Posts Tagged PTSD
Virtual reality to help more military and other public safety workers cope with PTSD is central to the work of a new group launched in Edmonton.
Heroes in Mind, Advocacy & Research Consortium (HiMARC) is made up of those who want “to serve the men and women in uniform who have served us and continue to serve us daily,” Bob Haennel, dean of the University of Alberta’s Faculty of Rehabilitation Medicine, said in a Wednesday news release.
HiMARC’s Motion-Assisted, Multi-Modal Memory Desensitization and Reconsolidation (3MDR) research study — the largest of its kind in Canada with 40 Armed Forces participants — allows PTSD patients to use the Computer-Assisted Rehabilitation Environment (CAREN) system at the Glenrose Rehabilitation Hospital.
“It was incredible. I don’t know how else to describe it. My senses were heightened. I was even sensitive to the clanging sound of the carabiner on my harness,” said Capt. Anna Harpe, a social worker at CFB Edmonton, after experiencing the 3MDR system.
Patients who step into the CAREN unit walk on a treadmill toward a stimulus, sounds and images that may remind them of events that trigger traumatic memories. A therapist is with them through the process, guiding the patient confronting the memories.
While Harpe does not have PTSD, she said testing the 3MDR brought back vivid recollections of a mission in Afghanistan when she was in the infantry.
“I have worked with some clients who have been diagnosed with PTSD, and I have to say, the 3MDR is mind-blowing. My whole body was activated. You just cannot get the same thing through talk therapy in an office,” she said.
Study participants are receiving the therapy once a week for six weeks.
“By walking towards the fear, there is a shift in the brain,” said Suzette Brémault-Phillips, director of HiMARC in the Faculty of Rehabilitation Medicine and co-principal investigator for the study in Canada.
The 3MDR system — developed by Col. Eric Vermetten, head of research at the Military Mental Health unit of the Dutch ministry of defence in the Netherlands — has been effective in the Netherlands where it’s been used to treat the rise in PTSD cases there after its mission to Afghanistan.
Vermetten traveled to Edmonton to train Brémault-Phillips and her team to use the system.
HiMARC’s founding members also include the Royal Canadian Legion Alberta-NWT Command, NAIT, the Department of National Defence, Veteran Affairs Canada and Covenant Health.
“HiMARC is creating hope and I am so grateful for this group. I really believe this is just the beginning,” added Harpe.
Current treatments for depression and PTSD only suppress symptoms, if they work at all. What if we could prevent these diseases from developing altogether? Neuroscientist and TED Fellow Rebecca Brachman shares the story of her team’s accidental discovery of a new class of drug that, for the first time ever, could prevent the negative effects of stress — and boost a person’s ability to recover and grow. Learn how these resilience-enhancing drugs could change the way we treat mental illness.
This talk was presented at an official TED conference, and was featured by our editors on the home page.
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Anxiety disorders, addiction, acute pain and stroke rehabilitation are just a few of the areas where VR therapy is already in use
If you still think of virtual reality as the province of dystopian science fiction and geeky gamers, you had better think again. Faster than you can say “Ready Player One,” VR is starting to transform our world, and medicine may well be the first sector where the impact is profound. Behavioral neuroscientist Walter Greenleaf of Stanford University has been watching this field develop since the days when VR headsets cost $75,000 and were so heavy, he remembers counterbalancing them with a brick. Today some weigh about a pound and cost less than $200. Gaming and entertainment are driving current sales, but Greenleaf predicts that “the deepest and most significant market will be in clinical care and in improving health and wellness.”
Even in the early days, when the user entered a laughably low-resolution world, VR showed great promise. By the mid-1990s research had shown it could distract patients from painful medical procedures and ease anxiety disorders. One initial success was SnowWorld, which immersed burn patients in a cool, frozen landscape where they could lob snowballs at cartoon penguins and snowmen, temporarily blocking out the real world where nurses were scrubbing wounds, stretching scar tissue and gingerly changing dressings. A 2011 study with 54 children in burn units found an up to 44 percent reduction in pain during VR sessions—with the bonus that these injured kids said they had “fun.”
