Shaili Jain: Treatments for PTSD are more effective than ever
Shaili Jain first got interested in studying post-traumatic stress disorder (PTSD) on an East Coast road trip listening to her father describe his experiences during the 1947 Partition of British India.
As she listened to details of his trauma and losses, many revealed to her only for the first time, Jain realized she had a deep personal connection to trauma survivors that had, until now, been hidden. This realization spurred a new career, committed to specializing in PTSD and advancing the science of traumatic stress.
PTSD became Jain’s life’s work as a medical doctor and a researcher. She would eventually go on to pen a 2019 book, The Unspeakable Mind. Her book combines vividly recounted patient stories, cutting-edge neuroscience, interviews with some of the world ’s top trauma scientists and Jain’s professional expertise, and offers a textured portrait of a widely misunderstood condition.
PTSD has historically been hidden in plain sight, she says, and it is typically tough to diagnose and often goes hand in hand with anxiety, mood and substance abuse disorders. But now, she says, researchers are making great strides at understanding trauma and treating PTSD effectively.
In the latest episode of Stanford Engineering’s “The Future of Everything podcast,” Jain discusses the hopeful prognosis for traumatic stress disorders with host and bioengineer Russ Altman.
Transcript
Russ Altman: Today on The Future of Everything, the future of post-traumatic stress disorder, or PTSD.
Since really ancient times, we have known that people who suffer traumatic experiences also continue to suffer after these events, and sometimes for prolonged period of time.
In World War I, returning soldiers had a syndrome that was referred to as shell shock, characterized by upsetting and sometimes vivid memories of the trauma, flashbacks, nightmares, those kinds of things. Feeling on edge, trouble sleeping, anxiety, depression. Emotional numbness, in the sense of like a muted response to emotional situations. Maybe even avoidance of people, places, and activities that remind the sufferer of the original trauma.
Similar syndromes have been described, not only for soldiers returning from battle, but victims of violent crimes, including sex crimes. But it’s not an ancient disease. And in fact, this came more to the public awareness with the return of Vietnam vets and public awareness of sex crimes where the victims were just not getting better. As a trainee in medicine, I was introduced in my training at the Veterans Administration Hospital to vets who had these symptoms and were seeking help. And it was clear that it can by incapacitating and it wasn’t always obvious how to best treat them.
Dr. Shaili Jain is a professor of psychiatry in behavioral sciences at Stanford University, and she specializes in the diagnosis and treatment of PTSD. She has written a book entitled "The Unspeakable Mind," which provides moving examples of people with PTSD as well as the scientific basis for our understanding of it and strategies for treatment and prevention.
Shaili, how did you get interested in PTSD and can you review for me the key clinical features for people who are not familiar with it?
Shaili Jain: Yeah, absolutely. So how did I get interested?
A little bit of a personal story in that I was a psychiatrist in private practice in Milwaukee, Wisconsin. My parents were visiting from England where I was born and raised and we went on this road trip. And, in essence, during this road trip, it was a trip to celebrate my dad’s 70th birthday.
He reminded me of his own background. He was a trauma survivor. He was a war orphan, a refugee, a child laborer. He was born and raised in India during the 1947 Partition of British India. As a young man, he ended up moving to England. That was where I was born and raised and that was the only world I ever knew. But I think getting that reminder of my own family trauma history was just really moving for me and made me think I should think about what I wanted to do with my career. And so that’s when I decided to move and specialize to become a PTSD specialist.
Russ Altman: Yes.
Shaili Jain: And trauma scientist.
Russ Altman: You were already a psychiatrist?
Shaili Jain: Yes. I was already a psychiatrist, so clearly on some level I made it there. But that was like the final, final thing that as physicians we have this great platform.
Russ Altman: Yes.
Shaili Jain: We’re so educated so what was I gonna commit my career to and so that’s where I am today. Kind of more than ten years later.
Russ Altman: And now I try to characterize the disease in my own rough way, but I wanted to make sure that I got it right or there features you might like to stress that are perhaps underappreciated or people don’t understand how complex this disorder might be?
