Tetris or sleep deprivation to treat or prevent PTSD?

Here's a reference to an interesting 2009 study showing that playing tetris for 30 minutes can interfere with memory consolidation of upsetting visual imagery:
http://www.ncbi.nlm.nih.gov/pubmed/19127289

This is an example of evolving evidence that an important period for consolidation of  memories occurs in the first 24 hours after an experience.  A consolidated implicit association between the factual components of memory and strong negative emotions may also form most strongly during this initial post-exposure period.

The same group published a 2010 study showing that a game like tetris was more effective than a quiz-type game activity for reducing visual flashbacks following exposure to upsetting imagery:
http://www.ncbi.nlm.nih.gov/pubmed/21085661

I think the message here is not that tetris in particular has some kind of unique medicinal properties, but that a non-passive activity which requires continuous, intense visual attention is most effective at reducing consolidation of intrusive visual memory.  A distracting activity lacking strong visual involvement may be less likely to interfere with this consolidation mechanism. 

Other research has suggested that propranolol, a beta-blocking drug, can reduce post-traumatic memory consolidation, particularly the troubling implicit or emotional component responsible for psychological symptoms of PTSD.  (see my other post, http://garthkroeker.blogspot.com/2009/02/beta-blockers.html)

Some of the standard psychological treatments in the immediate post-trauma period may be harmful, such as critical incident stress debriefing.  If individuals are compelled to revisit details of their trauma in a group setting,  during the sensitive 24-hour post-incident window,  this may increase rather than decrease memory consolidation.  I think this tactic is especially problematic if there is social pressure or overt prescriptive advice from professionals to do this, when the individual may not wish to talk about the trauma.   This type of pressure may feel coercive rather than freely consensual, a dynamic which could be re-traumatizing. 

In another recent study (http://www.ncbi.nlm.nih.gov/pubmed/20889142 ),  sleep deprivation following exposure to upsetting visual stimuli was shown to reduce aspects of implicit memory consolidation.  This is consistent with other evidence showing that sleeping facilitates learning, by helping to consolidate recently acquired memories.

In conclusion, I think it is useful to know some simple techniques which could reduce the harm which traumatic experience can immediately impose upon the brain's memory systems.  Immediate distraction with an absorbing visual activity, such as tetris, could be helpful.  Sleeping right away may not be helpful, and may actually increase consolidation of traumatic memory.

For consolidated symptoms of PTSD, and for longstanding troubling thoughts, memories, images, and emotions, etc.  it is clear that therapeutic dialog can be very helpful, provided the setting is safe, non-pressured, comfortable, with a strong sense of trust.    Such gentle dialog could begin the process of weakening the strong negative emotional grip that the traumatic experiences may have in daily life.  The evidence mentioned above has to do with reducing the incidence of PTSD in the first place, through specific tactics to be undertaken immediately after the trauma. 

We could infer, conversely,  that engaging in distracting activities, such as video games, after doing an activity that you would want to remember vividly (such as studying, or some other pleasurable or meaningful event), could lessen retention of these positive experiences  (so, you shouldn't distract yourself with an absorbing visual activity right after studying).  Also, having a good sleep after a pleasurable event, or after studying, would be expected to make these experiences more permanent in your factual and emotional memory. So, it's important to be conscious of what you do, during, but also after, events of significance.

"The King's Speech"

I recently watched this movie ("The King's Speech"), which I thoroughly enjoyed.

I found it to be a nice story about the potential benefits of therapeutic change, and about the ingredients required to achieve this.

The literal facts of the story were interesting, but like a plot of a play, are not important in themselves to appreciate the theme or message.  

The story has to do with the relationship between Prince Albert--who would become King George VI--and a seemingly unconventional speech therapist he met to deal with his stuttering problem.

I see the stuttering/speech therapy angle of the story (and its implied psychodynamic underpinnings) to be more of a metaphor for psychological symptoms.   The facts about the causation of stuttering do not include a prominent role for psychodynamic factors or childhood trauma, etc.   But the therapy for any problem, irrespective of its cause, is often helped greatly through psychodynamic insights and focus, particularly if the context of the problem has affected relationships and sense of self. 

The compelling message I found about therapy in general, was that symptoms in the mind can obstruct the attainment of greatness or satisfaction in achievement or character.    I see this often -- that there is tremendous potential in an individual, almost a sense that there is a special place or purpose for the person in the world, but this potential is obstructed and trapped because of symptoms, psychological injury, or illness.    For a therapeutic endeavour to be helpful, it requires trust, a safe and balanced therapeutic frame, and a good rapport.  I like the idea that playfulness, spontaneity,   physical activity,  and humour are essential elements of therapeutic benefit in this story.  The other ingredient for therapeutic change--often under-emphasized in many stories--is that the work required needs to be very intense and disciplined.  A good therapist can have the role of trusted confidante, listener, teacher, or advisor, but also of a behavioural coach, to help and encourage the long and difficult daily work involved to effect behavioural and psychological change.

