In the ever-evolving landscape of mental health care, the treatment of Post-Traumatic Stress Disorder (PTSD) stands out as a field ripe with innovation and transformative practices. As a PTSD psychiatrist, navigating through the complexities of trauma's impact on the human psyche requires not just an understanding of traditional therapeutic approaches but an openness to the integration of cutting-edge technologies and methodologies. Let’s take a look at this disorder as some of the latest treatment options. What Is PTSD? PTSD is a disorder that develops after a person has experienced either one traumatic event or multiple traumas. While we often think about soldiers developing PTSD after returning from war, this is just one example of the type of trauma that can lead to PTSD. For instance, a traumatic car accident can trigger this disorder, or perhaps years of abuse from a spouse or parent. Seeing a person die or watching your house burn down or experiencing the horrors of a terrible disease can trigger PTSD. These are just a few of the many examples of traumatic events that could cause PTSD symptoms. According to the DSM-5, a publication by the American Psychiatric Association, symptoms that arise following exposure to traumatic events and fit the criteria for diagnosing PTSD include: 1. Intrusion SymptomsPeople with PTSD often face continuous, unwanted, and deeply distressing memories of their trauma. They might have nightmares about what happened, feel like they're reliving the trauma through flashbacks, or experience intense distress from things that remind them of the event. This can include both physical and emotional reactions to anything that brings back memories of the trauma. 2. AvoidancePeople often try to avoid anything that reminds them of a traumatic event they've experienced. This includes steering clear of certain thoughts, feelings, or conversations that bring back memories of the trauma, as well as places, people, or activities that might trigger those painful memories. 3. Mood ChangesAfter experiencing a traumatic event, a person's thoughts and feelings might change negatively. These changes could include having trouble remembering parts of the trauma, forming negative views about oneself, others, or the world, or mistakenly blaming oneself or others for what happened. This might lead to feeling sad often, losing interest in activities that were once enjoyed, feeling disconnected from people, and finding it hard to experience joy. 4. Changes In Reactions & AlertnessPeople may experience significant changes in their alertness and reactions related to the trauma, which may get worse after the event. This can lead to getting easily irritated or having sudden outbursts of anger, engaging in risky or harmful behaviors, being overly watchful or on guard, jumping at small surprises, facing trouble with focusing and having difficulties with sleep. 5. Duration of SymptomsYour symptoms need to persist for more than a month for it to be considered PTSD. As a psychiatrist for PTSD, I find that many of my patients wait for years before seeking treatment, which is a shame, because treatments can be highly effective and reduce or eliminate your symptoms. 6. Impact on Daily LifeThe problems one faces because of these symptoms can seriously disrupt one’s daily life, affecting relationships, work, or other important areas. 7. Other CausesAdditionally, it is important to determine that your PTSD is not caused by the physiological effects of a substance (e.g., medication, alcohol) or another medical condition. As a PTSD psychiatrist, I view patients both from a physical as well as mental health perspective and will look at potential physical conditions or other causes that could contribute to any mental health disorder. Keep in mind, that the aforementioned information comes from the DSM-5, but if you’ve experienced any type of trauma and find yourself suffering from anxiety, depression, nervousness, paranoia, difficulty concentrating, nightmares or sleep issues, memory issues, panic attacks or perhaps you turn to substances to help reduce these feelings, seeking treatment can help. Traditional Treatments For PTSDTraditionally, a PTSD psychiatrist would recommend a combination treatment that includes both talk therapy and perhaps some type of medication. Talk therapy options might include cognitive behavioral therapy, prolonged exposure therapy or cognitive processing therapy. The medications we often use can help reduce the symptoms of PTSD, but they don’t treat the underlying cause of PTSD, which is why talk therapy is so crucial for patients with PTSD. Medications we can use include antidepressants and perhaps mood stabilizers or anti-psychotic drugs. Innovations In TreatmentFor many people, the traditional approach works well, but we do have many newer treatment options that have yielded promising results and as a psychiatrist for PTSD, I sometimes recommend some not-so-traditional options for my patients. These might include the following treatments. Eye Movement Desensitization and Reprocessing (EMDR)This therapy was developed to help people recover from