The Future of PTSD Treatment | Dr. Shaili Jain | TEDxPaloAltoSalon

I'm a psychiatrist in a post-traumatic stress specialist I'm also a researcher committed to advance of PTSD my compulsion to do this work is rooted in my own family history of trauma and tragedy suffered during the 1947 partition of British India the partition was a really brutal chapter in the history of the South Asian subcontinent 2 million perished 75,000 women were raped mutilated and 14 million were forced to flee it was the largest refugee crisis of the 20th century now my paternal grandfather was murdered in partition linked violence and as a result of his death my dad who was aged 10 at the time was orphaned forced to flee and live as a refugee in the newly independent India and work as a child laborer now 20 years later my dad would move to England and that was where I was born and raised but despite this separation in geography in time I felt I spent big chunks of my youth living in the shadow that partition had cast on his life and with this feeling that no matter how much I loved him and he loved me a part of him would remain inaccessible because of what happened to him in 1947 from my two decades as a frontline clinician and researcher it's become very apparent to me the post-traumatic stress disorder is an inextricable part of all of our lives and there's actually a lot we can do to prevent it imagine if tomorrow you survived the unspeakable you survived a rape or a mass shooting or a brutal assault or maybe you survived a natural disaster or a deadly house fire or even an act of war now I have a feeling some of you are probably thinking I don't need to imagine I've survived those things I'm a trauma survivor and I would not be surprised why more than half of Americans report that at some point in their life they've survived such a trauma now once the danger has ebbed it is natural to feel this tres you might have nightmares you might be troubled by memories of the trauma you might feel like this for hours you might feel like this for days or weeks the good news is humans by design are psychologically resilient the vast majority of you will heal naturally with the passage of time the bad news is a significant minority of you won't heal naturally you will suffer every day with invisible wounds you won't be able to organically transcend that trauma you will have post-traumatic stress disorder and you wouldn't be alone at any given moment in time there are six million Americans with active symptoms of PTSD that requires professional attention and there are many many millions of more with this condition called partial PTSD where they're not meeting the textbook criteria but nonetheless they suffer and they could benefit from getting help as well so the statistics are clear the odds are one of you will the vast majority of you will at some point experience a major trauma and if you're lucky enough not to experience a trauma someone you love or someone with whom your life is inextricably intertwined at the place where you work in the community where you live where your children go to school or where they play someone will have their life destroyed by PTSD so none of us can afford to ignore it so how does PTSD infiltrate a life or a family or even our wider society post traumatic stress disorder is a condition that's been documented since ancient times but it remains elusive it's famous for causing things like flashbacks nightmares and an exaggerated startle reaction lesser-known but equally devastating is how it renders an emotional life barren it mutes happiness and yields instead to this raging irritability that keeps the sufferer on the perpetual verge of alienation from the world and everybody who loves them now this incapacity of PTSD it's not bought on by poor lifestyle choices or moral weakness or character flaws it's actually a really complex interplay between our environment our brains our bodies and our genes in the PTSD brain the there's a region known as the temporal lobe that's highlighted in this slide and in the temporal lobe is the hippocampus a part of the brain that is crucial to memory formation that is smaller in people who have PTSD also in the temporal lobe is this region known as the amygdala which is crucial to how we mount a response to fear or anger that is amped up in people who have PTSD it's hyperactive in the frontal lobe of the brain that is the part where as humans we regulate our decision-making our judgments our execution and our day to day life that is under active in the PTSD brain in addition to these neurobiological changes people with PTSD also have alterations in the stress hormone cortisol serotonin and noradrenaline PTSD seeps beyond the confines of mind or brain it infiltrates cells and bodily organs and bodily systems it emerged as a risk factor for a variety of conditions from heart disease to cancer to obesity and PTSD rarely lives alone eighty percent of sufferers have at least one of the psychiatric condition be it depression be it anxiety or addiction and all have an elevated rate of death by suicide so you can start to get a sense of the tremendous disease burden of PTSD now we tend to think of PTSD is linked to this external traumatic event the reality is is PTSD is highly heritable so up to one third of the odds of you developing PTSD after exposure to trauma is actually determined by your genetics how your brain is wired how your body mounts a response to trauma on top of that dr. Rachel Yehuda who is a neuroscientist at the Mount Sinai School of Medicine recently unearthed early evidence to suggest that epigenetic mechanisms are at play with PTSD and what do I mean by epigenetics then having PTSD literally determines which of your genes gets switched on or off and then these alterations in genes are passed down via this process called intergenerational transmission to subsequent children via the man sperm or the woman's eggs so these children literally carry these alterations in their blood like carrying these sorrows in their blood even though the children themselves may never have been exposed to a traumatic event so when we think of mass traumatization when you think of Holocaust or genocide or slavery or torture you start to get a sense of the deep footprint of PTSD a footprint that could literally last generations now PTSD is an inextricable part of all of our lives in the world we live in so what if we could prevent it and if so how primary prevention is the purest form of prevention imagine if you could prevent a mass shooting or sexual violence or family violence then the PTSD related to that trauma simply ceases to exist it sounds idealistic I know but Stanford researchers recently entered into a collaboration with the nonprofit no means no and the Kenyan