Exciting Treatments for PTSD: New Ways to Heal your Trauma

You. Hey there, everybody. Welcome to this presentation on emerging treatments for PTSD 2025. I'm your host, Dr. Donnelly Snipes. Today we're going to explore emerging treatments including emdr, CBT exposure therapy, medications, psychedelics, the gut microbiome, the vagus nerve transcription, cranial magnetic stimulation, sleep improvement, and oxytocin nasal spray. We'll start with emdr. And when I say cutting edge or emerging treatments, these are things that haven't been around for 20 years. EMDR is relatively new now. EMDR is sort of your gold standard right now, and it is effective for a lot of people. Not everybody, but for a lot of people. EMDR is a structured psychotherapy that encourages people to process traumatic memories while simultaneously engaging in bilateral stimulation through guided eye movements or sometimes tapping or auditory sounds. EMDR addresses symptoms such as intrusive thoughts, flashbacks, and heightened arousal by facilitating the reprocessing of that traumatic information. They believe that when we engage that bilateral stimulation, it puts our brain into a state very similar to REM sleep, where it's able to file some of that stuff and to reprocess some of that stuff more effectively. This promotes adaptive resolution, reducing stress associated with the trauma. I do have a video that goes much more into detail on how EMDR is done, but EMDR is one of those treatments that is really effective for a lot of people, especially people who have a singular acute trauma or a set of very distinct traumas. People who have CPTSD where the trauma was pretty much just every day, all day, may still benefit from it for sure. However, it may not be as dramatic of a resolution as somebody who has a very distinct episode. Cognitive behavioral therapies. Now, they have been around since sort of the beginning of time, but I think they're worth mentioning because there are more and more cognitive behavioral therapies coming out or therapies based on the cognitive behavioral premise. Cognitive processing therapy is one that actually started out for veterans. To help handle ptsd. CPT uses a set of questions that help people evaluate their thoughts and determine, based on the facts in context at this time, the. The accuracy and effectiveness of their beliefs and helps them look at the bigger picture of what actually happen. Because a lot of times we get tunnel vision when we're experiencing trauma. So cognitive processing therapy can be really awesome for helping people better conceptualize what happened. If they're thinking back to a time when they were a child and they experienced trauma, the cognitive processing therapist would have them step back and go, okay, you know, this is what you perceived. This is what you experienced, Tell me who else was there. Tell me what else was going on. Tell me which parts were and were not within your control. Tell me which parts of your beliefs are based on feelings versus facts. So they go through these questions to evaluate the situation. The therapist doesn't tell the person, you're right or you're wrong about this. They just say, let's look at this through a few different lenses. Let's add some information that you may not have noticed before and see if it changes your perception. And then once we've, you know, processed what, what happened, then let's figure out how those beliefs are helping you move toward your rich and meaningful life or keeping you from moving toward your rich and meaningful life. CPT helps people restructure maladaptive beliefs and develop a more balanced understanding of what happened, reducing symptoms of guilt, shame, and often intrusive thoughts. Those intrusive thoughts often happen when you feel guilt or shame or even anger. You have this thought that keeps coming up going, you're not safe, you're not okay. And when the person processes it and gets a more balanced perception, then the brain doesn't feel the need to keep alerting them to, you know, don't forget about this. Don't forget that there's this threat or vulnerability. Prolonged exposure therapy is another one that's been around for a while, and I think we're getting a lot more fine tuned with it. They're using VR for some of the prolonged exposure therapy, which is showing a lot of very promising effects for people. Through prolonged exposure therapy, the person is given gradual exposure to trauma related memories and stimuli in a controlled setting. Okay, so this is one of the things that's really important. It's a controlled setting, so the person feels safe before they even start approaching that memory, before they even start going into that situation. They feel safe, they feel in control. With VR, they can pull the headset off with VR, you know, hopefully we can help them stay in the moment and feel safe through the use of our voice and our presence. But if not, they're able to leave the situation, which is excellent. People are able, with this process to confront and process distressing memories with their wise mind. And why do I say with their wise mind? Because when we have a distressing memory, when we have a flashback, we are essentially back in fight or flight. And we know that people are not nearly as able to think clearly and make good decisions and process based on facts when they're in fight