Carmen currently works with The Soldiers Project, providing voluntary therapeutic care to returning veterans and their families. 

She also offers half-price discount sessions to any Vet suffering from PTSD who wishes to see her privately, in recognition of their service.


LINKS OF INTEREST

Watch Colin Powell's endorsement of Barack Obama here:

Veterans for Obama
In Their Boots
EMDR
Trauma Pages
Gold Star Families for Peace
Military Families Speak Out
Veterans for Peace
Iraq Veterans Against the War
Blue Star Mothers
Aftermath of War
My PTSD
One Freedom
PTSD Info
New Directions Vets
Operation Home Front
Living with War Today
PTSD Combat - Online Classes
Curt Remington's Blog
ePluribus Media
Fort Bliss
Healing for Soldiers
When Our Troops Come
Journey Home
Brothers Bound by Honor

Bring Them Home Now
Center on Conscience
Iraq and Afghanistan Vets
Peace Out
Service Academy Graduates Against the War
Objector
PTSD Help
Vets Against the Iraq War
Veterans for Common Sense
Vets for Justice
Vietnam Vets Against the War


BOOKLIST

“Invisible Heroes” by Belleruth Naparstek
“Flashback” by Penny Coleman
“War and the Soul” by Edward Tick
“Trauma and Recovery” by Judith Herman


ARTICLES OF INTEREST

1. Army's New PTSD Treatments: Yoga, Reiki, Bioenergy - by Noah Shachtman March 2008

The military is scrambling for new ways to treat the brain injuries and post-traumatic stress of troops returning home from war. And every kind of therapy -- no matter how far outside the accepted medical form -- is being considered. The Army just unveiled a $4 million program to investigate everything from "spiritual ministry, transcendental meditation, [and] yoga" to "bioenergies such as Qi gong, Reiki, [and] distant healing" to mend the psyches of wounded troops.

As many as 17 percent of Iraq and Afghanistan veterans have some form of post-traumatic stress disorder, or PTSD, one congressional study estimates. Nearly 3,300 troops have suffered traumatic brain injury, or TBI, according to statistics assembled last summer. And the lifetime costs of treating these ailments could pile up to as much as $35 billion, a Columbia University report guesses.

Small wonder, then, that the government is looking for alternate means to treat these injuries. The Defense Department "is dedicated to supporting evidence-based approaches to medical treatment and wants to support the use of alternative therapies if they are proven efficacious," notes a recently-issued request for proposals.

But many of these treatments haven't been held up to much rigorous scientific scrutiny before. So the Army is looking to hand out $4 million in "seedling grants" to "conduc[t] rigorous clinical studies" into all sorts of "novel approaches." Projects "containing preliminary data" will be eligible for up to $1 million. But even "innovative but testable hypotheses without preliminary data" could get as much as $300,000. Proposals are due May 15.

"Music, animal-facilitated therapy, art, dance/movement, massage therapy, EMDR [Eye Movement Desensitization and Reprocessing] program evaluation, virtual reality, acupuncture, spiritual ministry, transcendental meditation, [and] yoga," might all be considered worth of the military's largess. So would "biologically-based treatments, botanicals, and nutritional supplements for enhancing cognitive function and mood in patients with trauma spectrum disorders, including TBI and/or PTSD, depression, anxiety, and/or substance dependence/abuse." Even proposals for wild-sounding "therapies using bioenergies such as Qi gong, Reiki, distant healing and acupuncture" would be accepted.

The program also wants to investigate the "perceptions" of these treatments, and any "gender-specific implications and issues" involved. All "proposals must provide a clear justification and military relevance for the choice of therapies selected," the Army reminds grant applicants.

This isn't the first time the military has investigated these sorts of nontraditional approaches. The semi-legendary "First Earth Battalion," immortalized in The Men Who Stare at Goats, advocated that soldiers utilize everything from "yogic cat stretch[es]" to "Ginseng tab regulator[s]" to "amphetamines." A 1973 RAND Corporation study, put together for Darpa, lamented Soviet advances over the American military in everything from yoga to telekinesis. More recently, Rep. Pete Visclosky, D-Ind., inserted $2 million into last year's defense budget bill for "research into the effects of prayer." Darpa has invested millions into natural dietary supplements. Troops -- even flag-level officers -- have been known to do yoga on their own.

And while some of these techniques seem way out there -- I mean way, way out there -- others may have a more practical effect on psychiatric health. Yoga, for instance, has been shown to improve the mood of psychiatric inpatients and reduce so-called "stress hormones" like cortisol. After promising early results, planning is underway for a major study into the effects of yoga on the treatment of schizophrenia. Full disclosure: The doctor running that study is my wife, Elizabeth. But she's not planning to take any Army money.

