Printer Friendly Page

RESEARCHERS STUDY POSSIBILITY OF FACING COMBAT

WITHOUT STRESS -- Yale doctors have been exploring what

makes some soldiers who endure trauma resilient enough

to deal with stress without debilitating symptoms.

 

 

For more about PTSD, use the VA Watchdog search engine...click here...
http://www.yourvabenefits.org/ses
search.php?q=ptsd&op=and

Story here... http://www.courant.
com/news/custom/topnews/hc-p
erfectsoldier.artaug25,0,2802450
.story?coll=hc_tab01_layout

Story below:

-------------------------

Facing Combat Without Stress?

Researchers Examine Most Resilient Soldiers

By LISA CHEDEKEL
Courant Staff Writer

 

No one's trying to engineer the perfect soldier.

Yet.

But if a network of researchers that includes clinicians at the veterans hospital in West Haven continues down the track they've set out on, troops heading off to war could someday be inoculated against combat stress.

"Are there ways to emotionally inoculate people? It's a new area of research," said Dr. Steven Southwick, deputy director of the Clinical Neurosciences Division of the National Center for PTSD, an arm of the Department of Veterans Affairs that is housed at the West Haven campus. "We do know there are factors that make some people resilient. There are genetic components to it, but there's a huge learning component. People can train themselves to be more resilient."

Nearly a decade ago, Southwick and his colleagues began studying the chemical and psychosocial factors that make some trauma survivors more resilient than others. Through extensive studies of Vietnam POWs and other trauma survivors, and U.S. special forces and Navy SEALs, the researchers have identified a dozen behavioral traits - and two stress-related hormones - that appear to buffer the effects of psychological trauma.

The findings could have implications for future training, screening and even medication of troops preparing for combat.

The Sept. 11 attacks and the wars in Iraq and Afghanistan have given the research efforts momentum and relevance. The military has embraced resilience as its new watchword as it works to preserve troop strength and stem the growing mental health toll of combat.

"This is of great interest to us," said Army Col. Elspeth Ritchie, psychiatry consultant to the Army surgeon general and a leading expert on military mental health. "Our soldiers don't like to be thought of as victims. They like to be, and they are, warriors. And so it's better-speak for us to talk in the terms of enhancing resiliency," rather than focusing on the potentially debilitating effects of combat stress.

Southwick and Dr. Dennis Charney, the former head of the West Haven neurosciences division and now academic dean of the Mount Sinai School of Medicine in New York, began studying Vietnam POWs six years ago, in the hope of finding out why many of them had escaped depression and post-traumatic stress disorder, despite years of solitary confinement and torture. Through interviews and neuropsychological tests, they identified certain personality traits that appear to fuel resilience. They found the same qualities in civilians who had endured severe trauma, such as abuse or medical crises.

Among the characteristics they have identified are some simple ones, such as physical fitness, and some complex ones, such as "cognitive flexibility" - the ability to rethink negative events and draw strength from adversity. They also found that spirituality, optimism and having role models and a strong moral code were keys to resilience.

Southwick said having a supportive social network - family members, friends or fellow soldiers - is critical to rebounding from trauma. Organized religion plays a role because it gives some people grounding in a supportive community. Similarly, troops who train and deploy together as cohesive units form bonds that boost emotional resilience.

In their studies of the Vietnam POWs, Southwick and Charney were struck by the importance of the "tap code" that was used by the captives to communicate with each another through their cell walls. It was the prisoners' only form of social support, but it was enough to keep many of them from falling apart.

"All of the POWs will tell you that the tap code was instrumental," Southwick said. "They realized they weren't isolated. They could let each other know, `Look, we understand that nobody can withstand this level of torture, but do your best.'"

The moral of the story was plain:

"If you're looking to be resilient," Southwick said, "you really need other people."

Charney and Southwick, a psychiatry professor at Yale University, said they believe most of the qualities found in resilient people can be learned, and they see implications not only for military training but for child-rearing and early education. Parents who think they should shield their children from any kind of stress could be doing more damage than good, in their view.

"The art of raising resilient kids, and then resilient adults, is challenge and master, challenge and master," Charney said. "You don't want to raise your kids stress-free because then they're not prepared, they're not equipped."

The Biological Markers

Training is only one path in the research maze. Southwick, Charney and other researchers also are chasing the biological markers of resilience - the genes and hormones that influence how people react to stress.

Extensive studies of Army and Navy elite forces, led by Dr. Charles A. Morgan, a Yale psychiatrist and VA researcher, found that troops who performed well under stress had elevated levels of two hormones - a peptide called neuropeptide Y (NPY) and the adrenal steroid dehydroepiandrosterone (DHEA). The studies suggest the two substances may act as anti-stress agents, opening up possibilities that they might be effective in treating or preventing PTSD symptoms - or even measured to predict which recruits are a good fit for combat duty and which ones are not.

"One next step is to see whether NPY, which has been administered to people not for this purpose in the past, helps with anxiety and fear," Charney said.

"It's possible someday there may be some neurochemical interventions," Southwick agreed. "We don't know yet. It's still new."

