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Treatment for Trauma-Related Disorders: The “Three Buckets” Model

  • Elspeth Cameron Ritchie
  • Rachel M. Sullivan
  • Kyle J. Gray
Chapter

Abstract

PTSD is a complex psychiatric disorder with common comorbidities that can be difficult to treat. Conventional evidence-based therapies include trauma-focused cognitive behavioral therapy and certain antidepressants, but these treatments may not be tolerated or preferred for a variety of reasons, or they may only be partially effective. This lesson familiarizes the clinician with a variety of CAM treatment options for PTSD as well as the rapidly growing use of transcranial magnetic stimulation (TMS) for PTSD. We review the basics of various meditation practices, animal-assisted therapy, acupuncture, and TMS and potential ways they can be incorporated into practice. We also briefly discuss what is known about the use of cannabinoids for PTSD.

Keywords

Military Veterans PTSD Complementary and alternative medicine (CAM) Meditation Animal-assisted therapy Acupuncture Transcranial magnetic stimulation (TMS) 

References

  1. 1.
    Kessler RC, Berglund P, Demler O, Jin R, Merikangas KR, Walters EE. Lifetime prevalence and age-of-onset distributions of DSM-IV disorders in the National Comorbidity Survey Replication. Arch Gen Psychiatry. 2005;62(6):593–602.  https://doi.org/10.1001/archpsyc.62.6.593.CrossRefPubMedGoogle Scholar
  2. 2.
    American Psychiatric Association. Diagnostic and statistical manual of mental disorders. 5th ed. Washington, DC: American Psychiatric Association Press; 2013.Google Scholar
  3. 3.
    Kessler RC, Sonnega A, Bromet E, et al. Posttraumatic stress disorder in the National Comorbidity Survey. Arch Gen Psychiatry. 1995;52:1048.CrossRefGoogle Scholar
  4. 4.
    Schneiderman AI, Braver ER, Kang HK. Understanding sequelae of injury mechanisms and mild traumatic brain injury incurred during the conflicts in Iraq and Afghanistan: persistent postconcussive symptoms and posttraumatic stress disorder. Am J Epidemiol. 2008;167:1446.CrossRefGoogle Scholar
  5. 5.
    Scioli-Salter ER, Forman DE, Otis JD, Gregor K, Valovski I, Rasmusson AM. The shared neuroanatomy and neurobiology of comorbid chronic pain and PTSD. Clin J Pain. 2015;31(4):363–74.  https://doi.org/10.1097/ajp.0000000000000115.CrossRefPubMedGoogle Scholar
  6. 6.
    Ritchie EC. Three buckets for treatment of PTSD [Web log post]. 2016, June 07. Retrieved August 18, 2016, from https://www.psychiatry.org/news-room/apa-blogs/apa-blog/2016/06/three-buckets-for-treatment-of-ptsd.
  7. 7.
  8. 8.
    Waits WM, Kip KE, Hernandez DF. Accelerated resolution therapy. In: Ritchie EC, editor. Posttraumatic stress disorder and related diseases in combat veterans. New York: Springer; 2015. p. 105–22.CrossRefGoogle Scholar
  9. 9.
    Cukor J, Gerardi M, Alley S, Reist C, Roy M, Rothbaum BO, Difede J, Rizzo A. Virtual reality exposure therapy for combat-related PTSD. In: Ritchie EC, editor. Posttraumatic stress disorder and related diseases in combat veterans. New York: Springer; 2015. p. 179–96.Google Scholar
  10. 10.
    Hoge CW, Grossman SH, Auchterlonie JL, Riviere LA, Milliken CS, Wilk JE. PTSD treatment for soldiers after combat deployment: low utilization of mental health care and reasons for dropout. PS Psychiatr Serv. 2014;65(8):997–1004.  https://doi.org/10.1176/appi.ps.201300307.CrossRefGoogle Scholar
  11. 11.
    NCCIH Homepage. 2016, August 4. Retrieved from https://nccih.nih.gov/health/integrative-health.
  12. 12.
