had lasted at least three months despite pain medications.

All participants were screened for five common anxiety disorders: generalized anxiety (persistent worry); panic, or sudden, repeated attacks of fear; social anxiety (overwhelming anxiety in everyday social interactions); post-traumatic stress, or a repeated feeling of danger after a stressful event; and obsessive-compulsive disorder (repeated thoughts or rituals that interfere with daily life).

Patients were also screened for health-related quality of life issues, such as fatigue, sleep habits, and work productivity.

The findings showed that 45 percent of the chronic pain patients screened positive for at least one or more of the common anxiety disorders.

Those who had an anxiety disorder also reported significantly worse pain and health-related quality of life than patients without a disorder.

“It is important to note that patients in our study screened positive for an anxiety disorder but not all would have a full-blown anxiety disorder if they had a diagnostic psychiatric interview,” said Kroenke.

“Some may just have anxiety symptoms and not all would warrant active treatment. However, probably at least 1 in 5 might have some type of anxiety disorder.”

The results also showed that it was common for the five different types of anxiety conditions to occur in combination with each other and with depression.

“Psychological comorbidities are common in patients with chronic low back pain and other studies have also shown a high prevalence of depression, anxiety and other psychological conditions,” said pain expert Roger Chou, M.D., an assistant professor of medicine at Oregon Health & Science University.

Chou added that the clinician guidelines for managing lower back pain do recommend that physicians evaluate patients for psychological factors that may be contributing to a poorer prognosis.

“Many patients benefit from cognitive behavioral therapy to help them in coping with the pain and related anxiety,” Chou continued.

“Just throwing pain medications at someone like this doesn’t tend to be very effective since you’re not dealing with an important driver of the pain.”

Source:  Center for Advancing Health

Such discoveries have the possibility of leading to new, specific treatment protocols for post-traumatic stress disorder among individuals who experienced child abuse.

In the study, researchers examined adult civilians with PTSD (post-traumatic stress disorder) and found that individuals with a history of childhood abuse have distinct, profound changes in gene activity patterns, compared to adults with PTSD but without a history of child abuse.

Investigators took blood samples from 169 participants in the Grady Trauma Project, a study of more than 5,000 Atlanta residents with high levels of exposure to violence, physical and sexual abuse and with high risk for civilian PTSD.

“These are some of the most robust findings to date showing that different biological pathways may describe different subtypes of a psychiatric disorder, which appear similar at the level of symptoms but may be very different at the level of underlying biology,” said Kerry Ressler, M.D., Ph.D., professor of psychiatry and behavioral sciences at Emory University.

“As these pathways become better understood, we expect that distinctly different biological treatments would be implicated for therapy and recovery from PTSD based on the presence or absence of past child abuse.”

Study results are found online in the Proceedings of the National Academy of Sciences, Early Edition.

Divya Mehta, Ph.D., a postdoctoral fellow at the Max Planck Institute of Psychiatry in Munich, Germany,  and her colleagues examined changes in the patterns of which genes were turned on and off in blood cells from patients.

They also looked at patterns of methylation, a DNA modification on top of the four letters of the genetic code that causes genes to be “silenced” or made inactive.

For the study participants were divided into three groups: people who experienced trauma without developing PTSD, people with PTSD who were exposed to child abuse, and people with PTSD who were not exposed to child abuse.

The researchers were surprised to find that although hundreds of genes had significant changes in activity in the PTSD with and without child abuse groups, there was very little overlap in patterns between these groups.

The two groups shared similar symptoms of PTSD, which include intrusive thoughts such as nightmares and flashbacks, avoidance of trauma reminders, and symptoms of hyperarousal and hypervigilance.

The PTSD with child abuse group displayed more changes in genes linked with development of the nervous system and regulation of the immune system, while the PTSD minus child abuse group displayed more changes in genes linked with apoptosis (cell death) and growth rate regulation.

In addition, changes in methylation were more frequent in the PTSD with child abuse group. The authors believe that these biological pathways may lead to different mechanisms of PTSD symptom formation within the brain.

