INTEGRATIVE + ONLINE PSYCHIATRY + HOLISTIC HEALTH

Tag: PTSD

Spiritual Emergence, Recovery

Neuroplasticity – Recovery & Transformation

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Recovery and Transformation are often felt to be impossible for individuals with addictions or mental health problem as depression, anxiety, Post-Traumatic Stress Disorder, and other stress or painful conditions.

There is new hope with the advances in neuroplasticity, neuroscience and its technology to identify, modify or change neuro-circuitry, behavior, responses and reactions. Progress in better understandings of the psychology of the human mind and behavior have contributed to greater success in overcoming what was known previously, which in the past was considered hopeless and beyond the reach of those who had been affected by unrelenting, disabling conditions. The study of other healing methods and traditions, as the 12-Step-Programs for addictions, also has led to more successful integrative treatment programs.

As in the first two steps of 12-Step-Programs, for addiction recovery, there must first be the acceptance of the disease as such, and realization of the impossibility of recovery without profound change. Pursuing treatment on a superficial level for an addiction or any other persistent or chronic illness often fails, such as making limited attempts to make cosmetic changes in one personal way, learned habits, or in the expectation that medication will help. To the person afflicted, life has become unmanageable, and the individual “me” admits to being powerless to make the deep changes needed for recovery. The nature of the illness often has led to feeling hopeless, helpless and powerlessness.

The reason for repeated failures or relapses is that a person unsuccessfully tries to use what was learned from earlier life as:

  • non-effective coping
  • use of manipulation and attempts to control others and the environment
  • efforts to rebuild failing relationships to fulfill unmet needs for nurturance, love, and acceptance
  • repeated ineffective efforts to feel sufficient, empowered and adequate

To recover and transform, one has to get beyond ego, personality, habits, reactions, and behaviors.

If there comes a realization of the powerlessness to change the existing status quo, the opportunity exists to embrace the insight that there are the greater potentiality and possibilities beyond a person’s individual ways and self-identity. When one can’t find any viable alternatives from the repertoire of prior failed actions and behaviors – one has “hit the wall” or “rock bottom” – survival is threatened, the need to tap into a greater “well of resourcefulness” hopefully becomes apparent. After running out of the “customary” choices for survival, there has to be a willingness to let go of the old and embrace options out of the larger sphere of positive possibilities – turning one’s life over to a “higher power.”

The idea for acceptance of a higher power is confusing to some that come to 12-Step-Programs, who may associate this with earlier life negative religious experiences or associations with an abusive authoritarian or dominating figure, especially if there has been traumatic abuse. Gaining flexibility to explore and invest in behaviors or practices to bring about recovery and transformation is what is needed. When stuck in an inflexible state of a rigid self, one needs to shift from an unproductive personal belief about power and control existing in the limitation of individual development and programming since birth, to the realization that there is much more: a greater potentiality, a higher resource beyond the personal limitations and rigid entrapments.

One of the barriers to change relates to deep held core beliefs of:

  1. not being safe
  2. not being loved
  3. not being enough
  4. not being worthy – burdened with guilt and shame

Arriving at a place of great despair, a “dark night of the soul,” there is a need of letting go of the established, old limiting “ego identity.” Embracing spiritual attunement becomes the only viable option, with an acceptance that there is a greater field of possibilities and potentialities, where love, acceptance, and inclusion prevail. Embracing the essence of being – the higher power – allows for profound empowerment and motivation for the steps required for transformation – restoration of “sanity” as identified in the 2nd of the 12 Steps.

Spiritual emergence

is the experience of personal awakening, beyond the constriction and restriction, set by the trained and programmed part of the mind (the ego) – to a higher level of perception, realization, and functioning. A new developing integrative addiction treatment program in Asheville, NC – Center for Spiritual Emergence (see their website) – describes spiritual emergence as a “natural opening and awakening that many people experience as a result of coming to terms with the difficulties of life, through an established faith tradition, as a result of systematic spiritual practices or through unexpected peak experiences.  Spiritual emergences gently allow one to experience and embrace their natural connection to the transcendent domain, forever changing their limiting self-concepts into a more integrative, awakened self”.