or flight. Fight or flight uses almost exclusively emotional reasoning. When people Are using their wise mind, they. It means they're in that situation, but they're not feeling terrified, they're not feeling enraged. They're able to look at it more objectively, Saying that all the feelings are not going to be there. That's not realistic. But they're able to downregulate enough to be able to think a little bit more clearly about what's going on and understand the situation based on the. The actual facts, not their. Not only their emotional perceptions. Prolonged exposure therapy diminishes avoidance behaviors and reduces flashbacks and hyperarousal and desensitizes to triggers. Well, it makes sense when you approach something. If I'm afraid of spiders, which I'm not, I love them, but if I were and I didn't want to go near a spider, if I went through desensitization processes, which is very similar to prolonged exposure therapy, I would get used to being around the spider. So initially it might cause me distress to think, oh my gosh, it's right there. But eventually I would be able to be in the presence of the spider and recognize it's really not a threat to me. So my stress response wouldn't trigger as much. Therefore, I wouldn't be as motivated to avoid places Where I might run into spiders. Because I've developed a different relationship with spiders with that trigger. It reduces flashbacks again because the brain has processed and started integrating a lot of that stuff. And when those flashbacks happen, they are less emotionally overwhelming and distressing to the person, and they feel more safer and more empowered to handle that flashback and recognize, yeah, that sucked in that moment, I felt awful. And I'm in the present right now, and I can. I have tools I can use in order to manage this. And hyperarousal again, we'll go back to the spiders. If I have a different relationship with those spiders, if I have developed an understanding that they're really not interested in me, they're not going to approach me, they don't want to hurt me, Then when I go out to the park, I'm not going to be hypervigilant for spiders Because I recognize they'd really rather me not be there, and they're not going to approach me because they know I can squish them. And it also desensitizes that people to triggers that are associated with that particular trauma. Traumatic event. For example, we'll go with soldiers being triggers that might set them off. Being around guns, hearing guns, fireworks, other things like that, they can start to develop a. Because they're less hyper Vigilant, because their nervous system is actually starting to heal, because they're not being triggered constantly. Their emotional reactions, their stress reactions, the neurochemical reactions are going to be less intense. So they're not going to be as triggered, if you will, in terms of medications, an oldie but goodie or well, an oldie at least. Selective serotonin reuptake inhibitors. Your SSRIs like Prozac, Paxil, Zoloft, these are FDA approved for PTSD to address symptoms of depression and anxiety by enhancing serotonin activity in the brain. Now, it doesn't address the hypervigilance, it doesn't address the flashbacks or the nightmares. It does help some with mood for some people. And again we want to go back to this person has ptsd, this person has these symptoms of ptsd. If this person has depression and anxiety related to their trauma, okie dokie, let's look at what is contributing to that. Is it a disruption in their serotonin or is it that they are not getting enough sleep and their circadian rhythms are out of whack and something else is out of balance? So we need to take a more holistic approach to figure out is the SSRI solving a problem or merely covering it up. Prazoin, Prazo, Prazosin, sorry, Originally used for hypertension, has been found effective in reducing nightmares and sleep disturbances associated with PTSD by blocking alpha 1 adrenergic receptors linked to hyper arousal. Your adrenergic receptors think adrenaline. When they are not activated as much, then people can feel less hypervigilant, people can feel less stressed, less tense and so that can help in reducing the stress reaction. This is another one. It is a, in my opinion, a tool that can be used temporarily to help sort of mask a symptom while we heal what's causing it. The underlying, the underlying issue. But on its own it's not solving anything, it's just kind of covering it up. Now we're going to move into psychedelics and I know there's a lot of controversy here. I'm not advocating or negating psychedelics, but I think it's important we recognize that some of the standard treatments don't work for every person. And every person deserves to be able to live their rich and meaningful life. MDMA is the first one we're going to talk about. And MDMA may facilitate emotional processing by increasing feelings of trust and reducing fear responses, thereby addressing avoidance and hypervigilance. So when the person starts to feel less anxious and more trusting in the therapy session. Then they're able to approach that memory and feel safer, feel potentially more empowered, but feel like they can trust their therapist, feel like they can trust this, the system or whatever to keep them safe. And that's really at the core, as I've said so many times, of healing trauma. People need to feel safe and empowered. So MDMA can help alter people's perception of a situation. MDMA assisted therapy in some studies, in this one significantly reduced PTSD symptoms compared to a placebo. Okay, that's good. The MDMA group showed a greater reduction in symptoms. By the end of the study. 