The German group evaluated gene activity in blood cells, rather than brain tissue. Similar results have been obtained by researchers studying the influence of child abuse on the brains of people who had committed suicide.

“Traumatic events that happen in childhood are embedded in the cells for a long time,” said senior author Elisabeth Binder, M.D., Ph.D. “Not only the disease itself, but the individual’s life experience is important in the biology of PTSD, and this should be to be reflected in the way we treat these disorders.”

Source: Emory Health Sciences

The collaborative study from the University of Michigan Health System and the VA Ann Arbor Healthcare System discovered the eight-week mindfulness-based group treatment plan was more effective than traditional treatment.

Mindfulness-based cognitive therapy, or MBCT, combines the practice of cognitive therapy with the meditative approach of mindfulness that stresses an increased awareness of all thoughts and emotions.  Mindfulness exercises include meditation, stretching, and acceptance of thoughts and emotions.

Prior studies have demonstrated that stress reduction classes that use mindfulness meditation have been beneficial to people with a history of trauma exposure, including veterans, civilians with war-related trauma and adults with a history of childhood sexual abuse.

The current study is the first to examine the effect of mindfulness-based psychotherapy for PTSD with veterans in a PTSD clinic.

“The results of our trial are encouraging for veterans trying to find help for PTSD,” says Anthony P. King, Ph.D., the study’s lead author.

“Mindfulness techniques seemed to lead to a reduction in symptoms and might be a potentially effective novel therapeutic approach to PTSD and trauma-related conditions.”

Veterans in the mindfulness treatment groups participated in in-class exercises such as mindful eating, in which they focus on sensations associated with eating very slowly and “body scanning,” an exercise where patients focus on physical sensations in individual parts of the body, paying special attention to pain and tension.

Additional therapeutic activities included mindful movement and stretching, and mindfulness meditation, in which distracting thoughts and feelings are not ignored but instead acknowledged as they arise and observed nonjudgmentally.

The participants were also instructed to practice mindfulness at home through audio-recorded exercises and during the day while doing activities such as walking, eating and showering.

After eight weeks of treatment, 73 percent of patients in the mindfulness group displayed meaningful improvement compared to 33 percent in the treatment-as-usual groups.

King says the most noticeable area of improvement for patients in the mindfulness group was a reduction in avoidance symptoms.

One of the main tenets of mindfulness therapy is a sustained focus on thoughts and memories, even ones that might be unpleasant.

“Part of the psychological process of PTSD often includes avoidance and suppression of painful emotions and memories, which allows symptoms of the disorder to continue,” King said. “Through the mindfulness intervention, however, we found that many of our patients were able to stop this pattern of avoidance and see an improvement in their symptoms.”

Mindfulness techniques also emphasize focus and attention to positive experiences and nonjudgmental acceptance to one’s thoughts and emotions.

Because of this, the researchers found that the patients in the mindfulness group experienced a decrease in feelings of self-blame and a trend toward decreased perception of the world as a dangerous place.

Researchers say that although the results of this pilot study are encouraging, additional studies with a larger sample size are needed to fully understand the benefits of mindfulness intervention.

King added that the UM-VA group is currently conducting a larger study including military veterans returning from Iraq and Afghanistan.

“Further studies will help us understand whether mindfulness training is more aptly considered an adjunct option to gold-standard trauma-focused treatments such as prolonged exposure or EMDR, or whether it can function as an intervention in its own right for treating avoidance and other symptoms,” he says.

“Either way, mindfulness-based therapies provide a strategy that encourages active engagement for participants, are easy to learn and appear to have significant benefits for veterans with PTSD.”

Study results are published online in the journal Depression and Anxiety.

Source: University of Michigan

New research on rats shows how the right amount of acute stress tweaks the brain and improves performance and health.

“You always think about stress as a really bad thing, but it’s not,” said Dr. Daniela Kaufer, associate professor at the University of California, Berkeley.“Some amounts of stress are good to push you just to the level of optimal alertness, behavioral and cognitive performance.”