Psychoneuroplasticity (PNP)

as presented by Lawlis in his well-done book – Psychoneuroplasticity Protocols for Addictions (Lawlis et al. 2015) is portrayed as an evidence-based science with restorative, rehabilitation, and transformational tools and applications. PNP is founded on post 0716 edit mindset-developments in neuroscience, neural therapies, rehabilitation medicine, addiction and other integrative approaches to mental health treatments.  Though the book focuses on evidence-based treatment approaches for addiction, it is very applicable to the care of other mental health issues and problems and supports the value of integrative approaches and therapies. Brain plasticity is based on the understanding of brain activity, neuronal circuitry, and the ability for the stimulation, modification, retraining, and growth of nerve cells and their complex networks.

Positive brain plasticity can be helpful in many problematic areas as:

  • cognitive processing, worries, physical pain, migraines
  • emotions, depression, anger, reactiveness, stress
  • anxiety, fear, phobias, obsessiveness, distractibility
  • alertness, focus, arousal, ADHD, brain fog, fatigue
  • PTSD, sleep disturbance, addictions, cravings, over-weight

To set the stage for healing, recovery, transformation, and neuroplasticity, any difficulties in above noted areas, may need to be addressed early on. Several are discussed in greater detail below.

Anxiety and fear

can be a disabling condition and a major interference with life and productivity and can act as a barrier to recovery from other mental health condition, including addictions and other health problems. The following can contribute to anxiety or panic like conditions:

  1. unmanaged stress
  2. prior life losses and trauma
  3. lack of adequate parenting or an early life nurturing environment
  4. adverse effects from medication and drugs
  5. life-threatening physical illness

Resulting impairment can become chronic with only temporary relief, if any, from drugs or use of substances that could be harmful to one’s health and well-being. Studies of brain waves often will show high-frequency beta waves in localized regions of the brain suggesting increased activation and the need to retrain and repair the brain’s neural networks to more relaxed frequencies and a healthier state. Mental health professionals sometimes will label people as having other mental health conditions or personality disorders, like borderline personality disorders, because they have not been able to grow and mature emotionally. The behaviors and personality may be related to earlier life abuse, persistent severe anxiety, and feelings of being overwhelmed – resulting in resistance or the inability to resolve severe chronic anxiety that blocks healthy development around their families, social network, and peers.

Traumatic life events

can lead to post-traumatic stress disorder (PTSD), which can either be of a simple type where there has only been one major traumatic event or complex where there have been multiple accumulative traumas. A person’s life development can get stuck in a time-relation to an earlier trauma. Integrative type treatment protocols and therapies focusing on treatment of  trauma, as those presented by Lawlis (Lawlis et al. 2015) have the potential to bring relief by relieving the emotional connection to trauma memories and supporting positive brain changes and plasticity . The use of neurofeedback type treatments as the BAUD (bioacoustical utilization device) can disrupt the reconsolidation of traumatic memory and has been shown to relieve symptoms of PTSD (RESET Therapy). Relaxation or stress-reducing therapies, music, meditation practices, breathing techniques, nutritional diet, neuro-biofeedback and skill development can be a part of neuroplasticity enhancing protocols. Other sensory or trauma-focused therapies as EMDR, are also utilized to form new and healthy neuro-circuitry and response patterns.

Depression

can interfere with recovery and be due a multitude of factors including:

  • response to negative life events, chronic stress, trauma, and losses
  • low self-esteem
  • genetics, nutritional deficiencies, and medical illness
  • toxic environmental exposure including to drugs and alcohol

With depression there may be associated: ruminations and obsessional thought, as seen in OCD (Obsessive Compulsive Disorder); anxiety; loss of productivity; feelings of loss of control; loss of interest in things; a downward spiral of increasing depression and development of suicidal thinking, which can lead to loss of life or complication with other medical illness. If suicidal thinking occurs, immediate help should be sought from mental health professionals.

The brain, if studied with EEG brain wave studies in identified areas of the brain, will show a pattern of under activation and low voltage waves. Neuroplasticity focused protocols look for healthy interventions to bring these areas of the nervous system back online and restore responsive feelings, energy, joy and happiness without the individual resorting to using potentially dangerous drugs or chemicals. Intervention may include therapies as noted above including:

  • neurofeedback or neuro-therapies, BAUD
  • psychotherapies including trauma-focused therapies as EMDR
  • exercise, nutritional diet, supplements
  • sound, rhythm, aroma, movement, and dance therapy
  • mindful meditation, breathing techniques
  • social network development with active peer support
  • coping, relapse prevention, and social skill development

Cyclic patterns of disturbed emotions and behavior

can interfere with recovery. These can present as periods of irritability, rage, heightened anxiety, obsessiveness, sleep disturbance, periods of dramatic increase in activity and hyper focus alternating with times of fatigue, depression, loss of motivation and loss of interest in things. These patterns are sometimes labeled as being in the Bipolar Spectrum (see Dr. Parks article) but can also be related to PTSD and prior accumulative trauma. Many of the above-noted treatments and others are considerations to correct altered behavioral pattern, skill deficits, dysfunctional brain patterns, and neuro-circuitry.

