17 August 2013, PTSD News Roundup

August 17, 2013 / no comments

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Bad Science Department

Sometimes the names of the trauma-focused therapies that folks come up with make me shudder all by themselves, they’re so weirdly Orwellian.  That’s the case for “reprogramming therapy,” of which Accelerated Resolution Therapy (ART) is being hyped as the latest and greatest “cure.”  Here’s the headline: “Scottish nurses are to be trained in a treatment for post-traumatic stress disorder that works by reprogramming the brains of combat veterans.” Though it sounds like a kind of Orwellian brainwashing, it’s yet another version of Francine Shapiro’s endlessly “promising” (no-longer-so-)new therapy, Eye Movement Desensitization and Reprocessing (EMDR).  EMDR and its variants have proved no more effective than any other trauma-focused therapy, which means they’re moderately effective at relieving clinical symptoms in the short-term, for a very small segment of the population that suffers from PTSD (the 20% of women, and about 12% of men with no co-morbid psychological disorders). The description of how ART works is pretty weak: “The patient is asked to move their eyes back and forth while recalling traumatic events, a process which is thought to “unlock” the memory and enable the therapist to start a discussion aimed at detaching the associated negative emotions.”

Since even variations on EMDR that don’t use eye movements all seem to work about the same, it’s pretty hard to argue convincingly that eye movements are the key to “unlocking” the memory.  The idea of “unlocking” is purely metaphorical anyway, since there’s no proof that the memory mechanism (whatever it is) “locks” or “unlocks” at all.  Since we don’t (even the neuroscientists) have good models for the mechanisms by which we remember, forget, revise or associate, “explanations” like the above are no better than “just so” stories, and often worse than no explanations at all.  Sterling University of the UK is teaming up with University of South Florida (USF) to implement ART, which was developed at USF. The rationale is a an allegedly successful study “carried out among 80 war veterans in the US found that the proportion showing signs of PTSD fell from 90 per cent to 17 per cent after four sessions or fewer. (When I found the study, it did not seem to include any war veterans. See next paragraph.) Incidences of depression in the same group dropped from 80 per cent to 28 per cent.”  The people who report on science these days are so dim that they don’t understand that stats like this are like giving half a baseball score.  A drop from 90% to 17% sounds pretty stunning, but it sure would be nice to know the response rate in the control group (if there was a control group), if they accounted for the placebo effect, and if there was a follow-up study to find out if the treatment had lasting effect.  So I poked around and looked for the study (not referenced in the article).

Brief Treatment of Symptoms of Post-Traumatic Stress Disorder (PTSD) by Use of Accelerated Resolution Therapy (ART®)” wasn’t hard to find. It was published in June of this year in a relatively new open-access journal called Behavioral Sciences. It’s so new that it’s published a total of 45 articles and I can’t find any record of its impact factor.  This doesn’t make it a bad journal, and it’s from a reputable publisher, but a more robust study would have found a more prominent home.  So let’s see what the study says…  1) Those selected for the study suffered from PTSD, but veteran status was not a criteria for inclusion; 2) 77% of the subjects were women, and 29% were Hispanic: those numbers are not representative of the population of British veterans (none of the subjects appeared to be vets); 3) 17.5% of the subjects dropped out before the end of the study, and 18.2% of the remaining subjects dropped out before the 2-month followup, which means that they collected full data on less than 70% of the full group of participants (54 people); 4) they excluded substance abusers (which would exclude 64%-84% of veterans with PTSD); 5) there was no control group, and all therapists were trained in and administered only ART therapy, which means that the effect of researcher allegiance on the patient was unaccounted for; 6) all data was self-reported.   So there is no way to know if the amazingly large effect they reported was due to ART or simply a product of entering any kind of very short-term trauma-focused treatment.  Section 4.2, “Possible Therapeutic Mechanisms,” is pretty funny.  I’ve rarely seen a longer list of “may be.. postulate… may help… may occur… may simultaneously…” and so on.  The chain of conjecture continues for miles. Some of it is just plain pseudoscientific gobbledygook: “… ART involves an additional therapeutic element known as the ‘Director’ intervention that directs the patient to establish a new narrative to address ‘unfinished business’ in much the way that Gestalt techniques are used experientially to achieve positive results. Success of the intervention is determined by the therapist asking the participant to pull up the original distressful [sic] images, and reporting being unable to do so.”  In light of the fact that the study did not include combat veterans, the final line of the paper is telling:  “Future controlled studies with ART are warranted, particularly given its short treatment duration, and in light of current heightened emphasis on health care cost constraints, as well as the very large clinical burden of treatment of PTSD being experienced from the lengthy wars in Iraq and Afghanistan.” To me, this just screams:  “We’re gonna sell this to the military!”  And, of course, the military bought it: the DOD paid for the initial research, and now ART® (don’t forget that trademark!) is a product now offered to British war veterans.