New research by Kaufer and UC Berkeley postdoctoral fellow Elizabeth Kirby, Ph.D., has uncovered exactly how acute stress — short-lived, not chronic — primes the brain for improved performance.

In studies on rats, they found that significant, but brief stressful events caused stem cells in their brains to proliferate into new nerve cells that, when mature two weeks later, improved the rats’ mental performance.

“I think intermittent stressful events are probably what keeps the brain more alert, and you perform better when you are alert,” she said.

Study results are published online the open access online journal eLife.

Experts say the new findings reinforce the notion that stress hormones help an animal adapt and manage future situations.

Kaufer is especially interested in how both acute and chronic stress affects memory. Knowing that the brain’s hippocampus is critical to memory, she and her colleagues focused on the effects of stress on neural stem cells in the hippocampus of the adult rat brain.

Neural stem cells are a sort of generic or progenitor brain cell that, depending on chemical triggers, can mature into neurons, astrocytes or other cells in the brain.

The hippocampus is one of only two areas in the brain that generate new brain cells in adults, and is highly sensitive to glucocorticoid stress hormones, Kaufer said.

Prior research has demonstrated that chronic stress elevates levels of glucocorticoid stress hormones. These hormones, in turn, suppresses the production of new neurons in the hippocampus, impairing memory.

This is in addition to the effect that chronically elevated levels of stress hormones have on the entire body, such as increasing the risk of chronic obesity, heart disease and depression.

Less is known about the effects of acute stress, Kaufer said, and studies have been conflicting.

In an effort to clear up the confusion, Kirby subjected rats to what, to them, is acute but short-lived stress — immobilization in their cages for a few hours.

This led to stress hormone (corticosterone) levels as high as those from chronic stress, though for only a few hours. The stress doubled the proliferation of new brain cells in the hippocampus, specifically in the dorsal dentate gyrus.

Kirby discovered that the stressed rats performed better on a memory test two weeks after the stressful event, but not two days after the event.

Using special cell labeling techniques, the researchers established that the new nerve cells triggered by the acute stress were the same ones involved in learning new tasks two weeks later.

“In terms of survival, the nerve cell proliferation doesn’t help you immediately after the stress, because it takes time for the cells to become mature, functioning neurons,” Kaufer said.

“But in the natural environment, where acute stress happens on a regular basis, it will keep the animal more alert, more attuned to the environment and to what actually is a threat or not a threat.”

They also found that nerve cell growth after acute stress was triggered by the release of a protein, fibroblast growth factor 2 (FGF2), by astrocytes — brain cells formerly thought of as support cells, but that now appear to play a more critical role in regulating neurons.

Kaufer noted that exposure to acute, intense stress can sometimes be harmful, leading, for example, to post-traumatic stress disorder.

Further research could help to identify the factors that determine whether a response to stress is good or bad.

“I think the ultimate message is an optimistic one,” she concluded. “Stress can be something that makes you better, but it is a question of how much, how long and how you interpret or perceive it.”

Source: UC Berkeley

Experts report that PTSD affects nearly 8 million adults in any given year.

Fortunately, clinical research has identified certain psychological interventions that can significantly help to reduce PTSD symptoms.

However, a new report published in Psychological Science in the Public Interest suggests that most people struggling with PTSD fail to receive those treatments.

The report is authored by Edna Foa, Ph.D., a PTSD expert at the University of Pennsylvania, and a team of distinguished psychological scientists who reviewed studies describing interventions that can effectively treat post-traumatic stress disorder.

Foa pioneered the use of prolonged exposure therapy (PE), in which patients approach — in both imaginary and real-life settings — situations, places, and people they have been avoiding.

The repeated exposure to the perceived threat disconfirms individuals’ expectations of experiencing harm and, over time, leads to a reduction in their fear.

Over years of testing, PE and other forms of cognitive-behavioral therapy have proved highly effective in addressing the distress and dysfunction that trauma victims experience.