Shaili Jain: So, I mean that was a great characterization. So, it’s famous for the nightmares, the flashbacks, the exaggerated startled reaction. Lesser known is how it impacts a life more insidiously. The emotional numbing, you know. The muted capacity to love and how it leaves the sufferer on this perpetual verge of alienation from the world and everybody around them. So it really insidiously infiltrates the way people love, the way they work, the way they play, the way they create, and I think that is what is a little more difficult to put your finger on.
And certainly in the last 20 years, so much has happened in the science of PTSD in the last 20 years, but one other thing that’s becoming really really apparent is it goes beyond mind and brain. It infiltrates bodily organs, bodily systems. Its emergence in independent risk factor for heart disease. Its implicated in major conditions, like obesity and cancer. So I think we’re just discovering more and more about PTSD and how it’s just kind of whole bodily system condition.
Russ Altman: Yeah and in that way, it’s a great model for reminding us about the connection. I mean, this is obvious.
Shaili Jain: Yeah.
Russ Altman: The connection between the mind and the body is real.
Shaili Jain: Yes.
Russ Altman: And has real repercussions when there’s a disharmony of any kind. So let me ask, is it true? I think I’ve read that the onset of symptoms can be rapid after the trauma or can be delayed. And I don’t know if that’s a folk myth and if actually these people are showing signs and symptoms right away. Or how true is it that the onset of the disease may be very delayed versus immediate?
Shaili Jain: It is true and that’s what makes it really perplexing. Right, because there’s no way I could predict how any one individual is gonna respond to traumatic event because there’s a multitude of factors that determines that trauma responses. A third of which can be explained by genetics, by the way. Literally how our brain is wired and how our body might respond.
Russ Altman: And so there are clear genetic components?
Shaili Jain: We don’t have it identified on a marker level. Like I cannot tell you which gene, but there is a huge heritable component.
Russ Altman: Okay, okay.
Shaili Jain: So I have no way of predicting. I would say the majority of cases you can say, okay, it is normal to have this reaction in the first, you know, hours, days after trauma. If it hasn’t disappeared by a month, you are thinking this is PTSD. This delayed onset pattern is there. I would say it’s probably less common.
Russ Altman: And is it also true that, I mean, it seems to me obvious that trauma is in the eyes of the sufferer and so I’m wondering, is the magnitude of the trauma from some objective measure? Like, well, a terrible war situation versus a personal trauma. Does that matter or is it really how it’s experienced by the sufferer?
Shaili Jain: It’s both. Dose really matters, right? We’ve all got our limits. We’ve seen these in studies with veterans from Iraq and Afghanistan. The more deployments they have the odds of PTSD go up. There is the dose response curve. But at the same time, you’re right. It’s a very personalized thing, too. You take three people who survive a terrorist attack, all three will have different reactions to the same situation, even though their lives were threatened in the same way they probably witnessed pretty similar things.
So it’s both and a lot of it is the history they bring to that trauma. If this is somebody who had a horrible childhood history of trauma, maybe they were assaulted in their 20s and in their 40s they experience a terrorist attack. Very different to someone who may have never experienced trauma before. There’s this cumulative effect that we often don’t know and that all plays a role.
Russ Altman: When you say, "we often don’t know," do you mean, we, the physicians trying to help or even the sufferer’s patients themselves?
Shaili Jain: Both, again. So again, just understanding that people come to a particular situation with a background and history and we have to make ourselves aware of that as the physician but also sometimes patients because denial and avoidance, like you say, is a big part of trauma.
Oftentimes, I’ll meet people who significant things happened to them in their early life, but they kind of figured out a way to manage or cope and they’ve patched together a way of doing things and it was kind of, sort of working, but then something major will hit and that’s it. The whole house of cards comes falling down and they have to kind of go backwards and reconcile all of it.
Russ Altman: Yes.
Shaili Jain: To make sense of it.
Russ Altman: Yes. So very helpful. So how good are we at identifying these patients and getting them into the system for help?
Shaili Jain: Yeah. Some places are better than others. And as we were talking earlier, I think the VA for many reasons: A, it’s a population health model. B, because it serves veterans, has PTSD on the radar. People who care about PTSD have a seat at the table when it comes to that organization. So it’s kind of part of our culture that we think about it, we ask about it, we know what to do when we see it.
I’m afraid the same is not true outside the VA. I think we’re still struggling. I think PTSD is still really tough to diagnose. It’s still challenging to treat and I think the average clinician is still not where we need to be in terms of awareness of PTSD, just how common it is. That it goes far beyond the horrors of war.