The Department of Veterans Affairs uses it in their Hepatitis C treatment program. Fort Bliss' Warrior Resilience program -- the same one Army Chief of Staff Gen. George Casey believes should be replicated throughout the military -- uses it as one tool to help soldiers strengthen and recover following combat.

Military OneSource's Health Library says it can increase wellness and "treat diseases of all types."

And it's the reason given by New Zealand's champ cyclist Hayden Roulston for bouncing back from a serious heart condition to claim both Olympic silver and bronze medals this past week in Beijing.

Alternative and Complementary Therapies

Energy healing

Energy healing is based on the concept that the human body is surrounded by various kinds of energy fields--electrical, magnetic, and subtle. In this healing-based tradition, practitioners are consciously aware of their client's imbalances of energy, and claim they can alter it to improve the overall sense of well being for their clients. The concept that unseen energy flows through and around all living things is a belief that comes from many cultures since ancient times.

Conventional medicine concerns itself with health on a very physical and cellular level. Viewing the body as having other dimensions requires a shift in thought. The concept of subtle energy fields continues to have slow acceptance into our traditional, Western medical approach.

Therapeutic Touch

Therapeutic touch is a type of energy healing where the Therapeutic Touch (TT) practitioner "smooths out" the energy field of a client without touching them. The practitioner's hands are a few inches or more away from the physical body. The goal of TT is to help stimulate the recipient's innate healing processes. These are theories, and are not scientifically proven. Case reports indicate that TT is effective in stimulating the relaxation response. TT can be used with other interventions such as guided imagery and visualization.

Reiki

Reiki is another type of energy healing. The Reiki practitioner's hands are either lightly touching the patient's body or are held slightly over it. Energy is thought to flow through areas most in need of healing. In Reiki, the energy is thought to come from the Universe, and the practitioner helps to transfer this positive, healing energy to the recipient. The concept is bizarre to some, but people who receive Reiki often have positive experiences.

Practitioners claim Reiki can aid in healing at a physical, emotional and mental level. Most recipients of Reiki report a peaceful sense of relaxation, and some people have reported reduction in pain, anxiety, fear and anger. There is no scientific evidence to confirm the effectiveness of Reiki.

The federal National Institutes of Health is funding research on energy healing therapies.

This month marks the one year anniversary of the opening of the Fort Bliss Restoration and Resilience Center in Texas.
Back in May, Secretary of Defense Robert Gates visited the groundbreaking facility, which offered up the first test of the Army's new holistic Warrior Resilience Program, saying, "This center here is illustrative of what can be done."

The one-of-a-kind program offers its participating Afghanistan and Iraq veterans group and individual therapy sessions with meditation, yoga, acupuncture, massage therapy, chiropractic and hot-stone therapy treatments.

[Fort Bliss is not the only enlightened embrace of a more holistic approach to treating combat PTSD by the Army. A welcome progression forward of military culture occurred in March when the Army sought proposals for $4 million in grant monies to be spent investigating "spiritual ministry, transcendental meditation, yoga, bioenergies such as Qi gong, Reiki, [and] distant healing."]

Building on all of this, it's great to see that Army Chief of Staff Gen. George Casey, following a visit to Fort Bliss last week, seems to agree with the movement.

FORT BLISS, Texas, May 9, 2008 – A revolutionary treatment program here is demonstrating “little miracles” as it gives new hope to soldiers afflicted with post-traumatic stress disorder who want to stay in the Army, its director reports.

The new program is the brainchild of clinical psychologist John E. Fortunato, who uses a holistic approach to treating PTSD at the new Fort Bliss Restoration and Resilience Center.

Fortunato conceded that his proposal “wasn’t an easy sell” initially, particularly because it wove yoga, massage therapy and other nontraditional approaches into its treatment program. But driven by the frustration of seeing soldiers with PTSD forced to leave the Army against their wishes, Fortunato pressed forward and won approval for his prototype program.

With $2.2 million in initial funding and a 1940s barracks building to rehab, he set out to launch the Restoration and Resilience Center in June 2006. The center opened last summer.

Fortunato was convinced traditional PTSD treatments weren’t long enough, intense enough or comprehensive enough. “So we set out to create a program to address all aspects of PTSD and treat the whole soldier,” he said.

The participants, all volunteers, take about one-half the doses of medications they’d typically get through community mental-health programs. “That’s because we’re doing a bunch of other things,” Fortunato said.

Many PTSD-afflicted soldiers experience “hyper-arousal,” which the center staff treats with techniques like medical massage and “Reiki,” a Japanese stress-reduction technique. Acupuncture has proven to be “extremely effective” in treating the anxiety, panic, and tension-induced physical pain many experience, Fortunato said.

