The Auriculotherapy Treatment of Post Traumatic Stress Disorder PTSD. – Jim Chalmers

Auriculotherapy Treatment of Post Traumatic Stress Disorder (PTSD)

 

Author  Jim Chalmers BAc FAACMA

 

This article is an updated version of one I presented at the 7th International Symposium of Auriculotherapy held in Lyon France in 2012, and should serve as a general treatment guide for practitioners who encounter patients with PTSD and also  as a warning to be aware of the condition’s covert signs. J. C.

 

One of the lasting legacies of war is the damage inflicted on the bodies and minds of the servicemen and women, as well as others exposed to its brutality. The physical damage is visible and is often addressed, but psychological trauma can remain unseen and silently subvert the survivor’s spirit, manifesting in what may appear to be unrelated pathologies or psychopathies.

Research shows that people with a mixed lateral preference (dyslateral) and those born to left-handed parents tend to experience a higher incidence of PTSD than clearly-lateralised persons (1) . Iraq war veterans with mixed lateral preference also showed higher incidences of PTSD (2). Whilst not all of those diagnosed with PTSD come from this category, the trauma initiating the condition can have, among a series of other symptoms, the consequence of destabilising hemispheric balance and communication. A cascade of other symptoms follows.

There are also undiagnosed trauma patients whose trauma has somatised; the psychological effects manifest as a physical condition. Auriculotherapy gives practitioners an opportunity to address PTSD and undiagnosed trauma by accessing points on the auricle that influence intra-hemispheric communication and on anatomically-specific regions of the brain and body that may be affected.

Definition of PTSD

Post Traumatic Stress Disorder is a normal human response to an extraordinary situation where the survivor has been exposed to a serious traumatic event or series of events outside the range of normal human experience. (3) Classed as an anxiety disorder, it is defined by a person’s response to a serious life-threatening event, to witnessing traumatic death, or by a person’s genuine perception that their own life was in danger, and when their symptoms have persisted for longer than four weeks.

Diagnosis (4)

Medical/psychiatric diagnosis is made on the basis there is an external factor outside the individual that is the cause of the condition and that the survivor has repeatedly experienced a number of disturbing events including –

  1. Persistent arousal. Hyper-vigilance, difficulty falling asleep, irrational outbursts of anger, an exaggerated response to being startled.
  2. Recurring flashbacks recalling and re-experiencing the event. A recurring impulsive feeling the event is happening again.
  3. Nightmares, disturbing dreams.
  4. Severe distress when confronted with situations that may in some way be similar to events that initiated or were evident at the time of the original trauma.
  5. Persistent avoidance of stimuli associated with the trauma. Sights, sounds, smells. Numbing strategies.
  6. DSM1V also requires the survivor to demonstrate a reaction to the trauma, including horror, intense fear and/or helplessness.

Signs and Symptoms

  • Flashbacks – repeatedly re-experiencing the event/s
  • Guilt, denial, anger
  • Grief
  • Panic attacks
  • Dissociation from loved ones
  • Short-term memory loss
  • Hypersensitivity to sudden noises
  • Hyper-arousal
  • Insomnia
  • Alcohol and drug abuse

Physical Symptoms

  • Headaches
  • Gastro-intestinal disorders
  • Vertigo
  • Chest pain
  • Immune system dysfunction
  • Muscle spasm or tension

The experience of trauma sufficient to cause Post Traumatic Stress triggers the body’s flight/fight response. A whole-system reaction begins with the adrenal glands releasing high doses of adrenalin and glucocorticoids, especially cortisol, into the body. One of the consequences of high adrenalin levels is it causes muscle tension that can manifest anywhere in the body; hence the huge range of symptoms that can be associated with PTSD (5). The exaggerated flight-fight response affects the brain’s ability to integrate the situational memory (sensory perception, right hemisphere) with the verbal, rational thought memory (left hemisphere).  This affects intra-hemispheric communication and thus laterality.

Treatment 

  • Pharmaceutical treatment includes – antipsychotic, anxiolytic, antidepressant, analgesics, insomnia (hypnotic), glucocorticoids, antiaggression, beta-blocker, SSRI medications, and (less frequently) opioid receptor antagonists.
  • Referral to psychotherapy and counselling sessions.
  • Cognitive Behaviour Therapy (CBT), Eye Movement Desensitisation and Reprocessing (EMDR) or Emotional Freedom Technique (EFT) may be recommended.

Auriculotherapy/Auriculomedicine Treatment

Auriculotherapy treatment aims to facilitate the integration of right and left hemispheric communication, the processing of past trauma, amelioration of persistent associated symptoms and a return to functional homeostasis.

This protocol requires the use of the VAS, the pulse quality first discovered by Paul Nogier in 1966, to most efficiently address issues of laterality, and to readily locate active points on the auricle.

