Quality of prelim study?

[CaliMac]

A preliminary study from UW-Madison investigates therapeutic effects of breathing practices on vets w PTSD. Would you please evaluate the strength of the research?

http://www.news-medical.net/news/20...tice-can-be-effective-treatment-for-PTSD.aspx

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[G Costanza]

Not nearly enough info on sample, method, and results to really evaluate much of what is being suggested here.

 

[erg923]

A preliminary study from UW-Madison investigates therapeutic effects of breathing practices on vets w PTSD. Would you please evaluate the strength of the research?

http://www.news-medical.net/news/20...tice-can-be-effective-treatment-for-PTSD.aspx

Well, lots of things can be effective for PTSD, if "effective" is simply defined as a decrease symptoms for a specified period of time. Getting stoned or drunk is effective in the short term. As is distraction. As is an Prozac. Are you doing anything to underlying disorder, no. CPT and PE are the only ones I know of that do.

 

[WisNeuro]

Agreed, not enough information. But, of course breathing exercises have an effect. We already knew that. Breathing is a part of PE and CPT protocols. It can help with short-term anxiety, but you need to pair it with other methods for more long term benefit.

 

[smalltownpsych]

Yup. I think we already knew that. I almost always assign some type of active intervention for level of CNS arousal for patients for a wide variety of diagnoses and if they are already involved in an activity that fits the bill, all the better. The CNS doesn't care if it is yoga, prayer, exercise, archery, sewing, art, meditation, biofeedback, and even dancing which some psychiatrists use as their sole intervention.

 

[CaliMac]

Thank you all for answering the question I posed and going a level beyond it.

A friend of mine is an LMFT and runs a wellness clinic where I volunteer. She has recently founded a non-profit specializing in treating veterans and is interested in my teaching yoga classes there. As I research specialized training courses, I'm trying to find the most legitimate available and your feedback helps focus my search.

 

[Le Mo]

I m very interested to know new treatment methods in this regards except routine cares


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[erg923]

Titrated propanalol dosing schedule after trauma occurrence.

 

[smalltownpsych]

Titrated propanalol dosing schedule after trauma occurrence.

As I read the literature, this can help with some of the symptoms, but not necessarily treat the disorder or prevent the disorder after exposure to the trauma. Any idea of what treatments to administer after exposure to trauma? Most of what I have seen states that some attempts to prevent like crisis debriefing have actually made symptoms worse.

 

[WisNeuro]

As I read the literature, this can help with some of the symptoms, but not necessarily treat the disorder or prevent the disorder after exposure to the trauma. Any idea of what treatments to administer after exposure to trauma? Most of what I have seen states that some attempts to prevent like crisis debriefing have actually made symptoms worse.

Yeah, CISD as implemented was a disaster. It just primed people for acute stress symptoms. Similar to concussion management, if you tell someone they're going to have all these horrible symptoms, guess what happens? They do. If you tell someone that they may have a headache for a couple days, but should be just fine within a week, they're fine.

The literature would suggest that no intervention is probably necessary after trauma exposure considering the vast majority of people will experience brief symptoms that go away within a couple weeks. This may be a case where the "cure" hurts more people than it helps if we go forward with CISD type interventions.

 

[CaliMac]

Yeah, CISD as implemented was a disaster. It just primed people for acute stress symptoms. Similar to concussion management, if you tell someone they're going to have all these horrible symptoms, guess what happens? They do. If you tell someone that they may have a headache for a couple days, but should be just fine within a week, they're fine.

The literature would suggest that no intervention is probably necessary after trauma exposure considering the vast majority of people will experience brief symptoms that go away within a couple weeks. This may be a case where the "cure" hurts more people than it helps if we go forward with CISD type interventions.

At a sexual assault response team where I also volunteer, victims receive a few papers after their forensic (physical) exam. One describes PTSD symptoms. I can't imagine anyone going over it specifically with victims; rather, it's simply provided along with the other information. Thoughts? Victims are contacted by counselors shortly after the occurrence if they are amenable to it.