There’s a big physical component to the program, too. The soldiers must walk at least 10,000 steps a day, including a daily 45-minute “power walk.” They play water polo three times a week, forcing interaction that Fortunato said many would rather avoid.

“That’s another piece of PTSD. They want to socially isolate. They don’t like to interact with other people,” he said. “So we have them interact with the people they feel most comfortable with: other soldiers with PTSD.”

Field trips during the program take the soldiers to the local mall and Wal-mart, “two hells” to many of them because they’re too big, too crowded and too noisy, Fortunato said. “We teach them ways to regulate their stress level so they can handle those kinds of environments.”

Many afflicted soldiers have trouble with concentration and memory, Fortunato said. For them, the program’s mix of physical activity and calming techniques appears to help. They do yoga; tai chi, a Chinese martial art; “Quigong,” a centuries-old Chinese self-healing method; and biofeedback, which uses the mind to heal the body. “We have a meditation room that looks like it came out of a Zen monastery,” Fortunato said.

The program aims to repair the physical damage to the “learning center” in many PTSD sufferers’ brains. That’s caused, Fortunato explained, when the body’s stress hormone is elevated too high and for too long -- as it commonly is among combat troops.

“The good news is, [the learning center] is one of only two parts of the brain that can grow new cells,” he said. So his program requires participants to sit at a computer several times a day, doing mental exercises to help them regain their cognitive functioning.

While confronting the physical aspects of PTSD, the program addresses the emotional and spiritual aspects, too.

“Few soldiers come back from war without terrible images and events in their head,” Fortunato said. Many “suck it up and soldier on” in the combat theater because they have no choice. But when they return home, these issues can percolate to the surface as nightmares, flashbacks and other problems.

Fortunato’s program uses “rehearsal therapy” to help participants confront their most painful memories and experiences. “The soldier tells the story, as painful as it is, over and over until you’ve emptied it of its emotional punch,” he said. “They are never going to forget the story, but it doesn’t have to have the grip on their guts that it did before.”

Meanwhile, many soldiers with PTSD find that their combat experience has shaken their core beliefs and values, Fortunato said. A chaplain helps them review “the big organizing things in their life” as they address the spiritual piece of their PTSD struggle. “We weren’t doing much to address this before,” but it’s critical to a soldier’s healing, he said.

Fortunato said there’s nothing monumental about the Recovery and Resilience Center’s approach to treating PTSD. “If you put all of that together, it isn’t magic,” he said. “None of it is magic. And do you know what? None of it is new. All we did is, we looked at the whole soldier and tried to treat all of him.”

The “whole soldier” approach appears to be paying off. Twelve of the 37 soldiers who volunteered for the program have graduated and returned to their units. Among the recent graduates is a soldier who was in a catatonic state in August, but now is free of all signs of PTSD.

“Little miracles are what we are watching happen,” Fortunato said.

So far, only two participants have washed out of the program, both taking medical discharges from the Army.

Fortunato is the first to say his program isn’t for everyone. “This is a hard program,” he said. “[Participants are] in treatment 35 hours a week [with] daily psychotherapy, daily group therapy [and] integrative medicine. They go from 8:30 in the morning until 4:30 every afternoon. You have to be highly motivated to put up with that much treatment.”

There’s no set timetable for completing the program, but Fortunato said he’s finding six months to be optimal for most soldiers. “As long as they are working hard, we are going to hang in with them,” he said.

The soldiers formed their own platoon, which they dubbed, “the Wolf Pack.” It’s a testament, Fortunato said, to the way they take care of each other and the strength they’ve shown in admitting they have PTSD and seeking treatment.

As the soldiers work to overcome their combat stress and return to their units, Fortunato said he’s convinced the program is in the Army’s best interest as well.

The cost alone of treating a soldier -- somewhere between $14,000 and $20,000 -- is a bargain to the force, he said. By comparison, he said it would cost about $400,000 to recruit and train a new soldier and provide lifetime disability payments and medical care to the discharged soldier.

“So why wouldn’t you do this?” Fortunato said. “I think the numbers are all in our favor.”

Defense Secretary Robert M. Gates appears to agree. He toured the Restoration and Resilience Center on May 1, calling the visit an “extraordinary experience.”

“They are doing some amazing things here in terms of helping soldiers who want to remain soldiers but who have been wounded with post-traumatic stress disorder,” he said. “It is a multi-month effort by a lot of caring people, and they are showing some real success in restoring these soldiers.”

Gates called the center an example of new approaches the military is taking to care for these troops. “This center here is illustrative of what can be done,” he said.

