Post Traumatic Stress Disorder (PTSD) is characterized by several physical, emotional, and mental symptoms that occur in response to a traumatic event. This disorder is alarmingly common among military personnel but is also common to other professions such as Law Enforcement and Emergency Responders. Conventional PTSD treatments rely on fairly standard psychotherapy and prescription medications. Recently, however, the FDA’s classification of Methylenedioxymethamphetamine (MDMA), commonly referred to as Ecstasy, has sparked interest in alternative treatments for PTSD. This article is a brief overview of the prevalence of PTSD, conventional therapies, and potential alternative treatments for PTSD.
Post Traumatic Stress Disorder (PTSD) is well-described by its name and is a diagnosis used to described current stress responses to events in the past. PTSD is commonly associated with symptoms of soldiers returning from battle but can be an issue for anyone that has experienced a traumatic event in their lives. Other common professional fields which see high incidence rates of PTSD are those of emergency personnel and first responders such as Firefighters, Police Officers, and Emergency Medics. There are many symptoms of PTSD which, on their own, may not necessarily qualify a diagnosis of PTSD. The Clinician-Administered PTSD Scale (CAPS) is a diagnostic tool used by doctors to qualify a PTSD diagnosis. As a rule of thumb, a score of 50 on this test indicates moderate PTSD while higher numbers in the seventies or eighties indicate a strong likelihood of PTSD.
To understand the need for alternative therapies (with more successful treatment rates) one first needs to examine the prevalence rates of PTSD. One can do this by referencing the National Comorbidity Survey (NCS) conducted 1990-1992. This study was the first large-scale investigation of the prevalence of mental health in the United States and has since received several follow-ups to provide more insightful data. In a 1995 paper published in the Archives of General Psychiatry, researchers described a prevalence rate of nearly 8% among Americans, with women being a little more than twice as likely to experience lifetime PTSD. This analysis also provided several other insights such as first traumas being much more likely to produce PTSD as well as many other incident-type granulations. This analysis was pretty lacking regarding analysis for military personnel and military-specific data .
Among Americans, age 18 and older, there is a lifetime PTSD rate of roughly 7%
Analysis of follow-ups to the initial NCS, conducted under the name of National Comorbidity Survey Replication (NCS-R) and relied on DSM-IV criteria for making a diagnosis of PTSD. The US Department for Veteran Affairs (VA) provides an analysis of this data with a bit more updated insight into national prevalence rates. They report, among Americans age 18 and older, there is a lifetime PTSD rate of roughly 7% with women reported, again, as being more than twice as likely as men to develop PTSD . In addition to analysis of the NCS-R, the VA provides an analysis of the of a RAND Corporation-published 2008 study investigating the prevalence of PTSD among Veterans of military personnel deployed during Operation Iraqi Freedom. This analysis found that PTSD rates among those on active duty during that period to be nearly 14%, roughly a 75% higher incidence rate than among the general population . Needless to say; PTSD isn’t some obscure diagnosis given to a few unfortunate individuals each year—it’s a serious issue.
The current treatments for PTSD, depending on the severity and other circumstances, are combination psychotherapy and prescription medication treatments. Some of the methods used in psychotherapy sessions include the following:
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- Prolonged Exposure Therapy: Focuses on exposing people living with PTSD to situations that force them to face negative emotions associated with past trauma.
- Cognitive Processing Therapy: Focuses on the mental processing of thoughts surrounding the trauma responsible for a patient’s PTSD.
- Eye Movement Desensitization & Reprocessing (EMDR): A method of recalling past events while focusing on current physical stimuli such as finger tapping, metronome swaying, or tonal therapy.
There are several other types of psychotherapies utilized by doctors to help address a patient’s PTSD, many of which are use-case-dependent. One commonality among these is their design to bring past emotions and memories of events to current awareness, where therapists then help a patient re-process (or process for the first time in some cases) events surrounding their trauma.
Medications such as Selective Serotonin Re-uptake Inhibitors (SSRIs) are often prescribed to those who have PTSD as well.
