Wednesday, December 11, 2013

Immediate "Accelerated Resolution Therapy" Eases PTSD

When I worked with Vietnam era vets as a volunteer PTSD co-facilitator with the VA, the most common attribute of the men and women in our groups was the length of time it had been since the trauma that caused their distress.  Most often, it had been years since their experience.  As PTSD is known to be a slowly debilitating disease, the people we counseled were well established in the behavior and thought patterns of the illness.

Now it's found that an approach applied immediately after the event can be very effective in resolving the issues and prevent the long-term debilitation of PTSD.  Accelerated Resolution Therapy, or ART, is a brief, safe, and effective treatment for combat-related symptoms of post-traumatic stress disorder (PTSD) among veterans and U.S. service members, researchers at University of South Florida College of Nursing report in a new study. 

They found this newer treatment -- a combination of evidence-based psychotherapies and use of eye movements -- was shorter and more likely to be completed, than conventional therapies formally endorsed by the U.S. Department of Defense and the Veterans Administration.

Kevin Kip, PhD, FAHA, professor and executive director for the Research Center at the USF College of Nursing, led the team of scientists and clinicians who conducted the first randomized controlled trial of ART in a military population. The trial enrolled 57 service members and veterans, primarily from the Tampa Bay area.

"Based on this trial and an earlier study completed at the USF College of Nursing, we believe that accelerated resolution therapy may provide the quickest way to effectively and safely treat post-traumatic stress disorder," Dr. Kip said. "Our goal is to obtain enough evidence and interest to warrant classifying ART as a potential first-line treatment for PTSD among both civilian and military personnel."

"Dr. Kip's work on this project has been phenomenal," said Dianne Morrison-Beedy, PhD,  senior associate vice president of USF Health, and dean of the College of Nursing. "ART has been a cornerstone of RESTORE LIVES at USF Nursing as we continue developing research and education to advance the health care received by veterans, service members and their families."

ART works in two phases to alleviate psychological trauma symptoms and related disorders such as depression and anxiety.

  1. The patient first visualizes in his or her mind a prior traumatic experience which typically elicits uncomfortable physiological sensations like tightness of the chest, increased heart rate and sweating. Then, 
  2. through talk therapy and a series of rapid left-to-right eye movements in which the patient follows the clinician's hand back and forth, the sensations are minimized. In the second phase, and with similar clinician input, the patient "replaces" the distressing images they have seen with positive ones in a way that the original distressing images can no longer be accessed. 
ART is delivered in two to five one-hour sessions, requires no homework, and no written or verbal recall of the traumatic experience.

"Through this therapy, we're able to quiet down and separate physiological symptoms that come with re-envisioning a traumatic experience," Dr. Kip said. "We can also alter or replace the traumatic images and add positive material to them. We are changing how images are remembered in the brain."

It worked well for Brian Anderson, a former Green Beret, 10-year Army veteran and director of the Pasco County Veteran Services and Stand Down program. He had tried an endorsed first-line PTSD treatment known as prolonged exposure therapy, which was very lengthy and worked for a while, but then symptoms like hyper-vigilance returned.

"ART changed my life," Anderson said. "This brief therapy took the bad memories that constantly resurfaced and put them in the proper order or long-term storage; it was almost like I was thinking about a time in history. As a veteran, I would much rather go through a therapy that works, in only a few sessions, than sit through intensive and grueling sessions that last as long as 16 weeks."

PTSD is a prevalent, disabling disorder that can emerge following a life-threatening event or traumatic experience. Those experiences create chronic symptoms such as flashbacks, nightmares, sleep disturbances, mood swings, and loss of interest in life. According to PTSD Foundation of America, one in three troops returning from combat suffers PTSD symptoms, although less than 40 percent seek help. The organization also reports that at least five active duty military members attempt suicide every day.