Russ Altman: This is “The Future of Everything.” I’m speaking with Shaili Jain about PTSD and capturing it. And I want to just follow up on that in the community. You said that there was a comorbidity with many other more common things like heart disease and I can only imagine there might be many people out in the world who are not vets, and therefore whose providers might not be thinking about this at the tip of their tongue. And they’re treating the heart disease or they’re treating the cancer or even depression and anxiety, and there’s never that moment to step back say, wait a minute, can we tie all of this together with this diagnosis? So I’m sure that there are probably cryptic, hidden cases.
Russ Altman: Yup. out in the community.
Shaili Jain: Absolutely.
Russ Altman: So would it be useful, and I guess this is the obvious question, how useful would it be for a primary care physician to make the diagnosis of PTSD and how might it change their treatment of a patient who otherwise they’re trying to individually manage depression, anxiety, and other problems?
Shaili Jain: I mean, it would be hugely useful. You know, name it so we can tame it, right? If we don’t get the diagnosis right our whole conceptualization —
Russ Altman: Yes.
Shaili Jain: — is prone to errors and I would say with PTSD it’s really important you get it right because these patients have got really, really complicated histories that seep into everything. So even if you look like adherence to dietary advice or advice about exercise we know people with PTSD are not good at being adherent. It’s much harder for them to quit smoking. It’s much harder for them to eat right.
So if you don’t factor that in as part of your counseling, the way you kind of predict how they’re gonna respond, you’re gonna be frustrated. You’re not gonna understand.
Russ Altman: Yes.
Shaili Jain: So it’s hugely important. I feel that it’s very under recognized and I think that causes a lot of problems.
Russ Altman: So one of the great things about your book is it’s filled with these personal stories where people can say a lot, and we can’t do that here but I would love for you to paint a picture of like a patient and kind of a situation that you’ve faced so that the people who are listening have an idea of how these things come to you and what the challenges are in treating them and in helping make the diagnosis and the patient response to the diagnosis. Is there a story you can tell us?
Shaili Jain: So I guess the first thing that comes to mind as you were speaking.
Russ Altman: Real or fictitious.
Shaili Jain: Yeah, it’s kind of like a composite type of scenario that I think is relevant to a lot of people, especially people who aren’t psychiatrists.
Russ Altman: Yes.
Shaili Jain: Sometimes I meet people, the last person they want to meet is someone like me. Because the last thing they want to do is talk about the trauma and face the trauma and that is inherent to the condition called PTSD. This kind of pathological avoidance and denial.
So, oftentimes you have people, I definitely see that in the veteran community. Definitely see with older veterans, who’ve constructed a whole life where they have avoided that trauma. And the problem is it’s a very constricted life. So emotionally they might be estranged and cut off from loved ones. They’ve led an isolated existence. They’ve really not bloomed and lived the full life that they deserve and they’re entitled to, and oftentimes where the hit issues is is when they run into medical problems. So, you know, they have a stroke. Or, you know, they have some complication of diabetes where they are forced to be dependent on other people. Where they have to show up for doctor appointments, where they are no longer in control. People are poking a prodding at them, telling them that they need to get this test.
Russ Altman: So the walls that they’ve built up no longer work.
Shaili Jain: Come crashing down. And what you see is people who are irritable. They fly off the handle. They’re difficult, you know.
Russ Altman: Yes.
Shaili Jain: Quote on quote. A lot of anxiety. Intense anxiety. And if you got to the age of 50, 60, 70, and you’ve never really learned a way to verbalize what you’re feeling in terms of anxiety, you can really get into issues, you know.
Russ Altman: Yes.
Shaili Jain: And then it really hits at that intersection between receiving your medical care and having good outcomes from your medical issues.
Russ Altman: Yes, yes.
Shaili Jain: So oftentimes that’s when someone like gets brought in where they’re like, okay, something’s going on. We don’t know what’s going on. And that’s where you have to have these really delicate conversations with people and really skirt around old wounds that they might not want to open, but time is of the essence.
Russ Altman: This is “The Future of Everything.” I’m Russ Altman. I’m speaking with Shaili Jain about PTSD and I definitely want to get to current treatment and prevention, but before that, tell us a little bit about where the science is.