Consider broader integrative or neuroplasticity related approaches if you or a loved one has difficulties with any the above-discussed symptoms or conditions. Seek out competent and well-trained health care practitioners trained in these areas.

Written by Ron Parks, MD, edited by Shan Parks

Question:

What symptoms or conditions do you or a significant other have that may be helped by one of the above-discussed approaches? I would be interested in your comments or opinions. Please respond below.

Man on Boardwalk, depression, PTSD,veteran

PTSD Treatment with RESET Therapy

RESET Therapy (Reconsolidation Enhancement by Stimulation of Emotional Triggers)

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An amazing solution to PTSD difficulty is RESET Therapy (Reconsolidation Enhancement by Stimulation of Emotional Triggers) which combines neuro-acoustical stimulation (sound) with patient recall of traumatic memories. The idea is to reset emotional memory circuits in the brain to pre-trauma levels. This occurs during a process designed to interfere with a targeted memory being repeatedly restored after it is selectively lit up in the emotional part of the brain through the patient’s intentional focus.

Targeted binaural sound using the BAUD (Bio-acoustical Utilization Device) interrupts the brain’s natural restoration of memory. The device as well as the basic protocol was invented in 2003 by Dr. Frank Lawlis, a pioneer in the field of medical psychology. By focusing on the trauma, PTSD patients activate (light up) the targeted neural circuits. Their active participation is critical to the success of RESET Therapy.

PTSD (Post Traumatic Stress Disorder)

is defined as a mental health condition that’s triggered by a terrifying event – either from personal experience or as a witness. Symptoms include: flashbacks, nightmares, stress, severe anxiety, depression, sleep disorders, various addictions, and social withdraw. PTSD concerns more than veterans. The symptoms also impact first responders, clinicians working in acute hospital settings, and any adult or child that has experienced trauma.

Overcoming erroneous beliefs.

My primary mission is to offer veterans as well as civilians who continue to suffer from PTSD and their loved ones, the promise of hope from a member of the healing profession! I do this to replace the erroneous belief that currently pervades many of our mental health professionals about PTSD being a lifelong psychic injury that cannot be healed.

With this point of view in mind, veterans and victims of PTSD have been led to believe that they must either ingest medications designed to contain and control their minds at the expense of their personalities or, they are required to be in some form of psychotherapy for the rest of their lives, or both of the above.

This way of thinking has pervaded our civilian population to the extent that when our veterans return to either re-integrate or touch base with their families on their varied rotations, others who come in contact with them perceive that they must be careful not to trigger the veterans’ inner time bombs.

PTSD is a disease of the memory system.

A key point I’d like to make is that PTSD is a disease of the memory system. The real problem is not that the trauma happened in the first place, but the fact that the memory of the trauma can’t be forgotten. Adults and children dealing with PTSD end up reliving the trauma over and over again. This includes physiological reactions to the experience as well as their associated emotions such as fear, anger and sadness. The emotional charge of the memories remain hair-trigger and intrudes into numerous activities of daily living.

Neuronal Model of PTSD

The next major neuro-scientific piece of information I’d like to provide is how trauma specifically affects the brain. I’ve come to call this the Neuronal Model of PTSD. If we looked at it through sophisticated brain imaging equipment, specific areas deep within the Limbic System would appear to be activated (flared) and other brain areas such as the speech center located in the left hemisphere would be shut down; going offline when the trauma is triggered.

Also, the area that is associated with making complex decisions in the prefrontal lobes referred to as ‘executive functioning’ also goes offline when the trauma is reactivated. After, a person who was well able to multi-process typically has difficulty with this advanced level ability.

Perhaps this is the reason, that talking to someone in the depths of their PTSD despair, hardly ever does anything but frustrate the speaker, whose words can’t be fully received by the supposed listener. Also, perhaps this is why the person with PTSD seems dumbfounded by tasks that he/she was previously well able to manage.

Hope for PTSD suffers.

Methods like RESET Therapy are giving many trauma impaired patients hope that PTSD doesn’t have to permanently ruin their lives. It’s increasingly clear that brain-based methods and tools are the future of medicine.