71.2% of MDMA treated participants no longer met PTSD criteria. Wow. 71.2%. That's awesome. And it's not. They're not just taking MDMA and then going to sleep. They're taking. It's MDMA assisted therapy. MDMA helps them get into the mental space where they can approach and reprocess those memories. For some people, which is earlier I said EMDR doesn't work for everybody. For some people, they can't let go enough. They can't feel safe enough. Their fear responses are too strong for them to be able to be as effective in emdr. The FDA has not approved MDMA for ptsd, citing the need for further research. This is one of those you'd have to look for a clinical trial. Psilocybin is the next one we're going to talk about. It has been shown to reduce amygdala reactivity, our emotion, especially fear processing, and enhance fear extinction during deep introspection and emotional processing. So that's really interesting. When people start using their wise mind and really thinking about a situation and the past. The psilocybin keeps their amygdala from. From becoming overactive and basically kicking them into fight or flee. So they are able to approach the situation, think about the situation, process the situation, and feel less fear. They can approach it and say, okay, I did that, I approached it, I thought about it, and it didn't consume me. Psilocybin also, and this is a huge benefit, long term, increases hippocampal neurogenesis, which is helpful for memory formation and emotional regulation. We've talked before about how when we are chronically stressed, the environment in the brain becomes neurotoxic and we start losing brain cells. Neurogenesis is just the opposite. Neurogenesis is when the environment is conducive to rebuilding brain cells and rebuilding connections. And the hippoc is where we do a lot of our Emotional processing and memory formation. So psilocybin actually helps us heal part of the brain. This is again not one of those things that people are given a bottle of psilocybin and told to go home and take it three times a day. Now that's not how it works. In the COMP360 study, which is a 2024 study, a single 25 milligram dose of psilocybin with counseling psilocybin with counseling resulted in 81.8 of participants experiencing significant improvement and 63.6 achieving remission from their symptoms by week four. And the effects were maintained at about that same level for each person at week 12. So that indicated to the researchers that something changed in the brain. That's where we start seeing that neurogenesis and benefits. There was another 2024 study that found significant improvements in psychological flexibility, mindfulness and valued living psilocybin plus acceptance and commitment therapy based interventions. These improvements correlated with reductions in depression severity as well as PTSD symptoms which it makes sense. When we are in fight or flight, we don't have good psychological flexibility. We are focused on survival. We're not focused on looking at the options considering, you know, different perspectives. That's not what we're worried about. We're running from the hungry lion. So when people are able to feel less stressed, when people are able to get that amygdala under, under control a little bit and start rebuilding the autonomic nervous system, they will develop greater psychological flexibility, mindfulness and valued living. Those are principle components of acceptance and commitment therapy. So obviously adding ACT helped. The next psychedelic we're going to talk about is LSD. LSD in LSD assisted therapy is being dosed in really high doses. 100 to 200 micrograms was indicated for use in LSD assisted psychotherapy. Now LSD's assisted psychotherapy is recommended for later stages of therapy after a lot of the trauma processing has been done because it is more geared toward helping people address negative self beliefs that are deeply anchored in their personality. These core schema that they formed about themselves as a result of the trauma. LSD can help them kind of unhook from those and evaluate them more objectively. It does this through a process called ego dissolution, which sounds kind of scary. And again I mentioned it's a really high dose. 100 to 200 micrograms is needed depending on the person and a lot of other factors. But Generally at least 100 micrograms is needed to promote ego dissolution. Ego dissolution correlates with increased Functional connectivity in the brain and connectivity between parts of the brain that don't usually talk to each other. It's like all the different parts of the brain wake up and they're like, hey, never knew you were over there. And I'm not sure exactly how this benefits in the recovery process, but it does contribute to the benef, the ability of LSD and in the state of eco dissolution to alter brain functioning networks including the default mode Network, the Salience network and the Dorsal Attention network. We've talked before about these networks and Default mode network is your autopilot. With LSD people are able to turn