    Goertz C, Marriott BP, Finch MD, Bray RM, Williams TV, Hourani LL, Hadden LS, Colleran HL, Jonas WB. Military report more complementary and alternative medicine use than civilians. J Altern Complement Med. 2013;19(6):509–17.  https://doi.org/10.1089/acm.2012.0108.CrossRefPubMedPubMedCentralGoogle Scholar
  13. 13.
    VA Healthcare Analysis and Information Group. 2011 complementary and alternative medicine. Washington, DC: Department of Veterans Affairs; 2011.Google Scholar
  14. 14.
    Office of Research & Development. 2016, April 26. Retrieved August 18, 2016, from http://www.research.va.gov/topics/cam.cfm.
  15. 15.
    Strauss JL, Coeytaux R, McDuffie J, et al. Efficacy of complementary and alternative medicine therapies for posttraumatic stress disorder. Washington, DC: Department of Veterans Affairs; 2011.Google Scholar
  16. 16.
    Ritchie EC. Posttraumatic stress disorder and related diseases in combat veterans. Cham: Springer; 2015.CrossRefGoogle Scholar
  17. 17.
    Khusid M. Meditation for combat-related mental health concerns. In: Ritchie EC, editor. Posttraumatic stress disorder and related diseases in combat veterans. New York: Springer; 2015. p. 133–5.Google Scholar
  18. 18.
    Creswell J, Way B, Eisenberger N, Lieberman M. Neural correlates of dispositional mindfulness during affect labeling. Psychosom Med. 2007;69(6):560–5.CrossRefGoogle Scholar
  19. 19.
    Chiesa A, Serretti A. A systematic review of neurobiological and clinical features of mindfulness meditations. Psychol Med. 2010;40(8):1239–52.CrossRefGoogle Scholar
  20. 20.
    Farb N, Anderson A, Segal Z. The mindful brain and emotion regulation in mood disorders. Can J Psychiatr. 2012;57(2):70–7.CrossRefGoogle Scholar
  21. 21.
    Ospina M, Bond K, Karkhaneh M, Tjosvold L, Vandermeer B, Liang Y, et al. Meditation practices for health: state of the research. Evid Rep Technol Assess (Full Rep). 2007;155:1–263.Google Scholar
  22. 22.
    Vujanovic AA, Niles B, Pietrefesa A, Schmertz SK, Potter CM. Mindfulness in the treatment of posttraumatic stress disorder among military veterans. Prof Psychol Res Pract. 2011;42(1):24–31.CrossRefGoogle Scholar
  23. 23.
    Bormann J, Thorp S, Wetherell J, Golshan S. A spiritually based group intervention for combat veterans with posttraumatic stress disorder: feasibility study. J Holist Nurs. 2008;26(2):109.CrossRefGoogle Scholar
  24. 24.
    Bormann J, Liu L, Thorp S, Lang A. Spiritual wellbeing mediates PTSD change in veterans with military-related PTSD. Int J Behav Med. 2012;19(4):496–502.CrossRefGoogle Scholar
  25. 25.
    Bormann J. Frequent, silent mantram repetition: a Jacuzzi for the mind. Top Emerg Med. 2005;27(2):163.Google Scholar
  26. 26.
    Lang A, Strauss J, Bomyea J, Bormann J, Hickman S, Good R, et al. The theoretical and empirical basis for meditation as an intervention for PTSD. Behav Modif. 2012;36(6):759–86.CrossRefGoogle Scholar
  27. 27.
    Davidson RJ, Begley S. The emotional life of your brain: how its unique patterns affect the way you think, feel, and live—and how you can change them. New York: Plume Book; 2012.Google Scholar
  28. 28.
    Klimecki O, Leiberg S, Lamm C, Singer T. Functional neural plasticity and associated changes in positive affect after compassion training. Cereb Cortex. 2012;23(7):1552–161.CrossRefGoogle Scholar
  29. 29.
    Lutz A, Brefczynski-Lewis J, Johnstone T, Davidson R. Regulation of the neural circuitry of emotion by compassion meditation: effects of meditative expertise. PLoS One. 2008;3(3):10.CrossRefGoogle Scholar
  30. 30.