Guest Post by: George Lindenfeld, PhD (see his new E-book on RESET)

[callout]What type of therapy has helped most with yourself or someone you know with PTSD? I will be interested in your comments.[/callout]

Man with PTSD, terror, trauma

PTSD, Terror and Trauma – Holistic Approach

PTSD, terror, trauma  – how common and what to do after recognition?

A greater number of people, appear to be now having more exposure to terror events, trauma and are developing an increase in trauma-related illnesses, including PTSD. The causes could be attributable to any of a long list of suspected or debatable factors. It is valuable to focus on what we do know about trauma and the development of trauma-related illnesses, so as to work effectively on prevention, early recognition, treatment, and recovery.
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Are there more sensible and holistic approaches to trauma related problems?

About seventy percent of adults in the U.S. have experienced a traumatic event at least once in their lifetime. Ten percent or more of these people will develop PTSD according to some studies. Women are about twice as likely as men to develop PTSD (one out of nine women); see more at ptsdunited.org..  About 8 out of every 100 people (or 8% of the population) will have PTSD at some point in their lives. About 8 million adults have PTSD during any given year, which represents only a small portion of those who have experienced trauma; see more at ptsd.va.gov.

When you look at current statistics on PTSD (Post Traumatic Stress Disorder) and TRI (Trauma Related Disorders) – also referred to as Trauma Spectrum Disorders – two immediate questions come to mind. Is it a growing epidemic, or is it an expected outcome from the level of dysfunction and violence in our society — in our homes, on the street, in the workplace or on the battlefield? If the answer to both questions is yes, and if we are seeing more victims and sufferers from the effects of trauma, what then can we do as individuals and as a community? Can there be hope for a more sensible, comprehensive approach to include prevention; earlier recognition of the acute and lingering effects of trauma; timely interventions; proper diagnosis; application of more holistic, integrative and innovative treatments; and improvement in availability of services and resources.

Most people would not expect trauma-related illnesses and PTSD to show up from events which can occur outside of the military. Most people who are affected often go unrecognized and never seek treatment. They continue to suffer the ill effects of trauma and its aftermath.

Now it is recognized that the effects of trauma and it aftermath can occur to anyone at any life stage – childhood or adulthood.  The trauma itself can result from a wide variety of experiences:

  1. Exposure to threatened death, serious injury, auto accidents or violence
  2. Feeling helpless during a trauma as childhood sexual abuse, rape, physical assaults
  3. Major overwhelming adverse life threatening events (early life or in adulthood) or poly-trauma (i.e., series of traumatic events: as a job loss, divorce, death of a significant other)
  4. Sudden or major emotional losses
  5. Witnessing domestic violence, death or injury to others
  6. Natural disasters or mass causality event as a terrorist attack

The list of the many different types of trauma is extensive and affects each person differently.

There are a number of contributing factors that can make an individual more vulnerable to PTSD or TRI including earlier life traumas as listed above and some of the following additional vulnerability factors:

  1. Having less social support
  2. History of another physical or mental health problem such as a co-morbid substance use disorder
  3. Recent losses
  4. Contributing genetic factors

Martha is a survivor of terror and trauma.

Martha* was a well-liked and very effective 8th-grade teacher in her inner city school. Her students admired her for her understanding, effective teaching and leadership in several extracurricular programs – as the school drama club. She came to work one day, visibly shaken, reporting that two older teens had pushed her down and stole her purse when she was leaving her house – in what she thought was a safe neighborhood. She was upset and anxious for most of the day and the next, but she seemed to get back to her usual self and pace by the third day. Two weeks after this occurrence, arriving at school a half hour early to catch up on some paperwork, she was suddenly shoved through the entrance door by a large man from behind, causing her to fall to the ground. She started to scream but stopped when hit by the attacker with a glancing blow on her arm with a gun. Some other staff and students began to arrive, causing the nervous assailant to turn and flee. Martha went to her physician, and he found no physical injuries or any evidence of head injury. He offered some tranquilizers, which she refused. After a few days, she felt well enough to return to work. Over the next few weeks, going into a month, she felt easily distracted, began to startle easily, especially to sudden movement or noise. Her sleep was often disrupted with nightmares of being attacked or chased. For the first time, she began having what she and others described as panic attacks – with the sudden onset of a pounding rapid heart, an overwhelming feeling of dread that something terrible was going to happen and an urge to flee or leave the room. She could no longer drive herself as panic attacks would occur while driving. She had to take sick leave from her teaching work, and she sought out professional help.