Gates said he’ll consider the idea of possibly replicating Fort Bliss’ prototype program to other posts.

Fortunato said he’s all for duplicating his effort, but emphasized that his program’s small size is a key to its success. The soldiers and staff all know each other, have nicknames for each other, and feel a personal commitment to each other. “We all love these guys,” he said.

The Inner Resources Center of the Pacific Graduate School of Psychology is conducting a study about the effects of military participation in Iraq and Afghanistan. In the light of the current dialogue concerning the difficulties that veterans have in finding effective mental health treatment, this study is an opportunity for veterans to experience and evaluate novel treatment methods for coping with the difficulties of serving in the military and coming back home. Meditation or Education Participants will be compensated for their time.

I'd like to share a few words on the blossoming awakening that's clearly been taking place in the area of combat PTSD health care. First, a personal story:

This past summer, I've been blessed by taking a breather. I've been doing a lot of reading and some writing in the background on holistic forms of therapy for PTSD, depression and general stress.

After three years of juggling things here at PTSD Combat, researching and writing a slim offering on combat PTSD, and attending NIU as an Honors student (and being closer than I might have liked -- yet certainly not as close as those who lost their lives or were inside that very room -- to February's fatal school shooting), by May I was feeling spent and in need of a break to recharge my batteries and refocus my energies.

It's amazing what an investment in mind, body, and spirit renewal can do for someone simply a bit worn out.

I can't help but wonder what it could do for someone coping with more serious issues like PTSD. In light of the fact that so few of our traditional treatment therapies seem to be working, it's nice to see that the Army is now firmly on the cutting edge (it's about time...) -- and what they're finding is that these therapies do have a role to play in warrior well being.

Hopefully, we'll continue to see a more popular embrace of holistic therapies such as mindfulness mediation, yoga or other forms of exercise, bioenergy, etc. because these mind-body-spirit tools can serve a serious function in helping us all achieve overall strength and wellness. I know they've certainly helped me clear the cobwebs away and get back to business.

An example of this new enlightened approach in action is found in the Virginia Tech strength and conditioning program (VT, as you might recall, is also the site of previous school shooting; their comfort and support meant a lot to us in the days after ours).

Not surprisingly (to me at least) my fellow partner-in-crime, PTSD blogger Lily Casura over at the very fine Healing Combat Trauma, has immersed herself in the very same topic of late and has been writing some really exquisite stuff on the issue. I would heartily, heartily recommend taking a look at her Mind Body Medicine tag to catch a glimpse of what I mean. You won't regret it.

In future posts, I'll continue to share some of what I've personally unearthed and learned during my forays into the topic. I think we are going to continue to see an up tick in energy and attention to these all-encompassing approaches to easing the pain and suffering that so many with PTSD and depression -- or merely acute stress or exhaustion -- endure.

There's no reason why anyone should be a prisoner to their past, held hostage by their thoughts ruminating over and over on events that have long since transpired. And there's certainly no reason anyone should have to deal with combat trauma alone -- they are not the only ones at war. Our entire nation is at war and it's our duty to carry our own share of the load.

In the final analysis, we are one. No matter how alone we feel at times -- or even how much we'd just like to be left alone -- one person's angst is everyone's angst. There's just no way around it.


The Pacific Graduate School of Psychology (PGSP), a private, independent professional school educating undergraduate and graduate students in the greater Bay Area, announced today that faculty member Lynn C. Waelde, Ph.D. is launching a two part study of military veterans who have served in Iraq and Afghanistan. Dr. Waelde and her team of nine PGSP doctoral students will study the experiences and responses of military personnel who have served in Iraq and Afghanistan. Dr. Waelde began inviting individuals for participation this week.

“The war in Iraq has been going on for six years, and yet little research has been done about how to provide treatment to these veterans from a psychological standpoint,” says Dr. Waelde. “We know more about the Vietnam generation than we do this group.”

The first part of Dr. Waelde’s investigation will interview veterans and active duty military personnel about their experiences in Iraq and Afghanistan. The survey pool will not be limited to combat troops. Dr. Waelde and her team are soliciting all members of the military, from doctors and engineers to those on the front lines, from any branch of the armed forces who served in Iraq or Afghanistan.

After this initial round of research is complete, Dr. Waelde will invite those who qualify to participate in an eight week program. Sessions will be conducted at the school’s not-for-profit clinic, the Kurt and Barbara Gronowski Clinic in Los Altos, Calif. as well as at several convenient locations through the Bay Area. This group will include at least 60 veterans.

