Acupuncture and PTSD

PTSD, post traumatic stress disorder,  has had many different names throughout  history, names such as shell shock, battle fatigue, and soldiers heart. Many of these names recognize trauma from war as a cause for PTSD, however, the current definition of PTSD has expanded to include trauma that comes from any other acutely shocking event, as well as complex and prolonged or repeated trauma that may come from child abuse or domestic violence.

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PTSD is defined by a group of symptoms that range from intrusive thoughts, hyperarousal (vigilance) flashbacks, nightmares, avoidance, sleep disturbances, changes in memory and concentration. PTSD includes having intense psychological distress at exposure to (internal or external) events that symbolize or resemble a part of the traumatic event, and having physiological reaction on exposure to those events.

Intrusive thought are intrusive  because they are unwanted and involuntary. Symptoms of intrusive thoughts include involuntary, distressing images, thoughts, or memories.

Symptoms of hyperarousal include difficulty falling or staying asleep, irritability with outbursts of anger, difficulty concentrating, exaggerated startle responses, and symptoms of hypervigilance.

Flashbacks are dissociative reactions where it seems as if the trauma is reoccurring.

Symptoms of avoidance include efforts to avoid thoughts, activities, places, people, feelings, or conversations that may be associated with the trauma,  and also inability to recall an important aspect of the trauma, diminished interest or participation in significant activities, feelings of detachment or estrangement from others, and feelings of “numbness” on the inside.

Symptoms of PTSD are hypothesized to represent the behavioral manifestation of stress-induced changes in brain structure and function. Trauma or traumatic events result in acute and chronic changes in neurochemical systems and in specific brain regions, which in turn result in long term changes in brain circuits involved in the stress response.

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(photo credit, Yale University)

Brain regions that are felt to play an important role in PTSD include:

Hippocampus: The hippocampus converts short term memory to long term. In PTSD it may shrink.

Amygdala: The fear induced by trauma hypersensitizes the amygdala to danger. Everything becomes a threat. In PTSD the amygdala may increase in size  

Hypothalamus:  the hypothalamus regulates a hormone called corticotropin-releasing factor (CRF). Increases in the secretion of CRF mobilizes the body to respons to an emergency. In PTSD the increased secretions alert the body for emergencies that are not there in reality.

Ventromedial prefrontal cortex:   When we realize that something we first feared is not actually a threat after all, our response triggered by the amygdala is regulated by the ventromedial prefrontal cortex. PTSD is linked to changes in volume that can decrease the functional ability of the ventromedial prefrontal cortex. 

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(Photo credit: National Institute of Mental Health)

PTSD is a complex disorder, and it is equally complex to treat. Individuals with PTSD commonly experience comorbidities such as depression, substance abuse, and other anxiety disorders that need to be treated simultaneously.

It is not enough to treat PTSD with acupuncture alone, often a team of specialist are involved in the treatment plan, and medication is often necessary.
However, research has found acupuncture to be effective in individuals with PTSD. In one study participants diagnosed with PTSD were randomized to either acupuncture treatment, an integrated cognitive-behavioral therapy (iCBT) group, or a wait-list control (WLC). Compared to the WLC condition, the acupuncture group showed significant effects for PTSD. PTSD symptoms scores declined significantly from baseline to end treatment of both the acupuncture group and the iCBT group. In addition, treatment effects for depression, anxiety, and impairment were similar to effects for PTSD, and both treatment groups improved significantly more than the WLC group. Symptom reductions at end-treatment were maintained at the 3-month follow-up for both interventions (iCBT and acupuncture) as compared to the WLC group.

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Clinical and experimental data suggest that at least some acupuncture effects are mediated in the central nervous system. MRI and PET studies on acupuncture at specific acupuncture points have demonstrated significant modulatory effects on the limbic system (ie hippocampus, amygdala and hypothalamus) and subcortical structures. These are the brain structures that are involved in PTSD.  For example, acupuncture stimulation on a specific acupuncture point (ST36) produced a reduction in neuronal activity, particularly the limbic/paralimbic structures and limbic areas in the cerebrum. These clinical findings could explain the positive effects of acupuncture in the treatment of PTSD.