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Ptsd

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Introduction
The human body has been designed a mechanism to deal with pain and damage. The human immune system deals with all kinds of injures. The human immune system helps regulate bodily functions. When the body is exposed to a certain amount of pain the body goes into shock. This can be a life threatening situation or it can be the bodies’ response to the life threatening situation allowing a solders to keep fighting and things of that nature.
If the damage the body may go into what is called a "comatose" condition. Where all nonessential function shuts down for repairs. This is due to the trauma that was experienced. Many of these actions are automated. This is because God has a system in the body to regulate the body.
With that in mind PTSD is put into two different categories. They would be direct exposure and indirect exposure to an event. Direct events would be first hand experiences but the person. A point in time that the person felt significant risk of life and limb. An indirect traumatic event would be if an individual would witness a traumatic event.
The mind has the same kind of defense mechanism. This is used to cope with severe mental trauma or mental stress. When a person goes through extremely powerful mental trauma that the mind cannot deal with the pain many things happen. One of those things is PTSD or post-Traumatic Stress Disorder. This report will look at this disorder from a biblical point of view using the lives of many people.

Dreams

The dilemma is what PTSD victims deal with frequently. PTSD is a reaction to some kind of stressor but definition. “PTSD is a disorder that has to do with the experiencing, witnessing, or confrontation with any event(s) that involved serious injury, death, or any threat to the physical wellbeing of that person or others” (Friedman, 755). The after effects of dealing with harmful situations. Physically a great example is the aftermath of a stressful situation.
What further adds to the response is not only the damage and violence that occurred to the person involved, but also the danger and violence of other people that were involved in the event. In dealing with the even there are money symptoms the first is habitual dreaming of the event. In a study of dreams and PTSD Dr. Phelps wrote that “. All participants reported that the selected dream had recurred with little change since the trauma, irrespective of dream type, suggesting that those dreams that persist over time are more likely to be those that remain unchanged.” In other words dreams are linked to the trauma. (Phelps 858) the Bible has little to nothing on nightmares but speaks of God talking to people in dreams.
While PTSD nightmares are bad God talks to people in dreams. The only thing that can come close to God speaking to someone in nightmares is the dreams of Pharaoh. Pharaoh seemed so upset that he had people look for someone who could interpret his dreams. Daniel did interpret dreams later but the images in those dreams were not as dramatic. Visions are dreams are in the Bible. God speaks to Abimelech in Gen 20 as a warning about Sarah, Jacob dreamed of a ladder in Gen 28, Pilates wife had a dream as well. None of the below mentioned were nightmares relating to flashbacks.
Which is unfortunate but it does not mean that people do not struggle with this problem today. The idea of habitual dreaming is that people re-experience an event. This is not limited to dreams as flashbacks are known to have people literally be in the stressful moment their entire life. the idea is that the victim will relive the experience over and over again. Many times replaying alternative outcomes in their head. A great example of that in modern culture is the man that the movie the Butterfly Effect was based on. In his delusion the man though he was traveling back in time which is his hallucinating the events. This is a rather extreme case another example in popular culture would be Batman. It is hard to not watch a Batman movie or TV show and not see a reenactment of the death of his parents. Even in the video game “In the video game Batman: Arkham Asylum (18), the Batman character relives the deaths of his parents--hearing their last words, then seeing them lying dead in the alley.” (Taylor, 252)
The idea is that the person could be anywhere and a flashback can occur. Because they are like any other memories just more intense. In reality hallucinations are very uncommon and linked with other psychological disorders. Negative thoughts on the other hand are very common in the wake of PTSD. “Explanations for the occurrence of shame and guilt after trauma include stigmatization and secrecy and victims taking the blame or being blamed by others for what happened.” (Aakvaag) People will do their best to avoid situations that may trigger PTSD even at the case of social interaction. The person will engage less and less in social activities. With the death of the person social life the individual starts feeling disinterested to other people. This leads to a negative outlook on the past, present and future. This also can lead to the person suppressing all emotions. In the end flashbacks are very dangerous because it pushes the person to be emotionally isolated.