A major focus of Dr. Waelde’s current research is the empirical validation of Inner Resources TM, a psychotherapeutic meditation intervention that she developed. Dr. Waelde will test her meditation techniques and a telehealth intervention for their ability to provide relief for symptoms experienced as a result of military service.

Dr. Waelde currently runs the Inner Resources program at the Gronowski Clinic where patients are offered relaxation, breathing, and meditation techniques to enhance their abilities to cope with stress.

Veterans interested in participating in the study may contact Dr. Waelde’s team at 650-421-4874. For more information on the Pacific Graduate School of Psychology, or call 800-818-6136. For more information about the Kurt and Barbara Gronowski Clinic, please call 650-961-9300.

About the Pacific Graduate School of Psychology
The Pacific Graduate School of Psychology, a private, independent professional school in the San Francisco Bay area, has educated doctoral students since 1975. In 2006, it added an undergraduate program and currently offers a Bachelor of Science degree in Psychology through a partnership with De Anza College. Established to serve society, PGSP is a diverse learning community dedicated to the search for knowledge and its dissemination. PGSP brings together a community of highly talented faculty and graduate students working side-by-side to bring scientific rigor and theoretical knowledge to the analysis and practice of clinical psychology.

About the Kurt and Barbara Psychology Clinic
The Kurt and Barbara Gronowski Psychology Clinic at PGSP is a community-based psychology training clinic and treatment center dedicated to providing high quality, evidence-based, clinical services to adults, children, and families in our community. Our clinic uses several evidence based psychological treatments including cognitive behavioral therapy, behavioral therapy, interpersonal therapy, illness management, and family psychoeducation and family management.

Program details:

Inner Resources™ for Stress:

* An educational program using relaxation, breathing, and meditation to enhance your ability to cope with stress
* Learn to deal with stress as it is happening
* Participants benefit from a small group setting and individualized attention
* Participants receive a week-by-week manual and audio recordings of guided practice sessions for home use

There are many conceptual models within traditional psychotherapeutic models which seek to understand the nature of Post Traumatic Stress Disorder (PTSD). These models are helpful in describing and categorizing the way in which the disorder presents itself in panic, dissociation, hallucinations and other phenomena, but they are not so helpful in providing resolution to deeply-held shock and terror which is usually at the root of the presenting symptoms.
 
In working with patients who are suffering from PTSD-like symptoms, I generally have only one guideline: the way in which the symptom demonstrates a separation from the self. By taking whatever presenting symptom appears seriously, I find I can find a path to the self back through the symptom to the pain and then to triggering event of the symptom. My goal is to bring the individual back to a sense of an integrated self. I have found the best way to do that is to follow a few basic steps:
    •    Induction
    •    Creating a safe place
    •    Letting defences speak
    •    Entering into time/place where trauma occurred
    •    Allowing abreaction to the extent the person feels safe
    •    Re-patterning/transforming relationship to trauma
    •    Reintegration of experience with larger self

Induction
I use words to relax the patient and to bring him into harmonious contact with his body and mind. This allows him to "turn down the volume" on the defences to experience contained in the conscious mind and allows him to "turn up the volume" on his ability to focus on his actual experience. All later steps take place in the hypnotic state the induction provides.
 
The hypnotic state as used here is best described as a state of calm alertness to all aspects of a patient's inner reality: emotional, physical, mental and spiritual.
 
Creating a safe place
In the first hypnosis session, I invite the patient, through guided meditation to connect with a safe place within himself and to define parts of himself which contain resources to help with the process of transformation. Suggestions are given to return to this place if anything becomes too scary or overwhelming. Also, in each session, the patient is reminded that he has full control over the entire process and that the hypnotist can "count him out" at any time.
 
Letting defenses speak
I generally ask the patient to identify where in his body he is feeling the presenting symptom, whatever its nature. By asking him to describe and vivify the sensations in his body in this way, the conscious mind's defences to feeling are dismantled. I then ask him to go to a time and place where he was feeling the same sensations in his body for the first time. At this point, we may find ourselves in some sort of "side loop" or "blank place." If this is the case, we simply explore the defences until they resolve themselves.
 
We can then continue with the work of returning to the original situation where he was first feeling the sensations in the body identified at the beginning of the session. If we find ourselves in another defense, we will simply explore it until it is understood and the patient feels it is safe to let it rest while we continue the work.
 
We may spend a whole session, or several sessions on this process, allowing the patient to get comfortable with the process and reinforcing the control he can have if he needs it. Defenses are recognized as having been valuable at the time of trauma, but that they are less useful now and even perhaps standing in the way of further self-understanding. However, suggestions are constantly given that he can "go deeper" or "further" into this matter each time.
 
