A new paradigm for an effective treatment for PTSD.
The NeuroTrophic Stimulation Therapy [NTST] program is a joint venture between the Last Door Recovery Society in New Westminster, BC; and myself, Poppi Sabhaney, Registered Acupuncturist [BC]. It is a program focused for service personnel and veterans who are Post Traumatic Stress Disorder [PTSD] survivors with co-morbid conditions such as alcohol and/or drug abuse. The NTST program is very comprehensive including both social model programs and counselling services in a residential environment.
It further includes holistic and medical components such as meditation, lifestyle and nutrition adjustments, and several forms of physical stimulation including: Neural Auricular Acupuncture, Cranial Electrotherapy Stimulation [CES], and Transcranial direct current stimulation [tDCS]. Each key medical component working synergistically to promote quicker neuroplasticity of the brain. This equates to a more effective treatment and recovery from both conditions.
When I see private patients in my clinic that outside of the NTST program, especially complex ones, I always recommend that they also work with a certified counsellor or therapist in conjunction with the treatments. The NTST medical treatments are effective to help heal the physical brain and body, but it’s really a team effort. I believe it’s highly valuable to work with other certified or licensed professionals to help with the social, emotional and psychological aspects of reintegrating PTSD survivors back into their lives.
And in this article I would like to use the term Post Traumatic Stress Injury [PTSi], instead of PTSD as General Peter Chiarelli, retired vice chief of staff of the U.S. Army states, “It’s not a disorder. It’s an injury” i . Which we will discuss in this article.
What does a traumatic brain injury [tbi], long-term emotional abuse, and an unhealthy diet have in common? All three can lead to dysfunctional brain responses due to different types of trauma to the body.
The traditional medical model viewed trauma as an experience, but didn’t always recognize that there may be certain physiological changes that can occur in the brain because if it. It can happen acutely or accumulate over time. And even longterm nutritional deficiencies can contribute to the likelihood of PTSi ii occurring. Luckily medical diagnostic technology has advanced and we can see what happens to the brain after a direct blow to the head, or several traumatic accident that leads to PTSi. It is now known that there is a usual pattern of prefrontal cortex and hippocampal shrinkage, and an overstimulation for the fear center of the brain, the amygdalaiii. And with this confirmation of changes in the brain posttraumatic stress can no longer be looked upon as a disorder, it is confirmed that it is a physical injury, and needs to be reassigned to the term PTSi.
In a healthy individual, when a traumatic event happens, signals and impulses are sent through the nervous system and into the brain. Neurotransmitters send signals that trigger chemical and hormone reactions leading to the activation of the body’s stress response. All in a split second. The 100 billion neurons (nerve cells) of the brain adjusts the switches and valve flows of the brain accordingly to get through the moment, and then turned off when it is over and brain-body homeostasis is restored by the parasympathetic system. There is a clear line between the beginning and end to the stressful stimulus. And the brain responds appropriately when in a healthy state, processing all the stimulus, and returning to normal resting states.
The saying, ‘you get what you think about most of time’; it’s good for learning and creating positive habits, but in the case of PTSi, where the mind is reliving the negative experience over and over. It is actually creating negative neural connections, or a ‘rut’, strengthening the negative pattern, and the physical neural network every time it’s activated.
‘Out of sight, out of mind’, is how the hidden emotional and psychosocial scars are treated, or better yet… forgotten to be treated. It’s easy to forget that a trauma victim can be continually reliving the past events and memories as the present moment. The brain is confused because its usual parameters for its proper operation now have changed, but the brain doesn’t know that its calibration is off and presenting incorrect data. The past and present become fluid, ever changing, the PTSi victim starts to be triggered off easier, and easier with less provocation.
But how do we heal the brain when the cranium is in the way? Besides brain surgery or Trepanation [relieve pressure inside the skull by drilling a hole through it), we cannot access it with pharmaceutical intervention because of the brainblood barrier [BBB]. Most medications are large-molecule based and only smallmolecule can pass through the BBB. The brain requires this physical BBB to keep molecules from the bloodstream out of strictly regulated micro-environment. It’s akin to having a highly restrictive security door at the front of an apartment building.
