Somewhere between 3 to 8 percent of the population will deal with Post Traumatic Stress Disorder, or PTSD, in their lifetime. In the past 30 years, progress has been made in identifying therapies to aid in the recovery of individuals afflicted by PTSD. Several treatment modalities have shown benefit. The purpose of this article is to review some of those treatment modalities. We hear more about PTSD today due in part to its fairly recent recognition by several organizations as a “real” psychiatric disorder as well as increased public service announcements. 

A lengthy and specific definition of PTSD can be found in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5). To summarize, people who have PTSD are often those who have undergone a traumatic experience related to near death or perhaps a trauma related to sexual abuse. They often have flashbacks, distressing dreams, or memories of the traumatic event. Because of these symptoms, patients may avoid anything that reminds them of the event. 

These experiences cause a variety of symptoms, including anxiety, irritability, disruptive behavior, depression, isolation, and even suicidal thoughts. We now have a common screening assessment for PTSD, called the PTSD Checklist (PCL). There’s a version for civilians (PCL-C) and one for military (PCL-M). If you score above 44 on the PCL-C, or 50 on the PCL-M, you may have PTSD, and need to see a doctor for further recommendations. A shorter version is the PCL-6, where a score of 14 or greater suggests that PTSD is likely.

A physician may prescribe medication, psychotherapy, or both to assist in treatment. Studies have shown that these are about 50-percent effective in helping those with symptoms of PTSD — not perfect, but every bit helps. Medication stabilizes the mood and lessens some of the symptoms that are disrupting the individual’s life. Therapy is an essential adjunct to help the person overcome the negative associations and psychological pain attributed to the event. 

Medication

Drugs like Selective Seratonin Reuptake Inhibitors (SSRIs) and Seratonin-Norepinephrine Reuptake Inhibitors (SNRIs) are the standard of care for PTSD. SSRIs include drugs like Sertraline (Zoloft), Fluoxetine (Prozac), and Paroxitine (Paxil); Venlefaxine (Effexor) is a recommended SNRI. These drugs work on chemical components of the brain that help the patient deal with anxiety and depression that’s often experienced with PTSD. 

Another drug that has been helpful in some patients with PTSD is Prazosin. This drug is commonly used to treat enlarged prostate in men; however, it has been shown in some people to reduce the number of nightmares and improve quality of sleep. Study conclusions have been mixed as to Prazosin’s general effectiveness; however, it’s typically recommended to see if there’s a benefit in each individual patient. 

Lastly, medical marijuana has gained a lot of popularity for treating just about everything under the sun; however, it hasn’t been shown to provide a benefit in PTSD patients. 

Mindfulness

Jon Kabat-Zinn wrote his treatise on mindfulness back in 1990, detailing what mindfulness is and how to go about being mindful. In short, he proposed that we become mindful of the moment. Savor the food we chew. Feel the sun on our face and the grass beneath our feet. In doing so, we can gain an appreciation of our current moment and live a better, more in touch, life. 

Often with PTSD, the trauma keeps rearing its ugly head, and we forget about the moment we are living, and step back into a horrible time in our lives. Mindfulness offers an escape from the past as we focus on the now. There’s an excellent app called Mindfulness Coach that I recommend. Also check out www.mindful.org to learn more about mindfulness.

Above: Mindfulness and meditation are essential components of PTSD treatment.  

EMDR

Eye Movement Desensitization and Reprocessing (EMDR) was developed by Dr. Francine Shapiro in 1990. It’s a complex form of therapy that combines modalities from other therapies to have its beneficial effects. Basically, in EMDR, the traumatic event is recalled while a repetitive act is performed (tapping fingers, roving eyes). This interrupts the old thoughts associated with the memory and creates a new pathway for the brain to associate with the event. The process can take a while to prime the patient for successful treatment. It has a lot of research showing its benefit, as supported by the World Health Organization, the American Psychiatric Association, and the Veterans Administration. I have seen this work in several patients with amazing success. See www.emdr.com for more information.

Above: Physicians should take a multi-disciplinary approach to treat PTSD.

Stellate Ganglion Block

The idea of using medication injected into the stellate ganglion on the right side of the neck was first proposed in the 1940s. It wasn’t until 2010 that the first study was done to see if stellate ganglion block could help with PTSD. Although the exact mechanism of how it works is unknown, the idea is that it “calms down” sympathetic stimulation of the nerves during anxious times. It’s still being used, but there’s mixed evidence that it’s helpful. The Veterans Administration suggests that more study needs to be done on this modality. 

