The most important task for a PTSD service dog for veterans is disrupting anxiety
July 22, 2020
Science Daily/Purdue University
Science has shown that service dogs can benefit some veterans with PTSD. But the exact role service dogs play in the day-to-day lives of veterans -- and the helpfulness of the tasks they perform -- is less known.
A recent study led by Purdue University's College of Veterinary Medicine shows what trained tasks service dogs perform the most often and which ones are the most helpful to veterans with post-traumatic stress disorder. The study found that the task of disrupting episodes of anxiety ranked among the most important and most often used.
"There has been some debate on what kind of training PTSD service dogs need to be effective and how their assistance may be different than what a pet dog can provide," said Kerri Rodriguez, a human-animal interaction graduate student and a lead author on the study. "This study suggests that veterans are, in fact, using and benefiting from the specific trained tasks, which sets these dogs apart from pet dogs or emotional support dogs."
Rodriguez led the work with Maggie O'Haire, associate professor of human-animal interaction. Their research was published in Frontiers in Psychology. The study was done in conjunction with K9s For Warriors, with support and funding from Merrick Pet Care, and is in preparation for an ongoing large-scale clinical trial that is studying veterans with and without service dogs over an extended period of time.
The study found that, on average, the dog's training to both alert the veteran to any increasing anxiety and providing physical contact during anxiety episodes were reported to be the most important and the most often used in a typical day. Veterans with a service dog also rated all of the service dog's trained tasks as being "moderately" to "quite a bit" important for their PTSD.
Some trained tasks include picking up on cues veterans display when experiencing distress or anxiety and consequently nudging, pawing or licking them to encourage the veteran to focus on the dog. The service dogs also are trained to notice when veterans are experiencing anxiety at night and will actively wake up the person from nightmares.
The dogs also are trained to perform tasks in public -- such as looking the opposite way in a crowded room or store to provide a sense of security for the veteran.
The study also found that trained service dog tasks were used on average 3.16 times per day, with individual tasks ranging from an average of 1.36 to 5.05 times per day.
Previous research led by Rodriguez showed that the bond between a service dog and the veteran was a significant factor in the importance of untrained behaviors. Although all trained tasks were reported to be important for veterans' PTSD, those with a service dog actually rated the importance of untrained behaviors higher than the importance of trained tasks. This suggests that there are some therapeutic aspects of the service dog's companionship that are helping just as much, if not more, than the dog's trained tasks, Rodriguez said. "These service dogs offer valuable companionship, provide joy and happiness, and add structure and routine to veterans' lives that are likely very important for veterans' PTSD."
The study surveyed 216 veterans from K9s For Warriors, including 134 with a service dog and 82 on the waitlist. The study complements a previous publication published last year that focused specifically on the service dogs' training, behavior and the human-animal bond.
While service dogs were reported to help a number of specific PTSD symptoms such as having nightmares, experiencing flashbacks, or being hyperaware in public, there were some symptoms that service dogs did not help, such as amnesia and risk-taking.
"Both this research, as well as other related studies on PTSD service dogs, suggest that service dogs are not a standalone cure for PTSD," O'Haire said. "Rather, there appear to be specific areas of veterans' lives that a PTSD service dog can help as a complementary intervention to other evidence-based treatments for PTSD."
Veterans on the waitlist to receive a service dog expected the service dog's trained tasks to be more important for their PTSD and used more frequently on a daily basis than what was reported by veterans who already had a service dog.
"Veterans on the waitlist may have higher expectations for a future PTSD service dog because of feelings of hope and excitement, which may not necessarily be a bad thing," Rodriguez said. "However, it is important for mental health professionals to encourage realistic expectations to veterans who are considering getting a PTSD service dog of their own."
https://www.sciencedaily.com/releases/2020/07/200722142116.htm
Meaningful PTSD symptom decrease may lower type 2 diabetes risk
August 21, 2019
Science Daily/Saint Louis University
Research from Saint Louis University finds treatment for Post-Traumatic Stress Disorder (PTSD) that leads to an improvement in symptoms was associated with a 49 percent lower risk of incident type 2 diabetes.
The study, "Clinically Meaningful PTSD Improvement and Risk for Type 2 Diabetes," by Jeffrey Scherrer, Ph.D., professor in Family and Community Medicine at SLU, was published online Aug. 21 in JAMA Psychiatry.
"Some long-term chronic health conditions associated with PTSD may be less likely to occur among patients who experience clinically meaningful symptom reduction either through treatment or spontaneous improvement," Scherrer said.
PTSD affects up to 12 percent of civilians and nearly 30 percent of the veteran population. Those with PTSD are at risk for other health issues and improvement in PTSD symptoms is associated with parallel improvements in depression, emotional well-being, sleep, blood pressure and general physical health.
PTSD is associated with an increased risk of type 2 diabetes, which may be explained by the high prevalence of obesity, glucose dysregulation, inflammation, metabolic syndrome and depression among those diagnosed with PTSD versus those without PTSD.
This retrospective cohort study reviewed Veterans Health Affairs medical record data from 2008 to 2015. The researchers randomly selected 5,916 cases from among a veteran patient population aged 18 to 70 who had more than two visits to PTSD specialty care between 2008 and 2012. The patients were followed through until 2015.
After applying eligibility criteria, 1,598 patients with PTSD and free of diabetes risk were available for analysis.
Clinically meaningful symptom reduction is a decrease of 20 points on the PTSD Checklist score. The research found the results were independent of numerous demographic, psychiatric and physical comorbidities. The sample was 84.3 percent male, 66 percent Caucasian and 22 percent African-American. The mean age of the patients was 42.
The association was also independent of the number of PTSD psychotherapy sessions used.