Another great thing about this movie is the soundtrack, which includes some of my very favourite, wonderful and thematically relevant pieces by Mozart and Beethoven.

Psychiatry & Dentistry

There could obviously be psychiatric issues in dentistry, such as phobias.  A good dentist could be quite therapeutic in this regard.

But there are a other dental issues that have to do with psychiatry.

For example, having unhealthy gums probably causes increased transient bacteremia each time one eats; this is caused by the mechanical stimulation of gums with a high bacterial load leading to leakage of bacteria into the blood circulation.  This would not be expected to cause a systemic infection, but it would stimulate an immune response.  Some research suggests that this type of recurrent phenomenon causes heightened systemic inflammation, which in turn stresses the brain.  
Here are some references which show a relationship between gum disease and systemic inflammation; this causative relationship is further associated with increases in the risk of various systemic diseases, and overall mortality. 
http://www.ncbi.nlm.nih.gov/pubmed/20306866
http://www.ncbi.nlm.nih.gov/pubmed/20502435
http://www.ncbi.nlm.nih.gov/pubmed/18052701
http://www.ncbi.nlm.nih.gov/pubmed/19909639
 http://www.ncbi.nlm.nih.gov/pubmed/17559634
http://www.ncbi.nlm.nih.gov/pubmed/20960226
http://www.ncbi.nlm.nih.gov/pubmed/19774803
 http://www.ncbi.nlm.nih.gov/pubmed/20509364

The existing research shows a link between oral disease and increased risk for various other diseases, such as cardiovascular disease.  We can hypothesize that any factor increasing risk for cardiovascular disease would also be deleterious to the brain, as it would affect the brain's very sensitive vascular system.  Not much research clearly proves this risk.  Here is a reference which starts a discussion on the subject:
http://www.ncbi.nlm.nih.gov/pubmed/19864654
Here's another, suggesting that controlling or preventing gum disease is a preventable risk factor for Alzheimer's Disease:
http://www.ncbi.nlm.nih.gov/pubmed/18631974

So, it is a relevant part of preventative mental health care to take good care of your teeth, including regular dental visits!

There are other overlaps between psychiatry and dentistry.  Many people, when depressed, neglect daily dental care.   Psychotic symptoms can arise over dental issues (e.g. believing there is a transmitter implanted in a filling).  Various overvalued ideas can persuade people to seek arguably unnecessary dental procedures (e.g. regarding mercury amalgam filling removals).  While mercury is likely to be of some risk, e.g. regarding the development of autoimmune reactions, it is likely that many people overestimate the degree of risk, or falsely attribute symptoms to the type of dental fillings they have.  Therefore, a business may arise of expensive filling replacements which are medically unnecessary.   Here are a few articles about this: http://www.ncbi.nlm.nih.gov/pubmed/16042501
http://www.ncbi.nlm.nih.gov/pubmed/16393137
http://www.ncbi.nlm.nih.gov/pubmed/18517065
http://www.ncbi.nlm.nih.gov/pubmed/16448848
Another dentistry/psychiatry intersection has to do with cosmetic dentistry, and orthodontics.  Orthodontic treatment is associated with at least a temporary increase in self-esteem, and possibly even an improvement in motivation. (reference: Karen Korabik, "Self Concept Changes during Orthodontic Treatment",  Journal of Applied Social Psychology, 1994, 24, 11, pp. 1022-1034).   Korabik's earlier work showed that orthodontic treatment led to individuals being perceived in a more positive way by others, with regard to impressions of personality, intelligence, as well as appearance (even, for example, based on pictures in which teeth were not visible). (Basic and Applied Social Psychology 2, 59-66, 1981).   This phenomenon illustrates a problem with human nature, that we would infer things about one another based on superficial factors.   The power of such superficial phenomena, relationally,  is usually also short-lived and superficial, yet I do think that simple esthetic practices, if available, could be at least a small positive in affecting interpersonal dynamics, and therefore be a small positive influence in maintaining a healthy mood.  

Psychiatry and Linguistics

The history of spoken and written language is a very interesting field of study.  The manner in which languages evolve over time is similar, literally, to the way in which species evolve (languages do evolve much more rapidly than species).  It is interesting to look at a kind of linguistic evolutionary tree, to see the parallels and differences alongside a genetic evolutionary tree, say of Indo-European languages in comparison to mitochondrial or Y-chromosome haplotype analysis in Eurasian groups.

Styles of language, and of word choice, etc. are certainly influenced by the culture of the day.  It would be interesting to consider the degree to which word choices affect individual psychology.  Some modern feminist thinking has certainly looked at the issue of language issues having important elements of psychological effects, particularly if the language itself is biased towards being sexist.  This is a big area, one which I'd be interested to learn more about.