off that autopilot and then reprogram it basically. And that's important. With the LSD assisted psychotherapy they found that people were able to alter what they paid attention to and what they gave more weight to. The salience of information is how much we care about things we see and whether we remember it or not. And so it's really interesting how when our brain is in this very sort of fluid state, we are able to alter some of our cognitions. The therapy model observed improvement in trauma lad trauma related depression with 8 out of 12 patients experiencing complete remission and 4 showing improvement. That, that's a really good number. And all of these numbers for the psychedelics, I'm sorry to say all of these numbers for the psychedelics are far superior to your traditional SSRIs. And yes, they bring risks with them. LSD for example, is a rule out drug, if you will, for people who are in law enforcement and maybe the military because it can trigger dissociative states years, even years later occasionally. So there are some concerns about LSD for. Long term side effects, but it is showing a lot of short term promise. The treatment of complex PTSD or CPTSD required more psychedelic experiences than single trauma PTSD with patients receiving between 1 to 12 LSD applications. Now let's think about this for a second. People with complex PTSD have a whole lot more schema and a whole lot more triggers that have been associated with, with that trauma. So it may take more time to sort through all of that stuff. However, it is promising that for that particular population because there's not a lot out there right now that addresses the symptoms of cptsd. Mescaline and DMT are considered classical psychedelics but, but they are in the early stages of investigation. There's like virtually no published research on them, especially as it relates to ptsd. But I did want to mention, because I know somebody's going to ask about it I did want to mention that it is out there and may come to the forefront in the next couple of years. Trauma sensitive Yoga studies indicate that trauma sensitive yoga can help reduce PTSD symptoms and improve overall well being, especially in patients without a history of sexual trauma. Soldiers found it to be very helpful. People who've experienced other types of trauma have found it to be very helpful. People who've experienced sexual trauma, it's a lot more mixed. During trauma sensitive yoga, participants stay present and focused on their current experience, which reduces the risk of retriggering past traumas. They stay focused on where, when and who they are right now and they're really encouraged to articulate that. People who experience sexual abuse may have focused on their somatic sensations during the abuse. So doing so in trauma sensitive yoga can actually re traumatize and re trigger that trauma. Therefore, if somebody has sexual abuse in their history, especially if they haven't done a whole lot of processing of it already, it is cautioned to use trauma sensitive yoga with them especially early in the process. Trauma sensitive yoga focuses focuses on mindfulness and body awareness which can help individuals reconnect with their bodies and emotions. This approach may be beneficial for those who experience somatic complaints and dissociation. I've told you all before about a patient I worked with who sadly as a child experienced significant abuse at the hands of her mother. And whenever she'd go into the kitchen in her current house and and try to make her meals, she would dissociate because she remembered episodes of getting beaten for making too much noise in the kitchen. Trauma sensitive yoga would be helpful there because she needs to be able to learn how to stay focused in the present. But there isn't that somatic component to the trauma. Participants often report positive experiences including feelings of safety, comfort and empowerment. And the gut microbiome. Again, yes, it's being looked at for just about everything, which is good, but I know you get tired of may get tired of hearing about the gut microbiome, but it is so important. The brain gut microbiome system, BGMB is so important in regulating our autonomic nervous system, our fight or flight and our rest and digest. So we need to make sure that gut is healthy. Traumatic experiences disrupt the brain gut microbiome system leading to neuroinflammation, altered neuroplasticity, which together may contribute to PTSD symptoms. We when we get stressed, our environment in our gut changes. The microbiome microbes in our gut changes because they bring in the crew that is designed to help Prepare the fight or flight chemicals and help us handle the threat. Not the crew that's designed to help create GABA and all those feel good, wonderful chemicals. So the crew, if you will, the microbes and that are in there and the peptides that are in there when we're stressed are different and the environment is very different. So the signaling from the gut to the brain through the vagus nerve is very different. Individuals with PTSD and trauma exposed controls. Now this is an important part. PTSD is what I call traumatic injury. You can experience trauma and process it and integrate it and move on. Not everybody who experiences trauma develops ptsd. So they looked at people. All of the people had experienced trauma, but only