Chemical Basis

The serotonin transporter is a transporter for serotonin to be transported to the neurons, a presynaptic neurons to be exact. The problem with the serotonin transporter is that if the serotonin booster is present I can lead to ““increased sensitivity to stress and an increased incidence of depression and anxiety disorder” (Carlson 2011). In more simplifies words the person becomes vulnerable to other stress related disorders like PTSD.
The theory was placed to test as the people who lived in Florida in the 2004 hurricane season. Which the state was hit by several high level hurricanes and several tropical depressions. The results as depicted by Carlson are as follows. Those with no social support and high exposure to the trauma from the hurricanes the serotonin transporter that leads to PYSD was present. (Carlson 2011).
In addition amygdala which is the emotional center of the body is also thought to play an important role. What it does is the amygdala takes normal emotions such as anger or fear and allows the body to process them to allow for emotional reactions. Not only does it control emotions but is controls memories. The amygdala controls where the memories are stored. This relates to PTSD because memories are stored where the amygdala decides.
In another study done twenty-five people who experienced the Tokyo subway sarin attack were given Magnetic resonance imaging (MRI’S) of their brains and the results were added together.
The result shows what researchers show a smaller bilateral amygdala volume in the group with PTSD. Also the study discovered that the amygdala volume is negatively correlation with the correlation of PTSD symptomatology. The lower the left amygdala the more PTSD symptoms that are faced. Pietrzaka Says the same thing in his research study on PTSD “ These pilot findings suggest that the 5-HTTLPR genotype x trauma exposure interaction is uniquely related to hyperarousal symptom dimensions that comprise the 5-factor model, as this interaction effect was significantly associated with severity of anxious arousal, but not dysphoric arousal symptoms. This finding suggests that separation of the DSM-IV hyperarousal cluster into anxious arousal and dysphoric arousal symptoms may provide a more refined understanding of how genetic risk factors for PTSD relate to the clinical expression of PTSD symptoms.” (Pietrzaka,127)
Neural Basis While PTSD has a very confusing physical or neurological base it also has a physical base to it. PTSD. In the Bible there was a man named Jacob. His son was taken from him at the time his brothers said that Joseph was eaten by a wild animal. He grieved nonstop until his son was returned Gen 37:35 “No," he said, "I will continue to mourn until I join my son in the grave." So his father wept for him.” Over a long period of time this had an emotional and psychological effect on him. Jacob would be what we call a secondary receiver of trauma. It impacted the physiology of him as he mourned and ate less and his body adjusted to the new routine. As pertaining to the memory most victims remember the trauma unless they repress the memory.
In the case of the person who remembers they have a tendency to avoid any stimulant that would be associated with the events. Veterans have a tendency to not want to hear fireworks and even place signs in their yards warning people. The events that causes the PTSD are in the memory banks of the person probably after the persons death. It would be interesting to see how people in heaven process traumatic events in their lives. For people with PTSD it is as hard to forget the event just like Jacob could not forget his son. With ambiguous loss, the trauma (the ambiguity) continues to exist in the present. It is not post anything. Ambiguous loss is typically a long-term situation that traumatizes and immobilizes, not a single event that later has a flashback. But ambiguous loss is unique in that the trauma goes on and on in what families describe as a roller-coaster ride, during which they alternate between hope and hopelessness. (Wright, 90) For PTSD patients, it is almost impossible to simply “forget” and move on from it; they will continually revisit that dreadful day, and experience a fear that they have never felt before. Brohawn et al. (2010) Jacob lived that day over and over in his head.
In the experiment the amygdala and hippocampus activation was looked at in 18 people exposed to PTSD and a control group of 18 non PTSD people. Looking at the body’s ability to create memories specifically the amygdala’s function to get memories. While at the same time processing the importance of memories that invoke emotional responses in people.
The next area of the brain is the hippocampus. “In symptom provocation studies in PTSD, symptom severity was correlated positively with amygdala activity and/or negatively with hippocampus and/or medial PFC activity (Shin et al., 2004a; Armony et al., 2005; Shin et al., 2005). During encoding of forgotten faces a negative correlation has been found between symptom severity and ventromedial PFC activity (Dickie et al., 2008), but not during retrieval (Bremner et al., 2003a; Shin et al., 2004b). Two symptom provocation studies among PTSD patients found that depression comorbidity may account for more bilateral ACC activity (BA 24) and relatively less left insula (Lanius et al., 2007), amygdala and medial prefrontal activity compared to PTSD-only patients (Kemp et al., 2007).” (Thomaes,9)
On the other hand the hippocampus is very important for short term memories, because it helps forms short terms memories it stands to reason that it also helps with long term memories or permanent memories. Traumatic events act like a permanent memory for people with PTSD. With this in mind the hippocampus was looked at the same time as the amygdala was also looked at. What Brohawn discovered in 2012 is that PTSD victims exhibited “exaggerated amygdala activation during the encoding of negative versus neural pictures” (Brohawn et al. 2010). In other worse PTSD victims express more emotions in the face of negative imagery. Also the PTSD group displayed over amplified hippocampal activity as a result as result of negative pictures. That moved Brohawn to arrive at the judgment that the amount of amygdala activation was positively correlated to hippocampal activity and the severity of PTSD symptoms. The more activity the amygdala exhibited the higher the hippocampal action, the more PTSD symptoms.