    Fredrickson B, Cohn M, Coffey K, Pek J, Finkel S. Open hearts build lives: positive emotions, induced through loving-kindness meditation, build consequential personal resources. J Pers Soc Psychol. 2008;95(5):1045–62.CrossRefGoogle Scholar
  31. 31.
    Cohn M, Fredrickson B, Brown S, Mikels J, Conway A. Happiness unpacked: positive emotions increase life satisfaction by building resilience. Emotion. 2009;9(3):361–8.CrossRefGoogle Scholar
  32. 32.
    Johnson D, Penn D, Fredrickson B, Kring A, Meyer P, Catalino L, et al. A pilot study of loving-kindness meditation for the negative symptoms of schizophrenia. Schizophr Res. 2011;129(2–3):137–40.CrossRefGoogle Scholar
  33. 33.
    Service Animals. 2011, July 12. Retrieved August 07, 2016, from https://www.ada.gov/service_animals_2010.htm.
  34. 34.
    Hunt MG, Chizkov RR. Are therapy dogs like Xanax? Does animal-assisted therapy impact processes relevant to cognitive behavioral psychotherapy? Anthrozoös. 2014;27(3):457–69.CrossRefGoogle Scholar
  35. 35.
    Olmert MD. Made for each other, the biology of the human-animal bond. Cambridge, MA: DaCapo Press; 2009.Google Scholar
  36. 36.
    Nuemann ID, Landgraf R. Balance of brain oxytocin and vasopressin: implications for anxiety, depression, and social behaviors. Trends Neurosci. 2012;35(11):649–59.CrossRefGoogle Scholar
  37. 37.
    Beetz A, Uvnas-Moberg K, Julius H, et al. Psychological and psychophysiological effects of human-animal interactions: the possible role of oxytocin. Front Psychol. 2012;3:234.  https://doi.org/10.3389/fpsyg.2012.00234.CrossRefPubMedPubMedCentralGoogle Scholar
  38. 38.
    Olff M. Bonding after trauma: on the role of social support and the oxytocin system intraumatic stress. Eur J Psycho-Traumatol. 2012;3:18597.  https://doi.org/10.3402/ejpt.v3i0.18597.CrossRefGoogle Scholar
  39. 39.
    Katcher AH. Interactions between people and their pets: form and function. In: Fogle B, editor. Interrelations between people and pets. Springfield: Charles C Thomas; 1987. p. 41–67.Google Scholar
  40. 40.
    Yount RA, Lee MR, Olmert MD. Service dog training program for treatment of posttraumatic stress in service members. US Army Med Dep J. 2012; 63–9.Google Scholar
  41. 41.
    Beck AM, Seraydarian L, Hunter F. Use of animals in the rehabilitation of psychiatric patients. Psychol Rep. 1986;58:63–6.CrossRefGoogle Scholar
  42. 42.
    Wilkes JK. The role of companion animals in counseling and psychology: discovering their use in the therapeutic process. Springfield: Charles C. Thomas; 2009.Google Scholar
  43. 43.
    Earles JL. Equine-assisted therapy for anxiety and posttraumatic stress symptoms equine-assisted therapy. J Trauma Stress. 2015;28(2):149–52.CrossRefGoogle Scholar
  44. 44.
    Hickey AH, Koffman R. Adding a face and the story to the data: acupuncture for PTSD in the military. In: Ritchie EC, editor. Posttraumatic stress disorder and related diseases in combat veterans. New York: Springer; 2015. p. 161–78.CrossRefGoogle Scholar
  45. 45.
    Pillington K. Acupuncture therapy for psychiatric illness. Int Rev Neurobiol. 2013;111:197–216.CrossRefGoogle Scholar
  46. 46.
    McDonald JK, Cripps AW, Smith PK. Mediators, receptors, and signaling pathways in the anti-inflammatory and antihyperalgesic effects of acupuncture. Evid Based Complement Alternat Med. 2015;2015:975632.CrossRefGoogle Scholar
  47. 47.
    Yang J, Li Q, Li F, Fu Q, Zeng X, Liu C. The holistic effects of acupuncture treatment. Evid Based Complement Alternat Med. 2014;2014:10, Article ID 73978.Google Scholar
  48. 48.