 

[WisNeuro]

At a sexual assault response team where I also volunteer, victims receive a few papers after their forensic (physical) exam. One describes PTSD symptoms. I can't imagine anyone going over it specifically with victims; rather, it's simply provided along with the other information. Thoughts? Victims are contacted by counselors shortly after the occurrence if they are amenable to it.

Actually, if there were one area where some kind of debrief may be beneficial, it may be sexual assault. It's the highest conversion rate to PTSD, at least by DSM-IV criteria. The CISD stuff was a bit flawed because they did it in response to events with a relatively low conversion rate, which doesn't make sense.

 

[smalltownpsych]

Yeah, CISD as implemented was a disaster. It just primed people for acute stress symptoms. Similar to concussion management, if you tell someone they're going to have all these horrible symptoms, guess what happens? They do. If you tell someone that they may have a headache for a couple days, but should be just fine within a week, they're fine.

The literature would suggest that no intervention is probably necessary after trauma exposure considering the vast majority of people will experience brief symptoms that go away within a couple weeks. This may be a case where the "cure" hurts more people than it helps if we go forward with CISD type interventions.

Maybe we should test a treatment that lets people know that their symptoms would likely resolve? Also, what do I do when patients come to me after a significant trauma? Guided by current research, I generally try to minimize retraumatization and also utilize expectancy of improvement, and usually only see them for a couple of sessions unless it is a re-traumatization and they already have long-standing PTSD. A lot of times we find out more about what doesn't work in this field than what does work which is a good argument for why we need psychologists doing research, as well as clinical work, instead of just cranking out non-scientific practitioners who did a lit review.

 

[smalltownpsych]

Actually, if there were one area where some kind of debrief may be beneficial, it may be sexual assault. It's the highest conversion rate to PTSD, at least by DSM-IV criteria. The CISD stuff was a bit flawed because they did it in response to events with a relatively low conversion rate, which doesn't make sense.

I participated in a debrief session in the community after a police shooting. The gentleman who was in charge was very clear that most symptoms would resolve in a few days and described some of the expected short-term aftereffects. I thought he did a good job, but this was an event that has a lower likelihood of conversion to PTSD and it raises the question if it would have been better to not have the people process it. Fortunately because of the group, most of the processing was very cognitive as opposed to re-experiencing the emotions so that might be better than other instances of CSID given what we know about trauma. It still seemed a little risky to me though.

 

[WisNeuro]

It's tough research to do. You need a relatively unpredictable event (trauma) and even then if you try to compare groups (debriefing intervention vs. waitlist/supportive/etc) there are so many peritraumatic variables that have to be controlled for for each individual. I'm not saying it shouldn't be done, just that it's messy and likely time consuming and exhausting. I applaud anyone willing to take it on and do it right, but it won't be me.

 

[CaliMac]

Actually, if there were one area where some kind of debrief may be beneficial, it may be sexual assault. It's the highest conversion rate to PTSD, at least by DSM-IV criteria. The CISD stuff was a bit flawed because they did it in response to events with a relatively low conversion rate, which doesn't make sense.

That is good to know, thank you. Since it was my first call and I was totally green (even my wonderful training didn't address absolutely everything ), I handed it to the victim's son and made him aware that it contained help for things she may experience in the future. I mentioned it briefly to her ("when you're ready, you might read through these papers. They contain information that may be helpful as you heal") and reinforced that she should mention the incident to her PCP (who prescribes her multiple meds for anxiety, sleep, pain, et al) as he may choose to adjust her dosage or refer her.

The nurse liked my help so much that she and the other staff asked my coordinator if I wouldn't mind doing backup more often. Of course I accepted! So I may be in a particularly unusual position to have access to recent trauma victims with a high conversion rate.

Maybe this needs a new topic, not that I mind my own thread diverging into my favorite psych issue...

 

[G Costanza]

I attended a 2 day CISM training and I think I remember them suggesting that group debriefs were more effective a few weeks after the incident.

I was in a fire a few years ago and attended a group debrief the next day. It didn't seem that helpful as we just relived the experience. N=1