half of the group had ex developed PTSD from it. So they looked at people who experienced trauma and, and found that the people who developed PTSD had a persistently different makeup of their gut microbiome compared to the people who did not develop ptsd. They determined that the microbes influence the vagus nerve signaling and the PTSD symptoms. So the people with PTSD have a proliferation of, of those, we'll call them stress microbes and stress signaling. So even when the relaxation microbes want to come in, they're still overwhelmed and dominated by the, the stress microbes. Lifestyle interventions to restore gut microbiota balance may potentially alleviate PTSD symptoms by reducing neuroinflammation and promoting neural resistance. That neuroinflammation, you're thinking to yourself, well, how does this all relate? We're talking about the gut. How does it make the brain inflame? There are a couple of different ways, but in general, when our stress levels are high, when our gut microbiome is signaling stress and it's telling our brain that our brain is saying, yep, it's a stressful situation, I'm hyper vigilant, I'm noticing all these threats. Eventually that system is going to disregulate and one of our main stress chemicals, cortisol, which normally suppresses inflammation, becomes completely ineffective. So we have rampant inflammation. We also see changes in the gut microbiome where a lot of 90% of our serotonin is made that cause the mucus layer inside our gut to become more permeable. So the toxins that are produced in our, in our GI system, instead of just going out like they're supposed to, can actually permeate into the bloodstream and then come up and cross the blood brain barrier and again cause neuroinflammation. So we really want to keep that microbiome healthy. Because it reduces inflammation and it improves or alters the signaling. So our gut is saying to the brain, hey, no problems out here. The vagus nerve connects the gut to the brain, but it also connects every, pretty much every other organ to the brain. The vagus nerve is the wandering nerve. Vagus nerve stimulation involves the application of electrical impulses to the vagus nerve, which is a critical component of the parasympathetic or the relaxation nervous system that is involved in the stress response. The original vagus nerve devices were and still are implanted almost like a pacemaker. They're implanted under the skin and they actually directly stimulate that vagus nerve. Now that's invasive. A lot of people don't want invasive, and sometimes it doesn't qualify per insurance for in the invasive technique. Okay. So they've developed a lot of other strategies. Non invasive vagus nerve stimulation devices deliver stimulation to the vagus nerve through the skin. And we've talked before, One of the easiest places to access the vagus nerve is through the tragus, which is the little flap on the ear, and right up here, sort of over your temple. And you have a lot of nerve endings there that feed into the vagus nerve through the trigeminal nerve and the vagus nerve. And by stimulating those areas, you are able to stimulate the vagus nerve. When the vagus nerve is stimulated, it helps trigger the rest and digest. So think about, you know, normally your relaxation response is trying to kick in, but the stress response is just, it's too powerful. So what you're doing is you're adding power to it literally by stimulating that vagus nerve and you're strengthening the vagus nerve signal to the brain to say, hey, you know, look over here. You know, I'm actually here. And helps the person start feeling more relaxed. When the vagus nerve is triggered, when the brain actually starts paying attention to it, then it starts releasing GABA and your relaxation hormones active. Vagus nerve training is what I call it involves using biofeedback to activate and strengthen the vagus nerve. And we've talked about this before in many other classes. Start out with somebody wearing like a polar chest strap. That's the best because it gives you pretty much real time data from your heart. Your wearable devices are often about 30 seconds behind, and that's just doesn't work as effectively. But a polar heart rate strap is relatively accurate. And you can have somebody put it on and they app on their phone. You go out, you walk around the building or something and get their Heart rate up a little bit. And then you come in and you sit down, you help them practice deep breathing or some whatever else they want to practice to slow their breathing and their heart rate so they learn how to. When their heart rate's up, they see that they can actively make it go down. And when we engage in high intensity interval training, that's one of the things we do as exercisers. I don't know that I call myself an athlete anymore because I will do a work episode and I'll get my heart rate up to 98, 99 of my max. But then my goal is to be able to bring it back to 70% of my max in the no more amount of time than it took for me to get up to the top. So if I takes me a minute to get up to the top, I, I need to be back to baseline in a minute or less. And that is my challenge to myself, I guess. But by doing that, I am actively strengthening my vagus nerve. It's getting stronger and it's able to go in even when my heart rate's at 171 beats a minute, it's able to go in and