However, the majority of mental health professionals do not use such evidence-based treatments when working with patients suffering from PTSD, the researchers write.

Many clinicians believe that the best psychotherapy should be individualized and should focus on the underlying causes of one’s problems and symptoms. But studies show scant evidence that such psychodynamic therapy — which focuses on such issues as difficult childhood relationship with parents — effectively eases PTSD symptoms, according to the report.

Foa and her colleagues say their findings are important given that traumatic events such as natural disasters, terrorist attacks, and gun violence are on the rise.

For example, more than 273,000 Iraq and Afghanistan war veterans have sought treatment for post-traumatic stress disorder over the past decade, the U.S. Department of Veterans Affairs reports.

Researchers at Harvard Medical School found that at least one-third of residents in the path of Hurricane Katrina suffered some form of post-traumatic stress after the 2005 storm.

And in the two months following last year’s tragic mass shooting at Sandy Hook Elementary School in Connecticut, more than 16 percent of Newtown, Connecticut’s police force had missed work because of PTSD-related issues, according to news reports.

“Not counting traumatic events that are experienced by individuals as opposed to entire populations, the number of people who need help for their PTSD and related symptoms is mind-boggling,” Foa and her co-authors write.

“Thus PTSD treatment researchers are acutely aware of the tremendous need to disseminate effective treatments widely such that patients have access to them, and are also aware of the challenges to successfully meet this need.”

Source: Association for Psychological Science

The risk of developing more severe symptoms of post-traumatic stress (PTS) is increased during the early stage of the child’s cancer, and this risk is particularly apparent in mothers.

The researchers set out to find any causal factors that — in addition to the child’s illness — may contribute to serious traumatic stress symptoms in parents. The findings indicate the need to develop psychosocial cancer care that takes into account the parents’ individual vulnerability and previous life history.  These two factors play a large role in how parents manage to cope with the crisis caused by the child’s illness.

The research is part of a larger study that was designed to help researchers understand the psychosocial consequences following a child’s cancer diagnosis, identify stress-related psychosocial risk factors, and support the needs of the families.

The study involved 169 parents (97 mothers, 72 fathers) of 103 children diagnosed with cancer. The children were between the ages of one month and 20 years (median age, 5.9 years). Among the parents, 20.7 percent had an immigrant background.

Post-traumatic stress symptoms were measured through standardized self-assessment methods.

The experience of past traumatic life events predicted more severe symptoms of post-traumatic stress measured in the study.

Furthermore, it was discovered that compared with fathers, mothers consistently showed higher symptom levels in all measured dimensions of PTS. A previous assumption that older parents, and parents with immigrant backgrounds, would be more vulnerable to experiencing cancer-related stress was not supported by the results.

The study suggests that the care and follow-up of parents of children diagnosed with cancer should be individually adapted.

Psychological support to the family would be more effective if attention is paid to the parents’ lifetime history of prior traumatic experiences, and the study demonstrates how it can be done, said Krister Boman, Ph.D., one of the researchers.

The study is published in the journal PLOS One.

Source:  Karolinska Institutet

Experts say the relatively new concept of mental defeat has previously been associated with post-traumatic stress disorder.

Researchers define mental defeat as a state in which someone with chronic pain views it as an “enemy” which takes over his or her life, eroding autonomy and identity.

A new study of chronic pain patients suggests that targeting feelings of mental defeat could prevent severe depression, anxiety and interference with daily activities.

In the new study, researchers followed three groups of individuals living in Hong Kong — people with chronic pain who had sought specialist treatment, people with chronic pain who did not require specialist treatment and people with acute pain.

The chronic pain individuals reported pain in a variety of sites, with the majority in both groups identifying back pain as their predominant complaint.

Researchers monitored levels of mental defeat through how much the participants agreed with statements such as “because of the pain I felt destroyed as a person” and “I felt humiliated and that I was losing my sense of “inner dignity.”