In all reality PTSD is the bodies inability to maintain it’s normal homeostatic internal environment. This is done for the comfortability and the overall function of the person. With the imbalance such as a heart failure and dehydration the body must reconcile and return to homeostasis of cease to function. In an experiment by Malashenko, Laskov, and Pogosov 165 military personnel were examined.135 people were in combat zones. Obviously they are areas of high danger. Out of the 135 people 105 were diagnosed with PTSD. Out of the men 78% were diagnosed with PTSD.
In this study they discovered a objective measurable difference in the military personnel with PTSD in the bodies ability to maintain a homeostatic environment. The study failed to determine what the imbalance is in the person. Fortunately other people have looked at this issue Doctor Kovacic did a paper on “Platelet serotonin concentration and suicidal behavior in combat related posttraumatic stress disorder” and in the paper he looked to find the connection between PTSD and the serotonin levels in the brain.

Serotonin is a neurotransmitter that controls emotional behavior behavior, anxiety, impulsivity and aggression. This is why it is looked at so much when examining people who suffer from PTSD and even other side effects of PTSD such as depression.

In addition to biochemical changes, PTSD also involves changes in the brain itself. Combat veterans of the Vietnam War with PTSD showed an 8% reduction in the volume of their hippocampus which is associated with the consolidation of episodic memories, defined as memories of personally experienced events and their associated emotions, in comparison with veterans who suffered no such symptoms. (Williams, Poijula 2005)
Kovacic et al. focused their efforts specifically on platelet serotonin, serotonin that is found in blood platelets. They believed that platelet serotonin concentration affects suicidal behavior in combat-related PTSD. A total of 342 male subjects were examined. 73 of the subjects were suicidal, 47 were non-suicidal veterans with current and chronic combat-related PTSD, 45 were suicidal non-PTSD subjects, 30 were non-suicidal non PTSD subjects, and 147 were perfectly healthy men. The results showed that concentration of platele serotonin was much lower in suicidal PTSD and non-PTSD than the concentration in the other groups. The results not only showed that reduced platelet serotonin levels is related to suicidal tendencies in non-PTSD patients, but that it is also related to suicidal tendencies in PTSD patients.

Treatment Options

PTSD is a long lasting problem that comes from many different things and generally has left people with eight different ways of coping. For the victims of PTSD there are a wide variety of options in treatment. Due to the wide variety of secondary problems that PTSD treatment is also varied. PTSD may bring about depression is some people. In this depressed state some people may turn to substance abuse. Some people turn towards alcohol which may help in the short term but in the Lord it hurts a person. This is because in their efforts to attempt and eliminate the stimuli the person will consume more and more alcohol.
Unfortunately in the end we know the long effects of alcohol are very bad for the physical body and the make the symptoms of PTSD worse in the patient. Now that the author have rules alcohol out as a viable treatment method the first area of treatment will be looking at is non medical forms of treatment.

