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Trauma and Transformation AUSA Military Family Forum II October 22, 2013

Trauma and Transformation AUSA Military Family Forum II October 22, 2013. James S. Gordon, MD Founder & Director The Center for Mind-Body Medicine. “There is nobody normal here anymore.” ~ Kosovar psychiatrist. Trauma. Trauma means “injury”— to our mind, body, and spirit

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Trauma and Transformation AUSA Military Family Forum II October 22, 2013

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  1. Trauma and TransformationAUSA Military Family Forum IIOctober 22, 2013 James S. Gordon, MD Founder & DirectorThe Center for Mind-Body Medicine

  2. “There is nobody normal here anymore.” ~Kosovar psychiatrist

  3. Trauma Trauma means “injury”— to our mind, body, and spirit It may come to any or all of us Trauma is about loss

  4. Where Does It Come From?

  5. Fight or Flight A Survival Response

  6. Fight or Flight • Marked by: • Sympathetic Nervous System Activation • Arousal and preparation • Increased heart rate • Faster breathing • Muscular tension • Coldness and sweating • Decreased intestinal activity • Dilated pupils • Mediated by periorbital, frontal cortex (limbic system), hypothalamus, and autonomic nervous system

  7. The Freeze Response Mongeau R et al. Neural correlates of competing fear behaviors evoked by an innately aversive stimulus. J of Neuro. 2003 May; 23:3855-3868. Porges, SW. Social engagement and attachment: A phylogenetic perspective. Ann NY Acad Sci. 2003 Dec; \1008:31-47 . • “Deer In Headlights” • In extremely threatening situations, response may be Parasympathetic dominance. • Most primitive response • Inhibition of motor function • Slow heart rate, decreased blood pressure, etc. • Higher baseline anxiety may predispose. • May be persistent in those with PTSD.

  8. Slide # 8 The Stress of Life Hans Selye, 1956 In general, stress comes when fight or flight is prolonged beyond immediate reaction and/or repeated. • Alarm (Fight or Flight) • Adaptation • Exhaustion

  9. Slide # 9 EFFECTS OF STRESS ON RATS THAT WERE FORCEFULLY IMMOBILIZED NORMAL STRESSED* Marked enlargement and dark discoloration Adrenals Intense shrinkage Thymus A group of 3 lymph nodes Intense shrinkage Inner surface of the stomach Numerous blood-covered stomach ulcers

  10. Slide # 10 Hypothalamus Pituitary STRESS Limbic system 1. ACTH Feedback 2. Corticoid Feedback 3. Catecholamine Feedback Autonomic nervous system Endocrine system Immune system Thymus Spleen Lymph nodes Skin, etc. Corticoids Gastrointestinal Corticoids Peptic ulcer Adrenals Catecholamines Blood pressure, metabolism, etc.

  11. Slide # 11 Stress Influences the Onset and Course of Virtually All Illness Source: Institute of Medicine

  12. Slide # 12 STRESS… May contribute in a significant way to every major illness and condition including heart disease, diabetes, cancer, infections, chronic pain, anxiety, and depression, and PTSD, as well as early death.

  13. The highly catabolic stress hormones glucocorticoids pass the blood-brain barrier and easily bind to receptors located in the amygdala, hippocampus, and frontal lobe – the areas most responsible for emotion, self-regulation and appraisal, learning, and memory. Over time, they cause structural changes to theseregions.

  14. Biological Structure of Traumatic Stress RonakPatela, R. Nathan Sprengb, Lisa M. Shinc, Todd A. Girarda (2012) Neurocircuitry models of posttraumatic stress disorder and beyond: A meta-analysis of functional neuroimaging studies. Neuroscience & Biobehavioral Reviews. July 2012 Excessive exposure to glucocorticoids has caused observed changes in trauma-exposed people: Hyperactivation of the Amygdala Alteration in Hippocampal Functioning Hypoactivation of the medial prefrontal cortex (encompassing the anterior cingulate cortex (ACC), ventromedial prefrontal cortex, subcallosal cortex, and oribitofrontal cortex) results in an inability to effectively control attention and response to trauma-related stimuli.

