Let’s Talk: Therapies

LET’S TALK: LET’S TALK: THERAPIES THERAPIES

BY BERNICE HALSBAND, TORONTO FIREFIGHTER, STATION 232-C

THE NUMBERS GAME

• 17 veterans, on average, continue to commit suicide each day, which is a number that has remained persistent over the past decade”

– U.S. Department of Veteran Affairs 2020 National Veteran Suicide Prevention Annual Report

• 4% of Canadians First Responders will experience PTSD in their lifetime

(Centre for Suicide Prevention)

• 22% of paramedics will develop PTSD

(Centre for Suicide Prevention)

• 16 active and 15 retired RCMP officers died by suicide between 2006 and 2014

(Centre for Suicide Prevention)

THE PLAYERS

There are any number of mental health challenges that can come your way throughout your life. Among them are PTSD (Post Traumatic Stress Disorder), ASD (Acute Stress Disorder), Compassion Fatigue, Burnout Syndrome, SUD (Substance Use Disorder), and MMD (Major Depressive Disorder).

PTSD

WHAT IT IS AND WHAT IT ISN’T

The buzzword PTSD has been around for a while. It’s the modern version of Shell Shock, Delayed Stress Syndrome, Combat Disorder, Operational Exhaustion, Soldier’s Heart and Battle Fatigue. As the many names over the years have suggested, PTSD has been difficult to pin down in the public narrative. Even these days I hear the term misused ad nauseum.

How many times has the absence of a firefighter been noted as, ‘Why is he gone?’ With the answer being, ‘I dunno… some kind of PTSD or something.’ Then the conversation turning into a matter of whether someone believes in it or not.

This is what the science says: it absolutely exists. Without question. Whether someone is diagnosed properly or not is another question.

What it isn’t: Simply put, it’s not just the blues. Just because you witnessed the same event as your colleague and they got PTSD from it and you didn’t, doesn’t mean they’re faking it. I’m allergic to raw carrots. For whatever reason, I have an anaphylactic reaction to them. If you and I each eat a raw carrot and my throat closes up because I am allergic, it doesn’t mean I’m faking.

A PTSD brain scan, when performed properly, will show the following: 1. A hyper-active amygdala 2. Reduced activity in the pre-frontal cortex 3. Reduced activity in the hippocampus

AMYGDALA HIJACK

PTSD is sometimes called the “amygdala hijack,” because the amygdala is where we process fear. The prefrontal cortex is where we think logically and the hippocampus is where we process memories into long-term storage. PTSD occurs when the amygdala confiscates the traumatic event with all of its intensity and impulse of emotion, and replays it over and over when triggered by anything resembling fragments of images, smells, sounds, tastes or touches.

If you are depressed or have trauma, it may be very real but may not show as PTSD.

The Phoenix Society for Burn Survivors states that ‘1 out of every 4 burn survivors will experience PTSD’.

The brain and body become inseparable in trauma. The body directly reacts to the brain’s amygdala, which sends out memories of the trauma as sensory fragments. The trauma memory is not stored as a story, but is replayed as if it is happening in real life.

TREATMENTS

This is where things get interesting. Different treatments have had different success ratios, and so far, the pull-ahead winner has been psychedelic research.

The Phoenix Society admittedly states that ‘Today we recognize that the frontal part of the brain has limited ability to change the deeper parts of the brain, especially when the body is in a trauma response or distress. Talk therapy works when the brain is online and functioning, but when the rational part of the brain is hijacked by the trauma memory, people may not hear words or reasoning, or make meaning of events and experiences. When the deeper regions of the brain are in this state of distress, survivors are back in the trauma and their brain and body seem to be in a time warp.’

EMDR

What it is: Eye Movement Desensitization and Reprocessing. This therapy uses bilateral stimulation to alternately engage both sides of the brain in action. How it works: It is meant to use bilateral movement (having the person follow a therapist’s finger back and forth in front of their vision field) to cause the traumatic memory that is looping in the emotional side of the brain to integrate with the cognitive part of the brain. The theory is that the eye a nd brain movement should increase the ability of the prefrontal cortex to ‘get online’ or find rationality in the traumatic event. The downside: High drop-out rates and inconsistent results.

SENSORIMOTOR THERAPY

What it is: Limbic calming through soothing music, prayer and meditation, mindful breathing, yoga, and exercise. Your amygdala is a part of the limbic system which is involved in our behavioural and emotional responses, especially when it comes to behaviours we need for survival such as feeding, reproduction and caring for our young as well as our fight or flight responses. How it works: It gets you to notice sensory body responses and be in tune with your body’s messages. To address healing, it engages the body and mind in the recovery process. Examples: Taking 5 minutes in the morning and evening to

EMDR, SENSORIMOTOR THERAPY, CBT, MEDICATIONS, TALK THERAPY

rock back and forth or side to side, noticing and relaxing the body, finding music or tones that are calming, deep breathing, exercise for 12-15 minutes to stimulate serotonin and dopamine production, 5-10 minutes of prayer and meditation through the spiritual center of the brain that is able to influence the deeper regions of the brain. The downside: This method requires calm and consistency which is difficult for a trauma brain to attain. It is difficult to access the deeper parts of the brain and according to Michael W. Smith (MD, MBA,CPT), almost a third of patients drop out of therapy and up to 58% of people still have PTSD symptoms after they finish.

