Bobby Miller
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Technology for the Mind: Treating PTSD and Other Anxiety Disorders
1,900 words
It’s shocking how many people suffer from anxiety disorders. It has been estimated that anywhere from 5 to 20 percent of children cope with an anxiety disorder. Roughly 18 percent of adults are in the same situation, according to the Archives of General Psychiatry.
Due to the wars in Iraq and Afghanistan, one of the most prominent anxiety disorders in America today is post-traumatic stress disorder (PTSD). The condition is characterized by frightening memories of a painful or disturbing experience. These flashbacks are strong enough to make the person feel as if he or she is actually reliving the event. Ordeals such as war, natural disasters and rape are common causes of PTSD. Their effects are intense enough to alter the physiology of the brain.
According to At Ease USA, an organization dedicated to the treatment of soldiers with PTSD, one in four soldiers returning home from Iraq or Afghanistan suffers from a psychological disorder of some sort, and it is usually PTSD. Up to 11 percent of soldiers returning from Afghanistan suffer from the disorder, and up to 20 percent of troops returning from Iraq must deal with the disease as well. Aside from the huge emotional toll that accompanies the disorder, there is a significant financial toll as well. The U.S. Department of Veterans Affairs has reported that $4.3 billion in taxpayers’ dollars is set aside for PTSD victims’ disability payments every year.
Attention Bias Modification (ABM)
However, a cost-effective means of treating PTSD might be just around the corner. At Ease USA is experimenting with a new type of therapy called Attention Bias Modification (ABM). Yair Bar-Haim, who holds a doctorate in clinical psychology, has used ABM to treat other anxiety disorders. His studies, published in the Journal of Child Psychology and Psychiatry, have shown promising results. The treatment is based on the fact that people with anxiety disorders are more likely than the general population to view the world around them as a negative, threatening force. For instance, individuals with arachnophobia overestimate the potential threat of spiders. Similarly, people with PTSD are likely to see disturbing traces of their traumatic memory in seemingly innocent situations. A victim of wartime trauma may, for example, interpret a loud noise as a gunshot.
The goal of ABM is to help the individual guide his or her attention away from threatening stimuli and towards neutral stimuli. The therapy uses a series of “dot-probe tasks” to accomplish this. The patient is asked to identify where a certain symbol (such as “:”) appears on a computer screen. Before the symbol is shown, two words or images briefly appear, one on the top, one on the bottom. One word or image is neutral (for instance, “ivy”). The other is threatening (for instance, “gun”). After that, the symbol will appear on either the top or the bottom. It has been shown that people with anxiety disorders are usually able to find the symbol more quickly when it takes the place of the threatening word or image.
ABM seeks to reverse this by regularly placing the symbol where the neutral word or image appears. This implicitly forces the patient to guide his or her attention away from the threats and towards the innocent material.
It takes hundreds of trials for ABM to work, but it has proven effective in the treatment of other anxiety disorders. Yair Bar-Haim tested it on people with social phobia, that is, a fear of being around others. As a result of the treatment, 72 percent of his patients improved, whereas only 11 percent of patients in the control group showed any progress. A higher number of sessions usually resulted in more long-term benefits, though further testing is necessary to determine what the optimal amount is. In addition to treating social phobias, Bar-Haim has used ABM to reduce people’s short-term stress. For example, the procedure has helped college students relax before taking their finals.
Since the treatment has been so effective in treating anxiety, At Ease USA researchers are confident that it can assist those suffering from PTSD. In order to verify that ABM produces real results, researchers will look at patients’ brain patterns using magnetoencephalography (MEG) technology. This advanced technology, found only in about 20 U.S. facilities, shows 3-D, real-time images of a person’s brain activity. If ABM can treat PTSD, then At Ease USA should find reduced activity in brain centers believed to be responsible for PTSD symptoms. Since April, veterans with PTSD have been able to apply for a spot in this experiment. The study will not be complete until December 2014.
If the experiment proves successful, it can revolutionize PTSD treatment in the U.S. Since ABM treatment is done on a computer, it can be accessed through the Internet, allowing victims of PTSD to find help privately. This is extremely significant due to the huge amount of stigma surrounding PTSD. Many soldiers perceive themselves as weak if they suffer from the condition, or they fear getting kicked out of the military if they confess to having it. Since the military does not offer a Purple Heart to a PTSD victim, it is easy for a soldier to perceive the disorder as something wrong with his or her own willpower as opposed to a real medical condition. For these reasons, the Government Accountability Office (GAO) estimates that PTSD might be underreported by as much as 60 percent.