Entering into time/place where trauma occurred
As we enter into the situation where the trauma occurred, I establish place/time by asking the patient to describe details which may or may not be related to the trauma to bring him closer to the event. I ask questions related to sight, smell, touch, feel, hearing and taste. I don't ask "what are you thinking" or other cognitive questions. I gently ease him into contact with the trauma through breathing and focusing.
 
Allowing abreaction to the extent the person feels safe. In this phase, strong emotions or physical movements may occur. I allow this to continue for a brief period of time until the "charge" is reduced. I create a "container" of safety with my words and intentions so the patient feels supported in going as deeply as possible into the emotions. He is reminded that it is safe to re-experience what he may have thought was not safe to experience the first time as he has developed resources and understandings since that event which will help him re-experience the trauma in a safe way.
 
Re-patterning/transforming relationship to trauma
Here I will often use inner child work (bringing the current self's resources to the past self's situation) or call forth the resources connected with safety to transfer the "containing" aspect of the experience to the patient. I will ask him to re-enter the situation, with the perspective that he has in current day life or with the perspectives gained in the dismantling of defences as above. Many health care professionals do not believe people who are suffering from PTSD can bring this type of strength to the situation, but I have found that even so-called psychotic individuals have strengths which can be activated for this process.
 
I ask him to see the situation/ his reaction to it from this perspective. Generally, forgiveness of self (for things not done which should have been done or things done which should not have been done: i.e.: running for cover when fellow soldiers stayed to fight or killing someone in battle) or forgiveness other is order here. Forgiveness is never forced. Discharge of responsibility for events he cannot be logically responsible for is addressed as this is often a mitigating factor in recovering an integrated sense of self.
 
Reintegration of experience with larger self
As the shift in understanding of the experience at the situational level occurs, the patient is ready to reintegrate this newly-understood experience into the larger framework of the self. Some questions to be asked here: What did you learn from this experience that you could not have learned any other way? Can you bring this learning to past situations where you reacted off of the fear/shock/trauma and now insert this learning into that situation? Feel how it shifts your experience / understanding of that situation. How can you visualise acting on this learning in future situations?
 
I have heard some health care professional’s say that they think hypnosis is dangerous. I can see how allowing abreaction to occur in hypnosis with none of the re-patterning or reintegration to occur can be counter-productive. But I never go into a panic state with a patient in hypnosis without integration to the larger self as my main intention.
 
I sometimes wonder if people who think hypnosis might be dangerous think it might be dangerous for them, not the patients, because of their inability to deal with the full emotional and energetic patterns associated with panic/shock/trauma. It may true this work would be dangerous for them. But I am sufficiently comfortable with extreme fear and panic states that I have never been drawn into the patient's panic in such a way that would hamper my ability to draw forth new perspectives on the panic from the client's psyche.
 
This is a very brief resume of my work with PTSD-like symptoms. There are many nuances and choices to be made during the hypnosis session which must be navigated by remaining fully present and open to the patient's experience. These cannot be easily outlined but they play a significant role in the process. This process has helped many, many individuals in my practice regain normal functioning without the disruption of panic attacks or trigger events in their everyday lives. It has even taken them beyond simply functioning normally to a much fuller understanding of themselves and the nature of reality.

Isa Gucciardi Ph.D

or simply PTSD, is a psychiatric disorder that may occur after experiencing or witnessing some life-threatening events. Such events could be military combats, natural disasters, terrorist incidents, serious accidents, or violent personal assaults like raping, child abuse and similar. Most of the people who experienced these things are able to return to normal life within some given time, but there is also a great number of people who develop a serious stress reaction disorder that, will not go away on its own and may even get worse over time.

Many people say that they are literally haunted by the memories of traumatic experiences which disrupt their everyday activities.

The primary symptoms of PTSD are:

• Intrusion - the reliving of the trauma causing event on a fairly persistent basis such as: Recurring and disturbing memories of the event,
• Distressing dreams of the event,  
• Feeling of re-experiencing the event itself, such as illusions, hallucinations and flashbacks,  
• An intense fear during exposure to events that could resemble the past traumatic event
• Avoidance – This is very common mechanism in which, the individual attempts to avoid situations which are associated with the trauma
• Hyper arousal – When the individual has problems with feelings of increased arousal or vigilance that were not present before the trauma:
• Difficulty with sleep,  
• Intense irritability and angry outbursts,  
• Difficulty with concentration,  
• Hyper vigilance,
• An over-exaggerated startle response when surprised

Signs of increased panic and stress response, such as rapid breathing, higher heart rate, sweating etc. when exposed to situations that resemble the earlier trauma.