Whenever possible, the patient should be treated lying down (supine), not seated. The practitioner sits at the head of the treatment table and uses his/her left hand to interpret the VAS response from the radial pulse of the patient’s left hand. This procedure is the ideal approach to allow a quiet, focused and intimate communication between the practitioner and the patient.

Begin by determining handedness by using a questionnaire (for example, the Edinburgh Handedness Inventory), and then use the VAS and the Black/White filter to determine laterality. If dysfunction in laterality is detected, needle Point Zero and Point Zero Prime as appropriate. Sometimes it is necessary to needle both points bilaterally. If there is no dyslaterality detected, confirm by retesting several times then, needle or treat only Point Zero bilaterally.

Point Zero was one of the first Master points Nogier discovered. It influences all points of the ear, establishes homeostasis, and exerts a calming affect on the organism.  Point Zero reflects the anatomical representation of the umbilicus in the ear. Chinese classical texts identify the umbilicus with the acupoint Ren 8 (Shenque), called “the Abode of the Spirit” with indications of “calming the mind and lifting the spirit”.

Point Zero Prime, known as the Master Oscillation point, is indicated in all cases of dyslaterality. It helps re-establish right-left intra-hemispheric communication.

The next most important point to consider is Point R, dominant side first. Treating this point (only when active) allows the patient to re-experience the trauma in a non-confrontational and non-traumatic way, usually in dreams.(8) This allows re-integration of the experience recorded in the situational memory (right hemisphere in a right-handed person) with that of the verbal memory in the left hemisphere.

Further points to consider are point E (Epiphysis) and the Amygdala and Hippocampus points in Phase 1 and Phase 3; also consider the Anterior White Commissure point on the tragus.

Point E (9 ) has an influence on the regulation of sleep and body functions. It may be implicated in Seasonal Affective Disorder (SAD) and hyperactivity disorders. Check all Phases. Treating the Amygdala and Hippocampus points has an influence on these significant regions of the brain affected by PTSD – check for a VAS response for these points on both ears and treat accordingly. Remember to choose only those with the greater number of VAS pulses.

During initial treatment, the practitioner has the option to consider further treatment based on the interpretation of the patient’s signs and circumstances and the immediacy of their need. Other points to consider are, Hypophysis, Cingulate Gyrus, Adrenal, Hypothalamus, and functional points such as the Sympathetic Autonomic Point, Insomnia point, the Tranquil point, Shen Men and the Omega points. Body acupuncture points can be chosen after auriculotherapy treatment, if considered necessary, for example the four gates points for Liver Qi constraint, Liver 3 (Taichong) and Colon 4 (Hegu). I find using the extra point Yintang, traditionally used to calm the spirit, helpful.

Low-level infrared laser set at the appropriate Nogier frequency for the chosen point, can be used instead of needles.

It is essential to explain to patients that in the days following the treatment they may experience periods of intense non-traumatic dreaming which is considered a normal part of the trauma resolution process.

Subsequent treatments follow a similar approach, but practitioners can include further dimensions such as clearing scars and first rib where appropriate.  Other therapeutic priorities evolve with each treatment as the patient recovers. It is incumbent on the physician to adapt treatment to the patient’s needs.

The number of treatments varies with the individual; generally the sooner the treatment is begun after the event, the quicker the recovery. It may be necessary to begin with frequent treatments, maybe twice weekly, moving to weekly and then as appropriate. Acute Stress Syndrome, a condition that differs from PTSD mainly by the length of time that the individual has experienced symptoms, can be addressed in a similar manner.

Concomitant psychological therapy such as Eye Movement Desensitisation and Reprocessing (EMDR) or CognitiveBehavioural Therapy (CBT) will enhance and/or may even be the synergistic essential to facilitate the desired outcomes.(10) The latter therapy (CBT) is better introduced after there has been some improvement in the patient’s dyslaterality.

With the exception of the first two points, Zero and Zero Prime, this protocol is patient specific. Auriculotherapy and auriculomedicine* require individualised treatments to be based on the reflexive feedback information from patients; formulae-based treatments cannot properly accommodate the diverse manifestations of any disorder. Treatment should only be applied by appropriately-trained professionals.

Commentary and Conclusion

Chronic unresolved trauma, which may or may not fit in the DSMIV categorisation of PTSD can seriously disrupt a person’s life, socially, emotionally and physically. More often than not, it will not be the reason for the consultation. This is a reminder to look beyond the initial presenting symptoms for signs of unresolved trauma, especially when there are indications of failure to respond to conventional treatments.

I have taught this protocol to practitioners in Australia, New Zealand, Greece and the United Kingdom. To date results are qualitative and experiential; there are no comparative studies, pre-treatment evaluations, or collation of data to any of the various formal scales (Clinician Administered PTSD Scale [CAPS], Short Screening Scale PTSD for DSM IV etc.), however results are very encouraging. My experience, as well as that of other practitioners using this approach has often shown positive results allowing patients to address and resolve the trauma and move on in life.

PTSD Point Choices.