The first doctor felt she had ADHD or attention problems and prescribed a commonly use stimulant type drug to help her focus.  This only made her worse: more anxious with difficulty sleeping, jumpy and irritable. She went to someone else who felt that her main problem was depression and anxiety — he tried her on an antidepressant that again seemed to make her worse. When he wanted to change her to a bipolar condition medication, she decided to go to another health care provider. The therapist, who saw her, recognized the impact that the trauma experience was having on her. The therapist recommended someone specialized and experienced with specific trauma-related therapy and treatment. She also saw a holistic physician that helped her improve her lifestyle, nutrition and exercise program. Martha reported that she had been sexually and verbally abused as a child growing up with an alcoholic mother and often absent father. She was often bullied by her peers as she was somewhat shy as a child. Her recovery was gradual, but Martha was able to resume her effective classroom work with her students after three to four months.  *(To protect confidentiality, the above is a composite of some clinical experiences and does not represent an actual person or any prior patients).*

The annual cost to our medical care system for PTSD and TRI is staggering – in the billions of dollars, which is often compounded by misdiagnosis and improper treatment. Beyond the actual treatment costs, there are the related workplace costs; drug costs; and cost of other associated illness, disabilities and mortality.

It is estimated that 80%-90% of persons exposed to the various types of severe trauma will not develop PTSD. Predisposing — vulnerability factors — are the more important deciding factors as to whether an individual gets a trauma related illness or not, more so than the trauma itself. The traumatic experience can have profound effects on some and very little effects on others who experience the same event.  What makes one more susceptible to post-trauma problems and another not – is of great interest now. Where there is more exposure, there is more potential for traumatic experiences and the occurrence of trauma related illness – as was the situation with Martha, as described above.

For a detailed description of trauma related illness and PTSD symptoms see the official DSM-5  (Diagnostic and Statistical Manual of Mental Disorders, 5th Edition: DSM-5 by American Psychiatric Association (APA), available through the APA or at Amazon .

Recognizable intermittent or chronic emotional or physical symptoms that may be a sign of TRI or PTSD from prior trauma or trauma exposure may include:

  1. Re-living: People with PTSD repeatedly relive the ordeal through thoughts and intrusive memories of the trauma — including flashbacks, hallucinations, nightmares, feeling great distress when reminded of the trauma, acting and feeling as if the trauma were recurring and psychological distress
  2. Avoiding or feeling numb: the person may avoid people, places, thoughts or situations that remind him or her of the trauma, inability to recall an important aspect of the trauma; feeling of detachment or estrangement from others; isolation and withdrawal from family and friends – as well as a loss of interest in activities that the person once enjoyed; difficulty experiencing love, joy or intimacy – a restricted range of feelings; difficulty relating to others; diminished interest or participation in significant activities;  sense of foreshortened future
  3. Increased arousal as: having excessive emotions, worry and guilt; difficulty falling or staying asleep; feeling nervous, fearful; increased irritability; outbursts of anger and agitation; difficulty concentrating; being hyper vigilant, guarded and constantly alert;  physiologic reactivity upon exposure to trauma cues and having exaggerated startled responses – being jumpy
  4. Experiencing worsening physical symptoms and medical problems, e.g., increased blood pressure and heart rate, fatigue, rapid breathing, muscle tension, headaches, sweating, digestive problems, poor appetite, nausea, and diarrhea

The onset of trauma-related symptoms or illness can be delayed, emerging months after the traumatizing event. However symptoms may appear, earlier, be more subtle and difficult to recognize. Other symptoms or characteristics of TRI and PTSD that may occur include:

  •  Feelings of hopelessness, helplessness, shame, despair or sadness
  • Distrust of others
  • Self-blame, negative views of oneself or the world
  • Family, employment or school problems
  • Relationship problems including conflicts, being over-controlling, violence and divorce
  • Failure to engage in exercise, diet, safe sex or regular health care
  • Excess smoking, alcohol and drugs problems
    Violence of man against womanSee National Center PTSD Fact Sheet

More info at Medscape – does require a free registration)

An integrated holistic approach would be to bring together the tools, practices and scope of integrative psychiatry, psychology and medicine. The goal would be for early recognition, assessment, diagnosis and treatment of people with symptoms or problems resulting from trauma — including an investigation into contributing factors as those related to prior traumatic exposures; environmental, genetics, medical and psychological issues; and developmental and family history. The tools of integrated psychiatry and psychology would include in-depth clinical history and psycho-social assessment, physical examination, psychological testing, consulting with significant others – like family members, laboratory testing – and finally a comprehensive treatment program.