In addition to these therapies, there is a number of alternative therapies such as Yoga and meditation that have been reported as effective in addressing PTSD. To date, there isn’t enough scientific data to make any conclusive statements about the effectiveness of such therapies specific to PTSD. Such “alternative” PTSD therapies have a growing body of Scientific support and are being discussed in a much more serious of tone in recent years.
Recent Research suggests that a chemical compound named methylenedioxymethamphetamine (MDMA), commonly referred to as Ecstasy, may soon qualify for FDA consideration as an approved PTSD treatment. Researchers have just completed a series of phase 2 clinical trials for the treatment of PTSD with Ecstasy. The researchers of one such study, recently published in the Lancet, describe this study’s design as being the “first dose-response study of MDMA-assisted psychotherapy to compare three doses of MDMA, in a population of first responders and veterans with PTSD” . This study is among only a handful of phase-2 clinical trials used by the FDA in their announcement of Breakthrough Therapy Designation last year for MDMA treatment for PTSD. Phase 3 clinical trials have received considerable funding from organizations such as the non-profit Multidisciplinary Association for Psychedelic Studies (MAPS) and are reportedly scheduled to begin in spring 2018. Before anyone with PTSD goes out and starts gobbling-up MDMA however—it’s important to recognize that these studies are designed to work in conjunction with professional therapy and have also had some reports of adverse side-effects.
Meditation is a process that is hard to define and is subjective to each. It can be as simple as taking 5 minutes a day to focus on one’s breathing, or it can be as in-depth as multi-day fasts centered about hours of meditation at a time. What it boils down to is personal growth on a mental, emotional, and sometimes (such as in the case of Yoga) a physical level. Some need to grow much more than others to address issues common to modern life, while others may seek to grow to address issues more specific to their journey through life. In a 2015 meta-analysis published in the Journal of Clinical Psychology  researchers noted that, among the clinical studies qualified for inclusion in their analysis, there was very “encouraging” evidence for the use of Mindful Meditation in the treatment of PTSD. Pretty non-committal right? Some important considerations were noted in this analysis though, that I feel are worth mention:
- One study found that fewer than 50% of people living with PTSD referred to a clinic reported symptoms of anxiety as their primary emotion while the rest experienced sadness, disgust or anger.
- PTSD has historically been classified as an anxiety disorder and only recently has the diagnostic umbrella been expanded to include symptoms of negative cognition and mood.
- Variables in existing research aren’t tightly controlled, and methods also vary wildly making a strong consensus of overall effectiveness tough.
A 2011 study, investigating the impact of mindful meditation on the symptoms of PTSD in 124 firefighters, found that mindfulness was strongly associated with decreased emotional and physical symptoms of PTSD . Among other points, researchers of this study found that the largest influence over symptoms of PTSD was “resilience resources” available to firefighters which included optimism, personal mastery, social support, and mindfulness. Researchers note that “Mindfulness may allow greater cognitive flexibility and improve emotion regulation” and use the results of this study to reinforce their opinion that “Mindfulness may be important to consider and include in models of stress, coping, and resilience.” 
Acupuncture is a practice of stimulating certain points of the body, commonly done with needles. This practice originated in ancient China and had seen a growth in popularity among Western countries in recent years. Science has yet to fully devise a way to describe the underlying mechanisms of acupuncture but also doesn’t hesitate to accept its’ reproducible benefits towards such physical symptoms as nausea and stress. In a pilot clinical trial to assess the effectiveness of acupuncture on PTSD, conducted March 2003-April 2004, researchers found that acupuncture was similarly effective to cognitive behavioral therapy (CBT) in its’ ability to treat PTSD . This study highlights the potential of acupuncture to be considered a viable treatment option for the treatment of PTSD along with its related symptoms. At this point, there still needs to be much more clinical testing done before acupuncture can be considered an “official” treatment for PTSD. Nonetheless, it stands as a promising consideration to those who have PTSD that isn’t responding to conventional psychotherapy.
