Brianna Roth

Mrs. Lewis
Due: 4/12/15
Senior Research Paper
Post Traumatic Stress Disorder (PTSD) is common in a variety people, especially soldiers
where the rate is 1 out of 8 returning from service. However less then half of all PTSD victims
actually get treatment, and those who are getting treatment tend not to continue with it.
Traumatic brain injuries (TBI) also coincide with PTSD and people who develop either disorder
are given the same treatments. In most cases of TBI, the patient may even become more prone to
develop PTSD. Thus causing PTSD and TBI to be lumped together, which generalizes the two
disorders. TBI is often seen as superficial because it is considered an inside functioning issue
whereas PTSD can easily be seen on the outside during a social episode. It is important to note
that neither disorder is more severe than the other and that they should be, instead, regarded as
two different disorders that deserve two different specific treatments, rather than as a generalized
disorder. Many treatments for PTSD and TBI are focused on temporary fixes to help ease
patients and there are few that reach for a long-term satisfaction. This research interests me
because I have many family members who suffer from TBI and PTSD, who have received
treatment for both that has not met their needs, such as my father Lonnie Roth. He claims that the
treatment he has been given does not meet all his needs and feels as if they could be doing more.
With TBI and PTSD come depression and many other life long issues. Although years of
research have been devoted toward PTSD and TBI treatment, there is no proven effective way to
treat these co-occurring disorders due to confusion and generalizing of the two.
Research that has focused on treatment does not focus on just one disorder rather, it

attempts to kill two birds with one stone in treating PTSD and TBI. This only further confuses
the two in some cases making it almost harder to treat patients. These two co-occurring disorders
are also frequently associated with Alcohol Use Disorder (AUD), which is important to note
because it shows that they focus on almost too many disorders at once rather then specifying the
research for treatment. A research article by Amy Herrold et al. state that These conditions have
overlapping symptoms [confusion, mood swings, social outburst, ect.] which are, in part,
reflective of overlapping neuropathology. These conditions become problematic because their
co-occurrence can exacerbate symptoms. Therefore, treatments must be developed that are
inclusive to all three conditions (Herrold et al). Their goal in their research is to find what
treatment helps all three disorders and in their case, they are focusing on Repetitive Transcranial
Magnetic Stimulation (RTMS). RTMS is a form of brain stimulation therapy; it uses magnetic
pulses instead of electricity to activate parts of the brain. They commonly use RTMS as a
possible form of therapy for depression, which occurs with all three disorders in the research.
Even though RTMS did not produce the results they wanted for AUD, it was reported to have
lowered alcohol cravings in patients. Case studies for TBI treatment with RTMS were all focused
on different aspects of TBI so not one study can really be compared to another. Future research
has been aspired from these case studies to look at RTMS and TBI treatment individually for
patients and not looking for a generalized treatment, Given the heterogeneity of injuries within
the TBI population, it may be beneficial to determine if RTMS can be optimized and tailored to
each TBI patient or injury (Herrold et al). Out of the three disorders being researched PTSD
had the most effective results in treatment with RTMS, Collectively, the evidence suggests that
high frequency, supra-threshold intensity RTMS applied to the DLPFC may hold promise for the
treatment of PTSD (Herrold). It was discovered that when treating PTSD, placing the RTMS

over the left DLPFC improved PTSD and depression symptoms and placing it over the right
DLPFC improved anxiety symptoms also along with PTSD but not the depression aspect. These
studies help show how RTMS can further be researched in developing a co-occurring treatment
system. RTMS is an effective treatment but only to some aspects of either disorder and it is not
very specific.
In an article published by Jan E. Kennedy, he and his colleagues discuss clinical aspects of
TBI and PTSD and the treatment of PTSD in context of TBI through the use of pharmacotherapy
interventions and psychotherapy interventions, and possible future treatments. Pharmacotherapy
interventions are administered through the department of Veteran affairs (VA). Antidepressants
have proven effective for treating PTSD, especially SSRIs, and are recommended in the
VA/DOD CPG. The SSRIs [Selective serotonin re-uptake inhibitors or serotonin-specific
reuptake inhibitors are typically used as antidepressants in the treatment of major depressive
disorder and anxiety disorders.] are considered "strongly recommended" as having significant
benefit for treating PTSD. They have relatively acceptable side effects and wide safety margins
for overdose (Kennedy et al). Even though researchers are still looking methods other than sole
use of pharmaceuticals they still recommend for veteran patients to take the medication given to
them by the VA. Complications with mixing medications arise with different side effects but also
the effect medication has on a patient with TBI while treating PTSD. TBI may cause the patient
to be more sensitive to side effects or to the main effects of many medications. [] When
initiating any medication for a patient with TBI, one should be prudent and start at a lower dose
and observe closely during a gradual increase to a therapeutic dose (Kennedy et al). Treatment
with medications will always be problematic not only for co-occurring disorders but the long
term effects medication can have on ones body. Psychotherapy interventions, such as exposure