Other symptoms that could occur months or even years after the original trauma may include the following:

•    amnesia, forgetfulness, inability to concentrate
•    panic attacks
•    obsession - the experience takes over your life
•     feelings of nervousness, anxiety and fear
•    depression and avoidance behavior
•    excessive shame, embarrassment or guilt
•    emotional numbness or detachment
•    Lack of motivation
•    Poor concentration

Statistical data

An estimated 7.8 percent of Americans experience PTSD at some point in their lives. Women (10.4%) are affected almost twice as much as men (5%). About 3.6 percent of U.S. adults aged 18 to 54 have PTSD during the course of a given year.
 
War is also an important risk factor because it is proven that, about 30 percent of men and women who have spent time in war zones experience PTSD. More than half of all male Vietnam veterans and almost half of all female Vietnam veterans have experienced PTSD.
 
What causes PTSD?

Following a traumatic event, it is normal that a person's perception changes and serves to somehow distance the person from the extreme circumstance.
This is a completely natural mechanism. It helps a person cope with the situation and provides self-protection. Persons who are diagnosed with PTSD are those where the above mentioned thought processes continue to occur later in life. This is considered to be the consequence of a response to any trigger that brings back thoughts of the trauma.
 
Biochemically, several researches done in the past showed that this may be related to persistent elevations of a substance called glutamate in the brain. What is the role of this glutamate?
 
Glutamate generally rises in response to stress and returns to normal following the event.
 
Who is most likely to develop PTSD?

Target groups that are most likely to develop this psychiatric disorder are:

Those who experience greater intensity of stress situations, especially if those situations are unpredictable and uncontrollable. 

Those with vulnerability factors such as

•    genetics,
•    early age of onset and
•    longer-lasting childhood trauma,
•    lack of functional social support, and
•    Concurrent stressful life events.

Those who experience threat or danger, suffering, upset, terror, and horror or fear

Those whose social environment produces feeling of shame, guilt, stigmatization, or self-hatred

What are the consequences associated with PTSD?

It is proven that PTSD is associated with a number of distinctive neurobiological and physiological changes. People diagnosed with PTSD may experience several neurobiological alterations in the

•    Central nervous system and
•    Autonomic nervous systems

Many experts believe that the main problem is that, people with PTSD tend to have abnormal levels of key hormones involved in the body's response to stress:

•    Cortisol levels in those with PTSD are lower than normal
•    Norepinephrine levels are higher than normal.

PTSD patients also develop problems with over-active thyroid gland. When the diagnosis of PTSD is set early in childhood, those children have greater chances to develop some other psychiatric disorders.
 
The most common disorders found in people with PTSD are:
 
MAN
•    alcohol abuse or dependence (51.9 percent),
•    major depressive episodes (47.9 percent),
•    conduct disorders (43.3 percent), and
•    Drug abuse and dependence (34.5 percent).

WOMEN
•    major depressive disorders (48.5 percent),
•    simple phobias (29 percent),
•    social phobias (28.4 percent), and
•    Alcohol abuse/dependence (27.9 percent).

Some other, non-psychiatric disorders may also occur. They include headaches, gastrointestinal complaints, immune system problems, dizziness, chest pain, and discomfort in other parts of the body.

Treatment of PTSD

There are several forms of PTSD therapy and most of them showed beneficial results. The most common are:

MEDICATIONS

Doctors often prescribe different antidepressants such as
•    Selective serotonin re-uptake inhibitors -Sertraline, Fluoxetine, Fluvoxamine, or Paroxetine or
•    Monoamine oxidase inhibitors - such as Phenelzine
•    Medications for anxiety may be helpful as well.

PSYCHO-THERAPY
Behavioral therapy
This is a procedure which uses specific processes that involve mental imagery of the traumatic event combined with relaxation techniques
 
Cognitive therapy
This involves learning various coping skills in order to change the thought process about the past traumatic event
 
Psychodynamic therapy

This includes a very effective supportive therapy that is made to help an individual gain insight into his reactions to the event and then he can learn how to battle with occurrence of the trauma.

HYPNOSIS
Hypnosis is a normal and natural altered state of consciousness or awareness. Although many people think of hypnosis as some “zombie-like” method, the fact is that, after a hypnosis session, most of the people ask if they have really been hypnotized. This is because it feels like such a normal state, although they were expecting something very strange.
 
Hypnotherapy has long been used to treat war-related post-traumatic conditions. In the last couple of years it has been also used in cases of sexual assault, car accidents and other traumatic events.
 
The principle of hypnosis is to induce a deep state of relaxation in patient, which may help cope with PTSD, causing

•    Feelings of safer and less anxious environment,
•    Decrease of the intrusive thoughts, and
•    Re-involvement in daily activities.