government what they did was trained thousands of Kenyan high school girls in a six-week self-defense program at the heart of this self-defense program was this desire to quash the null cultural notion that a girl should stay quiet or obedient when faced with an attacker or in a harasser and the location of this study was really important why more than half of Kenyan women report being sexually assaulted when they were children so the researchers followed these girls they gathered data on how they were doing half of these girls went on to use the skills they had learned in that self-defense program to fend off a potential attacker or harasser now self-defense programs in themselves aren't new what's really fascinating about this research is that the Stanford researchers are using sophisticated statistical methodologies to really tease a out what is the secret ingredients to this program what really makes it work and the exciting news about that is if we know what the key ingredients are then we can scale this program and effectively replicate it to communities all around the world and that's really exciting news now primary prevention is not always possible and so researchers have entered this realm known as secondary prevention and in the case of PTSD that's known as the golden hours a period of time between the exposure to trauma and the onset of PTSD an opportunity for medical intervention to set a pathway for the brain to recovery researchers at the University of Oxford hypothesize that if they could interfere with memory consolidation a process that goes over I in PTSD if they could interfere with that by engaging trauma survivors in a visually absorbing task then then they could prevent PTSD so what did they do they went to the emergency room and they found 70 people who'd survived a major trauma in the form of a car accident and they divided those car accident survivors into two groups the first group was given a log to complete so they simply completed a log of what happened since they got to the emergency room and kind of documented what happened the second group were asked to engage in a visually absorbing task for 20 minutes and what was that task they were asked to play the computer game Tetris for 20 minutes lo and behold the tetris playing group when they were followed in the weeks that followed the car accident they were significantly less likely to have symptoms of PTSD so here we have this early evidence that if we can disrupt memory consolidation in the immediate aftermath of someone being exposed to trauma we might be able to thwart PTSD and that's really exciting news now the most common form of prevention that takes place on a day to day basis is tertiary prevention also known as early intervention so when we think of breast cancer or heart disease of course we know now early screening early detection early intervention saves lives will the same applies to PTSD the problem is a lot of PTSD sufferers simply do not get help only 1/3 will get the mental-health attention they need and there are many reasons for that there are many obstacles for sufferers getting help first of all PTSD is tough to diagnose so a lot of medical professionals either don't know how to diagnose it or they miss diagnose it secondly sufferers the very nature of PTSD makes it tough to treat people who live with PTSD they're avoidant they're mistrustful the last thing they want to do is talk about trauma they can be prickly so that immediately represents a barrier to them getting help thirdly even though it's true that any one of us could develop PTSD the reality is the socially disadvantaged they're the biggest brunt of PTSD and oftentimes they simply do not have access to high-quality mental health care and the fourth obstacle is this unfortunate societal stigma that still persists towards anybody seeking help for any mental health issue the problem with these obstacles is when people do not get help for PTSD in a timely fashion remission rates plummet and they just suffer needlessly for years and years now I've spent ten years trying to figure out how to overcome these obstacles and I want to share one solution with you today a solution that sounds simple but it's cutting-edge and remarkably effective ten years ago I ditched my regular psychiatrist office so you can imagine my office was on this leafy campus with comfortable chairs and a nice rug and nice wall furnishings and I ditched it and I moved my office here a regular medical exam room in a regular medical clinic and why did I do that because people with PTSD they show up to see their regular doctor very few of them actually make it to see a psychiatrist so I figured if I move there I'll have more chance of being able to help them because location really matters in my experience the stigma about addressing mental health issues just dissolves when primary care and mental health are integrated in this way I think it's because as a medical profession we send a really clear message that there is no health without mental health I've been doing this clinic for ten years and I feel like I'm seeing the patients I've always seen my entire career I'm just meeting them 20 years earlier when their symptoms were less entrenched and more amenable to treatment and that's not just my clinical experience the research backs it up to people with PTSD simply do better in these integrated care models and beyond the integrated care there's a lot of innovation of Foote PTSD treatment is being brought to emergency rooms intensive care units neonatal intensive care units because there's in this implicit understanding that we've gotta meet sufferers where there are not just psychologically and emotionally but physically where there are to be found even educators are being trained to be more trauma-informed and by that I mean recognize the signs and symptoms of trauma in children recognize how that impacts the way children learn and behave and play so that the process of education doesn't reach Ramat eyes children and that's where you all have a role to play too if you educate yourself about PTSD if you can recognize the signs and symptoms when you meet a trauma survivor you'll feel more empowered to be empathic and to help them and that's really important because the more trauma conscious we become as a society the more spontaneous avenues for healing open up for trauma survivors and the most spontaneous healing that goes on means there'll be less PTSD in our society and that's a truly wonderful thing for all of us thank you [Applause]

Channel: TEDx Talks

Views: 22,526

Rating: 4.909297 out of 5

Keywords: TEDxTalks, English, Health, Hardship, Medical research, Mental health, Tragedy

Id: __HB6yyMNUY

Length: 16min 46sec (1006 seconds)

Published: Tue Oct 22 2019