PTSD in Physicians: A Treatment Approach with Eye Movements (Accelerated Resolution Therapy)


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PTSD Treatment Approach with Eye Movements (Accelerated Resolution Therapy)

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PTSD in Physicians: A Treatment Approach with Eye Movements (Accelerated Resolution Therapy)

  1. 1. PTSD in Physicians: A Treatment Approach with Eye Movements (Accelerated Resolution Therapy) MS Caduceus Annual Retreat July 11-13 Alexis Polles, MD, PLLC
  2. 2. OUTLINE I: Trauma and its sequelae II: Trauma in physicians III: Treatment options III: Use of special approaches in the treatment of trauma • Eye Movements IV: Conclusion
  3. 3. Definition of Trauma The diagnostic manual used by mental health providers (DSM-5) defines trauma an event that involves actual or threatened death or serious injury or sexual violation in which the individual: • directly experiences the event • witnesses the event in person • learns that the event occurred to a close friend or relative • experiences first-hand repeated or extreme exposure to aversive details of the traumatic event DSM-IV requirement that “The person‟s response to the event must involve intense fear, helplessness or horror” has been eliminated in DSM-5. •
  4. 4. Trauma • May include events that are not beyond the scope of normal human experience, as long as the event has had a trauma-like impact on the person. • DSM-5 moved it from an Anxiety Disorder to Trauma- and Stress-or-Related Disorders • What makes an event traumatic: – The severity of the event – The proximity of the experience – The personal impact of the event – The after-event impact
  5. 5. Potential Victims Of A Traumatic Stressor 1 Primary Victims Those individuals most directly affected by the event, e.g., the persons whose houses are blown down in a hurricane. 2 Secondary Victims Those individuals who in some way observe the consequences of the traumatic event on the primary victims, e.g., bystanders, rescuers, and emergency response personnel. (Partners/kids) 3 Tertiary Victims Those individuals who are indirectly affected by the traumatic event as a result of later exposure to the scene of the trauma or to the primary or secondary victims of the trauma.
  6. 6. None Transient or no symptoms Acute Stress Disorder PTSD + Trauma Consequences Impairment > 30d Re-experience, arousal and avoidant symptoms Co-occurring syndromes - - + -/+ - + + - + + + + + +++ ++ ++ + Trauma Spectrum
  7. 7. Types of PTS/PTSD Simple PTS/D • The response to one or more traumatic events that are NOT linked in any way (e.g., one rape, one car accident, one sudden loss). Complex PTS/D • The response to a combination of specific traumatic events that ARE linked to each other in some way or occur repeatedly over time
  8. 8. Symptom Clusters (Now four in DSM-5) • Re-experiencing • Avoidance • Persistent Negative Alterations in Cognitions and Mood (retains numbing symptoms and includes other symptoms such as persistent negative emotional states and includes inability to remember key aspects of the event) • Arousal (includes fight and flight) Subtypes include kids < 6 and dissociative
  9. 9. Trauma is an experience that overwhelms our capacity to have a sense of control over ourselves and our immediate environment, to maintain connection with others and to make meaning of our experience. In Summary:
  10. 10. How does the past become the present? •Threat + Sensorimotor Experience (Traumatic Cues) + Level of Arousal is imprinted in procedural memory and leads to fear conditioning •There is a walling off of this memory (“dissociative capsule”) that is brought into the present by external representative cues or internal cues
  11. 11. Trauma and the Brain • Thalamus (temporal lobe) receives sensory signals • Amygdala sorts for immediate danger - Shuts down „thinking brain‟ - Diverts energy to physical response • Hippocampus stores episodic long term memory • Reactivation of this pathway strengthens it
  12. 12. ¥ Thoughts that perpetuate arousal: “It is my fault;” “I am being punished;” “the world is not safe.” And inhibits ¥ Thoughts that might attenuate arousal: “I did the best I could” “These things happen – you can’t control everything” and “the world is usually safe, and fortunately I survived this event… It’s over”… Leads to Interference with proper integration of emotional memories Adapted from Dr. Uri Bergman
  13. 13. 14 Trauma Response Amygdala Visual Cortex Trauma Response
  14. 14. Healthcare Professionals and PTSD • Most studies are with non-physician providers (EMTs), first responders • Nearly all of those dealing with physicians/nurses are post disaster • Much written on physician “stress and burnout” that does not specifically look at PTSD spectrum disorders
  15. 15. Physician Specific Literature Review – There was no association between PTSD symptoms and professional exposure to victims inside the hospital in studies of non-military physicians in terrorist attacks/war zones – 15.6% had PTSD symptoms – No gender differences – Burnout was significantly more prevalent among doctors with PTSD – Those with PTSD used more negative coping strategies and functioning was significantly reduced – Only 15% of those with PTSD and who had identified themselves as having it actually attended available therapy – SOOOOO……
  16. 16. What do affected physicians do? • Drugs/Alcohol • Overwork • Overeat • Some gamble/game
  17. 17. Posttraumatic Stress and Co-Occurring Disorders • Trauma survivors often attempt to control their internal state of hyper or hypo arousal through the use of substances or behaviors that produce neurotransmitter responses similar to those produced by substances • While substances may initially restore a sense of control, they actually inhibit the accessing of memories and integrating the experience in an adaptive manner.