"Accelerated resolution therapy is giving hope to many veterans who felt like they had no hope," said Lt. Col. (Ret.) Lawrence A. Braue, EdD, director of the USF Office of Veterans Services. "I look forward to the day when this treatment is widely available across the country. USF College of Nursing faculty and staff genuinely care about our veterans, and that means the world to any veteran."
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Story Source:  Kip, Kevin E.; Rosenzweig, Laney; Hernandez, Diego F.; Shuman, Amy; Sullivan, Kelly L.; Long, Christopher J.; Taylor, James; McGhee, Stephen; Girling, Sue Ann; Wittenberg, Trudy; Sahebzamani, Frances M.; Lengacher, Cecile A.; Kadel, Rajendra; and Diamond, David M. Randomized Controlled Trial of Accelerated Resolution Therapy (ART) for Symptoms of Combat-Related Post-Traumatic Stress Disorder (PTSD). Military Medicine, Vol. 178, No. 12, December 2013

Tuesday, December 10, 2013

As Life and Work Become One and the Same

Flexible workplaces may seem attractive when considering work-life balance but new research being published shows it's not unusual for firms to cash-in, profiting from our "free" time and non-professional aptitudes, experts warn.

Peter Fleming, Professor of Business and Society at Cass Business School, City University, London, UK, weighs the evidence for this shift in work culture in "When 'life itself' goes to work: Reviewing shifts in organizational life through the lens of biopower" in the current issue of the journal Human Relations, published by SAGE.

Liberation Management ~ Giving Employers Something for Nothing
In the past it was very clear where work stopped and play started -- managers at offices and factories encouraged a formal environment. Personal lives were left at the door as employees clocked in.

Today, jobs increasingly allow us to work flexible hours, yet we are expected to be responsive around the clock. Dubbed Liberation Management, the latest trend encourages us all to 'be ourselves' at work, dropping the formal, professional attitudes of the past. And workers looking for ideas or opinions free of charge can crowd-source them from the Internet.

Businesses are getting something for nothing, experts say.
Examining the dark side to today's apparent freedom and autonomy for workers, Fleming uses a concept known as biopower developed by French scholar, historian, and social theorist Michel Foucault, an expert in the workings of discipline and control. Foucault spoke about biopower in a series of 1970s lectures at the College de France, which have only recently been translated into English.

As long as a project deadline is met, firms don't care when, how and where the work is done -- be it in your underwear in the middle of the night or in a cafe on Monday morning, Fleming says. Today, managers often rely on aspects of life that were previously inappropriate at work.

This is a 'lifestyle approach' to management, where companies hope to get a better performance from employees by encouraging their everyday selves on the job. Largely seen in Western economies, this trend is linked to a decline in jobs focused on concrete or industrial tasks. Life skills, communication and organization skills, and emotional intelligence are now key.

If the onset of flu is coupled with relief that you can finally take a day for yourself, and you feel that your work is your life, blame this trend of always being at work, even when you aren't. The widely reported death of banking intern Moritz Erhadt following three days of non-stop work is perhaps an extreme example of what this trend can do to us: When work and life become blended to such an extent, even rest and sleep are considered a 'waste of time'.

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Moritz Erhardt at home on the day of his father Hans-Georg's 50th birthday in 2011.
Click here to read:
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"The Foucault lectures are astoundingly prescient in the way they concentrate on biopower as a sign of things to come," says Fleming. "Our jobs are no longer defined as something we do among other things, but what we are… Ominously, we are now permanently poised for work."
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Suggest reading ~

Story Source:  Peter Fleming. When 'life itself' goes to work: Reviewing shifts in organisational life through the lens of biopower. Human Relations, November 2013

Monday, December 9, 2013

How Meditation Changes the Way Your Genes Express Themselves

Gene Expression Changes With Meditation
Meditators show genetic and molecular differences which in turn correlate with faster physical recovery from a stressful situation.
With evidence growing that meditation can have beneficial health effects, scientists are working to understand how these practices physically affect the body. A new study by researchers in Wisconsin, Spain, and France reports the first evidence of specific molecular changes in the body following a period of mindfulness meditation.

The study investigated the effects of a day of intensive mindfulness practice in a group of experienced meditators, compared to a group of untrained control subjects who engaged in quiet non-meditative activities. After eight hours of mindfulness practice, the meditators showed a range of genetic and molecular differences, including altered levels of gene-regulating machinery and reduced levels of pro-inflammatory genes, which in turn correlated with faster physical recovery from a stressful situation.