Treatment considerations would be:

  1. Lifestyle and nutritional improvements
  2. Reduction in psycho-social stressors
  3. Individual or group psychotherapies that address current, past developmental and trauma issues
  4. Interventions as suggested by clinical finding and lab testing

Medication use is a consideration after other contributing factors have been addressed, and non-medication interventions have not been adequate. Medications commonly considered are:

  • Selective serotonin re-uptake inhibitors for depression and anxiety (SSRIs; e.g., fluoxetine, sertraline)
  • Symptomatic treatments with sleep agents or more helpful for trauma-related nightmares in adults — prazosin — an anti-hypertensive
  • Benzodiazepines (tranquilizers)— long-term use does not appear beneficial and difficult to wean and stop
  • β-blockers — used to reduce arousal but of questionable benefit.

If there has been significant trauma and apparent TRI or PTSD — a team or network approach would be optimal — this would include health care practitioners trained in the modalities referred to above, plus the presence and needed interventions by an experienced trauma therapist. Therapy may involve different approaches depending on the training of the available trauma therapist as:

  1. Individual or group psychotherapy
  2. Behavioral or cognitive behavioral therapy (CBT)
  3. Exposure therapy, trauma-focused cognitive behavioral therapy, trauma systems therapy
  4. Body-mind therapies, somatic experiencing, eye movement desensitization and reprocessing (EMDR), Emotional Freedom Technique, Reset Therapy –  see E-book on RESET by Lindenfeld.
  5. Other natural alternatives or medication

See PTSD.VA.gov treatment of returning vets

The role of the holistic and integrative health care practitioner would be to add his unique skills and knowledge to the team or network of practitioners, experienced with the treatment and management of someone experiencing TRI or PTSD. As there is often dysfunction or problems in multiple areas, a careful and thorough diagnostic evaluation is needed. Any corrective interventions will help to alleviate symptoms or  illnesses – as treating any infections; digestive disturbance; nutritional or hormonal imbalances; allergies; drug, alcohol addiction problems; emotional and mood problems; personal or family stressors – with the goal of improving comfort, well-being, sleep and restoration; and improvement of autonomic Well-being, Peacefulnessregulation. All of these interventions would be potentially helpful in assisting recovery, along with the assistance of a trauma therapist when needed. Procedures or lab testing that is indicated would be done: as nutrition and digestive evaluation, thyroid and hormonal testing, blood chemistry as complete blood count, blood sugar, lipids, B12 and folic acid levels, vitamin D 25-hydroxy levels, and more specific and advanced testing if indicated.  If with treatment, the person can become less stressed from contributing psycho-social and medical factors, have more restorative sleep, be more free of pain and discomfort, get relief from environmental related illness and allergies, and relief from traumatic memories — there would be more possibilities for the body, mind and spirit to recover from the wounds of trauma.

Other treatments, mind-body therapies or psychotherapies, tests currently available or in development are beyond the limited scope of this article. If interested, see above linked references and my prior article and references – PTESD.

Be knowledgeable and prepared for when anybody that you know or meet with TRI or PTSD needs your support, help or encouragement. Healing or reducing somatic, emotional, mental and spiritual issues, and other factors contributing to the severity of TRI and PTSD – in conjunction with medication when needed — has the potential for relief and the reduction of  suffering from illness associated with recent or prior trauma.

Article by Ron Parks, MD and edited by Shan Parks – see related slide presentation in Library http://ronparksmd.com/jfk-lecture-092016/

[reminder]How could you be helpful to yourself or a significant other when suggestive or actual symptoms of TRI or PTSD appear? I’d be interested in your comments.[/reminder]

Lost in Jungle with light ahead

Holistic Approach to Bipolar Illness – Part 1

BPI (Bipolar illness),

often referred to as bipolar disorder or manic depression, affects more than 2.2 million people in the United States. BPI is characterized by bouts of illness with significant often disabling symptoms, alternating with periods of less or no symptoms. These may be a sign of the disorder: unusual shifts in mood, energy or the ability to function.

What is happening to Sarah?*

conflicted young women
©Aleutle/Dollar Photo Club–Conflicted young women.

