This is just out in the American Journal of Psychiatry.
Two randomized controlled trials compared the efficacy of attention bias modification and attention control training for PTSD: one in Israel Defense Forces veterans and one in U.S. military veterans. Both utilized variants of the dot-probe task, with attention bias modification designed to shift attention away from threat and attention control training balancing attention allocation between threat and neutral stimuli. PTSD symptoms, attention bias, and attention bias variability were measured before and after treatment.
Both studies indicated significant symptom improvement after treatment, favoring attention control training. Additionally, both studies found that attention control training, but not attention bias modification, significantly reduced attention bias variability. Finally, a combined analysis of the two samples suggested that reductions in attention bias variability partially mediated improvement in PTSD symptoms.
To my knowledge, there have been no effective medications, and the previously clinical trials that show efficacy use exposure as a component of treatment, which many people do not accept. This looks hopeful. One hopes it can be automated.
PTSD is one of those physical ailments that’s never really going to be directly treatable via medication. It’s not a single-sector or receptor line issue. At the more functional level, it’s a collapse via overstimulus of the body’s Stress Response system, which leads to a multi-system response by the body to maintain function. The body, however, can’t make up for the damage (quickly) nor produce enough inhibitors to shut down new stimulus. Considering the Stress Response system covers pretty much every major organ and the entire endocrine system, it takes a lot to get the body into a place to actually recover.
So I’m happy to see they’re starting to find Behavioral Training techniques that are helpful. Hopefully they can develop more that work well. I’ve known a few PTSD cases and it’s rough, as most have done nothing wrong but their body has betrayed them. Hopefully over the next 10-15 years, the better understanding of Medical Diets will permeate much further, as those are where you’ll find something closer to a “cure”, on the assumption the body is willing to repair itself.
Oh, and Chris, check your email, if you would.
On the general ideas of PTSD — and I have seen my fair share of the “real thing” — we have two problems (1) extension of the criteria driven by lawyers and people trying to claim disability (not only in the VA, locally the Accident compensation corporation will pay out on PTSD but no other MH issue. So ACC registered therapists ALWAYS look for PTSD) and (2) limited understanding about how the brain repairs itself. The current pharmacology ideas relate to microglia, synaptic pruning and the consequent neural networks, and how to manipulate BDNF to ensure repair.
Classic pharmacology is not as helpful: at best it is symptom control. And I say that as someone who has prescribed my fair share of things. Moving behavioural techniques into computer games and internet based therapy tasks is where things need to go — and we are doing this in NZ (google SPARX) and OZ (google This way up). But the US insurance and health system cannot change as fast as we can do things in the antipodes.
Nothing at the email, LG: I do have my spam filters set well above stun and all spam is automatically deleted. So if it has not got through, that is probably why.
Ah, good point on the Insurance Scam issues. Not being “on the ground”, as it were, that wouldn’t normally cross my mind, but I imagine it’s a big problem and causes problems for proper analysis. Garbage In, Garbage Out. (But it can get you FDA approved!)
The problem for PTSD is that it is not just nervous system tissue that’s effected. Stress Responses are mitigated in the GI Tract, Liver, Kidneys and the rest of the Endocrine System. Further, for something like PTSD, it’s not actually neuronal firing that’s necessarily impacted, but the ability to inhibit responses properly. (Dependent on the nervous system tissue, obviously. ) Granted, we’re still not even perfectly sure how nutrients and energy are shunted down axons, so we’ve got a long ways to go on studying the nerves.
As for having to prescribe medications, a Doctor has to start somewhere. I’ll always be very grateful to my GP for accepting he didn’t have a clue what my issue was (and would sign off referrals to whoever I wanted), but would attempt to address the issues I asked about. While the medications didn’t help too much, the understanding of what their pharmacology did was supremely valuable to me. Which is part of the reason I mention Medical Diets as being where things will eventually end up, minus the issue that you can force someone to eat them properly.
As for the email, I can mention it here. LinkedIn sent my email, attached to this account, a request to join your profile as a connection. I was surprised that you would give them access to your email list. Which is what I was concerned about.