In addition to drawing in people reluctant to share their condition with others, ABM can also help those who have a resistant attitude towards treatment. One huge problem with almost any anxiety disorder is that people usually do not confront their fears, but rather avoid them. For instance, people who have an intense fear of water will probably avoid pools rather than try to ease themselves into one. Although avoiding the source of a fear may bring comfort in the short term, it ultimately reinforces the fear by training the person to flee from it.
ABM overcomes this by working on an implicit level. Let’s say we’re treating someone with PTSD. We will not always show a pair of words where one is threatening (“gun”) and the other is neutral (“ivy”). If we do that all the time, then the person might grow disturbed by all the threatening words or simply grow resistant due to how obvious the associations are. To avoid this, some pairs of words will be completely irrelevant, like “book” and “glasses.” This puts the person at ease, allowing us to challenge his or her preexisting biases towards anxiety at a gentle pace. In fact, as Bar-Haim points out, the vast majority of patients in early ABM trials believed that they were assigned to the placebo control group. They would be surprised to learn that many of them were actually receiving treatment.
Herein lies an important advantage of ABM over traditional forms of treatment, namely, cognitive-behavioral therapy. ABM operates by gradually changing how sub-cortical neural circuits make associations: this is not something available to conscious thought. Other forms of treatment, ones that try to change how a person consciously thinks about the source of anxiety, fail to influence a person on this level. For this reason, traditional forms of anxiety treatment only work on about half of patients.
Other Forms of Treatment
Still, conscious treatment of PTSD and other anxiety disorders can help 50 percent of the time, so it should not be overlooked. Many experts believe that ABM should be used to complement cognitive-behavioral therapy, not usurp it.
ABM is not the only form of anxiety treatment that uses computer technology: in fact, many different approaches use computers. For instance, programs such as Beating the Blues and FearFighter allow patients to receive private treatment from the comfort of their homes. These tend to work on a conscious level, encouraging patients to think realistically.
Virtual reality has also proven effective in anxiety treatment. Although it is counterproductive to avoid the source of a fear, it is also counterproductive to force PTSD victims to return right to the location where they experienced the original trauma. Exposure therapy must be gradual, and virtual reality helps doctors to control the rate at which people confront their fears. Therapists begin by creating virtual worlds that only loosely involve the patient’s fears, and then they slowly work up to worlds very similar to the actual traumatic scene. Since patients are mostly in control, virtual reality allows them to overcome feelings of helplessness and regain their self-esteem.
This treatment does not need to be expensive. In fact, the free online game Second Life (depicted here) has a thriving community full of therapists and patients specifically dedicated to PTSD. The U.S. Army Training and Doctrine Command even hosts two islands for soldiers in the virtual world. There are even some therapists who have desensitized their patients through video games such as Doom.
Strangely enough, a study carried out by a little place called the University of Oxford has also found that Tetris might help PTSD victims. Yep, that block-turning timewaster might actually have therapeutic value. You see, PTSD usually involves having flashbacks to the traumatic event; as in, your brain visualizes that scene. In Tetris, you can only do well if you visualize how, exactly, you’re going to use the given shapes to form lines. You’re giving your visualization brain muscles a workout. So, by playing Tetris, a PTSD victim will have less visualization energy to devote to flashbacks. It also allows the person to better control their visualization techniques. This treatment is particularly effective if used shortly after the traumatic experience, so soldiers can benefit from having a Tetris app ready on their smartphones. By playing it right after a difficult experience, they will be less likely to solidify the images into their long-term visual memory. However, it must be conceded that the study was performed with only a small sample and has yet to be replicated. Also, any puzzle game involving visualization would probably yield similar results.
The Internet provides one more path for treatment of psychological disorders. In real life, some people participate in group therapy, where they can discuss their troubles with others and find that they are not alone. This is not always a viable option, however. Some people are too shy to participate in these groups, and some people have unusual psychological disorders, making it difficult to find others dealing with similar issues. On the Internet, though, people can find carefully moderated forums dedicated to individuals with psychological disorders. The site Mental Earth Community is an example of this. Experts such as Dr. Azy Barak have confirmed that online communities can yield positive results, especially for people that feel lonely.
Not everyone reacts the same way to a medication. If that were the case, you would not find so many different kinds of pills for the same condition, such as seasonal allergies. Treatment of psychological disorders is the same way: no form of therapy will prove effective for all victims of a certain condition, such as PTSD. However, thanks to recent technological advances, people today have a wide variety of options as they seek treatment. Once they find the form of treatment that seems right for them, amazing progress can be made.
Bobby Miller originally wrote this article for the digital magazine Nvate in May of 2012. Due to its age, some of the information or links in the article may be outdated.