Abstract
There are a number of psychiatric conditions that can affect
the lives of military veterans and active duty members. One such condition is
posttraumatic stress disorder, which can be accompanied by symptoms that can
make life challenging. However, there are a number of underlying biological and
neural causes that may contribute to the development of some of the symptoms.
This recognition has helped to shape some of the treatment options and
therapeutic interventions that are commonly used to address the symptoms of
posttraumatic stress disorder.
Keywords: PTSD, veterans, neuroscience, mental health
Psychological Disorders: Neural
Components of PTSD, Cultural Influence, and Treatment
The body
has a number of reactions to various stimuli, which are designed to alert and
warn individuals of potential danger, leading to an increase in the likelihood
of survival. However, in some instances, the reaction to these stimuli can lead
to the development of various psychiatric conditions. One such reaction occurs
to the exposure to one or multiple stressful events, which can trigger the
onset of symptoms that are associated with a condition called posttraumatic
stress disorder, or PTSD.
It has been shown that up to 15% of
military members, both active duty and those who are veterans of the military
experience symptoms that are associated with PTSD, with a significant
percentage of these military members becoming debilitated and unable to
participate fully in life (Dursa, Reinhard, Barth, & Schneiderman, 2014).
As such, understanding the various influences on the development of symptoms
that are associated with PTSD, along with the level of exposure and knowledge a
mental health professional has on the topic of PTSD, can help to provide
patients with the highest quality of care to adequately address his or her
symptoms.
PTSD
and Behavior
It should
be expected that following the exposure to a traumatic event, or even reading
or watching media that details traumatic events, could lead to a change in
one’s behavior. Traumatic experiences can lead to changes in a number of neural
areas that can influence one’s behavior. For example, three of the brain
regions that are often cited as being affected by the stress response that
often occurs in the wake of a traumatic experience include the amygdala,
hippocampus, and the prefrontal cortex (Bremner, 2006). Changes in these brain
regions can bring about changes in behavior, including the symptoms that are
commonly associated with PTSD such as hyperarousal, nightmares, difficulty in
memory and concentration tasks, and a heightened startle response (Bremner,
2006).
Influences
on PTSD
Humans do
not exist in a specimen jar, and as such, they are vulnerable to a number of
internal and external stimuli and influences that can affect the behavior and
experience of symptoms associated with various psychiatric conditions,
including PTSD. These influences include structural, anatomical, physiological,
and cultural factors. Through providing a foundation for the cultivation of a
deeper understanding of the role these influences have on a person experiencing
symptoms of PTSD, psychologists, therapists, and other mental health
professionals can be prepared to treat patients in the most effective manner.
Structural
There are a
number of neurobiological changes that have been observed in the brains of
individuals who have been diagnosed with PTSD. This includes neuroendocrine and
neurochemical components (Sherin & Nemeroff, 2011). Changes in the volume
of various neural structures, such as the left hippocampal section of the brain
as well as gray matter volume have been found to be reduced in the brains of
individuals who have been diagnosed with PTSD (Zandieh et al., 2016).
Anatomical
As
mentioned in an earlier section, the hippocampus, amygdala, and cortex are the
neuroanatomical areas that are often affected in the wake of a traumatic
experience. More specifically, a reduction in the volume of the hippocampus is
thought to be responsible for altered stress responses (increased startle
response); increased activity within the amygdala can also play a role in hypervigilance
and threat appraisal issues (Sherin & Nemeroff, 2011). Additionally, when
the cortex is affected, namely reduced volume and activation in the prefrontal,
anterior cingulate, and medial prefrontal areas of the brain, can lead to
cluttered thinking and fear appraisal (Sherin & Nemeroff, 2011).
Physiological
The
exaggerated startle response is one symptom that is often associated with PTSD
and is a topic that has been explored in the body of literature in order to
conceptualize this condition. According to a study conducted by Butler et al.