    Manni L, Albanesi M, Guaragna M, Garbaro Paparo S, Aloe L. Neurotrophins and acupuncture. Auton Neurosci. 2010;157(1/2):9–17.CrossRefGoogle Scholar
  49. 49.
    Kim Y, Heo I, Shin B, Crawford C, Kang H, Lim J. Acupuncture for posttraumatic stress disorder: a systematic review of randomized controlled trials and prospective clinical trials. Evid Based Complement Alternat Med. 2013;2013:12, Article ID 615857.Google Scholar
  50. 50.
    Rossi S, De Capua A, Tavanti M, Calossi S, Polizzotto NR, Mantovani A, Falzarano V, Bossini L, Passero S, Bartalini S, Ulivelli M. Dysfunctions of cortical excitability in drug-naïve posttraumatic stress disorder patients. Biol Psychiatry. 2009;66(1):54–61.CrossRefGoogle Scholar
  51. 51.
    Grammer GG, Cole JT, Rall CJ, Scacca CC. Use of transcranial magnetic stimulation for the treatment of PTSD. In: Ritchie EC, editor. Posttraumatic stress disorder and related diseases in combat veterans. New York: Springer; 2015. p. 161–78.Google Scholar
  52. 52.
    Boggio PS, Rocha M, Oliveira MO, et al. Noninvasive brain stimulation with high-frequency and low-intensity repetitive transcranial magnetic stimulation treatment for posttraumatic stress disorder. J Clin Psychiatry. 2010;71(8):992–9.CrossRefGoogle Scholar
  53. 53.
    Kim SY, Lee DW, Kim H, Bang E, Chae JH, Choe BY. Chronic repetitive transcranial magnetic stimulation enhances GABAergic and cholinergic metabolism in chronic unpredictable mild stress rat model: (1)H-NMR spectroscopy study at 11.7T. Neurosci Lett. 2014;572:32–7.CrossRefGoogle Scholar
  54. 54.
    Karsen EF, Watts BV, Holtzheimer PE. Review of the effectiveness of transcranial magnetic stimulation for posttraumatic stress disorder. Brain Stimul. 2014;7(2):151–7.CrossRefGoogle Scholar
  55. 55.
    Breit S, Kupferberg A, Rogler G, Hasler G. Vagus nerve as modulator of the brain–gut axis in psychiatric and inflammatory disorders. Front Psych. 2018;9:44.  https://doi.org/10.3389/fpsyt.2018.0004.CrossRefGoogle Scholar
  56. 56.
    Avery T, Blasey C, Rosen C, Bayley P. Psychological flexibility and set-shifting among veterans participating in a yoga program: a pilot study. Mil Med. 2018.  https://doi.org/10.1093/milmed/usy045.
  57. 57.
    Staples JK, Hamilton MF, Uddo M. A yoga program for the symptoms of post-traumatic stress disorder in veterans. Mil Med. 2013;178(8):854–60.  https://doi.org/10.7205/MILMED-D-12-00536.CrossRefPubMedGoogle Scholar
  58. 58.
    Horowitz S. Transcranial magnetic stimulation and cranial electrotherapy stimulation: treatments for psychiatric and neurologic disorders. Altern Complement Ther. 2013;19(4):188–93.  https://doi.org/10.1089/act.2013.19402.CrossRefGoogle Scholar
  59. 59.
    McCarthy L, Fuller J, Davidson G, Crump A, Positano S, Alderman C. Assessment of yoga as an adjuvant treatment for combat-related posttraumatic stress disorder. Australas Psychiatry. 2017;25(4):354–7.  https://doi.org/10.1177/1039856217695870. Epub 2017 Mar 1. PubMed PMID: 28747121.CrossRefPubMedGoogle Scholar
  60. 60.
    Crombie KM, Brellenthin AG, Hillard CJ, Koltyn KF. Psychobiological responses to aerobic exercise in individuals with posttraumatic stress disorder. J Trauma Stress. 2018;31(1):134–45.  https://doi.org/10.1002/jts.22253. Epub 2018 Feb 1. PubMed PMID: 29388710.CrossRefPubMedGoogle Scholar
  61. 61.
