Sunday, 27 May 2018

Mindfulness found to be Useful in the Treatment of PTSD

If you have experienced and/or witnessed a threat to your life, your body, your moral integrity, or have had a close encounter with violence or death, you may have felt an array of emotions including that of fear. Fear triggers what is commonly known as a  “fight, flight or freeze” response in the body that results in psychological, behavioural and physiological actions to occur in the body during the event. Those who continue to experience effects related to the occurrence after the danger or problem has subsided may go on to be diagnosed with Post Traumatic Stress Disorder (PTSD).

PTSD is described as a severe response to trauma and can causes a huge deal of distress and severely limit active daily life in those who experience it. PTSD is characterised by three primary symptoms:

1.     Re-experiencing the traumatic event
2.     Avoiding any reminders of the event, or feeling emotionally numb 
3.     Hyper-arousal, which consists of a very sensitive startle/fear response

Those who experience PTSD may also develop other mental illnesses such as severe anxiety, depression and suicidal feelings
The three areas of the brain associated with PTSD are the Amygdala, Hippocampus and the Pre-frontal Cortex. The nature of the brain is that it has the capacity to change, otherwise known as neuroplasticity and exposure to trauma may cause the brain to change in structure as a coping mechanism. 

The role of the amygdala is to recognise threat and trigger the appropriate “fight, flight or freeze” response. Once the threat has subsided the amygdala will send out the appropriate signal to indicate safety. In PTSD this signal is significantly disrupted to a state where fear signals may be triggered more often and usually in situations that pose minimal levels of threat.

The relationship between the amygdala and the hippocampus, the area of the brain responsible for memory highlights the role memory plays in fear response behaviour. In PTSD memories may be adversely affected and the sufferer can experience difficulty discriminating between the past and present; flashbacks may for instance, result in the trigger of fear responses in the body.

The pre-frontal cortex is responsible for regulating behaviour such as impulses, emotions, and fear responses. MRI scans have shown that the pre-frontal cortex of a person who experiences PTSD is less reactive than someone who does not have the disorder and therefore has a reduced ability in regulating the overly sensitive hippocampus activity.

The most common treatments for PTSD are: Cognitive Behavioral Therapy (CBT) including Prolonged Exposure (PE), Eye Movement Desensitization and Reprocessing (EMDR), and Psychopharmacologic Treatment. The incorporation of mindfulness-based practices has increasingly been proven to be beneficial as an integrated form of treatment.

Following an eight-week course participants of the Adrienne A. Taren et al  (2013) study who had participated in the mindfulness practice were found to have a reduced size amygdala and a thicker pre-frontal cortex.  There was also a decrease in reactions between the two areas. The findings support the belief that mindfulness meditation reduced fear symptoms associated with the amygdala while increasing the awareness and decision making functions of the prefrontal cortex. 

The recent study by Bremner et al (2017) though a pilot study showed the effects of Mindfulness Based Stress Reduction (MBSR) on PTSD symptoms and brain response to traumatic reminders of combat in Operation Enduring Freedom/Operation Iraqi Freedom Combat Veterans with PTSD. The findings supported the use of MBSR as a possible treatment for PTSD, as the veterans in the MBSR group saw an improvement in PTSD symptoms that persisted for up to 6 months after treatmentMindfulness meditation has both physiological and behavioral implications. Though the usefulness of mindfulness-based practices requires further research there is enough information to suggest that it does have considerable benefits, which can be utilised to support more traditional treatment methods. Further studies with a long-term focus on managing PTSD will be required in order to determine the durational impact of mindfulness on the long-term prognosis.









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