I hope that cardiologists everywhere are paying attention to a startling finding reported online in PloS One. A review of over 20 observational studies of cardiac patients found that 1 in 8 (12.5%) heart attack victims, or patients with unstable angina had diagnosable PTSD (post traumatic stress disorder). That’s almost double the (lifetime) rate for PTSD in the general population. Even more alarmingly this subgroup had double the mortality rate of those without PTSD within 3 to 5 years. In these studies PTSD is very strictly defined as meeting the criteria in the current Diagnostic Manual of mental disorders. If post traumatic effects like depression are factored in, the rates would undoubtedly be higher. These findings were broadcast on mainstream media as well.
The study of the effects of war trauma have also reached the headlines as the rate of suicide among active duty military personnel now surpasses the rate of battlefield deaths. ( The New York Times, 6/8/12). The rate is nearly one a day.
Think about that. Young men and women serving in combat zones are more at risk for killing themselves than they are for being killed by enemy combatants. The war moves inside and destroys from within, at a devastating rate.
Long before PTSD reached the headlines, long before the shock and carnage of 911 made knowledge of the sequelae of trauma practically mainstream, mental health clinicians were reporting back from the front lines of the child abuse wars that a goodly portion of adults who had suffered as children from sexual abuse, neglect, physical violence, sex trafficking and child pornography suffered from chronic PTSD; victims of domestic and sexual violence, ditto. Suicide rates may not be as high, but soul deaths, certainly.
The articles that I read that reviewed the heart attack studies, noted that psychotherapy and medications were the treatment of choice for cardiac patients demonstrating trauma symptomatology.
I would like to add that body based techniques such as Somatic Experiencing and Sensorimotor Psychotherapy, as well as EMDR, are good choices in the treatment of a trauma that is essentially body based. A heart attack is an attack on the heart. It is a "mugging" within the body that is life threatening, not unlike a near fatal automobile accident, a rape, surviving an airplane crash, or other near death experience.
The principal behind these body based approaches is that trauma triggers biologically based mechanisms of defense: fight, flight, and freeze. PTSD and other serious problems will follow when the tremendous reservoir of energy that is recruited when we are threatened and overwhelmed gets locked in the body and can not be discharged. A heart attack victim doesn’t have a lot of ways to discharge the impulse to flee the “attack,” or unlock from the freeze induced by overwhelming terror (I’m going to die!”). A child victim cannot fight the predator even though the impulse to do so might be very present.
These body based treatments, or more accurately sensory based approaches, like Somatic Experiencing or Sensorimotor Psychotherapy are designed to address and rebalance the nervous system by addressing it directly and not by way of the higher cognitive functions.
A heart attack victim coming for treatment for PTSD may be gently and progressively lead through the body memories of what it was like to experience the crushing pain, the terror, the helplessness, the uncertainty, all this on a sensory level. Where is it stored in the body? What happens when we pay attention to those sensations of the body? Together patient and therapist track sensation, imagery, and maybe motor inclinations. All of these activities in the interest of discharging all that pent up energy. The work is done from the grass roots, so to speak, from the bottom up. Cognitive approaches might be aptly described as from the top down.
This method is direct, gentle and amazingly effective. For more information see
or write to me.