PTSD Made Them Do It!

In Denver, a military veteran named Daniel Abeyta was arrested for allegedly shooting two women and blowing up a propane tank. The CBS Denver headline was “Neighbors say shooting suspect is vet with PTSD,” but that’s not mentioned in the article until the final paragraph: “Neighbors said Abeyta… suffers from post-traumatic stress disorder and is involved in a difficult marriage.”  It’s always fun when your neighbors diagnose you for the news media and then the news affiliate headlines the hearsay. In other news, 43-year-old Dinalynn Inez Andrews Potter, a retired Navy vet, allegedly jumped on stage and clobbered elderly soul singer, Lester Chambers when he sang a song dedicated to murdered teenager Trayvon Martin. Apparently Potter’s claim she has PTSD makes this “not a racial attack” in the eyes of the arresting officer, even though Potter yelled, “It’s all your fault, you caused this shit,” before she knocked the frail singer on his ass.  This “It’s not racism, it’s PTSD” stuff is just silly. It’s not like the two are mutually exclusive.  PTSD doesn’t change your political beliefs or give you prejudices you didn’t have in the first place, even though it might remove your inhibitions to acting on them.

 

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16 August 2013 PTSD News Roundup

August 16, 2013 / no comments

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Yesterday I talked about the military funding yoga as a PTSD “treatment”.  Today, it’s military funding for studies on transcendental meditation. I don’t have anything against yoga or TM; in fact, I practice TM because it makes me feel more relaxed, and yoga is great for stretching.  But that doesn’t mean it’s a “treatment” for people with posttraumatic stress.   According to Iraq war veteran David George, “Veterans spend a few hours learning how to meditate with certified TM instructors and can work on the skill independently after that. Veterans never have to take a pill or go through Veterans Affairs for health care.”  I guess not having to go through the VA and endure its notably lousy treatment of soldiers and vets with PTSD is a plus, whether TM works or not, but  reporter Megan Cloherty of WTOP is not real strong on the science.  The treatment is being pushed by Sarina Grosswald of the David Lynch Foundation. The Lynch Foundation runs Operation Warrior Wellness, and claims on their website that “More than 340 peer-reviewed studies, including research funded by $26 million in grants from the National Institutes of Health, document the effectiveness of the TM technique for relieving stress and stress-related disorders.”  340 peer-reviewed studies?  Really?  A pubmed search gives me only 44 studies that include the very broad keywords of “meditation + post + traumatic” in any field.  I’m not sure where the other 296 studies are hiding, and the site doesn’t say. My guess is that they don’t exist. The only study on TM and PTS that was actually listed in the promo material for the Operation Warrior Wellness program includes Ms. Grosswald as an author, was uncontrolled (meaning that it was impossible to measure the effects of TM against a group of people who did not engage in the practice) and included only five veterans. (The authors claimed that the vets showed “significant improvement”, but I’m not sure how they measured that, since significance testing on a group of 5, with no control, is pretty much impossible. That this passed peer review in Military Medicine simply underlines the journal’s low standards, and you don’t get much lower than an impact factor of 1).  But, hey, that was enough for the DOD to dump $2.4 million dollars into studying TM among vets at the San Diego VA Hospital.  Maybe it’s the inanity of the reporter, but I’m not impressed by Greenwald’s assurance that TM works because “in brain scans taken during TM, the prefrontal cortex of patients’ brains lit up.”  Sheesh.