What do we understand about this disorder? Is it related to other disorders that are more familiar? Is it a type of depression? Is it a type of anxiety? Is it its own thing? And what do we understand about the molecular or scientific neural basis of these responses?
Shaili Jain: So the last 20 years, huge growth in the science of PTSD because of world events like 9/11 and wars in Iraq.
Russ Altman: Unfortunately.
Shaili Jain: Unfortunately but this huge body of evidence that continue to grow exponentially. It’s definitely its own thing. It’s actually earned its own category, trauma and stress-related disorders. But PTSD really lives alone. It goes hand-in-hand with depression, anxiety, addiction. So you’re rarely gonna see it by itself. So, clinically, just to be aware that it doesn’t live alone. And in terms of its biological basis, we’re still in that infancy.
Russ Altman: Of course.
Shaili Jain: It’s like as soon as I start talking about it, I know that it’s probably outdated.
Russ Altman: Even depression and bipolar disorder —
Shaili Jain: Everything.
Russ Altman: — and schizophrenia —
Shaili Jain: Yes.
Russ Altman: — are at the very early stages.
Shaili Jain: Exactly just because the tools with which we probe these things are evolving and changing and how we interpret things, but we do know there are certain systems that are implicated. So we know the hippocampus, for example, that’s smaller in people who have PTSD. That’s the part of our brain that processes memory. We don’t know why, we don’t know if they pre-existingly had a small hippocampus…
Russ Altman: I see. So if it’s a cause or an effect.
Shaili Jain: We don’t know that yet, but we do know that it is smaller. We know that the amygdala, the part of our brain that responds to fear and anger, that is out of control in people who have PTSD. They’re very quick to react and that explains why they could go from zero to 100 in less than a second. So a lot of times they’ll see danger where danger doesn’t exist.
Russ Altman: And it can be traced to these specific brain regions that deal with danger?
Shaili Jain: Yes, right.
Russ Altman: So you said something about there’s strong evidence in general for genetic, that if your relatives —
Shaili Jain: Yes.
Russ Altman: Have had a higher risk. And that seems to me to be particularly difficult because so much of genetics co-occurs with cultural.
Shaili Jain: Yes.
Russ Altman: So it’s possible that my mom and dad had the same traumas that I had —
Shaili Jain: Yeah.
Russ Altman: Depending on where we’re living in the world.
Shaili Jain: Yeah.
Russ Altman: So I’m sure it’s very difficult to separate out the cultural influences from the underlying biological influences.
Shaili Jain: Yeah.
Russ Altman: But, nonetheless, the evidence seems to show.
Shaili Jain: Yeah. So there’s been a lot of work done in the area of epigenetics, literally in the last 20 years. And you’re right, conventionally that’s the way we used to see it.
That it was all like learned behaviors or your environment. Some interesting work done by Rachel Yehuda, who is a neuroscientist out of Mount Sinai, where she followed moms who were pregnant during 9/11, and who escaped the Twin Towers, and she followed these moms and she followed their offspring using the biomarker of saliva cortisol. And there is this very early, really really early we’re just not there yet.
But really early evidence to indicate epigenetic mechanisms are at play. So if you’re someone whose experienced trauma who are living with PTSD, it’s gonna influence which genes are switched on and which genes are switched off, and you’re gonna pass those changes on.
Russ Altman: I see, so they’re looking at whether these moms got PTSD.
Shaili Jain: Yup.
Russ Altman: And also whether their unborn children, had something passed on.
Shaili Jain: Yes.
Russ Altman: That’s what the study of epigenetics is —
Shaili Jain: Yes, exactly.
Russ Altman: — that gives them an increased risk in the future.
Shaili Jain: Even though these kids themselves didn’t experience the trauma, per se. And that to me is fascinating because when you think of mass traumatization, right. When you think of slavery, when you think of genocide, when you think of Holocaust, you can’t help get this sense that the deep footprint that PTSD might be leaving through these generations.
Russ Altman: Yes, and that is a cause for pause.
Shaili Jain: Yeah, right.
Russ Altman: Just thinking about what you just said.
Shaili Jain: Yeah.
Russ Altman: Because that means that things that happened 30, 50, 70 years ago are affecting the biology of people today.