Cognitive Behavioral Therapy

This popular and effective therapy focuses on the symptoms of trauma and its effects on thoughts, feelings, and behaviors. There are two modalities commonly used in CBT: exposure therapy and cognitive restructuring. In exposure therapy, the person might be asked to relive the trauma in a safe environment. The exposure can be written, verbal, or even virtual reality-based. In cognitive restructuring, the person is asked to recall the trauma in a more logical way, as they often only remember pieces of the trauma and sew together what they may have missed. The goal is to have the patient re-evaluate their negative associations with the trauma and to develop more effective patterns of thought. There are typically 12 to 16 sessions involved. 

Above: Cognitive Behavioral Therapy has been proven to be effective in treating PTSD.

Cognitive Processing Therapy

This was developed in the 1980s and is a specific subset of Cognitive Behavioral Therapy aimed at treating those who have succumbed to a sexually traumatic experience. Often, patients blame themselves after such an incident. Patients are asked to think about their trauma and how it has affected them. In order to overcome their trauma, they must develop an understanding of how they feel in relation to the trauma. They must develop new patterns of behavior associated with the event (e.g. “I survived the trauma because I fought the SOB,” rather than “How did I let this happen?”). CPT is typically 12 sessions long. 

Post-Traumatic Stress Disorder affects millions of people in the U.S. Our understanding of screening, diagnosis, and treatment has improved over the past 30 years. PTSD is now recognized by the American Psychiatric Association and the World Health Organization as a disease. Medications and relatively newer therapies, such as Eye Movement Desensitization and Reprocessing, as well as older therapies, such as Cognitive Behavioral Therapies, can provide benefits to people afflicted with PTSD. Treatment is lifelong, and there are no shortcuts. There is help, and there is hope, for those suffering with PTSD. 

About the Author

David L. Miller, DO, FACOI, is an internist in private practice for 20 years. His experiences away from the office have included time as a fight doctor in regional MMA events and as a team physician for 10 years at a mid-major university in the Midwest. Currently, he serves as the lead medical instructor for the Civilian Crisis Response team based out of Indianapolis.

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I recently participated in my very first two-gun match alongside Iain Harrison, RECOIL’s editor-in-chief, and Nick Saiti, a frequent contributor to the magazine. Both of them made the stages I struggled with look easy. I soon learned that Saiti, who I had just met that morning, is a Grand Master in all eight USPSA divisions. He was kind enough to offer me some pointers and encouragement, and at the end of the match, he invited me to join him at an upcoming Competition Pistol Clinic hosted by his training company, Secret Weapon Training. After watching him shoot, there was no way I was going to pass that up.

Unlike prior classes I’ve written about, this class was specifically designed to help competition shooters. Before you dismiss this as impractical, remember that it’s a different approach to the same end result: fast, consistent hits on targets. There are differences, of course, but if you’re a good competition shooter, it’s not hard to apply those same skills to self-defense.

Saiti explained that he breaks down shooting skills into six manageable chunks, which must be mastered individually and then layered. The first subject of the day was stance. Feet should be shoulder-width apart, hips square to the target, and knees and elbows slightly bent to absorb recoil. Saiti recommended shifting more weight onto the balls of my feet until I almost toppled forward. I felt my toes digging into the ground and shin muscles tightening — this greatly improved my stability.

The second topic of the clinic was grip. Some instructors recommend 60/40 or 70/30 pressure from your support and dominant hands; Saiti recommends 100/100. Grip the gun as tightly as possible with both hands, as long as trigger finger dexterity isn’t diminished. Choke up high on the grip, make sure there are no voids between the hands and the gun, and push the support thumb forward on the frame.

Third, Saiti discussed draw technique. Both hands should be moved in unison to the level of the holster; this symmetrical movement prevents favoring one side. Establish a consistent, strong grip, and bring hands together in the workspace where you’d naturally clap your hands. Keep the barrel flat as you drive the gun up and out to eye level, fast at first, then slower to acquire a sight picture. To test your draw, start with a good stance, close your eyes, draw normally, and open your eyes. If your mechanics are perfect, you should see a clear sight picture every time. Saiti says, “Technique will take you most of the way. Your eyes just confirm it.”

These three topics are the most fundamental layers — if you can nail them, you’re off to a great start. Reloading was the fourth topic. Focus on getting the mag up to the gun and aligned quickly, then guide it in and re-establish grip. Too many students try to save time by slamming the magazine in quickly; this is only a tiny fraction of the reload time. Topics five and six, efficient transitions and movement, offered more “meat on the bone” to shave time that can be spent taking shots.

Saiti closed the Competition Pistol Clinic with an analogy. If you spill nails on the floor, what’s the fastest way to clean them up? You could go get a vacuum, rig up a magnet on a string, or Google a solution, but the real answer is to simply bend down and pick them up immediately. Learning to become a Grand Master is much the same — it’s a matter of time and hard work. At the end of this class, I noticed measurable improvement in my speed and consistency, and felt renewed determination to keep working on my fundamentals. 

For more information on Secret Weapon Training, go to www.secretweapontraining.com or check @secretweapontraining on Instagram. 

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