Holistic Approach to PTSD & Trauma: Finding Help and Healing

1. PTSD, Terror and Trauma A Holistic ApproachFinding help for Trauma-Related Illness and PTSD by early recognition and treatment RONALD R. PARKS, MPH, MD Integrative Medicine and Psychiatry 1070-1 Tunnel Road, Ste. 10, #274 Asheville, NC 28805 ronparksmd.com (828) 333-7282

2. Disclosure Statement No relevant financial relationships to disclose All of the information on the following slides and references can be found in the article by Dr. Parks at: http://ronparksmd.com/ptsd-terror-trauma-holistic-approach/

4. PTSD, terror, trauma  – how common? • An estimated seventy percent of adults in the U.S. have experienced a traumatic event at least once in their lifetime • An estimated ten percent of the above will develop Post Traumatic Stress Disorder (PTSD) • Women are about twice as likely as men to develop PTSD (one out of nine women) • An estimated eight percent of the population will have PTSD at some point in their lives - about eight million adults during any given year

5. The onset of trauma-related symptoms or illness • Can be delayed and emerge months after the traumatizing event • May appear, earlier, be more subtle and difficult to recognize, or be ignored • 50% of children who lost parents in the 9/11 attack developed anxiety and PTSD *reported on CBS “Sixty Minutes” - 9/11/16 special

6. Trauma related illness (TRI) can occur at any life stage as a result of: • Exposure to threatened death, serious injury, auto accidents, violence, or major emotional losses • Feeling helpless during a trauma as childhood sexual abuse, rape, physical assaults • Overwhelming adverse life threatening events or poly-trauma (i.e., series of traumatic events: as a job loss, divorce, death of a significant other) • Witnessing domestic violence, death or injury to others • Natural disasters or mass causality event as a terrorist attack

7. Vulnerability factors for TRI & PTSD • Lack of social support • Co-occurring physical or mental health problem such as a substance use disorder, TBI, depression, or anxiety • Single or compounded losses • Contributing genetic factors • Early life ordeals or upheavals (parents divorce, abandonment, abuse, neglect, & bullying)

8. Cost of TRI and PTSD • The cost to our medical care system for PTSD and TRI is in the billions of dollars annually, and is compounded by misdiagnosis and improper treatment • Beyond treatment costs, there are the related workplace, drug, associated illness, disabilities, and mortality costs • Fortunately, an estimated 80%-90% of persons exposed to the various types of severe trauma will not develop PTSD

9. “Traumatic experience can have a profound effect on one person and very little impact on another” • Predisposing — vulnerability factors — are important deciders • Where there is more exposure to traumatic experiences, there is a greater chance of TRI • Most people won't develop TRI, but instead enhance their resilience

11. Intermittent or chronic emotional or physical symptoms of TRI or PTSD #1 • Re-living: relive the ordeal through thoughts and intrusive memories of the trauma — including flashbacks, hallucinations, nightmares, feeling great distress when reminded of the trauma, acting and feeling as if the trauma were recurring • Feeling numb: avoiding people, places, thoughts or situations that are reminders of the trauma, inability to recall aspects of the trauma; feeling of detachment or estrangement from others; isolation and withdrawal (freeze response)

12. Intermittent or chronic emotional or physical symptoms of TRI or PTSD #2 • Loss of interest in once enjoyed activities, difficulty relating to others, experiencing love, joy, or intimacy – a restricted range of feelings, interest, and activities • Sense of a foreshortened future • Increased arousal as: excessive emotions, worry and guilt, difficulty falling or staying asleep, feeling nervous, fearful, increased irritability, outbursts of anger, agitation, and difficulty concentrating (flight, fight response)

13. Intermittent or chronic emotional or physical symptoms of TRI or PTSD #3 • Hypervigilant, guarded, and constantly alert;  physiologic reactivity upon exposure to trauma cues and having exaggerated startled responses – being jumpy, panic attacks • Experiencing worsening physical symptoms and medical problems, e.g., increased blood pressure, heart rate, fatigue, rapid breathing, muscle tension, headaches, sweating, digestive problems as poor appetite, and diarrhea

