What is PTSD?
Post-traumatic stress disorder (PTSD) impacts an estimated 13 million Americans annually. Many commonly associate the term trauma with combat veterans, but PTSD presents in a broad range of people who have experienced life-threatening or traumatic events, such as assault, abuse, illness, accidents, or natural disasters. It disproportionally affects women—10% will experience PTSD in their lives compared to only 3.6% of men, and the risk of PTSD is highest from intentional interpersonal assaults, rapes, and kidnapping.
According to the National Center for PTSD, 7 out of every 100 Veterans will have PTSD, while 6 out of every 100 adults in the general population will experience PTSD in their lifetime. With the increasing frequency of mass traumatic events, such as the pandemic, armed conflict, wildfires, hurricanes, and transportation accidents, the prevalence is expected to continue to rise.
Symptoms vary for people with PTSD, falling into four clusters: intrusive recurrent involuntary memories, efforts to avoid memories/thoughts/cues of the trauma, negative alterations of cognitions and mood, and hyper arousal and hyper reactivity symptoms. In order to be classified as PTSD, these symptoms must persist for at least one month after the traumatic event and adversely impact a person’s employment, social interactions, and relationships.
Traditional Treatment Options
The main standard-of-care treatment for PTSD is trauma focused psychotherapy, which involves recalling the trauma repeatedly until it becomes a regular memory. Because recalling trauma is difficult, over 30% of therapists and patients do not initiate this treatment, and there is a 38% dropout rate. The second line of treatment is medication, which often leads to side effects. While both of these treatment modalities work, half of patients already treated for PTSD remain significantly symptomatic. Additionally, 50% of individuals living with symptoms of PTSD do not seek treatment in the first place.
Many individuals living with PTSD avoid treatment because of medication side effects, having to talk about traumatic experiences, and enduring stigma. These difficulties are magnified by the critical shortage of mental healthcare professionals in the U.S., resulting in long waiting lists to get an appointment with a provider. In addition, lack of access to care disproportionately affects people living in healthcare deserts, as well as financially disadvantaged individuals.
Prism™: Drug-Free, Trauma-Free Treatment
There is a treatment now available that can potentially help reduce these barriers to mental health care.
Interventional psychiatry clinics are adopting neurotechnology to augment standard-of-care therapies. The latest technology, FDA-cleared for PTSD, is Prism™ self-neuromodulation. This technology, developed by GrayMatters Health, takes a different approach by helping patients learn to regulate the brain activity associated with their PTSD symptoms.
Research has shown that the amygdala, an almond-shaped structure located deep within the brain, is the key to emotional processing as well as the fight-flight-freeze fear response. Thousands of publications have demonstrated the role of amygdala hyperactivity in PTSD and other fear-based disorders. Until recently, there were no noninvasive treatments that made use of the knowledge of the hyperactive amygdala.
How Prism™ Works
Every day, we look in the mirror to shave, put on makeup, or comb our hair, but what if we could put a mirror in front of our brain activity associated with the amygdala?
Existing technologies for imaging brain activity include functional magnetic resonance imaging (fMRI) and electroencephalogram (EEG). fMRI scanners are used to measure blood oxygenation (known as the BOLD signal) in deep brain regions; however, they are expensive and are used mainly in research labs. EEG is a low-cost modality that uses sensors to measure electrical activity of the brain, but it is only effective for activity near the scalp.
In order to overcome these limitations, a digital biomarker was created by applying machine learning to register fMRI amygdala data to EEG. This amygdala-based biomarker is the technology behind Prism™ and is being used in clinics today to help patients.
During Prism™ treatment, the patient watches a computer simulation of a crowded waiting room or train station. This simulation acts like a mirror, reflecting the amygdala-based biomarker level as animated characters stand up and speak in loud voices or sit down quietly.
Patients are instructed to find a mental strategy to get the animated characters to sit down and lower their voices. This mental strategy is a unique aspect of Prism™ treatment. It is a personal memory, experience, or emotion that helps the patient learn to lower the amygdala-based biomarker over 15 sessions in the clinic.
Prism™ is non-invasive and does not require application of energy or taking additional drugs. Most importantly, Prism™ continues to have an impact even after the patient completes treatment, because the skill can be used when facing stressful situations in everyday life.
The Future of Mental Health Care
Results from three clinical studies have shown high response rates with Prism™ as an adjunctive treatment. Improvement has been shown across all PTSD symptoms clusters, and only mild side effects have been reported, such as headache and fatigue, which resolve on their own. Not surprisingly, patients continue to use this emotional regulation skill in their daily life. Three months after treatment, their PTSD continues to improve without any additional treatments. This is similar to the improvement one has after learning a language and then continuing to use it in daily life. You don’t see this from a medication treatment or psychotherapy, where there is typically a gradual decline after the treatment is discontinued.
Prism™ for PTSD is the first of many firsts for mental health. It is a rationally and scientifically designed treatment that has been proven to help PTSD symptoms. Almost all other treatments in psychiatry are based on serendipitous discoveries, but Prism™ is an objective, biomarker-based treatment, rather than a subjective, questionnaire-based treatment. It gives the patient a tool, a steering wheel for their mind in the domain of emotional regulation. It opens the door for biomarker-based diagnosis and treatment in mental health, something that does not yet exist. Fellow clinicians and scientists, this is the future of mental health treatment.
Editor’s Note: Aron Tendler, MD, Chief Medical Officer of GrayMatters Health