Also being studied is whether a class of antidepressant drugs known as SSRIs - selective serotonin reuptake inhibitors - can help to buffer the effects of stress. Research on animals suggests SSRIs have some stress-protective benefits. But because the drugs must be closely monitored for side effects, their use among troops deployed to war has stirred concern.

Research into the genetics of resilience also is relatively new. Researchers in 2003 identified variations of a serotonin-transporting gene that, in one form, appears to increase the likelihood of depression after stressful life events.

But how big a part genetics plays in resilience remains uncertain. Another researcher at the West Haven VA, Yale psychologist Joan Kaufman, found in a recent study of abused and neglected children that depression levels in those with the vulnerable gene form could be moderated by environmental factors. Children who had "positive social supports" were less likely to suffer depression than those without such supports, regardless of whether they had the genetic variation that predisposed them to depression.

"With regard to resilience, you're not doomed by genetics," Southwick summed up. "Experience and training can definitely affect the outcome."

Although some of the qualities found in resilient people, such as optimism, might seem more ingrained than learned, Southwick and Charney say training can change the way the brain processes frightening or negative information, forging new synaptic connections and memory encoding.

"Realistic optimists," as Southwick dubs those who show resilience, "have a habitual way of explaining events to themselves. They see the negative but don't dwell on it or over-generalize. ... So the question becomes, could you train people to put information into a realistic optimistic perspective?"

He says yes, pointing to the kind of counseling that is proving successful in treating people with PTSD.

"Just like you can address cognitive distortions in people with PTSD who might be attributing much more blame to themselves than they deserve, you can train someone to believe optimistically ... that things will work out," he said.

A Shift In Focus

Southwick, a Vietnam-era veteran himself, began work at the West Haven VA in 1983, just a few years after PTSD was recognized as a clinical diagnosis.

Early on, he said, veterans were routinely misdiagnosed with depression, schizophrenia and other mental disorders. The VA's early work focused on the pathology of PTSD, with the Clinical Neurosciences Division, established in 1989, emerging as a leader in educating clinicians about the symptoms and science of the disorder.

Then, about a decade ago, Southwick, Charney, Morgan and other researchers quietly began shifting gears.

"It occurred to us, what if we studied people who are resistant to trauma, who are resilient? What could we learn from them?" Charney said.

Since the national trauma of Sept. 11, researchers around the globe have joined in that pursuit.

The military's interest in resilience has grown as the war in Iraq grinds on, with troops being sent back to combat for multiple tours - a deployment cycle that is testing stress tolerance in unprecedented ways. A recent report by a team of military mental health experts found that 27 percent of troops serving repeat tours screened positive for PTSD or other mental disorders, compared with 17 percent of those deployed for the first time. Suicides in the war zone have climbed.

The human wear and tear is of concern to top military officials, who are balancing manpower demands with the mental health needs of troops.

Col. Ritchie, of the surgeon general's office, said the Army's training and counseling programs are increasingly focusing on improving soldier resilience. Pre-deployment training emphasizes that flashbacks, nightmares and other reactions to trauma are "normal" responses. Basic training "has evolved over time," Ritchie said. "Even just five years ago, it was more about how to march, and now it's much more oriented to what it's going to be like over in the [combat] theater."

More training on how to handle trauma is planned, she said.

Some mental health experts worry that the military is pushing the notion of resilience too far by sending some troops diagnosed with PTSD back for additional combat tours. The practice runs counter to accepted medical doctrine and research, which cautions that re-exposure to trauma intensifies psychiatric problems.

But military leaders have argued that PTSD is treatable and that soldiers who want to return to combat should be given the chance. Recently, the Army opened a special "restoration and resilience center" at Fort Bliss in Texas, where soldiers diagnosed with PTSD will receive counseling and treatment aimed at helping them to recover enough to return to combat.

To Southwick and Charney, who started their research before the war in Iraq began, the prolonged conflict has served as a ready-made laboratory. Southwick has been involved in research at Fort Drum, in upstate New York, looking at brain functioning and stress reactions in active-duty soldiers, some who have developed PTSD and some who haven't. A few years ago, Southwick and Charney were instrumental in establishing a partnership between Mount Sinai and the West Haven center, called the Resilience Lab, to continue research into stress resistance.

Charney and Southwick are now collaborating on a book about resilience, to be published next year, which will detail their research on Vietnam POWs.

Both men say their studies of resilience have influenced their own lives. Charney said his children complained that he got tougher on them as he began appreciating the merits of learning to master emotional challenges.

Southwick said his interviews with the POWs replay often in his head, at odd times. He might be at the gym, ready to quit exercising because he is tired, when he will remember the story of one POW who was determined to keep up enough strength to escape.

"He realized he could exercise, even in the tiniest of cells, even under the worst conditions," Southwick said.

"At one point, he could do 61 one-armed pushups." At another, he ran circles in his cell for 24 hours straight.

"I think about them every day," Southwick said of the POWs he met. "These guys, if you're honest with yourself - you can do better getting through the challenges we all have."

Contact Lisa Chedekel at lchedekel@courant.com.

-------------------------

Larry Scott  --