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PTSD PREVENTION AMIDST COVID-19 PANDEMIC: A MULTI-DISCIPLINARY APPROACH

A trauma victim, survivor, and life coach presents evidence-based practices to protect ourselves against life's unwelcome surprises.

I guess it was in my early years — first as a Cub Scout, then as a Boy Scout, and finally as an Explorer Scout — that I learned the motto: Be Prepared. But, when tragedy struck me — my wife was brutally stabbed to death by her eldest son — I wasn’t prepared. And, for many years, I suffered with the debilitating effects of chronic and ongoing trauma. Rather than suffering as I did, why not try to prevent PTSD or, at the very least, catch it at an early stage? Preparedness is key. 

According to the Institute of Medicine’s report on prevention of mental disorders, prevention is broadly defined as measures taken to avoid the occurrence of disease or “interventions that are applied before the onset of a clinically diagnosable disorder with the aim of reducing the number of new cases of that disorder.” Of course, whenever possible, the best remedy would be to prevent the traumatic event itself. However, we don’t frequently get that opportunity. In the case of the current coronavirus pandemic, first and foremost, we should take any and all practical steps to prevent ourselves from getting sick. But, remaining healthy is not always within our control. And, even if we manage to remain healthy, there are many reasons to get stressed out during this unprecedented and unusually disturbing time.

As a direct result of the coronavirus pandemic, our already over-stressed healthcare system will face yet another crisis: a mental health crisis, with a preponderance of Acute Stress Disorder (ASD) that, if left untreated, can become chronic PTSD, delayed PTSD, and complex PTSD (CPTSD).

When tragedy strikes, if we experience it as severe psychological trauma, our immediate response will involve intense fear, helplessness, or horror. By keeping an eye on our stress levels and looking out for PTSD symptoms — such as flashbacks, nightmares, and severe anxiety regarding the event — we are better equipped to detect and treat the anxiety disorder in its early stages. While PTSD symptoms typically appear within the first three months after trauma, symptoms may be delayed by months or even years. So, we must remain vigilant in self-monitoring our anxiety levels.

While the incidence of PTSD is skyrocketing, standard treatment protocols, the traditional psychiatric paradigm, and success rates in treating this disorder have barely changed in the last seven decades. During that time, PTSD research has focused mostly on what PTSD is and how to “cure” it. Far less research has focused on how to prevent it. And, even less is understood about what we can do to prevent the underlying causes of tragedy in our world. For example, we know very little about eradicating mental illnesses and substance abuse. But, Dr. Daniel G. Amen, MD, a physician, double-certified psychiatrist, founder of Amen Clinics, and a 10-time New York Times bestselling author, is changing all that.

Using evidence-based neuroscience, Amen has discovered that “the amount of brain reserve you have can help you handle life’s stresses or make you more vulnerable to them.” According to Amen, that explains why some people develop PTSD following exposure to a traumatic event, while others do not. Amen says that “your vulnerability to illness depends on many factors — the strength of your immune system, the level of exposure, stress, and daily habits. Addressing your BRIGHT MINDS risk factors can strengthen your immune system to reduce your risk.” Specifically, Amen recommends: “1. Care about the electrical activity in your brain. 2. Avoid anything that increases your risk for mind storms. and, 3. Engage regularly in healthy habits that decrease the risk for mind storms and treat them when necessary — practice stress-management techniques; get seven to eight hours of sleep each night; eliminate drugs and limit alcohol; consider a ketogenic diet; seek treatment for PMS and chronic pain conditions; limit video games; consider neurofeedback (to gain control of your brain waves through self-regulation) and nutraceuticals to calm overfilling in the brain; and, take antiseizure medication, if necessary.” He has found scientific evidence that supports prescribing nutraceuticals for treating a broad variety of common conditions by promoting brain health. For anxiety and stress, Amen prescribes: Ashwagandha, Theanine, Omega-3 fatty acids, EPA, and DHA — but, only after using brain imaging to determine your deficiency in one or more vital nutraceuticals and after determining the best approach and nutraceuticals for your particular brain health/mental health issues. 

Amen’s cutting edge, radical new way to overhaul psychiatry is based on his brain-imaging work at Amen Clinics, with more than 170,000 scans on patients from 121 countries around the world. His work suggests that most psychiatric illnesses are not mental health issues; rather, they are brain health issues. So, we have many reasons to be hopeful about the future. But, until Amen’s methods become more widely available, I’ve written this article in an effort to get in front of PTSD — by exploring evidence-based practices, drawn from multiple disciplines, in order to identify proactive actions that we can take to minimize the traumatic effects of the coronavirus global pandemic.

According to the National Center for Biotechnology Information (NCBI), much of the pretrauma prevention research has focused on decreasing the likelihood that individuals exposed to trauma will develop PTSD. While more research is necessary, it appears that better adaptation skills, mental or emotional resilience, social support, and coping (rather than avoiding) behaviors, as well as greater preparedness and more realistic expectations, may play a role in mitigating the escalation of ASD to PTSD. 