How does it work?
It is important to know that our minds work on two levels, the conscious and the unconscious. This conscious part is used when we make decisions, think and act. Part of the unconscious mind's responsibility is to run any habitual behaviors. Communication directly with the unconscious mind is possible and it is called hypnosis. This enables the doctors to change even the lifetime habits quickly and easily.
 
Many people are confused because they’ve heard that hypnosis can't work for all. Well, they are partially right, because, it works only with people that have IQ bigger then 70. This means that it works with the majority of people.
 
It is also very important to know that hypnosis is completely safe.

   Patients should know that hypnosis is not sleep, nor can they get "stuck" in a state of hypnosis, as many believe. You cannot be made to do anything against your will, or against your moral code. In severe cases, anti-anxiety and antidepressant drugs are also a part of the treatment along with the hypnotherapy.

PTSD can develop following involvement in a critical incident such as a life-threatening assault or traffic accident. PTSD can also develop among people who witnessed these events. During the traumatic incident people can feel intense fear, helplessness, horror and a sense of being overwhelmed and unable to cope. Its difficult to predict who will develop PTSD after such an incident, and not everyone will do so. In some people PTSD develops soon after the trauma. Its not unusual, however, to see a delayed onset of symptoms, sometimes months or even years after the initial trauma.

The strict definition of PTSD is that the trauma you had or witnessed must be serious. Examples of this are - a severe accident, rape, a life-threatening assault, torture, seeing someone killed or a natural disaster such as a strong earthquake. However, symptoms similar to PTSD can develop in some people after less severe events. What they all have in common, however, is that the problematic symptoms begin with the incident.

So who can suffer from it?

Certain groups of people are more prone to PTSD than others:
    •    Emergency services, especially rescue workers such as fire fighters
    •    Survivors of road traffic accidents
    •    Rape victims
    •    The majority of people who have been tortured develop PTSD
    •    Military personnel involved in combat

Symptoms
    •    Recurring and intrusive thoughts and memories surrounding the incident. Flashbacks can happen and these can be distressing
    •    Avoidance: this is when people try to avoid anything that reminds them of the incident. This includes thoughts, conversations, associated places, people, activities or anything which may trigger memories of the trauma. A common trigger is reports in the media, especially at anniversaries of incidents
    •    A feeling of emotional numbness and feeling isolation from others. Some people report that nothing feels real anymore. Relationships with those close to you may suffer
    •    You may lose interest in previously enjoyable activities and only be able to look on the dark side of life
    •    Hypersensitivity - This includes Irritability and bouts of temper

Post traumatic stress disorder is generally defined as a condition where the sufferer experiences recurring distressing and intrusive memories and other symptoms after involvement in a traumatic event.

The important thing to remember about PTSD is that it is a normal reaction to an abnormal event which is outside the range of normal experience.

Post Traumatic Stress Disorder symptoms can include the following:
    •    Being constantly on guard and aware of every danger
    •    Exaggerated startle response, jumping at every little thing
    •    Problems sleeping or staying asleep, awakening very early and unable to return to sleep
    •    Difficulty concentrating and short term memory problems.

All of the above are normal reactions to an abnormal event and are easily understood in relation to the fight or flight response.. In most cases, PTSD resolves itself in about 6 months. In some cases the symptoms of PTSD persist long-term. Modern research now means that trauma specialists have effective techniques they can use to help people.

There is no need to wait and see if your symptoms are going to persist beyond 6 months. You can seek help immediately after a traumatic incident

What about treatment?
The aim of treatment is not to wipe away the memories. What happened has happened and that cant be changed. The aim is to desensitise the memory so it no longer causes you distress. We all have unpleasant or disturbing memories but they dont interfere with our day to day lives. Successful treatment for PTSD will return you to a state where you can function well in your day to day life without the distress you previously experienced.

Many thousands of people have left PTSD behind and gone on to live full and active lives.

The following treatment options have been shown to be effective for those already suffering from PTSD:
    •    Hypnotherapy
    •    Eye Movement Desensitization and Reprocessing (EMDR)
    •    The Rewind Technique
    •    Anxiety management
    •    Relaxation training
    •    CBT  Cognitive Behavioral Therapy

It is essential that anyone who wishes to treat people experiencing Post-Traumatic Stress Disorder (PTSD) be properly trained or experienced to do so.
 
In some cases, it has become apparent that previous training as a therapist or counselor can serve as a disadvantage. This is because of the unique place that PTSD occupies among clinically defined mental health conditions. PTSD is cause specific, i.e. linked directly with a known cause. As such, the treatment of the condition can be approached in a much more direct manner that would be the case with many other conditions.