Another success came in the wake of 9/11. Psychologist JoAnn Difede of NewYork-Presbyterian/Weill Cornell Medical Center began using VR with World Trade Center survivors suffering from post-traumatic stress disorder (PTSD) and later with soldiers returning from Afghanistan and Iraq.
In Difede’s laboratory, I saw the original 9/11 VR program with its scenes of lower Manhattan and the newer Bravemind system, which depicts Iraqi and Afghan locales. Developed with Department of Defense funding by Albert “Skip” Rizzo and Arno Hartholt, both at the University of Southern California, Bravemind is used to treat PTSD at about 100 U.S. sites. The approach is based on exposure therapy, in which patients mentally revisit the source of their trauma guided by a therapist who helps them form a more coherent, less intrusive memory. In VR, patients do not merely reimagine the scene, they are immersed in it.
Difede showed me how therapists can customize scenes in Bravemind to match a patient’s experience. A keystroke can change the weather, add the sound of gunfire or the call to prayers. It can detonate a car bomb or ominously empty a marketplace. An optional menu of odors enables the patient to sniff gunpowder or spices through a metal tube. “What you do with exposure therapy is systematically go over the trauma,” Difede explains. “We’re teaching the brain to process and organize the memory so that it can be filed away and no longer intrudes constantly in the patient’s life.” The results, after nine to 12 gradually intensifying sessions, can be dramatic. One 2010 study with 20 patients found that 16 no longer met the criteria for PTSD after VR treatment.
Until recently, large-scale studies of VR have been missing in action. This is changing fast with the advent of cheaper, portable systems. Difede, Rizzo and three others just completed a randomized controlled trial with nearly 200 PTSD patients. Expected to be published this year, it may shed light on which patients do best with this high-tech therapy and which do not. In a study with her colleague, burn surgeon Abraham Houng, Difede is aiming to quantify the pain-distraction effects of a successor to SnowWorld called Bear Blast, a charming VR game in which patients toss balls at giggly cartoon bears. They will measure whether burn patients need lower doses of intravenous painkillers while playing.
Greenleaf counts at least 20 clinical arenas, ranging from surgical training to stroke rehabilitation to substance abuse where VR is being applied. It can, for example, help recovering addicts avoid relapses by practicing “refusal skills”—turning down drinks at a virtual bar or heroin at a virtual party. Brain imaging suggests that such scenes can evoke very real cravings, just as Bravemind can evoke the heart-racing panic of a PTSD episode. Researchers foresee a day when VR will help make mental health care cheaper and more accessible, including in rural areas.
In a compelling 2017 paper that reviews 25 years of work, Rizzo and co-author Sebastian Koenig ask whether clinical VR is finally “ready for primetime.” If today’s larger studies bear out previous findings, the answer seems to be an obvious “yes.”
[TEDx Talks] Can Virtual Reality Ease Post-traumatic Stress Disorder? | Dr. Brenda Wiederhold | TEDxChapmanU – YouTube
[Abstract] Combined transcranial direct current stimulation with virtual reality exposure for posttraumatic stress disorder: Feasibility and pilot results
Facilitating neural activity using non-invasive brain stimulation may improve extinction-based treatments for posttraumatic stress disorder (PTSD).
Here, we examined the feasibility of simultaneous transcranial direct current stimulation (tDCS) application during virtual reality (VR) to reduce psychophysiological arousal and symptoms in Veterans with PTSD.
Twelve Veterans with PTSD received six combat-related VR exposure sessions during sham-controlled tDCS targeting ventromedial prefrontal cortex. Primary outcome measures were changes in skin conductance-based arousal and self-reported PTSD symptom severity.
tDCS + VR components were combined without technical difficulty. We observed a significant interaction between reduction in arousal across sessions and tDCS group (p = .03), indicating that the decrease in physiological arousal was greater in the tDCS + VR versus sham group. We additionally observed a clinically meaningful reduction in PTSD symptom severity.