Some of the following have been mentioned in the above article but are included here in a list of possible point choices for the treatment of PTSD. This list is by no means exhaustive.

Zero Prime and/or Point Zero (bilateral if necessary)*


Point R (bilateral)*

Amygdala (Phase 1 and/or Phase 3)*

Hippocampus (Phase 1 and/or Phase 3)*

Point E*, Insomnia 1 &2*

Valium/Tranquility Point

Shen Men*

Sympathetic Nervous System Point

Aggression*

White Commissure Point

Hypothalamus

Thalamus

Master Omega

Omega 1 and Omega 2

TCM organ/emotion related points –

Kidney, Liver, Gallbladder, Heart, Pericardium, Lung

* These points are frequently required. Select those with the strongest VAS or ED signal, remembering to limit the number of needles in each ear to a minimum. Choose according to clinical presentation.

Fig 86 cc and amygdala  hc x Fig 63 Master mental emotional x

References and Notes

  1. Mixed Lateral Preference and Parental Left-Handedness: Possible Markers of Risk for Ptsd. Journal of Nervous & Mental Disease: May 2003 – Volume 191 – Issue 5 – pp 332-338
  2. Consistent Association Between Mixed Lateral Preference and PTSD: Confirmation Among a National Study of 2490 US Army Vietnam Veteran Psychosomatic Medicine May 1, 2007 69 no. 4 365-
  3. Turnbull, Professor Gordon. Trauma Bantam Press 2011 This part of the definition of PTSD, originating from DSM111 and referred to by Professor Turnbull, is emphasised throughout his book.
  4. DSM IV ‘PTSD Diagnosis’, paraphrased. For a comprehensive description and list of signs and symptoms see the section on PTSD in DSMIV
  5. Turnbull, Professor Gordon. p. 340 Trauma Bantam Press 2011
  6. Neuroimaging Clinics of North America, Volume 17, Issue 4, November 2007, Pages 523-538 Douglas Bremner
  7. Frank Bryan L. M.D. Auricular Medicine and Auriculotherapy, A Practical Approach. P239 Author House 2007
  8. Chalmers J. “Reflections on Point R”. ICAMAR Journal Number 5 March Ed 2012.and www.auriculotherapy.info
  9. Frank, Bryan L. M.D. and Soliman, Nader E. M.D. Auricular Therapy: A Comprehensive Text. P266. Author House 2005
  10. Dr Hammer notes in his book Dragon Rises, Red Bird Flies: Psychology & Chinese Medicine (Eastland Press 2005) that treatment of psycho-emotional disorders using psychotherapy in conjunction with traditional Chinese Acupuncture is far more effective than using either treatment alone.
  11. Turnbull, Professor Gordon. Trauma Bantam Press 2011 (re: work of   Peter Levine and Bessell van der Kolk. p 399) and The Nature of Traumatic Memories: A 4-T fMRI Functional Connectivity Analysis Am J Psychiatry 2004;161:36-44. 1176/appi.ajp.161.1.36

 

Bibliography

  • Nogier Dr. PFM. From Auriculotherapy to Auricular Medicine. (Maionneuve, 1983)
  • Nogier Dr. PFM. Treatise of Auriculotherapy. (Maionneuve, 1972)
  • Nogier Dr. Paul, Nogier. Dr. Raphael. The Man in the Ear. (Maionneuve, 1985)
  • Nogier Raphael M.D. Thieme 2009
  • Frank Bryan M.D. & Soliman Nadir MD. Auriculotherapy A Comprehensive Text. Author House 2005
  • Ackerman J The Biophysics of the VAS, The Phenomenon of Healing, The integration of the VAS techniques with Traditional Western Medical Techniques. (publications du Glem)
  • Bourdiol RJ Elements of Auriculotherapy. (Maionneuve, 1982
  • Symposium proceedings and workshop notes, various authors, 4th and 5th GLEM International Symposiums 2000 and 2006.
  • Dr Rouxeville, Yves translated extract “Cahiers de Biothérapie” June 2003
  • Bouratinos Ilaira, Chris Jarmey, A Practical Guide to Acu-Points. Radom House Inc. 2008.
  • Romoli Marco. Auricular Acupuncture Diagnosis. Churchill Livingstone 2010.
  • Frank Bryan M.D. Auricular Medicine and Auricular Therapy, A Practical Approach. Author House 2007
  • LeBel Marc. Lecture Notes 2006
  • Turnbull Professor Colin. Trauma Bantam Press 2011
  • Maciocia Giovanni. The Psyche in Chinese Medicine. Churchill Livingstone 2009
  • Rossi, Elisa Shen, Psycho-Emotional Aspects of Chinese Medicine. Churchill Livingstone 2007
  • Hammer, Leon. M.D. Dragon Rises, Red Bird Flies: Psychology & Chinese Medicine Eastland Press 2005.

 

Jim Chalmers B.Ac FAACMA. © 2012

 

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