Well, let us first look at non-medical treatment options. Deep brain stimulation, which can sound somewhat barbaric, is actually extremely helpful for PTSD patients. Basically, an electrical signal is delivered through an electrode, which is then transmitted to your brain. To test how effective deep brain stimulation can be, Langevin et al. (2010) tested with 10 rats. Five of the rats were delivered the electrical signal, while the other five were not. All of the rats were subjected to inescapable shocks in the presence of a ball, which is the conspicuous object. This is done since rats develop a tendency to bury the unfamiliar object due to them being traumatized by the inescapable shocks, mimicking symptoms of PTSD. What Langevin et al. discovered was that the DBS-treated rats spent, on average, 13x less time burying the ball, and spent 18x more time exploring the ball when compared to the amount of time spent by the “sham” rats, the rats that were not given DBS. Another treatment option is cognitive behavioral treatment, or CBT. What CBT strives to accomplish is to change the way people think about the trauma they might be going through. The ultimate goal of CBT is not to directly cure you, but to make you realize those thoughts you’ve been having about that trauma and how they cause nothing but further stress and the worsening of your symptoms. With CBT, you learn what aspects of the world make you upset, and the goal is to replace those thoughts with thoughts that cause less distress on you. Specifically, in CBT, PTSD patients learn new coping skills. They learn to cope with the trauma that they habitually experience, which involves reteaching the brain how that trauma is viewed. One way this is possible is through instrumental conditioning. Instrumental conditioning is the process by which “the consequence of a behavioral response affects the likelihood the individual will produce the response again” (Raghavan 2011). The person behaves in a certain way, and as a result, a consequence arises. Whether the consequence itself is negative or positive depends on the behavior displayed by the person. With PTSD, patients with PTSD behave in a negative manner, shutting themselves off from society in order to avoid anything related to the trauma that they experienced. As a result, their status in society and relationships with friends and family members worsen. With CBT, PTSD patients could learn that the very things they are doing in order to avoid experiencing the event is significantly hurting others and hurting themselves. As such, the therapist could show that not avoiding the stimuli that is associated with the trauma could actually yield no negative consequence whatsoever. In turn, the patient could then begin to accept the stimuli, and function “normally”. One approach of CBT that a researcher discussed was the Structured Approach Theory (Sautter et al. 2011). The Structured Approach Theory “uses empathetic communication training and stress inoculation procedures to help couples improve their ability to cope with trauma-related anxiety” (Sautter et al. 2011). In other words, it is CBT for couples who are coping with trauma-related anxiety. As an experiment, the Structure Approach Theory was tested on Operation Iraqi Freedom (OIF) and Operation Enduring Freedom (OEF) veterans. As a result, PTSD symptoms actually decreased, along with any PTSD-related relationship problems the veterans could have been having. One common method of decreasing PTSD symptoms is with the use of exposure therapy. With PTSD, because the hippocampus and the amygdala chose to remember those trauma-filled memories, PTSD patients become afraid of those memories. With exposure therapy, PSTD patients, theoretically, have less fear about their memories. By continually talking about those fears with a therapist, PTSD patients realize that they can have control over those fears. Over time, they learn that they do not have to be afraid of their memories. Because the trauma was deeply ingrained into their memories, PTSD patients’ emotions could have been paralyzed due to the fear of those memories. With exposure therapy, PTSD patients learn to let go of that fear, gradually. It is not a process that can be immediately rushed into. By this, I mean that PTSD patients focus on less upsetting memories before talking about the memories that truly upset them. This gradual process is known as “desensitization”. Of course, being that PTSD affects the body on a neurological basis, as well as a psychological one, several different types of medication can be used to treat patients with PTSD. For example, selective serotonin reuptake inhibitors (SSRIs), such as Prozac and Zoloft, is a type of antidepressant medicine. The purpose of SSRIs is to raise the concentration of serotonin in the brain. Depression is often associated with low concentrations of serotonin in the brain. With SSRIs, you become to feel less sad and worried about your problems. However, the problem with using antidepressants for PTSD patients is that they are antidepressive medications. Depression could be a consequence of PTSD, but it is not the consequence. Because PTSD affects your dreams, one mode of treatment could be addressing the sleep problems that are directly associated with PTSD. If done so in a correct manner, not only would symptoms of PTSD decrease, but problems would be alleviated as well. In addition, mood stabilizers is an indirect mode of treatment, such as Gabitril and Risperdal (Dryden-Edwards). What seems to work well is antipsychotic medication. When used in combination with an SSRI, antipsychotic medications tend to alleviate any type of agitation or paranoia associated with some patients with PTSD.