Nutrition is essential to optimal health and, arguably, plays a role in the development of any health condition. Sometimes, in the case of PTSD, nutrition’s role is one of restoring balance rather than in other cases, such as heart disease, where improper nutrition may be the cause of the disease. To consider the potential nutritional approaches have on the treatment and management of PTSD, let’s break things down to a symptom level. Two of the most common symptoms of PTSD are anxiety and trouble sleeping.
Quality sleep is one of the most important aspects of maintaining optimal health, aside from nutrition of course, and can be impacted in many ways. There are many natural sleep aids such as melatonin that have strong support for addressing sleep issues naturally. Having access to a licensed nutritionist or Dietician to help better assess one’s personal nutritive needs can make any nutrition or supplement based treatment protocol better tailored to the individual—which strongly increases the likelihood of success.
Other supplements such as GABA or Magnesium have both demonstrated strong potential in addressing symptoms of anxiety and depression. Magnesium is involved in hundreds of essential cellular processes in the body. Ensuring that magnesium deficiency isn’t present can be a great first step in the treatment of many health concerns, and would likely be of use when addressing symptoms of PTSD. Not all types of magnesium are created equally and knowing which types are regarded as being more effective can greatly improve the success of any magnesium therapy. Lithium Orotate, a non-prescription form of Lithium, has also shown tremendous potential in its ability to address issues of mental and emotional health.
Post Traumatic Stress Disorder is no joke. This condition is a growing concern among military personnel, but anyone can be at risk. The human condition doesn’t always process traumatic events in ways that are suited for long-term mental, physical, or emotional health. Research suggests that people scoring higher for traits such as optimism, mindfulness, and social support are more resilient to developing PTSD after experiencing a traumatic event. The recent classification of Ecstasy (MDMA) as a “breakthrough treatment” by the FDA has given hope to many suffering from PTSD that don’t respond well to conventional treatment.
This honest reassessment of a compound formerly considered to have no medicinal value (DEA, Schedule I) has rekindled interest in many other alternative therapies such as mindful meditation. I’d like to urge everyone to take a moment to applaud the system for working for a change. Also, I’d like to point out that the Ecstasy available from the sketchy guy down the hall isn’t likely going to offer the same potential benefit for PTSD as a laboratory-prepared, dose-standardized, somewhat pure form being used in clinical trials.
- Mithoefer, Michael C et al. 3,4-methylenedioxymethamphetamine (MDMA)-assisted psychotherapy for post-traumatic stress disorder. The Lancet Psychiatry. 01 May, 2018. https://doi.org/10.1016/S2215-0366(18)30135-4
- U.S. Department of Veteran’s Affairs. “Epidemiology of PTSD.” Negative Coping and PTSD , National Center for PTSD, 31 Jan. 2007, www.ptsd.va.gov/professional/PTSD-overview/epidemiological-facts-ptsd.asp.
- Kessler, Ronald C. “Posttraumatic Stress Disorder in the National Comorbidity Survey.” JAMA Internal Medicine, American Medical Association, 1 Dec. 1995, jamanetwork.com/journals/jamapsychiatry/article-abstract/497313
- Banks, Kirsty, et al. “An Overview of the Research on Mindfulness‐Based Interventions for Treating Symptoms of Posttraumatic Stress Disorder: A Systematic Review.” Freshwater Biology, Wiley/Blackwell, 20 July 2015, onlinelibrary.wiley.com/doi/abs/10.1002/jclp.22200.
- Smith, B W, et al. “Mindfulness Is Associated with Fewer PTSD Symptoms, Depressive Symptoms, Physical Symptoms, and Alcohol Problems in Urban Firefighters.” Journal of Consulting and Clinical Psychology., U.S. National Library of Medicine, Oct. 2011, https://doi.org/10.1037/a0025189.
- Hollifield, M, et al. “Acupuncture for Posttraumatic Stress Disorder: a Randomized Controlled Pilot Trial.” The Journal of Nervous and Mental Disease., U.S. National Library of Medicine, June 2007, doi.org/10.1097/NMD.0b013e31803044f8.