Laureate Institute Thinks Ahead on PTSD

Apr 22, 2013

More and more veterans are returning home from long years of combat in Iraq and Afghanistan. Many are able to reacclimate to their civilian lives with little trouble. Many others, however, struggle.

New study at Tulsa’s Laureate Institute for Brain Research, funded by the Department of Defense, investigates a potential treatment for post traumatic stress disorder.

One of the current subjects is a war veteran with combat experience.

“Four years in the marines, got out, did another five in the army, was in artillery,” he said. “Did a lot of mobile patrols, not so many foot patrols, more working with IED teams, stuff like that.”

The goal of the project is to develop a new way to treat patients, veterans, who suffer from post traumatic stress disorder.

“We’re hoping to teach people inside the FRMI machine, which is the big, complicated machine, to control their emotional circuit in the brain,” said Dr. Jerzy Bodurka, head researcher on the project, who wrote the grant proposal.

“We will specifically be investigating one very important region in the brain which is called amygdala,” he said.

The current subject, the veteran, doesn't suffer from PTSD, and is instead serving as a member of the control group. But he has the kind of background in which complications from post traumatic stress wouldn't necessarily be a surprise. His job was to work with the teams who dismantled “improvised explosive devices.”

“They can’t go out alone, you know, because if they’re going to deactivate a bomb, or if they’re going to recover one, or what have you,” he explained, “they need someone to make sure they’re safe. And so that’s what we would do. We would go out in our humvees and we would … basically be bodyguards for them.”

He's chosen to remain anonymous, and for good reason: though he doesn’t suffer from PTSD, the stigma associated with it, of not being tough, can be damaging.

“You don’t want to say anything, because maybe you went through something, same thing your buddy did, but everyone has different levels of how they deal with something,” he said. “So they don’t want to get named out for being the wimpy kid or … whatever.”

Bodurka says finding veterans to participate in the project is a challenge, and this stigma is one reason that’s the case. He says it’s a common problem with research about mental disorders more generally.

It’s why he stresses that all patient information is completely confidential. No one will find out who's participating in the study. He also stresses, the process is completely safe and painless. In fact, a non-invasive therapeutic approach is one of his main goals.

“I’m interested in noninvasive in ways to modulate the brain activity,” he said. “I call it neuromodulation. There’s a lot of techniques which actually allow you to do it, but they’re invasive technique. FMRI gives you ability to peer inside your brain without any harm.”

He says the goal is to retrain the amygdala, the section of the brain that behaves abnormally in PTSD patients.

“It’s a key region in the brain involved with emotional regulation,” he said. “We have some evidence, experimental evidence, that the people who can self-regulate this region can cope better with diseases like PTSD.”

A Test That Looks Simple

What happens is this: inside the fMRI machine, the subject watches a screen, which will show him, in a simple way, what's going on in his amygdala, which is the part of the brain that behaves abnormally in PTSD patients.

“The subject is essentially inside the scanner,” Bodurka said. “He will see his own brain signal from amygdala on the screen. And we teach the subject how to control the signal.”

He says members of the research team prep the subject before the scan.

“And we told the subject what kind of strategies they can use,” he said, “in this case that would be positive autobiographic memories.”

A blue bar on the screen he sees during the scan will serve as the goal. A red bar signifies what's going on in the subject's brain.

“They will see their amygdala signal in the form of the bar,” he said, “which will move up or down depending on their amygdala single from their own brain, and we ask them to up-regulate this bar”

The subject uses the happy memories to get the red bar to rise to at least the level of the blue bar.

“We will train them several times like that,” he said,
and they will exert better control over this crucial region.”

The concept seems simple. But Dr. Bodurka says that actually seeing the work your brain is doing is potentially much more powerful than simply trying to recall happy memories to combat the negative effects of PTSD.

“Without the neurofeedback it’s really hard to essentially teach yourself to control something,” he said. “So neurofeedback is visual representation that you’re actually achieving your goal.”

He says previous research at the Laureate Institute has used a similar procedure with depression patients, and that that study has had promising results.

But Bodurka doesn't want this treatment, should it also prove to be effective, to just be limited to patients of clinics or hospitals that have fMRI machines.

That's why, if you’re a subject in this study, not only are you being scanned and seeing your own brain activity via the fMRI, but researchers are also recording data from your brain using electroencephalography.

“We would like to explore the EEG data and come up with the methods,” he says, “and build much simpler device which would provide the same functionality, neurofeedback, but with EEG only. So that’s the secondary goal of this research.”

Bodurka hopes that information can help them create a smaller, even portable version of the treatment. That would mean you could easily take it to, say, a combat zone, where it could be used to treat war-fighters on the spot.

Right now though, researchers are looking for veterans, with or without PTSD symptoms, to participate.

The veteran serving as part of the control group says he hopes his contribution can help. He says he can imagine what it would be like to live with PTSD.

“When we came home—we were always around explosions—so they said, hey, when you get home for the first week and you hear something loud, you’re going to respond to it,” he explained.

“You kind of shrug it off, yeah, whatever, but when you get home and you go to see a movie, and there’s ten of you gathered around, which you can’t do that over there,” he says, “Boom, you hear boom—everyone kind of ducks or scatters real quick.”

“About a week it goes away,” he said. “Then again, some people, it never goes away.”

“So it kind of got me interested in the idea,” he said. “Maybe there’s some way I can help.”

For him, the effects did go away in a week. But he says he knows how hard it would be to be a veteran for whom that reaction is a way of life.