This study demonstrates feasibility of applying tDCS during VR. Preliminary data suggest a reduction in psychophysiological arousal and PTSD symptomatology, supporting future studies.
via Combined transcranial direct current stimulation with virtual reality exposure for posttraumatic stress disorder: Feasibility and pilot results – Brain Stimulation: Basic, Translational, and Clinical Research in Neuromodulation
Why Do So Many Survivors Have Sleep Disorders After Brain Injury?
January 2018, Written by Bill Herrin
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January’s Brain Injury Journey Bulletin dives into the new year with a topic that often keeps people up at night…sleep disorders after TBI.
Sleep. It can be elusive, and one of the most frustrating things to accomplish after brain injury – especially on a consistent basis. Quite often, sleep disorders can take hold after brain injury – and cause everything from anxiousness to feeling depressed, tired, irritable, and more. In this issue of the Brain Injury Journey Bulletin, we’re going to take a look at all the things that sleep can affect, and some ways to conquer a sleep disorder after TBI.
Tossing and Turning
When your quality of life is being affected by lack of sleep, the desperation of wanting to rest can actually hinder you from getting the rest you need. Here are some changes in sleep patterns after TBI that are quite common:
- difficulty falling asleep easily
- trouble staying asleep throughout the night
- waking up very early in the morning and not falling back to sleep
- falling asleep and awakening far later than desired
- purposely staying up late at night to get things done
- You get into bed around 10 but it takes you several hours to fall asleep.
- You wake up frequently during the night for no major reason.
- You wake up at 4 in the morning and cannot fall back to sleep.
- You’re up late every night working on the computer and your partner keeps asking
you to come to bed.
Sleep Disorders and Other Factors
There are lots of different sleep disorders, and they can involve many different parts of the brain. Here are some of the more well-known sleep disorders that people encounter: Insomnia, extreme drowsiness, altered sleep patterns and Narcolepsy. Other disorders that can directly contribute to lack of sleep are Restless Leg Syndrome, teeth grinding or clenching, involuntary movements of your arms/legs during sleep, sleepwalking, sleep apnea, etc. Other factors that can deprive you from sleep are pain, alcohol, caffeine and nicotine, depression…and naps. A poorly timed nap (late in the day) obviously can end up backfiring on you later that night! It’s best to limit the length of naps so they help you get through the day, but don’t keep you up at night.
When PTSD is involved, especially in military veterans, sleep disorders can disturb sleep to the point of a person dreading bedtime, and efforts to quiet the symptoms with drugs or alcohol can make symptoms worse in the long run. Hyper-alertness, flashbacks, or nightmares can play a big part in keeping PTSD survivors up at night.
Research has found that sleep disorders are 3 times more common in persons with TBI than the general population, that about 60% of TBI survivors have ongoing problems with sleeping, that women are more affected than men…and that aging increases the likelihood of sleep problems.
This group has been researching how people sleep, and they have collected some great information about how drug addiction and recovery can affect a person’s ability to have healthy, restorative sleep….along with addressing other sleep disorders. You can read the full guide at this link.
Sleep, when achieved regularly, brings a bevy of positive side-effects, and is an essential component of mental and physical well-being. It can affect healing of the brain and body, improve short-term memory and attention, improvement of your mood, and it can even reduce physical pain. The main thing that sleep obviously provides is that you feel rested and more alert!
How You Sleep Also Matters
Being uncomfortable can affect your sleep more than you realize, too. Here’s a link to an article on WebMD.com that covers different sleep positions, and how they can help (or hinder) sleep, or even cause pain in your back, neck, etc. Here’s the link.
Talk It Over With Your Doctor
There are plenty of over-the-counter and off-the-shelf medications specifically made to help you “catch some ZZZZZ’s” – but it’s very important that persons with brain injury talk to their doctor about the side effects of sleep medications before using any of them.
Brain injury presents a variety of issues that can cause stress, and the stress can easily parlay itself into loss of sleep. If loss of sleep is wearing you down, or slowing your recovery after TBI, you should speak with a physician right away. Once you seek medical advice, the doctor can help you discover the causes and effects of your sleep issues, and discuss all possibilities of easing the loss of sleep. From sleep labs to prescription medications, to discussing techniques for easing your mind before bedtime, your doctor will hopefully help you resolve the sleep deprivation to some degree.