Interventions for trauma-exposed persons are aimed at interfering with over-consolidation of fear memory and accelerating its extinction. Psychologic debriefing of survivors or other affected persons was widely employed as a treatment for those exposed to trauma caused by the September 11 attacks. Such interventions — that encouraged people to talk about their experiences during trauma and to express their thoughts, emotions, and physical reactions both during and after the event — were found to be either largely ineffective or to actually do more harm than good. Sometimes, it’s best to try to forget, rather than relive, trauma. In a critical analysis of approaches to targeted PTSD prevention, Feldner reports that Cognitive Behavior Therapy (CBT) is often used to treat early symptoms of PTSD in an effort to prevent the development of chronic PTSD. The VA/DoD clinical practice guideline for the management of PTSD recommends a dual system of education and resilience training programs, aiming to: provide realistic training; strengthen perceived ability to cope; create supportive interpersonal work environments; develop and maintain adaptive beliefs; and, develop workplace-specific comprehensive traumatic-stress management programs. However, at present, there is no evidence to support the effectiveness of any of these programs in preventing or reducing PTSD or stress. While the VA/DoD recognizes that benzodiazepines have historically been used as effective treatments for anxiety and insomnia, the guidelines do not recommend their use as preventive measures “due to lack of evidence for effectiveness and risks that may outweigh potential benefits.” 

In the midst of this unusually dystopian time, I find it sadly ironic that I’ve been able to accelerate writing my spiritual memoir that describes my journey from tragedy to post-traumatic stress and, eventually, to post-traumatic growth. But, perhaps its more important than ever to share my story of trauma and the tortuous, arduous, often torturous road to recovery. For me, writing has provided what I call clarity in hindsight. And, such clarity has enabled me to deeply explore the question that the University of California San Francisco asked a decade ago: Can Post-Traumatic Stress Disorder Be Stopped Before It Begins?

We know that trauma manifests itself in our bodies. We experience it physically, mentally, emotionally, and spiritually. PTSD is a stress disorder. PTSD is a normal reaction to abnormally horrid events. PTSD is not a mental illness. Specific evidence-based wellness practices have demonstrated their abilities to improve our physical, mental, emotional, and spiritual functioning. Such methods may help us prevent escalation of acute stress to post-traumatic stress. With so little offered by traditional methods, the time for poo-pooing alternative methods has long past. Instead, we must take hold of the opportunity to manage our self-care with non-traditional, evidence-based practices and techniques that are noninvasive and have, in many instances, withstood the test of time.

Physical practices & techniques. COVID-19 Disease Prevention – get enough sleep; eat well; maintain physical activity; wear protective face masks; wash hands; and, practice social distancing, not social isolation — stay connected to your family & friends. Meditate – practice deep, controlled breathing and empty your mind of any thoughts. If a thought comes, just gently let it go and continue focusing on your breath. Body scan & relaxation – to release tension in various muscle groups. Grounding techniques – to quiet distressing thought, use techniques that help you feel your length (self-respect); feel your width (feeling of connection); feel your depth (who you are, your purpose and beliefs); and, feel your center (what you love, care about, and can act from and live by). Desensitization training & Virtual Reality Exposure Therapy (VRET) – to assist with managing your reactions to things that make you anxious. Neurofeedback (aka EEG Biofeedback) Training – to gain more control over normally involuntary functions, such as anxiety and stress, by learning to recognize and control responses. Emotional Freedom Technique (EFT) aka tapping – to treat anxiety amongst a wide variety of physical and psychological disorders. EFT is a self-focused technique that draws on various theories of alternative medicine including acupuncture, neuro-linguistic programming, energy medicine, and Thought Field Therapy. Yoga — to learn how to stretch our limits by using a group of physical, mental, and spiritual practices or disciplines that provide the additional benefits of a complete yoga workout. Healthy eating — to build our immune system, improve brain health, and so much more. Nutraceuticals – to reduce anxiety and stress with a customized plan that may include taking Omega-3 Fatty Acids; DHEA; Ashwagandha; and, Theanine.

Mental practices & techniques. Cognitive Behavior Therapy – to overcome stress and sadness and acceptance of what we can’t change. Uses talk therapy to manage stress and anxiety with techniques such as deep breathing, coping self-talk, and identifying situations that are often avoided and then gradually approaching those feared situations. Supportive counseling and/or expert companion or coach and/or compassionate family or friends. Create self-imposed structures – to feel more comfortable in this ‘new normal’. Take breaks – to pace yourself. Be silent and keep still. Designate an uncluttered area in your home as a workspace. Maintain cognitive activity & learning. Use your creativity. Laugh. Listen to music.Engage in Self-Massage/Dance/Movement. Maintain healthy self-care habits. Accept what we can’t control. Practice mindfulness. Practice positive self-talk and reframing techniques. Gratitude exercise – to offset an unpleasant circumstance or event, identify the stressful event and then pair it with an event-related reason to be grateful (i.e., “While this pandemic scares me, it reminds me of how grateful I am to be alive.”). In your head, turn down the volume on the negative event and turn up the volume on your reasons to feel grateful.

Emotional practices & techniques. Coaching/Expert Companion for emotion self-regulation skills. Deep breathing for relaxation. Emotion self-regulation training — to de-escalate instead of catastrophizing. Practice stress resilience in virtual environments (STRIVE). Practice acceptance. Practice Shinrin Yoku – to receive the benefits of mindfully immersing yourself in nature.

Spiritual practices & techniques. Meditate. Pray. Deepen your relationship with your spiritual self. Consult your spirit guide. Keep the faith. Keep hope alive — we’re all in this together and we will, somehow, manage to get through it.

Concluding remarks. Thankfully, I am now in a position — with clarity, knowledge, and experience — to help others with their own trauma recovery and personal transformation. But, of course, it’s best to prevent the causes of trauma, whenever and wherever possible. When we can’t prevent trauma, it’s best to prevent our alarming response to it. I hope this article has helped you identify practices that may help you prevent PTSD. But, remember, if you need help, seek it. Help is readily available; and, you – each and every one of you – deserve the best in this life.

Photo by LN on Unsplash

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