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Recently, a number of PatientsLikeMe members shared some of the questions they had about psychotherapy and  remission from PTSD symptoms, so we asked Meaghan Zisk, R.N. M.P.H., a nurse and Health Data and Patient Safety Clinical Specialist, to investigate. She took a deep dive into variations of PTSD, psychotherapy types, how they work and resources to help you choose which therapy type is right for you. She also touched on the possibility of remission from PTSD symptoms. Check out what she found…

PTSD vs C-PTSD

• Complex PTSD (C-PTSD) is a relatively new diagnostic term intended to describe the symptoms associated with prolonged, repeated trauma. Examples of such trauma include long-term child abuse, long-term domestic violence, concentration camps, prisoner of war camps, among others. Individuals with C-PTSD generally have all of the symptoms associated with PTSD. However, individuals with C-PTSD also experience additional symptoms such as difficulty with emotion regulation, feeling worthless or guilty, and interpersonal problems that are not seen as frequently in PTSD.
• Due to the combination of interpersonal and emotional symptoms with other PTSD symptoms, C-PTSD can be harder to treat and may take longer to recover from than PTSD.
  • The International Society of Traumatic Stress Studies (ISTSS) has published treatment guidelines for C-PTSD that focuses on a 3 step approach:
    • Phase 1 focuses on ensuring the individual’s safety and increasing emotional, social and psychological skills. This phase may involve the use of medications.
    • Phase 2 focuses on processing traumatic memories, reviewing the memories so individuals build an adaptive sense of self and the world.
    • Phase 3 focuses on consolidating treatment gains, using gains to engage more in interpersonal relationships, work and social life, and the community.
• C-PTSD is not a recognized subtype in the Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-V); however, it is expected to be included as a diagnosis in the International Classification of Diseases, 11th revision (ICD-11), which is due to be finalized in 2018.

Therapies for PTSD

Trauma-focused psychotherapies are typically the most highly recommended treatment for PTSD. Some of the most common trauma-focused psychotherapies are Cognitive Behavior Therapy (CBT), Eye Movement Desensitization and Reprocessing (EMDR) and Prolonged Exposure (PE). These treatments use various techniques intended to help process the trauma.

• CBT
  • CBT is one of the oldest and most commonly used types of psychotherapy. It focuses on the relationship between thoughts, feelings, and behaviors. CBT often involves controlled exposure to reminders of the trauma or emotions associated with the trauma in order to process and reduce maladaptations. Interested to know what other patients are saying about CBT? Take a look at these evaluations.
• EMDR
  • EMDR is type of psychotherapy that uses external stimuli along with accessing traumatic memories or thoughts to help the individual process the trauma.
  • Lateral eye movements directed by the psychotherapist are the most common type of external stimulus used, although hand-tapping or audio stimuli have also been used. With lateral eye movements, the therapist might have the individual follow their hand while it moves back and forth across the field of vision.
  • There isn’t agreement about how EMDR works, although research studies have shown it to be effective for PTSD.
    • Some researchers theorize that the focus on an external stimulus while holding a traumatic memory in mind allows for enhanced information processing and the development of new mental pathways to alleviate the distress associated with the memory.
    • It is also thought to be similar to how the brain process information during REM (rapid eye movement) sleep.
  • Although EMDR has been shown to be more effective than no treatment at all, it has not been shown to be more effective than other trauma-focused therapies like CBT or PE. There are more than sixty evaluations for this treatment on PatientsLikeMe, see what those who have tried it have said.
• PE
  • Prolonged exposure is a specific type of CBT that teaches individuals to gradually approach trauma-related memories, feelings, and situations. Since exposure can be very anxiety-provoking for patients, the therapist works to ensure the relationship is a safe space for confronting stimuli. Read what PatientsLikeMe members have said about the approach here.