"In patients with only PTSD, clinically meaningful PCL decrease is associated with lower risk for diabetes and in patients with PTSD and depression, we found improvement in PTSD was coupled with a decrease in depression," Scherrer said. "Thus decreased risk for type 2 diabetes appears to follow large PTSD symptom decrease and in patients with both PTSD and depression, improvement in both conditions may be necessary to reduce risk for type 2 diabetes."
"Surprisingly, clinically meaningful PTSD improvement was not associated with a change in BMI and A1C values." A prospective study is needed to advance research, Scherrer says, due in part to the limitations of medical record data. Such a study could determine if large decreases in PTSD checklist scores are associated with improved insulin resistance and reduced inflammation.
Take-aways
· The observational study examined whether veterans who experienced a greater reduction in symptoms of posttraumatic stress disorder (PTSD) had an associated lower risk of developing type 2 diabetes.
· The analysis included medical records from almost 1,600 veterans who received PTSD specialty care and had repeated completion of the PTSD Checklist as part of their treatment at the VA.
· Patients with versus patients without clinically meaningful improvement in PTSD symptoms had a 49 percent lower risk for type 2 diabetes over a 3-6-year follow-up period.
· In patients with PTSD and depression, improvement in both conditions was associated with lower risk for diabetes.
https://www.sciencedaily.com/releases/2019/08/190821142734.htm
PTSD and Addiction Among Veterans: Causes, Comorbidity, and Treatment
April 2, 2019
By: Cassidy Webb
While the United States is fighting a fatal drug epidemic that is at fault for the deaths of far too many young people, veteran substance abuse continues to pose a growing problem in the nation. As military personnel are returning home from deployment, they are suffering from a vast variety of mental and physical health problems as a result of their experiences. With the comorbidity of co-occurring mental illnesses, such as Post-traumatic Stress Disorder (PTSD), and substance abuse being so prevalent, many veterans are suffering in silence from the progressive, chronic disease of addiction.
PTSD and Veterans
Due to the nature of military service and combat, many veterans are frequently exposed to life-threatening events that can lead to the development of PTSD. When stress is brought on by a traumatic experience, the brain enters a fight or flight response causing the alteration of brain chemicals and heart rate. Adrenaline begins to flow and blood pressure rises. While this response is a natural way for people to protect themselves against harm, those who experience this stress persistently after the danger has passed may have PTSD.
Symptoms of PTSD can begin shortly after the traumatic event occurs and could last a lifetime without treatment. These symptoms can include:
Recall of memories from the event or flashbacks
Difficulty coping with and expressing emotions
May avoid situations that remind them of the traumatic event
Jittery composure or unprecedented anger
Difficulty sleeping
Feelings of hopelessness or despair
Although statistics vary depending on the length of time in the military and the severity of the trauma, there is substantial evidence that veterans suffer from high rates of PTSD. In a study on veterans from Iraq and Afghanistan, it suggests that 14% suffer from PTSD and 39% suffer from alcohol abuse. For Vietnam veterans, rates of PTSD have been found to be as high as 31%. Despite the high necessity for treatment, as many as 50% of veterans who have PTSD do not receive the treatment they need.
PTSD can be a terrifying disorder that is difficult to cope with. For this reason, many veterans turn to alcohol or drugs to cope with their emotions.
Co-Occurring Disorders
The symptoms of PTSD are severe and can cause a lot of emotional distress on those who suffer from it. Unfortunately, many find solace by turning to drugs or alcohol to suppress their emotions and manage their symptoms as drugs and alcohol can increase pleasure, decrease anxiety, and distract an individual from their emotions. The comorbidity of PTSD and drug abuse is so severe that studies have found that nearly 52% of men and 28% of women with PTSD also have a substance use disorder.
While drugs and alcohol may allow individuals with PTSD to cope with their emotions in the short term, this often turns into a pattern of abuse that can lead to an addiction. After a substance is abused over an extended period of time, it becomes harder for the brain to regulate healthy amounts of dopamine. When the substances are suddenly removed, a person may experience a shortage of dopamine resulting in withdrawal symptoms. In turn, using substances to cope with the symptoms of PTSD can actually worsen symptoms. An affected person may suffer from insomnia, impaired judgment, and may engage in risky behaviors such as impaired driving or other illegal, dangerous activities.
Dual-Diagnosis Treatment
The cycle of PTSD and drug abuse is a vicious one if left untreated. On the other hand, if a person seeks treatment but only one condition is treated, they are left highly susceptible to relapse. Fortunately, forms of integrated therapy like dual-diagnosis can help treat both mental illness and substance use disorders simultaneously.
In order to get away from the persistent fight or flight mode that is so common with a PTSD diagnosis, it is important that the individual learns to identify and cope with their PTSD triggers by working closely with psychiatric and addiction specialists. Dual diagnosis therapy will generally consist of different treatment modalities, such as group therapy, individual therapy, cognitive behavioral therapy, and trauma-informed care. Individuals will be encouraged to look at their past and get to the root of their problems as well as learn of healthy coping techniques like deep breathing, meditation, and yoga.
Another benefit of dual diagnosis therapy is that clients will be able to get the right medications, like antidepressants and anti-anxiety drugs, to better treat their mental health. This combination of counseling, support, and medical treatment is typically used to help an individual with co-occurring PTSD and addiction reach a place where they are mentally and physically stable.
Treating addiction hand in hand with mental illness increases the likelihood of maintaining sobriety in the long term, and with the proper diagnosis and medications, symptoms of PTSD can be effectively managed.
Cassidy Webb is an avid writer from South Florida. She advocates spreading awareness on the disease of addiction. Her passion in life is to help others by sharing her experience, strength, and hope. cassidy@recoverylocal.org