Because of the insistence of her family and one of her ex-husbands, Sarah had been to several mental health evaluations. She had been married and divorced four times and in and out of many jobs. She had an early life history of trauma: at age 14, she was sexually abused by her divorced mother’s live-in boyfriend; at age 15, she was raped when at a party. She occasionally had nightmares about the incidences and had triggered flashbacks, or panic like attacks, when she smelled certain odors or sounds reminiscent of her rape. She had made several suicidal attempts during recurring periods of severe depression. Hospitalization was required two times when her doctors considered her to be a danger to herself. Her mother and one aunt had a history of bipolar illness. Sarah never had any severe period of mood activation or mania, though one of her treating psychiatrist thought she had periods of what he called hypomania (milder periods of mood, behavior activation or changes). Her diagnosis was Bipolar II type of BPI and PTSD (Post Traumatic Stress Disorder). Her best response to treatment finally came when she received appropriate treatments and therapy for both BPI and PTSD, and when she also sought out the help of a holistically oriented health care provider who encouraged her to follow a more optimal health, nutritional, spiritual lifestyle program.
*(To protect confidentiality, the above is a composite of some clinical experiences and does not represent an actual person or any prior patients).

Sarah’s family and significant others began to pay attention and to take action when her once normal ups and downs of everyday life began to get more dramatic, extreme and destructive.  If you, a family member, or someone you know shows unusual shifts in mood and energy with uncharacteristic behaviors, it may be an early sign of bipolar illness (BPI).

Getting evaluation and treatment when needed.

Evaluation by a trained professional such as a psychologist or psychiatrist should be considered when changes in moods are severe, persistent, and interfering with daily life.  Identify BPI early in its course and treat with a comprehensive, holistic treatment program. If not, the illness can have devastating effects on relationships, careers and health – as was the case of Sarah.

Recurrence of bipolar episodes with depression, anxiety, mania or hypomania has adverse effects on family, social and occupational functioning. BPI disrupts many normal day to day activities in areas as:

  • social functioning and relationships
  • work and productivity
  • sleep and physical health

Recognize bipolar illness in all its forms.

The illness can lead to impaired thinking (cognition), poor judgments, increased distractibility (poor focus), dysphoria (painful moods) and physical discomfort with increased preoccupations with health problems. There can be compromised functioning as with:

  1. more impulsive or volatile behavior and expression
  2. loss of interest, pleasure and motivation in doing things
  3. suicidal thinking.

BPI’s early appearance is often not recognized by significant others or by health-care providers.  A key feature that separates the illness from recurring depression is the occurrence of hypomania or a more severe manic episode.  A manic episode is a period of elevated, expansive or irritable moods, and increase goal-directed activity or energy – often lasting for at least a week – which is a characteristic of the more severe bipolar I type of BPI.

Image of a conflicted brain
©Sangolrl/Dollar Photo Club—conflicted mind.

Other commonly associated symptoms may include:

  • inflated self-esteem or grandiosity
  • decreased need to sleep
  • more talkative than usual or pressure to keep talking
  • flight of ideas or the experience of racing thoughts
  • distractibility
  • increase goal-directed activity
  • excessive involvement in high risk activities
  • marked impairment in social and work functioning
  • sometimes need for hospitalization (if potential for harm to self or others and/or the presence of poor judgement and thought disturbance – psychotic symptoms)

In Bipolar I disorder, the manic episode may have been preceded or followed by hypomania or major depressive episodes. Milder “hypomanic” episodes can have:

  1. a persistent elevated, expansive or irritable mood
  2. signs of sharpened and overly active thinking (hyper-focused)
  3. increased energy and activity that last for at least four consecutive days (present for most of the day – nearly every day)

This “hypomania” alternates with frequent periods of depression and are typical of the less dramatic bipolar II type of the bipolar illness. Recurrent depression is characteristic of both conditions, and the depth of the depression usually determines overall severity.

Both bipolar I and bipolar II types of BPI can be both severe and disabling. Bipolar I disorder more specifically describes a sufferer who has experienced distinct periods of severe depression or hypomania, alternating with at least one episode of severe activation or mania. Bipolar II disorder, by definition, has not had any manic episode.  If mania later presents in bipolar II individuals, this results in reclassification to Bipolar I type of BPI.

Symptoms of Bipolar II have a similarity to those seen in Bipolar I but are often milder, less severe, or more subtle as:

  1. inflated self-esteem or grandiosity
  2. decreased need for sleep
  3. more talkative than usual or pressure to keep talking
  4. flight of ideas or racing thoughts
  5. distractibility
  6. agitation
  7. increase in goal directed, hyper-focused activity (school, work, socially or sexually)

Some subtler bipolar I or bipolar II conditions, at any given time, can present with milder and more difficult to recognize symptoms as irritability, anxiety, and moodiness – alternating with periods of less pronounced depression. Another classification, for the entire range of BPI in its varying expression, is — bipolar spectrum illness —  which would include even the less recognizable forms of recurrent depression with milder periods of activation, hypomania and less dramatic symptoms.