Shaili Jain: Yes. Yes.
Russ Altman: And at the same time, and I you referred to this a couple times in our conversation, there are people who’ve had terrible trauma for whom this doesn’t seem to manifest.
Shaili Jain: Yup.
Russ Altman: And so it seems that they’re also a resource to try to understand what it was about either their biology or as you said before, their previous life, what particular things might have been helpful to help them not get the disorder?
Shaili Jain: Yeah. To me, I mean there’s so many factors that go into resilience. It’s such a complicated construct, the concept of resilience.
Russ Altman: Yes.
Shaili Jain: But, to me, I kind of see myself as a social psychiatrist. What comes through loud and clear is you cannot underestimate the power of a positive social network. So if you come from a community that is resilient, that has got resources, that rallies around you after a trauma, that in itself is gonna prevent you from developing PTSD. Or if you do develop PTSD, your symptoms will resolve faster.
Russ Altman: Very remarkable.
Shaili Jain: Yeah.
Russ Altman: This is “The Future of Everything.” I’m Russ Altman. More with Dr. Shaili Jain about PTSD and we’re gonna get to treatment and prevention next on SiriumXM.
Welcome back to “The Future of Everything.” I’m Russ Altman and I’m speaking with Dr. Shaili Jain about PTSD. And I’d like to get to prevention and treatment. But prevention is the one that I’m really interested in because the kind of initial response would be, well how are you gonna ever really prevent the trauma? Nobody goes into a trauma on purpose. So of course you’re gonna tell us, please avoid trauma. But I think there might be more to it than that. So where are we with prevention?
Shaili Jain: So I think the future of PTSD is in prevention because we have, as you know, a massive lack of mental health professionals. There’s just no way we’re gonna train up enough people to meet the need. And the way I like to think about prevention is on three levels, like primary, secondary and tertiary.
Russ Altman: Okay.
Shaili Jain: And so primary prevent, you’ve heard about all this, like the violence prevention programs. Self-defense programs.
Russ Altman: Yes.
Shaili Jain: So if you think about violent assault or sexual assault, if we could prevent those, then obviously we’d have less PTSD, and a big chunk of PTSD comes from crimes like that.
Russ Altman: Right, right.
Shaili Jain: I think what’s exciting now that was missing from years before is I think we’ve got a lot more precise about prevention. So there’s a lot of do-gooders before, like coming up with these programs and just assuming they’re helping people, but no one was measuring outcomes.
Russ Altman: Kind of invalidated.
Shaili Jain: Invalidated and then that’s when you get into trouble and people aren’t gonna fund your causes because you have no proof that what you’re doing is really working. Just because you feel like it’s working doesn’t mean it’s working.
So I think what’s really cool now is that people are taking the time and a lot of this is because of the sophisticated statistical modeling that we have now that maybe we didn’t have years ago. We can actually pinpoint the details of what is working in a program. Like what is the secret source ingredient? What really works, say, how do you train women to defend themselves effectively from violent attackers? What is the secret source ingredient?
And if we know what the secret source ingredient is we can scale it and replicate those programs. So there’s some really great work being done in that regard. Not enough in my mind. We need a lot more money behind these type of efforts, but that is exciting to me.
Russ Altman: Yes and you can imagine, they have all these kids programs for drug abuse and violence —
Shaili Jain: Yup.
Russ Altman: And this could actually be inculcated into children, appropriately without scaring them.
Shaili Jain: Sure, right.
Russ Altman: But also empowering them to think about this and be positioned to handle situations in the future.
Shaili Jain: Absolutely. Preparing them and if we can introduce them in a way that’s effective I think is a worthwhile investment.
Russ Altman: So that’s what we will call primary.
Shaili Jain: Yeah. Because they’re limiting the amount of trauma they’re exposed to.
Russ Altman: Yes.
Shaili Jain: Secondary prevention is really exciting for me because it’s something about that PTSD construct. There’s a very clear before and after, which is very unusual for mental health conditions. There’s a before the trauma —
Russ Altman: In terms of the triggers.
Shaili Jain: Yeah.
Russ Altman: Yes.
Shaili Jain: There’s a before the trauma and there’s an after, so there’s this opportunity where we can intervene between when someone’s exposed to trauma and before they develop PTSD because there is this window.
