Professional Documents
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Patrick Marius Koga, MD, MPH UC Davis School of Medicine & VIRTIS CAMFT March 19, 2010
Transpersonal?
How could a transpersonal approach have any relevance to such a personal experience?
CLINICAL
T R A U M A E V E N T
TIME
3mths-Several Yrs Community interventions -Education - Network formation
NON CLINICAL
Pre-Trauma Preventative strategies Training (emergency services) Briefing Pre-torture Preparation (special Groups SAS etc.)
2wks 6 months Selective responses to high risk group -selective debriefing - Repeat debriefing - Continuing psychological first aid
24 hrs-2 wks Early general responses Psychological first aid debriefing
Assessment
Cognitive Formulation Ready for treatment Therapy boundaries
NO
Support Monitor
Trauma story
EMDR
IMAGERY
EMDR
Cognitive therapy Normalisation, Vulnerability, Responsibility, Appraisal of trauma, Survival Behaviour, Avoidance
Behavioral Therapy
Drugs
SSRIs tricyclics, Carbamazepine
Relapse Prevention
Follow - up
(-)
Cortisol is released in
relation to stressor severity. An important role of cortisol in stress is to contain other biological stress responses
Data from MRI studies showed an 8% reduction of left hippocampal volume in Vietnam vets and similar decreases in the right sides of physically and sexually abused women.
11
Cortex
PFC
Sensory Thalamus
Amygdala
Thalamo-cortico-amygdalic pathway
FEAR
VINE?
SNAKE?
VINE
Phew! Vine
SNAKE!
SNAKE!
Fear
the information that has travelled via the high road and been processed in the cortex reaches the amygdala and tells it whether or not the stimulus represents a real threat. To provide this assessment, various levels of cortical processing are required.
20
The hippocampus
supports the explicit memory required to learn about the dangerousness of an object or situation. especially sensitive to the encoding of the context associated with an aversive experience. not only can a stimulus become a source of conditioned fear, but so can all the objects surrounding it and the situation or location in which it occurs.
SNAKE!
Fear
No Threat
No Danger
Threat!!
Danger!!
Integrated Narrative
Hippocampus
Hippocampus
PTSD:
Inability to extinguish conditioned fear responses
PFC bypass
Sights Sounds
_
dissociation
AMYGDALA +
+ _
Hippocampus
Thalamus
2. Access
Imaginal In-vivo Virtual
3. Change
Cognitive re-framing Habituation, re-appraisal, and mastery
VR headsets
small TV screen for each eye slightly different angles 3D effect
inside VR
scenes projected on walls realistic 3-D environment real controls; moving within the world
other people interactive
Engages
the senses sight:
visual realism, 3D effects: shadows, etc.,
sound:
surround sound, subseat woofers etc.
touch:
haptic and force feedback
the body realistic devices movement in the environment interaction and control of objects, rapid feedback
A HMD exposure therapy simulation that uses digital assets from Full Spectrum Warrior.
The object of the simulation is to allow the patient to create personal narratives about real-life traumatic events that foster psychic
integration rather than the dissociation of PTSD. Some versions of the simulation use a motion platform and/or scent release device.
Virtual Classroom
Albert Skip Rizzo ADHD Children
Telemedicine
Rehabilitation and training in virtual environments for amputees, spinal injury patients, the blind, and the developmentally disabled.
VR - PTSD
Virtual Vietnam Emory University World Trade Center Weill Cornell Medical Center/U of Wash Terrorist Bus Bombing - U. of Haifa/U of Wash Motor Vehicle Accidents Univ. of Buffalo
Virtual Angola
U. of Lusfona de Humanidades e
Tecnologias, Lisbon
Virtual Iraq USC Institute for Creative Technologies Virtual Baghdad Virtual Reality Medical Centers
Virtual Vietnam
Emory University
Virtual Iraq
HUMVEE Convoy
User perspective
Alone, Patrol, HUMVEE, Helicopter, etc.
No evil?
We are not merely human beings having a spiritual experience; we are spiritual beings having a human experience Teilhard de Chardin
Meditation
sustained and deliberate concentration suggesting frontal attentional network activation. functional neuro-imaging (fMRI) demonstrate DL activation meditation may represent mixed transient hypofrontal state wherein the attentional structures are well activated, but other frontal structures are purposefully without content. If psychiatrist Mark Epsteins understanding of the ego as the self concept, the actual internal representation of ones self (Epstein, 1993, p.123), then selective activation and deactivation of the DL and VM would produce a profound state of consciously aware egolessness.
Contd
6) the reverberant circuit bounces back via the limbic system back into OAA. 7) OAA registers calming impulses and relays them back down for further more laps 8) meanwhile the meditatorss continuing intention to clear up the mind keeps on building up this reverberating circuit. 9) this bombardment produces in hypothalamus a maximum calming effect 10) the electric spillover triggers a maximum arousal effect
Contd
11) the mind is overwhelmed by simultaneous calming and arousal responses and the OAA is forced by the sudden surge to operate at its maximum rate, overloads and shuts down. Deafferentation is complete. 12) the impacts on attention area: a) RT orientation area lacks the info need for a sense of space in which to orient the self b) LFT orientation area lacks the info needed for a subjective sense of self. RESULT: collapse of subjective selfs boundaries. Oneness. A unitive experience with potential for selftransformation.
Research Questions
If both VR and Spiritual Experiences (SE) can provide a safe inner (virtual) space for ones witness consciousness, then why not try using SE for re-exposure to traumatic memories? Compare & contrast outcomes and costeffectiveness Inform policies
God Helmet
Dr. Michael A. Persinger a magnetic field pattern stimulates "microseizures" in the temporal lobes of the brain which, in turn, produces "spiritual" and "supernatural" experiences the sense of a presence in the room, an out-of-body experience, bizarre distortion of body parts, and even religious feelings.
may dehumanize soldiers & civilians via gradual desensitization (inoculation) to combat & killing stress. dissociation depersonalization, derealization, brainwashing/programming , fanaticism . Risk of training cyborg soldiers, suicide bombers, Talibanization of future armies in local and global conflicts.
International ethical guidelines? Enforceability?
www.virtis-ptsd.org
email address
pmkoga@ucdavis.edu