    Oppizzi LM, Umberger R. The effect of physical activity on PTSD. Issues Ment Health Nurs. 2018;39(2):179–87.  https://doi.org/10.1080/01612840.2017.1391903. Epub 2018 Jan 10. PubMed PMID: 29319376.CrossRefPubMedGoogle Scholar
  62. 62.
    Kip KE, Rosenzweig L, Hernandez DF, Shuman A, Sullivan KL, Long CJ, Taylor J, McGhee S, Girling SA, Wittenberg T, Sahebzamani FM, Lengacher CA, Kadel R, Diamond DM. Randomized controlled trial of accelerated resolution therapy (ART) for symptoms of combat-related post-traumatic stress disorder (PTSD). Mil Med. 2013;178(12):1298–309.  https://doi.org/10.7205/MILMED-D-13-00298. PubMed PMID: 24306011.CrossRefPubMedGoogle Scholar
  63. 63.
    Church D, Yount G, Rachlin K, Fox L, Nelms J. Epigenetic effects of PTSD remediation in veterans using clinical emotional freedom techniques: a randomized controlled pilot study. Am J Health Promot. 2018;32(1):112–22.  https://doi.org/10.1177/0890117116661154. Epub 2016 Aug 12. PubMed PMID: 27520015.CrossRefPubMedGoogle Scholar
  64. 64.
    Hernandez DF, Waits W, Calvio L, Byrne M. Practice comparisons between accelerated resolution therapy, eye movement desensitization and reprocessing and cognitive processing therapy with case examples. Nurse Educ Today. 2016;47:74–80.  https://doi.org/10.1016/j.nedt.2016.05.010. Epub 2016 May 21. PubMed PMID: 27250615.CrossRefPubMedGoogle Scholar
  65. 65.
    Lynch JH, Mulvaney SW, Kim EH, de Leeuw JB, Schroeder MJ, Kane SF. Effect of stellate ganglion block on specific symptom clusters for treatment of post-traumatic stress disorder. Mil Med. 2016;181(9):1135–41.  https://doi.org/10.7205/MILMED-D-15-00518. PubMed PMID: 27612365. Hanling SR, Hickey A, Lesnik I, Hackworth RJ, Stedje-Larsen E, Drastal CA, McLay RN. Stellate ganglion block for the treatment of posttraumatic stress disorder: a randomized, double-blind, controlled trial. Reg Anesth Pain Med. 2016;41(4):494–500.  https://doi.org/10.1097/AAP.0000000000000402. PubMed PMID: 27187898.
  66. 66.
    McLean B. Safety and patient acceptability of stellate ganglion blockade as a treatment adjunct for combat-related post-traumatic stress disorder: a quality assurance initiative. Cureus. 2015;7(9):e320.  https://doi.org/10.7759/cureus.320. PubMed PMID: 26487996; PubMed Central PMCID: PMC4601906.CrossRefPubMedPubMedCentralGoogle Scholar
  67. 67.
    Lipov E, Ritchie EC. A review of the use of stellate ganglion block in the treatment of PTSD. Curr Psychiatry Rep. 2015;17(8):599.  https://doi.org/10.1007/s11920-015-0599-4. Review. PubMed PMID: 26073361.CrossRefPubMedGoogle Scholar
  68. 68.
    Mulvaney SW, Lynch JH, Kotwal RS. Clinical guidelines for stellate ganglion block to treat anxiety associated with posttraumatic stress disorder. J Spec Oper Med. 2015;15(2):79–85. PubMed PMID: 26125169.PubMedGoogle Scholar
  69. 69.
    Mulvaney SW, Lynch JH, Hickey MJ, Rahman-Rawlins T, Schroeder M, Kane S, Lipov E. Stellate ganglion block used to treat symptoms associated with combat-related post-traumatic stress disorder: a case series of 166 patients. Mil Med. 2014;179(10):1133–40.  https://doi.org/10.7205/MILMED-D-14-00151. PubMed PMID: 25269132.CrossRefPubMedGoogle Scholar
  70. 70.