go, okay, relaxation time. Y' all need to just chill out. And you can see the heart rate go down. And it's very validating. I don't know, I guess maybe I enjoy it way too much. But to be able to know that you can reduce your heart rate that effectively. We can do the same thing with anxiety, but when people are learning how to do it, ideally I don't want to start out by saying, okay, let's get you all real stressed out and then I'll help you figure out how to get back to baseline. That sounds pretty horrid. So we generally start with physical activity until they develop a belief in their ability to rapidly bring down their heart rate and rapidly trigger that relaxation response. You can also do it with blood pressure cuffs, but again, that's something that's a little bit more delayed. And you take your blood pressure, you practice some down regulation techniques and then you take your blood pressure again. And it's not quite as reinforcing, if you will, as being able to watch that little graph on the mobile device. Vegas nerve stimulation helps reduce hyper arousal and anxiety symptoms by enhancing parasympathetic tone. It enhances the strength of the rest and digest nervous system, so it's able to battle, if you will, or turn, turn off the stress response. Why is this important? With people with pds, ptsd, their stress response is uber Strong and their relaxation response is very weak. Even when they want to relax, that relaxation response can't dominate, can't turn off the stress response, which means the person's constantly stressed. When we're constantly stressed, we cause sleep problems. Neuroinflammation, all of these things further trigger the stress response and hypervigilance and a lot of the symptoms that are associated with ptsd. When you look at ptsd, most of those symptoms can be attributed to the stress response. So if people develop the ability to feel like they can better manage their stress response, it is extremely empowering. Auricular transcutaneous vagus nerve stimulation stimulates the auricular, which means ear, branch of the vagus nerve to influence the central nervous system and modulate stress responses. Auricular vagus nerve stimulation modulates the autonomic nervous system by affecting PTSD related neural networks, including the prefrontal cortex, the hippocampus and the amygdala. So where we think, where we process a lot of our memories and fear processing, those are all stimulated by the, the trigeminal nerve and the vagus, vagus nerve here, which is why the ear clips and ear devices that stimulate the vagus nerve have been started becoming so popular. Auricular vagus nervous nerve stimulation can influence autonomic activity, potentially offering a non invasive method to modulate the ANS function. In conditions like PTSD where ANS disregulation is present, really what we're doing is we are strengthening. Even if you are electrically, mechanically strengthening that parasympathetic response, what happens? Well, that is turned on and then the stress response is turned off. That's good. Then we start seeing inflammation reduce, we start seeing the gut microbiome change out. We start seeing changes in the physiology of the person. We start seeing them able to sleep a little bit better. All of these things contribute to healing of the autonomic nervous system and reduction of stress and sleep issues and hypervigilance. Transcranial magnetic stimulation, we talked about it for depression and anxiety. We're going to talk about it again because we're trying to figure out different ways besides drugs and cognitive behavioral therapy to activate parts of the brain that have become inactive or that have become overactive. TMS is non invasive neuromodulation that uses magnetic fields to stimulate specific brain regions by targeting the prefrontal cortex, where we use do our executive processing. TMS modulates neural circuits involved in emotion processing and executive function. So you have parts of your brain that process emotions, but then you have parts of your brain that process emotions and executive functioning where you understand, where you reason, where you plan, where you problem solve. So by activating the prefrontal cortex and enabling it to effectively use those executive functions to help process those memories, people are better able to integrate what happened. TMS has shown promise in addressing depressive symptoms in ptsd. A Cochrane review, which is one of those big meta analysis that they do, assess the effect efficacy of repetitive TMS in PTSD treatment, indicating potential benefits, but calling for further high quality trials to establish definitive conclusions. Quite honestly, I can't ever remember a Cochrane review that I've seen in behavioral health that hasn't said we need further high quality clinical trials. TMS is commercially available now. It's not one that you have to go to a clinical trial for. Sleep. Sleep is another wonderful thing that we need to address in terms of treatment. And sleep dysregulation can exacerbate symptoms by dysregulating the stress response, the hypothalamic pituitary axis, the HPA axis, otherwise known as the sympathetic nervous system or the stress response. We call it a lot of different things, doesn't matter what you call it, when you don't get enough sleep, it's activated. Improving sleep quality can help restore the balance between