What treatment can you offer someone with PTSD and a brain injury to the amygdala?
[Lt. Col, Philip Holcombe] Sometimes with a traumatic brain injury,
the injury will be to the frontal lobe or to the amygdala.
The frontal lobe is that part of your brain which helps you to ask yourself,
is what I'm getting ready to do a good idea or a bad idea.
It's really involved in planning amongst other things.
We call the frontal lobe the executive of the brain.
It helps us think through our actions,
helps us control our impulsivity,
helps us think about what's next.
So when you start thinking about treatment,
and you're thinking about frontal lobe,
and you have a patient with PTSD who's experiencing frontal lobe issues,
you'll want to make sure that you're interacting with a patient
in a way that clearly spells out the plan in a collaborative fashion.
We've established our treatment priorities based upon a collaborative discussion.
We're going to do this first,
and then we're going to do this,
and then we're going to do this.
And these are the reasons that we're going to do these kinds of things.
So with regard to frontal lobe injury,
planning is very important.
The other thing that's important with regard to
a frontal lobe injury or any brain injury
is to understand that the ability of the person
with regard to mental energy to make it through an intense session
may not be what it would be if they didn't have the brain injury.
So you may need to design your sessions in such a way that
they are less intense or shorter in duration
so that you can be intervening while the person
has the mental energy to help you do that.
The amygdala is also a very, very important part of our brain.
The amygdala is that emotional part of our brain.
Post-traumatic stress disorder--we've talked about that some of the criteria
related to that has to do with anger and has to do with irritability.
And so to help somebody who's struggling with amygdala issues,
you'll really need to make sure that you emphasize
methods for coping and self-soothing.
Self-soothing is important for everybody
but certainly when somebody is experiencing amygdala problems.
They really need to learn how to anticipate
situations that may upset them.
So let's say you have an amygdala and a frontal lobe issue.
A great combination and approach for that
would be something like stress inoculation training
that integrates an intervention that we call behavioral rehearsal.
So this is helping patients anticipate situations with which
they've struggled before,
and over and over again rehearsing—imaginal rehearsing—
of how they would address these kinds of situations.
How am I going to address this, how am I going to prepare that this may upset me.
If this upsets me, what am I going to do
so that I maintain emotional control and keep my dignity intact.
Maybe I'm going to plan for what I need to do when I need to exit.
Maybe I need to plan on how do I tell a person politely, I need a few minutes.
Maybe I need to plan to not engage in interactions that are
likely to upset me when I think I'm most likely to be tired.
Maybe the end of the day is not a good time for me to take on heavy things
because I do better earlier in the day after I'm more well rested.
So with regard to the frontal lobe, we are looking at executive planning,
looking at mental energy,
the ability to get through the day,
the ability to get through a session.
And with the amygdala, we're really looking at emotional control
and deliberate plans to engage in self-soothing
and planning on the emotional intensity
that you're getting ready to take on in various situations through the day.
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Lt. Col. Philip Holcombe, PhD, Lt. Col. Philip Holcombe is an Army psychologist who serves as the chief of Clinical Recommendations at the Deployment Health Clinical Center at the Defense Centers of Excellence for Psychological Health and Traumatic Brain Injury.
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