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Breaking down anxiety one fear at a time

Marine Staff Sgt. Andrew Gales participates in ‘battlefield’ acupuncture, also known as ‘ear acupuncture,’ at Walter Reed National Military Medical Center, as a treatment for anxiety related to PTSD. (U.S. Navy photo courtesy Mass Communication Specialist 2nd Class Kevin Cunningham) Marine Staff Sgt. Andrew Gales participates in ‘battlefield’ acupuncture, also known as ‘ear acupuncture,’ at Walter Reed National Military Medical Center, as a treatment for anxiety related to PTSD. (U.S. Navy photo courtesy Mass Communication Specialist 2nd Class Kevin Cunningham)

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Even a subtle sight, smell, or sound can trigger Marine Staff Sgt. Andrew Gales, making him jittery, inducing a pounding in his chest, or causing him to break out in a sweat. He suffers from anxiety related to post traumatic stress disorder, and he never knows how long an anxiety bout will last; it can be moments, or it can be hours.

For Gales, who did combat tours in Iraq and Afghanistan, situations where he used to be calm and collected, such as when spending time with family or going to the store, now increase his anxiety. “(It gets worse) with things I can’t control,” he said. “The loss of control increases the hypersensitivity to people and situations around me.”

Gales is not alone. Generalized anxiety, panic disorder, and anxiety related to PTSD are common. An estimated 31 percent of U.S. adults experience anxiety at some point in their lives, according to National Institute of Mental Health diagnostic interview data from the 2017 Harvard Medical School National Comorbidity Study.

“Everyone experiences symptoms of anxiety,” said Navy Capt. (Dr.) Sawsan Ghurani, a staff psychiatrist at Walter Reed National Military Medical Center in Bethesda, Maryland. “When it disrupts your daily life – going to work, leaving the house, interrupting sleep – that’s when we classify it as a disorder.”

Asked for a few PTSD anxiety symptoms, Dr. Amanda Edwards-Stewart, a research psychologist at the Psychological Health Center of Excellence, Joint Base Lewis-McChord in Tacoma, Washington, cited avoiding driving in the passing lane for fear of being boxed in; taking a different route to work every day for fear of being followed or ambushed; displaying hypervigilance as one waits for the next bad thing to happen; or, as seen in generalized anxiety, experiencing ruminating thoughts of losing one’s job, family, or health. She said the anxiety has to be constant and debilitating to be considered a disorder.

Unfortunately, many people have more than one disorder at a time – for example, depression and anxiety. Edwards-Stewart explained some of the common related disorders and their symptoms:

  • Depression is often found in people with anxiety. Major depression includes feelings of hopelessness that last for more than two weeks, a change in eating and sleeping patterns, and social isolation. Depression can be so severe that the person cannot get out of bed, or it may take a slightly milder form.
  • Panic disorder involves consistently having panic attacks that can include sweating, heart racing, hyperventilating, and a general feeling that one is going to die. Panic attacks can last 20 minutes or more and often are triggered by no apparent event or situation.
  • PTSD occurs several months after a psychological trauma. Those who suffer from it go to great lengths to avoid people, places, and thoughts that remind them of the trauma. They are numb and have difficulty feeling a full range of emotions. They also have problems with sleep and invasive thoughts. The Diagnostic and Statistical Manual of Mental Disorders changed PTSD to a stress trauma disorder in 2013.

If one suffers from one of these disorders, the good news is that MHS providers are using a variety of treatment services. “If you’re just prescribing medication, you’re not getting at the root cause,” Ghurani said.

But some forms of therapy may seem counterintuitive. Edwards-Stewart noted that treating panic disorder sometimes involves recreating the setting that induces the panic. “By putting the person in the situation that scares them, it teaches teach them it is OK to feel that way, and it becomes less anxiety provoking,” she said.

In addition to cognitive therapy, Walter Reed Bethesda also offers patients “battlefield” acupuncture, which treats the whole body by stimulating corresponding points on the ear; as well as transcranial magnetic stimulation, a noninvasive, effective intervention that uses magnetic energy to help relieve symptoms.

Gales, who’s been receiving medical care since 2011, has tried many forms of treatment and has found help for his anxiety. He explained that one of the Marine leadership principles, “seek self-improvement,” was a key factor in why he sought help.

“It was realizing this isn’t a failure,” he said. “I have some sort of a problem. (The important thing is) accepting it, and realizing reaching out for help is not a weakness. For those who are on the fence, come in with an open mind. There are a lot of treatments available. It’s like anything in the military – resources are there, and it’s up to you to take advantage of it to improve yourself.”


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This retrospective study estimated the rates of seizures diagnosed among deployed and non-deployed service members to identify factors associated with seizures and determine if seizure rates differed in deployment settings. It also attempted to evaluate the associations between seizures, traumatic brain injury (TBI), and post-traumatic stress disorder (PTSD) by assessing correlations between the incidence rates of seizures and prior diagnoses of TBI and PTSD. Seizures have been defined as paroxysmal neurologic episodes caused by abnormal neuronal activity in the brain. Approximately one in 10 individuals will experience a seizure in their lifetime. Line graph 1: Annual crude incidence rates of seizures among non-deployed service members, active component, U.S. Armed Forces data •	A total of 16,257 seizure events of all types were identified among non-deployed service members during the 10-year surveillance period. •	The overall incidence rate was 12.9 seizures per 10,000 person-years (p-yrs.) •	There was a decrease in the rate of seizures diagnosed in the active component of the military during the 10-year period. Rates reached their lowest point in 2015 – 9.0 seizures per 10,000 p-yrs. •	Annual rates were markedly higher among service members with recent PTSD and TBI diagnoses, and among those with prior seizure diagnoses. Line graph 2: Annual crude incidence rates of seizures by traumatic brain injury (TBI) and recent post-traumatic stress disorder (PTSD) diagnosis among non-deployed active component service members, U.S. Armed Forces •	For service members who had received both TBI and PTSD diagnoses, seizure rates among the deployed and the non-deployed were two and three times the rates among those with only one of those diagnoses, respectively. •	Rates of seizures tended to be higher among service members who were: in the Army or Marine Corps, Female, African American, Younger than age 30, Veterans of no more than one previous deployment, and in the occupations of combat arms, armor, or healthcare Line graph 3: Annual crude incidence rates of seizures diagnosed among service members deployed to Operation Enduring Freedom, Operation Iraqi Freedom, or Operation New Dawn, U.S. Armed Forces, 2008 – 2016  •	A total of 814 cases of seizures were identified during deployment to operations in Iraq and Afghanistan during the 9-year surveillance period (2008 – 2016). •	For deployed service members, the overall incidence rate was 9.1 seizures per 10,000 p-yrs. •	Having either a TBI or recent PTSD diagnosis alone was associated with a 3-to 4-fold increase in the rate of seizures. •	Only 19 cases of seizures were diagnosed among deployed individuals with a recent PTSD diagnosis during the 9-year surveillance period. •	Overall incidence rates among deployed service members were highest for those in the Army, females, those younger than age 25, junior enlisted, and in healthcare occupations. Access the full report in the December 2017 MSMR (Vol. 24, No. 12). Go to www.Health.mil/MSMR

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