When the two groups of individuals with chronic pain were compared, those who were seeking specialist treatment for their pain were found to have higher levels of mental defeat than those who did not require such treatment.

Both chronic pain groups had higher levels of mental defeat than the acute pain group.

The study also found that people who had a sense of mental defeat because of pain also reported higher levels of depression and anxiety as well as a higher incidence of the pain interfering with their daily lives.

The findings of the Hong Kong study reflect earlier studies carried out in the United Kingdom, which suggests that mental defeat is common across cultures.

The study’s lead author, Nicole Tang, Ph.D., said: “The presence of mental defeat in both Western and Eastern populations suggests that aspects of the psychological impact of pain on people’s sense of self and identity are shared across geographical boundaries.

“We know from work in the UK that mental defeat is a significant factor differentiating chronic patients who thrive despite pain from those who develop high levels of distress, depression and interference from pain in their everyday lives.”

Tang said the study results suggest that early screening for mental defeat can predict whether a patient will go on to suffer from severe anxiety and depression.”

“Standard group pain management programs do not have a treatment component targeting the sense of mental defeat,” she said. “The current development of multidisciplinary pain management services in Hong Kong presents an opportunity to address this gap with a view towards enhancing overall treatment effectiveness.”

The study is published in The Clinical Journal of Pain.

Source: University of Warwick

Patient at doctors office photo by shutterstock.

Although millions of adults are exposed to traumatic events each year, researchers admit little is known about the effectiveness of treatments aimed at preventing posttraumatic stress symptoms.

In a new study, researchers looked into various forms of treatment to prevent PTSD after at least one traumatic event.

After reviewing 2,563 abstracts, the investigators found 19 studies that met the criteria for inclusion in the review. Only two psychotherapeutic treatments showed possible benefits for adults exposed to trauma.

Cognitive-behavioral therapy (CBT) in particular was found to be more effective than another type of therapy called supportive counseling for individuals exposed to a traumatic event and who meet the diagnostic criteria for another trauma-related syndrome, Acute Stress Disorder.

In addition, a type of therapy called collaborative care (care management, evidence-based pharmacologic interventions, and components of CBT) showed promise to reduce severity of symptoms based on one study.

“Unfortunately, because this body of evidence is so small, the generalizability of these findings is not known,” said researcher Catherine A. Forneris, Ph.D., A.B.P.P. “Much more research is needed before we can make definitive conclusions.”

Co-author Gerald Gartlehner, M.D., M.P.H., agrees, “Clinicians and patients have to be aware that while there are many treatments offered for the prevention of PTSD, many lack sufficient scientific evidence.”

The authors recommend immediate attention from funding agencies, clinicians, researchers, policymakers, and other public health authorities to support further, well-designed research that can broaden the evidence base.

They suggest that future studies expand their examination of the impact of trauma interventions to a wider range of outcomes such as risk-taking behaviors and suicidality and focus on longer-term indicators of development and functioning.

The article is published online by the American Journal of Preventive Medicine.

Source: University of North Carolina Health Care

Man suffering from PTSD photo by shutterstock.

For most, the grief subsides over time. But some continue to yearn for the lost loved one, experience waves of painful emotion, and feel hopeless about the future.

A new study looks into this complex process with researchers finding that individuals with complicated grief have difficulty remembering specific memories of the past — a symptom often associated with post-traumatic stress disorder or major depression.

However, complicated grief is framed by one notable exception: Individuals often retain their ability to recall specific memories for events that include the lost loved one.

Harvard researchers were intrigued by this cognitive paradox, and it raised another question: Do thoughts of lost loved ones also shape how people with complicated grief think about the future?

To find out, graduate student Donald Robinaugh and professor of psychology Richard McNally, Ph.D., recruited adults who had lost their spouse or life partner in the last one to three years. Some of the participants showed signs of complicated grief, while others showed signs of more typical bereavement.

The participants completed a series of tasks to assess their memory for past events and their ability to imagine future events, both with and without the deceased.