Russ Altman: Right.
Shaili Jain: We call it the golden hours in my field. What about if we intervene then to prevent the onset of PTSD?
Russ Altman: I see.
Shaili Jain: And part of that is moving where we meet trauma survivors. Part of that is showing up in emergency rooms. Not waiting for the weeks, months, years later when they show up in the office of someone like me.
Russ Altman: Right. So we’re not only gonna tend to their physical elements —
Shaili Jain: Yup.
Russ Altman: But there’s an opportunity here to do something.
Shaili Jain: Yes.
Russ Altman: You’ll tell me what it is.
Shaili Jain: Right.
Russ Altman: Right now to try to minimize the chances of PTSD.
Shaili Jain: Absolutely. So the same algorithmic way we might prevent a stroke or a heart attack or intervene early.
Russ Altman: So what might you do?
Shaili Jain: So there’s some early research done. There’s a group out of Atlanta Emory University that modified a psychological treatment for PTSD and packaged it in a way that you can deliver it to trauma survivors right there in the ER. They did some RCTs to show that —
Russ Altman: Randomized control trials.
Shaili Jain: Control trials. Whoever got that modified prolonged exposure intervention compared to the ones who didn’t, they ended up having less PTSD symptoms.
Russ Altman: Okay, so this a validated maneuver?
Shaili Jain: Yes, right. So that’s one example. Cortisol, you know there are some studies done with patients in the ICU because a lot of people develop PTSD after being in the ICU.
Russ Altman: Yes.
Shaili Jain: The patients who got IV hydrocortisone had less PTSD symptoms,
Russ Altman: Interesting.
Shaili Jain: Compared to the ones who didn’t. So again, early stuff but really encouraging. That if we hit it early we can prevent. There are situations that are still traumatizing for people.
Russ Altman: And it does make some intuitive sense that the brain has been traumatized.
Shaili Jain: Right.
Russ Altman: In the same way that you can help the body improve its chances of healing, it makes sense that there would be things to help the brain heal —
Shaili Jain: Yeah, right.
Russ Altman: More quickly and therefore not have the long-term scars, I’m using analogies here.
Shaili Jain: Right. Absolutely. So the same way we would approach physical illness, like let’s approach the psychological wounds right there.
Russ Altman: Is this part of your practice? The secondary interventions? Do you get called to emergency rooms to try to administer or is that not yet a standard of care?
Shaili Jain: It’s not primetime. Not ready as a standard of care. Now what is as tertiary prevention.
Russ Altman: Okay, so let’s move —
Shaili Jain: Probably the least.
Russ Altman: To tertiary.
Shaili Jain: Yeah, least glamorous. But lowest hanging fruit. So an example would be integrated care. So 10 years ago, I ditched my regular psychiatrist office which was in a mental health care clinic, of course on a different campus from the regular hospital, which seems to be the way.
Russ Altman: Yeah, right.
Shaili Jain: Yeah, psychiatry departments are all over the world. So I ditched it and I moved my practice to primary care. So I sit in primary care. And why do I do that? Because guess what? People with mental health disorders they show up in primary care. A lot of them will drop off before they show up —
Russ Altman: Yes.
Shaili Jain: Up in specialty mental health. So reaching people earlier by the psychiatrist changing their location, that we know works.
Russ Altman: Okay.
Shaili Jain: There’s a lot of data to support that model.
Russ Altman: This is “The Future of Everything.” I’m Russ Altman and we’re speaking with Dr. Shaili Jain now about tertiary prevention and then treatment.
So this is the early, whereas secondary was the trauma has occurred and before we even worry about the diagnosis we’re gonna start doing some things. Tertiary, the diagnosis is now manifest but maybe not recognized by the health care system. But using these interventions, such as having real life psychiatrists in the primary care suite, we have a better chance of picking these people up and getting them into, what I now want to talk about, which is what are our treatments? Is this psychoanalytical type things? Or is it drugs or is it both? Where are we in treatment?
Shaili Jain: So the good news is what was once an incurable disabling condition, PTSD today is really really treatable because we’ve come so far in what we can offer folks. The first line standard of treatment is talk therapies. Typically, trauma-focused psychotherapies. Things like prolonged exposure, cognitive processing therapy, EMDR, those are —
Russ Altman: I don’t know those letters. So EMDR.