For clear description and definition of BPI, go to the current American Psychiatric Association — the official nomenclature that has been codified and defined in the DSM-5 (published by American Psychiatric Publishing).

What is the cause of bipolar illness and who is affected?

Bipolar illness is considered an inherited condition related to instability in brain neurotransmitters (nerve chemicals) regulation, which leads to greater vulnerability to emotional or physical stress, over-stimulation, upsetting life experiences, drug or alcohol use, and interference with rest and sleep.  The brain is not able to properly calm or activate itself, or restore its usual healthy balance.

Research studies strongly support inherited genetic factors as important contributors to BPI. First-degree relatives of people with BPI are seven times more likely to develop bipolar I type of BPI. Environmental factors (epigenetic factors) are also suspected to affect bipolar illness — physical factors (as radiation or trauma), chemical factors (as pesticides, toxic metals, and air pollution) and biologic influences (as bacteria, mold, viruses).

Lifetime prevalence estimates are 1% for bipolar I disorder — BP 1 type of BPI, 1.1% for bipolar II disorder (BP 2 type of BPI), and 2.4% to 4.7% for sub-threshold BPI (a person is not meeting the full symptom criteria for BP 1 or BP 2). Age of onset range from childhood to the  mid-20s and later, and BPI onset is unusual after age 40. Recurrence of active BPI over a five year period is very common – with the associate in between times of no symptoms, minor symptoms, or with significant residual symptoms. (see  “Bipolar Disorder” by Vinitsky and Parks, Advancing Medicine with Food and Nutrients, 2nd edition, Chapter 32, Dec. 2012, CRC Press)

When can depression actually be bipolar illness?

Recurrent depression is often bipolar illness unrecognized. Additional clues to underlying BPI include:

  • poor response to treatment for depression
  • manic or psychotic symptoms
  • rapid mood fluctuations triggered by antidepressants
  • family history of bipolar illness
  • onset or recurrent depression before the 20s
  • severe premenstrual syndrome, PMS, or premenstrual dysphoria syndrome (PMDS)
  • postpartum depression
  • atypical depression with a lot of irritability, sleep disturbance and anxiety.

At its worst, BPI can lead to higher mortality from suicide and other co-occurring medical illnesses. Among psychiatric disorders, BPI has a significant risk of death from suicide. The risk in bipolar 2 type of BPI for suicide is greater than bipolar 1 type of BPI – according to some studies. Unrecognized co-occurrence of BPI, with other mental or physical illness, can lead to ineffectual treatment and poor outcomes. Six months after suffering a myocardial infarction, victims with major depression – commonly seen in BPI – had six times the mortality rate of non-depressed patients. Presentation of BPI in the older population, greater than 50 years, will often have other medical problems at the time of diagnoses – including cognitive changes. More than 50 percent of people will abuse drugs or alcohol if BPI is not recognized and treated.

Bipolar illness can be overlooked or misdiagnosed resulting in inadequate treatment.

People with this disorder are sometimes misdiagnosed as having just depression, and treated as such, often resulting in a poor treatment outcome.  These individuals would respond better to a bipolar illness focused treatment program. (see for more information)

A holistic or integrative approach to the study and treatment of BPI offers a better path to disease understanding, treatment and prevention of future illness.

Sunset on tropical beach
©Slttltap/Dollar Photo Club—Harmony on a tropical beach.

With a broader open health-care model, there is the potential for improved research, diagnosis and treatment of BPI. All disciplines can be included in an integrative model – including biochemistry; psycho-pharmacology; toxicology; genetics; spirituality; psychology; physiology; endocrinology; sociology; and nutritional, metabolic, environmental, psychiatric medicine and complementary mind/body/spiritual therapies. Effective outcomes can happen with patience and commitment to finding a suitable care and treatment program as occurred with Sarah – as described above.

(For support and assistance consider below sites):

(psych.com/guides)

(dbsalliance.org/)

(NIMH on Bipolar Disorder)

(adaa.org/)

Part 2 of this topic: “Holistic Treatment of Bipolar Illness.”

Article by Ron Parks, MD and edited by Shan Parks

Question:

What would be your first consideration, if you or a significant other is developing signs of bipolar illness? I would like to hear your comments.

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