trauma, including PTSD. With EMDR, we have the patient focus on a traumatic memory while simultaneously using bilateral stimulation (typically through eye movements), which is believed to help the brain process and integrate traumatic memories. EMDR was developed by Francine Shapiro in 19871 and it has been used as treatment for PTSD since the late 1980s. Since its inception, EMDR has become an accepted treatment for PTSD because it so often effectively reduces symptoms as well as the anguish tied to traumatic memories. EMDR also may be helpful for those with anxiety disorders and treatment-resistant depression. In many cases, a person with PTSD also may be suffering from depression, anxiety or other co-occurring disorders and EMDR can be an excellent approach to consider. An anxiety psychiatrist or depression psychiatrist also might recommend this option. Of course, it is important to note that many psychiatrists, such as myself, specialize in treating a wide range of mental health disorders. Ketamine TherapyKetamine has been used for treatment-resistant depression with much success, but there is research to show that ketamine also can treat PTSD and greatly reduce the symptoms of this disorder. Ketamine can be a very dangerous drug, so this must be administered in a doctor’s office by trained professionals. As a PTSD psychiatrist, I do still recommend that if you opt for a ketamine treatment you also combine this approach with talk therapy for the best possible outcome. PsilocybinPsilocybin, otherwise known as magic mushrooms, is a controversial topic. Of course, psilocybin is only legal in Oregon and Colorado, although it has been decriminalized in cities such as Santa Cruz, CA and Oakland, CA. Psilocybin often is used recreationally, but there is evidence to suggest that this substance can be used to treat PTSD, anxiety and depression. If you do consider this approach, I recommend going to a licensed and legal facility as self-medication is not recommended. I am, however, hopeful that more studies with psilocybin will be conducted because I believe this substance is promising for the treatment of PTSD and other disorders. If you have bipolar disorder as a co-occurring disorder, however, I do not recommend this treatment approach. Stellate Ganglion Block (SGB)This is a unique approach and one that is not currently FDA-approved for PTSD treatment. However, there is some evidence to suggest that SGB can be beneficial for some PTSD patients, especially for those who have tried other therapies without good results. This treatment is FDA-approved for other conditions, such as complex regional pain syndrome. For this treatment, we inject a type of anesthetic into the stellate ganglion nerves, which are located in your neck. These nerves are an important component of our nervous system, controlling blood pressure and heart rate, among others. Injecting an anesthetic has been shown to reduce norepinephrine levels, which, in turn, may reduce PTSD symptoms. Again, this is an alternative treatment and might only be recommended after you’ve tried other treatment options and found these to be ineffective. Also, it is crucial that if you do opt for this treatment you go to a licensed facility that uses ultrasound to help guide the injection into the correct area. Transcranial Magnetic Stimulation (TMS)For TMS, we use magnetic fields to stimulate the nerve cells in your brain, and you can kind of think of this treatment as a brain “reboot” so to speak. Electromagnetic coils are placed on your scalp and these coils deliver a pulse to stimulate the nerve cells in the region of the brain that handles mood control. TMS has been used successfully for treatment-resistant depression, and some also find that it alleviates PTSD symptoms. Don’t Wait – Get Help For PTSD NowPTSD is a complex mental health disorder that can greatly impact your day-to-day life, but, the good news is that we do have many treatment options to consider and many patients recover from PTSD and enjoy a much happier life.
As a psychiatrist for PTSD, I urge you to seek treatment as soon as possible. No one should have to suffer from past traumas, and I will work diligently to find a treatment plan that addresses your PTSD as well as any other mental health disorders you face. Whether you need a psychiatrist for PTSD or perhaps a psychiatrist for anxiety, a psychiatrist for depression, bipolar disorder, eating disorders, substance use disorders or other mental health conditions, I provide services at my office in Thousand Oaks as well as telepsychiatry. Contact me at any time to set up a thorough evaluation and let’s get you started on a path toward a better life.
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Post-Traumatic Stress Disorder, or PTSD, is estimated to affect more than 3.5% of the U.S. population, and this disorder can happen to anyone. If you think you have PTSD, a PTSD psychiatrist can help you reach a diagnosis and there are many treatments available including EMDR, which is a type of psychotherapy that many people are unaware exists. Let’s take a look at PTSD, EDMR and other treatment options.