Other types of treatments

• Electroconvulsive therapy
  • Electroconvulsive therapy (ECT) is a procedure, done under general anesthesia, in which small electric currents are passed through the brain in a controlled setting. The electric currents cause a brief seizure and change the brain chemistry.
  • Immediately following the procedure, some people may feel disoriented or confused for a few hours. In certain cases, people may not remember the events leading up to the procedure.
  • Since the effects on memory are not completely understood, ECT should be considered when other treatments have failed.
  • ECT has primarily been used for severe depression and has not been studied extensively for PTSD. However, some studies have shown it may be helpful for people who have both depression and PTSD.
  • There are 120 evaluations from patients who have tried this treatment on PatientsLikeMe. Read what they said.
• Biofeedback
  • Over the years, research on biofeedback, which may be neurofeedback, heart rate variability biofeedback, or another type, has been mixed with some studies showing positive results, others being inconclusive, and some showing no benefit. Researchers and clinicians are still pursuing neurofeedback as a treatment option for PTSD and other conditions such as TBI or ADHD.
  • It is thought that neurofeedback may help to stabilize brain activity and improve focus and attention. Since many symptoms of PTSD are related to hyperarousal, stabilizing brain activity may be helpful in reducing symptoms.
  • Insurance coverage for biofeedback treatments would vary depending on the insurer.
  • Patients have offered feedback on how effective this treatment has been for them here.

Choosing therapy

Different types of therapy may work for each person – it really depends on the individual and the relationship to the care provider. The VA offers a tool (https://www.ptsd.va.gov/apps/decisionaid/) to explore different types of therapy and medication based on your preferences; for example, whether you want to discuss the trauma, whether you want to participate in individual or group therapy, or whether you want to focus on medications.

The American Psychological Association (APA) also publishes clinical guidelines for recommendations on therapies or medications based on available evidence. Although primarily intended for clinicians, these guidelines can also be used by patients to understand various options.

Is remission possible?

Many providers believe most people with PTSD can experience remission of symptoms. People who experienced childhood trauma, interpersonal violence, or who have an anxiety disorder in addition to PTSD may experience lower rates of remission or a longer time to remission. In all cases, there is a chance of symptoms returning and people may need additional treatment if that happens. Some people may continue receiving care through their psychiatrist to ensure they are on the right medications; there’s not necessarily a right time to stop seeing a specialist. It depends on each individual’s relationship with their provider and who is available in their area.

Data about different types of treatment for PTSD is limited and as shown above, it’s hard to know what treatment to try first.

On PatientsLikeMe there are more than 29,000 members living with and discussing their experiences with PTSD and C-PTSD. Want to join the conversation? Become a member here.

Resources

https://www.psychiatry.org/patients-families/ect

https://www.istss.org/ISTSS_Main/media/Documents/ISTSS-Expert-Concesnsus-Guidelines-for-Complex-PTSD-Updated-060315.pdf

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4165723/

https://neurodevelopmentcenter.com/psychological-disorders/ptsd/neurofeedback-for-ptsd/

http://journals.plos.org/plosone/article?id=10.1371%2Fjournal.pone.0166752

https://www.ncbi.nlm.nih.gov/pubmed/21130362

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Inflammation is a hot topic. What’s it all about? And what’s the scoop on certain diets, foods and supplements, such as turmeric, when it comes to fighting inflammation?

What is inflammation?

Not all inflammation is “bad.” Acute inflammation is part of the body’s natural way of defending itself from foreign substances like viruses, bacteria, cuts and splinters. It may cause redness, swelling, heat and/or pain. The upside is, these symptoms are a sign that the body is responding after an injury or infection by triggering white blood cells and disease-fighting chemicals.

But some “other” kinds of inflammation — like chronic inflammation (which may include constant low-grade or systemic inflammation) and inflammation from autoimmune disorders (where the body attacks its own healthy cells as if they’re foreign) — doesn’t always show visible or obvious symptoms and can play a more long-term and complex role, according to Mayo Clinic.

Which diseases or conditions does it affect?

Mounting research shows that inflammation is a common underlying factor (and possibly a cause) in many — perhaps even all — diseases.

You’ve probably heard about the role of inflammation in arthritis or heart health. But researchers and doctors have also studied inflammation’s link to a wide range of other diseases and conditions, including cancer, diabetes, Alzheimer’s disease, multiple sclerosis (MS), Parkinson’s disease (PD), major depressive disorder (MDD), post-traumatic stress disorder (PTSD) and ALS (note: in the case of ALS and some other conditions, researchers are still determining whether some inflammation may be protective rather than harmful, so more research is needed).