They were asked to generate specific events based on positive cue words (e.g., safe, happy, successful, loved) and negative cue words (e.g., hurt, sad, afraid, angry).

Researchers discovered that adults suffering from complicated grief showed deficits in their ability to recall specific autobiographical memories and to imagine specific events in the future compared to adults experiencing typical grief but only for events did not include the deceased.

They showed no difficulty generating events that included the partner they had lost.

“Most striking to us was the ease with which individuals with complicated grief were able to imagine the future with the deceased relative to their difficulty imagining the future without the deceased,” said Robinaugh and McNally.

“They frequently imagined landmark life events — such as the birth of their first child or a 50th wedding anniversary — that had long since become impossible. Yet, this impossible future was more readily imagined than one that could, at that point, realistically occur.”

These findings point to a cognitive mechanism underlying the distressed yearning that is characteristic of complicated grief.

Investigators say the finding underscores the importance of generating goals and aspirations for the future after the loss of a loved one. According to the researchers, “setting goals and working toward them may be an important component of natural recovery from the disruptive and painful experience of loss.”

The study is published in the journal Clinical Psychological Science.

Source: Association for Psychological Science

Grieving woman photo by shutterstock.

Researchers from the University of Utah compared emotional and physiological responses of two groups of military veterans and their partners during and after engaging in a “disagreement task” set in a clinically monitored environment.

The veterans in one group had been diagnosed with PTSD, and those in the control group had not.

Investigators discovered the partners of veterans with PTSD showed even greater increases in blood pressure during conflict than the veterans with PTSD themselves. This may suggest that these partners may be at similar, if not greater, risk for health consequences from relationship conflict and PTSD as the veterans.

While prior research has documented greater cardiovascular reactivity to general stressors and higher levels of anger in veterans with PTSD, this is the first study to report such physiological and anger responses to intimate relationship conflict for veterans, as well as their partners.

Investigators discovered female partners of male veterans who had been diagnosed with PTSD suffered not only from general psychological distress, but also exhibited more negative emotional and physical effects from relationship conflict.

The responses included a significant increase in measurement of blood pressure and anger.

“Overall, we found that couples where the veteran has PTSD showed greater emotional and relationship distress than military couples without PTSD,” said Catherine Caska, whose doctoral dissertation is the basis of this research.

“The couples affected by PTSD also showed greater increases in blood pressure, heart rate, and other indicators of cardiovascular health risk in response to the relationship conflict. Veterans with PTSD showed larger increases in blood pressure in response to the relationship conflict discussion than did veterans without PTSD.

“These responses and the greater emotional reactions and overall relationship distress reported by veterans with PTSD could contribute to the increased risk of cardiovascular disease previously found to be associated with PTSD.”

The research is important as up to 25 percent of the more than 2 million veterans returning from the wars in Iraq or Afghanistan have signs of PTSD.

PTSD is strongly associated with both increased risk of cardiovascular disease — including stroke, hypertension, and heart disease—and emotional distress between couples, especially for those in the military.

Researchers note that the annual health care costs for military veterans are estimated at $4 billion to $6 billion, much of which is related to physical health problems other than trauma-related physical injury.

This is the first study to explore the emotional and cardiovascular effects of relationship discord in military personnel, as well as the potential physical health risks for partners of veterans with PTSD.

“We learned that couples with PTSD experience more signs of physical and emotional stress than other military couples when under a challenge to their relationship,” said Tim Smith, Ph.D., a co-author on the study. “Understanding possible links between increased relationship stress and the risk of heart problems gives practitioners new insights in the treatment of PTSD, as well as the management of couple difficulties.”

For the study, researchers recruited 65 male veterans and their female partners. The veterans had deployed to Iraq or Afghanistan an average of 1.5 times since 2001.

There were 32 couples in which the veteran had PTSD and 33 couples in the control group without PTSD being a factor. Although efforts were made to include couples with female veterans and male partners, none were found for this study.

All participants were interviewed by a clinician and completed standard questionnaires to measure PTSD, depression, anger and anxiety, marital satisfaction and areas of disagreement.