And though the DOD and the VA can throw hundreds of millions at “foundations” that push pseudoscience, and pharmaceutical companies that push expensive drugs, they can’t seem to do much for guys like Howard Berry, whose son, Josh, committed suicide after battling PTSD for years. Josh had been wounded eight years before by Nadal Hassan, the Fort Hood shooter. Berry believes that soldiers with PTSD “need more” than the government is giving them.  He’s right, of course.  Unless militaries admit that the psychological cost of war and violence are ongoing, and last lifetimes after combat has ended, they will never provide adequate services to soldiers and veterans. Iraq war veteran Sgt. Mike Bergman might agree.  A Colorado 9 news article says of Berman: “Looking back, he knows he changed forever when he saw the faces of the first three people he killed. His message to the politicians and military leaders: thousands more like me are coming home.” The article also mentions Curtis Bean, “a sniper, who also attributes his PTSD to his decisions to kill.”  It’s clear enough to the soldiers that killing people is bad for you, even if extenuating circumstances (like a declared war) make it necessary.  But the military is so invested in the notion that “war makes men” that they’ll never admit that war breaks men, and especially not that it breaks strong, normal men who were perfectly healthy and psychologically well-adjusted before they got into the military.

Veteran Curtis Bean, mentioned above, turned to art as a method for handling his pain.  He founded an organization called the Art of War Project, which held a show in May of this year.  I dropped by his website to see his paintings and was impressed by his work: he paints with bright, bold colors, and captures monstrous and beautiful images with a combination of comic art and graffiti on canvas and wood. Photojournalist Ashley Gilbertson also practices a kind of art therapy.  In the process of working through his own PTSD and guilt over the death of a soldier in Iraq who preceded him into danger and paid the cost, he began photographing the rooms of the young American soldiers who had been killed in the war.  The series, “Bedrooms of the Fallen,” is powerful because it evokes the memory of fallen soldiers as they were when they lived in the civilian world. The rooms are untouched, and they evoke a loneliness that’s without solace. On the one hand, each room looks as if its owner has stepped out for a moment, and on the other hand there’s a sense of frozen stillness—one can almost see the dust settling deeper by the day.

And to sum it up today, we can consider the inhumanity and downright creepiness of Thomas Donnelly’s war-loving editorial in that bastion of ethical rectitude, The Wall Street Journal. Donnelly waxes nostalgic; he wants to bring back the days when soldiers were seen as “models of self-control, courage and patriotism.” He also makes absurd claims: “It is possible to identify those who are most prone to stress problems, and that has more to do with nonmilitary issues—again, substance abuse, money and family problems are the culprits—than with the experience of combat or deployment to a war zone.” His lip curl when he states firmly that military commanders have “long known” this, is almost visible.  We just have to keep out those pesky undesirables, and war will turn back into a manly game for manly men.  After all, as humans, we have an “underlying, primal instinct for violence.”  As if all this dick waving wasn’t enough, he then insinuates that the claims of rampant sexual harassment and abuse put forward by military women are baseless since (he quotes a woman here), “there is no evidence that the military has a higher rate of sexual assault than, say, colleges and universities).  Finally, he invokes the myth of the “civilian weakling” who prevents the manly soldier from doing his job:   “By regarding soldiers… as victims and patients, we are in danger of foisting our very own, very civilian and very modern, therapeutic pathologies on people who don’t need them and whose ability to do their jobs—that is, keep us safe—is likely to be diminished.”

If you haven’t already puked on your shoes from the above Rambo redux, you may wonder where he draws his evidence for the claim that we’re creating “epidemics that aren’t.”  On August 7, JAMA published a longitudinal study called “Risk Factors Associated with Suicide in Current and Former U.S. Military Personnel,” by LeardMann, Powell, et al. The study, which took place over almost 8 years, found that “suicide risk was independently associated with male sex and mental disorders but not with military-specific variables.”  So this is a suicide study, although Donnelly uses it as if it debunks any link between PTSD and military service.  I’ll talk about the study later, and what it really does or doesn’t show, in a separate essay, but I wanted to point out this pretty sneaky dodge on Donnelly’s part.  His other piece of “evidence” that real manly man soldiers are being maligned by women who serve in the military comes from Gail Heriot, who claimed in an article for the Weekly Standard (July 8, 2013) that “there is no sexual assault crisis” in the military, and that it is the military itself that is being “harassed.” Heriot’s conjecture that sexual assault is simply over-reported is taken by Donnelly as a fact.  Others have critiqued Heriot, including attorney Roger Canaff. Given that Heriot has crusaded against anti-harassment courses, calling them “propaganda,” and a “rather blatant form of racial and sexual harassment,”  and that she sees anti-discrimination laws as a form of harassment against employers, I think her agenda is pretty clear.  Of course, agendas don’t matter if you have the facts to support your arguments, but Heriot doesn’t.

 

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