(1990), individuals who have been diagnosed with or experience symptoms of
PTSD, specifically the increased startle reactivity, can be observed via a
lowered startle threshold when stimuli are presented. This may help to explain
the ability for certain sounds, such as the backfire of a car and other
auditory stimuli, to startle individuals who have been diagnosed with PTSD,
while the same sounds do not have the same effect on other individuals who have
not developed symptoms of PTSD.
More recent
research has identified the disconnect that is present between physiological
state and the psychological and/or behavioral processes that are involved in
daily activities. The rapid oscillation between the body’s fight or flight
response and dissociation or emotional withdrawal has been found to be an
identified risk factor for the development of a number of comorbid disorders
(Williamson, Porges, Lamb, & Porges, 2014). Additionally, with the constant
back and forth between fight or flight and dissociation can lead to premature
aging of the brain, resulting in changes in the immune, autonomic, and
endocrine systems of the body (Williamson et al., 2014).
Cultural Factors
Within the military, it is often
thought of as a culture within a culture, as the traditions and regulations or
rules that people follow are akin to the traditions and values that are held by
various ethnic cultures. However, in this paper, only the ethnic background
will be identified as a cultural factor for the sake of time and space.
Research that involved veterans from various eras of conflicts has revealed
that certain ethnic minority groups were exposed to a greater number of
traumatic events when compared to their Caucasian counterparts (Roberts,
Gilman, Breslau, Breslau, & Koenen, 2011). Additionally, veterans who fall
within an ethnic minority category were found to be more likely to disclose
symptoms, but only when they are paired with a counselor or therapist who came
from the same ethnic background (Rosenheck, Fontana, & Cottol, 1995).
Influence
of Culture and Experience on Mental Health Professionals Conception of PTSD
Just as
with the patients who do not exist in a bubble, free from internal and external
influences, the same can be said for the counselors, psychologists, and other
mental health professionals who work with diverse patients or client bases. As
such, it is imperative that the individuals who are tasked with caring for
patients put aside their own personal opinions and beliefs, in favor of
evidence-based practices (American Psychological Association, 2016).
Additionally, patient input can be beneficial in helping to foster not only a
therapeutic relationship that is necessary
Treatments
for PTSD
Providing
effective and ethical treatments for patients with PTSD is one of the most
important aspects of mental health. The research that has been conducted in
regards to the neurobiological changes that occur as a result of experiencing a
traumatic event have helped to contribute to the development of a number of
treatment options for individuals, military veterans and civilians alike, to
regain their quality of life. However, it should be noted that not all patients
will respond equally to treatments and a qualified mental health professional
should be attuned to his or her patient’s needs and responses to treatment.
Efficacy
The
efficacy of the various types of treatments that have been used in addressing
the symptoms of PTSD vary, depending on the type, as well as individual characteristics
of the patient. Some research has found that, for example, cognitive behavioral
therapy (CBT) and eye movement desensitization and reprocessing (EMDR) are
ineffective for 1:4 to 1:2 patients who receive these types of interventions
(Zandieh et al., 2016). However, this efficacy rate can also be influenced
through the type and location of any structural changes in the brain. Poor
treatment outcomes for patients who received CBT for the treatment of their
PTSD symptoms were associated with damage to the ventral anterior cingulate
activation response and parts of the amygdala (Bryant et al., 2008); poor
treatment outcomes with EMDR treatment were linked to a decrease in gray matter
volume (Nardo et al., 2010).
Ethics
When it
comes to treatment for patients with PTSD, there can be ethical issues that
should be addressed as they arise. For instance, it is important to make an
accurate diagnosis and assessment of the patient in regards to the symptoms
present, with treatment focused on the patient and his or her experience of the
symptoms associated with PTSD (Cahill & Anderson, 2013). Additionally, it
is imperative that the risk for suicide is conducted in order to reduce the
access to lethal means, if warranted (Cahill & Anderson, 2013). Healthy
therapist boundaries are also important and should be an ethical consideration
that psychologists and other mental health professionals are cognizant of when
working with any patient, not just those who may have PTSD.