The topic area of highest disagreement provided the basis for a laboratory conflict task for each couple.

Before beginning the conflict task, each participant’s blood pressure and heart rate were monitored while looking at neutral landscape photographs to measure their cardiovascular functioning while in a “resting” state. Participants also completed questionnaires to assess their levels of anxiety and anger before the conflict task.

To measure couples’ emotional and cardiovascular functioning during conflict, each discussed together a current issue for them in a structured and timed fashion.

The conversations on their selected topic were divided into three segments: an unstructured conversation, a structured segment where the partners took turns speaking and listening and a final unstructured discussion.

Physiological measurements were taken throughout the segments, and following the task, each participant completed additional questionnaires and was interviewed separately.

Perhaps not surprisingly, veterans in the PTSD group showed significantly greater symptoms of PTSD than in the control group. Those veterans—and their partners—also had greater psychological distress, that is, depression and anxiety, than their counterparts in the control group.

Investigators also examined how well participants function emotionally as couples with results again showing that the couples with PTSD were under greater stress, than those couples without PTSD.

The effect is shown through higher levels of conflict or disharmony, as well as higher levels of disaffection, which also means emotional distance or lack of warmth and closeness.

Though these were all higher compared to control couples, PTSD couples reported even greater problems with frequent and intense conflict than they did with disaffection.

The emotional functioning of the couples was assessed by the conflict task. Overall, after the challenge couples reported larger increases in negative affect — meaning anxiety and anger — compared to the baseline.

PTSD couples reported more negative affect than control couples, with a significantly larger increase in anger than anxiety. This was shown in both veterans and their partners, with the latter displaying even greater anger responses than the veterans with PTSD.

Physical health signs — such as blood pressure and heart rate — were each elevated in the couples with PTSD compared to controls.

Alarmingly, partners in the PTSD group not only had greater increases in blood pressure than control group partners, but also compared to the veterans with PTSD.

“The results of our study emphasize the potential role of relationship difficulties in the increased risk for cardiovascular disease among Iraq and Afghanistan War veterans with PTSD,” Caska said.

“These data also suggest the possibility of similar health risks for their partners. These findings could have important implications for the focus of treatments and services for this population, and further drives home the need to continue to focus research and resources on understanding and better serving military families.”

Source: University of Utah

Boston University School of Medicine (BUSM) researchers say their finding could one day help lead to the development of effective behavioral and pharmacological therapies to treat anxiety disorders, such as post-traumatic stress disorder, phobias and panic attacks.

The research findings are published in the Journal of Neuroscience.

Experts explain that there are two main stages of sleep — REM and non-REM — and both are necessary to maintain health and to regulate multiple memory systems, including emotional memory.

Non-REM sleep is associated with repair and maintenance as the body repairs tissue and improves the function of the body’s immune system.

During REM sleep, the brain becomes more active and the muscles of the body become paralyzed. Dreaming generally occurs during REM sleep, as well as physiological events including saccadic eye movements and rapid fluctuations of respiration, heart rate and body temperature.

One particular hallmark of REM sleep is the appearance of phasic pontine waves (P-waves). The P-wave is a unique brain wave generated by the activation of a group of cells involving the neurotransmitter glutamate. This particular group is in the brainstem in a structure called the pons.

Researchers say the memories of fearful experiences can lead to enduring alterations in emotion and behavior and sleep plays a natural emotional regulatory role after stressful and traumatic events.

Persistence of sleep disturbances, particularly of REM sleep, is predictive of developing symptoms of anxiety disorders.

A core symptom of these disorders frequently reported by patients is the persistence of fear-provoking memories that they are unable to extinguish.

Current intervention frequently includes exposure therapy, which involves controlled re-exposure to the original fearful experience. This modality is considered one of the most effective evidence-based treatments for anxiety disorders.

Exposure therapy produces a new memory, called an extinction memory, to coexist and compete with the fearful memory when the fearful cue/context is re-encountered.