Time, rest, medication (and see what happens) is the usual prescription because we are presented with limited perceived treatment options. This is where the physical stimulation component of the NTST program can really help. The body has both chemical and electrical synapses coexisting in the CNS. But the electrical synapse operates much faster and are bidirectionaliv than its chemical counterparts. These neural connections are found in the nerves that require the fastest possible reaction such as the limbic system. Using the electrical synapses from the peripheral nervous system, signals can be sent to the brain bypassing the biochemical brain-blood issue completely. If the brain is likened to a physical building with an electrical front door buzzer. The entrance maybe locked, but we can still ring each occupant and interact with them from the outside of the building.
Cranial Electro Stimulation [CES] It has been around in its current state since the 1960’s and has been continuously studied showing positive and replicable results for PTSD, Anxiety and Depressionv . In the NTST program, a client uses a personal CES device twice daily; stimulating both the neurons of the brain through the auricular [ear] nerve structure and the vagal nerve running through the neck. When the device is attached to the center of the ear lobe it provides a gentle electrical massage for the brain. This helps regulate normal brain homeostasis and facilitates creation of new neural pathways when used in combination with daily meditation for 20-30mins.
The CES device is also used to attach to the lateral side of the neck to stimulate the vagus nerve. It’s the longest nerve in the body with a wide distribution throughout the central nervous system (CNS), connecting the abdomen, esophagus, heart and lungs. By creating a vagovasal response with the CES device, it lowers both blood pressure and heart rate. The client immediately feels calmer and promotes both restorative sleep and more restful, calm waking states.vi
Transcranial Direct Current Stimulation [tDCS]
This is a neurostimulation that uses a constant, low level current applied through a set of electrodes to a specific area of the brain. Originally developed for brain injuries such as strokes and other motor skill disorders, it has been shown to increase cognitive performance and memory enhancementvii . If the client has an initial qEEG brain mapping scans, any areas of interest can be gently stimulated through the skin of the head with no short term side effects. This may sound like a science experiment, but such organizations as Defense Advanced Research Projects Agency [DARPA], have shown accelerated learning performance with about a 50% increase in trainingviii. tDCS is very useful because it helps re-train the brain, relieves depression and withdrawal symptomsix .
Neural Auricular Acupuncture
There is several styles of acupuncture, both Eastern and Western. This western form of acupuncture also uses the peripheral nervous system from the lobe of the auricular structure [the ear] to send signals to the brain. It became popularized by its usage in detox and recovery centers in the 1970’s, but has been limited due to popular stigma that only addicts would use this type of therapy.
The ear is a complete microsystem of the body, containing all the nerve endings of the entire body in it. While the CES device that the client uses daily gives a general signal to the brain, acupuncture can target very specific parts of the brain through the ear. The prefrontal cortex, hippocampus and the amygdala, all areas affected by PTSi, can be stimulated in a particular order that creates a neurological cascade response for brain homeostasis.
The NTST medical program is about gently assisting the brain and its various neural-hormonal processes back into balance as it was before the trauma or moment occurred. All three major stimulations, CES, tDCS, and ear acupuncture have very quick, positive results and no side effects when used correctly. There is no one magical component to cure PTSD, it’s all about synergy. Once the body starts the healing momentum, the various physical stimulations are needed less and less as the body becomes stronger and starts to bring itself to homeostatic.
NTST Case Study
A recent case study of a 52 year old firefighter diagnosed with depression, PTSD and alcohol misuse, completed the NTST program and showed a 29% reduction in hyperactive brain activity within part of the limbic system, the Cingulate Gyrus, within 12 weeks. This is significant as the Cingulate Gyrus is critical to the limbic system, and is involved memory, learning, and emotion formation. It is linked to behavioural outcomes to motivation and is highly important in disorders such as depression, anxiety and PTSi. There was also a significant improvement in the global resting state of brainwave activity standard deviation Z-Score change of 53 percentile points [-2.5 to -.60], showing great improvement in brain function and optimization.
His PTSD Checklist [PCL-C] Civilian Version initial score of 49/90 or 54% with higher scores in the categories of social and emotional isolation with a wide distribution pattern on all five categories of the checklist. On completion of the NTST program his PTSD Checklist score had lowered from the initial score of 49/90 [54%] to 33/90 [37%], with the highest score in the minimal range [1-2] verses the initial distribution ranging from minimal to extreme scores [1-5].
The NTST Treatment Effectiveness Assessment [TEA] that was used showed an initial average of 2.4/10 indicating a poor self-image, social withdrawal and poor involvement in his workplace environment and general community. His exit assessment TEA report average had increased to 8/10, a marked difference from the initial 2.4/10 score. While the TEA is subjective in nature, it does give insight to patient’s outlook in life and his frame of mind upon leaving the program.