Another aspect of linguistics has to do with the multi-sensory nature of language perception.  I find this very interesting, in expanding our understanding of the way the mind works in general:  words on their own may be perceived or understood in different ways intellectually (this is an issue often discussed by literary scholars), but the manner in which words are perceived is also influenced very directly by core neurologic processes.

For example, I recently discovered the existence of a very powerful perceptual phenomenon called the "McGurk Effect."   Here are a few examples from YouTube:
http://www.youtube.com/watch?v=DsdyE491KcM&feature=related
http://www.youtube.com/watch?v=aFPtc8BVdJk&feature=related
If you watch the video while listening to the speaker pronounce a syllable, it sounds completely different from when you close your eyes and just listen without watching.  The phenomenon demonstrates how powerfully visual input changes how we perceive an auditory stimulus.  I was surprised to find how overpoweringly strong the effect was, how difficult it is to somehow "over-ride" it.

Other linguistics research demonstrates that other sensory modalities, including tactile, also have strong effects on language perception.

As an extension to psychiatry, and to the general workings of the mind, I think it is true that many different perceptual and psychological inputs have very strong effects on the way we perceive other stimuli.  In social exchanges, there may be a wide variety of inputs which we are not consciously aware of, which could be substantially affecting our experiences.  In most cases, these other inputs assist us in understanding better.  The purpose of having one sensory modality influence another is to bolster the input from both, so as to facilitate understanding.  This is the foundation for how lip-reading works, for example.   But if one input is, without our knowledge, giving opposing information compared to another input, then this could lead to a very problematic behavioural cycle.

I think such phenomena are likely to happen in many anxiety disorders, for example, in which the anticipatory anxiety, and resultant physical and emotional tension, are likely to cause one's perceptions of benign social stimuli to become exaggeratedly negative.  This is happening not just on an intellectual level, but arguably on a core perceptual level, akin to the McGurk effect.  Similar perceptual distortions are likely to happen in other psychological states, such as depression.  The cognitive theory of depression centres around so-called "cognitive distortions," but I think it is important to expand this concept to admit that the phenomena could be powerful "cognitive-perceptual" distortions, which could require a lot of disciplined work to overcome.  Without acknowledging the strength of this phenomenon, frustration could quickly set in, just as it would if you were to simply practice hearing McGurk-style syllables without knowledge of the McGurk effect.

Psychiatry and Economics

I've alluded to the field of "behavioural economics" in other posts.  I think this is a very interesting extension of social and motivational psychology.

I think that a broad analogy can be made between economics and psychiatry:
the phenomenon of an economy is similar to the mind, or to one's life, in a variety of ways:
1) there are engines which drive the economy, in the form of productivity.  Economic productivity may be measured by goods or services generated by the population.  Life productivity includes various tasks of developmental "work".
2) There is a relationship between "supply" and "demand" which changes the valuation and flow of productivity.
3) Currencies become symbolic short-cuts to exchange goods or services; emotional or behavioural "currencies" can be short-cuts in to obtain needs in the community or in relationships.
4) Problems in an economy could occur at many different levels in the system:  productivity failure due to a technical, external problem (e.g. a natural disaster), a failure to exchange or trade freely, a symbolic or regulatory system which goes out of control despite integrity in the rest of the system (e.g. stock market crashes).  In the economics of mind, there could be core external problems (e.g. a neurological disorder), but there could certainly also be problems "trading freely."  Heightened neurotic defenses could be compared to a lack of "free trade," where healthy inner resources cannot be shared, not with other parts of oneself, nor with others.  Such phenomena stunt an economy, even if the core capacity for productivity is strong.  A "stock market" crash, similarly, could occur in the mind, if regulatory mechanisms in one's mind run wild, while losing touch with a moment-to-moment sense of self or present. 
5) Borrowing could, one the one hand, be a powerful means to accomplish tasks that would otherwise be impossible (e.g. buying a house).  Refusal to borrow limits capacity for growth.  But if debt cannot be managed, it leads to an economic instability, reduced autonomy, and ultimate failure (bankruptcy).  Similarly, in one's mind, risks need to be taken to grow, and one needs to borrow from others and from the community in order to develop oneself.  Refusal to borrow limits what is possible.  However, over-borrowing, and accumulation of social & emotional debts, leads to a cascade of chaotic effects. 
6) Investing is a means of taking a risk of giving one's resources away, with the hope that the community will prosper as a result, and return the investment prosperously.  Emotional and social investments are risks taken which, on the one hand, are immediately depleting, and which may cause permanent losses (e.g. with unfruitful actions are relationships) but which permit the possibility of substantial growth in one's own life, while also allowing resources for the community to grow (emotionally or socially) around you. 

Much in the field of economics include sophisticated mathematical analysis of the energy dynamics in an economic system, accounting for the many variables at play.  It would be interesting to apply some of this analysis to psychological dynamics.  Behavioural economics is more psychology than economics, at this point.  It would be curious to have more of the leaders in the study of mathematical economics apply some of their ideas to "psychological economics."