The person you are with little or no sleep, versus the one you are when well rested can be like the difference in…well, like night and day! Tips for managing your sleep schedule, and how to improve it, are available in this easy-to-read tip card – available on our website. It’s titled “Sleep after brain injury”, and if you go to this link, you can get a free tip card and catalog. Here’s the link. for the catalog & tip card. Here’s more info on the SLEEP tip card.
New Year, New Sleep Habits?
With a new year started, you can reference any issues imaginable that relate to PTSD, TBI, ABI, brain injury, concussion, and more, on Lash & Associates’ blog page. Specifically relating to the new year, realistic resolutions after TBI, here is a blog article by Donna O’Donnell Figurski that talks all about it. Here’s the link.
Knowing that stress and anxiety (after TBI) can take its toll, this blog post by Marilyn Lash and Taryn Stejskal, discusses managing stress, and the symptoms of stress that become evident when they’re taking their toll on your health and well-being. Here’s the link.
Blog Posts Galore On A Wide Range of TBI Issues
Feel free to keyword search our entire collection of blog posts, many written by well-known experts, clinicians in the field of brain injury, and also people who have survived brain injury, had family members that have a TBI, and much more. It’s a treasure trove of information that is available for FREE, 24/7/365. It’s all for you at this link!
Resolution of sleeping issues is a “2018 Resolution” for the new year that many have added to their lists to achieve. We hope that you have a great new year, and that you rest assured…and sleep well!
Virtual reality (VR) is used in various areas in hospitals such as medical treatment, the education of medical staffs and the enhancement of the convenience and safety of those who visit hospitals.
According to the medical world on November 21, VR is touching various medical fields such as medical education through virtual surgery, virtual rehabilitation treatment and the like. Especially, the field of mental health medicine is garnering much attention and an exposure treatment method which treats various phobias and addictions by using VR is already in a clinical utilization stage.
An exposure therapy is a behavioral therapy that develops emotional tolerance in a deliberate and painful situation for patients suffering from psychological distress that occurs in certain situations. VR is receiving much attention from medical staffs in that it allows precise control over a situation that doctors want to expose patients to. The field to which VR is most actively applied is posttraumatic stress disorder (PTSD). VR is actively used to treat patients suffering from the avoidance and re-experiencing of traumatic situations such as war or traffic accidents and anxiety about such situations.
Gil Hospital of Gachon University will establish the ‘Virtual Reality Therapy Center’ in January of next year and treat PTSD and panic disorder patients in earnest. In the future, the hospital is planning to expand VR treatment areas to mild cognitive impairment or attention deficit hyperactivity disorder (ADHD). “In order to treat PTSD and panic disorder, patients and therapists must go to sites which trigger PTSD and panic disorder or be exposed to stimuli that spark off stress but it is practically or physically impossible,” said professor Cho Seong-jin, a professor of mental health medicine in Gil Hospital. “VR can enable patients to reach a treatment stage by repeatedly giving stimuli in accordance with patients’ conditions.”
Sejong Hospital recently launched a VR application to let patients take a tour of examination rooms, wards, the checkup center and surgery center before visiting the hospital in person. ‘Cancer Hospital VR’ App was released by Samsung Seoul Hospital. The application guides patients about the hospital’s major facilities. VR can help patients reduce their anxiety and stress by taking a look at places where they will be treated and their medical procedures. Bundang Hospital of Seoul National University came up with the results of the application of a VR video for child patients. That is to say, the hospital developed a VR video that allows children close to undergoing surgery to experience surgical procedures with “Pororo” Character popular among kids in a VR world. So the hospital could reduce children’s anxiety before anesthesia 40% in actual surgery.
Gangnam Severance Hospital which has operated a virtual reality clinic since 2005 is developing technology to manage mental health via VR in cooperation with Samsung Electronics. The hospital and the IT giant will jointly develop diagnostic kits and chairs to analyze psychological states with VR devices, a VR mental health program including psychological evaluation, education and training processes, and an artificial intelligence diagnosis system among others with the goal of commercializing them next year.