14. Intermittent or chronic emotional or physical symptoms of TRI or PTSD #4 • Feelings of hopelessness, helplessness,shame, despair or sadness • Self-blame, negative views of oneself or the world and distrust of others • Family, employment or school problems • Relationship problems including conflicts, being over-controlling, violence, and divorce • Failure to engage in exercise, diet, safe sex, or regular health care • Excess smoking, alcohol and drugs problems

16. Recognition, then a comprehensive approach including: • Prevention and avoidance of re-traumatization • Earlier recognition of the acute and lingering effects of trauma and timely interventions • Assessment, diagnosis, and investigation into contributing factors, as TBI or developmental issues • Application of holistic, integrative and innovative treatments • Restoration of health, well-being, sleep, autonomic regulation, interpersonal and daily functioning

17. Role of Integrative Medicine & Psychiatry • A caring and holistic approach with an integration of environmental, functional medicine, traditional psychiatry, nutrition and evidenced based alternatives • Attention to: physical, psychological, emotional, behavioural, biochemical, genetic, nutritional, environmental, interpersonal, developmental, family history, spiritual, and lifestyle issues • Assessment and treatment of malfunction in complex integrated biologic systems • Goal of restoring functionality, health, & well-being

18. The tools of integrated psychiatry, medicine, and psychology • In-depth clinical history • Psycho-social assessment • Physical examination and laboratory testing • Psychological testing • Consulting with significant others – treatment team, family members and friends when possible • Comprehensive treatment programs

19. Treatment considerations for TRI and PTSD • Lifestyle and nutritional modifications • Reduction in psycho-social stressors • Individual and group psychotherapies that address current, past, developmental, and trauma issues • Interventions as suggested by clinical finding, treatment team and lab testing • Medication use after other contributing factors have been addressed, and when non-medication interventions have failed

20. Team or network approach for TRI would include: • Health care practitioners and therapists experienced and trained in trauma work • Individual, group, behavioral or cognitive behavioral therapy (CBT) psychotherapies • Exposure therapy, trauma-focused cognitive behavioral therapy, trauma systems therapy • Somatic experiencing, Eye Movement Desensitization and Reprocessing (EMDR), Emotional Freedom Technique, Reset, BAUD • Transpersonal, Spiritual Emergence Therapies, and other natural alternatives or medication

21. Medications commonly considered: • Selective serotonin re-uptake inhibitors for depression and anxiety (SSRIs; e.g., fluoxetine, sertraline) • Symptomatic treatments with sleep agents or more helpful for trauma-related nightmares in adults — Prazosin — an anti-hypertensive • Benzodiazepines (tranquilizers)— long-term use does not appear beneficial and difficult to wean and stop • β-blockers — used to reduce arousal but of questionable benefit

22. Simple vs complex trauma • Simple trauma – one incident without compounding or related problems • Complex trauma – multiple layering on of traumatic experiences and associated problems • Corrective interventions to alleviate compounding issues as: infections, digestive disturbance, nutritional, metabolic, or hormonal imbalances, allergies, drug, alcohol addictions, emotional, mood, pain, sleep problems, personal, or family stressors

23. Emerging Therapies • Symptoms or crisis become the doorway to growth, change in personal and spiritual life • New paradigm, as Spiritual Emergence, Transpersonal Psychology, where presentation is not seen as pathology, but as a gateways to healing and transformation • Emphasis on resolution of core issues, underlying problems and dynamics, • Assisting positive change in personality, development of compassion, openness, flexibility, insightfulness, and resilience

25. References • All of the information on the following slides and references can be found in article by Dr. Parks at: http://ronparksmd.com/ptsd-terror-trauma-holistic-approach/ • Also review other relevant articles on Dr. Parks’ blog http://ronparksmd.com/ • For information on Center for Spiritual Emergence in Asheville, NC http://www.centerforspiritualemergence.com/

26. “The Truth” ۞"Don't seek the truth. Just cease to cherish opinions." -- Zen saying

27. "Old School"