Save Our School 
Letter From Austin
Fear Less
As an alarming number of veterans return from war suffering from the debilitating effects of post-traumatic stress disorder, one University of Texas psychologist is trying to figure out how to help our soldiers—before it’s too late.
Cindy says: Exposure therapy works. As a sufferer of PTSD, I’ve had all types of therapy and all types of drugs, and the only thing that has helped with the anxiety has been exposure therapy. It "breaks the magic" of the object or circumstance that triggers the anxiety. (March 24th, 2010 at 2:31pm)
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There’s a precedent for inoculating people against future anxiety disorders. Take, for example, the research that has been done with carbon dioxide. Numerous studies have shown that when people inhale a gas mixture that is 35 percent carbon dioxide—which induces breathlessness and light-headedness—some remain calm while others panic. Telch’s preliminary research suggests that those who panic are more susceptible to anxiety problems in general, and he believes this predisposition can be remedied. With repeated exposure to the carbon dioxide mixture, patients can train themselves to modify their response—a behavioral change that, Telch believes, will apply to other anxiety-causing situations. People, it seems, can be taught to keep their cool.
“The Army requires demanding drills, such as exposure to gunshot noise,” Telch said of the preparation soldiers undergo before deploying. Perhaps, he suggested, soldiers with a predisposition to PTSD could undergo a specialized stress-training regimen, such as CO2 therapy. “This would be just another set of drills to knock out their anxiety sensitivity,” he said. It would be a completely new strategy for attacking PTSD—the difference between improving cardiac surgery techniques and figuring out ahead of time who might benefit from cutting back on bacon cheeseburgers.
In the fall of 2007, 184 Fort Hood soldiers who had volunteered for Telch’s study began visiting the IRC, a plain one-story building in North Austin. They had never been deployed, but in a few weeks nearly all of them would be sent overseas. Most of them would prove to be resilient in the face of their ordeals. A few wouldn’t be so lucky.
Since researchers have established an association between prior mental illness and PTSD, the first tests assessed the participants’ mental health via online surveys and clinical interviews. “Before the soldiers left and then when they returned, they were administered a structured, gold-standard diagnostic interview,” Telch said. Depression, anger, dissociation, social support, and alcohol and drug use were a few of the indicators researchers were measuring.
Next, each soldier lay down inside a magnetic resonance imaging machine that recorded his brain structure and activity. The primary areas of interest were the prefrontal cortex—the area that moderates social behavior—and the amygdala and the hippocampus, segments that, along with the prefrontal cortex, work together as our internal warning system. Some PTSD patients display abnormalities in all three areas: underactive prefrontal cortices, hyperactive amygdalae, and shrunken hippocampi. But researchers weren’t sure if abnormalities were present before the onset of PTSD or materialized afterward. Were they a cause or a consequence?
Telch also looked into the soldiers’ genetic vulnerabilities. Researchers had soldiers spit into small cups and then examined their DNA for evidence of the serotonin transporter gene, which has been shown to predict risk for depression and anxiety if a particular variant is present. Then the soldiers participated in eye-tracking experiments, which recorded what they looked at on a computer screen. Last winter, at the IRC’s eye-tracking laboratory, Christopher Beevers, the project’s mood disorder specialist, explained to me how his state-of-the-art device worked. “The basic idea is, you present different images to individuals and directly measure their line of gaze,” he said. The equipment, which looks like a typical flat-screen computer monitor, shines an infrared light that bounces off the eye and correlates the reflection with anchor points on the screen. Using his eye-tracking software, Beevers can ascertain precisely what a viewer is looking at on the screen and for how long. He can even generate a map showing the order in which the viewer looks at each spot. To demonstrate, he tapped on his keyboard and produced a screen separated into four quadrants. Each portion displayed a black and white photograph of a man’s face: One exhibited fear, one happiness, one sadness, and one no emotion at all. In theory, folks who are prone to depression are likely to spend more time looking at sad faces; people who are prone to PTSD are likely to avoid the frightened faces.
The final station was Telch’s carbon dioxide challenge. After the participants were fitted with a heart-rate device, they took one deep breath of the gas mixture. Telch instructed them to hold it in their lungs for five seconds. In PowerPoint presentations, Telch likes to play a video of previous tests with college students showing the variety of responses to the gas. In the first segment, a student inhales deeply through a gas mask, holds his breath for a few seconds, and almost immediately goes into a panic attack. His eyes dart around the room and he looks completely freaked-out, grabbing the researcher’s arm and pitching forward. In the second segment, a student takes a breath and holds it as if it were a bong hit, giggling as he lets it out; he pumps his fist, then flops back into the chair with a big smile on his face. “Some people get really scared of the CO2 ,” Telch said. “Some people actually enjoy it.” Past experiments have demonstrated that those who panic are susceptible to anxiety problems. But only after deployment would Telch be able to determine what this might mean for soldiers in combat.
Most of the soldiers who participated in the study fought in Iraq for fifteen months; thirty to ninety days after their homecoming, 162 of them returned to the IRC for a post-deployment round of tests. The results aren’t definitive enough that the Army is about to subject all incoming soldiers to carbon dioxide tests; for one thing, it’s too early to know which soldiers will develop PTSD, a condition that often emerges months or years after the precipitating event. (At most, Telch and his team have observed symptoms of what might turn into full-blown PTSD.) But the results trickling in show promise. Sitting at his computer two and a half years after he began the study, Telch pointed to a chart that confirmed that, as past research had shown, those who had a history of mental disorders were much more vulnerable to stress, depression, and what appeared to be early PTSD symptoms. Other findings broke new ground: In the short time during and after deployment, those who had avoided fearful faces in the eye-tracking tests and who had displayed high reactivity in the carbon dioxide challenge exhibited more stress and possible PTSD symptoms. Neuroimaging and genetic factors were still under evaluation, but Deborah Stote, a neuroscientist working on the project, said, “I would bet my bankroll that the people with early PTSD symptoms will show decreases in the size of the hippocampus.” If that is the case, pre-trauma hippocampal size can be ruled out as a predictor of PTSD.
There is still plenty of work to do. Telch is seeking funding to extend the current study, so he can track what happens as some of his test subjects develop PTSD. He also wants to launch a larger study of more than three hundred soldiers. And, at some point, he will want to test out various methods of inoculation. Still, Baldwin believes this first report is a major step. “We didn’t start out thinking we would find a silver bullet,” he said. “But world-changing discoveries occur because people believe that a silver bullet is possible.”
Of course, no treatment will ever offer a cure-all for veterans. Combat trauma produces anxiety and painful memories even in the hardiest soldier. But the men and women who suffer from post-traumatic stress disorder carry a far greater burden: decades of debilitating mental anguish that can destroy their lives and the lives of those around them. If counterinsurgency is the future of military engagement, and the wars our soldiers will fight in the years to come are anything like the wars they are fighting now, a cure can’t come soon enough.
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