PTSD Treatment Approach with Eye Movements (Accelerated Resolution Therapy)

1. PTSD in Physicians: A
Treatment Approach with Eye
Movements
(Accelerated Resolution Therapy)
MS Caduceus Annual Retreat
July 11-13
Alexis Polles, MD, PLLC

2. OUTLINE
I: Trauma and its sequelae
II: Trauma in physicians
III: Treatment options
III: Use of special approaches in the treatment
of trauma
• Eye Movements
IV: Conclusion

3. Definition of Trauma
The diagnostic manual used by mental health
providers (DSM-5) defines trauma an event that
involves actual or threatened death or serious
injury or sexual violation in which the individual:
• directly experiences the event
• witnesses the event in person
• learns that the event occurred to a close friend or
relative
• experiences first-hand repeated or extreme
exposure to aversive details of the traumatic event
DSM-IV requirement that “The person‟s response to the event must
involve intense fear, helplessness or horror” has been eliminated in
DSM-5.
•

4. Trauma
• May include events that are not beyond the
scope of normal human experience, as long as
the event has had a trauma-like impact on the
person.
• DSM-5 moved it from an Anxiety Disorder to
Trauma- and Stress-or-Related Disorders
• What makes an event traumatic:
– The severity of the event
– The proximity of the experience
– The personal impact of the event
– The after-event impact

5. Potential Victims Of A Traumatic
Stressor
1 Primary Victims
Those individuals most directly affected by the
event, e.g., the persons whose houses are blown down
in a hurricane.
2 Secondary Victims
Those individuals who in some way observe the
consequences of the traumatic event on the primary
victims, e.g., bystanders, rescuers, and emergency
response personnel. (Partners/kids)
3 Tertiary Victims
Those individuals who are indirectly affected by the
traumatic event as a result of later exposure to the scene
of the trauma or to the primary or secondary victims of
the trauma.

7. None
Transient
or no
symptoms
Acute
Stress
Disorder
PTSD +
Trauma
Consequences
Impairment > 30d
Re-experience, arousal and avoidant symptoms
Co-occurring syndromes
-
-
+
-/+
-
+
+
-
+
+
+
+
+
+++
++
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+
Trauma Spectrum

8. Types of PTS/PTSD
Simple PTS/D
• The response to one or more traumatic events that are
NOT linked in any way (e.g., one rape, one car
accident, one sudden loss).
Complex PTS/D
• The response to a combination of specific traumatic
events that ARE linked to each other in some way or
occur repeatedly over time

9. Symptom Clusters
(Now four in DSM-5)
• Re-experiencing
• Avoidance
• Persistent Negative Alterations in Cognitions and
Mood (retains numbing symptoms and includes
other symptoms such as persistent negative
emotional states and includes inability to remember
key aspects of the event)
• Arousal (includes fight and flight)
Subtypes include kids < 6 and dissociative

10. Trauma is an experience that
overwhelms our capacity to
have a sense of control over
ourselves and our immediate
environment, to maintain
connection with others and
to make meaning of our
experience.
In Summary:

11. How does the past become the present?
•Threat + Sensorimotor Experience (Traumatic
Cues) + Level of Arousal is imprinted in
procedural memory and leads to fear conditioning
•There is a walling off of this memory
(“dissociative capsule”) that is brought into the
present by external representative cues or internal
cues

12. Trauma and the Brain
• Thalamus (temporal lobe) receives sensory
signals
• Amygdala sorts for immediate danger
- Shuts down „thinking brain‟
- Diverts energy to physical response
• Hippocampus stores episodic long term
memory
• Reactivation of this pathway strengthens it

13. ¥ Thoughts that perpetuate arousal: “It is my
fault;” “I am being punished;” “the world is
not safe.”
And inhibits
¥ Thoughts that might attenuate arousal: “I
did the best I could” “These things happen
– you can’t control everything” and “the
world is usually safe, and fortunately I
survived this event… It’s over”…
Leads to
Interference with proper integration of emotional memories
Adapted from Dr. Uri Bergman

14. 14
Trauma Response
Amygdala
Visual
Cortex
Trauma Response

15. Healthcare Professionals and PTSD
• Most studies are with non-physician providers
(EMTs), first responders
• Nearly all of those dealing with
physicians/nurses are post disaster
• Much written on physician “stress and burnout”
that does not specifically look at PTSD
spectrum disorders

16. Physician Specific Literature Review
– There was no association between PTSD symptoms and professional
exposure to victims inside the hospital in studies of non-military
physicians in terrorist attacks/war zones
– 15.6% had PTSD symptoms
– No gender differences
– Burnout was significantly more prevalent among doctors with PTSD
– Those with PTSD used more negative coping strategies and
functioning was significantly reduced
– Only 15% of those with PTSD and who had identified themselves as
having it actually attended available therapy
– SOOOOO……

17. What do affected physicians do?
• Drugs/Alcohol
• Overwork
• Overeat
• Some gamble/game

18. Posttraumatic Stress and
Co-Occurring Disorders
• Trauma survivors often attempt to control their internal
state of hyper or hypo arousal through the use of
substances or behaviors that produce neurotransmitter
responses similar to those produced by substances
• While substances may initially restore a sense of
control, they actually inhibit the accessing of memories
and integrating the experience in an adaptive manner.