    Peterson K, Bourne D, Anderson J, Mackey K, Helfand M. Evidence brief: effectiveness of stellate ganglion block for treatment of posttraumatic stress disorder (PTSD). In: VA evidence-based synthesis program evidence briefs [Internet]. Washington, DC: Department of Veterans Affairs (US); 2017; 2011. Available From http://www.ncbi.nlm.nih.gov/books/NBK442253/PubMed PMID: 28742302.Google Scholar
  71. 71.
    Bowles DW. Persons registered for medical marijuana in the United States. J Palliat Med. 2012;15(1):9–11.CrossRefGoogle Scholar
  72. 72.
    Boden MT, Babson KA, Vujanovic AA, Short NA, Bonn-Miller MO. Posttraumatic stress disorder and cannabis use characteristics among military veterans with cannabis dependence. Am J Addict/Am Acad Psychiatr Alcohol Addict. 2013;22(3):277–84.CrossRefGoogle Scholar
  73. 73.
    State Medical Marijuana Laws. National Conference of State Legislatures, 27 June 2018, www.ncsl.org/research/health/state-medical-marijuana-laws.aspx.
  74. 74.
    Shisko S, Oliveira R, Moore TA, Almeida K. A review of medical marijuana for the treatment of posttraumatic stress disorder: real symptom re-leaf or just high hopes? Ment Health Clin [Internet]. 2018;8(2):86–94.  https://doi.org/10.9740/mhc.2018.03.086.CrossRefGoogle Scholar
  75. 75.
    Wilkinson ST, Radhakrishnan R, D’Souza DC. A systematic review of the evidence for medical marijuana in psychiatric indications. J Clin Psychiatry. 2016;77(8):1050–64.CrossRefGoogle Scholar
  76. 76.
    Kansagara D, O’Neil M, Nugent S, et al. Benefits and harms of cannabis in chronic pain or post-traumatic stress disorder: a systemic review [internet]. Washington, DC: Department of Veterans Affairs (US); 2017.Google Scholar
  77. 77.
    Bitencourt RM, Takahashi RN. Cannabidiol as a therapeutic alternative for post-traumatic stress disorder: from bench research to confirmation in human trials. Front Neurosci. 2018;12:502.  https://doi.org/10.3389/fnins.2018.00502.CrossRefPubMedPubMedCentralGoogle Scholar
  78. 78.
    Lipov E. The use of stellate ganglion block in the treatment of panic/anxiety symptoms (including suicidal ideation) with combat-related posttraumatic stress disorder. In: Ritchie EC, editor. Posttraumatic stress disorder and related diseases in combat veterans. New York: Springer; 2015. p. 179–96.CrossRefGoogle Scholar
  79. 79.
    Petruzzello SJ, Landers DM, Hatfield BD, Kubitz KA, Salazar W. A meta-analysis on the anxiety-reducing effects of acute and chronic exercise. Outcomes and mechanisms. Sports Med. 1991;11(3):143–82.CrossRefGoogle Scholar
  80. 80.
    de Assis MA, de Mello MF, Scorza FA, Cadrobbi MP, Schooedl AF, Gomes da Silva S, de Albuquerque M, da Silva AC, Arida RM. Evaluation of physical activity habits in patients with posttraumatic stress disorder. Clinics (Sao Paulo). 2008;63(4):473–8.CrossRefGoogle Scholar
  81. 81.
    Manger TA, Motta RW. The impact of an exercise program on posttraumatic stress disorder, anxiety, and depression. Int J Emerg Ment Health. 2005;7(1):49–57.PubMedGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  • Elspeth Cameron Ritchie
    • 1
    • 2
    • 3
    • 4
  • Rachel M. Sullivan
    • 5
  • Kyle J. Gray
    • 6
  1. 1.Department of PsychiatryMedStar Washington Hospital CenterWashington, DCUSA
  2. 2.Georgetown University School of MedicineWashington, DCUSA
  3. 3.George Washington University School of MedicineWashington, DCUSA
  4. 4.Uniformed Services University of the Health SciencesSilver SpringUSA
  5. 5.Psychiatry Residency Program, Tripler Army Medical Center, Behavioral HealthHonoluluUSA
  6. 6.Walter Reed National Military Medical Center, Behavioral HealthBethesdaUSA

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