Over the past decade, scientists have also started to identify certain genes associated with inflammation, and research on that front continues.

What can food do?

Some people follow an “anti-inflammatory diet,” but the science behind these particular diets does not clearly support the theory that they thwart inflammation, and doctors advise being wary of the health claims they make.

That said, taking steps to maintain a healthy weight and eat a variety of foods with anti-inflammatory properties (rather than follow a certain “Diet” with a capital “D”) may benefit your health.

“Many experimental studies have shown that components of foods or beverages may have anti-inflammatory effects,” says Dr. Frank Hu, professor of nutrition and epidemiology at the Harvard School of Public Health.

The team at Harvard says these foods have anti-inflammatory properties:

• Tomatoes
• Olive oil
• Green leafy vegetables, such as spinach, kale and collards
• Nuts like almonds and walnuts
• Fatty fish like salmon, mackerel, tuna and sardines
• Fruits such as strawberries, blueberries, cherries and oranges

On the flip side, they say, some foods promote inflammation — so try to avoid or limit these (hint: they’re already foods with a pretty bad rap):

• Refined carbohydrates, such as white bread and pastries
• French fries and other fried foods
• Soda and other sugar-sweetened beverages
• Red meat (burgers, steaks) and processed meat (hot dogs, sausage)
• Margarine, shortening and lard

Talk with your doctor or a registered dietician about a healthy eating plan with your health condition(s) in mind.

What’s the deal with turmeric?

There’s currently a lot of buzz around turmeric and some other supplements believed to help fight inflammation. Turmeric, a plant related to ginger, is a common spice known for its gold color and use in curry powder.

On top of being used as spice, it can be taken as a supplement. The main anti-inflammatory ingredient in turmeric is curcumin, which is available as a supplement on its own (the content of curcumin in turmeric spice is only around 3%, so curcumin supplements may pack more of an anti-inflammatory punch). One study found that curcumin may have the same anti-inflammatory effects as NSAID pain relievers, such as aspirin, ibuprofin, (Advil/Motrin) and naproxen (Aleve).

Preliminary studies have shown promise for curcumin’s use in people with ulcerative colitis, multiple myeloma, lupus and depression. However, there’s still a lack of conclusive research on the effects of turmeric or curcumin in people with many other conditions, so these supplements typically aren’t recommended as part of a treatment plan at this point. Additional studies on curcumin are currently underway for people with some forms of cancer and neurodegenerative diseases, such as ALS, MS and PD.

Talk with your healthcare provider before starting any new vitamin, supplement or treatment.

What about other supplements?

Overall, the potential role of dietary supplements is “largely uncharted when it comes to carefully done clinical trials for safety and effectiveness,” according to Brent Bauer, M.D., of the Mayo Clinic. Dietary supplements are not regulated by the U.S. Food and Drug Administration (FDA) for safety and effectiveness. Keeping that in mind, here are some other supplements with possible anti-inflammatory effects that researchers have studied to some extent, the Mayo Clinic says:

• Cat’s claw (Uncaria tomentosa) — This could ease rheumatoid arthritis joint pain and osteoarthritis knee pain during activity, but more research is needed.
• Devil’s claw (Harpagophytum procumbens) — It’s commonly used in Europe and may be effective in the short-term treatment of osteoarthritic pain.
• Mangosteen (Garcinia mangostana) — Made from the mangosteen fruit, this supplement may have anti-allergy, antibacterial, antifungal, antihistamine and anti-inflammatory qualities, but more research in humans is needed.
• Milk thistle (Silybum marianum) — This may help improve organ function in people with cirrhosis, a chronic liver disease. It may also be helpful in treating chronic hepatitis. But more research is needed before it can be recommended.

“My best advice concerning chronic inflammation is to stay tuned,” says Dr. Bauer. “This is a huge area of interest in the medical world and there are bound to be discoveries down the road that can improve well-being and the quality of health.”

On PatientsLikeMe

Hundreds of patients report using turmeric for a wide variety of health reasons — see what they have to say. Join the community for even more details on the treatments patients have tried and to learn and share about nutrition with your condition.

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