the sympathetic and the parasympathetic nervous system, relaxation and stress, reducing cortisol disregulation and mitigating the stress response. Interventions targeting sleep aim to alleviate insomnia, reduce nightmares and decrease overall hyper arousal. When we don't get enough sleep, we have more difficulty controlling our thoughts. We have more difficulty with intrusive thoughts and ruminations and those intrusive thoughts and ruminations. And people with PTSD are often about feeling unsafe and powerless. The nightmares can be exhausting in and of themselves, but they can also bring up those memories. And when people are feeling unsafe, when they're feeling like their brain is just gonna give them a flashback or an intrusive thought, or wake them up with a nightmare at any time, then they stay tense and they stay hyper aroused. So reducing sleep disruption is huge now and I've cited this study a bunch of times. I'm gonna talk about it again. Up to 75% of people with PTSD, irrespective of their weight, experience obstructive sleep apnea. And they've determined that the obstructive sleep apnea, the osa, is caused by tension as a result of the hyper vigilance and that tension that the people with PTSD experience can cause them to develop Obstructive sleep apnea. People with obstructive sleep apnea are not going to get good quality sleep until it's addressed. Now if they get on a CPAP machine or something, then you know, there's certainly hope, there are treatments. But if you've got somebody with ptsd, it's almost required to assess them, to screen them for sleep apnea because your interventions are going to be so much more effective if they're getting good quality sleep. A systematic review emphasized the bi directional relationship between sleep disturbances and PTSD suggested suggesting that addressing sleep issues positively impacts PTSD outcomes. When people get enough sleep, they're not as hypervigilant, their stress response is not as overactive, they may feel less emotional numbing. Behavioral therapies and pharmacological interventions that enhance sleep quality have been associated with improved PTSD symptoms. They do have cognitive behavioral therapy for insomnia. If you've got a patient who may not have sleep apnea, but they have insomnia, they have difficulty actually ever getting to sleep. And finally, oxytocin. Oxytocin is a neuropeptide involved in social bonding. We've talked about it so many times. It's the love hormone. It's also a super powerful anti inflammatory and we keep talking about the stress response being dysregulated in people with PTSD causing neuroinflammation and causing damage, you know, cell, cell death. So what we do want that neuroinflammation to go down when we don't have as much inflammation. We have, it alters our gut microbes, it alters our hormone balances, it alters our neurotransmitter balances, it alters our circadian rhythms. It's just wonderful when we get rid of all this inflammation. So oxytocin is involved in social bonding and stress and inflammation regulation and has been explored as a potential treatment for ptsd. Administered intranasally through a nasal spray, oxytocin is thought to enhance social cognition and attenuate amygdala activity. So it enhances awareness of other people and improves the person's ability to interpret other people's non verbals. Because their amygdala is not hyperactive, their amygdala is not saying person danger, person danger. So the, so the person with PTSD can't focus. They are identifying that oxytocin can actually help reduce that fear response so the individual can feel safer. Among people. Oxytocin primarily targets social withdrawal, emotional numbing and hypervigilance. By promoting feelings of trust and safety. This is something we talk a lot about. Oxytocin and bonding in mothers and babies and in mothers and babies. This is one of the main functions of oxytocin to help the baby develop a sense of trust and feel safe. Well, that doesn't go away when we get older. Oxytocin helps us feel more trusting and safer. Intranasal oxytocin can reduce PTSD symptoms. In this particular study, it was in female patients, particularly by decreasing avoidance behaviors. Well, it makes sense if your amygdala is not hyperactive. If you're not feeling completely fearful and stressed out, you're likely going to be less avoidant of things. Your holistic treatment goals reduce autonomic dysregulation. We want to help people re regulate their stress response. PTSD has caused them to be perpetually stressed and that sympathetic nervous system to take on a life of its own. And the parasympathetic nervous system kind of fades to the background. They're supposed to be roughly equal. So we need to help them feel safe enough that they're not constantly triggering that stress response. And we need to help them strengthen that parasympathetic nervous system so when they do recognize that, hey, there's nothing to be stressed about, that parasympathetic nervous system can actually kick in and turn down the stress response. We want to help them develop reduced emotional reactivity. Part of that is by healing the nervous system. Part of that is by helping them develop skills to manage their emotional reactions. When we reduce autonomic dysregulation, it helps reduce emotional reactivity, which helps reduce, when they're not feeling reactive