References
Brohawn, K., Offringa, R., Pfaff, D. L., Hughes, K. C., & Shin, L. M. (2010). The neural correlates of emotional memory in posttraumatic stress disorder. Biological Psychiatry, 68(11), 1023-1030. doi:10.1016/j.biopsych.2010.07.018
Dryden-Edwards, Roxanne. Posttraumatic Stress Disorder (PTSD). Retrieved from http://www.medicinenet.com/posttraumatic_stress_disorder/article.htm
Langevin, J., De Salles, A. F., Kosoyan, H. P., & Krahl, S. E. (2010). Deep brain stimulation of the amygdala alleviates post-traumatic stress disorder symptoms in a rat model. Journal of Psychiatric Research, 44(16), 1241-1245. doi:10.1016/j.jpsychires.2010.04.022
Rogers M, Yamasue H, Kasai K, et al. Smaller amygdala volume and reduced anterior cingulate gray matter density associated with history of post-traumatic stress disorder. Psychiatry Research: Neuroimaging [serial online]. December 2009;174(3):210-216. Available from: PsycINFO, Ipswich, MA. Accessed March 25, 2011.
Sah, R., Ekhator, N. N., Strawn, J. R., Sallee, F. R., Baker, D. G., Horn, P. S., & Geracioti, T. D. (2009). Low cerebrospinal fluid neuropeptide Y concentrations in posttraumatic stress disorder. Biological Psychiatry, 66(7), 705-707. doi:10.1016/j.biopsych.2009.04.037
Sautter, F. J., Armelie, A. P., Glynn, S. M., & Wielt, D. B. (2011). The development of a couple-based treatment for PTSD in returning veterans. Professional Psychology: Research and Practice, 42(1), 63-69. doi:10.1037/a0022323

Williams, Mary Beth, Ph.D., LCSW, CTS, Poijula, Soili, Ph.D. (2005). The PTSD Workbook. Boston: New Harbinger Publications, Inc.

Malashenko, O. I., Laskov, V. B., & Pogosov, A. V. (2010). Neurological changes in military personnel with post-traumatic stress disorders. Neuroscience and Behavioral Physiology, 40(5), 533-536. doi:10.1007/s11055-010-9293-5

Kovacic, Z., Henigsberg, N., Pivac, N., Nedic, G., & Borovecki, A. (2008). Platelet serotonin concentration and suicidal behavior in combat related posttraumatic stress disorder. Progress in Neuro-Psychopharmacology & Biological Psychiatry, 32(2), 544-551. doi:10.1016/j.pnpbp.2007.10.014

Friedman, Resick, Bryant, Brewin “Considering PTSD for DSM-5” Depression and Anxiety, Volume 28, Issue 9, pages 750–769, September 2011

Phelps AJ; Trauma-related dreams of Australian veterans with PTSD: content, affect and phenomenology. Date of Electronic Publication: 2011 Aug 22.

Taylor, “Holy PTSD, Batman!:" An Analysis of the Psychiatric Symptoms of Bruce Wayne”, Academic Psychiatry36.3 (May/Jun 2012): 252-5.

Aakvaag, “Shame and Guilt in the Aftermath of Terror: The Utøya Island Study” Journal of Traumatic Stress Volume 27, Issue 5, pages 618–621, October 2014
Carlson, Neil R. (2011), “Foundations of Behavioral Neuroscience” Pearson Education, Inc.

Garske, “Military-related PTSD: A Focus on the Symptomatology and Treatment Approaches”, Journal of Rehabilitation (Oct-Dec 2011): 31-36. Journal of Affective Disorders
Volume 148, Issue 1, 15 May 2013, Pages 123–128

Pietrzaka “Examining the relation between the serotonin transporter 5-HTTPLR genotype x trauma exposure interaction on a contemporary phenotypic model of posttraumatic stress symptomatology: A pilot study” Journal of Affective Disorders Volume 148, Issue 1, 15 May 2013, Pages 123–128

Bormann “Spiritual Wellbeing Mediates PTSD Change in Veterans with Military-Related PTSD” International Journal of Behavioral Medicine (Dec 2012): 496-502.

Wright, H. N. (2011). Helping those in grief: a guide to help you care for others (p. 90), Regal.
Thomaes, K., Dorrepaal, E., Draijer, N., de Ruiter, M. B., Elzinga, B. M., Sjoerds, Z., … Veltman, D. J. (2013). Increased anterior cingulate cortex and hippocampus activation in Complex PTSD during encoding of negative words. Social Cognitive and Affective Neuroscience, 8(2), 190–200. doi:10.1093/scan/nsr084

Brohawn, “Diminished rostral anterior cingulate cortex activation during trauma-unrelated emotional interference in PTSD”, Biology of Mood & Anxiety Disorders 2013

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