CBT

What it is: Cognitive Behavioural Therapy How it works: Essential components of CBT practice 5 things: developing an individualized case formulation, session structuring, activity scheduling, the thought record and schema change method. CBT focuses on the relationship among thoughts, feelings and behaviours and notes how changes in any one domain can improve functioning in the other domains. This happens over 12-16 sessions. The downside: The downside can be considered the upside, depending on what you expect the success rate to be. One third of those who completed self-management CBT achieved high end state functioning at six months. Of that one third, CBT led to a 53% reduction of PTSD symptoms.

MEDICATIONS

What it is: Medications are often a cocktail of FDA approved drugs that are meant to treat the symptoms of PTSD and trauma. It ends up being a cocktail because the side-effects need their own treatment. How it works: Depending on the brand of antidepressant or anti-psychotic drug, it can sometimes be a long and harrowing process, but when people are ‘dialed’ into the right dosage they can be helpful. The downside: Getting dialed in can take a long time, with some people that I’ve interviewed taking over a year to get the dosage right. Some people have also stated that as they have progressed through different stages in their life, the dosage has had to be adjusted, and to go through the process of it all becomes emotionally and physically exhausting, with some people getting frustrated and ready to give up entirely. Some have experienced states of psychosis, saying that they felt worse (i.e. violent, suicidal) than their regular depression, trauma or PTSD. The other downside is that once you are on medications, you will have to be on them for life.

MAPS – MULTIDISCIPLINARY ASSOCIATION FOR PSYCHEDELIC STUDIES: THIS IS YOUR BRAIN ON DRUGS

Yes, you read that right. Psychedelics.

Since 2017 the FDA has deemed MDMA as a breakthrough therapy tool because of its beneficial effects on PTSD symptoms. The findings have propelled MDMA assisted therapies into an ‘expanded access status’, which means that mental health professionals can give the drug to people who have such severe forms of PTSD that it could be life threatening without a clinical trial.

One study found that 67% of people reported that they no longer met the criteria for PTSD after a year of MDMA assisted therapy – which is the equivalent of three 6-8 hour sessions.

The CBC reported that in July of 2021, Health Canada greenlighted the Vancouver psychedelics company Numinus to go ahead with an MDMA therapy study for more than a dozen people suffering from PTSD, sponsored by MAPS. What it is: MDMA is NOT Ecstasy or Molly. MDMA is short for 3, 4-methylenedioxymethamphetamine. It is administered in a clinical setting with one or two psychotherapists. How it works: One dose is administered in a clinical setting, with a second dose administered 45 minutes to two hours after the first. The MDMA causes the release of neurotransmitters (chemical messengers including dopamine, serotonin, norepinephrine, oxytocin, prolactin, cortisol and vasopressin) to brain cells that change brain activity. Its effects are the reverse effects of PTSD; the amygdala.

The downside:

MDMA assisted therapy is still being studied, even though there is 30 years of research and data backing up its claims of helping traumatized brains. Because the medicine leaked into the counterculture and became a party drug, much like psilocybin and LSD, it has earned a very bad reputation, and deservedly so. The abuse of any medicine leads to more issues, not the resolution of problems. Street drugs have a different composition than pure medicinal MDMA. MDMA is NOT Ecstasy or Molly. Researchers have found methamphetamine, ketamine, caffeine and ephedrine mixed into street drugs like Molly and Ecstasy.

To mental health experts that have studied the effects in a clinical setting, this has meant observing patients that become more empathetic, self-aware, energetic, less anxious, and able to open up about emotions.

Results have been promising; even in conservative estimates, the researchers are stating that MDMA assisted therapy is reaping more benefits than any other psychotherapy or medications that are now used. Not only did the patients that cease to suffer from PTSD improve their mental health, but the three session treatments were all that were necessary to keep them from slipping back into a trauma brain state. Dr. Allison Feduccia, a neopharmacologist and clinical trial leader for the study in Canada, has said that the drug facilitates a memory reconsolidation, which can be the key to root issues of PTSD causes.

The Nature Medicine Journal Publication, a peer reviewed magazine, has published placebo-controlled phase 3 studies revealing the efficacy of MDMA treatment, which were also published in the New York Times this year. In addition to numerous mainstream media publications and peer reviewed papers, the Canadian trials have been presented to the Canadian Institute for Military and Veteran Health Research Forum in Vancouver.

MAPS has been doing research and collecting data on the use of psychedelics, including cannabis and ayahuasca, for thirty years. The stigma of misuse has left a deep imprint on governing bodies in both Canada and the U.S. It wasn’t until this year that the U.S. House Appropriations Bill directed the National Institute of Health to undertake and fund research into psychedelic-assisted therapies and potential benefits of cannabis, with special emphasis on veterans with PTSD, as well as recommendations for (first ever) public funding of MDMA-assisted therapy. Until now, the funding was provided by MAPS and private donors.