and, and, you know, getting stressed out all the time, we actually see a reduction in hyper vigilance when we're not as hyper vigilant. When we're not feeling like a soldier in a foxhole, we get improved sleep. When we get improved sleep and our autonomic nervous system's working and the parasympathetic nervous system is able to do its job. Then we see the gut biome start to rebalance itself and those rest and digest microbes start multiplying again and developing a stronger team, which all of that leads to reduced systemic and neuro inflammation. Physically, we want to target, if we want to talk about very specific goals, circadian rhythm regulation, this is something we can do without any of those other things. But if somebody's having difficulty sleeping, for example, we can help them develop tools to downregulate that can include vagus Nerve stimulation to help them relax enough so they can get to sleep. So improve circadian rhythms, improve sleep. Encourage them to explore an anti inflammatory diet with pre and probiotics which is basically fiber and fermented foods whether it's kefir or yogurt or sauerkraut and then and soluble and insoluble fibers. Exercise. Oh, a lot of people hate exercise. You can do something fun. Clean the house, play with the dog, I don't care. Turn, put on your headphones and dance around the house like nobody's watching. Doesn't matter. Get your heart rate up a little bit. That helps reduce cortisol, reduces endorphins or releases endorphins your feel good chemicals and improves vagal tone. When we exercise, our brain says hey, lots of activity for some reason we're going to trigger the stress response, we're going to increase the heart rate. But then when you stop exercising your brain goes okay, not moving, we can calm down. So that's what it's supposed to do. And we can help people actually focus on improving vagal tone through transcutaneous through the skin oricular vagus nerve stimulation. So using a stimul ear stimulation device or active vagus nerve training through biofeedback interpersonally we want to help them develop a support system. We want to address guilt and shame. We want to help them improve their sense of self esteem and self efficacy and reconceptualize themselves as safe and empowered in their own skin as well as in their world emotionally. We want to enhance distress tolerance skills, help them mindfully improve awareness of their emotions, their cues and their triggers so again they don't feel like they get punched in the stomach when they go to the store and there's a trigger there. They're like okay, I know what that trigger is and I know how to handle it. I'm okay with this. Exposure therapy and systematic desensitization and reprocessing can also be helpful for addressing some of those emotions cognitively. Cognitive processing and restructuring based on CPT which uses a focus on FitCat the facts in this context at this time and using a strengths and empowerment focus. What do you have control over? Yeah, there are things you don't have control over, but what do you have control over? Environmentally we want to identify and manage trauma triggers. For example sights, sounds, smells, etc. 4th of July and New Year's Eve are horrid for a lot of soldiers who have PTSD because of the fireworks and we know they're going to happen. So planning for those ahead of time, knowing they're going to happen and figuring out, okay, how am I going to manage this? This is what I call an in, an inevitable trigger. However, it doesn't have to trigger me. I don't have to sit here and go, okay, fireworks are getting ready to go off. Countdown to traumatic reaction in 3, 2, 1. No. I can develop tools like wearing headphones or turning up the music really loud or. Or whatever it is. There are a lot of different strategies people use to manage different triggers and identify and increase triggers that help the person feel safe and empowered. What is it that can help them feel safer and empowered? An emotional support animal. Okay. Adding an extra lock to the door and maybe motion activated outside lights. Okay. What is it that can help you feel safe and empowered in your environment? Trauma represents an extreme stressor. I don't care who you are. Unresolved trauma leads to dysregulation of the autonomic nervous system and a cascade of stress related physical and psychological symptoms. Resolving trauma requires being able to reconceptualize the trauma in your wise mind, to understand what happened, to process it, to grieve it, to do whatever you need to do with it, and to integrate it. It's not going away. So how is that experience going to impact you? Henceforth develop tools to feel safe and empowered in your skin so your thoughts and your nightmares and whatever else don't terrify you and in your environment and rebalance the autonomic nervous system to reduce sympathetic dominance and everything that goes with it. Are there any questions? You are quite welcome, Alyssa. Thank you for being here. I'm glad it was helpful. It. All right, if there are no questions. You know, Crystal, I'm not really familiar with electroshock therapy and how they're using it anymore. I do know it sort of resets the electric signaling in the brain. My understanding is it's far less targeted than transcranial magnetic stimulation. Everyone have an absolutely amazing rest of your day.