In the TEA interview comments it was noted that he reported no cravings for alcohol, less anxiety, improvement in memory with an increased awareness for his health, physical exercise, and social responsibilities. He also show a healthier attitude and desire to go back to his workplace with a new practical skillset that he plans to use to maintain sobriety and promote a positive impact with his peers.
The baseline results of the qEEG Brain Mapping showed an increase in Beta and HiBeta activity in the central parts of his brain which are associated with PTSD, Anxiety, Stress, Insomnia. His exit assessment results showed a significant decrease in Beta and HiBeta activity in the central regions of the brain, especially from 18-29Hz. This reduction of HiBeta activity usually means a reduction in worry, stress, rumination and PTSD symptoms.
If you would like to know more about PTSD and trauma services, please visit The Neural Clinic’s website at www.theneuralclinic.com or if you would like to know more about the full NeuroTrophic Stimulation Therapy [NTST], please visit www.lastdoor.org/NTST/
NTST Acupuncture & Related Professional Services
Poppi Sabhaney, R.Ac. is the facilitator and practitioner for the NTST Program. Poppi is a BC Registered Acupuncturist, governed by the College of Traditional Chinese Medicine Practitioners and Acupuncturists of British Columbia (CTCMA). He graduated from the 5 year Doctorate of Traditional Chinese Medicine program from the International College of Traditional Chinese Medicine of Vancouver. Poppi has 194 post graduate hours of formal training injection therapies and is insured by John Ross Insurance. Poppi is also past president of the Traditional Chinese Medicine Association of British Columbia (TCMABC), past board member and current member of the British Columbia Association of TCM & Acupuncture Practitioners (ATCMA) and a member of the Society for Acupoint Injection Therapy (SAIT) in BC.
Case Study Comparisons
Patient qEEG Brain Activity Comparison June 2015 – Pre NTST Program The limbic system, in the Beta and HiBeta frequencies are overactive, outwardly presenting in excessive worry and PTSD hypervigilance and addiction tendencies.
September 2015 – Post NTST Program HiBeta activity has been reduced and a balanced resting state achieved.
BrainWave Activity Change Pre- and Post- NTST Treatments Data Set A –Sept2015 Data Set B – Jun2015
i An Injury Is Not A Disorder. By Frank Ochberg- Military Review http://usacac.army.mil/CAC2/MilitaryReview/Archives/English/MilitaryReview_20130430_art014.pdf
iii Bremner, J.D., et al. (1995). MRI-based measurements of hippocampal volume in combat-related posttraumatic stress disorder. American Journal of Psychiatry, 152, 973-978.
iv Purves, Dale, George J. Augustine, David Fitzpatrick, William C. Hall, Anthony-Samuel LaMantia, James O. McNamara, and Leonard E. White (2008). Neuroscience. 4th ed. Sinauer Associates. pp. 85– 88. ISBN 978-0-87893-697-7.
vii J Cogn Neurosci. 2011 Sep;23(9):2309-23. doi: 10.1162/jocn.2010.21579. Epub 2010 Oct 14. Transcranial direct current stimulation improves word retrieval in healthy and nonfluent aphasic subjects. Fiori V1, Coccia M, Marinelli CV, Vecchi V, Bonifazi S, Ceravolo MG, Provinciali L, Tomaiuolo F, Marangolo P. (http://www.ncbi.nlm.nih.gov/pubmed/20946060)
ix J Physiol Paris. 2013 Dec;107(6):493-502. doi: 10.1016/j.jphysparis.2013.07.003. Epub 2013 Jul 25. Behavioral effects of transcranial direct current stimulation (tDCS) induced dorsolateral prefrontal cortex plasticity in alcohol dependence. da Silva MC1, Conti CL, Klauss J, Alves LG, do Nascimento Cavalcante HM, Fregni F, Nitsche MA, Nakamura-Palacios EM. [http://www.ncbi.nlm.nih.gov/pubmed/23891741]
Neurostimulation for traumatic brain injury. A review: Samuel S. Shin, M.D., Ph.D., C. Edward Dixon, Ph.D., David O. Okonkwo, M.D., Ph.D., and R. Mark Richardson, M.D., Ph.D., Journal of Neurosurgery Nov 2014 / Vol. 121 / No. 5 / Pages 1219-1231. Published online August 29, 2014; DOI: 10.3171/2014.7.JNS131826.