therapy and trauma-focused cognitive therapy, and non-trauma-focused therapy are discussed
and reviewed in this research. Also relaxation therapy is a common way of treatment for veterans
with PTSD Most include teaching relaxation techniques so that the patient can control the
intense physiological response to reminders of the trauma in PTSD and enable him or her to
overcome the avoidance symptoms to proceed with the therapy. Many directly or indirectly use
desensitization of negative stimuli by repeated exposure without negative consequences
(Kennedy et al). My father Lonnie Roth claims this is his favorite type of therapy he has
received. It has proven to be the most effective for him in helping him control his anger when a
trigger of his PTSD is present. CBT interventions includes fight or flight reactions, In the
behavioral component of CBT, the therapist helps guide the patient through recalling significant
aspects of the traumatic event and assigns "homework" for the patient to practice activities that
reinforce adaptive coping behaviors (e.g., effectively communicating with family and friends)
and extinguish maladaptive behaviors (e.g., getting angry when feeling unsafe) (Kennedy et al).
This kind of treatment I know first hand with my father once again; Ive taken part in the
homework that is given to him. Though future research looks promising for TBI patients with
PTSD, researchers are beginning to look at a more personal connection between PTSD and TBI
development, Studies of the characteristics of "resilient" people seek to determine the
interacting roles of (1) genetic vulnerability (or relative strength); (2) early life experiences that
acclimate the neurochemical sensitivity of the stress response; and (3) the acquisition of
cognitive "frames" that reduce or channel terror, hopelessness, horror, and physiological
overreaction, and promote resilience and adaptive responses (Kennedy et al).
Researchers focused on an 8week program to help veterans with PTSD and TBI as a form
of treatment. This treatment was designed to help PTSD, MDD, and a history of TBI because

they often co-occur among each other, [] their physical, cognitive, and psychological
symptoms may overlap. For example, insomnia, low motivation, anger and frustration, and
memory and concentration problems are symptoms commonly associated with all three
conditions (Speicher et al). Canadian Occupational Performance Measure (COPM) is a process
in which they measure ones overall self-perceived occupational performance and satisfaction
over time. The 26 veterans that were chosen underwent baseline test to evaluate their symptoms
and then determine the appropriate care for them, really focusing on eachs individual needs. The
program setting took place in a VA hospital, and the participants were to share the same living
area with one another and required to take part in the program from 8 a.m. to 4:30 p.m. Monday
through Friday and weekend participation was encouraged. While participating, patients went
through Trauma-Focused Treatment that was primarily to decrease PTSD symptoms and increase
functional performance. When these CPT groups took place they were to help by, Identifying
maladaptive beliefs; encouraging patients to complete related worksheets designed to increase
self-awareness of thoughts and feelings and to challenge problematic thinking and beliefs; and
providing opportunities to successfully engage in activities that challenge maladaptive beliefs in
a safe, supportive environment (Speicher et al). Participants also underwent Group and
Adjunctive Programming, this included veterans to attended other psychoeducation groups, such
as communication skills, anger management, and relapse prevention. Veterans took part in plenty
of social and group activities. Not only did they meet in groups they also worked individually in
occupational therapy Occupational therapy focused on each veterans unique set of selfidentified goals that the COPM helped to identify (Speicher et al). After completion of the
program the veterans took the same test from the beginning to establish their accomplishment
and improvement from the program. The program overall helped the 26 veterans that took part in

it to help decrease their symptoms of PTSD and TBI. Even though this program helped to reduce
ones symptoms it is a short-term fix, symptoms were expected to come back in time. What could
better help these patients is a program similar to this but continued on throughout life.
Throughout reading and researching PTSD and TBI treatments, questions of individuality
arose. Generalizing treatment for these co-occurring disorders seems to be every researchers
issue. It makes me wonder why no one has taken time to research further, by looking at one
individual rather then a group setting. Research claims that with advancing technologies there
will be more opportunity for future projects. It seems to be that there is not enough effort into
developing the technology needed to further continue research such as the RTMS treatment. I
plan on joining the Navy and continuing my medical education through doing that, therefore
PTSD and TBI could one day affect me and I will be helping and working those affected by it
daily.

Works Cited
Herrold, Amy A. "Transcranial Magnetic Stimulation: Potential Treatment for
Co-Occurring Alcohol, Traumatic Brain Injury and Posttraumatic Stress
Disorders. ." Neural Regeneration Research . 1 october 2014.
Kennedy, Jan E. "Posttraumatic stress disorder and posttraumatic stress
disorder-like symptoms and mild traumatic brain injury." Journal of
rehabillation research and development . 7 november 2007.
Speicher, Sarah M., Kristen H. Walter, and Kathleen M. Chard.
"Interdisciplinary Residential Treatment of Posttraumatic Stress Disorder and
Traumatic Brain Injurt: Effects of symptoms severity and occupational
performance and satisfacation." The American Journal of Occupational
Therapy . jul.-aug. 2014.