  15. Trauma Among Military and Veterans • Up to 30% of veterans receiving treatment by the VA are coded as having PTSD • 349 active duty military members took their own lives in 2012 • In 2012, more active duty military members committed suicide than were killed in combat • 22 veterans commit suicide every day • Only 50% of veterans and active duty with diagnosed PTSD ever seek out treatment • Only half of those continue after the first session. Walsh, M. February 2, 2013 “U.S. Vets Commit Suicide at an Alarming Rate: VA Study.” NEW YORK DAILY NEWS http://www.fas.org/sgp/crs/natsec/RS22452.pdf http://www.publichealth.va.gov/docs/epidemiology/ptsd-report-fy2012-qtr3.pdf

  16. Diagnosis may be useful—and may also be limiting What is needed is an approach which gives all active duty and veterans the tools they need to deal with the stress they are experiencing or may encounter. Without stigma Open to all In a context of small group support

  17. Change and Trauma Healthy systems (beings) move toward complexity (includes differentiation and integration) After trauma we tend to oscillate between rigidity (withdrawal, inhibition, flashback) and chaos (agitation, disorganization) Effective therapeutic work entails helping those who are traumatized to find a new level of homeostasis which fosters continued growth and development

  18. Lessons:

  19. 1) Ground mental health services in the skills of self-care rather than the treatment of disorders

  20. Techniques of Self-Care • Meditation • Biofeedback and autogenic training • Guided Imagery • Self-hypnosis • Self-Expression in words, drawings, and movement • Yoga, Qi-Gong, and other forms of physical exercise • Individual and Group Support

  21. 2) Make these services universally available -- and compulsory

  22. 3) Work with the body as well as the mind

  23. Mind-Body Approaches Directly address issues of hyper-arousal by promoting physiological relaxation response Balance the sympathetic fight or flight with the parasympathetic relaxation response Remedy the freeze response by using active physical techniques Offer, through meditative practice and a meditative approach, a more relaxed perspective on trauma, traumatic memories, flashbacks, dreams.

  24. 4) Make group approaches standard

  25. 5) Use medication only as a last resort and in the context of an intensive and comprehensive approach.

  26. 6) Find a way to provide true confidentiality to those who seek help.

  27. The CMBM Approach Acts By • Quieting anxiety and agitation • Providing perspective on flashbacks and nightmares • Inviting but not forcing emotional openness and connection • Increasing energy • Restoring control • Promoting hope • Working with participants’ strengths and capacity for self-reliance • Can be used by people of all ages (3 on up) and with all conditions • Building cohesion and mutual support • Enhancing resiliency in both professionals and those they serve • Interfaces well with therapeutic and educational approaches • Integrates well within existing structures: clinics, hospitals, community groups

  28. Global Reach: The CMBM Model Capacity to fully and effectively train thousands in cohorts of up to 300

  29. United States Military, Veterans, and Families

  30. 350 clinicians who work with US military and veterans and their families trained in CMBM approach

  31. Data on Training US MilitaryInitial Training San Diego 2009

  32. Findings (continued)

  33. Uses PTSD Checklist (PCL) *Preliminary data which has NOT been tested for statistical significance Preliminary Data on CMBM DoD/VA Study with Veterans

  34. “The Center for Mind-Body Medicine’s program…is the most comprehensive of all [treatments], giving participants a variety of different strategies to choose from: breathing, meditation, guided visual imagery, bio-feedback, self-awareness, dance, self-expression, drawing. And it is the one with the strongest evidence that it works to cure PTSD.” The New York Times, Sept 26, 2012

  35. Research Supporting the CMBM Model

  36. Research Supporting the CMBM Model • 498 children in Gaza participated in 10-week-long mind-body skills groups show significant decreases in PTSD symptoms, depression and hopelessness. • Almost 80% who met the criteria for PTSD no longer did after the groups were over despite ongoing armed conflict • Data from 500 adults in Gaza show comparable results • Published in The International Journal of Stress Mnagement , August 2011

  37. First ever randomized controlled trial published on any intervention with children with post-war PTSD • 82 adolescents met PTSD criteria -Harvard Trauma Questionnaire • 25% of Kosovar Albanians 15 years or older reported PTSD symptoms • 12 session mind-body group • Significant decrease in PTSD symptom scores (90%) maintained at 3 month follow up • Paper published in Journal of Clinical Psychiatry, Fall 2008

  38. CMBM Uses the “Unstuck” Approach to Trauma Unstuck: Your Guide to the Seven Stage Journey Out of Depression Profiles techniques designed to reduce stress, break-up fixed patterns by engaging the body and mind, enhance a sense of community, and utilize innate wisdom to facilitate creative solutions and promote growth and healing.

  39. Food as Medicine A Feast of Science and Wisdom June 5-8, 2014 San Francisco Bay Area, CA Mind-Body Medicine Learn the Science, Live the Techniques October, 2014… . San Francisco Bay Area, CA . WWW.CMBM.ORG

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