An Evidence-Based Program to Effectively Treat Posttraumatic Stress Disorder June 17, 2008 Gunter Chasse, Oberstleutnant a.D. Alarik Arenander, PhD.

An Evidence-BasedAn Evidence-Based

Program to Effectively Treat Program to Effectively Treat

Posttraumatic Stress DisorderPosttraumatic Stress Disorder

June 17, 2008June 17, 2008

Gunter Chasse, Oberstleutnant a.D.Gunter Chasse, Oberstleutnant a.D.

Alarik Arenander, PhDAlarik Arenander, PhD

PTBSPTBS Re-experiencingRe-experiencing

phenomenaphenomena HyperarousalHyperarousal Avoidance Avoidance

behaviorbehavior

3

PTBSPTBS

““Overwhelmed”Overwhelmed”

Prefrontal shutdownPrefrontal shutdown

Brewin, Brewin, Prog Brain ResProg Brain Res, 2008, 2008

4

BRAIN DYSFUNCTIONBRAIN DYSFUNCTION

Hypoactivation of Hypoactivation of mPFCmPFC

Hyperactivation of Hyperactivation of amygdalaamygdala

Hyperactivation of Hyperactivation of hippocampus?hippocampus?

Brewin, Brewin, Prog Brain ResProg Brain Res, 2008, 2008

Liberzon & Sripada, Liberzon & Sripada, Prog Brain ResProg Brain Res, 2008, 2008

Key Components of PTBSKey Components of PTBS

NegativeNegativeCorrelationCorrelation

6

PTBSPTBS Persistence ofPersistence of

symptomssymptoms Adaptation & Adaptation &

plasticityplasticity Complex pathwaysComplex pathways Case uniquenessCase uniqueness

7

18.5%: PTSD or depression (300k)18.5%: PTSD or depression (300k)

19.5 %: TBI (330k)19.5 %: TBI (330k)

50% seek help50% seek help

50% get minimal care50% get minimal care

Evidence-based treatment lackingEvidence-based treatment lacking

High economic & human lossHigh economic & human loss

Rand Center for Military Health Policy, Rand Center for Military Health Policy, MG-720-CCFMG-720-CCF, 2008, 2008

Invisible WoundsInvisible WoundsAmerican VeteransAmerican Veterans

Prefrontal CortexPrefrontal Cortex

Executive Executive

Control Control

CenterCenter

The brain is The brain is plasticplastic

Coherence uniquely Coherence uniquely supports rehabilitationsupports rehabilitation

DoingDoingDoingDoing

BeingBeingBeingBeing

TMTMTMTM

Post-Vietnam RehabilitationPost-Vietnam Rehabilitation

Random assignmentRandom assignment TM vs psychotherapyTM vs psychotherapy 18 Ss, voluntary18 Ss, voluntary Demographics, 33 yrsDemographics, 33 yrs 9 dependent variables9 dependent variables 3 month treatment3 month treatment

Brooks & Scarano, Brooks & Scarano, J Couns Develop, J Couns Develop, 19851985

MeasuresMeasures PTSD symptomsPTSD symptoms AnxietyAnxiety DepressionDepression S/AS/A InsomniaInsomnia EmploymentEmployment Family lifeFamily life

Brooks & Scarano, Brooks & Scarano, J Couns Develop, J Couns Develop, 19851985

Post-Vietnam RehabilitationPost-Vietnam Rehabilitation

Psychotherapy: no changePsychotherapy: no change

TM: 8 variablesTM: 8 variables improvedimproved TM: 7/10 no longer needed TM: 7/10 no longer needed

services of VAMCservices of VAMC

Brooks & Scarano, Brooks & Scarano, J Couns Develop, J Couns Develop, 19851985

Personal ExperiencePersonal Experience

Brooks & Scarano, Brooks & Scarano, J Couns Develop, J Couns Develop, 19851985

““I feel after I meditate that I I feel after I meditate that I no longer have the same no longer have the same

intensity of tension, rage, and intensity of tension, rage, and guilt inside — it’s as if a huge guilt inside — it’s as if a huge

burden has been lifted.”burden has been lifted.”

— Vietnam Vet — Vietnam Vet

Brainwave CoherenceBrainwave Coherence

TMTM

NeuromuscularNeuromuscularFlexibilityFlexibility

NeuromuscularNeuromuscularFlexibilityFlexibility

Self-Self-AwarenessAwareness

Self-Self-AwarenessAwareness

LearningLearningAbilityAbility

LearningLearningAbilityAbility

DecreasedDecreasedAnxietyAnxiety

DecreasedDecreasedAnxietyAnxiety

Self-Self-DevelopmentDevelopment

Self-Self-DevelopmentDevelopment

InnerInnerOrientationOrientation

InnerInnerOrientationOrientation

MoralMoralReasoningReasoning

MoralMoralReasoningReasoning

ConceptConceptLearningLearningConceptConceptLearningLearningEmotionalEmotional

StabilityStabilityEmotionalEmotionalStabilityStability

DecreasedDecreasedNeuroticismNeuroticismDecreasedDecreased

NeuroticismNeuroticism

IntelligenceIntelligenceIntelligenceIntelligence

ComputationalComputationalEfficiencyEfficiency

ComputationalComputationalEfficiencyEfficiency

CreativityCreativityCreativityCreativity

BrainwaveBrainwaveCoherenceCoherenceBrainwaveBrainwaveCoherenceCoherence

-5-5

-4-4

-3-3

-2-2

-1-1

00

11

22

33

44

55 TMTM PMRPMR SBFSBF RABFRABFSM +SM +relaxationrelaxation

* **

Blo

od

Pre

ssu

reC

han

ge

Sco

res

Rainforth M, Schneider R, Nidich S, et al: Rainforth M, Schneider R, Nidich S, et al: Current Hypertension ReportsCurrent Hypertension Reports [9] 520-528, [9] 520-528, 20072007

A Meta-analysis of Stress Reduction Programs: High Blood Pressure

** p = .0002 p = .0002

**** p = .02 p = .02

SummarySummaryUpgrading Brain IntegrationUpgrading Brain Integration

to Improve Rehabilitationto Improve Rehabilitation

TM Improves RehabilitationTM Improves Rehabilitation

PTSDPTSD CorrectionsCorrections Substance abuseSubstance abuse Traumatic brain Traumatic brain

injuryinjury

Brain IntegrationBrain Integration

CoherenceCoherence

ExperienceExperience

Improved RehabImproved Rehab

Brain PlasticityBrain Plasticity

Evidence-basedEvidence-based Easy to implement, learnEasy to implement, learn Produces desired resultsProduces desired results Changes rapid & holisticChanges rapid & holistic High ComplianceHigh Compliance Cost-effectiveCost-effective ComplementaryComplementary Culture neutralCulture neutral

Why use?Why use?

ContactContactAlarik Arenander, PhDAlarik Arenander, PhD

001 641-472-3443001 [email protected]@aol.com

Gunter Chasse, Oberstleutnant a.D.Gunter Chasse, Oberstleutnant a.D.0178-53883260178-5388326

[email protected]@chasse.de