"To the best of our knowledge, this is the first paper that shows rapid alterations in gene expression within subjects associated with mindfulness meditation practice," says study author Richard J. Davidson, founder of the Center for Investigating Healthy Minds and the William James and Vilas Professor of Psychology and Psychiatry at the University of Wisconsin-Madison.

Meditation vs. Drugs to Reduce Inflammation
"Most interestingly, the changes were observed in genes that are the current targets of anti-inflammatory and analgesic drugs," says Perla Kaliman, first author of the article and a researcher at the Institute of Biomedical Research of Barcelona, Spain (IIBB-CSIC-IDIBAPS), where the molecular analyses were conducted.  The study was published in the journal Psychoneuroendocrinology.

Mindfulness-based training has shown beneficial effects on inflammatory disorders in prior clinical studies and are endorsed by the American Heart Association as a preventative intervention. The new results provide a possible biological mechanism for therapeutic effects.

Perhaps surprisingly, the researchers say, there was no difference in the tested genes between the two groups of people at the start of the study. Effects were seen only in the meditators following mindfulness practice. In addition, several other DNA-modifying genes showed no differences between groups, suggesting that the mindfulness practice specifically affects certain regulatory pathways.

"Our genes are quite dynamic in their expression and these results suggest that the calmness of our mind has a potential influence on their expression," Davidson says.
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Suggested reading ~

Story Source:  Materials provided by University of Wisconsin-Madison. The original article was written by Jill Sakai, (2013, December 8). Gene expression changes with meditation. ScienceDaily.

Friday, December 6, 2013

Parental Stress Linked to Obesity in Children

Parental stress is linked to weight gain in children, according to a new study from St. Michael's Hospital.

The study found that children whose parents have high levels of stress have a Body Mass Index, or BMI, about 2 per cent higher than those whose parents have low levels of stress. Children with higher parental stress also gained weight at a 7 per cent higher rate during the study period than other children.

Those figures may sound low, said lead author Dr. Ketan Shankardass, but they're significant because they are happening in children, whose bodies and eating and exercise habits are still developing. Plus, if that weight gain continues and is compounded over a lifetime, it could lead to serious obesity and health issues.

Dr. Shankardass, a social epidemiologist with the hospital's Centre for Research on Inner City Health, studied data collected during the Children's Health Study, one of the largest and most comprehensive investigations into the long-term effects of air pollution on the respiratory health of children.

The childrens' BMI was calculated each year. Their parents were given a questionnaire to measure their perceived psychological stress that asked how often in the last month they were able or unable to control important things in their life and whether things were going their way or their difficulties were piling up so high they could not overcome them.

Dr. Shankardass said he believes this is the first study to link parental stress to weight gain in such young children. His research was published today in the journal Pediatric Obesity.

Dr. Shankardass, who is also an assistant professor in psychology at Wilfrid Laurier University, said it was not clear why the link between stress and obesity exists.

He said parents could change their behavior when they are stressed, to reduce the amount of physical activity in the household or increase the amount of unhealthy food available. Parental stress could also create stress for the children, who cope by eating more or exercising less, or whose stress leads to biological changes that cause weight gain, he said.

Dr. Shankardass said that rather than focusing only on getting parents to change their behavior, it would be useful to focus on interventions that can support families living in challenging conditions, such as making sure they have a reliable supply of healthy food, an opportunity to live in a nice neighbourhood and other financial or service resources to help cope with stress.

"Childhood is a time when we develop inter-connected habits related to how we deal with stress, how we eat and how active we are," Dr. Shankardass said. "It's a time when we might be doing irreversible damage or damage that is very hard to change later."

Dr. Shankardass noted that more than half the students followed in the California study were Hispanic, and that the effects of stress on their BMI was greater than children of other ethnic backgrounds. He said this was consistent with other research which has suggested that Hispanic children may be more likely to experience hypherphasia (excessive hunger or increased appetite) and sedentary lifestyle. Future research should consider other reasons that Hispanic children are more susceptible to parental stress, including differences in how Hispanic parents respond to stress or how Hispanic children perceive stressors or cope with stress.
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Story Source:  K. Shankardass, R. McConnell, M. Jerrett, C. Lam, J. Wolch, J. Milam, F. Gilliland, K. Berhane. Parental stress increases body mass index trajectory in pre-adolescents. Pediatric Obesity, 2013