What Is PTSD & What Causes It? PTSD is a mental health disorder that affects people who have either experienced a traumatic event or witnessed a traumatic event. Soldiers often will suffer from PTSD because of their combat experiences. In fact, PTSD was sometimes called combat fatigue or shell shock, and while it is common for soldiers to experience PTSD, many other traumatic events can trigger this disorder. For instance, if you have been the victim of violent crime, such as rape or assault or witnessed a violent crime, this can cause PTSD. Victims of abuse (physical, sexual or mental abuse) can suffer from PTSD. A car accident or another type of accident or a near-death experience can cause PTSD, even if it was a loved one who was near death or in an accident. A person who lost a loved one to suicide or a long-term illness also can experience PTSD. Additionally, others might experience PTSD. For instance, police officers or firefighters that repeatedly are exposed to violent crimes or severe trauma, such as car accidents, might experience PTSD. In general, the American Psychiatric Association defines PTSD as a disorder caused by either experiencing or witnessing a traumatic event or series of traumatic events. In addition to witnessing or experiencing trauma, the person must be experiencing intrusion-related symptoms, such as suffering from flashbacks, experiencing recurrent dreams related to the trauma or perhaps experiencing frequent involuntary memories of the event. For children, they may engage in repetitive play that mimics various aspects of trauma. Additionally, the criterion for PTSD includes avoidance. This means the person might avoid any places or people that remind them of the event or perhaps try to block out the memories or their feelings regarding the trauma. People with PTSD also experience altered moods and reactivity. For instance, they might have difficulty expressing any positive feelings and instead focus on feelings of negativity. They might even have trouble remembering details about the trauma itself, which is known as dissociative amnesia, which is an amnesia that is not caused by factors such as a head injury or drug use. We also find that PTSD sufferers experience heightened reactivity. For instance, they might be hypervigilant, constantly checking doors and windows. They might have outbursts of anger or physical violence that seem out of proportion. They often experience difficulty with sleep and general concentration or even engage in reckless behavior. In order to reach a diagnosis, these issues must last for at least one month and cause a significant disruption in your daily functioning and relationships. This could be problems at home or at work that can not be attributed to another physical condition or substances such as medication or alcohol. Your PTSD psychiatrist should conduct a thorough evaluation to ensure a proper diagnosis and once we’ve reached a diagnosis of PTSD, psychiatrists will start looking at treatment options. What Is EMDR & How Can It Help? While there are many treatments for PTSD, one that I find particularly interesting is known as Eye Movement Desensitization and Reprocessing (EMDR). This treatment was designed to help those with traumatic memories, and it requires no medication nor extensive treatment to be effective. There are several steps or phases in the process of EMDR, including: Phase 1: History, Evaluation & Planning During the first session, your PTSD psychiatrist or psychologist will take a detailed history and identify the traumatic memories associated with your PTSD as well as taking a look at what current situations trigger a negative response. Once we’ve evaluated the source or sources of your trauma, we can begin to focus on planning effective treatment. Keep in mind, if you don’t meet the full criteria for PTSD, EMDR may still be a successful treatment option for your anxiety and stress. Some studies show anxiety and depression may be reduced using EMDR techniques. Phase 2: Preparation In this phase, your PTSD psychiatrist, psychologist or therapist, will provide you with some tools to help you handle emotional distress. These tools will be useful during your actual EMDR sessions, but also can help you handle stress and anxiety in general, especially during the times in between an EMDR session. Phases 3-6: The Desensitization Phases In Phase 3, we identify a specific trigger memory that we want to address. For those with single traumas, that experience (car accident, rape, death of a loved one, etc.) will be the memory we target. For people with multiple traumas, we might select a specific incident, such as a particular moment of abuse that was especially traumatic or typical of the general type of trauma you experienced. In Phases 4-6, we undergo the desensitization process. The patient will focus on the memory, and we use special eye movements where your therapist moves their fingers in your line of sight, and you follow the movement with just your eyes. Your therapist then will introduce more pleasant thoughts as you continue to move your eyes and follow hand movements, although a therapist often uses a different rhythm or type of hand movement when introducing positive thoughts. Phase 7: Closure After we’ve completed a session, we evaluate whether or not the specific target memory was processed during the