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Healing the Invisible Wounds of War

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Not every traumatized person develops full-blown, or even minor, PTSD. Symptoms usually begin within three months of the incident, but occasionally emerge years afterward. Some people recover within

six months, while others have symptoms that last much longer, with the possibility the condition becomes chronic, according to the NIMH site.

PTSD affects about 7.7 million American adults, but it can occur at any age, including childhood. Women are more likely to develop PTSD than men, and there is some evidence that susceptibility to the disorder may run in families. PTSD often is accompanied by depression, substance abuse, or one or more of the other anxiety disorders, the NIMH reports.

Traditional methods of treatment are talk therapy, cognitive processing and exposure therapy, all of which help patients understand their feelings and develop skills to confront them, Tuma said.

In an average session of "imaginal" therapy, for instance, patients may be asked to close their eyes and provide a first-person account of their traumatic recollection as thoroughly as memory allows: what they saw, smelled and heard.

While this and other talk therapies offer some of the best, most proven forms of treatment, Tuma said, one problem is that there are insufficient numbers of trained medical providers. At the same time, the nature of the therapy itself - an emotionally tasking exercise - creates a barrier on the road to recovery.

Some PTSD sufferers don't fully reveal themselves during cognitive therapy sessions, which can result in ineffective treatment. Others find the treatment too daunting, and avoid treatment altogether.

At the psychiatric wing of Walter Reed Army Medical Center here, medical personnel are exploring less traditional forms of treatment including alternative healing rituals like acupuncture and aromatherapy -- methods that convey elements of relaxation and spiritual mindfulness, experts said.

They are also testing a therapy that lets soldiers re-live their traumatic experience in virtual reality. The upshot of "Virtual Iraq," and similar other types of treatment, is that those afflicted with PTSD can learn to become less sensitive to their painful and disturbing memories by confronting them.

Other health practitioners, meanwhile, are in the early phases of a therapy that combines pharmacology and a treatment known as extinction learning. This method involves unlearning the linkages between harmless cues that trigger reminders of the trauma, and replacing them with new memories -- all while taking the drug Cycloserine, an antibiotic that has been found to accelerate the learning process, Tuma said.

He added that developing newer and better treatments represents the current phase of PTSD research, including the emphasis on better understanding the relationship between neuro-circuitry and pharmacology. One therapy involves giving the endocrine mechanism a "shock to the system" so that memories of the event do not get as strong a toehold.

Tuma said doctors are studying the value that early intervention has on treating PTSD. Some have floated the idea of making a Web-based tool to facilitate early screening and diagnosis. Early detection, Tuma said, can prevent the disorder from snowballing and leading to other problems like alcoholism, homelessness, divorce and financial problems.

With PTSD, there is this stress response system that goes into overdrive in response to things in the environment that it has come to associate with being in danger, and it turns up the heat.

Unfortunately, PTSD does not alert the human body with early warning signs in the way that tingling in the left arm might warn of an ensuing heart attack. For this reason, Tuma said, researchers are developing tools to predict when somebody is at high-risk for developing the disorder.

"The glass is maybe not half-full yet, but it's improving," he said of the comprehensive effort to stem PTSD.

A sustained effort is needed to ensure that PTSD treatment and research continue to evolve,
Tuma said.

"Throwing some resources at new research and propping up new service programs is right, is a good thing to do," he said. "But the scars of these kind of conflicts are not easily mended and patched up and moved on within a couple of years.

"The kind of services and programs we're talking about probably are going to have to be around for a while. Sustained investment and attention is key."