PTSD work looks personalize treatment

Special to Western NewsCanadian Armed Forces Maj. Ronald Miller saw a significant change in his personality before being diagnosed with post-traumatic stress disorder (PTSD). He has since been part of a research study with Psychiatry professor Ruth Lanius.

Canadian Armed Forces Maj. Ronald Miller is working on healing himself.

In 1971, Miller enlisted as a young infantry private in the 1st Battalion, Royal Canadian Regiment, later becoming an officer in the Royal Canadian Artillery. He served a tour in Germany during the Cold War then reoriented his career towards peacekeeping missions, with seven deployments to a variety of conflict zones.

“Over the years, I was exposed to the kind of death and destruction that can be rather difficult from a psychological standpoint,” he said. It was during a NATO military exercise in the U.K. in 2016 when he began experiencing horrible nightmares – every night.

“I just wasn’t myself. I could see a significant change in my personality that just wasn’t me,” he said. “The older I got, the less I was able to suppress those experiences. I knew I needed to seek help.”

Veteran Affairs Canada referred Miller to the Operational Stress Injury Clinic at Parkwood Institute. There, he was officially diagnosed with post-traumatic stress disorder (PTSD) and learned about the work of Psychiatry professor Ruth Lanius.

Lanius’ research uses advanced imaging technologies like PET/MRI to study differences in brain activity and neural connections between healthy individuals and those with different subtypes of PTSD.

She established the Traumatic Stress Service and the Traumatic Stress Service Workplace Program at London Health Service Centre, both specializing in the treatment and research of PTSD and related disorders.

The service helps individuals, aged 18-64, who have experienced acts of violence (personal or witnessed), emotional, physical and/or sexual abuse, severe neglect, catastrophic events such as motor vehicle accidents, natural disasters, or war-related trauma. Because of that experience, these individuals are then suffering from vivid, distressing memories, nightmares, intrusive memories, anxiety and/or panic, depression, anger and/or irritability, shame and guilt, low self-esteem, or self-destructive behaviour.

The service’s research component uses neuroimaging to demonstrate the effects of trauma on the brain.

“One of the core symptoms of PTSD is that the traumatic memory is not remembered, but is actually relived. People will have flashbacks of an experience where they will feel they are actually back at the scene of that trauma, re-experiencing what they felt at that time,” said Lanius, a Lawson Health Research Institute scientist and the Harris-Woodman Chair in Mind-Body Medicine in the Schulich School of Medicine & Dentistry.

“The horror of the shock can happen at any time. In the day. At night during their dreams. They are re-living the events and they have no control over it. It often comes after being exposed to triggers in the environment. It could be sounds, smells, something you see. Sometimes you are aware of it and sometime you’re not.”

Paul Mayne//Western NewsPsychiatry professor Ruth Lanius explores the different subtypes of post-traumatic stress disorder (PTSD) to allow for a more personalized treatments for sufferers.

There are different severities and subtypes of PTSD, with her research group instrumental in identifying the dissociative subtype. Recently added to the DSM-5, this subtype is characterized by a feeling of ‘de-realization’ by the sufferer – the feeling that one’s external surroundings are unreal, dreamlike or distorted.

By studying brain activity and connectivity in PTSD patients, Lanius uses biomarkers to accurately diagnosis different subtypes. This is an important qualifier, she explained, as the clearer the understanding of the subtype, the more personalized the treatment can be.

“We can actually predict at a resting stage scan who is going to have what type of PTSD with a 92 per cent accuracy,” she said. “They present themselves differently. The future really lies in that personalized medicine.”

In one study, Lanius studied patterns of brain activity for those with a ‘moral injury,’ an intense feeling of shame or guilt that can sometimes affect veterans with PTSD.

“Sometimes you’re involved in situations you don’t have control over, but you feel responsible for,” said Miller, who is managing his PTSD through a combination of therapies. “You wonder, ‘Could I have done something differently?’”

Being part of the research has been a rewarding experience for Miller.

While talking about incidents that trigger his PTSD inside an MRI can be daunting, he understands that what he does today will help someone dealing with PTSD tomorrow.

“My biggest fear was giving up the things I love. I’ve been a soldier since day one – and I’m sure I will be until the day I die. It’s important we come up with solutions to ensure our veterans receive proper care. Through research, we can tailor treatment to the individual rather than looking for a broad-brush solution that might not suit everyone.”

Lanius is hopeful she can be part of that solution.

“Neuroimaging is about making the invisible visible,” she said. “The brain is a fascinating organ. We learn significantly more and more every day – and we also learn how little we still know. But continually learning more it helps us to understand and develop new treatments newer and better treatments.”