desensitization phases. If not, the therapist will provide the patient with some techniques to help them handle anxiety and stress between the sessions. The goal of the closure section of the session is also to help the patient feel more peaceful, less anxious and more optimistic about the next session and the future in general. Often the sessions are spaced very closely together, so that the patient can work through the issues as quickly as possible. Phase 8: Re-Evaluation This actually will be the first component of your next session as your therapist evaluates the success of the previous treatment or treatments. If you have completed all of your sessions, this re-evaluation appointment might be a follow-up appointment scheduled several weeks after finishing your desensitization treatments. The advantages of EMDR include the success rate, ranging from 70% up to more than 95% in some studies. Typically, patients with a single trauma experience faster and more permanent success. If you have experienced multiple traumas, it can take a few more sessions to achieve successful remission of PTSD symptoms. Additionally, no medication is needed, and the entire process can be handled very quickly, providing you with quick relief from your PTSD symptoms. EMDR also seems to yield permanent results for most patients. Of course, in some cases, especially for those who experienced multiple traumas, such as years of abuse or perhaps just several traumatic episodes, it can be helpful to use additional therapies, and there are several options to consider. What Other Types Of Treatments Can A PTSD Psychiatrist Provide? There are several additional options to help reduce or eliminate symptoms of PTSD. Cognitive Processing Therapy (CPT) can be an option. With this type of therapy, you address negative thoughts about the trauma or about yourself, and this includes talk therapy as well as writing about your trauma. Typically, CPT begins with a person writing a detailed account of the trauma and reading it aloud to their therapist. The therapist’s office serves as a safe space so that the patient can face their emotions and also perhaps identify issues associated with their interpretations of the events. For instance, an abuse victim might write out several examples about why they, the victim, are to blame, and the therapist can begin to redirect these thoughts and help them look at the trauma from a more detached perspective. With CPT, the therapist also provides their patients with an assortment of strategies to help them deal with issues related to PTSD. People with PTSD often struggle with issues related to self-esteem, safety, power/control, intimacy and trust. Finding ways to redirect negative thoughts about these issues can be very helpful. Prolonged Exposure (PE) therapy also has shown some success, and, again, this targets those negative feelings and thoughts. With PE, you undergo talk therapy where you discuss traumatic events in detail and process your emotions regarding these events and use different breathing techniques to help you manage your anxiety. Additionally, with PE, the therapist will give you some homework to help you begin to expose yourself to situations or people that might generate fear and anxiety. This homework begins with smaller, less stressful assignments and is known as in vivo exposure. For example, with PTSD from a car accident, a person might be fearful of allowing another person to drive while they are a passenger, as this can feel like a lack of control. With in vivo exposure, you might begin by just sitting in the passenger seat with someone in the driver’s seat. Then, you might allow that person to drive around the block. Gradually, you could increase the time as you begin to feel more comfortable, utilizing the breathing techniques and other tools you learned in therapy. Finding A Psychiatrist for PTSD A PTSD psychiatrist is a professional that provides you with a solid diagnosis. My goal as a psychiatrist is to identify all of the issues troubling a patient, which might include identifying PTSD as well as any co-occurring mental health disorders. Additionally, as a medical doctor, I also consider any medical conditions that might need to be addressed to achieve a happier, healthier life. Typically, a PTSD psychiatrist can provide you with a diagnosis and any medications that you might need, and some might provide EMDR treatments. In some cases, your PTSD psychiatrist might refer you to a therapist or psychologist for EMDR or other types of therapy. In my practice, I offer comprehensive telepsychiatry services, so we can meet virtually from wherever you might live. My offices are in Thousand Oaks, but as a virtual psychiatrist, I can provide services to patients throughout Southern California and beyond. If you are suffering from PTSD or severe anxiety related to a single trauma or multiple traumas, don’t hesitate to get in touch with me or another PTSD psychiatrist as soon as possible. PTSD is a treatable disease, and we can provide you with options that will help you live a happier, successful life. |
AuthorDr Jesalva is a psychiatrist. He is in private practice in Thousand Oaks, CA since 1989. He successfully treats very challenging patients with varying co-occurring disorders with medications. Archives
September 2024
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