The strength of the extinction memory determines the efficacy of exposure therapy. A demonstrated prerequisite for the successful development of an extinction memory is adequate sleep, particularly REM sleep, after exposure therapy.

However, adequate or increased sleep alone does not universally guarantee its therapeutic efficacy.

“Given the inconsistency and unpredictability of exposure therapy, we are working to identify which process(es) during REM sleep dictate the success or failure of exposure therapy,” said Subimal Datta, Ph.D., director and principal investigator at the Laboratory of Sleep and Cognitive Neuroscience and the study’s lead author.

The researchers used contextual fear extinction training, which works to turn off the conditioned fear, to study which brain mechanisms play a role in the success of exposure therapy.

The study results showed that fear extinction training increased REM sleep. Surprisingly, however, only 57 percent of subjects retained fear extinction memory, meaning that they did not experience the fear, after 24 hours.

There was a tremendous increase of phasic P-wave activity among those subjects. In 43 percent of subjects, however, the wave activity was absent and they failed to retain fear extinction memory, meaning that they re-experienced fear.

“The study results provide direct evidence that the activation of phasic P-wave activity within the brainstem, in conjunction with exposure therapy, is critical for the development of long-term retention of fear extinction memory,” said Datta.

In addition, the study indicates the important role that the brainstem plays in regulating emotional memory.

Researchers call for future studies to explore how to activate this mechanism in order to help develop potential pharmacological treatments; these could complement exposure therapy to better treat anxiety and other psychological disorders.

Source: Boston University Medical Center

Abstract image of the brain photo by shutterstock.

During the past nine years, over 2 million American soldiers have served in Iraq and Afghanistan. As many as several hundred thousand may now suffer from PTSD, say experts. Symptoms include anxiety, anger, depression, flashbacks and nightmares.

PTSD is usually treated with drugs, behavioral therapy and other approaches. But for many, these approaches don’t work. Now, a completely natural method is proving itself successful: mindfulness meditation.

In this type of meditation, the practitioner focuses on a single thing, such as breathing, for a set period of time.  This generally lasts for 15 to 20 minutes.

“It’s clear that mindfulness can lower stress in many contexts,” said Elizabeth Stanley, Ph.D., an associate professor of security studies at Georgetown University, and a former U.S. Army captain, who has been involved in the studies and began practicing meditation to deal with her own PTSD. “We think it can work for soldiers dealing with the extreme stress of combat.”

Stanley believes that meditation should be as much a part of basic training as learning to fire a weapon or march in formation.

The research by Stanley and her colleagues has attracted the attention of some military leaders, including the commander of all allied forces in Afghanistan.

A pilot study focused on 60 Marine reservists who were going through two months of intense training before being deployed to Iraq. One group received instruction in mindfulness meditation and were asked to meditate for 15 minutes a day; the other group got no meditation training.

After two months, the meditation group reported significantly lower levels of stress and anxiety.

Mindfulness training provided another benefit as well—it made the soldiers smarter. Specifically, it improved their ability to retain new information.

Participants were asked to remember letters from the alphabet while doing simple arithmetic. Those in the mindfulness meditation group did significantly better at this task than those who didn’t receive such training, and those who meditated more did better than those who meditated less.

The researchers followed up this pilot study with more research, funded by the Department of Defense. One study looked at 320 Marines at Camp Pendleton, Calif., who were preparing to go to Afghanistan.

One group was given mindfulness training. During intense training sessions, researchers monitored all of the Marines’ blood pressure, heart rate and breathing as well as a range of neurochemicals related to stress.

They found that the mindfulness group was not only calmer during and after the immersion exercises but also responded faster when a threat appeared.

Meditation seems to produce its effects though a variety of mechanisms, according to the researchers. They found that mindfulness increases levels of insulin-like growth factor 1, a hormone that repairs cellular damage caused by stress. It also lowers levels of cortisol and neuropeptide Y, stress-related chemicals that, over time, can damage tissues.

Source:  Elsevier