Shaili Jain: Yeah. So it’s eye, movement, desensitization, and reprocessing. It’s a bit of a mouthful. And then the others I had spelled out. So the trauma-focused psychotherapies in that integral to these psychotherapies is a focus on that trauma. And dismantling that trauma and helping the patient get past that trauma. They’ve got the biggest body of evidence to support their effectiveness, so that is really first line treatment.
Russ Altman: And some of the indicators of success might be whereas a patient was closed down and was unwilling to discuss, you now see signs that they’re willing to discuss it without their blood pressure going up, without their heart rate going up. They’ve come to peace with discussing this event without having it be a huge emotional and physical reaction —
Shaili Jain: Absolutely.
Russ Altman: And you actually measure that I would guess.
Shaili Jain: Yes, absolutely, you can. And integral to these treatments is these exposure exercises. Part of the problem with PTSD is when the person is confronted with reminders of the trigger their body’s responses go out of control.
Russ Altman: Absolutely.
Shaili Jain: Like you said,
Russ Altman: Easy to imagine.
Shaili Jain: So part of it is helping them recognize triggers, giving them tools and strategies and coping mechanisms to handle that response.
Russ Altman: Yes.
Shaili Jain: So they’re back in the driver’s seat of their life.
Russ Altman: Right.
Shaili Jain: That’s what I always say to patients. Right now the traumas in charge of you, you’ll be back in the driver’s seat.
Russ Altman: Very attractive.
Shaili Jain: Yup.
Russ Altman: I mean, that’s a great thing to say. I could imagine that would be a very attractive model for patients.
Shaili Jain: To help people. You know, they’re never gonna forget the trauma.
Russ Altman: To give them hope.
Shaili Jain: They’re not gonna forget it. It’s gonna leave them forever changed, but it doesn’t have to derail their life the way it is.
Russ Altman: Great. Is there a role for drugs?
Shaili Jain: Yes, absolutely. The type of medications you want to use first are the SSRIs or SNRIs, commonly known as antidepressant medications.
Russ Altman: Prozac and friends.
Shaili Jain: Yeah, two have an FDA indication that would be sertraline and paroxetine. They actually have an FDA indication for PTSD. And a month doesn’t go by when I don’t see someone have a life-altering transformation on medicine, or on these types of medications.
Russ Altman: Is this usually done after the cognitive approaches have begun or is it contemporaneous with the cognitive talk therapies? How does timing —
Shaili Jain: It’s sequential.
Russ Altman: Usually work?
Shaili Jain: Yeah. Usually I want people to do therapy first because a lot of people have a great response. Obviously, that doesn’t always happen for a multitude of reasons. Then meds is a second line option.
Russ Altman: So in addition to the antidepressants, are there other, the one I’m wondering about are beta blockers.
Shaili Jain: Yeah.
Russ Altman: Only because they’re sometimes used for people who have performance anxiety, which I understand is very different. But it keeps your heart rate down, it stop the flight or fight response. Does that have any role?
Shaili Jain: There was some early evidence to suggest a role for beta blockers in that secondary prevention that I talked about. I don’t think it really panned out in the bigger trials. One thing we know not to use that does not help people with PTSD that can be harmful are benzodiazepines.
Russ Altman: I was gonna ask about those as well, which has also addictive potential.
Shaili Jain: Definitely addictive potential, but also it’s almost like they kick the can down the road, they delay the recovery, do you know what I mean?
Russ Altman: Yes.
Shaili Jain: Because they actually dampen down some of the responses that people need to actually get better. Plus, long-term side effects in terms of falls and memory issues, just not a good choice.
Russ Altman: So, this is really great news because we’ve heard about prevention being not a random thing but actually a very rational thing. And then the treatments you describe, both the talk therapies and the medications, it sounds like there’s emerging evidence that these really are working —
Shaili Jain: Yeah.
Russ Altman: And as you’ve said, you’ve seen miraculous turnarounds.
Shaili Jain: Yes, yup.
Russ Altman: Well, thank you for listening to “The Future of Everything.” I’m Russ Altman. If you missed any of this episode, listen anytime on demand with the SiriusXM app.
